RESUMEN
Lymphangioma, soft tissue tumor was originally reported by R. Backer in 1828 and “cystic hygroma” name was first given by Wernker in 1834. It can occur in the head, neck, axilla, cervico-facial regions and below tongue. Although it is well recognized in children, it may present in adulthood. Cystic hygroma neck is traditionally removed via an overlying incision near or over the swelling. The resultant scar can be displeasing to an adult. Various endoscopic approach present in literature for excision are via neck, anterior chest, combined or robotic assisted. We here, are reporting transoral endoscope excision of cystic hygroma via vestibular approach. A 51 year old female with swelling over anterior aspect of neck, trans-illumination positive, diagnosis confirmed on CT neck, of size ~4×4 cm was our case. We decided for transoral endoscopic vestibular approach for excision, first of its kind with no assisted approach. Patient discharged after 3 post-operative days (PODs). There was mild seroma which resolved within a week. Transoral endoscopic excision of cystic hygroma via vestibular approach without any assisted approach can be applied in adult. Various approach present in literature for excision of cystic hygroma are via neck, anterior chest or combined or robotic assisted. Hence this approach can be an excellent choice for adult cystic hygroma patients who desire to avoid a neck incision. Transoral endoscopic excision of cystic hygroma via vestibular approach was successfully performed. Patient was satisfied with good cosmosis. It results in good cosmesis and better dissection. Hence can be a new method of excision of cystic hygroma in adult.
RESUMEN
Thyroidectomy is one of the most common operations performed throughout the world, with solitary thyroid nodules being one of the more common indications for surgery. Though conventional open thyroidectomy is considered extremely safe and remains the treatment of choice, it is associated with an undesirable scar. Endoscopic thyroidectomy has the distinct advantage of limiting external scarring and having better cosmetic results. It moreover is associated with reduced post-operative pain, and enhanced postoperative recovery. Methods: It was a hospital based non randomized prospective descriptive study carried out in department of general surgery at tertiary hospital in which 39 patients with benign thyroid lesions were included on the basis of a predefined inclusion and exclusion criteria. Detailed history, clinical and local examination was done in all the cases. Thyroid function tests, FNAC under ultrasound guidance, indirect laryngoscopy and imaging of thyroid gland was done in all the cases. All patients underwent endoscopic thyroid surgery (Total, near total, subtotal or hemithyroidectomy). Patients were followed up for 6 months after surgery. P value less than 0.05 was taken as statistically significant. Results: Out of 39 studied cases there were 35 males and 4 females with a M:F ratio of 1:8.75. Most common age group was found to be 30-40 years with a mean age of 32 yrs. Average size of thyroid nodule was 3.20 cms and right lobe was predominantly involved (69.23%). Predominant Pathology on FNAC was found to be colloid goiter (71.79%). All patients underwent endoscopic thyroidectomy. Mean duration of surgery was 55 minutes. Most common surgery undertaken was hemithyroidectomy (84.62%) followed by total thyroidectomy (10.16%) and completion total thyroidectomy (5.13%). Average total blood loss was significantly less (36 ml). Mean visual analogue score at 24 and 48 hours post-operatively were 4.14 and 2.85. Mean duration of hospital stay was 3.3 days. Majority of the patients (89.75%) were extremely satisfied with the cosmetic results. Conclusion: Endoscopic thyroidectomy for Benign thyroid lesion is associated with less blood loss during surgery, comparatively less severe pain, decreased mean duration of hospital stay and satisfactory cosmetic results.