Different surgical approaches of endoscopic thyroidectomy for patients with separation of flap size,complications and the corresponding damage / 局解手术学杂志

Objective To explore the effect of trans-axillary single-port and bilateral breast of ipsilateral axillary approach in endoscopic thyroidectomy on area of skin flap ,complications and the corresponding impact damage .Methods A total of 72 patients who were underwent either BBIAA or TASPET in our hospital from February 2013 to April 2015,were divided into BBIAA group and TASPET group ,each group had 36 cases.The area of skin flap ,complications and the corresponding impact damage between two surgical methods were compared .Results The average separation of the flap area in TASPET group was significantly higher than that in BBIAA group (P<0.01).The VAS score of BBIAA group was (0.24 ±0.39) point,which was lower than (1.85 ±1.37)point of TASPET group,the difference was significant(P<0. 01 ) .The patients of BBIAA group had no complications ,while there were 10 patients suffered complications in TASPET group ,and the differ-ence of postoperative complications was significant (P<0.01).Conclusion Bilateral breast and ipsilateral axillary approach have the advan-tage of less operative time ,smaller separation of the flap area ,lower complication incidence and less damage on parathyroid gland and nerve , which had an ideal safety and cosmetic result .

Comparison of robotic thyroidectomy through the trans-axillary and the anterior chest approach in a por-cine model / 中华内分泌外科杂志

Objective To evaluate the safety of the da Vinci Si surgical system in thyroid surgery and to accumulate operation experience .Methods The da Vinci Si surgical system consists of a surgeon's console, a patient-side robotic cart, and high-definition 3D vision system.The robot arm tips were introduced via a single axillary incision or small chest wall ports and attached to the arms of the robot .The surgeon , sitting at the con-sole, manipulated the EndoWrist instruments and endoscope view that transfer the surgeon 's movements to the arm tips.The so called EndoWrist'technology offers seven degrees of movements ( up, down, left, right, twist, et al) , thus exceeding the capacity of a surgeon's hand in open surgery .The da Vinci Si surgical system was used to perform thyroidectomy in two small pigs .The animals were intubated and kept anesthetized with halothane .Re-sults Four surgical procedures were done using the da Vinci Si system from beginning to the end , including 2 thyroidectomies and 2 thymectomies .No conversions to open or laparoscopic procedure was used .The procedure length was 61 minutes and 50 minutes, respectively.Conclusions Robotic thyroidectomy can be performed safe-ly by the experienced surgeons after short-term da Vinci Si surgical system training .The learning curve for robotic thyroidectomy is shorter .

Gasless Transaxillary Robot-Assisted Neck Dissection: A Preclinical Feasibility Study in Four Cadavers

PURPOSE: We hypothesized that comprehensive neck dissection could be achieved via a gasless transaxillary approach using a robotic system. We intended to evaluate the accessibility of level I, IIB and VA nodes with transaxillary robot-assisted neck dissection of four cadavers. MATERIALS AND METHODS: Transaxillary robotic neck dissection was performed in four cadavers through a 7-cm longitudinal incision at the anterior axilla and a 0.8-cm-sized incision in the chest wall. RESULTS: We successfully performed neck dissection from level II to V in all four cadavers. However, dissection of levels IIB and VA, which lie on the cephalic portion of the spinal accessory nerve, was difficult. Vital structures, including the internal jugular vein, carotid artery, vagus nerve, phrenic nerve, superior thyroid artery and hypoglossal nerve, were successfully identified and preserved. CONCLUSION: Our results demonstrate the feasibility of robot-assisted neck dissection using a transaxillary approach. We suggest that gasless, transaxillary robotic neck dissection is a promising technique for treating nodal metastasis in thyroid cancers or in selected squamous cell carcinomas of the head and neck. However, some modification of the approach might be needed when performing comprehensive neck dissections of all levels of the neck.

Gasless Endoscopic Thyroidectomy using the Trans-axillary Approach: Surgical Outcomes of 634 Patients / 대한내분비외과학회지

PURPOSE: Various techniques of minimally invasive thyroid surgery have been introduced during the past decade, including the endoscopic technique. We have developed a novel method of gasless endoscopic thyroidectomy via an axillary approach. The present report describes the technique of this method and the analysis of the surgical outcomes. METHODS: Between Dec. 2001 and Feb. 2008 (the actual operation period was 55 months), 634 patients with thyroid tumors underwent gasless endoscopic thyroidectomy via an axillary approach. The clinical and pathologic characteristics of the patients, the type of operation, the operative time, the post operative hospital stay and the post operative complications were retrospectively analyzed. RESULTS: Among the 634 patients, 176 patients had benign tumor and 458 patients had malignant tumor. The type of operationwas classified according to the extent of surgery. Lymphadenectomy (CCND, SND, MRND) was respectively performed for treating the patients with malignant tumor, depending on the indications. The mean operating time and the mean length of the post-operative hospital stay were 129.4±51.3 minutes, 3.3±1.7 days for benign tumor and 135.5±47 minutes, 3.4±0.9 days for malignancy, respectively. The mean tumor size was 2.7±1.2 (0.4~6.0) cm for benign tumor and 0.78±0.5 (0.1~4.0) cm for malignancy. Central compartment lymph node metastasis was found in 117 (25.6%) patients and lateral neck lymph node metastasis was found in 14 (3.0%) patients. There was no conversion to open thyroidectomy. As for the post-operative complications, transient hypocalcemia occurred in 19 patients, transient hoarseness was noted in 13 patients and permanent vocal cord palsy occurred in 2 patients. For the TNM stage, 406 (88.6%) patients were stage I, 51 (11.2%) patients were stage III and 1 (0.2%) patient was stage IVA. CONCLUSION: According to our experience, gasless endoscopic thyroidectomy using a trans-axillary approach is a feasible and safe method. Endoscopic thyroid surgery has become a new treatment modality for selected patients with benign tumors and it can be an effective treatment for selected patients who suffer with thyroid cancer.