Working space establishment with Miccoli's approach: spatial characteristics of the cavity created by a working space marker / 中华内分泌外科杂志

ABSTRACT

Objective To comprehend spatial characteristics of the cavity created by a working space market.Methods 40 patients were successively operated according to the surgJical mode of minimally invasive video-assisted thyroidectomy from Jan.2010 to Aug.2010.Instead of hand-retraction.a mechanical arm-working space marker type I(WSM-I(R)，MIEO Medinstr Co.Ltd，China)，was applied to establish a working space.After the pathway making，a cavity above the gland was created and adjusted properly by the space maker，and then，endoscopic view was built and manipulation in the cavity was progressed throughout the later process.Geometric measurement of the cavity were performed at abasic space positionjust after the initial cavitation，and parameters such as length，width and height of the cavity were measured with a specifically scale-marked puncture needle(MC1820，Bard4(R)Max·Cor(R)Instrument)through mini-holes lay in the lifting hook(φ4mm，middle point and distant point).Results13 cases received a lobectomy and isthmectomy.The other 27 cases received a partial thyroidectomy.Dimensional parameters were calculated as below.①The basic length of cavity button was(4.35±0.39)cm.The basic width of cavity button(distance at central point)was(4.66±0.53)cm.The basic central height of cavity was( 1.36±0.34)cm.The maximal central height archived by readjusting was(1.66±0.32)cm and a height increase of0.3 cm can be achieved(22.1％).②The basic peripheral height was(0.98±0.29)cm.The maximal peripheral height archived by readjusting directionally was(1.33±0.14)cm and a height increase of 0.35 cm can be achieved(35.7％).③Statistic analysis yielded a negative correlation between the cavity volume and the size of the nodule.Conclusions The working space created by WSM-I appears to be an laigh and irregular trapezoid stock with oblique roof formed by lifting hook.Although vertical height，especially the peripheral height，is a major restrictive dimension，the cavity can still be usable and enough for factual observation and manipulation，due tocompensating effectof endoscope，finite space requirement of harmonica anddirectional volume shiftingof WSM.