the current status and prospect of endoscopic thyroid operation yu wenbin qilu hospital of sdu

The current status and prospect of endoscopic thyroid operation

Yu WenbinQilu Hospital of SDU

Current status and Prospect of endoscopic thyroid operation

The neck is the represent of the beauty of human body.

Most of the time, the neck is bare.

The obvious cervical scar after traditional thyroid operation affect the appearance seriously.

With the development of endoscopic surgery, an minimal invasive operation mode emerged which could cure the thyroid tumor, and does not affect the appearance in the same time.


The incision of endoscopic thyroid operation is minimal invasive and is designed skillfully.

The scar is hard to be noticed.The cosmetic results are excellent.


Endoscopic thyroid operation

IS

minimally invasive operation


It is “a giant operation” in terms of the physical injury.

It is “a minimal operation” in terms of the mental injury.

At present, we are inclined to take it as a cosmetic operation.


Since then

August. 2001 Hu Sanyuan

June. 2001 Qiu Ming

Developed gradually

First endoscopic thyroid operation in China

carry out this technique subsequently

1996 Gagner 1997 Huscher

First endoscopic subtotal parathyroidectomyFirst endoscopic thyroid lobectomy

Brief history of endoscopic thyroidectomy

China Biology Medicine disc (CBM)& Chinese Journal Full-text Database

More than 2000 cases on all kinds of endoscopic thyroid operations in china so far

More than 200 papers on endoscopic thyroidectomy were published in our country during 2001-2007

This technique developed better in the area where laparoscopic technology is mature.

•We had completed more than 200 cases endoscopic thyroid operation since our first case from Aug. 2001.（ Qi Lu hospital of Shandong University）


Indications

Thyroid or parathyroid carcinoma in early stage

Thyroid adenoma

Nodular goiter

Hyperthyroidism less than Ⅱ°

Parathyroid adenoma

Endoscopic thyroidectomy

Contraindication

Thyroid

malignant

tumor in

late stage

Ⅲ° hyperthyroidism

and thyroiditis

Giant or multiple nodular goiter (>5 cm)

Whether the past thyroid operation history is an

contraindication of endoscopic thyroid operation?


Aug. 2005,we successfully performed 1 case on endoscopic right lobe subtotal thyroidectomy, in which the patient accepted left lobe thyroidectomy （ traditional operation）） 10 years ago.

With the improvement of the operation level and development of the equipment, past thyroid surgery history is no longer an absolute contraindication.


Endoscopic thyroid operation mode

Endoscopic thyroid adenoma

removal

Endoscopic partial

thyroidectomy

Endoscopic thyroid

carcinoma radical

resection Endoscopic subtotal

thyroidectomy

The method to establish operation space

Advantage:avoid the complications caused by CO2

Disadvantage:scar left on the skin. Operation space not enough.

suspension type

Sling the flap Kirschner wire

CO2insufflation

Advantage ：No scar & better space

Disadvantage ：Hypercapnia,Respirator acidosis,arrhythmia , increased intracranial pressure

Solution: low-pressure perfusion (6-8mmHg), limiting the CO2

perfusion time and use of free gas method to establish the operation space.

The method to establish operation space

Discomfort:

Palpitation

Dizziness,

nausea,

vomiting

Operative approach

Breast Areola Approach

Anterior chest approach

Sternal notch approach

Axillary approach

Subclavian approach

surgical approach

Operative demonstration

Take the Take the Breast Areola ApproachBreast Areola Approach as an example to introduce the as an example to introduce the specific steps of endoscopic thyroid specific steps of endoscopic thyroid operationoperation


Anesthesia and posture

Establish the operation space


Separate the subcutaneous space, up to the hyoid bone, lateral to the medial margin of the sternocleidomastoid muscle.


Longitudinal separation of infrahyoid muscles, reveal the thyroid gland and mass.



Removed the mass completely

The mass was removed in self-made specimen bag.


Suture of infrahyoid muscles


Place the drainage & close the incision.


Reexamination at one month after operation






Axillary approach

Subclavian approach

surgical approach

Breast areola approach



Axillary approach

Subclavian approach

surgical approach

Axillary approach




Axillary approach

Subclavian approach

surgical approach

Subclavian route

Advantages and disadvantages of each operation path

Areola Approach

Advantage ：No scar in the neck;One of the popular Method in clinic

Disadvantage:

Larger trauma


Axillary approach

Advantage ：The incision is hided tactfully

Disadvantage:

Far away from the lesions;Difficult to operate


Sternal notch & subclavian approach

Advantage ：Closer to the lesion;Smaller trauma;Easy for endoscopy-assisted thyroid operations

Disadvantage:Scar is visible in the neck; less cosmetic effect



Smaller trauma compared to areola approach

Favorable

postoperative

appearance compared

to sternal notch

approach

Common in clinic

Endoscopic parathyroid operation

Postoperative complications

11Complications caused by CO2: Subcutaneous emphysema & hypercapnia

22Complications caused by subcutaneous dissection:

Fat liquefaction,errhysis, Chest numbness,ect.

33Injury of parathyroid and nerve: convulsion,hoarseness,cough

The reason for conversion to open surgery

Tumor too large, no enough operative space

Severe ahension with

thyroid carcinoma

Uncontrolled bleeding

during operation

Conversion

to open

decidedly

Safety of the endoscopic thyroid operation

With the improvement of endoscopic

technique and development of equipment,

endoscopic thyroid operation is safe,

effective and feasible.

It will continue to development

ThanksThanks ！！


the current status and prospect of endoscopic thyroid operation yu wenbin qilu hospital of sdu

Documents

traditional thyroid

thyroid tumor

past thyroid operation

minimal operation

cosmetic operation

operation spacesling

giant operation

operation spacediscomfort