The current status and prospect of endoscopic thyroid operation Yu Wenbin Qilu Hospital of SDU.
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Transcript of The current status and prospect of endoscopic thyroid operation Yu Wenbin Qilu Hospital of SDU.
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The current status and prospect of endoscopic thyroid operation
Yu WenbinQilu Hospital of SDU
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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.
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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.
Current status and Prospect of endoscopic thyroid operation
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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.
Current status and Prospect of endoscopic thyroid operation
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Endoscopic thyroid operation
IS
minimally invasive operation
Current status and Prospect of endoscopic thyroid operation
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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.
Current status and Prospect of endoscopic thyroid operation
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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
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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)
Current status and Prospect of endoscopic thyroid operation
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Indications
Thyroid or parathyroid carcinoma in early stage
Thyroid adenoma
Nodular goiter
Hyperthyroidism less than Ⅱ°
Parathyroid adenoma
Endoscopic thyroidectomy
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Contraindication
Thyroid
malignant
tumor in
late stage
Ⅲ° hyper- thyroidism
and thyroiditis
Giant or multiple nodular goiter (>5 cm)
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Whether the past thyroid operation history is an
contraindication of endoscopic thyroid operation?
Current status and Prospect of endoscopic thyroid operation
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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.
Current status and Prospect of endoscopic thyroid operation
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Endoscopic thyroid operation mode
Endoscopic thyroid adenoma
removal
Endoscopic partial
thyroidectomy
Endoscopic thyroid
carcinoma radical
resection Endoscopic subtotal
thyroidectomy
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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
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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
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Operative approach
Breast Areola Approach
Anterior chest approach
Sternal notch approach
Axillary approach
Subclavian approach
surgical approach
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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
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Breast Areola Approach
Anesthesia and posture
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Establish the operation space
Breast Areola Approach
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Separate the subcutaneous space, up to the hyoid bone, lateral to the medial margin of the sternocleidomastoid muscle.
Breast Areola Approach
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Longitudinal separation of infrahyoid muscles, reveal the thyroid gland and mass.
Breast Areola Approach
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Breast Areola Approach
Removed the mass completely
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The mass was removed in self-made specimen bag.
Breast Areola Approach
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Suture of infrahyoid muscles
Breast Areola Approach
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Place the drainage & close the incision.
Breast Areola Approach
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Reexamination at one month after operation
Breast Areola Approach
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Sternal notch approach
Breast Areola Approach
Anterior chest approach
Sternal notch approach
Axillary approach
Subclavian approach
surgical approach
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Sternal notch approach
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Sternal notch approach
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Breast areola approach
Anterior chest approach
Sternal notch approach
Axillary approach
Subclavian approach
surgical approach
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Axillary approach
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Breast Areola Approach
Anterior chest approach
Sternal notch approach
Axillary approach
Subclavian approach
surgical approach
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Subclavian route
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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
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Advantages and disadvantages of each operation path
Axillary approach
Advantage :The incision is hided tactfully
Disadvantage:
Far away from the lesions;Difficult to operate
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Advantages and disadvantages of each operation path
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
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Advantages and disadvantages of each operation path
Anterior chest approach
Smaller trauma compared to areola approach
Favorable
postoperative
appearance compared
to sternal notch
approach
Common in clinic
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Endoscopic parathyroid operation
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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
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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
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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
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ThanksThanks !!
Current status and Prospect of endoscopic thyroid operation