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Endoscopic thyroidectomy: Our technique.

Puntambekar SP, Palep RJ, Patil AM, Rayate NV, Joshi SN, Agarwal GA, Joshi M - J Minim Access Surg (2007)

Bottom Line: All thyroidectomies were completed successfully.It is a safe and effective technique in the hands of an appropriately trained surgeon.The patients get a cosmetic benefit without any morbidity.

View Article: PubMed Central - PubMed

Affiliation: Galaxy Laparoscopy Institute, 25-A, Karve Road, Near Garware College, Pune - 411 004, India.

ABSTRACT

Unlabelled: Minimally invasive surgery is widely employed for the treatment of thyroid diseases. Several minimal access approaches to the thyroid gland have been described. The commonly performed surgeries have been endoscopic lobectomies. We have performed endoscopic total thyroidectomy by the anterior chest wall approach. In this study, we have described our technique and evaluated the feasibility and efficacy of this procedure.

Materials and methods: From June 2005 to August 2006, 15 cases of endoscopic thyroidectomy were done at our institute. Five patients were male and 10 were female. Mean age was 45 years. (Range 23 to 71 years). Four patients had multinodular goiter and underwent near-total thyroidectomy; four patients had follicular adenoma and underwent hemithyroidectomy. Out of the seven patients of papillary carcinoma, four were low-risk and so a hemithyroidectomy was performed while three patients in the high risk group underwent total thyroidectomy. A detailed description of the surgical technique is provided.

Results: The mean nodule size was 48 mm (range 20-80 mm) and the mean operating time was 85 min (range 60-120 min). In all cases, the recurrent laryngeal nerve was identified and preserved intact, the superior and inferior parathyroids were also identified in all patients. No patients required conversion to an open cervicotomy. All patients were discharged the day after surgery. All thyroidectomies were completed successfully. No recurrent laryngeal nerve palsies or postoperative tetany occurred. The postoperative course was significantly less painful and all patients were satisfied with the cosmetic results.

Conclusions: It is possible to remove large nodules and perform as well as total thyroidectomies using our endoscopic approach. It is a safe and effective technique in the hands of an appropriately trained surgeon. The patients get a cosmetic benefit without any morbidity.

No MeSH data available.


Related in: MedlinePlus

Creating a subplatysmal palne
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Figure 0002: Creating a subplatysmal palne

Mentions: The procedure was performed with the patient in a supine position under general anesthesia with endotracheal intubation. The neck was extended and the chin was in the midline. A 10 mm skin incision was made on the chest over the sternum about 10 cm from suprasternal notch so as to be covered by the patient's clothes postoperatively [Figure 1]. A long hemostat was inserted through this incision in the subcutaneous plane above the sternum advancing forwards towards the subplatysmal plane as shown in Figure. A 10 mm trocar and cannula was then inserted through this incision. Pneumoinsufflation with carbon dioxide (CO2) was begun under endoscopic vision till a continuous pressure of 8 to 10 mmHg was maintained. The gas not only opens up the subplatysmal plane and maintains the operative space, but also may decrease the effect of any minor bleeds [Figure 2].


Endoscopic thyroidectomy: Our technique.

Puntambekar SP, Palep RJ, Patil AM, Rayate NV, Joshi SN, Agarwal GA, Joshi M - J Minim Access Surg (2007)

Creating a subplatysmal palne
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2749190&req=5

Figure 0002: Creating a subplatysmal palne
Mentions: The procedure was performed with the patient in a supine position under general anesthesia with endotracheal intubation. The neck was extended and the chin was in the midline. A 10 mm skin incision was made on the chest over the sternum about 10 cm from suprasternal notch so as to be covered by the patient's clothes postoperatively [Figure 1]. A long hemostat was inserted through this incision in the subcutaneous plane above the sternum advancing forwards towards the subplatysmal plane as shown in Figure. A 10 mm trocar and cannula was then inserted through this incision. Pneumoinsufflation with carbon dioxide (CO2) was begun under endoscopic vision till a continuous pressure of 8 to 10 mmHg was maintained. The gas not only opens up the subplatysmal plane and maintains the operative space, but also may decrease the effect of any minor bleeds [Figure 2].

Bottom Line: All thyroidectomies were completed successfully.It is a safe and effective technique in the hands of an appropriately trained surgeon.The patients get a cosmetic benefit without any morbidity.

View Article: PubMed Central - PubMed

Affiliation: Galaxy Laparoscopy Institute, 25-A, Karve Road, Near Garware College, Pune - 411 004, India.

ABSTRACT

Unlabelled: Minimally invasive surgery is widely employed for the treatment of thyroid diseases. Several minimal access approaches to the thyroid gland have been described. The commonly performed surgeries have been endoscopic lobectomies. We have performed endoscopic total thyroidectomy by the anterior chest wall approach. In this study, we have described our technique and evaluated the feasibility and efficacy of this procedure.

Materials and methods: From June 2005 to August 2006, 15 cases of endoscopic thyroidectomy were done at our institute. Five patients were male and 10 were female. Mean age was 45 years. (Range 23 to 71 years). Four patients had multinodular goiter and underwent near-total thyroidectomy; four patients had follicular adenoma and underwent hemithyroidectomy. Out of the seven patients of papillary carcinoma, four were low-risk and so a hemithyroidectomy was performed while three patients in the high risk group underwent total thyroidectomy. A detailed description of the surgical technique is provided.

Results: The mean nodule size was 48 mm (range 20-80 mm) and the mean operating time was 85 min (range 60-120 min). In all cases, the recurrent laryngeal nerve was identified and preserved intact, the superior and inferior parathyroids were also identified in all patients. No patients required conversion to an open cervicotomy. All patients were discharged the day after surgery. All thyroidectomies were completed successfully. No recurrent laryngeal nerve palsies or postoperative tetany occurred. The postoperative course was significantly less painful and all patients were satisfied with the cosmetic results.

Conclusions: It is possible to remove large nodules and perform as well as total thyroidectomies using our endoscopic approach. It is a safe and effective technique in the hands of an appropriately trained surgeon. The patients get a cosmetic benefit without any morbidity.

No MeSH data available.


Related in: MedlinePlus