CC BY
10
26
Вестник хирургии Казахстана №3, 2014
УДК 616-43
Video-assisted thyroid resection for nodular goiter.
ArzykulovZh.A., Zhuraev Sh. Sh., ShokebayevA.A., Imammyrzayev N.E., Lee A.I., AlievA.K. A.N. Syzganov,s National scientific center of surgery, Almaty, Kazakhstan
Background. The aim of our study was to improve results of surgical treatment for patients with nodular goiter. And also we evaluated cosmetic effect, intraoperative and postoperative complications, such as bleeding, pain and length of hospital stay.
Materials and methods.Video-assisted thyroid resection technology was invaded in our center in cooperation with Japanese colleagues in 2013. Between April 2013 and August 2014, 6 patients (5 female and 1 male; mean age 32 years) with nodular goiter underwent videoassisted subtotal or near-total tyroidectomy. The present study focused on six of these patients with nodular goiter. generally carried out in relatively young patients (mean age 32 years), while a conventional (sub) thyroidectomy performed in elderly men (mean age 40 years).Treatment outcome was evaluated, including surgical complications, quality of life and patient satisfaction with the surgical result.
Results. All patients were operated on using a videoassisted technique, with some modifications depending on time and experience. There were no conversions to open surgery. All patients were satisfied with the surgical results, particularly regarding the placement of the surgical scars.
Conclusion. Video assisted thyroidectomy is an alternative to traditional intervention can be performed in clinical practice for thyroid nodules in an adequate amount with observance of all safety regulations
Introduction
Video-assisted thyroid surgery, equal in the effectiveness to traditional operations, so the development and implementation in practice is one of the main challenges of modern surgery. Prospects of this direction is based on the lesser traumatic video assisted thyroidectomy, a small amount of complications in their conduct, of high social and cosmetic significance.
Endosurgery progress, without which it is difficult to submit now an efficient and effective work of doctors of many specialties, will significantly expand the range of different minimally invasive procedures, including in surgical diseases of the thyroid gland (1). The direction of endoscopic surgery of the thyroid gland has good prospects for development, as evidenced by the accumulating data on the results of such operations. However, the surgery of the thyroid gland, these innovations have come is slowly. Particularly, patients pay much attention to aspects of cosmetic surgery, namely state of the scar. In the world literature there are publications dedicated to fulfillment video-assisted thyroid surgery.
When studying draws attention that not completely determined the criteria of patient selection, indications and contraindications for such operations, are not selected optimal approaches for and ways of formation the operating cavity is not perfect surgical technique for performing these procedures.
This opens up new possibilities for performing video assisted surgery on the organs of the neck. In our country,
minimally invasive surgery of the thyroid and parathyroid gland is not well developed, while many foreign clinics have already experience of endoscopic surgery in the neck. With regards to relevance, in general, thyroid disorders are widespread in Kazakhstan as well as observed increase in the number of diagnosed cancers, often develop on the background of goiter [2]. In various countries of thyroid nodular lesion is a common disease and occurs in 4-6% of the adult population [3,4]. The risk of developing cancer of the thyroid gland is significantly higher in the female population. So, at the age of 30-39 years old women get sick to 7 times more often than men. In 2006, women accounted for 86.3% of all patients with identified malignant tumors of the thyroid gland. Maximum incidence in the age group 50-59 years [5]. It should be noted that 20% of patients underwent surgical treatment about the the alleged benign nodular thyroid disease after morphological examination revealed nodular malignant pathology [6].
Patients and methods
Video-assisted thyroid resection technology was invaded in our center in cooperation with Japanese colleagues in 2013. Between April 2013 and August 2014, 6 patients (5 female and 1 male; mean age 32 years) with nodular goiter underwent videoassisted subtotal or near-total tyroidectomy. The present study focused on six of these patients with nodular goiter. generally carried out in relatively young patients (mean age 32 years), while a conventional (sub) thyroidectomy performed in elderly men (mean age 40 years).Treatment outcome was evaluated, including surgical complications, quality of life and patient satisfaction with the surgical result.
To use this method, we identified indications:
1) The maximum size of the nodule 35 mm;
2) The absence of ultrasound increased cervical lymph nodes;
3) No surgery on the neck in history.
For the implementation and development of endoscopic thyroid surgery to use all the advantages of the method. In favor of the method demonstrates gasless publications [7] on the removal of the thyroid gland. The authors draw attention to the ease of identification and visualization of the recurrent laryngeal nerve and parathyroid glands, so that they are saved during the operation.
Operations was performed without gas fired manner under endotracheal anesthesia. To provide optimum accessibility to the thyroid gland used the patient's position on the back without the roller. The head is slightly tilted backwards. Regarding the patient's surgeon is on the side of the alleged interference. Assistants are located on the opposite side of the surgeon. Rack with video endoscopic equipment is located at the head of the patient. The surgical incision is made parallel to the clavicle below the 2.0 cm to 3.0 cm in length set tread wounds and two cuts at 0.7 cm below the left clavicle for video ports.
Working space created by the lift at tools were used for open surgery, video surveillance and gasless way to, an
Журнал Национального научного центра хирургии им. А.Н. Сызганова
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ultrasonic a scalpel. The operation was carried out under video control using a 30 ° 5-mm endoscope and retractor. Second an assistant manipulates the endoscope. Slicing through skin and subcutaneous tissue, subcutaneous neck muscle. Further, by dissection with endoscopic instruments, bipolar forceps or ultrasonic scalpel, endoscopic retractor with a light guide created space (operating cavity) for the operation of mechanical traction (lifting) tissues up. The next stage begins mobilizing thyroid isthmus, mobilized and separated from the trachea as in conventional surgery. Special attention was given visualization of the recurrent laryngeal nerve and parathyroid glands during the mobilization of the thyroid gland. After mobilization upper and lower thyroid arteries, which intersect with the use of a harmonic scalpel. Only after assurance that the laryngeal nerve and parathyroid glands are not damaged, extrafascial
hemistrumectomy performed with the removal of the isthmus. After revision the recurrent laryngeal nerve of the operation is finished.
Results
Small access is not allow sufficient orientate in the wound, but the use of endovideosystem allows you to clearly visualize and control all the action on the screen, smaller structures during the operation, including the parathyroid glands, blood vessels and recurrent laryngeal nerve. Drains were not used. Skin incision was sutured cosmetic seam. The operative time was 100 minutes, this is due to the development of techniques. In a comparative analysis with traditional intervention on the thyroid gland had lower intraoperative blood loss greater duration of surgery. As the authors point to the accumulation of experience in endoscopic thyroid surgery observed reduction in the duration of surgery [8].
The postoperative period was uneventful, the patient noted satisfying cosmetic result. Length of hospital stay after surgery was 4 bed day
The prospects of the method are evident video assisted thyroidectomy has obvious advantages:
• incision video assisted thyroid surgery is not done in a traditional place, the length of the cut is 30% less than traditional surgery, which improves the cosmetic effect
• methods allows not cross the neck muscles, which reduces swelling, pain, trauma operations and improves wound healing in the postoperative period;
• dangerous structures of the neck recurrent laryngeal nerve", the parathyroid gland, the thyroid gland the vessels are allocated under microscopic magnification, which makes the operation safer;
• Reduce contact with wounds the environment during endoscopic operations and work in a dry field reduces the risk of infectious complications;
• Use of a harmonious scalpel, jewelry isolation and crossing vessels without ligatures makes the procedure "bloodless".
Conclusions
Result of our intervention, and numerous publications by foreign authors testify that the video assisted thyroidectomy is an alternative to traditional intervention can be performed in clinical practice for thyroid nodules in an adequate amount with observance of all safety regulations. For patients is more comfortable, less traumatic and minimally invasive, reducing the duration of hospital treatment, the timing of disability and, most importantly, is conjugate to minimal complications and provide a favorable cosmetic effect. We necessary consider the introduction and development of the method.
References
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12. 4. Video-assisted thyroidectomy for papillary thyroid carcinoma R. Bellantone,1 C. P. Lombardi,1 M. Raffaelli,1 P. F. Alesina,1 C. De Crea,1 E. Traini,1 M. Salvatori Division of Endocrine Surgery, Department of Surgery, Universita' Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy Received: 10 October 2002/Accepted: 21 March 2003/Online publication: 21 July 2003
