The current status and prospect of endoscopic thyroid operation

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The current status and prospect of endoscopic
thyroid operation

• Yu Wenbin
• Qilu 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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Current status and Prospect of endoscopic thyroid
operation

• 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.

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Current status and Prospect of endoscopic thyroid
operation

• 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.

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Current status and Prospect of endoscopic thyroid
operation
Endoscopic thyroid operation
IS minimally invasive
operation
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Current status and Prospect of endoscopic thyroid
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.

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Brief history of endoscopic thyroidectomy
Developed gradually
carry out this technique subsequently
First endoscopic thyroid operation in China
First endoscopic thyroid lobectomy
1997 Huscher
1996 Gagner
First endoscopic subtotal parathyroidectomy
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Current status and Prospect of endoscopic thyroid
operation

• 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)

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Indications
Thyroid adenoma
Thyroid or parathyroid carcinoma in early stage
Nodular goiter
Endoscopic thyroidectomy
Hyperthyroidism less than ?
Parathyroid adenoma
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Contraindication
Thyroid malignant tumor in late stage
? hyper- thyroidism and thyroiditis
Giant or multiple nodular goiter (gt5 cm)
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Current status and Prospect of endoscopic thyroid
operation
Whether the past thyroid operation history is an
contraindication of endoscopic thyroid operation?
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Current status and Prospect 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.

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Endoscopic thyroid operation mode
Endoscopic thyroid adenoma removal
Endoscopic thyroid carcinoma radical resection
Endoscopic partial thyroidectomy
Endoscopic subtotal thyroidectomy
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The method to establish operation space
Sling the flap  Kirschner wire
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The method to establish operation space
Discomfort Palpitation Dizziness,  nausea,  vomi
ting

• Solution low-pressure perfusion (6-8mmHg),
  limiting the CO2 perfusion time and use of free
  gas method to establish the operation space.

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Operative approach
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Operative demonstration
Take the Breast Areola Approach as an example to
introduce the specific steps of endoscopic
thyroid operation
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Breast Areola Approach
Anesthesia and posture
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Breast Areola Approach
Establish the operation space
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Breast Areola Approach
Separate the subcutaneous space, up to the hyoid
bone, lateral to the medial margin of the
sternocleidomastoid muscle.
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Breast Areola Approach
Longitudinal separation of infrahyoid muscles,
reveal the thyroid gland and mass.
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Breast Areola Approach

• Removed the mass completely

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Breast Areola Approach

• The mass was removed in self-made specimen bag.

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Breast Areola Approach

• Suture of infrahyoid muscles

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Breast Areola Approach

• Place the drainage close the incision.

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Breast Areola Approach
Reexamination at one month after operation
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Sternal notch approach
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Sternal notch approach
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Sternal notch approach
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Axillary approach
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Subclavian route
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Advantages and disadvantages of each operation
path
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Advantages and disadvantages of each operation
path
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Advantages and disadvantages of each operation
path
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Advantages and disadvantages of each operation
path

• Favorable postoperative appearance compared to
  sternal notch approach

Common in clinic
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Endoscopic parathyroid operation
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Postoperative complications
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The reason for conversion to open surgery
Tumor too large, no enough operative space
Conversion to open decidedly
Severe ahension with thyroid carcinoma
Uncontrolled bleeding during operation
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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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Current status and Prospect of endoscopic thyroid
operation

• Thanks!