Endoscopic neck surgery by the axillary approach... Report 45 cases of Lobectomy & Isthmusectomy.[r]
(1)Thai – Vietnam Laparoscopic - Endoscopic Surgery for ASEAN People 4 – March 2014, at Bach-Mai Hospital Vietnam
(2)BACH MAI HOSPITAL
SOCIALIST REPUBLIC OF VIETNAM
(3)Retrosternal Thyroid
Thyroid gland in neck
Thyroid gland in retrosterenal
Neck incision
Sternal splitting incision
CURRENT STATUS OF
(4)Gagner M , et al
Br J Surg 1996 ;83:875
Endoscopic subtotal parathyroidectomy in patients with hyperparathyroidism
Ikeda Y , et al
J Am Coll Surg2000;191:336-40
(5)Report 45 cases of Lobectomy & Isthmusectomy
Port placements &
Approaches
of the Common Techniques
1.CERVICAL APPROACH
(6)1.CERVICAL APPROACH
Yeung GH, Wong HW, Asian J Surg 2003 : 26 : , 133-8
(7)(Miccoli’s Technique)
Prof Quan-Yang Duh, U of California, San Francisco
CERVICAL APPROACH
(8)2.EXTRA - CERVICAL APPROACH
ANTERIOR CHEST & BREAST APPROACHS
(9)PURE AXILLARY APPROACH
Yeung GH, Wong HW, Asian J Surg 2003 : 26 : , 133-8
3 Ports
4 Ports
(10)COMBINE AXILLARY APPROACH
(11)n n
World J Surg (2008) 32:1325–1332
1 Total Video - Endoscopic
Thyroidectomy
( CO2 insufflation )
Minimally Invasive Video - Assisted Thyroidectomy ( MIVAT )
( Gasless technique )
(12)Rajavithi’s Gas Technique
Lang BHH, The Hong Kong Medical Diary; 14 : 7: 2009 9-11
(13)Rajavithi’s Gasless Technique
(14)surgeon Assist Assist 2 Anesth Nurse LCD display O.R Layout
Position & Incision
Right Axilla Approach
Left Axilla Approach Bilateral Axilla Approach
(15)90º
120º
Regular Rigid laparoscope
( mm or 10 mm / 0o or 30o )
0o
(16)Flexible laparoscope
( 10 mm or mm )
(17)Ultrasonically activated scapel
(18)Right Lobectomy : Axillary Approach
(19)Immediate Post-op
First Day Post-op
(20)First Week Post-op after Lobectomy
First Week Post-op after
(21)Rajavithi Hospital Experience
(April 2001 – Feb 2014)
TECHNIQUES n ( cases )
1 4-Ports Technique :
- Lobectomy & isthmusectomy 809 - Lobectomy & subtotal lobectomy 25
-Total Thyroidectomy 23
2 Single Incision / Single Port Technique :
2.1 Closed Technique ( Gas ) :
- Lobectomy & isthmusectomy 11 2.2 Gasless Technique :
- Lobectomy & isthmusectomy 6
Total 874
FUTURE DIRECTIONS OF
(22)Approaches:
- Both Cervical & Extracervical Ports - Single Incision & Single Port
Indications:
- Include benign, Grave’s and malignant diseases
- Usage for Neck node dissection
Robotic Neck Surgery:
- Mostly from Korea
Future Directions :
(23)4 Jul 2011
Hartley-Dunhill’s Operation for “Grave’s Disease” (Rt Lobectomy & Lt Subtotal Lobectomy)
Total Thyroidectomy for “Grave’s Disease”
(24)(25)Single Incision/Port
5 mm
(26)5 mm
Asian J Surg 2003
1 PORT AXILLARY APPROACH
Glove Port
RIGHT Lobectomy : Single Incision
(27)RIGHT Lobectomy : Single Incision
Gasless Technique
Single Incision Technique
(28)After surgery 1 week
1 year
Single Incision Technique
(29)(30)NOTES Thyroidectomy
Endoscopic minimally invasive thyroidectomy(eMIT): a prospective proof-of-concept study in humans
NOTES thyroidectomy eliminates the skin incision total thyroidectomy
partial thyroidectomy
Procedures : 10-mm, sublingual mucosal incisions
• converted to standard open approach, • developed RLN injury ( permanent), • had transient mental nerve injury
Conclusion: This proof-of-concept study
demonstrated the feasibility of pure NOTES thyroidectomy
(31)(32)• What ever the technique or approach
SUMMARY
• What ever the technique or approach • The first thing to concern is
(33)• What ever the technique or approach • The first thing to concern is
the benefit of our patients
• As a surgeons, we should offer the
“safe and effective surgery” to our patient
SUMMARY
• What ever the technique or approach • The first thing to concern is
the benefit of our patients
• As a surgeons, we should offer the
“safe and effective surgery” to our patient
• Depend on our knowledges and skills
(34)THANK YOU FOR