Name: gasless endoscopic thyroidectomy via the trans-axillary approach
Uploaded: 2023-09-15T13:00:00
Description: Watch this Scientific Journal Video about Gasless Endoscopic Thyroidectomy via the Trans-Axillary Approach at JoVE.com

这项研究是严格按照《赫尔辛基宣言》中概述的伦理原则进行的，并遵守了我们机构人类研究伦理委员会制定的指导方针。该研究方案经过全面审查，获得四川大学华西医院伦理委员会批准。所有参与研究的患者在参与研究之前都提供了书面知情同意书，并在整个研究过程中采取了严格的措施来确保其数据的隐私和机密性。本研究纳入良性甲状腺结节、滤泡性肿瘤或状微癌患者，肿瘤大小小于 2 c...

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Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gasless+endoscopic+thyroidectomy+via+an+axillary+approach:+experience+of+30+cases.">Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases.</a> Surg Laparosc Endosc Percutan Tech. 16 (4), 226-231 (2006).</li><li>Song, C. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Postoperative+pain+after+robotic+thyroidectomy+by+a+gasless+unilateral+axillo-breast+or+axillary+approach.">Postoperative pain after robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach.</a> Surg Laparosc Endosc Percutan Tech. 25 (6), 478-482 (2015).</li><li>Ji, Y. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+cosmetic+outcomes+after+robotic/endoscopic+thyroidectomy+by+a+gasless+unilateral+axillo-breast+or+axillary+approach.">Long-term cosmetic outcomes after robotic/endoscopic thyroidectomy by a gasless unilateral axillo-breast or axillary approach.</a> J Laparoendosc Adv Surg Tech A. 24 (4), 248-253 (2014).</li><li>Tan, C. T., Cheah, W. K., Delbridge, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=#34;Scarless&amp;#34;+(in+the+neck)+endoscopic+thyroidectomy+(SET):+an+evidence-based+review+of+published+techniques.">#34;Scarless&amp;#34; (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques.</a> World J Surg. 32 (7), 1349-1357 (2008).</li><li>Tae, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Initial+experience+with+a+gasless+unilateral+axillo-breast+or+axillary+approach+endoscopic+thyroidectomy+for+papillary+thyroid+microcarcinoma:+comparison+with+conventional+open+thyroidectomy.">Initial experience with a gasless unilateral axillo-breast or axillary approach endoscopic thyroidectomy for papillary thyroid microcarcinoma: comparison with conventional open thyroidectomy.</a> Surg Laparosc Endosc Percutan Tech. 21 (3), 162-169 (2011).</li><li>Aidan, P., Bechara, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gasless+trans-axillary+robotic+thyroidectomy:+the+introduction+and+principle.">Gasless trans-axillary robotic thyroidectomy: the introduction and principle.</a> Gland Surg. 6 (3), 229-235 (2017).</li><li>Hakim Darail, N. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gasless+transaxillary+endoscopic+thyroidectomy:+a+decade+on.">Gasless transaxillary endoscopic thyroidectomy: a decade on.</a> Surg Laparosc Endosc Percutan Tech. 24 (6), e211-e215 (2014).</li><li>Wei, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Autotransplantation+of+Inferior+Parathyroid+glands+during+central+neck+dissection+for+papillary+thyroid+carcinoma:+a+retrospective+cohort+study.">Autotransplantation of Inferior Parathyroid glands during central neck dissection for papillary thyroid carcinoma: a retrospective cohort study.</a> Int J Surg. 12 (12), 1286-1290 (2014).</li><li>Naytah, M., Ibrahim, I., da Silva, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Importance+of+incorporating+intraoperative+neuromonitoring+of+the+external+branch+of+the+superior+laryngeal+nerve+in+thyroidectomy:+A+review+and+meta-analysis+study.">Importance of incorporating intraoperative neuromonitoring of the external branch of the superior laryngeal nerve in thyroidectomy: A review and meta-analysis study.</a> Head Neck. 41 (6), 2034-2041 (2019).</li><li>Kim, E. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Single-incision,+gasless,+endoscopic+trans-axillary+total+thyroidectomy:+a+feasible+and+oncologic+safe+surgery+in+patients+with+papillary+thyroid+carcinoma.">Single-incision, gasless, endoscopic trans-axillary total thyroidectomy: a feasible and oncologic safe surgery in patients with papillary thyroid carcinoma.</a> J Laparoendosc Adv Surg Tech A. 27 (11), 1158-1164 (2017).</li><li>Wang, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modification+and+application+of+&amp;#34;zero-line+&amp;#34;+incision+design+in+total+endoscopic+gasless+unilateral+axillary+approach+thyroidectomy:+A+preliminary+report.">Modification and application of &amp;#34;zero-line &amp;#34; incision design in total endoscopic gasless unilateral axillary approach thyroidectomy: A preliminary report.</a> Front Surg. 10, 1121292 (2023).</li><li>Dhoomun, D. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+health-related+quality+of+life+and+cosmetic+outcome+between+traditional+gasless+trans-axillary+endoscopic+thyroidectomy+and+modified+gasless+trans-axillary+endoscopic+thyroidectomy+for+patients+with+papillary+thyroid+microcarcinoma.">Comparison of health-related quality of life and cosmetic outcome between traditional gasless trans-axillary endoscopic thyroidectomy and modified gasless trans-axillary endoscopic thyroidectomy for patients with papillary thyroid microcarcinoma.</a> Cancer Med. , (2023).</li><li>Cho, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Single-incision+endoscopic+thyroidectomy+by+the+axillary+approach+with+gas+inflation+for+the+benign+thyroid+tumor:+retrospective+analysis+for+a+single+surgeon's+experience.">Single-incision endoscopic thyroidectomy by the axillary approach with gas inflation for the benign thyroid tumor: retrospective analysis for a single surgeon's experience.</a> Surg Endosc. 31 (1), 437-444 (2017).</li><li>Jeong, J. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparative+study+of+endoscopic+thyroidectomy+versus+conventional+open+thyroidectomy+in+papillary+thyroid+microcarcinoma+(PTMC)+patients.">Comparative study of endoscopic thyroidectomy versus conventional open thyroidectomy in papillary thyroid microcarcinoma (PTMC) patients.</a> J Surg Oncol. 100 (6), 477-480 (2009).</li><li>Lee, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Excellence+in+robotic+thyroid+surgery:+a+comparative+study+of+robot-assisted+versus+conventional+endoscopic+thyroidectomy+in+papillary+thyroid+microcarcinoma+patients.">Excellence in robotic thyroid surgery: a comparative study of robot-assisted versus conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma patients.</a> Ann Surg. 253 (6), 1060-1066 (2011).</li><li>Cong, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gasless,+endoscopic+trans-axillary+thyroid+surgery:+our+series+of+the+first+51+human+cases.">Gasless, endoscopic trans-axillary thyroid surgery: our series of the first 51 human cases.</a> World J Surg Oncol. 20 (1), 9 (2022).</li><li>Bhargav, P. R., Kumbhar, U. S., Satyam, G., Gayathri, K. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gasless+single+incision+trans-axillary+thyroidectomy:+The+feasibility+and+safety+of+a+hypo-morbid+endoscopic+thyroidectomy+technique.">Gasless single incision trans-axillary thyroidectomy: The feasibility and safety of a hypo-morbid endoscopic thyroidectomy technique.</a> J Minim Access Surg. 9 (3), 116-121 (2013).</li></ol>

无气内窥镜甲状腺切除术经腋窝入路 （GETTA） 是一种新型手术方法，可解决甲状腺状微癌 （PTMC） 发病率上升的问题，同时产生美观的结果 14,15,16。然而，这种技术需要对关键操作步骤有深刻的理解17。在开始实际手术之前，外科医生应通过研究该领域专家提供的现有演示来熟悉该程序16.主...

最近甲状腺状微癌 （PTMC） 发病率的增加1,2 主要影响年轻女性，因此需要提高手术技术，以提供医疗有效性和美学敏感性 3,4。Chung 于 2004年推出的无气内窥镜甲状腺切除术经腋窝切除术 （GETTA） 的主要目标是提供一种满足这两种需求的最佳手术方法。
GETTA 的开发是为了解决传统开放手术的缺点，例如导致患者自我意识的明显疤痕以及对他们的工作和社交活动的潜在负面影响。甲状腺内窥镜手术已逐渐应用于甲状腺良性和恶性疾病的治疗3,4，为开放手术提供了一种侵入性较小的替代方法。然而，GETTA的创新在于其独特的无气方法。与其他技术相比，GETTA 程序具有多项优势。它通过腋窝的自然褶皱建立空腔，使切口隐藏起来，并产生卓越的术后美容效果6.此外，GETTA 在操作过程中无需 CO2 气体充气，从而避免了与 CO2 气体相关的并发症。此外，这种方法使颈前皮瓣完好无损，从而保护了术后颈椎前部区域的功能，并防止术后吞咽皮肤-气管连接6,7。
该技术位于有关甲状腺内窥镜手术的更广泛文献中。虽然有大量关于内窥镜甲状腺手术经口和乳房入路的研究报告 8,9，但非充气甲状腺手术仍未得到充分报道10,11。因此，这种方法对该领域做出了重大贡献，为 GETTA 程序提供了全面的协议。
对于考虑应用这种方法的读者来说，它最适合早期、低风险的甲状腺状癌患者，他们希望在手术后留下最小的疤痕。然而，由于其空间限制，这种技术的成功取决于从业者对内窥镜手术的熟练程度。因此，该方法可能不适合没有高级内窥镜技能的从业者或医疗中心无法获得必要设备的从业者。
本文旨在加强对 GETTA 程序的理解，提供对其应用的见解，并希望促进其在更多医疗中心的采用。GETTA 的好处不仅限于医疗效果，还满足了患者对微创手术和良好美容效果的渴望。

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	<tbody>
		<tr>
			<td>EMG Endotracheal Tube</td>
			<td>Medtronic Xomed, Inc.</td>
			<td>20173666541</td>
			<td>EMG Endotracheal Tube&#160;</td>
		</tr>
		<tr>
			<td>Forceps</td>
			<td>Kangji Medical</td>
			<td>106.890.A</td>
			<td>Gasless endoscopic thyroidectomy trans-axillary approach Equipment (Within)</td>
		</tr>
		<tr>
			<td>Gasless endoscopic thyroidectomy trans-axillary approach Equipment</td>
			<td>Kangji Medical</td>
			<td>106.890.A</td>
			<td>Gasless endoscopic thyroidectomy trans-axillary approach Equipment</td>
		</tr>
		<tr>
			<td>Intraoperative neuromonitoring (IONM) Device</td>
			<td>Medtronic Xomed, Inc.</td>
			<td>20083210370</td>
			<td>NIM-Response 2.0</td>
		</tr>
		<tr>
			<td>Laparoscopic aspirator</td>
			<td>Kangji Medical</td>
			<td>106.891.A</td>
			<td>Gasless endoscopic thyroidectomy trans-axillary approach Equipment (Within)</td>
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		<tr>
			<td>Nerve monitoring probe</td>
			<td>Medtronic Xomed, Inc.</td>
			<td>20173666541</td>
			<td>EMG Endotracheal Tube (Within)</td>
		</tr>
		<tr>
			<td>Retractors (Two types)</td>
			<td>Kangji Medical</td>
			<td>106.890.A</td>
			<td>Gasless endoscopic thyroidectomy trans-axillary approach Equipment (Within)</td>
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		<tr>
			<td>Trocar</td>
			<td>Johnson &#38; Johnson</td>
			<td>B5LT</td>
			<td>Trocar (5 mm)</td>
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		<tr>
			<td>Ultrasonic scalpel</td>
			<td>Johnson &#38; Johnson</td>
			<td>HAR36</td>
			<td>Ultrasonic scalpel</td>
		</tr>
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gasless endoscopic thyroidectomy via the trans-axillary approach

对于早期低风险甲状腺状癌患者，越来越多的人选择内窥镜甲状腺手术，因为它能够在保持良好美容效果的同时获得良好的治疗效果。在可用的内窥镜手术中，无气内窥镜甲状腺切除术经腋窝入路 （GETTA） 在外科医生中越来越受欢迎。这归因于其简单的型腔结构、宽敞的操作区域、精确的视野暴露和可管理的学习曲线。然而，很少有研究对 GETTA 所涉及的具体手术步骤进行详细描述。根据现有文献和我们自己的临床专业知识的综合，我们提出了 GETTA 程序的全面概述。这个过程可以分为五个不同的阶段：定位和切口计划;建立手术腔;喉返神经、甲状旁腺下位和颈中央夹层的识别和保护; 喉上神经、甲状旁腺的定位和保存，甲状腺上极的解剖;甲状腺峡部横断术，然后整体切除甲状腺和颈部中央淋巴结。GETTA 的五步方法易于学习，可用于切除良性和恶性甲状腺和甲状旁腺疾病。

在这项研究中，一组 200 名女性患者，平均年龄均为 36 岁（SD = 4.52;范围为 20 至 59 岁），接受了无气内窥镜甲状腺切除术经腋窝入路 （GETTA）（表 1）。患者的平均体重指数 （BMI） 为 22.79 kg/m2 （SD = 4.52;范围 = 18.27-27.31）。超声检查显示平均肿瘤大小为 7.09 mm （SD = 3.84）。所有患者都充分了解可用的手术选择，随后选择了 GETTA。在总数中，54 名 （27%） 患者有手术史并选择 GETT...

Watch this Scientific Journal Video about Gasless Endoscopic Thyroidectomy via the Trans-Axillary Approach at JoVE.com

Gasless Endoscopic Thyroidectomy via the Trans-Axillary Approach

本方案介绍了使用无气内窥镜甲状腺切除术经腋窝入路 （GETTA） 进行甲状腺切除术的程序。

通过经腋窝入路进行无气内窥镜甲状腺切除术

For patients with early, low-risk papillary thyroid carcinoma, an increasing number are opting for endoscopic thyroid surgery due to its ability to ...

GETTA 的五步法易于学习，可用于解剖良性和恶性甲状腺和甲状旁腺疾病。这种技术提供了显着改善的美容效果。它消除了二氧化碳气体的吹入，并保留了颈椎前区的功能。对于希望避免宫颈瘢痕的早期低危甲状状癌患者来说，这是一种可行且安全的技术。首先，将麻醉患者置于仰卧位，并将患侧的上肢外展至 60 至 90 度角。然后，用手术刀做一个大约四到六厘米长的初级切口。接下来，使用手术刀为套管针创建一个约 0.5 厘米的二次切口。找到胸骨乳突肌的胸骨头和锁骨头之间的间隙。使用超声波手术刀的迷你按钮，凝固间隙内的小血管。在超声手术刀中使用解剖钳来解剖胸骨甲状肌和颈内静脉之间的解剖空间。剖析甲状腺和胸骨甲状肌之间的自然空间。将牵开器放置在空间内，并完成手术腔的创建。使用神经监测探头定位甲状腺下动脉分叉周围的喉返神经。解剖甲状腺下动脉周围区域，同时保护和凝固甲状腺下血管以暴露气管。在凝固并切断甲状腺下动脉的分支后，沿着神经通路到达喉部，确保其在解剖过程中得到保护。进行颈部中央清扫术，如开放手术，并根据患者疾病的程度从颈部中央隔室切除淋巴结。分离甲状腺上极后，继续沿环甲间隙分离过程，露出甲状腺上极的血管。使用超声波手术刀的迷你按钮，凝固并小心地切断甲状腺上极的血管。完全分离甲状腺上极和环甲肌之间的间隙。使用超声波手术刀凝固小血管。然后切除甲状腺峡部和位于甲状腺旁中央区域的淋巴结。将标本收集在标本袋中。使用腹腔镜抽吸器，用温热的无菌盐水冲洗手术腔。然后在气管附近放置一根引流管，并使用解剖镊将引流管从腋窝引出。用 30 厘米的中断可吸收 4.0 缝合线闭合腋窝切口。在这项研究中，一组 200 名平均年龄为 36 岁的女性患者接受了无气内窥镜甲状腺切除术经腋窝入路。5例患者术后出现暂时性喉返神经信号减弱，一个月后消退。未观察到永久性喉返神经损伤病例。然而，三名患者因术中出血需要转为开放手术。在进行任何涉及凝血或切割的手术干预之前，识别和保护喉返神经至关重要。在此程序之后，甲状旁腺切除术和侧淋巴结清扫术可以同时进行。经过进一步改进，该技术除了适用于内窥镜乳房手术外，还可以促进甲状腺全切除术、甲状旁腺切除术和外侧淋巴结清扫术。

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Gasless Endoscopic Thyroidectomy via the Trans-Axillary Approach

Bronchial Thermoplasty:  A Novel Therapeutic Approach to Severe Asthma

支气管Thermoplasty：严重哮喘的一种新的治疗方法

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled ...

科研

医学

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection

永久性脑血管闭塞<em&gt;通过</em&gt;双人结扎横断

Stroke is a leading cause of death, disability, and socioeconomic loss worldwide. The majority of all strokes result from an interruption in blood flow ...

Non-invasive Assessment of the Efficacy of New Therapeutics for Intestinal Pathologies Using Serial Endoscopic Imaging of Live Mice

新的治疗肠道病变的疗效，使用活体小鼠的串行内镜成像的非侵入性评估

Animal models of inflammatory bowel disease (IBD) and colorectal cancer (CRC) have provided significant insight into the cell intrinsic and extrinsic ...

Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow

气道局部麻醉清醒用于内镜插管使用喷雾为你去技术在高氧流量

A patient&#39;s willingness to cooperate is an absolute precondition for successful awake intubation of the trachea. Whilst drug-sedation of patients can ...

Step-by-Step Stapedotomy through Transcanal Exclusive Endoscopic Approach

通过经卡全线内窥镜方法进行逐步镫骨切除术

In recent years there has been an increasing trend in the use of the endoscope to treat a variety of middle ear pathologies, including otosclerosis. ...

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction

内镜超声引导下胆道引流：内镜超声引导下肝胃造瘘术治疗恶性胆道梗阻

Patients with unresectable malignant biliary obstruction often require biliary drainage to decompress the biliary system. Endoscopic Retrograde ...

Endoscopic Cholesteatoma Surgery

Implementation of endoscopes in cholesteatoma surgery resulted in considerable changes in the management of cholesteatoma in the last two decades. ...

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer

腹腔镜根治性顺行屈行模块化胰腺脾切除术经背尾动脉 入路治疗 胰腺颈体癌

Laparoscopic radical resection of the pancreatic neck is one of the most complicated radical operations for pancreatic cancer, especially for patients who ...

Full-Endoscopic Isolation Zone Technique for the Treatment of Lumbar Disc Herniation

Lumbar disc herniation (LDH) is a type of serious sinus or sciatic nerve dysfunction caused by nucleus pulposus protrusion and annulus fibrosus tears. Its ...

Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy

经口内窥镜甲状腺切除术甲状腺叶切除术前庭入路甲状腺叶切除术

The manuscript describes the transoral endoscopic thyroidectomy vestibular approach (TOETVA) for thyroid lobectomy. The patient is placed in the supine ...