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

Denne undersøgelse blev udført i nøje overensstemmelse med de etiske principper, der er skitseret i Helsingfors-erklæringen og overholdt de retningslinjer, der er fastlagt af vores institutions Human Research Ethics Committee. Forskningsprotokollen gennemgik en grundig gennemgang og modtog godkendelse fra den etiske komité på West China Hospital ved Sichuan University. Alle deltagende patienter gav skriftligt informeret samtykke, før de blev involveret i undersøgelsen, og der blev truffet strenge foranstaltninger...

<ol>
	<li>Megwalu, U. C., Moon, P. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Thyroid+cancer+incidence+and+mortality+trends+in+the+United+States:+2000-2018.">Thyroid cancer incidence and mortality trends in the United States: 2000-2018.</a> Thyroid. 32 (5), 560-570 (2022).</li><li>Qian, Z. J., Jin, M. C., Meister, K. D., Megwalu, U. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pediatric+thyroid+cancer+incidence+and+mortality+trends+in+the+United+States,+1973-2013.">Pediatric thyroid cancer incidence and mortality trends in the United States, 1973-2013.</a> JAMA Otolaryngol Head Neck Surg. 145 (7), 617-623 (2019).</li><li>Lattoo, M. 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=Outcome+of+trans-axillary+approach+for+surgical+decompression+of+thoracic+outlet:+a+retrospective+study+in+a+tertiary+care+hospital.">Outcome of trans-axillary approach for surgical decompression of thoracic outlet: a retrospective study in a tertiary care hospital.</a> Oman Med J. 29 (3), 214-216 (2014).</li><li>Kwak, H. 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=Learning+curve+for+gasless+endoscopic+thyroidectomy+using+the+trans-axillary+approach:+CUSUM+analysis+of+a+single+surgeon's+experience.">Learning curve for gasless endoscopic thyroidectomy using the trans-axillary approach: CUSUM analysis of a single surgeon's experience.</a> Int J Surg. 12 (12), 1273-1277 (2014).</li><li>Yoon, J. H., Park, C. H., Chung, W. 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>

Gasless Endoscopic Thyroidectomy Trans-axillary Approach (GETTA) er en ny kirurgisk metode, der adresserer den stigende forekomst af papillært skjoldbruskkirtelmikrokarcinom (PTMC), samtidig med at den giver æstetisk tiltalende resultater 14,15,16. Ikke desto mindre kræver denne teknik en dyb forståelse af centrale operationelle trin17. Før den egentlige operation påbegyndes, forventes kirurger at g...

Den nylige stigning i forekomsten af papillært skjoldbruskkirtelmikrokarcinom (PTMC)1,2, der overvejende påvirker unge kvinder, kræver fremskridt inden for kirurgiske teknikker, der tilbyder både medicinsk effektivitet og æstetisk følsomhed 3,4. Det primære mål med Gasless Endoscopic Thyroidectomy Trans-axillary Approach (GETTA), introduceret af Chung i 20045, er at tilvejebringe en optimal kirurgisk metode, der gifter sig med disse to behov.
GETTA blev udviklet som et svar på ulemperne ved traditionel åben kirurgi, såsom mærkbare ar, der fører til patienternes selvbevidsthed og potentiel negativ indvirkning på deres arbejde og sociale aktiviteter. Endoskopisk skjoldbruskkirtelkirurgi er gradvist blevet anvendt til behandling af godartede og ondartede skjoldbruskkirtelsygdomme 3,4, hvilket tilbyder et mindre invasivt alternativ til åben kirurgi. Alligevel ligger innovationen i GETTA i dens unikke gasløse tilgang. GETTA-proceduren har flere fordele i forhold til alternative teknikker. Det etablerer hulrummet gennem axillens naturlige folder, hvilket gør snittet skjult og giver overlegne postoperative kosmetiske resultater6. Desuden udelader GETTA behovet for CO2 -gasinflation under operationen, hvorved komplikationer relateret til CO2 -gas undgås. Desuden efterlader denne tilgang den forreste halsklap intakt, hvilket beskytter funktionen af den forreste cervikale region efter operationen og forhindrer postoperativ synkning af hud-trakealkobling 6,7.
Teknikken er placeret inden for den bredere litteratur om endoskopisk skjoldbruskkirtelkirurgi. Mens der er rigelige forskningsrapporter om transoral og bryst tilgang af endoskopisk skjoldbruskkirtel kirurgi 8,9, ikke-oppustelig skjoldbruskkirtel kirurgi forbliver underrapporteret10,11. Denne metode udgør derfor et væsentligt bidrag til dette område, idet den udgør en omfattende protokol for GETTA-proceduren.
For læsere, der overvejer anvendelsen af denne metode, er den bedst egnet til patienter med papillært skjoldbruskkirtelkarcinom i tidlig fase, lav risiko, der ønsker minimal ardannelse efter operationen. Succesen med denne teknik afhænger imidlertid af udøverens færdigheder i endoskopiske procedurer på grund af dets rumlige begrænsninger. Som sådan er metoden muligvis ikke egnet til praktiserende læger uden avancerede endoskopiske færdigheder eller dem i medicinske centre med begrænset adgang til det nødvendige udstyr.
Denne artikel har til formål at styrke forståelsen af GETTA-proceduren, give indsigt i dens anvendelse og forhåbentlig fremme dens vedtagelse i flere medicinske centre. Fordelene ved GETTA strækker sig ud over medicinsk effektivitet og imødekommer patienternes ønske om mindre invasiv kirurgi med gunstige kosmetiske resultater.

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			<td>EMG Endotracheal Tube</td>
			<td>Medtronic Xomed, Inc.</td>
			<td>20173666541</td>
			<td>EMG Endotracheal Tube&#160;</td>
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			<td>Forceps</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>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>
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			<td>Intraoperative neuromonitoring (IONM) Device</td>
			<td>Medtronic Xomed, Inc.</td>
			<td>20083210370</td>
			<td>NIM-Response 2.0</td>
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			<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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			<td>Nerve monitoring probe</td>
			<td>Medtronic Xomed, Inc.</td>
			<td>20173666541</td>
			<td>EMG Endotracheal Tube (Within)</td>
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			<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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			<td>Trocar</td>
			<td>Johnson &#38; Johnson</td>
			<td>B5LT</td>
			<td>Trocar (5 mm)</td>
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			<td>Ultrasonic scalpel</td>
			<td>Johnson &#38; Johnson</td>
			<td>HAR36</td>
			<td>Ultrasonic scalpel</td>
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gasless endoscopic thyroidectomy via the trans-axillary approach

For patienter med tidlig, lavrisiko papillært skjoldbruskkirtelkarcinom vælger et stigende antal endoskopisk skjoldbruskkirtelkirurgi på grund af dets evne til at opnå gunstige terapeutiske resultater, samtidig med at der opretholdes fremragende kosmetiske resultater. Blandt de tilgængelige endoskopiske procedurer har Gasless Endoscopic Thyroidectomy Trans-axillary Approach (GETTA) vundet popularitet blandt kirurger. Dette tilskrives dens enkle hulrumskonstruktion, rummelige operationsområde, præcise synsfelteksponering og håndterbare indlæringskurve. Imidlertid har få undersøgelser givet detaljerede beskrivelser af de specifikke kirurgiske trin, der er involveret i GETTA. På baggrund af en syntese af eksisterende litteratur og vores egen kliniske ekspertise præsenterer vi en omfattende oversigt over GETTA-proceduren. Denne proces kan kategoriseres i fem forskellige faser: positionering og snitplanlægning; etablering af kirurgiske hulrum; identifikation og beskyttelse af den tilbagevendende larynxnerve, ringere biskjoldbruskkirtel og dissektion i centralhalsen; lokalisering og bevarelse af den overlegne larynxnerve, overlegen biskjoldbruskkirtel og dissektion af skjoldbruskkirtlens overlegne pol; Transsektion af skjoldbruskkirtlen Isthmus efterfulgt af en bloc resektion af skjoldbruskkirtlen og centrale hals lymfeknuder. Den fem-trins tilgang til GETTA er let at lære og kan tilpasses til resektering af både godartede og ondartede skjoldbruskkirtel- og parathyroideasygdomme.

I denne undersøgelse gennemgik en kohorte på 200 kvindelige patienter, alle med en gennemsnitsalder på 36 år (SD = 4,52; spænder fra 20 til 59 år), den gasløse endoskopiske thyroidektomi transaksillære tilgang (GETTA) (tabel 1). Patienterne havde et gennemsnitligt Body Mass Index (BMI) på 22,79 kg/m2 (SD = 4,52; interval = 18,27-27,31). Sonogrammet angav en gennemsnitlig tumorstørrelse på 7, 09 mm (SD = 3, 84). Alle patienter blev fuldt informeret om de kirurgiske muligheder, der va...

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

Denne protokol præsenterer proceduren for udførelse af thyroidektomi ved anvendelse af den gasløse endoskopiske thyroidektomi trans-aksillære tilgang (GETTA).

Gasløs endoskopisk thyroidektomi via den transaksillære tilgang

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

Den fem trin tilgang af GETTA er let at lære og kan tilpasses til dissekering af både godartede og ondartede skjoldbruskkirtlen og parathyroideasygdomme. Denne teknik giver betydeligt forbedrede kosmetiske resultater. Det eliminerer kuldioxidgasinsufflationen og bevarer funktionen af den forreste livmoderhalsregion.Det er en levedygtig og sikker teknik til patienter med tidligt papillært skjoldbruskkirtelkarcinom med lav risiko, der ønsker at undgå et cervikal ar. Til at begynde med skal du placere den bedøvede patient i liggende stilling og bortføre overekstremiteten på den berørte side til en vinkel på 60 til 90 grader. Lav derefter et primært snit på cirka fire til seks centimeter i længden ved hjælp af en skalpel.Opret derefter et sekundært snit på ca. 0,5 centimeter ved hjælp af en kirurgisk skalpel til trokaren. Find mellemrummet mellem brysthovedet på brystcleomastoidmusklen og kravebenshovedet. Brug mini-knappen på ultralydskalpellen til at koagulere de små blodkar i mellemrummet.Anvend dissekere tang i ultralydskalpellen for at dissekere det anatomiske rum mellem sternothyroidmusklen og den indre jugular vene. Dissekere det naturlige rum mellem skjoldbruskkirtlen og sternothyroid muskel. Placer retraktorerne i rummet, og fuldfør oprettelsen af de kirurgiske hulrum.Find den tilbagevendende larynxnerve omkring bifurcation af den ringere skjoldbruskkirtelarterie ved hjælp af en nerveovervågningssonde. Dissekere området omkring den ringere skjoldbruskkirtelarterie, mens du beskytter og koagulerer de ringere skjoldbruskkirtelblodkar for at udsætte luftrøret. Efter koagulering og afskæring af grene af den ringere skjoldbruskkirtelarterie skal du følge nervevejen til strubehovedet og sikre dets beskyttelse under dissektionsprocessen.Udfør en central halsdissektionsmetode, som åben kirurgi, og fjern lymfeknuder fra det centrale rum i nakken baseret på omfanget af patientens sygdom. Efter adskillelse af skjoldbruskkirtlens øvre pol skal du fortsætte separationsprocessen langs cricothyroid-rummet for at udsætte blodkarrene i den øvre skjoldbruskkirtelpol. Brug mini-knappen på ultralydskalpellen til at koagulere og omhyggeligt afskære blodkarrene i skjoldbruskkirtlens øvre pol.Fuldt dissociere kløften mellem den øvre pol i skjoldbruskkirtlen og cricothyroid muskel. Brug en ultralydskalpel til at koagulere små blodkar. Fjern derefter både skjoldbruskkirtlen isthmus og lymfeknuderne placeret i det centrale område langs skjoldbruskkirtlen.Saml prøven i prøveposen. Brug en laparoskopisk aspirator til at skylle driftshulrummet med varmt sterilt saltvand. Placer derefter et drænrør nær luftrøret og brug dissekeretang til at lede røret ud fra axillen.Luk det aksillære snit med en 30 centimeter afbrudt absorberbar 4,0 sutur. I denne undersøgelse gennemgik en kohorte på 200 kvindelige patienter med en gennemsnitsalder på 36 år den gasløse endoskopiske thyroidektomi trans aksillære tilgang. Fem patienter oplevede midlertidig tilbagevendende svækkelse af larynxnervesignalet efter operationen, som forsvandt efter en måned.Der blev ikke observeret tilfælde af permanente tilbagevendende larynxnerveskader. Tre patienter måtte dog konverteres til åben kirurgi på grund af intraoperativ blødning. Det er afgørende at genkende og beskytte den tilbagevendende larynxnerve før ethvert kirurgisk indgreb, der involverer koagulation eller skæring.Efter denne procedure kan parathyroidektomi og lateral lymfeknudedissektion samtidig udføres med en procedure. Efter yderligere forfining kan denne teknik lette total thyroidektomi, parathyroidektomi og laterale lymfeknudedissektioner ud over at kunne tilpasses endoskopiske brystoperationer.

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Gasless Endoscopic Thyroidectomy via the Trans-Axillary Approach

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection

Stroke is a leading cause of death, disability, and socioeconomic loss worldwide. The majority of all strokes result from an interruption in blood flow (ischemia) 1. Middle cerebral artery (MCA) delivers a great majority of blood to the lateral surface of the cortex 2, is the most common site of human stroke 3, and ischemia within its territory can result in extensive dysfunction or death 1,4,5. Survivors of ischemic stroke often suffer loss or disruption of motor capabilities, sensory deficits, and infarct. In an effort to capture these key characteristics of stroke, and thereby develop effective treatment, a great deal of emphasis is placed upon animal models of ischemia in MCA.
Here we present a method of permanently occluding a cortical surface blood vessel. We will present this method using an example of a relevant vessel occlusion that models the most common type, location, and outcome of human stroke, permanent middle cerebral artery occlusion (pMCAO). In this model, we surgically expose MCA in the adult rat and subsequently occlude via double ligature and transection of the vessel. This pMCAO blocks the proximal cortical branch of MCA, causing ischemia in all of MCA cortical territory, a large portion of the cortex. This method of occlusion can also be used to occlude more distal portions of cortical vessels in order to achieve more focal ischemia targeting a smaller region of cortex. The primary disadvantages of pMCAO are that the surgical procedure is somewhat invasive as a small craniotomy is required to access MCA, though this results in minimal tissue damage. The primary advantages of this model, however, are: the site of occlusion is well defined, the degree of blood flow reduction is consistent, functional and neurological impairment occurs rapidly, infarct size is consistent, and the high rate of survival allows for long-term chronic assessment.

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection

We describe a highly reproducible method for the permanent occlusion of a rodent major cerebral blood vessel. This technique can be accomplished with very little peripheral damage, minimal blood loss, a high rate of long-term survival, and consistent infarct volume commensurate with the human clinical population.

Permanent Cerebral karokklusion<em&gt; Via</em&gt; Dobbelt Ligature og transection

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

Animal models of inflammatory bowel disease (IBD) and colorectal cancer (CRC) have provided significant insight into the cell intrinsic and extrinsic mechanisms that contribute to the onset and progression of intestinal diseases. The identification of new molecules that promote these pathologies has led to a flurry of activity focused on the development of potential new therapies to inhibit their function. As a result, various pre-clinical mouse models with an intact immune system and stromal microenvironment are now heavily used. Here we describe three experimental protocols to test the efficacy of new therapeutics in pre-clinical models of (1) acute mucosal damage, (2) chronic colitis and/or colitis-associated colon cancer, and (3) sporadic colorectal cancer. We also outline procedures for serial endoscopic examination that can be used to document the therapeutic response of an individual tumor and to monitor the health of individual mice. These protocols provide complementary experimental platforms to test the effectiveness of therapeutic compounds shown to be well tolerated by mice.

We describe methods for longitudinal monitoring of the efficacy of therapeutics for the treatment of colonic pathologies in mice using a rigid endoscope. This protocol can be readily used for the characterization of the therapeutic response of an individual tumor in live mice and also for monitoring potential disease relapse.

Ikke-invasiv vurdering af effekten af ​​nye lægemidler til behandling af Intestinal patologier Brug Serial Endoskopisk Imaging af levende mus

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

Step-by-Step Stapedotomy through Transcanal Exclusive Endoscopic Approach

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. Several studies comparing traditional microscopic and endoscopic stapes surgery have reported similar hearing results and an overall low rate of complications. The endoscope has unraveled its full potential in demanding settings of stapes surgery, such as unfavorable anatomy of the oval window niche or revision cases. Reduced manipulation of the chorda tympani and low rate of post-operative dysgeusia are further benefits to mention for endoscopic stapes surgery.
Being a one-handed technique, management of bleeding, positioning, and crimping of the prosthesis may be challenging for novice endoscopic surgeons, so some training in endoscopic ear surgery is recommended before performing endoscopic stapedotomy. The problem of sharing the surgical field between the endoscope and the operating instruments could be easily overcome if proper instruments positioning is understood. One-handed bleeding control in the narrow space of the ear canal may represent an issue during the elevation of the tympano-meatal flap, possibly discouraging the surgeon since the preliminary steps of surgery. Following appropriate technique to raise the flap and the collaboration with the anesthesiology team in keeping the blood pressure low guarantee an adequate bleeding control in most cases.
The aim of this article is to describe the entire surgical procedure of a transcanal exclusive endoscopic stapedotomy, from operating room set up and patient positioning to post-operative care. A step-by-step description of the surgical maneuvers with technical hints is reported, to guide the surgeon across the procedure and allow any ear surgeon to perform stapes surgery endoscopically.

The aim of this article is to provide a step-by-step method for endoscopic stapes surgery from operating room setting and patient positioning to post-operative care. This work would represent a guide for any otologic surgeon who is willing to treat otosclerosis with endoscopic transcanal technique.

Trin-for-trin Stapedotomi gennem Transcanal Eksklusiv endoskopisk tilgang

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 Cholesteatoma Surgery

Implementation of endoscopes in cholesteatoma surgery resulted in considerable changes in the management of cholesteatoma in the last two decades. Compared to the microscopic approach with an excellent but straight-line view and limited illumination, the introduction of endoscopes provides a wide-angled panoramic view. Moreover, angled lenses allow the surgeon to visualize the middle ear and its hidden recesses through a transcanal, minimally-invasive approach. The endoscope enables the surgeon to remove limited cholesteatoma of the middle ear and its recesses using an exclusive endoscopic technique by taking advantage of these benefits. This reduces the rate of residual disease and sparing external incisions and excessive temporal bone drilling as in a transmastoid approach. Since transcanal endoscopic access is mainly a one-handed technique, it implies the need for specific procedures and technical refinements. This article describes a step-by-step guide as a surgical manual for endoscopic removal of epitympanic cholesteatoma. Different techniques for cholesteatoma dissection and bone removal for epitympanectomy, including curettage and powered instruments such as drills and ultrasonic devices with their outcomes, are discussed. This may offer ear surgeons insight into technical refinements and the latest technological developments and open the horizon for different techniques.

The present protocol describes a step-by-step guide for the complete endoscopic removal of epitympanic cholesteatoma with different techniques for cholesteatoma dissection and bone removal for epitympanectomy.

Endoskopisk kolestatom kirurgi

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 resection of the pancreatic neck is one of the most complicated radical operations for pancreatic cancer, especially for patients who have had neoadjuvant chemotherapy. Here, we present a technique to perform laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) using the dorsal-caudal artery approach by making full use of the high-definition vision and operation modes of the laparoscope.
The innovation and optimization of this operation are provided in the protocol. Priority should be given to the dorsal resection plane, including the dorsal side of the superior mesenteric artery (SMA), the dorsal side of the pancreatic head, the root of the celiac artery (CeA), the ventral side of the left renal vessels, and the renal hilum. On the condition that the operation for pancreatic neck-body cancer is feasible and safe, the second step is to perform tumor resection en bloc surrounding the SMA and CeA from the caudal to the cephalic side to increase the rate of R0 (radical zero) resection and further prognosis.

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

With advancements in laparoscopic techniques, laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) has been widely recognized. However, owing to several technical difficulties in this procedure, the artery-first approach in L-RAMPS still remains uncommon. Here, we developed the dorsal-caudal artery approach for L-RAMPS, which might be safe and beneficial for pancreatic neck tumors.

Laparoskopisk radikal antegrad modulær pancreatosplenektomi via dorsal-kaudal arterie tilgang til kræft i bugspytkirtlen hals-krop

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

Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy

The manuscript describes the transoral endoscopic thyroidectomy vestibular approach (TOETVA) for thyroid lobectomy. The patient is placed in the supine position with extension and fixation of the neck. One 20 mm transverse incision and two 5 mm incisions are made through the mucosa of the oral vestibule for camera and instrument placement after disinfection of the skin and oral cavity. The workspace is established and maintained by the skin suspension device, which is made of unabsorbable string (3-0) and rubber bands, and the CO2 insufflation pressure. Lobectomy using a medial-to-lateral technique and prophylactic ipsilateral central neck dissection is performed simultaneously on patients with papillary thyroid cancer (PTC). The specimen is extracted through the 20 mm incision. The parathyroid gland is immediately searched for in the specimen and auto-transplanted to the left brachioradialis. A drainage tube is inserted through the retractor hole into the bed of the thyroid gland, and absorbable sutures are used to close the mucosal incisions in the oral vestibule and the linea alba cervicalis. Prophylactics administered intravenously are recommended for the first 24 h after surgery, and oral antibiotics are used for 7 days postoperatively.

Here, we present a protocol to describe the methodology for the transoral endoscopic thyroidectomy vestibular approach in detail.

Transoral endoskopisk thyroidektomi vestibulær tilgang til skjoldbruskkirtlen lobektomi

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

<meta charset="utf8"></head><body>En omfattende trin-for-trin guide til eksklusiv endoskopisk ossikuloplastik

Techniques of Endoscopic Ossiculoplasty

The utilization of endoscopes in modern otology has evolved from diagnostic purposes to the development of exclusive endoscopic ear surgery. This technique offers a panoramic view of the middle ear and provides an optimal magnification of the oval window region, the stapes' suprastructure, and the footplate, allowing great precision in prosthesis positioning during ossiculoplasty (OPL). Various techniques for ossicular chain reconstruction have been described in the literature. Either autologous or synthetic materials can be used for reconstruction. The use of a patient's own tissue minimizes the risk of implant rejection or extrusion of the prosthesis through the tympanic membrane. On the other hand, synthetic materials like titanium are light and rigid and do not require time-consuming prosthesis remodeling. The main objective of this article is to present a comprehensive step-by-step guide that serves as a surgical manual for exclusive endoscopic OPL. This guide will explain various forms of OPL using synthetic and autologous materials. The goal is to provide a comprehensive understanding of the various surgical techniques and support the integration into clinical practice.

<meta charset="utf8"></head><body>Forfatter Spotlight: Fremme af endoskopisk ossikuloplastik – teknikker, innovationer og praktisk vejledning til klinisk integration

Exclusive Endoscopic ossiculoplasty (EEO) is a promising and minimally invasive approach for the treatment of conductive hearing loss due to ossicular chain disruptions and associated middle ear pathologies. Herein, step-by-step instructions and a discussion of various endoscopic ossiculoplasty techniques are presented.

Teknikker til endoskopisk ossikuloplastik

The utilization of endoscopes in modern otology has evolved from diagnostic purposes to the development of exclusive endoscopic ear surgery. This ...

<meta charset="utf8"></head><body>Behandling af lumbal spinal stenose med en minimalt invasiv rygkirurgi

Percutaneous Endoscopic Unilateral-Approach Bilateral Decompression for Lumbar Spinal Stenosis

Lumbar spinal stenosis (LSS) involves the narrowing of the spinal canal due to degenerative changes in the vertebral joints, intervertebral discs, and ligaments. LSS encompasses central canal stenosis (CCS), lateral recess stenosis (LRS), and intervertebral foramen stenosis (IFS). The utilization of lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has gained popularity in the treatment of CCS and LRS. This popularity is attributed to the rapid development of endoscopic instruments and the progress of endoscopic philosophy.
In this technical report, a detailed introduction to the steps and key points of LE-ULBD is provided. Simultaneously, a retrospective review of 132 consecutive patients who underwent LE-ULBD for central canal and/or lateral recess stenosis was conducted. The outcomes after more than two years of follow-up were assessed using the visual analogue score (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, and the modified MacNab criteria to evaluate surgical efficacy. All 132 patients underwent LE-ULBD successfully. Among them, 119 patients were rated as "excellent," while 13 patients were rated as "good" based on the modified MacNab criteria during the last follow-up. Incidental dural tears occurred in four cases, but there were no post-operative epidural hematomas or infections. The experience demonstrates that LE-ULBD is a less invasive, effective, and safe approach. It can be considered as an alternative option for treating patients with lumbar central canal stenosis and/or lateral recess stenosis.

<meta charset="utf8"></head><body>Forfatter Spotlight: Omfanget af LE-ULBD som en sikker, effektiv og minimalt invasiv tilgang til behandling af lumbal spinal stenose

The present protocol describes the steps and key points of lumbar endoscopic unilateral laminotomy for bilateral decompression for the treatment of degenerative lumbar spinal stenosis.

Perkutan endoskopisk unilateral tilgang bilateral dekompression for lumbal spinal stenose

Lumbar spinal stenosis (LSS) involves the narrowing of the spinal canal due to degenerative changes in the vertebral joints, intervertebral discs, and ...