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

Deze studie werd uitgevoerd in strikte overeenstemming met de ethische principes die zijn uiteengezet in de Verklaring van Helsinki en hield zich aan de richtlijnen die zijn opgesteld door de Human Research Ethics Committee van onze instelling. Het onderzoeksprotocol onderging een grondige herziening en kreeg goedkeuring van de ethische commissie van het West China Hospital van de Universiteit van Sichuan. Alle deelnemende patiënten gaven schriftelijke geïnformeerde toestemming voordat ze bij het onderzoek betrokken wa...

<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>

De Gasless Endoscopic Thyroidectomie Trans-axillaire Benadering (GETTA) is een nieuwe chirurgische methode die de stijgende incidentie van papillair schildkliermicrocarcinoom (PTMC) aanpakt en tegelijkertijd esthetisch aantrekkelijke resultaten oplevert 14,15,16. Desalniettemin vereist deze techniek een diepgaand begrip van de belangrijkste operationele stappen17. Alvorens met de eigenlijke operatie te be...

De recente toename van de incidentie van papillair schildkliermicrocarcinoom (PTMC)1,2, die voornamelijk jonge vrouwen treft, vereist vooruitgang in chirurgische technieken die zowel medische effectiviteit als esthetische gevoeligheid bieden 3,4. Het primaire doel van de Gasless Endoscopic Thyroidectomie Trans-axillaire Benadering (GETTA), geïntroduceerd door Chung in 20045, is om een optimale chirurgische methode te bieden die deze twee behoeften combineert.
GETTA is ontwikkeld als antwoord op de nadelen van traditionele open chirurgie, zoals merkbare littekens die leiden tot het zelfbewustzijn van patiënten en mogelijke negatieve gevolgen voor hun werk en sociale activiteiten. Endoscopische schildklierchirurgie is geleidelijk toegepast bij de behandeling van goedaardige en kwaadaardige schildklieraandoeningen 3,4 en biedt een minder invasief alternatief voor open chirurgie. De innovatie van GETTA ligt echter in de unieke gasloze aanpak. De GETTA-procedure heeft verschillende voordelen ten opzichte van alternatieve technieken. Het vestigt de holte door de natuurlijke plooien van de oksel, waardoor de incisie verborgen wordt en superieure postoperatieve cosmetische resultaten oplevert6. Bovendien laat GETTA de noodzaak van het opblazen van CO2 -gas tijdens de operatie achterwege, waardoor complicaties in verband met CO2 -gas worden voorkomen. Bovendien laat deze aanpak de voorste nekflap intact, wat de functie van het voorste cervicale gebied na de operatie beschermt en postoperatieve slikhuid-tracheale koppeling voorkomt 6,7.
De techniek maakt deel uit van de bredere literatuur over endoscopische schildklierchirurgie. Hoewel er voldoende onderzoeksrapporten zijn over de transorale en borstbenadering van endoscopische schildklierchirurgie 8,9, blijft niet-opblaasbare schildklierchirurgie ondergerapporteerd10,11. Deze methode levert dan ook een belangrijke bijdrage op dit gebied en biedt een alomvattend protocol voor de GETTA-procedure.
Voor lezers die de toepassing van deze methode overwegen, is deze het meest geschikt voor patiënten met papillair schildkliercarcinoom in een vroeg stadium met een laag risico die na de operatie minimale littekens wensen. Het succes van deze techniek hangt echter af van de vaardigheid van de beoefenaar in endoscopische procedures vanwege de ruimtelijke beperkingen. Als zodanig is de methode mogelijk niet geschikt voor beoefenaars zonder geavanceerde endoscopische vaardigheden of mensen in medische centra met beperkte toegang tot de benodigde apparatuur.
Dit artikel is bedoeld om het begrip van de GTTA-procedure te versterken, inzicht te bieden in de toepassing ervan en hopelijk de acceptatie ervan in meer medische centra te bevorderen. De voordelen van GETTA gaan verder dan medische effectiviteit en voldoen aan de wens van patiënten voor minder invasieve chirurgie met gunstige cosmetische resultaten.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<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>
		</tr>
		<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>
		</tr>
		<tr>
			<td>Trocar</td>
			<td>Johnson &#38; Johnson</td>
			<td>B5LT</td>
			<td>Trocar (5 mm)</td>
		</tr>
		<tr>
			<td>Ultrasonic scalpel</td>
			<td>Johnson &#38; Johnson</td>
			<td>HAR36</td>
			<td>Ultrasonic scalpel</td>
		</tr>
	</tbody>
</table>

gasless endoscopic thyroidectomy via the trans-axillary approach

Voor patiënten met vroeg papillair schildkliercarcinoom met een laag risico kiest een toenemend aantal voor endoscopische schildklierchirurgie vanwege het vermogen om gunstige therapeutische resultaten te bereiken met behoud van uitstekende cosmetische resultaten. Van de beschikbare endoscopische procedures is de Gasless Endoscopic Thyroidectomie Trans-axillary Approach (GETTA) populair geworden onder chirurgen. Dit wordt toegeschreven aan de eenvoudige holteconstructie, het ruime werkgebied, de nauwkeurige belichting van het gezichtsveld en de beheersbare leercurve. Er zijn echter maar weinig studies die gedetailleerde beschrijvingen hebben gegeven van de specifieke chirurgische stappen die betrokken zijn bij GETTA. Op basis van een synthese van bestaande literatuur en onze eigen klinische expertise, presenteren we een uitgebreide schets van de GETTA-procedure. Dit proces kan worden onderverdeeld in vijf verschillende fasen: positionering en incisieplanning; aanleg van chirurgische holtes; identificatie en bescherming van de recidiverende larynxzenuw, de inferieure bijschildklier en de centrale halsdissectie; lokalisatie en behoud van de superieure larynxzenuw, superieure bijschildklier en dissectie van de superieure pool van de schildklier; Transsectie van de landengte van de schildklier gevolgd door en bloc resectie van de schildklier en de lymfeklieren in de centrale nek. De vijfstappenaanpak van GETTA is gemakkelijk te leren en kan worden aangepast voor het resectieren van zowel goedaardige als kwaadaardige schildklier- en bijschildklieraandoeningen.

In deze studie onderging een cohort van 200 vrouwelijke patiënten, allemaal met een gemiddelde leeftijd van 36 jaar (SD = 4,52; variërend van 20 tot 59 jaar), de Gasless Endoscopic Thyroidectomie Trans-axillaire Benadering (GETTA) (Tabel 1). De patiënten hadden een gemiddelde Body Mass Index (BMI) van 22,79 kg/m2 (SD = 4,52; bereik = 18,27-27,31). De echo gaf een gemiddelde tumorgrootte aan van 7,09 mm (SD = 3,84). Alle patiënten werden volledig geïnformeerd over de beschikbare chirurgisc...

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

Dit protocol presenteert de procedure voor het uitvoeren van thyreoïdectomie met behulp van de gasloze endoscopische thyreoïdectomie transaxillaire benadering (GETTA).

Gasloze endoscopische thyreoïdectomie via de trans-axillaire benadering

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

De vijfstappenaanpak van GETTA is gemakkelijk te leren en kan worden aangepast voor het ontleden van zowel goedaardige als kwaadaardige schildklier- en bijschildklieraandoeningen. Deze techniek biedt aanzienlijk verbeterde cosmetische resultaten. Het elimineert de insufflatie van kooldioxidegas en behoudt de functie van het voorste cervicale gebied.Het is een haalbare en veilige techniek voor patiënten met papillair schildkliercarcinoom met een laag risico in een vroeg stadium die een cervicaal litteken willen vermijden. Plaats om te beginnen de verdoofde patiënt in rugligging en ontvoer de bovenste ledemaat aan de aangedane zijde in een hoek van 60 tot 90 graden. Maak vervolgens een primaire incisie van ongeveer vier tot zes centimeter lang met een scalpel.Maak vervolgens een secundaire incisie van ongeveer 0,5 centimeter met behulp van een chirurgisch scalpel voor de trocar. Lokaliseer de opening tussen de borstkop van de sternale cleo-mastoïdspier en de sleutelbeenkop. Gebruik de miniknop van de ultrasone scalpel om de kleine bloedvaten in de opening te coaguleren.Gebruik een ontleedtang in de ultrasone scalpel om de anatomische ruimte tussen de sternothyroïdspier en de interne halsader te ontleden. Ontleed de natuurlijke ruimte tussen de schildklier en de sternothyroïdspier. Plaats de retractors in de ruimte en voltooi het maken van de chirurgische holtes.Lokaliseer de recidiverende larynxzenuw rond de vertakking van de inferieure schildklierslagader met behulp van een zenuwbewakingssonde. Ontleed het gebied rond de inferieure schildklierslagader terwijl u de inferieure schildklierbloedvaten beschermt en coaguleert om de luchtpijp bloot te leggen. Na het coaguleren en afsnijden van de takken van de inferieure schildklierslagader, volgt u het zenuwpad naar het strottenhoofd en zorgt u voor bescherming tijdens het dissectieproces.Voer een centrale nekdissectiemethode uit, zoals open chirurgie, en verwijder lymfeklieren uit het centrale compartiment van de nek op basis van de omvang van de ziekte van de patiënt. Na het scheiden van de bovenste pool van de schildklier, gaat u verder met het scheidingsproces langs de cricothyroid-ruimte om de bloedvaten van de bovenste schildklierpool bloot te leggen. Gebruik de miniknop van de ultrasone scalpel om de bloedvaten van de bovenste pool van de schildklier te coaguleren en voorzichtig af te snijden.Dissocieer de opening tussen de bovenste pool van de schildklier en de cricothyroid-spier volledig. Gebruik een ultrasone scalpel om kleine bloedvaten te laten stollen. Verwijder vervolgens zowel de landengte van de schildklier als de lymfeklieren die zich in het centrale gebied naast de schildklier bevinden.Verzamel het monster in de monsterzak. Gebruik een laparoscopische aspirator om de operatieholte te spoelen met warme steriele zoutoplossing. Plaats vervolgens een drainagebuis in de buurt van de luchtpijp en gebruik een ontleedtang om de buis uit de oksel te leiden.Sluit de okselincisie met een onderbroken resorbeerbare 4.0-hechting van 30 centimeter. In deze studie onderging een cohort van 200 vrouwelijke patiënten met een gemiddelde leeftijd van 36 jaar de gasloze endoscopische thyreoïdectomie transaxillaire benadering. Vijf patiënten ervoeren een tijdelijke verzwakking van het larynxzenuwsignaal na de operatie, die na een maand verdween.Er werden geen gevallen van blijvend recidiverend larynxzenuwletsel waargenomen. Drie patiënten moesten echter worden omgezet in een open operatie vanwege intraoperatieve bloedingen. Het is van cruciaal belang om de terugkerende larynxzenuw te herkennen en te beschermen vóór elke chirurgische ingreep waarbij coagulatie of snijden wordt uitgevoerd.Na deze procedure kunnen parathyreoïdectomie en de laterale lymfeklierdissectie gelijktijdig met een procedure worden uitgevoerd. Bij verdere verfijning kan deze techniek totale thyreoïdectomie, parathyreoïdectomie en de laterale lymfeklierdissecties vergemakkelijken, naast dat het aanpasbaar is voor endoscopische borstoperaties.

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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.

Permanente Cerebrale vatocclusie<em&gt; Via</em&gt; Dubbele Ligatuur en doorsnijding

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.

Niet-invasieve evaluatie van de werkzaamheid van nieuwe therapieën voor Intestinale Pathologieën gebruik van een serieel Endoscopische Imaging van levende muizen

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.

Stap-voor-stapotomie door transcanale exclusieve endoscopische aanpak

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.

Endoscopische cholesteatoomchirurgie

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.

Laparoscopische radicale antegrade modulaire pancreatosplenectomie via dorsale-caudale slagaderbenadering voor pancreashals-lichaamskanker

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.

Transorale endoscopische thyroidectomie Vestibulaire benadering voor schildklierlobectomie

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>Een uitgebreide stap-voor-stap handleiding voor exclusieve endoscopische ossiculoplastiek

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>Auteur in de schijnwerpers: Voortschrijdende endoscopische ossiculoplastiek - technieken, innovaties en praktische richtlijnen voor klinische integratie

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.

Technieken van endoscopische ossiculoplastiek

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>Lumbale spinale stenose behandelen met een minimaal invasieve wervelkolomoperatie

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>Auteur in de schijnwerpers: reikwijdte van LE-ULBD als een veilige, effectieve en minimaal invasieve benadering voor de behandeling van lumbale spinale 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.

Percutane endoscopische bilaterale decompressie met unilaterale benadering voor lumbale spinale stenose

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