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 studien ble gjennomført i strengt samsvar med de etiske prinsippene som er skissert i Helsinkideklarasjonen og fulgte retningslinjene fastsatt av vår institusjons forskningsetiske komité. Forskningsprotokollen gjennomgikk en grundig gjennomgang og fikk godkjenning fra etikkomiteen ved West China Hospital ved Sichuan University. Alle deltakende pasienter ga skriftlig informert samtykke før de deltok i studien, og strenge tiltak ble tatt for å sikre personvernet og konfidensialiteten til dataene deres gjennom he...

<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 som adresserer den økende forekomsten av papillær skjoldbruskmikrokarsinom (PTMC), samtidig som den gir estetisk tiltalende resultater 14,15,16. Likevel krever denne teknikken en dyp forståelse av viktige operasjonelle trinn17. Før selve operasjonen påbegynnes, forventes det at kirurgene setter seg inn i prosed...

Den nylige økningen i forekomsten av papillær skjoldbruskmikrokarsinom (PTMC)1,2, som hovedsakelig påvirker unge kvinner, nødvendiggjør fremskritt i kirurgiske teknikker som tilbyr både medisinsk effektivitet og estetisk følsomhet 3,4. Det primære målet med Gasless Endoscopic Thyroidectomy Trans-axillary Approach (GETTA), introdusert av Chung i 20045, er å gi en optimal kirurgisk metode som forener disse to behovene.
GETTA ble utviklet som et svar på ulempene ved tradisjonell åpen kirurgi, for eksempel merkbare arr som fører til pasientens selvbevissthet og potensiell negativ innvirkning på deres arbeid og sosiale aktiviteter. Endoskopisk skjoldbruskkjertelkirurgi har blitt gradvis brukt i behandlingen av godartede og ondartede skjoldbrusk sykdommer 3,4, og tilbyr et mindre invasivt alternativ til åpen kirurgi. Likevel ligger innovasjonen til GETTA i den unike gassløse tilnærmingen. GETTA-prosedyren har flere fordeler i forhold til alternative teknikker. Det etablerer hulrommet gjennom de naturlige foldene i armhulen, noe som gjør snittet skjult og gir overlegne postoperative kosmetiske resultater6. Videre utelater GETTA behovet for CO2 gass inflasjon under operasjonen, og dermed avverge komplikasjoner knyttet til CO2 gass. Videre lar denne tilnærmingen den fremre nakkeklaffen være intakt, noe som beskytter funksjonen til den fremre cervikale regionen etter operasjonen og forhindrer postoperativ svelging av hud-trakealkobling 6,7.
Teknikken ligger innenfor den bredere litteraturen om endoskopisk skjoldbruskkjertelkirurgi. Mens det er rikelig med forskningsrapporter om transoral og bryst tilnærming av endoskopisk skjoldbrusk kirurgi 8,9, forblir ikke-oppblåsbar skjoldbrusk kirurgi underrapportert10,11. Følgelig utgjør denne metoden et betydelig bidrag til dette feltet, og gir en omfattende protokoll for GETTA-prosedyren.
For lesere som vurderer anvendelsen av denne metoden, er den mest egnet for pasienter med tidlig stadium, lavrisiko papillær skjoldbruskkarsinom som ønsker minimal arrdannelse etter operasjonen. Suksessen til denne teknikken avhenger imidlertid av utøverens ferdigheter i endoskopiske prosedyrer på grunn av dens romlige begrensninger. Som sådan kan metoden ikke være egnet for utøvere uten avanserte endoskopiske ferdigheter eller de i medisinske sentre med begrenset tilgang til nødvendig utstyr.
Denne artikkelen tar sikte på å styrke forståelsen av GETTA-prosedyren, gi innsikt i søknaden, og forhåpentligvis fremme adopsjonen i flere medisinske sentre. Fordelene med GETTA strekker seg utover medisinsk effektivitet, og møter pasientenes ønske om mindre invasiv kirurgi med gunstige kosmetiske resultater.

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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>
		</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>
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		<tr>
			<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 pasienter med tidlig, lavrisiko papillær skjoldbruskkarsinom, velger et økende antall endoskopisk skjoldbruskkirurgi på grunn av sin evne til å oppnå gunstige terapeutiske resultater samtidig som de opprettholder gode kosmetiske resultater. Blant de tilgjengelige endoskopiske prosedyrene har Gasless Endoscopic Thyroidectomy Trans-axillary Approach (GETTA) blitt populær blant kirurger. Dette tilskrives den enkle hulromskonstruksjonen, det romslige driftsområdet, presis eksponering for synsfelt og håndterbar læringskurve. Imidlertid har få studier gitt detaljerte beskrivelser av de spesifikke kirurgiske trinnene som er involvert i GETTA. Med utgangspunkt i en syntese av eksisterende litteratur og vår egen kliniske ekspertise, presenterer vi en omfattende oversikt over GETTA-prosedyren. Denne prosessen kan kategoriseres i fem forskjellige stadier: posisjonering og snittplanlegging; etablering av kirurgiske hulrom; identifisering og beskyttelse av den tilbakevendende larynxnerven, nedre biskjoldbruskkjertel og sentral nakkedisseksjon; lokalisering og bevaring av nervus larynx superior, biskjoldbruskkjertelen superior og disseksjon av skjoldbruskkjertelens øvre pol; transeksjon av thyreoidea-eidet etterfulgt av en blokkreseksjon av glandula thyreoidea og lymfeknuter i sentralhalsen. Fem-trinns tilnærmingen til GETTA er lett å lære og kan tilpasses for å resektere både godartede og ondartede skjoldbruskkjertel- og parathyroidsykdommer.

I denne studien gjennomgikk en kohort på 200 kvinnelige pasienter, alle med en gjennomsnittsalder på 36 år (SD = 4,52; varierende fra 20 til 59 år), Gasless Endoscopic Thyroidectomy Trans-axillary Approach (GETTA) (tabell 1). Pasientene hadde en gjennomsnittlig kroppsmasseindeks (BMI) på 22,79 kg/m2 (SD = 4,52; spredning = 18,27-27,31). Sonogrammet indikerte en gjennomsnittlig tumorstørrelse på 7,09 mm (SD = 3,84). Alle pasientene ble fullt informert om de tilgjengelige kirurgiske alter...

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 protokollen presenterer prosedyren for å utføre skjoldbruskektomi ved bruk av gasless endoskopisk tyreoidektomi transaksillær tilnærming (GETTA).

Gasless endoskopisk tyreoidektomi via transaksillær tilnærming

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

De fem trinns tilnærming til GETTA er lett å lære og kan tilpasses for å dissekere både godartede og ondartede skjoldbrusk og parathyroid sykdommer. Denne teknikken gir betydelig forbedrede kosmetiske resultater. Det eliminerer karbondioksidgassinsufflasjonen, og bevarer funksjonen til den fremre livmorhalsregionen.Det er en levedyktig og sikker teknikk for pasienter med tidlig lav risiko papillær skjoldbruskkarsinom som ønsker å unngå et cervikal arr. For å begynne, plasser den bedøvede pasienten i en liggende stilling og bortfør overekstremiteten på den berørte siden til en 60 til 90 graders vinkel. Deretter gjør du et primært snitt på omtrent fire til seks centimeter i lengde ved hjelp av en skalpell.Deretter lager du et sekundært snitt på omtrent 0,5 centimeter ved hjelp av en kirurgisk skalpell for trokaren. Finn gapet mellom det sternale hodet til den sternale cleo mastoidmuskelen og kragebenhodet. Bruk miniknappen til ultralydskalpellen til å koagulere de små blodkarene i gapet.Bruk dissekere tang i ultralydskalpellen for å dissekere det anatomiske rommet mellom sternothyroidmuskelen og den indre jugularvenen. Dissekere det naturlige rommet mellom skjoldbruskkjertelen og sternothyroid muskelen. Plasser tilbaketrekkerne i rommet, og fullfør opprettelsen av de kirurgiske hulrommene.Finn den tilbakevendende larynxnerven rundt bifurkasjonen av den nedre skjoldbruskarterien ved hjelp av en nerveovervåkingssonde. Dissekere området rundt den nedre skjoldbruskkjertelarterien mens du beskytter og koagulerer de dårligere skjoldbruskblodkarene for å avsløre luftrøret. Etter koagulering og kutting av grenene til den nedre skjoldbruskarterien, følg nervebanen til strupehodet, og sørg for beskyttelse under disseksjonsprosessen.Utfør en sentral halsdisseksjonsmetode, som åpen kirurgi, og fjern lymfeknuter fra det sentrale rommet i nakken basert på omfanget av pasientens sykdom. Etter å ha separert den øvre polen i skjoldbruskkjertelen, fortsett separasjonsprosessen langs cricothyroid-rommet for å eksponere blodkarene i den øvre skjoldbruskstangen. Bruk miniknappen på ultralydskalpellen, koaguler og kutt forsiktig av blodkarene i skjoldbruskkjertelens øvre pol.Fullstendig dissociere gapet mellom skjoldbruskkjertelens øvre pol og cricothyroid muskelen. Bruk en ultralyd skalpell for å koagulere små blodkar. Fjern deretter både skjoldbruskkjertelen og lymfeknuter som ligger i det sentrale området langs skjoldbruskkjertelen.Samle prøven i prøveposen. Bruk en laparoskopisk aspirator, skyll operasjonshulen med varm steril saltvann. Plasser deretter et dreneringsrør nær luftrøret og bruk dissekerende tang for å lede røret ut fra armhulen.Lukk det aksillære snittet med en 30 centimeter avbrutt absorberbar 4,0 sutur. I denne studien gjennomgikk en kohort på 200 kvinnelige pasienter med en gjennomsnittsalder på 36 år den gassløse endoskopiske tyreoidektomi transaksillære tilnærmingen. Fem pasienter opplevde midlertidig tilbakevendende larynxnervesignalsvekkelse, etter operasjonen, som forsvant etter en måned.Det ble ikke observert tilfeller av varige residiverende larynxnerveskader. Tre pasienter krevde imidlertid konvertering til åpen kirurgi på grunn av intraoperativ blødning. Det er avgjørende å gjenkjenne og beskytte den tilbakevendende larynxnerven før kirurgisk inngrep som involverer koagulering eller kutting.Etter denne prosedyren kan paratyreoidektomi og lateral lymfeknutedisseksjon samtidig utføres med en prosedyre. Ved ytterligere forbedring kan denne teknikken lette total skjoldbruskektomi, parathyroidektomi og laterale lymfeknutedisseksjoner, i tillegg til å være tilpasningsdyktig for endoskopiske brystoperasjoner.

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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 Vessel Okklusjon<em&gt; Via</em&gt; Dobbel Ligatur 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.

Non-invasiv Vurdering av effekt av New Therapeutics for Intestinal Patologier Bruke Serial Endoskopisk Imaging av 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.

Steg-for-steg Stapedotomi gjennom transcanal eksklusiv endoskopisk tilnærming

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 kolesteatom 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 pankreatosplenektomi via dorsal-kaudal arterie tilnærming for bukspyttkjertelhals-kroppskreft

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 tyreoidektomi vestibulær tilnærming for thyroid 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 trinn-for-trinn-veiledning for eksklusiv endoskopisk ossikuloplastikk

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 i søkelyset: Fremme endoskopisk ossikuloplastikk – teknikker, innovasjoner og praktisk veiledning for klinisk integrasjon

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 for endoskopisk ossikuloplastikk

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 av lumbal spinal stenose med en minimalt invasiv ryggradskirurgi

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 av LE-ULBD som en trygg, effektiv og minimalt invasiv tilnærming for å behandle 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 ensidig tilnærming bilateral dekompresjon 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 ...