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

Este estudo foi conduzido em estrita conformidade com os princípios éticos delineados na Declaração de Helsinque e seguiu as diretrizes estabelecidas pelo Comitê de Ética em Pesquisa com Seres Humanos de nossa instituição. O protocolo de pesquisa passou por uma revisão completa e recebeu aprovação do Comitê de Ética do West China Hospital da Universidade de Sichuan. Todos os pacientes participantes assinaram o termo de consentimento livre e esclarecido antes de seu envolvimento no estudo, e medidas rigorosas...

<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>

A abordagem transaxilar da tireoidectomia endoscópica gasosa (GETTA) é um novo método cirúrgico que aborda a crescente incidência de microcarcinoma papilífero da tireoide (CMPT) enquanto produz resultados esteticamente agradáveis 14,15,16. No entanto, essa técnica requer um profundo conhecimento das principais etapas operacionais17. Antes de iniciar a cirurgia propriamente dita, espera-se que os c...

O recente aumento da incidência do microcarcinoma papilífero de tireoide (CMPT)1,2, acometendo predominantemente mulheres jovens, exige avanços nas técnicas cirúrgicas que ofereçam eficácia médica e sensibilidadeestética3,4. O objetivo primário da Abordagem Transaxilar de Tireoidectomia Endoscópica Sem Gás (GETTA), introduzida por Chung em 20045, é fornecer um método cirúrgico ideal que combine essas duas necessidades.
O GETTA foi desenvolvido como uma resposta às desvantagens da cirurgia aberta tradicional, como cicatrizes perceptíveis que levam à autoconsciência dos pacientes e potencial impacto negativo em suas atividades laborais e sociais. A cirurgia endoscópica da tireoide tem sido gradualmente aplicada no tratamento das doenças tireoidianas benignas e malignas 3,4, oferecendo uma alternativa menos invasiva à cirurgia aberta. No entanto, a inovação do GETTA reside na sua abordagem única sem gás. O procedimento GETTA apresenta várias vantagens sobre as técnicas alternativas. Estabelece a cavidade através das pregas naturais da axila, tornando a incisão oculta e proporcionando resultados cosméticos pós-operatórios superiores6. Além disso, o GETTA omite a necessidade de insuflação do gás CO2 durante a operação, evitando complicações relacionadas ao gás CO2. Além disso, essa abordagem deixa intacto o retalho cervical anterior, o que protege a função da região cervical anterior no pós-operatório e impede a ligação pele-traqueal pós-operatóriada deglutição6,7.
A técnica situa-se no corpo mais amplo da literatura sobre cirurgia endoscópica da tireoide. Embora existam amplos relatos de pesquisas sobre a abordagem transoral e mamária da cirurgia endoscópica da tireoide 8,9, a cirurgia não inflável da tireoide permanece subnotificada10,11. Consequentemente, este método constitui uma contribuição significativa para este campo, fornecendo um protocolo abrangente para o procedimento GETTA.
Para os leitores que contemplam a aplicação deste método, ele é mais indicado para pacientes com carcinoma papilífero de tireoide em estágio inicial, de baixo risco, que desejam cicatrizes mínimas no pós-operatório. No entanto, o sucesso desta técnica depende da proficiência do profissional em procedimentos endoscópicos devido às suas limitações espaciais. Como tal, o método pode não ser apropriado para profissionais sem habilidades endoscópicas avançadas ou aqueles em centros médicos com acesso limitado ao equipamento necessário.
Este artigo visa reforçar a compreensão do procedimento GETTA, oferecendo insights sobre sua aplicação e, esperançosamente, promovendo sua adoção em mais centros médicos. Os benefícios do GETTA vão além da eficácia médica, atendendo ao desejo dos pacientes por cirurgias menos invasivas com resultados estéticos favoráveis.

<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

Para pacientes com carcinoma papilífero precoce e de baixo risco da tireoide, um número crescente está optando pela cirurgia endoscópica da tireoide devido à sua capacidade de alcançar resultados terapêuticos favoráveis, mantendo excelentes resultados cosméticos. Dentre os procedimentos endoscópicos disponíveis, a Abordagem Transaxilar da Tireoidectomia Endoscópica sem Gás (GETTA) tem ganhado popularidade entre os cirurgiões. Isso é atribuído à sua construção de cavidade direta, área de operação espaçosa, exposição precisa do campo visual e curva de aprendizado gerenciável. No entanto, poucos estudos forneceram descrições detalhadas dos passos cirúrgicos específicos envolvidos no GETTA. Baseando-nos em uma síntese da literatura existente e de nossa própria experiência clínica, apresentamos um esboço abrangente do procedimento GETTA. Esse processo pode ser categorizado em cinco etapas distintas: posicionamento e planejamento da incisão; estabelecimento de cavidades cirúrgicas; identificação e proteção do nervo laríngeo recorrente, glândula paratireoide inferior e esvaziamento cervical central; localização e preservação do nervo laríngeo superior, glândula paratireoide superior e dissecção do polo superior da tireoide; Transecção do istmo tireoidiano seguida de ressecção em bloco da glândula tireoide e linfonodos cervicais centrais. A abordagem em cinco etapas do GETTA é fácil de aprender e pode ser adaptada para a ressecção de doenças benignas e malignas da tireoide e paratireoide.

Neste estudo, uma coorte de 200 pacientes do sexo feminino, todas com idade média de 36 anos (DP = 4,52; variando de 20 a 59 anos), foi submetida à Abordagem Transaxilar de Tireoidectomia Endoscópica sem Gás (GETTA) (Tabela 1). Os pacientes apresentaram Índice de Massa Corporal (IMC) médio de 22,79 kg/m2 (DP = 4,52; variação = 18,27-27,31). A ultrassonografia indicou tamanho médio do tumor de 7,09 mm (DP = 3,84). Todos os pacientes foram totalmente informados sobre as opções cirúrg...

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

Este protocolo apresenta o procedimento para a realização da tireoidectomia por via transaxilar gasosa endoscópica da tireoidectomia (GETTA).

Tireoidectomia endoscópica sem gás por via transaxilar

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

A abordagem dos cinco passos do GETTA é fácil de aprender e pode ser adaptada para dissecar doenças benignas e malignas da tireoide e paratireoides. Esta técnica oferece resultados cosméticos significativamente melhorados. Elimina a insuflação do gás carbônico e preserva a função da região cervical anterior.É uma técnica viável e segura para pacientes com carcinoma papilífero de tireoide de baixo risco precoce que desejam evitar uma cicatriz cervical. Para começar, coloque o paciente anestesiado em decúbito dorsal e abduzir o membro superior do lado afetado em um ângulo de 60 a 90 graus. Em seguida, faça uma incisão primária de aproximadamente quatro a seis centímetros de comprimento com bisturi.Em seguida, crie uma incisão secundária de cerca de 0,5 centímetros usando um bisturi cirúrgico para o trocarte. Localizar o espaço entre a cabeça esternal do músculo cleomastóideo esternal e a cabeça da clavícula. Usando o mini botão do bisturi ultra-sônico, coagule os pequenos vasos sanguíneos dentro da lacuna.Empregar pinça dissecante no bisturi ultrassônico para dissecar o espaço anatômico entre o músculo esternotireoidismo e a veia jugular interna. Dissecção do espaço natural entre a tireoide e o músculo esternotireoideo. Posicione os afastadores dentro do espaço e complete a criação das cavidades cirúrgicas.Localizar o nervo laríngeo recorrente ao redor da bifurcação da artéria tireoidiana inferior usando uma sonda de monitoração do nervo. Dissecar a área ao redor da artéria tireoidiana inferior enquanto protege e coagula os vasos sanguíneos inferiores da tireoide para expor a traqueia. Após coagular e cortar os ramos da artéria tireoidiana inferior, seguir o trajeto do nervo até a laringe, garantindo sua proteção durante o processo de dissecção.Realizar um método de esvaziamento cervical central, como cirurgia aberta, e remover os gânglios linfáticos do compartimento central do pescoço com base na extensão da doença do paciente. Depois de separar o polo superior da glândula tireoide, continue o processo de separação ao longo do espaço cricotireoideo para expor os vasos sanguíneos do polo tireoidiano superior. Usando o mini botão do bisturi ultra-sônico, coagular e cortar cuidadosamente os vasos sanguíneos do polo superior da glândula tireoide.Dissociar completamente a lacuna entre o polo superior da glândula tireoide e o músculo cricotireoideo. Utilize um bisturi ultra-sônico para coagular pequenos vasos sanguíneos. Em seguida, remova o istmo da tireoide e os gânglios linfáticos localizados na área central ao lado da glândula tireoide.Recolher o espécime no saco do espécime. Usando um aspirador laparoscópico, lave a cavidade de operação com soro fisiológico estéril quente. Em seguida, posicione um tubo de drenagem próximo à traqueia e use pinça dissecante para guiar o tubo para fora da axila.Fechar a incisão axilar com sutura absorvível 4.0 interrompida de 30 centímetros. Neste estudo, uma coorte de 200 pacientes do sexo feminino com idade média de 36 anos foi submetida à abordagem transaxilar de tireoidectomia endoscópica sem gás. Cinco pacientes apresentaram enfraquecimento temporário do sinal do nervo laríngeo recorrente, no pós-operatório, que se resolveu após um mês.Não foram observados casos de lesão permanente do nervo laríngeo recorrente. Entretanto, três pacientes necessitaram de conversão para cirurgia aberta devido ao sangramento intraoperatório. É fundamental reconhecer e proteger o nervo laríngeo recorrente antes de qualquer intervenção cirúrgica que envolva coagulação ou corte.Após esse procedimento, a paratireoidectomia e a dissecção lateral do linfonodo podem ser realizadas concomitantemente com um procedimento. Com maior refinamento, essa técnica pode facilitar a tireoidectomia total, a paratireoidectomia e as dissecções linfonodais laterais, além de ser adaptável para cirurgias endoscópicas da mama.

gasless-endoscopic-thyroidectomy-via-the-trans-axillary-approach

Research

JoVE Journal

Medicine

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 oclusão vascular cerebral<em&gt; Via</em&gt; Dupla ligadura e transecção

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

Medicina

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.

Avaliação não invasiva da eficácia de novos Therapeutics para Intestinal Patologias Usando imagem endoscópica série da Vivo Ratos

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.

Stapedotomia passo-a-passo através da abordagem endoscópica exclusiva transcanal

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.

Cirurgia endoscópica de Cholesteatoma

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.

Pancreatosplenectomia modular radical anterógrada laparoscópica via abordagem da artéria dorsal-caudal para câncer pancreático do pescoço-corpo

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.

Tireoidectomia Endoscópica Transoral Abordagem Vestibular para Lobectomia Tireoidiana

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>Um guia passo a passo abrangente para ossiculoplastia endoscópica exclusiva

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>Autor em destaque: Avançando na ossiculoplastia endoscópica - técnicas, inovações e orientações práticas para integração clínica

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.

Técnicas de Ossiculoplastia Endoscópica

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>Tratamento da estenose espinhal lombar com uma cirurgia minimamente invasiva da coluna vertebral

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>Autor em destaque: Escopo do LE-ULBD como uma abordagem segura, eficaz e minimamente invasiva para tratar a estenose espinhal lombar

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.

Descompressão bilateral endoscópica percutânea de abordagem unilateral para estenose espinhal lombar

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