重庆市技术创新与应用开发总项目（批准号）CSTC2019jscx-msxmX0196）。

本研究遵循陆军医科大学人类研究伦理委员会的指导方针。研究中提到的所有患者都签署了知情同意书。
1. 术前准备
<ol><li>鼻气管插管成功后，将患者仰卧位，头部和颈部过度伸展。</li>
	<li>让眼睛自然闭上。涂抹眼膏，并用适当的眼罩或手术贴覆盖从眉骨顶部到鼻侧的区域，以防止消毒剂、血液和其他液体流入眼睛。</li>
	<li>用棉球填充两个外耳道，以防止消...

<ol>
	<li>Shimazu, 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=Endoscopic+thyroid+surgery+through+the+axillo-bilateral-breast+approach.">Endoscopic thyroid surgery through the axillo-bilateral-breast approach.</a> Surgical Laparoscopy, Endoscopy &amp; Percutaneous Techniques. 13 (3), 196-201 (2003).</li><li>Ikeda, Y., Takami, H., Niimi, M., Kan, S., Sasaki, Y., Takayama, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+thyroidectomy+by+the+axillary+approach.">Endoscopic thyroidectomy by the axillary approach.</a> Surgical Endoscopy. 15 (11), 1362-1364 (2001).</li><li>Alabbas, H., Bu Ali, D., Kandil, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+retroauricular+thyroid+surgery.">Robotic retroauricular thyroid surgery.</a> Gland Surgery. 5 (6), 603-606 (2016).</li><li>Witzel, K., von Rahden, B. H. A., Kaminski, C., Stein, H. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transoral+access+for+endoscopic+thyroid+resection.">Transoral access for endoscopic thyroid resection.</a> Surgical Endoscopy. 22 (8), 1871-1875 (2008).</li><li>Benhidjeb, T., Wilhelm, T., Harlaar, J., Kleinrensink, G. -. J., Schneider, T. A. J., Stark, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Natural+orifice+surgery+on+thyroid+gland:+totally+transoral+video-assisted+thyroidectomy+(TOVAT):+report+of+first+experimental+results+of+a+new+surgical+method.">Natural orifice surgery on thyroid gland: totally transoral video-assisted thyroidectomy (TOVAT): report of first experimental results of a new surgical method.</a> Surgical Endoscopy. 23 (5), 1119-1120 (2009).</li><li>Wilhelm, T., Metzig, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Video.+Endoscopic+minimally+invasive+thyroidectomy:+first+clinical+experience.">Video. Endoscopic minimally invasive thyroidectomy: first clinical experience.</a> Surgical Endoscopy. 24 (7), 1757-1758 (2010).</li><li>Park, J. O., Sun, D. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transoral+endoscopic+thyroidectomy:+our+initial+experience+using+a+new+endoscopic+technique.">Transoral endoscopic thyroidectomy: our initial experience using a new endoscopic technique.</a> Surgical Endoscopy. 31 (12), 5436-5443 (2017).</li><li>Clark, J. H., Kim, H. Y., Richmon, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transoral+robotic+thyroid+surgery.">Transoral robotic thyroid surgery.</a> Gland Surgery. 4 (5), 429-434 (2015).</li><li>Richmon, J. D., Pattani, K. M., Benhidjeb, T., Tufano, R. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transoral+robotic-assisted+thyroidectomy:+a+preclinical+feasibility+study+in+2+cadavers.">Transoral robotic-assisted thyroidectomy: a preclinical feasibility study in 2 cadavers.</a> Head &amp; Neck. 33 (3), 330-333 (2011).</li><li>Wilhelm, T., Metzig, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+minimally+invasive+thyroidectomy+(eMIT):+a+prospective+proof-of-concept+study+in+humans.">Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans.</a> World Journal of Surgery. 35 (3), 543-551 (2011).</li><li>Nakajo, 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=Trans-oral+video-assisted+neck+surgery+(TOVANS).+A+new+transoral+technique+of+endoscopic+thyroidectomy+with+gasless+premandible+approach.">Trans-oral video-assisted neck surgery (TOVANS). A new transoral technique of endoscopic thyroidectomy with gasless premandible approach.</a> Surgical Endoscopy. 27 (4), 1105-1110 (2013).</li><li>Anuwong, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transoral+endoscopic+thyroidectomy+vestibular+approach:+a+series+of+the+first+60+human+cases.">Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases.</a> World Journal of Surgery. 40 (3), 491-497 (2016).</li><li>Kim, 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=Transoral+robotic+thyroidectomy:+lessons+learned+from+an+initial+consecutive+series+of+24+patients.">Transoral robotic thyroidectomy: lessons learned from an initial consecutive series of 24 patients.</a> Surgical Endoscopy. 32 (2), 688-694 (2018).</li><li>Kim, H. Y., Park, D., Bertelli, A. A. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+pros+and+cons+of+additional+axillary+arm+for+transoral+robotic+thyroidectomy.">The pros and cons of additional axillary arm for transoral robotic thyroidectomy.</a> World Journal of Otorhinolaryngology - Head and Neck Surgery. 6 (3), 161-164 (2020).</li><li>Park, D., 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=Robotic+versus+endoscopic+transoral+thyroidectomy+with+vestibular+approach:+A+literature+review+focusing+on+differential+patient+suitability.">Robotic versus endoscopic transoral thyroidectomy with vestibular approach: A literature review focusing on differential patient suitability.</a> Current Surgery Reports. 10, 133-139 (2022).</li><li>Park, D., 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=Institutional+experience+of+200+consecutive+papillary+thyroid+carcinoma+patients+in+transoral+robotic+thyroidectomy+surgeries.">Institutional experience of 200 consecutive papillary thyroid carcinoma patients in transoral robotic thyroidectomy surgeries.</a> Head &amp; Neck. 42 (8), 2106-2114 (2020).</li></ol>

作者声明不存在利益冲突。

一些学者报道了经口机器人甲状腺手术。在Kim的一系列TORT研究中，作者在自动化平台上使用了四个机械臂来执行TORT程序。第四只手臂通过经腋窝切口使用，主要用于牵引带带肌肉，并且该通道还用于提取标本并在需要时放置引流管13,14。
在这种三端口机器人方法中，一个约8毫米的横切口位于下唇韧带上方，两侧约8毫米长的纵向切...

甲状腺外科医生使用不同的手术方法（双侧腋窝乳房入路 1 [图 1]、腋窝入路 2 [图2]、耳后入路 3 [图 3] 等）来隐藏手术切口并实现颈部无疤痕甲状腺手术。然而，这些技术都无法完全避免患者皮肤表面的疤痕。在所有方法中，只有口腔前庭入路（图4）可以实现最短的皮瓣分离距离，在整个身体表面不留下疤痕4,5,6。近年来，自然口腔内窥镜手术（NOTES）7已被引入口腔甲状腺手术。
通过这种方法进行的甲状腺手术可以通过内窥镜或机器人手术系统完成。与甲状腺手术的内窥镜手术系统相比，该机器人系统具有放大的三维高清视野和可旋转的机械手腕，能够直观地运动，使外科医生在进行令人满意的手术时更加灵活8,9。这项创新技术的好处包括微创解剖和双甲状腺的通道10,11,12。然而，口腔甲状腺切除术通常需要腋窝辅助切口才能完成手术。为了达到最终的美容效果，我们的外科团队深入研究了无腋窝切口的口腔三孔机器人甲状腺切除术治疗早期状甲状腺癌的可行性。
本文介绍了机器人手术系统在完成口腔甲状腺切除术和双侧中央淋巴结清扫术中的应用。此外，成功完成了无腋窝切口和中央区域淋巴结清扫术的三端口机器人甲状腺切除术，证明了这种方法的可行性和安全性。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>4-0 absorbable sutures</td>
			<td>Covidien</td>
			<td>VLOCM0023</td>
			<td>Suture the linea alba cervicalis&#160;</td>
		</tr>
		<tr>
			<td>5-0 Polyglactin braided absorbable suture</td>
			<td>Johnson &#38; Johnson</td>
			<td>VCP433H</td>
			<td>Oral mucosa suture</td>
		</tr>
		<tr>
			<td>8 mm Cadiere forceps&#160;</td>
			<td>Intuitive Surgical, Inc</td>
			<td>LOT N10210823</td>
			<td>Clamp tissue</td>
		</tr>
		<tr>
			<td>8 mm Harmonic ACE scalpel&#160;</td>
			<td>Intuitive Surgical, Inc</td>
			<td>REF 480275</td>
			<td>Coagulation, expand operating space</td>
		</tr>
		<tr>
			<td>8 mm Maryland bipolar forceps&#160;</td>
			<td>Intuitive Surgical, Inc</td>
			<td>LOT K10210830 REF 470172</td>
			<td>Expose the recurrent laryngeal nerve</td>
		</tr>
		<tr>
			<td>8 mm Monopolar curved scissors</td>
			<td>Intuitive Surgical, Inc</td>
			<td>LOT K10211108 REF 470179</td>
			<td>Fine capsular anatomy</td>
		</tr>
		<tr>
			<td>Carbon Nanoparticles Suspension Injection</td>
			<td>Chongqing Laimei Pharmaceutical Co., Ltd</td>
			<td>N/A</td>
			<td>1 mL/50 mg; used for tracing regional drainage lymph nodes.</td>
		</tr>
		<tr>
			<td>Da Vinci Xi Surgical System</td>
			<td>Intuitive Surgical, Inc</td>
			<td>Xi</td>
			<td>Surgical system</td>
		</tr>
		<tr>
			<td>Endoscopy surgical specimen setrieval bag</td>
			<td>Hangzhou Kangji Medical Equipment Co.Ltd.</td>
			<td>LOT 22021921 REF 104Y.111</td>
			<td>Remove specimens from air cavity</td>
		</tr>
		<tr>
			<td>Medical pressure garment</td>
			<td>Foshan qiaoke bio technology Co.Ltd.</td>
			<td>20200149</td>
			<td>Pressure dressing of the anterior neck area of the mandible</td>
		</tr>
	</tbody>
</table>

transoral robotic total thyroidectomy and bilateral central regional lymph node dissection for papillary thyroid carcinoma

目前，常见的甲状腺手术方法包括常规甲状腺切除术、双侧腋窝-乳腺、腋窝、耳后和口腔前庭入路。从本质上讲，各种甲状腺手术方法只能将传统的手术切口移动到更隐蔽的位置，但仍会在体表留下疤痕。其中，通过口腔前庭入路的甲状腺手术可以通过最短的自然腔获得最佳的美容效果。然而，在早期，通过口腔前庭入路进行的甲状腺手术通常需要在口腔中切开三个切口和一个腋窝切口。我们通过口腔前庭入路将机器人手术系统引入甲状腺切除术，并成功完成了甲状腺全切除术和双侧中央淋巴结清扫术。手术过程中，口腔前庭只做了三个切口，没有腋窝切口。本文旨在介绍独特的三端口口腔前庭机器人甲状腺切除术治疗甲状腺状癌患者的方法。

平均手术时间~253 min（最短时间：205 min，最长时间：300 min），平均失血量~20 mL（最小失血量：10 mL，最大失血量：50 mL）。拔除引流管至引流量降至30mL/d以下，患者术后2-3天出院。 图 12 显示了 4 名患者术后 1 个月的随访图像。图像显示患者身上没有手术疤痕。4例患者的临床资料见 表1。
<img alt="Figure 1" class="x...

Watch this Scientific Journal Video about Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma at JoVE.com

Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma

经口机器人甲状腺全切除术和双侧中央区淋巴结清扫术，使用三个端口，无需腋窝切口，对于早期甲状腺状癌是可行且安全的。在这里，我们介绍了该操作的操作技术。

经口机器人甲状腺全切除术和双侧中央区域淋巴结清扫术治疗甲状腺状癌

Currently, the common approaches to thyroid surgery include conventional thyroidectomy, bilateral axillo-breast, axillary, retroauricular, and oral ...

本研究描述了一种新型经口前庭机器人甲状腺切除术，无需腋窝开口，用于治疗甲状腺状癌。在这项研究中，使用机器人手术系统通过口腔前庭入路进行甲状腺全切除术和双侧中央淋巴结清扫术。首先，使用超声波手术刀将皮瓣向下分离到锁骨。双侧延伸至胸骨锁乳突肌前缘。接下来，使用单极弯曲剪刀将白色颈线和部分带状肌肉分开，从而使甲状腺部分暴露。使用 25 号注射器，将 0.1 毫升碳纳米颗粒悬浮液注射到甲状腺实质中以可视化甲状旁腺。然后使用超声刀释放横纹肌。使用 4-O 可吸收缝合线，悬吊横纹肌缝合线以获得清晰的手术可视化。注射一毫升吲哚菁绿后，切换到自动荧光成像模式，以生动地表示荧光甲状旁腺与非荧光淋巴结的对比。使用超声刀，切开甲状腺上极的血管，同时保护和定位甲状旁腺。然后使用弯曲的双极镊子进行将甲状旁腺保存在其自然位置的复杂过程。现在将喉神经定位在由内侧甲状旁腺、甲状腺和喉肌形成的三角形区域内。揭开喉返神经的喉部入口。启动排烟装置以清除肿块切除术期间出现的任何渗出物和血液。保持晶状体和手术区域的清洁，以确保在手术过程中准确暴露和保护喉返神经。开始预防性单侧颈中央清扫术。进行对侧半甲状腺切除术和同侧中央淋巴结预防性清扫术。将所有切除的组织转移到标本袋中并继续取出。接下来，用生理盐水冲洗伤口。通过宫颈穿刺孔将负压引流管插入甲状腺床。采用 4-O 可吸收倒钩缝合线连续缝合带状肌肉。手术后一个月对四名患者的随访图像显示，患者身上没有手术疤痕。使用三孔法是四孔法通过口腔前庭入路进行甲状腺手术的安全可靠的替代方案。

transoral-robotic-total-thyroidectomy-bilateral-central-regional

Research

JoVE Journal

Medicine

580 Views.  Army Medical University (Third Military Medical University). This study describes a novel transoral vestibular robotic thyroidectomy without axillary opening for the treatment of papillary thyroid carcinoma. In this study, a robotic surgical system was used to perform total thyroidectomy and bilateral central lymph node dissection via an oral vestibular approach. To begin, use an ultrasonic scalpel and separate the flap downward towards the clavicle.Extending bilaterally to the anterior border of the sternal cleidomastoid muscle. Next, use unipo...