Transoral endoscopic thyroidectomy (구강 접근 갑상선 내시경 수술)

 

 

 

Transoral endoscopic thyroidectomy

-적응증: 갑상선암 (thyroid cancer)

-transoral endoscopic thyroidectomy is a recent advance

-aims : scar-free surgery

-trans-axillary approach 는 chest 의 dissection이 가해지는데, 이 보다 minimal 한 dissection을 얻을 수 있다.

 

 

 

 

1.set

new package + GS Minor + GB SET (dilator)

 

 

 

 

2.setting

lithotomy position 사이에 monitor setting

skin pre - betadine + hibitane 0.05

 

 

 

 

 

3.준비물품

RM7 - 10mm 30도 + light cable +  CO2 Line + CO2 Line extension + 보온병 + sani sleeve

Trocar - saft pass 10mm, R5 2ea

부속 - pf. 안 lapa set , bovie lapa 용 blue tip, harmonic 신형 36cm, endo dissector hook type

로봇 물품 - kelly, tunneler

 

15mess , marker, 무영등, glove, gause, lap bag small, 10cc srynge(*2)

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suture material

-4/0vicryl

-3/0nylon

-steri-strip 소​

-6/0nylon

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dressing

-meplex 2cm​

 

 

 

 

 

4.intra op

guidix tip + guadix 3g

green plast tip + green plast 2ml

n/s 500ml + epi 1cc + veress needle - injection

 

 

 

 

 

5.procedure

 

 

 

1)Oral cavity irrigtaion

종지+0.05% hibitan irrigation

2)marker design

 

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The approach was through the inferior vestibule of the oral cavity.

where the ports were placed and included one midline safe pass 10 mm camera port

and two lateral R5 5 mm working ports by using 15mess 

->mosq,criel dissection

->CO2 on

->Trocar temporary fixation by 3-0nylon

3)The sub-platyssmal plane was entered and dissected.

The deep fascia was opened in the midline and strap muscles retracted.

The isthmus of the thyroid gland was identified and divided.

The superior and inferior pedicles on the left side were identified and divided

by Harmonic scapel, bovie, endo dissector hook type

Recurrent laryngeal nerve was identified and preserved 

nerve check by using nerve stimulator

Hemostasis was secured.

The left lobe was brought out through the oral cavity using an endobag.

The deep fascia was closed using 4-0 vicryl

and the vestibular port sites were closed in layers using  4-0 vicryl

 

 

6.op table setting

 

 

 

7.Reference

vishwanath M pai 외. transoral endoscopic thyroidectomy : A case report . 2015 volume 12

 

 

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