Thyroid surgery is one of the most common surgical procedures in general surgery, and thyroid disease is common in women. Conventional thyroid surgery leaves a “disfiguring” surgical scar on the neck, which causes a great psychological burden and pain to the patient. The endoscopic thyroid surgery is a minimally invasive procedure that does not leave a scar.
In 1997, Huscher et al. performed the first lumpectomy of the thyroid gland with satisfactory aesthetic results. The advent of this surgical approach can be considered a technical innovation in the history of thyroid surgery.
With the help of a high-definition camera, endoscopic minimally invasive thyroid surgery magnifies the image of the surgical operation area 6-10 times on the monitor, so that the lesion is displayed more clearly than with the naked eye, and every blood vessel, nerve, mass and surrounding conditions are displayed very clearly during the operation. This makes it easier to protect important nerves and blood vessels during surgery, and the operation can reach a level of refinement that cannot be achieved by traditional open surgery under the naked eye. As a result, the incidence of postoperative complications such as hoarseness and pharyngeal bleeding is correspondingly greatly reduced, and it is less likely that the thyroid tumor is not removed cleanly. In addition, the minimally invasive thyroid surgery does not cut through the skin of the neck and the broad neck muscle layer, which makes the neck area relatively closed and less likely to be infected after surgery.
At the same time, the absence of incision in the neck results in less exudation from the surgical area and much less post-operative adhesions, resulting in less post-operative pulling and pain than traditional surgery. Patients can be discharged from the hospital in 3 – 5 days after surgery, reducing the cost of hospitalization. Not only that, the biggest advantage of lumpectomy thyroid surgery is that there is no scar on the neck, so after lumpectomy thyroid surgery, patients can’t see the wound on their neck in summer no matter how low-necked they wear, and the cosmetic advantage is very obvious.
Minimally invasive endoscopic thyroid surgery still requires a surgical incision, just a smaller and more discreet one. Traditional thyroid surgery requires a horizontal incision in the neck, leaving an unsightly permanent surgical scar on the neck after surgery. The most common and mature minimally invasive thyroid surgery site is now three small incisions in the armpit or areola area, which are covered by natural folds or areolas after healing, and the incisions are only about 5-10 mm long (6-10 cm for traditional surgery), so you can’t even notice the surgical marks without looking closely.
One of the small incisions is placed into the camera probe, which is equivalent to the doctor’s eyes being extended, and the other two small incisions are placed into the precise slender instruments, which are equivalent to the doctor’s two hands becoming thin and elongated to be able to reach the position of the thyroid gland. This is combined with the use of ultrasonic knife to separate and cut the thyroid gland from a distance to stop bleeding, etc. The original neck incision is moved down to the part of the chest that is easily covered by clothes, achieving the cosmetic effect of no surgical scars on the neck.
Advantages of minimally invasive endoscopic thyroid surgery.
1. Image magnification: the tiny neurovascular can be clearly seen, which is equivalent to doing surgery under a magnifying glass.
2. Accurate anatomical level: with inflation, it is easy to find the lax gap for bloodless separation.
3. Accurate identification of nerves and parathyroid glands: with high definition, the recurrent laryngeal nerve is in a characteristic silvery-white cord shape, and the vascular network of parathyroid glands is very clear and easy to find and confirm.
4, meticulous and clear observation: the light can be adjusted in strength and weakness, and the lens can be adjusted near and far and rotated in multiple angles, which is very conducive to the detailed observation of tissue structure.
5.Precise vascular treatment: Using advanced ultrasonic knife to cut off blood vessels bloodlessly one by one, the tissue structure inside the wound will not be contaminated by blood.
6.No scar on the neck: no cut on the neck, cut on the chest wall or armpit, oral cavity and other parts, small and hidden incision.
7.Conventional surgical incision to cut the dermal nerve leads to postoperative neck discomfort and abnormal sensation without la;
8, no more psychological burden and inferiority complex for patients;
9, skilled doctors can complete the surgery in a very short time, the whole procedure can not see bleeding;
10. The recovery of the patient after the surgery is smoother and faster, and the hospital stay is significantly shorter.
Of course, we can’t keep talking about the advantages, everything is accompanied by disadvantages, and lumpectomy thyroid surgery is also the same: 1.
1. Although there is no skin incision, it is necessary to separate the surgical space under the skin in front of the chest, and the subcutaneous trauma is relatively large;
2, the surgery uses some high-end medical equipment such as lumpectomy, ultrasonic knife, hemostatic clamps and other equipment materials, which will increase medical costs;
3. High requirements for surgeons, not only rich experience in traditional thyroid surgery, but also proficient endoscopic surgery skills are required;
4. A small percentage of patients with unsuccessful endoscopic thyroid surgery need to change to traditional thyroid surgery.
5. Some patients cannot use this surgical approach, such as those with a history of surgery in the thyroid area of the neck, huge thyroid masses, inflammatory lesions with infiltrative growth and malignant tumors that locally invade important vascular nerves in the neck.
Open neck surgery has a slightly smaller separation area than lumpectomy, but it continues the traumatic neck incision long after surgery or even for life, causing long trauma and pain to many patients, especially young women. In terms of overall physical and psychological recovery assessment after surgery, lumpectomy thyroid surgery is minimally invasive, which is the vitality of endoscopic surgery.
Minimally invasive is the trend of surgical development in this century, and thyroid surgery is also undergoing the same course of minimally invasive endoscopic development. In recent years, lumpectomy thyroid surgery has been developed to the extent that 90% of all thyroid surgeries (including radical thyroid cancer treatment and cervical lymph node dissection) can now be performed. However, it is still lagging behind in Shanxi, not only in terms of technology, but also in terms of philosophy and conservatism.
In conclusion, minimally invasive endoscopic thyroid surgery offers patients a new surgical treatment option that can achieve the “original neck”.
With the support of the operating room of the Department of Anesthesiology, the Department of General Surgery has successfully completed nearly 30 cases of minimally invasive endoscopic thyroid surgery without complications such as postoperative bleeding or subcutaneous emphysema, and all of them were successfully discharged from the hospital. Our endoscopic minimally invasive thyroid surgery is currently the most successful and the most performed in the province, ranking among the leading hospitals in the province.