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Minimally invasive endoscopic parathyroidectomy

WebSurg是個虛擬大學，可在世界各地透過網路取得。我們的目標是提供外科醫師、科學協會及醫學產業第一個腹腔鏡及其最新發展之線上持續醫學教育的平台，包括NOTES和機器人手術。

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Minimally   invasive   endoscopic   parathyroidectomy

作者群
BW Inabnet
關鍵字
parathyroidectomy,hyperparathyroidism,minimally invasive,video-assisted surgery
媒體類型
期間
06'00''
刊物
2005-05
普通的
最愛
Favorites Media
音訊
en
副標題
en
數位出版
WeBSurg.com, May 2005;5(05).
URL: http://www.websurg.com/doi-vd01en1793.htm

Minimally   invasive   endoscopic   parathyroidectomy

3. Skin access and optical positioning 01'35''
And at the sternal notch there’s a 5mm trocar through which the camera is inserted. We’re looking right at the adenoma and this approach is very nice because you get the benefit of gliding from the video endoscope and also the benefit of a very small incision. Here’s the adenoma we think we’ve not dissected at all yet and this is probably the nerve and this is deep in the retro-esophageal space, we’re behind the esophagus here. And I think that through a small incision it’s very difficult to see unless you make a larger incision. We’ll better demonstrate the nerve in just a moment. The thyroid is up here. We’re behind the thyroid and the esophagus. This is the esophagus underneath the retractor. There’s the adenoma and the nerve is there. We’re going to dissect out the adenoma. Why do you stop the lateral approach? With the insufflation, it was difficult to maintain a working space and this actually demonstrates why the endoscopic approach is not recommended in most cases. This is the nerve right here. Hopefully this is demonstrating the benefit of having a video-endoscopic approach. It’s a big adenoma and it’s very deep and if you’re doing a conventional approach and even if it’s a focused approach and you make your incision in the middle of the neck, you have to make a very large incision to get to the adenoma. I’m going to work away towards the pedicle. However, I often will do a mini-open lateral approach but even then it’s still sometimes hard to see the nerve. This way actually, you have the advantage of both. Here’s the pedicle of the adenoma here. You can see the nerve very nicely and also if things are not going well, you can simply enlarge the incision and still do an open-focused approach. Here’s the pedicle of the adenoma, let’s see if we can find the nerve. The nerve is going to be medial right there. You can see it running underneath.