CC BY
20
II. ХИРУРГИЯ
UDC 616.441-006.5-089.87
VIDEO-ASSISTED THYROID RESECTION FOR NODULAR GOITER
ABOUT THE AUTHORS
Arzykulov Zhetkergen Anesovich - General Director of JSC «NSCS named after A.N. Syzganov», dr. med., professor, academician of NAS RK;
Shokebayev Adil Abayevich - head of the department of surgery of the gastrointestinal tract and endocrine organs of the NSCS named after A.N. Syzganov, a high level certificate physician, surgeon
Key words
nodular goiter, thyroidectomy, glands, laryngeal nerve, lymph nodes.
Arzykulov Zh.A., Zhuraev Sh.Sh., Shokebayev A.A., Imammyrzayev N.Ye., Lee A.I., Aliev A.K.
National Scientific Center of Surgery named after A.N. Syzganov, Almaty
Abstract
Background. The aim of our study was to improve results of surgical treatment for patients with nodular goiter. And also we evaluated cosmetic effect, intraoperative and postoperative complications, such as bleeding, pain and length of hospital stay.
Materials and methods. This technology was invaded in our center in cooperation with Japanese colleagues in 2013. Between April 2013 and August 2014, 6 patients with nodular goiter underwent videoassisted subtotal hemithyroidectomy. Treatment outcome was evaluated, including surgical complications, quality of life and patient satisfaction with the surgical result.
Results. All patients were operated on using a video-assisted technique, with some modifications depending on time and experience. There were no conversions to open surgery. All patients were satisfied with the surgical results, particularly regarding the placement of the surgical scars.
Conclusion. Video assisted thyroidectomy is an alternative to traditional intervention, can be performed in clinical practice for thyroid nodules in an adequate amount with observance of all safety regulations.
Туйш сездер
ryéiH жемсауы, тиреоидэк-томия, бездер, квмей нерв1, лимфалык тушндер.
Бейне аркылы керш отырып колдау кезшде тушн жемсауына калканбездщ резекциялауы
Арзьщулов Ж.Э., Жураев Ш.Ш., Шекебаев A.A., Имаммырзаев Н.Е., Ли А.И., Алиев А.К.
А.Н. Cbi3f3H0B атындаш Улттык, шлыми хирургиялык, орталыш, Алматы Ацдатпа
Тацырыптьщ квкейкестю. Eiçâiœ зерттеудн максаты туйн жемсауына шалдыккан хирургиялык ауруларды емдеу нэтижeлepiн жаксарту болды. Сондай-ак косметикалык эсepiн, интраоперациялык пен операциядан кейшп канкету, ауырсыну жэне стационарда жату мepзiмiнiн созылып кетуi сиякты аскынуларды багаладык.
Материалдар мен эд'стер'!. Б±л технология 2013 жылы жапон эpiптeстepiмiзбeн бipгe ынтымакстастыкта жумыс стеу кезнде бiздiн орталыгымызга енпзш^. 2013 жылдын сэуip айынан ба-стап 2014 жылдын, тамыз айына дейшп мерз'шнде туйш жемсауына шалдыккан 6 пациент усынылган идеясын колдануымен субтотальды гемитиреоидэктомия емн алды. Емдеу нэтижeлepiнe, сонын Шнде хирургиялык аскынуларына, пациенттердн вмip суру сапасы мен канагаттанарлыгына бага бер^i.
Нэтижелер1. Барлык пациенттерге уакыты мен тэжipибeсiнe катысты кeйбip взгepiстepiмeн бейне технологияны колдануымен опеациялар жасалды. Ашык хирургияда ешкандай взгерстер болмаган. Барлык пациенттер, эаресе хирургиялык тыртыктарына катысты, хирургиялык нэтижeлepiнe кзнагаттанды.
Цорытынды. Бейне тиреоидэктомиясы балама дэстурл'1 хирургиялык араласу болып табылады, кау 'пс 'здк техниканын барлык epeжeлepiнiн сакталуымен балама санында калканбез тyйiнiнiн пайда болуы уш 'н клиникалык тэжipибeдe колдануга болады.
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ВЕСТНИК ХИРУРГИИ КАЗАХСТАНА № 1-2015
Резекция щитовидной железы для узлового зоба при видео поддержки
Арзыкулов Ж.А., Жураев Ш.Ш., Шокебаев A.A., Имаммырзаев Н.Е., Ли А.И., Алиев А.К.
Национальный научный центр хирургии имени А.Н. Сызганова, Алматы Аннотация
Актуальность темы. Целью нашего исследования было улучшение результатов хирургического лечения больных с узловым зобом. Также мы оценивали косметический эффект, интраоперационные и послеоперационные осложнения, такие как кровотечение, боль и продолжительность пребывания в стационаре.
Материалы и методы. Эта технология была внедрена в наш центр при сотрудничестве с японскими коллегами в 2013 году. В период между апрелем 2013 и августом 2014 года, 6 пациентов с узловым зобом получили субтотальную гемитиреоидэктомию с идео-поддержкой. Результаты лечения оценивались, в том числе хирургические осложнения, качество жизни и удовлетворенности пациентов хирургическим результатом.
Результаты. Все пациенты были прооперированы с использованием видео-технологии, с некоторыми изменениями в зависимости от времени и опыта. Не было никаких преобразований в открытой хирургии. Все пациенты были удовлетворены хирургическим результатом, особенно в отношении размещения хирургических рубцов.
Заключение. Видео тиреоидэктомия является альтернативной традиционным вмешательства, может быть использована в клинической практике для узловых образований щитовидной железы в адекватном количестве с соблюдением всех правил техники безопасности.
ОБ АВТОРАХ
Арзыкулов Жеткерген Анесович -генеральный директор АО «ННЦХ им. А.Н. Сызганова», д.м.н., профессор, академик НАН PK; Шокебаев Адиль Абаевич - заведующий отделением хирургии желудочно-кишечного тракта и эндокринных органов ННЦХ им. А.Н. Сызганова, врач-хирург высшей категории,
e-mail: Shokebaev_a@mail.ru
Ключевые слова
узловой зоб, тиреоидэктомия, железы, гортанный нерв, лимфатические узлы.
Introduction
Video-assisted thyroid surgery is equal in the effectiveness to traditional operations, so the development and implementation in practice are one of the main challenges of modern surgery. Prospects of this direction is based on the lesser traumatic video assisted thyroidectomy, a small amount of complications in their conduct, of high social and cosmetic significance.
Endosurgery progress, without which it is difficult to submit now an efficient and effective work of doctors of many specialties, will significantly expand the range of different minimally invasive procedures, including in surgical diseases of the thyroid gland (1). The direction of endoscopic surgery of the thyroid gland has good prospects for development, as evidenced by the accumulating data on the results of such operations. However, the surgery of the thyroid gland, these innovations have come is slowly. Particularly, patients pay much attention to aspects of cosmetic surgery, namely state of the scar. In the world literature there are publications dedicated to fulfillment of videoassisted thyroid surgery.
When studying it is drawn attention that not completely determined the criteria of patient selection, indications and contraindications for
such operations, there are not selected optimal approaches for and ways of formation the operating cavity is not perfect surgical technique for performing these procedures.
This opens up new possibilities for performing video assisted surgery on the organs of the neck. In our country, minimally invasive surgery of the thyroid and parathyroid gland is not well developed, while many foreign clinics have already experience of endoscopic surgery in the neck. With regards to relevance, in general, thyroid disorders are widespread in Kazakhstan as well as observed increase in the number of diagnosed cancers, often develop on the background of goiter [2]. In various countries thyroid nodular lesion is a common disease and occurs in 4-6% of the adult population [3,4]. The risk of developing cancer of the thyroid gland is significantly higher in the female population. So, at the age of 30-39 years old women get sick to 7 times more often than men. In 2006, women accounted for 86.3% of all patients with identified malignant tumors of the thyroid gland. Maximum incidence is in the age group of 50-59 years [5]. It should be noted that 20% of patients underwent surgical treatment about the alleged benign nodular thyroid disease after morphological examination revealed nodular malignant pathology [6].
Patients and methods
Video-assisted thyroid resection technology was invaded in our center in cooperation with Japanese colleagues in 2013. Between April 2013 and August 2014, 6 patients (5 female and 1 male; mean age 32 years) with nodular goiter underwent videoassisted subtotal or near-total tyroidectomy. The present study focused on six of these patients with nodular goiter. generally carried out in relatively young patients (mean age of 32 years), while a conventional (sub) thyroidectomy performed in elderly men (mean age of 40 years). Treatment outcome was evaluated, including surgical complications, quality of life and patient satisfaction with the surgical result.
To use this method, we identified indications:
1) The maximum size of the nodule 35 mm;
2) The absence of ultrasound increased cervical
lymph nodes;
3) No surgery on the neck in history
For the implementation and development of endoscopic thyroid surgery it is used all the advantages of the method. In favor of the method demonstrates gasless publications [7] on the removal of the thyroid gland. The authors draw attention to the ease of identification and visualization of the recurrent laryngeal nerve and parathyroid glands, so that they are saved during the operation.
Operations were performed without gas fired manner under endotracheal anesthesia. To provide optimum accessibility to the thyroid gland the patient's position was on the back without the roller. The head is slightly tilted backwards. Regarding the patient's surgeon is on the side of the alleged interference. Assistants are located on the opposite side of the surgeon. Rack with video endoscopic equipment is located at the head of the patient. The surgical incision is made parallel to the clavicle below the 2.0 cm to 3.0 cm in length set tread wounds and two cuts at 0.7 cm below the left clavicle for video ports.
Working space created by the lift at tools was used for open surgery, video surveillance and gasless way to, an ultrasonic scalpel. The operation was carried out under video control using a 30 ° 5-mm endoscope and retractor. The second assistant manipulates the endoscope, slicing through skin and subcutaneous tissue, subcutaneous neck muscle. Further, by dissection with endoscopic instruments, bipolar forceps or ultrasonic scalpel, endoscopic retractor with a light guide created space (operating cavity) for the operation of mechanical traction (lifting) tissues
up. The next stage begins with mobilizing thyroid isthmus, mobilized and separated from the trachea as in conventional surgery. Special attention was given to visualization of the recurrent laryngeal nerve and parathyroid glands during the mobilization of the thyroid gland. After mobilization upper and lower thyroid arteries were intersected with the use of a harmonic scalpel. Only after assurance that the laryngeal nerve and parathyroid glands are not damaged, extrafascial hemistrumectomy was performed with the removal of the isthmus. After revision the recurrent laryngeal nerve the operation is finished.
Results
Small access is not allow sufficient to orientate in the wound, but the use of endovideosystem allows to clearly visualize and control all the action on the screen, smaller structures during the operation, including the parathyroid glands, blood vessels and recurrent laryngeal nerve. Drains were not used. Skin incision was sutured cosmetic seam. The operative time was about 100 minutes, this is due to the development of techniques. In a comparative analysis with traditional intervention of the thyroid gland had lower intraoperative blood loss, greater duration of surgery. As the authors point to the accumulation of experience in endoscopic thyroid surgery observed reduction in the duration of surgery [8].
The postoperative period was uneventful, the patient noted satisfying cosmetic result. Length of hospital stay after surgery was 4 bed days.
The prospects of the method are evident, video assisted thyroidectomy has obvious advantages:
• incision video assisted thyroid surgery is not done in a traditional place, the length of the cut is 30% less than traditional surgery, which improves the cosmetic effect
• methods allows not to cross the neck muscles, which reduces swelling, pain, trauma operations and improves wound healing in the postoperative period;
• dangerous structures of the neck recurrent laryngeal nerve», the parathyroid gland, the thyroid gland the vessels are allocated under microscopic magnification, which makes the operation safer;
• Reduce contact with wounds the environment during endoscopic operations and work in a dry field reduces the risk of infectious complications;
• Use of a harmonious scalpel, jewelry isolation and crossing vessels without ligatures makes the procedure «bloodless».
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BECTHMK XMPyPfMM KA3AXCTAHA № 1-2015
Conclusions
Result of our intervention, and numerous publications by foreign authors testify that the video assisted thyroidectomy is an alternative to traditional intervention, that can be performed in clinical practice for thyroid nodules in an adequate amount with observance of all safety regulations.
For patients it is more comfortable, less traumatic and minimally invasive, reducing the duration of hospital treatment, the timing of disability and, most importantly, is conjugate to minimal complications and provide a favorable cosmetic effect. We necessary consider the introduction and development of the method.
References
1. S. Maeda, T. Uga, N. Hayashida, K. Ishigaki, J. Furui and T. Kanematsu. Video-assisted subtotal or near-total thyroidectomy for Graves' disease, British Journal of Surgery 2006; 93: 61-66
2. Grandfathers 1.1., Troshina E.A., Yuschkov P.V., Aleksandrov G.F. Diagnosis and treatment of thyroid nodules. Guidelines. Moscow, 2001.
3. Davies L., Welch H.G. Increasing incidence of thyroid cancer in the United States, 1973-2002/ JAMA, 2006, V.295, pp.2164-2167.
4. Dalmau-Galofre J. Echography of the thyroid gland. An.-Otornnolanngo, Ibero-Am. 1993, V.20 (1), pp.5-22.
5. Malignancies neoplasms of in Russia in 2006 (morbidity and mortality). Edited by Chissova V., Starynska V.V., Petrova G.V. Moscow, 2008.
6. Rechetov I.V., Olshansky V.O., Trofimov E.I., Golubtsov A.K., Ratushniy M.V. Russian Journal of Oncology. Moscow, Medicine, 2002, № 3, p.7-11. (in Russ.).
7. Bellantone R., Lombardi C.P., Rafaelli M., Rubino F., Boscherini M., Perilli W. J Laparoendosc Adv Surg Tech A 1999; 9: 5: 397-400
8. Shimizu K., Kitagawa W., Akasu H. et al. Indications for and limitations of endoscopic thyroid surgery. Nippon Geka Gakkai Zasshi 2002 Oct; 103 (10): 708-712.
