내시경 보조 갑상선 절제술의 유용성
Endoscopy-assisted Thyroidectomy - Bridge between Conventional and Endoscopic Thyroidectomy
문병인, 정규영,
소속 상세정보
문병인 ( )
이화여자대학교 의과대학 외과학교실
정규영 ( )
이화여자대학교 의과대학 외과학교실
KMID : 0978820020050020170
Abstract
Purpose: Recently, endoscopic thyroidectomy is widely used to small benign tumors of thyroid for its good cosmetic results. But endoscopic thyroidectomy can't be applied in cases of larger tumors over 3 cm, Graves' disease and carcinoma. We developed unique method of endoscopy assisted thyroidectomy which can be done by smaller incision than that of conventional thyroidectomy. This study assessed the feasibility and usefulness of endoscopy-assisted thyroidectomy.
Metheods: The 2.5~3.0 cm horizontal skin incision is made in lateral neck near to anterior border of the mid-sternocleidomastoid (SCM) muscle in case for unilateral disease or 2 cm above the sternal notch in case for bilateral disease. After developing subplatysmal working space, we retract skin, after covering with the special skin protector, by using conventional retractor such as army and navy, we reach to thyroid gland laterally or centrally. Under the endoscopic guidance we perform thyroidectomy with usual manner of endoscopic thyroidectomy. Thyroid vessels and parenchyma were dissected and divided by ultrasonic shears.
Results: Endoscopy assisted thyroidectomy was successfully done without conversion to open method in all of 30 patients with adenomatous goiter (8) and follicular adenomas (10) micropapillary carcinoma (8) Graves' disease (3) and Hashimoto' thyroiditis (1). Tumor size was median 4.0 cm (range: 0.5~8 cm). Median operative time was 165 min (range 270~120 min), operative blood loss was mean 152 cc (300~20). Cosmetic result was relatively good in all cases. There was 1 cases of wound infection and one case of transient hypocalcemia.
Conclusion: We could successfully perform endoscopy assisted thyroidectomy with good cosmetic results and without significant complications. Endoscopy assisted thyroidectomy can be a good alternative modality of surgery in cases with contraindication of endoscopic thyroidectomy. We suggest that endoscopy assisted thyroidectomy can be a bridge between conventional thyroidectomy and endscopic thyroidectomy.
키워드
Endoscopy assisted thyroidectomy; Conventional endoscopic thyroidectomy; 내시경보조; 내시경; 갑상선 절제술; 전통적
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