Gaslose Videoendoskopische Hemithyreoidektomie von dorsal ohne sichtbare Narbe ausführbar durch einen einzelnen Chirurgen: Methodische Erarbeitung einer neuen Operation

Abstract

Existing video endoscopic techniques either leave a visible scar or allow resection of only small specimen. Also a small number of patients could be selected for endoscopic procedures. The aim of our study was to systematically develop a new technique leaving no visible scar in the neck but allowing big specimen to be resected.

After the dissection of human cadavers (n = 7) the course of the operation was planned using a virtual three dimensional model. We developed nodal points to ensure a navigation within the neck. Based on nodal points we carried out mental training. A new retractor spatula with an exchangeable optic was employed for retraction and tested on eight human cadavers. Training of linear video endoscopic surgery through a single channel was carried out in a porcine animal model (n = 10). Surgery carried out under OR-conditions on human cadavers was valuated by a new quality score issuing each important anatomic structure encountered in the procedure a specific organ value and a factor for positive identification of a given structure, inability to identify it, sparing or injury. A repeated achievement of the maximum quality score suggests the ability to operate on a patient.

It is possible to resect the thyroid gland by a gasless dorsal approach. The operation can be carried out by a single surgeon. Training of linear video endoscopic surgery in a porcine animal model was successful. Within the first four thyroidectomies we were able to improve operating time starting from two hours down to 15 min.. The nodal points may serve as a basis for mental training. They were helpful during dissection of and navigation in the neck. Autopsy following each thyroidectomy corresponded with the achieved value of the quality score. Concerning the quality score we were able to achieve a maximum value after four out of the sixteen lobectomies under OR-conditions on human cadavers. One human cadaver with a detected thyroiditis in the autopsy was inoperable.

We expected a training under OR-conditions to be a good preparation for the clinical situation.

In summary we were able to establish a hemithyroidectomy procedure by using a dorsal approach from the sculp. The operation leaves no visible scar after the hair grows back and allows the resectin of specimen larger than 40 ml.