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J Zhejiang Univ (Med Sci)  2021, Vol. 50 Issue (6): 694-700    DOI: 10.3724/zdxbyxb-2021-0337
    
“Three-propulsion” suspension method for endoscopic thyroid surgery gasless axillary approach
HU Xiaotian1,2,XIN Ying2,3,ZHENG Chuanming2,3,MENG Kexin2,3,GE Minghua1,2,3,*()
1. Medical College of Qingdao University, Qingdao 266000, Shandong Province, China;
2. Department of Head and Neck Surgery, Center of Otolaryngology, Head and Neck Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital of Hangzhou Medical College, Hangzhou 310014, China;
3. Zhejiang Provincial Key Laboratory of Endocrine Gland Diseases, Hangzhou 310014, China
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Abstract  

Gasless endoscopic thyroidectomy through unilateral axillary approach has advantages of clear vision, simple manipulation, short learning curve, hidden surgical incision, no postoperative neck scar, and less swallowing discomfort. During the procedure the separation path goes through thoracic muscle surface, sternocleidomastoid gap and jugular vein, which may meet various variations of neck muscles, blood vessels and nerves. With the “three-propulsion” suspension cavity construction method the procedure advances the dissection from the axillary incision to clavicle, from the clavicle to sternocleidomastoid gap and from the sternocleidomastoid gap to thyroid. Combined with intraoperative hanging upward hook it can establish a good cavity for the subsequent surgical operation. This article introduces the main steps, key points and attentions of the “three-propulsion”suspension cavity construction method in gasless endoscopic thyroidectomy through unilateral axillary approach.



Key wordsThyroidectomy      Anatomical abnormality      Endoscope      Recurrent laryngeal nerve      Omohyoid     
Received: 30 October 2021      Published: 22 March 2022
CLC:  R653.2  
Corresponding Authors: GE Minghua     E-mail: geminghua@hmc.edu.cn
Cite this article:

HU Xiaotian,XIN Ying,ZHENG Chuanming,MENG Kexin,GE Minghua. “Three-propulsion” suspension method for endoscopic thyroid surgery gasless axillary approach. J Zhejiang Univ (Med Sci), 2021, 50(6): 694-700.

URL:

https://www.zjujournals.com/med/10.3724/zdxbyxb-2021-0337     OR     https://www.zjujournals.com/med/Y2021/V50/I6/694


无充气腋窝入路完全腔镜甲状腺手术的“三推进”悬吊建腔法

无充气腋窝入路完全腔镜下甲状腺手术具有手术视野清晰、操作简便、术者学习曲线短、手术切口隐蔽以及患者术后颈部无疤痕、吞咽不适感轻微等优点。该术式由侧方入路,分离路径需经胸大肌表面、胸锁乳突肌肌间隙、颈内静脉等解剖结构,会面临颈部肌肉、血管和神经的各种变异,采用自腋窝—锁骨、锁骨—胸锁乳突肌肌间隙、胸锁乳突肌肌间隙—甲状腺三次拉钩推进,配合术中悬吊向上拉钩进行建腔的方法可以为手术操作打下良好基础。本文介绍“三推进”悬吊建腔法的主要步骤、要点及其注意事项。


关键词: 甲状腺切除术,  解剖异常,  内窥镜,  喉返神经,  肩胛舌骨肌 
Figure1 Pattern diagram of “three propulsion” suspension method and position placement during operation
Figure2 Endoscopic surgical field by “three propulsion” suspension method
Figure3 Important structures in “three propulsion”suspension method
Figure4 Variant forms of right external jugular vein and surgical separation strategies
Figure5 Variations in initiation of clavicular head of sternocleidomastoid muscle
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