Comparison of the effect of endoscopic surgery and routine cervical approach in the treatment of benign thyroid tumors / 中国现代普通外科进展

Objective:To compare the therapeutic effects of endoscopic surgery and routine neck surgery on benign thyroid tumors.Methods:From August 2014 to August 2016,240 patients with benign thyroid tumor were treated by operation in Zoucheng people's hospital,according to the random number method,they were divided into the observation group and the control group,120 cases in each group.According tothepatient's willingness to choose the choice of operation,the control group was performed the routine thyroid operation on the neck approach,and the observation group underwent endoscopic thyroidectomy through the breast approach.The two groups of surgical indexes,postoperative complications,and thyroid related hormone levels before and after the operation were compared.Results:The operation time of the observation group was significantly longer than that of the control group,but the amount of bleeding and the time of hospitalization in the operation were significantly shorter than those in the control group,the difference was statistically significant (P＜0.05).The incidence of cervical sensory decline,dysphagia and pain in the observation group was significantly lower than that in the control group,and the total incidence of complications was also lower than that in the control group(P＜0.05).The levels of FT3,T4 and TSH after the operation in the two groups were significantly lower than those before the operation,while the level of FT4 was significantly higher than that before the operation (P＜0.05).There was no significant difference in the levels of FT3,FT4,T4 and TSH after the operation between the two groups before and after the operation (P＜0.05).Conclusion:Endoscopic surgery for the treatment of thyroid benign tumors is better,less traumatic,and more beautiful.

Technical Feasibility and Cosmetic Superiority of Far Lateral Approach Using Natural Skin Fold of Lateral Neck for Thyroidectomy / 대한내분비외과학회지

PURPOSE: Surgery for thyroid disease requires skin incisions that can result in postsurgical problems. Therefore, several approaches in thyroid surgery have been developed to avoid large scars on the anterior neck. Since the first report of endoscopic subtotal parathyroidectomy, various endoscopic approaches have been reported. However, to be able to perform these procedures using endoscopic instruments in a skillful manner, sufficient training time and effort is required. We assessed the feasibility and cosmetic benefit of the far lateral neck approach using natural skin fold thyroidectomy. METHODS: From July 2011 to February 2014, 123 patients underwent thyroidectomy via far lateral neck approach by one surgeon. An approximately 5 to 6 cm incision was created on the natural skin fold at the far lateral neck, so that the scar can be completely hidden by a V-shaped collar shirt. Thyroidectomy was performed using a Harmonic scalpel(R) and conventional tie technique. RESULTS: The mean operation time was 89.6+/-18.4 min for benign tumors and 79.1+/-30.1 min for malignant tumors. The number of retrieved lymph nodes (mean) was 5.4+/-3.5 in the central neck compartment dissection group, and 26.9+/-13.1 in the lateral neck lymph node dissection group. The 3, 6, and 12 month cosmetic satisfaction score (mean) after the operation was 7.47, 7.68, and 8.81. There were no hypertrophic scars or keloid on the neck. CONCLUSION: Far lateral approach using natural skin fold for thyroidectomy is safe and patients expressed high cosmetic satisfaction. In addition, the technique is suitable for inexperienced surgeons in endoscopic thyroidectomy. It can be a feasible alternative to conventional or endoscopic thyroidectomy.

A modified endaural and neck approach to the parotid gland tumor

Generally we use the preauricular incision to access and remove the parotid gland tumor. But the preauricular approach has some complications such as damage of facial nerve and sensory nerve, Frey's syndrome, and postoperative scar. Especially, the postoperative scar can often cause an unesthetic result and mental stress in young patients. Therefore, if we avoid preauricular incision to be performed outside of tragus, the postoperative scar would be hardly remarkable, and patients would be satisfied cosmetically. We performed surgical excision using a modified endaural and neck approach in a 21-year-old female with a pleomorphic adenoma and 15-year-old male with a neurofibroma occured in the parotid gland. A new, modified endaural and neck approach is a combined method of the modified endaural incision by Starck et al and Gutierrez's neck extension. We obtained an adequate access and the cosmetically acceptable postsurgical scar. The postoperative scars were hidden in the external ear and the hairline. Moreover, except the neck dissection can this approach be applied to the surgery of temporomandibular joint as well as the parotid gland tumor.