RU2500355C1 - Method of endovideosurgical access to thyroid gland lobe - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to endocrine surgery, thyroid surgery, and can be applied in operative treatment of patients with pathology, localised in one of thyroid gland lobes. Method consists in access to thyroid gland lobe, outside thyroid gland projection. Two trocars are introduced in axilla, and one trocar is introduced on lower edge of mastoid process of temporal bone from ipsilateral side. Dissection in the layer between fascia and pectoralis major muscle is performed through trocars. Opening between cruses of m.sternocleistomastoideus is created. After that, lateral edges of prethyroid muscles are intersected and thyroid gland lobe on operation side is visualised.

EFFECT: application of claimed invention makes it possible to ensure full visualisation of anatomical structures during surgery, reduce probability of specific complications, provide possibility of examining operation field at other vision angle, and achieve high degree of cosmetic effect of surgery.

10 dwg

Description

The invention relates to methods for minimally invasive approaches in thyroid surgery and can be used for surgical treatment of patients with pathology localized in one of the thyroid glands.

The closest to the considered method is, according to the authors, the method of endoscopic axillary-mammary access, which is carried out by installing trocars in the axillary and paraareolar regions [1, 2]. However, unlike the claimed method, this one has a different surgical technique, which does not allow for a full visualization of the anatomical structures in the area of the operation, which increases the likelihood of specific complications. In addition, performing an operation from axillary-mammary access in patients with an asthenic constitution is accompanied by a “conflict of instruments” due to the small distance between the installation points of the trocars and, accordingly, reducing the angle of the axis of the surgical action, which reduces the degree of feasibility of the intervention and increases the duration of the operation.

The invention:

Improving the results of surgical treatment of patients with thyroid diseases by eliminating the development of specific complications, as well as increasing the degree of feasibility of the operation by preventing a “tool conflict”.

Features:

Intervention is carried out through a fully endoscopic, axillary-retroauricular access (Figure No. 1). The operation begins by performing two skin incisions along the posterior surface of the free edge of the pectoralis major muscle and installing two 10 mm trocars at the most distant upper and lower points of the armpit (Figure No. 2). The blunt way is the creation of tunnels in the fiber, going inward and in the medial direction under the Thompson fascia, which are combined into a single cavity at a point at a distance of 3-4 cm from the skin incisions. Dissection is performed in the layer between Thompson fascia and pectoralis major muscle, with visualization of the medial part of the clavicle (Figure No. 3) and legs m. stemocleidomastoideus (Figure No. 4). Dissection continues more medially than m.sternocleidomastoideus until the white line of the neck is reached and the anterior surface of the prethyroid muscles is released. In the skin incision along the lower edge of the mastoid process of the temporal bone (Figure No. 5), a 10 mm trocar is inserted into the formed cavity (Figure No. 6). When performing traction upward behind the medial pedicle of m.sternocleidomastoideus (Figure No. 7) with simultaneous dissection of the tissue and creating a space between the legs of m.sternocleidomastoideus (Figure No. 8), the medial pedicle completely bypasses the back, the lateral edges of the thyroid muscles are visualized, which intersect in layers and separate. in different directions, the anterior surface of the thyroid lobe on the side of the operation is visualized (Figure 9, 10).

A positive result of the use of the invention is achieved by the fact that it is possible to inspect the anatomical structures in the field of surgery from different angles of view, which allows more information about their relative position. This ensures a confident visualization of the anatomical structures, which reduces the likelihood of complications. The application of the method of endovideo surgical access to the thyroid lobe allows you to increase the angle of the axis of the surgical action, preventing the "conflict of instruments" and facilitating the implementation of the intervention. At the same time, the presented method of access to the thyroid lobe provides a high degree of cosmetic surgery, since all sections are located in invisible areas.

List of figures:

1. Figure number 1. Points of installation of trocars and directions of the axes of instruments with axillary retroauricular access.

2. Figure number 2. The implementation of skin access in the armpit (left-side operation).

3. Figure number 3. Visualization of the clavicle during dissection (left-side operation).

4. Figure No. 4. Visualization of the legs of m.sternocleidomastoideus (right-side operation).

5. Figure No. 5. Access to the projection of the mastoid process of the temporal bone (right-side operation).

6. Figure No. 6. Introduction of a retroauricular trocar (left-side operation).

7. Figure No. 7. Separation of the legs of m.sternocleidomastoideus, "top view" (right-hand operation).

8. Figure No. 8. Created window between the legs of m.sternocleidomastoideus (left-side operation).

9. Figure No. 9. Dissected prethyroid muscles, "top view" (left-side operation).

10. Figure No. 10. The front surface of the thyroid lobe, "top view" (left-side operation).

Bibliographic sources:

1. Irawati N. Endoscopic right lobectomy axillary-breast approach: a report of two cases // Int. J. Otolaryngol. - 2010. - Dec. - 4 pages.

2. Hong H.J., Kirn W.S., Koh Y.W., Lee S.Y., Shin Y.S., Koo Y.C., Park Y.A., Choi E.C. Endoscopic thyroidectomy via an axillo-breast approach without gas insufflation for benign thyroid nodules and micropapillary carcinomas: preliminary results // Yonsei Med. J. - 2011 .-- v. 52 (4). - P.643-654.

Claims (1)

A method of endovascular surgical access to the thyroid lobe, including placing access outside the projection of the thyroid gland, characterized in that two trocars are introduced into the axilla and one trocar along the lower edge of the mastoid of the temporal bone from the ipsilateral side, through which dissection is performed in the layer between the fascia and the large by the pectoral muscle, create a window between the legs of m.sternocleidomastoideus, after which the lateral edges of the prethyroid muscles are crossed and the thyroid lobe is visualized on the side of the operation.

Images