tailieunhanh - ENDOCRINE SURGERY - PART 4

cắt bỏ tuyến giáp là một trong những hoạt động phổ biến nhất được thực hiện trên toàn thế giới. Thủ tục này là cổ điển được thực hiện thông qua một vết rạch ngang cổ tử cung và được liên kết với một tỷ lệ mắc rất thấp và tỷ lệ tử vong. Tuy nhiên, các vết sẹo có thể nhìn thấy | 15 Endoscopic Thyroid Surgery Laurent Biertho Les Cliniques Saint Joseph Liege Belgium Michel Gagner Mount Sinai School of Medicine New York University New York New York . 1 INTRODUCTION Thyroid resection is one of the most common operations performed throughout the world. This procedure is classically realized through a transverse cervical incision and is associated with a very low morbidity and mortality rate. However the visible scar on the anterior surface of the neck is disliked by many patients especially by young women in which this operation is commonly performed. With the general tendency to perform a less invasive surgery an endoscopic approach has been applied to neck surgery. The first endoscopic neck exploration was performed in 1995 for parathyroidectomy 1 . Since then endoscopic parathyroid resections have been performed worldwide and large series have been reported 2 3 . After experimentation on animal models 4 showing the feasibility of the technique Hilscher performed the first endoscopic thyroid resection in 1997 5 . Nonetheless endoscopic thyroid surgery is more technically challenging compared to parathyroidectomy due to the size of the thyroid gland the extent of the dissection required and the higher rate of malignancy. The current indications techniques and results of endoscopic thyroid surgery are described in this chapter. 2 PREOPERATIVE WORKUP In addition to a detailed history physical examination and thyroid function tests the following exams are usually realized. Ultrasonography is performed to define the dimension nature and localization of the thyroid pathology and to evaluate the contralateral lobe. A Doppler study is also used to assess the vascularization of the gland in case of thyroiditis. Fine needle aspiration is used to define the histology of cold nodules and before endoscopic thyroid surgery to rule out a carcinoma. Atypical or suspicious cytology are currently considered as a contraindication for an endoscopic .