经腋窝机器人辅助腔镜甲状腺手术:单中心实践经验总结
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作者单位:

1.复旦大学附属肿瘤医院 头颈外科,上海 200032;2.复旦大学上海医学院 肿瘤学系,上海 200032;3.复旦大学附属闵行医院 普通外科,上海 201199

作者简介:

史荣亮,复旦大学附属肿瘤医院副主任医师,主要从事头颈部鳞癌及甲状腺癌方面的研究。

基金项目:

国家自然科学基金资助项目(82072951);上海市科委重点领域创新计划基金资助项目(22Y21900100);上海市抗癌协会基金资助项目(SACA-AX202213)。


Transaxillary robotic-assisted thyroid surgery: summary of single-center practical experience
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Affiliation:

1.Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China;2.Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China;3.Department of General Surgery, Minhang Hospital, Fudan University, Shanghai 201199, China

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    摘要:

    近十几年来,国内机器人甲状腺手术飞速发展,腋窝入路手术的安全性、肿瘤治疗的根治性和美容性不断得到验证,其比例正在快速增长。在此,笔者从入路选择、适应证与禁忌证、器械的改进、切口选择、建腔、术中技巧和并发症等方面对本中心实施的经腋窝机器人辅助腔镜甲状腺手术进行总结和分享,旨在为该手术的发展提供参考和帮助。

    Abstract:

    In the past decade, there has been a rapid development of robotic thyroid surgery in China. The safety, the oncological radical nature, and the cosmetic outcomes of transaxillary approach surgery are continuously validated, and the rate of its implementation is rapidly increasing. Here, we summarize and share insights on tansaxillary robotic-assisted endoscopic thyroid surgery performed in our center, covering aspects such as approach selection, indications and contraindications, instrument improvement, incision selection, space creation, intraoperative skills, and complications. The aim is to offer reference and assistance for the development of this surgical procedure.

    图1 拉钩的改良 A:悬吊器实物图;B:将传统的悬吊卷帘器改为滑动装置;C:拉钩较之前明显变窄变浅;D:装机成功后,在床边即可进行拉钩的高低调节Fig.1 Improvement of the retractor A: Physical picture of the suspension device; B: Replacement of the traditional suspension shutter with a sliding device; C: The retractor showing a noticeable reduction in width and depth compared to its previous state; D: Easy height adjustments of the retractor at the bedside after successful installation
    图2 切口的选择(取腋窝皱褶切口,1、2、3号机械臂均经腋窝切口入路) A:正面观;B:侧面观Fig.2 Incision selection (utilizing the axillary wrinkle incision, with the No. 1, 2, and 3 mechanical arms all entering through the axillary incision) A: Frontal view; B: Lateral view perspectives
    图3 达芬奇甲状腺手术术中照片 A:显露喉返神经;B:显露甲状旁腺;C:清扫Ⅵ区淋巴结;D:侧颈淋巴结清扫术后Fig.3 Intraoperative photos of Da Vinci thyroid surgery A: Exposure of the recurrent laryngeal nerve; B: Exposure of the parathyroid gland; C: Dissection of lymph nodes in the region Ⅵ; D: View after lateral neck lymph node dissection
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史荣亮,倪兆娴,王宇,孙国华,渠宁,刘婉琳,马奔,王玉龙,魏文俊,向俊,嵇庆海.经腋窝机器人辅助腔镜甲状腺手术:单中心实践经验总结[J].中国普通外科杂志,2023,32(11):1657-1662.
DOI:10.7659/j. issn.1005-6947.2023.11.004

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  • 收稿日期:2023-10-05
  • 最后修改日期:2023-11-04
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  • 在线发布日期: 2023-12-15