대한내시경복강경외과학회지 한상문 허훈 1 박해린 김원우, 1 <bstract> Endoscopic Thyroid Surgery Using 2 mm Instruments: Supraclaviclar pproach Sang Moon Han, M.D., Hoon Hur, M.D. 1, Hai Lin Park, M.D., Won Woo Kim, M.D. Department of Surgery, Kangnam CH Hospital, College of Medicine, Pochon CH University, 1 Department of Surgery, St. Mary s Hospital, College of Medicine, The Catholic University With recent development in endoscopic surgery, several approaches have been applied to endoscopic thyroid surgery. The most advantage of endoscopic thyroid surgery leads to a reduction in the size of the surgical scar, so most procedure of it have been performed by axillary and breast approach in Korea. We are try to introduce surgical technique and to assess the feasibility and efficacy of other minimally invasive endoscopic technique. 46-year-old women presented with an incidentally found anterior neck small mass. Imaging study showed 2.5 cm thyroid isthmic portion mass consistent with cystic nature. Two 5 mm incisions and one 2 mm incision was made at sternal notch and anterior border of SCM muscle and then trocar was inserted. Endoscopic view was made by lateral approach and then superior and inferior thyroid vessels and recurrent laryngeal nerve was easily identified. Isthmic portion mass was identified and dissected from around thyroid tissue. Mass was cystic nature and contained serous fluid. The specimen was extracted through 5 mm the sternal notch trocar site. This patient did well without any complications and discharged at next day. This procedure was a technically feasible and safe procedure that leads to an reduced invasiveness and a quicker recovery. So, if appropriate patient is selected, we believe that endoscopic thyroid surgery by supraclaviclar approach will play a role in the treatment of some thyroid tumor. Key words: Endoscopic thyroid surgery, Supraclaviclar approach :,, 1 650-9, 135-081 Tel 02-3468-3349, Fax 02-558-1119, E-mail wwk@cha.ac.kr 122
2 mm : 123 B B Fig. 1. Operative field of endoscopic thyroid surgery; supraclaviclar approach (: 5 mm trocar, B: 2 mm trocar). 서론. 1996 Gagner(1) (2,3,4) (5,6).. (7,8) (9,10).. 환자 : 46 증례 Fig. 2. Operative finding of endoscopic thyroid surgery; Lt. lateral approach (: Parathyroid, B: Lt. recurrent laryngeal nerve). 주소 : 2 현병력 : 2. 과거력, 가족력 :. 신체검사소견 : 2.5 cm. 검사실소견 :. 갑상선초음파 : 2.5 cm. 갑상선스캔 :. 수술방법 :. (sternal notch) (mastoid process) 2/3 5 mm (platysma) 5 mm (CO 2) 5 mm. 2 mm trochar 5 mm (Fig. 1). (isthmus) (recur-
124 Fig. 3. Operative wound at post operative 1 week. rent laryngeal nerve) (Fig. 2). 5 mm. 5 mm. 수술후경과 :. 1 (Fig. 3).. 고찰 19,..... 1985 Muhe.(11). 1996 Gagner(1). 5 mm. (12,13)...(14) 30 mm 10 mm 12 mm 5 mm.(15) 30 mm 12 mm 5 mm (9).(15) Ikeda (15). Ochiai (16) 4 mmhg,,,
2 mm : 125... 2.5 cm. 2 mm,,. Gagner (12). 3 cm. (multinodular goiter),,..,. 참고문헌 1) Gagner M. Endoscopic subtotal parathyroidectomy in patients with primary hyperthyrodism. Br J Surg 1996;83:875. 2) Huscher CSG, Chiodini S, Napolitano C, Recher. Endoscopic right thyroid lobectomy. Surg Endosc 1997;11:877. 3) Yeung GHC, Ng WT, Kong CK. Endoscopic thyroid and parathyroid surgery. Surg Endosc 1997;11:1135. 4) Bellantone R, Lombardi CP, Raffacelli M, Rubino F, Boscherini M, Perilli W. Minimally invasive, totally gasless video-assisted thyroid lobectomy. m J Surg 1999;177:342-3. 5) Norman J, lbrink MH. Minimally invasive videoscopic parathyroidectomy: a feasiblity study in dogs and humans. J Laparoendosc dv Surg Technol 1997;7:301-6. 6) Henry JF, Defechereux T, Gramatica L, de Boissezon C. Minimally invasive videoscopic parathyroidectomy by lateral approach. Langenbecks rch Surg 1999;384:298-301. 7) Ohgami M, Ishii S, risawa Y, et al. Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Technol 2000; 10:1-4. 8) Nam SY, Park YL, Bae WG. clinical analysis of one hundred cases of endoscopic thyroidectomy: breast approach. J Korean Surg Soc 2002;62:303-7. 9) Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M. Endoscopic neck surgery by the axillary approach. J m Coll Surg 2000;191:336-40. 10) Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J. Endoscopic thyroidectomy by the axillary approach. Surg Endosc 2001;15:1362-4. 11) Soper NJ, Stockman PT, Dunnegan DL, shley SW. Laparoscopic cholecystectomy: the new gold standard? rch Surg 1992;127:917-21. 12) Gagner M, Inabnet III WB. Endoscopic thyroidectomy for solitary thyroid nodules. Thyroid 2001;11: 161-3. 13) Yeung GH. Endoscopic surgery of the neck: a new frontier. Surg Laparosc Endosc 1998:8;227-32. 14) Kim JS, Kim KH, hn CH, Jeon HM, Kim EG, Jeon CS. clinical analysis of gasless endoscopic thyroidectomy. Surg Laparosc Endosc 2001;114:268. 15) Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi
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