Clinical application of endoscopic parathyroidectomy by gasless unilateral axillary approach and perioperation management of patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIE Chenying , SHEN Lifeng , ZHU Hui ,  JIN Aixiang

Department of Head and Neck Surgery, Center of Otolaryngology-head and Neck Surgery, Zhejiang Provincial People’s Hospital (People’s Hospital of Hangzhou Medical College), Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou 310014, P. R. China;

Corresponding?author：

JIN Aixiang, Email: jinaixiang770311@163.com

Keywords：

endoscopic parathyroidectomy; axillary approach; hyperparathyroidism; perioperation management

DOI：

10.7507/1007-9424.202209091

Video：

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Objective To investigate the clinical value on application of endoscopic parathyroiddectomy by gasless unilateral axillary approach, and perioperation management of patients. Methods Twenty-four patients with primary hyperparathyroidism were enrolled and were divided into open group (14 patients underwent open parathyroid surgery) and lumpectomy group (10 patients underwent endoscopic thyroidectomy by gasless unilateral axillary approach) according to the surgical method. All patients received the “5A” model management. The indexes related with perioperative conditions, postoperative incisional pain, and anterior cervical function were compared between the two groups. Results In the open group, 1 patient suffered from transient hoarseness after operation, 5 patients suffered from hypocalcemia on the first day after operation, and 6 patients suffered from temporary hypoparathyroidism. In the lumpectomy group, hypocalcemia occurred in 3 cases and temporary hypoparathyroidism occurred in 3 cases. There were no incision hematoma and infection cases occurred. There was no significant difference between the two groups in the incidence of hypocalcemia and the incidence of temporary hypoparathyroidism after operation (P>0.05). There was no case of incisional hematoma and infection, incisional pain, coughing and sputum excretion or painful swallowing with pain ≥3 in either group. The swallowing disorder index on postoperative day 3 and at 6 months, the scar assessment score and cosmetic satisfaction score at 6 months were higher in the open group than those in the lumpectomy group (P<0.05). Conclusion Patients underwent parathyroidectomy by gasless unilateral axillary approach have the advantages of good cosmetic results and preservation of the function of the anterior cervical region while safely removing the lesion.

Citation： XIE Chenying, SHEN Lifeng, ZHU Hui, JIN Aixiang. Clinical application of endoscopic parathyroidectomy by gasless unilateral axillary approach and perioperation management of patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(2): 148-153. doi: 10.7507/1007-9424.202209091 Copy

1.	王松, 代文杰. 原發性甲狀旁腺功能亢進的診斷與治療. 中國普外基礎與臨床雜志, 2014, 21(2): 236-239.
2.	朱精強, 蘇安平. 甲狀旁腺功能與甲狀腺外科的診治進展. 中國普外基礎與臨床雜志, 2017, 24(10): 1169-1172.
3.	Yoon JH, Park CH, Chung WY. Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech, 2006, 16(4): 226-231.
4.	鄭傳銘, 毛曉春, 王佳峰, 等. 無充氣腋窩入路完全腔鏡下甲狀腺癌根治術效果初步評價初期體會. 中國腫瘤臨床, 2018, 45(1): 27-32.
5.	中國抗癌協會甲狀腺癌專業委員會, 中華醫學會腫瘤學分會甲狀腺腫瘤專業委員會, 中國研究型醫院學會甲狀腺疾病專業委員會, 等. 無充氣腋窩入路腔鏡甲狀腺手術專家共識 (2022版). 中華內分泌外科雜志, 2021, 15(6): 557-563.
6.	鄭傳銘, 徐加杰, 王佳峰, 等. 無充氣腋窩入路腔鏡甲狀腺手術的進展與展望. 中國普外基礎與臨床雜志, 2021, 28(10): 1266-1269.
7.	Kandil E, Hadedeya D, Shalaby M, et al. Robotic-assisted parathyroidectomy via transaxillary approach: feasibility and learning curves. Gland Surg, 2021, 10(3): 953-960.
8.	胡康, 孫素紅, 鄭傳銘, 等. 改良無充氣腋窩入路腔鏡甲狀 (旁) 腺手術40例分析. 中國普通外科雜志, 2019, 28(11): 1437-1440.
9.	李文杰, 徐海倩, 翟立斌. 甲狀旁腺微血管解剖與甲狀腺囊內切除技術. 中國普外基礎與臨床雜志, 2013, 20(1): 104-107.
10.	鄭傳銘, 徐加杰, 蔣烈浩, 等. 無充氣腋窩入路完全腔鏡下甲狀腺葉切除的方法—葛-鄭氏七步法. 中國普通外科雜志, 2019, 28(11): 1336-1341.
11.	胡嘯天, 忻瑩, 鄭傳銘, 等. 無充氣腋窩入路完全腔鏡甲狀腺手術的“三推進”懸吊建腔法. 浙江大學學報(醫學版), 2021, 50(6): 694-700.
12.	張國莉, 張麗敏. 應用5A護理模式提高肺癌術后化療患者自我效能. 護理學雜志, 2016, 31(6): 91-92.
13.	Lombardi CP, Raffaelli M, D’alatri L, et al. Video-assisted thyroidectomy significantly reduces the risk of early postthyroidectomy voice and swallowing symptoms. World J Surg, 2008, 32(5): 693-700.
14.	Ha TK, Kim DW, Park HK, et al. Comparison of postoperative neck pain and discomfort, swallowing difficulty, and voice change after conventional open, endoscopic, and robotic thyroidectomy: A single-center cohort study. Front Endocrinol (Lausanne), 2018, 9: 416. doi: 10.3389/fendo.2018.00416.
15.	Taylor RJ, Chepeha JC, Teknos TN, et al. Development and validation of the neck dissection impairment index: a quality of life measure. Arch Otolaryngol Head Neck Surg, 2002, 128(1): 44-49.
16.	Roh MR. The SCAR (Scar Cosmesis Assessment and Rating) scale: new evaluation method for postoperative scars. Br J Dermatol, 2016, 175(6): 1151-1152.
17.	代文杰, 喻慶安. 原發性甲狀旁腺功能亢進癥圍手術期處理中國專家共識 (2020版). 中國實用外科雜志, 2020, 40(6): 634-638.
18.	湯敏譽, 梁鵬. 甲狀腺/甲狀旁腺術后早期低鈣血癥誘發的清醒狀態下喉痙攣2例報道. 中國普外基礎與臨床雜志, 2022, 29(7): 943-945.
19.	徐加杰, 張李卓, 張啟弘, 等. 無充氣經腋窩腔鏡甲狀腺手術的臨床應用. 中華耳鼻咽喉頭頸外科雜志, 2020, 55(10): 913-920.
20.	王佳峰, 徐加杰, 蔣烈浩, 等. 無充氣腋窩入路完全腔鏡下甲狀腺癌根治術對術后頸部功能影響的初步研究. 中華內分泌外科雜志, 2021, 15(1): 10-14.
21.	Zhang WC, Lu DN, Xu JJ, et al. Clinical application of endoscopic surgery using a gasless unilateral transaxillary approach in the treatment of primary hyperparathyroidism. Front Surg, 2022, 9: 962463. doi: 10.3389/fsurg.2022.962463.
22.	莊大勇, 賀青卿, 周鵬, 等. 達芬奇機器人與開放性手術治療原發性甲狀旁腺功能亢進的對照研究. 中華內分泌外科雜志, 2021, 15(4): 348-352.

1. 王松, 代文杰. 原發性甲狀旁腺功能亢進的診斷與治療. 中國普外基礎與臨床雜志, 2014, 21(2): 236-239.
2. 朱精強, 蘇安平. 甲狀旁腺功能與甲狀腺外科的診治進展. 中國普外基礎與臨床雜志, 2017, 24(10): 1169-1172.
3. Yoon JH, Park CH, Chung WY. Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech, 2006, 16(4): 226-231.
4. 鄭傳銘, 毛曉春, 王佳峰, 等. 無充氣腋窩入路完全腔鏡下甲狀腺癌根治術效果初步評價初期體會. 中國腫瘤臨床, 2018, 45(1): 27-32.
5. 中國抗癌協會甲狀腺癌專業委員會, 中華醫學會腫瘤學分會甲狀腺腫瘤專業委員會, 中國研究型醫院學會甲狀腺疾病專業委員會, 等. 無充氣腋窩入路腔鏡甲狀腺手術專家共識 (2022版). 中華內分泌外科雜志, 2021, 15(6): 557-563.
6. 鄭傳銘, 徐加杰, 王佳峰, 等. 無充氣腋窩入路腔鏡甲狀腺手術的進展與展望. 中國普外基礎與臨床雜志, 2021, 28(10): 1266-1269.
7. Kandil E, Hadedeya D, Shalaby M, et al. Robotic-assisted parathyroidectomy via transaxillary approach: feasibility and learning curves. Gland Surg, 2021, 10(3): 953-960.
8. 胡康, 孫素紅, 鄭傳銘, 等. 改良無充氣腋窩入路腔鏡甲狀 (旁) 腺手術40例分析. 中國普通外科雜志, 2019, 28(11): 1437-1440.
9. 李文杰, 徐海倩, 翟立斌. 甲狀旁腺微血管解剖與甲狀腺囊內切除技術. 中國普外基礎與臨床雜志, 2013, 20(1): 104-107.
10. 鄭傳銘, 徐加杰, 蔣烈浩, 等. 無充氣腋窩入路完全腔鏡下甲狀腺葉切除的方法—葛-鄭氏七步法. 中國普通外科雜志, 2019, 28(11): 1336-1341.
11. 胡嘯天, 忻瑩, 鄭傳銘, 等. 無充氣腋窩入路完全腔鏡甲狀腺手術的“三推進”懸吊建腔法. 浙江大學學報(醫學版), 2021, 50(6): 694-700.
12. 張國莉, 張麗敏. 應用5A護理模式提高肺癌術后化療患者自我效能. 護理學雜志, 2016, 31(6): 91-92.
13. Lombardi CP, Raffaelli M, D’alatri L, et al. Video-assisted thyroidectomy significantly reduces the risk of early postthyroidectomy voice and swallowing symptoms. World J Surg, 2008, 32(5): 693-700.
14. Ha TK, Kim DW, Park HK, et al. Comparison of postoperative neck pain and discomfort, swallowing difficulty, and voice change after conventional open, endoscopic, and robotic thyroidectomy: A single-center cohort study. Front Endocrinol (Lausanne), 2018, 9: 416. doi: 10.3389/fendo.2018.00416.
15. Taylor RJ, Chepeha JC, Teknos TN, et al. Development and validation of the neck dissection impairment index: a quality of life measure. Arch Otolaryngol Head Neck Surg, 2002, 128(1): 44-49.
16. Roh MR. The SCAR (Scar Cosmesis Assessment and Rating) scale: new evaluation method for postoperative scars. Br J Dermatol, 2016, 175(6): 1151-1152.
17. 代文杰, 喻慶安. 原發性甲狀旁腺功能亢進癥圍手術期處理中國專家共識 (2020版). 中國實用外科雜志, 2020, 40(6): 634-638.
18. 湯敏譽, 梁鵬. 甲狀腺/甲狀旁腺術后早期低鈣血癥誘發的清醒狀態下喉痙攣2例報道. 中國普外基礎與臨床雜志, 2022, 29(7): 943-945.
19. 徐加杰, 張李卓, 張啟弘, 等. 無充氣經腋窩腔鏡甲狀腺手術的臨床應用. 中華耳鼻咽喉頭頸外科雜志, 2020, 55(10): 913-920.
20. 王佳峰, 徐加杰, 蔣烈浩, 等. 無充氣腋窩入路完全腔鏡下甲狀腺癌根治術對術后頸部功能影響的初步研究. 中華內分泌外科雜志, 2021, 15(1): 10-14.
21. Zhang WC, Lu DN, Xu JJ, et al. Clinical application of endoscopic surgery using a gasless unilateral transaxillary approach in the treatment of primary hyperparathyroidism. Front Surg, 2022, 9: 962463. doi: 10.3389/fsurg.2022.962463.
22. 莊大勇, 賀青卿, 周鵬, 等. 達芬奇機器人與開放性手術治療原發性甲狀旁腺功能亢進的對照研究. 中華內分泌外科雜志, 2021, 15(4): 348-352.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical application of endoscopic parathyroidectomy by gasless unilateral axillary approach and perioperation management of patients

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