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. 原发性甲状旁腺功能亢进的诊断与治疗. 中国普外基础与临床杂志, 2014, 21(2): 236-239.
2.	朱精强, 苏安平. 甲状旁腺功能与甲状腺外科的诊治进展. 中国普外基础与临床杂志, 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.	郑传铭, 毛晓春, 王佳峰, 等. 无充气腋窝入路完全腔镜下甲状腺癌根治术效果初步评价初期体会. 中国肿瘤临床, 2018, 45(1): 27-32.
5.	中国抗癌协会甲状腺癌专业委员会, 中华医学会肿瘤学分会甲状腺肿瘤专业委员会, 中国研究型医院学会甲状腺疾病专业委员会, 等. 无充气腋窝入路腔镜甲状腺手术专家共识 (2022版). 中华内分泌外科杂志, 2021, 15(6): 557-563.
6.	郑传铭, 徐加杰, 王佳峰, 等. 无充气腋窝入路腔镜甲状腺手术的进展与展望. 中国普外基础与临床杂志, 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, 孙素红, 郑传铭, 等. 改良无充气腋窝入路腔镜甲状 (旁) 腺手术40例分析. 中国普通外科杂志, 2019, 28(11): 1437-1440.
9.	李文杰, 徐海倩, 翟立斌. 甲状旁腺微血管解剖与甲状腺囊内切除技术. 中国普外基础与临床杂志, 2013, 20(1): 104-107.
10.	郑传铭, 徐加杰, 蒋烈浩, 等. 无充气腋窝入路完全腔镜下甲状腺叶切除的方法—葛-郑氏七步法. 中国普通外科杂志, 2019, 28(11): 1336-1341.
11.	胡啸天, 忻莹, 郑传铭, 等. 无充气腋窝入路完全腔镜甲状腺手术的“三推进”悬吊建腔法. 浙江大学学报(医学版), 2021, 50(6): 694-700.
12.	张国莉, 张丽敏. 应用5A护理模式提高肺癌术后化疗患者自我效能. 护理学杂志, 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, 喻庆安. 原发性甲状旁腺功能亢进症围手术期处理中国专家共识 (2020版). 中国实用外科杂志, 2020, 40(6): 634-638.
18.	汤敏誉, 梁鹏. 甲状腺/甲状旁腺术后早期低钙血症诱发的清醒状态下喉痉挛2例报道. 中国普外基础与临床杂志, 2022, 29(7): 943-945.
19.	徐加杰, 张李卓, 张启弘, 等. 无充气经腋窝腔镜甲状腺手术的临床应用. 中华耳鼻咽喉头颈外科杂志, 2020, 55(10): 913-920.
20.	王佳峰, 徐加杰, 蒋烈浩, 等. 无充气腋窝入路完全腔镜下甲状腺癌根治术对术后颈部功能影响的初步研究. 中华内分泌外科杂志, 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.	庄大勇, 贺青卿, 周鹏, 等. 达芬奇机器人与开放性手术治疗原发性甲状旁腺功能亢进的对照研究. 中华内分泌外科杂志, 2021, 15(4): 348-352.

1. 王松, 代文杰. 原发性甲状旁腺功能亢进的诊断与治疗. 中国普外基础与临床杂志, 2014, 21(2): 236-239.
2. 朱精强, 苏安平. 甲状旁腺功能与甲状腺外科的诊治进展. 中国普外基础与临床杂志, 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. 郑传铭, 毛晓春, 王佳峰, 等. 无充气腋窝入路完全腔镜下甲状腺癌根治术效果初步评价初期体会. 中国肿瘤临床, 2018, 45(1): 27-32.
5. 中国抗癌协会甲状腺癌专业委员会, 中华医学会肿瘤学分会甲状腺肿瘤专业委员会, 中国研究型医院学会甲状腺疾病专业委员会, 等. 无充气腋窝入路腔镜甲状腺手术专家共识 (2022版). 中华内分泌外科杂志, 2021, 15(6): 557-563.
6. 郑传铭, 徐加杰, 王佳峰, 等. 无充气腋窝入路腔镜甲状腺手术的进展与展望. 中国普外基础与临床杂志, 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, 孙素红, 郑传铭, 等. 改良无充气腋窝入路腔镜甲状 (旁) 腺手术40例分析. 中国普通外科杂志, 2019, 28(11): 1437-1440.
9. 李文杰, 徐海倩, 翟立斌. 甲状旁腺微血管解剖与甲状腺囊内切除技术. 中国普外基础与临床杂志, 2013, 20(1): 104-107.
10. 郑传铭, 徐加杰, 蒋烈浩, 等. 无充气腋窝入路完全腔镜下甲状腺叶切除的方法—葛-郑氏七步法. 中国普通外科杂志, 2019, 28(11): 1336-1341.
11. 胡啸天, 忻莹, 郑传铭, 等. 无充气腋窝入路完全腔镜甲状腺手术的“三推进”悬吊建腔法. 浙江大学学报(医学版), 2021, 50(6): 694-700.
12. 张国莉, 张丽敏. 应用5A护理模式提高肺癌术后化疗患者自我效能. 护理学杂志, 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, 喻庆安. 原发性甲状旁腺功能亢进症围手术期处理中国专家共识 (2020版). 中国实用外科杂志, 2020, 40(6): 634-638.
18. 汤敏誉, 梁鹏. 甲状腺/甲状旁腺术后早期低钙血症诱发的清醒状态下喉痉挛2例报道. 中国普外基础与临床杂志, 2022, 29(7): 943-945.
19. 徐加杰, 张李卓, 张启弘, 等. 无充气经腋窝腔镜甲状腺手术的临床应用. 中华耳鼻咽喉头颈外科杂志, 2020, 55(10): 913-920.
20. 王佳峰, 徐加杰, 蒋烈浩, 等. 无充气腋窝入路完全腔镜下甲状腺癌根治术对术后颈部功能影响的初步研究. 中华内分泌外科杂志, 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. 庄大勇, 贺青卿, 周鹏, 等. 达芬奇机器人与开放性手术治疗原发性甲状旁腺功能亢进的对照研究. 中华内分泌外科杂志, 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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