The Study Of Laparoscopic Anatomy And Operative Approaches For The Laparoscopic Thyroidectomy & Laparoscopic Parathyroidectomy(172-case Report)

Objective:Demonstrate laparoscopic anatomic characteristics of the organs around the thyroid(include itself),to explore the best operative approach and technique for laparoscopic thyroidectomy(LTD)& laparoscopic parathyroidectomy(LPD).Methods:A retrospective study of 171patients have been performed LT and 1 patient has been performed LPD by the same surgeons from 2002 to 2006. The clinic materials,videos,meanwhile relative references were reviewed.The anterior thoracic pathway(ATP)was summarized,the LTD by other pathways were referenced.Results:171 patient's operations all were smoothly(1 LPD),1 patient reverse to open because retrosternal struma.The mean operating time is 116±17min,the mean bleeding volume is 85±6ml,the drainage volume is 105±35ml,the mean hospital stay is 4.0±0.8d.The anatomic structure of ATP and operative procedure:1.White tissue under the yellow fat can be seen in the visual field,that's the manifestations and characteristics of superficial fascia anterior thoracic,Identification of which can help to establish operative pervium; 2.sternomastoid muscle strike like a reverse triangle,and the anterior cervical triangle always include a layer of fat,Behind which is the linea alba,thyroid should be protected when cut it out.3.the thyroid's exposure and resection, segregate between the genuine capsule &false capsule,abscise the thyroid vessels gradually.4.cervicalis's close and drainage. Conclusion:Either benign or malignant diseases of thyroid,thorough ATP performed LTD&LPD are safe and feasible.The organs must to be identify include:anterior cervix fascia,sternomastoid muscle,linea alba cervicalis, trachea,oesophagus,jugular vein & arteries,recurrent laryngeal nerve,superior laryngeal nerve,thyroid & parathyroid et al.the main procedure:1. establishment of operative pervium;2.upper thoracic diastem's exposure;3.the thyroid exposure and resection;4.linea alba cervicalis close and drainage.The pathway include:cervical pathway,cervical aeration,suprasternal fossa pathway, infraclavicular pathwayand mamma pathway.