Application Of Digital Technology In Single-site Endoscopic Parathyroid Surgery Based On ERAS Principle

OBJECTIVE: In the surgical treatment of primary hyperparathyroidism(PHPT),transareola single-site endoscopic parathyroidectomy(TASSEP)was utilized according to the ERAS principle,to establish a surgical plan with 3D digital technology to optimize the surgical strategy.Explore the precise surgical treatment mode of PHPT under the principle of ERAS.METHODS: Twenty-three patients with PHPT were enrolled in the study between January 2017 and December 2018.There were 11 patients in the conventional open surgery group and 12 in the TASSEP group.All patients were diagnosed qualitatively by biochemical examination before operation,and the lesions were located by ultrasound,SPECT/CT and CT.Using the ultra-thin layer CT image to establish a 3D model of the neck,finely locate the parathyroid lesions,accurately determine the anatomical relationship between the parathyroid lesion and the thyroid gland.On the premise of preserving the thyroid gland,surgical planning such as parathyroid lesion localization,surgical approach selection,tissue dissection procedure,and surgical ligation sequence were established to optimize the surgical strategy and reduce the difficulty of single-site endoscopic surgery.Intraoperative carbon nanoparticles negative development technique is used to accurately identify the lesions and achieve precise surgical resection.First,the general clinical data balance between the two groups of patients was compared.Then,closely follow the ERAS principle,measure the CRP and immunity indicators before and after the surgery,and compare the effects of surgical trauma on the body's stress and immune function.Furthermore,the important data indicators of ERAS were examined in detail,including the VAS score after operation,postoperative hospital stay and complications.The effect of PHPT treatment and cosmetic satisfaction score were evaluated during follow-up.RESULTS: There were no significant differences in age,gender,and BMI between the two groups.The procedures were successfully accomplished in both groups,and there was no conversion in the TASSEP group.There was no significant differences in the duration of surgery,the volume of intraoperative blood loss,and the lesions length between the two groups.On the first day after surgery,both PTH and Calcium decreased to the normal range.Compared with preoperative,IgA,IgM and IgG in the conventional open group were significantly decreased(p<0.05)while CRP was significantly increased(p<0.05);IgG in the TASSEP group was significantly decreased(p<0.05)while CRP was significantly elevated(p < 0.05).There was no significant difference in CRP between the two groups before operation.CRP in the conventional open group was significantly higher than the TASSEP group(p<0.05).The VAS score in the TASSEP group was significantly lower than the conventional open group(p<0.05).No complications occurred in either group,and there was no significant difference in the postoperative hospital stays.The cosmetic satisfaction score in the TASSEP group was significantly higher than that in the conventional open group(p<0.05).All the patients achieved biochemical cured.Conclusion: In the surgical treatment of primary hyperparathyroidism(PHPT),TASSEP is more consistent with the ERAS principle than conventional open surgery.3D digital technology can effectively optimize the surgical strategy,significantly improve the safety and effectiveness of TASSEP.TASSEP combined with digitalassisted surgery design is a new mode for precise surgical treatment of PHPT.