Initial Technique Regarding Application Of Miccoli's Minimally Invasive Endoscope-assisted Thyroidectomy With Technical Modifications

To discussion of Initial technique regarding Application of Miccoli's Minimally Invasive Endoscope-assisted Thyroidectomy with Technical Modifications. 18 patients with nodular goiter, adenoma and Graves'disease consecutively received the endoscope- assisted thyroid operation according to Miccoli's mode with Technical Modifications. A new device was used to maintain the working-space and to regulate its inner volume 3 dimensionally. The approach was designed to use ultrasonically activated scalpels [Harmonic Scalpel (R), Johnson & Johnson, USA] as a major, suction-dissector or others as supplementary instruments during the whole process. During the operations, two methods,"sequenced dissect-coagulate-cut"and"pre-coagulation+interlaced cut-suck- coagulate-dissect", were employed and separately evaluated for their safety or efficacy. The key points of the operative procedure consist of identifying the parathyroids and protecting well its delicate vessels intake while performing the dissection, keep away also the recurrent laryngeal nerves using a meticulous technique of excapsular dissection. All of the procedures were successfully completed. None of them were interrupted and converted to open surgery due to uncontrolling bleeding or severe postoperative hematoma. No case postoperative tetany or temporary hoarseness was observed. Ultrasonic scalpel-based and space-regulating techn iques are beneficial additive measures in performing endoscopic thyroidectomy. Application of these innovative techniques helps to render this minimally invasive approach simple and reliable. During the clinical course of Application of Miccoli's Minimally Invasive Endoscope-assisted Thyroidectomy with Technical Modifications, The maintenance of operative space, procedure points, the advant ges and disadvantages, the complications, the indications and contraindications are absolutely necessary. Application of these innovative techniques helps to render this minimally invasive appr oach simple and reliable. The meticulous technique adopted plays a key role in ensuring the safety of thyroidectomy for radical pur- poses, and will get the more extensive application gradually with more experience.