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Modifications of transaxillary approach in endoscopic da Vinci-assisted thyroid and parathyroid gland surgery

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Abstract

Endoscopic surgery for treatment of thyroid and parathyroid pathologies is increasingly gaining attention. The da Vinci system has already been widely used in different fields of medicine and quite recently in thyroid and parathyroid surgery. Herein, we report about modifications of the transaxillary approach in endoscopic surgery of thyroid and parathyroid gland pathologies using the da Vinci system. 16 patients suffering from struma nodosa in 14 cases and parathyroid adenomas in two cases were treated using the da Vinci system at the ENT Department of Homburg/Saar University and in cooperation with the Department of General Surgery in New Sant’Agostino Hospital, Modena/Italy. Two different retractors, endoscopic preparation of the access and three different incision modalities were used. The endoscopic preparation of the access allowed us to have a better view during preparation and reduced surgical time compared to the use of a headlamp. To introduce the da Vinci instruments at the end of the access preparation, the skin incisions were over the axilla with one incision in eight patients, two incisions in four patients and three incisions in a further four patients. The two and three skin incisions modality allowed introduction of the da Vinci instruments without arm conflicts. The use of a new retractor (Modena retractor) compared to a self-developed retractor made it easier during the endoscopic preparation of the access and the reposition of the retractor. The scar was hidden in the axilla and independent of the incisions selected, the cosmetic findings were judged by the patients to be excellent. The neurovascular structures such as inferior laryngeal nerve, superior laryngeal nerve and vessels, as well as the different pathologies, were clearly 3D visualized in all 16 cases. No paralysis of the vocal cord was observed. All patients had a benign pathology in their histological examination. The endoscopic surgery of the thyroid and parathyroid gland can be performed using the da Vinci system and offers an excellent, intra-operative, 3D visualization of the neurovascular structures. The new incision modalities, use of a new retractor, and endoscopic preparation of the access made the surgery easier and safer using the transaxillary access to the thyroid and parathyroid glands. The modified skin incisions allowed an improved movement of the da Vinci arms during operation.

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Conflict of interest

Basel Al Kadah, Micaela Piccoli, Barbara Mullineris, Giovanni Colli, Martin Janssen, Stephan Siemer, and Bernhard Schick declare that they have no conflict of interest.

Ethical standard

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, University Medical Center, Kirrberger Straße, 66421, Homburg, Saar, Germany

    Basel Al Kadah & Bernhard Schick

  2. Department of General Surgery, New Sant’Agostino Hospital, Modena, Italy

    Micaela Piccoli, Barbara Mullineris & Giovanni Colli

  3. Department of Urology, University Medical Center, Homburg, Saar, Germany

    Martin Janssen & Stephan Siemer

Authors
  1. Basel Al Kadah
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  2. Micaela Piccoli
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  3. Barbara Mullineris
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  4. Giovanni Colli
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  5. Martin Janssen
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  6. Stephan Siemer
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  7. Bernhard Schick
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Correspondence to Basel Al Kadah.

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Al Kadah, B., Piccoli, M., Mullineris, B. et al. Modifications of transaxillary approach in endoscopic da Vinci-assisted thyroid and parathyroid gland surgery. J Robotic Surg 9, 37–44 (2015). https://doi.org/10.1007/s11701-014-0486-8

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  • DOI: https://doi.org/10.1007/s11701-014-0486-8

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