经腋窝无充气后入路腔镜甲状腺手术的“场景化”辅助操作  

"Scene-based" approach for gasless transaxillary posteriorendoscopic thyroidectomy

作　　者：孙百慧 余诗桐 葛军娜[1] 魏志刚[1] 雷尚通[1] SUN Baihui;YU Shitong;GE Junna;WEI Zhigang;LEI Shangtong(Department of General Surgery,Nanfang Hospital of Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院普通外科,广东广州510515

出　　处：《中国普通外科杂志》2023年第5期724-730,共7页China Journal of General Surgery

摘　　要：随着腔镜甲状腺手术的发展及推广,经腋窝腔镜甲状腺手术无疑被证实是一种安全、可行的手术方式。其中,经腋窝无充气后入路腔镜甲状腺手术(GTPET)因无充气干扰的清晰视野,已被广泛接纳并采用。但因其侧面观视角、镜头与器械共用手术空间的特点,使手术操作存在固有难点。为解决腔镜操作中视角配合问题,有团队应用扶镜机器人,但对于GTPET这种操作范围较小的手术方式,手术视角及操作仍依赖于术者及扶镜手的配合。为克服GTPET操作中的难点,笔者引入“场景化”操作理念,从扶镜手的角度出发,通过三部分规范GTPET手术过程中扶镜手的操作流程。一为手术前准备:规范患者体位摆放及扶镜手位置;二为扶镜手操作要点:概括为“一支点”“二入路”“三平行”;三为“四宫格”法镜下视野场景化辅助操作:将手术区域划分为I~Ⅳ区,据此引导手术操作。With the development and promotion of endoscopic thyroid surgery,transaxillary endoscopic thyroid surgery has been proven to be a safe and feasible surgical method.Among them,gasless transaxillary posterior endoscopic thyroid surgery(GTPET)has been widely accepted and adopted due to its clear field of vision without gas interference.However,due to the characteristics of the lateral viewing angle,shared surgical space of the lens and instruments,inherent difficulties exist in the surgical operation.To solve the problem of visual angle coordination in endoscopic operations,some teams have applied an assistant robot.However,for GTPET,which has a small operating range,the surgical view and operation still depend on the coordination of the surgeon and the camera-holding assistant.To overcome the difficulties in GTPET procedures,the author introduces the concept of"scene-based"operations,focusing on the perspective of the camera-holding assistant.This involves standardizing the assistant's operational procedures during the GTPET surgery into three parts.Firstly,preoperative preparation:standardizing patient positioning and the location of the camera-holding assistant.Secondly,key points for the assistant's operation: summarized as "one pivot," "two approaches," and "three planes."Thirdly, the "four-quadrant" method was used to assist the operation by visualizing the field ofendoscopic view, dividing the surgical area into zones I to Ⅳ and guiding the surgical proceduresaccordingly.

关 键 词：甲状腺切除术 内窥镜 场景 

分 类 号：R653.2[医药卫生—外科学]