1. The current status and prospect of endoscopic thyroid operation Yu Wenbin Qilu Hospital of SDU

2. Current status and Prospect of endoscopic thyroid operation The neck is the represent of the beauty of human body. Most of the time, the neck is bare.

3. The obvious cervical scar after traditional thyroid operation affect the appearance seriously. With the development of endoscopic surgery, an minimal invasive operation mode emerged which could cure the thyroid tumor, and does not affect the appearance in the same time. Current status and Prospect of endoscopic thyroid operation

4. The incision of endoscopic thyroid operation is minimal invasive and is designed skillfully. The scar is hard to be noticed.The cosmetic results are excellent. Current status and Prospect of endoscopic thyroid operation

5. Endoscopic thyroid operation IS minimally invasive operation Current status and Prospect of endoscopic thyroid operation

6. It is “a giant operation” in terms of the physical injury. It is “a minimal operation” in terms of the mental injury. At present, we are inclined to take it as a cosmetic operation. Current status and Prospect of endoscopic thyroid operation

7. Since then August. 2001 Hu Sanyuan June. 2001 Qiu Ming Developed gradually First endoscopic thyroid operation in China carry out this technique subsequently 1996 Gagner 1997 Huscher First endoscopic subtotal parathyroidectomy First endoscopic thyroid lobectomy Brief history of endoscopic thyroidectomy

8. China Biology Medicine disc (CBM)& Chinese Journal Full-text Database More than 2000 cases on all kinds of endoscopic thyroid operations in china so far More than 200 papers on endoscopic thyroidectomy were published in our country during 2001-2007 This technique developed better in the area where laparoscopic technology is mature. We had completed more than 200 cases endoscopic thyroid operation since our first case from Aug. 2001. （ Qi Lu hospital of Shandong University ） Current status and Prospect of endoscopic thyroid operation

9. Indications Thyroid or parathyroid carcinoma in early stage Thyroid adenoma Nodular goiter Hyperthyro idism less than Ⅱ ° Parathyroid adenoma Endoscopic thyroidectomy

10. Contraindication Thyroid malignant tumor in late stage Ⅲ ° hyper- thyroidism and thyroiditis Giant or multiple nodular goiter (>5 cm)

11. Whether the past thyroid operation history is an contraindication of endoscopic thyroid operation? Current status and Prospect of endoscopic thyroid operation

12. Aug. 2005,we successfully performed 1 case on endoscopic right lobe subtotal thyroidectomy, in which the patient accepted left lobe thyroidectomy （ traditional operation ）） 10 years ago. With the improvement of the operation level and development of the equipment, past thyroid surgery history is no longer an absolute contraindication. Current status and Prospect of endoscopic thyroid operation

13. Endoscopic thyroid operation mode Endoscopic thyroid adenoma removal Endoscopic partial thyroidectomy Endoscopic thyroid carcinoma radical resection Endoscopic subtotal thyroidectomy

14. The method to establish operation space Advantage: avoid the complicatio ns caused by CO 2 Disadvant age: scar left on the skin. Operation space not enough. suspension type Sling the flap Kirschner wire

15. CO 2 insufflation Advantage ： No scar & better space Disadvantage ： Hypercapnia, Respirator acidosis, arrhythmia, increased intracranial pressure Solution: low-pressure perfusion (6-8mmHg), limiting the CO 2 perfusion time and use of free gas method to establish the operation space. The method to establish operation space Discomfort: Palpitation Dizziness, nausea, vomiting

16. Operative approach Breast Areola Approach Anterior chest approach Sternal notch approach Axillary approach Subclavian approach surgical approach

17. Operative demonstration Take the Breast Areola Approach as an example to introduce the specific steps of endoscopic thyroid operation

18. Breast Areola Approach Anesthesia and posture

19. Establish the operation space Breast Areola Approach

20. Separate the subcutaneous space, up to the hyoid bone, lateral to the medial margin of the sternocleidomastoid muscle. Breast Areola Approach

21. Longitudinal separation of infrahyoid muscles, reveal the thyroid gland and mass. Breast Areola Approach

22. Removed the mass completely

23. The mass was removed in self-made specimen bag. Breast Areola Approach

24. Suture of infrahyoid muscles Breast Areola Approach

25. Place the drainage & close the incision. Breast Areola Approach

26. Reexamination at one month after operation Breast Areola Approach

27. Sternal notch approach Breast Areola Approach Anterior chest approach Sternal notch approach Axillary approach Subclavian approach surgical approach

28. Sternal notch approach

30. Breast areola approach Anterior chest approach Sternal notch approach Axillary approach Subclavian approach surgical approach

31. Axillary approach

32. Breast Areola Approach Anterior chest approach Sternal notch approach Axillary approach Subclavian approach surgical approach

33. Subclavian route

34. Advantages and disadvantages of each operation path Areola Approach Advantage ： No scar in the neck; One of the popular Method in clinic Disadvantage: Larger trauma

35. Advantages and disadvantages of each operation path Axillary approach Advantage ： The incision is hided tactfully Disadvantage: Far away from the lesions; Difficult to operate

36. Advantages and disadvantages of each operation path Sternal notch & subclavian approach Advantage ： Closer to the lesion; Smaller trauma; Easy for endoscopy- assisted thyroid operations Disadvantage: Scar is visible in the neck; less cosmetic effect

37. Advantages and disadvantages of each operation path Anterior chest approach Smaller trauma compared to areola approach Favorable postoperative appearance compared to sternal notch approach Common in clinic

38. Endoscopic parathyroid operation

39. Postoperative complications 1 Complications caused by CO2: Subcutaneous emphysema & hypercapnia 2 Complications caused by subcutaneous dissection: Fat liquefaction,errhysis, Chest numbness,ect. 3 Injury of parathyroid and nerve: convulsion,hoarseness,cough

40. The reason for conversion to open surgery Tumor too large, no enough operative space Severe ahension with thyroid carcinoma Uncontrolled bleeding during operation Conversion to open decidedly

41. Safety of the endoscopic thyroid operation With the improvement of endoscopic technique and development of equipment, endoscopic thyroid operation is safe, effective and feasible. It will continue to development

42. Thanks ！ Current status and Prospect of endoscopic thyroid operation