无充气经腋窝入路腔镜甲状腺系膜切除技术要点OA

Gasless transaxillary endoscopic thyroid surgery,characterized by a concealed incision and an extensible operative channel,is an important procedure embodying the concepts of membrane anatomy and precision minimally invasive surgery.Based on mesothyroid anatomy,this procedure emphasizes real-time identification and expansion of the fascial fusion planes among the superficial,deep,and visceral fascial layers.Standardized incision selection and patient positioning are prerequisites for reducing complications:the incision is recommended near the axillary apex to minimize scar hypertrophy,and the upper limb should be mildly elevated with elbow flexion to avoid brachial plexus traction injury caused by excessive abduction.Intraoperatively,sequential and precise dissection of the plane on the surface of the pectoralis major fascia,incision of the investing fascia,passage through the sternocleidomastoid interval,and extension across the carotid sheath to the visceral fascial layer allow complete mesothyroid dissection of the thyroid gland and central compartment lymphofatty tissue.The thyroid gland lies within the visceral fascial layer and is surrounded by key anatomical planes,including the retro-infrahyoid muscle fascial space,prevertebral fascial space,pretracheal space,and cricothyroid space.The essence of resection is the identification,expansion,and connection of these fascial planes.This technique depends on dynamic judgment of fascial spaces,coordinated instrument manipulation,and rational use of energy devices,thereby helping reduce operative difficulty and improve safety and efficiency.A standardized strategy for expanding fascial fusion planes may decrease intraoperative bleeding and related complications and promote standardized,high-quality development of thyroid surgery.