经口内镜甲状腺切除术前庭入路的灵活单端口通路

经口内窥镜甲状腺切除术前庭入路 (TOETVA) 被认为是唯一一种无疤痕技术，它结合了最小化的手术创伤和内窥镜检查的所有优势，例如增强视野、荧光甲状旁腺成像 (FPI) 和最佳美容效果。 解决 TOETVA 特定的局部风险状况，如精神神经损伤、皮肤损伤的可能性或难以取回标本，将基于三个套管针的 TOETVA 修改为一个软的单端口平台。

建立了单端口 TOETVA (SP-TOETVA) 并在 5 名患者中进行了回顾性分析，这些患者使用了一个装有多个套管针阀的软手工单端口。 使用了标准腹腔镜器械、一个铰接器械和一个血管密封装置。 CO2 吹入维持在 6-8 mmHg。

在所有患者中，SP-TOETVA 均成功完成。 Hemigland 和总甲状腺体积分别为 5-40 和 55 mL。 既不需要额外的套管针也不需要转换为开放式。 手术时间为 102-214 分钟。 应用了神经监测和 FPI。 柔软的伤口保护箔用于方便标本采集。 没有发生术中或术后并发症。 特别是未见精神神经功能障碍。

SP-TOETVA 采用柔软灵活的手工单端口系统，是可行的，可确保伤口保护。 它允许简单的仪器应用和微创手术的好处，而没有侧前庭切口的特定风险。

经口内镜甲状腺切除术前庭入路的灵活单端口通路

手术室设置。

经口内镜甲状腺切除术前庭入路的灵活单端口通路

颈阔肌下间隙的水分离（该图像在患者同意的情况下发布）。

经口内镜甲状腺切除术前庭入路的灵活单端口通路

手工单端口系统。

经口内镜甲状腺切除术前庭入路的灵活单端口通路

安装手工制作的单端口系统。 (A) 插入伤口保护膜； (B) 连接手套前将外圈卷起； (C) 连接手套端口。

经口内镜甲状腺切除术前庭入路的灵活单端口通路

在 SP-TOETVA 右半甲状腺切除术中用于动态牵引的缝合线（腹侧和侧向）（此图像在患者同意的情况下发布）。 SP-TOETVA，单孔经口内窥镜甲状腺切除术前庭入路。

经口内镜甲状腺切除术前庭入路的灵活单端口通路

术中使用吲哚菁绿以利于甲状旁腺的鉴别。 (A) 正常视图和 (B) 使用 ICG 负染色识别甲状旁腺的对比视图。 ICG，吲哚菁绿； TG，甲状腺； SP，PTG的支持血管； F、脚； H，头部； L，左； R，右； PTG，甲状旁腺。

经口内镜甲状腺切除术前庭入路的灵活单端口通路

通过腹腔镜持针器时手工端口的内部视图。 IR，伤口保护器内圈； N，腹腔镜持针器。

经口内镜甲状腺切除术前庭入路的灵活单端口通路

操作关键步骤的图示。 (A) 暴露贝里韧带； (B) 解剖 Berry 韧带后识别右喉返神经（黑色箭头）； (C) SP-TOETVA 技术右半甲状腺切除术后自上而下的解剖概览，暴露右喉返神经（黑色箭头）。 SP-TOETVA，单孔经口内镜前庭甲状腺切除术； RL，甲状腺右叶； BL，Berry韧带； Tr，气管； rCCA，右颈总动脉； LL，甲状腺左叶。

经口内镜甲状腺切除术前庭入路的灵活单端口通路

标本的引导收获截留在回收袋中并通过箔套传送。

经口内镜甲状腺切除术前庭入路的灵活单端口通路

缝合单个正中口腔前庭通路。 黑色刻度以厘米为单位。

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