Ukuhlolisisa i-Transaxillary Scarless Surgery ye-Robotic kunye noDkt. Emad Kandil
Esinye seziphumo ezingapheliyo zonyango lwe-thyroid - eyaziwa ngokuba yi-thyroidectomy - ingqayi eshiywe emva kwe-incision. Abagqirha be-thyroid abagqwesileyo banobungcali ngokubeka ngokucophelela i-incision ukuze inkohlakalo ifihliwe entanyeni. Kwiminyaka yakutshanje, iziphumo zifumene ezincinci, ngokubonga kwiindlela zobugcisa zokuncediswa ngevidiyo. Ukubonakala kwamehlo e-thyroid kuye kwaphucuka ngokubanzi, kodwa i-thyroidectomy ngentambo yentamo ishiya inqabunga ebonakalayo.
Abanye oogqirha baqhuba ubuchopho be-thyroid kunye nentamo kunye noncedo lwe-robotic, bafake isiqwenga kwi-underarm (axilla). Oku kwaziwa ngokuba "utyando lwe-roshan". I-FDA ivunye le nkqubo ngo-2009 kwaye amaziko amathathu aseburhulumenteni okwangoku asebenzisa i-robotics eziphambili kwi-thyroidectomy.
Ukongezelela kwintlawulo yezonyakatho zokuba yinto ebomvu kwindawo engaphantsi kwesidumbu - kunokuba ibe entanyeni - indawo engaphantsi kwesifo se-underarm ineziphetho ezincinci kwi-intshi yeekremu ngaphezu kwendawo yomqala, ukwenjenjalo ukuphulukiswa kungenabuhlungu kunye nokunyamekela, ukunyanzelisa Uya kuphulukisa ngokukhawuleza kunokuba entanyeni yendawo.
U-Emad Kandil, MD, i-FACS, yiNtloko yeCreater Surgery e-Tulane University School of Medicine. UDkt. Kandil uye wanceda ukuguqula nokuphuhlisa iindlela zobugcisa zentambo ye-robantic robotic, usebenzisa i-intraoperative nerve monitoring monitor ukukhusela i-laryngeal (ibhokisi yezwi). UDkt. Kandil uye wathatha inxaxheba kule Seshoni yombuzo kunye neempendulo ukuze ancede abafundi be-site ye-Thyroid bafunde kabanzi malunga ne-robotic-assisted thyroid kunye nentliziyo.
Umbuzo: Ukuhlinzwa kwintamo ye-robantic robotic kuthathwa njengentuthuko engaphaya kwe-endoscopic ukuhlinzwa okwenziwe ngevidiyo okwenziwe ngokugqithiseleyo ekusebenzisweni kwe-thyroid neyentamo, kwaye ukuhlinzwa ngokugqithiseleyo kuthathwa njengobume bobugcisa kunokwenziwa kobugcisa bendabuko. Ngaba ungazixelela malunga nale ndlela yokuhlinzwa?
UDkt Kandil: Utyando lwe-thyroid oluqhelekileyo ludla ngokubandakanya ixesha elide elisezantsi entanyeni. Ubunzima obubonakalayo obunaphakade. Ngoku kutshanje, ukuhlinzwa okwenzelwe i-endoscopic ye-thyroid nentamo sele isetyenziswa. Oku kutyunjwa kwenziwa ngentambo encinci yentamo, usebenzisa ukubonakaliswa kwe-endoscopic ngekhamera encinane. Le nkqubo yaphayona e-Italy nguDkt. Paolo Miccolli waza wafumana udumo eMelika emva kokuba uDkt. David Terris amkele le nkqubo. Ndiye ndinika le gulane kwizigulane zam ngeendlela zokongezwa kwendlela yokubeka iliso - kunye nokuqeqesha abanye oogqirha kule nkqubo - kwiminyaka emibini edlulileyo. Le nqubo, kodwa, isenza ukuba inqabile entanyeni.
Mayelana neTransaxillary Surgery ye-Thyroid
Umbuzo: Nguwuphi utyando lwe-thyroid owenziwe nge-robantic kunye neendlela ezenziwa ngayo?
UDkt Kandil: UDkt. Woong Youn Chung eSeoul, eKorea, wavelisa ubuchule bokutyanda intamo engenazintlu kunye noncedo lwe-robotic.
Ekuqaleni, indlela yokuhlinzwa yentamo ye-robotic yenziwe nge-carbon dioxide (CO2) ukungena kwegesi (ukufakwa kwegesi kwindawo yokugada) kwindawo yentamo. Ukusetyenziswa kwegesi kunakho ukubangela ezinye iziphumo zogqirha, emva koko, njengoko izigulane zinokuva ubunzima ngenxa yegesi egcinwe kwiimfucu ezijikeleze imiphunga (imeko eyaziwa ngokuba yi-pneumomediastinum) okanye umoya ongaphantsi kunye nama-crepitations.
Intlungu kunye neentlungu ziya kuhlala zize igesi igqitywe.
I-Robotic, engenasiphelo, i-transaxillary thyroidectomy yindlela yokucwangcisa esanda kuphuhliswa, yokunciphisa yonke into okanye inxalenye ye-thyroid. Kwakhona ngamanye amaxesha kuthiwa utyando lwe-thyroid, okanye utyando lwe-endoscopic ye-thyroid.
Ngale ndlela entsha, i-gas insufflation igwenywe, ngoko ke iingxaki ezinxulumene nokugcinwa kwegesi nazo ziyakuphepha.
Ngalolu cwangciso olutsha, udidi oluthile lwenziwa phantsi kwengalo, kunye neengalo zerobhothi zenzelwe ngokuzenzekelayo, zivumela ukuba ugqirha usebenze ngokulawulwa nokuhamba kakuhle.
I-robhotic inkqubo ivumela ukuba ugqirha ukuba abone kwi-stereo-optic emithathu-dimension (i-3D), enekhamera ecacileyo ecacileyo eyenza ukuphakanyiswa kweshumi kumbono oqhelekileyo. Siphinde satshintshela inkqubo yokubandakanya ukusetyenziswa kwenkqubo yokujonga iliso.
Le nkqubo iye yakwamukelwa ngokutsha yi-FDA ngo-2009 kwaye iboniswe ukuba yindlela ekhuselekileyo.
Umbuzo: Nceda uchaze iintlawulo ze-transaxillary utyando lwe-thyroid ngokuqhathaniswa ne-thyroidectomy yendabuko.
UDkt Kandil: Inzuzo eyintloko kukuba u-tansaxillary utyando lwe-robotic ayiphumeli kwintambo ebonakalayo yintliziyo.
Umngcipheko wokuhlinzwa okwe-thyroid ngumngcipheko wokulimala kwi-laryngeal nererve, eya kwibhokisi yezwi. Oku kunokubangela ukutshatyalaliswa kwesikhashana okanye okusisigxina. Utyando lwe-thyroid lunokubangela ukuba utyhafu kwizakhiwo ezikufuphi, kubandakanywa neengqungquthela ze-parathyroid, ezikufutshane ne-thyroid. Umonakalo we-Parathyroid ungakhokelela kwi-hypocalcemia yesikhashana okanye isisigxina, imeko ephathwa nge-calcium supplementation.
Ukusuka kwimeko yokuphepha, kwi-rotictic robotic operation, ukusetyenziswa kwezixhobo zokusebenza ze-robotic eziphezulu, kunye nokuphakanyiswa kwe-10X kwintsimi kunye nomboniso we-3D kusenza ukuba sisebenze ngokuchanekileyo. Oku kuthetha ukuba kunokunciphisa umonakalo womonakalo kunye nomngcipheko omngcipheko weentlungu ezikufuphi ezinjengeentsimbi zelaryal okanye izigulane zengqondo. Kunzima ukulimaza izakhiwo ezikufuphi ukuba unokujonga ngeso sihlandlo kwimizuzu elishumi ubungakanani obuqhelekileyo. Siyakwazi ukubeka iliso umsebenzi wentsholongwane ngexesha lo msebenzi wonke ukuphepha umngcipheko wokuthungatha emva kokusebenza.
Ukongezelela, idilesi yam yokuqala ibonisa ukuba intlungu emva kokungaphantsi kwayo. Oku kubangelwa ngenxa yamanani amaninzi okuphela kweentliziyo phantsi kweengalo, xa kuthelekiswa nentlaphu epholileyo entanyeni. Uninzi lwezigulane zam azifunanga naluphi na unyango lwamayeza emva kokuhlinzwa.
Ngokuqhelekileyo, ukuphulukana kwakhona kukhawuleza ekusebenzisweni kwe-robotic transaxillary, xa kuthelekiswa nezinye i-thyroid kunye nentambo yokuhlinzwa.
Umbuzo: Ngaba utyando lwe-rotictic robotic unikeza naliphi na ixesha kunye neendleko zokulondoloza?
UDkt Kandil: Ixesha lokwenza utyando lithelekiswa nokuhlinzwa okwenzelwe i-thyroid ngezandla. Okwangoku, asinayo iiphononongo eziye zavavanya iindleko-mpu meko kule nkqubo xa kuthelekiswa nokuhlinzwa okwenzelwe i-thyroid. Xa lo uphando lwenziwa, kunjalo, kufuneka lubandakanye umngcipheko weengxaki kunye neendleko zokulawula ezi ngxaki.
Umbuzo: Kuthatha ixesha elingakanani ukuqeqesha oogqirha kwi-transaxillary yokuhlinzwa?
UDkt Kandil: Inyaniso ayiyazi impendulo yalo mbuzo. Ndenza utyando lwe-robotic kwezinye i-endocrine kunye neenkqubo ze-oncological, ngoko kwakungelula kum ukuba ndisebenzise le ndlela. Ngokwazi kwam, le nkqubo yaqhutyelwa kumaziko asibhozo e-United States, nangona kunjalo, kukho amaziko amathathu kuphela anikezela ngolu hlobo uhlobo lotyando.
Ndiyakholelwa ukuba inxalenye yolu liva elifunekayo ukwenza utyando lwe-robotic kuba uqeqesho olukhethekileyo namava kunye nokuhlinzwa ngonyango kubalulekile. Njengoko oogqirha abagqithisileyo banamava kule nkqubo, izigulane ezininzi zinokunikezelwa ngale ndlela, nangona kunjalo.
Jonga uVukani kwiNtshukumo
Umlingani kaDkt. Kandil, uDkt. Ronald Kuppersmith, waseKholeji yeZiko leZonyango kwiTexas, wenza amavidiyo amaninzi abonisa ubugcisa bokugqirha uDkt. Kandil uchaza. [ Isexwayiso: ezi vidiyo zibonisa ngokucacileyo ukuhlinzwa okwenziweyo. ]
- I-Robotic Surgery Ukubonakaliswa nguDivin Surgery, Intuitive Surgical, Inc.
- I-Da Vinci Thyroidectomy kwi-YouTube - Icandelo 1
- I-Da Vinci Thyroidectomy kwi-YouTube - Icandelo 2
Emva kokunyamekela
Umbuzo: kungekudala emva kokuhlinzwa, isigulane siza kufunda isiphumo sokuhlinzwa kunye nokuba kukho ukuxilongwa komhlaza? Ukuba ufumane umhlaza, ngaba ucebisa unyango lwe-iodine (RAI) kuzo zonke iimeko?
UDkt Kandil: Ngokuqhelekileyo, kufuneka kubekho iintsuku ezintathu ukuya kweentetho zokugcina. Uninzi lwezigulane ezinomhlaza womhlaza we-thyroid ziya kufuna unyango lwe-radioiodine ngaphandle kokuba i-tumor encinci. Ndikhetha kwakhona ukwenza i-pretreatment scan ukuze ndibone ukuba kukho naziphi na izicubu ezincinci ezishiywe emva. Iipesenti ezilishumi zexesha, ezinye izigulane ziya kuphephelela imfuno yonyango lwe-radioiodine ngenxa yokuba i-resectic good resection. Nangona kunjalo, oku akuqinisekanga. Siceba ukwenza isifundo esizayo kwiziko lethu ukuze sibone ukuba uphando lwe-robotic lunokunikela ngesiphumo esingcono se-oncological ngenxa yokubonakalisa okungcono kunikezelwa yinkqubo.
Umbuzo: Nangona ubuqhezu buncinci kakhulu, ukuxhwaleka kokususa i-thyroid gland kubalulekile. Uxelela ntoni izigulane zakho ukuba zilindele njengengqamaniso yenkqubo yokuphilisa?
UDkt Kandil: Siqala i-hormone ye-thyroid endaweni yesibini emva kokuhlinzwa. Iimvavanyo zemiSebenzi ye-Thyroid zitshekishwe iiveki ezine ukuya ezintandathu emva kokusebenza. Uninzi lwezigulane zihlala zilandelelana ne-endocrinologist ukulungelelanisa umthamo kwaye ngokuqhelekileyo zichanekile ukwenza oko. Ezinye izigulane zihamba kakuhle ngezinga elixhaswe yi-TSH, ingakumbi abo abanomdlavuza we-thyroid, nangona nantoni na eyenza ukuba isigulane sifune kakuhle kufuneka sibe yinto yokonyango.
Umbuzo: Ekutyelelweni kweofisi yokulandelelana, ngaba izigulane zikholiswa ngokuphulukiswa kwazo? Njengogqirha, ngaba uhlala ujabule nenkqubela yabo, xa kuthelekiswa nezigulane ezithobele i-thyroidectomy yendabuko?
UDkt Kandil: Ngokuqinisekileyo. Olu lukhetho olutsha olusandul 'ukhathalelo lwezigulane zethu. Ayikho inqabunga yentamo, ingozi encinane yeengxaki, intlungu engaphantsi kunye nokuphucula ngokukhawuleza. Uninzi lwezigulane zam ngokwenene zibhekiselele kuba zifuna uhlobo lotyando lwe-thyroid kunye neengcingo ezincinci ezibonakalayo.
Kwixesha elizayo
Umbuzo: Kuqikelelo lwakho, kuya kuba kude kangakanani ngaphambi kokuba i-thyroidectomy engenabala ifikeleleke kwiindawo eziphambili zokugula? Ingaba kukho ikamva kwixesha elizayo xa singalindela ukuhlinzwa ngonyango lwe-robotic ukuze kube yindlela yokuhlinzwa eyenzelwe ukwenziwa kwe-thyroid?
UDkt Kandil: Utyando lwe-thyroid oluxhaswa ngevidiyo lunikezelwa kwinani elikhulu lamaziko kulo lonke ilizwe kule minyaka mibini yokugqibela. Kukho iikhosi ezininzi ezifundisa oogqirha ukuba benze njani le nkqubo kwaye oogqirha abaninzi baphendukela kule teknoloji.
Kuyahluke, nangona kunjalo, ngenxa yokuhlinzwa kwentambo ye-transaxillary rojotic.
Okokuqala, ufuna i-robotic ehamba phambili ukwenza umsebenzi, njengendlela ye-da Vinci. Okwesibini, amava kunye neteknoloji kuyafuneka ukuba enze lo msebenzi ngokukhuselekileyo. Ndisebenze ukunceda uDkt. Floyd C. Holsinger kwiYunivesithi yaseTexas I-Anderson ICancer Centre kunye nenkambo yakhe yokufundisa ukutyunjwa kwentamo ebomvu. Ndifundisa iikholeji zaseTulane, apho sizisa oogqirha abavela kulo lonke elase-US nakwamanye amazwe ukuba bafunde kabanzi malunga nokuhlinzwa okwenziwe nge-robotic transaxillary.
Umphandi kunye nesigulane sokukhuthaza uLeslie Blumenberg negalelo kule nqaku.
Umthombo: uFebhuwari / Matshi 2010 Udliwano-ndlebe noEmad Kandil, MD, FACS, uNjingalwazi oPhezulu woPhephelo, uNjingalwazi oMncedisi wezeMpilo, uNjingalwazi oNcedisayo we-Otolaryngology, oyiNtloko, iNgcali ye-Endocrine Surgery, i-Endocrine ne-Ocological Surgery, i-Tulane University
Ulwazi loQhagamshelwano noDkt Kandil
Emad Kandil, MD, FACS
UNjingalwazi oPhezulu woPhepha, uNjingalwazi oNcedisayo wezeMpilo, uNjingalwazi oNcedisayo we-Otolaryngology, oyiNtloko, iCandelo loPhando lwe-Endocrine, i-Endocrine kunye noBuchule be-Oncological
KwiYunivesithi yaseTulane
Inombolo: 504-988-7520, iFeksi: 504-988-4762
Ukhululekile: 1-877-378-7874
Amatyunjwa: 504-988-3589
I-imeyile: ekandil@tulane.edu
ICandelo leKharityhulam yeKharityhulam yeKhola (PDF)
Amaziko ezonyango anikezela nge-Transaxillary Robotic Surgery
- I-Tulane School School of Medicine Isebe Lophando, Ukhuseleko lwe-Endocrine - uEmad Kandil, MD, FACS
- IYunivesithi yaseTexas, i-Anderson I-Cancer Centre - i-Floyd Christopher Holsinger, MD, i-FACS
- Iziko lezonyango zeKholeji yeeKholeji, iSikole seKholeji, iTexas - uRonald Kuppersmith, MD, FACS, Andrew de Jong, MD, FACS
Ezinye izixhobo
- uVivinci Robotic Surgery
- I-American Association ye-Endocrine Surgeons
- Uluhlu lwabalungu be-AAES ngoRhulumente (PDF)
- Amaziko enyango e-US Eyokwenza i-Endocrine Surgery
Iividiyo ze-YouTube
- "Ayikho i-neck Scar" Endoscopic Thyroidectomy
- I-Robotic Surgery Ukubonakaliswa ngu-Da Vinci Ukuhlinzwa, Intuitive Surgical, Inc. I-Da Vinci Thyroidectomy kwi-YouTube
- I-Da Vinci Thyroidectomy kwi-YouTube - Icandelo 1
- I-Da Vinci Thyroidectomy kwi-YouTube - Icandelo 2