Ukuhlola Ukwelashwa Kwe-Transaxillary Robotic Thyroid Engenangqondo noDkt. Emad Kandil
Enye yemiphumela ehlala njalo yokuhlinzeka ngegciwane - eyaziwa ngokuthi i-thyroidectomy - yilelo eshiya ngemuva kwesisindo. Abahlinzayo abahlinzayo abahle kakhulu bezobuchwepheshe babe nobuchwepheshe lapho bebeka ngokucophelela ukuchotshozwa ukuze ubuchopho bufihleke entanyeni. Eminyakeni yamuva, ukucubungula okutholile kuncane, ngenxa yamasu ahlinzekwe ukusizwa ngevidiyo. Ukubonakala kwesikhumba se-thyroid sekuqinisekisiwe kakhulu, kepha i-thyroidectomy ene-neck incision ishiya ukonakala obonakalayo.
Abanye odokotela abahlinzayo manje benza ukuhlinzwa kwegciwane neyentamo nge-robotic usizo, bebeka ukusikwa endaweni engaphansi kwe-axil (axilla). Lokhu kwaziwa ngokuthi "ukuhlinzwa kwe-transaxillary robotic". I-FDA ivumile le nqubo ngo-2009 kanti izikhungo ezintathu zokwelashwa okwamanje zisebenzisa ama-robhotics ethuthukile we-thyroidectomy.
Ngaphandle kokuzuzisa izimonyo zokuba nokuphela kwesikhala endaweni engaphansi kwe-underarm - kunokuba kube entanyeni - indawo engaphansi kwe-underarm inezinkinga ezimbalwa zokuphela kwesigcawu esingamakhilogremu angu-square kunendawo yomphimbo, ngakho ukuphulukiswa akubuhlungu kakhulu futhi kunakekelwa kahle, ukuhlushwa uzophulukisa ngokushesha kunendawo entanyeni.
U-Emad Kandil, MD, FACS, unguMqondisi wezokwelapha ze-Endocrine eTulane University School of Medicine. UDkt Kandil uye wasiza ukuguqulwa nokuthuthukisa amasu okuhlinzwa we-transaxillary i-robotic entanyeni, besebenzisa ukuqapha kwe-nerveative intraoperative ukuvikela i-laryngeal (ibhokisi lezwi) inzwa. UDkt. Kandil uhlanganyele kulolu hlelo lwesifundo sempendulo nempendulo ukusiza abafundi baseSyroid ukuthi bafunde kabanzi mayelana nokuhlinzwa kwe-thyroid neyentambo yama-robotic.
Umbuzo: Ukuhlinzwa kwentamo ye-transaxillary i-robotic kubhekwa ukuthuthuka ngaphandle kokuhlinzeka nge-endoscopic okusizwa ngevidiyo okuye kwasetshenziswa kakhulu ekuhlinzekeni kwe-thyroid neyentamo, futhi ukuhlinzwa okungapheliyo kubhekwa njengesimo se-art ngaphezu kokuhlinzwa kwendabuko. Ungatshela ngalezi zindlela zokuhlinzwa?
UDkt. Kandil: Ukuhlinzwa okwejwayelekile kwe-thyroid kuhilela ukugxilisa isikhathi eside phansi kwentamo. Uhlamvu olubonakalayo olunaphakade lungenzeka. Muva nje, ukuhlinzeka nge-endoscopic ukusizwa ngevidiyo kwe-thyroid nentamo sekusetshenziswe. Lokhu kuhlinzwa kwenziwa nge-incision encane yentamo, besebenzisa ukubukwa kwe-endoscopic ngekhamera encane. Le nqubo yaphayona e-Italy nguDkt. Paolo Miccolli futhi yathola ukuthandwa e-United States ngemuva kokuba uDkt. David Terris athathe le nqubo. Ngiye nginikezela lezi ziguli iziguli zami ngokufaka isimiso sokuqapha izinzwa - kanye nokuqeqesha abanye odokotela abahlinzayo kule nqubo - eminyakeni emibili edlule. Le nqubo yenza, noma kunjalo, ibangele ubuhlungu entanyeni.
Mayelana ne-Transaxillary Robotic Surgery Thyroid
Umbuzo: Iyini ukuhlinzekwa kwe-thyroid ye-transaxillary futhi isenziwa kanjani?
UDkt. Kandil: UDkt. Woong Youn Chung waseSeoul, eKorea, uthuthukise inqubo yokuhlinzwa kwentamo engenakutholakala ngokusizwa nge-robotic.
Ekuqaleni, indlela yokuhlinzwa kwentamo ye-robotic yenziwa nge-carbon dioxide (CO2) ukungena kwegesi (ukufakwa kwegesi endaweni yokuhlinzeka) endaweni yentamo. Ukusetshenziswa kwegesi kunomthelela wokubangela imiphumela eminye emva kokuhlinzwa, kodwa njengoba iziguli zingakwazi ukuzwa ubuhlungu ngenxa yegesi egcinwe emathisini azungeze amaphaphu (isimo esaziwa ngokuthi i-pneumomediastinum) noma umoya ongaphansi komzimba kanye nama-crepitations.
Ubuhlungu nobuhlungu bungala kuze kube yilapho igesi igxila.
I-robotic, i-gasless, i-transaxillary ye-thyroidectomy iyindlela yokuhlinzeka esanda kuthuthukiswa, encane-inqamulelayo yokukhipha konke noma ingxenye ye-thyroid. Kanti futhi ngezinye izikhathi kuthiwa ukuhlinzeka nge-robot-kusizwa nge-thyroid, noma ukuhlinzeka nge-endoscopic ye-robot.
Nale ndlela entsha, ukungena kwegesi kugwenywe, ngakho-ke izinkinga ezihlobene nokugcinwa kwegesi ziyakugwema.
Ngalolu lwazi olusha, ukuchotshozwa okuncane kwenziwa ngaphansi kwengalo, futhi izingalo ze-robotic ezenziwe ngokukhethekile zisebenza njengezandla, okuvumela udokotela ohlinzayo ukuba asebenze ngokulawula nokuhamba kahle ngokuqondile.
Uhlelo lwe-robotic luvumela futhi udokotela ohlinzayo ukuba abone ukukhanya kwe-stereo-optic ezintathu-3D (nge-3D), enekhamera ephezulu ekhethiwe ecacisa ukuthi inikeza ukukhuliswa izikhathi eziyishumi umbono ovamile. Siphinde sishintsha le nqubo ukufaka ukusetshenziswa kokuqapha kwe-nervative intraoperative.
Le nqubo isanda kuvunyelwa yi-FDA ngo-2009 futhi iboniswe ukuthi iyindlela ephephile kakhulu.
Umbuzo: Sicela uchaze izinzuzo ze-transaxillary ekuhlinzekeni kwe-thyroid ngokuqhathaniswa ne-thyroidectomy yendabuko.
UDkt. Kandil: Inzuzo eyinhloko yukuthi ukuhlinzekwa kwe-transaxillary robotic akusho ukuthi kubonakale inkohlakalo ebonakalayo, engapheli.
Ingozi yokuhlinzwa kwe-thyroid ingozi yokulimala emndenini we-laryngeal, oya ebhokisini lezwi. Lokhu kungabangela ukuzwakalisa okwesikhashana noma okuhlala njalo. Ukuhlinzwa kwe-thyroid kungabangela ukuhlukumezeka ezakhiweni eziseduze, kufaka phakathi izigonda ze-parathyroid, eziseduze ne-thyroid. Umonakalo we-parathyroid ungabangela i-hypocalcemia yesikhashana noma engunaphakade, isimo esibhekwa nge-calcium supplementation.
Kusukela ekuboneni kokuphepha, ekuhlinzekeni kwe-transaxillary i-robotic, ukusebenzisa imishini ephezulu yokuchaza nge-10X ukukhuliswa kwensimu ne-3D umbono kusenza senze umsebenzi oqondile. Lokhu kusho ukuthi kunokunciphisa amathuba okulimala kwamantombazane kanye nengozi encane yokuhlukumezeka ezakhiweni eziseduze njengezinyosi zokugcoba noma izigulane ezibuhlungu. Kulukhuni kakhulu ukulimaza izakhiwo eziseduze uma ungabona ngeso lengqondo inkambu ngezikhathi eziyishumi usayizi ojwayelekile. Siphinde sikwazi ukuqapha umsebenzi wezinzwa ngesikhathi sonke sokusebenza ukuze sigweme ingozi yokuphazamiseka kwe-postoperative.
Ukwengeza, idatha yami yokuqala yabonisa ukuthi ubuhlungu be-postoperative bukhulu kakhulu. Lokhu kungenzeka ngenxa yezinombolo ezimbalwa zokuphela kwezinzwa ngaphansi kwengalo, uma kuqhathaniswa nesikhumba esibucayi entanyeni. Iziguli zami eziningi azidingi imithi yokwelashwa ngemva kokuhlinzwa.
Ngokuvamile, ukutakula kuyashesha futhi ukuhlinzeka nge-transaxillary robotic, uma kuqhathaniswa nezinye izindlela zokuhlinza nge-thyroid kanye neyentamo.
Umbuzo: Ingabe ukuhlinzekwa kwe-transaxillary robotic kunikeza nganoma yisiphi isikhathi kanye nokonga izindleko?
UDkt. Kandil: Isikhathi sokwenza ukuhlinzwa sikhathaniswa nokuhlinzekwa kwendabuko yegciwane ngezandla ezihlangene. Kuze kube manje, asinayo izifundo eziye zahlola izindleko zempumelelo yale nqubo uma kuqhathaniswa nokuhlinzwa okwejwayelekile kwe-thyroid. Uma lolu cwaningo seluqedile, noma kunjalo kufanele lufake ingozi yezinkinga kanye nezindleko zokuphatha lezi zinkinga.
Umbuzo: Kuthatha isikhathi esingakanani ukuqeqesha abagqirha ekuhlinzeni i-transaxillary robotic?
UDkt Kandil: Angiyazi impendulo yalo mbuzo ngokwethembeka. Ngangenza ukuhlinzeka nge-robotic kwezinye izinqubo ze-endocrine nezinhlelo ze-oncological, ngakho-ke kwakungelula kimi ukuthola le nqubo. Ngolwazi lwami, le nqubo yenziwa ngezikhungo eziyisishiyagalombili e-United States, noma kunjalo, kunezikhungo ezintathu kuphela ezihlinzekela lolu hlobo lokuhlinzeka ngenkuthalo.
Ngiyakholelwa ngempela ukuthi ingxenye yalokhu yinto edingekayo ukwenza ukuhlinzeka nge-robotic ngoba ukuqeqeshwa okukhethekile kanye nokuhlangenwe nakho okuhlinzekwa nge-robotic kubalulekile. Njengoba odokotela abahlinzayo abaningi beba nolwazi ngalolu lwazi, iziguli eziningi zinganikezwa ngale ndlela, noma kunjalo.
Bheka ukuhlinzwa okusebenzayo
Osebenza naye uDkt. Kandil, uDkt. Ronald Kuppersmith, ovela e-College Station Medical Centre eTexas, wenza amavidiyo amaningana abonisa izindlela zokuhlinza uDkt. Kandil uchaza. [ Isexwayiso: la mavidiyo abonisa ngokucacile ukuhlinzeka kwangempela. ]
- Ukwelashwa kwe-Robotic Ukuboniswa ngu-Da Vinci Surgery, Intuitive Surgical, Inc.
- I-Da Vinci Thyroidectomy ku-YouTube - Ingxenye 1
- I-Da Vinci Thyroidectomy ku-YouTube - Ingxenye 2
Aftercare Care
Umbuzo: Ngokushesha ngemva kokuhlinzwa, isiguli siyofunda kanjani umphumela wokuhlinzeka futhi uma kunesifo sokuxilongwa komdlavuza? Uma umdlavuza atholakele, uyancoma ukwelashwa kwe-i-radioactive i-iodine (RAI) kuwo wonke amacala?
UDkt. Kandil: Ngokuvamile, kuyadingeka ukuthi kube nosuku olulodwa kuya kwezintathu ukuze ube nombiko wokugcina wezifo. Iningi leziguli ezinomdlavuza wegciwane le-papillary zizodinga ukwelashwa kwe-radioiodine ngaphandle uma isisu sincane. Ngiphinde ngikhethe ukwenza iskripthi esandulele ukuhlola ukuthi kukhona yini izicubu ezincane ezishiywe ngemuva. Amaphesenti ayishumi esikhathi, ezinye iziguli zizogwema isidingo sokwelashwa kwe-radioiodine ngoba zathola ukuthengiswa okuhle kwezinto eziphilayo. Noma kunjalo, lokhu akuqinisekisiwe. Sihlela ukwenza ucwaningo olulindeleke esikhungweni sethu ukuze sibone ukuthi ukuhlinzeka nge-robotic kunganikeza umphumela ongcono wezemvelo ngenxa yokubukeka okungcono okunikezwa uhlelo.
Umbuzo: Ngenkathi ukonakala kuncane kakhulu, ukuhlukunyezwa kokususa igciwane le-thyroid kubalulekile. Yini oyitshela iziguli zakho ukuthi zilindele njengomzila wesikhathi wendlela yokuphulukisa?
UDkt. Kandil: Siqala i-hormone ye-thyroid esikhundleni samalanga amabili emva kokuhlinzwa. Izivivinyo zomsebenzi we-thyroid zihlolwe ngemva kwamasonto amane kuya kwamasonto ayisithupha emva kokusebenza. Iningi leziguli ngokuvamile lilandelana ne-endocrinologist ukulungisa umthamo futhi ngokuvamile kuqondakala kahle ukwenza lokho. Ezinye iziguli zenza kahle ngezinga eliphethwe yi-TSH, ikakhulukazi labo abanomdlavuza wegciwane, nakuba noma yini edingekayo ukuze isiguli sigcine kahle kufanele ibe yinto yokwelashwa.
Umbuzo: Ekuvakashelweni kwamahhovisi okulandelwayo, iziguli ngokuvamile zijabulela ukuthuthukiswa kwazo? Njengodokotela, ingabe ujabulela intuthuko yabo, uma kuqhathaniswa neziguli ezitholile i-thyroidectomy yendabuko?
UDkt Kandil: Kusobala. Lokhu kuyindlela entsha yokwelashwa okuthakazelisayo yeziguli zethu. Ayikho inqwaba yezintambo, ingozi encane yezinkinga, ubuhlungu obuncane nokutholakala ngokushesha. Iziguli zami eziningi empeleni zizithumela ngoba zifuna uhlobo lokuhlinzeka nge-thyroid ngamacembe amancane abonakalayo.
Ngesikhathi Esizayo
Umbuzo: Kulinganisweni yakho, kuyoba isikhathi esingakanani ngaphambi kokuba i-thyroidectomy encane ingatholakali ezindaweni ezinkulu zokuhlinzeka? Ingabe ikhona iphuzu esikhathini esizayo lapho singalindela ukuhlinzeka nge-robotic-kusiza ukuhlinzwa kwe-thyroid ukuze kube ukuhlinzekwa okukhethwa ukukhishwa kwe-thyroid?
UDkt. Kandil: Ukuhlinzeka ngezokwelapha ezisiza ngevidiyo kunikezwa inamba enkulu yezikhungo ezweni lonke kule minyaka emibili edlule. Kunezifundo eziningi ezifundisa odokotela abahlinzayo indlela yokwenza le nqubo kanye nabahlinzayo abaningi abavumelanisa nalolu buchwepheshe.
Kodwa-ke, kuhlukile ngenxa yokuhlinzwa kwentamo ye-transaxillary i-robotic.
Okokuqala, udinga uhlelo lwe-robotic oluphambili lokwenza umsebenzi, njenge-da Vinci Surgery system. Okwesibili, okuhlangenwe nakho nobuchwepheshe kuyadingeka ukwenza lo msebenzi ngokuphepha. Ngisebenzela ukusiza uDkt. Floyd C. Holsinger eNyuvesi yaseTexas Isikhungo seKhansela ye-Anderson enenkambiso yakhe yokufundisa ukuhlinzwa okungenasici kwe-robotic. Ngiphinde ngifundise izifundo eTulane, lapho siletha odokotela abahlinzayo abavela kulo lonke elase-US nakwamanye amazwe ukuze bafunde kabanzi mayelana nalokhu kuhlinzwa kwe-robantic transaxillary.
Umcwaningi nommeli wesiguli uLeslie Blumenberg banikele kulokhu kulesi sihloko.
Umthombo: Februwari / Mashi 2010 Ingxoxo no-Emad Kandil, MD, FACS, uProfesa oPhezulu wezokwelapha, uProfesa wezokwelapha oMtholampilo, uProfesa we-Otolaryngology, oyiNhloko, i-Endocrine Surgery Section, i-Endocrine ne-Oncological Surgery, i-Tulane University
Ulwazi lokuthintana noDkt Kandil
Emad Kandil, MD, FACS
Usizi loProfesa Wokuhlinza, uProfesa Wokwelashwa Wezokwelapha, uProfesa Osizayo Ochwepheshe Otolaryngology, Oyinhloko, Isigaba Sokuhlinzwa Kwe-Endocrine, i-Endocrine ne-Surgery Oncological
I-Tulane University
Ucingo: 504-988-7520, Ifeksi: 504-988-4762
I-free-free: 1-877-378-7874
Ukuqokwa: 504-988-3589
Imeyili: ekandil@tulane.edu
UDkt Kandil's Curriculum Vitae (PDF)
Izikhungo Zokwelapha Ukuhlinzeka nge-Transaxillary Robotic Surgery Thyroid
- I-Tulane University School of Medicine uMnyango Wezokwelapha, Ukwelashwa Kwe-Endocrine - Emad Kandil, MD, FACS
- I-University of Texas, isikhungo se-MD Anderson Cancer - u-Floyd Christopher Holsinger, MD, FACS
- I-College Station Medical Centre, i-College Station, eTexas - uRonald Kuppersmith, MD, FACS, Andrew de Jong, MD, FACS
Ezinye izinsiza
- Ukwelashwa kwe-da Vinci Robotic
- I-American Association ye-Endocrine Abahlinzayo
- Uhlu lweLungu le-AAES ngoHulumeni (PDF)
- Izikhungo Zokwelapha E-US Ezenza Ukuhlinzwa Kwe-Endocrine
Amavidiyo we-YouTube
- "Ayikho i-neck scar" i-Endoscopic Thyroidectomy
- Ukuhlinza nge-robotic Ukuboniswa ngu-Da Vinci Surgery, Intuitive Surgical, Inc. I-Da Vinci Thyroidectomy ku-YouTube
- I-Da Vinci Thyroidectomy ku-YouTube - Ingxenye 1
- I-Da Vinci Thyroidectomy ku-YouTube - Ingxenye 2