212001 Surgical anatomy of totally trans-oral videoassisted thyroidectomy

/Guo Peiyi(郭培義，Dept Anat，Zhongshan School Med，Sun Yat-sen Univ Guangzhou 510080)…∥China J Surg.-2011，49(10).-934～936

ObjectiveTo define the anatomical approach，anatomical planes related vessels and nerves to create a safe and reproducible combined sublingual and bi-vestibular access for trans-oral video-assisted thyroidectomy.MethodsFrom November 2009 to May 2011，twentyfive embalmed human specimens were dissected for anatomical information of the cervical region，the mandible region and the suprahyoid muscles.On twenty fresh frozen human specimens after an experimental trans-oral endoscopic thyroidectomy，the related vascular，neural structures and muscles were evaluated.ResultsThe optical access port was placed in the midline sublingual.The geniohyoid muscle，mylohyoid muscle and the anterior belly of the digastric muscle were divided in the midline in order to reach the plane under the platysma muscle.The mucosa was sagittal incised bilaterally in the vestibular of oral cavity for working trocar，at the level of the first molar of the mandible.The working trocar reached directly the periosteum of the mandible，under the facial vessel and the marginal branch of facial nerve，and then passed below the platysma muscle into the infra-laryngeal working area.The distance from mental nerve to mandibular midline and between mental nerve and facial artery were(25.8 ±0.9)mm and(29.4 ±0.9)mm，respectively.Anatomical dissections showed that after an experimental trans-oral combined sublingual and bi-vestibular access，all muscles of the floor of the oral cavity as well as the related vascular and neural structures are intact.The maximum nodule size of the resected specimens in the totally trans-oral approach was up to 50 mm.ConclusionThe combined sublingual and bi-vestibular access of trans-oral video-assisted thyroidectomy is safe and reproducible.15 refs，8 figs.