内視鏡下の良性甲状腺手術―AAA-ETSについて―

Endoscopic surgery for benign thyroid tumor―AAA-ETS

◆要旨：甲状腺良性腫瘍に対する内視鏡下手術としてAAA-ETSを施行してきたが，その後新たな工夫，改良を加えて，より低侵襲となった．視野確保は送気法に落ち着いた．また，LCSのミスト処理に関しては，同側ないし患側乳輪にトロッカーを追加し，4ポートで施行することで解決した．さらに，時折見られたLCSのthermal spreadingによる術後一過性の反回神経麻痺は，洗浄冷却やbipolar sealing deviceを用いることで回避できるようになった．AAA-ETSを施行し約9年を迎えるが，頸部変形もなく，創部に関してきわめて高い整容性を維持しており，これらの改良によりさらに本術式が普及すると思われた．

　Axillar-areolar approache's endoscopic thyroid surgery（AAA-ETS）has been performed for benign thyroid tumors. With the addition of a new device and some technical improvements, the procedure has become even more minimally invasive.

　To secure the operation field, total gas method was used.

　A toroccar was added to the same or the other side of mammary areola for the processing mist from LCS, and thus, four ports were used. In addition, transient recurrent nerve paralysis caused by thermal spreading of LCS which was sometimes observed after the operation, was prevented by washing and cooling with the saline water or by using the bipolar sealing device.

　The procedure of AAA-ETS has been performed for nearly 9 years but there has been no deformity in the neck, and extremely high cosmetic results were maintained. With the improvement of the techniques and devices, AAA-ETS will be more popular and used more widely.