吊り上げ法を用いた内視鏡補助下甲状腺手術―悪性甲状腺腫に対する適応と現状―

Endoscopic thyroid surgery for malignant disease by using video-assisted neck surgery（VANS method）

◆要旨：内視鏡補助下甲状腺手術の標準術式とその適応と現況につき述べる．主切開を開襟衣類で隠せる鎖骨下の前胸壁に置き，全摘を行う場合は同様の切開を対側に置く．2本の直径1.2mm Kirschner鋼線を用いて吊り上げ，手術腔を作製して甲状腺に到達する．片葉切除または全摘出術を行い，気管前，傍リンパ節の予防的リンパ節郭清を施行している．外側区域リンパ節郭清は技術上可能であるが，低侵襲の観点より現在は施行していない．したがって，手術適応は甲状腺微小癌で術前リンパ節転移のない症例としている．本手術は手術創からの用指操作が可能であり，通常手術の感覚で手術を行える．術式は簡便，安全で，整容性も大変優れている．

　We have been performing endoscopic thyroid surgery for malignant disease. Based on the experience of our 56 patients with malignant diseases, our standard technique and surgical indications are described.

　A main wound was made below the clavicle on the chest wall so that the wound would be covered when wearing an open-neck clothes. For total thyroidectomy, bilateral wound was made similarly. Two pieces of Kirschner wire, which were horizontally inserted, lifted up the anterior skin to obtain the working space.

　The standard method is unilateral lobectomy or total thyroidectomy with prophylactic lymph node dissection at the central compartment. Lymph node dissection of the lateral compartment is technically possible. However it has been discontinued based on minimally invasiveness of the surgery. Therefor, the indication of this procedure for malignant disease is strictly limited to micropapillary carcinoma with no lymph node metastasis by preoperative evaluations.

　In conclusion, our method has a benefit of utilizing the fingers through the surgical wound and thus performing with a similar touch to conventional surgery. In addition, it is simple, practical, safe and easy besides having a good cosmetic appearence.