Kutsvaga Zvisina Kukwana Transaxillary Robotic Thyroid Surgery naDkt Emad Kandil
Imwe yemigumisiro yenguva dzose yekuvhiya kwetachiona - inozivikanwa setiroidectomy - ndiyo tsasi yakasara shure kwekudzivirira. Vadzidzisi vezvechirwere vakanakisisa vane unyanzvi pakuisa zvakanyatsokonzerwa nekudzikisa kuitira kuti ruvara ruvanze mumutsipa. Mumakore achangobva kupfuura, kusarudzwa kwakawana zviduku, nekuda kwehutano hwekubatsira mavhidhiyo. Kuonekwa kwezvirwere zvehutachiona kwakanyatsobudirira kusvika pamwero wakawanda, asi utachiona hwetachiona nehutambo hwemutsipa huchiri kusiya ruvara rwakaonekwa.
Vamwe vanachiremba vava kuita chirwere chetachiona uye chemutsipa nerubatsiro rwebhobhoti, vachiisa kuvhara munzvimbo yepasi (axilla). Izvi zvinozivikanwa se "transaxillary robotic" chirwere. Dhiyabhorosi yeDefA yakabvumira nzira iyi muna 2009 uye zvitatu zvekurapa ikozvino kushandisa robotics yakakura ye thyroidectomy.
Pamusoro pezvipfeko zvinokonzerwa nekuve nekuputika munharaunda ye-underarm - panzvimbo yepamutsipa - nzvimbo isina kusimba ine mutsara unopedzisira uri pamakiromita masendimita yakaita sehuro, saka kuporesa hakunzwisisiki uye kunetseka, kusanganisa Achaporesa nekukurumidza kupinda mukati memutsipa.
Emad Kandil, MD, FACS, ndiye Mutungamiriri weKupurika kweEstocrine kuTulane University School of Medicine. Dr Kandil akabatsira revolutionize uye kukura matanho ekuvhiya emutsipa transaxillary mitsipa, achishandisa intraoperative mutsara yekuongorora kuchengetedza laryngeal (izwi box) nerve. Dr. Kandil akabatanidzwa mumusangano uyu wemubvunzo nemhinduro kuti ubatsire vateereri venzvimbo yeKiroid dzidza zvakawanda nezverobhotic-yakabatsira utachiona uye kuvhiyiwa kwemutsipa.
Mubvunzo: chirwere chetransaxillary robotic mutsva chinonzi kufambira mberi kunze kwebhidhiyo-yakabatsirwa chirongwa chekupedzisira chevhidhiyo chakange chichishandiswa kushandiswa kwetachiona uye chepuropa, uye chirwere chekupedzisira chinonzi chinonzi huni-ye-unyanzvi kupfuura kuvhiyiwa kwechirwere. Iwe unogona here kutaura pamusoro pemhando idzi dzekuvhiya?
Dr. Kandil: Chirwere chetachiona chetachiona kazhinji chinowanzobatanidza kutora kwenguva refu pasi pehuro. Chiso chinoramba chichioneka chinogoneka. Munguva pfupi yapfuura, chirwere chinoshandiswa pakugadzirwa kwevhidhiyo chetachiona nemitsipa zvakashandiswa. Iko kuravhidzika kunoitwa nekadiki kako kusanganisa, uchishandisa kuonekwa kwekupedzisira nekamu kamera. Iyi nzira yakapayona muItaly naDr. Paolo Miccolli uye akawana mukurumbira muUnited States mushure mokunge Dr. David Terris atora nzira iyi. Ndave ndichipa nzira iyi kuvarwere vangu vane kuwedzera kwehutano hwekuongorora zvirongwa - pamwe nekurovedza vamwe vanachiremba mune iyi nzira-pamusoro pemakore maviri apfuura. Iyi nzira inoita, zvisinei, ichiri kukonzera kuora pamutsipa.
Nezve Transaxillary Robotic Thyroid Surgery
Mubvunzo: Chii chinonzi chirwere chetroxtic chine chirwere chetroctic robotic uye chinoitwa sei?
Dr. Kandil: Dr. Woong Youn Chung muSeoul, korea, vakagadzira nzira yekuvhiyiwa kwehuro musingashayiwi nerobhoti.
Pakutanga, nzira yekuvhiya yemitsipa ye robotic yakagadzirwa ne carbon dioxide (CO2) gesi insufflation (kuiswa kwegesi munzvimbo yekuvhiya) kumutsipa. Kushandiswa kwegesi kunogona kukonzera mamwe maitiro ekuvhiya mushure mekuvhiya, zvisinei, sezvo varwere vanogona kurwadziwa nekugadziriswa kwegasi mumasukisi akakomberedza mapapu (chirwere chinozivikanwa se pneumomediastinum) kana mumhepo ine michina ine makiritini.
Kutambudzika uye kushungurudzika zvinogona kuramba zviripo kusvikira gasi ichizopedzisira yawana.
Robotic, gasless, transaxillary thyroidectomy ndiyo nzira itsva yekugadzira, inowedzera-inopisa yekubvisa zvose kana chikamu chetachiona. Iyo dzimwe nguva inonzi chirwere chinonzi robot-inobatsira chirwere chetroji, kana kuti robot-yakabatsirwa endoscopic chirwere cherosi.
Neyiyi nzira itsva, gesi insufflation inodziviswa, saka zvinetso zvine chokuita nokuchengetedza gasi zvinodziviswa zvakare.
Neyiyi nzira itsva, kubata zvishoma kunoshandiswa pasi pemaoko, uye zvigadzirwa zvakagadzirirwa-robotic zvinoshanda semaoko, zvichibvumira chiremba chiremba kuti aite nekunyatsorongedza kudzora uye kufamba.
Iyo robotic system inobvumirawo chirembachire kuti aone mu stereo-optic katatu-dimension (3D), neyo yakagadzirirwa yakananga-kamera tsanangudzo iyo inopa kukudzwa kusvika kagumi nguva yakaratidzwa yakajairika. Isu takashandurawo nzira iyo kusanganisira kushandiswa kwemuitiro wenguva dzose inonzi intraoperative nerve monitoring.
Iyi nzira ichangobva kugamuchirwa neDDA muna 2009 uye inoratidzwa kuva nzira yakachengeteka.
Mubvunzo: Ndapota tsanangura mararamiro eTransaxillary robotic chirwere chetachiona kana zvichienzaniswa nekodhiectectomy yemagariro.
Dr. Kandil: Chimwe chinhu chinokosha ndechokuti chirwere cheransaxillary robotic hazviiti kuti kuonekwe, kusingaperi kwemutsipa kupera.
Mukana wekuvhiyiwa kwehutano ingozi yekukuvadzwa kune mutezo wemarara, unoenda kuzwi rebhokisi. Izvi zvinogona kukonzera kukurumidza kwenguva pfupi kana kusingaperi. Kuvhiyiwa kwehutano kunogonawo kukonzera kushungurudzika kune zvivako zvakapoteredza, kusanganisira zvipembenene zvepathyroid, zviri pedyo nehutachiona. Kuparara kweparathyroid kunogona kukonzera kuitika kwenguva pfupi kana kusingaperi hypocalcemia, chirwere chinoshandiswa ne calcium supplementation.
Kubva pakuona kwekuchengeteka, mu transaxillary robotic chirwere chetroji, kushandiswa kwepamusoro-tsanangudzo robotic vifaa ne 10X kukura kwemasango uye 3D inotitendera kuita basa rakanyatsojeka. Izvi zvinoreva kuti kune uwandu huri shoma hwehutano hwehutano uye huwandu hutengo hwekuvhiringidzika kune zvivako zvakapoteredza sezvinongoita mutsara kana mavara eparathyroid. Zvakaoma zvikuru kukuvadza zvivako zvakapoteredza kana iwe uchigona kufungidzira munda wacho kaviri pakukura kwawo. Isu tinokwanisawo kutarisa kushanda kwehutano panguva yese yekuvhiya kuti tisapinda dambudziko rekushanda kwemashure.
Uyezve, data yangu yepakutanga yakaratidza kuti kurwadziwa kwepasoperative kunonyanya kuderera. Izvi zvinokonzerwa nehuwandu hwehuwandu hwemutsara hunopera pasi pechipfuva, kana uchienzaniswa neganda rinonyangadza remutsipa. Vakawanda vevarwere vangu havana kuda chirwere chipi nechipi mushure mekuvhiyiwa.
Muzhinji, kupora kunomhanya zvakare kune chirwere cheransatic robotic, zvichienzaniswa nedzimwe chirwere chetachiona nemutsipa.
Mubvunzo: Ko chirwere chetransxillary robotic chinopa chero nguva uye mari yekugadzirisa?
Dr. Kandil: Nguva yekuita chirwere ichi inofananidzwa nekuvhiya kwetachiona yakagadzirwa nemaoko ane ruzivo. Kusvika iye zvino, hatina zvidzidzo zvakave zvichiongorora kukosha-kubudirira kweiyi nzira zvichifananidzwa nekuvhiyiwa kwetachiona hwemazuva ose. Apo kutsvakurudza uku kwaitwa, zvakadaro, kunofanira kusanganisira njodzi yezvinetso uye mari yekugadzirisa zvinetso izvi.
Mubvunzo: Zvinotora nguva yakareba sei kudzidzisa vanachiremba muchirongwa chetraxtic robotic?
Dr. Kandil: Ini zvechokwadi handizivi mhinduro kumubvunzo uyu. Ndakanga ndiri kuita chirwere chebhobhoti kune mamwe magumo uye maitiro, saka zvakanga zviri nyore kwandiri kuti nditore nzira iyi. Kuziva kwangu, iyi nzira yakagadzirwa mumasangano masere muUnited States, zvisinei, kune zvikamu zvitatu zvesangano izvo zviri kupa kupa chirwere ichi.
Ndinonyatsodavira chikamu cheizvi chiitiko chinodiwa kuita chirongwa chebhobhotiki nokuti kudzidziswa kwakanaka uye ruzivo nerokuvhiya robotic zvakakosha. Sezvo vamwe vanachiremba vanovhima vane ruzivo mune urongwa uhwu, vamwe varwere vanogona kupiwa izvi, asi zvakadaro.
Ona Kuvhiya muKushanda
Vashandi vaDkt Kandil, Dr. Ronald Kuppersmith, kubva kuCollec Station Medical Center muTexas, vakaita mavhidhiyo akawanda achiratidzira nzira dzokuvhiya Dr. Kandil ari kutsanangura. [ Manyevero: mavhidhiyo aya anoratidza zvakajeka kuvhiyiwa. ]
- Robotic Surgery Zviratidzo zveDa Vinci Surgery, Intuitive Surgical, Inc.
- Da Vinci Thyroidectomy paYouTube - Chikamu 1
- Da Vinci Thyroidectomy paYouTube - Chikamu 2
Patient Aftercare
Mubvunzo: Ko nokukurumidza mushure mekuvhiyiwa, murwere angadzidza sei mugumisiro wekuvhiyiwa uye kana pane chirwere chekuongorora chirwere? Kana kenza yakawanika, unorayira here inonzi radioactive iodine (RAI) mune dzimwe nguva?
Dr. Kandil: Kazhinji, mazuva matatu kana matatu anodiwa kuti ave nemashoko ekupedzisira ekurapa. Vazhinji varwere vane kenza yemapirisa yeproid vachada kurapwa kweradioineodin kunze kwekuti kana chironda chiri chiduku. Iniwo ndinosarudza kuita shanduro yekufungidzira kuti ndione kana pane chero michina yakawanda yakasara shure. Tumi muzana yenguva yacho, vamwe varwere vacharamba kudiwa kweradioineodyrapi nokuti vakagadziriswa zvakanaka. Zvisinei, izvi hazvisimbiswi. Tinoronga kuita zvidzidzo zvidzidzo munzvimbo yedu kuti tione kana chirwere chinonzi robotic chinogona kupa mamiriro ehupenyu hwepamusoro nekuda kwekuratidzwa kwakanaka kunopiwa nehurongwa.
Mubvunzo: Kunyange zvazvo ruvara ruduku zvikuru, dambudziko rekubvisa chirwere chetachiona rinokosha. Iwe unoudzei varwere vako kuti vatarisire sechinguvana chekuporesa?
Dr. Kandil: Tinotanga utachiona huri panzvimbo mbiri mazuva maviri mushure mekuvhiyiwa. Zviratidzo zvebhiiyo zvinozoongororwa mavhiki mana kusvika matanhatu mushure mekushanda. Vakawanda varwere vanowanzofambidzana ne endocrinologist kuti agadzirise chirwere uye kazhinji kazhinji zvakananga kuita izvozvo. Vamwe varwere vanoita zvakanaka nekudzvinyirirwa kweTSH yepamusoro, kunyanya avo vane kenza yekemikari, kunyange zvazvo zvingaita kuti murwere achinzwe zvakanaka anofanira kuva chinhu chinorapwa.
Mubvunzo: Pakufambiswa kwehofisi yehofisi, varwere vanowanzofarira kurapwa kwavo here? Sechiremba, iwe unowanzofadzwa nekufambira mberi kwavo, kana uchienzaniswa nevarwere vane chirwere chetachiona chetachiona here?
Dr. Kandil: Zvechokwadi. Iyi inofadza mushonga mushonga wevarwere vedu. Hapana kupera kwemutsipa, panjodzi shomanana yezvinetso, kusuruvara kwakanyanya nekukurumidza kupora. Vakawanda vevarwere vangu vari kunyanya kuzvidzora nokuti vari kutsvaga maitiro ekuvhiya kwerosiyo nemapanga asingaratidziki.
Kuzopinda Ramangwana
Mubvunzo: Mukufungidzira kwako, inguva yakareba sei kusati kwava nehutachiona hwehutachiona hunowanikwa nyore nyore panzvimbo dzekuvhiya zvikuru? Pane chinangwa mune ramangwana apo tinogona kutarisira chirwere cheroyotic-kubatsira chirwere chetachiona kuva chirongwa chinoshandiswa chekutora utachiona?
Dr. Kandil: Kuvhiyiwa kwetachiona yakabatsirwa nevhidhiyo inopiwa mune imwe nhamba yemasangano munyika yose pamusoro pemakore maviri apfuura. Kune dzidzo dzakawanda dzinodzidzisa vanachiremba kuti vanoita sei izvi nenzira uye vanachiremba vakawanda vanogadzirisa ino teknolojia.
Izvo zvakasiyana, zvisinei, nokuda kwekushayiwa chirwere chegandaxillary robotic mutsipa.
Kutanga, iwe unoda robotic yapamusoro yekuita basa, yakadai se da Vinci Surgery system. Chechipiri, ruzivo nehutaneti hunodikanwa kuti huite basa iri zvakanaka. Ndave ndichishanda kubatsira Dr. Floyd C. Holsinger paYunivhesiti yeTexas MD Anderson Cancer Centre nekambani yake yekudzidzisa pasina robotic mushonga wokuvhiya. Ndiri kudzidzisawo zvidzidzo kuTulane, kwatinoendesa vanachiremba vanobva kumativi ose eU.S. uye kune dzimwe nyika kuti vadzidze zvakawanda pamusoro peiyo chirwere cheransaxillary robotic.
Mutsvakurudzi uye murwere anotsigira Leslie Blumenberg vakapinza munyaya ino.
Zvinyorwa: February / March 2010 Kubvunzurudza naEmad Kandil, MD, FACS, Mutevedzeri Purofesa Wokuvhiya, Clinical Assistant Purofesa weMishonga, Adjunct Assistant Purofesa weOtolaryngology, Chief, Endocrine Surgery Chikamu, Endocrine uye Oncological Surgery, Tulane University
Contact Information for Dr. Kandil
Emad Kandil, MD, FACS
Mudzidzisi Purofesa Wokuvhiya, Clinical Assistant Purofesa weMishonga, Adjunct Assistant Purofesa weOtolaryngology, Chief, Endocrine Surgery Chikamu, Endocrine uye Oncological Surgery
Tulane University
Tel: 504-988-7520, Fax: 504-988-4762
Kusasununguka kusina: 1-877-378-7874
Kusarudzwa: 504-988-3589
Imeyili: ekandil@tulane.edu
Dr Kandil's Curriculum Vitae (PDF)
Zvipatara Zvokurapa Kupa Transaxillary Robotic Thyroid Surgery
- Tulane University School of Medicine Dhipatimendi Rokuvhiya, Endocrine Surgery - Emad Kandil, MD, FACS
- University of Texas, MD Anderson Kanzura Center - Floyd Christopher Holsinger, MD, FACS
- College Station Medical Center, College Station, Texas - Ronald Kuppersmith, MD, FACS, Andrew de Jong, MD, FACS
Other Resources
- da Vinci Robotic Surgery
- The American Association of Endocrine Surgeons
- AAES Nhengo yeLute neHurumende (PDF)
- Zvipatara muUnited States Kuti Do Endocrine Surgery
YouTube Videos
- "Hapana Neck Scar" Endoscopic Thyroidectomy
- Robotic Surgery Kuratidzwa neDa Vinci Surgery, Intuitive Surgical, Inc. Da Vinci Thyroidectomy paYouTube
- Da Vinci Thyroidectomy paYouTube - Chikamu 1
- Da Vinci Thyroidectomy paYouTube - Chikamu 2