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General Surgery
Video-Assisted Thyroidectomy
Built from Atlas of Thyroid Surgery
What’s inside
4 sections · 75 slides
Overview
What the operation is, how it developed, and how it compares with open surgery
- Core features of VAT
- Minimally invasive thyroid approaches
- Milestones in VAT
- Advantages of VAT
- Endoscopic magnification
- VAT versus conventional surgery
- Evidence for VAT
Indications
Patient selection and eligibility criteria
- Patient selection
- Early indications and contraindications
- Widening selection criteria
- VAT in papillary thyroid carcinoma
- Central compartment lymph node dissection
- RET gene mutation carriers
- Eligibility criteria today
Operative Technique
Setup, anesthesia, instruments, and the step-by-step procedure
- 1.5–2 cm
- Patient and surgical team positions
- Operating room setup and surgical team position
- Anesthesia options
- Superficial cervical block
- Surgical instruments
- Surgical instruments for VAT
- Surgical sequence at a glance
- Skin incision
- Central skin incision
- Marking the incision site
- Incising skin and subcuticular fat
- Incision through skin and fat
- Platysma and flaps
- Incising the platysma muscle
- Upper and lower flaps
- Opening the cervical linea alba
- Opening the cervical linea alba
- Creating the working space
- Creating the operative space
- Freeing the thyroid gland
- Vagus nerve monitoring
- Vagus nerve monitoring
- Exposing the upper pole
- Upper pole vessels exposed
- Identifying the EBSLN
- Identifying the external branch of the superior laryngeal nerve
- Sealing the upper pedicle vessels
- Sealing the upper pedicle vessels
- Identifying the RLN
- Endoscopic identification of the recurrent laryngeal nerve
- Recurrent laryngeal nerve under endoscopic view
- Recurrent laryngeal nerve exposed
- Checking RLN function
- Stimulating the recurrent laryngeal nerve
- Electromyographic response curve
- Dissecting the RLN
- Preparing and dissecting the recurrent laryngeal nerve
- Superior parathyroid gland
- Superior parathyroid gland identified
- Extracting the thyroid lobe
- Extraction of the thyroid lobe
- Completing the procedure under dual vision
- Inferior parathyroid gland and lower pole
- Inferior parathyroid gland identified
- Inferior parathyroid gland preserved
- Separating the thyroid from the trachea
- Dissection of the thyroid from the trachea
- Isthmus, contralateral side, and closure
- Skin closure
Conclusions
Safety, costs, oncologic role, and key points
- Safety and costs
- Oncologic role
- Summary
- References
- References (continued)
- References (continued)
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- References (continued)
- References (continued)
- Atlas of Thyroid Surgery