Videoendoscopic neck surgery: techniques and results
Khullar, Rajesh (2002) Videoendoscopic neck surgery: techniques and results. In: Congress of Endoscopic and Laparoscopic Surgeons of Asia, 2002 [ELSA 2002], 19-21 Sep 2002, Tokyo, Japan.
Full text available as:
Minimal access surgery has shown definite progressive improvement in the technical expertise and instrumentation in this field. The endosurgeon thus emboldened has now started exploring areas including those where even a preformed cavity is not present. The neck is one such area where the well defined tissue planes with minimal vascular/ structures traversing them provide potential spaces for performing endo surgery. Benign thyroid nodules and parathyroid adenomas are the commonest indications for endoscopic neck exploration. Other indications include carotid body tumor, cervical discectomies and tuberculosis of spine etc. The working space is the pretracheal space lying deep to the strap muscles of the neck. The anatomical land marks include the tracheal rings (which indicate access to the right plain) and the carotid sheath (marking the lateral limit of dissection). The ultrasonic knife is an excellent, instrument for dissection as it eliminates the need for clip application and ensures complete hemostasis as dissection proceeds. Monopolar cautery has been found to be quite adequate for dissection & hemostasis. Alternatively the harmonic scalpel may be used. The working space being small, excessive diathermy use may result in fogging and loss of vision. Suctioning should be avoided to prevent rapid loss of space instead a pledget of gauze may be used to mop blood Meticulous hemostasis ensures brighter vision by decreasing light absorption. External pressure may be used to control bleeding and for palpation of area under dissection. The enhanced illumination and magnification are ideal for structure identification in this area with several important anatomical structures. Being deep to the cervical fascia has not caused any significant post operative surgical emphysema. Recovery has been found to be quicker and cosmesis highly appreciated by the patients.
Archive Staff Only: edit this record