Kufufuza Opaleshoni Yopanda Thanzi Yopanda Thanzi ndi Dr. Emad Kandil
Chimodzi mwa zotsatira zokhudzana ndi opaleshoni ya chithokomiro - wotchedwa thyroidectomy - ndicho chotsalira chimene chimasiyidwa ndi incision. Opaleshoni yabwino kwambiri ya opaleshoni imakhala ndi luso loika malo osakaniza kuti chivundicho chibisike m'khosi. Zaka zaposachedwapa, zomwe zakhala zikugwiridwa zakhala zochepa, chifukwa cha njira zothandizira mavidiyo. Maonekedwe a zikopa za chithokomiro zakhala zikupita patsogolo kwambiri, koma chithokomiro chokhala ndi incision ya khosi chimachoka pachiguduli chowonekera.
Madokotala ena opaleshoni tsopano akuchita opaleshoni ya chithokomiro ndi khosi pogwiritsa ntchito robotic, akuyika malowa m'deralo (a axilla). Izi zimadziwika ngati opaleshoni ya "transaxillary robotic". The FDA inavomereza njirayi mu 2009 ndipo zipatala zitatu tsopano akugwiritsa ntchito robotics apamwamba kwa chithokomiro.
Kuphatikizapo phindu lodzikongoletsera lokhala ndi khungu lokha m'malo osungunuka - osati pamutu - malo osokonezeka ali ndi mapeto ochepa kwambiri pamtunda wa masentimita kuposa mmero wa mmero, choncho machiritso sakhala opweteka komanso amakhala osamala kwambiri. adzachiza mofulumira kuposa m'khosi.
Emad Kandil, MD, FACS, ndiye Mkulu wa Opaleshoni ya Endocrine ku Tulane University School of Medicine. Dr Kandil wathandizira kusintha ndi kuyambitsa njira zothandizira opaleshoni ya robotic khosi, pogwiritsa ntchito njira zowonongeka za mitsempha yoteteza ku laryngeal (bokosi la mawu) mitsempha. Dr Kandil watenga nawo gawoli mu gawo la Mafunso ndi Mayankho kuti athandize owerenga malo a Chithokomiro kuti aphunzire zambiri za chithandizo cha chithokomiro ndi chitsipa cha roboti.
Funso: Kugwiritsidwa ntchito opaleshoni ya khosi la transaxillary kumaonedwa kuti ndi kupita patsogolo kuposa opaleshoni ya endoscopic yothandizira mavidiyo yomwe yakhala ikugwiritsidwa ntchito kwambiri kwa opaleshoni ya chithokomiro ndi khosi, ndipo opaleshoni yotsiriza imayesedwa kuti ndi yowonjezera kuposa opaleshoni yachibadwa. Kodi mungadziwe za mitundu iyi ya opaleshoni?
Dr. Kandil: Kuchita opaleshoni yamakono kawirikawiri kumaphatikizapo kutengeka kwambiri pamunsi pa khosi. Chipewa chowoneka chosatha n'chotheka. Posachedwapa, chithandizo cha endoscopic chothandizira mavidiyo cha chithokomiro ndi khosi chagwiritsidwa ntchito. Kuchita opaleshoniyi kumapangidwa ndi kamvedwe kakang'ono ka khosi, pogwiritsa ntchito kujambula kosatha ndi kamera kakang'ono. Ndondomekoyi inachita upainiya ku Italy ndi Dr. Paolo Miccolli ndipo adatchuka ku United States pambuyo pa Dr. David Terris. Ndakhala ndikupereka chithandizo kwa odwala anga ndi kuwonjezera njira yowunikira mitsempha - komanso kuphunzitsa opaleshoni ena mwa njirayi - zaka ziwiri zapitazo. Njira imeneyi imayambitsa ululu pa khosi.
About Surgery Chithandizo cha Chithokomiro cha Transaxillary
Funso: Kodi opaleshoni ya chithokomiro ya transaxillary imathandizira bwanji?
Dr Kandil: Dr. Woong Youn Chung ku Seoul, ku Korea, adapanga njira yopaleshoni yopanda tsitsi ndi kuthandizira robotic.
Poyamba, njira yochitira opaleshoni ya khosi inkachitika ndi mpweya wa carbon dioxide (CO2) (kutsegulira mpweya mu malo opaleshoni) kumalo a khosi. Kugwiritsidwa ntchito kwa gasi kungayambitse zotsatira zina za opaleshoni, komabe, monga odwala amatha kumva ululu chifukwa cha mpweya womwe umakhalapo m'mapapo pafupi ndi mapapo (chidziwitso chotchedwa pneumomediastinum) kapena mpweya wodutsa m'madzi.
Ululu ndi zowawa zikhoza kukhalapo mpaka mpweya utatha.
Robotic, alibe, transaxillary thyroidectomy ndi njira yatsopano yopangira opaleshoni yochotsera zonse kapena gawo limodzi la chithokomiro. Nthaŵi zina amatchedwanso opaleshoni ya chithokomiro, kapena kuti opaleshoni yotchedwa robot.
Ndi njira yatsopanoyi, kupeweratu mpweya kumapewa, choncho mavuto okhudzana ndi kusungidwa kwa mafuta amapezedwanso.
Ndi njira yatsopanoyi, kamangidwe kakang'ono kamapangidwa pansi pa mkono, ndipo manja opangidwa ndi robotiki omwe amagwiritsidwa ntchito mwachindunji amagwira ntchito ngati manja, amalola dokotalayo kuti azigwira ntchito ndi kayendetsedwe ka kayendetsedwe kake.
Mawotchiwa amachititsanso dokotalayo kuti aziwoneka mu-dimensional optic (3D), ndi kamera yapamwamba yomwe imapanga kamvekedwe kamene kamapereka kukula kwa kasanu ndi kawiri kawonedwe kakang'ono. Tinasinthiranso ndondomekoyi kuti tigwiritse ntchito njira yowonongeka ya mitsempha yothandizira.
Ndondomekoyi inavomerezedwa ndi FDA mu 2009 ndipo ikuwonetsedwa kuti ndi njira yabwino kwambiri.
Funso: Chonde fotokozani ubwino wa opaleshoni ya chithokomiro ya transaxillary poyerekeza ndi chithokomiro chachikhalidwe.
Dr. Kandil: Chofunika kwambiri ndikuti opaleshoni ya transaxillary yopanga roboti siimapangitsa kuti phokoso lalitali, lokhalitsa likhale lokhazikika.
Kuopsa kwa opaleshoni ya chithokomiro ndi chiopsezo chovulaza mitsempha, yomwe imapita ku bokosi la mawu. Izi zingayambitse mantha osakhalitsa kapena osatha. Kuchita opaleshoni ya chithokomiro kungayambitsenso mavuto kumadera oyandikana nawo, kuphatikizapo zilonda za parathyroid, zomwe ziri pafupi ndi chithokomiro. Kuwonongeka kwa Parathyroid kungabweretsere hypocemiaemia yam'tsogolo kapena yosatha, yomwe imadwalitsidwa ndi calcium supplementation.
Malingaliro otetezeka, mu transaxillary opaleshoni ya chithokomiro ya robotic, kugwiritsa ntchito zipangizo zamakono zogwiritsira ntchito robotic ndi 10X kukula kwa munda ndi 3D masomphenya kumatipatsa ife ntchito yoyenera kwambiri. Izi zikutanthauza kuti pangakhale kuchepa kwa mitsempha ya mitsempha ndi chiopsezo chochepa cha kupsyinjika kwa malo oyandikana nawo monga mitsempha ya laryngeal kapena glands parathyroid. Zili zovuta kuvulaza malo oyandikana nawo ngati mungathe kuona m'mundawo nthawi zambiri kukula kwake. Timayang'ananso ntchito ya mitsempha mkati mwa ntchito yonse kuti tipewe chiopsezo chotsitsimula.
Kuonjezerapo, deta yanga yoyamba inasonyeza kuti kupweteka kwa postoperative kuli kochepa kwambiri. Izi zikutheka chifukwa cha kuchepa kwa chiwerengero cha mitsempha pansi pa mkono, poyerekezera ndi khungu lotupa la khosi. Ambiri mwa odwala anga sankafuna mankhwala alionse opweteka atatha opaleshoni.
Kawirikawiri, kuchira kumakhalanso mofulumira kwa opaleshoni ya robotic transaxillary, poyerekeza ndi opaleshoni ina ya chithokomiro ndi khosi.
Funso: Kodi opaleshoni ya robotic transaxillary imapereka nthawi iliyonse ndi ndalama?
Dr. Kandil: Nthaŵi yochita opaleshoniyi ikufanana ndi opaleshoni ya chithokomiro mmanja mwawo. Pakalipano, tilibe maphunziro omwe awonetsa kuti mtengowu ndi wofunika kwambiri poyerekeza ndi opaleshoni ya chithokomiro. Pamene kafukufukuyu wachitika, komabe ziyenera kuphatikizapo chiopsezo chokumana ndi mavuto komanso mtengo wogonjetsera mavutowa.
Funso: Zimatengera nthawi yaitali bwanji kukaphunzitsa ochita opaleshoni mu opaleshoni ya robotic transaxillary?
Dr. Kandil: Ine moona sindikudziwa yankho la funso ili. Ndinali opaleshoni yopanga mavitamini kwa zina zotchedwa endocrine ndi njira zamakono, kotero zinali zophweka kuti nditenge njira iyi. Zomwe ndikudziwa, ndondomekoyi inachitikira m'madera asanu ndi atatu ku United States, komabe pali magulu atatu okha omwe akupereka opaleshoni imeneyi.
Ndimakhulupirira kuti gawo limodzi ndilofunika kuchita opaleshoni yapamwamba chifukwa chakuti maphunziro apadera ndi opaleshoni ndi opaleshoni yapamwamba ndi zofunika. Monga opaleshoni ambiri ochita opaleshoni amadziŵa bwino njirayi, odwala ambiri angathe kupatsidwa njirayi, komabe.
Onani Surgery mu Action
Wokondedwa wa Dr. Kandil, Dr. Ronald Kuppersmith, wochokera ku College Station Medical Center ku Texas, anapanga mavidiyo angapo akuwonetsa njira za opaleshoni Dr. Kandil akulongosola. [ Chenjezo: mavidiyo awa akuwonetsa chithandizo choyenera. ]
- Kupanga Opaleshoni Yopangira Mavitamini Kuwonetsera kwa Opaleshoni ya Da Vinci, Intuitive Surgical, Inc.
- Da Vinci Thyroidectomy pa YouTube - Gawo 1
- Da Vinci Chithokomiro pa YouTube - Gawo 2
Odwala Pambuyo
Funso: Kodi atangoyamba opaleshoni, wodwala angaphunzire bwanji zotsatira za opaleshoniyo komanso ngati ali ndi matenda a khansa? Ngati khansa imapezeka, kodi mukupangira chithandizo cha mankhwala a iodine (RAI) nthawi zonse?
Dr. Kandil: Kawirikawiri, masiku atatu kapena atatu amafunika kuti likhale ndi lipoti lomaliza la matenda. Odwala ambiri omwe ali ndi khansa ya chithokomiro ya papilisi amafunika chithandizo cha radioiodine kupatula ngati chotupacho n'chochepa. Ndimakondanso kupanga kanema kuti ndiwone ngati pali minofu yambiri yosiyidwa. Pa khumi peresenti ya nthawi, odwala ena amapewa kufunika kwa mankhwala a radioiodine chifukwa iwo anali ndi chidwi chabwino chokhudzidwa. Komabe, izi sizikutsimikiziridwa. Tikukonzekera kuti tipange phunziro lomwe tikuyembekezera pa malo athu kuti tiwone ngati opaleshoni yapamwambayi ingapereke zotsatira zabwino zowonjezera chifukwa cha kuyang'ana bwinoko komwe kunaperekedwa ndi dongosolo.
Funso: Pamene chilonda chili chochepa, vuto la kuchotsa chithokomiro ndilofunika. Kodi mumauza odwala anu kuti awone ngati nthawi yeniyeni ya machiritso?
Dr. Kandil: Timayambitsa timadzi timadzi timadzi tokoma masiku awiri kuchokera pamene opaleshoniyi yadutsa. Mayeso a ntchito ya chithokomiro amatha kuyang'aniridwa masabata anayi kapena asanu mutatha opaleshoni. Odwala ambiri nthawi zambiri amatsatiridwa ndi katswiri wotchedwa endocrinologist kuti asinthe mlingo ndipo kawirikawiri amakhala oongoka kwambiri. Odwala ena amachita bwino ndi vuto la TSH loponderezedwa, makamaka omwe ali ndi kansa ya chithokomiro, ngakhale zilizonse zomwe zimapangitsa wodwalayo kumva bwino ayenera kukhala mankhwala.
Funso: Pa maofesi akutsatira akupita, kodi odwala amakondwera ndi machiritso awo? Monga dokotala, kodi mumakonda kwambiri kupita patsogolo, poyerekeza ndi odwala omwe achita chithokomiro chachikhalidwe?
Dr. Kandil: Mwamtheradi. Ichi ndi chithandizo chosangalatsa chatsopano cha odwala athu. Palibe ululu wa khosi, zovuta zochepa za mavuto, zopweteka zochepa komanso kupuma msanga. Ambiri mwa odwala anga alidi odzikonda okha chifukwa akufunafuna mawonekedwe a chithokomiro ndi zida zosaoneka.
M'tsogolo
Funso: Mukulingalira kwanu, tidzatha nthawi yayitali bwanji tisanatenge chithokomiro chosavuta kuchipatala chachikulu? Kodi pali tsogolo mtsogolomu pamene tingayembekezere opaleshoni ya chithokomiro chothandizira pa roboti kuti ikhale opaleshoni yotchuka ya kuchotsa chithokomiro?
Dr. Kandil: Opaleshoni ya chithokomiro yothandizira mavidiyo imaperekedwa ku mabungwe ochuluka m'dziko lonse lapansi zaka ziwiri zapitazo. Pali maphunziro ambiri omwe amaphunzitsa ochita opaleshoni momwe angapangire njirayi ndipo madokotala ambiri opaleshoni akutsata njirayi.
Komabe, ndi zosiyana ndi opaleshoni yopanga khosi la transixillary.
Choyamba, mukufunikira dongosolo lapamwamba la robotic kuti lipange opaleshoni, monga da da Surgery system. Chachiwiri, kudziŵa ndi luso lamakono ndikofunikira kuti ntchitoyi ikhale bwino. Ndakhala ndikuthandiza kuthandizira Dr. Floyd C. Holsinger ku University of Texas MD Anderson Khancer Center ndi njira yake yophunzitsira opaleshoni yopanda mpweya wa roboti. Ndimaphunzitsanso maphunziro ku Tulane, kumene tikubweretsa madokotala ochita opaleshoni ochokera kumayiko onse ku US ndi ochokera kunja kuti aphunzire zambiri za opaleshoniyi ya transaxillary.
Wofufuza ndi woleza mtima amene amalimbikitsa Leslie Blumenberg anapereka gawo ili.
Source: February / March 2010 Kucheza ndi Emad Kandil, MD, FACS, Wothandizira Pulofesa wa Opaleshoni, Pulojekiti Wothandizira Pulofesa wa Zamankhwala, Pulofesa Wothandizila wa Otolaryngology, Chief, Endocrine Surgery Section, Endocrine ndi Oncological Surgery, Tulane University
Information Contact for Dr. Kandil
Emad Kandil, MD, FACS
Pulofesa Wopaleshoni Wothandizira, Pulojekiti Wothandizira Pulofesa wa Zamankhwala, Pulofesa Wothandizira Othandizira wa Otolaryngology, Chief, Gawo la Opaleshoni ya Endocrine, Endocrine ndi Opaleshoni ya Oncological
University of Tulane
Tel: 504-988-7520, Fax: 504-988-4762
Zosasintha: 1-877-378-7874
Osankhidwa: 504-988-3589
Imelo: ekandil@tulane.edu
Dr. Kandil's Curriculum Vitae (PDF)
Malo Ochipatala Akupereka Opaleshoni ya Chithokomiro cha Transaxillary
- Tulane University Sukulu ya Zamankhwala Dipatimenti Yopaleshoni, Opaleshoni ya Endocrine - Emad Kandil, MD, FACS
- University of Texas, MD Anderson Center ya Khansa - Floyd Christopher Holsinger, MD, FACS
- College Station Medical Center, College Station, Texas - Ronald Kuppersmith, MD, FACS, Andrew de Jong, MD, FACS
Zina Zofunikira
- Opaleshoni ya Robotic ya Da Vinci
- Bungwe la American Association of Endocrine Surgeons
- Mndandanda wa Olemba AAES ndi State (PDF)
- Malo Ochipatala ku US Amene Amachita Opaleshoni ya Endocrine
Mavidiyo a YouTube
- "Palibe Ng'ombe Yopsa" Endoscopic Thyroidectomy
- Kupanga Opaleshoni Yopangira Mavitamini Kuwonetsera kwa Opaleshoni ya Da Vinci, Intuitive Surgery, Inc. Da Vinci Chithokomiro pa YouTube
- Da Vinci Thyroidectomy pa YouTube - Gawo 1
- Da Vinci Chithokomiro pa YouTube - Gawo 2