Cervicoscopy, a minimally invasive approach for the thyroid, parathyroid, and thymus in children

Abstract

Since the beginning of the 1990s minimally invasive endoscopic techniques have been applied for surgery in natural body cavities such as the thorax and abdomen of children. The pediatric surgeon had to be trained to work in limited spaces. With the improvement in technical skills in endoscopic surgery and the development of thinner and shorter instruments, new spaces have become accessible to endoscopic surgery. With the aid of CO2 pneumodissection virtual spaces, for example the retroperitoneum, can be turned into to real spaces allowing for endoscopic surgery in these areas. In 1996, Gagner published the first case of subtotal resection of the parathyroids via a cervical endoscopic approach in a 37-year-old man. The operation lasted five hours, and the only problems encountered were hypercarbia and tachycardia. Other such experiences have been reported, both in animal experiments as well as in human adults (Naitoh et al. 1998; Norman and Albrink 1997). In 1997, at the first course of endocrine endosurgery at the European Institute of Telesurgery (EITS) in Strasbourg, France, Gagner, Marescaux, and colleagues demonstrated their technique of endoscopic neck operations both in animals as well as in adult human patients, and discussed the potential hazards as well as the measures to avoid them. In 1997, Hscher et al. reported their first endoscopic right thyroid lobectomy for a 4 mm adenoma. A year later Yeung (1998) reported his experience on three endoscopic parathyroidectomies for adenomas and five endoscopic hemithyroidectomies, which were carried out without any complication. These preliminary experiences demonstrated that endoscopic dissection and surgical intervention of the neck were technically feasible and safe. After having performed two video-assisted thymectomies in children in 1996 (Reinberg 1998) we changed to a totally closed approach in five additional cases by so-called cervicomediastinoscopy (Reinberg and Montupet 1999, 2000). Meanwhile this minimally invasive method has been successfully used for thyroid and parathyroid surgery as well. The surgical technique for both the thyroid and parathyroids as well as for the thymus will be described in detail. © Springer-Verlag Berlin Heidelberg 2008.