| 摘要 |
Laparoscopic adrenalectomy was the first endoscopic procedure proposed in the filed of endocrine surgery and very soon it proved to present such important advantages to become in few years the golden standard for the treatment of adrenal diseases. The same approach to the neck, where thyroid and parathyroid glands are located, was though more problematic: the small operative space, the possible trouble linked wiyh long insufflations, the inadequacy of the available surgical instruments, were important obstacles to the introduction of minimally invasive thyroidectomy and parathyroidectomy. In spite of this both procedures have become widespread during the last three years even though several factors still limit their wide application. The advantages offered by these techniques, although demonstrated by prospective studies, appear less crucial than those offered by laparoscopic abdominal surgery; furthermore a limiting factor is the volume of the thyroid masses which often exceed the present possibilities of endoscopic neck surgery. All the same some aspects must be pointed out: the cosmetic advantage offered by this approach in a critical area such as the neck should be carefully evaluated; the rapid development of technology will more and more facilitate this surgery by making available new dedicated instruments such as the 5mm 14 cm long harmonic scalpel (Ultracision). Finally even the operative time, that was considered too long with respect to traditional endocrine surgery, has now equaled that of standard surgery in most of the procedures. |
