Exoscope-assisted thyroid surgery

11.1

Technological advancements in thyroid and parathyroid surgery

At the beginning of the 21st century, technological advancements in thyroid and parathyroid surgery served to obtain better cosmetics results and lower postoperative pain. Minimally invasive video-assisted parathyroidectomy and thyroidectomy relied on the use of an endoscope. ^, A further upgrade was obtained by adding a three-dimensional (3D) view of the surgical field. More recent techniques, including thyroidectomy via transaxillary approach, transoral robotic-assisted thyroidectomy, and transoral endoscopic thyroidectomy via vestibular approach, rely on the use of endoscopes combined with 3D view. In fact, 3D vision allows for better identification and visualization of anatomical structures. Similar to previous endoscopic approaches, the exoscope combines 3D technology with 4K view and permits to perform thyroid surgery with an open approach, without changing surgical steps and using the same instrumentation, but resulting in enhanced vision.

The primary aim in thyroid surgery is to remove the gland tissue completely, while preserving the recurrent laryngeal nerve (RLN) and parathyroid glands (PGs). After a preliminary dissection, the RLN and PGs should be adequately identified and visualized to reduce the risk of iatrogenic damage. Although various medical devices have been developed for intraoperative use to simplify RLN and PGs identification, visual identification still represents the gold standard. Surgical loupes are widely used to enhance the surgical field magnification, reducing the risk of RLN tearing and PGs devascularization. However, the magnification is restricted to the surgeon unless the loupes are coupled to a microcamera. In this context, the introduction of the exoscope as a new visualization and magnification tool represents an innovative way to improve the identification and preservation of RLN and PGs during conventional open thyroidectomy. The exoscopic system projects the surgical image onto a 4K 3D 32-in. monitor that can be seen by all the operators and other surgical staff, allowing for an outstanding view of the surgical field, coupled with depth perception. Moreover, image magnification can be adjusted and modulated during the procedure to focus on anatomical structures of interest, aiding in surgical dissection.

11.2