After our teams experience in neck scarless thyroidectomy at our center and various other centres, especially SGPGI, Lucknow where we used to go as a mentor for endocrine surgery department, we felt a need to modify the procedure so it becomes standardised and reproducible. 1. Earlier many use arms up and abducted position for this procedure, we now use arms by the side and never felt the need of lifting up the arms. This position will not cause any injuries to brachial nerves . 2. We don’t use spacer, we use one arm or scissors to create space and insert other instruments. This avoids wrong planes with blind passages and it avoids larger incision with possible gas leak. 3. Total thyroidectomy and neck dissection is easier than Trans oral and Trans Axillary approach
We published our data on Trans Oral Thyroidectomy in 2017. We found that
1.20% of cases the access was creating a painful scar in gingival labial sulcus in the long run
2.Very difficult to do neck dissections and access lateral nodes which is important in thyroid carcinoma
3.Not many were doing it even after our mentoring. It was not simply reproducible
1.Cant do opposite neck dissection satisfactorily
2.Oppesite thyroid lobe is a problem sometimes
3.Need a 10 lakhs retractor and local made is not of good quality
TRADITIONAL RABBIT
1.Arms were extended up above the head and caused and cause neuropraxia and always on the mind of Surgeon and Anaesthetist.
2. Spacer or dilator used was going into wrong planes and causing more pain
MODIFICATION OF RABBAT
1.The are are by the sides and absolutely no chance of nerve injuries
2.Axillary port with 8 mm incision and a periaerolar incision to insert camera
3. The plane is dissected with single arm, scissors till opposite axilla and areola. The 3rd and 4th arm ports are inserted under visions with direction given by a verses needle
THIS TECHNIQUE IS SIMPLE, REPRODUCIBLE, SAFE, NO NEUROPRAXIA, NO EXPENSIVE RETRACTOR NEEDED, CAN ACCESS BILATERAL NECK, CAN DO BILATERAL NECK DISSECTION OR TOTAL THYROIDECTOMY WITH SWAPPING OF CAMERA