Binciken marasa lafiya Transaxillary Robotic Thyroid tiyata da Dr. Emad Kandil
Ɗaya daga cikin cututtuka na ciwon tiyata - wanda aka sani da thyroidectomy - shi ne maganin da aka bari a baya ta hanyar incision. Mafi kyau likitoci na thyroid suna da gwaninta a saka idanu a hankali don haka alamar an boye a cikin wuyan wuyansa. A cikin 'yan shekarun nan, incisions sun samu karami, godiya ga fasahar bidiyo da aka taimaka. Halin da ake gani na thyroid scars ya inganta sosai, amma thyroidectomy tare da wuyansa na wuyansa har yanzu ya fita bace mai gani.
Wasu likitocin likita a halin yanzu suna yin tiyata da kuma wuyan ɗaure tare da taimakon robotic, suna sanya karkatarwa a cikin underarm (axilla) yankin. Wannan shi ne ake magana da shi kamar aikin "transaxillary robotic". FDA ta amince da wannan tsari a shekara ta 2009 da kuma cibiyoyin kiwon lafiya guda uku suna amfani da na'urori masu mahimmanci don thyroidectomy.
Bugu da ƙari, amfani na kwaskwarima na ciwon kawai a cikin underarm area - maimakon a kan wuyansa - yankin da ba a san shi ba yana da ƙananan ƙarancin ƙwayar jiki ta murabba'in kilomita fiye da maƙarar, don haka warkewar ba ta da zafi kuma tare da kulawa mai kyau, haɗuwa zai warkar da sauri fiye da a wuyan wuyanki.
Emad Kandil, MD, FACS, shi ne Babban Ayyukan Endocrine a Tulane University of Medicine. Dokta Kandil ya taimakawa juyin juya hali da kuma samar da fasahar tiyata na wucin gadi, ta yin amfani da kulawa da ƙwayar jijiyar jiki domin kare lafiyar laryngeal (murya). Dr. Kandil ya shiga cikin wannan Tambayar Tambaya da Amsa don taimaka wa masu karatun shafin yanar gizon Thyroid su koyi game da aikin robotic-assisted thyroid and neck tiyata.
Tambaya: An yi aikin tiyata a cikin wucin gadi a kan abin da aka yi amfani da shi a bayan da aka yi amfani da shi na maganin endoscopic wanda yake amfani da shi don yin amfani da tiyata da kuma wuyansa, kuma ana gwada aikin tiyata a matsayin likita fiye da tiyata. Shin za ku iya fada game da waɗannan nau'i na tiyata?
Dr. Kandil: Traditional thyroid tiyata yawanci yakan ƙunshi tsawon tsawo incision a tushe na wuyansa. Za'a iya ganin maiguwa mai gani. Kwanan nan kwanan nan, tilasta aikin maganin endoscopic na bidiyo ya taimaka wajen yin amfani. An yi wannan tiyata tare da ƙaramin wuyansa a cikin wuyansa, ta yin amfani da nuna hotunan endoscopic tare da karamin kamara. Wannan Dokar da Dr. Paolo Miccolli ya yi wa Italiya aiki a Italiya kuma ya sami karbuwa a Amurka bayan Dr David Terris ya karbi wannan hanyar. Na miƙa wannan hanya ga marasa lafiya tare da ƙarin tsarin kulawa na jijiyar jiki - kazalika da horar da wasu likitoci a cikin wannan fasaha - a cikin shekaru biyu da suka gabata. Wannan dabarar ta yi, duk da haka, har yanzu yana haifar da wata ƙaya a wuyansa.
Game da Transaxillary Robotic Thyroid Tiyata
Tambaya: Menene transaxillary robotic-taimaka thyroid tiyata da kuma yadda aka yi?
Dokta Kandil: Dokta Woong Youn Chung a Seoul, Koriya, ya kafa fasaha ta wucin gadi na wucin gadi tare da taimakon robotic.
Da farko, an yi amfani da aikin tiyata na wucin gadi tare da carbon dioxide (CO2) gas na kasa (gabatar da gas a cikin ƙwayar mota) zuwa yanki. Yin amfani da iskar gas yana da yiwuwar haifar da wasu cututtuka, bayan haka, yayin da marasa lafiya zasu iya sha wahala saboda ginin da aka riƙe a cikin kyallen da ke kewaye da huhu (yanayin da aka sani da pneumomediastinum) ko iska mai karkashin ruwa tare da tsinkaye.
Abin ciwo da rashin jin daɗi zai iya kasancewa har sai an yi amfani da iskar gas.
Kayan aiki, gasless, transaxillary thyroidectomy ne sabon ɓullo da, ƙananan-m inganci don cire duk ko ɓangare na thyroid. An kuma kira wani lokacin robot-assisted thyroid tiyata, ko robot-taimaka endoscopic thyroid tiyata.
Tare da wannan sabon tsarin, an kawar da matsalar gas gas, saboda haka ana hana kaurin matsalolin kare gas.
Tare da wannan sabon fasaha, an sanya karamin ginin a ƙarƙashin hannu, kuma kayan aikin da aka tsara musamman na hannu kamar yadda hannayensu suka tsara, wanda zai sa likitan likita ya yi aiki tare da iko da ƙungiyoyi masu kyau.
Tsarin magungunan kuma ya ba da damar likita don ganin su a cikin girman nau'i-nau'i uku na 3D (3D), tare da kyamara mai mahimmanci da aka tsara musamman wanda ke bada ɗaukakawa har sau goma kallon al'ada. Mun kuma canza hanyar da za a hada da yin amfani da aikin kulawa na kulawa da ƙwayar cuta na yau da kullum.
Wannan tsari ya amince da shi a kwanan nan ta hanyar FDA a 2009 kuma an tabbatar da cewa ya zama kyakkyawan tsari.
Tambaya: Da fatan za a kwatanta amfanin dabarar da ake yi wa thythoidectomy.
Dr. Kandil: Abinda ke da mahimmanci shi ne cewa aikin tiyata ne ba zai haifar da tsohuwar wuyansa ba.
Rashin ciwon tiyata yana da hadarin rauni ga ciwon laryngeal, wanda ke zuwa akwatin murya. Wannan na iya haifar da wucin gadi ko na ƙarshe. Tawan tiyata zai iya haifar da cututtuka zuwa sassa na kusa, ciki har da giraben parathyroid, wanda ke kusa da thyroid. Cinwanci na Parathyroid zai iya haifar da hypocalcemia na wucin-gadi ko na dindindin, yanayin da ake bi da shi tare da ƙarin ƙwayoyin calcium.
Daga hanyar kula da tsaro, a aikace-aikace ta hanyar yin amfani da kayan aikin motsa jiki, aikin yin amfani da kayan aiki mai mahimmanci tare da girman girman 10X da filin 3D yana ba mu damar yin aiki sosai. Wannan yana nufin akwai rashin yiwuwar cututtuka na jijiya da kuma rashin hadarin cututtuka ga wurare masu kusa kamar laryngeal nerve ko parathyroid glands. Yana da matukar wuya a cutar da hanyoyi na kusa idan za ku iya ganin filin a sau goma a matsayin girman su. Har ila yau, muna iya saka idanu akan aikin nervan a yayin aiki duka don kauce wa haɗarin lalacewa.
Bugu da ƙari, bayanan na farko sun nuna cewa ciwon daji ba shi da muhimmanci sosai. Wannan yana iya yiwuwa saboda ƙananan ƙarancin ciwon daji a ƙarƙashin hannu, idan aka kwatanta da fata mai wuya na wuyansa. Mutane da yawa daga cikin marasa lafiya ba su buƙatar wani magani ba bayan tiyata.
Bugu da ƙari, dawowa ya fi gaggawa don tilasta aikin tiyata, idan aka kwatanta da sauran thyroid da wuyansa.
Tambaya: Shin tilasta aikin tiyata ne na kowane lokaci da kudin kuɗi?
Dr. Kandil: Lokacin da za a yi aikin tiyata ya dace da aikin tiyata na al'ada a hannayen da aka sani. Har zuwa yau, ba mu da nazarin da suka kimanta farashi mai amfani da wannan hanya idan aka kwatanta da al'ada ta maganin thyroid. Lokacin da aka gudanar da wannan binciken, duk da haka, ya kamata ya haɗa da hadarin matsalolin da farashi don gudanar da waɗannan matsalolin.
Tambaya: Yaya tsawon lokaci ya kamata a horar da likitoci a cikin aikin tiyata?
Dr. Kandil: Ina da gaskiya ba san amsar wannan tambayar ba. Na yi aikin tiyata don sauran endocrin da hanyoyin ka'idoji, don haka yana da sauƙi a gare ni in yi amfani da wannan fasaha. Don sanin ni, an gudanar da wannan tsari a cikin hukumomi takwas a Amurka, duk da haka, akwai ƙananan hukumomi guda uku waɗanda ke ba da irin wannan tiyata.
Na tabbata wani ɓangare na wannan shine aikin da ake buƙata don aikin tiyata saboda horo na musamman da kwarewa tare da aikin tiyata na da muhimmanci. Kamar yadda karin likitocin likitoci suka shawo kan wannan fasaha, za a iya miƙa wa marasa lafiya wannan madadin, duk da haka.
Dubi Harkokin Aikin
Kwalejin Kandil, Dokta Ronald Kuppersmith, daga Cibiyar Kasuwancin Cibiyar Kwalejin Kolejin ta Jihar Texas, ta gabatar da bidiyon da dama da ke nuna magungunan likita Dr. Kandil yana kwatanta. [ Gargadi: wadannan bidiyo suna nuna hoto sosai. ]
- Robotic Surgery Demonstration by da Vinci tiyata, Intanitive M, Inc.
- Da Vinci Thyroidectomy a YouTube - Part 1
- Da Vinci Thyroidectomy a YouTube - Part 2
Patient Aftercare
Tambaya: Yaya jimawa bayan tiyata wanda likita zai koya game da sakamakon aikin tiyata kuma idan akwai ganewar cutar kankara? Idan aka samu ciwon daji, shin kana bada shawarar maganin Idinin rediyo (RAI) a duk lokuta?
Dokta Kandil: Yawancin lokaci, ana bukatan daya zuwa kwana uku don samun rahoto na karshe. Yawancin marasa lafiya tare da ciwon maganin ciwon thyroid na jariri zai buƙaci magani na radioiodine sai dai idan ƙwararrun ƙananan ne. Na kuma fi son in yi samfurin kirkiro don ganin idan akwai wani abu mai ƙwayar microscopic da aka bari a baya. Kashi goma daga cikin lokaci, wasu marasa lafiya zasu kauce wa bukatun magungunan radioiodine saboda suna da kyakkyawar tasiri na zamani. Duk da haka, wannan ba tabbas ba ne. Mun shirya yin wani binciken da zai yiwu a cikin ma'aikata don ganin ko aikin tiyata na iya samar da mafi kyawun sakamako akan abubuwan da ke faruwa a sakamakon tsarin da aka samar da tsarin.
Tambaya: Yayin da ƙananan ya yi ƙanƙara, ƙwaƙwalwar cire glandan thyroid shine muhimmi. Mene ne kake fada wa marasa lafiyarka da zata tsammaci tsarin lokaci na warkarwa?
Dr. Kandil: Mun fara maye gurbin thyroid hormone sau biyu bayan tiyata. Ana gwada gwaje-gyaren aikin aikin thyroid hudu zuwa shida makonni bayan aiki. Yawancin marasa lafiya sukan biyo baya tare da endocrinologist don daidaita tsarin kuma yana da sauƙi sosai don yin haka. Wasu marasa lafiya suna da kyau tare da matakin TSH da aka ƙaddamar, musamman ma waɗanda ke fama da ciwon maganin thyroid, ko da yake duk abin da yake so ya sa likita ya ji daɗi ya kamata ya zama abin lura.
Tambaya: A lokacin ziyara a kan ofishin jakadanci, shin marasa lafiya ne suke so da ci gaba da warkarwa? A matsayin likita, kina jin daɗin ci gaban su, idan aka kwatanta da marasa lafiya da suka taɓa yin maganin thyroidectomy?
Dr. Kandil: Babu shakka. Wannan wani sabon zaɓi na zabin likita ga marasa lafiya. Babu wuyan wuya, ƙananan hadarin rikitarwa, rashin ciwo da sauri. Yawancin marasa lafiya na ainihi an kira su ne saboda suna neman nau'in tiyata tare da ƙananan baƙi.
Cikin Gaba
Tambaya: A kimantawar ku, tsawon lokacin zai zama kafin kurancin ku na samuwa a manyan ƙananan cibiyoyin? Shin akwai wata ma'ana a nan gaba lokacin da za mu iya tsammanin cewa aikin tiyata ya taimaka wa tilasta aikin tiyata don zama aikin da za a fi so don maganin thyroid?
Dokta Kandil: An ba da cikakken bayani game da irin wajan da ake yi na maganin maganin thyroid a yawancin cibiyoyi a fadin kasar a cikin shekaru biyu da suka wuce. Akwai darussa da yawa waɗanda ke koyar da likitoci yadda za su yi wannan hanya kuma likitoci masu yawa suna daidaitawa da wannan fasahar.
Ya bambanta, duk da haka, saboda aikin da aka yi da wuyan wucin gadi na wucin gadi.
Na farko, kana buƙatar tsarin na'urar da aka ci gaba don aiwatar da aikin, kamar tsarin daji na Vinci. Na biyu, kwarewa tare da fasaha ana buƙatar ɗaukar wannan aiki a amince. Na yi aiki don taimaka wa Dr. Floyd C. Holsinger a Jami'ar Texas MD Anderson Cancer Center tare da aikinsa don koyar da aikin ba da wucin gadi a wuyansa. Har ila yau, ina koyarwa a Tulane, inda muke kawo likitoci daga ko'ina cikin {asar Amirka da kuma} asashen waje, don koyon sanin abinda ake yi, dangane da irin wannan aikin da ake yi na robotic.
Mai bincike da haƙuri sun bada shawara ga Leslie Blumenberg sun taimaka wa wannan labarin.
Source: Fabrairu / Maris 2010 Tattaunawa tare da Emad Kandil, MD, FACS, Mataimakin Farfesa na Hoto, Mataimakin Farfesa na Magunguna, Adjunct Mataimakin Farfesa na Otolaryngology, Cif, Endocrin Harkokin Tiyata, Endocrin da Tiyoloji Surgery, Jami'ar Tulane
Bayanan hulda ga Dokta Kandil
Emad Kandil, MD, FACS
Mataimakin Farfesa na Tiyata, Mataimakin Farfesa na Kwalejin Medicine, Adjunct Mataimakin Farfesa na Otolaryngology, Cif, Endocrine Saka'ar Sashin, Endocrin da Surcological Surgery
Jami'ar Tulane
Tel: 504-988-7520, Fax: 504-988-4762
Ba da kyauta ba: 1-877-378-7874
Gayyata: 504-988-3589
Imel: ekandil@tulane.edu
Dr. Kandil's Curriculum Vitae (PDF)
Cibiyoyin lafiya Ana ba da Transaxillary Robotic thyroid Tiyata
- Makarantar Cibiyar Magunguna na Jami'ar Tulane, Endocrine Tiyata - Emad Kandil, MD, FACS
- Jami'ar Texas, MD Anderson Cancer Center - Floyd Christopher Holsinger, MD, FACS
- Cibiyar Kwararren Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Kwalejin Koleji
Sauran albarkatun
- da Vinci Robotic tiyata
- Ƙungiyar {asar Amirka na Endocrin Surgeons
- AAES Member List by State (PDF)
- Cibiyoyin Kiwon Lafiyar Aiki a Ƙasar Amurka Wannan Ya Kamo Cutar Dama
YouTube Bidiyo
- "Babu Ƙarƙashin Ƙira" Endoscopic Thyroidectomy
- Hanyar Jirgin Lafiya ta hanyar da Vinci tiyata, Intanitive M, Inc. Da Vinci Thyroidectomy a YouTube
- Da Vinci Thyroidectomy a YouTube - Part 1
- Da Vinci Thyroidectomy a YouTube - Part 2