Transoral Endoskopik Tiroidektomide Anestezi Yönetimi
Özet
Transoral endoskopik tiroidektomi vestibüler yaklaşım (TOETVA) tekniğinde anestezi yönetimini ele alan bu çalışmada, geleneksel açık tiroidektominin (AT) boyun bölgesinde bıraktığı kalıcı izlerin aksine, TOETVA'nın izsiz ve güvenli bir alternatif olarak popülaritesinin arttığı vurgulanmaktadır. Cerrahi süreç, alt dudak vestibül bölgesinden yapılan üç küçük insizyon ve karbon dioksit (CO2) insüflasyonu ile gerçekleştirilmektedir. Anestezi yönetimi, CO2 kullanımı ve cerrahi sahanın hassasiyeti nedeniyle kritik bir öneme sahiptir. Preoperatif dönemde havayolu değerlendirmesi ve tiroid fonksiyon testleri temel önceliklerdir. İntraoperatif süreçte, cerrahi alanı rahatlatmak adına oral entübasyon tercih edilirken; intraoperatif nöromonitörizasyon (İONM) planlanan hastalarda elektrotlu tüplerin kullanılması zorunludur. Anestezi idamesinde, postoperatif bulantı ve kusmayı minimize etmek için genellikle total intravenöz anestezi (TİVA) önerilmektedir. Operasyon sırasında CO2 insüflasyonuna bağlı gelişebilecek hiperkarbi, cilt altı amfizemi ve pnömotoraks gibi komplikasyonların yakın takibi elzemdir. Postoperatif süreçte ise en ciddi riskler arasında kanama, hematom ve bilateral rekürren laringeal sinir hasarına bağlı gelişebilecek havayolu tıkanıklıkları yer almaktadır. Sonuç olarak, anestezi hekimlerinin cerrahinin her aşamasına ve potansiyel risklere hâkim olması, başarılı bir hasta yönetimi için temel şarttır.
This study examines anesthetic management in the transoral endoscopic thyroidectomy vestibular approach (TOETVA) technique, highlighting its growing popularity as a scarless and safe alternative to traditional open thyroidectomy (OT), which leaves permanent neck scars. The surgical procedure is performed via three small incisions in the lower lip vestibule using carbon dioxide (CO2) insufflation. Anesthetic management is critical due to CO2 use and the sensitivity of the surgical site. Preoperative priorities include airway assessment and thyroid function tests. Intraoperatively, oral intubation is preferred to facilitate surgical access; however, if intraoperative neuromonitoring (IONM) is planned, the use of specialized electrode tubes is mandatory. For maintenance, total intravenous anesthesia (TIVA) is generally recommended to minimize postoperative nausea and vomiting. Close monitoring of complications such as hypercarbia, subcutaneous emphysema, and pneumothorax resulting from CO2 insufflation is essential. In the postoperative period, the most serious risks include bleeding, hematoma, and airway obstruction due to bilateral recurrent laryngeal nerve damage. In conclusion, it is vital for anesthesiologists to be proficient in every stage of the surgery and its potential risks to ensure successful patient management.
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