Transaxillary thyroidectomy video. The purpose of this article is .

Transaxillary thyroidectomy video. Methods Between Jun 6, 2024 · Contrary to open thyroidectomy, in transaxillary robotic thyroidectomy, the thyroid lobe is first released laterally and inferiorly (lateral approach). Jan 1, 2020 · This multicenter, retrospective observational study compared an endoscopic technique with a robotic one: minimally invasive video-assisted thyroidectomy (MIVAT) and robot-assisted transaxillary thyroidectomy (RATT) and found that the results tend to be equal in the long term. This study aimed to assess the surgical efficacy of endoscopic thyroidectomy (ET) as compared to conventional open thyroidectomy (COT) in PTC patients. Apr 21, 2021 · Transaxillary approach :robot thyroidectomy Won Woong Kim 58 subscribers Subscribed. Sep 28, 2021 · The learning curve for robotic thyroidectomy: a multicenter study Robotic thyroidectomy learning curve for beginning surgeons with little or no experience of endoscopic surgery IVORY guidelines (instructional videos in otorhinolaryngology by YO-IFOS): a consensus on surgical videos in ear, nose, and throat Apr 8, 2015 · Recent technological advances have led to a rapid progress in endocrine surgery. We believe with time RT will be widened and it will be performed more often. Methods: Single-center retrospective review of 31 consecutive thyroid lobectomies: 16 VANS (Nov 2020-Feb 2025) and 15 TART (Mar 2022-Feb 2025). Here we analyzed recorded video files of patients undergoing robotic or endoscopic transaxillary thyroidectomy and compared each step of the two surgical procedures. Mar 19, 2017 · Keywords: History, mini invasive video-assisted thyroidectomy, robotic thyroidectomy, transaxillary approach The concept of endoscopic neck surgery for thyroid or parathyroid gland started with Gagner et al. In experienced hands, robotic transaxillary thyroidectomy is feasible and safe even in patients with large thyroid nodules or thyroiditis. Although the surgical incision of MIVAT is only about 2 cm, there are still a considerable number of patients with cervical scar hyperplasia [14 – 16]. The spread of this surgical technique has remained limited mainly because the difficulty to expose and access the controlateral lobe. It presents preparation and major steps of robot-assisted thyreidectomy performed through Dec 10, 2022 · Minimally invasive video-assisted thyroidectomy (MIVAT) was first described in 1999 [10], and it has become a widespread technique for low- and intermediate-risk DTC [11 – 13]. Oct 30, 2023 · Our video demonstrates a modified gasless transaxillary endoscopic thyroid surgery with the posterior approach for bilateral low-risk thyroid cancer. Jul 10, 2025 · The thyroidectomy techniques were minimal invasive video-assisted thyroidectomy (MIVAT), TOETVA, and transaxillary robotic thyroidectomy. Sep 28, 2021 · All consecutive transaxillary approaches for robotic thyroidectomy between 2010 and 2018, performed by the same head and neck surgeon (PA), were retrospectively analyzed (duration and complications), for the analysis of the learning curve. Aug 1, 2020 · The use of a robotic system to perform a transaxillary approach for total thyroidectomy has been proposed since 2007 and is currently an option in some specialized groups in western countries [1]. Learn more Apr 24, 2019 · Robotic thyroidectomy by transaxillary approach (RATS) is regarded as a feasible and safe alternative procedure in selected patients with benign disease or thyroid cancer of low risk, facilitating thyroidectomy with respect to conventional endoscopic approach and offering improved cosmetic results. He shows the external video of patient positioning, marking the patient for dissection, and port placement and also the internal surgical video with the daVinci robotic camera. Jan 2, 2025 · The use of transaxillary and transsubclavian approaches for endoscopic thyroidectomy has increased globally. At present, the most used robotic and endoscopic thyroidectomy approaches are minimally invasive video assisted thyroidectomy (MIVAT), bilateral axillo-breast approach endoscopic thyroidectomy Dec 19, 2012 · The areas of dissection of different endoscopic thyroidectomy. 015), although all bleedings but one occurred in the remote-access site from the axilla to the neck. The safety of this new method has been reported in a retrospective study of a single cohort. The present study reviewed the records of patients with papillary thyroid carcinoma (PTC) who underwent robotic thyroidectomy using these 2 systems by the same surgeon, YWC. Feb 15, 2024 · Our objective was to assess the viability and oncological security of a gasless, transaxillary single-incision endoscopic procedure for performing total thyroidectomy and bilateral central neck dissection (TT + BCND). Aug 12, 2021 · Purpose: Conventional thyroidectomy has been standard of care for surgical thyroid nodules. The approach typically uses a gasless method, and a long incision to insert a special retractor. A brief historic review of the advent of robots to the medical and mainly surgical field. Pairwise and network meta-analyses were performed for outcomes and complications of 9 minimally invasive interventions (minimally invasive video-assisted, endoscopic or robotic bilateral axillo-breast approach, endoscopic or robotic postauricular, endoscopic or robot transaxillary approach, transoral endoscopic Mar 18, 2017 · The Da Vinci robotic system (Intuitive Surgical, Sunnyvale, California) was first utilized for transaxillary thyroidectomy by Chung in 2007. With the advent of minimally invasive techniques in thyroid surgery, robot-assisted transaxillary thyroid surgery (RATS) has emerged as one of the most promising The South Korean surgeons published the first paper about transaxillary gasless thyroidectomy, and they suggest surgical indication, outcomes, type of instruments, associated technologies, costs, concluding that this technique is feasible and can be safely performed in selected population [7]. Keywords: History, mini invasive video-assisted thyroidectomy, robotic thyroidectomy, transaxillary approach Download scientific diagram | The areas of dissection of different endoscopic thyroidectomy. From left to right, minimally invasive video-assisted thyroidectomy, transaxillary thyroidectomy, and Mar 26, 2023 · We collected studies from January 2020 to July 2022 in 6 databases. : To evaluate the safety and feasibility of transaxillary robotic thyroidectomy (TART) in Japan by comparing early cases with video-assisted neck surg… : To evaluate the safety and feasibility of transaxillary robotic thyroidectomy (TART) in Japan by comparing early cases with video-assisted neck surg… Our video demonstrates a modified gasless transaxillary endoscopic thyroid surgery with the posterior approach for bilateral low-risk thyroid cancer. Jun 8, 2010 · Transaxillary Excision of the Thyroid and Parathyroids: Thom Lobe, M. There have been a number of advancements in minimally invasive thyroid surgery procedures during the last decade, with the main goal of improving the aesthetic outcome. They have an advantage over the breast approach in that a circumareolar incision is avoided. Dec 10, 2022 · Minimally invasive video-assisted thyroidectomy (MIVAT) was first described in 1999 [10], and it has become a widespread technique for low- and intermediate-risk DTC [11 – 13]. Right gasless transaxillary endoscopic total thyroidectomy (RGTETT) with video: our experience with the posterior approach: Lei’s seven-sinking method Mar 1, 2024 · Minimally invasive video-assisted thyroidectomy (MIVAT), lateral remote-access approaches (robot-assisted trans-axillary approaches), and midlines remote-access approaches (bilateral axilla-breast approach and transoral endoscopic thyroidectomy via vestibular approach) are the most performed minimally invasive approaches. Oct 26, 2023 · Abstract Our video demonstrates a modified gasless transaxillary endoscopic thyroid surgery with the posterior approach for bilateral low-risk thyroid cancer. Jun 1, 2015 · Robot-assisted transaxillary thyroid surgery avoids the need for a neck incision. Careful dissection is perform to identify the recurrent laringeal nerve and parathyroid glands. Dec 1, 2010 · Robotic thyroidectomy using the gasless transaxillary approach is still in its early phases of development and only a few other teams worldwide have adopted this technique [5]. In the past two decades, many new approaches have been developed such as the lateral approach (LA), minimally invasive video-assisted thyroidectomy (MIVAT), and transaxillary approach (TA). In this study, we set out to explore the feasibility of an endoscopic transaxillary approach in performing near total to total thyroidectomy for benign thyroid disease. Pure transoral robotic thyroidectomy; institutional adaptation and early results from a tertiary 115 endocrine surgery centre. In this paper, we provided a detailed introduction to the right gasless transaxillary endoscopic total thyroidectomy surgical procedure for bilateral low-risk thyroid cancer, and briefly summarized the Lei’s seven-sinking method Transaxillary Thyroidectomy Dr Jignesh Ashwin Gandhi 3. However, an adequate angle of visualization with RATT allows for a more thorough central neck dissection. The purpose of this article is In this focused review and commentary, we aim to explore the rationale behind these approaches; describe and discuss some of the more commonly performed remote-access thyroidectomy approaches in the United States today: transaxillary, bilateral axillo-breast, retroauricular or “facelift,” and transoral and also comment on the value, future directions, and best practices for implementation Abstract Background: No studies have compared robot-assisted transaxillary thyroidectomy (RATT) and minimally invasive video-assisted thyroidectomy (MIVAT) regarding cosmetic outcome and satisfaction Nov 5, 2021 · Background This study aims to report the results of a pioneering clinical study using the single-port transaxillary robotic thyroidectomy (START) for 200 patients with thyroid tumor and to introduce our novel two-step retraction method. Oct 16, 2018 · Since its first publication in 1997, minimally invasive video-assisted thyroidectomy (MIVAT) has developed into the predominant minimally invasive surgery of the thyroid. In this paper, we provided a detailed introduction to the right gasless transaxillary endoscopic total Robotic-assisted thyroidectomy using a gasless transaxillary approach is a feasible, safe and noninferior surgical alternative for selected patients. However, studies examining the comparative outcomes of these procedures are scarce. Aug 14, 2024 · Watch this full-length, narrated surgical video of a robotic thyroidectomy performed via the bilateral axillo-breast approach by Dr. Oct 24, 2023 · In a previous study, we proposed a novel anatomy-based five-settlement method for transaxillary endoscopic thyroidectomy (fs-TAT) for patients with papillary thyroid carcinoma. In this report, we detail the technical approach to gasless transaxillary endoscopic thyroidectomy for unilateral low-risk thyroid cancer and highlight operating skills and precautions to perform this procedure ef ficiently without an apparent increased risk of postoperative complications. Knowledge of indications, contraindications, advantages, and disadvantages ensures proper patient selection and optimal shared decision-making. The left lobe is dissected from the trachea. Endoscopic transaxillary thyroidectomy is a common method for remote-access thyroidectomy. Although this approach became widely used in Asian countries, its diffusion in Sep 25, 2023 · We modified the conventional gasless transaxillary thyroidectomy procedure to a transaxillary gas insufflation approach with shorter incisions, and a smaller flap creation area. Female patient, 35 years, BMI &gt;35, with exceptionally large (12 cm) pathological left lobe (STN) with substernal extension. The past decade has witnessed rapid advances in gasless transaxillary endoscopic thyroidectomy (GTET) for thyroid cancer, which has become a reliable procedure with good therapeutic effectiveness, aesthetic benefits, and safety. These PDF | On Oct 1, 2023, Tingting Li and others published Right gasless transaxillary endoscopic total thyroidectomy (RGTETT) with video: our experience with the posterior approach: Lei’s seven The past decade has witnessed rapid advances in gasless transaxillary endoscopic thyroidectomy (GTET) for thyroid cancer, which has become a reliable procedure with good therapeutic effectiveness The indications for transaxillary thyroidectomy should be the same as for conventional surgery. The Jan 10, 2024 · In our multicenter, retrospective observational study, we first compared an endoscopic technique with a robotic one: minimally invasive video-assisted thyroidectomy (MIVAT) and robot-assisted transaxillary thyroidectomy (RATT). Conclusion Single-incision transaxillary robotic thyroidectomy can be technically challenging in North American patients with a larger body frame due to difficulty in optimal placement of all 4 robotic instruments via a single axillary incision. Transoral thyroidectomy is safe and feasible. Controlateral lobe dissection is performed using the same method, identifying and sparing the controlateral laingeal nerve. Improvements in surgical techniques were also reported, and the learning curves of gasless endoscopic TAT were further studied. All 3 cases of temporary vocal cord paresis occurred early in our experience and may have been due to our relative inexperience with this new approach In our multicenter, retrospective observational study, we first compared an endoscopic technique with a robotic one: minimally invasive video-assisted thyroidectomy (MIVAT) and robot-assisted transaxillary thyroidectomy (RATT). However, they require a single long axillary incision to accommodate all Transaxillary vs. Jun 4, 2017 · With technical advancement, thyroid procedures transitioned from conventional to video-assisted thyroidectomy and, lately, to robot-assisted approaches for better cosmetic outcome. 8K From a channel with a health professional licensed in the US Learn more about how experts define health sources 104K views 5 years ago #RoboticSurgery #RoboticThyroidectomy #Thyroidectomy Abstract Single-port (SP) transaxillary robotic thyroidectomy represents a significant innovation in the field of endocrine surgery, offering a minimally invasive approach that combines oncological efficacy with enhanced cosmetic outcomes. It consists of thyroid lobectomy and isthmectomy for moderately large unilateral benign nodules. From left to right, minimally invasive video-assisted thyroidectomy, transaxillary thyroidectomy, and endoscopic thyroidectomy by bilateral axillo-breast approach Minimally invasive video-assisted thyroidectomy, transaxillary, bilateral axillo-breast approach, facelift and transoral approaches are in common use today. From August 2003 to August 2005, we successfully performed endoscopic transaxillary thyroid and parathyroidectomy surgery for unilateral and parathyroid disease in 41 patients. This procedure can be an alternative endoscopic transaxillary method for thyroidectomy. This video is aimed to describe the step-by-step procedure of a case of modified endoscopic transaxillary gas insufflation thyroidectomy (ETGT). The introduction of the SP robotic system has enabled surgeons to perform thyroidectomy and lateral neck dissection through a single axillary incision Supplementary video of an original research "Single-port Access Endoscopic Thyroidectomy via Axillary Approach for the Benign Thyroid Tumor: New Aspects from Background Transaxillary gasless endoscopic thyroidectomy (TGET) is a widely performed operation, but its side view angle and instrument interference have caused concerns for most surgical groups. And finally, an introduction to transaxillary robotic thyroidectomy. in 1996 (1), where the first case of endoscopic parathyroidectomy was reported. The indications for transaxillary thyroidectomy should be the same as for conventional surgery. The introduction of the Da Vinci robotic system marked a turning point, with its first application in transaxillary thyroidectomy by Chung in 2007. Chung and his colleagues have since performed over 5,000 robotic transaxillary thyroidectomy cases demonstrating the safety and feasibility of the robotic procedure for thyroidectomy. Methods We retrospectively analyzed 354 patients who underwent robotic thyroidectomy between January 2019 Robot-assisted transaxillary approaches to thyroidectomy have been well described. All patients had been given a choice between conventional cervicotomy and transaxillary robotic approach. This technique provides outstanding exposure compared to endoscopic or open thyroidectomy procedures. Jun 5, 2024 · Background Gasless transaxillary endoscopic thyroidectomy (GTET) and endoscopic thyroidectomy via the areola approach (ETA) have emerged as minimally invasive surgical techniques for managing papillary thyroid carcinoma (PTC). For cosmetic purposes different minimally invasive and remote-access surgical approaches have been developed. Thyroidectomy is a frequent surgical treatment with a low rate of complications when carried out by well-trained surgical teams. International Journal of Medical Robotics and Computer Assisted Surgery, 2020, 16, 1-8. Only 30% of the studies with neuromonitoring included evaluation of the vagus, and 25% neuromonitored the external branch of the superior laryngeal nerve [22]. This procedure has been widely promoted in some Asian countries; howeve … Shangtong Lei's 17 research works with 146 citations and 620 reads, including: Right gasless transaxillary endoscopic total thyroidectomy (RGTETT) with video: our experience with the posterior The procedure for transaxillary thyroidectomy with the da Vinci S and Xi systems is exactly the same, so we could compare each step of the procedure. A major advantage over conventional thyroid surgery is the superior cosmetic result. In Apr 17, 2023 · In experienced hands, robotic transaxillary thyroidectomy is feasible and safe even in patients with large thyroid nodules or thyroiditis. The surgical imperatives are the same as for conventional surgery, but with differences in terms of patient positioning, surgical incision, equipment, surgical technique and indications. These alternative types of thyroidectomy can be extremely efficient however, the standard cervical incision approach offers a broader inclusion criterion. Five patients experienced temporary recurrent laryngeal nerve signal weakening, post surgery, which resolved after a month. This video shows a 32-year-old woman presenting a 12-mm papillary Dec 9, 2022 · In general, gasless transaxillary endoscopic thyroidectomy (GTET) has advantages in terms of convenience, clarity of vision, and aesthetic incision. 1. This video is age-restricted and only available on YouTube. Methods An exact 1:1 matching analysis was performed to compare the technical safety and oncologic outcomes May 2, 2025 · An RCT provides the best evidence supporting this conclusion, demonstrating that robotic total thyroidectomy with central neck dissection via a bilateral axillary breast approach is not only safe and effective but also offers significant cosmetic advantages. In general, the best candidates are nonobese young patients, with < 3 cm unilateral nodule, and without history of axillary surgery or irradiation who wishes to avoid a neck scar. With the advent of minimally invasive techniques in thyroid surgery, robot-assisted transaxillary thyroid surgery (RATS) has emerged as one of the most promising approaches. These include whole endoscopic procedures with continual gas insufflation, video-assisted gasless Jul 3, 2021 · Robotic transaxillary thyroid surgery is safe and feasible, when performed in a high-volume practice setting. No description has been added to this video. D. Hyunsuk Suh at The Mount Sinai Hospital. In this paper, we provided a detailed introduction to the right gasless transaxillary endoscopic Oct 10, 2023 · Our video demonstrates a modified gasless transaxillary endoscopic thyroid surgery with the posterior approach for bilateral low-risk thyroid cancer. Sep 25, 2023 · Background We conducted this study to report our novel robotic thyroidectomy using gas-insufflation one-step single-port transaxillary (GOSTA) approach and compare it with a conventional transaxillary (CTA) approach using a retraction method for intraoperative and postoperative outcomes. Keywords: Robotic transaxillary thyroidectomy, Robot-assisted surgery, Remote-access thyroidectomy, Thyroidectomy, Thyroid Mar 19, 2017 · The indirect approach is divided into transaxillary and chest/breast incisions. Apr 6, 2025 · From August 2003 to August 2005, we successfully performed endoscopic transaxillary thyroid and parathyroidectomy surgery for unilateral and parathyroid disease in 41 patients. 50 However, an RCT comparing robot-assisted surgery with minimally invasive video Apr 15, 2025 · This study evaluated voice and swallowing outcomes following thyroidectomy by using the gasless transaxillary (GTAA) and transoral (TOA) approaches compared with the conventional transcervical approach (CTA). Methods START was performed on consecutive 200 patients using the da Vinci Single-Port (SP) robot system from January 2019 to September 2020 at the Yonsei Abstract To evaluate the safety and feasibility of transaxillary robotic thyroidectomy (TART) in Japan by comparing early cases with video-assisted neck surgery (VANS). Jun 23, 2025 · The evolution of robotic thyroidectomy began with the first endoscopic thyroidectomy performed in 1997, which paved the way for minimally invasive and remote-access surgical approaches. Jul 17, 2023 · Scarring and neck discomfort after conventional thyroidectomy are two main factors that decrease the patient’s quality of life. If you have a Postsurgical complications after robot-assisted analysis of a large cohort of European patients Updates in Surgery Apr 17, 2023 · Moreover, bleeding resulted associated to thyroid nodule > 3 cm (p = 0. 7th National Conference – ISTS 2025Indian Society of Thyroid Surgeons📅 Day 1 – Saturday, 27th September 📍 HALL : HALSTED🔔 Subscribe for more sessions fro The gasless, transaxillary endoscopic thyroidectomy (GTET) and minimally invasive video-assisted thyroidectomy (VAT) are both well-recognized endoscopic thyroid procedures, but how their postoperative outcomes are compared remains unclear. We evaluated intraoperative features, complications, and cosmetic outcomes in a cohort of 609 patients. The parathyroid glands are identified and preserved (circle indicates an inferior parathyroid gland being carefully separated from the thyroid capsule), along with their blood supply, by Mar 2, 2024 · The robot-assisted transaxillary thyroidectomy (RATT) eliminates the need for insufflation, hence reducing the risks of such CO 2 -related complications that may occur with traditional endoscopic techniques [3]. Before the era of robot, endoscopic remote access thyroidectomy was associated with several technical drawbacks in its implementation (1, 2). The safety and short-term oncological outcome of this method was confirmed by comparing it with conventional open surgery (COT Recent technological advances have led to a rapid progress in endocrine surgery. Pairwise and network meta-analyses were performed for outcomes and complications of 9 minimally invasive interventions (minimally invasive video-assisted, endoscopic or robotic bilateral axillo-breast approach, endoscopic or robotic postauricular, endoscopic or robot transaxillary approach, transoral endoscopic thyroidectomy Objective: To evaluate the safety and feasibility of transaxillary robotic thyroidectomy (TART) in Japan by comparing early cases with video-assisted neck surgery (VANS). In this video we can see minimally invasive approach to thyroid surgery. It is hoped that our improvements in surgical procedures will contribute to the progress and popularization of this approach. However, there have been few studies reporting on the learning curve of robot-assisted transaxillary Gasless transaxillary endoscopic thyroidectomy has been popular among surgeons for its unique advantages. In addition, it is considered only suitable for unilateral Jan 1, 2021 · Transaxillary and retroauricular or “facelift” thyroidectomy are the most commonly performed remote-access procedures in the United States, and with the recent introduction of transoral thyroidectomy, they may be considered “conventional” robotic approaches. Jan 1, 2020 · Robotic and endoscopic transaxillary thyroidectomy procedures are relatively similar, making direct comparisons possible. Jun 1, 2023 · Methods We collected studies from January 2020 to July 2022 in 6 databases. Nov 13, 2024 · The transaxillary approach is primarily used for papillary thyroid microcarcinoma, in addition to expansion to papillary thyroid cancer. Mar 2, 2024 · Discussion Robotic thyroidectomy is a new procedure that has shown early results that are at least similar to standard endoscopic techniques. Feb 1, 2024 · Our results showed that our novel transaxillary thyroidectomy procedure is feasible and safe. Sep 1, 2024 · This study was conducted to evaluate the feasibility and surgical outcomes of minimally invasive video-assisted thyroidectomy (MIVAT) and three remote-access approaches, namely the robotic bilateral axillo-breast approach (BABA-R), endoscopic breast-chest approach (BCA-E), and robotic gasless transaxillary approach (GTAA-R) in lateral neck dissection for papillary thyroid carcinoma, compared Sep 15, 2023 · In this study, a cohort of 200 female patients with a mean age of 36 years underwent the gasless endoscopic thyroidectomy trans axillary approach. Apr 24, 2019 · Abstract Background Robotic thyroidectomy by transaxillary approach (RATS) is regarded as a feasible and safe alternative procedure in selected patients with benign disease or thyroid cancer of low risk, facilitating thyroidectomy with respect to conventional endoscopic approach and offering improved cosmetic results. Jan 7, 2022 · A comparison of postoperative pain after conventional open thyroidectomy and single-incision, gasless, endoscopic transaxillary thyroidectomy: a single institute prospective study. This study focused on patients diagnosed with bilateral papillary thyroid microcarcinoma (PTMC). TART used da Vinci Surgical system (da Vinci) Xi for early cases and Sep 18, 2023 · Gasless robot-assisted transaxillary thyroidectomy, popularized in South Korea, was introduced in order to satisfy the desire to avoid a neck scar in patients scheduled for thyroidectomy. May 27, 2021 · Video 1 Steps of gasless transaxillary endoscopic thyroidectomy for clinical N0 (cN0) unilateral low-risk thyroid cancer. Mar 30, 2024 · However, since the introduction of da Vinci SP in 2018, it has been used in conjunction with conventional RTTS and single-port transaxillary robotic thyroidectomy with a two-step retraction method 23. 07K subscribers Subscribed Aug 23, 2023 · Robot-assisted transaxillary thyroidectomy is widely performed in Asian countries, although it is still under discussion in the Western World. Robotic thyroidectomy employing the gasless transaxillary approach, first published in 2007, may be considered a “scarless” alternative to standard open thyroidectomy for patients with thyroid cancer. Transsubclavian Gasless endoscopic thyroidectomy approaches for papillary thyroid cancer Hongji Wu1,5, Meiyu Zhu1,5, Chi Ma1, Rui Yang2, Yanzhong Gu3, Shujian Wei1, Xincheng Liu1 Jun 9, 2022 · Background We aimed to evaluate the feasibility and oncologic safety of gasless endoscopic transaxillary thyroidectomy (TAT) in patients with thyroid diseases. May 19, 2015 · This video is an informative animated presentation that explains in detail about Robotic Transaxillary Thyroidectomy, a thyroid surgery generally used for removal of thyroid tumour. ydolxn jf2t3s 7eo zn1b14 qi15t s9 q76r q4et 7j5sn qrwnk7qzj