BACKGROUND
The increasing number of patients with primary hyperparathyroidism together with the improvement of the quality of preoperative topical diagnosis leads to an increase in the number of operations and active introduction of various minimally invasive techniques in parathyroid surgery. However, their undifferentiated application contributes to the unjustified increase of operative time and occurrence of complications uncharacteristic for parathyroidectomy. All this requires topographic-anatomical justification of the choice of optimal minimally invasive access to the parathyroid glands.
OBJECTIVE
On the basis of the peculiarities of the topographic-anatomical structure of the anterior neck region to substantiate the choice of the optimal technique of minimally invasive surgery on the thyroid gland and to analyze its clinical efficacy.
MATERIAL AND METHODS
The study was carried out in two stages: clinical and topographic-anatomical. The anatomical stage consisted of two sections: layer-by-layer dissection of the anterior neck region of human cadavers (n=15) and study of plastinated neck dissections (n=44) of human cadavers. The clinical stage was based on the results of examination and surgical treatment of 179 patients with primary hyperparathyroidism, divided into retrospective (n=97) and prospective (n=82) groups.
RESULTS
The analysis of the results of the study allowed us to justify the choice of MIVAP technique with “lateralization” of thyroid lobe without thyroid vessels crossing as an optimal minimally invasive parathyroid surgery from anatomic positions. Its application in a prospective group of patients allowed to reduce the number of bilateral neck revisions from 57.7% to 6.1% (p<0.05), to decrease the operative time from 77.0±37.4 minutes to 37.5±13.2 minutes, the frequency of specific complications — from 12.4% to 6.1% (p<0.05), and disease persistence — from 8.3% to 2.4% (p<0.05).
CONCLUSION
Thus, as a result of the conducted anatomical and clinical study it has been established that endoscopic-assisted parathyroidectomy according to MIVAP technique with “lateralization” of the thyroid lobe without crossing the upper and lower thyroid vessels is the optimal effective and safe minimally invasive operation on the thyroid gland.
