КЛИНИКО-АНАТОМИЧЕСКОЕ ОБОСНОВАНИЕ МИНИМАЛЬНО ИНВАЗИВНЫХ ХИРУРГИЧЕСКИХ ВМЕШАТЕЛЬСТВ НА ОКОЛОЩИТОВИДНЫХ ЖЕЛЕЗАХ

Abstract

The information presented in the literature on the use of minimally invasive interventions in the treatment of hyperparathyroidism is not fully justified by topographical and anatomical studies and does not take into account individual features of the location and syntopia of the parathyroid glands, which requires additional scientific research. Purpose of the study: based on the topographical and anatomical features of the structure of the anterior neck region, determine the most rational methods of minimally invasive interventions on the parathyroid glands, evaluate their clinical effectiveness and justify their use in the implementation of a treatment and diagnostic algorithm in patients with hyperparathyroidism. Material and methods: The design of the study consisted of two stages – anatomical and clinical. Anatomical stage is performed on 2 levels: 1) on anatomical material, which included 15 human cadavers; 2) on plastinated cross-cuts of the neck (n=3) of human cadavers. During the clinical stage, the results of examination and treatment of 53 patients with hyperparathyroidism, who underwent surgery using three methods: Сonventional (n=18/34%); Minimally Invasive Video Assisted Parathyroidectomy (n=32/60%) and Transoral Endoscopic Parathyroidectomy Vestibular Approach (n=3/6%). Results: at the anatomical stage, the validity and safety of minimally invasive video-assisted Parathyroidectomy was proved. The use of this access in clinical practice as an alternative to the traditional one has shown its effectiveness in reducing the frequency of specific postoperative complications from 16.7% to 6.3% with an acceptable increase in the duration of surgery from 42.8±15.7 to 64.4±23.5 minutes and maintaining the average duration of inpatient treatment after surgery at the level of 3.4±0.6 days. Conclusion: minimally invasive video-assisted parathyroidectomy can be considered the operation of choice in the treatment of patients with hyperparathyroidism. The use of this technique with the implementation of lateralization of the thyroid lobe, the preservation of the upper and lower thyroid vessels, as well as the use of intraoperative neuromonitoring and Identification of pathological and normal parathyroid tissue by fluorescent labeling with 5-aminolevulinic acid can improve the results of surgical treatment, reduce the number of postoperative complications, the frequency of persistence and relapse of the disease, and improve the quality of life of patients.