Videoassistirovannye operatsii pri opukholyakh shchitovidnoy zhelezy s biopsiey storozhevogo limfaticheskogo uzla

Abstract

The paper describes the procedure for mini-invasive lateral-access video-assisted resection of the thyroid in its tumors, which has been tested in cadaver experiments. The length of skin incision varied between 2.0 and 3.0 cm, depending on the length and thickness of the neck. There were no problems in imaging the recurrent laryngeal nerve and in exposing the superior and inferior thyroid arteries. The parathyroids were difficult to visualize in some cases. With lateral access, the distance to cervical structures averaged 3.0 and 3.0 cm to the superior and inferior thyroid arteries, respectively; it did 3.5 cm to the recurrent laryngeal nerve. The pretracheal and paratracheal fats, the nearest regional metastasizing areas, could be adequately revised in all cases. Video-assisted resection of the thyroid was clinically used in 135 patients in the treatment of benign and low-grade malignant thyroid tumors (T1-2NxM0). Surgery was performed in 120 women and 15 men; their age was 40.9 years. Preoperative cytological studies revealed papillary/follicular adenoma and low-grade adenocarcinoma (T1-2N0M0) in 92 and 52 patients, respectively. The surgical interventions were hemithyroidectomy with isthmusectomy and subtotal thyroid resection, sentinel lymph node biopsy was made in 18 patients. On the basis of topographic and anatomic studies, the authors have proven the principal possibility of adequate thyroid resection through the mini-invasive lateral access; the latter allows biopsy of the sentinel lymph node of thyroid cancer; hemithyroidectomy with the determination of the sentinel lymph node through a mini-invasive lateral approach reduces operative time and blood loss and does not increase the frequency of postoperative complications, decreases postoperative hospital bed/days to 2-3 days, results in a good cosmetic scar, and does not impair cervical organ function. The indications for mini-invasive lateral-access hemithyroidectomy are adenoma of the thyroid and its low-grade cancer (T1NxM0); the relative indications are female gender and under 60 years of age.