Вестник хирургии имени И.И. Грекова (Dec 2021)
Topographic, anatomical and clinical rationale of the optimal minimally invasive technique of parathyroidectomy
Abstract
Introduction. 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.Objective.Based on the topographical and anatomical features of the structure of the anterior neck region, we determined the most rational methods of minimally invasive interventions on the parathyroid glands and evaluated their clinical effectiveness in patients with hyperparathyroidism.Methods and materials. The design of the study consisted of two stages – topographical and anatomical, and clinical. Topographical and anatomical stage was performed on 2 levels: 1) on anatomical material, which included 15 human cadavers; 2) on plastinated cross sections of the neck (n=44) of human cadavers. During the clinical stage, we studied 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. During the topographical and 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 conventional 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 superior and inferior 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.
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