THE ROLE OF ENDOSCOPIC INTERVENTIONS IN THE THYROID AND PARATHYROID SURGERY

Nowadays, in the thyroid surgery a great experience of using different variants of minimally invasive approaches, including endovideosurgical and da Vinci surgical robotic technologies. However, there are still no approved recommendations (protocols) for the application of these approaches; indications and contraindications remain the subject of debate and rely on the experience of the individual authors. Based on the indicated positions the purpose of our study was to determine the criteria for selecting patients with surgical diseases of the thyroid and parathyroid glands for the reasonable implementation of optimal minimally invasive surgical interventions. The article analyzes the results of a comprehensive medical examination and treatment of 417 patients with surgical diseases of the thyroid and parathyroid glands, who were operated by using various minimally invasive procedures. The medical examination of patients was conducted under international protocols and management guidelines. The patients were divided into four groups based on the nature of the minimally invasive techniques used: the 1st (n = 151) includes the patients, who underwent minimally invasive nonendoscopic thyroidectomy; the 2nd (n = 141) - is a minimally invasive video-assisted thyroidectomy; the 3rd (n = 110) - is an endoscopic thyroidectomy with the use of axillo-bilateral-breast approach; the 4th (n = 15) - is a transoral endoscopic thyroidectomy vestibular approach. It was stated that the main criteria that determine the rationale for minimally invasive interventions on the thyroid gland are: the nodule size and the thyroid volume; hyperfunctioning thyroid and clinical thyroiditis; substernal extension; extrathyroid extension and the necessity of implementation of central neck dissection due to central and laterocervical lymph node metastases. The application of the determined criteria based on the integrated use of modern diagnostic techniques for patients with surgical diseases of the thyroid and parathyroid glands can justify the selection of optimal surgical interventions, avoid unreasonable operations, to avoid increasing of the frequency of specific complications, reduces surgical trauma and duration of stay in hospital, improves cosmetic outcome and enhances the quality of life of the patients.

thyroid gland, parathyroid glands, thyroid diseases, thyroid surgery, minimally invasive surgery, endoscopic thyroidectomy, videoassisted thyroidectomy