The experience of access application to recurrent laryngeal nerve and parathyroid glands as the way of the postoperative complications prevention in case of video-assisted surgery

Aim. To justify the application of surgical access to thyroid and parathyroid glands by means of videoendoscopic equipment. Methods. 14 video-assisted surgeries on thyroid and parathyroid glands were performed during the period of 2011-2014 using low-invasive midline cervical access by means of videoendoscopic equipment. Results. The surgery was carried out with a skin access of less than 3 cm, the section was made 1.5-2 cm above than jugular notch. Tissue dissection was performed by means of «channel» formation with mobilization of tissues while looking for recurrent laryngeal nerve and parathyroid glands up to allocation of the superior pole of a thyroid gland lobe under the laparoscopic control. In case of parathyroidectomy due to adenoma special attention was paid to presurgical topical diagnostics which included neck organs ultrasound examination with the use of expert class equipment as well as thyroid and parathyroid glands scintigraphy. Intrasurgical ultrasound examination of the area of surgery to specify the pathologically changed parathyroid gland location was performed in some cases. Jugular notch of sternum, lower pole of thyroid gland, lateral surface of trachea, tracheo-oesophageal groove, and inferior thyroid artery were used as reference points for identification of recurrent laryngeal nerve and parathyroid glands while using video equipment. As a rule, the recurrent laryngeal nerve was located behind and below the parathyroid glands. The distance from a skin section to a recurrent laryngeal nerve and lower parathyroid glands was 3.6 and 3.1 cm respectively. Conclusion. Use of video endoscopic equipment allows to reduce traumatic surgeries on neck organs and promotes the better visualization of anatomical structures in an area of surgery.

recurrent laryngeal nerve, midline cervical access, thyroid and parathyroid glands, video-assisted surgery, vizualization