Surgical aspects of topographic and anatomical changes in the neck after hemithyroidectomy

Abstract

Objective. To develop the optimal surgical techniques for repeated interventions on the thyroid gland, taking into account topographic and anatomical changes in the neck after a previous hemithyroidectomy.

Materials and methods. The results of repeated surgical treatment of 69 patients (divided into two groups) with various pathologies of the thyroid gland were analyzed. Patients of the main group (39 person) underwent magnetic resonance imaging of the soft tissues of the neck before the surgery. In the comparison group (30 person), reintervention in the volume of thyroidectomy was performed in the classical way without tomography.

Results. Based on magnetic resonance imaging of the soft tissues of the neck, the topographic anatomy of its anterior section in patients after hemithyroidectomy was studied. Two types of disposition of organs and structures were revealed: anterior lateral and posterior medial. The first type is characterized by an anterior displacement of the esophagus to the posterior surface of the lateral lobe of the thyroid gland and the neurovascular bundle. In the second type, a tight contact between the thyroid gland and the short muscles of the neck and displacement of the carotid artery and jugular vein posteriorly and medially was detected. Surgical techniques for repeated surgical intervention have been adjusted for each type of disposition.

Conclusions. The proposed techniques made it possible to minimize the length of surgical access, the duration of intervention, the severity of pain syndrome, as well as the number of intra- and postoperative complications.

Keywords

topographic anatomy / thyroid gland / thyroidectomy / hemithyroidectomy / recurrence / displacement / magnetic resonance imaging

References

[1] Kukhtenko Yu. V., Shulutko A.M., Semikov V.I., Kosivtsov O.A., Mikhin I.V., Ryaskov L.A. The structure of thyroid diseases in patients of different age groups. Vestnik Volgogradskogo gosudarstvennogo medicinskogo universiteta 2016; 3 (59): 130–136 (in Russian).

[2] Кухтенко Ю.В., Шулутко А.М., Семиков В.И., Косивцов О.А., Михин И.В., Рясков Л.А. Структура заболеваний щитовидной железы у пациентов различных возрастных групп. Вестник Волгоградского государственного медицинского университета 2016; 3 (59): 130–136.

[3] Romanchishen A.F., Gostimsky A.V., Akinchev A.L., Karpatsky I.V., Matveeva Z.S., Vabalaite K.V. Oncological risk of recurrent goiter. Golova i sheya = Head and neck. Russian Journal 2019; 7 (2): 12–17 (in Russian).

[4] Романчишен А.Ф., Гостимский А.В., Акинчев А.Л., Карпатский И.В., Матвеева З.С., Вабалайте К.В. Онкологическая опасность рецидивного зоба. Голова и шея = Head and neck. Russian Journal 2019; 7 (2): 12–17.

[5] Indian J., Atul M.B., Pradheep K. Role of Total Thyroidectomy in Painful (Symptomatic) Hashimoto's Thyroiditis: Descriptive Study. Otolaryngology. Head and Neck Surgery 2021; 73 (3): 296–303 (in Russian).

[6] Indian J., Atul M.B., Pradheep K. Role of Total Thyroidectomy in Painful (Symptomatic) Hashimoto's Thyroiditis: Descriptive Study. Otolaryngology. Head and Neck Surgery 2021; 73 (3): 296–303.

[7] Sitges-Serra A., Lorente-Poch L., Sancho J. Parathyroid autotransplantation in thyroid surgery. Langenbecks Archive of Surgery 2018; 403 (3): 309–315 (in Russian).

[8] Sitges-Serra, A., Lorente-Poch L., Sancho J. Parathyroid autotransplantation in thyroid surgery. Langenbecks Archive of Surgery 2018; 403 (3): 309–315.

[9] Styazhkina S.N., Chernyadeva E.V., Chernysheva T.E., Kazakova I.A., Tikhomirova G.I., Kolbina T.V., Nabiullina Z.R. Analysis of the development of recurrence during operations on the thyroid gland. Modern Science 2021; 11 (2): 66–68 (in Russian).

[10] Стяжкина С.Н., Чернядева Е.В., Чернышева Т.Е., Казакова И.А., Тихомирова Г.И., Колбина Т.В., Набиуллина З.Р. Анализ развития рецидива при операциях на щитовидной железе. Modern Science 2021; 11 (2): 66–68.

[11] Maleev Yu.V., Chernykh A.V. Rationale for surgical interventions in the anterior region of the neck based on new topographic and anatomical data. Ukrainskij zhurnal e`ksperimental`noj mediciny` imeni O. Mozhaeva 2014; 14 (3): 20–24 (in Russian).

[12] Малеев Ю.В., Черных А.В. Обоснование оперативных вмешательств в передней области шеи на основе новых топографо-анатомических данных. Украинский журнал экспериментальной медицины имени О. Можаева 2014; 14 (3): 20–24.

[13] Gerasimov G.A. Sad statistics. Klinicheskaya i e`ksperimental`naya tireoidologiya 2015; 11 (4): 6–12 (in Russian).

[14] Герасимов Г.А. Печальная статистика. Клиническая и экспериментальная тиреоидология 2015; 11 (4): 6–12.

[15] Makarov I.V., Galkin R.A., Shpigel A.S., Lebedeva E.A., Akhmataliev T. Kh., Romanov R.M. Surgical tactics in the treatment of patients with thyroid diseases. Aspirantskij vestnik Povolzh`ya 2017; 1–2: 113–117 (in Russian).

[16] Макаров И.В., Галкин Р.А., Шпигель А.С., Лебедева Е.А., Ахматалиев Т.Х., Романов Р.М. Хирургическая тактика лечения больных с заболеваниями щитовидной железы. Аспирантский вестник Поволжья 2017; 1–2: 113–117.

[17] Zhirnova S.N. Lyashchenko O.M. Abramzon Patent A method for preoperative planning of reoperations on the thyroid gland. Patent RF № 2733321, 2019; 3 (in Russian).

[18] Жирнова А.С., Лященко С.Н., Абрамзон О.М. Пат. RU2733321 Российская Федерация, МПКA61B17/00. Способ предоперационного планирования повторных операций на щитовидной железе: заявл. 7.10.2019: опубл. 1.10.2020. Заявитель и патентообладатель федеральное государственное бюджетное образовательное учреждение высшего образования «Оренбургский государственный медицинский университет» Министерства здравоохранения Российской Федерации. 3 с.

[19] Naja H., Tresallet C. Role of frozen section in the surgical management of indeterminate thyroid nodules. Gland Surgery 2019; 8 (2): 112–117 (in Russian).

[20] Naja H., Tresallet C. Role of frozen section in the surgical management of indeterminate thyroid nodules. Gland Surgery 2019; 8 (2): 112–117.

[21] Mikhailichenko V.Yu., Kerimov E.Ya., Butyrsky A.G., Kerimov E.E., Trofimov P.S., Samarin S.A. Reoperations for thyroid cancer. Tavricheskij mediko-biologicheskij vestnik 2021; 24 (22): 180–185 (in Russian).

[22] Михайличенко В.Ю., Керимов Э.Я., Бутырский А.Г., Керимов Э.Э., Трофимов П.С., Самарин С.А. Повторные операции при раке щитовидной железы. Таврический медико-биологический вестник 2021; 24 (22): 180–185.

[23] Osechkin I.A., Malenko K.Yu. Statistics of complications after thyroidectomy in thyroid diseases. Aktual`ny`e problemy` teoreticheskoj i prakticheskoj mediciny` 2020; 2: 224–225 (in Russian).

[24] Осечкин И.А., Мальенко К.Ю. Статистика осложнений после тиреоидэктомии при заболеваниях щитовидной железы. Актуальные проблемы теоретической и практической медицины 2020; 2: 224–225.

[25] Roman B.R., Randolph G.W., Kamani D. Conventional Thyroidectomy in the Treatment of Primary Thyroid Cancer. Endocrinology and Metabolism Clinics of North America 2019; 48 (1): 125–141 (in Russian).

[26] Roman B.R., Randolph G.W., Kamani D. Conventional Thyroidectomy in the Treatment of Primary Thyroid Cancer. Endocrinology and Metabolism Clinics of North America 2019; 48 (1): 125–141.

[27] Duboshina T.B., Askerov M.R. Ways to improve the quality of life of surgical patients with thyroid pathology. Vestnik xirurgii imeni I.I. Grekova 2015; 180 (1): 50–52 (in Russian).

[28] Дубошина Т.Б., Аскеров М.Р. Пути улучшения качества жизни хирургических больных с патологией щитовидной железы. Вестник хирургии имени И.И. Грекова 2015; 180 (1): 50–52.

[29] Voskanyan S.E., Naydenov E.V., Korsakov I.N., Bazhanova Yu.A. Clinical efficacy of water jet dissection in thyroid surgery (immediate results; quality of life of patients). Saratovskij nauchno-medicinskij zhurnal 2015; 11 (4): 663–667 (in Russian).

[30] Восканян С.Э., Найденов Е.В., Корсаков И.Н., Бажанова Ю.А. Клиническая эффективность применения водоструйной диссекции при операциях на щитовидной железе (непосредственные результаты; качество жизни больных). Саратовский научно-медицинский журнал 2015; 11 (4): 663–667.

[31] Romanchishen A.F., Gostimsky A.V., Karpatsky I.V. Surgical anatomy of the capsule and fascial sheath of the thyroid gland. Medicina: teoriya i praktika 2017; 2 (4): 10–18 (in Russian).

[32] Романчишен А.Ф., Гостимский А.В., Карпатский И.В. Хирургическая анатомия капсулы и фасциального влагалища щитовидной железы. Медицина: теория и практика 2017; 2 (4): 10–18.

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