MIVAP is the optimal parathyroidectomy technique

Abstract

Objective. To ground from clinical, topographo-anatomical positions the choice of the most rational techniques of parathyroidectomy in patients with hyperparathyroidism, which permit to reduce the intraoperative injury, to minimize operative complications, persistence and hyperparathyroidism relapse rates, to elevate the quality of life.

Materials and methods. The research had two stages. Topographo-anatomical stage was realized at two levels: 1) on the anatomical material including 15 dead bodies; 2) on the plated end-grain cuttings of the dead bodies’ necks (n = 4). During a clinical stage, the results of examination and treatment of 182 patients with hyperparathyroidism, operated with traditional and different minimally invasive techniques, were studied.

Results. The analysis of short-term results of surgical treatment of hyperparathyroidism patients in the retrospective group allowed determining the starting points for the topographo-anatomical stage of the research. The data received during the topographo-anatomical stage permitted to substantiate the choice of minimally invasive endoscopically-assisted technique for parathyroidectomy as the most rational and safety one. Introduction of the study results into surgical treatment of patients of the prospective group showed the efficiency of MIVAP technique in the form of decrease in the frequency of surgical complications from 12.1 to 6.0 % (all complications are attributed to I and II degree by Clavien-Dindo classification and had transitory character) with the reduction of the time of operative intervention and average duration of hospital treatment after the surgery.

Conclusions. Minimally invasive endoscopically-assisted parathyroidectomy with the lateralization of the lobe of the thyroid gland, preservation of the upper and lower thyroid vessels in conditions of intraoperative neuromonitoring and photodynamic visualization of the parathyroid gland can be considered an optimal surgical technique.

Keywords

anterior cervical anatomy / parathyroid surgical anatomy / parathyroid surgery / hyperparathyroidism / parathyroidectomy / minimally invasive parathyroidectomy

References

[1] Dedov I.I., Mokrysheva N.G., Mirnaya S.S., Rostomyan L.G., Pigarova E.A., Rozhinskaya L.Ya. Epidemiology of primary hyperparathyroidism in Russia (the first results from the database of Federal state institution «Endocrinological Research Centre»). Problems of Endocrinology 2011; 57 (3): 3–10 (in Russian).

[2] Дедов И.И., Мокрышева Н.Г., Мирная С.С., Ростомян Л.Г., Пигарова Е.А., Рожинская Л.Я. Эпидемиология первичного гиперпаратиреоза в России (первые результаты по базе данных ФГУ ЭНЦ). Проблемы эндокринологии 2011; 57 (3): 3–10.

[3] Dedov I.I., Melnichenko G.A., Mokrysheva N.G. Rozhinskaya L.YA., Kusnezov N.S., Pigarova E.A., Voronkova I.A., Lipatenkova A.K., Egshatyan L.V., Mamedova E.O., Krupinova Yu.A. Primary hyperparathyroidism: the clinical picture, diagnostics, differential diagnostics, and methods of treatment. Problems of Endocrinology 2016; 62 (6): 40–77 (in Russian).

[4] Дедов И.И., Мельниченко Г.А., Мокрышева Н.Г., Рожинская Л.Я., Кузнецов Н.С., Пигарова Е.А., Воронкова И.А., Липатенкова А.К., Егшатян Л.В., Мамедова Е.О., Крупинова Ю.А. Первичный гиперпаратиреоз: клиника, диагностика, дифференциальная диагностика, методы лечения. Проблемы эндокринологии 2016; 62 (6): 40–77.

[5] Bilezikian J.P., Brandi M.L., Eastell R., Silverberg S.J., Udelsman R., Marcocci C., Potts J.T., Jr. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab. 2014; 99 (10): 3561–3569.

[6] Bilezikian J.P., Brandi M.L., Eastell R., Silverberg S.J., Udelsman R., Marcocci C., Potts J. T., Jr. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab. 2014; 99 (10): 3561–3569.

[7] Samohvalova N.A., Maistrenko N.A., Romashchenko P.N. Programmed approach to the treatment of secondary hyperparathyroidism in chronic renal disease. Grekov's Bulletin of Surgery 2013; 172 (2): 043–046. (in Russian).

[8] Самохвалова Н.А., Майстренко Н.А., Ромащенко П.Н. Программный подход к лечению вторичного гиперпаратиреоза при хронической болезни почек. Вестник хирургии имении И.И. Грекова 2013; 172 (2): 043–046.

[9] De Leeuw F., Breuskin I., Abbaci M., Casiraghi O., Mirghani H., Ben Lakhdar A., Laplace-Builhé C., Hartl D. Intraoperative near-infrared imaging for parathyroid gland identification by autofluorescence: a feasibility study. World J Surg. 2016; 40 (9): 2131–2138.

[10] Ryan S., Courtney D., Moriariu J. et al. Surgical management of primary hyperparathyroidism. European Archives of Oto-Rhino-Laryngology 2017; 274 (12): 4225–4232.

[11] Ryan S., Courtney D., Moriariu J. et al. Surgical management of primary hyperparathyroidism. European Archives of Oto-Rhino-Laryngology. 2017; 274 (12): 4225–4232.

[12] Romashchenko P.N., Fomin N.F., Maistrenko N.A., Maleev Yu.V., Krivolapov D.S., Pryadko A.S., Vshivtsev D.O., Starchik D.A. Clinical and anatomical rationale of minimally invasive parathyroid surgery. Tavricheskiy Mediko-Biologicheskiy Vestnik 2020; 23 (2): 155–164 (in Russian).

[13] Майстренко Н.А., Довганюк В.С., Фомин Н.Ф., Ромащенко П.Н. Гормонально-неактивные» опухоли надпочечников. СПб.: ЭЛБИ 2001; 171.

[14] Russell J.O., Anuwong A., Dionigi G., Inabnet 3rd W.B., Kim H.Y., Randolph G., Richmon J.D., Tufano R.P. Transoral Thyroid and Parathyroid Surgery Vestibular Approach: A Framework for Assessment and Safe Exploration. Thyroid. 2018; 28 (7): 825–829.

[15] Майстренко Н.А., Фомин Н.Ф., Ромащенко П.Н., Довганюк В.С. Клинико-анатомическое обоснование доступов и техники эндовидеохирургической адреналэктомии. Вестник хирургии им. И.И. Грекова 2002; 161 (3): 21

[16] Ruhle B.C., Bryan A.F., Grogan R.H. Robot-Assisted Endocrine Surgery: Indications and Drawbacks. J Laparoendosc Adv Surg Tech A. 2019; 29 (2): 129–135.

[17] Майстренко Н.А., Чумасов Е.И., Петрова Е.С., Довганюк В.С., Ромащенко П.Н., Прядко А.С., Бойко И.С., Коржевский Д.Э. Особенности патоморфоза хронического панкреатита в обосновании хирургических подходов. Вестник хирургии им. И.И. Грекова 2013; 172 (4): 029–039.

[18] Henry J.F., Iacobone M., Mirallie E., Deveze A., Pili S. Indications and results of video-assisted parathyroidectomy by a lateral approach in patients with primary hyperparathyroidism. Surgery. 2001; 130 (6): 999–1004.

[19] Ромащенко П.Н. Обоснование доступов при эндовидеохирургических вмешательствах на надпочечниках (клинико-анатомическое исследование): автореф. дис. … канд. мед. наук. СПб. 2000: 26.

[20] Miccoli P., Berti P., Conte M., Raffaelli M., Materazzi G. Minimally invasive video-assisted parathyroidectomy: lesson learned from 137 cases. J Am Coll Surg. 2000; 191 (6): 613–618.

[21] Ромащенко П.Н. Современные подходы к диагностике и хирургическому лечению хромаффинных опухолей: автореф. дис. … д-ра мед. наук. СПб. 2007; 39.

[22] Ikeda Y., Takami H., Niimi M., Kan S., Sasaki Y., Takayama J. Endoscopic thyroidectomy by the axillary approach. Surgical Endoscopy 2001; 15 (11): 1362–1364.

[23] Майстренко Н.А., Ромащенко П.Н., Криволапов Д.С. Обоснование минимально-инвазивных оперативных вмешательств на щитовидной железе. Вестник хирургии им. И.И. Грекова 2017; 176 (5): 21–28.

[24] Wilhelm S.M., Wang T.S., Ruan D.T. et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg. 2016; 151 (10): 959–968.

[25] Майстренко Н.А., Ромащенко П.Н., Криволапов Д.С., Пришвин А.П., Михальченко Г.В. Минимальноинвазивная хирургия щитовидной железы. Международный научно-исследовательский журнал 2017; 1–1 (55): 144–151.

[26] Takeuchi S., Shimizu K., Shimizu K. Jr., Akasu H., Okamura R. Identification of pathological and normal parathyroid tissue by fluorescent labeling with 5-aminolevulinic acid during endocrine neck surgery. J Nippon Med Sch. 2014; 81 (2): 84–93.

[27] Майстренко Н.А., Ромащенко П.Н., Криволапов Д.С. Современные подходы к диагностике и хирургическому лечению заболеваний щитовидной железы. Военно-медицинский журнал 2018; 339 (1): 37–46.

[28] Dindo D., Demartines N., Clavien P.A. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery. 2004; 240 (2): 205–213.

[29] Ромащенко П.Н., Фомин Н.Ф., Майстренко Н.А., Малеев Ю.В., Криволапов Д.С., Прядко А.С., Вшивцев Д.О., Старчик Д.А. Клинико-анатомическое обоснование минимально инвазивных хирургических вмешательств на околощитовидных железах. Таврический медико-биологический вестник 2020; 23 (2): 155–164.

[30] Bellantone R., Lombardi C.P., Rubino F., Perilli V., Sollazzi L., Mastroianni G., Gagner M. Arterial PCO2 and cardiovascular function during endoscopic neck surgery with carbon dioxide insufflation. Arch Surg. 2001; 136 (7): 822–827.

[31] Russell J.O., Anuwong A., Dionigi G., Inabnet 3rd W.B., Kim H.Y., Randolph G., Richmon J.D., Tufano R.P. Transoral Thyroid and Parathyroid Surgery Vestibular Approach: A Framework for Assessment and Safe Exploration. Thyroid. 2018; 28 (7): 825–829.

[32] Maleev Yu.V., Romashchenko P.N., Fomin N.F., Chernykh A.V., Krivolapov D.S., Vshivtsev D.O., Golovanov D.N. Simulation model of operational interventions taking into account new neck topographic-anatomical data. Tavricheskiy Mediko-Biologicheskiy Vestnik 2020; 23 (2): 124–132 (in Russian).

[33] Ruhle B.C., Bryan A.F., Grogan R.H. Robot-Assisted Endocrine Surgery: Indications and Drawbacks. J Laparoendosc Adv Surg Tech A. 2019; 29 (2): 129–135.

[34] Romashchenko P.N., Maistrenko N.A., Krivolapov D.S., Vshivtsev D.O. Radio navigation and photodynamic methods for intraoperative visualization of the parathyroid glands (review of literature). Grekov's Bulletin of Surgery 2020; 179 (3): 113–119 (in Russian).

[35] Henry J.F., Iacobone M., Mirallie E., Deveze A., Pili S. Indications and results of video-assisted parathyroidectomy by a lateral approach in patients with primary hyperparathyroidism. Surgery. 2001; 130 (6): 999–1004.

[36] Romashchenko P.N., Maistrenko N.A., Krivolapov D.S., Vshivtsev D.O. New standard of evidence and safety in the parathyroid surgery. Grekov's Bulletin of Surgery 2020; 179 (1): 58–62 (in Russian).

[37] Miccoli P., Berti P., Conte M., Raffaelli M., Materazzi G. Minimally invasive video-assisted parathyroidectomy: lesson learned from 137 cases. J Am Coll Surg. 2000; 191 (6): 613–618.

[38] Romashchenko P.N., Maistrenko N.A., Vshivtsev D.O., Krivolapov D.S., Pryadko A.S. Safety in parathyroid surgery: innovation in diagnostic and minimally invasive operations. Bulletin of the Russian Military Medical Academy 2021.23 (3): 29–34 (in Russian).

[39] Ikeda Y., Takami H., Niimi M., Kan S., Sasaki Y., Takayama J. Endoscopic thyroidectomy by the axillary approach. Surgical Endoscopy. 2001; 15 (11): 1362–1364.

[40] Wilhelm S.M., Wang T.S., Ruan D.T. et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg. 2016; 151 (10): 959–968.

[41] Takeuchi S., Shimizu K., Shimizu K. Jr., Akasu H., Okamura R. Identification of pathological and normal parathyroid tissue by fluorescent labeling with 5aminolevulinic acid during endocrine neck surgery. J Nippon Med Sch. 2014; 81 (2): 84–93.

[42] Takeuchi S., Shimizu K., Shimizu K. Jr., Akasu H., Okamura R. Identification of pathological and normal parathyroid tissue by fluorescent labeling with 5-aminolevulinic acid during endocrine neck surgery. J Nippon Med Sch. 2014; 81 (2): 84–93.

[43] Dindo D., Demartines N., Clavien P.A. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery. 2004; 240 (2): 205–213.

[44] Bellantone R., Lombardi C.P., Rubino F., Perilli V., Sollazzi L., Mastroianni G., Gagner M. Arterial PCO2 and cardiovascular function during endoscopic neck surgery with carbon dioxide insufflation. Arch Surg. 2001; 136 (7): 822–827.

[45] Maleev Yu.V., Romashchenko P.N., Fomin N.F., Chernyh A.V., Krivolapov D.S., Vshivcev D.O., Golovanov D.N. Simulyacionnaya model' operativnyh vmeshatel'stv s uchetom novyh topografoanatomicheskih dannyh shei. Tavricheskij medikobiologicheskij vestnik 2020; 23 (2): 124–132.

[46] Малеев Ю.В., Ромащенко П.Н., Фомин Н.Ф., Черных А.В., Криволапов Д.С., Вшивцев Д.О., Голованов Д.Н. Симуляционная модель оперативных вмешательств с учетом новых топографо-анатомических данных шеи. Таврический медико-биологический вестник 2020; 23 (2): 124–132.

[47] Chernyh A.V., Maleev YU.V., Cherednikov E.F., SHevcov A.N., Golovanov D.N. Novye dannye po hirurgicheskoj anatomii okoloshchitovidnyh zhelez. Novosti hirurgii 2016; 24 (1): 26–31.

[48] Черных А.В., Малеев Ю.В., Чередников Е.Ф., Шевцов А.Н., Голованов Д.Н. Новые данные по хирургической анатомии околощитовидных желез. Новости хирургии 2016; 24 (1): 26–31.

[49] Chernyh A.V., Maleev Yu.V. Klinikomorfologicheskie aspekty topograficheskoj anatomii zadnej poverhnosti shchitovidnoj zhelezy. Vestnik eksperimental'noj i klinicheskoj hirurgii 2010; 3 (3): 201–206.

[50] Черных А.В., Малеев Ю.В. Клинико-морфологические аспекты топографической анатомии задней поверхности щитовидной железы. Вестник экспериментальной и клинической хирургии 2010; 3 (3): 201–206

[51] Romashchenko P.N., Majstrenko N.A., Krivolapov D.S., Vshivcev D.O. Radionavigacionnye i fotodinamicheskie metodiki intraoperacionnoj vizualizacii okoloshchitovidnyh zhelez (obzor literatury). Vestnik hirurgii imenii I. I. Grekova 2020; 179 (3): 113–119.

[52] Ромащенко П.Н., Майстренко Н.А., Криволапов Д.С., Вшивцев Д.О. Радионавигационные и фотодинамические методики интраоперационной визуализации околощитовидных желез (обзор литературы). Вестник хирургии имении И.И. Грекова 2020; 179 (3): 113–119.

[53] Romashchenko P.N., Majstrenko N.A., Krivolapov D.S., Vshivcev D.O. Novyj uroven' dokazatel'nosti i bezopasnosti v hirurgii okoloshchitovidnyh zhelez. Vestnik hirurgii imenii I.I. Grekova 2020; 179 (1): 58–62.

[54] Ромащенко П.Н., Майстренко Н.А., Криволапов Д.С., Вшивцев Д.О. Новый уровень доказательности и безопасности в хирургии околощитовидных желез. Вестник хирургии имении И.И. Грекова 2020; 179 (1): 58–62.

[55] Romashchenko P.N., Majstrenko N.A., Vshivcev D.O., Krivolapov D.S., Pryadko A.S. Bezopasnost' v hirurgii okoloshchitovidnyh zhelez. Innovacii diagnostiki i minimal'no invazivnyh operacij. Vestnik Rossijskoj Voennomedicinskoj akademii 2021; 23 (3): 29–34.

[56] Ромащенко П.Н., Майстренко Н.А., Вшивцев Д.О., Криволапов Д.С., Прядко А.С. Безопасность в хирургии околощитовидных желез. Инновации диагностики и минимально инвазивных операций. Вестник Российской Военно-медицинской академии 2021; 23 (3): 29–34.

RIGHTS & PERMISSIONS

Eco-Vector