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.