Novosti
Khirurgii

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Year 2021 Vol. 29 No 3

EXCHANGE OF EXPERIENCE

S.E. GRYAZNOV 1, G.G. MELKONYAN 1, 3, A.M. SHULUTKO 2, V.I. SEMIKOV 2, E.G. OSMANOV 2, E.G. GANDYBINA 2

TRANSORAL THYROIDECTOMY AND PARATHYROIDECTOMY: SERIES OF CASES

City Clinical Hospital No4, Moscow Health Department 1,
Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University) 2,
Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation3, Moscow
The Russian Federation

Objective. To present the results of the author’s own series of transoral operations in patients with pathology of the thyroid and parathyroid glands.
Methods. Transoral surgery was performed in women (n=20) and man (n=1). All patients were operated on for the primary disease and met the selection criteria based on ultrasound and cytological examinations, hormonal levels, and somatic status. Indications for surgery were: nodular goiter in 17 cases, diffuse toxic goiter – in 2 cases, parathyroid adenoma – in 2 cases. The surgical technique included a three-port approach in the lower fornix of the vestibule of the mouth and a gas technique for maintaining the working cavity. Standard laparoscopic instruments and an energy based ultrasonic device were used for the operation. In the postoperative period, patients underwent a test for subjective assessment of the aesthetic result of the operation using the survey of the dermatology life quality index.
Results. Thyroidectomy was performed in 4 patients, hemithyroidectomy – in 15 patients and parathyroidectomy – in 2 patients. In one patient, transoralparathyroidectomy was performed as a part of a simultaneous operation for multiple endocrine neoplasia type 1 syndrome. Papillary cancer T1N0M0 was verified in two patients after surgery. The mean operation time was 196.1 min (range 110 – 300 min). Average blood loss – 39.5 ml (range 10 – 300 ml). The nineth operation required the conversion due to severe bleeding. In one case, the temporary recurrent laryngeal nerve (RLN) injury was reported, in one case – hematoma. After surgery, the median and average values of the dermatology life quality index were 1 (IQR 0-4) and 2.05, respectively, which indicates an insignificant effect on the quality of life.
Conclusion. Transoral endoscopic surgery on the thyroid and parathyroid glands would be the promising optimal choice in patients to avoid scarring on the neck.

Keywords: transoral thyroidectomy, transoral parathyroidectomy, Dermatology Life Quality Index, endoscopic thyroidectomy, transoral neck surgery, natural orifice surgery
p. 382-392 of the original issue
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Address for correspondence:
115093, Russian Federation,
Moscow, Pavlovskaya Str., 25,
City Clinical Hospital No 4,
Moscow Health Department
tel.: +7 916 299-26-88,
e-mail: gryzli_37@mail.ru
Gryaznov Sergey E.
Information about the authors:
Gryaznov Sergey E., PhD, Surgeon, City Clinical Hospital No4, Moscow Health Department, Moscow, Russian Federation.
https://orcid.org/0000-0003-2074-4130
Melkonyan Georgiy G., MD, Professor of the Surgery Departmentr, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation , Head physician, City Clinical Hospital No4, Moscow Health Department, Moscow, Russian Federation.
https://orcid.org/0000-0001-7234-4185
Shulutko Alexandr M., MD, Professor of the Surgery Department No2, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation.
https://orcid.org/0000-0002-8001-1601
Semikov Vasily I., MD, Professor of the Surgery Department No2, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation.
https://orcid.org/0000-0002-3844-1632
Osmanov Elkhan G., MD, Professor of the Surgery Department No2, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation.
https://orcid.org/0000-0003-1451-1015
Gandybina Elena G., PhD, Associate Professor of the Surgery Department No245, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation.
https://orcid.org/0000-0002-6765-5154
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