METHOD OF PREOPERATIVE PLANNING OF REPEATED OPERATIONS ON THYROID Russian patent published in 2020 - IPC A61B17/00 A61B6/02 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery of thyroid gland, and can be used for selection of technique of repeated operation on thyroid on the basis of type of disposition of neck organs after hemithyroidectomy. Preoperative magnetic resonance imaging (MRI) of soft tissues of neck and repeated operation on thyroid are performed. Results of the magnetic resonance imaging of the soft tissues of the neck are used to determine the type of neck organs following hemithyroidectomy: 1) anterolateral displacement - displacement of oesophagus to posterior surface of lateral lobe, neurovascular bundle - along lateral surface of lobe anterior, and 2) posteromedial displacement - tight thrust of thyroid to short neck muscles, with disposition of vascular bundles behind and medial, oesophagus retains its location. In anterolateral displacement, the portion is separated from the lateral surface of the trachea. Exact topography of the lower thyroid artery is determined and taken on a holder. Median portion is shifted to locate the recurrent laryngeal nerve, preserving blood supply and localizing parathyroid glands. By controlling the nerve stroke, the lower pole is separated and ligatured, which is cut off closer to the pancreas capsule and the midline of the neck. Further, the upper pole is separated and ligatured; then, the portion is pulled medially and upwards and the lateral surface of the lobe is mobilized to form a space under the Zuckergan tubercle to visualize the oesophagus and the recurrent laryngeal nerve to the point of its entry into the trachea. Vascular-neural bundle is plainly shifted to the lateral angle of the wound and a portion is removed. With posteromedial displacement, the portion is mobilized along the lateral surface and dislocated in the wound, shifting in the medial direction. Shield-tracheal ligament is visualized and a trajectory of a recurrent laryngeal nerve is traced to a lower pole. Before localization of the laryngeal nerve, the upper thyroid artery is separated and bandaged with mobilization of the upper pole, the share is dislocated upwards and its extirpation is performed.

EFFECT: method provides reduced time of surgical intervention, reduced probability of iatrogenic complications ensured by selection of tactics of gland operation on the basis of neck disposition after hemithyroidectomy.

1 cl, 2 ex, 10 dwg