Endocrine Abstracts

Twenty years of experience (4, 573 operations) of performing medial access and thyroid mobilization according to the Nikolaev’s method is presented. The operation is preceded by an ultrasound performed by a surgeon. Changes have been made to the primary technique: subcutaneous veins and short neck muscles do not intersect. The secretion of the thyroid gland begins from the trachea with traction of the thyroid gland to the lateral side. Ligation of large vessels begins at the lower pole, while the parathyroid glands are visualized and separated. With subsequent cranial traction of the thyroid gland, it is possible to move away from the esophagus (left) and recurrent nerves with a visual assessment. Vascular ligation at the upper pole is performed last after visualization of the upper parathyroid glands. Twenty years of experience in using this technique (medial thyroidectomy) suggests that it is effective and radical (for thyroid tumors). At the same time, it is possible to preserve thyroid tissue in the upper pole during a benign process. Complications (1.2%) arising during surgery are associated with an incorrect choice of access (including size), excessive traction of the thyroid lobe during its mobilization, and irrational use of electrocoagulation. The technique of the operation allows the use of neuromonitoring, however, the visualization of the nerve by the surgeon is performed at the second stage (cranial traction), in which the nerve should be maximally removed from the manipulation zone, which is achieved due to surgical technique. The technique of medial access has proven itself positively in giant goiter (up to 2000 grams) and large toxic goiter (more than 200 grams). The frequency of complications after surgery: dysphonia–2.1%, bleeding in the early postoperative period–0.3%, hypocalcemia–2.2%. In 93% of patients, dysphonia and hypocalcemia were transient (stopped within 6-12 months)