Romanchishen, Anatoly1; Romanchishen, Filipp1; Karpatsky, Igor1; Vabalayte, Kristina1
1 Department of hospital surgery of Saint-Petersburg Pediatric Medical University, Saint-Petersburg Center of Endocrine Surgery and Oncology, Russia
Objectives: The aim of the research was an improvement of TC patients’ surgical treatment results.
Methods: The technique of thyroid gland (TG) resections were developed during 42 autopsies and surgical dissections of 587 TG ligaments, 1717 recurrent laryngeal nerves (RLN), 177 spinal accessory nerves (SAN).
Results: Before entry into a larynx RLN could divided on 2 or more branches (26.7%), crossed by an artery and vein (95.3%). Preventive ligation of crossing vessels provided hemostasis. Zuckerkandl’s tubercle (ZT) was found in 60.0% of anatomical and 73.4% – clinical cases. ZT tumors were found in 12.5%. SAN descended from jugular aperture of skull in front and laterally – in 85.4%, behind – in 12.2% and medially – in 2.4% to internal jugular vein. Further SAN passed along back surface of sternocleidomastoid muscle (SCMM), penetrated (87.8%) or passed adjacent to it (12.2%). Connection of SAN and C3 was revealed in 73.2%. Surgical topography of SAN depend considerably of approaches chosen (by Romanchishen or MacFee). SAN lefts the SCMM at level of middle third in 24.4% and lower – in 61.0%. Clinical use of this knowledge during 6148 operations provided decrease of RLN palsy up to 0.31%, SAN – up to 0.41%.
Conclusion: Precise anatomical technique of RLN, SAN dissection during Thyroidectomy and neck lymphadenectomy ensured the safety of TC patients surgery.