BACKGROUND: Despite the intensive development of safe thyroid surgery technologies, it has not yet been possible to achieve a significant reduction in the level of specific complications. One of the possible reasons is the method of the conventional surgical operation especially possible traction during thyroid tissue rotation on the way to n.reccurence. In 2022, group of authors led by I.V. Sleptsov proposed a new technique for Tention-Free Thyroidectomy (TFT), which demonstrated a significant reduction in the level of specific complications.AIM: To conduct a pilot study to assess the reproducibility, efficacy and safety of TFT in the work of the endocrine surgery department of Pavlov First St. Petersburg State Medical University.MATERIALS AND METHODS: The study was conducted at the Department of Endocrine Surgery in the period from January to April 2022. Patients with surgical thyroid disease underwent a new proposed TFT intervention. The method is fully consistent with the author’s description in patent No. 2772015, and the surgeons performing the new surgical technique underwent an internship with the authors of TFT before the initiation of the study. The study is prospective, non-randomized, uncontrolled. Persistent laryngeal dysfunction and persistent hypoparathyroidism were considered the primary endpoint. Secondary endpoints were transient vocal cord paresis, hypocalcemia and hypoparathyroidism.RESULTS: The study included 20 people. The indications for surgery were endocrinological and oncological. The number of performed hemithyroidectomies were 15, thyroidectomy (TE) — 5 (one with central lymph node dissection), the volume of the thyroid gland varied from 4 cm3 to 280 cm3 . None of the patients reached the primary endpoint. There were no permanent dysfunction of the larynx in our study. Only in one patient in the postoperative period, a violation of the mobility of the vocal fold was revealed, however, during follow up on the 30th day of the postoperative period the mobility of the vocal fold was restored (confirmed by direct laryngoscopy). Hypoparathyroidism and hypocalcemia were not detected. However, it is necessary to mention the number of TE was too small.CONCLUSION: Thus, the new proposed TFT method is fully reproducible in the work of a specialized department of endocrine surgery. The method has demonstrated high rates of efficiency and safety in real clinical practice. However, further studies with a higher evidence base are required.

Primary hyperparathyroidism (PH) is one of the most common diseases of the endocrine system that requires surgical treatment. The most common cause of PH is parathyroid adenoma, which occurs in 8590% of cases, in 510% multiple adenomas or hyperplasia of several or all parathyroid glands. Surgical treatment is the only radical and effective method of treating PH, however, the variability of the anatomy of the parathyroid glands, the possibility of their ectopic location, as well as the close connection with the thyroid gland, in some cases, complicate the intraoperative verification of the parathyroid adenoma. All this can lead to inadequate volumes with parathyroidectomy. In this article, the presented clinical case demonstrates how the complexity of intraoperative verification of the parathyroid glands during parathyroidectomy led to intra-abdominal life-threatening complications acute duodenal ulcer with subsequent perforation and acute cholecystitis against the background of persistent hypercalcemia and perioperative stress. Also, on the example of this case, surgical tactics are demonstrated, taking into account the pathogenesis of abdominal complications.

The definition of a sentinel lymph node is a technique that appeared at the middle of the 20th century. For a number of malignant neoplasms, the definition of a sentinel lymph node is standard procedure, but for highly differentiated thyroid cancer, the data is conflicting. The role of prophylactic central compartment lymph node dissection in the clinical N0 stage is not established. Sentinel lymph node detection seems to be the possible way to reduce the risk of persistence and recurrence of highly differentiated thyroid cancer.

OBJECTIVE. The aim of the study is to analyze the results of practical application of endovideosurgical transaxillary access in thyroid surgery. MATERIAL AND METHODS. We performed the retrospective comparative analysis of the results of surgical treatment of thyroid diseases using traditional, Miccoli’s endovideo-assisted access, endovideosurgical transaxillary access. RESULTS. With the use of endovideosurgical transaxillary access, the best cosmetic result is achieved – the absence of a scar on the neck. The number of specific complications in the samples is not significantly different, nonspecific complications are not accompanied with functional disorders. CONCLUSION. The expediency of improving the endovideosurgical thyroid surgery from remote accesses showed demand ability and safety of the technique. The important condition for their application is the possibility of performing an operative intervention in a proper manner.

Backgraund. Papillary thyroid cancer (PTC) has a favorable course and low mortality rates. However, the incidence of morbidity and mortality continues to increase, especially in the high-risk group. BRAF mutation is a marker of the PTC aggressive course. Aims. Тo study the relationship between surgical treatment tactics and the BRAF positive PTC prognosis. Materials and methods. Our prospective study included 80 patients with BRAF positive PTC, operated from 2009 to 2016 y. Surgical tactics were determined by existing clinical guidelines. To the patients with BRAF positive thyroid cancer it is proposed to perform thyroidectomy with central compartment lymph node dissection. BRAF status was determined by the PCR method in fine needle aspiration biopsy material (FNAB). Results. Recurrence was detected in 7 of the 18 patients of the hemi/thyroidectomy group. Among 62 patients from the group of thyroidectomy with central compartment lymph node dissection recurrence was detected only in 3 cases. The mean recurrence time also differed significantly, and in the group of patients with (hemi)thyroidectomy without central compartment lymph node dissection is detected earlier (53 months and 59.61 months). Also, organ-preserving operations without central compartment lymph node dissection in BRAF positive tumor has worse result, regardless of T stage. Conclusions. In the presence of BRAF-positive PTC thyroidectomy with central compartment lymph node dissection is indicated.

Backgraund. Papillary thyroid cancer (PTC) has a favorable course and low mortality rates. However, the incidence of morbidity and mortality continues to increase, especially in the high-risk group. BRAF mutation is a marker of the PTC aggressive course. Aims. Тo study the relationship between surgical treatment tactics and the BRAF positive PTC prognosis. Materials and methods. Our prospective study included 80 patients with BRAF positive PTC, operated from 2009 to 2016 y. Surgical tactics were determined by existing clinical guidelines. To the patients with BRAF positive thyroid cancer it is proposed to perform thyroidectomy with central compartment lymph node dissection. BRAF status was determined by the PCR method in fine needle aspiration biopsy material (FNAB). Results. Recurrence was detected in 7 of the 18 patients of the hemi/thyroidectomy group. Among 62 patients from the group of thyroidectomy with central compartment lymph node dissection recurrence was detected only in 3 cases. The mean recurrence time also differed significantly, and in the group of patients with (hemi)thyroidectomy without central compartment lymph node dissection is detected earlier (53 months and 59.61 months). Also, organ-preserving operations without central compartment lymph node dissection in BRAF positive tumor has worse result, regardless of T stage. Conclusions. In the presence of BRAF-positive PTC thyroidectomy with central compartment lymph node dissection is indicated.

OBJECTIVE. The aim of the study is to analyze the results of practical application of endovideosurgical transaxillary access in thyroid surgery. MATERIAL AND METHODS. We performed the retrospective comparative analysis of the results of surgical treatment of thyroid diseases using traditional, Miccoli’s endovideo-assisted access, endovideosurgical transaxillary access. RESULTS. With the use of endovideosurgical transaxillary access, the best cosmetic result is achieved – the absence of a scar on the neck. The number of specific complications in the samples is not significantly different, nonspecific complications are not accompanied with functional disorders. CONCLUSION. The expediency of improving the endovideosurgical thyroid surgery from remote accesses showed demand ability and safety of the technique. The important condition for their application is the possibility of performing an operative intervention in a proper manner.

OBJECTIVE. Analysis of GLUT1 levels as a prognostic marker for highly differentiated thyroid carcinoma.MATERIAL AND METHODS. The expression levels of GLUT-1, NIS, thyroglobulin and the presence of BRAF mutation were analyzed in 32 patients with highly differentiated thyroid cancer from the Department of Surgical Endocrinology at the Research Institute for Surgery and Emergency Medicine of “Pavlov First Saint Petersburg State Medical University”.RESULTS. There was a trend to increased levels of GLUT-1 in patients with regional or intra-organ metastases or peripheral invasion. This suggests that increased expression of GLUT-1 is found in proliferatively active cells. In our study, the expression level of GLUT-1 was independent of the level of NIS, thyroglobulin and the presence of BRAF mutation. Thus, the level of expression of GLUT-1 can be considered as an independent factor of the prognosis of the course of highly differentiated thyroid carcinoma.CONCLUSION. The level of expression of GLUT-1 could potentially be used as a prognostic marker in highly differentiated thyroid cancer.

A possibility of detection of BRAF mutation has been studied by means of polymerase chain reaction in punctate from the thyroid node with the aim of diagnostics of high-differentiated cancer on pre-operative stage. A study includes 94 patients with nodal lesions of the thyroid. According to cytological investigation of material, received by fine-needle aspiration biopsy, papillary thyroid cancer was revealed in 47 patients, follicular tumor-in 35 and nodal colloid goiter in 12 patients. In case of papillary thyroid cancer data of genetic analysis showed the following indices of sensitivity, specificity and diagnostic accuracy: 86%, 100% and 92% correspondingly. Detection of BRAF mutation could be used in pre-operative differential diagnostics of high-differentiated cancer and benign nodal lesions of the thyroid.

To assess the utility of combined detection BRAF gene mutation and Gal-3 expression from FNAB specimens in preoperative diagnostic of thyroid gland cancer. 41 patients with thyroid gland nodules were included in the study. By cytological conclusions of evaluated FNA specimens 20 patients had papillar thyroid cancer (PTC), 17 – follicular neoplasia, and 4 – nodular colloid goiter. Gal-3 expression were evaluated by flow cytometry method; BRAF gene mutation were evaluated by PCR. In our study the sensitivity of combined detection BRAF gene mutation and Gal-3 expression was 95%, specificity – 95%, diagnostic accuracy – 95%. Combined detection of BRAF gene mutation by PCR and Gal-3 expression by flow cytometry could be used in preoperative diagnostic of thyroid glad cancer.

To assess the utility of combined detection BRAF gene mutation and Gal-3 expression from FNAB specimens in preoperative diagnostic of thyroid gland cancer. 41 patients with thyroid gland nodules were included in the study. By cytological conclusions of evaluated FNA specimens 20 patients had papillar thyroid cancer (PTC), 17 – follicular neoplasia, and 4 – nodular colloid goiter. Gal-3 expression were evaluated by flow cytometry method; BRAF gene mutation were evaluated by PCR. In our study the sensitivity of combined detection BRAF gene mutation and Gal-3 expression was 95%, specificity – 95%, diagnostic accuracy – 95%. Combined detection of BRAF gene mutation by PCR and Gal-3 expression by flow cytometry could be used in preoperative diagnostic of thyroid glad cancer.

Galectin-3 expression in fine-needle aspiration biopsies from 66 patients with thyroid Nodes (TN) was studied by flow fluorocytometry (FFC). Cytological study revealed 29 patients with papillary thyroid cancer, 31 with follicular tumour, and 6 with colloid nodular goiter. Galectin-3 expression was documented in 27 of the 29 patients with preoperative diagnosis of papillary cancer; in 25 (92.6%) of these cases diagnosis of highly differentiated cancer was confirmed histologically, the remaining 2 (7.4%) cases presented with benign thyroid disease. Two (6.9%) patients without galectin-3 expression had papillary cancer. In the group of patients with cytologically verified diagnosis of follicular tumour, galectin-3 expresion occurred in 2 with highly differentiated (papillary and follicular) thyroid cancer and in 2 with follicular and oncocytic thyroid adenoma. The remaining 27 patients with benign neoplasms did not show expression of galectin-3. Nor was it detected in 6 (100%) patients with colloid nodular goiter. Sensitivity of flow fluorocytometry for detection of galectin-3 expression in thyroid node aspirates was estimated at 93.1%, specificity 89.2%, diagnostic precision 90.9%. It is concluded that this method may be used as an additional tool for preoperative diagnosis of high-differentiated thyroid cancer.

Purpose: To assess the utility of BRAFV600E mutation detection in preoperative thyroid cancer diagnostic. Material and methods: We studied 46 aspirates taken by FNA from patients with thyroid gland nodes. Thyroid tissue aspirates DNA was extracted by sorbent method. BRAF gene mutation was analyzed with primers specific for wild and mutant gen type by RT-PCR. Results: All patients were divided into three groups by cytological conclusions: colloid nodules (9), PTC (19), and suspicious for malignancy (18). In the group of patients with PTC all diagnoses were confirmed by histology, and BRAF gene mutation was detected in 15 (79%) FNAB specimens. In the group with suspicious cytological diagnosis only one patient had follicular cancer by histology and positive BRAF mutation. There were detected no BRAF mutation in 16 patients with histologically proven follicular adenoma, in 9 patients with colloid nodular goiter and in one patient with follicular cancer. Thereby, we received the following criteria valuers of method’s reliability: sensitivity – 76%, specificity – 100%, diagnostic accuracy – 89%. Conclusions: Detection of the BRAFV600E mutation may be a useful adjunct marker for preoperative diagnostic of thyroid gland cancer.

Purpose: To assess the utility of BRAFV600E mutation detection in preoperative thyroid cancer diagnostic. Material and methods: We studied 46 aspirates taken by FNA from patients with thyroid gland nodes. Thyroid tissue aspirates DNA was extracted by sorbent method. BRAF gene mutation was analyzed with primers specific for wild and mutant gen type by RT-PCR. Results: All patients were divided into three groups by cytological conclusions: colloid nodules (9), PTC (19), and suspicious for malignancy (18). In the group of patients with PTC all diagnoses were confirmed by histology, and BRAF gene mutation was detected in 15 (79%) FNAB specimens. In the group with suspicious cytological diagnosis only one patient had follicular cancer by histology and positive BRAF mutation. There were detected no BRAF mutation in 16 patients with histologically proven follicular adenoma, in 9 patients with colloid nodular goiter and in one patient with follicular cancer. Thereby, we received the following criteria valuers of method’s reliability: sensitivity – 76%, specificity – 100%, diagnostic accuracy – 89%. Conclusions: Detection of the BRAFV600E mutation may be a useful adjunct marker for preoperative diagnostic of thyroid gland cancer.