endosergЭндокринная хирургияEndocrine Surgery2306-35132310-3965Типография «Печатных дел Мастер»10.14341/serg9637endoserg-9637Research ArticleКлиническая практикаClinical practiceКлинико-анатомические особенности кровоснабжения околощитовидных желез: серия наблюдений на аутопсийном материалеClinical and anatomical features of blood supply of parathyroid glands: autopsy case serieshttps://orcid.org/0000-0001-8757-3415МалюгаВиктор ЮрьевичMalyugaViktor Y.

д.м.н., заместитель главного врача по медицинской части

MD, PhD

malugav70@mail.ruhttps://orcid.org/0000-0001-5810-2999КупринАлександр АлександровичKuprinAleksandr A.

к.м.н.

MD, PhD

fishbig04@mail.ru<p>ГБУЗ МО &ldquo;Щелковская районная больница №2&rdquo;</p>Россия<p>District City Hospital №2</p>Russian Federation<p>ГБУЗ &ldquo;Городская клиническая больница им. А.К. Ерамишанцева Департамента здравоохранения города Москвы&rdquo;</p>Россия<p>A.K. Eramishanzeva City Clinical Hospital</p>Russian Federation2018180720181214054Copyright &#x00A9; Малюга В.Ю., Куприн А.А., 20182018Малюга В.Ю., Куприн А.А.Malyuga V.Y., Kuprin A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surg-endojournals.ru/jour/article/view/9637

Гипопаратиреоз является самым частым осложнением после оперативных вмешательств на щитовидной железе. Всеми исследователями подтверждается тот факт, что основной причиной гипопаратиреоза является нарушение кровоснабжения околощитовидных желез, а также их повреждение или даже случайное удаление во время операции. Анализируя литературу, собственный опыт, мы пришли к выводу о необходимости подробного изучения типов кровоснабжения околощитовидных желез с целью предупреждения данного осложнения. Нами выполнено 46 односторонних микродиссекций и рентгенангиографических исследований артериального русла на 23 органокомплексах шеи. Выявлены 42 верхние и 43 нижние околощитовидные железы. Установлено, что основным питающим сосудом околощитовидных желез является нижняя щитовидная артерия (I тип). Связь околощитовидных желез с нижней щитовидной артерией была выявлена в 71,8% случаев. Смешанный вариант кровоснабжения (одновременно от верхней и нижней щитовидных артерий) был выявлен в 14,1% случаев (II тип). Только 10,6% желез изолированно получали питание от верхней щитовидной артерии (III тип). В 8,7% случаев в препаратах отсутствовала нижняя щитовидная артерия. В 3,5% случаев достоверно связи нижних околощитовидных желез с щитовидными артериями не выявлено. Вероятно, их питание осуществлялось за счет мелких коллатералей из окружающих органов (VI тип).

Hypoparathyroidism is the most common complication after surgery on the thyroid gland. All authors confirm the fact that the main cause of hypoparathyroidism is a violation of the blood supply of parathyroid glands, as well as their damage or even accidental removal during surgery. Having analyzed the real cases, and based on our own experience, we came to the conclusion that in order to prevent complications, we will need to study the types of blood supply of the parathyroid glands in details. To this end, we have performed 46 unilateral microdissections and X-ray angiography studies of the arterial supply at 23 organocomplexes of the neck. 42 upper and 43 lower parathyroid glands were detected. It has been established that the main feeding vessel of parathyroid glands is the inferior thyroid artery (type I). The association of glands with the inferior thyroid artery was revealed in 71.8% of cases. A mixed variant of blood supply (simultaneously from the superior and inferior thyroid arteries) was revealed in 14.1% cases (type II). Only 10.6% of the gland were fed isolated from the superior thyroid artery (type III). In addition, in 8.7% cases in the preparations there was no inferior thyroid artery. In 3.5% cases, the connections of the lower parathyroid glands with the thyroid arteries were not reliably detected. Most probably, their feeding was provided at the expense of small collaterals from surrounding organs (type VI).

гипопаратиреозкровоснабжение околощитовидных железпрофилактика послеоперационного гипопаратиреозаhypoparathyroidismblood supply of parathyroid glandsprevention of postoperative hypoparathyroidismReferencesHalsted WS, Evans HM. The parathyroid glandules. Their blood supply, and their preservation in operation upon the thyroid gland. Ann Surg. 1907;46(4):489-506. doi: 10.1097/00000658-190710000-00001.Halsted WS, Evans HM. The parathyroid glandules. Their blood supply, and their preservation in operation upon the thyroid gland. Ann Surg. 1907;46(4):489-506. doi: 10.1097/00000658-190710000-00001.Song CM, Jung JH, Ji YB, et al. Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy. World J Surg Oncol. 2014;12:200. doi: 10.1186/1477-7819-12-200.Song CM, Jung JH, Ji YB, et al. Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy. World J Surg Oncol. 2014;12:200. doi: 10.1186/1477-7819-12-200.Wang YH, Bhandari A, Yang F, et al. Risk factors for hypocalcemia and hypoparathyroidism following thyroidectomy: a retrospective Chinese population study. Cancer Manag Res. 2017;9:627-635. doi: 10.2147/CMAR.S148090.Wang YH, Bhandari A, Yang F, et al. Risk factors for hypocalcemia and hypoparathyroidism following thyroidectomy: a retrospective Chinese population study. Cancer Manag Res. 2017;9:627-635. doi: 10.2147/CMAR.S148090.Нурутдинов Р.М. Профилактика и лечение осложнений при операциях на щитовидной железе: Дис. … канд. мед. наук. – М.; 2010. [Nurutdinov RM. Profilaktika i lechenie oslozhneniy pri operatsiyakh na shchitovidnoy zheleze. [dissertation] Moscow; 2010. (In Russ.)]Нурутдинов Р.М. Профилактика и лечение осложнений при операциях на щитовидной железе: Дис. … канд. мед. наук. – М.; 2010. [Nurutdinov RM. Profilaktika i lechenie oslozhneniy pri operatsiyakh na shchitovidnoy zheleze. [dissertation] Moscow; 2010. (In Russ.)]Dolapci M, Doganay M, Reis E, Kama NA. Truncal ligation of the inferior thyroid arteries does not affect the incidence of hypocalcaemia after thyroidectomy. Eur J Surg. 2000;166(4):286-288. doi: 10.1080/110241500750009096.Dolapci M, Doganay M, Reis E, Kama NA. Truncal ligation of the inferior thyroid arteries does not affect the incidence of hypocalcaemia after thyroidectomy. Eur J Surg. 2000;166(4):286-288. doi: 10.1080/110241500750009096.Zhu J, Tian W, Xu Z, et al. Expert consensus statement on parathyroid protection in thyroidectomy. Ann Transl Med. 2015;3(16):230. doi: 10.3978/j.issn.2305-5839.2015.08.20.Zhu J, Tian W, Xu Z, et al. Expert consensus statement on parathyroid protection in thyroidectomy. Ann Transl Med. 2015;3(16):230. doi: 10.3978/j.issn.2305-5839.2015.08.20.Kolly A, Sarathi V, Bothra S, et al. Hypocalcemia: What a surgeon should know. World Journal of Endocrine Surgery. 2017;9(2):72-77. doi: 10.5005/jp-journals-10002-1215.Kolly A, Sarathi V, Bothra S, et al. Hypocalcemia: What a surgeon should know. World Journal of Endocrine Surgery. 2017;9(2):72-77. doi: 10.5005/jp-journals-10002-1215.Abou-Amra M, Abdel-Rahman YO. Effect of bilateral truncal inferior thyroid artery ligation on parathyroid function. AAMJ. 2011;9(2).Abou-Amra M, Abdel-Rahman YO. Effect of bilateral truncal inferior thyroid artery ligation on parathyroid function. AAMJ. 2011;9(2).Maralcan G, Başkonuş I, Borazan E, et al. The effects of inferior thyroid arteries ligation type on post-thyroidectomy clinical hypocalcemia in nontoxic multinodular goiter. Endokrinolojide Diyalog. 2010;7(4):137-140.Maralcan G, Başkonuş I, Borazan E, et al. The effects of inferior thyroid arteries ligation type on post-thyroidectomy clinical hypocalcemia in nontoxic multinodular goiter. Endokrinolojide Diyalog. 2010;7(4):137-140.Iqbal M, Parveen S. Recurrent laryngeal nerve palsy and hypocalcemia with and without bilateral ligation of inferior thyroid artery in total thyroidectomy. J Surg Pakistan (International). 2015;20(1):19-22.Iqbal M, Parveen S. Recurrent laryngeal nerve palsy and hypocalcemia with and without bilateral ligation of inferior thyroid artery in total thyroidectomy. J Surg Pakistan (International). 2015;20(1):19-22.Araujo Filho VJFd, Silva Filho GBe, Brandão LG, et al. The importance of the ligation of the inferior thyroid artery in parathyroid function after subtotal thyroidectomy. Rev Hosp Clin Fac Med Sao Paulo. 2000;55(4):113-120. doi: 10.1590/s0041-87812000000400002.Araujo Filho VJFd, Silva Filho GBe, Brandão LG, et al. The importance of the ligation of the inferior thyroid artery in parathyroid function after subtotal thyroidectomy. Rev Hosp Clin Fac Med Sao Paulo. 2000;55(4):113-120. doi: 10.1590/s0041-87812000000400002.Singh H, Kumar V. Hypocalcemia in thyroid surgery: a prospective study. Int J Sci Study. 2017;4(12):8-11. doi: 10.17354/ijss/2017/86.Singh H, Kumar V. Hypocalcemia in thyroid surgery: a prospective study. Int J Sci Study. 2017;4(12):8-11. doi: 10.17354/ijss/2017/86.Thomusch O, Machens A, Sekulla C, et al. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery. 2003;133(2):180-185. doi: 10.1067/msy.2003.61.Thomusch O, Machens A, Sekulla C, et al. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery. 2003;133(2):180-185. doi: 10.1067/msy.2003.61.Wu J, Harrison B. Hypocalcemia after thyroidectomy: the need for improved definitions. World J Endocrine Surg. 2010;2(1):17-20.Wu J, Harrison B. Hypocalcemia after thyroidectomy: the need for improved definitions. World J Endocrine Surg. 2010;2(1):17-20.Chaudhary IA, Afridi Z, Samiullah, et al. To ligate or not the inferior thyroid artery to avoid hypocalcaemia after thyroid surgery. J Ayub Med Coll Abbottabad. 2007;19(2):19-22.Chaudhary IA, Afridi Z, Samiullah, et al. To ligate or not the inferior thyroid artery to avoid hypocalcaemia after thyroid surgery. J Ayub Med Coll Abbottabad. 2007;19(2):19-22.Dogru O, Kama NA, Sakrak O, et al. The effect of plasma calcium and phosphorus levels on the ligation of inferior thyroid artery. Turk J Surg. 1992;8(4):271-276.Dogru O, Kama NA, Sakrak O, et al. The effect of plasma calcium and phosphorus levels on the ligation of inferior thyroid artery. Turk J Surg. 1992;8(4):271-276.Naseem N, Mengal MZ, Maqbool HMA. Comparison of frequency of clinical tetany between truncal ligation and peripheral ligation of inferior thyroid arteries in subtotal thyroidectomy. PJMHS. 2015;9(1):151-153.Naseem N, Mengal MZ, Maqbool HMA. Comparison of frequency of clinical tetany between truncal ligation and peripheral ligation of inferior thyroid arteries in subtotal thyroidectomy. PJMHS. 2015;9(1):151-153.Кузнецов Н.С., Симакина О.В., Ким И.В. Предикторы послеоперационного гипопаратиреоза после тиреоидэктомии и методы его лечения. // Клиническая и экспериментальная тиреоидология. – 2012. – Т. 8. – №2. – С. 20–30. [Kuznetsov NS, Simakina OV, Kim IV.Predictors of postoperative hypoparathyroidism after thyroidectomy and methods of treatment. Clinical and experimental thyroidology. 2012;8(2):20-30. (In Russ.)] doi: 10.14341/ket20128220-30.Кузнецов Н.С., Симакина О.В., Ким И.В. Предикторы послеоперационного гипопаратиреоза после тиреоидэктомии и методы его лечения. // Клиническая и экспериментальная тиреоидология. – 2012. – Т. 8. – №2. – С. 20–30. [Kuznetsov NS, Simakina OV, Kim IV.Predictors of postoperative hypoparathyroidism after thyroidectomy and methods of treatment. Clinical and experimental thyroidology. 2012;8(2):20-30. (In Russ.)] doi: 10.14341/ket20128220-30.Бельцевич Д.Г., Ванушко В.Э., Румянцев П.О., и др. Российские клинические рекомендации по диагностике и лечению высокодифференцированного рака щитовидной железы у взрослых, 2017 год. // Эндокринная хирургия. – 2017. – Т. 11. – №1. – С. 6–27. [BeltsevichDG, Vanushko VE, Rumyantsev PO, et al. 2017 Russian clinical practice guidelines for differentiated thyroid cancer diagnosis and treatment. Endocrine Surgery. 2017;11(1):6-27. (In Russ.)] doi: 10.14341/serg201716-27.Бельцевич Д.Г., Ванушко В.Э., Румянцев П.О., и др. Российские клинические рекомендации по диагностике и лечению высокодифференцированного рака щитовидной железы у взрослых, 2017 год. // Эндокринная хирургия. – 2017. – Т. 11. – №1. – С. 6–27. [BeltsevichDG, Vanushko VE, Rumyantsev PO, et al. 2017 Russian clinical practice guidelines for differentiated thyroid cancer diagnosis and treatment. Endocrine Surgery. 2017;11(1):6-27. (In Russ.)] doi: 10.14341/serg201716-27.Wang JB, Wu K, Shi LH, et al. In situ preservation of the inferior parathyroid gland during central neck dissection for papillary thyroid carcinoma. Br J Surg. 2017;104(11):1514-1522. doi: 10.1002/bjs.10581.Wang JB, Wu K, Shi LH, et al. In situ preservation of the inferior parathyroid gland during central neck dissection for papillary thyroid carcinoma. Br J Surg. 2017;104(11):1514-1522. doi: 10.1002/bjs.10581.Malik V, Watson GJ, Phua CQ, Murthy P. Fluctuation of corrected serum calcium levels following partial and total thyroidectomy. Int J Clin Med. 2011;02(04):411-417. doi: 10.4236/ijcm.2011.24069.Malik V, Watson GJ, Phua CQ, Murthy P. Fluctuation of corrected serum calcium levels following partial and total thyroidectomy. Int J Clin Med. 2011;02(04):411-417. doi: 10.4236/ijcm.2011.24069.Cakmakli S, Aydintug S, Erdem E. Post-thyroidectomy hypocalcemia: does arterial ligation play a significant role? Int Surg. 1992;77(4):284-286.Cakmakli S, Aydintug S, Erdem E. Post-thyroidectomy hypocalcemia: does arterial ligation play a significant role? Int Surg. 1992;77(4):284-286.Wade JSH, Goodall P, Dauncey TM, Fourman P. The course of partial parathyroid insufficiency after thyroidectomy. Br J Surg. 1965;52(7):497-503. doi: 10.1002/bjs.1800520705.Wade JSH, Goodall P, Dauncey TM, Fourman P. The course of partial parathyroid insufficiency after thyroidectomy. Br J Surg. 1965;52(7):497-503. doi: 10.1002/bjs.1800520705.Nies C, Sitter H, Zielke A, et al. Parathyroid function following ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy. Br J Surg. 1994;81(12):1757-1759. doi: 10.1002/bjs.1800811215.Nies C, Sitter H, Zielke A, et al. Parathyroid function following ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy. Br J Surg. 1994;81(12):1757-1759. doi: 10.1002/bjs.1800811215.Canbeyli B, Karaoğlan M, Özenen B, et al. The role of ligation of inferior thyroid artery on hypocalcemia in thyroidectomies. J Tepecik Hosp Turkey. 1991;1(2):115-118.Canbeyli B, Karaoğlan M, Özenen B, et al. The role of ligation of inferior thyroid artery on hypocalcemia in thyroidectomies. J Tepecik Hosp Turkey. 1991;1(2):115-118.Sut S, Kurt N, Yildirim M, et al. Is the parathyroid function effected by ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy? Turk J Surg. 1996;12(4): 293-298.Sut S, Kurt N, Yildirim M, et al. Is the parathyroid function effected by ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy? Turk J Surg. 1996;12(4): 293-298.Kebsch A, Settmacher U, Lesser T. Bilateral truncal ligation of the inferior thyroid artery during bilateral subtotal thyroidectomy causes a decrease in parathormone without clinically manifest hypoparathyroidism: a randomized clinical trial. Eur Surg Res. 2015;55(3):141-150. doi: 10.1159/000437094.Kebsch A, Settmacher U, Lesser T. Bilateral truncal ligation of the inferior thyroid artery during bilateral subtotal thyroidectomy causes a decrease in parathormone without clinically manifest hypoparathyroidism: a randomized clinical trial. Eur Surg Res. 2015;55(3):141-150. doi: 10.1159/000437094.Cocchiara G, Cajozzo M, Amato G, et al. Terminal ligature of inferior thyroid artery branches during total thyroidectomy for multinodular goiter is associated with higher postoperative calcium and PTH levels. J Visc Surg. 2010;147(5):e329-332. doi: 10.1016/j.jviscsurg.2010.08.020.Cocchiara G, Cajozzo M, Amato G, et al. Terminal ligature of inferior thyroid artery branches during total thyroidectomy for multinodular goiter is associated with higher postoperative calcium and PTH levels. J Visc Surg. 2010;147(5):e329-332. doi: 10.1016/j.jviscsurg.2010.08.020.Kosinski B. Evaluation of the effect of ligation of the inferior thyroid arteries during non-radical thyroidectomy in simple goiter on selected parameters of calcium-phosphate metabolism in the body. Ann Acad Med Stetin. 1991;37:179-190.Kosinski B. Evaluation of the effect of ligation of the inferior thyroid arteries during non-radical thyroidectomy in simple goiter on selected parameters of calcium-phosphate metabolism in the body. Ann Acad Med Stetin. 1991;37:179-190.Li ZD, Liu HW, Dong HL, Li SC. Preservation of parathyroid glands and their functions during total thyroidectomy. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2010;45(11):899-903.Li ZD, Liu HW, Dong HL, Li SC. Preservation of parathyroid glands and their functions during total thyroidectomy. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2010;45(11):899-903.Kapre M. Preservation of the parathyroids in thyroid surgery. World Articles in Ear, Nose and Throat. 2009;2(1).Kapre M. Preservation of the parathyroids in thyroid surgery. World Articles in Ear, Nose and Throat. 2009;2(1).Nobori M, Saiki S, Tanaka N, et al. Blood supply of the parathyroid gland from the superior thyroid artery. Surgery. 1994;115(4):417-423.Nobori M, Saiki S, Tanaka N, et al. Blood supply of the parathyroid gland from the superior thyroid artery. Surgery. 1994;115(4):417-423.Лысенков Н.К., Бушкович В.И., Привес М.Г. Учебник нормальной анатомии человека. – М: Медгиз; 1958. [Lysenkov NK, Bushkovich VI, Prives MG. Uchebnik normal&apos;noy anatomii cheloveka. Moscow: Medgiz; 1958. (In Russ.)]Лысенков Н.К., Бушкович В.И., Привес М.Г. Учебник нормальной анатомии человека. – М: Медгиз; 1958. [Lysenkov NK, Bushkovich VI, Prives MG. Uchebnik normal&apos;noy anatomii cheloveka. Moscow: Medgiz; 1958. (In Russ.)]Zhao W, Gao B-L, Yi G-F, et al. Thyroid arterial embolization for the treatment of hyperthyroidism in a patient with thyrotoxic crisis. Clin Invest Med. 2009;32(1):78. doi: 10.25011/cim.v32i1.5091.Zhao W, Gao B-L, Yi G-F, et al. Thyroid arterial embolization for the treatment of hyperthyroidism in a patient with thyrotoxic crisis. Clin Invest Med. 2009;32(1):78. doi: 10.25011/cim.v32i1.5091.Johansson K, Ander S, Lennquist S, Smeds S. Human parathyroid blood supply determined by laser-Doppler flowmetry. World J Surg. 1994;18(3):417-420. doi: 10.1007/bf00316825.Johansson K, Ander S, Lennquist S, Smeds S. Human parathyroid blood supply determined by laser-Doppler flowmetry. World J Surg. 1994;18(3):417-420. doi: 10.1007/bf00316825.Testini M, Gurrado A, Lissidini G, Nacchiero M. Hypoparathyroidism after total thyroidectomy. Minerva Chir. 2007;62(5):409-415.Testini M, Gurrado A, Lissidini G, Nacchiero M. Hypoparathyroidism after total thyroidectomy. Minerva Chir. 2007;62(5):409-415.Sciume C, Geraci G, Pisello F, et al. Complications in thyroid surgery: symptomatic post-operative hypoparathyroidism incidence, surgical technique, and treatment. Ann Ital Chir. 2006;77(2):115-122.Sciume C, Geraci G, Pisello F, et al. Complications in thyroid surgery: symptomatic post-operative hypoparathyroidism incidence, surgical technique, and treatment. Ann Ital Chir. 2006;77(2):115-122.Ander S, Johansson K, Smeds S. Blood supply and parathyroid hormone secretion in pathological parathyroid glands. World J Surg. 2014;20(5):598-602. doi: 10.1007/pl00012250.Ander S, Johansson K, Smeds S. Blood supply and parathyroid hormone secretion in pathological parathyroid glands. World J Surg. 2014;20(5):598-602. doi: 10.1007/pl00012250.Ander S, Johansson K, Smeds S. In situ preservation of the parathyroid glands during operations on the thyroid. Eur J Surg. 1997;163(1):33-37.Ander S, Johansson K, Smeds S. In situ preservation of the parathyroid glands during operations on the thyroid. Eur J Surg. 1997;163(1):33-37.Randolph GW. Surg Thyroid Parathyroid Glands. 2nd ed. Philadelphia: Elsevier Saunders; 2012.Randolph GW. Surg Thyroid Parathyroid Glands. 2nd ed. Philadelphia: Elsevier Saunders; 2012.Arrangoiz R, Cordera F, Caba D, et al. Parathyroid embryology, anatomy, and pathophysiology of primary hyperparathyroidism. Int J Otorhinolaryngol Head Neck Surg. 2017;06(04):39-58. doi: 10.4236/ijohns.2017.6400.Arrangoiz R, Cordera F, Caba D, et al. Parathyroid embryology, anatomy, and pathophysiology of primary hyperparathyroidism. Int J Otorhinolaryngol Head Neck Surg. 2017;06(04):39-58. doi: 10.4236/ijohns.2017.6400.Delattre JF, Flament JB, Palot JP, Pluot M. Variations in the parathyroid glands. Number, situation and arterial vascularization. Anatomical study and surgical application. J Chir (Paris). 1982;119(11):633-641.Delattre JF, Flament JB, Palot JP, Pluot M. Variations in the parathyroid glands. Number, situation and arterial vascularization. Anatomical study and surgical application. J Chir (Paris). 1982;119(11):633-641.Emedicine.medscape.com [Internet]. Kochhar A, Patel AA. Gest TR, editors. Parathyroid Gland Anatomy [updated 2013 Sep 17; cited 2018 Jun 25]. Available from: https://emedicine.medscape.com/article/1949105-overview#showall.Emedicine.medscape.com [Internet]. Kochhar A, Patel AA. Gest TR, editors. Parathyroid Gland Anatomy [updated 2013 Sep 17; cited 2018 Jun 25]. Available from: https://emedicine.medscape.com/article/1949105-overview#showall.Bonjer HJ, Bruining HA. The technique of parathyroidectomy. In: Clark O, Duh Q, Kebebew E, et al, editors. Textbook of Endocrine Surgery. Philadelphia: Saunders; 1997. p. 277-283.Bonjer HJ, Bruining HA. The technique of parathyroidectomy. In: Clark O, Duh Q, Kebebew E, et al, editors. Textbook of Endocrine Surgery. Philadelphia: Saunders; 1997. p. 277-283.Wang C-A. The anatomic basis of parathyroid surgery. Ann Surg. 1976;183(3):271-275. doi: 10.1097/00000658-197603000-00010.Wang C-A. The anatomic basis of parathyroid surgery. Ann Surg. 1976;183(3):271-275. doi: 10.1097/00000658-197603000-00010.

The authors declare that there are no conflicts of interest present.