BACKGROUND. Current trends of «fast track surgery» give rise to development of new safe techniques of the thyroid and parathyroid surgery, the purpose of which is to minimize the level of postoperative complications, such as vocal cord palsy, hypoparathyroidism, bleeding. In this regard, it is important for the endocrine surgeon to save «dry operating field», which contributes to the clear visualization of such «thin» structures as the recurrent laryngeal nerve, the external branch of the superior laryngeal nerve and the parathyroid glands. Therefore, the key issue of this surgery is to understand the anatomical and topographic features of the blood supply to the internal neck organs (a complex of neck organs consisting of the thyroid and parathyroid glands, larynx, trachea, esophagus).

AIM. To determine the main sources of arterial blood supply of the internal neck organs and their anatomical, topographic features.

MATERIALS AND METHODS. The computed tomography protocols of cervical branches of brachiocephalic arteries were analysed in the study. The thickness of the reconstructed sections in the axial, frontal and sagittal planes was 0.35±0.05 mm. The fact of blood supply was confirmed by the anatomical close of the arterial structure to the internal organ and the presence of intramural arterial branches.

RESULTS. The course of all cervical branches of the subclavian and common carotid artery was traced among 42 patients. It is noted, that only the inferior, superior thyroid arteries and thyroid ima artery supply internal neck organs with the blood. At the same time, the superior thyroid artery was visualized in all angiograms. However, the inferior thyroid artery was absent in 2.4% of cases. The thyroid ima artery was rarely detected (in 4.8% of patients). In 73.2% of cases, the inferior thyroid artery was detected high at the upper third level of the thyroid lobe and then had a descending course. In 23.2% of cases, the artery was formed at the middle third level of the thyroid lobe and was directed horizontally to the gland. Only in 3.6% of cases, the ascending course was determined in the vessel. The inferior thyroid artery was located on the posterior surface of the thyroid lobe, where it formed glandular branches. On the contrary, the branches of the superior thyroid artery were located mainly along the anterolateral surface of the thyroid gland. The average thickness of the inferior thyroid artery was 2.1±0.5 mm, and the superior thyroid artery was 1.6± 0.7 mm.

CONCLUSION. According to the study, arterial blood supply to the internal neck organs is provided mainly by the inferior and superior thyroid arteries. At the same time, the trunk of the inferior thyroid artery is larger than the superior thyroid artery (p=0.032). The inferior thyroid artery forms branches along the posterior surface of the thyroid lobe and from a topographic point of view it is the main source of blood supply to the parathyroid glands. In most cases, the inferior thyroid artery has a descending course, is directed along the posterior surface of the thyroid gland and forms an X-shaped intersection with the recurrent laryngeal nerve.

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.

Neurofibromatosis type 1 is a hereditary disease that has a multisystem character of organism damage, a wide variability of clinical manifestations, up to the almost complete absence of typical symptoms. Phenotypic manifestations, their expressiveness and heaviness can be varied even among members of the same family with identical mutations. One of the possible clinical manifestations of this pathology is pheochromocytoma, the development of which is associated with a high risk of developing life-threatening conditions. Timely diagnosis of the disease, the choice of treatment tactics for the patient, genetic testing of blood relatives can significantly improve the survival rate and prognosis of the disease. In this article, on the presented clinical examples of patients with a typical and atypical course of type 1 neurofibromatosis in combination with pheochromocytoma, the issues of managing patients with this pathology are outlined.

Nowadays, diabetes and diseases of thyroid gland take place on the first two stage in the rank of all endocrine diseases. There are 3 directions to treat thyroid glands pathologies such as: using special pills which substitute natural thyroid hormones, surgery and radioiodine therapy. It has proven that surgery of thyroid gland is the most effective method among considering upper. at The same time, it is associated with the greatest risks of complications. The most common injuries are damage to the recurrent laryngeal nerve and unintentional traumatization or removal of a healthy parathyroid gland. Parathyroid gland is a critical organ during thyroid surgery. It means that all negative reaction nearby the structure can lead to development different complications: hypoparathyroidism (transient or chronic) and hypocalcemia. In this article is considered actual methods of intraoperative optical visualization of parathyroid glans. The fundamental foundations of such methods, their advantages and disadvantages are also analyzed. It is shown that fluorescent methods in the red and near infrared regions of the spectrum using exogenous dyes have essential importance for endocrine surgery, as they allow to improve identification and reduce the risk of postoperative complications.