Magnetic resonance imaging for preoperative planning of safe thyroidectomy in complex circumstances

Objective. To improve thyroidectomy technique by integrating magnetic resonance imaging data into preoperative planning and intraoperative process. Material and methods. The study included 140 patients (group A) with thyroid diseases associated with neck compression syndrome and 69 patients (group B) with previous hemithyroidectomy scheduled for redo thyroidectomy. In each group, patients were divided into two subgroups: main group with surgical planning based on MRI data and control group without these data. Effectiveness of surgical techniques was assessed considering the following parameters: the need for access expansion, surgery time, intra- and postoperative complications. Results. MR-based surgical technique was developed for patients with compression syndrome and high-lying / thickened upper poles of thyroid gland. Two types of anatomical disposition were identified in patients with previous hemithyroidectomy: anterolateral and posteromedial. Individual techniques for resection of residual lobe were proposed for each disposition. Original techniques in patients with neck organ compression and previous hemithyroidectomy reduced duration of thyroidectomy (p=0.001) and incidence of intra- and postoperative complications. Conclusion. Evaluation of the upper pole thyroid (thickness and position) in patients with thyroid pathology accompanied by neck compression syndrome improved thyroidectomy technique and reduced the risk of bleeding and damage to superior laryngeal nerve. In redo thyroid surgeries, analysis of cervical organ displacement is valuable for a differentiated approach to thyroid lobe mobilization.