Current status and development prospects of priority directions of endocrine surgery in Ukraine

Abstract

This report defines the main directions of endocrine surgery development in Ukraine. Currently, the largest proportion of patients of endocrine surgeons around the world are patients with thyroid pathology. To date, the problem of differential diagnosis of thyroid nodules and tactics of their management remains relevant. One of the relatively new methods for the preoperative diagnosis of papillary thyroid carcinomas is a molecular genetic study of thyroid cancer panel, that includes BRAFV600Е, NRAS, HRAS, KRAS gene mutations and RET/PTC1, RET/PTC3 and PAX8/PPARγ gene translocations, which may occur in papillary and follicular thyroid carcinomas. The issues of reducing the aggressiveness of surgical treatment of lowrisk well-differentiated thyroid cancers, in particular, in cases of microcarcinoma detection, are considered. The issues for introduction of ligature-free operations into practice on the thyroid and parathyroid glands are considered. Videoendoscopic operations on the thyroid gland with various approaches and minimally invasive methods of surgical intervention such as Minimally invasive thyroidectomy and Minimally invasive videoassisted thyroidectomy have been introduced. Researches on the indications and contraindications for the appointment of radioiodine therapy and radioiodine diagnostics, depending on the degree of aggressiveness of the tumor process, the presence of radioiodine insensitivity, are conducted in the Institute. The paper discusses the directions of diagnosis and treatment of adrenal gland disorders. Most operations are performed endoscopically, which is generally recognized as the «gold standard». At the same time, the surgeons of the department master both through peritoneal and extraperitoneal approaches. The largest tumor that was removed endoscopically reached 10 cm, the removed cysts were more than 10 cm in maximum size. The technique of X-ray endovascular occlusion of adrenal vessels as a method of preventing complications, before adrenalectomy for pheochromocytoma, in particular by laparoscopic access was developed together with specialists from State Institute «Shalimov’s National Institute of Surgery and Transplantation of National Academy of Medical Sciences of Ukraine». The Institute also provides assistance to children with disorders of sexual development, in particular congenital dysfunction of the adrenal cortex, gonadal dysgenesis, etc. The surgical department performs the entire range of operations on the gonads and perineum in the formation of the external genitalia according to the female type.