Objective. To determine the peculiarities of operative technique in surgical treatment of patients with nodular goiter on background of autoimmune thyroiditis. Materials and methods. The results of surgical treatment of nodular goiter, basing on data from surgical clinic of the Second Clinical Hospital in City of Poltava through 2003 - 2017 yrs were adduced. There were operated 549 patients, suffering nodular goiter. There were 58 (10.6%) men and 491 (89.4%) women. Unilateral nontoxic nodular goiter was observed in 187 (34.1%) patients, multinodular nontoxic – in 322 (58.7%), multinodular toxic – in 30 (5.5%), thyreotoxic adenoma – in 21 (3.8%) patients. Cervico-retrosternal goiter was in 110 (20.0%) patients. For recurrent goiter 21 (3.8%) patients were operated. Malignant tumors were revealed intraoperatively or after definite histological investigation in 22 (4/0%) patients. Of 108 patients, to whom, basing on the disease clinical signs, laboratory data and preoperative cytological investigation the diagnosis of nodular goiter on background of autoimmune thyroiditis was established, while performing of definite postoperative investigation macromicrofollicular colloidal goiter was revealed in 41 (38%), nodular goiter with the autoimmune thyroiditis – in 51 (47.2%), cancer (papillary, follicular) – in 8 (14.8%) patients. Subtotal resection of thyroid gland was performed in 8 (15.7%) patients, hemithyroidectomy - in 12 (23.5%), extrafascial thyroidectomy – in 23 (45.1%). In patients, suffering thyroidal gland cancer, extrafascial thyroidectomy was performed, while in 3 – with central lymphodissection. Intraoperatively visual macroscopic estimation of thyroid gland and obligatory suboperative cyto- and histological investigations of the specimen obtained were performed. Operative tactics was applied in accordance to actual clinical protocols for treatment of patients, suffering surgical pathology of endocrine system. Results. Some technical measures were proposed to minimize the risk of injury of anatomic structures: lower laryngeal nerve, parathyroidal glands, trachea, the neck vessels. Conclusion. Extrafascial procedure guarantees a visual control in the risk zones and radicality of operation, minimizes the specific complications rate.

The training of healthcare professionals must include practical training when they can interact with patients and apply the latest techniques to develop clinical thinking and ethical principles. To ensure the quality of education and the development of the healthcare system as a whole, it is crucial to enable medical students to deepen their skills at various specialized departments. However, one of the problems is the lack of practice and opportunities for independent work in real conditions that can lessen the quality of training outcomes and complicate young doctors’ adaptation to professional activities and environment. The primary objective of clinical practice is to develop professional skills and competencies, such as gathering and analyzing medical information, identifying necessary laboratory and instrumental tests, and evaluating their results. Practical skills, including diagnosing, preventing, and treating illnesses, working with medical documentation, and evaluating the impact of determinants on health status, are also taught. Engagement in carrying out sanitary, hygienic and preventive measures, while considering social and ethical aspects, is equally important. Medical students have practical training in hospitals and clinics across various fields of medicine. For example, they learn to manage physiological pregnancy and take delivery at obstetric or maternity departments, to assess the child development and provide preventive vaccinations in paediatric clinics, as well as to handle emergency medical care in extraordinary situations and military operations. Modern digital technologies and programs, such as e-books, video lessons, and online courses, have made learning more efficient. However, it is still important for students to develop teamwork and leadership skills and proficiency in both Ukrainian and English. By engaging in practical training, medical students can avoid professional mistakes and provide highquality medical care for patients.

Проаналізовані результати хірургічного лікування 606 хворих з приводу різних форм зобу. Відображені показання до операції, оперативне втручання, новітні хірургічні технології. За вузлового і дифузного токсичного зобу (ДТЗ) перевагу віддають радикальним методам операцій. Застосування екстрафасціальних маніпуляцій на щитоподібній залозі (ЩЗ) та прецизійної техніки дозволяє зменшити вірогідність ушкодження під час операції гортанних нервів і прищитоподібних залоз та частоту післяопераційних ускладнень. Ключові слова: щитоподібна залоза; зоб; хірургічне лікування.

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Objective. To analyze the operative interventions character, performed in patients, suffering goiter of large size and cervico-retrosternal localization of thyroid gland with signs of compressive syndrome, and to determine preventive measures for prophylaxis of suboperative complications. Materials and methods. The data were obtained, concerning operative treatment of 331 patients, suffering various forms of large size goiter, coincided with compressive syndrome and changes in anatomic-topographic interrelationship of the thyroid gland and adjacent organs and structures with their activity disorders, in Department of Surgery of the Second Clinical Hospital of Poltava (clinical base Department of Surgery No 1 of Ukrainian Medical Stomatological Academy) in 2004 - 2018 yrs period. Results. There were depicted the operative interventions character, peculiarities of operative technique for patients, suffering large size goiter, as well as the ways for optimal prevention of injury of laryngeal nerves, parathyroid glands and other adjacent organs and structures. Original procedure of suboperative determination of the tracheomalacia presence and creation of external tracheal carcass was depicted. Conclusion. The measures and procedures in operations, performed for goiter of large size proposed, have permitted to reduce the operative morbidity risks.