Abstract
Abstract
Introduction:
Endoscopic thyroid surgery through the extracervical approach is a safe and well-accepted technique. Endoscopic techniques have to be applied widely in thyroid cancer treatment, and the technique of complete lymph node dissection (CLND) of the same or higher quality than conventional open surgery must be established. We have developed a new bidirectional approach video-assisted neck surgery (BAVANS) to perform endoscopic thyroid cancer surgery, and we report the usefulness of the craniocaudal approach in endoscopic CLND.
Materials and Methods:
BAVANS is a combination procedure involving two different directional approaches to the cervical region. Initially we perform thyroidectomy through a gasless precordial or axillary approach (selected by patients). After thyroidectomy, only two small ports (2.5 and 5 mm) were inserted in the submandibular area to obtain the craniocaudal view for CLND. We are able to obtain a magnified clear craniocaudal view and perform meticulous manipulation in the narrow space by using a new rigid laparoscope featuring variable viewing direction.
Results:
A total of 40 patients with papillary thyroid cancer underwent BAVANS (level VI dissection = 37 and level III+IV+VI dissection = 3) and were highly satisfied. All patients began oral intake within 5 hours after surgery. The average number of retrieved unilateral central nodes was 8.5 in central node (level VI) dissection (n = 40), and 16 in central and lateral neck (level III+IV+VI) dissection (n = 3). Only one patient had Horner syndrome caused by injury to the cervical sympathetic nerve during central node dissection, but no patients experienced recurrent laryngeal nerve injury, chyle leakage, or other complications.
Conclusions:
We performed BAVANS with craniocaudal approach in all patients of papillary thyroid cancer, and there is no data to compare with only precordial approach. Considering anatomical feature around the trachea, however, we are confident that additional craniocaudal approach will lead to more number of harvested lymph nodes compared with only the precordial approach. The craniocaudal approach is useful for CLND in endoscopic thyroid cancer surgery. BAVANS is a progressive and feasible surgical procedure with cosmetic advantages.
No competing financial interests exist.
Runtime of video: 7 mins 47 secs
