Central Node Dissection: Comparison of Standard Open to Minimally Invasive Video‐Assisted Approach

Abstract

Objectives: Compare outcomes of primary concomitant thyroidectomy with central neck dissection by standard open vs. minimally invasive video-assisted (MIVA) approach in patients with low risk thyroid carcinoma. Methods: A retrospective chart review was performed using CPT code 60502 for patients undergoing central neck dissection from February 2005 through June 2012. Revision cases were excluded. Primary outcomes included lymph node yield, complications, and recurrence. Results: One hundred eighty-five patients were identified, with 134 as open cases and 51 as MIVA. Of the open cases, 87 were primary, 46 were revision, and 1 had insufficient data. Of the MIVA cases, 49 were primary, and 2 were revision. Of the 136 eligible patients, mean age was 46 years in both groups (range 14-97). The MIVA group was more likely female (88% vs. 68%, P < 0.01), T1 (80% vs. 42%, P < 0.001), and N0 (57% vs. 37%, P < 0.001). Nodal yield was lower in the MIVA group (5.0 vs. 6.7, P = 0.04), but was similar in unilateral cases (4.9 vs. 5.5, P = 0.58). Transient recurrent laryngeal nerve injury was similar (4.1% vs. 5.8%, P = 0.67); however, transient hypoparathyroidism defined by postanesthesia care unit parathyroid hormone < 15 pg/ml was lower in the MIVA group (29.8% vs. 49.3%, P = 0.03). Recurrence rates were similar (2.0% vs. 6.0%, P = 0.29). Conclusions: Primary concomitant central neck dissection with MIVAT may result in a slightly lower nodal yield but with reduced transient hypoparathyroidism, likely from less aggressive dissection in the presence of less advanced disease. MIVAT with central neck dissection appears a safe alternative to the standard open approach for low risk thyroid carcinoma.