Comparison Between Video-Assisted and Open Lateral Neck Dissection for Papillary Thyroid Carcinoma with Lateral Neck Lymph Node Metastasis: A Prospective Randomized Study.

Abstract

The safety and oncologic completeness of video-assisted lateral neck dissection (VALND) for papillary thyroid carcinoma (PTC) with lateral neck lymph node metastasis (LNM) have been reported. However, their generalization has remained limited because the advantages and drawbacks are not well demonstrated. A total of 64 patients with PTC and unilateral lateral neck LNM who underwent total thyroidectomy with central compartment neck dissection and lateral neck dissection (LND) were prospectively enrolled. They were randomly assigned to the video-assisted (VA) group (n = 32) or open group (n = 32) and were treated either by VALND or conventional open LND, respectively. We compared operating time, complications, oncologic completeness, postoperative pain, and cosmetic results between the two groups. The complication rate and oncologic completeness, including the results of radioactive iodine scans, mean number of lymph nodes retrieved, and mean postoperative serum thyroglobulin levels, were similar between the groups. Postoperative pain was observed less frequently after surgery in the VA group (P < .0001). Cosmetic results evaluated by a verbal response scale and a numeric rating scale were in favor of the VA group (P < .0001 and P = .0004, respectively). Total operating time was 176 ± 16 minutes in the VA group and 161 ± 16 minutes in the open group (P = .0003). VALND yielded complication and oncologic completeness rates that were similar to those of open LND. However, VALND resulted in less postoperative pain and better cosmetic results.