Minilaparoscopy-Assisted Hemithyroidectomy and Central Neck Dissection (Level VI) Using Bilateral Breast Approach

Abstract

Introduction: Minilaparoscopy-assisted thyroidectomy using the bilateral breast approach is a technique for thyroidectomy in patients with thyroid disease. This technique can promote the effect of cosmetology in thyroid surgery. In this video, we outline the instrument, operating room setup, and trocar position, present a minilaparoscopy-assisted hemithyroidectomy and central neck dissection (level VI), and demonstrate recurrent laryngeal nerve and two parathyroids in operation. Materials and Methods: In August 2014, we operated on a 35-year-old female patient. The patient underwent fine-needle aspiration cytology, diagnosed as left papillary thyroid carcinoma. After CT scan and ultrasonic inspection preoperation, the clinical staging is cT1aN0M0 staging I. According to the Chinese thyroid nodule and thyroid cancer guideline,1 we decided to perform left hemithyroidectomy and central neck dissection (level VI) using a bilateral areolar approach. 0.2 mL carbon nanoparticle suspension was injected to the thyroid gland with ultrasonic guidance 2 weeks before operation. The approach starts with the thyroid isthmus liberation that is dissected free from the anterior part of the trachea and transected. Then, the superior pole vessels are divided. The superior pole is then mobilized laterally and the recurrent laryngeal nerve is searched for at the inferior pole. The dissection continues between the nerve and the posterior part of the thyroid progressively, from bottom to top. After the recurrent nerve dissection, the gland can usually be extracted without difficulty, dividing the last vessels in berry ligament holding the gland. While in central neck dissection, first, we confirmed the lateral boundaries of central compartment and identified the recurrent laryngeal nerve. Then completed the central neck dissection. Finally, we present the superior thyroid artery, recurrent laryngeal nerve, and parathyroids after dissection, cleaning up, and closure. Results: The patient who was operated with this technique had a duration of hospitalization of 3 days without any postoperative complication. Carbon nanoparticle suspension is an ideal lymphatic tracer for endoscopic thyroidectomy and central neck dissection, although there is some leakage of carbon nanoparticle suspension in this patient. It does not affect the identification and preservation of recurrent laryngeal nerve and parathyroids. Conclusions: We prefer to operate cN0 thyroid cancer using this technique because it allows us to better identify and preserve the recurrent laryngeal nerve and parathyroids and same boundaries in central neck dissection. Moreover, it brings better cosmetic results for young patients. No competing financial interests exist. Runtime of video: 9 mins 57 secs