Needle-Assisted Endoscopic Lateral Neck Dissection Through Bilateral Areola Approach for Papillary Thyroid Carcinoma Patients

Abstract

Introduction: Needle-assisted endoscopic lateral neck dissection through the bilateral areola approach is a technique of selective neck dissection for levels IIA, IIB, III, IV, VB, and VI lymph nodes. This technique has a cosmetic effect on patients with N1b papillary thyroid carcinoma (PTC). Methods/Case Presentation: In January 2016, a 26-year-old female patient was found to have PTC with right lateral cervical lymph node metastasis by fine-needle aspiration. It was found to be clinical stage I cT1bN1bM0. After CT scan and ultrasonography inspection, we decided to perform total thyroidectomy and right lateral neck dissection through the bilateral areola approach. Incisions were made at the bilateral areola with a 5-mm trocar and a 10-mm trocar was inserted into the right breast margin at the 4 o'clock position. Needle-assisted instruments directly approached the surgery region through the neck skin. We built up an operating space by the liquid–gas method with 6 mmHg CO2 and suture suspension to maintain the spaces. Using needle-assisted instruments, the external jugular vein was separated primarily and was protected well. Then we anatomized the anterior border of the sternocleidomastoid to show the carotid triangle, including the posterior belly of the digastric muscles, hypoglossal nerve (XII), and accessory nerve (XI), and dissected the levels IIA, IIB, and III lymph nodes at the same time. Furthermore, the level IV lymph node was dissected after exposing the venous angle and ligating the lymphatic duct at the intermuscular approach. For identifying the transverse cervical artery and cervical nerves, we returned to level V to remove the specimen and complete the lateral neck dissection. Finally, the recurrent laryngeal nerves, parathyroids, and other important structures mentioned previously were taken on completely. Three drainage tubes were placed in the neck. This surgery left minimal scars on the neck, and the cervical sensory nerves were properly preserved. Results/Discussion: The patient received treatment after surgery in the hospital for 5 days without postoperative complications. Needle-assisted endoscopic lateral neck dissection through the bilateral areola approach for PTC patients can obtain significant cosmetic results and also minimal invasion for young PTC patients with lateral lymph node metastasis. Conclusions: Needle-assisted endoscopic lateral neck dissection through the bilateral areola approach is considered for N1b papillary thyroid carcinoma without mediastinal metastasis. It is an excellent option for young patients that gives better cosmetic effect and minimal invasion. No competing financial interests exist. Runtime of video: 8 mins 30 secs