The past decade has witnessed rapid advances in gasless transaxillary endoscopic thyroidectomy (GTET) for thyroid cancer, which has become a reliable procedure with good therapeutic effectiveness, aesthetic benefits, and safety. This procedure has been widely promoted in some Asian countries; however, few studies have described the specific surgical steps for unilateral low-risk thyroid cancer. Based on a review of the literature and our own clinical experience, we introduce in detail the surgical procedure of GTET for the unilateral low-risk thyroid cancer, briefly summarized into Li's 6 steps: surgical position and incision design; creation of surgical cavities; dissection of the superior pole of the thyroid and its vessels, and identification and protection of superior laryngeal nerve; identification and protection of the superior parathyroid gland, and identification of the inferior parathyroid gland; identification and protection of the recurrent laryngeal nerve and the inferior parathyroid gland, and central neck dissection; and processing of the suspensory ligaments of thyroid gland and en bloc resection of the tumor. The six-step approach is simple to learn. The lymph nodes are dissected first, followed by resection of the primary lesion and protect important structures, which meets the principles of radical tumor treatment. It is hoped that the proposed Li's six-step method can promote the standardized, safe, and wide application in treating early thyroid cancer.

Background: Retrosternal goiter refers to when the thyroid gland extends from the neck to the substernal portion, descending below the thoracic inlet into the mediastinum. It is typically accompanied by compressive symptoms, and most patients need to undergo surgery. This retrospective study set out to

<b><i>Purpose:</i></b> To explore the applied value of the selective neck dissection to treat second, third, and fourth branchial cleft anomalies with recurrent or repeated neck infections. <b><i>Method:</i></b> We made a retrospective study about 29 patients with the second, third, and fourth branchial cleft anomalies with recurrent or repeated neck infections who were treated by surgery from 2002 to 2018 in Sichuan Province Cancer Hospital. According to the characteristics of branchial cleft anomaly on embryology and anatomy, different types of selective neck dissection were chosen to remove pathological scar tissue or inflammatory tissue en bloc. <b><i>Result:</i></b> Of 29 cases, 28 had primary healing, and 1 had local infection, healing after dressing change for a long time. In 1 case, branchial cleft anomalies adhered to the internal jugular vein, which was ruptured and sutured. During the follow-up time of 12∼195 months with an average of 91.76 months, there were no recurrent cases. <b><i>Conclusion:</i></b> The selective neck dissection technique is safe and effective in the treatment of branchial cleft anomalies with recurrent or repeated neck infection.

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Objective To explore relevant clinical factors of Level IIB and contralateral Level VI lymph node metastasis and evaluate the safety of low -collar extended incision(LCEI) for lymph node dissection in level II for papillary thyroid carcinoma(PTC) with pN1b. Method A retrospective analysis was performed on 218 patients with PTC with pN1b who were treated by surgery in the Head and Neck Surgery Center of Sichuan Cancer Hospital from September 2021 to May 2022.The data on age, gender, body mass index(BMI), tumor location, maximum tumor diameter, multifocality, Braf gene, T staging, surgical incision style and lymph node metastasis in each cervical subregion were collected. The chi-square test were used for comparative analysis of relevant factors. All statistical analysis was completed by SPSS.24 software. Result Each subgroup on gender, age, BMI, multifocality ,tumor location, extrathyroidal extension, Braf gene, lymphatic metastasis in level III, level IV and level V had no statistical difference in the positive rate of lymph node metastasis in level IIB(P > 0.05).In contrast, patients with bilateral lateral cervical lymphatic metastasis were more likely to have lymphatic metastasis in level IIB than those with unilateral lateral cervical lymphatic metastasis, with a statistically significant difference (P = 0.000). Besides, lymph node metastasis in level IIA was significantly associated with lymph node metastasis in level IIB (P = 0.001). The LCEI group had the similar lymphatic metastasis number and lymphatic metastasis rate in both level IIA and level IIB with the L-shaped incision group(P > 0.05).Patients with ipsilateral central lymphatic metastasis had 86 cases(78.2%). While patients with contralateral central lymphatic metastasis accounted for 56.4%.The contralateral central lymphatic metastasis rate was not correlated with age, BMI, multifocality, tumor invasion and ipsilateral central lymphatic metastasis, and there was no statistical difference (P > 0.05). The contralateral central lymphatic metastasis in males was slightly higher than that in females, and the difference was statistically significant (68.2%vs48.5%, P = 0.041). Conclusion Lymphatic metastasis in Level IIA was an independent predictor of lymphatic metastasis in Level IIB. When bilateral lateral cervical lymphatic metastasis or lymph node metastasis of level IIA are found, lymph node dissection in level IIB is strongly recommended.When unilateral lateral cervical lymphatic metastasis and lymphatic metastasis in level IIA is negative, lymph node dissection in level IIB may be performed as appropriate on the premise of no damage to the accessory nerve.LCEI is safe and effective for lymph node dissection in Level II. When the tumor is located in unilateral lobe, attention should be paid to the contralateral central lymph node dissection because of the high lymphatic metastasis rate.

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