Endoscopic Lateral Neck Dissection: A New Frontier in Endoscopic Thyroid Surgery

Zhang, Zeyu; Sun, Botao; Ouyang, Hui; Cong, Rong; Xia, Fada; Li, Xinying

doi:10.3389/fendo.2021.796984

Cited by 21 publications

(15 citation statements)

References 53 publications

(112 reference statements)

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“…After more than 20 years of exploration and innovation by surgeons, endoscopic thyroidectomy has gradually developed to include the mouth, axillary, breast, chest wall, or a combination of multiple surgical procedures ( 17 ). Endoscopic thyroidectomy successfully transfers the incision to a hidden part of the neck, and the advantage of “no scar left” on the neck satisfies people’s aesthetic demands ( 18 ). Patients who meet the inclusion criteria have the complete and independent right to choose the surgical approach, and the average age of the patients included in this study was 34.98±7.87 years old, with a ratio of men to women of 1:5.…”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes of different approaches to dissection of lymph nodes posterior to right recurrent laryngeal nerve: a retrospective comparative cohort study of endoscopic thyroidectomy via the areolar approach and via the axillo-breast approach

Si¹,

Mei²,

Wang³

et al. 2022

Gland Surg

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Background: The American Thyroid Association (ATA) points out that lymph nodes posterior to right recurrent laryngeal nerve (LN-prRLN) should be routinely dissected. Due to the high risk of nerve injury, the lymph nodes in this area are difficult to dissect thoroughly. Although there are many approaches to endoscopic thyroidectomy, no study has been conducted on which one is more suitable. The purpose of this study was to evaluate the safety, thoroughness, related trauma, and feasibility of two widely used endoscopic thyroidectomy approaches, so as to provide a basis for the surgeon to select a better surgical approach.Methods: This retrospective study included patients who underwent ETA (n=26) and ETAB (n=36). All patients had a pathological diagnosis of papillary thyroid carcinoma (PTC) and underwent endoscopic right thyroidectomy from May 2015 to February 2022 in the Affiliated Hospital of Nantong University. The basic clinical data and surgical outcomes of the two groups were compared.Results: There was no statistical difference between the two groups in basic clinical data and oncological characteristics, which meant that the baseline data of the two groups of patients were comparable. Significant statistical significance was observed in the operation duration (149.38±44.15 vs. 119.22±45.48 min, P=0.011), drainage volume 24 h after operation (95.54±16.79 vs. 54.46±15.11 mL, P<0.001), visual analog score (VAS) 24 h after operation (3.69±1.44 vs. 2.25±1.32, P<0.001), hospitalization duration after the operation (3.19±0.75 vs. 2.25±0.44 days, P<0.001), number of lymph node dissections after right recurrent laryngeal nerve resection (0.96±1.08 vs. 2.06±1.77, P=0.007), and number of lymph node metastases after right recurrent laryngeal nerve resection (0.12±0.33 vs. 0.58±1.00, P=0.025). Besides, there was no significant difference in the numbers of central lymph node dissections and central lymph node metastases.Conclusions: Our study indicated that compared with ETA, ETAB may perform a more efficient dissection of the LN-prRLN based on less surgical trauma, which could provide a basis for the surgeon to select a better surgical approach.

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Section: Discussionmentioning

confidence: 99%

Surgical outcomes of different approaches to dissection of lymph nodes posterior to right recurrent laryngeal nerve: a retrospective comparative cohort study of endoscopic thyroidectomy via the areolar approach and via the axillo-breast approach

Si¹,

Mei²,

Wang³

et al. 2022

Gland Surg

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“…For example, the high cost of robotic instruments has made robotic LND difficult to popularize. With the endoscopic LND approaches, due to obstruction by the clavicle, dissection of LNs at levels IV and VI via the chest approach is inherently challenging (10). Additionally, although the superior-to-inferior view of the transoral approach is helpful for LNs dissection at levels IV and VI, it does not permit complete dissection of LNs at level II.…”

Section: Introductionmentioning

confidence: 99%

A novel hybrid approach for “Scarless” (at the neck) lateral neck dissection for papillary thyroid carcinoma: A case series and literature review

Chen

Pang

et al. 2022

Front. Oncol.

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Lateral neck dissection (LND) is a necessary treatment for thyroid cancer with lateral lymph node metastasis. However, the defect created during open surgery leaves a visible scar on the neck. With advancements in surgical technology, many robotic and endoscopic surgical techniques have been reported as alternatives to open surgery. In this study, we present a case series demonstrating the successful application of a novel hybrid approach for endoscopic LND and a review of different surgical approaches for “scarless” (at the neck) LND. We performed endoscopic LND via a combined chest and transoral approach in 24 patients between January 2021 and March 2022. The surgery was completed successfully in all patients with an average operation time of 298.1 ± 72.9 min. The numbers of positive/retrieved lymph nodes at levels II, III-IV, and VI were 0.7 ± 0.9/8.4 ± 4.1, 3.6 ± 2.7/19.5 ± 6.8, and 4.9 ± 3.9/10.3 ± 4.5, respectively. Complications included transient hypoparathyroidism in 10 patients, transient recurrent laryngeal nerve injury in 1 patient, internal jugular vein (IJN) injury in 1 patient, IJN sacrifice due to cancer invasion in 1 patient, and chyle leak in 1 patient, and no cases of tumor recurrence were observed during follow-up. The present case series indicates that the combined chest and transoral approach is feasible and effective for performing LND. Our review of different approaches for “scarless” (at the neck) LND identified advantages and disadvantages for all techniques. Our novel approach has unique advantages, and thus, it can provide an ideal surgical procedure for specific papillary thyroid carcinoma patients.

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“…In the history of robotic and endoscopic lateral neck dissection for thyroid cancer, a minimally invasive video-assisted lateral neck dissection approach was reported in 2007 ( 10 ). Since then, robot-assisted lateral neck dissection via gasless axillary, breast, anterior chest, and retroauricular approaches have been developed ( 11 , 12 ). However, lateral neck dissection via the transoral approach has been considered difficult.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of transoral robotic selective neck dissection with or without a postauricular incision for papillary thyroid carcinoma: A pilot study

Tae

Choi

et al. 2022

Front. Surg.

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BackgroundThe study aimed to evaluate the feasibility of transoral robotic selective neck dissection (SND) with or without a postauricular incision for papillary thyroid carcinoma (PTC).MethodsWe studied 14 patients with PTC who underwent robotic SND via the transoral or combined transoral and postauricular approaches.ResultsThe transoral approach was performed on 10 patients for dissection of levels III and IV. An additional postauricular incision was made on 4 patients for dissection of level II in addition to levels III, IV, and V. The operation was completed successfully in 13 patients, except 1 patient with the procedure conversion due to uncontrolled bleeding from the internal jugular vein. The mean numbers of removed lymph nodes in the lateral compartment were 23.1 ± 9.4 and 38.3 ± 8.5 in the transoral and combined groups. Transient recurrent laryngeal nerve palsy occurred in 1 patient, transient hypoparathyroidism in 3 patients, and chyle leakage in 1 patient. There were no hematomas, mental nerve injuries, surgical space infections, or CO2 embolisms.ConclusionTransoral robotic SND is feasible with or without a postauricular incision.

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Endoscopic Lateral Neck Dissection: A New Frontier in Endoscopic Thyroid Surgery

Cited by 21 publications

References 53 publications

Surgical outcomes of different approaches to dissection of lymph nodes posterior to right recurrent laryngeal nerve: a retrospective comparative cohort study of endoscopic thyroidectomy via the areolar approach and via the axillo-breast approach

Surgical outcomes of different approaches to dissection of lymph nodes posterior to right recurrent laryngeal nerve: a retrospective comparative cohort study of endoscopic thyroidectomy via the areolar approach and via the axillo-breast approach

A novel hybrid approach for “Scarless” (at the neck) lateral neck dissection for papillary thyroid carcinoma: A case series and literature review

Feasibility of transoral robotic selective neck dissection with or without a postauricular incision for papillary thyroid carcinoma: A pilot study

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