Surgical Skills and Technological Advancements to Avoid Complications in Lateral Neck Dissection for Differentiated Thyroid Cancer

Abstract

Neck dissection is a surgical procedure reserved for thyroid cancer cases with clinically evident lymphatic invasion. Although neck dissection is a reliable and safe procedure, it can determine a significant morbidity involving a variety of structures of nervous, vascular and endocrine typology. A careful pre-operative study is therefore essential to better plan surgery. Surgical experience, combined with accurate surgical preparation and merged with adequate and specific techniques, can certainly help reduce the percentage of complications. In recent years, however, technology has also proved to be useful. Its crucial role was already recognized in the safeguard of the integrity of the laryngeal nerve through neuro-monitoring, but new technologies are emerging to help the preservation also of the parathyroid glands and other structures, such as the thoracic duct. These surgical skills combined with the latest technological advancements, that allow us to reduce the incidence of complications after neck dissection for thyroid cancer, will be reported in the present article. This topic is of significant interest for the endocrine and metabolic surgeons’ community.

Establishment and verification of the first prognostic nomograms in locally advanced thyroid cancer based on the analysis of clinical and follow-up information on 2396 patients

“…Therefore, providing optimal choices of surgical strategies for LATC patients to further increase the resection rate, reduce surgical risks, decrease the incidence of postoperative complications and mortality, and safeguard the quality of life while prolonging survival as much as possible are the current hotspots of controversy and the direction of endeavor. However, it is worth noting that the current editions of academic guidelines [ 3 , [32] , [33] , [34] ] for the surgical treatment of LATC emphasise the weighing of the surgical benefit-risk ratio, i.e., the need for the surgeon to weigh radical versus palliative tumor-reducing treatments. However, there is still a lack of convincing evidence in terms of comparing the assessment of the efficacy benefits of different treatment options.…”

Mapping complications in thyroid surgery: statistical data are useful for medico-legal management of a recurrent safety issue

“…Consistent with the available evidence, the data obtained show that electrophysiological monitoring of the recurrent nerve is not yet a routine practice due to the recent acquisition and indication in a limited number of cases. In particular, the association of electrophysiological monitoring with direct visualization of nerve structures in cases at higher risk (reoperations, oncological surgery, and approach to voluminous goiters) represents the gold standard for the prevention of iatrogenic lesions of the recurrent nerve [ 27 , 28 ].…”

An effective method to reduce lymphatic drainage post-lateral cervical lymph node dissection of differentiated thyroid cancer: a retrospective analysis

“…If there was no obvious lymph or chylous exudation in the inferior carotid sheath area under observation for at least 1 min, the operation was finished. If there was obvious lymph of chylous exudation during observation, we mainly ligated the injured duct and its tributaries using a running suture (5-0 Prolene) without any other tissue for additional covering [ 11 – 13 ] until the exudation stopped as a conventional method. We found that some patients still had LL/CL after surgery.…”