Published in:
01-08-2015
“Scarless” (in the neck) endoscopic thyroidectomy (SET) with ipsilateral levels II, III, and IV dissection via breast approach for papillary thyroid carcinoma: a preliminary report
Published in: Surgical Endoscopy | Issue 8/2015
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Background
Endoscopic thyroidectomy with level II dissection has previously been reported to be performed endoscopically via various approaches. However, very few reports were available regarding level II dissection performed via the breast approach. In this article, we reported a series of 12 papillary thyroid carcinoma (PTC) patients with scarless (in the neck) endoscopic thyroidectomy (SET) via breast approach to level II dissection and evaluated its feasibility and safety.
Methods
Between January 2011 and March 2013, 12 PTC female patients with suspected lymph node metastasis at level II, III, or IV were selected for this procedure. After completing thyroidectomy and central compartment dissection, dissection of ipsilateral levels II, III, and IV was performed. The steps of endoscopic lateral neck dissection were similar to those of conventional surgery except that the lateral cervical compartment was exposed by splitting the sternocleidomastoid muscle (SCM) longitudinally and dividing between the strap muscles and the anterior margin of the SCM.
Results
This procedure was carried out in all of the 12 patients (Table 1). Mean operative time was 243 min (range 165–355 min). Nine patients (75 %) had lymph node metastasis in the lateral compartment confirmed on the final pathological report. Mean lymph node yield (LNY) in the lateral compartment (including ipsilateral level II, III, and IV dissection) was 21.8 (range 5–42). Five patients (41.6 %) had lymph node metastasis in the ipsilateral level II. The mean LNY in the ipsilateral level II was 6.7 (range 1–14). In 1 of the 12 patients, bleeding from injury to the internal jugular vein in level II was encountered intraoperatively, and a 4-cm upper neck transverse incision was made to stop the bleeding. Average postoperative hospital stay was 5.0 days (range 3–7 days).
Table 1
Original article on endoscopic lateral neck dissection (including level II) by other authors
Author (Ref.) | Year | Mean age (years) | Tumor size (cm) | No. of patients | M:F | Tech. | Type of operation | Mean LNY in lateral zone | Mean operative time (min) | Postoperative bleeding | Chyle leakage | Mean PHS (days) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Wu et al. [13] | 2013 | 43.2 | 1.88 | 26 | 6:20 | VAT | SLND | 8.3 | 137.7 | None | None | 3.6 |
Lee et al. [8] | 2013 | 40.2 | 1.39 | 62 | 5:57 | Robot | MRND | 32.8 | 271.8 | None | None | 6.9 |
Kang et al. [5] | 2012 | 35.8 | 1.14 | 56 | 10:46 | Robot | MRND | 31.1 | 277.4 | 1 | 5 | 6 |
Kang et al. [6] | 2011 | NA | NA | 36 | NA | Robot | MRND | 27.7 | 280.91 | 1 | 3 | NA |
Kang et al. [4] | 2009 | NA | NA | 13 | NA | AP | MRND/SLND | 18.8 | 286 | NA | NA | 5.3 |
Current article | 31.2 | 1.67 | 12 | 0:12 | SET | SLND | 21.8 | 243 | None | None | 5 |
Conclusions
According to the present SET data, level II dissection by SET was a feasible and safe procedure. With reasonable costs and satisfactory cosmetic results, oncoplastic SET via breast approach might gain wider acceptance in the near future.