Central Lymph Node Dissection by Endoscopic Bilateral Areola Versus Open Thyroidectomy

Surg Laparosc Endosc Percutan Tech. 2019 Feb;29(1):e1-e6. doi: 10.1097/SLE.0000000000000579.

Abstract

Background: Endoscopic thyroidectomy by bilateral areola approach (ETBAA) potentially expose a technical limitation for anatomize the central compartment lymph nodes located in its most caudal portion because of visual obstruction and instrument interference of clavicles and sternum. We provide a comparative analysis of ETBAA versus open thyroidectomy approach (OTA) for central compartment dissection (CND).

Methods: From October 2013 to August 2017, 400 patients with papillary thyroid cancer (PTC) underwent CND; 200 patients were enrolled in each group. For the endoscopic group, a 10-mm curved incision is made along the margin of the right areola at 2 to 4'oclock for the 30 degrees endoscope. Bilaterally 5-mm incisions are on the edges of the areola at 11 to 12'oclock as accessory operating ports. Supplementary video (Supplemental Digital Content 1, http://links.lww.com/SLE/A180) depicts steps of ETBAA with CND.

Results: In ETBAA group, a total of 1049 lymph nodes were removed, nodes excision ranged from 1 to 19 (mean, 5.25), the ratio positive/metastatic rate was 18.6%. In OTA group, 916 lymph nodes were excised, nodes removal amplitude was 1 to 20 (average, 4.58), 12.1% were metastatic. Compared with the open group, significantly more lymph nodes were extracted during ETBAA (P<0.05). There was no significant difference between the 2 groups per resected side or surgical morbidity (P>0.05). Periodic monitoring of PTC patients revealed no clinical or US recurrence, undetectable serum Tg in both groups.

Conclusions: Our results show the feasibility of CND in ETBAA.

Publication types

  • Evaluation Study
  • Video-Audio Media

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Carcinoma, Papillary / pathology
  • Carcinoma, Papillary / surgery*
  • Endoscopy / methods*
  • Feasibility Studies
  • Female
  • Humans
  • Lymph Node Excision / methods*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Operative Time
  • Postoperative Care / methods
  • Prospective Studies
  • Specimen Handling / methods
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / surgery*
  • Thyroidectomy / methods*
  • Treatment Outcome
  • Young Adult