Central Lymph Node Dissection by Endoscopic Bilateral Areola Versus Open Thyroidectomy. Issue 1 (February 2019)

• Record Type: Journal Article
• Authors: Zhang, Daqi; Wang, Tie; Dionigi, Gianlorenzo; Zhang, Jiao; Xue, Gaofeng; Sun, Hui
• Is Part Of: Surgical laparoscopy endoscopy & percutaneous techniques. Volume 29:Issue 1(2019)
• Publication Date: 2019-02
• Subjects: central node dissection -- lymph node metastases -- morbidity -- neuromonitoring -- recurrent laryngeal nerve -- endoscopic thyroidectomy; Endoscopic surgery -- Periodicals; Laparoscopic surgery -- Periodicals; Endoscopy -- Periodicals; Laparoscopy -- Periodicals; 617.550597
• DOI: 10.1097/SLE.0000000000000579
• Languages: English
• ISSNs: 1530-4515

Abstract

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. Abstract : Supplemental Digital Content is available in the text.