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Technique for endoscopic thyroidectomy with selective lateral neck dissection via a chest–breast approach

  • Youming Guo
  • Rui QuEmail author
  • Jinlong Huo
  • Cunchuan Wang
  • Xiaochi Hu
  • Chen Chen
  • Daosheng Liu
  • Weiwei Chen
  • Jing Xiong
New Technology

Abstract

Background

Endoscopic thyroidectomy has been widely accepted because it can effectively avoid neck scarring. However, there are seldom reports concerning completely endoscopic lateral neck dissection approaches. In this study, we introduced a technique for performing endoscopic thyroidectomy with lateral neck dissection via a chest–breast approach.

Methods

We retrospectively reviewed 18 patients who underwent endoscopic total thyroidectomy along with levels II, III, IV, and VI dissection. All major outcomes, such as cosmetic effect, operative time and complications, etc., were analyzed. In addition, another 20 patients who underwent traditional open surgery (open group) were enrolled in the study to conduct a contrasting analysis between patients treated with the endoscopic technique (endoscopic group) and open group patients, in terms of demographic data and main operative outcomes, to evaluate the feasibility of this technique.

Results

All 18 endoscopic surgery cases were successfully performed, and no patient was converted to the open procedure intra-operatively. There were no significant differences between the two groups regarding age (P = 0.209), Body Mass Index (P = 0.479), sex (P = 0.218), drainage time (P = 0.153), operation time (P = 0.065), intra-operative blood loss (P = 0.139), post-operative pain (P = 0.114), and number of dissected lateral lymph nodes (II: P = 0.201; III + IV: P = 0.107). The mean total and lateral lymph nodes dissection (LLND) time in the endoscopic group were longer than those of the open group (P = 0.002; 235 ± 35 vs. 182 ± 20 min, P = 0.000; 125 ± 21 vs. 80 ± 14 min, P = 0.000). The primary lesion diameter of the endoscopic group was smaller than that of the open group (1.7 ± 0.8 vs. 2.9 ± 1.3 cm, P = 0.002). The scores for cosmetic satisfaction in the endoscopic group were higher than those in the open group (8.3 ± 0.7 vs. 4.4 ± 0.9, P = 0.000). Among the complications, there was no significant difference between the two approaches in transient vocal cord paresis (1/18 vs. 0/20, P = 0.474), transient hypoparathyroidism (4/18 vs. 4/20, P = 1.000), post-operative lymphatic leakage (1/18 vs. 3/20, P = 0.606), and intra-operative large blood vessel injury (2/18 vs. 0/20, P = 0.218). There was no incidence of uncontrolled bleeding, mental nerve injury, permanent hypoparathyroidism, permanent recurrent laryngeal nerve (RLN) injury, skin bruise on the neck, asphyxia/dyspnea or other complications like tracheal injury, esophageal injury, etc., nor was there any death or recurrence in either of the two groups during the short follow-up period.

Conclusion

It is feasible to perform LLND (levels II, III, IV, and VI) with endoscopic thyroidectomy via a chest–breast approach. In particular, this technique avoids a large scar on the patient’s neck and has well operative outcomes compared with open surgery. Accordingly, this technique may offer one more option for selective patients.

Keywords

Endoscopic thyroidectomy Chest–breast approach Lateral neck dissection Clearance of lateral lymph nodes 

Notes

Acknowledgements

This work was supported by the Major Project from the Technology and Science Bureau of Zunyi City, China (No. 2014-25).

Compliance with ethical standards

Disclosures

Drs. Youming Guo, Rui Qu, Jinlong Huo, Cunchuan Wang, Xiaochi Hu, Chen Chen, Daosheng Liu, Weiwei Chen and Jing Xiong have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MP4 440558 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Youming Guo
    • 1
  • Rui Qu
    • 1
    Email author
  • Jinlong Huo
    • 1
  • Cunchuan Wang
    • 2
  • Xiaochi Hu
    • 1
  • Chen Chen
    • 1
  • Daosheng Liu
    • 1
  • Weiwei Chen
    • 3
  • Jing Xiong
    • 1
  1. 1.Department of Thyroid SurgeryFirst People’s Hospital of ZunyiZunyiChina
  2. 2.Department of General SurgeryFirst Affiliated Hospital of Jinan UniversityGuangzhouChina
  3. 3.Department of Endoscopy CenterFirst People’s Hospital of ZunyiZunyiChina

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