Skip to main content

Advertisement

SpringerLink
Log in

Gasless Single-Incision Endoscopic Surgery via Subclavicular Approach for Lateral Neck Dissection in Patients with Papillary Thyroid Cancer

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The technical difficulties and trauma of remote access methods in endoscopic surgery (ES) for lateral neck dissection (LND) can be daunting for most patients with papillary thyroid cancer (PTC) and surgeons. The purpose of study was to introduce gasless single-incision ES via a subclavicular approach (ESSA) and to explore its safety and efficacy for LND.

Methods

Between January 2022 and February 2023, we retrospectively reviewed 17 patients with PTC who underwent ESSA for LND. In addition, 22 patients who received video-assisted ES (VAES) and 48 patients who underwent open surgery (OP) for LND during the same period were included. Clinicopathological characteristics, complications, and efficacy of the lymph node yield (LNY) were compared between the ESSA and the other two groups (VAES and OP).

Results

The LNY from central and lateral neck dissection by ESSA was comparable to that by VAES (9.2 ± 8.1 vs. 9.5 ± 4.2, P = 0.986, and 33.5 ± 11.6 vs. 30.6 ± 9.2, P = 0.382, respectively) and OP (9.2 ± 8.1 vs. 11.0 ± 5.4, P = 0.420, and 33.5 ± 11.6 vs. 31.5 ± 7.9, P = 0.383, respectively). Swallowing impairment scores at 1 and 3 months were significantly lower after ESSA than those after VAES (1.8 ± 1.0 vs. 3.0 ± 1.2, P = 0.003, and 0.9 ± 0.8 vs. 1.7 ± 0.8, P = 0.006, respectively). The cosmetic satisfaction rate 1 month after surgery was significantly higher in the ESSA group than that in the VAES group (100 vs. 31.8%, P < 0.001).

Conclusions

ESSA is a safe and minimally invasive procedure that provides a scarless cervical appearance and has good efficacy for LND. Therefore, ESSA may be a feasible choice for selected patients with N1b PTC with cervical cosmetic needs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. Kasemsiri P, Trakulkajornsak S, Bamroong P, Mahawerawat K, Piromchai P, Ratanaanekchai T. Comparison of quality of life between patients undergoing trans-oral endoscopic thyroid surgery and conventional open surgery. BMC Surg. 2020;20:18.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Jiang WJ, Yan PJ, Zhao CL, et al. Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis. Surg Endosc. 2020;34:1891–903.

    Article  PubMed  Google Scholar 

  3. Lombardi CP, Raffaelli M, Princi P, De Crea C, Bellantone R. Minimally invasive video-assisted functional lateral neck dissection for metastatic papillary thyroid carcinoma. Am J Surg. 2017;193:114–8.

    Article  Google Scholar 

  4. Zhang D, Gao L, Xie L, et al. Comparison between video-assisted and open lateral neck dissection for papillary thyroid carcinoma with lateral neck lymph node metastasis: a prospective randomized study. J Laparoendosc Adv Surg Tech A. 2017;27(11):1151–7.

    Article  PubMed  Google Scholar 

  5. Chen ZX, Song YM, Chen JB, et al. Qin’s seven steps for endoscopic selective lateral neck dissection via the chest approach in patients with papillary thyroid cancer: experience of 35 cases. Surg Endosc. 2022;36:2524–31.

    Article  PubMed  Google Scholar 

  6. Yan HC, Xiang C, Wang Y, Wang P. Scarless endoscopic thyroidectomy (SET) lateral neck dissection for papillary thyroid carcinoma through breast approach: 10 years of experience. Surg Endosc. 2021;35:3540–6.

    Article  PubMed  Google Scholar 

  7. Tan Y, Guo B, Deng X, et al. Transoral endoscopic selective lateral neck dissection for papillary thyroid carcinoma: a pilot study. Surg Endosc. 2020;34:5274–82.

    Article  PubMed  Google Scholar 

  8. Wang Y, Luo Y, Wu G, Lin S, Fu Y. Wu’s seven steps for endoscopic central and lateral neck dissection via breast combined with oral approach for papillary thyroid cancer. Surg Endosc. 2023;37(7):5380–7.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Zhang Z, Sun B, Ouyang H, Cong R, Xia F, Li X. Endoscopic lateral neck dissection: a new frontier in endoscopic thyroid surgery. Front Endocrinol. 2021;12:796984.

    Article  Google Scholar 

  10. Mathew G, Agha R, Albrecht J, et al. STROCSS 2021: strengthening the reporting of cohort, cross-sectional and case-control studies in surgery. Int J Surg. 2021;96:106165.

    Article  PubMed  Google Scholar 

  11. Zheng G, Xu J, Wu G, et al. Transoral versus gasless transaxillary endoscopic thyroidectomy: a comparative study. Updates Surg. 2022;74:295–302.

    Article  PubMed  Google Scholar 

  12. Lombardi CP, Raffaelli M, D’alatri L, et al. Video-assisted thyroidectomy significantly reduces the risk of early postthyroidectomy voice and swallowing symptoms. World J Surg. 2008;32:693–700.

    Article  PubMed  Google Scholar 

  13. Akasu H, Shimizu K, Kitagawa W, Ishii R, Tanaka S. Evaluation of an alternative, subclavicular approach to thyroidectomy. Med Sci Monit. 2002;8:CS80–2.

    PubMed  Google Scholar 

  14. Beisša V, Sileikis A, Eismontas V, Strupas K. Video-assisted loboisthmectomy by the subclavicular approach. A case report. Wideochir Inne Tech Maloinwazyjne. 2012;7:206–9.

    PubMed  PubMed Central  Google Scholar 

  15. Kitagawa W, Shimizu K, Akasu H, Tanaka S. Endoscopic neck surgery with lymph node dissection for papillary carcinoma of the thyroid using a totally gasless anterior neck skin lifting method. J Am Coll Surg. 2003;196:990–4.

    Article  PubMed  Google Scholar 

  16. Zhang D, Xie L, He G, et al. A comparative study of the surgical outcomes between video-assisted and open lateral neck dissection for papillary thyroid carcinoma with lateral neck lymph node metastases. Am J Otolaryngol. 2017;38:115–20.

    Article  CAS  PubMed  Google Scholar 

  17. Zhang Z, Xu Z, Li Z, et al. Minimally invasive endoscopically-assisted neck dissection for lateral cervical metastases of thyroid papillary carcinoma. Br J Oral Maxillofac Surg. 2014;52(9):793–7.

    Article  PubMed  Google Scholar 

  18. Aliyev S, Taskin HE, Agcaoglu O, et al. Robotic transaxillary total thyroidectomy through a single axillary incision. Surgery. 2013;153:705–10.

    Article  PubMed  Google Scholar 

  19. Xu S, Huang H, Huang Y, et al. Comparison of lobectomy vs total thyroidectomy for intermediate-risk papillary thyroid carcinoma with lymph node metastasis. JAMA Surg. 2023;158:73–9.

    Article  PubMed  Google Scholar 

  20. Kuba S, Yamanouchi K, Hayashida N, et al. Total thyroidectomy versus thyroid lobectomy for papillary thyroid cancer: comparative analysis after propensity score matching: a multicenter study. Int J Surg. 2017;38:143–8.

    Article  PubMed  Google Scholar 

  21. Adam MA, Pura J, Gu L, et al. Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients. Ann Surg. 2014;260:601–5.

    Article  PubMed  Google Scholar 

  22. Wang Z, Xiang J, Gui Z, et al. Unilateral TNM T1 and T2 papillary thyroid carcinoma with lateral cervical lymph node metastasis: total thyroidectomy or lobectomy? Endocr Pract. 2020;26:1085–92.

    Article  PubMed  Google Scholar 

  23. Guo Y, Qu R, Huo J, Wang C, Hu X, Chen C, Liu D, Chen W, Xiong J. Technique for endoscopic thyroidectomy with selective lateral neck dissection via a chest-breast approach. Surg Endosc. 2019;33:1334–41.

    Article  PubMed  Google Scholar 

  24. Chen ZX, Chen JB, Pang FS, et al. A novel hybrid approach for “scarless” (at the neck) lateral neck dissection for papillary thyroid carcinoma: a case series and literature review. Front Oncol. 2022;12:985761.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Zheng G, Ma C, Sun H, et al. Safety and surgical outcomes of transoral endoscopic thyroidectomy vestibular approach for papillary thyroid cancer: a two-centre study. Eur J Surg Oncol. 2021;47:1346–51.

    Article  PubMed  Google Scholar 

  26. Qu R, Hu X, Guo Y, et al. Endoscopic lateral neck dissection (IIA, IIB, III, and IV) using a breast approach: outcomes from a series of the first 24 cases. Surg Laparosc Endosc Percutan Tech. 2020;31:66–70.

    Article  PubMed  Google Scholar 

  27. Lin P, Liang F, Cai Q, et al. Comparative study of gasless endoscopic selective lateral neck dissection via the anterior chest approach versus conventional open surgery for papillary thyroid carcinoma. Surg Endosc. 2021;35:693–701.

    Article  CAS  PubMed  Google Scholar 

  28. Huo J, Guo Y, Hu X, et al. Endoscopic thyroidectomy with level Vb dissection via a chest-breast approach: technical updates for selective lateral neck dissection. Surg Laparosc Endosc Percutan Tech. 2021;31:342–5.

    Article  PubMed  Google Scholar 

  29. Hyun K, Byon W, Park HJ, Park Y, Park C, Yun JS. Comparison of swallowing disorder following gasless transaxillary endoscopic thyroidectomy versus conventional open thyroidectomy. Surg Endosc. 2014;28:1914–20.

    Article  PubMed  Google Scholar 

  30. Liu N, Chen B, Li L, Zeng Q, Lv B. Subplatysmal or subfascial approach in totally endoscopic thyroidectomy has better postoperative efficacy for voice, sensory, swallowing symptoms and cosmetic result. Cohort study. Int J Surg. 2018;60:22–7.

    Article  PubMed  Google Scholar 

  31. Arakawa-Sugueno L, Ferraz AR, Morandi J, Capobianco DM, Cernea CR, Sampaio MA, Kulcsar MA, Simões CA, Brandão LG. Videoendoscopic evaluation of swallowing after thyroidectomy: 7 and 60 days. Dysphagia. 2015;30:496–505.

    Article  PubMed  Google Scholar 

  32. Li Z, Wang P, Wang Y, et al. Endoscopic lateral neck dissection via breast approach for papillary thyroid carcinoma: a preliminary report. Surg Endosc. 2011;25:890–6.

    Article  MathSciNet  PubMed  Google Scholar 

  33. Yan H, Wang Y, Wang P, Xie Q, Zhao Q. “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. Surg Endosc. 2015;29:2158–63.

    Article  PubMed  Google Scholar 

  34. Wang B, Weng YJ, Wang SS, et al. Feasibility and safety of needle-assisted endoscopic thyroidectomy with lateral neck dissection for papillary thyroid carcinoma: a preliminary experience. Head Neck. 2019;41:2367–75.

    Article  PubMed  Google Scholar 

  35. Kuang P, Wang Y, Wu G, et al. Endoscopic lateral neck dissection via the breast and transoral approaches for papillary thyroid carcinoma: a preliminary report. Front Surg. 2022;9:997819.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgment

The authors thank Editage (www.editage.cn) for English language editing.

Funding

This work was funded by the Taishan Scholars Foundation of Shandong Province (No. ts20190991) and the Key R&D Project of Shandong Province (2022CXPT023).

Author information

Author notes

  1. Guibin Zheng, Weifang Ding and Xincheng Liu have contributed equally to this work.

Authors and Affiliations

  1. Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, People’s Republic of China

    Guibin Zheng MD, Xincheng Liu MD, Yang Liu MD, Haiqing Sun MD & Haitao Zheng MD, PHD

  2. Department of Health Care, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, People’s Republic of China

    Weifang Ding MD

  3. Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, People’s Republic of China

    Xicheng Song MD, PHD

  4. Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, Shandong, People’s Republic of China

    Xicheng Song MD, PHD

Authors
  1. Guibin Zheng MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Weifang Ding MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xincheng Liu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yang Liu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Haiqing Sun MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xicheng Song MD, PHD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Haitao Zheng MD, PHD
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HZ, XS: Study concept and design. GZ, WD, XL: Drafting of the manuscript. WD, XL, YL, HS: Acquisition of data, analysis, and interpretation of data. GZ, HZ, XS: Critical revision of the manuscript. GZ, WD, XL: Statistical analysis. HZ, XS: Study supervision. All authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Xicheng Song MD, PHD or Haitao Zheng MD, PHD.

Ethics declarations

Disclosure

The authors have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 3447 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zheng, G., Ding, W., Liu, X. et al. Gasless Single-Incision Endoscopic Surgery via Subclavicular Approach for Lateral Neck Dissection in Patients with Papillary Thyroid Cancer. Ann Surg Oncol 31, 1498–1508 (2024). https://doi.org/10.1245/s10434-023-14639-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-023-14639-1

Keywords

Search

Navigation