Wu's seven steps for endoscopic central and lateral neck dissection via breast combined with oral approach for papillary thyroid cancer

Abstract

Objective: We had previously reported endoscopic central and lateral neck dissection via breast combined with an oral approach for papillary thyroid cancer treatment. In this study, we optimized the procedure with Wu's seven steps to make the procedure quicker and easier.

Methods: Wu's seven steps for endoscopic central and lateral neck dissection via breast combined with oral approach for papillary thyroid cancer are: (1) establish the working space, (2) isolate the sternocleidomastoid and internal jugular vein, (3) dissect the thyroid via breast approach, (4) dissect the central lymph nodes via oral approach, (5) dissect the inferior board of level IV via oral approach, (6) remove the tissues of levels IV, III, and II via breast approach, and (7) wash the working space and place drainage tubes. Twelve patients were assigned to the Wu's seven steps group, and 13 patients were assigned to the contrast group. The operative procedure of the contrast group was the same as Wu's seven steps except for a few key differences, such as that the central lymph nodes were dissected via breast approach first and the internal jugular vein(IJV) was dissected from the cricoid cartilage down to the venous angle.

Results: The Wu's seven steps group had a short operation time and few injuries of the internal jugular vein. There were no statistical differences in other clinicopathological features or surgical complications.

Conclusion: It appears that Wu's seven steps for endoscopic central and lateral neck dissection via breast combined with oral approach for papillary thyroid cancer are effective and safe.

Keywords: Endoscopic thyroidectomy; Neck dissection; Papillary thyroid cancer.

Fig. 1

Step 1: working space is established. a Working space is established between platysma and AJVS. b The submandibular salivary gland and digastric muscle as the superior edge of lateral neck compartment. AJVS anterior jugular venous system, SCM sternocleidomastoid muscle, EJV external jugular vein, DM digastric muscle

Fig. 2

Step 2: the sternocleidomastoid and internal jugular vein are isolated. a The internal jugular vein (IJV) was exposed. b The accessory nerve was exposed. SCP superficial cervical plexus. IJV internal jugular vein, SCM sternocleidomastoid muscle, DM digastric muscle, AN accessory nerve

Fig. 3

Step 3: the thyroid was dissected via breast approach. a Thyroid is dissected via breast approach. b The recurrent laryngeal nerve (RLN) and superior parathyroid gland (SPT). IPT inferior parathyroid gland, SPT superior parathyroid gland, RLN recurrent laryngeal nerve

Fig. 4

Step 4: central lymph nodes were dissected via oral approach. CCA common carotid artery, RLN recurrent laryngeal nerve

Fig. 5

Step 5: the inferior board of level IV is dissected via oral approach. a The lymph node between sternocleidomastoid and sternohyoid muscle (LNSS). b The venous angle was carefully dissected along the surface of the subclavian vein via oral approach. SCM sternocleidomastoid muscle, LNSS lymph node between sternocleidomastoid and sternohyoid muscle, AJVS anterior jugular venous system, EJV external jugular vein, TCA transverse carotid artery, IJV internal jugular vein

Fig. 6

Step 6: the tissues of levels IV, III, and II are moved via breast approach. a The C4 nerve were protected carefully. b Dissect the carotid triangle. c Level II and accessory nerve after dissection. d Level III and C3, C4. e Level IV and the transverse carotid artery. SCM sternocleidomastoid muscle, SCP superficial cervical plexus, DM digastric muscle, LV lingual vein, IJV internal jugular vein, AN accessory nerve, TCA transverse carotid artery

Fig. 7

Step 7: working space is washed, and drainage tubes are placed. a The working space was washed with distilled water. b The cervical linea alba was sutured. c Drainage tubes were placed

Fig. 8

Operation time (min) of  the contrast group (from the case 1 to 13) and the Wu’s seven steps group (from the case 14 to 25)