Endoscopic lateral neck dissection via breast approach for papillary thyroid carcinoma: a preliminary report

Traditional open surgery for lateral neck dissection for patients with papillary thyroid carcinoma (PTC) requires a large incision to obtain adequate exposure of the surgical field, leaving an unsightly scar. We applied scarless (in the neck) endoscopic thyroidectomy (SET) via breast approach to lateral neck dissection for PTC and evaluated its feasibility and safety.

Between July 2007 and October 2009, 11 T1 (tumor size not exceeding 2 cm) low-risk PTC female patients with suspected lymph node metastasis at level III or IV were selected for this procedure. After accomplishing thyroidectomy and central compartment dissection, ipsilateral level III and IV dissection via breast approach was performed. The steps of endoscopic lateral neck dissection were similar to that of conventional surgery except that the lateral cervical compartment was exposed by splitting the sternocleidomastoid muscles (SCM) longitudinally.

This procedure was carried out successfully in all 11 patients. Mean operative time for lateral neck dissection was 94.3 min (range 77-123 min). No significant blood loss or complications occurred. Average postoperative hospital stay was 4.3 days (range 3-6 days). Ten patients had lymph node metastasis in both central and lateral zones, while one patient had central zone metastasis only. Mean lymph node yield in the lateral compartment was 18.3 (range 9-26). No evidence of residual or recurrent disease was found at follow-up. The cosmetic results of this procedure were excellent.

Endoscopic lateral neck dissection via breast approach is feasible and safe with excellent cosmetic results for selected cases of PTC. Further study based on large comparative series and long-term follow-up is needed to verify its oncological validity.