Technical hints and potential pitfalls in modified radical neck dissection for thyroid cancer

Modified radical neck dissection (MRND) is often performed in conjunction with total thyroidectomy for the management of thyroid cancer. Prevention of postoperative sequelae after MRND is closely dependent on the avoidance of technical mistakes that may lead to significant complications and long-term morbidity. A thorough technical discussion with emphasis on potential pitfalls is made of the most relevant steps of MRND using the extrafascial approach: fascial dissection, approach to the accessory nerve, posterior limits, upper internal jugular vein (IJV), transverse cervical vessels, thoracic duct and compartment V dissection. Some anatomical hints are emphasized to help the novice surgeon to develop a refined surgical technique, the key to an uneventful postoperative course.