The surgical planes and anatomic landmarks in endoscopic thyroidectomy-a clinical anatomic research of 83 cases

Endoscopic thyroidectomy (ET) has been carried out for more than 20 years, but few studies on the anatomy of ET can be found in the literature. We performed this study to identify ET's surgical planes and anatomic landmarks by clinical anatomic research.

The surgical planes and anatomic landmarks were observed through an endoscope in 83 consecutive cases during living ET by the anterior chest approach.

The appropriate procedure spaces were between the superficial fascia and the pectoralis major fascia on the anterior chest, and between the platysma and the superficial layer of the deep fascia on the anterior neck, which formed two continuous layers. The ET dissecting triangle was the space between the strap muscles and the thyroid lobe, which formed the surgical plane for finding the inferior thyroid vessels (100.0%) and the middle thyroid vein (100.0%). The inferior parathyroid gland could be found beneath the inferior thyroid artery (92.5%), while the superior parathyroid gland was adjacent to the middle thyroid veins (90.0%). The recurrent laryngeal nerve could be found beneath the inferior parathyroid gland (85.7%). All exposed recurrent laryngeal nerves entered the larynx posterior and inferior to the thyroid cartilage, above which a vessel, perpendicular to the recurrent laryngeal nerve, and running from the thyroid lobe to the larynx (100.0%), served as a landmark.

The surgical planes and anatomic landmarks identified could guide surgeons and aid the preservation of the recurrent laryngeal nerve and the parathyroid glands during ET.