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Central Lymph Node Dissection by Endoscopic Bilateral Areola Versus Open Thyroidectomy

Zhang, Daqi, MD*; Wang, Tie, MD*; Dionigi, Gianlorenzo, MD, FACS, MD; Zhang, Jiao, MD*; Xue, Gaofeng, MD*; Sun, Hui, MD*

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: February 2019 - Volume 29 - Issue 1 - p e1–e6
doi: 10.1097/SLE.0000000000000579
Online Articles: Technical Reports

Background: Endoscopic thyroidectomy by bilateral areola approach (ETBAA) potentially expose a technical limitation for anatomize the central compartment lymph nodes located in its most caudal portion because of visual obstruction and instrument interference of clavicles and sternum. We provide a comparative analysis of ETBAA versus open thyroidectomy approach (OTA) for central compartment dissection (CND).

Methods: From October 2013 to August 2017, 400 patients with papillary thyroid cancer (PTC) underwent CND; 200 patients were enrolled in each group. For the endoscopic group, a 10-mm curved incision is made along the margin of the right areola at 2 to 4’oclock for the 30 degrees endoscope. Bilaterally 5-mm incisions are on the edges of the areola at 11 to 12’oclock as accessory operating ports. Supplementary video (Supplemental Digital Content 1, depicts steps of ETBAA with CND.

Results: In ETBAA group, a total of 1049 lymph nodes were removed, nodes excision ranged from 1 to 19 (mean, 5.25), the ratio positive/metastatic rate was 18.6%. In OTA group, 916 lymph nodes were excised, nodes removal amplitude was 1 to 20 (average, 4.58), 12.1% were metastatic. Compared with the open group, significantly more lymph nodes were extracted during ETBAA (P<0.05). There was no significant difference between the 2 groups per resected side or surgical morbidity (P>0.05). Periodic monitoring of PTC patients revealed no clinical or US recurrence, undetectable serum Tg in both groups.

Conclusions: Our results show the feasibility of CND in ETBAA.

*Jilin Provincial Key Laboratory of Surgical Translational Medicine, Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China

Department of Human Pathology in Adulthood and Childhood “G. Barresi,” Division of Endocrine and Minimally Invasive Surgery, Department of Surgical Oncology, University Hospital - Policlinico “G.Martino,” University of Messina, Messina, Italy

Supported by Jilin provincial special fund for health care (no. SCZSY201714 and SCZSY201504) and the Outstanding Young Talent Foundation Project of Science and Technology Department in Jilin Province (grant no. 20170520018JH), China.

The authors declare no conflicts of interest.

Reprints: Hui Sun, MD, Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun, Jilin Province, China (e-mail:

Received June 24, 2018

Accepted August 14, 2018

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