Central neck lymph node removal during minimally invasive video-assisted thyroidectomy for thyroid carcinoma: a feasible and safe procedure.
OBJECTIVE
In 1998, we developed a technique for video-assisted thyroidectomy (VAT) which we proposed using also in patients with small low-risk papillary thyroid carcinomas (PTC). In some cases, enlarged lymph nodes are incidentally found at surgery for PTC. These nodes should be removed because of the risk of metastases. In this paper, we report on the patients in whom we removed enlarged central neck lymph nodes during VAT for PTC and discuss the feasibility and safety of video-assisted central neck lymph node dissection (VALD).


METHODS
The procedure is performed by a totally gasless video-assisted technique through a single 1.5-to 2.0-cm skin incision above the sternal notch. Dissection is performed under endoscopic vision using a technique very similar to that of conventional surgery. Only enlarged lymph nodes were removed and sent for frozen section examination (FS). No other dissection was performed in case of negative FS. Five patients underwent VALD during VAT for PTC.


RESULTS
The mean number of lymph nodes removed was 2.4. No metastases were found at FS or final histology examination. Postoperative complications included two transient postoperative hypocalcemias. No evidence of residual or recurrent disease was observed at postoperative follow-up. The cosmetic result was excellent.


CONCLUSIONS
Our experience demonstrates that removal of central compartment lymph nodes is feasible and safe. Perhaps also complete central neck lymph node dissection can be performed. Some doubts persist about the oncologic validity of this approach. For definitive conclusions, larger series and comparative studies are necessary.
Division of Endocrine Surgery, Department of Surgery, Universitá Cattolica del Sacro Cuore, Rome, Italy.
Rocco
R
Bellantone
Celestino Pio
CP
Lombardi
Marco
M
Raffaelli
Mauro
M
Boscherini
Pier Francesco
PF
Alesina
Pietro
P
Princi
D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000601:surgery*; D018265:Carcinoma, Papillary, Follicular / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008197:Lymph Node Excision / Q000379:methods*; D008875:Middle Aged; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D014741:Video Recording