title: Bidirectional Approach of Video-Assisted Neck Surgery (BAVANS): Endoscopic complete central node dissection with craniocaudal view for treatment of thyroid cancer.
abstract: BACKGROUND
  Endoscopic thyroidectomy is a well-established surgical technique that is mainly performed for benign thyroid disease. We considered that endoscopic surgery could also be widely indicated for the treatment of thyroid cancer. We herein describe our new bidirectional approach of video-assisted neck surgery (BAVANS) for complete central node dissection in endoscopic thyroid cancer surgery.
  
  
  METHODS
  BAVANS involves two different directional pathways to the cervical lesion. Before lymph node dissection, we perform endoscopic thyroidectomy via a conventional gasless precordial or axillary approach. After thyroidectomy, the surgeon repositions by the head of the patient and inserts three ports in front of the upper neck lesion in the submandibular area to approach the paratracheal lesion from an overhead-to-caudal direction.
  
  
  RESULTS
  BAVANS allows for an excellent craniocaudal view and easy access to the peritracheal lymph nodes. Sixteen patients with papillary thyroid cancer underwent BAVANS and progressed satisfactorily after surgery. Of those patients, eight underwent total or near total thyroidectomy, and five patients underwent bilateral central node dissection. The average number of retrieved lymph nodes with unilateral central node dissection was nine, which was higher than that achieved with conventional open surgery. All patients began oral intake within 5 h after surgery. Postoperative Horner syndrome occurred in one patient. No other complications were noted.
  
  
  CONCLUSIONS
  BAVANS is a very effective surgical procedure that many endoscopic surgeons can perform safely and easily. It has both a cosmetic advantage and excellent curability in endoscopic thyroid cancer surgery.
authors.affiliation: Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nakajo
authors.affiliation: Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Arima
authors.affiliation: Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan.
authors.forename: Munetsugu
authors.initials: M
authors.lastname: Hirata
authors.affiliation: Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan.
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shinden
authors.affiliation: Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Hayashi
authors.affiliation: Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan.
authors.forename: Yota
authors.initials: Y
authors.lastname: Kawasaki
authors.affiliation: Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Arigami
authors.affiliation: Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan.
authors.forename: Yasuto
authors.initials: Y
authors.lastname: Uchikado
authors.affiliation: Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Mori
authors.affiliation: Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Mataki
authors.affiliation: Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Sakoda
authors.affiliation: Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kijima
authors.affiliation: Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Uenosono
authors.affiliation: Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan.
authors.forename: Kosei
authors.initials: K
authors.lastname: Maemura
authors.affiliation: Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Natsugoe
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000601:surgery*; D002291:Carcinoma, Papillary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D010865:Pilot Projects; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000379:methods*
keywords: BAVANS; bidirectional approach; endoscopic thyroidectomy