Qin’s seven steps for endoscopic selective lateral neck dissection via the chest approach in patients with papillary thyroid cancer: experience of 35 cases

Abstract

Background Endoscopic thyroidectomy is widely performed as it does not result in neck scar. However, there is a paucity of reports pertaining to completely endoscopic lateral neck dissection (LND). In this study, we introduce our step-wise approach for performing endoscopic selective LND via the chest–breast approach. We refer to this approach as Qin’s seven steps. Methods The Qin’s seven steps are: (1) establishment of working space range; (2) dissection of lymph nodes between the SCM and the sternohyoid muscle (level IV) and exposure of omohyoid; (3) dissection of lymph nodes at level IV; (4) dissection of lymph nodes at level III; (5) dissection of lymph nodes at carotid triangle (level III); (6) exposure of accessory nerve and dissection of lymph nodes at level II a; (7) dissection of lymph nodes at level II b. We reviewed the clinical data of 35 patients with papillary thyroid cancer (PTC) who were operated using the Qin’s seven steps. Results All 35 patients successfully underwent LND; bilateral LND was performed in 5 patients. The mean tumor size was 1.8 ± 1.0 cm; seven patients had multiple lesions. The mean number of retrieved lymph nodes in level II, III and IV were 8.8 ± 5.6, 6.1 ± 4.0 and 9.3 ± 5.1, respectively. As for complications, there were 3 cases of accessory nerve injury and 1 case of hypoglossal nerve injury. Internal jugular vein injury, cervical plexus injury and lymphatic leakage occurred in 2, 7, and 1 patients, respectively. Conclusion The Qin’s seven steps for performing endoscopic selective LND could be safely used in PTC patients with lateral lymph node metastasis. Satisfactory results were achieved in the short-term follow-up period. We recommend the use of Qin’s seven steps for PTC patients who are not desirous of neck scar.

Cumulative sum analysis for evaluating learning curve of endoscopic lateral neck dissection

“…However, complete endoscopic LND is a technically challenging procedure, and has only been reported in a few studies [11][12][13]. Here, we demonstrate the feasibility of endoscopic LND via chest approach by summarizing early cases of our previous study [14].…”

“…However, due to the high cost of robotic instruments, the former have had limited application. In contrast, endoscopic LND via a chest approach is currently the most popular method among endoscopic approaches [11,14,20,22]. Since the learning curve has not been examined for the latter approach, CUSUM was applied in this study.…”

“…This surgical team completed over 2000 cases of endoscopic thyroidectomy in total. An early study on endoscopic LND has been published [14]. Inclusion criteria for the present study were: 1) con rmed case of PTC with metastatic lymph nodes at levels II, III, or IV based on ultrasonography, computed tomography, ne needle aspiration cytology, or intra-operative exploration; and 2) patients elected to undergo endoscopic surgery.…”

Endoscopic Lateral Neck Dissection: A New Frontier in Endoscopic Thyroid Surgery

“…Injury to the SAN was found in 2 patients, who subsequently developed light SCM dystrophy ( 41 ). Cervical plexus and hypoglossal nerve injury have been reported in Chen’s study ( 46 ). The general characteristics, technical safety (complications), and oncological outcomes of totally endoscopic surgeries are listed in Table 3 .…”

Wu’s seven steps for endoscopic central and lateral neck dissection via breast combined with oral approach for papillary thyroid cancer

“…In the wake of the development of endoscopic thyroidectomy and central compartment dissection in papillary thyroid cancer patients [10][11][12][13][14], more and more surgeons have begun attempting endoscopic lateral neck dissection [6, [15][16][17]. Most endoscopic lateral neck dissection were done by breast approach.…”