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

Abstract

Objective We had previously reported endoscopic central and lateral neck dissection via breast combined with an oral approach for papillary thyroid cancer treatment. In this study, we optimized the procedure with Wu’s seven steps to make the procedure quicker and easier. Methods Wu’s seven steps for endoscopic central and lateral neck dissection via breast combined with oral approach for papillary thyroid cancer are: (1) establish the working space, (2) isolate the sternocleidomastoid and internal jugular vein, (3) dissect the thyroid via breast approach, (4) dissect the central lymph nodes via oral approach, (5) dissect the inferior board of level IV via oral approach, (6) remove the tissues of levels IV, III, and II via breast approach, and (7) wash the working space and place drainage tubes. Twelve patients were assigned to the Wu’s seven steps group, and 13 patients were assigned to the contrast group. The operative procedure of the contrast group was the same as Wu’s seven steps except for a few key differences, such as that the central lymph nodes were dissected via breast approach first and the internal jugular vein(IJV) was dissected from the cricoid cartilage down to the venous angle. Results The Wu’s seven steps group had a short operation time and few injuries of the internal jugular vein. There were no statistical differences in other clinicopathological features or surgical complications. Conclusion It appears that Wu’s seven steps for endoscopic central and lateral neck dissection via breast combined with oral approach for papillary thyroid cancer are effective and safe.

Prophylactic central lymph node dissection in cN0 papillary thyroid cancer: a comparative study of via breast and transoral approach versus via breast approach alone

“…In this study, the mean number of CLND in the combined approach group was 10.6 ± 7.1, which was not different from that reported in previous studies [10.3 ± 4.6 ( 27 ), 11.3 ± 7.3 ( 28 )]. At the same time, we observed no difference in the mean number of central lymph nodes cleared in the combined approach group compared with traditional open surgery on the neck [10.87 ± 6.43 ( 21 ), 10.71 ± 5.17 ( 22 ), 10.1 ± 6.98 ( 23 )].…”

A scoping review of endoscopic and robotic techniques for lateral neck dissection in thyroid cancer

“…In Chen et al's case series of 24 patients, there was one case of chyle leak and IJV injury (18). In Wang et al's comparison study, there was one case of Horner's syndrome and 1 case of accessory nerve injury in the 7-step group (52). Transient chin or mandibular numbness also occurred in 4/63 patients (6.35%) but generally resolved within 2 weeks (50, 51).…”

“…Mean post operative LOS was specified in 2 studies and was 4.9-5.8 days for 49 patients (18,52). Mean operative times ranged from 256.0 to 362.1, with an outlier of 437 minutes for the case report by Wang et al (Table 5).…”

“…In the case report by Wang et al, they harvested 66 LN but do not specify levels nor describe their technique (44). There were no formal assessments of cosmetic outcomes in these studies, but the authors do note that all patients were satisfied with the cosmetic results in all cases (18,50,52).…”

“…Two case series, one comparative study, and a case report were identified for a total 63 patients ( Table 5 ). All cases began with thyroidectomy via the breast approach, but the technique used for CND varied between these studies, with 2 studies performing it through the breast approach, while 2 other studies preferred CND through the transoral approach ( 18 , 50 – 52 ). Afterwards, LND was done via the breast approach, dissecting level II-IV as previously described above ( 18 , 50 , 52 ).…”