Upgraded bidirectional approach video-assisted neck surgery (BAVANS) using a rigid endoscope with variable viewing direction for advanced endoscopic lymph node dissection in thyroid cancer patients

A retrospective comparison of mid-cheek tumor dissection between endoscopically assisted and conventional approach

BACKGROUND

Surgery for tumors in the mid-cheek area are challenging. Endoscopic-assisted dissection of benign mid-cheek tumors is gradually being reported. This study evaluated the indications, advantages and disadvantages of endoscopically assisted mid-cheek benign tumor resection using a single preauricular or transoral incision and compared it with the conventional approach.

METHODS

Fifty-four patients with benign mid-cheek tumors could be divided into three groups: a conventional (20 patients) parotidectomy access surgery group, another two endoscope-assisted tumor dissections groups through a single preauricular incision (17 patients) or transoral incision (17 patients). Their surgical approaches were introduced, and the tumor long-axis length, incision length, operative time, estimated intraoperative bleeding, postoperative drainage amount and time, aesthetic satisfaction, perioperative complications, and follow-up were recorded and analyzed.

RESULTS

The tumor long-axis lengths were comparable between the groups, and all surgical procedures were completed as planned. The endoscopic procedure group improved the incision size, intraoperative blood loss, drainage, perioperative complications, and cosmetic satisfaction. Meanwhile, aesthetic pleasure is highest with the transoral incision. No tumor recurrence was found during the 1-54-month of follow-up.

CONCLUSION

Endoscopic-assisted preauricular or transoral incision for dissecting mid-cheek benign tumors is more aesthetic and minimally invasive than conventional surgical approaches with available results, reducing complications, narrowing the surgical incision, and obtaining satisfactory aesthetic results.

Optimal surgical population for cervical lymph node dissection in PTC

Objective

There is still controversy about whether cervical lymph node dissection should be performed in surgical treatment of PTC. Based on the data of thyroid cancer patients from Liaocheng People's Hospital from 2015 to 2018, this study focused on appropriate indications for cervical lymph node dissection surgery.

Methods

The clinical and pathological data of patients with initial treatment of PTC in thyroid surgery department from 2015 to 2018 were collected. In all cases, 1001 patients underwent total thyroidectomy + central lymph node dissection, and 1107 patients underwent total thyroidectomy + central + cervical lymph node dissection.

Results

The average metastasis rate of all cases was 57.23%, and even the metastasis rate of PTMC was as high as 48.97%. The total metastasis rate of central and lateral cervical lymph nodes was 74.44%, and the cervical lymph nodes were present in 49.32% of the metastatic cases. In 55.56% of the cases, the tumor diameter was more than 1 cm, and the metastasis rate of cervical lateral area was 56%. With the increase of tumor diameter, the cervical metastasis rate increased from 22.54% to 73.33%.

Conclusion

The metastasis rate of PTC is more than 50%, and nearly half of them have cervical metastasis, especially in patients with high risk factors. We observed that PTC 1 cm or greater has significant rates of metastasis.

The usefulness and utilization of a detachable steel wire-rimmed retractor (KN retractor) for endoscopic thyroid and parathyroid surgery

PURPOSE

In endoscopic surgery, surgeons occasionally encounter difficulties due to visual field obstruction by muscles or blood vessels. In these situations, specialized instruments that can effectively retract these obstructions are required. Recently, we developed a new detachable wire-rimmed retractor (KN retractor) for narrow-space surgery.

METHODS

We evaluated the utility of this KN retractor in 15 patients with thyroid and parathyroid disease. Of those, five patients with papillary thyroid cancer had gasless endoscopic hemithyroidectomy with central node dissection, five underwent endoscopic total thyroidectomy for Graves' disease, and the remaining five received endoscopic parathyroidectomy with gas insufflation.

RESULTS

Surgeons were able to perform meticulous operations in a satisfactory visual field supported by the KN retractor. In all patients, the strap muscles were preserved without cutting. The average operating time was 149, 154, and 81 min in patients who underwent hemithyroidectomy with central node dissection, total thyroidectomy, and parathyroidectomy, respectively. Gas insufflation was successfully completed in all cases while maintaining sufficient airtightness.

CONCLUSIONS

The KN retractor is suitable for both the gasless lifting method and gas insufflation surgery in a narrow space. We believe that the KN retractor is a new device that will greatly improve the safety and shorten the operation time in endoscopic surgery.