Zhao Wenxin, Wang Bo, Yan Shouyi, Zhang Liyong
Department of Vascular and Thyroid Surgery, Fujian Medical University Affiliated Union Hospital, Fuzhou, China.
VideoEndocrinology. 2016 Jun 6;3(2). doi: 10.1089/ve.2015.0038. eCollection 2016.
Minilaparoscopy-assisted modified neck dissection through bilateral breast approach is a technique for thyroidectomy in patients with thyroid disease. This technique can promote the effect of cosmetology in thyroid surgery and neck dissection. In this video, we present a modified neck dissection and demonstrate important structures in the operation. In January 2015, we operated a 28-year-old female patient. The patient underwent fine-needle aspiration cytology and was found to have papillary thyroid carcinoma with lateral lymph node metastasis in the right side of the neck. After CT scanning and ultrasonic inspection preoperatively, the clinical staging was cT1bN1bM0 staging I. According to the , we decided to perform total thyroidectomy and right modified neck dissection through the bilateral areolar approach. The operation room setup and the steps to create the operation space are described in the video So the approach started with incision in front of the sternocleidomastoid muscle, then we dissected the carotid triangle, presenting the posterior belly of the digastric muscles, accessory nerve (XI), and hypoglossal nerve (XII). The dissection continued by the intermuscular approach to expose the venous angle and ligature of the right lymphatic duct. While identifying the transverse cervical artery and cervical nerves, we removed the specimen, then completed the modified neck dissection. Finally, we present the recurrent laryngeal nerves, parathyroids, and other important structures mentioned earlier after dissection. The patient operated using this technique was hospitalized for 6 days without any postoperative complication. Minilaparoscopy-assisted modified neck dissection through bilateral breast approach can give more cosmetic results and minimal invasion for young patients with lateral lymph node metastasis. We prefer to operate N1b thyroid cancer without mediastinal lymph node metastasis. This technique can bring better cosmetic results and minimal invasion for young patients. This video is funded under the clinical major departments' construction project by the Ministry of Health, the clinical major department's construction project by the Fujian Provincial and Young and middle-aged backbone training project in health system of Fujian province, grant number 2013-ZQN-ZD-13. No competing financial interests exist. Runtime of video: 7 mins 24 secs.
经双侧乳晕入路的微型腹腔镜辅助改良颈部淋巴结清扫术是一种用于治疗甲状腺疾病患者的甲状腺切除术技术。该技术可提高甲状腺手术和颈部淋巴结清扫术的美容效果。在本视频中，我们展示了改良颈部淋巴结清扫术并演示了手术中的重要结构。2015年1月，我们为一名28岁女性患者进行了手术。该患者接受了细针穿刺细胞学检查，发现患有甲状腺乳头状癌并伴有右侧颈部淋巴结转移。术前经CT扫描和超声检查，临床分期为cT1bN1bM0 Ⅰ期。根据相关情况，我们决定经双侧乳晕入路行全甲状腺切除术及右侧改良颈部淋巴结清扫术。视频中描述了手术室设置及创建手术空间的步骤。手术入路始于胸锁乳突肌前方切口，然后我们解剖颈动脉三角，显露二腹肌后腹、副神经（Ⅺ）和舌下神经（Ⅻ）。通过肌间入路继续解剖以暴露静脉角并结扎右淋巴导管。在识别颈横动脉和颈神经的同时，我们切除标本，然后完成改良颈部淋巴结清扫术。最后，我们展示了解剖后的喉返神经、甲状旁腺及其他前述重要结构。采用该技术手术的患者住院6天，无任何术后并发症。经双侧乳晕入路的微型腹腔镜辅助改良颈部淋巴结清扫术可为有侧方淋巴结转移的年轻患者带来更好的美容效果且创伤极小。我们更倾向于为无纵隔淋巴结转移的N1b期甲状腺癌患者实施手术。该技术可为年轻患者带来更好的美容效果且创伤极小。本视频由卫生部临床重点专科建设项目、福建省临床重点专科建设项目及福建省卫生系统中青年骨干培养项目资助，资助编号2013-ZQN-ZD-13。不存在利益冲突。视频时长：7分24秒。
