Transoral Endoscopic Modified Radical Neck Dissection for Papillary Thyroid Carcinoma
Transoral Endoscopic Modified Radical Neck Dissection for Papillary Thyroid Carcinoma
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DOI：
10.1245/s10434-020-09466-7
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发表时间：
2021-01-18
影响因子：
3.7
通讯作者：
Van Le, Quang
中科院分区：
文献类型：
--
作者：
Ngo, Duy Quoc;Tran, Toan Duc;Van Le, Quang
背景最近，经前庭入路的经口内镜甲状腺切除术（TOETVA）已在全球范围内流行。1 -3在对该技术进行控制后，作者使用经口内镜入路进行改良根治性颈淋巴结清扫术（MRND），治疗甲状腺乳头状癌伴外侧间室临床阳性淋巴结。据他们所知，作者报告了第一例TOETVA治疗MRND患者。1例27岁女性被诊断为cT 1aN 1bM 0右侧甲状腺乳头状癌（转移至右侧4级小淋巴结）。因此，经口内镜入路行甲状腺全切除术、双侧中央颈淋巴结清扫术和右侧第2、3、4节段MRND。采用Anuwong三套管针技术行甲状腺全切除术和双侧中央淋巴结清扫术，然后在右侧口前庭区第6颗牙齿附近作第4个切口，插入第4个5 mm套管针，暴露外侧淋巴室，便于进行右侧MRND。手术顺利完成，未转为开放手术。总手术时间170 min，MRND手术时间55 min。中央和右侧间室分别收获淋巴结7个和8个。转移淋巴结的数目分别为2个和1个，在中央和外侧室。术后无严重并发症发生。对于高度选择的患者，经口内镜MRND 2、3和4级是可行和安全的。
Background. Recently, transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) has become popular worldwide.1-3 After controlling for the technique, the authors used the transoral endoscopic approach to modified radical neck dissection (MRND) for papillary thyroid carcinoma with clinically positive lymph nodes in the lateral compartments. To the best of their knowledge, the authors report the first case of TOETVA for MRND.Patient. A 27-year-old woman had a diagnosis of cT1aN1bM0 right papillary thyroid carcinoma (metastatic to a small right level 4 lymph node). Therefore, total thyroidectomy, bilateral central neck dissection, and MRND of right levels 2, 3, and 4 were performed via the transoral endoscopic approach.Methods. Total thyroidectomy and bilateral central lymph node dissections were performed based on the three-trocar Anuwong technique.4 Then, the fourth incision was made near the sixth teeth in the right oral vestibular area for insertion of the fourth 5-mm trocar, which was used to expose the lateral lymph compartment and to perform right MRND easily.Results. The operation was completed successfully without conversion to open surgery. The total operative time was 170 min, and the operating time for MRND was 55 min. The numbers of harvested lymph nodes were 7 and 8 in the central and right lateral compartments, respectively. The numbers of metastatic lymph nodes were 2 and 1 in the central and lateral compartments, respectively. No major postoperative complications occurred.Conclusion. Transoral endoscopic MRND of levels 2, 3, and 4 can be feasible and safe for highly selected patients.