Minilaparoscopy-Assisted Modified Neck Dissection Through Bilateral Breast Approach

Introduction: 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. Materials and Methods: 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 Chinese thyroid nodule and thyroid cancer guideline,(1) 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 Minilaparoscopy-assisted hemithyroidectomy and central neck dissection (level VI) using bilateral breast approach.(2) 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. Results: 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. Conclusions: 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. Acknowledgments: 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