Central Lymph Node Dissection by Endoscopic Bilateral Areola Versus Open Thyroidectomy

Background: Endoscopic thyroidectomy by bilateral areola approach (ETBAA) potentially expose a technical limitation for anatomize the central compartment lymph nodes located in its most caudal portion 17 because of visual obstruction and instrument interference of clavicles and sternum. We provide a comparative analysis of ETBAA versus open 19 thyroidectomy approach (OTA) for central compartment dissection (CND). Methods: From October 2013 to August 2017, 400 patients with papillary thyroid cancer (PTC) underwent CND; 200 patients were 23 enrolled in each group. For the endoscopic group, a 10-mm curved incision is made along the margin of the right areola at 2 to 4’oclock 25 for the 30 degrees endoscope. Bilaterally 5-mm incisions are on the edges of the areola at 11 to 12’oclock as accessory operating ports. Supplementary video (Supplemental Digital Content 1, http://links. lww.com/SLE/A180) depicts steps of ETBAA with CND. Results: In ETBAA group, a total of 1049 lymph nodes were removed, 29 nodes excision ranged from 1 to 19 (mean, 5.25), the ratio positive/ 31 metastatic rate was 18.6%. In OTA group, 916 lymph nodes were excised, nodes removal amplitude was 1 to 20 (average, 4.58), 12.1% were metastatic. Compared with the open group, significantly more 33 lymph nodes were extracted during ETBAA (P < 0.05). There was no significant difference between the 2 groups per resected side or surgical 35 morbidity (P > 0.05). Periodic monitoring of PTC patients revealed no clinical or US recurrence, undetectable serum Tg in both groups. Conclusions: Our results show the feasibility of CND in ETBAA.