[Modified gasless trans-subclavian approach endoscopic lateral neck dissection for treatment of papillary thyroid carcinoma: a series of 31 cases].

Objective: To examine the feasibility of the modified gasless trans-subclavian approach endoscopic thyroidectomy for lateral neck dissection (LND) in papillary thyroid carcinoma (PTC). Methods: The clinical data of 31 patients with PTC who underwent modified gasless trans-subclavian approach endoscopic LND in the Department of Head and Neck Surgery, Run Run Shaw Hospital, from January to October 2022 were retrospectively analyzed. There were 2 males and 29 females, aged (32.6±8.3) years (range: 17 to 55 years). The maximum diameter of the primary thyroid lesion (M(IQR)) was 1.06 (1.16) cm (range: 0.53 to 2.44 cm), and the maximum diameter of the metastatic lymph node was (1.04±0.37) cm (range: 0.44 to 1.88 cm). Operation time, postoperative hospital stay, number of lymph nodes dissected, and postoperative complications were recorded. Outpatient follow-up was conducted until November 30, 2022. Results: All operations were successfully completed with the endoscopy approach without conversion to open surgery. The operation time was 160 (20) minutes (range: 100 to 215 minutes), and the postoperative hospital stay was 4 (2) days (range: 2 to 14 days). The number of lymph nodes obtained by dissection in the central and lateral compartment of the neck was 11 (12) (range: 0 to 37) and 34.7±14.8 (range: 15 to 69), respectively. Temporary hypoparathyroidism occurred in 4 cases and all recovered within 1 month after the operation. One case suffered from recurrent laryngeal nerve injury (continuing followed up to assess whether it is a temporary injury). The complication of LND included 1 case of chylous leakage that was recovered with conservative treatment, 1 case of Horner syndrome returned to normal 3 months after surgery. During follow-up, there was no residual tumor or recurrence. Conclusion: The modified gasless trans-subclavian approach endoscopic LND for PTC is feasible, with a thorough dissection and concealed incision.目的： 探讨改良无充气经锁骨下入路腔镜甲状腺手术进行甲状腺乳头状癌颈侧区淋巴结清扫的可行性。 方法： 回顾性分析2022年1—10月在浙江大学医学院附属邵逸夫医院头颈外科接受改良无充气经锁骨下入路腔镜颈侧区淋巴结清扫术的31例甲状腺乳头状癌患者的临床资料。其中男性2例，女性29例，年龄（32.6±8.3）岁（范围：17~55岁）。甲状腺原发灶最大径［M（IQR）］为1.06（1.16）cm（范围：0.53~2.44 cm），淋巴结转移灶最大径为（1.04±0.37）cm（范围：0.44~1.88 cm）。记录手术时间、住院时间、清扫淋巴结数目及术后并发症。患者术后通过门诊随访，随访截至2022年11月30日。 结果： 所有手术均在腔镜下顺利完成，无中转开放。手术时间为160（20）min（范围：100~215 min），术后住院时间为4（2）d（范围：2~14 d）。中央区及颈侧区淋巴结清扫获取的淋巴结数目分别为11（12）枚（范围：0~37枚）和（34.7±14.8）枚（范围：15~69枚）。术后发生暂时性甲状旁腺功能减退4例，均在术后1个月恢复；喉返神经损伤1例，继续随访评估是否为暂时性损伤。颈侧区淋巴结清扫相关并发症包括1例乳糜漏，经保守治疗痊愈；霍纳综合征1例，术后3个月恢复正常。随访过程中，未见肿瘤残留或复发。 结论： 改良无充气经锁骨下入路腔镜颈侧区淋巴结清扫术治疗甲状腺乳头状癌是可行的，手术清扫彻底，切口隐蔽性好，有临床运用价值。.