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The advantages of extended subplatysmal dissection in thyroid surgery—the “mobile window” technique

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Abstract

Purpose

Minimal access thyroidectomy, using various techniques, is widely known, but respective data on thyroidectomy for thyroid cancer with lymphadenectomy is scarce. The present study aims to evaluate the feasability of extended subplatysmal dissection in combination with a small incision (“mobile window” technique).

Methods

A retrospective study was performed analysing data from 93 patients. All patients suffered from thyroid carcinoma and underwent (total) thyroidectomy, bilateral cervico-central (levels VI and VII) and functional lateral neck dissection (levels II to V) on the side of the malignancy. In group A, consisting of 47 patients, the operation was performed by a traditional Kocher incision (minimal range 6–7 cm), in 46 patients (group B) a mini-incision (≤4 cm) was made. Intra- and postoperative morbidity as well as oncological accuracy were assessed.

Results

There was no significant difference between the two groups comparing postoperative pathological diagnosis, intra- and postoperative complications and the number of removed lymph nodes. However, operating time was slightly longer in group A and thyroid weight was heavier in group B.

Conclusions

Extended subplatymsal dissection allows thyroidectomy and even lateral lymphadenectomy for thyroid carcinoma via “mobile” mini-incision. The procedure is safe, of equivalent oncological accuracy compared to traditional incision and the cosmetic results are excellent.

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References

  1. Linos D (2011) Minimally invasive thyroidectomy: a comprehensive appraisal of existing techniques. Surgery 150(1):17–24. doi:10.1016/j.surg.2011.02.018

    Article  PubMed  Google Scholar 

  2. Terris DJ, Gourin CG, Chin E (2006) Minimally invasive thyroidectomy: basic and advanced techniques. Laryngoscope 116(3):350–356. doi:10.1097/01.mlg.0000191462.58630.e4

    Article  PubMed  Google Scholar 

  3. Liu J, Song T, Xu M (2012) Minimally invasive video-assisted versus conventional open thyroidectomy: a systematic review of available data. Surg Today 42(9):848–856. doi:10.1007/s00595-012-0130-z

    Article  PubMed  Google Scholar 

  4. Gagner M, Inabnet BW, 3rd, Biertho L (2003) Endoscopic thyroidectomy for solitary nodules. Ann Chir 128 (10):696–701

  5. Gottlieb A, Sprung J, Zheng XM, Gagner M (1997) Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflation. Anesth Analg 84(5):1154–1156

    Article  CAS  PubMed  Google Scholar 

  6. Henry JF (2006) Minimally invasive surgery of the thyroid and parathyroid glands. Br J Surg 93(1):1–2. doi:10.1002/bjs.5199

    Article  PubMed  Google Scholar 

  7. Miccoli P, Bellantone R, Mourad M, Walz M, Raffaelli M, Berti P (2002) Minimally invasive video-assisted thyroidectomy: multiinstitutional experience. World J Surg 26(8):972–975. doi:10.1007/s00268-002-6627-7

    Article  PubMed  Google Scholar 

  8. Yamashita H, Watanabe S, Koike E, Ohshima A, Uchino S, Kuroki S, Tanaka M, Noguchi S (2002) Video-assisted thyroid lobectomy through a small wound in the submandibular area. Am J Surg 183(3):286–289

    Article  PubMed  Google Scholar 

  9. Ban EJ, Yoo JY, Kim WW, Son HY, Park S, Lee SH, Lee CR, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS (2014) Surgical complications after robotic thyroidectomy for thyroid carcinoma: a single center experience with 3,000 patients. Surg Endosc 28(9):2555–2563. doi:10.1007/s00464-014-3502-1

    Article  PubMed  Google Scholar 

  10. Brunaud L, Zarnegar R, Wada N, Ituarte P, Clark OH, Duh QY (2003) Incision length for standard thyroidectomy and parathyroidectomy: when is it minimally invasive? Arch Surg 138(10):1140–1143. doi:10.1001/archsurg.138.10.1140

    Article  PubMed  Google Scholar 

  11. Rafferty M, Miller I, Timon C (2006) Minimal incision for open thyroidectomy. Otolaryngol Head Neck Surg 135(2):295–298. doi:10.1016/j.otohns.2006.03.013

    Article  PubMed  Google Scholar 

  12. Terris DJ, Bonnett A, Gourin CG, Chin E (2005) Minimally invasive thyroidectomy using the Sofferman technique. Laryngoscope 115(6):1104–1108. doi:10.1097/01.MLG.0000163761.03764.44

    Article  PubMed  Google Scholar 

  13. Alvarado R, McMullen T, Sidhu SB, Delbridge LW, Sywak MS (2008) Minimally invasive thyroid surgery for single nodules: an evidence-based review of the lateral mini-incision technique. World J Surg 32(7):1341–1348. doi:10.1007/s00268-008-9554-4

    Article  PubMed  Google Scholar 

  14. Thomusch O, Hoffmann T, Dobschuetz E (2006) Indications and techniques of minimally invasive surgery applied to the thyroid. MMW Fortschr Med 148 (51–52):44–45

  15. Dhiman SV, Inabnet WB (2008) Minimally invasive surgery for thyroid diseases and thyroid cancer. J Surg Oncol 97(8):665–668. doi:10.1002/jso.21019

    Article  PubMed  Google Scholar 

  16. Gosnell JE, Sackett WR, Sidhu S, Sywak M, Reeve TS, Delbridge LW (2004) Minimal access thyroid surgery: technique and report of the first 25 cases. ANZ J Surg 74(5):330–334. doi:10.1111/j.1445-1433.2004.02982.x

    Article  PubMed  Google Scholar 

  17. Brown BC, McKenna SP, Siddhi K, McGrouther DA, Bayat A (2008) The hidden cost of skin scars: quality of life after skin scarring. J Plast Reconstr Aesthet Surg 61(9):1049–1058. doi:10.1016/j.bjps.2008.03.020

    Article  CAS  PubMed  Google Scholar 

  18. Asari R, Niederle BE, Scheuba C, Riss P, Koperek O, Kaserer K, Niederle B (2010) Indeterminate thyroid nodules: a challenge for the surgical strategy. Surgery 148(3):516–525. doi:10.1016/j.surg.2010.01.020

    Article  PubMed  Google Scholar 

  19. Dralle H, Damm I, Scheumann GF, Kotzerke J, Kupsch E, Geerlings H, Pichlmayr R (1994) Compartment-oriented microdissection of regional lymph nodes in medullary thyroid carcinoma. Surg Today 24(2):112–121

    Article  CAS  PubMed  Google Scholar 

  20. Bocca E, Pignataro O (1967) A conservation technique in radical neck dissection. Ann Otol Rhinol Laryngol 76(5):975–987

    Article  CAS  PubMed  Google Scholar 

  21. Medina JE (1989) A rational classification of neck dissections. Otolaryngol Head Neck Surg 100(3):169–176

    Article  CAS  PubMed  Google Scholar 

  22. Davidson HC, Park BJ, Johnson JT (2008) Papillary thyroid cancer: controversies in the management of neck metastasis. Laryngoscope 118(12):2161–2165. doi:10.1097/MLG.0b013e31818550f6

    Article  PubMed  Google Scholar 

  23. Berber E, Bernet V, Fahey TJ 3rd, Kebebew E, Shaha A, Stack BC Jr, Stang M, Steward DL, Terris DJ (2016) American Thyroid Association statement on remote-access thyroid surgery. Thyroid 26(3):331–337. doi:10.1089/thy.2015.0407

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ryu HR, Lee J, Park JH, Kang SW, Jeong JJ, Hong JY, Chung WY (2013) A comparison of postoperative pain after conventional open thyroidectomy and transaxillary single-incision robotic thyroidectomy: a prospective study. Ann Surg Oncol 20(7):2279–2284. doi:10.1245/s10434-012-2557-2

    Article  PubMed  Google Scholar 

  25. Musholt TJ (2014) Classification of locoregional lymph nodes in medullary and papillary thyroid cancer. Langenbeck's Arch Surg 399(2):217–223. doi:10.1007/s00423-013-1146-6

    Article  CAS  Google Scholar 

  26. Dralle H, Musholt TJ, Schabram J, Steinmuller T, Frilling A, Simon D, Goretzki PE, Niederle B, Scheuba C, Clerici T, Hermann M, Kussmann J, Lorenz K, Nies C, Schabram P, Trupka A, Zielke A, Karges W, Luster M, Schmid KW, Vordermark D, Schmoll HJ, Muhlenberg R, Schober O, Rimmele H, Machens A, German Societies of G, Visceral Surgery, Endocrinology, Nuclear Medicine, Pathology, Radiooncology, Oncological Hermatologoy, the German Thyroid Cancer Patient Support Organization Ohne Schilddruse leben e V (2013) German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors. Langenbeck's Arch Surg 398(3):347–375. doi:10.1007/s00423-013-1057-6

    Article  Google Scholar 

  27. Tavares MR, Cruz JA, Waisberg DR, Toledo SP, Takeda FR, Cernea CR, Capelozzi VL, Brandao LG (2014) Lymph node distribution in the central compartment of the neck: an anatomic study. Head Neck 36(10):1425–1430. doi:10.1002/hed.23469

    PubMed  Google Scholar 

  28. Stamatakos M, Paraskeva P, Katsaronis P, Tasiopoulou G, Kontzoglou K (2013) Surgical approach to the management of medullary thyroid cancer: when is lymph node dissection needed? Oncology 84(6):350–355. doi:10.1159/000351148

    Article  PubMed  Google Scholar 

  29. Ferzli GS, Sayad P, Abdo Z, Cacchione RN (2001) Minimally invasive, nonendoscopic thyroid surgery. J Am Coll Surg 192(5):665–668

    Article  CAS  PubMed  Google Scholar 

  30. Miccoli P, Berti P, Conte M, Bendinelli C, Marcocci C (1999) Minimally invasive surgery for thyroid small nodules: preliminary report. J Endocrinol Investig 22(11):849–851. doi:10.1007/BF03343657

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland

    Tina Runge, Roman Inglin, Reto M. Kaderli, Daniel Candinas & Christian A. Seiler

  2. Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, 1090, Vienna, Austria

    Philipp Riss & Andreas Selberherr

Authors
  1. Tina Runge
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  2. Roman Inglin
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  3. Philipp Riss
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  4. Andreas Selberherr
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  5. Reto M. Kaderli
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  6. Daniel Candinas
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  7. Christian A. Seiler
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Corresponding author

Correspondence to Christian A. Seiler.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This trial was approved by the local ethics committee.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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The technique of extended subplatysmal dissection in combination with a small incision (“mobile window”- technique) is shown in Video 1. (MP4 19,822 kb)

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Runge, T., Inglin, R., Riss, P. et al. The advantages of extended subplatysmal dissection in thyroid surgery—the “mobile window” technique. Langenbecks Arch Surg 402, 257–263 (2017). https://doi.org/10.1007/s00423-016-1545-6

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  • DOI: https://doi.org/10.1007/s00423-016-1545-6

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