Bidirectional Approach of Video Assisted Neck Surgery (BAVANS) Enables Advanced Endoscopic Lymph Node Dissection in Thyroid Cancer Surgery – Introduction of a Rigid Endoscope with Flexible Direction of View

Akiihro Nakajo, MD, PhD, Hideo Arima, Yoshie Takae, Munetsugu Hirata, Yoshiaki Shinden, Yuko Kijima, Shoji Natsugoe. Kagoshima University Hospital

Objectives: We developed a new Bidirectional Approach of Video Assisted Neck Surgery (BAVANS) for endoscopic thyroid cancer surgery, and have already reported that cranio-caudal approach is extremely useful for endoscopic complete lymph node dissection (CLND) around the trachea. We consider BAVANS is better endoscopic technique for CLND than conventional open surgery. In 2014, we upgraded this original BAVANS via introducing a new rigid endoscope with variable direction of view. We’d like to report a new version of BAVANS for endoscopic CLND with better maneuverability and cosmetic advantage than original BAVANS.

Methods: Original BAVANS combines different approaching pathway to the cervical lesion. Prior to lymph node dissection, we perform endoscopic total or hemi-thyroidectomy via a conventional gasless precordial or axillary approach. After thyroidectomy, 3 ports (2-5mm) inserted at upper neck area to get the cranio-caudal view for CLND in original BAVANS. However, this new improved BAVANS requires only 2 ports (2 and 5mm) at submandibular area. We could reduce one port on the neck via using a new rigid laparoscope featuring variable viewing direction.

Results: Total of 42 patients with papillary thyroid cancer received BAVANS and this improved BAVANS was performed in 24 patients. The average bleeding volume was 25 ml. All patients began oral intake within 5 hours after surgery. Although postoperative Horner syndrome due to injury of the cervical sympathetic nerve occurred in one patient, no other complications were noted. The average number of retrieved lymph nodes with unilateral central node dissection was 9, which was same as original BAVANS and was higher than that achieved with conventional open surgery. All patients were very satisfied with the cosmetic result of the surgery.

Conclusions: BAVANS is very effective surgical procedure that many endoscopic surgeons can perform safely and easily. It has both a cosmetic advantage and excellent curability in endoscopic thyroid cancer surgery. In upgraded BAVANS, we can also get the easy maneuverability and the same quality of CLND as original BAVANS despite of reducing one port on the neck. Endoscopic thyroid surgery will evolve together with the new visual technology.

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