Hybrid approach of Video Assisted Neck Surgery (HAVANS) – Endoscopic complete central node dissection with cranio-caudal view for thyroid carcinoma

Akihiro Nakajo, MD, PhD, Hideo Arima, MD, PhD, Munetsugu Hirata, MD, Yoshie Takae, MD, Yuko Kijima, MD, PhD, Heiji Yoshinaka, MD, PhD, Shoji Natsugoe, MD, PhD

Department of Surgical Oncology, Breast and Thyroid Surgery, Kagoshima University.

Aims
Endoscopic thyroid surgery including Robotics with extracervical approaches is a safety and well-accepted technique. As the next step, we have to apply these endoscopic techniques widely in thyroid cancer treatment, and aim to establish the technique of complete lymph node dissection with same or further quality than conventional open surgery. With the trans-axillary approach or precordial approach which is current mainstream, however, complete dissection of the paratracheal lymph nodes beside the clavicula or sternal notch is likely to be inadequate. For complete endoscopic lymph nodes dissection around the trachea, we consider that operation under the cranio-caudal view is the most important. We developed a new hybrid approach of Video Assisted Neck Surgery (HAVANS) for central node dissection in thyroid cancer treatment. We will introduce the endoscopic complete central node dissection for thyroid cancer patients via the excellent cranio-caudal view in this presentation.

Methods
To get the fine cranio-caudal view, we developed the new Hybrid approach of Video Assisted Neck Surgery (HAVANS). Hybrid approach technique combines different approaching pathway to the cervical lesion. Prior to the lymph node dissection, we performed total or hemi thyroidectomy via gasless precordial or axillary approach. After thyroidectomy, three ports (2-5mm) inserted in front of upper neck lesion of submandibular area for lymph node dissection. In this methods, we can get an excellent cranio-caudal view and access to pre-tracheal and latero-tracheal lymph nodes is easy.

Results:
Total of 25 patients with thyroid papillary cancer received HAVANS and were progressing satisfactorily after surgery. Additional time for endoscopic central node dissection is from 35 to 65 minutes. There is no patient with recurrent laryngeal nerve injury and palsy. One patient had Horner syndrome by injury of cervical sympathetic nerve.

Conclusions:
Cranio-caudal view is considered to be necessary for complete central neck node dissection. HAVANS provide easy access to the central node compartment for dissection in endoscopic thyroid cancer surgery.

Session: Podium Presentation

Program Number: S028