We are presenting a transaxillary robotic total thyroidectomy with central neck dissection in a patient having a suspicious 4.4cm left nodule with suspicious Level VI lymph nodes.
It is a case of a 39-year-old Moroccan male having discovered on auto palpation a huge left neck mass. Investigations have shown a TIRADS 5 44x20x24mm (14.2cc) nodule of left thyroid lobe with suspicious Level VI LN. Total thyroidectomy with central neck dissection was decided. The patient requested a robotic approach to avoid neck scar.We show in this video the dissection of the left recurrent laryngeal nerve from the tumor. At first, the nerve seemed to be invaded by the tumor. But a step by step careful dissection while benefitting from the precision and the 3D vision of the robot allowed a preservation of a functional nerve confirmed by positive NIM stimulations. Surgery was uneventful and took 125 minutes. On follow up the patient had full recovery. Patient was satisfied from the scar. Final pathology is a papillary carcinoma (pT3N1a) with 6+/7 LN. So, there is indication for radioactive iodine therapy.
IC2 – ATA Guidelines on Surgical Management of Thyroid Cancer: Thyroid and nodes
- Victor Bernet
- Richard Payne
- David Steward