Lymph Nodes and Thyroid CancerLymph nodes are part of the lymphatic system in your body which functions as a drainage or filter system. Lymph nodes play an important role in immune system. Lymph nodes help fight infection but also play a very important role filtering abnormal cells including cancer cells. Thyroid cancer is very efficient in invading into the lymphatic system and therefore, spreading to adjacent lymph nodes.
Your neck is one of the highest concentrated areas of lymph nodes (~300 lymph nodes). Appropriate lymph node assessment prior to thyroid surgery is important in determining the extent of the surgery that should be performed by your surgeon (partial versus total thyroid removal, with or without lymph node surgery). Your doctor may perform the neck ultrasound examination and sometimes order a CT scan of the neck in case of a more extensive neck disease. If suspicious lymph nodes are found on one of these scans, a fine needle aspiration (FNA) biopsy should be done to assess for thyroid cancer.
If cancerous lymph nodes are confirmed, your surgery should include total thyroid resection and the lymph node surgery. Comprehensive resection of the lymph nodes will determine the cure, proper staging, additional cancer treatment (such as radioactive iodine) and appropriate follow up plan.
Lymph Node Removal (Neck Dissection) During Thyroid SurgeryThere are two groups of lymph nodes in the neck that are involved in thyroid cancer: The central neck lymph nodes, and the lateral neck lymph nodes. Central neck lymph nodes are group of lymph nodes adjacent to thyroid gland in the center of the neck. If indicated, these lymph nodes are removed along with the thyroid gland (add figure of lymph nodes).
Central Neck Lymph Node Removal During Thyroid Surgery. To remove the central neck lymph nodes, the recurrent laryngeal nerve which controls the voice box must be dissected more extensively down to the upper chest and, therefore, it is associated with higher risk of nerve injury. Also, the dissection is associated with higher rate of parathyroid gland injury due to unintended resection of the parathyroid, compromised blood supply to parathyroid gland when removing the lymph node tissue. Due to these inherent risks, central neck lymph node surgery should be done by an experienced surgeon and only when clearly indicated.
Lateral Neck Lymph Node Removal During Thyroid Surgery. Lateral neck lymph nodes are found in the side of the neck surrounding the major vessels and nerves. These lymph nodes run from your chin down to the upper chest and if these nodes are positive for a metastatic thyroid cancer, the entire lymph nodes along with the entire thyroid gland and the central neck lymph nodes must be removed.
A thyroid cancer operation that involves the dissection of the lateral neck lymph nodes is considered a much extensive operation for this reason and in order to resect these lymph nodes on the side of your neck, your neck incisions are much larger than the standard thyroid surgery. This operation is called the modified radical neck dissection (MRND) or lateral neck dissection.
Robotic Thyroid Surgery for Lymph Node Removal (Neck Dissection)Scarless robotic thyroid surgery is an option in preventing such significant morbidity to the surgery and save the undesirable neck scar through the same four small minimally invasive incisions. This is the greatest benefit of scarless robotic thyroid surgery. Compared to the routine thyroid surgery, removing the thyroid cancer and lymph nodes with a robot can prevent scars that extend up to your chin.
As a cancer operation, the robotic surgery has demonstrated its safety and efficacy of one sided robotic lateral neck dissection as well as bilateral lateral neck dissection where the benefits of scarless technique is even more significant in avoiding scars that could extend from “ear-to-ear.” With robotic surgery, enhanced visualization with 3D high definition camera and 10x magnification helps with depth perception, structure identification, tissue plane clarity and orientation. Furthermore, special form of luminescence (spontaneous lighting) imaging known as fluorescence is a built in feature of the robotic camera (Firefly fluorescence technology) and this function can be used in a unique method of parathyroid gland visualization to prevent damate to these important glands.
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