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Operative Technique
June 15, 2009

Operative Technique for Modified Radical Neck Dissection in Papillary Thyroid Carcinoma

Author Affiliations

Author Affiliations: Mayo Clinic, Rochester, Minnesota.

Arch Surg. 2009;144(6):567-574. doi:10.1001/archsurg.2009.89

Background  Papillary thyroid carcinoma is the most common endocrine malignancy. Recently, controversy has focused on the management of lymph node metastases, which represent approximately 90% of disease recurrences and may require considerable time, effort, and resources to diagnose and treat. Current intense postoperative surveillance by endocrinologists nationwide has the sensitivity to detect even minute lymph node metastases using ultrasonography, radioactive iodine scan, and thyroglobulin monitoring.

Objectives  To (1) present a succinct synopsis of the rationale and elements of our current surgical management strategy for papillary thyroid carcinoma and, within this context, (2) provide a detailed stepwise description of a compartment-oriented modified radical neck dissection. This description is combined with intraoperative photographs and a medical artist's illustrations to enhance and emphasize the most important points.

Conclusions  With anatomically defined precise dissection, following the steps outlined and illustrated, a thorough lymphadenectomy can be accomplished safely, with reasonable cosmetic results, minimizing disease relapse.

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