Neck dissection through the classic Kocher cervicotomy

Objective: Total thyroidectomy with modified radical neck dissection (MRND) is the treatment of choice of papillary thyroid carcinoma (PTC) with lymphnodal involvement. The aim of this study was to describe an alternative lateral neck access to perform lymph nodes sampling and/or neck dissection via extra-thyroideal space (MRND vets). Methods: Twenty-one consecutive patients with papillary thyroid carcinoma were included. Lymph node sampling and modified radical neck dissection, unilateral or bilateral, were performed acceding via a lateral dissection through a traditional Kocher incision, running along the medial fascia of the neck, posteriorly to the sterno-cleidomastoideus muscle (SCM), and finally reaching the neurovascular bundle. Results: Mean age was 38.35 ± 13.66 years. Seventeen patients were women, and 4 were men. Mean tumor size was 2.5 ± 1 cm. Total thyroidectomy with lymph node dissection of the central compartment associated to modified radical neck dissection was performed in 13 patients. Among these, five patients had a preoperative diagnosis of latero-cervical lymph node metastases, and eight had a perioperative diagnosis of metastases of the extensive sampling of the lower third of the jugular chain. Metastatic lymph nodes were found in 89 out of 529 of the lymph nodes dissected. Conclusion: The MNRD vets access for modified lateral neck dissection seems to carry a lower risk in terms of specific morbility and allows a quicker recovery and a better cosmetic result. This access has to be considered as a less invasive procedure compared with the other surgical accesses for the radical modified lateral neck dissection.