Donghang Huang’s procedure, also termed as direct-access single-port endoscopy assisted mini-incision thyroidectomy, is a hybrid surgery conducted in the following 3 major steps:
1.A mini-incision of approximately 2.5-3 cm long on the central neck is made. A working space under the platysmal muscle or strap muscles for single-port endoscopic surgery is constructed with carbon dioxide insufflation (performed under direct vision).
2.Mobilization of the superior and inferior pole of the thyroid lobe, and exposure of the recurrent laryngeal nerve (performed under single-port endoscopy).
3.Extraction and resection of the thyroid lobe. (performed under direct vision).
Donghang Huang’s procedure can provide shorter incision and better cosmetic results while maintaining adequate exposure.
In this video, we present a new method of minimally invasive thyroidectomy, Donghang Huang’s procedure, which may also be termed as direct-access single-port endoscopy assisted mini-incision thyroidectomy. The operation was performed under general anesthesia with endotracheal intubation. Patients were placed in a supine position with neck extension. The surgical steps were as follows.
1.A 30 mm horizontal skin incision was made 2 cm above the sternal notch. Subplatysmal dissection was made. The linea alba was opened. Strap muscles were separated from the anterior surface of the thyroid lobe.
2.A working space for single-port endoscopic surgery was made under the strap muscles: The internal anchoring ring of the retractor component of a single port device was inserted into the operative site under the strap muscles. Grasped the external retraction ring and pull it up. Flipped the external ring inward until desired retraction was achieved. Connected the valve component of the single port device with the external ring. The working space was maintained with low pressure carbon dioxide insufflation.
3.Under single-port endoscopy, the superior pole was pulled caudally, the branches of the superior thyroid artery and vein were divided as close as possible to the thyroid. The superior pole was freed up from its attachments and mobilized inferiorly. The dissection was kept to the thyroid capsular plane to avoid injury to the external branch of superior laryngeal nerve and superior parathyroid gland.
4.The thyroid lobe was retracted medially. The carotid artery was exposed. The middle thyroid vein was transected. The isthmus was divided.
5.The branches of the inferior thyroid vein were carefully dissected. The inferior parathyroid gland was identified. The recurrent laryngeal nerve was identified in the tracheoesophageal groove.
6.The endoscope and the valve component of the single port device were removed. The thyroid lobe was pulled out from the wound and the lobectomy was done as in open surgery under direct vision. The retractor component of the single port device was removed and the wound was closed.
1.Thyroid nodule size not exceeding 35 mm in its largest diameter.
2.Total thyroid volume not exceeding 30 cc as measured by ultrasound.
1.The presence of metastatic or suspicious lymph-nodes in the lateral neck compartment.
2.Caution must be taken towards some small low risk thyroid cancers when located very posteriorly because they could have an extracapsular infiltration: this situation could represent a reason for a prompt conversion to conventional open thyroidectomy.
The primary surgeon stands contralateral to the lesion. An assistant stands contralateral to the primary surgeon. The monitor is positioned at the head of the patient.
thyroid ultrasound (performed by the operating surgeon) - fine-needle aspiration biopsy for thyroid nodules - laryngoscopy
Main advantages: shorter incision and better cosmetic result.
Disadvantages: more cost.
The main risk is to damage the recurrent laryngeal nerve during its mobilisation. To prevent this don't use an energy device too close to the nerve.
1.Tae K, Ji YB, Song CM, et al. Robotic and Endoscopic Thyroid Surgery: Evolution and Advances. Clin Exp Otorhinolaryngol 2019 ;12(1):1-11.
2.Russell JO, Noureldine SI, Al Khadem MG, et al. Minimally invasive and remote-access thyroid surgery in the era of the 2015 American Thyroid Association guidelines. Laryngoscope Investig Otolaryngol. 2016 ;1(6):175-179.