Bidirectional Approach of Video-Assisted Neck Surgery (BAVANS): Endoscopic complete central node dissection with craniocaudal view for treatment of thyroid cancer

Akihiro Nakajo, Hideo Arima, Munetsugu Hirata, Yoshie Yamashita, Yoshiaki Shinden, Naoki Hayashi, Yota Kawasaki, Takaaki Arigami, Yasuto Uchikado, Shinichiro Mori, Yuko Mataki, Masahiko Sakoda, Yuko Kijima, Yoshikazu Uenosono, Kosei Maemura, Shoji Natsugoe

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


INTRODUCTION: Endoscopic thyroidectomy is a well-established surgical technique that is mainly performed for benign thyroid disease. We considered that endoscopic surgery could also be widely indicated for the treatment of thyroid cancer. We herein describe our new bidirectional approach of video-assisted neck surgery (BAVANS) for complete central node dissection in endoscopic thyroid cancer surgery.

METHODS: BAVANS involves two different directional pathways to the cervical lesion. Before lymph node dissection, we perform endoscopic thyroidectomy via a conventional gasless precordial or axillary approach. After thyroidectomy, the surgeon repositions by the head of the patient and inserts three ports in front of the upper neck lesion in the submandibular area to approach the paratracheal lesion from an overhead-to-caudal direction.

RESULTS: BAVANS allows for an excellent craniocaudal view and easy access to the peritracheal lymph nodes. Sixteen patients with papillary thyroid cancer underwent BAVANS and progressed satisfactorily after surgery. Of those patients, eight underwent total or near total thyroidectomy, and five patients underwent bilateral central node dissection. The average number of retrieved lymph nodes with unilateral central node dissection was nine, which was higher than that achieved with conventional open surgery. All patients began oral intake within 5 h after surgery. Postoperative Horner syndrome occurred in one patient. No other complications were noted.

CONCLUSIONS: BAVANS is a very effective surgical procedure that many endoscopic surgeons can perform safely and easily. It has both a cosmetic advantage and excellent curability in endoscopic thyroid cancer surgery.

Original languageEnglish
Pages (from-to)40-46
Number of pages7
JournalAsian journal of endoscopic surgery
Issue number1
Publication statusPublished - 01-02-2017
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Medicine(all)


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