We aim to refine and define surgical techniques for doing difficult adherent bulky cervical nodal metastases from thyroid cancer to help surgeons do dissections with better curability and lesser morbidity.

Patients with thyroid cancer with large nodal metastases presenting with severe neck pain due to compression effects and encasing carotid artery and other major vessels pose a challenge to surgeons to do complete resections while preserving important structures in the neck.

We define surgical planning and road map to dissect difficult bulky adherent cervical nodes encasing carotid artery and jugular vein by splaying the plane over carotid sheath by doing adventitial level dissection and dissecting medial and lateral to carotid sheath the large nodal mass adherent to adjacent structures preserving the major vessels and nerve plexus.

By appropriate surgical planning and meticulous dissection techniques, we can do major neck dissections with complete resections and same time preserving important structures in the neck minimizing morbidity.

Clinical significance: By doing neck dissections with complete oncological resections and saving vital structures in the neck, we aim to offer best possible chance of cure to the patient along with reduced morbidity at same time.

Ramakant P, Singh KR, Rana C, Mishra AK. Surgical Techniques for operating on Large Adherent Cervical Nodal Metastases from Thyroid Cancer causing Severe Neck Pain and Compression Effects and encasing Major Vessels. World J Endoc Surg 2016;8(3):217-219.