Preoperative evaluation of endoscopic thyroidectomy via the total areola approach (ETA): a fluid-structure interaction model for predicting lymph node clearance and surgical suitability
The global increase in thyroid cancer incidence has driven the adoption of minimally invasive techniques, such as endoscopic thyroidectomy via the total areola approach (ETA), which is widely used in China. However, concerns persist regarding the completeness of central lymph node dissection (CLND)...
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Frontiers Media S.A.
2025-08-01
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| Series: | Frontiers in Bioengineering and Biotechnology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fbioe.2025.1599770/full |
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| author | Ping Li Yuheng Du Xudong Wang Yu Shi Chongyang Ye Rui Jin |
| author_facet | Ping Li Yuheng Du Xudong Wang Yu Shi Chongyang Ye Rui Jin |
| author_sort | Ping Li |
| collection | DOAJ |
| description | The global increase in thyroid cancer incidence has driven the adoption of minimally invasive techniques, such as endoscopic thyroidectomy via the total areola approach (ETA), which is widely used in China. However, concerns persist regarding the completeness of central lymph node dissection (CLND) in ETA due to anatomical constraints (e.g., clavicle and sternum), which may obscure the surgical view of the upper diaphragm (level VII, defined as the region between the clavicular surface and innominate artery). Clinical reports of residual/recurrent lymph nodes in ETA patients underscore the need for precise preoperative evaluation. We retrospectively analyzed 513 patients with T1–T2 thyroid cancer (178 ETA, 335 open surgery) who underwent CLND. Preoperative CT imaging was used to construct a fluid-solid interaction model simulating tissue deformation and stress under 0.5–2 N traction forces, with innominate artery flow velocities predicted computationally. Patients were stratified by clavicle-to-innominate artery distance: <5 mm, 5–13 mm, and >13 mm. No significant difference in lymph node yield was observed between the <5 mm and 5–13 mm groups compared to open surgery. However, the >13 mm group had significantly fewer dissected nodes (p < 0.05), with three recurrence cases during follow-up. ETA achieves oncologic outcomes comparable to open surgery for patients with clavicle-to-innominate artery distances <13 mm. Beyond this threshold, incomplete dissection may occur, suggesting preoperative CT assessment of this anatomical parameter could guide surgical approach selection. |
| format | Article |
| id | doaj-art-6914e1d1860b481f9744c080603aba72 |
| institution | Kabale University |
| issn | 2296-4185 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Bioengineering and Biotechnology |
| spelling | doaj-art-6914e1d1860b481f9744c080603aba722025-08-20T03:47:12ZengFrontiers Media S.A.Frontiers in Bioengineering and Biotechnology2296-41852025-08-011310.3389/fbioe.2025.15997701599770Preoperative evaluation of endoscopic thyroidectomy via the total areola approach (ETA): a fluid-structure interaction model for predicting lymph node clearance and surgical suitabilityPing Li0Yuheng Du1Xudong Wang2Yu Shi3Chongyang Ye4Rui Jin5Key Laboratory of Basic an Translational Medicine on Head and Neck Cancer, Department of Maxillofacial and Ear, Nose and Throat Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, ChinaKey Laboratory of Basic an Translational Medicine on Head and Neck Cancer, Department of Maxillofacial and Ear, Nose and Throat Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, ChinaKey Laboratory of Basic an Translational Medicine on Head and Neck Cancer, Department of Maxillofacial and Ear, Nose and Throat Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, ChinaCollege of Arts, South China Agricultural University, Guangzhou, Guangdong, ChinaSchool of Fashion and Textiles, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, ChinaKey Laboratory of Basic an Translational Medicine on Head and Neck Cancer, Department of Maxillofacial and Ear, Nose and Throat Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, ChinaThe global increase in thyroid cancer incidence has driven the adoption of minimally invasive techniques, such as endoscopic thyroidectomy via the total areola approach (ETA), which is widely used in China. However, concerns persist regarding the completeness of central lymph node dissection (CLND) in ETA due to anatomical constraints (e.g., clavicle and sternum), which may obscure the surgical view of the upper diaphragm (level VII, defined as the region between the clavicular surface and innominate artery). Clinical reports of residual/recurrent lymph nodes in ETA patients underscore the need for precise preoperative evaluation. We retrospectively analyzed 513 patients with T1–T2 thyroid cancer (178 ETA, 335 open surgery) who underwent CLND. Preoperative CT imaging was used to construct a fluid-solid interaction model simulating tissue deformation and stress under 0.5–2 N traction forces, with innominate artery flow velocities predicted computationally. Patients were stratified by clavicle-to-innominate artery distance: <5 mm, 5–13 mm, and >13 mm. No significant difference in lymph node yield was observed between the <5 mm and 5–13 mm groups compared to open surgery. However, the >13 mm group had significantly fewer dissected nodes (p < 0.05), with three recurrence cases during follow-up. ETA achieves oncologic outcomes comparable to open surgery for patients with clavicle-to-innominate artery distances <13 mm. Beyond this threshold, incomplete dissection may occur, suggesting preoperative CT assessment of this anatomical parameter could guide surgical approach selection.https://www.frontiersin.org/articles/10.3389/fbioe.2025.1599770/fulltechnology of total areola approachfluid-solid interaction modelcentral lymph node dissectiontissue deformationinnominate artery velocity |
| spellingShingle | Ping Li Yuheng Du Xudong Wang Yu Shi Chongyang Ye Rui Jin Preoperative evaluation of endoscopic thyroidectomy via the total areola approach (ETA): a fluid-structure interaction model for predicting lymph node clearance and surgical suitability Frontiers in Bioengineering and Biotechnology technology of total areola approach fluid-solid interaction model central lymph node dissection tissue deformation innominate artery velocity |
| title | Preoperative evaluation of endoscopic thyroidectomy via the total areola approach (ETA): a fluid-structure interaction model for predicting lymph node clearance and surgical suitability |
| title_full | Preoperative evaluation of endoscopic thyroidectomy via the total areola approach (ETA): a fluid-structure interaction model for predicting lymph node clearance and surgical suitability |
| title_fullStr | Preoperative evaluation of endoscopic thyroidectomy via the total areola approach (ETA): a fluid-structure interaction model for predicting lymph node clearance and surgical suitability |
| title_full_unstemmed | Preoperative evaluation of endoscopic thyroidectomy via the total areola approach (ETA): a fluid-structure interaction model for predicting lymph node clearance and surgical suitability |
| title_short | Preoperative evaluation of endoscopic thyroidectomy via the total areola approach (ETA): a fluid-structure interaction model for predicting lymph node clearance and surgical suitability |
| title_sort | preoperative evaluation of endoscopic thyroidectomy via the total areola approach eta a fluid structure interaction model for predicting lymph node clearance and surgical suitability |
| topic | technology of total areola approach fluid-solid interaction model central lymph node dissection tissue deformation innominate artery velocity |
| url | https://www.frontiersin.org/articles/10.3389/fbioe.2025.1599770/full |
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