Introduction: We present the case of a 18 year old woman with a 7mm papillary carcinoma of the left thyroid lobe and ipsilateral lymphonode metastases (FNAC positive). The patient underwent Minimally Invasive Video-Assisted Thyroidectomy and Lateral neck Lymphadenectomy.

Methods: Two accesses: a 1.5 cm central incision two fingers above the sternal notch and a 5-7mm incision along the posterior border of the sternocleidomastoid muscle at median level. Through the central incision, by blunt dissection, the sternocleidomastoid muscle and strap muscles are progressively separated. At the beginning two small retractors are used gain the operative space. When the jugular vein and carotid artery come into direct vision, larger and deeper retractors are introduced, which maintain the operative space via pulling the vascular trunk medially and the sternocleidomastoid muscle laterally. All instruments except the endoscope, which is introduced in a 5mm trocar through the second incision, are introduced through the central access. It's view is opposite the jugulocarotid chain, or up to the digastric muscle and down to the supraclavicular space. A modified lateral lymphadenectomy can be performed via already known needlescopic instruments, Harmonic Scalpel and vascular clips.

Results: The lymphatic and adipose tissue are progressively dissected from the posterolateral aspect of the jugulocarotid chain to the medial border of the sternocleidomastoid muscle and from the supraclavicular space upward to the apex. The specimen finally is removed en bloc through the main access. After removal of the specimen, the lateral trocar is extracted.

Conclusion: No drainage, wounds are closed by reabsorbable stitches and skin glue.