The parathyroid glands, the recurrent laryngeal and spinal accessory nerves are at risk of injury during surgery for papillary thyroid carcinoma with cervical metastases. The most significant morbidity following therapeutic neck dissection is transient hypoparathyroidism. The frequency of postoperative transient hypocalcemia after combined neck dissection and thyroidectomy is higher than when these operations are not combined. In the attempt to reduce the rate of such complication in the management of thyroid papillary carcinoma with cervical metastases we perform the lateral neck dissection as first step of the surgical procedure.

Through a traditional high cervical incision, that allows us to dissect lymph nodes of level II as well as lymph nodes of levels III, IV and V, we approach the lateral compartment via extra - thyroideal space between the strap muscles and sternocleidomastoid muscle. The skin incision used is an extended collar incision, 3-4 cm along a natural skinfold marked to the midpoint between the thyroid notch and the suprasternal notch. It enables us to perform radical neck dissection of the lateral compartment's nodes from the supraclavicular space (level IV) to the level of the carotid artery bifurcation (level II).

The central compartment is not interested during the nodal dissection and its content is protected from the dissected area by the carotid sheath.

With this procedure is possible to decrease complications related to cervical neck dissection, especially permanent hypoparathyroidism. This procedure allows also better cosmetic results.