In the surgical management of papillary thyroid cancer, central group lymph node dissection is very important. Some patients develop lymph node enlargement soon after the first surgery, in which case active surgical treatment, i.e. modified cervical root surgery, should be performed. Even if there is hoarseness and numbness, as long as the surgeon has sufficient knowledge of the anatomical variation of the recurrent laryngeal nerve and parathyroid glands, and the temporary clinical symptoms occur due to the blood supply, they can be recovered after 3 months. Therefore, we believe that the first surgery is very important. My clinical experience is to perform total thyroidectomy on the affected side on preoperative ultrasound and intraoperative estimation of the possibility of malignancy of the node, and to perform central group lymph node dissection even if there is no lymph node enlargement. For patients who have undergone surgery outside the hospital, as long as they are familiar with the anatomical location of the recurrent laryngeal nerve and the parathyroid glands, the probability of injury is often small with careful dissection of the recurrent laryngeal nerve intraoperatively, and I have not had a single case of postoperative hoarseness or numbness in the hands and feet.