Thyroid micropapillary carcinoma (PTMC) accounts for about 74.8% of newly diagnosed thyroid papillary carcinoma (PTC) in China. Although PTMC has an excellent prognosis, some PTMC patients will develop early lymph node metastasis or even distant metastasis. For instance, about 30.7% to 49.2% of patients with cN0 PTMC have central lymph node metastasis (CLNM). China’s guideline for differentiated thyroid cancer suggests that ipsilateral central lymph node dissection (CLND) should be performed for patients with cN0 PTMC on the premise of the effective technical guarantee. However, the latest guideline of the American Thyroid Association points out that prophylactic central lymph node dissection (pCLND) is ineffective in improving long-term survival, but may increase the incidence of complications. So, whether or not performing a pCLND for cN0 PTMC patients is still controversial. The supporters think that pCLND can reduce local recurrence, and the results of pathological examination can improve the accuracy of TNM staging, which may help make the individualized treatment plan for the patients after operation. The opponents argue against pCLND, as it does not improve the prognosis, but increases the risk of hypoparathyroidism and recurrent laryngeal nerve (RLN) injury. Right central lymph nodes are divided into lymph nodes superior to the RLN (VIa) and lymph nodes posterior to the RLN (VIb). The level VIb lymph nodes are locate in deep tissue, with a narrow anatomical space, and these anatomical characteristics make it difficult to predict the metastasis of them in preoperative assessment, and complete dissection of the lymphatic and adjacent adipose tissues in this area during surgery may cause various complications, such as RLN injury, pleural rupture, and chylous fistula. However, the incidence rates of CLNM and VIb level lymph node metastasis in cN0 PTMC patients reach 30.7% to 49.2%, which should not be ignored. Performing pCLND in cN0 PTMC patients with high-risk characteristics can avoid the repeated operation for tumor recurrence. The difficulty of reoperation is increased and the incidence of complications will also be greatly increased. Therefore, identification of the risk factors of VIb lymph node metastasis is of great significance. The risk factors for VIb lymph node metastasis in cN0 PTMC patients may include patient age <45 years, male sex, tumor diameter larger than 0.5 cm, multifocality, upper pole location, capsular invasion, extrathyroidal extension, concomitant nodular goiter and VIa lymph node metastasis, et al. Here, the authors address the metastasis and dissection of the VIb level lymph nodes in cN0 PTMC patients.