Needle-assisted technique in endoscopic thyroidectomy by gasless endoscopic thyroidectomy <i>via</i> an axillary approach: an exploratory study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FU Qingfeng , HE Rundong , ZHAO Yishen , SUN Ping , SUN Hui ,  ZHOU Le

Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Translational Medicine of Surgery, Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Treatment, Changchun 130033, P. R. China;

Corresponding?author：

ZHOU Le, Email: zhoule@jlu.edu.cn

Keywords：

Thyroidectomy; endoscopic surgery; gasless unilateral axillary approach; needlescopic assisted technique

DOI：

10.7507/1007-9424.202508113

Video：

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Objective To investigate the feasibility and safety of using a custom-made needle-assisted retractor derived from a nerve monitoring monopolar ball-tip probe in endoscopic thyroidectomy by a gasless unilateral axillary approach (GUA). Methods A retrospective analysis was performed on the clinical data and surgical procedures of 50 consecutive patients who underwent endoscopic thyroidectomy by GUA by a single surgeon in the Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University from April 2023 to December 2023. Surgical experiences and operative techniques were summarized. Results Among the 50 patients, there were 48 females and 2 males, with an age of (35.16±7.56) years. Forty-seven patients were diagnosed with papillary thyroid carcinoma, with a tumor diameter of (0.69±0.52) cm; 3 patients had benign nodules, with a maximum diameter of (2.67±0.58) cm. All patients underwent unilateral thyroid lobectomy (patients with malignancy additionally underwent central neck dissection). All surgery was successfully completed without conversion to open surgery. The operative time was (156.12±34.27) min. Postoperative complications included temporary hoarseness in 2 patients, subcutaneous effusion in 2 patients, and ipsilateral upper limb numbness in 1 patient. All complications recovered within one month. Conclusions The results of this study suggest that the in endoscopic thyroidectomy by a GUA approach demonstrates good feasibility and safety. Furthermore, it helps reduce the difficulty of the procedure, providing effective support for surgeons, especially beginners, to rapidly master this technique.

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2.	Filetti S, Durante C, Hartl D, et al. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2019, 30(12): 1856-1883.
3.	Yoon JH, Park CH, Chung WY. Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech, 2006, 16(4): 226-231.
4.	Xu T, Qin X, Zhang Y, et al. A prospective study comparing the gasless endoscopic thyroidectomy trans-axillary approach to conventional open thyroidectomy: health and quality of life outcomes. Surg Endosc, 2024, 38(4): 1995-2009.
5.	Ge JN, Yu ST, Sun BH, et al. A novel anatomy-based five-settlement method for endoscopic thyroid lobectomy and ipsilateral central compartment neck dissection via gasless unilateral axillary approach: a preliminary report. Front Endocrinol (Lausanne), 2023, 14: 1147313. doi: 10.3389/fendo.2023.1147313.
6.	徐加杰, 張李卓, 張啟弘, 等. 無充氣經腋窩腔鏡甲狀腺手術的臨床應用. 中華耳鼻咽喉頭頸外科雜志, 2020, 55(10): 913-920.
7.	楊曉鋒, 孫馳, 王文博, 等. 針式抓鉗水分離輔助腹腔鏡睪丸固定術的初步經驗. 中國微創外科雜志, 2024, 24(6): 451-454.
8.	Mamazza J, Schlachta CM, Seshadri PA, et al. Needlescopic surgery. A logical evolution from conventional laparoscopic surgery. Surg Endosc, 2001, 15(10): 1208-1212.
9.	朱峰, 鄔一軍, 沈亦斌, 等. 經胸鎖乳突肌肌間入路行甲狀腺手術對頸前區功能保護研究. 中國實用外科雜志, 2020, 40(7): 847-850.
10.	Liu N, Chen B, Li L, et al. Subplatysmal or subfascial approach in totally endoscopic thyroidectomy has better postoperative efficacy for voice, sensory, swallowing symptoms and cosmetic result. Cohort study. Int J Surg, 2018, 60: 22-27.
11.	吳雪松, 秦彥超, 韓飛, 等. 不同入路腔鏡甲狀腺手術治療甲狀腺癌的臨床效果分析. 中華內分泌外科雜志, 2024, 18(4): 473-478.
12.	Lu Q, Zhu X, Wang P, et al. Comparisons of different approaches and incisions of thyroid surgery and selection strategy. Front Endocrinol (Lausanne), 2023, 14: 1166820. doi: 10.3389/fendo.2023.1166820.
13.	Ikeda Y, Takami H, Sasaki Y, et al. Endoscopic neck surgery by the axillary approach. J Am Coll Surg, 2000, 191(3): 336-340.
14.	Li T, Chen L, Qiu Z, et al. Right gasless transaxillary endoscopic total thyroidectomy (RGTETT) with video: our experience with the posterior approach: Lei's seven-sinking method. Gland Surg, 2023, 12(10): 1414-1424.
15.	中國抗癌協會甲狀腺癌專業委員會, 中華醫學會腫瘤學分會甲狀腺腫瘤專業委員會, 中國研究型醫院學會甲狀腺疾病專業委員會, 等. 無充氣腋窩入路腔鏡甲狀腺手術專家共識(2022版). 中華內分泌外科雜志, 2021, 15(6): 557-563.
16.	Sun B, Yu S, Ge J, et al. Analysis of scene-guided camera assistance in transaxillary gasless endoscopic thyroidectomy: a minor improvement in operative technique. Front Endocrinol (Lausanne), 2023, 14: 1146336. doi: 10.3389/fendo.2023.1146336.
17.	Wang B, Weng YJ, Wang SS, et al. Feasibility and safety of needle-assisted endoscopic thyroidectomy with lateral neck dissection for papillary thyroid carcinoma: a preliminary experience. Head Neck, 2019, 41(7): 2367-2375.
18.	王波, 趙文新, 顏守義, 等. 針式輔助技術在全腔鏡甲狀腺癌手術中的應用研究. 中華外科雜志, 2016, 54(1): 44-48.
19.	Zhao Y, Wang P, Dionigi G, et al. Utilization of recurrent laryngeal nerve monitoring during thyroid surgery in China: a point prevalence survey (2015-2023). Int J Surg, 2025, 111(1): 439-449.
20.	Kou J, Zhao Y, Han Y, et al. Noticeable effect of lower baseline amplitude on the predictive accuracy of intraoperative amplitude changes for postoperative vocal cord palsy: a prospective cohort study. Int J Surg, 2024, 110(5): 2765-2775.
21.	Han Y, Zhao Y, Kou J, et al. The risk factors for postoperative temporary vocal cord paralysis after thyroid cancer surgery: an observational retrospective cohort study. Int J Surg, 2024, 110(8): 4821-4829.
22.	Sun H, Zheng H, Wang X, et al. Comparison of transoral endoscopic thyroidectomy vestibular approach, total endoscopic thyroidectomy via areola approach, and conventional open thyroidectomy: a retrospective analysis of safety, trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma. Surg Endosc, 2020, 34(1): 268-274.
23.	Liu YC, Shen CL, Fu ZY, et al. Effectiveness of the recurrent laryngeal nerve monitoring during endoscopic thyroid surgery: systematic review and meta-analysis. Int J Surg, 2023, 109(7): 2070-2081.
24.	趙文新, 王波, 顏守義, 等. 針式輔助全腔鏡甲狀腺癌功能性頸淋巴結清掃的策略與技巧. 腹腔鏡外科雜志, 2017, 22(4): 241-245.

1. 鄔一軍, 朱峰. 重視甲狀腺手術頸前區功能的保護. 中華內分泌外科雜志, 2020, 14(4): 265-268.
2. Filetti S, Durante C, Hartl D, et al. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2019, 30(12): 1856-1883.
3. Yoon JH, Park CH, Chung WY. Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases. Surg Laparosc Endosc Percutan Tech, 2006, 16(4): 226-231.
4. Xu T, Qin X, Zhang Y, et al. A prospective study comparing the gasless endoscopic thyroidectomy trans-axillary approach to conventional open thyroidectomy: health and quality of life outcomes. Surg Endosc, 2024, 38(4): 1995-2009.
5. Ge JN, Yu ST, Sun BH, et al. A novel anatomy-based five-settlement method for endoscopic thyroid lobectomy and ipsilateral central compartment neck dissection via gasless unilateral axillary approach: a preliminary report. Front Endocrinol (Lausanne), 2023, 14: 1147313. doi: 10.3389/fendo.2023.1147313.
6. 徐加杰, 張李卓, 張啟弘, 等. 無充氣經腋窩腔鏡甲狀腺手術的臨床應用. 中華耳鼻咽喉頭頸外科雜志, 2020, 55(10): 913-920.
7. 楊曉鋒, 孫馳, 王文博, 等. 針式抓鉗水分離輔助腹腔鏡睪丸固定術的初步經驗. 中國微創外科雜志, 2024, 24(6): 451-454.
8. Mamazza J, Schlachta CM, Seshadri PA, et al. Needlescopic surgery. A logical evolution from conventional laparoscopic surgery. Surg Endosc, 2001, 15(10): 1208-1212.
9. 朱峰, 鄔一軍, 沈亦斌, 等. 經胸鎖乳突肌肌間入路行甲狀腺手術對頸前區功能保護研究. 中國實用外科雜志, 2020, 40(7): 847-850.
10. Liu N, Chen B, Li L, et al. Subplatysmal or subfascial approach in totally endoscopic thyroidectomy has better postoperative efficacy for voice, sensory, swallowing symptoms and cosmetic result. Cohort study. Int J Surg, 2018, 60: 22-27.
11. 吳雪松, 秦彥超, 韓飛, 等. 不同入路腔鏡甲狀腺手術治療甲狀腺癌的臨床效果分析. 中華內分泌外科雜志, 2024, 18(4): 473-478.
12. Lu Q, Zhu X, Wang P, et al. Comparisons of different approaches and incisions of thyroid surgery and selection strategy. Front Endocrinol (Lausanne), 2023, 14: 1166820. doi: 10.3389/fendo.2023.1166820.
13. Ikeda Y, Takami H, Sasaki Y, et al. Endoscopic neck surgery by the axillary approach. J Am Coll Surg, 2000, 191(3): 336-340.
14. Li T, Chen L, Qiu Z, et al. Right gasless transaxillary endoscopic total thyroidectomy (RGTETT) with video: our experience with the posterior approach: Lei's seven-sinking method. Gland Surg, 2023, 12(10): 1414-1424.
15. 中國抗癌協會甲狀腺癌專業委員會, 中華醫學會腫瘤學分會甲狀腺腫瘤專業委員會, 中國研究型醫院學會甲狀腺疾病專業委員會, 等. 無充氣腋窩入路腔鏡甲狀腺手術專家共識(2022版). 中華內分泌外科雜志, 2021, 15(6): 557-563.
16. Sun B, Yu S, Ge J, et al. Analysis of scene-guided camera assistance in transaxillary gasless endoscopic thyroidectomy: a minor improvement in operative technique. Front Endocrinol (Lausanne), 2023, 14: 1146336. doi: 10.3389/fendo.2023.1146336.
17. Wang B, Weng YJ, Wang SS, et al. Feasibility and safety of needle-assisted endoscopic thyroidectomy with lateral neck dissection for papillary thyroid carcinoma: a preliminary experience. Head Neck, 2019, 41(7): 2367-2375.
18. 王波, 趙文新, 顏守義, 等. 針式輔助技術在全腔鏡甲狀腺癌手術中的應用研究. 中華外科雜志, 2016, 54(1): 44-48.
19. Zhao Y, Wang P, Dionigi G, et al. Utilization of recurrent laryngeal nerve monitoring during thyroid surgery in China: a point prevalence survey (2015-2023). Int J Surg, 2025, 111(1): 439-449.
20. Kou J, Zhao Y, Han Y, et al. Noticeable effect of lower baseline amplitude on the predictive accuracy of intraoperative amplitude changes for postoperative vocal cord palsy: a prospective cohort study. Int J Surg, 2024, 110(5): 2765-2775.
21. Han Y, Zhao Y, Kou J, et al. The risk factors for postoperative temporary vocal cord paralysis after thyroid cancer surgery: an observational retrospective cohort study. Int J Surg, 2024, 110(8): 4821-4829.
22. Sun H, Zheng H, Wang X, et al. Comparison of transoral endoscopic thyroidectomy vestibular approach, total endoscopic thyroidectomy via areola approach, and conventional open thyroidectomy: a retrospective analysis of safety, trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma. Surg Endosc, 2020, 34(1): 268-274.
23. Liu YC, Shen CL, Fu ZY, et al. Effectiveness of the recurrent laryngeal nerve monitoring during endoscopic thyroid surgery: systematic review and meta-analysis. Int J Surg, 2023, 109(7): 2070-2081.
24. 趙文新, 王波, 顏守義, 等. 針式輔助全腔鏡甲狀腺癌功能性頸淋巴結清掃的策略與技巧. 腹腔鏡外科雜志, 2017, 22(4): 241-245.

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