Research progress on gasless trans-subclavian approach endoscopic thyroidectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Xinyu ,  DAI Wenjie , YU Qing’an

Department of Thyroid Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P. R. China;

Corresponding?author：

DAI Wenjie, Email: davidhmu@163.com

Keywords：

thyroid tumor; endoscopic thyroidectomy; gasless; subclavian approach

DOI：

10.7507/1007-9424.202509128

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To understand the research status, advantages and disadvantages, indications and contraindications, as well as the current challenges and countermeasures, controversies, and future development of gasless trans-subclavian approach endoscopic thyroidectomy (GTAET). Method The relevant domestic and international literature on GTAET was reviewed. Results In terms of oncological outcomes (such as the number of central lymph nodes dissected), GTAET is comparable to traditional open surgery. It demonstrates markedly higher postoperative cosmetic satisfaction and significantly lower incidences of anterior neck paresthesia and swallowing traction discomfort. Compared to other endoscopic approaches (such as the transaxillary approach), GTAET offers advantages including a shorter surgical path, less trauma during cavity creation, a better visual field for central lymph node dissection, and a shorter operative time. It also avoids CO₂ insufflation-related risks such as subcutaneous emphysema and hypercapnia. The main limitations of this technique are its generally longer operative time compared to open surgery and the potential for increased postoperative drainage. Furthermore, it faces several technical challenges and application difficulties in clinical practice, including the optimization of specialized instruments, standardization of surgical procedures, and management of lateral neck lymph node dissection. Conclusions GTAET is a safe and feasible minimally invasive surgical approach for thyroid disease. While ensuring thorough tumor eradication, it combines the advantages of a well-concealed incision, excellent preservation of anterior neck function, and the safety and convenience of gasless technique. It also has a relatively manageable learning curve, making it an excellent surgical option for patients with thyroid tumors who prioritize cosmetic outcomes and quality of life.

Citation： ZHAO Xinyu, DAI Wenjie, YU Qing’an. Research progress on gasless trans-subclavian approach endoscopic thyroidectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(3): 413-420. doi: 10.7507/1007-9424.202509128 Copy

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2.	Kim K, Lee S, Bae JS, et al. Comparison of long-term surgical outcome between transaxillary endoscopic and conventional open thyroidectomy in patients with differentiated thyroid carcinoma: a propensity score matching study. Surg Endosc, 2021, 35(6): 2855-2861.
3.	Shimizu K, Akira S, Jasmi AY, et al. Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound. J Am Coll Surg, 1999, 188(6): 697-703.
4.	Shimizu K, Shimizu K, Okamura R, et al. Video-assisted neck surgery (VANS) using a gasless lifting procedure for thyroid and parathyroid diseases: “The VANS method from A to Z”. Surg Today, 2020, 50(10): 1126-1137.
5.	劉躍武, 李小毅, 高維生, 等. 經鎖骨下途徑行腔鏡甲狀腺手術. 中國普通外科雜志, 2006, 15(4): 319-320.
6.	何高飛, 姜金汐, 褚俊杰, 等. 改良無充氣經單側鎖骨下入路腔鏡甲狀腺全切除術治療甲狀腺乳頭狀癌的臨床分析. 西安交通大學學報(醫學版), 2024, 45(1): 80-86.
7.	曹海玲, 洪云, 曹余彥, 等. 經鎖骨下入路行腔鏡輔助甲狀腺手術: 附62例報告. 中國普通外科雜志, 2008, 17(11): 1071-1073.
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10.	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.
11.	李明闖, 范璇, 陳征, 等. 無充氣經鎖骨下入路與經腋窩入路及傳統開放手術治療單側甲狀腺癌的臨床隊列研究. 中華外科雜志, 2025, 63(7): 613-619.
12.	王巖巖, 黃建康, 張超, 等. 經鎖骨下切口無充氣腔鏡雙側甲狀腺切除術的療效和安全性. 實用醫學雜志, 2021, 37(8): 1026-1030.
13.	金純. 鎖骨下雙孔入路腔鏡甲狀腺手術方式分析. 溫州醫科大學學報, 2022, 52(12): 1005-1008.
14.	何高飛, 姜金汐, 褚俊杰, 等. 無充氣經鎖骨下腔鏡甲狀腺右葉切除+右側中央區清掃1例視頻報告. 中國普通外科雜志, 2023, 32(11): 1705-1712.
15.	陳浩浩, 劉巖巖, 馬小鵬, 等. 無充氣后入路經鎖骨下腔鏡甲狀腺手術治療甲狀腺乳頭狀癌的學習曲線及短期臨床療效. 中國普通外科雜志, 2024, 33(5): 848-855.
16.	Jiang J, He G, Chu J, et al. Single-incision gasless trans-subclavian endoscopic approach thyroidectomy. Updates Surg, 2025, 77(1): 175-182.
17.	李理想, 劉巖巖, 陳浩浩, 等. 免充氣經鎖骨下后入路腔鏡甲狀腺手術治療甲狀腺乳頭狀癌的臨床研究. 中華內分泌外科雜志, 2025, 19(1): 51-56.
18.	沈方媛, 朱雙九, 鄭新聞, 等. 經胸鎖乳突肌肌間入路甲狀腺手術保護頸前區功能的效果分析. 徐州醫科大學學報, 2020, 40(8): 583-585.
19.	趙海舟, 李明闖, 呂晶. 改良免充氣經鎖骨下入路腔鏡手術治療甲狀腺癌的臨床觀察. 實用中西醫結合臨床, 2025, 25(3): 87-90.
20.	汪杰. 腔鏡甲狀腺手術的臨床應用進展. 腹腔鏡外科雜志, 2021, 26(9): 711-714.
21.	Wolfe SA, Russell JO. A narrative review of transoral thyroidectomy—2021 update. Ann thyroid, 2022, 7: 11. doi: 10.21037/aot-22-5.
22.	文華玲, 肖子健, 胡神保, 等. 經口及頦下聯合入路腔鏡手術治療早期甲狀腺乳頭狀癌的臨床價值分析. 腹腔鏡外科雜志, 2025, 30(3): 161-167.
23.	李明闖, 范璇, 陳征, 等. 無充氣經鎖骨下入路與經腋窩入路及傳統開放手術治療單側甲狀腺癌的臨床隊列研. 中華外科雜志, 2025, 63(7): 611-617.
24.	許瑞庭, 沈炎, 常瑞, 等. 免充氣鎖骨下入路腔鏡甲狀腺手術治療良性甲狀腺腫瘤臨床分析. 寧夏醫學雜志, 2022, 44(12): 1084-1086.
25.	徐嘉, 史維臣, 何奕卉, 等. 無充氣腋窩入路與鎖骨下入路腔鏡對單側甲狀腺癌的療效比較. 中國現代普通外科進展, 2024, 27(7): 561-563.
26.	刁建華, 龔利花, 邵志偉, 等. 無充氣鎖骨下入路腔鏡甲狀腺術與傳統開放性手術的療效比較. 中國腫瘤外科雜志, 2025, 17(3): 257-260.
27.	Yin X, Fu J, Zhang Z, et al. The efficacy of gasless endoscopic thyroidectomy via trans-subclavian approach in unilateral papillary thyroid carcinoma. Front Endocrinol (Lausanne), 2025, 16: 1621481. doi: 10.3389/fendo.2025.1621481.
28.	劉子靖, 王冰, 姚京, 等. 無充氣經鎖骨下入路腔鏡甲狀腺癌根治術治療單側甲狀腺乳頭狀癌的臨床療效及學習曲線. 解放軍醫學院學報, 2025, 46(3): 279-286.
29.	王平, 謝秋萍. 全腔鏡甲狀腺手術并發癥及防治. 中國實用外科雜志, 2018, 38(6): 635-638.
30.	李莎, 朱建敏, 劉秀文, 等. 無充氣腋窩入路腔鏡手術治療甲狀腺乳頭狀癌的研究進展. 腹腔鏡外科雜志, 2023, 28(3): 218-221.
31.	蘇華健, 王連臣. 腔鏡甲狀腺手術的研究進展. 腹腔鏡外科雜志, 2022, 27(3): 227-231.
32.	Nagaoka R, Sugitani I, Kazusaka H, et al. Learning curve for endoscopic thyroidectomy using video-assisted neck surgery: retrospective analysis of a surgeon’s experience with 100 patients. J Nippon Med Sch, 2022, 89(3): 277-286.
33.	邢家亮, 孟佳佳, 徐娜娜. 精細化被膜解剖技術在經鎖骨下入路腔鏡甲狀腺癌手術中的應用進展. 腹腔鏡外科雜志, 2025, 30(9): 687-691.
34.	章德廣, 何高飛, 褚俊杰, 等. 改良無充氣經鎖骨下入路腔鏡頸側區淋巴結清掃術治療甲狀腺乳頭狀癌31例臨床分析. 中華外科雜志, 2023, 61(9): 801-806.
35.	張永泉, 黎志超, 陳飛, 等. 腔鏡與開放手術在甲狀腺近全切除術后引流量與全身創傷反應的對比. 南方醫科大學學報, 2017, 37(10): 1364-1369.
36.	熊銳佳, 潘瑾潔, 胡志強, 等. 新型免充氣拉鉤在鎖骨下入路腔鏡甲狀腺手術中的應用. 實用醫學雜志, 2026, 42(3): 463-469.
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38.	何高飛, 姜金汐, 褚俊杰, 等. 經鎖骨下腔鏡甲狀腺手術中喉上神經外支探查及臨床應用. 中國普外基礎與臨床雜志, 2024, 31(11): 1376-1379.

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. Kim K, Lee S, Bae JS, et al. Comparison of long-term surgical outcome between transaxillary endoscopic and conventional open thyroidectomy in patients with differentiated thyroid carcinoma: a propensity score matching study. Surg Endosc, 2021, 35(6): 2855-2861.
3. Shimizu K, Akira S, Jasmi AY, et al. Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound. J Am Coll Surg, 1999, 188(6): 697-703.
4. Shimizu K, Shimizu K, Okamura R, et al. Video-assisted neck surgery (VANS) using a gasless lifting procedure for thyroid and parathyroid diseases: “The VANS method from A to Z”. Surg Today, 2020, 50(10): 1126-1137.
5. 劉躍武, 李小毅, 高維生, 等. 經鎖骨下途徑行腔鏡甲狀腺手術. 中國普通外科雜志, 2006, 15(4): 319-320.
6. 何高飛, 姜金汐, 褚俊杰, 等. 改良無充氣經單側鎖骨下入路腔鏡甲狀腺全切除術治療甲狀腺乳頭狀癌的臨床分析. 西安交通大學學報(醫學版), 2024, 45(1): 80-86.
7. 曹海玲, 洪云, 曹余彥, 等. 經鎖骨下入路行腔鏡輔助甲狀腺手術: 附62例報告. 中國普通外科雜志, 2008, 17(11): 1071-1073.
8. 宋昱穎, 畢鐵強. 腔鏡甲狀腺手術路徑的研究進展. 中國腫瘤外科雜志, 2024, 16(4): 313-317.
9. 章德廣, 何高飛, 李建波, 等. 改良無充氣經鎖骨下入路腔鏡甲狀腺手術治療甲狀腺乳頭狀癌70例療效分析. 中國實用外科雜志, 2022, 42(6): 691-694.
10. 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.
11. 李明闖, 范璇, 陳征, 等. 無充氣經鎖骨下入路與經腋窩入路及傳統開放手術治療單側甲狀腺癌的臨床隊列研究. 中華外科雜志, 2025, 63(7): 613-619.
12. 王巖巖, 黃建康, 張超, 等. 經鎖骨下切口無充氣腔鏡雙側甲狀腺切除術的療效和安全性. 實用醫學雜志, 2021, 37(8): 1026-1030.
13. 金純. 鎖骨下雙孔入路腔鏡甲狀腺手術方式分析. 溫州醫科大學學報, 2022, 52(12): 1005-1008.
14. 何高飛, 姜金汐, 褚俊杰, 等. 無充氣經鎖骨下腔鏡甲狀腺右葉切除+右側中央區清掃1例視頻報告. 中國普通外科雜志, 2023, 32(11): 1705-1712.
15. 陳浩浩, 劉巖巖, 馬小鵬, 等. 無充氣后入路經鎖骨下腔鏡甲狀腺手術治療甲狀腺乳頭狀癌的學習曲線及短期臨床療效. 中國普通外科雜志, 2024, 33(5): 848-855.
16. Jiang J, He G, Chu J, et al. Single-incision gasless trans-subclavian endoscopic approach thyroidectomy. Updates Surg, 2025, 77(1): 175-182.
17. 李理想, 劉巖巖, 陳浩浩, 等. 免充氣經鎖骨下后入路腔鏡甲狀腺手術治療甲狀腺乳頭狀癌的臨床研究. 中華內分泌外科雜志, 2025, 19(1): 51-56.
18. 沈方媛, 朱雙九, 鄭新聞, 等. 經胸鎖乳突肌肌間入路甲狀腺手術保護頸前區功能的效果分析. 徐州醫科大學學報, 2020, 40(8): 583-585.
19. 趙海舟, 李明闖, 呂晶. 改良免充氣經鎖骨下入路腔鏡手術治療甲狀腺癌的臨床觀察. 實用中西醫結合臨床, 2025, 25(3): 87-90.
20. 汪杰. 腔鏡甲狀腺手術的臨床應用進展. 腹腔鏡外科雜志, 2021, 26(9): 711-714.
21. Wolfe SA, Russell JO. A narrative review of transoral thyroidectomy—2021 update. Ann thyroid, 2022, 7: 11. doi: 10.21037/aot-22-5.
22. 文華玲, 肖子健, 胡神保, 等. 經口及頦下聯合入路腔鏡手術治療早期甲狀腺乳頭狀癌的臨床價值分析. 腹腔鏡外科雜志, 2025, 30(3): 161-167.
23. 李明闖, 范璇, 陳征, 等. 無充氣經鎖骨下入路與經腋窩入路及傳統開放手術治療單側甲狀腺癌的臨床隊列研. 中華外科雜志, 2025, 63(7): 611-617.
24. 許瑞庭, 沈炎, 常瑞, 等. 免充氣鎖骨下入路腔鏡甲狀腺手術治療良性甲狀腺腫瘤臨床分析. 寧夏醫學雜志, 2022, 44(12): 1084-1086.
25. 徐嘉, 史維臣, 何奕卉, 等. 無充氣腋窩入路與鎖骨下入路腔鏡對單側甲狀腺癌的療效比較. 中國現代普通外科進展, 2024, 27(7): 561-563.
26. 刁建華, 龔利花, 邵志偉, 等. 無充氣鎖骨下入路腔鏡甲狀腺術與傳統開放性手術的療效比較. 中國腫瘤外科雜志, 2025, 17(3): 257-260.
27. Yin X, Fu J, Zhang Z, et al. The efficacy of gasless endoscopic thyroidectomy via trans-subclavian approach in unilateral papillary thyroid carcinoma. Front Endocrinol (Lausanne), 2025, 16: 1621481. doi: 10.3389/fendo.2025.1621481.
28. 劉子靖, 王冰, 姚京, 等. 無充氣經鎖骨下入路腔鏡甲狀腺癌根治術治療單側甲狀腺乳頭狀癌的臨床療效及學習曲線. 解放軍醫學院學報, 2025, 46(3): 279-286.
29. 王平, 謝秋萍. 全腔鏡甲狀腺手術并發癥及防治. 中國實用外科雜志, 2018, 38(6): 635-638.
30. 李莎, 朱建敏, 劉秀文, 等. 無充氣腋窩入路腔鏡手術治療甲狀腺乳頭狀癌的研究進展. 腹腔鏡外科雜志, 2023, 28(3): 218-221.
31. 蘇華健, 王連臣. 腔鏡甲狀腺手術的研究進展. 腹腔鏡外科雜志, 2022, 27(3): 227-231.
32. Nagaoka R, Sugitani I, Kazusaka H, et al. Learning curve for endoscopic thyroidectomy using video-assisted neck surgery: retrospective analysis of a surgeon’s experience with 100 patients. J Nippon Med Sch, 2022, 89(3): 277-286.
33. 邢家亮, 孟佳佳, 徐娜娜. 精細化被膜解剖技術在經鎖骨下入路腔鏡甲狀腺癌手術中的應用進展. 腹腔鏡外科雜志, 2025, 30(9): 687-691.
34. 章德廣, 何高飛, 褚俊杰, 等. 改良無充氣經鎖骨下入路腔鏡頸側區淋巴結清掃術治療甲狀腺乳頭狀癌31例臨床分析. 中華外科雜志, 2023, 61(9): 801-806.
35. 張永泉, 黎志超, 陳飛, 等. 腔鏡與開放手術在甲狀腺近全切除術后引流量與全身創傷反應的對比. 南方醫科大學學報, 2017, 37(10): 1364-1369.
36. 熊銳佳, 潘瑾潔, 胡志強, 等. 新型免充氣拉鉤在鎖骨下入路腔鏡甲狀腺手術中的應用. 實用醫學雜志, 2026, 42(3): 463-469.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research progress on gasless trans-subclavian approach endoscopic thyroidectomy

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