ObjectiveTo evaluate the safety and efficacy of gasless endoscopic thyroidectomy via transaxillary approach in treating papillary thyroid cancer (PTC). MethodsThe patients who underwent gasless endoscopic thyroidectomy (Abbreviated as the “endoscopic group”) and neck open surgery (Abbreviated as the “open group”), in the Zhejiang Provincial People’s Hospital from January 2018 to June 2023, were collected. The intraoperative and postoperative outcomes of the patients in the two groups were compared after propensity score matching (PSM). Statistical analysis was conducted using SPSS 26.0 software, with a test level of α=0.05. ResultsAfter PSM, there were 409 patients in the endoscopic group and 421 patients in the open group. There were no statistically significant differences in the baseline data between the two groups (P>0.05), except for tumor location, vascular invasion, intraglandular dissemination, and preoperative levels of total triiodothyronine and thyroid hormone (P<0.05). Compared with the open group, the patients in the endoscopic group had less intraoperative blood loss (P<0.05), higher points of incision satisfaction and cosmetic effect (P<0.05), but the number of lymph nodes dissected was less (P<0.05) and the operation time was longer (P<0.05) in the endoscopic group. The incidence of postoperative overall complications had no statistically significant difference between the endoscopic group and open group (3.6% versus 5.8%, P=0.127). There was no statistically significant difference in the recurrence rate between the endoscopic group and open group within one year of follow-up (0.2% versus 0.5%, P=0.099). ConclusionsFrom the results of this study, the gasless endoscopic thyroidectomy is safety and reliability in treatment of PTC. It can achieve the same effect as traditional open thyroidectomy. However, it can also be seen that young female patients are more willing to choose gasless endoscopic thyroidectomy as long as their condition permits (such as early tumor stage, low invasiveness).
ObjectiveTo 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). MethodsA 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. ResultsAmong 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. ConclusionsThe 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.
ObjectiveTo 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). MethodThe relevant domestic and international literature on GTAET was reviewed. ResultsIn 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. ConclusionsGTAET 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.
ObjectiveTo evaluate the safety, efficacy, and advantages of gasless trans-subclavian approach endoscopic parathyroidectomy (GTAEPT) in the treatment of primary hyperparathyroidism (PHPT). MethodsA retrospective analysis was conducted on the clinical data of 10 patients with PHPT who underwent GTAEPT at Xuzhou Central Hospital from October 2022 to September 2024. Data collected included operative time, recurrent laryngeal nerve exposure time, intraoperative blood loss, total drainage volume within the first two postoperative days, total hospital stay, changes in preoperative and postoperative intact parathyroid hormone (PTH) and serum calcium levels, and the occurrence of postoperative complications such as hoarseness, choking during drinking, active bleeding, and surgical site infection. Additionally, PTH and serum calcium levels were monitored at 6-month postoperatively. ResultsAll surgical procedures were successfully completed in the 10 patients. The operative time was (67.0±14.5) min, recurrent laryngeal nerve exposure time was (15.3±8.2) s, intraoperative blood loss was (9.5±3.5) mL, total drainage volume within the first two postoperative days was (36.7±5.2) mL, and total hospital stay was (6.4±1.0) d. The preoperative-to-postoperative differences in PTH and serum calcium levels [mean difference (95%CI)] were 191.3 (160.7, 220.0) ng/L and 0.5 (0.3, 0.6) mmol/L, respectively, both returning to normal reference ranges. Only one case of transient hoarseness was observed postoperatively, with no complications such as active bleeding, choking during drinking, or surgical site infection. At the 6-month follow-up, all patients maintained serum PTH and calcium levels within the normal reference ranges. ConclusionsGTAEPT has preliminarily demonstrated safety and feasibility in treating PHPT, with short intraoperative recurrent laryngeal nerve exposure time, rapid postoperative normalization of PTH and serum calcium levels, and stable therapeutic outcomes during the 6-month follow-up. This technique combines the benefits of minimal invasiveness and favorable cosmesis, representing a viable treatment option for patients with unilateral parathyroid lesions.
