ObjectiveTo investigate the feasibility of dissecting the external branch of the superior laryngeal nerve using endoscopic thyroidectomy via gasless unilateral subclavian approach combined with intraoperative nerve monitoring. MethodsThe clinical data of 30 patients who underwent the gasless nilateral subclavian approach endoscopic thyroidectomy in the Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine from October 2023 to February 2024 were retrospectively analyzed. ResultsAll operations were successfully completed under endoscopy approach without transfer to open surgery. A total of 29 cases of the external branch of superior laryngeal nerves were revealed in 30 cases, the revealed rate was 96.7%. The time for dissecting the external branch of the superior laryngeal nerve was 2–6 min [(3.6±2.3) min]. There was no obvious sound change related to the injury of the external branch of superior laryngeal nerve in postoperative patients. ConclusionFor the modified endoscopic thyroidectomy via gasless unilateral subclavian approach combined with intraoperative nerve monitoring, excellent anatomical protection of the external branch of the superior laryngeal nerve can be obtained.
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.
