Modified Gasless Endoscopic Total Thyroidectomy via a Unilateral Subclavian Approach for Papillary Thyroid Carcinoma

To evaluate the technical feasibility and surgical outcomes of modified gasless endoscopic total thyroidectomy via a unilateral subclavian approach for treating papillary thyroid carcinoma. A retrospective analysis of the clinical data of 117 patients with papillary thyroid carcinoma who underwent modified gasless endoscopic total thyroidectomy via a unilateral subclavian approach at the Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, from March 2022 to June 2024 was conducted. All surgeries were successfully completed endoscopically without conversion to open surgery. The mean tumour size was 8.4±4.7 mm, and the mean operative time was 154.2±32.4 minutes. The mean number of harvested central compartment lymph nodes was 12.4±6.6, and the mean length of postoperative hospital stay was 3.2±1.1 days. Postoperative complications included temporary hypoparathyroidism (n=6, 5.1%), temporary hoarseness (n=3, 2.6%), and postoperative haemorrhage (n=2, 1.7%). All temporary complications resolved spontaneously within three months. No permanent recurrent laryngeal nerve（RLN）palsy, permanent hypoparathyroidism, or incision infection occurred. During the follow-up period, one patient developed lateral neck lymph node recurrence at 13 months postoperatively and subsequently underwent bilateral neck dissection. Modified gasless endoscopic total thyroidectomy via a unilateral subclavian approach demonstrated feasibility in carefully selected patients. This technique enables comprehensive central compartment lymph node dissection while preserving anterior cervical function, suggesting its potential clinical applicability.