Transaxillary vs. Transsubclavian Gasless endoscopic thyroidectomy approaches for papillary thyroid cancer

The use of transaxillary and transsubclavian approaches for endoscopic thyroidectomy has increased globally. However, studies examining the comparative outcomes of these procedures are scarce. In this study, we aimed to compare the safety and efficacy of thyroidectomy between the gasless endoscopic thyroidectomy transaxillary approach (GETTA) and gasless endoscopic thyroidectomy transsubclavian approach (GETTSA) in patients with papillary thyroid cancer (PTC). Medical records of patients with PTC who underwent GETTA or GETTSA performed by the same surgical team between August 2022 and August 2023 were retrospectively reviewed. Propensity score matching (PSM) was used to mitigate potential selection bias and adjust for baseline clinical characteristic differences. After PSM using 10 covariates, 196 patients (GETTA: 98; GETTSA: 98) were included. In comparison to the GETTSA group, the GETTA group exhibited a longer duration of operation (120.00 [103.75-140.00] vs. 110.00 [90.00-125.00] min, P = 0.001), longer postoperative hospital stays (1.00 [1.00-3.00] vs. 1.00 [1.00-2.00] days, P = 0.008), higher hospitalisation costs (23,973.02 [22,640.80-25,379.80] vs. 23,306.00 [21,968.97-24,070.68] Yuan, P = 0.015), and greater postoperative drainage (60.00 [50.00-70.00] vs. 46.50 [40.00-56.25] mL, P < 0.001). Intraoperative parathyroid autotransplantation and vocal cord paralysis rates were not significantly different between groups. The number of lymph node metastases via central lymph node dissection was not significantly different between groups (0.00 [0.00-1.00] vs. 0.00 [0.00-1.00], P = 0.645). No significant procedural safety or completeness differences were observed between GETTA and GETTSA. GETTA had better cosmetic outcomes. GETTSA had shorter duration of operation durations, shorter hospital stays, lower hospitalisation costs, and lower postoperative drainage, making it a better option for clinical use.