Critical Landmark Exposure & Anatomical Recognition and Axillo-Breast Lateral Entry: Endoscopic Thyroidectomy

Area of Science:

• Endocrine Surgery
• Minimally Invasive Surgery
• Surgical Anatomy

Background:

• Minimally invasive thyroidectomy aims to improve cosmetic results and surgical safety.
• The axillo-breast approach is gaining traction, but standardized techniques for anatomical clarity and nerve preservation are lacking.
• This study addresses the need for enhanced anatomical visualization in endoscopic thyroid surgery.

Purpose of the Study:

• To present the Axillo-Breast Lateral Entry (ABLE) technique for endoscopic hemithyroidectomy.
• To introduce the Critical Landmark Exposure & Anatomical Recognition (CLEAR) concept for improved dissection safety.
• To evaluate the safety and efficacy of the ABLE technique with the CLEAR concept.

Main Methods:

• Retrospective review of 40 patients undergoing ABLE endoscopic hemithyroidectomy without intraoperative neuromonitoring.
• Utilized standard laparoscopic instruments and energy devices with ergonomic port placement.
• Applied the CLEAR concept to identify the recurrent laryngeal nerve (RLN), inferior thyroid artery (ITA), and parathyroid glands.

Main Results:

• All 40 patients had benign nodules (mean size 4.4 ± 1.2 cm).
• 100% visual identification of the recurrent laryngeal nerve (RLN) was achieved.
• No permanent vocal cord palsy or hypoparathyroidism occurred; all patients discharged by postoperative day one.

Conclusions:

• The ABLE technique is safe, reproducible, and ergonomically advantageous, especially for novice surgeons.
• The CLEAR concept provides a reliable anatomical framework for critical structure preservation, even without intraoperative neuromonitoring.
• This approach can promote wider adoption of endoscopic thyroidectomy, particularly in resource-limited environments.