Ultrasound-guided needle localization in trans-mammary endoscopic thyroidectomy: a case report

Thyroid nodules are relatively common, with a high incidence rate among adults, particularly women. With the widespread application of ultrasound imaging technology, the detection rate of thyroid nodules has significantly increased. However, traditional open surgery can lead to significant scar formation and potential thyroid dysfunction. Therefore, minimally invasive techniques that preserve thyroid function and aesthetic appearance are increasingly important.

A 51-year-old Han Chinese female patient had nodules in both thyroid glands (right side C-TIRADS 4A, left side C-TIRADS 3). The patient was placed in a supine position with the neck extended ("human" position). Following ultrasound guidance, a localization needle was precisely marked at the nodule in the left lower pole, with the needle tip positioned at the deep margin of the lesion. The needle tail was secured to the skin with sterile tape. Trocar incisions were made at the margins of both areolas and the right upper outer quadrant. Carbon dioxide was insufflated to 6 mmHg to create the surgical space. The right thyroid lobe and isthmus were completely resected; subsequently, the surgeon shifted to the left thyroid lobe, identified the preplaced localization needle via endoscopy, and traced it to the nodule at the left lower pole. A circular dissection was performed around the needle tip with a 0.5-cm margin of normal tissue, precisely resecting the nodule. The localization needle enabled real-time, targeted resection under intraoperative guidance.

Combining ultrasound-guided localization needles with endoscopic thyroidectomy via the trans-breast approach offers a minimally invasive surgical option that preserves thyroid function and aesthetics while enabling precise resection of thyroid nodules, minimizing damage to normal tissue, and improving patient outcomes. This surgical method holds great potential in the field of thyroid surgery, achieving a balance between radical resection and functional preservation. Highlights 1. Precision-guided minimally invasive surgery: this study introduces an innovative integration of ultrasound-guided needle localization with endoscopic thyroidectomy via the areola approach, achieving highly precise resection of thyroid nodules. The method significantly improves surgical accuracy, especially for small or nonpalpable nodules located deep within the thyroid gland. 2. Function-preserving surgical strategy: by restricting the resection margin to only 0.5 cm beyond the lesion, the technique maximizes preservation of normal thyroid tissue. Consequently, the patient maintained relatively stable postoperative thyroid function, requiring only minimal hormone replacement therapy. 3. Excellent cosmetic and clinical outcomes: the areola-based access route provided a scar-free aesthetic result, while the patient recovered smoothly without complications such as hoarseness or hypocalcemia. The procedure was completed in a reasonable duration with minimal blood loss, underscoring both the safety and efficiency of the approach. 4. Pathological and functional validation: postoperative pathology confirmed complete resection of a papillary thyroid carcinoma in the right lobe and a noninvasive follicular thyroid neoplasm in the left lobe. No residual disease was detected, and subsequent thyroid function tests validated the success of the tissue-preserving strategy. This case highlights a promising advancement in thyroid surgery by merging technological precision with functional and cosmetic priorities. It underscores the potential for broader clinical adoption of approaches that balance oncologic safety with quality-of-life outcomes.