The clinical value and learning curve analysis of the modified areolar approach for endoscopic thyroidectomy

To compare the clinical outcomes and learning curve characteristics of the traditional bilateral areolar approach (BAA) and the modified areolar approach (MAA) in endoscopic thyroidectomy and to assess the advantages and potential for clinical dissemination of the modified technique.

We retrospectively reviewed 79 female patients who underwent endoscopic radical thyroidectomy for thyroid cancer. Patients were assigned to the BAA group or the MAA group according to the incision placement. Perioperative parameters were compared between groups, such as operative time, intraoperative blood loss, number of lymph nodes harvested, incidence of postoperative complications, and patient satisfaction. A cumulative sum analysis (CUSUM) was performed to construct learning curves and evaluate the progression of surgical proficiency.

Compared with the BAA group, the MAA group demonstrated a significantly shorter operative time (P < 0.001), reduced intraoperative blood loss (P = 0.029), and a lower rate of short-term postoperative complications (P = 0.05). The CUSUM learning curve inflection point occurred earlier in the MAA group (20th case vs. 26th case), indicating more rapid acquisition of the technique.

By optimizing incision placement and instrument alignment, the modified areolar approach shortens operative time, minimizes intraoperative trauma, and decreases complication rates. Its shorter learning curve and greater procedural stability facilitate faster mastery of endoscopic thyroidectomy, supporting its wider clinical adoption.