Combined Vacuum-Assisted Excision and Thermal Ablation for Symptomatic Benign Thyroid Nodules: A Pilot Study

Thyroid nodules are a common clinical condition, while thermal ablation (TA) has emerged as a minimally invasive alternative to surgery. Single-session ablation often fails to achieve complete symptomatic resolution in large, hypervascular nodules. Post-ablation carbonization further limits volumetric resorption, necessitating optimized therapeutic strategies. This pilot study aimed to evaluate the feasibility, safety, and preliminary efficacy of combined vacuum-assisted excision and thermal ablation (VAE-TA) for symptomatic benign thyroid nodules refractory to initial ablation. From December 2023 to January 2025, five patients underwent VAE-TA at a single center. Inclusion criteria included persistent symptoms ≥12 months post-initial ablation and confirmed benignity via fine-needle aspiration. The procedure involved ultrasound-guided vacuum-assisted excision of post-ablation fibrotic tissue followed by microwave ablation. Primary outcomes included feasibility and safety, while secondary outcomes focused on volume reduction rate (VRR) and symptom improvement. Patients were followed up at 1 and 6 months. These preliminary findings suggest that VAE-TA may be a feasible, minimally invasive salvage approach for selected symptomatic benign thyroid nodules with incomplete response to initial ablation, although larger, controlled studies with longer follow-up are required.