A Novel Contralateral Axillo-Bilateral-Breast Approach for Endoscopic Thyroid Surgery

The incidence of thyroid cancer has increased significantly, with surgical resection remaining the primary treatment modality. Traditional open thyroidectomy leaves visible neck scars that cause significant cosmetic concerns for patients. This protocol describes a novel endoscopic thyroidectomy technique using a contralateral axillo-bilateral-breast approach (CABBA-ET). The key innovations include: (i) supine patient positioning without leg separation, reducing surgeon discomfort and patient hip strain risk; (ii) optimized camera and instrument positioning that minimizes surgical field obstruction; and (iii) trans-areolar incisions providing excellent scar concealment. In a cohort of 130 patients treated between 2019 and 2025, this approach demonstrated operative safety comparable to that of conventional thyroidectomy, with superior cosmetic outcomes. The technique is suitable for papillary thyroid carcinomas ≤2 cm in maximum diameter without extensive lymph node metastasis, and benign nodules <6 cm. All patients achieved satisfactory cosmetic results with no permanent complications. This approach represents a safe and feasible alternative for patients seeking cosmetically favorable thyroid surgery.