[Clinical study of endoscopic thyroidectomy by gasless unilateral axillary approach for large thyroid nodules]

Objective:To investigate the safety and efficacy of endoscopic thyroidectomy by gasless unilateral axillary approach in the treatment of large thyroid nodules. Methods:A retrospective analysis was performed on 49 patients with large unilateral thyroid nodules who underwent endoscopic thyroidectomy by gasless unilateral axillary approach performed by the same surgeon in our hospital from August 2022 to October 2025（Large thyroid nodules were defined as maximum intrathyroidal lesion diameter ≥4 cm, or ≥3 cm with ipsilateral lobe volume ≥20 mL, malignancy, rapid progression（within 6 months） or clinical symptoms）. These patients were matched with 49 patients with thyroid cancer（microcarcinoma group） whose maximum diameter of single lesion was <1 cm and the volume of the affected lobe was<20 mL during the same period. The operation time, specimen retrieval time, intraoperative blood loss, postoperative drainage volume, and early complications were compared between the two groups. Results:All 98 operations were completed successfully, with rapid and intact specimen retrieval, and no conversion to open surgery. There were no statistically significant differences in operation time, specimen retrieval time, intraoperative blood loss, and total postoperative complication rate between the two groups. During the follow-up period of 3-39 months, no residual thyroid tissue, effusion, tumor recurrence or metastasis was observed in the surgical field, and vocal cord mobility was normal in all patients. Conclusion:Endoscopic thyroidectomy by gasless unilateral axillary approach provides a stable surgical space, a unique dorsolateral view of the thyroid lobe, and an excellent surgical field smoke evacuation system. This technique is safe and effective for large thyroid nodules without reducing surgical efficiency or increasing surgical risk and difficulty. Moreover, it allows complete and natural specimen retrieval, thus ensuring the accuracy of postoperative pathological diagnosis.