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Updated: Oct 15, 2026
Gasless Endoscopic Thyroidectomy via the Trans-Axillary Approach
Published on: September 15, 2023
Gasless endoscopic thyroidectomy via the transsubclavian approach: comparable safety and superior anterior cervical
Chengmin Huang1, Wenxia Wang1, Jiang Yao2
1Department of Surgery, Changxing People's Hospital, 66 Taihu Road, Changxing, 313100, Huzhou, China.
Background:
Conventional open thyroidectomy (COT) for papillary thyroid carcinoma (PTC) frequently induces anterior cervical dysfunction and conspicuous scarring. The gasless endoscopic thyroidectomy via the transsubclavian approach (GETTSA) offers technical simplicity and superior cosmesis. This study assessed whether GETTSA provides adequate completeness of resection and effectiveness compared with COT while achieving superior preservation of anterior cervical function.
Methods:
This prospective cohort study enrolled consecutive patients with unilateral PTC who underwent hemithyroidectomy between 2023 and 2025, with 37 in the GETTSA group and 65 in the COT group. Baseline and perioperative data were prospectively collected. Scar appearance and anterior cervical function were assessed using the Vancouver Scar Scale (VSS), Neck Impairment Score (NIS), Swallowing Impairment Score (SIS), and Voice Impairment Score (VIS) at 1, 3, and 6 months. Group comparisons were performed using t‑tests, Mann-Whitney U tests, or chi‑square tests, and generalized estimating equations (GEE) evaluated longitudinal group, time, and interaction effects.
Results:
Baseline characteristics between the two groups were comparable. GETTSA had a longer operative time (P < 0.001) but less intraoperative blood loss (P = 0.002); hospital stay was slightly longer (P < 0.001). Parathyroid autotransplantation rates were higher in GETTSA (P < 0.001), yet postoperative PTH and calcium levels were similar. GEE demonstrated significant group and time effects for VSS, NIS, and SIS (all P < 0.001), with significant group‑by‑time interactions (P = 0.048, P = 0.026, and P < 0.001, respectively), indicating better and faster recovery in the GETTSA group. VIS showed a significant time effect (P < 0.001), but no group effect (P = 0.333) or interaction (P = 0.637). R0 resection was achieved in all patients, and no major procedure‑related complications occurred.
Conclusion:
GETTSA offers superior functional and cosmetic outcomes-notably improved swallowing function, better scar appearance, and reduced neck discomfort-with less intraoperative bleeding, comparable parathyroid safety, and adequate completeness of resection. Long‑term oncological surveillance is ongoing.
