Gasless endoscopic thyroidectomy via the trans-subclavian approach versus conventional open thyroid surgery for unilateral thyroid cancer

Abstract

Abstract The incidence of papillary thyroid carcinoma (PTC) is increasing worldwide. With advancements in society and technology, the variety of thyroid endoscopic surgeries is expanding. Gasless endoscopic thyroidectomy via the trans-subclavian approach (GETTSA) has been used for many years; yet, relevant research data are limited. This study aimed to assess the reliability of GETTSA by comparing it with conventional open thyroid surgery (COT). Clinical data were collected from 488 patients who underwent unilateral PTC surgery at Yantai Yuhuangding Hospital. Based on propensity score matching, relevant data were compared between the two procedures using the chi-square test, independent-sample t-test, and Mann-Whitney U test. COT and GETTSA significantly differed with respect to Thyroid Cancer-Specific Quality of Life ( P  < 0.001), scar appearance ( P  = 0.031), swallowing function ( P  = 0.001), operative time ( P  < 0.001), hospital fees ( P  < 0.001), number of central lymph node dissections ( P  < 0.001), drainage volume on the first postoperative day ( P  = 0.017), and parathyroid autotransplantation( P  = 0.019). However, no notable differences in the number of lymph node metastases ( P  = 0.155), length of postoperative hospital stay ( P  = 0.181), or transient vocal cord paralysis ( P  = 0.478) were observed between COT and GETTSA. Additionally, no complications (secondary surgery, tracheal fistula, poor healing, or postoperative bleeding) occurred in either group. In conclusion, GETTSA is a reliable surgical procedure with the help of carbon nanoparticles; however, attention should be paid to protecting the parathyroid glands.