Application, innovation, and quality control of endoscopic thyroidectomy by gasless unilateral axillary approach

doi:10.16139/j.1007-9610.2025.01.01

Abstract

Abstract:

The endoscopic thyroidectomy by gasless unilateral axillary approach (GUA) represents a significant advancement in the field of endoscopic thyroid surgery, offering notable aesthetic and clinical therapeutic benefits. This paper reviewed the current clinical application, core technological innovations, quality control systems, and future developmental directions of GUA. Research indicated that GUA achieved surgical outcomes comparable to traditional open surgery in the treatment of benign thyroid tumors and thyroid cancer, while substantially enhancing cosmetic results and patient satisfaction. By optimizing the surgical approach design, enhancing cavity construction equipment, and standardizing the operational process, GUA markedly reduced the incidence of postoperative complications, preserved the anterior cervical functional area, and improved patients' postoperative quality of life. Furthermore, multidisciplinary collaboration and thorough pre-operative evaluation were fundamental to surgical success, while intraoperative quality control measures and a comprehensive postoperative follow-up system ensured the safety and efficacy of the procedure. In the future, the integration of robotic technology and advancements in single-site devices are anticipated to enhance the role of GUA in endoscopic thyroid surgery, thereby offering patients more minimally invasive and aesthetically favorable treatment options.

Key words: Endoscopic thyroidectomy by gasless unilateral axillary approach (GUA), Thyroid tumor, Surgical technique, Quality control

CLC Number:

R653

GUO Yawen, ZHENG Chuanming, GE Minghua. Application, innovation, and quality control of endoscopic thyroidectomy by gasless unilateral axillary approach[J]. Journal of Surgery Concepts & Practice, 2025, 30(01): 1-6.

References 31

[1]	SIEGEL R L, KRATZER T B, GIAQUINTO A N, et al. Cancer statistics,2025[J]. CA Cancer J Clin, 2025, 75(1):10-45.
[2]	LI M, DAL MASO L, VACCARELLA S. Global trends in thyroid cancer incidence and the impact of overdiagnosis[J]. Lancet Diabetes Endocrinol, 2020, 8(6):468-470.
[3]	LI M, HU M, JIANG L, et al. Trends in cancer incidence and potential associated factors in China[J]. JAMA Netw Open, 2024, 7(10):e2440381.
[4]	HAN B, ZHENG R, ZENG H, et al. Cancer incidence and mortality in China, 2022[J]. J Natl Cancer Cent, 2024, 4(1):47-53.
[5]	YOON J H, PARK C H, CHUNG W Y. Gasless endoscopic thyroidectomy via an axillary approach:experience of 30 cases[J]. Surg Laparosc Endosc Percutan Tech, 2006, 16(4):226-231.
[6]	TAE K, JI Y B, CHO S H, et al. Initial experience with a gasless unilateral axillo-breast or axillary approach endoscopic thyroidectomy for papillary thyroid microcarcinoma:comparison with conventional open thyroidectomy[J]. Surg Laparosc Endosc Percutan Tech, 2011, 21(3):162-169.
[7]	KANG S W, JEONG J J, YUN J S, et al. Robot-assisted endoscopic surgery for thyroid cancer:experience with the first 100 patients[J]. Surg Endosc, 2009, 23(11):2399-2406.
[8]	郑传铭, 毛晓春, 王佳峰, 等. 无充气腋窝入路完全腔镜下甲状腺癌根治术效果初步评价初期体会[J]. 中国肿瘤临床, 2018, 45(1):27-32.
	ZHENG C M, MAO X C, WANG J F, et al. Preliminary evaluation of effect of endoscopic thyroidectomy using the gasless unilat-eral axillary approach[J]. Chin J Clin Oncol, 2018, 45(1):27-32.
[9]	郑传铭, 徐加杰, 蒋烈浩, 等. 无充气腋窝入路完全腔镜下甲状腺叶切除的方法——葛-郑氏七步法[J]. 中国普通外科杂志, 2019, 28(11):1336-1341.
	ZHENG C M, XU J J, JIANG L H, et al. Endoscopic thyroid lobectomy by a gasless unilateral axillary approach:Ge & Zheng's seven-step method[J]. Chin J Gene Surg, 2019, 28(11):1336-1341.
[10]	中国抗癌协会甲状腺癌专业委员会, 中华医学会肿瘤学分会甲状腺肿瘤专业委员会, 中国研究型医院学会甲状腺疾病专业委员会, 等. 无充气腋窝入路腔镜甲状腺手术专家共识(2022版). 中华内分泌外科杂志, 2021, 15(6):557-563.
	Chinese Association of Thyroid Oncology, Thyroid Tumor Committee of Oncology Branch of Chinese Medical Association, Thyroid Disease Professional Committee of Chinese Research Hospital Association, et al. Expert consensus on endoscopic thyroidectomy by a gasless unilateral axillary approach(version 2022)[J]. Chin J Endo Surg, 2021, 15(6):557-563.
[11]	葛明华, 张大宏, 牟一平. 肿瘤微创手术学[M]. 厦门: 厦门大学出版社,2022:1-433.
	GE M H, ZHANG D H, MOU Y P. Tumor Minimally Invasive Surgery[M]. Xiamen: Xiamen University Press,2022:1-433.
[12]	高明, 葛明华. 甲状腺肿瘤学[M]. 北京: 人民卫生出版社,2018:1-550.
	GAO M, GE M H. Thyroid Oncology[M]. Beijing: People's Medical Publishing House,2018:1-550.
[13]	郑传铭, 葛明华. 无充气腋窝入路腔镜/机器人甲状腺外科学[M]. 杭州: 浙江大学出版社,2024:1-173.
	ZHENG C M, GE M H. Surgery of Endoscopic/Robotic Thyroidectomy by Gasless Unilateral Axillary Approach[M]. Hangzhou: Zhejiang University Press,2024:1-173.
[14]	葛军娜, 余诗桐, 谭洁, 等. 经腋窝后入路无充气腔镜甲状腺系膜切除术"五沉法"[J]. 中国普通外科杂志, 2023, 32(5):718-723.
	Ge J N, YU S T, TAN J, et al. "Five-settlement method" for gasless endoscopic mesothyroidexcision via unilateral axillary approach[J]. Chin J Gene Surg, 2023, 32(5):718-723.
[15]	陈孝磊, 李超, 周雨秋, 等. 经腋无充气完全腔镜下颌下腺及肿瘤切除术1例[J]. 中华耳鼻咽喉头颈外科杂志, 2022, 57(2):212-214.
	CHEN X L, LI C, ZHOU Y Q, et al. Resection of submandibular gland and tumor via transaxillary gasless endoscopy:a case report[J]. Chin J Otorhinolary Head Neck Surg, 2022, 57(2):212-214.
[16]	ZHENG X, WANG X, WEI T. Gasless endoscopic thyroidectomy via the trans-axillary approach[J]. J Vis Exp, 2023(199).
[17]	中国抗癌协会甲状腺癌专业委员会护理学组. 甲状腺癌加速康复外科围术期护理专家共识[J]. 护理研究, 2022, 36(1):1-7.
	Nursing Committee of Chinese Association of Thyroid Oncology. Enhanced recovery after surgery(ERAS) of peri-operative nursing in thyroid oncology:experts consensus[J]. Chin Nurs Rese, 2022, 36(1):1-7.
[18]	胡啸天, 忻莹, 郑传铭, 等. 无充气腋窝入路完全腔镜甲状腺手术的“三推进”悬吊建腔法[J]. 浙江大学学报(医学版), 2021, 50(6):694-700.
	HU X T, XIN Y, ZHENG C M, et al. "Three-propulsion" suspension method for endoscopic thyroid surgery gasless axillary approach[J]. J ZheJiang Univ (Medi Sci), 2021, 50(6):694-700.
[19]	蒋烈浩, 刘清, 凌枭凯, 等. 无充气腋窝入路腔镜甲状腺手术空间构建的常见问题及解决思路[J]. 西安交通大学学报(医学版), 2024, 45(1):87-93.
	JIANG L H, LIU Q, LING X K, et al. Common challenges and resolutions in the spatial construction of endoscopic thyroid surgery using a gasless axillary approach[J]. J Xi’an Jiao Tong Univ (Medi Sci), 2024, 45(1):87-93.
[20]	徐加杰, 郑传铭, 张怡宁, 等. 无充气经腋窝腔镜甲状腺乳头状癌侧颈部淋巴结清扫的临床应用[J]. 中华内分泌外科杂志, 2023, 17(1):5-10.
	XU J J, ZHENG C M, ZHANG Y N, et al. Clinical application of modified radical neck dissection by gasless unilateral axillary approach in papillary thyroid cancer[J]. Chin J Endocr Surg, 2023, 17(1):5-10.
[21]	KIM J K, LEE C R, KANG S W, et al. Robotic transaxillary lateral neck dissection for thyroid cancer:learning expe-rience from 500 cases[J]. Surg Endosc, 2022, 36(4):2436-2444.
[22]	LOBE T E, WRIGHT S K, IRISH M S. Novel uses of surgical robotics in head and neck surgery[J]. J Laparoendosc Adv Surg Tech A, 2005, 15(6):647-652.
[23]	贺青卿, 周鹏, 庄大勇, 等. 经腋窝与胸前径路da Vinci Si机器人甲状腺腺叶切除二例[J]. 国际外科学杂志, 2014, 41(2):104-107.
	HE Q Q, ZHOU P, ZHUANG D Y, et al. Technical particularities of robotic-assisted thyroidectomy by a axillary approach or anterior chest approach:a report of two cases[J]. Int J Surg, 2014, 41(2):104-107.
[24]	梁发雅, 韩萍, 蔡谦, 等. 经腋下入路机器人辅助甲状腺手术的初步经验[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(14):1051-1055.
	LIANG F Y, HAN P, CAI Q, et al. Robot-assisted transaxillary thyroidectomy:our early experience[J]. J Clin Otorhinolaryngol Head Neck Surg, 2018, 32(14):1051-1055.
[25]	AN S, PARK J, KIM K, et al. Safety and surgical outcomes of single-port trans-axillary robot-assisted thyroidectomy:experience from a consecutive series of 300 patients[J]. J Robot Surg, 2024, 18(1):13.
[26]	NING K, YU Y, ZHENG X, et al. Risk factors of transient and permanent hypoparathyroidism after thyroidectomy:a systematic review and meta-analysis[J]. Int J Surg, 2024, 110(8):5047-5062.
[27]	HE J, ZHANG C, ZHANG Z, et al. Evaluation of the clinical value of carbon nanoparticles in endoscopic thyroidectomy and prophylactic central neck dissection through total mammary areolas approach for thyroid cancer[J]. World J Surg Oncol, 2021, 19(1):320. doi: 10.1186/s12957-021-02427-8 pmid: 34736481
[28]	YE Z, WU K, HU Z, et al. Nanocarbon or indocyanine green:which is superior for gasless transaxillary endoscopic thyroidectomy to protect the parathyroid gland?[J]. Front Surg, 2022,9:1035840.
[29]	HUNG K C, WANG W T, Chen I W. Intraoperative nerve monitoring reduces recurrent laryngeal nerve palsy in endoscopic thyroid surgery:a trial sequential analysis[J]. Int J Surg, 2024, 110(7):4490-4491.
[30]	徐加杰, 张李卓, 张启弘, 等. 无充气经腋窝腔镜甲状腺手术的临床应用[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(10):913-920.
	XU J J, ZHANG L Z, ZHANG Q H, et al. Clinical application of the gasless unilateral axillary approach in endoscopic thyroid surgery[J]. Chin J Otorhinolaryngol Head Neck Surg, 2020, 55(10):913-920.
[31]	陈俊勇, 邵子力, 韩梦玲, 等. 经腋窝入路免充气腔镜甲状腺单侧腺叶切除术的学习曲线[J]. 腹腔镜外科杂志, 2022, 27(9):667-671.
	CHEN J Y, SHAO Z L, HAN M L, et al. The learning curve of gasless endoscopic unilateral thyroid lobectomy via axillary approach[J]. J Lap Surg, 2022, 27(9):667-671.