Gasless subclavicular lateral approach: an anatomically tailored surgical technique for parathyroid surgery

doi:10.16139/j.1007-9610.2025.06.08

Abstract

Abstract:

Objective To explore the safety and effectiveness of gasless subclavicular lateral approach in parathyroid surgery. Methods A retrospective comparative study was conducted to collect a total of 53 patients with primary hyperparathyroidism who underwent surgical treatment at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from November 2024 to April 2025. Among them, 20 patients underwent subclavicular lateral approach surgery (experimental group). The control group was matched 1∶1 based on criteria including gender, age, tumor size, and preoperative （parathyroid hormone, PTH） levels. Twenty patients who underwent conventional anterior cervical approach during the same period were selected for a case-control study. The surgical efficacy, postoperative incision pain, incidence of complications, and cosmetic effects between two groups were compared. Results There was no statistically significant difference (P>0.05) in operative time, intraoperative bleeding, hospitalization time, and surgical efficiency between the two groups. There was no statistically significant difference in the incidence of postoperative complications such as hoarseness, water choking, incision infection, incision hematoma, fever, and postoperative pain scores between the two groups during hospitalization (P>0.05). In the scar assessment one month after surgery, the score of the experimental group was lower than that of the control group (P<0.05). The satisfaction score of the beauty effect in the experimental group was significantly better than that in the control group (P<0.01). Conclusions Gasless subclavicular lateral approach for parathyroidectomy, as an emerging and anatomically optimized surgical technique, has good effectiveness and safety, without significantly increasing surgical risks. It can safely remove lesions without leaving surgical scars in the anterior neck, and has the advantage of good cosmetic effects. As a safe and feasible surgical method, it provides a new and ideal choice for patients undergoing parathyroid surgery.

Key words: Gasless subclavicular approach, Parathyroidectomy, Hyperparathyroidism, Lateral approach

CLC Number:

R653

FENG Wenqing, GAO Haoji. Gasless subclavicular lateral approach: an anatomically tailored surgical technique for parathyroid surgery[J]. Journal of Surgery Concepts & Practice, 2025, 30(06): 503-508.

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Item		Experimental group(n=20)	Control group(n=20)	Statistic value	P value
Age(year)		58.4±11.7	57.3±12.1	t=0.292	0.985
Gender[n(%)]	female	15（75.0）	15（75.0）	χ²=0	1
Tumor longest diameter (cm)		1.5±0.6	1.5±0.6	t=-0.210	0.917
Tumor location（left/right）	Left	10（50.0）	11（55.0）	χ²=0.1	0.752
Tumor location (upper/lower)	Upper	7（35.0）	5（25.0）	χ²=0.476	0.490
Operation time (min)		50.8±13.3	53.7±21.5	t=-0.521	0.058
Intraoperative blood loss (mL)		13.3±13.8	11.8±12.1	t=0.365	0.706
Postoperative hospital stay (d)		2.9±0.8	3.0±0.9	t=-0.402	0.623
PTH（ng/L）
Preoperative		302.2±199.6	279.5±184.1	t=0.372	0.665
Postoperative		40.6±19.8	40.9±33.2	t=-0.031	0.976
Serum calcium（mmol/L）
Preoperative		2.7±0.2	2.8±0.4	t=-0.798	0.275
Postoperative		2.3±0.2	2.3±0.1	t=0.162	0.522

Item	Experimental group(n=20)	Control group(n=20)	Statistic value	P value
Temporary hoarseness	2(10.0)	2(10.0)	χ²=0	1.00
Choking while drinking	1(5.0)	2(10.0)	χ²=0.36	0.548
VAS of the first day after surgery	2.8±0.6	2.6±0.5	t=1.192	0.511

Item	Experimental group(n=20)	Control group(n=20)	t value	P value
One-month postoperative VAS	0.4±0.6	0.6±0.6	-1.057	0.801
SCAR scale score	3.0±0.5	3.4±0.7	-1.981	0.03
Satisfaction score	4.9±0.4	4.6±0.6	1.897	0.001