Safety and Efficacy of Endoscopic Thyroidectomy by Gasless Unilateral Axillary for Papillary Thyroid Carcinoma in Primary Hospitals.

Abstract

To compare the safety and surgical efficacy of endoscopic thyroidectomy by gasless unilateral axillary (ETGUA) with conventional open thyroidectomy in patients with papillary thyroid carcinoma (PTC). This prospective, single-center, and randomized controlled trial included 196 patients with PTC who met the inclusion and exclusion criteria. Patients were randomly assigned in a 1:1 ratio to the ETGUA group (n = 98) or the open thyroidectomy group (n = 98). Complications within 30 days, parathyroid function [intact parathyroid hormone (iPTH) and serum calcium], and short-term oncological outcomes were observed. Secondary outcomes included operative time, intraoperative blood loss, postoperative recovery, pain score, cosmetic satisfaction, and hospitalization cost. The ETGUA group had a significantly longer operative time than the open thyroidectomy group, less intraoperative blood loss, more postoperative drainage at postoperative day 1, as well as a shorter postoperative hospital stay (all p < 0.05). At 1 year postoperatively, surgical efficacy and oncological indicators such as the number of lymph nodes dissected, number of positive lymph nodes, stimulated thyroglobulin (sTg) level, and the proportion of patients receiving adjuvant radioactive iodine therapy were comparable between groups (p > 0.05). The ETGUA group reported lower visual analog scale (VAS) pain scores and higher cosmetic satisfaction, though the total hospitalization cost was slightly higher (all p < 0.05). The learning curve analysis indicated that operative time and intraoperative blood loss stabilized after approximately 30-40 cases. ETGUA demonstrates comparable safety and oncological efficacy to conventional open thyroidectomy in PTC patients.