Endoscopy-assisted thyroid surgery via a subclavian approach

To evaluate the effectiveness of an endoscopy-assisted surgical technique, designed to leave a scar-free neck, for removing large benign thyroid tumors.

The subjects were 63 patients who underwent endoscopy-assisted surgery via a subclavian approach (endoscopic group) and 79 patients who underwent similar surgery via the conventional approach (conventional group). With the endoscopy-assisted approach, a 4–6 cm incision was made over the larger side of the tumor, at the lower edge of the clavicle, 3–5 cm beside the midline.

There was no significant difference in the distribution of patients within each group and pathological examination proved benign for all patients. The cosmetic results of the endoscopic group were significantly better than those of the conventional group (Z = 9.900, P = 0.000). None of the patients in either group suffered permanent recurrent laryngeal nerve paralysis. The only minor complications in the endoscopic group were transient hypocalcemia, which resolved within 1 week (n = 2); skin tension which cleared up within 3 months (n = 2); and temporary recurrent laryngeal nerve paralysis, which resolved within 1 month (n = 1). No significant distinction was found between the endoscopic group and the conventional group (χ ² = 1.129, P = 0.466).

Endoscopic surgery via a subclavian approach is appropriate and effective for treating patients with a benign thyroid tumor larger than 4 cm.