Gasless single-incision transaxillary endoscopic total thyroidectomy versus conventional open thyroidectomy in patients with papillary thyroid carcinoma based on propensity score matching: a case-control study.

Background: In a previous study, we proposed a modified technique for gasless transaxillary endoscopic total thyroidectomy (ETT) for patients with bilateral papillary thyroid carcinoma (PTC) using a single incision. Whether this method shows non-inferiority to the conventional open approach (COT) remains unclear. This study aims to investigate the safety and feasibility of ETT compared to COT in patients with PTC.
Methods: We retrospectively analyzed the medical records of cT1-2 PTC patients who underwent total thyroidectomy between April 2020 and December 2022. All patients were diagnosed with bilateral PTC and categorized into ETT and COT groups based on the type of surgery. Propensity score matching (PSM) using nine clinicopathological characteristics was employed to compare the technical safety and short-term oncologic outcomes of ETT and COT, generating 45 pairs of matched patients to reduce potential selection bias. This study was followed by STROBE guideline.
Result: After PSM, 90 patients who underwent ETT (n = 45) or COT (n = 45) were included. Age, sex, tumor size, BMI, Hashimoto's thyroiditis, multifocality, extrathyroidal extension, T-stage, and central compartment lymph node metastasis were not different between both groups. Both groups showed similar surgical outcomes, including lymph node yield, complications, and total medical costs. A few patients in each group experienced transient complications, all of which resolved within 6 months. No patients had permanent complications.
Conclusion: Compared to COT, ETT with a modified technique offers excellent safety and acceptable short-term oncological outcomes in a selected cohort of patients with bilateral papillary thyroid carcinoma. ETT is a safe and feasible alternative to COT.
Competing Interests: Declarations. Disclosures: Drs. Shi Tong Yu, Ruitian Ouyang, Guobin Miao, Junna Ge, Zhigang Wei, Baihui Sun, Tingting Li, Zhicheng Zhang, Weisheng Chen, and Shangtong Lei have no conflicts of interest or financial ties to disclose. Ethical approval: The study was approved by the Ethics Committees of Nanfang Hospital with the number: NFEC-2021-324, and all patients were fully informed and provided written consent.
(© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)