Comparative Analysis of Clinical Manifestations of Gasless Endoscopic Surgery via Transaxillary and Subclavicular Approaches in Unilateral cN0 Thyroid Cancer

AIM: To compare the clinical efficacy and safety of gasless endoscopic radical thyroidectomy via the transaxillary approach versus the subclavicular approach for unilateral cN0 thyroid cancer.METHODS: A total of 415 patients with unilateral cN0 thyroid cancer admitted between January 2022 and May 2025 were retrospectively included. After propensity score matching (PSM), patients were divided into Group A (gasless endoscopic radical thyroidectomy via the transaxillary approach, n = 57) and Group B (gasless endoscopic radical thyroidectomy via the subclavicular approach, n = 57). The clinical outcomes of these two approaches were compared.RESULTS: Group B had significantly shorter operative time, lower postoperative drainage volume, and a higher rate of complete central compartment exposure than Group A (p < 0.05). Repeated-measures analysis of variance (ANOVA) showed significant main effects of time, group, and time-by-group interaction for interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), incision pain scores, parathyroid hormone (PTH), and Quality of Life Questionnaire-Core 30 (QLQ-C30) scores (p < 0.05). Group B had a lower total complication rate and higher aesthetic satisfaction scores at 1 and 3 months postoperatively than Group A (p < 0.001).CONCLUSIONS: Gasless endoscopic radical thyroidectomy via the subclavicular approach demonstrated potential short-term advantages over the transaxillary approach, including shorter operative time, improved central compartment exposure, attenuated inflammatory response, milder early postoperative pain, and more favorable trends in PTH levels and early quality-of-life recovery. However, given the limited 3-month follow-up period, the absence of significant differences in clinical hypocalcemia rates, and the lack of long-term oncological outcomes, these findings should be interpreted with caution.