Three-port gasless intermuscular approach for endoscopic thyroidectomy: A six-step method

Background The global incidence of thyroid cancer is on the rise. Endoscopic thyroid surgery via an infraclavicular approach preserves anterior cervical function, with patients experiencing no postoperative numbness of the anterior cervical skin, neck muscle tightness, or foreign body sensation during swallowing. It also offers superior cosmetic outcomes due to the relatively concealed incision site, thereby gradually becoming a strong complement to conventional open surgery. However, this technique presents certain limitations in terms of incision size, extent of flap dissection, and surgical instrument manipulation. The present study proposes a three-port gasless intermuscular approach for endoscopic thyroidectomy, aiming to further enhance operating surgeon comfort, reduce infraclavicular incision trauma in patients, and improve cosmetic satisfaction. Methods The clinical data of 91 patients who underwent unilateral thyroid lobectomy between June and September 2024 were retrospectively analyzed. Among them, 41 patients underwent endoscopic surgery via a three-port gasless intermuscular approach (TGI group), and 50 patients were treated via conventional open surgery (OP group). The study provides a detailed description of the standardized six-step surgical technique, summarizes intraoperative precautions, and compares the clinical outcomes between the TGI and OP groups. Results There were no statistically significant differences between the two groups in terms of sex, age, body mass index, hospital length of stay, and temporary recurrent laryngeal nerve injury (all P > 0.05). The TGI group had a significantly lower total drainage volume (83.5 ± 18.2 mL vs. 93.2 ± 25.3 mL) and a higher cosmetic satisfaction score [5.0 (5.0, 5.0) vs. 4.0 (3.0, 4.0)] at 6 months postoperatively compared to those in the OP group ( P < 0.05). The TGI group also showed a trend toward shorter operative time [47.0 (45.0, 51.0) min vs. 50.0 (45.0, 67.3) min, P = 0.064]. Conclusions The three-port gasless intermuscular approach for endoscopic surgery further shortens the incision length of conventional infraclavicular surgery, reduces the extent of flap dissection, decreases soft tissue trauma, and improves cosmetic outcomes. It also optimizes the instrument operating plane to further reduce the “chopstick effect” between instruments, thereby enhancing operating surgeon comfort.