Objective  To determine the technical feasibility, intraoperative safety, and efficacy of endoscopic thyroidectomy using the gasless unilateral axillary approach.

  Methods  We analyzed 11 patients diagnosed with papillary thyroid carcinoma who underwent an endoscopic thyroidectomy between February and April 2017 using a gasless unilateral axillary approach at the Department of Head and Neck Surgical Oncology, Zhejiang Cancer Hospital. Additionally, we compared the clinical features, early surgical outcomes, surgical complications and postoperative satisfaction of endoscopic thyroidectomy with those of 11 patients who underwent conventional open thyroidectomies during the same period. Result In the endoscopic group, the mean age of patients ((35.6±2.6) years was younger than that of the open thyroidectomy group (48.5±2.3) years, (P=0.002). The endoscopic thyroidectomy (unilateral lobectomy) procedure was successfully completed in all patients. The rate of central compartment neck dissection was not different between the groups (2.4±1.7) vs. (2.8±1.6), P > 0.05. The operative time was longer and the amount of drainage was higher in the endoscopic than in the open group (123.9±28.1) min vs. (48.6±9.8) min, P < 0.01; (145.9±81.8) mL vs. (87.7±18.9) mL, P < 0.01. Everage length of hospitalizntion was 1 day longer in the endoscopic group. The complication rate was not statistically significantly different between the groups. The postoperative pain score of the neck and anterior chest was not different between the groups except the anterior chest pain score at day 3 after operation. The cosmetic satisfaction was greater in the endoscopic group (P < 0.01).

  Conclusions  Endoscopic thyroidectomy using a gasless unilateral axillary approach for the management of selected patients presenting with papillary thyroid carcinoma is a safe, feasible, and cosmetically superior procedure.