Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Advertisement

Scientific Reports
  • View all journals
  • Search
  • My Account Login
  • Content Explore content
  • About the journal
  • Publish with us
  • Sign up for alerts
  • RSS feed
  1. nature
  2. scientific reports
  3. articles
  4. article
Gasless endoscopic thyroidectomy via the trans-subclavian approach versus conventional open thyroid surgery for unilateral thyroid cancer
Download PDF
Download PDF
  • Article
  • Open access
  • Published: 06 March 2026

Gasless endoscopic thyroidectomy via the trans-subclavian approach versus conventional open thyroid surgery for unilateral thyroid cancer

  • Rui Yang1,3 na1,
  • Peng Han2 na1,
  • Chi Ma2,
  • Yanzhong Gu4,
  • Hongji Wu2,
  • Haiqing Sun2,
  • Shujian Wei2,
  • Xincheng Liu2 &
  • …
  • Haitao Zheng2 

Scientific Reports , Article number:  (2026) Cite this article

  • 1022 Accesses

  • Metrics details

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Cancer
  • Endocrine system and metabolic diseases
  • Thyroid cancer
  • Thyroid diseases

Abstract

The incidence of papillary thyroid carcinoma (PTC) is increasing worldwide. With advancements in society and technology, the variety of thyroid endoscopic surgeries is expanding. Gasless endoscopic thyroidectomy via the trans-subclavian approach (GETTSA) has been used for many years; yet, relevant research data are limited. This study aimed to assess the reliability of GETTSA by comparing it with conventional open thyroid surgery (COT). Clinical data were collected from 488 patients who underwent unilateral PTC surgery at Yantai Yuhuangding Hospital. Based on propensity score matching, relevant data were compared between the two procedures using the chi-square test, independent-sample t-test, and Mann-Whitney U test. COT and GETTSA significantly differed with respect to Thyroid Cancer-Specific Quality of Life (P < 0.001), scar appearance (P = 0.031), swallowing function (P = 0.001), operative time (P < 0.001), hospital fees (P < 0.001), number of central lymph node dissections (P < 0.001), drainage volume on the first postoperative day (P = 0.017), and parathyroid autotransplantation(P = 0.019). However, no notable differences in the number of lymph node metastases (P = 0.155), length of postoperative hospital stay (P = 0.181), or transient vocal cord paralysis (P = 0.478) were observed between COT and GETTSA. Additionally, no complications (secondary surgery, tracheal fistula, poor healing, or postoperative bleeding) occurred in either group. In conclusion, GETTSA is a reliable surgical procedure with the help of carbon nanoparticles; however, attention should be paid to protecting the parathyroid glands.

Similar content being viewed by others

Transaxillary vs. Transsubclavian Gasless endoscopic thyroidectomy approaches for papillary thyroid cancer

Article Open access 02 January 2025

Safety and cosmetic results of trans-submental endoscopic thyroidectomy

Article Open access 27 November 2025

Determining the optimal port placement for transoral endoscopic thyroidectomy vestibular approach in a retrospective study

Article Open access 26 February 2025

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Miranda-Filho, A. et al. Thyroid cancer incidence trends by histology in 25 countries: a population-based study. Lancet Diabetes Endocrinol. 9, 225–234 (2021).

    Google Scholar 

  2. Lu, Q., Zhu, X., Wang, P., Xue, S. & Chen, G. Comparisons of different approaches and incisions of thyroid surgery and selection strategy. Front. Endocrinol. (Lausanne). 14, 1166820 (2023).

    Google Scholar 

  3. Choi, Y. et al. Impact of postthyroidectomy scar on the quality of life of thyroid cancer patients. Ann. Dermatol. 26, 693–699 (2014).

    Google Scholar 

  4. Kasemsiri, P. et al. Comparison of quality of life between patients undergoing trans-oral endoscopic thyroid surgery and conventional open surgery. BMC Surg. 20, 18 (2020).

    Google Scholar 

  5. Shimizu, K., Akira, S. & Tanaka, S. Video-assisted neck surgery: endoscopic resection of benign thyroid tumor aiming at scarless surgery on the neck. J. Surg. Oncol. 69, 178–180 (1998).

    Google Scholar 

  6. Huang, X. M. et al. Endoscopic surgery by infraclavicular approach for larger benign thyroid tumors. Zhonghua Yi Xue Za Zhi. 91, 993–995 (2011).

    Google Scholar 

  7. Zhang, D. G. et al. Modified gasless trans-subclavian approach endoscopic lateral neck dissection for treatment of papillary thyroid carcinoma: a series of 31 cases. Zhonghua Wai Ke Za Zhi. 61, 801–806 (2023).

    Google Scholar 

  8. Zhu, X. M. et al. Comparison of clinical effects of endoscopic thyroidectomy using the modified gasless transsubclavian approach and traditional open surgery for cN0 unilateral papillary thyroid carcinoma. Zhonghua Wai Ke Za Zhi. 61, 807–811 (2023).

    Google Scholar 

  9. Husson, O. et al. Development of a disease-specific health-related quality of life questionnaire (THYCA-QoL) for thyroid cancer survivors. Acta Oncol. (Stockholm Sweden). 52, 447–454 (2013).

    Google Scholar 

  10. Oh, M. Y. et al. Transoral endoscopic thyroidectomy vestibular approach as a safe and feasible alternative to open thyroidectomy: a systematic review and meta-analysis. Int. J. Surg. (London England). 109, 2467–2477 (2023).

    Google Scholar 

  11. Dong, F., Yang, A. & Ouyang, D. Retroauricular Single-Site Endoscopic Thyroidectomy-A Balanced Endoscopic Approach for Thyroid Excision. JAMA Surg. 158, 548–549 (2023).

    Google Scholar 

  12. Kwak, H. Y. et al. Learning curve for gasless endoscopic thyroidectomy using the trans-axillary approach: CUSUM analysis of a single surgeon’s experience. Int. J. Surg. (London England). 12, 1273–1277 (2014).

    Google Scholar 

  13. Ikeda, Y. et al. Total endoscopic thyroidectomy: axillary or anterior chest approach. Biomed. Pharmacother. 56 (Suppl 1), 72s–78s (2002).

    Google Scholar 

  14. Lee, M. C., Park, H., Lee, B. C., Lee, G. H. & Choi, I. J. Comparison of quality of life between open and endoscopic thyroidectomy for papillary thyroid cancer. Head Neck. 38 (Suppl 1), E827–831 (2016).

    Google Scholar 

  15. Juarez, M. C. et al. Objectively measuring social attention of thyroid neck scars and transoral surgery using eye tracking. Laryngoscope 129, 2789–2794 (2019).

    Google Scholar 

  16. Xu, T. et al. A prospective study comparing the gasless endoscopic thyroidectomy trans-axillary approach to conventional open thyroidectomy: health and quality of life outcomes. Surg. Endosc. 38, 1995–2009 (2024).

    Google Scholar 

  17. Liu, Y. H., Xue, L. B., Zhang, S., Yang, Y. F. & Li, J. Appearance characteristics of incision, satisfaction with the aesthetic effect, and quality of life in of thyroid cancer patients after thyroidectomy. Int. J. Health Plann. Manage. 36, 784–792 (2021).

    Google Scholar 

  18. Li, S. L. et al. Quantitative comparison of three thyroidectomy approaches in neck muscles, voice, and swallowing functions. Asian J. Surg. 47, 1734–1739 (2024).

    Google Scholar 

  19. Lin, P. et al. Comparative study of gasless endoscopic selective lateral neck dissection via the anterior chest approach versus conventional open surgery for papillary thyroid carcinoma. Surg. Endosc. 35, 693–701 (2021).

    Google Scholar 

  20. Ge, J. N. et al. A propensity score matching analysis of gasless endoscopic transaxillary thyroidectomy with five-settlement technique versus conventional open thyroidectomy in patients with papillary thyroid microcarcinoma. Surg. Endosc. 37, 9255–9262 (2023).

    Google Scholar 

  21. Li, Y. et al. Comparison of the endoscopic thyroidectomy via areola approach and open thyroidectomy: A propensity score matched cohort study of 302 patients in the treatment of papillary thyroid non-microcarcinoma. Front. Oncol. 13, 1081835 (2023).

    Google Scholar 

  22. Liu, Z. et al. Comparison of the transoral endoscopic thyroidectomy vestibular approach and open thyroidectomy: A propensity score-matched analysis of surgical outcomes and safety in the treatment of papillary thyroid carcinoma. Surgery 170, 1680–1686 (2021).

    Google Scholar 

  23. Haugen, B. R. et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid Off. J. Am. Thyroid Assoc. 26, 1-133 (2016).

  24. Mehanna, H. et al. Differences in the recurrence and mortality outcomes rates of incidental and nonincidental papillary thyroid microcarcinoma: a systematic review and meta-analysis of 21 329 person-years of follow-up. J. Clin. Endocrinol. Metab. 99, 2834–2843 (2014).

    Google Scholar 

  25. Yan, S., Zhao, W., Wang, B. & Zhang, L. Standardization of simple auxiliary method beneficial to total endoscopic thyroidectomy on patients with PTC, based on retrospective study of 356 cases. Endocrine 61, 51–57 (2018).

    Google Scholar 

  26. Zuniga, S. & Sanabria, A. Prophylactic central neck dissection in stage N0 papillary thyroid carcinoma. Archives otolaryngology–head neck Surg. 135, 1087–1091 (2009).

    Google Scholar 

  27. Jiang, W. J. et al. Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis. Surg. Endosc. 34, 1891–1903 (2020).

    Google Scholar 

  28. Wang, Z. et al. Application of carbon nanoparticles combined with refined extracapsular anatomy in endoscopic thyroidectomy. Front. Endocrinol. 14, 1131947 (2023).

    Google Scholar 

  29. Huang, X. M. et al. Gasless endoscopic thyroidectomy via an anterior chest approach–a review of 219 cases with benign tumor. World J. Surg. 35, 1281–1286 (2011).

    Google Scholar 

  30. Owaki, T., Nakano, S., Arimura, K. & Aikou, T. The ultrasonic coagulating and cutting system injures nerve function. Endoscopy 34, 575–579 (2002).

    Google Scholar 

  31. Zhu, J. et al. Expert consensus statement on parathyroid protection in thyroidectomy. Ann. Transl Med. 3, 230 (2015).

    Google Scholar 

  32. Ezzy, M. & Alameer, E. Predictors and Preventive Strategies of Bleeding After Thyroid Surgery. Cureus 15, e47575 (2023).

    Google Scholar 

Download references

Acknowledgements

We would like to thank Editage (www.editage.cn) for the English language editing.

Author information

Author notes
  1. These authors contributed equally: Rui Yang and Peng Han.

Authors and Affiliations

  1. Shapingba Hospital affiliated to Chongqing University(Shapingba District People’s Hospital of Chongqing), No. 2, Jialang Road, Shapingba District, Chongqing, China, 400030

    Rui Yang

  2. Yantai Yuhuangding Hospital, Yantai, 264000, Shandong, China

    Peng Han, Chi Ma, Hongji Wu, Haiqing Sun, Shujian Wei, Xincheng Liu & Haitao Zheng

  3. School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, China

    Rui Yang

  4. The Second School of Clinical Medicine of Binzhou Medical University, Yantai, Shandong, China

    Yanzhong Gu

Authors
  1. Rui Yang
    View author publications

    Search author on:PubMed Google Scholar

  2. Peng Han
    View author publications

    Search author on:PubMed Google Scholar

  3. Chi Ma
    View author publications

    Search author on:PubMed Google Scholar

  4. Yanzhong Gu
    View author publications

    Search author on:PubMed Google Scholar

  5. Hongji Wu
    View author publications

    Search author on:PubMed Google Scholar

  6. Haiqing Sun
    View author publications

    Search author on:PubMed Google Scholar

  7. Shujian Wei
    View author publications

    Search author on:PubMed Google Scholar

  8. Xincheng Liu
    View author publications

    Search author on:PubMed Google Scholar

  9. Haitao Zheng
    View author publications

    Search author on:PubMed Google Scholar

Contributions

Conception and design: Yang, Han, Ma, Zheng. Acquisition of data: Yang, Han, Gu, Wu, Sun, Wei, Liu. Analysis and interpretation of data: Yang, Ma, Gu, Wu, Sun, Wei, Liu. Drafting the article: Yang, Han. Critically revising the article: Ma, Sun, Zheng. Reviewed submitted version of manuscript: Yang, Han, Ma, Zheng. Approved the final version of the manuscript on behalf of all authors: Zheng.

Corresponding author

Correspondence to Haitao Zheng.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, R., Han, P., Ma, C. et al. Gasless endoscopic thyroidectomy via the trans-subclavian approach versus conventional open thyroid surgery for unilateral thyroid cancer. Sci Rep (2026). https://doi.org/10.1038/s41598-026-42491-2

Download citation

  • Received: 03 January 2025

  • Accepted: 26 February 2026

  • Published: 06 March 2026

  • DOI: https://doi.org/10.1038/s41598-026-42491-2

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Keywords

  • Papillary thyroid carcinoma
  • Thyroid surgery
  • Endoscopy
  • Trans-subclavian approach
  • Conventional open thyroid surgery
Download PDF

Advertisement

Explore content

  • Research articles
  • News & Comment
  • Collections
  • Subjects
  • Follow us on Facebook
  • Follow us on X
  • Sign up for alerts
  • RSS feed

About the journal

  • About Scientific Reports
  • Contact
  • Journal policies
  • Guide to referees
  • Calls for Papers
  • Editor's Choice
  • Journal highlights
  • Open Access Fees and Funding

Publish with us

  • For authors
  • Language editing services
  • Open access funding
  • Submit manuscript

Search

Advanced search

Quick links

  • Explore articles by subject
  • Find a job
  • Guide to authors
  • Editorial policies

Scientific Reports (Sci Rep)

ISSN 2045-2322 (online)

nature.com footer links

About Nature Portfolio

  • About us
  • Press releases
  • Press office
  • Contact us

Discover content

  • Journals A-Z
  • Articles by subject
  • protocols.io
  • Nature Index

Publishing policies

  • Nature portfolio policies
  • Open access

Author & Researcher services

  • Reprints & permissions
  • Research data
  • Language editing
  • Scientific editing
  • Nature Masterclasses
  • Research Solutions

Libraries & institutions

  • Librarian service & tools
  • Librarian portal
  • Open research
  • Recommend to library

Advertising & partnerships

  • Advertising
  • Partnerships & Services
  • Media kits
  • Branded content

Professional development

  • Nature Awards
  • Nature Careers
  • Nature Conferences

Regional websites

  • Nature Africa
  • Nature China
  • Nature India
  • Nature Japan
  • Nature Middle East
  • Privacy Policy
  • Use of cookies
  • Legal notice
  • Accessibility statement
  • Terms & Conditions
  • Your US state privacy rights
Springer Nature

© 2026 Springer Nature Limited

Nature Briefing: Cancer

Sign up for the Nature Briefing: Cancer newsletter — what matters in cancer research, free to your inbox weekly.

Get what matters in cancer research, free to your inbox weekly. Sign up for Nature Briefing: Cancer