Abstract:

Objective To evaluate the safety and feasibility of a novel self-made retractor in subclavian approach endoscopic thyroid surgery. Methods A retrospective analysis was conducted on 180 cases of unilateral papillary thyroid carcinoma surgery performed at the Thyroid Hernia Surgery Department of the First Affiliated Hospital of South Gannan Medical University from January 2023 to April 2025. Among these， 57 cases underwent non-inflated thyroid surgery using the novel non-inflated retractor （subclavian group）， 50 underwent pneumatic transsternal thyroid surgery （transsternal group）， and 73 underwent traditional open thyroid surgery （open group）. Differences in surgical indicators， postoperative complication rates， and postoperative incision satisfaction were compared among the three groups. Results Compared with the open group， patients in the subclavian group were younger ［（40.3 ± 9.4） years vs. （44.8 ± 9.4） years， P < 0.05］ and underwent longer surgery duration ［（81.68 ± 12.08） min vs. （73.01 ± 10.04） min， P < 0.05］. However， the subclavian group exhibited lower postoperative pain scores on the first day ［（2.28 ± 0.92） points vs. （4.19 ± 1.35） points， P < 0.05］ and higher patient satisfaction with postoperative incisions. Compared with the thoracic-mammary group， patients in the subclavian group were older ［（40.3 ± 9.4） years vs. （34.9 ± 8.2） years， P < 0.05］ and had shorter operative times ［（81.68 ± 12.08） min vs. （98.18 ± 15.14） min， P < 0.05］. Additionally， patients in the subclavicular group exhibited lower postoperative pain scores on day 1 ［（2.28 ± 0.92） points vs. （3.12 ± 1.02） points， P < 0.05］ and lower total postoperative drainage volume ［80 （70， 100） mL vs. 120 （100， 150） mL， P < 0.05］. No significant differences were observed between groups in terms of incision satisfaction. There were no statistically significant differences among the three groups in terms of the number of lymph nodes removed， intraoperative blood loss， white blood cell count on postoperative day 1， parathyroid hormone， calcium ion concentration， or postoperative complications（P > 0.05）. Conclusion The novel non-inflatable retractor effectively maintains the necessary surgical space during subclavicular approach thyroid endoscopic surgery， offering high surgical safety. Compared to traditional open surgery and trans-sternal endoscopic approaches， subclavicular endoscopic thyroid surgery demonstrates reliable therapeutic efficacy and excellent cosmetic outcomes.

Key words: tension-free retractor, subclavian approach, thyroid surgery