This protocol presents a novel contralateral axillo-bilateral-breast approach for endoscopic thyroidectomy that optimizes surgical positioning and operative space while achieving excellent cosmetic outcomes.
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Method Article
A Novel Contralateral Axillo-Bilateral-Breast Approach for Endoscopic Thyroid Surgery
* These authors contributed equally
In This Article
Summary
Abstract
The incidence of thyroid cancer has increased significantly, with surgical resection remaining the primary treatment modality. Traditional open thyroidectomy leaves visible neck scars that cause significant cosmetic concerns for patients. This protocol describes a novel endoscopic thyroidectomy technique using a contralateral axillo-bilateral-breast approach (CABBA-ET). The key innovations include: (i) supine patient positioning without leg separation, reducing surgeon discomfort and patient hip strain risk; (ii) optimized camera and instrument positioning that minimizes surgical field obstruction; and (iii) trans-areolar incisions providing excellent scar concealment. In a cohort of 130 patients treated between 2019 and 2025, this approach demonstrated operative safety comparable to that of conventional thyroidectomy, with superior cosmetic outcomes. The technique is suitable for papillary thyroid carcinomas ≤2 cm in maximum diameter without extensive lymph node metastasis, and benign nodules <6 cm. All patients achieved satisfactory cosmetic results with no permanent complications. This approach represents a safe and feasible alternative for patients seeking cosmetically favorable thyroid surgery.
Introduction
Over the past two decades, thyroid cancer incidence has risen dramatically, becoming the third most common malignancy among women1. Surgical resection remains the cornerstone of thyroid disease management2. Traditional open thyroidectomy via the Kocher incision leaves permanent neck scars that cause significant psychological distress, particularly for patients who prefer low-collared clothing3,4. Postoperative complications such as hypertrophic scarring further impact quality of life5.
To address these concerns,....
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Protocol
1. Patient selection and preoperative assessment
- Inclusion criteria
- Evaluate patients for CABBA-ET candidacy based on the following criteria: (i) the patient meets standard indications for thyroid surgery (e.g., confirmed or suspicious malignancy, symptomatic benign goiter, progressive nodule enlargement, or refractory hyperthyroidism); and (ii) the patient expresses cosmetic concerns or anxiety regarding visible neck scarring.
- For benign thyroid nodules, verify that the maximum diameter is < 6 cm by ultrasound measurement.
- For hyperthyroidism requiring surgical treatment, confirm goiter Grade II or be....
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Results
In this representative case, a 29-year-old female with a 1.2 cm papillary thyroid carcinoma in the right thyroid lobe (AJCC 8th edition stage T1aN0M0)10underwent successful CABBA-ET (Table 1). The patient expressed great cosmetic concerns and desired a scar-free neck appearance. Preoperative fine-needle aspiration confirmed papillary thyroid carcinoma. The patient met all inclusion criteria with no contraindications.
The surgical procedure (
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Discussion
The CABBA-ET technique represents a significant advancement in extra-cervical endoscopic thyroidectomy, addressing key limitations of existing approaches while maintaining oncologic safety. This protocol provides detailed, step-by-step instructions enabling accurate replication by surgeons at various experience levels.
Several steps are critical for successful CABBA-ET execution. First, precise trocar placement is essential. The ipsilateral areolar camera port must be positioned to provide opt.......
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Disclosures
The authors declare that they have no competing interests or conflicts of interest related to this work.
Acknowledgements
This work was supported by the Project from Shanghai Sixth People's Hospital (grant number YNLC201905). We thank the nursing staff and anesthesiology team at Shanghai Sixth People's Hospital for their support in performing these procedures.
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Materials
| Name | Company | Catalog Number | Comments |
|---|---|---|---|
| 10 mm 30-degree endoscope | Karl Storz | 26003BA | Standard laparoscopic camera |
| 4-0 barbed suture | Covidien | VLOC180 | For strap muscle closure |
| Closed-suction drain | Aiyuan | AY-Y12-G150 | 12 French |
| CO2 insufflator | Karl Storz | 264305 20 | Maintains 8 mmHg pressure |
| Endoscopic nerve monitoring forceps | Medtronic | 8225490 | Stimulating forceps |
| Nanocarbon tracer | Chongqing Lummy | N/A | Lymph node mapping |
| Nerve monitoring system | Medtronic | NIM 3.0 | Continuous monitoring |
| Ultrasonic scalpel | Ethicon | HARMONIC ACE | For vessel sealing |
References
- Boucai L, Zafereo M, Cabanillas ME. Thyroid cancer: A review. JAMA. 2024;331(5):425-35.
- Durante C, Grani G, Lamartina L, Filetti S, Mandel SJ, Cooper DS. The diagnosis and management of thyroid nodules: A Review. JAMA. 2018;319(9):914-24.
- Kobaly K, Kim CS, Mandel SJ. Contemporary management of thyroid nodules. Annu Rev Med. 2022;73:517-28.
- Li X, Ding W, Zhang H. Surgical outcomes of endoscopic thyroidectomy approaches for thyroid cancer: a systematic review and network meta-analysis. Front Endocrinol (Lausanne). 2023;14:1256209.
- Chung YS, Choe JH, Kang KH, et al. Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional ....
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