Name: A Novel Contralateral Axillo-Bilateral-Breast Approach for Endoscopic Thyroid Surgery (Video) | JoVE Journal
Uploaded: 2026-07-28T14:30:00.000+00:00
Duration: 6 min 30 s
Description: Learn the CABBA-ET technique for endoscopic thyroidectomy using trans-areolar and axillary incisions. This minimally invasive approach achieves superior cosmetic outcomes with concealed scars and safe operative results.

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5 minutes

This work was supported by the Project from Shanghai Sixth People&#39;s Hospital (grant number YNLC201905). We thank the nursing staff and anesthesiology team at Shanghai Sixth People&#39;s Hospital for their support in performing these procedures.

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	<li>Chung YS, Choe JH, Kang KH, et al. Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional open thyroidectomy. World J Surg. 2007;31(12):2302-6.</li>
	<li>Bakkar S, Al Hyari M, Naghawi M, Corsini C, Miccoli P. Transoral thyroidectomy: a viable surgical option with unprecedented complications-a case series. J Endocrinol Invest. 2018;41(7):809-13.</li>
	<li>Ma T, Shi P, Zhang X, Liang M, Wang L, Shi Y. Transoral and submental endoscopic thyroidectomy (TOaST) for early stage papillary thyroid carcinoma: a real-world data retrospective cohort study. Surg Endosc. 2023;37(10):7649-57.</li>
	<li>Zheng D, Yang Q, Wu J, et al. Global trends in research of endoscopic thyroidectomy from 2013 to 2022: a scientometric and visualization analysis. Front Endocrinol (Lausanne). 2023;14:1199563.</li>
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	<li>Saavedra-Perez D, Manyalich M, Dominguez P, et al. Thyroidectomy via unilateral axillo-breast approach (UABA) with gas insufflation: prospective multicentre European study. BJS Open. 2022;6(4).</li>
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The authors declare that they have no competing interests or conflicts of interest related to this work.

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...

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, various extra-cervical endoscopic approaches have been developed, including transoral6, submental7, trans-axillary8, chest-breast, and bilateral axillo-breast approach (BABA) techniques9. However, each approach has inherent limitations. The transoral approach raises concerns regarding mental nerve injury and infection risk6. The chest-breast approach (CBA) and unilateral axillo-breast approach (UABA) may encounter interference from the ipsilateral clavicle and sternocleidomastoid muscle. Additionally, the BABA approach requires patients to be positioned in a split-leg position, which can cause hip strain and requires surgeons to stand between the patient&#39;s legs, leading to lumbar discomfort during prolonged procedures.
To optimize these limitations, we developed a modified approach termed the contralateral-axillo-bilateral-breast approach for endoscopic thyroidectomy (CABBA-ET). This technique offers three key advantages: First, the patient remains in a standard supine position without leg separation, eliminating hip strain risk and allowing surgeons to maintain ergonomic positioning throughout the procedure. Second, the camera port is placed at the ipsilateral areola while the surgeon operates from the contralateral side, preventing instrument-camera interference and optimizing surgical field visualization. Third, all incisions are made through the areolae, ensuring excellent cosmetic concealment even if incision extension is required for specimen retrieval.
This protocol presents a detailed, step-by-step description of the CABBA-ET technique, enabling accurate replication by both experienced endoscopic surgeons and those new to extra-cervical thyroidectomy. We demonstrate the safety and feasibility of this approach through representative results from 130 consecutive cases performed at our institution.

<table><tbody><tr><td>10 mm 30-degree endoscope</td><td>Karl Storz</td><td>26003BA</td><td>Standard laparoscopic camera</td></tr><tr><td>4-0 barbed suture</td><td>Covidien</td><td>VLOC180</td><td>For strap muscle closure</td></tr><tr><td>Closed-suction drain</td><td>Aiyuan</td><td>AY-Y12-G150</td><td>12 French</td></tr><tr><td>CO&lt;sup&gt;2&lt;/sup&gt; insufflator</td><td>Karl Storz</td><td>264305 20</td><td>Maintains 8 mmHg pressure</td></tr><tr><td>Endoscopic nerve monitoring forceps</td><td>Medtronic</td><td>8225490</td><td>Stimulating forceps</td></tr><tr><td>Nanocarbon tracer</td><td>Chongqing Lummy</td><td>N/A</td><td>Lymph node mapping</td></tr><tr><td>Nerve monitoring system</td><td>Medtronic</td><td>NIM 3.0</td><td>Continuous monitoring</td></tr><tr><td>Ultrasonic scalpel</td><td>Ethicon</td><td>HARMONIC ACE</td><td>For vessel sealing</td></tr></tbody></table>

a novel contralateral axillo-bilateral-breast approach for endoscopic thyroid surgery

A Novel Contralateral Axillo-Bilateral-Breast Approach for Endoscopic Thyroid Surgery

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 &#8804;2 cm in maximum diameter without extensive lymph node metastasis, and benign nodules &#60;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.

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 (<strong clas...

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.

The incidence of thyroid cancer has increased significantly, with surgical resection remaining the primary treatment modality. Traditional open ...

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Learn the CABBA-ET technique for endoscopic thyroidectomy using trans-areolar and axillary incisions. This minimally invasive approach achieves superior cosmetic outcomes with concealed scars and safe operative results.

A Novel Contralateral Axillo-Bilateral-Breast Approach for Endoscopic Thyroid Surgery

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