{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:10:59Z","timestamp":1753891859794,"version":"3.41.2"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T00:00:00Z","timestamp":1715299200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>We previously made a detailed expansion to the gasless transaxillary endoscopic thyroidectomy(GTET) procedure described in the previous literatures. In this study, we optimized the procedure focused on the limitation of the approach in terms of trauma and lymph node dissection and made a comparison with the early procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>This paper gave a detailed description of the updated procedure and prospectively collected data about patients with papillary thyroid carcinoma(PTC) performed by the two procedures from December 2020 to April 2023. The differences in surgical outcome, surgical trauma and parathyroid gland(PG) function protection were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 302 patients, 184 underwent with early procedure(EP), and 118 underwent with updated procedure(UP). The surgical outcomes of operative time, time of thyroidectomy and central neck dissection, blood loss, drainage and postoperative hospital stay were shorter in UP than that of the EP. The mean number of lymph nodes retrieved and weight of dissection lymphatic tissue in the UP were significantly more than that in EP without increasing the mean number of metastatic lymph nodes. Postoperative complications did not differ between the two procedures. The UP had more advantages in the identification and preservation of the superior parathyroid gland, however, it did not improve the preservation <jats:italic>in situ<\/jats:italic> of the inferior parathyroid gland. The visual analog scale score for pain and the changes among inflammation factors was lower in the UP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The UP of GTET could perform safely and efficiently while reducing surgical trauma in selected patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2024.1377878","type":"journal-article","created":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T04:38:31Z","timestamp":1715315911000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The updated surgical steps of gasless transaxillary endoscopic thyroidectomy with neck level and region orientation for thyroid cancer"],"prefix":"10.3389","volume":"14","author":[{"given":"Yuqiu","family":"Zhou","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunyan","family":"Shui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linjie","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongcong","family":"Cai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronghao","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dingfen","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoli","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pei","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,5,10]]},"reference":[{"key":"B1","article-title":"Endoscopic resection of thyroid tumors by the axillary approach","volume":"41","author":"Ikeda","year":"2000","journal-title":"J Cardiovasc Surg (Torino)"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/00129689\u2013200608000\u201300006","article-title":"Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases","volume":"16","author":"Yoon","year":"2006","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1097\/SLE.0000000000000003","article-title":"Gasless transaxillary endoscopic thyroidectomy: a decade on","volume":"24","author":"Hakim Darail","year":"2014","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"key":"B4","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1007\/s00268-017-4209-y","article-title":"Yonsei experience of 5000 gasless transaxillary robotic thyroidectomies","volume":"42","author":"Kim","year":"2018","journal-title":"World J Surg"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.21037\/gs-21\u2013257","article-title":"Gasless transaxillary endoscopic thyroidectomy for unilateral low-risk thyroid cancer: Li's six-step method","volume":"10","author":"Zhou","year":"2021","journal-title":"Gland Surg"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.k08e-306","article-title":"Gasless endoscopic thyroidectomy using trans-axillary approach; surgical outcome of 581 patients","volume":"56","author":"Kang","year":"2009","journal-title":"Endocr J"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.4103\/0972\u20139941.115370","article-title":"Gasless single incision trans-axillary thyroidectomy: The feasibility and safety of a hypo-morbid endoscopic thyroidectomy technique","volume":"9","author":"Bhargav","year":"2013","journal-title":"J Minim Access Surg"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2009.09.007","article-title":"Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients","volume":"146","author":"Kang","year":"2009","journal-title":"Surgery"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2018.0404","article-title":"Gasless transaxillary endoscopic thyroidectomy with robotic assistance: A high-volume experience in North America","volume":"28","author":"Stang","year":"2018","journal-title":"Thyroid"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/s00464\u2013020-07721\u20132","article-title":"Comparison of long-term surgical outcome between transaxillary endoscopic and conventional open thyroidectomy in patients with differentiated thyroid carcinoma: a propensity score matching study","volume":"35","author":"Kim","year":"2021","journal-title":"Surg Endosc"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.21053\/ceo.2018.00766","article-title":"Robotic and endoscopic thyroid surgery: evolution and advances","volume":"12","author":"Tae","year":"2019","journal-title":"Clin Exp Otorhinolaryngol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24715","article-title":"Indications and extent of central neck dissection for papillary thyroid cancer: An American Head and Neck Society Consensus Statement","volume":"39","author":"Agrawal","year":"2017","journal-title":"Head Neck"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2014.06.021","article-title":"The impact of trauma on neutrophil function","volume":"45","author":"Hazeldine","year":"2014","journal-title":"Injury"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3390\/medicina58060755","article-title":"Surgical Significance of Berry's Posterolateral Ligament and Frequency of Recurrent Laryngeal Nerve Injury into the Last 2 cm of Its Caudal Extralaryngeal Part(P1) during Thyroidectomy","volume":"58","author":"Mantalovas","year":"2022","journal-title":"Medicina (Kaunas)"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.3366","article-title":"Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach","volume":"153","author":"Anuwong","year":"2018","journal-title":"JAMA Surg"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s00464\u2013023-09910\u20131","article-title":"Wu's seven steps for endoscopic central and lateral neck dissection via breast combined with oral approach for papillary thyroid cancer","volume":"37","author":"Wang","year":"2023","journal-title":"Surg Endosc"},{"key":"B17","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1007\/s00464\u2013014-3658\u20138","article-title":"Endoscopic thyroidectomy via areola approach: summary of 1,250 cases in a single institution","volume":"29","author":"Wang","year":"2015","journal-title":"Surg Endosc"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0407","article-title":"American thyroid association surgical affairs committee. American thyroid association statement on remote-access thyroid surgery","volume":"26","author":"Berber","year":"2016","journal-title":"Thyroid"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2024.1377878\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T04:38:34Z","timestamp":1715315914000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2024.1377878\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,10]]},"references-count":18,"alternative-id":["10.3389\/fonc.2024.1377878"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2024.1377878","relation":{},"ISSN":["2234-943X"],"issn-type":[{"type":"electronic","value":"2234-943X"}],"subject":[],"published":{"date-parts":[[2024,5,10]]},"article-number":"1377878"}}