The impact of gasless insufflation transaxillary endoscopic thyroidectomy on the parathyroid gland injury in patients with thyroid cancer: a retrospective analysis.

Background: Recently, endoscope has been widely used in thyroid surgery and gasless insufflation transaxillary endoscopic thyroidectomy (GTET) has been the mainstay of thyroid surgery. Parathyroid gland (PG) damage is a common complication of thyroid surgery. Therefore, the aim of this study was to investigate the effect of GTET on hypoparathyroidism (HPT) in patients with thyroid cancer.

Methods: According to the surgical approach, the patients were divided into a GTET group and a conventional open thyroidectomy (COT) group. Univariate analysis and logistic regression were used to identify factors associated with PG injury. The odds ratio (OR) and 95% confidence interval (CI) for each independent variable were calculated.

Results: A retrospective analysis was conducted on 405 patients diagnosed with papillary thyroid cancer (PTC). A total of 51 patients experienced PG injury, including 7 cases (5%) of GTET group and 44 cases (16.5%) of COT group (P<0.001). Among them, the incidence of GTET group injury with one PG was 50.4%, two were 2.9%, and COT group were 59.8% and 7.9%, respectively (P=0.006). Univariate and multivariate analysis revealed that GTET was a protective factor for PG injury (OR, 0.251; 95% CI, 0.110-0.576; P=0.001), while Hashimoto's thyroiditis (HT) was identified as a risk factor for PG injury (OR, 2.722; 95% CI, 1.114-6.654; P=0.02).

Conclusions: GTET reduces the incidence of PG injury and nerve injury, when PTC is combined with HT, it increases the risk of PG injury.