经锁骨下入路无充气腔镜甲状腺切除术"七步法"OA

Conventional open thyroidectomy is a safe and well-established surgical procedure;however,it is as-sociated with disadvantages such as visible anterior cervical scars,postoperative neck tightness,and discomfort during swallowing.In recent years,remote-access endoscopic thyroidectomy has continuously evolved to achieve both cosmetic satisfaction and minimally invasive surgery.Among these approaches,gasless endoscopic thyroidectomy via the trans-subclavian approach has attracted increasing attention because of its shorter operative pathway,relatively limited flap dis-section range,and avoidance of carbon dioxide-related complications.The major technical challenges of this procedure include establishing the correct anatomical plane,precise preservation of the recurrent laryngeal nerve and parathyroid glands,and safe management of the Berry ligament region.Based on current domestic and international studies and guide-lines regarding remote-access and gasless thyroid surgery,together with the operative experience of our center,this arti-cle systematically summarizes the Seven-step technique for gasless endoscopic thyroidectomy via the trans-subclavian approach.The procedure includes:(1)patient positioning and incision design;(2)establishment of the subcutaneous tunnel and entry into the natural space of the sternocleidomastoid muscle;(3)exposure of the omohyoid muscle and thy-roid gland;(4)identification and preservation of the recurrent laryngeal nerve;(5)management of the superior pole of the thyroid;(6)dissection of the Berry ligament and final identification of the nerve entry point into the larynx;and(7)management of the inferior pole and central compartment followed by specimen removal.This standardized workflow helps establish a clear and reproducible endoscopic operative framework,achieving both cosmetic and functional benefits while maintaining oncological safety,and may provide a useful reference for the standardized implementation and wider adoption of this technique.