# Protective effect of complete endoscopic thyroidectomy through different approaches on the recurrent laryngeal nerve

## TL;DR

This study compares two surgical approaches for thyroidectomy and finds that the clavicular approach better protects the recurrent laryngeal nerve and improves patient outcomes.

## Contribution

The study introduces evidence that the clavicular approach in endoscopic thyroidectomy offers superior RLN protection and better functional and cosmetic outcomes compared to the axillary approach.

## Key findings

- The clavicular approach improved acoustic parameters more than the axillary approach.
- Patients in the clavicular group had lower voice handicap index scores post-surgery.
- The clavicular approach resulted in better cosmetic and health status outcomes.

## Abstract

Papillary thyroid carcinoma (PTC) is a malignancy originating from the thyroid follicular epithelium, accounting for over 80% of thyroid cancer globally. It is often asymptomatic in its early stages, but over time, it may invade the unilateral recurrent laryngeal nerve (RLN), leading to hoarseness, weak speech, or dysphagia. In order to prevent further complications, prompt treatment is required, and surgery remains the primary and most effective option.

This study aimed to evaluate the protective effect of complete endoscopic thyroidectomy (CET) via different approaches on the RLN.

The study analyzed clinical data of 100 patients with clinically node-negative PTC, who underwent CET via the breast approach from February 2023 to February 2025. The patients were divided into 2 groups: the control group (n = 55) which underwent CET via the axillary approach and the study group (n = 45), subjected to CET via the clavicular approach.

Postoperative assessments showed considerable improvements in amplitude perturbation, fundamental frequency perturbation, harmonic-to-noise ratio, and normalized noise energy in both groups, with the study group demonstrating superior results (P <⁠0.05). One month after surgery, the voice handicap index score decreased in both groups, as compared with preoperative levels, the study group having obtained a lower score (P <⁠0.05). The Scar Cosmesis Assessment and Rating score increased postoperatively in both groups, with a higher score recorded in the study group (P <⁠0.05). The Short Form-36 Heath Status Questionnaire scores increased across all dimensions postoperatively in both groups, with the study group showing greater improvements (P <⁠0.05).

Compared with the axillary approach, CET via the clavicular approach results in greater postoperative improvements in acoustic parameters, lower voice handicap index scores, better scar appearance, and higher Short Form-36 health status scores.