Cosmetic Excellence Meets Surgical Precision: A prospective Cohort Study of Endoscopic Thyroidectomy via Axillo-Breast Approach in Benign Thyroid Nodules

Background: Endoscopic Thyroidectomy approaches are gaining attraction and popularity as safe, feasible and effective alternatives to conventional open thyroidectomy with superior cosmetic results. Each endoscopic approach has its advantages and disadvantages. No single approach is associated with both maximum cosmesis and least invasiveness simultaneously. We here evaluate endoscopic thyroidectomy via axillo-breast approach in benign thyroid nodules in terms of safety, feasibility, surgical and cosmetic outcomes.Methods: This prospective cohort study was carried out at Assiut University Hospital and Mansoura University Oncology Center between January 2020 and January 2024. 54 patients were included with benign thyroid nodules (Bethesda 2,3,4) ≤ 6cm in diameter. 50 patients underwent endoscopic hemithyroidectomy via unilateral axillo-breast approach (UABA) and 4 patients underwent endoscopic total thyroidectomy via axillo-bilateral breast approach (ABBA) with gas insufflation.Results: Mean operative time in UABA was 130.70 ± 32.55 minutes while in ABBA was longer 210.00 ± 25.82 minutes. Conversion to open hemithyroidectomy was done in 4 cases with unilateral thyroid nodules. Temporary hypocalcemia developed in one patient following endoscopic total thyroidectomy, two patients developed transient hoarseness of voice, two patients exhibited temporary neck stiffness and five patients developed paresthesia in the neck and anterior chest wall. Pain levels were evaluated at multiple time points, with most patients reported minimal to mild discomfort that resolved completely within one month. The mean hospital stay was 2.19 ± 0.59 days. Cosmetic and patient satisfaction outcomes were excellent, 83.3% of patients were extremely satisfied, while the remaining patients found the results satisfactory or acceptable. None expressed dissatisfaction.Conclusion: Endoscopic thyroidectomy via unilateral axillo-breast and axillo-bilateral breast approaches in selected patients with benign thyroid disease are feasible, safe, and effective procedures with excellent cosmetic results.