Endoscopic-assisted rotary cutter for axillary osmidrosis: high efficacy and safety in a large retrospective cohort

Background Minimally invasive axillary osmidrosis surgery is limited by an efficacy-safety trade-off caused by blind visualization. This study evaluated intermediate-term outcomes of a novel endoscopic-assisted rotary cutter technique. Methods This single-center retrospective cohort enrolled 980 consecutive moderate-to-severe axillary osmidrosis patients undergoing the procedure between January 2022 and June 2024. Treatment success was defined as patient-reported marked improvement or complete odor elimination. We assessed complications, recurrence, and compared outcomes between the learning phase (first 100 cases) and proficiency phase. Results With a 13-month median follow-up, overall patient-reported success rate was 97.7% (95% confidence interval [CI]: 96.5–98.5%), recurrence rate 2.35%, and overall complication rate 3.27% (only 0.2% required hematoma intervention). After 100 cases, operative time and complication rate dropped significantly ( P < 0.01), with consistently high efficacy (>96%). Preoperative severity was an independent success predictor (adjusted odds ratio [OR] = 0.45, P < 0.05). Conclusion This technique appears to help reconcile the traditional efficacy-safety trade-off in minimally invasive axillary osmidrosis treatment, with outcomes improving over an estimated learning curve of approximately 100 cases; these promising intermediate-term results warrant prospective comparative evaluation.