Refined Supraclavicular Approach in Unilateral Thyroid Surgery

What this episode covers

Refined Supraclavicular Approach in Unilateral Thyroid Surgery This retrospective cohort study by Wang et al. presents a clinically significant refinement of thyroidectomy via an oblique supraclavicular incision through the sternohyoid-sternothyroid intermuscular space. The study rigorously compares this approach (n=204) against conventional Kocher (n=202) and endoscopic (n=102) techniques in 508 unilateral thyroid cancer patients. Key strengths include its robust methodology: a substantial sample size powered for subgroup analyses, standardized surgical protocols, validated outcome metrics (VAS for pain, PSAQ for scar satisfaction), and comprehensive assessment of functional, oncological, and aesthetic outcomes. The supraclavicular approach demonstrated superior perioperative outcomes, including shorter operative time (36.74±3.01 min vs. 41.05±6.46 min for Kocher and 105.67±10.16 min for endoscopic), reduced drainage (18.69±8.99 mL vs. 46.57±12.78 mL/125.5±17.81 mL), and significantly lower neck discomfort (12/204 vs. 44/202 in Kocher group, p＜0.01). Crucially, it maintained oncological equivalence in central lymph node dissection (4.65±1.26 nodes) and complication rates while offering enhanced cosmesis (smaller incision: 3.77±0.29 cm vs. 4.68±0.76 cm for Kocher) and superior long-term scar satisfaction (PSAQ 11.58±2.31 vs. 15.24±0.94 at 3 months, p＜0.01). The study’s most compelling contribution is its anatomic innovation—leveraging the avascular plane between strap muscles to minimize tissue disruption. This technique reduced flap dissection area by 58.7% versus Kocher, translating to better-preserved cervical sensation and function. By avoiding linea alba incision, it mitigated adhesion-related morbidity while obviating endoscopic costs and steep learning curves. However, limitations include demographic imbalance (endoscopic cohort younger, p＜0.01), potential selection bias from single-surgeon design, and lack of long-term oncologic follow-up (＞36 months). Despite these, the authors successfully validate this approach as a cost-effective middle ground between open and endoscopic techniques, harmonizing radical resection with patient-centered recovery. Future multicenter studies with extended follow-up will strengthen clinical adoption, but this work already offers a pragmatic advancement for thyroid surgeons prioritizing both efficacy and quality-of-life outcomes. Reviewed by Dr. Reza Lankarani, General Surgeon and Founder of Surgical Pioneering Series To access additional details, please refer to the Surgical Pioneering Podcast Series application available at the following link: https://Surgicalpioneer.codeadx.me

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