Endoscopic thyroidectomy via the submental approach: a balanced approach to aesthetics, safety, and recovery- a case series study

Objective: To overcome certain anatomical limitations of transoral vestibular thyroidectomy, we introduced endoscopic thyroidectomy via the submental approach. During subsequent clinical practice, additional advantages of the submental approach were identified, further enhancing its feasibility and clinical applicability. This study aimed to evaluate the safety, efficacy, and postoperative outcomes of this technique in thyroid surgery. Methods: We retrospectively analyzed patients who underwent endoscopic thyroidectomy via the submental approach at Hunan Cancer Hospital between March and September 2023. Perioperative outcomes, complications, and postoperative quality of life were assessed using validated clinical indicators and the Thyroid Cancer-Specific Quality of Life questionnaire. Results: A total of 50 patients (27 males, 23 females; mean age 41.66 ± 9.70 years) were included. The mean operative time was 93.61 ± 21.78 minutes for unilateral thyroidectomy and 137.39 ± 27.76 minutes for total thyroidectomy. The mean pain score at 48 hours postoperatively was 1.56 ± 0.61, and the mean postoperative hospital stay was 2.84 ± 0.81 days. The mean aesthetic satisfaction score was 4.28 ± 0.67 (1-5, with higher scores indicating better satisfaction). The mean quality-of-life score was 10.23 ± 5.33 (0-130, with lower scores indicating better quality of life). No surgical site infections occurred. Transient hypoparathyroidism occurred in 14.8% of patients, and transient recurrent laryngeal nerve palsy occurred in 4.00%. The mean follow-up duration was 22 months, and no cases of recurrence or distant metastasis were observed during the follow-up period. Conclusions: Endoscopic thyroidectomy via the submental approach effectively balances cosmetic outcomes, surgical trauma, oncological integrity, and surgical feasibility, providing a promising alternative for endoscopic thyroidectomy. Further prospective, multicenter studies are needed to validate its long-term safety and broader clinical applicability. Clinical trial registration: https://www.chictr.org.cn, identifier ChiCTR2400089684.