Abstract
PURPOSE: Endoscopic thyroidectomy utilizing the Gasless Unilateral Axillary Approach (GUA) offers distinct advantages including clear visibility, simple manipulation, safe oncological outcomes. This technique eliminates postoperative neck scarring, ensures concealed surgical incisions, and minimizes postoperative swallowing discomfort. METHODS: We retrospectively reviewed 150 surgical videos to document key anatomical features and their variations during this procedure. RESULTS: The GUA endoscopic thyroidectomy, which approaches from the contralateral side, presents significant difficulties in identifying anatomical structures, especially anatomical abnormalities in the contralateral neck, while constructing feasible operative fields. This article offers an in-depth discussion of the anatomical challenges, pitfalls, and viable strategies associated with this surgery, particularly for less experienced surgeons. CONCLUSIONS: Given the intricate interplay of muscular, vascular, and neural anatomical structures, novices in surgery must be well-acquainted with the underlying anatomy to minimize potential complications.