Lateral Route Endoscopic Thyroidectomy with gas Insufflation: Proposed Critical View of Safety

BACKGROUND: The extra-cervical lateral route endoscopic thyroidectomy (LRET) approaches such as the trans-axillary, breast and axillo-breast approaches are proved to be safe, feasible, esthetic, highly effective. The inherent difficulty and long learning curve of these techniques prevents its widespread application. METHODS: Benefiting from the experience of more than 5 years in LRET approaches with CO(2) insufflation, the authors developed ten surgical key steps and a critical view of safety (CVS) for performing thyroid lobectomy via LRET approaches. A detailed description and a video of the surgical technique is provided. RESULTS: Application of these structured key steps and CVS was feasible and effective in achieving thyroid lobectomy in all selected cases with unilateral goiter up to 8 cm, even in cases with thyroiditis or controlled toxic adenoma, without any adverse events and with shorter operative time than the non-structured surgical technique. CONCLUSION: The described ten key steps and CVS are conclusive, applicable, easy to learn. Our video could act as a guide for promoting the standardized, safe, and wide application of LRET techniques. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00268-023-06977-8.