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Objective To investigate the safety and feasibility of modified gasless trans-subclavian approach endoscopic total thyroidectomy for papillary thyroid carcinoma(PTC).Methods We retrospectively analyzed the clinical data of consecutive 82 patients with PTC who underwent the modified gasless trans-subclavian approach endoscopic total thyroidectomy in the Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine, from March 2022 to June 2023. Results All operations were successfully completed under endoscopy approach without transfer to open surgery. The maximum diameter of PTC was(6.6±5.4)mm. The operation duration was(156.5±32.7)min, and the number of lymph nodes in the central compartment was(12.3±6.4). The postoperative hospital stay was(3.3±1.2)d. Postoperative complications included two cases of transient hypoparathyroidism and six cases of transient recurrent laryngeal nerve injury. All the patients recovered in one month. One case of postoperative bleeding was observed. No permanent laryngeal nerve injury, permanent hypoparathyroidism or incision infection occurred. Conclusion The gasless trans-subclavian approach endoscopic total thyroidectomy is a feasible and safety approach in selected PTC patients. The lymph nodes in the central compartment are thoroughly dissected. This approach has obvious advantages in functional protection of the anterior cervical region, and has clinical application value. [ABSTRACT FROM AUTHOR]

We present the case of a severely symptomatic patient with a malfunctioning aortic bioprosthesis and severe multidistrict atherosclerosis that was addressed to our unit for transcatheter valve-in-valve implantation. The imaging and clinical assessment that led to the selection of the access route is discussed.