To explore the effect of establishing "RLN triangle" on RLN exposure in transaxillary approach endoscopic thyroidectomy.

Data of 91 patients with thyroid cancer admitted from December 2021 to October 2022 were retrospectively analyzed, all of whom were treated with axillary approach endoscopic thyroidectomy. The patients were divided into two groups according to different RLN exposure pathways. The observation group (n=48 cases) was exposed in the "RLN triangle" area established in the lower section of the medial wall of the common carotid artery by the lowest approach method. In the control group (n=43 cases), RLN was exposed in the larynx 1.0 cm below the inferior Angle of thyroid cartilage by traditional road approach. SPSS 24.0 statistical software was used to analyze the data. The counting data were represented by [cases (%)], and the comparison between groups was conducted by χ² test. Measurements of perioperative indexes, voice function and swallowing function were expressed as(), and independent sample t test was performed for inter-group comparison. P<0.05 was statistically significant.

The indexes of operation time, RLN exposure time, intraoperative blood loss and postoperative drainage volume in observation group were better than those in control group (P<0.05). The voice disturbance index and swallowing disturbance index in the observation group were significantly lower than those in the control group (P<0.05). There was no significant difference in voice disorder index and swallowing disorder index between the two groups 6 months after operation (P>0.05). There was no significant difference in the total incidence of surgical complications between the two groups (P>0.05).

The use of the lowest approach method in axillary endoscopic thyroidectomy can significantly shorten the exposure time and surgical time of RLN, reduce intraoperative bleeding, and alleviate postoperative vocal and swallowing dysfunction, which is more conducive to RLN protection.