Modified supraclavicular approach for hemithyroidectomy with central neck dissection in unilateral papillary thyroid microcarcinoma: a feasibility-focused retrospective cohort study

Background: Conventional open thyroidectomy provides reliable exposure for hemithyroidectomy and central neck dissection but leaves a visible anterior cervical scar. Remote-access approaches may improve cosmetic outcomes but often require specialized equipment, longer operative time, and greater technical complexity. This study evaluated the feasibility and perioperative outcomes of a modified supraclavicular approach in selected patients with unilateral papillary thyroid microcarcinoma(PTMC).

Methods: This single-center retrospective cohort study included 130 patients with unilateral PTMC who underwent hemithyroidectomy with isthmusectomy and central neck dissection between June 2023 and January 2026. Patients were categorized into three surgical groups: modified supraclavicular approach, infraclavicular endoscopic approach, and conventional midline open approach. Perioperative outcomes, central lymph node yield, postoperative day 1 parathyroid hormone levels, hospitalization costs, complications, incision-related outcomes, and the learning curve were assessed. To address baseline imbalance, the primary comparison between the modified supraclavicular and conventional midline open approaches was analyzed using propensity score overlap weighting based on age, sex, body mass index, comorbidity status, Hashimoto’s thyroiditis, tumor size, tumor side, and tumor location.

Results: Among the 130 patients included, 29 underwent the modified supraclavicular approach, 65 underwent conventional midline open thyroidectomy, and 36 underwent the infraclavicular endoscopic approach, which was retained as an institutional contextual cohort. In the primary comparison with the midline open group, no statistically significant difference was detected in operative time or central lymph node yield after adjustment for relevant covariates. No intraoperative conversion occurred in the modified supraclavicular group. No postoperative hematoma requiring reoperation, clinically suspected permanent recurrent laryngeal nerve dysfunction, or permanent hypoparathyroidism was documented. The modified supraclavicular group had lower postoperative pain scores and less frequent neck discomfort, although these subjective outcomes should be interpreted cautiously because assessment was retrospective and unblinded. Cosmetic superiority over conventional open or remote-access thyroidectomy was not assessed using a validated scar scale. CUSUM analysis identified an approximate transition in operative performance at case 14.

Conclusions: In selected patients with unilateral PTMC for whom hemithyroidectomy with ipsilateral central neck dissection had already been planned, the modified supraclavicular approach appeared technically feasible as an alternative cervical access route. In the primary adjusted comparison with conventional midline open thyroidectomy, no statistically significant differences were detected in operative time or central lymph node yield, and no intraoperative conversion occurred. These findings should be considered exploratory and do not establish equivalence, non-inferiority, cosmetic superiority, or long-term oncological effectiveness.