Abstract: Objective Investigate the clinical efficacy and application value of gasless trans-subclavian approach endoscopic surgery(GTAES) for the treatment of primary hyperparathyroidism(PHPT).Methods 55 PHPT patients who underwent unilateral parathyroid adenoma resection from January 2023 to October 2024 were absorbed.Based on surgical approaches,31 patients were divided into the traditional low-collar arc incision open surgery group(open group) and 24 patients were divided into gasless trans-subclavian approach endoscopic surgery group(endoscopic group).The perioperative data,anterior neck function recovery,and incision healing were compared between two groups.Results There were no significant differences in operation time, intraoperative blood loss, postoperative drainage volume and postoperative hospital stay between the two groups(P > 0.05).The preoperative blood calcium levels of the endoscopic group and the open group were (2.68±0.10) mmol/L and (2.63±0.16) mmol/L, respectively.The blood calcium levels on the first day after surgery were (2.39±0.12) mmol/L and (2.36±0.16) mmol/L, respectively.Preoperative parathyroid hormone(PTH) was 27.55(110.05,155.75)pg/ml in endoscopic group and 137.00(107.00,210.30)pg/ml in open group, respectively.PTH on the first day after surgery was 18.98(12.64,23.53)pg/ml and 13.85(7.36,23.23)pg/ml, respectively.Blood calcium and PTH in each group 1 day after surgery decreased compared with that before surgery, and the difference was statistically significant(P < 0.05).There were no postoperative complications such as hoarseness, bleeding and incision infection in both groups. Postoperative hand and foot numbness: 5 cases(20.8%) in endoscopic group and 8 patients(25.8%) in the open group, there was no significant difference between the two groups(P=0.667).There was no significant difference in the score of neck pain 3 days after surgery between the two groups(P > 0.05). The score of swallowing tension [(1.92±1.06) points compared with(2.77±1.38) points, P=0.015] and the score of anterior neck discomfort [(1.63±0.88) points compared with (2.35±1.33) points, P=0.018] in the endoscopic group one month after surgery were better than those in the open group.There was no significant difference in the score of neck scar scale between the two groups 3 months after surgery(P > 0.05). VAS score of incision satisfaction was (9.08±0.88) in endoscopic group and (8.19±1.30) in open group, and the endoscopic group was better than the open group, the difference was statistically significant (P=0.004).Conclusion For PHPT patients caused by unilateral parathyroid adenoma confirmed through preoperative localization examination,GTAES is a safe and effective surgical approach,which offers unique advantages in intraoperative lesion identification,cosmetic outcomes of the incision,and preservation of anterior neck function,providing a new surgical option for PHPT patients.

Key words: gasless;trans-subclavian approach;endoscope;primary hyperparathyroidism;clinical efficacy