[Abstract] Objective To apply laparoscopy for scarless thyroidectomy in the neck and to explore the aesthetic value of the postoperative period. Methods We retrospectively analyzed 30 patients undergoing laparoscopic thyroidectomy via axillary areola approach from May 2010 to May 2011 and 30 patients undergoing conventional thyroidectomy during the same period in our hospital. Results The lumpectomy group not only achieved excellent cosmetic results of the neck, but also had better intraoperative bleeding and faster postoperative recovery than the conventional surgery group. The operative time was also not longer than that of the conventional surgery group. Conclusion The laparoscopic thyroid surgery through the axillary areola not only has excellent cosmetic neck results, but also achieves the same therapeutic effect as the traditional surgery, and should be a developmental direction of thyroid surgery. [Keywords] Laparoscopy, thyroid, surgical scar, aesthetics Today, minimally invasive surgical techniques marked by laparoscopy are increasingly used and have been extended from intra-abdominal and thoracic operations to some potential cavities of the body or even cavity-free areas, thus making the clinical effect of minimally invasive more significant. We use lumpectomy to perform thyroid surgery via axillary areola approach and have excellent postoperative cosmetic neck results, which are reported below. 1. Clinical data 1.1. General data and grouping We retrospectively analyzed 30 patients undergoing lumpectively performed thyroid surgery via axillary areola approach from May 2010 to May 2011 (lumpectomy group) and 30 patients undergoing conventional thyroid surgery in the same period (conventional surgery group). The inclusion criteria for cases were unilateral benign lesions, lesion diameter of 4 cm, and no other concomitant diseases. The age of patients in both groups ranged from 19 to 72 years old, including 5 males and 55 females, 42 cases of nodular goiter, 13 cases of papillary adenoma, and 5 cases of follicular adenoma. 22 cases of unilateral partial thyroid lobectomy and 38 cases of total lobectomy were performed. 1.2 Surgical method: In the conventional surgery group, a 4-6 cm long curved incision was made in front of the transcervical plexus, and the skin and the broad cervical muscle were incised. The flap was free behind the broad cervical muscle, up to the upper edge of the thyroid cartilage and down to the sternal notch. The white line of the neck is cut and the anterior cervical muscle is pulled away to reveal the thyroid gland. Depending on the lesion, a partial or complete lobe of the thyroid gland is excised and the incision is closed intradermally. The drainage tube is drained through a poked hole below the incision. The patient is placed in a supine position with the neck and shoulders slightly padded, the operator stands between the patient’s legs, the monitor is placed on the patient’s head, and the assistant stands on the patient’s left and right side. A 10-mm skin incision was made in the axillary fold of the affected side to the subcutaneous tissue layer, where a water injection needle was inserted and an appropriate amount of epinephrine saline was injected in and around the superior sternal fossa. 10-mm Trocar was inserted through the incision to the anterior aspect of the sternocleidomastoid muscle, and a separation rod was inserted to separate the subcutaneous space. A 5-mm incision was then made at the superior margin of the right and left areolas, and the 5-mm Trocar was inserted into the separated gap through the loose subcutaneous tissue. The gap was widened with an ultrasonic knife, and the surgical space was created posterior to the broad cervical muscle, up to the superior border of the thyroid cartilage and down to 2 cm below the sternotomy. the left and right sides were free to the anterior sternocleidomastoid muscle. The cervical white line was incised with an ultrasonic knife, and the anterior cervical muscle was suspended with a No. 4 silk suture through the skin to separate and reveal the thyroid gland. Depending on the lesion, a partial or complete excision of one lobe of the thyroid gland was performed with the ultrasonic knife, and the specimen was placed in a specimen bag and removed in pieces. The cervical white line was sutured and a drainage tube was placed to drain the incision from the right areola. Intraoperative bleeding in the two groups was 43.0±24.516 and 12.767±20.123 ml, and the operative time was 67.0±20.282 and 67.0±21.278 min, respectively. were, 3.767±0.504d, respectively. intraoperative bleeding and postoperative hospitalization days were compared by the nonparametric wilcoxon rank sum test, and there was a highly significant difference between the two groups (p<0.001); the operative time was compared by the t-test for group comparison, and there was no significant difference between the two groups. 3.Discussion The neck is an important cosmetic part of the human body, which is exposed to the sight of others for almost years. Scarring of the neck should be something that everyone does not want to see. Thyroid disorders are common in general surgery and most of them require surgical treatment. Traditional thyroid surgery involves a direct incision in the neck, which leaves an obvious surgical scar on the neck after surgery, seriously affecting the aesthetics of the neck and often leaving a psychological shadow that is difficult to erase. With the development of laparoscopic technology, surgery has entered the era of minimally invasive surgery. In order to improve the aesthetics of the neck, Hüscher et al. first reported endoscopic-assisted thyroidectomy in 1997, and Miccoli described endoscopic-assisted thyroidectomy through a small incision in the anterior neck in 1999, especially the Miccoli procedure, which has been widely used in China because of its ease of operation. All of these techniques require a small incision in the neck. Although the incision is obviously reduced, it still leaves more or less scarring and the cosmetic effect is not very satisfactory. In our group, we used the lumpectomy thyroidectomy through the axillary areola approach, and the cosmetic results were very satisfactory. Because the traditional surgery is to make an incision directly on the neck, it will inevitably leave an obvious surgical scar on the neck after surgery, but in this group, the lumpectomy thyroidectomy is to transfer the surgical incision to a hidden place on the body, and there is no surgical scar on the neck after surgery, so the cosmetic effect is extremely satisfactory. The lumpectomy group not only achieved excellent cosmetic results in the neck, but also had better intraoperative bleeding and faster postoperative recovery than the traditional surgery group. The operative time was not longer than that of the conventional surgery group, which was related to the operator's skilled lumpectomy skills. Some scholars believe that lumpectomy is only a cosmetic surgery because it requires more flaps to be freed to create an operating space during surgery. In our group, we adopted the method of direct percutaneous subcutaneous puncture, and the flap release range is basically close to that of the traditional surgery group, and the trauma is significantly reduced. At present, the indications for endoscopic thyroid surgery are: 1) unilateral or bilateral benign adenomas, cysts and nodular hyperplasia of the thyroid gland with a diameter of <5 cm; 2) hyperthyroidism with a normal or mildly enlarged gland; 3) papillary thyroid cancer with a diameter of <1 cm, no invasion of the gland surface, and no enlarged lymph nodes in the central and lateral cervical regions. It is believed that with the advancement of technology, the indications for surgery will be relaxed continuously. In conclusion, lumpectomy of the thyroid through the axillary areola should be a direction of development for thyroid surgery, as it not only has excellent cosmetic effects on the neck, but also achieves the same therapeutic effects as traditional surgery.