无充气经锁骨下入路腔镜甲状腺手术是在传统颈部腔镜辅助外科技术基础上，结合器械创新、入路改良和操作流程优化逐步形成的改良术式。该术式通过锁骨下沿皮纹小切口、胸锁乳突肌胸骨头与锁骨头肌间隙入路及专用悬吊建腔拉钩，在无充气条件下建立稳定操作空间，可减少颈前区大范围分离及对锁骨上神经等结构的牵拉损伤。该术式在保证甲状腺癌手术安全性和肿瘤根治性的基础上，兼具微创及美容优势，并有助于降低病人术后吞咽功能障碍和颈前区不适发生风险。其适应证已由单侧甲状腺腺叶切除及同侧中央区淋巴结清扫，逐步拓展至全甲状腺切除、双侧中央区清扫及同侧颈侧区淋巴结清扫。规范开展该术式应重视切口定位、建腔层次、喉返神经和喉上神经外支定位、甲状旁腺原位保护或自体移植、中央区下段及颈侧区关键区域显露等技术要点。单侧手术学习曲线相对较短，具备推广价值；复杂范围手术仍需在充分掌握单侧手术基础上循序渐进开展，并依托规范化培训、严格适应证把握和多中心经验积累进一步提升手术质量。

Gasless endoscopic thyroidectomy via the subclavian approach is a modified surgical procedure that has gradually evolved from conventional cervical endoscopic-assisted surgery through instrument innovation, approach refinement, and optimization of the operative workflow. This technique establishes a stable working space without insufflation through a small subclavian skin-crease incision, an approach via the intermuscular plane between the sternal and clavicular heads of the sternocleidomastoid muscle, and a specialized suspension retractor. It reduces extensive dissection in the anterior neck and minimizes traction injury to structures such as the supraclavicular nerves. While ensuring the safety and oncological radicality of thyroid cancer surgery, this approach also offers minimally invasive and cosmetic advantages and may help reduce the risk of postoperative dysphagia and anterior neck discomfort. Its indications have gradually expanded from unilateral thyroid lobectomy with ipsilateral central compartment lymph node dissection to total thyroidectomy, bilateral central compartment dissection, and ipsilateral lateral neck lymph node dissection. Standardized implementation of this technique should emphasize key technical points, including precise incision placement, the plane of working space creation, identification of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve, in situ preservation or autotransplantation of the parathyroid glands, and adequate exposure of critical areas in the lower central compartment and lateral neck. The learning curve for unilateral procedures is relatively short, indicating good potential for wider adoption. However, more extensive procedures should be introduced progressively only after surgeons have fully mastered unilateral procedures, and surgical quality should be further improved through standardized training, strict control of indications, and accumulation of multicenter experience.