Abstract: Objective To compare the clinical efficacy and surgical complications of modified Miccoli surgery and trans-areolar endoscopic thyroid surgery in the treatment of early differentiated thyroid cancer.
Methods The clinical data of 100 patients with early differentiated thyroid cancer were retrospectively analyzed，and patients were divided into the modified Miccoli group and the areola approach group according to the random number table method，50 cases each.The modified Miccoli group used the modified Miccoli technique for subtotal or total resection of thyroid cancer，while the areola approach group used the areola approach for subtotal or total resection of the thyroid cancer.The surgical indicators，pain，aesthetics，pharyngeal discomfort score（RSI），and sound impairment score（VSI），complications，and recurrence and metastasis were compared between the two groups.
Results The modified Miccoli group had shorter operation time，post-extubation time，neck recovery time，and hospital stay time than the areola approach group（P<0.05），and the intraoperative blood loss was less than the areola approach group（P<0.05）.At 12 and 24 hours after surgery，the VAS score of the modified Miccoli group was lower than that of the areola approach group（P<0.05）.In the modified Miccoli group，VSS and PSAS were higher at 1 month after operation than those of the areola approach group（P<0.05），and the VSI at 3 days after operation was lower than that of the areola approach group（P<0.05）.There was no incision infection or permanent recurrent laryngeal nerve injury after surgery in the two groups.There was no significant difference in the incidence of subcutaneous ecchymosis，numbness of hands and feet，neck discomfort，hoarseness，transient recurrent laryngeal nerve injury，parathyroid injury，and incision bleeding between two groups（P>0.05）.No recurrence，metastasis or death occurred during follow-up in both groups.
Conclusion 〖JP2〗Both the modified Miccoli surgery and the areola endoscopic surgery are safe and effective treatments for early differentiated thyroid cancer.Modified〖JP〗 Miccoli has less damage during operation，faster postoperative recovery，and lower postoperative pain，but leaves an incision in the neck，which is insufficient in aesthetics.Patients with low aesthetic requirements may prefer modified Miccoli surgery for endoscopic surgery.

Key words: improved Miccoli surgery, areola approach, endoscopic thyroid surgery, early differentiated thyroid cancer