ObjectiveTo investigate the feasibility and safety of a custom-made, needle-assisted retractor (derived from a nerve monitoring monopolar ball-tip probe) in gasless unilateral axillary approach (GUA) endoscopic thyroidectomy. MethodsA retrospective analysis was performed on the clinical data and surgical procedures of 50 consecutive patients who underwent endoscopic thyroidectomy using the needle-assisted technique via GUA at the Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University from April 2023 to December 2023. All surgical procedures were performed by a single surgeon. Surgical experiences and operative techniques were summarized. ResultsAmong the 50 patients, there were 48 females and 2 males, with an age of (35.16±7.56) years. Forty-seven patients were diagnosed with papillary thyroid carcinoma, with a tumor diameter of (0.69±0.52) cm; 3 patients were diagnosed with benign nodules, with a maximum diameter of (2.67±0.58) cm. All patients underwent unilateral thyroid lobectomy (patients with malignancy additionally underwent central neck dissection). All surgery was successfully completed without conversion to open surgery. The operative time was (156.12±34.27) min. Postoperative complications included temporary hoarseness in 2 patients, subcutaneous effusion in 2 patients, and ipsilateral upper limb numbness in 1 patient. All complications recovered within one month. ConclusionsThis study demonstrates the good feasibility and safety of needle-assisted endoscopic thyroidectomy via the GUA. Furthermore, it helps reduce the difficulty of the procedure, which provides effective support for surgeons, especially beginners, to rapidly master this technique.