ObjectiveTo evaluate the safety, efficacy, and advantages of gasless trans-subclavian approach endoscopic parathyroidectomy (GTAEPT) in the treatment of primary hyperparathyroidism (PHPT). MethodsA retrospective analysis was conducted on the clinical data of 10 patients with PHPT who underwent GTAEPT at Xuzhou Central Hospital from October 2022 to September 2024. Data collected included operative time, recurrent laryngeal nerve exposure time, intraoperative blood loss, total drainage volume within the first two postoperative days, total hospital stay, changes in preoperative and postoperative intact parathyroid hormone (PTH) and serum calcium levels, and the occurrence of postoperative complications such as hoarseness, choking during drinking, active bleeding, and surgical site infection. Additionally, PTH and serum calcium levels were monitored at 6-month postoperatively. ResultsAll surgical procedures were successfully completed in the 10 patients. The operative time was (67.0±14.5) min, recurrent laryngeal nerve exposure time was (15.3±8.2) s, intraoperative blood loss was (9.5±3.5) mL, total drainage volume within the first two postoperative days was (36.7±5.2) mL, and total hospital stay was (6.4±1.0) d. The preoperative-to-postoperative differences in PTH and serum calcium levels [mean difference (95%CI)] were 191.3 (160.7, 220.0) ng/L and 0.5 (0.3, 0.6) mmol/L, respectively, both returning to normal reference ranges. Only one case of transient hoarseness was observed postoperatively, with no complications such as active bleeding, choking during drinking, or surgical site infection. At the 6-month follow-up, all patients maintained serum PTH and calcium levels within the normal reference ranges. ConclusionsGTAEPT has preliminarily demonstrated safety and feasibility in treating PHPT, with short intraoperative recurrent laryngeal nerve exposure time, rapid postoperative normalization of PTH and serum calcium levels, and stable therapeutic outcomes during the 6-month follow-up. This technique combines the benefits of minimal invasiveness and favorable cosmesis, representing a viable treatment option for patients with unilateral parathyroid lesions.