Combined Cervical and Video-assisted Thoracoscopic Thyroidectomy (CAVATT): A Simplified and Innovative Approach for Goiter with Posterior Mediastinal Extension

Abstract

We report a case of benign multinodular goiter with right sided posterior mediastinal extension managed by a simplified anaesthetic and surgical protocol. Single lumen endotracheal tube was used for intubation. Access to mediastinum was obtained by 2 working ports in 2nd and 4th intercostal spaces. Mediastinal extension is dissected thoracoscopically and delivered cervically. Post operative course was uneventful with no pulmonary and surgical morbidity.

A Novel Approach of Videothoracoscopic Surgery for Posterior Mediastinal Goiter

“…We used similar technique successfully in three more cases and detailed technique is described in our paper. 5 The advantages of this minimally invasive approach as we found were, minimal anesthetic complexity, low cost and shorter operative time as patient lies supine throughout the procedure without frequent change in position. Moreover, thoracoscopic dissection facilitates delivery of the goiter under vision without the fear of damage to vital mediastinal structures and vasculature, which can occur with blind digital delivery.…”

A simplified protocol of combined thoracoscopy and laparoscopic excision for large subdiaphragmatic hepatic hydatid cysts

“…Various thoracic procedures like esophagectomy, pneumonectomy, empyema drainage, sympathectomy, thyroidectomy etc., have been performed safely using this technique of anaesthesia in the past. [1112] Additional advantage is we can combine this thoracoscopic technique with laparotomy if needed, as highlighted in this case.…”

Simultaneous unilateral anterior thoracoscopy with transcervical thyroidectomy for the resection of large mediastinal thyroid goiter

“…To date, there have only been four cases reported of mediastinal goiters resected with thoracoscopy (4,12,13).…”

“…Bhargav et al described a case of a goiter with significant posterior mediastinal extension that was unable to be delivered through the transcervical approach. Intraoperative right anterior thoracoscopy was performed in order to deliver the goiter into the cervical incision (13). To our knowledge, this is the first case series of elective simultaneous anterior thoracoscopy and transcervical resection for large mediastinal goiters.…”