When is Transthoracic Approach Indicated in Retrosternal Goiters?

Abstract

Purpose: It is critical to differentiate among pathologies of substernal thyroid gland diseases because surgical approaches (i.e., median sternotomy or thoracotomy) might also include a cervical incision. The aim of this study was to analyze the features of patients with goiter who underwent a thyroidectomy via a cervical incision and a median sternotomy or thoracotomy. Methods: We reviewed 9 cases of thyroid disease in patients undergoing thoracic incisions with or without a cervical incision for varying indications between March 2003 and Jun 2009 were reviewed. Thyroidal masses were removed via a median sternotomy in six patients and thoracotomy in three patients. Split median sternotomy combining thoracotomy was performed in 1 patient. Cervical incision was added in all patients. Results: Pathologic examination revealed multinodular goiter in 5 patients, thyroid carcinoma in 3, and reidel thyroiditis in 1. All patients were extubated in the early postoperative period. There was no postoperative mortality or morbidity. The mean hospital stay was 8.6 days (range, 4-11 days), and mean follow-up was 24.3 months (range, 4-39 months). Conclusions: We recommend the use of transthoracic approaches, such as median sternotomy and thoracotomy for retrosternal goiter for surgical exposure, because they provide a wide exposure and facilitate removal of the mass. By using median sternotomy and thoracotomy, we can avoid catastrophic results, such as hemorrhage, as well as completely remove malignancies.

A case of mediastinal goiter treated surgically using a clavicle-lifting technique

“…Mediastinal goiters extending to the aortic arch, like the present case, have been reported to be good candidates for an extracervical approach [2] . It has been reported that a thyroidectomy should be performed for all mediastinal goiters because of the risk of airway obstruction, potential malignancy, tracheomalacia and invasion into adjacent structures [3] , [4] .…”

“…In most cases, the goiter can be resected via a cervical approach. However, between 2% and 29% of all mediastinal goiters require an extracervical incision [3] , [4] , [5] , [6] . However, there is disagreement about whether a cervical approach is best choice for a lesion causing tracheal or vascular compression.…”

Giant recurrent intrathoracic goitre treated by clamshell thoracotomy and reverse sternotomy

“…The cervical approach is considered the preferred surgical approach for the majority of intrathoracic goitres 3 4. However, a surgical approach requiring sternotomy is preferred in cases of recurrent goitres, goitres of very large dimensions and volume and larger than the thoracic inlet, ectopic intrathoracic goitres and suspicion of malignancy 4 – 6. To this repertoire we add the inferior surgical approach of clamshell thoracotomy and reverse sternotomy, which allows central vascular control and excision of giant goitres.…”

Retrosternal goitre, do humans need a sternotomy?

“…In a review of pathology of RGs Kilic et al commented that using median sternotomy and thoracotomy, we get better surgical exposure, we can avoid catastrophic results, such as hemorrhage, and completely remove malignancies and the draining nodes. 22 Thyroid tissue density is said to predict the need for sternotomy in a RG. Sari et al in a prospective study of 260 patients, noted that patients with harder thyroid tissue density needed sternotomy 47 times more frequently than those with softer thyroids (P=0.001).…”