When is transthoracic approach indicated inretrosternal 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 incisionswith or without a cervical incision for varying indications between March 2003 and Jun2009 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 carcinomain 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 8.6days (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 thora cotomy for retrosternal goiter for surgical exposure, because they provide awide 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. © 2011 The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery. All rights reserved.