Case Report: Modified Thoracoscopic-Assisted Cervical Resection for Retrosternal Goiter

Abstract

Introduction: The treatment of choice for retrosternal goiters (RSG) is surgical resection to relieve symptoms and rule out malignancy. Although the majority of RSG can be removed by a cervical approach only, an extracervical approach (e.g., sternotomy, thoracotomy or thoracoscopy) may be required. Herein, we describe a refined thoracoscopic-assisted cervical two-team RSG resection without thoracoscopic mediastinal dissection.Technique: A 57-year-old man presented with a large RSG with posterior mediastinal extension (PME) and extensive peritumoral vascularization. Due to its extension below the aortic arch and its small connection with the right thyroid lobe, a combined cervical and thoracoscopic approach was intended. The endocrine surgery unit performed the cervical mobilization of the right thyroid lobe, while the thoracic surgery unit gently pushed the mediastinal tumor through the thoracic inlet without performing mediastinal dissection. This allowed a safe visualization of the inserting vessels by the endocrine surgery team at the neck, followed by a stepwise division of the vessels and resection of the retrosternal nodule through the cervical access.Comment: The described approach is indicated for RSG with posterior mediastinal extension, anteroposterior dimension smaller than the thoracic inlet and inaccessibility from a cervical approach only. This minimally invasive approach is associated with a faster recovery, decreased morbidity and postoperative pain, shorter hospital stay and better cosmetic results.

Pathological diagnosis and immunohistochemical analysis of giant retrosternal goiter in the elderly: A case report

“…Malignant giant retrosternal goiter is potentially malignant and requires a more aggressive treatment strategy. The clinical manifestations of giant retrosternal goiter in the elderly usually include dyspnea, dysphagia, hoarseness, and neck mass[ 14 ]. These symptoms are similar to other diseases and can easily lead to misdiagnosis or delayed diagnosis.…”

Surgical Management and Predictors of Postoperative Complications of Retrosternal Goiters: A Retrospective Study

“…Video-assisted thoracoscopic surgery and robot-assisted thoracoscopic surgery are becoming increasingly popular in thoracic surgery due to their faster recovery times, less pain, and shorter hospital stays compared to open approaches [16,17]. However, there are few reports of minimally invasive procedures for the removal of posterior mediastinal and ectopic intrathoracic goiters [18,19]. Furthermore, the use of novel procedures requires specialized equipment, making them less suitable for emergency conversion.…”

Mediastinal Goiter from the View of Thoracic Surgery

“…A novel was published in 2006 using anterior mediastinotomy together with the cervical incision with performing bimanual manipulation to deliver the troublesome retrosternal goiter (24) . Thoracoscopy, and more recently robotic assisted thoracoscopy, have also been used to aid in resection of RSG and are described in a few case series (7,12,14,16) .…”

“…This happens with extension of goiter below the aortic arch, in redo surgeries, involvement of the posterior mediastinum, extension of the RSG towards carina, and primary ectopic RSG in the mediastinum (4,14) . Generally, sternotomy combined with a cervical approach is the standard favored approach for resection of anterior mediastinal goiters, while thoracotomy is advised for removal of posterior mediastinal goiters (1,5,7,12) .…”