Transcervical and robotic-assisted thoracoscopic resection of a substernal goiter

Abstract

Several genetic and environmental factors contribute to the development of multinodular goitre. A transcervical surgical resection is recommended for larger goitres, though a minority of cases may require sternotomy or thoracotomy. We present a case of a posterior substernal goitre that was resected with combined transcervical and robotically assisted thoracic approaches. A woman in her 30s with an enlarging thyroid goitre elected to proceed with surgical resection. CT imaging demonstrated significant extension of the goitre into the posterior mediastinum and a staged approach was decided on. Both the initial transcervical thyroidectomy and the subsequent robotically assisted resection of the mediastinal portion were successful, without major complications. While most substernal goitres can be resected transcervically, certain rare anatomic features, such as extension into the posterior mediastinum, warrant consideration of a thoracic approach. Specifically, a robotic-assisted resection poses several advantages over traditional, more invasive approaches.

Extracervical Approaches to Substernal Thyroid Goiter Resection: A Systematic Review and Meta‐Analysis

“…Despite increasing use of minimally invasive techniques in other settings, existing literature on surgically treated SSG consists almost exclusively of patients undergoing open approaches. The use of minimally invasive techniques in this population is mainly restricted to case reports for planned excision of posterior mediastinal goiters and ectopic intrathoracic goiters 34‐36 . Furthermore, the requirement of specialized equipment for VATS and RATS makes these approaches less amenable to emergent conversion to an ECA compared to a traditional open approach.…”

“…The use of minimally invasive techniques in this population is mainly restricted to case reports for planned excision of posterior mediastinal goiters and ectopic intrathoracic goiters. 34 , 35 , 36 Furthermore, the requirement of specialized equipment for VATS and RATS makes these approaches less amenable to emergent conversion to an ECA compared to a traditional open approach. In the future, minimally invasive surgery may provide an alternative to treat SSG necessitating an ECA, although more published data is needed to provide a reliable recommendation.…”

A critical update on the management of retrosternal goiter

“…For example, the subxiphoid thoracoscopic approach is a novel alternative proposed by a Chinese group for median RGs 74 . Robotic-assisted procedures are being also actively explored but they are always combined with a transcervical incision [75][76][77] .…”