Video assisted thoracoscopic thyroidectomy for retrosternal goitre

Gupta, Prity; Lau, Kelvin; Rizvi, Irfan; Rathinam, Sridhar; Waller, David

doi:10.1308/003588414x14055925058634

Cited by 23 publications

(13 citation statements)

References 11 publications

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“…Manubriotomy is considered to be another safe alternative, which allows exposure of structures within the thoracic inlet although direct comparison of this technique against others has not been evaluated in terms of patient risk [12]. Newer techniques such as endoscope-assisted and video-assisted thoracoscopic thyroidectomy also provide options for minimally invasive surgical removal of RSG [15]. Further study of the success of these techniques is needed.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Retrosternal Goitre

Welman

Heyes

Dalal

et al. 2017

Indian J Otolaryngol Head Neck Surg

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This study aims to evaluate surgical approaches to the management of retrosternal goitre. Between 2004 and 2014, 35 patients (eight males; mean age 67.4 ± 10.9 years) with retrosternal goitre (mainly right-sided in 9, left-sided in 14 and bilateral in 12) underwent surgery. A palpable neck mass was found in 11 (31.4%), stridor in 10 (28.6%) and thyrotoxicosis in 4 (11.4%) cases. 4 (11.4%) patients were asymptomatic. Tracheal compression was detected radiologically in 27 (77.2%) patients with deviation in 18 (51.4%). A collar incision was performed in 34 patients, 6 (17.1%) of whom required additional sternotomy, 1 (2.9%) was assisted by an anterior mediastinotomy. 1 (2.9%) had a right lateral thoracotomy. There was no operative mortality. Transient vocal changes occurred in 3 (8.6%) patients, recurrent laryngeal nerve palsy in 3, atrial fibrillation in 2, and wound complications in 2 (5.7%). Hospital stay ranged from 2 to 12 days (5.5 ± 2.0). Multinodular goitre was found in 33 patients, diffuse goitre in 1 and ectopic thyroid in 1. The average vertical length of goitres in the collar incision group was 7.6 cm compared to 10.6 cm in the sternotomy group. The average weight of specimens was 156.3 g in patients with collar incisions and 307.5 g in the sternotomy group. Removal of retrosternal goitre is more commonly performed via a cervical collar incision with mandatory availability of sternotomy. Radiological measurement of craniocaudal length may predict the risk of sternotomy. Surgical outcomes are not affected by surgical approach.

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Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Retrosternal Goitre

Welman

Heyes

Dalal

et al. 2017

Indian J Otolaryngol Head Neck Surg

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“…Small studies have reported good results from using less invasive methods than open thoracic surgery, such as VATS (video-assisted thoracoscopic surgery). [29,30] …”

Section: Discussionmentioning

confidence: 99%

Volumetric Analysis is Useful for Predicting Use of Sternotomy During Retrosternal Thyroidectomy

Evans¹,

Shafi²,

Singh³

et al. 2017

ASS

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Surgical removal is the recommended treatment for retrosternal goitre. This can be successfully achieved through a cervical incision in most cases, however occasionally a thoracic approach is required. Being able to predict the need for sternotomy would improve logistical efficiency, saving time and money, and allow patients to be better informed preoperatively. The aim of this study was to determine whether analysing thyroid volume on preoperative CT scans could help predict the use of sternotomy. To the best of our knowledge this is the first study investigating this. A retrospective study was conducted on 64 patients who underwent thyroidectomy for retrosternal goitre at the Golden Jubilee National Hospital, Scotland, between 2012-2016. Patient demographic information and pathological reports were obtained from databases. Preoperative CT scans were used for volumetric analysis. The total volume, the volume inferior to the level of the sternal notch (intrathoracic volume), and the anteroposterior diameter of the thoracic inlet were measured. An index of relative goitre size was calculated by dividing intrathoracic volume by thoracic inlet diameter. Mann-Whitney U tests and Fisher's exact tests were used to analyse continuous and categorical variables respectively. Goitres were successfully removed by a cervical incision alone in 55 patients, while thoracic intervention was needed in 9 cases (13.3%). Intrathoracic volume (p=0.0091) and volumetric index (p=0.0033) were significantly larger in those requiring sternotomy. Total volume was not significantly different. All other variables measured were similar in both groups. Our results suggest that assessing intrathoracic volume of goitre is useful in predicting the need for sternotomy. However, it is not able to completely rule out thoracic intervention. The volumetric index is likely to be a better predictor than volume alone.

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“…With these significant morbidity considerations in mind, they concluded that where anatomically possible, a trans-cervical approach should be used regardless of pathology [4] . Alternatively, there are reported video-assisted thoracoscopic approaches which may be of benefit in select patients where the anterior mediastinal space may be accessed [15] .…”

Section: Discussionmentioning

confidence: 99%

Trans-cervical resection of a separate substernal goitre

Karmakar

Farrell

et al. 2017

International Journal of Surgery Case Reports

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HighlightsA separate substernal goitre is an unusual entity, which may have embryological origin as ectopic thyroid tissue, or residual cervical thyroid tissue following prior thyroid resection.Pre-operative imaging via a thyroid nuclear scan and computer tomography (CT) imaging aids in determining its characteristics and for pre-operative planning.A trans-cervical resection is preferred due to lower morbidity.A trans-cervical resection is achievable when the lesion is accessible and delivered through the thoracic inlet according to CT characteristics.

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Video assisted thoracoscopic thyroidectomy for retrosternal goitre

Cited by 23 publications

References 11 publications

Surgical Treatment of Retrosternal Goitre

Surgical Treatment of Retrosternal Goitre

Volumetric Analysis is Useful for Predicting Use of Sternotomy During Retrosternal Thyroidectomy

Trans-cervical resection of a separate substernal goitre

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