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Cervical leverage: A new procedure to deliver deep retrosternal goitres without thoracotomy
Vijay Naraynsingh1, Ian Ramarine, Shamir O Cawich
1Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago.
Introduction:
Although most retrosternal goitres can be removed through a standard collar incision, some cases require extra-cervical incisions for complete resection. We report a new technique to remove large retrosternal goitres without extra-cervical incisions.
Presentation Of Case:
We present two cases in which a US Army-Navy (Parker-Langenback) retractor was used to deliver large retrosternal components into the cervical incisions.
Discussion:
This technique is useful in cases where the retrosternal component extends beyond the reach of the exploring finger and a well-developed plane can be developed between the gland and surrounding tissue.
Conclusion:
The cervical leverage technique allows removal of a large retrosternal component through a cervical incision, thereby avoiding the attendant morbidity of a thoracotomy or median sternotomy. It should not be used if there is suspected neoplastic disease, dense adherence to or invasion of surrounding intra-thoracic structures.
