Video assisted thoracoscopic thyroidectomy for retrosternal goitre

Area of Science:

• Thoracic Surgery
• Endocrine Surgery
• Minimally Invasive Surgery

Background:

• Retrosternal goitre thyroidectomy typically uses cervical incisions, but 4-12% require extracervical approaches like sternotomy.
• Sternotomy is a substantial incision and offers suboptimal exposure due to the thyroid's deep anatomical position.
• Video-assisted thoracoscopic surgery (VATS) presents an alternative to sternotomy for these complex cases.

Purpose of the Study:

• To evaluate the efficacy and outcomes of VATS thyroidectomy for retrosternal goitre requiring an extracervical approach.
• To compare VATS with traditional sternotomy in terms of invasiveness and exposure.
• To assess the feasibility of VATS as a primary surgical strategy for selected retrosternal goitres.

Main Methods:

• A retrospective descriptive study was conducted on seven patients with retrosternal goitre.
• These patients underwent VATS thyroidectomy, with a transverse cervical incision, as an alternative to sternotomy or thoracotomy.
• Data collected included operating time, goitre size, conversion rates, complications, pain scores, and length of stay.

Main Results:

• Seven patients (median age 68 years) underwent VATS thyroidectomy for retrosternal goitre.
• Median operating time was 218 minutes for a median goitre diameter of 70 mm.
• One conversion to manubriotomy and one transient recurrent laryngeal nerve palsy were observed; median postoperative pain and length of stay were low (1 and 5 days, respectively).

Conclusions:

• VATS thyroidectomy is a viable, minimally invasive option for retrosternal goitre requiring an extracervical approach.
• This technique offers reduced morbidity and excellent surgical exposure compared to sternotomy.
• VATS facilitates effective management of retrosternal goitres, improving patient outcomes.