Split Sternotomy in Retrosternal Thyroid and Mediastinal Parathyroid Pathologies

Area of Science:

• Thoracic Surgery
• Endocrine Surgery
• Surgical Oncology

Background:

• Cervical incisions are standard for thyroid and parathyroid pathologies.
• Mediastinal extension of these pathologies sometimes necessitates broader surgical approaches.
• Minimally invasive techniques are increasingly preferred over traditional median sternotomy.

Purpose of the Study:

• To evaluate the adequacy and safety of split sternotomy for retrosternal goiter (RG) and mediastinal parathyroid pathologies.
• To compare split sternotomy outcomes with traditional median sternotomy.

Main Methods:

• Retrospective review of 12 patients undergoing split sternotomy between January 2010 and January 2021.
• Inclusion criteria: retrosternal thyroid pathology or mediastinal ectopic parathyroid adenoma requiring split sternotomy.
• Assessment of operative success, surgical exposure, and complication rates.

Main Results:

• Split sternotomy was performed on 12 patients (mean age 57.25 years; 66.7% female).
• Indications included multinodular goiter (25%), recurrent MNG (25%), hyperparathyroidism (25%), and thyroid cancer (25%).
• Postoperative complications included transient hypocalcemia (50%) and unilateral vocal cord paralysis (8.3%), all resolving spontaneously. Median sternotomy was avoided in all cases.

Conclusions:

• Split sternotomy is an adequate and applicable surgical method for retrosternal goiter and mediastinal parathyroid pathologies.
• This approach facilitates successful excision when cervical access is insufficient, avoiding the need for median sternotomy.