Minimal Invasive Resection of Large Retrosternal Thyroid Goiter

Area of Science:

• Endocrine Surgery
• Thoracic Surgery
• Minimally Invasive Procedures

Background:

• Resecting large retrosternal goiters poses surgical challenges, often requiring sternotomy or thoracotomy.
• Transthoracic approaches are associated with higher postoperative morbidity (up to 30%) than transcervical methods.
• While thoracoscopic resection is an alternative, mediastinal dissection morbidity remains a concern.

Purpose of the Study:

• To outline the steps and potential pitfalls of the thoracoscopic-assisted transcervical approach for large retrosternal goiter resection.
• To present a case demonstrating the feasibility and safety of this minimally invasive technique.

Main Methods:

• A two-team approach: initial cervical mobilization followed by thoracoscopic guidance if needed.
• Thoracoscopic assistance guides the mediastinal tumor through the thoracic inlet for controlled transcervical dissection.
• Recurrent laryngeal nerve monitoring using a neurostimulation device during dissection.

Main Results:

• Successful resection of a large retrosternal goiter in an 84-year-old male with oncocytic thyroid carcinoma.
• No recurrent laryngeal nerve palsy observed postoperatively.
• Uneventful postoperative course with discharge on the second day.

Conclusions:

• Thoracoscopic-assisted transcervical resection is a feasible, less invasive alternative for large retrosternal goiters.
• This technique may decrease postoperative morbidity and length of hospital stay.
• Requires thoracoscopic expertise and may have limitations based on goiter size and position.