Use of a Foley catheter in the removal of a substernal goiter

Substernal goiters present a technical challenge to the surgeon. Most substernal goiters may be removed through a cervical incision; however, a median sternotomy may be required in 1% to 2% of patients. To avoid a median sternotomy, many techniques have been described in the literature to facilitate extraction. Special spoons and clamps have been described, and techniques, such as morcellation, the drawer technique, and piecemeal extraction, have been popularized. We describe a method whereby a Foley catheter is used to deliver a large substernal goiter through a cervical incision. It consists of steady traction on the inflated balloon of a Foley catheter placed beyond the substernal component of the goiter. This method has been used successfully and safely on 2 patients and may obviate the need for a sternotomy.