Unlabelled: The possibility of needing a combined access, with neck and chest incisions makes the treatment of substernal goiter a challenge both in the pre-op and the intraoperative. We hereby, discuss a standardization of the surgical technique to minimize the need for a chest approach, making the substernal goiter a surgically treatable disease, through a single neck incision, and with low indices of complication.
Aim: To assess the substernal goiter surgically approach through a neck incision and to analyze the surgical complications.
Materials And Methods: We carried out a historical cohort by retrospective analysis of the charts of patients submitted to thyroidectomy, and 33 of them (10.4%) had substernal goiter.
Results: All 33 patients were surgically treated through a neck incision without the need for sternotomy. We did not observe definitive lesions in the inferior laryngeal nerve or definitive hypoparathyroidism. Only 2 patients had recurrent nerve paresis; and 2 patients were re-operated because of a neck hematoma.
Conclusion: Patients with substernal goiter can be safely treated surgically through a single neck incision, bearing low complication rates.
Retrosternal or substernal goitre is a clinical entity defined when a significant proportion of the thyroid gland extends inferiorly through the thoracic inlet into the mediastinum. It has an incidence of 5.1-15.
Background: Thyroid rests are common and arise during embryological development, with aberrant descent of thyroid tissue along the thyro-thymic tract. These give rise to a range of pathologies, including goitre formation and malignancy. Thyroid rests have been graded I-IV based on their connection to the thyroid gland proper - grade I is a short protuberance, grade II & III are connected via a pedicle and fibrous band respectively, and grade IV is completely disconnected.
Resecting a large goiter that extends into the chest area is complex, and traditional surgical methods like sternotomy can lead to higher complications (up to 30% morbidity rates).
The video outlines a promising alternative technique called thoracoscopic-assisted transcervical resection, which minimizes the need for more invasive procedures while maintaining safety by monitoring critical nerves during surgery.
A case study of an 84-year-old man with thyroid cancer illustrates that this method can lead to successful outcomes with fewer complications and a shorter hospital stay, demonstrating its potential as a preferred approach.
Postoperative complications from mediastinal goitre surgery can include issues like nerve damage and changes in swallowing and voice, with possible links to gastro-oesophageal reflux disease (GERD).
A case study presented a man in his 40s who, after total thyroidectomy for mediastinal goitre, developed heartburn and a laryngeal granuloma, which were effectively treated with vonoprazan.
The authors suggest that pressure changes post-surgery may increase gastric reflux, leading to GERD symptoms, thus highlighting the importance of managing these reflux issues after thyroid surgery.
* The surgery involved a 3-cm incision at the fifth intercostal space, where exploration showed no adhesions, and a large goitre was found adjacent to the trachea, necessitating careful dissection to avoid injury to surrounding structures.
* The procedure was completed successfully without complications, demonstrating that the uniportal thoracoscopic method is both feasible and effective for managing complex mediastinal conditions with good perioperative outcomes.
