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Tsur N, Levi L, Frig O, Koch N, Eshel Y, Bachar G, Shpitzer T, Yehuda M, Pescovitz Y, Wiesel O, Dudkiewicz D, Mizrachi A. Extended cervical approach for retrosternal multinodular goiter. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:21-26. [PMID: 38420718 PMCID: PMC10914353 DOI: 10.14639/0392-100x-n2746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/17/2023] [Indexed: 03/02/2024]
Abstract
Objective Partial or total sternotomy is required for 10% of retrosternal goiter. This study reviewed our experience with an extended cervicotomic approach as an alternative surgical solution for retrosternal goiter. Methods A retrospective study was performed on patients who underwent partial or total thyroidectomy for retrosternal goiter between 2014 and 2019 at a tertiary medical centre. Data on clinical, radiologic, and pathologic factors were analysed. Peri- and postoperative outcomes were compared between extended and standard cervical approaches to predict the need for an extended cervical approach. Results The cohort included 265 patients, of whom 245 (92.4%) were treated by standard thyroidectomy. In 17 (6.4%), the standard approach proved insufficient, and the horizontal incision was extended to a T-shape to improve access. The remaining 3 patients required a sternotomy. Use of the extended cervical approach was significantly associated with clinical features such as male gender, diabetes, high body mass index and postoperative hypocalcaemia. Conclusions The extended cervicotomic approach is an alternative surgical solution for retrosternal goiter, with no increased risk of significant post-operative complications.
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Affiliation(s)
- Nir Tsur
- Department of Otorhinolaryngology – Head & Neck Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel
| | - Lirit Levi
- Department of Otorhinolaryngology – Head & Neck Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel
| | - Omry Frig
- Department of Otorhinolaryngology – Head & Neck Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel
| | - Noam Koch
- Department of Otorhinolaryngology – Head & Neck Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
| | - Yossi Eshel
- Department of Otorhinolaryngology – Head & Neck Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel
| | - Gideon Bachar
- Department of Otorhinolaryngology – Head & Neck Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel
| | - Thomas Shpitzer
- Department of Otorhinolaryngology – Head & Neck Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel
| | - Moshe Yehuda
- Department of Otorhinolaryngology – Head & Neck Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel
| | - Yuri Pescovitz
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
| | - Ory Wiesel
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
| | - Dean Dudkiewicz
- Department of Otorhinolaryngology – Head & Neck Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel
| | - Aviram Mizrachi
- Department of Otorhinolaryngology – Head & Neck Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Aviv University, Aviv, Israel
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Ghabisha SA, Ahmed F, Al-Wageeh S, Alyhari Q, Badheeb MA, Altam A, Alsharif A. Management of Retrosternal Goiter in Resource-Limited Settings: Outcomes From 28 Cases Using Cervical Approach. Cureus 2023; 15:e41288. [PMID: 37539408 PMCID: PMC10395659 DOI: 10.7759/cureus.41288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/05/2023] Open
Abstract
Background Despite thyroidectomy being the preferred approach for retrosternal goiter (RSG), controversies surround its rationale in asymptomatic cases. This study aimed to investigate the treatment of RSG in resource-limited settings. Methods A retrospective study conducted between April 2010 and June 2022 included 28 RSG cases who underwent thyroidectomy using the cervical approach at Al-Nasar Hospital, Ibb, Yemen. A bivariate analysis was performed to investigate the risk factors for postoperative complications. Results The main age was 49.4±9.9 years, and most of them (60.7%) were females. The main symptoms were cervical mass appearance and breathing difficulty in 75 %, and 32.1%, respectively. Twenty-four (86%) cases were classified as Grade 1 (above aortic arch) and four (14%) cases were classified as Grade 2 (aortic arch to the pericardium). All patients underwent total thyroidectomy through the cervical approach without needing sternotomy. The mean operative time was 121.9±26.7min (99-200 min) and the mean intraoperative bleeding was 321.2±137.4 mL. Postoperatively, the malignant entity was histopathologically proven in seven patients (25%). The postoperative complications (14%) were transient hypocalcemia in two (7.1%) and hematoma in two (7.1%). Older age, bigger thyroid mass, extension below the aortic arch (Grade 2), longer operative time and bleeding, intensive care unit admission, and malignant features are associated with postoperative complications (all p < 0.05). Conclusion Cervical approach for patients with RSG in our experience is an optimum, feasible, and less invasive surgical approach, in a resource-limited setting. Older age, bigger thyroid, extension below the aortic arch, longer operative time and bleeding, intensive care unit admission, and malignant features are associated with postoperative complications.
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Affiliation(s)
- Saif A Ghabisha
- Department of General Surgery, School of Medicine, Ibb University of Medical Science, Ibb, YEM
| | | | - Saleh Al-Wageeh
- Department of General Surgery, School of Medicine, Ibb University of Medical Science, Ibb, YEM
| | - Qasem Alyhari
- Department of General Surgery, School of Medicine, Ibb University of Medical Science, Ibb, YEM
| | | | | | - Afaf Alsharif
- Department of Gynecology, Jeblah University for Medical and Health Sciences, Ibb, YEM
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Cervical approach to cervico-mediastinal goiters: Experience of a Moroccan ENT tertiary center - Case series. Ann Med Surg (Lond) 2021; 62:353-357. [PMID: 33552494 PMCID: PMC7848720 DOI: 10.1016/j.amsu.2021.01.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 12/01/2022] Open
Abstract
Background The purpose of the study was to analyze and discuss the demographic, clinical, radiological, therapeutic and postoperative findings of the Cervico-mediastinal goiters (CMG) treated through a cervical approach admitted in the ENT department of Ibn Rochd university hospital, Casablanca, Morocco between January 2014 and January 2020. Materiels and methods Over a period of 6 years, 116 patients underwent surgical treatment for CMG. It was defined as a goiter extending below the plane of superior thoracic aperture on CT scan. All our patients had clinical, biological and radiological assessment before surgery. A nasofibroscopy was carried out pre and postoperatively. All the CMG have been extracted trough a cervical approach by an experimented ENT surgeon. Results 84,48% of the CMG was diving into the anterior mediastinum and 15.52% into the posterior. The CMGs extended above, at, and below the level of the aortic arch respectively in 76.72%, 18.10% and 5.17% of the patients. All of 116 goiters were successfully removed through a cervical approach. No patient required a sternotomy. Postoperatively, vocal cord paralysis was transient in 3 patients (2.58%) and permanent in 2 patients (1.72%). Hypocalcemia was transient in 10 patients (8.62%) and permanent in 2 patients (1.72%). Final histology found 106 benign multinodular goiters (91.37%), 7 papillary carcinomas (6.03%) and 3 vesicular carcinomas (2.58%). No death was noted. Conclusions With expertise in thyroid surgery, cervical approach for CMGs is safe and sufficient in the majority of the cases with low morbidity rate and no mortality. In the literature, there is no consensus on the definition of cervico-mediastinal goiters. CMG is a challenging disease that needs proper clinical, biological and radiological assessment. Malignancy in a CMG is not higher than that of the cervical goiters and most of the foci in CMG were in the intrathoracic region. With expertise in thyroid surgery, cervical approach for CMGs is safe and sufficient in the majority of the cases.
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Abdelrahman H, Al-Thani H, Al-Sulaiti M, Tabeb A, El-Menyar A. Clinical Presentation and Surgical Treatment of Retrosternal Goiter: A Case Series Study. Qatar Med J 2020; 2020:13. [PMID: 32391249 PMCID: PMC7198470 DOI: 10.5339/qmj.2020.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/01/2019] [Indexed: 11/03/2022] Open
Abstract
Background: The retrosternal goiter (RSG) is a slow-growing mass often benign in nature; thyroidectomy remains the preferred standard curative treatment. This study aimed to explore the local experience of RSG with respect to the clinical presentation, classifications, management, and outcomes. Method: A retrospective chart review was conducted to include all cases diagnosed with RSG and underwent thyroidectomy between January 1998 and December 2013. Results: A total of 1210 patients underwent thyroidectomy; of which 30 (2.5%) patients were diagnosed to have RSG. The commonly reported symptoms were dyspnea (40%), pain and discomfort (30%), dysphagia (26.7%), and hoarseness (20%). Thirteen patients (43.3%) were completely asymptomatic. The fine-needle aspiration cytology was performed in 22 (73.3%) patients, of whom the majority was benign (77.3%). The grading classification showed that grade 1 is the most frequent (73.3%). Total bilateral thyroidectomy was the most prevailing procedure in 57% cases followed by partial thyroidectomy. All patients underwent retrosternal thyroidectomy through a cervical incision except for one case. Postoperative histopathology showed frequent benign multinodular goiter (83.3%), followed by papillary thyroid cancer (10%) and thyroiditis (6.7%). The most common complication after thyroidectomy was tracheomalacia (13.4%), transient hypocalcemia (10%), and hypoparathyroidism (6.7%). There was no intraoperative or perioperative mortality. Conclusion: RSG is a rare entity often presented with pressure symptoms, mostly involving anterior mediastinum and had a challenging surgical procedure. A large multicenter study is needed to include more cases in order to have a consensus on the definition and classification system for such important clinical goiter presentation.
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Affiliation(s)
| | - Hassan Al-Thani
- Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | | | - Abdelhakem Tabeb
- Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital (HGH), Doha, Qatar.,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
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Cui R, Yu J, Han ZY, Liu FY, Yu XL, Liang P. Ultrasound-Guided Percutaneous Microwave Ablation for Substernal Goiter: Initial Experience. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2883-2891. [PMID: 30900322 DOI: 10.1002/jum.14992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/12/2019] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To preliminarily evaluate the safety, effectiveness, and feasibility of microwave ablation (MWA) for substernal goiter (SSG) in select patients and to provide a relevant treatment reference for further studies. METHODS From April 2017 to December 2017, 10 patients with SSG were treated by MWA. All patients were followed for at least 3 months to observe the therapeutic effects and complications. Therapeutic effects were assessed at follow-up for the relief of patients' symptoms, resolution of the cosmetic grade, and volume reduction rate (VRR) of SSG. Possibly related factors for the 3-month VRR of the nodules were analyzed. RESULTS The study included 9 female patients and 1 male patient with a mean age ± SD of 56.8 ± 10.1 years (range, 34-70 years). The mean volume of the nodules was 52.9 ± 27.9 mL (range, 23.7-122.6 mL). The nodule volume was significantly reduced at the 3-month follow-up (17.5 ± 9.5 mL; P < .05). The mean 3-month VRR of the index nodule was 66.7% ± 7.1%. A higher ablated portion-to-nodule ratio 1 day after MWA predicted a higher 3-month VRR (Spearman r = 0.646; P = .044). The mean symptom score (from 4.5 ± 1.7 to 1.5 ± 1.0; P = .005) and cosmetic grade (from 3.3 ± 0.5 to 2.2 ± 0.4; P = .004) declined significantly 3 months after the procedure. No complications or unexpected side effects were observed. CONCLUSIONS Our preliminary results support the effectiveness and safety of MWA for local control of SSG. This technology can be applied in select patients with SSG who are ineligible for surgery.
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Affiliation(s)
- Rui Cui
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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Ching HH, Kahane JB, Foggia MJ, Barber AE, Wang RC. Medial Approach for the Resection of Goiters with Suprahyoid, Retropharyngeal, or Substernal Extension. World J Surg 2018. [PMID: 29532142 DOI: 10.1007/s00268-018-4576-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Resection of massive goiters with suprahyoid, retropharyngeal, and substernal extension may not be amenable to standard approaches. This study evaluates a surgical approach allowing resection of massive goiters with minimal substernal and deep neck dissection. METHODS Cases of thyroidectomy for goiters with substernal, retropharyngeal, or suprahyoid extension at a single institution from 2006 to 2017 were reviewed. The technique involves initial complete division of the medial thyroid tracheal attachments after identification of the RLN medial-inferiorly or superiorly. Deep components are then delivered into the superficial paratracheal region of the neck. RESULTS Sixty patients were included, 46 of which had substernal and 14 had only suprahyoid or retropharyngeal extension. Mean substernal extension was 3.7 cm (range 1.5-7.5 cm). The medial approach was successful in identifying the RLN in 70 (83%) of 84 goiter sides (71% medial-inferiorly and 29% superiorly). Standard inferior/lateral approaches were used in 12 (14%) nerves or not found until after goiter removal in 2 (2.5%). No patients required sternotomy or tracheotomy. Complications included postoperative seroma/hematoma (n = 9, 15%) with one re-exploration, transient RLN injury (n = 4, 4% of all lobectomies), transient hypocalcemia (n = 6, 16% of total thyroidectomies), permanent hypocalcemia (n = 2, 5% of total thyroidectomies), and permanent RLN paralysis (n = 1, 1% of all lobectomies). CONCLUSION Large suprahyoid, retropharyngeal, and substernal goiters were resected transcervically with low morbidity. Early complete division of Berry's ligament after medial-inferior RLN identification was achieved in a high proportion of patients, facilitating goiter delivery with minimal mediastinal and deep neck dissection.
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Affiliation(s)
- Harry H Ching
- Department of Otolaryngology - Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Blvd, Suite 490, Las Vegas, NV, 89102, USA
| | - Jacob B Kahane
- Department of Otolaryngology - Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Blvd, Suite 490, Las Vegas, NV, 89102, USA
| | - Megan J Foggia
- Department of Otolaryngology - Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Blvd, Suite 490, Las Vegas, NV, 89102, USA.,University of Nevada, Reno School of Medicine, Las Vegas, NV, USA
| | - Annabel E Barber
- Department of Otolaryngology - Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Blvd, Suite 490, Las Vegas, NV, 89102, USA.,Department of Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Robert C Wang
- Department of Otolaryngology - Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Blvd, Suite 490, Las Vegas, NV, 89102, USA.
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Amore D, Cicalese M, Scaramuzzi R, Di Natale D, Curcio C. Antero mediastinal retrosternal goiter: surgical excision by combined cervical and hybrid robot-assisted approach. J Thorac Dis 2018; 10:E199-E202. [PMID: 29707373 DOI: 10.21037/jtd.2018.01.169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Most intrathoracic goiters are located in the anterior mediastinum. Surgical resection is usually recommended in case of morbidity associated with the goiter's mass effect or for suspicion of malignancy difficult to diagnose without resection. Intrathoracic goiters are usually resected through a cervical approach, with sternotomy needed in selected cases. We report a case of antero mediastinal retrosternal goiter in old age patient undergoing surgical excision by combined cervical and hybrid robot-assisted approach. All steps of the thoracic procedure were completely performed using the da Vinci robot system with final extension of a port-site incision to extract the specimen. This approach provides more advantages than sternotomy regarding post operative clinical benefits and allows a more accurate surgical resection in the antero-superior mediastinum than conventional thoracoscopy.
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Affiliation(s)
- Dario Amore
- Division of Thoracic Surgery, Monaldi Hospital, Naples, Italy
| | | | | | | | - Carlo Curcio
- Division of Thoracic Surgery, Monaldi Hospital, Naples, Italy
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To H, Karmakar A, Farrell S, Manolas S. Trans-cervical resection of a separate substernal goitre. Int J Surg Case Rep 2017; 41:373-376. [PMID: 29156233 PMCID: PMC5709340 DOI: 10.1016/j.ijscr.2017.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/06/2017] [Indexed: 11/29/2022] Open
Abstract
A separate substernal goitre is an unusual entity, which may have embryological origin as ectopic thyroid tissue, or residual cervical thyroid tissue following prior thyroid resection. Pre-operative imaging via a thyroid nuclear scan and computer tomography (CT) imaging aids in determining its characteristics and for pre-operative planning. A trans-cervical resection is preferred due to lower morbidity. A trans-cervical resection is achievable when the lesion is accessible and delivered through the thoracic inlet according to CT characteristics.
Introduction A separate substernal goitre which is not continuous with the main cervical thyroid proves a unique challenge for resection. A trans-cervical approach is preferred but may be hazardous due to the possibility of ectopic thyroid tissue with alternate blood supply. Presentation of case A 72 year old female who had a previous left hemithyroidectomy presents with a symptomatic central substernal thyroid mass. Following radiological work-up, the separate goitre was carefully removed via a trans-cervical approach and avoidance of sternotomy. She had a rapid recovery without complication. Discussion The anatomy and embryology of substernal masses need to be carefully considered particularly if the mass is ectopic thyroid tissue. Careful pre-operative assessment may determine its nature and anatomical features. Intra-operative dissection requires consideration of blood supply and surrounding structures, but often may be and is best completed via a cervical approach to minimise morbidity. Review of the literature affirms the preference for a trans-cervical approach and offers criteria for successful resection via this method. Conclusion Confirming the nature and anatomy of a separate substernal goitre enables successful removal of the mass via a trans-cervical approach with minimal morbidity.
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Affiliation(s)
- Henry To
- Department of Surgery, The Northern Hospital, 185 Cooper St, Epping, Victoria, 3076, Australia.
| | - Antara Karmakar
- Department of Surgery, The Northern Hospital, 185 Cooper St, Epping, Victoria, 3076, Australia
| | - Stephen Farrell
- Department of Surgery, St Vincent's Hospital, Victoria St, Fitzroy, 3065, Australia
| | - Steve Manolas
- Department of Surgery, The Northern Hospital, 185 Cooper St, Epping, Victoria, 3076, Australia
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Ito E, Ohdaira H, Yasuda J, Yoshida M, Suzuki Y. A case of mediastinal goiter treated surgically using a clavicle-lifting technique. Int J Surg Case Rep 2015; 16:12-4. [PMID: 26406312 PMCID: PMC4643343 DOI: 10.1016/j.ijscr.2015.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/02/2015] [Accepted: 09/05/2015] [Indexed: 11/04/2022] Open
Abstract
A thyroidectomy is indicated in all cases of mediastinal goiter because of the risks of airway obstruction, potential malignancy, tracheomalacia and invasion into the adjacent structures. The clavicle-lifting technique is a simple and safe technique that involves lifting the clavicles with a pediatric extension retractor (Kent Retractor Set, Takasago Medical Industry, Tokyo, Japan). The clavicle-lifting technique is a good surgical option for upper-mediastinal lesions such as mediastinal goiters and it obviates the need for a sternotomy.
Introduction Mediastinal goiter is a benign disease, which is defined as a goiter with the greater portion of its mass lying below the thoracic inlet. It is controversial whether the cervical approach is the best approach for all mediastinal goiter surgeries. Case presentation A 71-year-old woman presented with respiratory discomfort during exertion. Computed tomography (CT) revealed a mediastinal goiter extending to the arch of the aorta. Surgical resection was performed using a clavicle-lifting technique. The excised specimen was 13 × 10 × 5 cm in size and weighed 220 g. The pathological diagnosis was nodular goiter. Discussion The clavicle-lifting technique is a simple and safe technique that involves lifting the clavicles with a pediatric extension retractor (Kent Retractor Set, Takasago Medical Industry, Tokyo, Japan). This is a good choice for surgery on upper mediastinal lesions such as mediastinal goiters as it obviates the need for a median sternotomy. Conclusion Although further study is necessary, it appears that a transcervical approach using the clavicle-lifting technique may be an acceptable treatment for mediastinal goiters that extend to the aortic arch.
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Affiliation(s)
- Eisaku Ito
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi 329-2763, Japan.
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi 329-2763, Japan.
| | - Jungo Yasuda
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi 329-2763, Japan.
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi 329-2763, Japan.
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi 329-2763, Japan.
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Mesli SN, Regagba D, Tidjane A, Bouallou F, Abi-Ayad C. [Plunging goitre in Tlemcen in western Algeria: clinical and therapeutic aspects of 1996-2014]. Pan Afr Med J 2015; 21:58. [PMID: 26405494 PMCID: PMC4564399 DOI: 10.11604/pamj.2015.21.58.6615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/17/2015] [Indexed: 11/30/2022] Open
Abstract
La définition du goitre plongeant, la plus couramment employée, est tout goitre ne siégeant pas dans la région cervicale en position opératoire. Le but d’évaluer sa prise en charge, en insistant plus particulièrement sur les examens préopératoires, les difficultés chirurgicales et les complications postopératoire. Etude rétrospective étalée sur 16 ans; portant sur 50 cas colligés au service de chirurgie viscérale du CHU Tlemcen. L'intervention a consisté en une thyroïdectomie totale par voie cervicale dans 94% des cas. Ont été notées essentiellement, les hématomes, des paralysies récurentiels et les hypoparathyroïdie. L’âge moyen est de 54,76 ±11,992 ans Le caractère plongeant du goitre à été retrouvé chez 52% (n = 26) par une échographie thyroïdienne. Le scanner cervico-thoracique était pratiqué chez 25 patients 50%. Il a permis de confirmer le caractère plongeant du goitre. Tous nos patients ont bénéficié eu un geste radicale (thyroïdectomie totale n = 45, 90%), alors que 5 patients (10%) ayant déjà ont eu un geste sur la thyroïde, ont subi une totalisation. L'examen histologique à confirmé la bénignité dans 48 cas 96%. Trois patients (6%) avaient une paralysie récurentielle transitoire et un cas (2%) de paralysie récurentielle persistante. L'hypoparathyroïdie transitoire était notée chez (14%). Les goitres plongeants représentent une éventualité assez fréquente. Souvent révélés à l'occasion d'un examen clinique. L'examen tomodensitométrique qui permet l'exploration des espaces peu accessibles à l'imagerie conventionnelle. L'imagerie par résonance magnétique nucléaire paraît constituer une technique d'avenir.
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Affiliation(s)
| | | | - Anisse Tidjane
- Service de Chirurgie Hépatobiliaire et Greffe du Foie, EHU-1er Novembre 1954, Oran, Algérie
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Komninos G, Galata' G, Schulte KM. Giant recurrent intrathoracic goitre treated by clamshell thoracotomy and reverse sternotomy. BMJ Case Rep 2014; 2014:bcr-2013-202790. [PMID: 24849634 DOI: 10.1136/bcr-2013-202790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 59-year-old man with a giant recurrent intrathoracic goitre was admitted for completion thyroidectomy for recurrent severe retrosternal pain. The patient had undergone a cervical thyroidectomy elsewhere 13 years earlier, during which only the cervical part of the goitre had been resected. Owing to the previous operation with an expected scar around the innominate vein, and the goitre's size and localisation obstructing the upper chest aperture, we chose an alternate access. Clamshell thoracotomy with reverse sternotomy allows central vascular control and excision of large goitres bypassing predictable problems at the cervicothoracic junction. Surgery was performed with minimal blood loss and with excellent functional outcome. The described access adds to the repertoire to deal with this unusual situation.
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Affiliation(s)
- Georgios Komninos
- Department of Endocrine Surgery, King's College Hospital, King's Health Partners, London, UK
| | - Gabriele Galata'
- Department of Endocrine Surgery, King's College Hospital, King's Health Partners, London, UK
| | - Klaus-Martin Schulte
- Department of Endocrine Surgery, King's College Hospital, King's Health Partners, London, UK
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Berri T, Houari R. Complications of thyroidectomy for large goiter. Pan Afr Med J 2013; 16:138. [PMID: 24847400 PMCID: PMC4024433 DOI: 10.11604/pamj.2013.16.138.3277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/27/2013] [Indexed: 12/17/2022] Open
Abstract
Thyroidectomy is a routinely common practiced surgery. Morbidity and mortality from thyroid surgery are disregarded nowadays and undervalued in the literature. Perioperative risks and complications still exist for large goiters and can be life-threatening. These complications may occur during the anesthesia and intubation, intra-, or postoperatively. We set out through a case of a large cervical multinodular goiter (MNG) and a review of literature the perioperative complications and how to avoid them. During the total thyroidectomy operation, an accidental devascularisation of a parathyroid gland, a cervical hematoma which was evacuated by surgical reoperation, hemodynamic disorder and a transitory hypoparathyroidism were the postoperative complications that occurred. Surgery for large goiters remains difficult; so adequate preoperative assessment, particular attention and careful operative procedure should be followed to obtain better surgical outcomes.
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Affiliation(s)
- Toufik Berri
- Department of surgery, Tourabi Boudjemaa Hospital, Bechar, Algeria
| | - Rachida Houari
- Department of surgery, Benzardjab Hospital, Oran, Algeria
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13
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Nair CG, Babu MJC, Menon R, Jacob P. Hypocalcaemia following total thyroidectomy: An analysis of 806 patients. Indian J Endocrinol Metab 2013; 17:298-303. [PMID: 23776907 PMCID: PMC3683209 DOI: 10.4103/2230-8210.109718] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Permanent hypocalcaemia following thyroidectomy causes considerable morbidity. This prospective observational study aims to define the factors likely to predict hypocalcaemia following total thyroidectomy. MATERIALS AND METHODS Patients who were subjected to total thyroidectomy during January 2005 to December 2009 were followed up for a minimum period of 1 year. Efficacy of an intraoperative parathyroid hormone assay to predict hypocalcaemia was validated. RESULTS Overall incidence of hypocalcaemia was 23.6% (n = 190) and that of permanent hypocalcaemia was 1.61% (n = 13). Onset was delayed up to 3(rd) postoperative day in 13 patients. Hypocalcaemia was significantly associated with thyroidectomy for Grave's Disease (P = 0.001), Hashimoto's thyroiditis (P = 0.003), and with incidental parathyroidectomy (P = 0.006). The intraoperative assay of parathyroid hormone showed low sensitivity (0.5) and satisfactory specificity (0.9) in predicting hypocalcemia. CONCLUSION Hypocalcemia could manifest late in the immediate postoperative period and this may explain latent hypocalcemia. High incidence of hypocalcaemia noted in Grave's Disease could be due to the autoimmunity since same feature was noted associated with Hashimoto's thyroiditis and the incidence of hypocalcaemia was not high in the subgroup with toxic nodular goiter. The incidence of hypocalcemia was not affected by age or sex.
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Affiliation(s)
- C. Gopalakrishnan Nair
- Department of General Surgery, Amrita Institute of Medical Sciences, Elamakkara, Ernakulam, Kerala State, India
| | - Misha J. C. Babu
- Amrita School of Medicine, Elamakkara, Ernakulam, Kerala State, India
| | - Riju Menon
- Amrita School of Medicine, Elamakkara, Ernakulam, Kerala State, India
| | - Pradeep Jacob
- Amrita School of Medicine, Elamakkara, Ernakulam, Kerala State, India
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14
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Tsakiridis K, Visouli AN, Zarogoulidis P, Karapantzos E, Mpakas A, Machairiotis N, Stylianaki A, Christofis C, Katsikogiannis N, Courcoutsakis N, Zarogoulidis K. Resection of a giant bilateral retrovascular intrathoracic goiter causing severe upper airway obstruction, 2 years after subtotal thyroidectomy: a case report and review of the literature. J Thorac Dis 2013; 4 Suppl 1:41-8. [PMID: 23304440 DOI: 10.3978/j.issn.2072-1439.2012.s004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 11/23/2012] [Indexed: 11/14/2022]
Abstract
The intrathoracic (or substernal) goiter is more often benign; but it can be malignant in 2-22% of patients. There is history of prior thyroid surgery in 10% to more than 30% of patients. Intrathoracic goiters cause adjacent structure compression more frequently than the cervical goiters, due to the limited space of the thoracic cage. Compression of trachea, oesophagus, vascular and neural structures may cause dyspnoea, dysphagia, superior vena cava syndrome, subclavian vein thrombosis, hoarseness, and Horner's syndrome. There is usually progressive deterioration, but acute exacerbation may occur. The presence of a thoracic goiter (>50% of the mass below the thoracic inlet) is per se an indication for resection. Tracheal compression by (cervical or thoracic) goiter is also an indication for resection; early tracheal decompression is recommended particularly in symptomatic patients. In severe respiratory distress, intubation and semi-urgent operation may be required. With early intervention, most intrathoracic goiters can be removed through a cervical approach, while tracheomalacia is avoided. We hereby present successful and uncomplicated total thyroidectomy, through a median sternotomy, of a benign, gigantic, bilateral, retrovascular, posterior mediastinal, intrathoracic goiter, encircling the trachea, and causing severe respiratory distress in a 63 year old man with history of previous subtotal thyroidectomy.
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Affiliation(s)
- Kosmas Tsakiridis
- Cardiothoracic Department, St Luke's Hospital, Panorama, Thessaloniki, Greece
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Smith CT, Zarebczan B, Alhefdhi A, Chen H. Infrared thermographic profiles of vessel sealing devices on thyroid parenchyma. J Surg Res 2011; 170:64-8. [PMID: 21529840 DOI: 10.1016/j.jss.2011.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 02/07/2011] [Accepted: 03/02/2011] [Indexed: 11/13/2022]
Abstract
BACKGROUND During thyroid lobectomy, division of the thyroid parenchyma has traditionally been accomplished using suture ligation. Development of hemostatic techniques in the forms of ultrasonic dissection (UD) and electronic vessel sealing (EVS) have increased the usage of these devices during thyroid operations. We sought to characterize the thermal profile of each of these devices when used to divide the parenchyma of the thyroid gland. METHODS Using a porcine model, the parenchyma of the gland was sealed by alternating application of the UD and EVS devices. In each case, the thermal activity was recorded using infrared thermal imaging. We performed multiple seals with each instrument and then compared the thermal profiles. RESULTS There was no significant difference in lateral thermal spread of EVS and UD above 39, 40 or 60°C (2.30 ± 0.31 mm versus 2.53 ± 0.47 mm, P = 0.26; 2.22 ± 0.27 mm versus 2.47 ± 0.47 mm, P = 0.22, and 1.37 ± 0.27 mm versus 1.54 ± 0.26 mm, P = 0.22). There was no significant difference in mean time above 39 or 40°C (35.1 ± 8.7 s versus 31.7 ± 9.3 s, P = 0.47 and 29.9 ± 8.1 s versus 27.3 ± 6.7 s, P = 0.50). UD reached a greater maximum temperature (179.12 ± 0.0008C versus 96.52 ± 5.6C, P ≤ 0.001) and stayed over 60°C for longer than EVS (9.5 ± 1.8 s versus 5.3 ± 0.97 , P ≤ 0.001). CONCLUSIONS The amount of lateral spread of thermal energy was not significantly different between the UD and EVS devices. However, the use of UD produced a higher maximum temperature during thyroid parenchyma sealing and remained above 60°C longer than EVS. This may translate into greater thermal injury to thyroid and surrounding tissues during division.
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Affiliation(s)
- Carter T Smith
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA
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Zarebczan B, Mohanty D, Chen H. A Comparison of the LigaSure and harmonic scalpel in thyroid surgery: a single institution review. Ann Surg Oncol 2010; 18:214-8. [PMID: 20853030 DOI: 10.1245/s10434-010-1334-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND During the last few years, many surgeons have begun to utilize the LigaSure device or Harmonic scalpel to perform thyroid surgery. Several papers have demonstrated the benefits of these devices compared with traditional hand-tying techniques. The purpose of this study was to examine our institution's experience with the LigaSure device and Harmonic scalpel during thyroid surgery and to compare mean operative times and complications associated with each device. METHODS A retrospective chart review was performed on all patients who underwent thyroid surgery using the LigaSure device or Harmonic scalpel at a single institution between December 2005 and August 2009. Charts were reviewed for patient demographics, mean operative time, length of stay, and complications, such as transient recurrent laryngeal nerve injury, hypocalcemia, and hematoma formation. RESULTS A total of 231 patients were included in the study, of whom 123 underwent total thyroidectomy and 108 underwent lobectomy. There was a significant decrease in the operative time for both thyroidectomies and lobectomies when the Harmonic scalpel was utilized. In regard to complications, there was no statistically significant difference in the number of transient and permanent recurrent laryngeal nerve injuries, percentage of patients developing hypocalcemia, or rate of hematoma development. CONCLUSION In this study, there was no difference in the rate of complications between the two devices. However, the use of the Harmonic scalpel significantly decreased operative time for both thyroidectomies and thyroid lobectomies compared with the LigaSure device.
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Affiliation(s)
- Barbara Zarebczan
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, USA
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