Surgical Endoscopy

, Volume 30, Issue 11, pp 4721–4730 | Cite as

Strategies of laparoscopic thyroidectomy for treatment of substernal goiter via areola approach

  • Cunchuan Wang
  • Peng Sun
  • Jinyi Li
  • Wah Yang
  • Jingge Yang
  • Zhiqi Feng
  • Guo Cao
  • Shing Lee



This study was aimed at exploring the feasibility and strategies of laparoscopic thyroidectomy for treatment of substernal goiter via areola approach.


A retrospective analysis was conducted to investigate 15 cases of laparoscopic resection of substernal goiter via the areola approach (laparoscopic group) and 12 cases of open resection of substernal goiter via low-neck collar cervical approach (open group) that was completed between December 2012 and December 2014. Operative time, estimated blood loss, postoperative hospitalization and postoperative complication were compared. Follow-up data were assessed, and the mean duration of follow-up was 24.5 ± 7.5 months.


The surgery was successfully completed in 14 cases, and 1 case was intraoperatively converted to open surgery. All the procedures were successfully completed in the open group. There was no difference in the mean distance from the inferior border of the excised substernal mass to the sternal notch, operation time, intraoperative estimated blood loss, postoperative hospital stay or the drainage tubes removed. Five cases had transient hypocalcemia after surgery in the laparoscopic group, while 1 case in the open group. There were no cases of hoarseness, dysphagia, lymphatic leakage, dyspnea and death in the two groups. And there were no recurrent cases in the follow-up.


Laparoscopic thyroidectomy for the treatment of selected substernal goiter via the areola approach is feasible. Preoperative B-ultrasound and 3D-CT scan reconstruction help to select cases and formulate surgical strategies, and the way that the thyroid is suspended using silk threads intraoperatively can reduce surgical difficulties and risks of intraoperative conversion to open surgery.


Areola approach Laparoscope Thyroidectomy Substernal goiter Strategies Silk thread 


Compliance with ethical standards


Drs. Cunchuan Wang, Peng Sun, Jinyi Li, Wah Yang, Jingge Yang, Zhiqi Feng, Guo Cao and Shing Lee have no conflicts of interest or financial ties to disclose.


  1. 1.
    Hajhosseini B, Montazeri V, Hajhosseini L, Nezami N, Beygui RE (2012) Mediastinal goiter: a comprehensive study of 60 consecutive cases with special emphasis on identifying predictors of malignancy and sternotomy. Am J Surg 203:442–447CrossRefPubMedGoogle Scholar
  2. 2.
    Wang C, Feng Z, Li J, Yang W, Zhai H, Choi N, Yang J, Hu Y, Pan Y, Cao G (2015) Endoscopic thyroidectomy via areola approach: summary of 1,250 cases in a single institution. Surg Endosc 29:192–201CrossRefPubMedGoogle Scholar
  3. 3.
    Haller A (1749) Disputationes anatomicae selectae. Vandenhoeck, Gottingen, Holland, p 96Google Scholar
  4. 4.
    Rios A, Rodriguez JM, Balsalobre MB, Tebar FJ, Parrilla P (2010) The value of various definitions of intrathoracic goiter for predicting intra-operative and postoperative complications. Surgery 147:233–238CrossRefPubMedGoogle Scholar
  5. 5.
    Katlic MR, Grillo HC, Wang CA (1985) Substernal goiter, analysis of 80 patients from Massachusetts General Hospital. Am J Surg 149:283–287CrossRefPubMedGoogle Scholar
  6. 6.
    Batori M, Chatelou E, Straniero A (2007) Surgical treatment of retrosternal goiter. Eur Rev Med Pharmacol Sci 11:265–268PubMedGoogle Scholar
  7. 7.
    Batori M, Chatelou E, Straniero A, Mariotta G, Palombi L, Pastore P, Casella G, Casella MC (2005) Substernal goiters. Eur Rev Med Pharmacol Sci 9:355–359PubMedGoogle Scholar
  8. 8.
    White ML, Doherty GM, Gauger PG (2008) Evidence-based surgical management of substernal goiter. World J Surg 32:1285–1300CrossRefPubMedGoogle Scholar
  9. 9.
    Singh B, Lucente FE, Shaha AR (1994) Substernal goiter: a clinical review. Am J Otolaryngol 15(6):409–416CrossRefPubMedGoogle Scholar
  10. 10.
    Mack E (1995) Management of patients with substernal goiters. Surg Clin North Am 75:377–394CrossRefPubMedGoogle Scholar
  11. 11.
    Sakkary MA, Abdelrahman AM, Mostafa AM, Abbas AA, Zedan MH (2012) Retrosternal goiter: the need for thoracic approach based on CT findings: Surgeon’s view. J Egypt Natl Cancer Inst 24:85–90CrossRefGoogle Scholar
  12. 12.
    Grainger J, Saravanappa N, D’Souza A, Wilcock D, Wilson PS (2005) The surgical approach to retrosternal goiters: the role of computerized tomography. Otolaryngol Head Neck Surg 132:849–851CrossRefPubMedGoogle Scholar
  13. 13.
    Michel LA, Bradpiece HA (1988) Surgical management of substernal goitre. Br J Surg 75:565–569CrossRefPubMedGoogle Scholar
  14. 14.
    Shen WT, Kebebew E, Duh QY, Clark OH (2004) Predictors of airway complications after thyroidectomy for substernal goiter. Arch Surg 139:656–659CrossRefPubMedGoogle Scholar
  15. 15.
    Wang C, Zhai H, Liu W, Li J, Yang J, Huang J, Yang W, Pan Y, Ding H (2014) Thyroidectomy: a novel endoscopic oral vestibular approach. Surgery 155:33–38CrossRefPubMedGoogle Scholar
  16. 16.
    Yang J, Wang C, Li J, Yang W, Cao G, Wong H, Zhai H, Liu W (2015) Complete endoscopic thyroidectomy via oral vestibular approach versus areola approach for treatment of thyroid diseases. J Laparoendosc Adv Surg Tech A 25:470–476CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Cunchuan Wang
    • 1
  • Peng Sun
    • 1
  • Jinyi Li
    • 1
  • Wah Yang
    • 1
  • Jingge Yang
    • 1
  • Zhiqi Feng
    • 1
  • Guo Cao
    • 1
  • Shing Lee
    • 1
  1. 1.Department of General SurgeryFirst Affiliated Hospital of Jinan UniversityGuangzhouChina

Personalised recommendations