Abstract
Background
The thyroid disease can appear in 0.16–3.3% of cases as mediastinal goiter. The treatment is difficult and requires a mediastinal approach.
Materials and methods
We have analyzed our experience from September 1995 to September 2007 among 2,439 thyroidectomies conducted for thyroid disease; 16 cases required a sternotomy, in seven patients conducted as hemiclamshell approach (median sternotomy associated to a fourth intercostals space incision). Preoperative evaluation included otorhinolaryngology evaluation and computed tomography. All the cases were followed up to 12 months.
Results
For seven cases treated trough hemiclamshell, the mean age was 57.8 years; hospital stay is 5.2 days. All the patients were discharged after respiratory evaluation; two patients required a pneumological admittance to physio-kinesi-respiratory. There were no cases of hemorrhage, nerve injury, permanent hypocalcemia, and chylothorax. There was no mortality at 30 days.
Conclusions
The hemiclamshell is a safe procedure to treat mediastinal goiter and permit a good exposure of subclavian vessels and mediastinal nodes.
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References
Allo MD, Thompson NW (1983) Rationale for the operative management of substernal goiters. Surgery 94:969–977
Rusca M, Carbognani P, Bobbio P (2000) The modified hemiclamshell approach for tumors of the cervicothoracic junctions. Ann Thorac Surg 69(6):1961–1963
Douglas W (2003) Surgical treatment of substernal thyroid disease. Operative Technique in Otolaryngology-Head and Neck surgery 14(2):94–102
Rives JD (1947) Mediastinal aberrant goiter. Ann Surg 126:797–810
Newman E, Shaha AR (1995) Substernal goiter. J Surg Oncol 60:207–212
Kikugawa T, Nonomura M, Ishijima K (1997) Aberrant mediastinal goiter: a case report. Pract Otol 90:227–231
Hedayati N, McHenry CR (2002) The clinical presentation and operative management of nodular and diffuse substernal goiter. Am Surg 68(3):245–251
De Perrot M, Fadel E, Mercier O, Farhamand P, Fabre D, Mussot S, Dartevelle P (2007) Surgical management of mediastinal goiters: when is a sternotomy required? Thorac Cardiovasc Surg 55(1):39–43
Mellier D, Saada F, Etienne G, Becqueminn JP, Bonnet F (1988) Goiter with severe respiratory compromise: evaluation and treatment. Surgery 103(3):367–373
Ashak RS, Carlos B, Antonio A (1989) Goiters and airway problems. Am J Surg 158(4):378–380
Moran JC, Singer AJ, Sardi A (1998) Retrosternal goiter: a six year institutional review. Am Surg 64(5):889–893
Koyama H, Nakata T, Kumaki T, Aoki T, Kasuga Y, Ideura G et al (2001) Mediastinal goiter with superior vena cava syndrome: a case report. Endocr Surg 18:124–126
Kawakami M, Ito K, Yoshimura K, Tanaka H (2004) A case of mediastinal goiter. Auris Nasus Larynx 31:183–187
Ket S, Ozbudak O, Ozdemir T, Dertsiz L (2004) Acute respiratory failure and tracheal obstruction in patients with posterior giant mediastinal (intrathoracic) goiter. Interactive Cardiovascular and Thoracic Surgery 3:174–175
Bahavin C, Ravichand CS, Srinivas J, Atin A, Pramesh C, Mistry RC (2007) Ectopic thyroid cancer. Ann Thorac Cardiovasc Surg 13(2):122–124
Grainger J, Saravanapa N, D’Souza R, Wilcock D, Wilson P (2003) Sternotomy for retrosternal goiter: the role of computerized tomography scans. Otolaryngology-Head and neck surgery 129(2):250
Tartaglia F, Salvatori FM, Pichelli D, Sgueglia M, Blasi S, Custureri F (2007) Preoperative embolization of thyroid arteries in a patient with a large cervicomediastinal hyperfunctioning goiter. Thyroid 17(8):787–792
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Del Rio, P., Bezer, L., Arcuri, M.F. et al. Hemiclamshell incision in the treatment of mediastinal goiter. Langenbecks Arch Surg 394, 457–459 (2009). https://doi.org/10.1007/s00423-008-0342-2
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DOI: https://doi.org/10.1007/s00423-008-0342-2