Abstract
A 67-year-old woman was presented with a mediastinal tumor extending from the left lobe of the thyroid and passing through the posterior trachea, causing displacement of the esophagus to the left side of the patient and then descending into the right side of the mediastinum to below the carina. Surgery was performed under two-lung ventilation with the patient in a prone position; general anesthesia was performed with a single-lumen tube combined with artificial pneumothorax. In thoracoscopic surgery, we were able to confirm and preserve anatomical structures. After detachment of the tumor at the level of the left and right subclavian arteries, the patient was placed supine, a cervical incision was added, and the tumor was extracted. The tumor was diagnosed as a nonmalignant mediastinal goiter (MG). No such surgical report was found in the literature, and one would be useful for this new approach to MG removal.
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References
Lin YS, Wu HY, Lee CW, et al. Surgical management of substernal goitres at a tertiary referral centre: a retrospective cohort study of 2,104 patients. Int J Surg. 2016;27:46–52.
Shields TW. Lesions masquerading as primary mediastinal tumors or cysts. In: Shields TW, Surgery M, ed. General thoracic surgery. Philadelphia: Lea & Febiger; 1991.
Testini M, Gurrado A, Avenia N, et al. Does mediastinal extension of the goiter increase morbidity of total thyroidectomy? A multicenter study of 19,662 patients. Ann Surg Oncol. 2011;18:2251–9.
Coskun A, Yildirim M, Erkan N. Substernal goiter: when is a sternotomy required? Int Surg. 2014;99:419–25.
Qureishi A, Garas G, Tolley N, et al. Can pre-operative computed tomography predict the need for a thoracic approach for removal of retrosternal goitre? Int J Surg. 2013;11:203–8.
Rui Sheng Y, Chong Xi R. Surgical approach and technique in retrosternal goiter: case report and review of the literature. Ann Med Surg. 2016;5:90–2.
Sormaz IC, Uymaz DS, Iscan AY, et al. The value of preoperative volumetric analysis by computerised tomography of retrosternal goiter to predict the need for an extra-cervical approach. Balkan Med J. 2018;35:36–42.
Saikawa D, Okushiba S, Kawata M, et al. Efficacy and safety of artificial pneumothorax under two-lung ventilation in thoracoscopic esophagectomy for esophageal cancer in the prone position. Gen Thorac Cardiovasc Surg. 2014;62:163–70.
Brichkov I, Chiba S, Lagmay V, et al. Simultaneous unilateral anterior thoracoscopy with transcervical thyroidectomy for the resection of large mediastinal thyroid goiter. J Thorac Dis. 2017;9:2484–90.
Sahbaz NA, Tutal F, Aksakal N, et al. Cancer frequency in retrosternal goiter. Am Surg. 2017;83:1390–3.
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Hayashi, S., Kawada, M., Hyakushima, N. et al. Resection of mediastinal goiter extending to the carina with use of artificial pneumothorax, two-lung ventilation, and thoracoscopy, with the patient in a prone position. Gen Thorac Cardiovasc Surg 67, 561–565 (2019). https://doi.org/10.1007/s11748-018-0998-7
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DOI: https://doi.org/10.1007/s11748-018-0998-7