Peculiarities of surgical treatment of cervico-mediastinal goiter

Objective. To analyze a surgical tactics and a component of operative interventions, performed for goiter of cervico-mediastinal localization; to formulate the operative technique peculiarities, which give positive effect. Materials and methods. Into the investigation the materials of clinical work in 2005 - 2019 yrs were incorporated of Department of Surgery No 2 of the Second Municipal Clinical Hospital of Poltava City, which constitutes a base of the Department of Surgery No 1 of Ukrainian Medical Stomatological Academy. There were analyzed the results of surgical treatment of 530 patients, suffering various forms of goiter. Results. Basing on data of complex clinic-instrumental and cytological investigations several tactically different operative interventions were performed, the content of which was directly dependent on anatomic peculiarities present. In 155 patients a cervico-mediastinal goiter was present. Conclusion. In big mediastinal goiter a severe operative situation occurs, necessitating nonstandard surgical decisions making. That is why the neck surgical access of the authors own in accordance to Kocher method was proposed. Extrafascial procedures may prevent some iatrogenic complications.

Posterior Mediastinal Goiter Removal Through Cervical Incision

Intrathoracic goiter when encountered can be treated by thyroidectomy using cervical incision, only occasionally requiring extra cervical approach. We are reporting one such case in a patient with pituitary macroadenoma with extension of the adenomatous goiter into the posterior mediastinum. It was removed through the cervical collar incision using a vessel sealing device. There were no intraoperative and postoperative complications during the procedure. The need for extra cervical incision should be decided on a case-to-case basis to avoid the increased morbidity associated with sternotomy and lateral thoracotomy incision.

Mediastinal Goiter Operated as Trans Clavicular Access as Adjunct to Cervical Incision

There are cases in which resection of cervico-mediastinal goitres requires additional thoracic access as an adjunct to standard transverse cervicotomy, and typically this takes the form of sternotomy or thoracotomy. The authors propose transclavicular access as an alternative to thoracotomy or sternotomy access for the removal of such goitres. This technical variant is performed by means of resection of the middle third of the clavicle and extraperiosteal disarticulation. They report a case of cervico mediastinal or “plunged” goitre associated with mediastinal metastasis from a follicular thyroid carcinoma in a 77-year-old woman, in whom this technical variant was used. They conclude by stressing the greater effectiveness, ease of execution and relatively limited “aggressiveness” of the technique in comparison with other ways of reaching the mediastinum. The variant proves effective in solving a number of technical, functional and aesthetic problems.

« Neglected » Endothoracic Goitres : The Point of View of Thoracic Surgeon

Introduction : Neglected endothoracic goiter is an endothoracic mediastinal portion that was neglected during the surgical removal of a plunging cervical goiter in contrast to autonomous ectopic mediastinal goiter which has its own mediastinal vascularization without connection between the two components and but who was not diagnosed during the cervical thyroidectomy. The aim of this work is to report the point of view of thoracic surgeon to avoid "forgetting" this endothoracic component.Materiel and methods : This is a retrospective study involving four patients, all operated for an endothoracic goiter only by thoracotomy.Results : Among four patients, it was 3 women and one men with an average age of 46 years. All Four cases have already been operated for cervical goiter by cervicotomy alone. Also, for all patients, the discovery was accidental. the cervicothoracic scan found a posterior mediastinal heterogeneous mass, with calcification lesions in 2 patients, and necrosis zone in 2 patients. The four patients were operated by posterolateral thoracotomy. Operative outcome was simple in all patients except 2 cases of wound infection.Conclusion : Neglected endothoracic goiter poses a diagnostic and also a therapeutic problem because its a difficult surgery due to the adhesions already formed following a first cervical thyroid surgery and therefore it is essential not to miss the diagnosis of any diving goiter.

Large posterior mediastinal goiter post total cervical thyroidectomy: a case report

Thoracotomy approach is indicated for a complete and safe posterior mediastinal goitre removal. A 68 years old male was hospitalized due to a right mediastinal mass found in a chest X-ray and confirmed by computed tomography. The patient had undergone total cervical thyroidectomy thirty years ago. A computed tomography (CT) guided percutaneous needle biopsy of the mass revealed thyroid tissue. Subsequently, the mass was completely resected through a right posterolateral thoracotomy. The histopathology confirmed a large mediastinal goitre with no signs of malignancy. The patient had an uncomplicated recovery. We present a relatively rare case of a successful resection of a posterior mediastinal goitre, occurring thirty years post-total cervical thyroidectomy. We advocate lateral thoracotomy to achieve a broad operative field and enhance surgical safety.