Details
Category: Volume 08 Issue 03 March 2020
Hits: 1042

Title: Subcapsular dissection approach to the intrathoracic goiter: Safe Method

Authors: Dr Pandu Dasappa, Dr Bhagvan B C, Dr Navajith A. Mani, Dr Rashmi Raparla, Dr Hithashree Lingaiah, Dr Mrinal J Oble

 DOI: https://dx.doi.org/10.18535/jmscr/v8i3.117

Abstract

   

The definition of an intrathoracic goitre is a thyroid gland with more than 50% of its mass located below the thoracic inlet. Surgical resection is recommended in case of morbidity associated with the goiter’s mass effect or for suspicion of malignancy, in majority, the retrosternal goitre can be removed via a subcapsular dissection cervical approach to avoid sternotomy or thoracotomy. Surgical technique, results, and postsurgical complications were assessed. The study consisted of 20 patients of cervicomediastinal goiters (CMGs) who underwent total thyroidectomy between 2017 to 2019.  The following parameters were analysed- symptoms, gender, age, operative time, duration of drain, length of hospital stay, malignancy and outcome.

Symptoms, malignancy, overall morbidity, hypoparathyroidism, RLN palsy and hematoma are increased in cases of substernal goiter.

Keywords: Thyroid, Goiter, mediastinum, Retrosternal goitre, Surgical treatment, Complications.

References

  1. Haller A. Disputatones Anatomica Selectae. Gottingen: Vendenhoceck; 1749. p. 96.
  2. Huins CT, Georgalas C, Mehrzad H, Tolley NS. A new classification system for retrosternal goitre based on a systematic review of its complications and management. Int J Surg. 2008;6:71–6.
  3. Cougard P, Matet P, Goudet P, et al. Les goitre plongeants: 218 cas operas. Ann Endocrinol (Paris). 1992;53:230–5.
  4. Vadasz P, Kotsis L. Surgical aspects of 175 mediastinal goiters. Eur J Cardiothorac Surg. 1998; 14:393–7.
  5. Chow TL, Chan TT, Suen DT, Chu DW, Lam SH. Surgical management of substernal goitre: local experience. Hong Kong Med J. 2005;11:360–5.
  6. deSouza FM, Smith PE. Retrosternal goiter. J Otolaryngol. 1983;12:393–6
  7. Huins CT, Georgalas C, Mehrzad H, Tolley NS. A new classi- fication system for retrosternal goitre based on a systematic review of its complications and management. Int J Surg. 2008;6:71–6.
  8. Cougard P, Matet P, Goudet P, et al. Les goitre plongeants: 218 cas operas. Ann Endocrinol (Paris). 1992;53:230–5.
  9. Vadasz P, Kotsis L. Surgical aspects of 175 mediastinal goiters. Eur J Cardiothorac Surg. 1998; 14:393–7.
  10. Chow TL, Chan TT, Suen DT, Chu DW, Lam SH. Surgical management of substernal goitre: local experience. Hong Kong Med J. 2005;11:360–5.
  11. deSouza FM, Smith PE. Retrosternal goiter. J Otolaryngol. 1983;12:393–6.
  12. Huins CT, Georgalas C, Mehrzad H, Tolley NS. A new classification system for retrosternal goitre based on a systematic review of its complications and management. Int J Surg. 2008;6:71–
  13. Huins CT, Georgalas C, Mehrzad H, Tolley NS. A new classification system for retrosternal goitre based on a systematic review of its complications and management. Int J Surg.2008;6:71–
  14. Huins CT, Georgalas C, Mehrzad H, Tolley NS. A new classification system for retrosternal goitre based on a systematic review of its complications and management. Int J Surg.2008;6:71–
  15. Huins CT, Georgalas C, Mehrzad H, Tolley NS. A new classification system for retrosternal goitre based on a systematic review of its complications and management. Int J Surg. 2008;6:71–
  16. Huins CT, Georgalas C, Mehrzad H, Tolley NS. A new classification system for retrosternal goitre based on a systematic review of its complications and management. Int J Surg.2008;6:71–
  17. Huins CT, Georgalas C, Mehrzad H, Tolley NS. A new classification system for retrosternal goitre based on a systematic review of its complications and management. Int J Surg. 2008;6:71–
  18. Huins CT, Georgalas C, Mehrzad H, Tolley NS. A new classi-fication system for retrosternal goitre based on a systematicreview of its complications and management. Int J Surg.2008;6:71–6.
  19. Cougard P, Matet P, Goudet P, et al. Les goitre plongeants: 218cas operas. Ann Endocrinol (Paris). 1992;53:230–5.
  20. Vadasz P, Kotsis L. Surgical aspects of 175 mediastinal goiters. Eur J Cardiothorac Surg. 1998; 14:393–7.
  21. Chow TL, Chan TT, Suen DT, Chu DW, Lam SH. Surgicalmanagement of substernal goitre: local experience. Hong KongMed J. 2005;11:360–5.
  22. deSouza FM, Smith PE. Retrosternal goiter. J Otolaryngol.1983;12:393–6
  23. Katlic MR, Wang C, Grillo HC. Substernal goiter. J Otolaryngol.1992; 21:165–70
  24. .Podgaetz E, Gharagozloo F, Najam F, et al. A novel robot-assisted technique for excision of a posterior mediastinal thyroid goiter: a combinatedcervico-mediastinal approach. Innovations (Phila) 2009;4:225-8. 10.1097/IMI.0b013e3181a69bf0
  25. Mackle T, Meaney J, Timon C. Tracheoesophageal compression associated with substernal goitre. Correlation of symptoms with cross- sectional imaging findings. J LaryngolOtol 2007;121:358-61.
  26. Grainger J, Saravanappa N, D’Souza A, Wilcock D, Wilson PS. The surgical approach to retrosternal goiters: the role of computerized tomography. Otolaryngol Head Neck Surg 2005;132:849-51.
  27. Dahan M, Gaillard J, Eschapasse H. Surgical treatment of goiters with intrathoracic development. In: Delarue M, edi- tor. International trends in general thoracic surgery. Vol 5. Thoracic Surgery: frontiers and uncommon neoplasms. St. Louis: Mosby; 1989. p. 240-6.
  28. Sancho JJ, Kraimps JL, Sanchez-Blanco JM, Larrad A, Ro- drìguez JM, Gil P, et al. Increased mortality and morbid- ity associated with thyroidectomy for intrathoracicgoiters reaching the carina tracheae. Arch Surg 2006;141:82-5.
  29. Cohen JP, Cho HT. Surgery for substernal goiters. Oper Techn Otolaryngol Head Neck Surg 1994;5:118-25.
  30. Huins CT, Georgalas C, Mehrzad H, Tolley NS. A new clas- sification system for retrosternal goitre based on a system- ic review of its complications and management. Int J Surg 2008;6:71-6.
  31. Steurer M, Passler C, Denk DM, Schneider B, Niederle B, Bigenzahn W, et al. Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope 2002; 112:124-33.
  32. Kovács L, Góth MI, Vörös A, Hubina E, Szilágyi G, Szabolcs I, et al. Changes of serum calcium level following thyroid surgery – Reasons and clinical implications. Exp Clin Endocrinol Diabetes 2000;108:364- 8.
  33. Lahey FH, Hoover WB. Injuries to the recurrent laryngeal nerve in thyroid operations: Their management and avoidance. Ann Surg 1938;108:545-62.
  34. Hayward NJ, Grodski S, Yeung M, Johnson WR, Serpell J. Recurrent laryngeal nerve injury in thyroid surgery: A review. ANZ J Surg 2013;83:15-21.
  35. Serpell JW. New operative surgical concept of two fascial layers enveloping the recurrent laryngeal nerve. Ann Surg Oncol 2010;17:1628-36.
  36. Sousa Ade A, Salles JM, Soares JM, Moraes GM, Carvalho JR, Savassi-Rocha PR, et al. Predictors factors for post-thyroidectomy hypocalcaemia. Rev Col Bras Cir 2012;39:476-82.
  37. Demeester-Mirkine N, Hooghe L, Van Geertruyden J, De Maertelaer V. Hypocalcemia after thyroidectomy. Arch Surg 1992;127:854-8.
  38. Kovács L, Góth MI, Vörös A, Hubina E, Szilágyi G, Szabolcs I, et al. Changes of serum calcium level following thyroid surgery – Reasons and clinical implications. Exp Clin Endocrinol Diabetes 2000;108:364- 8.
  39. Noureldine SI, Genther DJ, Lopez M, Agrawal N, Tufano RP. Early predictors of hypocalcemia after total thyroidectomy: An analysis of 304 patients using a short-stay monitoring protocol. JAMA Otolaryngol Head Neck Surg 2014;140:1006-13.
  40. Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, et al. Hypocalcemia following thyroid surgery: Incidence and prediction of outcome. World J Surg 1998;22:718-24.
  41. Coimbra C, Monteiro F, Oliveira P, Ribeiro L, de Almeida MG, Condé A, et al. Hypoparathyroidism following thyroidectomy: Predictive factors. Acta Otorrinolaringol Esp 2017;68:106-11.
  42. Ross D.S. • Cooper D.S. • Martin K.A. Clinical manifestations and evaluation of obstructive or substernalgoiter. UpToDate. 2008; v16: 2
  43. White M.L, Doherty G.M, Gauger P.G.Evidence-based surgical management of substernal goiter. World J Surg. 2008; 32: 1285-1300.

Corresponding Author

Dr Bhagavan B C

Professor, Department of General Surgery, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India- 560004