VATS with a Supraclavicular Window for Huge Substernal Goiter: An Alternative Technique for Preventing Recurrent Laryngeal Nerve Injury

Abstract

A careless attempt to remove a huge substernal goiter using the cervical approach can lead to recurrent laryngeal nerve injury, which has been consistently reported after the surgery. We present an alternative and less invasive technique combining video-assisted thoracoscopic surgery (VATS) with a supraclavicular approach. This technique seems to offer improved exposure and reliable control of the neuro-vascular structures in the anterior mediastinum when resecting a huge substernal goiter that may prevent nerve injury.

Substernal goiter - VATS (video-assisted thoracoscopic surgery) - nerve injury - supraclavicular approach

References

• 1 Allo M D, Thompson N W. Rationale for operative management of substernal goiters.  Surgery. 1983;  94 969-977
• 2 Monchik J M, Materazzi G. The necessity for a thoracic approach in thyroid surgery.  Arch Surg. 2000;  135 467-472
• 3 Akashi A, Ohashi Y, Yoden Y, Kanno H, Tei K, Sasaoka H, Sakamaki Y, Katsura T, Nishino M, Manzurul H SM. Thoracoscopic surgery combined with a supraclavicular approach for removing superior mediastinal tumor.  Surg Endosc. 1997;  11 74-76
• 4 Akashi A, Hazama K, Miyoshi S, Minami M, Matsuda H, Kido T. An analysis of video-assisted thoracoscopic resection for mediastinal masses in 150 cases. An overview of the pansternal approach, histology, and complications.  Surg Endosc. 2001;  15 1167-1170
• 5 Ladas G, Rhys-Evans P H, Goldstrow P. Anterior cervical-transsternal approach for resection of benign tumors at the thoracic inlet.  Ann Thorac Surg. 1999;  67 785-789