scholarly journals Case Report: Modified Thoracoscopic-Assisted Cervical Resection for Retrosternal Goiter

2021 ◽  
Vol 8 ◽  
Author(s):  
Cédric Nesti ◽  
Benny Wohlfarth ◽  
Yves M. Borbély ◽  
Reto M. Kaderli
Keyword(s):  
Endocrine Surgery ◽  
Thyroid Lobe ◽  
Thoracic Inlet ◽  
Thoracoscopic Approach ◽  
Mediastinal Dissection ◽  
Retrosternal Goiter ◽  
Cervical Approach ◽  
Posterior Mediastinal ◽  
The Right ◽  
Mediastinal Extension

Introduction: The treatment of choice for retrosternal goiters (RSG) is surgical resection to relieve symptoms and rule out malignancy. Although the majority of RSG can be removed by a cervical approach only, an extracervical approach (e.g., sternotomy, thoracotomy or thoracoscopy) may be required. Herein, we describe a refined thoracoscopic-assisted cervical two-team RSG resection without thoracoscopic mediastinal dissection.Technique: A 57-year-old man presented with a large RSG with posterior mediastinal extension (PME) and extensive peritumoral vascularization. Due to its extension below the aortic arch and its small connection with the right thyroid lobe, a combined cervical and thoracoscopic approach was intended. The endocrine surgery unit performed the cervical mobilization of the right thyroid lobe, while the thoracic surgery unit gently pushed the mediastinal tumor through the thoracic inlet without performing mediastinal dissection. This allowed a safe visualization of the inserting vessels by the endocrine surgery team at the neck, followed by a stepwise division of the vessels and resection of the retrosternal nodule through the cervical access.Comment: The described approach is indicated for RSG with posterior mediastinal extension, anteroposterior dimension smaller than the thoracic inlet and inaccessibility from a cervical approach only. This minimally invasive approach is associated with a faster recovery, decreased morbidity and postoperative pain, shorter hospital stay and better cosmetic results.

scholarly journals Cervical approach for retro-sternal goiter reaching the arch of aorta

2021 ◽  
Author(s):  
Mohamed Tarek Hafez ◽  
Mostafa M. Abdelmaksoud ◽  
Shadi Awny ◽  
Alaa Jamjoom ◽  
Abdullah Mashat ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Thyroid Tissue ◽  
Median Sternotomy ◽  
Thoracic Inlet ◽  
Cervical Incision ◽  
Academic Medical ◽  
Retrosternal Goiter ◽  
Cervical Approach

Abstract Background: Although the retrosternal goiters are characterized by the protrusion of at least 50% of the thyroid tissue below the level of the thoracic inlet, their definite definition is still controversial. Total thyroidectomy for retrosternal goiter has a great challenge and mostly requires an experienced thyroid surgeon. Excision could be possible through a cervical incision in most cases, though Sternotomy remains an option. Patients and Methods: We report fourteen patients who presented to our academic medical center between 2016 and 2019 with large thyroid goiters and retrosternal extension proven by computerized tomography scan of the neck, presented in both Mansoura University Oncology Center, Egypt and East Jeddah Hospital, Saudi Arabia from 2016 to 2019. Results: Fourteen cases with retrosternal goiter been undergone total thyroidectomy through a cervical incision without the need for median sternotomy, although the thoracic surgeon was stand-by in three cases. Six patients were found to have a malignancy in the post-operative histopathological assessment.CONCLUSION: Surgical procedures for most all retrosternal goiters can be completed successfully using a cervical approach; however, a sternotomy is required in a small number of such patients.

scholarly journals Retrosternal goitre and its management

2021 ◽  
Vol 4 (2) ◽  
pp. 38-45
Author(s):  
Saurabh Varshney
Keyword(s):  
Retrospective Study ◽  
Personal Experience ◽  
Average Rate ◽  
Surgical Removal ◽  
Surgical Morbidity ◽  
Thoracic Inlet ◽  
Retrosternal Goiter ◽  
Risk Of Malignancy ◽  
Cervical Approach ◽  
Final Histological Diagnosis

 Retrosternal goiter (RSG) is a term that has been used to describe a goiter that extends beyond the thoracic inlet. Retrosternal goitre is defined as a goitre with a portion of its mass ≥ 50% located in the mediastinum. Surgical removal is the treatment of choice and, in most cases, the goitre can be removed via a cervical approach. Aim of this retrospective study was to analyse personal experience in the surgical management of retrosternal goitres, defining, in particular, the features requiring sternotomy.  Retrospective study, teaching hospital-based. Retrospective analysis of 687 thyroidectomies performed between 2008 and 2019. The 47 (6.84 %) patients with RSG were analyzed further, with regard to demographics, presentation, indications, and outcome of surgical treatment.  There were 47 patients (6.84 %) with RSG, [ 34 females (72.34%), 13 males (27.66%)] (mean age: 52 years, range: 34-76)], out of 687 thyroidectomies, in a 14 -year period. The most common presentation was neck swelling (68%), followed by respiratory symptoms (46.8%) and the surgical procedure predominantly used was total thyroidectomy. The RSGs were removed by collar incision in 43 (91.5 %) of the cases, only 4 cases (8.5 %) required sternotomy, (residual thyroid in mediastinum after cervical approach in one case and due to very large thyroid reaching the main bronchial bifurcation in the other three). The final histological diagnosis revealed malignancy in 8.5 % of the thyroid specimens. There was no mortality and minor complications occurred in nine patients (19.1%). The presence of an RSG is an indication for surgery owing to the lack of effective medical treatment, the higher incidence of symptoms related to compression, low surgical morbidity, and the risk of malignancy. Surgical removal of a retrosternal goitre is a challenging procedure; it can be performed safely, in most cases, via a cervical approach, with a complication rate slightly higher than the average rate for cervical goitre thyroidectomy, especially concerning hypoparathyroidism and post-operative bleeding. The most significant criteria for selecting patients requiring sternotomy are computed tomography features, in particular the presence of an ectopic goitre, the extent of the goitre to or below the tracheae carina. If retrosternal goitre thyroidectomy is performed by a skilled surgical team, familiar with its unique pitfalls, the assistance of a thoracic surgeon may be required only in a few selected cases

scholarly journals Surgical treatment of substernal goiters extending to posterior mediastinum

2018 ◽  
Author(s):  
Yao Peng ◽  
Xinying Li ◽  
Zhejia Zhang ◽  
Bo Jiang ◽  
Tiecheng Feng ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Present Report ◽  
Treatment Strategies ◽  
Posterior Mediastinum ◽  
Anterior Mediastinum ◽  
Surgical Removal ◽  
Thoracoscopic Approach ◽  
Cervical Approach ◽  
Posterior Mediastinal ◽  
Surgery Department

Introduction: Substernal goiters (SSGs) extending to posterior mediastinum which account for minority of total SSGs. In previous published reports, thoracic approaches were considered to surgical treatment for posterior medastinal goiter in most cases. The present report was to identify the clinical features of posterior mediastinal goiters and surgical treatment strategies on the basis of our experiences. Case presentation: Clinical data of 23 cases of posterior mediastinal goiters in 122 substernal goiters (SSGs) from a total of 4381 thyroidectomies performed in Division of thyroid surgery General Surgery Department of Xiangya hospital, Central South University, China over a 6-year period (2010-2016) was respectively were analyzed. Posterior mediastinal goiters have more prevalence of compression symptoms compared with anterior mediastinal goiters (P<0.05). SSGs which extend to posterior mediastinum have a higher probability of mass bottom below the aortic arch than those extending to anterior mediastinum (P<0.05). Twenty posterior mediastinal goiters (87.0%) underwent thyroidectomies by cervical approach without additional incision. In 3 of the 23 patients (13.0%), 1 thoracotomy and 2 thoracoscopic approaches were performed for a complete and safe removal. Postoperative complications occurred in 5 of 23 patients (21.7%) including temporary recurrent laryngeal nerve (RLN) paralysis and transient hypoparathyroidism in our series. Conclusion: Surgical removal of posterior mediastinal goiters can be performed safely by a single cervical approach in the majority of patients. Thoracoscopic approach proposes a new treatment strategy with feasibility.

66 SHORT-TERM RESULTS OF RADICAL SURGERY FOR ESOPHAGEAL CANCER WITHOUT THORACOTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Yasushi Rino ◽  
Norio Yukawa ◽  
Toru Aoyama ◽  
Atsumi Yosuke ◽  
Kentaro Hara ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lung Ventilation ◽  
Pulmonary Complications ◽  
Chronic Obstructive ◽  
Recurrent Nerve ◽  
Obstructive Pulmonary Disease ◽  
Recurrent Nerve Palsy ◽  
Mediastinal Dissection ◽  
Cervical Approach ◽  
The Right

Abstract   In recent years, surgery without thoracotomy for esophageal cancer has been reported by performing mediastinoscope and laparoscope-assisted esophagectomy. It is reported that this procedure reduces pulmonary complications. Methods Since June 2018, we introduced this surgical operation for esophageal cancer patients using mediastinoscope without thoracotomy. The patient was placed in a supine position and tilts head slightly to the right with bilateral lung ventilation. The upper mediastinal dissection, using a left cervical approach, was performed with a single-port mediastinoscopic technique using LigaSure™ Maryland. But the lymph nodes along the right recurrent laryngeal nerve (RLN) were dissected under direct vision using a right cervical approach. And then, the operation and the course after the operation were examined. Results We experienced 14 cases of surgery by February 2020 and have experienced only one pulmonary complication in the course of the surgery. This case had a left recurrent nerve palsy as a complication after surgery. For this reason, aspiration was combined, but it improved immediately. There were 2 patients that lung cancer and COLD (Chronic Obstructive Pulmonary Disease), but pneumonia did not occur. Suture failure was very high frequent. However, this complication decreased over time. Conclusion We reported that pneumonia after esophageal cancer surgery deteriorates the prognosis. Suppression of pneumonia by this operation formula can be expected to improve the prognosis.

scholarly journals Successful surgical rescue of delayed onset diaphragmatic hernia following radiofrequency ablation using a thoracoscopic approach for hepatocellular carcinoma: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Atsushi Morito ◽  
Shigeki Nakagawa ◽  
Katsunori Imai ◽  
Norio Uemura ◽  
Hirohisa Okabe ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Small Intestine ◽  
Radiofrequency Ablation ◽  
Diaphragmatic Hernia ◽  
Invasive Treatment ◽  
Thoracoscopic Approach ◽  
Case Presentation ◽  
Medial Segment ◽  
Liver Surface ◽  
The Right

Abstract Background Radiofrequency ablation (RFA) is widely used as a minimally invasive treatment for hepatocellular carcinoma (HCC). RFA has a low risk of complications, especially compared with liver resection. Nevertheless, various complications have been reported after RFA for HCC; however, diaphragmatic hernia (DH) is extremely rare. Case presentation A 78-year-old man underwent thoracoscopic RFA for HCC located at the medial segment adjacent to the diaphragm approximately 7 years before being transported to the emergency department due complaints of nausea and abdominal pain. Computed tomography revealed a prolapsed small intestine through a defect in the right diaphragm, and emergency surgery was performed. The cause of diaphragmatic hernia was the scar of RFA. We confirmed that the small intestine had prolapsed into the right diaphragm, and we resected the necrotic small intestine and repaired the right diaphragm. Herein, we report a case of ileal strangulation due to diaphragmatic hernia after thoracoscopic RFA. Conclusions Care should be taken when performing thoracoscopic RFA, especially for tumors located on the liver surface adjacent to the diaphragm. Patients should be carefully followed up for possible DH, even after a long postoperative interval.

scholarly journals Intrathyroidal Parathyroid Carcinoma: Report of an Unusual Case and Review of the Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Lizette Vila Duckworth ◽  
William E. Winter ◽  
Mikhail Vaysberg ◽  
César A. Moran ◽  
Samer Z. Al-Quran
Keyword(s):  
Thyroid Gland ◽  
Parathyroid Carcinoma ◽  
Unusual Case ◽  
Thyroid Tissue ◽  
Parathyroid Tissue ◽  
African American Female ◽  
Thyroid Lobe ◽  
Local Infiltration ◽  
Sestamibi Scan ◽  
The Right

Intrathyroidal parathyroid carcinoma is an exceedingly rare cause of primary hyperparathyroidism. A 51-year-old African American female presented with goiter, hyperparathyroidism, and symptomatic hypercalcemia. Sestamibi scan revealed diffuse activity within an enlarged thyroid gland with uptake in the right thyroid lobe suggestive of hyperfunctioning parathyroid tissue. The patient underwent thyroidectomy and parathyroidectomy. At exploration, a 2.0 cm nodule in the usual location of the right inferior parathyroid was sent for intraoperative frozen consultation, which revealed only ectopic thyroid tissue. No parathyroid glands were identified grossly on the external aspect of the thyroid. Interestingly, postoperative parathyroid hormone levels normalized after removal of the thyroid gland. Examination of the thyroidectomy specimen revealed a 1.4 cm parathyroid nodule located within the parenchyma of the right superior thyroid, with capsular and vascular invasion and local infiltration into surrounding thyroid tissue. We present only the eighth reported case of intrathyroidal parathyroid carcinoma and review the literature.

scholarly journals Case Report: Bow Hunter's Syndrome Caused by Compression of Extracranially Originated Posterior Inferior Cerebellar Artery

2021 ◽  
Vol 12 ◽  
Author(s):  
Noriya Enomoto ◽  
Kenji Yagi ◽  
Shunji Matsubara ◽  
Masaaki Uno
Keyword(s):  
Case Report ◽  
Posterior Inferior Cerebellar Artery ◽  
Head Rotation ◽  
Radiographic Examination ◽  
Posterior Decompression ◽  
First Case ◽  
Cerebellar Artery ◽  
Cervical Approach ◽  
The Right ◽  
Hunter's Syndrome

Bow hunter's syndrome (BHS) is most commonly caused by compression of the vertebral artery (VA). It has not been known to occur due to an extracranially originated posterior inferior cerebellar artery (PICA), the first case of which we present herein. A 71-year-old man presented with reproducible dizziness on leftward head rotation, indicative of BHS. On radiographic examination, the bilateral VAs merged into the basilar artery, and the left VA was predominant. The right PICA originated extracranially from the right VA at the atlas–axis level and ran vertically into the spinal canal. During the head rotation that induced dizziness, the right PICA was occluded, and a VA stenosis was revealed. Occlusion of the PICA was considered to be the primary cause of the dizziness. The patient underwent surgery to decompress the right PICA and VA via a posterior cervical approach. Following surgery, the patient's dizziness disappeared, and the stenotic change at the right VA and PICA improved. The PICA could be a causative artery for BHS when it originates extracranially at the atlas–axis level, and posterior decompression is an effective way to treat it.

Uniportal thoracoscopic right anterior basal (S8) segmentectomy using unidirectional dissection

2021 ◽  
Keyword(s):  
Minimally Invasive ◽  
Surgical Procedure ◽  
Lower Lobe ◽  
Lung Parenchyma ◽  
Surgical Instruments ◽  
Thoracoscopic Approach ◽  
Minimally Invasive Surgical Procedure ◽  
Small Incision ◽  
Minimally Invasive Surgical ◽  
The Right

Anterior basal (S8) segmentectomy is one of the most challenging procedures among the uncommon pulmonary segmentectomies because the surgeon has to identify dominant pulmonary vein branches located deep in the lung parenchyma. Moreover, with the uniportal thoracoscopic approach, the angulation of inserted surgical instruments via a single small incision is extremely limited, which causes technical difficulties. However, adoption of a suitable procedure such as unidirectional dissection enables us to perform this type of minimally invasive surgical procedure. We describe the successful results of a patient undergoing uniportal thoracoscopic S8 segmentectomy of the right lower lobe and explain the nuances of performing it.

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