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Sternotomy and thoracotomy incisions. (a) Anterolateral thoracotomy, partial sternotomy, complete sternotomy, trap-door incision, and cervical incision (Kocher incision). (b) Posterolateral thoracotomy incision.
Source publication
The most appropriate treatment of substernal goiter (SG) is surgery. These patients should be evaluated carefully and multidisciplinary in pre-operative period and surgical management should be planned preoperatively. Although most of the SGs can be resected by the cervical approach, an extracervical approach may be required in a small proportion o...
Contexts in source publication
Context 1
... most SGs can be operated by transcervical methods, approximately 2% of patients may require extracervical interventions (Fig. 2). [40] Many different techniques have been described for the surgery of SGs from past to present. Morcellation method, which was first defined by Kocher in 1889 and popularized by Lahey in the 1920s, was applied in SG surgery. In this technique, it is aimed to reduce the size of the goiter by intracapsular fragmentation of the thyroid ...
Context 2
... in patients extending to the posterior mediastinum or in whom the mediastinal extension cannot be fully evaluated and where other methods of reaching the mass and safe dissection cannot be performed. [53] Patients who may need thoracotomy should be consulted with the thoracic surgeon and anesthesia, and the operation should be planned together (Fig. ...
Citations
... A partial sternotomy, also called a sternal split, is suitable for resection of SGs extending to the level of the aortic arch. [12] The most crucial tool for determining which patients might need sternotomies before surgery is radiological imaging. Posteroanterior chest X-rays give information about trachea deviation or narrowing in patients with SG. ...
Objectives
Although thyroidectomy is completed with a cervical incision in most patients with substernal goiter (SG), sternotomies may be required occasionally. The purpose of this study is to examine computed tomography (CT) findings that may predict the need for sternotomy in SG surgery.
Methods
Neck-thoracic CT images of patients who underwent total thyroidectomy with the diagnosis of SG between 2013 and 2022 were retrospectively examined. The patients (n=41) were divided into two groups: sternotomies (n=6) and cervical (n=35). Preoperative pathological data, CT findings, and postoperative complications of the patients were recorded.
Results
The total thyroid volume of the sternotomy group (280.75±127.01 mm³) was significantly greater than that of the cervical group (155.38±74.18 mm³) (p=0.015). The retrosternal thyroid volume (mm³), thyroid craniocaudal, and anterior-posterior dimensions (mm) were significantly greater in the sternotomy group (p=0.001, p<0.001, and p=0.004, respectively). While the majority of mediastinal extension degrees in the cervical group were grade 1 (80%), grade 2 (83%) predominated in the sternotomy group (p=0.001).
Conclusion
The radiological findings of total thyroid volume, retrosternal thyroid tissue volume, retrosternal thyroid length, thyroid anterior-posterior dimension, and mediastinal extension degree on CT are valuable in predicting the decision to perform a sternotomy in SG surgery.
