Abstract
Introduction:
Retrosternal thyroid goitre, particularly those extending to the aortic arch and into the posterior mediastinum, can sometimes be challenging to remove trans-cervically alone. Traditionally a multidisciplinary approach with cardiothoracics is advocated with full length sternotomy being used for access. The use of mini-sternotomy in routine cardiothoracics practice for upper mediastinal access is well documented. Our team have been undertaking routine mini-sternotomy for removal of large RTG with good patient outcomes.
Here we present our technical approach to mini-sternotomy and outcome data for patients treated in a UK tertiary centre (2004-2017) with a multidisciplinary joint approach.
Methods:
Mini-sternotomy was performed by our cardiothoracic team with the ability to convert to full sternotomy if required and cardiac high dependency unit and total cardiopulmonary bypass facilities available. Once upper thoracic access is achieved, the goitre is delivered medially and removed as per regular thyroidectomy technique.
Retrospective case note analysis was undertaken of all RSG removed requiring any form of sternotomy and outcomes comparison was made between full and mini-sternotomy groups.
Results:
28 patients treated in a UK tertiary single centre (2004-2017), requiring sternotomy for retrosternal thyroidectomy (17 full, 11 mini). No return to theatre, no wound breakdown and no mortality. No mini-sternotomy required conversion to full. Most significant improved outcome was length of stay; reduced by 3 days (p=0.02). No difference between groups with infection rates, RLN palsy and hypocalciaemia. Chest drain requirement reduced by 30% in mini-sternotomy group.
Conclusion:
Mini-sternotomy for retrosternal thyroidectomy has outcome data that is as good or better than full sternotomy. In appropriate centres with cardiac HDU support, mini-sternotomy access for the removal of large, symptomatic retrosternal goitres is safe and increases recovery time for patients.
Retrosternal thyroid goitre, particularly those extending to the aortic arch and into the posterior mediastinum, can sometimes be challenging to remove trans-cervically alone. Traditionally a multidisciplinary approach with cardiothoracics is advocated with full length sternotomy being used for access. The use of mini-sternotomy in routine cardiothoracics practice for upper mediastinal access is well documented. Our team have been undertaking routine mini-sternotomy for removal of large RTG with good patient outcomes.
Here we present our technical approach to mini-sternotomy and outcome data for patients treated in a UK tertiary centre (2004-2017) with a multidisciplinary joint approach.
Methods:
Mini-sternotomy was performed by our cardiothoracic team with the ability to convert to full sternotomy if required and cardiac high dependency unit and total cardiopulmonary bypass facilities available. Once upper thoracic access is achieved, the goitre is delivered medially and removed as per regular thyroidectomy technique.
Retrospective case note analysis was undertaken of all RSG removed requiring any form of sternotomy and outcomes comparison was made between full and mini-sternotomy groups.
Results:
28 patients treated in a UK tertiary single centre (2004-2017), requiring sternotomy for retrosternal thyroidectomy (17 full, 11 mini). No return to theatre, no wound breakdown and no mortality. No mini-sternotomy required conversion to full. Most significant improved outcome was length of stay; reduced by 3 days (p=0.02). No difference between groups with infection rates, RLN palsy and hypocalciaemia. Chest drain requirement reduced by 30% in mini-sternotomy group.
Conclusion:
Mini-sternotomy for retrosternal thyroidectomy has outcome data that is as good or better than full sternotomy. In appropriate centres with cardiac HDU support, mini-sternotomy access for the removal of large, symptomatic retrosternal goitres is safe and increases recovery time for patients.
| Original language | English |
|---|---|
| Pages (from-to) | 17-18 |
| Number of pages | 2 |
| Journal | British Journal of Surgery |
| Volume | 106 |
| Issue number | S1 |
| DOIs | |
| Publication status | Published - Jan 2019 |
| Event | British Association of Endocrine and Thyroid Surgeons Annual Scientific Meeting - Glasgow, United Kingdom Duration: 11 Oct 2018 → 12 Oct 2018 |