Combined Cervicotomy And Robotic-assisted Surgical Approach For Intrathoracic Thyroid Goiter: A Case Series
Giorgia Piccioni, Alessandra Siciliani, Fabiana Messa, Paolo Mercantini, Erino Angelo Rendina, Mohsen Ibrahim.
Sapienza University of Rome - Sant'Andrea Hospital, Rome, Italy.
BACKGROUND: Goiter is a benign pathological condition of the thyroid gland, characterized by slow growth rate, occasionally reaching the mediastinum and extending through the thoracic inlet. In most cases, retrosternal goiters originate from the cervical portion of the thyroid. Most frequently, goiters are found in the superior mediastinum. In this case, a complete thyroidectomy could be guaranted through a cervical approach. Extension of the goiter into the anterior mediastinum is less common. In these patients, a single cervical approach could not lead to a radical excission of the mediastinal mass. Transcervical approach to intrathoracic thyroid goiters can be difficult, often necessitating a thoracotomy or sternotomy access. METHODS:This series describes the cases of five patients, affected by thyroid goiter extended into the anterior (n=3) and posterior (n=2) mediastinium, who underwent combined cervicotomy and robotic-assisted surgery. The masses presented a polylobulated morphology, and extended until the peritracheal area, contracting close contiguous relationships with the surrounding vascular or tracheal tissue structures. In each case, the thoracic and mediastinal portion of the goiter was approached with robot-assisted minimally invasive surgical techniques. Left or right triportal incisions, according to the predominance of the laterality of the mass (respectively at the 5th intercostal space along the anterior axillary line, at the 3rd intercostal space along the mid-axillary line and at the 5th intercostal space along the midclavicular line) were used to gain access to the mediastinum via the homolateral pleural cavity. Total thyroidectomy was then completed using the cervical approach. RESULTS: The procedure was well tollerated, with minimal intraoperative blood loss. The postoperative course was characterized by the absence of complications, without symptoms of dyspnoea or dysphonia. Patients were discharged after a short hospital stay (3-5 days). The pleural and cervical drainage tubes were removed on discharge. CONCLUSIONS: Combined Cervicotomy and Robotic assisted technique for surgical excission of intrathoracic thyroid goiter, is a feasible and safe procedure. This surgical approach avoid the use of invasive surgical access such as thoracotomy and sternotomy, with a positive impact on the onset of postoperative complications, reducing postoperative pain and lenght of stay.
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