According to literature, if the goiter is abutting the aortic arch, a sternotomy is indicated. In my experience of 8 cases over many years, there were no sternotomies. I was able to perform a blunt dissection and remove the goiter.
Does anyone have a similar experience?
This depends on the depth and size of the goiter. In my initial experience (Int Surg 2003; 88: 206-210) only 1 of 83 patients required sternotomy. When the goiter reaches the carina tracheae, 13 of 35 patients required sternotomy (12) or thoracotomy (1). Nine of 14 patients with thyroid glands weighing at least 260 g required sternotomy vs 3 of 14 patients with thyroid glands weighing less than 260 g (P=.02) (Arch Surg 2006; 141:82-85).
Regards.
Thanks for sharing your valuable experience Dr. Blanco. Is there a weight criteria to determine sternotomy ?
Hi
If by ‘Abutting the aortic arch’ you mean at the upper border, sternotomy is usually not necessary.
As dr blanco suggests, it’s not just the lower extent, but also other factors such as the shape of goitre, location in anterior vs posterior mediastinum, primary vs secondary mediastinal goitre, shape of neck, first time vs reoperative surgery, unilateral vs bilateral involvement and whether the goitre crosses the midline and if it does, it’s relation to the trachea and oesophagus.
i am not sure of the value of weight as it cannot be determined before surgery.
bw saba
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