Robotic-Assisted Retrosternal Thyroidectomy
Retrosternal thyroid goiters may occur in the anterior, middle, and posterior mediastinum. Symptomatic retrosternal thyroid goiters are usually amenable to resection via a cervical incision. Sternotomy and thoracotomy are typically employed for retrosternal goiters not amenable to a cervical approach alone. The authors demonstrate a robot-assisted approach for the resection of a retrosternal thyroid goiter in the middle mediastinum.
A patient developed a persistent cough and dyspnea from an enlarged retrosternal thyroid. A combined cervical and right robot-assisted approach for resecting the retrosternal thyroid was undertaken. The patient was positioned in the supine position with a right bump, in preparation for a possible right robot-assisted approach. The cervical approach was met with difficulties in dissecting the mediastinal extension of the enlarged thyroid. Three robotic ports and one assistant port were placed into the right chest. The robot was docked, and the mediastinal extension of the thyroid was released. The specimen was extracted from the cervical incision.
The patient did not develop a hoarse voice concerning for recurrent laryngeal nerve injury. The chest tube was removed on postoperative day one. Her pain was controlled well with oral agents. The patient was discharged on postoperative day one. Pathology demonstrated multinodular hyperplasia consistent with a goiter. The patient was doing well at the two week follow-up visit with resolution of her persistent cough and dyspnea.
A robot-assisted approach to retrosternal thyroidectomy is feasible. Avoiding the use of sternotomy or thoracotomy may decrease recovery time. Further work is necessary to determine the role of the robot-assisted approach for retrosternal thyroidectomy.
Dr Sancheti is on the Consultant/Advisory Board and receives honoraria on the Speakers Bureau for Intuitive Surgical.
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