title: Hemiclamshell incision in the treatment of mediastinal goiter.
abstract: BACKGROUND
  The thyroid disease can appear in 0.16-3.3% of cases as mediastinal goiter. The treatment is difficult and requires a mediastinal approach.
  
  
  METHODS
  We have analyzed our experience from September 1995 to September 2007 among 2,439 thyroidectomies conducted for thyroid disease; 16 cases required a sternotomy, in seven patients conducted as hemiclamshell approach (median sternotomy associated to a fourth intercostals space incision). Preoperative evaluation included otorhinolaryngology evaluation and computed tomography. All the cases were followed up to 12 months.
  
  
  RESULTS
  For seven cases treated trough hemiclamshell, the mean age was 57.8 years; hospital stay is 5.2 days. All the patients were discharged after respiratory evaluation; two patients required a pneumological admittance to physio-kinesi-respiratory. There were no cases of hemorrhage, nerve injury, permanent hypocalcemia, and chylothorax. There was no mortality at 30 days.
  
  
  CONCLUSIONS
  The hemiclamshell is a safe procedure to treat mediastinal goiter and permit a good exposure of subclavian vessels and mediastinal nodes.
authors.affiliation: Unit of General Surgery and Organ Transplantation, Department of Surgical Science, School of Medicine, University of Parma, Via Gramsci 14, 43100, Parma, Italy. paolo.delrio@unipr.it
authors.forename: P
authors.initials: P
authors.lastname: Del Rio
authors.forename: L
authors.initials: L
authors.lastname: Bezer
authors.forename: M F
authors.initials: MF
authors.lastname: Arcuri
authors.forename: M
authors.initials: M
authors.lastname: Sianesi
mesh_terms: D005260:Female; D006042:Goiter / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008477:Mediastinal Diseases / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D013249:Sternum / Q000601:surgery; D013908:Thoracotomy / Q000379:methods*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome