title: 'Ad hoc' sternal-split safely replaces full sternotomy for thyroidectomy requiring thoracic access.
abstract: Mediastinal goiter (MG) removal occasionally needs sternotomy, mainly in case of subaortic extension. We aimed to test the hypothesis that sternal-split may safely replace full sternotomy for MG removal (through total thyroidectomy) when thoracic access is required. We conducted a prospective observational cohort study comparing 15 subaortic MGs receiving sternal-split with 87 MGs undergoing cervicotomy alone between January 1997 and June 2009. Among 15 cases requiring sternal incision, sternal-split was extended to the angle of Louis in nine patients (60%), to the third intercostal space (IS) in one of five (20%) cases of MGs with anterior mediastinum involvement, and in five of 10 (50%) cases with posterior involvement (P = 0.6). Full sternotomy was never necessary. The median hospitalization was 5 days (range, 4-8 days) after sternal access as compared with 3 days (range, 2-4 days) after cervicotomy (P = 0.04). Complications were similar in these two study groups: one postoperative bleeding in each group and three recurrent laryngeal nerve palsies after cervicotomy (P = 0.5). There was no operative mortality, blood transfusion, tracheotomy requirement, wound infection, or persistent hypoparathyroidism. Proper extension of sternal-split to the second or third IS allows an adequate approach to both the anterior and to the posterior mediastinum, thus permitting safe management of MGs requiring thoracic access.
authors.affiliation: Department of Medical & Surgical Sciences, 1st Division of General Surgery, University of Brescia, Brescia, Italy. giacomopata@alice.it
authors.forename: Giacomo
authors.initials: G
authors.lastname: Pata
authors.forename: Claudio
authors.initials: C
authors.lastname: Casella
authors.forename: Mauro
authors.initials: M
authors.lastname: Benvenuti
authors.forename: Nicola
authors.initials: N
authors.lastname: Crea
authors.forename: Ernesto
authors.initials: E
authors.lastname: Di Betta
authors.forename: Bruno
authors.initials: B
authors.lastname: Salerni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006042:Goiter / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008482:Mediastinum / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D056346:Sternotomy; D013249:Sternum / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome