title: When is transthoracic approach indicated in retrosternal goiters?
abstract: OBJECTIVE
  It is critical to differentiate among pathologies of substernal thyroid gland diseases because surgical approaches (i.e., median sternotomy or thoracotomy) might also include a cervical incision. The aim of this study was to analyze the features of patients with goiter who underwent a thyroidectomy via a cervical incision and a median sternotomy or thoracotomy.
  
  
  METHODS
  We reviewed 9 cases of thyroid disease in patients undergoing thoracic incisions with or without a cervical incision for varying indications between March 2003 and Jun 2009 were reviewed. Thyroidal masses were removed via a median sternotomy in six patients and thoracotomy in three patients. Split median sternotomy combining thoracotomy was performed in 1 patient. Cervical incision was added in all patients.
  
  
  RESULTS
  Pathologic examination revealed multinodular goiter in 5 patients, thyroid carcinoma in 3, and reidel thyroiditis in 1. All patients were extubated in the early postoperative period. There was no postoperative mortality or morbidity. The mean hospital stay was 8.6 days (range, 4-11 days), and mean follow-up was 24.3 months (range, 4-39 months).
  
  
  CONCLUSIONS
  We recommend the use of transthoracic approaches, such as median sternotomy and thoracotomy for retrosternal goiter for surgical exposure, because they provide a wide exposure and facilitate removal of the mass. By using median sternotomy and thoracotomy, we can avoid catastrophic results, such as hemorrhage, as well as completely remove malignancies.
authors.affiliation: Departments of Thoracic Surgery, Baskent University Faculty of Medicine, Ankara, Turkey.
authors.forename: Dalokay
authors.initials: D
authors.lastname: Kilic
authors.forename: Alper
authors.initials: A
authors.lastname: Findikcioglu
authors.forename: Yahya
authors.initials: Y
authors.lastname: Ekici
authors.forename: Utku
authors.initials: U
authors.lastname: Alemdaroglu
authors.forename: Koray
authors.initials: K
authors.lastname: Hekimoglu
authors.forename: Ahmet
authors.initials: A
authors.lastname: Hatipoglu
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006044:Goiter, Nodular / Q000473:pathology / Q000601:surgery*; D006045:Goiter, Substernal / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D056346:Sternotomy / Q000009:adverse effects; D013908:Thoracotomy / Q000009:adverse effects; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D013966:Thyroiditis / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014421:Turkey