title: A novel robot-assisted technique for excision of a posterior mediastinal thyroid goiter: a combined cervico-mediastinal approach.
abstract: OBJECTIVE
  : Intrathoracic thyroid goiter is an uncommon condition. Most goiters are found in the superior and anterior mediastinum, which can be removed either through a cervical approach or through a combined cervicotomy and sternotomy approach. Extension of the goiter into the posterior mediastinum is even less common. Transcervival approach to thyroid goiters in the posterior mediastinum can be difficult, necessitating a thoracotomy, with its associated morbidity.
  
  
  METHODS
  : A 69-year-old patient underwent robotic assisted minimally invasive procedure, with the daVinci surgical robotic system to excise a thyroid goiter that extended into the posterior mediastinum. The blood supply of the mediastinal portion of the goiter originated from the right internal thoracic artery. The thoracic and mediastinal portion of the goiter was approached with robot-assisted minimally invasive surgical techniques. Small incisions were used to gain access to the posterior mediastinum via the right pleural cavity, obviating the need for thoracotomy. Using precise movements of the robotic arm, the mediastinal part of the goiter was dissected off vital structures, from within the posterior mediastinum. Total thyroidectomy was then completed using the cervical approach.
  
  
  RESULTS
  : The patient tolerated the procedure well, with minimal intraoperative blood loss. The patient was discharged home after a short hospital stay.
  
  
  CONCLUSIONS
  : Robotic surgical techniques for removal of a substernal goiter and other thyroid masses with mediastinal extension, in combination with cervical incision, are effective. Robotic-assisted techniques can complement video-assisted thoracic surgical techniques and broaden the indications for minimally invasive surgery.
authors.affiliation: From the *Washington Institute of Thoracic and Cardiovascular Surgery; and †The George Washington University Medical Center, Washington, DC, USA.
authors.forename: Eitan
authors.initials: E
authors.lastname: Podgaetz
authors.forename: Farid
authors.initials: F
authors.lastname: Gharagozloo
authors.forename: Farzad
authors.initials: F
authors.lastname: Najam
authors.forename: Nader
authors.initials: N
authors.lastname: Sadeghi
authors.forename: Marc
authors.initials: M
authors.lastname: Margolis
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Tempesta