title: Video assisted thoracoscopic thyroidectomy for retrosternal goitre.
abstract: BACKGROUND
  Thyroidectomy for retrosternal goitre is usually carried out through a cervical incision. Around 4-12% of patients, however, require an extracervical approach, usually by sternotomy. Anatomically, the thyroid extends deep behind the great vessels in the pretracheal fascia. A sternotomy is therefore not only a substantial incision but this anterior approach is also not ideal for exposure. We report the use of video assisted thoracoscopic surgery (VATS) instead of a sternotomy or thoracotomy in conjunction with a transverse cervical incision for these patients.
  
  
  METHODS
  A retrospective descriptive study was carried out of seven patients with retrosternal goitre who underwent a VATS thyroidectomy.
  
  
  RESULTS
  Twenty-one patients with retrosternal goitre were referred to our institution for surgical excision with the anticipation of requiring an extracervical incision. Of these, seven (median age: 68 years, range: 58-73 years) underwent a VATS thyroidectomy. The median operating time was 218 minutes (range: 120-240 minutes). The median diameter of the retrosternal goitre was 70 mm (range: 40-145 mm). Only one patient required conversion to a manubriotomy to deliver the bulky thyroid and one patient suffered a transient right recurrent laryngeal nerve palsy. The median postoperative pain scores for days 0 and 1 were 1 (range: 0-5) and 0 (range: 0-3) respectively. The median length of stay was 5 days (range: 3-7 days).
  
  
  CONCLUSIONS
  The use of VATS in thyroidectomy for retrosternal goitre offers a minimally invasive approach resulting in less morbidity while affording excellent exposure. </sec>
authors.affiliation: University Hospitals of Leicester NHS Trust, UK.
authors.forename: P
authors.initials: P
authors.lastname: Gupta
authors.forename: K K W
authors.initials: KK
authors.lastname: Lau
authors.forename: I
authors.initials: I
authors.lastname: Rizvi
authors.forename: S
authors.initials: S
authors.lastname: Rathinam
authors.forename: D A
authors.initials: DA
authors.lastname: Waller
mesh_terms: D000368:Aged; D006045:Goiter, Substernal / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013965:Thyroidectomy / Q000379:methods*