title: A case of mediastinal goiter treated surgically using a clavicle-lifting technique.
abstract: BACKGROUND
  Mediastinal goiter is a benign disease, which is defined as a goiter with the greater portion of its mass lying below the thoracic inlet. It is controversial whether the cervical approach is the best approach for all mediastinal goiter surgeries.
  
  
  METHODS
  A 71-year-old woman presented with respiratory discomfort during exertion. Computed tomography (CT) revealed a mediastinal goiter extending to the arch of the aorta. Surgical resection was performed using a clavicle-lifting technique. The excised specimen was 13×10×5cm in size and weighed 220g. The pathological diagnosis was nodular goiter.
  
  
  CONCLUSIONS
  The clavicle-lifting technique is a simple and safe technique that involves lifting the clavicles with a pediatric extension retractor (Kent Retractor Set, Takasago Medical Industry, Tokyo, Japan). This is a good choice for surgery on upper mediastinal lesions such as mediastinal goiters as it obviates the need for a median sternotomy.
  
  
  CONCLUSIONS
  Although further study is necessary, it appears that a transcervical approach using the clavicle-lifting technique may be an acceptable treatment for mediastinal goiters that extend to the aortic arch.
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi 329-2763, Japan. Electronic address: i_eisaku_ukasie@yahoo.co.jp.
authors.forename: Eisaku
authors.initials: E
authors.lastname: Ito
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi 329-2763, Japan. Electronic address: ohdaira@iuhw.ac.jp.
authors.forename: Hironori
authors.initials: H
authors.lastname: Ohdaira
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi 329-2763, Japan. Electronic address: j.yasuda@jikei.ac.jp.
authors.forename: Jungo
authors.initials: J
authors.lastname: Yasuda
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi 329-2763, Japan. Electronic address: masashi@iuhw.ac.jp.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi 329-2763, Japan. Electronic address: yutaka@iuhw.ac.jp.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Suzuki
keywords: Clavicle lifting technique; Mediastinal goiter