A Hybrid Surgical Approach for Retrosternal Goiter: Surgical Experience at a Tertiary Thoracic and Endocrine Surgery Center

Purpose: Retrosternal goiter with substantial mediastinal extension often present surgical challenges, with conventional approach frequently necessitating median sternotomy. This case series evaluates the safety, feasibility, and outcomes of a combined video-assisted thoracoscopic surgery (VATS) and transcervical approach in managing sizable retrosternal goiters without resorting to sternotomy. Methods: A retrospective analysis was conducted in the Divisions of the Endocrine and Thoracic Surgery, Department of General Surgery in the Medical City for Military and Security Services. Since the introduction of VATS in the department, 4 patients underwent hybrid approach for retrosternal goiter excision, utilizing VATS in conjunction with conventional cervical thyroidectomy. Results: All cases were completed without conversion to sternotomy. The mean operative time was 245 minutes (range: 150–360), with retrosternal extension ranging from 3.4 to 7 cm and mean thyroid volume of 125.1 g (range: 58–225.4 g). Two patients underwent hemithyroidectomy and another 2 total thyroidectomy. Our findings indicate that VATS thyroidectomy, when combined with conventional cervical thyroidectomy, significantly reduces postoperative pain, hospital stay, and enhances patient satisfaction. Notably, no complications were observed during either the intraoperative and postoperative periods. Conclusion: Hybrid approach utilizing VATS and cervical thyroidectomy presents itself as a safe and effective “minimally invasive” alternative to more invasive procedures, such as sternotomy, for selected cases of retrosternal goiters. This approach holds promise for achieving successful outcomes while minimizing patient discomfort and recovery time.