Mediastinal goitres: when the transthoracic approach?

The correct surgical approach to mediastinal goitre is not always well defi ned. We reviewed why and when our patients required a transthoracic approac h. From 1979 to 1998, on 7.480 patients who underwent thyroid surgery in our h ospital, 374 (5%) had a goitre whose greater bulk was inferior to the thora cic inlet; 43 patients of these last ones (11%) required a transthoracic ap proach. General anaesthesia was performed in all patients and orotracheal i ntubation was selective in 11 cases (double lumen tube of Carlens). In 34 c ases, the first approach was a cervicotomy, followed by sternotomy in 23 ca ses or right posterolateral thoracotomy in 11 cases. Three patients underwe nt a sternotomy and 6 a thoracotomy only. We had neither perioperative mortality nor major complications. The mean ho spital stay was 5 days. Mean goitre weight was 430 g and on average the gre ater diameter was 13 centimetres. The removal of a substernal goitre can be difficult and risky via the cervi cotomy only. A transthoracic approach is often required in the case of grea ter secondary, primary and recurrent mediastinal goitres.