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. 2013;4(11):992-6.
doi: 10.1016/j.ijscr.2013.08.014. Epub 2013 Sep 12.

Cervical leverage: A new procedure to deliver deep retrosternal goitres without thoracotomy

Vijay Naraynsingh  1 , Ian Ramarine, Shamir O Cawich, Ravi Maharaj, Dilip Dan
Affiliations

Cervical leverage: A new procedure to deliver deep retrosternal goitres without thoracotomy

Vijay Naraynsingh et al. Int J Surg Case Rep. 2013.

Abstract

Introduction: Although most retrosternal goitres can be removed through a standard collar incision, some cases require extra-cervical incisions for complete resection. We report a new technique to remove large retrosternal goitres without extra-cervical incisions.

Presentation of case: We present two cases in which a US Army-Navy (Parker-Langenback) retractor was used to deliver large retrosternal components into the cervical incisions.

Discussion: This technique is useful in cases where the retrosternal component extends beyond the reach of the exploring finger and a well-developed plane can be developed between the gland and surrounding tissue.

Conclusion: The cervical leverage technique allows removal of a large retrosternal component through a cervical incision, thereby avoiding the attendant morbidity of a thoracotomy or median sternotomy. It should not be used if there is suspected neoplastic disease, dense adherence to or invasion of surrounding intra-thoracic structures.

Keywords: Goitre; Mediastinal; Retrosternal; Thoracotomy; Thyroid.

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Figures

Fig. 1
Fig. 1
CT of the thorax showing a large goitre in the superior mediastinum (G) displacing the intra-thoracic trachea (T) and vena cava (V) to the right.
Fig. 2
Fig. 2
A Parker-Langenback (US Army-Navy) retractor is guided by the left index finger and placed against the inferior pole of the goitre.
Fig. 3
Fig. 3
Traction applied with the Parker-Langenback (US Army-Navy) retractor allows leverage on the goitre in order to allow continued development of the plane with the index finger.
Fig. 4
Fig. 4
Cervical leverage facilitates delivery of the goitre into the neck wound.
Fig. 5
Fig. 5
Complete delivery of the goitre through the cervical incision. White arrow marks a capsular tear in one of the colloid nodules from traction on the Parker-Langenback (US Army-Navy) retractor.
Fig. 6
Fig. 6
Extracted specimen showing the narrow “waist” (black arrow) and the large intra-thoracic portion of the goitre. The capsular tear in a colloid nodule is marked by the white arrow.
Fig. 7
Fig. 7
CT Scan of the thorax showing the intra-thoracic goitre (G) extending into the superior mediastinum beyond the aortic arch (A).
Fig. 8
Fig. 8
A Parker-Langenback (US Army-Navy) retractor is guided by the left index finger to the lower border of the goitre.
Fig. 9
Fig. 9
The Parker-Langenback (US Army-Navy) retractor is used to achieve leverage on the goitre allowing digital dissection of the adherent intra-thoracic portion.
Fig. 10
Fig. 10
The intra-thoracic component is completely delivered into the neck wound.
Fig. 11
Fig. 11
Goitre placed on the chest wall after excision to demonstrate the size of the intra-thoracic component.
See this image and copyright information in PMC

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