Background: This study was aimed at exploring the feasibility and strategies of laparoscopic thyroidectomy for treatment of substernal goiter via areola approach.
Methods: A retrospective analysis was conducted to investigate 15 cases of laparoscopic resection of substernal goiter via the areola approach (laparoscopic group) and 12 cases of open resection of substernal goiter via low-neck collar cervical approach (open group) that was completed between December 2012 and December 2014. Operative time, estimated blood loss, postoperative hospitalization and postoperative complication were compared. Follow-up data were assessed, and the mean duration of follow-up was 24.5 ± 7.5 months.
Results: The surgery was successfully completed in 14 cases, and 1 case was intraoperatively converted to open surgery. All the procedures were successfully completed in the open group. There was no difference in the mean distance from the inferior border of the excised substernal mass to the sternal notch, operation time, intraoperative estimated blood loss, postoperative hospital stay or the drainage tubes removed. Five cases had transient hypocalcemia after surgery in the laparoscopic group, while 1 case in the open group. There were no cases of hoarseness, dysphagia, lymphatic leakage, dyspnea and death in the two groups. And there were no recurrent cases in the follow-up.
Conclusion: Laparoscopic thyroidectomy for the treatment of selected substernal goiter via the areola approach is feasible. Preoperative B-ultrasound and 3D-CT scan reconstruction help to select cases and formulate surgical strategies, and the way that the thyroid is suspended using silk threads intraoperatively can reduce surgical difficulties and risks of intraoperative conversion to open surgery.
Keywords: Areola approach; Laparoscope; Silk thread; Strategies; Substernal goiter; Thyroidectomy.