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A surgical algorithm for the management of retrosternal goiters
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  • Tsu-Hui (Hubert) Low,
  • George Petrides,
  • Richard Inculet,
  • Kevin Fung,
  • Anthony Nichols,
  • S. Danielle MacNeil,
  • John Yoo
Tsu-Hui (Hubert) Low
Chris O'Brien Lifehouse
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George Petrides
Chris O'Brien Lifehouse
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Richard Inculet
London Health Sciences Centre
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Kevin Fung
University of Western Ontario
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Anthony Nichols
University of Western Ontario
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S. Danielle MacNeil
University of Western Ontario
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John Yoo
London Health Sciences Centre
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Abstract

Key points: - The heterogeneity of retrosternal goiter size and location, nearby anatomical structures, and evolving surgical techniques means selecting the most appropriate individualised surgical approach remains challenging. - Although most retrosternal goiters can be removed transcervically, a small proportion of patients fulfill anatomical and radiological criteria for concurrent extracervical approaches based on decades of experience at the London Health Sciences Centre. - Anterior goiters above the level of the pericardium were resected using cervical thyroidectomy with either mediastinoscopic-assisted delivery or cervical thyroidectomy with video- assisted thyroidectomy (VATS) - Anterior goiters extending beyond the pericardium require median sternotomy to facilitate sufficient vascular control and exposure. - Posteriorly extending goiters can be managed using trans-thoracic approaches including lateral thoracotomy or VATS.