胸腔縦隔鏡と頸部アプローチ併用にて摘出し得た前縦隔甲状腺腫例

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  • A Case of Anterior Mediastinal Goiter Removed via a Cervical Approach Together with Mediastinoscopy
  • キョウコウ ジュウカクキョウ ト ケイブ アプローチ ヘイヨウ ニテ テキシュツ シエタ ゼン ジュウカク コウジョウセンシュレイ

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<p>We devised a safe, minimally invasive surgery for anterior mediastinal goiter, that did not involve sternotomy, through cooperation between the otolaryngologic and thoracic surgical teams. We report the case of a patient with an anterior mediastinal tumor, in which a cervical incision was made by an otolaryngologist and mediastinoscopy was performed by a thoracic surgeon, and the anterior mediastinal tumor was removed collaboratively.</p><p>A 61-year-old female patient presented to us with a tumor extending from the superior mediastinum to the anterior mediastinum, posterior to the sternum and anterior to the aortic arch. A thoracic surgeon stripped off the anterior aspect of the mediastinum using a mediastinoscope with CO2 gas, inserted via the lower anterior mediastinum below the xiphoid process.</p><p>The otolaryngologist made a transcervical incision, performed tumor exfoliation while taking care to preserve the recurrent and superior laryngeal nerves, removed the portion of the anterior mediastinal tumor via the transcervical incision, and performed a left thyroidectomy. Oral intake was started on the following day. The patient was discharged on postoperative day 7, with no decrease of the thyroid function.</p><p>Removal of anterior mediastinal goiter is often difficult. The sternum obstructs the surgical field, necessitating blind removal, which is difficult and risky, because important vessels including the brachiocephalic arteries and innominate veins, and structures such as the thymus are present. Therefore, surgical removal of anterior mediastinal tumors requires safe and reliable sternotomy to preserve the vascular structure and a clear surgical field. However, this procedure is highly invasive for cases of benign mediastinal goiter.</p><p>We report our method for reliable tumor removal, in which the tumor is removed via a cervical incision using mediastinoscopic guidance, as a minimally invasive surgery for anterior mediastinal goiter, without the need for sternotomy. Cooperation between the otolaryngologic and thoracic surgical teams during surgery involving the thoracic cavity and mediastinum is important, and this case highlights the importance of teamwork in surgical practice.</p>

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