Split Sternotomy in Retrosternal Thyroid and Mediastinal Parathyroid Pathologies

Objectives: Although cervical incisions are usually sufficient in mediastinal located thyroid and parathyroid pathologies, sometimes mediastinal approaches are required. In recent years, less invasive methods have been used instead of median sternotomy. In this study, the adequacy of the incision and morbidity in patients who underwent split sternotomy due to retrosternal goiter (RG) and mediastinal parathyroid pathology in our clinic were investigated.
Methods: The files of patients who underwent split sternotomy in addition to cervical incision or split sternotomy extending from the sternal notch to the third intercostal space with a separate vertical incision due to retrosternal thyroid pathology or mediastinal ectopic parathyroid adenoma between January 2010 and January 2021 were retrospectively reviewed. Operative success, exposure provided by split sternotomy, and complication rates were investigated.
Results: Twelve patients who underwent split sternotomy were included in the study. The mean age of the patients was 57.25±12.62 (44–83) years. Eight (66.7%) of the patients were female and 4 (33.3%) were male. The indication for surgery was multinodular goiter (MNG) in 3 (25%) patients, recurrent MNG in 3 (25%) patients, hyperparathyroidism in 3 (25%) patients, and thyroid cancer in 3 (25%) patients. Transient hypocalcemia in 6 (50%) patients and unilateral vocal cord paralysis in 1 (8.3%) patient developed postoperatively, and all complications resolved spontaneously in an average of 3 weeks. Median sternotomy was not required for any of the patients.
Conclusion: Split sternotomy is an adequate and applicable method for the success of the surgery in RG and mediastinal parathyroid pathologies that cannot be excised with the cervical approach.

Retrosternal Tiroid ve Mediastinal Paratiroid Patolojilerinde Split Sternotomi

Amaç: Mediastinal yerleþimli tiroid ve paratiroid patolojilerinde genellikle servikal kesiler yeterli olsa da bazen mediastinal yaklaþýmlara ihtiyaç duyulmaktadýr. Son yýllarda median sternotomi yerine daha az invaziv yöntemler kullanýlmaktadýr. Bu çalýþmada, kliniðimizde retrosternal guatr (RG) ve mediastinal paratiroid patolojisi nedeniyle split sternotomi yapýlan hastalarda kesinin yeterliliði ve morbidite araþtýrýldý.
Yöntem: Ocak 2010- Ocak 2021 tarihleri arasýnda kliniðimizde retrosternal tiroid patolojisi veya mediastinal ektopik paratiroid adenomu nedeniyle servikal kesiye ek olarak ya da ayrý vertikal kesi ile sternal çentikten üçüncü interkostal aralýða uzanan split sternotomi uygulanan hastalarýn dosyalarý geriye dönük olarak incelendi. Operatif baþarý, split sternotominin saðladýðý ekspojur ve komplikasyon oranlarý incelendi.
Bulgular: Çalýþmaya split sternotomi uygulanan 12 hasta dahil edildi. Hastalarýn ortalama yaþý 57,25±12,62 (44-83) olarak hesaplandý. Hastalarýn 8’i (%66,7) kadýn, 4'ü (%33,3) ise erkekti. Ameliyat endikasyonu 3 (%25) hastada multinodüler guatr (MNG), 3 (%25) hastada nüks MNG, 3 (%25) hastada hiperparatiroidi ve 3 (%25) hastada tiroid kanseriydi. Ameliyat sonrasý 6 (%50) hastada geçici hipokalsemi ve 1 (%8,3) hastada geçici unilateral vokal kord paralizisi geliþmiþ olup, ortalama 3 haftalýk sürede tüm komplikasyonlar spontan düzeldi. Yine hiçbir hastada medyan sternotomi gerekmedi.
Sonuç: Split sternotomi servikal yaklaþýmla eksize edilemeyen RG ve mediastinal paratiroid patolojilerinde ameliyatýn baþarýsý için yeterli ve uygulanabilir bir yöntemdir. (SETB-2021-05-136)