Obviating the need for sternotomy: Safety and effectiveness of
microdebrider use for retrosternal goiter
Elad Dagan MD
Stephen Kleid MB, BS, FRACS
Division of Cancer Surgery, Peter
MacCallum Cancer Centre, Melbourne,
Elad Dagan, Division of Cancer Surgery,
Peter MacCallum Cancer Centre, 305
Grattan Street, Melbourne, Victoria,
Background: Most retrosternal goiter surgical removal can be performed via a trans-
cervical approach. However, it is often a challenging procedure, which might include
Methods: We describe a surgical technique using a microdebrider for intracapsular
volume reduction that precedes an extracapsular thyroidectomy, thereby avoiding the
need for sternotomy, with decreased morbidity and risk. The procedure is described
in detail with 2 representative cases and a summary of our experience in 26 cases.
Results: Twenty-six patients with retrosternal goiters are included in our cohort.
None of the patients needed a sternotomy, and no major or permanent complications
occurred. The average length of hospital stay was 4.30 days after total thyroidectomy
and 2.57 days after hemithyroidectomy.
Conclusion: The use of a microdebrider for intracapsular volume reduction thyroidec-
tomy is extremely helpful for transcervical removal of retrosternal goiters in selected
cases, and avoids the need for sternotomy, which is especially beneficial in elderly
patients, and those with comorbidities for whom sternotomy should be avoided.
avoiding sternotomy, intracapsular thyroidectomy, microdebrider, retrosternal goiter, thyroidectomy
Retrosternal goiters are documented in 2%-26% of all thyroi-
dectomies, depending on the defining criteria, especially
because the term is vague with no uniform definition.
most commonly accepted definitions describe a retrosternal goi-
ter as an enlarged thyroid that has descended below the plane
of the thoracic inlet, or has >50% of its mass lying inferior to
The clinical presentation of a retrosternal
goiter varies among patients, ranging from asymptomatic or
slight discomfort to a major dysfunction affecting airway and
swallowing, and even compression of large vessels.
gical management of a retrosternal goiter varies, ranging from
subtotal or complete hemithyroidectomy to total removal of the
Regardless of the surgical approach, such surgery is
challenging and involves a higher risk for the patient, with an
increased morbidity, especially if a sternotomy is performed.
In this article, we describe our surgical technique of intra-
capsular volume reduction in 26 patients over 10 years using
a microdebrider (which is usually used in endoscopic sinus
surgery), as part of a hemithyroidectomy or total thyroidec-
tomy, which has completely avoided the need for sternotomy
in our patients with retrosternal goiters without increasing
the risk to the patient.
MATERIALS AND METHODS
This retrospective study was of 26 patients with a CT proven
diagnosis of retrosternal goiter who underwent operations
between years 2006 and 2016 by the chief author (S.K.)
using a microdebrider/suction device for intracapsular
volume reduction (debulking) facilitating a subsequent
routine extracapsular thyroidectomy. We cannot describe a
Head & Neck. 2018;40:837–841. wileyonlinelibrary.com/journal/hed
2018 Wiley Periodicals, Inc.
Received: 13 March 2017
Revised: 22 September 2017
Accepted: 28 November 2017