Robot-assisted thoracoscopic surgery of primary and secondary intrathoracic goiter

Intrathoracic goiter can be primary or secondary. Surgical therapy depends on the size and location of the tumor mass. While traditional approaches involve sternotomy or thoracotomy for extracervical access, minimally invasive techniques have been increasingly used in recent years. We describe two cases of robot-assisted thoracoscopic surgery used for a primary and a secondary intrathoracic goiter.

The first case describes the treatment of an ectopic goiter located in the anterior and superior mediastinum by DaVinci robot-assisted thoracoscopic surgery (Intuitive Surgical, Sunnyvale, CA, USA). The blood supply came from intrathoracic vessels, and there was no connection to the orthotopic regular thyroid gland. The second intrathoracic goiter was in the posterior mediastinum and caused by a downgrowth of the right lobe of the thyroid gland. Surgery was performed in a two-stage procedure. Initially, the right lobe was mobilized by a cervical incision, then the thoracic mass was removed through DaVinci robot-assisted thoracoscopic resection.

Both procedures were carried out without complications. The postoperative course was uneventful for the first patient, who experienced only temporary intercostal pain. The second patient required postoperative intensive care due to respiratory and neurological issues and suffered temporary recurrent laryngeal nerve palsy.

The type of procedure depends on the size and location of the mass and may require a combined cervical and thoracoscopic approach. Minimally invasive techniques can reduce pain and morbidity in thoracic operative access. The DaVinci robotic surgical system also enables precise dissection in narrow spaces like the mediastinum.