Powered instrumentation for transcervical removal of gigantic intrathoracic thyroid

BACKGROUND: It is widely accepted that almost all intrathoracic goiters can be removed through the neck. For those rare gigantic goiters that cannot be removed transcervically, median sternotomy is usually recommended. During the last 11 years we used intracapsular volume reduction techniques to facilitate transcervical removal of extremely large intrathoracic goiters. Materials and Methods Of 149 patients with intrathoracic goiters, 11 patients had gigantic lesions that could not be removed transcervically. Instead of sternotomy, we used the arthroscopic or sinus microdebrider or a large-bore suction device for controlled intracapsular volume reduction. This was followed by complete removal of the gland through the neck. RESULTS: The thyroid gland was removed completely in all 11 patients. None of the patients had any evidence of intraoperative spillage of thyroid tissue. No major complications were noted. CONCLUSIONS: We have found the use of the microdebrider and/or suction device for intracapsular volume reduction to be extremely helpful for transcervical removal of gigantic intrathoracic goiters.