Minimally-Invasive Robotic-Assisted Resection for Intrathoracic Goiter – A Feasible Alternative to Thoracotomy and Sternotomy

Abstract Background Goiter is a common presentation in daily clinical practice. It usually grows slowly and in rare cases with intrathoracic extension. There is no clear definition of intrathoracic goiters. The incidence in the literature varies from 3% to 7%. Most intrathoracic goiters are localized in the anterior mediastinum, with less than 25% are localized in the posterior mediastinum. This presents a challenge for surgical resection. Traditionally, the intrathoracic portions have been resected via sternotomy for anterior goiters and thoracotomy for posterior goiters. With the increasing use of robotic surgery, new possibilities for minimally invasive surgery and especially robotic procedures have emerged. This may reduce morbidity and length of hospital stay. Aims The study aims to show that minimal-invasive, robotic-assisted resection for intrathoracic goiter is safe and feasible. Methods During the study period from January 2021 to December 2023, 548 thyroid operations were performed in our clinic. All operations were prospectively recorded in the Eurocrine registry and retrospectively analyzed. Goiter was defined as intrathoracic according to perioperative findings (caudal border not visible on sonography and/ or further preoperative investigations ordered). Primary and secondary endpoints were outcome, conversion rate, and incidence of intrathoracic goiter. Results In our clinic, 19/548 patients (3.5%) presented with intrathoracic goiter. 17/19 patients were operated via conventional cervical approach. In 2 patients, minimal-invasive robotic mobilization of the large posterior portion of the goiter was performed in combination with conventional cervical thyroidectomy. No conversion was required. Based on our cases, we present robotic intrathoracic thyroid mobilization as a novel technique to avoid thoracotomy. The rate of recurrent nerve palsy in intrathoracic goiter was 1/28 (3.5%) nerves at risk and occurred with conventional approach. No secondary bleeding or other complications were observed. Conclusion The minimal-invasive robotic approach seems to be a promising alternative to open procedures such as thoracotomy and can reduce morbidity and length of hospital stay.