Toboggans Technique for Retrosternal Goiters a Valuable Technique to Protect RLN

  • Toboggans technique for retrosternal goitre a valuable technique to protect RLN:
    • The surgery of retrosternal goiter is at increased risk for iatrogenic recurrent laryngeal nerve lesion
  • Charles Proye:
    • Described a surgical technique to avoid this lesion
  • To have a better exposition, resection of the prethyroid muscles can be considered:
    • Particularly if it is a voluminous and / or recurrent goiter. 
  • The approach starts with:
    • The thyroid isthmus liberation that is dissected free from the anterior part of the trachea and transected
  • Then:
    • The middle thyroid vein is divided and the superior pole vessels are divided
  • The superior pole is then mobilized laterally:
    • And the recurrent laryngeal nerve is searched for at its entry point into the larynx
  • The nerve function can be verified by the neuromonitoring:
    • Which also helps to find it in this vessel-rich area
  • The dissection continues between the nerve and the posterior part of the thyroid:
    • Progressively from top to bottom:
      • Descending as on a toboggan
  • After the recurrent nerve dissection:
    • The goiter can usually be extracted without difficulty:
      • Dividing the last vessels holding the goiter inside

https://www.liebertpub.com/doi/full/10.1089/ve.2014.0009

Rodrigo Arrangoiz MS, MD, FACS thyroid and parathyroid surgeon at Mount Sinai Medical Center.

Surgical Training:

• General Surgery
• Michigan State University:
• 2005 to 2010image-48• Complex Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:
• Fox Chase Cancer Center (Filadelfia):
• 2010 to 2012image-39• Masters in Science (Clinical research for health care professionals):
• Drexel University (Filadelfia):
• 2010 to 2012image-50• Head and Neck Surgery and Oncology
• IFHNOS / Memorial Sloan Kettering Cancer Center:
• 2014 to 2016

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