- 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
- Progressively from top to bottom:
- After the recurrent nerve dissection:
- The goiter can usually be extracted without difficulty:
- Dividing the last vessels holding the goiter inside
- The goiter can usually be extracted without difficulty:
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 2010
• Complex Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:
• Fox Chase Cancer Center (Filadelfia):
• 2010 to 2012
• Masters in Science (Clinical research for health care professionals):
• Drexel University (Filadelfia):
• 2010 to 2012
• Head and Neck Surgery and Oncology
• IFHNOS / Memorial Sloan Kettering Cancer Center:
• 2014 to 2016