Toboggans Technique for Retrosternal Goiters a Valuable Technique to Protect RLN

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • 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

image-6image-51

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.