7 - Approach to the Mediastinum: Transcervical, Transsternal, and Video-Assisted

Abstract

Indications for exploring the mediastinum in the setting of thyroid and parathyroid disease include benign substernal goiter, thyroid malignancy, metastatic lymph nodes arising from thyroid malignancy, and mediastinal parathyroid adenoma. Although these mediastinal pathologies can often be resected through a transcervical approach, a thoracic approach to the mediastinum may be required for complete exposure and resection depending on the lesion’s size, location, and relationship to adjacent structures. These thoracic approaches can include full sternotomy, partial sternotomy, trapdoor incision, and thoracotomy as well as minimally invasive approaches such as mediastinoscopy, thoracoscopy, and robot-assisted thoracoscopic surgery. In cases where a thoracic approach may be required, preoperative consultation and intraoperative collaboration with a cardiothoracic surgeon can facilitate an optimal approach for resection of these intrathoracic mediastinal pathologies.