# Partial upper sternotomy for resection of a large substernal goiter in a high-risk patient

## TL;DR

A partial upper sternotomy is a safer alternative to full sternotomy for removing large substernal goiters in high-risk patients like the morbidly obese.

## Contribution

The paper introduces partial upper sternotomy as a novel, less morbid surgical approach for resecting large substernal goiters in high-risk patients.

## Key findings

- A 33-year-old morbidly obese patient underwent successful resection of a large substernal goiter using a partial upper sternotomy.
- The procedure was well-tolerated with no complications and the patient was discharged on postoperative day two.
- Partial upper sternotomy provides adequate access to the mediastinum while reducing surgical risks compared to full sternotomy.

## Abstract

Substernal goiters (SGs) with significant mediastinal extension can present complex surgical dilemmas. While most SGs can be resected through a low cervical collar incision, a full median sternotomy may be required in select cases. Morbidly obese patients are susceptible to adverse outcomes following full sternotomy, such as wound infection and sternal dehiscence. Partial upper sternotomy is a safe, effective alternative that offers sufficient access to the mediastinum while minimizing surgical morbidity, making it a valuable approach in this high-risk population. We present the case of a 33-year-old female with a BMI of 47 kg/m2 who was found to have a large symptomatic SG with significant mediastinal extension. Due to the depth of extension, a combined cervical and trans-sternal approach was planned. A partial upper sternotomy was performed to avoid the morbidity of full sternotomy. The patient tolerated the procedure well without complications and was discharged home on postoperative day two.