Mediastinal Thyroid adenomas can be of two types. One with a nodule from cervical Thyroid , gets enlarged and protrudes into superior mediastinum. This can be sometimes dissect out from the neck and sometimes may require thoracic approach. Second it can be an adenoma from Thyroid totally situated in the superior mediastinum.
The second anatomical location is tough to approach. The right gland will have brachiocephalic trunk above, esophagus lower down and can have Vagus nerve with RLN laterally. It needs a meticulous , slow, steady dissection.The two videos illustrate our approach for these adenomas which are very risky to attempt to dissect from the neck. As seen in both the cases the glands were very vascular with very very vital structures around which need to be preserved at any cost
Easier a thoracotomy or sternotomy was needed for these cases with more pain and delayed recovery.
With robotic approach this surgery is made doable, standardised and safe for these cases. The steady, endowristed, tremor free, magnified 3D vision has enabled Surgeons to use this approach for successful dissection with delivery from neck side or thoracic side based on their size.