VATS with a supraclavicular window for huge substernal goiter: an alternative technique for preventing recurrent laryngeal nerve injury.

A careless attempt to remove a huge substernal goiter using the cervical approach can lead to recurrent laryngeal nerve injury, which has been consistently reported after the surgery. We present an alternative and less invasive technique combining video-assisted thoracoscopic surgery (VATS) with a supraclavicular approach. This technique seems to offer improved exposure and reliable control of the neuro-vascular structures in the anterior mediastinum when resecting a huge substernal goiter that may prevent nerve injury.