The Experts below are selected from a list of 1944 Experts worldwide ranked by ideXlab platform
Fengyu Chiang - One of the best experts on this subject based on the ideXlab platform.
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recurrent Laryngeal Nerve Injury with incomplete loss of electromyography signal during monitored thyroidectomy evaluation and outcome
Langenbeck's Archives of Surgery, 2017Co-Authors: Chewei Wu, Mengzi Tian, Icheng Lu, Piying Chang, Gianlorenzo Dionigi, Ralph P Tufano, Kwang-yoon Jung, Fengyu ChiangAbstract:Purpose During monitored thyroidectomy, a partially or completely disrupted point of Nerve conduction on the exposed recurrent Laryngeal Nerve (RLN) indicates true electrophysiologic Nerve Injury. Complete loss of signal (LOS; absolute threshold value <100 μV) at the end of operation often indicates a postoperative vocal cord (VC) palsy. However, the evaluation for the injured RLN with incomplete LOS and its functional outcome has not been well described.
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the mechanism of recurrent Laryngeal Nerve Injury during thyroid surgery the application of intraoperative neuromonitoring
Surgery, 2008Co-Authors: Fengyu Chiang, Ichen Lu, Ningchia Chang, Chewei WuAbstract:Background Identification of recurrent Laryngeal Nerve (RLN) has decreased the rates of permanent RLN palsy during thyroid operations; however, unexpected RLN palsy still occurs, even though the visual integrity was assured and most Nerve injuries were not recognized intraoperatively. The aim of this study is to determine the causes of RLN palsy and to identify potentially reversible causes of RLN Injury during the operation with the application of intraoperative neuromonitoring (IONM). Methods One hundred and thirteen patients with 173 Nerves at risk were enrolled in this study. All operations were performed by the same surgeon. The 4-step procedure of IONM was designed to obtain electromagnetic (EMG) signals from the vagus Nerve and RLN before and after resection of thyroid lobe. Results Sixteen Nerves had loss of EMG signals after thyroid dissection, and the causes of Nerve injuries were well elucidated with the application of IONM. One Nerve Injury was caused by inadvertent transection, which led to permanent RLN palsy. Among the remaining 15 Nerves, 1 Injury was caused by a constricting band of connective tissue, which was detected precisely and released intraoperatively, 2 by inadvertent clamping of the Nerve, and 12 by apparent overstretching at the region of Berry's ligament. (Five Nerves regained signals before closing the wound, but 1 showed impaired cord movement. Another 7 Nerves did not regain signals before closing the wound, and all developed temporary RLN palsy.) Conclusions Our 4-step procedure of IONM is useful and helpful in elucidating the potential operative pitfalls during dissection near the RLN. Although the rates of RLN palsy were not decreased in this study, the use of neuromonitoring provided instructive information for future operations by ascertaining where and how the RLN has been injured.
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optimal depth of nim emg endotracheal tube for intraoperative neuromonitoring of the recurrent Laryngeal Nerve during thyroidectomy
World Journal of Surgery, 2008Co-Authors: Koungshing Chu, Chengjing Tsai, Wenrei Kuo, Hsiuya Chen, Kawo Lee, Fengyu ChiangAbstract:Background Malpositioning of the endotracheal surface electrodes can result in dysfunction of intraoperative neuromonitoring (IONM) and increase the risk of recurrent Laryngeal Nerve Injury. The purpose of this study was to investigate the optimal depth of the Nerve integrity monitor (NIM) EMG endotracheal tube.
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optimal depth of nim emg endotracheal tube for intraoperative neuromonitoring of the recurrent Laryngeal Nerve during thyroidectomy
World Journal of Surgery, 2008Co-Authors: Ichen Lu, Hsiuya Chen, Chengjing Tsai, Fengyu ChiangAbstract:Background Malpositioning of the endotracheal surface electrodes can result in dysfunction of intraoperative neuromonitoring (IONM) and increase the risk of recurrent Laryngeal Nerve Injury. The purpose of this study was to investigate the optimal depth of the Nerve integrity monitor (NIM) EMG endotracheal tube.
Terry C Lairmore - One of the best experts on this subject based on the ideXlab platform.
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routine central lymph node dissection with total thyroidectomy for papillary thyroid cancer potentially minimizes level vi recurrence
Surgery, 2016Co-Authors: Chad Hall, Samuel K Snyder, Yolanda Munoz Maldonado, Terry C LairmoreAbstract:Background Treatment strategies for papillary thyroid cancer remain controversial due to the lack of large, randomized controlled trials. The purpose of this study was to review the benefit of routine bilateral central lymph node dissection (CLND) by analyzing local recurrence and complication rates from a single institution over a 15-year period. Methods A retrospective, institutional review board–approved review of the Baylor Scott & White Tumor Registry was performed on all patients who underwent operation for papillary thyroid cancer between 2000 and 2015. Patients were evaluated by age, sex, tumor size, operation performed, pathologic findings, adjuvant therapy, and date of recurrence. Primary outcomes were cancer recurrence, recurrent Laryngeal Nerve Injury, and hypoparathyroidism. Results Total thyroidectomy with CLND was performed in 266 patients. Metastases to level VI lymph nodes were present in 106/266 (39.8%) patients. Average follow-up after thyroidectomy was 46 months (range 1–125 months). Papillary thyroid cancer recurred in 4 patients after thyroidectomy with CLND for primary tumors with mean size of 1.6 cm (range 1.0–2.0 cm). Two patients with T4 tumors had local recurrence in the paratracheal soft tissues, and 2 patients presented with recurrence in the lateral neck. Temporary Nerve injuries occurred in 9/266 (3.4%) and permanent Nerve injuries in 1/266 (0.4%) of CLND. Permanent hypoparathyroidism occurred in 4/266 (1.5%) patients. Conclusion Total thyroidectomy with CLND can safely be performed routinely for treatment of papillary thyroid cancer in the hands of experienced endocrine surgeons. Dissection of level VI lymph nodes does not increase the risk of recurrent Laryngeal Nerve Injury when performed routinely. Bilateral CLND with total thyroidectomy for papillary thyroid cancer potentially minimizes recurrence in the level VI compartment.
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elucidating mechanisms of recurrent Laryngeal Nerve Injury during thyroidectomy and parathyroidectomy
Journal of The American College of Surgeons, 2008Co-Authors: Samuel K Snyder, Terry C Lairmore, John C Hendricks, John W RobertsAbstract:Background Intraoperative Nerve monitoring during thyroidectomy, parathyroidectomy, or related central neck procedures can elucidate actual or potential mechanisms of recurrent Laryngeal Nerve (RLN) Injury, especially visually intact Nerves, which were previously unknown to the endocrine surgeon. Study Design In this prospective evaluation study, 373 patients underwent 380 consecutive thyroidectomy- or parathyroidectomy-related operations using intraoperative Nerve monitoring, with 666 RLNs at risk. The success of visual and functional identification of the RLN, persistent loss of RLN function to Nerve stimulation, the mechanism and location of RLN Injury, and anatomy of the RLN or technical difficulties that appeared potentially risky for RLN Injury were recorded. Results RLN was identified visually or functionally in 98.2% of Nerves at risk. Initial intraoperative Injury to the RLN occurred in 25 Nerves at risk (3.75%). It was significantly more likely to be a visually intact RLN (n = 22; 3.3%) than a transected RLN (n = 3; 0.45%), p Conclusions RLN Injury during thyroidectomy or parathyroidectomy occurs intraoperatively significantly more often to a visually intact RLN than to a transected Nerve. The anterior motor branch of an RLN bifurcating near the ligament of Berry is particularly at risk of traction Injury.
Ichen Lu - One of the best experts on this subject based on the ideXlab platform.
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the mechanism of recurrent Laryngeal Nerve Injury during thyroid surgery the application of intraoperative neuromonitoring
Surgery, 2008Co-Authors: Fengyu Chiang, Ichen Lu, Ningchia Chang, Chewei WuAbstract:Background Identification of recurrent Laryngeal Nerve (RLN) has decreased the rates of permanent RLN palsy during thyroid operations; however, unexpected RLN palsy still occurs, even though the visual integrity was assured and most Nerve injuries were not recognized intraoperatively. The aim of this study is to determine the causes of RLN palsy and to identify potentially reversible causes of RLN Injury during the operation with the application of intraoperative neuromonitoring (IONM). Methods One hundred and thirteen patients with 173 Nerves at risk were enrolled in this study. All operations were performed by the same surgeon. The 4-step procedure of IONM was designed to obtain electromagnetic (EMG) signals from the vagus Nerve and RLN before and after resection of thyroid lobe. Results Sixteen Nerves had loss of EMG signals after thyroid dissection, and the causes of Nerve injuries were well elucidated with the application of IONM. One Nerve Injury was caused by inadvertent transection, which led to permanent RLN palsy. Among the remaining 15 Nerves, 1 Injury was caused by a constricting band of connective tissue, which was detected precisely and released intraoperatively, 2 by inadvertent clamping of the Nerve, and 12 by apparent overstretching at the region of Berry's ligament. (Five Nerves regained signals before closing the wound, but 1 showed impaired cord movement. Another 7 Nerves did not regain signals before closing the wound, and all developed temporary RLN palsy.) Conclusions Our 4-step procedure of IONM is useful and helpful in elucidating the potential operative pitfalls during dissection near the RLN. Although the rates of RLN palsy were not decreased in this study, the use of neuromonitoring provided instructive information for future operations by ascertaining where and how the RLN has been injured.
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optimal depth of nim emg endotracheal tube for intraoperative neuromonitoring of the recurrent Laryngeal Nerve during thyroidectomy
World Journal of Surgery, 2008Co-Authors: Ichen Lu, Hsiuya Chen, Chengjing Tsai, Fengyu ChiangAbstract:Background Malpositioning of the endotracheal surface electrodes can result in dysfunction of intraoperative neuromonitoring (IONM) and increase the risk of recurrent Laryngeal Nerve Injury. The purpose of this study was to investigate the optimal depth of the Nerve integrity monitor (NIM) EMG endotracheal tube.
Chewei Wu - One of the best experts on this subject based on the ideXlab platform.
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recurrent Laryngeal Nerve Injury with incomplete loss of electromyography signal during monitored thyroidectomy evaluation and outcome
Langenbeck's Archives of Surgery, 2017Co-Authors: Chewei Wu, Mengzi Tian, Icheng Lu, Piying Chang, Gianlorenzo Dionigi, Ralph P Tufano, Kwang-yoon Jung, Fengyu ChiangAbstract:Purpose During monitored thyroidectomy, a partially or completely disrupted point of Nerve conduction on the exposed recurrent Laryngeal Nerve (RLN) indicates true electrophysiologic Nerve Injury. Complete loss of signal (LOS; absolute threshold value <100 μV) at the end of operation often indicates a postoperative vocal cord (VC) palsy. However, the evaluation for the injured RLN with incomplete LOS and its functional outcome has not been well described.
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recurrent Laryngeal Nerve Injury in video assisted thyroidectomy lessons learned from neuromonitoring
Surgical Endoscopy and Other Interventional Techniques, 2012Co-Authors: Gianlorenzo Dionigi, Marcin Barczynski, Gregory W Randolph, Luigi Boni, Piero F Alesina, F Y Chiang, Gabriele Materazzi, David J Terris, Chewei WuAbstract:Introduction The objective of the study was to assess the mechanism of recurrent Laryngeal Nerve (RLN) Injury during video-assisted thyroidectomy (VAT).
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the mechanism of recurrent Laryngeal Nerve Injury during thyroid surgery the application of intraoperative neuromonitoring
Surgery, 2008Co-Authors: Fengyu Chiang, Ichen Lu, Ningchia Chang, Chewei WuAbstract:Background Identification of recurrent Laryngeal Nerve (RLN) has decreased the rates of permanent RLN palsy during thyroid operations; however, unexpected RLN palsy still occurs, even though the visual integrity was assured and most Nerve injuries were not recognized intraoperatively. The aim of this study is to determine the causes of RLN palsy and to identify potentially reversible causes of RLN Injury during the operation with the application of intraoperative neuromonitoring (IONM). Methods One hundred and thirteen patients with 173 Nerves at risk were enrolled in this study. All operations were performed by the same surgeon. The 4-step procedure of IONM was designed to obtain electromagnetic (EMG) signals from the vagus Nerve and RLN before and after resection of thyroid lobe. Results Sixteen Nerves had loss of EMG signals after thyroid dissection, and the causes of Nerve injuries were well elucidated with the application of IONM. One Nerve Injury was caused by inadvertent transection, which led to permanent RLN palsy. Among the remaining 15 Nerves, 1 Injury was caused by a constricting band of connective tissue, which was detected precisely and released intraoperatively, 2 by inadvertent clamping of the Nerve, and 12 by apparent overstretching at the region of Berry's ligament. (Five Nerves regained signals before closing the wound, but 1 showed impaired cord movement. Another 7 Nerves did not regain signals before closing the wound, and all developed temporary RLN palsy.) Conclusions Our 4-step procedure of IONM is useful and helpful in elucidating the potential operative pitfalls during dissection near the RLN. Although the rates of RLN palsy were not decreased in this study, the use of neuromonitoring provided instructive information for future operations by ascertaining where and how the RLN has been injured.
Chengjing Tsai - One of the best experts on this subject based on the ideXlab platform.
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optimal depth of nim emg endotracheal tube for intraoperative neuromonitoring of the recurrent Laryngeal Nerve during thyroidectomy
World Journal of Surgery, 2008Co-Authors: Koungshing Chu, Chengjing Tsai, Wenrei Kuo, Hsiuya Chen, Kawo Lee, Fengyu ChiangAbstract:Background Malpositioning of the endotracheal surface electrodes can result in dysfunction of intraoperative neuromonitoring (IONM) and increase the risk of recurrent Laryngeal Nerve Injury. The purpose of this study was to investigate the optimal depth of the Nerve integrity monitor (NIM) EMG endotracheal tube.
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optimal depth of nim emg endotracheal tube for intraoperative neuromonitoring of the recurrent Laryngeal Nerve during thyroidectomy
World Journal of Surgery, 2008Co-Authors: Ichen Lu, Hsiuya Chen, Chengjing Tsai, Fengyu ChiangAbstract:Background Malpositioning of the endotracheal surface electrodes can result in dysfunction of intraoperative neuromonitoring (IONM) and increase the risk of recurrent Laryngeal Nerve Injury. The purpose of this study was to investigate the optimal depth of the Nerve integrity monitor (NIM) EMG endotracheal tube.
