The Experts below are selected from a list of 297 Experts worldwide ranked by ideXlab platform
Gregory W. Randolph - One of the best experts on this subject based on the ideXlab platform.
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surgical management of the compromised Recurrent Laryngeal Nerve in thyroid cancer
Best Practice & Research Clinical Endocrinology & Metabolism, 2019Co-Authors: Marika D Russell, Gregory W. Randolph, Dipti KamaniAbstract:Surgical management of thyroid cancer requires careful consideration of the Recurrent Laryngeal Nerve and its impact on glottic function. Management of the compromised Recurrent Laryngeal Nerve is a complex task, requiring synthesis of multiple elements. The surgeon must have an appreciation for preoperative Recurrent Laryngeal Nerve function, intraoperative anatomic and electromyographic information, disease characteristics, and relevant patient factors. Preoperative clinical evaluation including preoperative laryngoscopy and assessment of Recurrent Laryngeal Nerve risk is essential to formulating a surgical plan and providing appropriate patient counseling. Intraoperative neuromonitoring information has significant implications for surgical management of the injured or invaded Recurrent Laryngeal Nerve and informs strategy with respect to staging of bilateral surgery. Disease characteristics and patient-related factors, including patient preference, must be considered with intraoperative decision-making. Multidisciplinary discussion and patient communication are essential for effective management and successful surgical outcome.
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Recurrent Laryngeal Nerve monitoring during thyroid surgery normative vagal and Recurrent Laryngeal Nerve electrophysiological data
Otolaryngology-Head and Neck Surgery, 2012Co-Authors: Eimear Phelan, Dipti Kamani, Andre S Potenza, Cristian M Slough, David Zurakowski, Gregory W. RandolphAbstract:ObjectiveInjury to the Recurrent Laryngeal Nerve (RLN) remains a significant cause of morbidity during thyroid surgery. Intraoperative Nerve monitoring (IONM) is being applied in many centers to facilitate Nerve identification. The aim of this study was to elucidate normative human vagal and Recurrent Laryngeal Nerve electromyograhic (EMG) parameters during standard IONM application.Study DesignA prospective IONM study conducted over an 8-month period. Internal review board (IRB) approval was obtained.SettingsDepartment of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Boston.Subjects and MethodsAll patients who were scheduled for routine thyroid, parathyroid, or neck exploration surgery were invited to participate. All patients had a preoperative and postoperative Laryngeal examination to assess vocal cord function. Any patient with an abnormal preoperative Laryngeal examination was excluded.ResultsFifty-eight patients participated in this study. The rig...
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Management of the Recurrent Laryngeal Nerve in thyroid surgery
Operative Techniques in Otolaryngology-head and Neck Surgery, 2009Co-Authors: Sara L. Richer, Gregory W. RandolphAbstract:The importance of preservation of the Recurrent Laryngeal Nerve in thyroid surgery has been well known since the early 19th century. All modern endocrine surgeons need to have a thorough knowledge of both anatomy and strategies for management of the Recurrent Laryngeal Nerve which, importantly, includes neural monitoring. Important considerations for surgical approaches to the Recurrent Laryngeal Nerve, Nerve-monitoring techniques, and management of infiltrated or traumatized Nerves are described.
Takeshi Aoki - One of the best experts on this subject based on the ideXlab platform.
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Minimally invasive esophagectomy and radical lymph node dissection without Recurrent Laryngeal Nerve paralysis
Surgical Endoscopy, 2020Co-Authors: Koji Otsuka, Masahiko Murakami, Satoru Goto, Tomotake Ariyoshi, Takeshi Yamashita, Akira Saito, Masahiro Kohmoto, Rei Kato, Alan Kawarai Lefor, Takeshi AokiAbstract:Background We introduce a novel operative technique to dissect lymph nodes adjacent to the Recurrent Laryngeal Nerve, referred to as the “native tissue preservation” technique. Using this technique, there was no damage to the Recurrent Laryngeal Nerve, which is maintained in its anatomical position. Methods From September 2016 to December 2018, minimally invasive esophagectomy was performed in the left lateral decubitus position in 87 patients with esophageal cancer. The native tissue preservation technique for lymphadenectomy around the Recurrent Laryngeal Nerve was used, and all patients were evaluated for Recurrent Laryngeal Nerve paralysis. Results Minimally invasive esophagectomy was completed in all patients without conversion to thoracotomy. Although an extended lymphadenectomy was performed in all patients, there were no grade II or higher complications (Clavien–Dindo classification) and no incidence of Recurrent Laryngeal Nerve paralysis. Conclusion The native tissue preservation technique may reduce the incidence of Recurrent Laryngeal Nerve paralysis after minimally invasive esophagectomy with radical lymph node dissection.
Koji Otsuka - One of the best experts on this subject based on the ideXlab platform.
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Minimally invasive esophagectomy and radical lymph node dissection without Recurrent Laryngeal Nerve paralysis
Surgical Endoscopy, 2020Co-Authors: Koji Otsuka, Masahiko Murakami, Satoru Goto, Tomotake Ariyoshi, Takeshi Yamashita, Akira Saito, Masahiro Kohmoto, Rei Kato, Alan Kawarai Lefor, Takeshi AokiAbstract:Background We introduce a novel operative technique to dissect lymph nodes adjacent to the Recurrent Laryngeal Nerve, referred to as the “native tissue preservation” technique. Using this technique, there was no damage to the Recurrent Laryngeal Nerve, which is maintained in its anatomical position. Methods From September 2016 to December 2018, minimally invasive esophagectomy was performed in the left lateral decubitus position in 87 patients with esophageal cancer. The native tissue preservation technique for lymphadenectomy around the Recurrent Laryngeal Nerve was used, and all patients were evaluated for Recurrent Laryngeal Nerve paralysis. Results Minimally invasive esophagectomy was completed in all patients without conversion to thoracotomy. Although an extended lymphadenectomy was performed in all patients, there were no grade II or higher complications (Clavien–Dindo classification) and no incidence of Recurrent Laryngeal Nerve paralysis. Conclusion The native tissue preservation technique may reduce the incidence of Recurrent Laryngeal Nerve paralysis after minimally invasive esophagectomy with radical lymph node dissection.
Feng Yu Chiang - One of the best experts on this subject based on the ideXlab platform.
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severity of Recurrent Laryngeal Nerve injuries in thyroid surgery
World Journal of Surgery, 2016Co-Authors: Gianlorenzo Dionigi, Chewei Wu, Stefano Rausei, Luigi Boni, Feng Yu ChiangAbstract:Background Few studies in the literature have reported recovery data for different types of Recurrent Laryngeal Nerve injuries (RLNIs). This study is the first attempt to classify RLNIs and rank them by severity.
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Recurrent Laryngeal Nerve palsy after thyroidectomy with routine identification of the Recurrent Laryngeal Nerve
Surgery, 2005Co-Authors: Feng Yu Chiang, Lingfeng Wang, Yinfeng HuangAbstract:Background The aim of this study was to assess the risk of Recurrent Laryngeal Nerve palsy (RLNP) after thyroidectomy with routine identification of the Recurrent Laryngeal Nerve (RLN) during the operation. Methods The present study was confined to 521 patients, 348 total lobectomies and 178 total thyroidectomies, treated by the same surgeon. Temporary and permanent RLNP rates were analyzed for patient groups with stratification of primary operation for benign thyroid disease, thyroid cancer, Graves' disease, and reoperation. Measurement of the RLNP rate was based on the number of Nerves at risk. Twenty-six RLNs in 20 thyroid cancer patients with intentional sacrifice were excluded from analysis. Results Forty RLNs (40 patients) developed postoperative RLNP. Complete recovery of RLN function was documented for 35 of the 37 patients (94.6%) whose RLN integrity had been ensured intraoperatively. Recovery from temporary RLNP ranged from 3 days to 4 months (mean, 30.7 days). Overall incidence of temporary and permanent RLNP was 5.1% and 0.9%, respectively. The rates of temporary/permanent RLNP were 4.0/0.2%, 2.0/0.7%, 12.0/1.1%, and 10.8/8.1% for groups classified according to benign thyroid disease, thyroid cancer, Graves' disease, and reoperation, respectively. Conclusions Operations for thyroid cancer, Graves' disease, and Recurrent goiter demonstrated significantly higher RLNP rates. Invasion of RLN was identified in 19.4% of patients with thyroid cancer. Postoperatively, the RLN recovered in most of the patients without documented Nerve damage during the operation. Total lobectomy with routine RLN identification is recommended as a basic procedure in thyroid operations.
Norikaki Ohuchi - One of the best experts on this subject based on the ideXlab platform.
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Complications following Recurrent Laryngeal Nerve lymph node dissection in oesophageal cancer surgery
Interactive Cardiovascular and Thoracic Surgery, 2014Co-Authors: Yusuke Taniyama, Go Miyata, Takashi Kamei, Toru Nakano, Kazunori Katsura, Tadashi Sakurai, Jin Teshima, Makoto Hikage, Norikaki OhuchiAbstract:OBJECTIVES: The Recurrent Laryngeal Nerve lymph node is one of the most common metastatic sites in oesophageal cancer, and dissection of this lymph node is considered beneficial. Although the risk of complications from this procedure, such as Recurrent Laryngeal Nerve palsy, is well known, few reports have detailed those risks in a large number of cases. Our study examined the risks of Recurrent Laryngeal Nerve lymph node dissection, with a special focus on Recurrent Laryngeal Nerve palsy. METHODS: Retrospectively collected data from 661 patients, who underwent transthoracic oesophagectomy for oesophageal cancer, were analysed. RESULTS: Recurrent Laryngeal Nerve palsy occurred in 36% of the patients. Among these patients, except those in whom Recurrent Laryngeal Nerve was intentionally excised due to metastatic lymph node, permanent palsy was detected in 12%. Bilateral Recurrent Laryngeal Nerve lymph node dissection, cervical anastomosis and upper oesophageal cancer were independent risk factors for Recurrent Laryngeal Nerve palsy. Although Recurrent Laryngeal Nerve palsy was a risk factor for aspiration, tracheostomy and postoperative pneumonia, it did not directly correlate with death caused by pneumonia. Among postoperative complications, only Recurrent Laryngeal Nerve palsy correlated with bilateral Recurrent Laryngeal Nerve lymph node dissection. CONCLUSIONS: Recurrent Laryngeal Nerve palsy is a complication that should be avoided but does not seem to be severe enough to affect patient survival after surgery. Although bilateral Recurrent Laryngeal Nerve lymph node dissection can induce Recurrent Laryngeal Nerve palsy in patients who undergo transthoracic oesophagectomy, this procedure did not correlate with aspiration and pneumonia.