The Experts below are selected from a list of 22968 Experts worldwide ranked by ideXlab platform
Julie Ann Sosa - One of the best experts on this subject based on the ideXlab platform.
-
Thyroid Surgery for differentiated Thyroid cancer recent advances and future directions
Nature Reviews Endocrinology, 2018Co-Authors: Tracy S Wang, Julie Ann SosaAbstract:Population-based studies have demonstrated that an increasing number of incidental Thyroid nodules are being identified. The corresponding increase in Thyroid-based diagnostic procedures, such as fine-needle aspiration biopsy, has in part led to an increase in the diagnoses of Thyroid cancers and to more Thyroid surgeries being performed. Small papillary Thyroid cancers account for most of this increase in diagnoses. These cancers are considered to be low risk because of the excellent patient outcomes, with a 5-year disease-specific survival of >98%. As a result, controversy remains regarding the optimal management of newly diagnosed differentiated Thyroid cancer, as the complications related to Thyroidectomy (primarily recurrent laryngeal nerve injury and hypoparaThyroidism) have considerable effects on patient quality of life. This Review highlights current debates, including undertaking active surveillance versus Thyroid Surgery for papillary Thyroid microcarcinoma, the extent of Thyroid Surgery and lymphadenectomy for low-risk differentiated Thyroid cancer, and the use of molecular testing to guide decision-making about whether Surgery is required and the extent of the initial operation. This Review includes a discussion of current consensus guideline recommendations regarding these topics in patients with differentiated Thyroid cancer. Additionally, innovative Thyroidectomy techniques (including robotic and transoral approaches) are discussed, with an emphasis on patient preferences around decision-making and outcomes following Thyroidectomy. Small papillary Thyroid cancers are considered low risk and account for the majority of incidental Thyroid nodules. Here, Tracy S. Wang and Julie A. Sosa discuss the current debates and advances regarding the diagnosis and optimal treatment of differentiated Thyroid cancer.
-
Thyroid Surgery for differentiated Thyroid cancer recent advances and future directions
Nature Reviews Endocrinology, 2018Co-Authors: Tracy S Wang, Julie Ann SosaAbstract:Population-based studies have demonstrated that an increasing number of incidental Thyroid nodules are being identified. The corresponding increase in Thyroid-based diagnostic procedures, such as fine-needle aspiration biopsy, has in part led to an increase in the diagnoses of Thyroid cancers and to more Thyroid surgeries being performed. Small papillary Thyroid cancers account for most of this increase in diagnoses. These cancers are considered to be low risk because of the excellent patient outcomes, with a 5-year disease-specific survival of >98%. As a result, controversy remains regarding the optimal management of newly diagnosed differentiated Thyroid cancer, as the complications related to Thyroidectomy (primarily recurrent laryngeal nerve injury and hypoparaThyroidism) have considerable effects on patient quality of life. This Review highlights current debates, including undertaking active surveillance versus Thyroid Surgery for papillary Thyroid microcarcinoma, the extent of Thyroid Surgery and lymphadenectomy for low-risk differentiated Thyroid cancer, and the use of molecular testing to guide decision-making about whether Surgery is required and the extent of the initial operation. This Review includes a discussion of current consensus guideline recommendations regarding these topics in patients with differentiated Thyroid cancer. Additionally, innovative Thyroidectomy techniques (including robotic and transoral approaches) are discussed, with an emphasis on patient preferences around decision-making and outcomes following Thyroidectomy.
Henning Dralle - One of the best experts on this subject based on the ideXlab platform.
-
postoperative vocal fold palsy in patients undergoing Thyroid Surgery with continuous or intermittent nerve monitoring
British Journal of Surgery, 2015Co-Authors: Rick Schneider, C Sekulla, Andreas Machens, Kerstin Lorenz, Nguyen P Thanh, Henning DralleAbstract:Background Continuous monitoring of electromyographic (EMG) amplitudes of the vocal muscles detects impending injury of the recurrent laryngeal nerve (RLN) during Thyroid operations earlier than intermittent EMG monitoring. This may alert the surgeon to stop a manoeuvre causing stretching or pressure on the RLN, with better recovery of nerve function. Methods Patients with intact preoperative RLN function who underwent Thyroid Surgery for benign disease between January 2011 and September 2014 under continuous intraoperative nerve monitoring (CIONM) or intermittent intraoperative nerve monitoring (IIONM) were included in this observational study conducted at a tertiary surgical centre. For CIONM, combined EMG events indicative of imminent nerve injury were defined as an EMG amplitude decrease of 50 per cent or more and a latency increase of 10 per cent relative to baseline values. The rates of early and permanent palsy for the two groups of patients were compared. Results There were 1526 patients, 788 of whom (1314 nerves at risk) underwent Thyroid Surgery using CIONM and 738 (965 nerves at risk) had IIONM. With the use of CIONM, 63 (82 per cent) of 77 combined events were reversible during the operation. No permanent vocal fold palsy occurred with CIONM, whereas four unilateral permanent vocal fold palsies (0·4 per cent) were diagnosed after IIONM (P = 0·019). Conclusion Operation with CIONM resulted in fewer permanent vocal fold palsies compared with IIONM after Thyroid Surgery in patients with benign disease.
-
safety of neural monitoring in Thyroid Surgery
International Journal of Surgery, 2013Co-Authors: Gianlorenzo Dionigi, Henning Dralle, Feng Yu Chiang, Marcin Barczynski, Luigi Boni, Stefano Rausei, Francesca Rovera, Eliana Piantanida, Alberto Mangano, Gregory W RandolphAbstract:Abstract During Thyroid Surgery, the functional integrity of the recurrent laryngeal nerve (RLN) is not only threatened by direct nerve injury resulting from accidental transection, clipping or ligation. In fact, indirect trauma, e.g. traction and compression occurring repeatedly throughout gland dissection, contribute to long-term nerve impairment. In order to avoid RLN lesions and preserve nerve function the surgeon must adhere to and comply with a strict standardized intraoperative neuromonitoring (IONM) technique to preserve results, quality and safety. IONM should be a team work between the surgeon and the anesthesiologist.
-
verdicts on malpractice claims after Thyroid Surgery emerging trends and future directions
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2012Co-Authors: Henning Dralle, Kerstin Lorenz, Andreas MachensAbstract:Background. Few investigations have addressed malpractice litigation after Thyroid Surgery. The purpose of this medico- legal review was to provide a more comprehensive picture of medico- legal trends in Thyroid Surgery. Methods. Reviewed were all expert opinions on claims of malpractice after Thyroid Surgery, commissioned between 1995 and 2010 at 1 tertiary center, and their corresponding verdicts. Results. Forty-three of 75 malpractice claims involved recurrent laryngeal nerve (RLN) palsy (21 unilateral and 22 bilateral palsies), with a 45% tracheostomy rate for bilateral RLN palsy. Twenty-one claims concerned permanent hypoparaThyroidism. Since 2007, intraoperative nerve monitoring (IONM) has become the subject of pleading in 4 of 7 malpractice claims involving unilateral or bilateral RLN palsy. In none of these cases did IONM follow international standards, resulting in 3 plaintiff verdicts. Conclusion. The growing appreciation that standardized IONM can prevent bilateral RLN palsies after signal loss on the initial side of resection may become increasingly relevant to malpractice litigation. V C 2012 Wiley Periodicals, Inc. Head Neck 34: 1591-1596, 2012
-
loss of the nerve monitoring signal during bilateral Thyroid Surgery
British Journal of Surgery, 2012Co-Authors: Henning Dralle, Rick Schneider, C Sekulla, Kerstin Lorenz, Nguyen P Thanh, Andreas MachensAbstract:Background: This study aimed to assess current use of recurrent laryngeal nerve monitoring (RLNM) for bilateral Thyroid Surgery in Germany. It explored the willingness of surgeons to change strategy after loss of signal (LOS) on the first side of resection. Methods: Surgical departments in Germany equipped with nerve monitors were asked to complete a structured questionnaire, specifying the number of Thyroidectomies done in 2010, and the frequencies of RLNM, vagal stimulation, and electromyographic (EMG) recording before and after Thyroidectomy. They were also asked about the surgical plan for bilateral goitre after LOS on the first side of resection. Results: Based on manufacturers' sales data, 1119 (89·1 per cent) of 1256 surgical departments in Germany were equipped with nerve monitors in 2010. A total of 595 departments (53·2 per cent), accounting for approximately 75 per cent of all Thyroidectomies in Germany during that year, returned a completed questionnaire. RLNM was used in 91·7–93·5 per cent of Thyroidectomies, with the addition of routine vagal stimulation in 49·3 per cent before, and 73·8 per cent after resection. EMG responses to vagal stimulation were recorded in 54·8 per cent before, and 72·5 per cent after resection. Some 93·5 per cent of surgeons changed the resection plan for the other side in bilateral Thyroid Surgery after LOS had occurred on the first side. Conclusion: RLNM is now the standard of care during Thyroidectomy in Germany. After LOS on the first side of resection in bilateral goitre, more than 90 per cent of respondents declared their willingness to change the resection plan for the contralateral side to avoid the risk of bilateral recurrent laryngeal nerve palsy. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
-
Thyroid Surgery guided by intraoperative neuromonitoring
2012Co-Authors: Henning Dralle, Gregory W Randolph, Kerstin Lorenz, Andreas MachensAbstract:From its humble beginnings 150 years ago, Thyroid Surgery not only endeavored to resect Thyroid disease but at the same time strove to preserve those structures adjacent to the Thyroid gland that are of utmost importance physiologically and for maintenance of quality of life: recurrent laryngeal nerves (RLN) and paraThyroid glands. Postoperative RLN palsy and postoperative hypoparaThyroidism, more than recurrence of Thyroid disease, were to become key performance indicators of the quality of Thyroid Surgery.
Gianlorenzo Dionigi - One of the best experts on this subject based on the ideXlab platform.
-
precision neuromuscular block management for neural monitoring during Thyroid Surgery
Journal of Investigative Surgery, 2020Co-Authors: Piying Chang, Gianlorenzo Dionigi, Gregory W Randolph, Tzuyen Huang, Yichu Lin, Dipti Kamani, Feng Yu ChiangAbstract:Titration of neuromuscular block (NMB) plays a key role in intraoperative recurrent laryngeal nerve monitoring during Thyroid Surgery. The combination of neuromuscular blocking agent and timely par...
-
gastric acid secretion and gastrin release during continuous vagal neuromonitoring in Thyroid Surgery
Langenbeck's Archives of Surgery, 2017Co-Authors: Liu Xiaoli, Gianlorenzo Dionigi, Chewei Wu, Gregory W Randolph, Angkoon Anuwong, Feng Yu Chiang, Wen Tian, Matteo LavazzaAbstract:Purpose The vagus nerve (VN) has essential regulatory roles in the gastric acid secretion and gastrin release. Continuous intraoperative neuromonitoring (CIONM) via VN stimulation is a promising technique in Thyroid Surgery because it potentially avoids injury to the recurrent laryngeal nerve. However, no studies have investigated changes in gastric acid secretion and gastrin release during CIONM.
-
safety of energy based devices for hemostasis in Thyroid Surgery
Gland surgery, 2016Co-Authors: Gianlorenzo Dionigi, Chewei Wu, Hoon Yub Kim, Renbin Liu, Gregory W Randolph, Xiaoli Liu, Angkoon AnuwongAbstract:Energy based devices (EBD) have been developed, implemented and increasingly applied in Thyroid Surgery because they can provide a combined dissection and haemostatic effect. In particular, advantages of EBD have been described in terms of efficacious haemostasis, reduction of procedure-associated time, reduced incision length, less operative blood loss and transfusion need, decreased postoperative drain, pain and hospital stay. In addition, EBD are essential for endoscopic procedures. On the contrary, a potential drawback is the increased health care costs. This paper reviews relevant medical literature published on the safety of new devices for achieving hemostasis and dissection around the recurrent laryngeal nerve (RLN).
-
stimulating dissecting instruments during neuromonitoring of rln in Thyroid Surgery
Laryngoscope, 2015Co-Authors: Feng Yu Chiang, Hoon Yub Kim, Ping Wang, Piying Chang, Hui Sun, Huichun Chen, Hsiuya Chen, Gianlorenzo DionigiAbstract:Objectives/Hypothesis During intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) in Thyroid Surgery, the need for frequent shifting between the dissecting instruments and stimulating probe is troublesome and time-consuming. Therefore, use of these two instruments in combination would be a noticeable future direction. This study aimed to investigate the feasibility and safety of using stimulating dissecting instruments (SDIs) that combine the function of surgical dissection and nerve stimulation during IONM. Study Design Prospective outcomes research. Methods One hundred consecutive patients with 168 RLNs at risk were enrolled. We developed prototypes of SDIs and applied them to early detect adverse EMG changes during the risky phase of RLN dissection. In the case of substantial EMG change (amplitude decrease > 50%) during dissection, the surgical maneuver was paused and Thyroid traction was released immediately. Results The application of SDIs was feasible in all cases and did not result in any morbidity. Nineteen RLNs were detected with substantial EMG change that was caused by traction stress during dissection with SDIs and that featured progressive gradual EMG recovery after releasing Thyroid traction. After Thyroid resection, 10 RLNs had a weak point of nerve conduction detected at region of Berry's ligament, but only one nerve with 79% amplitude reduction developed postoperative temporary vocal palsy. Conclusion The application of SDIs is a simple and effective way to monitor the nerve's function instantly during the risky phase of RLN injury in Thyroid Surgery. It provides surgeons with real-time feedback of EMG response and can be applied as a tool for the early detection of adverse EMG change caused by traction distress. Level of Evidence 4. Laryngoscope, 2015
-
safety of neural monitoring in Thyroid Surgery
International Journal of Surgery, 2013Co-Authors: Gianlorenzo Dionigi, Henning Dralle, Feng Yu Chiang, Marcin Barczynski, Luigi Boni, Stefano Rausei, Francesca Rovera, Eliana Piantanida, Alberto Mangano, Gregory W RandolphAbstract:Abstract During Thyroid Surgery, the functional integrity of the recurrent laryngeal nerve (RLN) is not only threatened by direct nerve injury resulting from accidental transection, clipping or ligation. In fact, indirect trauma, e.g. traction and compression occurring repeatedly throughout gland dissection, contribute to long-term nerve impairment. In order to avoid RLN lesions and preserve nerve function the surgeon must adhere to and comply with a strict standardized intraoperative neuromonitoring (IONM) technique to preserve results, quality and safety. IONM should be a team work between the surgeon and the anesthesiologist.
Tracy S Wang - One of the best experts on this subject based on the ideXlab platform.
-
Thyroid Surgery for differentiated Thyroid cancer recent advances and future directions
Nature Reviews Endocrinology, 2018Co-Authors: Tracy S Wang, Julie Ann SosaAbstract:Population-based studies have demonstrated that an increasing number of incidental Thyroid nodules are being identified. The corresponding increase in Thyroid-based diagnostic procedures, such as fine-needle aspiration biopsy, has in part led to an increase in the diagnoses of Thyroid cancers and to more Thyroid surgeries being performed. Small papillary Thyroid cancers account for most of this increase in diagnoses. These cancers are considered to be low risk because of the excellent patient outcomes, with a 5-year disease-specific survival of >98%. As a result, controversy remains regarding the optimal management of newly diagnosed differentiated Thyroid cancer, as the complications related to Thyroidectomy (primarily recurrent laryngeal nerve injury and hypoparaThyroidism) have considerable effects on patient quality of life. This Review highlights current debates, including undertaking active surveillance versus Thyroid Surgery for papillary Thyroid microcarcinoma, the extent of Thyroid Surgery and lymphadenectomy for low-risk differentiated Thyroid cancer, and the use of molecular testing to guide decision-making about whether Surgery is required and the extent of the initial operation. This Review includes a discussion of current consensus guideline recommendations regarding these topics in patients with differentiated Thyroid cancer. Additionally, innovative Thyroidectomy techniques (including robotic and transoral approaches) are discussed, with an emphasis on patient preferences around decision-making and outcomes following Thyroidectomy. Small papillary Thyroid cancers are considered low risk and account for the majority of incidental Thyroid nodules. Here, Tracy S. Wang and Julie A. Sosa discuss the current debates and advances regarding the diagnosis and optimal treatment of differentiated Thyroid cancer.
-
Thyroid Surgery for differentiated Thyroid cancer recent advances and future directions
Nature Reviews Endocrinology, 2018Co-Authors: Tracy S Wang, Julie Ann SosaAbstract:Population-based studies have demonstrated that an increasing number of incidental Thyroid nodules are being identified. The corresponding increase in Thyroid-based diagnostic procedures, such as fine-needle aspiration biopsy, has in part led to an increase in the diagnoses of Thyroid cancers and to more Thyroid surgeries being performed. Small papillary Thyroid cancers account for most of this increase in diagnoses. These cancers are considered to be low risk because of the excellent patient outcomes, with a 5-year disease-specific survival of >98%. As a result, controversy remains regarding the optimal management of newly diagnosed differentiated Thyroid cancer, as the complications related to Thyroidectomy (primarily recurrent laryngeal nerve injury and hypoparaThyroidism) have considerable effects on patient quality of life. This Review highlights current debates, including undertaking active surveillance versus Thyroid Surgery for papillary Thyroid microcarcinoma, the extent of Thyroid Surgery and lymphadenectomy for low-risk differentiated Thyroid cancer, and the use of molecular testing to guide decision-making about whether Surgery is required and the extent of the initial operation. This Review includes a discussion of current consensus guideline recommendations regarding these topics in patients with differentiated Thyroid cancer. Additionally, innovative Thyroidectomy techniques (including robotic and transoral approaches) are discussed, with an emphasis on patient preferences around decision-making and outcomes following Thyroidectomy.
Ronald G Amedee - One of the best experts on this subject based on the ideXlab platform.
-
intraoperative recurrent laryngeal nerve monitoring in Thyroid Surgery is it worth the cost
The Ochsner journal, 2012Co-Authors: Grayson Gremillion, Adil Fatakia, Adriana Dornelles, Ronald G AmedeeAbstract:Background: Intraoperative nerve monitoring (IONM) has been used in head and neck Surgery since the 1970s. Its utilization for monitoring and protecting the recurrent laryngeal nerve, however, is a controversial subject. This paper details the use, value, and cost of this technology within a single institution. Methods: We conducted a retrospective chart review, analysis of Surgery time with and without IONM, analysis of postoperative vocal cord function, and review of the literature. Results: IONM did not reduce the operative time during either Thyroid lobectomies or total Thyroidectomies in 119 surgeries. Use of IONM increased the cost of each Surgery by $387. IONM did not decrease the number of injured nerves (postoperative paresis). Conclusions: IONM has proven to be highly useful in certain circumstances but has not been definitively proven to protect the nerve any more effectively than the gold standard of nerve visualization. In our study, the use of IONM did not reduce the time of Thyroid Surgery and did increase the cost. While IONM may, in special clinical circumstances such as revision and malignant Thyroid Surgery, increase the value of the operation, its use for every Thyroid Surgery does not appear to be cost effective or valuable to the patient.