{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T12:44:41Z","timestamp":1758631481662,"version":"3.41.2"},"reference-count":14,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2018,1,1]],"date-time":"2018-01-01T00:00:00Z","timestamp":1514764800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p> To describe and evaluate a four step systematic approach to dissecting the recurrent laryngeal nerve (RLN) starting at the cricothyroid junction during thyroid surgery (subsequently referred to as the retrograde medial approach). <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> All thyroidectomies completed by the senior author between August 2014 and January 2016 were retrospectively reviewed. Patients were excluded if concurrent lateral or central neck dissection was performed. A follow up period of 1\u00a0year was included. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Surgical photographs and illustrations demonstrate the four steps in the retrograde medial approach to dissection of the RLN in thyroid surgery. Three hundred forty-two consecutive thyroid surgeries were performed in 17\u00a0months, including 213 hemithyroidectomies, 91 total thyroidectomies, and 38 completion thyroidectomies. The rate of temporary and permanent hypocalcemia was 13% (95% confidence interval [CI]: 8\u201320%) and 3% (95% CI: 1\u20138%) respectively. The rate of temporary and permanent vocal cord palsy was 9% (95% CI: 6\u201312%) and 0.3% (95%CI: 0.01\u20132%) respectively. The median surgical times for hemithyroidectomy, total thyroidectomy, and completion thyroidectomy were 39\u00a0min (Interquartile range [IQR]: 33\u201347\u00a0min), 48\u00a0min (IQR: 40\u201360\u00a0min), and 40\u00a0min (IQR: 35\u201351\u00a0min) respectively. 1% of cases required conversion to an alternative surgical approach. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> In a tertiary endocrine head and neck practice, the routine use of the retrograde medial approach to RLN dissection is safe and results in a short operative time, and a low conversion rate to other RLN dissection approaches. <\/jats:p><\/jats:sec>","DOI":"10.1186\/s40463-018-0306-7","type":"journal-article","created":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T13:59:23Z","timestamp":1537192763000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":15,"title":["A systematic approach to the recurrent laryngeal nerve dissection at the cricothyroid junction"],"prefix":"10.1177","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5086-3187","authenticated-orcid":false,"given":"Oleksandr","family":"Butskiy","sequence":"first","affiliation":[{"name":"Division of Otolaryngology \u2013 Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada"},{"name":"Gordon & Leslie Diamond Health Care Centre, 4th. Fl. 4299B-2775 Laurel Street, V5Z 1M9, Vancouver, BC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brent A.","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology \u2013 Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly","family":"Luu","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology \u2013 Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert M.","family":"McKenzie","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology \u2013 Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald W.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology \u2013 Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,1,1]]},"reference":[{"key":"bibr1-s40463-018-0306-7","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21193"},{"key":"bibr2-s40463-018-0306-7","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0020"},{"key":"bibr3-s40463-018-0306-7","doi-asserted-by":"publisher","DOI":"10.1016\/j.otot.2009.02.006"},{"key":"bibr4-s40463-018-0306-7","unstructured":"Kocher T, Stiles HJ Text-book of operative surgery 1895 London Adam and Charles Black http:\/\/archive.org\/details\/textbookofoperat00koch"},{"key":"bibr5-s40463-018-0306-7","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2006.03.026"},{"key":"bibr6-s40463-018-0306-7","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2005.07.010"},{"key":"bibr7-s40463-018-0306-7","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2003.11.001"},{"key":"bibr8-s40463-018-0306-7","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0347(199812)20:8<695::AID-HED6>3.0.CO;2-3"},{"key":"bibr9-s40463-018-0306-7","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2011.134"},{"key":"bibr10-s40463-018-0306-7","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12254"},{"key":"bibr11-s40463-018-0306-7","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010"},{"key":"bibr12-s40463-018-0306-7","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-008-0366-7"},{"key":"bibr13-s40463-018-0306-7","doi-asserted-by":"publisher","DOI":"10.1186\/s13044-015-0027-1"},{"key":"bibr14-s40463-018-0306-7","doi-asserted-by":"publisher","DOI":"10.1586\/erd.13.6"}],"container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1186\/s40463-018-0306-7","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s40463-018-0306-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1186\/s40463-018-0306-7","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s40463-018-0306-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1186\/s40463-018-0306-7","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T23:59:53Z","timestamp":1741651193000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1186\/s40463-018-0306-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,1]]}},"alternative-id":["10.1186\/s40463-018-0306-7"],"URL":"https:\/\/doi.org\/10.1186\/s40463-018-0306-7","relation":{},"ISSN":["1916-0216","1916-0216"],"issn-type":[{"type":"print","value":"1916-0216"},{"type":"electronic","value":"1916-0216"}],"subject":[],"published":{"date-parts":[[2018,1]]},"article-number":"57"}}