The Medial Approach to the Recurrent Laryngeal Nerve in Thyroidectomy
Bibliographic record
Abstract
Introduction: Three general approaches to identifying the recurrent laryngeal nerve during thyroid surgery are recognized: lateral, inferior, and superior.1 In the presented video we introduce a different technique for the recurrent laryngeal nerve identification. We call this technique the medial approach to the recurrent laryngeal nerve. Materials and Methods: A 57-year-old female presented with Bethesda IV right thyroid nodule. Open thyroidectomy using the medial approach to the recurrent laryngeal nerve identification was performed. Anatomy, surgical technique, along with advantages and drawbacks of the medial approach as compared with the other approaches are illustrated and discussed in the video presentation. Results: The medial approach to the recurrent laryngeal nerve consists of four steps that are performed sequentially. First, the thyroid isthmus is divided and the edge on the resection side is grasped with Babcock tissue forceps, placing the isthmus on lateral traction. Second, the medial portion of the thyroid gland is separated from the cricothyroid muscle and trachea. In this step, the Berry's suspensory ligament adjacent to the first tracheal ring is left intact. Third, the avascular space between the superior pole and the cricothyroid muscle is opened. In the fourth and the most critical step, the Berry's ligament lateral to the first tracheal ring is placed on differential traction using two retractors, and the recurrent laryngeal nerve is identified and dissected as it courses deep to the superior edge of the ligament. Conclusion: The anatomy and the surgical technique for the medial approach to identify the recurrent laryngeal nerve in thyroid surgery are presented. The advantages of this technique are consistent anatomical location of the recurrent laryngeal nerve, efficiency of dissection, and complete removal of thyroid tissue at the cricothyroid joint. Although we use this approach routinely,2 the medial approach is especially useful for large goiters and cases wherein identification of the recurrent laryngeal nerve is otherwise problematic. No competing financial interests exist. Runtime of video: 11 mins 48 secs
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".