Lisa A. Orloff, MD, FACS, FACE is Director of the Endocrine Head and Neck Surgery Program and Professor in the Department of Otolaryngology, Division of Head and Neck Surgery, at Stanford University School of Medicine. Her clinical practice focuses on the surgical management of thyroid and parathyroid tumors.

Dr. Orloff is an internationally recognized leader in the field of endocrine head and neck surgery. She is also an expert in the application of ultrasonography to the diagnosis and management of diseases of the head and neck, with an emphasis on thyroid cancer. Her background in microvascular and laryngeal surgical techniques lends a unique level of refinement to her endocrine surgical practice. A major component of her clinical work is the management of persistent or recurrent thyroid cancer. Dr. Orloff?s multidisciplinary approach to the management of endocrine head and neck disease involves collaboration with her colleagues in other specialties at Stanford and throughout the country. Dr. Orloff also studies the regeneration of tissue that has been lost as a result of cancer therapies. 

Dr. Orloff received her bachelor?s degree at Stanford, and her medical degree from the University of California, Los Angeles. She completed her residency in Otolaryngology/Head & Neck Surgery at the University of Washington and a visiting fellowship in Microvascular & Reconstructive Surgery at Mount Sinai Medical Center in New York. Prior to joining the faculty at Stanford, she was the Robert K. Werbe Distinguished Professor in Head and Neck Cancer, and Chief of the Division of Head and Neck Surgery at the University of California, San Francisco (UCSF.)

Dr. Orloff served three consecutive terms as the Chair of the American Academy of Otolaryngology?Head and Neck Surgery (AAO-HNS) Endocrine Surgery committee. She holds leadership roles within the American Head and Neck Society, the American Thyroid Association, the American Institute of Ultrasound in Medicine, and the American College of Surgeons. She is co-chair of the Thyroid, Parathyroid, and Neck Ultrasound training program at the ACS and a member of the ACS National Ultrasound Faculty board. She is also a member of such influential teams as the National Cancer Institute (NCI) steering committee on Thyroid Cancer Clinical Trials and the Endocrine Surgery Committee of the American Association of Clinical Endocrinology (AACE). She authored the leading textbook, Head and Neck Ultrasonography (Plural Publishing), as a reference for clinicians. Dr. Orloff is a former Fulbright scholar, and she is a voting member of the FDA?s Panel to evaluate medical devices for Otolaryngology. 

If you would like to refer a patient to Dr. Orloff, or have any questions, she and her team can be contacted at: by phone 650.498-6000; fax: 650.724.1433

Clinical Focus

  • Cancer > Head and Neck Cancer
  • Otolaryngology
  • Cancer, Thyroid
  • Parathyroidectomy
  • Endocrine Surgical Procedures
  • Ultrasonography

Academic Appointments

Professional Education

  • Residency:University of WashingtonWA
  • Internship:University of WashingtonWA
  • Medical Education:UCLA - School of Medicine (1986) CA
  • Fellowship, Mt Sinai Medical Center, NY
  • Board Certification: Otolaryngology, American Board of Otolaryngology (1993)


2016-17 Courses


All Publications

  • Prognostic Implications of Lymph Node Yield in Central and Lateral Neck Dissections for Well-Differentiated Papillary Thyroid Carcinoma. Thyroid Heaton, C. M., Chang, J. L., Orloff, L. A. 2016; 26 (3): 434-440


    The aim of this study was to evaluate the relationship between lymph node yield (LNY) from central (CND) and lateral (LND) neck dissections and risk of recurrence in patients undergoing primary surgery for well-differentiated papillary thyroid carcinoma (WDPTC).Clinical data were reviewed from all patients with biopsy-proven WDPTC who underwent primary total thyroidectomy with CND or LND at the authors' institution from 2005 to 2009. Patient demographics and tumor characteristics were obtained, and clinical data with at least five-year follow-up were used. Within the CNDs and LNDs, total number of nodes removed (LNY), total positive nodes removed, and the ratio of positive lymph nodes to LNY were determined.One hundred fifty-two patients were included in the study, with average follow-up of 69 months. Of 125 patients who underwent CND, 20 had central neck disease recurrence. The LNY of patients with central neck recurrence was significantly less than those who had no recurrence (2.5 vs. 10.3; p?

    View details for DOI 10.1089/thy.2015.0318

    View details for PubMedID 26825749

  • Prognostic Implications of Lymph Node Yield in Central and Lateral Neck Dissections for Well-Differentiated Papillary Thyroid Carcinoma THYROID Heaton, C. M., Chang, J. L., Orloff, L. A. 2016; 26 (3): 434-440
  • Improving the adoption of thyroid cancer clinical practice guidelines. The Laryngoscope Likhterov, I., Tuttle, R. M., Haser, G. C., Su, H. K., Bergman, D., Alon, E. E., Bernet, V., Brett, E., Cobin, R., Dewey, E. H., Doherty, G., Dos Reis, L. L., Klopper, J., Lee, S. L., Lupo, M. A., Machac, J., Mechanick, J. I., Milas, M., Orloff, L., Randolph, G., Ross, D. S., Rowe, M. E., Smallridge, R., Terris, D., Tufano, R. P., Urken, M. L. 2016


    To present an overview of the barriers to the implementation of clinical practice guidelines (CPGs) in thyroid cancer management and to introduce a computer-based clinical support system.PubMed.A review of studies on adherence to CPGs was conducted.Awareness and adoption of CPGs is low in thyroid cancer management. Barriers to implementation include unfamiliarity with the CPGs and financial concerns. Effective interventions to improve adherence are possible, especially when they are readily accessible at the point of care delivery. Computerized clinical support systems show particular promise. The authors introduce the clinical decision making modules (CDMMs) of the Thyroid Cancer Care Collaborative, a thyroid cancer-specific electronic health record. These computer-based modules can assist clinicians with implementation of these recommendations in clinical practice.Computer-based support systems can help clinicians understand and adopt the thyroid cancer CPGs. By integrating patient characteristics and guidelines at the point of care delivery, the CDMMs can improve adherence to the guidelines and help clinicians provide high-quality, evidence-based, and individualized patient care in the management of differentiated thyroid cancer. Laryngoscope, 2016.

    View details for DOI 10.1002/lary.25986

    View details for PubMedID 27074952

  • Preoperative Imaging for Thyroid Cancer: Beyond Ultrasonography. JAMA otolaryngology-- head & neck surgery Orloff, L. A., Randolph, G. W. 2016; 142 (6): 515-6

    View details for DOI 10.1001/jamaoto.2016.0165

    View details for PubMedID 26985777

  • ACTIVE SURVEILLANCE FOR PAPILLARY THYROID MICROCARCINOMA: NEW CHALLENGES AND OPPORTUNITIES FOR THE HEALTH CARE SYSTEM. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists Haser, G. C., Tuttle, R. M., Su, H. K., Alon, E. E., Bergman, D., Bernet, V., Brett, E., Cobin, R., Dewey, E. H., Doherty, G., Dos Reis, L. L., Harris, J., Klopper, J., Lee, S. L., Levine, R. A., Lepore, S. J., Likhterov, I., Lupo, M. A., Machac, J., Mechanick, J. I., Mehra, S., Milas, M., Orloff, L. A., Randolph, G., Revenson, T. A., Roberts, K. J., Ross, D. S., Rowe, M. E., Smallridge, R. C., Terris, D., Tufano, R. P., Urken, M. L. 2016; 22 (5): 602-11


    The dramatic increase in papillary thyroid carcinoma (PTC) is primarily a result of early diagnosis of small cancers. Active surveillance is a promising management strategy for papillary thyroid microcarcinomas (PTMCs). However, as this management strategy gains traction in the U.S., it is imperative that patients and clinicians be properly educated, patients be followed for life, and appropriate tools be identified to implement the strategy.We review previous active surveillance studies and the parameters used to identify patients who are good candidates for active surveillance. We also review some of the challenges to implementing active surveillance protocols in the U.S. and discuss how these might be addressed.Trials of active surveillance support nonsurgical management as a viable and safe management strategy. However, numerous challenges exist, including the need for adherence to protocols, education of patients and physicians, and awareness of the impact of this strategy on patient psychology and quality of life. The Thyroid Cancer Care Collaborative (TCCC) is a portable record keeping system that can manage a mobile patient population undergoing active surveillance.With proper patient selection, organization, and patient support, active surveillance has the potential to be a long-term management strategy for select patients with PTMC. In order to address the challenges and opportunities for this approach to be successfully implemented in the U.S., it will be necessary to consider psychological and quality of life, cultural differences, and the patient's clinical status.

    View details for DOI 10.4158/EP151065.RA

    View details for PubMedID 26799628

  • The Changing Landscape of Primary, Secondary, and Tertiary Hyperparathyroidism: Highlights from the American College of Surgeons Panel, "What's New for the Surgeon Caring for Patients with Hyperparathyroidism". Journal of the American College of Surgeons Shindo, M., Lee, J. A., Lubitz, C. C., McCoy, K. L., Orloff, L. A., Tufano, R. P., Pasieka, J. L. 2016; 222 (6): 1240-50

    View details for DOI 10.1016/j.jamcollsurg.2016.02.024

    View details for PubMedID 27107975

  • Transoral robotic-assisted surgical excision of a retropharyngeal parathyroid adenoma: A case report HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Bearelly, S., Prendes, B. L., Wang, S. J., Glastonbury, C., Orloff, L. A. 2015; 37 (11): E150-E152


    Transoral robotic surgery has been used with increasing frequency for oropharyngeal malignancies. We present the first known case of a transoral robotic-assisted parathyroidectomy.A 77-year-old woman with primary hyperparathyroidism was suspected of having a parathyroid adenoma. After several nonlocalizing single photon emission CT/CT sestamibi scans, a neck ultrasound revealed a suspicious low level 6 nodule. Surgical excision of this nodule proved to be a reactive lymph node. She then had a dynamic parathyroid protocol MRI and CT, which revealed a small retropharyngeal adenoma candidate. A transoral robotic-assisted surgical approach was utilized to bluntly dissect the retropharyngeal space just above the arytenoids to excise the nodule. After excision, the intraoperative parathyroid hormone (PTH) normalized and surgical pathology confirmed parathyroid adenoma.Transoral robotic-assisted surgery is a novel technique that can be utilized for resection of a parathyroid adenoma in the retropharyngeal space.

    View details for DOI 10.1002/hed.24010

    View details for Web of Science ID 000365406100004

    View details for PubMedID 25809987



    BID = bis in die DSPTC = diffuse sclerosing papillary thyroid cancer FNA = fine-needle aspiration HT = Hashimoto thyroiditis iPTH = intact parathyroid hormone 25OHD = 25-hydroxy vitamin D PTH = parathyroid hormone TPO = thyroid peroxidase US = ultrasonography.

    View details for DOI 10.4158/EP14462.DSC

    View details for Web of Science ID 000357732000014

    View details for PubMedID 26135962

  • Stimulation Threshold Greatly Affects the Predictive Value of Intraoperative Nerve Monitoring LARYNGOSCOPE Faden, D. L., Orloff, L. A., Ayeni, T., Fink, D. S., Yung, K. 2015; 125 (5): 1265-1270


    Using a standardized, graded, intraoperative stimulation protocol, we aimed to delineate the effects of various stimulation levels applied to the recurrent laryngeal nerve on the postoperative predictive value of intraoperative nerve monitoring.A total of 917 nerves at risk were included for analysis. Intraoperatively, patients underwent stimulation of the recurrent laryngeal nerve at 0.3, 0.5, 0.8, and 1.0 mA followed by postoperative laryngoscopy for correlation with intraoperative findings.Sensitivity, specificity, positive predictive value, and negative predictive value were calculated at each stimulation level.Sensitivity, specificity, positive predictive value, and negative predicative values ranged from 100% to 37%, 6% to 99%, 2% to 39%, and 100% to 99%, respectively at 0.3 to 1.0 mA. No demographic variables affected sensitivity or specificity. Receiver operating characteristic analysis identified 0.5 mA as the level of stimulation that optimizes sensitivity and specificity.The predictive value of intraoperative nerve monitoring varies greatly depending on the stimulation levels used. At low amplitudes of stimulation, nerve monitoring has high sensitivity and negative predictive value but low specificity and positive predictive value, related to the high rate of false positives. At high levels of stimulation, specificity and negative predictive value are high, sensitivity is low, and the positive predictive value rises as the rate of false negatives increase and the rate of false positives decrease. A stimulation level of 0.5 mA optimizes the predictive value of nerve monitoring; however, stimulation at multiple levels significantly improves the predictive value of intraoperative nerve monitoring.2b.

    View details for DOI 10.1002/lary.24960

    View details for Web of Science ID 000353996900050

    View details for PubMedID 25302692

  • Management of recurrent and persistent metastatic lymph nodes in well-differentiated thyroid cancer: a multifactorial decision-making guide for the thyroid cancer care collaborative. Head & neck Urken, M. L., Milas, M., Randolph, G. W., Tufano, R., Bergman, D., Bernet, V., Brett, E. M., Brierley, J. D., Cobin, R., Doherty, G., Klopper, J., Lee, S., Machac, J., Mechanick, J. I., Orloff, L. A., Ross, D., Smallridge, R. C., Terris, D. J., Clain, J. B., Tuttle, M. 2015; 37 (4): 605-614


    Well-differentiated thyroid cancer (WDTC) recurs in up to 30% of patients. Guidelines from the American Thyroid Association (ATA) and the National Comprehensive Cancer Network (NCCN) provide valuable parameters for the management of recurrent disease, but fail to guide the clinician as to the multitude of factors that should be taken into account. The Thyroid Cancer Care Collaborative (TCCC) is a web-based repository of a patient's clinical information. Ten clinical decision-making modules (CDMMs) process this information and display individualized treatment recommendations.We conducted a review of the literature and analysis of the management of patients with recurrent/persistent WDTC.Surgery remains the most common treatment in recurrent/persistent WDTC and can be performed with limited morbidity in experienced hands. However, careful observation may be the recommended course in select patients. Reoperation yields biochemical remission rates between 21% and 66%. There is a reported 1.2% incidence of permanent unexpected nerve paralysis and a 3.5% incidence of permanent hypoparathyroidism. External beam radiotherapy and percutaneous ethanol ablation have been reported as therapeutic alternatives. Radioactive iodine as a primary therapy has been reported previously for metastatic lymph nodes, but is currently advocated by the ATA as an adjuvant to surgery.The management of recurrent lymph nodes is a multifactorial decision and is best determined by a multidisciplinary team. The CDMMs allow for easy adoption of contemporary knowledge, making this information accessible to both patient and clinician.

    View details for DOI 10.1002/hed.23615

    View details for PubMedID 24436291

  • Database and registry research in thyroid cancer: striving for a new and improved national thyroid cancer database. Thyroid Mehra, S., Tuttle, R. M., Milas, M., Orloff, L., Bergman, D., Bernet, V., Brett, E., Cobin, R., Doherty, G., Judson, B. L., Klopper, J., Lee, S., Lupo, M., Machac, J., Mechanick, J. I., Randolph, G., Ross, D. S., Smallridge, R., Terris, D., Tufano, R., Alon, E., Clain, J., DosReis, L., Scherl, S., Urken, M. L. 2015; 25 (2): 157-168


    Health registries have become extremely powerful tools for cancer research. Unfortunately, certain details and the ability to adapt to new information are necessarily limited in current registries, and they cannot address many controversial issues in cancer management. This is of particular concern in differentiated thyroid cancer, which is rapidly increasing in incidence and has many unknowns related to optimal treatment and surveillance recommendations.In this study, we review different types of health registries used in cancer research in the United States, with a focus on their advantages and disadvantages as related to the study of thyroid cancer. This analysis includes population-based cancer registries, health systems-based cancer registries, and patient-based disease registries. It is important that clinicians understand the way data are collected in, as well as the composition of, these different registries in order to more critically interpret the clinical research that is conducted using that data. In an attempt to address shortcoming of current databases for thyroid cancer, we present the potential of an innovative web-based disease management tool for thyroid cancer called the Thyroid Cancer Care Collaborative (TCCC) to become a patient-based registry that can be used to evaluate and improve the quality of care delivered to patients with thyroid cancer as well as to answer questions that we have not been able to address with current databases and registries.A cancer registry that follows a specific patient, is integrated into physician workflow, and collects data across different treatment sites and different payers does not exist in the current fragmented system of healthcare in the United States. The TCCC offers physicians who treat thyroid cancer numerous time-saving and quality improvement services, and could significantly improve patient care. With rapid adoption across the nation, the TCCC could become a new paradigm for database research in thyroid cancer to improve our understanding of thyroid cancer management.

    View details for DOI 10.1089/thy.2014.0270

    View details for PubMedID 25517683

  • American Thyroid Association statement on preoperative imaging for thyroid cancer surgery. Thyroid Yeh, M. W., Bauer, A. J., Bernet, V. A., Ferris, R. L., Loevner, L. A., Mandel, S. J., Orloff, L. A., Randolph, G. W., Steward, D. L. 2015; 25 (1): 3-14


    The success of surgery for thyroid cancer hinges on thorough and accurate preoperative imaging, which enables complete clearance of the primary tumor and affected lymph node compartments. This working group was charged by the Surgical Affairs Committee of the American Thyroid Association to examine the available literature and to review the most appropriate imaging studies for the planning of initial and revision surgery for thyroid cancer.Ultrasound remains the most important imaging modality in the evaluation of thyroid cancer, and should be used routinely to assess both the primary tumor and all associated cervical lymph node basins preoperatively. Positive lymph nodes may be distinguished from normal nodes based upon size, shape, echogenicity, hypervascularity, loss of hilar architecture, and the presence of calcifications. Ultrasound-guided fine-needle aspiration of suspicious lymph nodes may be useful in guiding the extent of surgery. Cross-sectional imaging (computed tomography with contrast or magnetic resonance imaging) may be considered in select circumstances to better characterize tumor invasion and bulky, inferiorly located, or posteriorly located lymph nodes, or when ultrasound expertise is not available. The above recommendations are applicable to both initial and revision surgery. Functional imaging with positron emission tomography (PET) or PET-CT may be helpful in cases of recurrent cancer with positive tumor markers and negative anatomic imaging.

    View details for DOI 10.1089/thy.2014.0096

    View details for PubMedID 25188202

  • Management of invasive well-differentiated thyroid cancer: An American Head and Neck Society Consensus Statement AHNS Consensus Statement HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Shindo, M. L., Caruana, S. M., Kandil, E., McCaffrey, J. C., Orloff, L. A., Porterfield, J. R., Shaha, A., Shin, J., Terris, D., Randolph, G. 2014; 36 (10): 1379-1390

    View details for DOI 10.1002/hed.23619

    View details for Web of Science ID 000342157000004

  • What Is the Gold Standard for Comprehensive Interinstitutional Communication of Perioperative Information for Thyroid Cancer Patients? A Comparison of Existing Electronic Health Records with the Current American Thyroid Association Recommendations THYROID Dos Reis, L. L., Tuttle, R. M., Alon, E., Bergman, D. A., Bernet, V., Brett, E. M., Cobin, R., Doherty, G., Harris, J. R., Klopper, J., Lee, S. L., Lupo, M., Milas, M., Machac, J., Mechanick, J. I., Orloff, L., Randolph, G., Ross, D. S., Smallridge, R. C., Terris, D. J., Tufano, R. P., Mehra, S., Scherl, S., Clain, J. B., Urken, M. L. 2014; 24 (10): 1466-1472
  • Striving Toward Standardization of Reporting of Ultrasound Features of Thyroid Nodules and Lymph Nodes: A Multidisciplinary Consensus Statement THYROID Su, H. K., Dos Reis, L. L., Lupo, M. A., Milas, M., Orloff, L. A., Langer, J. E., Brett, E. M., Kazam, E., Lee, S. L., Minkowitz, G., Alpert, E. H., Dewey, E. H., Urken, M. L. 2014; 24 (9): 1341-1349


    The use of high-resolution ultrasound (US) imaging is a mainstay of the initial evaluation and long-term management of thyroid nodules and thyroid cancer. To fully capitalize on the diagnostic capabilities of a US examination in the context of thyroid disease, many clinicians consider it desirable to establish a universal format and standard of US reporting. The goals of this interdisciplinary consensus statement are twofold. First, to create a standardized set of US features to characterize thyroid nodules and cervical lymph nodes accurately, and second, to create a standardized system for tracking sequential changes in the US examination of thyroid nodules and cervical lymph nodes for the purpose of determining risk of malignancy.The Thyroid, Head and Neck Cancer (THANC) Foundation convened a panel of nine specialists from a variety of medical disciplines that are actively involved in the diagnosis and treatment of thyroid nodules and thyroid cancer. Consensus was achieved on the following topics: US evaluation of the thyroid gland, US evaluation of thyroid nodules, US evaluation of cervical lymph nodes, US-guided fine needle aspiration (FNA) of thyroid nodules, and US-guided FNA of cervical lymph nodes.We propose that this statement represents a consensus within a multidisciplinary team on the salient and essential elements of a comprehensive and clinically significant thyroid and neck US report with regards to content, terminology, and organization. This reporting protocol supplements previous US performance guidelines by not only capturing categories of findings that may have important clinical implications, but also delineating findings that are clinically relevant within those categories as specifically as possible. Additionally, we have included the specific features of diagnostic and therapeutic interventions that have not been previously addressed.

    View details for DOI 10.1089/thy.2014.0110

    View details for Web of Science ID 000341509300002

    View details for PubMedID 24967994

  • Clinician-Performed Thyroid Ultrasound-Guided Fine-Needle Aspiration OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA Tsao, G. J., Orloff, L. A. 2014; 47 (4): 509-?


    Fine needle aspiration biopsy (FNA) is the key step in selecting most patients with thyroid nodules for or against surgery. Accurate acquisition of cytologic samples from suspicious lesions is achieved by adding ultrasound guidance to optimize targeting as well as to enable sampling from nonpalpable lesions. This article discusses the indications, variations, and technical details of ultrasound-guided FNA.

    View details for DOI 10.1016/j.otc.2014.04.005

    View details for Web of Science ID 000340440800006

    View details for PubMedID 25041954

  • Improving the Quality of Thyroid Cancer Care: How Does the Thyroid Cancer Care Collaborative Cross the Institute of Medicine's Quality Chasm? THYROID Mehra, S., Tuttle, R. M., Bergman, D., Bernet, V., Brett, E., Cobin, R., Doherty, G., Klopper, J., Lee, S., Machac, J., Milas, M., Mechanick, J. I., Orloff, L., Randolph, G., Ross, D. S., Smallridge, R., Terris, D., Tufano, R., Alon, E., Clain, J., Dos Reis, L., Scherl, S., Urken, M. L. 2014; 24 (4): 615-624


    The current systems of healthcare delivery in the United States suffer from problems that often leave patients with inadequate quality of care. In their report entitled "Crossing the Quality Chasm," the Institute of Medicine (IOM) identified reasons for poor and/or inconsistent quality of healthcare delivery and provided recommendations to improve it. The purpose of this review is to describe features of an innovative web-based program called the Thyroid Cancer Care Collaborative (TCCC) and see how it addresses IOM recommendations to improve the quality of healthcare delivery.The TCCC addresses the three actionable IOM recommendations directed at healthcare organizations and clinicians to redesign the care process. It does so by exploiting information technology (IT) in ways suggested by the IOM, and it fits within a set of 10 rules provided by the IOM. Some features of the TCCC include: (i) automated disease staging based on three validated scoring systems; (ii) highly illustrated educational videos on all aspects of thyroid cancer care; (iii) personalized clinical decision-making modules for clinicians and physicians; (iv) portability of data to share among treating physicians; (v) virtual tumor boards, "ask the expert," and frequently asked questions modules; (vi) physician workflow integration; and (vii) data for comprehensive analysis to answer difficult questions in thyroid cancer management.The TCCC has the potential to improve thyroid cancer care delivery and offers several benefits to patients, clinicians, and researchers. The TCCC is a valuable example of how IOM initiatives can improve the healthcare system.

    View details for DOI 10.1089/thy.2013.0441

    View details for Web of Science ID 000334110700001

    View details for PubMedID 24512449

  • American Thyroid Association Statement on Outpatient Thyroidectomy THYROID Terris, D. J., Snyder, S., Carneiro-Pla, D., Inabnet, W. B., Kandil, E., Orloff, L., Shindo, M., Tufano, R. P., Tuttle, R. M., Urken, M., Yeh, M. W. 2013; 23 (10): 1193-1202


    The primary goals of this interdisciplinary consensus statement are to define the eligibility criteria for outpatient thyroidectomy and to explore preoperative, intraoperative, and postoperative factors that should be considered in order to optimize the safe and efficient performance of ambulatory surgery.A series of criteria was developed that may represent relative contraindications to outpatient thyroidectomy, and these fell into the following broad categories: clinical, social, and procedural issues. Intraoperative factors that bear consideration are enumerated, and include choice of anesthesia, use of nerve monitoring, hemostasis, management of the parathyroid glands, wound closure, and extubation. Importantly, postoperative factors are described at length, including suggested discharge criteria and recognition of complications, especially bleeding, airway distress, and hypocalcemia.Outpatient thyroidectomy may be undertaken safely in a carefully selected patient population provided that certain precautionary measures are taken to maximize communication and minimize the likelihood of complications.

    View details for DOI 10.1089/thy.2013.0049

    View details for Web of Science ID 000324832100004

    View details for PubMedID 23742254

  • External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement LARYNGOSCOPE Barczynski, M., Randolph, G. W., Cernea, C. R., Dralle, H., Dionigi, G., Alesina, P. F., Mihai, R., Finck, C., Lombardi, D., Hartl, D. M., Miyauchi, A., Serpell, J., Snyder, S., Volpi, E., Woodson, G., Kraimps, J. L., Hisham, A. N. 2013; 123: S1-S14


    Intraoperative neural monitoring (IONM) during thyroid surgery has gained widespread acceptance as an adjunct to the gold standard of visual identification of the recurrent laryngeal nerve (RLN). Contrary to routine dissection of the RLN, most surgeons tend to avoid rather than routinely expose and identify the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy or parathyroidectomy. IONM has the potential to be utilized for identification of the EBSLN and functional assessment of its integrity; therefore, IONM might contribute to voice preservation following thyroidectomy or parathyroidectomy. We reviewed the literature and the cumulative experience of the multidisciplinary International Neural Monitoring Study Group (INMSG) with IONM of the EBSLN. A systematic search of the MEDLINE database (from 1950 to the present) with predefined search terms (EBSLN, superior laryngeal nerve, stimulation, neuromonitoring, identification) was undertaken and supplemented by personal communication between members of the INMSG to identify relevant publications in the field. The hypothesis explored in this review is that the use of a standardized approach to the functional preservation of the EBSLN can be facilitated by application of IONM resulting in improved preservation of voice following thyroidectomy or parathyroidectomy. These guidelines are intended to improve the practice of neural monitoring of the EBSLN during thyroidectomy or parathyroidectomy and to optimize clinical utility of this technique based on available evidence and consensus of experts.5

    View details for DOI 10.1002/lary.24301

    View details for Web of Science ID 000323702000001

    View details for PubMedID 23832799

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