What is the REACHER?

At the time of writing this (octobre 2021) technique is only practiced in the USA by Dr Robert Lorenz at Cleveland

The REACHER stands for Retrograde Endoscopically Assisted Cricoid Hypertrophic Epithelium Resection. It is similar in many ways to the Madden procedure. Both remove the diseased lining of the cricoid, while preserving the outer cartilage. Essentially the differences are that the REACHER is done through an incision in the neck (transcervically) - which is closed at the time of the surgery, vs. the Madden which is done through the mouth (transorally).

Both the REACHER and Maddern Technique remove all the subglottic scarring and replace it with

skin graft from the thigh with the use of a temporary stent.

Compared with a resection, the recovery of both surgeries is faster, and risk of complications with voice reduced.

There is some anticipation that the Maddern procedure may become the standard with the REACHER reserved for patients with either hard to visualise subglottic areas through the laryngoscope, or else patients who cannot tolerate jet-ventilation (their oxygenation cannot be maintained throughout the endoscopic procedure).