# Tracheomalacia — GCMD Library living collection Everything in the library about tracheomalacia — built automatically from dossiers that name it. Updated: n/a · 7 episodes · 64 cited statements ## Episodes ### Surgical Management - [Posterior Tracheopexy For Severe Tracheomalacia](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320) — video · 2:17 · [machine version](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320.md) - [Posterior Tracheopexy For Severe Tracheomalacia](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375) — video · 2:18 · [machine version](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375.md) - [QUAD #1: Cervical Tracheopexy with Dr. Alessandro de Alarcon](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779) — video · 5:26 · [machine version](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779.md) - [QUAD #2 Thoracoscopic Tracheopexy with Dr. Aaron Garrison](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919) — video · 7:36 · [machine version](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919.md) ### Evidence & Research - [Tracheomalacia and tracheomegaly in infants and children with congenital diaphragmatic hernia managed with and without fetoscopic endoluminal tracheal occlusion (FETO): a multicentre, retrospective cohort study](https://library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334) — video · 0:59 · [machine version](https://library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334.md) - [Quick Literature Updates Ep 19](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465) — video · 4:27 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465.md) - [Quick Literature Updates Ep 27](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580) — video · 4:20 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580.md) ## Chapters - [0:00](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=0) Introduction and Guest Presentation (Ep 1) - [0:15](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=15) Paper Overview and Posterior Tracheopexy Technique (Ep 1) - [1:05](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=65) Study Results and Clinical Implications (Ep 1) - [1:58](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=118) Closing Remarks (Ep 1) - [0:00](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=0) Introduction and Context (Ep 2) - [0:15](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=15) Study Design and Patient Population (Ep 2) - [1:05](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=65) Results and Clinical Implications (Ep 2) - [1:54](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=114) Discussion and Closing (Ep 2) - [0:00](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=0) Introduction and Preoperative Workup (Ep 3) - [1:14](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=74) Intraoperative Setup and Tools (Ep 3) - [1:47](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=107) Surgical Technique and Approach (Ep 3) - [3:24](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=204) Outcomes and Follow-up (Ep 3) - [4:32](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=272) Summary and Conclusion (Ep 3) - [0:00](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=0) Introduction and Evolution of Practice (Ep 4) - [0:58](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=58) Rationale for Repair and Preoperative Imaging (Ep 4) - [2:02](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=122) Bronchoscopy Classification and Minimally Invasive Advantages (Ep 4) - [3:21](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=201) Patient Positioning and Aortopexy Technique (Ep 4) - [4:28](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=268) Posterior Tracheopexy Technique (Ep 4) - [6:07](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=367) Esophageal Management and Outcomes (Ep 4) - [6:47](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=407) Summary and Conclusion (Ep 4) - [0:00](https://library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=0) Introduction and Study Design (Ep 5) - [0:22](https://library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=22) Key Findings (Ep 5) - [0:46](https://library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=46) Conclusion (Ep 5) - [0:16](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=16) APSA Peer Support Program (Ep 6) - [1:44](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=104) Tracheomalacia in CDH with Fetal Tracheal Occlusion (Ep 6) - [3:02](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=182) Biopsy Methods for Neuroblastoma Diagnosis (Ep 6) - [0:00](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=0) Preoperative tracheobronchoscopy for tracheomalacia diagnosis in esophageal atresia (Ep 7) - [1:44](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=104) Intestinal strictures after conservative management of necrotizing enterocolitis (Ep 7) - [2:45](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=165) Expectant management versus early ibuprofen for patent ductus arteriosus (Ep 7) - [4:04](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=244) Closing remarks (Ep 7) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - "Tracheomalacia was 5% more common in tracheal occluded infants with 4% more cases" — Carlos Colunga (clinical) [Ep 5 · 0:24](https://library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=24) - "Tracheomalacia symptoms typically receded within 55 months in FETO-treated infants" — Carlos Colunga (clinical) [Ep 5 · 0:29](https://library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=29) - "FETO-treated infants showed a larger trachea, approximately 31% wider" — Carlos Colunga (clinical) [Ep 5 · 0:33](https://library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=33) - "37% of tracheally occluded cases retained metallic balloon components" — Carlos Colunga (clinical) [Ep 5 · 0:33](https://library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=33) - "No significant complications were reported from retained metallic balloon components" — Carlos Colunga (clinical) [Ep 5 · 0:33](https://library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=33) - "Tracheal occlusion is effective in promoting lung growth" — Carlos Colunga (clinical) [Ep 5 · 0:46](https://library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=46) - "FETO is associated with a higher risk of tracheomalacia" — Carlos Colunga (clinical) [Ep 5 · 0:46](https://library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=46) - "Most cases of FETO-associated tracheomalacia resolve and do not appear to have long-term effects" — Carlos Colunga (clinical) [Ep 5 · 0:46](https://library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=46) - "APSA created a peer support program for pediatric surgeons in 2020" — Lizzie Lee (clinical) [Ep 6 · 1:00](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=60) - "The program's goal was to support surgeons after traumatic events" — Lizzie Lee (clinical) [Ep 6 · 1:12](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=72) - "The most common referral reasons were toxic work environments and adverse events" — Lizzie Lee (epidemiological) [Ep 6 · 1:16](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=76) - "50 surgeons total agreed to receive training on how to be a supporter" — Lizzie Lee (epidemiological) [Ep 6 · 1:20](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=80) - "Over 80% of trained supporters were able to use peer support skills informally with colleagues, partners, and trainees" — Lizzie Lee (epidemiological) [Ep 6 · 1:25](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=85) - "Tracheomalacia was 5% more common in tracheal occluded infants with 4% more cases" — Carlos Colunga (epidemiological) [Ep 6 · 2:25](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=145) - "Tracheomalacia symptoms in tracheal occluded infants typically receded within 55 months" — Carlos Colunga (clinical) [Ep 6 · 2:25](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=145) - "Tracheal occluded infants typically showed a larger trachea, which was around 31% wider" — Carlos Colunga (clinical) [Ep 6 · 2:34](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=154) - "37% of tracheal occluded cases retained metallic balloon components" — Carlos Colunga (epidemiological) [Ep 6 · 2:34](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=154) - "No significant complications were reported from retained metallic balloon components" — Carlos Colunga (clinical) [Ep 6 · 2:34](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=154) - "While tracheal occlusion is effective in promoting lung growth, it is associated with a higher risk of tracheomalacia" — Carlos Colunga (clinical) [Ep 6 · 2:47](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=167) - "Most cases of tracheomalacia after tracheal occlusion resolve and do not appear to have long-term effects" — Carlos Colunga (clinical) [Ep 6 · 2:47](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=167) - "The IPSO meta-analysis gathered 8 retrospective studies with 490 patients" — Cecilia Gigena (epidemiological) [Ep 6 · 3:40](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=220) - "Tissue adequacy and biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups" — Cecilia Gigena (clinical) [Ep 6 · 3:40](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=220) - "Intraoperative transfusions were higher in the surgical biopsy group compared to image-guided core needle biopsy" — Cecilia Gigena (clinical) [Ep 6 · 3:54](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=234) - "Complications were higher in the surgical biopsy group compared to image-guided core needle biopsy" — Cecilia Gigena (clinical) [Ep 6 · 3:54](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=234) - "Image-guided core needle biopsy is safe and effective for diagnosing neuroblastoma" — Cecilia Gigena (clinical) [Ep 6 · 4:00](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=240) - "Cincinnati Children's typically uses a combined cervical and thoracic approach for esophageal atresia cases." — Alessandro de Alarcon (clinical) [Ep 3 · 0:49](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=49) - "Preoperative testing includes dynamic CT imaging, pulmonary function tests, microlaryngoscopy and bronchoscopy, and flexible bronchoscopy." — Todd Ponsky (host_summary) [Ep 3 · 0:55](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=55) - "Required intraoperative equipment includes a neck tray, MLB tray, and Maloney dilators or NG tubes." — Alessandro de Alarcon (clinical) [Ep 3 · 1:15](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=75) - "Flexible bronchoscopy during the operation is key, and endotracheal tube placement must allow visualization during the procedure." — Alessandro de Alarcon (clinical) [Ep 3 · 1:21](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=81) - "Nasotracheal intubation is often used with the cuff positioned high, sometimes almost at the glottis." — Alessandro de Alarcon (clinical) [Ep 3 · 1:29](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=89) - "A NIM tube is preferred when possible to prevent injury to recurrent nerves or provide awareness when approaching them." — Alessandro de Alarcon (clinical) [Ep 3 · 1:39](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=99) - "The surgical approach uses subplatysmal flaps and addresses anterior compression as needed." — Alessandro de Alarcon (clinical) [Ep 3 · 1:55](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=115) - "The cervical approach can assist thoracoscopic procedures by removing residual or regrown large thymus tissue." — Todd Ponsky (host_summary) [Ep 3 · 2:01](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=121) - "Aortopexy and innominate artery pexy can be added at the same time as the cervical procedure." — Alessandro de Alarcon (clinical) [Ep 3 · 2:09](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=129) - "In the lateral approach, the surgical team works on the side of the airway to find the esophagus." — Todd Ponsky (host_summary) [Ep 3 · 2:19](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=139) - "Pediatric surgeons identify the recurrent nerve for the ENT team to help prevent injury." — Todd Ponsky (host_summary) [Ep 3 · 2:23](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=143) - "The Cincinnati team has learned not to be afraid of mobilizing the esophagus, which is important for the procedure." — Alessandro de Alarcon (opinion) [Ep 3 · 2:29](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=149) - "The esophagus is mobilized above the level where the team aims to perform the pexy, making suture placement easier." — Todd Ponsky (host_summary) [Ep 3 · 2:43](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=163) - "Stitches are sometimes placed in the trachea to pull it up and out of the way for visualization of the posterior aspect and spine." — Alessandro de Alarcon (clinical) [Ep 3 · 2:54](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=174) - "A pulmonologist assists with flexible endoscopy through the endotracheal tube to visualize inside the trachea while stitches are placed." — Todd Ponsky (host_summary) [Ep 3 · 3:02](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=182) - "The team uses 3-0 prolene sutures and places all stitches before securing them down." — Alessandro de Alarcon (clinical) [Ep 3 · 3:15](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=195) - "Suture placement is performed under spontaneous ventilation conditions." — Alessandro de Alarcon (clinical) [Ep 3 · 3:15](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=195) - "The combined approach is valuable for complicated cases or patients needing additional operations for symptom relief." — Todd Ponsky (host_summary) [Ep 3 · 3:24](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=204) - "A patient who had prior thoracoscopic tracheopexy with dysphagia from torqued esophagus underwent the combined approach and became symptom-free." — Alessandro de Alarcon (clinical) [Ep 3 · 3:33](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=213) - "Outcome measures include follow-up endoscopy, pulmonary function tests when patients are old enough, and imaging." — Alessandro de Alarcon (clinical) [Ep 3 · 4:00](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=240) - "At 36 months follow-up, imaging may still show tracheomalacia, but patients can be symptomatically better." — Alessandro de Alarcon (clinical) [Ep 3 · 4:09](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=249) - "The team is still learning what measures should define good versus bad outcomes." — Alessandro de Alarcon (opinion) [Ep 3 · 4:15](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=255) - "Managing complications including swallowing dysfunction and vocal fold paralysis is part of postoperative care." — Alessandro de Alarcon (clinical) [Ep 3 · 4:26](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=266) - "Otolaryngology involvement is important both during the procedure and in follow-up due to potential complications." — Todd Ponsky (host_summary) [Ep 3 · 4:32](https://library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=272) - "Several years ago, the approach was that patients with tracheomalacia would undergo aortopexy." — Em Gootee (host_summary) [Ep 4 · 0:36](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=36) - "In the last 4 to 5 years, it has become standard practice to determine which patients will respond best to tracheopexy versus aortopexy." — Em Gootee (host_summary) [Ep 4 · 0:43](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=43) - "Pediatric surgery trainees were initially told that tracheomalacia is something that kids will grow out of and will get better." — Aaron Garrison (opinion) [Ep 4 · 0:58](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=58) - "Recent data has shown that there are long term consequences for soiling into the lungs and having chronic lung aspiration, which over time is detrimental." — Aaron Garrison (clinical) [Ep 4 · 1:08](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=68) - "Preoperative dynamic reconstruction studies give a lot of information for determining which procedure is best for each patient." — Aaron Garrison (clinical) [Ep 4 · 1:26](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=86) - "Dynamic expiratory films show what you need to see with the airway that inspiratory films alone do not reveal." — Aaron Garrison (clinical) [Ep 4 · 1:31](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=91) - "Part of the workup is making sure that there is space to anteriorly suspend the aorta so that the trachea diameter can actually be made larger." — Em Gootee (host_summary) [Ep 4 · 1:45](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=105) - "Surgeons always look for the thymus and make sure that there is enough tissue to remove to be able to bring the trachea up anteriorly." — Aaron Garrison (clinical) [Ep 4 · 1:55](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=115) - "Preoperative bronchoscopy gives the surgical team an idea of internal anatomy, which can assist in classifying the degree of tracheomalacia prior to surgical intervention." — Em Gootee (host_summary) [Ep 4 · 2:02](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=122) - "The classification system for tracheomalacia is in evolution, and trying to describe what is mild or severe or moderate is a little bit challenging." — Aaron Garrison (opinion) [Ep 4 · 2:17](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=137) - "The biggest benefit of minimally invasive approach is visualization and exposure." — Aaron Garrison (opinion) [Ep 4 · 2:34](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=154) - "Disadvantages of minimally invasive approach include that it takes longer to learn and is more uncomfortable to learn." — Aaron Garrison (opinion) [Ep 4 · 2:39](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=159) - "Anesthesia colleagues are sometimes hesitant to allow thoracoscopic cases to go on a little bit longer." — Aaron Garrison (opinion) [Ep 4 · 2:42](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=162) - "A paper in Anesthesiology looked at open, thoracoscopic, and converted patients and found no difference in blood gases and metabolic derangements during surgery." — Aaron Garrison (host_summary) [Ep 4 · 3:03](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=183) - "The same study found no difference when looking at blood pressure with acidosis and hypoxia between open and thoracoscopic approaches." — Aaron Garrison (host_summary) [Ep 4 · 3:17](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=197) - "When using a thoracoscopic approach, correct positioning is the key to success." — Em Gootee (host_summary) [Ep 4 · 3:23](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=203) - "It is best to use gravity to advantage as it aids in retracting the lungs and trachea placement." — Em Gootee (host_summary) [Ep 4 · 3:27](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=207) - "For anterior mediastinal work, babies are positioned with the arm up and a bump underneath so that there is access to the axilla and anteriorly." — Aaron Garrison (clinical) [Ep 4 · 3:33](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=213) - "The goal of aortopexy is to suspend the aorta." — Aaron Garrison (clinical) [Ep 4 · 3:51](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=231) - "The first step in aortopexy is taking out the thymus, finding the innominate junction, and then identifying the arch of the aorta." — Aaron Garrison (clinical) [Ep 4 · 3:54](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=234) - "Opening the pericardium and finding the area at the pericardial-adventitial junction to suspend is the key point of aortopexy." — Em Gootee (host_summary) [Ep 4 · 4:01](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=241) - "If you go up too high during aortopexy, then you are doing a pericardiopexy and it is not quite as successful or durable." — Aaron Garrison (clinical) [Ep 4 · 4:10](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=250) - "Passing suture transternally is preferred with the aortopexy approach, though it can be technically difficult." — Em Gootee (host_summary) [Ep 4 · 4:16](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=256) - "For tracheopexy, a posterior approach via semiprone position is preferred." — Em Gootee (host_summary) [Ep 4 · 4:23](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=263) - "Creating a pneumothorax by putting the Veress off the tip of the scapula helps collapse the lung for trocar placement." — Em Gootee (host_summary) [Ep 4 · 4:28](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=268) - "When operating posteriorly, triangulating your hands gives the best visualization and working space." — Em Gootee (host_summary) [Ep 4 · 4:38](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=278) - "The goal of posterior tracheopexy is taking the anterior spinal ligament and fixing it to the posterior membranous trachea." — Aaron Garrison (clinical) [Ep 4 · 4:45](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=285) - "The area of floppy membrane is distal to the dilated pouch usually." — Aaron Garrison (clinical) [Ep 4 · 4:56](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=296) - "When available, a multidisciplinary team which includes a pulmonologist can allow for internal visualization via bronchoscopy." — Em Gootee (host_summary) [Ep 4 · 4:56](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=296) - "Bronchoscopic guidance technique is primarily used in non-esophageal atresia patients." — Em Gootee (host_summary) [Ep 4 · 5:05](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=305) - "Surgeons can make an indent on the posterior wall of the trachea, and pulmonologists can see it pop up on their bronchoscopy to help guide suture placement." — Aaron Garrison (clinical) [Ep 4 · 5:09](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=309) - "It usually takes about 2 or 3 sutures for posterior tracheopexy, leaving enough space for the esophagus to come through." — Aaron Garrison (clinical) [Ep 4 · 5:43](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=343) - "Using the knot pusher and tension suture is helpful during tracheopexy." — Aaron Garrison (opinion) [Ep 4 · 5:48](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=348) - "It is important to create enough tension in the suture to ensure that the pexy is secure." — Em Gootee (host_summary) [Ep 4 · 5:53](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=353) - "Getting the suture to roll through the anterior spinal ligament is the hardest part and is pretty challenging." — Aaron Garrison (opinion) [Ep 4 · 5:58](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=358) - "The approach changes for patients without esophageal atresia or with an esophagus in continuity." — Em Gootee (host_summary) [Ep 4 · 6:07](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=367) - "For patients with esophagus in continuity, the first step is to dissect around the esophagus using a vessel loop for retraction." — Em Gootee (host_summary) [Ep 4 · 6:14](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=374) - "There are times when the esophagus is put to the left of the trachea, and times when it is put to the right of the trachea." — Aaron Garrison (clinical) [Ep 4 · 6:20](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=380) - "Dr. Garrison always worries a little bit about dysphagia when repositioning the esophagus, but it is not something he has seen a ton of." — Aaron Garrison (opinion) [Ep 4 · 6:26](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=386) - "Using pre- and post-operative bronchoscopy allows the surgeon to see the improvement prior to case completion." — Em Gootee (host_summary) [Ep 4 · 6:32](https://library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=392) - "Van Haal et al. conducted a retrospective cohort study in the Netherlands that included 79 patients who had rigid tracheobronchoscopy done before and after esophageal atresia surgery." — Lizzie Lee (host_summary) [Ep 7 · 1:04](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=64) - "Preoperative tracheobronchoscopy for the presence of post-operative tracheomalacia had a sensitivity of 50% and a specificity of 67%." — Lizzie Lee (host_summary) [Ep 7 · 1:24](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=84) - "Preoperative tracheobronchoscopy, though routine, has limited predictive value for post-operative tracheomalacia in esophageal atresia patients." — Lizzie Lee (host_summary) [Ep 7 · 1:34](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=94) - "Mina et al. performed a retrospective review of all patients who underwent conservative management of modified Bell stage 2A or greater necrotizing enterocolitis at a single institution from 2011 to 2022." — Alex Halpern (host_summary) [Ep 7 · 2:05](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=125) - "126 patients underwent conservative management of necrotizing enterocolitis, and 24 of those patients eventually underwent surgery for a post-NEC stricture." — Alex Halpern (host_summary) [Ep 7 · 2:20](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=140) - "Primary resection and anastomosis was performed in all cases of post-NEC stricture requiring surgery." — Alex Halpern (host_summary) [Ep 7 · 2:29](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=149) - "Post-NEC strictures are a common occurrence after conservative management of necrotizing enterocolitis." — Alex Halpern (host_summary) [Ep 7 · 2:33](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=153) - "Huncheid et al. conducted a multi-center non-inferiority trial that compared preterm infants treated with expectant management versus early ibuprofen for patent ductus arteriosus." — Cecilia Gigena (host_summary) [Ep 7 · 3:04](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=184) - "The trial included 273 infants: 136 treated with expectant management and 137 with early ibuprofen." — Cecilia Gigena (host_summary) [Ep 7 · 3:14](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=194) - "In the expectant management group for PDA, there was 17.6% necrotizing enterocolitis, 33% bronchopulmonary dysplasia, and 14% death rates." — Cecilia Gigena (host_summary) [Ep 7 · 3:24](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=204) - "In the ibuprofen group for PDA, there was 15.4% necrotizing enterocolitis, 50% bronchopulmonary dysplasia, and 80% death rates." — Cecilia Gigena (host_summary) [Ep 7 · 3:36](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=216) - "Expectant management is not inferior to early ibuprofen in preterm patients with patent ductus arteriosus." — Cecilia Gigena (host_summary) [Ep 7 · 3:53](https://library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=233) - "The paper by first author Hester Sche and last author Russell Jennings examined 98 patients who had severe tracheomalacia with posterior membranous intrusion." — Ian Glenn (host_summary) [Ep 1 · 0:16](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=16) - "All patients received bronchoscopy showing the trachea tended to collapse inward from the posterior aspect." — Ian Glenn (host_summary) [Ep 1 · 0:35](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=35) - "The authors distinguished between anterior compression (from the aortic arch) and posterior compression (collapse)." — Ian Glenn (host_summary) [Ep 1 · 0:44](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=44) - "Posterior tracheopexy involves taking pledgeted sutures and sewing the posterior wall of the trachea to the anterior longitudinal ligament of the spine." — Ian Glenn (host_summary) [Ep 1 · 0:54](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=54) - "88% of the 98 patients had esophageal atresia with or without TEF." — Ian Glenn (host_summary) [Ep 1 · 1:05](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=65) - "Patients were followed anywhere from 1 week to 36 months." — Ian Glenn (host_summary) [Ep 1 · 1:05](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=65) - "Clinical symptoms including cough, barking cough, noisy breathing, and infections improved across the board." — Ian Glenn (host_summary) [Ep 1 · 1:15](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=75) - "Patients improved on bronchoscopic evaluation." — Ian Glenn (host_summary) [Ep 1 · 1:25](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=85) - "Exercise tolerance did not improve statistically but showed a trend towards improvement." — Ian Glenn (host_summary) [Ep 1 · 1:30](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=90) - "Tracheomalacia is not a homogeneous disease." — Ian Glenn (host_summary) [Ep 1 · 1:35](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=95) - "The paper emphasized the importance of systematic bronchoscopic evaluation." — Ian Glenn (host_summary) [Ep 1 · 1:41](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=101) - "Some patients benefit from posterior tracheopexy, some from aortopexy or anterior approach, and some need both." — Ian Glenn (host_summary) [Ep 1 · 1:45](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=105) - "Approximately 20% of patients in the study required both posterior tracheopexy and aortopexy." — Ian Glenn (host_summary) [Ep 1 · 1:54](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=114) - "There is a need for standardization in the approach to tracheomalacia." — Ian Glenn (opinion) [Ep 1 · 1:58](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=118) - "The paper examined 98 patients who had severe tracheomalacia with posterior membranous intrusion." — Ian Glenn (host_summary) [Ep 2 · 0:28](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=28) - "All patients received bronchoscopy showing the trachea tended to collapse inward from the posterior aspect." — Ian Glenn (host_summary) [Ep 2 · 0:35](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=35) - "The study distinguished between anterior compression (from the aortic arch) and posterior compression (collapse)." — Ian Glenn (host_summary) [Ep 2 · 0:44](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=44) - "Posterior tracheopexy involves taking pledgeted sutures and sewing the posterior wall of the trachea to the anterior longitudinal ligament of the spine." — Ian Glenn (host_summary) [Ep 2 · 0:54](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=54) - "88% of the 98 patients had esophageal atresia with or without TEF." — Ian Glenn (host_summary) [Ep 2 · 1:05](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=65) - "Patients were followed anywhere from 1 week to 36 months." — Ian Glenn (host_summary) [Ep 2 · 1:05](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=65) - "Clinical symptoms improved pretty much across the board, including cough, barking cough, noisy breathing, and infections." — Ian Glenn (host_summary) [Ep 2 · 1:15](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=75) - "Patients improved on bronchoscopic evaluation." — Ian Glenn (host_summary) [Ep 2 · 1:25](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=85) - "Exercise tolerance did not improve statistically but showed a trend towards improvement." — Ian Glenn (host_summary) [Ep 2 · 1:30](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=90) - "Tracheomalacia is not one homogeneous disease." — Ian Glenn (host_summary) [Ep 2 · 1:35](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=95) - "The paper emphasized the importance of systematic bronchoscopic evaluation." — Ian Glenn (host_summary) [Ep 2 · 1:41](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=101) - "Some patients benefit from posterior tracheopexy, some from aortopexy or anterior approach, and some need both." — Ian Glenn (host_summary) [Ep 2 · 1:45](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=105) - "Almost 20% of patients in the study required both posterior tracheopexy and aortopexy." — Ian Glenn (host_summary) [Ep 2 · 1:54](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=114) - "There is a need for standardization in the treatment of tracheomalacia." — Ian Glenn (opinion) [Ep 2 · 1:58](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=118) ## Changelog - Sep 7: 2 items added automatically - Sep 7: 5 items added automatically --- Educational content from recorded physician discussions — not medical advice. 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