Alessandro de Alarcon

195 statements · 6 topics

Aerodigestive / ENT · guest expert

Featured statements

▶ Ep 35 · 0:35
MRSA or methicillin resistant Staph aureus, it's a lot of times kind of in the lay press. It's the bacteria that people have been really concerned about for the last decade as being a very resistant Staph aureus that can cause a lot of problems with infection.
quote · Pediatric Airway Reconstruction & Stenosis Management
▶ Ep 35 · 5:19
a lot of other surgical practices that have published papers about using screening and treatment programs, they often look at high risk patient populations as being kind of 8 to 10% of the patient population as having MRSA.
quote · Pediatric Airway Reconstruction & Stenosis Management
▶ Ep 1 · 1:28
Grafting is when we take a piece of rib cartilage and insert it into an incision in the back part of the voice box to make the voice box bigger at the level of the vocal cords.
quote · Bilateral Vocal Fold Paralysis & Posterior Glottic Disorders
▶ Ep 1 · 1:07
When we think about surgery for vocal fold paralysis, we like to balance breathing, voicing, and swallowing, and we like to obtain a result that balances those three things.
quote · Bilateral Vocal Fold Paralysis & Posterior Glottic Disorders
▶ Ep 15 · 1:39
If we can, we like to use a NIM tube as part of trying to prevent potential injury to recurrent nerves or at least make you aware when you're Getting close to them.
quote · Aerodigestive / ENT
▶ Ep 15 · 3:15
We like to use 30 prolenes and we like to place all the stitches before we actually secure them down, and it's important to do this under spontaneous conditions.
quote · Aerodigestive / ENT

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Alessandro's statements about Aerodigestive / ENT 26 statements

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QUAD #1: Cervical Tracheopexy with Dr. Alessandro de Alarcon

▶ Ep 15 · 0:49
clinical Cincinnati Children's typically uses a combined cervical and thoracic approach for esophageal atresia cases. ↗
▶ Ep 15 · 0:49
quote In Cincinnati we typically use a combined approach looking at the thoracic approach as well as with the cervical approach. ↗
▶ Ep 15 · 1:15
quote You need a neck tray, and MLB tray, and Maloney dilators versus NG tubes in the operating room and you do it. ↗
▶ Ep 15 · 1:15
clinical Required intraoperative equipment includes a neck tray, MLB tray, and Maloney dilators or NG tubes. ↗
▶ Ep 15 · 1:21
quote The flexible bronchoscopy is really key and Placing your endotracheal tube is really important so they can look as you were doing the operation. ↗
▶ Ep 15 · 1:21
clinical Flexible bronchoscopy during the operation is key, and endotracheal tube placement must allow visualization during the procedure. ↗
▶ Ep 15 · 1:29
clinical Nasotracheal intubation is often used with the cuff positioned high, sometimes almost at the glottis. ↗
▶ Ep 15 · 1:33
quote And sometimes that means your cuff is super high and it's almost at the glottis. ↗
▶ Ep 15 · 1:39
quote If we can, we like to use a NIM tube as part of trying to prevent potential injury to recurrent nerves or at least make you aware when you're Getting close to them. ↗
▶ Ep 15 · 1:39
clinical A NIM tube is preferred when possible to prevent injury to recurrent nerves or provide awareness when approaching them. ↗
▶ Ep 15 · 1:55
clinical The surgical approach uses subplatysmal flaps and addresses anterior compression as needed. ↗
▶ Ep 15 · 2:09
clinical Aortopexy and innominate artery pexy can be added at the same time as the cervical procedure. ↗
▶ Ep 15 · 2:29
opinion The Cincinnati team has learned not to be afraid of mobilizing the esophagus, which is important for the procedure. ↗
▶ Ep 15 · 2:29
quote And then it's thinking about your approach to mobilize the esophagus and the experience of working with our team in Cincinnati, we have learned how to not be afraid of the esophagus. ↗
▶ Ep 15 · 2:54
quote We will sometimes place stitches in the trachea to pull it up and out of the way so you can visualize that posterior aspect of where you see the spine. ↗
▶ Ep 15 · 2:54
clinical Stitches are sometimes placed in the trachea to pull it up and out of the way for visualization of the posterior aspect and spine. ↗
▶ Ep 15 · 3:15
clinical Suture placement is performed under spontaneous ventilation conditions. ↗
▶ Ep 15 · 3:15
quote We like to use 30 prolenes and we like to place all the stitches before we actually secure them down, and it's important to do this under spontaneous conditions. ↗
▶ Ep 15 · 3:15
clinical The team uses 3-0 prolene sutures and places all stitches before securing them down. ↗
▶ Ep 15 · 3:33
clinical A patient who had prior thoracoscopic tracheopexy with dysphagia from torqued esophagus underwent the combined approach and became symptom-free. ↗
▶ Ep 15 · 4:00
clinical Outcome measures include follow-up endoscopy, pulmonary function tests when patients are old enough, and imaging. ↗
▶ Ep 15 · 4:09
clinical At 36 months follow-up, imaging may still show tracheomalacia, but patients can be symptomatically better. ↗
▶ Ep 15 · 4:09
quote And when you look 36 months later, it may still look like there's some malaysia, but symptomatically, they're better. ↗
▶ Ep 15 · 4:15
quote So it's important to pair that piece and understand that we're still trying to learn exactly what are those measures that we want to use to be able to say that they are a good outcome versus a bad outcome. ↗
▶ Ep 15 · 4:15
opinion The team is still learning what measures should define good versus bad outcomes. ↗
▶ Ep 15 · 4:26
clinical Managing complications including swallowing dysfunction and vocal fold paralysis is part of postoperative care. ↗
Alessandro's statements about Bilateral Vocal Fold Paralysis & Posterior Glottic Disorders 14 statements

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Inside Tract: Bilateral Vocal Fold Paralysis | Cincinnati Children's

▶ Ep 1 · 0:16
clinical Bilateral vocal fold paralysis is when the vocal folds don't move and typically they're stuck in the middle. ↗
▶ Ep 1 · 0:16
quote So, bilateral vocal fold paralysis is when the vocal folds don't move and typically they're stuck in the middle. ↗
▶ Ep 1 · 0:22
clinical When vocal folds are stuck in the middle, patients have problems with breathing. ↗
▶ Ep 1 · 0:25
opinion Cincinnati Children's has outstanding airway reconstruction history over the last 30 to 40 years. ↗
▶ Ep 1 · 0:44
clinical The initial evaluation at Cincinnati Children's typically begins with a phone call from an airway nurse practitioner to obtain patient history. ↗
▶ Ep 1 · 0:51
clinical The airway nurse practitioner collaborates with a surgeon to determine the initial evaluation plan. ↗
▶ Ep 1 · 1:07
clinical Surgery for vocal fold paralysis aims to balance breathing, voicing, and swallowing. ↗
▶ Ep 1 · 1:07
quote When we think about surgery for vocal fold paralysis, we like to balance breathing, voicing, and swallowing, and we like to obtain a result that balances those three things. ↗
▶ Ep 1 · 1:28
quote Grafting is when we take a piece of rib cartilage and insert it into an incision in the back part of the voice box to make the voice box bigger at the level of the vocal cords. ↗
▶ Ep 1 · 1:28
clinical Grafting involves taking a piece of rib cartilage and inserting it into an incision in the back part of the voice box to make the voice box bigger at the level of the vocal cords. ↗
▶ Ep 1 · 1:39
clinical Endoscopic grafting is performed through the mouth without external neck incisions. ↗
▶ Ep 1 · 1:46
clinical Open grafting involves making an incision on the neck to open the larynx and insert the graft. ↗
▶ Ep 1 · 1:57
opinion Endoscopic and open posterior grafting offer the best advantage for balancing airway, voicing, and swallowing. ↗
▶ Ep 1 · 2:04
clinical These grafting techniques offer the opportunity to improve voice in the long term by allowing future voice reconstruction operations. ↗
Alessandro's statements about Esophageal Atresia 26 statements

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QUAD #1: Cervical Tracheopexy with Dr. Alessandro de Alarcon

▶ Ep 25 · 0:49
quote In Cincinnati we typically use a combined approach looking at the thoracic approach as well as with the cervical approach. ↗
▶ Ep 25 · 0:49
clinical Cincinnati Children's typically uses a combined cervical and thoracic approach for esophageal atresia cases. ↗
▶ Ep 25 · 1:15
clinical Required intraoperative equipment includes a neck tray, MLB tray, and Maloney dilators or NG tubes. ↗
▶ Ep 25 · 1:15
quote You need a neck tray, and MLB tray, and Maloney dilators versus NG tubes in the operating room and you do it. ↗
▶ Ep 25 · 1:21
clinical Flexible bronchoscopy during the operation is key, and endotracheal tube placement must allow visualization during the procedure. ↗
▶ Ep 25 · 1:21
quote The flexible bronchoscopy is really key and Placing your endotracheal tube is really important so they can look as you were doing the operation. ↗
▶ Ep 25 · 1:29
clinical Nasotracheal intubation is often used with the cuff positioned high, sometimes almost at the glottis. ↗
▶ Ep 25 · 1:33
quote And sometimes that means your cuff is super high and it's almost at the glottis. ↗
▶ Ep 25 · 1:39
clinical A NIM tube is preferred when possible to prevent injury to recurrent nerves or provide awareness when approaching them. ↗
▶ Ep 25 · 1:39
quote If we can, we like to use a NIM tube as part of trying to prevent potential injury to recurrent nerves or at least make you aware when you're Getting close to them. ↗
▶ Ep 25 · 1:55
clinical The surgical approach uses subplatysmal flaps and addresses anterior compression as needed. ↗
▶ Ep 25 · 2:09
clinical Aortopexy and innominate artery pexy can be added at the same time as the cervical procedure. ↗
▶ Ep 25 · 2:29
opinion The Cincinnati team has learned not to be afraid of mobilizing the esophagus, which is important for the procedure. ↗
▶ Ep 25 · 2:29
quote And then it's thinking about your approach to mobilize the esophagus and the experience of working with our team in Cincinnati, we have learned how to not be afraid of the esophagus. ↗
▶ Ep 25 · 2:54
quote We will sometimes place stitches in the trachea to pull it up and out of the way so you can visualize that posterior aspect of where you see the spine. ↗
▶ Ep 25 · 2:54
clinical Stitches are sometimes placed in the trachea to pull it up and out of the way for visualization of the posterior aspect and spine. ↗
▶ Ep 25 · 3:15
clinical The team uses 3-0 prolene sutures and places all stitches before securing them down. ↗
▶ Ep 25 · 3:15
clinical Suture placement is performed under spontaneous ventilation conditions. ↗
▶ Ep 25 · 3:15
quote We like to use 30 prolenes and we like to place all the stitches before we actually secure them down, and it's important to do this under spontaneous conditions. ↗
▶ Ep 25 · 3:33
clinical A patient who had prior thoracoscopic tracheopexy with dysphagia from torqued esophagus underwent the combined approach and became symptom-free. ↗
▶ Ep 25 · 4:00
clinical Outcome measures include follow-up endoscopy, pulmonary function tests when patients are old enough, and imaging. ↗
▶ Ep 25 · 4:09
quote And when you look 36 months later, it may still look like there's some malaysia, but symptomatically, they're better. ↗
▶ Ep 25 · 4:09
clinical At 36 months follow-up, imaging may still show tracheomalacia, but patients can be symptomatically better. ↗
▶ Ep 25 · 4:15
opinion The team is still learning what measures should define good versus bad outcomes. ↗
▶ Ep 25 · 4:15
quote So it's important to pair that piece and understand that we're still trying to learn exactly what are those measures that we want to use to be able to say that they are a good outcome versus a bad outcome. ↗
▶ Ep 25 · 4:26
clinical Managing complications including swallowing dysfunction and vocal fold paralysis is part of postoperative care. ↗
Alessandro's statements about Esophageal Atresia 50 statements

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QUAD #1: Cervical Tracheopexy with Dr. Alessandro de Alarcon

▶ Ep 48 · 0:49
quote In Cincinnati we typically use a combined approach looking at the thoracic approach as well as with the cervical approach. ↗
▶ Ep 48 · 0:49
clinical Cincinnati Children's typically uses a combined cervical and thoracic approach for esophageal atresia cases. ↗
▶ Ep 48 · 1:15
clinical Required intraoperative equipment includes a neck tray, MLB tray, and Maloney dilators or NG tubes. ↗
▶ Ep 48 · 1:15
quote You need a neck tray, and MLB tray, and Maloney dilators versus NG tubes in the operating room and you do it. ↗
▶ Ep 48 · 1:21
clinical Flexible bronchoscopy during the operation is key, and endotracheal tube placement must allow visualization during the procedure. ↗
▶ Ep 48 · 1:21
quote The flexible bronchoscopy is really key and Placing your endotracheal tube is really important so they can look as you were doing the operation. ↗
▶ Ep 48 · 1:29
clinical Nasotracheal intubation is often used with the cuff positioned high, sometimes almost at the glottis. ↗
▶ Ep 48 · 1:33
quote And sometimes that means your cuff is super high and it's almost at the glottis. ↗
▶ Ep 48 · 1:39
quote If we can, we like to use a NIM tube as part of trying to prevent potential injury to recurrent nerves or at least make you aware when you're Getting close to them. ↗
▶ Ep 48 · 1:39
clinical A NIM tube is preferred when possible to prevent injury to recurrent nerves or provide awareness when approaching them. ↗
▶ Ep 48 · 1:55
clinical The surgical approach uses subplatysmal flaps and addresses anterior compression as needed. ↗
▶ Ep 48 · 2:09
clinical Aortopexy and innominate artery pexy can be added at the same time as the cervical procedure. ↗
▶ Ep 48 · 2:29
quote And then it's thinking about your approach to mobilize the esophagus and the experience of working with our team in Cincinnati, we have learned how to not be afraid of the esophagus. ↗
▶ Ep 48 · 2:29
opinion The Cincinnati team has learned not to be afraid of mobilizing the esophagus, which is important for the procedure. ↗
▶ Ep 48 · 2:54
quote We will sometimes place stitches in the trachea to pull it up and out of the way so you can visualize that posterior aspect of where you see the spine. ↗
▶ Ep 48 · 2:54
clinical Stitches are sometimes placed in the trachea to pull it up and out of the way for visualization of the posterior aspect and spine. ↗
▶ Ep 48 · 3:15
clinical The team uses 3-0 prolene sutures and places all stitches before securing them down. ↗
▶ Ep 48 · 3:15
quote We like to use 30 prolenes and we like to place all the stitches before we actually secure them down, and it's important to do this under spontaneous conditions. ↗
▶ Ep 48 · 3:15
clinical Suture placement is performed under spontaneous ventilation conditions. ↗
▶ Ep 48 · 3:33
clinical A patient who had prior thoracoscopic tracheopexy with dysphagia from torqued esophagus underwent the combined approach and became symptom-free. ↗
▶ Ep 48 · 4:00
clinical Outcome measures include follow-up endoscopy, pulmonary function tests when patients are old enough, and imaging. ↗
▶ Ep 48 · 4:09
clinical At 36 months follow-up, imaging may still show tracheomalacia, but patients can be symptomatically better. ↗
▶ Ep 48 · 4:09
quote And when you look 36 months later, it may still look like there's some malaysia, but symptomatically, they're better. ↗
▶ Ep 48 · 4:15
quote So it's important to pair that piece and understand that we're still trying to learn exactly what are those measures that we want to use to be able to say that they are a good outcome versus a bad outcome. ↗
▶ Ep 48 · 4:15
opinion The team is still learning what measures should define good versus bad outcomes. ↗
▶ Ep 48 · 4:26
clinical Managing complications including swallowing dysfunction and vocal fold paralysis is part of postoperative care. ↗

Combined cervical and thoracic approach for esophageal atresia with tracheopexy

▶ Ep 79 · 0:49
clinical Cincinnati Children's typically uses a combined cervical and thoracic approach for esophageal atresia cases. ↗
▶ Ep 79 · 0:49
quote In Cincinnati we typically use a combined approach we're looking at the thoracic approach as well as with the cervical approach. ↗
▶ Ep 79 · 1:15
clinical Required intraoperative equipment includes a neck tray, MLB tray, and Maloney dilators versus NG tubes. ↗
▶ Ep 79 · 1:15
quote You need a neck tray, and MLB tray, and Maloney dilators versus NG tubes in the operating room and you do it. ↗
▶ Ep 79 · 1:21
clinical Flexible bronchoscopy during the operation is key, with the endotracheal tube placed exactly where needed for visualization. ↗
▶ Ep 79 · 1:21
quote The flexible bronchoscopy is really key and Placing your endotracheal tube is really important, so they can look as you were doing the operation. ↗
▶ Ep 79 · 1:29
clinical Nasotracheal intubation is often used with the cuff positioned very high, sometimes almost at the glottis. ↗
▶ Ep 79 · 1:34
quote And sometimes that means your cuff is super high and it's almost at the glottis, you just have to be aware of that. ↗
▶ Ep 79 · 1:39
clinical A NIM tube is used when possible to prevent potential injury to recurrent nerves or provide awareness when getting close to them. ↗
▶ Ep 79 · 1:39
quote If we can, we like to use a NIM tube as part of trying to prevent potential injury to recurrent nerves or at least make you aware when you're Getting close to them. ↗
▶ Ep 79 · 1:55
clinical The standard neck approach involves raising subplatysmal flaps and dealing with anterior compression as needed. ↗
▶ Ep 79 · 2:09
clinical Aortopexy and mopexy can be added at the same time as the cervical approach. ↗
▶ Ep 79 · 2:13
clinical The straps are separated to expose the airway and find the esophagus. ↗
▶ Ep 79 · 2:29
opinion The Cincinnati team has learned not to be afraid of the esophagus, being able to find it, move it, and get it out of the way. ↗
▶ Ep 79 · 2:35
quote We have learned how to not be afraid of the esophagus. ↗
▶ Ep 79 · 2:54
clinical Stitches are sometimes placed in the trachea to pull it up and out of the way to visualize the posterior aspect where the spine is visible. ↗
▶ Ep 79 · 3:15
clinical 3-0 Prolene sutures are used, with all stitches placed before securing them down, under spontaneous ventilation conditions. ↗
▶ Ep 79 · 3:15
quote We like to use 3 Orolines and we like to place all the stitches before we actually secure them down, and it's important to do this under spontaneous conditions. ↗
▶ Ep 79 · 3:33
clinical A patient who had prior thoracoscopic tracheopexy developed dysphagia from a torqued esophagus, was treated with the combined approach, achieved a good airway, and is now symptom-free. ↗
▶ Ep 79 · 4:00
clinical Outcome measures include follow-up endoscopy, pulmonary function tests when patients are old enough to perform them, and imaging. ↗
▶ Ep 79 · 4:09
clinical At 36 months follow-up, imaging may still show some malacia, but patients are symptomatically better. ↗
▶ Ep 79 · 4:09
quote And when you look 36 months later, it may still look like there's some malaysia, but symptomatically, they're better. ↗
▶ Ep 79 · 4:15
opinion The team is still learning what measures should be used to define good versus bad outcomes. ↗
▶ Ep 79 · 4:26
clinical Managing complications including swallowing dysfunction and vocal fold paralysis is part of the care process. ↗
Alessandro's statements about Pediatric Airway Reconstruction & Stenosis Management 29 statements

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Screening and treatment of MRSA colonization in pediatric airway surgery patients

▶ Ep 35 · 0:35
quote MRSA or methicillin resistant Staph aureus, it's a lot of times kind of in the lay press. It's the bacteria that people have been really concerned about for the last decade as being a very resistant Staph aureus that can cause a lot of problems with infection. ↗
▶ Ep 35 · 0:35
clinical MRSA (methicillin-resistant Staph aureus) can cause serious infections in the skin and wound sites after surgery. ↗
▶ Ep 35 · 0:58
epidemiological Studies in the last decade show an increasing number of MRSA infections both in the community and during surgical procedures globally. ↗
▶ Ep 35 · 1:14
opinion The increase in resistant bacterial strains is thought to be due to more frequent antibiotic use than in the past. ↗
▶ Ep 35 · 1:27
clinical At Cincinnati Children's, several patients had severe MRSA infections that led to failure of their airway reconstruction. ↗
▶ Ep 35 · 1:27
quote some of my co-authors noted they had a series of several patients that had pretty severe MRSA infections that led to actually failure of their airways. ↗
▶ Ep 35 · 1:46
clinical Cincinnati Children's protocol screens patients for MRSA prior to airway surgery and treats colonized patients before and during surgery with appropriate antibiotics. ↗
▶ Ep 35 · 2:00
quote colonized, that means that they have it either in their skin or some site. Their body where they're growing it, but it's not causing an infection ↗
▶ Ep 35 · 3:00
epidemiological MRSA surgical site infections can increase the cost of admission by up to approximately $62,000. ↗
▶ Ep 35 · 3:06
quote Studies show it increased costs up to about $62,000 for a single surgical site infection, which is not insignificant ↗
▶ Ep 35 · 3:19
clinical MRSA infections can cause rib grafts used in airway reconstructions to die, leading to complete surgical failure. ↗
▶ Ep 35 · 3:26
quote when we use rib grafts for airway reconstructions, those rib grafts can actually die and the whole operation. Itself will be a failure ↗
▶ Ep 35 · 3:34
quote a typical airway reconstruction in me, you know, if you're just looking at charges to a hospital or cost, runs around $90,000. ↗
▶ Ep 35 · 3:34
epidemiological A typical airway reconstruction runs around $90,000 in hospital charges. ↗
▶ Ep 35 · 3:58
clinical Hospital stays for airway reconstruction range from a couple of weeks to about a month. ↗
▶ Ep 35 · 4:31
clinical Cincinnati Children's is working on protocols to reduce or eliminate surgical site infections by identifying preventable harm. ↗
▶ Ep 35 · 4:31
opinion Surgical site infections have historically been looked at as accidents or something not preventable. ↗
▶ Ep 35 · 5:19
quote a lot of other surgical practices that have published papers about using screening and treatment programs, they often look at high risk patient populations as being kind of 8 to 10% of the patient population as having MRSA. ↗
▶ Ep 35 · 5:19
quote if you look at just the overall Numbers of children that we screen here with tracheostomies, about a third of them will have will be colonized with MRSA ↗
▶ Ep 35 · 5:19
epidemiological Other surgical practices typically define high-risk patient populations as having 8 to 10% MRSA colonization rates. ↗
▶ Ep 35 · 5:19
epidemiological About one-third of children with tracheostomies screened at Cincinnati Children's are colonized with MRSA. ↗
▶ Ep 35 · 5:59
clinical Cincinnati Children's airway surgery program focuses on improving outcomes beyond tracheostomy removal, including voice outcomes and long-term quality of life. ↗
▶ Ep 35 · 5:59
clinical Robin Cotton is one of the forefathers of airway reconstruction in children. ↗
▶ Ep 35 · 6:48
clinical Many children with tracheostomies will be MRSA positive from the tracheostomy site or an additional site. ↗
▶ Ep 35 · 7:07
opinion The study design could not prove that Cincinnati Children's protocol is the perfect protocol. ↗
▶ Ep 35 · 7:07
quote In our study, we couldn't really prove that our protocol is the perfect protocol. Partly just the nature of the design of the study ↗
▶ Ep 35 · 7:24
clinical The study showed no increase in MRSA infections in patients who were MRSA positive and treated according to the protocol. ↗
▶ Ep 35 · 7:24
guideline Centers performing significant airway reconstruction should have a clinical protocol for MRSA screening before surgery and treatment. ↗
▶ Ep 35 · 7:40
quote we did show that there wasn't any increase in MRSA infections in the patients that were MRSA positive, which was pretty fantastic ↗
Alessandro's statements about Tracheomalacia 50 statements

Open the Tracheomalacia collection →

QUAD #1: Cervical Tracheopexy with Dr. Alessandro de Alarcon

▶ Ep 4 · 0:49
quote In Cincinnati we typically use a combined approach looking at the thoracic approach as well as with the cervical approach. ↗
▶ Ep 4 · 0:49
clinical Cincinnati Children's typically uses a combined cervical and thoracic approach for esophageal atresia cases. ↗
▶ Ep 4 · 1:15
quote You need a neck tray, and MLB tray, and Maloney dilators versus NG tubes in the operating room and you do it. ↗
▶ Ep 4 · 1:15
clinical Required intraoperative equipment includes a neck tray, MLB tray, and Maloney dilators or NG tubes. ↗
▶ Ep 4 · 1:21
clinical Flexible bronchoscopy during the operation is key, and endotracheal tube placement must allow visualization during the procedure. ↗
▶ Ep 4 · 1:21
quote The flexible bronchoscopy is really key and Placing your endotracheal tube is really important so they can look as you were doing the operation. ↗
▶ Ep 4 · 1:29
clinical Nasotracheal intubation is often used with the cuff positioned high, sometimes almost at the glottis. ↗
▶ Ep 4 · 1:33
quote And sometimes that means your cuff is super high and it's almost at the glottis. ↗
▶ Ep 4 · 1:39
quote If we can, we like to use a NIM tube as part of trying to prevent potential injury to recurrent nerves or at least make you aware when you're Getting close to them. ↗
▶ Ep 4 · 1:39
clinical A NIM tube is preferred when possible to prevent injury to recurrent nerves or provide awareness when approaching them. ↗
▶ Ep 4 · 1:55
clinical The surgical approach uses subplatysmal flaps and addresses anterior compression as needed. ↗
▶ Ep 4 · 2:09
clinical Aortopexy and innominate artery pexy can be added at the same time as the cervical procedure. ↗
▶ Ep 4 · 2:29
opinion The Cincinnati team has learned not to be afraid of mobilizing the esophagus, which is important for the procedure. ↗
▶ Ep 4 · 2:29
quote And then it's thinking about your approach to mobilize the esophagus and the experience of working with our team in Cincinnati, we have learned how to not be afraid of the esophagus. ↗
▶ Ep 4 · 2:54
clinical Stitches are sometimes placed in the trachea to pull it up and out of the way for visualization of the posterior aspect and spine. ↗
▶ Ep 4 · 2:54
quote We will sometimes place stitches in the trachea to pull it up and out of the way so you can visualize that posterior aspect of where you see the spine. ↗
▶ Ep 4 · 3:15
clinical The team uses 3-0 prolene sutures and places all stitches before securing them down. ↗
▶ Ep 4 · 3:15
clinical Suture placement is performed under spontaneous ventilation conditions. ↗
▶ Ep 4 · 3:15
quote We like to use 30 prolenes and we like to place all the stitches before we actually secure them down, and it's important to do this under spontaneous conditions. ↗
▶ Ep 4 · 3:33
clinical A patient who had prior thoracoscopic tracheopexy with dysphagia from torqued esophagus underwent the combined approach and became symptom-free. ↗
▶ Ep 4 · 4:00
clinical Outcome measures include follow-up endoscopy, pulmonary function tests when patients are old enough, and imaging. ↗
▶ Ep 4 · 4:09
clinical At 36 months follow-up, imaging may still show tracheomalacia, but patients can be symptomatically better. ↗
▶ Ep 4 · 4:09
quote And when you look 36 months later, it may still look like there's some malaysia, but symptomatically, they're better. ↗
▶ Ep 4 · 4:15
opinion The team is still learning what measures should define good versus bad outcomes. ↗
▶ Ep 4 · 4:15
quote So it's important to pair that piece and understand that we're still trying to learn exactly what are those measures that we want to use to be able to say that they are a good outcome versus a bad outcome. ↗
▶ Ep 4 · 4:26
clinical Managing complications including swallowing dysfunction and vocal fold paralysis is part of postoperative care. ↗

Combined cervical and thoracic approach for esophageal atresia with tracheopexy

▶ Ep 13 · 0:49
quote In Cincinnati we typically use a combined approach we're looking at the thoracic approach as well as with the cervical approach. ↗
▶ Ep 13 · 0:49
clinical Cincinnati Children's typically uses a combined cervical and thoracic approach for esophageal atresia cases. ↗
▶ Ep 13 · 1:15
clinical Required intraoperative equipment includes a neck tray, MLB tray, and Maloney dilators versus NG tubes. ↗
▶ Ep 13 · 1:15
quote You need a neck tray, and MLB tray, and Maloney dilators versus NG tubes in the operating room and you do it. ↗
▶ Ep 13 · 1:21
quote The flexible bronchoscopy is really key and Placing your endotracheal tube is really important, so they can look as you were doing the operation. ↗
▶ Ep 13 · 1:21
clinical Flexible bronchoscopy during the operation is key, with the endotracheal tube placed exactly where needed for visualization. ↗
▶ Ep 13 · 1:29
clinical Nasotracheal intubation is often used with the cuff positioned very high, sometimes almost at the glottis. ↗
▶ Ep 13 · 1:34
quote And sometimes that means your cuff is super high and it's almost at the glottis, you just have to be aware of that. ↗
▶ Ep 13 · 1:39
quote If we can, we like to use a NIM tube as part of trying to prevent potential injury to recurrent nerves or at least make you aware when you're Getting close to them. ↗
▶ Ep 13 · 1:39
clinical A NIM tube is used when possible to prevent potential injury to recurrent nerves or provide awareness when getting close to them. ↗
▶ Ep 13 · 1:55
clinical The standard neck approach involves raising subplatysmal flaps and dealing with anterior compression as needed. ↗
▶ Ep 13 · 2:09
clinical Aortopexy and mopexy can be added at the same time as the cervical approach. ↗
▶ Ep 13 · 2:13
clinical The straps are separated to expose the airway and find the esophagus. ↗
▶ Ep 13 · 2:29
opinion The Cincinnati team has learned not to be afraid of the esophagus, being able to find it, move it, and get it out of the way. ↗
▶ Ep 13 · 2:35
quote We have learned how to not be afraid of the esophagus. ↗
▶ Ep 13 · 2:54
clinical Stitches are sometimes placed in the trachea to pull it up and out of the way to visualize the posterior aspect where the spine is visible. ↗
▶ Ep 13 · 3:15
quote We like to use 3 Orolines and we like to place all the stitches before we actually secure them down, and it's important to do this under spontaneous conditions. ↗
▶ Ep 13 · 3:15
clinical 3-0 Prolene sutures are used, with all stitches placed before securing them down, under spontaneous ventilation conditions. ↗
▶ Ep 13 · 3:33
clinical A patient who had prior thoracoscopic tracheopexy developed dysphagia from a torqued esophagus, was treated with the combined approach, achieved a good airway, and is now symptom-free. ↗
▶ Ep 13 · 4:00
clinical Outcome measures include follow-up endoscopy, pulmonary function tests when patients are old enough to perform them, and imaging. ↗
▶ Ep 13 · 4:09
quote And when you look 36 months later, it may still look like there's some malaysia, but symptomatically, they're better. ↗
▶ Ep 13 · 4:09
clinical At 36 months follow-up, imaging may still show some malacia, but patients are symptomatically better. ↗
▶ Ep 13 · 4:15
opinion The team is still learning what measures should be used to define good versus bad outcomes. ↗
▶ Ep 13 · 4:26
clinical Managing complications including swallowing dysfunction and vocal fold paralysis is part of the care process. ↗