IPEG 2018 - OUTCOMES USING CRYOABLATION FOR POST-OPERATIVE PAIN CONTROL IN CHILDREN

Good morning. Thank you very much for the opportunity to present our work. We have nothing to disclose. So pectus excavata repair is the most common chest wall deformity in children, but pain after repair is the main factor determining post-operative course. Traditional pain control methods include epidural catheters, as well as patient-controlled analgesia. And the aim of our study is to report our early experience with cryoablation following repair of pectus excavatum. We performed a single center retrospective review between January 1st and August 21st of 2017 of all children undergoing minimally invasive pectus excavatum repair. In this image, you can see the configuration with which we utilize our probe to perform our minimally invasive pectus excavatum repair, we utilize bilateral axo incisions and a subxiphoid incision, via which we perform blunt dissection to connect these sides. In this image, you can see that our probe is on the anterior aspect of our axillary incision, and we utilize a 5 millimeter port at the posterior aspect of our incision to introduce our camera. All of our cryoablation is performed thoracoscopically under direct visualization. In this image, you can see that we advance the probe out of its protective sheath and introduce a manual bend to this probe to facilitate contact to the nerve. In this image you can see a before and after shot after cryoablation. To perform the cryoablation, the probe is placed on the superior aspect of the fourth inner space, and a freeze is activated, which lasts 120 seconds and then follows with a brief thaw cycle which we will see in the next image. This is then performed through T4 and T7 bilaterally. In this image you can see a video. Let me get started here. You can see a freeze and a thaw cycle. You can see that the freeze is automatic, and once it is started, it sticks to the position that the probe was placed. In this next image, you can see a thaw cycle, which is very rapid. Once the thaw cycle is complete, the probe will detach from the tissue and is no longer cool enough to damage surrounding tissue. In our two groups, we had 19 patients who did not undergo cryoablation and 9 who did. There is no difference in their gender or their BMI, however, patients who underwent cryoablation had a higher holler and corrective index in comparison to those who did not. Comparing our operative outcomes, the operative time in the cryoablation group was approximately 30 minutes longer than the other group. This was due to the 122nd cycles it requires to perform cryoablation. However, you can see that there was a decrease in the time to PO pain control. It took 1.2 days in our cryoablation group for patients to be on only PO pain control in comparison to the other group, which was 2.6 days. Most intriguingly, patients who underwent cryoablation only stayed in the hospital for 1.4 days in comparison to their counterparts who were there for 4 days. And in fact, 6 out of 9 patients in our cryoablation group, or 67%, were discharged home on post-operative day one. In addition, their rate, their time to discontinuation of PO narcotics was only 8.2 days. In the other group, it was 18.2. We had no complications from bar placements in our non-cryoablation group. However, one cryoablation patient returned with a pneumothorax, which was managed without any chest tube. Looking at our pain scores, patients who underwent cryoablation had lower pain scores on post-operative day 0 and 2, and similar scores on post-operative day 1. However, no patients stayed after post-operative day 2. So in conclusion, cryoablation improves pain control, shortens hospital length of stay, but does slightly increase operative times to 30 minutes. With familiarity with this procedure, this has become approximately 20 minutes in our institution. Cryoablation has become the preferred method of pain control in our institution and has led to us beginning a prospective observational trial to verify these findings. Thank you, and I'll take any questions.