8th Annual Pediatric Surgery Update Course

Cone beam CT can be performed on a C-arm fluoroscopy unit in an OR, hybrid OR, or interventional suite by rotating around the patient to create stacked CT images

Ultrasound-guided foreign body removal becomes difficult after tissue dissection introduces air around the foreign body, making it virtually invisible on ultrasound

For pulmonary nodule localization, coil placement avoids wire dislodgement risk and can be combined with cone beam CT in the OR if the nodule is difficult to locate

The Shehata technique for intraabdominal testes achieves 88% success rate by fixing the testis to the contralateral abdominal wall for 2-3 months to allow vessel elongation without dividing testicular blood supply

Internal hernia has never been reported after Shehata technique in over 430 cases over 15 years, and is anatomically unlikely when attempting to bring bowel behind the spermatic cord

For adolescent trauma patients with orthopedic injuries requiring prolonged non-weight bearing, aspirin 81mg BID is being used as an alternative to Lovenox for outpatient DVT prophylaxis based on adult data, with better compliance expected

REBOA (resuscitative endovascular balloon aortic occlusion) can be used in children but is not commonly performed in pediatric hospitals, requires significant expertise for rapid deployment, and does not show clear survival advantage even in adult studies

Subpleural intercostal nerve blocks with 0.25% marcaine with epinephrine work immediately (versus 8-10 hour delay with cryo), take 15 seconds per interspace, and allow zero opioid use in the OR

The new cryoprobe reduces freeze time from 2 minutes to 90 seconds, reaches temperature 20 seconds faster, and has improved shaft insulation that only reaches room temperature so it can safely touch lung or skin

18% of lateral cutaneous nerve branches are posterior to the mid-axillary line, so cryoablation must be performed posterior enough (4 cm from vertebral column in posterior axillary line) to ensure effective nerve block

Double-freeze cryoablation technique targeting both the main intercostal nerve and the collateral branch on the rib below reduced peak pain scores from 5 to 3 in 20 patients, with 9 of 22 patients in Dr. Kim's study reporting pain scores of zero

For cryoablation during thoracotomy, going 1-2 levels above and below the incision with 60-second freeze cycles provides effective pain control; must avoid T10 or lower to prevent pseudo-hernias from motor branch involvement

Cryoablation for thoracotomy pain showed 2-3 fold reduction in narcotic use during hospitalization compared to regional blocks, with patients discharged without narcotic prescriptions

For slipping rib syndrome, intercostal nerve block with steroid and long-acting local anesthetic serves as a diagnostic test; if effective, percutaneous cryoablation can provide longer-term relief before considering surgery

Lipiodol marking for pulmonary nodules achieved 100% sensitivity in 33 nodules across multiple patients, with the radiopaque dye persisting for 3 months and allowing surgery to be performed days after marking