Sinus Venosus ASD Repair

This video demonstrates a sinus venosus ASD repair with the two patch repair technique. Authors: Emily Goodman; Brian Reemtsen, MD; Markus Renno, MD; Christian Eisenring, ACNP-BC; Lawrence Greiten, MD University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR Arkansas Children's Hospital, Little Rock, AR

Sinus Venosus ASD Repair

This video demonstrates a sinus venosus ASD repair with the two patch repair technique. Authors: Emily Goodman; Brian Reemtsen, MD; Markus Renno, MD; Christian Eisenring, ACNP-BC; Lawrence Greiten, MD University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR Arkansas Children's Hospital, Little Rock, AR

Hypoglossal Nerve Stimulator Implantation: 2-Incision Technique

Hypoglossal Nerve Stimulator Implantation: 2-Incision Technique Authors: Cheryl Yu, MD1; Nilan Vaghjiani, BS1; Ryan Nord, MD1 1Virginia Commonwealth University School of Medicine, Department of Otolaryngology/ Head and Neck Surgery, Richmond, VA 

Background: 

Obstructive sleep apnea is a worldwide health problem that affects all groups. Given its systemic associations with comorbid diseases, it ultimately increases lifetime risk of mortality and thus, should not be a disorder taken lightly. Although continuous positive airway pressure is thoroughly acknowledged as the gold standard for treating OSA with studied efficacy, adherence remains challenge. Given such, hypoglossal nerve stimulation therapy presents a revolutionary alternative for those with moderate to severe degrees of OSA who are unable to tolerate standard CPAP therapy. It has been studied to be very efficacious in treating the disorder, with reductions in apneas up to 70-80%. The surgery itself is less invasive, now even more so with the 2-incision technique, when compared to other surgical options such as mandibular advancement or other upper airway surgery, with decreased post-operative pain and healing times. Adherence to therapy is generally superior as the majority prefer it over traditional positive airway pressure therapy.  Overall, hypoglossal nerve stimulator implantation is an effective, tolerable long-term alternative treatment option for those with OSA. 

Case Overview: 84-year-old female with BMI of 31 with past medical history significant for hypertension, atrial fibrillation, and obstructive sleep apnea and inability to tolerate CPAP. Polysomnography revealed severe OSA with an AHI of 33 and minimal central or mixed apneas. Preoperative drug induced sleep endoscopy was performed noting complete anterior-posterior collapse of the velum, no collapse at the oropharynx, complete anterior-posterior collapse of the tongue base, and no collapse at the epiglottis. Patient was subsequently deemed an appropriate candidate for hypoglossal nerve stimulator implantation and elected to proceed with the procedure. The following video demonstrates her hypoglossal nerve stimulator implantation via the 2-incision technique detailing the procedure's anatomic landmarks and corresponding steps.

Two Layered End-to-side Duct to Mucosa Pancreaticojejunostomy

Contributors: David Caba-Molina, MD and Mark S. Talamonti, MD The following video depicts our technique for performing a two layered end-to-side duct to mucosa pancreaticojejunostomy without the use of a pancreatic duct stent, following the resection phase of a standard Whipple operation. DOI: http://dx.doi.org/10.17797/wvi4b33r6r Editor Recruited By: Jeffrey Matthews, MD

Full-thickness skin grafting for coverage of dorsal hand defect

Title: Full-thickness skin grafting for coverage of dorsal hand defect Authors: Vincent Riccelli, Brian Drolet MD, Elizabeth Lee MD Affiliations: Vanderbilt University Medical Center Corresponding Author: Vincent Riccelli (vincent.riccelli@vanderbilt.edu)

Dermis Fat Graft Implantation into Anophthalmic Socket

Dermis fat graft implantation has been used for decades to augment orbital volume and surface area in patients with congenital anophthalmia as well as those suffering complications of secondary anophthalmia following enucleation. It is most commonly performed as a means of socket reconstruction in patients with an exposed or extruded orbital implant and to prevent socket contracture. In this video, a dermis fat graft is harvested from the buttock and implanted into an anophthalmic socket for treatment of exposure of orbital implant in the right socket of a patient who was status post enucleation in both eyes for painful blind eyes. Suzanne K. Freitag, MD Victoria Starks, MD Zujaja Tauqeer Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School

Collagenase Injection of the Dupuytren Hand

Contributor: John Zhao Collagenase clostridium histolyticum (CCH) injections were FDA approved in 2010 for use in Dupuytren’s contracture.  Interest among surgeons in this office-based treatment has rapidly increased in the past 5 years due to its shorter recovery time and limited complication rates compared to open fasciectomy. DOI: http://dx.doi.org/10.17797/qps5cwzfgu Editor Recruited By: David Bozentka, MD

Superior Rectus Recession

Introduction Muscle recession is a type of strabismus surgical procedure that aims to weaken an extraocular muscle by adjusting its insertion posteriorly closer to its origin. The patient is a 14-year-old with dissociated vertical deviation, which can be corrected with recession of the superior rectus muscle. Methods A conjunctival incision is made in the fornix. Tenon's capsule is dissected to expose the superior rectus muscle. The superior rectus muscle is isolated using a Stevens tenotomy hook followed by a Jameson muscle hook. After the remaining Tenon's attachments are cleared, the muscle is secured at both poles with a double-armed 6-0 VicrylTM suture and double-locking bites. The muscle is then disinserted from the sclera with Manson-Aebli scissors. A caliper is used to mark the predetermined distance of muscle reinsertion. Next, the muscle is reattached to the sclera with partial thickness bites and then tied down to its new location. The conjunctival incision is closed with 6-0 plain gut sutures. Results No complications arose during the procedure. Postoperatively, the patient had subconjunctival hemorrhage, injection, and pain that decreased over the following week. Neomycin-polymyxin-dexamethasone drops were applied daily to prevent infection and inflammation. At the three-month follow up, the redness had resolved. The dissociated vertical deviation had improved. Conclusion Superior rectus recession is a safe procedure that can effectively treat vertical strabismus. By: Michelle Huynh College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA mhuynh@uams.edu Surgeons: Brita Rook, MD Arkansas Children’s Hospital – Department of Ophthalmology, Little Rock, Arkansas, USA BSRook@uams.edu Joseph Fong, MD Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA JFong@uams.edu Video was performed at Arkansas Children’s Hospital, Little Rock, AR, USA.

Robotic Inferior Mesenteric Artery, Common Iliac Artery, and Retroperitoneal Lymph Node Dissection

David Schwartzberg MD, Tushar Samdani MD, FASCRS, Mario M. Leitao MD, FACOG, FACS, Garrett M. Nash MD, MPH, FACS, FASCRS Recent data has shown an improved survival with metastasectomy for metastatic rectal cancer. Metastasectomy on a minimally invasive plateform (robotic) can be used for an R0 resection in patients who have retroperitoneal metastasis from rectal cancer after control of the primary tumor. DOI # http://dx.doi.org/10.17797/wd7d09sjgc

Ptosis Repair, Mullerectomy

Suzanne Freitag MD Juan Carlos Jimenez Perez, MD Benjamin Jastrzembski, MD Harvard Medical School, Massachusetts Eye and Ear

Nasal Encephalocele: Endoscopic Surgery

Contributors: Vincent Couloigner We describe the excision of a nasal encephalocele obstructing the left nasal fossa with an anterior subcutaneous portion deforming the nasal pyramid in a four-year-old girl using endoscopic surgery combined to a Rethi approach. The anterior skull base defect was reconstructed using autologous conchal cartilage and temporal fascia. Editor Recruited By: Sanjay Parikh, MD, FACS DOI: http://dx.doi.org/10.17797/udewjr2ge7

Microdebrider Assisted Lingual Tonsillectomy

Microdebrider Assisted Lingual Tonsillectomy Adrian Williamson, Michael Kubala MD, Adam Johnson MD PhD, Megan Gaffey MD, and Gresham Richter MD The lingual tonsils are a collection of lymphoid tissue found on the base of the tongue. The lingual tonsils along with the adenoid, tubal tonsils, palatine tonsils make up Waldeyer’s tonsillar ring. Hypertrophy of the lingual tonsils contributes to obstructive sleep apnea and lingual tonsillectomy can alleviate this intermittent airway obstruction.1,2 Lingual tonsil hypertrophy can manifest more rarely with chronic infection or dysphagia. A lingual tonsil grading system has been purposed by Friedman et al 2015, which rates lingual tonsils between grade 0 and grade 4. Friedman et al define grade 0 as absent lingual tonsils and grade 4 lingual tonsils as lymphoid tissue covering the entire base of tongue and rising above the tip of the epiglottis in thickness.3 Lingual tonsillectomy has been approached by a variety of different surgical techniques including electrocautery, CO2 laser, cold ablation (coblation) and microdebridement.4-9 Transoral robotic surgery (TORS) has also been used to improve exposure of the tongue base to perform lingual tonsillectomy.10-13 At this time, there is not enough evidence to support that one of these techniques is superior. Here, we describe the microdebrider assisted lingual tonsillectomy in an 8 year-old female with Down Syndrome. This patient was following in Arkansas Children's Sleep Disorders Center and found to have persistent moderate obstructive sleep apnea despite previous adenoidectomy and palatine tonsillectomy. Unfortunately, she did not tolerate her continuous positive airway pressure (CPAP) device. The patient underwent polysomnography 2 months preoperatively which revealed an oxygen saturation nadir of 90%, an apnea-hypopnea index of 7.7, and an arousal index of 16.9. There was no evidence of central sleep apnea. The patient was referred to otolaryngology to evaluate for possible surgical management. Given the severity of the patient’s symptoms and clinical appearance, a drug induced sleep state endoscopy with possible surgical intervention was planned. The drug induced sleep state endoscopy revealed grade IV lingual tonsil hypertrophy causing obstruction of the airway with collapse of the epiglottis to the posterior pharyngeal wall. A jaw thrust was found to relieve this displacement and airway obstruction. The turbinates and pharyngeal tonsils were not causing significant obstruction of the airway. At this time the decision was made to proceed with microdebrider assisted lingual tonsillectomy. First, microlaryngoscopy and bronchoscopy were performed followed by orotracheal intubation using a Phillips 1 blade and a 0 degree Hopkins rod. Surgical exposure was achieved using suspension laryngoscopy with the Lindholm laryngoscope and the 0 degree Hopkins rod. 1% lidocaine with epinephrine is injected into the base of tongue for hemostatic control using a laryngeal needle under the guidance of the 0 degree Hopkins rod. 1. The 4 mm Tricut Sinus Microdebrider blade was set to 5000 RPM and inserted between the laryngoscope and the lips to resect the lingual tonsils. Oxymetazoline-soaked pledgets were used periodically during resection to maintain hemostasis and proper visualization. A subtotal lingual tonsillectomy was completed with preservation of the fascia overlying the musculature at the base of tongue. She was extubated following surgery and there were no postoperative complications. Four months after postoperatively the patient followed up at Arkansas Children's Sleep Disorders Center and was found to have notable clinical improvement especially with her daytime symptoms. A postoperative polysomnography was not performed given the patient’s clinical improvement.

Excision of Scalp Congenital Hemangioma

Contributors: Adam Johnson, MD and Gresham Richter, MD, FACS Noninvovluting Congenital Hemangioma (NICH) is a congenital vascular lesion present at birth. These lesions do not regress, in contrast to infantile hemangioma or Rapidly Involuting Congenital Hemangioma (RICH), and may grow proportionately with age. Most lesions present in the head and neck, trunk, or limbs, and can be painful. Surgical excision is the treatment of choice. DOI #: http://dx.doi.org/10.17797/5hq5nro3j4

da Vinci Total Abdominal Colectomy for Ulcerative Colitis

Contributors: Craig Rezac, MD This video demonstrates the basic steps of a Robotic-Assisted Total Abdominal Colectomy for Ulcerative Colitis using the da Vinci Xi Robotic System. DOI: http://dx.doi.org/10.17797/zr41dcfdmt

da Vinci Robot Assisted Low Anterior Resection with Diverting Loop Ileostomy

Contributors: Jimmy Lin and Craig Rezac This procedure is a da Vinci Xi Robot assisted low anterior resection with diverting loop ileostomy performed on a 64 year old male patient who on work-up of hematochezia and change in bowel habits was found to have a locally advanced rectal adenocarcinoma approximately 5-6cm from the anal verge. The patient was found to have a single subcentimeter metastatic liver lesion, which was treated with radiofrequency ablation. He was treated with neoadjuvant chemoradiation prior to undergoing surgery. DOI: http://dx.doi.org/10.17797/vk8yonl7gj Editor Recruited By: Vincent Obias, MD, MS

da Vinci Assisted Extended Right Hemicolectomy and End Ileostomy

Contributors: Jimmy Lin and  Craig Rezac Robotic surgery offers benefits to both patient and surgeon by allowing smaller incisions and faster recovery time, to better accuracy, flexibility and control.  Many procedures which have previously been conducted with laparoscopy, or open surgery, are becoming further improved in robotic surgery. This video demonstrates once such procedure, the extended right hemicolectomy. DOI# http://dx.doi.org/10.17797/rv3nkbech0 Authors Recruited By: Vincent Obias. MD. MS

Vocal Fold Cordectomy Type I (ELS classification) for Carcinoma In Situ of the Vocal Fold Using Carbon Dioxide Laser

Authors: Yonatan Lahav, MD, Doron Halperin, MD, Hagit Shoffel-Havakuk, MD. Subepithelial vocal fold cordectomy (Type I cordectomy according to the ELS classification) for Carcinoma In Situ, performed under general anesthesia with direct microlaryngoscopy and suspension using a free beam CO2 Laser. The resection respects the layered structure of the vocal folds and preserves the superficial lamina propria and its vasculature. The video follows the procedure step by step and includes detailed instructions.

Pressure Equalization Tube Placement

Contributor: Gresham T. Richter, MD (Arkansas Children's Hospital) Pressure equalization tube placement is one of the most common procedures in the pediatric population. This video demonstrates the surgeon's view of the right ear through the operative microscope. Indications: recurrent otitis media with effusion, chronic otitis media with effusion (>3 months duration), speech/language delay secondary to otitis. Instruments: operative microscope, ear speculum, ear curette, myringotomy knife, suction tube, pressure equalization tube Procedure Steps: 1. Speculum inserted into external auditory canal 2. Cerumen removed with the curette (not shown in video) 3. Myringotomy performed on anterior-inferior quadrant of tympanic membrane 4. Fluid aspirated with suction tube 5. Pressure equalization tube (PET) inserted and secured 6. Antibiotic otic drops applied 7. Cotton dressing applied Recommended Resource: Lambert E, Roy S. Otitis media and ear tubes. Pediatric Clinics of North America. 2013;60(4):809-26. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23905821 The authors have no conflicts of interest or financial disclosures. DOI: http://dx.doi.org/10.17797/fzlqossgrh

Laparoscopic Nissen Fundoplication

A 51-year-old man seeks medical attention for intermittent chest pain. He describes the pain as “burning” and it has become increasingly frequent after meals over the last 4 to 6 months. In addition, he experiences regurgitation, and often wakes up at night with a feeling of choking. He has also noted hoarseness and cough. Proton pump inhibitors are very helpful for the heartburn and chest pain but do not improve the regurgitation. Long-term results have shown that a fundoplication provides control of reflux in about 90% of patients. To achieve these results the surgeon should focus on the technical elements of the operation, rather than on the eponyms. The technical elements of the operation are the following: (1) division of the short gastric vessels to achieve complete fundic mobilization; (2) extensive dissection of the distal esophagus in the posterior mediastinum to bring the gastroesophageal junction at least 3 cm below the diaphragm; (3) meticulous closure of the right and left pillar of the crus with non-absorbable sutures; (4) use of a bougie to decrease postoperative dysphagia; (5) a short fundoplication with three interrupted stitches placed at 1 cm of distance from each other (2-2.5 cm long). All these technical elements have been shown to positively impact long-term outcomes. Patients who are still symptomatic postoperatively must be thoroughly evaluated to identify the cause of failure, and treatment must be individualized. by Ciro Andolfi (The University of Chicago Medicine) Marco G. Patti (The University of Chicago Medicine) DOI: http://dx.doi.org/10.17797/287pfs38ls Editor Recruited By: Jeffrey Matthews, MD

Robotic Rectal Dissection; Total Mesorectal Excision (TME)

Robotic rectal dissection begins posteriorly in total mesorectal excision plane (TME) using 30° down-viewing scope. Posterior dissection in a TME plane provides a relatively bloodless plane of dissection and creates an anatomical reference point from which lateral and anterior dissection can proceed. With an assistant retracting the rectum anteriorly and cephalad, the robotic single fenestrated grasper retracts the posterior aspect of the mesorectum anteriorly and slightly caudally. When performed correctly the surgeon can visualize a “cotton candy”-like areolar tissue between the fascia propria of the rectum and presacral fascia. The hook cautery is used to divide the tissue in a U-shaped fashion. The dissection is taken to the level of Waldeyer’s fascia. Lateral Dissection and Division of Lateral Stalks The lateral dissection proceeds initially on the right side where the surgeon has a safer plane of dissection (away from left ureter). A monopolar hook moves from posterior to anterior at a deliberate pace while applying current. If the right and posterior dissection was performed correctly, the only structures that need to be divided on the left side are a layer of peritoneum and a small amount of remaining lateral stalks. The left lateral side is dissected by dividing the peritoneum over the left pararectal sulcus. The left ureter must be visualized during this step. It is important to control all vessels, even the ones that appear to be only mildly oozing. Failure to do so may result in the field becoming bloody and dark. In this video, a vessel, encounterd within the left stalk is coagulated using a bipolar grasper while retracting the mesorectum with the hook. After the vessel is sealed it is divided with hook cautery. Anterior Dissection As the dissection advances inferiorly, the right and left lateral peritoneal incisions that are created during lateral dissection at this point are connected in front of the rectum. At this stage in operation, with the switch to a 0° scope and change of the retraction of the rectum from anterior and cephalad to posterior and cephalad, the rectum is pulled straight out of the pelvis. Because the posterior dissection has now released the mesorectum, the rectum can be easily stretched placing under tension the anterior plane of dissection. Circumferential Dissection of the Rectum If the rectal cancer is distal within the rectum, the mobilization proceeds to the level of pelvic floor and occasionally performing some dissection within the levator muscle complex. As the surgeon advances towards the pelvic floor, the dissection alternates between the posterior, lateral and interior planes as the tissue tension changes based on dissection performed. One of the signs that the dissection is at the level of pelvic floor is observation of levator ani skeletal muscle fibers that contract upon contact with electrocautery and the tapering of the mesorectum. As it narrows at the level of pelvic floor, the rectum can be carefully grasped with a robotic grasper and retracted to obtain the necessary tension to provide dissection. Editor Recruited By: Jeffrey B. Matthews, MD DOI: http://dx.doi.org/10.17797/4bvv6oyrym

Cholesterol Granuloma Petrous Apex Revision

Contributors: Ravi N. Samy, M.D., F.A.C.S (University of Cincinnati / CCHMC) and  Shawn Stevens, M.D. Cholesterol granuloma recurrence at the petrous apex.   The patient had a prior surgery performed without stenting. Revision surgery at UC performed with double-barrel stent placement. External Related Links: www.cisurgeon.org    www.youtube.com/user/cisurgeon DOI: http://dx.doi.org/10.17797/vvmrb6t77g Editor Recruited By: Ravi N. Samy, MD, FACS

Awake Steroid Injection for Idiopathic Subglottic Stenosis

Contributor: Michael Johns III, MD This video demonstrates a steroid injection in an awake patient for the treatment of idiopathic subglottic stenosis. The patient is first anesthetized with topical 2% lidocaine over the larynx and 1% lidocaine with epinephrine percutaneously over the cricoid cartilage. An endoscope is passed transnasally and positioned just below the vocal folds. A 23 gauge needle is then passed through the cricothyroid membrane, and Kenalog is circumferentially injected submucosally taking care not to reduce the caliber size of the airway. DOI: http://dx.doi.org/10.17797/htvmbepobg

Stentless Choanal Atresia Repair

Choanal atresia (CA) occurs in roughly 1:5000-7000 live births. It affects females twice as often as males, and occurs bilaterally in roughly 50% of cases. Bilateral choanal atresia (BCA) is typically repaired in the newborn period as soon as the child is medically stable; tracheostomy for BCA alone has been widely abandoned. Unilateral CA repair is often deferred until age 2-3 years. Traditional techniques of endoscopic repair involved placing stents in the nasopharynx traditionally made of cut and shaped endotracheal tubes or silicon tubing stents. Stentless repair offers the advantage of decreased foreign body reaction in the nasopharynx causing granulation and scarring, and involves much less maintenance for families after discharge. In this technique, the procedure is performed endoscopically by opening the atresia bilaterally, drilling out pterygoid bone as needed, and removal of the posterior septum and vomer. Normal mucosa is preserved as much as possible to prevent scarring and restenosis. Postoperatively, babies are empirically treated with reflux medications and a short course of antibiotic and steroid drops in the nose; a second look procedure is recommended 4-6 weeks postop to ensure healing and confirm patency. Editor Recruited By: Sanjay Parikh, MD, FACS DOI: http://dx.doi.org/10.17797/6w5u6drd5e

Fully Laparoscopic Total Gastrectomy with Double Staple Anastomosis

Contributor: Joseph Kim This video demonstrates a fully laparoscopic total gastrectomy using a double-staple technique that facilitates the safe and effective creation of an esophagojejunal anastomosis. Fully laparoscopic total gastrectomy provides distinct advantages over the open laparotomy technique. An elderly gentleman was found to be anemic on routine bloodwork exam. Subsequent upper endoscopy revealed gastric cancer of the cardia, necessitating complete gastric resection. This video demonstrates a fully laparoscopic total gastrectomy using a double staple technique that facilitates the safe and effective creation of an esophagojejunal anastomosis. DOI: http://dx.doi.org/10.17797/i3nfwwigio Editor Recruited By: Jeffrey B. Matthews, MD

In-Office Awake Vocal Fold Steroid Injection

Contributors: Clark A. Rosen Superficial injection of steroids into the true vocal folds can be performed to reduce or prevent vocal fold scar formation as well as for treatments of benign vocal fold lesions. DOI: http://dx.doi.org/10.17797/zle2prpaif Editor Recruited By: Michael M. Johns, III, MD

Awake Trancervical Injection Laryngoplasty - Thyrohyoid Membrane Approach

The procedure shown in this video is an awake transcervical injection laryngoplasty via a thyrohyoid membrane approach. Editor Recruited By: Michael M. Johns III, MD DOI: http://dx.doi.org/10.17797/elckgrc4zg

Pediatric Ansa to Recurrent Laryngeal Nerve Reinnervation

The procedure shown in this video is a pediatric ansa to recurrent laryngeal nerve reinnervation. It is performed with a concurrent laryngeal electromyography and injection laryngoplasty. Editor Recruited By: Sanjay Parikh, MD, FACS DOI: http://dx.doi.org/10.17797/7jjbn56ca3

Choanal Atresia Repair

Contributor: Tyler McElwee Choanal atresia describes the congenital narrowing of the back of the nasal cavity that causes difficulty breathing in neonate. Choanal atresia is often associated with CHARGE, Treacher Collins and Tessier Syndrome. It is a rare condition that occurs in 1:7000 live births, seen in females twice as often as males, and affects bilaterally in roughly 50% of cases.  Bilateral choanal atresia is usually repaired in the newborn period. Unilateral CA repair is often deferred until age 2-3 years. Stent placement has become optional as stentless repair is gaining popularity because this technique decreases foreign body reaction in the nasopharynx which in term decreases granulation formation.  Transnasal endoscopic choanal atresia repair is performed by opening the atresia bilaterally, drilling out pterygoid bone as needed, and removal of the posterior septum and vomer. Normal mucosa is preserved as much as possible by elevating a lateral based mucosal flap to prevent scarring and restenosis. Postoperatively, these patients are treated with antibiotic, reflux medications and steroid nasal drops; a second look procedure is planned 4-6 weeks postop for debridement and possible removal of granulation tissue & scar. DOI: http://dx.doi.org/10.17797/9s5ty2f7yv Editor Recruited By: Sanjay Parikh, MD, FACS

Bilateral Dacryocystoceles Resection

Contributor: Tyler McElwee Congenital dacryocystocele describe the distended lacrimal sac in neonates with or without associated intranasal cyst.  The prevalence is about 0.1% of infants with congenital nasolacrimal duct obstruction and a slight prevalence in female infants.  It refers to cystic distention of the lacrimal sac as a consequence of the nasolacrimal drainage system obstruction.  It typically presents as a bluish swelling inferomedial to the medial canthus in the neonates.  Unilateral congenital dacryocystocele is more common but 12-25% of patients affected have bilateral lesions.  Ultrasound, CT scan or MRI can be used for diagnosis.  About half of the patient with acute dacryocystitis can be management with conservative management such as digital massage of lacrimal sac or in-office lacrimal duct probing.  The other half of patients will require surgery under general anesthesia for removal of the dacryocystocele.   Endoscopic excision of the intranasal cysts has been used successfully as a treatment option with Crawford stent placement.  Post-operatively patients are treated empirically with antibiotics and nasal saline.  No second look is usually planned unless patients develop significant nasal obstrctuion. Editor Recruited By: Sanjay Parikh, MD, FACS DOI: http://dx.doi.org/10.17797/16rnuq8n0y

Vocal Fold Lipoinjection

Contributor: VyVy N. Young and Clark A. Rosen Lipoinjection of the vocal folds results in medialization and augmentation of the vocal folds by deposition of autologous fat. Editor Recruited By: Michael Johns, III, MD DOI: http://dx.doi.org/10.17797/ngjuxe20iq

Spleen Preserving Laparoscopic Distal Pancreatectomy for a Solid Pseudopapillary Tumor

Contributors: Bestoun Ahmed Spleen preservation is advisable if feasible during distal pancreatectomy for benign pancreatic tumors. A 31 year old patient had a blunt abdominal injury. Computed Tomography (CT) scan showed an incidental tumor in the body of the pancreas. EUS-guided cytology revealed a solid pseudopapillary tumor with benign features.This video demonstrates the technical details during a minimally invasive excision of a rare tumor of the pancreas in a male patient. Very few cases have been reported in males. Editor Recruited By: Jeffrey B. Matthews, MD DOI: http://dx.doi.org/10.17797/cc7ot3ymd8

Laparoscopic Transgastric Pancreatic Necrosectomy and Cystgastrostomy

Contributors: Michael Nussbaum Pancreatic necrosectomy is a necessary operation for necrotizing pancreatitis. The traditional open approach has been associated with difficult access and significant negative outcomes including wound complications, pancreatic fistula and prolonged hospital stay. A 57-y-old female patient presented with mild abdominal pain and epigastric fullness.She had a history of multiple episodes of acute pancreatitis and pseudocyst formation. Abdominal computed tomography (CT )scan showed a large pseudocyst of 12x15 cm size compressing the posterior wall of the stomach. Following cystgastrostomy, a large amount of necrotic pancreatic tissue is found and so necrosectomty step was added to the operation.This video demonstrates the technical details during a minimally invasive necrosectomy of the pancreas with an expedited recovery. DOI: http://dx.doi.org/10.17797/1ms9xzjz24 Editor Recruited By: Jeffrey B. Matthews, MD

Routine Laparoscopic Ultrasound During Laparoscopic Cholecystectomy

Laparoscopic ultrasound (LUS) is a simple and reliable method for evaluating the common bile duct (CBD) during laparoscopic cholecystectomy. It is particularly useful for identifying the location of the CBD and common hepatic duct (CHD) during difficult operative circumstances when the anatomy is obscured. LUS can be performed prior to any potentially hazardous dissection and can easily be repeated as necessary to safely guide dissection. This brief video demonstrates the technique of LUS during routine LC. A flexible tip probe with a multi-frequency, side viewing, curvilinear transducer is used. Scanning is typically performed at a frequency of 10 MHz. During intraoperative applications, the ability to place the transducer in close contact with the tissue being examined allows use of a higher frequency transducer. Higher frequency ultrasound waves yield better resolution than the lower frequencies that are necessary for adequate depth of penetration during transabdominal imaging. Fluid is instilled over the hepatoduodenal ligament to improve acoustic coupling. The ultrasound probe, covered by a sterile sheath, is introduced through a 10 mm sub-xiphoid port. The probe is extended to the patients’ right side and then angled to 90 degrees. The bend is maneuvered under the lateral segment of the left liver so that the transducer can be positioned over the hepatoduodenal ligament with light contact. Scanning is started in a plane transverse to the hepatoduodenal structures. The normal anatomic landmarks are described as depicted in the sonographic image on the video. The junction of the cystic duct with the CBD is identified. The proper hepatic artery (HA) is to the right of the CBD on the screen. The portal vein (PV) is dorsal (“posterior”). The cross sectional image of the PV, HA and CBD together create a “Mickey Mouse” pattern with the cartoon characters’ circular head (PV) below and ears (CBD & HA) on top. The CBD is traced caudally to the duodenal ampulla which is well seen. This is accomplished by subtle rotation of the operators’ wrist. The internal diameter of the CBD is measured to be 4 mm (normal upper limit 6-7 mm). If present, stones are readily visualized as echogenic structures with posterior acoustic shadowing and sludge as echogenic material without shadowing. The CBD is traced cephalad and the transducer is rotated to yield a longitudinal view of the CBD and PV which appear as parallel tubular structures. In this plane, the right hepatic artery appears as a round structure and is most typically located dorsal to the CHD. Doppler can demonstrate the characteristic waveforms of the vascular structures, although it is not usually necessary for identification. The PV has a low velocity, continuous forward flow with minor undulations due to cardiac activity. Flow in the inferior vena cava is bi-directional due to the cardiac cycle and respirations. The HA demonstrates features of a low resistance type vessel with a bi-phasic spectral waveform that continues forward during diastole. The CBD has no Doppler signal other than the interference from respiratory excursion. The aorta and right renal artery are also seen at the inferior aspect of the sonographic images. When the examination has been completed, the flexible probe is straightened and withdrawn under direct vision. DOI: http://dx.doi.org/10.17797/njy9uc14u2 Editor Recruited By: Jeffrey B. Matthews, MD

Laparoscopic Sigmoid Colectomy for Complicated Diverticulitis

Contributors: Justin A. Maykel MD The following video demonstrates a laparoscopic sigmoid colectomy for the treatment of complicated sigmoid diverticulitis. The patient was initially managed with intravenous antibiotics and allowed three months for the acute inflammatory process to resolve. Subsequently she was taken to operating room electively for an uncomplicated sigmoid colectomy with a primary anastomosis. DOI: http://dx.doi.org/10.17797/xq6fosqsh3 Editor Recruited By: Jeffrey B. Matthews, MD

Laser Assisted Endoscopic Removal of Lower Tracheal Tumour

This video shows a KTP laser assisted endoscopic excision of a myofibroblastic lower tracheal tumour. Editor Recruited By: Sanjay Parikh, MD, FACS DOI: http://dx.doi.org/10.17797/jt8idqw53j

Skeeter Microdrill and Contact Laser Choanal Atresia Repair in Very Low Weight Newborns

DOI: http://dx.doi.org/10.17797/zn1m3e9e41 Editor Recruited By: Sanjay Parikh, MD, FACS

Treatment of Adult Idiopathic Subglottic Stenosis with CO2 Laser and Balloon Dilation

Contributors: Michael M. Johns III and Benjamin Anthony The patient is a 53 year-old female with history of idiopathic subglottic stenosis and long-standing right vocal fold scarring who had previously been treated endoscopically in the operating room and in the office with steroid injections. She returns to the operating room for scheduled endoscopic CO2 laser treatment, Depo-Medrol injection (not shown), balloon dilation, and Mitomycin C application (not shown). DOI: http://dx.doi.org/10.17797/p7s4gn9n20 Editor Recruited By: Michael M. Johns, III, MD

Use of a Heineke-Mikulicz Like Stricturoplasty for Skin Level Anal Strictures in Children with Anorectal Malformations

Contributors: Taiwo Lawal Richard Wood Victoria Lane Alessandra Gasior Karen Diefenbach Marc Levitt Anal strictures in children who have had anorectoplasties for anorectal malformation, although largely preventable, can be of two types; at the skin level or more extensive in nature. Skin level strictures are preventable and usually treatable by anal dilations but require surgery when intractable. We recently introduced a modification of the Heineke-Mikulicz technique to treat this problem, able to be performed in an ambulatory setting and without a protective colostomy. The aim of this article is to describe the technique and outcome in a series of patients. DOI: http://dx.doi.org/10.17797/dvy3xhv1k0 Editor Recruited By: Robert C. Shamberger, MD

Laparoscopic Needle Assisted Technique for Repair of Inguinal Hernias in Children

Contributors: Chris Streck (MUSC) Aaron Lesher (MUSC) Robert Cina (MUSC) Step-by-step demonstration on how to perform the laparoscopic needles assisted repair (LNAR) of inguinal hernias in infants and young children. This fairly new technique for laparoscopic repair of inguinal hernias in infants and children is now well accepted among many pediatric surgeons. Because of the very small skin incisions, it is associated with minimal pain and has great cosmetic appeal. The operation is indicated in the treatment of inguinal hernias and communicating hydroceles in children less than 12 years of age. Preliminary results reported by the authors have suggested a similar recurrence rate as reported for the open technique. Interestingly, the recurrence rate is lower in small and premature infants compared to open surgery. The authors prefer the use of non-absorbable suture (like Prolene) in order to minimize the risk of recurrence. Our experience has demonstrated that the laparoscopic needle-assisted repair of inguinal hernia is safe with a 4% rate of minor complications. The most common complication is the development of a suture granuloma at the site of the suture placement for closure of the internal inguinal ring. It usually can be treated medically. In rare occasions, it might be necessary to remove the suture. Other less common reported complications include infection, residual hydrocele, hernia recurrence, and injury to the spermatic vessels or vas. DOI: http://dx.doi.org/10.17797/bdmv3e7y2c Editor Recruited By: Robert Shamberger, MD

Laparoscopic Hepatic Left Lateral Sectionectomy

Contributors: David A Geller Laparoscopic left lateral sectionectomy performed for a 14 cm hypervascular left lobe liver mass which is hypervascular during arterial phase and isodense to liver during venous phasem consistent with giant Focal Nodular Hyperplasia. DOI: http://dx.doi.org/10.17797/yjare8xwt2 Editor Recruited By: Jeffrey B. Matthews, MD

Endoscopic Tracheoesophageal Fistula Repair

Contributors: Noemie Rouillard-Bazinet, MD and Deepak Mehta, MD Endoscopic repair of tracheoesophageal fistula using electrocautery and fibrin glue. DOI: http://dx.doi.org/10.17797/uq9ifhudgd Editor Recruited By: Sanjay Parikh, MD, FACS

Right Hepatic Lobectomy with Intraparenchymal Vascular Control

Contributors: Amy D. Lu and Diego Di Sabato A right hepatic lobectomy with laparoscopic mobolization and division of the short hepatic veins and intraparenchymal division of the vasculature is depiected in this video. Editor Recruited By: Jeffrey Matthews, MD DOI: http://dx.doi.org/10.17797/i04zpfb2x3

In-Office KTP Treatment of Recurrent Respiratory Papillomatosis

Contributors: Clark A. Rosen Laryngeal recurrent respiratory papillomatosis can be treated in the office using a 532-nm pulsed KTP laser under local anesthesia while the patient is awake without sedation. DOI: http://dx.doi.org/10.17797/5ar3jihu3g Editor Recruited By: Michael Johns III, MD

Endoscopic Removal of Suprastomal Granuloma Using a Flexible KTP laser

Surgical removal of suprastomal granuloma is a procedure performed prior to the probable decannulation of a tracheostomy. There are several ways of achieving this objective, but in certain cases, a KTP laser on a flexible delivery system offers a precise and controlled method to successful debulking of the granuloma with minimal risks of haemorrhage into the airway. DOI: http://dx.doi.org/10.17797/pqzu0ns9y9 Editor Recruited By: Sanjay Parikh, MD, FACS

Stapled Ileoanal Reservoir for Restorative Ileal Pouch Anal Anastomosis

Contributors: Roger Hurst and Neil Hyman This video demonstrates the approach to stapled ileoanal reservoir (Ileal pouch anal anastomosis (IPAA)) construction initiated utilizing enterotomy at the future reservoir inlet. This approach has the advantage of permitting reservoir eversion during construction to ensure hemostasis and limiting the apical enterotomy to a stab puncture for the sharp anvil trochar. Dr. F. Michelassi and Dr. G.E. Block originally described this technique in 1993, and the authors have made minor adaptations (1) DOI: http://dx.doi.org/10.17797/4gf38v9mw2 Editor Recruited By: Jeffrey B. Matthews, MD

Laparoscopic Roux-En-Y Gastric Bypass with Circular Stapled Gastrojejunostomy

Contributors: Ranjan Sudan This video depicts a laparoscopic Roux-en-Y gastric bypass performed with a linear stapled jejunojejunostomy and a circular stapled gastrojejunostomy. DOI: http://dx.doi.org/10.17797/4mc50uaz8e Editor Recruited By: Jeffrey B. Matthews, MD

Heineke - Mikulicz Strictureplasty in Crohn's Disease

This video shows the performance of a Heineke - Mikulicz Strictureplasty in the treatment of stricturing Crohn's disease of the small bowel. DOI: http://dx.doi.org/10.17797/jj8ee1q3mr Editor Recruited By: Jeffrey B. Matthews, MD

Endoscopic Ampullectomy

Contributor: Darin L. Dufault This video illustrates two cases of ampullary adenoma treated with endoscopic papillectomy (a.k.a. endoscopic ampullectomy in many manuscripts). Along with local surgical ampullectomy and pancreaticoduodenectomy, endoscopic papillectomy is an established treatment option for benign lesions of the ampulla of Vater. For the majority of benign ampullary lesions, complete endoscopic resection of ampullary lesions is usually feasible. Limitations to endoscopic therapy include deep extension into the bile or pancreatic duct, > 50% lateral extension along the duodenal wall, and carcinomatous transformation. In general, endoscopic resection should be considered equivalent to local surgical ampullectomy in terms of its depth of dissection. In the first case, the patient was noted to have adenomatous appearing change of the ampulla on endoscopy. An electrocautery snare is used to remove the entire papilla. When technically feasible, cholangiopancreatography should precede tissue resection to evaluate for intraductal extension and identify the orifices for post-resection therapy. Since this was unsuccessful prior to resection, the pancreatic duct is then cannulated and a pancreatogram is obtained. A pancreatic duct stent is then placed after pancreatic sphincterotomy to minimize the risk of post-ampullectomy and ERCP pancreatitis, and to prevent stenosis of the pancreatic orifice long-term. Then, a cholangiogram is performed, confirming no intraductal extension and to facilitate a biliary sphincterotomy. The second case is a patient referred for further evaluation of cholestatic liver function tests and a dilated bile duct. Endoscopically, they were noted to have a protuberant papilla. Endoscopic ultrasound (EUS) showed a mass between the bile and pancreatic ducts and within the ampulla of Vater, along with a significantly dilated bile duct. The mass did not invade the duodenal wall, as showed by preservation of the muscularis propria. In cases where malignancy is not suspected and in smaller lesions, EUS may not be required. Prior to papillectomy, the pancreatic duct was cannulated and methylene blue injected into the duct to allow easier identification of the duct following papillectomy. The mass was also able to be seen on cholangiogram (green circle). It is preferred to remove the papilla en bloc, as shown in case one, although this is not always possible. There was a small amount of residual tissue at the core of the lesion that was further resected in piecemeal fashion using a hot snare with blended cut and coagulation current. Biliary and pancreatic stents were then placed to minimize the risk of post-ERCP pancreatitis, delayed post-ampullectomy bleeding, and orifice stenosis. These stents are typically removed after 1-2 months, at which time the resection site may be surveyed for residual adenomatous tissue. Last, a small amount of residual abnormal appearing tissue was ablated using APC. Editor Recruited By: Jeffrey Matthews, MD DOI: http://dx.doi.org/10.17797/ju7gthra0v

Technique of Pancreaticojejunostomy

Contributors: Emily Gross and Mark Callery This video demonstrates an end-to-side duct-to-mucosa pancreaticojejunostomy as part of a pancreaticoduodenectomy to resect a pancreatic head neoplasm. The patient is a 69 year-old female who experienced months of right upper quadrant abdominal pain and had labs consistent with biliary obstruction. Work-up with endoscopic retrograde cholangiopancreatography (ERCP) identified an ampullary mass that was biopsied and returned as ampullary carcinoma. DOI: http://dx.doi.org/10.17797/dyb8dqxxnr Editor Recruited By: Jeffrey B. Matthews, MD

Endoscopic Ear Surgery - Incus Interposition for Traumatic Ossicular Discontinuity

A five year old with conductive hearing loss due to traumatic ossicular discontinuity presents for surgical management. Ossicular discontinuity with a fibrous union of the incudostapedial joint is identified. Transcanal Endoscopic middle ear exploration with incus interposition is performed. DOI: http://dx.doi.org/10.17797/t0il7famg9 Editor Recruited By: Sanjay Parikh, MD, FACS

Posterior Cricoid Split and Costal Cartilage Grafting for Bilateral Vocal Fold Paralysis

Contributors: Noemie Rouillard-Bazinet and Julina Ongkasuwan Bilateral vocal fold paralysis causes airway obstruction and, in some patients, tracheostomy dependence. Posterior cricoid split with costal cartilage grafting can open the posterior glottis and improving the airway. DOI: http://dx.doi.org/10.17797/hyp0b3mzd5 Editor Recruited By: Michael M. Johns III, MD

Robotic Pelvic Lymph Node Dissection

Contributors: Kristina Butler, MD and Javier Magrina, MD Pelvic lymphadenectomy is part of most gynecologic malignancy staging procedures. Knowledge of the retroperitoneal anatomy is key to safely completing this procedure. DOI: http://dx.doi.org/10.17797/5xzrp8fuk3 Editor Recruited By: Dennis S. Chi, MD, FACOG, FACS

Laparoscopic-assisted Small Bowel Resection for Retained Endoscopic Capsule

Contributors: Anna Sabih and Edward Auyang This video depicts a laparoscopic-assisted approach for the retrieval of an endoscopic capsule retained within the small bowel. DOI: http://dx.doi.org/10.17797/prub9rczs1 Editor Recruited By: Jeffrey B. Matthews, MD

Laparoscopic Choledochoduodenostomy for the Management of Post Gastric Bypass Biliary Stricture

Contributors: Jessica Cioffi

Laparoscopic hepatoduodenostomy is an excellent option for post-gastric-bypass patients with benign biliary tract disease as an indication for biliary bypass. It involves minimal dissection, but does require complex intracorporial suturing.

DOI: http://dx.doi.org/10.17797/5aizaeub3p

Editor Recruited By: Jeffrey B. Matthews, MD

Endoscopic Assisted Laparoscopic Transgastric Resection of GE Junction Gastrointestinal Stromal Tumor (GIST)

Contributors: Irving Waxman and John C. Alverdy Laparoscopic intragastric resection of a gastrointestinal stromal tumor 0.5cm distal to the gastroesophageal junction performed with oral endoscopic assistance. Related External Links: http://www.wjgnet.com/1948-5190/full/v7/i1/53.htm http://www.ncbi.nlm.nih.gov/pubmed/21224608 DOI: http://dx.doi.org/10.17797/5v0bdou315 Editor Recruited By: Jeffrey Matthews, MD

Laparoscopic Choledocotomy for Common Bile Duct Exploration

Contributor: Manish Parikh The patient is a 50 year-old man with a history of gallstone pancreatitis treated with endoscopic retrograde cholangiopancreatography (ERCP) and common bile duct stent at an outside hospital. The patient subsequently had migration of the stent into the stomach and recurrent choledocholithiasis. This is a video demonstrating techniques used for laparoscopic common bile duct (CBD) exploration via choledochotomy with primary closure of the duct. The intraoperative cholangiogram revealed the “meniscus sign” consistent with a large stone at the ampulla. Attempts at transcystic CBD exploration failed due to a tortuous duct and inability to pass the fogarty balloon. A laparoscopic choledochotomy was then made for stone extraction. A longitudinal choledochotomy was performed sharply after exposing the anterior aspect of the common bile duct. Intraoperative choledochoscopy confirmed the stone at the ampulla. A 4Fr fogarty catheter was used to extract the stone. Repeat choledochoscopy confirmed clearance of the duct. The choledochotomy was closed with 4-0 PDS sutures in interrupted fashion. The patient’s stent was removed from the stomach via intra-operative Esophagogastroduodenoscopy (EGD) at the conclusion of the procedure. If the surgeon confirms that the common duct is cleared, the evidence supports primary closure of the duct. In scenarios where the duct is not completely cleared of stones or if there is doubt, closure over a 14-16Fr t-tube is performed. A 10 Fr. JP is routinely left in the right upper quadrant when a choledochotomy is performed. DOI: http://dx.doi.org/10.17797/hawlc80i6c Editor Recruited By: H. Leon Pachter, MD

Totally Laparoscopic Total Proctocolectomy for Ulcerative Colitis

Contributor: Linda Ferrari Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is today considered the gold standard and, in experienced hands, can now be performed safely for UC with a low postoperative complication rate and a long-term pouch failure rate reported less than 10%6-8. The introduction of minimally invasive techniques might further decrease postoperative morbidity and improve patients’ satisfaction, with reduced impact on body image and better cosmesis9-11. Unfortunately not every patient is a candidate for a restorative operation and, like in the case of our patient, a total proctocolectomy (TPC) with a permanent Brook ileostomy is performed with a laparoscopic approach. Laparoscopic TPC offers significant advantages over the open conventional procedure in terms of body image and cosmesis, important factors in the acceptance of surgery in this young patient population, while conflicting results have been reported in terms of postoperative recovery. Faster return of bowel function after laparoscopy and decreased use of narcotics have been reported by some authors, not always translating into shorter hospital stay. DOI: http://dx.doi.org/10.17797/ukm5thekea Editor Recruited By: Jeffrey B. Matthews, MD

Invaginated Pancreaticojejunostomy (Whipple Reconstruction)

Contributor: Charles J Yeo Overview:The invaginated pancreaticojejunostomy is a method of reconstructing the pancreatic remnant to the intestinal tract during the Whipple operation. DOI: http://dx.doi.org/10.17797/ouyyb9jyj1 Editor Recruited By: Jeffrey B. Matthews, MD

Open Transhiatal Esophagectomy

Contributors: Mitchell C. Posner Open transhiatal esophagectomy DOI: http://dx.doi.org/10.17797/6ob5owtokl Editor Recruited By: Jeffrey Matthews, MD

Right Stapedotomy

Otosclerosis causes conductive hearing loss with absent acoustic reflexes. Stapedotomy is a successful surgery that is demonstrated in this video. Editor Recruited By: Ravi Samy, MD, FACS DOI: http://dx.doi.org/10.17797/6c3g45u2tw

Laparoscopic Transanal Total Mesorectal Excision: Rectal Cancer

Contributors: Justin A. Maykel MD The following video demonstrates a laparoscopic transanal total mesorectal excision (taTME) for the treatment of a locally advanced mid-rectal tumor. Eight weeks following neoadjuvant chemotherapy and radiation she was brought to the operating room for radical resection. DOI#: https://doi.org/10.17797/wvn5h86w7l Referred by Jeffrey B. Matthews

Fronto-Orbital Advancement and Cranial Vault Remodeling for Metopic Craniosynostosis

Contributors:Michael Golinko, MD, MA, Eylem Ocal, MD and Kumar Patel, PA Premature metopic suture fusion is corrected using fronto-orbital advancement and cranial vault remodeling to open the fused suture and allow for adequate brain growth. DOI#: https://doi.org/10.17797/hg9xbuxoms

Median Nerve Autogenous Vein Wrapping For Revision Carpal Tunnel Release

Contributors: Jonathan Isaacs and Amy Kite Median nerve autogenous vein wrapping for revision carpal tunnel release due to traction neuritis. DOI: http://dx.doi.org/10.17797/lr0euenlv3 Editor Recruited By: David Bozentka, MD

Bilateral Sagittal Spilt Osteotomy and Genioplasty in Patient with Lymphatic Malformation

Contributors: Michael Golinko, MD,  John Jones, MD, DMD,  Kumar Patel, PA Bilateral sagittal split osteotomy and genioplasty in 5y/o girl with lymphatic malformation. DOI#: https://doi.org/10.17797/hlo056ep2r

Microtia Reconstruction Stage 2

This is the second stage of Microtia Reconstruction, the first stage was depicted in a prior video. The ear is elevated and lateralized to take its 3-dimensional form, and this is accomplished with use of an anteriorly based mastoid fascial flap as well as costal cartilage graft and full thickness skin graft. Editor Recruited By: Michael Golinko, MD

Rhomboid Flap Reconstruction of Necrotic Cheek Lesion

The patient had an unidentified dermal filler placed outside of the United States over a decade ago. She developed a subsequent severe reaction which left her with extensive subdermal fibrosis and epidermal necrosis. Pathologic analysis revealed almost entire replacement of the dermal-epidermal layer with a foreign body and granulomatous reaction. The location at the cheek lower lid junction and the available lateral skin laxity deemed the rhomboid flap as the best option for reconstruction. Editor Recruited By: Michael Golinko, MD

Immediate post natal myelomeningocele defect closure using rhomboid fasciocutaneous flaps

Myelomeningocele is the most common form of neural tube defect, developing after the 4th week of gestation. Although diagnosed prenatally, many patients did not have a chance to be treated before birth. The best approach in these situation is to perform surgical treatment at time zero. A multidisciplinary team must be prepared to perform dural repair and soft tissue coverage. This video illustrates our approach for soft tissue reconstruction using rhomboid fasciocutaneous flaps with maximal preservation of perforator vessels. Contributors Dov Charles Goldenberg, MD Phd, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School Vania Kharmandayan, MD, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School Tatiana Moura, MD, MSc, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School

Surgical Treatment of Nasal Tip Hemangioma Using Open Rhinoplasty Approach

Hemangiomas are the most common benign tumors of the infancy and its location on the nasal tip poses particularly as a challenge. A recent study published by out group defined an algorithm for surgical approach to hemangiomas. Nasal tip hemangiomas carry a high risk for growth related deformities and is a usual indication for surgery. The best approach must warrant a result at least similar or even better to spontaneous involution. In this video we present a case where an open rhinoplasty approach was designed to remove the tumor, reposition the anatomic structures and reduce visible scars. Contributors Dov Charles Goldenberg, MD Phd, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School Vania Kharmandayan, MD, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School

Resection and modified purse-string closure of frontal hemangioma

Infantile hemangiomas occurring in the face may represent a real problem to a child. Clinical significance is ultimately determined by the degree of tissue deformation. Large dimensions; specific locations; and the presence of complications such as ulceration, bleeding, or infection indicate active treatment to minimize morbidity. The combination of clinical features and response to pharmacologic treatment are the main standpoints indicating surgery during the active phases of infantile hemangiomas. The concept of minimal possible scar is relevant, and the use of purse-string sutures, initially proposed by Mulliken et al., promotes a real reduction in the final scar dimensions. In this video surgical resection of a frontal hemangioma illustrates a modified purse string suture, to reduce the dimensions of a linear scar. Contributors Dov Charles Goldenberg, MD Phd, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School Vania Kharmandayan, MD, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School

Congenital Nasal Pyriform Aperture Stenosis (CNPAS): Sublabial Approach to Surgical Correction

Congenital nasal pyriform aperture stenosis (CNPAS) is defined as inadequate formation of the pyriform apertures forming the bony nasal openings resulting in respiratory distress and cyanosis soon after birth. Some clues such as worsening distress during feeding and improvement during crying may indicate a nasal cause of respiratory distress rather than distal airway etiology. Inability or difficulty passing a small tube through the nasal cavities may suggest CNPAS. The presenting clinical features of CNPAS can be similar to other obstructive nasal airway anomalies such as choanal atresia. Diagnosis is confirmed via CT scan with a total nasal aperture less than 11mm. CNPAS may occur in isolation or it may be a sign of other developmental abnormalities such as holoprosencephaly, anterior pituitary abnormalities, or encephalocele. Some physical features of holoprosencephaly include closely spaced eyes, facial clefts, a single maxillary mega incisor, microcephaly, nasal malformations, and brain abnormalities (i.e. incomplete separation of the cerebral hemispheres, absent corpus callosum, and pituitary hormone deficiencies). It is important to rule out other associated abnormalities to ensure optimal treatment and intervention. Conservative treatment of CNPAS includes humidification, nasal steroids, nasal decongestants and reflux control. Failure of conservative treatment defined by respiratory or feeding difficulty necessitates more aggressive intervention. The most definitive treatment for CNPAS is surgical intervention to enlarge the pyriform apertures. Contributors: Adam Johnson MD, PhD Abby Nolder MD

Mandibular Distraction for Micrognathia in a Neonate

Introduction Patients with Pierre-Robin Sequence (PRS) suffer from micrognathia, glossoptosis, and upper airway obstruction, which is sometimes associated with cleft palate and feeding issues. To overcome these symptoms in our full-term male neonate patient with PRS, mandibular distraction osteogenesis was performed. Methods The patient was intubated after airway endoscopy. A submandibular incision was carried down to the mandible. A distractor was modified to fit the osteotomy site that we marked, and its pin was pulled through an infrauricular incision. Screws secured the plates and the osteotomy was performed. The mandible was distracted 1.8 mm daily for twelve days. Results During distraction, the patient worked with speech therapy. Eventually, he adequately fed orally. He showed no further glossoptosis or obstruction after distraction was completed. Conclusion In our experience, mandibular distraction is a successful way to avoid a surgical airway and promote oral feeding in children with PRS and obstructive symptoms. By: Ravi W Sun, BE Surgeons: Megan M Gaffey, MD Adam B Johnson, MD, PhD Larry D Hartzell, MD Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA Arkansas Children's Hospital, Little Rock, AR, USA Recruited by: Gresham T Richter, MD

Le Fort I Osteotomy with placement of Distractor

Our patient is a 20 year old boy with severe maxillary hypoplasia with a history of bilateral cleft lip and palate. We performed a maxillary advancement with distraction osteogenesis. Nikhil Kamath, BS Aaron Smith, MD Michael S. Golinko, MD Kumar Patel, PA-C

Revision Facial Bipartition Osteotomy

Revision Facial Bipartition Osteotomy in 14y/o Female. Contributors: Aaron Smith, MD; Kumar Patel, PA; Ashley Bartels, BS; Rongsheng Cai, MD; Roop Gill, MD

Excision of Macrocystic Lymphatic Malformation

Introduction Lymphatic malformations (LM) are composed of dilated, abnormal lymphatic vessels classified as macrocystic (single or multiple cysts >2 cm3), microcystic (<2 cm3), or mixed. This patient is a 5-month-old with a right neck mass consistent with macrocystic lymphatic malformation on MRI. This low-flow vascular malformation required surgical intervention. Methods The site was marked in a natural skin crease. Subplatysmal flaps were raised and malformation was immediately encountered. Blunt soft tissue dissection was performed immediately adjacent to the mass to reflect tissue off the fluid-filled lesion. Neurovascular structures were preserved in this process. Mass was removed in total and Penrose drain and neck dressing were placed. Results A complete resection was performed. LM was confirmed on pathology. Patient is doing well with no deficits noted. The drain was removed after 1 week. One-month follow-up showed no recurrence. Conclusion Macrocystic lymphatic malformations are amenable to surgical resection at low risk and without recurrence. By: Ravi W Sun, BE Surgeons: Luke T Small, MD Gresham Richter, MD Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA Arkansas Children's Hospital, Little Rock, AR, USA Recruited by: Gresham T Richter, MD

Split Thickness Skin Graft

Skin grafting involves closure of an open wound using skin from another location which is transferred without its own vascular blood supply, relying on the vascular supply of the wound bed for survival. Skin grafts can be split thickness grafts that may involve meshing the donor skin in order to cover a proportionally larger area than the donor skin may have allowed. Besides the ability to cover a large area, a split thickness skin graft (STSG) allows for egress of fluids thereby maximizing close contact between the wound and the graft, which is necessary for vascularization and survival of the graft. A STSG can be taken at a variety of thicknesses but at any level taken, part of the donor dermis is left intact. Other options for skin grafts include full thickness grafts and biomedical grafts such as Integra. Full thickness skin grafts (FTSG) take the dermis as well as epidermis, usually covering smaller areas. FTSG has reduced contracture and often a better color match compared to STSG, but can have reduced survival due to increased thickness of tissue. The decision of the type of graft used in the procedure is made in accordance with the needs of the recipient site, the likelihood of graft take, and the availability of donor skin. The patient may either go home after the procedure with small areas of skin grafting with instructions for immobilization and elevation of the grafted area. The patient may be admitted depending on the patient’s general health status and the wound. Shear forces are avoided to the grafted area, and the donor site dressings may require prn changes due to fluid leakage until the skin epithelium regenerates from residual dermal structures. In the case presented in this video, a 12 year old girl was victim to a degloving injury of the left dorsal foot secondary to a motor vehicle accident. A STSG was determined appropriate for wound coverage as her wound bed had granulated in very well, covering all critical structures and providing a healthy bed for graft take. Linda Murphy MA Roop Gill, MD

Lower eyelid ectropion repair with lateral tarsal strip and medial spindle procedure

One of the most common causes of lower lid ectropion is horizontal lid laxity, the incidence of which increases with age. This condition induces poor ocular surface tear film coverage which leads to irritation, tearing, and keratopathy. Lateral tarsal strip fixation is the technique which is widely used to repair involutional ectropion due to horizontal lid laxity. Medial spindle procedure is the well-known technique for puntal ectropion correction. Both surgeries are minimally invasive, simple and effective. Contributors Suzanne K. Freitag, MD, Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School Thidarat Tanking, MD, Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School

Total Tonsillectomy

Total Tonsillectomy Sarah Maurrasse MD, Vikash Modi MD Weill Cornell Medicine, Department of Otolaryngology Tonsillectomy is one of the most common surgical procedures performed in children. The two main indications for tonsillectomy are sleep disordered breathing and recurrent infections, both of which are common in the pediatric population. This video includes 1) a detailed introduction including relevant anatomy 2) a discussion of the indications for total tonsillectomy 3) surgical videos and diagrams to explain the steps of the surgical procedure and 4) an explanation of possible post-operative complications.

Temporal (Gillies) Approach to a Zygomatic Arch Fracture

This video documents the steps typically followed during open reduction of isolated, depressed zygomatic arch fractures.  The patient's hair was shaven for clarity and for proper marking of key anatomic landmarks. Such landmarks are shown and discussed in sequence with the key surgical steps.

Marcus Couey, DDS, MD; Eric Reimer, DDS; Andrew Bhagyam, DDS; Phillip Freeman, DDS, MD; Jose M Marchena, DMD, MD

The University of Texas Health Science Center at Houston, School of Dentistry, Department of Oral & Maxillofacial Surgery

Partial Tonsillectomy

Partial Tonsillectomy Sarah Maurrasse MD, Vikash Modi MD Weill Cornell Medicine, Department of Otolaryngology Tonsillectomy is one of the most common surgical procedures performed in children. The main indication for partial tonsillectomy is sleep disordered breathing, which includes a spectrum of disorders from primary snoring to obstructive sleep apnea (OSA). This video includes 1) figures of the anatomy relevant to partial tonsillectomy 2) a discussion of the indications for partial tonsillectomy and 3) surgical videos and diagrams that explain the steps of the surgical procedure.

Total Facial Nerve Decompression via Combined Middle Fossa-Transmastoid Approach

This video demonstrates total facial nerve decompression via combined Middle Fossa-Transmastoid approach. Gavriel D. Kohlberg, MD,1 Noga Lipschitz, MD,1 Charles B. Poff, BS,2 MD, Ravi N. Samy, MD, FACS1,3 1 Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA 2 College of Medicine, Medical University of South Carolina, Charleston, SC, USA 3 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA

Frontalis Suspension Blepharoptosis Repair

Frontalis suspension blepharoptosis repair is the procedure of choice for the repair of blepharoptosis in the context of poor levator function (< 4mm). Numerous sling materials have been described for this procedure, however, preferred materials include banked, Tutoplast or autologous fascia lata, or silicone rods. This video demonstrates frontalis suspension utilizing silicone rods. Authors: Jay C. Wang, MD (Massachusetts Eye and Ear) Suzanne K. Freitag, MD (Massachusetts Eye and Ear)

EFFECTIVE REMOVAL OF A PEDIATRIC EMBEDDED ESOPHAGEAL FOREIGN BODY

Authors: Amanda Munoz, MD; Ian Vannix, BA; Victoria Pepper, MD; Joanne Baerg, MD OVERVIEW: A three-year old girl had an unwitnessed ingestion of a radiolucent foreign body that became embedded in the esophagus with formation of a symptomatic stricture. The foreign body was not visible on initial chest radiograph or at flexible endoscopy. Pediatric surgery was consulted for removal.

Middle Fossa Approach for Vestibular Schwannoma (Acoustic Neuroma) Resection

This video demonstrates the operative setup and surgical steps of a middle fossa approach for the resection of vestibular schwannoma (acoustic neuroma). Authors: Cameron C. Wick, MD (cameron.wick@wustl.edu) 1 Samuel L. Barnett, MD (sam.barnett@utsouthwestern.edu) 2 J. Walter Kutz Jr., MD (walter.kutz@utsouthwestern.edu) 3 Brandon Isaacson, MD (brandon.isaacson@utsouthwestern.edu) 3 1 - Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 2 - Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX 3- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX

Submental Intubation

Presented is a case of submental intubation performed prior to maxillomandibular advancement for the treatment of obstructive sleep apnea. Submental intubation is a viable alternative to tracheostomy for cases in which nasal intubation is contraindicated (e.g. trauma), or uninterrupted access to the oral cavity is preferred. [1] Briefly, the technique consists of performing oral intubation, and then exteriorizing the endotracheal tube through a tract created from the floor of mouth to the submental triangle. At the end of the case, the tube can be passed into the oral cavity, returning to an oral intubation. Surgeon: Raj C. Dedhia, MD, MSCR, Department of Otolaryngology, Emory University School of Medicine Video Production: Clara Lee, MS4, Emory University School of Medicine

Total Calvarial Reconstruction for Increased Intracranial Pressure and Chiari Malformation

This procedure is a total calvarial vault expansion to correct pansynostosis in a three-year-old child. Total calvarial reconstruction is an open procedure that consists of removing bone flaps with an osteotome, outfracturing the skull bone edges with a rongeur to allow for future expansion, shaving down the bone flap inner table with a Hudson brace to create a bone mush for packing the interosseus spaces, and modifying then reattaching the bone flaps with absorbable plates and screws. This patient is status post craniofacial reconstruction for earlier sagittal synostosis. Second operations are uncommon after correction of single-suture synostosis, so this more aggressive technique represents an attempt to definitively correct the calvarial deformity and resolve the signs and symptoms of the attendant intracranial hypertension. Indications for surgery include cosmetic and neurologic concerns, here including a Chiari malformation and cervicothoracic syrinx. This educational video is related to a current research project of the Children’s National Medical Center Division of Neurosurgery regarding single-suture craniosynostosis and the factors that place children at risk for surgical recidivism in the setting of intracranial hypertension. Kelsey Cobourn, BS - Children's National Medical Center Division of Neurosurgery and Georgetown University Owen Ayers - Children's National Medical Center Division of Neurosurgery and Princeton University Deki Tsering, MS - Children's National Medical Center Division of Neurosurgery Gary Rogers, MD, JD, MBA, MPH - Children's National Medical Center Division of Plastic and Reconstructive Surgery and George Washington University School of Medicine Robert Keating, MD - Children's National Medical Center Division of Neurosurgery and George Washington University School of Medicine (corresponding author)

Endoscopic Ossiculoplasty (TORP) with Prolapsed Facial Nerve

This video illustrates an endoscopic ossiculoplasty using a total ossicular replacement prosthesis (TORP) in a patient with a mixed hearing loss and a large conductive component. The video highlights the middle ear anatomy including a dehiscent and prolapsed facial nerve partially obstructing the oval window. Technical pearls for the ossiculoplasty are also highlighted. Cameron C. Wick, MD Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA cameron.wick@wustl.edu J. Walter Kutz Jr., MD Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA walter.kutz@utsouthwestern.edu

Upper Eyelid Blepharoplasty

Introduction: Cosmetic Upper Blepharoplasty involves removing excess skin from the upper eyelid to enhance the appearance of the upper eyelids. Methods: Markings were made for the inferior incision on the upper eyelid between 8-10 mm above the upper lash line. Forceps are used to pinch the excess upper eyelid skin in the middle, nasal, and temporal, aspects of the upper eyelid. Markings are then made superiorly at the middle, nasal, and temporal points and are connected. Toothed forceps are used to pinch the excess upper eyelid skin, using the markings as a guide. Iris scissor is used to excise the pinched excess skin and the underlying orbicularis muscle. The skin between the two eyelids was closed. Conclusions: In our experience, cosmetic upper blepharoplasty is an efficient way to enhance the appearance of the eyes. By: Peyton Yee, Addison Yee Surgeon: Suzanne Yee, MD, FACS Dr. Suzanne Yee Cosmetic and Laser Surgery Center, Little Rock, AR, USA Recruited by: Gresham T Richter, MD

External Ptosis Repair

This video shows an external levator advancement ptosis repair in a patient with involutional eyelid ptosis. Authors: Justin D. Pennington, BS Suzanne K. Freitag, MD

Endoscopic Stapedotomy

Endoscopic ear surgery is an emerging technique championed for its improved visualization within the middle ear space. Stapes surgery presents a unique endoscopic challenge in that it offers a different type of depth perception compared to the binocular microscopic view. This video highlights the surgical steps for an endoscopic stapedotomy using a CO2 laser and Eclipse nitinol piston. The stapes footplate and stapedotomy are well visualized with the endoscope. Just like in endoscopic sinus surgery, depth perception is achieved through muscle-memory and camera movement. Author: Cameron C. Wick, MD Institution: Department of Otolaryngology - Head and Neck, Washington University School of Medicine in St. Louis, St. Louis, MO, USA Email: cameron.wick@wustl.edu

Laparoscopic Management of Hemoperitoneum Occurring As A Complication of Sleeve Gastrectomy

A laparoscopic approach was used to evaluate and manage hemoperitoneum that occurred in a 50 year-old woman who had undergone recent sleeve gastrectomy complicated by pulmonary embolism and hemoperitoneum. This case illustrates an important complication of laparoscopic sleeve gastrectomy, the usefulness of laparoscopy for managing complications of bariatric surgery, and the challenge of laparoscopy in an peritoneum filled with a significant quantity of blood. Authors: Donald Q Brubaker, BA - West Virginia University. Nova Szoka, MD - West Virginia University.

Bilateral Subcranial Le Fort III Osteotomies with Midface Distraction – A Surgical Review

In this video, we showcase the bilateral subcranial Le Fort III osteotomies with midface distraction using Kawamoto distractors. The surgery was performed in a 4-year-old boy with Crouzon Syndrome to correct his severe proptosis, increase the nasopharyngeal airway space and improve his severe negative overjet. Internal distractors were chosen to achieve maximum correction at this age. The patient undergoing surgery had no intraoperative or postoperative complications. A full separation of his facial bones was achieved. The patient had an uneventful recovery period, and there was a significant improvement in his proptosis and malocclusion. Santiago Gonzalez, BS, BA (1); Michael Golinko, MD, MS (2) 1. University of Arkansas for Medical Sciences – College of Medicine 4301 W. Markham, #550 Little Rock, AR 72205 2. Vanderbilt University Medical Center, Department of Plastic Surgery 2900 Children’s Way, 9th Floor Doctor’s Office Tower Nashville TN 37232

Use of Surgical Theater to Facilitate Resection of an Arteriovenous Malformation

Hepzibha Alexander, BSN – Children’s National Medical Center, Division of Neurosurgery and Georgetown University School of Medicine Ehsan Dowlati, MD - Children’s National Medical Center, Division of Neurosurgery and Medstar Georgetown University Hospital Deki Tsering, MS - Children’s National Medical Center, Division of Neurosurgery Robert Keating, MD - Children’s National Medical Center, Division of Neurosurgery and George Washington University School of Medicine (corresponding author)

How to Perform Salivary Gland Massage: Instructional Video

Title: How to perform a salivary gland massage - an instructional video Delaney Sheehan, MS; David Thompson, MS; Brittany Foret, MS; Michael Olejniczak, MS; Rohan R. Walvekar, MD* *Corresponding and Senior Author MS - Medical Student Louisiana State University Health Sciences Center, Department of Otolaryngology Head & Neck Surgery, New Orleans, LA 70112 Introduction: Education is a vital component to patient compliance. Salivary gland conditions like sialadenitis, dry mouth and postoperative protocols for sialendoscopy procedures among other procedures on the salivary glands often require a protocol of salivary gland massage; which forms a vital part of salivary gland hygiene i.e. salivary gland massage, hydration and sialogogues. In our search, we did not find a specific educational video demonstrating salivary gland massage. Funding: No external funding. Methods: The Ear Nose and Throat Interest Group at Louisiana State University Health Sciences Center in New Orleans under the supervision of senior author compiled the patient education and instructional video. Summary: Educational video on salivary gland massage is a way to disseminate a resource that can be easily accessed by patients and can be helpful in standardizing technique and also compliance.

Robotic-assisted Base of Tongue Resection for Adult Sleep Apnea

A 52-year-old female presented for an evaluation for sleep apnea surgery. She complained of choking sensation at night. She had an AHI of 6.7 events per hour, a oxygen saturation nadir of 71%, and BMI of 30.6. She and a prior history of adenotonsillectomy as a child. Flexible examination in the office revealed grade 4 lingual tonsil hypertrophy. She was deemed a candidate for lingual tonsillectomy and was taken to the operating for robotic lingual tonsillectomy. The technique for adult lingual tonsillectomy is shown in step-by-step fashion with tips for good results both operatively and functionally learned from robotic surgery for cancer of the unknown primary origin. Contributors: Jessica Moskovitz, MD, Leila J. Mady, MD, PhD, MPH, Umamaheswar Duvvuri, MD, PhD

Pediatric Tracheostomy

The following video demonstrates the authors' method for performing a tracheostomy in a pediatric patient. Details of important anatomical landmarks and surgical technique are demonstrated in the video. Authors: Chrystal Lau, BA. University of Arkansas for Medical Sciences. Brad Stone, BA. University of Arkansas for Medical Sciences. Austin DeHart, MD. Arkansas Children's Hospital. Michael Kubala, MD. University of Arkansas for Medical Sciences. Gresham Richter, MD. Arkansas Children's Hospital.

A Guide to Temporal Bone Dissection: Cortical Mastoidectomy & Facial Recess Approach (Part 1 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Description This video covers the key steps of a cortical mastoidectomy and facial recess approach during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. The first part of this video demonstrates a basic cortical mastoidectomy and focuses on fundamental principles including the preservation of the tegmen and sigmoid plate, adequate posterior canal wall thinning, continual saucerization, adequate removal of air cells, and early identification of the lateral semicircular canal and incus. The second part of the video discusses the facial recess approach and enlightens the viewer on the boundaries of the facial recess, the course of the mastoid segment of the facial nerve, and the location of the round window. Key surgical landmarks demonstrated in the course of this video include: zygomatic root, temporal line, posterior meatal wall, Henle’s spine, mastoid tip, tegmen mastoideum, sigmoid sinus, Koerner’s septum, lateral semicircular canal, incus, incus buttress, chorda tympani nerve, mastoid segment of the facial nerve, facial recess, round window niche, and round window.

A Guide to Temporal Bone Dissection: Endolymphatic Sac Dissection (Part 2 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Video Description This video shows the key steps in the dissection of the endolymphatic sac during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. This video builds on part one of our video series and demonstrates fundamentals of endolymphatic surgery including the location and appearance of the endolymphatic sac, and its relationship to the labyrinth. Key surgical landmarks demonstrated in the course of this video include: sigmoid sinus, mastoid segment of the facial nerve, retrofacial air cells, endolymphatic sac, lateral and posterior semicircular canal, and Donaldson’s line

A Guide to Temporal Bone Dissection: Lateral Temporal Bone Resection (Part 3 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Video Description This video covers the key steps of a lateral temporal bone resection during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. This video builds on part two of our video series. This approach allows for the en bloc removal of the external auditory canal and demonstrates fundamental steps of the procedure including: the propagation of a superior trough between the tegmen and the superior aspect of the external auditory canal, the extension of the facial recess inferiorly with sacrifice of the chorda tympani, and the drilling of the hypotympanic bone towards the glenoid. At the completion of the demonstration, the viewer is afforded a labelled view of the medial wall of the mesotympanum, as well as the medial aspect of the external auditory canal with an intact tympanic membrane. Key surgical landmarks demonstrated in the course of this video include: tegmen, zygomatic root, malleus, incus, stapes, glenoid, eustachian tube, mastoid segment of the facial nerve, chorda tympani nerve, facial recess, hypotympanic space, annular bone, tensor tympani tendon, cochlear promontory, pyramidal process, round window, and lateral semicircular canal.

A Guide to Temporal Bone Dissection: Labyrinthectomy (Part 4 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Video Description This video demonstrates the key steps of a labyrinthectomy during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. This video builds on part three of our video series and demonstrates fundamental steps involved in a labyrinthectomy including: the identification of the three-dimensional (3D) orientation of the semicircular canals, the location of the common crus, the relationship between the second genu of the facial nerve and the posterior semicircular canal, the relationship of the vestibule to the endolymphatic sac, the course of the subarcuate artery, and the relationship of the labyrinth to the internal auditory canal. Key surgical landmarks demonstrated in the course of this video include: posterior semicircular canal, superior semicircular canal, lateral semicircular canal, common crus, external genu of facial nerve, tympanic segment of the facial nerve, tegmen, vestibule, endolymphatic sac, endolymphatic duct, subarcuate artery.

A Guide to Temporal Bone Dissection: Internal Auditory Canal Dissection (Part 5 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Video Description This video demonstrates key steps in the dissection of the internal auditory canal during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. This video builds on part four of our video series and demonstrates fundamental steps involved in the dissection of the internal auditory canal including: establishing an inferior trough and identification of the cochlear aqueduct, establishing a superior trough and identification of the labyrinthine segment of the facial nerve, and blue-lining the internal auditory canal from porous to fundus. Key surgical landmarks demonstrated in the course of this video include: internal auditory canal, cochlear aqueduct, meatal segment of the facial nerve, labyrinthine segment of the facial nerve, 1st genu of the facial nerve, tympanic segment of the facial nerve, 2nd genu of the facial nerve, mastoid segment of the facial nerve.

A Guide to Temporal Bone Dissection: Infratemporal Approach (Part 6 of 6)

Authors Mohamedkazim M. Alwani, MD1, 3 Jon L. Harper, BS1, 3 Rick F. Nelson, MD PhD1, 2, 3 Author Affiliations Department of Otolaryngology – Head and Neck Surgery1 Department of Neurological Surgery2 Indiana University School of Medicine3 Video Description This video demonstrates key steps in the infratemporal approach during lab dissection of the temporal bone. The goal of this video is to serve as a supplementary teaching resource for resident-level surgical trainees by demonstrating key surgical landmarks and proper lab dissection technique. This video builds on part five of our video series and demonstrates fundamental steps of the procedure including: decompression and mobilization of the facial nerve, dissection of the cochlear scalae, skeletonization of the carotid artery, and entry into the jugular bulb. We demonstrate the wide opening of the jugular bulb to facilitate visualization of the medial wall of the jugular bulb, which subsequently aids in the dissection of the pars nervosa. Key surgical landmarks demonstrated in the course of this video include: sigmoid sinus, jugular bulb, mastoid segment of the facial nerve, cochlear scalae, internal carotid artery, pars nervosa

Inferior Turbinate Trim

Basic Info: A 14-year-old male presented with chronic nasal obstruction and awake stertor. It was discovered that the patient had severe bilateral turbinate hypertrophy. A trial of Flonase and antihistamine was attempted with no improvement. It was recommended that the patient undergo a bilateral nasal turbinate reduction. This procedure is displayed step-wise in the video. Introduction: Chronic nasal obstruction can be caused by inferior turbinate hypertrophy. This video portrays a surgical treatment for turbinate hypertrophy, a turbinate trim with a microdebrider blade. Methods: An Afrin pledget was inserted into each nostril and lidocaine was injected into each inferior turbinate. Each turbinate was medially fractured using a freer. The microdebrider blade was used to trim the inferior 1/3 of each turbinate. A freer was used to out-fracture each inferior turbinate. Afrin pledgets were inserted into each nostril for hemostasis. Results: The inferior one-third of each inferior turbinate was removed via a microdebrider. Patient was sent to recovery in good condition, and Afrin pledgets were removed in recovery once hemostasis was achieved. No adverse reactions were reported by the surgeon or patient. Conclusion: Chronic nasal obstruction can be significantly improved by an inferior turbinate trim and out-fracture. Author: Merit Turner, BS, BS Surgeon: Gresham T. Richter, MD Institutions: Department of Otolaryngology-Head and Neck Surgery, Arkansas Children’s Hospital, Little Rock, AR University of Arkansas for Medical Sciences, Little Rock, AR

Excision of Thyroglossal Duct Cyst (Sistrunk Procedure)

This video demonstrates an excision of a thyroglossal duct cyst with special focus on 1) using the thyrohyoid membrane as a landmark and 2) dissection of the posterior hyoid space, which is the space between the thyrohyoid membrane and the posterior surface of the hyoid bone. Contributors: John Maddalozzo MD, FAAP, FACS; Monica Herron, MPAS, PA-C; Sarah Maurrasse, MD; Jesse Arseneau (editor) Ann & Robert H. Lurie Children's Hospital of Chicago

Lateral Rectus Plication

Introduction Muscle plication is a type of strabismus surgery that aims to tighten an extraocular muscle by partially folding the muscle under or over itself without disinsertion. The patient is a 14-year-old with alternating esotropia, who previously had a medial rectus recession. Therefore, she underwent plication of the lateral rectus muscle for this procedure. Methods A conjunctival incision is made in the fornix. Tenon's capsule is dissected to expose the lateral rectus muscle. The lateral rectus muscle is isolated using a Stevens tenotomy hook followed by a Jameson muscle hook. A Stevens tenotomy hook is used to sweep around the muscle to confirm the location of the muscle pole. A caliper is used to mark the predetermined amount of plication, starting at the muscle insertion and marking further posteriorly on the muscle. The muscle is then secured at the location marked by the caliper with a double-armed 6-0 VicrylTM suture with a central bite and double-locking bites at each pole of the muscle. Plication is achieved by bringing the muscle anteriorly and attaching it to the sclera adjacent to the muscle insertion with half-scleral depth bites in crossed-swords fashion. The muscle is tied down to its new location and 6-0 plain gut sutures are used to close the conjunctival incision. Results No complications arose during the procedure. Postoperatively, the patient had subconjunctival hemorrhage, injection, and pain that decreased over the following week. Neomycin-polymyxin-dexamethasone drops were applied daily to prevent infection and inflammation. At the three-month follow up, the redness had resolved. The alternating esotropia had improved. Conclusion Lateral rectus plication is a safe procedure that can effectively treat esotropia. By: Michelle Huynh College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA mhuynh@uams.edu Surgeons: Brita Rook, MD Arkansas Children’s Hospital – Department of Ophthalmology, Little Rock, Arkansas, USA BSRook@uams.edu Joseph Fong, MD Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA JFong@uams.edu Video was performed at Arkansas Children’s Hospital, Little Rock, AR, USA.

Preauricular Pit/Cyst Excision

This video demonstrates the excision of a preauricular pit/cyst in a pediatric patient. John Maddalozzo, MD Sarah Maurrasse, MD Johanna Wickemeyer, MD Sneha Giri, MD Division of Pediatric Otolaryngology-Head & Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago

Scleral Fixation of Intraocular Lens Using Gore-Tex Suture

  This video demonstrates scleral-fixation of an intraocular lens with GoreTex suture. The surgery was performed by Dr. Ahmed Sallam MD, PhD at the Jones Eye Institute at the University of Arkansas for Medical Sciences. The authors of the video are Victoria Ly, Adam Neuhouser, and Ahmed Sallam MD, PhD.    

Reconstruction of Transcribriform Skull Base Defects

A 51 year-old male presented to an outside otolaryngologist with recurrent facial pain and congestion. He was found to have a left-sided nasal mass. A work-up was performed, complete with biopsy, which was diagnosed as non-intestinal type adenocarcinoma. He underwent resection via the endoscopic endonasal transcribriform approach. In this video publication, we present our preferred method of reconstruction for sinonasal malignancies treated by endoscopic transcribriform resection using a multilayered closure with the following: a subdural DuraGen inlay graft, a fascia lata onlay graft, and an extradural, extracranial onlay pericranial flap via nasionectomy. A lumbar drain was placed at the end of the case for CSF diversion until the fifth postoperative day. Contributors: Paul A. Gardner, MD, Eric W. Wang, MD, Juan C. Fernandez-Miranda, MD, and Carl H. Snyderman, MD, MBA

Supraglottoplasty and Epiglottopexy for Sleep-Variant Laryngomalacia

Here we present a 6-year-old girl with sleep-variant laryngomalacia treated successfully with endoscopic epiglottopexy and supraglottoplasty. Johanna L. Wickemeyer, MD1 Sarah E. Maurrasse, MD2,3 Douglas R. Johnston, MD, FACS2,3 Dana M. Thompson, MD, MS, FACS2,3 1Department of Otolaryngology—Head & Neck Surgery, University of Illinois—Chicago, 1855 West Taylor Street, Chicago, IL 60612 2Division of Pediatric Otolaryngology—Head and Neck Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611 3Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611

Total Facial Nerve Decompression via Combined Middle Cranial Fossa and Transmastoid approach

Authors: Gavriel D. Kohlberg, MD - University of Cincinnati Noga Lipschitz, MD - University of Cincinnati Charlie Poff, BS - Medical University of South Carolina Ravi N. Samy, MD, FACS - University of Cincinnati

Transpalatal Advancement Pharyngoplasty

The retropalatal airway is a common site of collapse in obstructive sleep apnea. Transpalatal advancement pharyngoplasty aims to address this site of upper airway collapse by advancing the soft palate anteriorly, increasing the cross-sectional area of the airway and decreasing pharyngeal collapsibility. Surgeon: Raj C. Dedhia1, MD, MSCR Video Production: Yifan Liu1,2, MD, Jason Yu1, MD 1 Perelman School of Medicine, Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania 2 Department of Otorhinolaryngology - Head and Neck, Affiliated Beijing Anzhen Hospital, Capital Medical University

Sphenopalatine Artery Ligation

A 70-year-old male presented with persistent left-sided epistaxis, occurring 4 - 12 times a day for 3 weeks. Episodes lasted 10 - 15 minutes, but once required nasal packing at the ED. Introduction: Ligation of the sphenopalatine artery is often indicated for patients with persistent posterior epistaxis that cannot be attributed to other causes. This video demonstrates a step-wise endoscopic sphenopalatine artery ligation using hemoclips. Methods: In order to access the maxillary sinus cavity, a ball-tip probe was used to fracture the uncinate and a backbiter was used to remove the uncinate in its entirety. Once in the maxillary sinus, a backbiter was used to remove the tissue anterior to the normal ostium. A straight Tru-Cut was used to remove tissue posterior the natural ostium, taking down the posterior fontanelle. After this was done, a down-biter and a microdebrider blade were used to remove tissue inferior to the natural ostium towards the inferior turbinate. A caudal instrument was used to raise a subperiosteal flap just posterior to the left maxillary sinus posterior wall. Next, dissection from the inferior turbinate up to the top of the maxillary sinus was done from an inferior to superior direction, roughly 1 cm posterior to the posterior wall of the maxillary sinus. The sphenopalatine artery was seen coming out of the sphenopalatine foramen and soft tissue was dissected off this artery. Two hemoclips were placed over the entire artery. Results: The patient was sent to recovery in good condition and no adverse reactions were reported by the surgeon or patient. Surgeons: Alissa Kanaan, MD. Zachary V. Anderson, MD. Institution: Department of Otolaryngology - Head and Neck Surgery at the University of Arkansas for Medical Sciences.

Superficial Parotidectomy for a First Branchial Cleft Cyst

This video demonstrates a superficial parotidectomy approach for the excision of a first branchial cleft cyst in a pediatric patient. This particular patient was a 4-year-old girl who presented with intermittent swelling in the region of the left parotid. On MRI, she was found to have a lobular mass consistent with a first branchial cleft cyst. Here we outline the steps of the recommended surgical procedure. Authors: Sarah Maurrasse, MD1,2; Monica Herron, MPAS, PA-C1; John Maddalozzo MD, FAAP, FACS1,2 Editors: Sarah Maurrasse1,2; Jesse Arseneau1 Voiceover: Vidal Maurrasse 1Ann & Robert H. Lurie Children's Hospital of Chicago 2Northwestern University Feinberg School of Medicine

Cataract Phacoemulsification and Intraocular Lens Implantation in a Small Pupil Case

Intro Phacoemulsification and intraocular lens implantation is the gold standard procedure for removing cataracts in developed countries. The patient is an elderly adult who underwent the surgery to alleviate visual impairment from a significant age-related mixed cataract. Before the surgery, his visual acuity in the operative eye was 20/60. Methods This video highlights the steps of cataract phacoemulsification and intraocular lens implantation in a small pupil case, including paracentesis, epinephrine-lidocaine (epi-Shugarcaine) injection for extra dilation and anesthesia, viscoelastic injection into the anterior chamber, capsulorrhexis, hydrodissection, phacoemulsification featuring a divide and conquer technique, cortical irrigation and aspiration, intraocular lens insertion, and wound sealing by hydration. Results No complications arose during the procedure. At the two-week postoperative follow-up, the patient’s visual acuity in the operative eye was 20/30. He denied any pain or discomfort. The visual acuity at four weeks was 20/20. The patient was pleased with results of the surgery. Conclusion Phacoemulsification and intraocular lens implantation is a safe and effective surgery for the management of cataracts. In the setting of a small pupil, intracameral epinephrine-lidocaine mix (epi-Shugarcaine) can be administered for extra dilation. Authors Michelle L. Huynh, BA College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA Joseph G. Chacko, MD Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA Surgeon Joseph G. Chacko, MD Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA Music Royalty Free Music from Bensound

Chalazion Incision and Curettage

Intro A chalazion is a lipogranulomatous inflammation of a meibomian gland in the eyelid that presents as a painless eyelid nodule or swelling. This pediatric patient presented with a chalazion that caused symptoms of eye irritation. The lesion had persisted for many months without improvement in response to warm compresses and eyelid scrubs with baby shampoo. Therefore, she underwent chalazion incision and curettage under sedation. Methods This video highlights the steps of chalazion incision and curettage. With a chalazion clamp tightened over the lesion, the eyelid is everted and an incision is made into the tarsus. A curette is used to scrape the walls of the cyst to remove the chalazion contents. At the conclusion of the procedure, the clamp is removed and pressure is applied to the area of the lesion for hemostasis. Conclusion Incision and curettage is a safe, relatively quick, and effective procedure for the management of persistent chalazia. Authors Michelle L. Huynh, BA College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA Muhammad Shamim, MD Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA Christian Ponder, MD Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA A. Paula Grigorian, MD Arkansas Children’s Hospital – Department of Ophthalmology, Little Rock, Arkansas, USA The procedure was performed at Arkansas Children’s Hospital, Little Rock, AR, USA. Music by bensound.com.

Ahmed® Glaucoma Valve for Treatment of Refractory Glaucoma

Introduction Intraocular pressure is the single modifiable risk factor resulting in progression of various subtypes of glaucoma. Intraocular pressure control is often achieved with topical medications, outpatient laser procedures, or minimally-invasive glaucoma surgery (MIGS). This patient is a 63-year-old with traumatic glaucoma in the right eye with elevated intraocular pressure sub-optimally controlled despite maximum medical therapy (29 mmHg). His intraocular pressure must be controlled with incisional glaucoma surgery - in this case, with placement of an Ahmed Model FP7 glaucoma valve. An advantage of valved glaucoma shunts is lower risk of postoperative hypotony-related complications compared to non-valved glaucoma shunts. Methods The 10 and 12 o'clock meridians are marked with a marking pen to define the borders of the conjunctival peritomy. A limbal traction 6-0 Vicryl suture is placed superotemporally in the cornea at the limbus. The conjunctival peritomy is then completed using Westcott scissors along the predetermined marks. The peritomy is extended posteriorly with blunt dissection using Stevens tenotomy scissors. Wet field cautery is used to achieve hemostasis of the scleral bed. A Stevens tenotomy hook is used to identify the superior rectus muscle and a marking pen is used to mark its border. The Ahmed Model FP7 tube shunt is then introduced onto the surgical field. Balanced salt solution is injected into the tip of the tube using a 30-gauge cannula to ensure adequate patency of the valve. The Ahmed plate is then sutured to the sclera approximately 8 mm posterior to the limbus using 5-0 Nylon suture. A corneal paracentesis is made at the 8 o'clock position, and viscoelastic is injected to deepen the anterior chamber. A 23-gauge needle attached to the Healon syringe is then used to tunnel from a point 2.0 mm posterior to the limbus into the anterior chamber. The needle tract is anterior and parallel to the plane of the iris and the surgeon must ensure that the tube does not contact the iris or corneal endothelium after insertion. The implant tube is then laid flush with the cornea and shortened with Westcott scissors with an oblique cut, bevel up. Healon is injected as the needle is withdrawn. Non-toothed forceps are then used to insert the tube into the anterior chamber. A single 8-0 Vicryl suture is used to secure the tube to the underlying sclera. A corneal patch graft is cut to fit the site of tube implantation and secured with a single 8-0 Vicryl horizontal cross mattress suture. The conjunctival peritomy is then closed with a running 8-0 Vicryl suture on a BV needle. Anchoring sutures incorporating the conjunctiva and the episclera to firmly secure the corners of the peritomy to the limbus. A 9-0 Nylon suture is used to re-approximate the limbal conjunctiva. At the conclusion of the case, the eye is returned to a neutral position, the traction suture is removed, and satisfactory intraocular pressure is confirmed by palpation. Results No complications arose during the procedure. Postoperatively, the patient had subconjunctival hemorrhage, injection, and mild pain that decreased over the following week. Prednisolone acetate drops were applied six times daily to prevent inflammation and moxifloxacin drops were applied four times daily to prevent infection. At the three-month follow up, the eye was quiet and intraocular pressure was measured to be 9 mmHg. Conclusion Implantation of an Ahmed glaucoma tube shunt is a safe procedure that can effectively treat various subtypes of glaucoma with sub-optimally controlled intraocular pressure despite maximum medical therapy. Joseph W. Fong, MD Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA JFong@uams.edu Ahmed A. Sallam, MD, PhD Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA ASallam@uams.edu Surgery was performed at University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Endoscopic Frontal Sinusotomy with Osteoma Removal

A 49-year-old female presented with a one-year history of right frontal headaches, not controlled despite OTC medication. Work up with head CT revealed an osteoma of the right frontal sinus. The patient experienced no improvement in headache severity and elected to have surgical intervention. Methods: ENT Fusion Navigation system was used during the entire case. A ball-tip probe was used to fracture out the uncinate bone and a backbiter was used to remove the uncinate in its entirety. The natural ostium of the right maxillary sinus was then visualized. Again, the backbiter was used to remove tissue anterior to the natural ostium. A straight Tru-Cut was used to remove the ostium towards the posterior fontanelle. The right middle turbinate was resected in order to gain sufficient access for the resection of the osteoma. In order to remove the right middle turbinate, a turbinate scissors were used to make 3 cuts along the attachment of the middle turbinate and this was pulled down. A down biter was used to open up the maxillary sinus inferiorly. There was no tissue seen in the maxillary sinus. After this was done, an ethmoidectomy was performed by placing a J-curette behind the ethmoid bulla point anteriorly. This ethmoid bulla was removed along with several other anterior ethmoid cells. After this was done, a frontal sinus seeker was used to identify the right frontal osteoma. The patient did not have a right frontal sinus. Instead, an osteoma was in the area of what would have been the right frontal sinus or nasal frontal outflow tract. Image guidance was meticulously used to identify the osteoma. A 70-degree frontal drill was used and this osteoma was slowly drilled to remove as much as possible. Drilling was done from the posterior edge of the osteoma up to the skull base superiorly, to the lamina papyracea laterally and all bone that could be safely removed was removed. A right frontal propel stent was placed in the bony cavity created by the drill out and after this, the sinus was irrigated and suctioned. Results: The patient was sent to recovery in good condition and no adverse reactions were reported by the surgeon or patient. Surgeons: Alissa Kanaan, MD. Zachary V. Anderson, MD. Institution: Department of Otolaryngology - Head and Neck Surgery at the University of Arkansas for Medical Sciences.

Myringotomy and Tympanostomy Tube (Ear Tube) Placement

This video demonstrates the required instruments, appropriate set-up, relevant anatomy, and procedural steps for ear tube placement. Sarah Maurrasse, MD; Erik Waldman, MD Yale School of Medicine, Yale New Haven Children's Hospital

Pediatric Laryngeal Reinnervation with Ansa Cervicalis to Recurrent Laryngeal Nerve Anastomosis

Unilateral vocal fold paralysis in children has many different etiologies that can result in difficulties with breathing, swallowing, or phonation. Depending on the severity of symptoms, treatment modalities range from non-surgical interventions, to temporary surgical procedures, or more permanent surgical options. Laryngeal reinnervation has been demonstrated as an appropriate treatment option for children with permanent laryngeal nerve damage and persistent symptoms, but it still not widely performed among pediatric otolaryngologists. In this case, we present a 6 year-old female patient who developed unilateral vocal fold paralysis from a cardiac procedure as an infant, and she subsequently underwent laryngeal reinnervation with ansa cervicalis-to-recurrent laryngeal nerve (ANSA-RLN) anastomosis. The patient tolerated the procedure well with no peri-operative complications and demonstrated symptomatic improvement in voice quality and swallowing at her 3 month follow-up appointment. The goal of this case is to demonstrate the steps of the laryngeal reinnervation procedure and acknowledge its importance as a treatment option for unilateral vocal fold paralysis in pediatric patients.

Authors:

Cori N Walker MD¹, Christopher Blake Sullivan MD¹, Sohit P Kanotra MD¹

Department of ¹Otolaryngology – Head and Neck Surgery

University of Iowa Hospitals and Clinics, Iowa City, IA, USA

Endoscopic Repair of Unilateral Choanal Atresia

This video provides background information regarding the diagnosis and management of choanal atresia and demonstrates the endoscopic repair of a unilateral choanal atresia. Authors: Alexander Moushey1; Kiley Trott, MD2; Sarah E. Maurrasse, MD2 Voiceover: Vidal Maurrasse 1Yale School of Medicine, New Haven, CT 2Department of Surgery, Section of Pediatric Otolaryngology, Yale School of Medicine, Yale New Haven Children’s Hospital

Single Stage Laryngotracheal Reconstruction with Anterior Cartilage Graft

Single Stage Laryngotracheal Reconstruction with Anterior Cartilage Graft Leandro Socolovsky BA1, Rhea Singh BS1, Rajanya S. Petersson MS, MD1,2 1Virginia Commonwealth University School of Medicine, Richmond, VA 2Children’s Hospital of Richmond at VCU, Richmond, VA Overview This is a case of a 3-year-old male, former preterm infant born at 24 weeks with a past medical history of bronchopulmonary dysplasia and tracheomalacia status post tracheostomy for ventilator dependence. He had also developed subglottic stenosis from prolonged intubation. The patient was decannulated with grade 1 subglottic stenosis, and initially did well. However, over several months, the stoma remained fairly patent, prompting repeat direct laryngoscopy and bronchoscopy now demonstrating low grade 2 subglottic stenosis. The decision was made to proceed with laryngotracheal reconstruction with anterior rib cartilage graft, expanding the airway size from a 3.5 uncuffed endotracheal tube (ETT) to a 5.0 uncuffed ETT. The patient was transferred to the ICU and kept intubated and sedated until extubation on post-operative day 3. At 6 weeks postoperatively, direct laryngoscopy showed a well-mucosalized graft, with the airway still sized to a 5.0 ETT. Procedure details Direct laryngoscopy and bronchoscopy on the day of the reconstruction confirmed low grade 2 subglottic stenosis. The patient was intubated with a size 3.5 cuffed ETT for the procedure. Right rib cartilage harvest was performed after the endoscopic airway evaluation, followed by carving of the cartilage graft on the back table. The cartilage was carved into a modified tear drop shape to accommodate the tracheal stoma, with a length of 25mm and a width of 7mm. The intraluminal depth of the graft was sized to the bevel of a 15-blade. A fusiform incision was marked around the previous tracheostomy site. Scar tissue was dissected until the previous tracheostomy tract was clearly visualized and then excised. Once the patent tracheostomy was seen, the trachea and thyroid cartilage were skeletonized superiorly until the thyroid notch was reached. An incision site was marked from the superior aspect of the tracheostomy to the inferior border of the thyroid cartilage to avoid the anterior commissure. The marked incision site was then measured for confirmation of adequate sizing of graft, and confirmed to be 25 mm. A 15-blade was used to make the incision into the airway. An oral RAE tube was trimmed and placed at the inferior aspect of the tracheal incision, after the ETT was backed out, and ventilation continued through the modified oral RAE. The incision was then advanced into the inferior 2mm of the thyroid cartilage without performing laryngofissure, ensuring not to go through the anterior commissure. The patient was nasotracheally intubated with a 5.0 uncuffed ETT in preparation for graft placement, and the modified oral RAE was removed. The nasotracheal tube was advanced just beyond the graft site. The cartilage graft was placed using 4-0 Vicryl pop-off sutures on RB-1 needles in simple interrupted fashion. The sutures were first placed into the graft through the extraluminal side and coming out at the junction of the intraluminal depth and cartilage that would overlap the airway. Then the sutures were placed submucosally through the cartilaginous rings of the trachea, taking care to avoid entering the airway lumen to prevent granulation tissue. A total of 8-12 sutures are typically placed, left untied, and tagged. The graft was then parachuted into position, and all sutures tied to ensure knots are squared. The wound was filled with saline, and a Valsalva at 20cm H2O was performed to ensure there was no air leak. The strap muscles were then loosely closed, and a split Penrose drain was placed with one limb under the strap muscles and the other subcutaneously. The skin was closed in layered fashion with 4-0 Monocryl deep inverted interrupted sutures and 5-0 Monocryl in a running subcuticular manner. The patient was kept intubated and sedated for 3 days per protocol for anterior graft at our institution. Extubation was performed in the pediatric intensive care unit on post-operative day 3. A bronchoscopy was performed through the nasotracheal tube, and the patient was extubated over the bronchoscope. The graft site was visualized on the way out, and noted to be intact, mucosalizing, and without granulation tissue.and ensure it is intact. Humidified support was given via a nasal cannula following extubation. At 6 weeks postoperatively a direct laryngoscopy was performed, noting well-mucosalized graft, and airway still sized to a 5.0 uncuffed ETT. Indications/contraindications for single stage anterior cartilage graft reconstruction Indications Subglottic stenosis (SGS); high grade 1 to grade 2 SGS, failed decannulation for lower grade SGS, suprastomal collapse Proximal tracheal stenosis Other potential indications for rib cartilage grafting (with or without posterior grafting): Glottic stenosis Tracheal stenosis Vocal cord paralysis Laryngeal web Relative Contraindications Ventilator dependence Acute upper or lower respiratory tract infection Untreated concurrent airway obstruction (vocal cord paralysis, tracheomalacia, bronchopulmonary dysplasia, adenotonsillar hypertrophy, choanal atresia) Congestive heart failure (>30% oxygen requirements, weight < 1500g) Instrumentation Setup Patient placed supine with shoulder roll with head facing the anesthesia team. The neck and right anterior chest are prepped and draped in sterile fashion. If tracheostomy tube is present, modified cut down oral RAE, is sewn to chest wall opposite the planned cartilage donor site The anesthesia circuit is placed under sterile drapes in a manner to allow access by the anesthesia team during the procedure Preoperative workup Endoscopic examination of supraglottis, glottis, subglottis, trachea, and bronchi to confirm location of obstruction or stenosis and identify any other lesions or airway concerns. True vocal fold mobility is assessed and palpation of cricoarytenoid joint is performed to determine integrity of posterior glottis. Laryngopharyngeal reflux control may be considered prior to surgery. Discussion and communication with anesthesiologist before, during, and after the case to ensure smooth transitions between airways and during transport to the PICU. Weighted nasogastric feeding tube, if not already present, should be placed prior to beginning procedure, especially if posterior graft is planned. Anatomy and Landmarks Strap musculature Hyoid bone Thyroid cartilage Cricoid cartilage Proximal trachea Advantages Single stage procedure does not require decannulation at later date. Single stage allows for reconstructing the potentially weak area of the anterior tracheal wall at the trach site itself. Disadvantages For single stage procedure patients must be intubated and sedated in an intensive care unit for graft stenting for an adequate period of time. This requires sedation and occasionally paralysis, depending on the patient. Typically, the intubation is 3 days at our institution, but can be up to 5 for anterior grafting. Complications/risks Bleeding, infection, reaction to anesthesia, abnormal scarring, granulation, need for further procedures Graft dislodgement or failure Need for tracheostomy Pneumonia Pneumothorax Vocal cord injury if laryngofissure is performed

Treatment of mild eyelid ptosis with conjunctivo-mullerectomy

Mild eyelid ptosis with good elevator function can be treated with minimally invasive procedures. When Muller's muscle contraction corrects the deficiency (evaluated by phenilefrine test) conjunctivo-mullerectomy is the procedure of choice. This video presents the surgical steps to perform conjunctivo-mullerectomy. Contributors Dov Charles Goldenberg, MD Phd, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School Vania Kharmandayan, MD, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School

Open Tracheotomy in Ventilated COVID-19 Patients

Authors Carol Li, MD1*, Apoorva T. Ramaswamy, MD1*, Sallie M. Long, MD 1 , Alexander Chern, MD 1 , Sei Chung, MD 1 , Brendon Stiles, MD 2 , Andrew B. Tassler, MD 1 1Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY 2Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY *Co-First authors Overview The COVID-19 pandemic is an unprecedented global healthcare emergency. The need for prolonged invasive ventilation is common amid this outbreak. Despite initial data suggesting high mortality rates among those requiring intubation, United States data suggests better outcomes for those requiring invasive ventilation. Thus, many of these patients requiring prolonged ventilation have become candidates for tracheotomy. Considered aerosol generating procedures (AGP), tracheotomies performed on COVID-19 patients theoretically put health care workers at high risk for contracting the virus. In this video, we present our institution’s multidisciplinary team-based methodology for the safe performance of tracheotomies on COVID-19 patients. During the month of April 2020, 32 tracheotomies were performed in this manner with no documented cases of COVID-19 transmission with nasopharyngeal swab and antibody testing among the surgical and anesthesia team. Procedure Details The patient is positioned with a shoulder roll to place the neck in extension. The neck is prepped and draped in a sterile fashion with a clear plastic drape across the jawline extending superiorly to cover the head. An institutional timeout is performed. The patient is pre-oxygenated on 100% FiO2. A 2-cm vertical incision is made extending inferiorly from the lower border of the palpated cricoid cartilage. Subcutaneous tissues and strap muscles are divided in the midline. When the thyroid isthmus is encountered, it is either retracted out of the field or divided using electrocautery. The remaining fascia is then cleared off the anterior face of the trachea. Prior to airway entry, the anesthesiologist pauses all ventilation and turns off oxygen flow. The endotracheal tube (ETT) is advanced distally past the planned tracheotomy incision, without deflating the cuff, if possible. If necessary, the endotracheal cuff is deflated partially to advance the tube, with immediate reinflation once in position. The surgical team then creates a tracheotomy using cold steel instruments. The cricoid hook is placed in the tracheotomy incision and retracted superiorly for exposure of the lumen. The tube is withdrawn under direct visual guidance, without deflating the endotracheal cuff if possible. The tracheotomy tube is placed, and to minimize aerosolization of respiratory secretions, the cuff is inflated prior to re-initiation of ventilation. The tracheotomy tube is then sewn to the skin using 2-0 prolene suture. A total of five simple stitches are placed around the tube to prevent accidental decannulation. Indications/Contraindications Candidacy for tracheotomy was determined on a case by case basis with consideration for progression of ventilator weaning, viral load, and overall prognosis. All patients who underwent tracheotomy were intubated prior to the surgery for a minimum of 14 days, able to tolerate a 90-second period of apnea without significant desaturation or hemodynamic instability, and expected to recover. Optimal ventilator settings included FiO2

Introduction to IVC Filter Retrieval

This video demonstrates the procedural steps involved in the retrieval of an infrarenal Argon Option IVC filter. This educational video discusses the purpose of IVC filters as well as indications and contraindications for placement and retrieval. Authors: Alexander M. Moushey1; H. Alexander Chen1; Fabian Laage Gaupp, MD2; Todd Schlachter, MD2 1Yale University School of Medicine, New Haven, CT 2Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale University School of Medicine, New Haven, CT

Introduction to Tunneled Venous Infusion Catheter (Hickman) Placement

This video demonstrates the procedural steps involved in the placement of a Hickman brand tunneled venous infusion catheter. Authors: Alexander M. Moushey1; Junaid Raja2; Fabian Laage Gaupp, MD2; Melih Arici, MD2 1Yale University School of Medicine, New Haven, CT 2Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale University School of Medicine, New Haven, CT

Radial Free Flap Dissection

Institution: University of Cincinnati Medical Center Authors: Yash Patil MD- patilyj@ucmail.uc.edu Arvind Badhey MD- badheyad@ucmail.uc.edu Siddhant Tripathi- tripatst@mail.uc.edu

Flash Pulse Dye Laser (595nm) Therapy on Facial Capillary Malformation

This video teaches its viewers about facial capillary malformations, possible sequelae, as well as a treatment option, flash pulse dye laser. Authors: Maya Merriweather, BS and Richter T. Gresham, MD FACS Email: mmerriweather@uams.edu and GTRichter@uams.edu Institutions: University of Arkansas for Medical Sciences and Arkansas Children's Hospital

Introduction to Port-a-Cath Venous Infusion Catheter Placement

This video demonstrates the procedural steps involved in the placement of a Port-a-Cath venous infusion catheter. Authors: Alexander M. Moushey1; David S. Kirwin1; Fabian Laage Gaupp, MD2; Jessica Lee, MD2 1Yale University School of Medicine, New Haven, CT 2Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale University School of Medicine, New Haven, CT

Introduction to Tunneled Hemodialysis Catheter (Permacath) Placement

This video demonstrates the procedural steps involved in the placement of a Permacath tunneled hemodialysis catheter. Authors: Alexander M. Moushey1; David S. Kirwin1; Michael Chorney, MD2; Fabian Laage Gaupp, MD2 1Yale University School of Medicine, New Haven, CT 2Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale University School of Medicine, New Haven, CT

Non-fenestrated Extracardiac Fontan

This video demonstrates a non-fenestrated extracardiac fontan. This is the final step in palliation of hypoplastic left heart syndrome. Authors: Ethan Chernivec; Chris Eisenring, ACNP-BC; Lawrence Greiten, MD; Brian Reemtsen, MD. Arkansas Children's Hospital, Department of Pediatric Cardiothoracic Surgery, Little Rock, AR University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR

Incomplete Cleft Palate Repair: Von Langenbeck Converted to Two-flap Palatoplasty with Furlow Double Opposing Z-Plasty

Title: Incomplete Cleft Palate Repair: Von Langenbeck Converted to Two-flap Palatoplasty with Furlow Double Opposing Z-Plasty Authors: Nima Vahidi, MD1; Nilan Vaghjiani, BS1; Rajanya Petersson, MS, MD1,2 1Virginia Commonwealth University School of Medicine, Richmond, VA 2Children Hospital of Richmond at VCU, Richmond, VA Overview: 10-month-old male with 18q deletion syndrome, Pierre Robin sequence (cleft palate, glossoptosis, and micrognathia), eustachian tube dysfunction, cardiac disease including ASD, VSD and WPW, pulmonary hypertension, as well as tracheostomy and G-tube dependence. In preoperative evaluation he was noted to have an incomplete cleft palate involving the hard and soft palate. He was noted to have bilateral eustachian tube dysfunction with effusions present. After discussion with family decision was made to proceed with surgical intervention.

Closure of a Large Secundum ASD

Institution: University of Arkansas for Medical Sciences Authors: Thomas Heye - teheye@uams.edu Lawrence Greiten MD - lgreiten@uams.edu Christian Eisenring ACNP-BC - EisenringC@archildrens.org

Transannual Patch Repair of Tetralogy of Fallot

Institution: University of Arkansas for Medical Sciences Authors: Thomas Heye - teheye@uams.edu Lawrence Greiten MD - lgreiten@uams.edu Christian Eisenring ACNP-BC -EisenringC@archildrens.org

A Safe Stepwise Approach to the Critical View of Safety During Laparoscopic Cholecystectomy

Contributors: Eric Zimmerman and Pierre F Saldinger After the introduction of laparoscopic cholecystectomy bile duct injury rates have increased (3 per 1,000 cholecystectomies). Bile duct injuries after cholecystectomies are unfortunate events that can lead to significant morbidity, high cost and impair in quality of life. The purpose of this video is to demonstrate a safe stepwise approach to the critical view of safety described by Strasberg during laparoscopic cholecystectomy. DOI: http://dx.doi.org/10.17797/ce9i07jf03 Editor Recruited By: Jeffrey B. Matthews, MD

Robotic-assisted pyeloplasty for ureteropelvic junction obstruction

Introduction We present a case of ureteropelvic junction obstruction secondary to aberrant crossing gonadal vessels in a symptomatic 11-year-old female with horseshoe kidney, treated with a robotic-assisted pyeloplasty. Diagnostic Evaluation The patient presented with intermittent right-sided flank pain and vomiting. Renal ultrasound showed right-sided hydronephrosis and an abnormal-shaped kidney. MAG-3 renal scan demonstrated decreased function of the right kidney and no drainage. A MR Urogram showed a horseshoe type kidney with malrotation and an anterior dilated renal pelvis. Surgical Technique The patient underwent a robotic-assisted dismembered pyeloplasty. Intraoperatively, the right kidney was confirmed to be malrotated with a large, anteriorly directed renal pelvis. A packet of aberrant crossing gonadal vessels was identified and dissected from the right ureter and surrounding tissue. The ureter was sharply divided at the level of the ureteropelvic junction and transposed above the crossing vessels. A tension free mucosal to mucosal water-tight anastomosis was performed starting at the apex of the incision. A double-J stent was introduced into the ureter. The remainder of the anastomosis was completed with interrupted sutures. There were no intraoperative or postoperative complications. Conclusions Robotic-assisted dismembered pyeloplasty is a safe and effective method for UPJO correction in symptomatic patients with complex renal anatomy.

Robotic Sigmoid resection for Colovesicular Fistula and use of Firefly

Contributors: Ben Biteman, MD 61 year old male with diverticulitis and colovesicular fistula. Patient underwent robotic sigmoid colectomy with takedown of fistula. Firefly used to help identify if fistula still present. Editor Recruited By: Vincent Obias, MD, MS DOI# http://dx.doi.org/10.17797/9qxwhlr1q5

Robotic Assisted Redo Rectopexy and Low Anterior Resection

Contributors: Craig Rezac, MD Low anterior resection and rectopexy is the optimal treatment for well functioning patients with rectal prolapse. Reoperations for rectal prolapse may be challenging due to significant adhesions. Use of the robot for low anterior resection and rectopexy is safe, feasible and may be more useful than laparoscopy especially in challenging cases. DOI:http://dx.doi.org/10.17797/vkp7axh60l

Low Anterior Resection for Diverticulitis

Contributors: Craig Rezac, MD Treatment for recurrent or complicated diverticulitis is surgical resection. Minimally invasive techniques are associated with decreased length of stay and decreased post operative pain. However, laparoscopic low anterior resection is challenging especially in the narrow pelvis. Robotic surgery may overcome these obstacles and allow more surgery for divertiuclitis to be performed minimally invasively. These surgeons always do a LAR for diverticulitis because they transect on the proximal rectum. They take down the lateral stalks in order to mobilize the rectum and get the eea stapler through the rectum easier. Bilateral ureteral stents are routinely placed to better identify the ureters. This is especially important in cases of chronic/active diverticulitis or diverticulitis that has been complicated by abscess or fistula. This is the preference of the surgeon. DOI# http://dx.doi.org/10.17797/y1f1omu3mt

Completely Robotic Total Proctocolectomy and Ileal Pouch Anal Anastomosis

Contributors: Nell Maloney Patel, MD and Craig Rezac, MD There is little role for the use of minimally invasive techniques in the emergent setting for ulcerative colitis. However, for elective procedures, studies have shown that laparoscopic restorative proctocolectomy with IPAA is equivalent to open IPAA with regards to safety and feasibility, and that laparoscopic IPAA is associated with shorter recovery times, earlier return to bowel function, less post operative pain and a better cosmetic result. However laparoscopic approaches are difficult especially in the narrow pelvis. These challenges maybe overcome with the daVinci robotic system. DOI:http://dx.doi.org/10.17797/r1oi8fx5c2 Editor Recruited by: Neil Tanna

Robotic Assisted Repair of Morgagni Hernia

Contributors: Thomas Bauer, MD and Glenn Parker, MD Up to 25 % of diaphragmatic hernias may be incidentally diagnosed in adulthood. If symptomatic, patients often present with epigastric pain, chest pain or persistent cough. When found, they should be repaired to prevent incarceration and strangulation. DOI #: http://dx.doi.org/10.17797/wy2y9m77gv

Lateral Temporal Bone Resection

Contributors: Paul W. Gidley, MD This video demonstrates the basic steps of lateral temporal bone resection for cancers involving the ear canal. The lateral temporal bone resection removes the ear canal en bloc, preserving the facial nerve and stapes. DOI: http://dx.doi.org/10.17797/mn4edyy57u Editor Recruited By: Ravi N. Samy, MD, FACS

Revision mastoidectomy

Emphasis on soft tissue removal DOI: http://dx.doi.org/10.17797/1hfipu5fg1 Author Recruited by: Ravi N. Samy, MD, FACS

Sequential Balloon Dilation and Triamcinolone Injection in Premature Infant to Treat Glottic and Subglottic Injury

Contributors: Sanjay Parikh Sequential Balloon Dilation and Triamcinolone Injection in Premature Infant to Treat Glottic and Subglottic Injury. This video with narration shows a marked improvement in neonatal airway edema and successful extubation after three interventions of triamcinolone injection and balloon dilation. DOI# http://dx.doi.org/10.17797/w2iwnogofq Author Recruited by: Sanjay Parikh, MD. FACS

Flexible Laryngoscopy - An Overview

Authors Adam Karkoutli1 Wayne Wortmann1 Rohan R. Walvekar, MD2 Nathan C. Grohmann, MD2 Author Affiliations LSUHSC School of Medicine1 LSUHSC Department of Otolaryngology – Head and Neck Surgery2 Video Description This video demonstrates the procedure for use of firberoptic flexible laryngoscopy. The preoperative steps and recommendations for use of flexible laryngoscopy are outlined. Followed by a visual demonstration of insertion of the laryngoscope along with outlining pertinent landmarks encountered during this procedure.

Direct Laryngoscopy and Bronchoscopy: Purpose & Setup

This video is an introduction to operative direct laryngoscopy and bronchoscopy (DLB) and will demonstrate 1) How to set up the equipment for a safe and comprehensive DLB and 2) How to assemble a rigid bronchoscope. Authors: Alexander Moushey1; Taher Valika, MD2; Erik H. Waldman, MD3; Sarah E. Maurrasse, MD3 Voiceover: Vidal Maurrasse 1Yale School of Medicine, New Haven, CT 2Department of Surgery, Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine 3Department of Surgery, Section of Pediatric Otolaryngology, Yale School of Medicine, Yale New Haven Children’s Hospital

Direct Laryngoscopy and Bronchoscopy: Performing a Diagnostic Exam

This video is an introduction to operative direct laryngoscopy and bronchoscopy (DLB) and demonstrates how to perform a safe and comprehensive exam in the operating room. Authors: Alexander Moushey1; Taher Valika, MD2; Erik H. Waldman, MD3; Sarah E. Maurrasse, MD3 Voiceover: Vidal Maurrasse 1Yale School of Medicine, New Haven, CT 2Department of Surgery, Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine 3Department of Surgery, Section of Pediatric Otolaryngology, Yale School of Medicine, Yale New Haven Children’s Hospital

Endoscopic Management of a Duodenal Web

From the APSA 2016 Annual Meeting proceedings ENDOSCOPIC MANAGEMENT OF A DUODENAL WEB Lauren Wood, BS1, Zach Kastenberg, MD2, Tiffany Sinclair, MD2, Stephanie Chao, MD2, James Wall, MD2. 1Stanford School of Medicine, Palo Alto, CA, USA, 2Lucile Packard Children’s Hospital Stanford, Palo Alto, CA, USA. Introduction: Surgical intervention for duodenal atresia most commonly entails duodenoduodenostomy in the neonatal period. Occasionally, type I duodenal atresia with incomplete obstruction may go undiagnosed until later in life. Endoscopic approach to dividing intestinal webs has been reported in rare select cases. Methods: A two-year old female with a history of trisomy 21 and tetralogy of Fallot underwent laparoscopic and endoscopic exploration of intestinal obstruction as visualized on upper gastrointestinal series for symptoms of recurrent emesis and weight loss. After laparoscopy confirmed a duodenal web as the cause of intestinal obstruction, endoscopic division of the membrane was carried out with a triangle tip electrocautery knife followed by dilation with a 15 mm balloon. Results: The procedure took 210 minutes and the patient tolerated it well. Post-op Upper GI showed rapid passage of contents without leak and a diet was started. The patient was discharged on post-operative day 2 without narcotics. The patient had gained 2 pounds at 4 week follow-up and remains asymptomatic six months after the procedure. Conclusions: Endoscopic management of a duodenal web is feasible in children. Pediatric surgeons are ideally suited to offer the hybrid approach including laparoscopy to confirm no extraluminal obstructive process or complication from endoscopy. Endoscopy enables minimal recovery time and should be embraced as another tool in the minimally invasive toolbox of pediatric surgeons. DOI: https://doi.org/10.17797/pknxvd91zf

T Fastener Deply

Contributors: Marcus Jarboe, MD T-fasteners (pre-loaded into a slotted 18 G needle and fixed to nylon suture) are sequentially advanced using the introducer needle under endoscopic visualization into the stomach. A total of 3-4 concentric T-fasteners are deployed and secured to the skin externally, leaving a central area large enough to accomodate the G-tube. A skin incision is then made in this space between the T-fasteners, and an 18 G needle is inserted into the stomach under endoscopic visualization. A guidewire (preferrably stiff such as Amplatz superstiff -Boston Scientific) is passed through the needle and sequential dilation is performed using Seldinger technique to the diameter of the intended tube. A balloon-based G-tube is then inserted over the guidewire and the balloon is inflated with water per manufacturer guidelines. The external bumper is pulled down against the skin to secure the tube at an appropriate depth.

THORACOSCOPIC DIVISION OF A DOUBLE AORTIC ARCH AND TEF REPAIR THROUGH THE LEFT CHEST IN A PATIENT WITH A DOMINANT RIGHT ARCH

Contributors: Steven S. Rothenberg, MD This video depicts a thoracoscopic division of a double aortic arch and repair of a Tracheo-esophageal fistula (TEF) in a infant with a type 3 TEF and a dominant right arch.

ULTRASOUND-GUIDED LATERAL APPROACH TO INTERNAL JUGULAR CATHTER PLACEMENT

Contributors: Marcus Jarboe, MD The approach to the internal jugular vein is started adjacent to the clavicle, just lateral to the sternocleidomastoid muscle on the the right side. The ultrasound probe is placed in a transverse fashion cephalad and adjacent to the clavicle. The needle trajectory is in-line with the probe. The lateral approach enables clear and simultaneous visualization of the entire needle and key anatomic structures such as the edge of the lung, the internal jugular vein, and the carotid artery. Second, the approach allows a gentle curve on the catheter when tunneling, avoiding kinks and avoiding tendency of catheter movement in the tunnel pocket when the neck moves. Third, in cases of internal jugular occlusion, the lateral approach makes it possible to access the brachiocephalic vein.

RESECTION OF DUODENAL WEB USING HYBRID NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY (NOTES)

Contributors: Maria Carmen Mora, MD1 We performed an incisionless resection of the duodenal web via the existing gastrostomy site. Initially the plan was to use the endoscope for visualization and the gastrostomy site for instrumentation; however, the endoscope visualization was inadequate. The gastrostomy site was dilated and an extra small wound protector was placed with a sterile glove over it allowing insufflation and access via the fingers for the laparoscope and 3mm instruments. A 70-degree laparoscope was used for visualization. The opening of the web was cannulated using a Fogarthy catheter prolapsing the web towards the stomach. A 3mm hook cautery and then the LigaSure were used to incise and excise the anteriolateral aspect of the duodenal web. Intraoperative CXR ruled out free air. A 1cm 14-French Mickey button was placed at the completion of the procedure. The length of the operation was 100 minutes.

LNAR Technique

Contributors: Andre Hebra, MD

Lpm Bovie Cut

Contributors: Joe Iocono, MD

LPM Check For Leak

Contributors: Joe Iocono, MD

LAPAROSCOPIC REPAIR OF BILATERAL FEMORAL HERNIAS IN A CHILD

Contributors: Robert J. Vandewalle, MD During the initial laparoscopic examination, hernia defects were noted bilaterally, inferior to the inguinal ligaments and medial to the iliac veins, which was diagnostic for femoral hernias. The hernia sacs were everted and excised with electocautery. Care was taken to identify and preserve the Vas deferens and the iliac vein. The femoral hernia defects were then obliterated by approximating the inguinal and pectineal (Cooper’s) ligaments with 2-0 braided nylon suture. The patient tolerated the procedure well and was discharged home the same day. Operative time was approximately 60 minutes for each hernia defect, for a total time of around 120 minutes.

LAPAROSCOPIC REPAIR OF DIAPHRAGM EVENTRATION

Contributors: Oliver B. Lao, MD, MPH We demonstrate the use of an endostapler in a minimally invasive eventration repair in a pediatric patient. In contradiction to most other reported repairs, we approach the repair in a minimally invasive fashion through the abdomen. We invert the redundant diaphragm downward for our plication given this approach. We feel that this allows for better visualization of the intra-abdominal organs, avoids the pain and thoracostomy tube associated with a thoracoscopic procedure and gives a much more reliable and reproducible result. In addition the procedure can be done, on average, in less than 30 minutes, and it can be done as an outpatient procedure.

LAPAROSCOPIC ASSISTED RESECTION OF A TYPE IV SACROCOCCYGEAL TERATOMA IN A 6-MONTH-OLD GIRL

Contributors: Hans Joachim Kirschner, MD A three port technique was used for the minimal invasive approach in supine position. After abdominal dissection of the teratoma, the child was repositioned in a prone jack-knife position. A posterior longitudinal midline incision was carried out to remove the tumor completely.

HYDROCOLPOS DRAINAGE IN CLOACA

Contributors: Andrea Bischoff, MD A video was recorded highlighting the important technical details of hydrocolpos drainage in two cloaca patients that had previously underwent a colostomy opening and were left with an undrained hydrocolpos. In one patient, a vesicostomy was also previously performed in an attempt to drain the hydrocolpos, which in retrospect was unnecessary.With an infra-umbilical midline laparotomy or with a left lower quadrant oblique incision used for the colostomy opening, the hydrocolpos can be found behind the bladder. When opening the posterior vaginal wall at the dome, special emphasis should be placed on identification and protection of the uterus. When two hemivaginas are present a window can be created within the vaginal septum to allow for a single tube to drain both hemivaginas. The draining tube should remain in place until the time of the definitive cloacal reconstruction.

Thoracoscopic Management of Bilateral Congenital Pulmonary Airway Malformation with Systemic Blood Supply: Use of a Novel 5mm Stapler

from the APSA 2015 Annual Meeting proceedings THORACOSCOPIC MANAGEMENT OF BILATERAL CONGENITAL PULMONARY AIRWAY MALFORMATION WITH SYSTEMIC BLOOD SUPPLY: USE OF A NOVEL 5MM STAPLER Authors: Sandra M. Farach, MD, Paul D. Danielson, MD, Nicole M. Chandler, MD. All Childrenâs Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA. Purpose: Congenital pulmonary airway malformations (CPAM) and bronchopulmonary sequestrations (BPS) are two commonly discussed congenital lung malformations (CLM). We present a case of bilateral thoracoscopic lobectomy in a patient with bilateral, combined CPAM and BPS and report the novel use of a 5 mm linear stapling device. Methods: This is a retrospective review of a 9-month-old female patient with bilateral, combined CPAM and BPS who underwent bilateral thoracoscopic lower lobectomy. Results: The left lower lobectomy is demonstrated in this video. This was performed via a modified lateral position with the left side up using two 3 mm ports and two 5 mm ports. The lower lobe was resected cephalad. The systemic vessel was identified and secured. Polymer clips were placed, and the vessel was divided with a 5 mm stapling device. The pulmonary artery was divided with a vessel sealing instrument. The pulmonary vein was identified and was divided with the 5 mm stapler after endoscopic clips were placed. The bronchus was then identified and was divided with the 5 mm stapler. The most inferior port was removed and the incision widened to allow for extraction of the specimen. A 12 French chest tube was inserted into the left chest cavity under direct visualization. Total operative time was 146 minutes. The patient did well and was discharged on post-operative day two. Pathology revealed intralobar pulmonary sequestration with pulmonary systemic and pulmonary artery hypertensive changes and congenital cystic pulmonary airway malformation Type I. Conclusion: The literature has reported good outcomes with thoracoscopic lobectomy for congenital airway malformations. We present a successful case of bilateral thoracocsopic lobectomy for a rare finding of bilateral, combined CPAM and BPS as well as the effectiveness and safety of using a 5 mm linear stapling device.

Laparoscopic Partial Splenectomy

This edited video demonstrates the techniques of splenic hilar branch vessel sealing, parenchymal transection and hemostasis along the cut surface of the retained spleen segment.  It should be inserted into the APSA NAT chapter on "Splenectomy" Courtesy of Marcus Jarboe, MD

Pediatric Cervical Spine Injury

Video courtesy of: Christoper Corkins, MD Alfred Trappey, MD Ian Mitchell, MD

INDOCYANINE GREEN FLUOROESCENCE CHOLANGIOGRAPHY DURING LAPAROSCOPIC CHOLECYSTECTOMY

from the APSA 2017 Annual Meeting proceedings INDOCYANINE GREEN FLUOROESCENCE CHOLANGIOGRAPHY DURING LAPAROSCOPIC CHOLECYSTECTOMY Claire Graves, MD1, Olajire Idowu, MD2, Christopher R. Newton, MD2, Sunghoon Kim, MD2. 1UCSF Benioff Children’s Hospital, San Francisco, CA, USA, 2UCSF Benioff Children’s Hospital, Oakland, CA, USA. Purpose: Laparoscopic cholecystectomy is a common procedure performed by pediatric surgeons. Though  rare, with an incidence of approximately 0.4%  in the pediatric population, bile duct  injury is a serious complication often requiring  complex reconstruction. Aberrant  or distorted anatomy often contributes to biliary injuries, and  accurate identification of the anatomy is paramount. Indocyanine Green  (ICG) fluorescence, visualized  with near-infrared (NIR) imaging,  improves visualization and provides detailed anatomical mapping of the biliary structures. Though  increasingly used in adults via intravenous administration, this video demonstrates the first human use  of ICG injected directly into the gallbladder during laparoscopic cholecystectomy. Methods: Our patient is a 17-year-old female  who presented with biliary colic. A 0.25mg/ml ICG solution  is prepared on the surgical  backtable. A laparoscopic tower with NIR imaging  capability is used. After traditional  4-port  access is obtained, a needle- tip cholangiogram catheter is used to puncture the infundibulum of the gallbladder. 9ml of bile is drained and  mixed with 1ml of the ICG solution  to create a 0.025  mg/ml ICG and bile solution. The ICG and  bile solution  is then  re-injected into the gallbladder. The pre-mixed solution  fluoresces under  NIR light immediately upon  injection  with no lag time, quickly filling the gallbladder and  extrahepatic biliary system. Results: ICG fluorescence aids  significantly  in the visualization of the gallbladder, cystic duct  and  common bile duct.  When dissecting the gallbladder from the liver bed, this technique shows a well-defined plane  and  can  be used to identify accessory bile ducts. Conclusion: We demonstrate the first case of direct  administration of ICG into the gallbladder during laparoscopic cholecystectomy. This technique is safe,  avoids radiation and  can  be easily adopted by surgeons to improve  visualization of the biliary tree.

A TECHNIQUE TO PREVENT BAR DISPLACEMENT IN THE NUSS PROCEDURE

A TECHNIQUE TO PREVENT BAR DISPLACEMENT IN THE NUSS PROCEDURE Claire E. Graves, MD1, Andrew Phelps, MD1, Olajire Idowu, Jr., MD2, Sunghoon Kim, MD2, Benjamin E. Padilla, MD1. 1University of California, San Francisco Benioff Children’s Hospital, San Francisco, CA, USA, 2University of California, San Francisco Benioff Children’s Hospital, Oakland, CA, USA. Purpose: Bar displacement is a serious complication of the Nuss  procedure. Three types of displacement have  been well described: lateral sliding, bar flipping and posterior disruption. We propose a simple  modification in bar placement and  fixation that safeguards against all three  mechanisms of displacement. Methods: Nuss  bar length  is chosen to extend just beyond the pectus ridge on each side.  Using the external bar bender, we make  a gentle  curve on each side  of the bar, corresponding to the peak  of each pectus ridge.  The ends of the bar are left straight. After the bar is inserted and  flipped,  a stabilizer  is placed on each end  and  slid medially, just lateral to the chest wall insertion site. After the stabilizers are in position, in situ bar benders are used to complete the curvature of the bar around the chest wall. Results: This technique addresses all three  methods of displacement (Fig.1). Lateral sliding is prevented by locking the stabilizers in place with in situ bending just lateral to the chest exit site (A). The bar cannot move laterally as the stabilizers abut  the chest wall exit site (B). Placing  the stabilizers more  medially positions them  at the inflection point where  the ribs angle  superiorly. Thus the stabilizers straddle two ribs on the anterior chest (C). The stabilizers therefore have  a broader base of support, preventing bar flipping. Finally, placing  the stabilizers more  anterior  allows them  to directly counteract the posterior pressure on the bar from the sternum. Instead of relying on the intercostal musculature, the ribs themselves serve  to support the stabilizers and bar from posterior dislocation. Conclusion: We report  a technical modification of pectus bar placement and stabilization to minimize the risk of three  common mechanisms of displacement.

ROBOTIC LONGITUDINAL PANCREATICOJEJUNOSTOMY (PEUSTOW) FOR CHRONIC PANCREATITIS IN AN ADOLESCENT

From the APSA 2017 Annual Meeting proceedings ROBOTIC LONGITUDINAL PANCREATICOJEJUNOSTOMY (PEUSTOW) FOR CHRONIC PANCREATITIS IN AN ADOLESCENT Anna F. Tyson, MD, MPH, Daniel A. Bambini, MD, John B. Martinie, MD. Carolinas Medical Center, Charlotte, NC, USA. Purpose: A fifteen-year-old Hispanic girl presented with a brief history of nausea, vomiting and  severe abdominal pain. She  had  no prior episodes of pain, but reported a remote history of blunt abdominal trauma from a bicycle  handle injury. Workup revealed evidence of chronic  pancreatitis with diffuse calcifications throughout the pancreas and  a dilated, tortuous pancreatic duct.  This abstract describes robotic  longitudinal pancreaticojejunostomy for management of her disease. Methods: After thorough and  appropriate preoperative workup,  the patient underwent robotic  longitudinal  pancreaticojejunostomy. This was  accomplished using  three  8mm and  two 12mm  ports. The gastrocolic omentum was  opened using  a vessel sealing device, and  the stomach was  suspended. The pancreatic duct  was  identified  using ultrasound and  opened using  monopolar scissors. A Roux limb was  created 20cm  distal to the ligament of Treitz and  brought retrocolic to form the pancreaticojejunostomy. The side-to-side jejunal enteroenterostomy was  created using  a robotic  stapler and  the common enterotomy was  sutured closed. Finally, the longitudinal pancreaticojejunostomy was  sutured using  a series of running monofilament absorbable barbed sutures. Results: The patient tolerated the procedure well. Amylase level from the surgically placed drain was  normal  after eating, and  the drain was  removed prior to discharge on postoperative day five. She  has  subsequently been seen in clinic and  is doing  well 3 months out from surgery. She  has  no pain with eating  and  has  returned to her normal activities. Conclusions: Surgical  treatment of chronic  pancreatitis in children  is rare and  is difficult to perform  using  traditional  laparoscopic techniques. We conclude that totally robotic longitudinal  pancreaticojejunostomy is a safe  and  effective  option  for management of chronic  pancreatitis with a dilated  distal pancreatic duct  in appropriately sized  children. This minimally-invasive technique allows a faster  recovery and  improved cosmesis compared to a traditional  open approach.

Laparoscopic Assisted Gastric Pull-up for Long-gap Esophageal Atresia - Technical Aspects

Contributors: Kamal Dev LAPAROSCOPIC ASSISTED GASTRIC PULL-UP FOR LONG-GAP ESOPHAGEAL ATRESIA - TECHNICAL ASPECTS Hans Joachim Kirschner, MD, Joerg Fuchs, MD. University Children’s Hospital Tuebingen, Tuebingen, Germany. Purpose: We present the case of a four-month-old boy undergoing laparoscopic assisted gastric pull-up for long-gap esophageal atresia without fistula. The patient was an extremely low weight birth infant with a birth weight of 670 gr (gestational age 24 6/7 weeks). Sump suction drainage of the upper pouch and gastrostomy were performed initially. The esophageus showed no sufficient length after 4 months. Therefore, decision was taken to perform a laparoscopic assisted gastric pull-up. Methods: A three port technique was used for the minimal invasive approach. After abdominal dissection of the stomach, the midline tunnel was created laparoscopically through the hiatus window. The stomach was transferred through the extended subumbilical port incision and was prepared for the pull-up extracorporeally. A dilatation balloon catheter was inserted through the site of the gastrostomy for controlled dilatation of the pyloric muscle to avoid pyloroplasty. The upper esophageal pouch was dissected and the gastric pull-up and the anastomosis were performed through a cervical incision. Results: The postoperative course was uneventful. X-Ray contrast study and repeated esophagogastroscopy showed an adequate opening of the pylorus and absence of anastomosis stricture postoperatively. Oral feeding was uneventful after successful physiotherapy for swallowing Conclusion: Laparoscopic assisted gastric pull-up can be carried out safely in small infants. This video highlights the essential steps of the procedure. DOI: https://doi.org/10.17797/hjl4mzq5lt

Thoracoscopic Repair of a Symptomatic Congenital Cervical Lung Herniation

THORACOSCOPIC REPAIR OF A SYMPTOMATIC CONGENITAL CERVICAL LUNG HERNIATION Stephen J. Fenton, MD, Justin H. Lee, MD. University of Utah School of Medicine, Salt Lake City, UT, USA. Purpose: Congenital cervical lung herniation is an extremely rare cause of stridor and dysphagia. It more often occurs on the right and results from the disruption of Sibson’s fascia that allows for apical lung parenchyma to herniate into the neck. There is a known association with Vitamin E deficiency, cleft lip and palate, and Cri-du chat syndrome. Surgical intervention is rarely required for spontaneous pneumothorax, stridor, dysphagia, or cosmetic issues due to the incarcerated lung tissue. Methods: We report the thoracoscopic treatment of an infant with symptomatic congenital cervical lung herniation. Results: A previously healthy 9 month-old girl was evaluated with a several week history of progressive stridor and dysphagia. The stridor was more pronounced with crying and especially noted with crawling. The parents stated that she could not crawl for prolonged distances due to increased work of breathing. She was also noted to have dysphagia and would choke while feeding unless held upright. The child appeared healthy with normal vital signs and was noted to have stridor on exam. Plain films of the neck demonstrated herniation of the right lung apex into the thoracic inlet with significant displacement of the trachea. The child underwent an elective thoracoscopic repair. An opening below the Azygous vein was identified that allowed for herniation of an apical lobe into the neck. Inflation of this trapped lobe caused displacement of the esophagus and trachea to the contralateral side resulting in her symptoms. The hernia was opened by division of the Azygous vein and Sibson’s fascia. The apical lobe was resected and the area reinforced with placement of biologic mesh. She had an unremarkable post-operative course with resolution of her dysphagia and significant improvement in her stridor allowing for normal activity. Conclusions: A thoracoscopic approach to repair symptomatic congenital cervical lung herniation is feasible.

Minimally Invasive Repair of Pectus Carinatum

MINIMALLY INVASIVE REPAIR OF PECTUS CARINATUM Robert Kelly, MD1, Sherif Emil, MD, CM2. 1Children’s Hospital of the King’s Daughters; East Virginia Medical School, Norfolk, VA, USA, 2Montreal Children’s Hospital; McGill University Health Centre, Montreal, QC, Canada. Pectus carinatum is a chest wall anomaly amenable to correction by a number of surgical and non-surgical techniques. Minimally invasive repair of pectus carinatum, also unknown as the Abramson or reverse Nuss procedure, is an innovative technique that can achieve correction without major cartilage resection, large incisions, or prolonged bracing. Like other innovative techniques, the operation has gone through several technical problem-solving stages, and has yet to be adopted widely. We present a high fidelity video that illustrates the required equipment and surgical maneuvers necessary to optimize safety and outcome of this new technique. The results in two teen-age boys are demonstrated. DOI: https://doi.org/10.17797/fo5h3wx5hz

Intercostal Cryoablation: a Novel Method of Pain Management for the Nuss Procedure

From the APSA 2016 Annual Meeting proceedings INTERCOSTAL CRYOABLATION: A NOVEL METHOD OF PAIN MANAGEMENT FOR THE NUSS PROCEDURE Y. Julia Chen, MD, Benjamin Keller, MD, Jacob Stephenson, MD, Amy Rahm, MD, Rebecca Stark, MD, Shinjiro Hirose, MD, Gary Raff, MD. University of California, Davis Medical Center, Sacramento, CA, USA. Purpose: Achieving adequate analgesia in patients undergoing the Nuss Procedure for pectus excavatum is a significant determinant of postoperative recovery. Pain management strategies have evolved throughout the last decade, however there is no consensus on the optimal regimen. Practice varies according to institution and surgeon. Intercostal cyroanalgesia has been described in the literature for long-term management of post thoracotomy pain syndrome and has been established as safe and feasible in the adult population. The aim of this video is to introduce the usage of intercostal cryoablation as a novel method of pain control in children undergoing the Nuss Procedure for pectus excavatum. Methods/Results: We demonstrate operative footage and describe the technique of intraoperative intercostal nerve ablation during the Nuss Procedure. Using the cyroanalgesia probe T3-T6 are ablated bilaterally under direct visualization with the thoracoscope prior to insertion of the Nuss bar. This provides immediate and durable postoperative analgesia. Using this method, the need for thoracic epidural has been eliminated from our practice and patients are fast-tracked with decreased length of stay. There have been no complications reported related to cryoablation in the 6 months that we have used this technique. Conclusions: Intraoperative bilateral intercostal cryoablation is a safe and feasible method of pain control in children with pectus excavatum undergoing the Nuss Procedure. DOI:https://doi.org/10.17797/9s1mvk79sn

Anorectal Malformation, Rectoperineal Fistula with Vaginal Agenesis

From the APSA 2016 Annual Meeting proceedings OPERATIVE VIDEO: ANORECTAL MALFORMATION. RECTOPERINEAL FISTULA WITH VAGINAL AGENESIS Victoria A. Lane, MBChB, Richard J. Wood, MD, Carlos Reck, MD, Geri Hewitt, MD, Marc A. Levitt, MD. Nationwide Children's Hospital, Columbus, OH, USA. Purpose: We present the operative video of a female infant with a rectoperineal fistula with associated vaginal agenesis, who underwent reconstruction of the anorectal malformation and vaginal replacement. Methods: The case of a 6 month old female with a rectoperineal fistula and associated vaginal agenesis is presented. VACTERL screening identified an ASD and a dysplastic thumb. No spinal or renal anomalies were found and her sacrum was normal (Sacral ratio 1.0). At 7 months she underwent operative repair of the rectoperineal fistula and sigmoid colon vaginal replacement. The video demonstrates the initial examination findings of a vestibular fistula, with a normal vaginal introitus, however on closer inspection the vagina was found to be atretic. Standard mobilization of the rectum was performed in the prone position, followed by a lower midline laparotomy in order to examine the internal gynecological structures. A uterus and cervix were identified, but there was agenesis of the distal vagina. The operative technique for rectal pullthrough and simultaneous vaginal replacement, completion of the neo-vaginoplasty, and anoplasty is shown in the operative video. Results: One month after surgery the patient underwent an examination under anesthesia and vaginoscopy. The vaginal replacement was found to be healthy and a cervical dimple was seen. The anoplasty had healed well. Conclusions: Vaginal atresia is thought to occur in 5-10% of female patients with a rectoperineal/vestibular fistula. These patients require careful inspection of the perineum as the anomaly can be easily missed. The optimal timing of vaginal replacement has not been clearly established, but when rectal mobilization is required, there is a potential technical advantage to simultaneously completing the vaginal pullthrough.

Transanal Resection, How to Avoid Fecal Incontinence

from the APSA 2010 Annual Meeting proceedings TRANSANAL RESECTION, HOW TO AVOID FECAL INCONTINENCE Author: Alberto Pena, MD, Andrea Bischoff, MD, Marc A. Levitt, MD Cincinnati Children Hospital, Cincinnati, OH, USA Purpose: Transanal resection of the rectosigmoid is a valuable technique applicable for Hirschsprungâs disease, non-manageable idiopathic constipation, and idiopathic rectal prolapse. However, it represents a risk of producing damage to the continence mechanism. A series of important technical steps are crucial to avoid damage to the anal canal and sphincters. These are shown in a short video. Methods: In operations designed to remove the rectosigmoid and pull-through a new portion of colon it is mandatory to preserve the patientâs continence mechanism. This is achieved by avoiding damage to the sphincter and preserving the anal canal for up to 2 centimeters above the pectinate line. Damage to the continent mechanism can result from inadvertently resecting part, or the entire anal canal, leaving the patient without sensation. In addition, the striated sphincter mechanism may be resected or overstretched. Results: Over a period of ten years, 13 patients from other institutions were referred suffering from fecal incontinence following a transanal rectosigmoid resection. An examination under anesthesia demonstrated that the anal canal was non-existent or seriously damaged. During the same period of time we have done 125 transanal resections of the rectosigmoid and have made every effort to preserve intact the continence mechanism. As a result, we developed a series of technical recommendations that include: a) use of a Lone-Star retractor, b) placing and then replacing the eight hooks deeper so that the pectinate line is protected and hidden, c) placing multiple fine sutures on the rectal wall to apply uniform traction, d) starting the resection two centimeters above the pectinate line, e) avoiding overstretching of the anus using a three point exposure technique (one narrow malleable, a forceps or suction tip, and rectum; forming a triangle). Conclusions: With these technical maneuvers a transanal rectal and rectosigmoid resection can be performed preserving the continence mechanism.

Laparoscopic Nephrectomy for Wilms Tumor in a One-Year Old Girl

From the APSA 2011 Annual Meeting LAPAROSCOPIC NEPHRECTOMY FOR WILMS TUMOR IN A ONE YEAR OL D GIRL Authors:

• Guido Seitz, MD
• Steven W. Warmann, MD
• Martin Ebinger, MD
• Falko Fend, MD
• Jrg Fuchs, MD
• University Children`s Hospital, Tuebingen, Germany,
• University Hospital, Department of Pathology, Tuebingen, Germany

Percutaneous Endoscopically Assisted Repair (PEAR) of Inguinal Hernia

from the APSA 2015 Annual Meeting proceedings FROM BENCHTOP TO BEDSIDE: EVOLUTION OF THE MODERN LAPAROSCOPIC PEDIATRIC INGUINAL HERNIA REPAIR Author: Nicholas E. Bruns, MD, Todd A. Ponsky, MD. Akron Children's Hospital, Akron, OH, USA. Purpose: Laparoscopic pediatric inguinal hernia repair is an evolving procedure. We have previously shown certain maneuvers in the laparoscopic high ligation improve efficacy in the animal model. The purpose of this video presentation is to define a laparoscopic technique in children that provides equivalent efficacy of the open repair and to implement elements of the technique that were learned from an animal model. Methods: Based on animal research, braided suture and peritoneal injury have been suggested to improve durability of repair in the animal model likely by stimulating inflammation and scar tissue. We have thus modified Patkowskiâs method of percutaneous internal ring suturing to include the use of braided suture and peritoneal thermal injury. Results: This technique anecdotally has shown to be durable and effective. Conclusions: This technique is safe and efficacious for indirect inguinal hernia repair in children and may show promise in adults. Further study is needed to determine long term outcomes.

FB removal from Esophagus

Walaa Elfar, MD Upper endoscopy and esophageal FB removal chapters

Augmented Reality In A Hybrid Or For Pulmonary Nodule Localization And Thoracoscopic Resection - Feasibility Of A Novel Technique

from the APSA 2018 Annual Meeting proceedings AUGMENTED  REALITY IN A HYBRID OR FOR PULMONARY NODULE LOCALIZATION AND THORACOSCOPIC RESECTION - FEASIBILITY  OF A NOVEL TECHNIQUE John M. Racadio,  MD, Meera Kotagal, MD, Nicole A. Hilvert, RT(R)(VI), Andrew M. Racadio, BS, Daniel von Allmen, MD. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA. Purpose:  To assess the feasibility of utilizing a novel technique of augmented reality on a hybrid operating  room C-arm system  for image-guided localization and thoracoscopic resection of pulmonary  nodules. Methods: After obtaining IACUC approval,  silicone pulmonary  nodules were created and subsequently localized in a swine model in our research lab equipped as a hybrid operating room. Four optical cameras embedded in a C-arm system  allowed video co- registration  with a C-arm cone  beam  CT. Skin marker fiducials allowed for optical tracking and motion compensation. An integrated navigation system  enabled optically guided nodule localization without the need  for fluoroscopy,  thus reducing  radiation exposure. The optical augmented reality navigation was used  to both create and localize nodules. Localization was performed with microcoils. Thoracoscopic resection of the nodules was accomplished using direct visualization and fluoroscopic guidance. Results: As demonstrated in the video, realistic pulmonary  nodules were created and imaged  using the C-arm cone  beam  CT and an optical/image guidance system  to direct placement. Lesions  were accurately localized using optical/image guidance, enabling placement of microcoils  at the nodules.  Combined  thoracoscopic and fluoroscopic guidance allowed accurate wedge  resection of the nodules. Conclusions: Injection of silicone creates a realistic pulmonary  nodule  model. Image guidance using emerging  technology combining radiographic and optical imaging is effective in creating  and localizing pulmonary  nodules.  Real-time imaging combined with thoracoscopic visualization facilitates wedge  resection of nodules marked  with microcoils. The hybrid operating  room simplifies the radiographic localization and resection of pulmonary  nodules by eliminating the need  to move the patient from radiology to the operating  room. A collaborative approach combining the skill sets  and technologies of Interventional Radiology and Surgery  offers new opportunities for image guided  surgery.

Forced Sternal Elevation as an Adjunct to the Nuss Procedure for Pectus Excavatum

From the APSA 2016 Annual Meeting proceedings FORCED STERNAL ELEVATION AS AN ADJUNCT TO THE NUSS PROCEDURE FOR PECTUS EXCAVATUM Barry LoSasso, MD, Gerald Gollin, MD. Rady Children's Hospital and Sharp Memorial Medical Center, San Diego, CA, USA. Purpose: During most Nuss procedures, the dissector can be passed deep to the sternum in a manner that is safe and that allows for the tip of the instrument to exit the chest wall within 2 centimeters of the sternum. In some cases, proper passage of the dissector is prohibitively difficult and forced sternal elevation has been described as an adjunct. We present a video that demonstrates forced sternal elevation using the Ruhltract retractor. Procedure: The case presented in this video is that of an adult male, but the mechanical challenges are similar to older teenagers in whom we have used forced sternal elevation. In this patient, the Haller index was 5.2 and the excavatum defect was very asymmetric. Thoracoscopy demonstrated a deep and sharply angulated sternal defect that precluded safe and effective substernal dissection. A tenaculum was carefully placed by assuring deep entry of each side into the lateral sternum. The tenaculum was slowly clamped and connected to a wire loop and then to the snap clip of the Ruhltract. The Ruhltract rachet was then slowly turned to gradually retract the sternum anteriorly. Thoracoscopy after sternal retraction demonstrated a substantial correction of the pectus deformity which allowed for wide dissection between the sternum and pericardium. The dissector was then easily passed under the sternum and pushed through the corresponding left intercostal space one centimeter from the edge of the sternum. The pectus bar was then passed through the mediastinum. Conclusions: Use of forced sternal elevation can be a useful adjunct to Nuss repair in adult patients, in adolescents with particularly deep and asymmetric defects, and in re-do cases. In addition, as a surgeon gains experience with the Nuss operation, sternal elevation can offer an extra margin of safety during substernal dissection and passage of the dissector and bar. DOI: https://doi.org/10.17797/l3k45714ep

Faisal Aziz, MD

Penn State University

• Assistant Professor of Surgery and Interim Chief of Vascular Surgery

Dr. Faisal Aziz completed his General Surgery Residency at New York Medical College in Valhalla, New York and his Vascular Surgery Fellowship at Jobst Vascular Center in Toledo, Ohio. He currently works as an Assistant Professor of Surgery and Interim Chief of Vascular Surgery at Penn State University. Dr. Aziz has authored numerous book chapters and peer-reviewed publications, and was awarded the Servier Traveling Fellowship Award by American Venous Forum. Dr. Aziz also serves as the Section Editor for Venous Disorders, VESAP-4 and Examination Consultant for the American Board of Surgery.

Shadi Abu-Halimah, MD

West Virginia University, Charleston Division

• Assistant Professor of Surgery

Shadi J. Abu-Halimah, M.D. FACS is a Vascular/Endovascular Surgeon. He is Double Boarded in Vascular and General surgery. He was born in Riyadh, Saudi Arabia and currently resides in Charleston, WV. Dr. Abu-Halimah received his doctorate degree in 2000 from the University of Jordan in Amman, Jordan with Honors. He is licensed to practice in the state of West Virginia.

Currently, Dr. Abu-Halimah serves as Assistant Professor of Surgery at the Robert C. Byrd Health Science Center, West Virginia University (WVU), Charleston Division, as well as Clinical Assistant Professor of Surgery at WVU SOM in Lewisburg, WV.

Since 2000, Dr. Abu-Halimah has completed extensive post-doctoral training, as follows: (2000-2001) General Surgery Internship at the Ministry of Health Hospitals in Amman, Jordan; (2001 – 2003) General Surgery Residency at Ministry of Health Hospitals in Amman, Jordan; (2003 – 2004) General Surgery Prelim at WVU in Charleston, WV; (2004 – 2009) General Surgery Residency at WVU in Charleston, WV; and (2009 – 2011) Vascular Surgery Fellowship at University of North Carolina in Chapel Hill, NC.

Dr. Abu-Halimah currently belongs to several professional societies, including the Eastern Vascular Society, the Southern Association for Vascular Surgery, the Society for Vascular Surgery, and the American College of Surgeons. Moreover, from 2011 to present day, Dr. Abu-Halimah has served on numerous medical committees ranging from national, departmental, and institutional levels across the country.

Dr. Abu-Halimah’s previous teaching responsibilities include undergraduate medical education and supervision of medical trainees in a weekly outpatient clinic; at the graduate level, he was Attending Physician for the University V2 Vascular Surgery Service and delivered presentations at various conferences in areas of general surgery and vascular education.

He is a consultant for various medical/device companies involved in developing and teaching new technologies across the country. This involves case reviews, monitoring, and proctoring physicians at the national, local, and institutional levels.

Dr. Abu-Halimah has participated extensively in numerous lectures around the world where he was invited to deliver presentations on various topics of general and vascular surgery. He has been widely published in peer-reviewed articles, and research and clinical trials where he served as primary investigator and sub-investigator, as well as numerous book chapters around the world.

Jack Elder, MD, FACS

Massachusetts General Hospital

• Chief of Pediatric Urology

Jack S. Elder, M.D., FACS, is Chief of Pediatric Urology, Mass General. Dr. Elder received an M.D. with distinction from the University of Oklahoma College of Medicine, and was Vice President of Alpha Omega Alpha. He completed general surgery training at Yale-New Haven Hospital and a residency in urology, including chief resident, at The Johns Hopkins Hospital. Dr. Elder completed a pediatric urology fellowship at Johns Hopkins and at Children’s Hospital of Philadelphia. He was Director of Pediatric Urology at Rainbow Babies and Children’s Hospital for 21 years, and tenured Carter Kissell Professor of Urology at Case Western University School of Medicine. Subsequently, Dr. Elder was appointed Chief of Urology and Chief of Pediatric Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.

Dr. Elder was the Pediatric Urology Section Editor of The Journal of Urology from 1998-2007. Currently, he is on the editorial board of European Urology, Pediatric Surgery International, BJU International, Annals of Urology, and International Scholarly Research Notices. Dr. Elder served as President of the Society for Pediatric Urology and the American Academy of Pediatric Urologists. He was the Chairman of the first American Urological Association Pediatric Vesicoureteral Reflux Guidelines Committee, and was the facilitator of the second AUA Reflux Guidelines Committee, which published updated recommendations in 2010. He also is the Section Head, Pediatric Urology, AUA Online Robotic Surgery Handbook and is an annual reviewer for the European Association of Urology Paediatric Urology Guidelines. Dr. Elder has been Visiting Professor or Visiting Surgeon at 54 U.S. and international medical centers. Dr. Elder has > 160 peer-reviewed publications, edited or authored 6 books, 150 book chapters, and writes the pediatric urology section of the Nelson Textbook of Pediatrics. He is listed in Boston Magazine 2016 Top Docs.

Craig Rezac, MD

Rutgers Robert Wood Johnson Medical School

• Associate Professor of Surgery
• Section Chief, Colon and Rectal Surgery

Craig Rezac, M.D., is a Double Board Certified Surgeon with clinical interest in Colon and Rectal Surgery. American-born, Dr. Rezac received his doctorate degree from Pisa Medical School in Pisa, Italy in 1995, and his undergraduate degree from Adelphi University in Long Island, NY in 1981. Dr. Rezac is licensed to practice in New Jersey and the Republic of Italy.

Currently, Dr. Rezac serves as Associate Professor of Surgery, Section Chief Colon and Rectal Surgery at Rutgers Robert Wood Johnson Medical School (RWJMS) in New Brunswick, NJ. He also serves as Staff Physician, General Surgery at Somerset Medical Center in Somerville, NJ.

After receiving his medical degree, Dr. Rezac completed a Surgical Externship at La Spezia Hospital in La Spezia, Italy. He then completed a General Surgery Internship at the Monmouth Hospital in Long Branch, NJ. This was followed by a General Surgery Residency at UMDNJ-Robert Wood Johnson Medical School in New Brunswick, NJ, and a Colorectal Surgery Fellowship at UMDNJ-Robert Wood Johnson Medical School in Edison, NJ. Lastly, Dr. Rezac completed a Laparoscopic Fellowship at Hackensack University Hospital in Hackensack, NJ.

Dr. Rezac holds numerous medical certifications as follows: Cyberknife, Davinci Laparoscopic Robotic Surgery, Davinci Advanced Laparoscopic Robotic Surgery for Colon and Rectal Surgery, American Heart Association (BLS/CPR), Trans Anal Endoscopic Microsurgery (TEM), and Stapled Trans Anal Rectal Resection (STARR). Dr. Rezac has the distinct honour of being the first doctor in New Jersey to be certified in both TEM and STARR.

Dr. Rezac is a member of several professional associations, including: American College of Surgeons (Fellowship), American Society of Colon and Rectal Surgeons, Society of Laparoendoscopic Surgeons, American College of Surgeons, New Jersey Chapter, and the New Jersey Chapter of American Society of Colon and Rectal Surgeons (past-President).

Dr. Rezac has received a number of honors and awards for outstanding performance both academically and professionally. He currently serves on several major committees, in addition to school and hospital committees, while continuing to meet various teaching and clinical responsibilities.

Dr. Rezac has received substantial grant support for medical studies and has been widely published in national and international medical journals, books, monographs, chapters, and articles. Dr. Rezac has generously shared his time and talents to deliver over 30 scientific and clinical presentations around the world.

Anand R. Kumar, MD, FACS, FAAP

Johns Hopkins University School of Medicine

• Associate Professor, Departments of Plastic Surgery and Pediatrics

Anand R. Kumar, MD, FACS, FAAP is an Associate Professor in the Departments of Plastic Surgery and Pediatrics at the Johns Hopkins University School of Medicine. A pediatric plastic/craniofacial surgeon and basic science researcher, he conducts investigation into the cellular biology of muscle derived progenitor cells as a source of pathologic heterotopic ossification and for novel regenerative medicine applications. His clinical practice focuses on craniofacial surgery including craniosynostosis, correction of hypertelorism(wide eyes), pediatric and adolescent facial skeletal deformities (Pierre Robin Sequence) with airway obstruction using traditional orthognathic (jaw) surgery and distraction osteogenesis.

Dr. Kumar established the center for facial skeletal surgery and the center for pediatric craniofacial surgery at the University of Pittsburgh Medical Center and now at Johns Hopkins respectively with an emphasis on multidisciplinary care for dentofacial anomalies. He has led efforts to improve outcomes in pediatric sleep apnea using skeletal surgery and distraction osteogenesis for multilevel airway obstruction. In addition, he has participated in multi-institutional trials for improvement of clinical outcomes in neonatal tongue base collapse (Pierre-Robin Sequence).

Dr. Kumar as authored over 30 original scientific publications in peer-reviewed journals and contributed to multiple plastic and orthopedic surgery textbooks over the last 10 years. He serves as a reviewer for many plastic surgery and basic science journals and has been invited as a speaker or panelist to many institutions and at organizational meetings across the United States. He currently serves as Vice President of Communications on the board of the American Society of Maxillofacial Surgeons (ASMS). In addition, he serves on multiple committees in the American Society of Plastic Surgeons and the ASMS.

As an honor student in the biological sciences at the University of California, Irvine, Dr. Kumar received his medical degree from the Albert Einstein College of Medicine. He completed his general surgery residency at the Mayo Clinic Rochester and later completed a second residency in plastic and reconstructive surgery at the University of California, Los Angeles (UCLA). He subsequently completed a pediatric plastic/craniofacial surgery fellowship after his residency at UCLA. In 2004, prior to his academic appointment, Dr. Kumar volunteered for military service and joined the United States Navy until 2010. In Bethesda, MD, he served as director and staff pediatric plastic surgeon of the Military Craniofacial Unit at Walter Reed National Military Medical Center. He served as division chief in plastic and reconstructive surgery at the National Naval Medical Center in Bethesda and on board the United States Naval Support Hospital Ship Comfort. In 2010, Dr. Kumar was recruited to the University of Pittsburgh as the director of facial skeletal surgery until 2013 when he was recruited to Johns Hopkins.

Michael Golinko, MD

University of Arkansas for Medical Sciences

• Medical Director of Craniofacial Program, Arkansas Children’s Hospital
• Assistant Professor of Plastic Surgery, UAMS

Dr. Michael Golinko, M.D., is a Board Certified General Surgeon with clinical interests in Craniofacial, Cleft & Paediatric Plastic Surgery. Dr. Golinko is also Board Eligible with the American Board of Plastic Surgery, and is licensed in the states of Arkansas, and Georgia. Currently, Dr. Golinko serves as one of the Medical Directors of Arkansas Children’s Hospital Craniofacial Program, and is Assistant Professor of Plastic Surgery at the University of Arkansas Medical Sciences.

Dr. Golinko received his M.D. degree from University of South Florida (USF) in 2004, preceded by a M.A. in Medical Anthropology from Universiteit van Amsterdam (UVA) in 2002, and a B.Sc. in Physics from Massachusetts Institute of Technology (MIT) in 1998.

Dr. Golinko’s professional training includes General Surgery residencies at State University of New York (SUNY) and New York University (NYU), as well as a residency in Plastic & Reconstructive Surgery at Emory University School of Medicine, and he most recently served as a Fellow in Craniofacial Surgery/Pediatric Plastic Surgery at New York University (NYU).

From 1998 to 2008, Dr. Golinko held medical research positions at MIT, Massachusetts General Hospital, and completed Post-Doctoral Research Fellowships in the Department of Surgery, Division of Wound Healing at both Columbia University and New York University.

Dr. Golinko has contributed extensively to numerous peer-reviewed publications, book chapters, and abstracts. Moreover, Dr. Golinko has travelled the world to deliver numerous presentations, co-chair lectures and conferences, and media appearances.

Dr. Golinko has been awarded and recognized for the following: Operation Smile Regan Fellowship Recipient (2012), National Institute of Health (NIH) Loan Repayment Program Recipient (2007 – 2009), and Columbia University College of Physicians & Surgeons, Department of Surgery, Startup Grant (2006).

In the spirit of a true leader, Dr. Golinko served as past-President and Mission Leader of Project World Health, Managing Trustee of the Barry Golinko Trust of the Jewish Communal Fund, past-Surgery Department Representative of the Committee on Interns and Residents (CIR) and currently was selected to participate in the Arkansas Children’s Hospital Physician Leadership Development course.

Dr. Golinko currently belongs to several professional societies as follows: American Cleft Palate-Craniofacial Association, American Association of Wound Care, American College of Surgeons, and the Southeastern Society Of Reconstructive Plastic Surgeons.
In 2016, Dr. Golinko served on the American Society of Maxillofacial Surgeons/Plastic Surgery Foundation Combined Pilot Research Grant Committee. In addition to his professional work, Dr. Golinko has generously donated his time and many talents to numerous volunteer and humanitarian efforts all over the world.

Dov Goldenberg, MD

University of Sao Paulo Medical School

• Coordinator of Pediatric Plastic Surgery
• Supervisor (Residency Program in Plastic Surgery at the Division of Plastic Surgery), Hospital das Clinicas – University of Sao Paulo Medical School
• Attending Cranio-facial Surgeon – Division of Head and Neck Surgery and Otorhiolaryngology, Hospital A.C. Camargo
• Senior Surgeon and head of Cranio-maxillo-facial Surgery Team, Hospital Albert Einstein
• Chief of Pediatric Plastic Surgery Group, Hospital Municipal Infantil Menino Jesus

Residing in São Paulo, Brazil, Dr. Goldenberg graduated from the University of São Paulo Medical School. He then continued his studies with Postdoctoral Training and completed the Residency Program in General Surgery, followed by the Residency Program in Plastic Surgery at the Hospital of the Faculty of Medicine, University of São Paulo, Brazil.

Soon thereafter, Dr. Goldenberg earned his PhD in Plastic Surgery at the University of São Paulo Medical School, where he also gained his title as Full Professor of the Department of Surgery.

Dr. Goldenberg is the Editor-In-Chief for the Brazilian Journal of Plastic, International Associate Editor of Plastic and Reconstructive Surgery Journal (PRS), and past President of the Brazilian Association of Craniomaxillofacial Surgery.

His areas of interest in plastic surgery include Pediatric Plastic Surgery, Cranio-facial Surgery and Vascular Anomalies.

Steven Scot Rothenberg, MD

Columbia University College of Physicians and Surgeons

• Chief of Pediatric Surgery, Rocky Mountain Hospital for Children
• Clinical Professor of Surgery, Columbia University College of Physicians and Surgeons

Dr. Rothenberg is the Chief of Pediatric Surgery at the Rocky Mountain Hospital for Children at PSL in Denver, Co. He is also a Clinical Professor of Surgery at Columbia University College of Physicians and Surgeons. He is a world leader in the field of endoscopic surgery in infants and children and has pioneered many of the procedures using minimally invasive techniques.

Dr. Rothenberg completed medical school and general surgery residency at the University of Colorado in Denver. He then spent a year in England doing a fellowship in General Thoracic Surgery prior to returning to the states where he completed a two year Pediatric Surgery fellowship at Texas Children’s Hospital in Houston. He returned to Colorado in 1992 where he has been in practice for over the last 20 years.

Dr. Rothenberg was one of the founding members of the International Pediatric Surgical Group (IPEG) and is a past-president. He was also the Chair of the Pediatric Committee and on the Board of Directors for SAGES (The Society of American Gastro-intestinal Endoscopic Surgeons). He has authored over 180 publications on minimally invasive surgery in children and has given over 300 lectures on the subject nationally and internationally. In 2015 He received “The Pioneer in Surgical Endoscopy Award” from SAGES. He is also on the editorial board for the Journal of Laparoendoscopic Surgery and Advanced Surgical Technique, The Journal of Pediatric Surgery, and Pediatric Surgery International.

Dr. Rothenberg has been married to his wife Susan for over 30 years and has three children Jessica, Catherine, and Zachary. He is an avid outdoorsman and spends most of his free time in the mountains of Colorado skiing, hiking, biking, and fishing.

George W. Holcomb, III, MD, MBA

Children’s Mercy Hospital

• Surgeon-in-Chief
• Director of the Center for Minimally Invasive Surgery

Dr. George W. Holcomb, III was born in Osaka, Japan on December 11, 1953. He was raised in Nashville, Tennessee and attended elementary and high school in Nashville. He attended the University of Virginia for college and then Vanderbilt Medical School. His general surgery training was at Vanderbilt University Medical School and his pediatric surgery training was at the Children’s Hospital of Philadelphia. He began his pediatric surgery practice in 1988 as an Assistant and subsequently Associate Professor of Surgery in the Department of Pediatric Surgery at Vanderbilt University School of Medicine. In 1999, he was recruited to replace Dr. Keith Aschraft as Surgeon-in-Chief at Children’s Mercy Hospital in Kansas City, Missouri. In addition to being the Surgeon-in-Chief, he is also the Director of the Center for Minimally Invasive Surgery.

Dr. Holcomb is best known for his interest in minimally invasive surgery in infants and children and his emphasis on evidence-based medicine. He is the author of over 240 peer-reviewed publications and 50 book chapters, and has been the editor of 5 textbooks.

Adam Zanation, MD

University of North Carolina at Chapel Hill

• Director, Head and Neck Robotic Surgery Program
• Director of the Advanced Head and Neck Oncology, Skull Base, and Rhinology Fellowships
• Associate Professor, Department of Otolaryngology – Head and Neck Surgery

Dr. Adam Mikial Zanation is a tenure tract Associate Professor within the Department of Otolaryngology – Head and Neck Surgery at the University of North Carolina at Chapel Hill. He is also the Director of the Head and Neck Robotic Surgery Program and the Director of the Advanced Head and Neck Oncology, Skull Base, and Rhinology Fellowships. He was born on July 11, 1976, in Concord, North Carolina and attended the University of North Carolina where he was a three-year graduate with honors and research commendation in 1997. He then matriculated to the University of North Carolina School of Medicine where he graduated 1of 4 students in his class with highest honors. Following residency, Dr. Zanation completed a Cranial Base Surgical Oncology Fellowship at the University of Pittsburgh Medical Center. Dr. Zanation’s clinical practices focus on cranial base surgery, specifically employing endoscopic and minimally invasive approaches to complex tumor locations. His clinical research focuses on quality of life, neurofunctional, and neurocognitive outcomes, as well as application of new surgical technology such as robotic surgery to reduce patient morbidity. Dr. Zanation’s translational basic research interests focuses on genomic analyses of head and neck tumors and thyroid cancers for diagnostic and prognostic purposes. Dr. Zanation currently has 70 PubMed Indexed publications and in the last five years has presented at over 60 national and international meetings. Dr. Zanation is married to Jennifer Stegall Zanation who is a Neonatal ICU Pharmacist at UNC Hospitals. They have two young children and enjoy a multitude of outdoor activities.

Ravi N. Samy, MD, FACS

University of Cincinnati

• Director, Cochlear Implant and Auditory Brainstem Implant Program
• Program Director, Neurotology Fellowship
• Associate Professor, Department of Otolaryngology

Dr. Ravi Samy was born in Madras (now Chennai), India. He emigrated to the United States in 1973, at the age of 4. The first city in the US in which he lived was Canton, OH. After spending a few years in Connecticut during his father’s psychiatry residency, he moved to Wichita Falls, TX. He spent most of his formative years in Texas and considers himself a Texan. After graduating high school as co-valedictorian, Dr. Samy matriculated at Duke University. He graduated magna cum laude with a BS in Zoology in 1991. He then stayed on at Duke University School of Medicine and graduated in 1995. From 1995-2000, Dr. Samy was an intern and then a resident at Stanford University School of Medicine, where he developed a love for otology, neurotology, and skull base surgery. From 2000-2002, he was a fellow in Neurotology at the University of Iowa. After graduating, he was an Assistant Professor from 2002-2005 at UT-Southwestern Medical Center in Dallas, TX. Although he never wanted to leave Texas again, he was enamored with a phenomenal academic opportunity in the Department of Otolaryngology at the University of Cincinnati/Cincinnati Children’s Medical Center. He has been there for almost 8 years. He became an Associate Professor last year. During his time here, he has created an ACGME accredited, two-year Neurotology fellowship, one of only approximately 15 in the country. Dr. Samy serves not only as Program Director for the Neurotology Fellowship but also as the Director of the Cochlear Implant and Auditory Brainstem Implant program. His research interests include cochlear and auditory brainstem implantation as well as acoustic neuromas, neurofibromatosis type 2, facial nerve tumors, and other diseases and disorders of the lateral skull base. Finally, he is interested in using novel techniques and technologies to eradicate tumors, such as the use of surgical robotic systems or synthetic biology in the form of bacterial robotics systems. He is collaborating with researchers in India, including one of his former fellows, to incorporate these technologies and to enhance global health and increase collaboration between UC and international institutions, thus benefiting both US citizens and those of other nations.

Dr. Samy’s website, CiSurgeon.org provides information about Cochlear Implants, including FAQ, Cochlear Implant Surgery, preparation and more.

Michael M. Johns, III, MD

Emory University School of Medicine

• Director, Emory Voice Center
• Associate Professor
• Department of Otolaryngology

Dr. Johns is a graduate of Johns Hopkins School of Medicine. He completed his residency in Otolaryngology at the University of Michigan and trained as a research fellow through a National Institute of Health program. He then pursued a fellowship in laryngology and care of the professional voice at the Vanderbilt Voice Center at Vanderbilt University. Dr. Johns was awarded the highest honors during his academic career, including membership in Phi Beta Kappa and Alpha Omega Alpha medical honor society. He is the director of the Emory Voice Center at Emory University, pursing research, teaching and clinical care, with a specific interest in geriatric laryngology and the aging voice.

Ehab Hanna, MD, FACS

The University of Texas MD Anderson Cancer Center

• Professor and Vice Chair
• Department of Head and Neck Surgery

Ehab Hanna, M.D., FACS, is an internationally recognized head and neck surgeon and expert in the treatment of patients with skull base tumors and head and neck cancer. He is Professor and Vice Chair of the Department of Head and Neck Surgery at The University of Texas MD Anderson Cancer Center in Houston, Texas. After earning his medical degree, he completed a surgery internship at Vanderbilt University, and residency in Otolaryngology-Head and Neck Surgery at The Cleveland Clinic in Cleveland, Ohio. He received advanced fellowship training in skull base surgery and head and neck surgical oncology at the University of Pittsburgh Medical Center. He joined the MD Anderson faculty in 2004 with a joint appointment at Baylor College of Medicine. He is the medical director of the Multidisciplinary Head and Neck Center and co- director of the Skull Base Tumor program at MD Anderson. Dr. Hanna recently served as President of the North American Skull Base Society (NASBS) which was founded in 1989, and is a professional medical society that facilitates communication worldwide between individuals pursuing clinical and research excellence in skull base surgery. Dr. Hanna is leading the development of minimally invasive and robotic applications in skull base surgery. He has consistently been named one of America’s Top Doctors by the Castle Connolly Guide. In addition to patient care, Dr. Hanna is actively engaged in clinical and translational research with emphasis on skull base tumors. He is the Editor-in-Chief of the journal of Head & Neck, which is the official journal of the International Federation of Head and Neck Societies. He also co-edited a text book on “Comprehensive Management of Skull Base Tumors”.

Matthew Wade, MD

University of California, Irvine

• Department of Ophthalmology
• University of California, Irvine
• Gavin Herbert Eye Institute

Dr. Matthew Wade is a fellowship-trained eye surgeon who specializes in LASIK vision correction, complex cataract surgery and cornea transplantation at the Gavin Herbert Eye Institute. Dr. Wade earned his medical degree from the George Washington University School of Medicine and Health Sciences in Washington, D.C. He completed his residency in general ophthalmology at UC Irvine, where he also completed a fellowship in cornea, anterior segment and refractive surgery.

Mitul Mehta, MD

University of California, Irvine

• Clinical Assistant Professor
• Department of Ophthalmology, Retina Division
• University of California, Irvine
• Gavin Herbert Eye Institute

Dr. Mitul C. Mehta, completed his undergraduate degree at the Massachusetts Institute of Technology (MIT), and received a Masters of Science in Physiology & Biophysics from Georgetown University. He earned his medical degree from the Keck School of Medicine of USC in Los Angeles. After completing his ophthalmology residency at the University of Cincinnati College of Medicine in Cincinnati, Ohio, he completed fellowship training in vitreoretinal surgery at the New York Eye & Ear Infirmary of Mount Sinai in New York City.

In addition to the care of patients with vitreoretinal disorders, Mehta teaches medical students, residents and fellows. He also does research on surgical devices and techniques, as well as on vitreoretinal diseases, such as diabetic retinopathy and macular degeneration. His surgical interests include retinal detachment repair, ocular trauma, secondary lens placement, epiretinal membranes, macular holes, and surgery for endophthalmitis (severe eye infections).

Ram Eitan, MD, MPH

Sackler School of Medicine

• Chief of the Gynecologic Oncology Division
• Department of Obstetrics and Gynecology

Dr. Ram Eitan attended medical school at the Ben-Gurion University of the Negev Medical School in Beer Sheva, Israel. Dr. Eitan completed his Residency in Obstetrics and Gynecology at the Shaare Zedek Medical Center in Jerusalem, Israel and his Gynecologic Oncology Fellowship on the Gynecology Service, Department of Surgery at Memorial Sloan-Kettering Cancer Center in New York, NY, USA.

Dr. Eitan is now the Chief of the Gynecologic Oncology Division in the Department of Obstetrics and Gynecology at Rabin Medical Center in Petah Tikva, Israel and Assistant Professor at Sackler School of Medicine in Tel Aviv University, Israel. He is a member of the Society of Gynecologic Oncology, the Society of Memorial Gynecologic Oncologists and the Israel Society of Obstetrics & Gynecology.

Dr. Eitan’s expertise and research interests include minimally invasive surgery for the treatment of gynecological cancers, robotic- assisted surgery, pre-invasive cervical dysplasia – colposcopy diagnosis and management, and extensive cytoreductive surgery for advanced ovarian carcinoma.

Walter Jean, MD

George Washington University

• Professor of Neurosurgery

Dr. Walter Jean is Professor of Neurosurgery at George Washington University. His expertise is in open and endoscopic skull base surgery, and his clinical interest range from pituitary adenoma to acoustic neuroma.

Stefan Scholz, MD

Assistant Professor of Surgery, University of Pittsburgh

Director of Minimal Invasive Surgery, Children’s Hospital Pittsburgh

Stefan Scholz, M.D., is a Double Board Certified Surgeon born in Marburg, Germany and currently resides in Pittsburgh, PA. Dr. Scholz received his M.D. degree in 1997 from Philipps-Universitat Marburg school of Medicine in Marburg, Germany. In 2000, Dr. Scholz received his Dr. Med. Degree in Comparative Endocrinology at the Thomas Jefferson University in Philadelphia, PA.

Dr. Scholz currently serves as Assistant Professor of Surgery at University of Pittsburgh as well as Director of Minimal Invasive Surgery at Children’s Hospital Pittsburgh. Previous positions held include Clinical Fellow of Surgery at Harvard Medical School (2004-2008), and Clinical Instructor of Surgery at Johns Hopkins University (2008-2010). Dr. Scholz is currently licensed to practice medicine in Germany, Maryland, and Pennsylvania.

Dr. Scholz has completed extensive post-graduate work from 2000-2011 in the fields of pediatric surgery, endoscopic and laparoscopic surgery, and general surgery at various institutions in Germany, Tennessee, Georgia, Massachusetts, Maryland, and UK.

Dr. Scholz has received numerous certifications as follows: The American Board of Surgery – General Surgery (2009) and Pediatric Surgery (2011); Fundamentals of Laparoscopic Surgery (2007); Ultrasound Instructor, American College of Surgeons (2007); Basic Life Support (2006); Advanced Cardiac Life Support (2006); Advanced Trauma Life Support (2011/2015); Pediatric Advanced Life Support (2011); and daVinci Surgical System Console Surgeon (2011).

Since 2008, Dr. Scholz held various hospital administrative positions, committee appointments, and committee leadership roles at the following institutions: Johns Hopkins Hospital, Johns Hopkins University (2008-2010), Diana, Princess of Wales Children’s Hospital, University of Birmingham (2010-2011), Magee Women’s Hospital (2011), and Children’s Hospital of Pittsburgh of UPMC (2011-2016).

Since 1999, Dr. Scholz has been a member of several professional and scientific societies. Special honors include a Teaching Award – Best Resident at Beth Israel Deaconess Medical Center (2008), and SAGES Service Award Medal (2016).

Dr. Scholz has been extensively published around the world in various articles, reviews, invited papers, abstracts, monographs, books, and book chapters. Professional activities include formal teaching of resident students, grand rounds presentations, and peer teaching. Dr. Scholz has served on numerous national and international committees, panels, and boards.

H. Leon Pachter, MD

George David Stewart Professor of Surgery, Chair of the Department of Surgery at NYU Langone Medical Center

Known for his passion, energy, and skill, Dr. Pachter has perfected a number of life-saving techniques over the years, including a multidisciplinary approach to treating tumors of the adrenal gland. By introducing advances in minimally invasive surgical techniques, Dr. Pachter has played a key role in making NYU Langone’s surgical service one of the finest in the country. Dr. Pachter is also a world-renowned educator, whose mentees have become national leaders at other prestigious medical centers.

Dr. Pachter’s roots to NYU Langone stretch back to his days as a student and chief resident in the early 1970s. After completing his MD, residency, and American Cancer Society Fellowship at NYU School of Medicine, Dr. Pachter has had an unbroken record of outstanding contributions—as director of the Trauma Service at Bellevue Hospitals Center from 1978 to 1998; as executive director from 1999 to 2006; as director of Bellevue’s Surgical Intensive Care Unit from 1978 to 1997; as chairman of the Medical Board of Tisch Hospital; as vice chairman for Faculty Affairs; as division chief of General Surgery; and as author, clinical scientist, master laparoscopic surgeon, and world-class mentor. Additionally, Dr. Pachter was instrumental in garnering significant support from the city council to build the Ranson laboratory at Bellevue Hospital, a site of important cancer research investigations.

The author of more than 100 peer-reviewed publications and numerous book chapters, Dr. Pachter serves on the Editorial Board for the American Journal of Surgery, Annals of Surgery and The Journal of Trauma and Critical Care. He also served on the American Board of Surgery as a consultant for the written boards for 8 years and is currently serving on the membership committee of the American Surgical Association. The American College of Surgeons has also designated him a mentor for young female academic surgeons in the U.S. This year Dr. Pachter was chosen by the Society of Black Academic Surgeons for its 2015 fellowship award for his efforts to diversify his department and his seminal contributions to surgery.

Vincent Obias, MD, MS

Chief, Division of Colon and Rectal Surgery, George Washington University, Department of Surgery, Washington, DC

Dr. Obias is an Associate Professor of Surgery at George Washington University and Chief of the Division of Colon and Rectal Surgery.  Dr. Obias received his Bachelor’s Degree in Biology from James Madison University, his Masters degree in Physiology at the Medical College of Virginia, and his Doctorate in Medicine at the Medical College of Virginia.  He performed his internship and general surgery residency at Eastern Virginia Medical School in Norfolk, VA. Dr. Obias next undertook a fellowship in colon and rectal surgery at the Cleveland Clinic in Ohio. He further specialized in Advanced Laparoscopic colon and rectal surgery by undergoing a fellowship at University Hospitals Case Medical Center the following year. He is board certified in both general surgery and colon and rectal surgery.  Dr. Obias’s specialties include robotic and minimally invasive colon and rectal surgery. His interest include robotic single incision surgery, robotic transanal surgery, and clinical outcomes of robotic colorectal surgery.

Danny Chu, MD, PhD

University of Pittsburgh Medical Center

• Director of Cardiac Surgery, Veterans Affairs Pittsburgh Healthcare System
• Associate Professor of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center Heart and Vascular Institute

Dr. Chu received his undergraduate degree from the California Institute of Technology and his M.D. degree from the Tufts University School of Medicine. He completed general surgery residency at the University of California, San Diego School of Medicine. Dr. Chu has authored over 70 peer-reviewed articles, 50 abstracts, 4 book chapters, and 4 invited editorials during his career thus far. He currently serves as an editorial board member of 13 peer-review journals and has been an invited reviewer of over 20 other journals. He has also been elected membership to the prestigious Society of University Surgeons. Currently, he is the Director of Cardiac Surgery at the Veterans Affairs Pittsburgh Healthcare System and an Associate Professor of Cardiothoracic Surgery at the University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center (UPMC) Heart and Vascular Institute.

Jonathan D’Cunha, MD, PhD

University of Pittsburgh Medical Center

• Associate Professor of Surgery in the Department of Cardiothoracic Surgery
• Surgical Director of Lung Transplantation
• Associate Program Director of Thoracic Surgery
• Vice-Chair of Academic Affairs

Dr. Jonathan D’Cunha studied molecular biology at the University of Wisconsin–Madison before he earned his PhD and then MD at the Medical College of Wisconsin. He then did his internship, residency, and fellowship at the University of Minnesota before he became an Assistant Professor of Surgery, Division of Thoracic and Foregut Surgery, Department of Surgery, at the University of Minnesota.

Dr. D’Cunha’s research interests include molecular mechanisms of non-small cell lung cancer tumorigenesis,novel therapeutics for non-small cell lung cancer, lung transplantation, and surgical education.

He serves on the editorial boards of Journal of Thoracic Disease, Annals of Surgical Oncology, and Journal of Surgical Oncology. In addition, he is a grant reviewer for the National Institute of Academic Anesthesia.

Samir Pandya, MD

New York Medical College

• Assistant Professor
• Department of Surgery and Pediatrics

Dr. Samir Pandya was awarded his Bachelor’s of Science with honors in Biomedical Engineering at the University of Miami. He subsequently pursued medicine to be on the front lines of patient care and medical device development. He completed his medical training at the Medical College of Virginia and then General Surgery residency at the Westchester Medical Center Campus of New York Medical College in Valhalla, NY. He went on to train in Pediatric General and Thoracic Surgery at Children’s Healthcare of Atlanta at Emory University in Atlanta. Upon completion of his fellowship training in 2011 he joined joined the faculty at New York Medical College as Assistant Professor in the Department of Surgery and Pediatrics.

He has a very strong interest in minimally invasive pediatric surgery with expertise in mini-laparoscopy and single-incision procedures. He is currently the Surgical Director for Newborn Surgery, Pediatric and Neonatal Extracorporeal Life Support programs at the Maria Fareri Children’s Hospital. He has a strong interest in thoracic diseases as related at to pediatric patients such as chest wall anomalies, congenital lung lesions as well as surgical oncology.

Academically he enjoys working with medical students, residents and fellows. He has received numerous teaching awards during his career. He currently also serves as the Associate Program Director of the General Surgery Residency at New York Medical College. Dr. Pandya is an active member on numerous committees in the American Pediatric Surgery Association as well as the International Pediatric Endosurgery Group. Outside of pediatric surgery, Dr. Pandya enjoys running, skiing, diving, digital photography and target shooting.

Rohan R. Walvekar, MD

University of Pittsburgh / VA Medical Center

• Assistant Professor in Head Neck Surgery

Rohan R. Walvekar, MD, earned his doctoral degree from the University of Mumbai. After graduating in 1998, he completed a residency in Otolaryngology and Head Neck Surgery at the TN Medical College & BYL Nair Charitable Hospital, Mumbai, India, with triple honors. Subsequently, he completed two head neck surgery fellowships, and trained at at the Tata Memorial Hospital, Mumbai, which is India's most prestigious cancer institute. After completing an Advanced Head Neck Oncologic Surgery fellowship at the University of Pittsburgh, he became an Assistant Professor in Head Neck Surgery within the Department of Otolaryngology Head Neck Surgery at the University of Pittsburgh/VA Medical Center, prior to joining the LSU Health Sciences Center in July 2008. His clinical interests are head neck surgery and salivary endoscopy. His research interests include evaluating prognostic markers and clinical outcomes of head and neck cancer therapy and treatment of salivary gland disorders.

Joseph W. Turek, MD, PhD

University of Iowa

• Chief of Pediatric Cardiac Surgery
• Co-Director, University of Iowa Stead Family Congenital Cardiac Center
• Director of Extracorporeal Membrane Oxygenation Services
• Program Director of the Thoracic Surgery Fellowship and Thoracic Integrated Six-Year Residency Programs

Joseph William Turek, MD, PhD graduated from Northwestern University with a BA in Biochemistry in 1994 and received his MD/PhD (Pharmacology) from the University of Illinois – Chicago in 2002.  He completed his general surgery education at Duke University in 2007, where he also completed a cardiothoracic residency in 2010.  During this time he served as a visiting congenital fellow at Texas Children’s Hospital.  He completed a congenital cardiac fellowship at the Children’s Hospital of Philadelphia in 2011.  Dr. Turek was the third John H. Gibbon Jr. Research Scholarship Recipient awarded by the American Association for Thoracic Surgery (2014-2016).  Dr. Turek is Chief of Pediatric Cardiac Surgery and Co-Director, University of Iowa Stead Family Congenital Cardiac Center.  He is also the Director of Extracorporeal Membrane Oxygenation Services and serves as the Program Director of the Thoracic Surgery Fellowship and Thoracic Integrated Six-Year Residency Programs at the University of Iowa Hospitals and Clinics.  His specialties include congenital heart surgery, pediatric heart transplantation and assist devices.  Dr. Turek is quite active nationally, holding board positions and serving on varies committees.  Dr. Turek can be reached at his office number (319) 384-8365 or by e-mail at joseph-turek@uiowa.edu with any questions.

Joseph McCain, MD

• OMFS - Director of TMJ and Minimally Invasive Endoscopic
• Associate Professor of OMFS at the Harvard MEdical School and Harvard School of Dental Medicine
• Attending Surgeon at MGH

Dr. Joseph McCain is a Board Certified Oral and Maxillofacial Surgeon and Fellow of the American College of Surgeon. He completed his undergraduate and Dental School education at the University of Pittsburgh. Residency training in OMFS was completed at the University of Miami, Jackson Memorial Hospital. Dr. McCain was the Founder of Miami Oral and Maxillofacial Surgery, a hybrid academic private practice that focused on patient care, graduate medical education, and clinical research.

He has previously served as Chief of OMFS of the Baptist Health System in Miami, OMFS Program Director at Nova Southeastern School of Dental Medicine, and professor and Chairman of the OMFS section of Florida International University School of Medicine. He currently serves as the President of the American Society of TMJ Surgeons.

Dr. McCain's specialty focused interest  include TMJ and OMFS Endoscopic Surgery. Dr. McCain has published, lectured, and operated both nationally and internationally regarding this field of specialized surgery. Dr. McCain joined the Harvard/MGH Family as a a full-time faculty in the Department of OMFS in 2018. Currently he is an Associate Professor of OMFS at the Harvard Medical School and Harvard School of Dental Medicine and Attending Surgeon at Massachusetts General Hospital.

Jose M Marchena DMD, MD, FACS

• Associate Professor of Oral and Maxillofacial Surgery - University of Texas Health Science Center
• Chief of Oral and Maxillofacial Surgery - Ben Taub Hospital

Dr. Jose Marchena obtained his dental degree magna cum laude from Harvard School of Dental Medicine and his medical degree from Harvard Medical School. He completed internships in oral and maxillofacial surgery and general surgery at Massachusetts General Hospital in Boston and his residency training at Louisiana State University Medical Center in New Orleans. Dr. Marchena is an associate professor of oral and maxillofacial surgery at the University of Texas Health Science Center in Houston. He also serves as chief of oral and maxillofacial surgery at Ben Taub Hospital in Houston and as vice president of Smile Bangladesh, a nonprofit organization dedicated to providing cleft lip and palate repair operations in rural Bangladesh.

Inderpal S. Sarkaria, MD, FACS

University of Pittsburgh Medical Center

• Vice Chairman for Clinical Affairs
• Director of Thoracic Robotic Surgery
• Co-Director of the Esophageal and Lung Surgery Institute
• Department of Cardiothoracic Surgery  

Dr. Sarkaria is an expert in minimally invasive approaches to benign and neoplastic diseases of the esophagus, mediastinum, and lung. He is a recognized leader in robotic assisted approaches to these operations, and developed the minimally invasive esophageal program at Memorial Sloan Kettering Cancer Center prior to moving to UPMC. Dr. Sarkaria has one of the largest international experiences with robotic assisted minimally invasive esophagectomy (RAMIE) and other esophageal operations. Dr. Sarkaria has lectured, published, and presented his research and experience nationally and internationally and is a member of the major national and international thoracic surgical societies.

Board-certified in general surgery and thoracic surgery, Dr. Sarkaria earned his medical degree from the University of Medicine and Dentistry of New Jersey in Newark. He completed a residency in general surgery and cardiac surgery fellowship at New York Presbyterian Hospital – Weill Cornell Medical Center. He also completed fellowships in thoracic surgical oncology and cancer research at Memorial Sloan Kettering Cancer Center and in minimally invasive thoracic surgery at the University of Pittsburgh Medical Center.

L.D. Britt, MD, MPH, D.Sc (Hon), FACS, FCCM

Eastern Virginia Medical School

• Henry Ford Professor 
• Edward J. Brickhouse Chairman
• Department of Surgery

L.D. Britt, MD, MPH, D.Sc (Hon), FACS, FCCM, FRCSEng (Hon), FRCSEd (Hon), FWACS (Hon), FRCSI (Hon), FCS(SA) (Hon), FRCS(Glasg) (Hon) is a proud native of Suffolk, Virginia, has strong southern roots and is the product of the public school system. He attended the University of Virginia and was named to the Dean’s List each of the eight semesters. He received his Baccalaureate of Arts with Distinction.

Dr. L. D. Britt, a graduate of Harvard Medical School and Harvard School of Public Health, is the Brickhouse Professor and Chairman of the Department of Surgery at Eastern Virginia Medical School. He is the author of more than 220 peer-reviewed publications, more than 50 book chapters and non-peer-reviewed articles, and three books, including a recent edition of the highly touted Acute Care Surgery (Lippincott, Williams & Wilkens, Medford, NJ).

He serves on numerous editorial boards, including the Annals of Surgery, Archives of Surgery, World Journal of Surgery, Journal of the American College of Surgeons, the American Journal of Surgery (Associate Editor), the Journal of Trauma, Shock, Journal of Surgical Education, the American Surgeon, and others. In addition, he is a reviewer for the New England Journal of Medicine.

Dr. Britt, a member of Alpha Omega Alpha, is the recipient of the nation’s highest teaching award in medicine the Robert J. Glaser Distinguished Teaching Award, which is given by the AAMC in conjunction with AOA. He was honored by the Association of Surgical Education with its lifetime achievement award the Distinguished Educator Award given annually to one person considered by his peers to be a true master.

More than 180 institutions throughout the world have invited him to be their distinguished visiting professor. Dr. Britt is the past President of the Society of Surgical Chairs and the past Chairman of the ACGME Residency Review Committee for Surgery. Also, he is past Secretary of the Southern Surgical Association, the past Recorder/Program Chair for the American Association for the Surgery of Trauma, and past President of the Southeastern Surgical Congress, the Halsted Society, and the Southern Surgical Association. Dr. Britt is the past Chairman of the Board of Regents of the American College of Surgeons. He is also past President of the American College of Surgeons, the American Association for the Surgery of Trauma, and the American Surgical Association.

At the inaugural presidential ceremony held in Washington, D.C., during the 96th annual Clinical Congress of the American College of Surgeons, Dr. Britt was awarded the U.S. Surgeon Generals medallion for his outstanding achievements in medicine. The Honorable Regina Benjamin, MD, the 18th U.S. Surgeon General, presented this award at a formal ceremony. Dr. Britt was also appointed to the Robert Wood Johnson Clinical Scholar Program National Advisory Committee. The National Library of Medicine of the National Institutes of Medicine (in collaboration with the Reginald F. Lewis Museum of Maryland African American History and Culture) featured Dr. Britt for his contributions to academic surgery. President George W. Bush recognized Dr. Britts leadership role in medicine and nominated him to the Board of Regents of the Uniformed Services University (confirmed by the United States Senate).

At the end of his tenure, Dr. Britt was awarded the coveted Distinguished Service Medal. The National Board of Medical Examiners (NBME) also awarded him the Edithe J. Levit Distinguished Service Award.

An active participant in the community, Dr. Britt has received numerous awards for public service. Dr. Britt is the recipient of the 2010 Colgate Darden Citizen of the Year Award and the 2011 Dr. Martin Luther King, Jr. Community Award. Atlanta Post recently highlighted him as one of the top 21 black doctors in America. Ebony magazine recently listed him as one of the most influential African Americans in the nation.

At the 2012 annual meeting of the American Surgical Association, Dr. Britt became the 132nd President of the organization. He was conferred an Honorary Doctorate by the President of Tuskegee University. Dr. Britt was also elected to the position of Commissioner of the Joint Commission (formerly JACHO). In 2012, he was conferred an Honorary Fellowship in the French Academy of Surgery, and the Colleges of Medicine of South Africa.

Having recently been awarded an Honorary Fellowship in the Royal College of Surgeons of Glasgow, Dr. Britt now has the distinction of receiving the highest honor given by each of the four Royal Colleges in the United Kingdom England, Edinburg, Ireland, and Glasgow.

Dr. Britt, author of the term Acute Care Surgery and one of the principal architects of this emerging specialty, was the 2013 recipient of the prestigious Roswell Park Medal. He was honored for his major contributions to American surgery. At the 2015 annual meeting of the Society of Critical Care Medicine, Dr. Britt was bestowed the coveted title of Master of Critical Care Medicine (MCCM) by the American College of Critical Care Medicine. Recently, Virginia Governor Terry McAuliffe appointed Dr. Britt to the Board of Visitors of the University of Virginia.

Sudhen B. Desai, MD, FSIR

Baylor College of Medicine

• Department of Interventional Radiology  

Dr. Desai earned his Doctorate of Medicine with Distinction in Research and Alpha Omega Alpha honors from Albany Medical College, after completing the six-year BS/MD program in conjunction with Rensselaer Polytechnic Institute. During his latter years of medical school, he was selected as a scholar of the Clinical Research Training Program at the National Cancer Institute of the National Institutes of Health, a clinical fellowship geared towards the development of translational researchers. He then went on to residency at Stanford University (General Surgery) and UCSF (Diagnostic Radiology), followed by fellowship in Vascular and Interventional Radiology at Northwestern University. He was a private practice adult Interventional and Diagnostic Radiologist for ten years.  In July 2016, he returned to fellowship for an advanced training year with a focus on Pediatric Interventional Radiology, at Children’s Hospital of Boston. Subsequently, he joined Baylor College of Medicine (Houston, TX), on the staff at Texas Children’s Hospital.  He currently provides interventional care to adult and pediatric patients.

In his time outside of the clinic, he serves as a consultant to multiple established and start-up medical companies (TVA Medical, Exit BD/Bard 2018), Scientific Advisor to Santé Ventures (Austin, TX) and Chief Editor for Interventional Radiology CSurgeries.com.  Previously he was an invited advisor to the Rice University Jones School of Business (Technology Entrepreneurship). He was a member of the Advisory Council for the Masters in Clinical Translation Management at the St. Thomas (Houston, TX) University Cameron School of Business as well.  He has been appointed to multiple committees for the Society of Interventional Radiology and has lectured at multiple SIR annual meetings. He is the Chief Editor for IR Quarterly, a distribution of the SIR.

As Past-President/Founder of the Houston chapter of the Society of Physician Entrepreneurs, and a Member of the SoPE International Board of Directors, Dr. Desai works to engage physicians interested in innovation and idea development, as well as to provide mechanisms and insights to assist early-stage companies in tackling the many challenges to successful exits.

Robert Keating, MD

Children’s National Medical Center, Washington, DC

• Professor and Chief of Neurosurgery

Robert Keating, MD is currently Professor and Chief of Neurosurgery at the Children’s National Medical Center in Washington, DC. Dr. Keating graduated from Georgetown University Medical School in 1983 and subsequently went to New York where he did his training in Neurosurgery at the Albert Einstein and Montefiore Medical Center in the Bronx. A fellowship in Pediatric Neurosurgery as well as Craniofacial Surgery followed at Einstein / Montefiore in 1990.

Subsequent to his training, Dr Keating served in the Navy and was stationed at the Oakland Naval Hospital from 1990-1994, during which time he served as the Chief from ’91 to ’94. He then returned briefly for 2 years to the Bronx where he was on staff at Montefiore Medical Center as well as the Bronx Municipal Hospital Center. He came back to Washington in 1996 to join the faculty at the Children’s National Medical Center and later became Chief of the Division of Neurosurgery in 2003 and Professor of Neurosurgery and Pediatrics in 2008. His past appointments include the President of the Medical Staff at the Children’s National Medical Center as well as Head of Credentials and he currently maintains a busy practice of pediatric neurosurgery, with an emphasis on tumors, Chiari malformations, craniofacial reconstruction, spinal dysraphism, spasticity and brachial plexus surgery. As a member of the American Society of Pediatric Neurosurgery and International Society of Pediatric Neurosurgery, he has published and presented extensively in the field. His publications include the previous texts, “An Atlas of Orbitocranial Surgery” and “Tumors of the Pediatric Nervous System” (2nd edition published in 2013) with current work on Neurosurgical Operative Atlas, (2nd ed. Goodrich JT, and Keating RF, Thieme) due for publication in 2017. He is also Chair, Medical Advisory Committee on the Board of the American Syringomyelia Alliance Project as well as a founding member of the Posterior Fossa Society and maintains long-standing membership in the CNS, AANS, ASPN and ISPN.

Nahyoung Grace Lee, MD

Harvard Medical School

• Massachusetts Eye and Ear Infirmary

Grace Lee, M.D. is an ophthalmologist at Massachusetts Eye and Ear (MEE) with a rigorous clinical practice in ophthalmic plastic surgery.  Approximately 80% of her time is devoted to patient care, which is integrated with teaching residents and fellows in the clinic and surgical setting.  This component also includes direct instruction in the wet lab and weekly supervision in the MEE emergency room.  Twenty percent of Dr. Lee‘s time is spent doing clinical and basic science research.Dr. Lee completed her BA of Neuroscience at Johns Hopkins University followed by a doctorate in Medicine. Upon completing her ophthalmology residency at the University of Southern California, she pursued a fellowship in ocular oncology and pathology at the Casey Eye Institute, at the Oregon Health & Science University. She directly taught residents in the pathology lab as well as through over 15 hours of didactic lectures. Her additional training involved three years of fellowship in oculoplastic surgery at MEE, where she was the recipient of the Fellow of the Year teaching award.  During this fellowship, Dr. Lee collaborated with Dr. Leo Kim to produce an animal model of orbital inflammation and investigated angiogenesis in thyroid eye disease, which was published in Ophthalmology. At the culmination of her training, she was inducted into the American Society of Ophthalmic Plastic and Reconstructive Surgeons (ASOPRS) and is now Assistant Professor of Ophthalmology at Harvard Medical School (HMS).Dr. Lee‘s clinical expertise and innovations have focused on thyroid eye disease and common conditions in ophthalmic plastic surgery.  She has expanded her clinical practice to involve anterior segment tumors, building on her fellowship in ocular oncology.  In the process, she has trained 4 fellows, 3 of whom have accepted or will be accepting positions at academic institutions.  Additionally, she serves as an oral board examiner for the American Board of Ophthalmology.

Harold C. Pillsbury, III, MD, FACS

University of North Carolina at Chapel Hill

• Chair, University of North Carolina Department of Otolaryngology
• Thomas J. Dark Distinguished Professor of Otolaryngology/Head and Neck Surgery

Harold C. Pillsbury, III, M.D., F.A.C.S., is the Chair of the UNC Department of Otolaryngology/Head and Neck Surgery, as well as the Thomas J. Dark Distinguished Professor of Otolaryngology/Head and Neck Surgery.

A native of Baltimore, Maryland, Dr. Pillsbury earned his B.A. and M.D. degrees from George Washington University in Washington, DC (1970 and 1972, respectively). He completed his residency training in Otolaryngology/Head and Neck Surgery at the University of North Carolina School of Medicine in 1976. Following six years at the Yale University School of Medicine, he joined the UNC faculty in 1982 as an Associate Professor. He served as Chief of the Division of Otolaryngology/Head and Neck Surgery from 1983 to 2001.

Dr. Pillsbury has completed an eighteen year term on the American Board of Otolaryngology where he served as Exam Chair and President. He is also past President of the American Academy of Otolaryngology-Head and Neck Surgery, The American Laryngological Association, The Society of University Otolaryngologists, and the Triological Society. He is also past CME coordinator and Vice-President of the Southern Section Triological Society. He is the past President of the American Academy of Otolaryngic Allergy.

Dr. Pillsbury has written and/or contributed to over 270 publications and over 45 textbooks. He has also given over 326 presentations nationally and internationally. He has been the primary investigator or co-investigator on over 21 grants. His special field of interest is neurotology and, most especially, cochlear implantation.

Neil Tanna, MD, MBA, FACS

Hofstra Northwell School of Medicine

• Associate Program Director of Plastic Surgery
• Northwell Health
• Associate Professor of Plastic Surgery
• Hofstra Northwell School of Medicine

Dr. Neil Tanna is a Double Board Certified Plastic Surgeon with clinical interest in cosmetic and reconstructive surgery. He is among a very small group of Plastic Surgeons in the world to have completed formal training in Otolaryngology, Plastic & Reconstructive Surgery, and Microvascular Surgery.

After receiving his medical degree from Albany Medical College, Dr. Tanna completed a full Otolaryngology – Head & Neck Surgery residency at The George Washington University. He pursued further training and completed a second full residency in Plastic & Reconstructive Surgery at the University of California, Los Angeles (UCLA). He then completed a fellowship in advanced reconstructive and microvascular surgery at the Institute of Reconstructive Plastic Surgery at New York University (NYU).

Beyond his plastic surgery clinical practice, Dr. Neil Tanna is a mentor, respected educator, and prolific author. Currently, he serves in many leadership roles. He is Chief of Plastic Surgery at one of the one of the Northwell Health hospitals. He is an Associate Professor with the Hofstra University School of Medicine, where he is engaged in the education of students. He also serves as Associate Program Director for the Plastic Surgery Residency with Northwell Health System. He trains resident physicians in becoming Plastic Surgeons.

The medical work and clinical research of Dr. Neil Tanna have been widely published in national and international medical journals. He has authored over 75 publications in major peer-reviewed medical journals and written over 10 textbook chapters. Given his interest in aesthetic and reconstructive surgery of the head and neck, breast, and body, Dr. Tanna has been invited to present at over 75 national and international meetings. He presents the latest advances in plastic surgery to his colleagues and other surgeons from all around the world.

Dr. Neil Tanna has been recognized in the 2015 and 2016 New York Times Super Doctors List for his noteworthy and outstanding achievements.

Umamaheswar Duvvuri, MD, PhD

University of Pittsburgh Medical Center

• Director of Robotic Surgery, Division of Head and Neck Surgery
• Director of the Center for Advanced Robotics Training (CART)
• University of Pittsburgh School of Medicine

Umamaheswar Duvvuri, MD, PhD, is a graduate of the University of Pennsylvania obtaining his Medical Degree in 2000 and his PhD in Biophysics in 2002. He completed an internship in General Surgery in 2003 and residency training in Otolaryngology in 2007 at the University of Pittsburgh Medical Center. He completed fellowship training in Head and Neck Surgery in 2008 at the University of Texas MD Anderson Cancer Center.

He joined the University of Pittsburgh in August 2008 as an Assistant Professor in the Department of Otolaryngology, Head and Neck Surgery Division and is also a staff physician in the VA Pittsburgh Healthcare System.

He serves as the Director of Robotic Surgery, Division of Head and Neck Surgery, at the University Of Pittsburgh School Of Medicine and is the current Director of the Center for Advanced Robotics Training (CART) at the University of Pittsburgh Medical Center. He directs the Cart Training Courses which provide technical and circumstantial resources to initiate and optimize robotic surgery programs.

He has authored numerous research publications and book chapters and is an invited guest lecturer/speaker on the subject of robotic surgery both nationally and internationally.

A Fulbright scholar, his research interests include minimally invasive endoscopic and robotic surgery of the head and neck, tumors of the thyroid and parathyroid glands and molecular oncology of head and neck cancer.

He directs a federally funded laboratory that studies the biology of head and neck cancer. He holds funding from the National Institute of Health, Department of Veterans Affairs and the “V” foundation.

Michael Blute, Sr, MD

Massachusetts General Hospital

• Chief of Urology

Dr. Michael L. Blute received his BA Degree from the College of the Holy Cross in Worcester, and his MD Degree from Creighton University School of Medicine in 1982, graduating Magna Cum Laude. Subsequent to internship and residency in urology at the Mayo Clinic in Rochester, he remained on the staff and rose rapidly through the ranks to become the Anson L. Clark Professor and Chairman in the Department of Urology in 1999. He remained as Chairman of the Department of Urology and on the Executive Board of the Mayo Clinic until appointed Interim Chief of Urology and Director of the Cancer Center of Excellence at the University of Massachusetts Memorial Medical Center in 2010. In April 2012 Dr. Blute was appointed Chief of Urology at The Massachusetts General Hospital in Boston.

Dr. Blute has had a major interest in urologic oncology and is well-known in the field of academic urology. His major areas of interest include prostate cancer, nephron-sparing surgery for kidney masses, and the management of complex renal cell and bladder neoplasms. He has been involved in phase III trials of Finasteride, chemoprevention of prostatic intraepithelial neoplasia with anti-androgens, minimally invasive surgery for BPH, biomarkers in prostate cancer, and localization of tumor suppressor genes in prostate cancer. He serves as a reviewer on 13 editorial boards. He serves on the AUA Renal Mass Guideline Panel and served on the American Joint Committee on Cancer. He is the recipient of the 2010 AUA Career Contribution Award. He has been honored as Department of Urology Teacher of the Year at the Mayo Clinic on several occasions. His bibliography includes 387 peer-reviewed publications, one book, and 26 book chapters.

Nitin Garg, MD

Wake Forest University School of Medicine

• Assistant Professor, Vascular & Endovascular Surgery

Dr. Nitin Garg is an Assistant Professor in Vascular & Endovascular Surgery at Wake Forest University School of Medicine in Winston Salem, North Carolina. He graduated from the prestigious All India Institute of Medical Sciences (AIIMS) in New Delhi and pursued a Master’s in Public Health at Johns Hopkins Bloomberg School of Public Health in Baltimore. Dr. Garg completed General Surgery internship and residency at Creighton University in Omaha and Vascular Surgery Fellowship at the Mayo Clinic in Rochester.

Dr. Garg has a strong interest in clinical education and firmly believes that the adequate training of the next generation of surgeons is the responsibility of the surgeons in practice. He also believes that education of patients is critical for their buy in into their own health. Dr. Garg’s clinical interests include complex arterial and venous reconstructions, using both open and endovascular (or hybrid) techniques.

Destiny F. Chau, MD, FAAP

Professor of Anesthesiology and Pain Medicine / Pediatric Cardiothoracic Anesthesiology
Arkansas Children's Hospital / University of Arkansas for Medical Sciences

Dr. Destiny F. Chau is a board-certified anesthesiologist and pediatric anesthesiologist. She is currently a Professor of Anesthesiology and Pain Medicine at the University of Arkansas for Medical Sciences. After graduating with the highest honors with an undergraduate degree in chemical engineering, Dr. Chau earned her medical degree from the University of Kentucky College of Medicine in 2002. She finished anesthesiology residency training in 2006 at this institution and later completed a pediatric cardiac anesthesiology fellowship at the Children’s Hospital of Philadelphia. Since then, she has dedicated her professional time to advancing clinical medicine and medical education at national and international levels. Dr. Chau regularly participates in short-term medical and surgical initiatives in low- and middle-resourced areas with a focus on service and education. Dr. Chau held several leadership positions at the University of Kentucky College of Medicine and Eastern Virginia Medical School prior to joining the University of Arkansas for Medical Sciences as a Fellowship Program Director in 2020.

Eric Gantwerker MD MS MMSc (MedEd)

• Pediatric Otolaryngologist at Cohen Children’s Hospital at Northwell Health/Hofstra

Eric Gantwerker, MD, MS, MMSc(MedEd), FACS is a Pediatric Otolaryngologist at Cohen Children’s Hospital at Northwell Health/Hofstra, Associate Professor of Otolaryngology at Zucker School of Medicine at Hofstra/Northwell, and Vice President, MedicalDirector at Level Ex. He holds a Master of Medical Science (MMSc) in Medical Education with a special focus on educational technology, educational research, cognitive science of learning,and curriculum development from Harvard Medical School and a Master of Science in Physiology and Biophysics from Georgetown University. Previous Clinical Instructor at Harvard Medical School, Assistant Professor at UT Southwestern, and Associate Professor ofOtolaryngology and Medical Education at Loyola University Chicago Stritch School of Medicine. Dr. Gantwerker’s clinical focus includes complex aerodigestive disorders, airway reconstruction, children with tracheostomies, persistent obstructive sleep apnea, and quality improvement. His academic interests include professional development, educational technology and gaming, motivational theory, and the cognitive psychology of learning. He speaks nationally and internationally through invited lectureships and workshops on implementation of educational technologies and gaming, motivational theory, the cognitive psychology of learning, and putting theory into practice for health professions’ education.

Pediatric Cricotracheal Resection: A Step by Step Surgical Presentation

This talk will focus on the surgical principals of resective airway surgeries with a step by step discussion on the surgical technique of Pediatric Cricotracheal resection.

Sohit Paul Kanotra , MD

Director, Complex Pediatric Airway Program / Associate Professor of Otolaryngology Head and Neck Surgery & Pediatrics
University of Iowa Hospitals & Clinics

Dr. Sohit Kanotra is a Clinical Associate Professor in the Department of Otolaryngology – Head and Neck Surgery and the Department of Pediatrics at the Roy J. and Lucille A. Carver College of Medicine at University of Iowa and the Director of the Complex Pediatric Airway program at University of Iowa Hospitals & Clinics. He has clinical expertise in the management of children with complex airway disorders including open airway reconstructive surgeries. He also has clinical interest in the management of Head and Neck vascular anomalies, pediatric thyroid disorders, minimally invasive endoscopic ear surgery and robotic airway surgery. Dr. Kanotra joined University of Iowa in 2019 prior to which he was the Director of the Pediatric Aerodigestive Center and the surgical director of the vascular anomalies’ clinic at Children’s Hospital of New Orleans in Louisiana.

Basics of Blunt Force Trauma: ZMC Fractures

This webinar will address the definition of zygomaticomaxillary complex (ZMC) fractures, will review pertinent literature, mechanisms of injury, classification, surgical approaches and complications. The presenter will make use of clinical photos and will allow an opportunity to answer questions.

Jose M Marchena DMD, MD, FACS

Associate Professor of Oral and Maxillofacial Surgery / Chief of Oral and Maxillofacial Surgery

University of Texas Health Science Center / Ben Taub Hospital

Dr. Jose Marchena obtained his dental degree magna cum laude from Harvard School of Dental Medicine and his medical degree from Harvard Medical School. He completed internships in oral and maxillofacial surgery and general surgery at Massachusetts General Hospital in Boston and his residency training at Louisiana State University Medical Center in New Orleans. Dr. Marchena is an associate professor of oral and maxillofacial surgery at the University of Texas Health Science Center in Houston. He also serves as chief of oral and maxillofacial surgery at Ben Taub Hospital in Houston and as vice president of Smile Bangladesh, a nonprofit organization dedicated to providing cleft lip and palate repair operations in rural Bangladesh.

Alfredo R. Arribas DDS, MS, FACS

Assistant Professor in Department of Oral and Maxillofacial Surgery

University of Texas Health Sciences Center at Houston

Received his Bachelor of Science (BS) and Doctor in Dental Surgery (DDS) Degrees from Universidad Peruana Cayetano Heredia in Lima, Peru, in 1996, certificates in Advanced Education in General Dentistry (AEGD) at University of Maryland School of Dentistry, in 1998, two - year General Practice Residency (GPR) Program at LSU Health Sciences Center in 2000 and Oral, Maxillofacial Surgery internship at LSU Health Sciences Center in 2001, and Oral and Maxillofacial Surgery Residency at LSU Health Sciences Center, New Orleans in 2012, where he was trained in full scope Oral & Maxillofacial Surgery. Obtained a Master of Science (MS) degree in Health Care Management from University of New Orleans in 2004. Fields of interests includes: maxillofacial trauma, facial reconstructive surgery, dental implants, dentoalveolar surgery and orthognathic surgery.

A Discussion About Removal of Intraocular Foreign Bodies

Attendees will learn about the proper procedure to follow when removing foreign bodies from the eye by discussing the process with three expert Vitreoretinal Surgeons.

Mitul Mehta, MD, MS

Fellowship Director of Vitreoretinal Surgery / Health Sciences Clinical Associate Professor

Gavin Herbert Eye Institute / University of California, Irvine

Mitul Mehta MD MS, is a board-certified ophthalmologist with fellowship training in medical and surgical diseases of the retina. He sees patients at the UCI Medical Center in Orange, CA and the Gavin Herbert Eye Institute in Irvine, CA. Dr. Mehta graduated from the Massachusetts Institute of Technology (MIT), he then completed a Master of Science degree in Physiology & Biophysics at Georgetown University and earned his MD degree from the University of Southern California (USC). After completing his ophthalmology residency at the University of Cincinnati, he graduated from fellowship training in vitreoretinal surgery at the New York Eye & Ear Infirmary of Mount Sinai. Dr. Mehta cares for patients with vitreoretinal disorders as the Vitreoretinal Surgery Fellowship Director. He teaches medical students, residents, and fellows, and does research in surgical devices, techniques and vitreoretinal diseases such as retinitis pigmentosa, diabetic retinopathy and macular degeneration.

C. Kiersten Pollard, MD

Vitreoretinal Surgeon

The Retina Center of Western Colorado

Dr. Pollard completed her undergraduate education at the Massachusetts Institute of Technology, she then went on to earn her MD at the University of Colorado School of Medicine where she also completed her intern year in internal medicine. She completed her Ophthalmology residency at the University of Arizona and her vitreoretinal surgery fellowship at UT Southwestern Medical Center. Dr. Pollard practices at The Retina Center of Western Colorado where she and her partners provide advanced medical and surgical vitreoretinal care to the people of western Colorado, eastern Utah, and southern Wyoming.

Hemang K. Pandya, MD FACS

Vitreoretinal Specialist / President

Dallas Retina Center / American Retina Forum

Dr. Pandya earned his M.D., with Alpha Omega Alpha honors, from the Chicago Medical School. Dr. Pandya completed his Ophthalmology training at the Kresge Eye Institute. Thereafter, Dr. Pandya completed a 2-year fellowship in Vitreoretinal Surgery at the Dean McGee Eye Institute. Dr Pandya practices at Dallas Retina Center and can be reached at DrPandya@DallasRetina.com.

Basics of Blunt Force Trauma: NOE Fractures

This webinar will address the definition of naso-orbito-ethmoidal (NOE) fractures, relevant anatomy, prevalence and etiology, diagnosis, classification, goals and timing of surgery, surgical sequence and complications. The presenter will make use of clinical photos and will allow an opportunity to answer questions.

Jose M Marchena DMD, MD, FACS

Associate Professor of Oral and Maxillofacial Surgery / Chief of Oral and Maxillofacial Surgery

University of Texas Health Science Center / Ben Taub Hospital

Dr. Jose Marchena obtained his dental degree magna cum laude from Harvard School of Dental Medicine and his medical degree from Harvard Medical School. He completed internships in oral and maxillofacial surgery and general surgery at Massachusetts General Hospital in Boston and his residency training at Louisiana State University Medical Center in New Orleans. Dr. Marchena is an associate professor of oral and maxillofacial surgery at the University of Texas Health Science Center in Houston. He also serves as chief of oral and maxillofacial surgery at Ben Taub Hospital in Houston and as vice president of Smile Bangladesh, a nonprofit organization dedicated to providing cleft lip and palate repair operations in rural Bangladesh.

Alfredo R. Arribas DDS, MS, FACS

Assistant Professor in Department of Oral and Maxillofacial Surgery

University of Texas Health Sciences Center at Houston

Received his Bachelor of Science (BS) and Doctor in Dental Surgery (DDS) Degrees from Universidad Peruana Cayetano Heredia in Lima, Peru, in 1996, certificates in Advanced Education in General Dentistry (AEGD) at University of Maryland School of Dentistry, in 1998, two - year General Practice Residency (GPR) Program at LSU Health Sciences Center in 2000 and Oral, Maxillofacial Surgery internship at LSU Health Sciences Center in 2001, and Oral and Maxillofacial Surgery Residency at LSU Health Sciences Center, New Orleans in 2012, where he was trained in full scope Oral & Maxillofacial Surgery. Obtained a Master of Science (MS) degree in Health Care Management from University of New Orleans in 2004. Fields of interests includes: maxillofacial trauma, facial reconstructive surgery, dental implants, dentoalveolar surgery and orthognathic surgery.

Surgical Pitfalls, Early Career Advancement and Leadership

In this last Cardiothoracic DocTalk session of the Pathway to Independence for Junior Surgeons we will discuss early career mistakes and how to avoid them. Viewers of this webinar will learn tips and tricks learned from senior partners and knowing when to call for help.

Lawrence Greiten, MD

Assistant Professor in Division of Congenital Cardiac Surgery
Arkansas Children's Hospital (ACH) and the University of Arkansas for Medical Sciences (UAMS)

Lawrence Greiten, M.D., is an Assistant Professor in the Division of Congenital Cardiac Surgery at Arkansas Children’s Hospital (ACH) and the University of Arkansas for Medical Sciences (UAMS). Dr. Greiten received his undergraduate degree from Kansas Wesleyan University and his medical degree from the University Of Arizona College Of Medicine. He completed both his General Surgery training and Cardiovascular and General Thoracic Surgery fellowship at the Mayo School of Graduate Medical Education, where he also earned a Masters in Biomedical Sciences, Clinical and Translational Science. He did an advanced Fellowship in Congenital Cardiac Surgery at Children’s Hospital Los Angeles, Keck Medical School at the University of Southern California.

Surgical Exposure, Minimal Incision Surgical Option for ASD Repair

In this second Cardiothoracic DocTalk session of the Pathway to Independence for Junior Surgeons we plan to discuss the approach to a Minimal Incision ASD. Our panel will discuss the merits of offering this approach along with the potential pitfalls. Viewers of this webinar will gain insight into optimizing surgical exposure and understanding when it is safe to proceed with less invasive techniques.

Lawrence Greiten, MD

Assistant Professor in Division of Congenital Cardiac Surgery
Arkansas Children's Hospital (ACH) and the University of Arkansas for Medical Sciences (UAMS)

Lawrence Greiten, M.D., is an Assistant Professor in the Division of Congenital Cardiac Surgery at Arkansas Children’s Hospital (ACH) and the University of Arkansas for Medical Sciences (UAMS). Dr. Greiten received his undergraduate degree from Kansas Wesleyan University and his medical degree from the University Of Arizona College Of Medicine. He completed both his General Surgery training and Cardiovascular and General Thoracic Surgery fellowship at the Mayo School of Graduate Medical Education, where he also earned a Masters in Biomedical Sciences, Clinical and Translational Science. He did an advanced Fellowship in Congenital Cardiac Surgery at Children’s Hospital Los Angeles, Keck Medical School at the University of Southern California.

Pre-Operative Planning, Intraoperative Considerations and Troubleshooting

In this first Cardiothoracic DocTalk session of the Pathway to Independence for Junior Surgeons we will discuss Redo Sternotomy and Pulmonary Valve Replacement in a patient who had prior TOF repair. We plan to highlight the pre-operative strategy which will include necessary imaging and testing along with how to manage an intra-operative complication of air embolism. Viewers of this webinar will gain valuable insight into a stepwise approach to managing a very complex surgical scenario.

Lawrence Greiten, MD

Assistant Professor in Division of Congenital Cardiac Surgery
Arkansas Children's Hospital (ACH) and the University of Arkansas for Medical Sciences (UAMS)

Lawrence Greiten, M.D., is an Assistant Professor in the Division of Congenital Cardiac Surgery at Arkansas Children’s Hospital (ACH) and the University of Arkansas for Medical Sciences (UAMS). Dr. Greiten received his undergraduate degree from Kansas Wesleyan University and his medical degree from the University Of Arizona College Of Medicine. He completed both his General Surgery training and Cardiovascular and General Thoracic Surgery fellowship at the Mayo School of Graduate Medical Education, where he also earned a Masters in Biomedical Sciences, Clinical and Translational Science. He did an advanced Fellowship in Congenital Cardiac Surgery at Children’s Hospital Los Angeles, Keck Medical School at the University of Southern California.

IPAS 2022: Pediatric Tracheostomy

11 AM EST / 9:30 PM IST

Moderator: Stephen Chorney

Panelists: Tiffany Raynor, Kara Meister, Kara Prickett and Shazia Peer

This event is made possible by our partners at

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Course Directors:

IPAS 2022: Tracheoplasty

10 AM EST / 8:30 PM IST

Moderator: Kaalan Johnson

Panelists: Douglas Sidell, Briac Thierry, and Nagarajan Muthialu & Michael Rutter

IPAS 2022: Neonatal Nasal Obstruction

9 AM EST / 7:30 PM IST

Moderator: Brianne Roby

Panelists: Sanjay Parikh, Soham Roy, Michael Kuo

This event is made possible by our partners at

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Course Directors:

IPAS 2022: Open Airway Subglottic: LTR & CTR

8 AM EST / 6:30 PM IST

Moderator: Sophie Shay

Panelists: Prasad Thottam, Raj Petersson, Taher Valika, Douglas Sidell

This event is made possible by our partners at

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Course Directors:

IPAS 2022: Pediatric Vocal Cord Immobility: Unilateral & Bilateral Vocal Cords

11 AM EST / 9:30 PM IST

Moderator: Nikhila Raol

Panelists: Julina Ongkasuwan, Alessandro de Alarcon, Anne Hseu, Scott Rickert, Pamela Mudd

This event is made possible by our partners at

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Course Directors:

IPAS 2022: Tracheobronchomalacia: Complications of Long-Term Stents

10 AM EST / 8:30 PM IST

Moderator: Steve Goudy

Panelists: Michael Rutter, Charles Smithers, Matthew Brigger, Diego Preciado

This event is made possible by our partners at

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Course Directors:

IPAS 2022: Laryngeal Cleft: Workup & Repair

9 AM EST / 7:30 PM IST

Moderator: Vikash Modi

Panelists: Hamdy El-Hakim, Jen Lavin, Shyan Vijayasekaran, Bas Pullens

This event is made possible by our partners at

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Course Directors:

IPAS 2022: Cases of Stridor & Laryngomalacia

8 AM EST / 6:30 PM IST

Moderator: Gresham Richter

Panelists: Goh Bee-See, Hayley Herbert, Ravi Thevasagayam, Sohit Kanotra and Dana Thompson

This event is made possible by our partners at

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Course Directors:

Advanced Salivary Endoscopy: Challenging Cases Diagnosis & Treatment

The advanced course will assume a basic understanding of the procedure. It will include complex interventions including endoscopic and combined open (transoral and external procedures), complications and management of complications, approach to revision surgery, in-office procedures, advanced radiology, and will include case studies.

Meet the Course Directors!

Rohan R. Walvekar, MD

Assistant Professor in Head Neck Surgery

University of Pittsburgh/VA Medical Center

Rohan R. Walvekar, MD, earned his doctoral degree from the University of Mumbai. After graduating in 1998, he completed a residency in Otolaryngology and Head Neck Surgery at the TN Medical College & BYL Nair Charitable Hospital, Mumbai, India, with triple honors. Subsequently, he completed two head neck surgery fellowships, and trained at at the Tata Memorial Hospital, Mumbai, which is India's most prestigious cancer institute. After completing an Advanced Head Neck Oncologic Surgery fellowship at the University of Pittsburgh, he became an Assistant Professor in Head Neck Surgery within the Department of Otolaryngology Head Neck Surgery at the University of Pittsburgh/VA Medical Center, prior to joining the LSU Health Sciences Center in July 2008. His clinical interests are head neck surgery and salivary endoscopy. His research interests include evaluating prognostic markers and clinical outcomes of head and neck cancer therapy and treatment of salivary gland disorders.

Barry M Schaitkin, MD

Professor of Otolaryngology

UPMC Pittsburgh

Dr. Schaitkin specializes in the treatment of inflammatory and neoplastic conditions of the salivary glands. He practices at UPMC in the Department of Otolaryngology and is affiliated with UPMC branches all across the city of Pittsburgh. He completed his medical degree and residency at Pennsylvania State University College of Medicine.

Meet the Presenters!

Jolie Chang, MD

Associate Professor, Chief of Sleep Surgery and General Otolaryngology

University of California, San Francisco

Dr. Chang specializes in sleep apnea surgery and minimally invasive approaches to the salivary duct with sialendoscopy. She has interest in studying patient reported outcomes after sialendoscopy procedures.

Mark Marzouk, MD

Clinical Associate Professor of Otolaryngology - Head and Neck Surgery

SUNY Upstate Medical University

Dr. Marzouk completed his residency training in 2010 from the UPMC Department of Otolaryngology. He is currently the Division Chief of Head and Neck Oncologic Surgery in Syracuse. He is also the Associate Program Director of Residency Programs.

David W. Eisele, MD. FACS

Andelot Professor and Director - Department of Otolaryngology-Head and Neck Surgery

Johns Hopkins University School of Medicine

Dr. Eisele is the Past-President of the American Board of Otolaryngology- Head and Neck Surgery and a member of the NCCN Head and Neck Cancer Panel. He has served as a member of the Residency Review Committee for Otolaryngology, as Chair of the Advisory Council for Otolaryngology - Head and Neck Surgery for the American College of Surgeons, President of the American Head and Neck Society, and as Vice-President of the Triological Society. He served as President of the Maryland Society of Otolaryngology and is a former Governor of the American College of Surgeons.

M. Boyd Gillespie, MD, MSc, FACS

Professor and Chair

UTHSC Otolaryngology-Head and Neck Surgery

M. Boyd Gillespie is Professor and Chair of Otolaryngology-Head & Neck Surgery at University of Tennessee Health Science Center. He is a graduate of the Johns Hopkins University School of Medicine where he a completed residency and fellowship in Otolaryngology-Head & Neck Surgery. Dr. Gillespie earned a Masters in Clinical Research at the Medical University of South Carolina, and is board certified in Otolaryngology-Head and Neck Surgery and Sleep Medicine. He has published over 150 academic papers and is editor of the textbook Gland-Preserving Salivary Surgery: A Problem-Based Approach. He is a former Director of the American Board of Otolaryngology-Head & Neck Surgery (ABOHNS) and current member of the otolaryngology section of the Accreditation Council for Graduate Medical Education (ACGME).

M. Allison Ogden, MD FACS

Professor & Vice-Chair of Clinical Operations - Department of Otolaryngology

Washington University School of Medicine

Dr. Ogden is a Professor and Vice-Chair of Clinical Operations in the Department of Otolaryngology at Washington University School of Medicine. She graduated from the Washington University School of Medicine in 2002 and went on to complete her residency there as well in Otolaryngology in 2007. Her clinical interests include sialendoscopy, nasal obstructions, and hearling loss. In 2015 Dr. Ogden was listed in "Best Doctors in America", an honor that continues to this day.

Arjun S. Joshi, MD

Professor of Surgery

The George Washington University School of Medicine & Health Sciences

Arjun Joshi, MD is board-certified in Otolaryngology and Head & Neck surgery by both the American Board of Otolaryngology – Head and Neck Surgery and the Royal College of Physicians and Surgeons of Canada. Dr. Joshi received his medical degree from the State University of New York at Syracuse and completed his residency at The George Washington University Medical Center. His areas of expertise include: Head and Neck Cancer, Head and Neck Masses, Head and Neck Reconstruction, Thyroid and Parathyroid Surgery, and Salivary Endoscopy.

Henry T. Hoffman, MD

Professor of Otolaryngology / Professor of Radiation Oncology

University of Iowa Healthcare

Dr. Henry T. Hoffman is an ENT-otolaryngologist in Iowa City, Iowa and is affiliated with University of Iowa Hospitals and Clinics. He received his medical degree from University of California San Diego School of Medicine and has been in practice for more than 20 years.

David M. Cognetti, MD, FACS

Professor and Chair of Department of Otolaryngology-Head & Neck Surgery

Thomas Jefferson University

Dr. Cognetti received his BS in Biology from Georgetown University and his MD from the University of Pittsburgh School of Medicine. He completed a residency in Otolaryngology – Head and Neck Surgery at Thomas Jefferson University before completing a fellowship in Advanced Head and Neck Oncologic Surgery at the University of Pittsburgh Medical Center.  Dr. Cognetti returned to Jefferson, his professional home, as faculty in 2008.

Christopher H. Rassekh, MD, FACS

Professor in Department of Otorhinolaryngology - Head & Neck Surgery / Director of Penn Medicine Sialendoscopy Program

University of Pennsylvania

Christopher H. Rassekh, MD is Professor of Clinical Otorhinolaryngology-Head and Neck Surgery at Penn Medicine. He is the Director of the Penn Medicine Sialendoscopy Program, which provides evaluation of and minimally invasive surgery for diseases that cause swelling of the salivary glands including obstructive diseases such as salivary stones, salivary duct strictures and tumors. Dr. Rassekh sees patients with head and neck tumors including cancers of the mouth, throat, voice box, salivary gland, thyroid and neck and also was a very early adopter of Transoral Robotic Surgery (TORS) for tumors and salivary gland diseases, and is an expert in cranial base surgery. He also is co-chair of the Airway Safety Committee at the Hospital of the University of Pennsylvania.

Cleft Lip Revision: Tips and Tricks

Attendees will learn various tips and tricks to a successful cleft lip revision procedure. There will be a Q&A session to address common challenges and how to address them.

Course Directors

Panelists

Alveolar Bone Graft Surgery: Tips and Tricks

This webinar will focus on the surgical management of alveolar clefts with bone grafting and fistula closure. Our panel of experts will share various techniques and graft source materials including tips and tricks learned along the way. Our guest moderator will lead a panel discussion at the end of the session to discuss some of the controversies and key points in alveolar grafting.

Pediatric Endoscopic Airway Surgery

This webinar will address common and advanced pediatric airway pathology. There will be a focus on video demonstration of advanced surgical endoscopic management of pediatric airway pathology ranging from laryngomalacia to type 3 laryngeal clefts.

Vikash K. Modi, MD, is an Associate Professor and the Chief of Pediatric Otolaryngology - Head & Neck Surgery at New York Presbyterian Hospital- Weill Cornell Medical Center. After receiving his medical degree from the Rutgers Medical School, Dr. Modi completed his residency in Otolaryngology at the University of Southern California - Keck School of Medicine. Following residency, Dr. Modi completed a Pediatric Otolaryngology fellowship at Northwestern University - Children's Memorial Hospital. He founded the Cornell Aerodigestive Center and has one of the largest series of endoscopic posterior cricoid split with rib grafting (presented at ESPO). He also has presented his work on endoscopic repair of laryngeal clefts at ASPO and CEORL. He has been inducted as a Fellow, into the prestigious Triological Society for his thesis paper on airway balloon dilation and currently serves as a Section Editor-Video Editor of The Laryngoscope and is known for his surgical endoscopic airway videos.

Culture War: Positive vs. Negative Resilience Training in Healthcare

Original Air Date: August 22, 2019

Shame and Blame. Perfectionism. Error-Driven. Laser Focused on Mistakes. Does that sound like a description of a winning culture?

The practice of medicine is difficult, and the culture in healthcare can make it harder to deliver excellent patient care. What if we turned our focus to the positive?

There are times when negative resilience training reinforces important lessons. However, there are more times when positive resilience training would have a far greater impact on us, and others, particularly our patients.

In this webinar, SurgeonMasters founder Jeffrey Smith, MD, FACS, CPC, will describe positive and negative resilience training, give examples of each, and offer opportunities to use positive personal and team resilience habits over negative ones.

Three Stage Management of the Single Ventricle

In this session our team of experts will discuss the three stages of single ventricle palliation including the Norwood procedure, the bidirectional Glenn shunt and the Fontan procedure.  Included in this webinar will be single ventricle pathophysiology, diagnostic studies/imaging, indications and contraindications for palliation, timing of surgical intervention, and overview of surgical goals and associated mortality.

Selection and Optimal Irreversible Electroporation Technique in Pancreatic Adenocarcinoma

In this session our panelists will discuss:
- Optimal induction-based therapy in Stage 3 pancreatic adenocarcinoma
- Optimal pre-operative planning for patients undergoing IRE technique
- Optimal intra-operative IRE technique in pancreatic adenocarcinoma

Director of Division of Surgical Oncology
University of Louisville

Robert C. G. Martin, II, M.D. PhD, is The Sam and Lolita Weakley Endowed Chair in Surgical Oncology, The Director of the Division of Surgical Oncology, faculty member of the James Graham Brown Cancer Center, and a Professor in the Department of Surgery. He was appointed to the University of Louisville in 2002 as an Assistant Professor and achieved Professor of Surgery in 2011. Dr. Martin received his M.D. from the University of Louisville School of Medicine (1995), his surgical oncology training and hepato-pancreatico-biliary training from Memorial Sloan-Kettering Cancer Center (2002), and his PhD from the Department of Pharmacology and Toxiciology (2008) at the University of Louisville School of Medicine. Dr. Martin’s clinical interests are focused on the multi-disciplinary care and surgical management of patients with upper GI malignancies, including esophageal, gastric, duodenal, liver, biliary, and pancreatic cancers.

Salivary Interactive Case Study

Submit your own cases to be reviewed by our Salivary Surgery Experts, Dr. Rohan Walvekar and Dr. Barry Schaitkin. Cases will be selected prior to the session and those selected will be notified. Our experts, joined by guest panelists, will review the case details, provide their perspective, and go over alternative methods to consider when presented with a similar case.

If you feel uncomfortable submitting patient information, you can just bring the information to the session and present it directly to the experts. Here is what you need to have prepared when you join the webinar:
• Short patient history - medical and surgical
• Findings from images or scans - the actual images and scans are helpful too
• Any kind of operative images or videos that can help showcase the problem
• A question to pose to the expert panel

Cleft Primary and Revision Rhinoplasty: Tips and Tricks

Tune in for the latest in our series on Cleft Surgery featuring Dr. Raj Vyas from UC Irvine and Dr. Usama Hamdan with the Global Smile Foundation. The discussion will focus on making sure that attendees know proper procedures as well as common complications and how to avoid them.

Larry Hartzell, MD FAAP is an Associate Professor of Otolaryngology Head and Neck Surgery at Arkansas Children’s Hospital. He is the Director of the Pediatric Otolaryngology fellowship. Dr Hartzell also has been the Cleft Team Director in Arkansas since 2012. He is passionate about international humanitarian mission work and dedicates much of his research efforts to cleft surgical and clinical care as well as velopharyngeal insufficiency. Dr Hartzell is actively involved in multiple academic societies and organizations including the AAO-HNS and ACPA.

Dr. Goudy is a professor at Emory University School of Medicine and the director of the division of otolaryngology at Children’s Healthcare in Atlanta. Dr. Goudy’s clinical job involves repair of craniofacial malformations including cleft lip, cleft palate, and Pierre Robin sequence, and he also participates in head and neck tumor resection and reconstruction.

Dr. Hamdan is President and Co-Founder of Global Smile Foundation, a 501C3 Boston-based non-profit foundation that provides comprehensive and integrated pro bono cleft care for underserved patients throughout the world. He has been involved with outreach cleft programs for over three decades. Dr. Hamdan is an Otolaryngologist/Facial Plastic Surgeon with former university appointments at Harvard Medical School, Tufts University School of Medicine and Boston University School of Medicine. For his philanthropic service to the people of Ecuador, he was awarded the Knighthood, “Al Merito Atahualpa” En El Grado De Caballero, by the President of Ecuador in March 2005. He received Honorary Professorship at Universidad de Especialidades Espíritu Santo, School of Medicine, in Ecuador on March 5, 2015 for his contributions in the field of Cleft Lip and Palate.

Dr. Vyas obtained his BS from Stanford and his MD from UCLA before completing integrated plastic surgery residency at Harvard and a fellowship in Craniofacial Surgery at NYU. He is an active clinician, scientist and educator with over 200 peer-reviewed publications and presentations, 20 book chapters, dozens of invited lectures, and multiple NIH and foundational grants. Dr. Vyas is passionate about advancing knowledge and skill for cleft care worldwide, partnering with Global Smile Foundation as both a clinician and Director of Research.

After completing a pediatric craniofacial fellowship at Boston Children’s Hospital, he joined the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis 2011. He is Director of Craniofacial and Medical Director of the Operating Rooms at Saint Louis Children’s Hospital (SLCH). He treats patients with craniosynostosis or other craniofacial abnormalities (congenital or traumatic). He obtained a Master of Science in Clinical Investigation in May 2017 at Washington University to advance his ability to perform high quality clinical research and this program allows him to take advantage of the tremendous resources available for faculty and residents. His research focus is in craniofacial with particular interest in craniosynostosis and cleft lip and palate.

Dr. David Yates MD, DMD, FACS is passionate about serving children with Cranial and Facial deformities and Cleft Lip and Palate. He is a Board Certified Oral and Maxillofacial Surgeon and was recently awarded the inaugural “Physician of the Year” award by El Paso Children’s Hospital. He is the Division Chief of Cranial and Facial Surgery at El Paso Children’s Hospital and has been critical in bringing complex craniofacial surgery to the region. In addition to being a partner with High Desert Oral and Facial Surgery, he directs the craniofacial clinic at El Paso Children’s Hospital and the craniofacial clinic at Providence Memorial Hospital. He has also been integral in starting a clinic for children with Cleft Lip and Palate in Juarez, Mexico at the Hospital De La Familia (FEMAP). He is now happily settled with his wife and four kids serving the greater El Paso/Las Cruces/Juarez region.

What is Otolaryngology: More than Tonsils and Boogers

Come learn more about the jobs of Otolaryngologists (also known as ENT doctors!). We will discuss the breadth and depth of what ENT doctors cover with case descriptions. Medical students and residents of different levels will be on a panel to answer questions about the journey to and through Otolaryngology residency.

Otolaryngology Head and Neck Surgery / Resident Physician, PGY 5
Loyola University Medical Center

Dr Yang grew up in the arid and desert like climate of Eastern Washington before spending four years in rainy Seattle during her undergrad years, majoring in Neurobiology at the University of Washington. She then moved to sunny Southern California to complete her medical education at Loma Linda University School of Medicine. She is currently finishing her chief year of Otolaryngology Head and Neck Surgery residency at Loyola University Medical Center in Chicago, enjoying both life in the Windy City and surviving the cold winters. She recently matched to fellowship at Oregon Health and Science University in Facial Plastics and Reconstruction with Dr. Wax to specialize in microvascular reconstruction of complex head and neck defects. She is excited to return to the west coast and explore all the nature that Oregon has to offer.

Resident physician
University of Nebraska Medical Center

Steven is originally from San Diego, CA and attended the University of Notre Dame where he studied anthropology. He then earned a master's degree at Boston University and completed a year of service with Jesuit Volunteer Corps Northwest in Yakima, WA. Steven recently graduated from Loyola University Chicago Stritch School of Medicine and will be starting otolaryngology residency at the University of Nebraska Medical Center.

Medical Student
Loyola University Chicago Stritch School of Medicine

Alice is originally from San Jose, CA and attended UC Berkeley where she studied Molecular and Cell Biology as well as Nutrition. She is starting her fourth year at Loyola University Chicago Stritch School of Medicine, and preparing to apply for otolaryngology residency.

Resident
Loyola University Medical Center Otolaryngology Head and Neck Surgery Department

Dr. Sandelski grew up in Northwest Indiana, leaving the state for undergrad at the University of Michigan, and returning for medical school at Indiana University School of Medicine. She is in her second year at Loyola for ENT residency. She is undecided for plans after residency, with current interests in head and neck oncology and facial plastics and reconstruction.

Salivary Interactive Case Study: July

Submit your own cases to be reviewed by our Salivary Surgery Experts, Dr. Rohan Walvekar and Dr. Barry Schaitkin. Cases will be selected prior to the session and those selected will be notified. Our experts, joined by guest panelists, will review the case details, provide their perspective, and go over alternative methods to consider when presented with a similar case.

If you feel uncomfortable submitting patient information, you can just bring the information to the session and present it directly to the experts. Here is what you need to have prepared when you join the webinar:
• Short patient history - medical and surgical
• Findings from images or scans - the actual images and scans are helpful too
• Any kind of operative images or videos that can help showcase the problem
• A question to pose to the expert panel

Ventricular Septal Defects

As one of the most common congenital cardiac anomalies managed by pediatric cardiac teams, VSD’s often may present a challenge in optimal management.  Our team of experts will discuss pathophysiology, diagnostic studies, indications and timing of surgery, surgical management; along with the technical challenges/considerations of repairing each of the different anatomic variants of ventricular septal defects: perimembranous, conoventricular, supracristal (subpulmonary), inlet (atrioventricular canal type), and muscular.

Salivary Interactive Case Study: August

Submit your own cases to be reviewed by our Salivary Surgery Experts, Dr. Rohan Walvekar and Dr. Barry Schaitkin. Cases will be selected prior to the session and those selected will be notified. Our experts, joined by guest panelists, will review the case details, provide their perspective, and go over alternative methods to consider when presented with a similar case.

If you feel uncomfortable submitting patient information, you can just bring the information to the session and present it directly to the experts. Here is what you need to have prepared when you join the webinar:
• Short patient history - medical and surgical
• Findings from images or scans - the actual images and scans are helpful too
• Any kind of operative images or videos that can help showcase the problem
• A question to pose to the expert panel

Voice Feminisation Surgery

This webinar will discuss modern approach to voice feminisation including therapy and surgery.

The Ins and Outs of Medical Research & Publication

The International Journal of Medical Students and CSurgeries have come together to provide and exclusive inside scoop on the world of medical publications. They will review how to properly research and submit an article along with selecting the best journal to publish through.

Advanced Techniques of Esophageal Dilation

A UES Masterclass presented by Peter C. Belafsky, MD, MPH, PhD, this session will cover an advanced interpretation of swallowing fluoroscopy and pharyngeal HRM as well as techniques of UES dilation and esophageal web and stricture dilation. The presentation will be approximately 50 minutes with a 20 minute Q&A session to follow.

Peter Belafsky, MD, MPH, PhD
Professor & Director of the Center for Voice & Swallowing, Department of Otolaryngology/Head and Neck Surgery
UC Davis Medical Center

Dr. Peter Belafsky, M.D., Ph.D., M.P.H has dedicated his career to the care of individuals with devastating swallowing disorders and is currently working on exciting and new advances in the treatment of dysphagia. After obtaining a combined medical degree and masters in public health from Tulane University in New Orleans, Dr. Belafsky completed a surgical internship and subsequent Ph.D. in Epidemiology from the Tulane University Department of General Surgery and Graduate school. He is currently Associate Professor at the University of California, Davis.

Enabling Our Frontline Healthcare Warriors

How to Enable Our Frontline Healthcare Warriors to Use a Total Joint Hood for Total Head Protection Without the Need of a Total Joint Helmet

The Stay Strong Face Shield System was created to enable Frontline Healthcare Personnel to wear total joint hoods without needing a total joint helmet system.  Created by orthopedic surgeon, Ryan Grabow, MD, it is a resusable, face shield system specifically designed to work with total joint hoods (by Stryker and Zimmer-Biomet) and any other plastic sheeting (binder covers work great).

Through the Battle Born Maker Corps the shields are being 3D printed and donated to our frontline healthcare warriors throughout the country. All makers, hobbyists, universities, or companies with the ability to 3D print are invited to visit the website BattleBornMakerCorps.com to download the 3D printing file for free to help protect our colleagues who are on the frontlines protecting us all!

Disclosure of Conflicts:

The Stay Strong Face Shield 3D printing file is being provided free of charge to anyone wanting to download and print the face shield system to provide frontline healthcare personnel the ability to wear a total joint hood without the need for a total joint helmet that is expensive and in limited supply. Dr. Grabow holds the patent for this device.

How Surgical Videos Benefitted This Aspiring Surgeon’ By Andrew J Goates, Md

 Andrew J. Goates, MD is a first-year Otolaryngology — Head and Neck Surgery resident at Mayo Clinic in Rochester, Minnesota. He is passionate about patient and physician education through  the use of video and digital media and a member of the CSurgery Student Leaders. You can follow him on Twitter @goatesworld and on Instagram @goatolaryngologist. 

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“I like making movies, but I’m not sure what I’m going to do with it. Hopefully I’ll figure it out.”

That was my response. Those were my big career goals. It was our first date and I had just blown my opportunity to knock her socks off with my impressive aspirations and intellectual prowess. Somehow, despite her better judgement and advice of close friends, she continued allowing my romantic pursuits. Eventually, with her support, I discovered my love for medicine. We talked about my role models, many of which were in the medical field. I recognized that I wanted to do something everyday that brought new questions, challenges, and opportunities and at the same time directly impacted peoples’ lives. Medicine became the natural fit.

While in medical school and I spent the first two years trying to gain as much knowledge and experience as I could in order to match into my dream specialty of Otolaryngology– Head & Neck Surgery. I worked in the department as often as I could: helping with publications; attending lectures and grand rounds; all the while learning from residents, fellows, and staff surgeons. One of my mentors approached me about doing a surgical video on a new technique he had learned for excision of branchial cleft cysts. I didn’t know how to remove any type of cyst, and I didn’t even know what a branchial cleft cyst was. But, I did have a natural drive and curiosity, the motivation to learn, and a basic video editing skill set that I could contribute.

Through developing that video I saw the potential of surgical video footage in many aspects of education in surgery and medicine. I learned the practical anatomy relevant to this surgery. I learned about common pitfalls and picked up on the subtleties of technique and tissue handling. Although at that point I had not performed a single surgery, I got to spend a few moments in the mind of a surgeon. I became more prepared for when my opportunity to operate would soon come. In addition, I got to spend important moments learning from and working with a phenomenal surgeon. That project helped strengthen our mentoring relationship and lead to more opportunities for me to reach my potential with a strong letter of recommendation for residency applications.

Since that time I have consistently used high-quality surgical videos to research procedures, learn complex anatomy, and to augment my study of head and neck surgery. Surgical videos can help a learner assimilate difficult three-dimensional relationships and translate memorized anatomy and concepts into practical understanding needed to safely navigate a given operation. This allows a growing surgeon have a foundation on which to build the surgical skills needed to become a proficient and safe surgeon. I have really appreciated the work of CSurgeries in housing excellent surgical videos and making them available for all to benefit from.

So my career does involve making movies after all. But they are far more meaningful than what I had in mind. They don’t just tell stories. These movies teach, inspire, and motivate aspiring surgeons and inform nervous patients and their families from all over the world.

Facebook Live: Fighting Physician Burnout: 8 Practices To Train For The Inevitable Bout

On August 30^th, 2018 we were honored to have Jeff Smith, MD host a Facebook Live event. Mr. Smith is an Orthopaedic Trauma Surgeon who also assists other Surgeons to develop the critical skills needed to create a highly successful lifestyle-friendly practice which is physically, mentally and emotionally sustainable. Mr. Smith joins us to share his signature methodology “The 8 Practices of Highly Successful Surgeons” that he developed based on his own 21 years at University of California San Diego.

Mr. Smith is also a Surgeon Coach and Consultant at SurgeonsMasters, a medical education company delivering strategies and techniques overlooked and underemphasized in traditional medical training. The goal of SurgonsMasters is to focus on learning, understanding and implementing effective habits that will allow all healthcare professionals to create a thriving practice while still having time to travel, connect with family and pursue outside interests.

->Watch the video recording here<-

Mr. Smith’s Live Event covers the following topics

– The Definition and Test of Burnout

– Burnout Rates in Healthcare

– Our Perception and Awareness of Burnout

– 8 Practices of Highly Successful Surgeons

– Tips for Medical Students

– Key Take Aways

– Audience Questions & Answers

The Definition of Burnout

The Maslach Burnout Inventory (MBI)

o “Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who work with people in some capacity.”

o Find your specific MBI Test Here (https://www.mindgarden.com/117-maslach-burnout-inventory)

Burnout Rates in Healthcare

Our Healthcare culture or system is contributing to 80-90% of our burnout because of inefficiencies or stresses and frustrations imposed on us. However, there are aspects we can control with a proactive approach to train ourselves for facing burnout opposition in the ring.

– 20-30% experience burnout, but potentially more as there is less self awareness about the issue.

– High functioning organisations and departments with a physician leader who is very engaged and effective tend to have lower incidents of burnout among the physicians working under them. Ineffective leaders may be a contributing source of burnout among team members.

– Recent implementation of electronic medical records, other significant changes to the system can add stress to the environment, increasing burnout of those in the organization.

– 48% of women experience burnout vs. 38% of men. Rates increase to 50% between professionals aged 45 and 54 years old.

– Mr. Smith experienced burnout 5 years into his career and again around 50 years old. Even at those times, he was high functioning, busy and successful with his patient care as a surgeon. However, he was less efficient which is a cause of burnout.

Our Perception and Awareness of Burnout

– When surveyed, 40-60% of respondents report experiencing burnout.

– When presented with burnout statistics, we tend to hone in on our specialty in comparison to the others. But we shouldn’t care if our specialty experiences 40% vs 50% burnout when a high functioning specialty should be in the 20% range. There is a lot we can do to improve burnout rates across all specialties in healthcare.

– Burnout creates chaos and synergy. Often as physicians and healthcare administrators we help each other to win the fight. But we also tend to fight alone in our corner or even against each other, increasing stresses that lead to burnout.

– Higher rates of burnout on your team contribute to higher turnover, higher incidences of malpractice, medical errors, decreased patient safety and lost revenue.

– Our experience is not left in the clinic, hospital or research lab. It impacts other areas in our life, we take it with us which impacts our relationships, causes irritability, anxiety and in some cases mental health issues or substance abuses.

– We must take proactive steps to implement habits that reinforce a sustainable practice.

8 Practices to prevent, fight and win against burnout

1. Passion for performance

2. Reciprocity of roles & relationships

3. Attitude resilience

4. Community with mutual understanding

5. Time/life management using rhythm

6. Inspiring other to share goals

7. Complex problem solving through simplicity

8. Energy for personal & practice wellness

Tips for Medical Students

– Learn these practices early in your career, create and reinforce good habits.

– Implement these 8 practices with a regular effort

– Advance other areas other than just medical knowledge or surgery skills

– Improving communication or using simplicity to solve complex problems will help create a wider set of skills needed for a sustainable career in healthcare

– Be mindful of these practices even when you’ll intensely have to learn about one subject

– The key is being proactive and reflecting on how you did implement these practices

– Use constructive positive criticism to keep yourself engaged and accountable

Key Take-Aways

1. Reflection is Key

2. Planning & Setting Goals

3. Incremental Adjustments to Improve; “How can I do it better?”

Questions & Answer

How do we integrate others in implementing the 8 practices?

– Implementing the practices involves the Rs: Reciprocity, Roles and Relationships

– Although we can work on developing these practices on our own, in reality the 8 practices are integrated with those around you and on your team.

– Reach out to others to get feedback about your communication and time/life management.

– Ask how they perceive your quality time and how they can contribute towards improving your preventative burnout practices.

Do you have any tips for avoiding burnout during the last couple of weeks before exam?

– Start to learn healthy eating habits with a difficult schedules and odd rotations

– Start to learn sleep RECOVERY habits for those late nights studying, on rotations, and so on

– Find a way to get regular exercise, even if not your ideal form or quantity. Learning how to do it anyways is really helpful for the future

– Take the opportunity to reflect on what you’re doing. Over a series of exams, review the strategies you found effective and repeat them, making incremental adjustments to keep that success going.

– Allow a small physical recharge, a mental recharge or rest by taking mini breaks.

– Have the ability to support your connections, address people and stay positive!

The Value Of Research, Video-editing, And Publishing In Academic Surgery

Q: Tell me a little bit about yourself

A: I am an Academic Chief Resident at NYU Langone Medical Center in the in Department of Surgery. I plan on doing a colorectal surgery fellowship and a colorectal oncology fellowship after I graduate.  I am from New York, and my wife and I have two children and a dog.  I have written book chapters, journal articles, and peer-reviewed articles.  I’m involved in numerous performance improvement projects and more recently have been editing videos.

Q: What you LOVE about being a surgeon?

A: We get to operate which is probably the greatest joy in the world for us! In doing so, we get to practice our craft, improve upon it, while at the same time helping people. There aren’t too many professions in the world where your profession is also your hobby, that is also your passion, and is also lifesaving.  Especially in early stage cancers, surgical treatment remains the treatment of choice the majority of the time and we have an opportunity to cure people at the time of operation.

Q: How has CSurgeries contributed to your education and learning?

A: There is a video that is currently published that I did with Garett Nash, MD at Sloan Kettering, entitled, “Robotic Inferior Mesenteric Artery, Common Iliac Artery, and Retroperitoneal Lymph Node” about two and a half to three years ago. It was my first experience video editing operative footage and spending dozens of hours of unedited video forced me to think about and identify the essential steps of an operation, be able to identify the anatomy throughout the operation, and to be mindful of pitfalls and vital structures that can be commonly injured during key steps in an operation. Once you can do that, the rest is just cutting and pasting- spending some time in front of the computer to make sure the video looks nice.

Soon after, I heard about CSurgeries and I thought it was a wonderful avenue to publish! Not only is it a peer-reviewed publication (which is wonderful) but I get to continue to edit videos, which further re-enforces my understanding of an operation and my ability to breakdown an operation into its key steps and maneuvers.

Hopefully other surgeons are watching the videos before going into their operation (just as I do before I do an operation that I’m not familiar with).

Actually, there was a study published last year that looked at residents’ competency during a laparoscopic right hemi-colectomy. The study had one group of residents do the procedure essentially themselves.  They then compared them to a different group of residents, same program, who watched a video of a laparoscopic right hemi-colectomy narrated with the key essential steps prior to doing the right hemi-colectomy. They found the residents who watched a video just prior to doing the operation were more efficient and needed less assistance from the attending.  There were no adverse effects.

Certainly it’s been proven that videos help you become familiar with an operation more than just words in a book could. This was never possible in the past because we never had educational access online.  Video libraries are very recent, so it’s certainly an advantage that surgical residents have now that’s never been available before. To watch the operation prior to either doing it or assisting in is crucial- now that our work hours are so restricted and we can’t be in the operating room as much as our predecessors have be in the past. That is HUGE.

Q: That leads me into my next question. How do you think residency training resources are changing?

A: Certainly, the more time you’re in a hospital, the more time you’re with patients, the more operations you see, the more experienced you therefore become. However, if you talked to the surgeons who trained 30-40 years ago, they learned things by making small errors with absolute autonomy, and that’s why they became such advanced surgeons.

However, in this day and age there is absolutely no room for error. There’s no room for any compromise of patient safety. So, residents today are at least theoretically more relaxed, less stressed out, and less sleep deprived and that’s fine. But what is does mean is we are in the operating room less compared to the people who are teaching us were when they were residents.  Remember, medicine/healthcare in general has changed, so one of things that we need to do is make up for that operative experience.

What if you can place yourself in the operation by watching it?  Watching the operation and then the next day you perform the case… You may come out with the same knowledge, understanding, and ability to complete that case by yourself compared to previous generations who had more operative experience. We need to find ways for residents to become much more efficient as we have our hours restricted and many more academic responsibilities.

CSurgeries peer-reviewed videos may be the only way that residents and education can compete with the past.

Q: Is that what made you choose the video format of publishing? Was it easy? Was it difficult?

A: Yes, because it’s fun! It’s easy if you know what the essential steps of an operation are and if you have great footage by some great surgeons (which we have here at NYU).  We are fortunate to be able to work with these surgeons, and especially when it comes to laparoscopy, or the robot, is very easy to record. That video can then be edited and we can break down an operation into the essential steps. That’s really what an operation is.

Q: What would you be doing, career-wise, if you weren’t a surgeon?

A: Maybe I’d be a musician, but I couldn’t really think of doing anything else other than surgery.

Q: What advice would you give medical students who are thinking about surgical residency?

A: They need to be ready for residency. It’s certainly not as tough as it used to be, but surgical residency is still much more difficult than some other specialties. It requires the same amount of knowledge, but there’s an entire other component of operative ability, that’s extremely important.

Q: What’s the best way for students to get into residency and be really successful?

A: This may seem unrelated, but it’s based off of the teachings of William Hallstead, who is the founder of residency in America. While at John’s Hopkins, he believed that research is an absolutely mandatory part of your development as a surgeon.  Of course, students need to be aware of operating and the tough life that surgeons have, but they need to perform research. They need to get things published because advancing, whether in basic sciences research or outcomes research…it’s all part of becoming a surgeon.

Surgeons work with their hands and the good ones have greater ability, but part of that is research. And if students want to go into surgery, or surgery residents want to go into fellowship, they have to publish. You can do that with CSurgeries. CSurgeries is producing these videos that are peer-edited publications.  Students can use it as a research vehicle since it counts as a peer-reviewed publication. It’s a BIG deal. We surgeons know… To be a surgeon is to be an academic as well.

Q: What three adjective (s) best describe “A Day in the Life of a 4th Year Surgery Resident”

A: They aren’t really adjectives but, Honor, Responsibility and Passion.

 Other videos by David Schwartzberg:

Laparoscopic Adrenalectomy
Gastric Sleeve Obstruction From Adjustable Gastric Band Capsule
Per Oral Endoscopic Myotomy (POEM) for Zenker’s Diverticulum

Have a question you would like to ask Dr. Schwartzberg? Feel free to post a comment or send him an email at David.Schwartzberg@nyumc.org

The People Behind CSurgeries: Gresham Richter MD, FACS, FAAP

Meet Gresham Richter ─ Professor, Academic Surgeon and Co-founder of CSurgeries
(Better known as “G” to his colleagues at CSurgeries).

Q: How did CSurgeries get started? How did you come up with idea?

A: CSurgeries was originally developed to be an educational surgical outlet that was video based- to teach trainees how to perform the surgeries or  at least ask the appropriate questions during the procedure.  It was going to be a CD-based system, but then we realized we wanted to expand the market, not just for residents, but for everyone…students, patients and other surgeons alike.  We wanted to capture details for every field and do it on a grand scale, applicable to a bigger audience.

With this goal in mind, CSurgeries became a web-based venue.  To encourage publication, we wanted to make this a win-win for the surgeons taking the time to produce the video. Our answer was simple. Our “aha” moment, so to speak was… the videos submitted by our colleagues must be a peer reviewed publication where credit is given and the videos are validated.

Q: What can you tell me about CSurgeries that’s not on the website?

A: It’s an amazing site! It’s the perfect opportunity for surgical educators and anyone else trying to learn about a particular surgery or technique.  Surgical leaders from around the world are involved. There is so much activity already happening on CSurgeries.com.  Patients, students, and expert surgeons are exploring the posted peer-reviewed cases.

Q: What makes CSurgeries unique?

A: We are unique in so many ways, but really it’s the people behind CSurgeries team that make us unique. We are an academic physician owned and operated organization. Our mission as is to teach and we understand how to value video content for publication. We have brought in education leaders in each specialty who are hands-on ─ participating, editing, and overseeing the videos produced and published on the site. It has become clear also that those submitting are interested in authoring videos to teach, not just to have something on the internet.
We understand that in the area of academic surgery, publication is critical. We allow surgeons, and their trainees, to get academic credit for their high quality and annotated videos of procedures; each of our videos is peer –reviewed and as a result we are being recognized as the premier site for validating their procedures with a publication. In fact, each video that gets approved get assigned its own DOI publication number.  Companies like Research Gate already recognize our videos as a publication. Soon we head for PubMed and other Medline search engines…

Q: You are a surgeon. You are a teacher. You are an entrepreneur. Do you sleep?

Just enough. I have a very regimented schedule between family and work. Up early, home for dinner, kids to bed by 8pm and then I get right to work. Consistency helps. Family is critical. Thus sometimes I’m late to our late team conference calls!

Q: What advice would you give a medical student thinking about becoming a surgeon?

It’s a wonderful world and life…very rewarding.  More importantly, learn as much as you can by observing and operating as much as possible.

Q: What would you be doing, career-wise, if you didn’t become surgeon?

I actually went to med school to become a psychiatrist but I realized that I was simply not patient enough. Honestly, I think I would be in the business world one way or another. Fortunately, now I have a mix of both. Like they say they in Arkansas, sometimes a blind squirrel finds a nut.

Q: Where do you see surgical education headed…let’s say in the next 10-15 years?

Streaming education and no more books. On-line interactive education with video and chat. In this sense, surgical education is going to follow internet advances.

Have a question you would like to ask Dr. Richter? Feel free to post a comment or send him an email at gresham.richter@csurgeries.com

Michael Golinko Was Live! Craniosynostosis: A Surgeon's Perspective

On February 14th, 2018 we were honored to have Michael S. Golinko MD, MA, FAAP, host our first Facebook Live. Dr. Golinko is one of our valued CSurgeries Section Editors for Plastic Surgery, Medical Director of the Craniofacial Anomalies Program at the Arkansas Children’s Hospital, and an Assistant Professor of Plastic Surgery for the University of Arkansas for Medical Sciences.
Dr. Golinko was a great presenter during the live event and shared his views on best practices for approaching craniosynostosis. His discussion on the subject provides information that both surgeons, medical students, and patients will find interesting and informative.

Topics Dr. Golinko covers include:

• What is craniosynostosis
• How common is craniosynostosis
• Types of craniosynostosis – sagittal, coronal, metopic, lambdoid
• Craniosynostosis vs. plagiocephaly
• Brain growth in the first year of life
• Facts about the development of the brain and development issues that might occur with craniosynostosis
• The importance of operating on the skull when an infant has craniosynostosis to allow for normal brain growth
• Common consults including flat head, closed soft spot, suture closure, and premature fusion
• Signs, symptoms, and risks of craniosynostosis
• Downstream effects of untreated craniosynostosis
• Treatment options for addressing craniosynostosis – cranial vault remodeling, spring assisted
• Survivor rates and complications

Watch the recorded Facebook Live here!

Dr. Golinko also walks us through his team’s published CSurgeries video Fronto-Orbital Advancement and Cranial Vault Remodeling for Metopic Craniosynostosis.  He discusses why he recommends CSurgeries as an educational tool for both surgeons and medical students and wraps up by answering questions on the topic.
Dr. Golinko shared his presentation here.
A special thanks to Dr. Michael Golinko for hosting such an informative Facebook Live.

Meet our Presenters for Day 1!

The International Adult Airway Symposium is coming up on February 4th & 5th. For more information view the itinerary or register here!

Dr Gitta Madani, FRCR, MRCS, MBBS, FDSRCS, BDS

Consultant Radiologist and Honorary Senior Lecturer

Imperial College Healthcare NHS Trust and Imperial College London

Gitta Madani is a Consultant Radiologist with a specialist interest in all aspects of head and neck and skull base radiology and performs image-guided procedures in the head and neck. She is an Honorary Lecturer at Imperial College London and involved in research, training and teaching. She has authored several book chapters, various peer-reviewed articles and national imaging guidelines.

Ali Zul Jiwani, MD, MSc, DAABIP

Director of Interventional Pulmonology

Orlando Health Cancer Institute

Dr. Jiwani, is a board-certified interventional pulmonologist with the Rod Taylor Thoracic Care Center at Orlando Health Cancer Institute where he also leads the institute’s lung cancer screening program. As an interventional pulmonologist he specializes in minimally invasive diagnostic and therapeutic endoscopy and other procedures to treat malignant and benign conditions of the airway, lungs and thorax plus pleural diseases.

David E. Rosow, MD, FACS

Director, Division of Laryngology and Voice / Associate Professor, Dept. of Otolaryngology

University of Miami Miller School of Medicine

Dr. Rosow is Associate Professor of Otolaryngology at the University of Miami Miller School of Medicine, where he has led the Division of Laryngology and Voice for over 10 years. His research and clinical interests include laryngeal cancer, recurrent respiratory papillomatosis, vocal fold paralysis, laryngotracheal stenosis and airway reconstruction, and spasmodic dysphonia. In addition to scientific publications in these areas, he has also written and edited a textbook on evidence-based practice in Laryngology.

Professor Stephen R Durham MD FRCP

Professor of Allergy and Respiratory Medicinec

National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital London

Professor Durham is Head of Allergy and Clinical Immunology at NHLI and has run a joint Nose Clinic with Professor Hesham Saleh for many years. His research interests include allergic rhinitis, asthma and translational studies in allergen immunotherapy. He is a member of the Steering Committee, Immune Tolerance Network, National Institutes of Allergy and Infectious Diseases, NIH, USA.

Professor Jane Setterfield

Professor of Oral & Dermatological Medicine

Guy's & St Thomas Hospital & King's College London

Jane Setterfield is Professor of Oral and Dermatological Medicine at King’s College London and Consultant in Dermatology at St John’s Institute of Dermatology, Guy’s & St Thomas Hospitals. She leads the Oral Dermatology Service both at St John’s Institute and the Department Oral Medicine Guy’s Dental Institute. Her areas of clinical interest include immunobullous diseases, lichenoid disorders vulval dermatoses and mucocutaneous diseases. Her research areas include diagnostic techniques, pathogenic mechanisms, clinical outcome measures and optimising therapeutic approaches for mucocutaneous diseases.

Laura Matrka, MD

Associate Professor

Ohio State University Wexner Medical Center Department of Otolaryngology - Head and Neck Surgery

Laura Matrka, MD, is an Associate Professor at the Ohio State University Wexner Medical Department of Otolaryngology – Head & Neck Surgery. She graduated magna cum laude from Dartmouth College with a BA in English and concentrations in Anthropology and Spanish, completed medical school at University of Cincinnati College of Medicine, completed her residency in Otolaryngology at The Ohio State University, and completed a Laryngology fellowship at the University of Texas Health Sciences Center, San Antonio. She is a full-time clinician who devotes significant additional time to clinical research, focusing on complicated airway management, tracheostomy complications, dysphagia after anterior cervical spine surgery, recurrent respiratory papillomatosis, gender-affirming health care, and opioid-related research, among other topics. She was inducted into the American Laryngologic Association in 2020, the Triological Society in 2019, and the American Bronchoesophageal Association in 2015.

Alexander Gelbard, MD

Co-Director

Vanderbilt Center for Complex Airway Reconstruction (AeroVU)

Dr. Gelbard is a board certified Otolaryngologist at Vanderbilt University in Nashville Tennessee specializing in adult laryngeal and tracheal disease. He completed his undergraduate education at Stanford University, medical school at Tulane School of Medicine, and internship and residency at the Baylor College of Medicine in Houston Texas. Dr. Gelbard completed a postdoctoral research fellowship in Immunology at the MD Anderson Cancer Center as well as a clinical fellowship in Laryngeal Surgery at Vanderbilt School of Medicine. He has authored numerous peer-reviewed articles and book chapters and lectures internationally on adult airway disease. He currently is Co-director of the Vanderbilt Center for Complex Airway Reconstruction (AeroVU). Additionally, he is a NIH-funded principle investigator studying the immunologic mechanisms underlying benign laryngeal and tracheal disease. He is also PI of an externally funded prospective multi-institutional study of idiopathic subglottic stenosis (iSGS) and managing director of the North American Airway Collaborative (NoAAC). NoAAC is a funded, multi-institutional consortium with 40 participating centers in the United States and Europe that works to exchange information concerning the treatment of adult airway disease. It is composed of outstanding collaborators who pursue a unique combination of genetic, molecular, and epidemiologic based approaches to investigate the critical factors underlying the pathogenesis and outcomes of laryngotracheal stenosis.

Taner Yilmaz, MD

Professor of Otolaryngology-Head & Neck Surgery

Hacettepe University Faculty of Medicine, Ankara, Turkey

Dr. Yilmaz has worked in laryngology since 2000. He is a member of ELS, ALA and IAP, publishing 94 international manuscripts which received 1100 citations. On top of those achieveiments, he also has two patents for a laryngoscope for arytenoidectomies and an epiglottis holding forceps for grasping a floppy epiglottis that folds inside the larynx during larygoscopy.

Edward J. Damrose, MD, FACS

Professor of Otolaryngology-Head & Neck Surgery

Stanford University School of Medicine

Dr. Damrose is Professor of Otolaryngology/Head and Neck Surgery and (by courtesy) of Anesthesiology, Perioperative & Pain Medicine in the Stanford University School of Medicine. He is the founding Chief of the Division of Laryngology and Program Director of the Stanford Fellowship in Laryngology & Laryngeal Surgery. He is member of the American Laryngological Association as well as the Triological Society, and has authored or coauthored more than 80 peer reviewed publications and 16 book chapters.

Kate Heathcote, MBBS, FRCS

Consultant Laryngologist

University Hospitals Dorset

Kate Heathcote established the Robert White Centre for Airway, Voice and Swallow to provide a comprehensive diagnostic and treatment service. She has lectured and trained surgeons nationally and internationally in cutting edge laryngology techniques.

Phillip Song, MD

Division Director in Laryngology

Imperial College LonMassachusetts Eye and Ear Infirmary

Dr Song is the Division Director of Laryngology at Massachusetts Eye and Ear Infirmary and Assistant Professor of Otolaryngology and Head and Neck Surgery at Harvard Medical School. He specializes in laryngology with a special interest in neurolaryngology and central airway disease.

Brianna Crawley, MD

Associate Professor, Co-Director

Loma Linda University Voice and Swallowing Center

Dr. Crawley is a board-certified otolaryngologist and member of the Academy of Otolaryngology- Head and Neck Surgery, the ABEA, and the post-grad ALA. Her interests include neurolaryngology, swallowing disorders, performing voice and the surgical airway. She continues to work in new fields of research focusing on presbylarynx and presbyphonia, neurolaryngology, and understanding the patient experience.

Ramon Franco Jr, MD

Medical Director, Voice and Speech Lab, Senior Laryngologist

Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston MA, USA

Dr. Ramon Franco is a board-certified laryngologist who specializes in voice, swallowing, and breathing disorders. His main areas of expertise are in the diagnosis and treatment of voice disorders, airway stenosis, laryngeal cancer, and neurological disorders affecting the voice box. He also has special interests in the medical and surgical care of the professional voice. He serves as an Executive Board Member for the Massachusetts Society of Otolaryngology and is a fellow for the Triological Society and the American Laryngological Association.

Clark A. Rosen, MD

Co-Director / Chief - Division of Laryngology

UCSF Voice and Swallowing Center

Clark Rosen, MD is a Co-Director of the UCSF Voice and Swallowing Center, Chief of the Division of Laryngology, Professor of Otolaryngology-Head and Neck Surgery and the F Lewis Morrison MD Endowed chair of Laryngology. Dr. Rosen inaugurated modern laryngology at the University of Pittsburgh beginning in 1995 creating a dedicated center of excellence in Laryngology: University of Pittsburgh Voice Center. Dr. Rosen originated the outstanding Fellowship in Laryngology and Care of the Professional Voice at the University of Pittsburgh in 2002 and trained over 15 fellows in Larynogology and numerous visiting Otolaryngologists until 2018. He is now the director of the Laryngology fellowship at the UCSF Voice and Swallowing Center. Dr. Rosen has been a sought after speaker internationally and has had major service to multiple publications and professional societies. He is a founding member of the Fall Voice Conference, was the Vice Chair of the Annual Meeting Program Committee for the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS), and was the Treasurer of the American Laryngological Association (ALA) and is now president of the ALA.

Meet our Presenters for Day 2!

The International Adult Airway Symposium is coming up this weekend! For more information view the itinerary or register here!

Dr. Vyvy Young

Associate Professor and the Associate Residency Program Director in the Department of Otolaryngology-Head and Neck Surgery

University of California – San Francisco

VyVy Young, MD, is an Associate Professor and the Associate Residency Program Director in the Department of Otolaryngology-Head and Neck Surgery at the University of California – San Francisco. Dr. Young received her undergraduate and medical degrees from the University of Louisville, in Louisville, Kentucky, where she also pursued her Otolaryngology training. She then completed a fellowship in Laryngology and Care of the Professional Voice at the University of Pittsburgh Voice Center. She currently serves the American Academy of Otolaryngology – Head and Neck Surgery as member of the Annual Meeting Program Committee and Executive Committee for ENThealth.org. She is immediate past-chair of the Voice Committee and the Women in Otolaryngology Communications Committee and was recently selected as chair of the Finance and Audit Committee of the American Broncho-Esophagological Association.

Justin Roe, PhD, FRCSLT

Clinical Service Lead - Speech and Language Therapy – National Centre for Airway Reconstruction

Imperial College Healthcare NHS Trust

Dr. Roe is a clinical-academic and service lead, specialising in dysphagia in benign and malignant head and neck disease. He leads the speech and language therapy service for the National Centre for Airway Reconstruction at Imperial College Healthcare NHS Trust and is a consultant and service lead at the Royal Marsden NHS Foundation Trust. He is an Honorary Clinical Senior Lecturer at Imperial College London and an investigator on a number of NIHR portfolio studies. He is currently on an NIHR Imperial Biomedical Research Centre/ Imperial Health Charity funded post-doctoral research fellowship. He is an elected council member for the British Laryngological Association and British Association of Head and Neck Oncologists.

Professor Anil Patel MBBS PhD FRCA

Clinical Anaesthetist / Chairman of Department of Anaesthesia

Royal National ENT & Eastman Dental Hospital

Professor Anil Patel graduated from University College London in 1991. He is a clinical anaesthetist and continues to develop and refine the largest experience of anaesthetising adult airway patients under general anaesthesia (> 6,000 procedures) in the UK, probably Europe and possibly the world. His research interests include all aspects of shared airway and difficult airway management. Professor Patel has been an invited speaker to over 300 national and international meetings in 38 countries. He has over 130+ peer reviewed publications, 25 book chapters, over 4,500 citations and an h-index of 25.

Robbi A. Kupfer, MD

Associate Professor, Department of Otolaryngology-Head & Neck Surgery

University of Michigan

Dr. Kupfer is an Associate Professor of Otolaryngology-Head & Neck Surgery at the University of Michigan who specializes in Laryngology and Bronchoesophagology. She is the Program Director for the Laryngology Fellowship as well as the Otolaryngology Residency at the University of Michigan.

Alexander T. Hillel, MD, FACS

Associate Professor

Johns Hopkins University School of Medicine

Dr. Alexander Hillel is a Laryngologist, Residency Program Director, and Vice Director of Education in the Johns Hopkins Department of Otolaryngology – Head & Neck Surgery. His clinical practice and research centers on the treatment, prevention, and causes of laryngotracheal stenosis (LTS).

Dale Ekbom, MD

Associate Professor of Otolaryngology / Director of Voice Disorders/Laryngology

Mayo Clinic

Residency in Otolaryngology/Head and Neck Surgery at the University of Michigan with a fellowship in Laryngology/Care of the Professional Voice at Vanderbilt University Medical Center. Clinically specializing in voice, especially management of vocal fold paralysis, Zenker’s diverticulum and Cricopharyngeal muscle dysfunction, early laryngeal cancer, and airway compromise due to laryngeal, subglottic, and tracheal stenosis. Research interests include idiopathic subglottic stenosis and GPA with surgical and medical management of the airway, vocal fold paralysis, new injectables using Jellyfish collagen.

Dr. Ricky Thakrar

Consultant Chest Physician

University College London Hospital

Dr. Ricky Thakrar qualified in Medicine from Imperial College London. He trained in Respiratory Medicine at the Royal Brompton Hospital and completed his training in Northwest London. He was appointed to a three-year academic fellowship at UCL where his PhD examined state of the art bronchoscopy techniques for managing cancers arising in central airways and lung. He is a Consultant in Thoracic Medicine and his main interests are in interventional bronchoscopy procedures (laser resection, airway stenting, cryotherapy, photodynamic therapy and brachytherapy) for pre-malignant and malignant disease of the tracheobronchial tree.

Dr. Michael Rutter

Director of the Aerodigestive Center

Cincinnati Children's Hospital

Dr. Rutter is an ENT surgeon specializing in pediatric otolaryngology with an emphasis on airway problems in children, adolescents and young adults. His interests include tracheal reconstruction and complex airway surgery. Always a problem-solver, he strives to involve the patient in their own care by having them help evaluate the issue and then craft a solution together. He was drawn to his career by the challenge and highly individualized nature of pediatric airway problems and management. Dr. Rutter enjoys working in a multidisciplinary team setting and focusing on coordinated care for complex childhood airway conditions. He was honored to receive the 2016 Gabriel Frederick Tucker Award from the American Laryngological Association, and the 2018 Sylvan Stool Teaching Award from the Society for Ear Nose and Throat Advancement in Children (SENTAC). These awards are for his contributions to the field of pediatric laryngology. In addition to caring for patients, he is also dedicated to his research trying to find improvements in airway management.

Christopher T. Wootten, MD, MMHC

Director, Pediatric Otolaryngology—Head and Neck Surgery

Vanderbilt University Medical Center

Dr. Wootten has a longstanding interest in surgical management of congenital and acquired airway disorders.  To better equip himself to lead the Pediatric ENT service through expansion, evolution of practice models, and differentiation into multidisciplinary care, Dr. Wootten obtained a Masters of Management in Health Care at Vanderbilt’s Owen School of Business in 2017.  Areas of his professional research emphasis include airway obstruction in children and adults and aerodigestive care. He innovates minimally invasive surgical techniques in the head and neck.  Dr. Wootten is actively investigating the role of eosinophil and mast cell-based inflammation in the pediatric larynx.

Karla O'Dell, M.D.

Assistant Professor / Co-director

USC Voice Center, Caruso Department of Otolaryngology Head and Neck Surgery @ University of Southern California / USC Center for Airway Intervention and Reconstruction

Karla O’Dell, MD, specializes in head and neck surgery and disorders of the voice, airway and swallowing. She is cofounder and codirector of the USC Airway Intervention & Reconstruction Center (USC Air Center).

Jeanne L. Hatcher, MD, FACS

Co-Director of the Emory Voice Center and Associate Professor of Otolaryngology

Emory University School of Medicine

Dr. Hatcher has been at Emory since 2014 after completing her laryngology fellowship with Dr. Blake Simpson; she specializes in open and endoscopic airway surgery as well as voice disorders. Dr. Hatcher is a member of the ABEA and post-graduate member of the ALA and also serves on the Ethics and Voice Committees for the American Academy of Otolaryngology Head and Neck Surgery.

Mr. Lee Aspland

Patient / Freelance Artist

Lee Aspland Photography

Lee Aspland is a photographer, author and mindful practitioner who creates photography that reflects his feelings about living in such a glorious world. He specializes in Mindful Photography, capturing a fleeting feeling or thought, a hope or fear, a frozen single moment in time.

Gemma Clunie, MSc, BA (Hon), MRCSLT

Clinical Specialist Speech-Language Pathologist (Airways/ENT) and HEE/NIHR Clinical Doctoral Research Fellow

Imperial College Healthcare NHS Trust/ Imperial College London, Department of Surgery & Cancer

Gemma is a Clinical Specialist Speech and Language Therapist with an interest in voice and swallowing disorders that is particularly focused on the benign ENT, head and neck, respiratory and critical care populations. Gemma is a current NIHR/HEE Clinical Doctoral Research Fellow at Imperial College London. Her PhD studies focus on the voice and swallowing difficulties of airway stenosis patients. She is based at Charing Cross Hospital in London where she has worked for the last six years as part of the National Centre for Airway Reconstruction, Europe’s largest centre for the management of airway disorders.

Niall C. Anderson, CPsychol, MSc, BSc

Lead Psychologist (formerly Respiratory Highly Specialist Health Psychologist)

Bart's Health NHS Trust (formerly Central & North West London NHS Foundation Trust)

Niall is a HCPC Registered & BPS Chartered Practitioner Health Psychologist, and BPS RAPPS Registered Supervisor. Niall has specialist experience of working within healthcare systems with people with long-term health conditions at all system levels to support physical, psychological and social wellbeing. Niall worked in the Airway Service at Charing Cross Hospital (London, UK) between January-December 2021 in order to develop and implement the Airway Psychology Service.

Introducing a Two-Part Sialendoscopy Series!

Brought to you by our partnership with Cook Medical, we are having a two-part series on Sialendoscopy. The sessions will feed into one another, the first covering basics like a review of instrumentation and set up, as well as some of the most basic interventions you will see.

The second session will assume a basic knowledge of the procedure and will deal with complex interventions including both endoscopic and combined open procedures, advanced radiology, and complication management for revision surgery and in-office procedures.

Meet the Course Directors!

Rohan R. Walvekar, MD

Assistant Professor in Head Neck Surgery

University of Pittsburgh/VA Medical Center

Rohan R. Walvekar, MD, earned his doctoral degree from the University of Mumbai. After graduating in 1998, he completed a residency in Otolaryngology and Head Neck Surgery at the TN Medical College & BYL Nair Charitable Hospital, Mumbai, India, with triple honors. Subsequently, he completed two head neck surgery fellowships, and trained at at the Tata Memorial Hospital, Mumbai, which is India's most prestigious cancer institute. After completing an Advanced Head Neck Oncologic Surgery fellowship at the University of Pittsburgh, he became an Assistant Professor in Head Neck Surgery within the Department of Otolaryngology Head Neck Surgery at the University of Pittsburgh/VA Medical Center, prior to joining the LSU Health Sciences Center in July 2008. His clinical interests are head neck surgery and salivary endoscopy. His research interests include evaluating prognostic markers and clinical outcomes of head and neck cancer therapy and treatment of salivary gland disorders.

Barry M Schaitkin, MD

Professor of Otolaryngology

UPMC Pittsburgh

Dr. Schaitkin specializes in the treatment of inflammatory and neoplastic conditions of the salivary glands. He practices at UPMC in the Department of Otolaryngology and is affiliated with UPMC branches all across the city of Pittsburgh. He completed his medical degree and residency at Pennsylvania State University College of Medicine.

Meet the Presenters!

Jolie Chang, MD

Associate Professor, Chief of Sleep Surgery and General Otolaryngology

University of California, San Francisco

Dr. Chang specializes in sleep apnea surgery and minimally invasive approaches to the salivary duct with sialendoscopy. She has interest in studying patient reported outcomes after sialendoscopy procedures.

Mark Marzouk, MD

Clinical Associate Professor of Otolaryngology - Head and Neck Surgery

SUNY Upstate Medical University

Dr. Marzouk completed his residency training in 2010 from the UPMC Department of Otolaryngology. He is currently the Division Chief of Head and Neck Oncologic Surgery in Syracuse. He is also the Associate Program Director of Residency Programs.

David W. Eisele, MD. FACS

Andelot Professor and Director - Department of Otolaryngology-Head and Neck Surgery

Johns Hopkins University School of Medicine

Dr. Eisele is the Past-President of the American Board of Otolaryngology- Head and Neck Surgery and a member of the NCCN Head and Neck Cancer Panel. He has served as a member of the Residency Review Committee for Otolaryngology, as Chair of the Advisory Council for Otolaryngology - Head and Neck Surgery for the American College of Surgeons, President of the American Head and Neck Society, and as Vice-President of the Triological Society. He served as President of the Maryland Society of Otolaryngology and is a former Governor of the American College of Surgeons.

M. Boyd Gillespie, MD, MSc, FACS

Professor and Chair

UTHSC Otolaryngology-Head and Neck Surgery

M. Boyd Gillespie is Professor and Chair of Otolaryngology-Head & Neck Surgery at University of Tennessee Health Science Center. He is a graduate of the Johns Hopkins University School of Medicine where he a completed residency and fellowship in Otolaryngology-Head & Neck Surgery. Dr. Gillespie earned a Masters in Clinical Research at the Medical University of South Carolina, and is board certified in Otolaryngology-Head and Neck Surgery and Sleep Medicine. He has published over 150 academic papers and is editor of the textbook Gland-Preserving Salivary Surgery: A Problem-Based Approach. He is a former Director of the American Board of Otolaryngology-Head & Neck Surgery (ABOHNS) and current member of the otolaryngology section of the Accreditation Council for Graduate Medical Education (ACGME).

M. Allison Ogden, MD FACS

Professor & Vice-Chair of Clinical Operations - Department of Otolaryngology

Washington University School of Medicine

Dr. Ogden is a Professor and Vice-Chair of Clinical Operations in the Department of Otolaryngology at Washington University School of Medicine. She graduated from the Washington University School of Medicine in 2002 and went on to complete her residency there as well in Otolaryngology in 2007. Her clinical interests include sialendoscopy, nasal obstructions, and hearling loss. In 2015 Dr. Ogden was listed in "Best Doctors in America", an honor that continues to this day.

Arjun S. Joshi, MD

Professor of Surgery

The George Washington University School of Medicine & Health Sciences

Arjun Joshi, MD is board-certified in Otolaryngology and Head & Neck surgery by both the American Board of Otolaryngology – Head and Neck Surgery and the Royal College of Physicians and Surgeons of Canada. Dr. Joshi received his medical degree from the State University of New York at Syracuse and completed his residency at The George Washington University Medical Center. His areas of expertise include: Head and Neck Cancer, Head and Neck Masses, Head and Neck Reconstruction, Thyroid and Parathyroid Surgery, and Salivary Endoscopy.

Henry T. Hoffman, MD

Professor of Otolaryngology / Professor of Radiation Oncology

University of Iowa Healthcare

Dr. Henry T. Hoffman is an ENT-otolaryngologist in Iowa City, Iowa and is affiliated with University of Iowa Hospitals and Clinics. He received his medical degree from University of California San Diego School of Medicine and has been in practice for more than 20 years.

David M. Cognetti, MD, FACS

Professor and Chair of Department of Otolaryngology-Head & Neck Surgery

Thomas Jefferson University

Dr. Cognetti received his BS in Biology from Georgetown University and his MD from the University of Pittsburgh School of Medicine. He completed a residency in Otolaryngology – Head and Neck Surgery at Thomas Jefferson University before completing a fellowship in Advanced Head and Neck Oncologic Surgery at the University of Pittsburgh Medical Center. Dr. Cognetti returned to Jefferson, his professional home, as faculty in 2008.

Physician perspectives: Sialendoscopy during COVID-19

COVID-19 has changed the way that physicians are thinking about patient care, forcing them to adapt to new technologies and protocols. It has also given physicians the opportunity to think about the future of medicine, including what it may look like after COVID-19. Through this blog series, we’re interviewing physicians to share their first-hand experiences on how they’re adapting their practices during the COVID-19 pandemic, as well as their thoughts on the future of patient care.

We interviewed Rohan R. Walvekar, MD, to get his perspective on patient care and what the future of sialendoscopy procedures may look like during the COVID-19 pandemic. Dr. Walvekar is the Director of Salivary Endoscopy Service and the Co-Director of ENT Service University Medical Center in the department of Otolaryngology Head & Neck surgery at the Louisiana State University Health Sciences Center in New Orleans, Louisiana.

Below are some highlights of the interview. For the full interview, download the PDF here.

The future of sialendoscopy procedures

How have sialendoscopy procedures changed to adapt to COVID-19 in your practice?

COVID-19 has definitely changed our practice patterns, especially for outpatient services. Many of the otolaryngology procedures, including sialendoscopy, are now considered high-risk since they are aerosol-generating procedures (AGPs). Patients who need an interventional procedure, whether it is a routine flexible endoscopy as a normal part of a head and neck examination during their visit or an interventional sialendoscopy procedure, are now required to have a COVID-19 test within 48 to 72 hours of their in-office procedure, since these are all considered to be AGPs. Some of our clinic spaces have been re-structured to provide negative pressure ventilation in the rooms. In-office AGPs are performed in these negative pressure rooms with proper PPE precautions. Many practices at some sites, including ours, have moved to the use of disposable scopes and equipment when possible for COVID-19-positive patients. Social distancing and its impact on triaging patients, the need for COVID-19 testing, and the need to use additional sterilization procedures to clean and turnover clinic rooms, e.g., UV light technology, has significantly reduced overall patient volumes in clinics. Some of these factors have also impacted surgical turnovers in the hospital setting, impacting surgical volumes. However, these precautions have been vital to help keep our patients, staff, and other healthcare professionals safe during this pandemic.

How will the procedural landscape for salivary gland treatment change?

The thought process for salivary intervention will be influenced by the COVID-19 status. For COVID-19-negative patients, the procedural landscape may remain the same. However, if the patient is COVID-19 positive, then the surgical intervention will be postponed until the patient is past the infective phase, i.e., after 14 days of quarantine and after demonstrating two successive COVID-19-negative tests. Or, if intervention is necessary, a gland excision route may be preferred for certain indications where intra-oral intervention may be complex and have a high risk of viral shedding—for example, an intermediate sized (5-6 mm) hilar stone in the submandibular gland that needs a combined approach procedure, laser fragmentation of hilar-intraglandular stones, or possibly an endoscopic management of high-grade diffuse stenosis. All of these conditions are surgical challenges.

It is more likely that procedures will move from in office to the operating room setting as the intervention is more controlled and measured. All healthcare professionals can take adequate PPE precautions, and once the patient is intubated, the risk of viral shedding decreases compared to an awake patient, who may cough, sneeze, or have a robust gag reflex.

Innovations will come in various ways to help the current situation. Innovations such as the ACE2-X solution could be helpful, if proven effective, to help reduce viral burden and make intervention safer. There are many new innovations, such as innovative techniques to perform examinations, negative pressure environments, and perforated face masks or helmets to allow ENT examinations.

Sialendoscopy products

Do you anticipate an increase in demand in Cook’s minimally invasive sialendoscopy products?

I do anticipate an increase in the demand for certain Cook products, especially the disposable access catheters and wire guides. There also may be an increase demand for the use of the SialoCath^® Salivary Duct Catheter, which may be considered for irrigation and washout procedures for chronic sialadenitis, radioactive iodine induced sialadenitis, and Sjogren’s syndrome. Dilation followed by only irrigation with saline, or antibiotics or steroids, or a combination thereof may be a less-invasive alternative to endoscopy and pose a reduced risk of contamination to the salivary endoscope. For centers equipped with negative pressure clinics, the ability to perform these procedures may help reduce the demand for operating room time, which is already reduced due to the requirement for resource management and PPE conservation.

In the full interview, Dr. Walvekar also answers the following questions:

The future of sialendoscopy procedures

• As otolaryngology procedures start back up, how quickly do you see sialendoscopy procedures returning?
• How have patient consultations and physical examinations changed?
• How have you implemented PPE into your practice?
• How are the examination rooms set up?
• How are you screening patients for COVID-19?
• We have heard of some physicians changing from betadine to chlorhexidine for prep prior to salivary and sialendoscopy procedures. Do you have any thoughts on this and the impact on COVID-19?
• How do you see hands-on educational courses adapting to further physician education?
• Will there be a shift away from surgical procedures?

Sialendoscopy products

• Do you anticipate an increased usage of the Advance^® Salivary Duct Balloon Catheter by bringing more stricture patients into the office and using ultrasound?
• Do you anticipate an increase in the preference of disposable sialendoscopy devices over reusable devices?

To learn more about Cook’s products for sialendoscopy, click here.

Dr. Walvekar is a paid consultant of Cook Medical.
The opinions expressed by Dr. Walvekar in this interview are his own, and not the opinions of Cook Medical, and represent his experience within his practice.

Source: Cook Medical

To hear more from Dr. Walvekar and his
colleagues, register for their webinars below:

Introducing our presenters for the upcoming Cleft Lip Revision webinar!

This webinar comes as the latest in a long line of installments dealing with the Cleft Palate. In this session, attendees will learn various tips and tricks to a successful cleft lip revision procedure. There will be a Q&A session to discuss common challenges and how to address them.

Meet the Course Directors

Meet the Presenters

Introducing our IPAS Course Directors!

The 2022 International Pediatric Airway Symposium is coming up in two weeks! It's time to meet the people responsible for pulling together such an amazing group of surgeons: Our Course Directors!

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