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We found 5 results for Children\'s Hospital of Pittsburgh in video

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Endoscopic Repair of Tracheal-bronchial Sinus Tract
video

Contributor: Deepak Mehta (Children's Hospital of Pittsburgh) Endoscopic Repair of Tracheal-bronchial Sinus Tract: Clinical History: 6 year-old female with a history of tracheal-esophageal fistula s/p repair at birth and a right sided aortic arch. She has a recent history of 6 episodes of pneumonia requiring hospitalization. She had a normal modified barium swallow exam. CT chest revealed a tract arising from the posterior carina. Operative Course: The patient was taken to the OR and using a 5.0 rigid ventilating bronchoscope we are able to easily visualize the tracheal bronchial sinus tract originating from the posterior carina. A flexible suction catheter was used to probe the tract. It extended approximately 1.5cm. Then using a Urologic Bugbee electrocautery, we de- epithelialized the tract. Next, Tisseel fibrin sealant was injected into the tract, closing it off. The bronchoscope was removed and the patient was admitted overnight for observation. She did well with no desaturations or complications and was discharged home on post op day #1. DOI: http://dx.doi.org/10.17797/nqf3kv0qyp

Injection Laryngoplasty for Type 1 Laryngeal Cleft
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Schools: Children's Hospital of Pittsburgh Injection Laryngoplasty for type 1 laryngeal cleft is done with first identifying the deep cleft by palpation of the interarytenoid notch. Once a confirmation is made the larynx is suspended with a laryngoscope. Radiesse voice gel is then primed in a laryngeal needle and the needle is placed at the apex of the cleft. The needle is then pushed to palpate the cricoid cartilage with the bevel of the needle pointing towards the esophageal surface. The needle is then slightly retracted and about 0.2 ml of voice gel is injected. Care is taken not to make multiple punctures and the subglottisis watched so that the injection does not inadvertently go into subglottis. DOI: http://dx.doi.org/10.17797/g5r116zy3n

Adenotonsillectomy: Basic Technique Using Electrocautery
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Contributors: Deepak Mehta (Children's Hospital of Pittsburgh of UPMC) Purpose: Adenotonsillectomy is a procedure removing the tonsils and ablating the adenoids. Most commonly this is performed when the tonsils and adenoids have become obstructive, causing sleep disordered breathing or sleep apnea, or are recurrently or chronically infected. Key Instruments: McIvor mouth gag, Curved and Straight Allis clamps, Monopolar electrocautery with insulated blade set at 15W for removal, suction monopolar cautery set at 35 for adenoidectomy and 20 for cauterization of the tonsillar fossa. Anatomical Landmarks: Anterior and posterior pillars of the tonsil, vomer, torus tubarius of the Eustachian tube. Procedure: Tonsillectomy begins by placing the McIvor mouth gag into the oral cavity. The soft palate is palpated to assess for submucous cleft palate. One tonsil is grasped with the Allis clamp and retracted medially. This allows identification of the lateral extent of the tonsil. A mucosal incision is made at or slightly medial to the lateral extent and the fascial plane is entered between the tonsil and the pharyngeal musculature. Continuing in this plane throughout the dissection, the tonsil is effectively removed. The posterior pillar must be preserved. Hemostasis of the tonsillar fossa is achieved using the monopolar electrocautery. The contralateral tonsil is removed similarly. Monopolar adenoidectomy is performed using indirect mirror visualization of the adenoid tissue. Suction electrocautery is used to ablate the adenoid tissue up to the posterior choana and lateral to the torus tubarius. Conflict of Interest: None DOI: http://dx.doi.org/10.17797/xaqg93x7hy

Epiglottopexy for Severe Laryngomalacia with Epiglottic Prolapse
video

Contributors: Deepak Mehta (Children's Hospital of Pittsburgh of UPMC) Laryngomalacia is the most common cause of stridor in newborn infants. The majority of cases resolve spontaneously. Common surgical therapy consists of division of the aryepiglottic folds combined with trimming of the arytenoid mucosa and/or cuneiform cartilages. Less frequently, epiglottopexy is required. Initially, flexible laryngoscopy illustrated prolapse of the epiglottis into the laryngeal lumen causing severe obstruction. Microlaryngoscopy, bronchoscopy, and supraglottoplasty (division of the aryepiglottic folds only) were performed, however improvement did not occur due to persistent epiglottic prolapse. Transoral epiglottopexy was performed. A Lindholm laryngoscope was used for exposure. A needle point cautery was used to remove the mucosa of the lingual surface of the epiglottis and the base of tongue. Alternatively, a carbon dioxide laser could used. 5-0 polydioxanone suture on a P-2 needle was to suspend the epiglottis to the base of tongue using 3 sutures. Photographs of the suspension conclude the procedure. DOI: http://dx.doi.org/10.17797/locmhv8x9q

Video Assisted Thoracoscopic Thymectomy Langerhans Cell Histiocytosis
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Contributors: Gary Nace, Juan Calisto and Marcus Malek Langerhans Cell Histiocytosis (LCH) is an exceedingly rare proliferative disorder in which pathologic histiocytic cells accumulate in nearly every organ. Our patient, a five-month-old, six kilogram female with mild pulmonary valve stenosis, had both thymic and lung tissue involvement. To date there has never been a report of a thymic LCH with lung metastases in an infant. She underwent a video assisted thoracoscopic thymectomy. DOI: http://dx.doi.org/10.17797/2qbbejhisy

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