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We found 60 results for Endoscopy in video, leadership, webinar & news

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Hypoglossal Nerve Stimulator Implantation: 2-Incision Technique
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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.

Reoperative Laparoscopic Anti-Reflux Surgery
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Contributors: Marco P. Fisichella 65 year old man who underwent a laparoscopic Nissen fundoplication in August 2015. Preoperative manometry was normal and DeMeester score was 25. Two months later he began to experience difficulty of swallowing solid foods, then liquids. After 2 dilatations, dysphagia persisted. DOI#: http://dx.doi.org/10.17797/egw2097cpq Referred By: Jeffrey B. Matthews

Per Oral Endoscopic Myotomy (POEM) for Zenker's Diverticulum
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In contrast to major thoracic operations, per oral endoscopic myotomy for Zenker's diverticulum offers the possiblity to resect a symptomatic Zenker's under monitored anesthesia care (MAC) for patients to ill to undergo general anesthesia. Patients have similar functional results when compared to small Zenker's treated with traditional operative approaches. DOI# http://dx.doi.org/10.17797/f3gyzc3k95

Nasal Encephalocele: Endoscopic Surgery
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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
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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.

Laparoscopic Paraesophageal Hernia Repair
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Contributors: Reza Salabat and Marco P. Fisichella Preoperative work-up and surgical technique of laparoscopic paraesophageal hernia repair. DOI#: http://dx.doi.org/10.17797/c2kvm64ru5

Gastric Sleeve Obstruction From Adjustable Gastric Band Capsule
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The field of metabolic and bariatric surgery has recently switched from laparoscopic gastric banding (LGB) to laparoscopic sleeve gastrectomy (LSG) as the procedure of choice for weight loss surgery. As LGB has been replaced with LSG many patients who had complications with LGB or failed to loose a satisfactory amount of weight with LGB have had a conversation from their band to a sleeve gastrectomy. Meticulous dissection takes place when removing a band, as the fibrotic scar capsule that surrounds the band must be resected in its entirety to avoid staple firings across fibrotic tissue rather than healthy gastric tissue. In addition to ensuring a healthy staple line by resecting the fibrotic capsule, we present a case where the band capsule was thought to be removed however was incompletely dissected and caused a postoperative strictured proximal stomach with complete PO intolerance. For this reason, we routinely perform intra-operative endoscopy to ensure the lumen of the stomach is patent prior to staple firing to complete the sleeve gastrectomy in band to sleeve patients. DOI#: http://dx.doi.org/10.17797/19tn2xjdda

Endoscopic Tympanoplasty
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Transcanal endoscopic tympanoplasty is illustrated with steps explained. This is a "realistic" case with bleeding and middle ear adhesions; tips to overcome these hurdles are discussed. DOI# http://dx.doi.org/10.17797/atpw43so2e Editor Recruited by: Ravi N. Samy

Combined Modality: Laparoscopic Assisted Colonoscopic Polypectomy
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Laparoscopic assisted colonoscopic polypectomy aids in the safe excision of otherwise unresectable polyps with colonoscopy alone due to unfavorable locations or polyp charicteristics. A combined procedure allows for laparoscopy to assist in polypectomy by providing traction on the luminal wall, the ability to recognize a full thickness perforation and perform a segmental resection without delay and to spare the patient from multiple exposures to anesthesia. DOI# http://dx.doi.org/10.17797/d04no64kyu

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

Endoscopic Balloon Dilation of Tracheal Stenosis
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A 16 year old presented with stridor three after being intubated for a week following a head injury. Endoscopy revealed a long segment tracheal stenosis in a subacute phase. The airway was sized with a uncuffed 3.5 endotracheal tube with a leak at 20cm of water.This stenosis was Grade 3 Cotton-Myer classification. A 12 mm Vascular balloon (Boston Scientific-Blue Max) was placed in the in the airway with direct visualization and was dilated at 20 atmospheres for about a minute. The patient was under general anaesthesia but spontaneously breathing throughout the procedure. The patient was sized to a 6.5 endotracheal tube with a free leak after the dilation. DOI: http://dx.doi.org/10.17797/n35d0ug41t

Endoscopic Drainage of a Severe Subperiosteal Abscess - Less is More
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An adolescent male presented with a few day history of right eye swelling, erythema, and edema. The eye swelling was determined to be a result of subperiosteal abscess of the medial orbit, as seen on imaging. The vision was progressively getting worse and the decision was made to urgently take the patient to the operating room. The surgical indications are at times controversial but include decreased range of motion of the eye as well as loss of vision/color discrimination. This patient only had markedly decreased range of motion of the eye. The patient was taken to the operating room; afrin pledgets were placed and the middle turbinate was medialized. At this time the edema and swelling of the ethmoid sinuses was evident. The traditional teaching is to remove the ethmoid air cells and open up the lamina papyrecea. For the past several years, the author has adopted a less is more approach - where the author opens up the ethmoid sinuses and exposes the lamina to allow the pus a route of egress. This video clearly epitomizes the less is more approach. The ethmoid cells have been opened up and there is a large route of egress for the pus which is under pressure. The video demonstrates that upon palpation of the right eye (the Stankiewicz maneuver), there is a massive amount of pus that drains out. The child recovered expeditiously. Endoscopic sinus surgery is an area where is there significant potential for errors and complications - especially inadvertent injury to the eye and brain. As such, the author believes that in some cases, a less is more approach ultimately benefits the patient. DOI: http://dx.doi.org/10.17797/13t22bikb2

Orbital Fat Intentional Exposed Endoscopically
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The mystery of orbital fat should not be so intimidating. The surgical mantra for chronic rhinosinusitis is to not expose orbital fat, however in specific instances it is imperative to take down the lamina papyracea to expose the orbital fat. Instances where this would be necessary would be for infections, tumors, orbital decompression as well as others. Specifically in this case, we surgically opened the maxillary antrum and took down the anterior ethmoid air cells. From here, we dissected laterally to the lamina papyracea and opened up the lamina where the orbital fat is exposed. This video shows that when you compress on the orbit the orbital fat moves and is displaced towards the path of least resistance in this case the opened up lamina and hence the fat moves towards the ethmoid air cells (ie medial). DOI: http://dx.doi.org/10.17797/wmjp1t36k5

Fully Laparoscopic Total Gastrectomy with Double Staple Anastomosis
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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

Skeeter Microdrill and Contact Laser Choanal Atresia Repair in Very Low Weight Newborns
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DOI: http://dx.doi.org/10.17797/zn1m3e9e41 Editor Recruited By: Sanjay Parikh, MD, FACS

Endoscopic Ampullectomy
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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

Endoscopic Ear Surgery - Incus Interposition for Traumatic Ossicular Discontinuity
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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

Laparoscopic-assisted Small Bowel Resection for Retained Endoscopic Capsule
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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

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

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

Transcanal Endoscopic Infracochlear Approach for a Petrous Apex Cholesterol Granuloma
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This video demonstrates a transcanal endoscopic infracochlear approach to the petrous apex in a patient with a large cholesterol granuloma. The patient presented with a history of profound left sensorineural hearing loss, hemifacial spasm, and House Brackmann Grade 2 facial function. Preoperative imaging demonstrated a T1 and T2 hyperintense heterogenous lesion in both petrous apices with the left being larger than the right on magentic resonance imaging. A computed tomography scan (CT) of the temporal bones demonstrates extension of the left petrous apex lesion into the internal auditory canal and cochlea. Dr. Isaacson has had 2 patients who have had significant recovery of their bone line after using an infracochlear approach. In the unlikely event that the patient experiences hearing loss in the other ear, their cochlea is preserved for a possible CI. However, the patients hearing loss is likely secondary to the 8th nerve involvement of cholesterol granuloma erosion into IAC. The patient in this surgical video has been monitored for a year. One year postop CT shows aeration of the apex. This patient's facial spasm has resolved. Dr. Isaacson has used stents in the past, but in this case felt the opening was large enough that he could forego it. Patient did not recover their hearing. DOI: http://dx.doi.org/10.17797/1wq11j68wa

Endoscopic Excision of Nasolacrimal Duct Cyst
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The patient is a 4 week old female infant with right sided epiphora and complete right sided nasal obstruction resulting in respiratory and feeding difficulty.  Physical exam demonstrated a right medial canthal mass consistent with a dacrocystocele. Flexible fiberoptic nasal endoscopy demonstrated an anterior nasal mass below the inferior turbinate occluding the entire right nasal cavity consistent with a nasolacrimal cyst. The etiology is obstruction at the level of Hassner's valve.

Mandibular Distraction for Micrognathia in a Neonate
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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

Superiorly Based Pharyngeal Flap for Velopharyngeal Dysfunction
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Velopharyngeal dysfunction (VPD) refers to the improper control of airflow through the nasopharynx. The term VPD denotes the clinical finding of incomplete velopharyngeal closure. Other terms used to describe VPD include velopharyngeal insufficiency, inadequacy and incompetence. However, the use of VPD has gained popularity over these terms as they may be used to infer a specific etiology of impaired velopharyngeal closure.1 Control of airflow through the nasopharynx is dependent on the simultaneous elevation of the soft palate and constriction of the lateral and posterior pharyngeal walls. Disruptions of this mechanism caused by structural, muscular or neurologic pathology of the palate or pharyngeal walls can result in VPD. VPD can result in a hypernasal voice with compensatory misarticulations, nasal emissions and aberrant facial movements during speech.2 The assessment of velopharyngeal function is best preformed by a multispecialty team evaluation including speech-language pathologists, prosthodontists, otolaryngologists and plastic surgeons. The initial diagnosis of VPD is typically made with voice and resonance evaluation conducted by a speech-language pathologist. To better characterize the patient’s VPD, video nasopharyngeal endoscopy or speech videofluoroscopy can be used to visualize the velopharyngeal mechanism during speech. VPD may first be managed with speech-language therapy and removable prostheses. For those who are good surgical candidates and do not fully respond to speech-language therapy, surgical intervention may be pursued. Surgical management of VPD is most commonly accomplished by pharyngeal flap procedures or sphincter pharyngoplasty. In this video, a superiorly based pharyngeal flap with a uvular mucosal lining flap was preformed for VPD in a five-year-old patient with 22q11 Deletion Syndrome and aberrantly medial internal carotid arteries.

Endoscopic Assisted Laparoscopic Transgastric Division of a Gastroesophageal Fistula in an Adolescent
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This video describes division of a gastroesophageal fistula in a 16 year old female with a history of prior Nissen fundoplication and gastrostomy tube placement as an infant. She presented to our clinic with progressive dysphagia and epigastric pain over a 2 month period. Initial attempts were made to divide the stapler using only a 12mm transgastric port at the prior gastrostomy site for the stapling device and an endoscope for visualization. Ultimately division required placement of an additional 5mm transgastric port for a laparoscope. Using both endoscopic and laparscopic visualization, the fistula was able to be divided using a standard laparoscopic stapler. At the completion of the procedure, the 5mm gastrotomy was closed and a gastrostomy tube was placed at the 12mm trocar site, which was then removed 2 months later. The patient's dypshagia improved after the procedure and her gastrostomy tube site closed without event.

Combined drainage of subperiosteal orbital abscess complicating ethmoiditis
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A 4 year-old boy presented to our tertiary center with acute left ethmoiditis and a subperiosteal orbital abscess. He presented with exophtalmia but had no visual impairment or limitation of ocular mobility. CT-scan found a 8 mm large subperiosteal orbital abscess with no further complications. Surgery was decided using a combined approach to drain the abscess and to obtain a bacterial sample: first external (incision in the inner canthus area) and then endonasal (functional endoscopic sinus surgery - FESS) to open the middle meatus and ethmoid. External approach: 10 mm incision in the inner canthus region, elevation of the lamina papyracea periosteum until the abscess was reached. Rubber drain was put in place for irrigation. Endonasal approach: after careful CT-scan examination, endonasal surgery was performed with a 30° rigid endoscope. The middle turbinate was medialised to expose the middle meatus, uncinectomy and antrostomy followed by anterior and posterior ethmoidectomy was performed. Antibiotics were given intravenously for 5 days and saline irrigation on the drain was performed during 2 days. Patient was discharged after 5 days.

EFFECTIVE REMOVAL OF A PEDIATRIC EMBEDDED ESOPHAGEAL FOREIGN BODY
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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.

Fully Endoscopic Uniportal Interlaminar Microdiscectomy
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The conventional approach to the lumbar discectomy requires significant tissue dissection to obtain a sufficient working space and is known to cause possible complications and injuries. The minimally invasive, fully endoscopic uniportal interlaminar discectomy provides numerous advantages to the typical open procedure. Some advantages include: good visualization of anatomical structures utilizing continuous lavage; lower rates of operative complications such as dural injury, bleeding, and infection; and shorter hospitalization, with increased post-operative rehabilitation. Surgical procedure utilizes guided fluoroscopy to gain access to the interlaminar window, with subsequent placement of the working channel endoscope. Microscopic debridement of herniated lumbar disc and decompression of nerve roots is conducted. This case highlights a patient with significant disc herniation at the L5-S1 level with concurrent mild to moderate cervicothoracic scoliosis. The patient elected for the minimally invasive, fully endoscopic interlaminar microdiscectomy. Authors: William Fuell, Eylem Ocal M.D., Salih Aydin M.D. Institutions: Emsey Hospital-Istanbul, Arkansas Children’s Hospital

How to Perform Salivary Gland Massage: Instructional Video
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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.

Inferior Turbinate Trim
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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

Closure of H-type tracheoesophageal fistula
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We present the case of a 20 months old boy with developmental delay and chromosomal abnormality, who presented with a history of chronic aspiration. He was found to have a laryngeal cleft, which was injected with Prolaryn, then formally repaired, twice. Despite an initial a negative swallow study, the patient had persistent aspiration. A repeat direct laryngoscopy and bronchoscopy finally revealed the presence of an H-type tracheoesophageal fistula (TEF). We describe here the steps of the surgical repair of an H-type tracheoesophageal fistula.

Endoscopic Stapedotomy (2:55)
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Stapedotomy is used to treat conductive hearing loss caused by a fixed stapes footplate. The procedure is traditionally performed via a surgical microscope. In recent years an endoscopic approach has been increasingly utilized due to several advantages that it offers over the microscopic approach, chiefly the excellent visualization of middle ear structures provided by the endoscope. In this video we describe our technique for stapedotomy via an endoscopic approach.   This surgery was performed by James Prueter, DO, of Southwest Ohio ENT Specialists in Dayton, OH.   Video editing was performed by Wesley Greene, MS-4 Wright State University Boonshoft School of Medicine with assistance from Britney Scott, DO, PGY-3 Kettering Health Network Otolaryngology Surgery.

Endoscopic Tympanoplasty with Tragal Cartilage Graft in a Pediatric Patient (3:54)
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Tympanoplasty is used to repair persistent perforations of the tympanic membrane. The procedure has traditionally been performed via a surgical microscope. In recent years an endoscopic approach has been increasingly used due to several advantages that it offers over the microscopic approach, chiefly the excellent visualization of middle ear structures provided by the endoscope. In this video we describe our technique for endoscopic tympanoplasty using a tragal cartilage graft in a pediatric patient.   This surgery was performed by James Prueter, DO, of Southwest Ohio ENT Specialists in Dayton, OH.   Video editing was performed by Wesley Greene, MS-4 Wright State University Boonshoft School of Medicine with assistance from Britney Scott, DO, PGY-3 Kettering Health Network Otolaryngology Surgery.

Sphenopalatine Artery Ligation
video

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.

Endoscopic Frontal Sinusotomy with Osteoma Removal
video

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.

Orbital Floor Endoscopy 1
video

This video shows orbital floor repair via a trans-sinus approach and orbital floor reconstruction with porous polyethylene.

Nasopharyngeal Papillomatosis- A combined Transnasal Transoral Coblation Assisted Approach
video

Title: Nasopharyngeal Papillomatosis- A combined trans nasal transoral coblation assisted approach Authors - 1. Dr Deepa Shivnani- corresponding author MBBS, DNB Otolaryngology , MNAMS, Fellowship in Pediatric Otolaryngology Children’s Airway & Swallowing Center Manipal Hospital, Bangalore , India email- deepa.shivnani14@gmail.com 2. Dr E V Raman MBBS, DLO , MS Otorhinolaryngology Children’s Airway & Swallowing Center Manipal Hospital, Bangalore Here I am presenting a case of 16 yrs old boy, who had nasal block and occasional cough. Nasal endoscopy revealed an exophytic papillomatous growth in the nasopharynx. MRI showed lesion arising from the nasopharyngeal surface of the soft palate. The lesion was free from the posterior pharyngeal wall. The patient was taken up for the procedure under general anaesthesia. The transoral approach was followed first. The tissue was taken for histopathological examination followed by a traction suture placed over uvula for better visualisation. Once exposed, coblation device was used transorally with 45 degree hopkins rod transorally. The tissue was ablated with coblation and coagulation settings of 9:5 respectively. The base was ablated too, to prevent further recurrence. Tonsillar pillar retractor was then used for better visualisation and exposure. The coblation was then continued. The tissue was removed transorally as much as possible then trans nasal approach was performed. Then, the same coblation device with the same setting was used but the nasal endoscope was changed to O degree Pediatric scope due to space constraints. The lesion was pushed upward with the help of yankaurs suction tip for better exposure and the remaining tissue was removed with the help of same coblation device. The lesion was excised completely and successfully with minimal blood loss. The operative area was confirmed with the 70Degree hopkins rod for complete removal of the lesion. Post operative recovery was uneventful. Combined transoral trans nasal coblation assisted approach is potential to be safer, easier and less invasive than uvulo palato pharyngoplasty in Pediatric age group specially, in the areas which are difficult to access like nasopharyngeal surface of the soft palate what we showed in this video.

CAC (Coblation Assisted Cordectomy) in Bilateral Vocal Cord Palsy- Tips & Tricks
video

CAC (Coblation Assisted Cordectomy) in Bilateral Vocal Cord Palsy –tips & tricks Here, we have a 39 yrs old female with complaints of noisy breathing for last two years post thyroidectomy. Flexible laryngoscopy confirmed bilateral vocal cord paralysis. She was planned for coblation assisted cordectomy. Patient was taken up for procedure under general anaesthesia. She also started having stridor after induction. Nasopharyngeal intubation with spontaneous breathing technique was used. Entropy leads were placed over forehead to monitor the depth of anaesthesia. Tube position was confirmed with endoscopic view and Benjamin lindohlm laryngoscope was suspended. As the patient was spontaneously breathing, the stridor became more prominent, with stable vitals and the procedure was continued. The vocal cord retractor was fixed and coblation wand was then used with 7:3 settings for ablation and coagulation respectively. The surgical limits were-anteriorly the junction between ant 2/3 and post 1/3 of the vocal cord, posteriorly just anterior to the vocal process of arytenoid to prevent cartilage exposure and post operative granulations. Superely till the ventricle and inferioly till the medial most surface of the subglottis. Laterally approx. 5 mm depth was defined to prevent injury to the superior laryngeal artery branch and further bleeding. Once the final airway was achieved , the topical lignocaine was used to prevent laryngeal spasm post extubation. The patient was shifted to the ward without oxygen, the voice was assessed on post op day 2. Patient was called for follow up on post op day 14th and good voice outcomes were achieved. So lets have a look on some tips & tricks for the safe procedure----- Nasopharyngeal insufflation technique with entropy monitor will give adequate and safe surgical field 2. Appropriate exposure will help you to delineate the surgical margins 3. Topical anaesthesia before and after the procedure will prevent sudden laryngeal spasm 4. Firm holding of coblation device will help to prevent injury to surrounding structures like anterior 2/3 vocal cord, opposite side vocal cord, medial surface of vocal cord or aryteroid posteriorly 5. Do not ablate more laterally to prevent bleeding, if at all it happens, use patties or coagulation switch for hemostasis. 6. And at the end of the procedure ,use catheter suction to suck out blood clots or saline from the airway if any…. To Conclude-Coblation Assisted Cordectomy( CAC) can be performed safely with good outcomes in case of bilateral vocal cord paralysis using tubeless anesthesia technique without tracheostomy ! Thank you for Watching

Single Incision Laparoscopic Surgical (SILS) Placement of an Adjustable Gastric Band
video

Contributors: Melissa Beitner and George Fielding This video shows a single incision laparoscopic surgical placement of an adjustable gastric band. DOI: https://doi.org/10.17797/jdzx4zu6s8

Donghang Huang’s procedure for thyroidectomy
video

Donghang Huang’s procedure, also termed as direct-access single-port endoscopy assisted mini-incision thyroidectomy, is a hybrid surgery conducted in the following 3 major steps: 1.A mini-incision of approximately 2.5-3 cm long on the central neck is made. A working space under the platysmal muscle or strap muscles for single-port endoscopic surgery is constructed with carbon dioxide insufflation (performed under direct vision). 2.Mobilization of the superior and inferior pole of the thyroid lobe, and exposure of the recurrent laryngeal nerve (performed under single-port endoscopy). 3.Extraction and resection of the thyroid lobe. (performed under direct vision). Donghang Huang's procedure can provide shorter incision and better cosmetic results while maintaining adequate exposure.

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

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

Endoscopic Management of a Duodenal Web
video

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

FB removal from Esophagus
video

Walaa Elfar, MD Upper endoscopy and esophageal FB removal chapters

leadership (2)

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Steven Scot Rothenberg, MD
leadership

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.

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Rohan R. Walvekar, MD
leadership

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.

webinar (9)

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Drug Induced Sleep Endoscopy (DISE): Pros and Cons
webinar

Symposium of International Sleep Surgery
Day 1: Session 4

  • History of DISE
  • DISE Procedure and Scoring
  • DISE for Sleep Surgery
  • Utility of DISE in other OSAS Treatment (Mandibular Advancement Device, CPAP)

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Advanced Salivary Endoscopy: Challenging Cases Diagnosis & Treatment
webinar

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.


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Beginning Salivary Endoscopy: Office and OR management
webinar

The basic course/webinar will cover surgical anatomy relevant to salivary endoscopy, will discuss indications for the procedure, discuss the evaluation of the patient and surgical workup including a decision-making process, and will review a variety of instrumentation, set up, how to perform a diagnostic procedure, as well as basic interventions. There will also be a Q&A session that will speak to the challenges of starting a sialendoscopy service, billing, and case presentations.

Meet all the presenters here!

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Pediatric Sleep Apnea: State of the Art 2020
webinar

Drs. Stacey Ishman, Christina Baldassari, Erin Kirkham, and Derek Lam explain the role of the sleep endoscopy procedure and review the importance of a sleep study for a surgeon. They will also look forward to the future trends in sleep apnea and discuss their thoughts with the audience.

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Pediatric Stridor: A Systematic Approach
webinar

Drs. Goh Bee-See, Hayley Herbert, Sohit Kanotra, and Ravi Thevasagayam highlight the diagnostic approaches of flexible and rigid endoscopy. They also review the various pathologies and classifications with the audience.

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Covid-19 Impact on Anesthesia and Aero-Digestive Surgeries
webinar

Please join us for an interactive webinar on a variety of topics related to COVID 19. Organized by the Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India and moderated by Dr. Jayanthy Pavithran, Dr. Deepak Mehta, and Dr. Kishore Sandu, this panel will discuss the following topics:

1. Practical tips for endoscopy and use of powered instruments. | Presented by Dr. Deepak Mehta, Director, Pediatric Aerodigestive center and Dr. Shasidhar Tatavarthy, Senior consultant, Head, Ent Head Neck surgery Artemis Hospitals, Delhi

2. Psychiatry and C19. | Presented by Dr. Kusum Kathpalia (NY State)

3. Covid 19: An anesthetist’s view point from its pathogenesis to future airway interventions. | Presented by Dr. Patrick Schoettker, Medecin Chef- Anesthesia department. Lausanne University Hospital. Switzerland

4. Airway surgeries during Covid times. | Presented by Dr. Kishore Sandu, Medecin Chef, ORL department, Lausanne University Hospital. Switzerland.

5. Albatross Cases In Airway. | Presented by Dr. EV Raman , Consultant ENT Surgeon, Convenor, Children’s Airway and Swallowing Center ( CASC),Manipal Hospital, Bangalore and Dr.Rakesh Srivastava, Senior Consultant (Laryngologist, Sushrut Institute of Plastic Surgery & Super speciality Hospital, Lucknow, India.

This webinar is geared towards: airway surgeons (adult & pediatric), laryngologists, ENT, anesthesiologists and phoniatricians (SLP).

For more info on the CSurgeries webinar series, please go to www.csurgeries.com

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Salivary Interactive Case Study
webinar

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



Rohan R. Walvekar, MD
Barry M. Schaitkin, 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.

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.

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Salivary Interactive Case Study: July
webinar

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



Rohan R. Walvekar, MD
Barry M. Schaitkin, 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.

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.

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Salivary Interactive Case Study: August
webinar

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



Rohan R. Walvekar, MD
Barry M. Schaitkin, 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.

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.

news (4)

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Meet our Presenters for Day 1!
news

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.


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CSurgeries is the place to be!
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February and March are full of high-quality webinars and events for you to attend. We’re excited to have some of the top doctors in their areas presenting on a number of different topics. Take a look and see what interests you!

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Introducing a Two-Part Sialendoscopy Series!
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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.


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Physician perspectives: Sialendoscopy during COVID-19
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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

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