The efficacy and safety of the flexible fiber CO2 laser delivery system in the endoscopic management of pediatric airway problems: Our long term experience

Lee, Gi Soo; Irace, Alexandra; Rahbar, Reza

doi:10.1016/j.ijporl.2017.04.005

Cited by 28 publications

(7 citation statements)

References 12 publications

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“…[8][9][10][11][12] Recent studies suggest that selected patients with this pathology may be able to be repaired endoscopically. 5,13 We present our experience caring for patients with type III LTEC laryngeal clefts with both endoscopic and open approaches. Early on in the series, the majority of patients were treated with an open approach.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Type III Laryngotracheoesophageal Clefts: Techniques and Outcomes

et al. 2021

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Objectives/Hypothesis Determine surgical and swallowing outcomes after surgery for type III laryngotracheoesophageal cleft (LTEC). Study Design Case series with chart review. Methods Chart review was performed on patients with type III LTEC between 2000 and 2019. Demographics, surgical outcomes, and swallowing outcomes were collected and analyzed. Results Thirty‐three patients met inclusion criteria (28 open and 5 endoscopic repairs). Mean age was 3.4 years for the open group and 0.9 years for the endoscopic group. Seventeen (51.5%) patients had a syndromic diagnosis, most commonly Opitz syndrome and Trisomy 21. Mean follow‐up was 33.6 months. Thirteen (39.4%) patients had a previous repair attempt prior to repair at our institution. Twenty‐four (70.6%) patients had a tracheostomy prior to or at the time of surgical repair and 13 (38.2%) remain tracheostomy‐dependent. Nine patients (27.3%) required a revision cleft repair and four (12.1%) required two revisions. Thirty‐one patients had an intact repair at last follow‐up (93.9). Two patients died outside the hospital over a year after surgery. Preoperatively 13 of 17 patients with swallowing evaluations aspirated. After repair, 11 of 20 patients were deemed safe for all consistencies and seven were safe for thickened. Endoscopic approaches were performed during the last 2 years of the study and had significantly lower operative time (354.4 minutes vs. 171.5 minutes). Conclusions Endoscopic and open approaches are effective for treatment of type III LTEC with 27.3% requiring revision and 93.9% of repairs intact at last follow‐up. Overall swallowing outcomes were good in patients who underwent postoperative instrumental swallow evaluation. Level of Evidence 4 Laryngoscope, 132:1112–1117, 2022

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Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Type III Laryngotracheoesophageal Clefts: Techniques and Outcomes

et al. 2021

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“…Literature on surveillance bronchoscopy for pediatric patients with tracheostomy is notable for the variable but high prevalence of suprastomal collapse and granulation (1.6%-18% and 17%-80%, respectively). [6][7][8][9][10][11] While some granulation tissue may resolve spontaneously, 6 others can be excised endoscopically with cold instruments or microdebrider, 22,23 potassium-titanium-phosphate (KTP) laser, 12,24 carbon dioxide (CO 2 ) laser, 25 or even open tracheoplasty. 12,22 Some of this variety is likely due to the evolution of endoscopic techniques over time.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Seattle Suprastomal Safety Score (5S): A Novel Measure in Pediatric Tracheostomy‐Dependent Patients

Pattisapu

Abts

Bly

et al. 2021

Otolaryngol.--head neck surg.

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Objective Suprastomal collapse and granulation are common sequelae of pediatric tracheostomy. We present the first measure of suprastomal obstructive pathology, the Seattle Suprastomal Safety Score (5S), an instrument with 2 domains: collapse and granulation. Study Design Cross-sectional repeated testing survey. Setting Electronic survey. Methods A library of images was assembled from still pictures of the suprastomal area in 50 patients who previously underwent trachea-bronchoscopy at a quaternary children’s hospital. Five pediatric otolaryngologists and 2 pediatric pulmonologists reviewed the images in random, blinded fashion and provided 5S scores. Participants repeated this process 2 to 4 weeks later. Interrater agreement was calculated with an intraclass correlation coefficient (ICC) with a 2-way random-effects model and Fleiss’s κ. Intrarater agreement was measured with an ICC using a 2-way mixed-effects model as well as with test-retest correlations using Spearman rank coefficient. All measures were performed separately on collapse and granulation domains. Results ICC for interrater agreement was 0.88 (95% CI, 0.82-0.93) for collapse and 0.97 (95% CI, 0.96-0.98) for granulation, indicating almost perfect agreement. Fleiss’s κ demonstrated moderate agreement for collapse and almost perfect agreement for granulation. ICC for intrarater agreement was 0.95 (95% CI, 0.93-0.97) and 0.99 (95% CI, 0.98-0.99) for collapse and granulation, respectively, indicating almost perfect agreement. Spearman rank correlation for test-retest demonstrated substantial agreement for collapse and almost perfect agreement for granulation. Conclusion The 5S demonstrates excellent interrater and intrarater agreement, making it highly reliable as a novel measure of suprastomal collapse and granulation in tracheostomy-dependent pediatric patients.

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“…Plot data from (Segelstein 1981) applications. The main advantages are the easy handling of the comparatively light fiber and the possibility to penetrate into the body through the mouth, nose, or other body orifices (Lee et al 2017). Lee et al (2017) also describe long-term experiences, and Policicchio et al (2019) explain microsurgical treatments of intraventricular tumors by fiber-guided CO 2 laser beams.…”

Section: Medical Applicationsmentioning

confidence: 99%

Optics and Apparatus for CO2 and CO Laser Micro-processing

Hohnholz¹,

Rettschlag²,

Desens³

et al. 2020

Handbook of Laser Micro- And Nano-Engineering

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Since their development, carbon monoxide and carbon dioxide lasers have found their indispensable place in industrial and medical applications as well as in research facilities. Since then, beam sources in the infrared range have further developed and combined with various components to exploit their full potential. In this chapter, we present an overview of the functions and applications of CO and CO 2 lasers, as well as suitable optics, materials, and coatings for spatial beam shaping, deflection, and methods for temporal beam modulation. Finally, we present typical micro-processing applications.

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The efficacy and safety of the flexible fiber CO2 laser delivery system in the endoscopic management of pediatric airway problems: Our long term experience

Cited by 28 publications

References 12 publications

Surgical Treatment of Type III Laryngotracheoesophageal Clefts: Techniques and Outcomes

Surgical Treatment of Type III Laryngotracheoesophageal Clefts: Techniques and Outcomes

Validation of the Seattle Suprastomal Safety Score (5S): A Novel Measure in Pediatric Tracheostomy‐Dependent Patients

Optics and Apparatus for CO2 and CO Laser Micro-processing

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