BackTable / ENT / Podcast / Episode #21
Airway Surgery: What's in Your Toolbox?
with Dr. Laura Matrka, Dr. Mark Gerber and Dr. Romaine Johnson
We talk with Laura Matrka MD and Mark Gerber MD about their approaches to airway surgery, including endoscopic vs open, tips on technique, and the importance of communication in the OR.
BackTable, LLC (Producer). (2021, April 27). Ep. 21 – Airway Surgery: What's in Your Toolbox? [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Laura Matrka
Dr. Laura Matrka is an Assistant Professor of Otolaryngology at Ohio State University.
Dr. Mark Gerber
Dr. Mark Gerber is Division Chief of Otolaryngology, Head and Neck Surgery at Phoenix Children's Hospital.
Dr. Romaine Johnson
Dr. Romaine Johnson is a practicing ENT and Associate Professor at UT Southwestern Medical Center in Dallas, TX.
In this episode, Dr. Laura Matrka and Dr. Mark Gerber join Dr. Romaine Johnson and Dr. Gopi Shah to discuss airway surgery.
The evaluation of adult and pediatric patients requiring airway surgery is outlined. Key components include a thorough flexible scope exam, direct laryngoscopy/bronchoscopy and a detailed airway history. Deciding between an endoscopic and open approach depends on several factors including airway anatomy, surgical history, acuity of the procedure, and presence of a tracheostomy.
Dr. Matrka and Dr. Gerber review essential equipment for airway surgery - their “airway toolbox” – which can include a subglottic scope, bronchoscope, tracheoscope, or a drill depending on the extent of their procedure. The discussion then turns towards the selection of suture between PDS and Prolene. Dr. Johnson states that he has had less wound dehiscence, but more granulation tissue when using PDS as compared to Prolene.
Lastly, the panel describes technological improvements they would like to see in the coming years. All agree that new approaches to visualize what trainees are observing would significantly improve education and patient care. The panel concludes by discussing the importance of communication in the operating room, and the benefit of protocols in facilitating effective teamwork.
American Society of Pediatric Otolaryngology: https://aspo.us
Communication Protocol for Airway Surgery from Dr. Matrka and colleagues: https://onlinelibrary.wiley.com/doi/abs/10.1002/lary.28271
[Romaine Johnson MD]
That's one of the things with the toolbox, right? The airway toolbox. What are the things that you need when you're going to do an airway case consistently? What are some of the things that you all feel like that's got to be on the back-table every airway case no matter what?
[Laura Matrka MD]
I mean, for me, I did my whole Triologic thesis at answering this question. For me, I try to use the same setup for every difficult airway even if I'm not going to need some of the things just for consistency's sake. A good scope, a good subglottic scope, in my case, I love the extended length or that is called the Garrett extension of the Ossoff-Pilling scope. That's just an absolute go-to for me. You can ventilate through it there. I love it. When I get the chance, I try to have a resident expose someone with maybe a different scope, and when they can't we then they try again with the [Garrett extension of the Ossoff-Pilling scope] and just see what a difference a good scope makes. And then, I could go on answering this question forever so I want to make sure everyone else gets a chance.
[Mark Gerber MD]
I'm listening to Dr. Matrka saying I need to do a better job at teaching that. I'm a little bit like, you give me a butter knife, I will take care of the problem. So, I am not as much of a planner. I think that is an incredible point that I've just learned something. I'm not too old to learn something new. It just reminds me. Yes, if I have a trainee in my room and we're getting set up for a case, I am talking about the instruments and what I want up there in front of me as I prepare for the individual case, and I'm sort of looking around the room. If it's open, I'm less worried. If it's a endoscopic case, I'm much more attentive to the instrumentation, the appropriate size laryngoscope, the appropriate size telescopes, depending on the size of the child, whether or not I'm going to need a bronchoscope or a tracheal scope at times where just the opening is only at the distal end. Those things I'm very attentive to in endoscopic, and open, I worry about it a little bit less. When it's open, am I going to be wanting a drill to take care of a thick posterior cricoid plate if I'm doing a cricotracheal resection? Little things like that, and suture, if I'm doing a slight tracheoplasty. Those things are important.
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