1 Schaitkin Salivary Dilator Set 2 Kolenda Introducer Set (COOK) - - PowerPoint PPT Presentation

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UCSF Salivary Endoscopy Course 2014 Basic Set Up and Instruments

Rohan R. Walvekar, MD

Department of Otolaryngology & Head Neck Surgery Louisiana State University Health Sciences Center New Orleans, LA

Disclosure

I have the following relationship(s) with commercial interests. Hood Laboratories *Walvekar Salivary Stent Cook Industries Medtronic Xome

A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Instruments for Exposure of the Oral Cavity

Anesthesia – Nasal Intubation is preferred Epistaxis

• Pre-op nasal endoscopy to document spurs,

deviated septum or other abnormality

• Afrin and lubricated nasal trumpet while

patient is in preoperative holding area

Disposable Plastic cheek retractor Dental splints Jennings's mouth gag Minnesota and Sweetheart

retractors

Basic Sialendoscopy Set

Dilator System

Marchal Dilator System Probes No.0000 to No.8 Schaitkin’s Fluted Dilators \ No.0 – 5 Conical Dilator Helps to transition between dilators Useful usually once papilla is dilated up to Marchal

No.1 or 2 dilator

Bougies (increasing diameter) Compatible with 0.4 mm guide wire COOK Dilator System with Operating Sheath Guide Wire Cook Dilators 1-8

Basic Sialendoscopy Set

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Schaitkin Salivary Dilator Set

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Sialendoscopy

Kolenda Introducer Set (COOK)

Sialendoscopy Sialendoscopy

Sialendoscopes

Geisthoff UW. Basic sialendoscopy techniques. Otolaryngol Clin N Am 42 (2009) 1029-1052

1.3 mm Marchal* 1.1 mm Erlangen* 1.6 mm Erlangen*

*Karl Storz, Tuttlingen, Germany

Fiberoptic channel Irrigation Port

Interventional Port

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Fifth generation endoscopes Original was flexible 1.3 mm semi rigid scope with 6000 pixels,

0.25mm rinsing channel and 0.65mm working channel

Marchal Sialendoscope

Sialendoscopes 0.8 mm

Pediatric diagnostic sialendoscopy No interventional channel

1.1 mm “all in one” Erlangen Sialendoscope

Can be autoclaved Interventional Tools that can be used with the scope 0.4 mm guide wire basket 0.4 mm stone basket Laser fiber (Holmium laser) Hand held microburr Does not have a protective sheath Dilate up to No.3 or 4 prior to endoscopy

Basic Sialendoscopy Set

Sialendoscopes 1.3 mm Marchal “all in one” scope

Autoclavable. Interventional Tools that similar to 1.1 Erlangen

scope

Does have a protective sheath Optics are excellent Dilate up to No.4 / 5 prior to endoscopy Gentle bend at the tip of the scope

Basic Sialendoscopy Set

1.6 mm “all in one” Erlangen Sialendoscope

Can be autoclaved Interventional Tools that can be used with the scope 0.4/6 mm guide wire basket 0.4/6 mm stone basket Cup forceps** Does not have a protective sheath Dilate up to No.5 or 6 prior to endoscopy

Balloon Dilator (Storz) – compatible with all in one scopes

Basic Sialendoscopy Set

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Sialendoscopy

IV Extension Tubing 20 cc syringe Vessel loops Angled Forces with and without teeth Standard Endoscopy Tower and Monitor with recording

capabilities** Accessories

Disposables

Stone baskets Guide wires Cleaning brushes Stents (Hood Laboratories)* Balloon Dilator

Not Disposable

Hand-held micro burr Stone forceps

Basic Sialendoscopy Set

Three way stopcock/valve

STORZ WIRE BASKETS COOK WIRE BASKETS - - N Gage

6 LSU Sialendoscopy Course

Diagnostic Sialendoscopy

Rohan R. Walvekar, MD

Department of Otolaryngology & Head Neck Surgery Louisiana State University Health Sciences Center New Orleans, LA

100% Successful endoscopy Ductal or papillary stenosis in 7/15 (47%) Essentially normal endoscopy in 8/15 (53%) Symptoms improved in 13/15 (87%) cases

Diagnostic Sialendoscopy Data

Bowen M et al. Diagnostic and Interventional Sialendoscopy: A preliminary experience. 2010 Laryngoscope (accepted for publication)

Progressive dilation

Marchal Dilator System

(No.0000 to No.6)

Conical dilator

Seldinger technique

Guide wire and bougies

Papillotomy

25% (7/28)

Successful endoscopy

96% (27/28)

Sialendoscope Cannulation

SERIAL DILATION USING THE DILATOR SYSTEM SELDINGER TECHNIQUE USING GUIDE WIRE AND BOUGIES (adopted from Chossegros et al2)

Success of Diagnostic Endoscopy ~ 95-98% Rate Limiting Step : Dilation of Papilla

Approaches to the papilla

Dilation technique Seldinger technique With bougies With sialendoscope Papillotomy Proximal papillotomy and sialodochoplasty

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Papillotomy for diagnostic endoscopy…consequences.. Distal Papillotomy and Dilation Followed by Sialodochoplasty and Stent Placement

Acknowledgements

Dan W Nuss MD, Faculty and Residents Department of Otolaryngology

Head Neck Surgery, LSU HSC, New Orleans, LA

Barry Schaitkin, MD (University of Pittsburgh) OR Staff

(Our Lady of the Lake Regional Medical Center)

Head Neck Center,

(Our Lady of the Lake Medical Center)

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Avoid Complications

Local Anesthesia:

• Lidocaine 4.5mg/kg (<300mg)
• Lidocaine/epineprine 7mg/kg (<500 mg)

MAC (sedation):

• Over
• Under

Local Anesthesia:

• Beware of ETT position
• NO atropine or like medication

Technical Problems

Maceration of the papilla:

measured traction

Avoid creating pseudo-orifices:

injection forceps dilators

Technical Problems

Overinjection of NSS:

• 60cc syringe with IV extender
• control your assistant enthusiasm
• maintain one port open
• in the submandibular area it can

lead

to AIRWAY COMPROMISE

Technical Problems

False Passage (papilla):

• do not force the dilator
• do not cut the papilla

Ductal Perforation:

• do not advance blindly
• do not force the instrument in
• abort if identified

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Equipment Failure

Be cognizant of the turns:

• scope is semi-rigid (it is fragile)
• straighten the duct using manual traction

and pressure

Be cognizant of the teeth Have back up gear

The Learning Curve