Rocky Mountain Hospital for Children pediatric surgeon, Kristen Shipman, MD talks about a new technique that blocks pain for sunken chest surgery.
Interview conducted by Ivanhoe Broadcast News in 2022.
What is cryo procedure?
SHIPMAN: So cryoprocedure is a tool, instrument that allows us to freeze the intercostal nerves. And what we do during a thoracoscopic procedure for pectus excavatum, we’re able to freeze each intercostal nerve that runs underneath the rib on both sides, rib three through seen. It allows us to decrease the pain and sensation that a patient feels after the procedure without injuring the nerve and it recovers within three to six months after the procedure. And it’s been incredibly useful for patients considering that this is an operation that you would usually be a three to four day hospitalization. It’s allowing them to feel better. It allows them to go home quicker.
How much quicker?
SHIPMAN: So well, usually three to four days stay with the technique prior to cryoablation of the intercostal nerves. Now we can get them home sometimes post-op day one. So there’s studies that show there’s decreased length of stay of the hospitalization. It’s been studied and verified. It also decreases the cost of the family because it’s less medication unless hospital stay. They clearly get a pain benefit from this. If for something that is a hard surgery for a patient to go through and uncomfortable, we’ve shown that their pain needs are less and we’re getting them home quicker. So that’s studied as well. That’s a significant finding with cryoablation technique. Also, long term, the studies that we have out and relative to us that we’re taught and pediatric surgery show that there’s no increase in nerve pain after the procedure either. So it’s a really amazing technique for patients that are interested in undergoing this procedure to fix their chest.
What is sunken chest syndrome?
SHIPMAN: Pectus excavatum is a disorder where the sternum is displaced due to rapid growth of the costal cartilages on either side. So the patient have what you call a sunken chest. It looks very dished, almost like there’s a bowl shape in the front of their sternum.
Is that something they’re born with or is that something that happens as they’re growing?
SHIPMAN: It often is present prior to puberty and sometimes at birth. But it often it can worsen with growth when there’s inner the cartilages of our chest wall along our rib and our sternum start to grow just like any other growth plates in the body. Sometimes that dip can worsen. Most patients are asymptomatic, but some people can have significant compression that can affect their physiology as well.
Let’s talk about when you do this, can you tell, is it permanent? Are those nerves always there?
SHIPMAN: The freeze injures the nerves without damaging the structure of the nerve. And so what will happen is that nerve will repair itself and re-grow where it was frozen. And they’ll get their pain sensation or they’ll get I’m sorry, I said that wrong. They’ll get their sensation of their chest wall back in three to six months.
How you did it the surgery go before?
SHIPMAN: When we’re placing a nice bar for a surgery repair and were able to put in camera to see things within the chest, we call that thoracoscopy, and we use two incisions along the lower ribs. And we can put a camera into the chest on the left side and watch us freeze each one of those nerve bundles underneath the rib to prevent pain. And then we also do that on the other side as well. And we normally have a lower incision that’s only about five millimeters at each point on each side of the chest to perform that on both sides.
How many nerve bundles are there?
SHIPMAN: Cranial nerves three through seven, both sides.
Do you do it on all of them though?
SHIPMAN: In my experience, most patients really want the benefit of the pain effect from this, that it decreases the pain for their child. It decreases the need for narcotic medication in the hospital stay. So most parents are very in to going and with a cryo option, knowing that their child would be more comfortable after the procedure.
Without the cryo, how long can the patient go without pain compared to with cryo?
SHIPMAN: So without the cryoablation or tend to be in the hospital for about four days. And most of them are taking ibuprofen for several weeks after the procedure with the need for oral narcotic pain medicine for another several weeks, maybe two weeks.
Is there anything you’d like to add?
SHIPMAN: Well, first of all, I think this procedure is the new protocol to do cryoablation as a huge modification to improve any surgery for patients for pectus excavatum. And the pain difference is huge. We notice it despite its research and studies and those findings are found to be true. And we’ve had examples and families where maybe they know someone else who’s had the procedure, or even siblings whose other sibling has had a pectus excavatum repair or NAS repair. And the pain difference are huge. The families notice it when they’re talking to each other or within the family, the difference and what one of the other patients went through comparatively to the other friend or family member. So the pain effects are observed and it means a lot to the patients and they’re doing, they’re doing very well with us. It makes it a much easier procedure for patient.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Stephanie Sullivan
Stephanie.sullivan@HealthONEcares.com
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