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Expert Perspective with Felix Yang, MD, FHRS, CCDS ...
Expert Perspective with Felix Yang, MD, FHRS, CCDS
Expert Perspective with Felix Yang, MD, FHRS, CCDS
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Video Transcription
Hi, I'm Dr. Felix Yang, and I'm going to talk about the Essure Esophageal Deviator. There's actually some really good tips and tricks on the training sheet that are included with each device, which you can go through at your own leisure. There are also some really good hints on having the anesthesiologist perform a valsalva maneuver or apnea to also allow for esophageal deviation. This is one example of the esophagus being leftward at baseline, and you can see that the stylet is advanced here, and now the OG tube is advanced to apply some pressure towards the right of the patient. And then there's a little bit further advancement of the stylet, and then more advancement of the OG tube. So it's important to really distinguish advancement of the stylet versus advancement of the OG tube. In example two here, you have the leftward esophagus deviate to the right. You see that the primary curve is now flipped to be on the right-hand side of the patient, and when you advance the OG tube, the esophagus moves towards the right. Now, how do you flip the stylet? One option is to just remove the stylet, try to manually flip it, and then reinsert it more proximally. Another option is to just apply a couple of rotations on the stylet as you are withdrawing it through the OG tube, and that kind of flips it as it's moving up. And then as long as the primary curve is in the direction where you want to deviate, that's where you can re-advance the stylet a little bit further and then re-advance the OG tube to really do the bulk of the deviation. Here again, the stylet, you can see, which was moved to the primary curve being on the left of the patient, now pushing the esophagus leftward by advancement of the OG tube. And here, flipping it back to the other side here, now moving the primary curve towards the right of the patient, advancing that stylet at this point here to kind of straighten out the esophagus, and then now you can advance the OG tube for a straighter path towards the right of the patient. In example 3 here, you can see that the esophagus is completely to the left of the spine, and when you try to advance the esophagus straight down, it really goes just straight down, and it doesn't deviate towards the right or the left. So what you want to do is use that primary curve of the device, have it face to the right, and you advance the OG tube, applying that pressure. Now you want to be gentle, of course, and advance slowly. If you have any hang-up, you want to advance the stylet a little bit to see if it frees up some of that tension. And then finally here, you can advance and retract the stylet a little bit to see if it kind of works the esophagus towards that direction that you want it to go. Use the temperature probe to delineate the border, and of course, you could try to just retract the entire stylet all the way up and then try it again from up top to see if you have a better deviation. And so ultimately here, now the esophagus is completely out of the way on the left-hand side for ablation.
Video Summary
Dr. Felix Yang discusses the Essure Esophageal Deviator and provides tips and tricks for its use. The training sheet included with the device offers valuable information. One technique involves the anesthesiologist performing a valsalva maneuver or apnea to facilitate esophageal deviation. Different methods for flipping the stylet are presented, including manual flipping and rotating it while withdrawing it through the OG tube. The primary curve of the device determines the direction of deviation, and gentle, slow advancement is important to avoid complications. The temperature probe can be used to guide the procedure, and if needed, the stylet can be retracted and repositioned.
Keywords
Essure Esophageal Deviator
tips and tricks
esophageal deviation
flipping the stylet
procedure guidance
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