Children's Hospital Colorado

Pediatric Surgery Medical Education Videos

At the Department of Pediatric Surgery at Children's Hospital Colorado, we constantly strive to advance our treatments and innovate surgical techniques to improve outcomes and raise standards of care. We are happy to share that knowledge so children that live in different areas of the country and around the world can also benefit from our continuing research and innovation.

We hope that the shared knowledge in these medical education videos help other pediatric surgeons and providers advance their surgical practices and improve their level of care to children everywhere.

MRI use in appendicitis management

Appendicitis is one of the most common problems seen in the pediatric population with over 650 appendectomies performed each year at Children’s Hospital Colorado. While the most common imaging modality for diagnosing appendicitis is a right lower quadrant ultrasound, those with an atypical abdominal pain presentation or unclear ultrasound results may require additional testing. One underutilized imaging modality is the rapid sequence MRI.

In this video, Jose Diaz-Miron, MD, discusses the results of a recent quality improvement campaign aimed at increasing the use of rapid sequence MRI for diagnosing appendicitis while reducing CT scans. Although radiology algorithms existed for identifying ideal patients for rapid sequence MRI, most stakeholders were unaware of the benefits and accessibility of this imaging modality.

Living donor liver transplant

Too many children die while waiting for a liver transplant. In the United States, about one in 10 infants and one in 20 older children die while on the liver transplant waiting list — and 40% of children who make it to transplant spend over a year on the waitlist. As the largest volume center for pediatric living-donor liver transplants in the country, the multidisciplinary team at Children’s Hospital Colorado is positioned to ensure all children have access to life-saving liver transplants.

In this video, Amy Feldman, MD, and Megan Adams, MD, provide an overview of The Pediatric Liver Transplant Program at Children's Colorado and explain how pediatric patients across the country are able to access this life-saving transplant option.

Department of Pediatric ENT: overview and vision

At Children's Hospital Colorado, our otolaryngology (ear, nose and throat) experts provide some of the most comprehensive care in the Rocky Mountain region and beyond. Each year, we see more than 18,000 patients for conditions like hearing loss, sleep disorders like sleep apnea, ear problems, sinus issues and neck masses.

In this video, Soham Roy, MD, provides an overview of the Department of Pediatric Otolaryngology at Children's Colorado, which includes one of the largest groups of Pediatric Otolaryngology surgeons in the U.S. With specialty expertise in some of the most complex areas of pediatric otolaryngology care, the otolaryngology team is nationally and internationally recognized in clinical care, research and teaching.

Obstructive problems after Hirschsprung pull-through

Babies born with Hirschsprung disease lack ganglion cells in certain parts of the large intestine, causing an inability to properly regulate bowel movements. Babies are treated with a pull-through surgery to remove the diseased section of the large intestine and pull the healthy section down to the rectum, but 30% of patients will still have flare-ups of colitis — even if performed correctly.

In this video, Luis De la Torre, MD, discusses the problematic obstructive symptoms experienced after a technically well-performed pull-through for Hirschsprung disease. Dr. De la Torre also explains the importance of preserving the anal canal, workup for recurrent enterocolitis, when redo pull-throughs are recommended and treatment for constipation after a pull-through procedure.

Postoperative pain management after Nuss repair

Pectus excavatum is a condition in which the breastbone is sunken into the chest, often described as a sunken chest or funnel chest. Treatment for this diagnosis is via Nuss repair, which involves placing a metal bar inside the chest to elevate the sternum and achieve a normal chest contour. Past approaches in post-operative pain management include thoracic epidural analgesia or cryoablation. Longer hospital stays are common after a thoracic epidural, prolonged numbness can occur with cryoablation, and both analgesia techniques pose a risk of permanent nerve injury.

In this video, David Bliss, MD, discusses a recent study of erector spinae plane block after Nuss repair for pectus excavatum. The novel technique is a game-changer in mitigating the severe pain following a Nuss procedure.

Congenital Pulmonary Airway Malformation (CPAM)

CPAM is a rare congenital disorder characterized by abnormal cystic lung lesions that originate in utero. These lung lesions are often identified during routine prenatal ultrasound at 20 weeks gestation and continue to enlarge between 20 and 28 weeks. In rare cases, the cystic mass grows so large that it can become life-threatening and require fetal intervention.

In this video, Chris Derderian, MD, and David Patrick, MD, discuss prenatal evaluation and therapies as well as postnatal management. While most babies are born without symptoms and don’t require supplemental oxygen, the providers recommend resection within the first year to prevent malignancies and avoid recurrent infection.

Ceria Therapeutics: treating inflammatory disease

Through research, we discovered that fetuses regenerate tissues, including tendons and heart tissues without scarring. This research continues to help inform treatment for a range of complications, including COVID-associated acute respiratory distress syndrome, colitis and diabetic wounds in children. Ceria Therapeutics was designed to develop novel therapies to treat overactive and nonproductive inflammation to promote healing.

In this video, pediatric and fetal surgeon Ken Liechty, MD, discusses a recent early stage capital and retention award with Carlos Zgheib, PhD. This award will help with the development of novel therapeutics to treat inflammatory disease in children and benefit future patients. By treating the underlying mechanisms of disease, we can improve patients’ lives while saving billions of dollars in healthcare costs.

Inhibition of pressure ulcer development with Nanosilk

Pressure ulcers are a growing clinical concern and represent a significant complication of hospitalized patients and in patients with limited mobility – contributing to significant healthcare costs and added hospital stays. But treating skin topically with a new topical therapy, Nanosilk, shows promise by strengthening the skin and protecting it from full-thickness pressure ulcers.

In this video, Carlos Zgheib, PhD, and pediatric and fetal surgeon Ken Liechty, MD, discuss a recent award from the Wound Healing Foundation – the Medline Corious Innovation Grant. Dr. Zgheib received this award for his innovative research using Nanosilk (made from silk fibroin from the cocoons of Bombyx mori silkworms) as a pressure ulcer topical treatment. This preventative therapy is vastly different from other alternative treatments for pressure ulcers. The hope is to use the research findings to better understand the mechanisms of Nanosilk for the complete inhibition of pressure ulcers.

Pectus excavatum in Children

Accounting for 90% of all congenital chest wall deformities, pectus excavatum occurs in one to eight per 1,000 live births. While this can be noted early in life, pediatric pectus excavatum often worsens during a growth spurt in adolescence.

The severity of this condition can range from mild to severe. In cases that are moderate to severe, children may become self-conscious and have a negative body image. A common operative procedure to repair a pectus deformity is the minimally invasive repair of pectus excavatum (MIRPE), also called a Nuss procedure. This involves the substernal placement of a contoured metal bar secured to the lateral aspect of the ribs. Although cosmetic results are excellent, patients do report significant pain from the constant pressure exerted on the chest wall from the metal bar.

In this video, Jose Diaz-Miron, MD, and David Partrick, MD, Director of Pediatric Surgical Endoscopy, explain our surgical approach and the common pain methodologies at Children’s Colorado as they are leading a randomized controlled trial studying the three most used methods. These methods include patient-controlled analgesia (PCA), erector spinae blocks (ESB) with continues infusion pumps and video-assisted intercostal nerve cryoablation (INC). Newly FDA approved, INC essentially freezes the pain receptors, and they are studying these patients may experience shorter length of stay, decreased narcotic use and improved quality of life. Learn more about this approach and how they plan to complete the study by 2023.

Laparoscopic inguinal hernia repair in children

During normal pre-birth development, the testis descends though the groin into the scrotum, bringing with it part of the lining of the abdomen. This tube-like communication between the abdomen and the scrotum usually closes off by the time a child is born. If the communication does not close off, fluid is free to move back and forth from the abdomen into the scrotum. This is called a communicating inguinal hernia or hydrocele.

In this video, pediatric surgeon Jose Diaz-Miron, MD, explains the natural history and presentation of pediatric inguinal hernias. This discussion focuses around the laparoscopic approach for inguinal hernia repairs and the outcomes of the procedure. They also cover the most common questions we get from our patients and families in the pediatric surgery and urology clinics including origin, incident rates and possible recurrence.