Training in Minimally Invasive Surgery in Otorhinolaryngology

Head Profesor: Adolfo Hidalgo Gonzalez, MD
First degree specialist in Otorhinolaryngology.
Associate Professor.

Price: 18,360.00 USD

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Registration open throughout the year except from December 15 to January 15.

Duration: 47 weeks.

Addressed to: Specialists in ORL and Neurosurgery.

General objectives:

• To differentiate inflammatory, neoplastic, traumatic and infectious diseases in the paranasal sinuses, laryngotracheal diseases, skull base diseases, ear and esophageal diseases, as well as their medical treatment and surgical indications.
• To make the clinical assessment of patients who are candidates for surgery along with the surgical techniques required to solve their problems.
• To apply different diagnostic methods for each disease.
  • Radiology (Simple Radiography, Tomography, Magnetic Resonance Imaging, Angiography with Digital Subtraction).
  • Laboratory.
• To identify the anatomical concepts of the paranasal sinuses, skull base, laryngotracheal structures of the ear and esophagus, as well as the principles of microsurgery for the required surgical approach, as for its surgical variants.
• To establish the scientific methodology to be used in clinical research.
• To apply the anatomical and clinical principles of the paranasal sinuses, the skull base, larynx, trachea, ear and esophagus for the appropriate diagnosis of the patients.
• To skillfully and dexterously perform paranasal sinus surgeries, the nasal time of the skull base, ear, trachea, larynx and esophagus surgeries.
• To distinguish the different approaches and their indications, both in open and endoscopic surgery.
• To apply the regulations to achieve a satisfactory multidisciplinary teamwork as with the Institution.
• To behave with respect and commitment so as to carry out leadership assignments.
• To establish the ethical bases for clinical and research work.

Topics and contents

Module 1: Technological Generalities of Minimally Invasive Surgery in ORL.

• Topic 1.1: Generalities of minimally invasive surgery in ORL.
  Knowledge: Endoscopic diagnosis of otorhinolaryngological diseases. Otoscopy, rhinoscopy, laryngoscopy, tracheobronchoscopy.
• Topic 1.2: Equipment, instruments and technology in the approach by MIS.
  Knowledge: History and evolution of ORL instruments. Optics, types, Hopkins System, care and maintenance. Sources of light, halogen, xenon System, auto fluorescence light System, NBI, stroboscopy. Physical principles of functioning. Cameras and imaging documentation, 2D and 3D system, VITOM system, Karl Storz AIDA system. 5. Rigid instruments for endoscopic nasal functional surgery, skull base surgery, larynx surgery (Phono surgery), Transoral surgery, bronchoscopy, endoscopic surgery of the ear. Care and maintenance. Flexible instruments for endoscopic surgery of the airways, Storz system, Olympus system, general characteristics and maintenance. LASER in minimally invasive surgery in ORL. Types, functioning principles, uses.
• Topic 1.3: Dissection and endoscopic exploration in the laboratory.
  Knowledge: Dissection laboratory. Preservation and preparation of laboratory specimens. General principles of dissection and endoscopic exploration.
• Topic 1.4: Therapeutics in MIS.
  Knowledge: Endoscopic diagnosis of otorhinolaryngological diseases. Otoscopy, rhinoscopy, laryngoscopy, tracheobronchoscopy.

Module 2: Trans Nasal Endoscopic Surgery.

• Training 2.1: Therapeutics in MIS.
  Knowledge: Endoscopic diagnosis of otorhinolaryngological diseases. Otoscopy, rhinoscopy, laryngoscopy, tracheobronchoscopy.
• Training 2.2: Generalities in nasal sinus and skull base diseases.
  Knowledge: Surgical anatomy and embryology of the paranasal sinuses, anterior skull base and sellar region. General epidemiological aspects of nasal sinuses diseases. Apply referred knowledge in patient interview and physical exam. Pathology of nasal sinus diseases and sellar region tumors. Cytological techniques and biopsies. Etiopathogeny of nasal sinus diseases.
• Training 2.3: Imaging of the paranasal sinuses, skull base and sellar region.
  Knowledge: Physical principles of Computerized Axial Tomography and Magnetic Resonance Imaging, visit to the Department of Imaging, study of equipment. Simple Radiology, Computerized Axial Tomography and Magnetic Resonance Imaging in the different nasal sinus diseases. Anatomic-radiological aspects and radiology of nostrils, peri nasal sinuses and orbital tumors. Value of Computerized Axial Tomography and Magnetic Resonance Imaging in staging. Computerized Axial Tomography and Magnetic Resonance Imaging in the diagnosis of cerebrospinal fluid fistulas and sellar region tumors. Assisted surgery by neuro navigation.
• Training 2.4 Acute and chronic inflammatory processes of the paranasal sinuses.
  Knowledge: Acute and chronic rhinosinusitis. Antibiotic therapy. Nasal sinuses polyposis. Allergic rhinitis. Complications of rhinosinusitis, medical and surgical management. Diagnostic approach for nasal obstruction, rhinometry and rhinomanometry. Olfactory disorders, diagnostic and therapeutic approach, olfactometry. Ciliar dysfunction syndrome. Endoscopic management of epistaxis. Benign and malignant tumors of the nose and paranasal sinuses. Medical therapeutic approach for rhinitis. Use of different drugs.
• Training 2.5: Open approaches for nasal sinus diseases.
  Knowledge: Interview for patients with nasal sinus diseases. Basic endoscopic exploration at consultation, anatomical orientation, methodology for exploration. Staging system and surgical categorization of chronic non-malignant nasal sinus disease. Local and general anesthesia, drugs, infiltration techniques in local anesthesia, optimal dosage, anesthetic complications and their management. Standard endoscopic techniques in nasal sinus diseases. Centripetal endoscopic surgery. Reversed papilloma surgery. Lacrimal duct surgery. Endoscopic dacriocystorhinostomy. Management of nasal sinus diseases in Pediatrics. Endoscopic surgical techniques in children. Causes of failure in endoscopic nasal surgery. Reinterventions, combined approaches. Sinuplasty with balloon. Radiofrequency techniques in turbinate surgery.

Module 3: Endoscopic Trans Nasal Surgery of the Skull Base from the Perspective of the Otorhinolaryngologist.

• Training 3.1: Endoscopic trans nasal surgery of the skull base from the perspective of the Otorhinolaryngologist.
  Knowledge: Instruments in endoscopic trans nasal surgery of the skull base. Endoscopic exploration of the anterior base of the skull and sellar region. Medical-surgical management of cerebrospinal fluid fistulas. Medical-surgical management of hypophysis adenomas. Extended endoscopic surgery of the skull base. Reconstruction methods in endoscopic trans nasal surgery of the skull base. Assisted surgery by navigation.

Module 4: Generalities in Diagnostic and Therapeutic Respiratory Endoscopy

• Topic 4.1: Endoscopic trans nasal surgery of the skull base from the perspective of the Otorhinolaryngologist.
  Knowledge: Surgical anatomy and embryology of the larynx, trachea and bronchi. General epidemiological aspects of laryngotracheobronchial disease. Applying referred knowledge in patient interview and physical exam. Normal histology. Pathology of laryngotracheobronchial disease. Cytology and biopsy techniques, brushing and bronchial lavage. Developing skills for basic endoscopic exploration of the larynx, trachea and bronchi. Etiopathogenesis of laryngotracheobronchial diseases. Physiology of the voice and phonation. Exploration of the voice. Physiology of respiration. Spirometry. Dysphonic syndrome. Congenital lesions.
• Training 4.1: Imaging of the larynx, trachea and bronchi.
  Knowledge: Physical principles of Computerized Axial Tomography and Magnetic Resonance Imaging, visit to the Department of Imaging, study of the equipment. Simple Radiology, Computerized Axial Tomography and Magnetic Resonance Imaging in different laryngotracheobronchial diseases. Anatomical-radiological aspects and radiology of larynx, trachea and bronchi tumors. Value of Computerized Axial Tomography and Magnetic Resonance Imaging in staging. Computerized Axial Tomography and Magnetic Resonance Imaging in the diagnosis of laryngotracheobronchial stenosis. Basic principles of mediastinal and bronchial ultrasonography.
• Training 4.2: Acute and chronic inflammatory processes of the larynx, trachea and bronchi. Benign and malignant lesions.
  Knowledge: Acute and chronic laryngitis. Medical therapeutics. Granulomatous diseases of the larynx, trachea and bronchi. Complications of laryngotracheobronchitis. Medical management. Diagnostic approach for acute obstructive laryngeal syndrome. Tracheotomy techniques and indications. Percutaneous tracheotomy. Endotracheal cannulas and tubes. Endoscopic exploration of the larynx, trachea and bronchi. Orotracheal and nasotracheal tubing. Laryngeal mask. Pseudo tumoral lesions of the larynx. Laryngeal paralysis. External and internal trauma of the larynx and trachea. Benign tumors of the larynx, trachea and bronchi. Papillomatosis. Skills for: defining the causes of acute and chronic inflammatory processes of the larynx, trachea and bronchi, as its therapeutics; managing acute and chronic inflammatory processes of the larynx, trachea and bronchi; diagnosing the different types of laryngitis and treatment; managing laryngotracheobronchitis diseases with medical expertise.
• Topic 4.3: Open approaches for laryngotracheobronchial diseases.
  Knowledge: History and development of laryngeal and tracheal surgery up until nowadays. Radical surgery of the larynx. Surgery of the trachea. Techniques. Partial laryngectomies. Management of laryngotracheobronchial trauma. Thyroplasties. Aritenochordopexies. Sequelae of external trauma. Rigid bronchoscopy.
• Topic 4.4: Endoscopic exploration and endoscopic surgery of the larynx, trachea and bronchi.
  Knowledge: Instruments and equipment in laryngotracheobronchial exploration. Basic endoscopic exploration at consultation, anatomical orientation, methodology for exploration. Local and general anesthesia, drugs, infiltration techniques in local anesthesia, optimal dosage, anesthesia complications and their management. Patient preparation for endoscopy. Standard endoscopic techniques. Laryngoscopy, tracheoscopy, bronchoscopy. Trans-oral endoscopic surgery in laryngeal cancer and benign lesions. Papilloma surgery. LASER surgery of the larynx, trachea and bronchi. Management of laryngotracheobronchial diseases in Pediatrics. Endoscopic surgical techniques in children. Causes of failure of endoscopic surgery of the larynx, trachea and bronchi.

Module 5:

• Training 5.1: Advanced laryngeotracheobronchial surgery. Knowledge: Instruments in advanced laryngeotracheobronchial surgery. Medical- surgical management of tracheobronchial fistulas. Reconstruction methods in laryngeotracheobronchial surgery. Endoscopic tracheoplasty. Use of prosthesis. Mediastinal echobronchoscopy.

Module 6: Esophageal Endoscopy in ORL.

• Topic 6.1: Generalities in esophageal diseases from the point of view of ORL.
  Knowledge: Surgical anatomy and embryology of the pharynx and esophagus. General epidemiological aspects of esophageal diseases. Applying referred knowledge to interview and physical exam of a patient with dysphagia and esophageal symptomatology. Pathology of esophageal lesions. Cytology and biopsy techniques. Etiopathogenesis of esophageal diseases. General anatomical-radiological aspects in esophageal diseases. Radiological studies in esophageal disease.
• Topic 6.2: Endoscopic exploration of the ear.
  Knowledge: Video-otoscopy. Position in the operating room. Dilation of the tube with balloon. Tubular dysfunction. Endoscopic timpanumplasty. Complications of endoscopic exploration of the photodynamic ear. Endoscopic approaches of the inner ear. General principles.