Title:-       EXIT [ex utero intrapartum treatment] procedure

the EXIT procedure is defined as a procedure performed after partial externalization of the fetus from the uterine cavity, while maintaining uterine volume and fetoplacental circulation, ensuring the fetal oxygenation during airway access. Once adequate airway and ventilation are secured, the fetus can be safely taken off placental support.

the EXIT procedure guarantees the uteroplacental gas exchange achieving hemodynamic stability under severe conditions of airway compression in the fetus, therefore, maximizing the chances of neonatal survival. It is an innovative and promising technique in the initial approach to multiple neonatal pathologies.

the indications for EXIT procedure include various conditions associated with possible fetal airway obstruction such as congenital high airway obstruction syndrome (CHAOS) and giant neck masses arising around the upper airway are at high risk for hypoxic brain injury and death at birth. The ex utero intrapartum treatment (EXIT) procedure is a technique that can provide time to manage the fetal airway by intubation or tracheostomy while maintaining placental blood circulation to the fetus.

antenatal history reveals, precious pregnancy g7 p0 l0 a6. Prenatal anomaly scan shows neck mass. We planned elective caesarian section 1week prior to EDD. Expert team include gynecologist, fetal medicine expert, anesthesiologist, pead surgeon, pead ENT surgeon, neonatologist, OT staff, and technicians. We all had multiple prior meetings and practiced simulation of the EXIT procedure, allocated the timing, and role of each speciality. Finally succeded the EXIT.

the successful outcome of an EXIT procedure depends upon thorough and accurate prenatal investigations like imaging, including fetal ultrasonography and fetal magnetic resonance imaging (MRI) have led to changes in perinatal management and improved neonatal outcomes appropriate presurgical planning, and the availability of a highly skilled multidisciplinary team and facilities like NICU.

name of the participant-dr.Panchala murthy

address- rainbow children’s hospitals

[email protected]

name of hospital- rainbow children’s hospitals. Hyderabad, india

Partial tonsillectomy: surgical technique, case-based ev,idence, and long-term outcomes.

Introduction: adenoid hypertrophy is one of the main causes of nasal obstruction in 'children. Adenoid hypertrophy can be approached either with nasal corticosteroids, or surgically when medical treatment fails. Different adenoidectomy techniques have been proposed to reduce morbidity and surgical risks, with a consequent marked increase in the use of new surgical procedures in recent years, with a progressive increase in the use of coblation. in this presentation, i will talk about the advantages and disadvantages of coblation adenoidectomy with a video.

benefits of coblation adenoidectomy (compared to traditional methods like cold curettage):

• precise tissue removal: the controlled nature of coblation allows for more accurate removal of the adenoid tissue while minimizing damage to surrounding normal tissues, including the eustachian tube openings.

• less bleeding: the coblation technology helps to simultaneously ablate tissue and coagulate blood vessels, leading to significantly reduced intraoperative blood loss and often less postoperative bleeding.

• reduced pain and discomfort: lower operating temperatures result in less tissue trauma, which translates to less pain for the patient after surgery and a reduced need for strong pain medications.

• faster recovery: due to less pain and tissue damage, patients typically experience a quicker recovery time and can return to their normal activities, including school, sooner.

• lower risk of complications: the precision of coblation can reduce the likelihood of complications such as infection or injury to nearby structures.

• reduced recurrence rate: some studies suggest that coblation may lead to a lower chance of adenoid regrowth compared to traditional methods, as it allows for more complete removal.

• improved visualization: when performed with endoscopic guidance, the surgeon has an excellent view of the surgical field, ensuring thorough removal and minimizing residual tissue.

  conclusion: coblator adenoidectomy appears to offer better adenoid control and lower recurrence rate additionally another advantages of this technique are mainly less surgical bleeding in adenoidectomy .

4- The case i want to forget about.