Supprelin LA Implant Placement and Removal Training Course
VCU CHoR
Children’s Hospital of Richmond at VCU
Needs Assessment
Supprelin LA has been successfully used for over 12 years as a treatment option for central precocious puberty (CPP). There is a high satisfaction rate amongst patients and families that can have the implants placed, replaced, and removed by health care providers (HCPs) that are able to do the procedure in a consistently efficient and effective manner. Unfortunately, many HCPs haven’t incorporated Supprelin LA into their practice for a variety of reasons to include:
- have personally had a bad experience with implant removal
- have had a patient in their group’s practice that has had a bad experience with implant removal
- don’t do procedures themselves or have access to HCPs that do these implants on a regular basis.
In addition, many practicing pediatric surgeons have not started placing the implants, or have even stopped placing them, due to the technical challenges that are seen with removal. Currently, there are no training programs or courses for HCPs that have been placing / removing the implants for a prolonged period to share their processes and technical steps that they have developed to place and remove the implants safely and consistently.
Target Audience
Health Care Providers to include surgeons, endocrinologists, advanced practice providers, surgical assistants, and others.
Where
Center for Human Simulation & Patient Safety
McGlothlin Medical Education Center
1201 E. Marshall Street, 9th Floor
Richmond, VA 23298
When
November 16th, 2024, Saturday, from 8:00 AM – 3:15 PM.
Breakfast & lunch will be provided for those in attendance.
Course Objectives
This is a comprehensive course which will spend dedicated time discussing in detail each of the below bullet points in regards to placing, replacing, and removing the Supprelin LA implant. Additional details for the agenda can be found on the website. During the course, videos will be reviewed highlighting key techniques with placement, replacement, and removal of the implants. Lastly, there will be a ‘hands-on’ portion of the course for the insertion kit and additional instruments used for these procedures.
- Setup
- Technical Details
- Interaction with Patient and Family
- Anesthesia
- Problems & Complications
- Pearls
- Q&A
There are limited spots to attend the course in person, but a virtual option will be available.
There is no charge to attend the meeting in person or virtually.
Faculty
David Lanning, M.D., Ph.D. - Course Director
Associate Chief Medical Officer
Professor of Surgery and Pediatrics
Children’s Hospital of Richmond at VCU
David Lanning, M.D., Ph.D. - Course Director
Associate Chief Medical Officer
Professor of Surgery and Pediatrics
Children’s Hospital of Richmond at VCU
Department of Surgery
Jennifer Abuzzahab, M.D. Faculty
Pediatric Endocrinology
McNeely Pediatric Diabetes Center and Endocrine Clinic
Children’s Minnesota
Jennifer Abuzzahab, M.D. Faculty
Pediatric Endocrinology
McNeely Pediatric Diabetes Center and Endocrine Clinic
Children’s Minnesota
Pediatric Endocrinology McNeely Pediatric Diabetes
Arkadiy Dubovoy, M.D. Lecturer
Assistant Professor of Anesthesia
Department of Anesthesia
Children’s Hospital of Richmond at VCU
Arkadiy Dubovoy, M.D. Lecturer
Assistant Professor of Anesthesia
Department of Anesthesia
Children’s Hospital of Richmond at VCU
Department of Anesthesia
Michael Nance, M.D., FACS, FAAP Faculty
Chief of the Division of Pediatric General, Thoracic, and Fetal Surgery
Director of the Pediatric Trauma Program
Children’s Hospital of Philadelphia
Michael Nance, M.D., FACS, FAAP Faculty
Chief of the Division of Pediatric General, Thoracic, and Fetal Surgery
Director of the Pediatric Trauma Program
Children’s Hospital of Philadelphia
Children's Hospital of Philadelphia
7:30 to 8:00 – Breakfast and check in
8:00 to 8:10 – Welcome and Introductions
Session 1
8:10 to 8:35 – Procedure Setup
- Office vs procedure room vs OR
- Timing of procedure; in AM vs afternoon
- Implant kit
- Additional instruments
- Additional supplies - gauze, towels, local, skin glue, etc.
- Implant
- Flow of procedure
- Helper / arm holder
- Child life
- TV or their iPad / phone with video or music
- Arm prep
- Insertion vs Replacement vs Removal only
- Q&A
Session 2
8:35 to 9:05 - Dr. Abuzzahab (as an endocrinologist, got into placing these implants / current struggles / success, etc.)
Session 3
9:05 to 9:35 - Technical Details
- Prepping and draping
- Scalpel / incision
- Injection of local
- Table set up
- Insertion tool
- Finding / grasping implant
- Handling capsule
- Traction on implant
- Suture
- Skin glue vssteristrips
- Coban
- 2ndincision
- Use of extra instruments
- Assistant for procedure
- Aspects of placing the implants in the hip area (Dr. Abuzzahab)
- Q&A
Session 4
9:35 to 10:55 – Hands on session with insertion kit and instruments (Instruments and insertion kit will also be reviewed on camera for virtual audience)
10:55 to 11:05 – Break
Session 5
11:05 to 12:05 – Videos (5 - 10 minutes each)
- Instrument set up (x1)
- Insertion (x1 - 2)
- Replacement (x1 - 2)
- Removal (x3 – 5)
- Use of ultrasound (x1 - 2)
Session 6
12:05 - 12:35 - Dr. Nance
- Placing implants in the clinic w/o sedation
12:35 to 1:05 – Lunch
Session 7
1:05 to 1:30 - Interaction with Patient and Family
- Preop discussion re: implant
- Preop discussion re: anesthesia
- Billing
- Postop instructions
- Post procedure follow-up
- Notes to PCP and endocrinologist
- Office to set them up
- Need to see the patient before replacement / removal
- Q&A
Session 8
1:30 to 1:55 - Anesthesia
- Sedation
- General anesthesia
- EMLA cream
- Local anesthesia
- NPO
- Nitrous
- IV sedation
- Mask sedation
- Flexible plan
- Q&A
Session 9
1:55 to 2:25 – Problems and Complications
- Adherent capsule
- Broken implant
- Second incision
- Moving patient(non-cooperative)
- Using US with sterile cover
- Infection
- Rejection
- Implant stuck in delivery device
- Bleeding
- Difficult to find implant
- Implant placed over 1 year ago
- Patient known to pick at wounds
- Q&A
Session 10
2:25 to 2:50 - Pearls
- Don’t drop the implant!
- Several back-to-back for efficiency
- Placing Supprelin LA implants may result in more referrals for other endocrine operations
- Patients and families are incredibly appreciative
- Many are able to have procedure done w/o anesthesia
- Process can be very smooth and efficient
Session 11
2:50 - 3:10 Final Q&A and Wrap Up
3:10 – 3:15 - Closing Remarks
- Drs. Lanning, Abuzzahab, and Nance