Introducing the ePICL Procedure

Summary

Dr. Centeno introduces the E-PICL (Enhanced PICL) procedure, a significant evolution from the original PICL developed since 2013. This new technique enhances targeting of the ALAR ligament, promising improved patient outcomes and potentially fewer procedures. Key advancements include specialized 3D printed mouthpieces, endoscopic visualization, and the use of two CRMs for better accuracy. Currently, only Colorado physicians are trained in this complex procedure, which emphasizes patient safety and precise anatomical understanding. With over 1,500 procedures performed, Dr. Centeno highlights ongoing research and the aim to expand training in the future.

Takeaways

• 😀 The PICL procedure has evolved significantly since its inception in 2013, now rebranded as the E-PICL procedure.
• 🛠️ The E-PICL procedure includes enhancements that improve targeting of the ALAR ligament, potentially leading to better patient outcomes.
• 📅 By 2015, the PICL procedure was established as a viable treatment option (Version 1.0).
• 📈 Progression to Version 1.1 involved a specialized 3D printed mouthpiece, showcasing ongoing innovation.
• 🔍 Endoscopy was integrated into the procedure by 2018, marking a significant advancement (Version 1.2).
• ⚙️ The introduction of two CRMs in 2022 was a major step forward, contributing to improved procedure efficiency (Version 1.7).
• 👩‍⚕️ Only Colorado physicians have been trained to perform the E-PICL procedure as of February 2024, highlighting its complexity and need for specialized training.
• ⚠️ Ensuring patient safety is paramount, with strict requirements for proper technique and equipment use during the procedure.
• 📚 Dr. Centeno emphasizes ongoing research to better understand the anatomy and effectiveness of upper cervical ligament injections.
• ⏳ The E-PICL procedure aims to reduce the number of procedures needed by patients due to its enhanced targeting capabilities.

Q & A

What is the new name given to the PICL procedure?

The PICL procedure has been renamed the E-PICL procedure.

What does E-PICL stand for?

E-PICL stands for Enhanced PICL procedure.

How has the PICL procedure evolved since its inception?

The procedure started as a concept in 2013, became established by 2015, and has undergone several iterations with improvements and refinements each year, leading to the current E-PICL version.

What are some key developments in the E-PICL procedure?

Key developments include the use of specialized 3D printed mouthpieces, endoscopy for visualization, dual CRM systems for improved targeting, and a new technique for accurately targeting the ALAR ligament.

What is the significance of targeting the ALAR ligament?

Accurate targeting of the ALAR ligament is crucial for the effectiveness of the procedure, as it enhances the outcomes and may reduce the number of procedures needed for patients.

Why are only Colorado physicians currently performing the E-PICL procedure?

Only Colorado physicians are performing the E-PICL procedure because the techniques involved are complex and require specialized training to ensure patient safety.

What challenges are associated with anesthesia in CCI patients?

PI anesthesia in CCI patients poses challenges due to the complexity of the procedures and the need for precise targeting to avoid complications.

What advancements have been made regarding the mouthpiece used in the procedure?

The mouthpiece design has undergone several updates to improve its effectiveness throughout the various versions of the procedure.

How many procedures have been conducted so far, and how does this compare to typical practices?

Approximately 1,500 procedures have been conducted, with an increase of about 50 procedures per month, which is significantly higher than the average clinic that might perform only a few per year.

What is the future of training for the E-PICL procedure outside Colorado?

Currently, training for the E-PICL procedure is limited to Colorado, but there are plans to expand training once the procedure is fully refined and standardized.