# Fetal Surgery — GCMD Library living collection

Also covered as: congenital diaphragmatic hernia · myelomeningocele · pulmonary hypoplasia · hydrops · ascites · bronchial atresia · urethral atresia · oligohydramnios

Experts: Dr. Rod Gerardo, Dr. Alan Flake, Dr. Jack Langer, Dr. Steven Rothenberg

Updated: n/a · 30 episodes · 611 cited statements

## Episodes
### Diagnosis & Workup
- [Overview of Prenatal Diagnosis: Cincinnati Fetal Center](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743) — video · 40:34 · [machine version](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743.md)
- [Prenatal diagnosis of fetal lower urinary tract obstruction: Fetal...](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919) — video · 40:14 · [machine version](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919.md)
- [Utility of Fluorescence In Situ Hybridization as a Fetal Surgery Eligibility Criterion for....](https://qa.library.globalcastmd.com/watch/utility-of-fluorescence-in-situ-hybridization-as-a-fetal-surgery-eligibility-criterion-for-12688) — video · 0:52 · [machine version](https://qa.library.globalcastmd.com/watch/utility-of-fluorescence-in-situ-hybridization-as-a-fetal-surgery-eligibility-criterion-for-12688.md)

### Surgical Management
- [Controversies in Congenital Diaphragmatic Hernia: Update Course 2018](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338) — video · 41:42 · [machine version](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338.md)
- [Urologic Fetal Intervention: Cincinnati Fetal Center](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745) — video · 61:40 · [machine version](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745.md)
- [Fetal Interventions Part II: Lung Lesions](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884) — video · 16:30 · [machine version](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884.md)
- [Pediatric Hernia: Update Course 2013](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885) — video · 52:50 · [machine version](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885.md)
- [Fetal urological aspect: Fetal Genitourinary Disease 2015](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917) — video · 59:23 · [machine version](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917.md)
- [Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025) — video · 149:16 · [machine version](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025.md)
- [Open Fetal Surgery Overview: Fetal Surgery 2012](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027) — video · 37:55 · [machine version](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027.md)
- [Lung Lesions: Fetal Interventions Parts I+II](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088) — video · 30:56 · [machine version](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088.md)
- [Fetal Interventions Part I: Lung Lesions](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087) — video · 14:27 · [machine version](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087.md)
- [Prenatal Management of CPAMs: Lung Lesions](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089) — video · 18:16 · [machine version](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089.md)
- [Neonatal Lung Lesions with Dr. Steven Rothenberg](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307) — podcast · 66:58 · [machine version](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307.md)
- [Fetoscopic Endoluminal Tracheal Occlusion (FETO)](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330) — podcast · 5:54 · [machine version](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330.md)
- [Fetoscopic Repair of Myelomeningocele (MMC)](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391) — podcast · 5:52 · [machine version](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391.md)
- [Treatment for Long Gap Esophageal Atresia: Esophageal Elongation and Replacement](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791) — podcast · 10:56 · [machine version](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791.md)
- [Myelomeningoceles (open spina bifida) -Fetoscopic Intrauterine Myelomeningocele Closure](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326) — video · 3:41 · [machine version](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326.md)
- [Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569) — video · 4:30 · [machine version](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569.md)
- [Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570) — video · 4:30 · [machine version](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570.md)

### Evidence & Research
- [Fetal Surgical Intervention for Myelomeningocele: Fetal Surgery 2012](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026) — video · 165:47 · [machine version](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026.md)
- [Journal of Pediatric Surgery Article Review: January 2022 APSA Issue](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103) — podcast · 13:09 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103.md)
- [Update Course 2021: TOP PUBLICATIONS IN NON - PED SURG JOURNALS](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404) — video · 22:13 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404.md)
- [Journal of Pediatric Surgery Article Highlights: April 2022](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554) — podcast · 8:38 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554.md)
- [Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820) — video · 64:30 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820.md)
- [Tracheomalacia and tracheomegaly in infants and children with congenital diaphragmatic hernia managed with and without fetoscopic endoluminal tracheal occlusion (FETO): a multicentre, retrospective cohort study](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334) — video · 0:59 · [machine version](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334.md)
- [Quick Literature Updates Ep 19](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465) — video · 4:27 · [machine version](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465.md)

### In-Depth Reviews
- [The Full Story on CPAMs](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463) — podcast · 56:08 · [machine version](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463.md)
- [Open Fetal Surgery & EXIT Procedure with Dr. Jose Peiro](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333) — video · 10:23 · [machine version](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333.md)

### Emerging & Future Directions
- [The fetal frontier: A review of current and emerging fetal therapies for genetic diseases](https://qa.library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057) — video · 0:44 · [machine version](https://qa.library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/utility-of-fluorescence-in-situ-hybridization-as-a-fetal-surgery-eligibility-criterion-for-12688?t=0) FISH Testing Utility in Fetal Surgery Screening (Ep 28)
- [0:00](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=0) Introduction and Dr. Rothenberg's Background (Ep 14)
- [3:06](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=186) Prenatal Evaluation and Workup of Lung Lesions (Ep 14)
- [8:52](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=532) Spectrum of Congenital Lung Lesions (Ep 14)
- [11:43](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=703) Postnatal Management and Timing of Imaging (Ep 14)
- [17:28](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1048) Timing of Surgery and Rationale for Early Operation (Ep 14)
- [21:52](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1312) Preoperative Preparation and Anesthetic Considerations (Ep 14)
- [27:59](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1679) Patient Positioning, Port Placement, and Instrumentation (Ep 14)
- [34:20](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2060) Vascular Control Technique and Device Selection (Ep 14)
- [41:10](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2470) Left Lower Lobectomy: Step-by-Step Technique (Ep 14)
- [51:03](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3063) Right Lower Lobectomy (Ep 14)
- [51:42](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3102) Left Upper Lobectomy (Including Lingula) (Ep 14)
- [55:40](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3340) Right Middle Lobectomy (Ep 14)
- [57:02](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3422) Additional Technical Pearls for Lobectomy (Ep 14)
- [58:27](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3507) Management of Extralobar Sequestration (Ep 14)
- [62:32](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3752) Segmentectomy vs. Lobectomy (Ep 14)
- [64:40](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3880) Postoperative Course and Discharge (Ep 14)
- [65:50](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3950) Closing Remarks (Ep 14)
- [0:00](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=0) Introduction and Study Design (Ep 24)
- [0:22](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=22) Key Findings (Ep 24)
- [0:46](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=46) Conclusion (Ep 24)
- [0:00](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=0) Introduction and Case 1: Timing of Repair in Stable CDH (Ep 1)
- [4:31](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=271) Surgical Approach: MIS versus Open Repair (Ep 1)
- [7:50](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=470) Technical Aspects of Thoracoscopic CDH Repair (Ep 1)
- [17:47](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1067) Patch Materials and Recurrence Prevention (Ep 1)
- [25:02](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1502) Case 2: ECMO Management and Repair Timing (Ep 1)
- [30:27](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1827) ECMO Repair Strategies and David Kays' Results (Ep 1)
- [36:14](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2174) Redo Repairs, Muscle Flaps, and Fetal Intervention (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=0) Fetal Therapies for Genetic Diseases (Ep 27)
- [0:00](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=0) Introduction and Pressure Physiology in Fetal Bladder Obstruction (Ep 3)
- [7:26](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=446) Fetoscopic Cystoscopy: Rationale and Early Evidence (Ep 3)
- [14:33](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=873) Cincinnati Case Presentation: Urethral Stent Placement (Ep 3)
- [25:27](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1527) Debate: Serial Bladder Taps and Patient Selection (Ep 3)
- [37:31](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2251) Open Fetal Vesicostomy: Indications and Controversy (Ep 3)
- [49:15](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2955) Long-Term Renal Outcomes and Postnatal Bladder Management (Ep 3)
- [58:27](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=3507) Closing Pearls: Selection, Honesty, and Future Directions (Ep 3)
- [0:01](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=1) Introduction: Indications and Contraindications for Fetal Intervention in Urinary Tract Obstruction (Ep 7)
- [7:00](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=420) Fetoscopic Cystoscopy: Rationale and Early Evidence (Ep 7)
- [12:42](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=762) Technical Aspects and Case Presentation of Fetoscopic Intervention (Ep 7)
- [20:40](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=1240) Debate: Shunt Decompression vs. Pressure Theory (Ep 7)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Many centers require genetic testing to rule out chromosome abnormalities before fetal surgery, even when ultrasounds and blood tests already look reassuring" — Lizzie Lee (clinical) [Ep 28 · 0:09](https://qa.library.globalcastmd.com/watch/utility-of-fluorescence-in-situ-hybridization-as-a-fetal-surgery-eligibility-criterion-for-12688?t=9)
- "A study reviewed nearly 1000 pregnancies evaluated for fetal surgery" — Lizzie Lee (epidemiological) [Ep 28 · 0:23](https://qa.library.globalcastmd.com/watch/utility-of-fluorescence-in-situ-hybridization-as-a-fetal-surgery-eligibility-criterion-for-12688?t=23)
- "When imaging and cell-free DNA screening showed low risk for aneuploidy, the FISH test matched those results 100% of the time" — Lizzie Lee (clinical) [Ep 28 · 0:23](https://qa.library.globalcastmd.com/watch/utility-of-fluorescence-in-situ-hybridization-as-a-fetal-surgery-eligibility-criterion-for-12688?t=23)
- "For low-risk pregnancies, FISH did not provide any new information that changed surgery candidacy" — Lizzie Lee (clinical) [Ep 28 · 0:36](https://qa.library.globalcastmd.com/watch/utility-of-fluorescence-in-situ-hybridization-as-a-fetal-surgery-eligibility-criterion-for-12688?t=36)
- "In carefully selected low-risk cases, non-invasive screening may be enough, potentially avoiding the FISH procedure" — Lizzie Lee (opinion) [Ep 28 · 0:42](https://qa.library.globalcastmd.com/watch/utility-of-fluorescence-in-situ-hybridization-as-a-fetal-surgery-eligibility-criterion-for-12688?t=42)
- "Serial prenatal ultrasounds are the best way to follow cystic lung lesions; they are noninvasive, quick, and performed every couple of weeks." — Steven Rothenberg (clinical) [Ep 14 · 3:48](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=228)
- "Fetal MRI for lung lesions provides little additional benefit and does not change the management plan." — Steven Rothenberg (opinion) [Ep 14 · 4:11](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=251)
- "Anywhere from 6 to 40% of prenatally detected lung lesions will regress over time, and in some cases appear to completely disappear." — Steven Rothenberg (epidemiological) [Ep 14 · 5:43](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=343)
- "Fetal intervention (open surgery) for lung lesions is extremely rare; CHOP performs less than one open fetal surgery every couple of years." — Steven Rothenberg (epidemiological) [Ep 14 · 6:11](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=371)
- "Fetal thoracentesis or thoracoamniotic shunt is done only if the fetus shows significant distress or evidence of hydrops, which significantly increases mortality." — Steven Rothenberg (clinical) [Ep 14 · 6:31](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=391)
- "Steroids are given if larger cysts cause mediastinal shift, or to mature the lung if early delivery is anticipated." — Steven Rothenberg (clinical) [Ep 14 · 7:13](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=433)
- "A cyst volume ratio (CVR) greater than 2 has an extremely bad prognosis and is more likely to require fetal intervention." — Steven Rothenberg (clinical) [Ep 14 · 7:54](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=474)
- "Congenital lung lesions (CAMs, sequestrations, bronchogenic cysts) represent a spectrum; hybrid lesions are common on pathology." — Steven Rothenberg (clinical) [Ep 14 · 8:52](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=532)
- "Sequestrations are classified by the presence of a systemic artery (usually from the aorta); intralobar sequestrations share pleura with the lobe, extralobar have their own pleural lining." — Steven Rothenberg (clinical) [Ep 14 · 9:37](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=577)
- "If a baby is born doing well with no respiratory distress and a normal or mildly abnormal chest X-ray, the family can go home; CT scan is obtained at 4–6 weeks." — Steven Rothenberg (clinical) [Ep 14 · 11:43](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=703)
- "A chest X-ray or ultrasound is not adequate to prove a prenatally detected lung lesion has completely resolved; CT scan is required." — Steven Rothenberg (clinical) [Ep 14 · 12:39](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=759)
- "Some children with normal postnatal chest X-ray or ultrasound later present with pneumonia (9 months to 6–7 years) and are found to have an infected CPAM." — Steven Rothenberg (clinical) [Ep 14 · 14:44](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=884)
- "Depending on the series, 20–40% of untreated congenital lung lesions will develop a significant infection at some point." — Steven Rothenberg (epidemiological) [Ep 14 · 15:47](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=947)
- "The incidence of malignancy in untreated congenital lung lesions is over 1% in Rothenberg's series, which he considers significant." — Steven Rothenberg (epidemiological) [Ep 14 · 16:56](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1016)
- "Rothenberg prefers to operate by 3 months of age to avoid infection, because surgery is technically easier with smaller vessels and fresh anatomy, and to allow compensatory lung growth." — Steven Rothenberg (opinion) [Ep 14 · 17:49](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1069)
- "In Rothenberg's series, hospital stay, chest tube duration, recovery, and operative time were shorter in patients under 5 kg compared to those under 10 kg." — Steven Rothenberg (clinical) [Ep 14 · 19:19](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1159)
- "Most infants undergoing early lobectomy are discharged within 48 hours; by one month post-op, chest X-ray shows no evidence of surgery." — Steven Rothenberg (clinical) [Ep 14 · 19:46](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1186)
- "Even in asymptomatic children, waiting until around one year of age often reveals significantly enlarged lymph nodes and inflammation in the fissure, suggesting low-grade infection." — Steven Rothenberg (clinical) [Ep 14 · 18:46](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1126)
- "The key to success in small infants is proper setup and port placement; with the right approach, there is plenty of room to work." — Steven Rothenberg (clinical) [Ep 14 · 21:13](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1273)
- "Blood is typed and crossed for all lobectomies; it is one of the few pediatric cases where this is routine, because bleeding can be significant." — Steven Rothenberg (clinical) [Ep 14 · 22:36](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1356)
- "Most asymptomatic children on room air tolerate single-lung ventilation without problem." — Steven Rothenberg (clinical) [Ep 14 · 23:38](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1418)
- "Single-lung ventilation is achieved by main-stem intubation of the contralateral bronchus; bronchial blockers are difficult to place and add time, so are avoided." — Steven Rothenberg (clinical) [Ep 14 · 24:06](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1446)
- "After lung collapse, infants initially desaturate (low 90s to high 80s) due to shunting; saturations improve once shunting to the collapsed lung stops." — Steven Rothenberg (clinical) [Ep 14 · 26:02](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1562)
- "Anesthesiologists should use lower peak ventilatory pressures and increase rate (not pressure) to improve ventilation, avoiding high-pressure bagging that re-inflates the operative lung." — Steven Rothenberg (clinical) [Ep 14 · 26:36](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1596)
- "End-tidal CO₂ in the mid-40s is tolerable and does not cause significant acidosis during thoracoscopic lobectomy." — Steven Rothenberg (clinical) [Ep 14 · 27:41](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1661)
- "The surgeon and assistant stand at the patient's front (nipple side) in lateral decubitus position; there is more room from the front of the chest to the hilum than from the back." — Steven Rothenberg (clinical) [Ep 14 · 28:59](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1739)
- "The camera port is placed over the major fissure in the mid-axillary line (5th or 6th interspace for lower lobe), anterior to the scapula tip, to allow working from front to back without paradoxical instrument angles." — Steven Rothenberg (clinical) [Ep 14 · 30:39](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1839)
- "A fourth port is almost never needed; gravity and lung collapse provide adequate retraction in small children." — Steven Rothenberg (clinical) [Ep 14 · 32:28](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1948)
- "Rothenberg uses a 4 mm 30° short scope (20 cm) for wider angle view and to allow the assistant to stay close without interference." — Steven Rothenberg (clinical) [Ep 14 · 33:01](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1981)
- "Low-profile reusable 3 mm ports are essential in small infants; large-headed 5 mm ports cause instruments to collide in the limited space." — Steven Rothenberg (clinical) [Ep 14 · 33:56](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2036)
- "A 3 mm vessel sealer (bipolar technology) can seal vessels up to 5 mm in diameter." — Steven Rothenberg (clinical) [Ep 14 · 35:01](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2101)
- "The dual-seal technique: make two separate seals on a vessel 4–5 mm apart, then cut partway between them to confirm hemostasis before full division." — Steven Rothenberg (clinical) [Ep 14 · 35:15](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2115)
- "Vascular control is everything in thoracoscopic lobectomy; the dual-seal technique allows recovery if a seal fails, whereas full division without confirmation risks uncontrollable hemorrhage." — Steven Rothenberg (clinical) [Ep 14 · 35:52](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2152)
- "Clips can be knocked off vessels; the dual-seal technique with vessel sealing is safer than routine clipping." — Steven Rothenberg (opinion) [Ep 14 · 36:59](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2219)
- "Using energy devices that seal and cut simultaneously (e.g., Harmonic) on major vessels is a mistake and sets up the surgeon for unrecoverable bleeding." — Steven Rothenberg (opinion) [Ep 14 · 37:46](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2266)
- "Rothenberg had one case using a seal-and-cut device that failed, resulting in bleeding and conversion to open." — Steven Rothenberg (clinical) [Ep 14 · 39:09](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2349)
- "If using the LigaSure device, do not activate the cutting function; seal, remove the device, and cut with scissors to allow partial division and confirmation of hemostasis." — Todd Ponsky (host_summary) [Ep 14 · 39:28](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2368)
- "The first step in left lower lobectomy is to take down the inferior pulmonary ligament to check for a systemic vessel and to expose the inferior pulmonary vein." — Steven Rothenberg (clinical) [Ep 14 · 42:01](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2521)
- "The ease of lobectomy depends on fissure completeness; incomplete fissures require layer-by-layer completion using the vessel sealer, similar to finger fracture in liver surgery." — Steven Rothenberg (clinical) [Ep 14 · 42:54](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2574)
- "In a left lower lobectomy, the pulmonary artery trunk bifurcates into four basal segment branches; the superior segmental branch comes off higher and more posteriorly." — Steven Rothenberg (clinical) [Ep 14 · 44:06](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2646)
- "The bronchus sits directly underneath the pulmonary artery and can be palpated to aid dissection behind the artery." — Steven Rothenberg (clinical) [Ep 14 · 45:23](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2723)
- "If the main arterial trunk has good length, a 5 mm stapler can be used; otherwise, dissect and seal individual basal segmental branches for safer vascular control." — Steven Rothenberg (clinical) [Ep 14 · 45:35](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2735)
- "When using a stapler on a major vessel, always have proximal control (clamp) in place before firing, in case the staple line bleeds." — Steven Rothenberg (clinical) [Ep 14 · 46:25](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2785)
- "Rothenberg now works 'front to back' through the fissure (like turning pages of a book) rather than flipping the lung, because it is hard to change exposure thoracoscopically." — Steven Rothenberg (clinical) [Ep 14 · 47:35](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2855)
- "After dividing the artery, the next step is the bronchus (superior segmental first, then main trunk); the pulmonary vein lies directly behind the bronchus." — Steven Rothenberg (clinical) [Ep 14 · 48:04](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2884)
- "In children over 10 kg, a 12 mm stapler is needed for the bronchus; under 10 kg, a 5 mm stapler or clips suffice." — Steven Rothenberg (clinical) [Ep 14 · 49:11](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2951)
- "After dividing the bronchus, dissect the inferior pulmonary vein to its first bifurcation, seal the smaller branch for length, then staple the main trunk—never take the vein near the pericardium." — Steven Rothenberg (clinical) [Ep 14 · 49:46](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2986)
- "If a vascular device fails near the pericardium, the vessel retracts and the child will bleed to death before you can intervene; always ensure adequate length for proximal control." — Steven Rothenberg (clinical) [Ep 14 · 50:33](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3033)
- "Right lower lobectomy is the mirror image of left lower lobe; the key caution is that middle lobe vessels branch off just above the lower lobe artery." — Steven Rothenberg (clinical) [Ep 14 · 51:03](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3063)
- "For left upper lobectomy, retract the apex inferiorly to expose the apical/anterior arterial trunk at the apex of the chest; divide its branches first." — Steven Rothenberg (clinical) [Ep 14 · 52:02](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3122)
- "After taking the upper lobe arteries, retract the lung posteriorly to expose and divide the superior pulmonary vein and lingular vein." — Steven Rothenberg (clinical) [Ep 14 · 53:23](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3203)
- "In left upper lobectomy, the lingula is almost always taken with the upper lobe; on the right, the middle lobe is usually preserved." — Steven Rothenberg (clinical) [Ep 14 · 54:06](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3246)
- "Working through the fissure in upper lobectomy, the lingular artery is encountered first, then a large posterior segmental branch, then the upper lobe bronchus." — Steven Rothenberg (clinical) [Ep 14 · 54:30](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3270)
- "For right middle lobectomy, complete the minor fissure anteriorly; the pulmonary artery enters posteriorly and bifurcates into upper and lower branches." — Steven Rothenberg (clinical) [Ep 14 · 55:47](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3347)
- "If the lung has large cysts limiting visualization, use the vessel sealer to pop the cysts at the start of the case to decompress and improve exposure." — Steven Rothenberg (clinical) [Ep 14 · 57:38](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3458)
- "Extralobar sequestrations can have up to 6 systemic vessels; Rothenberg has seen vessels as large as 15 mm in diameter." — Steven Rothenberg (clinical) [Ep 14 · 58:40](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3520)
- "For sequestration vessels, use clips or vessel sealer with dual-seal technique; a 5 mm stapler can be used for very large vessels (e.g., 15 mm)." — Steven Rothenberg (clinical) [Ep 14 · 58:58](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3538)
- "Never use both clips and energy sealing on the same vessel; energy changes the vessel wall, causing clips to lose purchase and leading to delayed bleeding." — Steven Rothenberg (clinical) [Ep 14 · 59:45](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3585)
- "Systemic vessels to sequestrations come off the aorta under higher pressure than pulmonary vessels, so meticulous technique is critical." — Steven Rothenberg (clinical) [Ep 14 · 60:43](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3643)
- "Extralobar sequestrations can become infected; Rothenberg removes them all thoracoscopically with no chest tube and next-day discharge, so embolization is not indicated." — Steven Rothenberg (opinion) [Ep 14 · 61:07](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3667)
- "Rothenberg historically performed complete lobectomy but now considers segmentectomy (superior segment of lower lobe, lingula) if CT shows disease confined to one segment; approximately 20 cases with no recurrence on follow-up." — Steven Rothenberg (clinical) [Ep 14 · 62:42](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3762)
- "A chest tube is left overnight after lobectomy; if no air leak or drainage, it is removed the morning of postoperative day 1, chest X-ray obtained 2 hours later, and patient discharged that afternoon." — Steven Rothenberg (clinical) [Ep 14 · 64:46](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3886)
- "Average length of stay for lobectomy is 2.5 days; it is shorter (under 2 days) in infants under 5 kg." — Steven Rothenberg (clinical) [Ep 14 · 65:33](https://qa.library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3933)
- "Tracheomalacia was 5% more common in tracheal occluded infants with 4% more cases" — Carlos Colunga (clinical) [Ep 24 · 0:24](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=24)
- "Tracheomalacia symptoms typically receded within 55 months in FETO-treated infants" — Carlos Colunga (clinical) [Ep 24 · 0:29](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=29)
- "FETO-treated infants showed a larger trachea, approximately 31% wider" — Carlos Colunga (clinical) [Ep 24 · 0:33](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=33)
- "37% of tracheally occluded cases retained metallic balloon components" — Carlos Colunga (clinical) [Ep 24 · 0:33](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=33)
- "No significant complications were reported from retained metallic balloon components" — Carlos Colunga (clinical) [Ep 24 · 0:33](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=33)
- "Tracheal occlusion is effective in promoting lung growth" — Carlos Colunga (clinical) [Ep 24 · 0:46](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=46)
- "FETO is associated with a higher risk of tracheomalacia" — Carlos Colunga (clinical) [Ep 24 · 0:46](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=46)
- "Most cases of FETO-associated tracheomalacia resolve and do not appear to have long-term effects" — Carlos Colunga (clinical) [Ep 24 · 0:46](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=46)
- "A Columbia paper showed high recurrence rates with MIS CDH repair, creating resistance to the approach" — Wolfan (host_summary) [Ep 1 · 1:11](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=71)
- "For stable CDH patients not on ECMO, waiting 24-48 hours allows transitional circulation to stabilize and provides ventilator reserve before repair" — Ron (clinical) [Ep 1 · 2:49](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=169)
- "Bowel distention in unreduced CDH compromises pulmonary and cardiac function over time, favoring earlier repair" (clinical) [Ep 1 · 3:40](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=220)
- "Echocardiography to assess pulmonary hypertension guides timing of CDH repair" — David (clinical) [Ep 1 · 3:53](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=233)
- "Charlie Stoller showed approximately 30% recurrence rate with thoracoscopic CDH repair" — Ron (host_summary) [Ep 1 · 6:36](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=396)
- "Recurrence rates improve with surgical experience and technique refinement in thoracoscopic CDH repair" — Ron (opinion) [Ep 1 · 6:49](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=409)
- "Surgeons may unconsciously avoid placing adequate sutures in MIS repair if knot-tying is time-consuming, contributing to recurrence" — Wolfan (opinion) [Ep 1 · 9:49](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=589)
- "Cauterizing the edge of the CDH defect promotes inflammation and healing, similar to unfolding the posterior leaflet in open repair" — Wolfan (clinical) [Ep 1 · 10:17](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=617)
- "Excessive tension during thoracoscopic CDH closure can create an overly flat diaphragm, though Avi Schleger's work suggests post-op bowing may not significantly affect outcomes" — Wolfan (clinical) [Ep 1 · 10:49](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=649)
- "Using buttress material reduces recurrence rates in CDH repair, per data from Rusty and Craig's institution" — Wolfan (host_summary) [Ep 1 · 12:31](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=751)
- "Liberal use of absorbable mesh as underlay beneath primary repair reduces CDH recurrence" — Wolfan (clinical) [Ep 1 · 12:48](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=768)
- "MIS approach to CDH repair greatly reduces small bowel obstruction compared to laparotomy" — Wolfan (clinical) [Ep 1 · 22:53](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1373)
- "In the speaker's series, MIS and open CDH repairs showed similar recurrence rates, with patch use being a major factor" — Wolfan (epidemiological) [Ep 1 · 23:24](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1404)
- "For CDH with agenesis or near-agenesis (type C or D defects), open repair is preferred due to complexity and proximity to esophagus" — Wolfan (clinical) [Ep 1 · 23:53](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1433)
- "Severe CDH patients (O-to-E ratios 25% or below) often have small left ventricles causing hemodynamic problems in addition to pulmonary issues" — Ron (clinical) [Ep 1 · 25:35](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1535)
- "VV ECMO may not work well in CDH patients with small left ventricles; VA ECMO is preferred in those cases" — Ron (clinical) [Ep 1 · 26:02](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1562)
- "Inhaled nitric oxide (iNO) should not be trialed before ECMO in severe CDH; data show it does not work pre-ECMO" — Ron (clinical) [Ep 1 · 26:20](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1580)
- "After birth, severe CDH patients may initially have high CO2 that falls over the first couple hours; this response guides ECMO cannulation timing" — Ron (clinical) [Ep 1 · 26:51](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1611)
- "A recent Pediatric Surgery International paper showed low rates of return to ECMO and death following CDH repair, not justifying routine repair on ECMO" — Wolfan (host_summary) [Ep 1 · 29:43](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1783)
- "Timing of CDH repair has no real influence on ultimate survival" — Wolfan (host_summary) [Ep 1 · 30:08](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1808)
- "David Kays in Saint Petersburg achieves 100% survival in CDH (last 75 patients, all comers including preemies and heart disease), with 80% requiring ECMO and all repaired immediately on ECMO" (host_summary) [Ep 1 · 31:19](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1879)
- "David Kays switched to using bivalirudin for ECMO anticoagulation and reports decreased bleeding rates with immediate CDH repair on ECMO" — Ron (host_summary) [Ep 1 · 32:34](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1954)
- "When repairing CDH on ECMO, leaving the abdomen open or using a silo prevents compromised pulmonary compliance from increased intra-abdominal pressure" — Ron (clinical) [Ep 1 · 34:21](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2061)
- "Transversalis muscle flap repair for CDH shows very low recurrence rates but results in abdominal wall bulge" — Wolfan (clinical) [Ep 1 · 36:41](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2201)
- "Overall mortality for any CDH patient requiring ECMO is approximately 50%" — Ron (epidemiological) [Ep 1 · 37:34](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2254)
- "Midgut volvulus after CDH repair is surprisingly low in incidence; routine Ladd's procedure is not performed" — Wolfan (epidemiological) [Ep 1 · 38:33](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2313)
- "Indications for the FETO trial (fetal tracheal occlusion) are liver herniation and lung-to-head ratio (LHR) greater than 0.9" — Wolfan (guideline) [Ep 1 · 41:18](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2478)
- "Faster prenatal diagnosis enables detection of many genetic conditions early" — Lizzie Lee (clinical) [Ep 27 · 0:14](https://qa.library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=14)
- "Medications can be given to the mother that cross the placenta" — Lizzie Lee (clinical) [Ep 27 · 0:18](https://qa.library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=18)
- "Enzyme replacement therapy can be delivered directly to the fetus" — Lizzie Lee (clinical) [Ep 27 · 0:18](https://qa.library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=18)
- "Protein therapy can be delivered to the fetus" — Lizzie Lee (clinical) [Ep 27 · 0:24](https://qa.library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=24)
- "Stem cells can be delivered to the fetus" — Lizzie Lee (clinical) [Ep 27 · 0:24](https://qa.library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=24)
- "The fetus has a more tolerant immune system compared to postnatal life" — Lizzie Lee (clinical) [Ep 27 · 0:27](https://qa.library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=27)
- "The fetus has a more permissive blood-brain barrier compared to postnatal life" — Lizzie Lee (clinical) [Ep 27 · 0:27](https://qa.library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=27)
- "Most fetal therapies for genetic diseases are still experimental" — Lizzie Lee (clinical) [Ep 27 · 0:34](https://qa.library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=34)
- "Fetal intervention aims to prevent lifelong disease by treating during fetal development" — Lizzie Lee (clinical) [Ep 27 · 0:38](https://qa.library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=38)
- "In adult studies, bladder pressure exceeding 40 cm H₂O (29 mmHg) causes renal injury and abolishes net glomerular filtration." — Pramod Reddy (clinical) [Ep 3 · 4:49](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=289)
- "Safe bladder pressures for fetal kidneys are unknown; adult thresholds are used by extrapolation." — Pramod Reddy (clinical) [Ep 3 · 5:13](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=313)
- "Vesicoamniotic shunts have not improved renal outcomes because the long, thin tubes do not adequately reduce bladder pressure; they provide pulmonary survivors but not renal protection." — Pramod Reddy (clinical) [Ep 3 · 4:00](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=240)
- "Intravillous pressure that occludes venous flow in the placenta is approximately 23 mmHg; resting amniotic fluid pressure is 5–8 mmHg." — Todd Ponsky (clinical) [Ep 3 · 5:43](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=343)
- "When a vesicoamniotic shunt is placed, the bladder often collapses and upper tracts decompress significantly, though residual hydroureteronephrosis may persist." — Greg Tiao (clinical) [Ep 3 · 7:38](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=458)
- "Fetoscopic cystoscopy altered the diagnosis in 25–33% of fetuses with suspected LUTO, according to a review by Katie Morris." — Greg Tiao (host_summary) [Ep 3 · 11:35](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=695)
- "A French-Brazilian-Houston study of 111 LUTO fetuses found that only cystoscopy (not shunting) may prevent renal function impairment at 6 months of age." — Greg Tiao (host_summary) [Ep 3 · 12:09](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=729)
- "In a Barcelona-Leuven series of 20 fetoscopic valve ablations, bladder size and amniotic fluid normalized in 80% of cases; among livebirths, there was no pulmonary hypoplasia and three-quarters had normal renal function." — Greg Tiao (host_summary) [Ep 3 · 12:55](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=775)
- "Fetoscopic valve ablation carries a 9–10% risk of urethral fistula and a 6% risk of recurrent severe LUTO." — Greg Tiao (host_summary) [Ep 3 · 13:36](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=816)
- "Vesicoamniotic shunt complications include migration, blockage, and (rarely) iatrogenic gastroschisis when placed at 17 weeks." — Greg Tiao (clinical) [Ep 3 · 14:06](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=846)
- "The Cincinnati team uses a 3.3 Fr outer sheath fetoscope (1.2 mm scope) with a side port for guidewire passage during cystoscopy." — Foong Yen Lim (clinical) [Ep 3 · 30:01](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1801)
- "A flexible 4.9 Fr ureteroscope can be introduced through a 10 Fr sheath to improve maneuverability when accessing the fetal bladder neck and posterior urethra." — Pramod Reddy (clinical) [Ep 3 · 30:18](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1818)
- "Fetoscopic procedures for LUTO can be performed under epidural anesthesia with IV sedation and local anesthetic, avoiding the deep uterine relaxation required for open fetal surgery." — Foong Yen Lim (clinical) [Ep 3 · 24:13](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1453)
- "Fetal anesthesia for fetoscopy includes intramuscular vecuronium, atropine, and fentanyl to prevent fetal movement and mitigate pain response." — Todd Ponsky (clinical) [Ep 3 · 24:57](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1497)
- "Serial bladder taps carry a risk of bladder rupture and urinary ascites, which can preclude subsequent fetoscopic intervention." — Foong Yen Lim (clinical) [Ep 3 · 22:42](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1362)
- "The Pluto trial removed bladder taps from its protocol because data suggested the most powerful effect of shunting is in poor-prognosis fetuses, and even good-prognosis fetuses have ~50% risk of bad renal function postnatally." — Todd Ponsky (host_summary) [Ep 3 · 34:19](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2059)
- "In Mark Johnson's historical studies, the third vesicocentesis provided fresher urine that correlated strongly with histologic renal damage; the first and second taps were not predictive." — Greg Tiao (epidemiological) [Ep 3 · 34:57](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2097)
- "In a long-term follow-up series, one-third of shunted LUTO survivors developed end-stage renal disease requiring transplant after age 5 years, despite having acceptable discharge creatinine." — Greg Tiao (epidemiological) [Ep 3 · 49:58](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2998)
- "Posterior urethral valve patients required transplant at median age 10–12 years; prune belly/urethral hypoplasia at ~4.5 years; urethral atresia earlier." — Greg Tiao (epidemiological) [Ep 3 · 51:24](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=3084)
- "Progressive renal injury in shunted LUTO survivors is driven by repeated urinary tract infections, vesicoureteral reflux, and valve bladder dysfunction." — Greg Tiao (clinical) [Ep 3 · 52:13](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=3133)
- "Creatinine at hospital discharge is misleading; creatinine at age 1 year is a better predictor of long-term renal function. A creatinine <1.0 mg/dL at age 1 suggests the child will not require renal replacement therapy." — Pramod Reddy (clinical) [Ep 3 · 56:52](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=3412)
- "Infants with LUTO triple their birth weight in the first year, revealing the true extent of renal reserve; discharge creatinine does not account for this growth." — Pramod Reddy (clinical) [Ep 3 · 56:52](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=3412)
- "Bladder cycling enabled by fetoscopic valve ablation is physiologically important for bladder health, not for upper-tract protection." — Pramod Reddy (clinical) [Ep 3 · 16:39](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=999)
- "A urethral fistula from fetoscopic laser ablation can be repaired surgically with minimal morbidity, whereas renal dysplasia cannot be reversed." — Pramod Reddy (opinion) [Ep 3 · 17:57](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1077)
- "Posterior urethral valves can sometimes be ablated by blunt mechanical disruption (guidewire and catheter) rather than laser, because the valves are flimsy." — Pramod Reddy (clinical) [Ep 3 · 18:30](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1110)
- "Cincinnati performed open fetal vesicostomy in six anhydramniotic fetuses; four died from preterm delivery, one has normal renal function at age 5, and one required transplant." — Pramod Reddy (epidemiological) [Ep 3 · 41:33](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2493)
- "Open fetal vesicostomy predisposes the mother to shortened gestation (~10 additional weeks) and very high risk of preterm labor." — Pramod Reddy (clinical) [Ep 3 · 41:06](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2466)
- "Greg Ryan argues there is no role for open fetal surgery in LUTO, especially in the worst-prognosis group, given the maternal and fetal risks and the experimental nature of the procedure." — Greg Tiao (opinion) [Ep 3 · 43:12](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2592)
- "Foong Yen Lim proposes that open fetal vesicostomy should be considered only in good-prognosis fetuses who fail fetoscopic intervention, not in the sickest cohort." — Foong Yen Lim (opinion) [Ep 3 · 45:39](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2739)
- "Current algorithms reserve the most invasive interventions (open vesicostomy) for the worst-prognosis fetuses, which may be flawed because these patients are least likely to benefit and most likely to suffer maternal and fetal harm." — Pramod Reddy (opinion) [Ep 3 · 38:44](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2324)
- "Better biomarkers of fetal renal function are urgently needed to guide intervention selection and predict outcomes." — Pramod Reddy (opinion) [Ep 3 · 47:57](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2877)
- "Polyuria from fetal concentrating defects causes high bladder storage pressures, which damage the upper tracts in a vicious cycle; aggressive postnatal bladder management is required to break this cycle." — Pramod Reddy (clinical) [Ep 3 · 57:31](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=3451)
- "Mark Johnson's closing pearl: patient selection is the most critical factor in fetal intervention for LUTO." — Greg Tiao (opinion) [Ep 3 · 58:46](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=3526)
- "Greg Ryan's closing pearl: just because a procedure can be done does not mean it should be done; honest counseling about outcomes is essential." — Greg Tiao (opinion) [Ep 3 · 60:04](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=3604)
- "Fetoscopic cystoscopy must be considered experimental for LUTO until properly evaluated in a rigorous trial." — Greg Tiao (guideline) [Ep 3 · 11:58](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=718)
- "Not all fetuses with urinary tract obstruction are candidates for intervention; those too healthy (normal AFI, non-obstructive dilation, unilateral UPJ) or too sick (cystic dysplasia, abnormal karyotype, multiple anomalies) should not be offered fetal surgery." — Pramod Reddy (guideline) [Ep 3 · 2:04](https://qa.library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=124)
- "Not all fetuses with urinary tract obstruction are candidates for intervention; some are too healthy (normal AFI, non-obstructive dilation, unilateral UPJ obstruction) where intervention risk outweighs benefit." (clinical) [Ep 7 · 0:14](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=14)
- "Some fetuses are too sick for intervention to provide benefit (renal cystic dysplasia, abnormal urinary parameters, abnormal karyotype, multiple congenital anomalies)." (clinical) [Ep 7 · 0:56](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=56)
- "Vesicoamniotic shunts have not lived up to their promise because they are long thin tubes with high resistance; while they allow urine reflux for lung development, they do not adequately relieve pressure causing upper tract injury." (clinical) [Ep 7 · 2:09](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=129)
- "In adults, bladder pressure exceeding 40 cm H2O (29 mmHg) injures kidneys and eliminates net glomerular filtration." (clinical) [Ep 7 · 2:58](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=178)
- "Safe bladder pressure thresholds for fetal kidney development are unknown and should be studied by measuring opening pressure during vesicocentesis." (opinion) [Ep 7 · 3:22](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=202)
- "Intravillous pressure that occludes venous flow in the placenta is about 23 mmHg; resting amniotic fluid pressure is 5-8 mmHg." (clinical) [Ep 7 · 3:51](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=231)
- "Shunts have provided pulmonary survivors but have not significantly improved renal outcomes; fetoscopic and open vesicostomy approaches that reduce bladder pressure to near-zero may offer better renal preservation." (clinical) [Ep 7 · 4:56](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=296)
- "When a shunt is placed and the bladder collapses, upper tracts (ureters, renal pelvis) significantly decompress to near-normal appearance." (clinical) [Ep 7 · 5:53](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=353)
- "Even after bladder decompression with shunts, residual hydroureteronephrosis persists in some cases, suggesting incomplete pressure relief." (clinical) [Ep 7 · 7:41](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=461)
- "Fetoscopic cystoscopy may be superior to shunting because it allows cyclical voiding (more physiologic drainage), determines etiology (PUV vs. atresia), avoids amnioinfusion complications, and avoids shunt migration/blockage." (clinical) [Ep 7 · 9:06](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=546)
- "Cystoscopy altered the diagnosis in 25-33% of fetuses with suspected LUTO." (host_summary) [Ep 7 · 9:56](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=596)
- "In a French/Brazilian/Houston series of 111 LUTO fetuses (60 no intervention, 16 shunted, 34 cystoscopy), both interventions improved 6-month survival, but only cystoscopy may prevent renal function impairment at 6 months." (host_summary) [Ep 7 · 10:25](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=625)
- "In a Barcelona/Leuven series of fetal cystoscopy with laser valve ablation, urethra was accessed in nearly all cases, bladder size and amniotic fluid normalized in 80%, and among livebirths, none had pulmonary hypoplasia and three-quarters had normal renal function." (host_summary) [Ep 7 · 11:21](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=681)
- "Fetoscopic cystoscopy creates a urological fistula in 9-10% of cases and causes recurrent severe LUTO in about 6%." (host_summary) [Ep 7 · 11:49](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=709)
- "Shunt complications include migration (can end up around the cord) and gastroschisis when placed at 17 weeks." (clinical) [Ep 7 · 12:16](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=736)
- "Bladder cycling enabled by fetoscopic procedures is important for bladder health, not upper tract protection; the main renal benefit comes from pressure reduction via a normal urethral lumen." (clinical) [Ep 7 · 14:25](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=865)
- "A 10% risk of urological fistula from laser ablation is preferable to renal dysplasia because fistulas can be surgically repaired postnatally with minimal morbidity." (opinion) [Ep 7 · 16:08](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=968)
- "Posterior urethral valves can sometimes be bluntly ablated by pushing a catheter through with a guide wire because the valves are flimsy." (clinical) [Ep 7 · 16:39](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=999)
- "Hydrodistention alone is unlikely to rupture posterior urethral valves; if it could, the pressure in the obstructed urinary tract should already blow them open." (clinical) [Ep 7 · 16:56](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=1016)
- "Fetoscopic cystoscopy technique uses a 3.3mm outer sheath fetoscope (1.2mm scope) with side port for guide wire, sometimes switching to a 4.9 French flexible ureteroscope for better maneuverability to access the bladder neck." (clinical) [Ep 7 · 28:11](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=1691)
- "Three serial bladder taps are not necessary if the first and second show favorable values (at or below threshold on first, clearly below on second); additional taps risk bladder rupture and ascites." (clinical) [Ep 7 · 20:52](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=1252)
- "The first bladder drainage reflects urine that has been sitting in the bladder and is not predictive; the second is also not predictive; the third provides fresher urine with better correlation to underlying renal injury." (clinical) [Ep 7 · 33:29](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=2009)
- "The PLUTO trial removed bladder taps from their protocol, but the trial had many flaws including lack of patient selection based on urine parameters." (opinion) [Ep 7 · 32:28](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=1948)
- "Fetoscopic procedures can be performed with epidural plus IV sedation and local anesthetic rather than deep general anesthesia, reducing maternal anesthetic risk compared to open fetal surgery." (clinical) [Ep 7 · 22:23](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=1343)
- "Fetal anesthesia for fetoscopic procedures uses intramuscular vecuronium, atropine, and fentanyl to prevent fetal movement and mitigate pain response." (clinical) [Ep 7 · 23:06](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=1386)
- "Open fetal vesicostomy was pioneered by Harrison in 1982 with fetal ureterostomies; he later reported 8 open vesicostomies with 100% technical success but 50% mortality, leading him to stop the procedure." (host_summary) [Ep 7 · 38:24](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=2304)
- "Cincinnati Children's Hospital experience with open fetal vesicostomy: 6 cases offered to families with anhydramnios, 4 fetal deaths (all preterm deliveries), 2 survivors. One 5-year-old has normal creatinine and bladder function with solitary kidney; the other required transplant." (epidemiological) [Ep 7 · 39:01](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=2341)
- "Open fetal intervention predisposes to very shortened gestational age (about 10 more weeks maximum) and the operated uterus is highly unstable with high risk of preterm labor." (clinical) [Ep 7 · 39:33](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=2373)
- "There is no role for open fetal surgery for LUTO; offering the highest-risk procedure to the sickest patients exposes mothers to maximum harm for minimal fetal benefit and increases prematurity risk that further compromises already-damaged kidneys." (opinion) [Ep 7 · 41:35](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=2495)
- "Open fetal vesicostomy should be considered only in patients with good prenatal prognostic profile who have failed fetoscopic intervention, not in the worst-prognosis patients." (opinion) [Ep 7 · 44:19](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=2659)
- "In long-term follow-up (5-12 years) of shunted LUTO patients, 92% survived, 45% had normal renal function, 22% had mild insufficiency not requiring intervention, but 33% developed end-stage renal disease requiring transplantation." (epidemiological) [Ep 7 · 48:08](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=2888)
- "Among long-term survivors, 67% could spontaneously void, while 33% required intermittent catheterization or continuous catheterization." (epidemiological) [Ep 7 · 49:07](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=2947)
- "Time to transplant varies by diagnosis: posterior urethral valves at 10-12 years, prune belly/urethral hypoplasia at 4.5 years, urethral atresia earlier." (epidemiological) [Ep 7 · 49:42](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=2982)
- "Children who progressed to end-stage renal disease had acceptable discharge creatinine but developed progressive injury from repeated infections, severe reflux, and valve bladder dysfunction over subsequent years." (clinical) [Ep 7 · 50:05](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=3005)
- "Creatinine at hospital discharge is misleading; creatinine at age 1 year is a better prognostic indicator. If creatinine at age 1 is less than 1.0, the child likely will not need renal replacement therapy; if above 1.0, there is high probability of needing dialysis or transplant." (clinical) [Ep 7 · 54:54](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=3294)
- "Infants with LUTO triple their birth weight in the first year, revealing true renal reserve; discharge creatinine reflects a 3-5 kg body mass, but by age 1 they are 10-15 kg, generating 2-3 times more creatinine and potentially overwhelming marginal kidney function." (clinical) [Ep 7 · 53:39](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=3219)
- "The bladder initiates upper tract damage and is often underestimated; even with minimal kidney injury, concentrating defects cause polyuria, which damages the bladder, raises storage pressures, and creates a vicious cycle of progressive renal injury." (clinical) [Ep 7 · 55:40](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=3340)
- "Patient selection is the most critical factor for any fetal intervention; early shunting experience included inappropriate candidates with aneuploidy and major anomalies." (opinion) [Ep 7 · 56:59](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=3419)
- "Open fetal surgery for LUTO should only target fetuses with very high potential for success, not those with significant evidence of injury; the procedure has 4% loss rate and significant prematurity rate." (opinion) [Ep 7 · 57:46](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=3466)
- "Fetoscopic cystoscopy needs proper evaluation to avoid repeating the mistakes of the PLUTO trial; just because a procedure can be done does not mean it should be done." (opinion) [Ep 7 · 58:27](https://qa.library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917?t=3507)
- "The three major causes of LUTO are urethral atresia (complete obstruction with no communication from bladder neck through urethra), posterior urethral valves (flap of tissue in proximal urethra), and mid-urethral hypoplasia (significant tapering and narrowing)." — Mark (clinical) [Ep 6 · 0:32](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=32)
- "Incomplete urethral obstruction leads to progressive oligohydramnios until anhydramnios develops." — Mark (clinical) [Ep 6 · 1:30](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=90)
- "Oligohydramnios causes physical deformations including joint contractures, ear flattening, and Potter's phenotype, and leads to pulmonary hypoplasia by interfering with chest expansion." — Mark (clinical) [Ep 6 · 1:41](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=101)
- "Obstruction generates pressure to the kidneys causing severe hydronephrosis, collecting system dilation, and progressive renal fibrocystic dysplasia resulting in renal failure after birth." — Mark (clinical) [Ep 6 · 1:58](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=118)
- "The San Francisco group's sheep model demonstrated that early ureteral ligation produced fibrocystic dysplasia identical to human LUTO, with earlier and longer obstruction causing greater kidney damage." — Mark (clinical) [Ep 6 · 2:58](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=178)
- "Early mid-gestational reversal of obstruction in the sheep model prevented progressive dysplastic changes and preserved kidney function." — Mark (clinical) [Ep 6 · 3:33](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=213)
- "Many babies with LUTO have associated anomalies including myelomeningocele, higher frequency of cardiac disease, and genetic syndromes that would preclude benefit from shunting." — Mark (clinical) [Ep 6 · 4:53](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=293)
- "A significant portion of LUTO fetuses have chromosomal abnormalities including major trisomies and Klinefelter syndrome." — Mark (epidemiological) [Ep 6 · 5:36](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=336)
- "Female fetuses with large bladder-like structures are usually cloacal abnormalities and do not benefit from shunting due to different pathophysiology." — Mark (clinical) [Ep 6 · 5:53](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=353)
- "Renal function evaluation requires complete bladder drainage on several occasions to measure sodium, chloride, calcium, osmolarity, total proteins, and beta-2 microglobulin as markers of tubular and glomerular injury." — Mark (clinical) [Ep 6 · 6:17](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=377)
- "Increased kidney echogenicity represents compression of renal parenchyma rather than being a poor prognostic sign per se; following bladder drainage, kidneys re-expand and show more normal echogenicity." — Mark (clinical) [Ep 6 · 8:10](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=490)
- "Hydronephrosis pathophysiology involves the collecting system (like a water balloon) compressing the renal parenchyma (like a sponge) against the serosa (like a glass fishbowl), impairing delicate vasculature and causing cell death, fibrosis, and cystic dysplasia." — Mark (clinical) [Ep 6 · 8:49](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=529)
- "The presence of cortical cysts indicates irreversible kidney damage and the kidney is not amenable to in utero therapy." — Mark (clinical) [Ep 6 · 10:18](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=618)
- "Good prognostic urine values for potential survival with shunting are: sodium <100 mEq/L, chloride <90 mEq/L, osmolarity <210 mOsm, calcium <8 mg/dL, beta-2 microglobulin <6 mg/L, and total protein <40 mg/dL." — Mark (clinical) [Ep 6 · 18:00](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1080)
- "Fetuses with values above the prognostic thresholds showed significant fibrotic kidney injury on autopsy, while those below showed very little or early potentially salvageable changes." — Mark (clinical) [Ep 6 · 18:28](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1108)
- "The first urine specimen from bladder tap is not predictive or reliable due to degradation products and osmotic gradients; the third or fourth tap after serial drainages has much higher predictive value for detecting kidney injury." — Mark (clinical) [Ep 6 · 19:05](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1145)
- "Improving urine values across serial taps (e.g., sodium dropping from poor to good range) indicates an excellent shunting candidate, while worsening values indicate ongoing irreversible damage." — Mark (clinical) [Ep 6 · 20:18](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1218)
- "Bladder morphology after drainage correlates with etiology: urethral atresia shows symmetric thick-walled bladder with difficult keyhole; posterior urethral valves show elongated bladder with more proximal thickening; mid-urethral hypoplasia shows 'snowman appearance' with smooth muscle deficiency in upper bladder." — Mark (clinical) [Ep 6 · 21:19](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1279)
- "All electrolyte cutoff thresholds are based on urines analyzed between 18 to 22 weeks gestation and cannot be reliably used before 18 weeks or after 22 weeks without adjustment." — Mark (clinical) [Ep 6 · 26:18](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1578)
- "The primary goal of fetal intervention is to prevent pulmonary hypoplasia secondary to oligohydramnios; preservation of renal and bladder function are secondary goals." (clinical) [Ep 6 · 28:41](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1721)
- "The PLUTO trial randomized only 31 patients over 4 years (20% of planned 150), showing apparent 3-fold increase in survival with shunting but results were not statistically significant with confidence intervals crossing unity." (clinical) [Ep 6 · 33:41](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2021)
- "All 12 deaths in the PLUTO trial were from pulmonary hypoplasia, suggesting improved survival may relate to decreased lung hypoplasia." (clinical) [Ep 6 · 34:36](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2076)
- "Only 7 of 12 live-born shunted babies in PLUTO were alive at age 2, and only 2 of the shunted survivors had normal renal function." (clinical) [Ep 6 · 34:47](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2087)
- "All 3 conservatively managed survivors in PLUTO had significant renal impairment." (clinical) [Ep 6 · 34:56](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2096)
- "Across 6 long-term outcome studies of shunted LUTO cases, survival rates are consistent at approximately 47-70%, but only 40-50% of survivors have normal renal function and approximately one-third require dialysis or transplant." (epidemiological) [Ep 6 · 36:18](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2178)
- "Some LUTO cases can resolve spontaneously, as demonstrated by a case where a baby began voiding and refilling amniotic fluid by 19 weeks with recollection by 23 weeks without intervention." (clinical) [Ep 6 · 37:28](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2248)
- "Spontaneous bladder decompression can occur through bladder rupture (usually after drainage, rarely spontaneous) resulting in urinary ascites or perinephric urinoma." (clinical) [Ep 6 · 37:55](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2275)
- "Megacystis-microcolon-intestinal hypoperistalsis syndrome and cloacal dysgenesis are contraindications to shunting intervention." (clinical) [Ep 6 · 38:26](https://qa.library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2306)
- "Historically, surgeons have been incentivized based on work RVUs, which is important for clinical productivity but does not take advantage of other strengths surgeons have." — Gail Besner (opinion) [Ep 19 · 1:41](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=101)
- "The concept of academic RVUs was first described approximately 12-13 years ago but did not include how to incentivize people for academic work." — Gail Besner (clinical) [Ep 19 · 2:55](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=175)
- "Nationwide Children's Hospital implemented a point-based academic RVU system where people accumulate points based on number of publications, presentations, and other academic pursuits." — Gail Besner (clinical) [Ep 19 · 3:07](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=187)
- "The Nationwide system kept work RVUs as part of the incentivization plan along with other goals that must be achievable." — Gail Besner (clinical) [Ep 19 · 3:27](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=207)
- "After implementing the academic RVU system, Nationwide had an increase in presentations, peer-reviewed publications, and external federal research funding." (host_summary) [Ep 19 · 3:44](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=224)
- "External federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase." — Rod Gerardo (host_summary) [Ep 19 · 3:58](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=238)
- "At Akron Children's Hospital under Bob Perry, the bonus structure required the entire group to reach a certain RVU threshold for everyone to receive 50% of their bonus, eliminating competition for cases." — Todd Ponsky (clinical) [Ep 19 · 5:03](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=303)
- "The BC Children's Hospital gastroschisis study was a retrospective review comparing outcomes before and after implementation of a protocol in 2012, covering patients from 2008 to 2019." (host_summary) [Ep 19 · 5:51](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=351)
- "At Saint Justine Hospital, the approach to gastroschisis differed from other institutions in that there was very low use of silos, with pretty much every patient having an attempt at immediate bedside sutureless closure following a protocol developed several years prior." — Charza Jaharifard (clinical) [Ep 19 · 6:58](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=418)
- "Before and after protocol implementation at BC Children's Hospital, approximately 75% of gastroschisis patients could be closed immediately, whether in the OR pre-implementation with fascial closure or at bedside post-implementation." — Charza Jaharifard (clinical) [Ep 19 · 7:57](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=477)
- "With silo management, parents look at their newborn's intestines through a silo for 5-6 days and cannot hold their baby until the silo is completely reduced." — Charza Jaharifard (clinical) [Ep 19 · 8:27](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=507)
- "With immediate closure of gastroschisis, if babies are extubated within 48 hours, parents can hold them within 48 hours, or immediately if managed without intubation." — Charza Jaharifard (clinical) [Ep 19 · 8:43](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=523)
- "In prior studies of placental mesenchymal stem cells for in utero MMC repair, two surgeries were performed on lambs: one to create the defect and one to repair it, both in utero, with PMSCs used during repair." (host_summary) [Ep 19 · 10:17](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=617)
- "In the current study, a single operation was performed at approximately 100 days gestational age where the MMC defect was created and repaired simultaneously, with PMSCs placed directly onto the spinal cord." (host_summary) [Ep 19 · 10:43](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=643)
- "The PMSCs did not persist in the placentas, uteri, or lambs at 3 months follow-up." (host_summary) [Ep 19 · 11:23](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=683)
- "There was no histological evidence of abnormal growth or tumor development in the ovine model at 3 months." (host_summary) [Ep 19 · 11:30](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=690)
- "Human trials using PMSCs for in utero myelomeningocele repair have been initiated with the first two patients enrolled." (host_summary) [Ep 19 · 11:52](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=712)
- "The curation process filters approximately 1200 articles per month from 33 pediatric and general surgical journals plus 3 top clinical journals (NEJM, Lancet, JAMA) down to 25-50 relevant pediatric surgery articles, then further narrows to 10-15 through specialty filtering, quality ranking, methodology assessment, and popularity polling among general surgeons." — Todd Ponsky (host_summary) [Ep 20 · 1:53](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=113)
- "Upper GI contrast study is operator-dependent and requires direct communication with radiologist, readily available at high-volume centers but requires more coordination at community hospitals." — Todd Ponsky (clinical) [Ep 20 · 5:30](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=330)
- "Ultrasound for malrotation diagnosis is very dependent on the person who performs the ultrasound, making it less reliable than upper GI contrast study." (opinion) [Ep 20 · 8:08](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=488)
- "Reversal of vessels at the root of the mesentery on ultrasound is not a very reliable way to make the diagnosis of malrotation." (clinical) [Ep 20 · 8:35](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=515)
- "In the Annals of Surgery 5-year follow-up study of non-operative appendicitis management, 46% of patients randomized to non-surgical management required appendectomy during follow-up, while the surgical group had no complications or readmissions." — Todd Ponsky (host_summary) [Ep 20 · 11:52](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=712)
- "Half of the non-surgical appendicitis management group presented to the emergency room during 5-year follow-up." — Todd Ponsky (host_summary) [Ep 20 · 12:08](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=728)
- "The presence of an appendicolith in appendicitis has about a 50% failure rate with non-operative management, making it a contraindication for non-surgical treatment." — Todd Ponsky (clinical) [Ep 20 · 10:22](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=622)
- "In the Journal of Clinical Oncology study of 1,531 patients with stage 4 high-risk neuroblastoma, 5-year event-free survival and overall survival were significantly higher with complete resection compared to incomplete microscopic resection." (host_summary) [Ep 20 · 14:20](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=860)
- "Local progression in stage 4 neuroblastoma was lower with complete resection when compared with incomplete resection." (host_summary) [Ep 20 · 14:36](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=876)
- "In the New England Journal of Medicine randomized controlled trial of 80 women carrying fetuses with severe isolated left-sided congenital diaphragmatic hernia, fetal endoscopic tracheal occlusion (FETO) at 27-29 weeks resulted in 40% survival to discharge versus 15% with expectant care." (host_summary) [Ep 20 · 16:30](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=990)
- "At 6 months of age, survival was the same between FETO and expectant care groups in severe CDH." (host_summary) [Ep 20 · 16:44](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1004)
- "FETO was associated with an increased risk of pre-labor rupture of membranes and preterm labor." (host_summary) [Ep 20 · 16:47](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1007)
- "In the Journal of Trauma study of 135 children aged 1-17 years who received whole blood as adjunct to component therapy, matched to 270 children receiving only component therapy, the whole blood group had decreased transfusion volume at 24 hours and required fewer ventilation days, though mortality, length of stay, and major complications were the same." — Todd Ponsky (host_summary) [Ep 20 · 18:16](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1096)
- "Current ATLS protocols recommend initial bolus with normal saline or crystalloid solution before moving to blood products in pediatric trauma." — Todd Ponsky (guideline) [Ep 20 · 19:40](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1180)
- "Nationwide in adults, ambulance rigs are starting to travel with whole blood capabilities and people are using whole blood even earlier in trauma resuscitation." — Todd Ponsky (clinical) [Ep 20 · 19:40](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1180)
- "The challenge for whole blood in pediatrics is availability, and thankfully for children, we don't use a lot of massive transfusion protocols compared to adults." — Todd Ponsky (clinical) [Ep 20 · 20:28](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1228)
- "Some centers are limiting whole blood use to males and some to children older than 15, depending on institutional protocols and blood bank partnerships." — Todd Ponsky (clinical) [Ep 20 · 21:13](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1273)
- "The three major causes of LUTO are urethral atresia (complete obstruction with no communication from bladder neck through urethra), posterior urethral valves (flap of tissue in proximal urethra), and mid-urethral hypoplasia (significant tapering and narrowing that becomes progressive obstruction as pelvic anatomy matures)." — Mark (clinical) [Ep 2 · 0:44](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=44)
- "In complete urethral obstruction, progressive oligohydramnios leads to anhydramnios, causing physical deformations (joint contractures, ear flattening, Potter's phenotype), pulmonary hypoplasia due to inability to expand and contract chest, and severe hydronephrosis with progressive renal fibrocystic dysplasia resulting in renal failure after birth." — Mark (clinical) [Ep 2 · 1:41](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=101)
- "In the sheep model, early ureteral ligation produced the same fibrocystic dysplasia seen in humans, with earlier obstruction and longer duration causing greater kidney damage." — Mark (host_summary) [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=180)
- "Early mid-gestational reversal of obstruction in the sheep model prevented progressive dysplastic changes to the kidneys and preserved kidney function, giving rise to the concept of in utero shunting." — Mark (host_summary) [Ep 2 · 3:35](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=215)
- "The stepwise approach to identifying fetuses for possible shunt therapy involves: (1) high-resolution ultrasound to evaluate anatomy and rule out associated anomalies like myelomeningocele and cardiac disease, (2) karyotype confirmation to rule out chromosomal abnormalities and confirm male sex, and (3) renal function evaluation by serial bladder drainage." — Mark (guideline) [Ep 2 · 4:44](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=284)
- "Amnioinfusion is sometimes necessary when sonographic evaluation is difficult due to oligohydramnios, to expand the amniotic fluid space and restore the fluid interface for better ultrasound imaging." — Mark (clinical) [Ep 2 · 5:31](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=331)
- "Female fetuses with large bladder-like structures usually have cloacal abnormalities and do not benefit from shunting because it is a completely different process and underlying pathophysiology." — Mark (clinical) [Ep 2 · 6:04](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=364)
- "Renal function evaluation involves draining the bladder completely on several occasions and analyzing sodium, chloride, calcium, osmolarity, total proteins, and beta-2 microglobulin as reflections of proximal tubular injury and possible direct injury to the glomerular apparatus." — Mark (clinical) [Ep 2 · 6:27](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=387)
- "Characteristic early LUTO ultrasound findings include large fluid-filled bladder with markedly thickened and echogenic walls due to smooth muscle hypertrophy and hyperplasia from pressure, dilated kidneys with increased echogenicity, and dilation of the intrarenal collecting system." — Mark (clinical) [Ep 2 · 7:07](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=427)
- "Increased renal echogenicity is evidence of compression of the renal parenchyma rather than a poor prognostic sign per se; following serial bladder drainages and allowing kidneys to drain, re-expansion of parenchyma occurs with more normal echogenicity." — Mark (clinical) [Ep 2 · 8:21](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=501)
- "The pathophysiology of hydronephrosis involves the collecting system (like a balloon) expanding within the kidney (like a sponge in a glass fishbowl), compressing the parenchyma against the serosa, impairing delicate vasculature, resulting in cell death, progressive fibrosis, and eventually cystic dysplasia." — Mark (clinical) [Ep 2 · 9:01](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=541)
- "The presence of discrete cortical cysts indicates irreversible kidney damage and means the kidney is not amenable to any kind of in utero therapy because of the severity of underlying injury." — Mark (clinical) [Ep 2 · 10:29](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=629)
- "Obstructing ureteroceles from ectopic insertion of a duplicated collecting system upper pole can cause bladder outlet obstruction and obstructive uropathy, and these are amenable to therapy." — Mark (clinical) [Ep 2 · 10:59](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=659)
- "Patent urachus (a tract from the dome of the bladder to the umbilical cord insertion) can open back up with early obstruction and high bladder pressure, draining urine into the amniotic fluid space, which is one underlying etiology for obstructive uropathy with normal amniotic fluid volume." — Mark (clinical) [Ep 2 · 12:53](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=773)
- "In megacystis-microcolon-hypoperistalsis syndrome (more common in females but seen in at least six dozen male cases), there is a neurologic defect in bladder and ureteral muscles preventing bladder contraction and emptying, with massively distended bladder but normal amniotic fluid; most do not survive more than a few years." — Mark (clinical) [Ep 2 · 14:58](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=898)
- "In megacystis-microcolon-hypoperistalsis syndrome, after bladder drainage the bladder wall remains very thin because it does not develop the hyperplasia or thickening typically seen in complete obstruction, and amniotic fluid flows into the amniotic cavity through a completely patent urethra." — Mark (clinical) [Ep 2 · 15:34](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=934)
- "Severe congenital reflux can present with normal amniotic fluid, thickened but normal-sized bladder, patency through the urethra, massively dilated kidneys with severe hydronephrosis and huge megaureters, with the bladder refluxing back up to the kidneys." — Mark (host_summary) [Ep 2 · 16:15](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=975)
- "With new technology, particularly FISH, vesicocentesis can be used to screen and confirm male karyotype and rule out major aneuploidies when amniocentesis is difficult due to anhydramnios or severe oligohydramnios." — Mark (clinical) [Ep 2 · 17:01](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1021)
- "Good prognostic urinary values for potential survival with successful shunt placement are: sodium <100, chloride <90, osmolarity <210, calcium <8, beta-2 microglobulin <6, and total protein <20 (units not specified in transcript)." — Mark (clinical) [Ep 2 · 18:12](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1092)
- "Values above the cutoff thresholds indicate significant underlying renal injury and fibrotic changes; histologic examination of fetuses with values not much higher than these levels showed pretty significant fibrotic injury to the kidneys." — Mark (clinical) [Ep 2 · 18:35](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1115)
- "The first urine specimen from bladder tap is not predictive or reliable because it has been exposed to degradation products and osmotic gradients that change electrolyte composition; serial taps are necessary." — Mark (clinical) [Ep 2 · 19:16](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1156)
- "The second bladder tap (2 days after first) samples urine that was in the ureters and intrarenal collecting system; the third tap (2 days after second) samples freshly produced urine by the kidney and has much higher predictive value for detecting significant underlying injury." — Mark (clinical) [Ep 2 · 20:01](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1201)
- "Improving urinary values across serial taps (e.g., sodium initially poor but dropping after second and third taps) indicates an excellent candidate with reasonably good prognosis with successful shunting; worsening values indicate ongoing irreversible damage that shunting won't benefit." — Mark (clinical) [Ep 2 · 20:29](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1229)
- "After complete bladder drainage and refill, urethral atresia cases show symmetric, very thick, universal bladder wall thickening with a typical keyhole; posterior urethral valve cases show elongated bladder shape with more proximal than distal thickening; mid-urethral hypoplasia (prune belly/triad) cases show a 'snowman appearance' with typical keyhole but unusual three-part bladder shape." — Mark (clinical) [Ep 2 · 21:21](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1281)
- "In mid-urethral hypoplasia cases, histologic study showed typical hypertrophy and thickening in the lower bladder wall, but significant smooth muscle deficiency and abnormal composition in the upper bladder (more like a hernia sac), with abnormal smooth muscle from proximal ureters to renal pelvis and severe abnormalities in the bladder dome." — Mark (clinical) [Ep 2 · 22:18](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1338)
- "All urinary electrolyte cutoff thresholds are based on urine analyzed between 18 to 22 weeks of gestation and cannot be reliably used before 18 weeks or after 22 weeks without adjustment." — Mark (clinical) [Ep 2 · 26:26](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1586)
- "For fetuses at 17 weeks, the cutoff value would be extrapolated to be a bit higher; for 24 or 26 week fetuses, cutoff thresholds would be extrapolated to be much lower due to maturation and increasing kidney function with advancing gestational age." — Mark (clinical) [Ep 2 · 27:00](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1620)
- "There is no good data that allows prediction of renal injury at gestational ages of 26 or 28 weeks using the established electrolyte cutoffs." — Mark (opinion) [Ep 2 · 27:51](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1671)
- "The primary goal of fetal bladder shunting is to prevent pulmonary hypoplasia secondary to oligohydramnios; secondary goals are preservation of renal function and bladder function." (clinical) [Ep 2 · 28:52](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1732)
- "The Rocket shunt is a double-tailed silastic pigtail catheter inserted with coils in different directions; theoretically the flat end outside the baby's abdomen cannot be grabbed and pulled out, and the other end is inside the bladder." (clinical) [Ep 2 · 29:27](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1767)
- "Shunt procedures are done as outpatient with IV remifentanyl and if necessary propofol, local anesthetic, antibiotic, a dose of indomethacin, and possibly nifedipine immediately afterwards; the mother usually goes home a couple of hours later." (clinical) [Ep 2 · 29:54](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1794)
- "Amnioinfusion before shunt placement is the most important step because without good fluid volume around the fetus, the external end of the shunt (the trickiest part of the procedure) cannot be deposited properly." (clinical) [Ep 2 · 30:18](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1818)
- "Shunt placement inferior to the bladder is preferred; the higher the shunt placement, the greater the risk that when the bladder deflates, some holes in the shunt will be in the peritoneal cavity, potentially causing urine leakage and fetal urinary ascites." (clinical) [Ep 2 · 31:16](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1876)
- "The Birmingham group's meta-analysis showed that in the good prognosis group (based on urinary electrolytes), there appeared to be some benefit to drainage, and in the poor prognosis group, drainage appeared to have an even better result." (host_summary) [Ep 2 · 31:48](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1908)
- "In the PLUTO trial, babies were randomized only when the physician was uncertain whether to shunt; if certain, patients were entered into a registry. Karyotype and urinalysis were not mandatory for trial entry, and amniotic fluid volume was not used as a prognostic evaluator." (host_summary) [Ep 2 · 32:59](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1979)
- "The PLUTO trial was designed to collect 150 patients over approximately 4 years but by the end of 4 years only 31 patients had been randomized (20% of planned patients), and the trial was stopped early due to poor recruitment." (host_summary) [Ep 2 · 33:53](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2033)
- "In the PLUTO trial, fetuses that were shunted had about a 3-fold increase in survival compared to those not shunted, but the numbers were very small and the size and direction of the effect is uncertain, so the benefit is unproven." (host_summary) [Ep 2 · 34:33](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2073)
- "In the PLUTO trial, all 12 deaths were from pulmonary hypoplasia, suggesting improved survival was probably related to decreased lung hypoplasia; only 7 of 12 live-born shunted babies were alive at age 2, and only 2 of the shunted survivors had normal renal function." (host_summary) [Ep 2 · 34:48](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2088)
- "Difficulties in fetal therapy trials include: rare conditions, many undetected prenatally, many parents choosing termination when faced with outcome realities, delay in accepting new therapy reflecting clinician and patient bias based on small heterogeneous observational studies, and loss of clinical equipoise." (opinion) [Ep 2 · 35:18](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2118)
- "Six studies report long-term outcomes of shunted babies with consistent results across studies: approximately 40-50% of survivors have normal renal function, and approximately one-third end up requiring either dialysis or transplant." (host_summary) [Ep 2 · 36:17](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2177)
- "In the Canadian population, when parents look at the outcome studies showing that only 40-50% have normal renal function and one-third need dialysis or transplant, many parents opt for termination of pregnancy rather than shunting." (epidemiological) [Ep 2 · 37:25](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2245)
- "Some LUTO cases can resolve spontaneously, as demonstrated by a case where a baby diagnosed at 14 weeks with anhydramnios at 17 weeks was observed peeing and filling its sac at 19 weeks, with recollection of amniotic fluid by 23 weeks with no intervention." (clinical) [Ep 2 · 37:35](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2255)
- "Spontaneous bladder decompression can occur through asymmetrical hydronephrosis or urinary ascites from bladder rupture; spontaneous rupture is unusual but very commonly happens after bladder drainage and always resolves after a few days." (clinical) [Ep 2 · 38:06](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2286)
- "Megacystis-microcolon-hypoperistalsis syndrome presents with very large bladder in a female fetus with normal amniotic fluid volume; these are cases where shunting is not advocated." (clinical) [Ep 2 · 38:38](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2318)
- "Massively enlarged bladder secondary to cloacal dysgenesis is a case where there is no role whatsoever for intervention." (clinical) [Ep 2 · 39:03](https://qa.library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2343)
- "Radiofrequency ablation for vessel occlusion in fetal bronchopulmonary sequestrations was a disaster and is not recommended." — Jack (clinical) [Ep 4 · 1:27](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=87)
- "Coils were used for vessel occlusion with initial success, but the fetus died about a week later for unclear reasons." — Jack (clinical) [Ep 4 · 1:33](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=93)
- "Alcohol injection for vessel occlusion can travel through the vasculature and cause thrombosis in the systemic circulation, including thrombi in the heart chambers." — Alan (clinical) [Ep 4 · 1:52](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=112)
- "The effects of systemic alcohol injection on fetal neural development and other organ development have not been studied experimentally, even in sheep models." — Alan (clinical) [Ep 4 · 2:29](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=149)
- "Radiofrequency ablation cannot be controlled in the fetus due to 90% water content; energy can disperse unpredictably causing collateral damage." — Alan (clinical) [Ep 4 · 3:00](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=180)
- "In a laboratory study, a radiofrequency ablation probe placed in one side of a resected fetal teratoma caused the other side to boil when activated." — Alan (clinical) [Ep 4 · 3:12](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=192)
- "Probably 95% of CCAMs are now prenatally diagnosed." (epidemiological) [Ep 4 · 3:46](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=226)
- "Almost none of prenatally diagnosed lung lesions require prenatal intervention, and very few require intervention the day the child is born." (clinical) [Ep 4 · 3:52](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=232)
- "Only one or two centers in the world should be thinking about extreme fetal interventions for lung lesions because the numbers are so small." (opinion) [Ep 4 · 4:09](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=249)
- "Many lung lesions have been referred after a recommendation for termination by people who don't understand the natural history." — Alan (clinical) [Ep 4 · 5:20](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=320)
- "Even very large prenatal lung lesions can regress and be asymptomatic at birth, or have very good survival rates with appropriate interventions." — Alan (clinical) [Ep 4 · 5:31](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=331)
- "The garden variety postnatal CCAM is very different than some prenatal CCAMs." — Alan (clinical) [Ep 4 · 5:44](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=344)
- "True cystic CCAMs do not disappear; they regress but remain present and prominent on CT scan a month after birth." — Alan (clinical) [Ep 4 · 6:43](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=403)
- "Some lesions that look like CCAMs in utero, such as segmental bronchial stenosis, can be minimally apparent or non-apparent after birth." — Alan (clinical) [Ep 4 · 6:13](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=373)
- "Prenatal lung lesions should be called 'congenital lung lesions' (macrocystic, hyperechoic, or mixed) rather than CCAMs, since CCAM is a pathological diagnosis requiring a specimen." — Jean Martin (clinical) [Ep 4 · 7:45](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=465)
- "Many tertiary centers have the capacity to perform EXIT procedures with a huge team approach and leadership." — Jean Martin (clinical) [Ep 4 · 8:17](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=497)
- "Lung agenesis can be misdiagnosed as a microcystic CCAM with mediastinal shift on prenatal imaging." — Alan (clinical) [Ep 4 · 9:33](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=573)
- "EXIT procedures are more invasive than regular C-sections for the mother." — Jean Martin (clinical) [Ep 4 · 9:59](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=599)
- "Pleuro-amniotic shunts are used specifically for macrocystic CCAMs with evidence of hydrops." — Alan (clinical) [Ep 4 · 11:08](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=668)
- "Hydrops requires pleural effusion, pericardial effusion, and skin or scalp edema; pure ascites alone is not necessarily hydrops." — Alan (clinical) [Ep 4 · 11:18](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=678)
- "Pure ascites can be related to mediastinal shift and hepatic venous return rather than true hydrops." — Alan (clinical) [Ep 4 · 11:27](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=687)
- "Pleuro-amniotic shunts are not placed prophylactically; large macrocystic lesions may be tapped just prior to delivery to improve ventilation." — Alan (clinical) [Ep 4 · 11:48](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=708)
- "A CVR cutoff of 1.6 is used; if a CCAM presents with CVR less than 1.6, the likelihood of evolving hydrops is about 3-5%." — Alan (clinical) [Ep 4 · 13:33](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=813)
- "CVR greater than 1.6 requires close watching with much higher likelihood of evolving into hydrops." — Alan (clinical) [Ep 4 · 14:11](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=851)
- "Macrocystic lesions are a wild card because the cystic component can grow very rapidly and can be worrisome even if CVR is less than 1.6." — Alan (clinical) [Ep 4 · 14:18](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=858)
- "MRI is better for some fetal anomalies and not as good for others; it depends on the specific anomaly." — Alan (clinical) [Ep 4 · 15:55](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=955)
- "There is no registry for fetal surgery or EXIT procedures similar to the ECMO registry." — Alan (clinical) [Ep 4 · 16:17](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=977)
- "68% of audience members repair premature infant bilateral inguinal hernias prior to NICU discharge" (host_summary) [Ep 5 · 3:24](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=204)
- "Jack Langer's data shows very high incarceration rate in newborns and preemies with inguinal hernias" — Todd Ponsky (host_summary) [Ep 5 · 2:08](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=128)
- "VA cooperative study in adults showed 1.7% incidence of incarceration in adults with inguinal hernia" — Todd Ponsky (host_summary) [Ep 5 · 11:44](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=704)
- "80% of pediatric hernia incarcerations occur in children under 12 months of age" (epidemiological) [Ep 5 · 12:01](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=721)
- "Only 20% of patent processus vaginalis cases will ever become a clinical hernia" — Jack (epidemiological) [Ep 5 · 8:03](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=483)
- "If you have a patent processus vaginalis, you have 4 times greater risk than general population of developing a hernia on that side" — Todd Ponsky (host_summary) [Ep 5 · 8:31](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=511)
- "Reincarceration rate after reduction starts to go back up at 72 hours based on published data" — Jack (epidemiological) [Ep 5 · 17:18](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1038)
- "Data on anesthesia neurocognitive risk in premature infants is immature; unclear what the risk is or whether it's impacted by duration of case or age of child" — Dan (host_summary) [Ep 5 · 14:47](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=887)
- "Most anesthesia neurocognitive data is from animal studies, not human data, so direct extrapolation is uncertain" (opinion) [Ep 5 · 15:07](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=907)
- "Mesh inguinal hernia repair has 30% incidence of chronic pain, validated in multiple studies" — Todd Ponsky (host_summary) [Ep 5 · 28:16](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1696)
- "Mesh repair has significant risk of vas deferens injury" — Todd Ponsky (clinical) [Ep 5 · 28:27](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1707)
- "Studies show decreased sperm quality in patients who had bilateral inguinal hernia repairs, but infertility rate did not appear different in most studies" — Todd Ponsky (host_summary) [Ep 5 · 37:16](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2236)
- "Felix Schier's laparoscopic Z-stitch technique has about 6% recurrence rate" — Todd Ponsky (host_summary) [Ep 5 · 33:00](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1980)
- "SEAL technique (Craig Albanese, Mike Harrison, Sanjeev Dutta at Stanford) reports 1.2% recurrence rate, but other centers using it report 3-4%" — Todd Ponsky (host_summary) [Ep 5 · 33:06](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1986)
- "CK Young's extraperitoneal percutaneous technique has less than 1% recurrence (unpublished data)" — Todd Ponsky (host_summary) [Ep 5 · 33:30](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2010)
- "Todd Ponsky's laparoscopic series has approximately 2% recurrence rate (unpublished, anecdotal: 1 repair out of several hundred cases)" — Todd Ponsky (epidemiological) [Ep 5 · 33:43](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2023)
- "Open inguinal hernia repair recurrence rate is about 1% based on large published series (Ein: 5000 cases, Atkins: 4000 cases)" (host_summary) [Ep 5 · 35:40](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2140)
- "Mayo Clinic 50-year follow-up study shows most common cause of recurrence after open pediatric inguinal hernia repair is a direct hernia" — Todd Ponsky (host_summary) [Ep 5 · 26:59](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1619)
- "In rabbit model, laparoscopic hernia repair with stitch alone failed when stitch was cut at 2 months; adding cautery before cutting stitch resulted in all repairs staying closed" — Todd Ponsky (clinical) [Ep 5 · 39:51](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2391)
- "Laparoscopic approach allows clear visualization of inguinal floor to distinguish indirect hernia from direct/floor problem" — Todd Ponsky (clinical) [Ep 5 · 27:16](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1636)
- "Inguinodynia (chronic groin pain) is much more common in older patients than young children after open inguinal hernia repair" — Todd Ponsky (clinical) [Ep 5 · 25:47](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1547)
- "Laparoscopic hernia repair is more expensive than open due to equipment and need for extra nurse" — Jack (opinion) [Ep 5 · 36:33](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2193)
- "Learning curve for laparoscopic hernia repair may be 30-40 cases before recurrence rate becomes acceptably low" (opinion) [Ep 5 · 40:22](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2422)
- "Umbilical hernia size does not predict need for earlier repair; no data supports operating earlier on larger defects" — Todd Ponsky (clinical) [Ep 5 · 49:28](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2968)
- "Umbilical hernias can close spontaneously up to 8-10 years of age if getting smaller" — Jack (clinical) [Ep 5 · 49:38](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2978)
- "There are reports of postoperative cryptorchidism after hernia repair at a rate of a few percent" (host_summary) [Ep 5 · 48:39](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2919)
- "Incarcerated ovaries likely reduce spontaneously and come and go, so urgent repair may not be necessary" (opinion) [Ep 5 · 20:47](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1247)
- "Testicular ischemia is harder to control for than bowel ischemia in incarcerated hernias" (opinion) [Ep 5 · 21:31](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1291)
- "Operating unnecessarily on patent processus that will never incarcerate may expose testis to injury" (opinion) [Ep 5 · 21:44](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1304)
- "Torsed ovaries that are 5cm and black survive when detorsed rather than removed" (host_summary) [Ep 5 · 22:09](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1329)
- "Closing hernia sac during contaminated case (perforated appendicitis) risks creating scrotal abscess" — Dan (clinical) [Ep 5 · 45:08](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2708)
- "Epigastric hernias can become symptomatic in overweight teenagers and are difficult to localize on exam" — Dan (clinical) [Ep 5 · 51:51](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=3111)
- "Operating on epigastric hernias when patient is too young with diastasis recti may result in more hernias developing later" (clinical) [Ep 5 · 52:26](https://qa.library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=3146)
- "Spina bifida affects approximately 1500 babies born per year in the US, about 30 per week or 5-6 per day." — Scott Adzik (epidemiological) [Ep 8 · 82:06](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=4926)
- "With standard postnatal care, approximately 14% of MMC patients die by age 5, mostly due to symptomatic brain stem compression from hindbrain herniation." — Scott Adzik (clinical) [Ep 8 · 83:20](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5000)
- "About 85% of MMC patients require ventricular shunts with standard postnatal care, with approximately half developing shunt complications within one year." — Scott Adzik (clinical) [Ep 8 · 83:33](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5013)
- "The two-hit hypothesis for MMC proposes that secondary damage occurs in utero from amniotic fluid, meconium, or hydrodynamic forces after the initial failure of neurulation." — Scott Adzik (clinical) [Ep 8 · 83:41](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5021)
- "In fetal sheep models, mid-gestational spinal cord exposure leads to progressive neurologic injury that mimics human MMC, with paralysis and loss of sensation below the lesion level." — Scott Adzik (clinical) [Ep 8 · 86:09](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5169)
- "In utero coverage of experimentally created MMC in fetal sheep rescues neurologic function at birth, with lambs able to stand, walk, and maintain continence." — Scott Adzik (host_summary) [Ep 8 · 86:43](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5203)
- "Hindbrain herniation reverses after prenatal MMC repair because closing the defect prevents CSF leak, reestablishing the pressure column in the spinal canal." — Scott Adzik (clinical) [Ep 8 · 90:15](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5415)
- "In CHOP's pre-MOMS experience with 50 fetal MMC repairs, the shunt rate by one year was 40%, compared to 85% with postnatal repair." — Scott Adzik (clinical) [Ep 8 · 93:10](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5590)
- "Two-thirds of prenatally repaired MMC patients showed motor function two or more levels better than the anatomic lesion level." — Scott Adzik (clinical) [Ep 8 · 93:41](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5621)
- "The MOMS trial was stopped early on December 7, 2010 by the Data Safety Monitoring Board due to demonstrated efficacy of prenatal surgery." — Scott Adzik (clinical) [Ep 8 · 102:18](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6138)
- "In the MOMS trial, shunts were placed in 40% of the prenatal surgery group compared to 82% of the postnatal surgery group." — Scott Adzik (clinical) [Ep 8 · 102:55](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6175)
- "At 30 months, 42% of babies in the prenatal surgery group could walk independently versus only 21% in the postnatal surgery group." — Scott Adzik (clinical) [Ep 8 · 103:31](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6211)
- "Mean gestational age at delivery was 34 weeks in the prenatal surgery group versus 37 weeks in the postnatal group, with 13% of prenatal cases delivered before 30 weeks." — Scott Adzik (clinical) [Ep 8 · 104:57](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6297)
- "At the time of delivery in the MOMS trial, the hysterotomy site was intact in about two-thirds of cases, very thin in one-quarter, with dehiscence in 9% and complete dehiscence in one case." — Scott Adzik (clinical) [Ep 8 · 104:32](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6272)
- "Since the end of the MOMS trial, CHOP has had 359 referrals, with 202 evaluated on-site, but only 60 (30%) underwent fetal surgery." — Scott Adzik (clinical) [Ep 8 · 107:57](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6477)
- "Fetal MRI is mandatory for preoperative evaluation because ultrasound alone can incorrectly identify hindbrain herniation; in 9 cases with absent hindbrain herniation on MRI, ultrasound showed positive or equivocal findings." — Scott Adzik (clinical) [Ep 8 · 109:07](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6547)
- "Fetoscopic MMC repair using 3 or more ports leads to membrane fixation and tearing with uterine growth, resulting in premature birth 3-6 weeks after surgery and delivery before 30 weeks as a rule." — Scott Adzik (clinical) [Ep 8 · 109:47](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6587)
- "Compared to open fetal MMC repair, fetoscopic repair has higher rates of fetal death, premature rupture of membranes, chorioamnionitis, oligohydramnios, premature delivery, and persistent hindbrain herniation." — Scott Adzik (clinical) [Ep 8 · 110:06](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6606)
- "There have been three maternal deaths associated with open fetal surgery for MMC in South America (one in Colombia, two in Argentina)." — Todd Ponsky (host_summary) [Ep 8 · 132:16](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=7936)
- "In the US experience with open fetal surgery for MMC, there have been no maternal deaths and no serious maternal complications in recent years." — Todd Ponsky (clinical) [Ep 8 · 133:43](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=8023)
- "Longer operating room times and postoperative oligohydramnios correlate with increased risk for preterm birth in fetal MMC repair." — Scott Adzik (clinical) [Ep 8 · 106:17](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6377)
- "A Washington University financial model using MOMS trial data showed that over $3 million would be saved for 100 babies treated prenatally versus postnatally." — Scott Adzik (host_summary) [Ep 8 · 107:07](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6427)
- "In Europe, approximately one-third of mothers decline open fetal MMC surgery because it is an open procedure." — Todd Ponsky (epidemiological) [Ep 8 · 146:39](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=8799)
- "For proper neurosurgical repair of cystic MMC, it is essential to remove the cyst and excise tissues that don't belong, not simply cover the lesion—a step that may be missing in some fetoscopic approaches." — Todd Ponsky (clinical) [Ep 8 · 147:34](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=8854)
- "In the MOMS trial, 51% of prenatally repaired children met shunt criteria, but only 31 actually received shunts (approximately 65% of those meeting criteria), compared to 66 of 74 (89%) in the postnatal group." — Todd Ponsky (clinical) [Ep 8 · 150:23](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=9023)
- "The discrepancy between meeting shunt criteria and receiving shunts occurred because an independent neurosurgical review committee determined criteria, but individual neurosurgeons made placement decisions, and most discrepancies involved criterion 3 (head size/ventricle changes) without accompanying symptoms." — Scott Adzik (host_summary) [Ep 8 · 154:14](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=9254)
- "Using revised shunt criteria based on modified criterion 3, there is a close match between shunt criteria and actual shunt placement in both prenatal (46%) and postnatal (86%) groups." — Scott Adzik (host_summary) [Ep 8 · 156:43](https://qa.library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=9403)
- "Congenital diaphragmatic hernia occurs in 10-20% of monochorionic twin pregnancies and is responsible for large amounts of perinatal mortality and morbidity, with 80-100% mortality if untreated in the past." — Jan Deprest (epidemiological) [Ep 9 · 0:45](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=45)
- "Patient selection for FETO is based on lung-to-head ratio (LHR) corrected for gestational age (observed/expected) and presence of liver herniation, with severe hypoplasia defined as maximum 20% survival, moderate 50%, and mild 85% survival." — Jan Deprest (clinical) [Ep 9 · 1:20](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=80)
- "External validation from Children's Hospital Philadelphia (2006-2010 cohort) and Toronto confirmed that outcomes remain dependent on lung-to-head ratio and these selection criteria are still valid." — Jan Deprest (host_summary) [Ep 9 · 2:36](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=156)
- "The FETO procedure is done at 26-28 weeks (now 29 weeks in updated protocol) under local anesthesia with fetal analgesia and immobilization, lasting 6-10 minutes on average when fetal position is favorable." — Jan Deprest (clinical) [Ep 9 · 3:19](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=199)
- "The median gestational age at birth after FETO was 35 weeks, similar to open fetal surgery, with 20-22% experiencing ruptured membranes by 34 weeks." — Jan Deprest (clinical) [Ep 9 · 8:32](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=512)
- "Balloon removal in utero at least 24 hours prior to birth is associated with better survival and early morbidity compared to removal at delivery." — Jan Deprest (clinical) [Ep 9 · 11:19](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=679)
- "FETO increased survival from around 0% to 20% in the smallest lung group and by 30-35% on average in the severe hypoplasia group compared to historical controls." — Jan Deprest (clinical) [Ep 9 · 12:42](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=762)
- "Independent predictors of survival after FETO are initial lung size prior to operation, gestational age at delivery, and ability to remove balloon in utero at least 24 hours before birth." — Jan Deprest (clinical) [Ep 9 · 13:44](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=824)
- "Even with delivery prior to 32 weeks after FETO, survival rate is as high as predicted at term without fetal therapy; for delivery at 32 weeks or later, survival is 60%, which doesn't increase beyond 34 weeks." — Jan Deprest (clinical) [Ep 9 · 14:37](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=877)
- "There is an apparent decrease in bronchopulmonary dysplasia after FETO, with no evidence of substituting mortality by morbidity based on oxygen need, ventilator days, time to full enteral feeding, and NICU days." — Jan Deprest (clinical) [Ep 9 · 15:50](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=950)
- "The TOTAL trial in Europe compares tracheal occlusion at 27-29 weeks to expectant management, with survival as primary outcome in severe cases and survival without BPD in moderate cases." — Jan Deprest (clinical) [Ep 9 · 16:41](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=1001)
- "Centers offering FETO must have an active fetoscopy program (minimum 36 interventions per year or 3 per month), experience with 15 balloon occlusion cases (at least 5 done locally), and 24-hour balloon removal capability." — Jan Deprest (guideline) [Ep 9 · 19:45](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=1185)
- "In the moderate TTTS trial, 54 cases have been recruited beyond the first interim analysis, with all participating centers agreeing not to offer fetal therapy outside the trial." — Jan Deprest (clinical) [Ep 9 · 25:05](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=1505)
- "The severe FETO trial has been hampered by too long offering the procedure outside trial settings while trying to optimize technique, though the last 100 cases showed no improvement in outcomes." — Jan Deprest (opinion) [Ep 9 · 25:44](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=1544)
- "Ruben Quintero's 1997 staging system for TTTS actually describes physiologic states: stage 1 reflects initial volume transfer, stage 2 represents cephalization of blood flow, stage 3 represents increasing placental resistance, and stage 4 represents cardiac failure in the recipient." — Todd Ponsky (clinical) [Ep 9 · 86:57](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=5217)
- "Only 30-35% of stage 1 TTTS progresses to stage 2 or higher; 28% stay at stage 1 throughout pregnancy, and 40% regress completely or resolve." — Todd Ponsky (epidemiological) [Ep 9 · 89:21](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=5361)
- "Amnio-reduction in severe polyhydramnios improves fetal hypoxia and reverses acidemia by decreasing amniotic fluid pressure, which reduces placental compression and improves blood flow." — Todd Ponsky (host_summary) [Ep 9 · 90:22](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=5422)
- "The recipient twin in TTTS develops progressive hypertrophic cardiomyopathy due to both preload (volume) and afterload (peripheral vasoconstriction from renin-angiotensin activation) issues." — Todd Ponsky (clinical) [Ep 9 · 92:14](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=5534)
- "Huber's 2006 study of over 200 laser cases showed 84% survival of at least one twin, 60% both-twin survival, and average delivery at 34 weeks, compared to 29 weeks with amnio-reduction." — Todd Ponsky (host_summary) [Ep 9 · 102:07](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6127)
- "High-volume laser centers achieve 93-94% survival of at least one twin, 88% overall survival, 78% both-twin survival, with average delivery at 34 weeks." — Todd Ponsky (host_summary) [Ep 9 · 103:26](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6206)
- "Major and minor neurologic deficits occur in 55% after amnio-reduction versus less than half that rate after laser, with most recent studies showing 5-6% major neurodevelopmental delays and 7-8% minor delays after laser." — Todd Ponsky (host_summary) [Ep 9 · 104:15](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6255)
- "CHOP's cardiovascular score significantly drops within 1 week to 10 days after laser photocoagulation in the vast majority of cases, showing the recipient twin's heart has great potential to heal." — Todd Ponsky (clinical) [Ep 9 · 105:01](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6301)
- "CHOP's miss rate for vascular anastomoses is 0.8% based on placental injection studies, compared to 10-15% miss rates reported in literature." — Todd Ponsky (clinical) [Ep 9 · 110:00](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6600)
- "Diode laser is much safer than argon laser with lower penetration depth and no vessel rupture cases since switching to diode at CHOP." — Todd Ponsky (clinical) [Ep 9 · 107:05](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6425)
- "Eduardo Gratacos classified selective IUGR into three types: Type 1 with positive end-diastolic flow (good prognosis), Type 2 with persistent absent/reversed flow (progressive deterioration), and Type 3 with intermittent cycling (unpredictable with high IUFD and 20% PVL risk in normal twin)." — Todd Ponsky (host_summary) [Ep 9 · 128:56](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=7736)
- "Type 3 sIUGR fetuses have the smallest placental share and characteristic very large arterio-arterial anastomoses that cause episodic acute fetal-to-fetal transfusions." — Todd Ponsky (host_summary) [Ep 9 · 131:00](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=7860)
- "With purely expectant management of Type 2 sIUGR, there is 48% loss in the smaller twin and 33% in the normal twin, with only 37% intact survival in the smaller twin." — Todd Ponsky (host_summary) [Ep 9 · 136:04](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=8164)
- "Type 3 sIUGR with expectant management shows 38.5% intact survival in the normal twin and 60% in surviving smaller twins, with very high morbidity and mortality in both groups." — Todd Ponsky (host_summary) [Ep 9 · 136:36](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=8196)
- "CHOP has performed about 80 bipolar cord cauterizations with 86% singleton survival and over 90 radiofrequency ablations with 83% singleton survival for selective cord occlusion." — Todd Ponsky (clinical) [Ep 9 · 141:19](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=8479)
- "In Type 3 sIUGR, after laser photocoagulation to separate circulations, the smaller twin dies in 75% of cases within 48 hours because it was surviving on blood from the normal twin." — Eduardo Gratacos (clinical) [Ep 9 · 146:21](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=8781)
- "Open fetal surgery for CPAM is now rare due to maternal steroid therapy; CHOP and UCSF combined have performed one case in the past 5 years." (clinical) [Ep 10 · 28:44](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1724)
- "The CPAM volume ratio (CVR) is calculated by measuring the CPAM in 3 dimensions, applying an ellipse formula, and dividing by head circumference to standardize for gestational age." — Alan Flake (clinical) [Ep 10 · 26:38](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1598)
- "CVR >1.6 predicts high risk for CPAM evolving into hydrops, particularly for microcystic lesions." — Alan Flake (clinical) [Ep 10 · 6:11](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=371)
- "Maternal steroids are first-line therapy for high-risk CPAM (CVR >1.6); the majority respond, but open fetal surgery is considered if hydrops persists despite steroids at an early gestational age." — Alan Flake (clinical) [Ep 10 · 6:23](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=383)
- "CHOP's open fetal surgery for CPAM has approximately 60% survival; thoracoamniotic shunts have 70-75% survival." — Alan Flake (epidemiological) [Ep 10 · 10:34](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=634)
- "Bronchial atresia is more difficult to treat by fetal intervention than CPAM; CHOP has had one intraoperative fetal death, one postnatal hepatic necrosis death, and one likely survivor out of three cases." — Alan Flake (clinical) [Ep 10 · 10:49](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=649)
- "Sacrococcygeal teratoma fetal intervention targets tumor vascular steal leading to high-output cardiac failure; surgical debulking interrupts the arteriovenous steal." — Alan Flake (clinical) [Ep 10 · 12:18](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=738)
- "CHOP's recent SCT algorithm emphasizes preemptive early delivery (≥27 weeks) at the first sign of maternal or fetal decompensation, with improved outcomes in 5 recent cases." — Alan Flake (clinical) [Ep 10 · 16:33](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=993)
- "Watchful waiting for SCT between 27-32 weeks can be hazardous; the majority of patients who go into preterm labor or evolve significant high-output failure will die." — Alan Flake (clinical) [Ep 10 · 16:03](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=963)
- "The EXIT procedure maintains uteroplacental blood flow using complete uterine relaxation with deep maternal gaseous anesthetic and intrauterine volume maintenance." — Alan Flake (clinical) [Ep 10 · 18:41](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1121)
- "The EXIT procedure was initially developed to remove tracheal clips after tracheal occlusion for CDH." — Alan Flake (clinical) [Ep 10 · 18:25](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1105)
- "A massive cervical teratoma case required 11.5 hours on placental support during EXIT, with retrograde and antegrade cannulation attempts, ultimately requiring tumor dissection to reach the trachea." — Alan Flake (clinical) [Ep 10 · 20:04](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1204)
- "CHAOS (congenital high airway obstruction syndrome) can result in marked diaphragm inversion, ascites, and thoracic abnormalities; the first survivor was delivered by EXIT." — Alan Flake (clinical) [Ep 10 · 21:05](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1265)
- "CHAOS has a strong rationale for prenatal treatment due to morbidity associated with treating at birth and the need for patients to grow into their ventilatory mechanics." — Alan Flake (opinion) [Ep 10 · 21:33](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1293)
- "Steroids may drive lung development and maturation of microcystic CPAM tissue, though this is unproven." (host_summary) [Ep 10 · 29:41](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1781)
- "Preterm labor in hydropic CPAM patients may be secondary to a maternal-fetal immune response, and steroids may ameliorate this response." (opinion) [Ep 10 · 30:24](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1824)
- "Echocardiographic assessment of cardiac function is a more specific indicator of fetal heart failure than fluid in body compartments alone." (clinical) [Ep 10 · 31:39](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1899)
- "Some fetuses with massive ascites and mild pleural effusion can be observed if cardiac function remains intact, even before steroids became popular." (clinical) [Ep 10 · 31:49](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1909)
- "The CVR has been a very good way to counsel families and determine the pace of follow-up; high CVR may warrant follow-up 2-3 times per week." (clinical) [Ep 10 · 33:34](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2014)
- "CPAM growth rate can be quite abrupt between 18 and 26-28 weeks gestation, then tends to plateau; this is useful for counseling." (clinical) [Ep 10 · 34:11](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2051)
- "Steroids may put the CPAM further along the growth curve in terms of gestational age, which might explain their effect." (opinion) [Ep 10 · 34:30](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2070)
- "In Cincinnati's experience with 56 CPAM cases, prophylactic steroids for CVR >1.6 resulted in literally 100% survival." (epidemiological) [Ep 10 · 36:28](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2188)
- "In Cincinnati's experience, once hydrops was established, steroids resulted in 49% survival and good response." (epidemiological) [Ep 10 · 36:42](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2202)
- "If one course of steroids fails, a second course salvages about 2 out of 6 patients; others go on to fetal surgery." (clinical) [Ep 10 · 36:51](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2211)
- "Steroids are most effective in microcystic (solid) CPAM forms, but are used even in type 1 and type 2 lesions to arrest growth of the solid component, though less efficacious." (clinical) [Ep 10 · 35:52](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2152)
- "Macrocystic CPAM and bronchial atresia do not respond as well to steroids as microcystic CPAM." — Alan Flake (clinical) [Ep 10 · 29:19](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1759)
- "Bronchial atresia can be differentiated from microcystic CPAM by the presence of a dilated central bronchus or mucocele and documentation of a contralateral lung to rule out lung agenesis." — Alan Flake (clinical) [Ep 10 · 3:45](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=225)
- "Open fetal surgery for CPAM is indicated when hydrops persists despite steroids at an early gestational time point, if the capability exists." — Alan Flake (clinical) [Ep 10 · 6:31](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=391)
- "Macrocystic CPAM can be treated by thoracoamniotic shunt rather than open fetal surgery." — Alan Flake (clinical) [Ep 10 · 9:40](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=580)
- "RFA (radiofrequency ablation) technology for SCT has not identified a safe ablative technology that avoids collateral injury and bad outcomes; it is not recommended at present." — Alan Flake (clinical) [Ep 10 · 17:33](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1053)
- "Future directions in fetal surgery include clinical trials, reduction of maternal and fetal risk, better imaging for physiologic information, and tissue engineering approaches to make open fetal surgery obsolete." — Alan Flake (opinion) [Ep 10 · 23:57](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1437)
- "The EXIT procedure requires a multidisciplinary team with specific roles, and may require a second operating room team for definitive postnatal procedures and ECMO capability." — Alan Flake (clinical) [Ep 10 · 19:10](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1150)
- "Prophylactic steroid treatment for CVR >1.6 in the absence of hydrops is practiced, though there was equipoise for a randomized study because most centers give steroids in that group." (host_summary) [Ep 10 · 37:17](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2237)
- "The average CVR (congenital pulmonary airway malformation volume ratio) for EXIT procedures with CCAM has been over 2.0, representing large lesions." — Alan (clinical) [Ep 12 · 0:46](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=46)
- "EXIT procedures for CCAM are reserved for cases with evidence of compression including diaphragmatic aversion, marked mediastinal shift, and often ascites." — Alan (clinical) [Ep 12 · 0:46](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=46)
- "It is very rare to need ECMO in CCAM patients." — Alan (clinical) [Ep 12 · 1:41](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=101)
- "Complex CCAM cases requiring EXIT and fetal surgery are referred to specialized centers while simple cases stay at referring institutions, skewing the percentage of interventions at high-volume centers." — Jean-Martin (epidemiological) [Ep 12 · 2:04](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=124)
- "There is no clear reduction in the ability to have subsequent pregnancy after fetal surgery, based on approximately four published studies." — Alan (clinical) [Ep 12 · 2:46](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=166)
- "After fetal surgery, patients are not allowed to labor in future pregnancies because the hysterotomy is equivalent to a classical cesarean section in the upper part of the uterus." — Alan (guideline) [Ep 12 · 2:59](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=179)
- "There has been no observed placenta accreta at the hysterotomy site following fetal surgery thus far." — Alan (clinical) [Ep 12 · 3:12](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=192)
- "EXIT procedure requires an anesthetic team experienced with uterine relaxation and maternal issues, and expertise with hysterotomy." — Alan (clinical) [Ep 12 · 4:03](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=243)
- "EXIT procedures can be learned and disseminated more widely than fetal surgery programs, with training through observation." — Alan (opinion) [Ep 12 · 4:23](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=263)
- "CHOP has performed close to 100 EXIT procedures in the past 10 years for conditions including cervical teratomas and airway obstructive problems." — Alan (epidemiological) [Ep 12 · 4:43](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=283)
- "Maternal expertise must be available at the hospital performing EXIT procedures, with protection of the mother being the first priority." (guideline) [Ep 12 · 5:13](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=313)
- "Approximately 4 or 5 centers in the US clearly have the qualifications and background to perform EXIT procedures correctly." — Alan (epidemiological) [Ep 12 · 5:51](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=351)
- "EXIT procedures require weeks of planning and involve 15 to 20 people in the team." (clinical) [Ep 12 · 6:44](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=404)
- "A minimum case volume of 3 to 5 EXIT procedures per year is needed to justify establishing a program; one case per year is insufficient." — Alan (opinion) [Ep 12 · 7:15](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=435)
- "Most bronchopulmonary sequestrations causing hydrops have associated pleural effusions and mediastinal shift, with hydrops due to mass effect rather than high-output cardiac failure." — Alan (clinical) [Ep 12 · 8:23](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=503)
- "Embolization or sclerotherapy procedures for fetal vascular lesions, particularly using alcohol as a sclerosant, carry potential hazards including neurologic effects that have not been adequately studied." — Alan (opinion) [Ep 12 · 9:06](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=546)
- "The main technical difference in fetal lobectomy compared to postnatal surgery is the delicacy and gelatinous, friable consistency of tissues, particularly at 20-23 weeks gestation." — Alan (clinical) [Ep 12 · 10:28](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=628)
- "Mishaps in fetal surgery have usually been related to traction injuries that tear tissues more easily than in postnatal open surgery." — Alan (clinical) [Ep 12 · 11:04](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=664)
- "The fetus is positioned before opening the uterus by converting it to the desired position within the amniotic fluid space." — Alan (clinical) [Ep 12 · 11:48](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=708)
- "During fetal thoracotomy, the fetus is stabilized by extracting the ipsilateral arm through the hysterotomy and is buoyed by amniotic fluid infusion, creating a seal at the hysterotomy site." — Alan (clinical) [Ep 12 · 12:09](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=729)
- "No successful complete pneumonectomy has been performed in fetal surgery; one attempted case for bronchial atresia resulted in fetal death." — Alan (clinical) [Ep 12 · 12:58](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=778)
- "Bilobectomies have been successfully performed in fetal surgery." — Alan (clinical) [Ep 12 · 13:21](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=801)
- "Small fragments of lung tissue left after fetal resection can grow dramatically postnatally if airway and vasculature are preserved." — Alan (clinical) [Ep 12 · 13:37](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=817)
- "Fetal surgery can still be performed in mothers who have had previous cesarean sections because the uterus heals incisions well." — Alan (clinical) [Ep 12 · 14:07](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=847)
- "Most cesarean sections are performed through the lower uterine segment, which does not interfere with the fetal surgery hysterotomy site." — Alan (clinical) [Ep 12 · 14:12](https://qa.library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=852)
- "One center has performed close to 100 EXIT procedures in the past 10 years." — Alan (clinical) [Ep 11 · 4:56](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=296)
- "EXIT procedures have been used for CCAMs with average CVR over 2, which are large lesions." — Alan (clinical) [Ep 11 · 0:46](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=46)
- "EXIT is reserved for cases with evidence of compression: diaphragmatic aversion, marked mediastinal shift, often ascites." — Alan (clinical) [Ep 11 · 0:46](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=46)
- "ECMO is very rare in CCAM patients and has not been used during EXIT procedures; conventional ventilation is tried first." — Alan (clinical) [Ep 11 · 1:39](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=99)
- "Referral centers receive complex cases while simple cases stay local, skewing the percentage requiring EXIT and fetal surgery." — Jean-Martin (opinion) [Ep 11 · 2:04](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=124)
- "There is no clear reduction in ability to have subsequent pregnancy after fetal surgery, based on approximately 4 published studies." — Alan (epidemiological) [Ep 11 · 2:46](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=166)
- "After fetal surgery hysterotomy (equivalent to classical cesarean in upper uterus), patients should never labor with future pregnancies." — Alan (guideline) [Ep 11 · 2:59](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=179)
- "No long-term maternal morbidity aside from requirement for cesarean delivery has been observed after fetal surgery." — Alan (clinical) [Ep 11 · 3:12](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=192)
- "Feared complications like placenta accreta at the hysterotomy site have not been observed thus far." — Alan (clinical) [Ep 11 · 3:22](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=202)
- "EXIT procedure requires an anesthetic team tuned into uterine relaxation and maternal issues, and expertise with hysterotomy." — Alan (clinical) [Ep 11 · 4:03](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=243)
- "EXIT procedure can be learned and disseminated more widely than fetal surgery without requiring a full fetal surgery program." — Alan (opinion) [Ep 11 · 4:23](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=263)
- "EXIT is valuable for cervical teratomas and airway obstructive problems; most large children's hospitals experience cases that would benefit from EXIT from time to time." — Alan (clinical) [Ep 11 · 4:43](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=283)
- "Maternal expertise must be available at the hospital; bringing a mother into a freestanding children's hospital without maternal expertise is a bad idea." (opinion) [Ep 11 · 5:13](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=313)
- "There are probably 4 or 5 centers in the US that clearly have the qualifications and background to do good EXIT procedures." — Alan (epidemiological) [Ep 11 · 6:04](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=364)
- "EXIT procedure involves weeks of planning, discussions of the entire team, and 15 to 20 people in the operating room." (clinical) [Ep 11 · 6:44](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=404)
- "If a center does only one EXIT per year, it is probably not enough to justify doing EXIT procedures; 3 to 5 per year is a reasonable threshold." — Alan (opinion) [Ep 11 · 7:15](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=435)
- "Very few BPS cases with large feeding vessels have been seen where high-output failure was thought to be the mechanism of hydrops; most have associated pleural effusions, mediastinal shift, or mass effect." — Alan (clinical) [Ep 11 · 8:23](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=503)
- "Injecting alcohol into fetal vessels has potential hazard including neurologic effects and has not been adequately studied." — Alan (opinion) [Ep 11 · 9:06](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=546)
- "Alcohol injection can cause thrombosis in systemic circulation; one case showed thrombi in heart chambers that then embolized to various sites." — Alan (clinical) [Ep 11 · 16:18](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=978)
- "Radiofrequency ablation cannot be controlled in the fetus due to 90% water content; energy can disperse unpredictably causing collateral damage." — Alan (clinical) [Ep 11 · 17:21](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1041)
- "In one experiment, radiofrequency probe placed in one side of a teratoma caused the other side to boil when activated." — Alan (clinical) [Ep 11 · 17:38](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1058)
- "Probably 95% of CCAMs seen now are prenatally diagnosed." (epidemiological) [Ep 11 · 18:11](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1091)
- "Almost none of prenatally diagnosed congenital lung lesions require prenatal intervention, and very few require intervention the day the child is born." (clinical) [Ep 11 · 18:18](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1098)
- "The vast majority of congenital lung lesions do not fall in the realm of extreme treatments; only one or two centers in the world should be thinking about these interventions." (opinion) [Ep 11 · 18:35](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1115)
- "The majority of children with prenatal lung lesions can be delivered without fetal distress." (clinical) [Ep 11 · 18:51](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1131)
- "Many lesions have been referred after a recommendation for termination by people who don't understand the natural history." — Alan (clinical) [Ep 11 · 19:44](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1184)
- "Even very large congenital lung lesions can regress and be asymptomatic at birth, or have very good survival rates with appropriate interventions." — Alan (clinical) [Ep 11 · 19:57](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1197)
- "The garden variety postnatal CCAM is very different than some prenatal CCAMs." — Alan (clinical) [Ep 11 · 20:10](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1210)
- "True cystic CCAMs do not disappear; they regress but remain present and prominent on CT scan one month after birth." — Alan (clinical) [Ep 11 · 20:30](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1230)
- "Some things that look like CCAMs in utero (like segmental bronchial stenosis) can give an echogenic microcystic appearance but may be minimally apparent or non-apparent after birth." — Alan (clinical) [Ep 11 · 20:39](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1239)
- "Congenital lung lesions should be called macrocystic, hyperechoic, or mixed rather than 'CCAM' prenatally, since CCAM is a pathological diagnosis once the specimen is in the bucket." — Jean-Martin (opinion) [Ep 11 · 22:11](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1331)
- "Many tertiary centers have the capacity to do EXIT; it requires a huge team approach and somebody leading the team." — Jean-Martin (opinion) [Ep 11 · 22:40](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1360)
- "Good prenatal diagnosis is essential; lung agenesis has been diagnosed as microcystic CCAM elsewhere, leading to potential catastrophic errors." — Alan (clinical) [Ep 11 · 23:45](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1425)
- "Pleuro-amniotic shunts are used specifically for macrocystic CCAMs with evidence of hydrops (pleural effusion, pericardial effusion, and skin or scalp edema), not pure ascites alone." — Alan (clinical) [Ep 11 · 25:34](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1534)
- "Large macrocystic lesions are sometimes tapped just prior to delivery to improve ventilation, but shunts are not placed prophylactically." — Alan (clinical) [Ep 11 · 26:14](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1574)
- "CVR less than 1.6 on presentation predicts about 3% (less than 5%) likelihood of evolving hydrops in microcystic lesions; this has held true in prospective studies and ongoing experience." — Alan (clinical) [Ep 11 · 27:50](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1670)
- "CVR greater than 1.6 requires close watching; there is much higher likelihood of evolving into hydrops." — Alan (clinical) [Ep 11 · 28:37](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1717)
- "Macrocystic lesions are a wild card because the cystic component can grow very rapidly and can be worrisome even if CVR is less than 1.6." — Alan (clinical) [Ep 11 · 28:44](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1724)
- "At one center, all lung lesions get a fetal MRI routinely; MRIs help define anatomy and general size of lesions." — Alan (clinical) [Ep 11 · 29:01](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1741)
- "MRIs are not essential for all centers; they can clarify abnormalities if there is ambiguity on ultrasound or confusion about diagnosis." — Alan (opinion) [Ep 11 · 29:33](https://qa.library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1773)
- "Prenatal diagnosis has had a tremendous impact on the understanding and management of lung lesions." (opinion) [Ep 13 · 0:06](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=6)
- "Right CDHs are frequently misdiagnosed as CPAMs and vice versa because of the similar echogenicity of the liver and the right chest." (clinical) [Ep 13 · 1:09](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=69)
- "Steroids have reduced the need for surgical fetal intervention to almost zero in most fetal centers over the past 4-7 years for microcystic CPAMs when hydrops is threatened." (clinical) [Ep 13 · 1:52](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=112)
- "The CCAM volume ratio (CVR) is the volume of an ellipse (three dimensional volume of the CPAM) over the head circumference to standardize for gestational age." (clinical) [Ep 13 · 2:59](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=179)
- "CVR has proven to be probably the most valuable prognostic indicator for CPAMs both retrospectively and prospectively." (clinical) [Ep 13 · 3:11](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=191)
- "CPAMs typically grow up until about 25 to 28 weeks when they tend to plateau, and then they'll actually regress in size very often." (clinical) [Ep 13 · 3:27](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=207)
- "If the CVR is less than 1.6 with a solid lesion at presentation, there's less than a 3% chance of that lesion progressing to hydrops." (clinical) [Ep 13 · 3:46](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=226)
- "CVR of greater than 1.6 has a very high likelihood of developing hydrops, as high as 75%." (clinical) [Ep 13 · 4:10](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=250)
- "At the speaker's center, lesions with CVR greater than 1.6 are treated with steroids prophylactically to try to avoid heart failure." (clinical) [Ep 13 · 4:24](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=264)
- "The presented case is probably the only case in the last 5 years of a microcystic CPAM that didn't respond to steroids at the speaker's center." (clinical) [Ep 13 · 4:51](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=291)
- "Complete uterine relaxation with deep inhalational anesthetic is required before touching the uterus in fetal surgery." (clinical) [Ep 13 · 5:44](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=344)
- "If there is an anterior placenta, a posterior uterine incision is required, which necessitates dividing the rectus muscle and doing a bigger abdominal incision." (clinical) [Ep 13 · 7:27](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=447)
- "IV access is extremely important in fetal surgery to allow resuscitation, transfusions, and other interventions." (clinical) [Ep 13 · 8:00](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=480)
- "Continuous echocardiographic monitoring of the fetal heart by a scrubbed cardiologist is an invaluable component of fetal surgery." (clinical) [Ep 13 · 8:17](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=497)
- "When tumors are decompressed out of the chest during fetal surgery, the fetus can become bradycardic due to loss of preload on the heart." (clinical) [Ep 13 · 8:40](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=520)
- "Fetuses are usually preloaded via IV before chest decompression to prevent bradycardia." (clinical) [Ep 13 · 8:49](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=529)
- "Amniotic fluid is replaced with warm lactated Ringer solution during fetal surgery." (clinical) [Ep 13 · 9:05](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=545)
- "A three-layer closure of the uterus is performed after fetal surgery to prevent amniotic fluid leakage and control the membranes." (clinical) [Ep 13 · 9:36](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=576)
- "Open fetal surgery is required very rarely for lung lesions." (clinical) [Ep 13 · 9:48](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=588)
- "The fetus in the presented case was delivered at 35 weeks without ventilation required and showed good compensatory lung growth at 3.5 weeks post-op." (clinical) [Ep 13 · 9:58](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=598)
- "At CHOP, overall survival for open fetal surgery for lung lesions is around 60%, consistent over all years." (epidemiological) [Ep 13 · 10:20](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=620)
- "Survivors of open fetal surgery have good quality of life outcomes with no major neurologic sequelae or other bad quality of life impacts." (clinical) [Ep 13 · 10:30](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=630)
- "Losses in open fetal surgery are usually kids that have gone too far with their hydrops and can't tolerate the procedure or have early preterm labor." (clinical) [Ep 13 · 10:44](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=644)
- "Macrocystic CPAMs are less predictable, and even patients with CVR less than 1.6 will occasionally grow rapidly and induce hydrops." (clinical) [Ep 13 · 10:58](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=658)
- "In the presented macrocystic CPAM case, a thoracoamniotic shunt converted CVR from 3.6 to 0.8 and reversed the associated hydrops." (clinical) [Ep 13 · 11:18](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=678)
- "Many CPAMs have a large solid component, and the shunt can't entirely decompress that, but can still reverse the hydrops." (clinical) [Ep 13 · 11:43](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=703)
- "The shunt experience has been about 70% survival." (epidemiological) [Ep 13 · 11:53](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=713)
- "Losses after shunt placement are usually due to early delivery and associated prematurity, inadequate compensatory lung growth, or sometimes residual mass effect requiring invasive treatment." (clinical) [Ep 13 · 11:57](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=717)
- "Marked chest wall deformity can occur if shunts are placed for giant macrocystic CPAMs early in gestation, most prominent when shunts are done at 18 to 20 weeks." (clinical) [Ep 13 · 12:13](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=733)
- "Chest wall deformity from early shunt placement is related to collapse of the chest wall as opposed to the harpoon placement of the shunt." (opinion) [Ep 13 · 12:34](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=754)
- "Chest wall deformity from shunt placement becomes less pronounced over time, and thus far affected children haven't required chest reconstructive procedures." (clinical) [Ep 13 · 12:41](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=761)
- "CPAMs with multiple macrocysts generally communicate, so placement of a shunt can decompress those lesions dramatically." (clinical) [Ep 13 · 13:09](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=789)
- "Ascites alone is not considered hydrops." (clinical) [Ep 13 · 13:28](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=808)
- "The EXIT procedure is designed to maintain uteroplacental blood flow during delivery and resection of the mass." (clinical) [Ep 13 · 13:56](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=836)
- "Infants can be maintained with normal blood gases for an hour and a half by a well-performed EXIT procedure." (clinical) [Ep 13 · 15:36](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=936)
- "CHOP has performed 16 EXIT procedures for lung lesions, with 4 requiring ECMO and 15 survivors." (epidemiological) [Ep 13 · 15:44](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=944)
- "ECMO is a very unusual requirement for lung lesions because of their late enlargement, so they don't have the same effect on lung hypoplasia as CDH." (clinical) [Ep 13 · 15:49](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=949)
- "Fetal intervention with twins is generally considered a contraindication." (clinical) [Ep 13 · 16:19](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=979)
- "EXIT procedures are much trickier when you have twin gestations." (opinion) [Ep 13 · 16:27](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=987)
- "The majority of kids with large CPAMs at birth don't need EXIT procedures and can be managed with C-section and immediate resection." (clinical) [Ep 13 · 17:48](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=1068)
- "EXIT procedures are reserved for kids where you see mass effect with diaphragmatic aversion, can't visualize the opposite lung easily, or have dramatic mediastinal shift." (clinical) [Ep 13 · 18:01](https://qa.library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=1081)
- "It is difficult to determine with imaging exactly how large the hole in the diaphragm is in CDH." — Fung Lim (clinical) [Ep 15 · 1:29](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=89)
- "Ultrasound is usually the screening tool to find congenital diaphragmatic hernia in the fetus." — Rod Gerardo (host_summary) [Ep 15 · 1:40](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=100)
- "MRI provides higher resolution imaging than ultrasound and yields information about the pulmonary status of the fetus in CDH." — Rod Gerardo (host_summary) [Ep 15 · 1:48](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=108)
- "In mild diaphragmatic hernia, the left lung starts to shrink in size." — Fung Lim (clinical) [Ep 15 · 2:05](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=125)
- "In moderate diaphragmatic hernia, the left lung gets smaller as the intestines and part of the liver push upwards." — Fung Lim (clinical) [Ep 15 · 2:11](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=131)
- "In the most severe CDH cases, the liver occupies a good portion of the chest, the left lung is very small, and even the right lung is shrinking." — Fung Lim (clinical) [Ep 15 · 2:24](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=144)
- "Fetuses with severe CDH (liver herniation and bilateral lung hypoplasia) are good candidates for FETO." — Rod Gerardo (host_summary) [Ep 15 · 2:35](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=155)
- "The tracheal occlusion procedure is commonly performed at gestational age between 27 weeks and 29 weeks 6 days." — Fung Lim (guideline) [Ep 15 · 2:44](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=164)
- "Anesthesia for FETO is induced by ultrasound guidance with local anesthetic and numbing medication injected into the mother." — Fung Lim (clinical) [Ep 15 · 2:53](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=173)
- "An introducer is inserted into the amniotic space to allow placement of a fetoscope (small camera) through the introducer into the amniotic space." — Fung Lim (clinical) [Ep 15 · 3:04](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=184)
- "The fetoscope is advanced carefully into the fetal trachea once the baby's mouth is located." — Fung Lim (clinical) [Ep 15 · 3:16](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=196)
- "The ideal position for the fetoscope in FETO is in the main trachea below the vocal cords but above the carina, before the trachea splits into the two main bronchi." — Fung Lim (clinical) [Ep 15 · 3:27](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=207)
- "A balloon is inserted into the fetal airway, inflated to completely occlude the trachea, then detached and left in place." — Fung Lim (clinical) [Ep 15 · 3:38](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=218)
- "Fetal lung tissue constantly creates fluid that normally escapes through the trachea; occluding the trachea causes fluid and pressure to build up, which helps the lungs develop." — Rod Gerardo (host_summary) [Ep 15 · 3:48](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=228)
- "The balloon is left in place for a few weeks to accelerate lung growth." — Fung Lim (clinical) [Ep 15 · 4:12](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=252)
- "The balloon is typically removed at about 34 weeks gestation." — Rod Gerardo (host_summary) [Ep 15 · 4:18](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=258)
- "If the baby is in proper position, the balloon can be punctured under ultrasound guidance." — Fung Lim (clinical) [Ep 15 · 4:26](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=266)
- "The deflated balloon is pushed out of the baby's trachea by lung fluids and poses no risk to the baby's health." — Fung Lim (clinical) [Ep 15 · 4:33](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=273)
- "If the baby's position does not allow for needle puncture, a grasper is used to hold the balloon while a needle punctures it, and the deflated balloon is then removed from the airway using the grasper." — Fung Lim (clinical) [Ep 15 · 4:40](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=280)
- "After balloon removal, the mother and fetus are monitored carefully for the remainder of the pregnancy." — Fung Lim (guideline) [Ep 15 · 4:56](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=296)
- "Ideally, the baby is delivered vaginally at term, with cesarean section reserved for the usual obstetrical reasons." — Fung Lim (guideline) [Ep 15 · 5:02](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=302)
- "Neural tube defects are the most common congenital central nervous system anomaly." — Rod Gerardo (host_summary) [Ep 16 · 0:42](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=42)
- "Myelomeningocele or spina bifida is the most common neural tube defect." — Rod Gerardo (host_summary) [Ep 16 · 1:20](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=80)
- "In myelomeningocele, the patient is born with a cleft in the vertebral column and a defect in the skin, so the meninges and the spinal cord are exposed." — Rod Gerardo (host_summary) [Ep 16 · 1:25](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=85)
- "The patient may be left with neural defects based on the level of the spinal cord where the lesion is." — Rod Gerardo (host_summary) [Ep 16 · 1:33](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=93)
- "Prenatal repair is most commonly done between 22 and 26 weeks gestation." — Fung Lim (clinical) [Ep 16 · 1:44](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=104)
- "For maternal access, either a transverse incision or a midline incision may be used." — Fung Lim (clinical) [Ep 16 · 1:54](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=114)
- "Under ultrasound guidance, the first port is placed." — Rod Gerardo (host_summary) [Ep 16 · 2:17](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=137)
- "The amniotic cavity is expanded using humidified and heated carbon dioxide, which creates more space to do the repair." — Fung Lim (clinical) [Ep 16 · 2:22](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=142)
- "A camera is inserted into the amniotic cavity through the first port to enable visualization inside the womb." — Fung Lim (clinical) [Ep 16 · 2:34](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=154)
- "Two additional ports are placed under direct vision to allow placement of instruments for the repair." — Fung Lim (clinical) [Ep 16 · 2:43](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=163)
- "Anesthesia is induced on the baby via an intragluteal injection." — Rod Gerardo (host_summary) [Ep 16 · 2:51](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=171)
- "A stabilization stitch is placed in the baby's upper back above the spina bifida." — Fung Lim (clinical) [Ep 16 · 2:56](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=176)
- "The first step is to open the sac, then dissect around the sac circumferentially." — Rod Gerardo (host_summary) [Ep 16 · 3:08](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=188)
- "Once the sac is completely open, the placode is freed." — Fung Lim (clinical) [Ep 16 · 3:22](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=202)
- "The placode is the open area of exposed neural tissue." — Rod Gerardo (host_summary) [Ep 16 · 3:27](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=207)
- "Untethering allows the placode to fall back down nicely into the spinal canal." — Fung Lim (clinical) [Ep 16 · 3:34](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=214)
- "A skin flap is created to loosen up the skin, which will help form a watertight closure of the spinal defect." — Rod Gerardo (host_summary) [Ep 16 · 3:44](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=224)
- "To protect the placode, a patch is placed into the defect and anchored on one end to the baby's back using dissolvable sutures." — Fung Lim (clinical) [Ep 16 · 3:57](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=237)
- "A second patch is placed to give additional protection and is secured with dissolvable sutures." — Fung Lim (clinical) [Ep 16 · 4:08](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=248)
- "The skin is closed over the spinal defect using dissolvable sutures when the baby has enough skin to do so." — Fung Lim (clinical) [Ep 16 · 4:17](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=257)
- "When the defect is too big and the two ends of skin cannot be pulled together, a skin patch is used to form a watertight closure." — Fung Lim (clinical) [Ep 16 · 4:26](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=266)
- "Port sites are closed with dissolvable sutures." — Fung Lim (clinical) [Ep 16 · 4:49](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=289)
- "The amniotic fluid that was removed is replaced with warm fluid and antibiotics are placed into the amniotic cavity." — Fung Lim (clinical) [Ep 16 · 4:57](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=297)
- "The mother and the fetus are monitored postoperatively, and if able, the baby is delivered vaginally at term." — Rod Gerardo (host_summary) [Ep 16 · 5:14](https://qa.library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=314)
- "CPAMs are abnormally developed lung tissue that doesn't participate in gas exchange, coming off normal bronchial airways but lacking normal alveoli." — Pam Choi and Dr. Beth Romesky (clinical) [Ep 17 · 3:47](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=227)
- "The Stocker classification for CPAMs ranges from type 0 to type 4, moving from proximal to distal in the bronchial tree, with type 1 (distal bronchi/proximal bronchioles) being most common at 60-70% of cases." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 17 · 5:12](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=312)
- "CPAMs typically grow during the first 20-25 weeks of gestation and plateau around week 28." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 17 · 6:57](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=417)
- "The CPAM volume ratio (CVR) is calculated as the CPAM's length times width times height times 0.52 divided by the head circumference." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 17 · 8:41](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=521)
- "In patients with CVR over 1.6, it is estimated that 75% develop hydrops." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 17 · 9:14](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=554)
- "The presence of hydrops is the strongest prognostic indicator of mortality in fetuses with CPAMs." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 17 · 8:02](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=482)
- "Prenatal steroids (betamethasone 12mg given twice, 24 hours apart) have been shown to resolve hydrops and reduce the size of CPAM lesions such that the CVR can decrease." — Pam Choi and Dr. Beth Romesky (clinical) [Ep 17 · 10:42](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=642)
- "CPAMs are differentiated as microcystic (less than 5 millimeters) or macrocystic (larger than 5 millimeters)." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 17 · 10:14](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=614)
- "A thoracoamniotic shunt is placed so that half is inside the fetal chest and half is in the amniotic space, allowing egress of fluid from the fetal chest into the amniotic space for continued decompression throughout pregnancy." — Pam Choi and Dr. Beth Romesky (clinical) [Ep 17 · 13:33](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=813)
- "Fetal resection involves partially delivering the fetus, performing a thoracotomy, removing part of the lung, and placing the fetus back in the uterus to continue the pregnancy." — Pam Choi and Dr. Beth Romesky (clinical) [Ep 17 · 15:11](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=911)
- "Mirror syndrome means the mother is showing evidence of what the baby has going on, with the mother developing significant edema, pleural effusion, and other symptoms very quickly." — Pam Choi and Dr. Beth Romesky (clinical) [Ep 17 · 16:15](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=975)
- "During an EXIT procedure, the baby remains attached to mom through the umbilical cord while a thoracotomy and resection are performed, with the time available depending on how well mom tolerates it and uterine relaxation, typically ranging from a few minutes to rarely longer than an hour." — Pam Choi and Dr. Beth Romesky (clinical) [Ep 17 · 17:05](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1025)
- "Air trapping can occur where air enters the CPAM area as the infant breathes in but doesn't come out as easily, causing progressive hyperinflation of the non-functioning lobe and rapid progressive respiratory distress." — Pam Choi and Dr. Beth Romesky (clinical) [Ep 17 · 19:42](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1182)
- "CPAMs are not well-visualized on chest X-rays and can regress or get smaller over time." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 17 · 22:25](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1345)
- "In the United States, most surgeons resect CPAMs even if asymptomatic, while in Europe and Canada, surgeons sometimes choose to monitor asymptomatic lesions and avoid surgery." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 17 · 24:40](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1480)
- "The main reasons for operating on asymptomatic CPAMs are: risk of malignancy both at resection and from malignant transformation later, risk of infection that will make surgery more difficult, and better compensatory lung growth if operating sooner in life." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 17 · 25:29](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1529)
- "Thoracoscopic lobectomy risks include bleeding, prolonged post-op mechanical ventilation, infections, air leak, pneumothorax, nerve injury, and mortality." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 17 · 26:03](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1563)
- "The particular malignancy associated with CPAM is pleuropulmonary blastoma (PPB), with risk that the lesion at birth already has malignancy and risk of malignant transformation over a person's life." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 17 · 27:47](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1667)
- "Features suggesting higher risk of PPB include: lesion in more than one lobe, in more than one lung, associated pneumothorax, and DICER1 genetic mutation." — Jack Langer (clinical) [Ep 17 · 28:25](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1705)
- "Features suggesting very low risk of PPB are a feeding vessel and prenatal diagnosis." — Jack Langer (clinical) [Ep 17 · 28:59](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1739)
- "A recent study published in April 2021 found that no prenatally diagnosed lesions had malignancy, but 10% of patients diagnosed postnatally had malignancy in their resected mass." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 17 · 30:17](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1817)
- "Dr. Langer follows observed CPAM patients with regular chest X-rays for the first 2 years, expecting to see changes on serial X-rays if a PPB is developing from type 1 to type 2, then follows clinically after that." — Jack Langer (clinical) [Ep 17 · 30:56](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1856)
- "If a CPAM becomes infected, it should be treated with IV antibiotics, allowed to settle down, then removed, as infected CPAMs make surgery more difficult with more blood loss and complications." — Jack Langer (clinical) [Ep 17 · 31:51](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1911)
- "Single lung ventilation for thoracoscopic lobectomy is obtained by mainstem intubation of the contralateral bronchus, preventing the lung from overinflating during dissection of key vessels or structures." — Steven Rothenberg (clinical) [Ep 17 · 36:43](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2203)
- "For thoracoscopic lobectomy, the scope port should be placed over the major fissure in the mid-axillary line, anterior to the tip of the scapula, to allow working from front to back and avoid working in paradox." — Steven Rothenberg (clinical) [Ep 17 · 39:02](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2342)
- "When completing an incomplete fissure during lobectomy, work through it layer at a time like finger fracturing during liver lobectomy, starting at the front and working posteriorly until exposing the pulmonary artery." — Steven Rothenberg (clinical) [Ep 17 · 41:39](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2499)
- "Vascular control in thoracoscopic lobectomy is everything; dissect out vessels to get enough length to make a seal proximally and distally, then cut partway between seals to check for bleeding before completing division." — Steven Rothenberg (clinical) [Ep 17 · 43:09](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2589)
- "The bronchus sits right underneath the pulmonary artery and can be felt to help dissect behind the artery during lobectomy." — Steven Rothenberg (clinical) [Ep 17 · 44:13](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2653)
- "When dissecting behind the bronchus during lobectomy, stay hard on the backside of the bronchus and be aware that the pulmonary vein is right behind it." — Steven Rothenberg (clinical) [Ep 17 · 46:57](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2817)
- "Do not take the pulmonary vein trunk near the pericardium during lobectomy, because if the device fails, the vessel will retract into the pericardium and the child will bleed to death before you can do anything; ensure enough length away from pericardium for proximal control." — Steven Rothenberg (clinical) [Ep 17 · 48:44](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2924)
- "The incidence of CPAMs is estimated to be about 1 in every 8,000 to 35,000 births." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 17 · 52:39](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=3159)
- "60% of prenatally diagnosed lung lesions are CPAMs, making them the most common prenatal lung lesion." — Rod Gerardo and Ellen Ancisco (host_summary) [Ep 17 · 52:53](https://qa.library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=3173)
- "At Cincinnati Children's, if a child has no gas in the abdomen, they place a G-tube and may put something up the distal esophagus for a fluoro shot, then wait a couple of weeks for a protocol gap measurement in interventional radiology." — Daniel von Allmen (clinical) [Ep 18 · 0:46](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=46)
- "In the Foker technique, the surgeon ties sutures to either end of the esophagus through an open incision, brings them out through the chest wall, ties them together in a knot, and places spacers underneath periodically (about every day) until the ends come together for primary anastomosis." — Rod Gerardo (host_summary) [Ep 18 · 1:08](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=68)
- "Stretch is a very strong promoter of growth, and if you put things on tension they will actually grow over time, which is how the cardiovascular system develops in utero." — Daniel von Allmen (clinical) [Ep 18 · 2:10](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=130)
- "The philosophy of traction-based elongation is that with traction, you can get the two ends of the esophagus to grow, and if you can get them to grow far enough, you can put them together." — Daniel von Allmen (clinical) [Ep 18 · 2:10](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=130)
- "The van der Zee technique uses the same concept as Foker but is done thoracoscopically with no external sutures, so all tension is inside the thorax." — Rod Gerardo (host_summary) [Ep 18 · 2:39](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=159)
- "The Kimura technique involves creating a spit fistula and periodically moving it down the chest wall over time to stretch the proximal pouch closer to the distal pouch, but is not used all that often anymore." — Rod Gerardo (host_summary) [Ep 18 · 2:39](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=159)
- "In the Boston Group 2015 study, the primary group (de novo cases) achieved an intact esophagus in 96% of patients, while the secondary group (patients with previous operations) achieved this in about two thirds of patients." — Daniel von Allmen (host_summary) [Ep 18 · 3:15](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=195)
- "In the Boston Group 2015 study, the primary group had a median ICU stay of 70 days with a couple of weeks being paralyzed, and the secondary group had a median ICU stay of 110 days with a month of being paralyzed." — Daniel von Allmen (host_summary) [Ep 18 · 3:15](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=195)
- "In the Boston Group 2015 study, about two thirds of patients with primary repair were able to get full oral nutrition and about 10% of patients who had secondary repair achieved full oral nutrition." — Daniel von Allmen (host_summary) [Ep 18 · 3:15](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=195)
- "The surgical group from INOEA recommends gastric pull up as the first option for esophageal replacement, dividing the esophageal stump at the esophageal hiatus and mobilizing the fundus to pull it up in either the anterior or posterior mediastinum." — Daniel von Allmen (host_summary) [Ep 18 · 4:36](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=276)
- "The colon can be used as an interposition for esophageal replacement." — Daniel von Allmen (clinical) [Ep 18 · 4:36](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=276)
- "In colonic interposition, the piece of colon chosen is based on the blood supply and the diameter needed." — Rod Gerardo (host_summary) [Ep 18 · 5:08](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=308)
- "In colonic interposition, a pyloroplasty is performed to help with gastric emptying." — Rod Gerardo (host_summary) [Ep 18 · 5:08](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=308)
- "Common problems with colonic interposition are that the colon can dilate and become tortuous, and it's not uncommon to get a sigmoid sink drain deformity just above the diaphragm." — Daniel von Allmen (clinical) [Ep 18 · 8:00](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=480)
- "Von Allman was initially taught that sigmoid redundancy in colonic interposition can't be fixed and that it's too dangerous because it will risk the blood supply, but he found that this is not really true." — Daniel von Allmen (opinion) [Ep 18 · 8:17](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=497)
- "Von Allman passes the colonic interposition posterior to the stomach, which leaves the vascular pedicle along the spine, allowing mobilization of the colon by dividing the gastric duodenotomy and colon attachment to the stomach, then mobilizing the sigmoid redundancy transhiatally and reanastomosing the colon to the stomach." — Daniel von Allmen (clinical) [Ep 18 · 8:17](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=497)
- "Colonic interpositions sometimes need to be revised, but it is not impossible to revise them and the kids tend to do pretty well." — Daniel von Allmen (opinion) [Ep 18 · 8:17](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=497)
- "You can get extraordinary length with colonic interposition, allowing treatment of cases with caustic injuries extending to the pharynx by sewing the colon to the pharynx and down to the stomach, which is tough to do with a gastric pull-up." — Daniel von Allmen (clinical) [Ep 18 · 9:03](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=543)
- "The short interval between time of traction and anastomosis (less than five days) raises the question of whether the mechanism is stretching or growth, which will impact results and likely reflects on complications." — Rod Gerardo (host_summary) [Ep 18 · 9:27](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=567)
- "Von Allman states we don't know whether esophageal elongation is growth or stretch and should do studies to understand that, but notes that tension is a very good physiologic growth promoter in other organs, making this an area ripe for more basic science." — Daniel von Allmen (opinion) [Ep 18 · 9:56](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=596)
- "The first article examines surgical management, staging and outcomes of Wilms tumors with intravascular extension, using results from the SIOP (International Society of Pediatric Oncology) Renal Tumor Study." — Brittany Levy (host_summary) [Ep 21 · 0:34](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=34)
- "The study looked at children with Wilms tumor where tumor thrombus extended into the renal vein and provided outcomes for when complete resection of tumor thrombus was successful versus when it was not." — Brittany Levy (host_summary) [Ep 21 · 0:58](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=58)
- "Dr. Paul Tam states that Wilms tumor has been a great success story for pediatric surgery and pediatric oncology." — Brittany Levy (host_summary) [Ep 21 · 1:14](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=74)
- "Dr. Paul Tam suggests improving outcomes by identifying subgroups of patients who are still not doing well and trying to improve care in those particular areas." — Brittany Levy (host_summary) [Ep 21 · 1:39](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=99)
- "If half of Wilms tumor patients have complete tumor removal and half do not, and there is an outcome difference, then surgeons should still try hard to remove all of the tumor." — Brittany Levy (host_summary) [Ep 21 · 1:54](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=114)
- "The second article examines efficacy of clinical grade human placental mesenchymal stromal cells in fetal ovine myelomeningocele repair." — Brittany Levy (host_summary) [Ep 21 · 2:13](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=133)
- "The article discussed use of mesenchymal stromal cells on an extracellular matrix in ovine fetuses to determine if there was a benefit to motor function in fetal lambs given the intervention." — Brittany Levy (host_summary) [Ep 21 · 2:40](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=160)
- "Dr. Christina Theodoro states this study is a pivotal study in obtaining approval from the FDA for use of clinical grade stem cells in fetal myelomeningocele repair." — Christina Theodoro (clinical) [Ep 21 · 2:54](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=174)
- "The technique involves exposing the fetal back, re-exposing the spinal cord, identifying the myelomeningocele defect, placing an extracellular matrix patch with placental stem cells facing the spinal cord in direct contact, closing the skin, and returning the baby to the uterus to continue gestation until term." — Christina Theodoro (clinical) [Ep 21 · 3:27](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=207)
- "Lambs repaired with clinical grade placental stem cells have significantly improved motor function compared to lambs that did not receive the stem cells." — Christina Theodoro (clinical) [Ep 21 · 3:54](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=234)
- "Dr. Todd Ponsky states that in utero repair of myelomeningocele has already shown benefit, and impregnating the repair with mesenchymal stromal cells provides an even larger benefit in the chance of ambulation." — Todd Ponsky (clinical) [Ep 21 · 4:08](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=248)
- "The third article is titled 'Current Status of Sub-specialization in Pediatric Surgery, a Focus on fetal Surgery' and surveys practice patterns in fetal surgery across the country." — Rod Gerardo (host_summary) [Ep 21 · 4:37](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=277)
- "The survey included self-identified specialists within the field of fetal surgery, yet only 4% of those people reported receiving formal training in fetal surgery." — Natalie Lopian (epidemiological) [Ep 21 · 5:13](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=313)
- "Many survey respondents reported receiving fetal training during their pediatric surgery fellowship training, yet when the question was posed differently, many responded that they did not have exposure to fetal surgery during fellowship training." — Brittany Levy (host_summary) [Ep 21 · 5:37](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=337)
- "Dr. Paul Tam states that fetal surgery is a frontier for pediatric surgery and the survey provides a reality check on how to develop a treatment which remains rare and often experimental." — Brittany Levy (host_summary) [Ep 21 · 5:54](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=354)
- "Dr. Natalie Lopian suggests it will be interesting to see whether fetal surgery exposure becomes a requirement during training or whether fetal centers become the primary training ground for fetal surgeons as the field expands." — Natalie Lopian (opinion) [Ep 21 · 6:18](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=378)
- "Dr. Todd Ponsky states that disparities in practice patterns are what happens in an emerging field, and it is reasonable to expect different levels of what different hospitals do in fetal surgery." — Todd Ponsky (opinion) [Ep 21 · 6:38](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=398)
- "The study was not designed to link subspecialization of fetal surgery to outcomes and was not designed to provide a clear definition of a fetal surgery center." — Natalie Lopian (clinical) [Ep 21 · 7:26](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=446)
- "Microaggressions are verbal, nonverbal, environmental slights, snubs, invalidations, or insults that send hostile, derogatory, or negative messages to individuals based solely on their marginalized group membership" — Craig Lillehei (clinical) [Ep 22 · 3:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=210)
- "Microaggressions have a cumulative impact causing isolation and self-doubt despite being termed 'micro'" — Craig Lillehei (clinical) [Ep 22 · 4:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=240)
- "Bystanders who do not speak up compound the harm of microaggressions even if they address the issue later" — Craig Lillehei (opinion) [Ep 22 · 4:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=270)
- "In the TOTAL trial for severe CDH, FETO significantly improved survival" — Craig Lillehei (host_summary) [Ep 22 · 10:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=600)
- "In the TOTAL trial for moderate CDH, FETO showed some improvement in survival but did not approach statistical significance" — Craig Lillehei (host_summary) [Ep 22 · 10:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=630)
- "The TOTAL trial was conducted over an 11-year period at multiple centers with variable CDH management protocols" — Craig Lillehei (host_summary) [Ep 22 · 11:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=660)
- "Prematurity and premature rupture of membranes are significant complications of FETO" — Craig Lillehei (clinical) [Ep 22 · 11:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=690)
- "NPO guidelines for children are based on very poor evidence and vary considerably between institutions" (clinical) [Ep 22 · 15:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=900)
- "Pulmonary aspiration is very scary but very rare, usually occurring in emergency surgeries in high-risk children rather than elective procedures" (clinical) [Ep 22 · 15:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=930)
- "Studies suggest clear liquids containing carbohydrates empty the stomach very quickly regardless of age" (host_summary) [Ep 22 · 16:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=960)
- "British and Irish consensus recommends one hour NPO for clear liquids, four hours for breast milk, six hours for solid foods in children under 17" (host_summary) [Ep 22 · 16:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=990)
- "ASA currently recommends two hours for clear liquids, four hours for breast milk, six hours for non-human milk and light meals, eight hours for heavy meals" (host_summary) [Ep 22 · 17:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1020)
- "European Society of Anesthesia recommends one hour for clear liquids, three hours for breast milk, four hours for formula, six hours for everything else" (host_summary) [Ep 22 · 17:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1050)
- "Prolonged NPO periods generate ketone bodies, cause hypoglycemia, and make children irritable preoperatively" (clinical) [Ep 22 · 18:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1080)
- "In C-arm fluoroscopy, the x-ray source is conventionally placed below the table with the image intensifier above" (clinical) [Ep 22 · 25:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1500)
- "Placing radiation shields on top of the patient does nothing to protect them because radiation comes from below the table" (clinical) [Ep 22 · 25:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1530)
- "If a shield is in the fluoroscopy field, automatic brightness control increases x-ray energy to compensate, increasing patient exposure" (clinical) [Ep 22 · 26:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1560)
- "Collimation focuses the x-ray beam to a specific area, increasing detail and clarity while decreasing total patient dose and room exposure" (clinical) [Ep 22 · 27:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1620)
- "Pulse mode fluoroscopy is feasible for most pediatric surgery applications and does not require the temporal resolution of continuous fluoroscopy" (clinical) [Ep 22 · 28:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1680)
- "Using magnification setting on fluoroscopy significantly increases radiation dose to both patient and room" (clinical) [Ep 22 · 28:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1710)
- "In a study of 521 primary lung lesions from 11 children's hospitals, none of the prenatally diagnosed lesions were malignant" (host_summary) [Ep 22 · 40:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2400)
- "Approximately 10% of postnatally diagnosed lung lesions were malignant in the Midwest consortium study" (host_summary) [Ep 22 · 40:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2430)
- "About half of malignant lung lesions were associated with DICER1 mutation" (host_summary) [Ep 22 · 41:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2460)
- "No malignant lung lesion had a systemic feeding vessel in the consortium study" (host_summary) [Ep 22 · 41:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2490)
- "CT scan sensitivity and specificity for detecting pleuropulmonary blastoma was poor, with poor inter-rater reliability among nine radiologists" (host_summary) [Ep 22 · 42:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2520)
- "In a series of approximately 600 patients with prenatal lung lesion diagnosis, the chance of pleuropulmonary blastoma is close to zero" (host_summary) [Ep 22 · 44:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2640)
- "In the IMPACT study, piperacillin-tazobactam had significantly lower postoperative abscess rate, ER visit rate, and postoperative CT scan rate compared to ceftriaxone-metronidazole for perforated appendicitis" (host_summary) [Ep 22 · 48:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2880)
- "A NSQIP study by Sean Rangel of 654 patients showed opposite results, suggesting ceftriaxone-metronidazole were preferred over piperacillin-tazobactam" (host_summary) [Ep 22 · 48:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2910)
- "The IMPACT study was multi-institutional but 75% of patients were at one institution and 25% at another" (host_summary) [Ep 22 · 49:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2940)
- "Mechanical bowel preparation has no effect on surgical site infection rates" — Paul Yzotrak (host_summary) [Ep 22 · 51:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3060)
- "Some data suggests mechanical bowel preparation actually increases surgical site infections" — Paul Yzotrak (host_summary) [Ep 22 · 51:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3090)
- "The strongest data for preventing surgical site infection is appropriate timing of preoperative intravenous antibiotics" — Paul Yzotrak (clinical) [Ep 22 · 52:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3120)
- "The NEST trial showed neurodevelopmental outcomes are improved with laparotomy compared to peritoneal drainage for NEC" — Paul Yzotrak (host_summary) [Ep 22 · 55:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3300)
- "The NEST trial used approximately one kilogram as the cutoff weight for laparotomy" — Paul Yzotrak (host_summary) [Ep 22 · 54:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3240)
- "For NEC survival in the first 24-48 hours, it is unclear whether there is a survival advantage or disadvantage for drain versus laparotomy" (opinion) [Ep 22 · 58:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3480)
- "Prenatal ultrasound at mid-gestation around 20 weeks is the best tool for detecting fetal malformations, with high detection rates in developed countries." — Jose Peiro (clinical) [Ep 23 · 0:47](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=47)
- "Doppler ultrasound can assess fetal hemodynamic status by measuring flows in the umbilical artery, ductus venosus, and middle cerebral artery." — Jose Peiro (clinical) [Ep 23 · 1:27](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=87)
- "Fetal MRI contributes to diagnosis definition after ultrasound, especially for findings in the brain, chest, and abdomen." — Jose Peiro (clinical) [Ep 23 · 1:43](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=103)
- "In gastroschisis, earlier delivery can reduce bowel injury, resulting in less serositis and better recovery." — Jose Peiro (clinical) [Ep 23 · 2:13](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=133)
- "Opening the uterus for fetal surgery produces a scar and can activate uterine contractions; preterm delivery can occur days after surgery despite tocolysis." (host_summary) [Ep 23 · 2:39](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=159)
- "Open fetal surgery is still used for large solid chest masses, sacrococcygeal teratomas, and spina bifida." — Jose Peiro (clinical) [Ep 23 · 3:12](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=192)
- "Solid CPAM lesions grow rapidly and can cause mediastinal shift, compression of the contralateral lung and heart, leading to hydrops fetalis." — Jose Peiro (clinical) [Ep 23 · 3:30](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=210)
- "Hydrops fetalis (ascites, pleural effusion, scalp edema, anasarca) is very close to fetal demise and is the usual outcome if untreated." — Jose Peiro (clinical) [Ep 23 · 3:49](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=229)
- "CVR (CPAM volume ratio) is calculated as (width × height × length × 0.523) divided by head circumference, with a cutoff of 1.6." (host_summary) [Ep 23 · 4:11](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=251)
- "CVR less than 1.6 indicates very low risk of hydrops; CVR greater than 1.6 indicates high risk of hydrops and complications." — Jose Peiro (clinical) [Ep 23 · 4:25](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=265)
- "First-line therapy for high-risk CPAM is maternal intramuscular betamethasone, which can be given in 1, 2, or 3 weekly rounds to decrease CVR." (host_summary) [Ep 23 · 4:36](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=276)
- "Steroids rescue more than half of CPAM cases; the remaining 40% do not respond well." — Jose Peiro (epidemiological) [Ep 23 · 4:53](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=293)
- "Before 30 weeks, cystic CPAM can be treated with a shunt; solid CPAM requires open fetal surgery and lobectomy." — Jose Peiro (clinical) [Ep 23 · 5:01](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=301)
- "Solid sacrococcygeal teratomas are more dangerous than cystic ones due to rapid growth and vascularization visible on Doppler." — Jose Peiro (clinical) [Ep 23 · 5:22](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=322)
- "The Altman classification used postnatally can also be applied to prenatal MRI to determine teratoma type and need for intervention." — Jose Peiro (clinical) [Ep 23 · 5:32](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=332)
- "Open fetal surgery is the gold standard for spina bifida, though other innovations are in development." — Jose Peiro (guideline) [Ep 23 · 5:51](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=351)
- "Postnatal spina bifida repair is required on the first day of life to avoid infections and protect the spinal cord." (host_summary) [Ep 23 · 5:57](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=357)
- "Spina bifida originates at approximately 4 weeks of embryonic time when the neural tube fails to close." — Jose Peiro (clinical) [Ep 23 · 6:04](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=364)
- "In spina bifida, the exposed spinal cord is damaged by contact with amniotic fluid rich in meconium and enzymes (the 'second hit'), progressively destroying neural tissue and nerves." — Jose Peiro (clinical) [Ep 23 · 6:16](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=376)
- "Neonatal spina bifida surgery results in sequelae including fecal incontinence, urinary incontinence, sexual dysfunction, orthopedic abnormalities, motor impairments (potentially requiring wheelchair), and hydrocephalus from brainstem compression." (host_summary) [Ep 23 · 6:51](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=411)
- "At 24 weeks gestation, half of fetuses with spina bifida already have hydrocephalus; 95% will develop it later in pregnancy." (host_summary) [Ep 23 · 7:20](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=440)
- "Hydrocephalus in spina bifida requires ventriculoperitoneal shunting and causes migration disorders and heterotopia." — Jose Peiro (clinical) [Ep 23 · 7:28](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=448)
- "The rationale for fetal spina bifida repair is to prevent amniotic fluid from touching the nerves and to stop CSF leak." — Jose Peiro (clinical) [Ep 23 · 7:51](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=471)
- "The MOMS trial compared prenatal versus postnatal spina bifida surgery using the same closure technique (dura, layers, skin, sometimes patches)." (host_summary) [Ep 23 · 8:04](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=484)
- "MOMS trial results showed prenatal spina bifida surgery reduced shunting need by at least half, improved mental and motor scores, and completely reversed hindbrain herniation in most cases." (host_summary) [Ep 23 · 8:17](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=497)
- "In fetoscopic spina bifida repair, a collagen patch is introduced through the cannula for duroplasty, maintained with one stitch, followed by primary skin closure or patch." — Jose Peiro (clinical) [Ep 23 · 8:34](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=514)
- "Dr. Peiro's fetoscopic approach creates less maternal morbidity and allows vaginal delivery." (host_summary) [Ep 23 · 8:48](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=528)
- "The EXIT procedure is performed at delivery for conditions that can cause neonatal asphyxia or difficult intubation, such as neck masses compressing the trachea, congenital airway obstruction, or severe micrognathia." — Jose Peiro (clinical) [Ep 23 · 8:58](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=538)
- "During EXIT, placental oxygenation can be maintained for 1 to 3 hours, providing a controlled situation without need to rush airway securement." — Jose Peiro (clinical) [Ep 23 · 9:25](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=565)
- "EXIT procedure requires fetal paralysis and anesthesia, maternal monitoring and stability, and inhalational anesthetics for uterine relaxation." (host_summary) [Ep 23 · 9:37](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=577)
- "During EXIT for neck teratomas, if intubation is not possible with rigid instruments or laryngoscopy, partial resection of the teratoma can be performed to identify the trachea and then intubate." — Jose Peiro (clinical) [Ep 23 · 9:48](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=588)
- "Once intubation is achieved during EXIT, the cord is clamped and complete teratoma resection is performed in an adjacent operating room." — Jose Peiro (clinical) [Ep 23 · 10:10](https://qa.library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=610)
- "APSA created a peer support program for pediatric surgeons in 2020." — Lizzie Lee (host_summary) [Ep 25 · 1:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=60)
- "The goal of the APSA peer support program was to support surgeons after traumatic events." — Lizzie Lee (host_summary) [Ep 25 · 1:12](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=72)
- "The most common referral reasons for the peer support program were toxic work environments and adverse events." — Lizzie Lee (host_summary) [Ep 25 · 1:16](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=76)
- "50 surgeons total agreed to receive training on how to be a supporter in the APSA program." — Lizzie Lee (host_summary) [Ep 25 · 1:20](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=80)
- "Over 80% of trained peer supporters were able to use these peer support skills informally with colleagues, partners, and trainees." — Lizzie Lee (host_summary) [Ep 25 · 1:25](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=85)
- "The peer support program shows that this type of support system can work really well to help surgeons heal from traumatic experiences and toxic work environments." — Lizzie Lee (host_summary) [Ep 25 · 1:31](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=91)
- "Tracheomalacia was 5% more common in tracheal occluded infants with CDH, with 4% more cases." — Carlos Colunga (host_summary) [Ep 25 · 2:25](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=145)
- "Tracheomalacia symptoms in FETO-treated CDH infants typically receded within 55 months." — Carlos Colunga (host_summary) [Ep 25 · 2:25](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=145)
- "FETO-treated CDH infants typically showed a larger trachea, which was around 31% wider." — Carlos Colunga (host_summary) [Ep 25 · 2:34](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=154)
- "37% of tracheal occluded CDH cases retained metallic balloon components, although no significant complications were reported." — Carlos Colunga (host_summary) [Ep 25 · 2:34](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=154)
- "While tracheal occlusion is effective in promoting lung growth, it is associated with a higher risk of tracheomalacia, although most cases resolve and do not appear to have long-term effects." — Carlos Colunga (host_summary) [Ep 25 · 2:47](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=167)
- "The IPSO systematic review and meta-analysis gathered 8 retrospective studies with 490 patients comparing image-guided core needle biopsy to surgical biopsy for neuroblastoma." — Cecilia Gigena (host_summary) [Ep 25 · 3:27](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=207)
- "Tissue adequacy and biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups for neuroblastoma." — Cecilia Gigena (host_summary) [Ep 25 · 3:40](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=220)
- "Intraoperative transfusions and complications were higher in the surgical biopsy group compared to image-guided core needle biopsy for neuroblastoma." — Cecilia Gigena (host_summary) [Ep 25 · 3:54](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=234)
- "Image-guided core needle biopsy is safe and effective for diagnosing neuroblastoma." — Cecilia Gigena (host_summary) [Ep 25 · 4:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=240)
- "Myelomeningocele or open spina bifida is a neural tube defect." (host_summary) [Ep 26 · 0:20](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=20)
- "Myelomeningocele is when the spinal cord does not close and is exposed on surface through an opening in the spine." (host_summary) [Ep 26 · 0:25](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=25)
- "Myelomeningocele usually occurs in the low back region." (host_summary) [Ep 26 · 0:31](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=31)
- "The incidence of neural tube defects is around 0.2 per 1000 live births in the United States." (host_summary) [Ep 26 · 0:33](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=33)
- "When diagnosed prenatally, neural tube defects can be repaired during the fetal stage of life while in utero." (host_summary) [Ep 26 · 0:39](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=39)
- "The pregnant patient is placed under general anesthesia and the uterus is approached by a midline laparotomy." (host_summary) [Ep 26 · 0:47](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=47)
- "An ultrasound is used to map the location of the placenta and major vessels on the uterine surface." (host_summary) [Ep 26 · 0:55](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=55)
- "Under ultrasonic guidance, 4 full thickness sutures are placed through the uterine wall to delineate a 1 centimeter square area through which a 10 French trochar is inserted using Seldinger technique." (clinical) [Ep 26 · 1:00](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=60)
- "After removing a portion of the amniotic fluid, the uterus is insufflated with warm, humidified carbon dioxide." (clinical) [Ep 26 · 1:14](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=74)
- "Two subsequent trochars are placed under endoscopic visualization." (host_summary) [Ep 26 · 1:22](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=82)
- "Prior to surgical intervention, the fetus is administered a sedative cocktail of rocuronium, fentanyl, and atropine." (host_summary) [Ep 26 · 1:26](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=86)
- "Dissection of the myelomeningocele begins lateral to the exposed spinal cord, detaching it from the arachnoid and skin." (clinical) [Ep 26 · 1:32](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=92)
- "The spinal cord is circumferentially released, taking care not to injure the ascending spinal cord, lateral dorsal roots, or segmental vasculature." (clinical) [Ep 26 · 1:41](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=101)
- "The surgeon uses tenotomy scissors and right-angled hook electrocautery to sharply dissect through the tissue, which completely frees the placode." (host_summary) [Ep 26 · 1:51](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=111)
- "The neural placode is reconstructed with interrupted 6-0 sutures after it is completely untethered from the skin." (host_summary) [Ep 26 · 1:59](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=119)
- "The dura attaches laterally and ventrally to the open skin edge at the junctional zone." (clinical) [Ep 26 · 2:06](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=126)
- "The lateral extent of the dura is identified and detached." (clinical) [Ep 26 · 2:12](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=132)
- "The dural closure area can be an area of great tension." (host_summary) [Ep 26 · 2:16](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=136)
- "Lateral fascia and muscle may be freed to allow medialization and primary closure of the dura under less tension." (host_summary) [Ep 26 · 2:18](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=138)
- "A running, non-absorbable 6-0 suture is utilized to re-approximate the delicate dura, which will persist long term and act as a useful guide if subsequent untethering is required." (clinical) [Ep 26 · 2:24](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=144)
- "Skin closure should be performed in the mid-sagittal plane when possible." (host_summary) [Ep 26 · 2:37](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=157)
- "Skin closure may require mobilization of the skin, including subcutaneous fat layer, as the skin's vascular supply comes through this layer." (host_summary) [Ep 26 · 2:43](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=163)
- "Blunt dissection in the plane between the muscle and subcutaneous fat is the best method to preserve the blood supply." (host_summary) [Ep 26 · 2:49](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=169)
- "In some cases, the size of the skin defect may prevent primary skin closure." (clinical) [Ep 26 · 2:55](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=175)
- "A synthetic skin graft may be utilized and sutured to the edges of the healthy skin when primary closure is not possible." (clinical) [Ep 26 · 3:00](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=180)
- "The synthetic skin graft will promote eventual epithelialization of the open defect." (clinical) [Ep 26 · 3:07](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=187)
- "After completing the fetal back closure, the amniotic fluid is replaced in the uterus with warmed, lactated Ringer solution." (host_summary) [Ep 26 · 3:12](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=192)
- "The ports are removed and the insertion sites are closed, the uterus is returned to the abdominal cavity and the abdominal incision is closed in the standard fashion." (host_summary) [Ep 26 · 3:19](https://qa.library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=199)
- "FETO is a percutaneous intervention on the mother using one trocar placed through the abdominal wall into the uterus." — Beth Rymeski (clinical) [Ep 29 · 0:33](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=33)
- "A standard fetoscope with a side channel is used, and the balloon is worked through the side channel." — Beth Rymeski (clinical) [Ep 29 · 0:36](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=36)
- "The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow." — Jill Knepprath (host_summary) [Ep 29 · 0:47](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=47)
- "FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies." — Jill Knepprath (host_summary) [Ep 29 · 0:53](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=53)
- "The tongue is an easy landmark to identify during FETO because it is bumpy in appearance." — Beth Rymeski (clinical) [Ep 29 · 1:21](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=81)
- "Fluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement." — Beth Rymeski (clinical) [Ep 29 · 1:29](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=89)
- "If the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth." — Beth Rymeski (clinical) [Ep 29 · 1:38](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=98)
- "The epiglottis is a key landmark to locate when navigating to the trachea." — Beth Rymeski (clinical) [Ep 29 · 1:58](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=118)
- "Excessive torquing of the membranes should be avoided because the scope goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage." — Beth Rymeski (clinical) [Ep 29 · 2:23](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=143)
- "The scope should always be advanced until the carina is visualized, which confirms location in the trachea and not the esophagus." — Beth Rymeski (clinical) [Ep 29 · 2:36](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=156)
- "The balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea." — Beth Rymeski (clinical) [Ep 29 · 2:56](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=176)
- "The scope is backed up as the balloon is inflated so that balloon inflation can be watched." — Beth Rymeski (clinical) [Ep 29 · 3:03](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=183)
- "The balloon is filled with around 0.65 to 0.8 mL of water, depending on the size of the trachea." — Jill Knepprath (host_summary) [Ep 29 · 3:08](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=188)
- "The balloon contains a little metal ball that can be visualized." — Beth Rymeski (clinical) [Ep 29 · 3:29](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=209)
- "Sometimes the trocar advances into the mouth during the procedure and needs to be backed out." — Jill Knepprath (host_summary) [Ep 29 · 3:33](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=213)
- "Final confirmation includes advancing the scope one more time to verify the balloon is below the vocal cords and in the main trachea." — Jill Knepprath (host_summary) [Ep 29 · 3:40](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=220)
- "FETO is a percutaneous intervention on the mother using one trocar placed through the maternal abdominal wall into the uterus." — Beth Rymeski (clinical) [Ep 30 · 0:33](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=33)
- "A standard fetoscope with a side channel is used, and the balloon is worked through the side channel." — Beth Rymeski (clinical) [Ep 30 · 0:36](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=36)
- "The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow." — Jill Knepprath (host_summary) [Ep 30 · 0:47](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=47)
- "FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies." — Jill Knepprath (host_summary) [Ep 30 · 0:53](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=53)
- "The tongue is an easy landmark to identify during FETO because it is bumpy in appearance." — Beth Rymeski (clinical) [Ep 30 · 1:21](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=81)
- "Fluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement." — Beth Rymeski (clinical) [Ep 30 · 1:29](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=89)
- "If the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth." — Beth Rymeski (clinical) [Ep 30 · 1:38](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=98)
- "The epiglottis is a key landmark to identify when navigating toward the trachea." — Beth Rymeski (clinical) [Ep 30 · 1:58](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=118)
- "Excessive torquing of the membranes should be avoided because the trocar goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage." — Beth Rymeski (clinical) [Ep 30 · 2:23](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=143)
- "The scope should always be advanced until the carina is visualized to confirm position in the trachea and determine location within the trachea." — Beth Rymeski (clinical) [Ep 30 · 2:36](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=156)
- "The balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea." — Beth Rymeski (clinical) [Ep 30 · 2:56](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=176)
- "The scope is backed up as the balloon is inflated so that balloon inflation can be watched." — Beth Rymeski (clinical) [Ep 30 · 3:03](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=183)
- "The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea." — Jill Knepprath (host_summary) [Ep 30 · 3:08](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=188)
- "After balloon deployment, the scope is advanced one more time to confirm that the balloon is below the vocal cords and in the main trachea." — Jill Knepprath (host_summary) [Ep 30 · 3:40](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=220)

## Changelog
- Sep 9: Summaries and takeaways published for 4 audiences
- Sep 7: Audit reverted — short clips unhidden
- Aug 31: 33 doctors auto-found from episode dossiers
- Aug 30: 30 doctors auto-found from episode dossiers
- Aug 30: 29 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 37 doctors auto-found from episode dossiers
- Aug 29: 37 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 39 items, 31 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 33 items, 31 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 33 items, 31 dossiers, summaries for 3 audience(s)

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Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://qa.library.globalcastmd.com/ai