# Foundations of Minimally Invasive & Endoscopic Surgery — GCMD Library living collection

Updated: n/a · 27 episodes · 451 cited statements

## Episodes
### History & Pioneers of Endoscopic Surgery
- [Endoscopy and Surgery](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720) — video · 11:29 · [machine version](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720.md)
- [Special Lecture:  Dr. Jeffrey Ponsky | St. George's University](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726) — video · 45:44 · [machine version](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726.md)
- [ACS Icons in Surgery | Jeffrey L. Ponsky, MD, FACS](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682) — video · 20:00 · [machine version](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682.md)
- [Meet the Master: Jeffrey L. Ponsky, MD, FACS](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683) — video · 1:05:06 · [machine version](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683.md)
- [SAGES Stories Episode 11 – Jeff Ponsky, MD](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684) — video · 1:01:24 · [machine version](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684.md)
- [Residency Advice:  Dr. Jeffrey Ponsky | St. George's University](https://qa.library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685) — video · 2:20 · [machine version](https://qa.library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685.md)
- [Jeffrey L. Ponsky, MD, FACS](https://qa.library.globalcastmd.com/article/jeffrey-l-ponsky-md-facs-13688) — article · [machine version](https://qa.library.globalcastmd.com/article/jeffrey-l-ponsky-md-facs-13688.md)
- [Jeffrey Ponsky: Portrait of a SAGES Pioneer](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723) — video · 50:04 · [machine version](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723.md)
- [Jeffrey L. Ponsky Master Educator in Endoscopy](https://qa.library.globalcastmd.com/watch/jeffrey-l-ponsky-master-educator-in-endoscopy-13735) — video · [machine version](https://qa.library.globalcastmd.com/watch/jeffrey-l-ponsky-master-educator-in-endoscopy-13735.md)
- [SAGES/ALACE Symposium: Integrating New Technologies, Old Tricks, and Operative Approaches](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727) — video · 12:32 · [machine version](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727.md)

### Innovations & Surgical Entrepreneurship
- [From Idea to Ubiquity - the PEG Journey](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719) — video · 27:18 · [machine version](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719.md)
- [Ponsky and Gauderer invent the PEG tube](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724) — video · 7:03 · [machine version](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724.md)
- [Lessons learned from the introduction of a new endoscopic procedure: PEG](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725) — video · 14:32 · [machine version](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725.md)
- [Innovations in Surgery: PEG Tube](https://qa.library.globalcastmd.com/watch/innovations-in-surgery-peg-tube-13737) — podcast · [machine version](https://qa.library.globalcastmd.com/watch/innovations-in-surgery-peg-tube-13737.md)
- [From Idea to Ubiquity](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-13731) — video · [machine version](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-13731.md)

### Advanced Endoscopic Techniques
- [International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video)](https://qa.library.globalcastmd.com/article/international-multicenter-experience-with-peroral-endoscopic-myotomy-for-the-tre-13693) — article · [machine version](https://qa.library.globalcastmd.com/article/international-multicenter-experience-with-peroral-endoscopic-myotomy-for-the-tre-13693.md)
- [Peroral endoscopic myotomy (POEM) leads to similar results in patients with and without prior endoscopic or surgical therapy](https://qa.library.globalcastmd.com/article/peroral-endoscopic-myotomy-leads-to-similar-results-in-patients-with-and-without-13694) — article · [machine version](https://qa.library.globalcastmd.com/article/peroral-endoscopic-myotomy-leads-to-similar-results-in-patients-with-and-without-13694.md)
- [Retrograde myotomy: a variation in per oral endoscopic myotomy (POEM) technique](https://qa.library.globalcastmd.com/article/retrograde-myotomy-a-variation-in-per-oral-endoscopic-myotomy-technique-13695) — article · [machine version](https://qa.library.globalcastmd.com/article/retrograde-myotomy-a-variation-in-per-oral-endoscopic-myotomy-technique-13695.md)
- [How i do it: per-oral endoscopic myotomy (POEM)](https://qa.library.globalcastmd.com/article/how-i-do-it-per-oral-endoscopic-myotomy-13696) — article · [machine version](https://qa.library.globalcastmd.com/article/how-i-do-it-per-oral-endoscopic-myotomy-13696.md)
- [POEM by Surgeons – Dr. Jeffrey Ponsky](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722) — video · 20:52 · [machine version](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722.md)
- [Comparison of anterior transgastric access techniques for natural orifice translumenal endoscopic surgery](https://qa.library.globalcastmd.com/article/comparison-of-anterior-transgastric-access-techniques-for-natural-orifice-transl-13697) — article · [machine version](https://qa.library.globalcastmd.com/article/comparison-of-anterior-transgastric-access-techniques-for-natural-orifice-transl-13697.md)
- [Current status of natural orifice translumenal endoscopic surgery (NOTES)](https://qa.library.globalcastmd.com/article/current-status-of-natural-orifice-translumenal-endoscopic-surgery-13698) — article · [machine version](https://qa.library.globalcastmd.com/article/current-status-of-natural-orifice-translumenal-endoscopic-surgery-13698.md)
- [Transgastric natural-orifice transluminal endoscopic surgery peritoneoscopy in humans: a pilot study in efficacy and gastrotomy site selection by using a hybrid technique](https://qa.library.globalcastmd.com/article/transgastric-natural-orifice-transluminal-endoscopic-surgery-peritoneoscopy-in-h-13699) — article · [machine version](https://qa.library.globalcastmd.com/article/transgastric-natural-orifice-transluminal-endoscopic-surgery-peritoneoscopy-in-h-13699.md)
- [Intramural Surgery: A New Vista in Minimally Invasive Therapy](https://qa.library.globalcastmd.com/article/intramural-surgery-a-new-vista-in-minimally-invasive-therapy-13692) — article · [machine version](https://qa.library.globalcastmd.com/article/intramural-surgery-a-new-vista-in-minimally-invasive-therapy-13692.md)
- [Overview of Single Incision Surgery Tool Box and Technique: Jeffrey Ponsky, M.D.](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728) — video · 13:37 · [machine version](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728.md)

### General Endoscopy Education
- [Endoscopy, An Issue of Surgical Clinics, E-Book](https://qa.library.globalcastmd.com/article/endoscopy-an-issue-of-surgical-clinics-e-book-13717) — article · [machine version](https://qa.library.globalcastmd.com/article/endoscopy-an-issue-of-surgical-clinics-e-book-13717.md)
- [All About Advanced Surgical Endoscopy](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744) — podcast · 14:45 · [machine version](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744.md)

## Chapters
- [0:12](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=12) Early Life and Path to Surgery (Ep 3)
- [4:36](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=276) Residency and Discovery of Endoscopy (Ep 3)
- [7:51](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=471) Establishing Surgical Endoscopy Practice (Ep 3)
- [10:02](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=602) SAGES and American Board of Surgery Leadership (Ep 3)
- [13:54](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=834) Mentorship and Legacy (Ep 3)
- [18:16](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=1096) Personal Interests and Surgical Philosophy (Ep 3)
- [0:00](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=0) Introduction and Early Life (Ep 5)
- [6:35](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=395) Medical School and Surgical Training (Ep 5)
- [18:02](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1082) Mentors and Early Career Development (Ep 5)
- [31:50](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1910) Career Transitions and ERCP Expertise (Ep 5)
- [44:30](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2670) SAGES History and Surgical Endoscopy (Ep 5)
- [51:10](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=3070) Work-Life Balance and Legacy (Ep 5)
- [0:04](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=4) Introduction of Dr. Jeffrey Ponsky (Ep 11)
- [5:18](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=318) Origin of the PEG concept and initial development (Ep 11)
- [10:00](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=600) Technical evolution and tube variations (Ep 11)
- [14:28](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=868) Replacement devices and skin-level innovations (Ep 11)
- [17:33](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1053) Complications and their management (Ep 11)
- [22:47](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1367) Patient selection and creative applications (Ep 11)
- [0:06](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=6) History of Surgeons in Endoscopy: From Fiber Optics to Therapeutic Innovation (Ep 1)
- [3:39](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=219) Modern Integration of Endoscopy into Surgical Practice (Ep 1)
- [6:05](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=365) Advanced Therapeutic Endoscopic Techniques and Collaboration (Ep 1)
- [8:48](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=528) Future Vision: Transmural Surgery and Robotic Integration (Ep 1)
- [0:13](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=13) Introduction to POEM and the case for surgeons learning endoscopic myotomy (Ep 20)
- [3:09](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=189) POEM technique demonstration and procedural details (Ep 20)
- [6:11](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=371) POEM clinical outcomes and comparison to Heller myotomy (Ep 20)
- [9:50](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=590) POP (peroral pyloromyotomy) for gastroparesis (Ep 20)
- [13:23](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=803) STEER for esophageal leiomyomas (Ep 20)
- [14:39](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=879) Endoscopic cricopharyngeal myotomy for Zenker's diverticulum (Ep 20)
- [19:28](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=1168) Conclusion: intramural surgery as a surgical domain (Ep 20)
- [0:08](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=8) Introduction and Early Background (Ep 4)
- [3:38](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=218) Entry into Endoscopy and Institutional Resistance (Ep 4)
- [10:40](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=640) Development of PEG Procedure (Ep 4)
- [16:56](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1016) PEG Innovation and Concept Extension (Ep 4)
- [22:07](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1327) Academic Career at Mount Sinai (Ep 4)
- [27:54](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1674) Leadership in ASGE and SAGES (Ep 4)
- [34:49](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2089) NOTES and Noscar Consortium (Ep 4)
- [40:00](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2400) American Board of Surgery Leadership (Ep 4)
- [44:25](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2665) Cleveland Clinic and Return to Case Western (Ep 4)
- [53:24](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3204) Intramural Surgery and Current Practice (Ep 4)
- [60:40](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3640) Career Advice and Life Philosophy (Ep 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Basil Morrison in England was marking the tips of polyps with India ink to track polyp behavior over time. — Jeffrey L. Ponsky (clinical) [Ep 3 · 6:47](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=407)
- Endoscopic marking of colonic lesions with India ink was developed in 1975 to enable surgeons to locate polypectomy sites when pathology revealed cancer. — Jeffrey L. Ponsky (clinical) [Ep 3 · 7:01](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=421)
- India ink tattooing remains useful in the laparoscopic era when surgeons cannot palpate the colon to locate lesion sites. — Jeffrey L. Ponsky (clinical) [Ep 3 · 7:28](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=448)
- The first endoscope cost $5,200 in 1974. — Jeffrey L. Ponsky (clinical) [Ep 3 · 8:02](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=482)
- In the mid-1970s, endoscopes were cleaned with green soap before use. — Jeffrey L. Ponsky (clinical) [Ep 3 · 8:48](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=528)
- Transillumination of the abdominal wall during pediatric endoscopy, where the endoscope light shone through the belly and finger indentation was visible, led to development of the PEG procedure. — Jeffrey L. Ponsky (clinical) [Ep 3 · 9:01](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=541)
- Jacques Perrisat presented a video on laparoscopic cholecystectomy at a SAGES meeting in Louisville, Kentucky in 1989. — Jeffrey L. Ponsky (clinical) [Ep 3 · 10:44](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=644)
- The American Board of Surgery asked SAGES to nominate three members for a board director position representing minimally invasive surgery. — Jeffrey L. Ponsky (clinical) [Ep 3 · 12:01](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=721)
- Ponsky contributed to the American Board of Surgery by developing educational components for minimally invasive surgery, creating examination questions, and establishing endoscopy training requirements for surgical residents. — Jeffrey L. Ponsky (clinical) [Ep 3 · 12:42](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=762)
- The endoscope should be conceptualized as a vehicle like a car or bus that transports surgeons to operative sites rather than primarily as a tool for mucosal inspection. — Jeffrey L. Ponsky (opinion) [Ep 3 · 19:23](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=1163)
- Surgeons use the endoscope as a vehicle to reach sites for operations including POEM, POP, Zenker's procedures, and NOTES. — Jeffrey L. Ponsky (clinical) [Ep 3 · 19:38](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=1178)
- Ponsky graduated high school with a 2.027 GPA and his college counselor recommended trade school instead of college. — Jeffrey Ponsky (clinical) [Ep 5 · 6:53](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=413)
- Ponsky's father sold used tires for a living and the family had no money for college. — Jeffrey Ponsky (clinical) [Ep 5 · 8:26](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=506)
- Ponsky attended Miami University of Ohio on loans and scholarships, studying by memorizing everything and taking copious notes. — Jeffrey Ponsky (clinical) [Ep 5 · 9:01](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=541)
- Ponsky worked as an orderly at Mount Sinai Hospital during his first college summer, giving bed baths and changing bedpans, which increased his commitment to medicine. — Jeffrey Ponsky (clinical) [Ep 5 · 10:56](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=656)
- Ponsky was promoted to scrub tech the following summer and was allowed to close fascia, despite the head nurse objecting. — Jeffrey Ponsky (clinical) [Ep 5 · 12:10](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=730)
- Ponsky chose Case Western Reserve medical school partly because he had to live at home due to financial constraints. — Jeffrey Ponsky (clinical) [Ep 5 · 14:14](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=854)
- Case Western Reserve had a 'new curriculum' with pass/fail grading (pass, fail, and honors) rather than letter grades during Ponsky's time. — Jeffrey Ponsky (clinical) [Ep 5 · 14:48](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=888)
- Ponsky received honors in every medical school clerkship including psychiatry, internal medicine, cardiology, OBGYN, and surgery. — Jeffrey Ponsky (clinical) [Ep 5 · 17:11](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1031)
- Bill Holden, chairman of surgery at Case Western, was an elegant teacher who used the Socratic method, though not the greatest technician. — Jeffrey Ponsky (opinion) [Ep 5 · 19:43](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1183)
- Walter Pore taught using showmanship, including having students perform pinch grafts at bedside by injecting local anesthetic, cutting postage-stamp-sized skin pieces, and placing them on scraped bedsores. — Jeffrey Ponsky (clinical) [Ep 5 · 20:14](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1214)
- Walter Pore made Ponsky rewrite his first paper (a letter to the New England Journal about paradoxical air embolism) six times and read German poetry to teach more poetic writing. — Jeffrey Ponsky (clinical) [Ep 5 · 22:33](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1353)
- During residency, residents worked 36 hours on, 12 hours off, every other night. — Jeffrey Ponsky (clinical) [Ep 5 · 25:08](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1508)
- The head of GI at University Hospitals refused to train surgeons in endoscopy, telling Ponsky 'we're not training any surgeons, just forget it.' — Jeffrey Ponsky (clinical) [Ep 5 · 25:29](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1529)
- Ponsky trained in endoscopy with Jim King in Canton, Ohio, performing about 500 cases over 5-6 months using a mid-length colonoscope not designed to reach the cecum. — Jeffrey Ponsky (clinical) [Ep 5 · 25:47](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1547)
- Ponsky's mother-in-law purchased his first colonoscope as a Hanukkah present after hearing he couldn't use the hospital's scope. — Jeffrey Ponsky (clinical) [Ep 5 · 26:51](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1611)
- In the early days of endoscopy, scopes were washed with green soap (no high-level disinfection) and Ponsky kept his scope and light source in the back of his car. — Jeffrey Ponsky (clinical) [Ep 5 · 26:57](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1617)
- By the end of Ponsky's senior residency year, he was performing all endoscopy cases at University Hospitals while the GI physicians were not doing cases. — Jeffrey Ponsky (clinical) [Ep 5 · 27:19](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1639)
- Bill Holden provided Ponsky with grant money to purchase an ERCP scope instead of repaying his mother-in-law for the colonoscope. — Jeffrey Ponsky (clinical) [Ep 5 · 27:31](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1651)
- SAGES was founded around 1980-1981 with approximately 300 members when Ponsky became president in 1990. — Jeffrey Ponsky (clinical) [Ep 5 · 28:12](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1692)
- Jacques Perissat showed a video of laparoscopic cholecystectomy in the exhibit hall at the SAGES meeting in Louisville, Kentucky. — Jeffrey Ponsky (clinical) [Ep 5 · 28:48](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1728)
- When laparoscopic cholecystectomy began, instruments couldn't be purchased and surgeons used GYN instruments. — Jeffrey Ponsky (clinical) [Ep 5 · 29:04](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1744)
- Ponsky took one of the first laparoscopic cholecystectomy courses taught by Nat Soper, George Bercy, John Hunter, and John Sackier in Salt Lake City. — Jeffrey Ponsky (clinical) [Ep 5 · 29:10](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1750)
- Ponsky's first laparoscopic cholecystectomy patient was a member of the Mount Sinai board of trustees, with David Dupper (who had done 8 cases) serving as proctor. — Jeffrey Ponsky (clinical) [Ep 5 · 29:27](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1767)
- Ponsky joined the University Hospitals staff as chief of surgical endoscopy at age 29. — Jeffrey Ponsky (clinical) [Ep 5 · 30:31](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1831)
- Ponsky performed endoscopy on newborn babies because there was no pediatric gastroenterologist, with Bob Ezan (head of pediatric surgery) as his supporter. — Jeffrey Ponsky (clinical) [Ep 5 · 30:56](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1856)
- Ponsky and Mike Gower developed the PEG (percutaneous endoscopic gastrostomy) technique in May 1979, performing it on 5 babies with birth asphyxia and psychomotor retardation, without IRB approval but with family consent. — Jeffrey Ponsky (clinical) [Ep 5 · 31:11](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1871)
- Ponsky became chief of surgery at Mount Sinai at age 32. — Jeffrey Ponsky (clinical) [Ep 5 · 31:50](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1910)
- Mount Sinai Hospital was Ponsky's favorite workplace, a small hospital where every staff member knew each other, with an animal laboratory larger than the Cleveland Clinic's. — Jeffrey Ponsky (opinion) [Ep 5 · 32:44](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1964)
- Mount Sinai was sold to a for-profit company after 18 years, and Ponsky left because the new owners 'could care less about quality.' — Jeffrey Ponsky (opinion) [Ep 5 · 33:33](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2013)
- Mike Henderson recruited Ponsky to Cleveland Clinic to be head of surgical endoscopy, and Ponsky became the first head of minimally invasive surgery there. — Jeffrey Ponsky (clinical) [Ep 5 · 33:47](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2027)
- Ponsky had been president of both SAGES and ASGE before joining Cleveland Clinic. — Jeffrey Ponsky (clinical) [Ep 5 · 34:02](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2042)
- All but one of Ponsky's children were born before he finished residency; his last son was born during his final residency year and his daughter 3 years later. — Jeffrey Ponsky (clinical) [Ep 5 · 34:21](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2061)
- Ponsky's wife had no partners helping her while he was on call every other night during residency. — Jeffrey Ponsky (clinical) [Ep 5 · 34:43](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2083)
- Ponsky believes success requires a good partner and that his family's support was essential, making it a joint success rather than individual achievement. — Jeffrey Ponsky (opinion) [Ep 5 · 34:49](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2089)
- Ponsky's parents saw his greatest achievement as becoming chief of surgery at Mount Sinai Hospital, which was meaningful in the Jewish community, rather than his academic positions. — Jeffrey Ponsky (opinion) [Ep 5 · 36:10](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2170)
- Ponsky has two sons who are surgeons, one son who is a real estate developer, and a daughter who is a professional photographer. — Jeffrey Ponsky (clinical) [Ep 5 · 37:07](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2227)
- During ERCP procedures, Ponsky would kick, headbutt, or nudge his fellows when his hands were busy; one fellow wore shoulder pads in response. — Jeffrey Ponsky (clinical) [Ep 5 · 38:06](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2286)
- Ponsky counseled fellows to choose job opportunities based on overall life factors (family location, better academic opportunities, institutional need) rather than just institutional prestige, sometimes advising them away from his own institution. — Jeffrey Ponsky (opinion) [Ep 5 · 38:47](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2327)
- Ponsky performed distal splenorenal shunts early in his career with Jerry Walkoff's assistance, believing it was 'the greatest thing since sliced bread' based on Dean Warren's physiologic approach to reduce variceal pressure without decreasing portal flow. — Jeffrey Ponsky (clinical) [Ep 5 · 40:27](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2427)
- Distal splenorenal shunts became obsolete after a couple of years when rubber band ligation of varices was introduced. — Jeffrey Ponsky (clinical) [Ep 5 · 40:56](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2456)
- Ponsky performed 180 vertical banded gastroplasties in one year in the mid-1980s, believing it would be a great bariatric operation, but these later required reversal. — Jeffrey Ponsky (clinical) [Ep 5 · 41:05](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2465)
- Ponsky predicts that in 20 years, colonoscopy for screening may become obsolete, noting he performed 1600 colonoscopies in the previous year. — Jeffrey Ponsky (opinion) [Ep 5 · 41:34](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2494)
- ERCP is Ponsky's favorite operation, which he compares to golf and would come in day or night to perform. — Jeffrey Ponsky (opinion) [Ep 5 · 42:07](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2527)
- In Ponsky's last few years at Cleveland Clinic, he didn't have fellows learning ERCP and only performed cases when young gastroenterologists requested help or coverage. — Jeffrey Ponsky (clinical) [Ep 5 · 42:27](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2547)
- The first ERCP was performed by surgeons at George Washington Hospital, but the procedure was really developed in Japan by Itaru Oi and others, with contributions from Germans and Peter Cotton's group in London. — Jeffrey Ponsky (clinical) [Ep 5 · 43:09](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2589)
- Ponsky learned ERCP by watching videos and made a deal with George Brodmerkel (a gastroenterologist in Pittsburgh): Ponsky taught him laparoscopy under local anesthesia for liver biopsy, and Brodmerkel taught Ponsky sphincterotomy. — Jeffrey Ponsky (clinical) [Ep 5 · 43:40](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2620)
- Hospital administrators encouraged Ponsky to get an MBA, saying he made decisions 'out of his gut' without knowing return on investment or financing, and they paid for the degree. — Jeffrey Ponsky (clinical) [Ep 5 · 44:54](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2694)
- The business school dean told Ponsky's MBA class: 'you won't be a good businessman when you finish this, but you'll be able to sit in a business meeting and say bullshit at the right time.' — Jeffrey Ponsky (clinical) [Ep 5 · 45:22](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2722)
- Ponsky states he hates business and isn't interested in his children's investments and startups, preferring horses and physical work. — Jeffrey Ponsky (opinion) [Ep 5 · 45:36](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2736)
- The most important aspect of business school is the people you meet and learning their thought process and approach to problems, not the business content itself. — Jeffrey Ponsky (opinion) [Ep 5 · 46:18](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2778)
- Ponsky was on the ASGE governing board when SAGES started and initially felt 'like a traitor to ASGE' because surgeons were starting their own society. — Jeffrey Ponsky (opinion) [Ep 5 · 47:50](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2870)
- At an early SAGES meeting at the Legionnaires Hotel in Pennsylvania, Ponsky realized SAGES papers addressed surgically-specific problems (endoscopy in bowel obstruction, suture line evaluation, volvulus management) that differed from ASGE content. — Jeffrey Ponsky (clinical) [Ep 5 · 48:15](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2895)
- SAGES founders included upper GI surgeons, colorectal surgeons (Ted Schrock, Jerry Marks, Lee Smith), foregut surgeons, and general surgeons from different areas. — Jeffrey Ponsky (clinical) [Ep 5 · 49:01](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2941)
- When laparoscopy emerged, SAGES gained members who weren't involved with flexible endoscopy; today most SAGES members are laparoscopy/minimally invasive surgeons rather than flexible endoscopists. — Jeffrey Ponsky (clinical) [Ep 5 · 49:30](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2970)
- Ponsky advocated to the residency review committee (when Joe Fisher was head) for a minimum endoscopy requirement; the 50-case requirement was initially hated but established endoscopy as part of general surgery training. — Jeffrey Ponsky (clinical) [Ep 5 · 50:09](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=3009)
- Ponsky advises always volunteering, never saying no, and getting involved in everything, stating 'you'll find the time' and don't have to do everything yourself—residents can help with papers. — Jeffrey Ponsky (opinion) [Ep 5 · 51:55](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=3115)
- Ponsky's wife traveled with him to most meetings; if he went to Paris she was there, but she didn't go to Cincinnati. — Jeffrey Ponsky (clinical) [Ep 5 · 52:42](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=3162)
- Ponsky maintains hobbies including a barn with horses, physical work (mucking stalls, fixing things, inventing watering systems), and has friends outside surgery who don't know what he does for a living. — Jeffrey Ponsky (clinical) [Ep 5 · 54:31](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=3271)
- Ponsky's wife gave him a Harley trike (three-wheeled motorcycle) when he was 70; she would not allow a two-wheel motorcycle. They have ridden to Sturgis, South Dakota. — Jeffrey Ponsky (clinical) [Ep 5 · 55:22](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=3322)
- Ponsky has never been tempted to move from Cleveland because his entire family lives there: his son Zach built a house on 5 acres next to Ponsky's 8 acres, his daughter bought a house 2 houses down with 5 acres, Todd lives within half a mile, and his other son Lee lives 2 miles away. — Jeffrey Ponsky (clinical) [Ep 5 · 56:00](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=3360)
- Ponsky has owned a house in Florida for 13 years and would fly there Friday morning at 6 AM, return Monday, taking vacation days for those two days to have weekends in Florida while working full-time. — Jeffrey Ponsky (clinical) [Ep 5 · 57:22](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=3442)
- Ponsky states his family wants to be near his wife Jackie, not him, unless something breaks; she is 'the glue that holds our family together.' — Jeffrey Ponsky (opinion) [Ep 5 · 58:08](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=3488)
- Ponsky's favorite SAGES memories include his presidential addresses, the people he met (Barbara Bercy, Sally, Colleen, Shelly), friends like George Bercy and Jerry Marks, singing 'We Are the Sages' with the Japanese delegation (which brings him to tears), and performing 'Anything You Can Do' with his son Todd at song fest. — Jeffrey Ponsky (opinion) [Ep 5 · 59:19](https://qa.library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=3559)
- PEG was developed in 1979 by Jeffrey Ponsky and Michael Gauder working as equal partners, with Gauder contributing conceptual ideas and Ponsky contributing technical ideas. — Jeffrey Ponsky (clinical) [Ep 11 · 6:40](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=400)
- During pediatric endoscopy with room lights off, transillumination clearly showed the stomach in contact with the abdominal wall, which was the key observation leading to PEG development. — Jeffrey Ponsky (clinical) [Ep 11 · 7:15](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=435)
- Original indications for PEG were limited to CNS impairment, oropharyngeal tumors, and gastric atony. — Jeffrey Ponsky (clinical) [Ep 11 · 7:56](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=476)
- Within one year of publication, multiple other groups independently developed alternative PEG techniques because endoscopy and percutaneous techniques were evolving simultaneously. — Jeffrey Ponsky (clinical) [Ep 11 · 8:45](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=525)
- Ponsky approached Olympus, Ethicon, and Ross Laboratories asking them to manufacture the PEG device rather than seeking patent protection. — Jeffrey Ponsky (opinion) [Ep 11 · 9:32](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=572)
- The original PEG technique used a medicut IV catheter (without hub) as the puncture device and a snare to grasp the wire, after initial unsuccessful attempts using biopsy forceps. — Jeffrey Ponsky (clinical) [Ep 11 · 10:07](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=607)
- PEG-J (percutaneous endoscopic jejunostomy) was created by tunneling a Dobhoff tube alongside the G-tube to allow distal feeding while decompressing the stomach, published in 1984. — Jeffrey Ponsky (clinical) [Ep 11 · 10:49](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=649)
- PEG-J tubes cause significant long-term patient problems despite continued use at the request of internists. — Jeffrey Ponsky (opinion) [Ep 11 · 11:17](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=677)
- Direct jejunostomy involves advancing the endoscope further and puncturing the jejunum where indentation is visible. — Jeffrey Ponsky (clinical) [Ep 11 · 12:07](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=727)
- Ponsky negotiated a 3% of gross sales royalty with Marlin Junker of US Endoscopy for the silicone tube design, which continued for over 20 years and provided sufficient income for housing, vehicles, and children's college education. — Jeffrey Ponsky (opinion) [Ep 11 · 12:51](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=771)
- When a product lacks patent protection, competitors entering the market increase primary demand, and the originator with the best product can capture large market share. — Jeffrey Ponsky (opinion) [Ep 11 · 13:34](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=814)
- The basic PEG tube design has not changed in 38 years because manufacturers make small margins on each tube and see no business incentive to redesign it despite clinical need for improvement. — Jeffrey Ponsky (opinion) [Ep 11 · 13:52](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=832)
- Approximately 250,000 PEG procedures are performed annually in the United States. — Jeffrey Ponsky (epidemiological) [Ep 11 · 14:13](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=853)
- The original PEG tube was constructed from a DePezzer catheter with the end stuffed into a medicut catheter after placing a suture; stretching the tubing made it narrow enough to fit into the catheter. — Jeffrey Ponsky (clinical) [Ep 11 · 14:39](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=879)
- Bunsen burner tubing was cut and used as the external bolster on the original PEG device. — Jeffrey Ponsky (clinical) [Ep 11 · 15:05](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=905)
- Michael Gauder designed a one-step button device with a rip cord that peels away to create a skin-level device, but it never became mainstream for initial placement. — Jeffrey Ponsky (clinical) [Ep 11 · 15:24](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=924)
- Balloon catheters (Foley-type) are suitable for overnight use to maintain tract patency but do not work well long-term as PEG replacements. — Jeffrey Ponsky (clinical) [Ep 11 · 16:26](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=986)
- Gauder's Genie device allowed conversion of an existing PEG to a skin-level device by cutting the external portion and inserting a plastic valve, but it never achieved commercial success and is likely no longer sold. — Jeffrey Ponsky (clinical) [Ep 11 · 16:44](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1004)
- Mickey buttons and similar balloon-based skin-level devices have low complication rates and are widely available in multiple sizes, creating a substantial replacement device market. — Jeffrey Ponsky (clinical) [Ep 11 · 17:15](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1035)
- Wound infections from PEG placement were eliminated by using a single preoperative dose of antibiotic. — Jeffrey Ponsky (clinical) [Ep 11 · 17:41](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1061)
- Excessive tension on the external bolster can cause PEG tube erosion through the abdominal wall; tubes should not be placed under tension. — Jeffrey Ponsky (clinical) [Ep 11 · 18:00](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1080)
- PEG tubes can inadvertently pass through the colon; if they have been in place for an extended period, they can sometimes be removed with spontaneous closure of the colonic defect. — Jeffrey Ponsky (clinical) [Ep 11 · 18:22](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1102)
- During direct jejunostomy, aspiration during needle advancement does not guarantee avoidance of mesenteric injury; the needle can pass through the mesentery of the colon before entering the small bowel. — Jeffrey Ponsky (clinical) [Ep 11 · 18:42](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1122)
- Direct jejunostomy procedures have a higher complication rate than standard PEG placement. — Jeffrey Ponsky (clinical) [Ep 11 · 19:03](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1143)
- When changing a PEG tube, the stomach can be pushed away from the abdominal wall, creating a complication. — Jeffrey Ponsky (clinical) [Ep 11 · 19:15](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1155)
- Ponsky and Jeff Marks published the first human NOTES (natural orifice transluminal endoscopic surgery) procedure in the United States using a displaced PEG tract to access the peritoneal cavity. — Jeffrey Ponsky (clinical) [Ep 11 · 19:51](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1191)
- PEG tube deterioration is thought to be caused by lipases rather than gastric acid. — Jeffrey Ponsky (clinical) [Ep 11 · 22:49](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1369)
- Enterostomal therapists are needed to manage complications of PEG tube leakage and peristomal skin breakdown. — Jeffrey Ponsky (clinical) [Ep 11 · 23:00](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1380)
- Clinicians should decline PEG placement in patients with multi-system organ failure, massive ascites, and limited life expectancy. — Jeffrey Ponsky (opinion) [Ep 11 · 24:16](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1456)
- The peritoneal cavity extends above the rib cage endoscopically, allowing PEG placement between ribs when the abdomen is frozen or inaccessible. — Jeffrey Ponsky (clinical) [Ep 11 · 25:03](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1503)
- Percutaneous endoscopic cecostomy can be used for colonic decompression. — Jeffrey Ponsky (clinical) [Ep 11 · 25:38](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1538)
- Dual-site colonic fixation using PEG technique successfully detorsed sigmoid volvulus in a patient who could not undergo anesthesia; tubes were removed six weeks later with the colon remaining fixed in place, avoiding surgery. — Jeffrey Ponsky (clinical) [Ep 11 · 25:50](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1550)
- PEG ports can be used for transgastric surgery, with two PEG sites providing instrument access and a gastroscope providing visualization. — Jeffrey Ponsky (clinical) [Ep 11 · 26:15](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1575)
- Ponsky and Michel Gagné performed intragastric surgery using PEG access to remove a submucosal tumor at the esophagogastric junction. — Jeffrey Ponsky (clinical) [Ep 11 · 26:30](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1590)
- The fundamental innovation of PEG is fixation of a hollow viscus to the abdominal wall with creation of access to that viscus, a principle that cannot be patented as a procedure. — Jeffrey Ponsky (opinion) [Ep 11 · 26:42](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=1602)
- Modern endoscopy began with Basil Hersowitz in the late 1950s when he integrated flexible fiber-optic technology using fiber-optic cables to produce endoscopic instruments which could go through the mouth or rectum to produce images. — Jeff Ponsky (clinical) [Ep 1 · 0:59](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=59)
- Surgeons and gastroenterologists were involved in endoscopy from the very beginning, with Hersowitz using the technology to examine the upper GI tract first, then the lower. — Jeff Ponsky (clinical) [Ep 1 · 1:29](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=89)
- Gastroenterologists such as Gene Oberholt and Jerry Way were involved in the beginning using the scope to develop diagnostic applications of endoscopy. — Jeff Ponsky (clinical) [Ep 1 · 1:50](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=110)
- Surgeons saw the therapeutic applications of endoscopy and developed procedures including polypectomy using electrocautery (Hiromi Shia and Bill Wolf in New York). — Jeff Ponsky (clinical) [Ep 1 · 2:08](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=128)
- Greg Stigman from Colorado applied the principle of banding hemorrhoids in the rectum to variceal banding in the esophagus. — Jeff Ponsky (clinical) [Ep 1 · 2:37](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=157)
- Michael Godard and Jeff Ponsky applied surgical principles of percutaneous techniques to place feeding tubes using the endoscope to guide the procedure. — Jeff Ponsky (clinical) [Ep 1 · 2:50](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=170)
- In Germany, Nipsa Hendra, a surgeon, developed the first stenting of the bile duct. — Jeff Ponsky (clinical) [Ep 1 · 3:20](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=200)
- Surgeons have been involved in the advances in endoscopy, particularly the therapeutic advances. — Jeff Ponsky (opinion) [Ep 1 · 3:31](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=211)
- Modern bariatric and gastrointestinal surgeons use endoscopy to look at their anastomosis and test their anastomosis after they've done it. — Jeff Ponsky (clinical) [Ep 1 · 4:30](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=270)
- Surgeons use endoscopy to stent leaks or perform therapeutic stenting of strictures. — Jeff Ponsky (clinical) [Ep 1 · 4:42](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=282)
- Endoscopy for surgeons today is a technique they use to augment their surgical procedures. — Jeff Ponsky (opinion) [Ep 1 · 4:51](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=291)
- Not all surgeons perform ERCP. — Jeff Ponsky (clinical) [Ep 1 · 5:07](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=307)
- Surgeons in bariatric surgery use endoscopy daily to assess the results of their surgery, look for leaks, stent leaks, put in drainage tubes, and improve the treatment of their complications. — Jeff Ponsky (clinical) [Ep 1 · 5:12](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=312)
- Endoscopic submucosal dissection can be performed even in the colon to remove T2 tumors and extensive spreading tumors without the need for surgery. — Jeff Ponsky (clinical) [Ep 1 · 6:22](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=382)
- Emory Gorgon at the Cleveland Clinic has a huge experience in endoscopic submucosal dissection. — Jeff Ponsky (clinical) [Ep 1 · 6:38](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=398)
- Pre-malignant and early malignant lesions in the esophagus are being removed endoscopically by both GI and surgery specialists. — Jeff Ponsky (clinical) [Ep 1 · 6:50](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=410)
- Division of the esophageal muscles to treat achalasia can now be performed endoscopically where surgery used to be required. — Jeff Ponsky (clinical) [Ep 1 · 6:54](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=414)
- The purpose of endoscopic techniques is not to remove surgery but to augment it and choose the right procedure for the right patient. — Jeff Ponsky (opinion) [Ep 1 · 7:09](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=429)
- The only place surgeons and gastroenterologists fail is when they fail to work together. — Jeff Ponsky (opinion) [Ep 1 · 7:35](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=455)
- The gastroenterology community is excellent at endoscopic ultrasound, which has led to tremendous therapeutic advances. — Jeff Ponsky (opinion) [Ep 1 · 7:45](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=465)
- The ultimate potential of endoscopic ultrasound won't be reached unless surgeons and gastroenterologists work together. — Jeff Ponsky (opinion) [Ep 1 · 7:50](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=470)
- At the Cleveland Clinic, surgeons and gastroenterologists work together, combining surgical techniques with endoscopic techniques. — Jeff Ponsky (clinical) [Ep 1 · 8:03](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=483)
- In 10 years, the field will have advanced so much that current practices won't be recognizable. — Jeff Ponsky (opinion) [Ep 1 · 8:37](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=517)
- Future endoscopy will include transmural surgery, performing resections of pieces of bowel, removing tumors, and sewing up the lumen endoscopically. — Jeff Ponsky (opinion) [Ep 1 · 8:56](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=536)
- Future procedures will include gastrointestinal anastomosis performed endoscopically or using combined endoscopic and percutaneous techniques. — Jeff Ponsky (opinion) [Ep 1 · 9:18](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=558)
- Complications will be managed endoscopically in the future using ultrasound and endoscopy. — Jeff Ponsky (opinion) [Ep 1 · 9:32](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=572)
- New modalities will be integrated into endoscopy to deal with biliary disease, colonic disease, pancreatic disease, gastric disease, and inflammatory bowel disease. — Jeff Ponsky (opinion) [Ep 1 · 9:39](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=579)
- The integration of surgery and gastroenterology will improve the whole specialty. — Jeff Ponsky (opinion) [Ep 1 · 9:56](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=596)
- The robot refines surgical maneuvers and helps perform procedures better and more exactly. — Jeff Ponsky (opinion) [Ep 1 · 10:25](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=625)
- Jeff Ponsky was initially a critic of the robot in laparoscopic surgery when it first began because it was expensive and he thought it unnecessary. — Jeff Ponsky (opinion) [Ep 1 · 10:35](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=635)
- Robotics must be integrated into everything surgeons do and will be used with flexible endoscopy just as it has been used with colorectal and intestinal surgery. — Jeff Ponsky (opinion) [Ep 1 · 10:47](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=647)
- Laparoscopic Heller myotomy is the gold standard for the treatment of achalasia. — Jeffrey Ponsky (clinical) [Ep 20 · 0:51](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=51)
- In Heller myotomy, the operation fails if the myotomy does not extend 4-5 centimeters down onto the stomach. — Jeffrey Ponsky (clinical) [Ep 20 · 1:28](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=88)
- A fundoplication (Dor) is added to Heller myotomy based on a Vanderbilt paper, but surgeons know in their hearts it doesn't provide significant benefit. — Jeffrey Ponsky (opinion) [Ep 20 · 1:40](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=100)
- Dr. Inoue, a thoracic surgeon in Yokohama, performed the first POEM procedure in the world in 2010. — Jeffrey Ponsky (clinical) [Ep 20 · 2:55](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=175)
- The POEM procedure takes about one hour. — Jeffrey Ponsky (clinical) [Ep 20 · 3:29](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=209)
- In POEM, the mucosal entry is made 14 centimeters proximal to the EG junction. — Jeffrey Ponsky (clinical) [Ep 20 · 3:14](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=194)
- During POEM, the longitudinal muscle splits automatically when the circular muscle is divided. — Jeffrey Ponsky (clinical) [Ep 20 · 3:27](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=207)
- Occasionally during POEM, the mucosa cannot be separated from the submucosa; in these cases (three in seven years for the speaker), the procedure should be stopped, the entry clipped closed, and a Heller myotomy performed instead. — Jeffrey Ponsky (clinical) [Ep 20 · 7:03](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=423)
- POEM patients have almost a 40% incidence of abnormal reflux. — Jeffrey Ponsky (epidemiological) [Ep 20 · 7:51](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=471)
- All POEM patients should be placed on a PPI once daily indefinitely because they can develop strictures without it. — Jeffrey Ponsky (clinical) [Ep 20 · 7:51](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=471)
- POEM is effective in over 90% of cases. — Jeffrey Ponsky (epidemiological) [Ep 20 · 8:13](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=493)
- POEM patients have 35-40% abnormal reflux rates. — Jeffrey Ponsky (epidemiological) [Ep 20 · 8:13](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=493)
- Long-term data suggest POEM may be equal to Heller myotomy in every way after three years. — Jeffrey Ponsky (clinical) [Ep 20 · 9:08](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=548)
- Gastroparesis is caused by diabetes, idiopathic factors, and post-surgical complications including esophagectomy. — Jeffrey Ponsky (clinical) [Ep 20 · 10:00](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=600)
- POP (peroral pyloromyotomy) involves creating a 4 cm tunnel to the pyloric ring and dividing it, and takes 15 minutes. — Jeffrey Ponsky (clinical) [Ep 20 · 10:17](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=617)
- The speaker's institution has performed about 400 POP procedures. — Jeffrey Ponsky (epidemiological) [Ep 20 · 12:42](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=762)
- In the first 100 POP cases presented at a meeting, three-quarters of patients had normalized gastric emptying studies at three months, all of which were abnormal before the procedure. — Jeffrey Ponsky (clinical) [Ep 20 · 12:51](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=771)
- POP is an easy procedure that takes 15-20 minutes and is easy to learn, unlike ERCP. — Jeffrey Ponsky (opinion) [Ep 20 · 13:09](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=789)
- STEER (submucosal tunneling and endoscopic resection) is used to remove esophageal leiomyomas by creating a submucosal tunnel and shelling out the tumor. — Jeffrey Ponsky (clinical) [Ep 20 · 13:27](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=807)
- All esophageal leiomyomas undergo endoscopic ultrasound before STEER. — Jeffrey Ponsky (clinical) [Ep 20 · 13:45](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=825)
- The speaker treated a 17-year-old girl with a 7 cm esophageal leiomyoma causing dysphagia using STEER, dividing the tumor in half to remove it through the tunnel. — Jeffrey Ponsky (clinical) [Ep 20 · 13:38](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=818)
- ENT surgeons are now referring Zenker's diverticulum patients to the speaker because elderly patients with kyphoscoliosis and tight jaws are difficult to manage with general anesthesia and open neck surgery. — Jeffrey Ponsky (clinical) [Ep 20 · 14:13](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=853)
- Cricopharyngeal myotomy is the basis of treatment for Zenker's diverticulum. — Jeffrey Ponsky (clinical) [Ep 20 · 14:28](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=868)
- Endoscopic Zenker's treatment takes 15-20 minutes. — Jeffrey Ponsky (clinical) [Ep 20 · 16:39](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=999)
- For endoscopic Zenker's treatment, patients are kept on clear liquids for a couple of days before the procedure to clear debris from the diverticulum. — Jeffrey Ponsky (clinical) [Ep 20 · 17:12](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=1032)
- During endoscopic Zenker's myotomy, if a hole is made in the mucosa, it does not matter because the mucosal flap will cover it. — Jeffrey Ponsky (clinical) [Ep 20 · 17:56](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=1076)
- The speaker has trained gastroenterologists, thoracic surgeons, and general surgeons to perform intramural surgical procedures. — Jeffrey Ponsky (clinical) [Ep 20 · 20:06](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=1206)
- Thoracic surgeons at the speaker's institution have embraced intramural surgery techniques. — Jeffrey Ponsky (clinical) [Ep 20 · 20:22](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=1222)
- In 1973-1974, the chief of gastroenterology at Case Western Reserve refused to train a surgery resident in endoscopy, stating "we're not going to train a surgeon to do endoscopy." — Jeffrey L. Ponsky (clinical) [Ep 4 · 4:49](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=289)
- During six months of training in Canton, Ohio in 1974, Dr. Ponsky performed almost 500 endoscopies. — Jeffrey L. Ponsky (clinical) [Ep 4 · 6:06](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=366)
- Early endoscopy in the 1970s used green soap for scope disinfection with no gloves worn, even for colonoscopy, and no high-level disinfection or washing machines. — Jeffrey L. Ponsky (clinical) [Ep 4 · 10:04](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=604)
- The first PEG procedures were performed in May 1979 on five babies at Rainbow Babies hospital, followed by the first adult cases at Mount Sinai. — Jeffrey L. Ponsky (clinical) [Ep 4 · 15:27](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=927)
- When PEG was presented at the 1980 ASGE meeting in Salt Lake City, Peter Cotton stated "I'm only sorry that I didn't think of this." — Jeffrey L. Ponsky (opinion) [Ep 4 · 16:39](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=999)
- In babies, transillumination during PEG placement showed the endoscopist and surgeon were "only a couple of millimeters away from each other," making the procedure more obvious than in adults. — Jeffrey L. Ponsky (clinical) [Ep 4 · 17:20](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1040)
- Early PEG tubes were fashioned from Pezzer catheters with Bunsen burner tubing cut for side holes and a medicut IV catheter as a dilator. — Jeffrey L. Ponsky (clinical) [Ep 4 · 18:02](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1082)
- The discovery that stretching rubber makes it thinner allowed easier insertion of PEG tubes through the dilating catheter. — Jeffrey L. Ponsky (clinical) [Ep 4 · 18:42](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1122)
- Using a snare around the puncturing needle to grab the suture was more reliable than trying to grab it with biopsy forceps during PEG placement. — Jeffrey L. Ponsky (clinical) [Ep 4 · 19:08](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1148)
- The concept behind PEG is "affixing a loop of bowel to the abdominal wall and creating a tract that was permanent." — Jeffrey L. Ponsky (clinical) [Ep 4 · 20:53](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1253)
- The PEG concept was extended to cecal puncture for Ogilvie syndrome, published in 1984. — Jeffrey L. Ponsky (clinical) [Ep 4 · 21:16](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1276)
- Endoscopic tattooing with India ink was first performed in 1975 using a reusable NM1K injection needle and India ink from a bookstore to mark polyp locations for surgical resection. — Jeffrey L. Ponsky (clinical) [Ep 4 · 29:06](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1746)
- SAGES membership grew from 300 members to 2,000 members during Dr. Ponsky's presidency, driven by the laparoscopic cholecystectomy revolution. — Jeffrey L. Ponsky (epidemiological) [Ep 4 · 32:48](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=1968)
- Dr. Ponsky was the second surgeon to serve as president of ASGE, after Ted Schrock. — Jeffrey L. Ponsky (clinical) [Ep 4 · 34:02](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2042)
- The first human NOTES procedure in the United States was PEG rescue, where a string was passed through an existing PEG tract into the peritoneal cavity, pulled back into the stomach and out the mouth to place a new tube. — Jeffrey L. Ponsky (clinical) [Ep 4 · 38:54](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2334)
- The NOSCAR consortium established that experimental NOTES procedures would only be performed under IRB protocol with informed consent. — Jeffrey L. Ponsky (guideline) [Ep 4 · 38:44](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2324)
- POEM was first performed in humans by Haruo Inoue in Yokohama around 2007, though the tunneling concept was conceived earlier at IRCAD in France during the NOTES era. — Jeffrey L. Ponsky (clinical) [Ep 4 · 53:48](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3228)
- After POEM procedures, patients report "you changed my life, I feel so great," providing strong positive reinforcement for the technique. — Jeffrey L. Ponsky (opinion) [Ep 4 · 54:51](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3291)
- Per-oral pyloromyotomy (POP) via lesser curve tunneling results in improved or normalized gastric emptying in two-thirds to three-quarters of patients, performed as an outpatient procedure. — Jeffrey L. Ponsky (clinical) [Ep 4 · 55:32](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3332)
- Over 300 per-oral pyloromyotomy cases have been performed at Cleveland Clinic. — Jeffrey L. Ponsky (epidemiological) [Ep 4 · 55:15](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3315)
- For Zenker's diverticulum, the intramural approach involves opening the mucosa, tunneling under it, pushing it off the muscle, cutting the muscle, and clipping the mucosa closed—a "double-sided tunnel, one on each side of the muscle." — Jeffrey L. Ponsky (clinical) [Ep 4 · 56:22](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3382)
- Current ESD technique is "like pushing a nickel across the room with your nose," but future robotic platforms will allow surgeons to "lift it and cut it just like we do in surgery" with knot-tying and full-thickness resection capabilities. — Jeffrey L. Ponsky (opinion) [Ep 4 · 57:34](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3454)
- For tight radiation strictures preventing standard PEG placement, T-fasteners combined with a surgical step trocar (which radially expands) can be used to place a standard-sized gastrostomy tube. — Jeffrey L. Ponsky (clinical) [Ep 4 · 58:50](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3530)
- Dr. Ponsky currently performs approximately 1,200 endoscopic procedures annually at age 72. — Jeffrey L. Ponsky (epidemiological) [Ep 4 · 51:15](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3075)
- Ponsky was told not to go to college after Cleveland Heights High School, possibly trade school instead, due to poor academic performance. — Jeffrey Ponsky (clinical) [Ep 8 · 0:09](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=9)
- Ponsky achieved Phi Beta Kappa at Miami of Ohio after working very hard and changing his persona in college. — Jeffrey Ponsky (clinical) [Ep 8 · 0:20](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=20)
- Ponsky worked as an orderly at age 16 and then as a surgery assistant through college and medical school summers, making him facile with surgical techniques before his surgery clerkship. — Jeffrey Ponsky (clinical) [Ep 8 · 0:59](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=59)
- In Ponsky's medical school era (second year), most students were already married, making him unusual for being single. — Jeffrey Ponsky (clinical) [Ep 8 · 1:46](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=106)
- Ponsky married Jackie at age 22; they have been married 48 years, which he calls the luckiest choice and biggest influence on his life. — Jeffrey Ponsky (opinion) [Ep 8 · 1:59](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=119)
- Surgical residency was 36 hours on and 12 hours off (every other night call), which Ponsky describes as terrible and horrible, not fun. — Jeffrey Ponsky (clinical) [Ep 8 · 2:32](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=152)
- Ponsky chose endoscopy as a PG-4 elective because he wanted something less demanding, thinking it would be easy after watching gastroenterologists struggle with procedures in the ICU. — Jeffrey Ponsky (clinical) [Ep 8 · 3:03](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=183)
- The gastroenterology department at the university canceled Ponsky's endoscopy rotation one week before it was scheduled to start, saying they were not training a surgeon and had no spot. — Jeffrey Ponsky (clinical) [Ep 8 · 3:26](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=206)
- Jim King, a gastroenterologist in Canton, Ohio (1.5 hours from Cleveland), trained Ponsky for almost 5 months, performing about 20 procedures per day. — Jeffrey Ponsky (clinical) [Ep 8 · 4:03](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=243)
- After training with Jim King and completing about 500 procedures, the head of gastroenterology refused to let Ponsky touch their instruments or teach residents endoscopy. — Jeffrey Ponsky (clinical) [Ep 8 · 5:00](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=300)
- An endoscope cost $5,200 at the time, which the chairman Bill Holden could not afford to purchase for Ponsky. — Jeffrey Ponsky (clinical) [Ep 8 · 5:22](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=322)
- Ponsky's mother-in-law purchased an endoscope for him as a Christmas/Hanukkah present after hearing about his situation at a family party. — Jeffrey Ponsky (clinical) [Ep 8 · 5:39](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=339)
- By offering to come in day or night for GI bleeders and immediate procedures, Ponsky built such a strong practice that he "literally put the GI department out of business" within 2 years, with private internists calling him for every case. — Jeffrey Ponsky (clinical) [Ep 8 · 6:12](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=372)
- Doctor Holden provided a $5,000 American Cancer Society grant, which Ponsky used to purchase an ERCP scope rather than repaying his mother-in-law. — Jeffrey Ponsky (clinical) [Ep 8 · 6:41](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=401)
- Ponsky learned ERCP by watching videos, particularly from Peter Cotton, with no formal training and no nurse assistance—he and fellow residents set up the entire table themselves. — Jeffrey Ponsky (clinical) [Ep 8 · 6:58](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=418)
- By 1976, Ponsky was performing upper endoscopy, colonoscopy, and ERCP, and was hired as chief of surgical endoscopy at University Hospitals. — Jeffrey Ponsky (clinical) [Ep 8 · 7:23](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=443)
- In 1979, Ponsky and Michael Gauderer developed the PEG (percutaneous endoscopic gastrostomy) procedure after noticing light shining through babies' abdomens during upper endoscopy due to thin abdominal walls. — Jeffrey Ponsky (clinical) [Ep 8 · 7:46](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=466)
- The first PEG procedures were performed on 5 brain-damaged infants scheduled for open gastrostomy, with maternal consent but no IRB review (which Ponsky does not recall existing at that time). — Jeffrey Ponsky (clinical) [Ep 8 · 8:20](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=500)
- Ponsky became chairman of surgery at Mount Sinai Hospital at age 32, selected because it was a Jewish hospital, he was Jewish, and known as a good teacher. — Jeffrey Ponsky (clinical) [Ep 8 · 9:00](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=540)
- Ponsky served as chief of surgery at Mount Sinai for 18 years, where he performed the first adult PEG procedures and modified and improved the equipment. — Jeffrey Ponsky (clinical) [Ep 8 · 9:25](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=565)
- Around 1980, the American Board of Surgery mandated that surgeons must have experience in endoscopy, but most rotated to GI services where they only watched rather than performed procedures. — Jeffrey Ponsky (guideline) [Ep 8 · 10:18](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=618)
- Ponsky established endoscopy courses at Mount Sinai with faculty including Ken Ford, George Bercy, Rick Green, Tom Dent, Walter Gazeford, and Willie Webb, teaching basic flexible endoscopy to residents annually. — Jeffrey Ponsky (clinical) [Ep 8 · 10:41](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=641)
- Jerry Marks, a colorectal surgeon in Philadelphia, founded SAGES around 1980 because ASGE did not want surgical papers on their programs frequently and did not involve surgeons in leadership. — Jeffrey Ponsky (clinical) [Ep 8 · 11:35](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=695)
- SAGES founding members around 1980 included John Coller, Ken Ford, John Van Sant, Jim Lynn, and others who wanted a place where surgeons could discuss the surgical approach to endoscopy. — Jeffrey Ponsky (clinical) [Ep 8 · 12:06](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=726)
- Early SAGES meetings had a couple hundred attendees and focused on surgical applications of endoscopy, such as decompressing partial bowel obstruction and managing acute lower GI bleeding, which differed fundamentally from ASGE's medical approach. — Jeffrey Ponsky (clinical) [Ep 8 · 13:13](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=793)
- Barbara Saltzman became SAGES administrator early on and helped the society grow and mature, later marrying George Bercy to become Barbara Bercy; she is described as the "mother of SAGES." — Jeffrey Ponsky (clinical) [Ep 8 · 13:55](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=835)
- Around 1989-1990, at a SAGES meeting in Louisville, Jacques Perissat showed a video of laparoscopic cholecystectomy in the exhibit hall (not on the official program), which transformed the field. — Jeffrey Ponsky (clinical) [Ep 8 · 14:54](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=894)
- SAGES grew from 300 members at the beginning of Ponsky's presidency to 2,000 members at the end of his 18-month term, driven by the laparoscopic cholecystectomy revolution. — Jeffrey Ponsky (epidemiological) [Ep 8 · 15:48](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=948)
- Unlike hierarchical surgical societies where older, accomplished surgeons dominated and younger members remained quiet, SAGES developed a flat organizational structure encouraging young surgeons to participate actively on committees. — Jeffrey Ponsky (clinical) [Ep 8 · 16:11](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=971)
- The SAGES Song Fest began when Ponsky, as president, performed with "the Lap Rappers" (including John Hunter, Nat Soper, Lee Swanstrom, George Bercy) in tie-dye scrub suits, starting an annual tradition. — Jeffrey Ponsky (clinical) [Ep 8 · 21:08](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1268)
- The Japanese created the song "We Are the Sages" (based on "We Are the World"), which became the society's anthem, sung with members holding hands at the end of meetings. — Jeffrey Ponsky (clinical) [Ep 8 · 17:22](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1042)
- SAGES changed its name from Society of Gastrointestinal Endoscopic Surgeons to Society of Gastrointestinal and Endoscopic Surgeons, making both gastrointestinal surgery and endoscopic surgery equal parts of the organization. — Jeffrey Ponsky (clinical) [Ep 8 · 18:05](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1085)
- SAGES membership is close to 7,000 members. — Jeffrey Ponsky (epidemiological) [Ep 8 · 18:35](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1115)
- Japanese surgeons including Manabu Yamamoto, Dr. Suzuki, Dr. Idazuki, and Dr. Yamakawa became leaders in SAGES, teaching advanced techniques like POEM procedures and endoscopic submucosal dissection. — Jeffrey Ponsky (clinical) [Ep 8 · 20:32](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1232)
- Haru Inoue pioneered POEM (peroral endoscopic myotomy) procedures in Japan and helped teach these techniques at SAGES courses. — Jeffrey Ponsky (clinical) [Ep 8 · 22:29](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1349)
- SAGES established a Corporate Council under Jerry Marks to manage relationships with industry partners and address mutual concerns on a one-to-one basis. — Jeffrey Ponsky (clinical) [Ep 8 · 24:31](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1471)
- Key industry partners included Olympus (Mike Obsfeld, Mark Donahue, Mr. Moroshima, Terada), Pentax, Fuji, Karl Storz (Mrs. Stortz described as "guardian angel"), US Surgical/Covidian/Medtronic, and Ethicon, providing educational support, fellowships, and technical assistance. — Jeffrey Ponsky (clinical) [Ep 8 · 24:58](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1498)
- Ponsky's Mount Sinai endoscopy courses became official SAGES courses, then moved to the Ethicon Institute in Cincinnati with Ethicon's support for education. — Jeffrey Ponsky (clinical) [Ep 8 · 26:46](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1606)
- SAGES was the first organization to establish hands-on surgical training courses, which remain superior to others' programs. — Jeffrey Ponsky (opinion) [Ep 8 · 28:16](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1696)
- Early SAGES courses focused on flexible endoscopy (polyp removal, colonoscopy) with simulation, but laparoscopic training (Nissen fundoplication, laparoscopic colectomy, Heller myotomy) eventually dominated as the laparoscopic revolution expanded. — Jeffrey Ponsky (clinical) [Ep 8 · 28:28](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1708)
- Current SAGES courses have returned to teaching advanced flexible endoscopy techniques including POEM, ESD (endoscopic submucosal dissection), and EMR (endoscopic mucosal resection). — Jeffrey Ponsky (clinical) [Ep 8 · 29:02](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1742)
- Ponsky's fellows who became SAGES presidents include Bruce McFadden, Brian Duncan, and Jeff Marks (future president). — Jeffrey Ponsky (clinical) [Ep 8 · 31:00](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=1860)
- Mike Rosen, son of Arnie Rosen (who was a year ahead of Ponsky in residency), came as a research resident and became Ponsky's partner, training many fellows in abdominal wall reconstruction in addition to endoscopy. — Jeffrey Ponsky (clinical) [Ep 8 · 33:50](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2030)
- Walter Pore taught that department leaders should protect elder staff while simultaneously promoting younger staff, a lesson Ponsky applied as chairman. — Jeffrey Ponsky (opinion) [Ep 8 · 35:28](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2128)
- Walter Pore, now in his mid-80s, continues to have NIH grants and remains relevant in lecturing, demonstrating that surgeons can maintain relevance throughout their careers. — Jeffrey Ponsky (clinical) [Ep 8 · 35:59](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2159)
- In 1975, Ponsky performed peritoneoscopy under local anesthesia with air insufflation before switching to CO2, and contacted George Bercy in California for advice on purchasing a Storz scope with a $2,500 grant. — Jeffrey Ponsky (clinical) [Ep 8 · 36:23](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2183)
- George Bercy worked with Harold Hopkins and Karl Storz to develop the Hopkins rod lens system into practical surgical scopes, constantly seeking improvements in image quality, lighting, and camera technology. — Jeffrey Ponsky (clinical) [Ep 8 · 37:17](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2237)
- At age 96, George Bercy continues to call Ponsky monthly with new ideas, including a smaller choledochoscope with chip camera instead of fiber optics and a VTO scope mounted above the operating table for cardiac surgeons to view valve anastomoses without loupes. — Jeffrey Ponsky (clinical) [Ep 8 · 37:57](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2277)
- Video laparoscopy transformed surgery by allowing the entire team to see the operative field on TV, unlike earlier laparoscopy where only the surgeon looking through the eyepiece could see. — Jeffrey Ponsky (clinical) [Ep 8 · 39:01](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2341)
- Eddie Joe Reddick and Doug Olson in Nashville, and Barry McKernan and Bill Saye in Marietta, Georgia (who did the first laparoscopic cholecystectomy in the US), were key pioneers of laparoscopic cholecystectomy in America. — Jeffrey Ponsky (clinical) [Ep 8 · 39:44](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2384)
- SAGES trained trainers first (John Hunter, Nat Soper, John Saker, George Bercy) before broader dissemination of laparoscopic cholecystectomy techniques. — Jeffrey Ponsky (clinical) [Ep 8 · 40:17](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2417)
- Instrument shortages during early laparoscopy required personal connections to obtain equipment; Ponsky obtained Storz instruments through George Bercy, and surgeons used many gynecologic instruments and trocars. — Jeffrey Ponsky (clinical) [Ep 8 · 40:57](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2457)
- Laparoscopic common duct exploration was one of the earliest procedures because it required minimal special technique: the dilated common duct could be identified, peritoneum wiped away, incision made with scissors, stones extracted with Fogarty balloon, and choledochoscopy performed before T-tube placement. — Jeffrey Ponsky (clinical) [Ep 8 · 41:26](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2486)
- Before mastering laparoscopic suturing, Ponsky closed common duct incisions by twisting the two suture ends together like a twist-tie and securing with a clip. — Jeffrey Ponsky (clinical) [Ep 8 · 42:08](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2528)
- Ponsky was selected as the first SAGES member on the American Board of Surgery after SAGES received a board seat, with the board choosing from three nominated candidates. — Jeffrey Ponsky (clinical) [Ep 8 · 42:36](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2556)
- Ponsky and Courtney Townsend advocated for Steve Stein's appointment to the American Board of Surgery; Michael Nussbaum and John Hunter also later joined as SAGES representatives. — Jeffrey Ponsky (clinical) [Ep 8 · 43:12](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2592)
- The American Board of Surgery asked Ponsky how much endoscopy surgical residents should perform; he negotiated with the Residency Review Committee under Joe Fisher to establish numerical requirements. — Jeffrey Ponsky (guideline) [Ep 8 · 43:50](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2630)
- Ponsky was elected chairman of the American Board of Surgery, the first SAGES member to achieve this position. — Jeffrey Ponsky (clinical) [Ep 8 · 44:48](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2688)
- Ponsky left work early to have dinner and study hall with his family at the dining room table, helping children with homework while doing his own work, rather than staying late at the office like colleagues. — Jeffrey Ponsky (opinion) [Ep 8 · 46:05](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2765)
- Two of Ponsky's four children became surgeons: Lee (urologic oncology, head of urological oncology at Case Western) and Todd (pediatric surgery, interested in surgical education). — Jeffrey Ponsky (clinical) [Ep 8 · 46:50](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2810)
- Ponsky has four children and ten grandchildren, all living in Cleveland, whom he sees every week. — Jeffrey Ponsky (clinical) [Ep 8 · 47:11](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2831)
- Marriage requires continuous work like a career, not just falling in love; partners must consider each other's experiences, help each other, and understand what makes each other tick. — Jeffrey Ponsky (opinion) [Ep 8 · 47:45](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2865)
- Ponsky considers his 48-year marriage his crowning achievement, more important than his professional accomplishments. — Jeffrey Ponsky (opinion) [Ep 8 · 49:00](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2940)
- The future of surgery includes image-guided procedures such as needle ablation of liver tumors, requiring surgeons to embrace and test new technologies rather than remaining satisfied with current methods. — Jeffrey Ponsky (opinion) [Ep 8 · 49:16](https://qa.library.globalcastmd.com/watch/jeffrey-ponsky-portrait-of-a-sages-pioneer-13723?t=2956)
- Flexible fiber-optic endoscopy as currently known began around 1958 when Hersowitz at the University of Michigan developed a method using glass fibers to transmit images. — Todd Ponsky (clinical) [Ep 12 · 0:12](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=12)
- In the 1960s, flexible endoscopy was used only for visualization of the GI tract without therapeutic interventions. — Todd Ponsky (clinical) [Ep 12 · 0:34](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=34)
- In the early 1970s, Shina, a surgeon in New York, developed the ability to remove polyps from the GI tract endoscopically. — Todd Ponsky (clinical) [Ep 12 · 0:45](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=45)
- Endoscopic polypectomy was significant because it enabled removal of polyps before they became cancer. — Todd Ponsky (clinical) [Ep 12 · 0:48](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=48)
- The speaker trained in endoscopy in Canton, Ohio with Jim Canyon, performing approximately 500 cases over nearly 5 months. — Todd Ponsky (clinical) [Ep 12 · 1:47](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=107)
- The speaker and pediatric surgeon Michael Gauderer developed a technique to place feeding tubes endoscopically through the abdominal wall for children with brain damage requiring long-term feeding. — Todd Ponsky (clinical) [Ep 12 · 3:18](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=198)
- The PEG tube procedure was probably the beginning of minimally invasive surgery. — Todd Ponsky (opinion) [Ep 12 · 3:44](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=224)
- The PEG tube was developed in 1979, almost 40 years before this presentation. — Todd Ponsky (clinical) [Ep 12 · 3:51](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=231)
- Major medical device companies including Olympus, Ross Laboratories, and Eaton Laboratory initially declined to commercialize the PEG tube. — Todd Ponsky (clinical) [Ep 12 · 4:09](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=249)
- The PEG tube was commercialized through American Endoscopy, a small company owned by Marlon Yonker. — Todd Ponsky (clinical) [Ep 12 · 4:19](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=259)
- American Endoscopy was sold to Bard Endoscopy in 1986. — Todd Ponsky (clinical) [Ep 12 · 4:40](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=280)
- The PEG tube is now used and overused throughout the world. — Todd Ponsky (opinion) [Ep 12 · 4:53](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=293)
- The PEG was the first minimally invasive surgical procedure. — Todd Ponsky (opinion) [Ep 12 · 4:56](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=296)
- Current endoscopic procedures include dividing muscles for achalasia, a condition where people cannot swallow. — Todd Ponsky (clinical) [Ep 12 · 6:18](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=378)
- Endoscopic treatment is now available for Zenker's diverticulum, an outpouching of the esophagus causing swallowing difficulty. — Todd Ponsky (clinical) [Ep 12 · 6:26](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=386)
- Surgery is now performed through the endoscope. — Todd Ponsky (clinical) [Ep 12 · 6:33](https://qa.library.globalcastmd.com/watch/ponsky-and-gauderer-invent-the-peg-tube-13724?t=393)
- PEG will be 40 years old in a couple of years from the time of this presentation — Todd Ponsky (clinical) [Ep 13 · 1:13](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=73)
- In the late 1970s there were very few pediatric gastroenterologists — Todd Ponsky (epidemiological) [Ep 13 · 2:20](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=140)
- Before PEG, babies with birth asphyxia or severe psychomotor retardation who couldn't eat required nasal feeding tubes and operative gastrostomy before going to long-term care facilities — Todd Ponsky (clinical) [Ep 13 · 2:27](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=147)
- Patients with oral pharyngeal cancers who couldn't swallow required gastrostomy — Todd Ponsky (clinical) [Ep 13 · 2:57](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=177)
- Patients with severe gastric dilatation needed gastrostomies for venting — Todd Ponsky (clinical) [Ep 13 · 3:02](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=182)
- Transillumination during endoscopy could light up the whole room in babies, enabling visualization from outside — Todd Ponsky (clinical) [Ep 13 · 3:18](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=198)
- The original PEG technique used a silk suture, an IV catheter called a medicut with no hub, and initially a foreign body grasper rather than a snare — Todd Ponsky (clinical) [Ep 13 · 4:20](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=260)
- Capturing the silk suture with a snare was easier than using a foreign body grasper because the suture would move away from the grasper — Todd Ponsky (clinical) [Ep 13 · 4:34](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=274)
- Following the tube down with the endoscope was necessary to ensure it wasn't caught at the EG junction, as feeding the esophagus rather than stomach was a concern — Todd Ponsky (clinical) [Ep 13 · 4:42](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=282)
- The first PEG tube was made from a deep mushroom catheter with Bunsen burner tubing behind it to create a bolster, with a stitch through the end pushed through the medicut catheter to create a dilator — Todd Ponsky (clinical) [Ep 13 · 4:57](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=297)
- Pulling on rubber makes it thinner, which solved the problem of inserting the rubber tube into the medicut dilator — Todd Ponsky (clinical) [Ep 13 · 5:18](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=318)
- In 1979, the developers did not practice the PEG procedure in an animal lab or on explants before performing it in patients — Todd Ponsky (clinical) [Ep 13 · 5:54](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=354)
- The fallback procedure for the first PEG cases was laparotomy — Todd Ponsky (clinical) [Ep 13 · 6:05](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=365)
- By today's standards, not practicing in an animal model before human implementation would be criticized — Todd Ponsky (opinion) [Ep 13 · 6:10](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=370)
- The first PEG was performed in 1979, but the PEG tract formation was not studied in the laboratory until 1991 when John Mellinger studied it — Todd Ponsky (clinical) [Ep 13 · 6:35](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=395)
- Over 10 years passed between the first PEG procedure and laboratory study of tract formation — Todd Ponsky (clinical) [Ep 13 · 6:59](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=419)
- The transgastric appendectomy by Rao was shown as a movie in the NOTES era but was never published — Todd Ponsky (clinical) [Ep 13 · 7:21](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=441)
- Dr. Ponsky and Michael Gauder worked together from day one on PEG development, doing every single case together — Todd Ponsky (clinical) [Ep 13 · 7:40](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=460)
- The developers published the PEG technique in three different journals—pediatric surgery, endoscopy, and general surgery—with different patient numbers in each publication — Todd Ponsky (clinical) [Ep 13 · 8:06](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=486)
- Transcolonic PEG placement was a complication, with one case sent by a gastroenterologist rather than a surgeon — Todd Ponsky (clinical) [Ep 13 · 8:24](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=504)
- Buried bumper syndrome occurs when excessive traction on the PEG tube creates a tourniquet effect, causing the tube to migrate through the abdominal wall — Todd Ponsky (clinical) [Ep 13 · 8:37](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=517)
- Incorrect PEG tube reinsertion could result in entering the peritoneal cavity and causing soilage — Todd Ponsky (clinical) [Ep 13 · 8:47](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=527)
- A silicone tube with a bigger, softer head was developed to eliminate the need for an inner bolster and allow easier removal — Todd Ponsky (clinical) [Ep 13 · 9:06](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=546)
- Dr. Gauder invented the one-step button that could be pulled through and opened like a cocoon into a skin-level device — Todd Ponsky (clinical) [Ep 13 · 9:14](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=554)
- Greg Fouch, a gastroenterologist training with Bob Sanowski, developed the safe tract technique — Todd Ponsky (clinical) [Ep 13 · 9:26](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=566)
- The safe tract technique involves poking with a finger to see the site, then aspirating slowly with fluid in the syringe; if bubbles appear before the endoscopist sees the needle in the stomach, the needle is in the colon and should be withdrawn and repositioned — Todd Ponsky (clinical) [Ep 13 · 9:38](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=578)
- The safe tract technique is still used today — Todd Ponsky (clinical) [Ep 13 · 9:58](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=598)
- Sachs and Vine described a push method technique where the tube was pushed over a wire, a few years after the original pull method — Todd Ponsky (clinical) [Ep 13 · 10:02](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=602)
- Another technique used instruments from CVP line placement with peel-away sheets — Todd Ponsky (clinical) [Ep 13 · 10:09](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=609)
- Some practitioners used T-fastener anchors to hold the stomach up during PEG placement — Todd Ponsky (clinical) [Ep 13 · 10:17](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=617)
- B Panchan and his group developed a technique using a one-step trocar from laparoscopy that expands, through which a tube could be placed directly — Todd Ponsky (clinical) [Ep 13 · 10:22](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=622)
- Percutaneous endoscopic jejunostomy with a jejunal extension tube was published in 1984 — Todd Ponsky (clinical) [Ep 13 · 10:44](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=644)
- Jejunal extension tubes dropped into the duodenum don't work well and require frequent replacement, approximately every two weeks — Todd Ponsky (opinion) [Ep 13 · 10:55](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=655)
- Direct jejunostomy can be performed by advancing a pediatric colonoscope deep into the jejunum under fluoroscopy or without, though it is technically challenging — Todd Ponsky (clinical) [Ep 13 · 11:14](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=674)
- Combined gastrostomy for drainage and jejunostomy for feeding can be performed — Todd Ponsky (clinical) [Ep 13 · 11:26](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=686)
- Percutaneous endoscopic cecostomy can be used for Ogilvie syndrome — Todd Ponsky (clinical) [Ep 13 · 11:31](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=691)
- In obese patients, PEG can be performed using a spinal needle, staying in the midline where fascia is thinner, and going up under the xiphoid — Todd Ponsky (clinical) [Ep 13 · 12:48](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=768)
- Some patients would be better off without a PEG, and clinicians should have the courage to decline placement in patients who won't live two weeks, are septic, or have multi-organ failure — Todd Ponsky (opinion) [Ep 13 · 13:11](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=791)
- PEG can provide palliative benefit in terminal patients; a patient with carcinomatosis and frozen abdomen with only one to two months to live had a PEG placed between lower left ribs to decompress the stomach and prevent daily vomiting — Todd Ponsky (clinical) [Ep 13 · 13:58](https://qa.library.globalcastmd.com/watch/lessons-learned-from-the-introduction-of-a-new-endoscopic-procedure-peg-13725?t=838)
- The interview is only a small part of the whole process of selecting residents. — Jeffrey Ponsky (opinion) [Ep 6 · 0:21](https://qa.library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=21)
- Residency programs want candidates with 'bright eyes and full hearts' - desire and enthusiasm. — Jeffrey Ponsky (opinion) [Ep 6 · 0:29](https://qa.library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=29)
- Candidates must have passed their USMLE and have good letters of recommendation. — Jeffrey Ponsky (guideline) [Ep 6 · 0:46](https://qa.library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=46)
- Requesting letters of recommendation from people who will write bad letters is an intelligence test that many candidates fail. — Jeffrey Ponsky (opinion) [Ep 6 · 0:52](https://qa.library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=52)
- Candidates should only ask reliable people to write letters of recommendation. — Jeffrey Ponsky (guideline) [Ep 6 · 1:02](https://qa.library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=62)
- During interviews, candidates should make eye contact and look interested in what the interviewer is doing. — Jeffrey Ponsky (guideline) [Ep 6 · 1:08](https://qa.library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=68)
- Programs want a partner in education - someone who actively engages and participates. — Jeffrey Ponsky (opinion) [Ep 6 · 1:21](https://qa.library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=81)
- Interviewers want to know that candidates are willing to invest in their own education. — Jeffrey Ponsky (opinion) [Ep 6 · 1:35](https://qa.library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=95)
- Candidates should give interviewers a plan for their future and a vision for their career. — Jeffrey Ponsky (guideline) [Ep 6 · 1:42](https://qa.library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=102)
- Candidates should tell interviewers what they want to do and what their dreams are. — Jeffrey Ponsky (guideline) [Ep 6 · 1:48](https://qa.library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=108)
- A candidate who is 'electric' and engaging can be preferred even if their grades were just OK. — Jeffrey Ponsky (opinion) [Ep 6 · 1:58](https://qa.library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=118)
- During interviews, candidates should not be shy but also should not be a jerk. — Jeffrey Ponsky (guideline) [Ep 6 · 2:09](https://qa.library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=129)
- The interview is an important opportunity for candidates. — Jeffrey Ponsky (opinion) [Ep 6 · 2:17](https://qa.library.globalcastmd.com/watch/residency-advice-dr-jeffrey-ponsky-st-george-s-university-13685?t=137)
- Dr. Ponsky did not patent the PEG tube invention. — Jolene Espinoza (opinion) [Ep 2 · 5:14](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=314)
- Medical truth depends on the tools available to perceive it; as tools improve, our understanding of truth changes. — Jeffrey Ponsky (opinion) [Ep 2 · 9:12](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=552)
- In the late 1800s at Johns Hopkins, medical education focused primarily on anatomy because other fields (pharmacology, blood typing, antibiotics) did not yet exist. — Jeffrey Ponsky (clinical) [Ep 2 · 10:32](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=632)
- In 1889, gastric acid was believed to be the cause of peptic ulcer disease. — Jeffrey Ponsky (clinical) [Ep 2 · 13:07](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=787)
- H. pylori was discovered in 1990 as a cause of peptic ulcer disease by blocking prostaglandin E3 production and destroying the mucosal barrier. — Jeffrey Ponsky (clinical) [Ep 2 · 13:32](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=812)
- William Halsted became addicted to cocaine while experimenting with it as a local anesthetic in the 1880s. — Jeffrey Ponsky (clinical) [Ep 2 · 14:35](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=875)
- Gastrojejunostomy, the first operation for peptic ulcer disease, created a connection between stomach and jejunum to drain acid quickly but had a 50% recurrence rate due to marginal ulcers in the unbuffered small bowel. — Jeffrey Ponsky (clinical) [Ep 2 · 16:15](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=975)
- Subtotal gastrectomy (removing 80% of the stomach) had a 99% success rate in preventing ulcers by removing parietal cells that produce acid. — Jeffrey Ponsky (clinical) [Ep 2 · 18:09](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1089)
- Subtotal gastrectomy had high mortality due to lack of intensive care, IV fluids, and antibiotics; survivors often suffered malnutrition (inanition) and could not sustain life. — Jeffrey Ponsky (clinical) [Ep 2 · 19:01](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1141)
- About 15% of subtotal gastrectomy patients developed dumping syndrome with cramps, sweating, hypotension, and diarrhea. — Jeffrey Ponsky (epidemiological) [Ep 2 · 19:38](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1178)
- Early dumping syndrome (20 minutes to 2 hours post-meal) is caused by inappropriate release of vasoactive intestinal polypeptide (VIP) from the pancreas, not hypertonic fluid dumping into the bowel. — Jeffrey Ponsky (clinical) [Ep 2 · 19:52](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1192)
- Late dumping syndrome (2-4 hours post-meal) results from insulin-glucose imbalance: gastric inhibitory polypeptide (GIP) from the intestine stimulates excess insulin release from pancreatic islet cells, causing insulin shock. — Jeffrey Ponsky (clinical) [Ep 2 · 21:05](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1265)
- The subtotal gastrectomy operation was later adapted for bariatric surgery in morbidly obese patients, creating the gastric bypass procedure. — Jeffrey Ponsky (clinical) [Ep 2 · 22:58](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1378)
- Pavlov discovered the phases of digestion; the cephalic phase is triggered by sight or smell of food, mediated by the vagus nerve, causing salivation and gastric acid secretion. — Jeffrey Ponsky (clinical) [Ep 2 · 24:02](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1442)
- The gastric phase of digestion occurs when food distends the stomach and peptones stimulate G cells in the antrum to secrete gastrin, a 17-amino-acid hormone that stimulates parietal cells to produce acid. — Jeffrey Ponsky (clinical) [Ep 2 · 25:34](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1534)
- Lester Dragstedt designed truncal vagotomy to ablate the cephalic phase, but cutting the vagus nerves caused gastric stasis requiring drainage procedures (gastrojejunostomy or pyloroplasty). — Jeffrey Ponsky (clinical) [Ep 2 · 26:48](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1608)
- Truncal vagotomy with drainage had a 15% recurrence rate and was the standard operation from the 1950s through late 1970s. — Jeffrey Ponsky (epidemiological) [Ep 2 · 28:21](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1701)
- Complications of truncal vagotomy included diarrhea from bowel denervation, gallstones from liver denervation, and 15% dumping syndrome from pylorus destruction or bypass. — Jeffrey Ponsky (clinical) [Ep 2 · 29:13](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1753)
- Antrectomy combined with truncal vagotomy removed both the cephalic phase (via vagotomy) and gastric phase (by removing gastrin-producing G cells), achieving a 2% recurrence rate. — Jeffrey Ponsky (epidemiological) [Ep 2 · 30:07](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1807)
- Selective vagotomy denervates only the stomach while preserving the celiac and hepatic branches, eliminating gallstones and diarrhea but maintaining 15% recurrence and dumping syndrome. — Jeffrey Ponsky (clinical) [Ep 2 · 32:38](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=1958)
- The nerve of Latarjet, described by a French anatomist 100 years earlier, is a motor nerve to the pylorus that does not stimulate acid production because it innervates the antrum, which lacks parietal cells. — Jeffrey Ponsky (clinical) [Ep 2 · 34:01](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=2041)
- Highly selective vagotomy denervates the acid-producing body and fundus while preserving the nerve of Latarjet, eliminating the cephalic phase without causing dumping, diarrhea, or gallstones. — Jeffrey Ponsky (clinical) [Ep 2 · 35:17](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=2117)
- Highly selective vagotomy represents a synthesis of histology (knowing where parietal cells are located) with anatomy and physiology. — Jeffrey Ponsky (opinion) [Ep 2 · 35:42](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=2142)
- Discovery favors the prepared mind; combining old information (anatomy, physiology) with new insights enables innovation. — Jeffrey Ponsky (opinion) [Ep 2 · 37:07](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=2227)
- Surgery for peptic ulcer disease is indicated for complications: hemorrhage, obstruction, perforation, and intractability—the same indications as 120 years ago. — Jeffrey Ponsky (guideline) [Ep 2 · 37:48](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=2268)
- Modern management of peptic ulcer obstruction includes pyloroplasty to relieve obstruction, H. pylori treatment, and proton pump inhibitors, potentially avoiding vagotomy and its side effects. — Jeffrey Ponsky (clinical) [Ep 2 · 38:58](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=2338)
- Medical truth continues to evolve; students should combine old and new information creatively to develop future treatments. — Jeffrey Ponsky (opinion) [Ep 2 · 39:53](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=2393)
- In residency interviews, programs seek candidates with strong academic records, reliable letters of recommendation, genuine engagement, and articulated vision for their future. — Jeffrey Ponsky (opinion) [Ep 2 · 40:58](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=2458)
- Active participation in learning—even risking wrong answers—leads to better retention than passive observation because emotional investment strengthens memory. — Jeffrey Ponsky (opinion) [Ep 2 · 43:52](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=2632)
- In earlier days, surgeons had more functionality and flexibility with separate individual ports instead of multi-hole platforms for single-port surgery (opinion) [Ep 10 · 1:08](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=68)
- Current multi-hole platforms have improved functionality compared to earlier versions (opinion) [Ep 10 · 1:25](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=85)
- Multiple puncture holes in fascia was a concern and issue with separate trocar approach (clinical) [Ep 10 · 1:34](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=94)
- Most current platforms have a skin barrier protector sleeve for specimen extraction (clinical) [Ep 10 · 1:39](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=99)
- The mass population is probably not going to adopt the robot for single-site surgery (opinion) [Ep 10 · 2:00](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=120)
- Different types of myotomy have been tried for achalasia, starting from the Levatiti one circular or spiral — Silvanna (clinical) [Ep 10 · 2:23](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=143)
- Circular or spiral myotomies that left both longitudinal and circular layers with only mucosa had complications such as out-pouching — Silvanna (clinical) [Ep 10 · 2:23](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=143)
- Total circular myotomy gives length but the esophagus loses strength — Silvanna (clinical) [Ep 10 · 3:14](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=194)
- Bilateral myotomy is capable of elongating the esophagus while keeping good compliance — Silvanna (clinical) [Ep 10 · 3:14](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=194)
- The LINX device is a rosary of magnets that slide along so when you swallow, the bolus pushes the magnets apart and they lose some attraction force, making it more physiologic — Brian (clinical) [Ep 10 · 4:38](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=278)
- LINX is a potential in-between therapy, maybe more effective than current endoluminal therapies but maybe not as much of a barrier as Nissen, but more physiologic — Brian (opinion) [Ep 10 · 4:21](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=261)
- If you are already suffering what is believed to be a complication of gastroesophageal reflux disease (Barrett's), we should be aggressive about managing that and not just treat it expectantly, similar to a colon polyp — Brian (opinion) [Ep 10 · 5:31](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=331)
- It's not clear whether it's necessary to do radiofrequency ablation for non-dysplastic Barrett's in some people's minds — Brian (opinion) [Ep 10 · 5:51](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=351)
- Buried glands is actually a natural state of Barrett's esophagus — Brian (clinical) [Ep 10 · 6:53](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=413)
- Radiofrequency ablation definitely decreases buried glands and does so more than acid suppression and placebo — Brian (clinical) [Ep 10 · 7:12](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=432)
- If we know ahead of time that there are stones in the common bile duct, we don't send to ERCP but explore the common duct directly, either transcystic or via choledochotomy (clinical) [Ep 10 · 8:12](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=492)
- In a review of 500 ERCPs from 10 different endoscopists, only 68% were able to clean the biliary tree (clinical) [Ep 10 · 8:58](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=538)
- In many countries in Latin America, an endoscopist does 100 cases in 10 years as it's not everyday routine (epidemiological) [Ep 10 · 9:42](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=582)
- It's possible to do exploration of the common bile duct with decreased cost, same morbidity, and probably even less morbidity than ERCP (opinion) [Ep 10 · 9:42](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=582)
- Gastric leaks and biliary leaks have very common closure rates and usually close in about 2 to 3 weeks (clinical) [Ep 10 · 11:08](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=668)
- Most surgeons leave stents in place until about 4 to 6 weeks because it's not a big deal to remove them (clinical) [Ep 10 · 11:26](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=686)
- Chronic fistulas, especially tracheoesophageal fistulas managed for months through drainage procedures, clips, and glues, are left with stents for a much longer period and have lower success rates (clinical) [Ep 10 · 11:33](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=693)
- Many single-port surgery instruments were originally developed in preparation for NOTES (natural orifice transluminal endoscopic surgery). — Jeffrey Ponsky (clinical) [Ep 25 · 0:09](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=9)
- Laparoscopic incisions are hardly noticeable a month after surgery. — Jeffrey Ponsky (clinical) [Ep 25 · 0:34](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=34)
- Single-port surgery may make it difficult in the ER or clinical care to determine what procedures patients have had done due to lack of visible scars. — Jeffrey Ponsky (opinion) [Ep 25 · 0:57](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=57)
- There is no question that single-port laparoscopy has caught on and is this year's hot topic. — Jeffrey Ponsky (opinion) [Ep 25 · 1:16](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=76)
- The speaker is not sure that single-port surgery results in less pain than standard laparoscopy. — Jeffrey Ponsky (opinion) [Ep 25 · 1:30](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=90)
- The speaker is not sure that single-port surgery results in less morbidity than standard laparoscopy. — Jeffrey Ponsky (opinion) [Ep 25 · 1:34](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=94)
- The speaker does not think single-port surgery is less expensive than standard laparoscopy. — Jeffrey Ponsky (opinion) [Ep 25 · 1:38](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=98)
- Improved cosmetics is the whole selling point of single-port surgery, and patients want this, particularly in certain subsets of the population. — Jeffrey Ponsky (opinion) [Ep 25 · 1:42](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=102)
- Right transverse incisions from pyloromyotomy are not very nice incisions when seen years later in older patients. — Jeffrey Ponsky (clinical) [Ep 25 · 1:57](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=117)
- The speaker trained in an era when laparoscopy was performed with room air under local anesthesia with one eye to the scope. — Jeffrey Ponsky (clinical) [Ep 25 · 2:28](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=148)
- Laparoscopy became much easier after the advent of the video camera adapted to the scope. — Jeffrey Ponsky (clinical) [Ep 25 · 2:42](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=162)
- Single-site laparoscopic surgery is currently very difficult with surgeons banging into one another. — Jeffrey Ponsky (clinical) [Ep 25 · 2:50](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=170)
- With modified trocars, instruments, and laparoscopes, single-site surgery will become easier, and techniques may improve in the future. — Jeffrey Ponsky (opinion) [Ep 25 · 2:59](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=179)
- Traditional trocars placed through a single site move independently of one another (advantage), but their big heads bump into one another (disadvantage). — Jeffrey Ponsky (clinical) [Ep 25 · 3:25](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=205)
- The Advanced Surgical multi-port trocar (now distributed by Olympus) now has a quad port with four ports instead of three and is very easy to use and effective. — Jeffrey Ponsky (clinical) [Ep 25 · 3:45](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=225)
- The Advanced Surgical multi-port trocar used to leak out of the valves because the gel leaked, but this has been improved. — Jeffrey Ponsky (clinical) [Ep 25 · 3:57](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=237)
- The SurgiQuest trocar has no valve and uses rapid flow of CO2 so that there is no loss of pneumoperitoneum and no smudging of the lens regardless of what is inserted. — Jeffrey Ponsky (clinical) [Ep 25 · 4:01](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=241)
- The SurgiQuest trocar makes a little bit of noise in the operating room, which some people may not like. — Jeffrey Ponsky (clinical) [Ep 25 · 4:25](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=265)
- Applied Medical's gel port allows insertion of multiple trocars wherever desired, a concept taken from hand-assist laparoscopy. — Jeffrey Ponsky (clinical) [Ep 25 · 4:35](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=275)
- Covidien has developed a single-piece expandable port that is squeezed down small, popped in, and then expands, with the number of openings being modified from three to four. — Jeffrey Ponsky (clinical) [Ep 25 · 4:59](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=299)
- The Covidien expandable ports wiggle around a little bit, allowing them to function somewhat like multiple independent devices. — Jeffrey Ponsky (clinical) [Ep 25 · 5:11](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=311)
- Paul Kerchelow and his wife Stephanie King developed a technique using multiple low-profile Apple trocars for single-site surgery. — Jeffrey Ponsky (clinical) [Ep 25 · 5:32](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=332)
- The Apple trocar technique involves raising a flap above the fascia, inserting the first trocar, then raising more tissue and inserting additional trocars. — Jeffrey Ponsky (clinical) [Ep 25 · 5:46](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=346)
- With single-site surgery using the Apple trocar technique, you never see your additional trocars coming in, requiring extra caution. — Jeffrey Ponsky (clinical) [Ep 25 · 6:00](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=360)
- The anchor port is small, distended, popped in, then released to lock in place, and these trocars could be used in many situations beyond single-site surgery. — Jeffrey Ponsky (clinical) [Ep 25 · 6:16](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=376)
- Optical entry, used for a long time in standard laparoscopy, can be used in single-site surgery. — Jeffrey Ponsky (clinical) [Ep 25 · 6:41](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=401)
- The low-profile Apple trocars used by Paul Kerchelow and Stephanie King are very small and allow movement in multiple directions when placed. — Jeffrey Ponsky (clinical) [Ep 25 · 6:46](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=406)
- Many surgeons are very good at using rigid instruments for single-port surgery, and some are even good at crossing their hands, which is sometimes necessary. — Jeffrey Ponsky (clinical) [Ep 25 · 7:02](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=422)
- Rigid instruments sometimes bang into the scope and into each other during single-port surgery. — Jeffrey Ponsky (clinical) [Ep 25 · 7:19](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=439)
- Novare's real hand instruments allow maneuvering but are not necessarily intuitive and don't always work as expected, though they represent a great advancement. — Jeffrey Ponsky (clinical) [Ep 25 · 7:19](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=439)
- Covidien has rigid rotating graspers, scissors, and other instruments that articulate and are very good for dissecting and retracting. — Jeffrey Ponsky (clinical) [Ep 25 · 7:36](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=456)
- Curved instruments provide a new concept where the curved portion goes out of the visual field and back in, potentially obviating the need to cross instruments, and can be rotated around. — Jeffrey Ponsky (clinical) [Ep 25 · 7:53](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=473)
- If curved instruments are not the right length, they get in the way and are frustrating because they work well at a particular focal length but not at others. — Jeffrey Ponsky (clinical) [Ep 25 · 8:13](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=493)
- Two-millimeter minilap instruments for needlescopic surgery can be used for single-port surgery to add another port without taking up much space. — Jeffrey Ponsky (clinical) [Ep 25 · 8:25](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=505)
- The EndoGrab device, developed by an Israeli company for NOTES, does not require a trocar and can be clipped to tissue (such as the gallbladder) and then to the parietal peritoneum to provide retraction. — Jeffrey Ponsky (clinical) [Ep 25 · 9:07](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=547)
- The EndoGrab device could be used for regular laparoscopy, single-site surgery, or NOTES in the future. — Jeffrey Ponsky (opinion) [Ep 25 · 9:55](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=595)
- Rigid laparoscopes get in the way during single-port surgery, leading to use of flexible-tip laparoscopes by companies like Olympus and Stryker. — Jeffrey Ponsky (clinical) [Ep 25 · 9:56](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=596)
- Todd Ponsky found he was banging into himself with standard scopes and ports, so he used a 50-centimeter, 5-millimeter bronchoscope with a horizontal cord orientation to get the scope out of the way. — Jeffrey Ponsky (clinical) [Ep 25 · 10:07](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=607)
- The bronchoscope approach got the scope out of the way but had inferior optics compared to chip cameras. — Jeffrey Ponsky (clinical) [Ep 25 · 10:28](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=628)
- The TransEnterix system uses curved instruments that operate outside the visual field, and when used in the laboratory, it feels like doing regular laparoscopic surgery. — Jeffrey Ponsky (clinical) [Ep 25 · 10:44](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=644)
- The TransEnterix system has cost implications. — Jeffrey Ponsky (opinion) [Ep 25 · 11:08](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=668)
- Innovation is expensive, leading some to advocate for reusable instruments. — Jeffrey Ponsky (opinion) [Ep 25 · 11:14](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=674)
- Storz is developing a multi-port single-site port with curved instruments of various shapes as a reusable option. — Jeffrey Ponsky (clinical) [Ep 25 · 11:19](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=679)
- When the speaker used some Storz curved instruments in the lab, sometimes they worked and sometimes it was unclear where to place them. — Jeffrey Ponsky (clinical) [Ep 25 · 11:27](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=687)
- The speaker does not know whether single-port surgery is a game changer, noting that needlescopic surgery with two-millimeter instruments works pretty well. — Jeffrey Ponsky (opinion) [Ep 25 · 11:52](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=712)
- Single-port surgery is being used today for almost every procedure imaginable. — Jeffrey Ponsky (clinical) [Ep 25 · 12:11](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=731)
- The speaker's head of colorectal surgery now prefers single-port surgery for colectomies in adults because they make a single incision to remove the colon anyway. — Jeffrey Ponsky (clinical) [Ep 25 · 12:15](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=735)
- An operative laparoscope can be used to remove the appendix, grasp it, and pull it out through the umbilicus very easily. — Jeffrey Ponsky (clinical) [Ep 25 · 12:29](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=749)
- Robotics for single-port surgery may be very good in the future, but the speaker considers it another way to waste money currently. — Jeffrey Ponsky (opinion) [Ep 25 · 12:39](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=759)
- NOTES initially led to single-port surgery, and single-port surgery may eventually enable NOTES procedures after techniques improve. — Jeffrey Ponsky (opinion) [Ep 25 · 12:50](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=770)
- Danny Scott's magnetic instruments may be dropped through a single port and controlled from outside to perform sophisticated operations including camera insertion. — Jeffrey Ponsky (clinical) [Ep 25 · 13:03](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=783)
- Single-port surgery provides a great cosmetic result and does add that benefit without question. — Jeffrey Ponsky (opinion) [Ep 25 · 13:20](https://qa.library.globalcastmd.com/watch/overview-of-single-incision-surgery-tool-box-and-technique-jeffrey-ponsky-m-d-13728?t=800)
- In the early 20th century, rigid tubes were used for gastrointestinal examination, requiring patient contortion to align with the tubes to look inside the esophagus and colon. — Jeffrey Ponsky (clinical) [Ep 27 · 1:22](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=82)
- Fiber optic technology developed midway through the 20th century allowed endoscopic tubes to become flexible. — Jeffrey Ponsky (clinical) [Ep 27 · 1:39](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=99)
- Therapeutic endoscopy began with pinch biopsies to assess disease activity, then progressed to polypectomy using electrocautery snares to remove polyps that previously required surgical removal. — Jeffrey Ponsky (clinical) [Ep 27 · 2:05](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=125)
- Endoscopic coagulation of bleeding ulcers can prevent the need for surgery. — Jeffrey Ponsky (clinical) [Ep 27 · 2:26](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=146)
- Gallstones can be removed from the bile duct endoscopically by opening the bottom of the bile duct through the endoscope. — Jeffrey Ponsky (clinical) [Ep 27 · 2:37](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=157)
- Balloon-assisted enteroscopy uses balloons on the outside of endoscopes that inflate and deflate to walk down the intestine farther than normal scopes, allowing visualization and treatment of lesions in the small bowel. — Jeffrey Ponsky (clinical) [Ep 27 · 3:40](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=220)
- Video capsule endoscopy involves swallowing a pill-sized capsule with a flashing light that takes pictures frequently, recording to a hip-worn monitor to assess the small intestine for hidden bleeding sources. — Jeffrey Ponsky (clinical) [Ep 27 · 4:13](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=253)
- ERCP allows access to the bile duct opening in the duodenum, enabling injection of dye to visualize problems, cutting of the opening to remove stones, and placement of plastic or metal stents for tumors. — Jeffrey Ponsky (clinical) [Ep 27 · 4:59](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=299)
- Endoscopic ultrasound allows visualization beyond the intestinal wall to assess adjacent organs including the bile duct, pancreas, stomach wall, and vessels, enabling recognition and biopsy of tumors not visible by direct visualization. — Jeffrey Ponsky (clinical) [Ep 27 · 5:48](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=348)
- POEM (per oral endoscopic myotomy) allows treatment of esophageal motility disorders by making a tiny incision in the inner esophageal wall, tunneling down through the esophagus, cutting the lower esophageal muscles, and closing the esophagus internally, avoiding abdominal surgery. — Jeffrey Ponsky (clinical) [Ep 27 · 6:16](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=376)
- Endoscopic mucosal resection (EMR) can shave out tumors seen during endoscopy. — Jeffrey Ponsky (clinical) [Ep 27 · 7:27](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=447)
- Endoscopic submucosal dissection (ESD) allows removal of flat, long, broad tumors by lifting tissue and shaving down to the next layer, providing better cancer or pre-cancer resection than EMR. — Jeffrey Ponsky (clinical) [Ep 27 · 7:36](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=456)
- EMR and ESD have been proven safe and effective and avoid the need for open surgery. — Jeffrey Ponsky (clinical) [Ep 27 · 7:49](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=469)
- Percutaneous endoscopic gastrostomy (PEG) was developed 40 years ago by Michael Gauer and Dr. Ponsky to place feeding tubes in patients who cannot eat due to neurological or oral problems, using endoscopic guidance for needle puncture without open surgery. — Jeffrey Ponsky (clinical) [Ep 27 · 8:03](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=483)
- The PEG procedure was developed after observing bright transillumination through the abdomen of brain-damaged infants during endoscopy, realizing the stomach was in close contact with the abdominal wall and could be accessed with a needle. — Jeffrey Ponsky (clinical) [Ep 27 · 9:01](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=541)
- All endoscopic procedures carry risks of bleeding, perforation, or infection. — Jeffrey Ponsky (clinical) [Ep 27 · 9:54](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=594)
- Endoscopic pyloric myotomy can be performed as an outpatient procedure by opening the pyloric muscle in the intramural space, cutting the thick muscle, and clipping it closed, with patients going home the same day with improved gastric emptying. — Jeffrey Ponsky (clinical) [Ep 27 · 10:15](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=615)
- Endoscopic pyloric myotomy requires only a liquid diet for 2 days before the procedure and one week afterward. — Jeffrey Ponsky (clinical) [Ep 27 · 10:39](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=639)
- Zenker's diverticulum, which previously required major neck surgery, can now be treated through the mouth by making a small incision in the back of the throat, cutting the thick muscle, and clipping it closed, allowing same-day discharge. — Jeffrey Ponsky (clinical) [Ep 27 · 10:49](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=649)
- Zenker's diverticulum repair requires a liquid diet for a couple of days before surgery and one week after. — Jeffrey Ponsky (clinical) [Ep 27 · 11:09](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=669)
- Advanced endoscopic procedures are being performed as outpatients or with overnight stays in almost every case. — Jeffrey Ponsky (clinical) [Ep 27 · 11:15](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=675)
- Every surgical procedure is being evaluated for less invasive, endoscopically guided approaches. — Jeffrey Ponsky (opinion) [Ep 27 · 11:34](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=694)
- Robotics will play a future role in endoscopic surgery, including image-guided and robotically controlled surgery for more precise movements and better results. — Jeffrey Ponsky (opinion) [Ep 27 · 11:58](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=718)
- Cleveland Clinic is conducting ongoing evaluation and improvement of endoscopic procedures, integrating new technology to improve results. — Jeffrey Ponsky (clinical) [Ep 27 · 12:37](https://qa.library.globalcastmd.com/watch/all-about-advanced-surgical-endoscopy-13744?t=757)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Dr. Jeff Ponsky's impact on surgical endoscopy has been foundational through academic advancement of technology and technique, mentorship, and leadership in professional organizations like ASGE and SAGES to bring gastroenterology and surgery together in endoscopy. — The host summarizes what Dr. Jeffrey L. Ponsky said [Ep 3 · 11:19](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=679)
- Dr. Ponsky served as director and chair of the American Board of Surgery, president of both ASGE and SAGES, and vice president of the American Surgical Association and SSAT. — The host summarizes what Dr. Jeffrey L. Ponsky said [Ep 3 · 14:36](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=876)
- Dr. Ponsky trained 35 endoscopic surgery fellows who now carry on his legacy. — The host summarizes what Dr. Jeffrey L. Ponsky said [Ep 3 · 14:59](https://qa.library.globalcastmd.com/watch/acs-icons-in-surgery-jeffrey-l-ponsky-md-facs-13682?t=899)
- In Parkinson's disease, neurologists discovered that delivering medication into the jejunum via PEG-J improves patient outcomes. — Jeffrey Ponsky summarizing a resource [Ep 11 · 11:49](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=709)
- Ponsky retired from clinical surgery after performing over 1,600 endoscopies in his final year at Cleveland Clinic. — Steven Rothenberg summarizes what Dr. Jeffrey Ponsky said [Ep 11 · 4:03](https://qa.library.globalcastmd.com/watch/from-idea-to-ubiquity-the-peg-journey-13719?t=243)
- The American Board of Surgery made endoscopy a requirement for surgical training, which put stress on program directors but is necessary for modern bariatric and gastrointestinal surgeons. — Steve summarizes what Dr. Jeff Ponsky said [Ep 1 · 4:03](https://qa.library.globalcastmd.com/watch/endoscopy-and-surgery-13720?t=243)
- J Pasca at Hopkins originated the idea of creating a submucosal tunnel in the esophagus to avoid gastric leaks during NOTES procedures, and realized the esophageal muscle could be cut endoscopically like a Heller myotomy. — Jeffrey Ponsky summarizing a resource [Ep 20 · 2:08](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=128)
- Early European studies of 70 patients showed POEM was effective at one year. — Jeffrey Ponsky summarizing a resource [Ep 20 · 6:11](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=371)
- Eric Hungness and Nat Soper reported POEM was effective in an early study of 18 patients. — Jeffrey Ponsky summarizing a resource [Ep 20 · 6:27](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=387)
- Lee Swanström's 2014 study of 100 patients showed excellent POEM results but increased reflux compared to Heller myotomy. — Jeffrey Ponsky summarizing a resource [Ep 20 · 7:34](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=454)
- Marco Patti's study showed less dysphagia with POEM than with Heller myotomy, but more reflux. — Jeffrey Ponsky summarizing a resource [Ep 20 · 8:19](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=499)
- A prospective randomized controlled trial presented in Europe at the end of 2018 compared Heller myotomy with Dor fundoplication versus POEM and found both were effective in controlling dysphagia. — Jeffrey Ponsky summarizing a resource [Ep 20 · 8:31](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=511)
- In the 2018 RCT, POEM patients had higher reflux rates than Heller patients at two months, but at three years the reflux rates equalized. — Jeffrey Ponsky summarizing a resource [Ep 20 · 8:47](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=527)
- The PEG (percutaneous endoscopic gastrostomy) tube enables feeding without oral ingestion, helping cancer patients survive chemotherapy-induced anorexia and cachexia. — Jolene Espinoza summarizes what Dr. Jeffrey Ponsky said [Ep 2 · 2:23](https://qa.library.globalcastmd.com/watch/special-lecture-dr-jeffrey-ponsky-st-george-s-university-13726?t=143)
- In the New England Journal of Medicine study, there was a significant rate of buried glands in both treatment and placebo groups — Brian summarizing the discussion [Ep 10 · 6:27](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=387)
- The percent of buried glands at baseline before anything was done was around 15% in the placebo group and went up, while in the treatment group it went down — Brian summarizing the discussion [Ep 10 · 6:36](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=396)
- On average, to be able to have 85% success in cannulating and working the biliary tree, you need at least 100 cases — The host summarizing the discussion [Ep 10 · 9:23](https://qa.library.globalcastmd.com/watch/sages-alace-symposium-integrating-new-technologies-old-tricks-and-operative-appr-13727?t=563)

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