# Gastroparesis — GCMD Library living collection

Everything in the library about gastroparesis — built automatically from dossiers that name it.

Updated: n/a · 6 episodes · 77 cited statements

## Episodes
### Surgical Management
- [Gastric Neurostimulators: Update Course 2017](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410) — video · 35:22 · [machine version](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410.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)

### Evidence & Research
- [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)

### In-Depth Reviews
- [Top Ten Things to Remember from the 2017 Stay Current Annual Update Course...](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400) — podcast · 25:04 · [machine version](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400.md)
- [Top Ten Things to Remember: Update Course 2017](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401) — video · 25:04 · [machine version](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401.md)
- [Top Ten Things to Remember: Update Course 2017](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486) — podcast · 25:04 · [machine version](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0) Introduction and Updates 10-9: Gastric Stimulation and Cardiac Sympathectomy (Ep 1)
- [3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180) Updates 8-6: Diaphragm Pacing, Abdominal Wall Reconstruction, and Gastroesophageal Disconnection (Ep 1)
- [7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420) Updates 5-4: Blunt Abdominal Trauma CT Criteria and ATOMAC Solid Organ Protocol (Ep 1)
- [13:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780) Update 3: Radiology Advances - Volumetric CT and Contrast Use (Ep 1)
- [18:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080) Update 2: Top Three Journal of Pediatric Surgery Papers (Ep 1)
- [21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1260) Update 1: Minimally Invasive Pilonidal Disease Treatment (Ep 1)
- [22:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320) Thoracoscopic Lobectomy Technique with Steven Rothenberg (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=0) Introduction and Gastric Stimulation for Gastroparesis (Ep 2)
- [3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=180) Cardiac Sympathectomy for Arrhythmia and Diaphragm Pacing (Ep 2)
- [7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420) Abdominal Wall Reconstruction and Gastroesophageal Disconnection (Ep 2)
- [12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720) Blunt Abdominal Trauma CT Criteria and ATOMAC Solid Organ Protocol (Ep 2)
- [17:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020) Radiology Updates: CT for Foreign Body and Contrast Use (Ep 2)
- [21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260) Top Journal Papers: Pyloric Stenosis, Pneumomediastinum, and TEF Leaks (Ep 2)
- [23:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1380) Pilonidal Disease: Minimally Invasive Punch-Biopsy Technique (Ep 2)
- [24:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440) Thoracoscopic Lobectomy Technique Pearls (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=0) Case 1: 17-year-old with autoimmune gastroparesis—workup and treatment decision (Ep 3)
- [5:27](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=327) Gastric stimulation mechanism and temporary trial rationale (Ep 3)
- [14:24](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=864) Stimulation parameters and device implantation technique (Ep 3)
- [21:56](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1316) Case 2: Post-Nissen wretching in neurologically impaired child (Ep 3)
- [28:45](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1725) Trial duration, placebo effect, and mechanism of action (Ep 3)
- [33:44](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=2024) Safety, insurance coverage, and institutional experience (Ep 3)
- [0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=0) Introduction and Gastric Stimulation for Gastroparesis (Ep 4)
- [3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=180) Cardiac Sympathectomy for Arrhythmia Management (Ep 4)
- [6:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=360) Diaphragm Pacing for Ventilator Dependence (Ep 4)
- [8:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=480) Modern Abdominal Wall Reconstruction Techniques (Ep 4)
- [11:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=660) Gastroesophageal Disconnection for Failed Fundoplication (Ep 4)
- [14:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=840) CT Scan Decision Rule for Blunt Abdominal Trauma (Ep 4)
- [17:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1020) Revised Solid Organ Injury Management Protocol (Ep 4)
- [20:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1200) Radiology Updates: CT for Foreign Body and Contrast Use (Ep 4)
- [22:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1320) Top Journal Articles: Pyloric Stenosis, Pneumomediastinum, and TEF Leaks (Ep 4)
- [23:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1380) Minimally Invasive Pilonidal Disease Treatment and Thoracoscopic Lobectomy Technique (Ep 4)
- [0:08](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=8) Introduction and Early Background (Ep 5)
- [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 5)
- [10:40](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=640) Development of PEG Procedure (Ep 5)
- [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 5)
- [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 5)
- [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 5)
- [34:49](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=2089) NOTES and Noscar Consortium (Ep 5)
- [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 5)
- [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 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Gastric emptying scan showing 90% retention at 2 hours indicates severe gastroparesis. — Ronaldo (clinical) [Ep 3 · 3:54](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=234)
- The stomach's intrinsic pacemaker (interstitial cells of Cajal) generates electrical activity at 3 cycles per minute, 20–40 millivolts. — Ronaldo (clinical) [Ep 3 · 14:49](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=889)
- Gastric electrical activity sets the pace for contractions but does not initiate them; a stomach with 3 waves/min cannot contract more than 3 times/min. — Ronaldo (clinical) [Ep 3 · 15:50](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=950)
- Gastric stimulation uses low voltage (≤7V) and low current (≤10 mA) to reorganize gastric electrical conductivity, not to directly pace the stomach. — Ronaldo (clinical) [Ep 3 · 17:15](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1035)
- Temporary gastric stimulation can be performed via nasal leads (cardiac pacing wires clipped endoscopically) or via G-tube using fetal scalp electrodes. — Ronaldo (clinical) [Ep 3 · 26:25](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1585)
- Approximately 30% of patients do not respond to permanent gastric stimulation; temporary trial predicts response. — Todd Ponsky (clinical) [Ep 3 · 19:51](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1191)
- Post-Nissen wretching in patients with intact fundoplication and delayed gastric emptying may respond to gastric stimulation. — Todd Ponsky (clinical) [Ep 3 · 11:42](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=702)
- Performing Nissen fundoplication in a chronic vomiter may convert vomiting to wretching if gastroparesis is present. — Todd Ponsky (clinical) [Ep 3 · 11:59](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=719)
- Temporary gastric stimulation trials should last more than 2–3 days to distinguish placebo effect from true response. — Todd Ponsky (clinical) [Ep 3 · 29:25](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1765)
- Gastric stimulation likely works via vagal afferent modulation affecting brainstem nausea centers, not by improving gastric emptying. — Ronaldo (opinion) [Ep 3 · 32:18](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1938)
- Adult studies have not shown significant improvement in gastric emptying with gastric stimulation. — Todd Ponsky (clinical) [Ep 3 · 32:42](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1962)
- Patients reliably report symptom recurrence when gastric stimulator batteries fail. — Ronaldo (clinical) [Ep 3 · 31:31](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1891)
- Laparoscopic gastric stimulator implantation takes approximately 5 minutes in experienced hands. — Ronaldo (clinical) [Ep 3 · 21:56](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1316)
- Stimulation parameters: 14 Hz frequency, on 3 seconds / off 2 seconds, ≤10 mA current, ≤7V voltage. — Ronaldo (clinical) [Ep 3 · 20:25](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1225)
- Some patients feel transient sensation ("butterflies") when stimulator settings are changed, but most adapt within 1–2 days. — Todd Ponsky (clinical) [Ep 3 · 18:18](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1098)
- The implantable pulse generator (anode) can cause sensation if placed too close to the dermis, especially in thin children with little subcutaneous fat. — Ronaldo (clinical) [Ep 3 · 18:45](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1125)
- Jejunal feeding is not a long-term solution for gastroparesis; it is a diagnostic test to assess symptom response to bypassing the stomach. — Todd Ponsky (opinion) [Ep 3 · 7:23](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=443)
- Performing Nissen fundoplication often improves delayed gastric emptying in pediatric patients. — Todd Ponsky (clinical) [Ep 3 · 10:43](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=643)
- Post-Nissen wretching is the most exciting outcome for gastric stimulation, with dramatic symptom relief. — Todd Ponsky (opinion) [Ep 3 · 11:42](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=702)
- Performing fundoplication for nausea alone (without reflux) is the wrong operation. — Todd Ponsky (opinion) [Ep 3 · 11:47](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=707)
- Peroral pyloromyotomy (endoscopic) is now used in adults for gastroparesis and may change management, though pediatric experience is limited. (clinical) [Ep 3 · 13:00](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=780)
- Pediatric insurance denials for gastric stimulation are rare, unlike in adult populations. — Todd Ponsky (clinical) [Ep 3 · 34:29](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=2069)
- No patients who responded to temporary stimulation failed permanent implantation at the presenters' institution. — Ronaldo (clinical) [Ep 3 · 34:29](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=2069)
- Some patients have initial response to gastric stimulation but experience symptom recurrence long-term, possibly due to psychosocial or other factors. — David (clinical) [Ep 3 · 30:40](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1840)
- Gastric stimulation for obesity has passed FDA trials and is approved in Europe. — Ronaldo (clinical) [Ep 3 · 33:28](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=2008)
- Laparoscopic Heller myotomy is the gold standard for the treatment of achalasia. — Jeffrey Ponsky (clinical) [Ep 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 51:15](https://qa.library.globalcastmd.com/watch/meet-the-master-jeffrey-l-ponsky-md-facs-13683?t=3075)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Gastric stimulation for pediatric gastroparesis can be tested temporarily via endoscopic placement before permanent laparoscopic or open implantation — Todd Ponsky summarizing a resource [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0)
- Reynaldo Garcia from Akron Children's Hospital presented gastric stimulation results showing significant symptom improvement in patients with persistent nausea and vomiting unresponsive to medical therapy — Todd Ponsky summarizing a resource [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0)
- Cardiac sympathectomy for CPVT (catecholaminergic polymorphic ventricular tachycardia) and hypertrophic cardiomyopathy involves high thoracoscopic approach to the lower stellate ganglion to prevent fatal arrhythmias — Todd Ponsky summarizing a resource [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0)
- Sophia Abdulhai and John Clark presented cardiac sympathectomy technique using clips and scissors for partial stellate ganglion resection, avoiding electrocautery to prevent Horner's syndrome — Todd Ponsky summarizing a resource [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0)
- Sympathectomy provides 100% compliance for arrhythmia management as patients cannot skip the intervention once performed — Todd Ponsky summarizing a resource [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=0)
- Ray Anders from University Hospitals of Cleveland demonstrated diaphragm pacing for spinal cord injury, transverse myelitis, acute flaccid myelitis, and brain stem tumors, with youngest implant at one year of age — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- Diaphragm pacing requires intact phrenic nerve and motor neurons; diaphragm contraction with neurostimulation must be confirmed before implantation — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- Dave Carpata from Cleveland Clinic stated biologic mesh is not appropriate for bridging gaps in ventral hernia repair, only for temporary solution or reinforcement — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- The best mesh for ventral hernia repair is macroporous monofilament lightweight polypropylene synthetic mesh such as Marlex, which performs well in contaminated fields in retromuscular space — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- Retrorectus repair with mesh is superior to laparoscopic underlay for ventral hernia repair — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- Posterior component separation has less wound morbidity than anterior component separation while providing space for wide mesh overlap and minimal fixation — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- David Lanning from Virginia Commonwealth presented gastroesophageal disconnection (esophageal division with Roux-en-Y jejunal interposition) for severe reflux after failed Nissen fundoplication — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- Gastroesophageal disconnection may be appropriate as primary repair for high-risk patients predicted to fail fundoplication — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- Laparoscopic gastroesophageal disconnection can take 6 to 8 hours — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- Patients who took full feeds by mouth preoperatively can continue oral feeding after gastroesophageal disconnection — Todd Ponsky summarizing a resource [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=180)
- Chris Druck published a five-variable prediction rule identifying low-risk population for intra-abdominal injury after blunt trauma to guide CT scan decisions — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- Patients with only abdominal pain after trauma have approximately 5% risk of abdominal injury and nearly 0% chance of requiring intervention — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- Patients with abnormal physical exam findings such as handlebar injury have approximately 15% chance of abdominal injury — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- The low-risk group (55% of trauma population) has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- Patients without abdominal wall trauma, tenderness or distention, with normal chest X-ray, no abdominal pain complaints, normal AST, and normal pancreatic enzymes probably do not need CT scan and can be sent home — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- The ATOMAC prospective multi-institutional solid organ injury protocol de-emphasizes injury grade in favor of clinical predictive factors — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- Patients with solid organ injury who do not respond to 20 cc/kg crystalloid bolus should receive 10-20 cc/kg blood bolus rather than second crystalloid bolus — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- Patients requiring 40 cc/kg blood (4 units) or with hemoglobin less than 7 after blood transfusion should go to the operating room as this indicates non-operative management failure — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- Stable solid organ injury patients can be admitted to the floor with vitals every 2-4 hours and hemoglobin at 6 hours, and discharged the next day if they never required blood transfusion — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- Sean Saint Peter's group demonstrated stable solid organ injury patients can be discharged much more quickly than traditional prolonged admissions based on injury grade — Todd Ponsky summarizing a resource [Ep 1 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=420)
- Mike Rubin from Akron Children's Hospital recommends chest CT for suspected airway foreign bodies in unclear cases, with nearly 100% sensitivity for detecting radiolucent and radiopaque foreign bodies — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- CT scan for suspected airway foreign body eliminates unnecessary bronchoscopies in children with respiratory virus symptoms — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- Oral contrast is unnecessary for suspected bowel obstruction CT scans as intraluminal fluid serves as adequate contrast — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- Eliminating oral contrast speeds up CT acquisition time and prevents nausea and vomiting in bowel obstruction patients — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- Unsuccessful intussusception reduction should be reattempted if there is movement to the ileocecal valve, with second attempts mostly successful — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- Modern pediatric hospital CT scans deliver 1-10 millisieverts of radiation, equivalent to one year of natural background radiation on Earth — Todd Ponsky summarizing a resource [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=780)
- Dalton's pyloric stenosis resuscitation protocol: chloride less than 85 requires 3 fluid boluses, chloride less than 97 requires 2 boluses, chloride greater than 97 with bicarbonate less than 33 requires 1 bolus — Todd Ponsky summarizing a resource [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080)
- Richer's paper showed traumatic or non-traumatic pneumomediastinum requires only chest X-ray without further imaging — Todd Ponsky summarizing a resource [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080)
- Vella's randomized trial of 42 patients with post-TEF repair leaks showed glycopyrrolate group had 124 mL chest tube output versus 370 mL in placebo group — Todd Ponsky summarizing a resource [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080)
- Glycopyrrolate achieved leak resolution in 76% of treatment group versus 29% of placebo group after TEF repair — Todd Ponsky summarizing a resource [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1080)
- The Gips procedure for pilonidal disease involves trephine excision of pits, mosquito extraction of granulation tissue and hair, curettage with smaller trephine, and irrigation with saline then peroxide — Todd Ponsky summarizing a resource [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1260)
- Pilonidal disease Gips procedure takes 3-5 minutes with no packing, no sutures, no drains, and no activity restrictions except avoiding swimming for 2 weeks — Todd Ponsky summarizing a resource [Ep 1 · 21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1260)
- Steven Rothenberg recommends thoracoscopic lobectomy scope placement anterior to scapula tip at mid-axillary line, not posterior, to avoid working in paradox during anterior fissure dissection — Todd Ponsky summarizing a resource [Ep 1 · 22:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320)
- For thoracoscopic lobectomy vessel division, seal proximally and distally separately, make test incision between seals to confirm hemostasis, then complete division rather than using seal-and-divide device — Todd Ponsky summarizing a resource [Ep 1 · 22:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320)
- Understanding segmental pulmonary anatomy allows prediction of vessel relationships to bronchus, such as superior segmental artery location above lower lobe bronchus — Todd Ponsky summarizing a resource [Ep 1 · 22:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320)
- Incomplete fissure during thoracoscopic lobectomy should be managed by layer-by-layer sealing like finger fracture technique until structures are identified — Todd Ponsky summarizing a resource [Ep 1 · 22:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320)
- Contralateral main stem intubation is the best and easiest technique for single lung ventilation during thoracoscopic lobectomy, superior to double lumen tube, bronchial blocker, or CO2 collapse — Todd Ponsky summarizing a resource [Ep 1 · 22:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-from-the-2017-stay-current-annual-update-course-400?t=1320)
- Tom Abel's blinded crossover study showed 100% of patients improved on day 1 (placebo effect), but by day 3 only the stimulation-on group sustained benefit. — Todd Ponsky summarizing the discussion [Ep 3 · 29:25](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1765)
- Tom Abel demonstrated more coordinated gastric electrical waves after stimulation. — Ronaldo summarizing the discussion [Ep 3 · 32:52](https://qa.library.globalcastmd.com/watch/gastric-neurostimulators-update-course-2017-410?t=1972)
- Gastric stimulation reduces symptoms of gastroparesis in pediatric patients with persistent nausea and vomiting that does not respond to medical therapy — Todd Ponsky summarizing a resource [Ep 4 · 1:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=60)
- Temporary gastric stimulating test can be performed endoscopically before permanent implantation — Todd Ponsky summarizing a resource [Ep 4 · 2:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=120)
- High thoracoscopic sympathectomy extending to the lower stellate ganglion can shut off arrhythmias in patients with CPVT and hypertrophic cardiomyopathy who have ICDs — Todd Ponsky summarizing a resource [Ep 4 · 4:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=240)
- Partial resection of the stellate ganglion should be performed using clips and scissors, avoiding electric cautery to prevent Horner's syndrome — Todd Ponsky summarizing a resource [Ep 4 · 4:50](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=290)
- Sympathectomy provides 100% compliance as patients cannot skip the treatment once performed — Todd Ponsky summarizing a resource [Ep 4 · 5:30](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=330)
- Diaphragm pacing can only be used if the phrenic nerve and phrenic motor neurons are intact — Todd Ponsky summarizing a resource [Ep 4 · 7:20](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=440)
- The youngest patient to receive diaphragm pacing implantation was one year of age — Todd Ponsky summarizing a resource [Ep 4 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=420)
- Biologic mesh is not good for bridging a gap in abdominal wall reconstruction and is only a temporary solution or reinforcement — Todd Ponsky summarizing a resource [Ep 4 · 9:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=540)
- The best mesh for abdominal wall reconstruction is macroporous monofilament lightweight polypropylene synthetic mesh such as Marlex, which performs well in contaminated fields in a retromuscular space — Todd Ponsky summarizing a resource [Ep 4 · 9:20](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=560)
- Posterior component separation has less wound morbidity than anterior component separation while providing space for wide mesh overlap and minimal fixation — Todd Ponsky summarizing a resource [Ep 4 · 10:20](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=620)
- Gastroesophageal disconnection may be appropriate as a primary upfront repair for patients at high risk for fundoplication failure — Todd Ponsky summarizing a resource [Ep 4 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=720)
- Laparoscopic gastroesophageal disconnection can take 6 to 8 hours to complete — Todd Ponsky summarizing a resource [Ep 4 · 12:30](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=750)
- Patients who were taking full feeds by mouth preoperatively can continue to do so after gastroesophageal disconnection — Todd Ponsky summarizing a resource [Ep 4 · 12:50](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=770)
- A patient with only abdominal pain after blunt trauma has approximately 5% risk of abdominal injury and almost 0% chance of needing intervention — Todd Ponsky summarizing a resource [Ep 4 · 15:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=900)
- A child with abnormal physical exam findings such as handlebar injury has about 15% chance of abdominal injury — Todd Ponsky summarizing a resource [Ep 4 · 15:30](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=930)
- The low-risk group for abdominal trauma (55% of population) has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention — Todd Ponsky summarizing a resource [Ep 4 · 16:20](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=980)
- Patients without abdominal wall trauma, tenderness or distention, normal chest X-ray, no abdominal pain complaints, normal AST, and no abnormal pancreatic enzymes probably do not need CT scan and can be sent home — Todd Ponsky summarizing a resource [Ep 4 · 16:50](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1010)
- The grade of solid organ injury is falling by the wayside in favor of clinical predictive factors — Todd Ponsky summarizing a resource [Ep 4 · 17:40](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1060)
- Patients who receive 20 cc/kg crystalloid and do not respond should receive 10-20 cc/kg bolus of blood — Todd Ponsky summarizing a resource [Ep 4 · 18:20](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1100)
- If a patient's hemoglobin drops below 7 and they need further blood totaling 40 cc/kg, they probably need to go to the operating room — Todd Ponsky summarizing a resource [Ep 4 · 18:50](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1130)
- Transfusion with 40 cc/kg of blood or 4 units is an indication of failure of non-operative management and the patient should go to the operating room — Todd Ponsky summarizing a resource [Ep 4 · 19:10](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1150)
- Stable solid organ injury patients can be admitted to the floor with vitals every 2-4 hours and hemoglobin check at 6 hours, and can go home the next day if they never needed blood — Todd Ponsky summarizing a resource [Ep 4 · 19:40](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1180)
- Chest CT for suspected airway foreign body has nearly 100% sensitivity and can detect both radiolucent and radiopaque foreign bodies — Todd Ponsky summarizing a resource [Ep 4 · 20:40](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1240)
- Using chest CT for suspected airway foreign bodies will eliminate many unnecessary bronchoscopies — Todd Ponsky summarizing a resource [Ep 4 · 21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1260)
- Oral contrast is not needed for suspected bowel obstruction as fluid serves as the contrast agent — Todd Ponsky summarizing a resource [Ep 4 · 21:30](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1290)
- Patients with unsuccessful intussusception reduction should get a repeat attempt as long as there is some movement — Todd Ponsky summarizing a resource [Ep 4 · 21:50](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1310)
- The average range of radiation from a pediatric CT scan is 1-10 millisieverts, equivalent to living on Earth for one year — Todd Ponsky summarizing a resource [Ep 4 · 22:20](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1340)
- For pyloric stenosis resuscitation: if chloride is less than 85, give 3 boluses of fluid; if less than 97, give 2 boluses; if greater than 97 but bicarbonate less than 33, give 1 bolus — Todd Ponsky summarizing a resource [Ep 4 · 23:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1380)
- Patients with traumatic or non-traumatic pneumomediastinum probably do not need any imaging beyond chest X-ray — Todd Ponsky summarizing a resource [Ep 4 · 23:30](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1410)
- In a study of 42 TEF leak patients randomized to glycopyrrolate vs placebo, the treatment group had 124 mL chest tube output vs 370 mL in placebo, and 76% leak resolution vs 29% in placebo — Todd Ponsky summarizing a resource [Ep 4 · 24:10](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1450)
- The minimally invasive pilonidal procedure involves coring out pits with a trephine, removing granulation tissue and hair with a mosquito, curettage with a smaller trephine, and flushing with saline then hydrogen peroxide, leaving wounds unpacked and unsutured — Todd Ponsky summarizing a resource [Ep 4 · 24:50](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1490)
- For thoracoscopic lobectomy, the scope should be placed anterior to the tip of the scapula at the mid-axillary line, not posterior, to avoid working in paradox — Todd Ponsky summarizing a resource [Ep 4 · 25:40](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1540)
- When sealing blood vessels during thoracoscopic lobectomy, use a sealer (not seal-divider) to seal proximally and distally, make a small nick between seals to verify complete sealing, then complete the cut — Todd Ponsky summarizing a resource [Ep 4 · 26:20](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1580)
- For incomplete fissure during lobectomy, use a sealing device to go layer by layer until structures are identified — Todd Ponsky summarizing a resource [Ep 4 · 25:04](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1504)
- Contralateral main stem intubation is the best and easiest technique for single lung ventilation during thoracoscopic lobectomy — Todd Ponsky summarizing a resource [Ep 4 · 25:04](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-3486?t=1504)
- 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 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 6 · 8:47](https://qa.library.globalcastmd.com/watch/poem-by-surgeons-dr-jeffrey-ponsky-13722?t=527)
- Gastric stimulation reduces symptoms of gastroparesis in children with persistent nausea and vomiting unresponsive to medical therapy. — Todd Ponsky summarizing a resource [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=0)
- Temporary endoscopic gastric stimulation testing can predict response before permanent laparoscopic or open placement. — Todd Ponsky summarizing a resource [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=0)
- Thoracoscopic sympathectomy extending to the lower stellate ganglion can reduce ICD shocks in patients with CPVT and hypertrophic cardiomyopathy. — Todd Ponsky summarizing a resource [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=180)
- Partial resection of the stellate ganglion should use clips and scissors; electric cautery may damage the remaining ganglion and cause Horner's syndrome. — Todd Ponsky summarizing a resource [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=180)
- Sympathectomy provides 100% compliance because patients cannot skip the intervention once performed. — Todd Ponsky summarizing a resource [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=180)
- Diaphragm pacing is a reasonable option for children with spinal cord injury, transverse myelitis, acute flaccid myelitis, or brainstem tumors, allowing ventilator independence. — Todd Ponsky summarizing a resource [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=180)
- Diaphragm pacing requires an intact phrenic nerve and phrenic motor neurons; diaphragm contraction with neurostimulation must be confirmed before implantation. — Todd Ponsky summarizing a resource [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=180)
- The youngest patient to receive diaphragm pacing was one year of age. — Todd Ponsky summarizing a resource [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=180)
- Biologic mesh is not suitable for bridging gaps in ventral hernia repair; it is only a temporary solution or reinforcement. — Todd Ponsky summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420)
- The best mesh for ventral hernia repair is macroporous monofilament lightweight polypropylene synthetic mesh such as Marlex, which performs well in contaminated fields in the retromuscular space. — Todd Ponsky summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420)
- Retrorectus repair is superior to laparoscopic underlay for ventral hernias. — Todd Ponsky summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420)
- Posterior component separation has less wound morbidity than anterior component separation while providing space for wide mesh overlap and minimal fixation. — Todd Ponsky summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420)
- Gastroesophageal disconnection (esophageal division with Roux-en-Y jejunal interposition) is effective for children with severe reflux who have failed Nissen fundoplication. — Todd Ponsky summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420)
- Gastroesophageal disconnection may be appropriate as a primary repair in patients at high risk for fundoplication failure. — Todd Ponsky summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420)
- Laparoscopic gastroesophageal disconnection can take 6 to 8 hours. — Todd Ponsky summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420)
- Patients who were taking full feeds by mouth preoperatively can continue to do so after gastroesophageal disconnection. — Todd Ponsky summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=420)
- A five-variable prediction rule identifies children at low risk for intraabdominal injury after blunt trauma: no abdominal pain, normal abdominal exam, normal chest X-ray, normal AST, and normal pancreatic enzymes. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720)
- Children with only abdominal pain after blunt trauma have approximately 5% risk of abdominal injury and less than 0.3% risk of requiring intervention. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720)
- Children with abdominal wall trauma (e.g., handlebar injury) have approximately 15% risk of abdominal injury. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720)
- The low-risk group (55% of the trauma population) has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention; these patients may not need CT and can be observed or sent home with close follow-up. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720)
- The ATOMAC protocol recommends earlier blood transfusion: after 20 cc/kg crystalloid bolus, non-responders should receive 10–20 cc/kg blood rather than additional crystalloid. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720)
- Transfusion of 40 cc/kg blood (or 4 units) is an indication of non-operative management failure in solid organ injury; these patients should go to the operating room. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720)
- Patients with solid organ injury who respond to initial resuscitation and never require blood transfusion can be discharged the next day. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720)
- Stable solid organ injury patients should be admitted to the floor (not ICU) with vitals every 2–4 hours and hemoglobin at 6 hours; if hemoglobin remains above 7 and the patient is asymptomatic, they can be discharged. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720)
- The grade of solid organ injury is no longer the primary guide for management; clinical predictive factors are now used instead. — Todd Ponsky summarizing a resource [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=720)
- Volumetric chest CT has nearly 100% sensitivity for airway foreign body, including radiolucent objects. — Todd Ponsky summarizing a resource [Ep 2 · 17:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020)
- Chest CT for suspected airway foreign body can eliminate unnecessary bronchoscopies in children with unclear history or respiratory virus symptoms. — Todd Ponsky summarizing a resource [Ep 2 · 17:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020)
- Oral contrast is unnecessary for suspected bowel obstruction; fluid in the bowel serves as the contrast agent. — Todd Ponsky summarizing a resource [Ep 2 · 17:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020)
- Omitting oral contrast speeds up CT acquisition and prevents nausea and vomiting in patients with bowel obstruction. — Todd Ponsky summarizing a resource [Ep 2 · 17:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020)
- Repeat enema reduction attempts for intussusception are appropriate if there is movement of the intussusception toward the ileocecal valve. — Todd Ponsky summarizing a resource [Ep 2 · 17:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020)
- Modern pediatric CT scans deliver 1–10 millisieverts of radiation, equivalent to one year of background radiation on Earth. — Todd Ponsky summarizing a resource [Ep 2 · 17:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1020)
- For pyloric stenosis resuscitation, if chloride is less than 85, give 3 boluses of fluid; if chloride is less than 97, give 2 boluses; if chloride is greater than 97 but bicarbonate is less than 33, give 1 bolus. — Todd Ponsky summarizing a resource [Ep 2 · 21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260)
- Traumatic or non-traumatic pneumomediastinum requires only chest X-ray; no further imaging is needed. — Todd Ponsky summarizing a resource [Ep 2 · 21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260)
- Intravenous glycopyrrolate (Robinol) improves closure rates of post-TEF repair leaks: 76% in the treatment group vs 29% in the placebo group. — Todd Ponsky summarizing a resource [Ep 2 · 21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260)
- Glycopyrrolate treatment reduced chest tube output in post-TEF leak patients: 124 mL in the treatment group vs 370 mL in the placebo group. — Todd Ponsky summarizing a resource [Ep 2 · 21:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1260)
- The Gips technique for pilonidal disease involves coring out pits with a trephine, evacuating granulation tissue and hair with a mosquito, curettage with a smaller trephine, flushing with saline then hydrogen peroxide, and leaving the wounds open and unpacked. — Todd Ponsky summarizing a resource [Ep 2 · 23:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1380)
- The Gips pilonidal procedure takes 3–5 minutes with minimal bleeding, no drains, no sutures, and no activity restrictions except avoiding swimming for two weeks. — Todd Ponsky summarizing a resource [Ep 2 · 23:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1380)
- For thoracoscopic lobectomy, the scope should be placed anterior to the scapula tip at the mid-axillary line, directly over the major fissure, not posterior to the scapula. — Todd Ponsky summarizing a resource [Ep 2 · 24:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440)
- Placing the thoracoscope posterior to the scapula tip causes the surgeon to look back on themselves when working in the anterior fissure, creating a paradoxical view. — Todd Ponsky summarizing a resource [Ep 2 · 24:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440)
- When sealing vessels during thoracoscopic lobectomy, seal proximally and distally, then make a small nick between the seals to confirm hemostasis before completing the division; do not use seal-and-divide devices. — Todd Ponsky summarizing a resource [Ep 2 · 24:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440)
- Understanding segmental pulmonary anatomy helps predict vessel location and relationships during thoracoscopic lobectomy; for example, the superior segmental artery comes off the lower lobe with the bronchus directly below it. — Todd Ponsky summarizing a resource [Ep 2 · 24:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440)
- Incomplete fissures should be approached layer-by-layer with a sealing device, similar to finger fracture technique in the liver, until structures are identified. — Todd Ponsky summarizing a resource [Ep 2 · 24:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440)
- Contralateral main-stem intubation is the best and easiest method for single-lung ventilation during thoracoscopic lobectomy, superior to double-lumen tubes, bronchial blockers, or CO2 collapse. — Todd Ponsky summarizing a resource [Ep 2 · 24:00](https://qa.library.globalcastmd.com/watch/top-ten-things-to-remember-update-course-2017-401?t=1440)

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