Todd Ponsky

1077 statements · 38 topics · summaries given as host listed separately

Abdominal Wall Defects · series host Adrenal Tumors · episode host Aerodigestive / ENT · episode host Biliary Atresia · series host CICU / Post-op CHD Care · episode host Colorectal / ARM & Hirschsprung · series host Congenital Lung Lesions (CPAM) · series host Etiologies (Gastroschisis/NEC/Atresia/Volvulus) · series host Fetal Surgery · guest expert Inguinal Hernia · guest expert Intestinal Failure · episode host Intestinal Rehab · series host Intestinal Transplant · episode host Liver Tumors (Hepatoblastoma/HCC) · guest expert Motility / Pseudo-obstruction · episode host Neuroblastoma · series host Pancreatitis · episode host Pectus Excavatum · guest expert Sarcoma (Ewing/Rhabdo) · series host Short Bowel Syndrome · episode host Single Ventricle / HLHS · series host Soft Tissue Sarcoma (lymph nodes) · series host Wilms Tumor · episode host

Featured statements

The interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other, so that even if you just look at a longitudinal strip. You could see gangon cells at the proximal margin, but on the opposite side of that margin there may be no gangon cells, and so you may be dealing with a, a low transition zone pull through in that situation.

quote · Colorectal / ARM & Hirschsprung

in our experience of these drains actually don't drain the leak. Um, I saw this when I was training, and I see it now with my colleagues who still put drains in. Uh, we get routine contrast studies, and there's sometimes a leak that's contained, and it's not drained by the drain. So to me, it's, it's causing pain, it may increase your leak rate, and it doesn't even work most. Of the time. So that's why I don't leave drains.

quote · Esophageal Atresia

The reason that we switched to this, um, is that there are, if it's clearly if airway aspiration, you go to the operating room. It's the ones you don't know. And what we found is the ones you don't know, it's a suspicious story. They were coughing after eating. Um, more often than not, it's reactive airway and it's not a foreign body.

quote · Colorectal / ARM & Hirschsprung

What I use, Joyce, is, um, usually if they're bad enough that you're wondering what their bladder pressures are, they're often intubated. Um, if they're that sick, and so I look at their peak airway pressures to see, so as I'm reducing them, I watch their peak airway pressures, and that's how I decide when to stop reducing.

quote · Abdominal Wall Defects

the studies, uh, currently, I think, uh, you know, what this, uh, is hoping to highlight is the ability to use non-operative management of appendicitis in certain cases, but, um, uh, the studies that we have, uh, show that, uh, having the presence of an appendiculli actually has about a 50% failure rate.

quote · Etiologies (Gastroschisis/NEC/Atresia/Volvulus)

the reason these protocols at least in my opinion are important is because there's not variation in care generally speaking they've been tried and true and work all right but the nurses know what it is and you know you don't need to call a doctor every time you want to increase by 10 cc's or whatever

quote · Abdominal Wall Defects

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Todd's statements about Abdominal Wall Defects 100 statements

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Approach and component separation for suture closure and underlay mesh...

Statement spk_0 uses escharotic painting (escharization) followed by epithelialization for giant omphaloceles Open

Quotation I use escharization. I, I paint them and then treat them, I let them epithelialize. Open

Statement spk_0 tried silver-impregnated Aquacel which stuck to the sac, became incorporated, and could not be removed - described as a disaster Open

Quotation I laid the Aqua cell on the silver Aqua cell and it stuck to the, uh, sack and it became incorporated. And could not get it off. Open

Statement Component separation in small babies is not easy, especially if the omphalocele has been on a silo for a long period and tissues are scarred together Open

Statement Component separation requires dissection to the mid-axillary line to adequately mobilize tissue Open

Statement spk_0 now uses six-ply Surgisis which has 22 tension lines, allowing tension on the patch while bringing fascia together Open

Statement spk_0 had one massive omphalocele case with muscle only at lateral edge requiring combination of lateral component separation, Gore-Tex attachment, and serial stretching over 3 sessions (like Witzman patch) to achieve muscle-to-muscle closure Open

Statement Biologic dressings are not meant to be bridged - they turn into liquid as temporary material, not muscle, unless permanent Open

Statement spk_0 observed one pediatric case where biologic patch appeared to turn into muscle or scar Open

Tricks - Omphalocele - Approach & Component Separation For Suture Closure &...

Quotation I use escharization. I, I paint them and then treat them, I let them epithelialize. Open

Statement Silver Aquacel stuck to the omphalocele sac and became incorporated, failing to fall off as expected once it hardened underneath. Open

Quotation I laid the Aqua cell on the silver Aqua cell and it stuck to the, uh, sack and it became incorporated. And could not get it off. Open

Quotation he's one of these minds that you meet and, and he thinks so creatively, so he's so innovative, and every time I watch his videos, Um, I just am fascinated. Open

Statement Component separation dissection to the mid-axillary line is necessary to adequately mobilize tissue and achieve closure. Open

Statement Six-ply Surgisis with 22 tension lines works better, allowing tension on the patch while bringing the fascia together. Open

Statement With escharization and delayed closure, children go home, play, are active regular kids, epithelialize the whole omphalocele, and can be fixed when older with component separation techniques. Open

Quotation we forget where we, we were, where we've come from sometimes, you know, we look at those great old pictures and, you know, of skin covered in phallos, which still didn't have great techniques to fix them, which we do have now. You can just get out of the way. Open

Quotation They go home, they're playing, they're active regular kids. They they epithelialize the whole thing and then fix it when they're older with some of these maybe component separation type techniques. Open

Statement Livers in small-defect omphaloceles can have a mushroom or dumbbell shape, making reduction very difficult. Open

Bilateral Wilm's Tumor - Complex Gastroschisis - Complex Ileal Atresia:...

Statement For gastroschisis, bedside reduction can be attempted under sedation (rectal acetaminophen and small-dose fentanyl) without intubation, with success in approximately 80% of cases even when all bowel is eviscerated. Open

Statement Spring-loaded Bianchi silos may enlarge the fascial defect because the compressive forces are directed outward at the ring level. Open

Statement If apple-peel bowel is ischemic (not necrotic) and not twisted, waiting until the next day to reassess viability is reasonable before committing to resection. Open

Abdominal Wall Defects with Dr. Jacob Langer

Statement Dr. Baird published a paper in JPS showing that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair Open

Statement Spring-loaded silos (Bentech) create outward pressure forces as you push down, making the defect larger over time Open

Statement Cristobal Abello in Colombia uses Duoderm over the sac to compress and reduce omphaloceles over time Open

Statement Phil Gazzetta described the 'flip flop' technique (modification of component separation) for omphalocele closure: lateral incision of anterior sheath only, folding over while attached to posterior sheath, creating single posterior layer Open

Compiled Sandler Rapid Fire Sessions: Update Course 2015

Quotation How do you know for sure there wasn't? Open

Statement For gastroschisis with inflamed bowel, bedside reduction without intubation is feasible using rectal Tylenol and minimal fentanyl Open

Statement Spring-loaded Bianchi silos may enlarge the fascial defect because the outward forces from the compressed ring push laterally Open

Gastroschisis: Advanced Practice Providers

Statement Todd Ponsky has done only non-sutured gastroschisis repair for the last 6 years and has never had a ventral hernia. He reports 10-20% umbilical hernia rate, most resolving by age 3-5 years, with perfect cosmetic results. Open

Quotation I have only done this repair, uh, for the last 6 years. I have not done a sutured repair in 6 years. Open

Quotation I've never had a ventral hernia. Open

Quotation We did a pediatric surgery event just like this, but for the pediatric surgeons, and we pulled the audience, and I think it was about 75% of the surgeons that did the non-sutured repair. Open

Statement In a pediatric surgery event poll, about 75% of surgeons reported doing non-sutured (Tegaderm) gastroschisis repair. Open

Statement For non-sutured closure, Todd Ponsky places a silo on all patients, reduces at bedside, and if everything reduces he closes it by tying the umbilical cord with suture, laying it in a circle over the hole, applying gauze and Tegaderm, waiting 4 days, then changing dressing every 4 days until sealed (usually 2 weeks). Open

Statement Todd Ponsky does not use bladder pressures for gastroschisis monitoring, finding them not terribly accurate in this patient size. He uses peak airway pressures as primary assessment during reduction, watching them to decide when to stop reducing, and looks at overall baby appearance and urine output. Open

Quotation We do not use bladder pressures. Uh, I don't find them to be terribly accurate in this size, uh, patient. Open

Quotation What I use, Joyce, is, um, usually if they're bad enough that you're wondering what their bladder pressures are, they're often intubated. Um, if they're that sick, and so I look at their peak airway pressures to see, so as I'm reducing them, I watch their peak airway pressures, and that's how I decide when to stop reducing. Open

Quotation There's never a downside to just releasing the silo and letting things back out again, right. Open

Statement For gastroschisis monitoring, the volume of NG output matters less than the color: even high-volume clear/spitty output may allow feeding, but any bilious output (regardless of volume) means the patient is not ready to feed. Open

Quotation The exact opposite is true that you can have a ton of spit coming out, but it doesn't mean that they're not ready to be fed, um, so for some reason in the little kids the volume doesn't seem to be as critical, um, as the color. Open

7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW

Quotation Just two days ago, I had a baby that I was operating on. And because you taught me this, the hemoglobin, they were going to transfuse up to a hematocrit of thoracin. No, I learned from the PDC. We don't have to do that anymore. Transfuse clinically. Open

Quotation I don't know if any surgeon would look at that and go 41 percent failure rate is a success. Open

Quotation I use this as something in my back pocket now. So I don't do it, but I have it there. So if someone's not a good surgical candidate, for whatever reason, I don't want it. Then I know I have it as an option, but I don't do it. Open

Abdominal Wall Defects with Dr. Jacob Langer

Statement The sutureless plastic closure technique was described by Anthony Sandler and doesn't require suturing the umbilical cord Open

Statement A study by Dr. Baird published in JPS showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair Open

Statement Spring-loaded silos apply pressure outward as you push down, making the defect larger over time Open

Statement The 'flip flop' technique (modification of component separation) involves incising laterally through anterior sheath only, folding it over while attached to posterior sheath, creating a single posterior sheath closure Open

Umbilical Cord Defects with Dr. Kenneth Azarow

Statement A prospective trial at Dr. Ponsky's institution found triamcinolone (Kenalog) cream superior to silver nitrate for umbilical granulomas, with such a drastic difference the study was stopped early. Open

Statement Analysis of PHIS (Pediatric Health Information System) data showed the mean age for umbilical hernia repair across U.S. children's hospitals is 4 years. Open

Journal of Pediatric Surgery Article Review: January 2022 APSA Issue

Statement At Akron Children's Hospital under Bob Perry, the bonus structure required the entire group to reach a certain RVU threshold for everyone to receive 50% of their bonus, eliminating competition for cases. Open

Quotation In Akron, Bob Perry, the way that he structured the bonus was that the entire group has to get a certain RVU, not a single person. Open

Quotation That way, there was no competition like trying to steal cases and stuff, because the whole group rose as a group. Open

Omphalocele & Gastroschisis

Statement For large omphalocele defects, besides intestine, a good amount of the liver is on the outside in the majority of cases. Open

Statement Fetal growth is tracked monthly in these cases because there is concern for significant growth restriction. Open

Statement For gastroschisis, only ultrasound is normally obtained to confirm the diagnosis without additional imaging. Open

Statement For omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies. Open

Statement Gastroschisis affects approximately one in every 2200 live births. Open

Statement After sequential reduction with plastic clips in omphalocele, the patient is taken to the operating room for delayed primary closure of the fascia and skin. Open

Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS

Quotation We are, we all live in our own little country and we do our own little thing. And it's only when we talk to each other from all over that we do true learning. Open

Quotation This is about rapid fire. We're not doing in-depth stuff here. This is rapid fire, important topics that we feel and that a lot, that's why we bring new faculty in every year, that the faculty feel are kind of the real important points that we need to be highlighting all over the world that came up over the last year or so. Open

Quotation I promise you, I'm making this promise every year, something will glitch. Okay? I've been saying this for nine years. Even a few years ago, the whole power went out in the city and we had to drive to my living room. Something will glitch. Bear with us. Open

Quotation This only, as you know, this is free. This is free because, and we've been trying to keep this free as long as we can. We try to believe that knowledge should be free as long as we can do it, as best we can do it. Open

Statement 26% of respondents use intraoperative ICG to visualize the biliary tree, 23% use it in select patients, and 51% do not use it. Open

Statement Getting phenol into the operating room for sclerotherapy is not always easy due to institutional and pharmacy restrictions. Open

Statement The adoption of sutureless closure for abdominal wall defects represents a major practice change over nine years, with 90% now using it always or selectively compared to much lower rates previously. Open

Statement Approximately 50% of respondents always use sutureless abdominal closure for large abdominal wall defects, 40% use it in select patients, and only 11% do not use it. Open

Statement Implementing ERAS requires team buy-in, particularly from anesthesiologists, because of practice changes like allowing oral intake two hours preoperatively. Open

Statement Most institutions are either taking steps to address social determinants of health or working on it; few report no action. Open

Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee

Quotation the reason these protocols at least in my opinion are important is because there's not variation in care generally speaking they've been tried and true and work all right but the nurses know what it is and you know you don't need to call a doctor every time you want to increase by 10 cc's or whatever Open

Todd's statements about Achalasia 23 statements

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Ponsky and Gauderer invent the PEG tube

Quotation I'm not gonna give a lecture. Usually in these things, we all give a lecture about the state of the art of our specialty. I'm just gonna tell you a little story. Open

Statement 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. Open

Statement In the 1960s, flexible endoscopy was used only for visualization of the GI tract without therapeutic interventions. Open

Statement In the early 1970s, Shina, a surgeon in New York, developed the ability to remove polyps from the GI tract endoscopically. Open

Statement Endoscopic polypectomy was significant because it enabled removal of polyps before they became cancer. Open

Quotation The chief of gastroenterology said, we're not going to train any surgeons to do endoscopy. We won't train you because you're a surgeon. Open

Statement The speaker trained in endoscopy in Canton, Ohio with Jim Canyon, performing approximately 500 cases over nearly 5 months. Open

Quotation He said, You will not touch a scope. Because you're a surgeon Open

Quotation Next day I got a call from my mother-in-law, she said, Go buy a scope. We got you covered. It's your scope. Open

Quotation By the time I finished my residency, I had put the gastroenterologist out of business at University Open

Statement 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. Open

Statement The PEG tube procedure was probably the beginning of minimally invasive surgery. Open

Statement The PEG tube was developed in 1979, almost 40 years before this presentation. Open

Statement Major medical device companies including Olympus, Ross Laboratories, and Eaton Laboratory initially declined to commercialize the PEG tube. Open

Quotation They said we're not interested. Open

Statement The PEG tube was commercialized through American Endoscopy, a small company owned by Marlon Yonker. Open

Statement American Endoscopy was sold to Bard Endoscopy in 1986. Open

Statement The PEG tube is now used and overused throughout the world. Open

Statement The PEG was the first minimally invasive surgical procedure. Open

Statement Current endoscopic procedures include dividing muscles for achalasia, a condition where people cannot swallow. Open

Statement Endoscopic treatment is now available for Zenker's diverticulum, an outpouching of the esophagus causing swallowing difficulty. Open

Statement Surgery is now performed through the endoscope. Open

Quotation Marlon, I love you. Thank you. Open

Todd's statements about Acute Cholecystitis 1 statement

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Gallstone Disease

Statement In A-frame patients (narrow costal margin), port placement must be adjusted lower because ribs prevent standard subcostal port positioning. Open

Todd's statements about Acute Pancreatitis 12 statements

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Acute Pancreatitis

Quotation While most of these audio chapters are recordings between myself and experts in the field, we wanted to try something new this time. Open

Quotation Amylase and lipase, lipase more sensitive than amylase? Open

Welcome and Introductions: Pancreatic Disease

Quotation we have a panel of experts who know more than the rest of the world, it seems, uh, from what I've been reading Open

Statement Cincinnati Children's has been leading the world in pediatric surgical education Open

Statement The event will be recorded and available after 48 hours Open

Statement A new video portal will allow users to search by keyword and watch specific segments rather than entire events Open

Statement The Center of Telehealth at Cincinnati Children's is used daily by experts to help physicians and patients around the world Open

Statement Cincinnati Children's Pancreas Care Center is staffed by a large multidisciplinary group rather than one or two specialists Open

Acute and Acute Recurrent Pancreatitis: Pancreatic Disease

Statement Aspiration of pancreatic necrosis to rule out infection should be reserved for cases of true clinical deterioration; in the absence of significant clinical worsening, avoid needle aspiration due to risk of introducing infection into sterile necrosis. Open

Quotation You can very much be opening a can of worms if you're starting to stick things into the pancreas. Um, I can tell you that I, I think we've had, um, the need for one in the last 10 years, one necrosectomy for, for, you know, necro truly. Awful necrotizing pancreatitis. Open

Quotation In the absence of true significant clinical deterioration, we, we really avoid, avoid sticking needles in the pancreas, sticking drains. Open

Quotation You stick a needle into a collection that may be sterile, and then you have the risk of introducing infection, and then once you have infected necrosis. Things can can really deteriorate. Open

Todd's statements about Acute Recurrent Pancreatitis 14 statements

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Welcome and Introductions: Pancreatic Disease

Quotation we have a panel of experts who know more than the rest of the world, it seems, uh, from what I've been reading Open

Statement Cincinnati Children's has been leading the world in pediatric surgical education Open

Statement The event will be recorded and available after 48 hours Open

Statement A new video portal will allow users to search by keyword and watch specific segments rather than entire events Open

Statement The Center of Telehealth at Cincinnati Children's is used daily by experts to help physicians and patients around the world Open

Statement Cincinnati Children's Pancreas Care Center is staffed by a large multidisciplinary group rather than one or two specialists Open

Acute and Acute Recurrent Pancreatitis: Pancreatic Disease

Quotation In the absence of true significant clinical deterioration, we, we really avoid, avoid sticking needles in the pancreas, sticking drains. Open

Todd's statements about Aerodigestive / ENT 60 statements

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Aerodigestive & Esophageal Surgery - The Unsalvageable Esophagus & Cases

Quotation Some people believe that you have to use a scope to measure the true gap. I may not be at the end. Open

Statement In long-gap atresia, some surgeons use a Hagar dilator to measure the gap, but this may not reach the true end of the distal pouch. A flexible scope is more reliable for accurate gap measurement. Open

Quotation The only problem is the pigs keep dying. Open

Statement In experimental porcine models of endoscopic Foker (using olive beads and wire traction), pressure necrosis at the anastomotic site is the suspected cause of death. Open

Statement Intraluminal magnetic anastomosis is being developed as a minimally invasive approach to long-gap atresia, with the goal of reducing pressure necrosis compared to bead-based traction. Open

Quotation The whole big controversial thing is, do, are we trying too hard to save the esophagus? Open

Quotation Stents don't work in, in scarred, uh, form strictures that are not fresh. Open

Statement Placing endoscopes from above and below during thoracoscopic stricture resection allows identification of the stricture by transillumination ('go to the light'). Open

Statement Magnetic compression anastomosis (magnamosis) has been used successfully for gastrojejunostomy but is unproven in the esophagus. The main limitations are the distance magnets can attract across and the lack of mucosal lining in the resulting anastomosis. Open

Statement Serial bougie dilation (e.g., Maloney or Savary dilators) is less effective than balloon dilation for esophageal strictures. Balloon dilation applies radial force and can crack scar tissue without requiring needle knife incision. Open

Quotation I always tease our gastroenterologists that it's impossible to remove the endoscope without bringing out tissue with it. Open

Statement Mobilizing the gastroesophageal junction to achieve length for primary esophageal anastomosis effectively creates a hiatal hernia and predisposes to reflux. Open

Quotation Clearly I had ischemia because it was 100% a technical issue, whether it was ischemia. Open

Statement For a spit fistula to avoid recurrent TEF, the distal esophageal stump must be fully mobilized down to the diaphragm and separated from the trachea, not just divided and dropped. Open

Quotation It's been a real pleasure being here today and it's been an honor how much I've learned in one day. Open

Quotation Absolutely amazing webinar, some amazing cases with excellent skills that you all brought today. I'm happy that you all are there for us when these cases get beyond the norm. Open

Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula

Statement Trichloroacetic acid (TCA) can be used to demucosalize TEF tracts, but control is less precise than with bugbee cautery; TCA is applied on a pledget and can cause unintended burns if it contacts tissue during insertion. Open

Statement Anal fistula plugs (biologic, cone-shaped, made of Surgisis) can theoretically be used to occlude distal airway fistulas; they are wrapped with barbed suture and inserted into the tract to promote collagen matrix formation and scarring. Open

TEF Presentations (Extended): Aerodigestive & Esophageal Surgery

Quotation This instrument I learned from actually a previous Globalcast and now I use it all the time. Open

Statement The bugbee cautery is useful and underutilized among general surgeons for treating recurrent tracheoesophageal fistulas. Open

Quotation The bugbee is so useful and underutilized among us as general surgeons. Open

Statement The bugbee cautery is useful and underutilized among general surgeons for treating recurrent tracheoesophageal fistulas. Open

Quotation The bugbee is so useful and underutilized among us as general surgeons. Open

Quotation We may underappreciate tracheomalacia or malaysia. Open

Statement General surgeons may underappreciate tracheomalacia or laryngomalacia, making collaboration with ENT colleagues valuable for comprehensive airway assessment. Open

Statement Trichloroacetic acid (TCA) can be used for TEF demucosalization, but it is difficult to control precisely and leaves white tissue everywhere, whereas the bugbee provides more precise control. Open

Quotation I have to tell you what scares me is when I'm done, it's white everywhere because I mean, the whole, it's hard to control it and be precise. Open

Quotation When I switched to the bug bee, I have herby bug bee bug beat, um, it's, uh, it absolutely is much more precise. Open

Quotation I'm always afraid because I can't see down that tube, and I wonder not just word in the esophagus, I wonder if I'm really destroying that fistula so much that I'm gonna perforate Open

Statement Dead button batteries still have about 2 volts and continue to cause damage. Open

Quotation When they're dead, they're still not dead. They're still going. They got about 2 volts Open

Statement Button batteries can be distinguished from coins on AP X-ray by a visible rim, eliminating the need for a lateral view. Open

Statement For TEF repair, all that matters is achieving raw-on-raw tissue contact for healing. Open

Statement Thoracoscopic diaphragmatic hernia repairs may have a higher recurrence rate than open repairs, possibly because they do not cause enough raw-on-raw tissue contact. Open

Statement Anal fistula plugs made of biologic material (surgesis) can be used for TEF repair by wrapping them with barbed VOC suture and inserting them into the fistula tract to promote scarring and collagen matrix formation. Open

Todd's statements about Anorectal Malformation 43 statements

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Cloaca - Prental Imaging & Diagnosis - Counseling

Quotation I have never had a patient referred to me with a prenatal diagnosis of any rectum malformations, cloica ever. Open

Prenatal Imaging and Counseling: Cloaca and Complex ARMs 2015

Quotation I have never had a patient referred to me with a prenatal diagnosis of any rectal malformations, cloica ever. Open

Posterior Sagittal Anorectaplasty in a Female: Pediatric Colorectal...

Statement Total body prep from nipples to toes is standard for these patients, allowing flexibility to flip between supine and prone positions Open

Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)

Quotation Mark, you're always not only good at anal rectum malformations, but you have been interested in All the tech and the media from the very beginning. Open

Quotation What M and I are working on is how we can mass produce content to equilibrate knowledge around the world, and we know that the only way to do that is to use cutting edge technology, automation tools and AI. Open

Statement Notebook LM is a free offering from Google that can create realistic-sounding podcasts between two AI voices from uploaded documents. Open

Quotation I would love to hear your thoughts, Mark, on your first experience with Notebook LM. Open

Quotation No one has been able to do it as well as Notebook LM. Open

Statement The AI-generated podcast voices are not customizable; users are limited to the same male and female voices. Open

Quotation There's actually an incredible video where they uploaded a document telling these two podcast hosts that they were AI and how they reacted. They freaked out. Open

Quotation Do I think this is the future of podcasting? I don't. Open

Statement Notebook LM's beta version allows users to join the AI conversation interactively. Open

Quotation You could click join, and it goes, hey, what's up? And you could say, hey, I heard what you just said about the colostomy. I'm not sure I agree, and then it will talk with you. Open

Quotation The AI revolution has happened, and each month, it's blowing up and replacing jobs. Open

Quotation If you're not, you'll get behind. Open

Statement Hospitals should have teams that continuously bring new AI tools to clinicians every week. Open

Statement Em Gootee triangulates multiple AI platforms to combine the strengths of different tools (intelligence, audio, video). Open

Quotation You have to have human oversight to make sure they're correct. Open

Statement Human oversight is necessary to ensure AI-generated medical content is correct. Open

Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Care (with Help from AI)

Quotation The future will be that you will just tell AI, make me a 10 minute podcast on this so I can listen on the way to work, and you can actually do that now. Open

Statement Notebook LM is a free Google offering that can upload any document and create a realistic-sounding podcast between two people Open

Statement Notebook LM has perfected human-sounding conversation better than any other available tools Open

Quotation We have been trying to replicate this with different tools. No one has been able to do it as well as Notebook LM. Open

Statement The limitation of Notebook LM is that it uses the same two voices (one man and one woman) and is not customizable Open

Quotation There's actually an incredible video where they uploaded a document telling these two podcast hosts that they were AI and how they reacted. They freaked out. Open

Quotation Do I think this is the future of podcasting? I don't. I think the voices are great, but it's not customizable enough. Open

Statement Notebook LM beta version allows users to join the conversation and interact with the AI hosts in real-time Open

Quotation The AI revolution has happened, and each month it's blowing up and replacing jobs. Open

Statement AI can now create functional apps from descriptions alone, with code generated instantly, threatening developer jobs Open

Quotation You have to be looking at AI and using it in your workflow. If you're not, you'll get behind. Open

Statement Medical teams should triangulate multiple AI platforms, using the intelligence of one with the audio of another and video of another to create the best product Open

Quotation She doesn't rely on one AI platform. She will bring 3 or 4 together and use the intelligence of this one with the audio of this one and the video of this one to create the best product. Open

Statement Human oversight with medical writers is necessary to ensure AI-generated medical content is correct Open

Quotation You have to have human oversight to make sure they're correct. We have medical writers that make sure that everything we use is correct. Open

Colorectal Quiz: Episode 49 - Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)

Quotation what em and i are working on is how we can mass produce content to equilibrate knowledge around the world and we know that the only way to do that is to use cutting edge technology automation tools and ai Open

Statement NotebookLM is a free offering from Google that can upload any content and create a realistic-sounding podcast between two people. Open

Quotation do i think this is the future of podcasting i don't i think the voices are great but it's not customizable enough you're stuck with what it decided Open

Quotation the key thing is to be like you're doing and everyone else you have to be looking at ai and using it in your workflow if you're not you'll get behind Open

Quotation the ai revolution has happened and each month it's blowing up and replacing jobs Open

Statement A review article that took two weeks to produce five years ago can now be created in minutes using NotebookLM with the same 30 source articles. Open

Statement NotebookLM can identify gaps in knowledge across multiple research articles and recognize when new articles fill those gaps. Open

Colorectal Quiz: Episode 2

Quotation You all both looked at this image and said, you can tell, obviously, that this is too low, too posterior. Without a stimulator in the office, what do you look for to immediately tell that the analplasty was done too low? Open

Todd's statements about Appendicitis 19 statements

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Standardization of Care for Pediatric Perforated Appendicitis

Statement The way pediatric surgery is done is quite variable and not standardized, especially appendicitis. Open

Appendicitis Management & APPY Trial: Update Course 2016

Quotation what does the evidence tell us about how we should be managing appendicitis Open

Quotation I am not gonna use this as a treatment protocol. I'm treating this as, uh, that's good to know that this is an option Open

Statement At Nationwide, a separate small population with appendicoliths was allowed enrollment, but that arm was stopped based on the failure rate. Open

Statement In a cohort of patients with post-appendectomy abscesses, outcomes were relatively equivalent between drain and no drain, but the biggest abscesses and worst patients received drains. Open

Statement After size-matching to 17.5 cm² (AP versus lateral in axial dimension), there was an advantage to not having a drain. Open

Statement For abscesses less than 20 cm² (less than 4 x 5 cm), drains are typically discouraged because the advantage is small and drains add an extra anesthetic, procedure, and may increase length of stay. Open

Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...

Statement Dr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year. Open

Statement Dr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants. Open

Appendicitis with Dr. Whit Holcomb

Statement 10-12mm fascial incision is needed to safely exteriorize appendix without dropping it, as grasper creates U-shaped configuration Open

Statement Retrospective study of over 700 cases using electrocautery for mesoappendix showed almost no bleeding except one patient with factor 8 deficiency Open

Statement Early 1990s experience at Vanderbilt showed 3 children with adjacent small bowel injuries from cautery during laparoscopic appendectomy requiring reoperation Open

Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...

Statement Dr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year. Open

Statement Dr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants. Open

Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos

Quotation I met Jose Campos at, I think, an IPEG meeting or something and he came up to me and he says, I said, hi, how are you? He goes, yeah, the stuff you're doing is a problem. I was like, nice to meet you too. He said, you're only looking at pediatric surgical journals and pediatric surgical societies, you're missing all of the incredible publications that come out in articles we don't read. Open

Quotation It was invented before there was widespread laparoscopy. It came first. Then laparoscopic. Because of that order, a lot of people favor PEG, but it's blind. I mean, you're putting something right through the belly without looking, so it makes no sense to me. Open

Statement The article by Todd Ponsky Sr. and Mike Goddard on PEG tube placement remains the most cited article in the history of the Journal of Pediatric Surgery, with approximately three times the citations of the number two article. Open

Quotation The article by Jeff Ponsky and Mike Goddard remains the most cited article in the history of the Journal of Pediatric Surgery by far by like three times the number two article so it's a real landmark paper and we owe dr. Ponsky and Goddard a tip the cap for coming up with this technique when it really was the first minimally invasive way to insert a gastrostomy tube. Open

Update Course 2023 - Update Course 2022 and Best of the Best Recap

Quotation Best of the best is since we can't attend every conference, we invite the best conferences once a year to submit their top presentations that they felt were the best. And we do a battle of all of these people around the world to say, to give you a quick update of what was the best at each conference, and then we name at the end, who is the best of each conference and who is the best in the world that year in, in pediatric surgery. Open

Todd's statements about Biliary Atresia 53 statements

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Biliary Atresia - Robert Parry: Update Course 2014

Statement Rich Ricketts' series showed not statistically significant better results with Kasai at 76 days or older compared to 0-75 days, possibly representing a different disease phenotype in late presenters. Open

Statement Reversal of portal flow is a very concerning finding because patients can achieve good biliary drainage and normal bilirubin but still progress to transplant due to profound portal hypertension. Open

Quotation that reversal of portal flow makes me really concerned because, you know, I've I've had patients that I've done a cassa on have achieved good biliary drainage. They've got a normal bilirubin. But their portal hypertension then continues to ramp up Open

Quotation the hepatologists can actually limp these kids along. They're not nutritionally in a great place, but they can get them out to be, you know, a year in the absence of a cassai and the absence of a transplant Open

Statement Hepatologists can manage biliary atresia patients medically for up to a year in the absence of Kasai or transplant, though nutritional status suffers. Open

Statement In patients with end-stage liver disease signs (profound fibrosis, reversed portal flow), Kasai may not improve outcomes and the operative stress may worsen their condition. Open

Quotation it's almost like um a race between regeneration of hepatocytes and progression of fibrosis Open

Quotation I've had a patient that I didn't redo, and I thought surely the thing was a failure because the bilirubin remained elevated, and then at 5 months post-op, the bilirubin dropped to normal Open

Statement Some biliary atresia patients show delayed response to Kasai, with bilirubin remaining elevated for months then dropping to normal at 5 months post-op, suggesting a race between hepatocyte regeneration and fibrosis progression. Open

Quotation if the question is getting them to the OR sooner, now you're going to delay by, you know, however many days, you know, while you're inducing them with phenobarb Open

Statement A recent paper in Gastroenterology described a scoring system using liver biopsy plus clinical parameters with nearly 100% ability to predict biliary atresia. Open

Statement Pathologists' understanding of biliary atresia histology has improved significantly compared to 20 years ago. Open

Statement Interventional radiologists can perform percutaneous liver biopsy safely and routinely, making it a low-barrier test. Open

Biliary Atresia

Quotation This is uh Doctor Greg Tia. Greg is the, uh, congratulations, the new uh chief of pediatric surgery at the Cincinnati Children's Hospital. Open

Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...

Statement Dr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year. Open

Statement Dr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants. Open

Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...

Statement Dr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year. Open

Statement Dr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants. Open

Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS

Quotation We are, we all live in our own little country and we do our own little thing. And it's only when we talk to each other from all over that we do true learning. Open

Statement 26% of respondents use intraoperative ICG to visualize the biliary tree, 23% use it in select patients, and 51% do not use it. Open

Statement Getting phenol into the operating room for sclerotherapy is not always easy due to institutional and pharmacy restrictions. Open

Statement Approximately 50% of respondents always use sutureless abdominal closure for large abdominal wall defects, 40% use it in select patients, and only 11% do not use it. Open

Statement Implementing ERAS requires team buy-in, particularly from anesthesiologists, because of practice changes like allowing oral intake two hours preoperatively. Open

Statement Most institutions are either taking steps to address social determinants of health or working on it; few report no action. Open

Biliary Atresia Part I

Statement IPEG placed a moratorium on laparoscopic Kasai portoenterostomy because of poor outcomes. Open

Heat 1 Winner: Dariusz Patkowski, MD, PhD - Best of the Best in Pediatric Surgery 2024

Statement The thoracoscopic procedure for long gap esophageal atresia using sliding knots is beneficial to learn Open

Quotation I wanna do a whole thing on just sliding knots now. Open

Quotation If it's really true that resecting liver cuts mortality down by 50%, I, I just am curious about the data. Open

Statement Data was presented suggesting that resecting liver cuts mortality down by 50% in biliary atresia, though the judge expressed uncertainty about the data Open

Quotation I would love to know more about the data, but since we couldn't talk to her, I, I, I, I don't know. Open

Quotation I think that also could be a huge, um, breakthrough in pediatric surgery. Open

Quotation Darius, congratulations, you're moving on to the next heat. Open

Todd's statements about Bladder Outlet Obstruction 14 statements

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Fetal Genitourinary Diseases and Bladder Outlet Obstruction: Fetal...

Statement The area of preparing families and children with normal fluid bladder outlet obstruction for chronic medical care is probably most rapidly expanding Open

Quotation We have no good predictors of survival. Many things have been tried. They work with limited ability to predict which uh fetuses will survive into childhood. Open

Statement 50% of fetuses with bladder outlet obstruction that survive to live birth will survive infancy and childhood Open

Statement 50% of fetuses with bladder outlet obstruction will survive to birth with therapy Open

Statement Fetuses with bladder outlet obstruction and normal fluid are delivered close to term to avoid complicating prematurity Open

Statement For bladder outlet obstruction patients with normal amniotic fluid at evaluation, the historical approach has been observation regarding treatment Open

Statement Neonates with bladder outlet obstruction who survived birth and early infancy historically had no opportunity for additional treatment beyond that period Open

Statement There are no good predictors of survival for fetuses with bladder outlet obstruction, though many approaches have been tried with limited predictive ability Open

Statement Many children with bladder outlet obstruction who survived fetal life would die of end-stage renal disease in infancy Open

Statement For bladder outlet obstruction with abnormal fluid at evaluation, the approach includes evaluating renal fluid production and quality, preparing for chronic medical care, and restoring fluid to normal levels if chosen by the family Open

Statement Management of bladder outlet obstruction requires a multidisciplinary team including neonatologists, urologists, transplant surgeons, and nephrologists Open

Statement There is now a growing population of adult survivors of bladder outlet obstruction that requires ongoing care Open

Statement The historical paradigm for bladder outlet obstruction provides language and perspective for counseling families about other genitourinary diseases such as cloaca in females Open

Quotation 50% of fetuses with this disorder will survive to birth with therapy, and 50% of those that survive to live birth will survive infancy and childhood. Open

Todd's statements about Burns 2 statements

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Burns

Statement Escharotomies are performed in the first 24–36 hours if circumferential burns risk limb or torso ischemia; pulse oximetry or Doppler checks every 2 hours guide the decision. Open

Quotation the first thing we do is make sure that they're well decompressed Open

Todd's statements about Cancer 1 statement

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Unconscious Bias

Statement Todd Ponsky admits he thinks of who to put on panels by recalling who he's seen on other panels, thereby perpetuating bias. Open

Todd's statements about Catheter Fracture 2 statements

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Retained Central Venous Catheters

Statement Power ports are polyurethane catheters. Open

Statement Silastic lines generally have a larger size diameter for a given lumen compared to polyurethane lines. Open

Todd's statements about Catheter Retention 2 statements

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Retained Central Venous Catheters

Statement Power ports are polyurethane catheters. Open

Statement Silastic lines generally have a larger size diameter for a given lumen compared to polyurethane lines. Open

Todd's statements about Cervical Spine Injury 33 statements

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Cervical Spine Injury: Update Course 2016

Statement Tincture of time—observing a child overnight in a collar and re-examining when calm—is a valid alternative to immediate advanced imaging in some cases. Open

Statement One neck CT delivers radiation equivalent to approximately 600 plain films. Open

Quotation It takes 600 plane films to equal one neck CT and radiation. Open

Statement If an initial lateral C-spine film is inadequate, proceeding to CT results in radiation exposure from both modalities. Open

Statement Institutional protocols typically drive imaging decisions in level 2 trauma patients, with automatic CT scanning common in many centers. Open

Statement Flexion-extension films can be performed two ways: voluntary patient movement in cooperative older children, or assisted movement under fluoroscopy with a physician present. Open

Pediatric Trauma With Dr. Richard Falcone

Statement The challenge in pancreatic trauma is determining whether there is a pancreatic duct injury. Open

Quotation I think the challenge in pancreas trauma is really trying to figure out is there a duct, a duct injury or not. I think that's, that's your number one, your number one question and your number one concern. Open

Statement There is increasing evidence that true pancreatic duct disruption is better treated with early distal pancreatectomy, ideally spleen-preserving. Open

Statement Some children can have significant-appearing pancreatic injuries on CT, but ERCP or MRCP shows the duct is intact, and these children will heal without surgery. Open

Statement ERCP has the advantage of being potentially therapeutic (stent placement) but the disadvantage of injecting dye that can cause pancreatic inflammation. Open

Statement MRCP does not carry the risk of causing pancreatic inflammation that ERCP does. Open

Statement Conservative management of pancreatic duct disruption can work and pseudocysts are manageable and drainable, but this approach results in longer TPN time and longer hospital length of stay compared to early pancreatectomy. Open

Statement Centers that report good outcomes with distal pancreatectomy for pancreatic trauma are those with surgeons who are very comfortable operating on the pancreas and do it frequently. Open

Statement Surgeons who rarely operate on the pancreas may put patients at more complication risk by attempting distal pancreatectomy, and non-operative management may be in the patient's best interest at such centers. Open

Statement More literature is trending toward operating on pancreatic duct injuries more frequently, and if surgery is chosen, it should be done within the first 24 hours. Open

Statement The decision to operate on pancreatic trauma should be made within the 24-hour window after obtaining ERCP or MRCP to confirm duct disruption. Open

Statement If intraoperative findings show parenchymal pancreatic injury without ductal disruption, the appropriate management is drainage rather than distal pancreatectomy. Open

Statement Cincinnati Children's Hospital data showed that before implementing standardized screening, low socioeconomic status and minority children with head injuries were much more likely to receive skeletal surveys and social services evaluation than middle/upper class non-minority families. Open

Quotation One of the things that that we struggled with is who's making that decision to that which kid needs to be screened and it and how much bias, how much bias there exists around that decision. Open

Statement Abuse occurs in all races and all socioeconomic groups, though economic stress may add some risk. Open

Statement Cincinnati Children's Hospital implemented a protocol where all children under 2 admitted with head injuries from mechanisms not witnessed publicly receive skeletal survey and social work evaluation. Open

Statement Publicly witnessed mechanisms are defined as events seen by unrelated parties (e.g., fall from grocery cart at supermarket, motor vehicle collision), not events witnessed only by family members or caregivers. Open

Quotation Despite evaluating more kids, we would, you would have expected if you increased your denominator, um, you know, your percent positives, you know, positive abuse rates are going to drop. We actually didn't see that. We saw it stayed exactly the same. Open

Statement After implementing standardized screening criteria, the percentage of positive abuse cases remained at 50% despite evaluating more children, indicating previously undetected abuse was being identified. Open

Statement The 50% positive abuse rate in screened children represents a biased population because they had injuries severe enough to require hospital admission. Open

Statement A screening test with nearly 50% positive rate is more productive than most screening tests used for other conditions. Open

Statement Families find standardized non-accidental trauma screening more reassuring because it can be explained as standard protocol for all families with this injury type, not a judgment about the specific family. Open

Quotation The families are reassured by that. Open

Statement Abnormal liver function tests greater than 150-200 indicate good chance of some abdominal injury, but normal LFTs provide very little evidence of safety. Open

Statement Cincinnati Children's Hospital has moved away from routine LFTs, amylase, and lipase in trauma patients, obtaining them only when other indications for CT scan already exist. Open

Statement FAST examination has low sensitivity and is very user-dependent, providing false sense of security in stable patients. Open

Statement FAST remains useful for hypotensive patients to rapidly determine if there is blood in the abdomen, which was the original indication for its development. Open

Todd's statements about CHARGE Syndrome 4 statements

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Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula

Todd's statements about Chest Pain 5 statements

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Patient Testimonial and Experience: Pectus Innovations

Statement Pain team protocols eliminate the need to wait for individual physician orders for pain medication Open

Statement Having a dedicated pain team with established protocols reduces delays in pain medication administration Open

Quotation I think having a pain team and a protocol helps. Helps helps get the patients their their pain medicine faster because they don't have to wait for a doctor to get the order and all that. Open

Pectus-Patient Testimonial and Experience

Statement Having a pain team and protocol helps patients receive pain medicine faster because they don't have to wait for a doctor to write the order Open

Todd's statements about Choledochal Cyst / Biliary 1 statement

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Journal of pediatric surgery Article Review: April 2023, IPEG issue

Quotation I love it. And I think it's great to have a measurement tool that actually has use for clinical decision-making rather than just noting the severity is actually will help guide you in surgery. Open

Todd's statements about Cholelithiasis 13 statements

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Case-Based Journal Review: Cholelithiasis 2024

Quotation It really depends on the patient and the situation. Open

Quotation I typically do it before they go home, and I have not found that it's prohibitively difficult in most cases to do the operation. Open

Quotation So 2% of the time in patients, even if they have no stones, they will get recurrent pancreatitis from their initial insult, whereas 60% if you wait 6 weeks. That is so provocative. That is so clear cut that nobody should be debating this anymore. Open

Statement Even in patients with no stones remaining, 2% will get recurrent pancreatitis from the initial insult Open

Statement When patients present with gallstone pancreatitis, most pain and elevated enzymes occur as the stone is passing, and symptoms often resolve overnight as the stone passes Open

Quotation So if your numbers normalize, I do not do ERCP. I will do an intraoperative changiogram to make sure there's not another stone, but I would not do an ERCP if their numbers normalize. Open

Statement If laboratory values normalize after gallstone pancreatitis, ERCP is not indicated, but intraoperative cholangiogram should be performed to check for additional stones Open

Quotation If I have a patient that comes in with an impacted stone, and their lipase is elevated, the next day their lipase goes up even more, they're, they're getting more and more jaundiced, they're getting worse, I would send them for ERCP because I don't know how good I am at retrieving impacted stones. Open

Statement For patients with impacted stone, rising lipase, and worsening jaundice, ERCP is preferred because surgeon confidence in retrieving impacted stones intraoperatively is lower Open

Quotation So here's an example of where I am old and washed up. The answer to this should be yes. I just don't have as much experience as my younger colleagues. Open

Quotation I agree with you. I am skeptical of papers that claim that something is now the new standard just because it's become their new standard. It doesn't necessarily mean that it's recommended as the standard of care. Open

Statement ICG can be administered intravenously, eliminating the need for instrumentation required by traditional intraoperative cholangiogram Open

Quotation I think we should be learning about ICG. I mean this is provocative for me to say, Todd, come on, get with it. Like this is something you should probably learn. Open

Todd's statements about Cholestasis 13 statements

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Biliary Atresia - Robert Parry: Update Course 2014

Statement Hepatologists can manage biliary atresia patients medically for up to a year in the absence of Kasai or transplant, though nutritional status suffers. Open

Statement In patients with end-stage liver disease signs (profound fibrosis, reversed portal flow), Kasai may not improve outcomes and the operative stress may worsen their condition. Open

Quotation it's almost like um a race between regeneration of hepatocytes and progression of fibrosis Open

Quotation if the question is getting them to the OR sooner, now you're going to delay by, you know, however many days, you know, while you're inducing them with phenobarb Open

Statement Pathologists' understanding of biliary atresia histology has improved significantly compared to 20 years ago. Open

Statement Interventional radiologists can perform percutaneous liver biopsy safely and routinely, making it a low-barrier test. Open

Biliary Atresia

Quotation This is uh Doctor Greg Tia. Greg is the, uh, congratulations, the new uh chief of pediatric surgery at the Cincinnati Children's Hospital. Open

Todd's statements about CICU / Post-op CHD Care 4 statements

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Abdominal Wall Defects with Dr. Jacob Langer

Statement The sutureless plastic closure technique was described by Anthony Sandler and doesn't require suturing the umbilical cord Open

Statement Spring-loaded silos apply pressure outward as you push down, making the defect larger over time Open

Todd's statements about Cloaca 16 statements

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