From
Dr. Jeffrey Ponsky
Jeffrey Ponsky: Portrait of a SAGES Pioneer
With Dr. Jeffrey Ponsky · hosted by Dr. Todd Ponsky
Chapter 1 of 14 · Fundamentals
Early training
Early Life, Medical Training, and Introduction to Endoscopy
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What the experts said
Ponsky was told not to go to college after Cleveland Heights High School, possibly trade school instead, due to poor academic performance.
Ponsky achieved Phi Beta Kappa at Miami of Ohio after working very hard and changing his persona in college.
Ponsky worked as an orderly at age 16 and then as a surgery assistant through college and medical school summers, making him facile with surgical techniques before his surgery clerkship.
In Ponsky's medical school era (second year), most students were already married, making him unusual for being single.
Ponsky married Jackie at age 22; they have been married 48 years, which he calls the luckiest choice and biggest influence on his life.
Surgical residency was 36 hours on and 12 hours off (every other night call), which Ponsky describes as terrible and horrible, not fun.
Ponsky chose endoscopy as a PG-4 elective because he wanted something less demanding, thinking it would be easy after watching gastroenterologists struggle with procedures in the ICU.
The gastroenterology department at the university canceled Ponsky's endoscopy rotation one week before it was scheduled to start, saying they were not training a surgeon and had no spot.
Jim King, a gastroenterologist in Canton, Ohio (1.5 hours from Cleveland), trained Ponsky for almost 5 months, performing about 20 procedures per day.
After training with Jim King and completing about 500 procedures, the head of gastroenterology refused to let Ponsky touch their instruments or teach residents endoscopy.
An endoscope cost $5,200 at the time, which the chairman Bill Holden could not afford to purchase for Ponsky.
Ponsky's mother-in-law purchased an endoscope for him as a Christmas/Hanukkah present after hearing about his situation at a family party.
By offering to come in day or night for GI bleeders and immediate procedures, Ponsky built such a strong practice that he "literally put the GI department out of business" within 2 years, with private internists calling him for every case.
Doctor Holden provided a $5,000 American Cancer Society grant, which Ponsky used to purchase an ERCP scope rather than repaying his mother-in-law.
Ponsky learned ERCP by watching videos, particularly from Peter Cotton, with no formal training and no nurse assistance—he and fellow residents set up the entire table themselves.
By 1976, Ponsky was performing upper endoscopy, colonoscopy, and ERCP, and was hired as chief of surgical endoscopy at University Hospitals.
In 1979, Ponsky and Michael Gauderer developed the PEG (percutaneous endoscopic gastrostomy) procedure after noticing light shining through babies' abdomens during upper endoscopy due to thin abdominal walls.
The first PEG procedures were performed on 5 brain-damaged infants scheduled for open gastrostomy, with maternal consent but no IRB review (which Ponsky does not recall existing at that time).
Ponsky became chairman of surgery at Mount Sinai Hospital at age 32, selected because it was a Jewish hospital, he was Jewish, and known as a good teacher.
Ponsky served as chief of surgery at Mount Sinai for 18 years, where he performed the first adult PEG procedures and modified and improved the equipment.
Around 1980, the American Board of Surgery mandated that surgeons must have experience in endoscopy, but most rotated to GI services where they only watched rather than performed procedures.
Ponsky established endoscopy courses at Mount Sinai with faculty including Ken Ford, George Bercy, Rick Green, Tom Dent, Walter Gazeford, and Willie Webb, teaching basic flexible endoscopy to residents annually.
Jerry Marks, a colorectal surgeon in Philadelphia, founded SAGES around 1980 because ASGE did not want surgical papers on their programs frequently and did not involve surgeons in leadership.
SAGES founding members around 1980 included John Coller, Ken Ford, John Van Sant, Jim Lynn, and others who wanted a place where surgeons could discuss the surgical approach to endoscopy.
Early SAGES meetings had a couple hundred attendees and focused on surgical applications of endoscopy, such as decompressing partial bowel obstruction and managing acute lower GI bleeding, which differed fundamentally from ASGE's medical approach.
Barbara Saltzman became SAGES administrator early on and helped the society grow and mature, later marrying George Bercy to become Barbara Bercy; she is described as the "mother of SAGES."
Around 1989-1990, at a SAGES meeting in Louisville, Jacques Perissat showed a video of laparoscopic cholecystectomy in the exhibit hall (not on the official program), which transformed the field.
SAGES grew from 300 members at the beginning of Ponsky's presidency to 2,000 members at the end of his 18-month term, driven by the laparoscopic cholecystectomy revolution.
Unlike hierarchical surgical societies where older, accomplished surgeons dominated and younger members remained quiet, SAGES developed a flat organizational structure encouraging young surgeons to participate actively on committees.
The Japanese created the song "We Are the Sages" (based on "We Are the World"), which became the society's anthem, sung with members holding hands at the end of meetings.
SAGES changed its name from Society of Gastrointestinal Endoscopic Surgeons to Society of Gastrointestinal and Endoscopic Surgeons, making both gastrointestinal surgery and endoscopic surgery equal parts of the organization.
SAGES membership is close to 7,000 members.
Japanese surgeons including Manabu Yamamoto, Dr. Suzuki, Dr. Idazuki, and Dr. Yamakawa became leaders in SAGES, teaching advanced techniques like POEM procedures and endoscopic submucosal dissection.
The SAGES Song Fest began when Ponsky, as president, performed with "the Lap Rappers" (including John Hunter, Nat Soper, Lee Swanstrom, George Bercy) in tie-dye scrub suits, starting an annual tradition.
Haru Inoue pioneered POEM (peroral endoscopic myotomy) procedures in Japan and helped teach these techniques at SAGES courses.
SAGES established a Corporate Council under Jerry Marks to manage relationships with industry partners and address mutual concerns on a one-to-one basis.
Key industry partners included Olympus (Mike Obsfeld, Mark Donahue, Mr. Moroshima, Terada), Pentax, Fuji, Karl Storz (Mrs. Stortz described as "guardian angel"), US Surgical/Covidian/Medtronic, and Ethicon, providing educational support, fellowships, and technical assistance.
Ponsky's Mount Sinai endoscopy courses became official SAGES courses, then moved to the Ethicon Institute in Cincinnati with Ethicon's support for education.
SAGES was the first organization to establish hands-on surgical training courses, which remain superior to others' programs.
Early SAGES courses focused on flexible endoscopy (polyp removal, colonoscopy) with simulation, but laparoscopic training (Nissen fundoplication, laparoscopic colectomy, Heller myotomy) eventually dominated as the laparoscopic revolution expanded.
Current SAGES courses have returned to teaching advanced flexible endoscopy techniques including POEM, ESD (endoscopic submucosal dissection), and EMR (endoscopic mucosal resection).
Ponsky's fellows who became SAGES presidents include Bruce McFadden, Brian Duncan, and Jeff Marks (future president).
Mike Rosen, son of Arnie Rosen (who was a year ahead of Ponsky in residency), came as a research resident and became Ponsky's partner, training many fellows in abdominal wall reconstruction in addition to endoscopy.
Walter Pore taught that department leaders should protect elder staff while simultaneously promoting younger staff, a lesson Ponsky applied as chairman.
Walter Pore, now in his mid-80s, continues to have NIH grants and remains relevant in lecturing, demonstrating that surgeons can maintain relevance throughout their careers.
In 1975, Ponsky performed peritoneoscopy under local anesthesia with air insufflation before switching to CO2, and contacted George Bercy in California for advice on purchasing a Storz scope with a $2,500 grant.
George Bercy worked with Harold Hopkins and Karl Storz to develop the Hopkins rod lens system into practical surgical scopes, constantly seeking improvements in image quality, lighting, and camera technology.
At age 96, George Bercy continues to call Ponsky monthly with new ideas, including a smaller choledochoscope with chip camera instead of fiber optics and a VTO scope mounted above the operating table for cardiac surgeons to view valve anastomoses without loupes.
Video laparoscopy transformed surgery by allowing the entire team to see the operative field on TV, unlike earlier laparoscopy where only the surgeon looking through the eyepiece could see.
Eddie Joe Reddick and Doug Olson in Nashville, and Barry McKernan and Bill Saye in Marietta, Georgia (who did the first laparoscopic cholecystectomy in the US), were key pioneers of laparoscopic cholecystectomy in America.
SAGES trained trainers first (John Hunter, Nat Soper, John Saker, George Bercy) before broader dissemination of laparoscopic cholecystectomy techniques.
Instrument shortages during early laparoscopy required personal connections to obtain equipment; Ponsky obtained Storz instruments through George Bercy, and surgeons used many gynecologic instruments and trocars.
Laparoscopic common duct exploration was one of the earliest procedures because it required minimal special technique: the dilated common duct could be identified, peritoneum wiped away, incision made with scissors, stones extracted with Fogarty balloon, and choledochoscopy performed before T-tube placement.
Before mastering laparoscopic suturing, Ponsky closed common duct incisions by twisting the two suture ends together like a twist-tie and securing with a clip.
Ponsky was selected as the first SAGES member on the American Board of Surgery after SAGES received a board seat, with the board choosing from three nominated candidates.
Ponsky and Courtney Townsend advocated for Steve Stein's appointment to the American Board of Surgery; Michael Nussbaum and John Hunter also later joined as SAGES representatives.
The American Board of Surgery asked Ponsky how much endoscopy surgical residents should perform; he negotiated with the Residency Review Committee under Joe Fisher to establish numerical requirements.
Ponsky was elected chairman of the American Board of Surgery, the first SAGES member to achieve this position.
Ponsky left work early to have dinner and study hall with his family at the dining room table, helping children with homework while doing his own work, rather than staying late at the office like colleagues.
Two of Ponsky's four children became surgeons: Lee (urologic oncology, head of urological oncology at Case Western) and Todd (pediatric surgery, interested in surgical education).