Stay Current In Pediatric Surgery

Drs Daniel von Allmen, Todd Ponsky and Rae Hanke come together to provide you the essentials on the diagnosis and management of Neuroblastoma. Time Stops: 00:00 | Introduction 00:23 | Epidemiology 00:37 | Presentation 01:01 | Work Up 02:36 | Pre-biopsy staging 03:53 | Management 05:09 | Post-biopsy risk stratification 09:00 | Clinical Pearls Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

This episode is a panel discussion by members of the Benjy Brooks (Women of APSA) Committee during the APSA 50th Anniversary Meeting in celebration of Women in Medicine Month. It is part of our collaboration with the Behind the Knife podcast. Join Dr. Kathryn Anderson, Dr. Diana Farmer, and Dr. Marion Henry as they share their stories of flat heads from breaking glass ceilings and paving the way for women in Pediatric Surgery. Edited by Alejandra M. Casar Berazaluce, MD. Music tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

This episode reviews the Top Educational Content sessions from the APSA 50th Anniversary meeting. It is part of our collaboration with the Behind the Knife podcast. -Dr. Aaron Jensen discusses Cervical Spine Clearance in Pediatric Trauma. -Dr. Shawn Rangel covers Antibiotic Stewardship in Pediatric Surgery. -Dr. Samir Gadepalli addresses Sepsis as a Surgical Problem. (Tweetorial at https://twitter.com/alejandracasar/status/1130466960943267840) Remember to review the 2018 Pediatric Surgery Practice Gaps by the APSA Professional Development Committee. (Available in the StayCurrentApp Video Library and at https://twitter.com/StayCurrentApp/status/1141048992782069761) Edited by Alejandra M. Casar Berazaluce, MD. Music tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

Drs Erika Newman, Dan von Allmen and Tony Sandler join Dr. Todd Ponsky in a discussion covering the latest in neuroblastoma. Time Stops 00:00:31 Introductions 00:01:39 Case 1: Prenatal 26 week consult 00:01:55 Differential Diagnosis 00:02:29 Family counseling 00:04:05 Postnatal evaluation 00:04:33 Axial imaging 00:06:53 MIBG scan 00:07:05 Metastasis in neonatal phase 00:07:19 Observe? 00:08:23 Surveillance 00:12:35 To operate or not to operate? 00:13:49 Surgical Approach 00:14:44 Case 1: Now with metastasis 00:16:21 When to biopsy 00:18:08 Case 2: 3 year old with abdominal mass 00:18:29 Initial evaluation 00:20:31 Case 2 continued...management 00:21:49 Do you need a PET scan? 00:23:28 Laparoscopic vs Percutaneous vs Open Biopsy 00:31:18 Staging 00:36:56 Case 2 continued...further management 00:40:54 When to perform surgery in relation to chemotherapy 00:43:56 Surgical Approach 00:53:33 Immunotherapy Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter

Topics in 10: Drs Andrew Davidoff, Todd Ponsky and Rae Hanke come together to provide you the essentials on the diagnosis and management of Wilms Tumor. Contributing editor: Rachel (Rae) Hanke, MD 00:00:00:00 Introduction 00:00:15:24 What is Wilms tumor? 00:01:16:27 How does it present? 00:01:41:05 What do you do to work up suspected renal mass? 00:02:55:00 Staging (1 through 5) 00:04:03:13 Management 00:04:08:09 Unilateral disease 00:06:49:00 Bilateral disease 00:07:26:07 Solitary kidney or unilateral tumor but predisposed to developing second tumor 00:08:37:04 Intravascular tumor extension 00:09:52:29 Metastasis 00:11:03:14 Wilms Tumor Clinical Pearls Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

This podcast is an interactive discussion about the management of spontaneous pneumothorax between Dr. Todd Ponsky and Dr. Dan Ostlie. Dr. Ostlie is Surgeon-in-Chief, Chair of Surgery, and Executive Vice-President at Phoenix Children’s Hospital, and has helped carry out multiple studies looking at the optimal way to manage spontaneous pneumothorax in pediatric patients. 00:00:00:00 Introduction 00:01:24:19 Case Scenario: 16-year-old male with right-sided chest pain 00:02:21:12 Historical Management of Spontaneous Pneumothorax 00:05:01:18 What We Know Now 00:07:29:03 Option of Immediate VATS 00:08:58:07 Midwest Consortium 00:10:27:03 Rationale of Aspiration 00:12:16:03 Aspiration Study from Midwest Consortium 00:17:30:26 Algorithm from the Aspiration Study 00:17:53:20 Outcomes in Patients Discharged Home after Aspiration Alone 00:20:18:14 How would you counsel a family based on this study? 00:22:07:23 Technique for Aspiration 00:22:59:07 Technical Considerations for VATS 00:23:21:21 Is there a

Next in our #APSA50 series, comes a thoughtful discussion regarding academic surgery and future transformations. Dr. Ron Hirschl starts us off with a discussion on the changes they implemented at this years’ conference, including focused TED-style talks and presentations beyond the field of surgery. Dr. Allan Goldstein shares his thoughts on the shifting general surgery paradigm. We wrap it up with a continued debate on the role of social media in academic medicine. Drs Allan Goldstein and Todd Ponksy share their differing opinions. Have a listen, and tell us—what do you think? How do you think academic medicine will change? How can we harness the benefits of social media without losing the validity assigned to publications and presentations are attributed with? Join the discussion and let us know what you think! Timestops: 00:00:00 Introduction 00:00:31 Dr. Ron Hirschl discusses changes at #APSA50 00:03:07 Other possible changes in surgical training 00:05:07 What is social media’s role in academic medi

The 50th APSA meeting featured a debate moderated by Dr. Jacob Langer from The Hospital for Sick Children. The topic debated was: "Be it resolved that I would NOT encourage my daughter or son to become a pediatric surgeon." Representing the side supporting this statement were Dr. Cathy Burnweit from Nicklaus Children's Hospital and Dr. Daniel Ostlie from Phoenix Children's Hospital. Representing the side against this statement were Dr. Andrea Hayes-Jordan from North Carolina Children's Hospital and Dr. Douglas Barnhart from Primary Children's Hospital. 00:00:00 Introduction 00:36:05 Dr. Langer’s Preface 03:25:00 Dr. Burnweit’s Opening Argument (Pro) 08:39:07 Dr. Hayes-Jordan’s Opening Argument (Con) 13:25:04 Dr. Ostlie's Continued Argument (Pro) 18:32:16 Dr. Barnhart’s Continued Argument (Con) 24:19:24 Dr. Ostlie’s Rebuttal (Pro) 28:02:20 Dr. Hayes-Jordan’s Rebuttal (Con) 32:03:06 What are your thoughts about the effect of having more women in the specialty? 37:12:26 How ca

This episode is the third in our #APSA50 series, where we teamed up with the Behind the Knife Podcast to cover the 50th Anniversary Meeting of the American Pediatric Surgical Association. In this episode, we interviewed Dr. Michael Muelly, who gave the first of the meeting's PED (Pediatric Surgery, Education, and Disruption) talks on the topic of artificial intelligence in healthcare. Dr. Muelly is a product manager at Google Cloud’s Healthcare & Lifesciences team and is a radiology faculty member at Stanford University. He has spent time researching machine learning, and has co-founded companies dedicated to bringing radiology to the cloud. Stay tuned for more coverage of the 50th annual APSA meeting. 00:00:00:00 Introduction 00:01:11:07 How has AI already changed healthcare? 00:02:20:10 Examples of AI in Radiology 00:02:53:27 Will AI replace physicians? 00:03:43:02 AI and evidence-based medicine 00:04:19:01 Potential AI applications for surgery 00:06:19:18 AI in the ICU 00:07:39:15 Limitati

This is the next episode in our #APSA50 series, where we teamed up with the Behind the Knife Podcast to cover the 50th Anniversary Meeting of the American Pediatric Surgical Association. The coverage of the conference wouldn’t be complete without a little history lesson and guidance for the future. Drs Jim O’Neill, Jr. and Jo Shapiro join Rae Hanke, Alex Casar and Alex Gibbons to take a journey through the past and peak into the future. Throughout the discussion, we first review the journey of three pediatric surgery pioneers, Drs William Ladd, Herbert Coe, and Oswald Wyatt. Dr. O’Neill shares the efforts of H. William Clatworthy as he approached the American Board of Surgery to identify the reasoning for refusing Pediatric Surgery Board Certification. In brief this was due to the belief that we held no unique body of knowledge beyond general surgery, had no association with surgical roots, had no standard curriculum or standards for certification, and finally did not have a structure of governance. He goes

This episode is the first in our #APSA50 series, where we teamed up with the Behind the Knife Podcast to cover the 50th Anniversary Meeting of the American Pediatric Surgical Association. It is a conversation between Alex Casar, Alex Gibbons, Rae Hanke, and our invited guest. It presents an interactive discussion and thoughtful reflection on the topic of Social Determinants of Health, which was a cornerstone of this year’s meeting. Social determinants of health refer to factors like economic stability, housing, transportation, physical and psychological safety, zip code and geography, literacy and education, hunger, poverty, community support and engagement, discrimination, stress, and linguistic and cultural competencies from providers that affect healthcare outcomes like quality of care, mortality, morbidity, life expectancy, and even healthcare costs. We had the opportunity to interview Adam Foss – a lawyer, former District Attorney, and founder of Prosecutor Impact, a nonprofit organization improving

This podcast is an interactive discussion about gallstone disease between Dr. Todd Ponsky and his father, Dr. Jeffrey Ponsky. Dr. Jeffrey Ponsky is a professor of surgery at Cleveland Clinic Lerner College of Medicine, and is an expert in advanced therapeutic endoscopic treatment of biliary disease. 00:00:00:00 Introduction 00:01:55:10 Work-Up for Right Upper Quadrant Abdominal Pain 00:03:41:03 Case 1: 14-year-old overweight female 00:06:33:01 Laparoscopic Cholecystectomy Tips and Tricks: Port Placement 00:10:22:05 Tips for the Difficult Laparoscopic Cholecystectomy 00:12:58:16 Tips for the “Easy” Laparoscopic Cholecystectomy 00:14:48:12 Tips and Tricks for Cholangiography 00:18:33:29 Same-Day Discharge? 00:19:35:25 Case 2: One Week of Symptoms 00:20:17:19 Case 3: Excessive Post-Operative Pain 00:23:22:22 Case 4: Biliary Dyskinesia 00:23:44:28 Case 5: Gallstone Pancreatitis 00:27:27:14 Gallstone Pancreatitis: OR vs. ERCP 00:29:31:13 Maneuvers to Clear the Common Bile Duct 00:34:01:07 Todd’s Takeaway: Gallst

This episode is an interactive discussion about Unconscious Bias between Dr. Todd Ponsky, Dr. Julie Freischlag, Dr. Mary Brandt, Dr. Quinn Capers IV, Dr. Alejandra (Alex) Casar Berazaluce, Dr. Rachel (Rae) Hanke, and Dr. Alexander Gibbons. Dr. Julie Freischlag is CEO of Wake Forest Baptist Medical Center and Dean of Wake Forest School of Medicine. Dr. Mary Brandt is a Professor of Surgery, Pediatrics, and Medical Ethics at Baylor College of Medicine and a Pediatric Surgeon and Director of the Adolescent Bariatric Surgery Program at Texas Children’s Hospital. Dr. Quinn Capers IV is the Associate Dean for Admissions, Associate Professor of Medicine (Cardiovascular Medicine), and Program Director of the Interventional Cardiology Fellowship at The Ohio State University College of Medicine. Time stops: 00:01:06:17 Introduction 00:04:05:20 What is unconscious bias? How has it affected your career? 00:16:59:16 How does unconscious bias relate to social identity? 00:21:34:12 How do you approach a colleague putting

This podcast is a discussion of the international approach to diagnosis and management of biliary atresia, amongst Dr. Todd Ponsky, Dr. Yamataka Atsuyuki, Dr. Greg Tiao, Dr. Mark Davenport, and Dr. Jorge Bezerra. Dr. Greg Tiao is the Director of General and Thoracic Surgery, Frederick C. Ryckman Chair in Pediatric Surgery, Surgical Director of Liver Transplantation, and Associate Director of the Pediatric Surgery Fellowship at Cincinnati Children’s Hospital. Dr. Yamataka Atsuyuki is Professor and Head of Pediatric General and Urogenital Surgery at Juntendo University in Tokyo, Japan. Dr. Mark Davenport is the Head of Department of Pediatric Surgery and Professor at King’s College Hospital, London, and immediate past President of BAPS. Dr. Jorge Bezerra is the Director of the Division of Gastroenterology, Hepatology and Nutrition, and Medical Director of the Pediatric Liver Care Center at Cincinnati Children’s Hospital. Time stops: 00:02:28 Case 1: 50-day-old male with jaundice and clay-colored stools

This podcast is a discussion of the international approach to diagnosis and management of biliary atresia, amongst Dr. Todd Ponsky, Dr. Yamataka Atsuyuki, Dr. Greg Tiao, Dr. Mark Davenport, and Dr. Jorge Bezerra. Dr. Greg Tiao is the Director of General and Thoracic Surgery, Frederick C. Ryckman Chair in Pediatric Surgery, Surgical Director of Liver Transplantation, and Associate Director of the Pediatric Surgery Fellowship at Cincinnati Children’s Hospital. Dr. Yamataka Atsuyuki is Professor and Head of Pediatric General and Urogenital Surgery at Juntendo University in Tokyo, Japan. Dr. Mark Davenport is the Head of Department of Pediatric Surgery and Professor at King’s College Hospital, London, and immediate past President of BAPS. Dr. Jorge Bezerra is the Director of the Division of Gastroenterology, Hepatology and Nutrition, and Medical Director of the Pediatric Liver Care Center at Cincinnati Children’s Hospital. Time Stops: 00:01:41 Gastroenterology: Back to beginning for evaluation 00:04:10 Fut

This podcast is a multidisciplinary discussion on a controversial topic, management of pediatric Gastroesophageal Reflux Disease, amongst Dr. Todd Ponsky, Dr. Rachel Rosen, and Dr. George "Whit" Holcomb. Dr. Rachel Rosen is Director of the Aerodigestive Center and Pediatric Gastroenterologist at Boston Children's Hospital, and Associate Professor of Pediatrics at Harvard Medical School. Dr. George "Whit" Holcomb is the Senior Vice President at Children's Mercy Hospital, Director of the Center for Minimally Invasive Surgery, Professor of Pediatric Surgery at University of Missouri-Kansas City School of Medicine, and Editor in Chief of the Journal of Pediatric Surgery. Time stops: Introduction| 00:24:00 Work up of a patient with GERD like symptoms| 02:50:27 Esophagoscopy| 08:22:11 Normal Endoscopy - What next | 15:57:17 Management of "suspected GERD" who are unable to feed | 24:40:07 pH impedance testing| 40:07:14 When to do surgery? | 43:15:25 Neurological impairment | 50:21:22 Botox injections | 53:43:15

This podcast is an interactive discussion about pediatric trauma between Dr. Todd Ponsky, Dr. Mark McCollum, and Dr. David Notrica. Dr. David Notrica is the trauma medical director at Phoenix Children's Hospital and is associate professor of surgery at the Mayo Clinic College of Medicine and Associate Professor of Surgery at the University of Arizona College of Medicine in Phoenix. 00:01:30 Dr. David Notrica 00:02:28 Can you tell us a little bit more about what ATOMIC is and what you guys did about it? 00:05:12 In patient with blunt solid organ injury, what is the evidence to support non-operative management based on hemodynamic status as opposed to a grade of injury? 00:07:45 Can you describe some of the other factors that we would use to define hemodynamic stability? 00:10:22 Do you use that in your center? Are the vital signs indexes like the shock index or laboratory values like serum lactate in addition to physical exam findings? 00:12:44 From a crystalloid infusion standpoint, what are your thoughts a

An interactive discussion between Dr. Ponsky and Dr. Rescorla about the management of ovarian tumors in pediatric patients. Dr. Frederick Rescorla is surgeon-in-chief at Riley Children's Hospital, Anna Olivia Healey Professor of Pediatric Surgery at Indiana University School of Medicine, and COG germ cell committee member. Timestops: 00:00:00 Introduction 02:17:12 Case 1: Ovarian cystic mass with solid components 04:09:16 Overview of ovarian tumors 05:18:22 Workup of Case 1 08:02:10 Operative technique 11:06:21 Exploring retroperitoneal lymph nodes 12:40:13 Ovarian Salvage 14:20:07 Case 2: Large ovarian cystic mass in adolescent 16:59:00 Operative technique 18:23:23 Case 3: Solid ovarian mass in adolescent 20:27:09 Preoperative workup 21:10:02 Surgical approach 23:41:06 Chemotherapy 24:01:05 Cryopreservation 24:31:14 Case 4: Ovarian torsion 26:31:15 Role of oophoropexy 28:42:13 Follow up after torsion without a mass 29:11:22 Outcomes 31:57:20 Conclusion Intro track is adapted from "I dunno" by grapes,

An interactive discussion between Dr. Ponsky, Dr. Harmon and Dr. Inge about the role of bariatric surgery in pediatric patients. Dr. Inge is Chief of Pediatric Surgery, Akers Endowed Chair in Pediatric Surgery, and Director of Adolescent Bariatric Surgery at Children’s Hospital of Colorado. Dr. Harmon is professor of Surgery at University of Buffalo and Surgeon-in-Chief at Oishei Childrne’s Hospital. Timestamps: 00:00:00 Introduction 00:01:37 Need for Bariatric Surgery in the current era 00:03:05 Non-operative therapy for obesity 00:06:13 Pharmacotherapy for obesity in adolescents 00:07:13 Timing of bariatric surgery 00:09:46 Patient referral 00:12:12 Multidisciplinary pre-operative management 00:15:55 How often is surgery recommended 00:19:44 Surgical options 00:23:48 Technical steps of operation: Sleeve gastrectomy 00:30:21 Technical steps of operation: Roux-en-Y gastric bypass 00:33:20 Postoperative protocol 00:34:55 Complications 00:37:52 Weight loss outcomes 00:39:03 Health benefits 00:40:46 Long-te

An interactive discussion between Todd Ponsky, MD and Max Langham, MD on the management of hepatoblastomas. Dr. Max Langham is a Professor of Surgery and Pediatrics and the Vice Chairman of the Department of Surgery at the University of Tennessee Health Science Center. Table of Contents 00:00 - Introduction 01:15 - Work-up of a newly diagnosed liver mass 04:20 - Differential diagnosis of liver mass 08:03 - Tumor biopsy 10:11 - Pretext staging system 14:43 - Upfront resection 16:18 - How to use the pretext system to determine resectability 20:14 - Annotation factors 22:25 - Histologic subtypes 25:17 - Management of unresectable tumors 28:44 - What makes hepatoblastoma high-risk? 30:52 - Approach to pulmonary metastases 34:01 - Chemotherapy regimen for metastatic hepatoblastoma 35:29 - Maneuvers to improve safety and success of liver resection 38:27 - Anesthesia care during resection 39:32 - Key surgical steps 41:58 - When to consider extreme resection and Vascular reconstruction 44:35 - Recurrent disease