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This episode is spoken by SPEAKER_NAMES. You can see more of SPEAKER_AT_SPEAKER_URLS. The music is MUSIC1_TITLE by MUSIC1_ARTIST. You can see more of MUSIC1_ARTIST at MUSIC_1_ARTIST_URL.

This episode is spoken by Eric Thomas, Les Brown, Andy Frisella. You can see more of Eric Thomas at instagram.com/etthehiphoppreacher, Les Brown at instagram.com/thelesbrown, Andy Frisella at instagram.com/andyfrisella. The music is Vengeance by Zack Hemsey. You can see more of Zack Hemsey at MUSIC_1_ARTIST_URL.

This episode is spoken by TD Jakes at, Steve Harvey, Jocko Willink. You can see more of TD Jakes at instagram.com/bishopjakes, Steve Harvey at twitter.com/IAmSteveHarvey, Jocko Willink at instagram.com/jockowillink. The music is Reprise by Secession Studios. You can see more of Secession Studios at MUSIC_1_ARTIST_URL.

In this podcast, Dr. Alex Bondoc and Dr. Rae Hanke discuss the intricacies of choledochal cysts. Contributing editor: Dr. Rod Gerardo. 00:00 | Introduction 00:26 | Definition of Choledochal cyst 00:36 | Epidemiology 01:06 | Etiology 02:00 | Todani Classification 03:20 | Presentation 05:08 | Differential diagnosis 05:42 | Workup 07:54 | Why only surgical treatment options? 09:18 | When to operate 10:12 | Preoperative evaluation 11:10 | Surgical goals of care 13:17 | Surgical technique 16:42 | Type II cyst 17:40 | Type III cyst 18:43 | Post operative care 20:29 | Key clinical takeaways Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

Dr. Rae Hanke, Dr. Alex Casar, Dr. Jason Frischer, and Dr. Aaron Garrison come together to provide you the essentials on diagnosis and management of Hirschprung's Disease. Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

Dr. Meera Kotagal, Dr. Rae Hanke, and Dr. Gillian Goddard come together to provide you the essential on diagnosis and management of pediatric umbilical hernias. Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

Drs Jaimie Nathan, Rae Hanke, Alex Gibbons, and Todd Ponsky discuss the diagnosis and management of pancreatic masses. 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 Neurogenic Bladder between Dr. Rae Hanke, Dr. Lynn Woo, and Dr. Al Ray Dr. Lynn Woo is an Associate Professor of Urology and Program Director at Case Western and Cleveland Medical Center. She is also a Pediatric Urologist at Rainbow Babies & Children's Hospital. Dr. Al Ray is a urology PGY-4 at Case Western and currently on his research year. Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 Dr. @lynnlwoo & Dr. Al Ray from @CaseUrology

Dr. Beth Rymeski (Fetal Surgeon) and Dr. Rae Hanke (Pediatric Surgical Education Fellow) from Cincinnati Children’s Hospital bring you highlights from the 2019 International Fetal Medicine and Surgical Society (IFMSS) meeting. Part III includes interviews focusing on clinical studies. Special guests include: •Stephen Fenton, MD, Director of Fetal Center and Pediatric Surgeon at Primary Children’s Hospital in Salt Lake City, Utah, USA •Uchenna Kennedy, MD, Pediatric Surgeon at University Children’s Hospital Zurich, Switzerland, and previous Fellow at Children’s Hospital of Philadelphia, Pennsylvania, USA •Oluyinka Olutoye, MD, PhD, Surgeon-In-Chief at Nationwide Children’s Hospital, Ohio, USA •Christina (Nina) Bence, MD, Pediatric Surgical Research Fellow at Milwaukee, Medical College of Wisconsin, USA IFMSS facilitates international collaboration, networking and exchange of ideas, with the goal of advancing the field of fetal diagnosis and therapy. Check out the Stay Current: Pediatric Surgery app at https://staycurrent.globalcastmd.com/download. Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626.

Dr. Beth Rymeski (Fetal Surgeon) and Dr. Rachel (Rae) Hanke (Pediatric Surgical Education Fellow) from Cincinnati Children’s Hospital bring you highlights from the 2019 International Fetal Medicine and Surgical Society (IFMSS) meeting. Part II includes interviews focusing on technical and educational innovation. Special guests include: •Stephen Emery, MD, Director of Center for Innovative Fetal Intervention at University of Pittsburgh Medical Center & Associate Professor of Obstetrics and Gynecology at Pittsburgh Magee Hospital, Pennsylvania, USA •Jose Peiro, MD, Director of Endoscopic Fetal Surgery at the Cincinnati Fetal Center and Associate Professor at the University of Cincinnati Department of Surgery, Ohio, USA •Anouk van der Schot, MSc, technical physician at Radboud University Medical Center, Netherlands •Jena Miller, MD, Assistant Professor of Gynecology and Obstetrics at Johns Hopkins Center for Fetal Therapy and Lead of Fetoscopic Spina Bifida Repair Program, Maryland USA IFMSS facilitates international collaboration, networking and exchange of ideas, with the goal of advancing the field of fetal diagnosis and therapy. Check out the Stay Current: Pediatric Surgery app at https://staycurrent.globalcastmd.com/download. Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626.

Dr. Beth Rymeski (Fetal Surgeon) and Dr. Rachel (Rae) Hanke (Pediatric Surgical Education Fellow) from Cincinnati Children’s Hospital bring you highlights from the 2019 International Fetal Medicine and Surgical Society (IFMSS) meeting. Part I includes interviews focusing on translational research and clinical trials. Special guests include: •Ueli Moehrlen, MD, Pediatric Surgeon at University Children’s Hospital Zurich, Switzerland •Benjamin Amberg, MD/PHD student at Monash University, Melbourne, Australia •Barbara Coons, MD, recent Research Fellow at Children’s Hospital of Philadelphia and General Surgery Resident at Columbia-Presbyterian, New York, USA •David Stitelman, MD, Pediatric Surgeon at Yale University, Connecticut, USA •Adele Ricciardi, MD/PhD student at Yale University, Connecticut, USA •Anna David, MD, Obstetrician and Maternal Fetal Medicine specialist and Director of the Institute of Women’s Health at the University College London Hospital, UK •Eric Jelin, MD, Pediatric Surgeon and Fetal Program Director at John’s Hopkins Children’s Center, Maryland, USA IFMSS facilitates international collaboration, networking and exchange of ideas, with the goal of advancing the field of fetal diagnosis and therapy. Check out the Stay Current: Pediatric Surgery app at https://staycurrent.globalcastmd.com/download. Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626.

Dr. Pramod Puligandla, Pediatric Surgeon and Intensivist at Montreal Children’s Hospital, joins the Stay Current in Pediatric Surgery team to discuss the essentials on burn resuscitation. Podcast edited and narrated by Rachel (Rae) Hanke, MD at Cincinnati Children's Hospital. Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626.

Dr. Pramod Puligandla, Traumatic Pediatric Surgeon and Intensivist at Montreal Children’s Hospital, joins the Stay Current Team to review the Cliff Notes on traumatic brain injury (TBI). 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 coagulopathy, analgesia, sedation, and delirium in critically ill pediatric patients between Dr. Adam Vogel and Dr. Alexander Gibbons. 00:00:00:00 Introduction 00:01:22:01 Case Scenario: 12-year-old male in helmeted MVC vs. bicycle accident 00:02:36:10 See Where You Are 00:05:22:17 Initial Therapy 00:06:26:04 General Management 00:07:00:04 Viscoelastic Monitoring 00:08:05:01 Phases of Viscoelastic Monitoring 00:10:47:02 Targeted Therapy 00:11:42:25 Real Time Monitoring 00:14:38:13 Management of Fibrinolysis 00:16:06:18 Balanced Resuscitation 00:17:26:16 Efficiency 00:18:12:29 Pediatric Evidence 00:19:07:08 Massive Transfusion and Balanced Resuscitation 00:19:42:28 Case Scenario: Pain Control After Laparotomy 00:21:02:12 Narcotics 00:22:08:19 Regional Analgesia 00:23:29:12 Anxiety 00:25:43:24 Case Scenario: Sedation 00:27:51:13 Validated Pain Scores 00:29:53:14 Validated Sedation Scores 00:31:23:23 Sedation Holidays and ABCDEF Bundles 00:32:09:08 A: Assessing Pain 00:32:20:29 B: Breathing and Awakening Trials 00:33:30:15 C: Choice of Analgesia and Sedation 00:34:24:15 D: Delirium 00:34:31:25 E: Early Mobility and Exercise 00:34:37:24 F: Family Engagement 00:35:47:28 Case Scenario: Post-Operative/ICU Delirium 00:36:38:04 Risk Factors for Delirium 00:37:21:15 Delirium Assessment Tools 00:39:23:20 Evaluating for Causes of Altered Mental Status 00:40:36:16 Multimodal Treatment for Delirium 00:42:51:23 Preventing Delirium 00:43:58:22 Conclusion 00:44:21:22 Outro/Teaser 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 review of pediatric ECMO with Dr. Samir Gadepalli, Dr. Alejandra Casar Berazaluce, and Dr. Todd Ponsky. Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

Ponsky fellows Rae Hanke, Alex Casar and Alex Gibbons join forces to bring you highlights from IPEG 2019. Interviews with Drs Jordan Taylor, Daniel von Allmen, Bethany Slater, Philipp Szavay, Aayed Alqahtani, Steven Rothenberg and Whit Holcomb cover a breadth of topics, including using virtual reality to reduce sedation, repairing esophageal atresia with magnets, innovations in bariatric surgery and more! Enjoying Stay Current podcasts? Then you should check out the StayCurrent app for an even better listening experience including the ability to skip straight to the sections and topics you want, read the key points and highlights, resume where you left off, join comments and discussions, watch videos, and much more! Find in the app store--StayCurrent: Pediatric Surgery--or follow this link to download https://staycurrent.globalcastmd.com/. Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 483618

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.org/files/grapes/16626

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 role for pleurodesis? 00:24:55:15 Talc or Chemical Pleurodesis 00:26:00:17 Role of CT 00:27:22:16 Management of Multiply Recurrent Pneumothorax 00:29:46:27 Small Recurrence after VATS with Pleurodesis 00:31:16:24 Conclusion and Future Steps 00:32:48:23 Teaser Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

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 medicine 00:06:15 The Allan Goldstein perspective 00:07:58 The Todd Ponsky perspective 00:11:15 Conclusion Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

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 can we change APSA to make it more effective? 46:34:15 What are your thoughts on the huge number of unanswered questions in pediatric surgery? 48:53:13 Dr. Barnhart’s Closing Arguments (Con) 52:52:26 Dr. Ostlie’s Closing Arguments (Pro) 54:39:19 Dr. Hayes-Jordan’s Closing Arguments (Con) 56:06:23 Dr. Burnweit’s Closing Arguments (Pro) 58:47:27 Conclusion 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 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 Limitations of AI 00:11:03:12 Using the Cloud to gather datasets 00:12:02:28 Ethical concerns of AI 00:13:21:00 Future of AI in medicine 00:14:23:21 Outro Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

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 on to detail how these objections were overcome, involving the foundation of APSA and JPS. Dr. O’Neill goes on to highlight the clinical, technical and educational advancements made over the past 50 years. He challenges us to even more so increase our educational collaboration amongst other pediatric specialists. In continuity with this call for change from Dr. O’Neill, Dr. Shapiro discusses another exciting opportunity for the future of pediatric surgery—improving physician well-being. She emphasizes the challenges we face and the necessity for operationalizing proactive peer support programs. By facing the traumatic events we experience, we will improve patient care by decreasing physician burnout, depression and suicide. Will you accept their challenge to increase educational collaboration and encourage wellness amongst those around you? Continue this conversation on the StayCurrentApp. Stay tuned for a few more APSA 2019 highlights captured by the Behind the Knife Podcast team. Time Stops: 00:00:23 Introduction 00:00:49 Journey of pediatric surgery pioneers 00:01:20 Three pioneers devoted to Pediatric Surgery: William Ladd, Herbert Coe, and Oswald Wyatt 00:03:48 H. William Clatworthy and his insight 00:04:09 Why can't pediatric surgery obtain boards? 00:05:13 Objection 1: no unique body of knowledge beyond general surgery 00:05:37 Objection 2: no association with surgical roots 00:05:55 Objection 3: no approved curriculum or metrics for certification 00:06:56 Objection 4: no structure of governance 00:07:28 Linchpins: APSA and JPS designed to meet perceived deficiencies 00:07:59 Since board approval: clinically, technologically, and educationally 00:09:16 Endorsement of other pediatric surgery subspecialties 00:09:45 Call for future collaboration—particularly in education 00:12:11 Opportunity for impact through APSA 00:12:58 Along with this incredible profession comes significant challenges 00:13:29 Operationalizing proactive Peer Support Program 00:14:06 Not facing traumatic events leads to burnout, depression and suicide 00:14:40 Our emotional and physical well-being impacts patient care 00:14:54 As caring individuals, we deserve care 00:15:07 Shift to embrace our humanity 00:15:42 Now, let's do something to improve well-being Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

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 community safety in the United States through culture change in the criminal justice system. We hope you feel as simultaneously uncomfortable and enlightened by his message as the audience did in person. Our role as pediatric surgeons extends way further than the walls of our operating rooms. It is our responsibility as medical providers and community leaders to identify areas of opportunity within our reach and tackle them to improve healthcare outcomes. Join the conversation and share with us the steps you are taking to alleviate these disparities. Remember that your actions and commitment are contagious. Stay tuned for more updates from APSA 2019. Time Stops: 00:00:00 Introduction 00:00:24 Opening Remarks 00:01:45 Adam Foss 00:02:38 How are kids in the US at a disadvantage? 00:04:06 What can we do as Pediatric Surgeons? 00:06:22 Inequities in Medicine 00:11:00 Can diversifying our workforce improve patient care? 00:12:42 Message to Pediatric Surgeons 00:13:54 Here’s what you missed! 00:14:16 Presidential Symposium Introduction 00:14:57 Swords and Shields: A Discussion of Power, Privilege, and Opportunity 00:46:49 Closing Remarks Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

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: Gallstone Pancreatitis 00:34:41:11 Laparoscopic Common Bile Duct Exploration 00:39:02:05 Case 6: Severe Gallstone Pancreatitis 00:39:43:12 Choledochoduodenostomy 00:40:30:08 Case 7: Pericholecystic Phlegmon 00:42:20:17 Pitfalls: Why Do CBD Injuries Occur? 00:43:34:20 Pitfalls: What to Do with a CBD Injury 00:45:26:13 Pitfalls: Complete CBD Transection 00:45:59:17 Closing Remarks 00:46:23:27 Teaser Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

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. Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

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 together a manel? 00:23:23:09 How can we identify talent outside of our immediate group? 00:27:42:05 What can we do to counteract implicit bias? 00:40:05:08 What are your take home messages about discrimination in medicine? 00:50:10:09 How do we use and interpret the results of an Implicit Association Test? 00:51:45:14 How do we bring attention to unconscious bias without being labeled as radicals? 00:56:48:00 Closing remarks Music track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

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 00:03:26 Stool Card 00:05:20 Differential diagnosis 00:06:01 Bloodwork 00:07:48 Initial imaging: Ultrasound 00:09:38 Absence of gallbladder on ultrasound, now what? 00:09:49 Biopsy? 00:11:13 Scintography and diagnostic laparoscopy? 00:13:50 NASPHGAN Guidelines 00:14:44 Biopsy results 00:17:14 Role of ERCP 00:18:21 After positive biopsy, exploration and cholangiogram 00:19:09 Performing the Kasai procedure 00:19:29 Open Kasai (Davenport) 00:20:19 Open Kasai (Tiao) 00:21:36 Laparoscopic Exploration and Kasai (Yama) 00:25:48 US: Tips & Tricks for the operation 00:28:15 London: Tips & Tricks for the operation 00:30:31 Japan: Tips & Tricks for the operation Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

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 Future Evaluation Options 00:05:48 Post-operative Steroids 00:11:15 Steroid Regimens 00:16:17 Potential side effects of steroids 00:18:07 Timing of steroid initiation 00:19:03 Post-Operative Antibiotics 00:20:14 Post-Operative Nutrition 00:21:08 Case 2: 100-day-old infant with a similar presentation 00:25:23 Case 3: Patient younger than two weeks with similar presentation 00:27:08 Post-Operative Complications 00:27:19 Cholangitis 00:30:17 Non-clearance of bilirubin 00:32:30 Role of cytomegalovirus (CMV) 00:37:24 Patients with initial clearance of jaundice who then require transplantation Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

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 The perfect Fundoplication | 56:23:15 Post Nissen Retching | 61:32:28 Pyloroplasty | 64:17:00 Gastric stimulation| 65:17:00 Transoral Incisionless Fundoplication | 66:06:02 Failed fundoplication| 70:11:02 Esophageal dissociation| 75:25:11 Ruminators| 77:51:13 Conclusion | 80:00:20 Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626

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. Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: creativecommons.org/licenses/by/3.0/

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, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: creativecommons.org/licenses/by/3.0/

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-term outcomes 00:43:48 Research directions 00:48:54 Conclusion Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: creativecommons.org/licenses/by/3.0/

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 46:36 - Post-resection care 47:49 - Management of pretext 4 lesions 49:45 - Summary Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: creativecommons.org/licenses/by/3.0/

An interactive discussion about Wilms tumor between Todd Ponsky, MD, Avraham Schlager, and Peter Ehrlich, MD. Dr. Peter Ehrlich is a professor of pediatrics surgery at the University of Michigan C.S. Mott Children’s Hospital who is also a vice chair of surgery and renal tumor section of the children oncology group. Table of Contents 00:00 - Introduction 01:09 - Typical clinical case? 03:27 - Wilms tumor CT scan 04:48 - What after CT scan 06:10 - Therapeutic options 09:15 - Management of widespread tumor 10:18 - Intestinal invasion 10:57 - tumor upstaging 12:35 - Different therapeutic approaches 14:57 - Crossing midline tumor 15:35 - Lung lesion impact on the approach 17:15 - Biopsy technique 18:39 - Possibility of negative biopsy 19:18 - Central line type 23:02 - Chemotherapy regimen 25:02 - Stage I and II with lung lesion 27:39 - Need for lung lesion biopsy 29:02 - Lung lesion after nephrectomy 29:19 - Treatment without biopsy 30:08 - Differences between COG and SIOP 31:16 - Abdominal radiation criteria 32:20 - Impact of spillage 33:09 - Unclear imaging 34:12 - preoperative preparation 37:15 - patient position and incision 40:15 - Artery versus vein 40:40 - Placing metal clip 41:10 - significance of the surgical margins 42:12 - Frozen section 43:23 - Surgery alone 45:50 - Caval extension management 48:41 - Effect of chemotherapy on the tumor 49:23 - Technical steps to remove thrombus 52:29 - Pathological results 56:48 - Surprises: other types 57:40 - Bilateral wilms 01:00:28 - Role of the biopsy 01:02:35 - radiation after the biopsy 01:03:11 - Closure Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: creativecommons.org/licenses/by/3.0/

An interactive discussion between Todd Ponsky, MD and Don Nakayama, MD about the history of pediatric surgery, specifically the evolution of the management of pyloric stenosis, Hirschprung disease and esophageal atresia. Dr. Nakayama is an adjunct professor of the department of surgery at the Herbert Wertheim College of Medicine at Florida International University and pediatric surgeon at Sacred Heart Medical Group. Table of Contents 00:00:00 Introduction 00:01:54 Origin of Pediatric Surgery 00:05:47 Historical events in medicine involving pediatric patients 00:07:21 How Dr. Nakayama became interested in the history of pediatric surgery 00:08:59 History of pyloric stenosis 00:11:38 First pyloric stenosis operations 00:14:46 Start of perioperative care of pyloric stenosis patients 00:18:04 History of Hirschsprung disease 00:23:08 The contributions of Dr. Swenson 00:25:16 Feud between Dr. Swenson and Dr. Gross 00:28:16 History of the Soave procedure 00:30:33 Story of the first PDA ligation 00:36:41 Feud between Dr. Gross and Dr. Ladd 00:37:21 History of esophageal atresia 00:44:29 First successful esophageal atresia repair 00:46:36 Management of the first esophageal leak 00:50:36 Closing remarks Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: creativecommons.org/licenses/by/3.0/

An interactive discussion about intestinal failure between Todd Ponsky, MD and Brad Warner, MD. Dr. Warner is the Jessie L. Ternberg, MD, PhD Distinguished Professor of Pediatric Surgery at Washington University School of Medicine and surgeon-in-chief for St. Louis Children’s Hospital in St. Louis, Missouri. Table of Contents 00:00 - Introduction 01:39 - What is intestinal failure? 02:50 - Required bowel length 05:39 - Nature history of short gut 07:07 - Mortality in intestinal failure 07:39 - Small bowel transplant candidacy 09:15 - Causes of short gut 09:42 - Medical management of short gut syndrome 12:40 - Primary prevention of TPN cholestasis 16:15 - Summary of medical management 18:03 - Importance of breast milk 19:19 - Formula selection 20:13 - Management of volume administered 21:47 - Surgical management of intestinal failure 24:21 - Surgical evaluation 27:26 - Surgical options 28:47 - Bowel lengthening procedures 29:59 - Bianchi procedure 31:45 - STEP procedure 36:07 - Bianchi procedure pearls 38:10 - Role of tapering 38:43 - Secondary prevention of TPN cholestasis 40:16 - Medical management of intestinal bacterial overgrowth 43:39 - Role of growth factors 46:34 - Intestinal transplant 49:33 - Management of central line-associated infections 50:06 - Intestinal transplant as last resort Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: creativecommons.org/licenses/by/3.0/

An discussion of the medical and operative management of necrotizing enterocolitis between Todd Ponsky, MD and Gail Besner, MD. Dr. Besner is a H. William Clatworthy Professor of Pediatric Surgery, Chief of the Department of Pediatric Surgery, Principal Investigator of the Center of Perinatal Research, and Associate Director of the Pediatric Surgery Training Program at Nationwide Children's Hospital. Table of Contents 00:00:00 Introduction 00:02:41 Work-up of NEC 00:04:02 Medications associated with NEC 00:05:24 Physical Examination 00:07:04 Laboratory Work 00:08:44 Imaging studies 00:09:15 When to Operate on NEC 00:10:45 Medical Management of NEC 00:12:23 Antibiotic regimen 00:13:19 Frequency of imaging studies 00:13:55 Length to continue medical management 00:14:39 Stricture after NEC 00:15:43 When to operate after medical management without absolute indication 00:17:11 Peritoneal drain versus laparotomy 00:19:42 Randomized control trials comparing peritoneal drain and laparotomy 00:22:51 How to choose between peritoneal drain and laparotomy 00:26:03 Peritoneal drain placement technique 00:28:12 Operating after placement of a peritoneal drain 00:29:34 Management of patient after peritoneal drain placement 00:30:59 Laparotomy technique 00:33:39 Operative management of focal necrotic area 00:34:41 Creating a stoma 00:36:50 Management of Diffuse NEC 00:37:58 Management of skip lesions 00:39:21 When to reverse the stoma 00:40:34 Re-feeding mucous fistula 00:42:04 Management of NEC totalis 00:44:05 Management of tension pneumoperitoneum Intro and outro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: http://creativecommons.org/licenses/by/3.0/

This podcast discusses the work up and management of umbilical cord defects. Dr. Todd A. Ponsky is an associate professor of surgery and pediatrics and pediatric surgeon at Akron Children's Hospital. Dr. Kenneth S. Azarow is surgeon-in-chief for Doernbecher Children’s Hospital and Helen B. Tracy professor of pediatric surgery at Oregan Health and Science University. Time Markers: 00:00:00 Introduction 00:02:04 Timing of surgery 00:05:18 Diagnosing an incarcerated umbilical hernia 00:07:23 Anesthesia 00:08:24 Suture preference 00:08:49 Antibiotic use 00:10:09 Umbilicoplasty 00:12:30 Management of Gastroschisis 00:14:37 Management of Omphalocele 00:16:39 Use of mesh for umbilical hernia repairs 00:17:00 Do asymptomatic umbilical hernias require operative repair? 00:18:33 Work-up and management of drainage from umbilicus 00:20:54 Management of a granuloma 00:22:01 Operative management of urachal remnant 00:23:57 Workup and management of urachal anomalies 00:26:11 Operative management of a patent omphalomesenteric duct 00:27:53 Management of an epigastric hernia Intro and outro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: http://creativecommons.org/licenses/by/3.0/

This podcast discusses the work up, operative management, and follow-up management of tracheoesophageal fistulas. Dr. Todd Ponsky is an associate professor of surgery and pediatrics and pediatric surgeon at Akron Children's Hospital. Dr. Avraham Schlager is a pediatric surgeon at Akron Children's Hospital. Dr. Daniel von Allmen is the surgeon-in-chief, Lester W. Martin chair of pediatric surgery, senior vice president of the surgical services, and professor at University of Cincinnati department of surgery. Audio Index 00:00:00 Introduction 00:03:27 Diagnosis of TEF 00:06:21 Preoperative planning 00:07:09 Management of TEF with right sided aortic arch 00:09:00 Timing of Repair in stable patient 00:09:56 Management of patient with respiratory compromise prior to OR 00:10:58 Temporizing maneuvers to help improve respiratory function 00:13:26 Management of TEF in patients with duodenal atresia 00:14:29 Role of preoperative bronchoscopy 00:16:20 Positioning of endotracheal tube 00:17:09 Approaches to open technique and benefits of dividing azygous vein 00:17:59 Techniques to divide the tracheoesophageal fistula 00:19:25 Steps to gain exposure 00:20:58 Mobilization of esophagus 00:22:51 Managing an injury to the trachea 00:23:56 Creation of anastomosis 00:24:26 Elongating techniques for long gap esophageal atresia 00:29:06 Approaches to thoracoscopic repair 00:31:42 Techniques and pearls in performing thoracoscopic anastomosis 0034:15 Lung isolation techniques 00:35:46 Postoperative management 00:36:57 Drain management 00:37:44 Managing an anastomotic stricture 00:39:43 Managing an anastomotic leak 00:41:09 Postoperative and long term follow-up 00:42:45 Indications to perform anti-reflux surgery 00:43:46 Management of pure esophageal atresia 00:44:38 Closing remarks Intro and outro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: http://creativecommons.org/licenses/by/3.0/

An interactive discussion about malignant and benign pediatric thyroid disorders between Todd Ponsky, MD and Diana Diesen, MD. Dr. Diesen is assistant professor of surgery and pediatric surgery fellowship program director at the University of Texas Southwestern Medical Center and is a member of the Children's Health Pediatric Thyroid Center at the Children's Medical Center of Dallas. Contents 00:00 Introduction 02:31 Asymptomatic thyroid nodule 03:00 History 04:08 Risks factors for thyroid nodules and cancers 04:25 Family history 04:56 Physical exam 05:24 Physical exam pearls 06:03 Concerning physical exam findings 06:56 Laboratory evaluation 07:42 Thyroid scintigraphy 08:08 Hot thyroid nodules 09:13 Nodule with normal TSH 09:26 Thyroid ultrasound 10:15 Thyroid cysts 10:52 Lesion size and FNA biopsy 11:53 Anesthesia for FNA 12:30 Lymph node evaluation 13:12 Suspicious lymph node features 13:40 Papillary thyroid cancer 14:34 Lobectomy vs thyroidectomy 16:05 Thyroidecomy technique 17:07 Use of nerve monitor 17:40 Lymph node dissection 18:59 Post-operative management 20:37 Follow up 21:43 Radioactive iodine ablation 22:38 Thyroid hormone replacement therapy 22:54 Follicular cells on FNA 24:59 Frozen section for follicular lesions 25:55 Follicular carcinoma 26:36 Follicular adenoma 27:14 Pharmacologic TSH suppression 28:12 Benign FNA 29:45 Inadequate FNA specimen 30:32 Medullary carcinoma 33:22 Multiple endocrine neoplasia 37:26 Management of pheochromocytoma and hyperparathyroidism in MEN 2B 38:27 Central lymph node dissection in medullary thyroid cancer 39:42 Post-op medullary thyroid care 41:08 Recurrent/persistent medullary thyroid cancer 41:38 Systemic chemotherapy for MTC 42:03 Grave’s disease 42:57 Painful thyroid Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: http://creativecommons.org/licenses/by/3.0/

After a short hiatus, we are back with PKN Kyoto vol.18 speaker Robin Hoshino. Originally from Ireland, Robin presented just after a few months living in Kyoto, providing a fresh perspective on the city. Here she gives more details about her many passions: coffee, aikido, illustration, and most recently, working in a Japanese izakaya. Artist URL: http://www.hoshinorobin.com https://www.facebook.com/pknKyoto/ Venue: LEN http://backpackersjapan.co.jp/kyotohostel/en/ Music by Ash Ryan (ashryanbeats.com)

In this episode, Dr Jennifer Dietrich from Texas Children’s Hospital discusses ovarian torsion. Table of contents: 00:00 – PLAY FROM THE BEGINNING 01:33 – Evaluation of the adolescent with lower abdominal pain 02:49 – Ultrasound 04:29 – Ovarian blood flow 07:06 – Peripherally located follicle 08:06 – Ovarian mass or lesion 11:14 – What findings are suggestive of malignancy? 12:13 – Role for CT or MRI 13:16 – Are pelvic exams necessary? 13:58 – Labs 15:01 – Tumor markers 16:50 – When to operate with normal blood flow 19:40 – Classic presenation of ovarian torsion 21:09 – Difference between symptomatic ovarian cyst and ovarian torsion 22:38 – Operative technique 23:48 – Cystectomy vs fenestration 26:08 – Ovarian salvage 27:51 – Ovarian bivalve procedure 30:48 – Oophoropexy 35:00 – Tubo-ovarian abscess 35:53 – Pregnancy 37:57 – Ectopic pregnancy 39:49 – Endometriosis 42:15 – Post-operative management 43:26 – Oral contraceptives 44:19 – Surveillance 45:33 – Closing remarks Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: creativecommons.org/licenses/by/3.0/

An interactive discussion about pediatric lung lesions between Todd Ponsky, MD and Steve Rothenberg, MD. Dr. Rothenberg is Chief of Pediatric Surgery and the Chairman of the Department of Pediatrics at the Rocky Mountain Hospital for Children in Denver, CO. He is also faculty at Columbia University, College of Physicians and Surgeons in the Division of Pediatric Surgery as a Senior Consultant in Pediatric Minimal Access Surgery. Table of Contents 00:00 Introduction 02:46 Prenatal evaluation 04:11 Role of fetal MRI 04:30 Fetal imaging features 05:11 Choice of delivery location 06:01 Role of fetal intervention 07:09 Administration of corticosteroids 07:49 Cyst volume ratio 08:32 Spectrum of CPAM 11:16 Routine neonatal care 13:45 Role of neonatal MRI 15:15 Institutional variations in management 17:41 Decision to operate 20:10 Too small for thoracoscopic surgery? 21:59 Preoperative preparation 23:31 Anesthetic considerations 25:15 Avoidance of over-ventilation 26:36 Avoidance of high peak ventilator pressures 28:28 Patient positioning 30:02 Port placement 32:56 Instrument selection 35:17 Technique for vessel sealing 35:51 Vascular control 37:12 Vessel sealing devices 41:28 Left lower lobe technique 42:01 LLL-Take down inferior pulmonary ligament 42:31 LLL-Exposure of inferior pulmonary vein 42:44 LLL-Major fissure 43:46 LLL-Exposure of pulmonary artery 44:53 LLL-Dissection of superior segmental branch 45:11 LLL-Dissection of trunk to basal segments 45:33 LLL-Division of trunk 47:26 LLL-Division of the bronchus 49:33 LLL-Dissection of the pulmonary vein 50:33 Key point-Do not divide the trunk near the pericardium 51:02 Right lower lobe technique 51:46 Left upper lobe technique 52:17 LUL-Retraction 52:48 LUL-Identification of the pulmonary trunk 53:23 LUL- Exposure of the superior pulmonary vein 53:59 LUL- Isolation of venous supply to the lingula 54:25 LUL-Attention to the fissure 54:33 LUL-Lingular artery 54:54 LUL-Bronchus 55:12 LUL-Overview 55:40 Right middle lobe technique 56:43 RML-Pulmonary artery 57:05 Lobectomy technical pearls 57:38 Popping of lung cysts 58:33 Extralobar sequestration technique 59:48 Never use vessel sealer and clips on the same vessel 01:01:01 Alternative to resection of extralobar pulmonary sequestration 01:02:33 Role of segmental resection 01:04:41 Lobectomy post-operative course 01:05:50 Conclusion Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: creativecommons.org/licenses/by/3.0/

This episode is our first audio journal club. We discuss 5 papers today with our guests, Dr Dan von Allmen, Dr George Whit Holcomb, and Dr Aaron Lipskar. Table of contents: 00:00 Introduction 00:55 Corticosteroids for biliary atresia 05:21 Dr von Allmen’s comments 10:54 Antiseptic agents and surgical site infection 14:15 Dr Holcomb’s comments 20:17 Non-operative management of non-perforated appendicitis 25:19 Dr Holcomb’s comments 30:41 Enteral autonomy after intestinal failure 33:37 Dr Lipskar’s comments 36:41 Anesthesia neurotoxicity 40:27 Dr Lipskar’s comments Use of Corticosteroids After Hepatoportoenterostomy for Bile Drainage in Infants With Biliary Atresia: the START randomized clinical trial Discussed by Dr Dan von Allmen Bezerra JA, et al. Use of Corticosteroids After Hepatoportoenterostomy for Bile Drainage in Infants With Biliary Atresia: the START randomized clinical trial. JAMA. 2014 May 7;311(17):1750–10. Dr von Allmen’s comments: • Dr von Allmen would not use corticosteroids after Kasai procedure. • The difference of bile drainage in the steroid group versus control (58.6% vs 48.6%) was not significant enough to continue use of corticosteroids. Comparative Effectiveness of Skin Antiseptic Agents in Reducing Surgical Site Infections: A Report from the Washington State Surgical Care and Outcomes Assessment Program Discussed by Dr George Whit Holcomb Hakkarainen TW, et al. Comparative Effectiveness of Skin Antiseptic Agents in Reducing Surgical Site Infections: A Report from the Washington State Surgical Care and Outcomes Assessment Program. J Am Coll Surg. 2014 Mar 1;218(3):336–44. Dr Holcomb’s comments: • This paper would not change his choice of antiseptic agent. Dr Holcomb feels that iodine based agents and chlorhexidine agents are equally appropriate based on these results. • Dr Holcomb uses chlorhexidine and isopropyl alcohol for skin preparation. Nonoperative Treatment With Antibiotics Versus Surgery for Acute Nonperforated Appendicitis in Children: a pilot randomized controlled trial Discussed by Dr George Whit Holcomb Svensson JF, et al. Nonoperative Treatment With Antibiotics Versus Surgery for Acute Nonperforated Appendicitis in Children: a pilot randomized controlled trial. Annals of Surgery. 2015 Jan;261(1):67–71. Dr Holcomb’s comments: • This is a well done pilot study that shows that a larger randomized trial is needed. • Long term follow-up is needed to determine the true risk of recurrent appendicitis after non-operative management. Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study Discussed by Dr Aaron Lipskar Khan FA, et al. Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study. J Pediatr. 2015 Jul;167(1):29–34.e1. Dr Lipskar’s comments: • It is counterintuitive that NEC is a protective factor for enteral autonomy. • It is difficult to make sense of the data as centers with transplant programs likely attract sicker patients. • This highlights the importance of intestinal failure patients being managed in a multidisciplinary intestinal failure program. Anesthetic neurotoxicity--clinical implications of animal models Discussed by Dr Aaron Lipskar Rappaport BA, et al. Anesthetic neurotoxicity--clinical implications of animal models. N Engl J Med. 2015 Feb 26;372(9):796–7. Dr Lipskar’s comments: • Until further trials in humans are conducted and provide more conclusive evidence, elective cases should be deferred until the age of 3. • It may be difficult to define what constitutes an elective procedure in pediatric surgery. Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: creativecommons.org/licenses/by/3.0/

An interactive discussion about cloacal exstrophy between Todd Ponsky, MD and Alberto Peña, MD. Dr. Peña is is the founding director of the Peña Colorectal Center at Cincinnati Children's Hospital and clinical professor of surgery at the University of Cincinnati Table of Contents 00:00 Introduction 01:24 What is cloacal exstrophy? 06:24 Management of cloacal exstrophy 07:56 Sexual function in males 11:38 Team approach 12:50 Role of the pediatric surgeon 13:21 Differentiating urothelium from intestinal mucosa 13:51 Bladder closure 14:04 End colostomy creation 15:11 Consequences of end ileostomy creation 16:41 Rescue operation 18:51 Common mistake: Failure to separate bowel from bladder 20:15 Pelvic osteotomies for pelvic approximation 21:37 End colostomy complications 23:23 Reversal of colostomy and pull-through 24:09 Bladder augmentation 24:41 Stoma reversal candidates 25:43 Importance of colon length preservation 26:29 Bowel management program through stoma 27:31 Age for stoma reversal 27:59 Bladder augmentation options 29:22 How to determine if patient has an ileostomy 30:43 Surgical planning 32:56 Surgical technique 37:13 Prognosis 38:42 Female reproduction in cloacal exstrophy 40:40 Role of Mitrofanoff 42:17 Patient follow-up 43:42 The Pull-Thru Network 45:46 Summary 47:49 Prenatal diagnosis Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: creativecommons.org/licenses/by/3.0/

An interactive discussion about vascular access in the pediatric patient population between Todd Ponsky, MD and Mark Wulkan, MD. Dr. Wulkan is Professor of Surgery and Chief, Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Emory Children's Center, Atlanta, Georgia Table of Contents 01:15 - Catheter selection 02:48 - Neck cutdown technique 06:38 - Catheter selection, continued 07:02 - Neck cutdown technique, continued 07:18 - Determine catheter length 09:34 - Percutaneous technique 13:24 - Long-term access 15:22 - Utility of vascular studies 17:50 - Choice of vessel 19:17 - Line infections 20:06 - Choice of vessel, continued 22:44 - Groin cutdown technique 23:17 - Preoperative workup 24:38 - Heparin use 25:20 - Ethanol use 26:14 - Line infections, continued 27:35 - Antibiotic-coated catheters 27:47 - Heparin-coated catheters 28:04 - Exhaustion of vessel options 31:15 - Skin preparation 32:37 - Tunneled catheter removal Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: http://creativecommons.org/licenses/by/3.0/