# Myelomeningocele — GCMD Library living collection

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

Updated: n/a · 6 episodes · 96 cited statements

## Episodes
### Surgical Management
- [Fetoscopic Repair of Myelomeningocele (MMC)](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391) — podcast · 5:52 · [machine version](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391.md)
- [Myelomeningoceles (open spina bifida) -Fetoscopic Intrauterine Myelomeningocele Closure](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326) — video · 3:41 · [machine version](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326.md)

### Evidence & Research
- [Fetal Surgical Intervention for Myelomeningocele: Fetal Surgery 2012](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026) — video · 165:47 · [machine version](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026.md)
- [Journal of Pediatric Surgery Article Review: January 2022 APSA Issue](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103) — podcast · 13:09 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103.md)
- [Journal of Pediatric Surgery Article Highlights: April 2022](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554) — podcast · 8:38 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554.md)

### Case-Based Learning
- [Colorectal Quiz Episode 15: Bowel Management in Spinal Patients - Need for a UrologistPart 1](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232) — podcast · 17:26 · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=0) General Fetal Surgery Discussion: Steroids for CCAM and SCT (Ep 1)
- [20:00](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=1200) Minimally Invasive Approaches and Technology for Fetal Tumors (Ep 1)
- [45:00](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=2700) Establishing Fetal Surgery Centers: Requirements and Challenges (Ep 1)
- [65:00](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=3900) Video: CHOP Fetal Treatment Center Overview (Ep 1)
- [80:50](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=4850) Myelomeningocele: Pathophysiology and Rationale for Fetal Surgery (Ep 1)
- [111:40](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6700) The MOMS Trial: Design, Execution, and Results (Ep 1)
- [125:00](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=7500) Post-MOMS Experience and Center Development Guidelines (Ep 1)
- [141:40](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=8500) Innovation, Fetoscopic Approaches, and Future Directions (Ep 1)
- [158:20](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=9500) Shunt Criteria Discrepancies and Neurosurgical Perspective (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=0) Introduction and case presentation setup (Ep 2)
- [2:10](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=130) Initial presentation: 5-month-old with myelomeningocele and constipation (Ep 2)
- [4:10](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=250) Management of senna-induced rash and alternative laxative strategies (Ep 2)
- [6:12](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=372) Transition to enema-based bowel management (Ep 2)
- [9:33](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=573) Surgical planning: Malone procedure and coordination with urology (Ep 2)
- [11:08](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=668) Temporizing measures when urologic plan is uncertain (Ep 2)
- [15:53](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=953) Case summary and key takeaways (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=0) Introduction to Fetoscopic Myelomeningocele Repair (Ep 3)
- [1:13](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=73) Myelomeningocele Pathology and Timing (Ep 3)
- [1:51](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=111) Surgical Access and Port Placement (Ep 3)
- [3:08](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=188) Placode Untethering (Ep 3)
- [3:44](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=224) Defect Closure with Patches and Skin (Ep 3)
- [4:49](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=289) Procedure Completion and Postoperative Care (Ep 3)
- [0:04](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=4) Introduction to January 2022 APSA Issue Review (Ep 4)
- [1:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=60) Academic RVU System for Pediatric Surgical Productivity (Ep 4)
- [5:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=338) Standardized Gastroschisis Protocol and Sutureless Closure (Ep 4)
- [9:11](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=551) Placental Mesenchymal Stromal Cells for In Utero Myelomeningocele Repair (Ep 4)
- [0:03](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=3) Introduction and Wilms Tumor with Intravascular Extension (Ep 5)
- [2:10](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=130) Mesenchymal Stromal Cells for Fetal Myelomeningocele Repair (Ep 5)
- [4:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=277) Fetal Surgery Subspecialization and Training Patterns (Ep 5)
- [0:00](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=0) Introduction and Myelomeningocele Overview (Ep 6)
- [0:47](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=47) Initial Surgical Access and Preparation (Ep 6)
- [1:32](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=92) Myelomeningocele Dissection and Neural Reconstruction (Ep 6)
- [2:37](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=157) Skin Closure and Grafting (Ep 6)
- [3:12](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=192) Closure and Summary (Ep 6)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Myelomeningocele is a neural tube defect where the spinal cord does not close and is exposed on surface through an opening in the spine" (clinical) [Ep 6 · 0:20](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=20)
- "Myelomeningocele usually occurs in the low back region" (clinical) [Ep 6 · 0:31](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=31)
- "The incidence of neural tube defects is around 0.2 per 1000 live births in the United States" (epidemiological) [Ep 6 · 0:33](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=33)
- "When diagnosed prenatally, myelomeningoceles can be repaired during the fetal stage of life while in utero" (clinical) [Ep 6 · 0:39](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=39)
- "The pregnant patient is placed under general anesthesia and the uterus is approached by a midline laparotomy" (clinical) [Ep 6 · 0:47](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=47)
- "An ultrasound is used to map the location of the placenta and major vessels on the uterine surface" (clinical) [Ep 6 · 0:55](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=55)
- "Four full thickness sutures are placed through the uterine wall to delineate a 1 centimeter square area through which a 10 French trochar is inserted using Seldinger technique" (clinical) [Ep 6 · 1:00](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=60)
- "After removing a portion of the amniotic fluid, the uterus is insufflated with warm, humidified carbon dioxide" (clinical) [Ep 6 · 1:14](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=74)
- "Two subsequent trocars are placed under endoscopic visualization" (clinical) [Ep 6 · 1:22](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=82)
- "Prior to surgical intervention, the fetus is administered a sedative cocktail of rocuronium, fentanyl, and atropine" (clinical) [Ep 6 · 1:26](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=86)
- "Dissection of the myelomeningocele begins lateral to the exposed spinal cord, detaching it from the arachnoid and skin" (clinical) [Ep 6 · 1:32](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=92)
- "The spinal cord is circumferentially released, taking care not to injure the ascending spinal cord, lateral dorsal roots, or segmental vasculature" (clinical) [Ep 6 · 1:41](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=101)
- "Tenotomy scissors and right-angled hook electrocautery are used to sharply dissect through the tissue to completely free the placode" (clinical) [Ep 6 · 1:51](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=111)
- "The neural placode is reconstructed with interrupted 6-0 sutures after it is completely untethered from the skin" (clinical) [Ep 6 · 1:59](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=119)
- "The dura attaches laterally and ventrally to the open skin edge at the junctional zone" (clinical) [Ep 6 · 2:06](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=126)
- "Lateral fascia and muscle may be freed to allow medialization and primary closure of the dura under less tension" (clinical) [Ep 6 · 2:16](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=136)
- "A running, non-absorbable 6-0 suture is utilized to re-approximate the dura, which will persist long term and act as a useful guide if subsequent untethering is required" (clinical) [Ep 6 · 2:24](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=144)
- "Skin closure should be performed in the mid-sagittal plane when possible" (clinical) [Ep 6 · 2:37](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=157)
- "Skin mobilization may require including the subcutaneous fat layer, as the skin's vascular supply comes through this layer" (clinical) [Ep 6 · 2:43](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=163)
- "Blunt dissection in the plane between the muscle and subcutaneous fat is the best method to preserve the blood supply" (clinical) [Ep 6 · 2:49](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=169)
- "In some cases, the size of the skin defect may prevent primary skin closure" (clinical) [Ep 6 · 2:55](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=175)
- "A synthetic skin graft may be utilized and sutured to the edges of the healthy skin when primary closure is not possible" (clinical) [Ep 6 · 3:00](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=180)
- "The synthetic skin graft will promote eventual epithelialization of the open defect" (clinical) [Ep 6 · 3:07](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=187)
- "After completing the fetal back closure, the amniotic fluid is replaced in the uterus with warmed, lactated Ringer solution" (clinical) [Ep 6 · 3:12](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=192)
- "The ports are removed and the insertion sites are closed, the uterus is returned to the abdominal cavity and the abdominal incision is closed in the standard fashion" (clinical) [Ep 6 · 3:19](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=199)
- "Historically, surgeons have been incentivized based on work RVUs, which is important for clinical productivity but does not take advantage of other strengths surgeons have." — Gail Besner (opinion) [Ep 4 · 1:41](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=101)
- "The concept of academic RVUs was first described approximately 12-13 years ago but did not include how to incentivize people for academic work." — Gail Besner (clinical) [Ep 4 · 2:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=175)
- "Nationwide Children's Hospital implemented a point-based academic RVU system where people accumulate points based on number of publications, presentations, and other academic pursuits." — Gail Besner (clinical) [Ep 4 · 3:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=187)
- "The Nationwide system kept work RVUs as part of the incentivization plan along with other goals that must be achievable." — Gail Besner (clinical) [Ep 4 · 3:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=207)
- "After implementing the academic RVU system, Nationwide had an increase in presentations, peer-reviewed publications, and external federal research funding." (host_summary) [Ep 4 · 3:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=224)
- "External federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase." — Rod Gerardo (host_summary) [Ep 4 · 3:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=238)
- "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." — Todd Ponsky (clinical) [Ep 4 · 5:03](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=303)
- "The BC Children's Hospital gastroschisis study was a retrospective review comparing outcomes before and after implementation of a protocol in 2012, covering patients from 2008 to 2019." (host_summary) [Ep 4 · 5:51](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=351)
- "At Saint Justine Hospital, the approach to gastroschisis differed from other institutions in that there was very low use of silos, with pretty much every patient having an attempt at immediate bedside sutureless closure following a protocol developed several years prior." — Charza Jaharifard (clinical) [Ep 4 · 6:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=418)
- "Before and after protocol implementation at BC Children's Hospital, approximately 75% of gastroschisis patients could be closed immediately, whether in the OR pre-implementation with fascial closure or at bedside post-implementation." — Charza Jaharifard (clinical) [Ep 4 · 7:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=477)
- "With silo management, parents look at their newborn's intestines through a silo for 5-6 days and cannot hold their baby until the silo is completely reduced." — Charza Jaharifard (clinical) [Ep 4 · 8:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=507)
- "With immediate closure of gastroschisis, if babies are extubated within 48 hours, parents can hold them within 48 hours, or immediately if managed without intubation." — Charza Jaharifard (clinical) [Ep 4 · 8:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=523)
- "In prior studies of placental mesenchymal stem cells for in utero MMC repair, two surgeries were performed on lambs: one to create the defect and one to repair it, both in utero, with PMSCs used during repair." (host_summary) [Ep 4 · 10:17](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=617)
- "In the current study, a single operation was performed at approximately 100 days gestational age where the MMC defect was created and repaired simultaneously, with PMSCs placed directly onto the spinal cord." (host_summary) [Ep 4 · 10:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=643)
- "The PMSCs did not persist in the placentas, uteri, or lambs at 3 months follow-up." (host_summary) [Ep 4 · 11:23](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=683)
- "There was no histological evidence of abnormal growth or tumor development in the ovine model at 3 months." (host_summary) [Ep 4 · 11:30](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=690)
- "Human trials using PMSCs for in utero myelomeningocele repair have been initiated with the first two patients enrolled." (host_summary) [Ep 4 · 11:52](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=712)
- "Spina bifida affects approximately 1500 babies born per year in the US, about 30 per week or 5-6 per day." — Scott Adzik (epidemiological) [Ep 1 · 82:06](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=4926)
- "With standard postnatal care, approximately 14% of MMC patients die by age 5, mostly due to symptomatic brain stem compression from hindbrain herniation." — Scott Adzik (clinical) [Ep 1 · 83:20](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5000)
- "About 85% of MMC patients require ventricular shunts with standard postnatal care, with approximately half developing shunt complications within one year." — Scott Adzik (clinical) [Ep 1 · 83:33](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5013)
- "The two-hit hypothesis for MMC proposes that secondary damage occurs in utero from amniotic fluid, meconium, or hydrodynamic forces after the initial failure of neurulation." — Scott Adzik (clinical) [Ep 1 · 83:41](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5021)
- "In fetal sheep models, mid-gestational spinal cord exposure leads to progressive neurologic injury that mimics human MMC, with paralysis and loss of sensation below the lesion level." — Scott Adzik (clinical) [Ep 1 · 86:09](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5169)
- "In utero coverage of experimentally created MMC in fetal sheep rescues neurologic function at birth, with lambs able to stand, walk, and maintain continence." — Scott Adzik (host_summary) [Ep 1 · 86:43](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5203)
- "Hindbrain herniation reverses after prenatal MMC repair because closing the defect prevents CSF leak, reestablishing the pressure column in the spinal canal." — Scott Adzik (clinical) [Ep 1 · 90:15](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5415)
- "In CHOP's pre-MOMS experience with 50 fetal MMC repairs, the shunt rate by one year was 40%, compared to 85% with postnatal repair." — Scott Adzik (clinical) [Ep 1 · 93:10](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5590)
- "Two-thirds of prenatally repaired MMC patients showed motor function two or more levels better than the anatomic lesion level." — Scott Adzik (clinical) [Ep 1 · 93:41](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5621)
- "The MOMS trial was stopped early on December 7, 2010 by the Data Safety Monitoring Board due to demonstrated efficacy of prenatal surgery." — Scott Adzik (clinical) [Ep 1 · 102:18](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6138)
- "In the MOMS trial, shunts were placed in 40% of the prenatal surgery group compared to 82% of the postnatal surgery group." — Scott Adzik (clinical) [Ep 1 · 102:55](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6175)
- "At 30 months, 42% of babies in the prenatal surgery group could walk independently versus only 21% in the postnatal surgery group." — Scott Adzik (clinical) [Ep 1 · 103:31](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6211)
- "Mean gestational age at delivery was 34 weeks in the prenatal surgery group versus 37 weeks in the postnatal group, with 13% of prenatal cases delivered before 30 weeks." — Scott Adzik (clinical) [Ep 1 · 104:57](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6297)
- "At the time of delivery in the MOMS trial, the hysterotomy site was intact in about two-thirds of cases, very thin in one-quarter, with dehiscence in 9% and complete dehiscence in one case." — Scott Adzik (clinical) [Ep 1 · 104:32](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6272)
- "Since the end of the MOMS trial, CHOP has had 359 referrals, with 202 evaluated on-site, but only 60 (30%) underwent fetal surgery." — Scott Adzik (clinical) [Ep 1 · 107:57](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6477)
- "Fetal MRI is mandatory for preoperative evaluation because ultrasound alone can incorrectly identify hindbrain herniation; in 9 cases with absent hindbrain herniation on MRI, ultrasound showed positive or equivocal findings." — Scott Adzik (clinical) [Ep 1 · 109:07](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6547)
- "Fetoscopic MMC repair using 3 or more ports leads to membrane fixation and tearing with uterine growth, resulting in premature birth 3-6 weeks after surgery and delivery before 30 weeks as a rule." — Scott Adzik (clinical) [Ep 1 · 109:47](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6587)
- "Compared to open fetal MMC repair, fetoscopic repair has higher rates of fetal death, premature rupture of membranes, chorioamnionitis, oligohydramnios, premature delivery, and persistent hindbrain herniation." — Scott Adzik (clinical) [Ep 1 · 110:06](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6606)
- "There have been three maternal deaths associated with open fetal surgery for MMC in South America (one in Colombia, two in Argentina)." — Todd Ponsky (host_summary) [Ep 1 · 132:16](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=7936)
- "In the US experience with open fetal surgery for MMC, there have been no maternal deaths and no serious maternal complications in recent years." — Todd Ponsky (clinical) [Ep 1 · 133:43](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=8023)
- "Longer operating room times and postoperative oligohydramnios correlate with increased risk for preterm birth in fetal MMC repair." — Scott Adzik (clinical) [Ep 1 · 106:17](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6377)
- "A Washington University financial model using MOMS trial data showed that over $3 million would be saved for 100 babies treated prenatally versus postnatally." — Scott Adzik (host_summary) [Ep 1 · 107:07](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6427)
- "In Europe, approximately one-third of mothers decline open fetal MMC surgery because it is an open procedure." — Todd Ponsky (epidemiological) [Ep 1 · 146:39](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=8799)
- "For proper neurosurgical repair of cystic MMC, it is essential to remove the cyst and excise tissues that don't belong, not simply cover the lesion—a step that may be missing in some fetoscopic approaches." — Todd Ponsky (clinical) [Ep 1 · 147:34](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=8854)
- "In the MOMS trial, 51% of prenatally repaired children met shunt criteria, but only 31 actually received shunts (approximately 65% of those meeting criteria), compared to 66 of 74 (89%) in the postnatal group." — Todd Ponsky (clinical) [Ep 1 · 150:23](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=9023)
- "The discrepancy between meeting shunt criteria and receiving shunts occurred because an independent neurosurgical review committee determined criteria, but individual neurosurgeons made placement decisions, and most discrepancies involved criterion 3 (head size/ventricle changes) without accompanying symptoms." — Scott Adzik (host_summary) [Ep 1 · 154:14](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=9254)
- "Using revised shunt criteria based on modified criterion 3, there is a close match between shunt criteria and actual shunt placement in both prenatal (46%) and postnatal (86%) groups." — Scott Adzik (host_summary) [Ep 1 · 156:43](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=9403)
- "About 5% of colorectal work is surgical and the rest is bowel management." — Rebecca Rentia (host_summary) [Ep 2 · 1:48](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=108)
- "MiraLax softens stool but does not provide a 'push' to expel it, which can leave the colon full of soft stool." — Christine Warner (clinical) [Ep 2 · 6:16](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=376)
- "Senna and bisacodyl are the two medications that provide a 'kick' or push for stool expulsion; everything else is a stool softener." — Marc Levitt (clinical) [Ep 2 · 6:59](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=419)
- "MiraLax is problematic for patients with anorectal malformations who need fullness to detect stool, because it makes soft stool that 'mushes out' without discrete sensation." — Marc Levitt (clinical) [Ep 2 · 7:15](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=435)
- "Senna-induced perineal rash is thought to be a chemical burn rather than a true allergy, presenting with blistering." — Jason Frischer (clinical) [Ep 2 · 5:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=330)
- "Senna rash is treated with silver sulfadiazine and resolves with time; some patients tolerate senna upon reintroduction." — Jason Frischer (clinical) [Ep 2 · 5:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=338)
- "Timing senna doses in the early morning so that bowel movements occur during the day (when diapers are changed promptly) reduces the risk of senna rash." — Jason Frischer (clinical) [Ep 2 · 5:47](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=347)
- "Senna rash may be related to the formulation (tablet, liquid, or chocolate squares) or to prolonged contact with stool, particularly overnight." — Marc Levitt (host_summary) [Ep 2 · 5:07](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=307)
- "Glycerin is generally better tolerated than castile soap for enemas in children; castile soap commonly causes cramping and discomfort." — Wendy Lewis (clinical) [Ep 2 · 9:10](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=550)
- "A Malone appendicostomy provides tube-free access for antegrade enemas via daily catheterization of the channel." — Rebecca Rentia (clinical) [Ep 2 · 9:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=579)
- "Children with spinal differences may need bladder access later in life, and the appendix is the preferred conduit for a Mitrofanoff urinary channel." — Rebecca Rentia (clinical) [Ep 2 · 9:49](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=589)
- "Coordination with urology from the beginning of bowel management planning is essential in spinal patients to preserve the appendix for potential urologic reconstruction." — Marc Levitt (clinical) [Ep 2 · 10:02](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=602)
- "A cecostomy tube (placed laparoscopically or by interventional radiology) provides direct access to the cecum for antegrade enemas and preserves the appendix for future reconstruction." — Rebecca Rentia (clinical) [Ep 2 · 11:53](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=713)
- "A non-plicating, non-trimmed Malone appendicostomy (tip of appendix sewn to right lower quadrant with a balloon tube, without plication or trimming) preserves the appendix for potential future urologic use or splitting." — Marc Levitt (clinical) [Ep 2 · 12:22](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=742)
- "Urologists prefer an appendix of at least 5 cm length for a Mitrofanoff; shorter appendices are not suitable for urologic use." — Marc Levitt (clinical) [Ep 2 · 13:36](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=816)
- "An appendix of 2 cm is too short for either colorectal or urologic use; 5 cm goes to urology; 7 cm may be splittable (2 cm for colorectal, 5 cm for urology); longer appendices are certainly splittable." — Marc Levitt (clinical) [Ep 2 · 13:16](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=796)
- "For urologic reconstruction, the appendix is preferred over a Monti channel made from small bowel for long-term outcomes." — Marc Levitt (clinical) [Ep 2 · 14:07](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=847)
- "A neo-Malone can be created from a flap of colon if the appendix is used for urologic purposes." — Marc Levitt (clinical) [Ep 2 · 14:18](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=858)
- "Taking down a cecostomy tube is relatively easy and leaves the appendix free for subsequent use." — Marc Levitt (clinical) [Ep 2 · 15:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=938)
- "Bisacodyl can be administered as an enema or suppository in infants." — Jason Frischer (clinical) [Ep 2 · 8:31](https://library.globalcastmd.com/watch/colorectal-quiz-episode-15-bowel-management-in-spinal-patients-need-for-a-urologistpart-1-4232?t=511)
- "Neural tube defects are the most common congenital central nervous system anomaly." — Rod Gerardo (host_summary) [Ep 3 · 0:42](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=42)
- "Myelomeningocele or spina bifida is the most common neural tube defect." — Rod Gerardo (host_summary) [Ep 3 · 1:20](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=80)
- "In myelomeningocele, the patient is born with a cleft in the vertebral column and a defect in the skin, so the meninges and the spinal cord are exposed." — Rod Gerardo (host_summary) [Ep 3 · 1:25](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=85)
- "The patient may be left with neural defects based on the level of the spinal cord where the lesion is." — Rod Gerardo (host_summary) [Ep 3 · 1:33](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=93)
- "Prenatal repair is most commonly done between 22 and 26 weeks gestation." — Fung Lim (clinical) [Ep 3 · 1:44](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=104)
- "For maternal access, either a transverse incision or a midline incision may be used." — Fung Lim (clinical) [Ep 3 · 1:54](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=114)
- "Under ultrasound guidance, the first port is placed." — Rod Gerardo (host_summary) [Ep 3 · 2:17](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=137)
- "The amniotic cavity is expanded using humidified and heated carbon dioxide, which creates more space to do the repair." — Fung Lim (clinical) [Ep 3 · 2:22](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=142)
- "A camera is inserted into the amniotic cavity through the first port to enable visualization inside the womb." — Fung Lim (clinical) [Ep 3 · 2:34](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=154)
- "Two additional ports are placed under direct vision to allow placement of instruments for the repair." — Fung Lim (clinical) [Ep 3 · 2:43](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=163)
- "Anesthesia is induced on the baby via an intragluteal injection." — Rod Gerardo (host_summary) [Ep 3 · 2:51](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=171)
- "A stabilization stitch is placed in the baby's upper back above the spina bifida." — Fung Lim (clinical) [Ep 3 · 2:56](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=176)
- "The first step is to open the sac, then dissect around the sac circumferentially." — Rod Gerardo (host_summary) [Ep 3 · 3:08](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=188)
- "Once the sac is completely open, the placode is freed." — Fung Lim (clinical) [Ep 3 · 3:22](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=202)
- "The placode is the open area of exposed neural tissue." — Rod Gerardo (host_summary) [Ep 3 · 3:27](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=207)
- "Untethering allows the placode to fall back down nicely into the spinal canal." — Fung Lim (clinical) [Ep 3 · 3:34](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=214)
- "A skin flap is created to loosen up the skin, which will help form a watertight closure of the spinal defect." — Rod Gerardo (host_summary) [Ep 3 · 3:44](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=224)
- "To protect the placode, a patch is placed into the defect and anchored on one end to the baby's back using dissolvable sutures." — Fung Lim (clinical) [Ep 3 · 3:57](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=237)
- "A second patch is placed to give additional protection and is secured with dissolvable sutures." — Fung Lim (clinical) [Ep 3 · 4:08](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=248)
- "The skin is closed over the spinal defect using dissolvable sutures when the baby has enough skin to do so." — Fung Lim (clinical) [Ep 3 · 4:17](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=257)
- "When the defect is too big and the two ends of skin cannot be pulled together, a skin patch is used to form a watertight closure." — Fung Lim (clinical) [Ep 3 · 4:26](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=266)
- "Port sites are closed with dissolvable sutures." — Fung Lim (clinical) [Ep 3 · 4:49](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=289)
- "The amniotic fluid that was removed is replaced with warm fluid and antibiotics are placed into the amniotic cavity." — Fung Lim (clinical) [Ep 3 · 4:57](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=297)
- "The mother and the fetus are monitored postoperatively, and if able, the baby is delivered vaginally at term." — Rod Gerardo (host_summary) [Ep 3 · 5:14](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=314)
- "The first article examines surgical management, staging and outcomes of Wilms tumors with intravascular extension, using results from the SIOP (International Society of Pediatric Oncology) Renal Tumor Study." — Brittany Levy (host_summary) [Ep 5 · 0:34](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=34)
- "The study looked at children with Wilms tumor where tumor thrombus extended into the renal vein and provided outcomes for when complete resection of tumor thrombus was successful versus when it was not." — Brittany Levy (host_summary) [Ep 5 · 0:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=58)
- "Dr. Paul Tam states that Wilms tumor has been a great success story for pediatric surgery and pediatric oncology." — Brittany Levy (host_summary) [Ep 5 · 1:14](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=74)
- "Dr. Paul Tam suggests improving outcomes by identifying subgroups of patients who are still not doing well and trying to improve care in those particular areas." — Brittany Levy (host_summary) [Ep 5 · 1:39](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=99)
- "If half of Wilms tumor patients have complete tumor removal and half do not, and there is an outcome difference, then surgeons should still try hard to remove all of the tumor." — Brittany Levy (host_summary) [Ep 5 · 1:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=114)
- "The second article examines efficacy of clinical grade human placental mesenchymal stromal cells in fetal ovine myelomeningocele repair." — Brittany Levy (host_summary) [Ep 5 · 2:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=133)
- "The article discussed use of mesenchymal stromal cells on an extracellular matrix in ovine fetuses to determine if there was a benefit to motor function in fetal lambs given the intervention." — Brittany Levy (host_summary) [Ep 5 · 2:40](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=160)
- "Dr. Christina Theodoro states this study is a pivotal study in obtaining approval from the FDA for use of clinical grade stem cells in fetal myelomeningocele repair." — Christina Theodoro (clinical) [Ep 5 · 2:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=174)
- "The technique involves exposing the fetal back, re-exposing the spinal cord, identifying the myelomeningocele defect, placing an extracellular matrix patch with placental stem cells facing the spinal cord in direct contact, closing the skin, and returning the baby to the uterus to continue gestation until term." — Christina Theodoro (clinical) [Ep 5 · 3:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=207)
- "Lambs repaired with clinical grade placental stem cells have significantly improved motor function compared to lambs that did not receive the stem cells." — Christina Theodoro (clinical) [Ep 5 · 3:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=234)
- "Dr. Todd Ponsky states that in utero repair of myelomeningocele has already shown benefit, and impregnating the repair with mesenchymal stromal cells provides an even larger benefit in the chance of ambulation." — Todd Ponsky (clinical) [Ep 5 · 4:08](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=248)
- "The third article is titled 'Current Status of Sub-specialization in Pediatric Surgery, a Focus on fetal Surgery' and surveys practice patterns in fetal surgery across the country." — Rod Gerardo (host_summary) [Ep 5 · 4:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=277)
- "The survey included self-identified specialists within the field of fetal surgery, yet only 4% of those people reported receiving formal training in fetal surgery." — Natalie Lopian (epidemiological) [Ep 5 · 5:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=313)
- "Many survey respondents reported receiving fetal training during their pediatric surgery fellowship training, yet when the question was posed differently, many responded that they did not have exposure to fetal surgery during fellowship training." — Brittany Levy (host_summary) [Ep 5 · 5:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=337)
- "Dr. Paul Tam states that fetal surgery is a frontier for pediatric surgery and the survey provides a reality check on how to develop a treatment which remains rare and often experimental." — Brittany Levy (host_summary) [Ep 5 · 5:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=354)
- "Dr. Natalie Lopian suggests it will be interesting to see whether fetal surgery exposure becomes a requirement during training or whether fetal centers become the primary training ground for fetal surgeons as the field expands." — Natalie Lopian (opinion) [Ep 5 · 6:18](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=378)
- "Dr. Todd Ponsky states that disparities in practice patterns are what happens in an emerging field, and it is reasonable to expect different levels of what different hospitals do in fetal surgery." — Todd Ponsky (opinion) [Ep 5 · 6:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=398)
- "The study was not designed to link subspecialization of fetal surgery to outcomes and was not designed to provide a clear definition of a fetal surgery center." — Natalie Lopian (clinical) [Ep 5 · 7:26](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=446)

## Changelog
- Sep 7: 3 items added automatically
- Sep 7: 3 items added automatically

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