# Pediatric Surgery Update Course Highlights — GCMD Library living collection Updated: n/a · 3 episodes · 10 cited statements ## Episodes ### Annual Key Takeaways - [Update Course Rewind: 2024 Top Ten Key Takeaways](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591) — podcast · 18:01 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591.md) - [Update course rewind: 2024 top ten key takeaways in pediatric surgery](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592) — podcast · 18:01 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592.md) - [Update Course Rewind: 2024 Top Ten Key Takeaways](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526) — video · 18:01 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526.md) ## Chapters - [0:01](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1) Introduction and Topic 10: Collaboration of Surgery and Interventional Radiology (Ep 3) - [2:03](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=123) Topic 9: Top AI Tools of 2024 (Ep 3) - [4:17](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=257) Topic 8: Cryoanalgesia in Pectus Procedures (Ep 3) - [5:39](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=339) Topic 7: ECMO in Severe Congenital Diaphragmatic Hernia (Ep 3) - [7:59](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=479) Topic 6: CO2 Laser in Surgical Procedures (Ep 3) - [9:12](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=552) Topic 5: Autofluorescence and ICG in Thyroid Surgery (Ep 3) - [11:09](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=669) Topic 4: Surgery-First Mindset for Pediatric Biliary Stones (Ep 3) - [12:48](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=768) Topic 3: MMP-7 as Diagnostic Tool in Biliary Atresia (Ep 3) - [14:45](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=885) Topic 2: REBOA in Pediatric Trauma (Ep 3) - [16:07](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=967) Topic 1: Non-Surgical Management of Pilonidal Disease (Ep 3) - [0:00](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=0) Introduction and Takeaway #10: Collaboration of Surgery and Interventional Radiology in the OR (Ep 1) - [2:04](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=124) Takeaway #9: Top AI Tools of 2024 (Ep 1) - [4:17](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=257) Takeaway #8: Cryoanalgesia in Pectus Surgery (Ep 1) - [5:40](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=340) Takeaway #7: ECMO and Surgical Repair in Severe Congenital Diaphragmatic Hernia (Ep 1) - [7:59](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=479) Takeaway #6: CO₂ Laser in Pediatric Surgery (Ep 1) - [9:12](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=552) Takeaway #5: Autofluorescence and ICG in Thyroid Surgery (Ep 1) - [11:09](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=669) Takeaway #4: Surgery-First Mindset in Pediatric Biliary Stone Disease (Ep 1) - [12:48](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=768) Takeaway #3: MMP-7 as a Diagnostic Biomarker for Biliary Atresia (Ep 1) - [14:45](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=885) Takeaway #2: REBOA in Pediatric Trauma (Ep 1) - [16:07](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=967) Takeaway #1: Non-Surgical Management of Pilonidal Disease (Ep 1) - [0:08](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=8) Collaboration of Surgery and Interventional Radiology in the OR (Ep 2) - [2:04](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=124) Top AI Tools of 2024 for Surgical Research (Ep 2) - [4:17](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=257) Cryoanalgesia in Pectus Surgery (Ep 2) - [5:41](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=341) ECMO Management in Severe Congenital Diaphragmatic Hernia (Ep 2) - [7:59](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=479) CO2 Laser Applications in Pediatric Surgery (Ep 2) - [9:12](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=552) Autofluorescence and ICG in Thyroid Surgery (Ep 2) - [11:09](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=669) Surgery-First Approach for Pediatric Biliary Stones (Ep 2) - [12:48](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=768) MMP-7 as Diagnostic Biomarker for Biliary Atresia (Ep 2) - [14:45](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=885) REBOA in Pediatric Trauma (Ep 2) - [16:07](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=967) Non-Surgical Management of Pilonidal Disease (Ep 2) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - Cone beam CT is performed on a C-arm fluoroscopy unit that rotates around the patient collecting multiple images which are stacked together to create a CT. (clinical) [Ep 3 · 1:25](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=85) - With autofluorescence, parathyroids naturally autofluoresce at a specific wavelength without injecting anything. (clinical) [Ep 3 · 9:53](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=593) - Hypocalcemia rates were about 50% lower with autofluorescence use versus not using it. (epidemiological) [Ep 3 · 10:07](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=607) - A surgery-first pathway for pediatric biliary stones reduces resource utilization, including MRCP, according to recently published work. (epidemiological) [Ep 3 · 11:32](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=692) - With ERCP, you're going to get pancreatitis 10% of the time no matter how good you are. (epidemiological) [Ep 3 · 12:02](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=722) - If you just did flushing or got the catheter a little more into the common bile duct or reamed the sphincter, the success rate was in the 90s. (epidemiological) [Ep 3 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=745) - At lower volume institutions where neonatologists are very involved with care, switching to early repair when only putting one or two children on ECMO per year for CDH is a challenge and requires whole team buy-in. (opinion) [Ep 1 · 7:12](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=432) - No matter how good you are at ERCP, you're going to get pancreatitis 10% of the time, and if the patient gets pancreatitis when you could have gone straight to surgery, that was a mistake. (clinical) [Ep 1 · 12:02](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=722) - Switching to early repair in low-volume institutions (one or two children on ECMO per year for CDH) is a challenge requiring whole team buy-in. (clinical) [Ep 2 · 7:12](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=432) - ERCP causes pancreatitis 10% of the time regardless of operator skill. (epidemiological) [Ep 2 · 12:02](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=722) ## Host summaries Recaps by a host of what the experts said — not the host's own clinical position. - At Cincinnati Children's, interventional radiologists teach pediatric surgery fellows how to use ultrasound guidance for vascular access. — The host summarizing the discussion [Ep 3 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=53) - You don't have to have a hybrid OR to do image-guided surgery collaboration; it can occur in a regular OR by bringing in an ultrasound machine. — The host summarizing the discussion [Ep 3 · 1:02](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=62) - ChatGPT can screen thousands of articles in systematic reviews by analyzing Excel sheets and screening included articles based on title and abstract. — The host summarizing the discussion [Ep 3 · 2:20](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=140) - In cryoanalgesia for pectus procedures, a double lumen endotracheal tube is used in all patients to deflate the lung on the side of cryoablation. — The host summarizing the discussion [Ep 3 · 4:35](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=275) - Cryoanalgesia targets nerves from T3 to T8 with a 2-minute freeze cycle starting at the third rib and working down. — The host summarizing the discussion [Ep 3 · 4:46](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=286) - Subpleural injection with 0.25% marcaine with epinephrine works immediately, as opposed to the 8 to 10 hour delay with cryo nerve block. — The host summarizing the discussion [Ep 3 · 4:56](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=296) - Cryoanalgesia blocks fail when surgeons use a single lumen tube and perform the block too far anteriorly. — The host summarizing the discussion [Ep 3 · 5:13](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=313) - The SER Protocol from Michigan used prenatal criteria to guide decisions on offering ECMO versus comfort care for severe unilateral CDH, and outcomes showed survival was equivalent between groups. — The host summarizing the discussion [Ep 3 · 6:43](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=403) - Every unilateral isolated CDH should be pursued with ECMO if there was good prenatal counseling with the parents. — The host summarizing the discussion [Ep 3 · 6:58](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=418) - With bivalrudin, you can operate after 8 hours of putting patients on ECMO as long as levels are stable, and it's a much easier surgical repair. — The host summarizing the discussion [Ep 3 · 7:26](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=446) - Early repair while on ECMO is safe and can offer physiological benefits, with the optimal window between 8 to 24 hours. — The host summarizing the discussion [Ep 3 · 7:41](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=461) - CO2 laser emits infrared light in the spectrum of 920 to 1400 nanometers, which is well absorbed by water. — The host summarizing the discussion [Ep 3 · 8:14](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=494) - In 56 circumcision cases using CO2 laser with the sleeve technique, dorsal slit, and cyanoacrylate adhesive, the complication rate was only 3%. — The host summarizing the discussion [Ep 3 · 8:30](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=510) - CO2 laser was used for frenulectomy in 47 patients with low pain profile and no suture required. — The host summarizing the discussion [Ep 3 · 8:40](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=520) - Autofluorescence has shown to reduce rates of hypoparathyroidism and hypocalcemia following thyroidectomy in a randomized controlled trial from France. — The host summarizing the discussion [Ep 3 · 9:37](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=577) - With a surgery-first mindset, stone clearance rate reflected by negative intraoperative cholangiogram was 86%. — The host summarizing the discussion [Ep 3 · 12:14](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=734) - MMP-7 was identified about 10 years ago by Georgia Bezarra as a diagnostic biomarker for biliary atresia. — The host summarizing the discussion [Ep 3 · 13:07](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=787) - Data from a recent Midwest study shows that every 10-day delay in biliary atresia treatment worsens outcomes by 20%. — The host summarizing the discussion [Ep 3 · 13:41](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=821) - MMP-7 is not a validated biomarker for biliary atresia; it's not perfect, and the sensitivity is pretty good, but cutoffs vary because the assay is still evolving. — The host summarizing the discussion [Ep 3 · 13:58](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=838) - The institutional commitment is to perform Kasai procedure within 7 days of patients showing up if they have biliary atresia. — The host summarizing the discussion [Ep 3 · 14:15](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=855) - REBOA can be used in children if you have it at your center and you're good at it, though it's not done a lot in pediatric hospitals. — The host summarizing the discussion [Ep 3 · 15:08](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=908) - REBOA seems to take longer than opening the abdomen or chest if you're just needing to cross-clamp the aorta. — The host summarizing the discussion [Ep 3 · 15:48](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=948) - Patients presenting with wounds as their initial presentation for pilonidal disease tend to not always get to the finish line fully healed with a minimally invasive approach. — The host summarizing the discussion [Ep 3 · 16:23](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=983) - John Armstrong, while serving in the US Army, ran a clinic where patients were shaved weekly, and they observed a dramatic improvement, significantly reducing the need for surgical intervention in pilonidal disease. — The host summarizing the discussion [Ep 3 · 16:40](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1000) - If you're not pushing hair removal and meticulous hygiene, you're probably going to end up operating on some people that might not need an operation for pilonidal disease. — The host summarizing the discussion [Ep 3 · 16:55](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1015) - For pilonidal disease hair removal, if there's a parent or active caregiver involved, clipping is probably the easiest and simplest approach, with once-a-week recommended. — The host summarizing the discussion [Ep 3 · 17:17](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1037) - Image-guided surgery uses real-time imaging like CT, MRI, ultrasound, or fluoroscopy to improve precision during procedures. — The host summarizing the discussion [Ep 1 · 0:28](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=28) - At Cincinnati Children's, interventional radiologists teach pediatric surgery fellows how to use ultrasound guidance for vascular access. — The host summarizing the discussion [Ep 1 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=53) - You don't have to have a hybrid OR to do surgery-interventional radiology collaboration; it can occur in a regular OR by bringing in an ultrasound machine. — The host summarizing the discussion [Ep 1 · 1:02](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=62) - A hybrid operating room eliminates the need to transfer patients between imaging and surgical areas and combines advanced imaging technology with a traditional surgical setup. — The host summarizing the discussion [Ep 1 · 1:11](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=71) - Cone beam CT is a CT scan performed on a C-arm fluoroscopy unit that rotates around the patient's point of interest, collecting multiple images which are stacked together to create a CT. — The host summarizing the discussion [Ep 1 · 1:21](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=81) - Cone beam CT can be used for identifying and protecting critical structures during surgery and at the end of the case to confirm vessel patency. — The host summarizing the discussion [Ep 1 · 1:39](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=99) - ChatGPT can be used in systematic review and meta-analysis to screen thousands of articles based on title and abstract, with prompts asking it to explain its screening decisions. — The host summarizing the discussion [Ep 1 · 2:17](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=137) - Jenny AI is an academic model that helps with research paper writing by providing suggestions that the user can accept or modify, and includes a built-in chatbot that can research topics, provide relevant answers, cite supporting papers, and format citations. — The host summarizing the discussion [Ep 1 · 3:05](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=185) - ChatGPT can be used to upload a guideline and create a training session with interactive questions for learning specific topics. — The host summarizing the discussion [Ep 1 · 3:41](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=221) - Cryoanalgesia is a minimally invasive procedure to alleviate pain during chest wall surgery by temporarily freezing the nerve. — The host summarizing the discussion [Ep 1 · 4:24](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=264) - For cryoanalgesia in pectus surgery, a double lumen endotracheal tube is used in all patients to deflate the lung on the side of the cryoablation, and the surgeon uses a thoracoscope to guide the cryoprobe through axillary incisions from T3 to T8. — The host summarizing the discussion [Ep 1 · 4:35](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=275) - After cryoanalgesia, intercostal nerve blocks are performed with subpleural injection of 0.25% marcaine with epinephrine, which works immediately as opposed to the 8 to 10 hour delay with the cryo nerve block. — The host summarizing the discussion [Ep 1 · 4:48](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=288) - The cryoanalgesia procedure takes about 15 seconds per interspace with a 2 minute freeze cycle starting at the third rib and working down. — The host summarizing the discussion [Ep 1 · 4:52](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=292) - The double lumen endotracheal tube helps reduce the risk of pneumothorax during cryoanalgesia. — The host summarizing the discussion [Ep 1 · 5:09](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=309) - Cryoanalgesia blocks sometimes don't work when surgeons use a single lumen tube and do the block too far anteriorly. — The host summarizing the discussion [Ep 1 · 5:13](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=313) - Cryoanalgesia is an effective tool for pediatric pectus procedures, controlling pain and decreasing hospital length of stay with few short-term complications. — The host summarizing the discussion [Ep 1 · 5:24](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=324) - The SEER protocol from Michigan used prenatal criteria to guide decisions on offering ECMO versus comfort care for severe unilateral CDH, and outcomes showed that survival was equivalent between groups, revealing clinicians are often wrong about who will benefit from ECMO. — The host summarizing the discussion [Ep 1 · 6:43](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=403) - If there is good prenatal counseling with the parents, ECMO should be pursued for every unilateral isolated CDH. — The host summarizing the discussion [Ep 1 · 6:58](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=418) - With bivalirudin anticoagulation, you don't have to wait for the ECMO circuit to equilibrate; it's very fast and you can operate after 8 hours of starting bivalirudin as long as levels are stable, which happens really soon, and it's a much easier surgical repair. — The host summarizing the discussion [Ep 1 · 7:26](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=446) - In cases of very severe isolated unilateral CDH, the patient should be considered a survivor until proven otherwise. — The host summarizing the discussion [Ep 1 · 7:41](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=461) - Early repair while on ECMO is safe and can offer physiological benefits with the optimal window between 8 to 24 hours. — The host summarizing the discussion [Ep 1 · 7:49](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=469) - The CO₂ laser emits infrared light in the spectrum of 920 to 1400 nm which is really well absorbed by water and biological tissues. — The host summarizing the discussion [Ep 1 · 8:09](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=489) - CO₂ laser is very effective for precise cutting and ablation, reduces blood loss, has reduced pain and edema, and shorter operative time. — The host summarizing the discussion [Ep 1 · 8:21](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=501) - In 56 circumcision cases using CO₂ laser with the sleeve technique, dorsal slit, and cyanoacrylate adhesive, the complication rate was only 3%. — The host summarizing the discussion [Ep 1 · 8:30](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=510) - CO₂ laser has been used for frenulectomy in 47 patients with low pain profile and no suture required. — The host summarizing the discussion [Ep 1 · 8:40](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=520) - CO₂ laser has been used for perianal fistulas with fistulotomy, pilonidal cysts with laser ablation of sinus tracts, labial fusion, and condylomatosis ablation. — The host summarizing the discussion [Ep 1 · 8:45](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=525) - Barriers to CO₂ laser adoption include high equipment costs, required training, and limited availability. — The host summarizing the discussion [Ep 1 · 9:08](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=548) - In thyroid surgery, the goal is to preserve the parathyroids and decrease the risk of hypocalcemia and the need for calcium supplementation both initially and over a long period of time. — The host summarizing the discussion [Ep 1 · 9:28](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=568) - A randomized controlled trial from France demonstrated that autofluorescence has shown to reduce rates of hypoparathyroidism and hypocalcemia following thyroidectomy. — The host summarizing the discussion [Ep 1 · 9:37](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=577) - With autofluorescence, you don't inject anything; the parathyroids naturally autofluoresce at that wavelength, and in addition you can inject ICG to look at the perfusion of the actual parathyroid glands. — The host summarizing the discussion [Ep 1 · 9:53](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=593) - Studies using the FluoBeam system and probe system noted hypocalcemia rates that were about 50% lower with using autofluorescence versus not using it. — The host summarizing the discussion [Ep 1 · 10:07](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=607) - A surgery-first pathway for pediatric biliary stone disease reduces resource utilization, including MRCP. — The host summarizing the discussion [Ep 1 · 11:32](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=692) - Before a gastroenterologist does an ERCP, often the patient has had an ultrasound and an MRCP, but predictive factors can be used to go straight to a procedure if needed, whether a combined procedure with laparoscopic cholecystectomy, an intraoperative cholangiogram, and potentially ERCP if needed. — The host summarizing the discussion [Ep 1 · 11:42](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=702) - With a surgery-first mindset, the stone clearance rate reflected by negative intraoperative cholangiogram was 86%, and if you just did flushing or got the catheter a little more into the common bile duct or reamed the sphincter, that success rate was in the 90s. — The host summarizing the discussion [Ep 1 · 12:14](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=734) - The key to treating biliary atresia is making an early diagnosis. — The host summarizing the discussion [Ep 1 · 13:02](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=782) - MMP-7 was identified about 10 years ago by Georgia Bizarro as a diagnostic biomarker for biliary atresia. — The host summarizing the discussion [Ep 1 · 13:07](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=787) - You have to get the Kasai procedure done as soon as possible; the sooner you get it done, the more likely you'll save the native liver. — The host summarizing the discussion [Ep 1 · 13:22](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=802) - Data from a recent Midwest study shows that every 10 day delay in Kasai treatment worsens outcomes by 20%. — The host summarizing the discussion [Ep 1 · 13:41](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=821) - MMP-7 is not a validated biomarker for biliary atresia; it's not perfect, the sensitivity is pretty good, but the cutoffs that different teams used vary because it's an assay that's still evolving. — The host summarizing the discussion [Ep 1 · 13:58](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=838) - At Cincinnati Children's, the commitment to patients with suspected biliary atresia is that within 7 days of showing up, if they have it, they're in the OR for Kasai. — The host summarizing the discussion [Ep 1 · 14:21](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=861) - REBOA (resuscitative endovascular balloon aortic occlusion) is a procedure to control bleeding in traumatic shock or cardiac arrest where a catheter is inserted through the femoral artery into the aorta and a balloon is inflated to stop blood flow, buying time for surgical intervention. — The host summarizing the discussion [Ep 1 · 15:20](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=920) - REBOA would be appropriate for a patient in traumatic shock if you could not get them to the operating room to actually control the source of bleeding. — The host summarizing the discussion [Ep 1 · 15:33](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=933) - REBOA is often compared to resuscitative thoracotomy, which opens the chest surgically to control the source of bleeding, since both techniques occlude the aorta. — The host summarizing the discussion [Ep 1 · 15:39](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=939) - REBOA seems to take longer than opening the abdomen or the chest if you're just needing to cross clamp the aorta. — The host summarizing the discussion [Ep 1 · 15:48](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=948) - REBOA can be performed in pediatric patients but is rarely done with no clear survival advantage over laparotomy. — The host summarizing the discussion [Ep 1 · 15:54](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=954) - Most surgeons favor laparotomy over REBOA for quickly treating shock in a controlled environment. — The host summarizing the discussion [Ep 1 · 16:01](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=961) - Patients presenting with wounds as their initial presentation for pilonidal disease tend to not always get to the finish line fully healed with a minimally invasive approach. — The host summarizing the discussion [Ep 1 · 16:23](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=983) - John Armstrong, while serving in the US Army, ran a clinic with a captive patient population where they implemented a protocol of weekly shaving for pilonidal disease and observed a dramatic improvement, significantly reducing the need for surgical intervention. — The host summarizing the discussion [Ep 1 · 16:40](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=1000) - If you're not pushing hair removal and meticulous hygiene for pilonidal disease, you're probably going to end up operating on some people that might not need an operation. — The host summarizing the discussion [Ep 1 · 16:55](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=1015) - For pilonidal disease hair removal, options include shaving, depilatory hair removal agents like Nair, or laser hair removal. — The host summarizing the discussion [Ep 1 · 17:08](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=1028) - Many pilonidal disease patients are teenagers or people going to college who sometimes don't have anybody to help them with hair removal. — The host summarizing the discussion [Ep 1 · 17:17](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=1037) - If there's a parent or an active caregiver involved, clipping is probably the easiest and simplest approach for pilonidal disease hair removal, and having someone do it once a week is recommended. — The host summarizing the discussion [Ep 1 · 17:24](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-13591?t=1044) - Cross training occurs at Cincinnati Children's with interventional radiologists teaching pediatric surgery fellows how to use ultrasound guidance for vascular access. — The host summarizing the discussion [Ep 2 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=53) - You don't have to have a hybrid OR to do image-guided surgery collaboration; it can occur in a regular OR by bringing in an ultrasound machine. — The host summarizing the discussion [Ep 2 · 1:02](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=62) - Cone beam CT is a CT scan performed on a C-arm fluoroscopy unit that rotates around the patient collecting multiple images which are stacked together to create a CT. — The host summarizing the discussion [Ep 2 · 1:21](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=81) - ChatGPT can screen thousands of articles in systematic reviews by analyzing Excel sheets based on title and abstract, with explanatory columns for decision rationale. — The host summarizing the discussion [Ep 2 · 2:17](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=137) - In cryoanalgesia for pectus, a double lumen endotracheal tube deflates the lung on the side of cryoablation and the surgeon uses a thoracoscope to guide the cryoprobe through axillary incisions from T3 to T8. — The host summarizing the discussion [Ep 2 · 4:35](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=275) - After cryoablation, subpleural injection with 0.25% marcaine with epinephrine works immediately as opposed to the 8 to 10 hour delay with the cryo nerve block. — The host summarizing the discussion [Ep 2 · 4:56](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=296) - Cryoanalgesia blocks that don't work are invariably from surgeons using a single lumen tube and doing the block too far anteriorly. — The host summarizing the discussion [Ep 2 · 5:13](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=313) - The SEER protocol from Michigan used prenatal criteria to guide decisions on offering ECMO versus comfort care for severe unilateral CDH, and outcomes showed survival was equivalent between groups. — The host summarizing the discussion [Ep 2 · 6:43](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=403) - For every unilateral isolated CDH with good prenatal counseling, ECMO should be pursued. — The host summarizing the discussion [Ep 2 · 6:58](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=418) - With bivalirudin, you can operate after 8 hours of ECMO as long as levels are stable, and it's a much easier surgical repair. — The host summarizing the discussion [Ep 2 · 7:26](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=446) - Early repair while on ECMO is safe with optimal window between 8 to 24 hours. — The host summarizing the discussion [Ep 2 · 7:41](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=461) - CO2 laser operates in the spectrum of 920 to 1400 nanometers which is well absorbed by water. — The host summarizing the discussion [Ep 2 · 8:14](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=494) - In 56 circumcision cases using CO2 laser with sleeve technique, dorsal slit and cyanoacrylate adhesive, the complication rate was only 3%. — The host summarizing the discussion [Ep 2 · 8:30](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=510) - CO2 laser was used for frenulectomy in 47 patients with low pain profile and no suture required. — The host summarizing the discussion [Ep 2 · 8:40](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=520) - A randomized controlled trial from France demonstrated that autofluorescence reduces rates of hypoparathyroidism and hypocalcemia following thyroidectomy. — The host summarizing the discussion [Ep 2 · 9:37](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=577) - Hypocalcemia rates were about 50% lower with autofluorescence versus not using it. — The host summarizing the discussion [Ep 2 · 10:07](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=607) - A surgery-first pathway for pediatric biliary stones reduces resource utilization including MRCP. — The host summarizing the discussion [Ep 2 · 11:32](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=692) - With a surgery-first mindset, stone clearance rate reflected by negative intraoperative cholangiogram was 86%, and with simple interventions like flushing or reaming the sphincter, success rate was in the 90s. — The host summarizing the discussion [Ep 2 · 12:14](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=734) - MMP-7 was identified about 10 years ago by Georgia Bizarro's lab as a diagnostic biomarker for biliary atresia. — The host summarizing the discussion [Ep 2 · 13:07](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=787) - Data from a recent Midwest study shows that every 10 day delay in Kasai treatment worsens outcomes by 20%. — The host summarizing the discussion [Ep 2 · 13:41](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=821) - MMP-7 is not a validated biomarker for biliary atresia and the sensitivity is pretty good but cutoffs vary because the assay is still evolving. — The host summarizing the discussion [Ep 2 · 13:58](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=838) - Cincinnati Children's commitment is to perform Kasai procedure within 7 days of patient presentation if they have biliary atresia. — The host summarizing the discussion [Ep 2 · 14:21](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=861) - REBOA can be used in children but is rarely done in pediatric hospitals. — The host summarizing the discussion [Ep 2 · 15:08](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=908) - REBOA takes longer than opening the abdomen or chest if you're just needing to cross clamp the aorta. — The host summarizing the discussion [Ep 2 · 15:48](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=948) - Most surgeons favor laparotomy over REBOA for quickly treating shock in a controlled environment. — The host summarizing the discussion [Ep 2 · 16:01](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=961) - Patients presenting with wounds as their initial presentation for pilonidal disease tend to not always reach full healing with a minimally invasive approach. — The host summarizing the discussion [Ep 2 · 16:23](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=983) - John Armstrong's US Army clinic with captive patient population implemented weekly shaving protocol and observed dramatic improvement, significantly reducing need for surgical intervention in pilonidal disease. — The host summarizing the discussion [Ep 2 · 16:40](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=1000) - If you're not pushing hair removal and meticulous hygiene in pilonidal disease, you're probably going to end up operating on some people that might not need an operation. — The host summarizing the discussion [Ep 2 · 16:55](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=1015) - For pilonidal disease, if there's a parent or active caregiver involved, clipping is probably the easiest and simplest approach, with once weekly recommended frequency. — The host summarizing the discussion [Ep 2 · 17:17](https://library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-in-pediatric-surgery-13592?t=1037) --- Educational content from recorded physician discussions — not medical advice. 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