Update Course Rewind 2021 - Updates in Pectus
With Dr. Rob Rick & Dr. Sean St. Peter & Dr. Vic Garcia & Dr. Justin Wagner · hosted by Dr. Stephen Lee · Live Event Content
Part of
Pectus Excavatum 58 items
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Podcast
Update Course Rewind: Pectus Excavatum 2021
Dr. Lee Ponsky · 11 min · Published Aug 2022
Podcast
Update Course Rewind: Pectus Excavatum 2021
Dr. Lee Ponsky · 11 min · Published Aug 2022
Podcast
Update Course Rewind: Pectus Excavatum 2021
Dr. Lee Ponsky · 11 min · Published Aug 2022
Podcast
Update Course Rewind: Pectus Excavatum 2021
11 min · Published Aug 2022
Video
Update Course Rewind: Pectus Excavatum 2021
Dr. Todd Ponsky · 11 min · Published Aug 2022
Video
Cryoablation in 350 Nuss procedures
56 s · Published Oct 2023
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66 min · Published Apr 2026
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Clinical & Research Update: Pediatric Liver Tumors - A Case-Based Discussion with Drs. Katherine Somers & Alex Bondoc
69 min · Published Apr 2026
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Beyond ChatGPT_ AI Tools You’re Not Using (But Should) - Vail, CO
Dr. Todd Ponsky · 97 min · Published Jan 2026
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Beyond ChatGPT: AI Tools You’re Not Using (But Should)
Dr. Todd Ponsky · 109 min · Published Oct 2025
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2025 Pediatric Surgery Update Course - Updates in Lap Chole and Cholecystitis Management
18 min · Published Aug 2025
What the experts said
Pectus excavatum repair is the most painful procedure performed on children, more so than spine surgery
In randomized trial of 110 patients, epidural catheters did not show pain reduction advantage over PCA, with pain persisting on days 2-3 due to transition issues
Cryoanalgesia technique: freeze intercostal nerves 4 through 7, two minutes per rib, one interspace separation between camera and probe
Should not perform cryoanalgesia below rib 8 due to risk of abdominal wall paralysis
In prospective observational cryoanalgesia cohort, six of nine patients went home on post-op day one
Median length of stay with cryoanalgesia is one day, with tight range except for occasional failures that revert to four days
Median morphine equivalents with cryoanalgesia versus other modalities are not on the same planet—dramatically lower
Medical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs
Cryotherapy device received FDA approval via 510k predicate pathway based on similarity to 1976 device, not clinical trial data
Most patients retain normal anterior chest sensation even 2-3 weeks post-cryoanalgesia, suggesting nerve stunning rather than complete death
Adult thoracotomy cryotherapy experience spans 20 years without high enough complication incidence to warrant concern
Gabapentin dosing for pectus: 200-300mg three times daily for up to one week post-op, ideally started several days pre-op
In Texas Children's study, 50% of patients still taking opioids two weeks post-Nuss procedure
ERAS protocol without cryoanalgesia or catheters achieves length of stay under two days at Nebraska, patients off opioids by one week
Urinary retention is lower with cryoanalgesia (8%) versus non-cryo (34%)
Bar flippage rate with cryoanalgesia is eight times higher than without cryo in one study
Allodynia and neuropathy occur six times more frequently in cryoanalgesia group versus non-cryo
Epidural catheters could not be placed or were removed after one day in approximately 25% of patients in randomized trial
With erector spinae catheters, hospital stay is two days, opioid requirements reduced both in-hospital and post-discharge
Erector spinae catheters stay in for five days total, with family removing them at home on day three after discharge
Passing bar left-to-right angles away from the ventricle, reducing cardiac injury risk compared to right-to-left
When bars flip, it is always a technical issue—bar sitting in wrong interspace, not wrapped tight enough, or not secured properly
Activity restrictions lifted at two weeks post-op for cryoanalgesia patients; can return to bull riding, boxing, football, hockey
Patients at two weeks post-cryoanalgesia do not notice chest wall numbness as a significant issue
With cryoanalgesia, 70% of patients discharged home on post-op day one without narcotics
Computational models show shorter flat bars focus stress on sternum while larger curved bars create parasitic horizontal and torque forces at bar ends
Bar rotation rate of 0.7% in series of 554 patients using mid-axillary bar measurement
Sub-xiphoid incision technique allows palpation-guided bar passage and was associated with 0% pericarditis rate
Sternal elevator allows entry at mid-clavicular line, reduces intercostal tears, and improves bar stability in deep stiff pectus cases
Sternal elevator used in approximately 10% of cases—primarily older males over 16 with Haller index over 3.5 and stiff chest walls