# Spontaneous Pneumothorax — GCMD Library living collection

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

Updated: n/a · 17 episodes · 202 cited statements

## Episodes
### Surgical Management
- [Thoracoscopic Treatment of Spontaneous Pneumothorax](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233) — video · 3:16 · [machine version](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233.md)
- [Thoracoscopic Treatment of Spontaneous Pneumothorax](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249) — video · 3:16 · [machine version](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249.md)
- [Update Course Rewind 2021 - Updates in Pectus](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411) — video · 1:01:14 · [machine version](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411.md)
- [BOB in Ped Surg 2023 - PAPS Winner - Jamie Schnuck, MD](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319) — video · [machine version](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319.md)
- [BOB Ped Surg 2023 - Jamie Schnuck, PAPS  - Presentation](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348) — video · [machine version](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348.md)

### Evidence & Research
- [Spontaneous Pneumothorax Rapid Fire: Update Course 2015](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986) — video · 9:45 · [machine version](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986.md)
- [Aspiration Test Predicts Need for Operation in Pediatric Spontaneous...](https://origin-library.globalcastmd.com/watch/aspiration-test-predicts-need-for-operation-in-pediatric-spontaneous-2153) — video · [machine version](https://origin-library.globalcastmd.com/watch/aspiration-test-predicts-need-for-operation-in-pediatric-spontaneous-2153.md)
- [What's New in Pediatric Surgery 2020 - FULL SHOW](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217) — video · 57:41 · [machine version](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217.md)
- [Spontaneous Pneumothorax](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521) — podcast · 33:31 · [machine version](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521.md)
- [Management of Primary Spontaneous Pneumothorax in Children](https://origin-library.globalcastmd.com/watch/management-of-primary-spontaneous-pneumothorax-in-children-7190) — video · [machine version](https://origin-library.globalcastmd.com/watch/management-of-primary-spontaneous-pneumothorax-in-children-7190.md)
- [Manejo del neumotórax primario espontáneo en niños](https://origin-library.globalcastmd.com/watch/manejo-del-neumot-rax-primario-espont-neo-en-ni-os-7191) — video · [machine version](https://origin-library.globalcastmd.com/watch/manejo-del-neumot-rax-primario-espont-neo-en-ni-os-7191.md)
- [Todd Ponsky: What is new in Pediatric Surgery? Teaser](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347) — video · 1:05:21 · [machine version](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347.md)

### Case-Based Learning
- [Supine Positioning for Bilateral VATS: Pediatric Surgery Difficult...](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432) — video · 15:50 · [machine version](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432.md)
- [Tricks - Supine Positioning For Bilateral VATS](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638) — video · 17:04 · [machine version](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638.md)

### In-Depth Reviews
- [Spontaneous Pneumothorax: Update Course 2014](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044) — video · 15:59 · [machine version](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044.md)
- [Update Course Rewind: Spontaneous Pneumothorax 2021](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587) — video · [machine version](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587.md)
- [Update Course 2021: PNEUMOTHORAX](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419) — video · [machine version](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419.md)

## Chapters
- [0:03](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=3) Case Presentation: Bilateral VATS in Supine Position (Ep 1)
- [4:07](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=247) Patient Selection and Indications for Supine Bilateral VATS (Ep 1)
- [7:14](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=434) Technical Considerations: Positioning and Lung Collapse (Ep 1)
- [10:04](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=604) Pleurodesis Techniques and Necessity Debate (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=0) Case Presentation: Bilateral Supine VATS for Spontaneous Pneumothorax (Ep 2)
- [5:20](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=320) Indications and Patient Selection for Supine VATS (Ep 2)
- [9:15](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=555) Technical Details: Double-Lumen Intubation and Exposure (Ep 2)
- [11:28](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=688) Pleurodesis Techniques: Mechanical, Chemical, and Pleurectomy Debate (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=0) Initial management of large spontaneous pneumothorax and the thoracentesis-only approach (Ep 3)
- [3:21](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=201) Contralateral blebs: to scan and operate prophylactically or not (Ep 3)
- [6:00](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=360) Surgical technique: pleurodesis versus bleb resection alone (Ep 3)
- [0:00](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=0) Intraparenchymal disease mimicking effusion: diagnostic pitfalls (Ep 4)
- [1:33](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=93) Small pneumothorax management: observation vs. aspiration vs. chest tube (Ep 4)
- [7:23](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=443) Large pneumothorax and bilateral blebs: timing of intervention (Ep 4)
- [10:50](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=650) VATS technique: bleb resection and pleurodesis controversies (Ep 4)
- [0:00](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=0) Introduction and Case Presentation (Ep 9)
- [3:05](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=185) Retrospective Data on Chest Tube Outcomes (Ep 9)
- [8:59](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=539) Aspiration Protocol and Study Design (Ep 9)
- [14:22](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=862) Aspiration Study Results (Ep 9)
- [19:38](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1178) Clinical Application and Family Counseling (Ep 9)
- [23:27](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1407) Pleurodesis Evidence (Ep 9)
- [26:05](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1565) Role of CT Imaging (Ep 9)
- [27:31](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1651) Management of Recurrent Cases (Ep 9)
- [31:38](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1898) Future Directions and Closing (Ep 9)
- [0:00](https://origin-library.globalcastmd.com/watch/aspiration-test-predicts-need-for-operation-in-pediatric-spontaneous-2153?t=0) Aspiration Protocol for Spontaneous Pneumothorax Management (Ep 5)
- [0:03](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=3) Case presentation and patient positioning (Ep 6)
- [1:16](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=76) Talc preparation technique (Ep 6)
- [1:53](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=113) Bleb resection with endo-GIA stapler (Ep 6)
- [2:34](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=154) Talc pleurodesis and closure (Ep 6)
- [0:03](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=3) Case presentation and patient positioning (Ep 7)
- [1:16](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=76) Talc preparation technique (Ep 7)
- [1:53](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=113) Bleb resection with endo-GIA stapler (Ep 7)
- [2:34](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=154) Talc pleurodesis and closure (Ep 7)
- [0:03](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=3) Introduction and Spontaneous Pneumothorax Management (Ep 8)
- [9:15](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=555) Ovarian Teratoma Surveillance and Post-Appendectomy Opioids (Ep 8)
- [16:32](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=992) Pyloric Stenosis Feeding Protocols (Ep 8)
- [19:54](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1194) Stoma Takedown Infection Prevention and Umbilical Hernia Timing (Ep 8)
- [25:53](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1553) Appendectomy for Ulcerative Colitis and Circumcision Complications (Ep 8)
- [33:11](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1991) Pilonidal Disease Management (Ep 8)
- [38:35](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=2315) Chest CT for Airway Foreign Body (Ep 8)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- In a randomized trial of 110 patients comparing epidural to PCA, maximum pain scores did not drop off in the epidural group due to day 2-3 transition pain, whereas PCA group pain decreased over 4.5 days. — Shawn St. Peter (clinical) [Ep 11 · 3:27](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=207)
- Cryotherapy technique involves freezing ribs 4 through 7 for two minutes per rib; should not go to rib 8 or below due to risk of abdominal wall paralysis. — Shawn St. Peter (clinical) [Ep 11 · 6:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=380)
- In prospective observational cryoanalgesia study, six of nine patients in initial retrospective cohort went home on post-op day one. — Shawn St. Peter (clinical) [Ep 11 · 7:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=440)
- With cryoanalgesia, length of stay that couldn't get below four days became one day, with tight range except for occasional failures that look like traditional four-day stays. — Shawn St. Peter (clinical) [Ep 11 · 7:55](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=475)
- Median morphine equivalents with cryoanalgesia versus traditional approaches are not on the same planet in terms of magnitude of difference. — Shawn St. Peter (clinical) [Ep 11 · 8:30](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=510)
- Medical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs. — Victor Garcia (guideline) [Ep 11 · 10:40](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=640)
- Cryotherapy devices received FDA approval via 510(k) predicate pathway based on similarity to devices from 1976, not based on clinical trials. — Victor Garcia (guideline) [Ep 11 · 14:10](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=850)
- With erector spinae catheters, hospital stay is two days with reduced opioid requirements both in-hospital and post-discharge. — Victor Garcia (clinical) [Ep 11 · 28:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1700)
- When bars flip, it is always technical - related to bar sitting in funky inner space, bad spot, not wrapped tight enough, or not secured well - not related to patient activity or pain modality. — Shawn St. Peter (opinion) [Ep 11 · 30:50](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1850)
- Activity restrictions beyond two weeks post-Nuss can be liberalized to anything the patient can handle, including bull riding, boxing, football, and hockey. — Shawn St. Peter (clinical) [Ep 11 · 29:24](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1764)
- Adult experience using cryotherapy with thoracotomies goes back 20 years without high enough incidence of complications to warrant backing away from the treatment advantage. — Shawn St. Peter (epidemiological) [Ep 11 · 19:00](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1140)
- With cryoanalgesia, 70% of patients go home on post-op day one without narcotics. — Steven Rothenberg (clinical) [Ep 11 · 34:00](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2040)
- Sternal elevator is used in about 10% of cases, primarily in older males with deep, stiff pectus where flexibility is limited. — Steven Rothenberg (clinical) [Ep 11 · 45:50](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2750)
- In updated series of 554 patients, bar rotation rate was 0.7%, with most occurring within first few years of surgeon experience. — Shawn St. Peter (epidemiological) [Ep 11 · 39:16](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2356)
- Sub-xiphoid dissection technique allows palpation-guided bar passage and has resulted in 0% incidence of pericarditis. — Shawn St. Peter (clinical) [Ep 11 · 43:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2600)
- Many patients have normal anterior chest sensation even in early post-op phase (two to three weeks) after cryoanalgesia, suggesting nerve stunning rather than complete death. — Shawn St. Peter (clinical) [Ep 11 · 18:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1100)
- Gabapentin is most commonly given once pre-op then 200-300mg three times daily for up to one week post-op; pharmacokinetics suggest starting several days before operation for peak effect. — Justin Wagner (clinical) [Ep 11 · 22:40](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1360)
- When passing bar from left chest to right chest, the angle avoids pointing directly at the ventricle compared to right-to-left passage. (clinical) [Ep 11 · 41:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2480)
- In 15-patient magnetic repair trial, magnets were safe to place in children's chests and well-tolerated, but results were not as effective as hoped; appears most effective in young children with flexible chests. — Shawn St. Peter (clinical) [Ep 11 · 59:24](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=3564)
- Patient selection for supine bilateral VATS should include procedures with low morbidity and very well-defined pathology such that you won't encounter any surprises. — Nick (opinion) [Ep 1 · 4:54](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=294)
- Bilateral thoracic sympathectomies for hyperhidrosis can be performed in supine position at one sitting. — Jose (clinical) [Ep 1 · 5:15](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=315)
- For sympathectomy in supine position, the lung falls away adequately with table tipping and CO2 compression of the lung to help with exposure. — Jose (clinical) [Ep 1 · 6:04](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=364)
- Supine VATS is useful in low-risk to conversion thoracoscopic cases and applicable for low-risk pleural-based lesion cases, superficial wedge resections, or biopsies. — Mark McCollum (opinion) [Ep 1 · 6:41](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=401)
- If there's a high risk of conversion or difficulty with exposure, traditional decubitus position is preferred over supine. — Mark McCollum (opinion) [Ep 1 · 7:14](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=434)
- Bilateral phrenic nerve stimulators for patients with central hyperventilation syndrome is a good candidate for supine bilateral VATS because the phrenic nerve is quite anterior. — Sharif (clinical) [Ep 1 · 8:00](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=480)
- A double-lumen tube was used with positive pressure in the chest being worked on, providing great exposure. — Mark McCollum (clinical) [Ep 1 · 9:09](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=549)
- Mechanical pleurodesis was performed from about the 5th rib intercostal space up to the apex, circumferentially, and was as easy as the standard decubitus approach. — Mark McCollum (clinical) [Ep 1 · 9:09](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=549)
- Parietal pleurectomy is fairly easy once you get into the space underneath the parietal pleura and is a far more effective way to seal the pleural cavity than mechanical pleurodesis. — Jack (opinion) [Ep 1 · 10:13](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=613)
- Recurrences have been seen after mechanical pleurodesis, but no recurrences have occurred after pleurectomy in one surgeon's experience. — Jack (clinical) [Ep 1 · 10:40](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=640)
- Blood patch technique is very effective for pleurodesis, and blood should not be suctioned out during the procedure. — Jack (clinical) [Ep 1 · 10:57](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=657)
- Blebs are not just a one-point-in-time thing but relate to lung anatomy and overstretch, so removing one bleb does not prevent another from forming in a few months. — Jack (opinion) [Ep 1 · 11:43](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=703)
- Blebs are congenital and do not form over time at age 16; they become problematic during growth in the preteens. — Sharif (opinion) [Ep 1 · 11:55](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=715)
- In certain congenital problems, blebs can be present all over the chest, with the largest ones at the apex assumed to be the ones that burst, but blebs may exist that cannot be seen or identified. — Kathy (clinical) [Ep 1 · 12:22](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=742)
- Pleurectomy and talc pleurodesis are very painful postoperatively, and re-operating in a chest that has had talc is extremely difficult due to the entire lung being frozen. — Mark McCollum (clinical) [Ep 1 · 14:17](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=857)
- Mechanical pleurodesis works effectively by causing only the apex of the lung to adhere, which may be sufficient to prevent tension pneumothorax without freezing the entire chest. — Mark McCollum (opinion) [Ep 1 · 14:45](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=885)
- In the presented case, the area where the previous bleb had spontaneously erupted was well adhered to the apex of the chest when the right side was started. — Mark McCollum (clinical) [Ep 1 · 14:45](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=885)
- Parietal pleurectomy, once started, is hard to stop because it strips away easily, and postoperative pain is manageable with modern analgesics. — Jack (clinical) [Ep 1 · 15:14](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=914)
- Lateral decubitus positioning has been adopted from the transition from open thoracotomy to VATS and provides ease of exposure and rapid conversion to open thoracotomy, but with advancements in VATS this no longer applies. — Nick Bruns (opinion) [Ep 2 · 0:45](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=45)
- Lateral positioning may add unnecessary morbidity including brachial plexus injury and decubitus ulcers. — Nick Bruns (clinical) [Ep 2 · 1:30](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=90)
- The patient is a 17-year-old male with history of asthma who presented with shortness of breath and chest tightness when running, found to have bilateral apical blebs and a large right spontaneous pneumothorax treated with chest tube, later developing a small left spontaneous pneumothorax that resolved with observation. — Nick Bruns (clinical) [Ep 2 · 1:40](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=100)
- Bilateral VATS with bilateral apical bleb resections and mechanical pleurodesis was performed in the supine position due to the routine nature of the procedure. — Nick Bruns (clinical) [Ep 2 · 2:20](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=140)
- Port placement for supine VATS included 25mm ports at the 7th intercostal space midclavicular line and 6th intercostal space mid-axillary line, plus a 12mm port at the 4th intercostal space mid-axillary line to accommodate the GIA stapler. — Nick Bruns (clinical) [Ep 2 · 2:40](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=160)
- Bilateral VATS was safely completed in the supine position, providing simplicity, convenience, decreased operative time, and decreased positioning-related morbidity. — Nick Bruns (opinion) [Ep 2 · 4:40](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=280)
- Patient selection for supine VATS is important; appropriate cases include bilateral VATS with low morbidity and well-defined pathology where you won't encounter surprises. — Nick Bruns (clinical) [Ep 2 · 6:09](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=369)
- Bilateral thoracic sympathectomies for hyperhidrosis can be performed in the supine position at one sitting. — Jose (clinical) [Ep 2 · 6:30](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=390)
- For sympathectomy in supine position, the lung falls away adequately with table tipping and CO2 compression of the lung to help with exposure. — Jose (clinical) [Ep 2 · 7:19](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=439)
- Supine VATS is useful in low-risk-to-conversion thoracoscopic cases; any low-risk pleural-based lesion case for biopsy or superficial wedge resection would be applicable, but if there's high risk of conversion or difficulty with exposure, traditional decubitus positioning is preferred. — Mark McCollum (clinical) [Ep 2 · 7:58](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=478)
- Bilateral phrenic nerve stimulators for patients with central hyperventilation syndrome can be placed in supine position because the phrenic nerve is quite anterior. — Sharif (clinical) [Ep 2 · 9:15](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=555)
- In the presented case, a double-lumen tube was used with positive pressure in the chest being worked on, providing great exposure. — Mark McCollum (clinical) [Ep 2 · 10:34](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=634)
- Mechanical pleurodesis was performed circumferentially from about the 5th intercostal space up to the apex, which was as easy as the standard approach with decubitus positioning. — Mark McCollum (clinical) [Ep 2 · 10:34](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=634)
- The patient was moved to the side edge of the bed to allow full mobility of the surgeons' hands. — Mark McCollum (clinical) [Ep 2 · 10:34](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=634)
- Parietal pleurectomy is fairly easy—you get into the space underneath the parietal pleura and strip it off—and is a far more effective way to seal the pleural cavity than mechanical pleurodesis. — Jeff Blair (opinion) [Ep 2 · 11:28](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=688)
- There have been recurrences after mechanical pleurodesis, but no recurrences after pleurectomy in the speaker's experience. — Jeff Blair (clinical) [Ep 2 · 11:28](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=688)
- The blood patch technique is very effective for pleurodesis, and you don't want to suction out any blood for this reason. — Jack (clinical) [Ep 2 · 12:12](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=732)
- Pleurodesis may not be necessary in these cases because the cause of the problem is blebs in the apex of the lung; removing the blebs should prevent recurrent pneumothorax. — Jack (opinion) [Ep 2 · 12:40](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=760)
- Blebs are not just a one-point-in-time thing; they have to do with the anatomy of the lung and overstretch, so if you take out one bleb, another bleb could form in a few months. — Jack (opinion) [Ep 2 · 12:57](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=777)
- These are congenital blebs that don't form over time at age 16. — Jack (opinion) [Ep 2 · 13:10](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=790)
- There are certain congenital problems where you go in and there are blebs all over the place; you see the largest ones at the apex and assume those burst, but you can have blebs you can't see or identify. — Cathy (clinical) [Ep 2 · 13:35](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=815)
- The speaker strips the cupola of the pleura and uses the abrading technique for the lower aspects of the chest where stripping becomes harder. — Cathy (clinical) [Ep 2 · 13:35](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=815)
- Pleurectomy is incredibly painful postoperatively. — Jeff Blair (clinical) [Ep 2 · 14:34](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=874)
- Patients who received talc pleurodesis had more pain postoperatively compared to mechanical pleurodesis, based on anecdotal observation. — Sharif (clinical) [Ep 2 · 15:05](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=905)
- Pleurectomy and talc are very painful postoperatively, and if you've ever had to re-operate in a chest that's had talc in it, you'll never do it again because the whole lung becomes frozen. — Mark McCollum (clinical) [Ep 2 · 15:32](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=932)
- Mechanical pleurodesis works effectively because you just need the apex of the lung to stick up, not the whole lung frozen. — Mark McCollum (opinion) [Ep 2 · 15:32](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=932)
- In the presented case, when starting on the right side, the area where the previous bleb had spontaneously erupted was well adhered to the apex of the chest. — Mark McCollum (clinical) [Ep 2 · 15:32](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=932)
- The more painful the pleurodesis, probably the more effective it is. — Jack (opinion) [Ep 2 · 16:01](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=961)
- Once you start pleurectomy, it's hard to stop because it strips away easily, and with modern analgesics the pain is manageable. — Jeff Blair (clinical) [Ep 2 · 16:29](https://origin-library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=989)
- At Children's Mercy Kansas City, the approach was modified so that if aspiration doesn't work perfectly, they proceed straight to VATS that same day to avoid prolonged hospital stays of 5-6 days. — Shawn St. Peter (clinical) [Ep 10 · 4:49](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=289)
- The Children's Mercy approach of proceeding directly to VATS after failed aspiration turns cases into a maximum 2-3 day hospital stay instead of 4-5-6 days with back-and-forth management between water seal and suction. — Shawn St. Peter (clinical) [Ep 10 · 5:14](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=314)
- If a bleb ruptures and then doesn't continue to leak, it may scar down and never require intervention. — Rod (clinical) [Ep 10 · 6:33](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=393)
- Using a needle for aspiration is risky because as the lung expands, you risk poking a hole in it; an angiocath is preferred. — Todd Ponsky (opinion) [Ep 10 · 7:01](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=421)
- One approach is to put in a pigtail catheter and leave it in (rather than using an angiocath), then aspirate, clamp, and obtain an X-ray. — Todd Ponsky (clinical) [Ep 10 · 7:07](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=427)
- Spontaneous pneumothorax is a different disease than traumatic pneumothorax, and patients are never seen in extremis from spontaneous pneumothorax. — Todd Ponsky (opinion) [Ep 10 · 7:18](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=438)
- Despite a 44% recurrence rate after successful aspiration, most patients choose conservative management rather than immediate definitive surgery because the chance of a problem from spontaneous pneumothorax is low. — Todd Ponsky (opinion) [Ep 10 · 7:32](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=452)
- A 50% pneumothorax collapse actually represents 100% collapse because the lung cannot disappear. (clinical) [Ep 3 · 0:41](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=41)
- One approach is to put in a chest drain, aspirate the air, remove the tube, get an X-ray after 6 hours, and discharge the patient home from the ER without admission. (clinical) [Ep 3 · 1:59](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=119)
- The recurrence rate after initial pneumothorax treatment is quoted as 30%. (epidemiological) [Ep 3 · 3:42](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=222)
- In adult literature, the data does not support high rates of contralateral pneumothorax. (epidemiological) [Ep 3 · 4:50](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=290)
- One approach is to obtain CT scan preoperatively, and if blebs are present bilaterally, offer bilateral VATS with pleurodesis at the same operation. (clinical) [Ep 3 · 4:50](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=290)
- Pleurectomy causes severe postoperative pain, with patients 'climbing out of the hospital.' (clinical) [Ep 3 · 6:02](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=362)
- Pleurodesis causes significant postoperative pain. (clinical) [Ep 3 · 8:23](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=503)
- Ultrasound can sometimes be misleading in distinguishing pleural effusion from intraparenchymal disease, requiring trust in ultrasound technician skill and correlation with CT when findings are discordant. (clinical) [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=0)
- Intraparenchymal necrotic lung disease may require surgery a week or two later when the lung falls apart and develops an effusion and fistula. (clinical) [Ep 4 · 1:25](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=85)
- For a 5-10% apical pneumothorax in a minimally symptomatic patient, observation with oxygen is appropriate initial management. (clinical) [Ep 4 · 2:12](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=132)
- There is debate about whether oxygen therapy for pneumothorax actually works, though it is commonly used. (opinion) [Ep 4 · 2:16](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=136)
- Simple aspiration of small pneumothorax may cause more trouble and result in a bigger pneumothorax. (clinical) [Ep 4 · 2:40](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=160)
- Many pneumothorax patients never show an air leak after chest tube placement. (clinical) [Ep 4 · 3:15](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=195)
- If simple aspiration is performed, leaving a catheter overnight may prevent the need for two procedures in patients who fail aspiration. (clinical) [Ep 4 · 3:47](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=227)
- Needle aspiration of a small apical pneumothorax may result in a larger pneumothorax. (clinical) [Ep 4 · 3:55](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=235)
- Simple aspiration is not well studied in children under 16 years old due to the rarity of spontaneous pneumothorax in this age group. (epidemiological) [Ep 4 · 6:50](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=410)
- Patients with spontaneous pneumothorax typically have a very asthenic, thin chest configuration on X-ray. (clinical) [Ep 4 · 7:23](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=443)
- Every spontaneous pneumothorax patient has blebs in the upper part of the lung. (clinical) [Ep 4 · 7:23](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=443)
- CT is obtained to evaluate the contralateral side for blebs, which informs counseling about future risk and may guide decision for prophylactic intervention. (clinical) [Ep 4 · 7:38](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=458)
- If CT shows contralateral blebs, a future pneumothorax on that side can be treated directly with VATS without wasting time on chest tube placement. (clinical) [Ep 4 · 8:44](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=524)
- Before the era of VATS, the rule was to wait for a second pneumothorax before performing thoracotomy for bleb resection and pleural abrasion. (clinical) [Ep 4 · 9:11](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=551)
- In the current era, the paradigm has shifted to more aggressive intervention with primary VATS on first pneumothorax presentation. (clinical) [Ep 4 · 9:38](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=578)
- Prophylactic contralateral intervention may be justified in select cases such as patients planning extended remote travel (e.g., 2 months hiking in backcountry). (clinical) [Ep 4 · 9:46](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=586)
- Standard VATS technique for pneumothorax includes apical wedge resection and roughing up the pleura. (clinical) [Ep 4 · 10:58](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=658)
- If the patient has had multiple chest tubes previously, talc pleurodesis should be considered in addition to bleb resection and pleural abrasion. (clinical) [Ep 4 · 10:58](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=658)
- Talc applied thoracoscopically distributes beautifully throughout the pleural space. (clinical) [Ep 4 · 11:30](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=690)
- Mechanical abrasion of both visceral and parietal pleura improves outcomes, though aggressive visceral pleural abrasion can cause air leaks. (clinical) [Ep 4 · 11:52](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=712)
- On re-operation, chests that had previous pleural roughing may appear as if no prior surgery was performed. (clinical) [Ep 4 · 12:02](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=722)
- If all visible blebs are resected, pleurodesis may not be necessary. (opinion) [Ep 4 · 12:19](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=739)
- Re-entering a chest that has had talc pleurodesis is extremely difficult and may require pleural decortication. (clinical) [Ep 4 · 15:27](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=927)
- Mechanical pleurodesis should be limited to the apex (4th intercostal space and above) rather than the entire chest. (clinical) [Ep 4 · 12:42](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=762)
- Adequate mechanical pleurodesis is achieved when small blood vessels become prominent on the pleura. (clinical) [Ep 4 · 12:54](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=774)
- Deflating and reinflating the lung multiple times during surgery helps identify blebs, particularly on the edges of the lower lobe. (clinical) [Ep 4 · 13:46](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=826)
- Blebs can be sealed with energy devices rather than stapled, allowing surgery through 3 or 5 millimeter incisions. (clinical) [Ep 4 · 13:55](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=835)
- A study of 350 patients who underwent lung procedures without postoperative chest tube placement showed no complications. (epidemiological) [Ep 4 · 14:17](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=857)
- The no-chest-tube study included lung biopsies, not spontaneous pneumothorax patients. (epidemiological) [Ep 4 · 14:30](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=870)
- Omitting chest tubes after pneumothorax surgery requires reliable nursing care to detect early postoperative pneumothorax, which may not be available in all settings. (clinical) [Ep 4 · 14:49](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=889)
- Primary spontaneous pneumothorax is more common in males by approximately 3 to 1 ratio — Dan Osley (epidemiological) [Ep 9 · 1:42](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=102)
- CT scan data fairly convincingly shows that it is probably not beneficial with regard to changing treatment parameters or outcomes for spontaneous pneumothorax — Dan Osley (clinical) [Ep 9 · 3:05](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=185)
- In multi-institutional retrospective trial, chest tubes worked about 50% of the time for spontaneous pneumothorax — Dan Osley (clinical) [Ep 9 · 3:32](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=212)
- The failure rate for patients who get a chest tube and resolve is about 50% - they will be back and have to have another operation — Dan Osley (clinical) [Ep 9 · 5:00](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=300)
- Patients who get a chest tube and fail in the hospital and subsequently go on to VATS still have a failure rate of around 25 to 30% — Dan Osley (clinical) [Ep 9 · 5:24](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=324)
- Patients who get immediate VATS have about a 10 to 15% failure rate — Dan Osley (clinical) [Ep 9 · 8:02](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=482)
- Patients who get a chest tube and then VATS have higher failure rates (25%) than those who get immediate VATS, possibly because they are predisposed to recurrence — Dan Osley (clinical) [Ep 9 · 8:23](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=503)
- The Society of Thoracic Surgery in adult patients recommends primary aspiration for spontaneous pneumothorax — Dan Osley (guideline) [Ep 9 · 9:49](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=589)
- In most large studies for primary spontaneous pneumothorax, the mean age is around 20 to 22 years, making this primarily a young adult disease — Dan Osley (epidemiological) [Ep 9 · 9:49](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=589)
- The average age in pediatric spontaneous pneumothorax studies has been between 15.5 and 16 years — Dan Osley (epidemiological) [Ep 9 · 9:49](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=589)
- The hole in spontaneous pneumothorax has probably already closed by the time patients come to the hospital — Todd Ponsky (clinical) [Ep 9 · 10:27](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=627)
- There is no published paper documenting tension physiology for spontaneous pneumothorax — Todd Ponsky (clinical) [Ep 9 · 11:07](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=667)
- Of 81 patients in retrospective study across 3 institutions over 13 years, none presented with tension physiology from spontaneous pneumothorax — Dan Osley (clinical) [Ep 9 · 11:40](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=700)
- In Midwest Consortium prospective study, 50% of patients who got aspiration failed within 6 hours — Dan Osley (clinical) [Ep 9 · 14:22](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=862)
- In the aspiration study, 33 patients presented across 9 institutions over 2 years — Dan Osley (epidemiological) [Ep 9 · 14:39](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=879)
- Of 17 patients who failed aspiration, 12 received chest tubes and 83% of those had persistent air leak requiring VATS or had recurrent pneumothorax — Dan Osley (clinical) [Ep 9 · 15:50](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=950)
- Of 5 patients who went directly to VATS after failed aspiration, none recurred — Dan Osley (clinical) [Ep 9 · 16:38](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=998)
- Of 16 patients who passed aspiration and went home, 40% came back with recurrent pneumothorax — Dan Osley (clinical) [Ep 9 · 18:27](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1107)
- The positive predictive value of aspiration in treating pneumothorax was 83% with negative predictive value of 56% — Dan Osley (clinical) [Ep 9 · 18:39](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1119)
- There is good data suggesting that pleurodesis is not beneficial in preventing recurrence of spontaneous pneumothorax — Dan Osley (clinical) [Ep 9 · 23:27](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1407)
- In three-institution retrospective data, patients who underwent VATS with pleurodesis had the same recurrence rate as those who underwent VATS alone — Dan Osley (clinical) [Ep 9 · 23:48](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1428)
- A large Chinese trial of 289 patients over 3 years (average age 22) randomized patients to wedge resection with or without mechanical pleurodesis using standardized sandpaper abrasion and showed identical recurrence rates — Dan Osley (clinical) [Ep 9 · 24:20](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1460)
- Chemical pleurodesis with talc is probably more effective than mechanical pleurodesis but creates a treacherous reoperative field — Todd Ponsky (opinion) [Ep 9 · 25:13](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1513)
- CT scans may identify blebs that are incidental findings in patients who never develop pneumothorax, similar to traumatic pneumatoceles that rarely rupture — Dan Osley (clinical) [Ep 9 · 26:30](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1590)
- For patients with multiple recurrences after VATS, thoracoscopic pleurectomy of parietal pleura from apex down to a couple ribs above diaphragm is performed — Dan Osley (clinical) [Ep 9 · 27:31](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1651)
- Pleurectomy is an arduous, bloody operation that is super painful for children, usually requiring epidurals, with patients hospitalized for a week or 10 days — Dan Osley (clinical) [Ep 9 · 27:31](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1651)
- For recurrent recurrent pneumothorax cases, talc pleurodesis would be used if available because it is an appropriate population where preventing reoperation is critical — Dan Osley (opinion) [Ep 9 · 28:51](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1731)
- Aerosolized talc comes in a can with a straw, is inserted down the trocar site, and when sprayed looks like it is snowing inside the chest — Todd Ponsky (clinical) [Ep 9 · 29:31](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1771)
- For small apical pneumothorax after pleurodesis where lung is fixed to chest wall and patient is asymptomatic, observation with repeat chest X-ray in 48 hours is appropriate rather than operation — Dan Osley (clinical) [Ep 9 · 30:15](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1815)
- The Midwest Consortium data suggests chest tubes should not be placed in spontaneous pneumothorax patients because those whose hole is already sealed can go home after aspiration, and those whose hole remains open (83%) will need VATS anyway, making chest tubes an unnecessary source of pain. — Todd Ponsky (opinion) [Ep 8 · 6:40](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=400)
- At Cincinnati Children's, the current practice for spontaneous pneumothorax is to aspirate, wait 6 hours, check X-ray, and if no recurrence send home; if recurrence, go straight to VATS without placing a chest tube. — Todd Ponsky (clinical) [Ep 8 · 8:05](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=485)
- The speaker stopped sending home narcotics after uncomplicated appendectomy based on the data showing 85% of patients do not need opioids on post-op day 1. — Todd Ponsky (clinical) [Ep 8 · 14:10](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=850)
- One participant uses monopolar cautery for circumcision but wraps the base of the penis with saline-soaked gauze and keeps the penis attached to the body to prevent electrical injury, and has never seen penile necrosis. (clinical) [Ep 8 · 29:44](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1784)
- One participant always uses a knife for circumcision incision and cautery only for hemostasis, never for cutting. (clinical) [Ep 8 · 31:14](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1874)
- Putting a chest tube for spontaneous pneumothorax is probably an unnecessary step that will eventually be eliminated—either send patients home or go to the operating room. — Todd Ponsky (opinion) [Ep 17 · 5:43](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=343)
- A 1950s study showed larger umbilical hernias have lower spontaneous closure rates, which could justify earlier repair, but recommendation is to wait until after 4 years of age. — Todd Ponsky (clinical) [Ep 17 · 9:51](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=591)
- Traditional pilonidal disease excision with flaps has a recurrence rate of 30-40% published from Kansas City data. — Todd Ponsky (clinical) [Ep 17 · 13:00](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=780)
- In Akron Children's series of 133 patients with suspected airway foreign body, when CT showed a foreign body, findings were confirmed on bronchoscopy 94% of the time. — Todd Ponsky (clinical) [Ep 17 · 20:33](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1233)
- Patients with negative CT for airway foreign body who were called years later had zero problems—none ever had a foreign body issue. — Todd Ponsky (clinical) [Ep 17 · 21:08](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1268)
- Bronchoscopy alone for suspected airway foreign body is negative 40% of the time (61% positive rate). — Todd Ponsky (clinical) [Ep 17 · 21:26](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1286)
- The worst thing you could do with someone with reactive airway disease is instrument their airway—it's a high-risk case that makes them worse. — Todd Ponsky (clinical) [Ep 17 · 17:43](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1063)
- ATOMAC is a 12-institution prospective trial that produced approximately 15 articles radically changing solid organ injury management, including eliminating grade-based classification in favor of algorithm-based management. — Todd Ponsky (clinical) [Ep 17 · 25:44](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1544)
- Traditional ATLS teaching was to give two 20cc/kg boluses of crystalloid before giving blood, but this is now changing to earlier blood administration. — Todd Ponsky (guideline) [Ep 17 · 23:53](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1433)
- Neonatologists are nervous about glycopyrrolate because it slows secretions and could theoretically cause mucus plugs in the airway, though this hasn't been observed yet. — Todd Ponsky (clinical) [Ep 17 · 32:22](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1942)
- The disposable bouffant cap mandate in many US hospitals came out with no basis behind it, and when data was examined, it didn't make sense—people went back to wearing cloth caps. — Todd Ponsky (opinion) [Ep 17 · 35:35](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=2135)
- Medical publications are growing at an exponential rate, doubling every 73 days due to proliferation of open-access journals, making it impossible to know what to pay attention to. — Todd Ponsky (epidemiological) [Ep 17 · 41:22](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=2482)
- Machine learning algorithm for predicting important pediatric surgery papers has achieved 85% accuracy after one year of training; data scientists predict 95% accuracy after three years of content. — Todd Ponsky (clinical) [Ep 17 · 41:53](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=2513)
- Ultrasound guidance for jugular line placement, combined with fluoroscopy, decreases complications including hematoma and reduces need for multiple sticks, based on Kansas City study. — Todd Ponsky (clinical) [Ep 17 · 53:58](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=3238)
- Micro-pneumothoraces after central line placement or spontaneous pneumothorax are not as scary as previously thought—children with mild symptoms can be followed rather than routinely requiring intervention. — Todd Ponsky (opinion) [Ep 17 · 56:29](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=3389)
- Pleural drainage is nearly universally practiced in pediatric patients following lung resection — Jamie Schnuck (clinical) [Ep 14 · 0:30](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=30)
- Chest tube placement is often associated with increased pain, anxiety, subjecting patients to additional chest X-rays and may prolong hospitalizations — Jamie Schnuck (clinical) [Ep 14 · 0:45](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=45)
- 130 procedures at one academic children's hospital met inclusion criteria for the study — Jamie Schnuck (epidemiological) [Ep 14 · 2:00](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=120)
- In lobectomy patients (n=59), nearly 75% did not have an air leak noted post-operatively — Jamie Schnuck (epidemiological) [Ep 14 · 3:00](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=180)
- Median chest tube duration in lobectomy patients was two days regardless of air leak presence — Jamie Schnuck (epidemiological) [Ep 14 · 3:15](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=195)
- In diagnostic wedge resection patients (n=19), nearly 90% did not have an air leak noted post-operatively — Jamie Schnuck (epidemiological) [Ep 14 · 3:45](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=225)
- Median chest tube duration in diagnostic wedge resection patients was one day — Jamie Schnuck (epidemiological) [Ep 14 · 4:00](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=240)
- In diagnostic wedge resection patients with documented air leak, the leak lasted only one day and chest tubes were removed on post-op day two — Jamie Schnuck (epidemiological) [Ep 14 · 4:10](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=250)
- In excisional wedge resection patients (n=52), 80% did not have an air leak noted post-operatively — Jamie Schnuck (epidemiological) [Ep 14 · 4:30](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=270)
- Median chest tube duration in excisional wedge resection patients was one day — Jamie Schnuck (epidemiological) [Ep 14 · 4:45](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=285)
- In excisional wedge resection patients with air leak (n=10), median chest tube duration was two days — Jamie Schnuck (epidemiological) [Ep 14 · 4:55](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=295)
- Overall, 43% of patients had their chest tube removed on post-op day one — Jamie Schnuck (epidemiological) [Ep 14 · 5:10](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=310)
- 22% of patients had their chest tube removed on post-op day two — Jamie Schnuck (epidemiological) [Ep 14 · 5:20](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=320)
- A quarter of patients had their chest tube left in place for a documented air leak — Jamie Schnuck (epidemiological) [Ep 14 · 5:28](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=328)
- 35% of patients had their chest tube removed on post-op day three or later — Jamie Schnuck (epidemiological) [Ep 14 · 5:38](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=338)
- Chest tube duration following lung resection in children is typically brief with removal within one to two days post-operatively — Jamie Schnuck (clinical) [Ep 14 · 5:50](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=350)
- Avoidance of chest tube placement may reduce post-operative pain and hospital length of stay — Jamie Schnuck (opinion) [Ep 14 · 6:05](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=365)
- Plural drainage is nearly universally practiced in pediatric patients following lung resection (clinical) [Ep 13 · 3:57](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319?t=237)
- Routine chest tube placement is often associated with increased pain, anxiety, additional chest x-rays, and may prolong hospitalizations (clinical) [Ep 13 · 3:57](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319?t=237)
- Adult literature shows elimination of routine chest tubes as part of enhanced recovery after surgery (ERAS) pathways in select patients (clinical) [Ep 13 · 3:57](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319?t=237)
- In lobectomy patients (n=59), nearly 75% did not have an air leak noted post-operatively, with median chest tube duration of two days (clinical) [Ep 13 · 3:57](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319?t=237)
- In lobectomy patients with documented air leak (n=15), median chest tube duration was also two days (clinical) [Ep 13 · 3:57](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319?t=237)
- In diagnostic wedge resection patients (n=19), nearly 90% did not have an air leak post-operatively, with median chest tube duration of one day (clinical) [Ep 13 · 3:57](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319?t=237)
- In excisional wedge resection patients (n=52), 80% did not have an air leak post-operatively, with median chest tube duration of one day (clinical) [Ep 13 · 3:57](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319?t=237)
- Overall, 43% of patients had chest tube removed on post-op day one, 22% on post-op day two, and 25% had chest tube left in place for documented air leak (clinical) [Ep 13 · 3:57](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319?t=237)
- Chest tube duration following lung resection in children is typically brief with removal within one to two days post-operatively (clinical) [Ep 13 · 3:57](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319?t=237)
- Avoidance of chest tube placement may reduce post-operative pain and hospital length of stay (opinion) [Ep 13 · 3:57](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319?t=237)
- A previous study titled 'Chest Tubes not necessary in wedge biopsies' showed good outcomes in a cohort where no chest tubes were used (clinical) [Ep 13 · 8:45](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319?t=525)
- The critical concern is not the number of patients who don't need chest tubes, but what happens to those who did need it but didn't receive one (opinion) [Ep 13 · 8:45](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319?t=525)
- Even if there is a leak after wedge resection, it would likely be small (opinion) [Ep 13 · 9:13](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319?t=553)
- The need for chest tubes depends on the type of surgery, with clean lobectomy versus cases with infection having different risk profiles (opinion) [Ep 13 · 9:13](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319?t=553)
- The focus should shift from determining if eliminating chest tubes is feasible to identifying which specific patients will need them (opinion) [Ep 13 · 9:13](https://origin-library.globalcastmd.com/watch/bob-in-ped-surg-2023-paps-winner-jamie-schnuck-md-6319?t=553)
- If aspiration doesn't work perfectly, proceeding straight to VATS that day can turn cases into a maximum two or three day hospital stay instead of four, five, or six days while alternating between water seal and suction. (clinical) [Ep 12 · 7:47](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=467)
- The real discernment in spontaneous pneumothorax is whether you're treating somebody who has a leak or somebody who had a leak. (clinical) [Ep 12 · 7:47](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=467)
- Primary VATS for spontaneous pneumothorax has a recurrence rate of 15%. — Ronnie (epidemiological) [Ep 12 · 14:58](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=898)
- If you offer primary VATS right off the bat to people, you're actually doing surgery on people who may not necessarily need it. — Ronnie (opinion) [Ep 12 · 14:58](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=898)
- Even with a 44% recurrence rate, performing an operation upfront means operating on 56% of patients who may not need it, and that in itself has associated complications. (clinical) [Ep 12 · 15:51](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=951)
- The speaker has never seen a patient in extremis from a spontaneous pneumothorax, distinguishing it from traumatic pneumothorax. — Steve (clinical) [Ep 12 · 16:43](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=1003)
- For bilateral surgery consideration, CT scan stratification of the contralateral side shows no blebs correlates with zero recurrence, while blebs on the other side correlates with 20% recurrence. — Jose (epidemiological) [Ep 12 · 21:19](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=1279)
- Apical pneumothorax post-operatively is almost 100% because volume was removed and space was taken out. — Ronnie (clinical) [Ep 12 · 21:47](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=1307)
- The consequences of talc pleurodesis are so bad should a patient ever need a chest operation on that side that there's no justification for it. — Steve (opinion) [Ep 12 · 23:14](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=1394)
- Going back into one chest that's been talced is an awful experience. — Steve (clinical) [Ep 12 · 23:14](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=1394)
- Endobronchial valves work really well for persistent air leak post-surgery. — Dan (clinical) [Ep 12 · 25:05](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=1505)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- In Texas Children's study, 50% of patients still take opioids two weeks after Nuss procedure. — Justin Wagner summarizing the discussion [Ep 11 · 24:10](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1450)
- In past five years, hospital length of stay for Nuss procedures has been cut in half through protocol improvements. — Justin Wagner summarizing the discussion [Ep 11 · 24:40](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1480)
- In Nebraska protocol without epidurals, catheters, or cryo, length of stay is under two days and patients are off opioids by one week. — Justin Wagner summarizing the discussion [Ep 11 · 25:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1520)
- In Texas Children's study, urinary retention was 8% in cryo group versus 34% in non-cryo group. — Justin Wagner summarizing the discussion [Ep 11 · 26:00](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1560)
- Bar flippage occurs almost eight times more commonly in cryo group, and allodynia/neuropathy occurs about six times more frequently in cryo group. — Justin Wagner summarizing the discussion [Ep 11 · 26:25](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1585)
- In randomized epidural trial, epidural could either not be placed or was removed after one day in approximately 25% of patients. — Whit summarizing the discussion [Ep 11 · 26:55](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1615)
- Pilegaard technique uses shorter bars placed asymmetrically with right side covering two rib spaces and left side with single stabilizer, resulting in well below 1% bar flip rate. — Justin Wagner summarizing the discussion [Ep 11 · 37:19](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2239)
- Computational modeling shows flatter bars focus stress on sternum while bigger curved bars have parasitic forces causing unwanted horizontal and torque action at bar ends. — Justin Wagner summarizing the discussion [Ep 11 · 38:10](https://origin-library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2290)
- Lateral decubitus positioning was adopted from the transition from open thoracotomy to VATS but may add unnecessary morbidity including brachial plexus injury and decubitus ulcers. — The host summarizing the discussion [Ep 1 · 0:03](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=3)
- The presented case involved a 17-year-old male with asthma presenting with shortness of breath and chest tightness when running, found to have bilateral apical blebs and a large right spontaneous pneumothorax treated with chest tube, followed by a small left spontaneous pneumothorax that resolved with observation. — The host summarizing the discussion [Ep 1 · 0:30](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=30)
- Bilateral VATS with bilateral apical bleb resections and mechanical pleurodesis was performed in supine position with single sterile preparation, reducing operative time. — The host summarizing the discussion [Ep 1 · 1:30](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=90)
- Port placement for the right side included 25mm ports at the 7th intercostal space midclavicular line and 6th intercostal space mid-axillary line, plus a 12mm port at the 4th intercostal space mid-axillary line to accommodate the GIA stapler. — The host summarizing the discussion [Ep 1 · 2:00](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=120)
- Pleurodesis may not be necessary after bleb resection because the cause of pneumothorax is blebs in the apex of the lung, and removing the blebs should prevent recurrent pneumothorax. — Todd Ponsky summarizing the discussion [Ep 1 · 11:25](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=685)
- A prospective randomized trial comparing blebectomy with pleurodesis versus blebectomy without pleurodesis could determine if there is a higher incidence of recurrence without pleurodesis. — Todd Ponsky summarizing the discussion [Ep 1 · 12:59](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=779)
- Pleurectomy is incredibly painful postoperatively. — Todd Ponsky summarizing the discussion [Ep 1 · 13:34](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=814)
- Patients receiving talc pleurodesis had more postoperative pain compared to mechanical pleurodesis in one surgeon's anecdotal experience. — Todd Ponsky summarizing the discussion [Ep 1 · 13:52](https://origin-library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=832)
- The Midwest Pediatric Surgery Consortium conducted a multi-center prospective study enrolling 33 children with first presentation of spontaneous pneumothorax, managed with aspiration through a pigtail catheter ≤12 French followed by 6-hour observation with the tube clamped. — Rod summarizing the discussion [Ep 10 · 3:44](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=224)
- In the Midwest Consortium study, 48% of patients were successfully managed with aspiration alone and the rest failed. — Rod summarizing the discussion [Ep 10 · 4:07](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=247)
- Among patients who failed initial aspiration in the Midwest Consortium study, recurrence was 83%. — Rod summarizing the discussion [Ep 10 · 4:13](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=253)
- Of patients successfully managed with aspiration in the Midwest Consortium study, 44% had recurrence. — Rod summarizing the discussion [Ep 10 · 4:17](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=257)
- The Midwest Consortium study authors proposed changing the algorithm to proceed directly to VATS if initial aspiration fails. — Rod summarizing the discussion [Ep 10 · 4:30](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=270)
- The Australia/New Zealand study was a multi-center non-inferiority trial that enrolled 316 patients aged 14-50 years old with moderate to large pneumothoraces (approximately 32% collapse). — Rod summarizing the discussion [Ep 10 · 5:45](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=345)
- In the Australia/New Zealand trial, the success rate was 98.5% in the intervention group versus 94.4% in the observation group. — Rod summarizing the discussion [Ep 10 · 6:13](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=373)
- In the Australia/New Zealand trial, the observation group had lower rates of both adverse events and one-year recurrence compared to the intervention group. — Rod summarizing the discussion [Ep 10 · 6:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=380)
- The Australia/New Zealand study demonstrates that even patients with moderate to large spontaneous pneumothoraces can be managed with observation alone. — Rod summarizing the discussion [Ep 10 · 6:25](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=385)
- Conservative management definitions vary: some consider tube thoracostomy as conservative, while current literature defines it as observation with oxygen and pain management without any invasive intervention including needle aspiration or tube thoracostomy. — Rod summarizing the discussion [Ep 10 · 3:12](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=192)
- Aspiration can be performed with a needle or with a pigtail catheter less than 12 French. — Rod summarizing the discussion [Ep 10 · 2:42](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=162)
- Thoracentesis-only approach (needle aspiration without tube placement) has a surprisingly lower recurrence rate than chest tube placement in the literature. — The host summarizing the discussion [Ep 3 · 2:45](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=165)
- Talc pleurodesis creates adhesions that make subsequent operations extremely difficult, described as 'like cement.' — The host summarizing the discussion [Ep 3 · 6:02](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=362)
- A Korean study of 1400 patients across 11 hospitals randomized patients to bleb resection with fibrinogen glue on the staple line versus pleurodesis, showing no difference in recurrence rates. — The host summarizing the discussion [Ep 3 · 7:05](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=425)
- In the Korean study, at one-year follow-up the fibrinogen glue group had 5.8% recurrence versus 8% recurrence in the pleurodesis group. — The host summarizing the discussion [Ep 3 · 7:05](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=425)
- A Beijing study of 300 patients comparing pleurodesis versus no pleurodesis showed no difference in recurrence rates. — The host summarizing the discussion [Ep 3 · 7:51](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=471)
- There is a 50% chance of failure with chest tube alone for spontaneous pneumothorax. — The host summarizing the discussion [Ep 4 · 4:05](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=245)
- 85% of pneumothorax patients can avoid an operation, making primary VATS potentially unjustified for all first-time presentations. — The host summarizing the discussion [Ep 4 · 4:05](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=245)
- 2001 ACCP consensus guidelines stated there was no role for simple aspiration in pneumothorax. — The host summarizing a resource [Ep 4 · 4:30](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=270)
- British Thoracic Society 2010 guidelines recommend simple aspiration as first-line therapy for pneumothorax. — The host summarizing a resource [Ep 4 · 4:30](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=270)
- A Cochrane review in 2007 found only one randomized controlled trial comparing manual aspiration versus chest tube for pneumothorax, which included patients as young as 16 years old. — The host summarizing a resource [Ep 4 · 5:10](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=310)
- The randomized trial showed an immediate success rate of aspiration of 59%, similar to chest tube success rates. — The host summarizing a resource [Ep 4 · 5:50](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=350)
- In the aspiration trial, there were 11 failures: 9 received chest tubes and only 2 went on to VATS, with 50% avoiding hospitalization and no difference in overall hospital stay or recurrence rate. — The host summarizing a resource [Ep 4 · 6:20](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=380)
- Every patient with spontaneous pneumothorax who has been evaluated in adult thoracic surgery has blebs on the top of the lung. — The host summarizing the discussion [Ep 4 · 7:10](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=430)
- In adult thoracic surgery practice, the paradigm is to fix the symptomatic side with blebs and observe the contralateral side with blebs, intervening only if a second pneumothorax develops. — The host summarizing the discussion [Ep 4 · 8:29](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=509)
- TissueSeal applied after roughing up pleural edges may promote adhesion, though it is more expensive than other methods. — The host summarizing the discussion [Ep 4 · 11:36](https://origin-library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=696)
- The patient is an 18 year old male who had sudden onset of right chest pain and dyspnea, leading to a diagnosis of right spontaneous pneumothorax on chest X-ray — The host summarizing a resource [Ep 6 · 0:03](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=3)
- The patient had undergone thoracoscopic treatment of a left spontaneous pneumothorax approximately 2 years earlier after failed non-operative management — The host summarizing a resource [Ep 6 · 0:42](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=42)
- A decision was made to proceed directly to surgical treatment of the right side without an attempt at catheter thoracostomy due to prior contralateral recurrence — The host summarizing a resource [Ep 6 · 0:58](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=58)
- The patient is placed in the lateral decubitus position with an axillary roll on a beanbag for thoracoscopic pneumothorax treatment — The host summarizing a resource [Ep 6 · 1:08](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=68)
- Three triangulating incisions are used: 2 for 5 millimeter ports, and a third, more anterior one for direct insertion of a 12 millimeter endo GIA stapler — The host summarizing a resource [Ep 6 · 1:16](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=76)
- A Lukens trap works well for thoracoscopic talc application: talc is placed in the trap, tubing is cut and attached to the spout, with one side attached to installation tubing and the other to a 5mm trocar — The host summarizing a resource [Ep 6 · 1:26](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=86)
- Several blebs were identified in the lung apex during full examination — The host summarizing a resource [Ep 6 · 1:53](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=113)
- The initial stapler firing did not capture an adequate margin under the blebs on the posterior surface — The host summarizing a resource [Ep 6 · 1:59](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=119)
- The stapler should be applied across a more generous margin of grossly normal lung tissue when initial margin is inadequate — The host summarizing a resource [Ep 6 · 2:08](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=128)
- Three firings of the stapler were necessary to completely remove the apical wedge in this case — The host summarizing a resource [Ep 6 · 2:17](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=137)
- The specimen can be removed directly through the largest chest wall incision — The host summarizing a resource [Ep 6 · 2:27](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=147)
- A pressure of 15 millimeters of mercury and a flow of 4 L per minute is used to insufflate the talc — The host summarizing a resource [Ep 6 · 2:34](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=154)
- It is important to keep the second trocar open in order to maintain a pressure differential and promote flow during talc insufflation — The host summarizing a resource [Ep 6 · 2:45](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=165)
- The tip of the trocar can be manipulated to distribute the talc widely — The host summarizing a resource [Ep 6 · 2:53](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=173)
- Adequate talc distribution results when a snowstorm effect is witnessed in the thoracic cavity — The host summarizing a resource [Ep 6 · 2:58](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=178)
- It is particularly important to confirm adequate coverage of the apical, visceral, and parietal pleura with talc — The host summarizing a resource [Ep 6 · 3:05](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=185)
- A 16 French chest tube is placed at the conclusion of the procedure — The host summarizing a resource [Ep 6 · 3:12](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=192)
- The patient is an 18 year old male who had sudden onset of right chest pain and dyspnea, leading to a diagnosis of right spontaneous pneumothorax on chest X-ray — The host summarizing a resource [Ep 7 · 0:03](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=3)
- The patient had undergone thoracoscopic treatment of a left spontaneous pneumothorax approximately 2 years earlier after failed non-operative management — The host summarizing a resource [Ep 7 · 0:42](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=42)
- A decision was made to proceed directly to surgical treatment of the right side without an attempt at catheter thoracostomy due to prior contralateral recurrence — The host summarizing a resource [Ep 7 · 0:58](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=58)
- The patient is placed in the lateral decubitus position with an axillary roll on a beanbag for thoracoscopic pneumothorax treatment — The host summarizing a resource [Ep 7 · 1:08](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=68)
- Three triangulating incisions are used: 2 for 5 millimeter ports, and a third, more anterior one for direct insertion of a 12 millimeter endo GIA stapler — The host summarizing a resource [Ep 7 · 1:16](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=76)
- A Lukens trap works well for thoracoscopic talc application: talc is placed in the trap, tubing is cut and attached to the spout, with one side attached to installation tubing and the other to a 5mm trocar — The host summarizing a resource [Ep 7 · 1:26](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=86)
- Several blebs were identified in the lung apex during full examination — The host summarizing a resource [Ep 7 · 1:53](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=113)
- The initial stapler firing did not capture an adequate margin under the blebs on the posterior surface — The host summarizing a resource [Ep 7 · 1:59](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=119)
- The stapler should be applied across a more generous margin of grossly normal lung tissue when initial margin is inadequate — The host summarizing a resource [Ep 7 · 2:08](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=128)
- Three firings of the stapler were necessary to completely remove the apical wedge in this case — The host summarizing a resource [Ep 7 · 2:17](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=137)
- The specimen can be removed directly through the largest chest wall incision — The host summarizing a resource [Ep 7 · 2:27](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=147)
- A pressure of 15 millimeters of mercury and a flow of 4 L per minute is used to insufflate the talc — The host summarizing a resource [Ep 7 · 2:34](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=154)
- It is important to keep the second trocar open in order to maintain a pressure differential and promote flow during talc insufflation — The host summarizing a resource [Ep 7 · 2:45](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=165)
- The tip of the trocar can be manipulated to distribute the talc widely — The host summarizing a resource [Ep 7 · 2:53](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=173)
- Adequate talc distribution results when a snowstorm effect is witnessed in the thoracic cavity — The host summarizing a resource [Ep 7 · 2:58](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=178)
- It is particularly important to confirm adequate coverage of the apical, visceral, and parietal pleura with talc — The host summarizing a resource [Ep 7 · 3:05](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=185)
- A 16 French chest tube is placed at the conclusion of the procedure — The host summarizing a resource [Ep 7 · 3:12](https://origin-library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=192)
- In the Midwest Pediatric Surgery Consortium prospective trial of spontaneous pneumothorax, 83% of patients who failed initial aspiration (pneumothorax recurred within 6 hours) eventually required VATS procedure. — Todd Ponsky summarizing the discussion [Ep 8 · 3:52](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=232)
- Patients with spontaneous pneumothorax who were sent home after successful aspiration had a 44% recurrence rate with no episodes of tension pneumothorax. — Todd Ponsky summarizing the discussion [Ep 8 · 4:28](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=268)
- In a 12-center UK retrospective review, the recurrence rate of benign ovarian tumors (mature and immature teratomas and serous cystadenomas) in children was 8%. — Todd Ponsky summarizing the discussion [Ep 8 · 10:00](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=600)
- The UK study authors recommend every 6-month ultrasounds for benign ovarian tumor follow-up but do not conclude on duration of surveillance. — Todd Ponsky summarizing the discussion [Ep 8 · 10:25](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=625)
- After uncomplicated appendectomy, 84% of patients require no opioids on post-operative day 1, 95% by post-op day 2, and 100% by post-op day 3. — Todd Ponsky summarizing the discussion [Ep 8 · 12:10](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=730)
- In the Riley Hospital RCT comparing pyloric stenosis feeding strategies, a relaxed ad-lib feeding protocol decreased time to goal feeds and overall length of stay without significant differences in post-operative vomiting or readmissions compared to incremental scheduled feeds. — Todd Ponsky summarizing the discussion [Ep 8 · 17:30](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1050)
- Pyloric stenosis patients with serum chloride less than 100 on admission took significantly longer to reach their feeding goal. — Todd Ponsky summarizing the discussion [Ep 8 · 18:15](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1095)
- Nationwide Children's Hospital reduced stoma takedown wound infection rate from 21% to 8% by implementing a perioperative bundle, then further reduced it to 2% by changing antibiotics from cefoxitin to Unasyn. — Todd Ponsky summarizing the discussion [Ep 8 · 21:20](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1280)
- The reason for switching to Unasyn for stoma takedown was that infections after stoma closure were predominantly enterococcus, and Unasyn provides better enterococcus coverage than cefoxitin. — Todd Ponsky summarizing the discussion [Ep 8 · 24:10](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1450)
- Dr. Levitt identified changing gloves and changing instruments when doing fascial and skin closures as the bundle element that probably made the biggest difference in reducing stoma takedown infections. — Todd Ponsky summarizing the discussion [Ep 8 · 22:40](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1360)
- In a multi-state retrospective cohort study, umbilical hernia repair before age 4 had double the recurrence rate and double the readmission rate compared to repair at age 4 or later. — Todd Ponsky summarizing the discussion [Ep 8 · 19:00](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1140)
- A 1960s study of African-American children in the United States found that very large umbilical hernia defects had a lower chance of spontaneous closure. — Todd Ponsky summarizing the discussion [Ep 8 · 23:50](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1430)
- In a prospective multicenter study published in Journal of Crohn's and Colitis, appendectomy in patients with refractory ulcerative colitis resulted in sustained symptomatic improvement in 30%, pathologic improvement in 50%, and complete endoscopic remission in 17%. — Todd Ponsky summarizing the discussion [Ep 8 · 22:10](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1330)
- In a retrospective study of 24 patients with penile necrosis after circumcision, five predictive factors were identified: monopolar cautery use, post-circumcision infection, compartment syndrome, local anesthetic agent use, and methemoglobinemia. — Todd Ponsky summarizing the discussion [Ep 8 · 29:00](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=1740)
- The Gips procedure for pilonidal disease involves coring out pits with a trephine or punch biopsy, extracting granulation tissue and hair with a mosquito, curettage with a smaller trephine, flushing with saline then hydrogen peroxide, leaving punch openings unpacked and unsutured with no drains, and takes 3-5 minutes. — Todd Ponsky summarizing the discussion [Ep 8 · 35:00](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=2100)
- In a 133-patient series using chest CT for suspected airway foreign body, CT excluded foreign body in 30% of patients who would have otherwise undergone bronchoscopy. — Todd Ponsky summarizing the discussion [Ep 8 · 43:20](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=2600)
- When chest CT showed findings of airway foreign body, bronchoscopy confirmed the findings 94% of the time, compared to only 61% positive yield when bronchoscopy was performed based on clinical suspicion alone. — Todd Ponsky summarizing the discussion [Ep 8 · 43:45](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=2625)
- Modern pediatric chest CT delivers 1 to 10 millisieverts of radiation, equivalent to living on Earth for 1 year, with chest CTs often in the 1-3 millisievert range. — Todd Ponsky summarizing the discussion [Ep 8 · 46:40](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=2800)
- For intussusception that reaches the cecum on contrast enema but cannot be fully reduced, a second enema attempt has a 50-64% success rate in stable patients without peritoneal signs. — Todd Ponsky summarizing the discussion [Ep 8 · 48:00](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=2880)
- The ATOMAC multi-center prospective data showed that pediatric trauma patients do better with earlier blood administration: only one 20 cc/kg bolus of saline should be given, and if the patient does not respond, blood should be given rather than a second crystalloid bolus. — Todd Ponsky summarizing the discussion [Ep 8 · 49:10](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=2950)
- In pediatric trauma, the magic number for operative intervention is 40 cc/kg of blood or 4 units: patients transfused with this amount probably cannot be managed non-operatively and should go to the operating room. — Todd Ponsky summarizing the discussion [Ep 8 · 50:20](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=3020)
- For stable pediatric solid organ injury patients who never required blood transfusion, they can be discharged home the next day if hemoglobin remains stable. — Todd Ponsky summarizing the discussion [Ep 8 · 51:20](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=3080)
- Kansas City data on 622 central line placements showed that obtaining chest X-rays only for symptomatic patients (rather than routine post-procedure imaging) resulted in no critically ill patients, with only one patient requiring intervention. — Todd Ponsky summarizing the discussion [Ep 8 · 52:40](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=3160)
- In an RCT of glycopyrrolate for anastomotic leak after esophageal atresia repair, the treatment group had chest tube output of 124 mL versus 370 mL in placebo, leak resolution in 76% versus 29%, and oral feeding achieved in 71% versus 14%. — Todd Ponsky summarizing the discussion [Ep 8 · 53:50](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=3230)
- In the Riley Hospital study of operating room headgear, cloth skull caps had the lowest permeability and lowest particle/microbial shedding on the surgical field, while disposable bouffant caps had the highest shedding. — Todd Ponsky summarizing the discussion [Ep 8 · 56:20](https://origin-library.globalcastmd.com/watch/what-s-new-in-pediatric-surgery-2020-full-show-3217?t=3380)
- In the Midwest Pediatric Surgery Consortium prospective trial of spontaneous pneumothorax, 83% of patients who failed aspiration and received a chest tube eventually required VATS procedure. — The host summarizing the discussion [Ep 17 · 4:25](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=265)
- After aspiration protocol for spontaneous pneumothorax with 6-hour observation, 44% of patients sent home had recurrence, with no episodes of tension pneumothorax. — The host summarizing the discussion [Ep 17 · 4:31](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=271)
- Riley Hospital randomized controlled trial (2016) found relaxed ad-lib feeding after pyloromyotomy decreased time to goal feeds and overall length of stay without significant differences in post-operative vomiting or readmissions compared to incremental feeding protocol. — Todd Ponsky summarizing the discussion [Ep 17 · 7:00](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=420)
- Patients with serum chloride less than 100 on admission after pyloromyotomy took significantly longer to reach feeding goal. — Todd Ponsky summarizing the discussion [Ep 17 · 7:25](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=445)
- Multi-state retrospective cohort study (Journal of Pediatrics 2019) showed umbilical hernia repair before age 4 doubled the recurrence rate and doubled the readmission rate. — Todd Ponsky summarizing the discussion [Ep 17 · 9:15](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=555)
- Prospective multi-center study (Journal of Crohn's and Colitis, February 2019) found appendix removal in refractory ulcerative colitis resulted in sustained symptomatic improvement in 30% of patients, pathologic improvement in 50%, and complete endoscopic remission in 17%. — Todd Ponsky summarizing the discussion [Ep 17 · 11:22](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=682)
- The Gips procedure for pilonidal disease involves coring out pits with trephine, extracting granulation tissue and hair, curetting the cavity, and flushing with saline then peroxide, leaving holes unpacked and unsutured. — Todd Ponsky summarizing the discussion [Ep 17 · 13:59](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=839)
- The Gips procedure for pilonidal disease has the same recurrence rate as traditional flaps but with less pain and fewer sick days away from school. — Todd Ponsky summarizing the discussion [Ep 17 · 15:41](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=941)
- Volumetric chest CT for suspected airway foreign body has almost 100% sensitivity and incredibly high ability to detect foreign bodies whether radiolucent or not. — Todd Ponsky summarizing the discussion [Ep 17 · 18:46](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1126)
- ATOMAC protocol recommends that patients who receive 20cc/kg crystalloid and don't respond should get 10-20cc/kg bolus of blood rather than a second crystalloid bolus. — Todd Ponsky summarizing the discussion [Ep 17 · 24:23](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1463)
- The magic number in pediatric trauma is 40cc/kg of blood or 4 units—if a patient is transfused this amount, it indicates probable failure of non-operative management and need for operating room. — Todd Ponsky summarizing the discussion [Ep 17 · 24:54](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1494)
- Kansas City study of 622 fluoroscopy-guided central lines: 504 patients had no chest X-ray and no symptoms with no adverse outcomes. — Todd Ponsky summarizing the discussion [Ep 17 · 28:40](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1720)
- In the central line study, 25 patients were symptomatic and received chest X-ray; 4 had pneumothorax managed non-operatively and sent home next day, and 1 had pleural effusion requiring chest tube. — Todd Ponsky summarizing the discussion [Ep 17 · 29:00](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1740)
- Out of 622 central line patients, only 1 required a chest tube, and that patient was symptomatic—conclusion is routine chest X-ray after every line placement is not needed. — Todd Ponsky summarizing the discussion [Ep 17 · 29:11](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1751)
- Randomized controlled trial of glycopyrrolate for esophageal atresia anastomotic leak: treatment group had chest tube output of 124mL compared to 370mL in placebo group. — Todd Ponsky summarizing the discussion [Ep 17 · 31:45](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1905)
- Glycopyrrolate treatment for EA leak achieved leak resolution in 76% versus 29% in placebo group, and oral feeding in 71% versus 14% in placebo group. — Todd Ponsky summarizing the discussion [Ep 17 · 31:55](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1915)
- Riley Hospital Hats Off study found disposable bouffant caps had the highest microbial and particle shedding on the surgical field. — Todd Ponsky summarizing the discussion [Ep 17 · 34:36](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=2076)
- Cloth skull caps had the lowest permeability and lowest porous material with very low shedding compared to disposable bouffant caps. — Todd Ponsky summarizing the discussion [Ep 17 · 34:44](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=2084)
- In adult literature, elimination of routine chest tubes is part of enhanced recovery after surgery (ERAS) pathways in select patients — Jamie Schnuck summarizing a resource [Ep 14 · 1:00](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-jamie-schnuck-paps-presentation-6348?t=60)
- The study was a retrospective analysis conducted at Children's Mercy Hospital Kansas City — Cecilia Gigena summarizing a resource [Ep 16 · 0:00](https://origin-library.globalcastmd.com/watch/manejo-del-neumot-rax-primario-espont-neo-en-ni-os-7191?t=0)
- The study analyzed patients aged 12 to 18 years with spontaneous pneumothorax presenting between 2016 and 2021 — Cecilia Gigena summarizing a resource [Ep 16 · 0:00](https://origin-library.globalcastmd.com/watch/manejo-del-neumot-rax-primario-espont-neo-en-ni-os-7191?t=0)
- The study included 59 patients total — Cecilia Gigena summarizing a resource [Ep 16 · 0:00](https://origin-library.globalcastmd.com/watch/manejo-del-neumot-rax-primario-espont-neo-en-ni-os-7191?t=0)
- The hospital protocol involved starting with simple aspiration, which if it failed, proceeded to VATS — Cecilia Gigena summarizing a resource [Ep 16 · 0:00](https://origin-library.globalcastmd.com/watch/manejo-del-neumot-rax-primario-espont-neo-en-ni-os-7191?t=0)
- 33% of patients were treated with simple aspiration — Cecilia Gigena summarizing a resource [Ep 16 · 0:00](https://origin-library.globalcastmd.com/watch/manejo-del-neumot-rax-primario-espont-neo-en-ni-os-7191?t=0)
- 66% of patients were treated with VATS — Cecilia Gigena summarizing a resource [Ep 16 · 0:00](https://origin-library.globalcastmd.com/watch/manejo-del-neumot-rax-primario-espont-neo-en-ni-os-7191?t=0)
- Patients treated with simple aspiration had a recurrence rate of 45% — Cecilia Gigena summarizing a resource [Ep 16 · 0:00](https://origin-library.globalcastmd.com/watch/manejo-del-neumot-rax-primario-espont-neo-en-ni-os-7191?t=0)
- Patients treated with simple aspiration had a median hospital stay of 20.4 hours — Cecilia Gigena summarizing a resource [Ep 16 · 0:00](https://origin-library.globalcastmd.com/watch/manejo-del-neumot-rax-primario-espont-neo-en-ni-os-7191?t=0)
- Patients treated with VATS had a recurrence rate of 25% — Cecilia Gigena summarizing a resource [Ep 16 · 0:00](https://origin-library.globalcastmd.com/watch/manejo-del-neumot-rax-primario-espont-neo-en-ni-os-7191?t=0)
- Patients treated with VATS had a median hospital stay of 3.1 days — Cecilia Gigena summarizing a resource [Ep 16 · 0:00](https://origin-library.globalcastmd.com/watch/manejo-del-neumot-rax-primario-espont-neo-en-ni-os-7191?t=0)
- The study is a retrospective analysis from Children's Mercy Hospital in Kansas City examining spontaneous pneumothorax management. — Cecilia Gigena summarizing a resource [Ep 15 · 0:00](https://origin-library.globalcastmd.com/watch/management-of-primary-spontaneous-pneumothorax-in-children-7190?t=0)
- The study population included patients between 12 and 18 years old with spontaneous pneumothorax between 2016 and 2021. — Cecilia Gigena summarizing a resource [Ep 15 · 0:00](https://origin-library.globalcastmd.com/watch/management-of-primary-spontaneous-pneumothorax-in-children-7190?t=0)
- The institutional protocol was to start with simple aspiration and escalate to VATS if aspiration failed. — Cecilia Gigena summarizing a resource [Ep 15 · 0:00](https://origin-library.globalcastmd.com/watch/management-of-primary-spontaneous-pneumothorax-in-children-7190?t=0)
- The study included 59 patients total. — Cecilia Gigena summarizing a resource [Ep 15 · 0:00](https://origin-library.globalcastmd.com/watch/management-of-primary-spontaneous-pneumothorax-in-children-7190?t=0)
- 33% of patients received simple aspiration as their treatment. — Cecilia Gigena summarizing a resource [Ep 15 · 0:00](https://origin-library.globalcastmd.com/watch/management-of-primary-spontaneous-pneumothorax-in-children-7190?t=0)
- 66% of patients ended up receiving VATS. — Cecilia Gigena summarizing a resource [Ep 15 · 0:00](https://origin-library.globalcastmd.com/watch/management-of-primary-spontaneous-pneumothorax-in-children-7190?t=0)
- The aspiration group had a 45% recurrence rate. — Cecilia Gigena summarizing a resource [Ep 15 · 0:00](https://origin-library.globalcastmd.com/watch/management-of-primary-spontaneous-pneumothorax-in-children-7190?t=0)
- The aspiration group had a median length of stay of 20.4 hours. — Cecilia Gigena summarizing a resource [Ep 15 · 0:00](https://origin-library.globalcastmd.com/watch/management-of-primary-spontaneous-pneumothorax-in-children-7190?t=0)
- The VATS group had a 25% recurrence rate. — Cecilia Gigena summarizing a resource [Ep 15 · 0:00](https://origin-library.globalcastmd.com/watch/management-of-primary-spontaneous-pneumothorax-in-children-7190?t=0)
- The VATS group had a median length of stay of 3.1 days. — Cecilia Gigena summarizing a resource [Ep 15 · 0:00](https://origin-library.globalcastmd.com/watch/management-of-primary-spontaneous-pneumothorax-in-children-7190?t=0)
- The British Thoracic Society has been advocating for aspiration since 2003. — Ronnie summarizing the discussion [Ep 12 · 1:51](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=111)
- In the Midwest Consortium study, 48% of patients with first-presentation spontaneous pneumothorax were successfully managed with aspiration alone through a pigtail catheter ≤12 French, and 52% failed. — Ronnie summarizing the discussion [Ep 12 · 3:33](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=213)
- In patients who failed initial aspiration in the Midwest Consortium study, recurrence was 83% versus 44% in those who passed the first aspiration test. — Ronnie summarizing the discussion [Ep 12 · 3:33](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=213)
- The Midwest Consortium study proposed changing the algorithm to proceed directly to VATS if the initial aspiration fails. — Ronnie summarizing the discussion [Ep 12 · 3:33](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=213)
- The 2020 New England Journal of Medicine study was a multicenter non-inferiority trial enrolling 316 patients aged 14 to 50 years with moderate to large pneumothoraces (approximately 32% collapse). — Ronnie summarizing the discussion [Ep 12 · 9:27](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=567)
- In the NEJM trial, 84.6% of patients in the observation group did not have any interventions, whereas 15.4% did have interventions. — Ronnie summarizing the discussion [Ep 12 · 9:27](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=567)
- In the NEJM trial, 98.5% were managed successfully in the intervention group versus 94.4% in the observation group, with no significant difference. — Ronnie summarizing the discussion [Ep 12 · 9:27](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=567)
- Median time to reexpansion was 16 days for the intervention group versus 30 days for the observation group in the NEJM trial. — Ronnie summarizing the discussion [Ep 12 · 9:27](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=567)
- Median time to symptom resolution was approximately the same between intervention and observation groups in the NEJM trial. — Ronnie summarizing the discussion [Ep 12 · 9:27](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=567)
- Recurrences in the first 12 months were 8.8% in the observation group versus 16.8% in the intervention group in the NEJM trial. — Ronnie summarizing the discussion [Ep 12 · 9:27](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=567)
- The observation group had fewer days of chest tubes, fewer CT scans, fewer hospital revisits, fewer adverse events and serious adverse events, fewer chest x-rays, and fewer hospital days in the first eight weeks compared to the intervention group. — Ronnie summarizing the discussion [Ep 12 · 9:27](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=567)
- Studies have shown that pleurodesis is not needed for spontaneous pneumothorax. — Steve summarizing the discussion [Ep 12 · 16:43](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=1003)
- The presence or absence of a bleb on CT scan did not correlate with the presence or absence of patients coming back to seek care for a pneumothorax on that side. — Ronnie summarizing the discussion [Ep 12 · 20:22](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=1222)
- Studies show pleurodesis doesn't make a difference at all and just causes more pain. — Ronnie summarizing the discussion [Ep 12 · 20:50](https://origin-library.globalcastmd.com/watch/update-course-2021-pneumothorax-5419?t=1250)
- The Journal of Pediatric Surgery published a study from the Midwest Pediatric Surgery Consortium on optimal management of spontaneous pneumothorax — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/aspiration-test-predicts-need-for-operation-in-pediatric-spontaneous-2153?t=0)
- The study was a prospective trial where patients were initially treated with simple air aspiration from the pleural space with a pigtail catheter in the emergency department — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/aspiration-test-predicts-need-for-operation-in-pediatric-spontaneous-2153?t=0)
- After aspiration, patients underwent 6 hours of observation — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/aspiration-test-predicts-need-for-operation-in-pediatric-spontaneous-2153?t=0)
- If the pneumothorax did not recur after observation, patients were sent home — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/aspiration-test-predicts-need-for-operation-in-pediatric-spontaneous-2153?t=0)
- If the pneumothorax recurred after aspiration, patients were admitted to the hospital — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/aspiration-test-predicts-need-for-operation-in-pediatric-spontaneous-2153?t=0)
- 83% of patients who failed the aspiration eventually required a VATS procedure — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/aspiration-test-predicts-need-for-operation-in-pediatric-spontaneous-2153?t=0)
- The recurrence rate of those who were sent home after successful aspiration was 44% — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/aspiration-test-predicts-need-for-operation-in-pediatric-spontaneous-2153?t=0)
- There were no episodes of tension pneumothorax among patients sent home after successful aspiration — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/aspiration-test-predicts-need-for-operation-in-pediatric-spontaneous-2153?t=0)
- The authors recommend performing the aspiration protocol and sending all patients that fail straight to the operating room since the need for OR is so high in these patients — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/aspiration-test-predicts-need-for-operation-in-pediatric-spontaneous-2153?t=0)

## Changelog
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