Welcome to the 12th Annual Update Course in Pediatric Surgery recap series, hosted by Dr. Em Gootee from Cincinnati Children’s Hospital. In this Green Circle (established practice) session, Drs. David Vitale, Luke Neff, and Jeff Ponsky explore the “surgery-first” approach to pediatric biliary stone disease, highlighting the growing prevalence of choledocholithiasis in children and the evolving strategies to manage it effectively.

Key Highlights:

• Surgery-First vs. ERCP-First: The panel compares the two main management strategies: ERCP followed by laparoscopic cholecystectomy versus laparoscopic cholecystectomy with intraoperative cholangiogram (IOC) and stone removal.
• Practice-Based Decision Making: Experts emphasize that choice depends on surgeon skill, institutional resources, and the ability to perform IOC effectively.
• Clinical Evidence: Studies show an 86–90% success rate for ductal clearance using a surgery-first approach with IOC and flushing—offering a safe, resource-efficient option that minimizes ERCP-associated risks like pancreatitis.
• Learning Curve & Equipment: Surgeons are encouraged to become more comfortable with intraoperative stone removal techniques. Having a prepared kit and standardized workflow is key to success.
• ERCP Complications: While ERCP is effective, it carries a ~10% risk of complications including cholangitis and pancreatitis—making intraoperative solutions appealing when feasible.

This session underscores a shift toward empowering surgeons with tools and confidence to manage choledocholithiasis directly in the OR, improving outcomes and optimizing resource utilization across institutions.

In this 2024 Update Course Rewind, pediatric surgeon Dr. John DiFiore shares new insights into the growing use of cryoanalgesia for pectus excavatum repairs. Classified as a “Blue Square” practice—indicating a promising newer technique—this approach provides targeted nerve pain relief with less opioid use, better precision, and shorter hospital stays.

Key Highlights:

• What is Cryoanalgesia? A minimally invasive nerve freezing technique used to reduce chest wall pain during pectus repair.
• Technique Deep Dive: From double-lumen tubes to improved cryoprobes, learn how to perform blocks from T3–T8 with precision.
• Time-Saving Tools: New cryoprobes offer faster freeze cycles and better insulation, cutting procedure time nearly in half.
• Clinical Outcomes: Lower pain scores, next-day discharges, and potential to further improve outcomes with dual freeze points.
• Barriers & Workarounds: Addressing the main challenges of cost, equipment access, and proper training.

Whether you're currently using cryo or just considering it, this session is packed with pearls for improving postoperative pain control in pediatric patients.

In this special episode of the Colorectal Quiz, Drs. Marc Levitt and Jason Frischer are joined by Dr. Todd Ponsky and Em Gootee for a behind-the-scenes look at how AI is supporting medical education. The topic of this quiz: Collaborating for Kids: Colorectal & Pelvic Solutions. What’s unique about this episode? Everything after the intro was generated using NotebookLM, an AI tool that helped synthesize notes, transcripts, and case studies into an engaging, educational format. Key Highlights:

• Case-Based Learning: A multidisciplinary team approach to treating children with complex colorectal and pelvic conditions.
• Building the Right Team: The importance of urologists, gynecologists, psychologists, and colorectal surgeons working together to improve outcomes.
• International Collaboration: How programs like the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) are advancing global standards of care.
• Family-Centered Care: Strategies for improving communication with families and providing continuity as patients transition into adulthood.
• Innovative Communication: A glimpse into the future of podcasting and education in pediatric surgery.

This episode blends expert insight with cutting-edge technology to show what’s possible when collaboration meets innovation.

Alejandra Vilanova-Sánchez, Julie Choueiki, Caitlin A. Smith, Susan Callicot, Jason S. Frischer, Marc A. Levitt. Creating a collaborative program for the care of children with colorectal and pelvic problems. Seminars in Pediatric Surgery 29 (202) 150985.

In this insightful recap from the 12th Annual Update Course in Pediatric Surgery, Dr. Thomas Inge of Lurie Children’s Hospital explores emerging uses of cryoanalgesia beyond pectus repair. The video delves into novel applications of cryotherapy for conditions like slipping rib syndrome and rib fractures—highlighting how interventional radiology tools, including percutaneous needle probes, can offer powerful pain relief and reduce narcotic use and hospital stay.

Key Highlights:

• Slipping Rib Syndrome: Often overlooked in teens, this condition can be addressed with intercostal blocks and cryoablation.
• Percutaneous Cryoablation: A new frontier in treating rib fractures and chronic pain using ultrasound-guided techniques.
• Multidisciplinary Approach: Collaboration between surgery and IR expands treatment options for hard-to-diagnose chest wall pain.

This session emphasizes the evolving role of cryoanalgesia as a versatile, minimally invasive tool in pediatric surgical care.

In this engaging session from the 12th Annual Update Course in Pediatric Surgery, Dr. Timothy Lautz explores the expanding role of cryoanalgesia in pediatric thoracotomy beyond pectus repair. As more institutions embrace this technique, Dr. Lautz breaks down its use, safety, and clinical advantages for thoracotomy pain control.

Key Highlights:

• Beyond Pectus Repair: While commonly used for pectus excavatum, cryoanalgesia is now being applied in thoracotomy cases to improve postoperative recovery.
• How It Works: Temporary nerve blockade is achieved by freezing the intercostal nerves, reducing or eliminating the need for epidurals and long-term opioids.
• Safety & Recovery: The procedure is safe, repeatable, and allows even small children to benefit from reduced pain and faster recovery timelines.
• Clinical Implementation: Dr. Lautz offers insight into when and how his team applies cryo, including tips for technique, timing, and avoiding complications.

This talk underscores the value of multidisciplinary collaboration and highlights how surgical innovation can reduce patient discomfort and streamline recovery.

In this insightful session from the 12th Annual Update Course in Pediatric Surgery, Drs. David Vitale, Luke Neff, and Jeff Ponsky break down the essentials of intraoperative cholangiography (IOC)—a technique that plays a key role in identifying biliary anatomy and managing stones.

Key Highlights:

• Technique Tips: From contrast flushes to balloon dilation, the team shares practical advice on improving success rates during IOC.
• Clinical Decision-Making: When and how to incorporate glucagon, and when to call in GI for support.
• Avoiding Pitfalls: Recognizing common challenges, including misinterpretation of images and catheter misplacement.
• Collaborative Care: How surgical teams can streamline intraoperative strategy and reduce post-op complications through consistent IOC use.

This session emphasizes IOC as a powerful tool when performed correctly—and reminds us that thoughtful execution and teamwork can make all the difference in surgical outcomes.

We’re back with 20th episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review articles covering the most interesting and relevant topics in the field.

These articles are either chosen by JPS editors or our collaborators. We present these reviews as short news pieces with a summarization of key points.

Whether you're a trainee, attending, or an advanced medical professional, tune in to our podcast for a dose of medical knowledge in every episode. Stay up to date on the latest trends and advancements in pediatric surgery with "Quick Literature Updates".

Host: Em Gootee

0:00 Introduction

0:41 Comprehensive meta-analysis of surgical procedure for congenital diaphragmatic hernia: thoracoscopic versus open repair

1:35 Use of a new vertical traction device for early traction-assisted staged closure of congenital abdominal wall defects: a prospective series of 16 patients

2:39 Indocyanine green (ICG) fluorescent cholangiography during laparoscopic cholecystectomy using RUBINA™ technology: preliminary experience in two pediatric surgery centers

3:47 Outro

https://pmc.ncbi.nlm.nih.gov/articles/PMC11233350/ Shibuya S, Paraboschi I, Giuliani S, Tsukui T, Matei A, Olivos M, Inoue M, Clarke SA, Yamataka A, Zani A, Eaton S, De Coppi P. Comprehensive meta-analysis of surgical procedure for congenital diaphragmatic hernia: thoracoscopic versus open repair. Pediatr Surg Int. 2024 Jul 9;40(1):182. doi: 10.1007/s00383-024-05760-7. Erratum in: Pediatr Surg Int. 2024 Aug 31;40(1):247. doi: 10.1007/s00383-024-05832-8. PMID: 38980431; PMCID: PMC11233350.

https://pubmed.ncbi.nlm.nih.gov/38960901/ Ziegler AM, Svoboda D, Lüken-Darius B, Heydweiller A, Kahl F, Falk SC, Rolle U, Theilen TM. Use of a new vertical traction device for early traction-assisted staged closure of congenital abdominal wall defects: a prospective series of 16 patients. Pediatr Surg Int. 2024 Jul 3;40(1):172. doi: 10.1007/s00383-024-05745-6. PMID: 38960901; PMCID: PMC11222185.

https://pubmed.ncbi.nlm.nih.gov/34231069/ Esposito C, Alberti D, Settimi A, Pecorelli S, Boroni G, Montanaro B, Escolino M. Indocyanine green (ICG) fluorescent cholangiography during laparoscopic cholecystectomy using RUBINA™ technology: preliminary experience in two pediatric surgery centers. Surg Endosc. 2021 Nov;35(11):6366-6373. doi: 10.1007/s00464-021-08596-7. Epub 2021 Jul 6. PMID: 34231069; PMCID: PMC8523512.

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In this episode of the Colorectal Quiz, Drs. Marc Levitt, Jason Frischer, and special guest Dr. Julia Grabowski from Lurie Children’s dive deep into the diagnosis and management of anal stenosis in infants. They walk through the case of a 10-month-old presenting with constipation and distention, leading to a discussion on clinical exams, imaging, biopsy pitfalls, and surgical strategies.

Key Highlights:

• Physical Exam Essentials: Why a thorough digital rectal exam is critical and when to use a Hegar dilator vs. relying on feel.
• Distinguishing Anal Stenosis vs. Hirschsprung Disease: How misdiagnoses occur and why biopsies can be misleading if not done correctly.
• Surgical Management: Principles of preserving the anterior anal canal to protect continence during posterior sagittal approaches.
• Megarectosigmoid Management: Why most dilated rectums improve after addressing the obstruction and when a Malone procedure can prevent the need for resection.
• Special Considerations: The importance of spinal and pelvic MRI to rule out associated presacral masses before surgery.

This episode underscores the importance of a meticulous clinical approach, interdisciplinary review, and cautious surgical planning in treating children with suspected anal stenosis.

Join us for a highlight reel of the Top 10 Key Takeaways from the 12th Annual Update Course in Pediatric Surgery. This session covers the latest advances, practical tools, and emerging trends that are shaping the future of pediatric surgical care.

Key Highlights:

10. Collaboration Between Surgery & Interventional Radiology: Drs. Dan von Allmen, John Racadio, and Timothy Lautz highlight how combining surgical and interventional radiology techniques enhances precision and patient outcomes.

9. Top AI Tools for Surgeons: Drs. Ramy Shaaban and Carlos Colunga introduce AI platforms improving research, education, and clinical workflow.

8. Cryoanalgesia in Pectus Surgery: Dr. John DiFiore explains how cryoanalgesia is transforming pain management in chest wall repairs.

7. ECMO in Severe CDH: Drs. Steven Lee and Rebecca Stark explore ECMO’s evolving role in managing severe congenital diaphragmatic hernia.

6. CO₂ Laser Applications: Dr. Carlos Colunga shares expanding applications of CO₂ lasers for minimally invasive pediatric procedures.

5. Autofluorescence & ICG in Thyroid Surgery: Drs. Justin Huntington and Ben Ham showcase imaging technologies that improve parathyroid identification and reduce hypocalcemia.

4. Surgery-First Approach for Pediatric Biliary Stones: Drs. David Vitale, Luke Neff, and Jeff Ponsky advocate for earlier surgical intervention to avoid unnecessary imaging.

3. MMP-7 for Early Biliary Atresia Diagnosis: Dr. Greg Tiao presents the impact of MMP-7 as a biomarker for faster diagnosis and better outcomes.

2. REBOA in Pediatric Trauma: Dr. Regan Williams discusses the role of resuscitative endovascular balloon aortic occlusion in critical pediatric trauma cases.

1. Patient Education in Pilonidal Disease: Dr. Nelsen Rosen outlines strategies to manage pilonidal disease non-surgically through hygiene and hair removal.

These takeaways represent the cutting edge of pediatric surgery, offering practical insights for surgeons, researchers, and trainees alike.

This year was the 12th Annual Pediatric Surgery Update Course, where top hospital experts from around the world discussed this year’s changes in practices and innovation. Rewatch the event to learn more about the future of pediatric surgery and be at the forefront of medical excellence.

In this clip, Drs. Em Gootee, Ramy Shaaban, Carlos Colunga, with Todd Ponsky as moderator, speaks on the top AI tools of 2024.

Topics to be discussed:

• AI: TOP 10 websites & tools for everyday usage