Behind The Knife: The Surgery Podcast: Recent Episodes
Behind The Knife: The Surgery Podcast
Behind the Knife is the world’s #1 surgery podcast. From high-yield educational topics to interviews with leaders in the field, Behind the Knife delivers the information you need to know. Tune in for timely, relevant, and engaging content designed to help you DOMINATE THE DAY!
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Digital surgery has morphed from buzzword into ubiquitous high-impact technology. In this episode, the BTK MIS team steps into the rapidly evolving ecosystem of cameras, sensors, robotics, and software that are turning surgical operations into structured, analyzable datasets. From AI segmentation to real-time telepresence, don’t miss this opportunity to catch up on what’s new and what’s next, what’s exciting and what’s terrifying, just on the horizon of your surgical career.
Hosts:
· James Jung, MD, PhD, Assistant Professor of Surgery, Duke University
· Jacob Greenberg, MD, EdM, MIS Division Chief and Vice Chair for Education, Duke University
· Zachary Weitzner, MD, Minimally Invasive and Bariatric Surgery Fellow, Duke University, @ZachWeitznerMD
· Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actually
Learning Goals:
By the end of this episode, listeners will be able to:
· Define “digital surgery” and describe its core components, including video capture, instrumentation, robotics, data analytics, and system connectivity.
· Discuss current and emerging applications of digital surgery in surgical education, including video-based self-assessment, procedural segmentation, and structured feedback models.
· Describe how digital tools can be used to improve OR efficiency and resource utilization, including instrumentation usage, operative time analysis, and workflow optimization.
· Summarize current telepresence and teleproctoring technologies and their clinical use cases, including augmented reality–based collaboration across institutions and geographic boundaries.
· Identify key ethical, legal, and operational challenges in digital and tele-surgery, including credentialing, cross-state licensure, liability, and trust in remote expertise.
· Discuss how digital surgery may reshape surgical training and competency-based assessment, including implications for autonomy, deliberate practice, and feedback frequency.
· Recognize future directions of digital surgery integration, including predictive analytics, simulation using patient-specific imaging, and AI-assisted intraoperative decision support.
References:
- Balvardi S, Semsar-Kazerooni K, Kaneva P, et al. Validity of video-based general and procedure-specific self-assessment tools for surgical trainees in laparoscopic cholecystectomy. Surg Endosc. 2023;37(3):2281-2289. doi:10.1007/s00464-022-09466-6 [https://pubmed.ncbi.nlm.nih.gov/36307525/]
- Hospital Utilizes Intraoperative Idle Time Metrics to Improve Surgical Safety and Efficiency. Theator | The Surgical Intelligence Company. Accessed March 20, 2026. https://theator.io/customer-story/hospital-utilizes-intraoperative-idle-time-metrics-to-improve-surgical-safety-and-efficiency/
- Campbell KK, Abreu AA, Zeh HJ, et al. Using OR Black Box Technology to Determine Quality Improvement Outcomes for In-situ Timeout and Debrief Simulation. Ann Surg. 2026;283(1):122. doi:10.1097/SLA.0000000000006438 [https://pubmed.ncbi.nlm.nih.gov/38317208/]
- Al Abbas AI, Meier J, Daniel W, et al. Impact of team performance on the surgical safety checklist on patient outcomes: an operating room black box analysis. Surg Endosc. 2024;38(10):5613-5622. doi:10.1007/s00464-024-11064-7 [https://pubmed.ncbi.nlm.nih.gov/39069926/]
- Proximie’s telepresence platform helps surgeons across the globe grow and exchange experience in real-time. World Health Expo Insights. Accessed March 20, 2026. https://www.worldhealthexpo.com/insights/telemedicine/proximie-s-telepresence-platform-helps-surgeons-across-the-globe-grow-and-exchange-experience-in-real-time
- Hassan AE, Desai SK, Georgiadis AL, Tekle WG. Augmented reality enhanced tele-proctoring platform to intraoperatively support a neuro-endovascular surgery fellow. Interv Neuroradiol. 2022;28(3):277-282. doi:10.1177/15910199211035304 [https://pubmed.ncbi.nlm.nih.gov/34538166/]
- SAGES Digital Surgery Working Group; Ali JT, Yang G, Green CA, Reed BL, Madani A, Ponsky TA, Hazey J, Rothenberg SS, Schlachta CM, Oleynikov D, Szoka N. Defining digital surgery: a SAGES white paper. Surg Endosc. 2024 Feb;38(2):475-487. doi: 10.1007/s00464-023-10551-7. Epub 2024 Jan 5. PMID: 38180541. [https://pubmed.ncbi.nlm.nih.gov/38180541/]
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
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EPA Playbook: https://behindtheknife.org/course/epa-playbook
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ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review
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Navigating the path to becoming a surgeon in the US as an International Medical Graduate (IMG) can definitely have its hurdles. In this episode we sit down with Professor of Surgery, Dr. Ourania Preventza about her journey as an IMG, and how to break down the barriers in one of the most competitive surgical subspecialties. Dr. Preventza teaches us why sponsorship is invaluable, and how we as a surgical community can help support this vulnerable group of providers. With years of experience to offer, both as an IMG herself, and now as a fierce advocate and mentor for trainees, this interview with Dr. Preventza is not one to miss.
References:
https://www.jtcvsopen.org/article/S2666-2736(25)00059-2/fulltext
The current landscape and challenges facing international medical graduates in cardiothoracic surgery training
https://pubmed.ncbi.nlm.nih.gov/39886768/
International Medical Graduates in Academic Cardiothoracic Surgery
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S2666273625002840?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2666273625002840%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F
A career in cardiothoracic surgery in the United States: Guidance and resources for international medical graduates
https://jtd.amegroups.org/article/view/38164/html
US women in Thoracic Surgery: Reflections on the Past and Opportunities for the Future
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Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review
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OBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-review
EPA Playbook: https://behindtheknife.org/course/epa-playbook
Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards
ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review
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Join our burn team as they dive into the complex world of skin substitutes in burn care, breaking down a practical four-axis framework to help clinicians navigate product selection, patient factors, and clinical goals when managing massive burn injuries.
Hosts:
- Kathleen Romanowski – University of California Davis Hospital, Shriners Hospital Sacramento
- Laura Johnson – Grady Memorial Hospital
- Lauren Nosanov – Grady Memorial Hospital
- Victoria Miles – Louisiana State University Health Science Center, University Medical Center New Orleans
Learning objectives:
1. Classify skin substitutes along four axes: layer replaced, cellularity, origin, and duration.
2. Integrate wound, patient, phase-of-care, and goal factors to select an appropriate skin substitute or combination strategy.
3. Critically appraise the evidence base for skin substitutes, including industry influence and the distinction between adjunctive tools and definitive autologous coverage.
If you would like the table mentioned in the episode, please email hello@behindtheknife.org.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium: https://behindtheknife.org/premium
Oral Board Review: https://behindtheknife.org/oral-board
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General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review
OBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-review
EPA Playbook: https://behindtheknife.org/course/epa-playbook
Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards
ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review
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In this episode of the Behind the Knife Global Surgery Series, we take a closer look at the real-world complexity of global surgery partnerships between high-income institutions and partners in the Global South. Words like equity, bidirectionality, partnership, and decolonization are used often in global surgery—but what do they actually mean when funding, mobility, research access, publication opportunities, and institutional power are unequally distributed?
Host Mike Mallah is joined by Dr. Hugo Stark from George Hospital in South Africa and Dr. Sydney Bertram from Emory for a candid discussion about the benefits and tensions of collaborations in an unequal world. Together, they explore how global surgery partnerships can create meaningful educational and clinical value, how good intentions can still reproduce unequal systems, and how surgeons can build partnerships that are locally useful, honest about power, and ultimately centered on better surgical care for patients.
Hosts/Guests:
-
Mike M. Mallah, MD, FACS, FICS
Director of Global Surgery at Medical University of South Carolina
@MikeMMallahMD
@MUSCGlobalSurg
mallahm@musc.edu -
Hugo Stark, MD
Head of Department - Surgery, George Hospital, Western Cape, South Africa
Head of Surgical Services, Central Karoo Region
Sydney Bertram, MD
General Surgery Resident, Emory University
Trainee Advisory Council, Consortium of Universities for Global Health
@Sydney_Bertram
Learning objectives:
• Describe how global surgery partnerships can provide educational, clinical, professional, and research value for both high-income and Global South partners.
• Identify how asymmetries in funding, mobility, publication access, and institutional agenda-setting can create inequity within otherwise well-intentioned global surgery partnerships.
• Discuss practical principles for ethical global surgery engagement, including centering local needs, avoiding extraction, building durable partnerships, and focusing on patient access to surgical decision-making.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
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Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review
OBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-review
EPA Playbook: https://behindtheknife.org/course/epa-playbook
Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards
ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review
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Immune checkpoint inhibitors have rapidly reshaped care for triple-negative breast cancer (TNBC)—but surgical teams increasingly encounter their downstream perioperative consequences. In this episode, we define immunotherapy through the lens of checkpoint biology, review the landmark evidence supporting pembrolizumab in metastatic PD‑L1–positive TNBC (KEYNOTE‑355) and curative-intent stage II–III TNBC (KEYNOTE‑522), and translate immune-related adverse events (irAEs) into practical periop recognition, triage, and timing decisions—especially for endocrine, pulmonary, hepatic, dermatologic, and GI toxicities.
Hosts:
- Rashmi Kumar, MD, PhD
Resident, University of Michigan General Surgery Residency Program
Twitter/X: @RashmiJKumar
- Melissa Pilewskie, MD
Attending Breast Surgical Oncologist, Co-Director of the Weiser Family Center for Breast Cancer, Michigan Medicine
Twitter/X: @MPilewskie
- Stephanie Downs-Canner, MD
Attending Breast Surgical Oncologist & Physician-Scientist, Memorial Sloan Kettering Cancer Center, Program Director of the Breast Surgical Oncology Fellowship Training Program
Twitter/X: @SDownsCanner
Learning Objectives:
- Define immunotherapy and immune checkpoint inhibition in breast cancer
- Summarize current clinical indications and pivotal evidence for pembrolizumab in TNBC
- Equip perioperative clinicians to identify and manage immune-related adverse events (irAEs) or side effects of immunotherapy.
Rationale for Immunotherapy in Breast Cancer Review* Selecting Triple Negative Breast Cancer Patients for Immunotherapy: https://pubmed.ncbi.nlm.nih.gov/37714640/
Landmark Clinical Trials Discussed in this Episode* KEYNOTE-355: https://pubmed.ncbi.nlm.nih.gov/33232653/ * KEYNOTE-522: https://pubmed.ncbi.nlm.nih.gov/33232642/ * IMpassion130: https://pubmed.ncbi.nlm.nih.gov/30345906/ * IMpassion131: https://pubmed.ncbi.nlm.nih.gov/33930478/
Assessment of Surgical Outcomes in patients receiving chemoimmunotherapy* Surgical outcomes after neoadjuvant chemoimmunotherapy in triple-negative breast cancer: https://pubmed.ncbi.nlm.nih.gov/38332314/
Immune Related Adverse Events and Management* Schneider BJ, et al. Management of immune-related adverse events: https://pubmed.ncbi.nlm.nih.gov/34724392/ * Brahmer JR, et al. SITC clinical practice guideline: https://pubmed.ncbi.nlm.nih.gov/34177534/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
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Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review
OBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-review
EPA Playbook: https://behindtheknife.org/course/epa-playbook
Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards
ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review
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Join our OHSY Hernia team to review the current landscape of bioresorbable meshes and a conversation considering “are they worth it?"
Hosts:
- Dr. Maggie Bosley - @MBosleyMD
- Dr. Sean Orenstein - @OrensteinSean
- Dr. Amber Sandoval
- Dr. Peter Ferrin
Institution: Oregon Health & Science University
References:
- Long-Term, Prospective, Multicenter Study of Poly-4-Hydroxybutyrate Mesh (Phasix Mesh) for Hernia Repair in Cohort at Risk for Complication: 60-Month Follow-Up
https://pubmed.ncbi.nlm.nih.gov/36102523/
- Multicenter, Prospective, Longitudinal Study of the Recurrence, Surgical Site Infection, and Quality of Life After Contaminated Ventral Hernia Repair Using Biosynthetic Absorbable Mesh: The COBRA Study
https://pubmed.ncbi.nlm.nih.gov/28009747/
- A prospective, multicenter trial of a long-term bioabsorbable mesh with Sepra technology in cohort of challenging laparoscopic ventral or incisional hernia repairs (ATLAS trial)
https://pubmed.ncbi.nlm.nih.gov/34976385/
- Biosynthetic mesh in hernia repair: A systematic review and meta-analysis
https://journals.lww.com/rhaw/fulltext/2024/07020/biosynthetic_mesh_in_hernia_repair__a_systematic.2.aspx
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
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Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review
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Circulating tumor DNA (ctDNA), a minimally invasive blood-based biomarker, has emerged as one of the most promising advances in cancer surveillance. Today, we will explore how ctDNA is transforming the management of colorectal cancer and anal squamous cell cancer across the disease continuum—from risk stratification and adjuvant therapy decision-making to surveillance and early detection of recurrence. Through landmark clinical trials, real-world applications, and emerging research, we will examine how ctDNA is helping move cancer care closer to the goal of truly personalized medicine.
Hosts:
· Dr. Janet Alvarez - General Surgery Resident at New York Medical College/Metropolitan Hospital Center
· Dr. Wini Zambare – General Surgery Resident at Weill Cornell Medical Center/New York Presbyterian
· Dr. Philip Bauer, Assistant Professor of Surgery, Division of Colon and Rectal Surgery, The Ohio State University Wexner Medical Center, Arthur G. James Cancer Hospital
· Dr. J. Joshua Smith MD, PhD, Chair, Department of Colon and Rectal Surgery at MD Anderson Cancer Center
Guests:
Dr. Paul Romessor
· Director of Colorectal and Anal Cancer, Department of Radiation Oncology
· Associate Attending Radiation Oncologist
Memorial Sloan Kettering Cancer Center
Dr. Jeanne Tie
· Medical Oncologist | Lower GI Unit
· Lower GI Research Lead
· Chair | Lower GI Working Party | GI Cancer Trials
Peter MacCallum Cancer Centre
Dr. Takayuki Yoshino
· Professor, Global Center of Research Excellence for Advanced Medicine (G-CORE),
Keio University School of Medicine
· Executive Advisor to Hospital East Director
· Director, Department of Global Oncology
· Chief, Department of Gastrointestinal Oncology
National Cancer Center Hospital East
Learning Objectives:
· Describe the biological basis and clinical applications of circulating tumor DNA (ctDNA) as a biomarker of minimal residual disease (MRD) in colorectal cancer.
· Interpret the prognostic significance of postoperative and longitudinal ctDNA testing and its role in predicting recurrence risk across stages of colorectal cancer.
· Evaluate evidence from landmark clinical trials, including DYNAMIC and GALAXY, supporting ctDNA-guided treatment de-escalation and escalation strategies in colorectal cancer.
· Discuss emerging applications of ctDNA monitoring in personalized cancer care, including surveillance, treatment response assessment, and future clinical trial directions.
References:
· Ando, K. et al. (2026). Molecular Residual Disease and Recurrence in Rectal Cancer Patients Undergoing Upfront Surgery: A Prospective Cohort Study. Annals of Surgery. https://pubmed.ncbi.nlm.nih.gov/39854721/ (Note: If direct access is limited, the article is available via PMC: PMC12695342)
· Romesser, P. B. et al. (2026). Tumor-informed circulating tumor DNA stratifies recurrence risk and survival in anal squamous cell carcinoma. Nature Communications. https://pubmed.ncbi.nlm.nih.gov/38347209/
· Tie, J. et al. (2025). Circulating tumor DNA analysis guiding adjuvant therapy in stage II colon cancer: 5-year outcomes of the randomized DYNAMIC trial. Nature Medicine. https://pubmed.ncbi.nlm.nih.gov/39943485/
· Tie, J. et al. (2025). Circulating tumor DNA-guided adjuvant therapy in locally advanced colon cancer: the randomized phase 2/3 DYNAMIC-III trial. Nature Medicine. https://pubmed.ncbi.nlm.nih.gov/39974258/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
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Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review
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Every spring for over 50 years, the Trauma, Critical Care, and Acute Care Surgery conference, best known simply as the MATTOX conference, is held in Las Vegas (https://www.trauma-criticalcare.com/). The conference is unique in that it is entirely focused on practice-changing clinical education. It’s a damn good time too! A favorite feature is the annual debates. Today, we are featuring a showdown between Drs. Bryan A. Cotton, MD, MPH and Marty A. Schreiber, MD, FACS, FCCM, FCRST (Hon), COL, MC, USAR as they debate REBOA as a Life-Saving Intervention in Hemorrhagic Shock. You can listen on the podcast or watch the debate with accompanying slides on our website or app. Let's get ready to RUMMMBLLLEEEE!
TRAUMA SURGERY VIDEO ATLAS: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Preparing for the deadliest injuries is challenging, and currently available resources are limited. That is why we created the Behind the Knife Trauma Surgery Video Atlas. Be ready for the most complex injuries, like penetrating trauma to the neck, audible bleeding from the IVC, and pelvic hemorrhage, with 24 scenarios.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
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Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review
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Every spring for over 50 years, the Trauma, Critical Care, and Acute Care Surgery conference, best known simply as the MATTOX conference, is held in Las Vegas (https://www.trauma-criticalcare.com/). The conference is unique in that it is entirely focused on practice-changing clinical education. It’s a damn good time too! A favorite feature is the annual debates. Today, we are featuring a showdown between Drs. Carlos V.R. Brown, MD, FACS and Katie W. Russell, MD as they debate WHETHER OR NOT PEDIATRIC PANCREATIC INJURIES CAN BE MANAGED NON-OPERATIVELY. You can listen on the podcast or watch the debate with accompanying slides on our website or app. Let's get ready to RUMMMBLLLEEEE!
TRAUMA SURGERY VIDEO ATLAS: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Preparing for the deadliest injuries is challenging, and currently available resources are limited. That is why we created the Behind the Knife Trauma Surgery Video Atlas. Be ready for the most complex injuries, like penetrating trauma to the neck, audible bleeding from the IVC, and pelvic hemorrhage, with 24 scenarios.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium: https://behindtheknife.org/premium
Oral Board Review: https://behindtheknife.org/oral-board
Oral Board Simulator: https://behindtheknife.org/oral-board/simulator
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review
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Join us as we discuss research on mental health and wellbeing in the surgical workforce with Drs. Yang and Collins. The episode explores key findings from recent national surveys showing that nearly one in seven surgeons report suicidal ideation in the past year, with depression, anxiety, and PTSD affecting 15–20% of the surgical population. The conversation highlights protective factors—professional fulfillment, resilience, self-valuation, and connection—while distinguishing between healthy resilience and normalized suffering. Dr. Yang and Dr. Collins discuss systemic barriers including time constraints, out-of-pocket mental health costs, and persistent stigma, alongside actionable institutional interventions: protecting dedicated wellbeing time, establishing peer support and psychological first aid programs, ensuring free mental health access, and expanding research to understand what helps surgeons thrive. The episode emphasizes that self-care is essential to patient safety and invites listeners to become advocates, engage with the literature, and help drive culture change within their institutions. For more information about the AAS wellbeing survey, please email Dr. Yang at CJYANG@MGH.HARVARD.EDU.
Host:
- Steven Thornton, MD (General Surgery Resident at Duke University)
- Agnes Premkumar (General Surgery Resident at Creighton)
Guests:1. Jeff Yang, MD (Massachusetts General Hospital) 2. Reagan Collins, MD (University of Pennsylvania)
Publications Discussed:1. Hughes TM, Collins RA, Cunningham CE. Depression and Suicide Among American Surgeons-A Grave Threat to the Surgeon Workforce. JAMA Surg. 2024 Jan 1;159(1):7-8. doi: 10.1001/jamasurg.2023.4658. PMID: 37792380. [https://pubmed.ncbi.nlm.nih.gov/37792380/] 2. Collins RA, Herman T, Snyder RA, Haines KL, Stey A, Arora TK, Geevarghese SK, Phillips JD, Vicente D, Griggs CL, McElroy IE, Wall AE, Hughes TM, Sen S, Valinejad J, Alban A, Swan JS, Mercaldo N, Jalali MS, Chhatwal J, Gazelle GS, Rangel E, Yang CJ, Donelan K, Gold JA, West CP, Cunningham C. Unspoken Truths: Mental Health Among Academic Surgeons. Ann Surg. 2024 Mar 1;279(3):429-436. doi: 10.1097/SLA.0000000000006159. Epub 2023 Nov 23. PMID: 37991182. [https://pubmed.ncbi.nlm.nih.gov/37991182/] 3. Yaghmour NA, Bynum WE 4th, Hafferty FW, Könings KD, Richter T, Brigham TP, Nasca TJ. Causes of Death Among US Medical Residents. JAMA Netw Open. 2025 May 1;8(5):e259238. doi: 10.1001/jamanetworkopen.2025.9238. Erratum in: JAMA Netw Open. 2025 Jul 1;8(7):e2523489. doi: 10.1001/jamanetworkopen.2025.23489. PMID: 40366660; PMCID: PMC12079293. [https://pubmed.ncbi.nlm.nih.gov/40366660/] 4. Nasca BJ, Hunt ML, Ramirez RT, Eng JS, Li RD, Agarwal G, Bilimoria KY, Hu YY. One is too many: suicidality among general surgery residents. Acad Med. 2025 Dec 24:wvaf105. doi: 10.1093/acamed/wvaf105. Epub ahead of print. PMID: 41819820. [https://pubmed.ncbi.nlm.nih.gov/41819820/]
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium: https://behindtheknife.org/premium
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Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review
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INTRODUCING Behind the Knife OBGYN Oral Board Review!
The oral boards aren't just about knowledge—they are about executing under pressure. This course is designed to give you the structure and confidence to command the room. We have curated 98 high-yield scenarios covering the "Big Three" of the exam: Obstetrics, Gynecology, and Office Practice. Whether it’s a surgical emergency or a complex clinic workup, we will walk you through exactly how to articulate your plan, defend your decisions, and pass this exam.
Each scenario includes 2 parts. The first part is a perfectly executed scenario. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Please check out the preview episodes below that include Parts A and B, with and without commentary.
This course includes access to our Oral Board Simulator. Step into the hot seat and experience the pressure of the real exam and receive detailed, actionable feedback with the most advanced oral board prep available.
- 3-Month Purchase - 10 exams
- 6-Month Purchase - 22 exams
- 12-Month Purchase - 46 exams
Learn More: https://behindtheknife.org/premium/obgyn-oral-board-review
DOMINATE THE DAY!
Join Drs. Georgoff, Burke, and Premkumar in this episode of the EPA Playbook as they break down a practical, repeatable framework for managing patients in the trauma bay, one of the most high-pressure environments in surgical training. This episode focuses on the critical first minutes of evaluation, anchored in a structured primary survey. We emphasize how to recognize and immediately address life-threatening injuries, while maintaining situational awareness and clear communication with your team. From airway and hemorrhage control to adjuncts like FAST and early imaging, we highlight what matters most when time is critical.
***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbook
Simply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.
For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/.
BTK Resources:
Trauma Video Playlist (FAST, How to Read a CT, and more!)
https://behindtheknife.org/video-playlists/trauma-videos
Big T Trauma Podcasts
https://behindtheknife.org/podcast-series/big-t-trauma
Trauma Surgery Video Atlas (Premium)
https://behindtheknife.org/premium/trauma-surgery-video-atlas
Join Drs. Georgoff, Burke, and Premkumar in this episode of EPA Playbook, where we tackle the evaluation and management of small bowel obstruction. Through a realistic series of scenarios, we walk step-by-step through how junior residents can approach this diagnosis using an evidence-based approach.
We break down the key components of the small bowel obstruction EPA, from rapid initial assessment and focused physical exam to early resuscitation, recognizing when to go straight to the OR, and post-operative care. Along the way, we highlight critical teaching points you’ll actually use on call. Whether you’re a new intern or an early resident looking to build confidence, this episode is designed to help you act decisively and move one step closer to entrustment.
***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbook
Simply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.
For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/.
BTK Resources:
Nasogastric Tube (NGT) Management Video
https://behindtheknife.org/video/behind-the-knife-nasogastric-tube-ngt-management
Nasogastric Tube (NGT) Placement Video
https://behindtheknife.org/video/behind-the-knife-nasogastric-tube-ngt-placement
Ostomy Marking Video
https://behindtheknife.org/video/behind-the-knife-ostomy-marking
How to Change an Ostomy Appliance Video
https://behindtheknife.org/video/behind-the-knife-how-to-change-an-ostomy-appliance
How to Manage a Challenging Ostomy Video
https://behindtheknife.org/video/behind-the-knife-how-to-manage-a-challenging-ostomy
Cited Studies:
- National prospective cohort study of the burden of acute small bowel obstruction https://doi.org/10.1002/bjs5.50136
- Management and short-term outcomes of patients with small bowel obstruction in Denmark: a multicentre prospective cohort study https://doi.org/10.1007/s00068-022-02171-y
- Multi-institutional, prospective, observational study comparing the Gastrografin challenge versus standard treatment in adhesive small bowel obstruction https://doi.org/10.1097/ta.0000000000001499
- Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline https://doi.org/10.1097/ta.0b013e31827019de
In this episode of EPA Playbook, Drs. Jason Bingham, Emma Burke, and Agnes Premkumar discuss the evaluation and management of inguinal hernias through a case-based approach that reinforces key EPA concepts for surgical trainees. We specifically highlight the importance of a thorough history and physical exam, emphasize risk stratification, and indications for surgery versus watchful waiting. We briefly review a few postoperative considerations as well.
***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbook
Simply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.
For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/.
Cited studies:
Miserez M, et al. "Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients." Hernia. 2014;18(2):151-163. PubMed ID: 24504225
Carrick MA, et al. "Smoking and anaesthesia." BJA Educ. 2019;19(1):1-6. PubMed ID: 33456860
Amid PK, et al. "Local anesthesia for inguinal hernia repair step-by-step procedure." Ann Surg. 1994;220(6):735-737. PubMed ID: 7979603
Huy TC, et al. "Reoperation for chronic postoperative inguinal pain." JAMA Surg. 2025;160(9):984-991. PubMed ID: 39855588
In this episode of EPA Playbook, Drs. Kevin Kniery, Emma Burke, and Agnes Premkumar discuss management of critically ill surgical patients, using case-based discussions to reinforce core principles of shock, resuscitation, and ICU care. We first review the four major types of shock. We then discuss two cases centered around managing a patient in septic shock and cardiogenic shock, delving into the nuances on how management differs between the two. Additionally, we underscore a physiology-driven approach to critical care, the importance of multidisciplinary collaboration, and the need to align treatment decisions with patient goals and values.
***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbook
Simply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.
For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/.
Join Drs. Steele, Burke, & Premkumar in this episode of EPA Playbook, where we tackle a core general surgery EPA: the evaluation and management of benign and malignant colon disease. From common presentations like diverticulitis and lower GI bleeding to the diagnosis and workup of colon cancer, this episode provides a structured framework you can use on the wards, in clinic, and on call. Using case-based discussions, we walk through how to distinguishing benign from malignant processes, selecting appropriate imaging and endoscopy, and recognizing when a patient needs urgent intervention versus outpatient workup. We also cover key principles of colon cancer management, including staging, surgical planning, and multidisciplinary care, alongside high-yield management of benign conditions.
***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbook
Simply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.
For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/.
Cited Studies:
Gustafsson, U.O., Scott, M.J., Hubner, M. et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg 43, 659–695 (2019). https://doi.org/10.1007/s00268-018-4844-y
BTK Resources:
Ostomy Marking Video
https://behindtheknife.org/video/behind-the-knife-ostomy-marking
How to Change an Ostomy Appliance Video
https://behindtheknife.org/video/behind-the-knife-how-to-change-an-ostomy-appliance
How to Manage a Challenging Ostomy Video
https://behindtheknife.org/video/behind-the-knife-how-to-manage-a-challenging-ostomy
Two years into the EPA era — are we actually training surgeons differently, or just checking new boxes? In this episode, Behind the Knife co-director and Duke Trauma Surgeon Dr. Patrick Georgoff and Behind the Knife surgical education fellows Dr. Agnes Premkumar and Dr. Emma Burke sit down with Dr. Ruchi Thanawala, thoracic surgeon at OHSU, informatician, and founder of Firefly Labs, to get an honest look at the state of competency-based surgical education. We dig into why surgery is uniquely hard to assess, what the data are actually showing (spoiler: significant skewing, and we're not ready to make promotion decisions off it yet), and why collecting assessments is only 25% of the work. If you've ever wondered whether EPAs are moving the needle or just adding noise, this one's for you
***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbook
Simply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium: https://behindtheknife.org/premium
Oral Board Review: https://behindtheknife.org/oral-board
Oral Board Simulator: https://behindtheknife.org/oral-board/simulator
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review
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In this episode, we use the recent SAGES guidelines to tackle one of the most common and controversial questions in general surgery. Through a case-based discussion, our experts review the evidence for intraoperative biliary imaging, discuss strategies for difficult anatomy, and compare IOC with other imaging modalities. Join us as we translate the latest recommendations into practical lessons that can be applied in the operating room.
Take Home Points:
- Routine IOC is supported; however, this remains a conditional recommendation that should be individualized based on anatomy, surgeon experience, and available resources.
- Use a selective approach to IOC in special populations, including pediatric and pregnant patients, where risks and benefits may differ.
- Alternative imaging modalities including ICG fluorescence and laparoscopic ultrasound have complementary roles.
- Routine IOC may help maintain surgeon and team proficiency, and trainees should learn both IOC performance and interpretation
Hosts: * Jason Bingham, MD – General and Bariatric Surgeon * Nicole L. Petcka, MD, MHPE – General Surgery Resident at Emory University
Guests: * Emily Miraflor, MD – General and Colorectal Surgeon at UCSF East Bay, Senior Author on the SAGES Guidelines * Kevin El-Hayek, MD - HPB and Foregut Surgeon at MetroHealth and Professor of Surgery at Case Western Reserve School of Medicine, Chair of the SAGES HPB/Solid Organ Committee * Dena Shehata, MD - SAGES Guideline Fellow, Co-first author on the SAGES Guidelines
Resources:
Kumar, S. K., Shehata, D. G., Cetrulo, L. N., Ignacio, R., Chiu, J., Davis, B. R., McDonald, M., Bloom, M. B., Ayloo, S., Kchaou, A., Orthopoulos, G., Pucher, P. H., Oliphant, U., Hallowell, P. T., Serrot, F., Overby, D., Moreno-Paquentin, E., Slater, B. J., & Miraflor, E. (2025). SAGES guidelines for the use of intraoperative imaging of the common bile duct. Surgical endoscopy, 39(11), 7091–7102. https://doi.org/10.1007/s00464-025-12142-0
SAGES Safe Cholecystectomy Program -
https://www.sages.org/safe-cholecystectomy-program/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium: https://behindtheknife.org/premium
Oral Board Review: https://behindtheknife.org/oral-board
Oral Board Simulator: https://behindtheknife.org/oral-board/simulator
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review
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Join our Hernia Team for a review of the current controversy around preoperative optimization and the practical implications.
Hosts:
- Dr. Maggie Bosley - @MBosleyMD
- Dr. Sean Orenstein - @OrensteinSean
- Dr. Amber Sandoval
- Dr. Peter Ferrin
Institution: Oregon Health & Science University
References:
Adverse Events after Ventral Hernia Repair: The Vicious Cycle of Complications
https://pubmed.ncbi.nlm.nih.gov/26206646/
Risk factors for postoperative wound infections and prolonged hospitalization after ventral/incisional hernia repair
https://pubmed.ncbi.nlm.nih.gov/24030572/
lack of association between glycated hemoglobin and adverse outcomes in diabetic patients undergoing ventral hernia repair: an ACHQC study
https://pubmed.ncbi.nlm.nih.gov/35969297/
Impact of preoperative haemoglobin A1c levels on postoperative outcomes in adults undergoing major noncardiac surgery: A systematic review
https://pubmed.ncbi.nlm.nih.gov/38853752/
Does active smoking really matter before ventral hernia repair? An AHSQC analysis
https://pubmed.ncbi.nlm.nih.gov/30220485/
Abstinence from smoking reduces incisional wound infection: a randomized controlled trial
https://pubmed.ncbi.nlm.nih.gov/12832959/
The Association of Nicotine Replacement Therapy With Outcomes Among Smokers Hospitalized for a Major Surgical Procedure
https://pubmed.ncbi.nlm.nih.gov/31790653/
Is weight trajectory a better marker of wound complication risk than BMI in hernia patients with obesity?
https://pubmed.ncbi.nlm.nih.gov/38082008/
Gender, racial, and socioeconomic disparity of preoperative optimization goals in ventral hernia repair
https://pubmed.ncbi.nlm.nih.gov/37658198/
Limited or Lasting: Is Preoperative Weight Loss as Part of Prehabilitation Maintained after Open Ventral Hernia Repair?
https://pubmed.ncbi.nlm.nih.gov/39907236/
The impact of preoperative optimization for abdominal wall reconstruction on long-term glucose control and smoking cessation
https://pubmed.ncbi.nlm.nih.gov/40739418/
Watchful waiting as a treatment strategy for patients with a ventral hernia appears to be safe
https://pubmed.ncbi.nlm.nih.gov/26838293/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium: https://behindtheknife.org/premium
Oral Board Review: https://behindtheknife.org/oral-board
Oral Board Simulator: https://behindtheknife.org/oral-board/simulator
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review
Download our App:
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As colorectal cancer rates rise among younger adults, surgeons are increasingly caring for patients with rectal cancer who are pregnant or hoping to preserve future fertility. With more individuals delaying childbearing, balancing effective cancer treatment with fertility preservation and maternal–fetal safety has become an important clinical challenge. This timely topic was recently highlighted by Dr. Sharon Suwanabol during a presentation at the American Society of Colon and Rectal Surgeons annual meeting 2026.
In this episode, we explore the intersection of rectal cancer, fertility, and pregnancy through a multidisciplinary, case-based discussion. We review how surgery, chemotherapy, and pelvic radiation can affect fertility and sexual function in both men and women, and why early counseling and referral to reproductive endocrinology specialists are essential. The discussion also emphasizes that evaluation and treatment during pregnancy can often be performed safely, with care individualized based on tumor stage, gestational age, and the patient’s goals and values.
Hosts and discussants
· Dr. Betelhem Yohannes, General surgery resident at the University of Washington
· Dr. Griffen Allen, General surgery resident at the University of Washington
· Dr. Raga Siddharthan, Assistant Professor of Surgery in the Section of Colorectal Surgery at the University of Washington
· Dr. Stacey Cohen, Professor in the Division of Hematology and Oncology at the University of Washington and a gastrointestinal medical oncologist at Fred Hutch Cancer Center, specializing in colorectal and other GI cancers.
Learning objectives
· Describe the impact of rectal cancer surgery on fertility, sexual function, and future childbearing potential.
· Review the effects of chemotherapy and pelvic radiation on reproductive health and fertility preservation.
· Discuss available fertility preservation strategies and the importance of early pre-treatment counseling and referral.
· Recognize the diagnostic challenges of rectal cancer during pregnancy, including overlapping gastrointestinal symptoms.
· Review appropriate staging and workup considerations for suspected rectal cancer in pregnant patients.
· Discuss multidisciplinary management strategies for rectal cancer during pregnancy, including individualized treatment sequencing.
· Examine ethical and patient-centered considerations when balancing maternal cancer treatment and fetal outcomes.
References * Siegel RL, Wagle NS, Star J, Kratzer TB, Smith RA, Jemal A. Colorectal cancer statistics, 2026. CA Cancer J Clin. 2026;76(2):e70067. doi:10.3322/caac.70067 [https://pubmed.ncbi.nlm.nih.gov/38240409/]
* Pregnancy at Age 35 Years or Older: ACOG Obstetric Care Consensus No. 11. Obstet Gynecol. 2022;140(2):348-366. doi:10.1097/AOG.0000000000004873 [https://pubmed.ncbi.nlm.nih.gov/35640237/]
* Stal J, YI SY, Cohen-Cutler S, et al. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist. 2022;27(7):579-586. doi:10.1093/oncolo/oyac052 [https://pubmed.ncbi.nlm.nih.gov/35708892/]
* Druvefors E, Myrelid P, Andersson RE, Landerholm K. Female and Male Fertility after Colectomy and Reconstructive Surgery in Inflammatory Bowel Disease: A National Cohort Study from Sweden. J Crohns Colitis. 2023;17(10):1631-1638. doi:10.1093/ecco-jcc/jjad079 [https://pubmed.ncbi.nlm.nih.gov/37341355/]
* Ito M, Tsukada Y, Watanabe J, et al. Long-term survival and functional outcomes of laparoscopic surgery for clinical stage I ultra-low rectal cancers located within 5 cm of the anal verge: A prospective phase II trial (Ultimate trial). Ann Surg. Published online April 1, 2024. doi:10.1097/SLA.0000000000006290 [https://pubmed.ncbi.nlm.nih.gov/38629555/]
* Teh WT, Stern C, Chander S, Hickey M. The impact of uterine radiation on subsequent fertility and pregnancy outcomes. Biomed Res Int. 2014;2014:482968.
* Johnson GGRJ, Park J, Helewa RM, Goldenberg BA, Nashed M, Hyun E. Total neoadjuvant therapy for rectal cancer: a guide for surgeons. Can J Surg. 2023 Apr 21;66(2):E196-E201. doi: 10.1503/cjs.005822. PMID: 37085291; PMCID: PMC10125160. [https://pubmed.ncbi.nlm.nih.gov/37085291/]
* Naren G, Guo J, Bai Q, Fan N, Nashun B. Reproductive and developmental toxicities of 5-fluorouracil in model organisms and humans. Expert Rev Mol Med. 2022 Jan 31;24:e9. doi: 10.1017/erm.2022.3. PMID: 35098910; PMCID: PMC9884763. [https://pubmed.ncbi.nlm.nih.gov/35098910/]
* National Comprehensive Cancer Network. (2026). NCCN Clinical Practice Guidelines in Oncology: Rectal Cancer (Version 2.2026). Retrieved from NCCN Guidelines for Rectal Cancer [https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1449]
* Oktay, Kutluk M.D., Ph.D.. Expert Commentary on Fertility Preservation in Colorectal Cancers: Current State and Practical Tips for the Cancer Practitioner. Diseases of the Colon & Rectum 63(6):p 726-727, June 2020. | DOI: 10.1097/DCR.0000000000001688 [https://pubmed.ncbi.nlm.nih.gov/32479532/]
* Stal J, YI SY, Cohen-Cutler S, et al. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist. 2022;27(7):579-586. doi:10.1093/oncolo/oyac052 [https://pubmed.ncbi.nlm.nih.gov/35708892/]
* Gentile G, Ciccarone M. Management of fertility preservation in young female patients with gastrointestinal cancer: A case series and systematic literature review. Curr Probl Cancer. 2025;57:101221. doi:10.1016/j.currproblcancer.2025.101221 [https://pubmed.ncbi.nlm.nih.gov/39598263/]
* Saif MW. Management of colorectal cancer in pregnancy: a multimodality approach. Clin Colorectal Cancer. 2005;5(4):247-256. doi:10.3816/ccc.2005.n.035 [https://pubmed.ncbi.nlm.nih.gov/16183863/]
* Rogers JE, Dasari A, Eng C. The Treatment of Colorectal Cancer During Pregnancy: Cytotoxic Chemotherapy and Targeted Therapy Challenges. Oncologist. 2016 May;21(5):563-70. doi: 10.1634/theoncologist.2015-0362. Epub 2016 Mar 21. PMID: 27000464; PMCID: PMC4861360. [https://pubmed.ncbi.nlm.nih.gov/27000464/]
* Jiang Q, Hua H. Fertility in young-onset colorectal patients with cancer: a review. Oncologist. 2024;29(10):e1237-e1245. doi:10.1093/oncolo/oyae141 [https://pubmed.ncbi.nlm.nih.gov/39292850/]
* Dolmans MM, Hollanders de Ouderaen S, Demylle D, Pirard C. Utilization rates and results of long-term embryo cryopreservation before gonadotoxic treatment. J Assist Reprod Genet. 2015;32(8):1233-1237. doi:10.1007/s10815-015-0533-z [https://pubmed.ncbi.nlm.nih.gov/26162569/
* Moawad NS, Santamaria E, Rhoton-Vlasak A, Lightsey JL. Laparoscopic Ovarian Transposition Before Pelvic Cancer Treatment: Ovarian Function and Fertility Preservation. J Minim Invasive Gynecol. 2017;24(1):28-35. doi:10.1016/j.jmig.2016.08.831 [https://pubmed.ncbi.nlm.nih.gov/27599763/]
* Fish R. Ovarian transposition in rectal cancer: uncertain benefit at a high price. Colorectal Dis. 2022;24(6):706-707. doi:10.1111/codi.16086 [https://pubmed.ncbi.nlm.nih.gov/35191146/]
* Ribeiro R, Baiocchi G, Moretti-Marques R, Linhares JC, Costa CN, Pareja R. Uterine transposition for fertility and ovarian function preservation after radiotherapy. Int J Gynecol Cancer. 2023;33(12):1837-1842. Published 2023 Dec 4. doi:10.1136/ijgc-2023-004723 [https://pubmed.ncbi.nlm.nih.gov/38104863/]
* Haggar F, Pereira G, Preen D, et al. Maternal and neonatal outcomes in pregnancies following colorectal cancer. Surg Endosc. 2013;27(7):2327-2336. doi:10.1007/s00464-012-2774-6 [https://pubmed.ncbi.nlm.nih.gov/23645367/]
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Why do millions of patients qualify for bariatric surgery, yet only a fraction ever make it to the operating room?
Hosts
· Matthew Martin, trauma and bariatric surgeon at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California)
· Adrian Dan, bariatric and MIS surgeon, program director for the advanced MIS bariatric and foregut fellowship at Summa Health System (Akron, Ohio)
· Crystal Johnson Mann, bariatric and foregut surgeon at the University of Florida (Gainesville, Florida)
· Katherine Cironi, general surgery resident at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California)
Learning objectives:
This episode explores disparities in access to bariatric surgery through three key studies examining eligibility, referral patterns, and weight stigma.
References:
- Article #1: Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis (2010, Martin et al.) https://pubmed.ncbi.nlm.nih.gov/19782647/
- Analyzed national U.S. datasets to compare patients eligible for bariatric surgery with those who underwent surgery.
- Although more than 22 million Americans met criteria for bariatric surgery, only about 0.4% underwent surgery in 2006.
- Patients eligible for surgery were more likely to be female, uninsured, lower income, and from racial and ethnic minority groups, while those receiving surgery were disproportionately Caucasian women with private insurance.
- This discussion highlights insurance coverage as one of the largest structural barriers to care.
- Article #2: Investigating racial disparities in bariatric surgery referrals (2019, Johnson-Mann et al.) https://pubmed.ncbi.nlm.nih.gov/30824334/
- This study focused on referral patterns within a primary care network.
- Among nearly 4,700 eligible patients, only 5% were referred to bariatric surgery.
- Referral disparities were seen across sex, ethnicity, and insurance status.
- Hispanic patients were significantly less likely to be referred and were far more likely to be uninsured or self-pay.
- The study emphasizes that disparities begin long before the operating room, often at the level of primary care referral and institutional access policies.
- Article #3: Assessing Weight Stigma Interventions: A Systematic Review of Randomized Controlled Trials (2025, Wang et al.) https://pubmed.ncbi.nlm.nih.gov/40227369/
- Examined interventions designed to reduce weight stigma.
- Across 56 randomized controlled trials, most interventions demonstrated improvements in attitudes toward obesity.
- Effective approaches included emphasizing the biologic and environmental causes of obesity, promoting weight-inclusive healthcare, fostering empathy through shared narratives, and using cognitive dissonance strategies to challenge implicit bias.
- However, changing attitudes does not necessarily translate into improved clinical behavior or patient outcomes.
Together, these studies demonstrate that disparities in bariatric surgery occur at multiple stages: eligibility, referral, access, and treatment. Structural barriers, provider bias, insurance limitations, and societal stigma all contribute to inequitable care. Herein, we emphasize the importance of expanding access pathways, improving provider education, and actively reducing weight stigma to ensure equitable surgical care for all eligible patients.
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Prehospital blood is one of the hottest debates in trauma resuscitation — and the evidence just got a lot more interesting. In this episode, Drs. Patrick Georgoff and Ayman Ali sit down with Dr. Ed Barnard, UK defense professor of emergency medicine and author of the landmark SWIFT trial, and Dr. Juan De Chesney, trauma surgeon and pioneer in prehospital blood programs, to break down what we actually know about getting blood to patients before they hit the doors. The SWIFT trial — the largest prehospital whole blood RCT to date — found no superiority of whole blood over component therapy, but the story is far more nuanced than a negative headline suggests. From the logistics of carrying blood on a helicopter to the stark reality that only 1.8% of US ground EMS carries any blood products at all, this conversation exposes both the progress and the enormous gaps that remain.
Hosts:
- Ayman Ali, MD: Ayman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital.
- Patrick Georgoff, MD @georgoff: Patrick Georgoff is faculty in the Department of Surgery at the Duke University School of Medicine where he serves as an Associate Professor of Trauma, Acute, and Critical Care Surgery and Trauma Medical Director. He is a leading educator and creator for Behind the Knife, a premier digital education platform and podcast advancing surgical training through innovative, high-yield multimedia content.
- Juan Duchesne, MD: Juan Duchesne is a trauma surgeon and Professor of Surgery serving as the Trauma Medical Director and Division Chief at the University of Mississippi Medical Center. His pioneering contributions to the field—particularly in whole blood and balanced resuscitation practices—have been honored with numerous accolades.
- Ed Barnard, PhD FRCEM FIMC RCSEd, @edbarn @DefProfEM: Ed Barnard is an emergency physician and UK Defence Professor of Emergency Medicine, RCEM/NIHR Associate Professor, and Affiliated Assistant Professor at the University of Cambridge. He has sub-specialty training in pre-hospital and academic emergency medicine and possesses extensive experience in trauma, anaesthesia, and critical care across both civilian and military settings. His contributions to the field have been honored with five national research awards and a PhD - undertaken with the US Army in San Antonio, TX.
This episode was sponsored by Teleflex, a global provider of medical devices. Learn more at teleflex.com and at the Teleflex Trauma and Emergency Medicine LinkedIn page.
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Join the Behind the Knife Surgical Oncology Team as we discuss clinical challenges through case-based examples including the diagnosis, workup, and management of patients with cutaneous melanoma.
Learning Objectives:
In this episode, we review the workup and management of patients with cutaneous melanoma and both microscopic and macroscopic nodal disease.
References used in the making of this episode:
- Reijers, I.L.M., Menzies, A.M., van Akkooi, A.C.J. et al. Personalized response-directed surgery and adjuvant therapy after neoadjuvant ipilimumab and nivolumab in high-risk stage III melanoma: the PRADO trial. Nat Med 28, 1178–1188 (2022). https://doi.org/10.1038/s41591-022-01851-x
- Christian U. Blank et al. Neoadjuvant nivolumab plus ipilimumab versus adjuvant nivolumab in macroscopic, resectable stage III melanoma: The phase 3 NADINA trial.. J Clin Oncol 42, LBA2-LBA2(2024). DOI:10.1200/JCO.2024.42.17_suppl.LBA2
- Faries MB, Thompson JF, Cochran AJ, et al. Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. N Engl J Med. 2017;376(23):2211-2222. doi:10.1056/NEJMoa1613210 https://pubmed.ncbi.nlm.nih.gov/28591523/
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Cutaneous Melanoma. Version 1.2026. Accessed April 8, 2026. NCCN Guidelines PDF
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A 25-year-old pregnant woman presents with a 1-day history of progressive pain and swelling. The foot is cold, pulseless and neurologic function is deteriorating by the hour. Imaging shows a massive iliofemoral DVT. Now both the limb and the pregnancy are threatened. Do you anticoagulate, thrombolyse or operate? Join us as we break down the management and decision making behind this rare but devastating case.
Hosts:
· Christian Hadeed -PGY 4 General Surgery, Brookdale Hospital Medical Center
· Paul Haser -Division Chief, Vascular Surgery, Brookdale Hospital Medical Center
· Andrew Harrington, Vascular surgery, Brookdale Hospital Medical Center
· Lucio Flores, Vascular surgery, Brookdale Hospital Medical Center
Learning objectives:
- Recognize the clinical presentation and pathophysiology of phlegmasia cerulea dolens
- Describe how pregnancy affects decision making in patients with phlegmasia and venous thromboembolic disease
- Discuss the goals of treatment for patients with DVT’s and identify when operative intervention is indicated
- Describe the sequelae of DVT’s and how this relates to post thrombotic syndrome
- Review the indications, risks, and limitations of anticoagulation, catheter-directed thrombolysis, thrombectomy, and fasciotomy in the management of DVT and phlegmasia.
- Explain the role of IVUS in managing venous thromboembolic disease and May Thurner syndrome
References:
-
Vedantham, S., Goldhaber, S. Z., Julian, J. A., Kahn, S. R., Jaff, M. R., Cohen, D. J., Magnuson, E., Razavi, M. K., Comerota, A. J., Gornik, H. L., Murphy, T. P., Lewis, L., Duncan, J. R., Nieters, P., Derfler, M. C., Filion, M., Gu, C.-S., Kee, S., Schneider, J., … Kearon, C. (2017). Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. New England Journal of Medicine, 377(23), 2240–2252. https://doi.org/10.1056/NEJMoa1615066
-
Gomes, M. S., Guimarães, M., & Montenegro, N. (2019). Thrombolysis in pregnancy: A literature review. Journal of Maternal-Fetal & Neonatal Medicine, 32(14), 2418–2428. https://doi.org/10.1080/14767058.2018.1438402
-
Mangla, A., & Hamad, H. (2023). May-Thurner syndrome. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554377/
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Bates, S. M., Rajasekhar, A., Middeldorp, S., McLintock, C., Rodger, M. A., James, A. H., et al. (2018). American Society of Hematology 2018 guidelines for management of venous thromboembolism: Venous thromboembolism in the context of pregnancy. Blood Advances, 2(22), 3317–3359. https://doi.org/10.1182/bloodadvances.2018024802
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Kahn, S. R., Comerota, A. J., Cushman, M., Evans, N. S., Ginsberg, J. S., Goldenberg, N. A., et al. (2014). The postthrombotic syndrome: Evidence-based prevention, diagnosis, and treatment strategies. Circulation, 130(18), 1636–1661. https://doi.org/10.1161/CIR.0000000000000130 https://pubmed.ncbi.nlm.nih.gov/25246013/
Sponsor URL: https://www.goremedical.com/
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Get a behind-the-scenes look at one of the most anticipated sessions from the Association of Surgeons of Great Britain and Ireland Annual Conference: “Bad Day on Call.”
In this session, expert surgeons from the United States, United Kingdom, and Canada work through challenging real-world acute care and trauma cases. As each case unfolds, the panel explores key decision points while highlighting both the similarities and differences in surgical management across healthcare systems.
This year’s panel featured an outstanding group of acute care and trauma surgeons, including Dr. Rob Lim, Dr. Courtney Collins, Dr. Michael Cripps, Dr. Caroline Reinke, Dr. Chris Schlachta, Mr. Christian Macutkiewicz, Mr. Adam Peckham-Cooper, Miss Kate Hancorn, and Mr. Dimitrios Damaskos.
Hope you enjoy this engaging discussion filled with practical insights and international perspectives!
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It’s hospital day five. The patient looked better yesterday… but now she’s hypotensive, on vasopressors, acidotic, and spiraling toward multi-organ failure. The CT scan doesn’t show perforation or megacolon, but your gut tells you this is going south. Do you keep pushing medical therapy… or is it time to operate?
Join Drs. Rushabh Dev, Jeffrey Coughenour, Kevin Bartow, Raymond Okeke, and Desra Fletcher from the Emergency General Surgery team in Tiger Country at Mizzou as they tackle one of the deadliest and most challenging diseases acute care surgeons face: fulminant Clostridioides difficile infection.
In this Clinical Challenges episode, the panel discusses diagnostic stewardship, ASCRS recommendations, timing of operative intervention and technique, subtotal colectomy versus diverting loop ileostomy with lavage, and physiology that should push surgeons toward definitive source control.
Through a real-world high-risk case vignette, the team explores the hardest question in emergency general surgery: when to stop hoping medical therapy will work and pull the operative trigger.
Hosts
- Dr. Rushabh Dev FACS (Moderator, Surgical Attending) – Assistant Professor of Surgery, Associate PD ACS & SCCM Fellowship, SICU Medical Director, Lieutenant Commander United States Navy Reserve
- Dr. Jeffery Coughenour FACS (Surgical Attending) – Professor of Surgery and Emergency Medicine, Trauma Medical Director at the University of Missouri SOM
- Dr. Kevin Bartow FACS (Surgical Attending) –Professor of Surgery, Minimally Invasive Surgeon and General Surgery. Department of General Surgery at the University of Missouri SOM
- Raymond Okeke – Acute Care Surgery/Surgical Critical Care Fellow, University of Missouri School of Medicine
- Desra Fletcher – PGY 3 General Surgery Resident, University of Missouri School of Medicine
Learning Objectives
By the end of this episode, listeners should be able to:
- Define the spectrum of Clostridioides difficile infection (CDI), including non-severe, severe, and fulminant disease, and recognize the physiologic implications of fulminant colitis.
- Review contemporary diagnostic stewardship for CDI, including appropriate stool testing, pitfalls of PCR/NAAT interpretation, and the role and limitations of CT imaging in fulminant disease.
- Describe evidence-based medical management of fulminant CDI, including high-dose enteral vancomycin, intravenous metronidazole, rectal vancomycin for ileus, and principles of antimicrobial stewardship.
- Recognize the high-risk clinical features that should prompt urgent surgical evaluation, including worsening shock, vasopressor dependence, lactate elevation, organ failure, and evolving abdominal exam findings.
- Discuss the operative indications and timing for surgery in fulminant CDI and understand why delayed intervention contributes to mortality.
- Compare subtotal colectomy with end ileostomy versus diverting loop ileostomy with antegrade lavage, including current evidence, patient selection, limitations of the literature, and ASCRS recommendations.
- Review practical operative strategies for subtotal colectomy in unstable patients, including damage-control principles and common technical pitfalls.
- Apply clinical reasoning to a complex, high-risk case of fulminant CDI in a patient with decompensated cirrhosis, septic shock, and multi-organ dysfunction.
References ASCRS Clinical Practice Guidelines for Clostridioides difficile Infection (2021) * Surgical Management of Clostridium difficile Colitis — Neal et al., 2011 (Loop Ileostomy + Lavage Protocol) * Clinical Practice Guidelines for Clostridioides difficile Infection in Adults and Children (IDSA/SHEA, 2021 Update) * Adjunctive Hyperbaric Oxygen and Surgical Outcomes in Necrotizing Soft Tissue Infections (Background discussion of severe infection physiology) * Total Abdominal Colectomy Versus Diverting Loop Ileostomy for Fulminant CDI — Systematic Review & Meta-analysis * Current Status of Surgical Therapy for Fulminant Clostridioides difficile Colitis * Behind the Knife Episode 648 – Emergency General Surgery Journal Review: Clostridioides difficile* Infection
Bottom line: Fulminant C. diff is one of the few EGS diseases where the hardest decision is not what operation to perform — it’s recognizing when medical therapy has failed before the patient becomes unsalvageable.Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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The majority of non-fatal gunshot wound survivors walk away with a bullet still inside them. Most are discharged without a removal attempt, without a surveillance plan, and without a conversation about what comes next. This episode fills that gap.
Dr. Patrick Georgoff is joined by BIG T co-host Dr. Teddy Puzio (UT Houston), gun violence survivor and trauma surgeon Dr. Madhu Subramanian (Duke), and Dr. Tyler Simpson (Duke ACS Fellow) for a practical, honest conversation about one of trauma's most overlooked topics.
What we cover:
- Epidemiology: how common retained fragments really are, and why the downstream burden is underappreciated
- When to remove (and when not to): a framework for both index hospitalization and delayed removal
- Forensic evidence: how to handle bullets in the OR without destroying their evidentiary value — and who to call when you don't know
- Lead toxicity: the rare but real complication that can surface a decade later, which blood lead levels should prompt action, and when to call hematology or toxicology
- The psychology: retained bullets are independently associated with depression and reduced return to work — and that belongs in the risk-benefit conversation
DOMINATE THE DAY
BIG T Trauma Full Series: https://behindtheknife.org/podcast-series/big-t-trauma
This episode of Big T Trauma was sponsored by Teleflex, a global provider of medical devices. Learn more at teleflex.com and at the Teleflex Trauma and Emergency Medicine LinkedIn page.
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In this episode, hosts Drs. Maya Hunt, Nicole Santucci, Bryanna Stukes and Zoe Zhou explore the parallels between the literacy crisis in America and current challenges in surgical education, drawing insights from the podcast "Sold a Story." They discuss how both systems advance learners without true competency, blame struggling students rather than examining flawed teaching methods, and look to the promise of competency-based education as a path forward. Beyond surgical training, they examine how declining literacy rates will directly impact how we communicate with and care for our future patients.
Episode Hosts:
–Dr. Maya Hunt, Indiana University
mayahunt@iu.edu
-Dr. Nicole Santucci, Washington University in St. Louis
snicole@wustl.edu
-Dr. Bryanna Stukes, UT Southwestern
bryanna.stukes@UTSouthwestern.edu
-Dr. Nanruoyi (Zoe) Zhou, Weill Cornell Medicine
zhoun1@mskcc.org
–CoSEF: @surgedfellows, cosef.org
References:
1. Sold A Story: How teaching kids to read went so wrong | podcast. Accessed February 22, 2026. https://features.apmreports.org/sold-a-story/.
-
2024-2025 Literacy Statistics. National Literacy Institute. Accessed February 22, 2026. https://www.thenationalliteracyinstitute.com/2024-2025-literacy-statistics.
-
Purdy AC, Smith BR, Amersi F, et al. Characteristics Associated With Outstanding General Surgery Residency Graduate Performance, as Rated by Surgical Educators. JAMA Surg. 2022;157(10):918-924. doi:10.1001/jamasurg.2022.3340 https://pubmed.ncbi.nlm.nih.gov/35947371/
-
Santosa KB, Lussiez A, Bellomo TR, et al. Identifying Strategies for Struggling Surgery Residents. J Surg Res. 2022;273:147-154. doi:10.1016/j.jss.2021.12.026 https://pubmed.ncbi.nlm.nih.gov/35085942/
-
Mattar SG, Alseidi AA, Jones DB, et al. General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors. Ann Surg. 2013;258(3):440-449. doi:10.1097/SLA.0b013e3182a191ca https://pubmed.ncbi.nlm.nih.gov/24022436/
-
George BC, Bohnen JD, Williams RG, et al. Readiness of US General Surgery Residents for Independent Practice. Ann Surg. 2017;266(4):582-594. doi:10.1097/SLA.0000000000002414 https://pubmed.ncbi.nlm.nih.gov/28742711/
-
Brasel KJ, Lindeman B, Jones A, et al. Implementation of Entrustable Professional Activities in General Surgery: Results of a National Pilot Study. Ann Surg. 2023;278(4):578-586. doi:10.1097/SLA.0000000000005991 https://pubmed.ncbi.nlm.nih.gov/37436883/
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Ileocolic resection is one of the most common operations performed for Crohn's disease, yet the optimal approach to anastomotic construction and mesenteric management remains an active area of debate. From the configuration of the anastomosis to the extent of mesenteric excision, emerging evidence suggests that surgical technique may play a meaningful role in disease outcomes. Join Drs. Jared Hendren, Elissa Dabaghi, Joseph Trunzo, Ajaratu Keshinro, and David Rosen as they discuss methods for ileocolic anastomosis in Crohn's disease while reviewing the latest literature.
Hosts:
- Jared Hendren, MD
Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio
-
Elissa Dabaghi, MD
Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio -
Joseph Trunzo, MD
Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio
X/Twitter @joseph_trunzo -
Ajaratu Keshinro, MD
Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio
X/Twitter- @AJKesh -
David Rosen, MD
Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio
X/Twitter- @davidrrosenmd
Learning Objectives: By the end of this episode, listeners will be able to:
- Evaluate the evidence for the Kono-S anastomosis in reducing postoperative recurrence after ileocolic resection for Crohn's disease
- Describe the role of the mesentery in driving recurrence and discuss how mesenteric-targeting surgical approaches may influence outcomes
- Interpret the results of recent randomized controlled trials on extended mesenteric excision and apply them to surgical decision-making in ileocolic resection for Crohn's disease
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As cancer vaccines move into Phase II and III clinical trials, it is
increasingly important for surgeons to understand their role in this
evolving landscape. What exactly are these vaccines, how do they work,
and what should the surgical community know about their
implementation? Join BTK surgical education fellows Kara Button and
Michelle LaBella as they sit down with Professor Robert Jones to break
down the science of mRNA vaccines, the logistics of tissue
procurement, and the future of cancer care.
Hosts:
-
Professor Robert Jones: Consultant Liver Surgeon, Liverpool University
Hospitals; UK National Institute for Healthcare Research, Co-Lead for
the Cancer Vaccine Innovation Pathway, Bowel Cancer UK and Royal
College of Surgeons UK Lead for Research into Advanced Bowel Cancer,
and UK Chief Investigator for the BNT122-01 trial.
https://www.linkedin.com/in/robert-jones-6103722a/ -
Kara Button, DO: General Surgery Resident, Maine Medical Center;
Behind the Knife Surgical Education Fellow. -
Michelle LaBella, MD: General Surgery Resident; University of North
Carolina; Behind the Knife Surgical Education Fellow.
References:
https://clinicaltrials.biontech.com/trials/BNT122-01
Jones RP, Lee LYW, Corrie PG, et al. Individualized cancer vaccines
versus surveillance after adjuvant chemotherapy for surgically
resected high-risk stage 2 and stage 3 colorectal cancer: protocol for
a randomized trial. BJS. 2023;110(12):1883-1884.
doi:10.1093/bjs/znad332
https://pubmed.ncbi.nlm.nih.gov/37856683/
Tie J, Wang Y, Loree JM, et al. Circulating tumor DNA-guided adjuvant
therapy in locally advanced colon cancer: the randomized phase 2/3
DYNAMIC-III trial. Nat Med. 2025;31(12):4291-4300.
doi:10.1038/s41591-025-04030-w
https://pubmed.ncbi.nlm.nih.gov/41115959/
Rojas LA, Sethna Z, Soares KC, et al. Personalized RNA neoantigen
vaccines stimulate T cells in pancreatic cancer. Nature.
2023;618(7963):144-150. doi:10.1038/s41586-023-06063-y
https://pubmed.ncbi.nlm.nih.gov/37165196/
https://www.cancer.ox.ac.uk/research/lynchvax#:~:text=The%20LynchVax%20program%2C%20funded%20by,individuals%20with%20this%20genetic%20condition
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Can an algorithm actually give you your life back? A recent Stanford paper revealed that using large language models at home yields massive efficiency gains—up to 176%. For busy surgeons drowning in clinical duties and administrative bloat, every reclaimed second is priceless.
In this episode of Behind the Knife, Ayman and Patrick sit down with Christian Péan—an orthopedic trauma surgeon, Duke’s Executive Director of AI and IT Innovation, and the Founder/CEO of RevelAi Health. He’s also a Core faculty member at the Duke-Margolis Institute for Health Policy. Dr. Péan breaks down how naturally skeptical surgeons can adopt AI to save time, shares his granular daily workflow, and discusses his mission to cure physician burnout through tech. Whether you are a tech enthusiast or a total skeptic, this episode gives you the practical playbook for integrating AI into your surgical career today.
Hosts:
- Ayman Ali, MD
Ayman Ali is a PGY-4 at Duke Hospital and current Behind the Knife fellow.
- Patrick Georgoff, MD @georgoff
Patrick Georgoff is faculty in the Department of Surgery at the Duke University School of Medicine where he serves as an Associate Professor of Trauma, Acute, and Critical Care Surgery and Trauma Medical Director. He is a leading educator and creator for Behind the Knife, a premier digital education platform and podcast advancing surgical training through innovative, high-yield multimedia content.
- Christian Péan, MD @DrChristianPean
Christian Péan is faculty in the Department of Orthopaedic Surgery at the Duke University School of Medicine where he serves as Executive Director of AI and IT Innovation. He is the Founder and CEO of RevelAi Health, a health technology company advancing the transition to value-based care in musculoskeletal health with conversational AI. He is also author of the popular substack Techy Surgeon.
https://www.revelaihealth.com/
https://techysurgeon.substack.com/
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What are the experts saying about thyroid cancer treatment in 2025? Maybe it’s time to discuss deescalation of aggressive surgical care for lower risk thyroid cancers. We can accept that less surgery may be appropriate in select cases, including more thyroid lobectomies versus total thyroidectomies, consider less invasive approaches such as percutaneous ablation techniques, and utilize more observation with active surveillance. Early assessment of treatment may allow appropriate reduction in use of radioactive iodine ablation and more relaxed routine monitoring can reduce surveillance burden to patients and providers.
Hosts:- Amanda Doubleday, DO, MBA, Assistant Professor, Waukesha Surgical Specialists, ProHealth Care. Affiliated with University of Wisconsin School of Medicine and Public Health, Department of Surgery.
- Simon Holoubek, DO, MPH, Assistant Professor, University of Wisconsin School of Medicine and Public Health, Department of Surgery.
- Alexander Chiu, MD, Assistant Professor, University of Wisconsin School of Medicine and Public Health, Department of Surgery.
- Rebecca S Sippel, MD, FACS, Professor and Chair of Division of Endocrine Surgery, Vice Chair of Academic Affairs and Professional Development, University of Wisconsin School of Medicine and Public Health, Department of Surgery.
Learning Objectives:- Risk stratification system now includes 4 categories: low, low-intermediate, high-intermediate, and high
-TSH suppression targets are simplified: below the normal range if there is structural or biochemical disease and in the normal range if disease free.
- Thyroid lobectomy is recommended for tumors < 2cm cT1N0 tumors and can be considered for tumors 2-4 cm.
- Micro-Papillary Thyroid Carcinoma (<1cm) can be managed with active surveillance and/or percutaneous ablation
- Central compartment lymph node dissection includes levels 6-7.
- RAI is strongly not recommended for low risk cancers. Can be considered in low-intermediate and high-intermediate cancers. It is routinely recommended in high risk cancers.
References:
Ringel MD, Sosa JA, Baloch Z, Bischoff L, Bloom G, Brent GA, Brock PL, Chou R, Flavell RR, Goldner W, Grubbs EG, Haymart M, Larson SM, Leung AM, Osborne JR, Ridge JA, Robinson B, Steward DL, Tufano RP, Wirth LJ. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer. Thyroid. 2025 Aug;35(8):841-985. doi: 10.1177/10507256251363120. Erratum in: Thyroid. 2025 Nov;35(11):1350. doi: 10.1177/10507256251387671. PMID: 40844370.
https://pubmed.ncbi.nlm.nih.gov/40844370/
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For decades, a tight carotid stenosis felt like a ticking time bomb — a plaque waiting to throw an embolus and cause the next stroke. We were taught that severe narrowing meant surgery, and trials like ACAS and ACST-1 seemed to prove it. But medicine has changed. Statins, antiplatelets, tighter blood pressure control, even PCSK9 and GLP-1 therapies have quietly slashed stroke risk, and now newer data from CREST-2 suggest that for many asymptomatic patients, the knife — or the stent — may not add much at all. So if modern medical therapy works better than ever… who actually benefits from intervention anymore? Today, we unpack the evidence, the controversies, and how to counsel the patient who feels perfectly fine but has high-grade stenosis.
Hosts: Carolyn Judge, Andrew Huang, Luciano Delbono, Frank Davis, Robert Beaulieu
Institution: University of Michigan, Department of Surgery, Section of Vascular Surgery
Learning objectives:
- Describe how modern intensive medical therapy has transformed the natural history of asymptomatic carotid stenosis and explain why contemporary patients experience substantially lower annual stroke risk than those in earlier eras.
- Interpret and compare the results of landmark trials—including ACAS, ACST-1, and CREST-2—to assess the relative benefits of medical therapy, endarterectomy, and stenting.
- Apply current evidence and guideline recommendations to patient care by selecting which asymptomatic patients are most likely to benefit from carotid revascularization versus optimized medical therapy alone.
References:
SVS Guidelines:
Brook, R. D., et al. (2022). Society for Vascular Surgery clinical practice guidelines for management of extracranial carotid artery disease. Journal of Vascular Surgery, 75(1), e1–e67. https://doi.org/10.1016/j.jvs.2021.09.031
CREST (1)
Brott, T. G., Hobson, R. W., Howard, G., et al. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine, 363(1), 11–23. https://doi.org/10.1056/NEJMoa0912321
CREST-2
Brott, T. G., Howard, G., Fong, P., et al. (2024). Randomized trial of carotid artery stenting or carotid endarterectomy vs best medical therapy for asymptomatic carotid stenosis: CREST-2 results. [Manuscript in preparation]. ClinicalTrials.gov Identifier: NCT02089217. Retrieved from https://clinicaltrials.gov/ct2/show/NCT02089217
ACST-1
Halliday, A., Mansfield, A., Marro, J., et al. (2004). Randomised trial of carotid artery surgery for asymptomatic stenosis. Lancet, 363(9420), 1491–1502. https://doi.org/10.1016/S0140-6736(04)16153-1
ACST-2
Halliday, A., Bulbulia, R., Bonati, L. H., et al. (2021). Carotid artery stenting versus carotid endarterectomy in patients with asymptomatic carotid stenosis (ACST-2): A randomised trial. Lancet, 398(10291), 1065–1073. https://doi.org/10.1016/S0140-6736(21)01980-1
ACAS
Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. (1995). Endarterectomy for asymptomatic carotid stenosis. JAMA, 273(18), 1421–1428. https://doi.org/10.1001/jama.1995.03520420033036
Sponsor URL: https://www.goremedical.com/
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In this episode, our expert panel dives into the critical, historically debated topic of early burn wound excision using a real-world case of a patient with massive surface area burns. We explore the dramatic shift from the pre-1970s "wait and watch" approach to the modern standard of early source control, backed by landmark literature showing reduced mortality and shorter hospital stays. The discussion also highlights the nuances of this timeline, covering specific scenarios where delaying surgery is actually safer due to physiologic instability, uncertain burn depths, or mass casualty events. Tune in to hear the evidence behind these clinical decisions and learn why modern burn surgeons believe that removing necrotic eschar early is the best way to dominate the day!
Hosts:
- Kathleen Romanowski – University of California Davis Hospital, Shriners Hospital Sacramento
- Laura Johnson – Grady Memorial Hospital
- Lauren Nosanov – Grady Memorial Hospital
- Victoria Miles – Louisiana State University Health Science Center, University Medical Center New Orleans
Learning Objectives:
- Review the historical development of early burn excision and understand how these studies shaped modern burn surgical practice.
- Evaluate contemporary evidence on the timing of burn excision.
- Apply current evidence and clinical principles to operative decision-making, identifying key patient and injury factors that influence the timing of excision and grafting in patients with major thermal injury.
References:
- Thompson P, Herndon DN, Abston S, Rutan T. Effect of early excision on patients with major thermal injury. J Trauma. 1987 Feb;27(2):205-7. doi: 10.1097/00005373-198702000-00019. PMID: 3820353. https://pubmed.ncbi.nlm.nih.gov/3820353/
- Gray DT, Pine RW, Harnar TJ, Marvin JA, Engrav LH, Heimbach DM. Early surgical excision versus conventional therapy in patients with 20 to 40 percent burns. A comparative study. Am J Surg. 1982 Jul;144(1):76-80. doi: 10.1016/0002-9610(82)90605-5. PMID: 7046487. https://pubmed.ncbi.nlm.nih.gov/7046487/
- De La Tejera G, Corona K, Efejuku T, Keys P, Joglar A, Villarreal E, Gotewal S, Wermine K, Huang L, Golovko G, El Ayadi A, Palackic A, Wolf SE, Song J. Early wound excision within three days decreases risks of wound infection and death in burned patients. Burns. 2023 Dec;49(8):1816-1822. doi: 10.1016/j.burns.2023.06.003. Epub 2023 Jun 15. PMID: 37369613; PMCID: PMC10721718. https://pubmed.ncbi.nlm.nih.gov/37369613/
- Ramsey WA, O'Neil CF Jr, Corona AM, Cohen BL, Lyons NB, Meece MS, Saberi RA, Gilna GP, Satahoo SS, Kaufman JI, Schulman CI, Namias N, Proctor KG, Pizano LR. Burn excision within 48 hours portends better outcomes than standard management: A nationwide analysis. J Trauma Acute Care Surg. 2023 Jul 1;95(1):111-115. doi: 10.1097/TA.0000000000003951. Epub 2023 Apr 11. PMID: 37038260. https://pubmed.ncbi.nlm.nih.gov/37038260/
- Hayashi K, Sasabuchi Y, Matsui H, Nakajima M, Otawara M, Ohbe H, Fushimi K, Ono K, Yasunaga H. Does early excision or skin grafting of severe burns improve prognosis? A retrospective cohort study. Burns. 2023 May;49(3):554-561. doi: 10.1016/j.burns.2023.01.013. Epub 2023 Feb 3. PMID: 36774244. https://pubmed.ncbi.nlm.nih.gov/36774244/
- Janzekovic Z. Once upon a time ... how west discovered east. J Plast Reconstr Aesthet Surg. 2008;61(3):240-4. doi: 10.1016/j.bjps.2008.01.001. Epub 2008 Feb 1. PMID: 18243082. https://pubmed.ncbi.nlm.nih.gov/18243082/
This episode includes a full, sample cardiothoracic scenario pulled directly from our Cardiothoracic Surgery Oral Board Review Course. Listen in and test your clinical pathways in real-time as we walk through the perfect answers and provide high-yield commentary to help you pass the "hot seat."
About our Cardiothoracic Surgery Oral Board Review Course:
- 43 High-Yield Scenarios
- Dual-Format Learning: Each case includes "Part A" (a straight run-through of the perfect exam response) and "Part B" (the same scenario packed with expert tips, tricks, and commentary).
- Free Simulator Access: Every purchase of the course includes access to our new AI-powered Oral Board Simulator, allowing you to practice your verbal responses under pressure.
Resources:
* Cardiothoracic Surgery Oral Board Review Course: https://app.behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
* Oral Board Simulator: https://app.behindtheknife.org/oral-board-simulator
* Download the BTK App on iOS and Android for on-the-go studying.
DOMINATE THE DAY!
This mini-series on Behind the Knife delves into the technical aspects of the Operative Standards for Cancer Surgery, developed through the American College of Surgeons Cancer Research Program and Cancer Surgery Standards Program. This episode highlights sentinel lymph node biopsy for breast cancer.
Hosts:
- Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a Surgical Oncology fellow at MD Anderson Cancer Center.
- Lauren Postlewait, MD, FACS, is an Associate Professor of Surgery at Emory University School of Medicine and is the Medical Director of the Breast Center at Grady Memorial Hospital in Atlanta, GA.
- Chantal Reyna, MD, FACS (@kprgrl3) is a Breast surgical oncologist at Loyola University Medical Center in Chicago, IL and serves as the oncology clinical lead for the breast service line.
Guest:
- Susan E. Pories, MD, FACS (@SusanPoriesMD) is a professor of surgery, vice chair for quality and safety, and director of the Rutger’s Breast Center at the University hospital.
Learning Objectives:
- Understand the definition and identification of axillary sentinel lymph node.
- Understand the technique for injecting tracer or dye to perform sentinel lymph node biopsy.
- Understand the importance of preincision drainage evaluation and transcutaneous localization.
- Understand techniques to minimize seroma formation.
Links to Papers Referenced in this Episode
Operative Standards for Cancer Surgery, Volume 1: Breast, Lung, Pancreas, Colon
https://www.facs.org/quality-programs/cancer-programs/cancer-surgery-standards-program/operative-standards-for-cancer-surgery/purchase/
Kindle edition:
https://www.amazon.com/Operative-Standards-Cancer-Surgery-Section-ebook/dp/B07MWSNFSB
Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial Lancet Oncol. 2010 Oct;11(10):927-33.
https://pubmed.ncbi.nlm.nih.gov/20863759/
Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection J Clin Oncol. 2016 Apr 1;34(10):1072-8.
https://pubmed.ncbi.nlm.nih.gov/26811528/
The false-negative rate of sentinel node biopsy in patients with breast cancer: a meta-analysis World J Surg. 2012 Sep;36(9):2239-51.
https://pubmed.ncbi.nlm.nih.gov/22569745/
Effect of lymphoscintigraphy drainage patterns on sentinel lymph node biopsy in patients with breast cancer Am J Surg. 2005 Oct;190(4):557-62.
https://pubmed.ncbi.nlm.nih.gov/16164919/
Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial JAMA Oncol. 2023 Nov 1;9(11):1557-1564.
https://pubmed.ncbi.nlm.nih.gov/37733364/
Choosing Wisely Guidelines
Society of Surgical Oncology. Released 2016 July 12; last updated 2020 November 13. Choosing Wisely: Five Things Physicians and Patients Should Question.
https://surgonc.org/wp-content/uploads/2020/11/SSO-5things-List_2020-Updates-11-2020.pdf
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This episode includes two full, sample vascular scenarios pulled directly from our Vascular Surgery Oral Board Review Course. Listen in and test your clinical pathways in real-time as we walk through the perfect answers and provide high-yield commentary to help you pass the "hot seat."
Sample Scenarios Included in This Episode:
- Case 22: Aortoenteric Fistula (AEF). A 78-year-old woman presents to the ER with a massive upper GI bleed and a history of an open AAA repair 10 years ago. We walk you through the immediate stabilization, CTA evaluation, and the definitive operative management—including axillobifemoral bypass, aortic stump closure, and duodenal repair.
- Case 27: Acute Mesenteric Ischemia. A 79-year-old woman with a history of atrial fibrillation presents with abdominal pain out of proportion to her physical exam. Test your decision-making on systemic heparinization, SMA embolectomy versus stenting (ROMS), and how to appropriately evaluate bowel viability with a second-look laparotomy.
About our Vascular Surgery Oral Board Review Course:
72 High-Yield Scenarios: Covering everything from carotid stump syndrome to a AAA with a horseshoe kidney.
* Dual-Format Learning: Each case includes "Part A" (a straight run-through of the perfect exam response) and "Part B" (the same scenario packed with expert tips, tricks, and commentary).
* Free Simulator Access:* Every purchase of the course includes access to our new AI-powered Oral Board Simulator, allowing you to practice your verbal responses under pressure.
Resources:
* Vascular Surgery Oral Board Review Course: https://app.behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
* Oral Board Simulator: https://app.behindtheknife.org/oral-board-simulator
* Download the BTK App on iOS and Android for on-the-go studying.
DOMINATE THE DAY!
In response to increasing surgeon burnout, unsustainable clinical demands, and ongoing loss of surgeon autonomy in the setting of employee-based models, the American College of Surgeons is speaking out. In this episode, hosts Dr. Steven Thornton and Dr. Emma Burke sit down with Dr. Douglas Wood, Chair of Surgery at the University of Washington and Dr. Thomas Varghese, Editor-in-Chief of the Journal of the American College of Surgeons, to discuss the new ACS Workplace Standards Framework. The conversation covers how this initiative grew out of discussions around unionization, what domains the framework addresses — from call intensity and OR block access to administrative burden and inpatient census limits — and how specialty-specific guidelines can be developed and implemented at the local level. Dr. Wood and Dr. Varghese also reflect on the culture of "unlimited endurance" that has long defined surgery, why meaningful systems-level change is both necessary and achievable, and how improving workplace sustainability could transform the pipeline of future surgeons for generations to come.
Hosts: Emma Burke and Steven Thornton
Guests: Dr. Douglas Wood & Dr. Thomas Varghese Jr.
Papers Discussed:
1. Wood DE, Wolinsky PR, Dodgion CM, et al. Developing Specialty-Specific Workplace Standards for Surgeons: A Framework to Support Sustainable Surgical Careers. Journal of the American College of Surgeons, 2026. DOI: 10.1097/XCS.0000000000001880 https://pubmed.ncbi.nlm.nih.gov/41773743/
- Varghese TK Jr. Toward Sustainable Surgical Practice: Defining Workplace Standards for the Modern Era. J Am Coll Surg. 2026 Mar 3. doi: 10.1097/XCS.0000000000001888. Epub ahead of print. PMID: 41773737. https://pubmed.ncbi.nlm.nih.gov/41773737/
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The House Judiciary Committee just dropped a 47-page report calling the National Residency Match Program a hiring monopoly that harms patients, doctors, and the public — and the surgical community is talking. In this episode, Dr. Patrick Georgoff is joined by BTK surgical education fellows Dr. Emma Burke and Dr. Agnes Prem Kumar, along with special guest Dr. Brian Carmody (aka the Sheriff of Sodium), a pediatric nephrologist and one of the sharpest analysts of medical education policy working today. Together, they break down the report's central claims: that the NRMP exercises monopolistic control over residency hiring, suppresses resident wages, and strips trainees of bargaining power — and they separate what the report gets right from where its rhetoric badly outruns its evidence. From the history of Section 207 and the antitrust lawsuit that nearly brought down academic medicine, to the real economics of GME funding, resident unionization, and what a match-free world would actually look like — this is the context you need to understand one of the most consequential debates in graduate medical education in years. Don't miss Dr. Carmody's six-part YouTube series on the match, linked in the show notes.
Congressional Report: https://judiciary.house.gov/media/press-releases/new-report-exposes-how-medical-residency-hiring-monopoly-harms-patients-and
The Match 6-Part Video Series: https://www.youtube.com/playlist?list=PLc36yFQWkuG1sXk62A3zeRWB8aoK5SISP
The Sodium Sheriff Blog: https://thesheriffofsodium.com/
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A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons' emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame can tell us about learning and working as surgeons.
In this third episode, we talk with Drs. Sheina Theodore and Tejal Brahmbhatt about their study examining the relationship between internalized shame states and burnout among surgery residents. They make a compelling case that addressing the well-being crisis in surgery requires looking beyond external stressors to the internal experience of shame: the quiet, invisible voice that tells residents they aren't good enough, and ask what role the culture of surgery plays in that internal monologue.
Host: Steven Thornton
Guests:
1. Sheina Theodore (Assistant Professor of Surgery, Boston University)
2. Tejal Brahmbhatt (Associate Professor of Surgery, Cedars Sinai Medical Center)
Publications Discussed:
- Smith SM, Kobzeva-Herzog A, McGillen P, Castagne-Charlotin M, Davies J, Sanchez SE, Dechert T, Brahmbhatt TS, Theodore S. Internalized Shame Experiences and Burnout in General Surgery Residents. J Surg Educ. 2025 Apr;82(4):103447. doi: 10.1016/j.jsurg.2025.103447. Epub 2025 Feb 6. PMID: 39919584. https://pubmed.ncbi.nlm.nih.gov/39919584/
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A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons' emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame can tell us about learning and working as surgeons.
In this second episode, we talk with Dr. ElAbd and Dr. Zammit about their study examining the relationship between shame-based learning, grit, and burnout across surgical specialties. Their findings highlight how grit may both protect against burnout and mediate whether residents go on to shame others.
Host: Steven Thornton
Guests:
1. Rawan ElAbd (Plastic Surgery Resident, McGill University)
2. Dino Zammit (Assistant Professor of Plastic Surgery, McGill University)
Publications Discussed:
1. ElAbd R, Pu L, Esmonde-White C, ElHawary H, Vorstenbosch J, Zammit D. Association of Grit and Shame Based Learning on Burnout in Surgical Training: A Single Institution Analysis. J Surg Educ. 2025 Sep;82(9):103583. doi: 10.1016/j.jsurg.2025.103583. Epub 2025 Jun 27. PMID: 40580606.
https://pubmed.ncbi.nlm.nih.gov/40580606/
***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
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Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
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A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons’ emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame can tell us about learning and working as surgeons.
In this first episode, we talk with Dr. Will Bynum and Professor Luna Dolezal about how they understand shame in medicine, why it's so hard to see even when it's everywhere, and how developing what they call "shame competence" might be one of the most important steps we can take toward humanizing surgical training.
Host: Steven Thornton
Guests:
- Will Bynum (Associate Professor of Family Medicine, Duke University)
- Luna Dolezal (Professor of Philosphy and Medical Humanities, Exeter University)
Publications Discussed:1. Dolezal L, Bynum W. Shame competence: addressing the effects of shame in health care. Lancet. 2024 Oct 19;404(10462):1514-1515. doi: 10.1016/S0140-6736(24)02269-4. PMID: 39426826. https://pubmed.ncbi.nlm.nih.gov/39426826/ 2. The Nocturnists. Shame in Medicine: The Lost Forest [podcast series]. The Nocturnists; 2022. https://thenocturnists.org/shameinmedicine 3. Nguyen LN, Bynum WE 4th. When I Say…self-conscious emotions. Med Educ. 2021 Mar;55(3):291-292. doi: 10.1111/medu.14425. Epub 2020 Dec 23. PMID: 33289140. https://pubmed.ncbi.nlm.nih.gov/33289140/ 4. Tracy, J. L., Robins, R. W., & Tangney, J. P. (Eds.). (2007). The self-conscious emotions: Theory and research. The Guilford Press.
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Welcome back to the AI journal club! In this episode, we bring you a deep dive into a game-changing paper from The Lancet -- the MASAI study. This is the first randomized controlled trial to evaluate the use of artificial intelligence in breast cancer screening and we're so excited to discuss it.
We'll break down the study's impressive findings on interval cancer rates, sensitivity, and massive workload reductions for radiologists. Beyond the data, we'll tackle the big-picture questions and some sensational recent headlines. Are we deploying AI too fast? Or is it time to go faster?
Hosts:
- Ayman Ali, MD
Ayman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital in his academic development time where he focuses on data science, artificial intelligence, and surgery.
-
Ruchi Thanawala, MD: @Ruchi_TJ
Ruchi Thanawala is an Associate Professor of Informatics and Thoracic Surgery at Oregon Health and Science University (OHSU) and founder of Firefly, an AI-driven platform that is built for competency-based medical education. In addition, she is the Director of the Surgical Data and Decision Sciences Lab for the Department of Surgery at OHSU and Associate Program Director for the Clinical Informatics Sub-specialty Fellowship. -
Phillip Jenkins, MD: @PhilJenkinsMD
Phil Jenkins is a general surgery PGY-4 at Oregon Health and Science University and a National Library of Medicine Post-Doctoral fellow pursuing a master’s in clinical informatics.
***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6
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Join the Johns Hopkins Thoracic Surgery Subspecialty team on this rapid research review revealing how investigative efforts have changed the way we view and use Veno-venous (VV) ECMO therapy in the pre-lung transplant patient population working to avoid ventilator dependence and the associated morbidity while facilitating continued ambulation and preoperative optimization.
Hosts:
- Dr. Alfred J. Casillan, MD, PhD
Attending Thoracic Surgeon
Johns Hopkins Hospital
- Kyla Rakoczy, MD
Johns Hopkins General Surgery Resident
References:
Awake ECMO as Bridge to Lung Transplantation Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. American Journal of Respiratory and Critical Care Medicine. 2012;185(7):763–768. PMID: 22268135 Link: https://pubmed.ncbi.nlm.nih.gov/22268135/
Predictors of Successful ECMO Bridging Tipograf Y, Salna M, Minko E, Grogan EL, Sonett JR, Bacchetta MD. Outcomes of extracorporeal membrane oxygenation as a bridge to lung transplantation. Annals of Thoracic Surgery. 2019;107(5):1456–1463. PMID: 30790550 Link: https://pubmed.ncbi.nlm.nih.gov/30790550/
Intubation Status and ECMO Bridging Outcomes Zhou AL, Jennings MR, Akbar AF, et al. Utilization and outcomes of nonintubated extracorporeal membrane oxygenation as a bridge to lung transplant. Journal of Heart and Lung Transplantation. 2025;44(4):661–669. PMID: 39486773 Link: https://pubmed.ncbi.nlm.nih.gov/39486773/
ECMO Duration and Waitlist Mortality Shou BL, Kalra A, Zhou AL, et al. Impact of extracorporeal membrane oxygenation bridging duration on lung transplant outcomes. Annals of Thoracic Surgery. 2024;118(2):496–503. PMID: 38740080 Link: https://pubmed.ncbi.nlm.nih.gov/38740080/
Mechanical Ventilation as a Risk Marker Mason DP, Thuita L, Alster JM, Murthy SC, Budev MM, Mehta AC, et al. Lung transplantation in recipients requiring mechanical ventilation: outcomes and risk factors. Journal of Thoracic and Cardiovascular Surgery. 2010;139(1):114–119. PMID: 19931096 Link: https://pubmed.ncbi.nlm.nih.gov/19931096/
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Welcome back to Behind the Knife with Cody, Patrick, Jason, and Ayman. Today, we are tackling a defining professional ritual for every surgical trainee: the Morbidity and Mortality (M&M) Conference. We are providing a practical roadmap to help you build clear, high-quality presentations that facilitate real learning for the entire room. Whether you are a junior resident preparing for your first case or an attending looking to moderate effectively, this episode covers exactly what to include, what to leave out, and how to properly frame a complication.
Hosts:
- Cody Mullens, MD
- Patrick Georgoff, MD
- Jason Bingham, MD
- Ayman Ali, MD
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Xenotransplantation—the use of organs from other species to treat human disease—has long existed at the intersection of science fiction and surgical innovation. While early efforts were marked by limited success and ethical controversy, recent advances in genetic engineering, immunosuppression, and organ preservation have brought the field closer than ever to clinical reality.
In this episode of Behind the Knife, we are joined by Dr. Joshua Mezrich to explore the history, science, and future of xenotransplantation. Through a narrative lens, we trace the evolution of transplantation from its earliest experimental days to the modern era of gene-edited porcine organs, highlighting key breakthroughs, ethical challenges, and the pioneers who shaped the field. We also examine the current state of clinical trials and what xenotransplantation may mean for the future of organ availability and transplant practice.
Hosts
- Madeline Cloonan, MD PhD, General Surgery Resident, University of Nebraska Medical Center, @maddie_cloonan
- Joshua Mezrich, MD, Professor, University of Wisconsin School of Medicine and Public Health
Learning Objectives
By the end of this episode, listeners will be able to:
- Describe the historical evolution of xenotransplantation, including the primate and early porcine eras
- Explain the key immunologic and biologic barriers to xenotransplantation, including hyperacute rejection and the role of natural antibodies
- Summarize major scientific advances that enabled modern xenotransplantation, including cloning and CRISPR-based gene editing
- Discuss recent clinical experiences and ongoing trials of xenotransplantation in humans
- Evaluate the ethical considerations and societal implications of xenotransplantation
- Consider the potential role of xenotransplantation in addressing organ shortage and reshaping transplant eligibility and allocation
Check out Dr. Mezrich’s new book!
https://www.amazon.com/Every-Living-Creature-Xenotransplantation-Change-ebook/dp/B0FH14LF6K
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INTRODUCING Behind the Knife OBGYN Oral Board Review!
The oral boards aren't just about knowledge—they are about executing under pressure. This course is designed to give you the structure and confidence to command the room. We have curated 98 high-yield scenarios covering the "Big Three" of the exam: Obstetrics, Gynecology, and Office Practice. Whether it’s a surgical emergency or a complex clinic workup, we will walk you through exactly how to articulate your plan, defend your decisions, and pass this exam.
Each scenario includes 2 parts. The first part is a perfectly executed scenario. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Please check out the preview episodes below that include Parts A and B, with and without commentary.
This course includes access to our Oral Board Simulator. Step into the hot seat and experience the pressure of the real exam and receive detailed, actionable feedback with the most advanced oral board prep available.
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- 6-Month Purchase - 22 exams
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DOMINATE THE DAY!
In this episode, we explore the grueling realities of the general surgery preliminary year—a high-stakes, one-year audition for surgical trainees operating without a safety net. We sit down with a program director, a former IMG prelim turned attending, and a recently successful SOAP applicant to uncover exactly what it takes to survive the scramble and excel clinically. Listen in to learn actionable strategies for navigating hospital expectations, securing vital mentorship, and ultimately turning your preliminary position into a secured categorical spot.
Hosts:
Ayman Ali, MD
Dr. Ayman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital.
Kevin Naresh Shah, MD
Dr. Kevin Shah is an Assistant Professor of Hepatobiliary Surgery at the Duke University School of Medicine and Program Director of General Surgery.
Katharine Louise Jackson, MBBS
Dr. Louise Jackson is an Assistant Professor of Colon and Rectal Surgery at the Duke University School of Medicine and the Medical Student Clerkship Director.
Rafael Felix Tiongco, MD
Dr. Rafael Tiongco is a first-year resident at Penn State College of Medicine.
Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Identification of pancreatic cystic lesions has become increasingly common due to improved resolution and increased utilization of cross-sectional imaging. However, there are many types of pancreatic cysts, each with varying degrees of malignant potential. In this episode from the HPB team at Behind the Knife, listen in as we discuss the clinical presentation, diagnostic work-up, and management strategies for various pancreatic cysts: Pseudocysts, Serous Cystadenomas, Mucinous Cystic Neoplasms, and IPMNs, amongst others.
Hosts
Anish J. Jain MD (@anishjayjain) is a current PGY4 General Surgery resident at Stanford University and a former T32 Research Fellow at the University of Texas MD Anderson Cancer Center.
Jon M. Harrison MD is a Hepatobiliary & Pancreatic (HPB) surgeon at the Massachusetts General Hospital in Boston, MA and a former HPB Surgery fellow at Stanford University.
Learning Objectives
· Develop an understanding of the clinical presentation, diagnostic work-up, and treatment of benign pancreatic cysts
· Develop an understanding of the clinical presentation, diagnostic work-up, and treatment of pre-malignant pancreatic cysts
· Develop an understanding of when surveillance is appropriate for management of pancreatic cysts, and the criteria involved in making that determination
· Develop an understanding of the prognostic utility of PancSeq for IPMNs
References:
- Paniccia A, Polanco PM, Boone BA, et al. Prospective, Multi-Institutional, Real-Time Next-Generation Sequencing of Pancreatic Cyst Fluid Reveals Diverse Genomic Alterations That Improve the Clinical Management of Pancreatic Cysts. Gastroenterology. 2023 Jan;164(1):117-133.e7.
- PubMed Link: https://pubmed.ncbi.nlm.nih.gov/36209796/
- Ohtsuka T, Fernandez-Del Castillo C, Furukawa T, et al. International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas. Pancreatology. 2024 Mar;24(2):255-270.
- PubMed Link: https://pubmed.ncbi.nlm.nih.gov/38182527/
- Zelga P, Hernandez-Barco YG, Qadan M, et al. Number of Worrisome Features and Risk of Malignancy in Intraductal Papillary Mucinous Neoplasm. J Am Coll Surg. 2022 Jun 1;234(6):1021-1030.
- PubMed Link: https://pubmed.ncbi.nlm.nih.gov/35703792/
- Ciprani D, Weniger M, Qadan M, et al. Risk of malignancy in small pancreatic cysts decreases over time. Pancreatology. 2020 Sep;20(6):1213-1217.
- PubMed Link: https://pubmed.ncbi.nlm.nih.gov/32819844/
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Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content.
Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
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With the increasing incidence of colorectal cancer in those less than 50 years of age, one must wonder how many patients present with a Stage IV diagnosis. Take a deep dive with us discussing the management of metastatic colorectal cancer by joining our team and guests, Drs. Cathy Eng, Michael D’Angelica, and Nina Sanford.
Hosts:
- Dr. Janet Alvarez - General Surgery Resident at New York Medical College/Metropolitan Hospital Center
- Dr. Wini Zambare – General Surgery Resident at Weill Cornell Medical Center/New York Presbyterian
- Dr. Philip Bauer, Assistant Professor of Surgery, Division of Colon and Rectal Surgery, The Ohio State University Wexner Medical Center, Arthur G. James Cancer Hospital
- Dr. J. Joshua Smith MD, PhD, Chair, Department of Colon and Rectal Surgery at MD Anderson Cancer Center
Guest Speakers:
- Dr. Michael D’Angelica MD, FACS – Hepatopancreatobiliary Surgery, Memorial Sloan Kettering Cancer Center, Enid A. Haupt Chair in Surgery, Vice Chair, Education
- Dr. Cathy Eng MD, FACP - Division of Hematology and Oncology, Vanderbilt-Ingram Cancer Center, David H. Johnson Endowed Chair in Surgical and Medical Oncology, Professor of Medicine, Hematology and Oncology, VICC Associate Director for Strategic Relations and Research Partnerships, Executive Director, Young Adult Cancers Program
- Dr. Nina Sanford, MD – Radiation Oncology, UT Southwestern Medical Center, Chief of Gastrointestinal Radiation Oncology Service, Associate Professor
Learning Objectives:
1. Review the epidemiology, prognosis, and common metastatic patterns of metastatic colorectal cancer (mCRC).
-
Discuss the role of systemic chemotherapy and targeted therapies in the first- and subsequent-line treatment of mCRC, including the impact of molecular biomarkers such as MSI/MMR, RAS, BRAF, and HER2.
-
Evaluate the indications and timing of surgical and locoregional therapies for metastatic colorectal cancer, particularly in patients with liver-limited or oligometastatic disease.
-
Describe the multidisciplinary management of mCRC, including the roles of radiation therapy, systemic therapy sequencing, and palliative interventions to optimize outcomes and quality of life.
References:
Singh, M., Morris, V. K., Bandey, I. N., Hong, D. S. & Kopetz, S. Advancements in combining targeted therapy and immunotherapy for colorectal cancer. Trends Cancer 10, 598–609 (2024). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/38821852/
Napolitano, S. et al. BRAFV600E mutant metastatic colorectal cancer: Current advances in personalized treatment and future perspectives. Cancer Treat. Rev. 134, (2025). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/40009904/
Ciardiello, F. et al. Clinical management of metastatic colorectal cancer in the era of precision medicine. CA. Cancer J. Clin. 72, 372–401 (2022). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/35472088/
Kim, S. Y. & Kim, T. W. Current challenges in the implementation of precision oncology for the management of metastatic colorectal cancer. ESMO Open 5, e000634 (2020). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/32188714/
Biller, L. H. & Schrag, D. Diagnosis and Treatment of Metastatic Colorectal Cancer: A Review. JAMA 325, 669–685 (2021). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/33591350/
Smith, J. J. et al. Genomic stratification beyond Ras/B-Raf in colorectal liver metastasis patients treated with hepatic arterial infusion. Cancer Med. 8, 6538–6548 (2019). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/31503397/
Saadat, L. V. et al. Hepatic Artery Infusion Chemotherapy Compared to Transarterial Radioembolization For Unresectable Colorectal Liver Metastases. Ann. Surg. 10.1097/SLA.0000000000006851 doi:10.1097/SLA.0000000000006851. PubMed Link: https://pubmed.ncbi.nlm.nih.gov/?term=10.1097/SLA.0000000000006851 (Linked via DOI search as the direct PMID is still indexing)
Xiao, A. & Fakih, M. KRAS G12C Inhibitors in the Treatment of Metastatic Colorectal Cancer. Clin. Colorectal Cancer 23, 199–206 (2024). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/38825433/
André, T. et al. Pembrolizumab in Microsatellite-Instability–High Advanced Colorectal Cancer. N. Engl. J. Med. 383, 2207–2218 (2020). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/33264544/
Morris, V. K. et al. Treatment of Metastatic Colorectal Cancer: ASCO Guideline. J. Clin. Oncol. 41, 678–700 (2023). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/36252154/
Xu, Z. et al. Treatments for Stage IV Colon Cancer and Overall Survival. J. Surg. Res. 242, 47–54 (2019). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/31071604/
Smith, J. J. & D’Angelica, M. I. Surgical Management of Hepatic Metastases of Colorectal Cancer. Hematol. Oncol. Clin. North Am. 29, 61–84 (2015). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/25475573/
Strickler, J. H. et al. Tucatinib plus trastuzumab for chemotherapy-refractory, HER2-positive, RAS wild-type unresectable or metastatic colorectal cancer (MOUNTAINEER): a multicentre, open-label, phase 2 study. Lancet Oncol. 24, 496–508 (2023). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/37142372/
Kruijssen, D. E. W. van der et al. Upfront resection versus no resection of the primary tumor in patients with synchronous metastatic colorectal cancer: the randomized phase III CAIRO4 study conducted by the Dutch Colorectal Cancer Group and the Danish Colorectal Cancer Group. Ann. Oncol. 35, 769–779 (2024). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/38852675/
Hitchcock, K. E., Romesser, P. B. & Miller, E. D. Local Therapies in Advanced Colorectal Cancer. Hematol. Oncol. Clin. North Am. 36, 553–567 (2022). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/35562258/
Hitchcock, K. E. et al. Alliance for clinical trials in Oncology (Alliance) trial A022101/NRG-GI009: a pragmatic randomized phase III trial evaluating total ablative therapy for patients with limited metastatic colorectal cancer: evaluating radiation, ablation, and surgery (ERASur). BMC Cancer 24, 201 (2024). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/38350888/
Adam, R. et al. Liver transplantation plus chemotherapy versus chemotherapy alone in patients with permanently unresectable colorectal liver metastases (TransMet): results from a multicentre, open-label, prospective, randomised controlled trial. The Lancet 404, 1107–1118 (2024). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/39306468/
Elez, E. et al. Encorafenib, Cetuximab, and mFOLFOX6 in BRAF-Mutated Colorectal Cancer. N. Engl. J. Med. 392, 2425–2437 (2025). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/40444708/
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In the final installment of the Healthcare Econ 101 miniseries, Dr. Christopher Childers and Dr. Nina Clark demystify the "black box" of medical billing and coding. This episode breaks down the two essential components of every medical bill: ICD codes, which identify the patient's diagnosis (the "why"), and CPT codes, which describe the specific services or procedures performed (the "what"). The discussion emphasizes that surgeons are legally and ethically responsible for the accuracy of these codes, regardless of whether a professional coder or an automated system handles the data entry. Listeners will gain insights into the "Global Period," the pitfalls of illegal "unbundling," and how to use modifiers—such as the -22 for increased procedural services—to accurately reflect the complexity of a case.
***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6
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Ever wonder why a complex gallbladder surgery only nets the surgeon about $350, while the hospital collects thousands? In this episode, Dr. Christopher Childers and Dr. Nina Clark pull back the curtain on how the money actually flows in medicine. From the birth of the RVU to the "Two Midnight Rule," we’re breaking down the math behind your paycheck.
Next Step: Ready to make sure you're actually getting credit for the work you do? Join us for Episode 3, where we dive into the "Black Box" of Coding and Billing.
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Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
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Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
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Ever feel like you’re fluent in medical jargon but totally illiterate when it comes to the business side of surgery? You’re not alone. In this series premiere, Dr. Christopher Childers (Surgical Oncologist and health policy expert) joins Dr. Nina Clark to demystify the "second world" of medicine: healthcare finance. We’re breaking down the basic vocabulary every surgeon needs to advocate for themselves and their patients.
Next Step: Ready to see how this translates to your paycheck? In Episode 2, we dive into Physician and Hospital Compensation, RVUs, and the flow of funds.
***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6
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Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
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The high-stakes world of surgical oral boards just got a high-tech upgrade. In this episode, the Behind the Knife team dives deep into the 2026 evolution of their AI Oral Board Simulator. With over 10,000 exams completed and a 99% recommendation rate from recent examinees, we’re showing you how AI is leveling the playing field for residents everywhere.
Join Drs. Georgoff, Swenson, and Ali as they break down the new features designed to mimic the modern, non-linear, and "rapid branching" style of the American Board of Surgery. Whether you’re a junior resident honing your consult skills or a chief preparing for the "hot seat," this is the ultimate guide to dominating your boards without breaking the bank.
Simulator: behindtheknifeoralboardsimulator.org
In surgery, when we think of research, often we picture randomized controlled trials, meta-analyses, and big data sets. But have you ever considered what we might miss by limiting our research programs to quantitative inquiry? What if you want to understand the culture or identity of your department or your training program? Or, what If you want to understand the values, priorities, and lived experiences of your patients? Some of the most meaningful insights about how we teach, learn, and practice surgery come from talking to people. Their words, their stories, and their experiences, and that's where qualitative research comes in. In this episode we dive into the “why” and “how” of qualitative research with leaders in the space, Professor Nicole Perez and Dr. Maya Hunt.
Host:
- Steven Thornton, MD (General Surgery Resident at Duke University)
Guests:1. Nicole Perez (Assistant Professor of Medical Education, University of Illinois Chicago) 2. Maya Hunt (General Surgery Resident, Indiana University)
Publications Discussed:1. Bosk CL. Forgive and Remember: Managing Medical Failure. The University of ChicagoPress; 2011. 2. Liang et al 2019 Why do women leave surgical training? A qualitative and feminist study, doi: https://doi.org/10.1016/S0140-6736(18)32612-6 3. Jenkins TM. Doctors’ Orders: the Making of Status Hierarchies in an Elite Profession. Columbia University Press; 2020. 4. Yosso, T. J. (2005). Whose culture has capital? A critical race theory discussion of community cultural wealth. Race Ethnicity and Education, 8(1), 69–91. https://doi.org/10.1080/1361332052000341006
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Surgical quality is a term that is often thrown around in surgical practice. We have multiple quality improvement projects, metrics and benchmarks that motivate us to do better, and of course the ever expanding patient reviews to possibly “reflect” the type of surgical care provided. But what does quality actually mean? What metrics can we use to understand the type of care being provided by ourselves, our colleagues, and the health system at large.
Today, we delve into these questions to understand how quality is currently understood within surgery and how we hope it to evolve in the future. Joining BTK fellow Agnes Premkumar and ASGBI hosts Jared Wohlgemut and Gita Lingam are two fantastic guests - Dr. Mark Cheetham, joining us from the UK, has deep experience in national audits and system-level quality improvement. Dr. Cheetham is a colorectal surgeon and the National Clinical Lead for General Surgery at the Getting it Right First Time Programme in NHS England, or GIRFT. Dr. Alexander Perez is representing the US; he is a board-certified general surgeon and minimally invasive surgeon at Baylor St. Luke’s Medical Center. He has worked extensively with institutional quality programs and is the current assistant Dean for patient safety, simulation, and process improvement at the Baylor College of Medicine.
Resources:
- Institute for Healthcare Improvement: https://www.ihi.org/library/tools/quality-improvement-essentials-toolkit
- NSQIP: https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/
- Getting it right first time (UK): https://gettingitrightfirsttime.co.uk/
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The Match. Two words that define the trajectory of every physician’s career in the United States. But how does the algorithm actually work, and who is looking out for the applicants navigating this high-stakes process? In this episode, we sit down with Dr. Donna Lamb, President and CEO of the National Resident Matching Program (NRMP), to pull back the curtain on one of medicine’s most consequential systems.
Dr. Lamb unpacks the strengths and limitations of the match algorithm and shares her candid advice on overapplication, post-interview communication, and dual applying. She also addresses the growing financial burden on applicants, challenges facing international medical graduates amid shifting visa restrictions, and recent congressional scrutiny into the match algorithm’s antitrust exemption.
Join hosts Pooja Varman, MD, Judith French, PhD, and Jeremy Lipman, MD, MHPE for this conversation about the system that shapes the future of medicine—and the people working to make it more equitable, transparent, and efficient.
Learning Objectives
By the end of this episode, listeners will be able to
1. Explain how the NRMP match algorithm work and describe both its strengths and potential areas for reform.
2. Identify key match policies and best practices for applicants and programs.
3. Discuss the challenges applicants face in the match and the NRMP’s role in supporting equitable access.
References
1. Roth AE. The Origins, History, and Design of the Resident Match. JAMA. 2003;289(7):909-912. doi:10.1001/jama.289.7.909
2. Lamb D. Letter to the Medical Education Community. Published online December 8, 2025. Accessed January 7, 2026. https://www.nrmp.org/wp-content/uploads/2025/12/Dec8_Letter-to-Community_JudiciarySubcommittee-FINAL-PDF.pdf
***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6
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Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
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Robotic surgery has moved from novelty to norm, and in this episode of Behind the Knife, Drs. James Jung and Joey Lew sit down with urologic pioneer and Medtronic CMO Dr. Jim Porter to dissect how we got here, what the data really say about “the death of laparoscopy,” and where competing robotic platforms like Hugo may take the field next. From ergonomics and education to economics and global access, they tackle both the hype and the hard questions around robotics as the future of minimally invasive surgery.
Hosts:
· James Jung, MD, PhD, Assistant Professor of Surgery, Duke University
· Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actually
Learning Goals:
By the end of this episode, listeners will be able to:
· Describe key clinical, ergonomic, and educational drivers behind the rapid adoption of robotic surgery in the United States and globally.
· Summarize current evidence comparing robotic and laparoscopic approaches for common procedures, including where outcomes are equivalent, inferior, or clearly superior.
· Explain how surgeon ergonomics, trainee experience, and video-based learning influence practice patterns and learning curves in minimally invasive surgery.
· Discuss the role of cost, reimbursement structures, and market competition (e.g., Medtronic Hugo vs da Vinci) in shaping robotic adoption across different health systems.
· Anticipate how next-generation, task- or organ-specific robotic platforms may further change standards of care in minimally invasive surgery.
References:
· Violante T, Ferrari D, Novelli M, Larson DW. The Death of Laparoscopy - Volume 2: A Revised Prognosis. A retrospective study. Ann Surg. 2025 Jun 16. doi: 10.1097/SLA.0000000000006792. Epub ahead of print. PMID: 40518997. https://pubmed.ncbi.nlm.nih.gov/40518997/
· Yu Yoshida, Yoshiro Itatani, Takehito Yamamoto, Ryosuke Okamura, Koya Hida, Kazutaka Obama, Single-incision plus one robot-assisted surgery (SIPORS) using the Hugo robotic-assisted surgery (RAS) system for rectal cancer, Annals of Coloproctology, 10.3393/ac.2025.00787.0112, 41, 6, (586-591), (2025). https://pubmed.ncbi.nlm.nih.gov/41486916/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
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Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
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Join the Behind the Knife Surgical Oncology Team as we discuss the PRADO and NADINA randomized control trials regarding neoadjuvant therapy in Stage III melanoma with macroscopic nodal disease!
Hosts:
Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center.
Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist/HPB surgeon at Kaiser LAMC in Los Angeles.
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a 2ndYear Surgical Oncology fellow at MD Anderson.
Beth (Elizabeth) Barbera, MD (@elizcarpenter16) is a General Surgery physician in the United States Air Force station at RAF Lakenheath.
Joe (Joseph) Broderick, MD, MA (@joebrod5) is a General Surgery research resident between his second and third year at Brooke Army Medical Center.
Galen Gist, MD (@gistgalen) is a General Surgery research resident between his second and third year at Brooke Army Medical Center.
Learning Objectives:
- Evaluate the role of Completion Lymph Node Dissection (CLND) in patients with positive sentinel lymph nodes, specifically citing the lack of melanoma-specific survival benefit vs. the improvement in regional disease control demonstrated in the MSLT-II trial.
-
Determine the appropriate surgical excision margins for primary cutaneous melanoma, comparing the outcomes of 1 cm versus 2 cm margins as analyzed in the MINT trial (Lancet 2019).
-
Analyze the impact of adjuvant systemic therapy (Anti-PD1/Immunotherapy) on recurrence-free survival in patients with resected high-risk Stage III melanoma.
References:
Reijers, I.L.M., Menzies, A.M., van Akkooi, A.C.J. et al. Personalized response-directed surgery and adjuvant therapy after neoadjuvant ipilimumab and nivolumab in high-risk stage III melanoma: the PRADO trial. Nat Med 28, 1178–1188 (2022). https://doi.org/10.1038/s41591-022-01851-x
Christian U. Blank et al. Neoadjuvant nivolumab plus ipilimumab versus adjuvant nivolumab in macroscopic, resectable stage III melanoma: The phase 3 NADINA trial.. J Clin Oncol 42, LBA2-LBA2(2024). DOI:10.1200/JCO.2024.42.17_suppl.LBA2
*Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
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Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
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Research years. Professional development time. Career exploration.Whatever you call it, stepping out of clinical residency can feel confusing, intimidating, and oddly hard to plan for.
In this episode of Behind the Knife, our BTK Surgical Education Fellows Drs. Elizabeth Maginot, Nicole Petcka, Agnes Premkumar, Kara Button, Emma Burke, and Michelle LaBella sit down with Dr. Daniel Nussbaum, Associate Professor of Surgery at Duke University and leader in the Duke Residency Research Fellowship Program, to unpack dedicated resident profressional development time really looks like, who it helps, who it doesn’t, and how to make the most of it if you choose to step out of clinical training.
Together, the group tackles:
· Why “research years” are often better thought of as professional development time
· Whether taking time out of residency is actually necessary for fellowship or an academic career
· How to find the right mentor—and why there’s rarely a “perfect” project
· Practical advice on setting boundaries, saying yes (and no), and managing unstructured time
· A clear, resident-level overview of funding options, including:
- NIH T32 and F32 grants
- NIH Loan Repayment Program (LRP)
- Society, foundation, and departmental funding
· What faculty and program leadership look for when supporting resident research
· Lessons the panel wishes they’d known before starting research time
Whether you’re a medical student curious about residency structure, a resident debating whether to step out, or faculty mentoring trainees through career development, this episode offers candid insight, real examples, and reassurance that there’s more than one “right” path.
High-Yield Takeaway: You don’t need research time to be a great surgeon—but if you want to grow skills outside the OR, this may be the rare window to do it thoughtfully (and even enjoy it).
Resources & Links Mentioned:
NIH Funding & Training Programs
· NIH RePORTER – Explore active NIH-funded grants and training programs
https://reporter.nih.gov/#/
· NIH T32 Institutional Training Grants
https://grants.nih.gov/funding/activity-codes/T32
· NIH F32 Individual Postdoctoral Fellowshiphttps://grants.nih.gov/funding/activity-codes/F32
· NIH Loan Repayment Program (LRP)
https://grants.nih.gov/funding/funding-categories/lrp
· Foundational & Society Grants
(Not a comprehensive list; examples discussed in the episode)
· Association of Program Directors in Surgery (APDS) Job Board
https://apds.careerwebsite.com/jobs/?
· American College of Surgeons (ACS) – Resident research funding
https://www.facs.org/for-medical-professionals/professional-growth-and-wellness/scholarships-fellowships-and-awards/resident/resident-research/
· Association for Academic Surgery (AAS) – Resident research funding primer
https://www.aasurg.org/resident-research-funding-primer/
· American Surgical Association (ASA) – Research awards & fellowships
https://americansurgical.org/awards_Fellowship.cgi
· Society of University Surgeons (SUS) – Resident Research Scholar Awards
https://www.susweb.org/resident-scholar-research-awards/?
· American Association for the Surgery of Trauma (AAST) – Scholarships & grants
https://www.aast.org/professional-development/scholarships.html
· Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) – Research grants
https://www.sages.org/research/research-grants/
Helpful Application Resources
· NIH Biosketch Format & Instructions
https://grants.nih.gov/grants-process/write-application/forms-directory/biosketch
Sponsor Link: Medical Education master's program at the University of Pennsylvania Graduate School of Education - https://www.gse.upenn.edu/btk
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Abdominal organ procurement is a high-stakes operation that blends anatomy, speed, and coordinated teamwork. In this Behind the Knife episode, the UNMC transplant team walks through the practical “how-to” of deceased donor abdominal recovery—covering OR roles and logistics, key anatomic maneuvers, cannulation/flush troubleshooting, and the workflow differences that matter most between donation after brain death (DBD) and donation after circulatory death (DCD).
Hosts
Madeline Cloonan, MD PhD – General Surgery Resident, University of Nebraska Medical Center (@maddie_cloonan)
Evelyn Waugh, MD – Transplant Surgery Fellow, University of Nebraska Medical Center
Jacqueline Dauch, MD – Abdominal Transplant Surgeon, University of Nebraska Medical Center
Alex Maskin, MD – Kidney & Pancreas Transplant Surgeon, University of Nebraska Medical Center
Learning Objectives
- Compare DBD vs DCD donor workflow and define total vs functional warm ischemia.
- Identify key OR roles and the ethical/legal separation of death declaration from procurement teams.
- Outline the core steps of abdominal procurement, including exposure, cannulation, cross-clamp, and organ removal sequence.
- Apply a practical troubleshooting approach when flush flow is inadequate
References1. Englesbe MJ, Mulholland MW. Operative Techniques in Transplantation Surgery. Philadelphia, PA: Wolters Kluwer; 2018. 2. Tullius SG, Rabb H. Improving the supply and quality of deceased-donor organs for transplantation. N Engl J Med. 2018;378(20):1924–1933. doi:10.1056/NEJMra1708700. https://pubmed.ncbi.nlm.nih.gov/29768153/ 3. Croome KP, Barbas AS, Whitson B, et al. American Society of Transplant Surgeons recommendations on best practices in donation after circulatory death organ procurement. Am J Transplant. 2023;23(2):171–179. doi:10.1016/j.ajt.2022.10.009. https://pubmed.ncbi.nlm.nih.gov/36695685/
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What happens when the world of GLP-1s collides with the operating room? Today, we’re diving into the new era of obesity care.
Hosts
· Matthew Martin, trauma and bariatric surgeon at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) @docmartin2
· Adrian Dan, bariatric and MIS surgeon, program director for the advanced MIS bariatric and foregut fellowship at Summa Health System (Akron, Ohio) @DrAdrianDan
· Crystal Johnson Mann, bariatric and foregut surgeon at the University of Florida (Gainesville, Florida) @crys_noelle_
· Katherine Cironi, general surgery resident at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) @cironimacaroni
Learning objectives
1. Understand the evolving role of OMMs in bariatric surgical practice
· Recognize how widespread GLP-1 and dual-incretin therapies have reshaped patient presentations, expectations, and referral patterns.
· Appreciate current evidence comparing surgery to GLP-1 therapy, including the JAMA Surgery study out of Allegheny Health (2025), noting:
o Superior weight loss with bariatric surgery (~28% TBWL vs ~10% with GLP-1s)
o Higher health-care utilization and cost in GLP-1–treated patients.
· Frame OMMs not as alternatives but as complementary tools within a chronic disease model when treating obesity.
2. Review pharmacologic classes and their expected efficacy
· Surgeons should be able to articulate the mechanisms, efficacy, and limitations of:
o GLP-1 receptor agonists – incretin-based satiety; 5–12% TBWL.
o Dual GIP/GLP-1 agonists – most potent agents; 15–22% TBWL.
o Sympathomimetics – norepinephrine-driven appetite suppression; 3–7% TBWL.
o Combination agents (bupropion-naltrexone, phentermine-topiramate) – 5–12% TBWL depending on regimen.
o Emerging therapies – retatrutide, maritide, oral GLP-1s, with promising TBWL in phase 2 trials
3. Apply OMMs strategically in the preoperative phase
· Integrate OMMs without compromising surgical eligibility—OMM-related weight loss does not negate the indication for surgery.
· Counsel patients that medication response does not equal disease resolution; surgery remains the most durable intervention.
· Manage delayed gastric emptying and aspiration risk:
o Pause weekly GLP-1 or dual agonists for ≥1 week pre-op (longer if symptomatic).
o Collaborate closely with the anesthesia/OR teams
· Screen for nutritional depletion before surgery, especially protein deficits exacerbated by appetite suppression.
· Navigate insurance barriers that may paradoxically approve surgery but deny medication continuation.
4. Implement postoperative OMMs safely and effectively
· Establish criteria for OMM introduction:
o Typical initiation at 6–12 months, once the diet stabilizes and the physiologic curve flattens.
o Earlier initiation (4–6 weeks) may be appropriate in pediatric or select high-risk populations.
· Recognize altered pharmacokinetics after sleeve and bypass:
o Injectables may be preferred due to altered absorption of oral agents.
· Prevent postoperative nutritional compromise:
o Monitor protein intake, hydration, and micronutrient status (including iron, B12, and fat-soluble vitamins).
o Titrate doses slowly to minimize nausea/vomiting that can precipitate malnutrition.
· Frame OMM use as a tool for disease persistence (plateau/regain), not as a marker of failure.
5. Identify systems-level barriers and the implementation of coordinated care
· Understand insurance inconsistencies—coverage for surgery is often not paired with coverage for long-term medical therapy.
· Clearly document disease persistence and medical necessity when appealing denials.
· Avoid fragmented care: establish shared-care pathways between bariatric surgery, obesity medicine, and primary care.
· Use patient-centered language emphasizing complementary therapy, not hierarchy or competition between surgery and medications.
6. Counsel patients ethically and accurately within a chronic disease model
· Set expectations: sustained success requires surgery + medication + behavioral change.
· Educate patients that postoperative OMM use does not imply surgical failure.
· Normalize long-term multimodal management of obesity, analogous to diabetes or hypertension models.
*Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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In surgical residency, cases are long, expectations are high, and patient care always comes first. But then you become a parent, and suddenly you’re navigating pregnancy risk, parental leave, and lactation logistics in a system that wasn’t built for it. We’ve made meaningful progress over the past decade, but too many trainees still face becoming parents in residency without clear, consistent support.
In this episode, join Dr. Kara Button with Dr. Arielle Kanters and Dr. Sarah Shubeck as they ask: How do we build a surgical workforce that’s skilled, resilient—and genuinely supported as surgeon-parents? They’ll share practical, evidence-based steps programs can take to make parental support the norm—not the exception.
Hosts:
Kara Button, DO — General Surgery Resident, Maine Medical Center; Behind the Knife Surgical Education Fellow
Arielle Kanters, MD — Colorectal Surgeon; Associate Program Director, Colorectal Surgery Fellowship, Cleveland Clinic
Dr. Sarah Shubeck, MD — Assistant Professor of Surgery; Breast Surgical Oncologist, University of Chicago
References:
Bamdad MC, Hughes DT, Englesbe M. Safe and supported pregnancy: A call to action for surgery chairs and program directors: A call to action for surgery chairs and program directors. Ann Surg. 2022;275(1):e1-e2. doi:10.1097/SLA.0000000000005181 https://pubmed.ncbi.nlm.nih.gov/34433187/
Castillo-Angeles M, Atkinson RB, Easter SR, et al. Pregnancy during surgical training: Are residency programs truly supporting their trainees? J Surg Educ. 2022;79(6):e92-e102. doi:10.1016/j.jsurg.2022.06.011 https://pubmed.ncbi.nlm.nih.gov/35842402/
Castillo-Angeles M, Smink DS, Rangel EL. Perspectives of general surgery program directors on paternity leave during surgical training. JAMA Surg. 2022;157(2):105-111. doi:10.1001/jamasurg.2021.6223 https://pubmed.ncbi.nlm.nih.gov/34851404/
Kanters AE, Shubeck SP. The importance of parental leave and lactation support for surgeons. Clin Colon Rectal Surg. 2023;36(5):333-337. doi:10.1055/s-0043-1764288 https://pubmed.ncbi.nlm.nih.gov/37564351/
Kling SM, Slashinski MJ, Green RL, Taylor GA, Dunham P, Kuo LE. Parental leave experiences for the non-childbearing general surgery resident parent: A qualitative analysis. Surgery. 2024;176(5):1320-1326. doi:10.1016/j.surg.2024.04.035 https://pubmed.ncbi.nlm.nih.gov/38910045/
Mann H, Glazer T. Current state of safe pregnancy policies for the US surgical trainee. OTO Open. 2024;8(3):e172. doi:10.1002/oto2.172 https://pubmed.ncbi.nlm.nih.gov/39036338/
Rangel EL, Smink DS, Castillo-Angeles M, et al. Pregnancy and motherhood during surgical training. JAMA Surg. 2018;153(7):644-652. doi:10.1001/jamasurg.2018.0153 https://pubmed.ncbi.nlm.nih.gov/29562068/
Rangel EL, Castillo-Angeles M, Easter SR, et al. Incidence of infertility and pregnancy complications in US female surgeons. JAMA Surg. 2021;156(10):905-915. doi:10.1001/jamasurg.2021.3301 https://pubmed.ncbi.nlm.nih.gov/34319353/
https://www.nytimes.com/2019/12/20/science/doctors-surgery-motherhood-medical-school.html
https://behindtheknife.org/podcast/family-leave-during-surgical-training-a-discussion-with-abs-president-dr-jo-buyske
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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You’re in the middle of surgical residency, and you realize you need more than a few weeks away from clinical responsibilities. Maybe you need more time to be a parent, recover from an illness, care for family, learn a new skill, or simply create space to reflect and reset. What if you could complete five years of training over six calendar years by spreading that time out in a way that fits your life?
Join Dr. Kara Button with Dr. Joe Buyske, and Dr. Bridget Olson as they break down the 5-in-6 pathway including how it works, who it’s for, and the real-world logistics that matter.
Hosts:
Kara Button, DO — General Surgery Resident, Maine Medical Center; Behind the Knife Surgical Education Fellow
Jo Buyske, MD — President & CEO, American Board of Surgery
Dr. Bridget Olsen, MD — General Surgery Resident, Maine Medical Center
References:
Bamdad MC, Hughes DT, Englesbe M. Safe and supported pregnancy: A call to action for surgery chairs and program directors: A call to action for surgery chairs and program directors. Ann Surg. 2022;275(1):e1-e2. doi:10.1097/SLA.0000000000005181 https://pubmed.ncbi.nlm.nih.gov/34433187/
Castillo-Angeles M, Atkinson RB, Easter SR, et al. Pregnancy during surgical training: Are residency programs truly supporting their trainees? J Surg Educ. 2022;79(6):e92-e102. doi:10.1016/j.jsurg.2022.06.011 https://pubmed.ncbi.nlm.nih.gov/35842402/
Castillo-Angeles M, Smink DS, Rangel EL. Perspectives of general surgery program directors on paternity leave during surgical training. JAMA Surg. 2022;157(2):105-111. doi:10.1001/jamasurg.2021.6223 https://pubmed.ncbi.nlm.nih.gov/34851404/
Kanters AE, Shubeck SP. The importance of parental leave and lactation support for surgeons. Clin Colon Rectal Surg. 2023;36(5):333-337. doi:10.1055/s-0043-1764288 https://pubmed.ncbi.nlm.nih.gov/37564351/
Kling SM, Slashinski MJ, Green RL, Taylor GA, Dunham P, Kuo LE. Parental leave experiences for the non-childbearing general surgery resident parent: A qualitative analysis. Surgery. 2024;176(5):1320-1326. doi:10.1016/j.surg.2024.04.035 https://pubmed.ncbi.nlm.nih.gov/38910045/
Mann H, Glazer T. Current state of safe pregnancy policies for the US surgical trainee. OTO Open. 2024;8(3):e172. doi:10.1002/oto2.172 https://pubmed.ncbi.nlm.nih.gov/39036338/
Rangel EL, Smink DS, Castillo-Angeles M, et al. Pregnancy and motherhood during surgical training. JAMA Surg. 2018;153(7):644-652. doi:10.1001/jamasurg.2018.0153 https://pubmed.ncbi.nlm.nih.gov/29562068/
Rangel EL, Castillo-Angeles M, Easter SR, et al. Incidence of infertility and pregnancy complications in US female surgeons. JAMA Surg. 2021;156(10):905-915. doi:10.1001/jamasurg.2021.3301 https://pubmed.ncbi.nlm.nih.gov/34319353/
https://www.nytimes.com/2019/12/20/science/doctors-surgery-motherhood-medical-school.html
https://behindtheknife.org/podcast/family-leave-during-surgical-training-a-discussion-with-abs-president-dr-jo-buyske
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
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This new mini-series on Behind the Knife will delve into the technical aspects of the Operative Standards for Cancer Surgery, developed through the American College of Surgeons Cancer Research Program. This second episode highlights the thyroid cancer operative standard.
Hosts:
Tracy Wang, MD, MPH, FACS is a Professor of Surgery and Vice-Chair of Strategic and Professional Development at the Medical College of Wisconsin with a clinical focus on endocrine surgical oncology.
Vladmir Neychev, MD, PhD is a Professor of Surgery at the University of Central Florida College of Medicine with a clinical focus on endocrine surgical oncology.
Jack Sample, MD (@JackWSample) is a General Surgery Resident at Mayo Clinic Rochester.
Guests:
Elizabeth Grubbs, MD (@EGrubbsMD) is a Professor of Surgical Oncology at MD Anderson where she specializes in endocrine tumors, with expertise in cancer of the thyroid.
David Hughes, MD is a Clinical Associate Professor of Surgery at University of Michigan, where he focuses on surgical diseases of the endocrine system, including a particular focus on the diagnosis and management of papillary thyroid cancer.
Learning Objectives: Understand key preoperative and intraoperative aspects of the evaluation and treatment of patients with biopsy-proven papillary thyroid carcinoma (PTC) greater than or equal to 1 cm. Define factors that guide decision making regarding the extent of surgical resection (lobectomy versus total thyroidectomy) for PTC.
Links to Papers Referenced in this Episode
Operative Standards for Cancer Surgery, Volume 2: Thyroid, Gastric, Rectum, Esophagus, Melanoma
https://www.facs.org/quality-programs/cancer-programs/cancer-surgery-standards-program/operative-standards-for-cancer-surgery/purchase/
Kindle edition:
Amazon.com: Operative Standards for Cancer Surgery: Volume 2, Section 1: Thyroid eBook : Program, American College of Surgeons Clinical Research, Katz, Matthew HG: Kindle Store
Impact of Extent of Surgery on Survival for Papillary Thyroid Cancer Patients Younger Than 45 years.
https://pubmed.ncbi.nlm.nih.gov/25337927/
Extent of Surgery Affects Survival for Papillary Thyroid Cancer.
https://pubmed.ncbi.nlm.nih.gov/17717441/
Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
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Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
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Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
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In resuscitative trauma surgery every second counts. Can time and lives be saved by moving interventions closer to the point of injury? In this episode, we discuss a recent journal article on prehospital resuscitative thoracotomy as a treatment for traumatic cardiac arrest. Opening the chest on the street, who should do it, why should we do it, and for whom?
• Hosts:
- Mr Prashanth Ramaraj. General Surgery trainee, Edinburgh rotation. @LonTraumaSchool
- Dr Roisin Kelly. Major Trauma Junior Clinical Fellow, Royal London Hospital.
- Mr Max Marsden. Resuscitative Major Trauma Fellow, Royal London Hospital. @maxmarsden83
- Mr Christopher Aylwin. Consultant Trauma & Vascular Surgeon, Royal London Hospital and Co-Programme Director MSc Trauma Sciences at Queen Mary University of London. @cjaylwin
- Mr Zane Perkins. Consultant Trauma & UGI Surgeon, Royal London Hospital and Prehospital Surgeon at London’s Air Ambulance. @ZBPerkins
• Learning objectives:
A) To be aware of the steps of a resuscitative thoracotomy (RT)
B) To understand the rational for prehospital (PH) trauma interventions.
C) To understand the timelines required to optimise success in PH RT.
D) To be familiar with the training governance for clinicians undertaking PH RT.
E) To recognise that PH RT is predominantly an intervention for cardiac tamponade.
F) To understand the contexts in which PH RT might be successful as a standardised intervention.
• References:
- Perkins ZB, Greenhalgh R, Ter Avest E, Aziz S, Whitehouse A, Read S, Foster L, Chege F, Henry C, Carden R, Kocierz L, Davies G, Hurst T, Lendrum R, Thomas SH, Lockey DJ, Christian MD. Prehospital Resuscitative Thoracotomy for Traumatic Cardiac Arrest. JAMA Surg. 2025 Feb 26;160(4):432–40. doi: 10.1001/jamasurg.2024.7245. PMID: 40009367; PMCID: PMC11866073. https://pubmed.ncbi.nlm.nih.gov/40009367/
- ter Avest, E., Kocierz, L., Alvarez, C. et al. Improving decision-making for prehospital Resuscitative Thoracotomy in traumatic cardiac arrest: a data-driven approach. Crit Care 29, 485 (2025). https://doi.org/10.1186/s13054-025-05705-z. https://pubmed.ncbi.nlm.nih.gov/41233917/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Download our App:
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
In their fourth episode, the BTK Surgical Endoscopy team delves into the endoscopic management of the dreaded and unexpected. They review how to take care of high-risk surgical complications and introduce the use of a number of endoscopic tools including suturing, stent placement, clips, and the EndoVac. Following a review of a variety of endoscopic techniques, they present case-based scenarios that allow the listeners to understand the application of the endoscopic interventions in everyday practice. Becoming facile with endoscopic interventions may give surgeons the ability to nonoperatively take care of the most complex patients.
Hosts:
- Dr. Sullivan “Sully” Ayuso, Minimally Invasive Surgeon, Dell Medical School, University of Texas at Austin (Austin, TX), @SAyusoMD (Twitter)
- Dr. H. Mason Hedberg, Minimally Invasive Surgeon, Endeavor Health (Evanston, IL)
- Dr. Trevor Crafts, Minimally Invasive Surgeon, Rocky Mountain VA Medical Center (Denver, CO), @CraftsTrevor (Twitter)
- Dr. Zachary Callahan, Minimally Invasive Surgeon, Nashville Surgical Associates (Nashville, TN), @zmcallahan (Twitter)
Video Link: https://app.behindtheknife.org/video/surgical-endoscopy-series-ep-4-endoscopic-management-of-complications
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Download our App:
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Picture this: a patient with early-stage breast cancer is sitting in front of you in the clinic. You are about to offer your expert management plan. The age-old question arises—should you really perform a sentinel lymph node biopsy, or could omission actually help this patient more? Today, we're tackling one of the hottest debates in modern breast cancer care.
Should we rethink sentinel lymph node biopsy for select patients, and can skipping it actually improve quality of life without sacrificing cancer control? The stakes couldn’t be higher—balancing accurate cancer staging and minimizing harm is the name of the game. Together, we’re breaking down the latest evidence from the SOUND and INSEMA trials. What do these landmark studies mean for your patients, your practice, and the future of axillary management? Ready for a journal review that might just change your next consult?
Hosts:- Rashmi Kumar, MD, PhDResident, University of Michigan General Surgery Residency Program
Twitter/X: @RashmiJKumar
- Melissa Pilewskie, MDAttending Breast Surgical Oncologist, Co-Director of the Weiser Family Center for Breast Cancer, Michigan Medicine
Twitter/X: @MPilewskie
- Stephanie Downs-Canner, MDAttending Breast Surgical Oncologist & Physician-Scientist, Memorial Sloan Kettering Cancer Center, Program Director of the Breast Surgical Oncology Fellowship Training Program
Twitter/X: @SDownsCanner
Learning Objectives:- Understand when and for whom it is safe and beneficial to omit sentinel lymph node biopsy (SLNB) in early-stage breast cancer patients.
- Identify the risks associated with foregoing SLNB, including loss of nodal staging, and analyze how this impacts treatment selection and prognosis.
- Review key findings from the SOUND and INSEMA trials and their influence on axillary management.
- Discuss implications for adjuvant therapy, genomic profiling, and multidisciplinary clinical practice.
- Recognize which patient populations should still receive SLNB, and the importance of individualized, multidisciplinary decision-making.
References:- Gentilini OD, Botteri E, Sangalli C, et al. Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial. JAMA Oncol. 2023;9(11):1557–1564. doi:10.1001/jamaoncol.2023.3759 https://pubmed.ncbi.nlm.nih.gov/37733364/
- Reimer T, Stachs A, Veselinovic K, et al. Axillary surgery in breast cancer – primary results of the INSEMA trial. N Eng J Med. 2024. doi:10.1056/NEJMoa2412063.
https://pubmed.ncbi.nlm.nih.gov/39665649/
- Sparano JA, Gray RJ, Makower DF, Albain KS, Saphner TJ, Badve SS, Wagner LI, Kaklamani VG, Keane MM, Gomez HL, Reddy PS, Goggins TF, Mayer IA, Toppmeyer DL, Brufsky AM, Goetz MP, Berenberg JL, Mahalcioiu C, Desbiens C, Hayes DF, Dees EC, Geyer CE Jr, Olson JA Jr, Wood WC, Lively T, Paik S, Ellis MJ, Abrams J, Sledge GW Jr. Clinical Outcomes in Early Breast Cancer With a High 21-Gene Recurrence Score of 26 to 100 Assigned to Adjuvant Chemotherapy Plus Endocrine Therapy: A Secondary Analysis of the TAILORx Randomized Clinical Trial. JAMA Oncol. 2020 Mar 1;6(3):367-374. doi: 10.1001/jamaoncol.2019.4794. PMID: 31566680; PMCID: PMC6777230. https://pubmed.ncbi.nlm.nih.gov/31566680/
- Slamon DJ, Fasching PA, Hurvitz S, Chia S, Crown J, Martín M, Barrios CH, Bardia A, Im SA, Yardley DA, Untch M, Huang CS, Stroyakovskiy D, Xu B, Moroose RL, Loi S, Visco F, Bee-Munteanu V, Afenjar K, Fresco R, Taran T, Chakravartty A, Zarate JP, Lteif A, Hortobagyi GN. Rationale and trial design of NATALEE: a Phase III trial of adjuvant ribociclib + endocrine therapy versus endocrine therapy alone in patients with HR+/HER2- early breast cancer. Ther Adv Med Oncol. 2023 May 29;15:17588359231178125. doi: 10.1177/17588359231178125. Erratum in: Ther Adv Med Oncol. 2023 Sep 29;15:17588359231201818. doi: 10.1177/17588359231201818. PMID: 37275963; PMCID: PMC10233570. https://pubmed.ncbi.nlm.nih.gov/37275963/
Sponsor Disclosure: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Download our App:
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
This episode offers a practical, case-based overview of evaluating and managing anastomotic leaks in colorectal surgery. It highlights early clinical warning signs, optimal imaging, and a framework for choosing nonoperative versus operative strategies, including when to drain, divert, repair, or revise an anastomosis. The discussion also covers management considerations in diverted patients and those with Crohn’s disease, as well as long-term issues such as chronic leak–related complications and planning for stoma reversal. Join Drs. Jared Hendren, Elissa Dabaghi, Joseph Trunzo, Ajaratu Keshinro, and David Rosen as they discuss this clinical challenge in colorectal surgery.
Hosts:
- Jared Hendren, MD
ο Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio
- Elissa Dabaghi, MD
ο Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio
- Joseph Trunzo, MD
ο Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio
ο Social Media Handle: X/Twitter @joseph_trunzo
- Ajaratu Keshinro, MD
ο Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio
ο Social Media Handle: X/Twitter- @AJKesh
- David Rosen, MD
ο Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio
- Social Media Handle: X/Twitter- @davidrrosenmd
Learning Objectives: By the end of this episode, listeners will be able to:
- Assess postoperative changes that warrant imaging and/or intervention in suspected anastomotic leaks.
- Apply a structured decision-making approach to determine when nonoperative management, drainage, diversion, or operative intervention is most appropriate.
- Recognize key considerations in managing leaks in diverted patients and those with Crohn’s disease, including long-term complications and factors influencing stoma reversal planning.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Download our App:
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Ever feel powerless in the clinical environment? You’re not alone - and you may have more power than you think. In this Clinical Challenges in Surgical Education, hosts Drs. Maya Hunt and Mckenzie Rowe explore power and leadership within surgical learning environments. Joined by guests Drs. Paula Ferrada, Chair of Surgery at Inova Fairfax, and Frances Mei Hardin, co-founder of the Hippocratic Collective, the team discusses frameworks of conceptualizing power, how it can be found at any point in training, and tips on how to identify and better wield our own power in learning environments.
Episode Hosts:* Dr. Maya Hunt, Indiana University, mayahunt@iu.edu * Dr. Mckenzie Rowe, Inova Fairfax, mckenzie.rowe@inova.org * CoSEF: @surgedfellows, cosef.org
Guests: * Dr. Paula Ferrada, Inova Fairfax, @pferrada1, paula.ferrada@inova.org * Dr. Frances Mei Hardin, Hippocratic Collective, @francesmeimd, francesmei@hippocratic-collective.com
Learning Objectives:* Identify different sources of power within individuals * Define framework of ‘power-over’ vs. ‘power-to/power-with’ * Recognize how leaders (including residents) may wield different types of power in both harmful and helpful ways * Spark self-reflection upon how each of us wields our own power in our role
References:1. Brown B. Brené Brown on Power and Leadership. https://brenebrown.com/resources/brene-brown-on-power-and-leadership/. 2. Pansardi P, Bindi M. The new concepts of power? Power-over, power-to and power-with. Journal of Political Power. 2021;14(1):51-71. doi:10.1080/2158379x.2021.1877001 3. Bolman LG, Deal TE. Power, Conflict, and Coalition. In: Reframing Organizations: Artistry, Choice, and Leadership. 7th ed. Jossey-Bass; 2021:187-207. 4. Ferrada P. Breaking the silence: Addressing toxic leadership to restore psychological safety in healthcare. Forbes. October 8, 2025. https://www.forbes.com/councils/forbesbusinesscouncil/2025/10/08/breaking-the-silence-addressing-toxic-leadership-to-restore-psychological-safety-in-healthcare/.
Sponsor Disclaimer:
Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content.
Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Download our App:
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
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Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
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Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
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Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
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Peripheral artery disease has been called the ‘silent circulatory crisis’—affecting millions, limiting mobility, and quietly raising the risk of heart attack, stroke, and limb loss. For decades, treatment focused on walking programs, aspirin, and sometimes a stent or bypass. But today, the landscape is changing. From PCSK9 inhibitors that drive cholesterol to record lows, to GLP-1 agonists like semaglutide improving walking distance, to novel antithrombotic strategies that balance bleeding and clotting—PAD care is entering a new era. In this episode, we’ll explore the breakthroughs, the evidence behind them, and what they mean for patients who just want to keep moving forward.
Hosted by the University of Michigan Department of Vascular Surgery:- Robert Beaulieu, Program Director
- Frank Davis, Assistant Professor of Surgery
- Luciano Delbono, PGY-5 House Officer
- Andrew Huang, PGY-4 House Officer
- Carolyn Judge, PGY-2 House Officer
Learning objectives:
1. Describe the current evidence-based recommendations for multifactorial medical management of peripheral artery disease (PAD), including lipid, glycemic, and antithrombotic strategies per 2024 SVS/AHA guidelines.
-
Interpret the clinical implications of the FOURIER trial regarding the role of PCSK9 inhibition in reducing cardiovascular events in patients with atherosclerotic disease, including PAD.
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Evaluate the emerging role of GLP-1 receptor agonists, such as semaglutide, in improving walking performance and quality of life among patients with diabetic PAD based on findings from the STRIDE trial.
Sponsor URL: https://www.goremedical.com/
References:
H. L. Gornik et al., “2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease,” JACC, vol. 83, no. 24, pp. 2497–2604, June 2024, doi: 10.1016/j.jacc.2024.02.013.
L. Mazzolai et al., “2024 ESC Guidelines for the management of peripheral arterial and aortic diseases: Developed by the task force on the management of peripheral arterial and aortic diseases of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), the European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN), and the European Society of Vascular Medicine (ESVM),” Eur Heart J, vol. 45, no. 36, pp. 3538–3700, Sept. 2024, doi: 10.1093/eurheartj/ehae179.
https://pubmed.ncbi.nlm.nih.gov/40169145/
M. S. Sabatine et al., “Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease,” N Engl J Med, vol. 376, no. 18, pp. 1713–1722, May 2017, doi: 10.1056/NEJMoa1615664.
https://pubmed.ncbi.nlm.nih.gov/28304224/
M. P. Bonaca et al., “Semaglutide and walking capacity in people with symptomatic peripheral artery disease and type 2 diabetes (STRIDE): a phase 3b, double-blind, randomised, placebo-controlled trial,” Lancet, vol. 405, no. 10489, pp. 1580–1593, May 2025, doi: 10.1016/S0140-6736(25)00509-4.
https://pubmed.ncbi.nlm.nih.gov/40169145/
N. E. Hubbard, D. Lim, and K. L. Erickson, “Beef tallow increases the potency of conjugated linoleic acid in the reduction of mouse mammary tumor metastasis,” J Nutr, vol. 136, no. 1, pp. 88–93, Jan. 2006, doi: 10.1093/jn/136.1.88.
https://pubmed.ncbi.nlm.nih.gov/16365064/
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Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
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Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
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Strap in and grab your NG tubes, because the EGS team in TIGER Country is taking you on a fast, forceful, and evidence-packed ride through 15 years of global SBO literature. From the OG 2011 Zielinski model to the latest 2025 predictive tools sweeping across Europe and North America, we’re breaking down what matters when the bowel stops behaving and the clock starts ticking.
Join Dr. Rushabh Dev and the Acute Care Surgery crew at the University of Missouri as they tackle the most common EGS consult in America with humor, data, and real-world pearls. Get ready for CT red flags, strangulation scores, Gastrografin truths, and the eternal battle between “operate early” vs. “wait it out.” Whether you’re a med student trying to decode your first CT or a seasoned attending debating the next Gastrografin challenge, this episode delivers the insights you need to Dominate the Day.
Participants:* Dr. Rushabh Dev FACS (Moderator, Surgical Attending) – Assistant Professor of Surgery, Associate PD ACS & SCCM Fellowship, SICU Medical Director, Lieutenant Commander United States Navy Reserve * Dr. Raymond Okeke; Acute Care Surgery & SCCM Fellow * Dr. Eugene Ismailov, General Surgery Resident; PGY 5 * Dr. Brycen Ratcliffe, General Surgery Resident; PGY 4 * Dr. Desra Flecher, General Surgery Resident; PGY 3
Objectives:
1. Identify the core clinical and CT predictors of operative need in SBO including mesenteric edema, free fluid, closed-loop obstruction, lack of enhancement, and feces sign absence — and understand how these features have remained consistent across 15 years of research.
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Compare major international SBO predictive models (Zielinski, Geneva Severity Score, STRISK, and NOFA) and describe how they inform real-time decision-making in North American acute care surgery.
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Apply evidence-based algorithms, including the 2025 JTACS EGS pathway to structure SBO evaluation, integrate Water-Soluble Contrast studies, and avoid delayed surgery in high-risk patients.
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Evaluate the long-term impact of operative vs. non-operative management with emphasis on recurrence risk, timing between episodes, and how to incorporate recurrence data into patient counseling.
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Synthesize 15 years of evolving SBO literature into practical bedside strategies by balancing red-flag findings, risk-model guidance, and individualized clinical judgment to optimize outcomes.
STRISK and NOFA Calculator: Prediction Models | Clinical Abdominal Surgery Helsinki
References
1. Geneva Clinical Severity Score
Wassmer, C. H., Guber, J., Zeindler, J., Meier, R. P. H., Ouaïssi, M., Ris, F., Morel, P., Didier, C., & Gkikas, I. (2023). A new clinical severity score for the management of adhesive small bowel obstruction: A cohort study. International Journal of Surgery, 109, 262–270. https://pubmed.ncbi.nlm.nih.gov/37026805/
2. STRISK & NOFA Predictive Models
Räty, S., Rinta-Kilpinen, E., Eklund, M., Turunen, N., Koskinen, I., Rasilainen, S., Korhonen, T., & Paajanen, H. (2025). Development and external validation of prediction risk models for strangulation or non-operative treatment failure in small bowel obstruction: A multicenter prospective study. Surgery, 178(1), 45–56.
Prediction Models | Clinical Abdominal Surgery Helsinki
3. JTACS EGS Algorithm – Evidence-Based, Cost-Effective Management
Livingston, D. H., Wolfson, D., Cogbill, T. H., Rice, T. W., Patel, N., et al. (2025). Evidence-based, cost-effective management of small bowel obstruction: An Emergency General Surgery Algorithms Work Group project. Journal of Trauma and Acute Care Surgery, 98(4), 512–528. https://pubmed.ncbi.nlm.nih.gov/40842046/
4. Tennessee Recurrence Study (Operative vs Non-Operative Management)
Medvecz, A. J., Dennis, B. M., Wang, L., Countouris, M. E., Croce, M. A., Sharpe, J. P., Ivanova, A., & Miller, R. S. (2020). Impact of operative management on recurrence of adhesive small bowel obstruction: A longitudinal analysis of a statewide database. Journal of the American College of Surgeons, 230(4), 544–551.e1. https://pubmed.ncbi.nlm.nih.gov/31954815/
5. Early Predictive SBO Work – Zielinski (2010–2011)
Zielinski, M. D., Eiken, P. W., Bannon, M. P., Heller, S. F., Lohse, C. M., & Huebner, M. (2010). Small bowel obstruction—Who needs an operation? A multivariate prediction model. World Journal of Surgery, 34(5), 910–919. https://pubmed.ncbi.nlm.nih.gov/20217412/
- Zielinski, M. D., Haddad, N. N., Cullinane, D. C., Eiken, P. W., & Huebner, M. (2011). Prospective, observational validation of a multivariate small bowel obstruction model to predict the need for operative intervention. Journal of the American College of Surgeons, 212(6), 1068–1076. https://pubmed.ncbi.nlm.nih.gov/21458305/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
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Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
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Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
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Endocrine Surgery emergencies are rare. However, they can be clinically significant and understanding how to navigate them as a surgeon in timely fashion is critical.
Hosts:
Dr. Rebecca Sippel is an endowed professor of surgery and Division Chief of Endocrine Surgery at University of Wisconsin (UW) - Madison, and she is the most recent past president of the American Association of Endocrine Surgeons (AAES). She is an internationally recognized leader in the field of endocrine surgery with over 250 publications. She was the principal investigator for a hallmark randomized controlled trial which studied the need for prophylactic central neck dissections in thyroid cancer.
Dr. Amanda Doubleday is a fellowship trained endocrine surgeon in private practice with an affiliation to UW Health. Her primary practice is with Waukesha Surgical Specialists in Waukesha WI. Her clinical interests are in robotic adrenalectomy, benign and malignant thyroid cancer and hyperparathyroidism.
Dr. Simon Holoubek is a fellowship trained endocrine surgeon affiliated with UW Health. His primary practice is with UW Health with privileges at UW Madison and UW Northern Illinois. His clinical interests are aggressive variants of thyroid cancer, parathyroid autofluorescence, and nerve monitoring.
Learning Objectives:
1) Learn about thyroid storm in hyperthyroidism and treatment options.
2) Understand how to treat hypercalcemic crisis due to uncontrolled primary hyperparathyroidism.
3) Describe the modified surgical techniques required for thyroidectomy in patients with Graves’ disease to prevent recurrent laryngeal nerve traction injury.
4) Identify clinical and intraoperative indicators of parathyroid carcinoma and explain the necessity of en bloc resection to prevent parathyromatosis.
References:
1 Palit TK, Miller CC 3rd, Miltenburg DM. The efficacy of thyroidectomy for Graves' disease: A meta-analysis. J Surg Res. 2000 May 15;90(2):161-5. doi: 10.1006/jsre.2000.5875. PMID: 10792958. https://pubmed.ncbi.nlm.nih.gov/10792958/
2 Yoshimura Noh J, Inoue K, Suzuki N, Yoshihara A, Fukushita M, Matsumoto M, Imai H, Hiruma S, Ichikawa M, Koshibu M, Sankoda A, Hirose R, Watanabe N, Sugino K, Ito K. Dose-dependent incidence of agranulocytosis in patients treated with methimazole and propylthiouracil. Endocr J. 2024 Jul 12;71(7):695-703. doi: 10.1507/endocrj.EJ24-0135. Epub 2024 May 3. PMID: 38710619. https://pubmed.ncbi.nlm.nih.gov/38710619/
3 Christopher L, Mellman M, Buicko JL. Management of Hypercalcemic Crisis due to Primary Hyperparathyroidism During Pregnancy. Am Surg. 2023 Aug;89(8):3638-3640. doi: 10.1177/00031348231162704. Epub 2023 Apr 27. PMID: 37102502. https://pubmed.ncbi.nlm.nih.gov/37102502/
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
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Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Welcome back for our series on AI for the clinician. This episode is a discussion about the ethical challenges and questions of AI in surgery, and there are often more questions than answers.
Hosts:
Ayman Ali, MD
Ayman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital in his academic development time where he focuses on data science, artificial intelligence, and surgery.
Ruchi Thanawala, MD: @Ruchi_TJ
Ruchi Thanawala is an Associate Professor of Thoracic Surgery and Faculty in the Informatics Division at Oregon Health and Science University (tOHSU) and founder of Firefly, an AI-driven platform that is built for competency-based medical education. In addition, she directs the Surgical Data and Decision Sciences Lab for the Department of Surgery at OHSU.
Phillip Jenkins, MD: @PhilJenkinsMD
Phil Jenkins is a general surgery PGY-4 at Oregon Health and Science University and a National Library of Medicine Post-Doctoral fellow pursuing a master’s in clinical informatics.
Steven Bedrick, PhD: @stevenbedrick
Steven Bedrick is a machine learning researcher and an Associate Professor in Oregon Health and Science University’s Division of Informatics, Clinical Epidemiology, and Translational Data Science. His research is focused on biomedical applications for speech and language technologies, with particular emphases on facilitating secondary use of electronic health record data and on supporting the diagnosis and management of language and communication disorders.
Ryan Antiel, MD: @RyanAntiel
Ryan Antiel is an Associate Professor of Pediatric Surgery at Duke Hospital and an associate director of the Trent Center for Bioethics, Humanities, and History of Medicine. His research addresses ethical challenges surrounding the care of seriously ill fetuses and neonates. He is also interested in the moral formation of surgical trainees.
Kayte Spector-Bagdady, JD: @KayteSB
Kayte Spector-Bagdady is the Wantz Professor of Bioethics and Director of Michigan Bioethics at the University of Michigan Medical School. Her research focuses on increasing accessibility of health data for research and generalizability for diverse patient populations. She is also the former Associate Director for President Obama’s bioethics commission.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Download our App:
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
It’s 1:00 AM on a Saturday and a patient arrives with a gunshot wound and no distal pulses—who should hold the scalpel, Trauma or Vascular? In this episode of Big T Trauma, hosts Dr. Patrick Georgoff and Dr. Teddy Puzio are joined by vascular surgeon Dr. Brian Gilmore and dual-trained powerhouse Dr. Joe DuBose to debate this high-stakes turf war. We tackle the uncomfortable reality of declining vascular exposure in general surgery training and whether current "vascular expertise" standards are failing our patients. From the rise of endovascular technology to navigating institutional politics, our panel breaks down how to bridge the gap between specialties for better patient outcomes.
This episode of Big T Trauma was sponsored by Teleflex, a global provider of medical devices. Learn more at teleflex.com and at the Teleflex Trauma and Emergency Medicine LinkedIn page.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Download our App:
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Welcome back to our BTK/ASGBI Series! During this series, BTK fellow Agnes Premkumar and ASGBI hosts Jared Wohlgemut and Gita Lingam compare and contrast various aspects of surgery between the United States and the United Kingdom, debating who does what better.
We are happy to be continuing our AI discussion further with another episode. While last episode lay a foundation on discussing the unique differences in the role and regulation of AI in both these countries, now we delve into some of the clinical challenges. What does AI and the future of surgery look like in underserved locations such as the battlefield or the rural communities. What does this mean for our future as surgeons…will we be replaced? And how should we address the integration of AI within our practices?
We are thrilled to have our trio of experts discussing this further. Dr. Nelson is a surgical oncologist working at the Brook Army Medical Center in San Antonio, he's very interested in expanding the role of AI within surgical education and beyond. Dr. Larson is a general surgery resident at the Mayo Clinic. She's currently in her research time and finishing up her master's degree in AI and studying the role of machine learning within surgical practice. Dr. Mukherjee is a surgeon scientist alongside an Honorary Consultant General & Major Trauma Surgeon in Liverpool, England. His current research bridges academia with industry and is aimed at transforming the treatment of critical illness through the development of next-generation therapies for pancreatitis-induced acute lung injury through the utilisation of cutting-edge AI driven drug discovery approaches.
Take a listen and let us know what you think!
References:
Johns’ Hopkins Ex-Vivo Cholecystectomy by a Robot
https://hub.jhu.edu/2025/07/09/robot-performs-first-realistic-surgery-without-human-help/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Download our App:
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general
Welcome back to our BTK/ASGBI Series! During this series, BTK fellow Agnes Premkumar and ASGBI hosts Jared Wohlgemut and Gita Lingam compare and contrast various aspects of surgery between the United States and the United Kingdom, debating who does what better.
In this episode, we delve into all things artificial intelligence (AI) within surgery. Both the US and the UK have unique approaches to managing AI within healthcare and our experts help break down these key similarities and differences. We will discuss what AI and machine learning means, what does regulation look like in both these regions, and how is AI being used in both these countries.
We are fortunate to have two representatives, Dr. Nelson and Dr. Larson, representing the US side. Dr. Nelson is a surgical oncologist working at the Brook Army Medical Center in San Antonio, he's very interested in expanding the role of AI within surgical education and beyond. Dr. Larson is a general surgery resident at the Mayo Clinic. She's currently in her research time and finishing up her master's degree in AI and studying the role of machine learning within surgical practice.
We are fortunate to have Dr. Mukherjee representing the UK side. Dr. Mukherjee is a surgeon scientist alongside an Honorary Consultant General & Major Trauma Surgeon in Liverpool, England. He has a strong track record in research that spans the translational spectrum, with strengths in discovery science related to acute pancreatitis pathophysiology and mitochondrial injury, novel in vitro and in vivo experimental assay development and clinical translational research, including novel biomarker studies and clinical trials. He has won multiple awards, most recently the Hunterian Professorship 2024 from the Royal College of Surgeons of England.
Take a listen and let us know what you think- what do you think is the best way to promote and regulate AI within healthcare?
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Download our App:
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US
Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
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Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
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Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
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In this episode of Behind the Knife, the minimally invasive surgery (MIS) team dives deep into the evolving field of common bile duct exploration (CBDE). From the historical context of laparoscopic approaches to the latest advances including robotic-assisted techniques, Drs. Shaina Eckhouse, James Jung, Zachary Weitzner, and Joey Lew discuss key evidence shaping modern practice. Listeners will learn about indications and anatomy guiding trans-cystic versus trans-choledochal approaches, practical tips for safe stone clearance, and critical considerations around learning curves and team coordination for robotic procedures. The episode also highlights important studies comparing single-stage laparoscopic CBDE with staged ERCP and cholecystectomy, emphasizing outcomes such as stone clearance, pancreatitis rates, and hospital length of stay. This comprehensive overview is a must-listen for MIS and acute care surgeons interested in optimizing the management of choledocholithiasis and streamlining patient care with minimally invasive techniques.
Hosts:
- Shaina Eckhouse, MD, Bariatric Surgery Medical Director and Vice Chair of Clinical Operations, Department of Surgery, Duke University
- James Jung, MD, PhD, Assistant Professor of Surgery, Duke University
- Zachary Weitzner, MD, Minimally Invasive and Bariatric Surgery Fellow, Duke University, @ZachWeitznerMD
- Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actually
Learning Goals:
By the end of this episode, listeners will be able to:
- Describe the historical approaches to managing choledocholithiasis, including staged interventions and the evolution toward single-stage laparoscopic common bile duct exploration (CBDE).
- Summarize key clinical evidence comparing CBDE and ERCP, including landmark studies and meta-analyses evaluating outcomes, complications, and trends over time.
- Distinguish between transcystic and transcholedochal approaches to CBDE, explaining indications, contraindications, and technical nuances for each technique.
- Identify appropriate candidates for transcystic exploration based on cystic duct anatomy and stone characteristics.
- Recognize the impact of newer surgical technologies—such as digital choledochoscopy, Spyglass, and robotic platforms—on CBDE practice, efficiency, and safety.
- Discuss the importance of multidisciplinary teamwork, preparation, and perioperative planning for successful CBDE, particularly in complex or altered anatomy cases.
- Appraise the learning curve and quality of evidence for new CBDE procedures, outlining the need for mentorship, ongoing training, and knowing when to collaborate with GI or hepatopancreaticobiliary (HPB) surgery.
- Outline approaches and bailout strategies for challenging cases, including patients with surgically altered anatomy and use of adjuncts such as intraoperative cholangiography (IOC), feeding tube placement, and Fanelli stents.
- Evaluate safety outcomes and limitations associated with robotic-assisted CBDE and single-stage management, incorporating recent data from population-based studies.
- Reflect on strategies for tailoring CBDE techniques to individual patient anatomy, surgeon experience, and available resources, advocating for evidence-based practice and continuous learning.
References:- Giurgiu DI, Margulies DR, Carroll BJ, et al. Laparoscopic Common Bile Duct Exploration: Long-term Outcome. Arch Surg. 1999;134(8):839-844. doi:10.1001/archsurg.134.8.839 https://pubmed.ncbi.nlm.nih.gov/10443806/
- Lyu Y, Cheng Y, Li T, Cheng B, Jin X. Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis. Surg Endosc. 2019;33(10):3275-3286. doi:10.1007/s00464-018-06613-w https://pubmed.ncbi.nlm.nih.gov/30511313/
- Bekheit M, Smith R, Ramsay G, Soggiu F, Ghazanfar M, Ahmed I. Meta‐analysis of laparoscopic transcystic versus transcholedochal common bile duct exploration for choledocholithiasis. BJS Open. 2019;3(3):242-251. doi:10.1002/bjs5.50132 https://pubmed.ncbi.nlm.nih.gov/31183439/
- Cironi K, Martin MJ. Reclaim the duct! Laparoscopic common bile duct exploration for the acute care surgeon. Trauma Surg Acute Care Open. 2025;10(Suppl 1). doi:10.1136/tsaco-2025-001821 https://pubmed.ncbi.nlm.nih.gov/40255986/
- Zhang C, Cheung DC, Johnson E, et al. Robotic Common Bile Duct Exploration for Choledocholithiasis. JSLS J Soc Laparosc Robot Surg. 2025;29(1):e2024.00075. doi:10.4293/JSLS.2024.00075 https://pubmed.ncbi.nlm.nih.gov/40144383/
- Kalata S, Thumma JR, Norton EC, Dimick JB, Sheetz KH. Comparative Safety of Robotic-Assisted vs Laparoscopic Cholecystectomy. JAMA Surg. 2023;158(12):1303-1310. doi:10.1001/jamasurg.2023.4389 https://pubmed.ncbi.nlm.nih.gov/37728932/
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Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
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Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
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In this Thoracic Surgery episode of Behind the Knife we enjoy a conversation with world-renowned thoracic surgeon and educator, Dr. Stephen Yang, as he takes us through 30 years of experience divulging his personal tips, tricks, and pitfalls to avoid when tackling the technical nuances of mastering robotic segmentectomies.
Hosts: * Dr. Stephen C. Yang, MD - professor of surgery and medical oncology The Johns Hopkins Hospital * Dr. Kyla D. Rakoczy, MD - PGY3 General Surgery Resident at The Johns Hopkins Hospital
Learning Objectives:* Understand the utility of segmentectomies for peripheral T1N0 non-small-cell-lung cancer * How to prepare for robotic segmentectomy using CT scans and 3D reconstructions * Learn where to place your ports and how to optimize intra-operative techniques to minimize complications after robotic segmentectomy
References:
Kang MW. Evolution of Lung Cancer Surgery: Historical Milestones, Current Strategy, and Future Innovations. J Chest Surg. 2025 May 5;58(3):79-84. doi: 10.5090/jcs.25.025. Epub 2025 Apr 15. PMID: 40230346; PMCID: PMC12066400. https://pubmed.ncbi.nlm.nih.gov/40230346/
Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995 Sep;60(3):615-22; discussion 622-3. doi: 10.1016/0003-4975(95)00537-u. PMID: 7677489. https://pubmed.ncbi.nlm.nih.gov/7677489/
Pastorino U, Valente M, Bedini V, Infante M, Tavecchio L, Ravasi G. Limited resection for Stage I lung cancer. Eur J Surg Oncol. 1991 Feb;17(1):42-6. PMID: 1995356. https://pubmed.ncbi.nlm.nih.gov/1995356/
Liu L, Aokage K, Chen C, Chen C, Chen L, Kim YH, Lee CY, Liu C, Liu CC, Nishio W, Suzuki K, Tan L, Tseng YL, Yotsukura M, Watanabe SI. Asia expert consensus on segmentectomy in non-small cell lung cancer: A modified Delphi study. JTCVS Open. 2023 Apr 7;14:483-501. doi: 10.1016/j.xjon.2023.03.013. PMID: 37425437; PMCID: PMC10328970. https://pubmed.ncbi.nlm.nih.gov/37425437/
Galvez C, Bolufer S, Lirio F, Recuero JL, Córcoles JM, Socci L, Cabañero A, López I, Sánchez D, Figueroa S, Salcedo JG, Campo-Cañaveral JL, Genovés M, Hernando F, Moldes M, Blanco A, Azcarate L, Rivo E, Viti A, Mongil R. "Complex segmentectomies: Comparison with simple and effect of experience on postoperative outcomes". Eur J Surg Oncol. 2025 Jul;51(7):109748. doi: 10.1016/j.ejso.2025.109748. Epub 2025 Mar 5. PMID: 40064065.
https://pubmed.ncbi.nlm.nih.gov/40064065/
Perroni G, Veronesi G. Robotic segmentectomy: indication and technique. J Thorac Dis. 2020 Jun;12(6):3404-3410. doi: 10.21037/jtd.2020.02.53. PMID: 32642266; PMCID: PMC7330783. https://pubmed.ncbi.nlm.nih.gov/32642266/
Montagne, F., Dhainaut, C., & Benhamed, L. M. (n.d.). Pre-operative 3D reconstruction—let’s first anticipate the surgical procedure. Video-Assisted Thoracic Surgery. Retrieved November 13, 2025, from https://vats.amegroups.org/article/view/7889/html
Shimizu K, Nakazawa S, Nagashima T, Kuwano H, Mogi A. 3D-CT anatomy for VATS segmentectomy. J Vis Surg. 2017 Jul 1;3:88. doi: 10.21037/jovs.2017.05.10. PMID: 29078650; PMCID: PMC5637987. https://pubmed.ncbi.nlm.nih.gov/29078650/
Zhang O, Alzul R, Carelli M, Melfi F, Tian D, Cao C. Complications of Robotic Video-Assisted Thoracoscopic Surgery Compared to Open Thoracotomy for Resectable Non-Small Cell Lung Cancer. J Pers Med. 2022 Aug 12;12(8):1311. doi: 10.3390/jpm12081311. PMID: 36013260; PMCID: PMC9410342. https://pubmed.ncbi.nlm.nih.gov/36013260/
Lee BE, Altorki N. Sub-Lobar Resection: The New Standard of Care for Early-Stage Lung Cancer. Cancers (Basel). 2023 May 25;15(11):2914. doi: 10.3390/cancers15112914. PMID: 37296877; PMCID: PMC10251869. https://pubmed.ncbi.nlm.nih.gov/37296877/
Zhang Y, Liu S, Han Y, Xiang J, Cerfolio RJ, Li H. Robotic Anatomical Segmentectomy: An Analysis of the Learning Curve. Ann Thorac Surg. 2019 May;107(5):1515-1522. doi: 10.1016/j.athoracsur.2018.11.041. Epub 2018 Dec 19. PMID: 30578780. https://pubmed.ncbi.nlm.nih.gov/30578780/
Peeters M, Jansen Y, Daemen JHT, van Roozendaal LM, De Leyn P, Hulsewé KWE, Vissers YLJ, de Loos ER. The use of intravenous indocyanine green in minimally invasive segmental lung resections: a systematic review. Transl Lung Cancer Res. 2024 Mar 29;13(3):612-622. doi: 10.21037/tlcr-23-807. Epub 2024 Mar 27. PMID: 38601441; PMCID: PMC11002498. https://pubmed.ncbi.nlm.nih.gov/38601441/
Altorki N, Wang X, Damman B, Mentlick J, Landreneau R, Wigle D, Jones DR, Conti M, Ashrafi AS, Liberman M, de Perrot M, Mitchell JD, Keenan R, Bauer T, Miller D, Stinchcombe TE. Lobectomy, segmentectomy, or wedge resection for peripheral clinical T1aN0 non-small cell lung cancer: A post hoc analysis of CALGB 140503 (Alliance). J Thorac Cardiovasc Surg. 2024 Jan;167(1):338-347.e1. doi: 10.1016/j.jtcvs.2023.07.008. Epub 2023 Jul 18. Erratum in: J Thorac Cardiovasc Surg. 2025 Apr;169(4):1181. doi: 10.1016/j.jtcvs.2024.12.011. PMID: 37473998; PMCID: PMC10794519. https://pubmed.ncbi.nlm.nih.gov/37473998/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
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Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
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Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
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Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
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Liver transplantation continues to evolve as strategies expand to address organ shortage and optimize outcomes. Normothermic machine perfusion (NMP) offers a novel way to preserve and assess donor livers prior to implantation. In this episode of Behind the Knife, our transplant team at University of Nebraska Medical Center discusses the latest evidence from randomized trials, practical applications in donation after circulatory death (DCD) grafts, and how NMP is shaping clinical decision-making in high-risk transplants.
Hosts
- Madeline Cloonan, MD PhD, General Surgery Resident, University of Nebraska Medical Center, @maddie_cloonan
- Jacqueline Dauch, MD, Assistant Professor, University of Nebraska Medical Center
- Shaheed Merani, MD PhD, Associate Professor, University of Nebraska Medical Center
- Alan Langnas, DO, Professor, University of Nebraska Medical Center
Learning Objectives
- Describe the principles of normothermic machine perfusion (NMP) and how it differs from static cold storage.
- Summarize the design and key outcomes of the PROTECT trial and the Chapman et al. trial on NMP in liver transplantation.
- Recognize the clinical scenarios where NMP provides the greatest benefit, particularly in high-risk grafts (e.g., DCD donors, high donor risk index).
- Apply a practical viability assessment framework for livers on NMP, including hemodynamics, bile production, lactate trajectory, and histology when indicated.
- Discuss the implications of NMP for allocation, system logistics, and future adoption trends in transplantation.
References
1. Markmann JF, Abouljoud MS, Ghobrial RM, et al. Impact of portable normothermic blood-based machine perfusion on outcomes of liver transplant: the OCS Liver PROTECT randomized clinical trial. JAMA Surg. 2022;157(3):189-198. doi:10.1001/jamasurg.2021.6781. https://pubmed.ncbi.nlm.nih.gov/34985503/
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ChapmanWC, Barbas AS, D’Alessandro AM, et al. Normothermic machine perfusion of donor livers for transplantation in the United States: a randomized controlled trial. Ann Surg. 2023;278(5):e912-e921. doi:10.1097/SLA.0000000000005934. https://pubmed.ncbi.nlm.nih.gov/37389552/
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Nasralla D, Coussios CC, Mergental H, et al; Consortium for Organ Preservation in Europe. A randomized trial of normothermic preservation in liver transplantation. Nature. 2018;557(7703):50-56. doi:10.1038/s41586-018-0047-9. https://pubmed.ncbi.nlm.nih.gov/29670285/
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Brubaker AL, Sellers MT, Abt PL, et al. US liver transplant outcomes after normothermic regional perfusion vs standard super rapid recovery. JAMA Surg. 2024;159(6):677-685. doi:10.1001/jamasurg.2024.0520. https://pubmed.ncbi.nlm.nih.gov/38568597/
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Wall A, Snoddy M, Du J, et al. The current landscape of in situ and ex situ machine perfusion utilization for liver grafts from cardiac donation after circulatory death donors in the US. Am J Transplant. 2025;25(3):574-582. doi:10.1016/j.ajt.2024.09.012. https://pubmed.ncbi.nlm.nih.gov/39293517/
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Watson CJE, Gaurav R, Fear C, Swift L, Selves L, Ceresa CDL, Upponi SS, Brais R, Allison M, Macdonald-Wallis C, Taylor R, Butler AJ. Predicting Early Allograft Function After Normothermic Machine Perfusion. Transplantation. 2022 Dec 1;106(12):2391-2398. doi: 10.1097/TP.0000000000004263. https://pubmed.ncbi.nlm.nih.gov/36044364/
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Watson CJE, Hunt F, Messer S, Currie I, Large S, Sutherland A, Crick K, Wigmore SJ, Fear C, Cornateanu S, Randle LV, Terrace JD, Upponi S, Taylor R, Allen E, Butler AJ, Oniscu GC. In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival. Am J Transplant. 2019 Jun;19(6):1745-1758. doi: 10.1111/ajt.15241. https://pubmed.ncbi.nlm.nih.gov/30589499/
-
Olthoff KM, Kulik L, Samstein B, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl. 2010;16(8):943-949. doi:10.1002/lt.22091.https://pubmed.ncbi.nlm.nih.gov/20677285/
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Kwong AJ, Kim WR, Lake JR, Schladt DP, Handarova D, Howell J, Schumacher B, Weiss S, Snyder JJ, Israni AK. OPTN/SRTR 2023 Annual Data Report: Liver. Am J Transplant. 2025 Feb;25(2S1):S193-S287. doi: 10.1016/j.ajt.2025.01.022. https://pubmed.ncbi.nlm.nih.gov/39947804/
Ad Disclosures:
Visit goremedical.com/btk to learn more about GORE® ENFORM Biomaterial.
Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only
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In this kickoff episode of the Behind the Knife Global Surgery Series, we dive into what global surgery really means—and why it matters to all of us. Five billion people lack access to safe, timely, and affordable surgical care. Our guest, Dr. Juan Carlos Puyana, shares powerful insights on redefining global surgery, building meaningful collaborations, and why surgeons in high-resource countries should care deeply about this work. If you want to broaden your vision of surgery, challenge assumptions, and hear stories that connect operating rooms from South Carolina to South Africa, this is an episode you won’t want to miss.
Hosts/Guest:
Mike M. Mallah, MD, FACS, FICS
Director of Global Surgery at Medical University of South Carolina
@MikeMMallahMD
@MUSCGlobalSurg
mallahm@musc.edu
Juan Carlos Puyana, MD, FACS
O’Brian Chair of Global Surgery at the Royal College of Surgeons Ireland
@jcpuyanamd
@RCSI_GlobalSurg
Learning objectives:
* Define global surgery and explain how its meaning has evolved to highlight disparities in access to safe, timely, and affordable surgical care worldwide.
* Recognize the value of global surgery engagement for trainees and surgeons in high-resource settings, including broadening perspectives and fostering humility.
* Identify principles of ethical collaboration in global surgery, using real-world examples of partnerships built on trust, mutual respect, and shared goals.
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Surgical resection of perihilar cholangiocarcinoma (pCCA) is one of the highest-risk elective operations performed. The obstructive jaundice suffered by patients preoperatively, central location of the tumors, and extensive nature of the resection make pCCA one of the most challenging HPB disease processes. In this episode from the HPB team at Behind the Knife, listen in on the discussion about perioperative strategies to improve outcomes for surgical resection of perihilar cholangiocarcinoma.
Hosts
Anish J. Jain MD (@anishjayjain) is a current PGY4 General Surgery Resident at Stanford University and a former T32 Research Fellow at the University of Texas MD Anderson Cancer Center.
Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology at the University of Texas MD Anderson Cancer Center. He is also the associate program director of the HPB fellowship.
Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center.
Learning Objectives
· Develop an understanding of the three treatment sequences for resection of disease in patients with synchronous liver metastasis from a primary rectal cancer (reverse, combined, and classic approach)
· Develop an understanding of the benefits, risks, and nuances of each of the three treatment sequences
· Develop an understanding of which patient cases each treatment sequence is ideal for as well as which cases they are not suitable for.
Papers Referenced:
1) Ribero D, Zimmitti G, Aloia TA, Shindoh J, Fabio F, Amisano M, Passot G, Ferrero A, Vauthey JN. Preoperative Cholangitis and Future Liver Remnant Volume Determine the Risk of Liver Failure in Patients Undergoing Resection for Hilar Cholangiocarcinoma. J Am Coll Surg. 2016 Jul;223(1):87-97. https://pubmed.ncbi.nlm.nih.gov/27049784/
2) Jain AJ, Lendoire M, Haddad A, Tzeng CD, Boyev A, Maki H, Chun YS, Arvide EM, Lee S, Hu I, Pant S, Javle M, Tran Cao HS, Vauthey JN, Newhook TE. Improved Outcomes Following Resection of Perihilar Cholangiocarcinoma: A 27-Year Experience. Ann Surg Oncol. 2025 Jun;32(6):4352-4362. https://pubmed.ncbi.nlm.nih.gov/40000564/
Additional Suggested Reading
Olthof PB, Erdmann JI, Alikhanov R, Charco R, Guglielmi A, Hagendoorn J, Hakeem A, Hoogwater FJH, Jarnagin WR, Kazemier G, Lang H, Maithel SK, Malago M, Malik HZ, Nadalin S, Neumann U, Olde Damink SWM, Pratschke J, Ratti F, Ravaioli M, Roberts KJ, Schadde E, Schnitzbauer AA, Sparrelid E, Topal B, Troisi RI, Groot Koerkamp B; Perihilar Cholangiocarcinoma Collaboration Group. Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible. Ann Surg Oncol. 2024 Jul;31(7):4405-4412. https://pubmed.ncbi.nlm.nih.gov/38472674/
Mueller M, Breuer E, Mizuno T, Bartsch F, et al. Perihilar Cholangiocarcinoma - Novel Benchmark Values for Surgical and Oncological Outcomes From 24 Expert Centers. Ann Surg. 2021 Nov 1;274(5):780-788. https://pubmed.ncbi.nlm.nih.gov/34334638/
Ad Disclosures:
Visit goremedical.com/btk to learn more about GORE® ENFORM Biomaterial.
Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
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Join the Behind the Knife Surgical Oncology Team as we discuss the nuances in the work up and management of patients with pheochromocytomas.
Hosts:
Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center.
Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist/HPB surgeon at Kaiser LAMC in Los Angeles.
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a 2ndYear Surgical Oncology fellow at MD Anderson.
Beth (Elizabeth) Barbera, MD (@elizcarpenter16) is a General Surgery physician in the United States Air Force station at RAF Lakenheath.
Joe (Joseph) Broderick, MD, MA (@joebrod5) is a General Surgery research resident between his second and third year at Brooke Army Medical Center.
Galen Gist, MD (@gistgalen) is a General Surgery research resident between his second and third year at Brooke Army Medical Center.
Learning Objectives:
1) Review the presentation of patients with pheochromocytomas.
2) Review the work up of patients with pheochromocytomas.
3) Review the treatment of patients with pheochromocytomas.
4) Review the surveillance of patients with pheochromocytomas.
References used in the making of this episode:
Patel D. Surgical approach to patients with pheochromocytoma. Gland Surg. 2020;9(1):32-42. doi:10.21037/gs.2019.10.20. PMID: 32206597; PMCID:PMC7082266.
Eisenhofer G, Lenders JW, Siegert G, et al. Plasma methoxytyramine: a novel biomarker of metastatic pheochromocytoma and paraganglioma in relation to established risk factors of tumour size, location and SDHB mutation status. Eur J Cancer. 2012;48(11):1739-1749. doi:10.1016/j.ejca.2011.07.016. PMID:22036874; PMCID: PMC3372624.
Lenders JWM, Eisenhofer G, Mannelli M, Pacak K. Phaeochromocytoma. Lancet. 2005;366(9486):665-675. doi:10.1016/S0140-6736(05)67139-5.
Vicha A, Musil Z, Pacak K. Genetics of pheochromocytoma and paraganglioma syndromes: new advances and future treatment options. Curr Opin Endocrinol Diabetes Obes. 2013;20(3):186-191. doi:10.1097/MED.0b013e32835fcc45. PMID: 23481210; PMCID: PMC4711348. https://pubmed.ncbi.nlm.nih.gov/23481210/
Dickson PV, Alex GC, Grubbs EG, et al. Posterior retroperitoneoscopic adrenalectomy is a safe and effective alternative to transabdominal laparoscopic adrenalectomy for pheochromocytoma. Surgery. 2011;150(3):452-458. doi:10.1016/j.surg.2011.07.004. https://pubmed.ncbi.nlm.nih.gov/21878230/
Lei K, Wang X, Yang Z, et al. Comparison of the retroperitoneal laparoscopic adrenalectomy versus transperitoneal laparoscopic adrenalectomy for large (≥6 cm) pheochromocytomas: a single-centre retrospective study. Front Oncol. 2023;13:1043753. doi:10.3389/fonc.2023.1043753. PMID: 36910608; PMCID: PMC9992891. https://pubmed.ncbi.nlm.nih.gov/36910608/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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“It’s 5pm and your Consultant (attending) has headed off home. A patient arrives in the resuscitation room blood spurting from a stab wound in the armpit. Join Roisin – a junior Major Trauma fellow, Prash – a surgical trainee, Max – a senior trauma surgery fellow, and Chris – a Consultant trauma surgeon, as we talk through decision making from point of injury to aftercare in this challenging trauma surgical case”.
• Hosts: Bulleted list of host names, including title, institution, & social media handles if indicated
1. Mr Prashanth Ramaraj. General Surgery trainee, Edinburgh rotation. @LonTraumaSchool
2. Dr Roisin Kelly. Major Trauma Junior Clinical Fellow, Royal London Hospital.
3. Mr Max Marsden. Resuscitative Major Trauma Fellow, Royal London Hospital. @maxmarsden83
4. Mr Christopher Aylwin. Consultant Trauma & Vascular Surgeon and Co-Programme Director MSc Trauma Sciences at Queen Mary University of London. @cjaylwin
• Learning objectives: Bulleted list of learning objectives.
A) To become familiar with prehospital methods of haemorrhage control in penetrating junctional injuries.
B) To recognise the benefits of prehospital blood product resuscitation in some trauma patients.
C) To follow the nuanced decision making in decision for CT scan in a patient with a penetrating junctional injury.
D) To describe the possible approaches to the axillary artery in the context of resuscitative trauma surgery.
E) To become familiar with decision making around intraoperative systemic anticoagulation in the trauma patient.
F) To become familiar with decision making on type of repair and graft material in vascular trauma.
G) To recognise the team approach in holistic trauma care through the continuum of trauma care.
• References: Bulleted list of references with PubMed links.
- Perkins Z. et al., 2012. Epidemiology and Outcome of Vascular Trauma at a British Major Trauma Centre. EJVES. https://www.ejves.com/article/S1078-5884(12)00337-1/fulltext
- Ramaraj P., et al. 2025. The anatomical distribution of penetrating junctional injuries and their resource implications: A retrospective cohort study. Injury. https://www.injuryjournal.com/article/S0020-1383(24)00771-X/
- Smith, S., et al. 2019. The effectiveness of junctional tourniquets: A systematic review and meta-analysis. J Trauma Acute Care Surg. https://journals.lww.com/jtrauma/abstract/2019/03000/the_effectiveness_of_junctional_tourniquets__a.20.aspx
- Rijnhout TWH, et al. 2019. Is prehospital blood transfusion effective and safe in haemorrhagic trauma patients? A systematic review and meta-analysis. Injury. https://www.injuryjournal.com/article/S0020-1383(19)30133-0/
- Davenport R, et al. 2023. Prehospital blood transfusion: Can we agree on a standardised approach? Injury. https://www.injuryjournal.com/article/S0020-1383(22)00915-9.
- Borgman MA., et al. 2007. The Ratio of Blood Products Transfused Affects Mortality in Patients Receiving Massive Transfusions at a Combat Support Hospital. J Trauma Acute Care Surg. https://journals.lww.com/jtrauma/fulltext/2007/10000/the_ratio_of_blood_products_transfused_affects.13.aspx
- Holcomb JB., et al. 2013. The Prospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) Study. Comparative Effectiveness of a Time-Varying Treatment With Competing Risks. JAMA Surgery. https://jamanetwork.com/journals/jamasurgery/fullarticle/1379768
- Holcomb JB, et al. 2015. Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a 1:1:2 Ratio and Mortality in Patients With Severe Trauma. The PROPPR Randomized Clinical Trial. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2107789
- Davenport R., et al. 2023. Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury. The CRYOSTAT-2 Randomized Clinical Trial. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2810756
- Baksaas-Aasen K., et al. 2020. Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial. ICM. https://link.springer.com/article/10.1007/s00134-020-06266-1
- Wahlgren CM., et al. 2025. European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Vascular Trauma. EJVES. https://esvs.org/wp-content/uploads/2025/01/2025-Vascular-Trauma-Guidelines.pdf
- Khan S., et al. 2020. A meta-analysis on anticoagulation after vascular trauma. Eur J Traum Emerg Surg. https://link.springer.com/article/10.1007/s00068-020-01321-4
- Stonko DP., et al. 2022. Postoperative antiplatelet and/or anticoagulation use does not impact complication or reintervention rates after vein repair of arterial injury: A PROOVIT study. Vascular. https://journals.sagepub.com/doi/10.1177/17085381221082371?url_ver=Z39.88-2003𝔯_id=ori:rid:crossref.org𝔯_dat=cr_pub%20%200pubmed
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It has arrived! Introducing Behind the Knife's Oral Board Simulator (beta version):* Unlimited unique oral board scenarios * Available 24/7 * Diverse examiners * Natural conversation * Detailed, actionable feedback based on SCORE curriculum and American Board of Surgery grading scheme * Try it for free for a limited time!
Note, this is our FIRST version of the Oral Board Simulator. To make it better, we need your feedback. After using the simulator, please take <1 minute to complete the feedback form. This will help us refine the simulator and improve the user experience.
On this pod, we are thrilled to introduce the newest member of the Behind the Knife team, Dr. Matthew Swenson. Dr. Swenson is a general surgeon and U.S. Air Force veteran. He earned his medical degree from the Uniformed Services University and completed his general surgery residency at the University of Nevada in Las Vegas. After training he was stationed in Anchorage, Alaska for 7 years, where he took part in multiple domestic and overseas military exercises. His practice in Alaska also involved partnerships with the local community, including working with residents and local surgeons at the Alaska Native Medical Center. At the completion of his military service, he was recruited to return to Las Vegas as the Associate Program Direct for the Valley Health System General Surgery residency program. Dr. Swenson's primary passion is ensuring surgical residents are fully prepared for independent practice upon graduation, which has led him to create innovative, AI-powered study tools for oral board exam preparation. Whenever time allows, he enjoys family time and all things outdoors.
Hosts:
Ayman Ali, MD (PGY-4, Duke Hospital)
Patrick Georgoff, MD (Trauma/Critical Care Surgeon, Duke Hospital): @georgoff
Matthew Swenson, MD (General Surgeon, Valley Health System)
Talha Rafeeqi, MD (Foregut Surgeon, The Oregon Clinic)
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Joining Dr. Scott Steele today on Behind the Knife is Steve Crandall, a former medical negligence DEFENSE lawyer who, for reasons we will discuss, switched sides and now represents the patient who is suing care providers. He is a founding partner of Crandall & Pera Law and also has been ranked as both one of the Top 5 Lawyers in Cleveland and Top 10 best Lawyers in Ohio for over 15 years. Crandall, a seasoned plaintiff attorney specializing in medical malpractice, joins the hosts to illuminate the key factors behind common lawsuits in surgery, the pivotal role of informed consent, standout cases with crucial learning points, expert witness strategies, and practical advice for surgeons to stay out of legal trouble.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Welcome to the 6th episode of our BTK/ASGBI series! During this series, BTK fellow Agnes Premkumar and ASGBI hosts Jared Wohlgemut and Gita Lingam will compare and contrast various aspects of surgery between the United States and the United Kingdom, debating who does what better.
In this episode, we delve into surgical training, current challenges, and hopes for the future of surgical training in the US and the UK. We will be discussing the advent of the EPA curriculum in the US, the current challenge of obtaining a speciality position in the UK, and tips for making the resident to attending/junior faculty transition smoothly. Dr. Jeremy Lipman represents the US while Dr. Phil Pearce represents the UK in this thought-provoking conversation.
Dr. Lipman is a colorectal surgeon at the Cleveland Clinic and the director of graduate medical education for all training programs at the Cleveland Clinic. Additionally, he is an Associate Dean for Graduate Medical Education and Professor of Surgery at Case Western Reserve University. He is passionate about surgical training and holds the James E. Sampliner Endowed Chair in Surgical Education.
Dr. Phil Pearce is a consultant in emergency general surgery in Oxford with interests in trauma, complex biliary disease, and most importantly a passion for training.
Take a listen and let us know what you think- who does surgical education and training better?
References:
Speciality training position in the NHS
https://www.ft.com/content/e4b364c3-6a20-42ee-a9a5-ab9eea441c87?utm_source=chatgpt.com
https://www.theguardian.com/society/2025/jul/02/nhs-in-england-told-to-slash-recruitment-of-overseas-trained-medics?utm_source=chatgpt.com
Surgery job market in the US
https://surgpli.com/the-state-of-surgery-as-a-career-in-2025/
EPA curriculum
https://www.aamc.org/about-us/mission-areas/medical-education/cbme/core-epas
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Why are we still treating acute uncomplicated diverticulitis with antibiotics? There is plenty of evidence from several randomized controlled trials demonstrating that symptomatic management alone yields similar results. If we should continue prescribing antibiotics for acute uncomplicated diverticulitis, which patients should undergo treatment and when? Join Drs. Jared Hendren, Elissa Dabaghi, Joseph Trunzo, Ajaratu Keshinro, and David Rosen as they discuss the management of uncomplicated diverticulitis while reviewing groundbreaking literature.
Hosts:
-Jared Hendren, MD
Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio
- Elissa Dabaghi, MD
Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio
- Joseph Trunzo, MD
Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute,
Cleveland Clinic Foundation, Cleveland, Ohio
Social Media Handle: X/Twitter @joseph_trunzo
- Ajaratu Keshinro, MD
Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute,
Cleveland Clinic Foundation, Cleveland, Ohio
Social Media Handle: X/Twitter- @AJKesh
- David Rosen, MD
Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute,
Cleveland Clinic Foundation, Cleveland, Ohio
Social Media Handle: X/Twitter- @davidrrosenmd
Learning Objectives: By the end of this episode, listeners will be able to:
1. Identify criteria for managing acute uncomplicated diverticulitis without antibiotics based on recent literature
2. Define uncomplicated and complicated diverticulitis
3. Discuss nuanced management decisions of patients with uncomplicated diverticulitis to determine when antibiotics may be appropriate for management
References:
1. Azhar, N., Aref, H., Brorsson, A., Lydrup, M.‑L., Jörgren, F., Schultz, J. K., & Buchwald, P. (2022). Management of acute uncomplicated diverticulitis without antibiotics: Compliance and outcomes – a retrospective cohort study. BMC Emergency Medicine, 22(1), Article 28. https://doi.org/10.1186/s12873‑022‑00584‑X
2. Mora‑López, L., Ruiz‑Edo, N., Estrada‑Ferrer, O., Piñana‑Campón, M. L.,
Labró‑Ciurans, M., Escuder‑Perez, J., Sales‑Mallafré, R., Rebasa‑Cladera, P.,
Navarro‑Soto, S., Serra‑Aracil, X., & DINAMO‑study Group. (2021). Efficacy and safety of nonantibiotic outpatient treatment in mild acute diverticulitis (DINAMO‑study): A multicentre, randomised, open‑label, noninferiority trial. Annals of Surgery, 274(5), e435–e442. https://doi.org/10.1097/SLA.0000000000005031
3. Daniels, L., Ünlü, Ç., de Korte, N., van Dieren, S., Stockmann, H. B., Vrouenraets, B. C., Consten, E. C., van der Hoeven, J. A., Eijsbouts, Q. A., Faneyte, I. F., Bemelman, W. A., Dijkgraaf, M. G., & Boermeester, M. A. (2017). Randomized clinical trial of
observational versus antibiotic treatment for a first episode of CT‑proven uncomplicated acute diverticulitis. British Journal of Surgery, 104(1), 52‑61. https://doi.org/10.1002/bjs.10309
4. Chabok, A., Påhlman, L., Hjern, F., Haapaniemi, S., & Smedh, K.; AVOD Study Group. (2012). Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. British Journal of Surgery, 99(4), 532–539. https://doi.org/10.1002/bjs.8688
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Psst… wanna hear some tea? Join Drs. Maya Hunt, John Woodward, and Cait Silvestri as they discuss gossip - what it is, what it means, and how it can impact the surgical training environment. Joined by authors of a recent paper deconstructing gossip in surgical residency, Dr. Bobbi Ann Adair White and former CoSEF leader Dr. Joseph L’Huillier, the team examines the ways gossip can be positive and negative, how we can mitigate the harms that come with it, and reflect on some of our own experiences with gossip as trainees.
Episode Hosts:- Dr. Maya Hunt, Indiana University, mayahunt@iu.edu
- Dr. John Woodward, University at Buffalo, @JohnWoodward76, jmwoodwa@buffalo.edu
- Dr. Cait Silvestri, Columbia University, @CaitSilvestri, cs4004@cumc.columbia.edu
- CoSEF: @surgedfellows, cosef.org
Guests:
- Dr. Joseph L’Huillier, University of Buffalo, @JoeLHuillier101, josephlh@buffalo.edu
- Dr. Bobbi Ann Adair White, MGH Institute of Health Professions, @_BAAW_, bwhite2@mghihp.edu
Learning Objectives:- Define gossip in the context of surgical education, distinguishing between its academic definition and common perceptions
- Identify how forms of gossip can be constructive, as well as destructive
- Explore the process model of gossip in surgical residency programs, including what choices recipients have when receiving gossip
- Recognize environmental factors that contribute to gossip in surgical settings
- Apply practical strategies to mitigate harmful gossip in training environments
References:
- L'Huillier JC, Silvestri C, Brian R, et al. The Anatomy of Gossip: Dissecting Dynamics and Impacts in Surgical Residency. Surgery. 2025;180:109126. doi:10.1016/j.surg.2024.109126 https://pubmed.ncbi.nlm.nih.gov/39862712/
- L'Huillier JC, Woodward JM, Lund S, et al. Is it gossip or feedback? Surgical attendings' perceptions of gossip within residency. J Surg Educ. 2024;81(10):1362-1373. doi:10.1016/j.jsurg.2024.07.004 https://pubmed.ncbi.nlm.nih.gov/39173427/
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Ductal carcinoma in situ (DCIS) represents a clinical crossroads in breast surgery—balancing the risks of over-treatment with the need to prevent invasive cancer. With new data from active monitoring trials, the pressure is on for surgeons to personalize care. Tune in to this essential episode to stay ahead of the curve on DCIS management and to hear expert insights from two leading breast surgical oncologists.
Hosts:- Rashmi Kumar, MD, PhDResident, University of Michigan General Surgery Residency Program
Twitter/X: @RashmiJKumar
- Melissa Pilewskie, MDAttending Breast Surgical Oncologist, Co-Director of the Weiser Family Center for Breast Cancer, Michigan Medicine
Twitter/X: @MPilewskie
- Stephanie Downs-Canner, MDAttending Breast Surgical Oncologist & Physician-Scientist, Memorial Sloan Kettering Cancer Center, Program Director of the Breast Surgical Oncology Fellowship Training Program
Twitter/X: @SDownsCanner
Learning Objectives:- Define DCIS and explain its significance as a precursor to invasive breast cancer.
- Discuss challenges in diagnosing and risk-stratifying DCIS.
- Review current standards for surgical and adjuvant management of DCIS.
- Understand the implications of new research, including the COMET trial, for low-risk DCIS.
- Evaluate patient-centered strategies for managing DCIS and preventing over-treatment.
References:- Worni M, Akushevich I, Greenup R, et al. Trends in Treatment Patterns and Outcomes for Ductal Carcinoma In Situ. J Natl Cancer Inst. 2015;107(12):djv263. PubMed
- Francis A, Thomas J, Fallowfield L, et al. Addressing overtreatment of screen detected DCIS; the LORIS trial. Eur J Cancer. 2015 Jan;51(16):2296-303. PubMed
- Elshof LE, Tryfonidis K, Slaets L, et al. Feasibility of a non-surgical management strategy for low-grade DCIS: The LORD study. Eur J Cancer. 2015;51(12):1497–1510. PubMed
- Toss MS, et al. Ductal carcinoma in situ (DCIS): current management and future directions. Cancer Treat Rev. 2020;90:102091. PubMed
- Comparative Effectiveness of Surgery versus Active Monitoring for Low-Risk DCIS (COMET) Trial Results. Early COMET Results: King TA, et al. Surgical excision versus active monitoring for low-risk ductal carcinoma in situ (DCIS): 2-year results of the COMET randomized trial. J Clin Oncol. 2024; e2400110. PubMed
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Welcome back our series on AI for the clinician! In this episode, we go over some basics of machine learning statistics with the goal to help you read and analyze contemporary studies. Some of this will be a review, and parts will be technical, but by the end we hope reading these studies is less daunting.
Hosts:
Ayman Ali, MD
Ayman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital in his academic development time where he focuses on data science, artificial intelligence, and surgery.
Julie Doberne, MD, PhD: @juliedoberne
Julie Doberne is an Assistant Professor of Surgery, Assistant Professor of Medical Informatics and Clinical Epidemiology, cardiothoracic surgeon, and faculty member of the Surgical Data and Decision Sciences Lab at Oregon Health and Science University.
Phillip Jenkins, MD: @PhilJenkinsMD
Phil Jenkins is a general surgery PGY-4 at Oregon Health and Science University and a National Library of Medicine Post-Doctoral fellow pursuing a master’s in clinical informatics.
Steven Bedrick, PhD: @stevenbedrick
Steven Bedrick is a machine learning researcher and an Associate Professor in Oregon Health and Science University’s Department of Medical Informatics and Clinical Epidemiology.
Shelby Willis, MD
Shelby Willis is a general surgery PGY-4 at Oregon Health and Science University. She is currently in her research time in the Surgical Data and Decision Sciences lab at OHSU pursuing advanced training in informatics.
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In the second episode of this new collaboration between BTK and Annals of surgery, we discuss another hot topic: academic surgery. Specifically, we discuss dedicated research time for residents and how surgical leaders think about building the academic surgery enterprise. This discussion was inspired by a couple of recent papers in Annals of Surgery that stirred up a lot of conversation on social media which can be found below.
Host: Cody Mullens, MD MPH — general surgery resident at University of Michigan current BTK Surgery Education Fellow (@Cody_Mullens)
Guest: Justin Dimick, MD MPH — Fredrick A Coller Distinguished Professor and Chair of Surgery at the University of you Michigan and Editor in Chief at Annals of Surgery (@jdimick1)
Papers:
Career Trajectory After General Surgery Residency Do Academic Program Graduates Pursue Academic Surgery?
https://journals.lww.com/annalsofsurgery/abstract/2025/05000/career_trajectory_after_general_surgery_residency_.10.aspx
Training the Surgeon-scientist: Time (and Money) Well Spent?
https://journals.lww.com/annalsofsurgery/citation/9900/training_the_surgeon_scientist__time__and_money_.1318.aspx
Introducing a New Annals of Surgery Section Professional Development for the Contemporary Surgeon
https://journals.lww.com/annalsofsurgery/fulltext/2025/08000/introducing_a_new_annals_of_surgery_section_.8.aspx
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In this episode of Behind the Knife, Dr. Patrick Georgoff sits down with Dr. Keri Seymour and Dr. Joey Lew to tackle the complex world of gastrostomy tubes. What may seem like a routine and straightforward procedure is anything but—full of nuanced patient considerations, timing dilemmas, technical challenges, and potential complications that can turn a “simple” consult into a 2 a.m. call you won’t forget. From who truly needs a G tube and when to managing difficult post-op issues like dislodgement and buried bumper syndrome, this episode breaks down the practical, evidence-based approach every surgeon should know. Whether you’re managing stroke patients, trauma cases, or navigating the tricky administrative obstacles around enteral access, this episode will equip you with the insights and strategies to confidently dominate your G tube consults.
Hosts:
· Dr. Patrick Georgoff (Acute Care Surgeon, Duke University)
· Dr. Keri Seymour (Minimally Invasive & Acute Care Surgeon, Duke Regional)
· Dr. Joey Lew (Surgical Resident, BTK MIS Team)
Learning Goals:
By the end of this episode, listeners will be able to:
· Understand the nuanced indications for gastrostomy tube (G tube) placement.
· Learn which patients truly benefit from G tubes, and when enteral access is not appropriate or indicated.
· Appreciate the importance of goals of care discussions, assessment of comorbidities, and decision-makers—especially in neurocritical and elderly populations.
· Know evidence-based timing for gastrostomy tube placement in stroke, TBI, and other complex scenarios.
· Understand guideline recommendations and the clinical reasoning behind trial periods of nasogastric feeding versus early G tube placement.
· Describe technical approaches to G tube placement and how to tailor the method to patient anatomy and clinical context.
· Solidify knowledge of when to choose endoscopic, laparoscopic, open, or interventional radiology-guided placement.
· Recognize, manage, and strive to prevent common and serious complications of G tubes, including early and late dislodgement, buried bumper syndrome, infection, bleeding, and gastrocutaneous fistula.
· Discuss perioperative considerations, including anticoagulation, patient stability, and post-procedural care.
· Understand why routine suturing of the G tube or bumper is not recommended, and how administrative and facility factors can drive clinical decisions.
· Gain practical pearls and quick decision trees to dominate G tube consults and troubleshooting, day or night.
References:· Braun R, Han K, Arata J, Gourab K, Hearn J, Gonzalez-Fernandez M. Establishing a clinical care pathway to expedite rehabilitation transitions for stroke patients with dysphagia and enteral feeding needs. Am J Phys Med Rehabil. 2024;103(5):390-394. doi:10.1097/PHM.0000000000002387 https://pubmed.ncbi.nlm.nih.gov/36867953/
· Burgermaster M, Slattery E, Islam N, Ippolito PR, Seres DS. Regional comparison of enteral nutrition-related admission policies in skilled nursing facilities. Nutr Clin Pract. 2016;31(3):342-348. doi:10.1177/0884533616629636 https://pubmed.ncbi.nlm.nih.gov/26993318/
· Chaudhry R, Kukreja N, Tse A, Pednekar G, Mouchli A, Young L, Didyuk O, Wegner RC, Grewal N, Williams GW. Trends and outcomes of early versus late percutaneous endoscopic gastrostomy placement in patients with traumatic brain injury: Nationwide population-based study. J Neurosurg Anesthesiol. 2018;30(3):251-257. doi:10.1097/ANA.0000000000000434 https://pubmed.ncbi.nlm.nih.gov/28459729/
· Cleverdon SA, Costantini TW, McGrew TM, Santorelli JE, Berndtson AE, Haines LN. Dysphagia in patients with traumatic brain injury, how often do they really need feeding access? Presented at: Academic Surgical Congress; February 2025; Washington, DC. Abstract 92.33.
· Cmorej P, Mayuiers M, Sugawa C. Management of early PEG tube dislodgement: simultaneous endoscopic closure of gastric wall defect and PEG replacement. BMJ Case Rep. 2019;12(9):e230728. doi:10.1136/bcr-2019-230728 https://pubmed.ncbi.nlm.nih.gov/31488448/
· Galovic M, Stauber AJ, Leisi N, et al. Development and validation of a prognostic model of swallowing recovery and enteral tube feeding after ischemic stroke. JAMA Neurol. 2019;76(5):561-570. doi:10.1001/jamaneurol.2018.4858 https://pubmed.ncbi.nlm.nih.gov/30742198/
· Gallo RJ, Wang JE, Madill ES. Things we do for no reason™. J Hosp Med. 2024;19(8):728-730. doi:10.1002/jhm.13263 https://pubmed.ncbi.nlm.nih.gov/38180160/
· George BP, Hwang DY, Albert GP, Kelly AG, Holloway RG. Timing of percutaneous endoscopic gastrostomy for acute ischemic stroke. Stroke. 2017;48(2):420-427. doi:10.1161/STROKEAHA.116.015119 https://pubmed.ncbi.nlm.nih.gov/27965430/
· Goldberg LS, Altman KW. The role of gastrostomy tube placement in advanced dementia with dysphagia: a critical review. Clin Interv Aging. 2014;9:1733-1739. doi:10.2147/CIA.S53153 https://pubmed.ncbi.nlm.nih.gov/25342891/
· Hartford A, Li W, Qureshi D, et al. Use of feeding tubes among hospitalized older adults with dementia. JAMA Netw Open. 2025;8(2):e2460780. doi:10.1001/jamanetworkopen.2024.60780 https://pubmed.ncbi.nlm.nih.gov/39976967/
· Hochu G, Soule S, Lenart E, Howley IW, Filiberto D, Byerly S. Synchronous tracheostomy and gastrostomy placement results in shorter length of stay in traumatic brain injury patients. Am J Surg. 2024;227:153-156. doi:10.1016/j.amjsurg.2023.10.012 https://pubmed.ncbi.nlm.nih.gov/37852846/
· Kobzeva-Herzog AJ, Nofal MR, Bodde J, et al. Implementation of a quality improvement initiative reduced adult inpatient gastrostomy tube dislodgements. Am J Surg. 2025;(article 116522). doi:10.1016/j.amjsurg.2025.116522 https://pubmed.ncbi.nlm.nih.gov/40782502/
· Kurt Boeykens, Ivo Duysburgh. Prevention and management of major complications in percutaneous endoscopic gastrostomy. BMJ Open Gastroenterol. 2021;8:e000628. https://pubmed.ncbi.nlm.nih.gov/33947711/
· Murphy LM, Lipman TO. Percutaneous endoscopic gastrostomy does not prolong survival in patients with dementia. Arch Intern Med. 2003;163(11):1351-1353. doi:10.1001/archinte.163.11.1351 https://pubmed.ncbi.nlm.nih.gov/12796072/
· Papavramidis TS, Mantzoukis K, Michalopoulos N. Confronting gastrocutaneous fistulas. Ann Gastroenterol. 2011;24(1):16-19. https://pubmed.ncbi.nlm.nih.gov/24714282/
· Rajan A, Wangrattanapranee P, Kessler J, Kidambi TD, Tabibian JH. Gastrostomy tubes: fundamentals, periprocedural considerations, and best practices. World J Gastrointest Surg. 2022;14(4):286-303. doi:10.4240/wjgs.v14.i4.286 https://pubmed.ncbi.nlm.nih.gov/35664365/
· Reddy KM, Lee P, Gor PJ, Cheesman A, Al-Hammadi N, Westrich DJ, Taylor J. Timing of percutaneous endoscopic gastrostomy tube placement in post-stroke patients does not impact mortality, complications, or outcomes. World J Gastrointest Pharmacol Ther. 2022;13(5):77-87. doi:10.4292/wjgpt.v13.i5.77 https://pubmed.ncbi.nlm.nih.gov/36157266/
· Singh D, Laya AS, Vaidya OU, Ahmed SA, Bonham AJ, Clarkston WK. Risk of bleeding after percutaneous endoscopic gastrostomy (PEG). Dig Dis Sci. 2012;57(4):973-980. doi:10.1007/s10620-011-1965-7 https://pubmed.ncbi.nlm.nih.gov/22138961/
· Thosani N, Rashtak S, Kannadath BS, et al. Bleeding risk and mortality associated with uninterrupted antithrombotic therapy during percutaneous endoscopic gastrostomy tube placement. Am J Gastroenterol. 2021;116(9):1868-1875. doi:10.14309/ajg.0000000000001348 https://pubmed.ncbi.nlm.nih.gov/34158462/
· Ward EC, Green K, Morton AL. Patterns and predictors of swallowing resolution following adult traumatic brain injury. J Head Trauma Rehabil. 2007;22(3):184-191. doi:10.1097/01.HTR.0000271119.96780.f5 https://pubmed.ncbi.nlm.nih.gov/17510594/
· Wick B. Timing of PEG tube placement in stroke patients with dysphagia: a multi-center retrospective cohort analysis using the TriNetX database. Am J Gastroenterol. 2024;119(10 Suppl):S1146-S1147. doi:10.14309/01.ajg.0001035684.98119.d5
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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A silent danger lurks within the descending thoracic aorta. While most Type B aortic dissections are managed medically, up to half of these patients will either require life-saving surgery or die within just five years. So how do we separate those who will quietly recover from those on the edge of catastrophe? How do we protect the spinal cord, bowel, and limbs from the devastating consequences of malperfusion?
Join the University of Michigan Department of Vascular Surgery as they tackle the high-stakes decisions behind managing this unpredictable disease—where timing is critical, interventions are evolving, and lives hang in the balance.
Hosted by the University of Michigan Department of Vascular Surgery:
· Robert Beaulieu, Program Director
· Frank Davis, Assistant Professor of Surgery
· Luciano Delbono, PGY-5 House Officer
· Andrew Huang, PGY-4 House Officer
· Carolyn Judge, PGY-2 House Officer
Learning Objectives:
1. Discuss general approach to diagnosis and management of TBAD.
-
Identifying high-risk features in uncomplicated TBAD and understanding their role in determining the need for surgical management.
-
Review endovascular techniques for managing malperfusion of the limbs, viscera, and spinal cord and discuss associated decision making.
References:
Authors/Task Force Members, Czerny, M., Grabenwöger, M., Berger, T., Aboyans, V., Della Corte, A., Chen, E. P., Desai, N. D., Dumfarth, J., Elefteriades, J. A., Etz, C. D., Kim, K. M., Kreibich, M., Lescan, M., Di Marco, L., Martens, A., Mestres, C. A., Milojevic, M., Nienaber, C. A., … Hughes, G. C. (2024). EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. The Annals of Thoracic Surgery, 118(1), 5–115. https://doi.org/10.1016/j.athoracsur.2024.01.021
de Kort, J. F., Hasami, N. A., Been, M., Grassi, V., Lomazzi, C., Heijmen, R. H., Hazenberg, C. E. V. B., van Herwaarden, J. A., & Trimarchi, S. (2025). Trends and Updates in the Management and Outcomes of Acute Uncomplicated Type B Aortic Dissection. Annals of Vascular Surgery, S0890-5096(25)00004-4. https://doi.org/10.1016/j.avsg.2024.12.060
Eidt, J. F., & Vasquez, J. (2023). Changing Management of Type B Aortic Dissections. Methodist DeBakey Cardiovascular Journal, 19(2), 59–69. https://doi.org/10.14797/mdcvj.1171
Lombardi, J. V., Hughes, G. C., Appoo, J. J., Bavaria, J. E., Beck, A. W., Cambria, R. P., Charlton-Ouw, K., Eslami, M. H., Kim, K. M., Leshnower, B. G., Maldonado, T., Reece, T. B., & Wang, G. J. (2020). Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. Journal of Vascular Surgery, 71(3), 723–747. https://doi.org/10.1016/j.jvs.2019.11.013
MacGillivray, T. E., Gleason, T. G., Patel, H. J., Aldea, G. S., Bavaria, J. E., Beaver, T. M., Chen, E. P., Czerny, M., Estrera, A. L., Firestone, S., Fischbein, M. P., Hughes, G. C., Hui, D. S., Kissoon, K., Lawton, J. S., Pacini, D., Reece, T. B., Roselli, E. E., & Stulak, J. (2022). The Society of Thoracic Surgeons/American Association for Thoracic Surgery Clinical Practice Guidelines on the Management of Type B Aortic Dissection. The Annals of Thoracic Surgery, 113(4), 1073–1092. https://doi.org/10.1016/j.athoracsur.2021.11.002
Papatheodorou, N., Tsilimparis, N., Peterss, S., Khangholi, D., Konstantinou, N., Pichlmaier, M., & Stana, J. (2025). Pre-Emptive Endovascular Repair for Uncomplicated Type B Dissection—Is This an Option? Annals of Vascular Surgery, S0890-5096(25)00007-X. https://doi.org/10.1016/j.avsg.2025.01.003
Trimarchi, S., Gleason, T. G., Brinster, D. R., Bismuth, J., Bossone, E., Sundt, T. M., Montgomery, D. G., Pai, C.-W., Bissacco, D., de Beaufort, H. W. L., Bavaria, J. E., Mussa, F., Bekeredjian, R., Schermerhorn, M., Pacini, D., Myrmel, T., Ouzounian, M., Korach, A., Chen, E. P., … Patel, H. J. (2023). Editor’s Choice - Trends in Management and Outcomes of Type B Aortic Dissection: A Report From the International Registry of Aortic Dissection. European Journal of Vascular and Endovascular Surgery: The Official Journal of the European Society for Vascular Surgery, 66(6), 775–782. https://doi.org/10.1016/j.ejvs.2023.05.015
Writing Committee Members, Isselbacher, E. M., Preventza, O., Hamilton Black Iii, J., Augoustides, J. G., Beck, A. W., Bolen, M. A., Braverman, A. C., Bray, B. E., Brown-Zimmerman, M. M., Chen, E. P., Collins, T. J., DeAnda, A., Fanola, C. L., Girardi, L. N., Hicks, C. W., Hui, D. S., Jones, W. S., Kalahasti, V., … Woo, Y. J. (2022). 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology, 80(24), e223–e393. https://doi.org/10.1016/j.jacc.2022.08.004
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What if we could train patients for surgery the way elite athletes train for game day?
In this episode, we review the science, shed light on the disparities, explore real-world challenges, and honor the behind-the-scenes workers that facilitate prehabilitation in thoracic cancer care. Join attending surgeon Doctor Jinny Ha, 3rd year general surgery resident Doctor Kyla Rakoczy, and Community Outreach Patient Navigator, Leslie Ricks Chandler, in discussing prehabilitation in thoracic surgery.
Hosts:
Dr. Jinny Ha, MD, MHS, assistant professor of surgery and thoracic surgeon at Johns Hopkins
Leslie Ricks Chandler, Community Outreach Program Advisor Johns Hopkins Thoracic Surgery
Dr. Kyla Rakoczy, MD, 3rd year general surgery resident at Johns Hopkins LinkedIn: Kyla Rakoczy
Learning objectives:
After listening to this episode, participants will be able to:1. Define the role and components of prehabilitation in the context of thoracic oncology and ERAS/ESTS guidelines.
2. Interpret key findings from recent clinical trials on prehabilitation, including outcomes related to functional capacity and readmission rates.
3. Identify socioeconomic and structural barriers to prehabilitation participation and discuss strategies to improve equitable access to these interventions.
4. Apply evidence-based criteria to assess which patients may benefit most from preoperative nutrition and exercise interventions.
5. Recognize the importance of interdisciplinary collaboration—including social work and patient navigation—in optimizing surgical readiness and long-term outcomes.
References: * Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery: A Randomized Clinical Trial - PubMed * https://pmc.ncbi.nlm.nih.gov/articles/PMC12070588/ * https://pubmed.ncbi.nlm.nih.gov/39775660/ * https://ccts.amegroups.org/article/view/68030/html * https://pubmed.ncbi.nlm.nih.gov/36435646/ * https://www.sciencedirect.com/science/article/abs/pii/S1043067918301643?via%3Dihub * https://pubmed.ncbi.nlm.nih.gov/30304509/ * https://pubmed.ncbi.nlm.nih.gov/28385477/ * https://pubmed.ncbi.nlm.nih.gov/27226400/ * https://pubmed.ncbi.nlm.nih.gov/38546649/ * https://pubmed.ncbi.nlm.nih.gov/38614212/ * https://www.hopkinsmedicine.org/surgery/specialty-areas/thoracic-surgery/patient-education
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Primary hyperparathyroidism is an underdiagnosed condition which leads to decreased bone mineral density, fracture, renal disease, among other symptoms that can decrease the quality of a patient’s life. Moreover, once diagnosed, only a small fraction of patients with the diease end up being offered surgery. Whether it is because of misunderstood indications and benefits of surgery, non-localization of disease, or various other reasons, we thought it was worthwhile to review relevant literature.
Hosts: Dr. Becky Sippel is an endowed professor of surgery at Division Chief of endocrine surgery at University of Wisconsin Madison and she is the most recent past president of the AAES. She is an internationally recognized leader in the field of endocrine surgery. She has over 250 publications. She was the PI for a RCT which studies prophylactic central neck dissections which is a widely read and quoted study in endocrine surgery.
Dr. Amanda Doubleday is a fellowship trained endocrine surgeon in private practice with an affiliation to UW Health. Her primary practice is with Waukesha Surgical Specialists in Waukesha WI.
Dr. Simon Holoubek is a fellowship trained endocrine surgeons affiliated with UW Health. He works for UW Health with privileges at UW Madison and UW Northern Illinois. His clinical interests are aggressive variants of thyroid cancer, parathyroid autofluorescence, and nerve monitoring.
Learning Objectives:
1 Understand the natural history of primary hyperparathyroidism and how the disease process can affect bone mineral density.
2 Learn about fracture risk associated with primary hyperparathyroidism.
3 Learn about decreased fracture risk in patients with primary hyperparathyroidism who have parathyroidectomy compared to those who are observed.
References:
1 Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, Udesky J, Silverberg SJ. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab. 2008 Sep;93(9):3462-70. doi: 10.1210/jc.2007-1215. Epub 2008 Jun 10. PMID: 18544625; PMCID: PMC2567863. https://pubmed.ncbi.nlm.nih.gov/18544625/
2 Frey S, Gérard M, Guillot P, Wargny M, Bach-Ngohou K, Bigot-Corbel E, Renaud Moreau N, Caillard C, Mirallié E, Cariou B, Blanchard C. Parathyroidectomy Improves Bone Density in Women With Primary Hyperparathyroidism and Preoperative Osteopenia. J Clin Endocrinol Metab. 2024 May 17;109(6):1494-1504. doi: 10.1210/clinem/dgad718. PMID: 38152848. https://pubmed.ncbi.nlm.nih.gov/38152848/
3 VanderWalde LH, Liu IL, Haigh PI. Effect of bone mineral density and parathyroidectomy on fracture risk in primary hyperparathyroidism. World J Surg. 2009 Mar;33(3):406-11. doi: 10.1007/s00268-008-9720-8. PMID: 18763015. https://pubmed.ncbi.nlm.nih.gov/18763015/
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Behind the Knife's General Surgery Oral Board Review Course includes 123 Audio Scenarios + 10 Interactive Video Scenarios + 97 Operative Descriptions that cover all SCORE topic.
Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
All of our premium courses are available via our website and apps (iOS and Android). Users can take notes, pin chapters and download content for offline viewing.
Learn more about the General Surgery Oral Board Review Course at https://app.behindtheknife.org/premium/general-surgery-oral-board-review
Institutional Discounts Available - Please email hello@behindtheknife.org to learn more.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
In this episode, the Behind the Knife team shares exciting updates, including updates to the General Surgery Oral Board Review with 123 expert-commentary scenarios, 10 interactive videos, and 97 operative descriptions. They announce upcoming projects such as an AI-powered oral board simulator, Spanish-language review, a free pediatric surgery resource, and detailed surgical instrument flashcards. The team also introduces Dominate Surgery courses for medical students and advanced practice providers, designed to modernize and elevate surgical education.
***Choledocholithiasis wtih Gastric Bypass Video Scenario Link: https://app.behindtheknife.org/video/behindtheknife-general-surgery-oral-board-review-video-sample-choledocholithiasis-w-gastric-bypass
Behind the Knife's General Surgery Oral Board Review Course includes 123 Audio Scenarios + 10 Interactive Video Scenarios + 97 Operative Descriptions that cover all SCORE topic.
Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
All of our premium courses are available via our website and apps (iOS and Android). Users can take notes, pin chapters and download content for offline viewing.
Learn more about the General Surgery Oral Board Review Course at https://app.behindtheknife.org/premium/general-surgery-oral-board-review
Institutional Discounts Available - Please email hello@behindtheknife.org to learn more.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife's General Surgery Oral Board Review Course includes 123 Audio Scenarios + 10 Interactive Video Scenarios + 97 Operative Descriptions that cover all SCORE topic.
Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
All of our premium courses are available via our website and apps (iOS and Android). Users can take notes, pin chapters and download content for offline viewing.
Learn more about the General Surgery Oral Board Review Course at https://app.behindtheknife.org/premium/general-surgery-oral-board-review
Institutional Discounts Available - Please email hello@behindtheknife.org to learn more.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife's General Surgery Oral Board Review Course includes 123 Audio Scenarios + 10 Interactive Video Scenarios + 97 Operative Descriptions that cover all SCORE topic.
Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
All of our premium courses are available via our website and apps (iOS and Android). Users can take notes, pin chapters and download content for offline viewing.
Learn more about the General Surgery Oral Board Review Course at https://app.behindtheknife.org/premium/general-surgery-oral-board-review
Institutional Discounts Available - Please email hello@behindtheknife.org to learn more.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
When the gallbladder turns hostile, sometimes you must do more than just pause—you have to call in a senior partner for help. Join the Behind the Knife EGS team at Mizzou as we dive into the art and grit of open cholecystectomy. From fundus-first dissection to navigating the “barrier to happiness,” this episode is packed with surgical pearls, tough love, and the kind of wisdom only scars can teach.
Participants:* Dr. Rushabh Dev FACS (Moderator, Surgical Attending) – Assistant Professor of Surgery, Associate PD ACS & SCCM Fellowship, SICU Medical Director, Lieutenant Commander United States Navy Reserve * Dr. Jeffery Coughenour FACS (Surgical Attending) – Professor of Surgery and Emergency Medicine, Trauma Medical Director at the University of Missouri SOM * Dr. Christopher Nelson FACS (Surgical Attending) – Associate Professor of Surgery, Medical Director of Emergency General Surgery at the University of Missouri SOM * Dr. Micah Ancheta (ACS Fellow) – Major, United States Airforce * Dr. Desra Fletcher (3rd year general surgery resident)
Learning Objectives:
· Recognize Indications for Conversion
Identify clinical and intraoperative factors that necessitate conversion from laparoscopic to open cholecystectomy.
· Apply Risk Stratification Tools
Utilize grading systems (e.g., Parkland, Tokyo, AAST) to assess cholecystitis severity and predict surgical difficulty.
· Implement Safe Cholecystectomy Techniques
Describe the six steps of the SAGES Safe Cholecystectomy Program to minimize bile duct injury.
· Understand Bailout Strategies
Differentiate between fenestrating and reconstituting subtotal cholecystectomy techniques and their respective risks.
· Master Key Operative Steps
Outline the essential components of open cholecystectomy: positioning, incision, exposure, and dissection.
· Navigate High-Risk Anatomy
Recognize “zones of danger” and use the B-SAFE mnemonic to reorient and ensure safe progression.
· Develop Intraoperative Judgment
Demonstrate when to proceed with subtotal techniques, convert to open, or call for assistance.
· Perform Technical Nuances Safely
Identify proper dissection planes, manage gallbladder bed inflammation, and secure cystic structures with confidence.
· Prevent and Manage Complications
Understand the risks of bile leaks, bilomas, and subcostal hernias—and how to mitigate them through technique and closure.
· Foster Surgical Maturity
Emphasize humility, collaboration, and mentorship in difficult operations—knowing when to ask for help is a skill.
References:
1. Dhanasekara, C. S., Shrestha, K., Grossman, H., Garcia, L. M., Maqbool, B., Luppens, C., ... & Dissanaike, S. (2024). A comparison of outcomes including bile duct injury of subtotal cholecystectomy versus open total cholecystectomy as bailout procedures for severe cholecystitis: A multicenter real-world study. Surgery, 176(5), 605–613. https://doi.org/10.1016/j.surg.2024.03.057
2. Motter, S. B., de Figueiredo, S. M. P., Marcolin, P., Trindade, B. O., Brandao, G. R., & Moffett, J. M. (2024). Fenestrating vs reconstituting laparoscopic subtotal cholecystectomy: A systematic review and meta-analysis. Surgical Endoscopy, 38, 7475–7485. https://doi.org/10.1007/s00464-024-11225-8
3. Brunt, L. M., Deziel, D. J., Telem, D. A., Strasberg, S. M., Aggarwal, R., Asbun, H., ... & Stefanidis, D. (2020). Safe cholecystectomy multi-society practice guideline and state of the art consensus conference on prevention of bile duct injury during cholecystectomy. Surgical Endoscopy.https://www.sages.org/publications/guidelines/safe-cholecystectomy-multi-society-practice-guideline/
4. Elshaer, M., Gravante, G., Thomas, K., Sorge, R., Al-Hamali, S., & Ebdewi, H. (2015). Subtotal cholecystectomy for “difficult gallbladders”: Systematic review and meta-analysis. JAMA Surgery, 150(2), 159–168. https://doi.org/10.1001/jamasurg.2014.1219
5. Koo, S. S. J., Krishnan, R. J., Ishikawa, K., Matsunaga, M., Ahn, H. J., Murayama, K. M., & Kitamura, R. K. (2024). Subtotal vs total cholecystectomy for difficult gallbladders: A systematic review and meta-analysis. The American Journal of Surgery, 229(1), 145–150. https://doi.org/10.1016/j.amjsurg.2023.12.022
6. Strasberg, S. M., Pucci, M. J., Brunt, L. M., & Deziel, D. J. (2016). Subtotal cholecystectomy—“Fenestrating” vs “reconstituting” subtypes and the prevention of bile duct injury: Definition of the optimal procedure in difficult operative conditions. Journal of the American College of Surgeons, 222(1), 89–96. https://doi.org/10.1016/j.jamcollsurg.2015.09.019
7. Ahmed, O., & Walsh, T. N. (2020). Surgical trainee experience with open cholecystectomy and the Dunning-Kruger effect. Journal of Surgical Education.https://doi.org/10.1016/j.jsurg.2020.03.025
8. Seshadri, A., & Peitzman, A. B. (2024). The difficult cholecystectomy: What you need to know. The Journal of Trauma and Acute Care Surgery, 97(3), 325–336. https://doi.org/10.1097/TA.0000000000004156
9. Invited commentary on “A comparison of outcomes including bile duct injury of subtotal cholecystectomy versus open total cholecystectomy as bailout procedures for severe cholecystitis: A multicenter real-world study”. (2024). Surgery, 176(5), 614–615. https://doi.org/10.1016/j.surg.2024.05.003
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If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
You’re on call at a level I trauma center and you get called that you’re receiving a large TBSA burn patient – you’re not working at a burn center! You remember hearing about some controversy surrounding burn resuscitation – was it the parkland formula? Consensus formula? ABSITE asked about the Modified Brooke Formula?!? Join Dr. Kathleen Romanowski, Dr. Laura Johnson, Dr. Victoria Miles, and Dr. Lauren Nosanov to discuss modern burn fluid resuscitation!
Hosts:
· Kathleen Romanowski – University of California Davis Hospital, Shriners Hospital Sacramento
· Laura Johnson – Grady Memorial Hospital
· Lauren Nosanov – Grady Memorial Hospital
· Victoria Miles – Louisiana State University Health Science Center, University Medical Center New Orleans
Learning Objectives:
· Review the basics of initial burn fluid resuscitation
· Evaluate the literature informing national burn fluid resuscitation guidelines
· Consider the causes of failed burn resuscitation and strategies for identifying these complications
References:
· Pham TN, Cancio LC, Gibran NS. American Burn Association Practice Guidelines Burn Shock Resuscitation. J Burn Care Res. 2008: 257-266. doi:10.1097/jbcr.0b013e31815f3876. https://pubmed.ncbi.nlm.nih.gov/18182930/
· Rizzo JA, Coates EC, Serio-Melvin ML, et al. Higher Initial Formula for Resuscitation After Severe Burn Injury Means Higher 24-Hour Volumes. J Burn Care Res. 2023:1017-1022. doi:10.1093/jbcr/irad065. https://pubmed.ncbi.nlm.nih.gov/37339255/
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If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Today, we’re diving into a condition that’s as fascinating as it is complex: Achalasia—where the esophagus stops playing nice, and swallowing becomes a daily challenge.
We’re breaking down the latest evidence, comparing POEM, pneumatic dilation, and Heller myotomy, and digging into what actually matters when deciding how to treat each achalasia subtype.
Join show hosts Drs. Jake Greenberg, Dana Portenier, Zach Weitzner, and Joey Lew as they discuss the past, present, and future of Achalasia management. Whether you're a medical student or a seasoned attending, this episode will arm you with the tools to think critically about diagnosis, tailor your treatment strategy, and stay ahead of the curve on the future of achalasia care.
Hosts:
· Jacob Greenberg, MD, EdM, MIS Division Chief and Vice Chair for Education, Duke University
· Dana Portenier, MD, MIS Fellowship Director, Duke University
· Zachary Weitzner, MD, Minimally Invasive and Bariatric Surgery Fellow, Duke University, @ZachWeitznerMD
· Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actually
Learning Goals:
By the end of this episode, listeners will be able to:
· Describe the pathophysiology and key diagnostic criteria for achalasia, including the role of manometry, EGD, and esophagram.
· Differentiate between the three subtypes of achalasia based on the Chicago Classification and understand the clinical significance of each.
· Compare treatment options for achalasia—pneumatic dilation, Lap Heller myotomy, and POEM—including indications, efficacy, and long-term outcomes.
· Interpret landmark studies (e.g., European Achalasia Trial, JAMA POEM trial) and their impact on treatment decision-making.
· Recognize patient-specific factors (age, comorbidities, achalasia subtype) that influence the choice of therapy.
· Discuss evolving technologies and future directions in achalasia management, including endoluminal robotics, ARMS, and combined anti-reflux strategies.
· Outline a basic treatment algorithm for newly diagnosed achalasia, incorporating diagnostic steps and tailored interventions.
· Appreciate the multidisciplinary approach to achalasia care, including the roles of MIS surgeons, gastroenterologists, and emerging procedural skillsets.
References:
· Boeckxstaens G, Elsen S, Belmans A, Annese V, Bredenoord AJ, Busch OR, Costantini M, Fumagalli U, Smout AJPM, Tack J, Vanuytsel T, Zaninotto G, Salvador R; European Achalasia Trial Investigators. 10‑year follow-up results of the European Achalasia Trial: a multicentre randomised controlled trial comparing pneumatic dilation with laparoscopic Heller myotomy. Gut. 2024 Mar;73(4):582‑589. doi: 10.1136/gutjnl‑2023‑331374. PMID: 38050085 https://pubmed.ncbi.nlm.nih.gov/38050085/
· He J, Yin Y, Tang W, Jiang J, Gu L, Yi J, Yan L, Chen S, Wu Y, Liu X.
Objective Outcomes of an Extended Anti‑reflux Mucosectomy in the Treatment of PPI‑Dependent Gastroesophageal Reflux Disease (with Video). J Gastrointest Surg. 2022 Aug;26(8):1566–1574. doi:10.1007/s11605‑022‑05396‑9. PMID: 35776296 https://pubmed.ncbi.nlm.nih.gov/35776296/
· Modayil RJ, Zhang X, Rothberg B, et al. Peroral endoscopic myotomy: 10-year outcomes from a large, single-center U.S. series with high follow-up completion and comprehensive analysis of long-term efficacy, safety, objective GERD, and endoscopic functional luminal assessment. Gastrointest Endosc. 2021;94(5):930-942. doi:10.1016/j.gie.2021.05.014. PMID: 33989646. https://pubmed.ncbi.nlm.nih.gov/33989646/
· Ponds FA, Fockens P, Lei A, Neuhaus H, Beyna T, Kandler J, Frieling T, Chiu PWY, Wu JCY, Wong VWY, Costamagna G, Familiari P, Kahrilas PJ, Pandolfino JE, Smout AJPM, Bredenoord AJ.
Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-naive patients with achalasia: a randomized clinical trial. JAMA. 2019 Jul 9;322(2):134–144. doi:10.1001/jama.2019.8859. PMID: 31287522. https://pubmed.ncbi.nlm.nih.gov/31287522/
· Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT; ACG Clinical Guidelines Committee.
ACG clinical guidelines: Diagnosis and management of achalasia. Am J Gastroenterol. 2020 Sep;115(9):1393–1411. doi:10.14309/ajg.0000000000000731. PMID: 32773454; PMCID: PMC9896940 https://pubmed.ncbi.nlm.nih.gov/32773454/
· West RL, Hirsch DP, Bartelsman JF, de Borst J, Ferwerda G, Tytgat GN, Boeckxstaens GE. Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol. 2002;97(6):1346-1351. doi:10.1111/j.1572-0241.2002.05771.x. PMID:12094848. https://pubmed.ncbi.nlm.nih.gov/12094848/
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If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Every spring for over 50 years, the Trauma, Critical Care, and Acute Care Surgery conference, best known simply as the MATTOX conference, is held in Las Vegas (https://www.trauma-criticalcare.com/). The conference is unique in that it is entirely focused on practice-changing clinical education. It’s a damn good time too! A favorite feature is the annual debates. Today, we are featuring a showdown between Drs. Teddy Puzo and Joseph Dubois as they battle it out over the use of a DIRECT TO OR TRAUMA RESUSCITATION STRATEGY. You can listen on the podcast or watch the debate with accompanying slides on our website or app. Let's get ready to RUMMMBLLLEEEE!
Video Link: https://www.youtube.com/watch?v=-DTTGBaLcHo
TRAUMA SURGERY VIDEO ATLAS: https://app.behindtheknife.org/course-details/trauma-surgery-video-atlas
Preparing for the deadliest injuries is challenging, and currently available resources are limited. That is why we created the Behind the Knife Trauma Surgery Video Atlas. Be ready for the most complex injuries, like penetrating trauma to the neck, audible bleeding from the IVC, and pelvic hemorrhage, with 24 scenarios.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Every spring for over 50 years, the Trauma, Critical Care, and Acute Care Surgery conference, best known simply as the MATTOX conference, is held in Las Vegas (https://www.trauma-criticalcare.com/). The conference is unique in that it is entirely focused on practice-changing clinical education. It’s a damn good time too! A favorite feature is the annual debates. Today, we are featuring a showdown between Drs. Ryan Dumas and Bellal Joseph (@TopKniFe_B) as they battle it out over the use of TRAUMA VIDEO REVIEW. You can listen on the podcast or watch the debate with accompanying slides on our website or app. Let's get ready to RUMMMBLLLEEEE!
Video Link: https://app.behindtheknife.org/video/mattox-conference-pro-con-debate-2025-trauma-video-review
TRAUMA SURGERY VIDEO ATLAS: https://app.behindtheknife.org/course-details/trauma-surgery-video-atlas
Preparing for the deadliest injuries is challenging, and currently available resources are limited. That is why we created the Behind the Knife Trauma Surgery Video Atlas. Be ready for the most complex injuries, like penetrating trauma to the neck, audible bleeding from the IVC, and pelvic hemorrhage, with 24 scenarios.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
In this episode of the Big T Trauma Series, Dr. Patrick Georgoff (@georgoff) and Dr. Jason Brill dive into the evolving world of Trauma Video Review (TVR) with special guests Dr. Michael Vella and Dr. Ryan Dumas. Together, they explore how TVR is transforming trauma care by offering unprecedented insight into both technical and non-technical performance in the trauma bay. The conversation covers everything from implementation logistics and HIPAA concerns to cultural shifts and emerging AI applications. Whether you're curious about getting started or wondering if TVR should be part of trauma verification, this episode delivers essential insights from two national leaders in the space. Don’t miss it!
Dr. Ryan Dumas is an associate professor of surgery at Baylor College of Medicine in Houston Texas where he serves as the Section Chief of Acute Care Surgery. Dr. Dumas conducts and publishes research in trauma surgery and artificial intelligence, with a specific emphasis on video technology to capture and review trauma resuscitations. He has helped develop and run several Trauma Video Review programs across the country and utilizes video review as a tool for quality improvement, education, and research. Dr. Dumas is a consultant for Teleflex and Surgical Safety Technologies.
Dr. Michael Vella is an associate professor of surgery, division of acute care surgery and trauma, at the university of Rochester medical center in Rochester, NY and the trauma medical director of the Kessler Level I trauma center. He currently serves as chair of the New York State Committee on Trauma. He has a clinical and research interest in trauma video review, particularly as it relates to trauma team dynamics and initial resuscitation. Dr. Dumas is a consultant for Teleflex.
This episode of Big T Trauma was sponsored by Teleflex, a global provider of medical devices. Learn more at teleflex.com and at the Teleflex Trauma and Emergency Medicine LinkedIn page.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
The incidence of early onset colorectal cancer (EOCRC) has been rising prompting the change in change in screening guidelines to 45 years of age for average risk patients. Join us for an in-depth discussion with guest speakers Dr. Andrea Cercek and Dr. Nancy You, where we provide a comprehensive look at the growing challenge of EOCRC.
Hosts:
- Dr. Janet Alvarez - General Surgery Resident at New York Medical College/Metropolitan Hospital Center
- Dr. Wini Zambare – General Surgery Resident at Weill Cornell Medical Center/New York Presbyterian
- Dr. Phil Bauer, Graduating Colorectal Surgical Oncology Fellow at Memorial Sloan Kettering Cancer Center
- Dr. J. Joshua Smith MD, PhD, Chair, Department of Colon and Rectal Surgery at MD Anderson Cancer Center
- Dr. Andrea Cercek - Gastrointestinal Medical Oncologist at Memorial Sloan Kettering Cancer Center
- Dr. Y. Nancy You, MD MHSc - Professor, Department of Colon and Rectal Surgery at MD Anderson Cancer Center
Learning objectives:
- Describe trends in incidence of colorectal cancer, with emphasis on the rise of EOCRC.
- Identify age groups and demographics most affected by EOCRC.
- Summarize USPSTF recommendations for colorectal cancer screening.
- Distinguish between screening methods (e.g., colonoscopy, FIT-DNA) and their sensitivity.
- Understand treatment approaches for colon and rectal cancer (CRC)
- Understand the role of mismatch repair (MMR) status in guiding treatment.
- Outline the importance of genetic counseling and testing in young patients.
- Discuss racial, ethnic, and socioeconomic disparities in CRC incidence and outcomes.
- Describe the impact of cancer treatment on fertility and sexual health.
- Review fertility preservation options.
- Identify the value of integrated care teams for young CRC patients.
References:
- Siegel, R. L. et al. Colorectal Cancer Incidence Patterns in the United States, 1974–2013. JNCI J. Natl. Cancer Inst. 109, djw322 (2017). https://pubmed.ncbi.nlm.nih.gov/28376186/
- Abboud, Y. et al. Rising Incidence and Mortality of Early-Onset Colorectal Cancer in Young Cohorts Associated with Delayed Diagnosis. Cancers 17, 1500 (2025). https://pubmed.ncbi.nlm.nih.gov/40361427/
- Phang, R. et al. Is the Incidence of Early-Onset Adenocarcinomas in Aotearoa New Zealand Increasing? Asia Pac. J. Clin. Oncol.https://pubmed.ncbi.nlm.nih.gov/40384533/
- Vitaloni, M. et al. Clinical challenges and patient experiences in early-onset colorectal cancer: insights from seven European countries. BMC Gastroenterol. 25, 378 (2025). https://pubmed.ncbi.nlm.nih.gov/40375142/
- Siegel, R. L. et al. Global patterns and trends in colorectal cancer incidence in young adults. (2019) doi:10.1136/gutjnl-2019-319511. https://pubmed.ncbi.nlm.nih.gov/31488504/
- Cercek, A. et al. A Comprehensive Comparison of Early-Onset and Average-Onset Colorectal Cancers. J. Natl. Cancer Inst. 113, 1683–1692 (2021). https://pubmed.ncbi.nlm.nih.gov/34405229/
- Zheng, X. et al. Comprehensive Assessment of Diet Quality and Risk of Precursors of Early-Onset Colorectal Cancer. JNCI J. Natl. Cancer Inst. 113, 543–552 (2021). https://pubmed.ncbi.nlm.nih.gov/33136160/
- Standl, E. & Schnell, O. Increased Risk of Cancer—An Integral Component of the Cardio–Renal–Metabolic Disease Cluster and Its Management. Cells 14, 564 (2025). https://pubmed.ncbi.nlm.nih.gov/40277890/
- Muller, C., Ihionkhan, E., Stoffel, E. M. & Kupfer, S. S. Disparities in Early-Onset Colorectal Cancer. Cells 10, 1018 (2021). https://pubmed.ncbi.nlm.nih.gov/33925893/
- US Preventive Services Task Force. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 325, 1965–1977 (2021). https://pubmed.ncbi.nlm.nih.gov/34003218/
- Fwelo, P. et al. Differential Colorectal Cancer Mortality Across Racial and Ethnic Groups: Impact of Socioeconomic Status, Clinicopathology, and Treatment-Related Factors. Cancer Med. 14, e70612 (2025). https://pubmed.ncbi.nlm.nih.gov/40040375/
- Lansdorp-Vogelaar, I. et al. Contribution of Screening and Survival Differences to Racial Disparities in Colorectal Cancer Rates. Cancer Epidemiol. Biomarkers Prev. 21, 728–736 (2012). https://pubmed.ncbi.nlm.nih.gov/22514249/
- Ko, T. M. et al. Low neighborhood socioeconomic status is associated with poor outcomes in young adults with colorectal cancer. Surgery 176, 626–632 (2024). https://pubmed.ncbi.nlm.nih.gov/38972769/
- Siegel, R. L., Wagle, N. S., Cercek, A., Smith, R. A. & Jemal, A. Colorectal cancer statistics, 2023. CA. Cancer J. Clin. 73, 233–254 (2023). https://pubmed.ncbi.nlm.nih.gov/36856579/
- Jain, S., Maque, J., Galoosian, A., Osuna-Garcia, A. & May, F. P. Optimal Strategies for Colorectal Cancer Screening. Curr. Treat. Options Oncol. 23, 474–493 (2022). https://pubmed.ncbi.nlm.nih.gov/35316477/
- Zauber, A. G. The Impact of Screening on Colorectal Cancer Mortality and Incidence: Has It Really Made a Difference? Dig. Dis. Sci. 60, 681–691 (2015). https://pubmed.ncbi.nlm.nih.gov/25740556/
- Edwards, B. K. et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 116, 544–573 (2010). https://pubmed.ncbi.nlm.nih.gov/19998273/
- Cercek, A. et al. Nonoperative Management of Mismatch Repair–Deficient Tumors. New England Journal of Medicine 392, 2297–2308 (2025). https://pubmed.ncbi.nlm.nih.gov/40293177/
- Monge, C., Waldrup, B., Carranza, F. G. & Velazquez-Villarreal, E. Molecular Heterogeneity in Early-Onset Colorectal Cancer: Pathway-Specific Insights in High-Risk Populations. Cancers 17, 1325 (2025). https://pubmed.ncbi.nlm.nih.gov/40282501/
- Monge, C., Waldrup, B., Carranza, F. G. & Velazquez-Villarreal, E. Ethnicity-Specific Molecular Alterations in MAPK and JAK/STAT Pathways in Early-Onset Colorectal Cancer. Cancers 17, 1093 (2025). https://pubmed.ncbi.nlm.nih.gov/40227607/
- Benson, A. B. et al. Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Cancer Netw. JNCCN 19, 329–359 (2021). https://pubmed.ncbi.nlm.nih.gov/33724754/
- Christenson, E. S. et al. Nivolumab and Relatlimab for the treatment of patients with unresectable or metastatic mismatch repair proficient colorectal cancer. https://pubmed.ncbi.nlm.nih.gov/40388545/
- Dasari, A. et al. Fruquintinib versus placebo in patients with refractory metastatic colorectal cancer (FRESCO-2): an international, multicentre, randomised, double-blind, phase 3 study. The Lancet 402, 41–53 (2023). https://pubmed.ncbi.nlm.nih.gov/37331369/
- Strickler, J. H. et al. Tucatinib plus trastuzumab for chemotherapy-refractory, HER2-positive, RAS wild-type unresectable or metastatic colorectal cancer (MOUNTAINEER): a multicentre, open-label, phase 2 study. Lancet Oncol. 24, 496–508 (2023). https://pubmed.ncbi.nlm.nih.gov/37142372/
- Sauer, R. et al. Preoperative versus Postoperative Chemoradiotherapy for Rectal Cancer. N. Engl. J. Med. 351, 1731–1740 (2004). https://pubmed.ncbi.nlm.nih.gov/15496622/
- Cercek, A. et al. Adoption of Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer. JAMA Oncol. 4, e180071 (2018). https://pubmed.ncbi.nlm.nih.gov/29566109/
- Garcia-Aguilar, J. et al. Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy. J. Clin. Oncol. 40, 2546–2556 (2022). https://pubmed.ncbi.nlm.nih.gov/35483010/
- Schrag, D. et al. Preoperative Treatment of Locally Advanced Rectal Cancer. N. Engl. J. Med. 389, 322–334 (2023). https://pubmed.ncbi.nlm.nih.gov/37272534/
- Kunkler, I. H., Williams, L. J., Jack, W. J. L., Cameron, D. A. & Dixon, J. M. Breast-Conserving Surgery with or without Irradiation in Early Breast Cancer. N. Engl. J. Med. 388, 585–594 (2023). https://pubmed.ncbi.nlm.nih.gov/36791159/
- Jacobsen, R. L., Macpherson, C. F., Pflugeisen, B. M. & Johnson, R. H. Care Experience, by Site of Care, for Adolescents and Young Adults With Cancer. JCO Oncol. Pract. (2021) doi:10.1200/OP.20.00840. https://pubmed.ncbi.nlm.nih.gov/33566700/
- Ruddy, K. J. et al. Prospective Study of Fertility Concerns and Preservation Strategies in Young Women With Breast Cancer. J. Clin. Oncol. (2014) doi:10.1200/JCO.2013.52.8877. https://pubmed.ncbi.nlm.nih.gov/24567428/
- Su, H. I. et al. Fertility Preservation in People With Cancer: ASCO Guideline Update. J. Clin. Oncol. 43, 1488–1515 (2025). https://pubmed.ncbi.nlm.nih.gov/40106739/
- Smith, K. L., Gracia, C., Sokalska, A. & Moore, H. Advances in Fertility Preservation for Young Women With Cancer. Am. Soc. Clin. Oncol. Educ. Book 27–37 (2018) doi:10.1200/EDBK_208301. https://pubmed.ncbi.nlm.nih.gov/30231357/
- Blumenfeld, Z. How to Preserve Fertility in Young Women Exposed to Chemotherapy? The Role of GnRH Agonist Cotreatment in Addition to Cryopreservation of Embrya, Oocytes, or Ovaries. The Oncologist 12, 1044–1054 (2007).
- Bhagavath, B. The current and future state of surgery in reproductive endocrinology. Curr. Opin. Obstet. Gynecol. 34, 164 (2022).
- Ribeiro, R. et al. Uterine transposition: technique and a case report. Fertil. Steril. 108, 320-324.e1 (2017).
- Yazdani, A., Sweterlitsch, K. M., Kim, H., Flyckt, R. L. & Christianson, M. S. Surgical Innovations to Protect Fertility from Oncologic Pelvic Radiation Therapy: Ovarian Transposition and Uterine Fixation. J. Clin. Med. 13, 5577 (2024).
- Holowatyj, A. N., Eng, C. & Lewis, M. A. Incorporating Reproductive Health in the Clinical Management of Early-Onset Colorectal Cancer. JCO Oncol. Pract. 18, 169–172 (2022).
***Behind the Knife Colorectal Surgery Oral Board Audio Review: https://app.behindtheknife.org/course-details/colorectal-surgery-oral-board-audio-review
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You have probably seen recent headlines that Microsoft has developed an AI model that is 4x more accurate than humans at difficult diagnoses. It’s been published everywhere, AI is 80% accurate compared to a measly 20% human rate, and AI was cheaper too! Does this signal the end of the human physician? Is the title nothing more than clickbait? Or is the truth somewhere in-between? Join Behind the Knife fellow Ayman Ali and Dr. Adam Rodman from Beth Israel Deaconess/Harvard Medical School to discuss what this study means for our future.
Studies:
Sequential Diagnosis with Large Language Models: https://arxiv.org/abs/2506.22405v1
METR study: https://metr.org/blog/2025-07-10-early-2025-ai-experienced-os-dev-study/
Hosts:
Ayman Ali, MD
Ayman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital in his academic development time where he focuses on applications of data science and artificial intelligence to surgery.
Adam Rodman, MD, MPH, FACP, @AdamRodmanMD
Dr. Rodman is an Assistant Professor and a practicing hospitalist at Beth Israel Deaconess Medical Center. He’s the Beth Israel Deaconess Medical Center Director of AI Programs. In addition, he’s the co-director of the Beth Israel Deaconess Medical Center iMED Initiative.
Podcast Link: http://bedside-rounds.org/
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Join us as we dissect the use of robotics in bariatric surgery – where precision meets programming, and the scalpel gets a software upgrade.
Video Clip Link: https://app.behindtheknife.org/video/clinical-challenges-in-robotic-bariatric-surgery-the-robot-is-here-to-stay
This videos includes:
- Robotic RYGB
- Robotic Sleeve Gastrectomy
- SADI: Single Anastomosis Duodenoileostomy
Hosts:
- Matthew Martin, trauma and bariatric surgeon at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California)
- Adrian Dan, bariatric and MIS surgeon, program director for the advanced MIS bariatric and foregut fellowship at Summa Health System (Akron, Ohio)
- Crystal Johnson Mann, bariatric and foregut surgeon at the University of Florida (Gainesville, Florida)
- Katherine Cironi, general surgery resident at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California)
Learning objectives: * Strengths of the robot: + Surgical robots are at the forefront of technology and continue to improve with detailed, precision cameras and the ability to remove baseline tremors + Allows for smooth movements, fine dissection, and precise tissue handling + Ergonomics are more advantageous to the surgeon when compared to laparoscopy * Weaknesses of the robot: + The loss of haptic feedback can be challenging for surgeons early in their learning curve + Emphasis on surgical robots means some trainees may be losing exposure to laparoscopic techniques + Longer operative time when working robotically, and more time under anesthesia for the patient + Increased cost for robotic surgery * Outcomes data: + Mixed data from the MBSA QIP database (metabolic and bariatric surgery accreditation and quality improvement program) + The most recent study looked at 824,000 patients from 2015-2022 who had a sleeve gastrectomy or RNY gastric bypass, either laparoscopically (lap sleeve 61%, lap RYGB 24%) or robotically (robo sleeve 11%, robo RYGB 4%). - Robotic sleeves were reported to have higher complication rates compared to laparoscopy, seen as higher overall morbidity and an increased rate of leaks - While the robotic RYGBs have lower overall complications, including decreased morbidity and bleeding. Robotic RYGB can be especially advantageous with revisional surgeries when compared to lap. * Setting up for success + Train your eyes to determine tension on tissue, since there is no haptic feedback + Learn how to assist yourself (manipulating the camera and effectively utilizing the fourth arm) + Understand how techniques of the surgery change when doing it robotically, as compared to laparoscopy + Experienced operating room team + When learning, recommend putting all cases feasible on the robot (including easier cases), to master the straightforward cases before moving to technically challenging revision cases. + Don’t hesitate to add an additional trocar or assistant port when needed * Education in Robotic learning + Learning by observation/mirroring – ex: robotic bilateral inguinal hernia (mirroring the attending/instructor) + Easy for the attending/instructor in the case to switch instruments seamlessly, then give them back intermittently at the appropriate time + Helpful when the attending annotates the screen to depict where to go + Data-driven teaching tools on the Davinci system * Tips for robotic sleeve gastrectomy: + Of the robotic bariatric surgeries, sleeve gastrectomy is most similar to its laparoscopic procedure + 30-40 degrees of reverse Trendelenburg + Liver hammock stitch instead of a liver retractor (one less trocar), which makes a total of 4 trocars needed for the case + Green staple load for the first firing, then the rest are typically blue loads + Mixed opinions on reinforced staple loads versus non-reinforced staple loads and oversewing the staple line (discussed cost-benefit) * Tips for robotic gastric bypass: + Watch videos from colleagues to learn what they do + Gastric bypass is a multi-quadrant surgery; thus, you must set yourself up for success so that your arms are not fighting when moving through different quadrants + A size 12 trocar on the left can make the formation of the gastric pouch easier + GJ and JJ anastomosis formed with a linear fire, then a two-layer closure with absorbable barb suture + Don’t forget to close the mesenteric defect (non-absorbable braided suture) * Tips for robotic DS and SADI: + If doing a duodenal anastomosis hand-sewn, then recommend planning the exact number of sutures and locations of each for ease + Hand-sewn anastomosis can have less bleeding and fewer strictures for patients, and is completed in a much more seamless fashion with the robot * Future of Robotics + Haptic feedback + Integrated visual overlays to identify anatomical structures/serve as an intraoperative map + Artificial intelligence integration + Telesurgery – ex, small surgical robot deployed to space
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It’s 2 a.m. The on-call resident’s voice is shaky.
The CT shows an 18cm abdominal aortic aneurysm with a Type 1B endoleak.
There’s gas in the sac, fluid in the belly, and the patient has a defibrillator on both sides of his chest.
Is it a rupture? A graft infection? An aortoenteric fistula? All of the above?
You’re the vascular surgeon, what do you do?
This episode dives deep into decision-making when EVAR fails, when infection strikes, and when the patient might not survive a definitive repair. Let’s talk about what happens when clinical textbooks meet real-world chaos.
Hosts:
· Christian Hadeed -PGY 4 General Surgery, Brookdale Hospital Medical Center
· Paul Haser -Division chief, Vascular Surgery, Brookdale Hospital Medical Center
· Andrew Harrington, Vascular surgery, Brookdale Hospital Medical Center
· Lucio Flores, Vascular surgery, Brookdale Hospital Medical Center
Learning objectives:
· Understand the clinical implications and management of late EVAR complications, including Type 1B endoleak and aortoenteric fistula.
· Explore the decision-making process in critically ill patients with multiple comorbidities and infected aortic grafts.
· Compare endovascular vs open surgical approaches in the setting of infected AAA, and when each is appropriate.
· Recognize the role of multidisciplinary collaboration in complex vascular cases.
· Discuss the ethical considerations and goals-of-care planning in high-risk, potentially terminal vascular patients.
· Highlight the importance of long-term surveillance after EVAR and the consequences of noncompliance.
References
· Karl Sörelius et al.Nationwide Study of the Treatment of Mycotic Abdominal Aortic Aneurysms Comparing Open and Endovascular Repair.Circulation. 2016;134(22):1822–1832.
PubMed: https://pubmed.ncbi.nlm.nih.gov/27799273/ pubmed.ncbi.nlm.nih.gov+15pubmed.ncbi.nlm.nih.gov+15researchgate.net+15
· PARTNERS Trial (OVER Trial).Outcomes Following Endovascular vs Open Repair of Abdominal Aortic Aneurysm: A Randomized Trial.JAMA. 2009;302(14):1535–1542.
PubMed: https://pubmed.ncbi.nlm.nih.gov/19826022/ pubmed.ncbi.nlm.nih.gov+6pubmed.ncbi.nlm.nih.gov+6jamanetwork.com+6
· B.T. Müller et al.Mycotic Aneurysms of the Thoracic and Abdominal Aorta and Iliac Arteries: Experience with Anatomic and Extra-anatomic Repair in 33 Cases.J Vasc Surg. 2001;33(1):106–113.
PubMed: https://pubmed.ncbi.nlm.nih.gov/11137930/ sciencedirect.com+5pubmed.ncbi.nlm.nih.gov+5periodicos.capes.gov.br+5
· Chung‑Dann Kan et al.Outcome after Endovascular Stent Graft Treatment for Mycotic Aortic Aneurysm: A Systematic Review.J Vasc Surg. 2007 Nov;46(5):906–912.
PubMed: https://pubmed.ncbi.nlm.nih.gov/17905558/ researchgate.net+15pubmed.ncbi.nlm.nih.gov+15pubmed.ncbi.nlm.nih.gov+15
· Hamid Gavali et al.Outcome of Radical Surgical Treatment of Abdominal Aortic Graft and Endograft Infections Comparing Extra‑anatomic Bypass with In Situ Reconstruction: A Nationwide Multicentre Study.Eur J Vasc Endovasc Surg. 2021;62(6):918–926.
PubMed: https://pubmed.ncbi.nlm.nih.gov/34782231/ pubmed.ncbi.nlm.nih.gov+6pubmed.ncbi.nlm.nih.gov+6diva-portal.org+6
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In the corner of the ICU, on multiple pressors, distended, oliguric, and intubated you’ll find the necrotizing pancreatitis patient. Sounds intimidating, but with the persistence, patience, and the proper care these patients can make it! In this episode from the HPB team at Behind the Knife listen in as we discuss the Step-Up approach, when to surgically intervene, various approaches to pancreatic Necrosectomy, and additional aspects of the multidisciplinary care required for the successful treatment of necrotizing pancreatitis.
Hosts
Anish J. Jain MD (@anishjayjain) is a current PGY3 General Surgery Resident at Stanford University and a former T32 Research Fellow at the University of Texas MD Anderson Cancer Center.
Jon M. Harrison is a 2nd year HPB Surgery Fellow at Stanford University. He will be joining as faculty at the Massachusetts General Hospital in Boston, MA at the conclusion of his fellowship in July 2024.
Learning Objectives
· Develop an understanding of the severity of necrotizing pancreatitis and the proper indications to surgical intervene on this often-tenuous patients.
· Develop an understanding of the Step-Up approach and key aspects (reimaging, clinical status, physiologic status, etc.) that determine when to “step-up” treatment for patients with necrotizing pancreatitis.
· Develop an understanding of long term sequalae and complications associated with necrotizing pancreatitis and operative management
· Develop an understanding of multidisciplinary care and long-term follow-up necessary for adequate treatment of patients suffering from necrotizing pancreatitis.
Suggested Reading
Maurer LR, Fagenholz PJ. Contemporary Surgical Management of Pancreatic Necrosis. JAMA Surg. 2023;158(1):81–88. doi:10.1001/jamasurg.2022.5695 https://pubmed.ncbi.nlm.nih.gov/36383374/
Harrison JM, Day H, Arnow K, Ngongoni RF, Joseph A, Aldridge T, Wheeler KJ, DeLong JC, Bergquist JR, Worth PJ, Dua MM, Friedland S, Park W, Eldika S, Hwang JH, Visser BC. What's Behind it all: A Retrospective Cohort Study of Retrogastric Pancreatic Necrosis Management. Ann Surg. 2024 Sep 3. doi: 10.1097/SLA.0000000000006521. https://pubmed.ncbi.nlm.nih.gov/39225420/
Harrison JM, Visser BC. Not Dead Yet: Managing the Abdominal Catastrophe in Necrotizing Pancreatitis. Pancreas. 2025 May 20. doi: 10.1097/MPA.0000000000002512. https://pubmed.ncbi.nlm.nih.gov/40388698/
Harrison JM, Li AY, Sceats LA, Bergquist JR, Dua MM, Visser BC. Two-Port Minimally Invasive Nephrolaparoscopic Retroperitoneal Debridement for Pancreatic Necrosis. J Am Coll Surg. 2024 Dec 1;239(6):e7-e12. doi: 10.1097/XCS.0000000000001152. https://pubmed.ncbi.nlm.nih.gov/39051721/
van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H, Schaapherder AF, van Eijck CH, Bollen TL, van Ramshorst B, Nieuwenhuijs VB, Timmer R, Laméris JS, Kruyt PM, Manusama ER, van der Harst E, van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, van Leeuwen MS, Buskens E, Gooszen HG; Dutch Pancreatitis Study Group. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010 Apr 22;362(16):1491-502. doi: 10.1056/NEJMoa0908821. https://pubmed.ncbi.nlm.nih.gov/20410514/
Bang JY, Arnoletti JP, Holt BA, Sutton B, Hasan MK, Navaneethan U, Feranec N, Wilcox CM, Tharian B, Hawes RH, Varadarajulu S. An Endoscopic Transluminal Approach, Compared With Minimally Invasive Surgery, Reduces Complications and Costs for Patients With Necrotizing Pancreatitis. Gastroenterology. 2019 Mar;156(4):1027-1040.e3. doi: 10.1053/j.gastro.2018.11.031. https://pubmed.ncbi.nlm.nih.gov/30452918/
Zyromski NJ, Nakeeb A, House MG, Jester AL. Transgastric Pancreatic Necrosectomy: How I Do It. J Gastrointest Surg. 2016 Feb;20(2):445-9. doi: 10.1007/s11605-015-3058-y. https://pubmed.ncbi.nlm.nih.gov/26691148/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
RE-RELEASE
This was first published in 2023 but it's so good we are running it back!
Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.
In this last episode of the intern bootcamp mini-series, we’ll talk about tips & tricks as well as good habits to establish in order to dominate intern year.
Hosts: Shanaz Hossain, Nina Clark
Tips for New Interns:
GENERAL TIPS FOR SUCCESS ON THE WARDS* Spend time with the patient! * Trust, but verify. * Be kind to everyone. * Stay humble. * Be flexible. * Seek and apply feedback.
HOW TO LEARN IN THE OR* Double scrub as many cases as you can. * Write down/record everything after a case.
MAINTAIN YOUR PERSONAL SANITY* Figure out your stress outlets and what brings you joy. * Decompress after work. * Maintain work/life boundaries. * Keep in touch with loved ones. * Vacations are meant for relaxation. + Repeat after me: NO WORK ON VACATION!
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/
RE-RELEASE
This was first published in 2023 but it's so good we are running it back!
Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.
Today, we’re hitting the wards and tackling some of the scary clinical scenarios you will see as an intern.
Hosts: Shanaz Hossain, Nina Clark
Tips for new interns:
THINGS TO REMEMBER
· BREATHE. In most cases, you have a little bit of time – at least enough to take a breath and calm down outside the room before heading into an emergency. Panic doesn’t help anybody.
· See the patient. Getting a bunch of pages? Worried about someone? Confused as to what’s going on? Go see the patient and chat with the bedside team.
· Know your toolbox. There are a ton of people around who can help you in the hospital, and knowing the basic labs/imaging studies and when to use them can help you to triage even the sickest patients.
· Load the boat. You’ve heard this one from us all week! Loop senior level residents in early.
HYPOTENSION
· Differential: measurement error, patient’s baseline, and don’t miss – SHOCK.
- Etiologies of shock: hemorrhagic, hypovolemic,
· On the phone: full set of vitals, accurate I/Os,
· On the way: recent notes, PMH/PSH including from this hospital stay, and vitals/I&Os/studies from earlier in the day
· In the room: ABCDs – rapidly gives you a sense of how high acuity the patient is
· Get more info: labs, consider imaging, work up specific types of shock based on clinical concern.
· Initial management: depends on etiology of hypotension; don’t forget to consider peripheral or central access, foley catheterization for close monitoring of urine output, and level of care
HYPOXEMIA
· Differential: atelectasis, baseline pulmonary disease, pneumonia, PE, hemo/pneumothorax, volume overload
· On the phone: full set of vitals, amount of supplemental oxygen required and delivery device, rate of escalation in oxygen requirement
· On the way: review PMH/PSH, known injuries (known hemothorax/pneumothorax? Rib fractures? Chest tubes in already?), risk factors for DVT/PE, review I/Os for evidence of volume status, vitals and labs for evidence of infection
· In the room: ABCDs, pulmonary and cardiac exam, volume status exam
· Get more info: basic labs, ABG if worried about oxygenation, CXR, consider bedside US of the lungs/heart, if high suspicion for PE consider CTA chest
· Initial Management: supplemental O2, higher level of care, consider intubation or other supplemental oxygenation adjuncts, additional management dependent on suspected etiology
· ABG Vs VBG (IBCC): https://emcrit.org/ibcc/vbg/
ALTERED MENTAL STATUS
· Differential: stroke, medication effect, hypoxemia or hypercarbia, toxic or medication effect, endocrine/metabolic, stroke or MI, psychiatric illness, or infections, delirium
· On the way: review PMH/PSH, recent notes for evidence of altered mentation or agitation, or signs hinting at above etiologies
· In the room: ABCDs, focal neuro deficits?, alert/oriented? Be sure the patient’s mental status is adequate for airway protection!
· Get more info: basic labs, blood gas/lactate, CT head noncontrast if concerned for stroke.
· Initial management: rule out above; if concerned about delirium, optimize sleep/wake cycles, pain control, and lines/drains/tubes.
OLIGURIA
· Differential: prerenal due to hypovolemia or low effective circulating volume, intrinsic renal disease, post-renal obstruction
· On the phone: clarify functional foley or bladder scan results, full set of vitals
· On the way: review PMH/PSH, known injuries (known hemothorax/pneumothorax? Rib fractures? Chest tubes in already?), risk factors for DVT/PE, review I/Os for evidence of volume status, vitals and labs for evidence of infection
· In the room: ABCDs, confirm functioning foley catheter
· Get more info: basic labs, urine electrolytes, consider fluid challenge to evaluate responsiveness, consider adjuncts including renal US
· Initial management: typically consider IVF bolus initially, but if patient not volume responsive, don't overload them -- look for other etiologies!
TACHYCARDIA
· Differential: sinus tachycardia (pain, hypovolemia, agitation, infection), cardiac arrhythmia, MI, PE
· On the phone: full set of vitals, acuity of change in heart rate, updated I/Os
· On the way: Review PMH/PSH, known cardiac history, cardiac and PE risk factors, volume resuscitation, signs concerning for infection, updated I/Os
· In the room: ABCDs, cardiac/pulmonary exam, evaluate for any localizing signs for infection
· Get more info: basic labs, EKG, consider CXR, troponins
· Initial management: depends heavily on etiology
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/
RE-RELEASE
This was first published in 2023 but it's so good we are running it back!
Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.
This episode, we’ll talk about how to give and receive consults in the hospital like a pro. We’ll also provide some tips on how to make those long call days a little more manageable.
Hosts: Shanaz Hossain, Nina Clark
Tips for New Interns:
GIVING CONSULTS Clear and Concise Question! * Develop a script, such as: + “Hi, this is XX with the general surgery team. We’re calling to request an evaluation for a patient presenting with XX. I can give you the MRN whenever you are ready…” + Follow this with a brief* H&P. * If you are asking another team to perform a procedure on your patient, be prepared with the following information: + NPO Status + Ability to Consent or Proxy Contact + Blood Thinners + Urgency of Procedure
RECEIVING CONSULTS* Make sure you are clear on what the team is asking of you as a consultant. * Clarify if the patient is expecting to receive a surgery before talking to them about an operation! * Quickly gather information about the patient and their hospital course from the consultant, electronic medical record, and, most importantly, the patient! * Note the callback number on the primary team and call them with the plan after you have staffed the patient with your attending. * If you are asked to perform a procedure as a consultant, clarify the following information: + NPO Status + Ability to Consent or Proxy Contact + Blood Thinners + Urgency of Procedure * Develop a system to stay organized and keep track of your to-do list with consults!
CALL SHIFTS* Bring a survival bag with toothbrush/toothpaste, face wash, deodorant, change of clothes, etc to reset. * Try to nap when you can, but: + PM round to address non-urgent pages ahead of time + Set alarms!
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/
RE-RELEASE
This was first published in 2023 but it's so good we are running it back!
Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.
You’ve been a doctor for about 3.5 seconds, and suddenly that bright eyed, bushy-tailed medical student on service is looking to you for advice? Don’t fret, in this episode we’ll give you some tips for how to handle it.
Hosts: Shanaz Hossain, Nina Clark
Tips for new interns:
REMEMBER HOW INTERNS DO AND DO NOT TEACH
- Nobody, not even the med students, expect you to be an expert in everything or give a fully-planned formal lecture
- You WILL however spend a ton of time working with students on your team – and via modeling and teachable moments, you can help them learn how it’s done!
MODELING
- Remember how hard everything has been in the few days since you started residency? Think about all the information you’ve picked up, tips and tricks you’re developing for efficiency, and best practices you’re learning in the care of your patients. ALL of these are things you can pass on to students.
- Presentations, case prep, answering questions from senior members of the team are ALL excellent opportunities to teach (and show students how you learn yourself, so they can do it independently).
TEACHABLE MOMENTS
- Find small topics that you know or are getting to know well – things like looking at a CXR, CT scan, etc.
- Once you’re getting more comfortable caring for specific disease processes, think about high yield lessons for students:
- Acute trauma evaluation and management (ABCDE’s), appendicitis, diverticulitis, benign biliary disease all make great 5 minute chalk talks that you can have in your back pocket
IN THE OR
- Watch students practice skills, and try to give some feedback and tips that you use (you learned knot tying and suturing more recently than ANYONE else in the OR and probably have some tips that you’re still using to improve)
- If you’re not sure where or why the student is struggling with a particular skill (like tying a knot), model doing it yourself in slow motion while watching them do it – often the side by side comparison can help you identify where they’re going astray
BE THE RESIDENT YOU WISH YOU HAD
- Refer to EVERYONE with respect
- Model being a kind, conscientious, and curious physician
- Try to find universal lessons and crossover topics that non-surgeons need to know
- A great student makes their interns look even better – be explicit about how they can be successful, then advocate for them to have opportunities to show everything they’re learning!
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/
RE-RELEASE
This was first published in 2023 but it's so good we are running it back!
Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.
This episode, we’ll tackle the resources that you should know about to support your own learning throughout residency.
Hosts: Shanaz Hossain, Nina Clark
Tips for new interns:
STRUCTURE YOUR STUDYING
- 2 things you need to do: (1) develop a knowledge base and (2) answer questions
- Knowledge base* Pick a level-appropriate textbook, read it (ideally all of it) yearly.
* Ideally, lead a little bit every day - 10 pages/day is a good goal to start with and you may need to adjust.
- Questions
Do some questions every week – 50/week is a good goal to start* Plan to do more questions closer to ABSITE!
Consider storing everything you learn in one place – either a notebook you carry with you or a cloud-based note app* Share this with others, use it to take notes while reading, doing cases, getting feedback, or gaining experience while taking care of patients every day.
SPECIFIC RESOURCES
- Textbooks* Sabiston: big book, very dense, with a lot of great information.
* Schwartz: shorter chapters, clinically oriented, ideal for junior residents
* Cameron: shorter chapters, clinically oriented, ideal for senior residents
- ABSITE review books* Fiser: Classic, packed with facts but can be difficult to read, good for looking things up quickly
-
BTK ABSITE Companion: https://www.amazon.com/Behind-Knife-ABSITE-Review-Companion-ebook/dp/B0CLBZ273F/ref=sr_1_2?crid=3382SFZ81ZHKA&keywords=absite+review+behind+the+knife&qid=1698106031&sprefix=absite+review+behind+the+knife%2Caps%2C64&sr=8-2
-
Question banks* TrueLearn: high quality, can be pricy depending on program
- SCORE: written/edited by ABS, free for subscribing programs
LEARN HOW TO OPERATE??
- Carry suture and a needle driver with you and practice basic moves
- Consider a home suture kit for practice when you don’t want to be in sim lab – BTK released one this year
- Use VIDEOS to ensure learning things the correct way!
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/
RE-RELEASE
This was first published in 2023 but it's so good we are running it back!
Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.
First up, the first day of intern year.
Hosts: Shanaz Hossain, Nina Clark
Tips for new interns:1. BRING WHAT YOU NEED 1. Name badge 2. Scrubs, white coat, and extra clinic clothes 3. Comfortable shoes - even on clinic days 4. Pager 5. Phone 6. Pen 7. Bonus stuff that’s good to keep in your bag: Snacks, extras of everything, toothbrusth/toothpaste/deodorant, suture 2. STAY ORGANIZED 1. Preround purposefully and systematically 1. Look at the same things in the same order every day on every patient 2. Write data in the same physical location on your sheet so you can quickly find information on the fly 2. Keep track of to-do’s from rounds 1. Check box system: 1. Nina’s system: empty = not done, half full = ordered/needs follow up, full = completely done and followed up on 2. Don’t forget to look at the results of imaging studies, labs, or consults after they are entered! 2. Prioritize urgent/emergent things first, then consults and discharges, then routine orders, then notes 1. As you get more efficient, start drafting your notes as you pre-round – it will save you lots of time later in the afternoon! 3. OWN THE FLOOR 1. During the day, be ready to shift your priorities as urgent issues arise. 2. Develop a system for remembering what happened after rounds so you can quickly update seniors 1. Shanaz’s system: One color for AM rounds, a different color for afternoon events 3. Load the boat! Your team is there to help you. If you are concerned about someone or have a question, ask. There is truly no better time than as an intern. 1. Master the art of getting your seniors’ attention in the OR - be conscientious, be clear in what you’re asking, and be prepared to report back about urgent findings!
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our new how-to video series on suture and knot-tying skills - https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/
In this surgical education episode, the Cleveland Clinic General Surgery Education Team explores the past, present, and future of resident autonomy in the operating room. With guest colorectal surgeons Dr. Tracy Hull (recently retired) and Dr. David Rosen (early career faculty), we discuss how autonomy was granted in “the good ole days,” how educational culture and institutional pressures shape current practice, and what thoughtful autonomy looks like moving forward. Through candid stories—from emergent cases and missed enterotomies to thumbtacks pulled off the wall to stop bleeding—we get a nuanced look at what surgical independence really means, and how to responsibly develop it.
Join hosts Pooja Varman, MD, Judith French, PhD, and Jeremy Lipman, MD, MHPE, for this conversation about what it means to train competent, confident, and independent surgeons.
Learning Objectives
By the end of this episode, listeners will be able to
1. Define operative autonomy and its educational value in surgical training
2. Identify barriers to providing resident autonomy in modern surgical environments
3. Discuss strategies for tailoring autonomy to the skill level and readiness of the trainee
4. Describe approaches to communicating resident involvement to patients
References
1. Sehat AJ, Oliver JB, Yu Y, Kunac A, Anjaria DJ. Declining Surgical Resident Operative Autonomy in Acute Care Surgical Cases. J Surg Res. 2023;281(k7b, 0376340):328-334. doi:10.1016/j.jss.2022.08.041 https://pubmed.ncbi.nlm.nih.gov/36240719/
- Teman NR, Gauger PG, Mullan PB, Tarpley JL, Minter RM. Entrustment of General Surgery Residents in the Operating Room: Factors Contributing to Provision of Resident Autonomy. J Am Coll Surg. 2014;219(4):778-787. doi:10.1016/j.jamcollsurg.2014.04.019 https://pubmed.ncbi.nlm.nih.gov/25158911/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Join the Behind the Knife Surgical Oncology Team as we discuss the two key studies investigating optimal management strategies of neuroendocrine tumors of the small bowel.
Hosts:
- Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center
- Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist/HPB surgeon at Kaiser LAMC in Los Angeles.
- Connor Chick, MD (@connor_chick) is a 2nd Year Surgical Oncology fellow at Ohio State University.
- Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a 1st Year Surgical Oncology fellow at MD Anderson.
- Beth (Elizabeth) Barbera, MD (@elizcarpenter16) is a PGY-6 General Surgery resident at Brooke Army Medical Center
Learning Objectives:
In this episode we review two important papers that discuss optimal management strategies of neuroendocrine tumors (NET) of the small bowel. The first paper by Singh and colleagues discusses the NETTER-2 trial investigating the role of radioligand therapy for NET as a first-line treatment. The second article by Maxwell et all challenges surgical dogma regarding optimal debulking cutoffs for debulking of NET.
Links to Papers Referenced in this Episode:
1. Singh S, Halperin D, Myrehaug S, Herrmann K, Pavel M, Kunz PL, Chasen B, Tafuto S, Lastoria S, Capdevila J, García-Burillo A, Oh DY, Yoo C, Halfdanarson TR, Falk S, Folitar I, Zhang Y, Aimone P, de Herder WW, Ferone D; all the NETTER-2 Trial Investigators. [177Lu]Lu-DOTA-TATE plus long-acting octreotide versus high‑dose long-acting octreotide for the treatment of newly diagnosed, advanced grade 2-3, well-differentiated, gastroenteropancreatic neuroendocrine tumours (NETTER-2): an open-label, randomised, phase 3 study. Lancet. 2024 Jun 29;403(10446):2807-2817. doi: 10.1016/S0140-6736(24)00701-3. Epub 2024 Jun 5. PMID: 38851203. https://pubmed.ncbi.nlm.nih.gov/38851203/
- Maxwell JE, Sherman SK, O'Dorisio TM, Bellizzi AM, Howe JR. Liver-directed surgery of neuroendocrine metastases: What is the optimal strategy? Surgery. 2016 Jan;159(1):320-33. doi: 10.1016/j.surg.2015.05.040. Epub 2015 Oct 9. PMID: 26454679; PMCID: PMC4688152. https://pubmed.ncbi.nlm.nih.gov/26454679/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
You have a patient with complicated diverticulitis s/p IR drain with colo-cutaneous fistula and colo-vaginal fistula. They are scheduled for surgery. How will you do it? What is the role for hand assist? How can hand assist help? Tune in to find out!
Join Drs. Peter Marcello, Jonathan Abelson, and Tess Aulet as they discuss high yield papers discussing hand assist laparoscopy in Colon and Rectal surgery.
Learning Objectives
1. Describe the technical considerations and how to do hand assist laparoscopic surgery (HALS)
2. Discuss the indications for use of HALS
3. Review literature supporting use of HALS
Video Link: https://app.behindtheknife.org/video/journal-review-in-colorectal-surgery-hand-assist-laparoscopy-in-colon-and-rectal-surgery
References:
Marcello PW, Fleshman JW, Milsom JW, Read TE, Arnell TD, Birnbaum EH, Feingold DL, Lee SW, Mutch MG, Sonoda T, Yan Y, Whelan RL. Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial. Dis Colon Rectum. 2008 Jun;51(6):818-26; discussion 826-8. doi: 10.1007/s10350-008-9269-5. Epub 2008 Apr 17. PMID: 18418653. https://pubmed.ncbi.nlm.nih.gov/18418653/
Jacobs C, Read TE. "Peek port": avoiding conversion during laparoscopic colectomy-an update. Surg Endosc. 2020 Sep;34(9):3944-3948. doi: 10.1007/s00464-019-07165-3. Epub 2019 Oct 4. PMID: 31586252. https://pubmed.ncbi.nlm.nih.gov/31586252/
Heneghan HM, Martin ST, Kiran RP, Khoury W, Stocchi L, Remzi FH, Vogel JD. Laparoscopic colorectal surgery for obese patients: decreased conversions with the hand-assisted technique. J Gastrointest Surg. 2013 Mar;17(3):548-54. doi: 10.1007/s11605-012-2089-x. Epub 2012 Nov 27. PMID: 23188222. https://pubmed.ncbi.nlm.nih.gov/23188222/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Intern year: where the learning curve is steep and you’re not sure if the patient is crashing or you are. In this episode of Behind the Knife, our surgical education fellows reflect on what they wish they had known before Day 1—and all the humbling, hilarious, and genuinely formative moments along the way.
From getting lost wheeling a critical patient through the hospital, to triple-scrubbing just to be acknowledged, to accidentally spraying TPA into your own eye (yes, really)—this episode is a candid conversation about the highs, lows, and everything in between. Whether you're gearing up to start your intern year or reflecting on how far you've come, this is the episode we all needed.
Hosts: * Elizabeth Maginot, MD – General Surgery Resident, University of Nebraska Medical Center @e_magination95 * Nina Clark, MD – General Surgery Resident, University of Washington @clarkninam * Ayman Ali, MD – General Surgery Resident, Duke University * Michelle LaBella, MD – General Surgery Resident, University of North Carolina * Emma Burke, MD – General Surgery Resident, Baylor College of Medicine @emmaburke017
Learning Objectives:* Identify common misconceptions about intern year—and how to manage expectations * Understand how to approach early mistakes with humility and resilience * Recognize the importance of teamwork and asking for help * Reflect on what makes a strong, dependable intern
References* BTK Intern Survival Guide: https://app.behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide * Institutional pharmacists (seriously, call them—they’re the unsung heroes)
Check out our Medical Student and Intern Survival Guide HERE: https://app.behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide
This new series will be a collaboration between BTK and Annals of Surgery, where we will be discussing hot topics in surgery research. No, we won’t be getting into the nitty gritty of methods of individual papers but rather will focus on high-level discussions of contemporary topics that are moving our field forward.
Hosts:
Cody Mullens, MD is a general surgery resident at the University of Michigan, current Behind the Knife Surgery Education Fellow. (@Cody_Mullens)
Justin B. Dimick, MD MPH is the Fredrick A Coller Distinguished Professor and Chair of Surgery at the University of Michigan. He also serves as the Editor in Chief at Annals of Surgery. (@jdimick1)
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
The evidence for climate change is irrefutable. But how does surgical care contribute to global emissions, and is there anything we can do to make surgery more sustainable? Join Jon Williams and our ASGBI partners for the next installment of our BTK/ASGBI collaborative series, where we discuss how to make surgical care greener. Mrs. Cleo Kennington from the UK and Dr. Benjamin Miller from the US are our guest experts, and provide valuable insights into local sustainability efforts you can take home to your hospital, broader concepts of how high-quality care is sustainable, innovations in sustainability, and what the future of sustainable surgery may look like. After listening, you get to decide–Who has more sustainable surgical practices? The UK or US?
Mrs. Cleo Kenington is a Consultant Emergency General and Trauma Surgeon at St George’s Hospital, London and was the recent ASGBI Sustainability Lead. She is a big advocate for practicing what she preaches, focusing on how we can reduce the environmental impact at all stages, from cycling to work, preventing complications and unnecessary surgeries, to reducing the use of disposable surgical components.
Dr. Benjamin Miller is a general and minimally invasive surgeon at the Cleveland Clinic, with a clinical focus on complex abdominal wall reconstruction. After earning his MD from University of Minnesota School of Medicine in 2011, Dr. Miller went to Nashville to complete his general surgery residency at Vanderbilt University Medical Center. Following this, he became a MIS/complex ab wall fellow at Cleveland Clinic, after which he joined as faculty in 2023. In addition to his clinical interests, Dr. Miller has a deep passion for sustainability efforts within surgical practice, carrying on the legacy of established sustainability efforts within surgical care at Cleveland Clinic and training the next generation of sustainable surgeons.
If you enjoyed this episode, stay tuned for more upcoming BTK/ASGBI collaborative content. If you have any questions or comments, please feel free to reach out to us at hello@behindtheknife.org.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Join Drs. Michael Rosen, Benjamin T. Miller, Sara Maskal, and Ryan Ellis as they review mesh materials used in hernia repair and the general properties surgeons who perform hernia repairs should know.
Hosts:
- Sara Maskal, MD, Cleveland Clinic
- Ryan Ellis, MD, Cleveland Clinic
- Benjamin T. Miller, MD, Cleveland Clinic
- Michael Rosen, MD, Cleveland Clinic
Learning Objectives:- Understand common mesh materials
- Review properties of the different mesh materials
- Understand how to apply knowledge of the different mesh properties to different patient scenarios
References:- Ellis R, Miller BT. Mesh selection in abdominal wall reconstruction: an update on biomaterials. Surgical Clinics. 2023 Oct 1;103(5):1019-28. https://pubmed.ncbi.nlm.nih.gov/37709387/
- Krpata DM, Petro CC, Prabhu AS, Tastaldi L, Zolin S, Fafaj A, Rosenblatt S, Poulose BK, Pierce RA, Warren JA, Carbonell AM. Effect of hernia mesh weights on postoperative patient-related and clinical outcomes after open ventral hernia repair: a randomized clinical trial. JAMA surgery. 2021 Dec 1;156(12):1085-92. https://pubmed.ncbi.nlm.nih.gov/34524395/
- Rosen MJ, Krpata DM, Petro CC, Carbonell A, Warren J, Poulose BK, Costanzo A, Tu C, Blatnik J, Prabhu AS. Biologic vs synthetic mesh for single-stage repair of contaminated ventral hernias: a randomized clinical trial. JAMA surgery. 2022 Apr 1;157(4):293-301. https://pubmed.ncbi.nlm.nih.gov/35044431/
- Maskal S, Miller B, Ellis R, Phillips S, Prabhu A, Beffa L, Krpata D, Rosenblatt S, Rosen M, Petro C. Mediumweight polypropylene mesh fractures after open retromuscular ventral hernia repair: incidence and associated risk factors. Surgical Endoscopy. 2023 Jul;37(7):5438-43. https://pubmed.ncbi.nlm.nih.gov/37038022/
- Harris HW, Primus F, Young C, Carter JT, Lin M, Mukhtar RA, Yeh B, Allen IE, Freise C, Kim E, Sbitany H. Preventing recurrence in clean and contaminated hernias using biologic versus synthetic mesh in ventral hernia repair: the PRICE randomized clinical trial. https://pubmed.ncbi.nlm.nih.gov/33443907/
- Olavarria OA, Bernardi K, Dhanani NH, Lyons NB, Harvin JA, Millas SG, Ko TC, Kao LS, Liang MK. Synthetic versus biologic mesh for complex open ventral hernia repair: a pilot randomized controlled trial. Surgical Infections. 2021 Jun 1;22(5):496-503. https://pubmed.ncbi.nlm.nih.gov/33259771/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Welcome back to our series on AI for the clinician! Large language models, like ChatGPT, have been taking the world by storm, and healthcare is no exception to that rule – your institution may already be using them! In this episode we’ll tackle the fundamentals of how they work and their applications and limitations to keep you up to date on this fast-moving, exciting technology.
Hosts:
Ayman Ali, MD
Ayman Ali is a Behind the Knife fellow and general surgery PGY-3 at Duke Hospital in his academic development time where he focuses on data science, artificial intelligence, and surgery.
Ruchi Thanawala, MD: @Ruchi_TJ
Ruchi Thanawala is an Assistant Professor of Informatics and Thoracic Surgery at Oregon Health and Science University (OHSU) and founder of Firefly, an AI-driven platform that is built for competency-based medical education. In addition, she directs the Surgical Data and Decision Sciences Lab for the Department of Surgery at OHSU.
Phillip Jenkins, MD: @PhilJenkinsMD
Phil Jenkins is a general surgery PGY-3 at Oregon Health and Science University and a National Library of Medicine Post-Doctoral fellow pursuing a master’s in clinical informatics.
Steven Bedrick, PhD: @stevenbedrick
Steven Bedrick is a machine learning researcher and an Associate Professor in Oregon Health and Science University’s Department of Medical Informatics and Clinical Epidemiology.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Mastering the surgical consult is a true milestone in every young surgeon’s career. But it’s not easy! It is a difficult transition from lowly data gatherer to mighty data synthesizer. It is, in many ways, an art form. Is there anything more beautiful than breaking down a complex, convoluted patient presentation into an immaculate assessment and plan? Something so bullet proof that the attending surgeon has been left speechless. Perhaps not! Join Drs. Joey Lew and Patrick Georgoff as they review 10 CONSULT COMMANDMENTS TO DOMINATE THE DAY:
1. Have a System
2. Trust No One, Expect Sabotage
3. Always Ask at Least One Why
4. Always Look at the Imaging Yourself
5. Don’t Worry Alone
6. Don’t Bury the Lead
7. Never Lie
8. Include a Real Assessment and Plan in Your Note
9. Goals of care are important and individual
10. Over-communicate
Hosts:* Dr. Joey Lew, MD, MFA, PGY2, Duke University (@LewActually) * Dr. Patrick Georgoff, MD, Duke University (@georgoff)
Insensible Losses – Poems by Joey Lew: https://www.amazon.com/Insensible-Losses-Joey-Lew/dp/B0D773LSHL
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In this episode, we dive into the rapidly evolving world of ambient listening AI in healthcare. From outpatient clinics to inpatient wards and operating rooms, this technology is reshaping how care is delivered, documented, and experienced.
We explore how ambient listening AI is improving clinic flow by streamlining documentation and reducing interruptions, allowing clinicians to stay more present with their patients. The technology is increasingly adaptive to individual provider styles, learning preferences and workflows to deliver more personalized support. Plus, we share practical tips for new users to get the most out of their ambient listening AI systems from day one.
Join us as we hear from experts on the front lines and debate the future of ambient listening AI in medicine—where the walls really do have ears, but for all the right reasons.
Host:
- Nicole Petcka, MD – General Surgery Resident, Emory University, @npetcka2022
Guests:
- Samuel R. Torres Landa Fernández, MD – Minimally Invasive Surgery Fellow, Emory University
- Anastasios Nikolaos (Nick) Panagopoulos, MD – Internal Medicine Resident, Emory University
- Joe Sharma, MD - McGarity Chair in Endocrine Surgery and Professor of Surgery, Vice-chair for Patient Safety, Quality and Innovation, Emory University
Resources:
Enhancing Accuracy of Operative Reports with Automated Artificial Intelligence Analysis of Surgical Video
Khanna A, Wolf T, Frank I, Krueger A, Shah P, Sharma V, Gettman MT, Boorjian SA, Asselmann D, Tollefson MK. Enhancing Accuracy of Operative Reports with Automated Artificial Intelligence Analysis of Surgical Video. J Am Coll Surg. 2025 May 1;240(5):739-746. doi: 10.1097/XCS.0000000000001352. Epub 2025 Apr 16. PMID: 39918224.
https://pubmed.ncbi.nlm.nih.gov/39918224/
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Join the University of Washington Surgical Palliative Care Team for their final episode of this series — a dual journal review and clinical challenges discussion on assessing medical decision-making capacity. Using Dr. Paul Applebaum’s foundational framework, the team outlines the four key criteria for evaluating capacity and brings the topic to life through two contrasting standardized patient scenarios. This episode highlights why capacity assessment is not only relevant but essential for surgeons navigating complex, high-stakes decisions.
Hosts:
Dr. Katie O’Connell (@katmo15) is an associate professor of surgery at the University of Washington. She is a trauma surgeon, palliative care physician, director of surgical palliative care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA.
Dr. Ali Haruta is an assistant professor of surgery at the University of Washington. She is a trauma and emergency general surgeon and palliative care physician. Ali recently completed fellowships in palliative care at the University of Washington and Trauma and Critical Care at Parkland.
Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY6 general surgery resident at the University of Washington with an interest in surgical oncology.
Dr. Virginia Wang is a PGY3 general surgery resident at the University of Washington.
Learning Objectives:
1. Decipher the distinction between the terms “capacity” and “competence”.
-
Describe the four criteria for assessing medical decision-making capacity presented in Dr. Paul Applebaum’s article “Assessment of Patients’ Competence to Consent to Treatment.”
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Apply the capacity assessment framework to real-world clinical scenarios in surgical practice.
References:
1. Applebaum, PS. Assessment of Patients’ Competence to Consent to Treatment. New England Journal of Medicine 2007; 357(18):1834-1840. https://pubmed.ncbi.nlm.nih.gov/17978292/
- Special thank you to Mr. Mark Fox for his acting contribution to this episode.
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In their last Behind the Knife episode, the Hernia Content Team from Carolinas Medical Center discusses quality improvement in abdominal wall reconstruction (AWR). The complexity of AWR patients makes this discipline a perfect match for quality improvement efforts. The group review two papers published by their group: one that tracks patient outcomes over time and then another that reviews a specific quality improvement initiative (penicillin allergy protocol).
Hosts:
· Dr. Sullivan “Sully” Ayuso, Minimally Invasive Surgery, Endeavor Health (Evanston, IL), @SAyusoMD (Twitter)
· Dr. Monica Polcz, Assistant Professor, University of South Florida (Tampa, FL)
· Dr. Vedra Augenstein, Professor of Surgery, Carolinas Medical Center (Charlotte, NC), @VedraAugenstein (Twitter)
· Dr. Todd Heniford, Chief of GI & MIS, Carolinas Medical Center (Charlotte, NC), @THeniford (Twitter)
Learning Objectives:
- Define Quality Improvement and its Importance in Surgical Practice
- Identify Key Strategies and Examples of Quality Improvement Initiatives in Abdominal Wall Reconstruction
- Explain the Process of Implementing and Evaluating a Quality Improvement Project
- Recognize the Value of Multidisciplinary Collaboration in Quality Improvement
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Welcome to our new series – the AI Journal Club! In this series, we’ll cover some interesting studies and evidence-based applications of artificial intelligence in surgery in a case-based format. Surely AI can find a DVT by now … or can it? Stay tuned and find out!
Hosts:
- Ayman Ali, MD
Ayman Ali is a Behind the Knife fellow and general surgery PGY-3 at Duke Hospital in his academic development time where he focuses on data science, artificial intelligence, and surgery.
- Ruchi Thanawala, MD: @Ruchi_TJ
Ruchi Thanawala is an Assistant Professor of Informatics and Thoracic Surgery at Oregon Health and Science University (OHSU) and founder of Firefly, an AI-driven platform that is built for competency-based medical education. In addition, she directs the Surgical Data and Decision Sciences Lab for the Department of Surgery at OHSU.
- Marisa Sewell, MD: @MarisaSewell
Marisa Sewell is a general surgery PGY-4 at Oregon Health and Science University.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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It is the final episode of our Challenging Cases in Emergency General Surgery series and we’re diving into another dreaded topic: the complex abdominal wall. This structure is a daily partner to the general surgeon—but when things go wrong, it can quickly become our biggest challenge. In this episode, we’ll walk through the emergency presentation of a patient with multiple prior hernia repairs and mesh placements, and how these complicate diagnosis and management. From imaging pearls to OR decision-making and post-op dilemmas, this episode covers it all. We round things off with a fun game (as always!) and some hot takes on abdominal wall strategies in emergency general surgery. Whether you’re an EGS surgeon, trainee, or surgical enthusiast, this episode is packed with practical insights, decision-making frameworks, and real-world nuance.
Hosts:
- Dr. Ashlie Nadler
- Dr. Jordan Nantais
- Dr. Graham Skelhorne-Gross
Learning Objectives:
- Identify key factors to assess in patients presenting with complex abdominal wall problems, including detailed surgical history, hernia characteristics, and signs of complications.
- Discuss the role of imaging, particularly CT scans, in evaluating patients with ventral hernias and bowel obstruction, with a focus on identifying transition points and signs of strangulation.
- Outline the surgical approach to incarcerated incisional ventral hernias, including pre-operative considerations, operative techniques, and management of threatened bowel.
- Recognize the importance of patient-specific factors and interdisciplinary collaboration in the management of complex abdominal wall cases, including the role of pre-habilitation and hernia specialists.
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We got the gang together (minus John, who is on mission). Today, we are talking about diverticulitis with super expert Scott Steele. Scott walks Jason, Patrick, and Kevin through the nuances of modern-day management of diverticulitis. We cover laparoscopic lavage, review decision making for surgical resection after drainage, and discuss the evolving role of antibiotics in uncomplicated cases. Surgical techniques, including resection boundaries and the consideration of diverting ostomies in emergent situations, are also reviewed. DOMINATE THE COLON!
Hosts
Scott Steele, MD: @ScottRSteeleMD
Scott is the Rupert B. Turnbull MD Endowed Chair in Colorectal Surgery and Chairman of Colorectal Surgery at Cleveland Clinic in Cleveland, OH. A graduate of the United States Military Academy at West Point, he was an active duty Army officer for over 20 years, serving as the Chief of Colorectal Surgery at Madigan Army Medical Center. He also received his MBA from Case Western University Weatherhead School of Business and Management.
Patrick Georgoff, MD: @georgoff
Patrick Georgoff is an Acute Care Surgeon at Duke University. He went to medical school at the University of Pennsylvania, completed General Surgery residency and Surgical Critical Care fellowship at the University of Michigan, and a Trauma Surgery fellowship at the University of Texas in Houston. His clinical practice includes the full spectrum of Acute Care Surgery in addition to elective hernia surgery. Patrick is the Associate Program of the General Surgery Residency and associate Trauma Medical Director at Duke.
Kevin Kniery, MD: @Kniery_Bird
Kevin is a vascular surgeon at Brooke Army Medical Center. He completed his undergraduate degree at the United States Military Academy in West Point, medical school at Tulane University, general surgery residency at Madigan Army Medical Center, and vascular fellowship at Cornell and Columbia.
Jason Bingham, MD: @BinghamMd
Jason is a general and bariatric surgeon at Madigan Army Medical Center. He also serves as the Director of Research and Associate Program Director for the general surgery residency program. He received his undergraduate degree from New York University and medical degree at the Uniformed Services University of Health Sciences. He is a medical officer in the US Army with several combat deployments under his belt. Jason’s research efforts focus on the management of hemorrhagic shock, trauma induced coagulopathy, and ischemia-reperfusion injury.
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In our recent episode on global burn surgery with Dr. Barclay Stewart and Dr. Manish Yadav, we discussed several cases at Kirtipur Hospital in Nepal to illustrate the global burden of burns and similarities and differences in treating burns at Harborview Medical Center, a level 1 trauma and ABA verified burn center in Seattle, WA and Kirtipur Hospital (Nepal Cleft and Burn Center) in Kathmandu, Nepal. In this episode Dr. Stewart and Dr. Yadav return for an interview by UW Surgery Resident, Paul Herman, sharing insights on how to get involved in global surgery with an emphasis on sustainable participation.
Hosts:
Manish Yadav, Kirtipur Hospital, Nepal
Barclay Stewart, UW/Harborview Medical Center
Paul Herman, UW/Harborview General Surgery Resident, @paul_herm
Tam Pham, UW/Harborview Medical Center (Editor)
Learning Objectives
1. Approaches to global surgery
a. Describe historical perspectives on global health and global surgery reviewing biases global surgery inherits from global health due to the history of colonialism, neo-colonialism and systemic inequalities
b. Review a recently published framework and evaluation metrics for sustainable global surgery partnerships (GSPs) as described by Binda et al., in Annals of Surgery in March 2024.
c. Provide examples of this framework from a successful global surgery partnership
d. Define vertical, horizontal and diagonal global surgery approaches
e. Share tips for initial engagement for individuals interested in getting involved in global surgery
References
1. Gosselin, R., Charles, A., Joshipura, M., Mkandawire, N., Mock, C. N. , et. al. 2015. “Surgery and Trauma Care”. In: Disease Control Priorities (third edition): Volume 1, Essential Surgery, edited by H. Debas, P. Donkor, A. Gawande, D. T. Jamison, M. Kruk, C. N. Mock. Washington, DC: World Bank.
-
Qin R, Alayande B, Okolo I, Khanyola J, Jumbam DT, Koea J, Boatin AA, Lugobe HM, Bump J. Colonisation and its aftermath: reimagining global surgery. BMJ Glob Health. 2024 Jan 4;9(1):e014173. doi: 10.1136/bmjgh-2023-014173. PMID: 38176746; PMCID: PMC10773343.
https://pubmed.ncbi.nlm.nih.gov/38176746/ -
Binda CJ, Adams J, Livergant R, Lam S, Panchendrabose K, Joharifard S, Haji F, Joos E. Defining a Framework and Evaluation Metrics for Sustainable Global Surgical Partnerships: A Modified Delphi Study. Ann Surg. 2024 Mar 1;279(3):549-553. doi: 10.1097/SLA.0000000000006058. Epub 2023 Aug 4. PMID: 37539584; PMCID: PMC10829902.
https://pubmed.ncbi.nlm.nih.gov/37539584/ -
Jedrzejko N, Margolick J, Nguyen JH, Ding M, Kisa P, Ball-Banting E, Hameed M, Joos E. A systematic review of global surgery partnerships and a proposed framework for sustainability. Can J Surg. 2021 Apr 28;64(3):E280-E288. doi: 10.1503/cjs.010719. PMID: 33908733; PMCID: PMC8327986.
https://pubmed.ncbi.nlm.nih.gov/33908733/ -
Frenk J, Gómez-Dantés O, Knaul FM: The health systems agenda: prospects for the diagonal approach. The handbook of global health policy. 2014 Apr 24; pp. 425–439
-
Davé DR, Nagarjan N, Canner JK, Kushner AL, Stewart BT; SOSAS4 Research Group. Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries. Burns. 2018 Aug;44(5):1228-1234. doi: 10.1016/j.burns.2018.01.015. Epub 2018 Feb 21. PMID: 29475744.
https://pubmed.ncbi.nlm.nih.gov/29475744/ -
Strain, S., Adjei, E., Edelman, D. et al. The current landscape of global international surgical rotations for general surgery residents in the United States: a survey by the Association for Program Directors in Surgery’s (APDS) global surgery taskforce. Global Surg Educ 3, 77 (2024). https://doi.org/10.1007/s44186-024-00273-2
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Francalancia S, Mehta K, Shrestha R, Phuyal D, Bikash D, Yadav M, Nakarmi K, Rai S, Sharar S, Stewart BT, Fudem G. Consumer focus group testing with stakeholders to generate an enteral resuscitation training flipbook for primary health center and first-level hospital providers in Nepal. Burns. 2024 Jun;50(5):1160-1173. doi: 10.1016/j.burns.2024.02.008. Epub 2024 Feb 15. PMID: 38472005; PMCID: PMC11116054.
https://pubmed.ncbi.nlm.nih.gov/38472005/ -
Shrestha R, Mehta K, Mesic A, Dahanayake D, Yadav M, Rai S, Nakarmi K, Bista P, Pham T, Stewart BT. Barriers and facilitators to implementing enteral resuscitation for major burn injuries: Reflections from Nepalese care providers. Burns. 2024 Oct 28;51(1):107302. doi: 10.1016/j.burns.2024.107302. Epub ahead of print. PMID: 39577105.
https://pubmed.ncbi.nlm.nih.gov/39577105/
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Surgical conferences are a forum of the profession–where we all gather to socialize, share clinical experiences, promote academic work, and learn from each other. But what goes into putting these conferences together? In this next installment of the BTK/ASGBI collaborative series, Jon Williams and ASGBI co-hosts Kellie Bateman and Jared Wohlgemut welcome Mr. Dimitrios Damaskos from Edinburgh and Dr. Anne Lidor from the University of Wisconsin to take a look behind the scenes of conference planning. We’ll cover logistics, program selection, how surgical societies strive to support their members and trainees, and much more!
Mr Dimitrios Damaskos, initially from Greece, he came to the UK for his fellowship and is a UGI and Emergency General Surgical Consultant with an interest in abdominal wall surgery based in The Royal Infirmary Edinburgh. He is the current Director of Scientific Programme for ASGBI and responsible for organising our main International Congress which this year happens to be in Edinburgh. He has also held numerous other events for surgical societies including the British Hernia Society.
Dr. Lidor serves as the program chair for the Society for American Gastrointestinal and Endoscopic Surgeons (i.e. SAGES), which is a wide-reaching US-based international surgical society that encompasses many facets of general surgery. The SAGES Annual Meeting was just last month, and is a great opportunity for surgeons to convene and share clinical experiences, academic work, and professionally connect. Dr. Lidor completed medical school at the New York Medical College, and then moved on to George Washington University for general surgery residency training. Following residency, she moved to Baltimore to Johns Hopkins where she completed her MIS/Bariatric Surgery fellowship and subsequently stayed on as a faculty surgeon. After years at Hopkins during which she held many education leadership roles both at the medical school and as fellowship director, she moved to the University of Wisconsin to become Chief of Minimally Invasive and Bariatric Surgery, a role she continues to hold today.
If you enjoyed this episode, stay tuned for more upcoming BTK/ASGBI collaborative content. If you have any questions or comments, please feel free to reach out to us at hello@behindtheknife.org.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Hey APPs - Are you ready to DOMINATE surgery? Well let's go! Perform at the highest level on day one of your rotation using our easy to navigate text, tables, flashcards, podcasts, and videos. Go beyond rote memorization and learn what really matters. We are talking practical, high-yield, and engaging content all available at your fingertips. Get the information you need to know FAST. Whether it's learning how to two-hand tie, work up a patient with a colon mass, or organizing yourself for rounds, Behind the Knife has got you covered.
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation Course Link: https://app.behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Hey APPs - Are you ready to DOMINATE surgery? Well let's go! Perform at the highest level on day one of your rotation using our easy to navigate text, tables, flashcards, podcasts, and videos. Go beyond rote memorization and learn what really matters. We are talking practical, high-yield, and engaging content all available at your fingertips. Get the information you need to know FAST. Whether it's learning how to two-hand tie, work up a patient with a colon mass, or organizing yourself for rounds, Behind the Knife has got you covered.
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation Course Link: https://app.behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Hey APPs - Are you ready to DOMINATE surgery? Well let's go! Perform at the highest level on day one of your rotation using our easy to navigate text, tables, flashcards, podcasts, and videos. Go beyond rote memorization and learn what really matters. We are talking practical, high-yield, and engaging content all available at your fingertips. Get the information you need to know FAST. Whether it's learning how to two-hand tie, work up a patient with a colon mass, or organizing yourself for rounds, Behind the Knife has got you covered.
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation Course Link: https://app.behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
In this episode, the Surgical Endoscopy team, accompanied by Chief Medical Officer Dr. Brian Dunkin of Boston Scientific, review primary and revisional endoscopic treatment options for bariatric patients. They focus on the emerging data available for procedures such as endoscopic sleeve gastroplasty (ESG) and endoscopic gastrojejunal revision (EGJR) and offer technical tips on how to perform the procedures. In addition, they discuss accessibility challenges for patients and provide insight into the future direction of bariatric endoscopy as a field.
Hosts:
· Dr. Sullivan “Sully” Ayuso, Minimally Invasive Surgery, Endeavor Health (Evanston, IL), @SAyusoMD (Twitter)
· Dr. Trevor Crafts, Minimally Invasive Surgeon, Rocky Mountain VA Medical Center (Denver, CO), @CraftsTrevor (Twitter)
· Dr. H. Masson Hedberg, Minimally Invasive Surgeon, Endeavor Health (Evanston, IL)
· Dr. Michael Ujiki, Professor and Louis Biegler Chair of Surgery, Endeavor Health (Evanston, IL), @UjikiMike
· Dr. Brian Dunkin, Chief Medical Officer at Boston Scientific, @briandunkinmd
Learning Objectives:
- Identify and Describe Common Endobariatric Procedures: Learners will be able to name and briefly describe at least three common endobariatric procedures discussed in the episode, including Endoscopic Sleeve Gastroplasty (ESG), Endoscopic GJ Revisions (Transoral Outlet Reduction - TORR/EGJR), and Intragastric Balloons, along with their historical context and evolution.
- Explain the Mechanism and Benefits of Endoscopic Sleeve Gastroplasty (ESG): Learners will be able to articulate the procedural technique of ESG, including the U-shaped suture pattern, its impact on gastric volume reduction, and the proposed mechanisms of weight loss, such as slowed gastric emptying and hormonal changes, as compared to laparoscopic sleeve gastrectomy.
- Discuss the Role of Technology and Training in Endobariatrics: Learners will be able to explain the significance of endoscopic suturing devices like the Overstitch in the advancement of endobariatric procedures and recognize the importance of specialized training, including the recommendations against fundal suturing for safety during the initial learning curve.
- Compare and Contrast Endobariatric Procedures with Surgical and Pharmacological Obesity Treatments: Learners will be able to discuss the position of endobariatric procedures as a "gap therapy" in the spectrum of obesity treatments, highlighting their benefits such as reduced invasiveness, lower complication rates, faster recovery, and increased patient access compared to surgery, as well as their potential role in conjunction with pharmacologic therapies like GLP-1 agonists.
- Recognize Key Considerations and Potential Complications of Endobariatric Procedures: Learners will be able to identify important technical considerations during ESG, such as achieving full-thickness bites while avoiding injury to adjacent organs, and describe common post-procedure issues associated with intragastric balloons, including nausea, vomiting, and the need for general anesthesia during removal.
Discontinuation and Reinitiation of Dual-Labeled GLP-1 Receptor Agonists Among US Adults With Overweight or Obesity: https://pubmed.ncbi.nlm.nih.gov/39888616/
** VIDEO LINK: https://app.behindtheknife.org/video/surgical-endoscopy-series-ep-2-endobariatrics
Surgical Endoscopy Series Ep. 1: An Introduction to Surgical Endoscopy: https://app.behindtheknife.org/podcast/surgical-endoscopy-series-ep-1-an-introduction-to-surgical-endoscopy
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Thinking about doing an away rotation? In this episode of Behind the Knife, we break down everything you need to know about away rotations and sub-internships. From how to apply and what to expect to making a great impression and building connections, we’ve got you covered. Plus, we discuss whether you should even do an away rotation at all and how to decide if it's the right move for your application. We’re joined by a fantastic and diverse group of general surgery residents who share their insights, tips, and experiences.
Episode Hosts:
–Dr. Josh Roshal, University of Texas Medical Branch, @Joshua_Roshal, jaroshal@utmb.edu
–Dr. Colleen McDermott, University of Utah, @ColleenMcDMD, Colleen.McDermott@hsc.utah.edu
–Dr. Sophia Williams-Perez, Baylor College of Medicine, @SophWPerez, Sophia.Williams-Perez@bcm.edu
–CoSEF: @surgedfellows, cosef.org
Guests:
Dr. Steven Thornton, Duke University Medical Center, @swthorntonjr
swt12@duke.edu
Dr. Nicole Santucci, Washing University in St. Louis, @nicolemsantucci
snicole@wustl.edu
Abbas Karim, MS3, University of Texas Medical Branch, @_AbbasKarim
aakarim@utmb.edu
Reagan Collins, MS4, Texas Tech University Health Sciences Center, @ReaganACollins, reagan.collins@ttuhsc.edu
Dr. Annie Hierl, Indiana University, @annie_hierl
ahierl@iu.edu
Dr. Jorge Zarate Rodriguez, Washington University in St Louis, @jzaraterod, j.zarate@wustl.edu
References:1. McDermott CE, Anand A, Brian R, Gan C, L'Huillier JC, Lund S, Sathe T, Silvestri C, Woodward JM. Should I Do a General Surgery Away Rotation?: Perspectives From the Collaboration of Surgical Education Research Fellows (CoSEF). Ann Surg Open. 2024 Dec 3;5(4):e509. doi: 10.1097/AS9.0000000000000509. PMID: 39711667; PMCID: PMC11661735. https://pubmed.ncbi.nlm.nih.gov/39711667/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Listen as we discuss the highly-awaited ESOPEC trial, which examines treatment regimens for esophageal and EGJ adenocarcinoma. Wildly impress your thoracic attendings or peers with your nuanced knowledge! FLOT who? You’ll know. Pull out the paper and listen along!
Learning Objectives:
-Discuss the patient population in the ESOPEC trial
-Discuss the main differences between the ESOPEC trial and the CROSS trial
-Describe the main drawbacks between FLOT and the CROSS regimen.
Hosts:
Chloe Hanson MD, Brian Louie MD, and Peter White MD
Referenced Material
https://www.nejm.org/doi/full/10.1056/NEJMoa2409408
Hoeppner J, Brunner T, Schmoor C, Bronsert P, Kulemann B, Claus R, Utzolino S, Izbicki JR, Gockel I, Gerdes B, Ghadimi M, Reichert B, Lock JF, Bruns C, Reitsamer E, Schmeding M, Benedix F, Keck T, Folprecht G, Thuss-Patience P, Neumann UP, Pascher A, Imhof D, Daum S, Strieder T, Krautz C, Zimmermann S, Werner J, Mahlberg R, Illerhaus G, Grimminger P, Lordick F. Perioperative Chemotherapy or Preoperative Chemoradiotherapy in Esophageal Cancer. N Engl J Med. 2025 Jan 23;392(4):323-335. doi: 10.1056/NEJMoa2409408. PMID: 39842010.
https://www.nejm.org/doi/full/10.1056/NEJMoa1112088
van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, Richel DJ, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA, Blaisse RJ, Busch OR, ten Kate FJ, Creemers GJ, Punt CJ, Plukker JT, Verheul HM, Spillenaar Bilgen EJ, van Dekken H, van der Sangen MJ, Rozema T, Biermann K, Beukema JC, Piet AH, van Rij CM, Reinders JG, Tilanus HW, van der Gaast A; CROSS Group. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012 May 31;366(22):2074-84. doi: 10.1056/NEJMoa1112088. PMID: 22646630.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32557-1/abstract
Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, Kopp HG, Mayer F, Haag GM, Luley K, Lindig U, Schmiegel W, Pohl M, Stoehlmacher J, Folprecht G, Probst S, Prasnikar N, Fischbach W, Mahlberg R, Trojan J, Koenigsmann M, Martens UM, Thuss-Patience P, Egger M, Block A, Heinemann V, Illerhaus G, Moehler M, Schenk M, Kullmann F, Behringer DM, Heike M, Pink D, Teschendorf C, Löhr C, Bernhard H, Schuch G, Rethwisch V, von Weikersthal LF, Hartmann JT, Kneba M, Daum S, Schulmann K, Weniger J, Belle S, Gaiser T, Oduncu FS, Güntner M, Hozaeel W, Reichart A, Jäger E, Kraus T, Mönig S, Bechstein WO, Schuler M, Schmalenberg H, Hofheinz RD; FLOT4-AIO Investigators. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019 May 11;393(10184):1948-1957. doi: 10.1016/S0140-6736(18)32557-1. Epub 2019 Apr 11. PMID: 30982686.
***Fellowship Application Link: https://forms.gle/PQgAvGjHrYUqAqTJ9
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In 2002 a group of surgeons got together and radically changed surgical training forever. They just got together again...
They call themselves the Blue Ribbon Committee. When they met in 2002 they addressed critical issues such as residency structure, specialization, work-life balance, and simulation-based training. Now, with rapid advancements in medicine and education, BRC II has revisited these topics and introduced new priorities to ensure that surgical education meets the demands of the modern era.
In this episode, we are joined by Dr. Steven Stain, co-chair of BRC II and a leader in surgical education. Dr. Stain shares insights into the motivations behind the second committee, its key findings, and how competency-based education, entrustable professional activities (EPAs), and other innovations are shaping the future of surgical training.
Join hosts Pooja Varman MD, Judith French PhD, and Jeremy Lipman MD, MHPE for an engaging discussion on what surgical educators, trainees, and institutions need to know about the new recommendations from BRC II and the future of surgical education.
Learning Objectives
By the end of this episode, listeners will be able to
1. Under the origins and impact of the first Blue Ribbon Committee (BRC I)
2. Explain the factors that led to the formation of the BRC II and its major recommendations
3. Identify challenges and opportunities in modern surgical education
4. Discuss the role of competency-based education and EPAs in training future surgeons
5. Recognize how institutions and educators can adapt to BRC II recommendations
References
1. Recommendations on Surgical Education and Training in the United States: 2024. Ann Surg. 2024;280(4):535. doi:10.1097/SLA.0000000000006360 https://pubmed.ncbi.nlm.nih.gov/38814074/
- Blue Ribbon Committee II Advises Sweeping Changes in Surgical Education. ACS. Accessed January 12, 2025. https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2024/may-2024-volume-109-issue-5/blue-ribbon-committee-ii-advises-sweeping-changes-in-surgical-education/
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Join Drs. Galandiuk, Bolshinsky, Kavalukas, and Simon, with guest Dr. Farr Nezhat, as they discuss management, surgical treatment, and outcomes of bowel endometriosis. Come with us as we learn from expert Dr. Nezhat’s experience and discuss the importance of interdisciplinary approach to bowel endometriosis.
Hosts:
- Susan Galandiuk, University of Louisville, Louisville, KY, @DCREdInChief
- Vladimir Bolshinsky, Peninsula Health, Victoria, Australia, @bolshinskyv
- Sandy Kavalukas, University of Louisville, Louisville, KY, @sandykava
- Hillary Simon, University of Louisville, Louisville, KY, @HillaryLSimon
Guest Host:
- Farr Nezhat, Nezhat Surgery for Gynecology/Oncology (Cornell/NYU), New York, NY
Producer:- Manasa Sunkara MS4, University of Louisville, Louisville, Kentucky, @manasasunkara12
Learning objectives:
- Review pathophysiology of endometriosis.
- Understand key goals of bowel endometriosis treatment.
- Discuss interdisciplinary surgical care and outcomes of bowel endometriosis.
References:
1. Tsuei A, Nezhat F, Amirlatifi N, Najmi Z, Nezhat A, Nezhat C. Comprehensive Management of Bowel Endometriosis: Surgical Techniques, Outcomes, and Best Practices. J Clin Med. 2025 Feb 3;14(3):977. doi: 10.3390/jcm14030977 https://pubmed.ncbi.nlm.nih.gov/39941647/
2. Bendifallah S, Puchar A, Vesale E, Moawad G, Daraï E, Roman H. Surgical Outcomes after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol. 2021 Mar;28(3):453-466. doi: 10.1016/j.jmig.2020.08.015. https://pubmed.ncbi.nlm.nih.gov/32841755/
3. Erdem S, Imboden S, Papadia A, Lanz S, Mueller MD, Gloor B, Worni M. Functional Outcomes After Rectal Resection for Deep Infiltrating Pelvic Endometriosis: Long-term Results. Dis Colon Rectum. 2018 Jun;61(6):733-742. doi: 10.1097/DCR.0000000000001047. https://pubmed.ncbi.nlm.nih.gov/29664797/
4. Nasseri Y, Ma R, Fani N, La K, Solis-Pazmino P, Xu V, Siedhoff MT, Wright KN, Schneyer R, Hamilton KM, Barnajian M, Meyer R. The impact of surgeon specialty on surgical outcomes following colorectal resection for endometriosis. Colorectal Dis. 2025 Feb;27(2):e70028. doi: 10.1111/codi.70028. https://pubmed.ncbi.nlm.nih.gov/39949080/
5. Chua, Heidi, and Michael J Snyder. "Endometriosis.” ASCRS Textbook of Colon and Rectal Surgery, 4th ed., Springer Nature Switzerland AG, 2022. ASCRS U, www.ascrsu.com/ascrs/view/ASCRS-Textbook-of-Colon-and-Rectal-Surgery/2285036/all/Endometriosis.
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BIG T TRAUMA is back with more TRAUMA PITFALLS! Join Drs. Teddy Puzio (University of Texas in Houston), Jason Brill (Tripler Army Medical Center), Patrick Georgoff (Duke University, @georgoff) and special guest Dr. Tyler Simpson (Trauma Fellow at Duke University) for a fast-moving, no-nonsense discussion on the many pitfalls you are bound to encounter in the high-stakes world of trauma surgery. Remember, the eyes do not see what the mind does not know...
More from the BIG T series: https://app.behindtheknife.org/podcast-series/big-t-trauma
This episode of Big T Trauma was sponsored by Teleflex, a global provider of medical devices. Learn more at teleflex.com and at the Teleflex Trauma and Emergency Medicine LinkedIn page.
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BIG T TRAUMA is back with more TRAUMA PITFALLS! Join Drs. Teddy Puzio (University of Texas in Houston), Jason Brill (Tripler Army Medical Center), Patrick Georgoff (Duke University, @georgoff) and special guest Dr. Jared Ourieff (Trauma Fellow at University of Texas in Houston) for a fast-moving, no-nonsense discussion on the many pitfalls you are bound to encounter in the high-stakes world of trauma surgery. Remember, the eyes do not see what the mind does not know...
More from the BIG T series: https://app.behindtheknife.org/podcast-series/big-t-trauma
This episode of Big T Trauma was sponsored by Teleflex, a global provider of medical devices. Learn more at teleflex.com and at the Teleflex Trauma and Emergency Medicine LinkedIn page.
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In the third episode of our rural surgery series, Dr. Cody Mullens meets with Dr. Randy Lehman, a rural general surgeon from Rensselaer, Indiana to discuss rural practice, lifestyle, resources, and tips & tricks for general surgery residents interested in pursuing rural practice.
The Rural American Surgeon Podcast and Contact: https://www.theruralamericansurgeon.com/
The North American Rural Surgery Society: https://www.northamericanrss.org/
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In the second episode of our rural surgery series, Dr. Cody Mullens sits down with Dr. Brad Muncy, a 2nd year general surgery resident at Marshall University Rural General Surgery Residency Program and Dr. Jodi Cisco-Goff, an Associate Program Director at Marshall University Rural General Surgery Residency Program to discuss educating and training rural surgeons at Marshall University, the first of its kind training program.
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Introducing a new series on rural surgery - In this episode, BTK fellow Dr. Cody Mullens sits down with Dr. Bret Autrey, a general surgery attending at Ludington Hospital in Ludington, MI. Dr. Autrey is a career rural surgeon who discusses, in detail, rural surgery practice, how it's evolved, and both the upside and challenges of practicing rural general surgery.
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Join BTK hosts Dr. Scott Steele and Dr. John McClellan and our guest Julia Zumpano, RD. She is a registered dietitian at the Cleveland Clinic’s Center for Human Nutrition, and her expert insight helped inform the guidelines for two programs featured in the hospital’s new wellness and diet coaching app, the Cleveland Clinic Diet app. Both programs aim to educate and empower users in making healthier diet and lifestyle choices.
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Dr. Christian Jones was a trauma and acute care surgeon, and an early innovator in surgical education. Dr. Jones generously participated and promoted Behind The Knife in its early years. He passed away in late 2024, and we spend the first 15 minutes of this episode reflecting on the person he was and the impact he made in surgery.
Here is a link to his obituary
https://www.peacefulalternatives.com/obituary/christian-jones
Dr. Lisa Kodadek is a trauma and acute care surgeon at Yale. She was a resident under Dr. Jones at Johns Hopkins. She shares her insights and gratitude for being able to train under Dr. Jones.
Following the memorial portion of this interview we listen to mock oral cases that Dr. Jones took Kevin Kniery and Woo Do through when they were general surgery residents in 2017.
If you would like to hear more episodes from Dr. Jones, please search his name in our app as there are multiple others to enjoy.
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Join Patrick Georgoff as he welcomes Dr. Gene Moore and Dr. Ian Roberts, two giants in trauma surgery and epidemiology, to discuss tranexamic acid (TXA) in trauma care. Dr. Moore, a legendary trauma surgeon and researcher, and Dr. Roberts, the architect of the CRASH trials, break down the science, controversies, and practical applications of TXA. They explore who should get TXA, when it should be given, optimal dosing, and its potential risks. With insights from landmark trials like CRASH-2, STAMP, PATCH, and ROC TXA, this episode cuts through the confusion surrounding TXA in trauma and traumatic brain injury. Is early administration the key to saving lives? Should TXA be given intramuscularly prehospital? Tune in as we tackle these critical questions and define the future of TXA in trauma care!
This episode of Big T Trauma was sponsored by Teleflex, a global provider of medical devices. Learn more at teleflex.com and at the Teleflex Trauma and Emergency Medicine LinkedIn page.
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BIG T Trauma Series: https://app.behindtheknife.org/podcast-series/big-t-trauma
In this second part of a two-part series on disability insurance, Kevin and Larry delve into the specifics of Guaranteed Standard Issue (GSI) disability insurance. They discuss what GSI is, why it's crucial for residents and fellows, and how to avoid common pitfalls that could jeopardize eligibility.
In this first part of a two-part series, Dr. Kevin Kniery interviews Insurance Agent and Certified Financial Planner professional Larry Keller about the fundamentals of disability insurance for physicians, particularly surgeons. They discuss the importance of individual disability policies, key differences between policies, and how to choose the right agent.
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The Vascular Surgery Subspecialty Team dives into the pressing issue of burnout among vascular surgery trainees. Unveiling surprising statistics and expert insights, they explore the alarming prevalence of burnout, its causes like work-home conflict and physical discomfort, and the protective role of mentorship and a supportive learning environment. With research-backed discussions, they navigate strategies to combat burnout and enhance the well-being of medical professionals.
Hosts:
Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan and the Program Director of the Integrated Vascular Surgery Residency Program as well as the Vascular Surgery Fellowship Program at the University of Michigan.
Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan
Dr. Drew Braet is a PGY-5 Integrated Vascular Surgery Resident at the University of Michigan
Learning Objectives
- Review the definition and prevalence of burnout
- Understand the risk factors, including both modifiable and non-modifiable risk factors, for burnout
- Review the effects of burnout on trainees and attending surgeons
References
1. Hekman KE, Sullivan BP, Bronsert M, Chang KZ, Reed A, Velazquez-Ramirez G, Wohlauer MV; Association of Program Directors in Vascular Surgery Issues Committee. Modifiable risk factors for burnout in vascular surgery trainees. J Vasc Surg. 2021 Jun;73(6):2155-2163.e3. doi: 10.1016/j.jvs.2020.12.064. https://pubmed.ncbi.nlm.nih.gov/33675887/
2. Cui CL, Reilly MA, Pillado EB, Li RD, Eng JS, Grafmuller LE, DiLosa KL, Conway AM, Escobar GA, Shaw PM, Hu YY, Bilimoria KY, Sheahan MG 3rd, Coleman DM. Burnout is not associated with trainee performance on the Vascular Surgery In-Training Exam. J Vasc Surg. 2025 Jan;81(1):243-249.e4. doi: 10.1016/j.jvs.2024.08.057.
https://pubmed.ncbi.nlm.nih.gov/39233022/
3. Chia MC, Hu YY, Li RD, Cheung EO, Eng JS, Zhan T, Sheahan MG 3rd, Bilimoria KY, Coleman DM. Prevalence and risk factors for burnout in U.S. vascular surgery trainees. J Vasc Surg. 2022 Jan;75(1):308-315.e4. doi: 10.1016/j.jvs.2021.06.476.
https://pubmed.ncbi.nlm.nih.gov/34298120/
4. Davila VJ, Meltzer AJ, Hallbeck MS, Stone WM, Money SR. Physical discomfort, professional satisfaction, and burnout in vascular surgeons. J Vasc Surg. 2019 Sep;70(3):913-920.e2. doi: 10.1016/j.jvs.2018.11.026.
https://pubmed.ncbi.nlm.nih.gov/31279532/
5. Pillado E, Li RD, Chia MC, Eng JS, DiLosa K, Grafmuller L, Conway A, Escobar GA, Shaw P, Sheahan MG 3rd, Bilimoria KY, Hu YY, Coleman DM. Reported pain at work is a risk factor for vascular surgery trainee burnout. J Vasc Surg. 2024 May;79(5):1217-1223. doi: 10.1016/j.jvs.2024.01.003.
https://pubmed.ncbi.nlm.nih.gov/38215953/
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Do you find yourself saying: “Hey, what’s the big idea with that newfangled whole blood in the refrigerator next to the trauma bay?” Like using whole blood but not sure why? Don’t like using whole blood but not sure why? Join us for a 30 minute power session in whole blood where we try to get you the information you need to know!
Hosts:- Michael Cobler-Lichter, MD, PGY4/R2:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@mdcobler (X/twitter)
-
Eva Urrechaga, MD, PGY-8, Vascular Surgery Fellow
University of Pennsylvania
Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center General Surgery Residency
@urrechisme (X/twitter) -
Eugenia Kwon, MD, Trauma/Surgical Critical Care Attending:
Loma Linda University
Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center Trauma/CC Fellowship -
Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery, 6 years in practice
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@jpmeizoso (twitter)
Learning Objectives:
- Describe the proposed benefits of whole blood resuscitation in trauma
-
Identify current problems with synthesizing the existing literature on whole blood resuscitation in trauma
-
Propose needed areas for future research regarding whole blood resuscitation in trauma
Quick Hits:
1. There is significant heterogeneity in study design across whole blood resuscitation studies, complicating comparison
-
There is likely a mortality benefit to whole blood resuscitation in trauma, however this is likely dependent on the specific population
-
Future research directions should focus on prospective randomized work to try and better quantify the exact benefit of whole blood, and determine in which populations this benefit is actually realized
References
1. Hazelton JP, Ssentongo AE, Oh JS, Ssentongo P, Seamon MJ, Byrne JP, Armento IG, Jenkins DH, Braverman MA, Mentzer C, Leonard GC, Perea LL, Docherty CK, Dunn JA, Smoot B, Martin MJ, Badiee J, Luis AJ, Murray JL, Noorbakhsh MR, Babowice JE, Mains C, Madayag RM, Kaafarani HMA, Mokhtari AK, Moore SA, Madden K, Tanner A 2nd, Redmond D, Millia DJ, Brandolino A, Nguyen U, Chinchilli V, Armen SB, Porter JM. Use of Cold-Stored Whole Blood is Associated With Improved Mortality in Hemostatic Resuscitation of Major Bleeding: A Multicenter Study. Ann Surg. 2022 Oct 1;276(4):579-588. doi: 10.1097/SLA.0000000000005603. Epub 2022 Jul 18. PMID: 35848743.
https://pubmed.ncbi.nlm.nih.gov/35848743/
-
Sperry JL, Cotton BA, Luther JF, Cannon JW, Schreiber MA, Moore EE, Namias N, Minei JP, Wisniewski SR, Guyette FX; Shock, Whole Blood, and Assessment of Traumatic Brain Injury (SWAT) Study Group. Whole Blood Resuscitation and Association with Survival in Injured Patients with an Elevated Probability of Mortality. J Am Coll Surg. 2023 Aug 1;237(2):206-219. doi: 10.1097/XCS.0000000000000708. Epub 2023 Apr 11. PMID: 37039365; PMCID: PMC10344433.
https://pubmed.ncbi.nlm.nih.gov/37039365/ -
Meizoso JP, Cotton BA, Lawless RA, et al. Whole blood resuscitation for injured patients requiring transfusion: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2024;97(3):460-470. doi:10.1097/TA.0000000000004327
https://pubmed.ncbi.nlm.nih.gov/38531812/
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Join the BTK crew as they discuss how surgeons maintain relationships despite the demanding nature of their profession. The speakers are surgeons at different career stages (residents, fellows, attendings) and they share tips and tricks for maintaining relationships with significant others, children, parents, and friends.
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Join the Behind the Knife Bariatric Surgery Team as they kick off 2025 with a crucial discussion on pediatric and adolescent bariatric surgery. Drs. Matt Martin, Adrian Dan and Katherine Cironi delve into the latest ASMBS guidelines, comparing long-term outcomes of gastric bypass and sleeve gastrectomy in adolescents versus adults. They explore key comorbidities, including type 2 diabetes, hypertension, and orthopedic issues, and emphasize the importance of early intervention. This episode also tackles the complex ethical considerations surrounding surgery in this vulnerable population, including consent, multidisciplinary care, and the evolving role of medical therapies like GLP-1 agonists.
Show Hosts:
- Matthew Martin
- Adrian Dan
- Katherine Cironi
Learning Objectives:
· Identify the current ASMBS guidelines for pediatric and adolescent bariatric surgery, including BMI thresholds and associated comorbidities.
· Describe common comorbidities seen in the pediatric population eligible for bariatric surgery, such as type 2 diabetes, hypertension, and orthopedic issues.
· Compare and contrast long-term outcomes of bariatric surgery (gastric bypass and sleeve gastrectomy) in adolescents and adults, including remission rates of comorbidities and reoperation rates.
· Discuss the importance of a multidisciplinary approach, including psychological and ethical considerations, when evaluating adolescent patients for bariatric surgery.
· Explain the ethical framework used in evaluating adolescents for bariatric surgery, including consent/assent, parental involvement, and addressing potential coercion.
· Recognize the evolving role of medical management (e.g., GLP-1 agonists) in conjunction with or as an alternative to bariatric surgery in adolescents.
Article #1: Inge 2019 – Five-year outcomes of gastric bypass in adolescents as compared with adults
https://pubmed.ncbi.nlm.nih.gov/31461610/
- The cumulative effect of sustained severe obesity (BMI >35) from adolescence into adulthood increases the likelihood of diabetes, hypertension, respiratory conditions, kidney dysfunction, walking limitations, and venous edema in legs/feet (when compared to adults that did not report severe obesity in adolescence)
- American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines for adolescents who should be considered for bariatric surgery: BMI is ≥35 with a co-morbidity or if they have a BMI ≥40 (class 3 obesity, 140% of the 95th percentile)
- This article utilizes the Teen-Longitudinal Assessment of Bariatric Surgery (TEENS LAB) and LABS (adults) databases to evaluate the outcomes of adolescents vs. adults who underwent bariatric surgery Roux-en-Y gastric bypass (2006-2009)
- 161 adolescents (13-19 at the time of surgery) with severe obesity (BMI>35) vs 396 adults (25-50 years old at the time of surgery) who have remained obese (BMI>30) since adolescence
- Both groups had the gastric bypass procedure as their primary bariatric operation
- Both groups had unadjusted similar demographics, however, BMI was higher in adolescence (54) when compared to adults (51)
- Results were analyzed using linear mixed and Poisson mixed models to analyze weight and coexisting conditions
- After surgery, adolescents were significantly more likely than adults to have remission of type 2 diabetes and hypertension
- Increased likelihood of remission of diabetes due to the shorter duration of diabetes, lower baseline glycated Hgb, less use of medications, and increased baseline C-peptide levels
- Increased vascular stiffness in adults along with a longer duration of hypertension make the cessation of hypertension less responsive with surgery in adults
- No significant difference in percent weight changes between adolescents and adults 5 years after surgery
- Both adults and adolescent groups had decreased rates of hypertriglyceridemia and low HDL levels, albeit not significantly different when comparing the two groups
-
Of note, the rate of abdominal reoperations was significantly higher among adolescents (20%) than among adults (16%) with cholecystectomy representing nearly half the procedures in both groups
-
Limitations
- At baseline, adults had a high prevalence of both diabetes and hypertension
- only 14% of adolescents had diabetes vs 31% of adults
- Only 30% of adolescents had hypertension vs 61% of adults
Article #2: Ryder 2024 – Ten-year outcomes after bariatric surgery in adolescents
https://pubmed.ncbi.nlm.nih.gov/39476348/
- The goal is to discuss the long-term durability of weight loss and remission of coexisting conditions in adolescents after bariatric surgery
- This article utilizes the Teen-Longitudinal Assessment of Bariatric Surgery (TEENS LABS) database to evaluate the 10-year outcomes in adolescents who underwent gastric bypass or sleeve gastrectomy
- 260 adolescents with an average age of 17 years old at the time of surgery (ages ranged from 13-19 years old)
- 161 adolescents underwent gastric bypass, 99 adolescents underwent sleeve gastrectomy
- Results were analyzed using propensity score-adjusted linear and generalized mixed models
- At 10 years, the average BMI had decreased significantly with both groups experiencing about a 20% change in BMI on average
- To assess comorbidities, both groups were analyzed together
- 55% of patients who had DM2 at baseline, were in remission at 10 years
- 57% of patients who had HTN at baseline, were in remission at 10 years
-
54% of patients who had dyslipidemia at baseline, were in remission at 10 years
-
Limitations
-
Neither of these studies compare surgery to medical management. GLP-1s have shown promise for weight loss management but we need more data in terms of long-term outcomes in co-morbidities like diabetes, hypertension, dyslipidemia
-
Highlighted Outcomes
- Metabolic bariatric surgery is quite effective in the adolescent population
- Adolescents tend to have weight loss that is similar to that of adults and improved resolution of comorbid conditions (DM2, HTN, dyslipidemia)
Article #3: Moore 2020 – Development and application of an ethical framework for pediatric metabolic and bariatric surgery evaluation https://pubmed.ncbi.nlm.nih.gov/33191162/
- The purpose of this paper is to describe the ethical framework that supports the use of metabolic & bariatric surgery (MBS) on the principle of justice, and how providers can conduct a thorough evaluation of patients presenting for these surgeries
- Highlights adolescents with intellectual and developmental disabilities (IDD) and preadolescent children who pose more ethical questions before considering surgery
- This article utilizes the bariatric surgery center at one children’s hospital and the institution’s ethics consult service to develop an ethical framework to evaluate pediatric patients seeking bariatric surgery – using the national ASMBS guidelines
- This ethical framework utilized 4 central ethical questions
-
Should any patients be automatically excluded from evaluation for MBS?
-
How should it be determined that the benefits of MBS outweigh the risks?
-
How do we ensure the patient fully understands and is capable of cooperating with the surgery and follow-up care?
-
How do we make sure the decision to have surgery is truly voluntary, and not coerced by family or others?
-
Results: this ethical framework was discussed in depth in two case studies
- Overview of framework: an ethical question would arise from the bariatric team they would review & apply the ethical framework. The question is either resolved by the bariatric team OR ethics consult, continue pre-operative workup vs no surgery
-
Case 1: 17M (BMI 42) with a history of autism spectrum disorder, pre-DM, depression with behavior challenges, HTN, dyslipidemia. Testing at school demonstrates intellectual functioning at a fourth-grade level. Pt lives with mom and 11-year-old sister. Mom endorses food insecurity (on supplemental nutrition assistance benefits) and struggles with her son’s large intake of food.
-
Co-morbidities should not be exclusionary, but pt should undergo a comprehensive psychosocial evaluation with attention to family dynamics and support and the patient’s decision-making capacity
-
Discuss benefits vs risks. Benefits – decreased progression of DM2, HTN, hyperlipidemia, cardiometabolic dx. Risks – gastric leak, infection, bleeding, dumping syndrome, etc.
-
Can assess decision-making capacity with the surgical team or if need be other teams. In this case, the pt had limited decision-making capacity
-
His level of understanding remained stable during the pre-op visits, and he gave assent to surgery
- The mom identified a second source of support (extended family)
-
The team talked to both the patient and mother alone and then, together, found that the patient developed an independent desire for surgery, and thus moved forward.
-
Case 2: 8F (BMI 50) with a history of mod OSA, L slipped capital femoral epiphysis s/p surgical stabilization (6 mos prior). The patient is neurotypical & excels in school, and lives with mom & dad. Referred by mom & dad (mom with a recent history of sleeve gastrectomy).
- An 8-year-old should not be discriminated against based solely on age, but the patient should be offered more conservative/less invasive options before OR.
a. In this case, the family had not yet been offered these nonsurgical approaches (structured weight management program, physical support, dietician)
-
Discuss benefits vs risks. Benefits – preventing progression of hip disease, improvement of OSA, decreased risk of cardiometabolic dx. Risks – anatomic/infectious/nutrition risks
-
Decision-making capacity was assessed. Found that the parents were more advocating for the surgery saying she has a poor quality of life physically and socially. When the patient was separated from her parents, she said she could lose weight if she had healthier foods at home and someone to exercise with. The patient had decision-making capacity & did not assent to surgery.
-
When the ethics team interviewed the patient and parents, the parents had a strong preference toward surgery vs patient was scared of surgery and wanted to try other approaches first
a. Decided that the child’s dissent outweighed the medical necessity for surgery and that there were conservative treatment options still available to try
- Highlighted Outcomes
- ASMBS guidelines give us good direction on who qualifies for surgery and emphasize an interdisciplinary approach to decision-making. The decision to pursue surgery should always weigh the benefits and risks and should be made collaboratively with the patient, family, and care team
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You're a new attending leading a busy surgical service. You’re tasked with teaching a team that includes every learner from medical students to junior and senior residents—all from different generations. How do you adapt your teaching style to effectively reach everyone? Dr. Abbey Fingeret, Endocrine Surgeon at University of Nebraska and passionate Surgical Educator, joins our host, Dr. Elizabeth Maginot, to explore strategies for engaging learners across generations and creating inclusive, dynamic teaching environments.
Hosts:* Dr. Abbey Fingeret, MD, MHPTT, FACS: Associate Professor, University of Nebraska Medical Center Department of Surgery, Division of Surgical Oncology, Twitter: @DrFingeret
* Dr. Elizabeth Maginot, MD: General Surgery Resident and BTK Surgical Education Fellow, University of Nebraska Medical Center, Twitter: @e_magination95
Learning Objectives:
- Understand the defining characteristics of Baby Boomers, Gen X, Millennials, and Gen Z, and how these traits influence their learning and teaching styles in medical education.
- Explore how to adapt teaching strategies for multigenerational learners by understanding and addressing their unique perceptions of education, feedback, and expectations in the clinical setting.
- Discuss methods to build a positive learning environment that fosters collaboration and inclusivity across all levels of trainees.
- Recognize the strengths and challenges different generations bring to medical education and how to leverage these to enhance team learning and patient care."
References
Stillman, D., & Stillman, J. (2017). Gen Z@ work: How the next generation is transforming the workplace. HarperCollins. https://pubmed.ncbi.nlm.nih.gov/?term=Stillman%2C+D.%2C+%26+Stillman%2C+J.+%282017%29.+Gen+Z%40+work%3A+How+the+next+generation+is+transforming+the+workplace.+HarperCollins.
Elmore, T., & McPeak, A. (2019). Generation Z unfiltered: Facing nine hidden challenges of the most anxious population. Poet Gardener Publishing.
Twenge, J. M. (2023). Generations: The Real Differences Between Gen Z, Millennials, Gen X, Boomers, and Silents—and What They Mean for America's Future. Simon and Schuster.
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Join the Behind the Knife Surgical Oncology Team as we discuss the presentation, work-up, and management of neuroendocrine tumors of the small bowel.
Learning Objectives:
In this episode, we review the basics of neuroendocrine (NE) tumors of the small bowel, including how to evaluate patients with presenting symptoms consistent with NE tumors, initial work-up, staging, and management. We discuss key concepts including DOTATATE scans and medical therapies high yield for direct patient care and board exams.
Hosts:
Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center
Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist/HPB surgeon at Kaiser LAMC in Los Angeles.
Connor Chick, MD (@connor_chick) is a 2nd Year Surgical Oncology fellow at Ohio State University.
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a 1st Year Surgical Oncology fellow at MD Anderson.
Beth (Elizabeth) Barbera, MD (@elizcarpenter16) is a PGY-6 General Surgery resident at Brooke Army Medical Center
Links to Paper Referenced in this Episode:
Strosberg J, El-Haddad G, Wolin E, Hendifar A, Yao J, Chasen B, Mittra E, Kunz PL, Kulke MH, Jacene H, Bushnell D, O'Dorisio TM, Baum RP, Kulkarni HR, Caplin M, Lebtahi R, Hobday T, Delpassand E, Van Cutsem E, Benson A, Srirajaskanthan R, Pavel M, Mora J, Berlin J, Grande E, Reed N, Seregni E, Öberg K, Lopera Sierra M, Santoro P, Thevenet T, Erion JL, Ruszniewski P, Kwekkeboom D, Krenning E; NETTER-1 Trial Investigators. Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors. N Engl J Med. 2017 Jan 12;376(2):125-135. doi: 10.1056/NEJMoa1607427. PMID: 28076709; PMCID: PMC5895095.
https://pubmed.ncbi.nlm.nih.gov/28076709/
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Join Patrick Georgoff to learn more about how YOU can make amazing digital education content. At Behind the Knife we are often asked how to create digital education content. Thanks to the democratization of technology and rise of the creator economy, all of the tools are at your fingertips. Would you like to enhance your next lecture, grant application, manuscript submission, or patient educational material? You can, even if you are part luddite! You don't need a publisher, advanced computer skills, or tons of money. Don't believe us? Listen to this short podcast for tipsand tricks on how you can make great content.
Patrick Georgoff (@georgoff) is an Acute Care Surgeon at Duke University. He went to medical school at the University of Pennsylvania, completed General Surgery residency and Surgical Critical Care fellowship at the University of Michigan, and a Trauma Surgery fellowship at the University of Texas in Houston. His clinical practice includes the full spectrum of Acute Care Surgery in addition to elective hernia surgery. Patrick is deeply involved in surgical education and the is the Associate Program of the General Surgery Residency at Duke and Co-Director of Behind the Knife. He is passionate about trauma system performance and holds the position of associate Trauma Medical Director at Duke.
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Join Drs. Michael Rosen, Clayton Petro, and Sara Maskal as they review their recently published randomized controlled trial comparing open retromuscular Sugarbaker and Keyhole approaches to parastomal hernia repair
Hosts:
- Sara Maskal, MD, Cleveland Clinic
- Clayton Petro, MD, Cleveland Clinic
- Michael Rosen, MD, Cleveland Clinic
Learning Objectives:
- Understand the trial design
- Review trial outcomes
- Understand how to apply the outcomes to patients with parastomal hernias
References:
- Maskal SM, Ellis RC, Fafaj A, et al. Open Retromuscular Sugarbaker vs Keyhole Mesh Placement for Parastomal Hernia Repair: A Randomized Clinical Trial. JAMA Surg. Published online June 12, 2024. doi:10.1001/jamasurg.2024.1686 https://pubmed.ncbi.nlm.nih.gov/38865142/
- Maskal SM, Thomas JD, Miller BT, Fafaj A, Zolin SJ, Montelione K, Ellis RC, Prabhu AS, Krpata DM, Beffa LR, Costanzo A. Open retromuscular keyhole compared with Sugarbaker mesh for parastomal hernia repair: Early results of a randomized clinical trial. Surgery. 2024 Mar 1;175(3):813-21. https://pubmed.ncbi.nlm.nih.gov/37770344/
- Moreno-Matias J, Serra-Aracil X, Darnell-Martin A, Bombardo-Junca J, Mora-Lopez L, Alcantara-Moral M, Rebasa P, Ayguavives-Garnica I, Navarro-Soto S. The prevalence of parastomal hernia after formation of an end colostomy. A new clinico-radiological classification. Colorectal Dis. 2009 Feb;11(2):173-7. doi: 10.1111/j.1463-1318.2008.01564.x. Epub 2008 May 3. PMID: 18462232. https://pubmed.ncbi.nlm.nih.gov/18462232/
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You are planning to perform an APR on a patient with rectal cancer. How will you create your permanent stoma? Is there a role for prophylactic mesh? Post operatively at one year surveillance they have developed a parastomal hernia, when do you fix it and how? Join Drs. Abelson, Marcello and Aulet and special guest Dr. Paul Sturrock as they discuss key management considerations.
Learning Objectives:
1. Describe the different types of parastomal hernia repairs
2. List indications for repair of parastomal hernias
3. Discuss the approach to managing parastomal hernias
Articles:
Steele S, et al. The ASCRS Textbook of Colon and Rectal Surgery, fourth ed. 2022. https://link.springer.com/book/10.1007/978-3-030-66049-9
J C Goligher, Extraperitoneal colostomy or ileostomy, British Journal of Surgery, Volume 46, Issue 196, September 1958, Pages 97–103, https://doi.org/10.1002/bjs.18004619602
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
In this episode, Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill are joined by special guest Dr. Pat Murphy, who helps us delve into the evolving field of acute care surgery (ACS), exploring its history, challenges, and the nuances of defining full-time employment in this demanding specialty. The discussion highlights the origins of ACS as a response to unmet emergency surgical needs and its three foundational pillars: trauma surgery, emergency general surgery, and surgical critical care, with additional roles like surgical rescue evolving over time. Dr. Murphy share insights into the workload, including night shifts, call schedules, and the toll on surgeons' health, emphasizing the importance of fair compensation, equitable shift distribution, and transparency in job expectations. The episode underscores the value ACS surgeons bring to hospitals, likening them to essential infrastructure like firefighters, with their impact often unrecognized in traditional productivity metrics like RVUs.
Dr. Murphy would like to thank the many collaborators who made this volume of work possible including the many acute care surgeons who have taken the time to participate in the research and their dedication to patient care and surgeon wellbeing
Learning Objectives:
1) Define and understand the evolution of acute care surgery as a surgical subspecialty, including its historical development, key components (trauma, surgical critical care, emergency general surgery, surgical rescue), and its unique role within the surgical landscape.
2) Analyze the concept of "full-time equivalent" (FTE) for acute care surgeons, considering factors such as call schedules, shift length, service demands, and the impact of varying case volumes and intensities on workload.
3) Discuss the challenges of defining and measuring the value of acute care surgeons, considering factors beyond traditional productivity metrics (e.g., RVUs) such as the impact of surgical rescue, patient safety, and the value of 24/7 availability in preventing adverse outcomes.
4) Explore the importance of recognizing the unique demands and contributions of acute care surgeons, including the impact of high-stress environments, irregular schedules, and the importance of work-life balance and clinician well-being on long-term sustainability within the specialty.
This episode of Big T Trauma was sponsored by Teleflex, a global provider of medical devices. Learn more at teleflex.com and at the Teleflex Trauma and Emergency Medicine LinkedIn page.
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
BIG T Trauma Series: https://app.behindtheknife.org/podcast-series/big-t-trauma
In their BTK debut, the Surgical Endoscopy team from Endeavor Health (formerly Northshore University Health System) discusses why it is important for surgeons to acquire basic and advanced endoscopic skills. There are an increasing number of ways to endoscopically intervene and solve problems that were traditionally relegated to open and minimally invasive surgery. The Surg Endo team presents a number of case-based scenarios that are going to set the stage for future discussions about the role of therapeutic endoscopy in surgical practice.
Hosts:
- Dr. Sullivan “Sully” Ayuso, Minimally Invasive Surgery, Endeavor Health (Evanston, IL), @SAyusoMD (Twitter)
- Dr. Trevor Crafts, Minimally Invasive Surgeon, Rocky Mountain VA Medical Center (Denver, CO), @CraftsTrevor (Twitter)
- Dr. H. Masson Hedberg, Minimally Invasive Surgeon, Endeavor Health (Evanston, IL)
- Dr. Michael Ujiki, Professor and Louis Biegler Chair of Surgery, Endeavor Health (Evanston, IL), @UjikiMike
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
In this episode, Behind the Knife fellow Ayman Ali, and Dr. Patrick Georgoff introduce a new series on Behind the Knife – Artificial Intelligence for the Clinician. Over the course of a few episodes, we aim to go over all things AI, with a particular focus on how you can use AI today to enhance your quality of life as a clinician, with just enough detail to understand key concepts.
This first episode features guest Dr. Monica Agrawal, an expert in artificial intelligence and a pioneer in large language models. She recently joined Duke after completing a PhD in Computer Science at MIT in the clinical machine learning group and is a co-founder of Layer Health, a healthcare AI company. With her expertise, we’ll define some key terms and give a brief introduction to what artificial intelligence is and is not, as well as some examples and use cases.
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Research is so critical to the field of surgery worldwide. But how does the world of academic surgery compare in the UK? Join BTK fellow Jon Williams and ASGBI partner Jared Wohlgemut for another installment of our BTK/ASGBI collaborative series where we take a deep dive investigating the many facets of surgical research–everything from getting started, funding, collaboration, mentorship, and sage advice from two incredibly successful academic surgeons. Professor Susan Moug represents the UK while Dr. Lesly Dossett represents the US in this excellent episode for any trainee or surgeon who is academically-inclined. After listening, you get to decide–who does it better?? UK or US?
Professor Moug is an Honorary Professor at the University of Glasgow, Scotland. She is a Consultant Colorectal and Robotic surgeon at Golden Jubilee National University Hospital in Clydebank, and at the Royal Alexandra Hospital in Paisley, Scotland. She is also the Director of Research for the Association of Surgeons of Great Britain and Ireland since 2021, and the Surgical Specialty Lead for Colorectal Research at the Royal College of Surgeons of England. She has been awarded a Senior Fellowship from the Chief Scientist Office of the Scottish Government, and was the chief investigator for the Emergency Laparotomy in Frailty multicentre study, and the No-Laps follow-on study. Essentially, she is one of the leading researchers in emergency surgery in the UK, having been awarded over 1 million in grant funding for this under-researched and underfunded area.
Dr. Dossett is an associate professor and surgical oncologist at the University of Michigan. After completing her undergraduate degree at Western Kentucky University, She completed both medical school and her general surgery residency at Vanderbilt University in Nashville, TN, during which she obtained an Agency for Healthcare Research and Quality training grant as well as a Masters in Public Health during research time. Following residency, she served as an active duty staff surgeon in the US Navy for several years before pursuing surgical oncology fellowship training at Moffitt Cancer Center. In 2016 she came on to University of Michigan as faculty and has since held numerous academic leadership roles both institutionally and nationally, including vice chair for faculty development, chief of the division of surgical oncology, and president of the Surgical Outcomes Club. Dr. Dossett has an impressive portfolio of research work focusing on implementation and de-implementation of comprehensive cancer care, which is funded through multiple NIH grants.
If you enjoyed this episode, stay tuned for more upcoming BTK/ASGBI collaborative content. If you have any questions or comments, please feel free to reach out to us at hello@behindtheknife.org.
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Join University of Washington’s surgical palliative care team for another engaging role play episode, where we tackle the challenging goals-of-care conversation. Using the VitalTalk REMAP framework, we explore effective communication strategies, highlight common pitfalls, and simulate two real-world scenarios: an on-call surgeon discussing goals of care with a complex patient facing an emergent surgical issue, and a team member facilitating a family meeting about goals of care in the surgical ICU.
Hosts:
Dr. Katie O’Connell (@katmo15) is an associate professor of surgery at the University of Washington. She is a trauma surgeon, palliative care physician, director of surgical palliative care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA.
Dr. Ali Haruta is an assistant professor of surgery at the University of Washington. She is a trauma and emergency general surgeon and palliative care physician. Ali recently completed fellowships in palliative care at the University of Washington and Trauma and Critical Care fellowship at Parkland.
Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY6 general surgery resident at the University of Washington, with an interest in surgical oncology.
Dr. Virginia Wang is a PGY3 general surgery resident at the University of Washington.
Learning Objectives:
• Identify questions that elicit patients’ goals and values, particularly during emotionally charged conversations.
• Name the three categories of patient values in the values triad.
• Describe the importance of aligning with patients’ and families’ values and demonstrate techniques to achieve alignment.
• Develop a treatment plan that reflects patients’ stated values.
References:
“REMAP.” VitalTalk. Accessed December 2nd. https://www.vitaltalk.org/guides/transitionsgoals-of-care/
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Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
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Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
***SPECIALTY TEAM APPLICATION LINK: https://docs.google.com/forms/d/e/1FAIpQLSdX2a_zsiyaz-NwxKuUUa5cUFolWhOw3945ZRFoRcJR1wjZ4w/viewform?usp=sharing
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
***SPECIALTY TEAM APPLICATION LINK: https://docs.google.com/forms/d/e/1FAIpQLSdX2a_zsiyaz-NwxKuUUa5cUFolWhOw3945ZRFoRcJR1wjZ4w/viewform?usp=sharing
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
***SPECIALTY TEAM APPLICATION LINK: https://docs.google.com/forms/d/e/1FAIpQLSdX2a_zsiyaz-NwxKuUUa5cUFolWhOw3945ZRFoRcJR1wjZ4w/viewform?usp=sharing
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Among patients with colorectal cancer and synchronous liver metastases, the subgroup with a primary cancer in the rectum is especially challenging. Compared with colon cancer, most patients with stage IV rectal cancer will have locally advanced primary tumors at increased risk for obstructive and/or post-operative complications resulting in delays in systemic therapy. In this episode from the HPB team at Behind the Knife, listen in on the discussion about treatment sequencing for synchronous liver metastasis from rectal cancer
Hosts
Anish J. Jain MD (@anishjayjain) is a current PGY3 General Surgery Resident at Stanford University and a former T32 Research Fellow at the University of Texas MD Anderson Cancer Center.
Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology. He is also the associate program director of the HPB fellowship at the University of Texas MD Anderson Cancer Center.
Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center.
Learning Objectives
· Develop an understanding of the three treatment sequences for resection of disease in patients with synchronous liver metastasis from a primary rectal cancer (reverse, combined, and classic approach)
· Develop an understanding of the benefits, risks, and nuances of each of the three treatment sequences
· Develop an understanding of which patient cases each treatment sequence is ideal for as well as which cases they are not suitable for.
Papers Referenced (in the order they were mentioned in the episode):
1) Conrad C, Vauthey JN, Masayuki O, et al. Individualized Treatment Sequencing Selection Contributes to Optimized Survival in Patients with Rectal Cancer and Synchronous Liver Metastases. Ann Surg Oncol. 2017 Dec;24(13):3857-3864.
https://pubmed.ncbi.nlm.nih.gov/28929463/
2) Maki H, Ayabe RI, Nishioka Y, et al. Hepatectomy Before Primary Tumor Resection as Preferred Approach for Synchronous Liver Metastases from Rectal Cancer. Ann Surg Oncol. 2023 Sep;30(9):5390-5400. doi: 10.1245/s10434-023-13656-4. Epub 2023 Jun 7. Erratum in: Ann Surg Oncol. 2023 Sep;30(9):5405.
https://pubmed.ncbi.nlm.nih.gov/37285096/
Additional Suggested Reading
Mentha G, Majno PE, Andres A, Rubbia-Brandt L, Morel P, Roth AD. Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary. Br J Surg. 2006 Jul;93(7):872-8.
https://pubmed.ncbi.nlm.nih.gov/16671066/
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Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
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Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
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Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Join Drs. Galandiuk, Bolshinsky, Kavalukas, and Simon as they discuss non-operative and operative management of enterocutaneous fistula. Come with us as we navigate through tips and tricks for preventing and managing enterocutaneous fistulas!
Hosts:
- Susan Galandiuk, University of Louisville, Louisville, Kentucky, @DCREdInChief
- Vladimir Bolshinsky, Peninsula Health, Victoria, Australia, @bolshinskyv
- Sandy Kavalukas, University of Louisville, Louisville, Kentucky, @sandykava
- Hillary Simon, University of Louisville, Louisville, Kentucky, @HillaryLSimon
Producer:- Manasa Sunkara MS4, University of Louisville, Louisville, Kentucky, @manasasunkara12
Learning objectives:- Review causes of enterocutaneous (EC) fistulas.
- Understand EC fistula prevention and management tenets.
- Discuss surgical tips and tricks for tackling EC fistulas.
References:- Ellison EC, Upchurch GR, et al. Fischer’s Mastery of Surgery. 8th ed, Vol 1. Philadelphia, PA: Wolters Kluwer; 2024:1175-1182.
- Fazio VW, et al. Current Therapy in Colon and Rectal Surgery. 8th ed. Philadelphia, PA: Elsevier; 2017:404-411.
- Mulholland MW, et al. Operative Techniques in Surgery. Vol 2. Philadelphia, PA: Wolters Kluwer; 2015:934-942.
- Steele SR, et al. Illustrated Tips and Tricks in Colon and Rectal Surgery. Philadelphia, PA: Wolters Kluwer; 2021:263-269.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
A nearby house fire has brought several patients to your hospital via ambulance, where you are the sole provider on duty. These patients require urgent triage and stabilization before transfer to the regional burn center. You are very concerned about inhalation injury and are tasked with making complex clinical decisions in a high-pressure situation. What are the next steps? Join Drs. Kevin Foster, Tina Palmeri, Ryan Rihani, Tommy Tran, and Kiran Dyamenahalli as they explore the intricacies of managing smoke inhalation injury and more!
Hosts:
Tommy Tran, Tristar Skyline Medical Center
Kiran Dyamenahalli, MGH Sumner Redstone Burn Center
Kevin Foster, Arizona Burn Center
Tina Palmeri, UC Davis Firefighters Burn Institute Regional Burn Center
Ryan Rihani, UT Health Dunn Burn Center
Tam Pham, Harborview Medical Center (Editor)
Learning Objectives:1. Understand the etiology and common scenarios associated with inhalation injury 2. Understand the effect of inhalation injury on morbidity and mortality 3. Describe indications for invasive airway management (intubation, bronchoscopy, and mechanical ventilation). 4. Describe complications of inhalation injury and their management.
References:
Fournier, M., Turgeon, A. F., Doucette, S., Morrisette, M., Archambault, P., & Bouchard, N. (2016). Nebulized heparin for inhalation injury in burn patients: A systematic review and meta-analysis. Critical Care, 20(1), 1-10. https://doi.org/10.1186/s13054-016-1285-8
Norris, C., LaLonde, C., Slater, H., & Purser, D. (2005). Survival from inhalation injury. Burns, 31(7), 803-815. https://doi.org/10.1016/j.burns.2005.04.003
Li, W., Tang, X., Chen, Y., & Zhao, Z. (2021). Update on smoke inhalation injury: Pathogenesis, diagnosis, and treatment. Journal of Thoracic Disease, 13(4), 1797-1808. https://doi.org/10.21037/jtd-20-3328
Hahn, S. M., Kim, Y. H., Kim, K. H., & Lee, S. U. (2020). Advances in the diagnosis and treatment of smoke inhalation injury in burn patients. Acute and Critical Care, 35(1), 1-10. https://doi.org/10.4266/acc.2020.00175
Bittner, E. A., Shank, E., Woodson, L., & Martyn, J. A. (2015). Acute and long-term outcomes of burn injuries: A focus on inhalation injury. Clinics in Chest Medicine, 36(4), 549-560. https://doi.org/10.1016/j.ccm.2015.08.007
Romanowski, K. S., & Palmieri, T. L. (2019). Inhalation injury in burns: Pathophysiology, diagnosis, and treatment. Journal of Burn Care & Research, 40(5), 517-523. https://doi.org/10.1093/jbcr/irz123
Dyamenahalli, K., Garg, G., Shupp, J. W., Kuprys, P. V., Choudhry, M. A., & Kovacs, E. J. (2019). Inhalation injury: Unmet clinical needs and future research. Journal of Burn Care & Research, 40(5), 570-584. https://doi.org/10.1093/jbcr/irz055
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
In this episode, podcast hosts Dr. Josh Roshal, Dr. Darian Hoagland, and Dr. Maya Hunt discuss the ins and outs of professional development time (PDT) and professional identity formation (PIF) during surgical training. Joined by insights from fellow CoSEF members, the team dives into key topics such as mentorship, timing, and making the most of this critical phase in residency. From rapid-fire tips to personal reflections, this episode offers a wealth of advice for trainees considering their PDT and PIF..
Episode Hosts:
–Dr. Josh Roshal, University of Texas Medical Branch, @Joshua_Roshal, jaroshal@utmb.edu
–Dr. Darian Hoagland, Beth Israel Deaconess Medical Center, @DHoaglandMD, dlhoagla@bidmc.harvard.edu
–Dr. Maya Hunt, Indiana University, @dr_mayathehunt, mayahunt@iu.edu
–CoSEF: @surgedfellows, cosef.org
Guests:
-Dr. Ariana Naaseh, Washington University in St. Louis, @ariananaaseh, a.naaseh@wustl.edu
-Dr. Colleen McDermott, University of Utah, @ColleenMcDMD, Colleen.McDermott@hsc.utah.edu
-Dr. Shahnur Ahmed, Indiana University, shahme@iu.edu
-Dr. Xinyi “Cathy” Luo, Tulane University, @DoctorSoySauce, xluo@tulane.edu
-Dr. Ananya Anand, Stanford University, @AnanyaAnandMD, aa24@stanford.edu
References:1. Smith SM, Chugh PV, Song C, Kim K, Whang E, Kristo G. Perspectives of Surgical Research Residents on Improving Their Reentry Into Clinical Training. J Surg Educ. 2024 Nov;81(11):1491-1497. doi: 10.1016/j.jsurg.2024.07.005. Epub 2024 Aug 31. PMID: 39217679. https://pubmed.ncbi.nlm.nih.gov/39217679/ 2. Kochis MA, Cron DC, Coe TM, Secor JD, Guyer RA, Brownlee SA, Carney K, Mullen JT, Lillemoe KD, Liao EC, Boland GM. Implementation and Evaluation of an Academic Development Rotation for Surgery Residents. J Surg Educ. 2024 Nov;81(11):1748-1755. doi: 10.1016/j.jsurg.2024.08.015. Epub 2024 Sep 23. PMID: 39317122. https://pubmed.ncbi.nlm.nih.gov/39317122/ 3. Gkiousias V. Scalpel Please! A Scoping Review Dissecting the Factors and Influences on Professional Identity Development of Trainees Within Surgical Programs. Cureus. 2021;13(12):e20105. doi:10.7759/cureus.20105 https://pubmed.ncbi.nlm.nih.gov/35003955/ 4. Rivard SJ, Vitous CA, De Roo AC, et al. “The captain of the ship.” A qualitative investigation of surgeon identity formation. Am J Surg. 2022;224(1 Pt B):284-291. doi:10.1016/j.amjsurg.2022.01.010 https://pubmed.ncbi.nlm.nih.gov/35168761/ 5. Irby DM, Cooke M, O’Brien BC. Calls for reform of medical education by the Carnegie Foundation for the Advancement of Teaching: 1910 and 2010. Acad Med J Assoc Am Med Coll. 2010;85(2):220-227. doi:10.1097/ACM.0b013e3181c88449 https://pubmed.ncbi.nlm.nih.gov/20107346/ 6. Veazey Brooks J, Bosk CL. Remaking surgical socialization: work hour restrictions, rites of passage, and occupational identity. Soc Sci Med 1982. 2012;75(9):1625-1632.doi:10.1016/j.socscimed.2012.07.007 https://pubmed.ncbi.nlm.nih.gov/22863331/ 7. Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Acad Med J Assoc Am Med Coll.2015;90(6):718-725.doi:10.1097/ACM.0000000000000700 https://pubmed.ncbi.nlm.nih.gov/25785682/ 8. Huffman EM, Anderson TN, Choi JN, Smith BK. Why the Lab? What is Really Motivating General Surgery Residents to Take Time for Dedicated Research. J SurgEduc.2020;77(6):e39-e46.doi:10.1016/j.jsurg.2020.07.034 https://pubmed.ncbi.nlm.nih.gov/32768383/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Your post op day #4 right pneumonectomy patient is suddenly coughing up large volumes of serosanguinous sputum! What are you worried about and what do you need to do? Join your Swedish thoracic surgery team, Drs. Chloe Hanson, Peter White, and Brian Louie as we discuss the management of this dangerous and frustrating surgical complication.
Hosts:
Chloe E. Hanson, M.D., PGY3
Brian E. Louie, MD, Thoracic Attending
Peter T. White, MD, Thoracic Attending
Learning Objectives:1. What is a bronchopleural fistula (BPF) and what different ways do they present? 2. Describe the acute management of an early BPF. 3. Describe the differences in operative considerations between an early and late BPF. 4. Describe different options for closure of a pneumonectomy space.
References:
- Sugarbaker's Adult Chest Surgery, 3e Sugarbaker DJ, Bueno R, Burt BM, Groth SS, Loor G, Wolf AS, Williams M, Adams A. Sugarbaker D.J., & Bueno R, & Burt B.M., & Groth S.S., & Loor G, & Wolf A.S., & Williams M, & Adams A(Eds.),Eds. David J. Sugarbaker, et al. https://shc.amegroups.org/article/view/3787/html
- Dal Agnol G, Vieira A, Oliveira R, Ugalde Figueroa PA. Surgical approaches for bronchopleural fistula. Shanghai Chest 2017;1:14.
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Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Osteopathic education in surgery has undergone significant changes, especially with the transition to a single ACGME accreditation system in 2020. Despite initial concerns about equitable access and representation, studies have highlighted increasing competitiveness of osteopathic medical students in surgical residency matches and comparable outcomes between allopathic and osteopathic surgeons, affirming the quality of osteopathic training. In this episode, we talk with Dr. Kristen Conrad-Schnetz, recent president of the American College of Osteopathic Surgeons (ACOS) and General Surgery program director at Cleveland Clinic South Pointe Hospital, about osteopathy in general surgery. We delve into the role of osteopathic principles in surgical training and practice and the impact of transitioning to a single accreditation system. Dr. Conrad-Schnetz shares insights on overcoming misconceptions about DO surgeons and her vision for the future of osteopathic recognition in surgery.
Join hosts Pooja Varman MD, Judith French PhD, and Jeremy Lipman MD, MHPE for this exciting conversation with Kristen Conrad-Schnetz, DO.
Learning Objectives
By the end of this episode, listeners will be able to
1. List the four tenets of osteopathic medicine
2. Identify how osteopathic principles and practices can be incorporated into surgical practice
3. Explain the significance of osteopathic recognition in residency programs
4. Discuss strategies for promoting equity for DO surgery residents
References
1. Williamson TK, Martinez VH, Ojo DE, et al. An analysis of osteopathic medical students applying to surgical residencies following transition to a single graduate medical education accreditation system. Journal of Osteopathic Medicine. 2024;124(2):51-59. doi:10.1515/jom-2023-0118 https://pubmed.ncbi.nlm.nih.gov/37921195/
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Russell TA, Yoshida R, Men M, et al. Comparison of Outcomes for Patients Treated by Allopathic vs Osteopathic Surgeons. JAMA Surgery. Published online October 16, 2024. doi:10.1001/jamasurg.2024.4580 https://pubmed.ncbi.nlm.nih.gov/39412774/
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Etheart I, Krise SM, Burns JB, Conrad-Schnetz K. The Effect of Single Accreditation on Medical Student Match Rates in Surgical Specialties. Cureus. 2021;13(4):e14301. doi:10.7759/cureus.14301 https://pubmed.ncbi.nlm.nih.gov/33968513/
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If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
In this episode, we dive into the 2024 guidelines from the Surgical Infection Society (SIS). Using a case-based approach, we explore how the updated guidelines impact clinical decision-making in the management of intra-abdominal infections. Our expert guests break down best practices while emphasizing the importance of timely intervention, appropriate antibiotic selection, and the evolving role of local antibiograms in guiding therapy. Listeners will gain practical insights into the newest evidence-based recommendations, including when to shorten antibiotic courses, how to tailor therapy for individual patients, and the critical need for early source control. Whether you're a seasoned clinician or a trainee, this case-based discussion provides actionable takeaways for improving patient outcomes in surgical infections.
Take Home Points:
- Antibiotics and antibiotic resistance are continuously evolving. It’s essential to stay updated with current guidelines, consult your local antibiogram, and utilize available antimicrobial options to create an informed and effective treatment plan
- Shorter course antibiotics for intra-abdominal infections are generally well tolerated, but careful patient selection is crucial for optimizing outcomes.
- In cases of complicated appendicitis, antibiotics should be discontinued within 24-48 hours after effective source control is achieved.
- Time is life – early administration of appropriate antibiotics and prompt, definitive source control are key to improving patient outcomes
Hosts:
- Patrick Georgoff, MD – Trauma Surgeon at Duke University, @georgoff
- Nicole Petcka, MD – General Surgery Resident at Emory University, @npetcka2022
Guests:
- Heather Evans, MD, MS – Chief of Surgery at the Ralph H. Johnson VA Medical Center, President of the Surgical Infection Society
- Joe Forrester, MD, MSc – Assistant Professor of Surgery at Stanford University, Surgical Infection Society Therapeutics and Guidelines Committee Chair
Resources:
The Surgical Infection Society Guidelines on the Management of Intra-Abdominal Infection: 2024 Update
Huston JM, Barie PS, Dellinger EP, Forrester JD, Duane TM, Tessier JM, Sawyer RG, Cainzos MA, Rasa K, Chipman JG, Kao LS, Pieracci FM, Colling KP, Heffernan DS, Lester J; Therapeutics and Guidelines Committee. The Surgical Infection Society Guidelines on the Management of Intra-Abdominal Infection: 2024 Update. Surg Infect (Larchmt). 2024 Aug;25(6):419-435. doi: 10.1089/sur.2024.137. Epub 2024 Jul 11. PMID: 38990709.
https://pubmed.ncbi.nlm.nih.gov/38990709/
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Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
In this episode by the Emergency General Surgery team, we explore the inevitable in acute care surgery- complications. Once a taboo subject, we are now beginning to understand how surgeons and care teams are affected when things don't go as planned. The team discusses two articles that explore the impact of surgical complications on surgeons, both in the short and long term, as well as ways to rehabilitate and support surgeons when they face a challenging complication. Drawing on the article, as well as personal experience, this episode works towards the ongoing shift in surgical culture around outcomes and supports improved surgeon wellness.
Hosts
Dr. Ashlie Nadler
Dr. Jordan Nantais,
Dr. Graham Skelhorne-Gross
Dr. Marika Sevigny
References1. Zhu A, Deng S, Greene B, Tsang M, Palter VN, Jayaraman S. Helping the Surgeon Recover: Peer-to-Peer Coaching after Bile Duct Injury. J Am Coll Surg. 2021 Aug;233(2):213-222.e1. doi: 10.1016/j.jamcollsurg.2021.05.011. Epub 2021 Jun 7. PMID: 34111530. https://pubmed.ncbi.nlm.nih.gov/34111530/
2. Han K, Bohnen JD, Peponis T, Martinez M, Nandan A, Yeh DD, Lee J, Demoya M, Velmahos G, Kaafarani HMA. The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons' Attitude (BISA) Study. J Am Coll Surg. 2017 Jun;224(6):1048-1056. doi: 10.1016/j.jamcollsurg.2016.12.039. Epub 2017 Jan 16. PMID: 28093300. https://pubmed.ncbi.nlm.nih.gov/28093300/
Learning objectives1. Understand the psychological impact of surgical complications on the care provider 2. Explore the role of peer-to-peer mentoring in support and rehabilitation of surgeons
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2025 – Up-to-date and high yield learning to help you DOMINATE the exam.
Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Be sure to check out our brand new free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2025 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/en-us/index.html
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
In this episode, Dr. Atul Gawande joins Dr. Patrick Georgoff to share his experiences as a surgeon, writer, and global health leader. From his innovative work at Ariadne Labs and Lifebox to his current role as Assistant Administrator for Global Health at USAID, Dr. Gawande discusses the challenges and rewards of creating large-scale impact. He reflects on balancing creativity in writing with precision in surgery, lessons learned from managing teams, and the critical importance of strengthening global health systems. Enjoy!
Dr. Atul Gawande is the Assistant Administrator for Global Health at the U.S. Agency for International Development, where he oversees a bureau that manages more than $4 billion with a footprint of more than 900 staff committed to advancing equitable delivery of public health approaches around the world. The Bureau for Global Health focuses on work that improves lives everywhere--from preventing child and maternal deaths to controlling the HIV/AIDS epidemic, combating infectious diseases, and preparing for future outbreaks.
Prior to joining the Biden-Harris Administration, he was a practicing surgeon at Brigham and Women’s Hospital in Boston and a professor at the Harvard Medical School and the Harvard T.H. Chan School of Public Health. He is the founder and was the chair of Ariadne Labs, a joint center for health systems innovation, and of Lifebox, a nonprofit making surgery safer globally. From 2018-2020, he was also the CEO of Haven (an Amazon, Berkshire Hathaway, and JP Morgan Chase healthcare venture). In addition, Atul was a longtime staff writer for The New Yorker magazine and has written four New York Times best-selling books: Complications, Better, The Checklist Manifesto, and Being Mortal.
Visit https://www.usaid.gov/organization/atul-gawande to learn more about our special guest. To learn more about the Global Health Bureau, please visit https://www.usaid.gov/global-health.
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A 67 year old woman with a history of hypertension, hyperlipidemia, diabetes, and a 25 pack year smoking history is referred your clinic and is referred for evaluation of her peripheral arterial disease. She reports pain with walking that has limited her doing some daily activities. How can you optimally manage this patient? Does she need an operation? In this episode, we will cover the basics of peripheral arterial disease, discuss the specifics of optimal medical management and dive into the nuances of when (or if) you should offer these patients an operation.
Hosts:
Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan and the Program Director of the Integrated Vascular Surgery Residency Program as well as the Vascular Surgery Fellowship Program at the University of Michigan.
Dr. Drew Braet is a PGY-5 Integrated Vascular Surgery Resident at the University of Michigan
Learning Objectives
- Review the definition, prevalence, and risk factors for peripheral arterial disease
- Understand the specifics of optimal medical management of patients with peripheral arterial disease
- Discuss the controversy regarding operative management of patients with claudication and review indications for an operation in patients with peripheral arterial disease
- Review the appropriate anti-platelet and anti-coagulation strategies after interventions in patients with peripheral arterial disease
References
1. Woo K, Siracuse JJ, Klingbeil K, Kraiss LW, Osborne NH, Singh N, Tan TW, Arya S, Banerjee S, Bonaca MP, Brothers T, Conte MS, Dawson DL, Erben Y, Lerner BM, Lin JC, Mills JL Sr, Mittleider D, Nair DG, O'Banion LA, Patterson RB, Scheidt MJ, Simons JP; Society for Vascular Surgery Appropriateness Committee. Society for Vascular Surgery appropriate use criteria for management of intermittent claudication. J Vasc Surg. 2022 Jul;76(1):3-22.e1. doi: 10.1016/j.jvs.2022.04.012. Epub 2022 Apr 22. PMID: 35470016.
https://pubmed.ncbi.nlm.nih.gov/35470016/
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Nordanstig J, Behrendt CA, Baumgartner I, Belch J, Bäck M, Fitridge R, Hinchliffe R, Lejay A, Mills JL, Rother U, Sigvant B, Spanos K, Szeberin Z, van de Water W; ESVS Guidelines Committee; Antoniou GA, Björck M, Gonçalves FB, Coscas R, Dias NV, Van Herzeele I, Lepidi S, Mees BME, Resch TA, Ricco JB, Trimarchi S, Twine CP, Tulamo R, Wanhainen A; Document Reviewers; Boyle JR, Brodmann M, Dardik A, Dick F, Goëffic Y, Holden A, Kakkos SK, Kolh P, McDermott MM. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg. 2024 Jan;67(1):9-96. doi: 10.1016/j.ejvs.2023.08.067. Epub 2023 Nov 10. PMID: 37949800.
https://pubmed.ncbi.nlm.nih.gov/37949800/ -
Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024 Jun 11;149(24):e1313-e1410. doi: 10.1161/CIR.0000000000001251. Epub 2024 May 14. PMID: 38743805.
https://pubmed.ncbi.nlm.nih.gov/38743805/ -
Belch JJ, Dormandy J; CASPAR Writing Committee; Biasi GM, Cairols M, Diehm C, Eikelboom B, Golledge J, Jawien A, Lepäntalo M, Norgren L, Hiatt WR, Becquemin JP, Bergqvist D, Clement D, Baumgartner I, Minar E, Stonebridge P, Vermassen F, Matyas L, Leizorovicz A. Results of the randomized, placebo-controlled clopidogrel and acetylsalicylic acid in bypass surgery for peripheral arterial disease (CASPAR) trial. J Vasc Surg. 2010 Oct;52(4):825-33, 833.e1-2. doi: 10.1016/j.jvs.2010.04.027. Epub 2010 Aug 1. Erratum in: J Vasc Surg. 2011 Feb;53(2):564. Biasi, B M [corrected to Biasi, G M]. PMID: 20678878.
https://pubmed.ncbi.nlm.nih.gov/20678878/ -
Eikelboom JW, Connolly SJ, Bosch J, Dagenais GR, Hart RG, Shestakovska O, Diaz R, Alings M, Lonn EM, Anand SS, Widimsky P, Hori M, Avezum A, Piegas LS, Branch KRH, Probstfield J, Bhatt DL, Zhu J, Liang Y, Maggioni AP, Lopez-Jaramillo P, O'Donnell M, Kakkar AK, Fox KAA, Parkhomenko AN, Ertl G, Störk S, Keltai M, Ryden L, Pogosova N, Dans AL, Lanas F, Commerford PJ, Torp-Pedersen C, Guzik TJ, Verhamme PB, Vinereanu D, Kim JH, Tonkin AM, Lewis BS, Felix C, Yusoff K, Steg PG, Metsarinne KP, Cook Bruns N, Misselwitz F, Chen E, Leong D, Yusuf S; COMPASS Investigators. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. N Engl J Med. 2017 Oct 5;377(14):1319-1330. doi: 10.1056/NEJMoa1709118. Epub 2017 Aug 27. PMID: 28844192.
https://pubmed.ncbi.nlm.nih.gov/28844192/ -
Bonaca MP, Bauersachs RM, Anand SS, Debus ES, Nehler MR, Patel MR, Fanelli F, Capell WH, Diao L, Jaeger N, Hess CN, Pap AF, Kittelson JM, Gudz I, Mátyás L, Krievins DK, Diaz R, Brodmann M, Muehlhofer E, Haskell LP, Berkowitz SD, Hiatt WR. Rivaroxaban in Peripheral Artery Disease after Revascularization. N Engl J Med. 2020 May 21;382(21):1994-2004. doi: 10.1056/NEJMoa2000052. Epub 2020 Mar 28. PMID: 32222135.
https://pubmed.ncbi.nlm.nih.gov/32222135/
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In this BTK episode, the Hernia Content Team from Carolinas Medical Center discusses the evolution of training in hernia surgery. The team reviews residency and fellowship training requirements for hernia surgery and compares the training paradigm in the United States with other examples from around the world. As the field of hernia surgery continues to mature, so will training the next generation of hernia specialists.
Hosts:
- Dr. Sullivan “Sully” Ayuso, Minimally Invasive Surgery, Endeavor Health (Evanston, IL), @SAyusoMD (Twitter)
- Dr. Monica Polcz, Attending Surgeon, Baptist Health (Miami, FL)
- Dr. Vedra Augenstein, Professor of Surgery, Carolinas Medical Center (Charlotte, NC), @VedraAugenstein (Twitter)
- Dr. Todd Heniford, Chief of GI & MIS, Carolinas Medical Center (Charlotte, NC), @THeniford (Twitter)
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
The pancreatic anastomosis is often regarded to as the “Achilles Heel” of the Whipple operation, as technical failure and leakage is a significant source of perioperative morbidity and mortality. In this episode from the HPB team at Behind the Knife listen in as we discuss the standard techniques for the anastomosis, alternative techniques for the pancreatic anastomosis in patients with aberrant anatomy and/or physiology, key factors to consider when selecting the ideal approach/technique for the anastomosis, and mitigation strategies for leaks.
Hosts
Anish J. Jain MD (@anishjayjain) is a current PGY3 General Surgery Resident at Stanford University and a former T32 Research Fellow at the University of Texas MD Anderson Cancer Center.
Jon M. Harrison is a 2nd year HPB Surgery Fellow at Stanford University. He previously completed his general surgery residency at Massachusetts General Hospital, and will be returning to MGH as faculty at the conclusion of his fellowship.
Monica M. Dua (@MonicaDuaMD) is a Clinical Professor of Surgery and the Associate Program Director of the HPB Surgery Fellowship at Stanford University. She also serves as also serves as the regional HPB Surgeon at the VA Palo Alto Health Care System.
Learning Objectives
· Develop an understanding of the standard technical approaches to the pancreatic anastomosis during a Whipple (pancreatoduodenectomy) operation
· Develop an understanding of the alternative technical approaches to the pancreatic anastomosis during the Whipple when the standard approaches may not be feasible
· Develop an understanding of the key anatomic and physiologic factors in the decision making when selecting the optimal approach for the pancreatic anastomosis
· Develop an understanding of possible mitigation strategies in the event of a pancreatic anastomotic leak.
Suggested Reading
Jon Harrison, Monica M. Dua, William V. Kastrinakis, Peter J. Fagenholz, Carlos Fernandez-del Castillo, Keith D. Lillemoe, George A. Poultsides, Brendan C. Visser, Motaz Qadan. “Duct tape:” Management strategies for the pancreatic anastomosis during pancreatoduodenectomy. Surgery. Volume 176, Issue 4, 2024, Pages 1308-1311,
https://pubmed.ncbi.nlm.nih.gov/38796390/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
We’re excited to bring you the second episode in our BTK/ASGBI collaborative series, where we compare and contrast various aspects of surgery in the US and the UK, debating who does it better. In today’s episode, BTK fellow Jon Williams and ASGBI hosts Kellie Bateman and Jared Wohlgemut welcome the Christian Macutkiewicz from the UK and Scott Steele to discuss surgeon careers--from getting your first faculty job to broadening your impact to compensation structures.
Dr. Macutkiewicz is the President-Elect of the Association of Surgeons of Great Britain and Ireland. He is a General and HPB Surgeon in Manchester, England. He completed a Bachelor of Science in Biochemistry at the University of Birmingham, before studying medicine at the University of Manchester, and received an MD doctorate at the University of Manchester for research into sepsis. He underwent surgical training in North West Deanery, before completing an HPB and Liver Transplant Fellowship in Leeds. He has been a consultant surgeon in Nottingham, Leeds and most recently in Manchester since 2018. He also works privately at Spire Manchester Hospital.
Dr. Steele needs no introduction as a founder of BTK, but otherwise he is president of the Cleveland Clinic main campus and chair of the department of colorectal surgery. After graduating from West Point, Dr. Steele received his medical degree from University of Wisconsin. He then underwent general surgery residency training at Madigan Army Medical Center in Tacoma, WA followed by colorectal surgery fellowship training at University of Minnesota Medical Center. Dr. Steele then served in the military as an active duty surgeon until 2015, including several deployments and further faculty time at Madigan where he additionally served as Associate Program Director for general surgery. He then served as Division Chief of colorectal surgery at University Hospitals in Cleveland and associate director of surgical services at the Digestive Health Institute, prior to being named Chair of the department of colorectal surgery at the Cleveland Clinic in 2016, a position that he continues to hold today.
So, which country would you rather work in to carry out your illustrious surgical career? Give this episode a listen and decide for yourself!
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
The dreaded esophageal injury. Do you still have nightmares about mock oral board scenarios torturing you with the ins and outs of how to manage traumatic esophageal injury? Think you remember all the nuances? Whether you do or you don’t, this episode should serve as a good refresher for all levels while offering some pearls for management of this tricky scenario.
Hosts:- Michael Cobler-Lichter, MD, PGY4/R2:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@mdcobler (X/twitter)
-
Dylan Tanzer, MD, 2nd-year Trauma/Surgical Critical Care Fellow
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center -
Eugenia Kwon, MD, Trauma/Surgical Critical Care Attending:
Loma Linda University
Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center Trauma/CC Fellowship -
Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery, 5 years in practice
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@jpmeizoso (twitter)
Learning Objectives:
- Describe the diagnostic workup of a suspected traumatic esophageal injury
- Identify when someone with suspected esophageal injury needs immediate surgical management
- Describe appropriate surgical techniques for repair of both cervical and thoracic esophageal injuries
Quick Hits:
1. Don’t forget the primary survey. Unstable patients should be in the OR, as should patients with hard signs of vascular or aerodigestive injury
2. If there is concern for esophageal injury but no immediate indication for the OR, this should be further investigated with CTA of the affected area. Clinical exam has poor sensitivity.
3. The esophagus should be primarily repaired if the defect is able to come together without tension after debridement. Don’t forget a well-vascularized buttress
4. If you cannot perform a primary repair, your procedure of choice should be lateral esophagostomy with feeding jejunostomy and gastrostomy for decompression. Repair over T-tube can be considered for injuries with small amounts of tissue loss
References
1. Biffl WL, Moore EE, Feliciano DV, Albrecht RA, Croce M, Karmy-Jones R, et al. Western Trauma Association Critical Decisions in Trauma: Diagnosis and Management of Esophageal Injuries. J Trauma Acute Care Surg 2015;79(6):1089-95.
https://pubmed.ncbi.nlm.nih.gov/26680145/
- Sperry JL, Moore EE, Coimbra R, Croce M, Davis JW, Karmy-Jones R, et al. Western Trauma Association Critical Decisions in Trauma: Penetrating Neck Trauma. J Trauma Acute Care Surg 2013;75(6):936-40.
https://pubmed.ncbi.nlm.nih.gov/24256663/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
You have a patient with another episode of acute uncomplicated diverticulitis. This is the third episode. Do they need antibiotics? Is surgery the next step? What is their risk of recurrence with or without surgery? Tune in to find out!
Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Jason Hall MD, MPH as they discuss high yield papers discussing diverticulitis.
Learning Objectives:
1. Describe the impact on quality of life for patients who undergo surgery or non-operative management of diverticulitis
2. Discuss the indications for surgery in patients with diverticulitis
3. Describe ongoing clinical trials in management of diverticulitis
Video Link: https://app.behindtheknife.org/video/journal-review-in-colorectal-surgery-diverticulitis
References:
Santos A, Mentula P, Pinta T, et al. Quality-of-Life and Recurrence Outcomes Following Laparoscopic Elective Sigmoid Resection vs Conservative Treatment Following Diverticulitis: Prespecified 2-Year Analysis of the LASER Randomized Clinical Trial. JAMA Surg. 2023;158(6):593–601. doi:10.1001/jamasurg.2023.0466
https://pubmed.ncbi.nlm.nih.gov/37074706/
Bolkenstein HE, Consten ECJ, van der Palen J, van de Wall BJM, Broeders IAMJ, Bemelman WA, Lange JF, Boermeester MA, Draaisma WA; Dutch Diverticular Disease (3D) Collaborative Study Group. Long-term Outcome of Surgery Versus Conservative Management for Recurrent and Ongoing Complaints After an Episode of Diverticulitis: 5-year Follow-up Results of a Multicenter Randomized Controlled Trial (DIRECT-Trial). Ann Surg. 2019 Apr;269(4):612-620. doi: 10.1097/SLA.0000000000003033. PMID: 30247329.
https://pubmed.ncbi.nlm.nih.gov/30247329/
Hall J, Hardiman K, Lee S, Lightner A, Stocchi L, Paquette IM, Steele SR, Feingold DL; Prepared on behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis. Dis Colon Rectum. 2020 Jun;63(6):728-747. doi: 10.1097/DCR.0000000000001679. PMID: 32384404.
https://pubmed.ncbi.nlm.nih.gov/32384404/
Hall JF, Roberts PL, Ricciardi R, Read T, Scheirey C, Wald C, Marcello PW, Schoetz DJ. Long-term follow-up after an initial episode of diverticulitis: what are the predictors of recurrence? Dis Colon Rectum. 2011 Mar;54(3):283-8. doi: 10.1007/DCR.0b013e3182028576. PMID: 21304297.
https://pubmed.ncbi.nlm.nih.gov/21304297/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
We are seeing a 42F in the emergency room who underwent a laparoscopic sleeve gastrectomy 11 days ago. The operation was uneventful, and she had a negative airleak test. She had an uneventful postoperative course and was discharged on POD 1. Her medical history is significant for hypertension and hyperlipidemia, and he has no other surgical history. She has been able to keep up with her clear liquid diet. She complains that this morning she experienced abdominal and palpitations. You note her vitals show a mildly elevated blood pressure and her latest heart rate is 120s. Join Drs. Matthew Martin, Adrian Dan, Crystall Johnson-Mann, and Paul Wisniowski on a discussion about initial evaluation and management of bariatric patients with internal hernias.
Show Hosts:
Matthew Martin
Adrian Dan
Crystal Johnson-Mann
Paul Wisniowski
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
In this episode, we have a discussion about the intersection of health design/architecture and surgery with Dr. Andrew Ibrahim, a trained architect and practicing general surgeon and health services researcher. We discuss how hospitals, ICUs, operating rooms, and trauma bays are designed and the evidence behind them.
Host: Cody Mullens, general surgery resident at the University of Michigan, current Behind the Knife Surgery Education Fellow. (@Cody_Mullens)
Guest: Dr. Andrew Ibrahim. Associate Professor of Surgery at the University of Michigan, Maud T. Lane Research Professor, Co-Director for the Center for Healthcare Outcomes and Policy. (@AndrewMIbrahim)
Guide to hospital design on Dr. Ibrahim’s website: https://www.surgeryredesign.com/resources
Paper on measuring hospital design and quality of care using clinical data: https://shmpublications.onlinelibrary.wiley.com/doi/full/10.1002/jhm.12987
Science paper: https://www.science.org/doi/10.1126/science.6143402
CHEST paper: https://secure.jbs.elsevierhealth.com/action/getSharedSiteSession?redirect=https%3A%2F%2Fjournal.chestnet.org%2Farticle%2FS0012-3692%2810%2960225-5%2Ffulltext&rc=0
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
In this episode, Dr. Scott Butsch from the Cleveland Clinic’s Bariatric and Metabolic Institute discusses the evolving landscape of obesity medicine. He covers the history of obesity treatments, from behavioral interventions to groundbreaking medical therapies like GLP-1 receptor agonists and their future potential. The conversation also explores the challenges of bias, accessibility, and the integration of medications with surgical options for effective, long-term obesity management.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
In this, the fourth of 4 in our “What’s Your Worth” series, Matt and Mark discuss various compensation models including salary and hybrid models (e.g., productivity, quality-based, incentive-based) and fee-for-service. In addition, other variables that can be included in your contract when comparing jobs are covered (time away, professional fees, benefits, vacation). Finally, our guests cover aspects to think about when the job is not working out and you may need to leave an organization.
Matthew J. Donnelly, Esq,, Executive Director, Professional Staff Affairs, Cleveland Clinic, Cleveland, OH. https://my.clevelandclinic.org/about/overview/leadership/executive/donnelly-matt; Linkedin: https://www.linkedin.com/in/matthew-j-donnelly/
Mark Elinsky, Director, Professional Staff Compensation and Analytics, Cleveland Clinic, Cleveland, OH
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Behind the Knife es el podcast quirúrgico líder en el mundo y una plataforma de educación quirúrgica. Nuestra misión es crear contenido innovador de educación quirúrgica que sea accesible para todos. Estamos muy emocionados de expandirnos al público hispanohablante y ofrecerles 4 episodios de muestra de nuestro Curso de Repaso para el examen de certificación de Cirugía General.
Hoy, escucharás un caso de muestra de este curso de repaso en audio, que incluye 100 escenarios.
El curso tiene un formato emocionante y completamente único. Cada uno de los 100 caso consta de dos partes. La primera parte es un caso oral perfectamente ejecutado que imita la realidad. Cada caso tiene una duración de cinco a siete minutos e incluye una variedad de tácticas y estilos. Si logras alcanzar este nivel de desempeño en tu preparación, seguramente aprobarás el examen de certificación con éxito.
La segunda parte introduce comentarios de alto rendimiento para cada escenario. Estos comentarios incluyen consejos y trucos para ayudarte a dominar los escenarios más desafiantes, además de una enseñanza práctica y fácil de entender que cubre los temas más confusos que enfrentamos como cirujanos generales. Estamos seguros de que encontrarás este enfoque único de doble formato como una forma altamente efectiva de prepararte para el examen.
Nuestro contenido está disponible en nuestras aplicaciones para iOS y Android y en nuestro sitio web (behindtheknife.org). Por favor, consulta las notas del programa para más información. Nos encantaría escuchar tus comentarios sobre este episodio enviando un correo electrónico a hello@behindtheknife.org y apreciamos tu ayuda para difundir la palabra entre tus colegas si disfrutas del material. Si los comentarios son positivos, traduciremos todo nuestro curso al español.
presentadores de podcast:
- Auri P. Garcia Gonzalez, MD PhD nació en San Juan, Puerto Rico, y se trasladó a los Estados Unidos en el 2012 para sus estudios graduados. Actualmente, es estudiante de post-grado en cirugía general en Duke University.
- Diego Schaps, MD, MPH es un residente de cirugía general en Duke y nació en Miami, en el estado de la Florida. Sus padres nacieron en El Salvador.
Disclaimer: Los productos de contenido de Behind the Knife son únicamente para fines educativos. No diagnosticamos, tratamos ni ofrecemos consejos específicos para pacientes.
Behind the Knife is the world's leading surgical podcast and surgical education platform. Our mission is to create innovative surgical education content that is accessible to all. We are very excited to expand into the spanish audience and bring you 4 sample episodes of our General Surgery Oral Board Review Course which will be released over the course of the next week.
Today, you'll hear a sample scenario from this comprehensive audio review course which includes 100 scenarios. The course has an exciting and entirely unique format. Each of the 100 scenarios includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are five to seven minutes long and include a variety of tactics and styles. If you're able to achieve this level of performance in your preparation, you are sure to pass the oral exam with flying colors.
The second part introduces high yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy to understand teaching that covers the most confusing topics that we face as general surgeons. We are confident you will find this unique dual format approach a highly effective way to prepare for the test.
Our content is available on our iOS and Android apps and website (behindtheknife.org). Please check the show notes for more information. We would love to hear your feedback by emailing hello@behindtheknife.org and appreciate your help spreading the word to your colleagues if you enjoy the material. If feedback is positive, we will translate our entire course to Spanish.
Hosts:
- Auri P. Garcia Gonzalez, MD PhD was born and raised in San Juan, Puerto Rico and moved to the US in 2012 for graduate studies. At present, she is a surgical resident at Duke University.
- Diego Schaps, MD, MPH is a general surgery resident at Duke and was born in Miami, Florida. His parents were born in El Salvador.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
In the third episode in our 4 part “What’s Your Worth” series, Lauren covers the hospital-side of finances, going through the world of financial literacy. In this episode, basic definitions and importance of income statements, metrics of financial performance, and others including revenue and expenses are reviewed. She also provides an inside view as to considerations that hospitals have to take into account for the overall financial portfolio and how that may play into determining salaries, wages, and benefits.
Lauren Klein, MAcc, CPA, Executive Director, Financial Operations, Main Campus Submarket, Cleveland Clinic, Cleveland, OH.
Linkedin: https://www.linkedin.com/in/lauren-klein-cpa-67787213/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Behind the Knife es el podcast quirúrgico líder en el mundo y una plataforma de educación quirúrgica. Nuestra misión es crear contenido innovador de educación quirúrgica que sea accesible para todos. Estamos muy emocionados de expandirnos al público hispanohablante y ofrecerles 4 episodios de muestra de nuestro Curso de Repaso para el examen de certificación de Cirugía General.
Hoy, escucharás un caso de muestra de este curso de repaso en audio, que incluye 100 escenarios.
El curso tiene un formato emocionante y completamente único. Cada uno de los 100 caso consta de dos partes. La primera parte es un caso oral perfectamente ejecutado que imita la realidad. Cada caso tiene una duración de cinco a siete minutos e incluye una variedad de tácticas y estilos. Si logras alcanzar este nivel de desempeño en tu preparación, seguramente aprobarás el examen de certificación con éxito.
La segunda parte introduce comentarios de alto rendimiento para cada escenario. Estos comentarios incluyen consejos y trucos para ayudarte a dominar los escenarios más desafiantes, además de una enseñanza práctica y fácil de entender que cubre los temas más confusos que enfrentamos como cirujanos generales. Estamos seguros de que encontrarás este enfoque único de doble formato como una forma altamente efectiva de prepararte para el examen.
Nuestro contenido está disponible en nuestras aplicaciones para iOS y Android y en nuestro sitio web (behindtheknife.org). Por favor, consulta las notas del programa para más información. Nos encantaría escuchar tus comentarios sobre este episodio enviando un correo electrónico a hello@behindtheknife.org y apreciamos tu ayuda para difundir la palabra entre tus colegas si disfrutas del material. Si los comentarios son positivos, traduciremos todo nuestro curso al español.
presentadores de podcast:
- Auri P. Garcia Gonzalez, MD PhD nació en San Juan, Puerto Rico, y se trasladó a los Estados Unidos en el 2012 para sus estudios graduados. Actualmente, es estudiante de post-grado en cirugía general en Duke University.
- Diego Schaps, MD, MPH es un residente de cirugía general en Duke y nació en Miami, en el estado de la Florida. Sus padres nacieron en El Salvador.
Disclaimer: Los productos de contenido de Behind the Knife son únicamente para fines educativos. No diagnosticamos, tratamos ni ofrecemos consejos específicos para pacientes.
Behind the Knife is the world's leading surgical podcast and surgical education platform. Our mission is to create innovative surgical education content that is accessible to all. We are very excited to expand into the spanish audience and bring you 4 sample episodes of our General Surgery Oral Board Review Course which will be released over the course of the next week.
Today, you'll hear a sample scenario from this comprehensive audio review course which includes 100 scenarios. The course has an exciting and entirely unique format. Each of the 100 scenarios includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are five to seven minutes long and include a variety of tactics and styles. If you're able to achieve this level of performance in your preparation, you are sure to pass the oral exam with flying colors.
The second part introduces high yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy to understand teaching that covers the most confusing topics that we face as general surgeons. We are confident you will find this unique dual format approach a highly effective way to prepare for the test.
Our content is available on our iOS and Android apps and website (behindtheknife.org). Please check the show notes for more information. We would love to hear your feedback by emailing hello@behindtheknife.org and appreciate your help spreading the word to your colleagues if you enjoy the material. If feedback is positive, we will translate our entire course to Spanish.
Hosts:
- Auri P. Garcia Gonzalez, MD PhD was born and raised in San Juan, Puerto Rico and moved to the US in 2012 for graduate studies. At present, she is a surgical resident at Duke University.
- Diego Schaps, MD, MPH is a general surgery resident at Duke and was born in Miami, Florida. His parents were born in El Salvador.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Behind the Knife es el podcast quirúrgico líder en el mundo y una plataforma de educación quirúrgica. Nuestra misión es crear contenido innovador de educación quirúrgica que sea accesible para todos. Estamos muy emocionados de expandirnos al público hispanohablante y ofrecerles 4 episodios de muestra de nuestro Curso de Repaso para el examen de certificación de Cirugía General.
Hoy, escucharás un caso de muestra de este curso de repaso en audio, que incluye 100 escenarios.
El curso tiene un formato emocionante y completamente único. Cada uno de los 100 caso consta de dos partes. La primera parte es un caso oral perfectamente ejecutado que imita la realidad. Cada caso tiene una duración de cinco a siete minutos e incluye una variedad de tácticas y estilos. Si logras alcanzar este nivel de desempeño en tu preparación, seguramente aprobarás el examen de certificación con éxito.
La segunda parte introduce comentarios de alto rendimiento para cada escenario. Estos comentarios incluyen consejos y trucos para ayudarte a dominar los escenarios más desafiantes, además de una enseñanza práctica y fácil de entender que cubre los temas más confusos que enfrentamos como cirujanos generales. Estamos seguros de que encontrarás este enfoque único de doble formato como una forma altamente efectiva de prepararte para el examen.
Nuestro contenido está disponible en nuestras aplicaciones para iOS y Android y en nuestro sitio web (behindtheknife.org). Por favor, consulta las notas del programa para más información. Nos encantaría escuchar tus comentarios sobre este episodio enviando un correo electrónico a hello@behindtheknife.org y apreciamos tu ayuda para difundir la palabra entre tus colegas si disfrutas del material. Si los comentarios son positivos, traduciremos todo nuestro curso al español.
presentadores de podcast:
- Auri P. Garcia Gonzalez, MD PhD nació en San Juan, Puerto Rico, y se trasladó a los Estados Unidos en el 2012 para sus estudios graduados. Actualmente, es estudiante de post-grado en cirugía general en Duke University.
- Diego Schaps, MD, MPH es un residente de cirugía general en Duke y nació en Miami, en el estado de la Florida. Sus padres nacieron en El Salvador.
Disclaimer: Los productos de contenido de Behind the Knife son únicamente para fines educativos. No diagnosticamos, tratamos ni ofrecemos consejos específicos para pacientes.
Behind the Knife is the world's leading surgical podcast and surgical education platform. Our mission is to create innovative surgical education content that is accessible to all. We are very excited to expand into the spanish audience and bring you 4 sample episodes of our General Surgery Oral Board Review Course which will be released over the course of the next week.
Today, you'll hear a sample scenario from this comprehensive audio review course which includes 100 scenarios. The course has an exciting and entirely unique format. Each of the 100 scenarios includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are five to seven minutes long and include a variety of tactics and styles. If you're able to achieve this level of performance in your preparation, you are sure to pass the oral exam with flying colors.
The second part introduces high yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy to understand teaching that covers the most confusing topics that we face as general surgeons. We are confident you will find this unique dual format approach a highly effective way to prepare for the test.
Our content is available on our iOS and Android apps and website (behindtheknife.org). Please check the show notes for more information. We would love to hear your feedback by emailing hello@behindtheknife.org and appreciate your help spreading the word to your colleagues if you enjoy the material. If feedback is positive, we will translate our entire course to Spanish.
Hosts:
- Auri P. Garcia Gonzalez, MD PhD was born and raised in San Juan, Puerto Rico and moved to the US in 2012 for graduate studies. At present, she is a surgical resident at Duke University.
- Diego Schaps, MD, MPH is a general surgery resident at Duke and was born in Miami, Florida. His parents were born in El Salvador.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
This second episode of our 4 part "What’s Your Worth” series picks up what Dr. Maykel left off. Strategies regarding contracts and what can be negotiated into your contract are reviewed. In addition, gender-equity differences are discussed, as well as strategies to approach your contract negotiations depending on the stage in your career.
Justin A. Maykel, MD - Chief, Division of Colorectal Surgery, UMASS Medical Center, Worcester, MA.
https://www.ummhealth.org/about-us/our-caregivers/caregiver-justin-maykel-md-colorectal-surgeon-chief-division-colorectal-surgery
X; @JustinMaykel
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Behind the Knife es el podcast quirúrgico líder en el mundo y una plataforma de educación quirúrgica. Nuestra misión es crear contenido innovador de educación quirúrgica que sea accesible para todos. Estamos muy emocionados de expandirnos al público hispanohablante y ofrecerles 4 episodios de muestra de nuestro Curso de Repaso para el examen de certificación de Cirugía General.
Hoy, escucharás un caso de muestra de este curso de repaso en audio, que incluye 100 escenarios.
El curso tiene un formato emocionante y completamente único. Cada uno de los 100 caso consta de dos partes. La primera parte es un caso oral perfectamente ejecutado que imita la realidad. Cada caso tiene una duración de cinco a siete minutos e incluye una variedad de tácticas y estilos. Si logras alcanzar este nivel de desempeño en tu preparación, seguramente aprobarás el examen de certificación con éxito.
La segunda parte introduce comentarios de alto rendimiento para cada escenario. Estos comentarios incluyen consejos y trucos para ayudarte a dominar los escenarios más desafiantes, además de una enseñanza práctica y fácil de entender que cubre los temas más confusos que enfrentamos como cirujanos generales. Estamos seguros de que encontrarás este enfoque único de doble formato como una forma altamente efectiva de prepararte para el examen.
Nuestro contenido está disponible en nuestras aplicaciones para iOS y Android y en nuestro sitio web (behindtheknife.org). Por favor, consulta las notas del programa para más información. Nos encantaría escuchar tus comentarios sobre este episodio enviando un correo electrónico a hello@behindtheknife.org y apreciamos tu ayuda para difundir la palabra entre tus colegas si disfrutas del material. Si los comentarios son positivos, traduciremos todo nuestro curso al español.
presentadores de podcast:
- Auri P. Garcia Gonzalez, MD PhD nació en San Juan, Puerto Rico, y se trasladó a los Estados Unidos en el 2012 para sus estudios graduados. Actualmente, es estudiante de post-grado en cirugía general en Duke University.
- Diego Schaps, MD, MPH es un residente de cirugía general en Duke y nació en Miami, en el estado de la Florida. Sus padres nacieron en El Salvador.
Disclaimer: Los productos de contenido de Behind the Knife son únicamente para fines educativos. No diagnosticamos, tratamos ni ofrecemos consejos específicos para pacientes.
Behind the Knife is the world's leading surgical podcast and surgical education platform. Our mission is to create innovative surgical education content that is accessible to all. We are very excited to expand into the spanish audience and bring you 4 sample episodes of our General Surgery Oral Board Review Course which will be released over the course of the next week.
Today, you'll hear a sample scenario from this comprehensive audio review course which includes 100 scenarios. The course has an exciting and entirely unique format. Each of the 100 scenarios includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are five to seven minutes long and include a variety of tactics and styles. If you're able to achieve this level of performance in your preparation, you are sure to pass the oral exam with flying colors.
The second part introduces high yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy to understand teaching that covers the most confusing topics that we face as general surgeons. We are confident you will find this unique dual format approach a highly effective way to prepare for the test.
Our content is available on our iOS and Android apps and website (behindtheknife.org). Please check the show notes for more information. We would love to hear your feedback by emailing hello@behindtheknife.org and appreciate your help spreading the word to your colleagues if you enjoy the material. If feedback is positive, we will translate our entire course to Spanish.
Hosts:
- Auri P. Garcia Gonzalez, MD PhD was born and raised in San Juan, Puerto Rico and moved to the US in 2012 for graduate studies. At present, she is a surgical resident at Duke University.
- Diego Schaps, MD, MPH is a general surgery resident at Duke and was born in Miami, Florida. His parents were born in El Salvador.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Our first episode in our 4 part "What’s Your Worth” series introduces some of the basics of identifying all that factors that go into determining your worth as a surgeon. Topics vary from your “value" (ie., contribution margin, profit margin), revenue structure, hospital costs, and value based case. Further, Dr. Maykel covers how physician salaries are determined, average salaries across a spectrum of disciplines, and resources to find out more.
Justin A. Maykel, MD - Chief, Division of Colorectal Surgery, UMASS Medical Center, Worcester, MA.
https://www.ummhealth.org/about-us/our-caregivers/caregiver-justin-maykel-md-colorectal-surgeon-chief-division-colorectal-surgery
X; @JustinMaykel
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If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
In this episode, we review key components of the landmark MAGIC and FLOT-4 trials that investigated perioperative chemotherapy in the treatment of locally advanced gastric cancer. We discuss limitations of both trials and the evolving clinical landscape of gastric cancer treatment.
Hosts:
- Timothy Vreeland, MD, FACS (@vreelant) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist/HPB surgeon at Brooke Army Medical Center.
- Daniel Nelson, DO, FACS (@usarmydoc24) is a Surgical Oncologist/HPB surgeon at Kaiser Permanente Los Angeles Medical Center.
- Connor Chick, MD (@connor_chick) is a Surgical Oncology Senior Fellow at Ohio State.
- Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a Surgical Oncology Junior Fellow at MD Anderson Cancer Center.
- Beth (Elizabeth) Barbera, MD (@elizcarpenter16) is a PGY-6 General Surgery resident at Brooke Army Medical Center.
Learning Objectives:
1. Understand background, methodology, results, and interpretation of the MAGIC trial.
2. Understand background, methodology, results, and interpretation of the FLOT trial.
3. Be able to discuss the evolution of chemotherapeutic regimens in the treatment of locally advanced gastric cancer and rationale for their use.
4. Be able to describe key limitations for the above regimens.
5. Discuss the the evolving clinical landscape for chemotherapy in gastroesophageal junction tumors.
Links to Papers Referenced in this Episode:
Journal Articles:
Cunningham, D., Allum, W. H., Stenning, S. P., Thompson, J. N., Van de Velde, C. J., Nicolson, M., ... & Chua, Y. J. (2006). Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. New England Journal of Medicine, 355(1), 11-20.
https://pubmed.ncbi.nlm.nih.gov/16822992/
Al-Batran, S. E., Homann, N., Pauligk, C., Goetze, T. O., Meiler, J., Kasper, S., ... & Hofheinz, R. D. (2019). Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. The Lancet, 393(10184), 1948-1957.
https://pubmed.ncbi.nlm.nih.gov/30982686/
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Is the medical publishing industry a scam? As the open access model has grown, pay-to-publish has helped large publishers maintain profit margins similar to that of large tech companies. The problem? They do so by exploiting the blood, sweat, and tears of academics and the institutions that support them. Join Dr. Patrick Georgoff (@georgoff, Duke Surgery), Dr. Ayman Ali (BTK education fellow, Duke Surgery), and special guest Dr. Allan Detsky for an engaging discussion.
Paper discussed: The Changing Medical Publishing Industry: Economics, Expansion, and Equity (https://link.springer.com/article/10.1007/s11606-023-08307-z)
DR. ALLAN S. DETSKY, MD, PhD, FRCPC, CM is Professor, Institute of Health Policy, Management and Evaluation, and Department of Medicine at the University of Toronto; former Physician-in-Chief, Mount Sinai Hospital(1997-2009); and former Head of the Division of General Internal Medicine at The Toronto Hospital and University of Toronto (1987-1997). Dr. Detsky received his B.S. from Massachusetts Institute of Technology, his M.D. from Harvard Medical School, and his Ph.D. (in Economics) from Massachusetts Institute of Technology in 1978. He has served on the editorial board of the New England Journal of Medicine, and as a member of the Drug Quality and Therapeutics Committee for the Province of Ontario where he spearheaded the effort to formally include cost-effectiveness considerations into the Canadian drug reimbursement process. Dr. Detsky has received 2 Tony nominations as a producer (Jesus Christ Superstar 2012, Come From Away 2017 and an Olivier Award for Best Musical in 2018. In June 2018, he was appointed by the Governor General to the Order of Canada.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Welcome to the first episode of our new collaborative series with the Association of Surgeons in Great Britain and Ireland! During this series, BTK fellow Jon Williams and ASGBI hosts Kellie Bateman and Jared Wohlgemut compare and contrast the surgeon profession between the United States and the United Kingdom, debating who does what better. In this episode, we take a deep dive into surgical training in the US and the UK, from fostering student interest to trainee operating to specialization and certification. Dr. Jeremy Lipman represents the US while Dr. Jon Lund represents the UK in this thought-provoking conversation.
Dr. Lipman is a colorectal surgeon at the Cleveland Clinic and the director of graduate medical education for all training programs at the Cleveland Clinic. Additionally, he is an Associate Dean for Graduate Medical Education and Professor of Surgery at Case Western Reserve University. After going to Boston College for his bachelor degree, he obtained his medical degree from Drexel University College of Medicine in Philadelphia. Subsequently he completed his general surgery residency training at Case Western and his colorectal surgery fellowship at Cleveland Clinic. After practicing at MetroHealth Medical Center where he served many training and education leadership roles, he returned to Cleveland Clinic as faculty where he remains today.
Dr. Lund is Professor and Head of the Department of Surgery at University of Nottingham at Derby, and Consultant Colorectal Surgeon at Royal Derby Hospital. He is Chair of the Joint Committee on Surgical Training, and before that was Surgical Director of the Intercollegiate Surgical Curriculum Programme, the online training management system used by all trainees and trainers in Surgery in the UK. He has recently been appointed as Dean of education at the Royal College of Surgeons of Edinburgh.
So, who trains surgeons better? UK or US? Give the episode a listen and decide for yourself!
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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In this episode, podcast hosts Dr. Josh Roshal, Dr. Darian Hoagland, and Dr. Maya Hunt dive into two important papers that provide guidance on navigating the hidden curriculum of the surgical residency match process. Joined by fellow CoSEF members Dr. Ariana Naaseh and Dr. John Woodward, the discussion revolves around practical tips for finding your perfect surgical residency and filtering out the noise during the application process.
Journal Club Hosts:
–Dr. Josh Roshal, University of Texas Medical Branch, @Joshua_Roshal, jaroshal@utmb.edu
–Dr. Darian Hoagland, Beth Israel Deaconess Medical Center, @DHoaglandMD, dlhoagla@bidmc.harvard.edu
–Dr. Maya Hunt, Indiana University, @dr_mayathehunt, mayahunt@iu.edu
–CoSEF: @surgedfellows, cosef.org
Journal Club Authors:
-Dr. Ariana Naaseh, Washington University in St. Louis, @ariananaaseh, a.naaseh@wustl.edu
-Dr. John Woodwad, University at Buffalo, @JohnWoodward76, jmwoodwa@buffalo.edu
Medical Students:
-Rachel Kalbfell (MS4), Washington University in St. Louis, @rachelkalbfell, rkalbfell@wustl.edu
-Keith Makhecha (MS4), Indiana University, kmakhech@iu.edu
References:
1. Woodward JM, Lund S, Brian R, Anand A, Moreci R, Navarro SM, Zarate Rodriguez J, Naaseh A, Tate K, Roshal J, Silvestri C, Gan CY, Sathe T, Thornton SW, Cloonan M, Weaver L, Oh MH, Godley F, L’Huillier JC. Find Your Perfect Match for Surgical Residency: Six Steps to Building Your BRANDD from the Collaboration of Surgical Education Fellows. Annals of Surgery. 2024;5(3). doi:10.1097/AS9.0000000000000466.
- Naaseh A, Roshal J, Silvestri C, Woodward JM, Thornton SW, L’Huillier JC, Hunt M, Sathe TS, Hoagland DL, Godley F IV, Jindani R, Tieken KR, Rodriguez JGZ, Anand A, Chen JH, Navarro SM, Lund S. Filter Out the Noise: How to Narrow Your Search for the Perfect Match by the Collaboration of Surgical Education Fellows (CoSEF). Journal of Surgical Education. 2024;81(10):1394-1399. doi:10.1016/j.jsurg.2024.07.010
https://pubmed.ncbi.nlm.nih.gov/39178489/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Low urine output – when is it a cause for alarm? Emma Burke is joined by Dr. Brian Tucker to discuss quick hits on acute kidney injury as part of the Med/Surg Consult series.
Host:
- Emma Burke, MD – General Surgery Resident at Baylor College of Medicine, @emmaburke017
Guest:
- Brian Tucker, DO – Nephrologist at Baylor College of Medicine, @bmtucker3
Learning Objectives:
- Define acute kidney injury (AKI) using KDIGO guidelines.
- Develop a framework for initial workup of perioperative AKI.
- Discuss the importance of in urine output in AKI management.
- Identify AKI risk factors and preventative measures for high-risk surgical patients.
References:
- KDIGO AKI Guidelines: https://kdigo.org/guidelines/acute-kidney-injury/
Learn more about our Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship course and preview a full chapter here: https://app.behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
DOMINATE THE DAY
SHOWNOTES
Learn more about our Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship course and preview a full chapter here: https://app.behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
DOMINATE THE DAY
You're the new intern on your first night of night float. First page, right off the bat – AFib with rates into the 150s. What's your next move?! Dr. Nathan Anderson takes the anxiety out of approaching Atrial Fibrillation in the post-operative patient. Join him and Dr. Elizabeth Maginot as they discuss this very common post-operative you're guaranteed to see on the wards.
Hosts:
- Dr. Nathan Anderson, Internal Medicine Associate Professor and Hospitalist, University of Nebraska
- Dr. Elizabeth Maginot, General Surgery Resident and BTK Surgical Education Fellow, University of Nebraska Medical Center, Twitter: @e_magination95
Learning Objectives:
- Discuss the underlying pathophysiological mechanisms that contribute to the development of atrial fibrillation in the postoperative setting.
- Critically approach the different management options for atrial fibrillation in the post-cardiac and non-cardiac surgery settings, including rate versus rhythm control, indications for cardioversion, and the role of anticoagulation.
- Identify common risk factors for atrial fibrillation in the post-operative setting.
- Discuss long-term management and follow-up strategies for patients who develop atrial fibrillation after surgery.
References:
1. Bhave PD, Goldman LE, Vittinghoff E, Maselli J, Auerbach A. Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery. AmericanHeart Journal. 2012;164(6):918-924. doi:10.1016/j.ahj.2012.09.004
https://pubmed.ncbi.nlm.nih.gov/23194493/
2. Gialdini G, Nearing K, Bhave PD, et al.. Perioperative Atrial Fibrillation and the Long-term Risk ofIschemic Stroke. JAMA. 2014;312(6):616. doi:10.1001/jama.2014.9143
https://pubmed.ncbi.nlm.nih.gov/25117130/
3. Snow V, Weiss KB, LeFevre M, McNamara R, Bass E, Green LA, Michl K, Owens DK, Susman J, Allen DI, Mottur-Pilson C; AAFP Panel on Atrial Fibrillation; ACP Panel on Atrial Fibrillation.Management of newly detected atrial fibrillation: a clinical practice guideline from the AmericanAcademy of Family Physicians and the American College of Physicians. Ann Intern Med. 2003 Dec16;139(12):1009-17. doi: 10.7326/0003-4819-139-12-200312160-00011. PMID: 14678921.
https://pubmed.ncbi.nlm.nih.gov/14678921/
4. A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation. NewEngland Journal of Medicine. 2002;347(23):1825-1833. doi:10.1056/nejmoa021328
https://pubmed.ncbi.nlm.nih.gov/12466506/
Learn more about our Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship course and preview a full chapter here: https://app.behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
DOMINATE THE DAY
Parastomal hernias are some of the toughest cases in abdominal wall reconstruction. Join Drs. Ajita Prabhu, Lucas Beffa, Sara Maskal and Ryan Ellis as they talk through their approach to these difficult cases.
Hosts:
- Ajita Prabhu, MD, Cleveland Clinic, @aprabhumd1
- Lucas Beffa, MD, Cleveland Clinic, @BeffaLukeMD
- Ryan Ellis, MD, Cleveland Clinic, @EllisMD2020
- Sara Maskal, MD, Cleveland Clinic
Learning Objectives:
- Review anatomy of parastomal abdominal wall hernias
- Review perioperative pitfalls and tips for staying out of trouble
- Review common surgical approaches to repair
References:- Maskal SM, Ellis RC, Miller BT. Parastomal hernia repair, trying to optimize the impossible reconstruction. Hernia. 2024 Apr 28:1-6. https://pubmed.ncbi.nlm.nih.gov/38678529/
- Maskal SM, Thomas JD, Miller BT, Fafaj A, Zolin SJ, Montelione K, Ellis RC, Prabhu AS, Krpata DM, Beffa LR, Costanzo A. Open retromuscular keyhole compared with Sugarbaker mesh for parastomal hernia repair: Early results of a randomized clinical trial. Surgery. 2024 Mar 1;175(3):813-21.
https://pubmed.ncbi.nlm.nih.gov/37770344/
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If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
A patient with a large TBSA burn injury is transferred to a regional burn center. You are faced with some difficult clinical decisions as the resuscitation proves to be challenging. Join Drs. Tam Pham, Rob Cartotto, Julie Rizzo, Alex Morzycki and Jamie Oh as they discuss the clinical challenges in titrating and troubleshooting during acute burn resuscitation.
Hosts:
· Dr. Tam Pham: UW Medicine Regional Burn Center
· Dr. Robert Cartotto: University of Toronto, Ross Tilley Burn Centre
· Dr. Julie Rizzo: Brooke Army Medical Center
· Dr. Alex Morzycki: UW Medicine Regional Burn Center
· Dr. Jamie Oh: UW Medicine Regional Burn Center
Learning Objectives:
· Understand the role of colloids as complement/rescue to standard crystalloid fluid titration.
· Identify the fluid threshold associated with development of abdominal compartment syndrome
· Understand the role of continuous renal replacement therapy for patients with acute kidney injury during the resuscitation phase.
· List specific patient populations who may experience a more difficult resuscitation.
References:
1. Ivy ME, Atweh NA, Palmer J, et al. Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma 2000
https://pubmed.ncbi.nlm.nih.gov/11003313/
2. Cartotto R, Johnson LS, Savetamal A, et al. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. J Burn Care Res 2023
https://pubmed.ncbi.nlm.nih.gov/38051821/
3. Greenhalgh DG, Cartotto R, Taylor SL, et al. Burn Resuscitation practices in North America: results of the Acute Burn ResUscitation Prospective Trial (ABRUPT). Ann Surg 2023
https://pubmed.ncbi.nlm.nih.gov/34417368/
4. Cartotto R, Callum J. A review of the use of human albumin in burn patients. J Burn Care Res 2012
https://pubmed.ncbi.nlm.nih.gov/23143614/
5. Cruz MV, Carney BC, Luker JN, et al. Plasma ameliorates endothelial dysfunction in burn injury. J Surg Res 2019
https://pubmed.ncbi.nlm.nih.gov/30502286/
6. Falhstrom K, Boyle C, Makic MBF. Implementation of a nurse-driven burn resuscitation protocol: a quality improvement project. Critical Care Nurses 2013
https://pubmed.ncbi.nlm.nih.gov/23377155/
7. Salinas J, Chung KK, Mann EA, et al. Computerized decision support system improves fluid resuscitation following severe burns: an original study. Crit Care Med 2011
https://pubmed.ncbi.nlm.nih.gov/21532472/
8. Kenney CL, Singh P, Rizzo J, et al. Impact of alcohol and methamphetamine use on burn resuscitation. J Burn Care Res 2023
https://pubmed.ncbi.nlm.nih.gov/37227949/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Are you ready to DOMINATE surgery? Well let's go! Perform at the highest level on day one of your rotation using our easy to navigate text, tables, flashcards, podcasts, and videos. Go beyond rote memorization and learn what really matters. We are talking practical, high-yield, and engaging content all available at your fingertips. Get the information you need to know FAST. Whether it's learning how to two-hand tie, work up a patient with a colon mass, or organizing yourself for rounds, Behind the Knife has got you covered.
Today's episode includes 2 sample episodes from this course. Learn more and preview a full chapter here: https://app.behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
More Behind the Knife Student Resources: https://app.behindtheknife.org/students
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
DOMINATE THE DAY
Are you ready to DOMINATE surgery? Well let's go! Perform at the highest level on day one of your rotation using our easy to navigate text, tables, flashcards, podcasts, and videos. Go beyond rote memorization and learn what really matters. We are talking practical, high-yield, and engaging content all available at your fingertips. Get the information you need to know FAST. Whether it's learning how to two-hand tie, work up a patient with a colon mass, or organizing yourself for rounds, Behind the Knife has got you covered.
Today's episode includes 2 sample episodes from this course. Learn more and preview a full chapter here: https://app.behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
More Behind the Knife Student Resources: https://app.behindtheknife.org/students
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
DOMINATE THE DAY
Join for the fifth episode in the Association of Out Surgeons and Allies (AOSA) series for a comprehensive discussion of what the general surgeon needs to know prior to operating on a patient who has previously undergone gender affirming surgery.
Host:
Dan Scheese, MD
Andrew Schlussel, DO, Colorectal and General Surgeon, Charlie Norwood VA Medical Center
Guests:
Dr. Megan Lane (She/her)
megalane@med.umich.edu
Dr. Lane is a plastic surgery resident at the University of Michigan who is planning on going into Gender Affirming Surgery and general reconstruction. She completed a research fellowship in the National Clinician Scholars Program and focused primarily on patient-reported outcomes in gender affirming surgery.
Dr. Amy Suwanabol
pasuwan@med.umich.edu
Dr. Suwanabol is a colorectal surgeon at the University of Michigan and the Ann Arbor VA. She assists the gender affirming surgeons at the University of Michigan in performing robotic-assisted vaginoplasty. Her research focuses on optimizing quality of life among surgical patients and their families, surgeon well-being, and cancer survivorship.
Dr. Monica Llado-Farrulla
lladorfar@ohsu.edu
Dr. Llado-Farrulla was born and raised in Puerto-Rico, completed general surgery residency followed by plastic surgery residency at Tulane and Penn, respectively. She pursued a year of training in advanced gender surgery and is now currently at OHSU. Her practice largely focuses on facial feminization, chest affirming surgeries, phalloplasty, autologous breast reconstruction, and limb salvage.
Learn more and get involved with AOSA: https://www.outsurgeons.org
Twitter/X: @OutSurgeons
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Have you ever been confused about the concept of brain death, or struggled to explain brain death to a patient’s family or your fellow clinicians? Join the Behind the Knife Surgical Palliative Care team and our special guest, neurologist & neurointensivist Dr. Sarah Wahlster, as we explore the 2023 Pediatric & Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline and what this updated guideline means for our practice in surgical palliative care!
Hosts:
Dr. Katie O’Connell (@katmo15) is an Associate Professor of Surgery at the University of Washington in the division of Trauma, Burn, and Critical Care Surgery. She is a trauma surgeon, palliative care physician, Director of Surgical Palliative Care, and founder of the Advance Care Planning for Surgery Clinic at Harborview Medical Center in Seattle, WA.
Dr. Virginia Wang is a PGY-3 General Surgery resident at the University of Washington.
Guest:
Dr. Sarah Wahlster (@SWahlster) is an Associate Professor of Neurology at the University of Washington. She is a neurologist, neurointensivist, and Program Director of the Neurocritical Care Fellowship at Harborview Medical Center in Seattle, WA.
Learning Objectives:
· Understand the concept of assent and how it can be helpful in communicating with families of patients who have sustained brain death
· Explain the main steps required for diagnosis of brain death (prerequisites, clinical exam, apnea testing, ancillary testing)
· Understand key differences between the 2023 guideline and previous (2010 & 2011) guidelines
· Be able to name the 3 accepted modalities of ancillary testing for brain death
· Know basic communication best practices with families of patients who have sustained brain death from the surgical palliative care perspective (consistency of language & messaging; avoidance of phrases such as “life-sustaining treatment”, “comfort-focused measures”)
References:
1. Greer, D. M., Kirschen, M. P., Lewis, A., Gronseth, G. S., Rae-Grant, A., Ashwal, S., Babu, M. A., Bauer, D. F., Billinghurst, L., Corey, A., Partap, S., Rubin, M. A., Shutter, L., Takahashi, C., Tasker, R. C., Varelas, P. N., Wijdicks, E., Bennett, A., Wessels, S. R., & Halperin, J. J. (2023). Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline. Neurology, 101(24), 1112–1132. https://doi.org/10.1212/WNL.0000000000207740
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Lewis, A., Kirschen, M. P., & Greer, D. (2023). The 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline: A Comparison With the 2010 and 2011 Guidelines. Neurology. Clinical practice, 13(6), e200189. https://doi.org/10.1212/CPJ.0000000000200189
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AAN Interactive Brain Death/Death by Neurologic Criteria Evaluation Tool – https://www.aan.com/Guidelines/BDDNC
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AAN Brain Death/Death by Neurologic Criteria Checklist – https://www.aan.com/Guidelines/Home/GetGuidelineContent/1101
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Kirschen, M. P., Lewis, A., & Greer, D. M. (2024). The 2023 American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine Pediatric and Adult Brain Death/Death by Neurologic Criteria Determination Consensus Guidelines: What the Critical Care Team Needs to Know. Critical care medicine, 52(3), 376–386. https://doi.org/10.1097/CCM.0000000000006099
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Greer, D. M., Shemie, S. D., Lewis, A., Torrance, S., Varelas, P., Goldenberg, F. D., Bernat, J. L., Souter, M., Topcuoglu, M. A., Alexandrov, A. W., Baldisseri, M., Bleck, T., Citerio, G., Dawson, R., Hoppe, A., Jacobe, S., Manara, A., Nakagawa, T. A., Pope, T. M., Silvester, W., … Sung, G. (2020). Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project. JAMA, 324(11), 1078–1097. https://doi.org/10.1001/jama.2020.11586
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Lele, A. V., Brooks, A., Miyagawa, L. A., Tesfalem, A., Lundgren, K., Cano, R. E., Ferro-Gonzalez, N., Wongelemegist, Y., Abdullahi, A., Christianson, J. T., Huong, J. S., Nash, P. L., Wang, W. Y., Fong, C. T., Theard, M. A., Wahlster, S., Jannotta, G. E., & Vavilala, M. S. (2023). Caseworker Cultural Mediator Involvement in Neurocritical Care for Patients and Families With Non-English Language Preference: A Quality Improvement Project. Cureus, 15(4), e37687. https://doi.org/10.7759/cureus.37687
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Our oral board review course includes 100 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
All of our premium courses are available via our website and apps (iOS and Android). Users can take notes, pin chapters and download content for offline viewing.
Learn more about the General Surgery Oral Board Review Course at https://app.behindtheknife.org/premium
Institutional Discounts Available - Please email hello@behindtheknife.org to learn more.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Need a dose of inspiration? You found it here. This interview with Dr. Ammar Darwish will have you in awe. Dr. Darwish is a general and trauma surgery at Manchester University NHS Foundation Trust and Medical Director at The David Nott Foundation (https://davidnottfoundation.com/). Dr. Darwish volunteers for intensely dangerous but highly impactful surgical humanitarian missions in conflict zones around the world. In fact, he has been deployed to over 50 global humanitarian missions in the last 15 years. He is passionate about helping victims of conflict and natural disaster by better equipping and training doctors who care for them.
Want to learn more about the Nott Foundation? Good! You should. Check out their website for more: https://davidnottfoundation.com/
Interview with Dr. David Knott: https://app.behindtheknife.org/podcast/war-doctor-david-nott-on-surgery-in-war-zones
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Join our Emergency General Surgery team as we talk about the dreaded difficult duodenum. We discuss two cases on a common disease that has now become a rarity in surgical management. We cover principles of combined assessment and resuscitation, diagnosis and helpful adjuncts, and multidisciplinary and surgical management.
Hosts: Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross
We have come a long way from managing duodenal emergencies with vagotomies since the widespread use of proton pump inhibitors. But surgeons and trainees still need to gain competence in managing duodenal emergencies, despite the dearth of operative interventions often encountered. We discuss the two most common presentations related to duodenal ulcers - bleeding and perforation. We focus on resuscitation, damage-control surgery, and the role of non-surgical management options.
Learning Objectives:
- Learn to investigate and resuscitate patients with upper gastrointestinal bleeding
- Develop an approach to the management of upper gastrointestinal bleeding
- Understand the risks and benefits of various surgical techniques for dealing with perforated duodenal ulcers
References:
Tarasconi, A., Coccolini, F., Biffl, W.L. et al. Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg 15, 3 (2020). https://doi.org/10.1186/s13017-019-0283-9
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Join Drs. Galandiuk, Bolshinsky, Kavalukas, and Simon as they discuss the controversial management of colon cancer of the splenic flexure. What procedure do you perform? Does it matter? Tune in to hear the discussion!
Hosts:
- Susan Galandiuk MD, University of Louisville, Louisville, Kentucky, @DCREdInChief
- Vladimir Bolshinsky MD, Peninsula Health, Victoria, Australia, @bolshinskyv
- Sandy Kavalukas MD, University of Louisville, Louisville, Kentucky, @sandykava
- Hillary Simon DO, University of Louisville, Louisville, Kentucky, @HillaryLSimon
Producer:- Manasa Sunkara MS3, University of Louisville, Louisville, Kentucky, @manasasunkara12
Learning objectives: - Review surgical procedure options for splenic flexure cancer.
- Understand the importance of confirming the location of the tumor with imaging and/or endoscopically, perioperatively.
- Discuss surgical principles of operating in the left upper quadrant.
References:
de’Angelis, et al. Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis. Surg Endosc. 2021 (35) :661–672.
https://pubmed.ncbi.nlm.nih.gov/32072288/
Degiuli M, et al. Segmental Colonic Resection Is a Safe and Effective Treatment Option for Colon Cancer of the Splenic Flexure: A Nationwide Retrospective Study of the Italian Society of Surgical Oncology-Colorectal Cancer Network Collaborative Group. Dis Colon Rectum. 2020 Oct;63(10):1372-1382.
https://pubmed.ncbi.nlm.nih.gov/32969880/
Manceau G, et al. What Is the Optimal Elective Colectomy for Splenic Flexure Cancer: End of the Debate? A Multicenter Study From the GRECCAR Group With a Propensity Score Analysis. Dis Colon Rectum. 2022 Jan 1;65(1):55-65.
https://pubmed.ncbi.nlm.nih.gov/34882628/
Okazaki T, et al. Two Types of Variational Arteries' Courses From the Superior Mesenteric Artery to Supply the Splenic Flexure: Gross Anatomical Study. Dis Colon Rectum. 2024 Jan 1;67(1):120-128.
https://pubmed.ncbi.nlm.nih.gov/37493262/
Pang AJ, Marinescu D, Morin N, Vasilevsky CA, Boutros M. Segmental resection of splenic flexure colon cancers provides an adequate lymph node harvest and is a safe operative approach - an analysis of the ACS-NSQIP database. Surg Endosc. 2022 Aug;36(8):5652-5659.
https://pubmed.ncbi.nlm.nih.gov/34973078/
Rusli SM, et al. Laparoscopic D3 oncological resection in splenic flexure cancer: Technical details and its impact on long-term survival. Colorectal Dis. 2023 Mar;25(3):431-442.
https://pubmed.ncbi.nlm.nih.gov/36281503/
Sakamoto K, et al. Drainage pattern of the splenic flexure vein and its accompanying arteries using three-dimensional computed tomography angiography: a single-centre study of 600 patients. Colorectal Dis. 2023 Aug;25(8):1679-1685.
https://pubmed.ncbi.nlm.nih.gov/37221647/
Vargas, HD. Gaining Mesenteric Length following Colorectal Resection: Essential Maneuvers to Avoid Anastomotic Tension. Clin Colon Rectal Surg. 2023 Jan 13;36(1):37-46.
https://pubmed.ncbi.nlm.nih.gov/36643828/
Vogel JD, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer. Dis Colon Rectum. 2022 Feb 1;65(2):148-177.
https://pubmed.ncbi.nlm.nih.gov/34775402/
Video References
“Splenic Flexure Cancers.” Lahey Hospital & Medical Center. Disease of the Colon and Rectum Journal Club. February 28, 2022. https://www.youtube.com/watch?v=87HXHQYMxe4&list=PLMBNyGA6TZajQn4UlDyKxrLakFZb7SC_2&index=23
Varela, C. and Yang, S. Laparoscopic-Assisted Colonic Resection for Splenic-Flexure Cancer With D3 Lymphadenectomy, Diseases of the Colon & Rectum 66(6):p e295-e297, June 2023. https://journals.lww.com/dcrjournal/pages/collectiondetails.aspx?TopicalCollectionID=138&ParentCollection=109 *TRUELEARN LINK: https://truelearn.referralrock.com/l/BTKPODCAST/
Discount code: BTKPODCAST
Using the discount code, you can get a discount of $25 off our Residency (General surgery, anesthesiology, OBGYN, Psychiatry, Peds, Neurology, Emergency Medicine, Internal Medicine, and Family Medicine), USMLE, andCOMLEX SmartBank subscriptions of 90-days or more. The code can also be applied for 15% off our allied healthSmartBanks (PA, Nurse Practitioner, Pharmacy, PT, OT, etc.).
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Our Colorectal Surgery Oral Board Audio Review includes 51 high-yield scenarios designed for Colorectal Surgeons by Colorectal Surgeons.
Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as colorectal surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the full set of 51 scenarios here: https://behindtheknife.teachable.com/p/btk-colorectal-surgery-oral-board-review-course
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Our Surgical Oncology Oral Board Audio Review includes 46 high-yield scenarios that cover all of the SCORE CGSO topics designed for Surgical Oncology Surgeons by Surgical Oncology Surgeons.
Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as surgical oncology surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the course and see all the episode topics here: https://app.behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
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Our Vascular Surgery Oral Board Audio Review includes 72 high-yield scenarios that cover the majority of the VSCORE topics designed for Vascular Surgeons by Vascular Surgeons.
Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as vascular surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the full set of 72 scenarios here: https://app.behindtheknife.org/course-details/vascular-surgery-oral-board-audio-review
Our Vascular Surgery Oral Board Book is available on Amazon here: https://www.amazon.com/dp/B0CZ8ZBF83
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Pregnancy leads to many physiologic changes, and thyroid and parathyroid disorders alter that physiology even more leading to complex laboratory interpretation and decision-making impacting both mother and fetus. In this episode, join endocrine surgeons Drs. Barb Miller, John Phay, Priya Dedhia, and Surgical Oncology Fellow Dr. Vennila Padmanaban from The Ohio State University. Hear about normal and abnormal thyroid and parathyroid physiology and treatment of patients with thyroid cancer. The group discusses several articles focusing on current guidelines from the American Thyroid Association as well as other key studies.
Hosts: Barbra S. Miller, MD (Moderator), Clinical Professor of Surgery, John Phay, MD, Clinical Professor of Surgery, Priya H. Dedhia, MD, PhD, Assistant Professor of Surgery, Vennila Padmanaban, MD, Surgical Oncology Fellow, Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Twitter handles:
Barbra Miller - @OSUEndosurgBSM
John Phay – @JohnPhayMD
Priya Dedhia – @priyaknows
Vennila Padmanaban - @vennilapadmanMD
Learning objectives:
1) Understand normal changes in thyroid and parathyroid physiology during pregnancy
2) Describe the impact of thyroid and parathyroid dysregulation on maternal and fetal health
3) Compare and contrast management of thyroid and parathyroid disorders during pregnancy vs. non-pregnancy
4) Recognize the importance of multidisciplinary care of patients with thyroid and parathyroid disorders
References:
1. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017 Mar;27(3):315-389. doi: 10.1089/thy.2016.0457. Erratum in: Thyroid. 2017 Sep;27(9):1212. doi: 10.1089/thy.2016.0457.correx. PMID: 28056690
https://pubmed.ncbi.nlm.nih.gov/28056690/
2. Jee SB, Sawal A. Physiological Changes in Pregnant Women Due to Hormonal Changes. Cureus. 2024 Mar 5;16(3):e55544. doi: 10.7759/cureus.55544. PMID: 38576690; PMCID: PMC10993087
https://pubmed.ncbi.nlm.nih.gov/38576690/
3. Patel, Kepal N. MD; Yip, Linwah MD; Lubitz, Carrie C. MD, MPH; Grubbs, Elizabeth G. MD; Miller, Barbra S. MD; Shen, Wen MD; Angelos, Peter MD; Chen, Herbert MD; Doherty, Gerard M. MD; Fahey, Thomas J. III MD; Kebebew, Electron MD; Livolsi, Virginia A. MD; Perrier, Nancy D. MD; Sipos, Jennifer A. MD; Sosa, Julie A. MD; Steward, David MD; Tufano, Ralph P. MD; McHenry, Christopher R. MD; Carty, Sally E. MD. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Annals of Surgery 271(3):p e21-e93, March 2020. DOI: 10.1097/SLA.0000000000003580
https://pubmed.ncbi.nlm.nih.gov/32079830/
4. Appelman-Dijkstra NM, Pilz S. Approach to the Patient: Management of Parathyroid Diseases Across Pregnancy. J Clin Endocrinol Metab. 2023 May 17;108(6):1505-1513. doi: 10.1210/clinem/dgac734. PMID: 36546344; PMCID: PMC10188304
https://pubmed.ncbi.nlm.nih.gov/36546344/
5. Eremkina A, Bibik E, Mirnaya S, Krupinova J, Gorbacheva A, Dobreva E, Mokrysheva N. Different treatment strategies in primary hyperparathyroidism during pregnancy. Endocrine. 2022 Sep;77(3):556-560. doi: 10.1007/s12020-022-03127-3. Epub 2022 Jul 12. PMID: 35821184
https://pubmed.ncbi.nlm.nih.gov/35821184/
TRUELEARN LINK: https://truelearn.referralrock.com/l/BTKPODCAST/
Discount code: BTKPODCAST
Using the discount code, you can get a discount of $25 off our Residency (General surgery, anesthesiology, OBGYN, Psychiatry, Peds, Neurology, Emergency Medicine, Internal Medicine, and Family Medicine), USMLE, andCOMLEX SmartBank subscriptions of 90-days or more. The code can also be applied for 15% off our allied healthSmartBanks (PA, Nurse Practitioner, Pharmacy, PT, OT, etc.).
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Does the adult thymus have a purpose and function? Are there any long-term health effects of thymectomy? Tune in to another Swedish Thoracic surgery journal review where we discuss the recent paper out of the NEJM which reports on the health consequences of thymus removal in adults. This paper has been widely picked up by the media and our patients frequently bring it into the office. Listen as we discuss the study population, methods, and potential applications of this paper.
Learning Objectives:
- Review the purpose and function of the thymus.
- Discuss the population, methods, and results of this trial.
- Discuss the application of this paper and how it may or may not impact clinical practice for thoracic surgeons.
Hosts:
Chloe E. Hanson, MD, PGY-3
Kelly Daus MD, PGY-4
Peter White, MD, Thoracic Surgery Attending
Brian Louie, MD, Thoracic Surgery Attending
Reference Material:
Kooshesh KA, Foy BH, Sykes DB, Gustafsson K, Scadden DT. Health Consequences of Thymus Removal in Adults. N Engl J Med. 2023;389(5):406-417.
https://pubmed.ncbi.nlm.nih.gov/37530823/
Lin TM, Chang YS, Hou TY, et al. Risk of incident autoimmune diseases in patients with thymectomy. Ann Clin Transl Neurol. 2020;7(7):1072-1082.
https://pubmed.ncbi.nlm.nih.gov/32478484/
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Did you know that 13% of trauma patients who go home with an opioid prescription will develop opioid dependence? Multimodal pain regimens not only reduce opioid consumption, but also improve pain control. On this episode of the BIG T TRAUMA series, we explore a multimodal approach to pain management...and tackle some surgical dogma along the way.
Hosts:* Patrick Georgoff, MD, Trauma Surgeon, Duke University, @georgoff * Teddy Puzio, MD, Trauma Surgeon, University of Texas Houston * Gabby Hatton, MD, Trauma Surgery fellow, University of Texas Houston
References:
1. Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open 2020: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767637
2. Traumatic injuries and persistent opioid use in the USA: findings from a nationally representative survey. Injury Prevention 2017: https://pubmed.ncbi.nlm.nih.gov/27597400/
3. Ketamine For Acute Pain After Trauma (KAPT): A Pragmatic, Randomized Clinical Trial. J Trauma 2024:
https://pubmed.ncbi.nlm.nih.gov/38689402/
4. EAST PMG: Efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute pain after orthopedic trauma (2023): https://www.east.org/education-resources/practice-management-guidelines/details/efficacy-and-safety-of-nonsteroidal-antiinflammatory-drugs-nsaids-for-the-treatment-of-acute-pain-af
5. Systematic Review and Meta-Analysis of the Association Between Non-Steroidal Anti-Inflammatory Drugs and Operative Bleeding in the Perioperative Period. JACS 2021:
https://pubmed.ncbi.nlm.nih.gov/33515678/
6. Is the use of nonsteroidal anti-inflammatories after bowel anastomosis in trauma safe? J Trauma 2023:
https://pubmed.ncbi.nlm.nih.gov/36728125/
7. University of Texas at Houston Multimodal Pain Guideline: https://med.uth.edu/surgery/acute-trauma-pain-multimodal-therapy/
8. ACS TRAUMA QUALITY PROGRAMS BEST PRACTICES GUIDELINES FOR ACUTE PAIN MANAGEMENT IN TRAUMA PATIENTS: https://www.facs.org/media/exob3dwk/acute_pain_guidelines.pdf
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A 70 year old healthy female is referred to you with a 5.7 cm abdominal aortic aneurysm. As an astute clinician you are aware that current guidelines support surgical repair for her AAA. What if there was new data to suggest this patient may not benefit from repair? What would be the optimal size threshold that she would benefit from AAA repair? Tune into this episode of Behind the Knife, where the vascular surgery subspecialty team discusses a paper that challenges current size threshold guidelines for AAA repair.
Hosts:
Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan and the Program Director of the Integrated Vascular Surgery Residency Program as well as the Vascular Surgery Fellowship Program at the University of Michigan.
Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan
Dr. Drew Braet is a PGY-5 Integrated Vascular Surgery Resident at the University of Michigan
Learning Objectives
- Review the current size threshold guidelines for surgical repair of abdominal aortic aneurysms
-
Understand the limitations of the aforementioned guidelines
-
Understand the methodology, findings, limitations, and clinical applications of the manuscript “Size thresholds for repair of abdominal aortic aneurysms warrant reconsideration.”
References -
Columbo JA, Scali ST, Jacobs BN, et al. Size thresholds for repair of abdominal aortic aneurysms warrant reconsideration. Journal of Vascular Surgery. 2024;79(5):1069-1078.e8. doi:10.1016/j.jvs.2024.01.017
https://pubmed.ncbi.nlm.nih.gov/38262565/ -
Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. Journal of Vascular Surgery. 2018;67(1):2-77.e2. doi:10.1016/j.jvs.2017.10.044
https://pubmed.ncbi.nlm.nih.gov/29268916/ -
Wanhainen A, Van Herzeele I, Bastos Goncalves F, et al. Editor’s Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. European Journal of Vascular and Endovascular Surgery. 2024;67(2):192-331. doi:10.1016/j.ejvs.2023.11.002
https://pubmed.ncbi.nlm.nih.gov/38307694/ -
The UK Small Aneurysm Trial Participants, Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet 1998;352 (9141) 1649- 1655
https://pubmed.ncbi.nlm.nih.gov/9853436/ -
Lederle FAWilson SEJohnson GR et al. Aneurysm Detection and Management Veterans Affairs Cooperative Study Group, Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 2002;346 (19) 1437- 1444
https://pubmed.ncbi.nlm.nih.gov/12000813/ -
United Kingdom EVAR Trial Investigators; Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D. Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med. 2010 May 20;362(20):1872-80. doi: 10.1056/NEJMoa0911056. Epub 2010 Apr 11. PMID: 20382982.
https://pubmed.ncbi.nlm.nih.gov/20382982/ -
Lederle FA, Johnson GR, Wilson SE, Ballard DJ, Jordan WD Jr, Blebea J, Littooy FN, Freischlag JA, Bandyk D, Rapp JH, Salam AA; Veterans Affairs Cooperative Study #417 Investigators. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA. 2002 Jun 12;287(22):2968-72. doi: 10.1001/jama.287.22.2968. PMID: 12052126.
-
Lancaster EM, Gologorsky R, Hull MM, Okuhn S, Solomon MD, Avins AL, Adams JL, Chang RW. The natural history of large abdominal aortic aneurysms in patients without timely repair. J Vasc Surg. 2022 Jan;75(1):109-117. doi: 10.1016/j.jvs.2021.07.125. Epub 2021 Jul 26. PMID: 34324972.
https://pubmed.ncbi.nlm.nih.gov/34324972/
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Take a listen into the wild and fascinating world of lung transplantation! One of the biggest challenges for any transplant is organ preservation to provide the best possible recovery and outcome for recipients. That’s especially important for lung transplant, which remains one of the most complex and challenging areas in the field of transplantation. This episode takes a deep dive into the lung transplant landscape and discusses new technologies and innovations that are revolutionizing the field. Jon Williams is joined by Dr. Elliot Wakeam, MD, a thoracic surgeon and lung transplant expert from University of Toronto to discuss the advent of ex-vivo lung perfusion (EVLP) systems and how that and other preservation techniques may impact the future of lung transplantation. Also, Dr. Wakeam provides unique perspectives as faculty from one of the best lung transplant programs in the world.
If you have any questions or comments, or find the episode interesting and want to learn more, feel free to reach out to us at hello@behindtheknife.org. Dominate the Day!
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As we move towards a model of Competency-Based Surgical Education, individualization of training may be needed. How can we get the right education to the right trainee at the right time? How can we link education to actual patient outcomes? Precision education aims to do just that, while leveraging technology, data, and analytics to decrease burden on assessors. While this approach offers a lot of promise to advance surgical education, it can be difficult to conceptualize how this would be implemented in practice. We’re joined by an expert in the field of precision medical education, Dr. Jesse Burk-Rafel, to break down what precision education is and how it might integrate into our current system of surgical education
Join hosts Nicole Brooks MD, Judith French PhD, and Jeremy Lipman MD, MHPE for this exciting conversation with Jesse Burk-Rafel MD.
Learning Objectives
1. Listeners will define precision education.
2. Listeners will describe examples of how precision medical or surgical education is being used currently.
3. Listeners will explain barriers that must be addressed with the implementation of precision surgical education, including bias and issues with data sharing.
4. Listeners will consider how precision surgical education will evolve, including possible use within their own institution to completement competency-based surgical education.
References
Desai SV, Burk-Rafel J, Lomis KD, et al. Precision Education: The Future of Lifelong Learning in Medicine. Academic Medicine. 2024;99(4).
https://pubmed.ncbi.nlm.nih.gov/38277444/
Richardson J, Santen SA, Mejicano GC, et al. Learner Assessment and Program Evaluation: Supporting Precision Education. Academic Medicine. 2024;99(4).
https://pubmed.ncbi.nlm.nih.gov/38166211/
Perrone KH, Abdelaal AE, Pugh CM, Okamura AM. Haptics: The Science of Touch As a Foundational Pathway to Precision Education and Assessment. Academic Medicine. 2024;99(4).
https://pubmed.ncbi.nlm.nih.gov/38109654/
Sukhera J. Precision Education and Equity: A Participatory Framework to Advance Equitable Assessment. Academic Medicine. 2024;99(4).
https://pubmed.ncbi.nlm.nih.gov/38109658/
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In this Journal Review episode, the Hernia Content Team from Carolinas Medical Center reviews the definition and meaning of a hernia center. In a subspecialty field that is in its relative infancy, the specialization of care at hernia centers is a relatively new concept. The team reviews two relevant publications on hernia centers that help to provide guidance on this topic for the hernia community.
Hosts:
- Dr. Sullivan “Sully” Ayuso, Chief Resident, Carolinas Medical Center (Charlotte, NC), @SAyusoMD (Twitter)
- Dr. Todd Heniford, Chief of GI & MIS, Carolinas Medical Center (Charlotte, NC), @THeniford (Twitter)
- Dr. Vedra Augenstein, Professor of Surgery, Carolinas Medical Center (Charlotte, NC), @VedraAugenstein (Twitter)
- Dr. Monica Polcz, Attending Surgeon, Baptist Health (Miami, FL), No Twitter handle
- Dr. Brittany Mead, GI & MIS Fellow, Carolinas Medical Center (Charlotte, NC), No Twitter handle
References:
-Shulkin et al, Characterizing Hernia Centers in the United States: What Defines a Hernia Center?, Hernia, 2022
https://pubmed.ncbi.nlm.nih.gov/33871743/
-Köckerling et al, Accreditation and Certification Requirements for Hernia Centers and Surgeons: the ACCESS Project, Hernia, 2019
https://pubmed.ncbi.nlm.nih.gov/33871743/
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VTE prophylaxis is more than just some squeezy leg socks and a one-size fits all dose of enoxaparin! Ever wonder how VTE prophylaxis is similar to constipation? Have you or a loved one been hurt by a hospital administrator telling you that VTE is a never event? Come with us, and our special guest Dr. Bryan Cotton, on this journey to the frontier of research attempting to debunk this myth and improve patient care by reducing VTE rates in trauma patients.
Hosts:- Michael Cobler-Lichter, MD, PGY4/R2:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@mdcobler (X/twitter)
-
Eva Urrechaga, MD, PGY-8, Vascular Surgery Fellow
University of Pennsylvania
Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center General Surgery Residency
@urrechisme (X/twitter) -
Eugenia Kwon, MD, Trauma/Surgical Critical Care Attending:
Loma Linda University
Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center Trauma/CC Fellowship -
Brandon Parker, DO, Assistant Professor of Surgery, 5 years in practice
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@BrandonParkerDO (X/twitter) -
Bryan Cotton, MD, MPH, FACS, Professor of Surgery, 20 years in practice
University of Texas Health Science Center at Houston/Red Duke Trauma Institute at Memorial Herman Hospital
@bryanacotton1 (X/twitter)
Learning Objectives:
- Describe the rationale for the addition of aspirin to chemoprophylactic regimens for VTE
-
Identify appropriate screening systems for trauma patients at high risk for VTE
-
Describe the rationale for monitoring anti factor Xa levels in the trauma population receiving VTE chemoprophylaxis
-
List the major conclusions of the two studies discussed regarding the addition of aspirin to VTE chemoprophylaxis regimens in trauma patients, and the change in antithrombin activity levels over time in relation to enoxaparin responsiveness in polytrauma patients
Quick Hits:
1. On adjusted analysis, the standard VTE PPX plus aspirin group had a lower OR of developing VTE, though limitations of this study highlight need for future prospective work
2. Trauma patients often suffer from decreased activity of antithrombin 3, which may mediate the relatively higher rates of VTE in this population.
3. Trauma patients who went on to develop VTE were more likely to not achieve satisfactory anti Xa levels, with a VTE rate of 30% in the never-responder group, the group for which Xa levels were never higher than 0.2
4. Ex vivo supplementation of antithrombin seems to improve enoxaparin responsiveness. Remember, enoxaparin and heparin are HELPING AT3, not the other way around
References
1. Lammers D, Scerbo M, Davidson A, et al. Addition of aspirin to venous thromboembolism chemoprophylaxis safely decreases venous thromboembolism rates in trauma patients. Trauma Surg Acute Care Open. 2023;8(1):e001140. doi:10.1136/tsaco-2023-001140
https://pubmed.ncbi.nlm.nih.gov/37936904/
- Vincent LE, Talanker MM, Butler DD, et al. Association of Changes in Antithrombin Activity Over Time With Responsiveness to Enoxaparin Prophylaxis and Risk of Trauma-Related Venous Thromboembolism. JAMA Surg. 2022;157(8):713-721. doi:10.1001/jamasurg.2022.2214
https://pubmed.ncbi.nlm.nih.gov/35731524/
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Most surgeons know about malpractice lawsuits, but did you know that residents and even medical students can be involved in them? Join us for a discussion of what happens when patients sue their treatment teams -- and what happens when those teams involve trainees.
Host: Nina Clark, MD, MS
Guests:
Cindy Hamra, JD, MA is an associate dean in the GME Office at the University of Washington School of Medicine, where she leads the operational, administrative and finance functions. UW School of Medicine is sponsors clinical training for over 1600 medical and dental residents in fellows in over 200 programs. UW Medicine, through the School of Medicine, is the largest sponsor of GME programs in the five-state WWAMI region (Washington, Wyoming, Alaska, Montana and Idaho).
Lisa Hammel, JD is the senior director of clinical risk management for UW medicine. Prior to that, she spent over 20 years as a defense attorney primarily working in medical malpractice and professional liability defense.
References:
American College of Surgeons: https://www.facs.org/for-medical-professionals/news-publications/journals/rise/articles/litigation-overview/
AMA: https://www.ama-assn.org/medical-residents/residency-life/resident-medical-liability-lawsuits-why-and-how-often-they-happen
JAMA Surgery: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833625/ & https://jamanetwork.com/journals/jamasurgery/article-abstract/2670456
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Join Drs. Scott Steele and Dan Scheese as they engage in an in-depth conversation with Dr. Michael Valente about the intricate world of appendiceal masses, including carcinoid, adenocarcinoma, and mucinous neoplasms. Despite the complexity of the subject, this episode skillfully deconstructs the topic through the analysis of three distinct cases, illuminating the latest terminology, diagnostic approaches, and management strategies.
Hosts:
Scott Steele, MD (@ScottRSteeleMD)
Dan Scheese, MD (@DanScheese13)
Guest:
Michael Valente, MD (@DrMikeValente) is an Associate Professor of Surgery at the Cleveland Clinic and Program Director of the colon and rectal residency program. Dr. Valente's specialty and research interests include cancer of the appendix, peritoneum, colon, rectum and anus, cytoreductive surgery/HIPEC, complex re-operative surgery, inflammatory bowel disease, advanced endoscopic techniques, laparoscopic and minimally invasive colorectal surgery, and surgical education. Dr. Valente has published numerous peer-reviewed journal articles and book chapters and has presented his research interests both nationally and internationally.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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M&M - we all do it, but what is its purpose? Join Jason and Nina as they talk to two experts about why we present at all, and what we can do to better reach the educational and quality improvement goals of morbidity and mortality conference.
Hosts: Jason Bingham, Nina Clark
Panelists* Keith Lillemoe, MD + Chief of Surgery, Massachusetts General Hospital + Professor of Surgery at the Harvard Medical School * Luise Pernar, MD, MHPE + Bariatric Surgeon + Associate Professor of Surgery, Boston University Chobanian and Avedisian School of Medicine
References
https://jamanetwork.com/journals/jamasurgery/article-abstract/2810740
https://pubmed.ncbi.nlm.nih.gov/26649585/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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It’s that time of year (again!)- when medical students- both US and International- are preparing their residency applications. This year, we have been focusing on the special challenges International Medical Graduates face when applying to US surgical residency positions. In our previous episode, we discussed how residents can make their applications stand out to program directors. Today, we will explore the unique challenges, experiences, and the future of IMGs with special guest Dr. Hasan Alam.
Guests:
Hasan Alam, MD- Chair of the Department of Surgery and Professor of Surgery (Trauma and Critical Care) and Cell and Developmental Biology- Northwestern University
Previous DOMINATE the Match Episodes:
Episode 2- “Choose Me” (Personal Statements and Letters of Recommendations)
https://behindtheknife.org/podcast/dominate-the-match-episode-2-choose-me/
Episode 3- “The Interview”
https://behindtheknife.org/podcast/dominate-the-match-episode-3-the-interview/
Episode 4- “Rank and Match”
https://behindtheknife.org/podcast/dominate-the-match-episode-4-rank-and-match/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
It’s that time of year (again!)- when medical students- both US and International- are preparing their residency applications. In this episode, we will focus on the special challenges International Medical Graduates face when applying to US surgical residency positions and discuss tips and tricks for making IMG residency applicants standout to program directors in the US.
Guests:
David Hughes, MD- Clinical Associate Professor of Endocrine Surgery and General Surgery Residency Program Director- University of Michigan
Krishnan Raghavendran, MBBS- Professor of Acute Care Surgery and Critical Care- University of Michigan
Link to video:
You can watch Dr. Hughes’s full presentation here: https://youtu.be/iQ0CzH7xHwE
Previous DOMINATE the Match Episodes:
Episode 2- “Choose Me” (Personal Statements and Letters of Recommendations)
https://behindtheknife.org/podcast/dominate-the-match-episode-2-choose-me/
Episode 3- “The Interview”
https://behindtheknife.org/podcast/dominate-the-match-episode-3-the-interview/
Episode 4- “Rank and Match”
https://behindtheknife.org/podcast/dominate-the-match-episode-4-rank-and-match/
Residency Program Lists:
- FREIDA Residency and Fellowship Database: https://freida.ama-assn.org/
- Doximity: https://www.doximity.com/residency/?utm_campaign=marketing_resnav_competitor_broad_20210520&utm_source=google&utm_medium=cpc&gclid=CjwKCAjwt52mBhB5EiwA05YKo1J47BLAtTPtsJBmVvXGP2pDXLLqgDIwM0pgkSYjoBhFUOO1ktXDYRoC2bkQAvD_BwE
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Laparoscopic cholecystectomy was introduced approximately 30 years ago and quickly became the gold standard due to multiple benefits over open cholecystectomy. It ushered in the laparoscopic revolution but also increased the number of bile duct injuries. Through the dedicated efforts of many the rate of bile duct injury has been reduced, now mirroring open cholecystectomy. The robotic surgery revolution is well underway and unsurprisingly this technology has been applied to cholecystectomy. Given the devastating nature of bile duct injury and the history of increased injury with the last major shift in operative approach, we examine the current literature on the comparative safety of robotic-assisted cholecystectomy vs. laparoscopic cholecystectomy.
- Andrew Wright, UW Medical Center – Montlake and Northwest, @andrewswright
- Nick Cetrulo, UW Medical Center - Northwest, @Trules25
- Nicole White, UW Medical Center - Northwest
- Paul Herman, UW General Surgery Resident PGY-3, @paul_herm
- Ben Vierra, UW General Surgery Resident PGY-2 @benvierra95
Learning objectives:
- Examine the history of the laparoscopic cholecystectomy and review the efforts to reduce bile duct injury (SAGES Safe Cholecystectomy Task Force and Multi-Society Practice Guideline)
- Review literature on causes and prevention of bile duct injury
- Review a recent article on robotic cholecystectomy vs laparoscopic cholecystectomy outcomes
- Describe precautions that might mitigate expected increase in bile duct injury as a new approach is applied
References
1. https://www.sages.org/publications/guidelines/safe-cholecystectomy-multi-society-practice-guideline/
2. https://www.sages.org/safe-cholecystectomy-program/
3. MacFadyen BV Jr, Vecchio R, Ricardo AE, Mathis CR. Bile duct injury after laparoscopic cholecystectomy. The United States experience. Surg Endosc. 1998 Apr;12(4):315-21. doi: 10.1007/s004649900661. PMID: 9543520. https://pubmed.ncbi.nlm.nih.gov/9543520/
4. Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD006231. doi: 10.1002/14651858.CD006231. PMID: 17054285. https://pubmed.ncbi.nlm.nih.gov/17054285/
5. Way LW, Stewart L, Gantert W, Liu K, Lee CM, Whang K, Hunter JG. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg. 2003 Apr;237(4):460-9. doi: 10.1097/01.SLA.0000060680.92690.E9. PMID: 12677139; PMCID: PMC1514483. https://pubmed.ncbi.nlm.nih.gov/12677139/
6. Kalata S, Thumma JR, Norton EC, Dimick JB, Sheetz KH. Comparative Safety of Robotic-Assisted vs Laparoscopic Cholecystectomy. JAMA Surg. 2023;158(12):1303–1310. doi:10.1001/jamasurg.2023.4389 https://pubmed.ncbi.nlm.nih.gov/37728932/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Join for the forth episode in the Association of Out Surgeons & Allies (AOSA) series for a discussion on gender affirming care and gender affirming surgery.
Host:
Dan Scheese, MD
Andrew Schlussel, DO, Colorectal and General Surgeon, Charlie Norwood VA Medical Center
Guests:
1. Dr. Megan Lane (She/her)
megalane@med.umich.edu
Dr. Lane is a Plastic Surgery resident at the University of Michigan who is planning on going into Gender Affirming Surgery and general reconstruction, she completed a research fellowship in the National Clinician Scholars Program and focused primarily on patient-reported outcomes in gender affirming surgery.
-
Dr. Scott Chaiet (he/him/his/himself)
chaiet@surgery.wisc.edu
Dr. Chaiet is double board certified by the American Board of Otolaryngology and the American Board of Facial Plastic & Reconstructive Surgery and is currently at the University of Wisconsin. His areas of expertise include rhinoplasty and facial gender surgery. He also practices reconstructive surgery including facial paralysis reanimation. His gender affirming practice includes all areas of the face and Adam’s apple except for hair. -
Dr. Amy Suwanabol
pasuwan@med.umich.edu
Amy Suwanabol is a colorectal surgeon at the University of Michigan and the Ann Arbor VA. She assists the gender affirming surgeons at the University of Michigan in performing robotic assisted vaginoplasty. Her research focuses on optimizing quality of life among surgical patients and their families, surgeon well being, and cancer survivorship. -
Dr. Monica Llado-Farrulla
lladofar@ohsu.edu
Dr. Llado-Farulla was born and raised in Puerto Rico, completed a residency in general surgery and then plastic surgery at Tulane and Penn, respectively. She pursued a year of training in advanced gender surgery and is now currently at OHSU, her practice largely focuses on facial feminization, chest affirming surgeries, phalloplasty, autologous breast reconstruction, and limb salvage. -
Dr. Michele “Mike” Fascelli (he/him/his)
FASCELM2@ccf.org
Dr. Fascelli is a practicing reconstructive urologist at Cleveland Clinic. He comppleted his urology training at the Cleveland Clinic in Ohio and then fellowship in urogenital gender affirming surgery with the urology team at OHSU with Dr. Llado-Farulla. He is now the Director of Urogenital Reconstruction and Co-Director of the Gender Affirming Surgery Program at Cleveland Clinic. He is very committed to LGBTQIA+ urologic access and actively works to protect and expand care to the rainbow community, and to our trans and gender diverse patients. His practice is currently focused on queer urologic health concerns and genital gender surgery (i.e. vaginoplasty, metoidioplasty and phalloplasty).
Learn more and get involved with AOSA: https://www.outsurgeons.org
Twitter/X: @OutSurgeons
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Interested in cardiac surgery? The training paradigm for cardiac surgery has changed significantly over the past decade and we know may students often struggle when deciding what pathway is best for them. For this episode, we assembled a robust team of attendings, fellows, and residents to discuss their journey as well as some of the research that has been conducted about these different pathways to help guide students navigating this decision.
Hosts:
- Jessica Millar, MD- PGY-5 General Surgery Resident, University of Michigan, @Jess_Millar15
Guests:
- Nick Teman, MD- Assistant Professor of Thoracic and Cardiovascular Surgery, University of Virginia, @nickteman
-
Jolian Dahl, MD, MSc- Integrated Thoracic Surgery Resident (PGY-6), University of Virginia, @JolianDahl
-
Lyndsey Wessels, MD- Traditional Thoracic Surgery Resident (CT-1), University of Virginia, @LyndseyWessels
Articles Referenced:
-
Pathways to Certification: https://www.abts.org/ABTS/CertificationWebPages/Pathways%20to%20Certification.aspx
-
Narahari AK, Patel PD, Chandrabhatla AS, Wolverton J, Lantieri MA, Sarkar A, Mehaffey JH, Wagner CM, Ailawadi G, Pagani FD, Likosky DS. A Nationwide Evaluation of Cardiothoracic Resident Research Productivity. Ann Thorac Surg. 2024 Feb;117(2):449-455. doi: 10.1016/j.athoracsur.2023.08.011. Epub 2023 Aug 26. PMID: 37640148; PMCID: PMC10842395
https://pubmed.ncbi.nlm.nih.gov/37640148/ -
Bougioukas L, Heiser A, Berg A, Polomsky M, Rokkas C, Hirashima F. Integrated cardiothoracic surgery match: Trends among applicants compared with other surgical subspecialties. J Thorac Cardiovasc Surg. 2023 Sep;166(3):904-914. doi: 10.1016/j.jtcvs.2021.11.112. Epub 2022 Mar 22. PMID: 35461707.
https://pubmed.ncbi.nlm.nih.gov/35461707/
For episode ideas/suggestions/feedback feel free to email Jessica Millar at: millarje@med.umich.edu
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Bariatric surgery is an evolving field with new procedures, or variations of old ones, being developed to meet the needs of patients with obesity. The single anastomosis duodenoileal bypass (SADI) and one anastomosis gastric bypass (OAGB) are two such procedures which have recently entered the mainstream conversation. In this episode we will give a brief overview of the SADI and OAGB, go over some short and long term studies evaluating safety and efficacy, and discuss current sentiments about these options and how they may fit into bariatric practice.
Show Hosts:
Matthew Martin, MD
Adrian Dan, MD
Crystal Johnson-Mann, MD
Paul Wisniowski, MD
Article #1: Chao 2024 - Outcomes of SADI and OAGB Compared to RYGB from the Metabolic and Bariatric Surgery Quality Improvement Program: The North American Experience* Roux-en-Y gastric bypass (RYGB) and duodenal switch are well described procedure for weight loss; however, associated postoperative complications have led to the development of simpler techniques + Single anastomosis duodenoileal bypass (SADI) - modification of the duodenal switch where by a loop of ileum of the bilopancreatic limb approximately 200-300cm from the ileal cecal valve is anastomosed to the distal duodenal cuff of a tubularized stomach + One anastomosis gastric bypass (OAGB) – modification of the RYGB where a loop of jejunum of the bilopancreatic limb approximately 150-200cm from the ligament of treitz is anastomosed to the distal end of a gastric pouch. * There is increasing interest in these procedures given the perceived reduced risk reduction associated with one fewer anastomosis * Currently, there is insufficient data on the safety of these procedures compared to the established RYGB. * The article utilizes the MBSAQIP database to evaluate each procedure against the RYGB + Matched groups: SADI vs RYGB and OAGB vs RYGB + Matched against age, sex, BMI, operative time, and ASA classification + 30-day outcomes included complications and health care utilization + Results were analyzed with univariate comparative analysis, and significant outcomes were examined with logistic regression - SADI vs RYGB: SADI independently associated INCREASED odds with staple line leak, sepsis, organ space infection, and pneumonia. - OAGB vs RYGB: OAGB independently associated with REDUCED odds of SSI, transfusion requirement/GI bleed, ICU admission, bowel obstruction, and healthcare utilization (reoperation, readmissions, and reinterventions) - No significant differences in mortality + Limitation: Article generally reviews technical complications of procedures. Unable to address significant bariatric outcomes such as weight loss and metabolic profile, as well as long term outcomes. + https://pubmed.ncbi.nlm.nih.gov/38170422/
Article #2: Maud 2019 - Efficacy and safety of OAGB vs RYGB for obesity (YOMEGA trial): A multicentre, randomized, open label, non-inferiority trial
- Limited long-term evidence on OAGB
- Mostly arising from retrospective analyses and one meta-analysis
- Two randomized clinical trials but with poor power and questionable methodology.
- This is a randomized non-inferiority trial of in patients undergoing bariatric surgery
- Randomized into 2 groups: OAGB vs RYGB with 117 patients per group
- Patients were followed for 2 years with a loss to follow up of 21% in OAGB and 24% in RYGB cohorts
- The primary outcome was weight loss with a noninferiority threshold of 7% assuming 60% weight loss at 2 years. Secondary outcomes included complications and metabolic outcomes
- Groups were compared with Student’s T and Wilcoxon tests for quantitative data, and chi-squared and Fischer’s exact for qualitative endpoints.
- Cohorts were analyzed with the intention to treat, and missing data on the primary endpoint was imputed with prediction-based modeling.
- Highlighted Outcomes
- Mean percent excess BMI loss of 87.9% in OAGB group compared to 85.8% in RYGB group demonstrating non-inferiority in terms of weight loss
- Increased number of serious adverse events (SAE) in the OAGB group, but no difference in the proportion of patients with at least 1 SAE
- OAGB demonstrated 70% complete or partial remission of diabetes compared to 44% in RYGB but underpowered to demonstrate significant difference.
- Equal rates of gastritis and esophagitis based on endoscopic biopsy results at 2 years.
- There were increased nutritional complications in the OAGB groups with 21% vs 0% in RYGB and high rates of diarrhea/anal fissures 14% vs 0%, respectively. This suggests a greater malabsorptive effect of OAGB.
- There was equal satisfaction in quality of life between RYGB and OAGB on two validated surveys with >80% satisfaction rates.
- Limitations
- Data was imputed for the primary end point
- High rates of loss to follow up in both cohorts
- Use of “severe adverse events” instead of Clavien-Dindo classification
- Comparison of specific institutional/surgeon technique of OAGB vs RYGB
- https://pubmed.ncbi.nlm.nih.gov/30851879/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Bariatric surgery is an evolving field with new procedures, or variations of old ones, being developed to meet the needs of patients with obesity. The single anastomosis duodenoileal bypass (SADI) and one anastomosis gastric bypass (OAGB) are two such procedures which have recently entered the mainstream conversation. In this episode we will give a brief overview of the SADI and OAGB, go over some short and long term studies evaluating safety and efficacy, and discuss current sentiments about these options and how they may fit into bariatric practice.
Show Hosts:
Matthew Martin, MD
Adrian Dan, MD
Crystal Johnson-Mann, MD
Paul Wisniowski, MD
Article #1: Chao 2024 - Outcomes of SADI and OAGB Compared to RYGB from the Metabolic and Bariatric Surgery Quality Improvement Program: The North American Experience* Roux-en-Y gastric bypass (RYGB) and duodenal switch are well described procedure for weight loss; however, associated postoperative complications have led to the development of simpler techniques + Single anastomosis duodenoileal bypass (SADI) - modification of the duodenal switch where by a loop of ileum of the bilopancreatic limb approximately 200-300cm from the ileal cecal valve is anastomosed to the distal duodenal cuff of a tubularized stomach + One anastomosis gastric bypass (OAGB) – modification of the RYGB where a loop of jejunum of the bilopancreatic limb approximately 150-200cm from the ligament of treitz is anastomosed to the distal end of a gastric pouch. * There is increasing interest in these procedures given the perceived reduced risk reduction associated with one fewer anastomosis * Currently, there is insufficient data on the safety of these procedures compared to the established RYGB. * The article utilizes the MBSAQIP database to evaluate each procedure against the RYGB + Matched groups: SADI vs RYGB and OAGB vs RYGB + Matched against age, sex, BMI, operative time, and ASA classification + 30-day outcomes included complications and health care utilization + Results were analyzed with univariate comparative analysis, and significant outcomes were examined with logistic regression - SADI vs RYGB: SADI independently associated INCREASED odds with staple line leak, sepsis, organ space infection, and pneumonia. - OAGB vs RYGB: OAGB independently associated with REDUCED odds of SSI, transfusion requirement/GI bleed, ICU admission, bowel obstruction, and healthcare utilization (reoperation, readmissions, and reinterventions) - No significant differences in mortality + Limitation: Article generally reviews technical complications of procedures. Unable to address significant bariatric outcomes such as weight loss and metabolic profile, as well as long term outcomes. + https://pubmed.ncbi.nlm.nih.gov/38170422/
Article #2: Maud 2019 - Efficacy and safety of OAGB vs RYGB for obesity (YOMEGA trial): A multicentre, randomized, open label, non-inferiority trial
- Limited long-term evidence on OAGB
- Mostly arising from retrospective analyses and one meta-analysis
- Two randomized clinical trials but with poor power and questionable methodology.
- This is a randomized non-inferiority trial of in patients undergoing bariatric surgery
- Randomized into 2 groups: OAGB vs RYGB with 117 patients per group
- Patients were followed for 2 years with a loss to follow up of 21% in OAGB and 24% in RYGB cohorts
- The primary outcome was weight loss with a noninferiority threshold of 7% assuming 60% weight loss at 2 years. Secondary outcomes included complications and metabolic outcomes
- Groups were compared with Student’s T and Wilcoxon tests for quantitative data, and chi-squared and Fischer’s exact for qualitative endpoints.
- Cohorts were analyzed with the intention to treat, and missing data on the primary endpoint was imputed with prediction-based modeling.
- Highlighted Outcomes
- Mean percent excess BMI loss of 87.9% in OAGB group compared to 85.8% in RYGB group demonstrating non-inferiority in terms of weight loss
- Increased number of serious adverse events (SAE) in the OAGB group, but no difference in the proportion of patients with at least 1 SAE
- OAGB demonstrated 70% complete or partial remission of diabetes compared to 44% in RYGB but underpowered to demonstrate significant difference.
- Equal rates of gastritis and esophagitis based on endoscopic biopsy results at 2 years.
- There were increased nutritional complications in the OAGB groups with 21% vs 0% in RYGB and high rates of diarrhea/anal fissures 14% vs 0%, respectively. This suggests a greater malabsorptive effect of OAGB.
- There was equal satisfaction in quality of life between RYGB and OAGB on two validated surveys with >80% satisfaction rates.
- Limitations
- Data was imputed for the primary end point
- High rates of loss to follow up in both cohorts
- Use of “severe adverse events” instead of Clavien-Dindo classification
- Comparison of specific institutional/surgeon technique of OAGB vs RYGB
- https://pubmed.ncbi.nlm.nih.gov/30851879/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Join Drs. Jason Bingham (@BinghamMd) and Patrick Georgoff (@georgoff) for a thought-provoking discussion with titans of hernia surgery Drs. Todd Heniford (@THeniford) and Michael Rosen (@MikeRosenMD). You don't want to miss this one! This episode goes deep, touching on some of the most vexing questions in the world of abdominal wall reconstruction.
Highlights: * Hernia is chronic disease process. Surgeons should act like it and patients need to understand this. * Follow-up data is hard to come by and therefore limited. Studies must be interpreted with this in mind. * Hernia surgery is sexy, which is both exciting and concerning. * "Technology is not useful until it is boring." New techniques and devices can hurt patients. * Complicated hernias should be sent to hernia centers. Otherwise, general surgeons are more than capable of doing the repair.
Link to paper: https://jamanetwork.com/journals/jamasurgery/fullarticle/2816986
Link to ACHQC: https://achqc.org/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Join the Behind the Knife Surgical Oncology Team as we discuss the presentation, work-up, and management of gastric cancer.
Hosts:
- Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center
- Connor Chick, MD (@connor_chick) is a Surgical Oncology fellow at Ohio State University.
- Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-6 General Surgery resident at Brooke Army Medical Center
- Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-5 General Surgery resident at Brooke Army Medical Center
Learning Objectives:
In this episode, we review the basics of gastric cancer, including presentation, work-up, staging, and treatment modalities as well as high yield topics including the Siewert classification system. We also briefly discuss trials establishing peri-operative chemotherapy regimens for gastric cancer and the controversy of D1 vs. D2 lymphadenectomy.
Links to Papers Referenced in this Episode
Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer.
NEJM 2006 Jul;355(1):11-20.
https://www.nejm.org/doi/full/10.1056/NEJMoa055531
Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesphageal junction adenocarcinoma (FLOT4): a randomized, phase2/3 trial
Lancet 2019 May;393(10184):1948-1957.
https://pubmed.ncbi.nlm.nih.gov/30982686/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Philip Fleshner as they discuss the management of small bowel strictures in Crohn’s disease.
Learning Objectives
1. Discuss the role for J-pouch in a patient with inflammatory bowel disease
2. Identify the key steps in creation of the J-pouch and technical considerations.
3. Describe post operative complications and management in patients with a J-pouch
Video Link: https://www.youtube.com/watch?v=_PMFaQHah5A
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How is each release of the TAR contributing to the final tension on the anterior and posterior fascia? Join Drs. Michael Rosen, Benjamin T. Miller, Sara Maskal, and Ryan C. Ellis as they discuss their group’s recent cohort study of tensiometry in 100 TARs.
Hosts:
- Michael Rosen, Cleveland Clinic
- Benjamin T. Miller, Cleveland Clinic
- Sara Maskal, Cleveland Clinic
- Ryan C. Ellis, Cleveland Clinic, @ryanellismd
Learning objectives:
- Review the steps of a TAR
- Understand the changes in tension on the anterior and posterior fascia with each step of the TAR
- Think about the application this data has to similar operations
References:
Miller BT, Ellis RC, Petro CC, Krpata DM, Prabhu AS, Beffa LRA, Huang LC, Tu C, Rosen MJ. Quantitative Tension on the Abdominal Wall in Posterior Components Separation With Transversus Abdominis Release. JAMA Surg. 2023 Dec 1;158(12):1321-1326. doi: 10.1001/jamasurg.2023.4847. PMID: 37792324; PMCID: PMC10551814. https://pubmed.ncbi.nlm.nih.gov/37792324/
Miller BT, Ellis RC, Walsh RM, Joyce D, Simon R, Almassi N, Lee B, DeBernardo R, Steele S, Haywood S, Beffa L, Tu C, Rosen MJ. Physiologic tension of the abdominal wall. Surg Endosc. 2023 Dec;37(12):9347-9350. doi: 10.1007/s00464-023-10346-w. Epub 2023 Aug 28. PMID: 37640951. https://pubmed.ncbi.nlm.nih.gov/37640951/
Ramirez OM, Ruas E, Dellon AL. "Components separation" method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990 Sep;86(3):519-26. doi: 10.1097/00006534-199009000-00023. PMID: 2143588. https://pubmed.ncbi.nlm.nih.gov/2143588/
Hope WW, Williams ZF, Rawles JW 3rd, Hooks WB 3rd, Clancy TV, Eckhauser FE. Rationale and Technique for Measuring Abdominal Wall Tension in Hernia Repair. Am Surg. 2018 Sep 1;84(9):1446-1449. PMID: 30268173. https://pubmed.ncbi.nlm.nih.gov/30268173/
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Welcome to Humanism in Surgery, a new series where we take a deep dive into the extremes of humanity within the field of surgery. As surgeons, there are times when we feel deeply human and times when we feel we have lost our humanity. These experiences impact us immensely and shape our careers in important ways. It's time these stories are told! For those of you who are fans of NPR, think of this as Story Core for surgery.
Today, Dr. Patrick Georgoff is joined by Dr. Tamara Fitzgerald, Associate Professor of Pediatric Surgery at Duke University, and Dr. Ted Pappas, Professor of Surgery and Master Surgeon at Duke University.
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A patient with a large TBSA burn injury presents to a local emergency department and you are the only surgeon on duty that evening. With snow covered roads and poor visibility, the patient requires initial stabilization prior to transfer to the regional burn center. You are faced with some difficult clinical decisions as you begin their resuscitation. Join Drs. Tam Pham, Rob Cartotto, Julie Rizzo, Alex Morzycki and Jamie Oh as they discuss the clinical challenges in initiating burn resuscitation, pitfalls in long-distance transport, and more.
Hosts:
· Dr. Tam Pham: UW Medicine Regional Burn Center
· Dr. Robert Cartotto: University of Toronto, Ross Tilley Burn Centre
· Dr. Julie Rizzo: Brooke Army Medical Center
· Dr. Alex Morzycki: UW Medicine Regional Burn Center
· Dr. Jamie Oh: UW Medicine Regional Burn Center
Learning Objectives:
· Describe initial fluid strategies, including the recommendations of the Advanced Burn Life Support (ABLS) course, traditional resuscitation formulas, and the Rule of 10.
· Describe logistical and medical challenges of long-distance transport to a regional burn center.
· Understand recent advances learned from recent conflicts in military burn casualty care.
· List options for intravenous access.
· Understand endpoints of resuscitation, including adjuncts which may help guide fluid titration.
- Cartotto R, Johnson LS, Savetamal A, et al. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. J Burn Care Res 2023
https://pubmed.ncbi.nlm.nih.gov/38051821/
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Renz EM, Cancio LC, Barillo DJ, et al. Long-Range Transport of War-Related Burn Casualties. J Trauma 2008 https://pubmed.ncbi.nlm.nih.gov/18376156/
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Adibfar A, Camacho F, Rogers AD, Cartotto R. The Use of Vasopressors During Acute Burn Resuscitation. Burns 2021 https://pubmed.ncbi.nlm.nih.gov/33293152/
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Chung KK, Wolf SE, Cancio LC, et al. Resuscitaiton of Severely Burned Military Casualties: Fluid Begets More Fluid. J Trauma 2009 https://pubmed.ncbi.nlm.nih.gov/19667873/
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Chung KK, Salinas J, Renz EM, et al. Simple Derivation of the Initial Fluid Rate for the Resuscitation of Severely Burned Adult Combat Casualties: in Silico Validation of the Rule of 10, J Trauma 2009 https://pubmed.ncbi.nlm.nih.gov/20622619/
Joint Trauma System Clinical Practice Guideline (CPG)-Burn Care, updated 2022
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Your patient was in a terrible car crash and is currently intubated with multiple traumatic injuries that will need surgery. Family has just arrived and all they’ve heard is that he has a broken leg. How do you share this serious news with family? What do you do when they become angry, cry or bombard you with questions that you don’t have answers to? Join the surgical palliative care team from the University of Washington as we role play a difficult conversation with a standardized patient. We will identify common challenges that arise and discuss key skills to navigate these situations.
Hosts:
Dr. Katie O’Connell (@katmo15) is an assistant professor of surgery at the University of Washington. She is a trauma surgeon, palliative care physician, director of surgical palliative care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA.
Dr. Ali Haruta is a PGY7 current palliative care fellow at the University of Washington, formerly a UW general surgery resident and Parkland trauma/critical care fellow.
Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY5 general surgery resident and current surgical oncology research fellow at the University of Washington.
Dr. Virginia Wang is a PGY2 general surgery resident at the University of Washington.
Learning Objectives:
· Identify common pitfalls encountered during difficult conversations
· Learn how to synthesize complex medical information and construct a succinct headline statement to deliver a digestible take-home message
· Develop skills to respond to emotional cues using empathetic statements
References:
· “Responding to Emotion.” Vitaltalk. Accessed March 4, 2024. https://www.vitaltalk.org/guides/responding-to-emotion-respecting/
· “Serious News.” Vitaltalk. Accessed March 4, 2024. https://www.vitaltalk.org/guides/serious-news/
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Circulating tumor DNA, more commonly referred to as ctDNA, has emerged as an attractive and potentially highly sensitive biomarker for patients with colorectal cancer. But what exactly is ctDNA, does it have any prognostic value for patients with colorectal liver metastasis, and how can it be incorporated into the management of said patients? In this episode from the HPB team at Behind the Knife, listen in on the discussion about ctDNA and its role in the perioperative management of colorectal liver metastasis.
Hosts
Anish J. Jain MD (@anishjayjain) is a T32 Research Fellow at the University of Texas MD Anderson Cancer Center within the Department of Surgical Oncology.
Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology. He is also the associate program director of the HPB fellowship at the University of Texas MD Anderson Cancer Center.
Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center
Learning Objectives:
-Develop an understanding of what circulating tumor DNA (ctDNA) is.
-Develop an understanding of what makes ctDNA unique from other “tumor markers” like CEA.
-Develop an understanding of the prognostic value of ctDNA for colorectal liver metastasis (CRLM).
-Develop an understanding of the current role of ctDNA in the perioperative treatment of patients with CRLM.
-Develop an understanding of how ctDNA can be incorporated into future treatment algorithms for patients undergoing hepatic resection for CRLM.
Papers Referenced (in the order they were mentioned in the episode):
1) Newhook TE, Overman MJ, Chun YS, et al. Prospective Study of Perioperative Circulating Tumor DNA Dynamics in Patients Undergoing Hepatectomy for Colorectal Liver Metastases. Ann Surg. 2023;277(5):813-820.
https://pubmed.ncbi.nlm.nih.gov/35797554/
2) Nishioka Y, Chun YS, Overman MJ, et al. Effect of Co-mutation of RAS and TP53 on Postoperative ctDNA Detection and Early Recurrence after Hepatectomy for Colorectal Liver Metastases. J Am Coll Surg. 2022;234(4):474-483.
https://pubmed.ncbi.nlm.nih.gov/35290266/
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Taking a lactating patient the OR? Prescribing antibiotics? What about a CT scan with IV contrast? Pump and dump, right? WRONG. It's time to get educated! Today, we review the finer points of caring for our lactating patients.
In this episode Dr. Patrick Georgoff is joined by Dr. Austin Eckhoff, general surgery resident at Duke University, Dr. Annie Dotson, family medicine and breastfeeding medicine physician at Duke University, and Dr. Katrina Mitchell, breast surgeon at Ridley Tree Cancer Center in Santa Barbara, CA.
Resources:
https://www.bfmed.org/
https://www.e-lactancia.org/
https://physicianguidetobreastfeeding.org/
TRASH THE PUMP & DUMP: https://physicianguidetobreastfeeding.org/trash-the-pump-and-dump/trash-pump-dump/
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The American Board of Surgery In-Training Examination will officially be switching from reporting percentile scores by year level to percent of questions correct. What does this change mean for residents? Podcast hosts Dr. Ananya Anand, Dr. Joe L’Huillier, and Dr. Rebecca Moreci are joined by three fellow CoSEF members for this discussion: Dr. Gus Godley, Dr. Colleen McDermott, and Dr. Josh Roshal.
Hosts:
–Dr. Ananya Anand, Stanford University, @AnanyaAnandMD, ananya_anand@stanford.edu
–Dr. Joseph L’Huillier, University at Buffalo, @JoeLHuillier101, josephlh@buffalo.edu
–Dr. Rebecca Moreci, Louisiana State University, @md_moreci, morecir@med.umich.edu
–COSEF: @surgedfellows
Special guests:
-Dr. Gus Godley, University of Chicago, frederick.godley@uchicagomedicine.org, @GusGodley
-Dr. Colleen McDermott, University of Utah, colleen.mcdermott@hsc.utah.edu
-Dr. Josh Roshal, Brigham and Women’s Hospital, jaroshal@utmb.edu, @Joshua_Roshal
Learning Objectives:
Listeners will:
– Understand the changes to the ABSITE score reporting by the American Board of Surgery
– Describe both positive impacts and limitations of this change from the resident perspective
– List possible ideas for further refinements to standardized exams in medicine
References:
-Yeo HL, Dolan PT, Mao J, Sosa JA. Association of Demographic and Program Factors With American Board of Surgery Qualifying and Certifying Examinations Pass Rates. JAMA Surg. Jan 1 2020;155(1):22-30. doi:10.1001/jamasurg.2019.4081 https://pubmed.ncbi.nlm.nih.gov/31617872/
-Sathe TS, Wang JJ, Yap A, Zhao NW, O’Sullivan P, Alseidi A. Proposed Reforms to the American Board of Surgery In-Training Examination (ABSITE). https://www.ideasurg.pub/proposed-absite-reforms/
-Miller AT, Swain GW, Midmar M, Divino CM. How Important Are American Board of Surgery In-Training Examination Scores When Applying for Fellowships? J Surg Educ. 2010;67(3):149-151. doi:10.1016/j.jsurg.2010.02.007
https://pubmed.ncbi.nlm.nih.gov/20630424/
-Savoie KB, Kulaylat AN, Huntington JT, Kelley-Quon L, Gonzalez DO, Richards H, Besner G, Nwomeh BC, Fisher JG. The pediatric surgery match by the numbers: Defining the successful application. J Pediatr Surg. 2020;55(6):1053-1057. doi:10.1016/j.jpedsurg.2020.02.052 https://pubmed.ncbi.nlm.nih.gov/32197826/
-Alnahhal KI, Lyden SP, Caputo FJ, Sorour AA, Rowe VL, Colglazier JJ, Smith BK, Shames ML, Kirksey L. The USMLE® STEP 1 Pass or Fail Era of the Vascular Surgery Residency Application Process: Implications for Structural Bias and Recommendations. Annals of Vascular Surgery. 2023;94:195-204. doi:10.1016/j.avsg.2023.04.018
https://pubmed.ncbi.nlm.nih.gov/37120072/
-Williams M, Kim EJ, Pappas K, Uwemedimo O, Marrast L, Pekmezaris R, Martinez J. The impact of United States Medical Licensing Exam (USMLE) step 1 cutoff scores on recruitment of underrepresented minorities in medicine: A retrospective cross‐sectional study. Health Sci Rep. 2020;3(2):e2161. doi:10.1002/hsr2.161 https://pubmed.ncbi.nlm.nih.gov/32318628/
-Lucey CR, Saguil A. The Consequences of Structural Racism on MCAT Scores and Medical School Admissions: The Past Is Prologue. Academic Medicine. 2020;95(3):351. doi:10.1097/ACM.0000000000002939 https://pubmed.ncbi.nlm.nih.gov/31425184/
-Natanson H, Svrluga S. The SAT is coming back at some colleges. It’s stressing everyone out. Washington Post. https://www.washingtonpost.com/education/2024/03/18/sat-test-policies-confuse-students/. Published March 19, 2024. Accessed April 5, 2024.
-de Virgilio C, Yaghoubian A, Kaji A, Collins JC, Deveney K, Dolich M, Easter D, Hines OJ, Katz S, Liu T, Mahmoud A, Melcher ML, Parks S, Reeves M, Salim A, Scherer L, Takanishi D, Waxman K.. Predicting Performance on the American Board of Surgery Qualifying and Certifying Examinations: A Multi-institutional Study. Archives of Surgery. 2010;145(9):852-856. doi:10.1001/archsurg.2010.177 https://pubmed.ncbi.nlm.nih.gov/20855755/
-Weighted test content from the ABS:
https://www.absurgery.org/wp-content/uploads/2023/01/GS-ITE.pdf
-USMLE program announces upcoming policy changes | USMLE. Accessed April 9, 2024. https://www.usmle.org/usmle-program-announces-upcoming-policy-changes
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The ABSITE score report is changing… what does it mean? CEO of the American Board of Surgery Dr. Jo Buyske discusses ABSITE and MUCH more.
Hosts: Dr. Scott Steele, Dr. Nina Clark, Dr. Jessica Millar
Guest: Dr. Jo Buyske, President/CEO of the American Board of Surgery
Resources:
Announcement - ABSITE Percentiles:
https://www.absurgery.org/wp-content/uploads/2024/02/ABSITE-Percentiles.pdf
ABSITE Data Tools:
https://sandbox.absurgery.org/default.jsp?publicdata Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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In this episode our team dives into the diagnosis, workup and management of malignant pleural mesothelioma. Listen as we debate the pros and cons of surgical management of this disease with extrapleural pneumonectomy versus pleural decortication and discuss the nuances of choosing the right approach for the right patient.
Learning Objectives
- Describe the workup and staging of a patient with malignant pleural mesothelioma
- List the subtypes of malignant pleural mesothelioma, characteristics of resectable disease, and patient factors which impact surgical candidacy
- Describe the approach to an extrapleural pneumonectomy and pleural decortication
- Analyze which surgical approach is best for various subsets of patients
- Describe the adjuvant treatment for malignant pleural mesothelioma
Hosts
Kelly Daus MD, Adam Bograd MD, Peter White MD, Brian Louie MD
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Can appendicitis wait until the morning? Join Drs. Ashlie Nadler, Jordan Nantais, Graham Skelhorne-Gross, and Marika Sevigny from our Emergency General Surgery Team as they discuss the role of deferring appendectomies from overnight to the next morning.
Paper 1: Patel SV, Zhang L, Mir ZM, Lemke M, Leeper WR, Allen LJ, Walser E, Vogt K. Delayed Versus Early Laparoscopic Appendectomy for Adult Patients With Acute Appendicitis: A Randomized Controlled Trial. Ann Surg. 2024 Jan 1;279(1):88-93.
https://pubmed.ncbi.nlm.nih.gov/37436871/
-Non-inferiority randomized controlled trial comparing delayed appendectomy group with surgery taking place after 0600 the morning following a decision to operate versus the immediate appendectomy group with surgery taking place between 8pm and 4am and within 6 hours of a decision to operate
-A priori non-inferiority margin of 15% for 30-day complications
-Intention-to-treat analysis with risk difference -12% in favor of the delayed group (p < 0.001)
-Superiority as on per protocol analysis
-Underpowered at 91% due to early closure of study due to loss of reliable day time emergency triage operating time
Paper 2: Jalava K, Sallinen V, Lampela H, Malmi H, Steinholt I, Augestad KM, Leppäniemi A, Mentula P. Role of preoperative in-hospital delay on appendiceal perforation while awaiting appendicectomy (PERFECT): a Nordic, pragmatic, open-label, multicentre, non-inferiority, randomised controlled trial. Lancet. 2023 Oct 28;402(10412):1552-1561.
https://pubmed.ncbi.nlm.nih.gov/37717589/
-Non-inferiority randomized controlled trial comparing appendectomy within 8 hours versus 24 hours
-No difference in rate of perforation on intention-to-treat or per protocol analyses
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Before 1952, open heart surgery was considered science fiction. The heart was off limits to surgeons despite more than half a million Americans dying annually from heart disease. Doing nothing was the strategy. However, the status quo would soon change thanks to a few brave and imaginative surgeons who dared to break the most rigid of medical taboos: Do not touch the human heart. We sat down with Dr. Gerald Imber, author of the new book “Cardiac Cowboys: The Heroic Invention of Heart Surgery” to discusshow five men raced to invent an entirely new field of surgery.
Guests:
Jessica Millar, MD- General Surgery Resident- University of Michigan; Education Fellow- Behind the Knife
Nick Teman, MD- Associate Professor of Cardiac Surgery and Critical Care- University of Virginia
Gerald Imber- Assistant Clinical Professor of Plastic surgery at the Weill-Cornell Medical Center, Attending Surgeon at New York-Presbyterian Hospital, and Director of a private clinic in New York City, NY; Author of “Wendell Black, MD”, “Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted”, and “Cardiac Cowboys: The Heroic Invention of Heart Surgery”.
Want to hear more from Dr. Imber- be sure to check out his podcast series, Cardiac Cowboys, based on Dr. Imber’s book. You can listen to an introduction of the Cardiac Cowboys series here: https://shorturl.at/rKLM8
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Join Drs. Galandiuk, Bolshinsky, Kavalukas, and Simon as they discuss Management of Advanced and Malignant Polyps. Come with us as we navigate through sessile serrated lesions, pathology reports, and rectal polyp nuances.
Hosts:
- Susan Galandiuk, University of Louisville, Louisville, Kentucky, @DCREdInChief
- Vladimir Bolshinsky, Peninsula Health, Victoria, Australia, @bolshinskyv
- Sandy Kavalukas, University of Louisville, Louisville, Kentucky, @sandykava
- Hillary Simon, University of Louisville, Louisville, Kentucky, @HillaryLSimon
Producer:
- Manasa Sunkara MS3, University of Louisville, Louisville, Kentucky, @manasasunkara12
Learning objectives:
- Review colorectal cancer screening for the average risk patient.
- Understand what a malignant polyp is defined as and management strategies.
- Discuss the pathology review and re-review processes.
References:- Church J, et al. Keeping the Cecum Clean: A Randomized, Prospective, Placebo-Controlled Trial of Loperamide as Part of Preparation for Colonoscopy. Diseases of the Colon & Rectum 56(1):p 120-125, January 2013.
https://pubmed.ncbi.nlm.nih.gov/23222289/
- Fan C, et al. Management of Serrated Polyps of the Colon. Curr Treat Options Gastroenterol 16(1):182-202, March 2018.
https://pubmed.ncbi.nlm.nih.gov/29445907/
- Gupta S, et al. Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. The American Journal of Gastroenterology 115(3): 415-434, March 2020.
https://pubmed.ncbi.nlm.nih.gov/32039982/
- Hyman N, Waye JD. Endoscopic four quadrant tattoo for the identification of colonic lesions at surgery. Gastrointest Endosc 37:56–58, 1991.
https://pubmed.ncbi.nlm.nih.gov/1706283/
- Kaltenbach T, et al. Endoscopic Removal of Colorectal Lesions—Recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastrointestinal Endoscopy 91(3): 486-519, March 2020.
https://pubmed.ncbi.nlm.nih.gov/32067745/
- Keswani R, et al. AGA Clinical Practice Update on Strategies to Improve Quality of Screening and Surveillance Colonoscopy: Expert Review. Gastroenterology, 161(2): 701 – 711, Aug 2021.
https://pubmed.ncbi.nlm.nih.gov/34334168/
- Shaukat A, et al. Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps: Recommendations of the US Multi-Society Task Force on Colorectal Cancer.Gastroenterology, 159(5): 1916 - 1934.e2, Nov 2020.
https://pubmed.ncbi.nlm.nih.gov/33159840/
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Join for the third episodes in the Association of Out Surgeons & Allies (AOSA) series for a discussion on LGBTQIA+ healthcare providers and their patients.
Host:
Nina Clark, MD
Guests:
- Andrew Schlussel, DO, Colorectal and General Surgeon, Charlie Norwood VA Medical Center
- Dr. James Taylor, Assistant Professor of Colorectal Surgery at Montefiore Medical Center
- Dr. Alex Bonte, General Surgery PGY4 at Hackensack University Medical Center in Hackensack NJ.
- Dr. Paige Tannhauser, General Surgery PGY3 (completed) at Allegheny General Hospital in Pittsburgh PA, and currently finishing up a post-doctoral research fellowship at the University of Virginia.
Learn more and get involved with AOSA: https://www.outsurgeons.org
Twitter/X: @OutSurgeons
Resources Mentioned This Episode:
"Gender Unicorn" schema for terminology: https://transstudent.org/gender/
LGBTQ Healthcare Directory: https://lgbtqhealthcaredirectory.org/
CDC Recommendations in LGBTQ Health: https://www.cdc.gov/lgbthealth/index.htm
WPATH Resources: https://www.wpath.org/
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Listen to another episode by the Hernia Team from Carolinas Medical Center as they discuss their approach to open preperitoneal ventral hernia repair. Although uncommonly performed, a preperitoneal approach offers several advantages including the ability to achieve large mesh overlap without the need for myofascial release. The team discusses their tips and tricks for utilizing the preperitoneal space in even the most challenging hernia cases.
Hosts:
- Dr. Sullivan “Sully” Ayuso, Chief Resident, Carolinas Medical Center, @SAyusoMD (Twitter)
- Dr. Todd Heniford, Chief of GI & MIS, Carolinas Medical Center, @THeniford (Twitter)
- Dr. Vedra Augenstein, Professor of Surgery, Carolinas Medical Center, @VedraAugenstein (Twitter)
- Dr. Monica Polcz, Attending Surgeon, Baptist Health (Miami, FL)
Learning Objectives:
- Review standard methods of herniorraphy in open abdominal wall reconstruction
- Introduce the concept of open preperitoneal ventral hernia repair
- Discuss the advantages as well as the standard tips and tricks for performing an open preperitoneal repair
- Review outcomes for preperitoneal hernia repair over time
Podcast Video Clip: https://www.youtube.com/watch?v=3pMvB0rnokQ
References:
- Novitsky et al, Open Preperitoneal Retrofascial Mesh Repair for Multiply Recurrent Ventral Incisional Hernias, JACS, 2006
https://pubmed.ncbi.nlm.nih.gov/36280505/
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Heniford et al, Preperitoneal Ventral Hernia Repair: A Decade Long Prospective Observational Study with Analysis of 1023 Patient Outcomes, Annals of Surgery, 2020
https://pubmed.ncbi.nlm.nih.gov/30080725/ -
Katzen et al, Open Preperitoneal Ventral Hernia Repair: Prospective Observational Outcomes of Quality Improvement Outcomes Over 18 Years and 1,842 Patients, Surgery, 2023
https://pubmed.ncbi.nlm.nih.gov/36280505/
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Eat when you can, sleep when you can, and don’t F with the pancreas! What happens when that third rule goes wrong, and why do people say pancreas injuries are like eating crawfish? Whether you love the pancreas or just the mention of the P-word strikes fear in your heart, or if you just want the answer to the aforementioned questions, join Drs. Cobler-Lichter, Kwon, and Meizoso, as they guide you through all this and more!
Hosts:- Michael Cobler-Lichter, MD, PGY3, University of Miami/Jackson Memorial Hospital/Ryder Trauma Center, @mdcobler (twitter)
- Eugenia Kwon, MD, Trauma/Surgical Critical Care Fellow, University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
-Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery, 4 years in practice, University of Miami/Jackson Memorial Hospital/Ryder Trauma Center, @jpmeizoso (twitter)
Learning Objectives:- Describe the AAST grading system for pancreatic injuries
- Come up with a treatment plan for each grade of pancreatic injury
- Identify commonly associated injuries with pancreatic trauma
- List potential complications of pancreatic trauma and/or surgery
Quick Hits:
1. Pancreas injuries do not all require a trip to the operating room. Low grade injuries should be managed with a trial of nonoperative management if there are no other operative indications
2. CT is the best initial imaging modality, although it has low sensitivity. If there is high concern for a pancreas injury based on mechanism or associated injuries, further investigation is required.
3. Pancreas injuries are like crawfish: suck the head and eat the tail.
4. Injuries to the left of the SMV can generally be treated with distal pancreatectomy and splenectomy, whereas injuries to the right of the SMV are usually drained.
5. Its important to identify and address any concomitant injuries, with duodenal injuries being the most common in higher grade injuries.
6. In the case of the dreaded grade 5 injury, the safe answer is to come back and do your reconstruction at a later time.
References
1. https://www.westerntrauma.org/western-trauma-association-algorithms/management-of-pancreatic-injuries/
2. Bassi, Claudio et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery, Volume 161, Issue 3, 584 – 591
https://pubmed.ncbi.nlm.nih.gov/28040257/
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Join us for another episode of our Global Surgery series, where we have a special focus on trauma care in resource-limited settings.
Traumatic injury remains one of the largest burdens of disease and causes of mortality internationally. The WHO estimates that 4.4 million lives are lost to traumatic injuries per year, accounting for approximately 8% of all deaths. Notably, traumatic injuries are the top killer of children, adolescents, and young adults, compounding the patient-years lost. Trauma is ubiquitous–accidents and injuries happen all over the globe, and thus differences in trauma incidence and mortality is often a function of health systems and infrastructure.
Jon Williams is joined by Dr. Anthony Charles. Dr. Charles is a trauma surgeon at University of North Carolina, Chapel Hill. Additionally, he holds professorships in the medical school and school of public health at UNC, as well as serving as the director of the adult ECMO program and the director of global surgery at the UNC Institute of Global Health and Infectious Diseases. He leads the Malawian Surgical Initiative, designed to train and support local surgeons in the country of Malawi where he has established a longstanding partnership with UNC. Having been raised in Nigeria, Dr. Charles completed medical school at the University of Lagos, and subsequently underwent general surgery residency training in London at North Middlesex University Hospital and subsequently at Charles Drew University in Los Angeles. Upon completion of trauma and critical care fellowship at University of Michigan, he took a faculty position at UNC where he has remained since and grown the global surgery presence to what it is today.
Key Points:1. Often, the pivotal first step in developing global surgery trauma initiatives is increasing trained personnel, and so training initiatives are very meaningful and provide sustainability to the effort. 2. Growing a health system’s ability to provide trauma care helps develop improved care for all aspects of disease. The resources, training, and infrastructure required benefits healthcare at large. 3. Improvement of trauma care extends well beyond in-hospital care–injury prevention and pre-hospital care/triage/transport are even more impactful. 4. It takes more than surgeons to improve trauma care globally. Thus, clinician and non-clinician training and oversight is critical, and foundational concepts of care of the trauma patient must be familiar to all. 5. Local governing bodies need to understand the importance of trauma care to invest in it. Traumatic injuries and mortality are a health burden, but even more so an economic burden to a country. This is what is compelling to investment in trauma care.
We now have over 725 episodes! The easiest way to find specific topics or episodes is on our website https://app.behindtheknife.org/home or on our new Apple/Android app. You can search or browse by topic, podcast series, etc., making it much easier to navigate than podcast players.
iOS: https://apps.apple.com/us/app/behind-the-knife/id1672420049
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Premium Bundle Includes:
General Surgery Oral Board Audio Review
Trauma Surgery Video Atlas
Colorectal Surgery Oral Board Audio Review
Surgical Oncology Surgery Oral Board Audio Review
Vascular Surgery Surgery Oral Board Audio Review
Cardiothoracic Surgery Surgery Oral Board Audio Review
Join us for a new edition of our global surgery series! On this episode, Dr. Jon Williams is joined by Dr. Sudha Jayaraman and Dr. Justina Seyi-Olajide to discuss how we define global surgery today and how health infrastructure interacts with global surgical care.
Dr. Jayaraman is a trauma and acute care surgeon at University of Utah, and the director of the Center for Global Surgery. After attending UC Davis for medical school, Dr. Jayaraman completed general surgery residency at UCSF, during which time she obtained a masters in public health in developing countries from the London School of Hygiene and Tropical Medicine. During this time, her efforts were dedicated to researching and implementing trauma systems development in Uganda. After residency she then completed a trauma and critical care fellowship at Brigham and Women’s, during which she received the Harvard Medical School Health Disparities Fellowship to continue her trauma systems work in Rwanda. Her ongoing work investigating injury burden and trauma systems in low and middle income countries has been well funded by the NIH, DOD, and others and published in numerous forums, as she is a well-renowned expert in this field.
Dr. Justina Seyi-Olajide is a pediatric surgeon at the Lagos University Teaching Hospital in Lagos, Nigeria. She completed her medical school training at the Ahmadu Bello University in Zaria, Nigeria and subsequently her general surgical and pediatric surgical training at the Lagos University Teaching Hospital, earning the Fellowship of West African College of Surgeons in Pediatric Surgery and the Alinta Nwako prize for best graduating pediatric surgical trainee. Dr. Seyi-Olajide’s vision is to provide equitable pediatric surgical care in resource-limited settings, and has been highly influential for developing initiatives such as the National Surgical, Obstetric, Anesthesia and Nursing Plan for Nigeria. Additionally, she is a member of the Global Initiative for Children’s Surgery and is well published for her original research on topics regarding access to pediatric surgical care in low and middle income countries.
Have any feedback for the global surgery content, or have any suggestions for future episodes? Please feel free to reach out to us at hello@behindtheknife.org.
We now have over 725 episodes! The easiest way to find specific topics or episodes is on our website https://app.behindtheknife.org/home or on our new Apple/Android app. You can search or browse by topic, podcast series, etc., making it much easier to navigate than podcast players.
iOS: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android: https://play.google.com/store/apps/details?id=com.btk.app
PREMIUM BUNDLE:
https://app.behindtheknife.org/bundle/95
Please email hello@behindtheknife.org to learn more about our premium bundle and institutional discounts.
Premium Bundle Includes:
General Surgery Oral Board Audio Review
Trauma Surgery Video Atlas
Colorectal Surgery Oral Board Audio Review
Surgical Oncology Surgery Oral Board Audio Review
Vascular Surgery Surgery Oral Board Audio Review
Cardiothoracic Surgery Surgery Oral Board Audio Review
With the increasing popularity of artificial intelligence, its uses are quickly becoming not only a part of everyday life, but also training in surgery. Those of us without much understanding of the technology might be intimidated by this nebulous topic, or worry that we won’t be able to comprehend the advancements to come to the field. Luckily, we’re joined by a leading expert in the use of AI in surgery, Dr. Dan Hashimoto. He breaks down some examples of how AI is being used in surgical education, the role surgeons should play in these advancements, and some tips for how we can critically appraise work in the field of AI if we don’t understand the technology ourselves. Join hosts Nicole Brooks, MD, Judith French, PhD and Jeremy Lipman, MD, MHPE for this exciting conversation.
Learning Objectives
1. Listeners will describe how AI is being applied to surgical education.
2. Listeners will identify the roles surgeons without training in AI can play in developing the use of AI in surgery.
3. Listeners will explain the regulatory and ethical considerations that must be addressed with the implementation of AI in surgical education.
4. Listeners will consider principles for critically evaluating research or technology in AI for application or use in their own educational or surgical practice.
References
Laplante S, Namazi B, Kiani P, Hashimoto DA, Alseidi A, Pasten M, Brunt LM, Gill S, Davis B, Bloom M, Pernar L, Okrainec A, Madani A. Validation of an artificial intelligence platform for the guidance of safe laparoscopic cholecystectomy. Surg Endosc. 2023 Mar;37(3):2260-2268. doi: 10.1007/s00464-022-09439-9. Epub 2022 Aug 2. PMID: 35918549.
https://pubmed.ncbi.nlm.nih.gov/35918549/
Hashimoto DA, Varas J, Schwartz TA. Practical Guide to Machine Learning and Artificial Intelligence in Surgical Education Research. JAMA Surg. 2024 Jan 3. doi: 10.1001/jamasurg.2023.6687. Epub ahead of print. PMID: 38170510.
https://pubmed.ncbi.nlm.nih.gov/38170510/
We now have over 725 episodes! The easiest way to find specific topics or episodes is on our website https://app.behindtheknife.org/home or on our new Apple/Android app. You can search or browse by topic, podcast series, etc., making it much easier to navigate than podcast players.
iOS: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android: https://play.google.com/store/apps/details?id=com.btk.app
PREMIUM BUNDLE:
https://app.behindtheknife.org/bundle/95
Please email hello@behindtheknife.org to learn more about our premium bundle and institutional discounts.
Premium Bundle Includes:
General Surgery Oral Board Audio Review
Trauma Surgery Video Atlas
Colorectal Surgery Oral Board Audio Review
Surgical Oncology Surgery Oral Board Audio Review
Vascular Surgery Surgery Oral Board Audio Review
Cardiothoracic Surgery Surgery Oral Board Audio Review
The Fellowship of the Snow kept it interesting this year…both on and off the slopes! On this episode, Patrick Georgoff discusses the Western Trauma Association’s updated resuscitative thoracotomy algorithm with Ron Tesoriero, the results of a WTA multicenter trial exploring chest tube irrigation for the prevention of retained hemothorax with Thomas Carver, and prehospital blood administration with Juan Duchesne.
** Algorithms and papers are pending final review and are therefore not available to link to this episode.
Ron Tesoriero, MD: Associate Professor of Surgery, Director of the Acute Care Surgery Fellowship, and Co-Director of the SICU at UCSF.
Thomas Carver, MD: Associate Professor of Surgery, Director of the Acute Care Surgery Fellowship, and Senior Medical Director of Critical Care Services at the Medical College of Wisconsin.
Juan Duchesne, MD: Professor of Surgery and Chief of Trauma and Acute Care Surgery at Tulane university.
Resuscitative Thoracotomy: The Who (Episode 475): https://app.behindtheknife.org/podcast/big-t-trauma-series-ep-14-ed-thoracotomy-the-who
Resuscitative Thoracotomy: The How (Episode 476): https://app.behindtheknife.org/podcast/big-t-trauma-series-ep-15-ed-thoracotomy-the-how
Innovation Lifeflow (Episode 642): https://app.behindtheknife.org/podcast/innovations-in-surgery-lifeflow
We now have over 725 episodes! The easiest way to find specific topics or episodes is on our website https://app.behindtheknife.org/home or on our new Apple/Android app. You can search or browse by topic, podcast series, etc., making it much easier to navigate than podcast players.
iOS: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android: https://play.google.com/store/apps/details?id=com.btk.app
PREMIUM BUNDLE:
https://app.behindtheknife.org/bundle/95
Please email hello@behindtheknife.org to learn more about our premium bundle and institutional discounts.
Premium Bundle Includes:
General Surgery Oral Board Audio Review
Trauma Surgery Video Atlas
Colorectal Surgery Oral Board Audio Review
Surgical Oncology Surgery Oral Board Audio Review
Vascular Surgery Surgery Oral Board Audio Review
Cardiothoracic Surgery Surgery Oral Board Audio Review
In this episode of Behind the Knife the vascular surgery subspecialty team discusses a few case scenarios of patients with dialysis associated hand ischemia (or steal syndrome). Although a rare, steal syndrome can be detrimental to patients with end stage renal disease and result in not only risk of losing dialysis access but even their limb. What options do you have to fix this problem? In this episode, we will cover the who is at risk of this, and what options you have to fix it.
Hosts:
Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan and the Program Director of the Integrated Vascular Surgery Residency Program as well as the Vascular Surgery Fellowship Program at the University of Michigan.
Dr. David Schectman is a Vascular Surgery Fellow at the University of Michigan
Dr. Drew Braet is a PGY-4 Integrated Vascular Surgery Resident at the University of Michigan
Learning Objectives
- Review high-yield topics regarding hemodialysis access
- Understand the incidence of and the relevant risk factors for dialysis associated steal syndrome
- Review the spectrum of presenting symptoms and relevant workup for dialysis associated steal syndrome
- Understand surgical treatment options for dialysis associated steal syndrome
References
Please review the journal article below for helpful pictures and depictions of the operations we describe in this episode.
- Al Shakarchi J, et al. Surgical techniques for haemodialysis access-induced distal ischaemia. J Vasc Access. 2016 Jan-Feb;17(1):40-6.
https://pubmed.ncbi.nlm.nih.gov/26349875/
Other helpful references
- Kordzadeh A, Parsa AD. A Systematic review of distal revascularization and interval ligation for the treatment of vascular access-induced ischemia. J Vasc Surg 2019; 70:1364.
https://pubmed.ncbi.nlm.nih.gov/31153703/
- Huber TS, Larive B, Imprey PB, et al. Access-related hand ischemia and the Hemodialysis Fistula Maturation Study. J Vasc Surg 2016;64:1050.
https://pubmed.ncbi.nlm.nih.gov/27478007/
- Sidawy An, Spergel LM, Besarab A, et al. The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg 2008; 48:2S.
https://pubmed.ncbi.nlm.nih.gov/19000589/
Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Join BTK eduction fellows, Drs. Nina Clark and Jon Williams along with guests Drs. Sharmila Dissanaike and Paula Ferrada for a discussion on whether it’s time for a paradigm shift toward a circulation-first approach to trauma resuscitation.
Hosts:Nina Clark, MD and Jon Williams, MD
Guests:Sharmila Dissanaike, MD - Texas Tech University Health Sciences Center, Lubbock, TX
Paula Ferrada, MD - Inova, Fairfax, VA
References:Ferrada P, Dissanaike S. Circulation First for the Rapidly Bleeding Trauma Patient-It Is Time to Reconsider the ABCs ofTrauma Care. JAMA Surg. 2023 Aug 1;158(8):884-885. doi: 10.1001/jamasurg.2022.8436. PMID: 37195675.
https://pubmed.ncbi.nlm.nih.gov/37195675/
Ferrada P, Ferrada R, Jacobs L, Duchesne J, Ghio M, Joseph B, Taghavi S, Qasim ZA, Zakrison T, Brenner M,Dissanaike S, Feliciano D. Prioritizing Circulation to Improve Outcomes for Patients with Exsanguinating Injury: ALiterature Review and Techniques to Help Clinicians Achieve Bleeding Control. J Am Coll Surg. 2024 Jan 1;238(1):129-136. doi: 10.1097/XCS.0000000000000889. Epub 2023 Nov 28. PMID: 38014850; PMCID: PMC10718219.
https://pubmed.ncbi.nlm.nih.gov/38014850/
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Please visit https://app.behindtheknife.org/home to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here https://app.behindtheknife.org/listen
Join the Behind the Knife Surgical Oncology Team as we discuss “One versus Three Years of Adjuvant Imatinib for Operable Gastrointestinal Stromal Tumor: A Randomized Trial,” the randomized trial guiding duration of imatinib treatment for gastrointestinal stromal tumors (GIST).
Hosts:
- Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center.
- Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist and current HPB fellow at MD Anderson.
- Connor Chick, MD (@connor_chick) is a Surgical Oncology fellow at Ohio State University.
- Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-6 General Surgery resident at Brooke Army Medical Center.
- Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-5 General Surgery resident at Brooke Army Medical Center.
Learning Objectives:
In this episode, we discuss the article “One versus Three Years of Adjuvant Imatinib for Operable Gastrointestinal Stromal Tumor: A Randomized Trial” published in JAMA in 2012. This study demonstrated that 3 years of imatinib led to improved recurrence-free and overall survival compared to 1 year.
Links to Paper Referenced in this Episode
https://jamanetwork.com/journals/jama/fullarticle/1105116 Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9
Please visit https://app.behindtheknife.org/home to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here https://app.behindtheknife.org/listen
Though relatively rare, lateral abdominal wall hernias present a unique challenge to surgeons. Join Drs. Ajita Prabhu, Lucas Beffa, Sara Maskal and Ryan Ellis as they talk through their approach to these difficult cases.
Hosts:
· Ajita Prabhu, MD, Cleveland Clinic, @aprabhumd1
· Lucas Beffa, MD, Cleveland Clinic, @BeffaLukeMD
· Ryan Ellis, MD, Cleveland Clinic, @EllisMD2020
· Sara Maskal, MD, Cleveland Clinic
Learning Objectives:
· Review anatomy of lateral abdominal wall hernias
· Review pitfalls of operating in the retroperitoneum
· Review surgical approaches to repair defects based on algorithmic assessment
References:
· Montelione KC, Petro CC, Krpata DM, Lau B, Shukla P, Olson MA, Tamer R, Rosenblatt S, Rosen MJ, Prabhu AS. Open Retromuscular Lateral Abdominal Wall Hernia Repair: Algorithmic Approach and Long-Term Outcomes at a Single Center. J Am Coll Surg. 2023 Jan 1;236(1):220-234. doi: 10.1097/XCS.0000000000000419. Epub 2022 Dec 15. PMID: 36106747.
https://pubmed.ncbi.nlm.nih.gov/36106747/
· Beffa LR, Margiotta AL, Carbonell AM. Flank and Lumbar Hernia Repair. Surg Clin North Am. 2018 Jun;98(3):593-605. doi: 10.1016/j.suc.2018.01.009. Epub 2018 Mar 12. PMID: 29754624.
https://pubmed.ncbi.nlm.nih.gov/29754624/
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Please visit https://app.behindtheknife.org/home to access other high-yield surgical education podcasts, videos and more.
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Do the words “Is there a doctor on board” fill you with anxiety? For Dr. Thomas Doyle, responding to in flight medical events is just another day at the office. As the medical director for STAT-MD, him and his team provide on the ground consultation for passengers experiencing medical events at 35,000 feet. In this episode we talk about what events are most common, what equipment is on board, what are the rules/regulations around providing medical assistance, and what ground consultation services like STAT-MD can help offer to you so you’re never alone if you hear that phrase “Is there a doctor on board?”
Guests:
Thomas J. Doyle, MD, MPH- Clinical Associate Professor of Emergency Medicine- University of Pittsburgh Medical Center; Medical Director, STAT-MD
Jessica Millar, MD- General Surgery Resident- University of Michigan; Education Fellow- Behind the Knife
Major John McClellan, MD- Acute Care and Trauma Surgeon- University of North Carolina Chapel Hill
Want to learn more from Dr. Doyle about in-flight medical events- you can check out one of his previous lectures here: https://www.upmcphysicianresources.com/cme-courses/emergencies-at-35000-feet-is-there-a-medical-provider-on-board
**Introducing Behind the Knife's Trauma Surgery Video Atlas - https://app.behindtheknife.org/premium/trauma-surgery-video-atlas/show-content
The Trauma Surgery Video Atlas contains 24 scenarios that include never-before-seen high-definition operative footage, rich, original illustrations, and practical, easy-to-read pearls that will help you dominate the most difficult trauma scenarios.
Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out more recent episodes here: https://app.behindtheknife.org/listen
You have a patient referred to you for a history of anal dysplasia and found to have an anal lesion on colonoscopy. How do you evaluate this? What are the risk factors? How will you perform surveillance afterwards? Does everyone need HRA? Tune in to find out!
Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Lisa Breen as they discuss high yield papers discussing Anal Dysplasia.
Learning Objectives
1. Describe the different types of anal dysplasia and pathologic categorization
2. Describe high risk populations for development of anal squamous cell cancer
3. Discuss the different options and recommendations for surveillance and treatment of anal dysplasia
Video Link: https://www.youtube.com/watch?v=YdOjV1Gcqvk
**Introducing Behind the Knife's Trauma Surgery Video Atlas - https://app.behindtheknife.org/premium/trauma-surgery-video-atlas/show-content
The Trauma Surgery Video Atlas contains 24 scenarios that include never-before-seen high-definition operative footage, rich, original illustrations, and practical, easy-to-read pearls that will help you dominate the most difficult trauma scenarios.
Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out more recent episodes here: https://app.behindtheknife.org/listen
You get called to see a consult in the middle of the night. It is a middle-aged woman with a bariatric history, and she says her stomach is smaller but doesn’t know the name of the operation. She developed worsening abdominal pain after dinner and it’s been getting worse. She’s not peritonitic, but she’s clearly in discomfort. Is it cholecystitis, diverticulitis, pancreatitis, marginal ulcer, or an internal hernia? What do you do? Join Drs. Matthew Martin, Adrian Dan, and Paul Wisniowski on a discussion about initial evaluation and management of bariatric patients with internal hernias.
Show Hosts:
Matthew Martin
Adrian Dan
Paul Wisniowski
Video companion: https://app.behindtheknife.org/video/clinical-challenges-in-bariatric-surgery-internal-hernia
Show Notes
1. Initial Evaluation
a. Focused history and physical, labs, and imaging
i. Presenting symptoms may vary and include: nausea, emesis, and abdominal pain ranging from vague to severe.
ii. A basic lab panel can aid in developing the diagnosis and guide resuscitation.
iii. CT of the abdomen and pelvis with IV and oral contrast can assist in identifying intra-abdominal pathology
iv. Reviewing the previous operative report is beneficial to have a framework of the anatomy, i.e. type of bariatric surgery, and configuration of small bowel limbs (ante- vs retro-gastric and ante- vs retro-colic).
1. According to a 2019 study, 40-60% of closed defects had reopened at time of re-exploration
v. If the patient is peritonitic with abdominal pain, they should be treated similarly to any patient with an acute abdomen with emergent exploration.
b. CT Imaging
i. A mesenteric swirl sign with twisting of the soft tissue and mesenteric vessels with surrounding fat attenuation has been shown to have a sensitivity of 78-100% and specificity of 80-90%. Other findings include: a Bird’s beak, dilation of roux or biliopancreatic limbs, SMV narrowing, and displacement of JJ limb to the RUQ and can be used to support the diagnosis of internal hernia
ii. An experienced radiologist familiar with bariatric anatomy has been shown to have a positive predictive value to 81% and negative predictive value to 96% at radiologically diagnosing internal hernia.
iii. A CT scan can provide insight for a suspected diagnosis but it cannot rule out internal hernia
c. Nasogastric/Esophageal Tube
i. Use judiciously based on patient’s presenting symptoms
ii. Placement should be done by the surgical team
iii. This may mitigate the risk of aspiration during intubation.
2. Operative Management
a. Entry should be dependent on the comfort of the operating surgeon.
i. Veress entry into the abdomen with dilated bowels may lead to increased injuries.
ii. Optiview allows for direct visualization of each layer of the abdominal wall. Focusing on twisting the trochar and limiting perpendicular pressure.
iii. Hasson entry also allows for direct visualization but may be limiting in bariatric patients with thick abdominal walls
b. Exploration – a systematic approach
i. Start with evaluation of the gastric pouch and run the roux limb to the jejunojejunostomy, and examine Petersen’s and mesojejunal defects.
ii. Follow the biliopancreatic limb to the ligament of Treitz
iii. Lastly, identify the terminal ileum at the sail of Treves and run backwards to the jejunojejunostomy
iv. This will allow for examination of all possible defect and possible intussusception at the jejunostomy
c. Defect Management
i. All defects should be closed, with studies demonstrating reduced rates of internal hernia when defects are closed with a running suture. There is no strong evidence to support the use of a specific suture material.
1. The use of suture is superior to other methods of closure such as metallic clips, fibrin glue, mesh, or abrasive pads.
2. A barbed suture can be considered.
d. In a patient with unfavorable anatomy or those unable to tolerate pneumoperitoneum surgeons should consider early conversion to open exploration
3. Postoperative Care
a. Patients are started on ERAS protocol with limited narcotic use, same day mobilization, early oral nutrition with advancement, and no nasogastric tubes or foley catheters
b. Patients with bowel resection and those with suspected postoperative ileus may benefit from judicious advancement of diet.
4. Pregnancy
a. Pregnant patients with history of anastomotic bariatric surgery are at increased risk of internal hernia especially in 3rd trimester due to loss of intra-abdominal space
b. Evaluation of a pregnant patient should include abdominal imaging.
i. In a non-acute setting, an MRI abd/pelvis can be considered.
ii. Patients with abdominal pain presenting to the Emergency Department should undergo CT imaging.
iii. The risk of radiation to a fetus, especially beyond the 1st trimester, is limited. Based on the CDC guidelines, a human embryo and fetus are sensitive to ionizing radiation at doses greater than 0.1Gray. The amount of radiation from a typical CT range from 0.015 to 0.034Gray depending if it is multiphasic or not; well below the guideline level.
c. It is important to discuss with women of child bearing age the risk of internal hernia during pregnancy with anastomotic bariatric surgery
5. Outpatient Presentation
a. Half of patients with internal hernia will present in outpatient setting often >6 months after initial operation with complaints of intermittent nausea, vomiting, and abdominal pain
b. Workup includes: CT abd/pelvis with IV and oral contrast, Upper GI series, EGD, and a RUQ ultrasound based on their symptoms
c. If diagnostic testing is equivocal, proceed with diagnostic laparoscopy to mitigate the risk of internal hernia with bowel ischemia.
**Introducing Behind the Knife's Trauma Surgery Video Atlas - https://app.behindtheknife.org/premium/trauma-surgery-video-atlas/show-content
The Trauma Surgery Video Atlas contains 24 scenarios that include never-before-seen high-definition operative footage, rich, original illustrations, and practical, easy-to-read pearls that will help you dominate the most difficult trauma scenarios.
Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out more recent episodes here: https://app.behindtheknife.org/listen
We know cardiac surgery can seem a bit daunting on the surface. However, most surgeons will come across cardiac surgery patients at some point whether in the OR, ICU, ED, etc. As the FIRST cardiac surgery specialty team for Behind the Knife, we are excited to bring you episodes focused on high-yield topics to help you navigate common cardiac surgery challenges, discuss relevant literature to help you in practice, and help our listeners feel more comfortable around cardiac surgery patients.
In this episode we’ll discuss mitral valve disease. We’ll review important physiologic differences in patients with mitral valve disease, the most common surgical approaches to address mitral valve disease, and how to work up and address acute mitral regurgitation due to acute papillary muscle rupture.
Hosts:
- Jessica Millar, MD- PGY-5 General Surgery Resident, University of Michigan, @Jess_Millar15
- Aaron William, MD- Cardiothoracic Surgery Fellow, Duke University, @AMWilliamsMD
- Nick Teman, MD- Assistant Professor of Thoracic and Cardiovascular Surgery, University of Virginia, @nickteman
Learning objectives:
- Understand the physiologic differences that occur with mitral valve stenosis and regurgitation.
- Understand the basic principles of mitral valve repair and replacement strategies.
- Understand the presentation, work-up, and acute management of acute mitral valve regurgitations due to acute papillary muscle rupture/MI.
For episode ideas/suggestions/feedback feel free to email Jessica Millar at: millarje@med.umich.edu
**Introducing Behind the Knife's Trauma Surgery Video Atlas - https://app.behindtheknife.org/premium/trauma-surgery-video-atlas/show-content
The Trauma Surgery Video Atlas contains 24 scenarios that include never-before-seen high-definition operative footage, rich, original illustrations, and practical, easy-to-read pearls that will help you dominate the most difficult trauma scenarios.
Our Cardiothoracic Oral Board Audio Review includes 43 high-yield scenarios designed for Cardiothoracic Surgeons by Cardiothoracic Surgeons.
Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as cardiothoracic surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the course and see all the episode topics here: https://app.behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Our Cardiothoracic Oral Board Audio Review includes 43 high-yield scenarios designed for Cardiothoracic Surgeons by Cardiothoracic Surgeons.
Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as cardiothoracic surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the course and see all the episode topics here: https://app.behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
REBOA is one spicy meatball! On this episode, Drs. Nina Clark and Patrick Georgoff discuss the landmark UK-REBOA trial with Dr. Karim Brohi. This is the first randomized controlled trial studying REBOA and provides invaluable information about its potential indications.
Dr. Karim Brohi is a trauma and vascular surgeon at the Royal London Major Trauma Centre and director of the London Major Trauma System, which is the largest integrated urban trauma system in the world and manages over 33,000 injuries a year. He studied at University College of London where he obtained degrees in both computer science and medicine. Dr. Brohi went on to train in general surgery, vascular surgery, and anesthesia/critical care in the UK and trauma surgery in Cape Town and San Francisco. He is a prolific researcher and has led multiple large clinical trials.
Link to UK-REBOA paper: https://jamanetwork.com/journals/jama/article-abstract/2810757
BIG T Trauma episode 290 covers potential indications, placement, and complications of REBOA: https://behindtheknife.org/podcast/big-t-trauma-series-ep-2-reboa/
***TRAUMA SURGERY VIDEO ATLAS: https://app.behindtheknife.org/premium/trauma-surgery-video-atlas
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Surgical resection of bilateral colorectal liver metastasis (CLM) can pose a significant challenge to even the most experienced HPB surgeon. Is surgical resection justified, if so, in which patients? What’s the best surgical approach for curative intent resection of all lesions, and does ablation play a role? In this episode from the HPB team at Behind the Knife, listen in on the discussion about the surgical management of patients with bilateral colorectal liver metastasis.
Hosts
Anish J. Jain MD (@anishjayjain) is a T32 Research Fellow at the University of Texas MD Anderson Cancer Center within the Department of Surgical Oncology.
Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology. He is also the associate program director of the HPB fellowship at the University of Texas MD Anderson Cancer Center.
Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center
Learning Objectives:
· Develop an understanding of patient selection for surgical resection of bilateral colorectal liver metastasis (CLM).
· Develop an understanding of the use of Two Stage Hepatectomy (TSH) versus Parenchymal Sparing Hepatectomy (PSH) in the treatment of bilateral CLM.
· Develop an understanding of if and when to use ablative procedures for resection of bilateral CLM.
· Develop an understanding of selection and management of patients who suffer recurrence after resection of bilateral CLM.
Suggested Readings
· Omichi K, Shindoh J, Cloyd JM, Mizuno T, Chun YS, Conrad C, Aloia TA, Tzeng CD, Vauthey JN. Liver resection is justified for patients with bilateral multiple colorectal liver metastases: A propensity-score-matched analysis. Eur J Surg Oncol. 2018 Jan;44(1):122-129. doi: 10.1016/j.ejso.2017.11.006. Epub 2017 Nov 24. PMID: 29208318; PMCID: PMC5742306.
https://pubmed.ncbi.nlm.nih.gov/29208318/
· Kawaguchi Y, Kopetz S, Tran Cao HS, Panettieri E, De Bellis M, Nishioka Y, Hwang H, Wang X, Tzeng CD, Chun YS, Aloia TA, Hasegawa K, Guglielmi A, Giuliante F, Vauthey JN. Contour prognostic model for predicting survival after resection of colorectal liver metastases: development and multicentre validation study using largest diameter and number of metastases with RAS mutation status. Br J Surg. 2021 Aug 19;108(8):968-975. doi: 10.1093/bjs/znab086. PMID: 33829254; PMCID: PMC8378514.
https://pubmed.ncbi.nlm.nih.gov/33829254/
· Nishioka Y, Paez-Arango N, Boettcher FO, Kawaguchi Y, Newhook TE, Chun YS, Tzeng CD, Tran Cao HS, Lee JE, Vreeland TJ, Vauthey JN. Neither Surgical Margin Status nor Somatic Mutation Predicts Local Recurrence After R0-intent Resection for Colorectal Liver Metastases. J Gastrointest Surg. 2022 Apr;26(4):791-801. doi: 10.1007/s11605-021-05173-0. Epub 2021 Nov 1. PMID: 34725784.
https://pubmed.ncbi.nlm.nih.gov/34725784/
· Passot G, Chun YS, Kopetz SE, Zorzi D, Brudvik KW, Kim BJ, Conrad C, Aloia TA, Vauthey JN. Predictors of Safety and Efficacy of 2-Stage Hepatectomy for Bilateral Colorectal Liver Metastases. J Am Coll Surg. 2016 Jul;223(1):99-108. doi: 10.1016/j.jamcollsurg.2015.12.057. Epub 2016 Jan 18. PMID: 26968325; PMCID: PMC4925205.
https://pubmed.ncbi.nlm.nih.gov/26968325/
· Donadon M, Cescon M, Cucchetti A, Cimino M, Costa G, Pesi B, Ercolani G, Pinna AD, Torzilli G. Parenchymal-Sparing Surgery for the Surgical Treatment of Multiple Colorectal Liver Metastases Is a Safer Approach than Major Hepatectomy Not Impairing Patients' Prognosis: A Bi-Institutional Propensity Score-Matched Analysis. Dig Surg. 2018;35(4):342-349. doi: 10.1159/000479336. Epub 2017 Oct 14. PMID: 29032372.
https://pubmed.ncbi.nlm.nih.gov/29032372/
· Lillemoe HA, Kawaguchi Y, Passot G, Karagkounis G, Simoneau E, You YN, Mehran RJ, Chun YS, Tzeng CD, Aloia TA, Vauthey JN. Surgical Resection for Recurrence After Two-Stage Hepatectomy for Colorectal Liver Metastases Is Feasible, Is Safe, and Improves Survival. J Gastrointest Surg. 2019 Jan;23(1):84-92. doi: 10.1007/s11605-018-3890-y. Epub 2018 Aug 6. PMID: 30084064; PMCID: PMC6329635.
https://pubmed.ncbi.nlm.nih.gov/30084064/
· Panettieri E, Kim BJ, Kawaguchi Y, Ardito F, Mele C, De Rose AM, Vellone M, Chun YS, Tzeng CD, Aloia TA, Giuliante F, Vauthey JN. Survival by Number and Sites of Resections of Recurrence after First Curative Resection of Colorectal Liver Metastases. J Gastrointest Surg. 2022 Dec;26(12):2503-2511. doi: 10.1007/s11605-022-05456-0. Epub 2022 Sep 20. PMID: 36127553.
https://pubmed.ncbi.nlm.nih.gov/36127553/
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2023 was an exciting year for Surgical Palliative Care research! Join Drs. Katie O’Connell, Ali Haruta, Lindsay Dickerson, and Virginia Wang from the University of Washington to discuss two seminal randomized controlled trials in the Surgical Palliative Care space.
Hosts:
· Dr. Katie O’Connell (@katmo15) is an Assistant Professor of Surgery at the University of Washington. She is a trauma surgeon, palliative care physician, Director of Surgical Palliative Care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA.
· Dr. Ali Haruta is a PGY7 Hospice & Palliative Care fellow at the University of Washington, formerly a UW General Surgery resident and Parkland Trauma/Critical Care fellow.
· Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY5 General Surgery resident and current Surgical Oncology fellow at the University of Washington.
· Dr. Virginia Wang is a PGY2 General Surgery resident at the University of Washington.
Learning Objectives:
· Discuss the current state of the RCT literature in Palliative Care & Surgical Palliative Care
· Understand the primary outcomes of the Shinall and Aslakson trials as related to perioperative specialty palliative care intervention
· Identify limitations in existing surgical palliative care RCTs & further opportunities for study
· Identify underlying differences between medical oncology and surgical oncology patient populations
References:
1. Shinall MC, Martin SF, Karlekar M, et al. Effects of Specialist Palliative Care for Patients Undergoing Major Abdominal Surgery for Cancer: A Randomized Clinical Trial. JAMA Surg. 2023;158(7):747–755. doi:10.1001/jamasurg.2023.1396
https://pubmed.ncbi.nlm.nih.gov/37163249/
-
Aslakson RA, Rickerson E, Fahy B, et al. Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(5):e2314660. doi:10.1001/jamanetworkopen.2023.14660
https://pubmed.ncbi.nlm.nih.gov/37256623/ -
Ingersoll LT, Alexander SC, Priest J, et al. Racial/ethnic differences in prognosis communication during initial inpatient palliative care consultations among people with advanced cancer. Patient Educ Couns. 2019;102(6):1098-1103. doi:10.1016/j.pec.2019.01.002
https://pubmed.ncbi.nlm.nih.gov/30642715/ -
Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009;302(7):741-749. doi:10.1001/jama.2009.1198
https://pubmed.ncbi.nlm.nih.gov/19690306/ -
Corn BW, Feldman DB, Hull JG, O'Rourke MA, Bakitas MA. Dispositional hope as a potential outcome parameter among patients with advanced malignancy: An analysis of the ENABLE database. Cancer. 2022;128(2):401-409. doi:10.1002/cncr.33907
https://pubmed.ncbi.nlm.nih.gov/34613617/ -
El-Jawahri A, LeBlanc TW, Kavanaugh A, et al. Effectiveness of Integrated Palliative and Oncology Care for Patients With Acute Myeloid Leukemia: A Randomized Clinical Trial. JAMA Oncol. 2021;7(2):238-245. doi:10.1001/jamaoncol.2020.6343
https://pubmed.ncbi.nlm.nih.gov/33331857/ -
More about the metrics from both the Shinall and Aslakson studies:
a. FACT-G – https://www.facit.org/measures/fact-g
b. FACIT-Pal – https://www.facit.org/measures/facit-pal
c. PROMIS-29 – https://heartbeat-med.com/resources/promis-29/
d. PROPr (PROMIS-Preference) score – https://www.proprscore.com/
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Join Professor Michael Solomon, Dr Kilian Brown and Dr Jacob Waller from Royal Prince Alfred Hospital in Sydney, Australia, for this special four part series on pelvic exenteration surgery for locally advanced and recurrent rectal cancer. Learn about these ultra-radical procedures which go beyond the traditional TME planes that we learn during surgical training, and into all compartments of the pelvis.
Episode 4 outlines the complex perineal and soft tissue, urological, bone and vascular reconstructions that may be required as part of these multi-visceral resections, as well as how to approach challenging postoperative complications.
Each episode in this series features a different international guest surgeon. In episode 4, the RPA team are joined by A/Prof Gabrielle van Ramshorst from the Ghent University Hospital, Belgium.
Technical descriptions:
Ho K, Warrier S, Solomon MJ, Lee K. A prepelvic tunnel for the rectus abdominis myocutaneous flap in perineal reconstruction. J Plast Reconstr Aesthet Surg. 2006;59(12):1415-9. doi: 10.1016/j.bjps.2006.01.050. Epub 2006 Jun 22. PMID: 17113532.
https://pubmed.ncbi.nlm.nih.gov/17113532/
Jacombs AS, Rome P, Harrison JD, Solomon MJ. Assessment of the selection process for myocutaneous flap repair and surgical complications in pelvic exenteration surgery. Br J Surg. 2013 Mar;100(4):561-7. doi: 10.1002/bjs.9002. Epub 2012 Nov 27. PMID: 23188415.
https://pubmed.ncbi.nlm.nih.gov/23188415/
References:
Witte DYS, van Ramshorst GH, Lapid O, Bouman MB, Tuynman JB. Flap Reconstruction of Perineal Defects after Pelvic Exenteration: A Systematic Description of Four Choices of Surgical Reconstruction Methods. Plast Reconstr Surg. 2021 Jun 1;147(6):1420-1435. doi: 10.1097/PRS.0000000000007976. PMID: 33973948.
https://pubmed.ncbi.nlm.nih.gov/33973948/
van Ramshorst GH, Young JM, Solomon MJ. Complications and Impact on Quality of Life of Vertical Rectus Abdominis Myocutaneous Flaps for Reconstruction in Pelvic Exenteration Surgery. Dis Colon Rectum. 2020 Sep;63(9):1225-1233. doi: 10.1097/DCR.0000000000001632. PMID: 33216493.
https://pubmed.ncbi.nlm.nih.gov/33216493/
Sutton PA, Brown KGM, Ebrahimi N, Solomon MJ, Austin KKS, Lee PJ. Long-term surgical complications following pelvic exenteration: Operative management of the empty pelvis syndrome. Colorectal Dis. 2022 Dec;24(12):1491-1497. doi: 10.1111/codi.16238. Epub 2022 Jul 19. PMID: 35766998.
https://pubmed.ncbi.nlm.nih.gov/35766998/
Johnson YL, West MA, Gould LE, Drami I, Behrenbruch C, Burns EM, Mirnezami AH, Jenkins JT. Empty pelvis syndrome: a systematic review of reconstruction techniques and their associated complications. Colorectal Dis. 2022 Jan;24(1):16-26. doi: 10.1111/codi.15956. Epub 2021 Oct 25. PMID: 34653292.
https://pubmed.ncbi.nlm.nih.gov/34653292/
Persson P, Chong P, Steele CW, Quinn M. Prevention and management of complications in pelvic exenteration. Eur J Surg Oncol. 2022 Nov;48(11):2277-2283. doi: 10.1016/j.ejso.2021.12.470. Epub 2022 Jan 1. PMID: 35101315.
https://pubmed.ncbi.nlm.nih.gov/35101315/
Lee P, Tan WJ, Brown KGM, Solomon MJ. Addressing the empty pelvic syndrome following total pelvic exenteration: does mesh reconstruction help? Colorectal Dis. 2019 Mar;21(3):365-369. doi: 10.1111/codi.14523. Epub 2019 Jan 16. PMID: 30548166.
https://pubmed.ncbi.nlm.nih.gov/30548166/
Video Link: https://www.youtube.com/watch?v=GBC-ZD0B7UM
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Please visit https://app.behindtheknife.org/home to access other high-yield surgical education podcasts, videos and more.
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Join Professor Michael Solomon, Dr Kilian Brown and Dr Jacob Waller from Royal Prince Alfred Hospital in Sydney, Australia, for this special four part series on pelvic exenteration surgery for locally advanced and recurrent rectal cancer. Learn about these ultra-radical procedures which go beyond the traditional TME planes that we learn during surgical training, and into all compartments of the pelvis.
Episode 3 outlines the radical technical approaches to posterior and laterally invasive tumours, including en bloc iliac vascular resection and reconstruction, as well as radical sacrectomy techniques.
Each episode in this series features a different international guest surgeon. In episode 3, the RPA team are joined by Dr Oliver Peacock from the University of Texas MD Anderson Cancer Centre, USA.
Episode Video Link: https://www.youtube.com/watch?v=y25IYUiARgQ
Technical descriptions and videos:
Shaikh I, Holloway I, Aston W, Littler S, Burling D, Antoniou A, Jenkins JT; Complex Cancer Clinic St Mark's Hospital London. High subcortical sacrectomy: a novel approach to facilitate complete resection of locally advanced and recurrent rectal cancer with high (S1-S2) sacral extension. Colorectal Dis. 2016 Apr;18(4):386-92. doi: 10.1111/codi.13226. PMID: 26638828.
https://pubmed.ncbi.nlm.nih.gov/26638828/
Brown KGM, Solomon MJ, Austin KKS, Lee PJ, Stalley P. Posterior high sacral segmental disconnection prior to anterior en bloc exenteration for recurrent rectal cancer. Tech Coloproctol. 2016 Jun;20(6):401-404. doi: 10.1007/s10151-016-1456-0. Epub 2016 Mar 21. PMID: 27000857.
https://pubmed.ncbi.nlm.nih.gov/27000857/
Sutton PA, Solomon M, Sasidharan P, Lee P, Austin K. Abdominolithotomy sacrectomy for the management of locally recurrent rectal cancer: video vignette. Br J Surg. 2021 Aug 19;108(8):e257. doi: 10.1093/bjs/znab105. PMID: 34089593.
https://pubmed.ncbi.nlm.nih.gov/34089593/
Drami I, Fletcher JA, Corr A, West MA, Aston W, Hellawell G, Burns EM, Jenkins JT. Total pelvic exenteration with 'high and wide' sacrectomy for recurrent rectal cancer: A video vignette. Colorectal Dis. 2022 Dec;24(12):1625-1626. doi: 10.1111/codi.16230. Epub 2022 Jul 18. PMID: 35730692.
https://pubmed.ncbi.nlm.nih.gov/35730692/
References:
Rajendran S, Brown KGM, Solomon MJ. Oncovascular surgery for advanced pelvic malignancy. Br J Surg. 2023 Jan 10;110(2):144-149. doi: 10.1093/bjs/znac414. PMID: 36427187.
https://pubmed.ncbi.nlm.nih.gov/36427187/
Austin KK, Solomon MJ. Pelvic exenteration with en bloc iliac vessel resection for lateral pelvic wall involvement. Dis Colon Rectum. 2009 Jul;52(7):1223-33. doi: 10.1007/DCR.0b013e3181a73f48. PMID: 19571697.
https://pubmed.ncbi.nlm.nih.gov/19571697/
Rogers AC, Jenkins JT, Rasheed S, Malietzis G, Burns EM, Kontovounisios C, Tekkis PP. Towards Standardisation of Technique for En Bloc Sacrectomy for Locally Advanced and Recurrent Rectal Cancer. J Clin Med. 2021 Oct 25;10(21):4921. doi: 10.3390/jcm10214921. PMID: 34768442; PMCID: PMC8584798.
https://pubmed.ncbi.nlm.nih.gov/34768442/
van Kessel CS, Waller J, Steffens D, Lee PJ, Austin KKS, Stalley PD, Solomon MJ. Improving Surgical Outcomes in Pelvic Exenteration Surgery: Comparison of Prone Sacrectomy with Anterior Cortical Sacrectomy Techniques. Ann Surg. 2023 Jul 24. doi: 10.1097/SLA.0000000000006040. Epub ahead of print. PMID: 37485983.
https://pubmed.ncbi.nlm.nih.gov/37485983/
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Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
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Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
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Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
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Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
Download our iOS and Android apps from your App Store. You can easily search through our library of content, bookmark episodes for later and enjoy our premium content. You can also take notes, pin chapters and download for off-line listening.
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
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Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
Download our iOS and Android apps from your App Store. You can easily search through our library of content, bookmark episodes for later and enjoy our premium content. You can also take notes, pin chapters and download for off-line listening.
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
As the cost of living continues to rise, the salary and housing stipends of resident physicians are not keeping pace. Dr. Melissa Drezdzon and Dr. Jed Calata from the Medical College of Wisconsin have explored these issues in depth and share their insights. Join hosts Dr. Ananya Anand, Dr. Joe L’Huillier, and Dr. Rebecca Moreci and their special guests as they discuss the salary of resident physicians.
Hosts:
–Dr. Ananya Anand, Stanford University, @AnanyaAnandMD, ananya_anand@stanford.edu
–Dr. Joseph L’Huillier, University at Buffalo, @JoeLHuillier101, josephlh@buffalo.edu
–Dr. Rebecca Moreci, Louisiana State University, @md_moreci, morecir@med.umich.edu
–COSEF: @surgedfellows
Special guests:
-Dr. Melissa Drezdzon, Medical College of Wisconsin, @mdrezdzonmd, mdrezdzon@mcw.edu
-Dr. Jed Calata, Medical College of Wisconsin, jcalata@mcw.edu
Learning Objectives:
Listeners will:
– Appreciate the discrepancy between cost of living increases and stagnant resident salaries
– Describe how residency salaries are funded
– Recall the regional variation in resident stipends and access to affordable housing across the united states
– List possible solutions for addressing this issue
References:
Drezdzon MK, Cowley NJ, Sweeney DP, Peterson CY, Ridolfi TJ, Ludwig KA, Evans DB, Calata JF. Going for Broke: The Impact of Cost of Living on Surgery Resident Stipend Value. Ann Surg. 2023 Dec 1;278(6):1053-1059. doi: 10.1097/SLA.0000000000005923. Epub 2023 May 25. PMID: 37226808.
https://pubmed.ncbi.nlm.nih.gov/37226808/
Drezdzon, M.K., Cowley, N.J., Sweeney, D.P., Peterson CY, Ridolfi TJ, Ludwig KA, Calata JF. A costly threat to GME: the housing crisis and residency training. Global Surg Educ 2, 85 (2023).
https://doi.org/10.1007/s44186-023-00157-x
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Video Link: https://www.youtube.com/watch?v=4DYJIxCrsDE
Please visit https://app.behindtheknife.org/home to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here https://app.behindtheknife.org/listen
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
Download our iOS and Android apps from your App Store. You can easily search through our library of content, bookmark episodes for later and enjoy our premium content. You can also take notes, pin chapters and download for off-line listening.
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Download our iOS and Android apps from your App Store. You can easily search through our library of content, bookmark episodes for later and enjoy our premium content. You can also take notes, pin chapters and download for off-line listening.
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Download our iOS and Android apps from your App Store. You can easily search through our library of content, bookmark episodes for later and enjoy our premium content. You can also take notes, pin chapters and download for off-line listening.
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Download our iOS and Android apps from your App Store. You can easily search through our library of content, bookmark episodes for later and enjoy our premium content. You can also take notes, pin chapters and download for off-line listening.
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
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The percent surface area burn for which half of patients survive, known as lethal area 50, or LA50 depends on where in the world the injury occurs. Calling all surgeons and trainees with an interest in providing more equitable delivery of global injury care - Join our Burn Surgery team as we welcome Dr. Manish Yadav, Plastic and Burn Surgeon at Kirtipur Hospital in Kathmandu, Nepal to discuss several recent challenging cases. We’ll discuss the global burden of burn injuries, how emergency burn care systems reduce preventable morbidity and mortality, innovations in resuscitation of burn shock, use of checklists for critical care and safe early excision, and application of palliative care in different cultural contexts. (Co-hosts: Dr. Barclay Stewart, Burn and Trauma Surgeon at Harborview Medical Center and Paul Herman, UWMC/HMC Surgery Resident)
Hosts: (affiliation and SM handles)
1. Manish Yadav, Kirtipur Hospital, Nepal
2. Barclay Stewart, Harborview Medical Center
3. Paul Herman, UW/Harborview General Surgery Resident, @paul_herm
4. Tam Pham, Harborview Medical Center (Editor)
Learning Objectives
1. Describe the global epidemiology of burn injury, disparities in burn injury and care, and highlight efforts to improve burn care in low and middle-income countries
2. Discuss two cases at a burn center in Kirtipur, Nepal, highlighting challenges in burn care in LMICs and innovations to address these challenges and provide high level care
a. Highlight enteral resuscitation as an innovative strategy with advantages for treating burn shock in low resource settings
b. Discuss the key burn concept of early excision and steps to ensure safe application in low resource settings
- References
a. Gosselin, R., Charles, A., Joshipura, M., Mkandawire, N., Mock, C. N. , et. al. 2015. “Surgery and Trauma Care”. In: Disease Control Priorities (third edition): Volume 1, Essential Surgery, edited by H. Debas, P. Donkor, A. Gawande, D. T. Jamison, M. Kruk, C. N. Mock. Washington, DC: World Bank.
b. Stewart BT, Nsaful K, Allorto N, Man Rai S. Burn Care in Low-Resource and Austere Settings. Surg Clin North Am. 2023 Jun;103(3):551-563. doi: 10.1016/j.suc.2023.01.014. Epub 2023 Apr 4. PMID: 37149390.
https://pubmed.ncbi.nlm.nih.gov/37149390/
c. Davé DR, Nagarjan N, Canner JK, Kushner AL, Stewart BT; SOSAS4 Research Group. Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries. Burns. 2018 Aug;44(5):1228-1234. doi: 10.1016/j.burns.2018.01.015. Epub 2018 Feb 21. PMID: 29475744.
https://pubmed.ncbi.nlm.nih.gov/29475744/
d. Hebron C, Mehta K, Stewart B, Price P, Potokar T. Implementation of the World Health Organization Global Burn Registry: Lessons Learned. Annals of Global Health. 2022; 88(1): 34, 1–10. DOI: https://doi. Org/10.5334/aogh.3669
https://pubmed.ncbi.nlm.nih.gov/35646613/
e. Jordan KC, Di Gennaro JL, von Saint André-von Arnim A and Stewart BT (2022) Global trends in pediatric burn injuries and care capacity from the World Health Organization Global Burn Registry. Front. Pediatr. 10:954995. doi: 10.3389/fped.2022.954995
https://pubmed.ncbi.nlm.nih.gov/35928690/
f. Mehta K, Thrikutam N, Hoyte-Williams PE, Falk H, Nakarmi K, Stewart B. Epidemiology and Outcomes of Cooking- and Cookstove-Related Burn Injuries: A World Health Organization Global Burn Registry Report. J Burn Care Res. 2023 May 2;44(3):508-516. doi: 10.1093/jbcr/irab166. PMID: 34850021; PMCID: PMC10413420.
https://pubmed.ncbi.nlm.nih.gov/34850021/
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Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
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Download our iOS and Android apps from your App Store. You can easily search through our library of content, bookmark episodes for later and enjoy our premium content. You can also take notes, pin chapters and download for off-line listening.
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
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Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
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Download our iOS and Android apps from your App Store. You can easily search through our library of content, bookmark episodes for later and enjoy our premium content. You can also take notes, pin chapters and download for off-line listening.
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
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Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
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Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
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Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
Download our iOS and Android apps from your App Store. You can easily search through our library of content, bookmark episodes for later and enjoy our premium content. You can also take notes, pin chapters and download for off-line listening.
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Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
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Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
Download our iOS and Android apps from your App Store. You can easily search through our library of content, bookmark episodes for later and enjoy our premium content. You can also take notes, pin chapters and download for off-line listening.
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Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
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Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
Download our iOS and Android apps from your App Store. You can easily search through our library of content, bookmark episodes for later and enjoy our premium content. You can also take notes, pin chapters and download for off-line listening.
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
Download our iOS and Android apps from your App Store. You can easily search through our library of content, bookmark episodes for later and enjoy our premium content. You can also take notes, pin chapters and download for off-line listening.
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There is more than one way to plug a hole…
Perineal wounds after pelvic surgery can be challenging to manage. It is important for surgeons to have a general understanding of upfront reconstruction options and strategies to deal with the sequence of wound failure. Join Drs. Galandiuk, Bolshinsky, Kavalukas, and Simon as they discuss the management of perineal wounds following pelvic surgery.
Hosts:- Susan Galandiuk MD, University of Louisville, Louisville, Kentucky, @DCREdInChief
- Vladimir Bolshinsky MD, Peninsula Health, Victoria, Australia, @bolshinskyv
- Sandy Kavalukas MD, University of Louisville, Louisville, Kentucky, @sandykava
- Hillary Simon DO, University of Louisville, Louisville, Kentucky, @HillaryLSimon
Producer:- Manasa Sunkara MS3, University of Louisville, Louisville, Kentucky, @manasasunkara12
Learning objectives:- Review perineal reconstruction options after pelvic surgery for anorectal pathology.
- Understand management strategies for perineal wound breakdown.
- Discuss the importance of critical appraisal of studies surrounding perineal wound reconstruction and management.
References:- Asaad M, et al. Robotic Rectus Abdominis Muscle Flap following Robotic Extirpative Surgery. Plastic and Reconstructive Surgery 148(6):p 1377-1381, December 2021. doi: 10.1097/PRS.0000000000008592 https://pubmed.ncbi.nlm.nih.gov/34847128/
- Figg RE, Church JM. Perineal Crohn's disease: an indicator of poor prognosis and potential proctectomy. Dis Colon Rectum. 2009 Apr;52(4):646-50. doi: 10.1007/DCR.0b013e3181a0a5bf. https://pubmed.ncbi.nlm.nih.gov/19404069/
- Fuschillo G, Pellino G. Chronic Perineal Sinus After Proctectomy for Crohn’s Disease: Risk Reduction Strategies and Management. Diseases of the Colon & Rectum 65(4):p 468-471, April 2022. doi: 10.1097/DCR.0000000000002413 https://pubmed.ncbi.nlm.nih.gov/35067504/
- Mori GA, Tiernan JP. Management of Perineal Wounds Following Pelvic Surgery. Clin Colon Rectal Surg. 2022 Mar 7;35(3):212-220. doi: 10.1055/s-0042-1742414. https://pubmed.ncbi.nlm.nih.gov/35966381/
- Rather AA, Fisher AL, Chun D, Mannion JD, Alexander EL. Closed Incisional Negative Pressure Therapy Reduces Perineal Wound Complications After Abdominoperineal Resection. Dis Colon Rectum. 2023 Feb 1;66(2):314-321. doi: 10.1097/DCR.0000000000002289. https://pubmed.ncbi.nlm.nih.gov/35001048/
- Tiernan JP, Leavitt T, Sapci I, Valente MA, Delaney CP, Steele SR, Gorgun E. A Comparison of Perineal Myocutaneous Flaps Following Abdominoperineal Excision of the Rectum for Anorectal Pathology. Dis Colon Rectum. 2022 Nov 1;65(11):1316-1324. doi: 10.1097/DCR.0000000000002271. Epub 2021 Dec 13. PMID: 35156364. https://pubmed.ncbi.nlm.nih.gov/35156364/
- Wright J, et al. V-Y Gluteal Fasciocutaneous Advancement Flap After Robotic Abdominoperineal Resection. Diseases of the Colon & Rectum 64(9):p e526-e527, September 2021. doi: 10.1097/DCR.0000000000002126 ; https://www.youtube.com/watch?v=urs_yeLLKlQ
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Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
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Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
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Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
Download our iOS and Android apps from your App Store. You can easily search through our library of content, bookmark episodes for later and enjoy our premium content. You can also take notes, pin chapters and download for off-line listening.
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Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
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Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
Download our iOS and Android apps from your App Store. You can easily search through our library of content, bookmark episodes for later and enjoy our premium content. You can also take notes, pin chapters and download for off-line listening.
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Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
Download our iOS and Android apps from your App Store. You can easily search through our library of content, bookmark episodes for later and enjoy our premium content. You can also take notes, pin chapters and download for off-line listening.
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Join our Emergency General Surgery team as we talk about a popular and controversial issue in surgery: dealing with complicated cases in pancreatitis. We discuss two hard-hitting cases and cover principles of diagnosis, early management and disposition, and things to look out for every step of the way.
We cover some common and some rare but particularly problematic complications. Although there is no right answer to every case of pancreatitis, we try to help learners to develop an approach to pancreatitis that considers the morbidity and benefits of every option.
Hosts: Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross
Learning Objectives:
- Review the diagnostic criteria for acute pancreatitis
- Learn to anticipate common and major complications of acute pancreatitis
- Develop an approach to complications of pancreatitis accounting for patient, family, practitioner, and institutional factors
- Understand the risks and benefits of various methods for dealing with pancreatic necrosis and infection
TENSION trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32404-2/fulltext
MISER trial
https://pubmed.ncbi.nlm.nih.gov/30452918/
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Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
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In this episode our team reviews the two groundbreaking RCTs which challenged the long-held dogma that a lobectomy is the only acceptable oncologic procedure for NSCLC. Listen as we compare and contrast the North American CALGB trial and Japanese JCOG trial which were both designed to investigate survival and recurrence outcomes by randomizing stage 1A patients to lobectomy versus a sublobar resection.
Learning Objectives:
-Compare and contrast the patient characteristics of the CALGB and JCOG trials
-Understand the methodology each trial and be able to explain their nuanced differences
-Analyze the results of the CALGB and JCOG trials and how they apply to patients today
Hosts:
Kelly Daus MD, Peter White MD, Eric Vallieres, MD and Brian Louie MD
Referenced Material
https://pubmed.ncbi.nlm.nih.gov/36780674/
Altorki N, et al. Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer. N Engl J Med. 2023 Feb 9;388(6):489-498. doi: 10.1056/NEJMoa2212083. PMID: 36780674; PMCID: PMC10036605.
https://pubmed.ncbi.nlm.nih.gov/35461558/’
Saji H, et al. West Japan Oncology Group and Japan Clinical Oncology Group. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022 Apr 23;399(10335):1607-1617. doi: 10.1016/S0140-6736(21)02333-3. PMID: 35461558.
https://pubmed.ncbi.nlm.nih.gov/37473998/
Altorki N, et al. Lobectomy, segmentectomy, or wedge resection for peripheral clinical T1aN0 non-small cell lung cancer: A post hoc analysis of CALGB 140503 (Alliance). J Thorac Cardiovasc Surg. 2023 Jul 18:S0022-5223(23)00612-8. doi: 10.1016/j.jtcvs.2023.07.008. Epub ahead of print. PMID: 37473998.
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Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2024 – Brand new, up-to-date, high yield learning to help you DOMINATE the exam.
Don’t forget to check out our NEW ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet
Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2024 ABSITE podcast series. Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife. Learn more at https://www.medtronic.com/
If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.
Visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Making a discovery that changes how we practice is one of the most exciting things about the fields of medicine and surgery. In this episode, join endocrine surgeons Drs. Barb Miller, John Phay, Priya Dedhia, and Surgical Oncology Fellow Dr. Samantha Ruff from The Ohio State University. Hear Dr. Phay tell the story of how parathyroid autofluorescence was discovered and the work that has gone on since that day. The group discusses several articles focusing on intraoperative adjuncts used to identify parathyroid tissue during thyroid and parathyroid surgery.
Hosts: Barbra S. Miller, MD (Moderator), Clinical Professor of Surgery, John Phay, MD, Clinical Professor of Surgery, Priya H. Dedhia, MD, PhD, Assistant Professor of Surgery, Samantha Ruff, MD, Surgical Oncology Fellow, Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Twitter handles:
Barbra Miller - @OSUEndosurgBSM
John Phay – @JohnPhayMD
Priya Dedhia – @priyaknows
Samantha Ruff - @SamRuff_MD
Learning objectives:
1) Understand the background of the discovery of parathyroid autofluorescence
2) Describe various intraoperative adjuncts utilized to identify parathyroid tissue
3) Compare and contrast the advantages and disadvantages of using autofluorescence versus indocyanine green for identification of parathyroid tissue
4) Recognize the impact of use of intraoperative imaging adjuncts on postoperative hypocalcemia (short and long-term)
5) Understand the general safety issues for the parathyroid imaging techniques discussed
References:
1. Benmiloud, F., G. Godiris-Petit, R. Gras, et al., Association of Autofluorescence-Based Detection of the Parathyroid Glands During Total Thyroidectomy With Postoperative Hypocalcemia Risk: Results of the PARAFLUO Multicenter Randomized Clinical Trial. JAMA Surg, 2020. 155(2): p. 106-12 DOI: 10.1001/jamasurg.2019.4613. https://pubmed.ncbi.nlm.nih.gov/31693081/
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Kahramangil, B. and E. Berber, Comparison of indocyanine green fluorescence and parathyroid autofluorescence imaging in the identification of parathyroid glands during thyroidectomy. Gland Surg, 2017. 6(6): p. 644-8 DOI: 10.21037/gs.2017.09.04. https://pubmed.ncbi.nlm.nih.gov/29302480/
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Paras, C., M. Keller, L. White, et al., Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt, 2011. 16(6): p. 067012 DOI: 10.1117/1.3583571. https://pubmed.ncbi.nlm.nih.gov/21721833/
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Vidal Fortuny, J., V. Belfontali, S.M. Sadowski, et al., Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery. Br J Surg, 2016. 103(5): p. 537-43 DOI: 10.1002/bjs.10101. https://pubmed.ncbi.nlm.nih.gov/26864909/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other Behind the Knife endocrine episodes: https://behindtheknife.org/podcast-category/endocrine/
What is the best surgical treatment for a vasculopathy with critical limb threatening ischemia? In this episode of Behind the Knife the vascular surgery subspecialty team discusses two pivotal trials (BEST-CLI and BASIL-2) and how the findings of these trials can help answer this question. In this episode, we will discuss the age old question: open bypass versus best endovascular treatment.
Hosts: * Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan * Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan * Dr. David Schechtman is a Vascular Surgery Fellow at the University of Michigan * Dr. Drew Braet is a PGY-4 Integrated Vascular Surgery Resident at the University of Michigan
Learning Objectives* Review the definition, prevalence, and prognosis of critical limb threatening ischemia * Review basic treatment options for patients with critical limb threatening ischemia * Understand the methodology, findings, limitations, and clinical applications of the BEST-CLI trial * Understand the methodology, findings, limitations, and clinical applications of the BASIL-2 trial * Compare open bypass and best endovascular therapy for patients with critical limb threatening ischemia
References* Farber A, Menard MT, Conte MS, Kaufman JA, Powell RJ, Choudhry NK, Hamza TH, Assmann SF, Creager MA, Cziraky MJ, Dake MD, Jaff MR, Reid D, Siami FS, Sopko G, White CJ, van Over M, Strong MB, Villarreal MF, McKean M, Azene E, Azarbal A, Barleben A, Chew DK, Clavijo LC, Douville Y, Findeiss L, Garg N, Gasper W, Giles KA, Goodney PP, Hawkins BM, Herman CR, Kalish JA, Koopmann MC, Laskowski IA, Mena-Hurtado C, Motaganahalli R, Rowe VL, Schanzer A, Schneider PA, Siracuse JJ, Venermo M, Rosenfield K; BEST-CLI Investigators. Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia. N Engl J Med. 2022 Dec 22;387(25):2305-2316. doi: 10.1056/NEJMoa2207899. Epub 2022 Nov 7. PMID: 36342173. https://pubmed.ncbi.nlm.nih.gov/36342173/ * Bradbury AW, Moakes CA, Popplewell M, Meecham L, Bate GR, Kelly L, et al. A vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): an open-label, randomised, multicentre, phase 3 trial. The Lancet. 2023. 401(10390), 1798-1809. https://doi.org/10.1016/S0140-6736(23)00462-2 * Conte MS Bradbury AW Kolh P et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg. 2019; 58 (109.e33.): S1-109 https://pubmed.ncbi.nlm.nih.gov/31182334/ * Bradbury AW Adam DJ Bell J et al. Multicentre randomised controlled trial of the clinical and cost-effectiveness of a bypass-surgery-first versus a balloon-angioplasty-first revascularisation strategy for severe limb ischaemia due to infrainguinal disease. The bypass versus angioplasty in severe ischaemia of the leg (BASIL) trial. Health Technol Assess. 2010; 14: 1-210 https://pubmed.ncbi.nlm.nih.gov/20307380/ * Adam DJ Beard JD Cleveland T et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005; 366: 1925-1934 https://pubmed.ncbi.nlm.nih.gov/16325694/ * Bradbury AW Adam DJ Bell J et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL) trial: an intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg. 2010; 51: 5S-17 https://pubmed.ncbi.nlm.nih.gov/20435258/ * Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH; GVG Writing Group. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019 Jun;69(6S):3S-125S.e40. doi: 10.1016/j.jvs.2019.02.016. Epub 2019 May 28. Erratum in: J Vasc Surg. 2019 Aug;70(2):662. PMID: 31159978; PMCID: PMC8365864. https://pubmed.ncbi.nlm.nih.gov/31159978/ * Menard MT, Rosenfield K, Farber A. The BEST-CLI Trial: Implications of the Primary Results. Eur J Vasc Endovasc Surg. 2023 Mar;65(3):317-319. doi: 10.1016/j.ejvs.2022.12.032. Epub 2023 Jan 6. PMID: 36621707. https://pubmed.ncbi.nlm.nih.gov/36621707/
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If you liked this episode, check out other vascular surgery episodes: https://behindtheknife.org/podcast-category/vascular/
If you operate for long enough, chances are you will come across the unique, and potentially daunting scenario of operating on a pregnant patient. If, and when, you do, would you know what to do? Join University of Washington and MIS faculty Drs. Andrew Wright, Nicole White, and Nick Cetrulo, and residents Drs. Ben Vierra and Paul Herman as they discuss non-obstetric surgery in the pregnant patient so that you will be better informed when the challenge arises.
Hosts:
1. Andrew Wright, UW Medical Center—Montlake and Northwest, @andrewswright
2. Nick Cetrulo, UW Medical Center—Northwest, @Trules25
3. Nicole White, UW Medical Center—Northwest, @NicoleWhiteTho1
4. Paul Herman, UW General Surgery Resident PGY-3, @paul_herm
5. Ben Vierra, UW General Surgery Resident PGY-2
Learning Objectives
1. Describe important physiologic changes in pregnancy that are relevant for the surgeon to know.
2. Review the epidemiology of non-obstetric general surgery in the pregnant patient.
3. Discuss specific imaging considerations in the pregnant patient.
4. Become more familiar with the technical aspects of approaching a typical surgical case in a pregnant patient.
References
1. Pearl, J.P., Price, R.R., Tonkin, A.E. et al. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 31, 3767–3782 (2017). https://doi.org/10.1007/s00464-017-5637-3
2. Vasileiou G, Eid AI, Qian S, Pust GD, Rattan R, Namias N, Larentzakis A, Kaafarani HMA, Yeh DD; EAST Appendicitis Study Group. Appendicitis in Pregnancy: A Post-Hoc Analysis of an EAST Multicenter Study. Surg Infect (Larchmt). 2020 Apr;21(3):205-211. https://pubmed.ncbi.nlm.nih.gov/31687887/
3. Dongarwar D, Taylor J, Ajewole V, Anene N, Omoyele O, Ogba C, Oluwatoba A, Giger D, Thuy A, Argueta E, Naik E, Salemi JL, Spooner K, Olaleye O, Salihu HM. Trends in Appendicitis Among Pregnant Women, the Risk for Cardiac Arrest, and Maternal-Fetal Mortality. World J Surg. 2020 Dec;44(12):3999-4005. https://pubmed.ncbi.nlm.nih.gov/32737556/
4. Fong ZV, Pitt HA, Strasberg SM, Molina RL, Perez NP, Kelleher CM, Loehrer AP, Sicklick JK, Talamini MA, Lillemoe KD, Chang DC; California Cholecystectomy Group. Cholecystectomy During the Third Trimester of Pregnancy: Proceed or Delay? J Am Coll Surg. 2019 Apr;228(4):494-502.e1. https://pubmed.ncbi.nlm.nih.gov/30769111/
5. Hong J, Yang J, Zhang X, Su J, Tumati A, Garry D, Docimo S, Bates AT, Spaniolas K, Talamini MA, Pryor AD. Considering delay of cholecystectomy in the third trimester of pregnancy. Surg Endosc. 2021 Aug;35(8):4673-4680. https://pubmed.ncbi.nlm.nih.gov/32875420/
6. ACOG Committee Opinion No. 775: Nonobstetric Surgery During Pregnancy. Obstet Gynecol. 2019 Apr;133(4):e285-e286. https://pubmed.ncbi.nlm.nih.gov/30913200/
7. Ashbrook M, Cheng V, Sandhu K, Matsuo K, Schellenberg M, Inaba K, Matsushima K. Management of Complicated Appendicitis During Pregnancy in the US. JAMA Netw Open. 2022 Apr 1;5(4):e227555. https://pubmed.ncbi.nlm.nih.gov/35426921/
8. Capella CE, Godovchik J, Chandrasekar T, Al-Kouatly HB. Nonobstetrical Robotic-Assisted Laparoscopic Surgery in Pregnancy: A Systematic Literature Review. Urology. 2021 May;151:58-66. https://pubmed.ncbi.nlm.nih.gov/32445766/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other Behind the Knife minimally invasive surgery episodes: https://behindtheknife.org/podcast-category/minimally-invasive/
Join the Hernia Team from Carolinas Medical Center as they discuss applications of artificial intelligence in predicting outcomes for patients undergoing abdominal wall reconstruction. Emerging technologies are allowing us to understand hernia patients who are at risk for increased surgical complexity and postoperative complications – find out more in this Journal Review episode.
Hosts:* Dr. Sullivan “Sully” Ayuso, Chief Resident, Carolinas Medical Center, @SAyusoMD * Dr. Todd Heniford, Chief of GI & MIS, Carolinas Medical Center, @THeniford * Dr. Vedra Augenstein, Professor of Surgery, Carolinas Medical Center, @VedraAugenstein * Dr. Monica Polcz, Attending Surgeon, Baptist Health (FL)
Learning Objectives:* Provide and introduction to artificial intelligence * Develop an understanding of the applications of artificial intelligence in surgical outcome prediction for patients undergoing hernia repair * Learn how risk stratification of hernia patients can affect their care
References:* Elhage et al, Development and Validation of Image-Based Deep Learning Models to Predict Surgical Complexity and Complications in Abdominal Wall Reconstruction, JAMA Surgery, 2021
https://pubmed.ncbi.nlm.nih.gov/34232255/
- Ayuso et al, Predicting Rare Outcomes in Abdominal Wall Reconstruction Using Image-Based Deep Learning Models, Surgery, 2023
https://pubmed.ncbi.nlm.nih.gov/36229252/
- Hassan et al, Novel Machine Learning Approach for Prediction of Hernia Recurrence, Surgical Complication, and 30-Day Readmission after Abdominal Wall Reconstruction, JACS, 2022
https://pubmed.ncbi.nlm.nih.gov/35426406/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out more Behind the Knife hernia episodes: https://behindtheknife.org/podcast-category/hernia/
We’re all told to find mentors in medical training, but how does this actually work when you’re a new medical student interested in surgery? And how do you leverage those relationships into getting research experience and lines on your CV?
Hosts:
Nina Clark, MD
Jessica Millar, MD
Jon Williams, MD
Guests:
Michael Englesbe, MD, University of Michigan
Erika Bisgaard, MD, University of Washington
Some tips from the episode:
Get involved* Even if you’re not destined for an academic career, getting involved in research early on can help you to participate with the scientific literature, understand data, and incorporate new research into your practice.
* Realistically, research is an important component of your ERAS application and your CV. It’s also a great opportunity to learn new skills and develop strong relationships with mentors.
Remember why you’re in medical school* You came to medical school to become a doctor first – don’t forget that or let research take away from it. Your mentors have been through it and understand that things get busy.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our Medical Student Intern Survival Guide Series: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/
We’re all told to find mentors in medical training, but how does this actually work when you’re a new medical student interested in surgery? In this episode, our surgical education fellows and two expert mentors talk through the ins and outs of mentors – who are they, what can they do for you, how do you find one, and what do you do once you have one.
Hosts:
Nina Clark, MD
Jessica Millar, MD
Jon Williams, MD
Guests:
Michael Englesbe, MD, University of Michigan
Erika Bisgaard, MD, University of Washington
Some tips from the episode:
Mentorship teams: think about 4-5 people who can help you in different ways. * Research mentor who can help you find opportunities and be productive * 1-2 people who support you in all things (these might be residents!) * 1-2 higher level sponsors who facilitate opportunities and pay for things
Discipline and accountability* RESPOND TO EMAILS. If you get an indication that a potential mentor would like to meet with you, take them up on the offer and be prompt with your replies! Nobody likes to be ghosted. * Meet with your mentors at some regular cadence (every 2 weeks is a good place to start) * Think of mentorship as a game of tennis – if your mentor gives you something to work on, the next meeting you should bring it back completed. This is a relationship, and back and forth accountability can establish trust.
Change over time* As you grow, you’ll change, and so will your relationships with mentors. This is one of the most rewarding aspects of these relationships and something you should aim to maintain over time.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our Medical Student Intern Survival Guide Series: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/
Challenges continue to plague the residency application process, with programs receiving increased application volume that makes holistic review difficult, and medical student applicants burdened with application costs and uncertainty about what programs best align with their values. As a specialty, Ob/Gyn is facing these problems head on, and have united within their field to create a new independent residency application system, ResidencyCAS. While substantial changes to an already stressful process can be intimidating, the new platform offers many advantages that hope to improve the residency application experience for applicants, programs, and the Ob/Gyn community as a whole. We’re joined by Dr. Maya Hammoud and Dr. AnnaMarie Connolly, two of the leaders in this effort, to break down the creation of ResidencyCAS, plans for its implementation starting in the 2024-2025 application cycle, and the reaction of the Ob/Gyn and medical education communities to this change.
Learning Objectives
1. Listeners will describe current challenges to applicants and programs in the residency application process.
2. Listeners will identify the coming changes to the Ob/Gyn residency application process, with awareness of the planned design and use of the ResidencyCAS system.
3. Listeners will describe the value of potential changes to the residency application process.
4. Listeners will explain the barriers and efforts required to coordinate large-scale changes within medical education like the creation and implementation of ResidencyCAS.
5. Listeners will consider how changes to the residency application process could affect and improve their own field, program, or application.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our other Surgical Education Episodes: https://behindtheknife.org/podcast-category/surgical-education/
Direct Peritoneal Resuscitation! We’re not just dumping fluids into the open abdomen. What is DPR? Why do it? Who should get it? Does it work? Come try and stay awake for some basic science talk before then learning all about why you should consider adopting DPR into your Trauma/EGS practice? Join Drs. Cobler-Lichter, Kwon, Meizoso, Urréchaga, and Rattan as they guide you through all this and more!
Hosts:
Michael Cobler-Lichter, MD, PGY2:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@mdcobler (twitter)
Eva Urrechaga, MD, PGY6/R4:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@urrechisme (twitter)
Eugenia Kwon, MD, Trauma/Surgical Critical Care Fellow:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery, 3 years in practice
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@jpmeizoso (twitter)
Rishi Rattan, MD, Attending Surgeon in Trauma/Critical Care, 7 years in practice
Legacy Emanuel Medical Center
@DrRishiRattan (twitter)
Learning Objectives:
- State the proposed benefits of DPR
- Identify who can benefit from DPR
- Demonstrate the proper way to set up a DPR circuit
- Discuss the proposed basic science mechanism for DPR’s efficacy
Quick Hits:
1. Consider DPR in all your open abdomens in EGS/Trauma. You never know when you’re going to be able to close some of these patients.
2. The principal of DPR is to allow the fluid to dwell in the abdomen as long as possible. Keep the catheter deep and don’t put holes in your dressing.
3. DPR is ideal for patients with packing, who are in discontinuity, and for fresh anastomoses. These will only benefit from DPR, not be harmed by it.
4. Make sure these patients are receiving hourly I/Os. Nursing by-in is huge for this procedure.
5. DPR is associated with higher rates of fascial closure, reduces inflammation, and improves blood flow to the abdomen.
References1. Ribeiro-Junior MAF, Cássia Tiemi Kawase Costa, de Souza Augusto S, et al. The role of direct peritoneal resuscitation in the treatment of hemorrhagic shock after trauma and in emergency acute care surgery: a systematic review. Eur J Trauma Emerg Surg. Published online November 13, 2021. doi:10.1007/s00068-021-01821-x 2. Smith JW, Garrison RN, Matheson PJ, Franklin GA, Harbrecht BG, Richardson JD. Direct Peritoneal Resuscitation Accelerates Primary Abdominal Wall Closure after Damage Control Surgery. J Am Coll Surg. 2010;210(5):658-667. doi:10.1016/j.jamcollsurg.2010.01.014 3. Smith JW, Neal Garrison R, Matheson PJ, et al. Adjunctive treatment of abdominal catastrophes and sepsis with direct peritoneal resuscitation: indications for use in acute care surgery. J Trauma Acute Care Surg. 2014;77(3):393-398; discussion 398-399. doi:10.1097/TA.0000000000000393
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If you liked this episode, check out our recent episode here: https://behindtheknife.org/listen/
Join Professor Michael Solomon, Dr Kilian Brown and Dr Jacob Waller from Royal Prince Alfred Hospital in Sydney, Australia, for this special four part series on pelvic exenteration surgery for locally advanced and recurrent rectal cancer. Learn about these ultra-radical procedures which go beyond the traditional TME planes that we learn during surgical training, and into all compartments of the pelvis.
Episode 2 outlines the radical technical approaches to anteriorly invasive tumours, including en bloc cystectomy, perineal urethrectomy, inter-labial vaginectomy and radical pubic bone resections.
Each episode in this series features a different international guest surgeon. In episode 2, the RPA team are joined by Dr Paul Sutton from The Christie Hospital, Manchester, UK.
Technical videos:
Solomon MJ, Däster S, Loizides S, Sutton P, Brown KGM, Austin KKS, Lee PJ. Access to the anterior pelvic compartment in pelvic exenteration in women-the interlabial approach: video vignette. Br J Surg. 2021 Aug 19;108(8):e268-e269. doi: 10.1093/bjs/znab127.
Solomon MJ, Alahmadi R, Lee PJ, Austin KKS. En bloc partial pubic bone excision with complete soft tissue pelvic exenteration. Br J Surg. 2022 Jun 14;109(7):640-641. doi: 10.1093/bjs/znac122. PMID: 35485605.
References:
Solomon MJ, Austin KK, Masya L, Lee P. Pubic Bone Excision and Perineal Urethrectomy for Radical Anterior Compartment Excision During Pelvic Exenteration. Dis Colon Rectum. 2015 Nov;58(11):1114-9. doi: 10.1097/DCR.0000000000000479.
Check our more high-yield colorectal surgery content from Behind the Knife.
Join Professor Michael Solomon, Dr Kilian Brown and Dr Jacob Waller from Royal Prince Alfred Hospital in Sydney, Australia, for this special four part series on pelvic exenteration surgery for locally advanced and recurrent rectal cancer. Learn about these ultra-radical procedures which go beyond the traditional TME planes, that we learn during surgical training, and into all compartments of the pelvis.
Episode 1 provides listeners with an overview of the principles of exenteration surgery and preoperative patient assessment and selection.
Each episode in this series features a different international guest surgeon. In episode 2, the RPA team are joined by Dr Elaine Burns from St Mark's Hospital, London, UK.
References and further reading:
-Burns EM, Quyn A; Lexicon Collaboration of UKPEN and the ACPGBI Advanced Cancer subcommittee. The 'Pelvic exenteration lexicon': Creating a common language for complex pelvic cancer surgery. Colorectal Dis. 2023 May;25(5):888-896. doi: 10.1111/codi.16476.
-Brown KGM, Solomon MJ. Decision making, treatment planning and technical considerations in patients undergoing surgery for locally recurrent rectal cancer. Seminars in Colon and Rectal Surgery. 2020;31(3):100764
-van Kessel CS, Solomon MJ. Understanding the Philosophy, Anatomy, and Surgery of the Extra-TME Plane of Locally Advanced and Locally Recurrent Rectal Cancer; Single Institution Experience with International Benchmarking. Cancers. 2022 Oct 15;14(20):5058. doi: 10.3390/cancers14205058
-PelvEx Collaborative. Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative. Cancers (Basel). 2022 Feb 24;14(5):1161. doi: 10.3390/cancers14051161
Check out more high-yield colorectal surgery content from Behind the Knife: https://behindtheknife.org/podcast-category/colorectal/
This week, we discuss the experiences of residents and medical students in surgery who identify as LGBTQIA+. We discuss the question of disclosure during interviews, how to identify programs that are welcoming to diverse identities, and how AOSA has grown the community of trainees and faculty mentors and hopes to continue to support them in the future.
Hosts:* Jason Bingham, MD * Nina Clark, MD
Guests:* Andrew Schlussel, DO, Colorectal and General Surgeon, Charlie Norwood VA Medical Center * Christina Georgeades, MD, R4 General Surgery at Medical College of Wisconsin cgeorgeades@mcw.edu, Twitter/X: @CGeorgeades * Cameron Smith, MS3 at Kansas City University Cameron.smith@kansascity.edu, Instagram: @cameron_smith_1996, Twitter/X: @cafe_aficionad0 * Jillian Wothe, MD, R1 General Surgery at Brigham & Women’s Hospital jillian.wothe@gmail.com, Twitter/X: @JillianWothe
Learn more and get involved with AOSA:
https://www.outsurgeons.org
Twitter/X: @OutSurgeons
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If you liked this episode, check out episode one in this series: https://behindtheknife.org/podcast/association-of-out-surgeons-allies-aosa-episode-1/
Has the pendulum swung too far? Is it time to put the drill down?? Or, drill, baby, drill! While the number of rib plating cases has exploded the data supporting the practice is less-than-stellar. On this episode of the BIG T Trauma series Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill bring you up to speed on rib plating.
If you haven’t already, we recommend you listen to Behind the Knife episode 298, published in May 2020. (https://behindtheknife.org/podcast/big-t-trauma-series-ep-10-rib-fractures/) This episode covers comprehensive management of rib fractures, including multimodal pain control, regional blocks, pulmonary toilet, BiPAP, etc.
REFERENCES:
GUIDELINES
EAST PMG Rib Plating (2017): https://www.east.org/education-resources/practice-management-guidelines/details/rib-fractures-open-reduction-and-internal-fixation-of-update-in-process
EAST PMG Rib Fracture Non-Surgical Management (2022): https://www.east.org/education-resources/practice-management-guidelines/details/nonsurgical-management-and-analgesia-strategies-for-older-adults-with-multiple-rib-fractures-a-systematic-review-metaanalysis
Chest Wall Injury Society Guidelines (2020): https://cwisociety.org/wp-content/uploads/2020/05/CWIS-SSRF-Guideline-01102020.pdf
FLAIL/UNSTABLE CHEST
Operative vs Nonoperative Treatment of Acute Unstable Chest Wall Injuries: A Randomized Clinical Trial, JAMA 2022: https://jamanetwork.com/journals/jamasurgery/fullarticle/2796556
Prospective randomized controlled trial of operative rib fixation in traumatic flail chest, JACS 2013: https://pubmed.ncbi.nlm.nih.gov/23415550/
Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status, Interact Cardiovasc Thoracic Surg 2005: https://pubmed.ncbi.nlm.nih.gov/17670487/
Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients, J Trauma 2002: https://pubmed.ncbi.nlm.nih.gov/11956391/
Surgical Rib Fixation of Multiple Rib Fractures and Flail Chest: A Systematic Review and Meta-analysis, J Surg Research 2022: https://pubmed.ncbi.nlm.nih.gov/35390577/
Surgical versus nonsurgical interventions for flail chest, Cochrane Review 2015: https://pubmed.ncbi.nlm.nih.gov/26222250/
NON-FLAIL CHEST
Randomized Controlled Trial of Surgical Rib Fixation to Nonoperative Management in Severe Chest Wall Injury, Ann Surgery 2023: https://pubmed.ncbi.nlm.nih.gov/37317861/
Rib fixation in non-ventilator-dependent chest wall injuries: A prospective randomized trial, J Trauma 2022: https://pubmed.ncbi.nlm.nih.gov/35081599/
A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (NONFLAIL), J Trauma 2020: https://pubmed.ncbi.nlm.nih.gov/31804414/
Operative versus nonoperative treatment of multiple simple rib fractures: A systematic review and meta-analysis, Injury 2020: https://pubmed.ncbi.nlm.nih.gov/32650981/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out the rest of the BIG T Trauma episodes here: https://behindtheknife.org/podcast-series/big-t-trauma/
You have a young patient with a horseshoe abscess. How should you address the abscess initially? What is the best approach to drain it? Now that it is drained, what do I do with all the drains? Tune in to figure out how to best approach the most challenging of perianal abscesses.
Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Julia Saraidaridis as they discuss the management of horseshoe abscess and complicated perianal fistula.
Learning Objectives
1. Describe the evaluation for perianal abscesses and fistula.
2. Discuss the different surgical options in managing horseshoe abscesses and post operative care to definitive management
3. Explain the rationale behind use of different fistula surgeries in complex perianal fistulas
Link to episode video: https://behindtheknife.org/video/clinical-challenges-in-colorectal-surgery-management-of-horseshoe-abscess/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Our Colorectal Surgery Oral Board Audio Review includes 51 high-yield scenarios designed for Colorectal Surgeons by Colorectal Surgeons. Learn more here: https://behindtheknife.org/premium
To close or not to close - that is the question! Internal hernias following bariatric surgery can be a vexing source of delayed postoperative morbidity. Join Drs. Matthew Martin, Kunoor Jain-Spangler, Adrian Dan, and Vincent Cheng for this EXCELLENT Journal Review in Bariatric Surgery.
Article #1: Stenberg 2023 - Long-term Safety and Efficacy of Closure of Mesenteric Defects in Laparoscopic Gastric Bypass Surgery* Two mesenteric defects are created during Roux-en-Y gastric bypass (RNYGB) + Petersen’s Defect + Jejuno-jejunostomy mesenteric defect * Consensus does not exist regarding the standard of care for mesenteric defect closure (e.g., closure of one or both defects, material used for closure). + Risks of leaving defects open: internal herniation with or without bowel ischemia * Risks of closing defects + Kinking the bowel (especially near the jejunojejunostomy) leading to obstruction + Chronic abdominal pain * This article discusses a randomized controlled trial of obese patients undergoing bariatric RNYGB + Randomized into two groups: a closure group and a non-closure group + Followed patients for 10 years with 95-96% follow up rate + Results analyzed using a Cox proportional hazards regression that included risk factors like BMI, total weight loss at 1 year after surgery, and the other + Highlighted outcomes - Within the first 30 postop days, there was a higher rate of SBO in the closure group (1.3%) compared to the non-closure group (0.2%). This was attributed to kinking of the jejunojejunostomy - After 30 postop days and up to 10 years, reoperation rates for SBO were higher in the non-closure group (14.9%) compared to the closure group (7.8%). This trend was consistent regarding each site of mesenteric defect. - No significant differences between the two groups regarding chronic opioid use as a metric of chronic abdominal pain.
Article #2: Nawas 2022 - The Diagnostic Accuracy of Abdominal Computed Tomography in Diagnosing Internal Herniation Following Roux-en-Y Gastric Bypass Surgery* Unless there is an indication to immediately operate on a RNYGB patient in whom internal herniation is suspected, computed tomography (CT) is the recommended diagnostic test * This article is a meta-analysis of 20 studies published between 2007 and 2020 that analyzed the accuracy of CT or detecting internal hernias in adult patients who underwent RNYGB for morbid obesity. A collective total of 1,637 patients were included. * Accuracy was determined by comparing diagnostic CT with exploratory surgery or the combination of negative CT and a negative 90 days follow-up * Internal herniation was defined as presence of herniated small bowel with or without obstruction or ischemia through a visible opening at the mesenteric defect * Results + Pooled sensitivity of CT was 82% and specificity was 85% + Positive predictive value of CT was 83% and negative predictive value was 86% * CT signs with the highest sensitivity (sensitivity of finding) + Venous congestion (79%) + Swirl sign (78%) + Mesenteric edema (67%) * 15% risk of an internal hernia even with a negative CT scan + In conclusion, CT can provide useful information, but these are just additional data points to consider in the overall evaluation of a patient. Surgeons should still have a low threshold for diagnostic laparoscopy even with negative CT findings
If you liked this episode, check out other bariatric episodes here: https://behindtheknife.org/podcast-category/bariatric/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This week we sat down with the Association of Out Surgeons & Allies (AOSA) leadership in the first installment of a BTK/AOSA collaboration addressing issues important to LGBTQ+ surgeons, patients, and allies. We are joined by Guest Host Dr. Andrew Schlussel, BTK Members Drs. Nina Clark and Jason Bingham, and AOSA Leaders Drs. Nicole Goulet, Alexis Moren, and Courtney Collins. More information about AOSA and how to get involved can be found at https://www.outsurgeons.org.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/
Join the Behind the Knife Surgical Oncology Team as we discuss the presentation, work-up, and management of gastrointestinal stromal tumors (GISTs)!
Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center
Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist and current HPB fellow at MD Anderson
Connor Chick, MD (@connor_chick) is a Surgical Oncology fellow at Ohio State University.
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-6 General Surgery resident at Brooke Army Medical Center
Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-5 General Surgery resident at Brooke Army Medical Center
Learning Objectives:
In this episode, we review the basics of gastrointestinal stromal tumors (GISTs), how to evaluate patients with presenting mass consistent with GIST, initial work-up, staging, and management. We discuss key concepts including the genetic background of these tumors and high-yield targeted therapies that are relevant both in direct patient care and board exams.
Reference:
Gold JS, Gönen M, Gutiérrez A, Broto JM, García-del-Muro X, Smyrk TC, Maki RG, Singer S, Brennan MF, Antonescu CR, Donohue JH, DeMatteo RP. Development and validation of a prognostic nomogram for recurrence-free survival after complete surgical resection of localised primary gastrointestinal stromal tumour: a retrospective analysis. Lancet Oncol. 2009 Nov;10(11):1045-52. doi: 10.1016/S1470-2045(09)70242-6. Epub 2009 Sep 28. PMID: 19793678; PMCID: PMC3175638.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our surgical oncology oral board exam review here: https://behindtheknife.org/premium/
How do you counsel the patient with a large painful hernia who still smokes a pack of cigarettes every day? Join Drs. Michael Rosen, Clayton Petro, Sara Maskal, and Ryan Ellis as they discuss some of the highlights in the literature on smoking and its impact on postoperative outcomes in elective, clean open ventral hernia repairs.
Hosts:
- Michael Rosen, Cleveland Clinic
- Clayton Petro, Cleveland Clinic
- Sara Maskal, Cleveland Clinic
- Ryan Ellis, Cleveland Clinic, @ryanellismd
Learning objectives:
- Evaluate historical data on smoking in surgery
- Compare with newer literature specific to contemporary ventral hernia repairs
- Understand how the historical and new data can be applied in clinical practice
References:
Møller AM, Villebro N, Pedersen T, Tønnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet. 2002 Jan 12;359(9301):114-7. doi: 10.1016/S0140-6736(02)07369-5. PMID: 11809253.
Kubasiak JC, Landin M, Schimpke S, Poirier J, Myers JA, Millikan KW, Luu MB. The effect of tobacco use on outcomes of laparoscopic and open ventral hernia repairs: a review of the NSQIP dataset. Surgical Endoscopy. 2017 Jun;31:2661-6.
DeLancey JO, Blay Jr E, Hewitt DB, Engelhardt K, Bilimoria KY, Holl JL, Odell DD, Yang AD, Stulberg JJ. The effect of smoking on 30-day outcomes in elective hernia repair. The American Journal of Surgery. 2018 Sep 1;216(3):471-4.
Sørensen LT. Wound healing and infection in surgery: the clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Archives of surgery. 2012 Apr 1;147(4):373-83.
Petro CC, Haskins IN, Tastaldi L, Tu C, Krpata DM, Rosen MJ, Prabhu AS. Does active smoking really matter before ventral hernia repair? An AHSQC analysis. Surgery. 2019 Feb;165(2):406-411. doi: 10.1016/j.surg.2018.07.039. Epub 2018 Sep 13. PMID: 30220485.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out more hernia episodes here: https://behindtheknife.org/podcast-category/hernia/
Surgeons are trained to, well…do surgery, but is that always the right treatment for the patient? Not offering surgery can be a challenge, especially when you’re consulted about a sick patient in the middle of the night and the clinical momentum is moving toward the OR. Join Drs. Katie O’Connell, Ali Haruta, Lindsay Dickerson, and Virginia Wang from the University of Washington as we discuss how to recognize when a surgery is potentially not beneficial and communicate serious news with the patient and consulting team.
Hosts:
Dr. Katie O’Connell (@katmo15) is an assistant professor of surgery at the University of Washington. She is a trauma surgeon, palliative care physician, director of surgical palliative care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA.
Dr. Ali Haruta is a PGY7 current palliative care fellow at the University of Washington, formerly a UW general surgery resident and Parkland trauma/critical care fellow.
Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY5 general surgery resident and current surgical oncology fellow at the University of Washington.
Dr. Virginia Wang is a PGY2 general surgery resident at the University of Washington.
Learning Objectives:
Identify when a patient’s disease course is unlikely reversible by surgery
Learn to avoid defaulting to offering potentially non-beneficial surgical treatment for patients at the end-of-life
Learn to recommend comfort-focused treatments for patients at the end-of-life
Develop the communication skill of delivering serious news
References:
-
Cooper Z, Courtwright A, Karlage A, Gawande A, Block S. Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution. Ann Surg. Dec 2014;260(6):949-57. doi:10.1097/SLA.0000000000000721
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VitalTalk. One page Guides. https://www.vitaltalk.org/guides/
-
VitalTalk. Using Ask-Tell-Ask to Make a Recommendation.
https://www.vitaltalk.org/using-ask-tell-ask-to-make-a-recommendation/
-
VitalTalk. What's a Headline? https://www.vitaltalk.org/whats-a-headline/
-
Zaza SI, Zimmermann CJ, Taylor LJ, Kalbfell EL, Stalter L, Brasel K, Arnold RM, Cooper Z, Schwarze ML. Factors Associated With Provision of Nonbeneficial Surgery: A National Survey of Surgeons. Ann Surg. 2023 Mar 1;277(3):405-411. doi: 10.1097/SLA.0000000000005765. Epub 2022 Nov 24. PMID: 36538626; PMCID: PMC9905263.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other surgical palliative care episodes here: https://behindtheknife.org/podcast-category/palliative-care/
While on your burn rotation, the emergency department calls due to a patient who may have been injured at his job site, coming in contact with a high-voltage line. Join Drs. Tam Pham, Clifford Sheckter, Alex Morzycki and Jamie Oh as they discuss the work-up, management, resuscitation, and subsequent complications and reconstruction for electrical injuries.
Hosts:- Dr. Tam Pham: UW Medicine Regional Burn Center
- Dr. Clifford Sheckter: Stanford Medicine, Santa Clara Valley Medical Center
- Dr. Alex Morzycki: UW Medicine Regional Burn Center
- Dr. Jamie Oh: UW Medicine Regional Burn Center
Learning Objectives:
- Review the epidemiology and common mechanisms for electrical injuries
- Understand the impact of electrical injuries on different organ systems, including skin, musculoskeletal, cardiac, neurologic, and renal systems
- Be able to guide initial work-up and resuscitation of acute electrical injuries including upper extremity compartment evaluation and release
- Recognize possible long-term complications of electrical injuries and their subsequent management
References:
1. Daskal Y, Beicker A, Dudkiewicz M, Kessel B. [HIGH VOLTAGE ELECTRIC INJURY: MECHANISM OF INJURY, CLINICAL FEATURES AND INITIAL EVALUATION.]. Harefuah. 2019 Jan;158(1):65-69. Hebrew. PMID: 30663297.
-
Pawlik AM, Lampart A, Stephan FP, Bingisser R, Ummenhofer W, Nickel CH. Outcomes of electrical injuries in the emergency department: a 10-year retrospective study. Eur J Emerg Med. 2016 Dec;23(6):448-454. doi: 10.1097/MEJ.0000000000000283. PMID: 25969345.
-
Davis C, Engeln A, Johnson EL, McIntosh SE, Zafren K, Islas AA, McStay C, Smith WR, Cushing T; Wilderness Medical Society. Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update. Wilderness Environ Med. 2014 Dec;25(4 Suppl):S86-95. doi: 10.1016/j.wem.2014.08.011. PMID: 25498265.
-
Zemaitis MR, Foris LA, Lopez RA, et al. Electrical Injuries. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448087/
-
Leversedge F, Moore T, Peterson B, Seiler J; Compartment syndrome of the upper extremity. J Hand Surg. 2011; 36(4):P544-559. doi: https://doi.org/10.1016/j.jhsa.2010.12.008
-
Arnoldo B, Klein M, Gibran NS. Practice guidelines for the management of electrical injuries. J Burn Care Res 2006, 27(4): 439-47
-
Pilecky D, Vamos M, Bogyi P, et al. Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients. Clin Res Cardiol 2019, 108(8): 901-908
-
Soar J, Perkins GD, Abbas G, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2010, 81(10): 1400-33
-
Kaergaard A, Nielsen KJ, Casrtensen O, Biering K. Electrical injury and the long-term risk of cataract: A prospective matched cohort study. Acta Ophthalmologica 2023, e88-e94
-
Richard F. Edlich, MD, PhD and others, TECHNICAL CONSIDERATIONS FOR FASCIOTOMIES IN HIGH VOLTAGE ELECTRICAL INJURIES, The Journal of Burn Care & Rehabilitation, Volume 1, Issue 2, November-December 1980, Pages 22–26.
-
Lee DH, Desai MJ, Gauger EM. Electrical injuries of the hand and upper extremity. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2019 Jan 1;27(1):e1-8.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/
While on your burn rotation, the emergency department calls due to a patient who may have been injured at his job site, coming in contact with a high-voltage line. Join Drs. Tam Pham, Clifford Sheckter, Alex Morzycki and Jamie Oh as they discuss the work-up, management, resuscitation, and subsequent complications and reconstruction for electrical injuries.
Hosts:- Dr. Tam Pham: UW Medicine Regional Burn Center
- Dr. Clifford Sheckter: Stanford Medicine, Santa Clara Valley Medical Center
- Dr. Alex Morzycki: UW Medicine Regional Burn Center
- Dr. Jamie Oh: UW Medicine Regional Burn Center
Learning Objectives:
- Review the epidemiology and common mechanisms for electrical injuries
- Understand the impact of electrical injuries on different organ systems, including skin, musculoskeletal, cardiac, neurologic, and renal systems
- Be able to guide initial work-up and resuscitation of acute electrical injuries including upper extremity compartment evaluation and release
- Recognize possible long-term complications of electrical injuries and their subsequent management
References:
1. Daskal Y, Beicker A, Dudkiewicz M, Kessel B. [HIGH VOLTAGE ELECTRIC INJURY: MECHANISM OF INJURY, CLINICAL FEATURES AND INITIAL EVALUATION.]. Harefuah. 2019 Jan;158(1):65-69. Hebrew. PMID: 30663297.
-
Pawlik AM, Lampart A, Stephan FP, Bingisser R, Ummenhofer W, Nickel CH. Outcomes of electrical injuries in the emergency department: a 10-year retrospective study. Eur J Emerg Med. 2016 Dec;23(6):448-454. doi: 10.1097/MEJ.0000000000000283. PMID: 25969345.
-
Davis C, Engeln A, Johnson EL, McIntosh SE, Zafren K, Islas AA, McStay C, Smith WR, Cushing T; Wilderness Medical Society. Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update. Wilderness Environ Med. 2014 Dec;25(4 Suppl):S86-95. doi: 10.1016/j.wem.2014.08.011. PMID: 25498265.
-
Zemaitis MR, Foris LA, Lopez RA, et al. Electrical Injuries. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448087/
-
Leversedge F, Moore T, Peterson B, Seiler J; Compartment syndrome of the upper extremity. J Hand Surg. 2011; 36(4):P544-559. doi: https://doi.org/10.1016/j.jhsa.2010.12.008
-
Arnoldo B, Klein M, Gibran NS. Practice guidelines for the management of electrical injuries. J Burn Care Res 2006, 27(4): 439-47
-
Pilecky D, Vamos M, Bogyi P, et al. Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients. Clin Res Cardiol 2019, 108(8): 901-908
-
Soar J, Perkins GD, Abbas G, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2010, 81(10): 1400-33
-
Kaergaard A, Nielsen KJ, Casrtensen O, Biering K. Electrical injury and the long-term risk of cataract: A prospective matched cohort study. Acta Ophthalmologica 2023, e88-e94
-
Richard F. Edlich, MD, PhD and others, TECHNICAL CONSIDERATIONS FOR FASCIOTOMIES IN HIGH VOLTAGE ELECTRICAL INJURIES, The Journal of Burn Care & Rehabilitation, Volume 1, Issue 2, November-December 1980, Pages 22–26.
-
Lee DH, Desai MJ, Gauger EM. Electrical injuries of the hand and upper extremity. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2019 Jan 1;27(1):e1-8.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/
Surgical residency is hard. In some ways, intern year may be the hardest. We’ve been there. We’re a group of surgical residents formally known as the Collaboration of Surgical Education Fellows (CoSEF), a multi-institutional organization of surgical education research fellows working together to foster peer mentorship, networking, and scholarly collaboration. We’ve collectively reflected on our experiences as surgical interns across the country. Join Drs. Ananya Anand, Joe L’Huillier, and Rebecca Moreci as they discuss three tips for thriving as a surgical intern.
Hosts:
–Dr. Ananya Anand, Stanford University, @AnanyaAnandMD
–Dr. Joseph L’Huillier, University at Buffalo, @JoeLHuillier101
–Dr. Rebecca Moreci, Louisiana State University, @md_moreci
–COSEF: @surgedfellows
Learning Objectives:
Listeners will:
– List CoSEF’s three tips for thriving as a surgical intern
– Challenge their definition of patient ownership
– Recall the “Golden Rule” of treating others how you want to be treated
– Appreciate the importance of self-care in surgical residency
References:
L’Huillier, Joseph C. MD; Lund, Sarah MD; Anand, Ananya MD; Jensen, Rachel M. MD; Williamson, Andrea J.H. MD; Clanahan, Julie M. MD, MHPE; Moreci, Rebecca MD; Gates, Rebecca S. MD, MMHPE. Thriving as a Surgical Intern: Three Tips From the Collaboration of Surgical Education Fellows (CoSEF). Annals of Surgery Open 4(3):p e306, September 2023. | DOI: 10.1097/AS9.0000000000000306
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/
Ad referenced in episode: https://jomi.com/
For patients with insufficient future liver remnant (FLR) volume, adequate hypertrophy after Portal Venous Embolization (PVE) is associated with reduced likelihood of post-operative hepatic insufficiency. But what happens when PVE isn’t enough to obtain adequate volume prior to surgery? In this episode from the HPB team at Behind the Knife, listen in on the discussion about advances in venous deprivation techniques that can potentially increase resection rates and hypertrophy
Hosts
Anish J. Jain MD (@anishjayjain) is a T32 Research Fellow at the University of Texas MD Anderson Cancer Center within the Department of Surgical Oncology.
Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology. He is also the associate program director of the HPB fellowship at the University of Texas MD Anderson Cancer Center.
Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center
Learning Objectives:
- Develop an understanding of Portal Venous Embolization (PVE)
- Develop an understanding of Sequential Hepatic Venous Embolization (HVE)
- Develop an understanding of Radiological Simultaneous Porto-hepatic Venous Embolization (RASPE)
- Develop an understanding of the traditional two-stage hepatectomy with PVE
- Develop an understanding of the Fast Track Two-Stage Hepatectomy
Papers Referenced (in the order they were mentioned in the episode):
1) Niekamp AS, Huang SY, Mahvash A, Odisio BC, Ahrar K, Tzeng CD, Vauthey JN. Hepatic vein embolization after portal vein embolization to induce additional liver hypertrophy in patients with metastatic colorectal carcinoma. Eur Radiol. 2020 Jul;30(7):3862-3868. doi: 10.1007/s00330-020-06746-4. Epub 2020 Mar 7. PMID: 32144462.
2) Laurent C, Fernandez B, Marichez A, Adam JP, Papadopoulos P, Lapuyade B, Chiche L. Radiological Simultaneous Portohepatic Vein Embolization (RASPE) Before Major Hepatectomy: A Better Way to Optimize Liver Hypertrophy Compared to Portal Vein Embolization. Ann Surg. 2020 Aug;272(2):199-205. doi: 10.1097/SLA.0000000000003905. PMID: 32675481.
3) Nishioka Y, Odisio BC, Velasco JD, Ninan E, Huang SY, Mahvash A, Tzeng CD, Tran Cao HS, Gupta S, Vauthey JN. Fast-track two-stage hepatectomy by concurrent portal vein embolization at first-stage hepatectomy in hybrid interventional radiology / operating suite. Surg Oncol. 2021 Dec;39:101648. doi: 10.1016/j.suronc.2021.101648. Epub 2021 Aug 16. PMID: 34438236.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/
Our Surgical Oncology Oral Board Audio Review includes 46 high-yield scenarios that cover all of the SCORE CGSO topics designed for Surgical Oncology Surgeons by Surgical Oncology Surgeons.
Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as surgical oncology surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the course and see all the episode topics here: https://behindtheknife.teachable.com/p/btk-surgical-oncology-oral-board-review-course
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Our Surgical Oncology Oral Board Audio Review includes 46 high-yield scenarios that cover all of the SCORE CGSO topics designed for Surgical Oncology Surgeons by Surgical Oncology Surgeons.
Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as surgical oncology surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the course and see all the episode topics here: https://behindtheknife.teachable.com/p/btk-surgical-oncology-oral-board-review-course
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
We know cardiac surgery can seem a bit daunting on the surface. However, most surgeons will come across cardiac surgery patients at some point whether in the OR, ICU, ED, etc. As the FIRST cardiac surgery specialty team for Behind the Knife, we are excited to bring you episodes focused on high-yield topics to help you navigate common cardiac surgery challenges, discuss relevant literature to help you in practice, and help our listeners feel more comfortable around cardiac surgery patients.
In this episode we’ll discuss common cardiac surgery post-op problems. Whether you're on a cardiac surgery rotation or just covering an ICU with cardiac surgery patients for the night, these common post-op problems are bound to occur.
Hosts:
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Jessica Millar, MD- PGY-5 General Surgery Resident, University of Michigan, @Jess_Millar15
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Aaron William, MD- Cardiothoracic Surgery Fellow, Duke University, @AMWilliamsMD
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Nick Teman, MD- Assistant Profressor of Thorasis and Cardiovascular Surgery, University of Virginia, @nickteman
Learning objectives:
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Understand the workup and management strategies for post-operative bleeding in the post-cardiac surgery patient.
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Understand how to recognize and manage post-cardiotomy cardiogenic shock in the post-cardiac surgery patient.
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Understand the workup, short-term, and long-term management for post-cardiac surgery atrial fibrillation.
Helpful Resources:
-
2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000665
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2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures, Executive summary: https://www.jtcvs.org/article/S0022-5223(14)00835-6/fulltext
For episode ideas/suggestions/feedback feel free to email Jessica Millar at: millarje@med.umich.edu
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our 4 Part Cardiac Surgery Crash Course Series here: https://behindtheknife.org/podcast/cardiac-surgery-crash-course-series-episode-1-intro-to-the-cardiac-or/
CME - What is it? Why do I need it? How do I get it? How much do I need? How do I keep track of credits?
Listen to BTK's Dr. Kevin Kniery's interview with the CEO of ACCME, Dr. Graham McMahon, to learn about the nuts and bolts of CME as well as recent changes to the program.
Helpful Links:
Behind the Knife's FREE CME: https://behindtheknife.org/cme/
CME Passport: CMEpassport.org
CME Passport/Behind the Knife: https://www.cmepassport.org/activity/search?specialty=behind%20the%20knife
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/
In the fifth episode of the “Innovation in Surgery” series, Dan Scheese sits down with Dr. Jeffrey Ponsky to discuss his innovation, the PEG tube. Dr. Ponsky shares many stories about his work with endoscopy in the late 1970s and how the idea for the PEG tube originated.
“The Development of PEG: How it was” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136860/
“Following the light: A history of the percutaneous endoscopic gastrostomy tube” https://www.facs.org/media/cyrndd5u/07_gastrostomy_tube.pdf
Dr. Ponsky completed his surgical training at University Hospitals of Cleveland in 1976. In 1979, he became the Director of the Department of Surgery at The Mount Sinai Medical Center in Cleveland, where he remained through 1997. In 1997, Dr Ponsky joined The Cleveland Clinic as the Director of Endoscopic Surgery and Executive Director of the Minimally Invasive Surgery Center. In 2005, he assumed the Oliver H. Payne Professorship and Chair of the Department of Surgery at Case Western University School of Medicine. He returned to The Cleveland Clinic as Director of Developmental Endoscopy in 2014. Dr Ponsky has served as president of many organizations including the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) and the American Society for Gastrointestinal Endoscopy (ASGE). Additionally, Dr. Ponsky has received numerous awards and has published over 300 original articles and book chapters.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other innovation episodes here: https://behindtheknife.org/podcast-series/innovations-in-surgery/
Have you ever struggled choosing which type of stoma to mature in an anatomically or medically challenging patient? What about wrestled with the associated postoperative complications? Join Drs. Galandiuk, Bolshinsky, Kavalukas, and Simon as they discuss ostomy creation and management of stoma complications.
**Hosts:
-** Susan Galandiuk MD, University of Louisville, Louisville, Kentucky, @DCREdInChief
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Vladimir Bolshinsky MD, Peninsula Health, Victoria, Australia, @bolshinskyv
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Sandy Kavalukas MD, University of Louisville, Louisville, Kentucky, @sandykava
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Hillary Simon DO, University of Louisville, Louisville, Kentucky, @HillaryLSimon
Producer:- Manasa Sunkara MS3, University of Louisville, Louisville, Kentucky, @manasasunkara12
Learning objectives:- Review pre-operative stoma marking and ostomy education.
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Understand “bail-out” ostomy creation options in medically and anatomically challenging patients.
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Discuss common postoperative ostomy complications and management.
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Review common peristomal skin pathology and treatment options.
Video References:
- Colwell, Janice C. A.P.R.N., C.W.O.C.N.1; Williams, Toyia M.S.N., R.N.2. Management of the Patient With a Prolapsed Ileostomy. Diseases of the Colon & Rectum 65(12):p e1073, December 2022. | DOI: 10.1097/DCR.0000000000002605 https://www.youtube.com/watch?v=Wx83CpRLkqk
Non-operative management of stoma prolapse/reduction
- Colwell, Janice C. A.P.R.N.. Management of the Patient With a Retracted Loop Ileostomy Located in a Crease. Diseases of the Colon & Rectum 65(3):p e182-e183, March 2022. | DOI: 10.1097/DCR.0000000000002367 https://www.youtube.com/watch?v=mc6o7nG1fsQ
Management of a retracted stoma, in a crease, with peristomal skin breakdown
- Watanabe, Kazuhiro M.D., Ph.D.; Kohyama, Atsushi M.D., Ph.D.; Suzuki, Hideyuki M.D., Ph.D.; Kajiwara, Taiki M.D., Ph.D.; Karasawa, Hideaki M.D., Ph.D.; Ohnuma, Shinobu M.D., Ph.D.; Kamei, Takashi M.D., Ph.D.; Unno, Michiaki M.D., Ph.D.. Slug Method: A Technique for Stoma Prolapse Reduction Using High Osmolality of the 50% Glucose Solution. Diseases of the Colon & Rectum 63(12):p e565, December 2020. | DOI: 10.1097/DCR.0000000000001798 https://cdn-links.lww.com/permalink/dcr/b/dcr_1_1_2020_09_01_watanabe_20-00282_sdc1.mp4
Osmotic reduction
Other References:
-
Baker ML, Williams RN, Nightingale J.. Causes and management of a high-output stoma. Colorectal Dis. 2011;13(2):191–197. doi: 10.1111/j.1463-1318.2009.02107.x.
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Behrenbruch, C., Carr, G., Johnston, M. and Woods, R. (2019), Three-point stapled fixation technique to manage ileostomy spout retraction. ANZ Journal of Surgery, 89: 423-424. doi: 10.1111/ans.15006
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O’Brien, Stephen J. M.B. B.Ch., B.A.O.; Ellis, C. Tyler M.D., M.S.C.R.. The Management of Peristomal Pyoderma Gangrenosum in IBD. Diseases of the Colon & Rectum 63(7):p 881-884, July 2020. | DOI: 10.1097/DCR.0000000000001701
-
Paquette IM, Solan P, Rafferty JF, Ferguson MA, Davis BR.. Readmission for dehydration or renal failure after ileostomy creation. Dis Colon Rectum. 2013;56(8):974–979. doi: 10.1097/DCR.0b013e31828d02ba
-
Steele S, Hull Tracy, Hyman N, Maykel J, Read T, and Whitlow C. The ASCRS Textbook of Colon and Rectal Surgery. 4th Edition. Volume II. Springer, Switzerland AG, 2022.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other recent Colorectal Surgery Episodes here: https://behindtheknife.org/podcast-category/colorectal/
In this two-part episode our team debates management of complex pleural effusions and empyema. Our surgical team is joined by Dr. Jed Gorden, an interventional pulmonologist, as we explore the nuances of deciding on fibrinolytic therapy (part 1) versus surgical management (part 2).
Part 1: https://behindtheknife.org/podcast/clinical-challenges-in-thoracic-surgery-complex-pleural-effusions-empyema-part-1-of-2/
Learning Objectives:
-Discuss the pros and cons of small bore versus large bore chest tubes for complex pleural effusions
-Review the evidence for fibrinolytic therapy for management of complex pleural effusions
-Describe the surgical management of a complex pleural effusion including VATS, open thoracotomy, empyema tube, Eloesser flap, and Clagett window
-Create a framework for shared-decision making with patients regarding management of a complex pleural effusion
Hosts:
Kelly Daus MD, Peter White MD, Jed Gorden, MD and Brian Louie MD
Referenced Material
https://pubmed.ncbi.nlm.nih.gov/15745977/
Maskell NA, et al. First Multicenter Intrapleural Sepsis Trial (MIST1) Group. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005 Mar 3;352(9):865-74. doi: 10.1056/NEJMoa042473. Erratum in: N Engl J Med. 2005 May 19;352(20):2146. PMID: 15745977.
https://pubmed.ncbi.nlm.nih.gov/21830966/
Rahman NM, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011 Aug 11;365(6):518-26. doi: 10.1056/NEJMoa1012740. PMID: 21830966.
https://pubmed.ncbi.nlm.nih.gov/35830586/
Wilshire CL, et al. Comparing Initial Surgery versus Fibrinolytics for Pleural Space Infections: A Retrospective Multicenter Cohort Study. Ann Am Thorac Soc. 2022 Nov;19(11):1827-1833. doi: 10.1513/AnnalsATS.202108-964OC. PMID: 35830586.
https://pubmed.ncbi.nlm.nih.gov/37043201/
Wilshire CL, et al. Effect of Intrapleural Fibrinolytic Therapy vs Surgery for Complicated Pleural Infections: A Randomized Clinical Trial. JAMA Netw Open. 2023 Apr 3;6(4):e237799. doi: 10.1001/jamanetworkopen.2023.7799. PMID: 37043201; PMCID: PMC10098968.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out more thoracic surgery episodes here: https://behindtheknife.org/podcast-category/cardiothoracic/
In this two-part episode our team debates management of complex pleural effusions and empyema. Our surgical team is joined by Dr. Jed Gorden, an interventional pulmonologist, as we explore the nuances of deciding on fibrinolytic therapy (part 1) versus surgical management (part 2).
Learning Objectives:
-Discuss the pros and cons of small bore versus large bore chest tubes for complex pleural effusions
-Review the evidence for fibrinolytic therapy for management of complex pleural effusions
-Describe the surgical management of a complex pleural effusion including VATS, open thoracotomy, empyema tube, Eloesser flap, and Clagett window
-Create a framework for shared-decision making with patients regarding management of a complex pleural effusion
Hosts:
Kelly Daus MD, Peter White MD, Jed Gorden, MD and Brian Louie MD
Referenced Material
https://pubmed.ncbi.nlm.nih.gov/15745977/
Maskell NA, et al. First Multicenter Intrapleural Sepsis Trial (MIST1) Group. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005 Mar 3;352(9):865-74. doi: 10.1056/NEJMoa042473. Erratum in: N Engl J Med. 2005 May 19;352(20):2146. PMID: 15745977.
https://pubmed.ncbi.nlm.nih.gov/21830966/
Rahman NM, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011 Aug 11;365(6):518-26. doi: 10.1056/NEJMoa1012740. PMID: 21830966.
https://pubmed.ncbi.nlm.nih.gov/35830586/
Wilshire CL, et al. Comparing Initial Surgery versus Fibrinolytics for Pleural Space Infections: A Retrospective Multicenter Cohort Study. Ann Am Thorac Soc. 2022 Nov;19(11):1827-1833. doi: 10.1513/AnnalsATS.202108-964OC. PMID: 35830586.
https://pubmed.ncbi.nlm.nih.gov/37043201/
Wilshire CL, et al. Effect of Intrapleural Fibrinolytic Therapy vs Surgery for Complicated Pleural Infections: A Randomized Clinical Trial. JAMA Netw Open. 2023 Apr 3;6(4):e237799. doi: 10.1001/jamanetworkopen.2023.7799. PMID: 37043201; PMCID: PMC10098968.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out more thoracic surgery episodes here: https://behindtheknife.org/podcast-category/cardiothoracic/
Entrustable Professional Activities, or EPAs, is a term you may have heard…or maybe not. EPAs represent a tectonic shift in surgical training and how residents will be evaluated. So, what are EPAs? How will they affect you? And what do you need to know? We sat down with Dr. George Sarosi, previous member of the ABS EPA Advisory Council and current General Surgery Residency Program Director at the University of Florida, to answer all of our questions now that EPAs are here.
Guests:
George Sarosi, MD- Professor of Surgery and General Surgery Residency Program Director- University of Florida
Patrick Georgoff, MD- Trauma Surgery and Surgical Critical Care- WakeMed Hospital; Co-director and Host of Behind the Knife
Jessica Millar, MD- General Surgery Resident- University of Michigan; Education Fellow- Behind the Knife
Daniel Scheese, MD- General Surgery Resident- Virginia Commonwealth University; Education Fellow- Behind the Knife
Helpful Websites:
Resources Page
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ABS EPA resources page for Programs and Trainees: https://www.absurgery.org/default.jsp?eparesources
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FAQs about EPAs and the ABS EPA Project (continuously updated so be sure to check back periodically): https://www.absurgery.org/xfer/epaprogfaqs.pdf
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ABS EPA Program Timeline for program engagement (includes webinars, suggestions for activities for programs to consider, and an expected timeframe for the distribution of additional implementation resources): https://www.absurgery.org/xfer/absepaprogtimeline.pdf
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Checklists for Program directors/Residency administrators/Faculty (https://www.absurgery.org/xfer/epaimplementationchecklist_programs.pdf) and for Residents (https://www.absurgery.org/xfer/epaimplementationchecklist_residents.pdf) to guide and sequence implementation priorities and timing
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/
Entrustable Professional Activities, or EPAs, is a term you may have heard…or maybe not. EPAs represent a tectonic shift in surgical training and how residents will be evaluated. So, what are EPAs? How will they affect you? And what do you need to know? We sat down with Dr. George Sarosi, previous member of the ABS EPA Advisory Council and current General Surgery Residency Program Director at the University of Florida, to answer all of our questions now that EPAs are here.
Guests:
George Sarosi, MD- Professor of Surgery and General Surgery Residency Program Director- University of Florida
Patrick Georgoff, MD- Trauma Surgery and Surgical Critical Care- WakeMed Hospital; Co-director and Host of Behind the Knife
Jessica Millar, MD- General Surgery Resident- University of Michigan; Education Fellow- Behind the Knife
Daniel Scheese, MD- General Surgery Resident- Virginia Commonwealth University; Education Fellow- Behind the Knife
Helpful Websites:
Resources Page
-
ABS EPA resources page for Programs and Trainees: https://www.absurgery.org/default.jsp?eparesources
-
FAQs about EPAs and the ABS EPA Project (continuously updated so be sure to check back periodically): https://www.absurgery.org/xfer/epaprogfaqs.pdf
-
ABS EPA Program Timeline for program engagement (includes webinars, suggestions for activities for programs to consider, and an expected timeframe for the distribution of additional implementation resources): https://www.absurgery.org/xfer/absepaprogtimeline.pdf
-
Checklists for Program directors/Residency administrators/Faculty (https://www.absurgery.org/xfer/epaimplementationchecklist_programs.pdf) and for Residents (https://www.absurgery.org/xfer/epaimplementationchecklist_residents.pdf) to guide and sequence implementation priorities and timing
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other recent episode here: https://behindtheknife.org/listen/
An ever-present spectre looming over the hearts of general surgeons everywhere! Please join our Emergency General Surgery team for a journal review about Clostridium difficile (C. diff) infection. Dr. Ashlie Nadler and Dr. Jordan Nantais are joined by guest Dr. Marika Sevigny, recent graduate of trauma and acute care surgery at the University of Toronto, as Dr. Graham Skelhorne-Gross prepares for his upcoming fellowship at Harborview.
Paper 1: Ahmed et al. Risk factors of surgical mortality in patients with Clostridium difficile colitis. A novel scoring system. Eur J Trauma Emerg Surg. 2022 Jun.
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Risk score development study using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP)
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525 adult (18-89) patients undergoing colectomy between 2012 and 2016
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Split data into training (80%) and testing (20%) datasets
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Identified mortality risk factors to create and validate a scoring system
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Scores ranged from 0 to 37 with the highest score predicting an 83.9% risk of mortality
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This scoring system appears relatively straight-forward and methodically sound but the lack of a currently available calculator limits use to some degree
Paper 2: McKechnie et al. Total Abdominal Colectomy Versus Diverting Loop Ileostomy and Antegrade Colonic Lavage for Fulminant Clostridioides Colitis: Analysis of the National Inpatient Sample 2016-2019. J Gastrointest Surg. 2023 Apr 20.
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Retrospective cohort study of adults (18+) in the National Inpatient Sample (NIS) admitted between Jan 2016 and Dec 2019 for C. difficile colitis, undergoing either a total abdominal colectomy (TAC) or diverting loop ileostomy (DLI) with antegrade vancomycin enemas
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Focus on not only mortality and complications but also admission cost and length of stay
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886 TAC and 409 DLI patients were identified
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Multivariable logistic regression analysis showed no difference in mortality or overall complications
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TAC patients had shorter admissions (mean difference 4.06 days) and lower cost (mean difference $79,715.34)
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Study was limited as it considered only the initial admission and is unable to provide data on outcomes and costs beyond this time
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Furthermore, there is consideration for disease severity in the analysis, which may impede the ability to compare the two operative approaches
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our other Emergency General Surgery episodes here: https://behindtheknife.org/podcast-category/emergency-general-surgery/
It’s that time of year (again!)- when medical students across the country are preparing their residency applications. The process can be a bit daunting, and there have been a number of changes to process for the 2024 application cycle. Join our education fellow, Dr. Jessica Millar, and Dr. David Hughes as they review the “nuts and bolts” of this year’s residency application cycle.
Guests:
David Hughes, MD- Clinical Associate Professor of Endocrine Surgery, General Surgery Residency Program Director- University of Michigan
Important Dates:
-
June 7, 2023: ERAS application opens at 9 a.m. ET.
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September 6, 2023: Residency applicants may begin submitting MyERAS applications to programs at 9 a.m. ET.
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September 15, 2023: Deadline to register for NRMP
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September 27, 2023: Residency programs may begin reviewing MyERAS applications, MSPEs, and supplemental ERAS application data (if applicable) at 9 a.m. ET.
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October 26-31, 2023: Common Interview Release Window
Previous DOMINATE the Match Episodes:
Episode 2- “Choose Me” (Personal Statements and Letters of Recommendations)
https://behindtheknife.org/podcast/dominate-the-match-episode-2-choose-me/
Episode 3- “The Interview”
https://behindtheknife.org/podcast/dominate-the-match-episode-3-the-interview/
Episode 4- “Rank and Match”
https://behindtheknife.org/podcast/dominate-the-match-episode-4-rank-and-match/
Residency Program Lists:
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FREIDA Residency and Fellowship Database: https://freida.ama-assn.org/
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Doximity: https://www.doximity.com/residency/?utm_campaign=marketing_resnav_competitor_broad_20210520&utm_source=google&utm_medium=cpc&gclid=CjwKCAjwt52mBhB5EiwA05YKo1J47BLAtTPtsJBmVvXGP2pDXLLqgDIwM0pgkSYjoBhFUOO1ktXDYRoC2bkQAvD_BwE
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our intern bootcamp series here: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/
The first BTK THROW DOWN! A spicy debate…a war of words…a battle of ideas! This fiery episode features leaders in the field of trauma surgery discussing the optimal approach to vascular access in trauma patients. A recent study titled “Moving the Needle on Time to Resuscitation: An EAST Prospective multicenter study of vascular access in hypotensive injured patients using trauma video review”concluded that intraosseous access should be considered a first line therapy in hypotensive trauma patients. Is this appropriate? Crazy? Just so crazy it might work? Let’s get ready to ruuuummmmbbbbbbllllllleeeee!
Hosts:
Patrick Georgoff, MD (@georgoff)
Nina Clark, MD (@clarkninam)
Guests:
Ryan Dumas, MD – UT Southwestern (@RPDumasMD)
Michael Vella, MD, MBA – University of Rochester (@MichaelVella32)
Bellal Joseph, MD – University of Arizona (@TopKnife_B)
Moving the Needle on Time to Resuscitation: An EAST Prospective multicenter study of vascular access in hypotensive injured patients using trauma video review.
- Dumas RP, Vella MA, Maiga AW, Erickson CR, Dennis BM, da Luz LT, Pannell D, Quigley E, Velopulos CG, Hendzlik P, Marinica A, Bruce N, Margolick J, Butler DF, Estroff J, Zebley JA, Alexander A, Mitchell S, Grossman Verner HM, Truitt M, Berry S, Middlekauff J, Luce S, Leshikar D, Krowsoski L, Bukur M, Polite NM, McMann AH, Staszak R, Armen SB, Horrigan T, Moore FO, Bjordahl P, Guido J, Mathew S, Diaz BF, Mooney J, Hebeler K, Holena DN. Moving the needle on time to resuscitation: An EAST prospective multicenter study of vascular access in hypotensive injured patients using trauma video review. J Trauma Acute Care Surg. 2023 Jul 1;95(1):87-93. doi: 10.1097/TA.0000000000003958. Epub 2023 Apr 4. PMID: 37012624.
**Time to early resuscitative intervention association with mortality in trauma patients at risk for hemorrhage.
-** Deeb AP, Guyette FX, Daley BJ, Miller RS, Harbrecht BG, Claridge JA, Phelan HA, Eastridge BJ, Joseph B, Nirula R, Vercruysse GA, Sperry JL, Brown JB. Time to early resuscitative intervention association with mortality in trauma patients at risk for hemorrhage. J Trauma Acute Care Surg. 2023 Apr 1;94(4):504-512. doi: 10.1097/TA.0000000000003820. Epub 2023 Jan 11. PMID: 36728324; PMCID: PMC10038862.
Comparison of ultrasound guidance with palpation and direct visualisation for peripheral vein cannulation in adult patients: a systematic review and meta-analysis- van Loon FHJ, Buise MP, Claassen JJF, Dierick-van Daele ATM, Bouwman ARA. Comparison of ultrasound guidance with palpation and direct visualisation for peripheral vein cannulation in adult patients: a systematic review and meta-analysis. Br J Anaesth. 2018 Aug;121(2):358-366. doi: 10.1016/j.bja.2018.04.047. Epub 2018 Jul 2. PMID: 30032874.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/
In this two-part series, we come to you LIVE! from the 2023 Annual meeting of the American Association of Endocrine Surgeons in Birmingham, Alabama. If you think evaluating and managing patients with primary hyperparathyroidism is difficult, patients with secondary and tertiary hyperparathyroidism can be even more difficult to evaluate and manage. Join Drs. Barb Miller, Sophie Dream, Jessica Liu McMullin, and Herb Chen as they break down the controversies and complexities associated with evaluation and management of these patients and discuss the recently published AAES guidelines on the definitive surgical management of patients with secondary and tertiary renal hyperparathyroidism. Part 1 focuses on the impetus for creation of these guidelines, the differences in evaluation and indication for surgery when seeing patients with renally mediated hyperparathyroidism, and preoperative planning. Part 2 focuses on intraoperative and postoperative management, parathyroid autotransplantation, and renal transplant recipients.
Hosts:
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Barbra S. Miller, MD (Moderator), Clinical Professor of Surgery, The Ohio State University, @OSUEndosurgBSM
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Sophie Dream, MD, Assistant Professor of Surgery, Medical College of Wisconsin, @SDreamMD,
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Jessica Liu McMullin, MD, Endocrine Surgery Fellow, University of Alabama – Birmingham, @jess_mcmullin
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Herbert Chen, MD, Professor and Chair of Surgery, University of Alabama – Birmingham, @herbchen
Learning objectives:
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Understand the epidemiology and pathogenesis of kidney-related parathyroid disease and how these entities differ from primary hyperparathyroidism
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Describe the diagnosis of kidney-related hyperparathyroidism and its different presentations
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Define the indications for surgical intervention
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Recognize the different approaches and extents of surgery for treating the different types of renally mediated hyperparathyroidism including thymectomy and parathyroid autotransplantation
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Detail methods for safe and effective perioperative management
References:
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Dream S, Kuo LE, Kuo JH, Sprague SM, Nwariaku FE, Wolf M, Olson JA Jr, Moe SM, Lindeman B, Chen H. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism. Ann Surg. 2022 Sep 1;276(3):e141-e176. doi: 10.1097/SLA.0000000000005522. Epub 2022 Jul 18. PMID: 35848728.
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Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons Guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 2016;151:959–968.
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Ketteler M, Block GA, Evenepoel P, et al. Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guideline Update: what’s changed and why it matters. Kidney Int. 2017;92:26–36.
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Andress DL, Coyne DW, Kalantar-Zadeh K, et al. Management of secondary hyperparathyroidism in stages 3 and 4 chronic kidney disease. Endocr Pract. 2008;14:18–27.
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Cozzolino M, Brancaccio D, Gallieni M, et al. Pathogenesis of parathyroid hyperplasia in renal failure. J Nephrol. 2005;18:5–8.
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Lau WL, Cobi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism. Clin J Am Soc Nephrol. 2018;13:952–961.
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Parfrey PS, Chertow GM, Block GA, et al. The clinical course of treated hyperparathyroidism among patients receiving hemodialysis and the effect of cinacalcet: the EVOLVE trial. J Clin Endocrinol Metab. 2013;98:4834–4844.
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Costa-Hong V, Jorgetti V, Gowdak LH, et al. Parathyroidectomy reduces cardiovascular events and mortality in renal hyperparathyroidism. Surgery. 2007;142:699–703.
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McManus C, Oh A, Lee JA, et al. Timing of parathyroidectomy for tertiary hyperparathyroidism with end-stage renal disease: a cost-effectiveness analysis. Surgery. 2021;169:94–101.
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Finnerty BM, Chan TW, Jones G, et al. Parathyroidectomy versus cinacalcet in the management of tertiary hyperparathyroidism: surgery improves renal transplant allograft survival. Surgery. 2019;165:129–134.
Suture Kit:
Purchase on suturekit.com
Purchase on Amazon
How-to Video Series
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other endocrine episodes here: https://behindtheknife.org/podcast-category/endocrine/
In this two-part series, we come to you LIVE! from the 2023 Annual meeting of the American Association of Endocrine Surgeons in Birmingham, Alabama. If you think evaluating and managing patients with primary hyperparathyroidism is difficult, patients with secondary and tertiary hyperparathyroidism can be even more difficult to evaluate and manage. Join Drs. Barb Miller, Sophie Dream, Jessica Liu McMullin, and Herb Chen as they break down the controversies and complexities associated with evaluation and management of these patients and discuss the recently published AAES guidelines on the definitive surgical management of patients with secondary and tertiary renal hyperparathyroidism. Part 1 focuses on the impetus for creation of these guidelines, the differences in evaluation and indication for surgery when seeing patients with renally mediated hyperparathyroidism, and preoperative planning. Part 2 focuses on intraoperative and postoperative management, parathyroid autotransplantation, and renal transplant recipients.
Hosts:
-
Barbra S. Miller, MD (Moderator), Clinical Professor of Surgery, The Ohio State University, @OSUEndosurgBSM
-
Sophie Dream, MD, Assistant Professor of Surgery, Medical College of Wisconsin, @SDreamMD,
-
Jessica Liu McMullin, MD, Endocrine Surgery Fellow, University of Alabama – Birmingham, @jess_mcmullin
-
Herbert Chen, MD, Professor and Chair of Surgery, University of Alabama – Birmingham, @herbchen
Learning objectives:
-
Understand the epidemiology and pathogenesis of kidney-related parathyroid disease and how these entities differ from primary hyperparathyroidism
-
Describe the diagnosis of kidney-related hyperparathyroidism and its different presentations
-
Define the indications for surgical intervention
-
Recognize the different approaches and extents of surgery for treating the different types of renally mediated hyperparathyroidism including thymectomy and parathyroid autotransplantation
-
Detail methods for safe and effective perioperative management
References:
-
Dream S, Kuo LE, Kuo JH, Sprague SM, Nwariaku FE, Wolf M, Olson JA Jr, Moe SM, Lindeman B, Chen H. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism. Ann Surg. 2022 Sep 1;276(3):e141-e176. doi: 10.1097/SLA.0000000000005522. Epub 2022 Jul 18. PMID: 35848728.
-
Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons Guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 2016;151:959–968.
-
Ketteler M, Block GA, Evenepoel P, et al. Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guideline Update: what’s changed and why it matters. Kidney Int. 2017;92:26–36.
-
Andress DL, Coyne DW, Kalantar-Zadeh K, et al. Management of secondary hyperparathyroidism in stages 3 and 4 chronic kidney disease. Endocr Pract. 2008;14:18–27.
-
Cozzolino M, Brancaccio D, Gallieni M, et al. Pathogenesis of parathyroid hyperplasia in renal failure. J Nephrol. 2005;18:5–8.
-
Lau WL, Cobi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism. Clin J Am Soc Nephrol. 2018;13:952–961.
-
Parfrey PS, Chertow GM, Block GA, et al. The clinical course of treated hyperparathyroidism among patients receiving hemodialysis and the effect of cinacalcet: the EVOLVE trial. J Clin Endocrinol Metab. 2013;98:4834–4844.
-
Costa-Hong V, Jorgetti V, Gowdak LH, et al. Parathyroidectomy reduces cardiovascular events and mortality in renal hyperparathyroidism. Surgery. 2007;142:699–703.
-
McManus C, Oh A, Lee JA, et al. Timing of parathyroidectomy for tertiary hyperparathyroidism with end-stage renal disease: a cost-effectiveness analysis. Surgery. 2021;169:94–101.
-
Finnerty BM, Chan TW, Jones G, et al. Parathyroidectomy versus cinacalcet in the management of tertiary hyperparathyroidism: surgery improves renal transplant allograft survival. Surgery. 2019;165:129–134.
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How-to Video Series
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other endocrine episodes here: https://behindtheknife.org/podcast-category/endocrine/
The anterior abdominal stab wound! Who gets explored? When do you get imaging? Who gets serial abdominal exams? How does this change depending on the location of injury? Join Drs. Cobler-Lichter, Kwon, Meizoso, and Urréchaga in their first episode as the new Miami Trauma team - as they discuss how to navigate the nuances of stab wounds to the torso!
**Hosts:
-** Michael Cobler-Lichter, MD, PGY2:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@mdcobler (twitter)
- Eva Urrechaga, MD, PGY6/R4:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@urrechisme (twitter)
- Eugenia Kwon, MD, Trauma/Surgical Critical Care Fellow:
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
- Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery
University of Miami/Jackson Memorial Hospital/Ryder Trauma Center
@jpmeizoso (twitter)
**Learning Objectives:
-** Identify the differences in management of abdominal/thoracoabdominal stab wounds depending on location of injury
-
Identify who needs immediate operative intervention and who can undergo further evaluation
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Define the management pathways for patients with abdominal stab wounds without an immediate indication for the OR
-
Define thoracoabdominal stab wound and when to evaluate for thoracic injuries
-
Discuss the role of diagnostic imaging when evaluating a patient with a stab to the torso
Quick Hits:
-
Don’t forget about the blunt trauma that may be associated with an assault!
-
Don't miss injuries- always start with the ABCs and do a thorough head to toe exam
-
For stab wounds to the torso- hemodynamic instability, evisceration, peritonitis, impalement, or gross blood should go to the OR.
-
The three general clinical pathways for patients without a clear indication for the OR, include serial abdominal exams, local wound exploration, or diagnostic imaging.
-
Serial abdominal exams require frequent monitoring ideally by the same team member every time to detect changes early.
-
Local wound exploration requires adequate lighting and retraction to visualize the anterior rectus fascia. A negative LWE rules out an intra-abdominal injury, but a positive LWE does not necessarily rule it in.
-
Left thoracoabdominal stab wounds require evaluation of the diaphragm to rule out a traumatic diaphragm injury.
-
If there are no clear indications for the OR, diaphragm evaluation should be performed via laparoscopy after a period of 8 - 12 hours from injury.
-
A negative pericardial ultrasound does not rule out a cardiac injury in patients with a left-sided hemothorax.
-
Patients with flank and back stab wounds should be evaluated with CT scan to rule-out retroperitoneal injuries
References1.Martin MJ, Brown CVR, Shatz DV, Alam HB, Brasel KJ, Hauser CJ, de Moya M, Moore EE, Rowell SE, Vercruysse GA, Baron BJ, Inaba K. Evaluation and management of abdominal stab wounds: A Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg. 2018 Nov;85(5):1007-1015. doi: 10.1097/TA.0000000000001930. PMID: 29659472.
- Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, Ivatury RR, Scalea TM. Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma. 2010 Mar;68(3):721-33. doi: 10.1097/TA.0b013e3181cf7d07. PMID: 20220426.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this trauma episode, check out our BIG T Trauma Series here: https://behindtheknife.org/podcast-series/big-t-trauma/
In the fourth episode of the “Innovation in Surgery” series, Drs. Patrick Georgoff and Dan Scheese sit down with Dr. Mark Piehl to discuss his innovation, LifeFlow. Additionally, Dr. Piehl covers multiple other topics in this episode, including circulation-first resuscitation and the process of innovation from the physician’s perspective.
410 Medical Website: https://410medical.com
Reel Emergency trauma podcast: https://www.youtube.com/watch?v=unog3YkFSOE
Prehospital emergency care case report from the episode: https://pubmed.ncbi.nlm.nih.gov/36703273/
Dr. Piehl’s Resuscitation review article: https://link.springer.com/content/pdf/10.1007/s40138-021-00237-6.pdf
Dr. Piehl’s Shock article on circulation-first resuscitation in trauma: https://pubmed.ncbi.nlm.nih.gov/36703273/
Preliminary data on prehospital trauma resuscitation with LifeFlow (Larger version of this with historical controls to be presented at AAST): https://410medical.com/app/uploads/2023/04/ESO-Poster-Presentation-April-2023.pdf
“Unraveling the Fluid Confusion in Sepsis” webinar: https://www.youtube.com/watch?v=yip3AhEezA0
Dr. Mark Piehl is a pediatric critical care physician at WakeMed in Raleigh, NC, and a Medical Director with the WakeMed Mobile Critical Care transport team. Mark is also Founder and Chief Medical Officer of 410 Medical, a company focused on improving resuscitation in shock, sepsis, and trauma. He previously served as Medical Director of the WakeMed Children's Hospital and Director of Pediatrics at WakeMed. He has numerous Department of Defense grants funding the development of technology to improve trauma care. Mark is also Founder of the Samaritan Health Center, a clinic for the homeless and uninsured in Durham, NC.
Suture Kit:
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other innovation episodes here: https://behindtheknife.org/podcast-series/innovations-in-surgery/
In this episode of Behind the Knife the vascular surgery subspecialty team discusses a case of an infected endovascular aortic graft. Although rare, aortic graft infections remain a devastating complication. What options do you have to fix this problem? In this episode, we will cover the who is at risk of this, how they present, and what options you have to fix it.
Hosts:
Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan
Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan
Dr. David Schechtman is a Vascular Surgery Fellow at the University of Michigan
Dr. Drew Braet is a PGY-3 Integrated Vascular Surgery Resident at the University of Michigan
Learning Objectives
· Understand the incidence of and the relevant risk factors for aortic graft infections
· Review the spectrum of presenting symptoms and relevant workup for aortic graft infections
· Understand surgical treatment options including options for in-situ bypass and extra-anatomic bypass
· Review the different conduits that can be used for in-situ and extra-anatomic reconstruction
· Discuss relevant post-operative considerations for patients undergoing operative intervention for aortic graft infection
References
· Chiesa R, Astore D, Frigerio S, Garriboli L, Piccolo G, Castellano R, Scalamogna M, Odero A, Pirrelli S, Biasi G, Mingazzini P, Biglioli P, Polvani G, Guarino A, Agrifoglio G, Tori A, Spina G. Vascular prosthetic graft infection: epidemiology, bacteriology, pathogenesis and treatment. Acta Chir Belg. 2002 Aug;102(4):238-47. doi: 10.1080/00015458.2002.11679305. PMID: 12244902.
· Bisdas T, Bredt M, Pichlmaier M, Aper T, Wilhelmi M, Bisdas S, Haverich A, Teebken OE. Eight-year experience with cryopreserved arterial homografts for the in situ reconstruction of abdominal aortic infections. J Vasc Surg. 2010 Aug;52(2):323-30. doi: 10.1016/j.jvs.2010.02.277. Epub 2010 Jun 8. PMID: 20570473.
· PereraG. B.FujitaniR. M.KubaskaS. M.2006Aortic graft infection: Update on Management and Treatment Options.Vasc Endovascular Surg, 401Jan), 1101538-5744
· Hallett J., Marshall D.M., Petterson T.M., et. al.: Graft-related complications after abdominal aortic aneurysm repair: Population-based experience. J Vasc Surg 1977; 25: pp. 277-284.
· Kieffer E, Sabatier J, Plissonnier D, Knosalla C. Prosthetic graft infection after descending thoracic/ thoracoabdominal aortic aneurysmectomy: management with in situ arterial allografts. J Vasc Surg. 2001 Apr;33(4):671-8. doi: 10.1067/mva.2001.112314. PMID: 11296316.
· Gutowski P. Zakazenie aortalno-biodrowej protezy naczyniowej jako problem diagnostyczny i leczniczy [Aortoiliac graft infection as a diagnostic and treatment problem]. Ann Acad Med Stetin. 1998;Suppl 41:1-72. Polish. PMID: 9766086.
· Capoccia L, Mestres G, Riambau V. Current technology for the treatment of infection following abdominal aortic aneurysm (AAA) fixation by endovascular repair (EVAR). J Cardiovasc Surg (Torino). 2014;55:381–389.
· Setacci C, Chisci E, Setacci F, Ercolini L, de Donato G, Troisi N, Galzerano G, Michelagnoli S. How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair. Aorta (Stamford). 2014 Dec 1;2(6):255-64. doi: 10.12945/j.aorta.2014.14-036. PMID: 26798744; PMCID: PMC4682678.
· Reinders Folmer E.I., Von Meijenfeldt G.C.I., Van der Laan M.J., Glaudemans A.W.J.M., Slart R.H.J.A., Saleem B.R., Zeebregts C.J. Diagnostic Imaging in Vascular Graft Infection: A Systematic Review and Meta-Analysis. Eur. J. Vasc. Endovasc. Surg. 2018;56:719–729. doi: 10.1016/j.ejvs.2018.07.010.
· Rafailidis V., Partovi S., Dikkes A., Nakamoto D.A., Azar N., Staub D. Evolving clinical applications of contrast-enhanced ultrasound (CEUS) in the abdominal aorta. Cardiovasc. Diagn. Ther. 2018;8:S118–S130. doi: 10.21037/cdt.2017.09.09.
· Hayes P.D., Nasim A., London N.J., et. al.: In situ replacement of infected aortic grafts with rifampicin-bonded prostheses: The Leicester experience (1992 to 1998). J Vasc Surg 1999; 30: pp. 92-98.
· Oderich GS, Bower TC, Hofer J, Kalra M, Duncan AA, Wilson JW, Cha S, Gloviczki P. In situ rifampin-soaked grafts with omental coverage and antibiotic suppression are durable with low reinfection rates in patients with aortic graft enteric erosion or fistula. J Vasc Surg. 2011 Jan;53(1):99-106, 107.e1-7; discussion 106-7. doi: 10.1016/j.jvs.2010.08.018. PMID: 21184932.
· Bisdas T., Bredt M., Pichlmaier M., et. al.: Eight-year experience with cryopreserved arterial homografts for the in situ reconstruction of abdominal aortic infections. J Vasc Surg 2010; 52: pp. 323-330.
· O'Hara P.J., Hertzer N.R., Beven E.G., et. al.: Surgical management of infected abdominal aortic grafts: Review of a 25-year experience. J Vasc Surg 1986; 3: pp. 725-731.
· Quiñones-Baldrich WJ, Hernandez JJ, Moore WS. Long-term Results Following Surgical Management of Aortic Graft Infection. Arch Surg. 1991;126(4):507–511. doi:10.1001/archsurg.1991.01410280111018
· Kieffer E., Gomes D., Chieche L., et. al.: Allograft replacement for infrarenal aortic graft infection: Early and late results in 179 patients. J Vasc Surg 2004; 39: pp. 1009-1017.
· Zhou W., Lin P.H., Bush R.L., et. al.: In situ reconstruction with cryopreserved arterial allografts for management of mycotic aneurysms or aortic prosthetic graft infections: A multi-institutional experience. Texas Heart Institute J 2006; 33: pp. 14-18. 2006
· Ali AT, Modrall JG, Hocking J, Valentine RJ, Spencer H, Eidt JF, Clagett GP. Long-term results of the treatment of aortic graft infection by in situ replacement with femoral popliteal vein grafts. J Vasc Surg. 2009 Jul;50(1):30-9. doi: 10.1016/j.jvs.2009.01.008. PMID: 19563952.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other vascular episodes here: https://behindtheknife.org/podcast-category/vascular/
Have you transitioned a portion of your practice to the robot, but would be hesitant to book an urgent/call case on the robot? Have you wondered if the robot might be useful in your emergency or acute care surgery practice? Join University of Washington MIS Surgeons, Drs. Andrew Wright, Nicole White, and Nick Cetrulo, and Resident Drs. Ben Vierra and Paul Herman as they discuss the growing use of the robot for acute cases and provide tips on appropriate case selection.
Hosts:
1. Andrew Wright, UW Medical Center – Montlake and Northwest, @andrewswright
2. Nick Cetrulo, UW Medical Center - Northwest, @Trules25
3. Nicole White, UW Medical Center - Northwest
4. Paul Herman, UW General Surgery Resident PGY-3, @paul_herm
5. Ben Vierra, UW General Surgery Resident PGY-2
Learning objectives:
-
Describe the importance of the MIS approach in EGS
-
Review 3 articles on robotic EGS outcomes
1) Robotic surgery in emergency setting: 2021 WSES position paper
2) Emergent robotic versus laparoscopic surgery for perforated gastrojejunal ulcers: a retrospective cohort study of 44 patients
3) Urgent robotic subtotal colectomy for severe acute ulcerative colitis has comparable periop outcomes to laparoscopic surgery
-
Discuss factors influencing appropriate case selection for urgent/emergent robotic cases
-
Discuss value as it pertains to robotic EGS
References
1. Havens JM, Peetz AB, Do WS, Cooper Z, Kelly E, Askari R, Reznor G, Salim A. The excess morbidity and mortality of emergency general surgery. J Trauma Acute Care Surg. 2015 Feb;78(2):306-11. doi: 10.1097/TA.0000000000000517. PMID: 25757115.
2. Scott JW, Olufajo OA, Brat GA, Rose JA, Zogg CK, Haider AH, Salim A, Havens JM. Use of National Burden to Define Operative Emergency General Surgery. JAMA Surg. 2016 Jun 15;151(6):e160480. doi: 10.1001/jamasurg.2016.0480. Epub 2016 Jun 15. PMID: 27120712.
3. Arnold M, Elhage S, Schiffern L, Lauren Paton B, Ross SW, Matthews BD, Reinke CE. Use of minimally invasive surgery in emergency general surgery procedures. Surg Endosc. 2020 May;34(5):2258-2265. doi: 10.1007/s00464-019-07016-1. Epub 2019 Aug 6. PMID: 31388806.
4. Sheetz KH, Claflin J, Dimick JB. Trends in the Adoption of Robotic Surgery for Common Surgical Procedures. JAMA Netw Open. 2020 Jan 3;3(1):e1918911. doi: 10.1001/jamanetworkopen.2019.18911. PMID: 31922557; PMCID: PMC6991252.
5. de'Angelis N, Khan J, Marchegiani F, Bianchi G, Aisoni F, Alberti D, Ansaloni L, Biffl W, Chiara O, Ceccarelli G, Coccolini F, Cicuttin E, D'Hondt M, Di Saverio S, Diana M, De Simone B, Espin-Basany E, Fichtner-Feigl S, Kashuk J, Kouwenhoven E, Leppaniemi A, Beghdadi N, Memeo R, Milone M, Moore E, Peitzmann A, Pessaux P, Pikoulis M, Pisano M, Ris F, Sartelli M, Spinoglio G, Sugrue M, Tan E, Gavriilidis P, Weber D, Kluger Y, Catena F. Robotic surgery in emergency setting: 2021 WSES position paper. World J Emerg Surg. 2022 Jan 20;17(1):4. doi: 10.1186/s13017-022-00410-6. PMID: 35057836; PMCID: PMC8781145.
6. Robinson TD, Sheehan JC, Patel PB, Marthy AG, Zaman JA, Singh TP. Emergent robotic versus laparoscopic surgery for perforated gastrojejunal ulcers: a retrospective cohort study of 44 patients. Surg Endosc. 2022 Feb;36(2):1573-1577. doi: 10.1007/s00464-021-08447-5. Epub 2021 Mar 24. PMID: 33760973.
7. Anderson M, Lynn P, Aydinli HH, Schwartzberg D, Bernstein M, Grucela A. Early experience with urgent robotic subtotal colectomy for severe acute ulcerative colitis has comparable perioperative outcomes to laparoscopic surgery. J Robot Surg. 2020 Apr;14(2):249-253. doi: 10.1007/s11701-019-00968-5. Epub 2019 May 10. PMID: 31076952.
8. Gangemi A, Danilkowicz R, Bianco F, Masrur M, Giulianotti PC. Risk Factors for Open Conversion in Minimally Invasive Cholecystectomy. JSLS. 2017 Oct-Dec;21(4):e2017.00062. doi: 10.4293/JSLS.2017.00062. PMID: 29238153; PMCID: PMC5714218.
9. Bhama AR, Wafa AM, Ferraro J, Collins SD, Mullard AJ, Vandewarker JF, Krapohl G, Byrn JC, Cleary RK. Comparison of Risk Factors for Unplanned Conversion from Laparoscopic and Robotic to Open Colorectal Surgery Using the Michigan Surgical Quality Collaborative (MSQC) Database. J Gastrointest Surg. 2016 Jun;20(6):1223-30. doi: 10.1007/s11605-016-3090-6. Epub 2016 Feb 3. PMID: 26847352.
10. https://www.east.org/about-east/news-and-events/news/details/320/east-robotic-surgery-for-the-acute-care-surgeon-webinar-series
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other MIS episodes here: https://behindtheknife.org/podcast-category/minimally-invasive/
Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.
In this last episode of the intern bootcamp mini-series, we’ll talk about tips & tricks as well as good habits to establish in order to dominate intern year.
Hosts: Shanaz Hossain, Nina Clark
Tips for New Interns:
GENERAL TIPS FOR SUCCESS ON THE WARDS * Spend time with the patient! * Trust, but verify. * Be kind to everyone. * Stay humble. * Be flexible. * Seek and apply feedback.
HOW TO LEARN IN THE OR * Double scrub as many cases as you can. * Write down/record everything after a case.
MAINTAIN YOUR PERSONAL SANITY * Figure out your stress outlets and what brings you joy. * Decompress after work. * Maintain work/life boundaries. * Keep in touch with loved ones. * Vacations are meant for relaxation. + Repeat after me: NO WORK ON VACATION!
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/
Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.
Today, we’re hitting the wards and tackling some of the scary clinical scenarios you will see as an intern.
Hosts: Shanaz Hossain, Nina Clark
Tips for new interns:
THINGS TO REMEMBER
· BREATHE. In most cases, you have a little bit of time – at least enough to take a breath and calm down outside the room before heading into an emergency. Panic doesn’t help anybody.
· See the patient. Getting a bunch of pages? Worried about someone? Confused as to what’s going on? Go see the patient and chat with the bedside team.
· Know your toolbox. There are a ton of people around who can help you in the hospital, and knowing the basic labs/imaging studies and when to use them can help you to triage even the sickest patients.
· Load the boat. You’ve heard this one from us all week! Loop senior level residents in early.
HYPOTENSION
· Differential: measurement error, patient’s baseline, and don’t miss – SHOCK.
- Etiologies of shock: hemorrhagic, hypovolemic,
· On the phone: full set of vitals, accurate I/Os,
· On the way: recent notes, PMH/PSH including from this hospital stay, and vitals/I&Os/studies from earlier in the day
· In the room: ABCDs – rapidly gives you a sense of how high acuity the patient is
· Get more info: labs, consider imaging, work up specific types of shock based on clinical concern.
· Initial management: depends on etiology of hypotension; don’t forget to consider peripheral or central access, foley catheterization for close monitoring of urine output, and level of care
HYPOXEMIA
· Differential: atelectasis, baseline pulmonary disease, pneumonia, PE, hemo/pneumothorax, volume overload
· On the phone: full set of vitals, amount of supplemental oxygen required and delivery device, rate of escalation in oxygen requirement
· On the way: review PMH/PSH, known injuries (known hemothorax/pneumothorax? Rib fractures? Chest tubes in already?), risk factors for DVT/PE, review I/Os for evidence of volume status, vitals and labs for evidence of infection
· In the room: ABCDs, pulmonary and cardiac exam, volume status exam
· Get more info: basic labs, ABG if worried about oxygenation, CXR, consider bedside US of the lungs/heart, if high suspicion for PE consider CTA chest
· Initial Management: supplemental O2, higher level of care, consider intubation or other supplemental oxygenation adjuncts, additional management dependent on suspected etiology
· ABG Vs VBG (IBCC): https://emcrit.org/ibcc/vbg/
ALTERED MENTAL STATUS
· Differential: stroke, medication effect, hypoxemia or hypercarbia, toxic or medication effect, endocrine/metabolic, stroke or MI, psychiatric illness, or infections, delirium
· On the way: review PMH/PSH, recent notes for evidence of altered mentation or agitation, or signs hinting at above etiologies
· In the room: ABCDs, focal neuro deficits?, alert/oriented? Be sure the patient’s mental status is adequate for airway protection!
· Get more info: basic labs, blood gas/lactate, CT head noncontrast if concerned for stroke.
· Initial management: rule out above; if concerned about delirium, optimize sleep/wake cycles, pain control, and lines/drains/tubes.
OLIGURIA
· Differential: prerenal due to hypovolemia or low effective circulating volume, intrinsic renal disease, post-renal obstruction
· On the phone: clarify functional foley or bladder scan results, full set of vitals
· On the way: review PMH/PSH, known injuries (known hemothorax/pneumothorax? Rib fractures? Chest tubes in already?), risk factors for DVT/PE, review I/Os for evidence of volume status, vitals and labs for evidence of infection
· In the room: ABCDs, confirm functioning foley catheter
· Get more info: basic labs, urine electrolytes, consider fluid challenge to evaluate responsiveness, consider adjuncts including renal US
· Initial management: typically consider IVF bolus initially, but if patient not volume responsive, don't overload them -- look for other etiologies!
TACHYCARDIA
· Differential: sinus tachycardia (pain, hypovolemia, agitation, infection), cardiac arrhythmia, MI, PE
· On the phone: full set of vitals, acuity of change in heart rate, updated I/Os
· On the way: Review PMH/PSH, known cardiac history, cardiac and PE risk factors, volume resuscitation, signs concerning for infection, updated I/Os
· In the room: ABCDs, cardiac/pulmonary exam, evaluate for any localizing signs for infection
· Get more info: basic labs, EKG, consider CXR, troponins
· Initial management: depends heavily on etiology
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/
Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.
This episode, we’ll talk about how to give and receive consults in the hospital like a pro. We’ll also provide some tips on how to make those long call days a little more manageable.
Hosts: Shanaz Hossain, Nina Clark
Tips for New Interns:
GIVING CONSULTS * Clear and Concise Question! * Develop a script, such as: + “Hi, this is XX with the general surgery team. We’re calling to request an evaluation for a patient presenting with XX. I can give you the MRN whenever you are ready…” + Follow this with a brief H&P. * If you are asking another team to perform a procedure on your patient, be prepared with the following information: + NPO Status + Ability to Consent or Proxy Contact + Blood Thinners + Urgency of Procedure
RECEIVING CONSULTS * Make sure you are clear on what the team is asking of you as a consultant. * Clarify if the patient is expecting to receive a surgery before talking to them about an operation! * Quickly gather information about the patient and their hospital course from the consultant, electronic medical record, and, most importantly, the patient! * Note the callback number on the primary team and call them with the plan after you have staffed the patient with your attending. * If you are asked to perform a procedure as a consultant, clarify the following information: + NPO Status + Ability to Consent or Proxy Contact + Blood Thinners + Urgency of Procedure * Develop a system to stay organized and keep track of your to-do list with consults!
CALL SHIFTS * Bring a survival bag with toothbrush/toothpaste, face wash, deodorant, change of clothes, etc to reset. * Try to nap when you can, but: + PM round to address non-urgent pages ahead of time + Set alarms!
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/
Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.
You’ve been a doctor for about 3.5 seconds, and suddenly that bright eyed, bushy-tailed medical student on service is looking to you for advice? Don’t fret, in this episode we’ll give you some tips for how to handle it.
Hosts: Shanaz Hossain, Nina Clark
Tips for new interns:
REMEMBER HOW INTERNS DO AND DO NOT TEACH
-
Nobody, not even the med students, expect you to be an expert in everything or give a fully-planned formal lecture
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You WILL however spend a ton of time working with students on your team – and via modeling and teachable moments, you can help them learn how it’s done!
MODELING
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Remember how hard everything has been in the few days since you started residency? Think about all the information you’ve picked up, tips and tricks you’re developing for efficiency, and best practices you’re learning in the care of your patients. ALL of these are things you can pass on to students.
-
Presentations, case prep, answering questions from senior members of the team are ALL excellent opportunities to teach (and show students how you learn yourself, so they can do it independently).
TEACHABLE MOMENTS
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Find small topics that you know or are getting to know well – things like looking at a CXR, CT scan, etc.
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Once you’re getting more comfortable caring for specific disease processes, think about high yield lessons for students:
-
Acute trauma evaluation and management (ABCDE’s), appendicitis, diverticulitis, benign biliary disease all make great 5 minute chalk talks that you can have in your back pocket
IN THE OR
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Watch students practice skills, and try to give some feedback and tips that you use (you learned knot tying and suturing more recently than ANYONE else in the OR and probably have some tips that you’re still using to improve)
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If you’re not sure where or why the student is struggling with a particular skill (like tying a knot), model doing it yourself in slow motion while watching them do it – often the side by side comparison can help you identify where they’re going astray
BE THE RESIDENT YOU WISH YOU HAD
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Refer to EVERYONE with respect
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Model being a kind, conscientious, and curious physician
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Try to find universal lessons and crossover topics that non-surgeons need to know
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A great student makes their interns look even better – be explicit about how they can be successful, then advocate for them to have opportunities to show everything they’re learning!
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/
SHOW NOTES
Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.
This episode, we’ll tackle the resources that you should know about to support your own learning throughout residency.
Hosts: Shanaz Hossain, Nina Clark
Tips for new interns:
STRUCTURE YOUR STUDYING
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2 things you need to do: (1) develop a knowledge base and (2) answer questions
-
Knowledge base
- Pick a level-appropriate textbook, read it (ideally all of it) yearly.
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Ideally, lead a little bit every day - 10 pages/day is a good goal to start with and you may need to adjust.
-
Questions
Do some questions every week – 50/week is a good goal to start * Plan to do more questions closer to ABSITE!
Consider storing everything you learn in one place – either a notebook you carry with you or a cloud-based note app * Share this with others, use it to take notes while reading, doing cases, getting feedback, or gaining experience while taking care of patients every day.
SPECIFIC RESOURCES
- Textbooks
- Sabiston: big book, very dense, with a lot of great information.
- Schwartz: shorter chapters, clinically oriented, ideal for junior residents
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Cameron: shorter chapters, clinically oriented, ideal for senior residents
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ABSITE review books
- Fiser: Classic, packed with facts but can be difficult to read, good for looking things up quickly
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BTK ABSITE Companion: from yours truly! High quality illustrations and algorithms that pairs well with the BTK ABSITE podcast episodes. Stay tuned for an updated episodes and companion book in Fall 2023!
-
Question banks
- TrueLearn: high quality, can be pricy depending on program
- SCORE: written/edited by ABS, free for subscribing programs
LEARN HOW TO OPERATE??
-
Carry suture and a needle driver with you and practice basic moves
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Consider a home suture kit for practice when you don’t want to be in sim lab – BTK released one this year
-
Use VIDEOS to ensure learning things the correct way!
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/
Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.
First up, the first day of intern year.
Hosts: Shanaz Hossain, Nina Clark
Tips for new interns:
- BRING WHAT YOU NEED
- Name badge
- Scrubs, white coat, and extra clinic clothes
- Comfortable shoes - even on clinic days
- Pager
- Phone
- Pen
- Bonus stuff that’s good to keep in your bag: Snacks, extras of everything, toothbrusth/toothpaste/deodorant, suture
- STAY ORGANIZED
- Preround purposefully and systematically
- Look at the same things in the same order every day on every patient
- Write data in the same physical location on your sheet so you can quickly find information on the fly
- Keep track of to-do’s from rounds
- Check box system:
- Nina’s system: empty = not done, half full = ordered/needs follow up, full = completely done and followed up on
- Don’t forget to look at the results of imaging studies, labs, or consults after they are entered!
- Prioritize urgent/emergent things first, then consults and discharges, then routine orders, then notes
- As you get more efficient, start drafting your notes as you pre-round – it will save you lots of time later in the afternoon!
- Check box system:
- Preround purposefully and systematically
- OWN THE FLOOR
- During the day, be ready to shift your priorities as urgent issues arise.
- Develop a system for remembering what happened after rounds so you can quickly update seniors
- Shanaz’s system: One color for AM rounds, a different color for afternoon events
- Load the boat! Your team is there to help you. If you are concerned about someone or have a question, ask. There is truly no better time than as an intern.
- Master the art of getting your seniors’ attention in the OR - be conscientious, be clear in what you’re asking, and be prepared to report back about urgent findings!
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our new how-to video series on suture and knot-tying skills - https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/
In their BTK debut, the Hernia team from Carolinas Medical Center discusses how to approach a hernia patient with loss of domain. This Clinical Challenges episode reviews strategies that optimize patients and provide them with the best chance of fascial closure. So, tune in, and enjoy a data driven conversation with our newest hernia enthusiasts!
Hosts:
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Sullivan "Sully" Ayuso, MD - PGY4 General Surgery Resident, sullivan.ayuso@gmail.com, Carolinas Medical Center
-
Monica Polcz, MD - Clinical Fellow (PGY-8) in Abdominal Wall Reconstruction, monica.polcz@atriumhealth.org, Carolinas Medical Center
-
Vedra Augenstein, MD FACS - Associate Professor of Surgery (11 years in practice), vedra.augenstein@gmail.com, Carolinas Medical Center B
-
Todd Heniford, MD FACS - Professor of Surgery (25 years in practice), todd.heniford@gmail.com, Carolinas Medical Center
Links to articles:
- Katzen et al, Open Preperitoneal Ventral Hernia Repair: Prospective Observational Study of Quality Improvement Outcomes over 18 Years and 1,842 patients, Surgery, 2022
https://pubmed.ncbi.nlm.nih.gov/36280505/
- Bernardi et al, Primary Fascial Closure During Laparoscopic Ventral Hernia Repair Improves Patient Quality of Life: A Multicenter, Blinded Randomized Trial, Ann Surg, 2020
https://pubmed.ncbi.nlm.nih.gov/31365365/
- Deerenberg et al, The Effects of Preoperative Botulinum Toxin A on Abdominal Wall Reconstruction, J Surg Res, 2021
https://pubmed.ncbi.nlm.nih.gov/33360691/
- Bueno-Lledó, Preoperative Progressive Pneumoperitoneum and Botulinum Toxin A in Patients with Large Incisional Hernia, Hernia, 2017
https://pubmed.ncbi.nlm.nih.gov/28124308/
- Maloney et al, Twelve Years of Component Separation Technique in Abdominal Wall Reconstruction, Surgery, 2021
https://pubmed.ncbi.nlm.nih.gov/31358348/
- Ayuso et al, Delayed Primary Closure (DPC) of the Skin and Subcutaneous Tissues Following Complex, Contaminated Abdominal Wall Reconstruction (AWR): A Propensity-Matched Study, Surg Endo, 2022
https://pubmed.ncbi.nlm.nih.gov/34018046/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out more hernia episodes here: https://behindtheknife.org/podcast-category/hernia/
Join BTK's Dr. Kevin Kniery for a discussion on How to do a Liver Transplant with Dr. Shah and Dr. Dageforde.
Additional resources:
-
Watch: Liver Transplant Surgical Techniques - https://www.youtube.com/watch?v=Vk1Ld7Fp5es
-
Listen:
Surgical Technique: Kidney Transplant (Part 1) https://behindtheknife.org/podcast/surgical-technique-kidney-transplant-part-1/
Surgical Technique: Kidney Transplant (Part 2)
https://behindtheknife.org/podcast/surgical-technique-kidney-transplant-part-2/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Dr. Buckwald is Professor Emeritus of Surgery and Biomedical Engineering at the University of Minnesota. He is a veteran, world-renowned metabolic surgeon, author, professor and patient healthcare advocate. His book “Healthcare Upside Down: A Critical Examination of Policy and Practice” was born out of Dr. Buckwald’s observations of the healthcare industry over the last 50 years. In it, he explores how healthcare has been turned upside down to serve the administrators of the system and away from its basic function of offering the best care for patients. More importantly, he discusses solutions for turning our broken healthcare system right-side up to better serve all patients.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other recent episodes here: https://behindtheknife.org/listen/
Application season is almost here! Whether you are about to apply to surgery residency or are part of a program recruiting applicants, there are several recent changes to the process that you should be aware of. Residency recruitment continues to see increased numbers of applications that create challenges for both students and programs. ERAS and other organizations are trying to address these issues with alterations to the application process. Today, we’ll discuss how the ERAS supplemental application, as well as new concepts like a single interview release period and decoupled rank lists, can help. We’re joined by Dr. Jennifer LaFemina, one of the leaders in these efforts within the general surgery recruitment process.
Learning Objectives
-
Listeners will describe current challenges in the residency recruitment process.
-
Listeners will describe the value that changes such as the ERAS supplemental application can add to the residency recruitment process.
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Listeners will recognize the results that changes to the residency application process have had during the first 2 years of implementation in surgery.
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Listeners will consider how alterations to the residency application process can be successfully applied within their own program or application.
References:
LaFemina J, Rosenkranz KM, Aarons CB, et al. Outcomes of the 2021-2022 APDS General Surgery Recruitment Process Recommendations. Journal of Surgical Education. 2023;80(6):767-775. doi:10.1016/j.jsurg.2023.02.019
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other surgical education episodes here: https://behindtheknife.org/podcast-category/surgical-education/
You just finished a difficult case in which a complication occurred. Feelings of guilt, sadness, and anxiety are pouring over you. You can't help but think you are a terrible surgeon, maybe even a terrible person. Does this sound familiar? Complications have profound psychological impact on surgeons. Find out how one surgeon decided to do something about it by creating a peer support program. Join Jessica Millar and Patrick Georgoff as they discuss the second victim syndrome with Dr. Haytham Kaafarani (@hayfarani).
References:
- The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons' Attitude (BISA) Study: https://pubmed.ncbi.nlm.nih.gov/28093300/
- Design and Impact of a Novel Surgery-Specific Second Victim Peer Support Program: https://pubmed.ncbi.nlm.nih.gov/31857209/
- When Things Go Wrong: The Surgeon as Second Victim: https://pubmed.ncbi. nlm.nih.gov/30480564/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/
Join the Surgical Oncology team from UTSouthwestern and the University of Miami as they tackle a journal review covering how to choose perioperative antimicrobial prophylaxis for pancreatoduodenectomy. Listen in as they also review novel methodology and the origins of the study.
Learning Objectives:
What antibiotics are you giving before your Whipple? In the group’s final episode together, we review the 1st of its kind, registry linked, pragmatic surgical trial in North America. In the episode we dissect “Piperacillin-Tazobactam Compared With Cefoxitin as Antimicrobial Prophylaxis for Pancreatoduodenectomy - A Randomized Clinical Trial” and discuss the practice changing findings, and the future of surgical clinical trials.
Hosts:
Adam Yopp, MD, FACS (@AdamYopp) is an Associate Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program.
Caitlin Hester, MD (@CaitlinAHester) is a recent graduate of the MD Anderson Complex General Surgical Oncology fellowship and is now a new faculty member in the Division of Surgical Oncology within the Sylvester Cancer Center at the University of Miami where she specializes in surgery for cancers of the liver, pancreas, and other gastrointestinal sites.
Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-4 Research Fellow and General Surgery Resident at the UT Southwestern Medical Center. He is studying the pancreatic tumor microenvironment and targeted therapies in the lab of Rolf Brekken within the Hamon Center for Therapeutic Oncology Research. He also does work on access to care, social determinants of health, and interventions to mitigate disparities in surgical and oncologic outcomes under the mentorship of Patricio Polanco.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out surgical oncology episodes here: https://behindtheknife.org/podcast-category/surgical-oncology/
Join BTK’s Dr. Scott Steele for a discussion with Dr. Tom Read on leadership opportunities outside of clinical medicine. They discuss Dr. Tom Read's role as the executive chairman for the American Board of Colorectal Surgery.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our other recent episode here: https://behindtheknife.org/listen/
Join BTK’s Dr. Scott Steele for a discussion with Dr. Conor Delaney on leadership opportunities outside of clinical medicine.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our other recent episode here: https://behindtheknife.org/listen/
Join BTK's Dr. Scott Steele for a discussion with Dr. Bradley Champagne on leadership opportunities outside of clinical medicine.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our other recent episode here: https://behindtheknife.org/listen/
Join BTK's Dr. Scott Steele for the first episode of a new leadership series that explores opportunities outside of clinical medicine. In this episode, Dr. Steele sits down with Dr. Amy Lightner who is the Chief Medical Officer for Direct Biologics.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our other recent episode here: https://behindtheknife.org/listen/
This spectacular keynote address was given by Dr. David Knott at the “Mattox” Trauma Conference in 2023.
Mattox Vegas TCCACS: https://www.trauma-criticalcare.com/
War Doctor: https://www.amazon.com/War-Doctor-Surgery-Front-Line/dp/1419744240/ref=asc_df_1419744240/?tag=hyprod-20&linkCode=df0&hvadid=508953752346&hvpos=&hvnetw=g&hvrand=15602939439351749599&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9009673&hvtargid=pla-906115140419&psc=1
The David Nott Foundation: https://davidnottfoundation.com/
Dr. Nott on BTK July 1, 2020: https://behindtheknife.org/podcast/war-doctor-david-nott-on-surgery-in-war-zones/
David gained his medical degree from Manchester University and in 1992 gained his FRCS from the Royal College of Surgeons of England to become a Consultant Surgeon.
He is a Consultant Surgeon at St Mary’s Hospital where he specialises in vascular and trauma surgery and also performs cancer surgery at the Royal Marsden Hospital. David is an authority in laparoscopic surgery and was the first surgeon to combine laparoscopic and vascular surgery.
For the past 30 years David has taken unpaid leave to work for the aid agencies Médecins Sans Frontières, the International Committee of the Red Cross and Syria Relief. He has provided surgical treatment to patients in conflict and catastrophe zones in Bosnia, Afghanistan, Sierra Leone, Liberia, Ivory Coast, Chad, Darfur, Yemen, the Democratic Republic of Congo, Haiti, Iraq, Pakistan, Libya, Syria, Central African Republic, Palestine, Nepal and Ukraine
As well as treating patients affected by conflict and catastrophe and raising hundreds of thousands of pounds for charitable causes, David teaches advanced surgical skills to local medics and surgeons when he is abroad. In Britain, he set up and led the teaching of the Surgical Training for the Austere Environment (STAE) course at the Royal College of Surgeons.
In 2015 David established the David Nott Foundation with his wife Elly. The Foundation supports surgeons in developing their operating skills for war zones and austere environments and has now trained over 900 doctors through their bespoke Hostile Environment Surgical Training (HEST) course. In 2019, Picador published David’s bestselling memoir, War Doctor.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episode list here: https://behindtheknife.org/listen/
Join our transplant team as they discuss cases of acute and chronic liver disease requiring liver transplant.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out more transplant episodes here: https://behindtheknife.org/podcast-category/transplant/
For our last submission as the BTK Bariatric Surgery Team, we thought we would take a minute to review some recent landmark trials in bariatric surgery. Get caught up on the impact of bariatric surgery on obesogenic cancers and non-alcoholic steatohepatitis.
Journal articles:
Association of Bariatric Surgery with Cancer Risk and Mortality in Adults with Obesity: https://pubmed.ncbi.nlm.nih.gov/35657620/.
Bariatric-Metabolic Surgery versus Lifestyle Intervention plus Best Medical Care in Non-Alcoholic Steatophepatitis (BRAVES): A Multicentre, Open-Label, Randomised Trial: https://pubmed.ncbi.nlm.nih.gov/37088093/.
Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed robotic general surgery procedures. If you are a general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com for more information on how you could be compensated $500 per video submitted of each (up to $1000 per surgeon).
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other bariatric episodes here: https://behindtheknife.org/podcast-category/bariatric/
Our Colorectal Surgery Oral Board Audio Review includes 51 high-yield scenarios designed for Colorectal Surgeons by Colorectal Surgeons.
Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as colorectal surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the full set of 51 scenarios here: https://behindtheknife.teachable.com/p/btk-colorectal-surgery-oral-board-review-course
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Our Colorectal Surgery Oral Board Audio Review includes 51 high-yield scenarios designed for Colorectal Surgeons by Colorectal Surgeons.
Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as colorectal surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the full set of 51 scenarios here: https://behindtheknife.teachable.com/p/btk-colorectal-surgery-oral-board-review-course
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss the nuances of 3 common pediatric general surgery scenarios.
Journal Article links:
Nguyen HN, Navarro OM, Bloom DA, Feinstein KA, Guillerman RP, Munden MM, et al. Ultrasound for Midgut Malrotation and Midgut Volvulus: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2022;218(6):931-9.
https://pubmed.ncbi.nlm.nih.gov/35107311/
Plut D, Phillips GS, Johnston PR, Lee EY. Practical Imaging Strategies for Intussusception in Children. AJR Am J Roentgenol 2020;215(6):1449-63.
https://pubmed.ncbi.nlm.nih.gov/33084362/
Markel TA, Scott MR, Stokes SM, Ladd AP. A randomized trial to assess advancement of enteral feedings
following surgery for hypertrophic pyloric stenosis. J Pediatr Surg 2017;52(4):534-9.
https://pubmed.ncbi.nlm.nih.gov/27829521/
St Peter SD, Holcomb GW, 3rd, Calkins CM, Murphy JP, Andrews WS, Sharp RJ, et al. Open versus
laparoscopic pyloromyotomy for pyloric stenosis: a prospective, randomized trial. Ann Surg
2006;244(3):363-70.
https://pubmed.ncbi.nlm.nih.gov/16926562/
Dalton BG, Gonzalez KW, Boda SR, Thomas PG, Sherman AK, St Peter SD. Optimizing fluid resuscitation in
hypertrophic pyloric stenosis. J Pediatr Surg 2016;51(8):1279-82.
https://pubmed.ncbi.nlm.nih.gov/26876090/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other pediatric surgery episodes here: https://behindtheknife.org/podcast-category/pediatric/
On this episode of the BIG T Trauma series Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill discuss brain death and why you as a provider must be able to provide clarity when it is needed most. This episode is packed with useful information on a very complicated topic. So, sit back, relax, and enjoy the show.
The World Brain Death Project (JAMA 2020): https://pubmed.ncbi.nlm.nih.gov/32761206/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out the rest of the BIG T trauma series here: https://behindtheknife.org/podcast-series/big-t-trauma/
Upon encountering a patient who develops an anastomotic leak after a straight-forward low anterior resection, you are taken aback, as the patient is healthy and has no apparent risk factors. This prompts you to consider whether the microbiota may have played a role in causing the leak.
Join Dr. Carole Richard, Dr. François Dagbert, Dr. Maher Al Khaldi, and Dr. Roy Hajjar in their conversation about the impact of gut microbiota on anastomotic healing and leak.
Learning objectives
- To list the known risk factors for anastomotic leak.
- To understand how preoperative gut microbiota influence anastomotic healing and could lead to leak.
Reference
Hajjar R, Gonzalez E, Fragoso G, et al. Gut microbiota influence anastomotic healing in colorectal cancer surgery through modulation of mucosal proinflammatory cytokines. Gut. Published Online First: 30 December 2022. doi: 10.1136/gutjnl-2022-328389
Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed robotic general surgery procedures. If you are a general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com for more information on how you could be compensated $500 per video submitted of each (up to $1000 per surgeon).
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other colorectal surgery episodes here: https://behindtheknife.org/podcast-category/colorectal/
Dr. Cunningham is the section head of the Massachusetts General Hospital Endocrine Surgery unit, a NIH-funded researcher, and the immediate past-president of the Association for Academic Surgery. This episode is a recording of her presidential address at their annual Academic Surgical Congress.
Guest
Dr. Carrie Cunningham, MD, MPH
Associate Professor of Surgery, Harvard Medical School
Learn More
Association for Academic Surgery: https://www.aasurg.org/
Dr. Lorna Breen Heroes foundation: https://drlornabreen.org/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
De novo metastatic breast cancer represents 6% of all new breast cancer diagnoses. This figure has not changed at all over the past 20 years; however, systemic therapy options have evolved dramatically during this time and have significantly increased life expectancy for these patients. While surgical management of the primary tumor in the setting of metastatic disease has typically been reserved for palliative indications, surgeons are now being asked to consider resecting the primary tumor to potentially increase overall survival. In this episode, we will use a case study to examine the data that should inform our conversations and decisions when we encounter patients with metastatic breast cancer who are interested in having their primary tumor resected.
Links:
Khan, S.A., S. Schuetz, and O. Hosseini (2022). Primary-Site Local Therapy for Patients with De Novo Metastatic Breast Cancer: An Educational Review. Ann Surg Oncol; 29: 5811-5820. https://link.springer.com/article/10.1245/s10434-022-11900-x
Khan, S.A. et al (2022). Early Local Therapy for the Primary Site in De Novo Stage IV Breast Cancer: Results of a Randomized Clinical Trial (E2108). J Clin Oncol; 40(9): 978-987. https://ascopubs.org/doi/10.1200/JCO.21.02006?url_ver=Z39.88-2003𝔯_id=ori:rid:crossref.org𝔯_dat=cr_pub%20%200pubmed
Badwe, R. et al (2015). Locoregional treatment versus no treatment of the primary tumor in metastatic breast cancer: an open-label randomized controlled trial. Lancet Oncol; 16: 1380-1388. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00135-7/fulltext
Fitzal, F. et al (2019). Impact of Breast Surgery in Primary Metastasized Breast Cancer: Outcomes of the Prospective Randomized Phase III ABCSG-28 POSYTIVE Trial. Ann Surg; 269(6): 1163-1169. https://journals.lww.com/annalsofsurgery/Abstract/2019/06000/Impact_of_Breast_Surgery_in_Primary_Metastasized.24.aspx
Soran, A. et al (2018). Randomized Trial Comparing Resection of Primary Tumor with No Surgery in Stage IV Breast Cancer at Presentation: Protocol MF07-01. Ann Surg Oncol; 25: 3141-3149. https://link.springer.com/article/10.1245/s10434-018-6494-6
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other breast surgery episodes here: https://behindtheknife.org/podcast-category/breast/
Calling all surgeons! It’s time to take back common bile duct stones!
Join our surgical education fellow, Shanaz Hossain, as she talks about laparoscopic common bile duct exploration (LCBDE) with Drs. Maggie Bosley, Lucas Neff, and Byron Fernando Santos. Dr. Bosley is a graduating chief resident at Wake Forest and incoming MIS fellow at Washington University in St. Louis. Dr. Neff is an assistant professor of pediatric surgery with Wake Forest Baptist Health and Brenner’s Children’s Hospital. Dr. Santos is an assistant professor of surgery at Dartmouth-Hitchcock Medical Center. As a research resident at Northwestern University, he co-invented a LCBDE simulator that is used to train surgeons in these techniques. He is also a member of the SAGES Safe Cholecystectomy Task Force and has led numerous LCBDE courses.
Join us for a discussion on LCBDE indications, implementation, techniques, and tips for incorporation into patient care. If you’re interested in learning more, check out the instructional video from these surgeons as well as some of their work on LCBDE:
Instructional Video:
https://behindtheknife.org/video-playlists/laparoscopic-common-bile-duct-tutorial-series/
Research Articles
· Anterograde Balloon Sphincteroplasty as an Adjunct to Laparoscopic Common Bile Duct Exploration for the Acute Care Surgery: https://journals.lww.com/jtrauma/Citation/2022/03000/Antegrade_balloon_sphincteroplasty_as_an_adjunct.22.aspx
· Choledocholithiasis – A New Clinical Pathway: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343507/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Hernias are some of the most common problems treated by general surgeons. The field of abdominal wall surgery has rapidly evolved as a result of innovation and the development of new techniques. In this podcast, Drs. Charlotte Horne and Jenny Shao join Vahagn Nikolian to discuss their decision to pursue careers as abdominal wall specialists, the role that hernia surgeons play in modern day surgical programs, and the pathway to becoming a hernia surgeon.
· Dr. Charlotte Horne is an Assistant Professor of Surgery at Pennsylvania State University.
· Dr. Jenny Shao is an Assistant Professor of Surgery at the University of Michigan.
· Dr. Vahagn Nikolian is an Assistant Professor of Surgery at Oregon Health & Science University.
Recommended Reading:
Shulkin JM, Mellia JA, Patel V, Naga HI, Morris MP, Christopher A, Heniford BT, Fischer JP. Characterizing hernia centers in the United States: what defines a hernia center? Hernia. 2022 Feb;26(1):251-257. doi: 10.1007/s10029-021-02411-x. Epub 2021 Apr 19. PMID: 33871743.
Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ. Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg. 2012 Nov;204(5):709-16. doi: 10.1016/j.amjsurg.2012.02.008. Epub 2012 May 16. PMID: 22607741.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other Hernia episodes here: https://behindtheknife.org/podcast-category/hernia/
To operate or not to operate, to drain the urine leak or to not drain it, those are the questions. Join our Miami Trauma team including Drs. Urréchaga, Neeman, and Rattan- in their final episode together! - as they discuss how to navigate the ins and outs of renal trauma!
Learning Objectives:
· Define the different renal injury grades and how to manage each,
· Identify when to take the renal trauma patient to the operating room,
· Discuss when to involve IR for urinary drainage or embolization.
· Explain when and how to perform a nephrectomy.
· Debate the treatment of penetrating zone two injuries- to explore or not explore?
Quick Hits:
1. Most kidney injuries, the vast majority, can be non-operatively managed.
2. For pretty much all AAST grade of injury, the choice to go to the OR immediately lies in whether the patient is stable or unstable.
3. If there is a urinary leak seen on imaging, it can usually just be observed and followed with repeat imaging to determine the need for drainage, unless the injury is significant or if there is injury to the renal pelvis- then the patient will usually need a drainage procedure.
4. Consider IR in any stable patient found to have active extravasation, fistula, or pseudoaneurysm.
5. In the case of an unstable patient, except very rare circumstances, you should be going to the OR
6. If there is another cause of instability, address that first. If you’re opening Gerota’s fascia, be prepared to commit to a nephrectomy.
7. In penetrating injury, the formal teaching is mandatory exploration of a renal hematoma. Real world experience shows that this isn’t always necessary- such as in tangential injuries or injuries to the periphery- on a case-by-case basis.
References
1. Federico C, Moore Ernest E, Yoram K, Walter B, Aari L, Yosuke M, et al. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg 2019;14:54.
2. Morey AF, Brandes S, Dugi DD 3rd et al: Urotrauma: AUA guideline. J Urol 2014, 192: 327. Published 2014; Amended 2017, 2020.
3. Aziz HA, Bugaev N, Baltazar G, Brown Z, Haines K, Gupta S, Yeung L, Posluszny J, Como J, Freeman J, Kasotakis G. Management of adult renal trauma: a practice management guideline from the eastern association for the surgery of trauma. BMC Surg. 2023 Jan 27;23(1):22. doi: 10.1186/s12893-023-01914-x. PMID: 36707832; PMCID: PMC9881253.
4. Petrone P, Perez-Calvo J, Brathwaite CEM, Islam S, Joseph DK. Traumatic kidney injuries: A systematic review and meta-analysis. Int J Surg. 2020 Feb;74:13-21. doi: 10.1016/j.ijsu.2019.12.013. Epub 2019 Dec 21. PMID: 31870753.
**Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other trauma surgery episodes here: https://behindtheknife.org/podcast-category/trauma/
Have a grand idea for how to improve education and patient safety in surgery, but unsure how to make it a reality? Perhaps the OR Black Box can inspire you and set you on your path as an innovator. We are joined by Dr. Teodor Grantcharov, one of its creators. The OR Black Box is a system that collects, stores, and analyzes a large amount of data from the operating room beyond just surgical video, such as video and audio of the operating room and patient physiology data. Using the system for feedback through self-directed review, coaching, and integrated AI analysis has changed the way we can learn and teach in surgery, and may have implications for the future of evaluation and credentialing.
Learning Objectives1. Listeners will describe the value that accessible data review and analysis adds to surgical education. 2. Listeners will describe how review of operative data could be utilized for more objective evaluation and credentialing, and how this can be used for continuous improvement. 3. Listers will recognize common barriers to using new technology or process changes in surgery. 4. Listeners will recognize the importance of a well-developed research question and its application to a clinical need when designing research or innovation in surgery and education. 5. Listeners will appreciate the long and iterative process required to go from a research idea to implementation and impact on clinical outcomes. 6. Listeners will organize their own ideas for research utilizing the advice offered in the episode.
**Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other surgical education episodes here: https://behindtheknife.org/podcast-category/surgical-education/
Please join BTK's Dr. Nina Clark and Dr. Shreya Gupta for a discussion with Dr. Edward Barksdale on the important and sensitive topic of the underrepresented in medicine.
Society of Black Academic Surgeons: https://www.sbas.net/
References:
Yeo HL, Abelson JS, Symer MM, Mao J, Michelassi F, Bell R, Sedrakyan A, Sosa JA. Association of Time to Attrition in Surgical Residency With Individual Resident and Programmatic Factors. JAMA Surg. 2018 Jun 1;153(6):511-517. doi: 10.1001/jamasurg.2017.6202. PMID: 29466536; PMCID: PMC5875388.
McFarling, U.L. ‘It was stolen from me’: Black doctors are forced out of training programs at far higher rates than white residents. STAT. 6/20/2022. Accessed online: 10/1/2022. https://www.statnews.com/2022/06/20/black-doctors-forced-out-of-training-programs-at-far-higher-rates-than-white-residents/
Haruno LS, Chen X, Metzger M, et al. Racial and Sex Disparities in Resident Attrition Among Surgical Subspecialties. JAMA Surg. Published online February 08, 2023. doi:10.1001/jamasurg.2022.7640
**Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other recent episodes here: https://behindtheknife.org/listen/
Please join Drs. Graham Skelhorne-Gross, Jordan Nantais and Ashlie Nadler from our Emergency General Surgery Team for a discussion on cirrhotic patients.
Child-Pugh Score (https://www.mdcalc.com/calc/340/child-pugh-score-cirrhosis-mortality)
· Bilirubin, albumin, INR, ascites, encephalopathy
· Used to predict operative mortality based on cirrhosis severity
· Mortality in EGS:
- Child-Pugh A: 10% electively and 22% emergently
- Child-Pugh B: 30% electively and 38% emergently
- Child-Pugh C: 80% electively and up to 100% emergently
Model for End Stage Liver Disease (MELD) (https://www.mdcalc.com/calc/10437/model-end-stage-liver-disease-meld?utm_source=site&utm_medium=link&utm_campaign=meld_12_and_older)
· creatinine, bilirubin, INR, and sodium
· MELD < 20 – 1% increase in mortality with each point increase
· MELD > 20 – 2% increase in mortality with each point increase
Pre-operative Planning
· Identification of cirrhosis with physical examination, bloodwork and imaging
· Involvement of other medical services (internal medicine, hepatology, ICU) as needed
· Cirrhosis optimization, if possible
· Abdominal wall mapping
Unexpected Intraoperative Finding* Communicate unexpected findings to the operative team and think of additional adjuncts you may need such as additional ports, topical hemostatic agents or energy devices.
* Think about why you are in the OR. If its an elective situation and can wait, consider bailing. If its emergent, you may have to do something more definitive.
* Exposure may be a challenge, you may have to alter your typical approach including where the assistant grabs and retracts. Extra hands are helpful.
* Bleeding can be a big deal. If possible, map out the abdominal wall ahead of time with cross-sectional imaging. Stay away from varices around the umbilicus or porta
Ventral Hernia + Cirrhosis
· Ideally, control ascites pre-operatively, if you can’t consider leaving drains
· Small (< 2cm) hernias close primarily
· Larger (>2cm) hernias repair with mesh unless infected filed (controversial)
· Minimally invasive repairs can be performed
Benign Biliary Disease + Cirrhosis
· Incidence of gallstones is 4-5 times higher in cirrhotic patients
· Prophylactic laparoscopic cholecystectomy (LC) generally not done
· LC generally considered acceptable in CP A or B but not C (exceptions: HD instability, gangrenous cholecystitis, hemorrhagic cholecystitis)
· Cholecystostomy and ERCP are safe
References:
Bleszynski, M. et. Al. Acute care and emergency general surgery in patients with chronic liver disease: how can be optimize perioperative care? A review of the literature. 2018. World Journal of Emergency Surgery; 13:32
Mansour A, Watson W, Shayani V, et al. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery. 1997;122:730–5.
Yeom SK, Lee CH, Cha SH, Park CM. Prediction of liver cirrhosis, using diagnostic imaging tools. World J Hepatol. 2015 Aug 18;7(17):2069-79. doi: 10.4254/wjh.v7.i17.2069. PMID: 26301049; PMCID: PMC4539400.
Jain D, Mahmood E, V-Bandres M, Feyssa E. Preoperative elective transjugular intrahepatic portosystemic shunt for cirrhotic patients undergoing abdominal surgery. Ann Gastroenterol. 2018 May-Jun;31(3):330-337. doi: 10.20524/aog.2018.0249. Epub 2018 Mar 15. PMID: 29720858; PMCID: PMC5924855.
**Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other Emergency General Surgery episode here: https://behindtheknife.org/podcast-category/emergency-general-surgery/
In this episode, our team discusses the Checkmate 577 trial, the landmark paper which approved the use of nivolumab for adjuvant treatment of stage II & III esophageal & GE junction cancer. Listen as our team reviews the study population, methods and results of this trial & discusses its clinical application as well as potential areas of future research.
Learning Objectives:
-Review the staging and treatment of esophageal and GEJ cancer
-Discuss the population, methods, and results of the Checkmate 577 trial
-Understand the mechanism of action of nivolumab and the PD1 pathway
-Discuss the implications of the Checkmate 577 trial in clinical practice and areas of future research
Hosts:
Kelly Daus MD, Megan Lenihan MD, Peter White MD, and Brian Louie MD
Referenced Material
https://www.nejm.org/doi/full/10.1056/NEJMoa2032125
Kelly RJ, Ajani JA, Kuzdzal J, et al. Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer. N Engl J Med. 2021;384(13):1191-1203. doi:10.1056/NEJMoa2032125
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136921/
Han Y, Liu D, Li L. PD-1/PD-L1 pathway: current researches in cancer. Am J Cancer Res. 2020 Mar 1;10(3):727-742. PMID: 32266087; PMCID: PMC7136921.
Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed robotic general surgery procedures. If you are a general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com for more information on how you could be compensated $500 per video submitted of each (up to $1000 per surgeon).
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other thoracic surgery episodes here https://behindtheknife.org/podcast-category/cardiothoracic/
Please join BTK education fellow, Nina Clark, MD (University of Washington) along with Elina Serrano, MD, MPH (University of Washington) and Minerva Romero Arenas, MD (Weill Cornell Medicine) for a discussion inspired by the experience of trainees who are underrepresented in medicine.
Latino Surgical Society: https://www.latinosurgicalsociety.org/
Society of Black Academic Surgeons: https://www.sbas.net/
References:
Yeo HL, Abelson JS, Symer MM, Mao J, Michelassi F, Bell R, Sedrakyan A, Sosa JA. Association of Time to Attrition in Surgical Residency With Individual Resident and Programmatic Factors. JAMA Surg. 2018 Jun 1;153(6):511-517. doi: 10.1001/jamasurg.2017.6202. PMID: 29466536; PMCID: PMC5875388.
McFarling, U.L. ‘It was stolen from me’: Black doctors are forced out of training programs at far higher rates than white residents. STAT. 6/20/2022. Accessed online: 10/1/2022. https://www.statnews.com/2022/06/20/black-doctors-forced-out-of-training-programs-at-far-higher-rates-than-white-residents/
Haruno LS, Chen X, Metzger M, et al. Racial and Sex Disparities in Resident Attrition Among Surgical Subspecialties. JAMA Surg. Published online February 08, 2023. doi:10.1001/jamasurg.2022.7640
**Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other recent episodes here: https://behindtheknife.org/listen/
In this episode the Endocrine Surgery team at BTK goes over two cases to review the American Association of Endocrine Surgeons Guidelines for Adrenalectomy.
Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.
Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. Na Eun Kim is an Endocrine Surgery Fellow at UCLA in his first year of fellowship
Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research
Dr. Max Schumm is a PGY-5 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon.
Important Papers
Yip L, Duh QY, Wachtel H, Jimenez C, Sturgeon C, Lee C, Velázquez-Fernández D, Berber E, Hammer GD, Bancos I, Lee JA, Marko J, Morris-Wiseman LF, Hughes MS, Livhits MJ, Han MA, Smith PW, Wilhelm S, Asa SL, Fahey TJ 3rd, McKenzie TJ, Strong VE, Perrier ND. American Association of Endocrine Surgeons Guidelines for Adrenalectomy: Executive Summary. JAMA Surg. 2022 Oct 1;157(10):870-877. doi: 10.1001/jamasurg.2022.3544. PMID: 35976622; PMCID: PMC9386598.
Schumm M, Hu MY, Sant V, Kim J, Tseng CH, Sanz J, Raman S, Yu R, Livhits M. Automated extraction of incidental adrenal nodules from electronic health records. Surgery. 2023 Jan;173(1):52-58. doi: 10.1016/j.surg.2022.07.028. Epub 2022 Oct 4. PMID: 36207197.
M. Conall Dennedy, Anand K. Annamalai, Olivia Prankerd-Smith, Natalie Freeman, Kuhan Vengopal, Johann Graggaber, Olympia Koulouri, Andrew S. Powlson, Ashley Shaw, David J. Halsall, Mark Gurnell, Low DHEAS: A Sensitive and Specific Test for the Detection of Subclinical Hypercortisolism in Adrenal Incidentalomas, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 3, 1 March 2017, Pages 786–792, https://doi.org/10.1210/jc.2016-2718
Amar, L., Pacak, K., Steichen, O. et al. International consensus on initial screening and follow-up of asymptomatic SDHx mutation carriers. Nat Rev Endocrinol 17, 435–444 (2021). https://doi.org/10.1038/s41574-021-00492-3
**Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other endocrine episodes here: https://behindtheknife.org/podcast-category/endocrine/
In this episode the Critical Care BTK Team tackles nutrition in the ICU. High-yield journal articles will be presented, discussed, and reviewed. ICU nutrition myths will be busted, and listeners will learn about enteral nutrition, parenteral nutrition and other ICU nutrition pearls.
References
1. Casaer, M.P., et al., Early versus Late Parenteral Nutrition in Critically Ill Adults. New England Journal of Medicine, 2011. 365(6): p. 506-517.
2. Compher, C., et al., Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. Journal of Parenteral and Enteral Nutrition, 2022. 46(1): p. 12-41.
3. McClave, S.A., et al., Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient. Journal of Parenteral and Enteral Nutrition, 2016. 40(2): p. 159-211.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other Surgical Critical Care episodes here: https://behindtheknife.org/podcast-category/surgical-critical-care/
In the third episode of the “Innovations in Surgery” series, Behind the Knife’s surgery education fellow, Dan Scheese, sits down with Adam Sachs and Dr. Igor Belyansky to discuss the current state and future of surgical robotics. They discuss the start up of Vicarious Surgical and how they are working to improve the current state of surgical robotics with their innovative ideas.
Link for the Vicarious Surgical website which includes a short video demonstration of their single port design: https://www. vicarioussurgical.com/
Adam Sachs is the CEO and Co-founder of Vicarious surgical, a surgical robotics company founded in 2014. As an MIT trained roboticist, Adam has combined his passion for robots with this passion for helping patients and enhancing the work environment for surgeons through the development of proprietary surgical robotics.
Dr. Igor Belyanksy, an internationally-recognized expert in the field of abdominal wall reconstruction and complex laparoscopic and robotic hernia repair. Dr. Belyansky has earned his medical degree from Virginia Commonwealth University, completed his residency at MedStar Union Memorial Hospital, and completed a minimally invasive fellowship at Carolinas Medical Center. Dr. Belyanksy is currently the Medical Director of Anne Arundel Medical Center in Annapolis Maryland.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other Innovations in Surgery episodes here: https://behindtheknife.org/podcast-series/innovations-in-surgery/
You have a patient who underwent local excision of a rectal cancer. Final pathology demonstrates a T2 lesion. What is the rate of local recurrence? Is excision alone sufficient? Should the patient undergo radical resection or should chemoradiation be offered? Tune in to find out!
Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Jose Guillem MD, MPH, MBA as they discuss high yield papers discussing local excision for Rectal Cancer.
You may follow along with the slides mentioned in this episode here: https://behindtheknife.org/video/journal-review-in-colorectal-surgery-local-excision-for-rectal-cancer/
Learning Objectives
1. Describe the features that increase risk of lymph node involvement in early stage rectal cancer
2. Discuss the different options for management of early-stage rectal cancer
3. Describe patient related factors that favor local excision of rectal cancer
References:
Kidane B, Chadi SA, Kanters S, Colquhoun PH, Ott MC. Local resection compared with radical resection in the treatment of T1N0M0 rectal adenocarcinoma: a systematic review and meta-analysis. Dis Colon Rectum. 2015 Jan;58(1):122-40. doi: 10.1097/DCR.0000000000000293. PMID: 25489704.
Garcia-Aguilar J, Renfro LA, Chow OS, Shi Q, Carrero XW, Lynn PB, Thomas CR Jr, Chan E, Cataldo PA, Marcet JE, Medich DS, Johnson CS, Oommen SC, Wolff BG, Pigazzi A, McNevin SM, Pons RK, Bleday R. Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol. 2015 Nov;16(15):1537-1546. doi: 10.1016/S1470-2045(15)00215-6. Epub 2015 Oct 22. PMID: 26474521; PMCID: PMC4984260.
Friel CM, Cromwell JW, Marra C, Madoff RD, Rothenberger DA, Garcia-Aguílar J. Salvage radical surgery after failed local excision for early rectal cancer. Dis Colon Rectum. 2002 Jul;45(7):875-9. doi: 10.1007/s10350-004-6320-z. PMID: 12130873.
Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum. 2002 Feb;45(2):200-6. doi: 10.1007/s10350-004-6147-7. PMID: 11852333.
O'Neill CH, Platz J, Moore JS, Callas PW, Cataldo PA. Transanal Endoscopic Microsurgery for Early Rectal Cancer: A Single-Center Experience. Dis Colon Rectum. 2017 Feb;60(2):152-160. doi: 10.1097/DCR.0000000000000764. PMID: 28059911.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other colorectal episodes here: https://behindtheknife.org/podcast-category/colorectal/
DO NOT MISS THIS EPISODE! Need a little inspiration? Tune in for Dave's story. Links from the show:
Chasing My Cure: https://chasingmycure.com/ CDCN: https://cdcn.org/
Every Cure: https://everycure.org/
AMF: https://healgrief.org/actively-moving-forward/young-adult-grief/
David Fajgenbaum, MD, MBA, MSc, FCPP, is an Assistant Professor of Medicine in Translational Medicine & Human Genetics at the University of Pennsylvania, Founding Director of the Center for Cytokine Storm Treatment & Laboratory (CSTL), Associate Director, Patient Impact of the Penn Orphan Disease Center, and Co-Founder/President of the Castleman Disease Collaborative Network (CDCN) and co-founder of Every Cure. He is also the national bestselling author of 'Chasing My Cure: A Doctor's Race to Turn Hope Into Action' and a patient battling idiopathic multicentric Castleman disease (iMCD). He is in his longest remission ever thanks to a precision treatment that he identified, which had never been used before for iMCD. He has also identified and/or advanced 9 other treatment approaches for iMCD and cancer.
One of the youngest individuals ever appointed to the faculty at Penn Medicine and in the top 1 percent youngest awardees of an NIH R01 grant, Fajgenbaum has published scientific papers in high-impact journals such as the New England Journal of Medicine, Journal of Clinical Investigation, and Lancet, been recognized with awards such as the 2016 Atlas Award along with then Vice President Joe Biden, and profiled in a cover story by The New York Times as well as by Good Morning America, CNN, Forbes 30 Under 30, and the Today Show. An authority on cytokine storms and their treatment, Fajgenbaum currently leads over 20 translational research studies including the CORONA Project, which is the world’s largest effort to identify, track, and advance COVID-19 treatments. He also serves on the Board of Directors for the Reagan-Udall Foundation for the FDA, co-Chair of the Advisory Board for the CURE Drug Repurposing Collaboratory, and co-Chair of the Scientific Advisory Board for the CDCN.
Dr. Fajgenbaum earned a BS in Human Sciences with Distinction from Georgetown University, where he was USA Today Academic All-USA First Team and a Quarterback on the Division I football team, a MSc in Public Health from the University of Oxford as the 2007 Joseph L. Allbritton Scholar, a MD from the Perelman School of Medicine at the University of Pennsylvania, where he was a 21st Century Gamble Scholar, and a MBA from The Wharton School, where he was awarded the Joseph Wharton Award, Core Value Leadership Award, Kissick Scholarship, Wharton Business Plan Competition Social Impact Prize, Eilers Health Care Management Award, Mandel Fellowship, and Commencement Speaker.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our other recent episodes here: https://behindtheknife.org/listen/
How do we actually improve wellness? How do surgery trainees advocate for themselves as both learners and employees? In this final surgical education episode with Matt Chia MD MS and Karl Bilimoria MD MS, we review two articles discussing unions and wellness in surgical training. We’re joined by Meg Smith MD MS, Brian Brajcich MD MS, and Darci Foote MD MS to tackle this difficult topic and open the discussion for what’s next in surgical education.
Learning Objectives:
· Identify potential benefits and limitations of unionization in surgery training
· Describe strategies used by program leadership to improve wellness in surgery
References:
National Evaluation of the Association Between Resident Labor Union Participation and Surgical Resident Well-being https://doi.org/10.1001/jamanetworkopen.2021.23412
How Program Directors Understand General Surgery Resident Wellness - https://doi.org/10.1016/j.jsurg.2022.07.022
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other surgical education episodes here: https://behindtheknife.org/podcast-category/surgical-education/
Join the Behind the Knife HPB team as we dive deeper into the complex world of IPMNs with a journal article review of a recent JAMA Surgery publication and the first author of the article!
Learning Objectives: In this episode, we discuss the article, “Progression vs Cyst Stability of Branch-Duct Intraductal Papillary Mucinous Neoplasms After Observation and Surgery.” This article describes a multicenter retrospective study of centers in Italy, Korea, Singapore, and the US that specifically assessed what dynamic variables are associated with malignant progression in pathologically proven IMPNs under at least a year of initial surveillance.
Hosts:
Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center
Daniel Nelson, DO, FACS (@DWNelsonHPB) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center
Connor Chick, MD (@connor_chick) is a PGY-6 General Surgery resident at Brooke Army Medical Center
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-5 General Surgery resident at Brooke Army Medical Center
Beth Carpenter, MD (@elizcarpenter16) is a PGY-4 General Surgery resident at Brooke Army Medical Center
Guest:
Dr. Giovanni Marchegiani is a pancreas surgeon within the department of general and pancreatic surgery at the University of Verona in Italy. His research interests include exocrine and cystic neoplasms of the pancreas. He is the first author of the study discussed in the episode in addition to over 100 additional scientific, peer-reviewed articles.
Journal Article:
1. Marchegiani G, Pollini T, Andrianello S, et al. Progression vs Cyst Stability of Branch-Duct Intraductal Papillary Mucinous Neoplasms After Observation and Surgery. JAMA Surg. 2021;156(7):654–661. doi:10.1001/jamasurg.2021.1802
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other HPB episodes here: https://behindtheknife.org/podcast-category/hepatobiliary/
Our Vascular Surgery Oral Board Audio Review includes 72 high-yield scenarios that cover the majority of the VSCORE topics designed for Vascular Surgeons by Vascular Surgeons.
Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as vascular surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the full set of 24 scenarios here: https://behindtheknife.org/premium/vascular-surgery-oral-review/
Our Vascular Surgery Oral Board Book is available on Amazon here: https://www.amazon.com/Vascular-Surgery-Oral-Board-Review/dp/0578382296/ref=sr_1_4?crid=VUNDNTCJOH8M&keywords=behind+the+knife&qid=1675087641&sprefix=behind+the+knif%2Caps%2C82&sr=8-4&ufe=app_do%3Aamzn1.fos.f5122f16-c3e8-4386-bf32-63e904010ad0
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Our Vascular Surgery Oral Board Audio Review includes 72 high-yield scenarios that cover the majority of the VSCORE topics designed for Vascular Surgeons by Vascular Surgeons.
Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as vascular surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the full set of 24 scenarios here: https://behindtheknife.org/premium/vascular-surgery-oral-review/
Our Vascular Surgery Oral Board Book is available on Amazon here: https://www.amazon.com/Vascular-Surgery-Oral-Board-Review/dp/0578382296/ref=sr_1_4?crid=VUNDNTCJOH8M&keywords=behind+the+knife&qid=1675087641&sprefix=behind+the+knif%2Caps%2C82&sr=8-4&ufe=app_do%3Aamzn1.fos.f5122f16-c3e8-4386-bf32-63e904010ad0
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Surgery is a contact sport and can cause injuries that prevent us from taking care of our patients and even threaten our careers. Join Drs. Mike Weykamp, Nicole White, Nick Cetrulo, and Andrew Wright for a discussion on the ergonomic challenges of open, laparoscopic, and robotic surgery as well as some tips, tricks, and resources on how to protect yourself and your practice.
We apologize for some distracting background noise throughout the episode.
Referenced Articles & Websites:
1. Wells, A. C., Kjellman, M., Harper, S. J., Forsman, M., & Hallbeck, M. S. (2019). Operating hurts: a study of EAES surgeons. Surgical endoscopy, 33, 933-940.
2. Davis, W. T., Fletcher, S. A., & Guillamondegui, O. D. (2014). Musculoskeletal occupational injury among surgeons: effects for patients, providers, and institutions. Journal of surgical research, 189(2), 207-212.
3. Wright, A.S. Ergonomic Injury and Surgery: The Hidden Epidemic. Harkins Symposium at The University of Washington. October 21, 2022. https://www.youtube.com/watch?v=o1G1qGj4WaA
4. The Society of Surgical Ergonomics. https://www.societyofsurgicalergonomics.org/
5. OR Stretch. https://www.mayo.edu/research/labs/human-factors-engineering/or-stretch/or-stretch-videos
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other MIS episodes here: https://behindtheknife.org/podcast-category/minimally-invasive/
Vascular surgery is full of awesome anatomy and big open vessel exposures, but endovascular surgery is here to stay and can be hard to get into, particularly as a learner. The basics of endovascular surgery share very little with the basics of open surgery and getting up to speed can be a big challenge. This episode is an introduction to all things endovascular surgery, from wires, catheters and sheaths to balloons and stents. Take a listen to get up to speed quickly in prep for an upcoming vascular rotation and skip the pain of trying to follow your attendings words so you can instead pay attention to the actual case.
Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan.
Dr. Craig Brown is a PGY-7 in the General Surgery program and the upcoming 2023 vascular surgery fellow at the University of Michigan.
Check out the accompanying video for this episode available here: https://behindtheknife.org/video-playlists/podcast-clips/
Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed robotic general surgery procedures. If you are a general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com for more information on how you could be compensated $500 per video submitted of each (up to $1000 per surgeon).
To check out our Vascular Surgery Oral Board Audio Review and Book, please visit: https://behindtheknife.org/premium/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Interview season is over! There’s just one last hurdle in this residency application process to overcome- ranking and matching! Join our education fellow, Dr. Jessica Millar, and Dr. Charles Friel as they pull back the curtain on the ranking process and discuss how tooptimize your success in the match!
Guest:
Charles Friel, MD- Professor of Colorectal Surgery, Surgical Director - Digestive Center of Excellence, Chief - Section of Colon & Rectal Surgery, and General Surgery Residency Program Director- University of Virginia, Charlottesville, VA
“How the NRMP Matching Algorithm Works”: https://www.youtube.com/watch?v=kvgfgGmemdA&list=PLr0LH_NifZSpvQTwTqXVYn9jXfUKOTFN6&index=11
Important Dates
1. Ranking opens 2/1 at 12PM
2. Rank lists are due 3/1 at 9PM
3. Match status available 3/13 at 10AM
4. Match day results available 3/17 at 12PM EST
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out the rest of our “Dominate the Match Series” here: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/
In this episode, our team discusses the recent paper from JAMA Surgery Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers. Join us as we explore some of the history of blood transfusions, how we got to where we are today, and the role whole blood transfusion may play going forward
Hosts:
Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST) and editor-in-chief of Trauma Surgery and Acute Care Open.
Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.
David Sigmon, MD, MMEd, a PGY-7 resident at the University of Illinois at Chicago who will be a fellow at Lincoln Medical Center in the Bronx next year. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.
LITERATURE
- Torres CM, Kent A, Scantling D, Joseph B, Haut ER, Sakran JV. Association of whole blood with survival among patients presenting with severe hemorrhage in US and Canadian adult civilian trauma centers. JAMA Surg. Published online January 18, 2023.
https://pubmed.ncbi.nlm.nih.gov/36652255/ - Sperry JL, Guyette FX, Brown JB, et al. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. N Engl J Med. 2018;379(4):315-326.
https://pubmed.ncbi.nlm.nih.gov/30044935/ - Moore HB, Moore EE, Chapman MP, et al. Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial. Lancet. 2018;392(10144):283-291.
https://pubmed.ncbi.nlm.nih.gov/30032977/ - Cannon JW, Khan MA, Raja AS, et al. Damage control resuscitation in patients with severe traumatic hemorrhage: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):605-617.
https://pubmed.ncbi.nlm.nih.gov/28225743/ - Howley IW, Haut ER, Jacobs L, Morrison JJ, Scalea TM. Is thromboelastography (Teg)-based resuscitation better than empirical 1:1 transfusion? Trauma Surg Acute Care Open. 2018;3(1):e000140.
https://pubmed.ncbi.nlm.nih.gov/29766129/ - Guyette FX, Brown JB, Zenati MS, et al. Tranexamic acid during prehospital transport in patients at risk for hemorrhage after injury: a double-blind, placebo-controlled, randomized clinical trial. JAMA Surg. 2020;156(1):11-20.
https://pubmed.ncbi.nlm.nih.gov/33016996/ - Smart BJ, Haring RS, Zogg CK, et al. A faculty-student mentoring program to enhance collaboration in public health research in surgery. JAMA Surg. 2017;152(3):306-308.
https://pubmed.ncbi.nlm.nih.gov/27973649/ - National Academies of Sciences E. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths after Injury.; 2016.
https://nap.nationalacademies.org/catalog/23511/a-national-trauma-care-system-integrating-military-and-civilian-trauma - Braverman MA, Smith A, Pokorny D, et al. Prehospital whole blood reduces early mortality in patients with hemorrhagic shock. Transfusion. 2021;61 Suppl 1:S15-S21.
https://pubmed.ncbi.nlm.nih.gov/34269467/
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other trauma episodes here: https://behindtheknife.org/podcast-category/trauma/
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions.
Join Patrick Georgoff and Kevin Kniery for a special conversation with the king and queen of medical comedy Dr. Will Flanary, aka Dr. Glaucomflecken (@drglaucomflecken), and Kristin Flanary, aka Lady Glaucomflecken (@Lglaucomflecken).
Will is a practicing ophthalmologist and social media personality with over 4 million followers. During his 3rd year of medical school, he was diagnosed with testicular cancer, and he began using humor as a coping mechanism. Following a second bout with cancer three years into his medical career, he created a Twitter account under the pseudonym "Dr. Glaucomflecken"— because it is arguably the funniest word in ophthalmology. A cardiac event and near-death experience in 2020 only fueled his creativity. Kristin is formally trained in cognitive neuroscience and social psychology and now works in marketing and communications. Kristin is best known internationally as her social media alter ego, “Lady Glaucomflecken,” where she shares stories from her unique perspective of the healthcare system. She has been a patient, "married to medicine" through the entire medical training journey and beyond, a lay responder and CPR provider to her husband, and a caregiver and "co-survivor" of his two cancer occurrences and a sudden cardiac arrest. And, if that’s not enough, they also have a brand-new podcast called Knock, Knock – Hi! where they discuss quirky and unexpectedly hilarious medical stories. Check out their website here: https://glaucomflecken.com/
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our library of episodes here: https://behindtheknife.org/listen/
Did you miss this year’s Eastern Association for the Surgery of Trauma meeting? Don’t sweat it! Behind the Knife has got you covered. In this episode we discuss “Scientific Papers that Should Change Your Practice” with EAST manuscript and literature committee members Drs. Laura Brown (@laurarbrownMD), Brittany Bankhead (@bbankheadMD), and Julia Coleman (@juliacolemanMD).
Universal blunt cerebrovascular screening? Early renal replacement therapy? Artificial intelligence in emergency general surgery? This episode is PACKED with high-yield material.
To learn more about all the good things happening at EAST visit www.east.org.
Papers discussed:
1. Do not forget the platelets: The independent impact of red blood cell to platelet ratio on mortality in massively transfused trauma patients (https://pubmed.ncbi.nlm.nih.gov/35313325/)
2. The 35-mm rule to guide pneumothorax management: Increases appropriate observation and decreases unnecessary chest tubes (https://pubmed.ncbi.nlm.nih.gov/35125448/)
3. Timing of thromboprophylaxis in patients with blunt abdominal solid organ injuries undergoing nonoperative management (https://pubmed.ncbi.nlm.nih.gov/33048907/)
4. Universal screening for blunt cerebrovascular injury (https://pubmed.ncbi.nlm.nih.gov/33502144/)
5. A three-step support strategy for relatives of patients during in the intensive care unit: a cluster randomized trial (https://pubmed.ncbi.nlm.nih.gov/35065008/)
6. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest (https://pubmed.ncbi.nlm.nih.gov/34133859/)
7. Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury (https://pubmed.ncbi.nlm.nih.gov/32668114/)
8. Disparities in Spatial Access to Emergency Surgical Services in the US (https://pubmed.ncbi.nlm.nih.gov/36239953/)
9. Validation of the AI-based Predictive Optimal Trees in Emergency Surgery Risk (POTTER) Calculator in Patients 65 Years and Older (https://pubmed.ncbi.nlm.nih.gov/33378309/)
10. Accuracy of Risk Estimation for Surgeons Versus Risk Calculators in Emergency General Surgery (https://pubmed.ncbi.nlm.nih.gov/35594615/)
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other trauma episodes here: https://behindtheknife.org/podcast-category/trauma/
Please join Drs. Brian Gray, Amanda Jensen, and Manisha Bhatia from Indiana University as they discuss Hirschsprung disease in regard to variability of the transition zone and surgical operative and pathologic diagnosis reporting in pediatric surgery.
Journal Article links:
Veras LV, Arnold M, Avansino JR, Bove K, Cowles RA, Durham MM, et al. Guidelines for synoptic reporting of surgery and pathology in Hirschsprung disease. J Pediatr Surg 2019;54(10):2017-23.
https://pubmed.ncbi.nlm.nih.gov/30935730/
Thakkar HS, Blackburn S, Curry J, De Coppi P, Giuliani S, Sebire N, et al. Variability of the transition zone length in Hirschsprung disease. J Pediatr Surg 2020;55(1):63-6.
https://pubmed.ncbi.nlm.nih.gov/31706615/
Coyle D, O'Donnell AM, Tomuschat C, Gillick J, Puri P. The Extent of the Transition Zone in Hirschsprung Disease. J Pediatr Surg 2019;54(11):2318-24.
https://pubmed.ncbi.nlm.nih.gov/31079866/
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other pediatric surgery episodes here: https://behindtheknife.org/podcast-category/pediatric/
Join the Surgical Oncology team from UTSouthwestern and the University of Miami as they tackle a case of intrahepatic cholangiocarcinoma along with the data guiding current treatment paradigms. Listen in as they also review recent clinical trials changing the options available for patients with this dismal biliary tract cancer.
Learning Objectives:
In this episode, we review the workup and diagnostic approach to intrahepatic cholangiocarcinoma with emphasis on the role and benefits of biopsy, lymphadenectomy, operative approach, and the current treatment strategies involving chemotherapy, immunotherapy, and targeted therapies against actionable mutations.
Hosts:
Adam Yopp, MD, FACS (@AdamYopp) is an Associate Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program.
Caitlin Hester, MD (@CaitlinAHester) is a recent graduate of the MD Anderson Complex General Surgical Oncology fellowship and is now a new faculty member in the Division of Surgical Oncology within the Sylvester Cancer Center at the University of Miami where she specializes in surgery for cancers of the liver, pancreas, and other gastrointestinal sites.
Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-4 Research Fellow and General Surgery Resident at the UT Southwestern Medical Center. He is studying the pancreatic tumor microenvironment and targeted therapies in the lab of Rolf Brekken within the Hamon Center for Therapeutic Oncology Research.
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other surgical oncology episodes here: https://behindtheknife.org/podcast-category/surgical-oncology/
Who is a candidate for metabolic and bariatric surgery and what has changed in the past 30 years? Find out in this review!
Journal articles:
Bariatric Surgery versus Intensive Medical Therapy for Diabetes – 5 Year Outcomes. https://pubmed.ncbi.nlm.nih.gov/28199805/.
Association of Metabolic Surgery with Major Adverse Cardiovascular Outcomes in Patients with Type 2 Diabetes and Obesity. https://pubmed.ncbi.nlm.nih.gov/31475297/.
Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents. https://pubmed.ncbi.nlm.nih.gov/26544725/.
2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. https://pubmed.ncbi.nlm.nih.gov/36336720/.
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other bariatric surgery episodes here: https://behindtheknife.org/podcast/clinical-challenges-in-bariatric-surgery-revisional-bariatric-surgery/
You are faced with a patient complaining of pelvic fullness. On DRE, you feel a submucosal bulge without palpating a tumour in the lumen. A CT scan confirms a pelvic mass. The biopsy reveals a spindle cell type gastrointestinal stromal tumour (GIST) positive for CD117.
Join Dr. Carole Richard, Dr. François Dagbert and Dr. Maher Al Khaldi in their conversation about the diagnosis and management of rectal GIST.
Learning objectives
- To explain the origin of rectal GISTs
- To recognize the prognostic factors associated with rectal GISTs
- To understand the management of rectal GISTs in the era of Imatinib
- To list the surgical approaches for rectal GIST resection
*Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed robotic general surgery procedures. If you are a general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com for more information on how you could be compensated $500 per video submitted of each (up to $1000 per surgeon).
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other colorectal episodes here: https://behindtheknife.org/podcast-category/colorectal/
In this episode, our transplant team will discuss an article that reviews normothermic machine perfusion including how it has evolved over the years, current benefits and challenges, as well as future directions.
Learning objectives:
· Understand the current role of machine perfusion in renal transplantation
· Describe historical and current limitations of machine perfusion for abdominal organ transplantation
· Review the benefits of improved and expanded preservation techniques
References:
1. Hamelink, T. L., Ogurlu, B., de Beule, J., Lantinga, V. A., Pool, M. B. F., Venema, L. H., Leuvenink, H. G. D., Jochmans, I., & Moers, C. (2022). Renal Normothermic Machine Perfusion: The Road Toward Clinical Implementation of a Promising Pretransplant Organ Assessment Tool. In Transplantation (Vol. 106, Issue 2). https://doi.org/10.1097/TP.0000000000003817
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA
Please email hello@behindtheknife.org with any questions.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other transplant episode here: https://behindtheknife.org/podcast-category/transplant/
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
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If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions.
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions.
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions.
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions.
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA
Please email hello@behindtheknife.org with any questions.
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA
Please email hello@behindtheknife.org with any questions.
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
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Please email hello@behindtheknife.org with any questions.
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
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Please email hello@behindtheknife.org with any questions.
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA
Please email hello@behindtheknife.org with any questions.
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA
Please email hello@behindtheknife.org with any questions.
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA
Please email hello@behindtheknife.org with any questions.
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA
Please email hello@behindtheknife.org with any questions.
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Welcome to the fifth of a six-part series focused on the integration of palliative care into the practice of surgery. In this episode, we discuss nonbeneficial surgery (and how best to avoid it) as well as care of the imminently dying patient.
Nonbeneficial surgery is best defined as surgery that fails to meet the goals of the patient. As our surgical patients become older and more medically complex, we must be aware of the factors which lead to nonbeneficial surgery – including patient, surrogate, system, and surgeon factors – and how best to approach each of these to avoid causing harm to our patients. Nonbeneficial surgery not only causes harm to the patient, but can also cause harm to the surgical team, in the form of moral distress/injury. Focusing on patients’ goals of care can help us to avoid nonbeneficial surgery.
One of the benefits of integrating palliative medicine into the practice of surgery is that there is never “nothing left to do.” By learning how to recognize and then care for the imminently dying patient, as well as by having a basic understanding of the Medicare hospice benefit, we can support and care for the patient (and the family) beyond the operating room.
Non-Beneficial Surgery:
Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution.
https://pubmed.ncbi.nlm.nih.gov/24866541/
Surgeons’ perspectives on avoiding nonbeneficial treatments in seriously ill older patients with surgical emergencies: a qualitative study.
https://pubmed.ncbi.nlm.nih.gov/27105058/
The association between factors promoting beneficial surgery and moral distress: a national survey of surgeons.
https://pubmed.ncbi.nlm.nih.gov/33214444/
The Imminently Dying Patient and Hospice:
Fast Fact #3: Syndrome of Imminent Death
https://www.mypcnow.org/fast-fact/syndrome-of-imminent-death/
Fast Fact #82: Medicare Hospice Benefit – Part 1: Eligibility and Treatment
https://www.mypcnow.org/wp-content/uploads/2019/01/FF-82-Medicare-Hospice.-1-3rd-Ed-1.pdf
Fast Fact #87: Medicare Hospice Benefit – Part 2: Places of Care and Funding
https://www.mypcnow.org/wp-content/uploads/2019/01/FF-87-Medicare-Hospic-2-4th-Ed.pdf
Fast Fact #140: Medicare Hospice Benefit – Levels of Hospice Care
https://www.mypcnow.org/fast-fact/medicare-hospice-benefits-levels-of-hospice-care/
Dr. Red Hoffman (@redmdnd) is an acute care surgeon and associate hospice medical director in Asheville, North Carolina, host of the Surgical Palliative Care Podcast (@surgpallcare) and co-founder of the recently launched Surgical Palliative Care Society (www.spcsociety.org).
Dr. Zara Cooper (@zaracMD) is an acute care surgeon at Brigham and Women’s Hospital where she serves as Kessler Director for the Center of Surgery and Public Health (@csph_bwh). She is a Professor of Surgery at Harvard Medical School, associate faculty at Adriane Labs, and adjunct faculty at the Marcus Institute for Aging Research.
Dr. Amanda Stastny (@manda_plez) is a PGY-2 in the General Surgery program at Mountain Area Health Education Center (MAHEC) in Asheville, NC.
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Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
We do apologize for the overall audio quality! We were spread out over a couple states and sometimes talk over one another.
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
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Please email hello@behindtheknife.org with any questions.
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
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Please email hello@behindtheknife.org with any questions.
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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Please email hello@behindtheknife.org with any questions.
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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Join us for the BTK Throwback episode! Dr. Kenneth Mattox, a US legend in Trauma surgery, discusses retroperitoneal hematomas and the ever changing field of surgery.
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other trauma episodes here: https://behindtheknife.org/podcast-category/trauma/
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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Emergency abdominal wall surgery is a common scenario for all general surgeons. Decision making with regard to operative approach and mesh utilization can be confusing. This podcast will review the common circumstances and highlight advanced decision making.
· Dr. Vahagn Nikolian is an Assistant Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair.
· Dr. Sean Orenstein is an Associate Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair.
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If you liked this episode, check out other Clinical Challenge Episodes here: https://behindtheknife.org/podcast-series/clinical-challenges/
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
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Dipping your toes in the water of surgical education research can be a daunting task if you have no prior experience, even if you have done basic or clinical research before. How do you create a good surgical education research project? How can clinicians get involved in and find mentors for surgical education research? Is formal postgraduate training becoming necessary for a career in surgical education? Luckily, we invite Dr. Jon Sherbino and Dr. Lara Varpio, hosts of the successful KeyLIME (Key Literature in Medical Education) podcast to share their valuable insights on medical education research with us. Check out KeyLIME on their website at https://keylimepodcast.libsyn.com/ and subscribe to KeyLIME on iTunes, Spotify, or Google podcasts!
Learning Objectives
1. Listeners will identify that surgical education applies the same rigor as other areas of research.
2. Listeners will describe how observations within clinical practice and review of literature can lead to creation of a good research question.
3. Listeners will describe how research questions should align with theory and methodology, which then align with conclusions for a research project.
4. Listeners will identify that collaboration with colleagues with expertise in surgical education research, including education scientists, is important for successful completion of research with high rigor.
5. Listeners will recognize advantages and disadvantages to formal training in education research, including fellowship and master’s degree programs.
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Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
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Join our Miami Trauma team including Drs. Urréchaga, Neeman, and Rattan as they dive into the literature regarding a topic that has become all too common to the US news cycle- gun violence. They will go over a recent paper from JAMA and include other important literature while trying to understand this complex problem that has been grappling US public policy.
Quick Hits:
1. Firearm injury is the leading cause death in the US among ages 1-19
2. For every person killed violently by someone else with a firearm, there are 3 survivors.
3. Gun ownership triples the risk of homicide
4. Permit laws and preventing people convicted of a violent crime from owning a firearm decrease firearm-related death and have a positive ripple effect even outside state borders. In short, for effective reductions of firearm-related injury and death, federal legislation will be more effective than state-by-state
References
1. Liu, Y, Siegel, M, Sen, B. Association of State-Level Firearm-Related Deaths With Firearm Laws in Neighboring States. JAMA Network Open. 2022;5(11):e2240750. doi:10.1001/jamanetworkopen.2022.40750
2. Goldstick, JE, Cunningham, RM, Carter, PM. Current Causes of Death in Children and Adolescents in the United States. N Engl J Med. 2022 May 19;386(20):1955-1956. doi: 10.1056/NEJMc2201761.
3. Kellermann, AL, Rivara, FP, Rushforth, NB, Banton, JG, Reay, DT, Francisco, JT, Locci, AB, Prodzinski, J, Hackman, BB, Somes, G. Gun Ownership as a Risk Factor for Homicide in the Home. N Engl J Med 1993; 329:1084-1091. DOI: 10.1056/NEJM199310073291506
4. Liu Y, Siegel, M, Sen, B. Neighbors do matter: between-state firearm laws and state firearm-related deaths in the US, 2000-2017. Am J Prev Med. 2020;59(5):648-657. doi:10.1016/j.amepre.2020.06.022
5. Siegel, M, Pahn, M, Xuan, Z, et al. Firearm-related laws in all 50 US states,1991-2016. Am J Public Health.2017; 107(7):1122-1129. doi:10.2105/AJPH.2017.303701
6. Kalesan, B, Mobily, ME, Keiser, O, Fagan, J, Galea, S. Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study. Lancet. 2016 Apr 30;387(10030):1847-55. doi: 10.1016/S0140-6736(15)01026-0.
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If you liked this episode, check out other Journal Review episodes here: https://behindtheknife.org/podcast-series/journal-review/
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
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De novo metastatic breast cancer represents 6% of all new breast cancer diagnoses. This figure has not changed at all over the past 20 years; however, systemic therapy options have evolved dramatically during this time and have significantly increased life expectancy for these patients. While surgical management of the primary tumor in the setting of metastatic disease has typically been reserved for palliative indications, surgeons are now being asked to consider resecting the primary tumor to potentially increase overall survival. In this episode, we will use a case study to examine the data that should inform our conversations and decisions when we encounter patients with metastatic breast cancer who are interested in having their primary tumor resected.
Links:
§ Khan, S.A., S. Schuetz, and O. Hosseini (2022). Primary-Site Local Therapy for Patients with De Novo Metastatic Breast Cancer: An Educational Review. Ann Surg Oncol; 29: 5811-5820. https://link.springer.com/article/10.1245/s10434-022-11900-x
§ Khan, S.A. et al (2022). Early Local Therapy for the Primary Site in De Novo Stage IV Breast Cancer: Results of a Randomized Clinical Trial (E2108). J Clin Oncol; 40(9): 978-987. https://ascopubs.org/doi/10.1200/JCO.21.02006?url_ver=Z39.88-2003𝔯_id=ori:rid:crossref.org𝔯_dat=cr_pub%20%200pubmed
§ Badwe, R. et al (2015). Locoregional treatment versus no treatment of the primary tumor in metastatic breast cancer: an open-label randomized controlled trial. Lancet Oncol; 16: 1380-1388. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00135-7/fulltext
§ Fitzal, F. et al (2019). Impact of Breast Surgery in Primary Metastasized Breast Cancer: Outcomes of the Prospective Randomized Phase III ABCSG-28 POSYTIVE Trial. Ann Surg; 269(6): 1163-1169. https://journals.lww.com/annalsofsurgery/Abstract/2019/06000/Impact_of_Breast_Surgery_in_Primary_Metastasized.24.aspx
§ Soran, A. et al (2018). Randomized Trial Comparing Resection of Primary Tumor with No Surgery in Stage IV Breast Cancer at Presentation: Protocol MF07-01. Ann Surg Oncol; 25: 3141-3149. https://link.springer.com/article/10.1245/s10434-018-6494-6
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The cardiac OR can be a daunting place for any medical student or resident who finds themself on a cardiac surgery rotation. Have no fear, this Cardiac Surgery Crash Course is a short series focused on high-yield topics to help introduce students and residents to cardiac surgery prior to or during a cardiac surgery rotation. In this episode join Dr. Aaron Williams and our education fellow Dr. Jessica Millar as they break down ICU monitoring and hemodynamics of post-op cardiac surgery patients.
If you have any suggestions or requests for this series, please feel free to reach out to us by email:
Jessica Millar: millarje@med.umich.edu
Inotrope/Pressor Reference Card:
https://i0.wp.com/emcrit.org/wp-content/uploads/2020/02/pressortable.jpg?resize=1536%2C1345&ssl=1
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The cardiac OR can be a daunting place for any medical student or resident who finds themself on a cardiac surgery rotation. Have no fear, this Cardiac Surgery Crash Course is a short series focused on high-yield topics to help introduce students and residents to cardiac surgery prior to or during a cardiac surgery rotation. In this episode join Dr. Aaron Williams and our education fellow Dr. Jessica Millar as they break down the principles of Coronary Artery Bypass Grafting (CABG).
If you have any suggestions or requests for this series, please feel free to reach out to us by email:
Jessica Millar: millarje@med.umich.edu
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/
The cardiac OR can be a daunting place for any medical student or resident who finds themself on a cardiac surgery rotation. Have no fear, this Cardiac Surgery Crash Course is a short series focused on high-yield topics to help introduce students and residents to cardiac surgery prior to or during a cardiac surgery rotation. In this episode join Dr. Nick Teman and our education fellow Dr. Jessica Millar as they break down the principles of cardiopulmonary bypass.
If you have any suggestions or requests for this series, please feel free to reach out to us by email:
Jessica Millar: millarje@med.umich.edu
Helpful Images:
Cannula Insertion for Cardiopulmonary Bypass
https://www.uptodate.com/contents/image?imageKey=CARD%2F97188
Cardiopulmonary Bypass Machine
https://www.ebme.co.uk/images/arts/cpb/cardiopulmonary-bypass-machine-2.jpg
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/
The cardiac OR can be a daunting place for any medical student or resident who finds themself on a cardiac surgery rotation. Have no fear, this Cardiac Surgery Crash Course is a short series focused on high-yield topics to help introduce students and residents to cardiac surgery prior to or during a cardiac surgery rotation. We will cover several of the most frequently performed operations, post-operative management, common consults, and other topics to help you ace your cardiac rotation. In this episode join Dr. Nick Teman and our education fellow Dr. Jessica Millar as they introduce you to the cardiac OR.
If you have any suggestions or requests for this series, please feel free to reach out to us by email:
Helpful Resources:
https://www.tsranet.org/resources/tsra-resources-for-residents/
Jessica Millar: millarje@med.umich.edu
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Historically, a paucity of data has existed in the most appropriate modality of critical care management of brain dead organ donors prior to organ harvest. In this episode, Drs. Bankhead, Dumas, and Park are joined by special guest Dr. Ashley McGinity, a director in the donor management unit the Center for Life at the UT Health Science Center in San Antonio, joins us to discuss modern and current practices in the management of these patients to maximize the gift for patients and families.
References:
https://pubmed.ncbi.nlm.nih.gov/24980425/ https://pubmed.ncbi.nlm.nih.gov/25978154/
https://pubmed.ncbi.nlm.nih.gov/31957104/ https://pubmed.ncbi.nlm.nih.gov/23116641/ https://pubmed.ncbi.nlm.nih.gov/28318674/ https://pubmed.ncbi.nlm.nih.gov/25056510/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145376/
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The dreaded Surgical Site Complications! Join Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross from our Emergency General Surgery Team as they discuss surgical site complications and prevention techniques.
Paper 1: Arnold et. al. (2019) Not a Routine Case, Why Expect the Routine Outcome? Quantifying the Infectious Burden of Emergency General Surgery Using the NSQIP. American Surgeon
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NSQIP database 2005-2016 (>800,000 patients) including open/laparoscopic cholecystectomies, ventral hernia repairs, and partial colectomies
-
Comparing outcomes in emergent vs elective cases
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Primary outcome: aggregate of SSIs which includes wound disruption, superficial SSI, deep SSI, and organ space SSI
-
Results:
-- ↑SSI in the emergency group (5.3% vs 3.6%)
-- When controlling for multiple variables, emergency surgery associated with more SSIs (OR 1.15).
Paper 2: Lakhani et. al. (2022) Prophylactic negative pressure wound dressings reduces wound complications following emergency laparotomies: A systematic review and meta-analysis. Surgery
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NPWD remove excess fluid from subcutaneous space, ↓ collections/contaminants, promote angiogenesis, fibroblast infiltration
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Literature review 2005-2022 (NPWD, laparotomy, SSI)
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1199 patients included (566 NPWD, 633 standard dressings)
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Results:
-- NPWD ↓ wound infection (OR 0.43) and wound breakdown (OR 0.36)
-- No change in LOS, readmission
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In this episode, our team provides a comprehensive review of the differential diagnosis for mediastinal masses, their workup, and biopsy considerations. Listen as we dive deeper into the perioperative planning and operative approach for resection of these masses with special considerations for patients with thymoma.
Learning Objectives:
-Discuss the differential diagnosis of a mediastinal mass
-Review the workup of a mediastinal mass
-Outline indications for biopsy and describe the various approaches
-Describe the operative techniques for thymectomy, pearls & potential pitfalls
Hosts:
Megan Lenihan MD, Kelly Daus MD, Peter White MD, and Brian Louie MD
Referenced Material
https://pubmed.ncbi.nlm.nih.gov/21847052/
Detterbeck FC, Nicholson AG, Kondo K, Van Schil P, Moran C. The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol. 2011 Jul;6(7 Suppl 3):S1710-6. doi: 10.1097/JTO.0b013e31821e8cff. PMID: 21847052.
https://pubmed.ncbi.nlm.nih.gov/33468329/
Ahmad U. The eighth edition TNM stage classification for thymic tumors: What do I need to know? J Thorac Cardiovasc Surg. 2021 Apr;161(4):1524-1529. doi: 10.1016/j.jtcvs.2020.10.131. Epub 2020 Nov 13. PMID: 33468329.
https://pubmed.ncbi.nlm.nih.gov/34695605/
Marx A, et al. The 2021 WHO Classification of Tumors of the Thymus and Mediastinum: What Is New in Thymic Epithelial, Germ Cell, and Mesenchymal Tumors? J Thorac Oncol. 2022 Feb;17(2):200-213. doi: 10.1016/j.jtho.2021.10.010. Epub 2021 Oct 22. PMID: 34695605.
https://pubmed.ncbi.nlm.nih.gov/22882218/
Meriggioli MN, Sanders DB. Muscle autoantibodies in myasthenia gravis: beyond diagnosis? Expert Rev Clin Immunol. 2012 Jul;8(5):427-38. doi: 10.1586/eci.12.34. PMID: 22882218; PMCID: PMC3505488.
https://pubmed.ncbi.nlm.nih.gov/34339670/
Raja SM, Guptill JT, McConnell A, Al-Khalidi HR, Hartwig MG, Klapper JA. Perioperative Outcomes of Thymectomy in Myasthenia Gravis: A Thoracic Surgery Database Analysis. Ann Thorac Surg. 2022 Mar;113(3):904-910. doi: 10.1016/j.athoracsur.2021.06.071. Epub 2021 Jul 30. PMID: 34339670.
Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed general surgery procedures. If you are a PGY4/5 general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com, for more information on how you could be compensated up to $400 for recording and submitting those videos.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other clinical challenge episodes here: https://behindtheknife.org/podcast-series/clinical-challenges/
In this episode, our team provides a comprehensive review of the differential diagnosis for mediastinal masses, their workup, and biopsy considerations. Listen as we dive deeper into the perioperative planning and operative approach for resection of these masses with special considerations for patients with thymoma.
Learning Objectives:
-Discuss the differential diagnosis of a mediastinal mass
-Review the workup of a mediastinal mass
-Outline indications for biopsy and describe the various approaches
-Describe the operative techniques for thymectomy, pearls & potential pitfalls
Hosts:
Megan Lenihan MD, Kelly Daus MD, Peter White MD, and Brian Louie MD
Referenced Material
https://pubmed.ncbi.nlm.nih.gov/21847052/
Detterbeck FC, Nicholson AG, Kondo K, Van Schil P, Moran C. The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol. 2011 Jul;6(7 Suppl 3):S1710-6. doi: 10.1097/JTO.0b013e31821e8cff. PMID: 21847052.
https://pubmed.ncbi.nlm.nih.gov/33468329/
Ahmad U. The eighth edition TNM stage classification for thymic tumors: What do I need to know? J Thorac Cardiovasc Surg. 2021 Apr;161(4):1524-1529. doi: 10.1016/j.jtcvs.2020.10.131. Epub 2020 Nov 13. PMID: 33468329.
https://pubmed.ncbi.nlm.nih.gov/34695605/
Marx A, et al. The 2021 WHO Classification of Tumors of the Thymus and Mediastinum: What Is New in Thymic Epithelial, Germ Cell, and Mesenchymal Tumors? J Thorac Oncol. 2022 Feb;17(2):200-213. doi: 10.1016/j.jtho.2021.10.010. Epub 2021 Oct 22. PMID: 34695605.
https://pubmed.ncbi.nlm.nih.gov/22882218/
Meriggioli MN, Sanders DB. Muscle autoantibodies in myasthenia gravis: beyond diagnosis? Expert Rev Clin Immunol. 2012 Jul;8(5):427-38. doi: 10.1586/eci.12.34. PMID: 22882218; PMCID: PMC3505488.
https://pubmed.ncbi.nlm.nih.gov/34339670/
Raja SM, Guptill JT, McConnell A, Al-Khalidi HR, Hartwig MG, Klapper JA. Perioperative Outcomes of Thymectomy in Myasthenia Gravis: A Thoracic Surgery Database Analysis. Ann Thorac Surg. 2022 Mar;113(3):904-910. doi: 10.1016/j.athoracsur.2021.06.071. Epub 2021 Jul 30. PMID: 34339670.
Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed general surgery procedures. If you are a PGY4/5 general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com, for more information on how you could be compensated up to $400 for recording and submitting those videos.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other clinical challenge episodes here: https://behindtheknife.org/podcast-series/clinical-challenges/
In this episode from the Endocrine Surgery team at BTK we discuss how Dr. Yeh built the section of endocrine surgery at UCLA. From Sydney, Australia to Santa Monica, he discusses the risks and challenges involved in becoming a leader in academic endocrine surgery. In this podcast we answer the question “why endocrine surgery,” and mention tips for success at all level of training from medical students to early faculty. Finally, we take a moment to honor and remember Dr. Orlo Clark.
Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.
Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. Na Eun Kim is an Endocrine Surgery Fellow at UCLA in her first year of fellowship
Dr. Rivfka Shenoy is a PGY-6 General Surgery Resident at UCLA who has completed two years of research
Dr. Max Schumm is a PGY-6 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon.
Important Papers
Krishnamurthy VD, Gutnick J, Slotcavage R, Jin J, Berber E, Siperstein A, Shin JJ. Endocrine surgery fellowship graduates past, present, and future: 8 years of early job market experiences and what program directors and trainees can expect. Surgery. 2017 Jan;161(1):289-296. doi: 10.1016/j.surg.2016.06.069. Epub 2016 Nov 17. PMID: 27866719.
Krishnamurthy VD, Jin J, Siperstein A, Shin JJ. Mapping endocrine surgery: Workforce analysis from the last six decades. Surgery. 2016 Jan;159(1):102-10. doi: 10.1016/j.surg.2015.08.024. Epub 2015 Oct 9. PMID: 26456130.
Kulaylat AN, Kenning EM, Chesnut CH 3rd, James BC, Schubart JR, Saunders BD. The profile of successful applicants for endocrine surgery fellowships: results of a national survey. Am J Surg. 2014 Oct;208(4):685-9. doi: 10.1016/j.amjsurg.2014.03.013. Epub 2014 Jun 21. PMID: 25048570; PMCID: PMC4639920.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other Endocrine Surgery episodes here: https://behindtheknife.org/podcast-category/endocrine/
In this episode from the Endocrine Surgery team at BTK we discuss how Dr. Yeh built the section of endocrine surgery at UCLA. From Sydney, Australia to Santa Monica, he discusses the risks and challenges involved in becoming a leader in academic endocrine surgery. In this podcast we answer the question “why endocrine surgery,” and mention tips for success at all level of training from medical students to early faculty. Finally, we take a moment to honor and remember Dr. Orlo Clark.
Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.
Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. Na Eun Kim is an Endocrine Surgery Fellow at UCLA in her first year of fellowship
Dr. Rivfka Shenoy is a PGY-6 General Surgery Resident at UCLA who has completed two years of research
Dr. Max Schumm is a PGY-6 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon.
Important Papers
Krishnamurthy VD, Gutnick J, Slotcavage R, Jin J, Berber E, Siperstein A, Shin JJ. Endocrine surgery fellowship graduates past, present, and future: 8 years of early job market experiences and what program directors and trainees can expect. Surgery. 2017 Jan;161(1):289-296. doi: 10.1016/j.surg.2016.06.069. Epub 2016 Nov 17. PMID: 27866719.
Krishnamurthy VD, Jin J, Siperstein A, Shin JJ. Mapping endocrine surgery: Workforce analysis from the last six decades. Surgery. 2016 Jan;159(1):102-10. doi: 10.1016/j.surg.2015.08.024. Epub 2015 Oct 9. PMID: 26456130.
Kulaylat AN, Kenning EM, Chesnut CH 3rd, James BC, Schubart JR, Saunders BD. The profile of successful applicants for endocrine surgery fellowships: results of a national survey. Am J Surg. 2014 Oct;208(4):685-9. doi: 10.1016/j.amjsurg.2014.03.013. Epub 2014 Jun 21. PMID: 25048570; PMCID: PMC4639920.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other Endocrine Surgery episodes here: https://behindtheknife.org/podcast-category/endocrine/
You have a young patient with longstanding Crohn’s disease with a history of small bowel resections presenting with recurrent obstructions from a stricture. The patient has exhausted all medical options and requires surgery. How should you work up this patient prior to surgery? Should you perform a bowel resection or perform a strictureplasty? Which strictureplasty do you choose and why?
Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Fabrizio Michelassi as they discuss the management of small bowel strictures in Crohn’s disease.
Learning Objectives
-
Describe the evaluation for small bowel strictures and indications for operating in patients with Crohn’s disease
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Discuss the different surgical options in managing small bowel strictures
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Explain the rationale behind use of different strictureplasty approaches
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other Colorectal Surgery episodes here: https://behindtheknife.org/podcast-category/colorectal/
On this episode of the BIG T Trauma series Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill discuss hemodynamically unstable pelvic fractures. These patients are sick!! Really sick. Join as for a practical discussion about best to manage gnarly pelvic fractures. From binders to angioembolization to pelvic packing to REBOA, we cover it all.
Papers: 1. Burlew et al, Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures. J Trauma 2017: https://pubmed.ncbi.nlm.nih.gov/27893645/ 2. McDonogh et al, Preperitoneal packing versus angioembolization for the initial management of hemodynamically unstable pelvic fracture: A systematic review and meta-analysis. J Trauma 2022: https://pubmed.ncbi.nlm.nih.gov/34991126/ 3. Li et al, Role of pelvic packing in the first attention given to hemodynamically unstable pelvic fracture patients: a meta-analysis, J ournal of Orthopaedics and Traumatology 2022: https://pubmed.ncbi.nlm.nih.gov/35799073/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out the rest of the BIG T trauma series here: https://behindtheknife.org/podcast-series/big-t-trauma/
In the second episode of the “Innovations in Surgery” series, Behind the Knife’s surgical education fellow, Dr. Dan Scheese, sits down with Dr. Michael Amendola and Dr. Diana Otoya to discuss 3D Printing and its role in medicine and surgery. They speak on the history of this technology and the current utility in preoperative planning and intraoperative application.
Looking for information on getting involved in 3D Printing?
Link to the VHA Office of Advanced Manufacturing: https://www.innovation.va.gov/oam/views/about/whoweare.html
Link to information regarding the 3D printing fellowship: https://www.innovation.va.gov/oam/views/training/training.html
Additionally, you can contact Dr. Michael Amendola or Dr. Diana Otoya for more information regarding the 3D printing surgical fellowship.
Dr. Michael Amendola: michael.amendola@va.gov
Dr. Diana Otoya: Diana.Otoya@vcuhealth.org
Dr. Amendola also has a website for mentorship and other information: https://michaelamendola.com/
Download free 3D designs that are ready to print at https://www.thingiverse.com/
Lastly, anyone that has access to a VA can take the TMS module Dr. Amendola created. TMS: 3D Printing in the VA Health Care System: Building the Hospital of the Future. Item: 45343
Goes through history, types of printers, and basic medical information you need for 3D printing. Good intro lecture/ free education to any trainee within the VA.
https://www.tms.va.gov/SecureAuth35/
Dr. Amendola has received his medical degree, completed his general surgery residency and vascular surgery fellowship at Virginia Commonwealth University. He is board certified by the American Board of Surgery in both general and vascular surgery. In 2021 he was inducted into the American College of Surgeons Academy of Master Surgeon Educators. He maintains privileges at Central Virginia VA Health Care System in Richmond, Virginia and is a Professor of Surgery at VCU-SOM. Additionally, he is the program director of the Office of Advance Manufacturing’s Central Virginia VA Health Care System based 3D Printing Surgical Fellowship.
Dr. Diana Otoya is a third-year general surgery resident at VCU. She spent her first research year as a Veterans Health Administration (VHA) Chief Resident in Quality and Safety at the Central Virginia Health Care System while also becoming the inaugural fellow for the VHA 3D Printing Surgical Fellowship. She is now currently in her second year in the 3D Printing fellowship program.
Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed general surgery procedures. If you are a PGY4/5 general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com, for more information on how you could be compensated up to $400 for recording and submitting those videos.
Please visit https://behindtheknife.org/ to access other high-yield surgical education podcasts, videos, and more.
If you liked this episode, check out our latest episodes here: https://behindtheknife.org/listen/
Join our surgical education fellow, Dr. Dan Scheese as he kicks off a brand new BTK series titled “Innovations in Surgery.” This series will take a deeper look into past, present, and future innovations that have, or will, revolutionize the field of surgery. In this inaugural episode, Dr. Scheese and Dr. Patrick Georgoff sit down with a leader in the surgical artificial intelligence field, Dr. Daniel Hashimoto. They cover what surgical artificial intelligence is, go over some common terminology used in AI, talk about current applications of AI in the OR, and finally discuss the future of AI in surgery.
“Artificial Intelligence in Surgery: Promises and Perils” - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995666/
Video – Application of AI in the OR – https://youtu.be/kabcjtdI308
Daniel Hashimoto is assistant professor of surgery at the Hospital of the University of Pennsylvania and director of the Penn Computer Assisted Surgery and Outcomes (PCASO) Laboratory. He received his MD and MS in translational research from the University of Pennsylvania and completed his general surgery training at Massachusetts General Hospital and Harvard Medical School, where he was also associate director of research of the Surgical AI & Innovation Laboratory. He is vice-chair and co-founder of the Global Surgical AI Collaborative, a nonprofit that oversees and manages a global data-sharing and analytics platform for surgical data. His work focuses on the use of computer vision for the delivery of intraoperative decision support and assessment of surgical performance. He is editor of the textbook Artificial Intelligence in Surgery: Understanding the Role of AI in Surgical Practice, which provides a nontechnical foundation on key concepts in artificial intelligence as it applies to surgical care.
Please visit https://behindtheknife.org/ to access other high-yield surgical education podcasts, videos, and more.
If you liked this episode, check out our latest episodes here: https://behindtheknife.org/listen/
You get called to the ED to evaluate a patient with abdominal pain who is in extreme pain but without any helpful physical exam findings. Time is gut in mesenteric ischemia, so how do you prioritize your workup, initial treatment, and what do you do once you’ve made the diagnosis? In this episode of Behind the Knife, the vascular surgery team discusses all this and more by walking through a real case and talking through the principles of management as well as some helpful tips on how to actually get through these tough clinical scenarios.
Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan and the Program Director of the Integrated Vascular Surgery Residency Program as well as the Vascular Surgery Fellowship Program at the University of Michigan.
Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan.
Dr. Craig Brown is a PGY-7 in the General Surgery program and recently matched 2023 vascular fellow at the University of Michigan.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Check out our Vascular Surgery Oral Board Review Book here: https://www.amazon.com/Vascular-Surgery-Oral-Board-Review/dp/0578382296/ref=sr_1_3?crid=1IF8LX547EOEA&keywords=behind+the+knife&qid=1666184084&qu=eyJxc2MiOiIxLjM3IiwicXNhIjoiMC43MCIsInFzcCI6IjAuNTgifQ%3D%3D&sprefix=behind+the+knife%2Caps%2C57&sr=8-3&ufe=app_do%3Aamzn1.fos.f5122f16-c3e8-4386-bf32-63e904010ad0
What’s the one clinical scenario where you can really save a patient’s life with a pancreatectomy? An IPMN with high-grade dysplasia! Join the Behind the Knife HPB Team for a deep dive into the complex decision-making surgical management of IPMNs.
Learning Objectives
In this episode, we review the basics of intraductal papillary mucinous neoplasms, how to evaluate patients with a cystic mass of the pancreas, guidelines for surveillance, and indications for resection. We discuss key concepts such as Worrisome Features and High-Risk Stigmata and how those influence surgical decision-making, and tackle a few of the most challenging scenarios surgeons may face when treating patients with IPMNs.
Hosts:
Timothy Vreelant, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center
Daniel Nelson, DO, FACS (@DWNelsonHPB) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center
Connor Chick, MD (@connor_chick) is a PGY-6 General Surgery resident at Brooke Army Medical Center
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-5 General Surgery resident at Brooke Army Medical Center
Beth Carpenter, MD (@elizcarpenter16) is a PGY-4 General Surgery resident at Brooke Army Medical Center
Links to Papers Referenced in this Episode
Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas
Pancreatology. 2017 Sep-Oct;17(5):738-753.
https://pubmed.ncbi.nlm.nih.gov/28735806/
Number of Worrisome Features and Risk of Malignancy in Intraductal Papillary Mucinous Neoplasm.
J Am Coll Surg. 2022 Jun 1;234(6):1021-1030.
https://pubmed.ncbi.nlm.nih.gov/35703792/
Extent of Surgery and Implications of Transection Margin Status after Resection of IPMNs.
Gastroenterology Research and Practice 2014, 1–10.
https://pubmed.ncbi.nlm.nih.gov/25276122/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other Hepatobiliary Surgery episodes here: https://behindtheknife.org/podcast-category/hepatobiliary/
Gallbladders – bread and butter cases or underestimated challenges? Join Dr. Patrick Georgoff and Dr. Shanaz Hossain as they sit down with Dr. Eric Knauer to discuss difficult gallbladders. In this episode, we discuss the SAGES Safe Cholecystectomy program that were created in an effort to decrease the incidence of bile duct injuries. The six strategies outlined in the program include:
-
Use the Critical View of Safety (CVS) method of identification of the cystic duct and cystic artery during laparoscopic cholecystectomy.
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Understand the potential for aberrant anatomy in all cases.
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Make liberal use of cholangiography or other methods to image the biliary tree intraoperatively.
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Consider an Intra-operative Momentary Pause during laparoscopic cholecystectomy prior to clipping, cutting or transecting any ductal structures.
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Recognize when the dissection is approaching a zone of significant risk and halt the dissection before entering the zone. Finish the operation by a safe method other than cholecystectomy if conditions around the gallbladder are too dangerous.
a. Subtotal Cholecystectomies – Learn more with this landmark paper: http://dx.doi.org/10.1016/j.jamcollsurg.2015.09.019
- Get help from another surgeon when the dissection or conditions are difficult.
Take a look at all their great explanations and catch all the important points by completing the online program: https://www.sages.org/safe-cholecystectomy-program/
Dr. Eric Knauer is an assistant professor surgery at Emory University. He has recently published regarding the management of laparoscopic common bile duct stones in General Surgery News and, more importantly, was awarded the junior residents’ teaching award. Check out his great educational videos to learn more:
· Cholecystectomy: https://youtu.be/_oMNRINPY5I
Laparoscopic Common Bile Duct Exploration: https://youtu.be/mXl11I7mya0
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other hepatobiliary episodes here: https://behindtheknife.org/podcast-category/hepatobiliary/
Does surgery have a leaky pipeline problem? What is it like for LGBTQ+ students, trainees, and faculty to be in the field of surgery? In this Journal Club episode, we review recent research and calls to action that illuminate these and other questions in the field. We’re joined by a panel of guests from all levels of training, including Eric Pillado MD MS, Christopher Digesu MD, Jessica Halem MBA, and Michaela West MD PhD.
Learning Objectives:
· Identify hazards for LGBTQ+ trainees in surgery
· Describe potential actions to improve LGBTQ+ inclusivity in surgery
· Correlate the provision of LGBTQ+ health care and the wellbeing of LGBTQ+ staff
References:
Experiences of LGBTQ+ Residents in US General Surgery Training Programs - https://doi.org/10.1001/jamasurg.2021.5246
Invited Commentary - Discrimination, Harassment, and Bullying Is Reported to Be High by LGBTQ+ Surgical Residents – https://doi.org/10.1001/jamasurg.2021.5272
LGBTQ+ Inclusivity in Surgery—A Call to Action – https://doi.org/10.1001/jamasurg.2021.6777
Being queer without proximal or distal control - https://vascularspecialistonline.com/being-queer-without-proximal-or-distal-control/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other Surgical Education episodes here: https://behindtheknife.org/podcast-category/surgical-education/
Does surgery have a leaky pipeline problem? What is it like for LGBTQ+ students, trainees, and faculty to be in the field of surgery? In this Journal Club episode, we review recent research and calls to action that illuminate these and other questions in the field. We’re joined by a panel of guests from all levels of training, including Eric Pillado MD MS, Christopher Digesu MD, Jessica Halem MBA, and Michaela West MD PhD.
Learning Objectives:
· Identify hazards for LGBTQ+ trainees in surgery
· Describe potential actions to improve LGBTQ+ inclusivity in surgery
· Correlate the provision of LGBTQ+ health care and the wellbeing of LGBTQ+ staff
References:
Experiences of LGBTQ+ Residents in US General Surgery Training Programs - https://doi.org/10.1001/jamasurg.2021.5246
Invited Commentary - Discrimination, Harassment, and Bullying Is Reported to Be High by LGBTQ+ Surgical Residents – https://doi.org/10.1001/jamasurg.2021.5272
LGBTQ+ Inclusivity in Surgery—A Call to Action – https://doi.org/10.1001/jamasurg.2021.6777
Being queer without proximal or distal control - https://vascularspecialistonline.com/being-queer-without-proximal-or-distal-control/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other Surgical Education episodes here: https://behindtheknife.org/podcast-category/surgical-education/
In this episode, our team discusses the management of traumatic rib fractures including pearls and pitfalls. Join as we discuss the current standards of treatment as well as controversies in how to manage these patients!
Hosts:
Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST) and incoming editor-in-chief of Trauma Surgery and Acute Care Open.
Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.
David Sigmon, MD, MMEd, a PGY-7 resident at the University of Illinois at Chicago who will be a fellow at Lincoln Medical Center in the Bronx next year. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.
LITERATURE 1. Terry SM, Shoff KA, Sharrah ML. Improving blunt chest wall injury outcomes: introducing the pic score. J Trauma Nurs. 2021;28(6):386-394.
https://pubmed.ncbi.nlm.nih.gov/34766933/ 2. Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surg Acute Care Open. 2017;2(1):e000064.
https://tsaco.bmj.com/content/2/1/e000064 3. Utter GH, McFadden NR. Rib fractures, the evidence supporting their management, and adherence to that evidence base. JAMA Netw Open. 2020;3(3):e201591-e201591.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2763488 4. Dehghan N, Nauth A, Schemitsch E, et al. Operative vs nonoperative treatment of acute unstable chest wall injuries: a randomized clinical trial. JAMA Surgery. Published online September 21, 2022.
https://jamanetwork.com/journals/jamasurgery/article-abstract/2796556 5. Kasotakis G, Hasenboehler EA, Streib EW, et al. Operative fixation of rib fractures after blunt trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):618-626.
https://pubmed.ncbi.nlm.nih.gov/28030502/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other trauma episodes here: https://behindtheknife.org/podcast-category/trauma/
In this episode, our team discusses the management of traumatic rib fractures including pearls and pitfalls. Join as we discuss the current standards of treatment as well as controversies in how to manage these patients!
Hosts:
Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST) and incoming editor-in-chief of Trauma Surgery and Acute Care Open.
Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.
David Sigmon, MD, MMEd, a PGY-7 resident at the University of Illinois at Chicago who will be a fellow at Lincoln Medical Center in the Bronx next year. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.
LITERATURE 1. Terry SM, Shoff KA, Sharrah ML. Improving blunt chest wall injury outcomes: introducing the pic score. J Trauma Nurs. 2021;28(6):386-394.
https://pubmed.ncbi.nlm.nih.gov/34766933/ 2. Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surg Acute Care Open. 2017;2(1):e000064.
https://tsaco.bmj.com/content/2/1/e000064 3. Utter GH, McFadden NR. Rib fractures, the evidence supporting their management, and adherence to that evidence base. JAMA Netw Open. 2020;3(3):e201591-e201591.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2763488 4. Dehghan N, Nauth A, Schemitsch E, et al. Operative vs nonoperative treatment of acute unstable chest wall injuries: a randomized clinical trial. JAMA Surgery. Published online September 21, 2022.
https://jamanetwork.com/journals/jamasurgery/article-abstract/2796556 5. Kasotakis G, Hasenboehler EA, Streib EW, et al. Operative fixation of rib fractures after blunt trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):618-626.
https://pubmed.ncbi.nlm.nih.gov/28030502/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other trauma episodes here: https://behindtheknife.org/podcast-category/trauma/
On the University of Washington Minimally Invasive Surgery team’s search for value no piggy bank is safe and no couch cushion will be left unturned. Tune in to hear Drs. Mike Weykamp, Nicole White, Nick Cetrulo, and Andrew Wright discuss the state of the literature regarding the cost-effectiveness of robot assisted surgery.
Referenced Articles:
- Ye L, Childers CP, de Vigilio M, Shenoy R, Mederos MA, Mak SS, Begashaw MM, Booth MS, Shekelle PG, Wilson M, Gunnar W, Girgis MD, Maggard-Gibbons M. Clinical Outcomes and Cost of Robotic Ventral Hernia Repair: Systematic Review. BJS Open. 2021.
https://pubmed.ncbi.nlm.nih.gov/34791049/
- Finlayson SRG and Birkmeyer JD. Cost-effectiveness Analysis in Surgery. Surgery. 1998
https://pubmed.ncbi.nlm.nih.gov/9481400/
- Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu R, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 Explanation and Elaboration: A Report of the ISPOR CHEERS II Good Practices Task Force. Value Heatlh. 2022.
https://pubmed.ncbi.nlm.nih.gov/35031088/
Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed general surgery procedures. If you are a PGY4/5 general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com, for more information on how you could be compensated up to $400 for recording and submitting those videos.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other minimally invasive episodes here: https://behindtheknife.org/podcast-category/minimally-invasive/
On the University of Washington Minimally Invasive Surgery team’s search for value no piggy bank is safe and no couch cushion will be left unturned. Tune in to hear Drs. Mike Weykamp, Nicole White, Nick Cetrulo, and Andrew Wright discuss the state of the literature regarding the cost-effectiveness of robot assisted surgery.
Referenced Articles:
- Ye L, Childers CP, de Vigilio M, Shenoy R, Mederos MA, Mak SS, Begashaw MM, Booth MS, Shekelle PG, Wilson M, Gunnar W, Girgis MD, Maggard-Gibbons M. Clinical Outcomes and Cost of Robotic Ventral Hernia Repair: Systematic Review. BJS Open. 2021.
https://pubmed.ncbi.nlm.nih.gov/34791049/
- Finlayson SRG and Birkmeyer JD. Cost-effectiveness Analysis in Surgery. Surgery. 1998
https://pubmed.ncbi.nlm.nih.gov/9481400/
- Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu R, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 Explanation and Elaboration: A Report of the ISPOR CHEERS II Good Practices Task Force. Value Heatlh. 2022.
https://pubmed.ncbi.nlm.nih.gov/35031088/
Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed general surgery procedures. If you are a PGY4/5 general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com, for more information on how you could be compensated up to $400 for recording and submitting those videos.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other minimally invasive episodes here: https://behindtheknife.org/podcast-category/minimally-invasive/
You’ve finally submitted your ERAS application! As residency programs start to review your application, it’s time to start preparing for the next step- the interview. Join our education fellow, Dr. Jessica Millar, and Dr. Jeremy Lipman as they go over all the ways to start preparing to dominate your interviews.
Guests:
Jeremy Lipman, MD, MHPE- Professor of Colorectal Surgery, Designated Institutional Official, Director of Graduate Medical Education, and previous General Surgery Residency Program Director- Cleveland Clinic, OH
Most Commonly Asked Interview Questions:
· “Tell me about yourself”- have a 2-3 minute “elevator talk” rehearsed
· “Where do you see yourself in 5/10-years”
· “Why surgery?”
· “Tell me about a challenge you’ve had to overcome”
· “Tell me about a difficulty patient/team situation you’ve witnessed”- key here is to not throw anyone under the bus
· “Why are you interested in our program”
AAMC List of Common Interview Questions:
https://students-residents.aamc.org/interviewing-residency-positions/questions-frequently-asked-applicants-during-interviews
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out the rest of our "Dominate the Match Series" here: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/
You’ve finally submitted your ERAS application! As residency programs start to review your application, it’s time to start preparing for the next step- the interview. Join our education fellow, Dr. Jessica Millar, and Dr. Jeremy Lipman as they go over all the ways to start preparing to dominate your interviews.
Guests:
Jeremy Lipman, MD, MHPE- Professor of Colorectal Surgery, Designated Institutional Official, Director of Graduate Medical Education, and previous General Surgery Residency Program Director- Cleveland Clinic, OH
Most Commonly Asked Interview Questions:
· “Tell me about yourself”- have a 2-3 minute “elevator talk” rehearsed
· “Where do you see yourself in 5/10-years”
· “Why surgery?”
· “Tell me about a challenge you’ve had to overcome”
· “Tell me about a difficulty patient/team situation you’ve witnessed”- key here is to not throw anyone under the bus
· “Why are you interested in our program”
AAMC List of Common Interview Questions:
https://students-residents.aamc.org/interviewing-residency-positions/questions-frequently-asked-applicants-during-interviews
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out the rest of our "Dominate the Match Series" here: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/
The number of patients seeking evaluation for revisional bariatric surgery is increasing. Wondering how to approach the work-up for these patients and what surgical options may be best for them? An introduction to the work-up and potential revisional bariatric surgery options are included in this episode from your bariatric surgery team at UNMC!
Hosts:
Ivy Haskins, MD
Corrigan McBride, MD
Tiffany Tanner, MD
Journal Articles discussed:
-
Berger ER, Clements RH, Morton JH, Huffman KM, Wolfe BM, Nguyen NT, Ko CY, Hutter MM. The Impact of Different Surgical Techniques on Outcomes in Laparoscopic Sleeve Gastrectomies: The First Report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Ann Surg. 2016; 264.3: 464-473.
-
Haskins IN, Jackson HT, Graham AE, Chen S, Sparks AD, Lin PP, Vaziri K. The Effect of Bougie Size and Distance from the Pylorus on Dehydration after Laparoscopic Sleeve Gastrectomy: An Analysis of the ACS-MBSAQIP Database. Surg Obes Relat Dis. 2019; 15.10: 1656-1661.
-
Toro JP, Lin E, Patel AD, Davis SS, Sanni A, Urrego HD, Sweeney JF, Srinivasan JK, Small W, Mittal P, Sekhar A, Moreno CC. Association of Radiographic Morphology with Early Gastroesophageal Reflux Disease and Satiety Control after Sleeve Gastrectomy. J Am Coll Surg. 2014; 219.3: 430-438.
-
Maselli DB, Alqahtani AR, Dayyeh BKA, Elahmedi M, Storm AC, Matar R, Nieto J, Teixeira A, Al Khatry M, Neto MG, Kumbhari V, Vargas EJ, Jaruvongvanich V, Mundi MS, Deshumkh A, Itani MI, Farha J, Chapman CG, Sharaiha R. Revisional Endoscopic Sleeve Gastroplasty of Laparoscopic Sleeve Gastrectomy: An International, Multicenter Study.
-
Campos GM, Mazzini GS, Altieri MS, Docimo S, DeMaria EJ, Rogers AM. ASMBS Position Statement on the Rationale for Performance of Upper Gastrointestinal Endoscopy Before and After Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2021; 17.5: 837-847.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other bariatric surgery episodes here: https://behindtheknife.org/podcast-category/bariatric/
The number of patients seeking evaluation for revisional bariatric surgery is increasing. Wondering how to approach the work-up for these patients and what surgical options may be best for them? An introduction to the work-up and potential revisional bariatric surgery options are included in this episode from your bariatric surgery team at UNMC!
Hosts:
Ivy Haskins, MD
Corrigan McBride, MD
Tiffany Tanner, MD
Journal Articles discussed:
-
Berger ER, Clements RH, Morton JH, Huffman KM, Wolfe BM, Nguyen NT, Ko CY, Hutter MM. The Impact of Different Surgical Techniques on Outcomes in Laparoscopic Sleeve Gastrectomies: The First Report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Ann Surg. 2016; 264.3: 464-473.
-
Haskins IN, Jackson HT, Graham AE, Chen S, Sparks AD, Lin PP, Vaziri K. The Effect of Bougie Size and Distance from the Pylorus on Dehydration after Laparoscopic Sleeve Gastrectomy: An Analysis of the ACS-MBSAQIP Database. Surg Obes Relat Dis. 2019; 15.10: 1656-1661.
-
Toro JP, Lin E, Patel AD, Davis SS, Sanni A, Urrego HD, Sweeney JF, Srinivasan JK, Small W, Mittal P, Sekhar A, Moreno CC. Association of Radiographic Morphology with Early Gastroesophageal Reflux Disease and Satiety Control after Sleeve Gastrectomy. J Am Coll Surg. 2014; 219.3: 430-438.
-
Maselli DB, Alqahtani AR, Dayyeh BKA, Elahmedi M, Storm AC, Matar R, Nieto J, Teixeira A, Al Khatry M, Neto MG, Kumbhari V, Vargas EJ, Jaruvongvanich V, Mundi MS, Deshumkh A, Itani MI, Farha J, Chapman CG, Sharaiha R. Revisional Endoscopic Sleeve Gastroplasty of Laparoscopic Sleeve Gastrectomy: An International, Multicenter Study.
-
Campos GM, Mazzini GS, Altieri MS, Docimo S, DeMaria EJ, Rogers AM. ASMBS Position Statement on the Rationale for Performance of Upper Gastrointestinal Endoscopy Before and After Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2021; 17.5: 837-847.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other bariatric surgery episodes here: https://behindtheknife.org/podcast-category/bariatric/
In this episode we discuss two interesting cases in transplant surgery. In the first, we review a case in which a renal cell carcinoma was discovered during the backbench portion of a deceased donor kidney transplant procedure. In the second, we examine the unique challenges that are presented by simultaneous heart-liver transplantation.
Learning Objectives:
-
Discuss renal cell carcinoma in the immunosuppressed patient
-
Review some of the logistical components that accompany dual organ transplants
-
Examine the clinical challenge of a heart-liver transplant
Hosts:
-
Megan Lombardi, MD
-
Sasha McEwan, MD
-
Guilherme de Oliveira, MD
-
Alexander Toledo, MD
-
David Gerber, MD
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other transplant surgery episodes here: https://behindtheknife.org/podcast-category/transplant/
In this episode we discuss two interesting cases in transplant surgery. In the first, we review a case in which a renal cell carcinoma was discovered during the backbench portion of a deceased donor kidney transplant procedure. In the second, we examine the unique challenges that are presented by simultaneous heart-liver transplantation.
Learning Objectives:
-
Discuss renal cell carcinoma in the immunosuppressed patient
-
Review some of the logistical components that accompany dual organ transplants
-
Examine the clinical challenge of a heart-liver transplant
Hosts:
-
Megan Lombardi, MD
-
Sasha McEwan, MD
-
Guilherme de Oliveira, MD
-
Alexander Toledo, MD
-
David Gerber, MD
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other transplant surgery episodes here: https://behindtheknife.org/podcast-category/transplant/
You are faced with a young patient with ileal Crohn’s disease. He requires an ileocolic resection. Which type of anastomosis do you perform? You also see another patient with complex perianal fistulas and the patient asks about the safety and efficacy of stem cells for fistula closure. What do you tell the patient?
Join Dr. Carole Richard, Dr. François Dagbert and Dr. Maher Al Khaldi in their conversation about the Kono-S anastomosis after ileocolic resections and stem cell therapy for perianal complex fistulas for Crohn’s disease.
Learning objectives
-
To understand the rationale for the Kono-S anastomosis and the way it is fashioned.
-
To explain the possible advantages of the Kono-S anastomosis following ileocolic resection.
-
To explain the possible advantages of stem cell therapy for complex perianal fistulas.
-
To understand which patient population might be eligible for future stem cell therapy for complex perianal fistulas.
References
In order throughout the episode:
Article 1: Luglio G, Rispo A, Imperatore N, Giglio MC, Amendola A, Tropeano FP, Peltrini R, Castiglione F, De Palma GD, Bucci L. Surgical Prevention of Anastomotic Recurrence by Excluding Mesentery in Crohn's Disease: The SuPREMe-CD Study - A Randomized Clinical Trial. Ann Surg. 2020 Aug;272(2):210-217. doi: 10.1097/SLA.0000000000003821. PMID: 32675483.
Article 2: Panés J, García-Olmo D, Van Assche G, Colombel JF, Reinisch W, Baumgart DC, Dignass A, Nachury M, Ferrante M, Kazemi-Shirazi L, Grimaud JC, de la Portilla F, Goldin E, Richard MP, Leselbaum A, Danese S; ADMIRE CD Study Group Collaborators. Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn's disease: a phase 3 randomised, double-blind controlled trial. Lancet. 2016 Sep 24;388(10051):1281-90. doi: 10.1016/S0140-6736(16)31203-X. Epub 2016 Jul 29. PMID: 27477896.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our library of colorectal episodes and videos here: https://behindtheknife.org/podcast-category/colorectal/
Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss management of congenital diaphragmatic hernia in pediatric surgery.
Journal Article links:
Jancelewicz T, Brindle ME. Prediction tools in congenital diaphragmatic hernia. Semin Perinatol 2020;44(1):151165.
https://pubmed.ncbi.nlm.nih.gov/31676044/
Deprest JA, Benachi A, Gratacos E, Nicolaides KH, Berg C, Persico N, et al. Randomized Trial of Fetal Surgery for Moderate Left Diaphragmatic Hernia. N Engl J Med 2021;385(2):119-29.
https://pubmed.ncbi.nlm.nih.gov/34106555/
Deprest JA, Nicolaides KH, Benachi A, Gratacos E, Ryan G, Persico N, et al. Randomized Trial of Fetal Surgery for Severe Left Diaphragmatic Hernia. N Engl J Med 2021;385(2):107-18.
https://www.nejm.org/doi/full/10.1056/NEJMoa2027030
Guner Y, Jancelewicz T, Di Nardo M, Yu P, Brindle M, Vogel AM, et al. Management of Congenital Diaphragmatic Hernia Treated With Extracorporeal Life Support: Interim Guidelines Consensus Statement From the Extracorporeal Life Support Organization. ASAIO J 2021;67(2):113-20.
https://pubmed.ncbi.nlm.nih.gov/33512912/
Yang MJ, Russell KW, Yoder BA, Fenton SJ. Congenital diaphragmatic hernia: a narrative review of controversies in neonatal management. Transl Pediatr 2021;10(5):1432-47.
https://pubmed.ncbi.nlm.nih.gov/34189103/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our other pediatric surgery podcast episodes here: https://behindtheknife.org/podcast-category/pediatric/
What is the value of completion lymph node dissection for patients with melanoma with sentinel-node metastases?
The Multicenter Selective Lymphadenectomy Trial-1 (MSLT-1) confirmed that SLNB is an important part in the treatment of patients with melanoma, but what needed to be done beyond that in managing the axilla?
Learning Objectives:
In this episode, we review perioperative chemotherapy regimens for locally advanced, resectable Gastric cancer, standard of care, and the future role for immunotherapy.
Hosts:
Adam Yopp, MD, FACS (@AdamYopp) is an Associate Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program.
Caitlin Hester, MD (@CaitlinAHester) is a new Assistant Professor of Surgery at the University of Miami
Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-4 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research.
Papers Referenced in this Episode:
Final Trial Report of Sentinel-Node Biopsy versus Nodal Observation in Melanoma
Morton et al.
https://www.nejm.org/doi/full/10.1056/nejmoa1310460
Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma
Faries et al.
https://www.nejm.org/doi/full/10.1056/nejmoa1613210
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our Journal Review Series here: https://behindtheknife.org/podcast-series/journal-review/
Join BTK's Dr. Scott Steele and Dr. Jason Bingham as they discuss coding and billing with Dr. Sarah Vogler.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our Financial Principles for Surgeons series here: https://behindtheknife.org/podcast-series/financial-principles-for-surgeons/
Our oral board review course includes 92 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the Oral Board Review episodes at https://behindtheknife.org/premium/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Our oral board review course includes 92 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the Oral Board Review episodes at https://behindtheknife.org/premium/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Welcome to the second Surgical Palliative Care Journal Club, number four of a six-part series focused on the integration of palliative care into the practice of surgery. Join us as we discuss the value of utilizing an advance care planning video during surgical oncologic care and define the similarities and differences between advance care planning and serious illness communication. We then explore how a multidisciplinary committee may improve perioperative decision making and discuss the importance of the interdisciplinary palliative care team.
Please use the links below to learn more about advance care planning and serious illness conversation.
Integrating Advance Care Planning Videos into Surgical Oncologic Care: A Randomized Clinical Trial
https://pubmed.ncbi.nlm.nih.gov/30964385/
A Multidisciplinary High-Risk Surgery Committee May Improve Perioperative Decision Making for Patients and Physicians
https://pubmed.ncbi.nlm.nih.gov/34851187/
What’s Wrong with Advance Care Planning?
https://pubmed.ncbi.nlm.nih.gov/34623373/
Shifting to Serious Illness Conversation
https://pubmed.ncbi.nlm.nih.gov/34994773/
Serious Illness Care Program/ Serious Illness Communication Guide
https://www.ariadnelabs.org/serious-illness-care/serious-illness-care-program/
Vital Talk
https://www.vitaltalk.org/
Dr. Red Hoffman (@redmdnd) is an acute care surgeon and associate hospice medical director in Asheville, North Carolina, host of the Surgical Palliative Care Podcast (@surgpallcare) and co-founder of the recently launched Surgical Palliative Care Society (www.spcsociety.org).
Dr. Zara Cooper (@zaracMD) is an acute care surgeon at Brigham and Women’s Hospital where she serves as Kessler Director for the Center of Surgery and Public Health (@csph_bwh). She is a Professor of Surgery at Harvard Medical School, associate faculty at Adriane Labs, and adjunct faculty at the Marcus Institute for Aging Research.
Dr. Amanda Stastny (@manda_plez) is a PGY-3 in the General Surgery program at Mountain Area Health Education Center (MAHEC) in Asheville, NC.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other Palliative Care episodes here: https://behindtheknife.org/podcast-category/palliative-care/
Surgical training is evolving, and with advancing surgical techniques, the traditional “time-served” model of residency may not best serve the needs of our learners or patients. In this episode, we discuss recent efforts at the Indiana University surgical education program to implement a comprehensive laparoscopic cholecystectomy that utilizes all of the best practices of competency-based education. We’re joined by first author Dr. Betsy Huffman, along with her mentors Drs. Jennifer Choi, Matthew Ritter, and Dimitrios Stefanidis for a practical review of their pioneering work.
Learning Objectives:
· Review challenges to the current paradigm of surgical education
· Define competency-based education
· Discuss practical challenges facing surgical educators when implementing new curricula
References:
A competency-based laparoscopic cholecystectomy curriculum significantly improves
general surgery residents’ operative performance and decreases skill variability – https://doi.org/10.1097/SLA.0000000000004853
Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed general surgery procedures. If you are a PGY4/5 general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI @ rblaverty@gmail.com, for more information on how you could be compensated up to $400 for recording and submitting those videos.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out additional BTK surgical education episodes here: https://behindtheknife.org/podcast-category/surgical-education/
Ductal carcinoma in situ, or DCIS, is a precursor lesion to invasive breast cancer; however, not all DCIS becomes invasive cancer. Given our inability to accurately determine which DCIS lesions will progress, current clinical management consists of surgical resection for everyone with the possible additions of radiation and endocrine therapy. Multiple clinical trials and leaders in the field of breast surgical oncology are challenging our assumptions about the uniform approach to DCIS and are attempting to design treatment based on biology— tune in to hear about the evolving approach to management of DCIS!
Hosts:
Alexa Glencer, MD
Michael Alvarado, MD
Rita Mukhtar, MD
Laura Esserman, MD
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other breast surgery episodes here: https://behindtheknife.org/podcast-category/breast/
We are facing a difficult case tonight: stab wound to the base of the left neck. Hope you know your anatomy well and are ready for a ride. Let’s see how one manages a patient whose injury is life threatening, a challenge to correctly diagnose, approach and repair.
Join Drs. Urréchaga, Neeman, and Rattan from Ryder Trauma Center in Miami as they go through a real case trying to save a life and dominate the day.
Learning Objectives: * Reviewing thoracic outlet anatomy. * Simplifying primary survey and immediate care for penetrating great vessel injuries. * Discussing possible surgical approaches for various great vessel injuries, incisions, extensions, tips and tricks.
References
1) Feliciano DV, DuBose JJ. Cardiac, great vessel, and pulmonary injuries. In: Rasmussen TR, Tai NRM, eds. Rich’s Vascular Trauma. 4th ed. Philadelphia: Elsevier, 2022: 171-198.
2) Karmy-Jones R, Namias N, Coimbra R, et al. Western Trauma Association critical decisions in trauma: penetrating chest trauma. J Trauma Acute Care Surg. 2014;77(6):994-1002.
3) Sperry JL, Moore EE, Coimbra R, et al. Western Trauma Association critical decisions in trauma: penetrating neck trauma. J Trauma Acute Care Surg. 2013;75(6):936-940.
4) Wall MJ, Ghanta RK, Mattox KL. Heart and thoracic vessels. In: Feliciano DV, Mattox K L, Moore EE, eds. Trauma. 9th ed. New York: McGraw-Hill, 2021: 599- 628.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our Big T Trauma Series here: https://behindtheknife.org/podcast-series/big-t-trauma/
Personal Statements and Letters of Recommendations- two things that can make or break any residency or fellowship application. Join our education fellow, Dr. Jessica Millar, Dr. David Hughes, and Dr. Gifty Kwakye as they discuss what makes a truly great personal statement and how to compile a strong team for your letters of recommendation.
Guests:
David Hughes, MD- Clinical Associate Professor of Endocrine Surgery, General Surgery Residency Program Director- University of Michigan
GIfty Kwakye, MD, MPH- Clinical Assistant Professor of Colon and Rectal Surgery, Surgical Clerkship Director- University of Michigan
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our Medical Student and Intern Survival Guide here: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/
It’s that time of year- when medical students across the country are preparing their residency applications. The process can be a bit daunting, and there have been a number of changes to process over the past few years. Join our education fellow, Dr. Jessica Millar, and Dr. David Hughes as they review the “nuts and bolts” of this year’s residency application cycle.
Guests:
David Hughes, MD- Clinical Associate Professor of Endocrine Surgery, General Surgery Residency Program Director- University of Michigan
Important Dates:
· June 8, 2022: ERAS application opens at 9 a.m. ET.
· August 1, 2022: Supplemental ERAS application opens for applicants.
· September 7, 2022: Residency applicants may begin submitting ERAS applications to programs at 9 a.m. ET.
· September 16, 2022: Supplemental ERAS application closes for applicants at 5 p.m. ET.
· September 28, 2022: Residency programs may begin reviewing ERAS applications, MSPEs, and supplemental ERAS application data at 9 a.m. ET.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our Medical Student and Intern Survival Guide here: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/
Bringing back an oldie but a goodie - Join Dr. Patrick Georgoff and Dr. Vahagn Nikolian as they discuss common and critical intern dilemmas. This episode is Part 2 of 2.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our entire Medical Student and Intern Survival Guide series here - https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/
Bringing back an oldie but a goodie - Join Dr. Patrick Georgoff and Dr. Vahagn Nikolian as they discuss common and critical intern dilemmas. This episode is Part 1 of 2.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our entire Medical Student and Intern Survival Guide series here - https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/
Pilonidal cysts – a simple disease or a sneaky nuanced problem? Drs. Shanaz Hossain, Patrick Georgoff and Scott Steele sit down to discuss the difficulties encountered in the management of pilonidal cysts and the myriad of treatment options available, ranging from non-operative management to outpatient pit picking to major operations involving flaps.
Dr. Steele dropped his “8 Key Principles for Pilonidal Cyst Management”: 1. Control Sepsis 2. Do the Least Amount of Work Possible 3. Avoid Too Much Excision 4. Remove All Hair, Un-Roof All Disease, and Debride Granulation Tissue 5. Use Off-Midline Excision and Closure 6. Tension Must Be Minimized with Primary Wound Closure 7. Change the Anatomy – Flatten the Natal Cleft 8. Never Underestimate the Impact of Postoperative Care
Tune in for detailed insights regarding management and learn about all the options for surgical treatment!
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episode on Necrotizing Soft-Tissue Infections here.
Join our Emergency General Surgery team as they discuss Necrotizing Soft-Tissue Infections. Hosted by Drs. Jordan Nantais, Ashlie Nadler, Stephanie Mason and Graham Skelhorne-Gross.
Necrotizing Soft-Tissue Infections:
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Also known as “flesh eating disease”, gas gangrene, necrotizing fasciitis/myositis, Fournier’s gangrene.
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Early findings are non-specific
- Rapidly fatal - diagnostic delay can lead to tremendous additional morbidity and mortality
Classification: - Type 1 - polymicrobial category (most common) found in immunosuppressed or elderly - Type 2 - monomicrobial infection [Group A Streptococcus > Methicillin-resistant Staphylococcus aureus (MRSA)] - Type 3 - monomicrobial infection (Vibrio or Clostridium) - Type 4 - fungal (rare) in immunocompromised or after penetration or trauma from candida or Zygomycetes.
Initial Workup - History: (comorbidities, immunosuppression, recent infections or trauma)
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Exam: swelling, open lesions, drainage, erythema, crepitus, and pain out of proportion
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Most common: swelling, pain, erythema
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Bullae, skin necrosis, crepitus are less common
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Labs: Hb, wbc, Na, Creat, glucose, and CRP
- Imaging: CT, MRI *sensitive and specific but may not change management
- Cut-down: bedside vs in OR
- Gm stain
Management - Initially: two large bore IVs, foley catheter, aggressive fluid resuscitation, broad spectrum antibiotics, vasopressors PRN - Abx choices: carbopenem or piperacllin-tazobactam or cefotaxime plus metronidazole. Clindamycin (antitoxin effect) and vancomycin (MRSA) should be considered.
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OR: must debride all dead/infected tissue, involve other surgical specialties as needed
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Mark edge of cellulitis and use as initial debridement
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Healthy dermis – pearly and white
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Healthy fat – pale, yellow, glistening
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Healthy fascia – should bleed, doesn’t easily separate from muscle
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Healthy muscle – contract with cautery
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Dressing: betadine-soaked gauze on the wound
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Most patients will need at least 3 ORs (second OR generally 8-12 hours after the first)
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No VAC or stoma at first OR References:
- Pelletier J, Gottlieb M, Long B, Perkins JC Jr. Necrotizing Soft Tissue Infections (NSTI): Pearls and Pitfalls for the Emergency Clinician. J Emerg Med. 2022 Apr;62(4):480-491. doi: 10.1016/j.jemermed.2021.12.012. Epub 2022 Jan 31.
- Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg. 2009 Feb;208(2):279-88.
- Edlich RF, Cross CL, Dahlstrom JJ, Long WB 3rd. Modern concepts of the diagnosis and treatment of necrotizing fasciitis. J Emerg Med. 2010 Aug;39(2):261-5
- Hoesl V, Kempa S, Prantl L, Ochsenbauer K, Hoesl J, Kehrer A, Bosselmann T. The LRINEC Score-An Indicator for the Course and Prognosis of Necrotizing Fasciitis? J Clin Med. 2022 Jun 22;11(13):3583
- Bulger EM, May A, Bernard A, Cohn S, Evans DC, Henry S, Quick J, Kobayashi L, Foster K, Duane TM, Sawyer RG, Kellum JA, Maung A, Maislin G, Smith DD, Segalovich I, Dankner W, Shirvan A. Impact and Progression of Organ Dysfunction in Patients with Necrotizing Soft Tissue Infections: A Multicenter Study. Surg Infect (Larchmt). 2015 Dec;16(6):694-701.
- LRINEC Score from: https://www.mdcalc.com/calc/1734/lrinec-score-necrotizing-soft-tissue-infection#:~:text=Patients%20were%20classified%20into%20three,%25%20and%20NPV%20of%2096%25. Retrieved July 2022.
If you liked this episode, check out our recent episode titled, "Journal Review in Colorectal Surgery: Timing of Biologics and Surgery in the Setting of Crohn’s Disease" which can be found here.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
You get consulted on a 34-year-old with ileocolic Crohn’s disease on Humira. You determine he needs surgery for recurrent partial obstructions. When do you do the surgery? How long should he be off his biologic medication? When to restart it post op? Join Drs. Abelson, Marcello and Aulet as they take us through two articles to help us figure it out!
Learning Objectives: 1. Describe the complications of biologic medications in the peri-operative period 2. List the different classifications of medications for Crohn’s disease 3. Discuss the approach to managing timing of surgery for patients with crohn’s disease
Articles: Cohen BL, Fleshner P, Kane SV et al. Prospective Cohort Study to Investigate the Safety of Preoperative Tumor Necrosis Factor Inhibitor Exposure in Patients With Inflammatory Bowel Disease Undergoing Intra-abdominal Surgery. Gastroenterology. 2022 Apr 10;S0016-5085(22)00359-6. doi: 10.1053/j.gastro.2022.03.057. Online ahead of print.
Brouquet A, Maggiori L, Zerbib P, Lefevre JH, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Munoz-Bongrand N, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Guillon F, Vicaut E, Benoist S, Panis Y; GETAID chirurgie group. Anti-TNF Therapy Is Associated With an Increased Risk of Postoperative Morbidity After Surgery for Ileocolonic Crohn Disease: Results of a Prospective Nationwide Cohort. Ann Surg. 2018 Feb;267(2):221-228. doi: 10.1097/SLA.0000000000002017. PMID: 29300710.
Steele S, et al. The ASCRS Textbook of Colon and Rectal Surgery, fourth ed. 2022. https://link.springer.com/book/10.1007/978-3-030-66049-9
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Want to learn more about achalasia and its procedural management? Excited about the POEM procedure? Learn what the current literature says when it comes to recommending POEM or the tried-and-true Heller myotomy from the Swedish Thoracic surgery team.
Learning objectives - Review basics of achalasia - Discuss the current literature comparing POEM and Heller myotomy with fundoplication - Understand the major differences in outcomes for these procedures
Hosts: Peter White, MD Megan Lenihan, MD Brian Louie, MD
Kelly Daus, MD
Referenced Material Werner YB, Hakanson B, Martinek J, et al. Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia. N Engl J Med. 2019 Dec 5;381(23):2219-2229. doi: 10.1056/NEJMoa1905380. PMID: 31800987.
Gu L, Ouyang Z, Lv L, et al. Safety and efficacy of peroral endoscopic myotomy with standard myotomy versus short myotomy for treatment-naïve patients with type II achalasia: a prospective randomized trial. Gastrointest Endosc. 2021 Jun;93(6):1304-1312. doi: 10.1016/j.gie.2020.10.006. Epub 2020 Oct 13. PMID: 33058884.
Shemmeri E, Aye RW, Farivar AS, Bograd AJ, Louie BE. Use of a report card to evaluate outcomes of achalasia surgery: beyond the Eckardt score. Surg Endosc. 2020 Apr;34(4):1856-1862. doi: 10.1007/s00464-019-06952-2. Epub 2019 Jul 8. PMID: 31286258.
Mota RCL, de Moura EGH, de Moura DTH, Bernardo WM, de Moura ETH, Brunaldi VO, Sakai P, Thompson CC. Risk factors for gastroesophageal reflux after POEM for achalasia: a systematic review and meta-analysis. Surg Endosc. 2021 Jan;35(1):383-397. doi: 10.1007/s00464-020-07412-y. Epub 2020 Mar 23. PMID: 32206921.
McKay SC, Dunst CM, Sharata AM, Fletcher R, Reavis KM, Bradley DD, DeMeester SR, Müller D, Parker B, Swanström LL. POEM: clinical outcomes beyond 5 years. Surg Endosc. 2021 Oct;35(10):5709-5716. doi: 10.1007/s00464-020-08031-3. Epub 2021 Jan 4. PMID: 33398572.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
The utilization of point-of-care ultrasound and other non-invasive cardiac output monitoring technologies varies because of knowledge, resource availability and cultural practices. In this Clinical Challenge in Surgery episode from the Surgical Critical Care team at Behind the Knife, we provide a brief history of the use of cardiac-output monitoring in the ICU, introduce a few clinical scenarios in the context of point of care ultra-sound and other less-invasive cardiac-output monitoring technologies.
Learning Objectives: In this episode, we review the historical uses of central venous pressure monitoring, pulmonary-artery catheters and the more frequently utilized point-of-care-ultrasound (or POCUS) in managing complex ICU patients. We review the outcomes behind these technologies, describe the views and utility of POCUS, and introduce less-invasive or completely non-invasive ways to measure cardiac-output monitoring.
Hosts:
Brittany Bankhead, MD, MS (@BBankheadMD) is an Assistant Professor of Surgery at Texas Tech University Health Sciences Center.
Ryan Dumas, MD, FACS (@PMH_Trauma_RPD) is an Assistant Professor of Surgery at the University of Southwestern Medical Center and Parkland Memorial Hospital.
Caroline Park, MD, MPH, FACS (@CPark_MD) is an Assistant Professor of Surgery at the University of Southwestern Medical Center and Parkland Memorial Hospital.
Links to Papers Referenced in this Episode: National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006 May 25;354(21):2213-24. doi: 10.1056/NEJMoa061895. Epub 2006 May 21. PMID: 16714768.
Yildizdas D, Aslan N. Ultrasonographic inferior vena cava collapsibility and distensibility indices for detecting the volume status of critically ill pediatric patients. J Ultrason. 2020 Nov;20(82):e205-e209. doi: 10.15557/JoU.2020.0034. Epub 2020 Sep 28. PMID: 33365158; PMCID: PMC7705480.
Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990 Aug 15;66(4):493-6. doi: 10.1016/0002-9149(90)90711-9. PMID: 2386120.
Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med. 2013 Jul;41(7):1774-81. doi: 10.1097/CCM.0b013e31828a25fd. PMID: 23774337.
Acknowledgements: We would like to acknowledge Dr. Hassan Mashbari and the Department of Surgical Critical Care and Anesthesia at the Massachusetts General Hospital and Dr. Christopher Choi and the Department of Anesthesiology at the University of Texas Southwestern for their ultra-sound video contributions.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Dr. Jordan Frey, a Plastic Surgeon in Buffalo NY, joins us to talk about how he uses investments in real estate to diversify his portfolio. We discuss: -Types of real estate investments and the pros and cons -Books to read on real estate investing -How to get started in real estate -Criteria he uses to choose a property and more Books recommended: The Millionaire Real Estate Investor - Gary Keller https://www.amazon.com/Millionaire-Real-Estate-Investor/dp/0071446370 Doctor's Guide to Real Estate Investing - Cory Fawcett https://www.amazon.com/Dr-Cory-S-Fawcett/e/B01FGK0IC8/ref=aufs_dp_fta_dsk Find Dr. Frey at his website or on social media.
Prudentplasticsurgeon.com or @JordanFreyMD
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Dr. Jill Streams, Trauma Surgeon at Vanderbilt, takes us through the ins and outs of understanding your first contract and how and when to negotiate.
In this episode we cover -When/how to apply for your first job -Break down each part of a contract -Why you should negotiate -What and how to negotiate -Salary expectations -Contract landmines and more!
You can connect with Dr. Streams on Twitter @JCRStreams
Read more at WCI https://www.whitecoatinvestor.com/things-to-ask-for-in-a-physician-contract/
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Kevin interviews Dr. Adam Tanious a Vascular Surgeon at MUSC about the ins and outs of managing student debt.
Adam is passionate about personal finance and student debt and is happy to discuss further with our listeners, please reach out at tanious@musc.edu .
Want to learn more at student debt? Check out White Coat Investor resources on student debt.
https://www.whitecoatinvestor.com/ultimate-guide-to-student-loan-debt-management-for-doctors/
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Kevin Kniery and Jason Bingham interview Larry Keller of Physician Financial Services on how and when to choose the right disability policy.
You can reach Larry here Lkeller@physicianfinancialservices.com or at his website.
https://www.physicianfinancialservices.com/
White Coat Investor Article breaking down Disability Insurance https://www.whitecoatinvestor.com/what-you-need-to-know-about-disability-insurance/
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Kevin Kniery and Jason Bingham interview Dr. Jason Mizell, a colorectal surgeon at University of Arkansas and pioneer in finance education for surgeons. He won the 2020 White Coat Investor Award for excellence in financial education.
In this episode they discuss how to invest, and what to invest in, also cover topics regarding real estate, and biggest financial regrets.
Links to articles discussed
Financial Waterfall for Docs https://www.whitecoatinvestor.com/financial-waterfalls-for-new-residents-and-attendings/
Backdoor Roth IRA Point/Counter Point https://www.physicianonfire.com/the-backdoor-roth/
Simple Path to Wealth https://jlcollinsnh.com/stock-series/
Dr. Mizell can be reached at jsmizell@uams.edu
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Kevin Kniery and Jason Bingham interview Dr. Jason Mizell, a colorectal surgeon at University of Arkansas and pioneer in finance education for surgeons. He won the 2020 White Coat Investor Award for excellence in financial education. In this episode they discuss his lecture "How to Resuscitate Your Critically Ill Finances". Dr. Mizell can be reached at jsmizell@uams.edu
Book Recommendation:
The Psychology of Money
https://www.amazon.com/Psychology-Money-Timeless-lessons-happiness/dp/0857197681
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Join the BTK leadership team for a quick update on what's happening at Behind the Knife!
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In this episode from the Endocrine Surgery team at BTK we invited Dr. Kepal Patel to join us to discuss two endocrine surgery cases while discussing pertinent literature. We discuss the work-up and surgical decision making for a case of medullary thyroid cancer and a Bethesda III thyroid nodule. Dr. Kepal Patel is the Chief of the Division of Endocrine Surgery and a Professor of Surgery, Otolaryngology and Biochemistry at NYU Langone Health.
Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.
Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship
Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research
Dr. Max Schumm is a PGY-5 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon.
Important Papers
Miyauchi, A., Matsuzuka, F., Hirai, K., Yokozawa, T., Kobayashi, K., Ito, Y., ... & Yamaguchi, K. (2002). Prospective trial of unilateral surgery for nonhereditary medullary thyroid carcinoma in patients without germline RET mutations. World journal of surgery, 26(8), 1023-1028.
Cibas, E. S., Baloch, Z. W., Fellegara, G., LiVolsi, V. A., Raab, S. S., Rosai, J., ... & Alexander, E. K. (2013). A prospective assessment defining the limitations of thyroid nodule pathologic evaluation. Annals of internal medicine, 159(5), 325-332.
Papazian, M. R., Dublin, J. C., Patel, K. N., Oweity, T., Jacobson, A. S., Brandler, T. C., & Givi, B. (2022). Repeat Fine-Needle Aspiration With Molecular Analysis in Management of Indeterminate Thyroid Nodules. Otolaryngology–Head and Neck Surgery, 01945998221093527.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
The grind of surgical training has been celebrated in the past, but to what end? With mounting evidence that supports a high prevalence of burnout in the surgical community, surgical educators and leaders are often called to develop initiatives to address the detrimental and potentially irreversible effects on trainees’ wellness during surgical training. We invite Dr. David Rogers, who has personally experienced burnout, to share his insight and expertise in improving workplace wellness. Spoiler: it’s not as easy as group yoga sessions and daily donuts.
Hosts: Dr. David Rogers Dr. Jeremy Lipman Dr. Judith French Dr. Amy Han
Learning Objectives 1. Listeners will be able to define wellness in the context of surgical training. 2. Listeners will be able to better characterize and recognize signs of burnout among surgeons and surgical trainees. 3. Listeners will be able identify strategies for overcoming burnout. 4. Listeners will be able to apply conceptual frameworks from workplace wellness outside of medicine that can guide developing effective programs that promote wellness in surgical education community.
References:
Torres-Landa S, Moreno K, Brasel KJ, Rogers DA. Identification of Leadership Behaviors that Impact General Surgery Junior Residents' Well-being: A Needs Assessment in a Single Academic Center. J Surg Educ. 2022;79(1):86-93. doi:10.1016/j.jsurg.2021.07.017
Coverdill JE, Bittner IV JG, Park MA, Pipkin WL, Mellinger JD. Fatigue as impairment or educational necessity? Insights into surgical culture. Acad Med. 2011;86:S69-72.
Dyrbye LN, Thomas MR, Harper W, et al. The learning environment and medical student burnout: a multicentre study. Med Educ. 2009;43(3):274-282. doi:10.1111/j.1365-2923.2008.03282.x
Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016;50(1):132-149. doi:10.1111/medu.12927
Bordage G. Conceptual frameworks to illuminate and magnify. Med Educ. 2009;43(4):312 319. doi:10.1111/j.1365-2923.2009.03295.x
Bakker AB, de Vries JD. Job Demands–Resources theory and self-regulation: New explanations and remedies for job burnout. Anxiety, Stress, & Coping. 2021;34: 1-21.
Georgiadis F. Author Dr Amit Sood: Rising Through Resilience; Five Things You Can Do To Become More Resilient. Medium. https://medium.com/authority-magazine/author-dr-amit-sood-rising-through-resilience-five-things-you-can-do-to-become-more-resilient-673b0a1e9f2a. Published 2020. Accessed May 10, 2022.
Gino F. Are You Too Stressed to Be Productive? Or Not Stressed Enough? Harvard Business Review. Published October 5, 2017. https://hbr.org/2016/04/are-you-too-stressed-to-be-productive-or-not-stressed-enough
Goleman D. Primal Leadership, with a New Preface by the Authors : Unleashing the Power of Emotional ... Intelligence.Harvard Bus Review Press; 2016.
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Colorectal liver metastasis (CRLM) is a complex clinical situation requiring multidisciplinary management. In this episode from the Hepato-Pancreato-Biliary team at Behind the Knife, we review the genomics of CRLM, discuss a journal article investigating the frequency and impact of these mutations on survival in patients with stage IV disease, and interview the senior author Dr. Jean-Nicholas Vauthey about this research and his career in HPB.
Hosts: Timothy Vreeland, MD, FACS (@vreelant) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center
Daniel Nelson, DO, FACS (@usarmydoc24) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center
Connor Chick, MD (@connor_chick) is a PGY-5 General Surgery resident at Brooke Army Medical Center
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-4 General Surgery resident at Brooke Army Medical Center
Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-3 General Surgery resident at Brooke Army Medical Center
Guest: Jean-Nicholas Vauthey, MD (@VautheyMD) is a Professor of Surgical Oncology, Chief of HPB, and Dallas/Fort Worth Living Legend Chair for Cancer Research at MD Anderson. He is the Principal Investigator of the study discussed in the episode in addition to numerous other articles describing the genomics of colorectal liver metastases.
Learning Objectives: In this episode, we review basic mutations found in metastatic colorectal cancer and broadly discuss these in a clinical context. We review a journal article from Kawaguchi et al. in which authors analyze prognostic relevance of signaling pathways in patients undergoing resection of CRLM, later validated in an external cohort of unresected patients. We conduct an interview with the senior author of the study regarding relevant methodologic details, next steps in his research, and how to apply this information now and in the future to the care of patients with CRLM.
Links to Papers Referenced in this Episode: Journal Article: Kawaguchi Y, Kopetz S, Kwong L, Xiao L, Morris JS, Tran Cao HS, Tzeng CD, Chun YS, Lee JE, Vauthey JN. Genomic Sequencing and Insight into Clinical Heterogeneity and Prognostic Pathway Genes in Patients with Metastatic Colorectal Cancer. J Am Coll Surg. 2021 Aug;233(2):272-284.e13. doi: 10.1016/j.jamcollsurg.2021.05.027. Epub 2021 Jun 7. PMID: 34111531; PMCID: PMC8666966.
Recommended Additional Podcasts on CRLM: The AHPBA Podcast: 1. Episode 1: Dr. Jean Nicolas Vauthey - Colorectal Liver Metastases (https://podcasts.apple.com/us/podcast/episode-1-dr-jean-nicolas-vauthey-colorectal-liver/id1501441845?i=1000467381474)
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Acute limb ischemia is simultaneous one of the most fun but frustrating diseases to treat in vascular surgery. In this episode of Behind the Knife, the vascular surgery team gives a concise overview of the diagnosis/workup and treatment of patients with acute limb ischemia and talks about some of the difficult decision making regarding treatment modality given all the exciting technology available today.
Dr. Nicholas Osborne is an Associate Professor of Vascular Surgery at the University of Michigan and the Chief of Vascular Surgery at the Ann Arbor Veteran’s Affairs Healthcare System.
Dr. Frank Davis is a Chief Resident in the Integrated Vascular Surgery program at the University of Michigan.
Dr. Craig Brown is a PGY-6 in the General Surgery program at the University of Michigan.
Papers discussed in this Episode: AHA/ACC/SVS, etc Guidelines on the Management of Patients with Lower Extremity Peripheral Artery Disease
https://pubmed.ncbi.nlm.nih.gov/27851992/
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It’s 1AM and the emergency department is calling about insert terrifying foregut problem you haven’t seen since you were an intern here and you wake up in a cold sweat to realize it was just a dream…this time. Tune in to this clinical challenge episode for some tips and tricks for managing foregut nightmares with Drs. Mike Weykamp, Nicole White, Andrew Wright, and Nick Cetrulo from the University of Washington’s Minimally Invasive Surgery team.
Referenced articles and videos:
- Rodriguez-Garcia HA, Wright AS, Yates RB. Managing obstructive gastric volvulus: challenges and solutions. Open Access Surgery. 2017 https://www.dovepress.com/getfile.php?fileID=35414
- Yates RB. Giant PEH: Management Principles for Unique Clinical Circumstances. 2017 SAGES Annual Meeting. Houston, TX. 2017 https://www.youtube.com/watch?v=vq6cZL2-pho
- Millet I, Orliac C, Alili C, Guillon F, Taourel P. Computed tomography findings of acute gastric volvulus. Eur Radiol. 2014. https://pubmed.ncbi.nlm.nih.gov/25278244/
- Mazaheri P, Ballard DH, Neal KA, Raptis DA, Shetty AS, Raptis CA, Mellnick VM. CT of Gastric Volvulus: Interobserver Reliability, Radiologists' Accuracy, and Imaging Findings. AJR Am J Roentgenol. 2019. https://pubmed.ncbi.nlm.nih.gov/30403524/
- Barmparas G, Alhaj Saleh A, Huang R, Eaton BC, Bruns BR, Raines A, Bryant C, Crane CE, Scherer EP, Schroeppel TJ, Moskowitz E, Regner JL, Frazee R, Campion EM, Bartley M, Mortus JR, Ward J, Margulies DR, Dissanaike S. Empiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulcer. Trauma Surg Acute Care Open. 2021. https://pubmed.ncbi.nlm.nih.gov/34079912/
- Horn CB, Coleoglou Centeno AA, Rasane RK, Aldana JA, Fiore NB, Zhang Q, Torres M, Mazuski JE, Ilahi ON, Punch LJ, Bochicchio GV. Pre-Operative Anti-Fungal Therapy Does Not Improve Outcomes in Perforated Peptic Ulcers. Surg Infect (Larchmt). 2018. https://pubmed.ncbi.nlm.nih.gov/30036134/
- Wee JO. Gastric Volvulus in Adults. In: UpToDate, Louie BE (Ed), UpToDate, Waltham, MA. (Accessed on May 15, 2022.)
https://www.uptodate.com/contents/gastric-volvulus-in-adults
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Determining when to order imaging for blunt cerebrovascular injury is a diagnostic quandary that has long engendered controversy. Today we discuss a paper that introduced universal CT angiogram of the neck to screen for BCVI in all blunt trauma patients and then compared the result to what would have happened if some of the current screening guidelines were utilized. Join us as we discuss their fascinating results and what it means for blunt trauma patients going forward.
Hosts: Elliott R. Haut, MD, Ph.D., a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST). Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Master's in Education in the Health Professions from Johns Hopkins. David Sigmon, MD, MMEd, a PGY-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.
LITERATURE 1. Black JA, Abraham PJ, Abraham MN, et al. Universal screening for blunt cerebrovascular injury. J Trauma Acute Care Surg. 2021;90(2):224-231.
https://pubmed.ncbi.nlm.nih.gov/33502144/ 2. Kim DY, Biffl W, Bokhari F, et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020;88(6):875-887. https://pubmed.ncbi.nlm.nih.gov/32176167/ 3. Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Elliott JP, Burch JM. Optimizing screening for blunt cerebrovascular injuries. (1999) American journal of surgery. 178 (6): 517-22.
https://pubmed.ncbi.nlm.nih.gov/10670864/ 4. Geddes AE, Burlew CC, Wagenaar AE, Biffl WL, Johnson JL, Pieracci FM, Campion EM, Moore EE. Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated. (2016) American journal of surgery. 212 (6): 1167-1174. https://pubmed.ncbi.nlm.nih.gov/27751528/ 5. Ciapetti M, Circelli A, Zagli G et-al. Diagnosis of carotid arterial injury in major trauma using a modification of Memphis criteria. Scand J Trauma Resusc Emerg Med. 2010;18 (1): 61.
https://pubmed.ncbi.nlm.nih.gov/21092211/
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Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss TEF management and the use of a post-operative transanastomotic feeding tubes in pediatric surgery.
Journal Article links: Wang, C., Feng, L., Li, Y., & Ji, Y. (2018). What is the impact of the use of transanastomotic feeding tube on patients with esophageal atresia: a systematic review and meta-analysis. BMC Pediatr, 18(1), 385. doi:10.1186/s12887-018-1359-5
https://pubmed.ncbi.nlm.nih.gov/30541487/
Bence, C. M., Rymeski, B., Gadepalli, S., Sato, T. T., Minneci, P. C., Downard, C., . . . Midwest Pediatric Surgery, C. (2021). Clinical outcomes following implementation of a management bundle for esophageal atresia with distal tracheoesophageal fistula. J Pediatr Surg, 56(1), 47-54. doi:10.1016/j.jpedsurg.2020.09.049 https://pubmed.ncbi.nlm.nih.gov/33131776/
LaRusso, K., Joharifard, S., Lakabi, R., Nimer, N., Shahi, A., Kasasni, S. M., . . . Emil, S. (2022). Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula: The Quebec experience. J Pediatr Surg, 57(1), 41-44. doi:10.1016/j.jpedsurg.2021.09.014
https://pubmed.ncbi.nlm.nih.gov/34666898/
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Join Shreya Gupta, MD and Jonathan Abelson, MD as they discuss highlights from the American Society of Colon and Rectal Surgeons. Dr. Sharon Stein and Dr. Erin King-Mullins are the guest speakers. They are discussing female leadership, diversity and inclusion topics, and much more! This is episode 2 of 2.
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FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform
Join Shreya Gupta, MD and Jonathan Abelson, MD as they discuss highlights from the American Society of Colon and Rectal Surgeons. This is episode 1 of 2.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform
Subjective and objective GERD are common amongst bariatric surgery patients. Is weight loss alone enough to improve GERD symptoms? Is the vertical sleeve gastrectomy really associated with worsening GERD? What technical factors of the vertical sleeve gastrectomy lead to improved or worsening GERD? Listen to find out!
Journal articles:
The Impact of Sleeve Gastrectomy on Gastroesophageal Reflux Disease in Patients with Morbid Obesity https://pubmed.ncbi.nlm.nih.gov/35048247/
Effect of Concomitant Laparoscopic Sleeve Gastrectomy and Hiatal Hernia Repair on Gastroesophageal Reflux in Patients with Obesity: A Systematic Review and Meta-Analysis https://pubmed.ncbi.nlm.nih.gov/34254259/
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FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform
How do you decide if a pancreatic head mass is resectable? Does vascular involvement matter? What impacts survival? Join the Surgical Oncology team as they dive into operative considerations when operating on borderline resectable and locally advanced pancreatic cancer. Break the nihilism and find out about the options available for patients with this dreaded malignancy.
Learning Objectives: In this episode, we review the various definitions for resectability in pancreatic cancer, as well as the various prognostic markers and decision points to consider when deciding which patients may benefit from an operation.
Hosts: Adam Yopp, MD, FACS (@AdamYopp) is an Assistant Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program.
Caitlin Hester, MD (@CaitlinAHester) is a 2nd Year Complex General Surgical Oncology Fellow at the MD Anderson Cancer Center.
Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-3 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform
In January 2022, the University of Maryland Medical Center performed the world’s first transplant involving a genetically modified animal heart. Join Behind the Knife as we discuss this significant transplant milestone with the 2 surgeons who led this historic case - Dr. Bartley Griffith and Dr. Muhammad M. Mohiuddin! Dr. Bartley Griffith is the Thomas E. and Alice Marie Hales Distinguished Professor in Transplant Surgery at UMSOM. Dr. Muhammad Mohiuddin is a Professor of Surgery at UMSOM and established the Cardiac Xenotransplantation Program with Dr. Griffith, the first in the United States. Tune in to learn about the history of xenotransplantation and the barriers that have been overcome to make xenotransplantation a reality.
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FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform
Inspired by recent transplant surgery headlines, in this episode we briefly review the history and challenges of xenotransplantation. We discuss an article recently published in the American Journal of Transplantation describing the transplant of a porcine kidney into a human decedent model.
Learning Objectives · Understand the timeline of xenotransplantation and its historical challenges · Review a recent article that describes the transplantation of a genetically-modified porcine kidney into a brain-dead human model · Discuss ongoing obstacles to successful xenotransplantation and next steps
References Porrett, P. M., Orandi, B. J., Kumar, V., Houp, J., Anderson, D., Cozette Killian, A., Hauptfeld-Dolejsek, V., Martin, D. E., Macedon, S., Budd, N., Stegner, K. L., Dandro, A., Kokkinaki, M., Kuravi, K. v., Reed, R. D., Fatima, H., Killian, J. T., Baker, G., Perry, J., … Locke, J. E. (2022). First clinical-grade porcine kidney xenotransplant using a human decedent model. American Journal of Transplantation, 22(4). https://doi.org/10.1111/ajt.16930
Schlich, T., & Lutters, B. (2022). Historical perspectives on xenotransplantation. The Lancet, 399(10331). https://doi.org/10.1016/s0140-6736(22)00529-3
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FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform
You are faced with a young patient with an advanced colon cancer. You suspect Lynch syndrome. He asks if he should undergo total colectomy as opposed to segmental colectomy. How do you approach such a patient?
Join Dr. Carole Richard, Dr. François Dagbert and Dr. Maher Al Khaldi in their conversation about Lynch syndrome, also known as Hereditary Non-polyposis Colorectal Cancer (HNPCC).
Learning objectives - To understand the rationale for universal testing for MMR deficiency of newly diagnosed colorectal cancers. - To know when to recommend screening for CRC for patients with LS and to those who have undergone resection - To understand the prevalence of cancers other than CRCs associated with Lynch syndrome, especially endometrial cancer.
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The landscape of surgery is shifting, reflecting the diverse composition of graduating medical students and the efforts to recruit the most talented people into the field. It is one thing to have a diverse group of people within surgery, but it is an entirely different thing to ensure a welcoming, supportive environment for them. In this Journal Club episode, we review these topics from the perspective of eminent surgeons Drs. Caprice and Jake Greenberg, who share with us their insights on recent articles examining the experience of women surgeons and trainees. We’re joined by Dr. Cary Schlick, who authored one of these articles, to shed light on a key issue for the field.
Learning Objectives: · Identify some of the challenges for women in surgical training programs · Discuss how stereotype threat can impact performance · Suggest ways to advocate for equity in surgery
References: Experiences of Gender Discrimination and Sexual Harassment Among Residents in General Surgery Programs Across the US - https://doi.org/10.1001/jamasurg.2021.3195
Effects of Gender Bias and Stereotypes in Surgical Training: A Randomized Clinical Trial - https://doi.org/10.1001/jamasurg.2020.1127
Gender Bias and Stereotypes in Surgical Training: Is It Really Women Residents We Need to Worry About? - https://doi.org/10.1001/jamasurg.2020.1561
The effect of gender on operative autonomy in general surgery residents - https://doi.org/10.1016/j.surg.2019.06.006
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Mattox Vegas TCCACS 2022: Ep. 2
The Trauma, Critical Care, and Acute Care Surgery conference (aka the MATTOX conference, named after trauma surgery legend Kenneth L Mattox) is the longest running show in Las Vegas at 55 consecutive years. The MATTOX conference is unique in its focus on clinical topics. Every talk, every panel, and every case discussion is relevant and practical. Join Behind the Knife as we use case-based discussions to hammer home key points from lectures given by some of the biggest names in trauma, critical care, and acute care surgery. This is episode 2 of 2.
The lineup: 1. Hasan Alam, MD (@DrHasanAlam) 2. Scott Steele, MD (@ScottRSteeleMD) 3. Joseph Dubose, MD (check out his exceptional podcast here: https://www.tiger-country.org/) 4. Mathew Martin, MD (@docmartin22) 5. Red Hoffman, MD (@redMDND, check out her amazing podcast here: https://thesurgicalpalliativecarepodcast.buzzsprout.com/) 6. Bellal Joseph, MD (@TopKnife_B)
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
The Trauma, Critical Care, and Acute Care Surgery conference (aka the MATTOX conference, named after trauma surgery legend Kenneth L Mattox) is the longest running show in Las Vegas at 55 consecutive years. The MATTOX conference is unique in its focus on clinical topics. Every talk, every panel, and every case discussion is relevant and practical. Join Behind the Knife as we use case-based discussions to hammer home key points from lectures given by some of the biggest names in trauma, critical care, and acute care surgery. This is episode 1 of 2.
The lineup: 1. Dennis Kim, MD (@traumaicurounds, check out his amazing podcast here: https://www.traumaicurounds.ca/) 2. Ali Salim, MD (@alisalimMD) 3. Jason Smith, MD (@DrJTrauma) 4. Meghan Lewis, MD 5. Demetrios Demetriades, MD 6. Alexander Eastman, MD (@PMHTrauma_ALE)
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The mortality rate for unstable pelvic hemorrhage due to blunt trauma remains around 30 percent. However, technological advances promise to finally make a dent. But on the cutting edge, it’s not clear which treatments should be used when to maximize lives saved. With life-threatening pelvic exsanguination, time is critical. Do you know when to rush to pack the pelvis? Do you know when to deploy a REBOA instead? Are there scenarios where you should do both? Join Drs. Urréchaga, Neeman, and Rattan from Ryder Trauma Center in Miami as they try to tease out answers using two studies hot off the presses with seemingly contradictory results.
Learning Objectives: Blunt Pelvic Hemorrhage
· Expanding knowledge of management strategies for blunt pelvic hemorrhage · Describe propensity score matching and its use in non-randomized studies · Compare outcomes of REBOA and preperitoneal pelvic packing (PPP) · Critically appraise study design and methods of studies
References 1. S. Mikdad, I.A.M. van Erp, M.E. Moheb, et al. Pre-peritoneal pelvic packing for early hemorrhage control reduces mortality compared to resuscitative endovascular balloon occlusion of the aorta in severe blunt pelvic trauma patients: A nationwide analysis. Injury. 2020; 51:1834–1839. doi.org/10.1016/j.injury.2020.06.003
2. S. Asmar, L. Bible, M. Chehab, et al. Resuscitative Endovascular Balloon Occlusion of the Aorta vs Pre-Peritoneal Packing in Patients with Pelvic Fracture. Journal of the American College of Surgeons. 2021; 232(1):17-26. doi.org/10.1016/j.jamcollsurg.2020.08.763
3. B. Joseph, M. Zeeshan, J.V. Sakran, et al. Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. JAMA Surg. 2019;154(6):500-508. doi:10.1001/jamasurg.2019.0096
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EPAs are coming in 2023. This isn’t about your carbon emissions, but it will dramatically impact surgery training programs. Join Drs. Karen Brasel, Jeremy Lipman, Judith French, and Amy Han as they discuss Entrustable Professional Activities (EPAs) and how they will change the way we assess trainees.
Learning Objectives 1. Listeners will be able to define entrustable professional activities (EPAs) within the context of competency-based education during General Surgery residency training 2. Listeners will be able to understand the impetus behind adopting EPA assessments for surgical trainees. 3. Listeners will be able to interpret and apply EPA assessment data based on the discussion of the example scenarios.
References: Brasel KJ, Klingensmith ME, Englander R, Grambau M, Buyske J, Sarosi G, Minter R. Entrustable professional activities in general surgery: development and implementation. Journal of surgical education. 2019 Sep 1;76(5):1174-86.
Lindeman B, Brasel K, Minter RM, Buyske J, Grambau M, Sarosi G. A Phased Approach: The General Surgery Experience Adopting Entrustable Professional Activities in the United States. Acad Med. 2021;96(7S):S9-S13.
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Dr. Michael Rosen returns to Behind the Knife – this time to discuss his RCT investigating biologic vs. synthetic mesh for single-stage repair of contaminated ventral hernias. Read the full article here in JAMA Surgery: https://jamanetwork.com/journals/jamasurgery/article-abstract/2788222
Dr. Rosen is the director for the Center of Abdominal Core Health at the Cleveland Clinic and has written the “Atlas of Abdominal Wall Reconstruction”. Want to learn more about his work and the Hernia Quality Collaborative? Catch up on Dr. Rosen’s previous episode on Behind the Knife:
Episode #21 (August 15, 2015): Hernias, Abdominal Wall Reconstruction, and Quality Collaboratives
https://behindtheknife.org/podcast/21-hernias-abdominal-wall-recon-and-quality-collaboratives-dr-michael-rosen/
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Welcome to the third of a six-part series focused on the integration of palliative care into the practice of surgery. Malignant bowel obstructions occur in 5-43 percent of patients with a diagnosis of advanced primary or metastatic intra-abdominal malignancy and both acute care surgeons and surgical oncologists are called upon to manage this condition. Using the case of an elderly gentleman with gastric outlet obstruction secondary to gastric cancer, in this episode we discuss how to approach a patient with a malignant bowel obstruction, review the medical and surgical options for management, discuss the importance of primary palliative care, define palliative surgery and conclude with a short rant about the necessity of being cognizant of one’s feelings and of taking the time and creating the space to discuss them.
Fast Fact #45: Medical Management of Bowel Obstructions https://www.mypcnow.org/fast-fact/medical-management-of-bowel-obstructions/
Chapter 8, Malignant Bowel Obstruction in Surgical Palliative Care: A Resident’s Guide https://www.facs.org/~/media/files/education/palliativecare/surgicalpalliativecareresidents.ashx
Palliative surgery and the surgeon’s role in the palliative care team: a review. https://apm.amegroups.com/article/download/72758/pdf
Dr. Red Hoffman (@redmdnd) is an acute care surgeon and associate hospice medical director in Asheville, North Carolina, host of the Surgical Palliative Care Podcast (@surgpallcare) and co-founder of the recently launched Surgical Palliative Care Society (www.spcsociety.org).
Dr. Fabian Johnston (@fabianjohnston) is Associate Professor of Surgery and Oncology and Chief, Division of GI Surgical Oncology at Johns Hopkins University.
Dr. Amanda Stastny (@manda_plez) is a PGY-2 in the General Surgery program at Mountain Area Health Education Center (MAHEC) in Asheville, NC.
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Umbilical hernias a common diagnoses that general surgeons must manage. Though these hernias are considered relatively simple problems to resolve, certain populations of patients are prone to higher rates of complications. As abdominal wall surgery has advanced, so to have the options that exist in management of primary umbilical hernias. The session will review common clinical circumstances and high-risk patient presentations. We will generally review the approaches to repair and the thought processing and data driving decision making. · Dr. Vahagn Nikolian is an Assistant Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair. · Dr. Sean Orenstein is an Associate Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair. · Dr. Shahrose Rahman is a resident in General Surgery at Oregon Health & Science University.
Seminal Papers in Umbilical Hernia Management Guidelines for treatment of umbilical and epigastric hernias (Henriksen et al. Br J Surg. 2020.): https://pubmed.ncbi.nlm.nih.gov/31916607/
Hernia-Neck Ratio: Predicting Factors for Complications of Umbilical Hernias (Fueter et al. WJS. 2016.): https://pubmed.ncbi.nlm.nih.gov/27194561/
Safety and effectiveness of umbilical hernia repair in patients with cirrhosis (Hew et al. Hernia. 2018.):https://pubmed.ncbi.nlm.nih.gov/29589135/
Fix it while you can...Mortality after umbilical hernia repair in cirrhotic patients (Hill et al. Amer Journal of Surgery. 2020.): https://pubmed.ncbi.nlm.nih.gov/32988606/
Postoperative complications with retromuscular mesh placement in emergency incisional hernia repair (Juul et al. Scand J Surg. 2021.): https://pubmed.ncbi.nlm.nih.gov/33092472/
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Warning! There is magic contained in this podcast. Real magic. The kind of magic that allows you to understand how to manage the axilla in breast cancer patients.
The standard of care approach to management of the axilla in patients with breast cancer has evolved rapidly. While a complete axillary dissection was historically indicated following identification of any positive nodes, that is no longer the case; indeed, axillary dissections are now uncommonly performed. Join Drs. Michael Alvarado, Rita Mukhtar, and Alexa Glencer as they discuss the impact of the ACOSOG Z0011, AMAROS, and ACOSOG Z1071 trials in defining the role of sentinel lymph node dissection and radiotherapy in patients with early-stage breast cancer with limited lymph node involvement as well as the approach when neoadjuvant chemotherapy has been received.
Learning Objectives: · Describe the study design and results of the ACOSOG Z0011 trial and its impact on the use of sentinel lymph node biopsy as an alternative to complete axillary lymph node dissection in clinically node-negative patients with T1 or T2 breast cancer · Describe the study design and results of the AMAROS trial and its implications for use of axillary radiation as an alternative to axillary lymph node dissection for patients with clinically node-negative T1 or T2 breast cancer · Understand the risk of lymphedema related to complete axillary lymph node dissection, as demonstrated by the AMAROS trial · Describe the study design and results of the ACOSOG Z1071 trial and how interpretation of its subgroup analysis has been applied to our approach of offering sentinel lymph node biopsy as a means of staging the axilla following neoadjuvant chemotherapy in patients with clinical node-positive disease at the time of diagnosis
Journal Article Links: ACOSOG Z0011: https://jamanetwork.com/journals/jama/article-abstract/2653737
AMAROS: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70460-7/fulltext
ACOSOG Z1071: https://jamanetwork.com/journals/jama/fullarticle/1748149%20
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Join our Emergency General Surgery Team as they discuss EGS in patients > 65.
Introduction
-
65 = 40% of EGS admissions
- In-hospital mortality for EGS in older adults is approximately 7-12% and the one-year mortality is around 30-38%.
- High risk due to decreased reserve, poor nutritional status, and chronic medical conditions
- Frailty correlates with poor post-operative outcomes
Paper #1: Mehta A, Dultz LA, Joseph B, Canner JK, Stevens K, Jones C, Haut ER, Efron DT, Sakran JV. Emergency general surgery in geriatric patients: A statewide analysis of surgeon and hospital volume with outcomes. J Trauma Acute Care Surg. 2018 Jun;84(6):864-875.
- retrospective population-based cross-sectional study using administrative data.
- looks at the association between surgeon and hospital annual experience with outcomes in geriatric patients with EGS conditions.
- Note Table 2 provides outcomes broken down by type of surgery
- Key finding: patients operated on by a low-volume surgeon had about twice the odds of mortality, and 1.7X the odds of failure to rescue
Paper #2: Guttman MP, Tillmann BW, Nathens AB, Saskin R, Bronskill SE, Huang A, Haas B. Alive and at home: Five-year outcomes in older adults following emergency general surgery. J Trauma Acute Care Surg. 2021 Feb 1;90(2):287-295.
- large-scale population-based retrospective cohort study looking at long-term outcomes of older adults with admissions for emergency general surgery diagnoses
- primary outcome of interest is “aging in place” or being able to reside in one’s home for as long as possible.
- Key finding: being admitted for an EGS diagnosis reduces your survival and time in your home by about 7 months.
- Very little reduction in low-risk diagnoses (acute appendicitis/cholecystitis)
- 57% of patients were alive and in their home 5 years later
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Thoughts of esophageal perforations keeping you up at night? Actual esophageal perforations keeping you up at night? Drs. Brian Louie, Peter White, and Megan Lenihan discuss both the tried-and-true and the cutting-edge management of this challenging problem.
Learning Objectives
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Understand basic principles of management
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Review differences in management based on different underlying pathology and location
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Learn indications and techniques for advanced endoscopic interventions for perforations
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Discuss nutrition planning
Referenced Material
- Thornblade LW, Cheng AM, Wood DE et al. A Nationwide Rise in the Use of Stents for Benign Esophageal Perforation. Ann Thorac Surg 2017; 104(1):227-233. DOI: 10.1016/j.athoracsur.2017.03.069
http://dx.doi.org/10.1016/j.athoracsur.2017.03.069
- Watkins JR and Farivar AS. Endoluminal Therapies for Esophageal Perforations and Leaks. Thorac Surg Clin 2018; 28(4):541-554. DOI: 10.1016/j.thorsurg.2018.07.002
https://doi.org/10.1016/j.thorsurg.2018.07.002
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A trauma patient rolls into the bay. CPR started 10 minutes ago. They are pulseless, the entire trauma team is looking to you for leadership, and the thoracotomy tray is prepped and ready. Do you pick up the knife and cut?
Welcome back to the BIG T TRAUMA series. Join Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill for a high-level discussion on the one surgical procedure that trumps them all – the ED thoracotomy. This is episode 2 of 2. In episode 1 we discussed who should get an ED thoracotomy. Today, we cover how to do it.Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
A trauma patient rolls into the bay. CPR started 10 minutes ago. They are pulseless, the entire trauma team is looking to you for leadership, and the thoracotomy tray is prepped and ready. Do you pick up the knife and cut?
Welcome back to the BIG T TRAUMA series. Join Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill for a high-level discussion on the one surgical procedure that trumps them all – the ED thoracotomy. This is episode 1 of 2. In episode 1 we discuss who should get an ED thoracotomy and in episode 2 we cover how to do it.
Listen to learn about the guidelines, signs of life, ultrasound, survival, and when NOT to do an ED thoracotomy.
EAST: https://www.east.org/education-career-development/practice-management-guidelines/details/emergency-department-thoracotomy
WTA: https://www.westerntrauma.org/wp-content/uploads/2020/08/Resuscitative-Thoracotomy_FINAL.svg
WakeMed Blunt Pulseless Trauma Resuscitation Guideline: https://www.wakemed.org/assets/documents/general-surgery-guidelines/trauma-guidelines/blunt-pulseless-arrest.pdfPlease visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
In the episode we will cover the following learning objectives:
· Listeners should be able to describe the evolution and changes in definitions sepsis over the past three decades · Listeners should be familiar with the three randomized controlled trials that studies early-goal directed therapy · Listeners should be able to describe the major changes in the new 2021 SCCM Sepsis Guidelines · Listeners should be able to describe the fundamental principles of sepsis management in the ICU
References:
https://www.nejm.org/doi/full/10.1056/nejmoa1500896
https://www.nejm.org/doi/full/10.1056/nejmoa1404380
https://www.nejm.org/doi/full/10.1056/nejmoa1701380
https://www.nejm.org/doi/full/10.1056/nejmoa1401602
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You are seeing a young female patient in the clinic with rectal prolapse. When do you offer surgery? Does she get a perineal approach or a transabdominal approach? Open or minimally invasive? Mesh or no mesh? Sigmoid resection or no resection? Join Drs. Abelson, Marcello and Aulet as they take us through the wide world of rectal prolapse!
Learning Objectives: 1. Describe the difference between rectal prolapse and hemorrhoidal prolapse 2. List the different approaches to surgical management of rectal prolapse 3. Discuss the approach to recurrent rectal prolapse
Be sure to check out the associated video below.
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In this episode from the Endocrine Surgery team at BTK we go through three controversial topics in endocrine surgery and cite pertinent articles during a lively debate format. We debate the role of four-gland exploration versus focused exploration for parathyroid disease. Indications for parathyroidectomy are hotly contested. And finally, we discuss the role and relevance of using a nerve monitor. Tune in to see if Dr. Yeh and Dr. Wu remain collegiate after recording this episode… Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.
Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship
Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research
Dr. Max Schumm is a PGY-5 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon.
Important Papers
Norlén O, Wang KC, Tay YK, Johnson WR, Grodski S, Yeung M, Serpell J, Sidhu S, Sywak M, Delbridge L. No need to abandon focused parathyroidectomy: a multicenter study of long-term outcome after surgery for primary hyperparathyroidism. Ann Surg. 2015 May;261(5):991-6. doi: 10.1097/SLA.0000000000000715. PMID: 25565223.
Schneider DF, Mazeh H, Sippel RS, Chen H. Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1,000 cases. Surgery. 2012 Dec;152(6):1008-15. doi: 10.1016/j.surg.2012.08.022. Epub 2012 Oct 12. PMID: 23063313; PMCID: PMC3501613.
Jinih M, O'Connell E, O'Leary DP, Liew A, Redmond HP. Focused Versus Bilateral Parathyroid Exploration for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis. Ann Surg Oncol. 2017 Jul;24(7):1924-1934. doi: 10.1245/s10434-016-5694-1. Epub 2016 Nov 28. PMID: 27896505.
Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med. 1999 Oct 21;341(17):1249-55. doi: 10.1056/NEJM199910213411701. Erratum in: N Engl J Med 2000 Jan 13;342(2):144. PMID: 10528034.
Seib CD, Meng T, Suh I, Harris AHS, Covinsky KE, Shoback DM, Trickey AW, Kebebew E, Tamura MK. Risk of Fracture Among Older Adults With Primary Hyperparathyroidism Receiving Parathyroidectomy vs Nonoperative Management. JAMA Intern Med. 2022 Jan 1;182(1):10-18. doi: 10.1001/jamainternmed.2021.6437. PMID: 34842909; PMCID: PMC8630642.
Yeh MW, Zhou H, Adams AL, Ituarte PH, Li N, Liu IL, Haigh PI. The Relationship of Parathyroidectomy and Bisphosphonates With Fracture Risk in Primary Hyperparathyroidism: An Observational Study. Ann Intern Med. 2016 Jun 7;164(11):715-23. doi: 10.7326/M15-1232. Epub 2016 Apr 5. PMID: 27043778.
Zanocco K, Butt Z, Kaltman D, Elaraj D, Cella D, Holl JL, Sturgeon C. Improvement in patient-reported physical and mental health after parathyroidectomy for primary hyperparathyroidism. Surgery. 2015 Sep;158(3):837-45. doi: 10.1016/j.surg.2015.03.054. Epub 2015 May 29. PMID: 26032828.
Barczyński M, Konturek A, Cichoń S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg. 2009 Mar;96(3):240-6. doi: 10.1002/bjs.6417. PMID: 19177420.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Our oral board review course includes 92 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the Oral Board Review episodes at https://behindtheknife.org/premium/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
The Vascular Surgery Oral Board Review Book has 60 of the highest yield scenarios that cover the majority of the VSCORE topics in an easy-to-read question and answer format that highlights the most important clinical concepts, concise procedural descriptions, and common surgical complications that everyone should know about the field of Vascular Surgery. Whether you are looking to excel on the wards or crush the boards, this book was created to help you Dominate the Day.
https://behindtheknife.org/premium/
https://www.amazon.com/dp/0578382296?ref_=pe_3052080_397514860
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
With more and more EVAR comes more and more endoleaks. But when do they matter and what can/should we do about them? In this episode, we present a case of a stubborn endoleak and use the course to illustrate a simple path towards the management of endoleaks following endovascular aneurysm repair.
Dr. Nicholas Osborne is an Associate Professor of Vascular Surgery at the University of Michigan and the Chief of Vascular Surgery at the Ann Arbor Veteran’s Affairs Healthcare System.
Dr. Frank Davis is a Chief Resident in the Integrated Vascular Surgery program at the University of Michigan.
Dr. Craig Brown is a PGY-6 in the General Surgery program at the University of Michigan.
Guidelines around Endoleak Management
Society for Vascular Surgery Practice Guidelines on the Care of Patients with an Abdominal Aortic Aneurysm:
https://pubmed.ncbi.nlm.nih.gov/29268916/
Conservative Management of Type II Endoleaks:
https://pubmed.ncbi.nlm.nih.gov/25042332/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Our oral board review course includes 92 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the Oral Board Review episodes at https://behindtheknife.org/premium/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Our oral board review course includes 92 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the Oral Board Review episodes at https://behindtheknife.org/premium/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Our oral board review course includes 92 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the Oral Board Review episodes at https://behindtheknife.org/premium/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Description: Metachronous colorectal liver metastasis (CRLM) is a complex clinical situation requiring multidisciplinary management. In this episode from the Hepato-Pancreato-Biliary team at Behind the Knife, we discuss a patient presenting with metachronous CRLM and how management may change with varying clinical scenarios.
Learning Objectives: In this episode, we review the initial workup and pre-operative considerations in a patient presenting with metachronous CRLM. We discuss key aspects of resectability of CRLM, including physiologic and hepatic fitness, biology of the disease, and technical considerations. We review the timing and common regimens of systemic treatment for differing clinical scenarios, as well as when adjuncts to treatment may be useful (e.g., portal venous embolization). Finally, we highlight important aspects of intraoperative and postoperative management.
Hosts: Timothy Vreeland, MD, FACS (@vreelant) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center
Daniel Nelson, DO, FACS (@usarmydoc24) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center
Connor Chick, MD (@connor_chick) is a PGY-5 General Surgery resident at Brooke Army Medical Center
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-4 General Surgery resident at Brooke Army Medical Center
Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-3 General Surgery resident at Brooke Army Medical Center
Links to Papers Referenced in this Episode:
NCCN Guidelines for Colon Cancer https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf
Mutation Status of RAS, TP53, and SMAD4 is Superior to Mutation Status of RAS Alone for Predicting Prognosis after Resection of Colorectal Liver Metastases. Clin Cancer Res. 2019 Oct 1;25(19):5843-5851. doi: 10.1158/1078-0432.CCR-19-0863. Epub 2019 Jun 20. PMID: 31221662; PMCID: PMC6774854. https://pubmed.ncbi.nlm.nih.gov/31221662/
Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2013 Nov;14(12):1208-15. doi: 10.1016/S1470-2045(13)70447-9. Epub 2013 Oct 11. PMID: 24120480. https://pubmed.ncbi.nlm.nih.gov/24120480/
FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as first-line treatment of patients with metastatic colorectal cancer: updated overall survival and molecular subgroup analyses of the open-label, phase 3 TRIBE study. Lancet Oncol. 2015 Oct;16(13):1306-15. doi: 10.1016/S1470-2045(15)00122-9. Epub 2015 Aug 31. PMID: 26338525. https://pubmed.ncbi.nlm.nih.gov/26338525/
Phase II Randomized Trial of Sequential or Concurrent FOLFOXIRI-Bevacizumab Versus FOLFOX-Bevacizumab for Metastatic Colorectal Cancer (STEAM). Oncologist. 2019 Jul;24(7):921-932. doi: 10.1634/theoncologist.2018-0344. Epub 2018 Dec 14. PMID: 30552157; PMCID: PMC6656450. https://pubmed.ncbi.nlm.nih.gov/30552157/
Bevacizumab plus mFOLFOX-6 or FOLFOXIRI in patients with initially unresectable liver metastases from colorectal cancer: the OLIVIA multinational randomised phase II trial. Ann Oncol. 2015 Apr;26(4):702-708. doi: 10.1093/annonc/mdu580. Epub 2014 Dec 23. PMID: 25538173. https://pubmed.ncbi.nlm.nih.gov/25538173/
Recommended Additional Podcasts on CRLM:
The AHPBA Podcast: 1. Episode 1: Dr. Jean Nicolas Vauthey - Colorectal Liver Metastases (https://podcasts.apple.com/us/podcast/episode-1-dr-jean-nicolas-vauthey-colorectal-liver/id1501441845?i=1000467381474) 2. Episode 12:Dr D'Angelica - Colorectal Liver Metastases and Hepatic Artery Infusion Pumps (https://podcasts.apple.com/us/podcast/episode-12-dr-dangelica-colorectal-liver-metastases/id1501441845?i=1000521718184) Behind the Knife: 1. Surgical Oncology-Hepatic Artery Infusion Pump (https://podcasts.apple.com/ye/podcast/surgical-oncology-hepatic-artery-infusion-pump/id980990143?i=1000525833877)
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Few audiences appreciate the importance of a properly functioning sphincter like surgeons. Magnetic sphincter augmentation using the LINX device, however, is one area that is beyond the sphincter-related expertise of most surgeons and surgical trainees. Drs. Mike Weykamp, Nicole White, Andrew Wright, and Nick Cetrulo review the literature surrounding the use of the LINX device for gastroesophageal reflux disease and how the device stacks up against the current gold standard in anti-reflux surgery, laparoscopic fundoplication, on this journal review episode of Behind the Knife.
References: 1. Skubleny D, Switzer NJ, Dang J, et al. LINX(®) magnetic esophageal sphincter augmentation versus Nissen fundoplication for gastroesophageal reflux disease: a systematic review and meta-analysis. Surg Endosc. Aug 2017;31(8):3078-3084. doi:10.1007/s00464-016-5370-3 2. Bonavina L, Horbach T, Schoppmann SF, DeMarchi J. Three-year clinical experience with magnetic sphincter augmentation and laparoscopic fundoplication. Surg Endosc. Jul 2021;35(7):3449-3458. doi:10.1007/s00464-020-07792-1 3. Ferrari D, Asti E, Lazzari V, Siboni S, Bernardi D, Bonavina L. Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease. Sci Rep. Aug 13 2020;10(1):13753. doi:10.1038/s41598-020-70742-3 4. Alicuben ET, Bell RCW, Jobe BA, et al. Worldwide Experience with Erosion of the Magnetic Sphincter Augmentation Device. J Gastrointest Surg. Aug 2018;22(8):1442-1447. doi:10.1007/s11605-018-3775-0 5. Perry KA. Alternatives to Fundoplication. Presented at SAGES Meeting 2018/16th World Congress of Endoscopic Surgery. April 2018. Hyperlink: https://www.youtube.com/watch?v=GXczKZxOg9Y
- Dominguez RV. LINX in GERD. The evolution of the technique. From none to full dissection of the crura. Presented at SAGES Meeting April 2019. Hyperlink: https://www.youtube.com/watch?v=uhhXZmsBd5c
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
In this episode, our team discusses the management of penetrating liver trauma both before, during, and after surgery. Listen in for helpful tips such as how to perform an intraoperative air cholangiogram, creating an occlusion catheter from a red rubber and a Penrose, and much more!
Hosts: Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST).
Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.
David Sigmon, MD, MMEd, a PGY-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.
LITERATURE 1. Murphy PB, de Moya M, Karam B, et al. Optimal timing of venous thromboembolic chemoprophylaxis initiation following blunt solid organ injury: meta-analysis and systematic review. Eur J Trauma Emerg Surg. Published online September 18, 2021. https://pubmed.ncbi.nlm.nih.gov/34537859/
- Kozar RA, Crandall M, Shanmuganathan K, et al. Organ injury scaling 2018 update: Spleen, liver, and kidney. J Trauma Acute Care Surg. 2018;85(6):1119-1122.
https://pubmed.ncbi.nlm.nih.gov/30462622/
- Kodadek LM, Efron DT, Haut ER. Intrahepatic balloon tamponade for penetrating liver injury: rarely needed but highly effective. World J Surg. 2019;43(2):486-489.
https://pubmed.ncbi.nlm.nih.gov/30280221/
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EAST Practice Management Guidelines: Selective Nonoperative Management of Hepatic Injury, Blunt https://www.east.org/education-career-development/practice-management-guidelines/details/hepatic-injury-blunt-selective-nonoperative-management-of
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WEST Nonoperative Management of Adult Blunt Hepatic Trauma Algorithm
https://www.westerntrauma.org/wp-content/uploads/2020/08/Non-Operative-Management-of-Adult-Blunt-Hepatic-Trauma-Algorithm_FINAL.svg
- THE JOURNAL OF TRAUMA AND ACUTE CARE SURGERY 3-MINUTE EXPERT CONSULT VIDEO: “BALLOON TAMPONADE FOR PENETRATING LIVER TRAUMA.
https://journals.lww.com/jtrauma/Pages/videogallery.aspx?videoId=13
- Coccolini F, Coimbra R, Ordonez C, et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020;15:24.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106618/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
What is one of the most energy-intensive and waste-generating areas of the hospital? The operating room! In the new BTK/Annals of Surgery Journal Club, we talk to Dr. Elizabeth Yates and Dr. Louis Nguyen about their new article – “Empowering Surgeons, Anesthesiologists, and Obstetricians to Incorporate Environmental Sustainability in the Operating Room.” They review the impact ORs have on the environment, the consequences this has for patients, and ways surgeons lead efforts to “green” the operating room. As the topic of environmental sustainability becomes a growing concern with each passing year, the surgical workplace is going to play a big role in moving in the right direction. Join us for a great discussion!
Dr. Yates earned her medical degree from the University of Michigan Medical School. She is currently a General Surgery resident at Brigham and Women’s Hospital where she is now completing two years of protected research time at the Center for Surgery and Public Health while also pursuing a Masters in Public Health focused on Occupational and Environmental Health. She conducts interdisciplinary research examining the interface between surgery, sustainability, and climate change.
Dr. Nguyen is a vascular surgeon at Brigham and Women’s Hospital and associate professor of surgery at Harvard Medical School. He earned his medical and business degrees from the University of Chicago Pritzker School of Medicine, completed his General Surgery residency at Barnes-Jewish Hospital in St. Louis, and completed a vascular surgery fellowship at the Brigham as well. He also currently serves as Vice Chair of Digital Health Systems in the Department of surgery. He is a recognized leader in health services research and outcomes implementation, where he utilizes econometric analyses to better understand clinical outcomes.
Link to article: https://journals.lww.com/annalsofsurgery/Abstract/2021/06000/Empowering_Surgeons,_Anesthesiologists,_and.15.aspx
Climate change and equity issues permeate all aspects of our life and work. If you are (or know) a current general surgery resident, help us understand the equity and environmental impacts of residency interviews! https://redcap.link/gensurginterview
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In this episode we will explore two challenging transplant surgery cases. In the first, we discuss Nutcracker syndrome and the unique ethical questions that accompanied a living donor case. In the second, we examine a perplexing post-operative development in a complicated liver transplant patient.
Learning Objectives · Understand the presentation and general treatment strategies for renal nutcracker syndrome · Discuss protocol and ethical considerations for living donor renal transplants · Review portal hypertension physiology, clinical manifestations, and options for treatment
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Chemotherapy or surgery first? What is the contemporary management for patients with locally advanced, resectable gastric cancer, and what does the data show? In this episode from the Surgical Oncology team at Behind the Knife, join the discussion on perioperative treatment of locally advanced gastric cancer and future advances that will benefit surgical patients.
Learning Objectives: In this episode, we review perioperative chemotherapy regimens for locally advanced, resectable Gastric cancer, standard of care, and the future role for immunotherapy.
Hosts: Adam Yopp, MD, FACS (@AdamYopp) is an Assistant Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program.
Caitlin Hester, MD (@CaitlinAHester) is a 2nd Year Complex General Surgical Oncology Fellow at the MD Anderson Cancer Center.
Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-3 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research.
Papers Referenced in this Episode: Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial Al Batran et al https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32557-1/fulltext
Efficacy and Safety of Pembrolizumab or Pembrolizumab Plus Chemotherapy vs Chemotherapy Alone for Patients With First-line, Advanced Gastric Cancer. The KEYNOTE-062 Phase 3 Randomized Clinical Trial Shitara et al https://jamanetwork.com/journals/jamaoncology/fullarticle/2769922
First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial Janjigian et al https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00797-2/fulltext
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss neuroblastoma management in pediatric surgery.
Journal Article links: Croteau N, Nuchtern J, LaQuaglia MP. Management of Neuroblastoma in Pediatric Patients. Surg Oncol Clin N Am 2021;30(2):291-304.
https://pubmed.ncbi.nlm.nih.gov/33706901/
Madonna MB, Newman E. Handbook for Children with Neuroblastoma. Updated Spring 2018. Cancer Committee American Pediatric Surgical Association. 2018. https://www.pedsurglibrary.com/apsa/ub?cmd=repview&type=682-76&name=4_1884004_PDF
https://www.pedsurglibrary.com/apsa/ub?cmd=repview&type=682-76&name=4_1884004_PDF
Newman EA, Abdessalam S, Aldrink JH, Austin M, Heaton TE, Bruny J, et al. Update on neuroblastoma. J Pediatr Surg 2019;54(3):383-9.
https://pubmed.ncbi.nlm.nih.gov/30305231/
Nuchtern JG, London WB, Barnewolt CE, Naranjo A, McGrady PW, Geiger JD, et al. A prospective study of expectant observation as primary therapy for neuroblastoma in young infants: a Children's Oncology Group study. Ann Surg 2012;256(4):573-80.
https://pubmed.ncbi.nlm.nih.gov/22964741/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
You are faced with a young patient with low rectal cancer who is a complete responder to neoadjuvant chemoradiotherapy. He asks if he should undergo surgical resection despite the absence of visible tumour. How do you approach such a question?
Join Dr. Carole Richard, Dr. François Dagbert and Dr. Maher Al Khaldi in their conversation about the Watch and Wait strategy for rectal cancer, also known as the Organ Preservation strategy.
Learning objectives
- To understand the rationale for Watch and Wait Strategy and the proportion of patients who become complete clinical responders.
- To explain how patients under the Watch and Wait Strategy protocol should be followed up and when to consider a patient a clinical nonresponder.
- To understand the inclusion criteria for patients in the Watch and Wait Strategy
References
In order throughout the episode [1–3]:
- Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U, Sousa AHS e, et al. Operative Versus Nonoperative Treatment for Stage 0 Distal Rectal Cancer Following Chemoradiation Therapy. Transactions Meet Am Surg Assoc. 2004;122(NA;):309–16.
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Valk MJM van der, Hilling DE, Bastiaannet E, Kranenbarg EM-K, Beets GL, Figueiredo NL, et al. Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study. Lancet. 2018;391(10139):2537–45.
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Fernandez LM, Julião GPS, Figueiredo NL, Beets GL, Valk MJM van der, Bahadoer RR, et al. Conditional recurrence-free survival of clinical complete responders managed by watch and wait after neoadjuvant chemoradiotherapy for rectal cancer in the International Watch & Wait Database: a retrospective, international, multicentre registry study. Lancet Oncol. 2021;22(1):43–50.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Marginal ulcers are a common cause of abdominal pain following Roux-en-Y gastric bypass. Ever wonder how bariatric surgeons triage abdominal pain in post-bariatric surgery patients? A simplified approach to the work-up of these patients as well as the long-term management of marginal ulcers is included in this episode from your bariatric surgery team at UNMC!
Journal Articles discussed: 1. Opened Proton Pump Inhibitor Capsules Reduce Time to Healing Compared with Intact Capsules for Marginal Ulceration following Roux-en-Y Gastric Bypass: https://pubmed.ncbi.nlm.nih.gov/27773764/
2. Thoracoscopic Truncal Vagotomy versus Surgical Revision of the Gastrojejunal Anastomosis for Recalcitrant Marginal Ulcers: https://pubmed.ncbi.nlm.nih.gov/30132208/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Visit behindtheknife.org to access podcasts, videos, CME, and more.
Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Visit behindtheknife.org to access podcasts, videos, CME, and more.
Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Visit behindtheknife.org to access podcasts, videos, CME, and more.
Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Visit behindtheknife.org to access podcasts, videos, CME, and more.
Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Visit behindtheknife.org to access podcasts, videos, CME, and more.
Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Visit behindtheknife.org to access podcasts, videos, CME, and more.
Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Visit behindtheknife.org to access podcasts, videos, CME, and more.
Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
Visit behindtheknife.org to access podcasts, videos, CME, and more.
Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
Please note that we apologize for the static in this episode
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam. Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts. Visit behindtheknife.org to access podcasts, videos, CME, and more.
Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2
If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
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Behind the Knife ABSITE 2022 - high yield learning to help you DOMINATE the exam.
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Preoperative Optimization
Recurrences and complications following abdominal wall reconstruction and hernia repair are common challenges for the general surgery. In this episode, the Hernia and Abdominal Wall Reconstruction team discusses evidence-based approaches to preoperative optimization and prehabilitation. We review patient modifiable risk factors and multi-disciplinary strategies for risk, complication, and recurrence reduction. · Dr. Vahagn Nikolian is an Assistant Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair. · Dr. Sean Orenstein is an Associate Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair. · Dr. Emaad Iqbal is a resident in General Surgery at Columbia University Medical Center. · Dr. Shahrose Rahman is a resident in General Surgery at Oregon Health & Science University.
Seminal Papers in Preoperative Optimization Preoperative Optimization by Orenstein and Martindale: https://pubmed.ncbi.nlm.nih.gov/30138281/
Impact of smoking cessation on wound healing: https://pubmed.ncbi.nlm.nih.gov/22508785/
Prehabilitation in abdominal wall reconstruction: https://pubmed.ncbi.nlm.nih.gov/30138261/
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Why should a surgeon care about breast cancer chemotherapy trials? Join Drs. Michael Alvarado, Rita Mukhtar, and Alexa Glencer as they discuss the benefits of neoadjuvant chemotherapy over upfront surgery and the role of adjuvant chemotherapy for select patients who harbor residual disease at the time of surgery.
Learning objectives: - Understand the benefits conferred by neoadjuvant chemotherapy compared to upfront surgery in certain patients with breast cancer - Learn about the study design and results of the CREATE-X phase 3 randomized controlled trial comparing adjuvant capecitabine to standard therapy in patients with HER2 negative invasive breast cancer with residual disease following cytotoxic neoadjuvant chemotherapy - Describe the specific benefit of adjuvant capecitabine for triple negative breast cancer patients and discuss its evolving role with recent FDA approval of neoadjuvant pembrolizumab in this group - Learn about the study design and results of the KATHERINE phase 3 randomized controlled trial comparing adjuvant T-DM1 to trastuzumab in patients with HER2+ invasive breast cancer with residual disease following cytotoxic and HER2-targeted neoadjuvant chemotherapy
Journal article links: CREATE-X: https://www.nejm.org/doi/full/10.1056/NEJMoa1612645
KATHERINE: https://www.nejm.org/doi/full/10.1056/NEJMoa1814017
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Has anyone else ever felt the anxiety of hearing the EMS radio call in a pregnant trauma patient, knowing you will soon be getting two patients in one? How do we prioritize our assessment, diagnostic work up, and treatment options for our patient when we have a second patient growing in her uterus? Join our Miami Trauma team including Drs. Urréchaga, Neeman, and Rattan as they discuss how to navigate the physiologic changes and management considerations for the pregnant trauma patient!
Learning Objectives: - Understand the physiology of the pregnant patient and how it changes how we clinically assess them in the trauma bay - Emphasize the basics of the primary and secondary assessment in the pregnant patient - Identify when radiology adjuncts are appropriate - Identify laboratory and diagnostic adjuncts that are unique to the pregnant patient’s work up - Discuss treatment options for mom and fetus depending on clinical status
Quick Hits: 1. Sick mom before sick baby - stick to basics and treat mom like any other trauma patient 2. Misuse of seatbelts are an important risk factor for morbidity and mortality in pregnant patients. The lap belt must lie below the uterus and shoulder strap should lie between the breasts. 3. Injured pregnant women should be screened for intimate partner violence. 4. Despite changes in pregnant patient physiology, they can still present with compensated shock. Always have a high index of suspicion when interpreting vital signs and remember to offload patient to the left in order to decompress the IVC. 5. For fetal viability: get FHT when mother’s condition allows. Remember- Fetal distress could be the first sign of maternal hypovolemia 6. NEVER withhold indicated imaging just to avoid radiation in a pregnant patient. Try shielding the uterus when possible, but always proceed with diagnostic imaging when necessary. 7. One more time- sick mom = sick baby!
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Welcome to the first Surgical Palliative Care Journal Club, the second of a six-part series focused on the integration of palliative care into the practice of surgery. Join us as we discuss the first study of how to best integrate palliative medicine principles into the care of trauma ICU patients. We then tackle the question: Why are surgeons often unwilling to discontinue life-sustaining treatments in the post-operative period? We discuss a 2013 study about “surgical buy-in” and review alternatives to making “informal contracts” with patients before surgery.
References: Mosenthal AC, Murphy PA, Barker LK, et al. Changing the culture around end-of-life care in the trauma intensive care unit. J Trauma. 2008;64(6):1587-1593. doi:10.1097/TA.0b013e318174f112.
Schwarze ML, Redmann AJ, Alexander GC, Brasel KJ. Surgeons expect patients to buy-in to post-operative life support preoperatively: results of a national survey. Crit Care Med. 2013;41(1):1-8. doi: 10.1097/CCM.0b013e31826a4650.
Dr. Red Hoffman (@redmdnd) is an acute care surgeon and associate hospice medical director in Asheville, North Carolina, host of the Surgical Palliative Care Podcast (@surgpallcare) and co-founder of the recently launched Surgical Palliative Care Society (www.spcsociety.org).
Dr. Zara Cooper (@zaracMD) is an acute care surgeon at Brigham and Women’s Hospital where she serves as Kessler Director for the Center of Surgery and Public Health (@csph_bwh). She is Associate Professor of Surgery at Harvard Medical School, associate faculty at Adriane Labs, and adjunct faculty at the Marcus Institute for Aging Research.
Dr. Amanda Stastny (@manda_plez) is a PGY-2 in the General Surgery program at Mountain Area Health Education Center (MAHEC) in Asheville, NC.
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5 years of General Surgery residency? Check. Case numbers? Check. Ready for independent practice? Hmmm.
Join Drs. John D. Mellinger, Jeremy Lipman, Judith French, and Amy Han as we discuss the past, present and future of operative assessment.
Learning objectives:
In this episode, we discuss the current practices of operative assessment in surgical training and the opportunities for improvement. We delve into evidence-based framework for operative performance assessment outlined in “A Proposed Blueprint for Operative Performance Training, Assessment, and Certification.” We explore the distinction between high versus low frequency operations, standards setting, training of assessors, and the role of technology in improving reliability, generalizability, and frequency of operative assessments.
References:
Bansal N, Simmons KD, Epstein AJ, Morris JB, Kelz RR. Using Patient Outcomes to Evaluate General Surgery Residency Program Performance. JAMA Surg. 2016;151(2):111–119. doi:10.1001/jamasurg.2015.3637
Bell RH Jr, Biester TW, Tabuenca A, et al. Operative experience of residents in US general surgery programs: a gap between expectation and experience. Ann Surg. 2009;249(5):719-724. doi:10.1097/SLA.0b013e3181a38e59
Williams RG, Sanfey H, Chen XP, Dunnington GL. A controlled study to determine measurement conditions necessary for a reliable and valid operative performance assessment: a controlled prospective observational study. Ann Surg. 2012;256(1):177-187. doi:10.1097/SLA.0b013e31825b6de4
Williams RG, George BC, Bohnen JD, et al. A Proposed Blueprint for Operative Performance Training, Assessment, and Certification. Ann Surg. 2021;273(4):701-708. doi:10.1097/SLA.0000000000004467
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Cardiac arrhythmias such as atrial fibrillation are common in any ICU. But, adequately addressing additional perioperative considerations is key in the surgical ICU. In this Critical Care episode of Behind the Knife, Drs. Bankhead, Dumas, & Park will address how to approach a critically ill patient who presents with an arrythmia. Hemodynamically stable vs. unstable patients are discussed, as well as the current ACLS guidelines for management of a patient in cardiac arrest.
Referenced Articles and Guidelines:
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Van Gelder I, Groenveld H, Crijns H, et al. Lenient versus Strict Rate Control in Patients with Atrial Fibrillation. NEJM 2010.
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Walkey A, Hogarth K, Lip G. Optimizing Atrial Fibrillation Management: From ICU and Beyond. CHEST 2015.
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AFFIRM Investigators. A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation. NEJM 2002.
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ACLS Training Center: Tachycardia with a Pulse Algorithm. https://www.acls.net/acls-tachycardia-algorithm
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ACLS Training Center: Cardiac Arrest Algorithm. https://www.acls.net/acls-secondary-survey
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ACLS Training Center: Acute Coronary Syndromes Algorithm. https://www.acls.net/acute-coronary-syndromes-algorithm
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November is Lung Cancer Awareness Month, and what better way is there to spend your time than getting to know the recent advances in adjuvant therapy for early-stage lung adenocarcinoma?
Learning Objectives
- Review work-up and treatment of lung adenocarcinoma
- Review evidence behind Osimertinib as an adjuvant therapy in EGFR mutation positive disease
- Review recent advances in gene expression profiles for targeted application of adjuvant chemotherapy
- Discuss future directions for research
- Discuss additional advancements in diagnosis, monitoring, and immunotherapy
Referenced Material
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Wu Y, Tsuboi M, He J, et al. Osimertinib in resected EGFR-mutated non-small-cell lung cancer. N Engl J Med 2020; 383:1711-1723. DOI: 10.1056/NEJMoa2027071 https://www.nejm.org/doi/full/10.1056/NEJMoa2027071
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Woodard GA, Wang SX, Kratz JR, et al. Adjuvant Chemotherapy Guided by Molecular Profiling and Improved Outcomes in Early Stage, Non-Small-Cell Lung Cancer. Clin Lung Cancer 2018;19(1):58-64. DOI: 10.1016/j.cllc.2017.05.015 https://www.clinical-lung-cancer.com/article/S1525-7304(17)30150-X/fulltext
- Woodard GA, Kratz JR, Haro G, et al. Molecular Risk Stratification is Independent of EGFR Mutation Status in Identifying Early-Stage Non-Squamous Non-Small Cell Lung Cancer Patients at Risk for Recurrence and Likely to Benefit From Adjuvant Chemotherapy. Clin Lung Cancer. 2021;20:S1525-7304(21)00212-6. DOI: 10.1016/j.cllc.2021.08.008
https://www.clinical-lung-cancer.com/article/S1525-7304(21)00212-6/fulltext
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Join Behind the Knife's very own Dr. Scott Steele, Chairman of the Department of Colorectal Surgery at Cleveland Clinic, for a high-level talk on the treatment of T2N0 rectal cancer.
There is an associated video that goes along with this episode. Check it out at behindtheknife.org or YouTube.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Join Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross as they tackle Cancer Emergencies.
Case 1 - Learning Points: 1. These are complex patients and multidisciplinary care should be provided with input from oncology. 2. A step-up approach should be used, starting with medical management prior to considering surgery in appropriate patients. 3. Highly selected patients may benefit from surgery, namely those with a high performance status, a prognosis of months if the bowel obstruction was resolved, minimal carcinomatosis, and a single transition point. Diversion, bypass, or resection are all options, but a patient’s capacity to heal related to recent systemic therapy needs to be taken into account. 4. Consent for surgery should focus on goals of care, quality of life, and achievable outcomes, and highlight the inherent risk in patients with advanced disease and a limited lifespan.
Case 2 - Learning Points: 1. Colorectal malignancy is an exceedingly common cause of general surgical emergency and requires a thoughtful, systematic approach 2. The role of stenting as a bridge to surgery in obstructing distal colon malignancy is somewhat controversial but can help to avoid permanent stomas; however there is some potential risk of perforation and possibly disease recurrence 3. Treatment decisions should take place in the context of an informed discussion with the patient and consideration of both quantity and quality of life whenever possible 4. Consistent involvement of a multidisciplinary team, including radiology, enterostomal therapy, and surgical oncology can be extremely useful in guiding complex decisions
References:
- Shariff F, Bogach J, Guidolin K, Nadler A. Malignant Bowel Obstruction Management Over Time: Are We Doing Anything New? A Current Narrative Review. Ann Surg Oncol. 2021 Oct 18. doi: 10.1245/s10434-021-10922-1. Epub ahead of print.
- Ripamonti C, Gerdes H and Easson A. Management of malignant bowel obstruction. Eur J Cancer 2008 May;44(8):1105-15
- Chen, T, Huang, Y. & Wang, G. Outcome of colon cancer initially presenting as colon perforation and obstruction. World J Surg Onc 15, 164 (2017).
- Olmsted C, Johnson A, Kaboli P, et al. Use of palliative care and hospice among surgical and medical specialties in the Veterans Health Administration. JAMA Surg. 2014;149(11):1169–75.
- Dunn GP, Martensen R, Weissman D. Surgical palliative care: a resident’s guide. Essex: American College of Surgeons; 2009.
- Biondo S, Martí-Ragué J, Kreisler E, et al. A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg. 2005;189:377–83.
- National Comprehensive Cancer Network. https://www.nccn.org/. Accessed October 15, 2021.
- Shariat-Madar B, Jayakrishnan TT, Gamblin TC, Turaga KK. Surgical management of bowel obstruction in patients with peritoneal carcinomatosis. J Surg Oncol. 2014 Nov;110(6):666-9. doi: 10.1002/jso.23707.
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In this episode from the Endocrine Surgery team at BTK we discuss the clinical applications of genetic testing for thyroid cancer. We walk through three cases of thyroid nodules and discuss why and how genetic testing can guide surgical and medical management. As usual we review key points such as imaging criteria for thyroid nodules, the Bethesda system for thyroid cytopathology, and MEN syndromes. We also go into a more nuanced discussion of how progress in genetic testing has led to more variability in management options. Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.
Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research
Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship
Important Papers
Catherine Y Zhu, Ines Donangelo, Deepashree Gupta, Dalena T Nguyen, Joana E Ochoa, Michael W Yeh, Masha J Livhits, Outcomes of Indeterminate Thyroid Nodules Managed Nonoperatively after Molecular Testing, The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 3, March 2021, Pages e1240–e1247, https://doi.org/10.1210/clinem/dgaa887
Xing, Mingzhao & Alzahrani, Ali & Carson, Kathryn & Viola, David & Elisei, Rossella & Bendlova, Bela & Yip, Linwah & Mian, Caterina & Vianello, Federica & Tuttle, R & Robenshtok, Eyal & Fagin, James & Puxeddu, Efisio & Fugazzola, Laura & Czarniecka, Agnieszka & Jarząb, Barbara & O'Neill, Christine & Sywak, Mark & Lam, Alfred & Sykorova, Vlasta. (2013). Association Between BRAF V600E Mutation and Mortality in Patients With Papillary Thyroid Cancer. JAMA : the journal of the American Medical Association. 309. 1493-501. 10.1001/jama.2013.3190.
Wells SA Jr, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015;25(6):567-610. doi:10.1089/thy.2014.0335
Wang JR, Zafereo ME, Dadu R, Ferrarotto R, Busaidy NL, Lu C, Ahmed S, Gule-Monroe MK, Williams MD, Sturgis EM, Goepfert RP, Gross ND, Lai SY, Gunn GB, Phan J, Rosenthal DI, Fuller CD, Morrison WH, Iyer P, Cabanillas ME. Complete Surgical Resection Following Neoadjuvant Dabrafenib Plus Trametinib in BRAFV600E-Mutated Anaplastic Thyroid Carcinoma. Thyroid. 2019 Aug;29(8):1036-1043. doi: 10.1089/thy.2019.0133. PMID: 31319771; PMCID: PMC6707029.
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Adjuvant? Neoadjuvant? Short course? Long course? The treatment of rectal cancer treatment has come a long way. Tune in to learn more about Total Neoadjuvant Therapy (TNT) and the mysterious HOLY PLANE.
Learning Objectives:
1. Describe the rationale for Total Neoadjuvant Therapy (TNT) for rectal cancer 2. Review the history of chemo and radiation therapy in treatment of rectal cancer 3. Describe total mesorectal excision
References
Bahadoer RR, Dijkstra EA, van Etten B et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021 Jan;22(1):29-42. doi: 10.1016/S1470-2045(20)30555-6. Epub 2020 Dec 7 https://doi.org/10.1016/S1470-2045(20)30555-6
Fokas E, Allgäuer M, Polat B et al. Randomized Phase II Trial of Chemoradiotherapy Plus Induction or Consolidation Chemotherapy as Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer: CAO/ARO/AIO-12. J Clin Oncol. 2019 Dec 1;37(34):3212-3222. doi: 10.1200/JCO.19.00308 https://ascopubs.org/doi/10.1200/JCO.19.00308
Colorectal Surgery 2021-2022 Virtual Education Series Follow us on Twitter @CRSVirtualEd Email us: colorectal.educational.series@gmail.com
www.crsvirtualed.org
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The American Board of Surgery has a new family leave policy for surgery trainees: https://www.absurgery.org/default.jsp?policygsleave. What's new? Is it enough? And what does competency-based training have to do with it? Join Drs. Patrick Georgoff and Shanaz Hossain as they discuss the details with ABS president Dr. Jo Buyske.
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Tick tock tick tock, 5 min is up! There is a plus sign on the testing stick. And you are…. Pregnant! Congratulations??? Join Drs. Erika Rangel, Eugene Kim, Yue-yung Hu, and Debbie Li as they discuss the challenges surgeons and trainees face as they navigate through pregnancy and parenthood.
Learning objectives: In this episode, we learn about the personal experiences including the good, the bad, and the ugly behind pregnancy and parenthood. We discuss about the stigma faced and experienced by many surgeons and trainees, and most importantly, ways we can support our current and future trainees to navigate this deeply personal and should be celebrated occasion in their life.
References Incidence of Infertility and Pregnancy Complications in US Female Surgeons https://doi.org/10.1001/jamasurg.2021.3301
Pregnancy and Motherhood During Surgical Training - https://doi.org/10.1001/jamasurg.2018.0153
Perspectives of US General Surgery Program Directors on Cultural and Fiscal Barriers to Maternity Leave and Postpartum Support During Surgical Training - https://doi.org/10.1001/jamasurg.2021.1807
Factors Associated With Residency and Career Dissatisfaction in Childbearing Surgical Residents - https://doi.org/10.1001/jamasurg.2018.2571
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Post-operative pain is a challenging topic most surgeons would prefer not to have to think about, and post-inguinal hernia repair pain can be a particular pain in the…groin. Drs. Mike Weykamp, Andrew Wright, and Nick Cetrulo from the University of Washington provide a framework for approaching these challenging patients to help clarify when and how to best evaluate post-inguinal hernia repair pain and identify the patients who might benefit from surgical intervention.
Referenced Articles and Videos: 1. D Chen. Mapping for inguinal chronic pain: An approach that all surgeons can do. Your Session: Abdominal Wall Hernia - Provocative Questions in the Practice of Hernia Repair held during the 2017 SAGES Annual Meeting in Houston, TX https://www.youtube.com/watch?v=Yx5zSS3CA-U
- J Lange, R Kaufmann, A Wijsmuller, J Pierie, R Ploeg, P Amid. An international consensus algorithm for management of chronic postoperative inguinal pain. Hernia 2015. https://pubmed.ncbi.nlm.nih.gov/25138620/
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P Amid. Radiologic Images of Meshoma A New Phenomenon Causing Chronic Pain After Prosthetic Repair of Abdominal Wall Hernias. JAMA Surgery 2004. https://jamanetwork.com/journals/jamasurgery/fullarticle/397607
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McCormack K, Scott NW, Go PM, Ross S, Grant AM; EU Hernia Trialists Collaboration. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. https://pubmed.ncbi.nlm.nih.gov/12535413/
- Campanelli G, Pascual MH, Hoeferlin A, Rosenberg J, Champault G, Kingsnorth A, Miserez M. Randomized, controlled, blinded trial of Tisseel/Tissucol for mesh fixation in patients undergoing Lichtenstein technique for primary inguinal hernia repair: results of the TIMELI trial. Ann Surg. 2012 https://pubmed.ncbi.nlm.nih.gov/22395092/
- Jeroukhimov I, Wiser I, Karasic E, Nesterenko V, Poluksht N, Lavy R, Halevy A. Reduced postoperative chronic pain after tension-free inguinal hernia repair using absorbable sutures: a single-blind randomized clinical trial. J Am Coll Surg. 2014. https://pubmed.ncbi.nlm.nih.gov/24210149/
- Novik B, Nordin P, Skullman S, Dalenbäck J, Enochsson L. More Recurrences After Hernia Mesh Fixation With Short-term Absorbable Sutures: A Registry Study of 82 015 Lichtenstein Repairs. Arch Surg. 2011. https://jamanetwork.com/journals/jamasurgery/fullarticle/406587
- Barazanchi AW, Fagan PV, Smith BB, Hill AG. Routine Neurectomy of Inguinal Nerves During Open Onlay Mesh Hernia Repair: A Meta-analysis of Randomized Trials. Ann Surg. 2016. https://pubmed.ncbi.nlm.nih.gov/26756767/
- Bakker WJ, Aufenacker TJ, Boschman JS, Burgmans JPJ. Lightweight mesh is recommended in open inguinal (Lichtenstein) hernia repair: A systematic review and meta-analysis. Surgery. 2020.
https://pubmed.ncbi.nlm.nih.gov/31672519/
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The CODA trial is back – this time to shed light on long-term outcomes for antibiotics versus surgery for appendicitis! Dr. David Flum, lead investigator of the CODA trial, and Dr. Lillian Kao join us today to discuss the results after at least 1 year of follow-up in their patients. Read the full update here in the New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMc2116018
Utilizing the CODA trial results, Dr. Flum has created an innovative online tool for physicians to use with patients when discussing treatment options for appendicitis. Check out this new resource and keep it in mind next time you wander down to the ED for another patient with appendicitis: www.appyornot.org
Listen to our previous episodes on the CODA Trial:
Episode #321 (October 5, 2020): CODA Trial Results – Antibiotics versus Surgery for Appendicitis https://behindtheknife.org/podcast/coda-trial-results-antibiotics-versus-surgery-for-appendicitis/ o Dr. Flum and his team discuss the 90-day outcomes for the CODA trial as antibiotic treatment gains favor in the setting of the COVID-19 pandemic.
Episode #109 (June 7, 2017): CODA Trial with Dr. David Flum https://behindtheknife.org/podcast/109-coda-trial-with-dr-david-flum/ o Dr. Flum introduces the CODA Trial and the basis of his “pragmatic trial”.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
It’s a brave new world people! There has been an extraordinary and historic change in the way society interacts with information. With the COVID pandemic raging misinformation and conspiracy theories have taken off like wildfire. But why? And what can we as providers do about it? Join Drs. Patrick Georgoff and Brian Southwell for this timely discussion.
Dr. Southwell is Senior Director of the Science in the Public Sphere Program at the RTI International’s Center for Communication Science. He is also Adjunct Professor at Duke University and Adjunct Associate Professor in Health Behavior at the University of North Carolina at Chapel Hill. Dr. Southwell has published widely on topics such as public understanding of science and emerging infectious diseases. He co-founded the Duke Program on Medical Misinformation, a clinician training initiative to improve patient-provider conversations about misinformation. He also has organized several summits on trust in science and medical misinformation, such as the Misinformation Solutions Forum. In addition, Dr. Southwell created and hosts The Measure of Everyday Life, a public radio show that translates research for general audiences on WNCU, a station based at North Carolina Central University in Durham, NC.
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Journal Review in HPB – Surgical Outcomes of the SWOG S1505 Trial
Description: Neoadjuvant chemotherapy remains a controversial topic for resectable pancreatic adenocarcinoma. This randomized trial examines surgical and clinical outcomes from peri-operative regimens, mFOLFIRNOX and gem-Abraxane. The HPB Behind the Knife team dives into the specifics of the trial design and findings, as well as sits down with the Principal Investigator Dr. Syed Ahmad himself to ask about the behind-the-scenes decision-making and the investigations yet to come.
Links to Papers Reviewed in this Episode
Surgical Outcome Results from SWOG S1505: A Randomized Clinical Trial of mFOLFIRINOX Versus Gemcitabine/Nab-paclitaxel for Perioperative Treatment of Resectable Pancreatic Ductal Adenocarcinoma Ann Surg. 2020 Sep;272(3):481-486 https://pubmed.ncbi.nlm.nih.gov/32740235/
Efficacy of Periopertive Chemotherapy for Resectable Pancreatic Adenocarcinoma: A Phase 2 Randomized Clinical Trial JAMA Oncol. 2021 Mar;7(3):421-427
https://pubmed.ncbi.nlm.nih.gov/33475684/
Guest: Syed Ahmad, MD (@SyedAAhmad5) is a Professor of Surgery and Chief of the Division of Surgical Oncology at the University of Cincinnati College of Medicine, and the Director of the UC Cancer Center. He is the surgical chair of SWOG, and a co-Principal Investigator of the SWOG S1505 study in addition to numerous other national trials for pancreatic cancer.
Hosts: Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center
Daniel Nelson, DO, FACS (@usarmydoc24) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center
Connor Chick, MD (@connor_chick) is a PGY-4 General Surgery resident at Brooke Army Medical Center
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-3 General Surgery resident at Brooke Army Medical Center
Other References from this Episode
FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer N Engl J Med. 2018 Dec 20;379:2395-2406 https://www.nejm.org/doi/full/10.1056/NEJMoa1809775
APACT: phase III, multicenter, international, open-label, randomized trial of adjuvant nab-paclitaxel plus gemcitabine (nab-P/G) vs gemcitabine (G) for surgically resected pancreatic adenocarcinoma
J Clin Oncol. 2019 May 20;37:no. 15 suppl:4000. https://ascopubs.org/doi/10.1200/JCO.2019.37.15_suppl.4000
Operative Standards in Cancer Surgery: Pancreatoduodenectomy: Superior Mesenteric Artery Dissection American College of Surgeons. 2020 Jun 18. https://www.facs.org/quality-programs/cancer/acs-crp/oscs https://www.youtube.com/watch?v=bs8xlCr5XyE
The AHPBA Podcast The Americas Hepato-Pancreato-Biliary Association https://podcasts.apple.com/us/podcast/the-ahpba-podcast/id1501441845
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Join BTK founders, Dr. Jason Bingham and Dr. John McClellan, as they discuss bariatric emergencies for the general surgeon. This is Part 2 of 2.
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Large diameter 26-32Fr chest tubes are the treatment of choice at many institutions for the treatment of traumatic hemothorax, but does the currently available data support that? Are there better options available? Join our team as we discuss the The Small 14-French (Fr) Percutaneous Catheter vs. Large (28-32Fr) Open Chest Tube for Traumatic Hemothorax (P-CAT): A Multi-center Randomized Clinical Trial by Dr. N Kulvatunyou et al to address this question.
Hosts: Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST).
Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.
David Sigmon, MD, MMEd, a PGY-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.
Journal Articles
The Small 14-French (Fr) Percutaneous Catheter vs. Large (28-32Fr) Open Chest Tube for Traumatic Hemothorax (P-CAT): A Multi-center Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/33843831/
Randomized Clinical Trial of 14-French (14F) Pigtail Catheters versus 28-32F Chest Tubes in the Management of Patients with Traumatic Hemothorax and Hemopneumothorax. https://pubmed.ncbi.nlm.nih.gov/33415448/
Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. https://pubmed.ncbi.nlm.nih.gov/24375295/
14 French pigtail catheters placed by surgeons to drain blood on trauma patients: is 14-Fr too small?
https://pubmed.ncbi.nlm.nih.gov/23188235/
A Prospective Study of 7-Year Experience Using Percutaneous 14-French Pigtail Catheters for Traumatic Hemothorax/Hemopneumothorax at a Level-1 Trauma Center: Size Still Does Not Matter
https://pubmed.ncbi.nlm.nih.gov/28795207/
A History of Thoracic Drainage: From Ancient Greeks to Wound Sucking Drummers to Digital Monitoring https://www.ctsnet.org/article/history-thoracic-drainage-ancient-greeks-wound-sucking-drummer s-digital-monitoring
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Join BTK founders, Dr. Jason Bingham and Dr. John McClellan, as they discuss bariatric emergencies for the general surgeon. This is Part 1 of 2.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Peripheral Artery Disease – What the $#^% are we talking about?
Peripheral Artery Disease is all about saving peoples legs and lives, but we often don’t talk about PAD lesions with a common clinical language. In this episode of Behind the Knife, the vascular surgery team introduces the Global Vascular Guidelines anddiscusses the WIfI, TASC, and GLASS classifications systems designed to standardize our conversations about PAD lesions and how these fit into treatment decisions.
Dr. Nicholas Osborne is an Associate Professor of Vascular Surgery at the University of Michigan and the
Chief of Vascular Surgery at the Ann Arbor Veteran’s Affairs Healthcare System.
Dr. Frank Davis is a Chief Resident in the Integrated Vascular Surgery program at the University of
Michigan.
Dr. Craig Brown is a PGY-6 in the General Surgery program at the University of Michigan.
Papers discussed in this Episode:
Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365864/
Society for Vascular Surgery App:
https://apps.apple.com/app/id1014644425
Please visit behindtheknife.org to access our massive library of high-yield surgical education podcasts, videos and more.
The Colorectal Surgery Virtual Education team is back with Mock Oral exams. This is episode 2 of 2 and includes 2 high-yield cases.
Also available in video format at www.behindtheknife.org.
For more information on the Colorectal Surgery Virtual Education initiative visit www.crsvirtualed.org.
Learning Objectives: · Describe the role of portal vein embolization and how it is currently utilized in the setting of metastatic colon cancer · Understand adequate functional volume and delineate different methods of increasing a future liver remnant · Identify the leading causes of drug-induced liver failure and recognize how these have changed over time
Journal Articles: · Dueland, et al. “Survival Outcomes After Portal Vein Embolization and Liver Resection Compared With Liver Transplant for Patients With Extensive Colorectal Cancer Liver Metastases.” JAMA Surgery. 2021;156(6):550-557. https://doi.org/10.1001/jamasurg.2021.0267
· Ghabril, et al. “Eight fold increase in the dietary supplement related liver failure leading to transplant waitlisting over the last quarter century in the US.” Liver Transplantation. 31 July 2021. https://doi.org/10.1002/lt.26246
Please visit behindtheknife.org to access our massive library of high-yield surgical education podcasts, videos and more.
The Colorectal Surgery Virtual Education team is back with Mock Oral exams. This is episode 1 of 2 and includes 2 high-yield cases.
Also available in video format at www.behindtheknife.org.
For more information on the Colorectal Surgery Virtual Education initiative visit www.crsvirtualed.org.
Description: A patient being surveilled for untreated hepatitis C presents to your clinic for a newly identified liver mass. Hepatocellular carcinoma (HCC) accounts for ~90% of new liver cancers and infection by hepatitis B and hepatitis C viruses are the main risk factors. Non-alcoholic steatohepatitis associated with metabolic syndrome and diabetes mellitus, however, have contributed to HCC becoming the fastest growing solid organ tumor in the United States. In this episode from the Surgical Oncology team at Behind the Knife, join the discussion on a surgeons approach to this growing patient population.
Learning Objectives: In this episode, we review risk factors for hepatocellular carcinoma, key steps in the diagnostic work-up with a focus on pre-operative planning for hepatectomy in cirrhotic patients. We will cover interventions available preoperatively, options and considerations once in the operating room, as well as treatment strategies and shifting paradigms following successful resection.
Hosts: Adam Yopp, MD, FACS (@AdamYopp) is an Assistant Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program.
Caitlin Hester, MD (@CaitlinAHester) is a 2nd Year Complex General Surgical Oncology Fellow at the MD Anderson Cancer Center.
Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-3 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research.
Papers Referenced in this Episode:
Importance of low preoperative platelet count in selecting patients for resection of hepatocellular carcinoma: a multi-institutional analysis J Am Coll Surg. 2011 Apr;212(4):638-48; discussion 648-50. doi: 10.1016/j.jamcollsurg.2011.01.004. PMID: 21463803 https://pubmed.ncbi.nlm.nih.gov/21463803/
Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology J Natl Compr Canc Netw. 2021 May 1;19(5):541-565. doi: 10.6004/jnccn.2021.0022. PMID: 34030131 https://pubmed.ncbi.nlm.nih.gov/34030131/
Sequential arterial and portal vein embolizations before right hepatectomy in patients with cirrhosis and hepatocellular carcinoma Br J Surg. 2006 Sep;93(9):1091-8. doi: 10.1002/bjs.5341. PMID: 16779884 https://pubmed.ncbi.nlm.nih.gov/16779884/
Application of controlled low central venous pressure during hepatectomy: A systematic review and meta-analysis J Clin Anesth. 2021 Aug 1;75:110467. doi: 10.1016/j.jclinane.2021.110467. Online ahead of print. PMID: 34343737 https://pubmed.ncbi.nlm.nih.gov/34343737/
Portal vein embolization: rationale, technique and future prospects Br J Surg. 2001 Feb;88(2):165-75. doi: 10.1046/j.1365-2168.2001.01658.x. PMID: 11167863 https://pubmed.ncbi.nlm.nih.gov/11167863/
Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes: toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant J Am Coll Surg. 2013 Feb;216(2):201-9. doi: 10.1016/j.jamcollsurg.2012.10.018. Epub 2012 Dec 7. PMID: 23219349 https://pubmed.ncbi.nlm.nih.gov/23219349/
IMbrave 050: a Phase III trial of atezolizumab plus bevacizumab in high-risk hepatocellular carcinoma after curative resection or ablation Future Oncol. 2020 May;16(15):975-989. doi: 10.2217/fon-2020-0162. Epub 2020 Apr 30. PMID: 32352320 https://pubmed.ncbi.nlm.nih.gov/32352320/
Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection Is Associated With Increased Survival in Patients With a History of Hepatocellular Carcinoma Gastroenterology. 2019 Nov;157(5):1253-1263.e2. doi: 10.1053/j.gastro.2019.07.040. Epub 2019 Jul 30. PMID: 31374215 https://pubmed.ncbi.nlm.nih.gov/31374215/
Ever wonder why some bariatric patients received extended VTE prophylaxis and others do not? Or what the ideal chemical VTE prophylaxis is for bariatric patients? All of your questions answered in this journal review discussion!
Journal articles:
A single-center comparison of extended and restricted thromboprophylaxis with LMWH after metabolic surgery: https://pubmed.ncbi.nlm.nih.gov/31641983/
Risk factors for postdischarge venous thromboembolism among bariatric surgery patients and the evolving approach to extended thromboprophylaxis with enoxaparin: https://pubmed.ncbi.nlm.nih.gov/33814315/
You’re faced with a challenging case of a patient with rectal cancer and synchronous liver lesion. Where do you start: chemotherapy, chemoradiotherapy, upfront surgery, liver first, rectum first? Join Drs. Carole Richard, François Dagbert and Maher Al Khaldi as they discuss the management of a patient with rectal cancer with a synchronous hepatic metastasis.
Learning objectives
In this episode, we discuss the workup of a rectal tumour associated with synchronous liver metastases, indications for resection of the hepatic lesion, neoadjuvant and adjuvant treatment modalities, survival benefit of resection and patient follow-up.
Reference list:
Moulton C-A, Gu C-S, Law CH, Tandan VR, Hart R, Quan D, et al. Effect of PET Before Liver Resection on Surgical Management for Colorectal Adenocarcinoma Metastases: A Randomized Clinical Trial. JAMA. 2014;311(18):1863–9.
Bahadoer RR, Dijkstra EA, Etten B van, Marijnen CAM, Putter H, Kranenbarg EM-K, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021;22(1):29–42.
"The eyes do not see what the mind does not know."
Trauma surgery is riddled with pitfalls. Take your guard down for a minute and BAM, you are eating humble pie. Don't let this happen to you!
Join Drs. Bryan Cotton, Teddy Puzio, Krislynn Mueck, and host Patrick Georgoff for a fun, high-yield review. In this episode (2 of 2), we cover: 1. Splenic pseudoaneurysm 2. Compartment syndrome 3. Urogenital injury 4. Diaphragm injury 5. Esophageal injury
Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss ovarian mass in pediatric surgery.
Journal Article links:
Madenci AL, Vandewalle RJ, Dieffenbach BV, Laufer MR, Boyd TK, Voss SD, et al. Multicenter pre-operative assessment of pediatric ovarian malignancy. J Pediatr Surg 2019;54(9):1921-5.
https://pubmed.ncbi.nlm.nih.gov/30867096/
Dasgupta R, Renaud E, Goldin AB, Baird R, Cameron DB, Arnold MA, et al. Ovarian torsion in pediatric and adolescent patients: A systematic review. J Pediatr Surg 2018;53(7):1387-91.
https://pubmed.ncbi.nlm.nih.gov/29153467/
"The eyes do not see what the mind does not know."
Trauma surgery is riddled with pitfalls. Take your guard down for a minute and BAM, you are eating humble pie. Don't let this happen to you!
Join Drs. Bryan Cotton, Teddy Puzio, Rushabh Dev, and host Patrick Georgoff for a fun, high-yield review. In this episode (1 of 2), we cover:
- Extraperitoneal rectal injury
- Blunt cerebrovascular injury
- Chance fractures
- Cardiac injuries with a negative FAST exam
- Missed injuries during trauma ex lap
The chief residents in your program are at their wits end with some of their colleagues. Residents are yelling at nurses, skin closures look like they’re from a horror movie and a patient almost died because of a delay in being seen. How can the chiefs and program director help these struggling residents?
Join Drs. Kyla Terhune, Jeremy Lipman, Judith French and Amy Han as they discuss how to identify and support the struggling surgical resident.
Learning objectives:
After listening to this episode, the participant will be able to:
Recall some of the assessment tools available to identify struggling residents
Discuss strategies for identifying struggling surgical residents
Provide guidance to a struggling surgical resident who is struggling
Tune in to listen to two of the BTK original founders, Dr. Jason Bingham and Dr. Scott Steele, as they discuss clinical challenges in colorectal surgery, specifically large bowel obstruction.
Want to win a free Behind the Knife ABSITE review book? Simply leave us a review on Apple Podcasts before September 1st and you will be entered into the drawing. Be sure to include your Twitter or Instagram handle in the review. Or email us at BTKpodcast@gmail.com to let us know that you showed BTK some love. DOMINATE THE DAY!
Incisional hernia is one of the most common long-term complications associated with surgical interventions. In this episode from the Hernia and Abdominal Wall Reconstruction team at Behind the Knife, we discuss evidence-based decision making to reduce incisional hernia rates following laparotomy. We review preoperative factors associated with hernia occurrence, intraoperative decision making related to fascial closure technique, and review literature on prophylactic mesh augmentation.
· Dr. Vahagn Nikolian is an Assistant Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair. · Dr. Sean Orenstein is an Associate Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair. · Dr. Emaad Iqbal is a resident in General Surgery at Columbia University Medical Center. · Dr. Shahrose Rahman is a resident in General Surgery at Oregon Health & Science University.
Seminal Papers in Hernia Prevention Techniques STITCH Trial: https://pubmed.ncbi.nlm.nih.gov/26188742/
PRIMAAT Trial: https://pubmed.ncbi.nlm.nih.gov/26943336/
PRIMA Trial: https://pubmed.ncbi.nlm.nih.gov/28641875/
Want to win a free Behind the Knife ABSITE review book? Simply leave us a review on Apple Podcasts before September 1st and you will be entered into the drawing. Be sure to include your Twitter or Instagram handle in the review. Or email us at BTKpodcast@gmail.com to let us know that you showed BTK some love. DOMINATE THE DAY!
Welcome to the first of a six-part series focused on the integration of palliative care into the practice of surgery. Dr. Geoffrey Dunn defines Surgical Palliative Care as “the treatment of suffering and the promotion of quality of life for seriously ill or terminally ill patients under surgical care.” He has proposed that the Family Meeting is like a surgical procedure in which we “Prepare, Do and Close.” Using the case of a geriatric trauma patient in multi-system organ failure, in this episode we discuss how to run a family meeting, how to discuss code status and how to discuss goals of care.
Family Meeting: Fast Fact #16: Moderating the Family Meeting https://www.mypcnow.org/fast-fact/moderating-an-end-of-life-family-conference/
Fast Fact #222: The Family Meeting Part 1- Preparing https://www.mypcnow.org/fast-fact/the-family-meeting-part-1-preparing/
Fast Fact #223: The Family Meeting Part 2- Starting the Conversation https://www.mypcnow.org/fast-fact/the-family-meeting-part-2-starting-the-conversation/
Fast Fact #227: The Family Meeting Part 6- Goal Setting and Future Planning https://www.mypcnow.org/fast-fact/the-family-meeting-part-6-goal-setting-and-future-planning/
In-hospital CPR: CPR in adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation https://pubmed.ncbi.nlm.nih.gov/12969608/
Development and validation of the good outcome following attempted resuscitation (GO-FAR) score to predict neurologically intact survival after in-hospital cardiopulmonary resuscitation https://pubmed.ncbi.nlm.nih.gov/24018585/
Dr. Red Hoffman (@redmdnd) is an acute care surgeon and associate hospice medical director in Asheville, North Carolina, host of the Surgical Palliative Care Podcast (@surgpallcare) and co-founder of the recently launched Surgical Palliative Care Society (www.spcsociety.org).
Dr. Fabian Johnston (@fabianjohnston) is Associate Professor of Surgery and Oncology and Chief, Division of GI Surgical Oncology at Johns Hopkins University.
Dr. Amanda Stastny (@manda_plez) is a PGY-2 in the General Surgery program at Mountain Area Health Education Center (MAHEC) in Asheville, NC.
FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLSfxhjxgCE9Ek263XuGkpqqbaNiK9sVnu3M7_LFYUZxhr38SZw/viewform
Want to win a free Behind the Knife ABSITE review book? Simply leave us a review on Apple Podcasts before September 1st and you will be entered into the drawing. Be sure to include your Twitter or Instagram handle in the review. Or email us at BTKpodcast@gmail.com to let us know that you showed BTK some love. DOMINATE THE DAY!
Behind the Knife – ACS Cancer Surgery Standards Program
Host: Shreya Gupta, MD (@shreyaguptaMD)
Guests: Mediget Teshome, MD, MPH, FACS (@drmediget) is an Assistant Professor in the Department of Breast Surgical Oncology at the University of Texas MD Anderson Cancer Center. She is the Chair of the Education Committee of the Cancer Surgery Standards Program (CSSP).
Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center. He is the Vice Chair of the Education Committee of the CSSP.
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-4 General Surgery resident at Brooke Army Medical Center and a member of the Education Committee of the CSSP.
Description: The American College of Surgeons Cancer Surgery Standards Program is an initiative to improve the quality of cancer surgery by implementing evidence-based operative standards and its associated documentation. This episode discusses the CSSP’s role in not only enhancing the quality of care for patients, but also providing educational tools for trainees, resources for community surgeons caring for cancer patients, and a vehicle for research.
Learning Objectives
In this episode, we learn about the mission and vision of the American College of Surgeons Cancer Surgery Standards Program and the associated operative standards. We discuss the current rollout of standards 5.7 and 5.8, concerning synoptic pathology reporting of total mesorectal excision for mid/low rectal cancer and mediastinal and hilar lymph node sampling in lung cancer. In addition, we discuss future implementation of synoptic operative reporting standards for melanoma, breast cancer, and colon cancer. These standards are important not only for the sub-specialist, but also to surgical residents and any general surgeon that cares for cancer patients.
Resources Referenced in this Episode
The ACS CSSP homepage: facs.org/cssp
Operative Standards for Cancer Surgery – find it on Amazon! Volume 1: Breast, Lung, Pancreas, Colon Volume 2: Thyroid, Gastric, Rectum, Esophagus, Melanoma
Follow CSSP on Twitter at @AmColSurgCancer, with the hashtag #CSSP
FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLSfxhjxgCE9Ek263XuGkpqqbaNiK9sVnu3M7_LFYUZxhr38SZw/viewform
Want to win a free Behind the Knife ABSITE review book? Simply leave us a review on Apple Podcasts before September 1st and you will be entered into the drawing. Be sure to include your Twitter or Instagram handle in the review. Or email us at BTKpodcast@gmail.com to let us know that you showed BTK some love. DOMINATE THE DAY!
A young woman is referred urgently to your breast surgical oncology clinic for a second opinion. She has been told that she needs to have an urgent mastectomy for a palpable triple negative breast cancer with suspicious axillary lymphadenopathy. Are there other options she should consider? Join Drs. Michael Alvarado, Rita Mukhtar, and Alexa Glencer as they discuss the multidisciplinary management of a patient with triple negative breast cancer.
In this episode, we review the diagnosis and classification of triple negative breast cancer, its biologic implications, surgical management including the role of sentinel lymph node biopsy vs axillary dissection, and the role of targeted chemotherapy including the recent FDA approval of immunotherapy for triple negative breast cancer in the neoadjuvant setting and indication for adjuvant chemotherapy for patients with residual disease following neoadjuvant therapy.
Links: Enhanced recurrence and survival benefit of adjuvant chemotherapy for hormone receptor negative breast cancer compared to hormone receptor positive breast cancer Berry et al (2006). Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA; 295(14): 1658-1667.
https://jamanetwork.com/journals/jama/fullarticle/202666
Neoadjuvant pembrolizumab for triple negative breast cancer Schmid et al (2020). Pembrolizumab for early triple negative breast cancer. New England J of Medicine; 382(9): 810-821.
https://www.nejm.org/doi/pdf/10.1056/NEJMoa1910549?articleTools=true
ACOSOG 1071: Sentinel lymph node biopsy for patients who received neoadjuvant chemotherapy Boughey at al (2013). Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG 1071 (Alliance) clinical trial. JAMA; 310(14): 1455-1461.
https://jamanetwork.com/journals/jama/fullarticle/1748149
Adjuvant capecitabine for triple negative breast cancer patients with residual disease following neoadjuvant chemotherapy: Masuda et al (2017). Adjuvant capecitabine for breast cancer after preoperative chemotherapy. New England J of Medicine; 376(22): 2147-2159.
https://www.nejm.org/doi/pdf/10.1056/NEJMoa1612645?articleTools=true
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Medical students - do you want to DOMINATE your surgery clerkship? Of course you do! Tune in and find out how. In this episode we introduce Behind the Knife’s 5 Principles for Clerkship DOMINATION, we hear from clerkship directors at top-notch surgery programs around the country, and we review the primary learning environments in surgery and how you can excel in each of these environments.
Hosts: Drs. Patrick Georgoff (@georgoff) and Amir Motameni (@motameniA)
Special guests: Drs. Gifty Kwakye, Luigi Pascarella, Mackenzie Cook, and Alodia Gabre-Kidan.
Behind the Knife’s 5 Principles for Clerkship DOMINATION:
1. Be prepared
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Take a proactive role in your education
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Show enthusiasm and be engaged
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Give quality presentations with thoughtful assessments and plans
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Seek out feedback and incorporate it into what you do.
Systems based surgery plan:
•Neuro: Pain control, unneeded narcotics, sleep, home psych meds •Cardiovascular: HR, BP, home cardiac meds •Pulmonary: Supplemental O2, pulmonary toilet (e.g. incentive spirometry), home inhalers •GI: Diet, return of bowel function, bowel regimen, ostomy care •GU/FEN: Urine output, foley catheter, IV fluids, electrolytes •Endocrine: Blood glucose •ID: Identify and treat infections, duration of antibiotics •Heme: DVT chemoprophylaxis, anemia •Skin: Wound care, pressure ulcers •MSK: Activity restrictions, out of bed, PT/OT •Lines: Central line, arterial line •Disposition: PT/OT, social work, case management
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Your patient is pregnant in her third trimester and she has acute cholecystitis...a relatively common but unnerving scenario. What do you do?! Do you operate? Do you observe? What about the baby? Tune in and get the information you need to best care for this patient.
Hosts: Drs. Graham Skelhorne-Gross, Ashlie Nadler and Jordan Nantais.
Papers reviewed:
1) Fong, Z. et. al. Cholecystectomy during the third trimester of pregnancy: proceed or delay? J Am Coll Surg. 2019. 228 (4): 494-502.
2) Hong. J. et. al. Considering delay of cholecystectomy in the third trimester of pregnancy. Surg Endosc. 2020. Online ahead of print.
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Dr. Yue-Yung Hu, Dr. Ryan Ellis, and Dr. Rhami Khorfan discuss two key new papers discussing optimizing resident achievement and well-being. Check out the papers at these links!
https://pubmed.ncbi.nlm.nih.gov/33605580/
https://pubmed.ncbi.nlm.nih.gov/33491973/
Episode Description The timing of renal replacement therapy remains controversial and may be influenced by local resources, availability and institutional practices. In this episode from the Surgical Critical Care team at Behind the Knife, we provide a brief overview, introduce a clinical scenario and discuss two contemporary articles on the timing of initiation.
Learning Objectives: In this episode, we review the indications for renal replacement therapy, the different modalities of continuous replacement therapy, and discuss two randomized control trials that may help us answer the question of dialysis initiation.
Hosts: Brittany Bankhead-Kendall, MD, MS (@BBankheadMD) is an Assistant Professor of Surgery at Texas Tech University Health Sciences Center.
Ryan Dumas, MD, FACS (@PMH_Trauma_RPD) is an Assistant Professor at the University of Southwestern Medical Center and Parkland Memorial Hospital.
Caroline Park, MD, MPH, FACS (@CPark_MD) is an Assistant Professor at the University of Southwestern Medical Center and Parkland Memorial Hospital.
Links to Papers Referenced in this Episode: Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis. N Engl J Med. 2018 Oct 11;379(15):1431-1442. doi: 10.1056/NEJMoa1803213. https://pubmed.ncbi.nlm.nih.gov/30304656/
Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. N Engl J Med. 2020 Jul 16;383(3):240-251. doi: 10.1056/NEJMoa2000741. https://pubmed.ncbi.nlm.nih.gov/32668114/
Intro: Join Drs. Brian Louie, Peter White, and Megan Lenihan as they discuss the management of spontaneous pneumothorax in its various presentations.
Learning Objectives
- Management of primary spontaneous pneumothorax - Management of secondary spontaneous pneumothorax - Operative intervention - Nonoperative intervention - Recognition and management of uncommon causes of pneumothorax
Referenced Material
ACCP guidelines for spontaneous pneumothorax:
https://journal.chestnet.org/article/S0012-3692(15)38241-6/
BTS guidelines for spontaneous pneumothorax:
https://thorax.bmj.com/content/65/Suppl_2/ii18
Couldn’t log on to the American Association of Endocrine Surgeons Annual Meeting this year? No need to have FOMO, in this episode from the Endocrine Surgery team at Behind the Knife, we review key abstract presentations from the meeting. We discuss the strengths and limitations of the studies, and how the results translate to clinical practice. Specifically, we go into screening and surgery for primary hyperparathyroidism after a diagnosis of nephrolithiasis, and the role of prophylactic central lymph node dissection, radioactive iodine, and radiofrequency ablation for papillary thyroid carcinoma. Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.
Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research
Important Papers
Viola, D., Materazzi, G., Valerio, L., Molinaro, E., Agate, L., Faviana, P., Seccia, V., Sensi, E., Romei, C., Piaggi, P. and Torregrossa, L., 2015. Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study. The Journal of Clinical Endocrinology & Metabolism, 100(4), pp.1316-1324.
Sippel, R.S., Robbins, S.E., Poehls, J.L., Pitt, S.C., Chen, H., Leverson, G., Long, K.L., Schneider, D.F. and Connor, N.P., 2020. A randomized controlled clinical trial: No clear benefit to prophylactic central neck dissection in patients with clinically node negative papillary thyroid cancer. Annals of Surgery, 272(3), pp.496-503.
Alore, E.A., Suliburk, J.W., Ramsey, D.J., Massarweh, N.N., Balentine, C.J., Singh, H., Awad, S.S. and Makris, K.I., 2019. Diagnosis and management of primary hyperparathyroidism across the Veterans Affairs health care system. JAMA internal medicine, 179(9), pp.1220-1227.
Ganesan, C., Weia, B., Thomas, I.C., Song, S., Velaer, K., Seib, C.D., Conti, S., Elliott, C., Chertow, G.M., Tamura, M.K. and Leppert, J.T., 2020. Analysis of primary hyperparathyroidism screening among US veterans with kidney stones. JAMA surgery, 155(9), pp.861-868.
You find a 2.3 cm polyp in the right colon during a screening colonoscopy. Does this patient need a colectomy? Is polypectomy ok? What should I do?? Join Drs. Peter Marcello, Jonathan Abelson and Tess Aulet as they discuss the endoscopic management of advanced colorectal polyps.
Be sure to check out Behind the Knife's YouTube channel for the VideoCast version of this high-yield case: https://www.youtube.com/c/BehindTheKnifeTheSurgeryPodcast.
Interested in learning more about specific topics in Colorectal Surgery? Check out the Virtual Education Series in Colorectal Surgery on Sunday Evenings at 7 pm EST @CRSVirtualEd or visit our website at http://jc.kethman.org.
References:
Cohan JN, Donahue C, Pantel HJ, Ricciardi R, Kleiman DA, Read TE, Marcello PW. Endoscopic Step Up: A Colon-Sparing Alternative to Colectomy to Improve Outcomes and Reduce Costs for Patients With Advanced Neoplastic Polyps. Dis Colon Rectum. 2020 Jun;63(6):842-849. doi: 10.1097/DCR.0000000000001645. PMID: 32118624. https://pubmed.ncbi.nlm.nih.gov/32118624/
NCCN guidelines: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1428
Kudo Classification: Kudo S, Tamura S, Nakajima T, Yamano H, Kusaka H, Watanabe H. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996; 44: 8-14 [PMID:8836710]
UpToDate. Chromoendoscopy. Author:Marcia Irene Canto, MD, MHSSection Editor:John R Saltzman, MD, FACP, FACG, FASGE, AGAFDeputy Editor:Kristen M Robson, MD, MBA, FACG. Literature review current through: May 2021. | This topic last updated: Jan 14, 2021.
Haggit and Kikuchi classification: Haggitt RC, Glotzbch RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology 1985; 89: 328-36.
Minimally Invasive Surgery Journal Review
Evaluating the Robot Platform for use in General Surgery: ROLARR & RIVAL
The debate about whether or not robotic surgery has a place in mainstream general surgery practice has been raging years with critics highlighting concerns about cost and a lack of high-level evidence showing benefit in patient outcomes while proponents suggest benefits in visualization, dexterity, and ergonomics that have not yet been borne out in rigorous trials. Hosts, Drs. Mike Weykamp, Andrew Wright, and Nick Cetrulo use two recent JAMA articles to frame the debate surrounding the platform and offer insight into the future of robotic and minimally invasive surgery.
Learning objectives:
In this episode we review the current landscape of the literature surrounding robot assisted surgery with a particular focus on how to thoughtfully evaluate emerging surgical technologies, the need to consider the broader concept of value rather than simply healthcare costs, and the role of surgeon-focused outcomes including ergonomics.
Selected Articles:
Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomized Clinical Trial Link: https://pubmed.ncbi.nlm.nih.gov/29067426/
Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair: The RIVAL Randomized Clinical Trial Link: https://pubmed.ncbi.nlm.nih.gov/32186683/
RIVAL Author Interview with JAMA Surgery: https://edhub.ama-assn.org/jn-learning/audio-player/18318110
Dr. Shailesh Agarwal from Brigham and Women's Hospital in Boston joins us once more on the podcast! This time he lends us his expertise in the surgical management of lymphedema. Come listen to how Dr. Agarwal is improving the lives of patients with this terrible, chronic condition, often produced as a result of prior surgery.
On this episode we are joined by Dr. Gretchen Schwarze, Associate Professor of Vascular Surgery at the University of Wisconsin in Madison. Dr. Schwarze is an expert in surgical decision making, informed consent, advance directives, and end-of-life care, and in this episode we pick her brain for practical tips on how to talk to patients about surgery and end of life decisions. Tune in to hear Dr. Schwarze’s 7 Habits for Highly Effective Surgery Communication, created just for Behind the Knife.
1. Be clear about the goal 2. Stay away from anatomy and physiology 3. Remember the downsides of surgery are more than just complications 4. Help patients to anticipate and prepare 5. Ask people about their hopes and fears 6. Make a recommendation and show your work 7. Attend to emotion
The Patient Preferences Project: https://patientpreferences.org/
On this episode we talk about an extremely important topic - end of life care and decision making. We are lucky to be joined by Dr. Gretchen Schwarze, Associate Professor of Vascular Surgery at the University of Wisconsin in Madison. Dr. Schwarze is the creator of the Best Case Worst Case tool, an incredibly useful resource. The Best Case Worse Case tool helps improve communication between older patients and their surgeons so that patients can avoid unwanted treatment and make decisions that align with their values, preferences, and goals. As most of our listeners know, these conversations are not easy. Tune in and learn how to do better.
Whiteboard video: https://www.youtube.com/watch?v=FnS3K44sbu0
The Patient Preferences Project: https://patientpreferences.org/
Managing Uncertainty — Harnessing the Power of Scenario Planning: https://www.nejm.org/doi/full/10.1056/NEJMp1704149
Description: Pancreatic adenocarcinoma is a highly lethal cancer with a dismal long-term prognosis requiring complex multidisciplinary planning in order to optimize outcomes. In this episode from the Hepato-Pancreato-Biliary team at Behind the Knife, we discuss a patient presenting with a borderline resectable pancreatic head mass.
Learning Objectives: In this episode, we review risk factors for pancreatic adenocarcinoma, key steps of the diagnostic work-up and pre-operative planning, and definitions of resectable, borderline resectable, and unresectable tumors. The history of chemotherapy for pancreatic cancer is briefly reviewed, highlighting the importance of multi-agent regimens and role of neoadjuvant therapy. Finally, we highlight the critical steps of the Whipple procedure.
Hosts: Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center
Daniel Nelson, DO, FACS (@usarmydoc24) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center
Connor Chick, MD (@connor_chick) is a PGY-4 General Surgery resident at Brooke Army Medical Center
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-3 General Surgery resident at Brooke Army Medical Center
Links to Papers Referenced in this Episode
Treatment sequencing for resectable pancreatic cancer: influence of early metastases and surgical complications on multimodality therapy completion and survival J Gastrointest Surg. 2014 Jan;18(1):16-24
https://pubmed.ncbi.nlm.nih.gov/24241967/
Preoperative biliary drainage for cancer of the head of the pancreas N Engl J Med. 2010 Jan 14;362(2):129-37 https://pubmed.ncbi.nlm.nih.gov/20071702/
1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience J Gastrointest Surg. 2006 Nov;10(9):1199-210; discussion 1210-1. https://pubmed.ncbi.nlm.nih.gov/17114007/
Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial JAMA. 2013 Oct 9;310(14):1473-81. https://pubmed.ncbi.nlm.nih.gov/24104372/
Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial Lancet. 2017 Mar 11;389(10073):1011-1024 https://pubmed.ncbi.nlm.nih.gov/28129987/
FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer N Engl J Med. 2018 Dec 20;379:2395-2406
https://www.nejm.org/doi/full/10.1056/NEJMoa1809775
Surgical Outcome Results From SWOG S1505: A Randomized Clinical Trial of mFOLFIRINOX Versus Gemcitabine/Nab-paclitaxel for Perioperative Treatment of Resectable Pancreatic Ductal Adenocarcinoma Ann Surg. 2020 Sep 1;272(3):481-486.doi: 10.1097/SLA.0000000000004155 https://pubmed.ncbi.nlm.nih.gov/32740235/
ASCO Guidelines Potentially Curable Pancreatic Adenocarcinoma https://www.asco.org/research-guidelines/quality-guidelines/guidelines/gastrointestinal-cancer#/12146
NCCN Guidelines Pancreatic Adenocarcinoma https://www.nccn.org/guidelines/nccn-guidelines/guidelines-detail?category=1&id=1455
Today we have a very special guest on Behind the Knife- Dr Michael D’Angelica. He discusses surgical oncology with his HPB focus along with colorectal liver metastases. The episode digs in deeper on the origin of hepatic artery infusion pump, its surgical technique and common complications and much more. Enjoy!
https://jamanetwork.com/journals/jamasurgery/article-abstract/2735967
Clinical Challenges in Trauma Surgery: Penetrating Cardiac Trauma
A patient presents with a stab wound to the THE BOX. What do you do? X-ray? FAST? Heal with steel? In this episode, the BTK trauma team discusses your options and gives you a few pro tips along the way.
Join Drs. Haut, Feinman, and Sigmon for a high-yield clinical challenge.
Hosts:
Elliott Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST).
Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.
David Sigmon, MD, MMEd, a PGY-5 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.
Papers:
Inaba K, Chouliaras K, Zakaluzny S, et al. FAST ultrasound examination as a predictor of outcomes after resuscitative thoracotomy: a prospective evaluation. Ann Surg. 2015;262(3):512-518; discussion 516-518.
https://pubmed.ncbi.nlm.nih.gov/26258320/
Teeter W, Haase D. Updates in traumatic cardiac arrest. Emerg Med Clin North Am. 2020;38(4):891-901.
https://pubmed.ncbi.nlm.nih.gov/32981624/
Israr S, Cook AD, Chapple KM, et al. Pulseless electrical activity following traumatic cardiac arrest: Sign of life or death? Injury. 2019;50(9):1507
- https://pubmed.ncbi.nlm.nih.gov/31147/183/
Clinical Challenge in Surgery – Carotid Artery Stenosis
Carotid endarterectomy is a great option for most patients, but what do you do when the lesion extends high in the neck or the neck has been irradiated? In this episode from the Vascular Surgery team at Behind the Knife, we discuss carotid artery stenosis using a real patient case from the University of Michigan. We touch on diagnosis and imaging as well as medical and surgical management of carotid disease with a special discussion about Transcarotid Artery Revascularization (TCAR), a new technique available for the treatment of carotid lesions.
Dr. Nicholas Osborne is an Associate Professor of Vascular Surgery at the University of Michigan and the Chief of Vascular Surgery at the Ann Arbor Veteran’s Affairs Healthcare System.
Dr. Frank Davis is a Chief Resident in the Integrated Vascular Surgery program at the University of Michigan.
Dr. Craig Brown is a PGY-6 in the General Surgery program at the University of Michigan.
Seminal Papers in Carotid Artery Stenosis
The MRC European Carotid Surgery Trial (ECST): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)09292-1/fulltext
Endarterectomy for Asymptomatic Carotid Artery Stenosis (ACAS Trial): https://jamanetwork.com/journals/jama/article-abstract/388335
The North American Symptomatic Carotid Endarterectomy Trial (NASCET Trial): https://www.ahajournals.org/doi/epub/10.1161/01.STR.30.9.1751
Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure (ROADSTER Trial): https://pubmed.ncbi.nlm.nih.gov/26506270/
ROADSTER 2 Trial: https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.030550
“If you could go back to your very first day of intern year and tell yourself one thing, what would it be?"
In this episode, AlleaBelle Gongola joins Scott Steele, Kevin Kniery, and Patrick Georgoff to discuss this very question. Tune in to hear wise answers from previous BTK episodes and fill up on inspiration as we head into a new academic year.
Go to greenchef.com/90surgery with code "90surgery" to get 90 dollars off some fantastic meals and help support Behind The Knife.
Host: Kevin Kniery
Guests: Alexis Lauria and Alec Kersey
Go to greenchef.com/90surgery with code "90surgery" to get 90 dollars off some fantastic meals and help support Behind The Knife.
Host: Kevin Kniery
Guest Hosts: Alexis Lauria and Alec Kersey
For more details on vascular trauma discussion check previous episodes with Dr. Rasmussen.
Go to HelloFresh.com/Surgery12 to get up to 12 free meals and support Behind The Knife.
Host: Kevin Kniery
Guest Hosts: Alexis Lauria and Alec Kersey
Check our YouTube tutorial on REBOA https://bit.ly/3uSxLXb
For more in detail vascular trauma discussions check out our previous episodes with Dr. Todd Rasmussen.
In this episode, we host the Joint Commission who tell us about their efforts to improve healthcare disparities and healthcare provider diversity. We first briefly discuss structural racism before pivoting to how COVID has revealed how deep the roots of inequity travel. Finally we discuss the ways that Joint Commission are tackling the problem. Dr. Ana McKee, Executive Vice President and Chief Diversity, Equity, and Inclusion Officer of the Joint Commission joins our discussion, along with return guest Dr. Fabian Johnston from Johns Hopkins University.
Dr. McKee mentions the Bernard J Tyson National Award for Excellent in the Pursuit of Healthcare Equity in this episode! Applications open on May 17. Please see go to THIS LINK to learn more about the process!
In this episode, we follow up with our friends at COVIDSurg (https://globalsurg.org/covidsurg/). While the pandemic has been raging they have been hard at work, studying the interface between COVID and all things surgery. They’ve produced some amazing work, most of which impacts the day to day lives of surgeons around the country.
How long should you wait to operate on a patient who has had COVID? And what do you tell your patients about this? What about vaccines? Should your next patient undergoing elective surgery be vaccinated before you take them to the operating room? Find out!
Clinical Challenges in Surgery: ARDS
It's the middle of the night...the ventilator is alarming, the patient is hypoxic, and the nurse wants to know if you would like to paralyze the patient. What do you do?! Join Drs. Matt Martin, John McClellan, and Patrick Georgoff as they discuss the management of a real patient with severe Acute Respiratory Distress Syndrome. From paralytics and proning to steroids and ECMO, this episode has got you covered.
Note: We couldn't upload the video version to your podcast player because the file was just way too big! That's because the operative video is so high quality! Please go our YouTube channel to watch it! Or click this link: https://youtu.be/xx7JMIe2d_o
In the first of our Surgical Technique video series, Mass Gen Transplant surgeons take us step by step through a kidney transplant! This is Part 2 of the series. We are joined by Dr. Leigh Anne Dageforde, Dr. Anushi Shah, and Dr. Ashley Aaron. Just in time for National Donate Life Month!
Note: We couldn't upload the video version to your podcast player because the file was just way too big! That's because the operative video is so high quality! Please go our YouTube channel to watch it! Or click this link: https://youtu.be/xx7JMIe2d_o
In the first of our Surgical Technique video series, Mass Gen Transplant surgeons take us step by step through a kidney transplant! This is Part 1 of the series. We are joined by Dr. Leigh Anne Dageforde, Dr. Anushi Shah, and Dr. Ashley Aaron. Just in time for National Donate Life Month!
Dr. Anton Fries, Chief of Plastic Surgery at UT San Antonio, joins the podcast to give us all a primer on all we need to know about flap-based reconstruction.
Don’t forget to visit GreenChef.com and use promo code 90Surgery to get $90 off your first organic, delivered meals. It’s a great way to support your body and the podcast!
Check out the articles discussed in today's podcast here
ATTRACT Trial
https://www.nejm.org/doi/full/10.1056/NEJMoa1615066
Dual Antiplatelets Following Lower Extremity Bypass
https://pubmed.ncbi.nlm.nih.gov/32777321/
Discussing a REAL TRAUMA CASE that happened just a few months ago, Patrick Georgoff, John McClellan, and Hasan Alam come together to detail their thought process in managing a patient with a gunshot wound to the abdomen.
We brought Dr. Mary Klingensmith and Dr. Amit Joshi on the show, executive leaders on the Surgical Council on Resident Education. Listen to them discuss the history of SCORE, how it has improved over time, and how these two leaders in surgical education anticipate residency training changing over the next decade!
Diverticulitis has got to be one of the most classic problems encountered by surgeons and medical students in their surgery rotation. In this inaugural "Clinical Challenges" episode, colorectal surgeons Scott Steele and Joshua Bleier join acute care and trauma surgeon Patrick Georgoff to discuss the important clinical pearls, starting from when you meet the patient, all the way to when you're taking care of them after their surgery.
The venerable Dr. Timothy Pawlik from Ohio State joins us on the podcast today to discuss his Landmark Paper review of Intrahepatic Cholangiocarcinoma!
How do you discuss breast reconstruction with your patient? Dr. John Kim from Northwestern University joins us to talk about this rich topic.
Check out our YouTube channel this week as we will release video clips of the interview along with visual aids!
This is the second part of our discussion with Dr. Shailesh Agarwal, Plastic Surgeon at Brigham and Women's in Boston. In this half, we discuss the plastic surgeon's perspective on abdominal wall reconstruction and chest wall reconstruction. This is part of a short mini-series of episodes we are releasing about topics in plastic surgery that would interest every surgeon! Stay tuned for more. episode in the Plastic Surgery for the General Surgeon series!
This is our first episode in the Plastic Surgery for the General Surgeon series! Our guest Dr. Shailesh Agarwal, from Brigham and Women's in Boston, come onto the show to discuss trunk reconstruction with us. In this first-half of our recording session, Dr. Agarwal discusses perineal reconstruction. Stay tuned for next week's episode where we will release the second half of the conversation, all about abdominal and chest wall reconstruction!
The ABSITE is over! 2021 has truly begun now. Listen to this short update about what we have in store for you guys over the course of this next year.
If you want to hear more vascular surgery specific content, be sure to check out Audible Bleeding wherever podcasts are found.
Dr. Todd Rasmussen is a Colonel in the United States Air Force and is a Professor of Surgery and Associate Dean of Research at the Uniformed Services University of the Health Sciences and an attending vascular surgeon at Walter Reed National Military Medical Center. Dr. Rasmussen has been deployed numerous times to Iraq and Afghanistan and cared for many traumatic vascular injuries at Walter Reed Medical Center. Through his experience and research, he has become one of the foremost leaders on the management of vascular trauma and recently published the third edition of Rich’s Vascular Trauma.
Dr. Marlin “Wayne” Causey is a Lieutenant Colonel in the US Army and the Chief of Vascular Surgery at Brooke Army Medical Center.
Dr. Kevin Kniery is a vascular surgeon at Brooke Army Medical Center.
Seminal Papers in Blunt Thoracic Aortic Injury
AAST 1997 Paper: https://pubmed.ncbi.nlm.nih.gov/9095103/
AAST 2008 Paper: https://pubmed.ncbi.nlm.nih.gov/18545103/
JVS 2011 Paper: https://pubmed.ncbi.nlm.nih.gov/20974523/
Timing of repair of BTAI JVS 2020: https://www.jvascsurg.org/article/S0741-5214(20)31575-5/fulltext
Dr. Ben Starnes’ podcast on Behind The Knife on BTAI.
https://bit.ly/2LuycWq
In this episode we review the need to know information regarding anesthesia and preoperative work up. Very concentrated information intended for the ABSITE and boards.
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https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion-ebook/dp/B08NCX9N1V
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https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767
Quick hit hernia knowledge for ABSITE, boards and even rounds. Covers wide range of different types of hernia and repair options.
https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767
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Check out our book here
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Help us out by filling out our survey
https://survey.libsyn.com/behindtheknife
Check out our book here
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Help us out by filling out our survey
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Help us out by filling out our survey
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Help us out by filling out our survey
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Check out our YouTube landmark paper series here
https://www.youtube.com/watch?v=lzAoWs6w8q8
We review high yield breast topics, to include: high yield anatomy, benign breast disease, and management of breast cancer and the axilla.
SURVEY LINK:
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BTK ABSITE Companion
Check out our book at this link, and help us out with a 5-star rating! https://amzn.to/37sEH44
Subscribe to our YouTube Channel here for video ABSITE reviews.
https://www.youtube.com/channel/UCZkuV3bsUyp0q4mTFHFEoKg
BTK ABSITE Companion
Check out our book at this link, and help us out with a 5 star rating! https://amzn.to/37sEH44
Subscribe to our YouTube Channel here for video ABSITE reviews.
https://www.youtube.com/channel/UCZkuV3bsUyp0q4mTFHFEoKg
BTK ABSITE Companion
Check out our book at this link, and help us out with a 5 star rating! https://amzn.to/37sEH44
Subscribe to our YouTube Channel here for video ABSITE reviews.
https://www.youtube.com/channel/UCZkuV3bsUyp0q4mTFHFEoKg
BTK ABSITE Companion
Check out our book at this link, and help us out with a 5 star rating! https://amzn.to/37sEH44
Subscribe to our YouTube Channel here for video ABSITE reviews.
https://www.youtube.com/channel/UCZkuV3bsUyp0q4mTFHFEoKg
BTK ABSITE Companion
Check out our book at this link, and help us out with a 5 star rating! https://amzn.to/37sEH44
Subscribe to our YouTube Channel here for video ABSITE reviews.
https://www.youtube.com/channel/UCZkuV3bsUyp0q4mTFHFEoKg
Jason Bingham, Kevin Kniery, John McClellan and Woo Do review high-yield adrenal topics for the ABSITE, including: hyperaldosteronism, Cushing syndrome, congenital adrenal hyperplasia, adrenal incidentaloma, adrenocortical carcinoma, pheochromocytoma.
Review the congenital adrenal hyperplasia mnemonic here.
Buy and rate your BTK ABSITE Companion HERE
We continue with high-yield hepatobiliary, to include: cystic lesions and tumors of the liver and biliary tree.
ABSITE COMPANION:
https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767
We discuss high yield topics related to the liver and biliary tree, to include: benign biliary disease, portal hypertension, and liver abscesses.
Absite Companion:
https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767
We discuss high-yield Spleen topics for ABSITE and the boards.
Be sure to check out the BTK ABSITE Study Companion available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_5?dchild=1&keywords=absite&qid=1607311826&sr=8-5
Listen to our review on the very high-yield topic: stomach!
Don't forget to check out our new edition of the ABSITE Companion Book on Amazon!
We discuss high-yield topics related to the Esophagus. Show notes with illustrations are available in a new paperback form on Amazon: BTK ABSITE Podcast Companion
We discuss high-yield parathyroid topics, to include: PTH, calcitonin, hypercalcemia, hyperparathyroidism (primary vs. secondary vs. tertiary), and parathyroid cancer.
Be sure to check out the BTK ABSITE Study Companion available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_5?dchild=1&keywords=absite&qid=1607311826&sr=8-5
We discuss high-yield thyroid topics, to include: Hyperthyroidism Grave's disease, Toxic multinodular goiter, Thyroiditis Workup of the palpable thyroid nodule, Thyroid cancer (papillary vs. follicular vs. medullary)
Be sure to check out the BTK ABSITE Study Companion available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_5?dchild=1&keywords=absite&qid=1607311826&sr=8-5
If you find our ABSITE reviews helpful please give us a review on Apple Podcasts
https://apple.co/2JvIT9Z
And
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Jon Abelson and William Kethman bring us this week's episode. Tune in and listen to Michael Valente, David Liska, Jason Chen, and Sarath Sujatha-Bhaskar take us through several excellent oral boards scenarios related to colorectal surgery!
“Who Should Manage Vascular Trauma?”
Today’s podcast is a collaboration between
Audible Bleeding – AudibleBleeding.com
Behind The Knife – BehindTheKnife.org
Trauma ICU Rounds - TraumaICURounds.ca
Subscribe to all 3 on any podcasting platform!
The most recent article discussed in this podcast can be found here.
https://journals.lww.com/annalsofsurgery/Fulltext/2020/08000/Beyond_the_Crossroads__Who_Will_be_the_Caretakers.53.aspx
Vascular Surgery
Dr. Benjamin Starnes
Dr. Starnes is a Professor of Vascular Surgery, Chief of the Division of Vascular Surgery and Vice Chair of the Department of Surgery for UW Medicine. Additionally he is a former military surgeon with combat experience.
Dr. Westley Ohman
Dr. Ohman is an Assistant Professor of Vascular Surgery at Barnes-Jewish Hospital which is a level 1 trauma center where he is routinely involved in the care of complex vascular trauma.
Trauma Surgery
Dr. Tanya Zakrison is an Associate Professor of Surgery and a Trauma and Acute care surgeon at the University of Chicago medical center, which is a level 1 trauma center.
Dr. Matthew Martin is a Professor of Surgery at Scripps Medical Center in San Diego, a former Army Surgeon who is recognized as a leader in trauma care, and has served on 5 combat deployments.
Moderators
Dr. Dennis Kim is an Associate Professor of Surgery and an Acute Care and Trauma Surgeon at UCLA School of Medicine and is the host of the podcast Trauma ICU rounds
Dr. Kevin Kniery is a vascular surgeon at Brooke Army Medical Center.
Dr. James Howe and Dr. Alexandra Gangi, coauthors of The Landmark Series: Neuroendocrine Tumor Liver Metastases, join us to discuss their paper and the latest in the field of these rare but important tumors.
Read the paper yourself here! https://link.springer.com/article/10.1245%2Fs10434-020-08787-x
Leaders in clinical and health services research discuss keys to success in this collaborative effort between BTK and The Association for Academic Surgery. In this episode, Dr. Fabian Johnston discusses how to do health services research the right way with UCSF Surgery Chair Dr. Julie Sosa.
Dr. Bernadette Aulivola is a Professor of Vascular Surgery and Endovascular Surgery at Loyola Medical Center and the Division Director of Vascular Surgery.
https://loyolamedicine.org/doctor/bernadette-aulivola
Check out Audible Bleeding here https://www.audiblebleeding.com/ or on any podcast platform.
Find a vascular mentor here!
https://svsconnect.vascular.org/home
Request Dr. Aulivola and Dr. Ellozy
What is the latest, up to date practice in surgical oncology for liver mets from colorectal cancer? Dr. Jean-Nicolas Vauthey, author of the landmark paper on the topic, joins us to discuss.
In today's episode, the lead investigator of the CODA Trial, Dr. David Flum, joins us along with members of his team to discuss the newly released results of the CODA Trial.
Leaders in clinical and health services research discuss keys to success in this collaborative effort between BTK and The Association for Academic Surgery. In this episode, Dr. Fabian Johnston discusses research mentorship, building a health services career, and breaking down barriers between translation and implementation scientists with Dr. Sandra Wong, Surgery Chief at Geisel SOM at Dartmouth.
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The Society of Surgical Oncology has published The Landmark Series, an invaluable series of reviews that discuss the key papers of surgical oncology which shape our practice today.
Dr. George Chang of MD Anderson, author of The Landmark Series: Management of Lateral Lymph Nodes in Locally Advanced Rectal Cancer, joins us to discuss his work.
During the discussion, Dr. Chang mentioned his other work on robotic surgery and the lateral pelvic lymph node dissection, read it here: https://onlinelibrary.wiley.com/doi/abs/10.1111/codi.15350
You've been selected to be on the next team taking a 3-year trip to Mars. What will you bring with you? How will you treat appendicitis?
That, and much more regarding human space travel and surgery, is discussed by Dr. Rich Williams and Dr. Carol Scott-Conner in this week's episode about deep space medicine.
There is an urgent need to understand the outcomes of COVID-19 infected patients who undergo surgery. Capturing real-world data and sharing international experience will inform the management of this complex group of patients who undergo surgery throughout the COVID-19 pandemic, improving their clinical care. CovidSurg has been designed by an international collaborating group of surgeons and anaesthetists which has now reached 69 countries. More information here https://globalsurg.org/covidsurg/.
Connect on twitter @COVIDSurg
The Society of Surgical Oncology has published The Landmark Series, an invaluable series of reviews that discuss the key papers of surgical oncology which shape our practice today.
Dr. Kelly McMasters, Editor-in-Chief of the Annals of Surgical Oncology, joins us today to introduce the Landmark Series, as well as walk us through the Landmark papers regarding the treatment of melanoma.
Dr. Red Hoffman, Dr. Fabian Johnston, and Dr. Susan McCammon, each surgeons with unique expertise in palliative care, join us to discuss the difficult decisions and discussions we sometimes must make for those patients with the worst prognoses or who are suffering the most.
Leaders in clinical and health services research discuss keys to success in this collaborative effort between BTK and The Association for Academic Surgery. In this episode, Dr. Karan Chhabra discussing building a strong health services research program from the bottom-up with Dr. John Birkmeyer.
Dr. Travis McKenzie from Mayo Clinic discusses his approach to the adrenal incidentaloma, and shares pearls of wisdom for shucking out those adrenal masses.
Kevin and Nicole discuss the management of ceberbrovascular trauma, primarily blunt and penetrating injuries to the carotid and vertebral arteries.
Dr. Rasmussen is a Colonel in the United States Air Force and is a Professor of Surgery and Associate Dean of Research at the Uniformed Services University of the Health Sciences and an attending vascular surgeon at Walter Reed National Military Medical Center.
Dr. Rasmussen has been deployed numerous times to Iraq and Afghanistan and cared for many traumatic vascular injuries at Walter Reed Medical Center. Through his experience and research, he has become one of the foremost leaders on the management of vascular trauma and recently published the third edition of Rich’s Vascular Trauma.
Nicole Rich is a vascular surgery fellow at New York Presbyterian.
Behind The Knife YouTube Page
https://www.youtube.com/channel/UCZkuV3bsUyp0q4mTFHFEoKg
EAST Blunt Cerebrovascular Injury Guidelines
https://www.east.org/education/practice-management-guidelines/blunt-cerebrovascular-injury
Check out Rich’s Vascular Trauma
https://www.elsevier.com/books/richs-vascular-trauma/9781455712618
American Board of Surgery FAQs regarding 2020 QE
http://www.absurgery.org/default.jsp?faq_virtualgsqe2020
Guests on this podcast Dr. Buyske President and CEO of The American Board of Surgery Dr. Benjamin Jarman Gundersen Medical Foundation General Surgery Residency Program Director President - Association of Program Directors in Surgery Dr. Brittany Bankhead-Kendall Trauma and Acute Care Surgeon at Texas Tech University of Health Sciences Dr. Allison Martin Incoming surgical oncology fellow at MD-Anderson
In this 17th joint journal club with Annals of Surgery, we are joined by Dr. Sidra Bonner and Dr. Glenn Wakam, co-authors of the recently accepted paper "Covid-19 and Racial Disparities: Moving Toward Surgical Equity." Our two guests are residents at the University of Michigan who lead an excellent discussion around their recent work in which they challenge the common belief among surgeons that their practices are free from racial disparities, and propose tangible interventions to reduce systemic inequity in surgical care. Download the full paper here: https://journals.lww.com/annalsofsurgery/Citation/9000/Covid_19_and_Racial_Disparities__Moving_Towards.94434.aspx
The recent murder of George Floyd, among others, has once again brought to the forefront discourse on the deep-rooted, structural obstacles and mistreatment that black people face. Those roots have grown into our own profession as well, so join the BTK team this week as we discuss the serious topic of systemic racism in surgery and how we can begin to overcome it.
Featuring our guests:
Carla Pugh, MD, PhD; Professor of Surgery at Stanford University, Acute Care Surgeon, Director of the Technology Enabled Clinical Improvement Center
Lola Fayanju, MD, MA; Assistant Professor of Surgery and Population Health Sciences at Duke University, Associate Director for Disparities & Value in Healthcare with Duke Forge
Fabian Johnston, MD, MHS; Associate Professor of Surgical Oncology, Chief of GI Surgical Oncology, Director of the Peritoneal Surface Malignancy Program, Program Director of the Complex General Surgery Oncology Fellowship at Johns Hopskins University
Thanks to Patrick Georgoff @georgoff and Nicholas Teman @nickteman for this fantastic 3 part series.
Check out our new website designed by Michael Vu
Check out our new YouTube series on bedside procedures. First video is how to place a chest tube!
https://www.youtube.com/watch?v=o5HuiD51Su0
A big thanks to Patrick Georgoff and Nicholas Teman for putting together this great mini-series.
Have you seen our YouTube page? Everything from ABSITE review, to technical skills to landmark paper reviews.
https://www.youtube.com/channel/UCZkuV3bsUyp0q4mTFHFEoKg
Our website has also been updated.
https://www.youtube.com/channel/UCZkuV3bsUyp0q4mTFHFEoKg
Please enjoy this three part series on ECMO by Patrick Georgoff and
Please check out our Journal Cast for quick breakdowns of landmark papers.
https://www.youtube.com/watch?v=7tsRUhnVDCw
Join Dr. Scott Steele and Dr. Jason Bingham as they host our guests, Dr. Howard Ross and Dr. Ajita Prabhu to discuss interviewing in this new age of Zoom conferences. Prior BTK personality Dr. Woo Do also drops in to the show to discuss his own experiences interviewing for (and successfully matching in!) a Pediatric Surgery fellowship!
Dr. Howard Ross - Chief of Colorectal Surgery and General Surgery Residency Program Director at Temple University
Dr. Ajita Prabhu - Associate Professor of Surgery and General Surgery Residency Assistant Program Director at Cleveland Clinic
Abdominal Vascular Trauma – Venous with Dr. Todd Rasmussen.
Episode 3 of 6 for our vascular trauma series. Kevin and Adham discuss the management of injuries to the vena cava and portomesenteric venous system with Dr. Rasmussen.
Dr. Rasmussen is a Colonel in the United States Air Force and is a Professor of Surgery and Associate Dean of Research at the Uniformed Services University of Health Sciences and an attending vascular surgeon at Walter Reed National Military Medical Center.
Dr. Rasmussen has been deployed numerous times to Iraq and Afghanistan, and cared for many traumatic vascular injuries at Walter Reed Medical Center, through his experience and research he has become one of the foremost leaders on the management of vascular trauma and recently published the third edition of Rich’s Vascular Trauma.
Check out Dr. Rasmussen’s book
https://www.elsevier.com/books/richs-vascular-trauma/9781455712618
https://www.amazon.com/Richs-Vascular-Trauma-Todd-Rasmussen/dp/1455712612
Dr. David Nott has been a Consultant Surgeon at Chelsea and Westminster Hospital for 23 years where he specializes in general surgery. Professor Nott also performs vascular and trauma surgery at St Mary’s Hospital and cancer surgery at the Royal Marsden Hospital.
For the past twenty three years David has taken unpaid leave each year to work for the aid agencies Médecins Sans Frontières, the International Committee of the Red Cross and Syria Relief. He has provided surgical treatment to the victims of conflict and catastrophe in Bosnia, Afghanistan, Sierra Leone, Liberia, Ivory Coast, Chad, Darfur, Yemen, the Democratic Republic of Congo, Haiti, Iraq, Pakistan, Libya, Syria, Central African Republic, Gaza and Nepal.
Please check out his book "War Doctor" for an inspiring read
https://www.amazon.com/War-Doctor-Surgery-Front-Line-ebook/dp/B07WWGLY7Z/ref=sr_1_1?dchild=1&keywords=war+doctor&qid=1593638019&s=digital-text&sr=1-1
Also check out his foundation that supports training surgeons in war zones.
https://davidnottfoundation.com/
A big thanks to Patrick Georgoff for making this happen.
Leaders in clinical and health services research discuss keys to success in this collaborative effort between BTK and The Association for Academic Surgery. In this episode, Dr. Fabian Johnston has an engaging conversation with Dr. Karl Bilimoria about establishing a world-class health services research program.
Join us for our 16th joint Journal Club with Annals of Surgery! We discuss the hot topic of global surgery—specifically, how to advance your surgical career while pursuing interests in global surgery. This episode's guest author is Dr. Sherry Wren, Director of Global Surgery and Professor of Surgery at Stanford University. She is also Vice Chair for Professional Development and Diversity, and she manages Stanford’s educational surgical partnerships in sub-Saharan Africa. She was lead author of the recent paper "Academic Advancement in Global Surgery: Appointment, Promotion, and Tenure Recommendations From the American Surgical Association Working Group on Global Surgery" Dr. Wren will talk about her own career and experiences as a global surgeon alongside the working group's recommendations for academic advancement. Download the full paper here: https://journals.lww.com/annalsofsurgery/Fulltext/2020/02000/Academic_Advancement_in_Global_Surgery_.14.aspx
Join us for our 15th joint Journal Club with Annals of Surgery! We discuss a brand-new set of multisociety guidelines, putting together the latest evidence on preventing bile duct injury during laparoscopic cholecystectomy. This episode's guest author is Dr. Michael Brunt, Professor and Chief of MIS at Wash U in St. Louis, and lead author of the new paper "Safe Cholecystectomy Multi-Society Practice Guideline and State of the Art Consensus Conference on Prevention of Bile duct Injury during Cholecystectomy" He will walk us through the guidelines in oral boards style, providing safe and evidence-based answers to many of your common questions about laparoscopic cholecystectomy. Download the full paper here: https://journals.lww.com/annalsofsurgery/Abstract/9000/Safe_Cholecystectomy_Multi_society_Practice.94547.aspx
Hosts: Patrick Georgoff, MD and Jayne McCauley, MD
In this episode (the last of the series) we cover the management of blunt injury to the solid organs…the liver, spleen, and kidney. DOMINATE THE DAY.
References:
- Nonoperative management of blunt hepatic injury: An Eastern Association for the Surgery of Trauma practice management guideline (https://www.east.org/education/practice-management-guidelines/hepatic-injury-blunt-selective-nonoperative-management-of)
- Western Trauma Association/Critical Decisions in Trauma: Operative Management of Adult Blunt Hepatic Trauma (https://www.westerntrauma.org/algorithms/PublishedAlgorithms/WTACriticalDecisionsOperativeManagementOfAdultBluntHepaticTrauma.pdf)
- Selective nonoperative management of blunt splenic injury: An Eastern Association for the Surgery of Trauma practice management guideline (https://www.east.org/education/practice-management-guidelines/splenic-injury-blunt-selective-nonoperative-management-of)
- Western Trauma Association Critical Decisions in Trauma: Management of adult blunt splenic trauma—2016 updates (https://westerntrauma.org/documents/PublishedAlgorithms/WTACriticalDecisionsAdultBluntSplenicTrauma-2016Update.pdf)
- Western Trauma Association Critical Decisions in Trauma: Management of renal trauma (https://westerntrauma.org/documents/PublishedAlgorithms/WTACriticalDecisionsManagementOfRenalTrauma.pdf)
Hosts: Patrick Georgoff, MD and Jayne McCauley, MD
This…episode….covers…rib…fractures…sorry, I am splinting. Was that a fever? Am I developing pneumonia?! Could this have been avoided with regional anesthesia? Or surgical fixation? Tune in to find out everything you need to know about the management of rib fractures.
References:
- Kasotakis G, Hasenboehler EA, Streib EW, et al. Operative fixation of rib fractures after blunt trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2017; 82:618.
- Carver TW, Milia DJ, Somberg C, et al. Vital capacity helps predict pulmonary complications after rib fractures. J Trauma Acute Care Surg. 2015 Sep;79(3):413-6.
- Galvagno SM Jr, Smith CE, Varon AJ, et al. Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society. J Trauma Acute Care Surg. 2016 Nov;81(5):936-951.
- Cheema FA, Chao E, Buchsbaum J, et al. State of Rib Fracture Care: A NTDB Review of Analgesic Management and Surgical Stabilization. Am Surg. 2019 May 1;85(5):474-478.
- Pieracci FM, Leasia K, Bauman Z, et al. A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (Chest Wall Injury Society NONFLAIL). J Trauma Acute Care Surg. 2020;88(2):249.
- Pieracci FM, Coleman J, Ali-Osman F, et al. A multicenter evaluation of the optimal timing of surgical stabilization of rib fractures. J Trauma Acute Care Surg. 2018;84(1):1.
Host: Patrick Georgoff, MD with special guest Bryan Cotton, MD, Professor of Surgery at McGovern Medical School at the University of Texas in Houston, and Ethan Taub, MD, Assistant Professor of Surgery at McGovern Medical School at the University of Texas in Houston.
This is part 2 of complex case discussions. In this episode, we discuss the management of complex trauma cases with Dr. Bryan Cotton and Dr. Ethan Taub. Learn how to manage pericardial tamponade, subclavian injuries, and expanding zone I hemorrhage. Are you not entertained!?
Host: Patrick Georgoff, MD with special guest Bryan Cotton, MD, Professor of Surgery at McGovern Medical School at the University of Texas in Houston and Ethan Taub, MD, Assistant Professor of Surgery at McGovern Medical School at the University of Texas in Houston.
This is part I of complex case discussions. In this episode, we discuss the management of complex trauma cases with Dr. Bryan Cotton and Dr. Ethan Taub. Learn how to manage pericardial tamponade, subclavian injuries, and expanding zone I hemorrhage. Are you not entertained!?
This episode covers all things TBI. It’s a perfect review for the non-neurosurgeon.
References:
- ACS TQIP Best Practices in the Management of TBI (https://www.facs.org/-/media/files/quality-programs/trauma/tqip/tbi_guidelines.ashx)
- Brain Trauma Foundation guidelines (https://braintrauma.org/guidelines/guidelines-for-the-management-of-severe-tbi-4th-ed#/)
This episode covers spinal cord injury, including cervical spine clearance and pre-hospital, ED/trauma bay, and ICU management. Guaranteed to give you the confidence you need to appropriately toss that ill-fitting cervical collar in the trash.
References:
- NEXUS criteria: https://www.mdcalc.com/nexus-criteria-c-spine-imaging
- Canadian C-spine rule: https://www.mdcalc.com/canadian-c-spine-rule
- EAST guidelines: https://www.east.org/education/practice-management-guidelines/cervical-spine-collar-clearance-in-the-obtunded-adult-blunt-trauma-patient
- Inaba et al. Cervical spinal clearance: A prospective Western Trauma Association Multi-institutional Trial. J Trauma Acute Care Surg 2016 (https://www.ncbi.nlm.nih.gov/pubmed/27438681)
In this episode, we talk about gun violence in America. We cover gun violence statistics, the second amendment, current gun laws, the research conundrum, and gun policy with a focus on background checks, assault weapons, and public opinion. We also discuss recommendations from the American College of Surgeons.
References:
- Rand Corporation: The Science of Gun Policy (https://www.rand.org/pubs/research_reports/RR2088.html)
- American College of Surgeons Firearm Strategy Team (FAST) workgroup recommendations (https://www.journalacs.org/article/S1072-7515(18)32155-0/pdf)
Big T Trauma Series Ep. 4 - TEG and Anticoagulant Reversal
This is part II of trauma resuscitation. In this episode we cover TEG and anticoagulant reversal. We worked hard to keep things practical and clinically relevant - perfect for listeners who want to dominate their next trauma resuscitation.
Hosts: Patrick Georgoff, MD and Jason Brill, MD
This is part I of trauma resuscitation. In this episode we cover transfusion medicine from a trauma surgery perspective. Whole blood, 1:1:1, massive transfusion…it’s all here.
Hosts: Patrick Georgoff, MD and Teddy Puzio, MD
This episode covers all things REBOA, including indications, practical tips and tricks, and complications. Don’t be shy – have a listen.
References:
- Joseph et al. Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. JAMA Surgery 2019 (https://www.ncbi.nlm.nih.gov/pubmed/30892574)
- Brenner et al. Use of Resuscitative Endovascular Balloon Occlusion of the Aorta for Proximal Aortic Control in Patients With Severe Hemorrhage and Arrest. JAMA Surgery 2018 (https://www.ncbi.nlm.nih.gov/pubmed/28973104)
- Brenner et al. Resuscitative Endovascular Balloon Occlusion of the Aorta and Resuscitative Thoracotomy in Select Patients with Hemorrhagic Shock: Early Results from the American Association for the Surgery of Trauma's Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery Registry. J Am Coll Surg 2018 (https://www.ncbi.nlm.nih.gov/pubmed/29421694)
Neck trauma
Hosts: Patrick Georgoff, MD and Jayne McCauley, MD
The inaugural episode of the BIG T TRAUMA series! This series will offer clinically oriented material that focuses on how best to care for traumatically injured and critically ill patients. The information presented in this podcast is designed for surgical trainees but is appropriate for anyone with an interest in trauma surgery, including medical students, advanced practice providers, and nurses.
This episode will cover neck trauma, and includes important learning points related to blunt and penetrating injury. Demystify neck trauma today!!!
References:
- Burlew et al, J Trauma 2012, Blunt cerebrovascular injuries: Redefining screening criteria in the era of noninvasive diagnosis (https://www.ncbi.nlm.nih.gov/pubmed/22327974)
- Biffl et al, J Trauma 1999, Blunt carotid arterial injuries: implications of a new grading scale (https://www.ncbi.nlm.nih.gov/pubmed/10568710)
- EAST guideline: Clinical Practice Guideline: Penetrating Zone II Neck Trauma (https://www.ncbi.nlm.nih.gov/pubmed/18469667)
- East guideline: Blunt Cerebrovascular Injury Practice Management (https://www.ncbi.nlm.nih.gov/pubmed/20154559)
Leaders in clinical and health services research discuss keys to success in this collaborative effort between BTK and The Association for Academic Surgery. In this episode, Drs. Fabian Johnston and Stephanie Bonne have an engaging conversation with Dr. Clifford Ko about improving quality of surgical care through with a robust health services research program.
Dr. Peter Angelos is an endocrine surgeon and medical ethicist at the University of Chicago. He answers our questions regarding the ethical and moral obligations and implications during the struggles of this pandemic.
Dr. Sharmila Dissanaike discusses the stress that the surgical residents and attending are facing in this unprecedented times. Listen in for techniques that can help you and your close ones navigate through emotions and manage stress in a productive manner.
Dr. Mayur Narayan associate professor of surgery at Weill Cornell Medical Center, describes his early experience managing a SICU full of COVID-19 + positive patients.
Dr. Patrick Georgoff, critical care fellow, and frequent Behind The Knife contributor joins us to help break down the critical care aspects of COVID-19.
Resources
SCCM Covid guidelines: http://www.med.umich.edu/surgery/mcccn/documents/SSC-COVID19-Critical-Care-Guidelines.pdf
DOD Covid guidelines: http://www.med.umich.edu/surgery/mcccn/documents/DoD-COVID-19-Practice-Management-Guide-V10
JAMA treatment synopsis: https://jamanetwork.com/journals/jama/fullarticle/2763879?guestAccessKey=8e645e9d-64dc-436c-8f59-d0dd83afb7d9&utm_content=weekly_highlights&utm_term=032820&utm_source=silverchair&utm_campaign=jama_network&cmp=1&utm_medium=email
Michigan Critical Care Collaborative Network: http://www.med.umich.edu/surgery/mcccn/
MGH Treatment Guide: http://www.med.umich.edu/surgery/mcccn/documents/MGH-Guide-for-COVID-Patients.JPG
Behind the Knife joins Cal Walters on his podcast "Intentional Living and Leadership" to discuss leading in a healthcare crisis with two veteran physicians that have served on multiple combat tours to Iraq and Afghanistan.
If you are interested in becoming a better leader or living a more intentional life, please check out Cal's podcast. Highly recommend.
https://www.calwalters.me/
Intentional Living and Leadership
Dr. Tom Hustead graduated from West Point in the top 3% of his class and received his medical degree from Case Western University School of Medicine. As a retired Army Colonel, highlights from his distinguished career include deployments to Iraq and Afghanistan, being awarded Flight Surgeon of the Year for his service in combat, Outstanding Faculty of the Year for his medical teaching, and board selection as Department Chair for a family medicine residency department. As a result of his appointment by the Army Surgeon General to be the “face of military medicine” to recruit and share the Army Medicine story, Dr. Hustead recognized a need and developed a passion for teaching physicians across the country to be effectively engaged leaders. In his final appointment in the military, Dr. Hustead was the commander/CEO of a NATO military medical facility at the Supreme Headquarters Allied Powers Europe in Belgium. Dr. Hustead currently practices as a family physician at Hardin Memorial Health and serves as Medical Director for their employed medical group. Dr. Hustead also co-founded The Referent Group, which provides leadership training, coaching, and resources for healthcare leaders. With an emphasis on servant leadership, Dr. Hustead’s core conviction is that effective leadership is never about the leader, but is focused in creating a culture where those being led can flourish
Dr. Scott Steele is the Chair of Colorectal Surgery at Cleveland Clinic in Cleveland, OH. As a graduate of West Point, he was an active duty Army officer, serving as the Chief of Colorectal Surgery at Madigan Army Medical Center, Fort Lewis, WA. He has served 4 combat tours in Iraq and Afghanistan, being awarded the Combat Medical Badge amongst others. His contributions to the medical literature include over 140 peer-reviewed articles, 60 invited reviews and book chapters, 12 national practice parameters, guest editor for 5 volumes dedicated to colorectal disease, and currently is an editor on 4 textbooks in colorectal surgery.
We recorded this interview on March 28, 2020, a time when our nation’s entire medical ecosystem is mobilizing for war against the COVID-19 pandemic. While many Americans are working from home to blunt the spread of the virus, healthcare clinicians and administrators are working around the clock to prepare for the coming tsunami of patients. The scope and the scale of the coming fight is unprecedented in the healthcare community.
Check out Dr. Patrick Georgoff's Youtube video that describes in more detail the basics of managing a ventilator.
https://youtu.be/RHx-p5RFoaA
Some great resources tagged below:
ARDSnet ventilator protocols:
http://www.ardsnet.org/files/ventilator_protocol_2008-07.pdf
Caring for the COVID pt from JAMA
https://jamanetwork.com/journals/jama/fullarticle/2762996
Critical information on COVID-19 and how it impacts us as surgeons, and how we can help in the fight.
Dr. Sharmila Dissanaike – Chair of the Texas Tech Department of Surgery
-Discusses preparing her department of surgery for COVID
Dr. Angela Hewlett – Medical Director of the Nebraska Biocontainment Unit
-Breaks down the basics of this virus from an ID perspective
Dr. Christian Jones – Director of the Acute Care Surgery Fellowship at Johns Hopkins
-Discusses how we can safe when managing these patients
Dr. Vahagn Nikolian – Fellow At Columbia University in Abdominal Wall Reconstruction
- Discusses how to implement telemedicine into practice
Corona Virus Info
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emcrit.org/ibcc/covid19/
Johns Hopkins Corona Virus Map
https://coronavirus.jhu.edu/map.html
How to properly put on and remove PPE (seems silly but is important)
https://www.youtube.com/watch?v=CChf0-enyp0
Resources for learning about Vents
Propofology.com/non-icu.html
Episode 2 of 6 of our vascular trauma series collaboration with Audible Bleeding. Kevin and Adham discuss the management of abdominal arterial vascular injuries with Dr. Rasmussen
If you want to read more about vascular trauma, please refer to
Rich's Vascular Trauma
https://www.elsevier.com/books/richs-vascular-trauma/9781455712618
Join us for our 14th joint Journal Club with Annals of Surgery! We discuss a brand-new set of guidelines from the American Association of Endocrine Surgeons to help keep us up-to-date on thyroid disease. This episode's guest authors are Dr. Kepal Patel, the Director of Endocrine Surgery at NYU, and Dr Herb Chen, the Chair of Surgery at UAB. They are two of the authors of "Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults" Access the executive summary free of charge here: https://journals.lww.com/annalsofsurgery/Fulltext/2020/03000/Executive_Summary_of_the_American_Association_of.1.aspx And the full set of guidelines here: https://journals.lww.com/annalsofsurgery/Fulltext/2020/03000/The_American_Association_of_Endocrine_Surgeons.28.aspx
Recorded a few years ago for ABSITE and one of our first reviews, but these are truly your tips and tricks to get you those few extra points!
Dominate the ABSITE!
Check out our book: https://amzn.to/379rGtR
We review high-yield miscellaneous topics for the ABSITE, including: peritoneal dialysis catheters, sarcoma, and melanoma.
Check out our book: https://amzn.to/379rGtR
We discuss a wide range of high-yield thoracic topics for the ABSITE and General Surgery Boards. These include anatomy, benign/malignant pathology, and trauma.
Thoracic is not currently part of our ABSITE review Podcast Companion, but will be added in future editions.
Thanks for listening!
Quick hits for those ABSITE hernia questions. Once again we apologize for the audio quality, but unfortunately we were recording 100s of miles apart!
https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion-ebook/dp/B082MKW2VR
Another great ABSITE Review! Dr. Martin joins us once again to review Fluids, Electrolytes, and the terrifying Acid/Base!
Quick hits and tips to get you through these questions!
We do apologize for the overall audio quality! We were spread out over a couple states and sometimes talk over one another.
https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion-ebook/dp/B082MKW2VR
Dr. Matthew Martin takes through another thorough review of critical care. Part 2 up next.
Make sure to download our ABSITE Podcast Companion and review the notes a few times before your exam!
Here it is one more complete hour of us getting quizzed by Dr. Martin on pertinent trauma topics on the ABSITE.
-Pancreas, Vascular, Pelvis, Retroperitoneum, Pregnancy and Children + Quickfire
If you don't know Dr. Matthew Martin. He is a trauma and critical care surgeon in both Tacoma WA and Portland OR. He is the director of Madigan trauma and also a co-moderator of the EAST Traumacast.
Dr. Matthew Martin joins us today to take us head to toe in the trauma patient and highlights key testable points.
Be sure to join in next week for Part 2 where he takes us through a quick fire session to to sharpen your skills before the ABSITE.
Additionally we recorded a fantastic critical care review with him that we will be releasing next week.
We review high yield hematology, to include: acquired and congenital bleeding and clotting disorders, blood products, and anticoagulants.
Make sure to download our ABSITE podcast companion here!
We review high yield breast topics, to include: high yield anatomy, benign breast disease, and management of breast cancer and the axilla.
Make sure to download our ABSITE podcast companion here!
We review high-yield vascular topics for ABSITE, including: peripheral aneurysms, peripheral vascular disease, fasciotomies, diabetic foot infections, and venous disease.
https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion-ebook/dp/B082MKW2VR
We review high-yield vascular topics for the ABSITE, including: carotid disease, vascular access, thoracic aorta, thoracic outlet, and acute mesenteric ischemia.
https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion-ebook/dp/B082MKW2VR
Subscribe to our mailing list here http://eepurl.com/df5OTr
Please subscribe on iTunes/Spotify/Google Play and rate the podcast!
Colorectal part 2 ABSITE review.
Check out our book on Amazon https://amzn.to/2uCtn4l
Colorectal part 1 with the Behind The Knife Team.
Check out our book on amazon. https://amzn.to/2uCtn4l
Everyone's back for this episode on high-yield pancreas topics. We discuss everything from up to date management of pancreatitis, peri-pancreatic fluid collections, pancreatic tumors of all varieties and finally we give the usual quick hits.
Get the BTK ABSITE Podcast Companion here!
Jason Bingham, Kevin Kniery, John McClellan and Woo Do review high-yield adrenal topics for the ABSITE, including: hyperaldosteronism, Cushing syndrome, congenital adrenal hyperplasia, adrenal incidentaloma, adrenocortical carcinoma, pheochromocytoma.
Review the congenital adrenal hyperplasia mnemonic here.
Get the BTK ABSITE Podcast Companion here!
We continue with high-yield hepatobiliary, to include: cystic lesions and tumors of the liver and biliary tree. Don't forget to download our ABSITE Podcast Companion on Amazon at https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion-ebook/dp/B082MKW2VR/ref=sr_1_1?keywords=behind+the+knife&qid=1578444510&sr=8-1
We discuss high yield topics related to the liver and biliary tree, to include: benign biliary disease, portal hypertension, and liver abscesses. Our ABSITE Podcast Companion is available at https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion-ebook/dp/B082MKW2VR/ref=sr_1_1?keywords=behind+the+knife&qid=1578444510&sr=8-1
We review high-yield topics related to the spleen, to include: splenic trauma, hematologic disorders, splenic lesions, splenic artery aneurysms, and post-splenectomy infection.
Subscribe to our mailing list here: http://eepurl.com/df5OTr
We review high-yield topics related to the stomach, to include: hiatal hernias, gastroduodenal ulcer disease, GERD, post-gastrectomy syndromes, and gastric cancer.
Subscribe to our mailing list here: http://eepurl.com/df5OTr
We discuss high-yield topics related to the esophagus, to include: esophageal perforation, motility disorders, diverticula, Barrett's esophagus, and esophageal cancer.
We discuss high-yield parathyroid topics, to include: PTH, calcitonin, hypercalcemia, hyperparathyroidism (primary vs. secondary vs. tertiary), and parathyroid cancer.
We discuss high-yield thyroid topics, to include: hyperthyroidism, Grave's disease, toxic multinodular goiter, thyroiditis, workup of the palpable thyroid nodule, and thyroid cancer (papillary vs. follicular vs. medullary).
We discuss high-yield head and neck anatomy, squamous cell cancer, salivary gland tumors, melanoma, and the diagnostic dilemma of the unknown primary tumor with regional metastasis.
Exciting news! Many of you have asked for a written version of our popular ABSITE review series, well we came through with an ebook podcast companion. Get it here https://amzn.to/34eOkyr If you rely on BTK for ABSITE this companion is a must have. New ABSITE episodes coming soon!
Dr. Brendan Moran discusses HIPEC and cytoreductive surgery principles. Listen up to this very educational episode and interesting talk about HIPEC study and controversies.
Join us for our 13th joint Journal Club with Annals of Surgery! We discuss how to get patients better, faster with a surgery-first approach to gallstone pancreatitis. This episode's guest authors are Dr. Krislynn Mueck, a general surgery resident at the University of Texas Health Science Center, and Dr Lillian Kao, the Jack Mayfield, MD Chair in Surgery and Division Chief of Acute Care Surgery at the University of Texas Health Science Center in Houston. We discuss their paper, "Gallstone Pancreatitis: Admission versus Normal Cholecystectomy – a Randomized Trial." Access the paper free of charge here: https://journals.lww.com/annalsofsurgery/Abstract/2019/09000/Gallstone_Pancreatitis__Admission_Versus_Normal.14.aspx
Rounding out our week of interviews with pediatric surgeons who have unique stories, Woo and Meghana chatted with Dr. Don Nakayama about surgical history. He provides multiple narratives about the history of our field, and it's an episode you don't want to miss!
Continuing in our interview of leaders in pediatric surgery we sat down with Dr. Henri Ford to talk about his life, career, and spectacular work in Haiti. Check out our other interviews with leaders in global surgery when you're done! http://behindtheknife.libsyn.com/global-surgery-with-dr-john-meara-and-dr-mark-shrime http://behindtheknife.libsyn.com/global-surgery-part-ii-with-dr-robert-riviello http://behindtheknife.libsyn.com/global-surgery-in-a-civil-war-zone-with-doctors-without-borders-dr-james-peck http://behindtheknife.libsyn.com/149-lifebox-and-safe-surgery-with-dr-alex-haynes
This week, we present 3 interviews with leaders in pediatric surgery of varying expertise. First up, an interview with Dr. Michael Harrison, 'Father of Fetal Surgery'. He walks us through his career and how he developed an entire surgical sub-specialty. When you're done, check out our previous episodes on fetal surgery featuring Dr. Darrell Cass and Dr. Diana Farmer! http://behindtheknife.libsyn.com/fetal-surgery-with-dr-darrell-cass http://behindtheknife.libsyn.com/diana-farmer-md-uc-davis-women-in-surgery-fetal-surgery-hirschsprungs
With Patrick Georgoff (georgoff@gmail.com)
and Teddy Puzio (thaddeus.j.puzio@uth.tmc.edu)
With Patrick Georgoff (georgoff@gmail.com)
and Ben Jacobs (benjaminnormanjacobs@gmail.com)
With Patrick Georgoff (georgoff@gmail.com) and Craig Brown (brcraig@med.umich.edu). Chasing My Cure by Dr. David Fajgenbaum: https://www.amazon.com/dp/B07LDTZBBD/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1. A MUST READ!!!
With Patrick Georgoff (georgoff@gmail.com)
and Teddy Puzio (thaddeus.j.puzio@uth.tmc.edu)
Episode 2 is focused on pediatric surgical diseases
Patrick Georgoff is a trauma surgery fellow at UT Houston Red Duke Trauma Institute.
Joseph Church is a pediatric surgery fellow at The University of Michigan.
They can be reached at
Patrick.E.Georgoff@uth.tmc.edu
jchurch@umich.edu
Episode 1 is focused on diseased of the esophagus.
Patrick Georgoff is a trauma surgery fellow at UT Houston Red Duke Trauma Institute.
Vahagn Nikolian is a MIS fellow focused on complex abdominal wall repair at Columbia University Medical Center.
They can be reached at
georgoff@gmail.com
vahagn.nikolian@gmail.com
SCORE 2018-2019 curriculum: http://www.absurgery.org/default.jsp?scre_booklet
In our 12th joint Journal Club with Annals of Surgery, we have a fascinating discussion about the applications of telemedicine and new technology in the care of surgical patients! Our guest author is Dr. Shimul Shah, Professor and Director of Solid Organ Transplantation at the University of Cincinnati, discussing his team's ASA Paper "Telemedicine Based Remote Home Monitoring After Liver Transplantation: Results of a Randomized Controlled Trial." We are also joined by guest moderator Dr. Chad Ellimoottil, Assistant Professor of Urology and Director of the Telehealth Research Incubator at the University of Michigan. Access the paper free of charge here: https://journals.lww.com/annalsofsurgery/Citation/2019/09000/Telemedicine_Based_Remote_Home_Monitoring_After.19.aspx
Dr. Jeff Punch-- Global transplant surgery
Dr. Peter Liou-- Multi-visceral transplant
Dr. Lisa Johannesson-- Uterus Transplant
Dr. Rob Montgomery and Dr. Charles Rickert take us through their personal experiences of transplant donation and cutting edge research.
Dr. Satish Nadig and Dr. Daniela Ladner take us through the different types of rejections and IS medications.
Dr. Lisa McElroy and Dr. Adeel Khan take us through the work up on most common post transplant complications.
Dr. Josh Mezrich and Dr. Majella Doyle take us through the journey of taking through the transplant call and operations!
Dr. Arika Hoffman and Dr. Vincent Casingal walk us through our first kidney and liver patient scenarios and tips to remember in a pre-transplant setup.
BTK and ASTS join forces to discuss some of major hot topics of Transplant surgery, discuss the interesting and unique lives of some expert surgeons in this field for an entire month!
Join us for our 11th joint Journal Club with Annals of Surgery. In this episode, Dr. Francesco Squizzato, vascular surgeon at the University of Padova in Italy, joins us to discuss his randomized clinical trial "A Preventive Program for Work-related Musculoskeletal Disorders Among Surgeons." Access the paper free of charge here: https://journals.lww.com/annalsofsurgery/Abstract/publishahead/A_Preventive_Program_for_Work_related.95252.aspx If you want to try some of the exercises, you can learn about them here: http://links.lww.com/SLA/B570
Our final "Hot Topic" is Ergonomics. We are joined by Dr. Scott Hollenbeck (@sth_43206), plastic surgeon at Duke University, and Marissa Pentico, occupational therapist and ergonomist who started an ergonomics program in conjunction with the Duke chief residents. Learn what interventions you can implement in your practice to extend your surgical career and prevent musculoskeletal injuries!
https://www.safety.duke.edu/ergonomics/stretches-and-exercises
https://surgery.duke.edu/news/duke-surgery-introduces-ergonomics-program-improve-surgeon-health
https://youtu.be/Q17oHAP0HCk
We are rounding out the month with the 2nd half of our Hot Topics in Surgery series. Next up, a powerful speech by Adam Foss, Esq. from the American Pediatric Surgery Association meeting in May. He speaks about social and systemic factors that influence the care and outcomes of our patients. We hope listening to this will be as thought-provoking and uncomfortable as it was in person. Listen to his TED Talk: https://www.ted.com/talks/adam_foss_a_prosecutor_s_vision_for_a_better_justice_system?language=en
Episode 1 of 5 of our Vascular Trauma Series- Peripheral Vascular Trauma
Dr. Rasmussen is a Colonel in the United States Air Force and is a Professor of Surgery and Associate Dean of Research at the Uniformed Services University of Health Sciences and an attending vascular surgeon at Walter Reed National Military Medical Center. Dr. Rasmussen has been deployed numerous times to Iraq and Afghanistan, and cared for many traumatic vascular injuries at Walter Reed Medical Center, through his experience and research he has become one of the foremost leaders on the management of vascular trauma and recently published the third edition of Rich’s Vascular Trauma. Episode 1: Damage control vascular surgery of the injured extremity Episode 2: Damage control vascular surgery surgery of the torso Episode 3: Endovascular techniques to manage vascular injury Episode 4: REBOA Episode 5: Cervical carotid and vertebral artery management
If you are interested in a podcast focused on Vascular Surgery be sure to check out Audible Bleeding on all streaming platforms.
Continuing our series on the latest topics in surgery, we have a assembled a fantastic panel of guests to talk about fertility and family planning. Joining us are Dr. Arghavan Salles (@arghavan_salles), Dr. Emily Jungheim (@EmilyJungheim), and Dr. Melissa Levack. We hope this episode will be thought-provoking and lead to further discussions within our surgical community about work-life considerations!
https://www.kmov.com/news/more-and-more-women-turn-to-egg-freezing-to-pause/article_14b7d3b2-2b60-11e9-bfdc-2f9629fceea3.html http://time.com/5484506/fertility-egg-freezing/
Next up in our series on the hot topics in surgery, we are joined by Dr. Michael Englesbe to discuss the opioid epidemic. He takes us through some of the statistics and provides an excellent Tips & Tricks on how much we should actually be prescribing after specific surgeries. https://www.opioidprescribing.info/ http://michigan-open.org/
Dr. Laurie Punch gives us an excellent grand rounds on how to care for the trauma patient injured by firearm, and educates us on the social considerations of gun violence. Resources provided by Dr. Punch: https://journals.lww.com/jtrauma/Abstract/2016/10000/Effect_of_time_to_operation_on_mortality_for.9.aspx https://www.nejm.org/doi/10.1056/NEJMsr1804754 https://highline.huffingtonpost.com/articles/en/gun-violence/ https://journals.lww.com/jtrauma/Abstract/2016/09000/The_AAST_prospective_Aortic_Occlusion_for.1.aspx https://health.ucdavis.edu/what-you-can-do/risk-factors.html https://time.com/5645747/gun-violence-mental-illness/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4984734/ https://www.washingtonpost.com/news/wonk/wp/2018/06/19/there-are-more-guns-than-people-in-the-united-states-according-to-a-new-study-of-global-firearm-ownership/?noredirect=on https://affirmresearch.org/ https://www.injuryjournal.com/article/S0020-1383(17)30576-4/fulltext https://mphdegree.usc.edu/blog/guns-as-a-public-health-issue/ https://www.sprc.org/resources-programs/calm-counseling-access-lethal-means http://cureviolence.org/ http://besmartforkids.org/ http://nnhvip.org/ https://uk.reuters.com/article/us-health-emergency-bleeding/homemade-kits-with-tourniquets-make-gunshot-first-aid-more-available-idUKKCN1S12QK?feedType=RSS&feedName=healthNewsMolt https://lawcenter.giffords.org/gun-laws/policy-areas/who-can-have-a-gun/extreme-risk-protection-orders/ https://www.youtube.com/watch?v=TlW8cvzt_5Y
Kicking off the first of our series on the latest topics in surgery, we begin with a point-counterpoint style discussion with Dr. Brendan Campbell, a member of the ACS committee on trauma FAST workgroup, and Dr. Joseph Sakran, a prominent advocate for firearm injury prevention. This episode was recorded at the APSA 2019 Annual Meeting with a bonus full length recording of Dr. Sakran's guest presentation from the meeting. FAST Workgroup Recommendations: https://www.journalacs.org/article/S1072-7515(18)32155-0/fulltext
Rounding out our miniseries interviewing authors, we had the pleasure of interviewing Dr. Stephen Bergman who you may know as Samuel Shem, author of House of God.
His upcoming sequel to House of God will be released in November: https://www.amazon.com/Mans-Best-Hospital-Samuel-Shem/dp/1984805363
The STAT article he referenced: https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/
His Boston Globe article posted on his website: http://www.samuelshem.com/v2/what-it%e2%80%99s-like-in-a-country-without-war/
Dr. Carol Scott-Conner is a prolific surgeon writer whose first publication, Operative Anatomy, is a fantastic textbook for junior residents to prepare for cases. She talks to us about writing, her work as a consultant with NASA, and provides an excellent T&T segment on lymphedema. We hope you enjoy this episode!
Dr. Seymour Schwartz, the namesake of Schwartz's Principles of Surgery, joins us to talk about his life, the history of surgery, and the history of his textbook. He is an excellent speaker with an interesting life story. Listen in for fantastic advice to today's surgical trainees! This is part of our AccessSurgery give away. Follow @ABSITEQofWeek and look out for a question related to this episode on Wednesday, July 24th at 9PM EST. 2-3 winners will receive a free copy of Schwartz's Principles of Surgery, 11th edition!
Frequent friend of BTK, Dr. Lillian Kao (@LillianKao1) is the first female editor of Schwartz's Principles of Surgery and joins us to talk about her experience with editorial duties. She gives us great advice on authorship and how to get into editorial roles and reviewing papers.
This episode is part of our collaboration with AccessSurgery so look out for the quiz about this episode on Wednesday, July 17th, 2019 on @ABSITEQofWeek. Winners will receive a free copy of Principles of Surgery!
Title: Annals of Surgery Journal Club #10: Ventral Hernia Repair
Join us for our 10th joint Journal Club with Annals of Surgery. This time our guest author is Dr. Todd Heniford, Chief of GI and Minimally Invasive Surgery at Carolinas Medical Center, director of the Carolinas Hernia institute, and a well-known expert in the field of abdominal wall resection. We also have a guest moderator, Dr. Dana Telem (@DanaTelem), who is Associate Professor of Surgery and director of the Comprehensive Hernia Program at the University of Michigan.
Dr. Heniford is lead author of a new study on the preperitoneal method of ventral hernia repair, published recently in Annals: https://journals.lww.com/annalsofsurgery/Abstract/publishahead/Preperitoneal_Ventral_Hernia_Repair__A_Decade_Long.95443.aspx Join us for a great discussion of ventral hernia decision-making and technique with two leading experts!
In this episode we hear from the President Elect, President of Dukes' Club and Dr. John Monson.
Enjoy!
ACPGBI Day 2: Excellent interviews with Dr. Brendan Moran, Dr. Dale Vimalachandran, Dr. Ian Jenkins, Dr. Roel Hompes and more.
We talked about TA-TME, advanced rectal cancer, pelvic recurrences, and watch and wait lecture by Dr. Per Nilson.
Enjoy!
Association of Coloproctology of Great Britain and Ireland Annual Conference 2019 @ Dublin, Ireland.
Dr. Steele and Shreya cohost live from Dublin. Great recap and highlights from Day 1, interviews with world experts, lecture by Dr. Mike Solomon, and innovations and research talks with trainees.
Enjoy!
Dr. Monica Morrow is THE expert on breast cancer and gives us a very thorough discussion of the most confusing topics in the management of breast cancer and axillary disease. This is a must listen for all residents and general surgeons alike!
This very timely podcast post Surgical Oncology match discusses some key findings on the match process and takes us into the future of oncology research and how surgeons are making history.
Ever wondered how Behind the Knife came to fruition? Jason was a guest on Beyond Clean (@BeyondCleanInfo), a podcast about surgical instrument processing, and spends a few minutes answering that question. Most of us don't pay attention to what happens to our instruments after we use them in the OR, so take a listen to Beyond Clean and their well-made podcasts! beyondclean.net
Join us for our 9th joint Journal Club with Annals of Surgery. This time our guest author is Dr. Elizabeth Elsey, a general surgery chief resident in in the UK's East Midlands, and a former PhD fellow of the UK’s National Institute for Health Research (@lizzyelsey). We are also joined by guest host Dr. Brian George, Assistant Professor of Surgery at the University of Michigan, as well as the Director of Educational Research at Michigan's Center for Health Outcomes and Policy (@bcgeorge).
Dr. Elsey was lead author of a new study on the development of autonomy among British general surgery residents, published recently in Annals: https://journals.lww.com/annalsofsurgery/Fulltext/2019/03000/Changing_Autonomy_in_Operative_Experience_Through.3.aspx Join us for a thought-provoking discussion of residency training on both sides of the Atlantic!
Woo Do (@woosongdo) and Meghana Kashyap (@PubMEG) cover the American Pediatric Surgical Association's 50th Anniversary Meeting. In this episode, we hear experts debate the pros and cons of the profession of pediatric surgery, as they seek to answer the question: "Would I encourage my daughter or son to become a pediatric surgeon?"
Woo Do (@woosongdo) and Meghana Kashyap (@PubMEG) cover the American Pediatric Surgical Association's 50th Anniversary Meeting. In this episode, we hear from Dr. Keith Ashcraft, one of pediatric surgery's key historical figures.
Woo Do (@woosongdo) and Meghana Kashyap (@PubMEG) cover the American Pediatric Surgical Association's 50th Anniversary Meeting. In this episode, we hear from Dr. Arnold Coran, one of pediatric surgery's key historical figures.
Woo Do (@woosongdo) and Meghana Kashyap (@PubMEG) cover the American Pediatric Surgical Association's 50th Anniversary Meeting. In this episode, we have a panel of leaders in pediatric surgery who happen to be women - Dr. Kathryn Anderson, Dr. Diana Farmer (@dianafarmermd), and Dr. Marion Henry (@mcwhmd). They talk about Benji Brooks, the first female pediatric surgeon, and how APSA has diversified over the years. Also in this episode is Dr. Mike Chen who talks about his experience as a patient and encourages us to truly perform patient-centered care.
Woo Do (@woosongdo) and Meghana Kashyap (@PubMEG) cover the American Pediatric Surgical Association's 50th Anniversary Meeting. In this episode, we hear from pioneers who revolutionized the care of children with anorectal malformations (Dr. Alberto Pena @DrsPenaBischoff) and pectus excavatum (Dr. Donald Nuss).
Woo Do (@woosongdo) and Meghana Kashyap (@PubMEG) cover the American Pediatric Surgical Association's 50th Anniversary Meeting. In this episode, we hear from leaders showcasing the Journal of Pediatric Surgery (@jpedsurg) Top Educational Content (TEC): - Dr. David Powell (pedsurglibrary.com) on 2018’s TEC - Dr. Aaron Jensen (@arjensenmd) on pediatric cervical spine management - Dr. Shawn Rangel (@ShawnRangelMD) on antibiotic stewardship - Dr. Samir Gadepalli (@SamirGadepalli) on sepsis as a surgical problem
Woo (@woosongdo) and Meghana (@PubMEG) sit down with Dr. Allan Goldstein (@MGHPedisurg) to talk about the surgeon-scientist and how a young surgeon can become a successful academic surgeon (https://t.co/PJdjl0BQyP). Dr. Todd Ponsky (@tponsky) talks about the development of the Stay Current in Pediatric Surgery app and podcast as a means to digest all the information out there, and provides a contrasting opinion about social media's utility in academia. Finally, Dr. Ron Hirschl (@Ronstoppable) provides insight into how he brought APSA's 50th Anniversary Meeting into the 21st century and how his program is working on resident/fellow autonomy.
Woo Do (@woosongdo) and Meghana Kashyap (@PubMEG) joined forces in Boston to cover the American Pediatric Surgery Association's 50th Anniversary Meeting. We will be publishing episodes from the meeting throughout the week in our #APSA50 Series. We hope you follow along to hear some incredible insight and interviews with pioneers and leaders of pediatric surgery.
Kicking off APSA week, we begin with a Grand Rounds installment. Dr. Diana Diesen, pediatric surgeon at Dallas Children's Hospital, presents everything you need to know about bilious emesis in the pediatric population. This is high yield information for those pediatric surgery questions on ABSITE, and simplified enough for rotating medical students to understand as well. Enjoy!
SECOND trial follows up on FIRST trial. Listen in to get the details on the structure and outcomes anticipated from this trial. Send in your queries or comments at the email address below:
second@northwestern.edu
For more information:
www.secondtrial.org
Join us for our 8th joint Journal Club with Annals of Surgery, and the last episode of our series on malpractice. This time our guests are Dr. Rajshri Gartland, a resident at Massachusetts General Hospital, and Dr. Keith Lillemoe, the Chief of Surgery at MGH and Editor-in-Chief of Annals of Surgery. They co-authored a new study on the prevalence and risk factors for malpractice claims around gallbladder surgery, published recently in Annals: https://journals.lww.com/annalsofsurgery/Fulltext/2019/05000/What_Have_We_Learned_From_Malpractice_Claims.1.aspx Join us to hear about the latest data on malpractice in surgery and what you can do to keep yourself and your patients safe during gallbladder surgery!
In the penultimate episode of our malpractice series, we interview Dr. Ruth Bush (@RuthLBush) who obtained her JD and provides insight on malpractice from the surgeon's perspective. As a bonus at the end, we Dr. Rolando Pinchetti (@rfap3) from Argentina joins us to talk about malpractice in his country.
Up next in our Malpractice Series, Dan Cavett from Cavvett & Fulton, P.C. (https://www.cavettandfulton.com/) joins us to provide real life cases he has defended and provide further advice on insurance and patient relations. This episode is full of scenarios relevant to our surgical sub-specialty colleagues, including Ob/Gyn and Neurosurgery, so we hope everyone learns something new!
Continuing in our Malpractice Series, we have Laura Biel (@LJBeil) on to talk about Dr. Death (@DrDeathWondery) and the lessons the podcast and case revealed about our healthcare system and physician peer reporting. If you haven't listened to the podcast, we strongly recommend listening to it prior to this episode (https://t.co/ltmr3gsHpo). An interesting read mentioned in this episode is the Dissenting Opinion, found here: https://images.law.com/contrib/content/uploads/documents/401/14203/duntsch-dissent.pdf
Michelle Ator is a medical malpractice attorney in Arkansas. She joins us for the first installment of our malpractice series to explain the fundamentals of malpractice litigation. If you have any follow up questions for her, she can be reached at mator@fridayfirm.com. The Medscape report mentioned in the intro: https://www.medscape.com/slideshow/2017-malpractice-report-6009206#1
Join us for our 7th joint Journal Club with Annals of Surgery. This time our guest is Dr. Chad Ball, a hepatobiliary and acute care surgeon and Associate Professor at the University of Calgary. He has pioneered a new single-stage approach for walled off pancreatic necrosis, "surgical transgastric necrosectomy," described in this Annals paper: https://journals.lww.com/annalsofsurgery/Abstract/publishahead/Surgical_Transgastric_Necrosectomy_for_Necrotizing.95399.aspx Join us to learn more the range of approaches to this challenging problem and new, exciting techniques! PS: For those interested, a video of laparoscopic transgastric necrosectomy can be found here: https://www.youtube.com/watch?v=VWPiaZpzAxQ
Dr. Charles Yeo, Chairman at SKMC at Thomas Jefferson University, discusses pancreatic cancer and shares his pearls of wisdom of the performing a Mini-Whipple in this enjoyable and informative episode.
Dr. Rebecca Sippel discusses a whole range of endocrine pathologies in this very educational episode!
Dominate the day
Dr. Jeffrey Marks, President of SAGES, walks us through the past, present and future of Minimally Invasive Surgery. He is one of the internationally known surgeons who leads advancements in the field like POEM. He gives us his views on surgical residency education and his tips/tricks on ERCP. Enjoy!
Join us for the 6th episode of our Journal Club with Annals of Surgery. This time we interview Dr. Susan Pories, of Harvard Medical School and Mt. Auburn Hospital, about her paper: Leadership in American Surgery: Women are Rising to the Top, coming out in Annals in February 2019. Coauthored with Drs. Patricia Turner, Caprice Greenberg, Maya Babu, and Sareh Parangi, the paper describes the rapid ascent of women surgeons to the highest leadership positions in American surgery. BTK listeners can access their paper free of charge here: https://journals.lww.com/annalsofsurgery/Citation/2019/02000/Leadership_in_American_Surgery__Women_are_Rising.3.aspx Join us as we discuss this exciting time for women in surgery, and what we need to do next to make surgical leadership as diverse and representative as possible.
Recorded a few years ago for ABSITE and one of our first reviews, but these are truly your tips and tricks to get you those few extra points!
Thanks everyone for all the support through ABSITE season.
The hard part is over, now you just have to take the test.
We review high-yield miscellaneous topics for the ABSITE, including: peritoneal dialysis catheters, sarcoma, and melanoma.
In the second part of our education mini-series, we had Dr. Lau (@jnlau67) discuss his recent RISE article on medical student mistreatment. https://www.facs.org/education/division-of-education/publications/rise/articles/student-mistreatment
As we wind down the year and gear up for ABSITE episodes, we wanted to end with tips on surgical education in our two-part mini-series. This first episode is with Dr. PJ Schenarts (@Schenartspj) on education during surgical crises.
Dr. Potts is a leader in surgical education, having taken on roles with the American Board of Surgery and currently with the ACGME. He is known to be open with his thoughts on surgical education, so we posed him some tough questions about 'Controversies in Surgical Education'. We hope you enjoy these stimulating topics!
Better late than never...we interviewed Dr. Bass (@ACSPastPrez98) prior to Clinical Congress and discussed her Presidency, the surgical simulation center she started at Houston Methodist, women in surgery, and breast abscesses.
Join us for the 5th episode of our joint Journal Club series with Annals of Surgery. This time our guest is Dr. Mark Besselink, Professor at the University of Amsterdam and founder of the Dutch Pancreatic Cancer Study Group. He led two new, practice-changing studies on laparoscopic distal pancreatectomy: 1) DIPLOMA, an observational study of laparoscopic vs. open distal pancreatectomy for pancreatic cancer focusing on oncologic outcomes: https://journals.lww.com/annalsofsurgery/Abstract/publishahead/Minimally_Invasive_versus_Open_Distal.95844.aspx 2) LEOPARD, a randomized controlled trial of laparoscopic vs. open distal pancreatectomy for any disease type: https://journals.lww.com/annalsofsurgery/Abstract/publishahead/Minimally_Invasive_Versus_Open_Distal.95444.aspx Join us as we discuss the findings of these studies, the learning curve for advanced surgical techniques, and why the Dutch are just so good at surgical clinical trials.
Dr. Thomas White joins us on behalf of the Chest Wall Injury Society to discuss the newest recommendations for rib fixation after chest trauma and the studies that back these recommendations. You can hear more from him on the CWIS Ribcasts at https://cwisociety.org/ribcasts/
We have another great abdominal transplant episode with Dr. Betsy Tuttle (@tuttlejebetsy), chair of surgery at East Carolina University. She goes through the very basics of transplant surgery, from the immunosuppressive medications to the behind the scenes process of organ donation. We hope this helps as you rev up your ABSITE studying!
Continuing in our Grand Round series, we have a presentation by Dr. Langenfeld (@SeanLangenfeld) to discuss uncomplicated diverticulitis. Dr. Langenfeld is Chief of Colorectal Surgery at the University of Nebraska Medical Center. Hope this helps as you rev up for ABSITE studying!
Clavien-Diendo Classification is familiar to all of us! We have Dr. Clavien here discussing his most recent work, comprehensive complication index.
Click on the link below to access the paper:
https://journals.lww.com/annalsofsurgery/Abstract/2018/11000/The_Comprehensive_Complication_Index__CCI___is_a.12.aspx
In this episode, we interview Dr. Paula Ferrada (@pferrada1) and cover a wealth of topics pertinent to trauma/critical care and surgical education. Her passion and optimism shines through, and we hope this episode motivates you as much as it did us!
Meghana and Shreya attended the Association for Women Surgeons 2018 annual conference and interviewed leaders of the organization- Dr. Celeste Hollands (@celestehollands), Dr. Sareh Parangi (@sarehparangiMD), and Dr. Sharon Stein (@slsteinMD1). We also spoke with Dr. Smita Sihag (@ssihag_msk) about her research and Professor Robert Bordone (@bobbordone) about the negotiation skills session he led. We apologize for the inconsistent audio quality in this episode.
Continuing with our Annals of Surgery Journal Club series, episode #3 is with Dr. Ron Maier, who joins us to discuss his presidential address. We are excited to publish this episode as Dr. Maier officially takes over as ACS president this month! Here are links to his articles:
-
https://journals.lww.com/annalsofsurgery/Citation/2018/09000/Our_Calling.2.aspx
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https://journals.lww.com/annalsofsurgery/Abstract/2018/09000/Ensuring_Equity,_Diversity,_and_Inclusion_in.3.aspx
Want to be a surgical oncologist? Want to be a surgeon-scientist? Are you a junior resident who wants to do research? Or just want to know what CDH-1 is?
Listen up to this informative episode featuring Dr. Jeremy Davis, Surgeon-in-Chief at National Institutes of Health, as he discusses all these topics and much more.
Fellowship in Surgical Oncology at NIH:
https://ccr.cancer.gov/training/clinical/surgical-oncology
Just in time for oral boards, we have another episode of our Mock Orals series. Dr. Langenfeld (@seanlangenfeld) takes our guest residents Jon Abelson (@jabelsonmd) and Paul Johnson (@dr_johnson2012) through 6 colorectal board scenarios.
We are two days before our oral boards, and this is what we are going to say for our surgical descriptions. We hope you find these helpful.
Big thanks to Geb Black, a Major in the US Army, and a trauma fellow at UT Southwestern.
&
Matt Smith a vascular surgery fellow at Cornell/Columbia combined fellowship in NYC.
Dr. Jennifer LaFemina leads our second grand rounds series with a wonderful update on the treatment and management of Melanoma.
Dr. LaFemina practices at UMass and is the Program Director of General Surgery as well as an Assistant Professor at the University of Massachusetts Medical School.
As mentioned, if anyone has other great ideas for topics and guests to lead our Grand Rounds series please let us know!
Dr. Tomoaki Kato is a true pioneer in multi-visceral transplant surgery. In this episode he discusses everything from intestinal transplantation, to ex-vivo surgery, and tips on portal vein reconstruction.
This is the second episode of our journal club series with Annals of Surgery. In this episode, Dr. Kaafarani will discuss his recent paper "Surgical Risk Is Not Linear: Derivation and Validation of a Novel, User-friendly, and Machine-learning-based Predictive OpTimal Trees in Emergency Surgery Risk (POTTER) Calculator," presented at the 2018 meeting of the American Surgical Association and recently published in Annals of Surgery.
The full text is currently available online, free of charge for Behind the Knife listeners: https://journals.lww.com/annalsofsurgery/Abstract/publishahead/Surgical_Risk_Is_Not_Linear___Derivation_and.95426.aspx Episode hosts: Shreya Gupta (@shrey3467), Meghana Kashyap (@pubMEG), Karan Chhabra (@krchhabra) You can download the calculator following this link:
http://jack.dunn.nz/nsqip-vis/question4.html
September is Suicide Awareness and Prevention Month, and we have an important episode on the topic featuring Robyn Symon and Dr. Pamela Wible to discuss the film Do No Harm (www.DoNoHarmFilm.com). Robyn Symon is the writer, producer, and director of Do No Harm. Dr. Wible is a family physician who is featured in the film for her commitment to physician suicide prevention. For tickets to the NY pre-screenings, go to: https://donoharm-ny.eventbrite.com To schedule a screening at your institution, email: info@DoNoHarmFilm.com Dr. Wible is available 24/7 at: http://www.idealmedicalcare.org/contact/ National Suicide Prevention Line: 1-800-273-8255 Dr. Wible's Keynote in Chicago referenced in the podcast: http://www.idealmedicalcare.org/33-orthopaedic-surgeon-suicides-how-to-prevent-34/ Previous Behind the Knife episodes addressing wellness and burnout with tips for surgeons are available: Dr. Taylor Riall on Burnout - http://www.behindtheknife.org/podcast/dr-taylor-riall-tackles-burnout-and-importance-of-coaching-surgeons/ Dr. Charles Brunicardi on Work-Life Balance - http://www.behindtheknife.org/podcast/dr-charles-brunicardi-surgeon-songwriter-performer/ Dr. Rothenberger on Burnout - http://www.behindtheknife.org/podcast/dealing-with-complications-and-burnout-dr-rothenberger-tackles-difficult-issues-no-one-likes-to-talk-about-2/
Dr. John Lawrence is has lived an interesting medical career. Currently a Pediatric Surgeon practicing at Maimonides Medical Center in New York, Dr. Lawrence has been with Médecins Sans Frontières (MSF) or Doctors without Borders since 2009. He has visited the limits of the earth providing medical care abroad.
We discuss his background, his career with MSF, and most importantly his profound experiences. Dr. Lawrence also walks us through performing a Caesarian section as part of Tips and Tricks. Something that is foreign to many current General Surgeons.
Please join us for this interesting podcast and if you are interested in opportunities to help, follow the link below!!
www.doctorswithoutborders.org/pedsurgery
Our last medical student and intern survival guide episode. I am sure this won't be the last you will hear of Dr. Georgoff and Dr. Nikolian on Behind The Knife.
Thanks to Dr. Patrick Georgoff and Dr. Vahagn Nikolian for their production of this episode.
You can contact them at:
Georgoff@med.umich.edu
Vnikolia@med.umich.edu
or on Twitter
@georgoff
@VNikolian
If your heart stops when you think about cardiac surgery, we hope to ease your anxiety in our first episode featuring a cardiac surgeon! Dr. Danny Chu is professor of Cardiothoracic Surgery at the University of Pittsburgh and Director of Cardiac Surgery at the VA Hospital in Pittsburgh. Look out for a special re-appearance of Woo Do (@woosongdo)- he's back in this episode!
Two bonus episodes from our medical student and intern survival guide!
First up vascular surgery.
Thanks to Dr. Patrick Georgoff and Dr. Vahagn Nikolian for their production of this episode.
You can contact them at:
Georgoff@med.umich.edu
Vnikolia@med.umich.edu
or on Twitter
@georgoff
@VNikolian
This is the first of a new collaboration between BTK and Annals of Surgery where we interview the lead author of an upcoming publication in Annals. Our guest host for this series is Karan Chhabra (@krchhabra).
In this episode, Dr. Christopher Wolfgang discusses his research on pancreatic cancer and using circulating tumor cells as a biomarker. The full text is currently available online, until November, at:https://journals.lww.com/annalsofsurgery/Abstract/2018/09000/Circulating_Tumor_Cells_Dynamics_in_Pancreatic.4.aspx
Our last "BTK Medical Student and Intern Survival Guide" Please reach out to the hosts of this mini series to thank them for all of their work.
A big thanks to Dr. Patrick Georgoff and Dr. Vahagn Nikolian
Contact them at:
Georgoff@med.umich.edu
Vnikolia@med.umich.edu
Or on Twitter
@georgoff
@VNikloian
A big thanks to Dr. Patrick Georgoff and Dr. Vahagn Nikolian from the University of Michigan who are the guests hosts for this mini-series.
Contact them at:
Georgoff@med.umich.edu
Vnikolia@med.umich.edu
Or on Twitter
@georgoff
@VNikloian
A big thanks to Dr. Patrick Georgoff and Dr. Vahagn Nikolian from the University of Michigan who are the guests hosts for this mini-series.
Contact them at:
Georgoff@med.umich.edu
Vnikolia@med.umich.edu
Or on Twitter
@georgoff
@VNikloian
Our 9th Mock Oral Episode.
A big thanks to Dr. Salles who takes us through complicated upper GI and bariatric scenarios.
Dr. Salles is an Assistant Professor in the Department of Surgery at Washington University in St. Louis. She earned undergraduate degrees in Biomedical Engineering and French at the University of Southern California. She completed medical school, surgical residency, and a PhD in Education at Stanford University. She has been at Washington University in St. Louis since 2015 when she arrived here for a fellowship in Minimally Invasive Surgery. Dr. Salles specializes in bariatric surgery. Her research interests including research related to obesity as well as gender equity and physician well-being.
Intern year has started! Make sure you are prepared by listening to our pearls for surgical interns.
How are you liking our Med Student/Intern series? Please give us feedback and episode ideas on twitter and by email at BTKpodcast@gmail.com
What topics do you want to hear?!
A big thanks to Dr. Patrick Georgoff and Dr. Vahagn Nikolian from the University of Michigan who are the guests hosts for this mini-series.
Contact them at:
Georgoff@med.umich.edu
Vnikolia@med.umich.edu
Or on Twitter
@georgoff
@VNikloian
Hernias can be confusing as there are many anatomical details that help differentiate them. This episode will get you on the path to being a "herniologist"
How are you liking our Med Student/Intern series? Please give us feedback and episode ideas on twitter and by email at BTKpodcast@gmail.com
What topics do you want to hear?!
A big thanks to Dr. Patrick Georgoff and Dr. Vahagn Nikolian from the University of Michigan who are the guests hosts for this mini-series.
Contact them at:
Georgoff@med.umich.edu
Vnikolia@med.umich.edu
Or on Twitter
@georgoff
@VNikloian
How are you liking our Med Student/Intern series? Please give us feedback and episode ideas on twitter and by email at BTKpodcast@gmail.com
Enjoy this weeks episode which is an intro to managing septic patients!
A big thanks to Dr. Patrick Georgoff and Dr. Vahagn Nikolian from the University of Michigan who are the guests hosts for this mini-series.
Contact them at:
Georgoff@med.umich.edu
Vnikolia@med.umich.edu
Or on Twitter
@georgoff
@VNikloian
Dr. Doug Smink (Program Director of the General Surgery Residency at Brigham and Women's Hospital) discusses his approach to evaluating and repairing paraesophageal hernias, as well as his thoughts on non-technical skills (such as decision-making, situational awareness, teamwork, communication, and leadership) which distinguish the Master Surgeon.
Some people love it, some people hate it, but we all need to know it. Benign and malignant breast disease. Check out this weeks episode to refresh on it.
Dr. Patrick Georgoff and Dr. Vahagn Nikolian from the University of Michigan are the guests hosts for this mini-series.
Contact them at:
Georgoff@med.umich.edu
Vnikolia@med.umich.edu
Or on Twitter
@georgoff
@VNikloian
Part 2 of key knowledge needed to appropriately work up and treat a trauma patient from the surgeon's perspective.
Dr. Patrick Georgoff and Dr. Vahagn Nikolian from the University of Michigan are the guests hosts for this mini-series.
Contact them at:
Georgoff@med.umich.edu
Vnikolia@med.umich.edu
Or on Twitter
@georgoff
@VNikolian
Episode two of our medical student and intern survival series. Knowing how to evaluate a trauma patient is one of the most important skills you can learn, and will constantly be learning and adding to throughout your career.
Thanks to Dr. Patrick Georgoff and Dr. Vahagn Nikolian for putting this together.
Contact them at:
Georgoff@med.umich.edu
Vnikolia@med.umich.edu
or on Twitter
@georgoff
@VNikolian
Biliary disease basics for medical students and interns.
A big thanks to:
Dr. Patrick Georgoff and Dr. Vahagn Nikolian who can be contacted at
georgoff@med.umich.edu and vnikolia@med.umich.edu
or on Twitter at
@georgoff
@VNikolian
Dr. Julie Sosa, new Chair of Surgery at UCSF discusses a variety of topics during this recent podcast. This includes leadership in surgery, resident burnout, thyroid cancer, and tips and tricks on central neck dissection.
This week on BTK, we start off with Kevin giving you updates regarding the next steps in BTK future as well as our search for an adjunct member of our team. Check out the application here!
https://t.co/ihgTDph6Ex
Dr. Samer Mattar (current ASMBS President) discusses and refutes common bariatric myths that many practitioners fall for. It's a great review on current bariatric literature and recommendations!
Additionally, we discuss many new "interventions" in the world of weight loss surgery. Tune in to hear these options!
Trauma, Critical Care & Acute Care Surgery (TCCACS) 2018, Day 3 Lineup:
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Dr. Bellal Joseph and Dr. Chadwick Smith discuss TXA and TEG
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COL Jennifer Gurney, MD discusses current issues in military surgery and the joy of serving in uniform
This has been a great conference to attend and these were just a small portion of the highlights. A special thanks to Dr. Mattox and Mary Allen for having us once again!
Trauma, Critical Care & Acute Care Surgery (TCCACS) 2018, Day 2 Lineup:
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Dr. Sydney J. Vail, Kids are Different - Damage Control Resuscitation
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Dr. Nicholas Namias, Kids are Different - Severe TBI
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Dr. Jay Johannigman, Navigating the Portal Triad
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Dr. Elizabeth Benjamin, GE Junction Injuries
Trauma, Critical Care & Acute Care Surgery (TCCACS) 2018, Day 1 Lineup:
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Dr. Kenji Inaba on C-spine clearance.
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Dr. Matthew Martin on REBOA battlefield lessons learned.
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Dr. Alison Wilson on tourniquets.
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Dr. Martin Schreiber on transfusion strategies.
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Dr. Chris Cribari on the difficult gallbladder.
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Dr. Lynette Scherer on orthopedic considerations for the trauma surgeon.
Dr. Guy Orangio takes us through how he managed a successful private practice colorectal surgery clinic for many years. He also discusses the pitfalls associated with running a private practice.
Please check out O.R. Billing who sponsored this episode, if you are in private practice you will surely find this a great resource to help maximize your billing efficiency.
https://orbilling.com/
use code "knife2018" for free 6 months. You can all try it out for free for one month with no credit card.
Dr. Christian Jones takes us step by step on surgical options for acute pancreatitis.
Follow Dr. Jones on Twitter @jonessurgery or check him out here
https://jonessurgery.com/
Step Up Approach NEJM 2010
http://www.nejm.org/doi/full/10.1056/NEJMoa0908821
Dr. David King (trauma and acute care surgeon at Massachusetts General Hospital, Associate Professor of Surgery at Harvard Medical School, and Lieutenant Colonel in the US Army) discusses:
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What combat surgery in an austere environment can look like.
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How his experiences in combat and stateside have driven research efforts to develop novel ways to attack massive hemorrhage, such as with ResQFoam.
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How the Boston Marathon bombing showed him that we don't need to convince good people to act and do good things.
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Thoughts on the applicability and limitations of REBOA.
http://www.arsenalmedical.com/foam-system-acute-hemorrhage
Follow Dr. King on Twitter @GeococyxVelox
Woo Do and Jason Bingham interview Dr. Alex Haynes (Director of the Safe Surgery Division at Ariadne Labs and a surgical oncologist at MGH) about the history of surgical checklists, Lifebox, and how sustainable global surgery is about strengthening systems.
To learn more, visit:
lifebox.org
ariadnelabs.org
facebook.com/lifeboxfoundation
twitter.com/SaferSurgery
lifebox.org/thechecklisteffect
Jason Bingham and Woo Do interview leaders of surgical education at the 13th annual Academic Surgical Congress.
Day 3 Lineup:
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Rebecca Sippel (@rebecca_sippel): AAS President Experience, Re-defining Success
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Matthew Martin (@docmartin22): Trauma Resuscitation, TEG/ROTEM
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Joaquim Havens: Emergency General Surgery, Top Surf Spots
Subscribe to our mailing list here: http://eepurl.com/df5OTr
Jason Bingham and Woo Do interview leaders of surgical education at the 13th annual Academic Surgical Congress.
Day 2 Lineup:
-
Taylor Riall (@TaylorRiall): SUS President Experience, The Surgeon Scientist
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Jeff Matthews (@JBMatthews): A Chair's Perspective: Do's and Don'ts of Interviewing
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Heather Yeo (@heatheryeomd): Clinical Outcomes Research
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Herbert Chen (@herbchen): Changing Organization Culture
Subscribe to our mailing list here: http://eepurl.com/df5OTr
Jason Bingham and Woo Do interview leaders of surgical education at the 13th annual Academic Surgical Congress. Day 1 Lineup: - Jamie Coleman (@JJcolemanMD): social media to amplify your career - Stefan Holubar (@HolubarStefan): artificial intelligence in the age of the electronic medical record - Christian Jones (@jonessurgery): acute care surgery fellowship, AI, and social media - Lillian Kao (@LillianKao1): fundraising for educational initiatives Subscribe to our mailing list here: http://eepurl.com/df5OTr
Dr. Michael Sabel (Chief of the Division of Surgical Oncology at the University of Michigan and a world-renowned leader in breast cancer and melanoma) returns to BTK to take resident Vahagn Nikolian through three challenging breast and melanoma scenarios.
Dr. Christian Jones (@jonessurgery) takes Kevin and Woo through four challenging mock oral scenarios.
This is a must listen for any residents with the oral boards in their future or for staff that train residents.
Dr. Jones focuses on keeping the pace that you will see during the boards, and approaches to scenarios that may not require operative intervention.
Thank you Dr. Jones for your multiple fantastic contributions to Behind The Knife!
This episode is brought to you by Prytime Medical (prytimemedical.com), maker of the ER-REBOA catheter for Resuscitative Endovascular Balloon Occlusion of the Aorta. In our first-ever sponsored episode, Drs. Steve Smith (University of Florida) and Joseph Ibrahim (Orlando Health) discuss the lessons learned from building REBOA programs at their respective institutions. The study of REBOA and traumatic brain injury referenced by Dr. Smith can be viewed here: https://www.ncbi.nlm.nih.gov/pubmed/28452884/
This week on BTK we talk with Dr. Hasan Alam regarding his work in developing QuickClot, a field hemostatic agent. We also discuss whether the "Golden Hour" needs to be revisited and revised, his experiences during the September 11th attacks on the Pentagon, and finally he talks us through his research in EPR (Emergency Preservation and Resuscitation).
Great talk from a well-known and experienced trauma surgeon!
And another reminder about our T-shirts on sale. Follow the link below! 9 DAYS LEFT!
https://www.customink.com/fundraising/behind-the-knife-app-fundraiser
Click Here To Buy Your BTK Shirt!
The Skeptical Scalpel joins Behind The Knife as we examine surgical dogma.
Check out The Skeptical Scalpel at skepticalscalpel.blogspot.com
or on Twitter at @SkepticScalpel
Sources for Mythbuster Episode
Bouffants vs Cloth Hats
University of Buffalo Neurosurgery Study https://academic.oup.com/neurosurgery/article-abstract/doi/10.1093/neuros/ny x211/3786415?redirectedFrom=PDF Dr. Rosen Study https://www.ncbi.nlm.nih.gov/pubmed/28631104
ACS statement
http://bulletin.facs.org/2017/10/the-surgical-cap-symbol-science-argument-and-evidence/
Cephalosporins and Cross Reactivity with Pencilin Allergy
MGH Abx Study http://www.massgeneral.org/News/pressrelease.aspx?id=2157
https://www.aliem.com/2012/08/busting-myth-10-cephalosporin/
Post Operative Fevers
https://www.ncbi.nlm.nih.gov/pubmed/20655062
Bowel Sounds and Return of Bowel Function https://www.ncbi.nlm.nih.gov/pubmed/28481855
Behind the Knife coverage of the 2017 American College of Surgeons Clinical Congress: Dr. Sharmila Dissanaike (Chair of Surgery at Texas Tech University Health Sciences Center) takes Woo Do and Dominic Forte through her technique for a subtotal cholecystectomy. Additionally, Kevin Kniery invites listeners to support BTK's mobile app development through this t-shirt fundraiser (https://www.customink.com/fundraising/behind-the-knife-app-fundraiser).
Behind the Knife coverage of the 2017 American College of Surgeons Clinical Congress: Dr. Saketh Guntupalli (Gynecologic Oncology, University of Colorado) takes Woo Do and Dominic Forte through the workup and management of benign and malignant ovarian masses and offers surgical tips for ovarian torsion.
Dr. Kathleen Berfield, Chief of Thoracic Surgery at the Seattle VA, takes Woo Do and Kevin Kniery through 4 mock oral board scenarios.
The President of the Association for Surgical Education (Dr. Amalia Cochran) and Chair of the Committee on Graduate Surgical Education (Dr. Mo Shabahang) explore the future of surgical education (competency-based training that departs from traditional time-in-service models) and share their insights on helping struggling residents.
Dr. Douglas Wood, Chair of Surgery at the University of Washington, discusses thoracic surgery, carinal pneumonectomy (complete resection of a central tumor that would be deemed unresectable by traditional recommendations), bleeding from the hilum, and massive hemoptysis.
Dr. Alex Eastman, Trauma Medical Director at Parkland, draws from his experience as a trauma surgeon and police officer to discuss how leaders can "bring calm to chaos" in the midst of disasters, active shooter scenarios, and challenging cases in the OR.
We also welcome guest interviewer George Edward (GEB) Black, chief resident at Madigan Army Medical Center and future trainee of Dr. Eastman at UT Southwestern's rigorous trauma fellowship.
Dr. Thomas Scalea, Physician-in-Chief of the R Adams Cowley Shock Trauma Center, describes what makes Shock a unique institution, relates his frustrations with recurrent violence in Baltimore, regales us with tales of maximally invasive surgery, walks us through the management of retrohepatic vena caval injuries, and reveals which injury patterns still raise his sphincter tone. Violence Intervention Program: https://www.washingtonpost.com/opinions/how-to-break-baltimores-cycle-of-violence/2017/07/28/54f7fa7e-632a-11e7-84a1-a26b75ad39fe_story.html?utm_term=.5f8c53511896
Welcome Woo Do to the podcast! We are very lucky to have him as part of the team.
Woo is a general surgery resident on his research year and he will be joining BTK this upcoming year. He will be the go to for scheduling and interviewing.
Connect with us on Twitter (@behindtheknife) and behindtheknife.org
Dr. Edward Cherullo and Dr. Lee Ponsky are urologists at Case Western in Cleveland, Ohio.
In this episode they discuss their approach to:
-Testicular Torsion
-Urologic Trauma
-Urinary Retention
-Ureteral injuries and more
Dr. Romanelli is an Associate Professor of Surgery at University of Massachusetts Medical School; and is a general surgeon who is an expert in minimally invasive surgery and is pushing the boundaries with Natural Orifice Translumenal Endoscopic Surgery.
He joins us on Behind The Knife to discuss the future of NOTES and how we got to where we are.
He additionally gives us his insights into how surgical quality metrics will change our profession.
For Tips and Tricks he discusses how to choose the right patient for a laparoscopic ventral hernia repair.
Professor (Dr.) Antonio Lacy joins BTK this week to discuss his innovative AIS Channel (link below). The AIS Channel is an amazing tool for all levels of surgeons offering a collaboration to learn and discuss new cutting edge surgical techniques.
Dr. Lacy certainly has a unique way of approaching the training of current and future surgeons. We hope you enjoy this podcast as much as we did!
https://aischannel.com/
Dr. Faries of John Wayne Cancer Institute discusses the evolution and results of a melanoma trial he led that was 12 years in the making.
Do we need to do lymph node dissections in all melanoma patients with positive sentinel nodes?
http://www.nejm.org/doi/full/10.1056/NEJMoa1613210?af=R&rss=currentIssue
Our first of many upcoming journal clubs. Send us your ideas of any recent practice challenging journal articles you would like to hear on the podcast.
This week we sit down with Dr. Eric Johnson and Dr. Anjali Kumar and discuss the most recent Tripartite ASCRS Meeting in Seattle, WA.
Dr. Kumar served at this years Program Co-Chair and Symposium Director and Dr. Johnson will be serving as next year's Program Chair in Nashville, TN.
In the podcast, we discuss the many highlights from the conference including everything from those highly debated topics to symposiums on new, developing procedures in colorectal surgery.
Dr. Johnson and Dr. Kumar encourage everyone to get involved and by joining you will have access to the slides and lectures in the near future (free for residents!).
We can't make all the conferences, but this is definitely a great way to stay informed!
https://www.fascrs.org/
Dr. Nguyen is an Assistant Professor of Surgery in the Division of Plastic and Reconstructive Surgery. Dr. Nguyen completed his graduate studies at the University of Minnesota School of Medicine, followed by full general surgery training at the New York University Medical Center and Bellevue Hospital in New York City where he served as the academic chief resident. Following this, he completed a plastic surgery residency at the University of California Los Angeles Medical Center working with famed craniofacial surgeon Dr. Henry Kawamoto, and subsequently trained at the renowned Hospital for Sick Children in Toronto, Canada in pediatric craniofacial surgery.
Dr. Nguyen primarily is interested in all aspects of pediatric plastic surgery, with a practice focusing on facial palsy, facial trauma, vascular anomalies, microtia and ear anomalies, and congenital lesions.
Dr. Nguyen is also highly active in international mission work, focusing on cleft lips and palates. He frequently volunteers with Operation Smile as well as other humanitarian organizations, and has traveled to Vietnam, Nepal, India, Peru, and Guatemala, amongst others.
In this episode of BTK we discuss the ongoing Comparative Outcomes of Drugs and Appendectomy (CODA). Dr. David Flum heading this multicenter study with aims to truly determine the appropriate use of antibiotics in the treatment of appendicitis.
This is an often discussed topic, so get back up to date on the current literature and current works in this controversial field of study!
Great overview and hoping for a look at some of the prelim data soon!
CODA Website Below
http://www.pcori.org/research-results/2015/comparing-outcomes-drugs-and-appendectomy-coda
Dr. Andrew Wright from the University of Washington takes 3 chief residents from the University of Toronto through four different scenarios.
Elliot Wakeam, Chethan Sathya, and Ricky Jrearz knock these scenarios out of the park!
Scenarios:
Achalasia
Esophageal Perforation
Choledocholithiasis
Refractory Peptic Ulcer
Dr. Michael Sabel is the Chief of the Division of Surgical Oncology at the University of Michigan and a world renowned leader in breast cancer and melanoma. Who better to take us through the nuances of breast cancer scenarios.
We are also joined by Justin Huntington a Chief Resident at The Ohio State University, future pediatric surgeon.
Side note Ohio State has gone above and beyond to support these mock orals, so thank you!
This week on BTK we sit down with Jim Dahle, ER physician and founder of the popular website and book "The White Coat Investor". Dr. Dahle walks us through an important and often overwhelming part of every physician's life - investing, insurance, and financial planning. Dr. Dahle breaks down the important points that all physicians will encounter throughout their career. We learned a lot and I'm sure you all will as well!
This podcast is only a small taste of the of the world of financial planning for physicians so we do recommend checking out The White Coat Investor website below and if you are in for a good read, check out The White Coat Investor book!
http://whitecoatinvestor.com/
https://www.amazon.com/gp/product/0991433106/ref=as_li_qf_sp_asin_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0991433106&linkCode=as2&tag=whicoainv-20
Dr. Jennifer Gurney brings you to the combat hospitals of Iraq and Afghanistan. An expert panel of trauma surgeons both civilian and military retrospectively evaluate trauma cases and discuss the complexities of making war time surgical decisions.
This is a series normally featured on the EAST Traumacast podcast. There are multiple other episodes of cases from the JTS on that podcast so please go check it out!
COL (ret) George E. Peoples, MD, FACS recently retired from 30 years of active duty as a surgeon and research scientist in the military. He is the Founder and Director of Cancer Insight as well as the Cancer Vaccine Development Program (CVDP).
On this podcast we talk with Dr. Peoples after giving grand rounds to discuss his past and current work in cancer vaccines development. He explains his research in way so the new medical student to a veteran researcher can understand. He also gives great advice in getting research started and overcoming the inherent barriers to research.
http://www.cancerinsight.com/
Dr. Gerard Doherty is the new Chair of Department of Surgery at Brigham and Women's Health Care. He is an acclaimed endocrine surgeon who has been a leader and surgeon at many of the nations top institutions.
On the podcast he discusses his transition from Boston Medical Center to the Brigham and the challenges he faces. He also discusses some of his leadership philosophies to best connect with a new institution.
We then pick his brain about his subspecialty of endocrine surgery. We dive into neuroendocrine tumors of the pancreas and then discuss the difficult adrenal dissection.
Dr. Taylor Riall is the Acting Chair of Surgery at Arizona and is a surgical oncologist who trained under John Cameron and focuses on pancreatic cancer and hepatobiliary disease. She is internationally known for her work in comparative effectiveness and patient-centered cancer outcomes.
In this episode we dive into her experience with burnout and how she was able to rebound and use her experience to better the lives of surgeons throughout the country.
Dr. Jeffrey Lee from MD Anderson joins BTK this week!
Department Chair, Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
We talk about Dr. Lee's research in melanoma, work up of adrenal masses and then discuss the specifics of multiple approaches to perform adrenalectomies. Dr. Lee gives a great rundown of a laparoscopic retroperitoneal adrenalectomy! We are working to get a video to place on our website to allow listeners to follow along!
We appreciate all of the suggestions/recommendations that we receive. Thank you all for your support!
Dr. Mark Welton, Chief of Colorectal Surgery at Stanford Medical Center shares his experiences after a severely traumatic accident and how it changed himself as a surgeon, leader and family man. This is a must listen.
Here are some high yield colorectal points for the ABSITE
I apologize for the poor audio quality we were without our standard equipment for the recording of this episode, but the content is still very high yield.
In this episode we are reviewing the “Stomach”. Joined by another guest and fellow resident Rowan Sheldon, Jason and John take on a topic that’s not only highly tested, but also very relevant to every day practice.
Enjoy! We are going to knock out a few more out in the near future as the ABSITE is closing in!
Dr. Martin joins us once again (we think he just enjoys pimping us) to go over three important topics. Bariatrics is becoming more common on the ABSITE every year and as always spleen and pancreas are also very common!
We will be publishing a few more in the next weeks to come to really cram it in before the ABSITE!
Once again, thanks again to Dr. Martin to taking time out of his busy schedule to join us for review. Please take time to check out the EAST TRAUMACAST available on iTunes to really drive these trauma points home.
Dr. Nathan Aranson a vascular surgeon at Virginia Mason in Seattle helps us break down some of the high yield questions you can expect to see regarding vascular surgery on the ABSITE.
If you have ABSITE tips feel free to send them our way. (Kevin@behindtheknife.org)
Up next will be some of our basic science topics.
Finally getting started with our Absite Review Series! We plan to hit on many of the highly tested topics for each system. Not a comprehensive review, but should certainly get you a few more points come test day!
Starting off with the Esophagus!!
Send us what you want to hear since we don't have any particular order to our review series! Also if you have recommendations regarding the format of our review, please also send them our way as well!
The American Board of Surgery (the people who give the exam) heard all of the hype around our mock oral episodes, and offered to join us on the podcast to answer any of our questions.
Tweet us more questions if you have them and we will get them answered.
The Shouldice Hernia clinic is a world famous hospital near Toronto Canada that only performs hernia surgery. We dive in deep to the specifics of their clinic, their hernia repair and how they have such great outcomes with their chief of surgery Dr. Claude Burul.
Here is a video of Shouldice repair, though not performed at the Shouldice clinic so there are slightly different techniques seen here than you will hear described in the podcast.
http://bit.ly/2fazuF2
On this episode of BTK we put new residents under the knife with Dr. Drew Shirley proctoring.
Dr. Shirley is an Assistant Professor of the Division Surgical Oncology at THE Ohio State University.
He is joined by Dr. Kara Rossfeldt an R4 at Ohio State and also Dr. Amy Gore an R4 at Rutgers. Thanks again to our brave volunteers and also Dr. Shirley for taking time out of his busy schedule to help present a few great scenarios!
Listen to see if you can conquer the scenario!
Dr. Shirin Towfigh is a renowned hernia surgeon in Los Angeles and is currently the president of the Beverly Hills Hernia Center.
Check out a great resource for patients with hernias
http://www.herniatalk.com
http://www.beverlyhillsherniacenter.com/
Dr. William Hope is the current president of the Americas Hernia Society and an Associate Professor at UNC Wilmington.
Dr. Christian Jones walks two brave surgery residents, Sarah Bryczkowski and David Strosberg, through mock oral scenarios on trauma and acute care surgery.
If you are a brave resident and want to volunteer tweet at us or email us.
Oral Boards Part Deux!
This week on BTK we sit down again with Dr. Blatnik and run through some realistic oral board scenarios. We take our shot at two unique scenarios each and then Dr. Blatnik gives his excellent analysis afterwards.
Next week we plan to have two additional scenarios (maybe some guest residents??) to help listeners through the daunting process and allow them to become familiar with this important milestone in their surgical career.
Stay Tuned!
Disclaimer: These scenarios are not associated with ABS and the oral board exam. We received permission from the ABS to do this specific podcast. Please email us with any questions!
Dr. Blatnik from Washington University in St. Louis breaks down his approach to dominating the oral boards.
Dr. Emad Kandil breaks down the management of thyroid nodules, from diagnosis to surgical management. He also discusses his path in becoming a US surgeon after being a foreign medical graduate. Additionally he discusses his experience in pushing the technology of robotic thyroid surgery in the US.
In Part 1 of our discussion on dual physician marriages, these two married, medical professionals describe the ups and down, ins and outs, and give us recommendations regarding how to navigate the often chaotic world of a dual physician (or dual professional) relationship.
Please join us on this unique podcast discussing a topic that is not commonly discussed despite being an important aspect of many medical professionals!
Sandip Vasavada, MD, serves as the Urologic Director, Center for Female Urology and Reconstructive Pelvic Surgery, at Cleveland Clinic within the Glickman Urological Institute.
Pauravi Vasavada, MD serves as the Assistant Professor of Radiology at CWRU School of Medicine University Hospitals and Rainbow Babies and Children Hospital Cleveland an she is also the Division Head of Pediatric radiology.
Our next episode on this topic will be released soon!
This week on BTK, we sit down with guest Dr. Steven Curley and return guest (and prior fellow of Dr. Curley's) Dr. Vance Sohn to discuss another interesting topic in the world of surgical oncology. Dr. Steven Curley is an exceptional surgeon and academic resulting in an excellent interview.
In this podcast he discusses his research in nanoparticles and radio-frequency devices. He then dives into a discussion on management of colorectal liver metastasis and finally he walks us through his "1 Hour Hepatectomy."
A few more upcoming surgical oncology topics coming your way in the near future! Send us any ideas that you have!
All you need to know apply and interview well for a residency or fellowship.
Dr. Howard Ross a general surgery program director from Temple University and Dr. Bradley Champagne a colorectal fellowship director from Case Western Reserve University discuss the keys to matching into a residency or fellowship.
Karan Chhabra joins us to break down how to match into a top general surgery program.
Next week we will discuss how to match into an integrated program.
The following week we will discuss how to interview and match into fellowship.
This week on BTK we are joined by Dr. Darrell Cass from Texas Children's Hospital. We dive into an unfamiliar and very interesting topic on fetal surgery to include Dr. Cass' experiences with conjoined twins and "everyday" intrauterine surgery. Dr. Cass not only describes this topic in great detail, but does so in a way that allows listeners to truly understand the technical, ethical, and social aspects of the procedure! We hope you enjoy this podcast as much as we did recording it!
Also, we are consolidating all of the episode recommendations we have been receiving and starting to work through them one by one. Keep sending them our way!!
Repeat guest, accomplished surgeon and Pulitzer prize nominee Dr. Charles Brunicardi joins BTK once again to discuss his exceptional background. Dr. Brunicardi talks on how he balanced the world of medicine and still pursued his other passion of musical art and acting!
He dives into his current research on genomics, tips and tricks on pancreatic mass enucleation, and how music still changes his life.
Dr. Brunicardi is an intriguing man and great speaker. We hope you enjoy!
Check out the ACS website on operation give back! http://www.operationgivingback.facs.org/
Download Legends of Surgery
https://itunes.apple.com/us/podcast/legends-of-surgery/id1078480299?mt=2
This is our second podcast on the topic of Global Surgery. During this episode, we talk with Dr. Robert Riviello from Brigham and Women's hospital on his experiences with global surgery and even more specifically Dr. Riviello's dedication to the specialty, which also, indirectly, includes his family. We are sure you will be impressed with him just as much as we were while interviewing!
Send your suggestions our way if you have them!
A long awaited episode this week on Global Surgery. World renown global surgeons John Meara and Mark Shrime join us to talk about the evolving world of Global Surgery including its past, present and future! This new and evolving specialty is taking hold in the General Surgery world and these gentlemen and leading the cause.
Listen to the end because Dr. Meara then gives a great outline on the Lancet Commission and the "Bellweather Procedures" that everyone interested in Global Surgery should know!
We have one other global surgery episode with Dr. Reviello that we will publish in the near future and hopefully more to come!
Keep sending your suggestions our way!!
Dr. Flum is a board-certified general surgeon whose areas of particular expertise include surgical management of gastrointestinal disorders; advanced laparoscopy; biliary tract disorders; complex abdominal wall hernias; and bariatric surgery for the treatment of diabetes. He is also an Associate Chair of Research and the Director of the Surgical Outcomes Research Center (SORCE).
Dr. Marcello is a leader in colorectal surgery. He had a large part in advancing laparoscopic surgery and is now advancing the field of laparoendoscopic surgery. He gives a very practical interview that is entertaining, and inspiring. Enjoy!
Please welcome guest host Avery Walker, who is about to start a fellowship at Ochsner Clinic in colorectal surgery.
Dr. Peter Marcello is an Assistant Professor of Surgery, Tufts University School of Medicine and a Staff Surgeon at the Lahey Clinic, Burlington, Massachusetts. Peter was born in Boston, Massachusetts and received an M.D. degree from the Boston University School of Medicine. His general surgery training was conducted at the Deaconess–Harvard Surgical Service in Boston. This included a 1-year research fellowship at Lahey Clinic. His clinical fellowship in colon and rectal surgery was also performed at the Lahey Hitchcock Clinic, and this was followed by a 1-year Pelvic Floor Research Fellowship at Lahey. He then joined the colon and rectal surgery staff at the Cleveland Clinic Foundation in Cleveland, Ohio. After 2 years at Cleveland, Peter returned to the Colon and Rectal Surgery Department at Lahey. He is board certified in General Surgery and Colon and Rectal Surgery.
Rural Surgery Perspectives Part 2: Dr. Gary Timmerman
Experienced rural/academic surgeon Dr. Gary Timmerman joins us for the second half of our podcast on rural surgery. He discusses how he got involved with rural surgery and why he is still in love with surgery today. He also touches on some great points on why its important to emphasize rural surgery in medical training as well as how we make sure these smaller hospital centers can provide equivalent care to the large hospital centers around the country.
Enjoy and send any other suggestions our way!
Rural Surgery Perspectives Part 1: Dr. Tyler Hughes
Our goal for this two part episode on rural surgery is to give listeners insight into the practice of surgery in rural setting. Many find this area of surgery foreign as many medical schools don't emphasize rural surgery in their curriculum and many academic teaching facilities are focused in urban areas with little exposure to this world.
Dr. Tyler Hughes walks us through his career from moving from a metro area to small town USA and why he decided to stick around. More importantly, we also discuss the need for rural surgeons and the advantages/disadvantages of practicing in this environment.
We hope it is as eye opening for you as it was for us!
Next week we will talk with Dr. Gary Timmerman on his experiences in rural surgery. Enjoy!
Dr. As Beekley is currently a Trauma/Bariatric surgeon (yes, thats correct) at Thomas Jefferson University. He is a military trained surgeon and deployed multiple times to Iraq and Afghanistan. In this interview, Dr. Beekley walks us through some of his most memorable experiences including taking care of one high-profile patient.
He then discusses with us how these experiences have changed and altered his practice during his time in the military and moving forward to civilian life.
As a bonus, Dr. Beekley walks us through his version of a trauma laparotomy!
Almost like a story unfolding, this podcast is certainly unique to our show! Enjoy!
Small mistake on the last podcast.....editing error and I guess we can call that a near-miss! It is has been corrected!
Unfortunately the full BTK team was unable to make it down to LA this year for the American Society of Colon and Rectal Surgeons meeting, but we were able to track down a few people to talk to who not only attended the conference, but also had a hand in planning!
We are first joined by Drs. Kyle Cologne from USC and Anjali Kumar from Virginia Mason to discuss the social media presence at the conference, research awards, and finally some of the conference highlights. Then we are joined by own Dr. Scott Steele and Dr. Josh Bleier from UPenn to talk about the popular Rectal Ca panel!
Just a reminder, the app for the ASCRS 2016 meeting can be found on iTunes, which includes the entire program and most of the slides from the talks. On the fascrs.org website, they will also have links to the narrated slide shows from the meeting. ASCRS also has an online education module called CREST (ColoRectal Education System Template) which is available to members. Check it out!!
Dr. Frank Veith pioneered the way for endovascular surgery in the US. We are lucky enough to discuss with him the past, present and future of vascular surgery.
As you will learn Dr. Veith does not mince his words, and let's his opinions be known.
Below are the papers referenced in the podcast.
His presidential address to the SVS 1996 titled "Charles Darwin and Vascular Surgery"
http://www.jvascsurg.org/article/S0741-5214(97)70316-1/abstract
Collected World and Single Center Experience With Endovascular Treatment of Ruptured Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms
http://journals.lww.com/annalsofsurgery/Abstract/2009/11000/Collected_World_and_Single_Center_Experience_With.21.aspx
This week on BTK Dr. Timothy Eberlein (Chairman of Surgery at Wash U. SOM) first discusses with us the history and his current role as editor of Journal of American College of Surgeons and then we move to an in depth discussion on the future of surgical training. Dr. Eberlein gives us his opinion and insight into this currently highly debated topic!
In addition, we also hear Dr. Eberlein's tips and tricks on performing an axillary dissection!
We do apologize for some persistent feedback during this episode, but hope you don't notice!
This week Dr. Christian Jones and Dr. Matthew Exline take us step by step on the current management of sepsis 15 years after the publication of the most influential article on sepsis ever published: Rivers et al. "Early Goal Directed Therapy In The Treatment of Severe Sepsis and Septic Shock"
Dr. Christian Jones is a trauma and acute care surgeon at Johns Hopkins.
Connect with him on twitter @jonessurgery
Dr. Matthew Exline is a critical care physician at Ohio State University
Check out the Ultrasound App from Ohio State
https://itunes.apple.com/us/app/poc-ultrasound-guide/id590234691?mt=8
Please go on iTunes and give us a rating!
This week on BTK we discuss the often difficult topic of palliative care. Dr. Zara Cooper is a acute care surgeon, trauma surgeon, and surgical intensivist at Brigham and Women's Hospital in Boston. Her research is centered around end-of-life and palliative care.
Today she discusses all aspects of palliative care including how to initiate and lead these discussions with the patient and their family. In addition, Dr. Cooper also gives us tips and tricks on managing malignant bowel obstructions!
Enjoy!
We are in the beautiful Las Vegas joined by EAST Traumacast covering the Trauma, Critical Care, Acute Care Surgery conference headed by Dr. Mattox who invited us to come down and talk to faculty, attendees, and highlight the day's events.
During the last day of the conference we, first, had the opportunity to sit down with the great Dr. Demetrios Demetriades to discuss the management of the open abdomen. Certainly don't want to miss this discussion!
In addition, we speak with Drs. Alexander Eastman, Andrew Bernard, and R. Todd Maxson about the new Hartford Consensus, narcotic management in our trauma patients, and massive transfusion in pediatrics. Really great overview!
Enjoy!
We are in the beautiful Las Vegas joined by EAST Traumacast covering the Trauma, Critical Care, Acute Care Surgery conference headed by Dr. Mattox who invited us to come down and talk to faculty, attendees, and highlight the day's events.
On Day 2/3 we have two more great group discussions. In the first discussion with leading surgeons Carlos Brown and Alison Wilson we discuss NSTIs and necrotizing pancreatitis and important tips and tricks for dealing with these often complicated scenarios.
In the second group we have Richard Sidwell, Bellal Joseph, and return guest Martin Schreiber discussing controversial trauma topics such as EFAST, TEG, and finally the future of stem cell use in trauma.
Day 3 tomorrow!! Send your questions our way!
We are in the beautiful Las Vegas joined by EAST Traumacast covering the Trauma, Critical Care, Acute Care Surgery conference headed by Dr. Mattox who invited us to come down and talk to faculty, attendees, and highlight the day's events.
On Day 1, we start off strong with Dr. Mattox himself discussing the conference and it's continued success. We continue with a group panel including return guests Matthew Martin, Martin Schreiber, Ali Salim, and Kenii Inaba discussing current hot topics in trauma.
In addition, we have another great panel of guests to reviewing critical techniques in trauma in their respective specialties. These guests include our own Scott "Dominate the Day" Steele, Michael Sise, and Raul Coimbre.
We have two more days left with many more great interviews! Stayed Tuned!
Part 2/2 with Dr. Kenji Inaba discussing the difficult topic of neck trauma. Dr. Inaba walks two lackadaisical residents (Donald Moe and John McClellan) through the evaluation of neck trauma and then Dr. Matthew Martin returns for a further in depth discussion on the debated topics surrounding penetrating neck injuries. We haven't heard a better description about this topic yet!
BTK will be also attending the Trauma, Critical Care, Acute Care Surgery conference in Las Vegas on March 21-23 giving you daily updates and interviewing prominent surgeons! Send us your specific trauma questions to ask the faculty!
In Part 1/2, Trauma Surgeon Dr. Kenji Inaba from USC (The Keck School of Medicine) talks with us regarding his experience with REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta), becoming an LAPD officer, and the overwhelming world of organizing RCTs (Randomized Controlled Trials).
Joined by return guest Trauma Surgeon Dr. Matthew Martin and new guest (but long time listener) Dr. Donald Moe who is currently in his PGY3 research year at Madigan Army Medicine Center.
Next week, in Part 2, we have an awesome Tips and Tricks segment on penetrating neck trauma with Dr. Inaba and Dr. Martin warming up for their debate at the Trauma, Critical Care, and Acute Care Surgery conference in Vegas, March 21-23. BTK will be there covering daily highlights and interviewing prominent surgeons!
Dr. John Devine Chief of Spine Surgery at Medical College of Georgia highlights the most critical aspects of orthopedics that all general surgeons should know.
He also discusses his experience jumping into a combat zone with the US Army.
Exciting episodes coming up in March.
-Debate on Carotid Artery Stenting vs Endarterectomy
-Update on Sepsis
-Kenji Inaba discusses trauma
-Frank Veith discusses future of Vascular Surgery
"Failing Forward" was a recently presented panel discussion at the Academic Surgical Congress. Dr. Justin Dimick and Dr. Dorry Segev moderate this excellent panel of top surgeons (listed below) who discuss a specific example of failure and how they recovered through persistence and dedication.
Any surgeon, junior or senior, will appreciate this candid look how today's successful surgeons thrived in the face of diversity. Very inspiring and motivating!
Panel members in order of presentation: Drs. Timothy Pawlik, Michael Englesbe, Melina Kibbe, Mary Hawn, Keith Lillemoe, and Carla Pugh.
Enjoy and thank you to everyone for allowing us to publish this great talk!
At the Academic Surgical Congress last week we were fortunate enough to sit down with Dr. Craig Kent from University of Wisconsin and Dr. Michael Englesbe from University of Michigan for longer sessions. So we combined them into one large, diverse, and awesome podcast for everyone to enjoy!
Dr. Kent talks with us about academic medicine and his research in vascular surgery (specifically molecular and cellular mechanisms underlying vascular disease) and then Dr. Englesbe gives us a great rundown of preoperative optimization (MSHOP project) and gives us tips and tricks on dealing with cirrhotics in General Surgery.
Two great talks from two great physicians!!
During our third and final day at the ASC we once again had some great interviews. To start off, we sat down with Dr. Adil Haider to talk about the conference as well as his research on racial disparities in trauma. We continue with interviews of well-known surgeons Dr. Timothy Pawlik from John's Hopkins and Dr. Andrew Hill from Auckland, New Zealand.
Enjoy! Unfortunately no mustache tips and tricks today….
We are now in our second day of the Academic Surgical Congress and it has been going great thus far! We start off with Dr. Dimick and Dr. Segev giving us a great rundown after cohosting the popular event "Failing Forward", which we hope to air in the near future. In addition we are joined with well known surgeons Dr. Gene Moore, Dr. Michael Zinner, and Dr. Kevin Staveley-O'Carroll. They all discuss the conference as well give medical tidbits to make all better surgeons. Learn from the best!!
Don't miss Dr. Moore's advice on how to care for your mustache right after he tells us how to properly perform an ED thoracotomy!
Enjoy!! We'll have Day 3 for you tomorrow!
Dr. Justin B. Dimick president of the Association of Academic Surgeons gives his presidential address at the ASC discussing how to embrace "The Rookie Advantage" to excel in academic medicine. Certainly a highlight the ASC conference!!
BTK has live coverage of the Academic Surgical Congress 2016 in Jacksonville! We sit down with prominent staff and cover meeting highlights as well as mix in multiple Dissection of the Days and Tips and Tricks. Also, Dr. Bilimoria sits down with us and discusses the recently published FIRST Trial results in the NEJM.
Featured in the Podcast:
Taylor Riall, Brian Zuckerbraun, Karl Bilimoria, Melanie Morris, Daniel Chu, Jake Greenberg, and finally repeat guest Lillian Kao!
Great rundown of the happenings at ASC. More to follow tomorrow!!
This year marks the 50th birthday of the Association for Academic Surgery! We interview key surgeons in this week's episode to learn about the rise of the AAS and the current and future goals of the society. We are joined by current president Dr. Justin Dimick and past presidents, Dr. Charles Brunicardi and Dr. Lillian Kao.
A great listen that not only touches on the association itself, but also the ever-changing world of research.
Also, BTK will be covering the Academic Surgical Congress in Jacksonville from February 2-4, 2016! We will be giving live daily updates of the large conference that combines both the AAS and SUS (Society of University Surgeons). Going to be a good ride!
http://www.aasurg.org/
http://academicsurgicalcongress.org/index.cfm
Dr. Heidi Nelson of the Mayo Clinic joins us on this weeks episode. Dr. Nelson is the Fred C. Andersen Professor of Surgery and Chair, division of surgery research, Mayo Clinic, Rochester, MN, and Program Director of the Alliance/ACS Clinical Research Program.
She discusses:
Leading the COST trial
Future of Microbiome and medicine
Leadership and advice for young surgeons
Recurrent Rectal Cancer
How to operate in the re-operative abdomen/pelvis
This week on BTK, Dr. Ali Salim, Division Chief of Trauma, Burns, and Surgical Critical Care at Brigham and Women's hospital and Professor of Surgery at Harvard Medical School, is joined by return guest moderator Dr. Matthew Martin to discuss Dr. Salim's research on racial disparities in organ donation.
In addition, Dr. Salim gives us Tips and Tricks on how he (and his team) manage penetrating abdominal trauma. Specifically, we discuss the situations where management is not so cut and dry (pun intended!). There isn't a better way to discuss this topic than with two experienced trauma surgeons!!
A great listen!
Dr. Philip Quirke is a Professor of Pathology at Leeds University in the UK. He is one of the world experts in rectal pathology.
On the podcast he discusses how screening for colorectal cancer differs between the US and Europe. Then he goes into detail about what makes a good surgical specimen and the nuances of pathologic staging rectal cancer, and why it is important for surgeons to have an understanding of this process.
This week on Behind the Knife we bring you well-known surgeon Dr. Freischlag who currently is the Vice Chancellor for Human Health Sciences and Dean of the School of Medicine at UC Davis and previously served as professor, Chair of the Surgery Department and Surgeon-in-chief at Johns Hopkins.
Dr. Freischlag walks us from beginning to end her career in medicine and teaches us how resiliency and persistence are two of the most important factors that an aspiring surgeon must have.
Happy Holidays to all!!
Dr. Pruitt is a true surgery legend. With experience as a combat hospital commander in Vietnam and with over 40 years of experience treating burn patients, and advancing the science of burns. He was also the editor of the Journal of Trauma for 18 years. This episode is packed full of insight from a surgeon who has impacted the lives of many.
This week on BTK we give our listens we present interviews from leaders in bariatric surgery at the recent Obesity Week held in LA this past November. For those unable to attend, the conference was filled with new innovative techniques and presented research from around the world. Also, this year there were multiple live surgeries performed.
We interview Drs. Aurora Pryor, Phillip Schauer, Natan Zundel, Daniel Jones, Andrea Pakula, and finally Dr. Harvey Sugerman. They all give their unique take on the conference and the can't miss events!
BTK will also be covering the Academic Surgical Congress in February and the Trauma, Critical Care, and Acute Care Surgery conference in March! We plan to bring you live updates from both of these!
Dr. Ernest "Gene" Moore the editor of The Journal of Trauma and Acute Care Surgery discusses how he approaches the coagulopathic trauma patient and his experience with splenic salvage.
Dr. Jeff Hardacre at CWRU and trained under Dr. Cameron at Hopkins, discusses the often confusing topic of cholangiocarcinoma.
He gives us a great rundown of the work-up, disease process, and approach to treatment. Finally, Dr. Hardacre shares some tips that could help almost all of us intraoperatively.
Such a great discussion!!!
Dr. James Fleshman gives a in-depth author's perspective on the newly published trial in JAMA titled..
"Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes. The ACOSOG Z6051 Randomized Clinical Trial."
Not a better way to review an article than to hear it directly from the author himself!
Dr. Eidt a vascular surgeon of Baylor takes us through his workup and surgical management of acute limb ischemia.
Dr. John Eidt a vascular surgeon talks about how to improve surgical education.
Tune in in a few weeks when we will publish the rest of Dr. Eidt's interview where he walks us through the surgical management of peripheral artery disease.
Check out his YouTube!
How to do a gracilis flap by Dr. John Eidt
https://www.youtube.com/watch?v=FngQbkHtrrE
This special episode is dedicated to the late Dr. Carolyn Kaelin. Dr. Kaelin was a surgical oncologist in the Women's Cancers Program at Dana-Farber and director of the Breast Clinic at Brigham and Women's Hospital (BWH).
Please join Dr. Andrea Merrill and BTK in honoring Dr. Kaelin through multiple testaments from previous coworkers and friends. In order of interview on the podcast:
Mehra Golshan, MD
Mary Knust Graichen, NP
Esther Rhei, MD
Michael Zinner, MD
Dr. George Velmahos at MGH discusses his account of the Boston marathon bombings and how that day's events has changed today's mass casualty response in Boston.
In addition, Dr. Velmahos touches on surgical nutrition, ventilator and long-term airway management, and gives us excellent tips and tricks on penetrating neck injuries!
A very interesting podcast interviewing an amazing surgeon!!
Dr. William B. Long specializes in trauma surgery. He is the father of Oregon’s state-wide system of trauma and the ACS/COT-designated level 1 Trauma Center at Legacy Emanuel Medical Center, in Portland, Oregon, where he served until recently as Trauma Medical Director for nearly 35 years. Trained in general and cardiovascular surgery at the University of Maryland and the Royal Infirmary in Edinburgh, Dr. Long revolutionized trauma care on the west coast of the United States by establishing an infrastructure that would support technically advanced ways of restoring function. He has also pioneered numerous surgical innovations.
This week we bring you a special episode to track the current ACS Clinical Congress in Chicago. We (Kevin, Jason, and John) couldn't attend, but Dr. Steele is in attendance and gave up us some highlights thus far. He also got us hooked up with Dr. Ali Salim who discussed the conference and gave us some potentially practice changing updates!
Finally, we welcome Dr. Luke Selby who gave us a resident's perspective on the conference as well as new thoughts at the conference on resident training.
Enjoy!.....especially if you couldn't make it like us!
Dr. John Hunter who is the Chair of Surgery at OHSU discusses a topic familiar to all General Surgeons, the surgical management of GERD. We go in depth into the surgical options and Dr. Hunter gives some tips to deal with every surgeon's fear, mediastinal bleeding!
In addition, our opening shot is great review that focuses on the management of GERD and even includes newer treatment options!
You'll enjoy it! We promise!
Dr. Matthew Martin is a leading trauma surgeon who has served multiple deployments in both Iraq and Afghanistan. In this week's episode he reflects back on his deployments over the past 10 years and what medical advances we have seen move from the war zone to the civilian sector.
The focus on the episode is on prehospital care and initial resuscitation strategies.
Dr. Melina Kibbe of Northwestern University and Editor-in-Chief of JAMA Surgery gives an excellent in-depth discussion into the art and process of publishing.
This is a must listen for any and all residents and staff interested in academic medicine. Coming directly from a surgeon who reads and reviews your submissions, Dr. Kibbe discusses everything on how to write manuscripts to finally submitting and responding to the reviewers comments.
We learned so much just in interviewing Dr. Kibbe and excited to share it with you all!
Dr. Herbert Chen of University of Wisconsin tackles the tricky topic of parathyroid disease
-He also discusses what it was like to train under the greats Drs. Sabiston and Cameron
-His experience editing for the Annals of Surgery
-His tips on handling a reoperative neck, avoiding injury to the RLN, and managing the intrathoracic goiter
We are honored to have expert Dr. Steven Wexner from Cleveland Clinic join us to discuss his career, thoughts on fecal incontinence (including the origins of the Wexner score!) and he gives us insight on getting that pesky left colon to reach in dire situations.
In addition, Behind the Knife discussed the treatment and management of Ulcerative Colitis!
Definitely a can't miss from a man whos essentially published more articles and chapters than days I've been a resident!
Join us again this week where we dive into another hot topic in surgery...the social surgeon. We asked Dr. Ed Livingston (@ehlJAMA), Dr. Amalia Cochran (@AmaliaCochran), Dr. Scott Regenbogen (@scottregenbogen), and Dr. Lillian Kao (@LillianKao1) to give us insight into how social media plays a role in today's practice.
These surgeons know the ins and outs of social media and discuss their own personal stories and tips for navigating the often intimidating world of popular social media platforms!
Enjoy!
ilooklikeasurgeon has swept the nation as surgeons of all backgrounds, race, and gender raise awareness to support diversity in not only surgery, but all of medicine!
Staff physicians Dr. Amalia Cochran, Dr. Sharon Stein, and Dr. Patricia Turner join General Surgery resident and founder of #illooklikeasurgeon Dr. Heather Logghe as well as General Surgery resident Dr. Lauren Nosanov in discussing not only women in surgery, but the importance and need for diversity in medicine!
Dr. Jeffrey Matthews Surgeon-in-Chief The University of Chicago
We first talk chronic pancreatitis up to surgical options of this disease and then Dr. Matthews give us a great rundown of his surgical approach. He also discusses social media and its effect on his career in medicine. In addition, we get great insight on how Dr. Mathews relaxes with his love for music!
Dr. Michael Rosen is the director of the Cleveland Clinic hernia center.
On the podcast he discusses:
Purpose and role of the hernia surgical quality collaborative
Discusses his approach to the inguinal hernia
Also takes us through his reconstructive ladder when it comes to large abdominal wall hernias.
Dr. Rothenberger Chair of Surgery at University of Minnesota discusses how to manage complications and avoid burnout.
He also takes us through managing difficult pelvic bleeding.
Send us your topics and guests you would like us to interview.
We are also looking for debate topics, oral board topics, and journal articles to review.
Help us out and give us an iTunes ranking http://bitly.com/1BghLRf
Dr. Howard Ross from Temple University and Dr. Neil Hyman from University of Chicago debate a very common and difficult medical decision of whether to perform a primary anastomosis in complicated diverticulitis or to play it safe and divert. A question that many physicians debate on a daily basis today. Hear it from the experts!
On this podcast they first discuss primary anastomosis surrounding multiple scenarios and, second, the role of laparoscopic lavage!
Dr. Steven Stain Chair of Surgery at Albany Medical Center
Discusses:
-Future of surgical training
-Future of accredidation
-Managing pancreatic cysts
-Tips to performing a distal pancreatectomy
Dr. Kenneth Mattox a US legend in Trauma surgery, discusses retroperitoneal hematomas and the ever changing field of surgery. He is a Distinguished Professor at Baylor University and Surgeon-in-Chief at Ben Taub Hospital.
Dr. Kelly Hunt Chief of Breast Surgical Oncology at MD Anderson.
On the podcast she discusses
-Current therapies and management strategies for complex breast cancer patients
-The newest updates in regards to managing patients with axillary disease
-Managing breast cancer in the pregnant patient
-And more!
Intern basics episode!
Thanks to Andrea Merrill, Stewart Morrison and Sarwat Ahmad for their advice.
Check back to our website where we will links to all our resources mentioned in the episode at behindtheknife.org
Dr. Andrew Wright and Dr. Matthew Martin debate the nuances the recent study published in JAMA on antibiotics vs surgery for acute uncomplicated appendicitis.
Check out this podcast highlighting the history of appendicitis http://bit.ly/1TGQzkW
Give us a review or rating http://bitly.com/1BghLRf
Give usGiGIve
Give us a rating! http://apple.co/1BghLRe
Dr. McKenna Baylor abdominal transplant surgeon
-Managing the incarcerated umbilical hernia in the cirrhotic patient
-Step by Step how to do a liver transplant
Dr. Paramesh Tulane abdominal transplant surgeon
-Step by Step on how to perform a living donor kidney transplant
Dr. Dor abdominal transplant surgeon at Erasmus University, Netherlands.
-Managing the difficult donor kidney
-How to reimplant the ureter
Episode 1 of 2 from the American Transplant Congress 2015 in Philadelphia
Dr. Kirk is a surgeon/scientist and Chair of the Department of Surgery at Duke, he is also the editor of the American Journal of Transplant.
He discusess being a surgeon scientist, choosing transplant as a career, and basics of anti-rejection medications.
Dr. Segev is a transplant surgeon at Johns Hopkins and a leader in the field of living donor kidney chains. He has brought his talents to Capitol Hill and pushed through two very important transplant bills that he talks about on the podcast.
Dr. Dor is a transplant surgeon at Erasmus University in Rotterdam, Netherlands. He is a leader in living donor kidney transplants in Europe. He discusses the differences in the logistics of transplant surgery between Europe and the US and how to successfully implement a living donor program.
Don't miss episode 2 where we explore the technical aspects of transplant surgery with Drs. McKenna, Paramesh and Dor.
Diana Farmer M.D. FACS Chair and Pearl Stamps Stewart Professor, Department of Surgery Surgeon-in Chief
Renowned fetal and pediatric surgeon.
On the podcast she discusses:
Women in Surgery
Hirschsprung's Disease
Tips and Tricks: The pyloromyotomy
Episode 10
Dr. Stanley Goldberg is a Professor of Surgery at the University of Minnesota. He is considered a living legend in the field of colorectal surgery. He lived through and played a large part in advancing the field through the enormous changes that have occurred in the past 50 years.
On the podcast he discusses
-History and evolution of colorectal surgery
-Managing perianal fistulas
-Diagnosing and surgical options for rectal prolapse
-Discusses the utility of the prone position
Episode 9
Dr. John Weigelt is a Professor of Surgery and Chief of the Division of Trauma and Critical Care at the Medical College of Wisconsin. He is also the coordinating editor for Practical Reviews in General Surgery, and the medical director for SESAP 15 sponsored by the American College of Surgeons.
On the podcast he discusses
-How SESAP is made
-Anticoagulation and Reversal in the Trauma Patient
-Managing duodenal trauma
Episode 8
Dr. Kenneth Azarow former Army surgeon, now Surgeon-in-Chief for Doernbecher Children's Hospital and Professor of Surgery at OHSU.
On the Podcast he discusses
-Future of surgical training
-Detailed management and operative description of Tracheoesophageal Fistula
-Malrotation identification and surgical management for the general surgeon
Episode 7
Dr. John Holcomb former Army surgeon, now Professor of Surgery at UT Houston where he also serves as Chief of Acute Care Surgery, and Director of Center for Translational Injury Research.
On the Podcast he discusses (All Things Trauma)
-Taking care of soldier in Mogadishu, during the Blackhawk down incident
-Being lead author of PROPPR trial, and what we can really take away from this
-Massive resuscitation with blood products
-Using thromboelastography to guide resuscitation
Episode 6
Dr. Thomas E. Read colorectal surgeon and Professor of Surgery at Tufts University. Dr. Read is a co-editor for Diseases of the Colon & Rectum. Opening Shot: We discuss the evolving management and current guidelines for treating rectal cancer. On The Podcast He Discusses - His approach to complex rectal cancer patients - Controversies with: TME, neoadjuvant therapy, local excision, minimally invasive approaches - Tips and tricks on avoiding injury to the ureters
Episode 5 Dr. Keith Lillemoe is Surgeon-in-Chief and Chief of the Department of Surgery at the Massachusetts General Hospital and the W Gerald Austen Professor of Surgery at the Harvard Medical School. Additionally he is Editor-In-Chief of Annals of Surgery and editor of Greenfield's Surgical Text. On The Podcast He Discusses -Journey to becoming Chief of Surgery at MGH -Experience editing the top surgical journal and textbook -Walk us through managing bile duct injuries and reconstructive options -Tips and Tricks: Common Bile Duct Exploration
Episode 4. Dr. John Cameron served as the Chief of Surgery at The Johns Hopkins Hospital for nearly 20 years and is also the Alfred Blalock Distinguished Service Professor of Surgery at The Johns Hopkins School of Medicine. He has a long-standing interest in pancreatic cancer, and during his career has operated on more patients with pancreatic cancer and done more Whipple resections (>2000) than any other surgeon in the world.
-His tenure at Johns Hopkins
-Surgical Training
-Discusses all aspects of managing pancreatic cancer
-Tips and tricks for managing pancreatic fistulas
Episode 3 We are extremely proud to start this podcast off with Dr. Carlos Pellegrini MD, FACS. Professor of Surgery and Chairman of Surgery at University of Washington. World Renown Expert in Esophageal Disease Past President of the American College of Surgeons On The Podcast He Discusses: -Role of ACS in a surgeon's career -Workup and surgical management of esophageal cancer -Tips and Tricks: Treating an esophageal perforation -Random Fact of The Day: Origin of Boerhaaves
Episode 2 We are honored to have Dr. Benjamin Starnes MD, FACS as one of our first interviews Professor of Surgery and Chief of Vascular Surgery Division at University of Washington Pioneer in treating ruptured abdominal aortic aneurysms with endovascular grafts. On The Podcast He Discusses: -Stories from his multiple combat deployments -Future of vascular surgery training -Treatment of blunt aortic injury -Tips and Tricks: Managing penetrating vascular injury to the groin
Episode 1: Introduction to our new surgery podcast. Will discuss diverticular disease with Dr. Scott Steele.