Clinical Challenges in Vascular Surgery: Intermittent Claudication Nov 21, 2024

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/
2. 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/

3. 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/

4. 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/
5. 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/

6. 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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The Current State of Surgical Training in Advanced Abdominal Wall Reconstruction Nov 18, 2024

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)
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Clinical Challenges in Hepatobiliary Surgery: Pancreatic Anastomoses in Whipples Nov 14, 2024

The pancreatic anastomosis is often regarded 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/
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USA vs. UK: ASGBI Ep. 2 - Surgical Careers Nov 11, 2024

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!
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Clinical Challenges in Trauma Surgery: Traumatic Esophageal Injury Nov 07, 2024

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/

2. 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/

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Journal Review in Colorectal Surgery: Diverticulitis Nov 04, 2024

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/
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Clinical Challenges in Bariatric Surgery: Postoperative Leak Oct 31, 2024

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
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Hospital Design and Surgery Oct 28, 2024

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
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Exploring the Future of Obesity Treatment: Medications, Surgery, and the Battle Against Bias Oct 24, 2024

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.
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Business of Surgery: Your Contract Oct 21, 2024

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
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Behind the Knife en español: repaso para la certificación en cirugía general- Trauma cardiáco (Cardiac Trauma) Oct 18, 2024

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.
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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

Business of Surgery: The Hospital's Side Oct 17, 2024

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 en español: repaso para la certificación en cirugía general - Nódulo tiroidéo (Thyroid Nodule) Oct 16, 2024

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.
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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 en español: repaso para la certificación en cirugía general- Isquemia mesentérica (Mesenteric Ischemia) Oct 15, 2024

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

Business of Surgery: What is Your Worth - Part 2 of 2 Oct 14, 2024

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 en español: repaso para la certificación en cirugía general - Perforación esofágica (Esophageal Perforation) Oct 11, 2024

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

Business of Surgery: What is Your Worth - Part 1 of 2 Oct 10, 2024

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
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

Journal Review in Surgical Oncology: The MAGIC and FLOT-4 Landmark Trials Oct 07, 2024

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/
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

Is the Medical Publishing Industry a Scam? Oct 03, 2024

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.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

USA vs. UK: ASGBI Ep. 1 - Surgical Training Sep 30, 2024

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.
If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Journal Review in Surgical Education: Navigating the Surgical Residency Match Process Sep 26, 2024

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.
2. 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.

Medicine Consult Series: Ep. 3 - Acute Kidney Injury Sep 23, 2024

Low urine output – when is it a cause for alarm? Emma Burke is joined by Dr. Bryan 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:
- Bryan 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

Medicine Consult Series: Ep. 2 - Diabetes Management Sep 19, 2024

Welcome to another episode of our medicine-surgery consult series! If your case was just cancelled because you and your patient did not know to hold their new GLP-1 agonist and you’re wondering what to do in the interim, this may be the perfect time to tune into a quick refresher of diabetes quick-hits as it pertains to surgical teams.
You’ve just finished rolling a patient up to the OR in the middle of the night after a gunshot wound to the chest, and now you need to deal with something even more intimidating – finishing admission orders on your patient with chronic, poorly controlled diabetes on 7 different medications. Join Dr. Katherine Neal and Ayman Ali as they go over some general principles and tips and tricks in this ever-growing and complicated patient cohort!
Hosts:
Katherine Neal, MD. Assistant Professor of Medicine, Duke Hospital.
Ayman Ali, MD. General Surgery PGY-3, Duke University School of Medicine.
Learning Objectives:

General principles of in-patient diabetes management
Review of common medications and their side effects
Learn some common pitfalls and how to avoid them

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

Medicine Consult Series: Ep. 1 - Postoperative Atrial Fibrillation Sep 16, 2024

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

Clinical Challenges in Hernia Surgery: Parastomal Hernias Sep 12, 2024

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/
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

Clinical Challenges in Burn Surgery: Burn Resuscitation - Titrating and Troubleshooting - Part 2 of 2 Sep 09, 2024

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/
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Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship - Sample Episodes: Thyroid and Melanoma Sep 05, 2024

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
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DOMINATE THE DAY

Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship - Sample Episodes: Small Bowel Obstruction and Appendicitis Sep 02, 2024

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

Association of Out Surgeons & Allies (AOSA) - Episode 5: After Gender Affirming Surgery, What You Need to Know Aug 29, 2024

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
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Journal Review in Surgical Palliative Care: 2023 Pediatric & Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline Aug 26, 2024

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

2. 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

3. AAN Interactive Brain Death/Death by Neurologic Criteria Evaluation Tool – https://www.aan.com/Guidelines/BDDNC

4. AAN Brain Death/Death by Neurologic Criteria Checklist – https://www.aan.com/Guidelines/Home/GetGuidelineContent/1101

5. 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

6. 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

7. 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.
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BTK General Surgery Oral Board Review – Sample Episode 7 - Enteric Feeding Tube Troubles Aug 22, 2024

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.**
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Humanitarian Extraordinaire: An Interview with Dr. Ammar Darwish Aug 19, 2024

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
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Clinical Challenges in Emergency General Surgery: Management of Duodenal Emergencies Aug 15, 2024

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

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

Journal Review in Colorectal Surgery: Management of Splenic Flexure Cancer Aug 12, 2024

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.).
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BTK Colorectal Surgery Oral Board Review- Sample Episode 3 - Ulcerative Colitis Surgery Aug 08, 2024

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.

BTK Surgical Oncology Oral Board Review - Sample Episode 3: Adrenal Mass Aug 05, 2024

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
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

BTK Vascular Surgery Oral Board Review – Sample Episode 3 - Asymptomatic Carotid Stenosis Aug 01, 2024

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
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Journal Review in Endocrine Surgery: Thyroid and Parathyroid Disorders in Pregnancy Jul 29, 2024

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/
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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

Journal Review in Thoracic Surgery: Health Consequences of Thymectomy in Adults Jul 25, 2024

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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Big T Trauma Series Ep. 19 - Multimodal Pain Control Jul 22, 2024

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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Journal Review in Vascular Surgery: Updates on Size Threshold for Repair of Abdominal Aortic Aneurysms Jul 18, 2024

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
1. 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/
2. 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/
3. 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/
4. 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/
5. 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/
6. 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/

7. 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.
8. 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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Lung in a Box: The Present and Future of Lung Preservation for Transplant Jul 15, 2024

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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Clinical Challenges in Surgical Education: Precision Surgical Education Jul 11, 2024

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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Journal Review in Hernia Surgery: What Defines a Hernia Center? Jul 08, 2024

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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Journal Review in Trauma Surgery: VTE Prophylaxis Jul 01, 2024

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/
2. 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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Resident Involvement in Lawsuits Jun 27, 2024

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
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Appendiceal Masses Jun 24, 2024

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.
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Surgical M&M: Can We Do Better? Jun 20, 2024

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/
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Dominate the Match - Episode 7: Applying to Residency as an International Medical Graduate - Part 2 of 2 Jun 17, 2024

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/
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Dominate the Match - Episode 6: Applying to Residency as an International Medical Graduate - Part 1 of 2 Jun 13, 2024

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
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Journal Review in Minimally Invasive Surgery: Robotic Cholecystectomy and Bile Duct Injury Jun 10, 2024

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.
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 @benvierra95
Learning objectives:
1. 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)
2. Review literature on causes and prevention of bile duct injury
3. Review a recent article on robotic cholecystectomy vs laparoscopic cholecystectomy outcomes
4. 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/

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Association of Out Surgeons & Allies (AOSA) - Episode 4: Gender Affirming Care and Gender Affirming Surgery Jun 06, 2024

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.
2. 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.
3. 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.
4. 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.
5. 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
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So, You Want to be a Cardiac Surgeon?: Training Paradigms Jun 03, 2024

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
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Journal Review in Bariatric Surgery: Are Less Anastomoses Better? May 30, 2024

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/

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Are we failing our patients? Ventral hernia recurrence with Drs. Todd Heniford and Michael Rosen May 27, 2024

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/
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Clinical Challenges in Surgical Oncology: Gastric Cancer May 23, 2024

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/

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Clinical Challenges in Colorectal Surgery: J Pouch Creation and Management of Postoperative Pouch Complications May 20, 2024

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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Journal Review in Hernia Surgery: Quantitative Tension on the Abdominal Wall in Posterior Components Separation With Transversus Abdominis Release May 16, 2024

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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HuMaNiSm + Surgery # 1 May 13, 2024

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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Clinical Challenges in Burn Surgery: Burn Resuscitation - Getting Things Started - Part 1 of 2 May 09, 2024

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.
1. 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/
2. 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/
3. 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/

4. 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/

5. 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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Clinical Challenges in Surgical Palliative Care: Communication Skills for Difficult Conversations May 06, 2024

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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Journal Review in Hepatobiliary Surgery: ctDNA & Colorectal Liver Metastasis May 02, 2024

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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Is "Pump and Dump" Outdated? An Update on Lactating Patients Apr 29, 2024

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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Scoring Changes to the ABSITE: The Trainee Perspective on Impact and Ramifications Apr 25, 2024

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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ABSITE Updates and the Future of Boards with Dr. Jo Buyske Apr 22, 2024

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
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Clinical Challenges in Thoracic Surgery: Malignant Pleural Mesothelioma Apr 18, 2024

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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Journal Review in Emergency General Surgery: Appendicitis Apr 15, 2024

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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Cardiac Cowboys: The Heroic Invention of Heart Surgery Apr 11, 2024

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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Clinical Challenges in Colorectal Surgery: Management of Advanced and Malignant Polyps Apr 08, 2024

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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Association of Out Surgeons & Allies (AOSA) - Episode 3: LGBTQ+ Healthcare Apr 04, 2024

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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Clinical Challenges in Hernia Surgery: Open Preperitoneal Ventral Hernia Repair Apr 01, 2024

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/
- 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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Clinical Challenges in Trauma Surgery: Approach to Pancreatic Injury Mar 28, 2024

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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Global Surgery Episode 2: Trauma Care in Resource-Limited Settings Mar 25, 2024

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:

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.
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.
Improvement of trauma care extends well beyond in-hospital care–injury prevention and pre-hospital care/triage/transport are even more impactful.
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.
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.
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Global Surgery Episode 1: How Health Infrastructure Interacts with Global Surgical Care Mar 21, 2024

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.
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General Surgery Oral Board Audio Review
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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

Journal Review in Surgical Education: Artificial Intelligence Mar 18, 2024

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.
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Vascular Surgery Surgery Oral Board Audio Review
Cardiothoracic Surgery Surgery Oral Board Audio Review

Hot Topics in Trauma: Western Trauma Association 2024 Mar 14, 2024

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
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PREMIUM BUNDLE:
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Premium Bundle Includes:
General Surgery Oral Board Audio Review
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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

Clinical Challenges in Vascular Surgery: Dialysis Associated Steal Syndrome Mar 11, 2024

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/
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Circulation-First Approach to Trauma Resuscitation Mar 07, 2024

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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Journal Review in Surgical Oncology: Gastrointestinal Stromal Tumors (GISTs) Mar 04, 2024

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

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Clinical Challenges in Hernia Surgery: Lateral Abdominal Wall Hernias Feb 29, 2024

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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In-Flight Emergencies Feb 26, 2024

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.
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Journal Review in Colorectal Surgery: Anal Dysplasia and Anal Squamous Cell Carcinoma Feb 22, 2024

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***
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Clinical Challenges in Bariatric Surgery: Internal Hernia Feb 19, 2024

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.
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Clinical Challenges in Cardiac Surgery: Mitral Valve Disease Feb 15, 2024

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
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Behind the Knife Cardiothoracic Oral Board Review - Sample Episode 2 - Patent Ductus Arteriosus Feb 12, 2024

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.
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Behind the Knife Cardiothoracic Oral Board Review - Sample Episode 1 - Hemoptysis and Infectious Lung Disease Feb 08, 2024

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.
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UK-REBOA Trial with Dr. Karim Brohi Feb 05, 2024

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/
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Clinical Challenges in Hepatobiliary Surgery: Bilateral Colorectal Liver Metastasis Feb 01, 2024

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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Journal Review in Surgical Palliative Care: RCTs in Surgical Palliative Care Jan 29, 2024

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/
2. 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/
3. 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/
4. 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/
5. 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/
6. 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/
7. 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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Pelvic Exenteration Surgery Series Episode 4: Reconstruction and Recovery Jan 25, 2024

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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Pelvic Exenteration Surgery Series Episode 3: Posterior and Lateral Compartment Tumours Jan 22, 2024

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 - Quick Hits 4 Jan 16, 2024

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 ABSITE 2024 - Quick Hits 3 Jan 15, 2024

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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 - Quick Hits 2 Jan 12, 2024

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.

Journal Review in Surgical Education: The Salary of Resident Physicians Jan 11, 2024

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
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Behind the Knife ABSITE 2024 - Quick Hits 1 Jan 10, 2024

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 - Obstetrics & Gynecology Jan 09, 2024

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.
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Behind the Knife ABSITE 2024 - Urology Jan 08, 2024

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.
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Behind the Knife ABSITE 2024 - Pediatric Surgery Jan 05, 2024

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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Clinical Challenges in Burn Surgery: Global Burn Surgery Jan 04, 2024

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
1. 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 ABSITE 2024 - Minimally Invasive Surgery and Endoscopy Jan 03, 2024

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 ABSITE 2024 - Hernias Jan 02, 2024

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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Behind the Knife ABSITE 2024 - Fluids and Electrolytes Jan 01, 2024

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/

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 - Skin & Soft Tissue Dec 29, 2023

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/

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 - Burns Dec 28, 2023

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/

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 - Critical Care Dec 27, 2023

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 - Trauma - Part 2 Dec 26, 2023

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 - Trauma - Part 1 Dec 25, 2023

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 - Hematology Dec 22, 2023

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.

Journal Review in Colorectal Surgery: Management of Perineal Wounds Following Pelvic Surgery Dec 21, 2023

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 ABSITE 2024 - Breast Dec 20, 2023

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 - Thoracic Dec 19, 2023

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 - Vascular - Part 2 Dec 18, 2023

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 - Vascular - Part 1 Dec 15, 2023

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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Clinical Challenges in Emergency General Surgery: Complicated Pancreatitis Dec 14, 2023

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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If you liked this episode, check out other emergency general surgery episodes here: https://behindtheknife.org/podcast-category/emergency-general-surgery/

Behind the Knife ABSITE 2024 - Oncology Dec 13, 2023

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 - Colorectal - Part 2 Dec 12, 2023

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 - Colorectal - Part 1 Dec 11, 2023

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 - Pancreas Dec 08, 2023

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.

Journal Review in Thoracic Surgery: Lobar vs Sublobar Resection for Stage 1A NSCLC – CALGB & JCOG Dec 07, 2023

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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If you liked this episode, check out our other Cardiothoracic episodes: https://behindtheknife.org/podcast-category/cardiothoracic/

Behind the Knife ABSITE 2024 - Adrenal Dec 06, 2023

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 - Hepatobiliary Dec 05, 2023

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 - Spleen Dec 04, 2023

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 - Stomach Dec 01, 2023

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 - Esophagus Nov 30, 2023

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 - Parathyroid Nov 29, 2023

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 - Thyroid Nov 28, 2023

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 - Head and Neck Nov 27, 2023

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.

Clinical Challenges in Endocrine Surgery: Autofluorescence in Endocrine Surgery Nov 23, 2023

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/
2. 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/
3. 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/
4. 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/
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If you liked this episode, check out other Behind the Knife endocrine episodes: https://behindtheknife.org/podcast-category/endocrine/

Journal Review in Vascular Surgery: Chronic Limb Threatening Ischemia: BEST-CLI and BASIL-2 Trials Nov 20, 2023

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/

Clinical Challenges in Minimally Invasive Surgery: MIS in the Pregnant Patient Nov 16, 2023

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/

Journal Review in Hernia Surgery: Artificial Intelligence and Hernia Outcome Prediction Nov 13, 2023

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/

Medical Student Mentorship – Leveraging mentorship into scholarship Nov 09, 2023

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/

Medical Student Mentorship – Who they are, what they do. Nov 06, 2023

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/

Clinical Challenges in Surgical Education: Ob/Gyn ResidencyCAS - Creation of a New Independent Residency Application System Nov 02, 2023

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/

Journal Review in Trauma Surgery: Direct Peritoneal Resuscitation Oct 30, 2023

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.
References

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
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
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

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 here: https://behindtheknife.org/listen/

Pelvic Exenteration Surgery Series Episode 2: Anterior compartment tumors Oct 26, 2023

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.

Pelvic Exenteration Surgery Series Episode 1: Principles of Patient Selection and Surgery Oct 23, 2023

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/

Association of Out Surgeons & Allies (AOSA) – Episode 2: The Medical Student and Resident Perspective Oct 19, 2023

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
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out episode one in this series: https://behindtheknife.org/podcast/association-of-out-surgeons-allies-aosa-episode-1/

BIG T Trauma Series Ep. 18 – Rib Plating Update Oct 16, 2023

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/

Clinical Challenges in Colorectal Surgery: Management of Horseshoe Abscess Oct 12, 2023

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/

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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

Journal Review in Bariatric Surgery: Mesenteric Defect Closure and Internal Hernia Evaluation/Management Oct 09, 2023

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.

Association of Out Surgeons & Allies (AOSA) - Episode 1 Oct 05, 2023

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/

Clinical Challenges in Surgical Oncology: Gastrointestinal Stromal Tumors (GISTs) Oct 02, 2023

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.
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Journal Review in Hernia Surgery: Smoking in Elective Open Ventral Hernia Repair Sep 28, 2023

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/

Clinical Challenges in Surgical Palliative Care: “When the horse is out of the barn: Skills to avoid offering surgical overtreatment at the end of life" Sep 25, 2023

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:
1. 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
2. VitalTalk. One page Guides. https://www.vitaltalk.org/guides/
3. VitalTalk. Using Ask-Tell-Ask to Make a Recommendation.
https://www.vitaltalk.org/using-ask-tell-ask-to-make-a-recommendation/
4. VitalTalk. What's a Headline? https://www.vitaltalk.org/whats-a-headline/
5. 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/

Clinical Challenges in Burn Surgery: Electrical Burns - Part 2 of 2 Sep 21, 2023

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.
2. 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.
3. 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.
4. 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/

5. 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

6. Arnoldo B, Klein M, Gibran NS. Practice guidelines for the management of electrical injuries. J Burn Care Res 2006, 27(4): 439-47
7. 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
8. 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
9. 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
10. 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.
11. 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.
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Clinical Challenges in Burn Surgery: Electrical Burns - Part 1 of 2 Sep 18, 2023

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.
2. 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.
3. 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.
4. 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/

5. 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

6. Arnoldo B, Klein M, Gibran NS. Practice guidelines for the management of electrical injuries. J Burn Care Res 2006, 27(4): 439-47
7. 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
8. 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
9. 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
10. 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.
11. 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/

Clinical Challenges in Surgical Education: Thriving as a Surgical Intern Sep 14, 2023

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/

Journal Review in Hepatobiliary Surgery: Advances in Liver Venous Deprivation and Hypertrophy Sep 11, 2023

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/

BTK Surgical Oncology Oral Board Review - Sample Episode 2 - Pancreatic Adenocarcinoma Sep 07, 2023

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.

BTK Surgical Oncology Oral Board Review - Sample Episode 1 - Ductal Carcinoma In Situ Sep 04, 2023

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.

Clinical Challenges in Cardiac Surgery: Common Post-Op Cardiac Surgery Problems Aug 31, 2023

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:
- 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 Profressor of Thorasis and Cardiovascular Surgery, University of Virginia, @nickteman
Learning objectives:
- Understand the workup and management strategies for post-operative bleeding in the post-cardiac surgery patient.
- Understand how to recognize and manage post-cardiotomy cardiogenic shock in the post-cardiac surgery patient.
- 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
- 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/

Continuing Medical Education (CME) - What? When? How? Aug 28, 2023

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/

Innovations in Surgery: PEG Tube Aug 24, 2023

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/

Clinical Challenges in Colorectal Surgery: Let’s Talk Ostomies! Aug 21, 2023

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
- 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 pre-operative stoma marking and ostomy education.
- Understand “bail-out” ostomy creation options in medically and anatomically challenging patients.
- Discuss common postoperative ostomy complications and management.
- 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.
- 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
- 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/

Clinical Challenges in Thoracic Surgery: Complex Pleural Effusions & Empyema - Part 2 of 2 Aug 17, 2023

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/

Clinical Challenges in Thoracic Surgery: Complex Pleural Effusions & Empyema - Part 1 of 2 Aug 14, 2023

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 (EPAs)- They’re Here, Now What Aug 10, 2023

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
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/

Journal Review in Emergency General Surgery: Clostridium Difficile Infection Aug 07, 2023

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.
- Risk score development study using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP)
- 525 adult (18-89) patients undergoing colectomy between 2012 and 2016
- Split data into training (80%) and testing (20%) datasets
- Identified mortality risk factors to create and validate a scoring system
- Scores ranged from 0 to 37 with the highest score predicting an 83.9% risk of mortality
- 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.
- 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
- Focus on not only mortality and complications but also admission cost and length of stay
- 886 TAC and 409 DLI patients were identified
- Multivariable logistic regression analysis showed no difference in mortality or overall complications
- TAC patients had shorter admissions (mean difference 4.06 days) and lower cost (mean difference $79,715.34)
- Study was limited as it considered only the initial admission and is unable to provide data on outcomes and costs beyond this time
- 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/

Dominate the Match – Episode 5: "Meet the Match-2024” Aug 03, 2023

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.
- September 6, 2023: Residency applicants may begin submitting MyERAS applications to programs at 9 a.m. ET.
- September 15, 2023: Registration for the NRMP Match Opens
- September 27, 2023: Residency programs may begin reviewing MyERAS applications, MSPEs, and supplemental ERAS application data (if applicable) at 9 a.m. ET.
- October 26-31, 2023: Common Interview Release Window
- January 31, 2024: Registration for the NRMP Match Closes
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.
If you liked this episode, check out our intern bootcamp series here: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/

BTK Throw Down: Trauma Vascular Access Jul 31, 2023

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.
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Journal Review in Endocrine Surgery: AAES Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism - Part 2 of 2 Jul 27, 2023

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.
Suture Kit:
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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/

Journal Review in Endocrine Surgery: AAES Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism - Part 1 of 2 Jul 24, 2023

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.
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/

Clinical Challenges in Trauma Surgery: Approach to Stab Wounds of the Torso Jul 20, 2023

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
- 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:
1. Don’t forget about the blunt trauma that may be associated with an assault!
2. Don't miss injuries- always start with the ABCs and do a thorough head to toe exam
3. For stab wounds to the torso- hemodynamic instability, evisceration, peritonitis, impalement, or gross blood should go to the OR.
4. The three general clinical pathways for patients without a clear indication for the OR, include serial abdominal exams, local wound exploration, or diagnostic imaging.
5. Serial abdominal exams require frequent monitoring ideally by the same team member every time to detect changes early.
6. 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.
7. Left thoracoabdominal stab wounds require evaluation of the diaphragm to rule out a traumatic diaphragm injury.
8. 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.
9. A negative pericardial ultrasound does not rule out a cardiac injury in patients with a left-sided hemothorax.
10. Patients with flank and back stab wounds should be evaluated with CT scan to rule-out retroperitoneal injuries
References
1.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.
2. 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/

Innovations in Surgery: LifeFlow Jul 17, 2023

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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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 innovation episodes here: https://behindtheknife.org/podcast-series/innovations-in-surgery/

Clinical Challenges in Vascular Surgery: Aortic Graft Infections Jul 13, 2023

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/

Journal Review in Minimally Invasive Surgery: Robotic Emergency General Surgery Jul 10, 2023

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/

Intern Bootcamp - Dominate Intern Year Jul 07, 2023

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/

Intern Bootcamp - Scary Pages Jul 06, 2023

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/

Intern Bootcamp - Consults Jul 05, 2023

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/

Intern Bootcamp - Medical Students Jul 04, 2023

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/

Intern Bootcamp - Resource Overload Jul 03, 2023

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
- 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: 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
- 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/

Intern Bootcamp - The First Day Jun 30, 2023

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
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
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!
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/

Clinical Challenges in Hernia Surgery: Loss of Domain Jun 29, 2023

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:
- 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/

How to do a Liver Transplant with Dr. Shah and Dr. Dageforde Jun 26, 2023

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.

Healthcare Upside Down Interview with Dr. Buchwald Jun 22, 2023

Dr. Buchwald 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. Buchwald’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/

Journal Review in Surgical Education: Recent Changes to the Residency Application Process Jun 19, 2023

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.
- Listeners will recognize the results that changes to the residency application process have had during the first 2 years of implementation in surgery.
- 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/

The Second Victim Syndrome with Dr. Haytham Kaafarani Jun 15, 2023

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/

Journal Review in Surgical Oncology: Piperacillin-Tazobactam Compared With Cefoxitin as Antimicrobial Prophylaxis for Pancreatoduodenectomy Jun 12, 2023

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/

Leadership in Surgery: Dr. Tom Read Jun 08, 2023

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/

Leadership in Surgery: Dr. Conor Delaney Jun 05, 2023

Join BTK’s Dr. Scott Steele for a discussion with Dr. Conor Delaney on leadership opportunities outside of clinical medicine. They discuss Dr. Conor Delaney's role as the chief executive officer and president of Cleveland Clinic Florida.
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/

Leadership in Surgery: Dr. Bradley Champagne Jun 01, 2023

Join BTK's Dr. Scott Steele for a discussion with Dr. Bradley Champagne on leadership opportunities outside of clinical medicine. They discuss Dr. Bradley Champagne's role as the chief medical officer of a large hospital.
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/

Leadership in Surgery: Dr. Amy Lightner May 29, 2023

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/

Mattox Vegas TCCACS Keynote Dr. David Nott: Leaving a Legacy in Conflict Zones May 25, 2023

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/

Clinical Challenges in Transplant Surgery: Liver Transplant May 22, 2023

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/

Journal Review in Bariatric Surgery: SPLENDID and BRAVES Studies May 18, 2023

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/

BTK Colorectal Surgery Oral Board Review - Sample Episode 2 - Pouch Complications May 15, 2023

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.

BTK Colorectal Surgery Oral Board Review - Sample Episode 1 - Familial Adenomatous Polyposis May 11, 2023

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.

Clinical Challenges in Pediatric Surgery: Common Pediatric Surgery Scenarios May 08, 2023

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/

BIG T Trauma Series Ep. 17 - Brain Death May 04, 2023

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/

Journal Review in Colorectal Surgery: Anastomotic Healing, Leak and Gut Microbiome May 01, 2023

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/

Association for Academic Surgery: Removing the Mask with Dr. Carrie Cunningham Apr 27, 2023

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.

Journal Review in Breast Surgery: Management of Hereditary Breast Cancer Apr 24, 2023

While you are likely aware of BRCA mutations as a significant risk factor for development of breast cancer (60-80% lifetime risk), there are many other pathogenic gene variants that have been identified in recent years. The surgical treatment of women with hereditary breast cancer differs from that of women with sporadic breast cancer, and women with hereditary breast cancer are also eligible for prophylactic mastectomy or intensive surveillance protocols. In this episode of BTK, we examine current national consensus guidelines for management of hereditary breast cancer, discuss a recent population-based study that establishes risk associated with various genes, and address both surgical and surveillance strategy for patients without breast cancer but with known pathogenic gene variants.
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/

Taking Back the (Bile) Duct: Lap Common Bile Duct Exploration Apr 20, 2023

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.

Clinical Challenges in Hernia Surgery: Specialization in Hernia and Abdominal Wall Surgery Apr 17, 2023

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/

Clinical Challenges in Trauma Surgery: Renal Trauma Apr 13, 2023

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/

Journal Review in Surgical Education: The OR Black Box Apr 10, 2023

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 Objectives

Listeners will describe the value that accessible data review and analysis adds to surgical education.
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.
Listers will recognize common barriers to using new technology or process changes in surgery.
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.
Listeners will appreciate the long and iterative process required to go from a research idea to implementation and impact on clinical outcomes.
Listeners will organize their own ideas for research utilizing the advice offered in the episode.

References:
1. Goldenberg MG, Jung J, Grantcharov TP. Using Data to Enhance Performance and Improve Quality and Safety in Surgery. JAMA Surg. 2017;152(10):972. doi:10.1001/jamasurg.2017.2888
2. van Dalen ASHM, van Haperen M, Swinkels JA, Grantcharov TP, Schijven MP. Development of a Model for Video-Assisted Postoperative Team Debriefing. J Surg Res. 2021;257:625-635. doi:10.1016/j.jss.2020.07.065
**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/

The Society of Black Academic Surgeons with Dr. Edward Barksdale Apr 06, 2023

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/

Clinical Challenges in Emergency General Surgery: Cirrhotic Patients Apr 03, 2023

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/

Journal Review in Thoracic Surgery: Adjuvant Treatment in Esophageal and GEJ Cancer Mar 30, 2023

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/

The Latino Surgical Society with Dr. Minerva Romero-Arenas Mar 27, 2023

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/

Clinical Challenges in Endocrine Surgery: Adrenalectomy Guidelines Review Mar 23, 2023

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/

Journal Review in Surgical Critical Care: Nutrition in the ICU - when, how, why Mar 20, 2023

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/

Innovations in Surgery: Surgical Robotics Mar 16, 2023

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/

Journal Review in Colorectal Surgery: Local Excision for Rectal Cancer Mar 13, 2023

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/

Doctor Cure Thyself: An Interview With Dr. David Fajgenbaum Mar 09, 2023

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/

Journal Review in Surgical Education: Unions and Wellness Mar 06, 2023

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/

Journal Review in Hepatobiliary Surgery: Intraductal Papillary Mucinous Neoplasm IPMN Mar 02, 2023

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/

BTK Vascular Surgery Oral Board Review – Sample Episode 2 - Lower Extremity Trauma Feb 27, 2023

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://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.

BTK Vascular Surgery Oral Board Review – Sample Episode 1 - Fem and Pop Aneurysm Feb 23, 2023

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://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.

Clinical Challenges in Minimally Invasive Surgery: Ergonomics Feb 20, 2023

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/

Journal Review in Vascular Surgery: Introduction to Endovascular Surgery – A Primer Feb 16, 2023

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.

Dominate the Match – Episode 4: "Rank and Match" Feb 13, 2023

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/

Journal Review in Trauma Surgery: Blood Transfusions Feb 09, 2023

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/

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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/

JOIN THE BTK TEAM! Feb 07, 2023

**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions.

The King and Queen of Medical Comedy: Up Close and Personal with Dr. and Lady Glaucomflecken Feb 06, 2023

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/

EAST Papers That Should Change Your Practice Feb 02, 2023

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/

Journal Review in Pediatric Surgery: Hirschsprung Disease Jan 30, 2023

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/
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Clinical Challenges in Surgical Oncology: Intrahepatic Cholangiocarcinoma - Hope in the Face of Nihilism Jan 23, 2023

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.
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Journal Review in Bariatric Surgery: New ASMBS and IFSO Indications for Metabolic and Bariatric Surgery Jan 19, 2023

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/.
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Clinical Challenges in Colorectal Surgery: Rectal GIST Jan 16, 2023

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).
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Journal Review in Transplant Surgery: Normothermic Machine Perfusion Jan 12, 2023

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
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BTK ABSITE 2023 - DO NOT OPEN UNTIL MORNING OF ABSITE Jan 09, 2023

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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BTK ABSITE 2023 - Urology Jan 08, 2023

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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BTK ABSITE 2023 - Breast Jan 07, 2023

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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BTK ABSITE 2023 - ENT Jan 06, 2023

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BTK ABSITE 2023 - Biostatistics Jan 05, 2023

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BTK ABSITE 2023 - Anesthesia Jan 04, 2023

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BTK ABSITE 2023 - Transplant Jan 03, 2023

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BTK ABSITE 2023 - Pediatric Surgery Jan 02, 2023

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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BTK ABSITE 2023 - Thoracic Jan 01, 2023

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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BTK ABSITE 2023 - Hernias Dec 31, 2022

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BTK ABSITE 2023 - Critical Care Part 2 with Dr. Matthew Martin Dec 30, 2022

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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BTK ABSITE 2023 - Critical Care Part 1 with Dr. Matthew Martin Dec 29, 2022

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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BTK ABSITE 2023 - Trauma Part 2 with Dr. Matthew Martin Dec 28, 2022

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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BTK ABSITE 2023 - Trauma Part I with Dr. Matthew Martin Dec 27, 2022

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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Clinical Challenges in Surgical Palliative Care: Non-Beneficial Surgery (and How to Avoid it) and Care of the Imminently Dying Patient Dec 26, 2022

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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BTK ABSITE 2023 - Fluids and Electrolytes Dec 25, 2022

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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BTK ABSITE 2023 - Vascular Part 2 Dec 24, 2022

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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BTK ABSITE 2023 - Vascular Part 1 Dec 23, 2022

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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BTK ABSITE 2023 - Hematology Dec 22, 2022

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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BTK ABSITE 2023 - Colorectal Part 3 Dec 21, 2022

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BTK ABSITE 2023 - Colorectal Part 2 Dec 20, 2022

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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The Mattox Maneuver and Much More with Dr. Kenneth Mattox Dec 19, 2022

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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BTK ABSITE 2023 - Colorectal Part 1 Dec 18, 2022

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BTK ABSITE 2023 - Pancreas Dec 17, 2022

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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BTK ABSITE 2023 - Adrenal Dec 16, 2022

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam.
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Clinical Challenges in Hernia Surgery: Decision Making for Abdominal Wall Emergencies Dec 15, 2022

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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BTK ABSITE 2023 - Hepatobiliary Part 2 Dec 14, 2022

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.

BTK ABSITE 2023 - Hepatobiliary Part 1 Dec 13, 2022

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.

Clinical Challenges in Surgical Education: KeyLIME Podcast Crossover Dec 12, 2022

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.
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 videos here: https://behindtheknife.org/podcast-category/surgical-education/

BTK ABSITE 2023 - Spleen Dec 11, 2022

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.

BTK ABSITE 2023 - Stomach Dec 10, 2022

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.

BTK ABSITE 2023 - Esophagus Dec 09, 2022

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.

Journal Review in Trauma Surgery: Gun Violence Dec 08, 2022

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.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other Journal Review episodes here: https://behindtheknife.org/podcast-series/journal-review/

BTK ABSITE 2023 - Parathyroid Dec 07, 2022

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.

BTK ABSITE 2023 - Thyroid Dec 06, 2022

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.

Clinical Challenges in Breast Surgery: Surgical Management of Metastatic Breast Cancer Dec 05, 2022

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=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_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 our other clinical challenges episodes here: https://behindtheknife.org/podcast-series/clinical-challenges/

Cardiac Surgery Crash Course Series - Episode 4: ICU Hemodynamics Dec 01, 2022

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
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/

Cardiac Surgery Crash Course Series - Episode 3: Basics of CABG Surgery Nov 28, 2022

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/

Cardiac Surgery Crash Course Series - Episode 2: Principles of Cardiopulmonary Bypass Nov 24, 2022

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/

Cardiac Surgery Crash Course Series - Episode 1: Intro to the Cardiac OR Nov 21, 2022

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
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our collection of episodes here: https://behindtheknife.org/listen/all-series/

Clinical Challenges in Surgical Critical Care: Management of the Brain Dead Organ Donor Nov 17, 2022

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/
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/

Journal Review in Emergency General Surgery: Surgical Site Complications Nov 14, 2022

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
- NSQIP database 2005-2016 (>800,000 patients) including open/laparoscopic cholecystectomies, ventral hernia repairs, and partial colectomies
- Comparing outcomes in emergent vs elective cases
- 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
- NPWD remove excess fluid from subcutaneous space, ↓ collections/contaminants, promote angiogenesis, fibroblast infiltration
- Literature review 2005-2022 (NPWD, laparotomy, SSI)
- 1199 patients included (566 NPWD, 633 standard dressings)
- Results:
-- NPWD ↓ wound infection (OR 0.43) and wound breakdown (OR 0.36)
-- No change in LOS, readmission
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 episodes here: https://behindtheknife.org/podcast-category/emergency-general-surgery/

Clinical Challenges in Thoracic Surgery: Anterior Mediastinal Masses Nov 10, 2022

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/

Journal Review in Endocrine Surgery: How Dr. Yeh Built It Nov 07, 2022

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/

Clinical Challenges in Colorectal Surgery: Management of Small Bowel Strictures in Crohn’s Disease Nov 03, 2022

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
1. Describe the evaluation for small bowel strictures and indications for operating in patients with Crohn’s disease
2. Discuss the different surgical options in managing small bowel strictures
3. 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/

BIG T Trauma Series Ep. 16 – Pelvic Fractures Oct 31, 2022

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 us for a practical discussion about the best way to manage gnarly pelvic fractures. From binders to angioembolization to pelvic packing to REBOA, we cover it all.
Papers:

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/
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/
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/

Innovations in Surgery: 3D Printing Oct 27, 2022

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/

Innovations in Surgery: Artificial Intelligence Oct 24, 2022

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.
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Clinical Challenges in Vascular Surgery: Acute Mesenteric Ischemia Oct 20, 2022

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

Clinical Challenges in Hepatobiliary Surgery: Intraductal Papillary Mucinous Neoplasm (IPMN) Oct 17, 2022

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/

Difficult Gallbladders Oct 13, 2022

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:
1. Use the Critical View of Safety (CVS) method of identification of the cystic duct and cystic artery during laparoscopic cholecystectomy.
2. Understand the potential for aberrant anatomy in all cases.
3. Make liberal use of cholangiography or other methods to image the biliary tree intraoperatively.
4. Consider an Intra-operative Momentary Pause during laparoscopic cholecystectomy prior to clipping, cutting or transecting any ductal structures.
5. 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

6. 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/

Journal Review in Surgical Education: LGBTQ+ Experience in Surgery Oct 10, 2022

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/

Clinical Challenges in Trauma Surgery: Traumatic Rib Fractures Oct 06, 2022

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

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/
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
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
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
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/

Journal Review in Minimally Invasive Surgery: The Cost of Robotic Surgery Oct 03, 2022

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:
1. 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/
2. Finlayson SRG and Birkmeyer JD. Cost-effectiveness Analysis in Surgery. Surgery. 1998
https://pubmed.ncbi.nlm.nih.gov/9481400/
3. 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/

Dominate the Match - Episode 3: “The Interview” Sep 26, 2022

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/

Clinical Challenges in Bariatric Surgery: Revisional Bariatric Surgery Sep 22, 2022

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:
1. 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.
2. 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.
3. 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.
4. 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.
5. 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/

Clinical Challenges in Transplant Surgery: Heart & Liver Transplant Sep 19, 2022

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/

Journal Review in Colorectal Surgery: Kono-S Anastomosis and Stem Cells in Crohn’s Disease Sep 15, 2022

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/

Clinical Challenges in Pediatric Surgery: Congenital Diaphragmatic Hernia Sep 12, 2022

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/

Journal Review in Surgical Oncology: Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma Sep 08, 2022

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/

Coding and Billing: What, Why, and How Sep 05, 2022

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/

BTK General Surgery Oral Board Review – Sample Episode 6 - Hyperparathyroidism Sep 01, 2022

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.

BTK General Surgery Oral Board Review - Sample Episode 5 - Rectal Cancer Aug 29, 2022

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.

Journal Review in Surgical Palliative Care: Advance Care Planning, Serious Illness Conversations and Perioperative Decision Making Aug 25, 2022

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/

Clinical Challenges in Surgical Education: Competency-Based Education Aug 22, 2022

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, 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 additional BTK surgical education episodes here: https://behindtheknife.org/podcast-category/surgical-education/

Journal Review in Breast Surgery: Evolution of DCIS Management Aug 18, 2022

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/

Clinical Challenges in Trauma Surgery: Penetrating Great Vessel Injury Aug 15, 2022

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/

Dominate the Match - Episode 2: "Choose Me" Aug 11, 2022

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/

Dominate the Match - Episode 1: Meet the Match Aug 08, 2022

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/

Common and Critical Intern Dilemmas Part 2 - Behind The Knife Medical Student and Intern Survival Guide Aug 04, 2022

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/

Common and Critical Intern Dilemmas Part 1 - Behind The Knife Medical Student and Intern Survival Guide Aug 01, 2022

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 Disease - What You Need to Know Jul 28, 2022

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 https://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 - https://behindtheknife.org/podcast/clinical-challenges-in-emergency-general-surgery-necrotizing-soft-tissue-infections/

Clinical Challenges in Emergency General Surgery: Necrotizing Soft-Tissue Infections Jul 25, 2022

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:
- Also known as “flesh eating disease”, gas gangrene, necrotizing fasciitis/myositis, Fournier’s gangrene.
- 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)
- Exam: swelling, open lesions, drainage, erythema, crepitus, and pain out of proportion
- Most common: swelling, pain, erythema
- Bullae, skin necrosis, crepitus are less common
- 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.
- OR: must debride all dead/infected tissue, involve other surgical specialties as needed
- Mark edge of cellulitis and use as initial debridement
- Healthy dermis – pearly and white
- Healthy fat – pale, yellow, glistening
- Healthy fascia – should bleed, doesn’t easily separate from muscle
- Healthy muscle – contract with cautery
- Dressing: betadine-soaked gauze on the wound
- Most patients will need at least 3 ORs (second OR generally 8-12 hours after the first)
- No VAC or stoma at first OR
References:
1. 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.
2. 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.
3. 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
4. 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
5. 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.
6. 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" - https://behindtheknife.org/podcast/journal-review-in-colorectal-surgery-timing-of-biologics-and-surgery-in-the-setting-of-crohns-disease/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Journal Review in Colorectal Surgery: Timing of Biologics and Surgery in the Setting of Crohn’s Disease Jul 21, 2022

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
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Journal Review in Thoracic Surgery: POEM vs. Heller Myotomy Jul 18, 2022

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.

Clinical Challenges in Surgical Critical Care: Point-of-Care Ultrasound Jul 14, 2022

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.

Financial Principles for Surgeons Ep. 6: Real Estate Investing with Dr. Jordan Frey Jul 11, 2022

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
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Financial Principles for Surgeons Ep. 5: Contract Negotiations with Dr. Jill Streams Jul 07, 2022

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/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Financial Principles for Surgeons Ep. 4: Student Debt with Dr. Adam Tanious Jul 04, 2022

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/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Financial Principles for Surgeons Ep. 3: Disability Insurance with Larry Keller Jun 30, 2022

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/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Financial Principles for Surgeons Ep. 2: Investing and Buying a House with Dr. Mizell Jun 28, 2022

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.

Financial Principles for Surgeons Ep. 1 with Dr. Jason Mizell Jun 27, 2022

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
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Behind the Knife Update 2022 Jun 24, 2022

Join the BTK leadership team for a quick update on what's happening at Behind the Knife!
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Clinical Challenges in Endocrine Surgery: Medullar Thyroid Cancer with Special Guest Dr. Kepal Patel Jun 20, 2022

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.

Journal Review in Surgical Education: Intersection of Leadership and Wellness in Education Jun 16, 2022

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.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Journal Review in Hepatobiliary Surgery: Genomics of Colorectal Liver Metastasis Jun 13, 2022

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 (@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-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)
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Journal Review in Vascular Surgery: Acute Limb Ischemia – So Many Choices!?! Jun 09, 2022

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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Clinical Challenges in Minimally Invasive Surgery: Acute Gastric Volvulus and Duodenal Perforation Jun 06, 2022

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:
1. 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
2. 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
3. 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/
4. 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/
5. 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/
6. 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/
7. 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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Journal Review in Trauma Surgery: Imaging for Blunt Cerebrovascular Injury (BCVI) Jun 02, 2022

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

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/
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/
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/
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/
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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Journal Review in Pediatric Surgery: TEF & Transanastomotic Feeding Tube May 30, 2022

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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ASCRS 2022 Highlights 2 May 26, 2022

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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ASCRS 2022 Highlights 1 May 23, 2022

*** 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.
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Journal Review in Bariatric Surgery: Worsening or De Novo GERD following Vertical Sleeve Gastrectomy May 19, 2022

*** 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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Clinical Challenges in Surgical Oncology: Surgical Management for Borderline Resectable/Locally Advanced Pancreatic Cancer May 16, 2022

*** 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.
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Cardiac Xenotransplantation May 12, 2022

*** 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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Journal Review in Transplant Surgery: History and Challenges of Xenotransplantation May 09, 2022

*** 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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Clinical Challenges in Colorectal Surgery: Lynch Syndrome May 05, 2022

*** 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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Journal Review in Surgical Education: Gender Representation in Surgery May 02, 2022

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 Apr 28, 2022

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:

Hasan Alam, MD (@DrHasanAlam)
Scott Steele, MD (@ScottRSteeleMD)
Joseph Dubose, MD (check out his exceptional podcast here: https://www.tiger-country.org/)
Mathew Martin, MD (@docmartin22)
Red Hoffman, MD (@redMDND, check out her amazing podcast here: https://thesurgicalpalliativecarepodcast.buzzsprout.com/)
Bellal Joseph, MD (@TopKnife_B)

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Mattox Vegas TCCACS 2022: Ep. 1 Apr 25, 2022

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:

Dennis Kim, MD (@traumaicurounds, check out his amazing podcast here: https://www.traumaicurounds.ca/)
Ali Salim, MD (@alisalimMD)
Jason Smith, MD (@DrJTrauma)
Andre Campbell, MD (@TraumaDocSF)
Meghan Lewis, MD
Demetrios Demetriades, MD
Alexander Eastman, MD (@PMHTrauma_ALE)

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Journal Review in Trauma Surgery: Managing Blunt Pelvic Hemorrhage Apr 21, 2022

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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Clinical Challenges in Surgical Education: Entrustable Professional Activities (EPAs) Apr 18, 2022

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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Biologic vs. Synthetic Mesh for Single-stage Repair of Contaminated Ventral Hernias with Special Guest Dr. Michael Rosen Apr 14, 2022

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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Clinical Challenges in Surgical Palliative Care: Malignant Bowel Obstruction Apr 11, 2022

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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Journal Review in Hernia Surgery: Umbilical Hernias in Complex Patient Populations Apr 07, 2022

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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Clinical Challenges in Breast Surgery: Management of Axilla Apr 04, 2022

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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Journal Review in Emergency General Surgery: EGS in Patients > 65 Mar 31, 2022

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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Clinical Challenges in Thoracic Surgery: Esophageal Perforation Mar 28, 2022

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

- Understand basic principles of management
- Review differences in management based on different underlying pathology and location
- Learn indications and techniques for advanced endoscopic interventions for perforations
- 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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BIG T Trauma Series Ep. 15 - ED Thoracotomy: The How Mar 24, 2022

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.

BIG T Trauma Series Ep. 14 - ED Thoracotomy: The Who Mar 21, 2022

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/sites/default/files/hg_features/mercury_standard_layout/031abaa9027e1685ad340ac8f662e86a.pdf
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Journal Review in Surgical Critical Care: Sepsis Update Mar 17, 2022

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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Clinical Challenges in Colorectal Surgery: Rectal Prolapse Mar 14, 2022

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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Journal Review in Endocrine Surgery: The Great Debate of UCLA Endocrine Surgery Mar 10, 2022

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.
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BTK General Surgery Oral Board Review - Sample Episode 4 - Mesenteric Ischemia Mar 07, 2022

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.

BTK Vascular Surgery Oral Board Review Book - Sample Cases Mar 03, 2022

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
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Clinical Challenges in Vascular Surgery: Endoleaks Feb 28, 2022

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/

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BTK General Surgery Oral Board Review - Sample Episode 3 - Thyroid Nodule Feb 24, 2022

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.

BTK General Surgery Oral Board Review - Sample Episode 2 - Esophageal Perforation Feb 21, 2022

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.

BTK General Surgery Oral Board Review - Sample Episode 1 - Cardiac Trauma Feb 17, 2022

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.

Clinical Challenges in Hepatobiliary Surgery: Metachronous Colorectal Liver Metastasis Feb 14, 2022

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 (@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-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.

Journal Review in Minimally Invasive Surgery: Surgical Treatment of Esophageal Reflux - Fundoplication vs. LINX Feb 10, 2022

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
6. 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.

Clinical Challenges in Trauma Surgery: Penetrating Liver Trauma Feb 07, 2022

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/
2. 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/
3. 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/
4. 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
5. 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
6. 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
7. 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.

BTK/ANNALS JOURNAL CLUB #19 - Empowering Surgeons, Anesthesiologists, and Obstetricians to Incorporate Environmental Sustainability in the Operating Room Jan 31, 2022

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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Clinical Challenges in Transplant Surgery: Nutcracker Syndrome & Post-Op Liver Transplant Patient Jan 27, 2022

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
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Journal Review in Surgical Oncology: Perioperative Chemotherapy for Locally Advanced, Resectable, Gastric Cancer Jan 24, 2022

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
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Clinical Challenges in Pediatric Surgery: Neuroblastoma Management Jan 17, 2022

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/
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Journal Review in Colorectal Surgery: Watch and Wait Strategy for Distal Rectal Cancer Jan 13, 2022

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]:
1. 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.
2. 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.
3. 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.
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Clinical Challenges in Bariatric Surgery: Marginal Ulcers following Roux-en-Y Gastric Bypass Jan 10, 2022

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/

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BTK ABSITE 2022 - DO NOT OPEN UNTIL MORNING OF ABSITE Jan 09, 2022

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BTK ABSITE 2022 - Colorectal Bonus Episode Jan 09, 2022

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BTK ABSITE 2022 - Urology Jan 09, 2022

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BTK ABSITE 2022 - ENT Jan 09, 2022

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BTK ABSITE 2022 - Anesthesia Jan 08, 2022

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BTK ABSITE 2022 - Biostatistics Jan 08, 2022

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BTK ABSITE 2022 - Transplant Jan 08, 2022

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BTK ABSITE 2022 - Pediatric Surgery Jan 07, 2022

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BTK ABSITE 2022 - Thoracic Jan 07, 2022

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BTK ABSITE 2022 - Hernias Jan 06, 2022

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BTK ABSITE 2022 - Fluids and Electrolytes Jan 06, 2022

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BTK ABSITE 2022 - Critical Care Part 2 with Dr. Matthew Martin Jan 05, 2022

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BTK ABSITE 2022 - Critical Care Part 1 with Dr. Matthew Martin Jan 05, 2022

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BTK ABSITE 2022 - Trauma Part 2 with Dr. Matthew Martin Jan 04, 2022

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BTK ABSITE 2022 - Trauma Part 1 with Dr. Matthew Martin Jan 04, 2022

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BTK ABSITE 2022 - Hematology Jan 03, 2022

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BTK ABSITE 2022 - Breast Jan 02, 2022

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BTK ABSITE 2022 - Vascular Part 2 Jan 01, 2022

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BTK ABSITE 2022 - Vascular Part 1 Dec 31, 2021

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BTK ABSITE 2022 - Colorectal Part 2 Dec 30, 2021

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BTK ABSITE 2022 - Colorectal Part 1 Dec 29, 2021

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BTK ABSITE 2022 - Pancreas Dec 28, 2021

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BTK ABSITE 2022 - Adrenal Dec 27, 2021

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BTK ABSITE 2022 - Hepatobiliary Part 2 Dec 26, 2021

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BTK ABSITE 2022 - Hepatobiliary Part 1 Dec 25, 2021

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BTK ABSITE 2022 - Spleen Dec 24, 2021

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BTK ABSITE 2022 - Stomach Dec 23, 2021

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BTK ABSITE 2022 - Esophagus Dec 22, 2021

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BTK ABSITE 2022 - Parathyroid Dec 21, 2021

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BTK ABSITE 2022 - Thyroid Dec 20, 2021

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Clinical Challenges in Hernia Surgery: Preoperative Optimization for Abdominal Wall Reconstruction Dec 16, 2021

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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Journal Review in Breast Surgery: Management of Residual Disease After Neoadjuvant Chemotherapy Dec 13, 2021

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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Clinical Challenges in Trauma Surgery: The Pregnant Trauma Patient Dec 09, 2021

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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Journal Review in Surgical Palliative Care: Palliative Care in the Surgical ICU Dec 06, 2021

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.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Journal Review in Surgical Education: Operative Performance Assessment Dec 02, 2021

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
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Clinical Challenges in Surgical Critical Care: Arrhythmias Nov 29, 2021

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:
1. Van Gelder I, Groenveld H, Crijns H, et al. Lenient versus Strict Rate Control in Patients with Atrial Fibrillation. NEJM 2010.
2. Walkey A, Hogarth K, Lip G. Optimizing Atrial Fibrillation Management: From ICU and Beyond. CHEST 2015.
3. AFFIRM Investigators. A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation. NEJM 2002.
4. ACLS Training Center: Tachycardia with a Pulse Algorithm. https://www.acls.net/acls-tachycardia-algorithm
5. ACLS Training Center: Cardiac Arrest Algorithm. https://www.acls.net/acls-secondary-survey
6. ACLS Training Center: Acute Coronary Syndromes Algorithm. https://www.acls.net/acute-coronary-syndromes-algorithm
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Journal Review in Thoracic Surgery: Adjuvant Therapy in Lung Adenocarcinoma Nov 22, 2021

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

- 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
- 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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cT2N0 Middle Rectal CA: Neoadjuvant Therapy or Resect? Nov 18, 2021

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.

Clinical Challenges in Emergency General Surgery: Cancer Emergencies Nov 15, 2021

Join Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross as they tackle Cancer Emergencies.
Case 1 - Learning Points:

These are complex patients and multidisciplinary care should be provided with input from oncology.
A step-up approach should be used, starting with medical management prior to considering surgery in appropriate patients.
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.
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:

Colorectal malignancy is an exceedingly common cause of general surgical emergency and requires a thoughtful, systematic approach
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
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
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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Clinical Challenges in Endocrine Surgery: Genetic Testing for Thyroid Cancer Nov 11, 2021

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.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Journal Review in Colorectal Surgery: Total Neoadjuvant Therapy (TNT) for Rectal Cancer Nov 08, 2021

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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Family Leave During Surgical Training: A Discussion with ABS President Dr. Jo Buyske Nov 04, 2021

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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Clinical Challenges in Surgical Education: Pregnancy and Parenthood Nov 01, 2021

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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Clinical Challenges in Minimally Invasive Surgery: Post-Inguinal Hernia Repair Chronic Pain Oct 28, 2021

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
2. 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/
3. 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
4. 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/
5. 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/
6. 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/
7. 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
8. 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/
9. 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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CODA Long-Term Trial Results: Antibiotics versus Surgery for Appendicitis Oct 25, 2021

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”.
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Misinformation, Conspiracy Theories, and COVID: A Reckoning Oct 21, 2021

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 Hepatopancreaticobiliary Surgery: Surgical Outcomes of the SWOG S1505 Trial Oct 18, 2021

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 (@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-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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Clinical Challenges in Bariatric Surgery: Bariatric Emergencies for the General Surgeon Part 2 Oct 14, 2021

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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Journal Review in Trauma Surgery: Pigtail Catheters for Traumatic Hemothorax Oct 11, 2021

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
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Clinical Challenges in Bariatric Surgery: Bariatric Emergencies for the General Surgeon Part 1 Oct 07, 2021

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.
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Journal Review in Vascular Surgery: Peripheral Artery Disease Oct 04, 2021

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
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Colorectal Surgery Virtual Education Series: Mock Oral Exam Part 2 Sep 30, 2021

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.

Journal Review in Transplant Surgery: New Topics in Liver Transplantation Sep 27, 2021

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.

Colorectal Surgery Virtual Education Series: Mock Oral Exam Part 1 Sep 23, 2021

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.

Clinical Challenges in Surgical Oncology: Curative Options for Hepatocellular Carcinoma Sep 20, 2021

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/

Journal Review in Bariatric Surgery: Controversies Surrounding Extended VTE Prophylaxis Sep 16, 2021

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/

Clinical Challenges in Colorectal Surgery: Colorectal Cancer with Synchronous Colorectal Cancer Liver Metastasis Sep 13, 2021

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.

Big T Trauma Series Ep. 13 - Pitfalls in Trauma #2 Sep 09, 2021

"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:

Splenic pseudoaneurysm
Compartment syndrome
Urogenital injury
Diaphragm injury
Esophageal injury

Journal Review in Pediatric Surgery: Pediatric Ovarian Mass Sep 06, 2021

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/

Big T Trauma Series Ep. 12 - Pitfalls in Trauma #1 Sep 02, 2021

"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

Clinical Challenges in Surgical Education: Supporting the Struggling Resident Aug 30, 2021

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

Clinical Challenges in Colorectal Surgery: Large Bowel Obstruction Aug 26, 2021

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!

Journal Review in Hernia Surgery: Prophylactic Mesh Placement Aug 23, 2021

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!

Clinical Challenges in Surgical Palliative Care: The Family Meeting, Code Status and Goals of Care Aug 16, 2021

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!

ACS Cancer Surgery Standards Program Aug 12, 2021

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!

Clinical Challenges in Breast Surgery: Triple Negative Breast Cancer Aug 02, 2021

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
FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLSfxhjxgCE9Ek263XuGkpqqbaNiK9sVnu3M7_LFYUZxhr38SZw/viewform

How you can DOMINATE the surgery clerkship Jul 29, 2021

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
2. Take a proactive role in your education
3. Show enthusiasm and be engaged
4. Give quality presentations with thoughtful assessments and plans
5. 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
FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLSfxhjxgCE9Ek263XuGkpqqbaNiK9sVnu3M7_LFYUZxhr38SZw/viewform

Journal Review in Emergency General Surgery: Cholecystitis in Pregnancy Jul 26, 2021

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.
FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLSfxhjxgCE9Ek263XuGkpqqbaNiK9sVnu3M7_LFYUZxhr38SZw/viewform

BTK/ANNALS JOURNAL CLUB #18: RESIDENT WELLNESS, BURNOUT, AND PERSONAL ACCOMPLISHMENT Jul 22, 2021

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/

Journal Review in Surgical Critical Care: Renal Dysfunction in the Intensive Care Unit Jul 19, 2021

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/

Clinical Challenges in Thoracic Surgery: Spontaneous Pneumothorax Jul 15, 2021

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

Journal Review Endocrine Surgery: AAES 2021 Highlights Jul 12, 2021

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.

Clinical Challenges in Colorectal Surgery: Endoscopic Management of Advanced Colorectal Polyps Jul 08, 2021

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.

Journal Review (MIS): Evaluating the robotic platform in general surgery: ROLARR & RIVAL Jul 05, 2021

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

Plastic Surgery for the General Surgeon: Lymphedema Surgery Jul 01, 2021

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.

7 Habits for Highly Effective Surgery Communication with Dr. Gretchen Schwarze Jun 28, 2021

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/

Best Case Worst Case Tool: Scenario Planning with Dr. Gretchen Schwarze Jun 24, 2021

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

Clinical Challenges in Surgery HPB: Pancreatic Head Cancer Jun 21, 2021

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

Surgical Oncology- Hepatic artery infusion pump Jun 17, 2021

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 Jun 14, 2021

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
1510. https://pubmed.ncbi.nlm.nih.gov/31147/183/

Clinical Challenge in Vascular Surgery: Carotid Artery Stenosis Jun 07, 2021

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

#DearIntern May 31, 2021

“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.

Vascular Trauma Resident Survival Guide Part 3 - Abdomen, Pelvis, and Extremities May 27, 2021

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

Vascular Trauma Resident Survival Guide Part 2 - Neck & Chest May 24, 2021

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.

Vascular Trauma Resident Survival Guide Part 1 w/ Rich's Vascular Trauma May 17, 2021

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.

The Joint Commission Tackles Healthcare Disparities in the COVID Era May 10, 2021

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!

COVIDSurg Update May 03, 2021

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 Apr 26, 2021

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.

Surgical Technique: Kidney Transplant (Part 2) Apr 19, 2021

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!

Surgical Technique: Kidney Transplant (Part 1) Apr 19, 2021

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!

Plastic Surgery for the General Surgeon: Flap Reconstruction Apr 12, 2021

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!

Vascular Journal Club - When to Thrombolyse DVTs? Single or Dual Antiplatelet Following Bypasses? Apr 05, 2021

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/

Clinical Challenges: GSW to the Abdomen Mar 29, 2021

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.

Understanding SCORE and the Future of Surgical Education Mar 22, 2021

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!

Clinical Challenges: Diverticulitis Mar 16, 2021

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.

SSO Landmark Papers - Intrahepatic Cholangiocarcinoma Mar 08, 2021

The venerable Dr. Timothy Pawlik from Ohio State joins us on the podcast today to discuss his Landmark Paper review of Intrahepatic Cholangiocarcinoma!

Plastic Surgery for the General Surgeon: Breast Reconstruction with Dr. John Kim Mar 01, 2021

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!

Plastic Surgery for the General Surgeon: Abdominal and Chest Wall Reconstruction with Dr. Shailesh Agarwal Feb 22, 2021

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!

Plastic Surgery for the General Surgeon: Perineal Reconstruction with Dr. Shailesh Agarwal Feb 15, 2021

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!

Kick-Off to 2021! Feb 10, 2021

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.

Endovascular Management of Trauma with Dr. Todd Rasmussen and Dr. Wayne Causey Feb 08, 2021

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

BTK ABSITE 2021 - DO NOT OPEN UNTIL MORNING OF ABSITE (45 MINUTE REVIEW) Jan 29, 2021

The time has come. Dominate it.

BTK ABSITE 2021 - Anesthesia Jan 27, 2021

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.

BTK ABSITE 2021 - Biostatistics Jan 23, 2021

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BTK ABSITE 2021 - Transplant Jan 23, 2021

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BTK ABSITE 2021 - Pediatric Surgery Jan 19, 2021

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BTK ABSITE 2021 - Thoracic Jan 18, 2021

https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767

BTK ABSITE 2021 - Hernias Jan 15, 2021

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

BTK ABSITE 2021 - Fluids and Electrolytes Jan 15, 2021

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BTK ABSITE 2021 - Critical Care Part 2 with Dr. Matthew Martin Jan 13, 2021

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BTK ABSITE 2021 - Critical Care Part 1 with Dr. Matthew Martin Jan 13, 2021

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BTK ABSITE 2021 - Trauma Part 2 with Dr. Matthew Martin Jan 12, 2021

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BTK ABSITE 2021 - Trauma Part I with Dr. Matthew Martin Jan 12, 2021

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BTK ABSITE 2021 - Hematology Jan 11, 2021

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Check out our YouTube landmark paper series here

https://www.youtube.com/watch?v=lzAoWs6w8q8

BTK ABSITE 2021 - Breast Jan 05, 2021

We review high yield breast topics, to include: high yield anatomy, benign breast disease, and management of breast cancer and the axilla.

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BTK ABSITE 2021 - Vascular Part 2 Jan 03, 2021

BTK ABSITE Companion

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Subscribe to our YouTube Channel here for video ABSITE reviews.

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BTK ABSITE 2021 - Vascular Part 1 Jan 03, 2021

BTK ABSITE Companion

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Subscribe to our YouTube Channel here for video ABSITE reviews.

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BTK ABSITE 2021 - Colorectal Part 2 Dec 28, 2020

BTK ABSITE Companion

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BTK ABSITE 2021 - Colorectal Part 1 Dec 28, 2020

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BTK ABSITE 2021 - Pancreas Dec 23, 2020

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BTK ABSITE 2021 - Adrenal Dec 19, 2020

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

BTK ABSITE 2021 - Hepatobiliary Part 2 Dec 18, 2020

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

BTK ABSITE 2021 - Hepatobiliary Part 1 Dec 18, 2020

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

BTK ABSITE 2021 - Spleen Dec 15, 2020

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

BTK ABSITE 2021 - Stomach Dec 14, 2020

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!

BTK ABSITE 2021 - Esophagus Dec 10, 2020

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

BTK ABSITE 2021 - Parathyroid Dec 07, 2020

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

BTK ABSITE 2021 - Thyroid Dec 07, 2020

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

BTK ABSITE 2021 - Head and Neck Dec 03, 2020

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Colorectal Surgery Mock Oral Boards Nov 23, 2020

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? A Debate. Nov 16, 2020

“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.

SSO Landmark Papers - Neuroendocrine Tumor Liver Metastases Nov 09, 2020

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

BTK/AAS "How I Built It" Series - Dr. Julie Ann Sosa Nov 02, 2020

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.

Why a Career in Vascular Surgery with Dr. Bernadette Aulivola Oct 26, 2020

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

SSO Landmark Papers - Colorectal Cancer Liver Metastases Oct 13, 2020

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.

CODA Trial Results - Antibiotics versus Surgery for Appendicitis Oct 05, 2020

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.

BTK/AAS "How I Built It" Series - Dr. Sandra Wong Sep 28, 2020

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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SSO Landmark Papers - Rectal Cancer and Lateral Lymph Nodes Sep 21, 2020

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

Deep Space: What will Surgery and Medicine Away from Earth Look Like? Sep 14, 2020

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.

GlobalSurg - CovidSurg Week. International Collaborative. Sep 09, 2020

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

SSO Landmark Papers Series - Melanoma Sep 07, 2020

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.

Palliative Care and Surgery Aug 31, 2020

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.

BTK/AAS "How I Built It" Series - Dr. John Birkmeyer Aug 24, 2020

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.

Adrenal Incidentaloma and Adrenalectomy with Dr. Travis McKenzie Aug 17, 2020

Dr. Travis McKenzie from Mayo Clinic discusses his approach to the adrenal incidentaloma, and shares pearls of wisdom for shucking out those adrenal masses.

Cerebrovascular Trauma with Dr. Todd Rasmussen Aug 10, 2020

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

What Happened - American Board of Surgery 2020 Qualifying Exam Failure Aug 03, 2020

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

BTK/ANNALS JOURNAL CLUB #17: RACIAL DISPARITIES IN THE COVID-19 ERA Jul 30, 2020

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

Systemic Bias and Structural Racism in Surgery and Medicine Jul 27, 2020

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

ECMO Basics Part 3 with Patrick Georgoff and Nicholas Teman Jul 24, 2020

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