Explorez tous les épisodes du podcast Behind The Knife: The Surgery Podcast

Join for the fifth episode in the Association of Out Surgeons and Allies (AOSA) series for a comprehensive discussion of what the general surgeon needs to know prior to operating on a patient who has previously undergone gender affirming surgery.

Host: 
Dan Scheese, MD
Andrew Schlussel, DO, Colorectal and General Surgeon, Charlie Norwood VA Medical Center

Guests:
Dr. Megan Lane (She/her)
megalane@med.umich.edu
Dr. Lane is a plastic surgery resident at the University of Michigan who is planning on going into Gender Affirming Surgery and general reconstruction. She completed a research fellowship in the National Clinician Scholars Program and focused primarily on patient-reported outcomes in gender affirming surgery.

Dr. Amy Suwanabol
pasuwan@med.umich.edu
Dr. Suwanabol is a colorectal surgeon at the University of Michigan and the Ann Arbor VA. She assists the gender affirming surgeons at the University of Michigan in performing robotic-assisted vaginoplasty. Her research focuses on optimizing quality of life among surgical patients and their families, surgeon well-being, and cancer survivorship.

Dr. Monica Llado-Farrulla
lladorfar@ohsu.edu
Dr. Llado-Farrulla was born and raised in Puerto-Rico, completed general surgery residency followed by plastic surgery residency at Tulane and Penn, respectively. She pursued a year of training in advanced gender surgery and is now currently at OHSU. Her practice largely focuses on facial feminization, chest affirming surgeries, phalloplasty, autologous breast reconstruction, and limb salvage. 

Learn more and get involved with AOSA: https://www.outsurgeons.org

Twitter/X: @OutSurgeons

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

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

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.  

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

Our oral board review course includes 100 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.

All of our premium courses are available via our website and apps (iOS and Android).  Users can take notes, pin chapters and download content for offline viewing.  

Learn more about the General Surgery Oral Board Review Course at https://app.behindtheknife.org/premium

**Institutional Discounts Available - Please email hello@behindtheknife.org to learn more.**

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

Need a dose of inspiration?  You found it here.  This interview with Dr. Ammar Darwish will have you in awe.  Dr. Darwish is a general and trauma surgery at Manchester University NHS Foundation Trust and Medical Director at The David Nott Foundation (https://davidnottfoundation.com/).  Dr. Darwish volunteers for intensely dangerous but highly impactful surgical humanitarian missions in conflict zones around the world. In fact, he has been deployed to over 50 global humanitarian missions in the last 15 years. He is passionate about helping victims of conflict and natural disaster by better equipping and training doctors who care for them. 

Want to learn more about the Nott Foundation?  Good!  You should.  Check out their website for more: https://davidnottfoundation.com/

Interview with Dr. David Knott: https://app.behindtheknife.org/podcast/war-doctor-david-nott-on-surgery-in-war-zones

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

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

Join 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

Join Drs. Galandiuk, Bolshinsky, Kavalukas, and Simon as they discuss the controversial management of colon cancer of the splenic flexure. What procedure do you perform? Does it matter? Tune in to hear the discussion!

Hosts:
- Susan Galandiuk MD, University of Louisville, Louisville, Kentucky, @DCREdInChief
- Vladimir Bolshinsky MD, Peninsula Health, Victoria, Australia, @bolshinskyv
- Sandy Kavalukas MD, University of Louisville, Louisville, Kentucky, @sandykava
- Hillary Simon DO, University of Louisville, Louisville, Kentucky, @HillaryLSimon

Producer:
- Manasa Sunkara MS3, University of Louisville, Louisville, Kentucky, @manasasunkara12

Learning objectives:
- Review surgical procedure options for splenic flexure cancer.
- Understand the importance of confirming the location of the tumor with imaging and/or endoscopically, perioperatively.
- Discuss surgical principles of operating in the left upper quadrant. 

References: 
de’Angelis, et al. Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis. Surg Endosc. 2021 (35) :661–672. 
https://pubmed.ncbi.nlm.nih.gov/32072288/

Degiuli M, et al. Segmental Colonic Resection Is a Safe and Effective Treatment Option for Colon Cancer of the Splenic Flexure: A Nationwide Retrospective Study of the Italian Society of Surgical Oncology-Colorectal Cancer Network Collaborative Group. Dis Colon Rectum. 2020 Oct;63(10):1372-1382. 
https://pubmed.ncbi.nlm.nih.gov/32969880/

Manceau G, et al. What Is the Optimal Elective Colectomy for Splenic Flexure Cancer: End of the Debate? A Multicenter Study From the GRECCAR Group With a Propensity Score Analysis. Dis Colon Rectum. 2022 Jan 1;65(1):55-65.
https://pubmed.ncbi.nlm.nih.gov/34882628/

Okazaki T, et al. Two Types of Variational Arteries' Courses From the Superior Mesenteric Artery to Supply the Splenic Flexure: Gross Anatomical Study. Dis Colon Rectum. 2024 Jan 1;67(1):120-128.
https://pubmed.ncbi.nlm.nih.gov/37493262/

Pang AJ, Marinescu D, Morin N, Vasilevsky CA, Boutros M. Segmental resection of splenic flexure colon cancers provides an adequate lymph node harvest and is a safe operative approach - an analysis of the ACS-NSQIP database. Surg Endosc. 2022 Aug;36(8):5652-5659.
https://pubmed.ncbi.nlm.nih.gov/34973078/

Rusli SM, et al. Laparoscopic D3 oncological resection in splenic flexure cancer: Technical details and its impact on long-term survival. Colorectal Dis. 2023 Mar;25(3):431-442.
https://pubmed.ncbi.nlm.nih.gov/36281503/

Sakamoto K, et al. Drainage pattern of the splenic flexure vein and its accompanying arteries using three-dimensional computed tomography angiography: a single-centre study of 600 patients. Colorectal Dis. 2023 Aug;25(8):1679-1685.
https://pubmed.ncbi.nlm.nih.gov/37221647/

Vargas, HD. Gaining Mesenteric Length following Colorectal Resection: Essential Maneuvers to Avoid Anastomotic Tension. Clin Colon Rectal Surg. 2023 Jan 13;36(1):37-46.
https://pubmed.ncbi.nlm.nih.gov/36643828/

Vogel JD, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer. Dis Colon Rectum. 2022 Feb 1;65(2):148-177.
https://pubmed.ncbi.nlm.nih.gov/34775402/

Video References

 “Splenic Flexure Cancers.” Lahey Hospital & Medical Center. Disease of the Colon and Rectum Journal Club. February 28, 2022. https://www.youtube.com/watch?v=87HXHQYMxe4&list=PLMBNyGA6TZajQn4UlDyKxrLakFZb7SC_2&index=23

Varela, C. and Yang, S. Laparoscopic-Assisted Colonic Resection for Splenic-Flexure Cancer With D3 Lymphadenectomy, Diseases of the Colon & Rectum 66(6):p e295-e297, June 2023. https://journals.lww.com/dcrjournal/pages/collectiondetails.aspx?TopicalCollectionID=138&ParentCollection=109

***TRUELEARN LINK: https://truelearn.referralrock.com/l/BTKPODCAST/
Discount code: BTKPODCAST
Using the discount code, you can get a discount of $25 off our Residency (General surgery, anesthesiology, OBGYN, Psychiatry, Peds, Neurology, Emergency Medicine, Internal Medicine, and Family Medicine), USMLE, andCOMLEX SmartBank subscriptions of 90-days or more. The code can also be applied for 15% off our allied healthSmartBanks (PA, Nurse Practitioner, Pharmacy, PT, OT, etc.).

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

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

Our Colorectal Surgery Oral Board Audio Review includes 51 high-yield scenarios designed for Colorectal Surgeons by Colorectal Surgeons.  

Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as colorectal surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.

Learn more about the full set of 51 scenarios here: https://behindtheknife.teachable.com/p/btk-colorectal-surgery-oral-board-review-course

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

Our 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.  

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.  

Pregnancy leads to many physiologic changes, and thyroid and parathyroid disorders alter that physiology even more leading to complex laboratory interpretation and decision-making impacting both mother and fetus. In this episode, join endocrine surgeons Drs. Barb Miller, John Phay, Priya Dedhia, and Surgical Oncology Fellow Dr. Vennila Padmanaban from The Ohio State University. Hear about normal and abnormal thyroid and parathyroid physiology and treatment of patients with thyroid cancer. The group discusses several articles focusing on current guidelines from the American Thyroid Association as well as other key studies. 

Hosts: Barbra S. Miller, MD (Moderator), Clinical Professor of Surgery, John Phay, MD, Clinical Professor of Surgery, Priya H. Dedhia, MD, PhD, Assistant Professor of Surgery, Vennila Padmanaban, MD, Surgical Oncology Fellow, Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.

Twitter handles: 
Barbra Miller - @OSUEndosurgBSM
John Phay – @JohnPhayMD
Priya Dedhia – @priyaknows 
Vennila Padmanaban - @vennilapadmanMD

Learning objectives: 
1)  Understand normal changes in thyroid and parathyroid physiology during pregnancy
2)  Describe the impact of thyroid and parathyroid dysregulation on maternal and fetal health
3)  Compare and contrast management of thyroid and parathyroid disorders during pregnancy vs. non-pregnancy  
4)  Recognize the importance of multidisciplinary care of patients with thyroid and parathyroid disorders

References:
1. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017 Mar;27(3):315-389. doi: 10.1089/thy.2016.0457. Erratum in: Thyroid. 2017 Sep;27(9):1212. doi: 10.1089/thy.2016.0457.correx. PMID: 28056690
https://pubmed.ncbi.nlm.nih.gov/28056690/
2. Jee SB, Sawal A. Physiological Changes in Pregnant Women Due to Hormonal Changes. Cureus. 2024 Mar 5;16(3):e55544. doi: 10.7759/cureus.55544. PMID: 38576690; PMCID: PMC10993087
https://pubmed.ncbi.nlm.nih.gov/38576690/
3. Patel, Kepal N. MD; Yip, Linwah MD; Lubitz, Carrie C. MD, MPH; Grubbs, Elizabeth G. MD; Miller, Barbra S. MD; Shen, Wen MD; Angelos, Peter MD; Chen, Herbert MD; Doherty, Gerard M. MD; Fahey, Thomas J. III MD; Kebebew, Electron MD; Livolsi, Virginia A. MD; Perrier, Nancy D. MD; Sipos, Jennifer A. MD; Sosa, Julie A. MD; Steward, David MD; Tufano, Ralph P. MD; McHenry, Christopher R. MD; Carty, Sally E. MD. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Annals of Surgery 271(3):p e21-e93, March 2020.  DOI: 10.1097/SLA.0000000000003580
https://pubmed.ncbi.nlm.nih.gov/32079830/
4. Appelman-Dijkstra NM, Pilz S. Approach to the Patient: Management of Parathyroid Diseases Across Pregnancy. J Clin Endocrinol Metab. 2023 May 17;108(6):1505-1513. doi: 10.1210/clinem/dgac734. PMID: 36546344; PMCID: PMC10188304
https://pubmed.ncbi.nlm.nih.gov/36546344/
 5. Eremkina A, Bibik E,  Mirnaya S, Krupinova J, Gorbacheva A, Dobreva E, Mokrysheva N. Different treatment strategies in primary hyperparathyroidism during pregnancy.  Endocrine. 2022 Sep;77(3):556-560. doi: 10.1007/s12020-022-03127-3. Epub 2022 Jul 12. PMID: 35821184
https://pubmed.ncbi.nlm.nih.gov/35821184/

TRUELEARN LINK: https://truelearn.referralrock.com/l/BTKPODCAST/
Discount code: BTKPODCAST

Using the discount code, you can get a discount of $25 off our Residency (General surgery, anesthesiology, OBGYN, Psychiatry, Peds, Neurology, Emergency Medicine, Internal Medicine, and Family Medicine), USMLE, andCOMLEX SmartBank subscriptions of 90-days or more. The code can also be applied for 15% off our allied healthSmartBanks (PA, Nurse Practitioner, Pharmacy, PT, OT, etc.).

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

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

Does the adult thymus have a purpose and function? Are there any long-term health effects of thymectomy? Tune in to another Swedish Thoracic surgery journal review where we discuss the recent paper out of the NEJM which reports on the health consequences of thymus removal in adults. This paper has been widely picked up by the media and our patients frequently bring it into the office. Listen as we discuss the study population, methods, and potential applications of this paper.

Learning Objectives:

- Review the purpose and function of the thymus.
- Discuss the population, methods, and results of this trial.
- Discuss the application of this paper and how it may or may not impact clinical practice for thoracic surgeons. 

Hosts:

Chloe E. Hanson, MD, PGY-3
Kelly Daus MD, PGY-4
Peter White, MD, Thoracic Surgery Attending
Brian Louie, MD, Thoracic Surgery Attending

Reference Material:

Kooshesh KA, Foy BH, Sykes DB, Gustafsson K, Scadden DT. Health Consequences of Thymus Removal in Adults. N Engl J Med. 2023;389(5):406-417.

https://pubmed.ncbi.nlm.nih.gov/37530823/

Lin TM, Chang YS, Hou TY, et al. Risk of incident autoimmune diseases in patients with thymectomy. Ann Clin Transl Neurol. 2020;7(7):1072-1082.

https://pubmed.ncbi.nlm.nih.gov/32478484/

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

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

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

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/

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

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!

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

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/

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

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

In this 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/

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

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/

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

Most surgeons know about malpractice lawsuits, but did you know that residents and even medical students can be involved in them? Join us for a discussion of what happens when patients sue their treatment teams -- and what happens when those teams involve trainees.

Host: Nina Clark, MD, MS

Guests:
Cindy Hamra, JD, MA is an associate dean in the GME Office at the University of Washington School of Medicine, where she leads the operational, administrative and finance functions.  UW School of Medicine is sponsors clinical training for over 1600 medical and dental residents in fellows in over 200 programs.  UW Medicine, through the School of Medicine, is the largest sponsor of GME programs in the five-state WWAMI region (Washington, Wyoming, Alaska, Montana and Idaho).

Lisa Hammel, JD is the senior director of clinical risk management for UW medicine. Prior to that, she spent over 20 years as a defense attorney primarily working in medical malpractice and professional liability defense. 

References:
American College of Surgeons: https://www.facs.org/for-medical-professionals/news-publications/journals/rise/articles/litigation-overview/ 

AMA: https://www.ama-assn.org/medical-residents/residency-life/resident-medical-liability-lawsuits-why-and-how-often-they-happen

JAMA Surgery: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833625/ & https://jamanetwork.com/journals/jamasurgery/article-abstract/2670456

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

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

Join Drs. Scott Steele and Dan Scheese as they engage in an in-depth conversation with Dr. Michael Valente about the intricate world of appendiceal masses, including carcinoid, adenocarcinoma, and mucinous neoplasms. Despite the complexity of the subject, this episode skillfully deconstructs the topic through the analysis of three distinct cases, illuminating the latest terminology, diagnostic approaches, and management strategies. 

Hosts: 
Scott Steele, MD (@ScottRSteeleMD)
Dan Scheese, MD (@DanScheese13)

Guest:
Michael Valente, MD (@DrMikeValente) is an Associate Professor of Surgery at the Cleveland Clinic and Program Director of the colon and rectal residency program. Dr. Valente's specialty and research interests include cancer of the appendix, peritoneum, colon, rectum and anus, cytoreductive surgery/HIPEC, complex re-operative surgery, inflammatory bowel disease, advanced endoscopic techniques, laparoscopic and minimally invasive colorectal surgery, and surgical education. Dr. Valente has published numerous peer-reviewed journal articles and book chapters and has presented his research interests both nationally and internationally.

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

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

M&M - we all do it, but what is its purpose? Join Jason and Nina as they talk to two experts about why we present at all, and what we can do to better reach the educational and quality improvement goals of morbidity and mortality conference.

Hosts: Jason Bingham, Nina Clark

Panelists

• Keith Lillemoe, MD
  • Chief of Surgery, Massachusetts General Hospital
  • Professor of Surgery at the Harvard Medical School
• Luise Pernar, MD, MHPE
  • Bariatric Surgeon
  • Associate Professor of Surgery, Boston University Chobanian and Avedisian School of Medicine

References
https://jamanetwork.com/journals/jamasurgery/article-abstract/2810740
https://pubmed.ncbi.nlm.nih.gov/26649585/

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

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

It’s that time of year (again!)- when medical students- both US and International- are preparing their residency applications. This year, we have been focusing on the special challenges International Medical Graduates face when applying to US surgical residency positions. In our previous episode, we discussed how residents can make their applications stand out to program directors. Today, we will explore the unique challenges, experiences, and the future of IMGs with special guest Dr. Hasan Alam. 

Guests:
Hasan Alam, MD- Chair of the Department of Surgery and Professor of Surgery (Trauma and Critical Care) and Cell and Developmental Biology- Northwestern University 

Previous DOMINATE the Match Episodes: 
Episode 2- “Choose Me” (Personal Statements and Letters of Recommendations)
https://behindtheknife.org/podcast/dominate-the-match-episode-2-choose-me/

Episode 3- “The Interview”
https://behindtheknife.org/podcast/dominate-the-match-episode-3-the-interview/

Episode 4- “Rank and Match”
https://behindtheknife.org/podcast/dominate-the-match-episode-4-rank-and-match/

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

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

It’s that time of year (again!)- when medical students- both US and International- are preparing their residency applications. In this episode, we will focus on the special challenges International Medical Graduates face when applying to US surgical residency positions and discuss tips and tricks for making IMG residency applicants standout to program directors in the US. 

Guests:
David Hughes, MD- Clinical Associate Professor of Endocrine Surgery and General Surgery Residency Program Director- University of Michigan
Krishnan Raghavendran, MBBS- Professor of Acute Care Surgery and Critical Care- University of Michigan

Link to video: 
You can watch Dr. Hughes’s full presentation here: https://youtu.be/iQ0CzH7xHwE

Previous DOMINATE the Match Episodes: 

Episode 2- “Choose Me” (Personal Statements and Letters of Recommendations)
https://behindtheknife.org/podcast/dominate-the-match-episode-2-choose-me/

Episode 3- “The Interview”
https://behindtheknife.org/podcast/dominate-the-match-episode-3-the-interview/

Episode 4- “Rank and Match”
https://behindtheknife.org/podcast/dominate-the-match-episode-4-rank-and-match/

Residency Program Lists: 
- FREIDA Residency and Fellowship Database: https://freida.ama-assn.org/
- Doximity: https://www.doximity.com/residency/?utm_campaign=marketing_resnav_competitor_broad_20210520&utm_source=google&utm_medium=cpc&gclid=CjwKCAjwt52mBhB5EiwA05YKo1J47BLAtTPtsJBmVvXGP2pDXLLqgDIwM0pgkSYjoBhFUOO1ktXDYRoC2bkQAvD_BwE

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

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

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/

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

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

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

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

Interested in cardiac surgery? The training paradigm for cardiac surgery has changed significantly over the past decade and we know may students often struggle when deciding what pathway is best for them. For this episode, we assembled a robust team of attendings, fellows, and residents to discuss their journey as well as some of the research that has been conducted about these different pathways to help guide students navigating this decision. 

Hosts: 
- Jessica Millar, MD- PGY-5 General Surgery Resident, University of Michigan, @Jess_Millar15

Guests: 
- Nick Teman, MD- Assistant Professor of Thoracic and Cardiovascular Surgery, University of Virginia, @nickteman

- Jolian Dahl, MD, MSc- Integrated Thoracic Surgery Resident (PGY-6), University of Virginia, @JolianDahl

- Lyndsey Wessels, MD- Traditional Thoracic Surgery Resident (CT-1), University of Virginia, @LyndseyWessels 

Articles Referenced: 

- Pathways to Certification: https://www.abts.org/ABTS/CertificationWebPages/Pathways%20to%20Certification.aspx

- Narahari AK, Patel PD, Chandrabhatla AS, Wolverton J, Lantieri MA, Sarkar A, Mehaffey JH, Wagner CM, Ailawadi G, Pagani FD, Likosky DS. A Nationwide Evaluation of Cardiothoracic Resident Research Productivity. Ann Thorac Surg. 2024 Feb;117(2):449-455. doi: 10.1016/j.athoracsur.2023.08.011. Epub 2023 Aug 26. PMID: 37640148; PMCID: PMC10842395
https://pubmed.ncbi.nlm.nih.gov/37640148/

- Bougioukas L, Heiser A, Berg A, Polomsky M, Rokkas C, Hirashima F. Integrated cardiothoracic surgery match: Trends among applicants compared with other surgical subspecialties. J Thorac Cardiovasc Surg. 2023 Sep;166(3):904-914. doi: 10.1016/j.jtcvs.2021.11.112. Epub 2022 Mar 22. PMID: 35461707.
https://pubmed.ncbi.nlm.nih.gov/35461707/

For episode ideas/suggestions/feedback feel free to email Jessica Millar at: millarje@med.umich.edu

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

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

Bariatric surgery is an evolving field with new procedures, or variations of old ones, being developed to meet the needs of patients with obesity. The single anastomosis duodenoileal bypass (SADI) and one anastomosis gastric bypass (OAGB) are two such procedures which have recently entered the mainstream conversation. In this episode we will give a brief overview of the SADI and OAGB, go over some short and long term studies evaluating safety and efficacy, and discuss current sentiments about these options and how they may fit into bariatric practice. 

Show Hosts:
Matthew Martin, MD
Adrian Dan, MD
Crystal Johnson-Mann, MD
Paul Wisniowski, MD

Article #1: Chao 2024 - Outcomes of SADI and OAGB Compared to RYGB from the Metabolic and Bariatric Surgery Quality Improvement Program: The North American Experience

• Roux-en-Y gastric bypass (RYGB) and duodenal switch are well described procedure for weight loss; however, associated postoperative complications have led to the development of simpler techniques
  • Single anastomosis duodenoileal bypass (SADI) - modification of the duodenal switch where by a loop of ileum of the bilopancreatic limb approximately 200-300cm from the ileal cecal valve is anastomosed to the distal duodenal cuff of a tubularized stomach
  • One anastomosis gastric bypass (OAGB) – modification of the RYGB where a loop of jejunum of the bilopancreatic limb approximately 150-200cm from the ligament of treitz is anastomosed to the distal end of a gastric pouch.
• There is increasing interest in these procedures given the perceived reduced risk reduction associated with one fewer anastomosis
• Currently, there is insufficient data on the safety of these procedures compared to the established RYGB. 
• The article utilizes the MBSAQIP database to evaluate each procedure against the RYGB 
  • Matched groups: SADI vs RYGB and OAGB vs RYGB 
  • Matched against age, sex, BMI, operative time, and ASA classification
  • 30-day outcomes included complications and health care utilization
  • Results were analyzed with univariate comparative analysis, and significant outcomes were examined with logistic regression
    • SADI vs RYGB: SADI independently associated INCREASED odds with staple line leak, sepsis, organ space infection, and pneumonia. 
    • OAGB vs RYGB: OAGB independently associated with REDUCED odds of SSI, transfusion requirement/GI bleed, ICU admission, bowel obstruction, and healthcare utilization (reoperation, readmissions, and reinterventions)
    • No significant differences in mortality
  • Limitation: Article generally reviews technical complications of procedures. Unable to address significant bariatric outcomes such as weight loss and metabolic profile, as well as long term outcomes. 
  • https://pubmed.ncbi.nlm.nih.gov/38170422/

Article #2: Maud 2019 - Efficacy and safety of OAGB vs RYGB for obesity (YOMEGA trial): A multicentre, randomized, open label, non-inferiority trial

• Limited long-term evidence on OAGB
  • Mostly arising from retrospective analyses and one meta-analysis
  • Two randomized clinical trials but with poor power and questionable methodology. 
• This is a randomized non-inferiority trial of in patients undergoing bariatric surgery  
  • Randomized into 2 groups: OAGB vs RYGB with 117 patients per group
  • Patients were followed for 2 years with a loss to follow up of 21% in OAGB and 24% in RYGB cohorts
  • The primary outcome was weight loss with a noninferiority threshold of 7% assuming 60% weight loss at 2 years. Secondary outcomes included complications and metabolic outcomes
  • Groups were compared with Student’s T and Wilcoxon tests for quantitative data, and chi-squared and Fischer’s exact for qualitative endpoints. 
  • Cohorts were analyzed with the intention to treat, and missing data on the primary endpoint was imputed with prediction-based modeling. 
• Highlighted Outcomes
  • Mean percent excess BMI loss of 87.9% in OAGB group compared to 85.8% in RYGB group demonstrating non-inferiority in terms of weight loss
  • Increased number of serious adverse events (SAE) in the OAGB group, but no difference in the proportion of patients with at least 1 SAE
  • OAGB demonstrated 70% complete or partial remission of diabetes compared to 44% in RYGB but underpowered to demonstrate significant difference. 
  • Equal rates of gastritis and esophagitis based on endoscopic biopsy results at 2 years.
  • There were increased nutritional complications in the OAGB groups with 21% vs 0% in RYGB and high rates of diarrhea/anal fissures 14% vs 0%, respectively. This suggests a greater malabsorptive effect of OAGB. 
  • There was equal satisfaction in quality of life between RYGB and OAGB on two validated surveys with >80% satisfaction rates.
• Limitations
  • Data was imputed for the primary end point
  • High rates of loss to follow up in both cohorts
  • Use of “severe adverse events” instead of Clavien-Dindo classification
  • Comparison of specific institutional/surgeon technique of OAGB vs RYGB
  • https://pubmed.ncbi.nlm.nih.gov/30851879/
    
    

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

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

Join Drs. Jason Bingham (@BinghamMd) and Patrick Georgoff (@georgoff) for a thought-provoking discussion with titans of hernia surgery Drs. Todd Heniford (@THeniford) and Michael Rosen (@MikeRosenMD).  You don't want to miss this one!  This episode goes deep, touching on some of the most vexing questions in the world of abdominal wall reconstruction.  

Highlights: 

• Hernia is chronic disease process.  Surgeons should act like it and patients need to understand this.  
• Follow-up data is hard to come by and therefore limited.  Studies must be interpreted with this in mind.
• Hernia surgery is sexy, which is both exciting and concerning.
• "Technology is not useful until it is boring."  New techniques and devices can hurt patients.  
• Complicated hernias should be sent to hernia centers.  Otherwise, general surgeons are more than capable of doing the repair.

Link to paper: https://jamanetwork.com/journals/jamasurgery/fullarticle/2816986

Link to ACHQC: https://achqc.org/

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

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

Join the Behind the Knife Surgical Oncology Team as we discuss the presentation, work-up, and management of gastric cancer.

Hosts:
- Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center
- Connor Chick, MD (@connor_chick) is a Surgical Oncology fellow at Ohio State University.
- Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-6 General Surgery resident at Brooke Army Medical Center
- Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-5 General Surgery resident at Brooke Army Medical Center

Learning Objectives:
In this episode, we review the basics of gastric cancer, including presentation, work-up, staging, and treatment modalities as well as high yield topics including the Siewert classification system. We also briefly discuss trials establishing peri-operative chemotherapy regimens for gastric cancer and the controversy of D1 vs. D2 lymphadenectomy.

Links to Papers Referenced in this Episode

Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer.
NEJM 2006 Jul;355(1):11-20.
https://www.nejm.org/doi/full/10.1056/NEJMoa055531

Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesphageal junction adenocarcinoma (FLOT4): a randomized, phase2/3 trial
Lancet 2019 May;393(10184):1948-1957.
https://pubmed.ncbi.nlm.nih.gov/30982686/

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

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

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

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

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/

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

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

Welcome 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. 

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

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

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

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/

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

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/

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

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/

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

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

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

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

The ABSITE score report is changing… what does it mean? CEO of the American Board of Surgery Dr. Jo Buyske discusses ABSITE and MUCH more.  

Hosts: Dr. Scott Steele, Dr. Nina Clark, Dr. Jessica Millar
Guest: Dr. Jo Buyske, President/CEO of the American Board of Surgery

Resources: 
Announcement - ABSITE Percentiles: 
https://www.absurgery.org/wp-content/uploads/2024/02/ABSITE-Percentiles.pdf 

ABSITE Data Tools:
https://sandbox.absurgery.org/default.jsp?publicdata  

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

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

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

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

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

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

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

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

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 discuss how 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

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

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

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/

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

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/ 

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/

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/

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://app.behindtheknife.org/listen

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/

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

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

Join us for another episode of our Global Surgery series, where we have a special focus on trauma care in resource-limited settings. 

Traumatic injury remains one of the largest burdens of disease and causes of mortality internationally. The WHO estimates that 4.4 million lives are lost to traumatic injuries per year, accounting for approximately 8% of all deaths. Notably, traumatic injuries are the top killer of children, adolescents, and young adults, compounding the patient-years lost. Trauma is ubiquitous–accidents and injuries happen all over the globe, and thus differences in trauma incidence and mortality is often a function of health systems and infrastructure. 

Jon Williams is joined by Dr. Anthony Charles. Dr. Charles is a trauma surgeon at University of North Carolina, Chapel Hill. Additionally, he holds professorships in the medical school and school of public health at UNC, as well as serving as the director of the adult ECMO program and the director of global surgery at the UNC Institute of Global Health and Infectious Diseases. He leads the Malawian Surgical Initiative, designed to train and support local surgeons in the country of Malawi where he has established a longstanding partnership with UNC. Having been raised in Nigeria, Dr. Charles completed medical school at the University of Lagos, and subsequently underwent  general surgery residency training in London at North Middlesex University Hospital and subsequently at Charles Drew University in Los Angeles. Upon completion of trauma and critical care fellowship at University of Michigan, he took a faculty position at UNC where he has remained since and grown the global surgery presence to what it is today.

Key Points:

1. Often, the pivotal first step in developing global surgery trauma initiatives is increasing trained personnel, and so training initiatives are very meaningful and provide sustainability to the effort. 
2. Growing a health system’s ability to provide trauma care helps develop improved care for all aspects of disease. The resources, training, and infrastructure required benefits healthcare at large. 
3. Improvement of trauma care extends well beyond in-hospital care–injury prevention and pre-hospital care/triage/transport are even more impactful.
4. It takes more than surgeons to improve trauma care globally. Thus, clinician and non-clinician training and oversight is critical, and foundational concepts of care of the trauma patient must be familiar to all. 
5. Local governing bodies need to understand the importance of trauma care to invest in it. Traumatic injuries and mortality are a health burden, but even more so an economic burden to a country. This is what is compelling to investment in trauma care.

We now have over 725 episodes!  The easiest way to find specific topics or episodes is on our website https://app.behindtheknife.org/home or on our new Apple/Android app.  You can search or browse by topic, podcast series, etc., making it much easier to navigate than podcast players.
iOS: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android: https://play.google.com/store/apps/details?id=com.btk.app

PREMIUM BUNDLE:
https://app.behindtheknife.org/bundle/95
Please email hello@behindtheknife.org to learn more about our premium bundle and institutional discounts.

Premium Bundle Includes:
General Surgery Oral Board Audio Review
Trauma Surgery Video Atlas
Colorectal Surgery Oral Board Audio Review
Surgical Oncology Surgery Oral Board Audio Review
Vascular Surgery Surgery Oral Board Audio Review
Cardiothoracic Surgery Surgery Oral Board Audio Review

Join us for a new edition of our global surgery series! On this episode, Dr. Jon Williams is joined by Dr. Sudha Jayaraman and Dr. Justina Seyi-Olajide to discuss how we define global surgery today and how health infrastructure interacts with global surgical care. 

Dr. Jayaraman is a trauma and acute care surgeon at University of Utah, and the director of the Center for Global Surgery. After attending UC Davis for medical school, Dr. Jayaraman completed general surgery residency at UCSF, during which time she obtained a masters in public health in developing countries from the London School of Hygiene and Tropical Medicine. During this time, her efforts were dedicated to researching and implementing trauma systems development in Uganda. After residency she then completed a trauma and critical care fellowship at Brigham and Women’s, during which she received the Harvard Medical School Health Disparities Fellowship to continue her trauma systems work in Rwanda. Her ongoing work investigating injury burden and trauma systems in low and middle income countries has been well funded by the NIH, DOD, and others and published in numerous forums, as she is a well-renowned expert in this field. 

Dr. Justina Seyi-Olajide is a pediatric surgeon at the Lagos University Teaching Hospital in Lagos, Nigeria. She completed her medical school training at the Ahmadu Bello University in Zaria, Nigeria and subsequently her general surgical and pediatric surgical training at the Lagos University Teaching Hospital, earning the Fellowship of West African College of Surgeons in Pediatric Surgery and the Alinta Nwako prize for best graduating pediatric surgical trainee. Dr. Seyi-Olajide’s vision is to provide equitable pediatric surgical care in resource-limited settings, and has been highly influential for developing initiatives such as the National Surgical, Obstetric, Anesthesia and Nursing Plan for Nigeria. Additionally, she is a member of the Global Initiative for Children’s Surgery and is well published for her original research on topics regarding access to pediatric surgical care in low and middle income countries. 

Have any feedback for the global surgery content, or have any suggestions for future episodes? Please feel free to reach out to us at hello@behindtheknife.org.

We now have over 725 episodes!  The easiest way to find specific topics or episodes is on our website https://app.behindtheknife.org/home or on our new Apple/Android app.  You can search or browse by topic, podcast series, etc., making it much easier to navigate than podcast players. 
iOS: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android: https://play.google.com/store/apps/details?id=com.btk.app

PREMIUM BUNDLE:
https://app.behindtheknife.org/bundle/95
Please email hello@behindtheknife.org to learn more about our premium bundle and institutional discounts.

Premium Bundle Includes:
General Surgery Oral Board Audio Review
Trauma Surgery Video Atlas
Colorectal Surgery Oral Board Audio Review
Surgical Oncology Surgery Oral Board Audio Review
Vascular Surgery Surgery Oral Board Audio Review
Cardiothoracic Surgery Surgery Oral Board Audio Review

With the increasing popularity of artificial intelligence, its uses are quickly becoming not only a part of everyday life, but also training in surgery. Those of us without much understanding of the technology might be intimidated by this nebulous topic, or worry that we won’t be able to comprehend the advancements to come to the field. Luckily, we’re joined by a leading expert in the use of AI in surgery, Dr. Dan Hashimoto. He breaks down some examples of how AI is being used in surgical education, the role surgeons should play in these advancements, and some tips for how we can critically appraise work in the field of AI if we don’t understand the technology ourselves. Join hosts Nicole Brooks, MD, Judith French, PhD and Jeremy Lipman, MD, MHPE for this exciting conversation. 
Learning Objectives
1.     Listeners will describe how AI is being applied to surgical education.
2.     Listeners will identify the roles surgeons without training in AI can play in developing the use of AI in surgery. 
3.     Listeners will explain the regulatory and ethical considerations that must be addressed with the implementation of AI in surgical education. 
4.     Listeners will consider principles for critically evaluating research or technology in AI for application or use in their own educational or surgical practice.
References
Laplante S, Namazi B, Kiani P, Hashimoto DA, Alseidi A, Pasten M, Brunt LM, Gill S, Davis B, Bloom M, Pernar L, Okrainec A, Madani A. Validation of an artificial intelligence platform for the guidance of safe laparoscopic cholecystectomy. Surg Endosc. 2023 Mar;37(3):2260-2268. doi: 10.1007/s00464-022-09439-9. Epub 2022 Aug 2. PMID: 35918549.
https://pubmed.ncbi.nlm.nih.gov/35918549/
Hashimoto DA, Varas J, Schwartz TA. Practical Guide to Machine Learning and Artificial Intelligence in Surgical Education Research. JAMA Surg. 2024 Jan 3. doi: 10.1001/jamasurg.2023.6687. Epub ahead of print. PMID: 38170510.
https://pubmed.ncbi.nlm.nih.gov/38170510/

We now have over 725 episodes!  The easiest way to find specific topics or episodes is on our website https://app.behindtheknife.org/home or on our new Apple/Android app.  You can search or browse by topic, podcast series, etc., making it much easier to navigate than podcast players. 
iOS: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android: https://play.google.com/store/apps/details?id=com.btk.app

PREMIUM BUNDLE:
https://app.behindtheknife.org/bundle/95
Please email hello@behindtheknife.org to learn more about our premium bundle and institutional discounts.

Premium Bundle Includes:
General Surgery Oral Board Audio Review
Trauma Surgery Video Atlas
Colorectal Surgery Oral Board Audio Review
Surgical Oncology Surgery Oral Board Audio Review
Vascular Surgery Surgery Oral Board Audio Review
Cardiothoracic Surgery Surgery Oral Board Audio Review

The Fellowship of the Snow kept it interesting this year…both on and off the slopes!  On this episode, Patrick Georgoff discusses the Western Trauma Association’s updated resuscitative thoracotomy algorithm with Ron Tesoriero, the results of a WTA multicenter trial exploring chest tube irrigation for the prevention of retained hemothorax with Thomas Carver, and prehospital blood administration with Juan Duchesne.  

** Algorithms and papers are pending final review and are therefore not available to link to this episode.  

Ron Tesoriero, MD: Associate Professor of Surgery, Director of the Acute Care Surgery Fellowship, and Co-Director of the SICU at UCSF.

Thomas Carver, MD: Associate Professor of Surgery, Director of the Acute Care Surgery Fellowship, and Senior Medical Director of Critical Care Services at the Medical College of Wisconsin.  

Juan Duchesne, MD: Professor of Surgery and Chief of Trauma and Acute Care Surgery at Tulane university. 
 
Resuscitative Thoracotomy: The Who (Episode 475): https://app.behindtheknife.org/podcast/big-t-trauma-series-ep-14-ed-thoracotomy-the-who 

Resuscitative Thoracotomy: The How (Episode 476): https://app.behindtheknife.org/podcast/big-t-trauma-series-ep-15-ed-thoracotomy-the-how

Innovation Lifeflow (Episode 642): https://app.behindtheknife.org/podcast/innovations-in-surgery-lifeflow


We now have over 725 episodes!  The easiest way to find specific topics or episodes is on our website https://app.behindtheknife.org/home or on our new Apple/Android app.  You can search or browse by topic, podcast series, etc., making it much easier to navigate than podcast players.  
iOS: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android: https://play.google.com/store/apps/details?id=com.btk.app

PREMIUM BUNDLE:
https://app.behindtheknife.org/bundle/95
Please email hello@behindtheknife.org to learn more about our premium bundle and institutional discounts. 

Premium Bundle Includes:
General Surgery Oral Board Audio Review
Trauma Surgery Video Atlas
Colorectal Surgery Oral Board Audio Review
Surgical Oncology Surgery Oral Board Audio Review
Vascular Surgery Surgery Oral Board Audio Review
Cardiothoracic Surgery Surgery Oral Board Audio Review

In this episode of Behind the Knife the vascular surgery subspecialty team discusses a few case scenarios of patients with dialysis associated hand ischemia (or steal syndrome). Although a rare, steal syndrome can be detrimental to patients with end stage renal disease and result in not only risk of losing dialysis access but even their limb.  What options do you have to fix this problem? In this episode, we will cover the who is at risk of this, and what options you have to fix it.

Hosts: 
Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan and the Program Director of the Integrated Vascular Surgery Residency Program as well as the Vascular Surgery Fellowship Program at the University of Michigan.
Dr. David Schectman is a Vascular Surgery Fellow at the University of Michigan
Dr. Drew Braet is a PGY-4 Integrated Vascular Surgery Resident at the University of Michigan

Learning Objectives
- Review high-yield topics regarding hemodialysis access
- Understand the incidence of and the relevant risk factors for dialysis associated steal syndrome
- Review the spectrum of presenting symptoms and relevant workup for dialysis associated steal syndrome
- Understand surgical treatment options for dialysis associated steal syndrome

References
Please review the journal article below for helpful pictures and depictions of the operations we describe in this episode.
- Al Shakarchi J, et al. Surgical techniques for haemodialysis access-induced distal ischaemia. J Vasc Access. 2016 Jan-Feb;17(1):40-6.
https://pubmed.ncbi.nlm.nih.gov/26349875/

Other helpful references
- Kordzadeh A, Parsa AD. A Systematic review of distal revascularization and interval ligation for the treatment of vascular access-induced ischemia. J Vasc Surg 2019; 70:1364.
https://pubmed.ncbi.nlm.nih.gov/31153703/
- Huber TS, Larive B, Imprey PB, et al. Access-related hand ischemia and the Hemodialysis Fistula Maturation Study. J Vasc Surg 2016;64:1050.
https://pubmed.ncbi.nlm.nih.gov/27478007/
- Sidawy An, Spergel LM, Besarab A, et al. The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg 2008; 48:2S.
https://pubmed.ncbi.nlm.nih.gov/19000589/

***Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9***

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

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

Join BTK eduction fellows, Drs. Nina Clark and Jon Williams along with guests Drs. Sharmila Dissanaike and Paula Ferrada for a discussion on whether it’s time for a paradigm shift toward a circulation-first approach to trauma resuscitation.

Hosts:
Nina Clark, MD and Jon Williams, MD

Guests:
Sharmila Dissanaike, MD - Texas Tech University Health Sciences Center, Lubbock, TX
Paula Ferrada, MD - Inova, Fairfax, VA

References:
Ferrada P, Dissanaike S. Circulation First for the Rapidly Bleeding Trauma Patient-It Is Time to Reconsider the ABCs ofTrauma Care. JAMA Surg. 2023 Aug 1;158(8):884-885. doi: 10.1001/jamasurg.2022.8436. PMID: 37195675.
https://pubmed.ncbi.nlm.nih.gov/37195675/

Ferrada P, Ferrada R, Jacobs L, Duchesne J, Ghio M, Joseph B, Taghavi S, Qasim ZA, Zakrison T, Brenner M,Dissanaike S, Feliciano D. Prioritizing Circulation to Improve Outcomes for Patients with Exsanguinating Injury: ALiterature Review and Techniques to Help Clinicians Achieve Bleeding Control. J Am Coll Surg. 2024 Jan 1;238(1):129-136. doi: 10.1097/XCS.0000000000000889. Epub 2023 Nov 28. PMID: 38014850; PMCID: PMC10718219.
https://pubmed.ncbi.nlm.nih.gov/38014850/

***Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9***

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

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