No money, no mission. Understanding coding is the key to funding care and making your practice sustainable. In this episode of BackTable OBGYN, host, Dr. Mark Hoffman, chats with Dr. Jon Hathaway, associate professor at IU School of Medicine and coding specialist. They discuss the intricacies of medical billing, the impact of coding knowledge on revenue, and the systemic gaps in residency training regarding financial literacy. ---SYNPOSISDr. Hathaway shares his journey from mastering coding to becoming a national expert, providing a crash course on CPT, RVU, and ICD codes, and emphasizing the importance of accurate billing for the sustainability of healthcare practices. The episode offers valuable insights into the challenges and opportunities in medical coding and the broader financial aspects of healthcare.---TIMESTAMPS00:00 - Introduction 02:03 - Dr. Hathaway's Journey into Coding04:11 - Understanding the Financial Side of Healthcare07:10 - The Disconnect in Healthcare Payments11:26 - The Complexity of Medical Billing18:11 - The Role of CPT, RVU, and ICD Codes24:03 - The Process of Approving New Procedures32:38 - Understanding the Value Update Process33:47 - Case Study: Cystoscopy in Hysterectomy Codes35:26 - Survey Participation and Its Impact36:12 - Roles and Responsibilities in ACOG38:12 - Challenges of RVU-Based Compensation42:08 - Specialty-Specific RVU Valuation48:42 - Comparing OB and GYN Reimbursements50:02 - Envisioning an Ideal Healthcare System55:10 - Maximizing Billing Efficiency59:46 - Final Thoughts

The future of gynecologic surgery is less invasive, more precise, and closer than you think. In this episode of the BackTable OBGYN podcast, host Dr. Mark Hoffman welcomes Dr. Noam Smorgick, Director of Minimally Invasive Gynecologic Surgery at Shamir Hospital in Israel. They discuss Dr. Smorgick’s journey into the field of OBGYN and her innovative approaches to intrauterine adhesion management and hysteroscopic surgery for complex pathologies.---SYNPOSISTopics include the advantages of hysteroscopic management over traditional methods, the importance of maintaining fertility, the nuances of the Israeli healthcare system, and the development of new surgical instruments and procedures. The episode also highlights shared decision-making in patient care and looks ahead to the future direction of gynecologic surgery. Dr. Smorgick shares insights from recent studies and her experiences, making it a valuable listen for practitioners and anyone interested in gynecologic surgery advancements.---TIMESTAMPS00:00 - Introduction02:05 - Dr. Smorgick’s Journey to Medicine05:01 - Insights into Israeli Healthcare System10:20 - Intrauterine Adhesions and Hysteroscopic Management11:28 - Research on Retained Products of Conception15:07 - Comparing Management of Pregnancy Loss22:02 - Future Directions in Hysteroscopic Surgery23:46 - Infertility Treatments in Israel25:50 - Managing Uterine Septums and Adhesions28:03 - Shared Decision Making in Surgery32:03 - Techniques and Tools for Metroplasty33:08 - Adhesion Prevention Strategies35:35 - Postoperative Care and Follow-Up36:59 - Office Hysteroscopy Procedures38:05 - Reusable vs. Disposable Instruments45:51 - Future of Hysteroscopy---RESOURCESNetherlands Publication: Prevalence of intrauterine adhesions after the application of hyaluronic acid gel after dilatation and curettage in women with at least one previous curettage: short-term outcomes of a multicenter, prospective randomized controlled trial: https://pubmed.ncbi.nlm.nih.gov/28390688/ Dr. Smorgick’s Publications: A comparison of reproductive outcomes following hysteroscopic management versus dilatation and curettage of retained products of conception: https://pubmed.ncbi.nlm.nih.gov/24997472/ Hysteroscopy-assisted suction curettage for early pregnancy loss: does it reduce retained products of conception and postoperative intrauterine adhesions?: https://pubmed.ncbi.nlm.nih.gov/37782418/

Menopause isn’t just a diagnosis—it’s a transition, and the way we treat it needs to change. Dr. Kelly Casperson joins Dr. Suzette Sutherland in this urogynecology crossover episode of BackTable to challenge outdated beliefs about menopause and hormone replacement therapy (HRT). They revisit the impact of the 1990s Women’s Health Initiative (WHI) study and explain how its findings—especially around synthetic hormones—were widely misinterpreted and continue to adversely influence patient and provider decisions today. --- SYNPOSIS Dr. Casperson breaks down the differences between the hormones used in WHI and the safer, more targeted options available today. The conversation explores the broad benefits of modern HRT, including reduced risks of cardiovascular disease, osteoporosis-related fractures, and even dementia. Beyond the science, the episode also addresses the urgent need for better medical education and updated guidelines around menopause care.Dr. Casperson and Dr. Sutherland make the case for empowering patients through informed consent and better clinician training. They also discuss Dr. Casperson’s upcoming book, The Menopause Moment, which aims to equip women with the tools and knowledge to navigate this life stage with confidence. --- TIMESTAMPS 00:00 - Introduction02:50 - Focus on Menopause and Hormone Replacement Therapy04:20 - The Women's Health Initiative (WHI) Study05:39 - Understanding Risks and Misconceptions12:43 - Reevaluation of the Women’s Health Initiative Study18:31 - Impact of Media and Physician Education19:58 - Current State of Hormone Therapy22:17 - Broader Implications and Future Directions27:17 - Evaluating FDA Warnings and Gender Bias in Hormone Treatments29:49 - The Impact of Hormone Therapy on Women's Health32:11 - Risks of Not Using Hormones35:44 - Hormones and Brain Health: Debunking Myths40:41 - The Timing Hypothesis and Long-Term Hormone Use46:32 - Advocacy and Education for Menopause Awareness48:04 - Conclusion and Upcoming Resources --- RESOURCES PBS: The M Factor: Shredding the Silence on Menopause:https://www.pbs.org/show/the-m-factor-shredding-the-silence-on-menopause/ The Menopause Moment by Dr. Kelly Casperson: https://kellycaspersonmd.com/the-menopause-moment-book/ Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer's disease and dementia:https://pmc.ncbi.nlm.nih.gov/articles/PMC10625913/

In this episode, Dr. Ian Fields joins Dr. Mark Hoffman at the mic to discuss the role of the microbiome in obstetrical and gynecological conditions. --- SHOW NOTES Dr. Ian Fields completed a fellowship in Female Pelvic Medicine & Reconstructive Surgery and received a Master of Clinical Research degree from Oregon Health & Sciences University. His research focuses on changes in the urinary microbiome and their association with lower urinary tract symptoms. Dr. Fields begins the episode by describing the microbiome as “all of the things outside of our cells that make up the human body,” which includes bacteria, viruses, and fungi. He explains that the microbiome may play a role in how humans maintain states of health, in addition to having large impacts on the pathophysiology or development of disease states. Dr. Fields references the Human Microbiome Project, a United States National Institutes of Health research initiative that was aimed to improve the understanding of microbiota in relation to human health and diseases. The physicians then transition to cover the role of the microbiome, specifically in the field of obstetrics and gynecology. Dr. Fields explains that the most studied condition is bacterial vaginosis. From a urogynecology perspective, he expresses a particular interest in urinary tract disorders, such as urinary incontinence, recurrent urinary tract infections, and interstitial cystitis. Dr. Fields emphasizes to listeners that urine is not sterile. In addition, he highlights how the use of vaginal estrogen increases the presence of lactobacillus within the genital microbiome, and thus is beneficial in the settings of genitourinary syndrome of menopause and recurrent menopause. Dr. Fields concludes the episode by briefly addressing other areas of study regarding the microbiome in the field of obstetrics and gynecology. For example, studies have revealed a link between vaginal microbiota and risk of preterm birth, as well as neonatal gut microbiota and the mode of delivery. Ultimately, Dr. Fields states that the microbiome is an underfunded and understudied aspect of medicine, and he urges listeners to acknowledge the large potential the field has. --- RESOURCES The Human Microbiome Project: https://hmpdacc.org/hmp/overview/ Brubaker L, Nager CW, Richter HE, Visco A, Nygaard I, Barber MD, Schaffer J, Meikle S, Wallace D, Shibata N, Wolfe AJ. Urinary bacteria in adult women with urgency urinary incontinence. Int Urogynecol J. 2014 Sep;25(9):1179-84. Wolfe AJ, Toh E, Shibata N, Rong R, Kenton K, Fitzgerald M, Mueller ER, Schreckenberger P, Dong Q, Nelson DE, Brubaker L. Evidence of uncultivated bacteria in the adult female bladder. J Clin Microbiol. 2012 Apr;50(4):1376-83. Hoffman C, Siddiqui NY, Fields I, Gregory WT, Simon HM, Mooney MA, Wolfe AJ, Karstens L. Species-Level Resolution of Female Bladder Microbiota from 16S rRNA Amplicon Sequencing. mSystems. 2021 Oct 26;6(5):e0051821. Richter HE, Carnes MU, Komesu YM, Lukacz ES, Arya L, Bradley M, Rogers RG, Sung VW, Siddiqui NY, Carper B, Mazloomdoost D, Dinwiddie D, Gantz MG; Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Association between the urogenital microbiome and surgical treatment response in women undergoing midurethral sling operation for mixed urinary incontinence. Am J Obstet Gynecol. 2022 Jan;226(1):93.e1-93.e15. Fettweis, J.M., Serrano, M.G., Brooks, J.P. et al. The vaginal microbiome and preterm birth. Nat Med 25, 1012–1021 (2019).

In this episode, Dr. Mark Hoffman invites Dr. Cheryl Iglesia to shed light on the topic of cosmetic gynecology. --- SHOW NOTES Dr. Iglesia is the Director of the Section of Female Pelvic Medicine and Reconstructive Surgery at MedStar Washington Hospital Center, as well the current President of the Society of Gynecologic Surgeons. In addition to being involved with a consensus document regarding cosmetic gynecology, Dr. Iglesia has contributed numerous studies to the growing field and hopes to educate other providers on the topic. The episode begins with Dr. Iglesia sharing how she became passionate about cosmetic gynecology. Her experience initially began with a weekend course in California learning about topics such as “laser vaginal rejuvenation” and “designer laser vaginoplasty,” which were early marketing terms used for the field. After multiple years of training and education within a field filled with gray areas and limited evidence-based medicine, she later helped develop a consensus document about cosmetic gynecology procedures, which provides clarification for patients and opportunity for future research studies. Dr. Iglesia then describes the field of cosmetic gynecology, which includes the elective intervention to alter the aesthetic appearance of the external genitalia or modify the genital organs. These elective, functional procedures may be performed in the absence of any pathology (e.g., no incontinence, prolapse, etc.) with the goal of improving a person’s quality of life (e.g., sexual function). She describes two pillars of the field, including cosmetic (e.g., labiaplasty) versus functional (e.g., surgical tightening of the vagina for vaginal laxity) procedures. The physicians then address the concerns of societal pressure, agreeing that the goal is to help patients make well-informed, ethical decisions, which requires discussing goals with patients. After discussing the field as a whole, Dr. Iglesia then highlights different procedures and technologies. For example, a fractionated laser may be used to stimulate tissue growth and may be utilized for diagnosis such as genitourinary syndrome (GSM) of menopause or lichen sclerosis. In addition, she briefly mentions aesthetic procedures, including a clitoral frenulum reduction (frenulectomy) or clitoral amplification with platelet rich plasma or the O-Shot. She addresses that a lot of the procedures and technologies are proprietary, have limited evidence, and are not risk-free. Ultimately, Dr. Iglesia states that there is a need for more data, urging the need for future level I trials. --- RESOURCES Developed by the Joint Writing Group of the International Urogynecological Association and the American Urogynecologic Society. Joint Report on Terminology for Cosmetic Gynecology. Int Urogynecol J. 2022 Jun;33(6):1367-1386. Li FG, Maheux-Lacroix S, Deans R, Nesbitt-Hawes E, Budden A, Nguyen K, Lim CY, Song S, McCormack L, Lyons SD, Segelov E, Abbott JA. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Symptom Severity in Women With Postmenopausal Vaginal Symptoms: A Randomized Clinical Trial. JAMA. 2021 Oct 12;326(14):1381-1389. Paraiso MFR, Ferrando CA, Sokol ER, Rardin CR, Matthews CA, Karram MM, Iglesia CB. A randomized clinical trial comparing vaginal laser therapy to vaginal estrogen therapy in women with genitourinary syndrome of menopause: The VeLVET Trial. Menopause. 2020 Jan;27(1):50-56. Burkett LS, Siddique M, Zeymo A, Brunn EA, Gutman RE, Park AJ, Iglesia CB. Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus: A Randomized Controlled Trial. Obstet Gynecol. 2021 Jun 1;137(6):968-978. Cosmetic Gynecology and the Elusive Quest for the “Perfect” Vagina: https://journals.lww.com/greenjournal/Citation/2012/10000/Cosmetic_Gynecology_and_the_Elusive_Quest_for_the.34.aspx

In this episode, Drs. Maya Hammoud and Helen Morgan of the University of Michigan join Drs. Amy Park and Mark Hoffman to discuss the OB/GYN residency application process. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/MeFKJY --- SHOW NOTES Dr. Maya Hammoud is Chief of Women’s Health Division and Associate Chair for Education at the University of Michigan. Dr. Helen Morgan is the Director of Residency Preparation Courses at the University of Michigan. Together, Drs. Hammoud and Morgan are leading the $1.7 million American Medical Association (AMA) Reimagining Residency Grant for Association of Professors of Gynecology and Obstetrics (APGO) Right Resident, Right Program, Ready Day One. The episode begins with Drs. Hammoud and Morgan sharing a call to action regarding the need to transition the emphasis of applying to residency from the lens of individual achievements to that of an individual’s competency as a future physician. The two physicians share what inspired them to contribute to making changes in the realm of OB/GYN, including personal experiences from advising medical students at the University of Michigan to their own family members. During this time, they address pitfalls of the current system, including the financial expenses for applications. The group then transitions to describe the 5-year grant that led to the development of Right Resident, Right Program, Ready Day One. The program addresses 2 components: (1) the application process itself, and (2) students’ readiness for residency. The physicians cover the topic of “application fever” (i.e., the large increase in the number of applications that each student submits), and how the field of OB/GYN has adopted “program signaling” with the hope to mitigate this ongoing trend. Drs. Hammoud and Morgan also address topics such as growth mindset, holistic review of applications, importance of coaching for preparation for residency, and the increasing popularity of OB/GYN as a specialty. Lastly, the group highlights other aspects of the residency application process, including methods to ensure an equitable review process, the need to increase diversity in the field, the standardized letter of evaluation (SLOE), and best practices to facilitate transition to residency. During this conversation, Drs. Hammoud and Morgan share about the residency preparation courses that are available for medical students at the University of Michigan.

In this episode, Drs. Amy Park and Mark Hoffman welcome Dr. Angela Chaudhari, Chief of Gynecology and Gynecologic Surgery at Northwestern Memorial Hospital, to share her experience promoting a culture of physician wellness as the Director of the P2P Network for Physician Peer Support. --- SHOW NOTES Dr. Chaudhari discusses how her inspiration to advocate for physician wellness began when she herself was experiencing feelings of burnout. Initially an open ear for colleagues on an individual level, Dr. Chaudhari was later trained on the topic of wellness through the Scholars of Wellness Program and received her Organization Leadership and Coaching Certificate at Northwestern University. Dr. Chaudhari then explains that, through the program, volunteers from both medical and non-medical backgrounds are trained to provide support for those experiencing adverse events, “compassion fatigue,” and discriminatory patient experiences. In addition, peers are also available to provide feedback or education. Specific metrics for the program include retention, wellbeing scores, and culture surveys to identify “pain points'' within the Institution. Next, the doctors discuss the topic of “work-life integration,” rather than work-life balance, and how to promote this in your own practice. While acknowledging that it may be difficult to advocate for yourself and set boundaries early on in your career, the group emphasizes the role of mentorship and how this can empower trainees/learners to take action sooner rather than later. The episode ends with a discussion on creating culture in your workplace. The doctors express sentiments that maintaining an intentional, positive outlook and treating all colleagues with respect is a key aspect in promoting wellness. In addition, they encourage listeners to acknowledge difficult situations and to share personal experiences to further promote an environment of support and growth. --- RESOURCES Define Measure Analyze Improve Control (DMAIC) Process: https://asq.org/quality-resources/dmaic Stolarski A, Moseley JM, O’Neal P, Whang E, Kristo G. Retired Surgeons’ Reflections on Their Careers. JAMA Surg. 2020;155(4):359–361. doi:10.1001/jamasurg.2019.5476

In this episode, Dr. Jessica Branham, a board-certified obstetrician-gynecologist affiliated with Highlands ARH Regional Medical Center invites listeners to learn about practicing OB/GYN in a rural setting. As a Kentucky native who was born and raised in Eastern Kentucky, Dr. Branham shares her personal experiences and the challenges that she has faced caring for a population that often requires the most medical attention, yet has the least access to resources. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/29D37F --- SHOW NOTES The episode begins with Dr. Branham describing her day-to-day work schedule. As she shares the workflow of her clinic and OR days, as well as call shifts, she emphasizes how her patients’ care is typically subject to herself as their sole medical provider (e.g., handling a postpartum hemorrhage without access to Interventional Radiology). Due to this, Dr. Branham routinely thinks multiple steps ahead in regard to her patients’ care in order to decide if she can continue herself or if the patient has to be transported to a higher-acuity center. Dr. Branham then transitions to discuss the challenges that she faces as a physician practicing in a rural setting. Using personal anecdotes and published data, she emphasizes barriers such as decreasing numbers of OB/GYNs choosing to practice in rural areas, as well as the weather conditions dictating whether or not a patient may be transported via helicopter or ambulance to an alternative hospital. In addition, she covers the impact of the opioid use epidemic that largely impacts the Appalachian region. Lastly, Dr. Branham ends the episode by sharing why she passionately chooses to practice in rural Kentucky, despite the challenges she may face: her dedication to serving patients who are often in the most need of medical care. She also describes current systems in place to help improve care for her patients, including the Blue Angels Program, which provides telehealth visits with Maternal Fetal Medicine specialists at the University of Kentucky and traveling ultrasound clinics to specific areas in rural Kentucky counties. --- RESOURCES The Blue Angels Program: https://kytelecare.med.uky.edu/kytelecare-telehealth-mobile

In this episode, Dr. Cara King, the Fellowship Director for Minimally Invasive Gynecologic Surgery at Cleveland Clinic and a member of the Board of Directors of the Academy for Surgical Coaching, discusses the topic of surgical coaching and its benefits for physicians, trainees, and learners. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/8NpBpF --- SHOW NOTES Dr. King begins the episode by describing surgical coaching as an act of asking open-ended questions, determining where a “coachee” is currently at, identifying their goals, and then empowering them to make specific actions that are needed to close this gap. During the discussion, she emphasizes the importance of prioritizing self-assessment as a coach. Dr. King then explains how to find a surgical coach through the Academy for Surgical Coaching. The process requires a “coachee” to complete a form that identifies their personal goals, and then the “coachee” is paired with a coach from the pool of physicians from various specialties. Coaching experiences are performed through various platforms (e.g., in-person, video-based, etc.) and are ideally conducted for 3-, 6-, or 12-month periods. Dr. King also covers how outcomes and metrics are evaluated, describing the differences between technical and non-technical (e.g., judgment) skills. The doctors transition to emphasize the importance of incorporating coaching into a surgeon’s practice. Dr. King shares 2 methods to do so, including (1) replacing 1-hour of grand rounds or meetings with 1 hour of coaching sessions, as well as (2) integrating coaching at the level of national societies (e.g., American Association of Gynecologic Laparoscopists). The doctors go on to highlight also incorporating coaching at the level of medical schools and residency in order to instill the mentality of continual improvement early on in a physician’s career. The episode ends with Dr. King sharing the steps to becoming a surgical coach through the Academy for Surgical Coaching, which includes a paid certification program. --- RESOURCES Atul Gawande, “Personal Best”: https://www.newyorker.com/magazine/2011/10/03/personal-best The Academy for Surgical Coaching: https://surgicalcoaching.org Greenberg CC, Byrnes ME, Engler TA, Quamme SPR, Thumma JR, Dimick JB. Association of a Statewide Surgical Coaching Program With Clinical Outcomes and Surgeon Perceptions. Ann Surg. 2021 Jun 1;273(6):1034-1039.

In this episode, Dr. Bagrodia discusses cultivating a healthy culture inside and outside of the operating room with Dr. Chris Kane, Dean of Clinical Affairs at UCSD and CEO of the UCSD Physician Group. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/rVQG40 --- SHOW NOTES First, the doctors discuss the definition of culture, which Dr. Kane defines as the norms of behavior and relationships within an organization. Culture can include dress code, meeting rules, and punctuality. Most of the time, institutional culture is established in an unspoken way. Dr. Kane emphasizes the importance of having a conscious strategy to create a healthy culture and reiterates that trust is a crucial foundation for motivating cultural changes. Next, the doctors discuss helping team members find meaning in their work. Dr. Kane recommends that surgeons share patient gratitude with their other colleagues who are not frontline medical workers. He acknowledges his staff’s contributions during meetings and expresses his gratitude through written notes. He also recommends communication training for everybody on his team. Then, he shares tips for assessing organizational culture. He believes that it is most important to ask team members what they think the overarching goal of the institution is and to assess the attrition rate through exit surveys. He emphasizes that behavioral norms matter most, as department leaders often lead by example. One detrimental practice is favoritism, which Dr. Kane regards as disrespectful to other team members. Additionally, he shares his personal experiences with changing cultures at different institutions and utilizing change management theories. Finally, Dr. Kane shares general leadership advice. He highlights the importance of creating a patient-centered environment, leading by influence rather than authority, and the power of positivity.

In episode 8, Dr. Mark Hoffman invites Drs. Melissa Wong of Cedars-Sinai and Tony Shanks of Indiana University to share the mic and talk about the use of virtual reality (VR) in labor. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/StyzOA --- SHOW NOTES Dr. Melissa Wong, MD, MHDS is a board-certified Maternal Fetal Medicine specialist and an Assistant Professor of OB/GYN at Cedars-Sinai in Los Angeles, California. She also works in the division of informatics and with the National Institutes of Health Office of Research on Women’s Health. Dr. Wong has studied the use of VR to mitigate the pain associated with labor, and she is continually finding opportunities for the use of VR to enhance the field of OB/GYN. Dr. Tony Shanks, MD, a co-host of BackTable OBGYN, joins the podcast again as a Maternal Fetal Medicine specialist at Indiana University. He currently serves as the Vice Chair of Education at the institution, as well as the Maternal Fetal Medicine Fellowship Director. In this episode, Dr. Wong describes the methods and conclusions of her study, “Virtual Reality Reduces Pain in Laboring Women: A Randomized Controlled Trial,” which ultimately determined that the use of VR was associated with a reduction in pain during labor compared to patients who received no intervention. The group also discusses the potential for VR within the obstetrical and gynecologic sides of the field, as well as the field of medicine in general. Some topics that were mentioned include the use of VR for in-office procedures and patient education through visualization of complicated surgical procedures. In addition, the group highlights the potential for additional technological advancements in medicine through augmented reality, artificial intelligence, and informatics. --- RESOURCES Wong MS, Spiegel BMR, Gregory KD. Virtual Reality Reduces Pain in Laboring Women: A Randomized Controlled Trial. Am J Perinatol. 2021 Aug;38(S 01):e167-e172. doi: 10.1055/s-0040-1708851. Epub 2020 Jun 2. PMID: 32485759. Sridhar A, Shiliang Z, Woodson R, Kwan L. Non-pharmacological anxiety reduction with immersive virtual reality for first-trimester dilation and curettage: a pilot study. Eur J Contracept Reprod Health Care. 2020 Dec;25(6):480-483. doi: 10.1080/13625187.2020.1836146. PMID: 33140989. “Rewiring Education” by John D. Couch “Deep Medicine” by Eric Topol “Measure What Matters” by John Doerr

On this episode, Dr. Mathew Leonardi of McMaster University Medical Centre joins Drs. Park and Hoffman at the mic to discuss his experience with advanced ultrasound for endometriosis. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/stmXpZ --- SHOW NOTES Dr. Leonardi is a minimally invasive gynecologic surgeon and sonologist (ultrasound specialist) in Hamilton, Canada. He received his PhD at the University of Sydney, studying the role of ultrasound for diagnosis of endometriosis and its influence on surgical management of the disease. He then completed a 2-year fellowship in advanced gynecological surgery and ultrasound in Sydney, Australia. He now conducts a comprehensive clinic for the diagnosis and management of endometriosis. The episode begins with Dr. Leonardi describing his initial fascination with ultrasound as an OB/GYN resident and discussing his various training internationally for advanced gynecological surgery and ultrasound. He highlights specific steps he took, colleagues he collaborated with, as well as barriers he encountered and overcame along the way. The group then talks about the current role of ultrasound within gynecologic care and its potential in the field. Dr. Leonardi explains how he built a gynecologic ultrasound unit, detailing the workflow of his clinic. During this time, he also compares the use of ultrasound versus alternative imaging (e.g., MRI), ultimately favoring the dynamic, efficacious, and cost-effective benefits of ultrasound. Lastly, the group discusses the topic of bowel endometriosis. Dr. Leonardi describes the limitations of ultrasound in this setting, such as diagnosis of disease that spreads beyond the pelvic brim. The group then transitions to describe the involvement of colorectal surgeons in these cases and brings to light the need for additional training and exposure for minimally invasive gynecologic surgeons. --- RESOURCES Leonardi M, Espada M, Condous G. Closing the communication loop between gynecological surgeons, diagnostic imaging experts and pathologists in endometriosis: building bridges between specialties. Ultrasound Obstet Gynecol. 2021 Apr;57(4):523-525. doi: 10.1002/uog.23595. PMID: 33491846.

In this episode, Dr. Kelly Wright of Cedars-Sinai Medical Center in Los Angeles joins Drs. Park and Hoffman to discuss sustainability in surgery. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/Y371sv --- SHOW NOTES Dr. Wright is the Director of the Division of Minimally Invasive Gynecologic Surgery at Cedars-Sinai Medical Center. She has served on various hospital committees regarding patient safety and cost-optimization. She actively researches operating room cost-effectiveness and waste minimization, most recently publishing a manuscript titled, “Sustainability in Healthcare: A Call to Action for Surgeons and Healthcare Leaders.” Drs. Park and Hoffman begin the episode by asking Dr. Wright to bring to light the overall carbon footprint of healthcare in both the US and the world, as well as what should be included in biohazardous waste containers in the operating room (OR). During this conversation, Dr. Wright demystifies the common assumption that single-use products are related to better patient outcomes postoperatively. The group then breaks down the utilization of reusable, re-processable instruments in the OR, ultimately agreeing upon a reduced carbon footprint when using these products in comparison to those that are single-use. Dr. Wright further explains what surgeons can do in order to mitigate these issues. She discusses various approaches at the individual, institutional, and federal levels. She highlights options that include making conscious efforts to reduce waste, demanding the industry to develop reusable products, and advocate for tighter regulation to reduce carbon emissions in hospital facilities. Throughout the episode, Dr. Wright charges listeners to collaborate with members of their institutions / hospitals who are directly involved in OR waste (e.g. human factors groups, quality and safety officers, heads of linen services) to find ways to mitigate waste and engage in sustainable practices. --- RESOURCES Schwartz KM, Wright KN, Richards EG, King LP, Park AJ. Sustainability in Healthcare: A Call to Action for Surgeons and Healthcare Leaders. J Minim Invasive Gynecol. 2022 Sep;29(9):1040-1042. doi: 10.1016/j.jmig.2022.06.024. Epub 2022 Jul 1. PMID: 35788396. Malhotra GK, Tran T, Stewart C, Battey H, Tegtmeier B, McNeese K, Flood A, Melstrom L, Fong Y. Pandemic Operating Room Supply Shortage and Surgical Site Infection: Considerations as We Emerge from the Coronavirus Disease 2019 Pandemic. J Am Coll Surg. 2022 Apr 1;234(4):571-578. doi: 10.1097/XCS.0000000000000087. PMID: 35290277. https://practicegreenhealth.org https://noharm.org

Vaginal estrogen is not the enemy. Outdated data is. In this crossover episode of the BackTable Urology and OBGYN podcasts, Dr. Suzette Sutherland and Dr. Yahir Santiago-Lastra delve into the persistent challenges and ongoing advocacy efforts surrounding the FDA's black box warning on vaginal estrogen. --- SYNPOSIS They explore the historical context and far-reaching influence of the 1990s Women’s Health Initiative (WHI) study, asserting that its misinterpretation continues to shape misconceptions and hinder effective menopause care. The discussion highlights recent data refuting the risks associated with vaginal estrogen therapies and underscores the urgent need for updated, evidence-based guidelines to support women throughout menopause. Dr. Santiago-Lastra also draws attention to gender-based inequities in hormone treatment, the robust evidence contradicting the current black box warning, and the multi-faceted advocacy required to bring about change. This episode is part of a broader series focused on various aspects of menopause. --- TIMESTAMPS 00:00 - Introduction02:01 - Menopause Series Overview03:55 - History of the Black Box Warning on Estrogen07:26 - Understanding the Black Box Warning12:11 - The Citizen's Petition and FDA Process18:11 - Gender Inequity in Medical Treatment22:45 - Factors Resulting in Gender Inequity29:02 - Genital Urinary Syndrome of Menopause (GSM)29:32 - Benefits of Vaginal Estrogen33:33 - Legislative Advocacy and Medicare34:43 - Professional and Patient Advocacy36:35 - Challenges and Progress in Label Change43:35 - Historical Context and Gender Equity45:07 - Recap and Future Directions

For this episode of BackTable OBGYN, Drs. Park and Hoffman invite Dr. Louise King, MD, JD of Brigham and Women’s Hospital to talk about the legal perspective of Roe v. Wade. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/00DKvR --- SHOW NOTES Dr. King, who works in the Division of Minimally Invasive Gynecologic Surgery, is also an Assistant Professor and Obstetrics, Gynecology and Reproductive Biology and the Director of Reproductive Bioethics at Harvard Medical School. Initially a lawyer of constitutional law, Dr. King utilizes the combination of her legal training with her medical knowledge to educate patients and colleagues on the essential and compassionate delivery of abortion healthcare. The episode begins with Dr. King providing the legal history of reproductive care in the United States. She walks listeners through a timeline that includes the Comstock laws, as well as U.S. Supreme Court decisions, including Griswold v. Connecticut, Roe v. Wade, and Dobbs v. Jackson Women’s Health Organization. When discussing the history, Dr. King emphasizes the role of healthcare professionals in combating the current legal state. Specifically, she urges listeners to go beyond simply stating that discussions about abortion should remain between physicians and patients. Instead, she shares how providers should continue the conversation by vocalizing what abortion is, why it is essential, what makes it a complex topic, and why each person should defend the right for themselves and others. Dr. King then describes how to develop a space that promotes others to engage in conversation about abortion. Her approach to this dialogue includes allowing people to identify what gives them pause and determining ways to validate someone’s discomfort about the topic. Dr. King provides examples of how she frames her discussion with medical students at Harvard Medical School, which involves utilization of the pillars of ethics as a scaffolding for conversation. She then goes on to define reproductive justice for listeners. Lastly, Dr. King charges the audience to practice their first amendment right and educate about abortion care. She also discusses the developing course for OBGYN residency programs and acknowledges the varying levels of training based on geographical location. The episode concludes with Dr. King sharing avenues of support for physicians who regularly practice abortion care.

On this episode, BackTable VI host Dr. Christopher Beck shares the mic with two Maternal Fetal Medicine (MFM) specialists, Drs. Roxane Rampersad at Washington University and Tony Shanks at Indiana University, to discuss cross-specialty management of postpartum hemorrhage (PPH) between OBGYN and interventional radiology (IR). --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/ASxPdP --- SHOW NOTES To set the stage, Drs. Rampersad and Shanks explain the definition of PPH based on the American College of Obstetricians and Gynecologists (ACOG) guidelines. They further describe the differences between early / acute versus late blood loss, in addition to the most common etiologies using the “Four T’s” pneumonic: tone, trauma, tissue, thrombin. Drs. Rampersad and Shanks then describe their approach to the workup and management of PPH. The group discusses topics such as uterine massage, oxytocin, hemabate / methergine, tamponade (e.g. Bakri balloon, the JADA System), embolization, and hysterectomy. The physicians then describe the role of cross-specialty collaboration between OBGYN and IR, specifically in the management of PPH. When highlighting the role of IR, Dr. Beck describes how he counsels patients for uterine artery embolization (UAE), and he provides an anecdote regarding a repeat UAE. He also shares his perspective with utilization of gel foam versus coils. The group then transitions to describe diagnosis and management of placenta accreta spectrum (PAS), its association with PPH, and the role of radiology in this disease process. Lastly, Drs. Rampersad and Shanks allude to what the future may hold for PPH, including more personalized medicine and potential technologies to prevent PAS. The group ends the episode by providing IR colleagues with insight to what may strengthen the collaboration between OBGYN and IR in order to provide optimal care for patients with PPH. --- RESOURCES Silver RM, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006 Jun;107(6):1226-32. doi: 10.1097/01.AOG.0000219750.79480.84. PMID: 16738145. Bienstock RM, Eke AC and Hueppchen NA; Postpartum Hemorrhage. New England Journal of Medicine 2021 Vol. 384 Issue 17 Pages 1635-1645. Accession Number: 33913640 DOI: 10.1056/NEJMra1513247. https://www.nejm.org/doi/full/10.1056/NEJMra1513247 ACOG Postpartum Hemorrhage: https://www.acog.org/en/clinical/clinical-guidance/practice-bulletin/articles/2017/10/postpartum-hemorrhage

On this episode of BackTable OBGYN, we introduce our co-host Dr. Amy Park, the Section Head of Female Pelvic Medicine & Reconstructive Surgery at the Cleveland Clinic. She and Dr. Mark Hoffman raise awareness about the importance of surgeon ergonomics in preventing work-related musculoskeletal (MSK) injuries and optimizing career longevity. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/vpfOUm --- SHOW NOTES Dr. Park, a co-founder of the Society of Surgical Ergonomics, begins the episode by sharing her personal experience with a work-related shoulder injury and how it inspired her to prioritize surgeon ergonomics in her daily practice. She and Dr. Hoffman then encourage listeners to acknowledge the role of optimizing factors such as table height, body posture, and more in order to maximize the longevity of a surgeon’s career and thus patient care. The co-hosts then cover pitfalls commonly identified in normal, open surgery (e.g. excessive neck flexion, truncal deviation, arm abduction) and laparoscopic surgery (e.g. body posture, monitor height). They transition to highlight possible resolutions to these pitfalls, including anti-fatigue mats, appropriate footwear, and proper posturing; ultimately addressing a need for further research in this aspect of medicine. Lastly, they cover the role of robotic surgery and the potential to either mitigate or worsen the risk for work-related MSK injuries. The episode wraps up with a call to bring awareness to the value of surgeon ergonomics and to proactively impart this knowledge onto trainees, as the overall goal for surgeons is likely to continue operating and impacting patient care. --- RESOURCES Epstein S, Sparer EH, Tran BN, et al. Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg. 2018;153(2):e174947. doi:10.1001/jamasurg.2017.4947 Society of Surgical Ergonomics: https://www.societyofsurgicalergonomics.org The FIRST Trial: http://www.thefirsttrial.org The SECOND Trial: http://www.thesecondtrial.org

In this cross-specialty episode of BackTable OBGYN, Dr. Amy Park chats with Dr. Jose Silva, a board certified urologist and co-host of BackTable Urology, about the workup, counseling, and management of urinary incontinence and pelvic organ prolapse. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/BAr6XH --- SHOW NOTES The co-hosts begin by briefly discussing the workup for pelvic organ prolapse (POP). Dr. Park identifies common symptoms of prolapse and special exams (e.g. Pelvic Organ Prolapse Quantification System or POP-Q and urodynamics) that may be utilized for initial evaluation. She then explains the clinical indications for treatment of isolated POP, in addition to POP with concomitant urinary incontinence. Drs. Park and Silva then transitioned to cover the management of urinary incontinence. The two co-hosts reveal the benefits of pelvic floor physical therapy and other conservative management options, such as core-centric exercises and weight loss. In length, they elaborate on the benefits and takeaways of using sling procedures versus urethral bulking agents (e.g. Bulkamid). When discussing these topics, the co-hosts bring to light the possible differences in approach between Urogynecologists and Urologists. In regard to urethral bulking agents for treatment of urinary incontinence, Drs. Park and Silva highlight the potential role for stem cell injections. In addition, Dr. Park provides a tip to maximize patient comfort during in-office periurethral injections for urethral bulking. When focusing on sling procedures, Dr. Park highlights her preferred approach and encourages listeners to become proficient in the approach of their choosing. Lastly, they describe their approaches to treatment of stress urinary incontinence. In their discussion, Drs. Park and Silva consider factors such as patient age, desire for future fertility, and pregnancy. When wrapping up the episode, Dr. Park emphasizes the importance of patient counseling when it comes to management of these conditions, as well as practicing shared decision making to determine the best next steps for her patients. --- RESOURCES Nager CW, et al. Design of the Value of Urodynamic Evaluation (ValUE) trial: A non-inferiority randomized trial of preoperative urodynamic investigations. Contemp Clin Trials. 2009 Nov;30(6):531-9. doi: 10.1016/j.cct.2009.07.001. Epub 2009 Jul 25. PMID: 19635587; PMCID: PMC3057197. Erin A. Brennand, Shunaha Kim-Fine. A randomized clinical trial of how to best position retropubic slings for stress urinary incontinence: Development of a study protocol for the mid-urethral sling tensioning (MUST) trial, Contemporary Clinical Trials Communications, Volume 3, 2016, Pages 60-64, ISSN 2451-8654, https://doi.org/10.1016/j.conctc.2016.04.004. M. Abdel-Fattah, D. Cooper, T. Davidson, M. Kilonzo, M. Hossain, D. Boyers, et al. Single-Incision Mini-Slings for Stress Urinary Incontinence in Women New England Journal of Medicine 2022 Vol. 386 Issue 13 Pages 1230-1243. DOI: 10.1056/NEJMoa2111815 https://doi.org/10.1056/NEJMoa2111815. Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification System (POP-Q) - a new era in pelvic prolapse staging. J Med Life. 2011 Jan-Mar;4(1):75-81. Epub 2011 Feb 25. PMID: 21505577; PMCID: PMC3056425.

BackTable began five years ago as a podcast for the field of Interventional Radiology. Since then, the podcast has developed additional series for various areas of medicine, such as ENT/Otolaryngology, Urology, Med Tech Innovation, and now Obstetrics and Gynecology (OBGYN). On this inaugural episode, Dr. Aaron Fritts introduces one of the BackTable OBGYN hosts, Dr. Mark Hoffman, a minimally invasive gynecologic surgeon at the University of Kentucky. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/wBJ62y --- SHOW NOTES Dr. Hoffman shares the story of his training in minimally invasive surgery and chronic pelvic pain, and discusses the challenges he faced when starting his practice at the University of Kentucky where he treats complex, benign gynecologic concerns. Notably, he started a uterine fibroid embolization program alongside the Division of Vascular and Interventional Radiology. He also discusses caring for an underserved population in rural Kentucky may look like, in addition to factors that influenced his decision to practice in an academic versus community-based setting. Lastly, Dr. Hoffman highlights the role of podcasting and collaboration in medicine, which inspired his involvement in BackTable OBGYN. Drs. Hoffman and Fritts wrap up the episode by previewing the upcoming episodes for BackTable OBGYN, such as cross-specialty treatment of postpartum hemorrhage and the legal perspective of Roe versus Wade. The hosts encourage listeners to prepare for authentic, open conversations that address women’s health in both realms of obstetrics and gynecology. --- RESOURCES BackTable OBGYN Twitter and Instagram: @_backtableobgyn BackTable website: www.backtable.com

Step inside the evolving world of fetal therapy where precision, teamwork, and full-spectrum care matter most. In this episode of the BackTable OBGYN Podcast, Dr. Anthony Shanks, Vice Chair of Education in the OB department at Indiana University School of Medicine, interviews Dr. Hiba Mustafa, a distinguished maternal-fetal medicine specialist and fetal interventionalist at Riley Children's Hospital. They discuss Dr. Mustafa's expertise in fetal diagnosis and therapy, her training journey through various fellowships, and her role in directing multiple fetal medicine programs. --- SYNPOSIS Dr. Mustafa elaborates on the intricacies of fetal interventions, including procedures for complications in monochorionic twins, spina bifida repair, and new emerging therapies. They also touch on research methodologies like the Delphi consensus technique and summarize key findings from recent studies on conditions such as hemolytic disease, gastroschisis, lower urinary tract obstructions, and preterm birth in twin pregnancies. Dr. Mustafa shares insights on how to stay sharp in the field, the importance of teamwork in surgical procedures, and advice for those aspiring to enter the field of fetal therapy. --- TIMESTAMPS 00:00 - Introduction02:45 - The Role of a Fetal Interventionalist04:00 - Dr. Mustafa’s Training Journey07:42 - Fetal Surgery Fellowships16:43 - Conditions Treated by Fetal Interventionalists21:17 - Monitoring and Referrals for Monochorionic Twins30:04 - Understanding Percutaneous Procedures31:10 - Navigating the Equator in Fetal Surgery32:31 - Laser Surgery Techniques and Outcomes33:18 - The Importance of Placenta Delivery33:47 - In Utero Spina Bifida Repair36:19 - Minimally Invasive Techniques for Spina Bifida38:28 - Maintaining Skills in Fetal Interventions42:11 - Delphi Consensus Technique in Medical Research46:19 - Key Takeaways from Recent Research51:55 - Future of Fetal Therapy and Personal Insights

Real innovation? It’s not just the tools and techniques you use, it’s how you think. In this episode of the BackTable OBGYN podcast, hosts Dr. Mark Hoffman and Dr. Amy Park welcome Dr. Kevin Stepp, a MIGS surgeon and urogynecologist in Charlotte, North Carolina, and an OBGYN professor at Wake Forest University School of Medicine. Dr. Stepp shares his journey into the field, including his serendipitous start in single-port laparoscopy and the many surgical innovations that he has pioneered. --- SYNPOSIS The conversation highlights the importance of anatomical knowledge, thinking beyond conventional surgical approaches, and the significance of teamwork and efficiency in the operating room. A central focus is placed on the development and application of single-port techniques, highlighting the associated learning curves and the evolving role of robotic surgery. The discussion also explores how surgical team dynamics, effective communication, and ongoing innovation collectively contribute to better patient outcomes and advancement in the medical field. --- TIMESTAMPS 00:00 - Introduction03:50 - Pioneering Single Port Laparoscopy10:10 - Challenges and Advantages of Single Port Surgery13:52 - Cosmetic Considerations and Incision Techniques27:27 - Innovative Approaches and Future Directions30:40 - Understanding 3D Anatomy in GYN Surgery32:10 - Sustaining Innovation in Urogynecology33:53 - Efficiency in Surgical Procedures39:20 - Advancement of Surgical Educational Materials 42:47 - Single Port and Robotic Procedures50:50 - Building a Team through Positive Surgical Culture01:02:13 - Continuous Improvement and Humility in Surgery

What if surgery isn’t the only answer to pelvic pain? In this episode of the BackTable podcast, host Dr. Mark Hoffman and co-host Dr. Amy Park welcome Dr. Frank Tu, Vice Chair for Quality at Endeavor Health and Director of the Division of Gynecological Pain and Minimally Invasive Surgery. The episode explores the complexity of chronic pelvic pain, emphasizing its multifactorial origins and individualized treatment approaches.---SYNPOSISDr. Tu shares insights into the persistence and treatment of chronic pelvic pain, the role of trauma, and the evolving understanding of endometriosis and other gynecological conditions. The discussion covers patient treatment modalities, the potential of artificial intelligence in medical diagnostics, and the significant role of non-surgical interventions like physical therapy. Dr. Tu's reflections on interdisciplinary collaborations, preventative approaches, and the future directions of gynecologic pain management provide a comprehensive overview of this complex field.---TIMESTAMPS00:00 - Introduction05:21 - Mentorship and Influences07:01 - Research and Innovations in Pelvic Pain09:21 - Preventative Approaches to Chronic Pain14:15 - Exploring Pain Mechanisms and Treatments26:32 - The Role of Sensory Reintroduction30:20 - The Importance of Mental Health30:49 - Challenges in Treating Chronic Pelvic Pain31:24 - The Role of Surgery and Mental Health in Pain Management34:00 - Barriers to Effective Pelvic Floor Physical Therapy35:40 - The Complexity of Treating Dysmenorrhea44:11 - Exploring Personalized Medicine and AI in Pain Management51:22 - The Future of Pain Management and AI54:25 - The Role of Big Data and AI in Medical Research59:25 - Final Thoughts

Equity is not just a box to check; it is the framework for lasting change. In this week's BackTable podcast, guest host Dr. Veronica Lerner speaks with Dr. Ebony Carter, a high-risk obstetrician and Division Director for Maternal-Fetal Medicine at the University of North Carolina at Chapel Hill. Dr. Carter shares insights into her career journey, which was influenced by her mother's activism in health equity, her work on reproductive health disparities, and community engagement projects. ---SYNPOSISThe conversation underscores the importance of patient participation and agency in clinical decision-making. Dr. Carter and Dr. Lerner also discuss the development of an equity rubric for peer-reviewed journals, highlighting the need for inclusive and intentional research practices. They explore practical applications of the rubric, including the proper acknowledgment of contributors to foundational concepts. The episode further delves into Dr. Carter’s mentorship initiatives at the Green Journal and her guiding philosophy of pursuing impactful, community-driven work rooted in passion and purpose.---TIMESTAMPS00:00 - Introduction02:06 - Dr. Carter's Journey and Inspiration05:19 - Community Engagement and Health Equity06:19 - Patient Advocacy and Shared Decision Making08:54 - Collaborative Research and Community Partnerships16:58 - Addressing Bias in Medical Practice22:12 - Equity in Academic Publishing28:26 - Diversifying the Peer Review Pool30:33 - Creating and Implementing the Equity Rubric31:17 - The Impact and Application of the Equity Rubric33:31 - Personal Reflections on Equity and Research35:25 - Citing Foundational Work38:48 - Mentorship and Training Future Leaders47:05 - Career Transitions and Future Goals52:36 - Final Thoughts and Advice for Aspiring Professionals---RESOURCESFull Equity Rubric:https://journals.lww.com/greenjournal/Documents/OnG_Equity_Rubric_1.pdf ​Equity Rubric Introduction Video:https://youtu.be/Jh5_L-pYkuE?si=JREjSSCr98jqjVVB Equity Rubric Introduction Video Slide Deck:https://journals.lww.com/greenjournal/Documents/Green%20Journal%20Equity%20Rubric%20YouTube_final_2022_01_16%20(Slides).pdf

Curious how cross-specialty teamwork is reshaping endometriosis care? In this episode of BackTable OBGYN, host Dr. Mark Hoffman speaks with Dr. Peter Movilla, Associate Medical Director at Newton Wellesley Hospital, and Dr. Anuradha Shenoy-Bhangle, Assistant Professor of Radiology at Harvard Medical School, about their collaborative efforts in advancing endometriosis care. --- SYNPOSIS The discussion covers the development and benefits of monthly multidisciplinary conferences that include gynecologists, radiologists, colorectal, urologic, and thoracic surgeons. The conferences aim to improve preoperative planning, intraoperative accuracy, and postoperative care through detailed imaging techniques, primarily MRI. They also highlight the importance of educating fellows and colleagues, the role of ultrasound screening, and future directions like AI and PET imaging. The episode emphasizes the challenges and rewards of treating endometriosis and fostering better patient outcomes through teamwork and innovation. --- TIMESTAMPS 00:00 - Introduction 01:55 - The Journey to Specialization 07:02 - Building a Multidisciplinary Team 15:07 - The Value of Postoperative Reviews 22:49 - Patient Counseling and Personalized Care 29:36 - Challenges in Endometriosis Treatment 31:00 - Educating Beyond the Clinic 33:05 - Innovations in Imaging 46:22 - Future Directions in Endometriosis Research 53:15 - Conference Highlights and Final Thoughts --- RESOURCES Recommendations for MRI technique in the evaluation of pelvic endometriosis: consensus statement from the Society of Abdominal Radiology endometriosis disease‑focused panel: https://drive.google.com/file/d/1VRBpw5V3AH-rWGEG43K1CMCx2flCXl2M/view?usp=sharing

When should you consider surgical management of chronic pelvic pain conditions? In this episode of the BackTable OBGYN podcast, Dr. Mark Dassel, a MIGS surgeon at Intermountain Health in Salt Lake City, joins hosts Dr. Mark Hoffman and Dr. Amy Park to discuss medical and surgical management strategies for chronic pelvic pain, particularly endometriosis. --- SYNPOSIS Dr. Dassel emphasizes the importance of stopping the hormonal triggers associated with pain and explores various medical treatments, including hormonal therapies and the role of contraceptives. He also highlights his approach to surgical interventions such as endometriosis excision, endometrioma removal, and hysterectomy, and the importance of holistic treatment plans involving pelvic floor physical therapy and central pain modulators. The episode also covers the complexities of diagnosing and treating pelvic pain, the role of early intervention, and the value of multidisciplinary care. --- TIMESTAMPS 00:00 - Introduction 07:55 - Differentiating Causes of Chronic Pelvic Pain 10:13 - Multidisciplinary Care and Costs 14:26 - Acute vs Chronic Pain 17:00 - Centralized Pain 18:46 - When to Offer Surgery 23:42 - Fertility and Endometriosis 33:25 - Hormonal Suppression Post-Surgery 37:24 - Pelvic Floor Botox and Physical Therapy 44:42 - Hysterectomy for Pelvic Pain 51:53 - Nerve Ablation and Pain Management 57:10 - Final Thoughts

Endometrial ablation has become a cornerstone procedure in the treatment of abnormal uterine bleeding, but is it the right solution for every patient that meets the indication? In this episode of the BackTable OBGYN Podcast, Dr. Ted Anderson from Vanderbilt University joins host Dr. Mark Hoffman to discuss the evolution of endometrial ablation and its contemporary utilization, including patient selection, technical considerations, and alternative treatments for abnormal uterine bleeding. --- SYNPOSIS Dr. Anderson begins by detailing the history of abnormal uterine bleeding alongside the evolution of the endometrial ablation techniques that have been used to treat it. Shifting focus to current day practice, he then shares his approach to endometrial ablation, covering patient selection and the technical aspects of his approach. Throughout the conversation, Dr. Anderson emphasizes the importance of how we define success in endometrial ablation, explaining that eumenorrhea (normal bleeding that no longer interferes with life events) is the goal, as opposed to the more traditional view that amenorrhea is the target outcome. The episode closes with a discussion on the role of alternative treatments, such as the Mirena IUD and hysterectomy for abnormal uterine bleeding. --- TIMESTAMPS 00:00 - Introduction 09:29 - History of Abnormal Uterine Bleeding and Endometrial Ablation 23:31 - Evolution of Endometrial Ablation Devices/Techniques 31:11 - Selecting the Right Patient for Ablation Success 34:38 - Post-Tubal Sterilization Ablation Syndrome 38:27 - The Role of IUDs in Managing AUB 44:07 - Reevaluating Endometrial Ablation Success Metrics 49:55 - Innovative Ablation Techniques: Cryoablation and Steam 51:48 - Adenomyosis and Fertility-Sparing Treatments 57:28 - Final Thoughts

What surgical techniques and safety measures are important to consider when operating in a pregnant patient? In this episode of the BackTable OBGYN podcast, Dr. Craig Sobolewski, a minimally invasive GYN surgeon at Duke, speaks with host Dr. Mark Hoffman about the intricacies of laparoscopic surgery in pregnant patients. --- SYNPOSIS The surgeons delve into the critical importance of understanding anatomy and ensuring proper exposure during surgeries, particularly the challenges and techniques for operating during pregnancy. Key discussions include the use of liver retractors, the management of symptomatic ovarian cysts, and the methods for performing and evaluating abdominal cerclages. They also explore the physiological changes in pregnant patients and the adjustments needed for anesthesia, laparoscopic entry, pressures during surgery, and pre/post-operative care. --- TIMESTAMPS 00:00 - Introduction 07:20 - Laparoscopy in Pregnant Patients 11:23 - Common Surgeries During Pregnancy 15:56 - Laparoscopic Surgery Techniques 24:04 - Physiologic Changes in Pregnancy 27:33 - Access Methods and Pressure Considerations 28:53 - Managing Torsion and Cysts in Pregnancy 30:21 - Energy Use and Safety in Pregnant Patients 31:38 - Preoperative and Postoperative Care 34:15 - Cerclage Procedures and Counseling 47:46 - Professional Reflections and Conclusions

When radiology meets surgery, endometriosis care becomes more precise, personalized, and proactive. In this BackTable OBGYN Brief, host Dr. Mark Hoffman is joined by Dr. Wendaline VanBuren, an associate professor of radiology at Mayo Clinic, and Dr. Tatnai Burnett, a minimally invasive GYN surgeon at Mayo Clinic, to discuss the complexities of diagnosing and managing endometriosis. The discussion covers the roles of advanced imaging techniques like MRI and ultrasound, the importance of pre-surgical planning, and the need for multidisciplinary collaboration. They share their approach to managing symptomatic and asymptomatic patients, the use of hormonal treatments, and the significance of monitoring potential malignant transformations in endometrioma cases. The episode underscores the critical role of imaging in planning effective surgical interventions for patients while highlighting the progression of endometriosis management protocols. TIMESTAMPS 00:00 - Introduction  01:07 - Discussing Endometriosis Management 02:18 - Imaging Techniques and Their Importance 04:24 - Interdisciplinary Collaboration 05:40 - Advanced Imaging Protocols 08:12 - Monitoring and Follow-Up Strategies 08:50 - Concerns About Malignancy 11:04 - Future Directions CHECK OUT THE FULL EPISODE OBGYN Ep. 69 https://www.backtable.com/shows/obgyn/podcasts/69/imaging-protocols-to-guide-endometriosis-treatment

How does gynecology care in the United States compare to Canada? In this episode of the BackTable OBGYN podcast, Dr. Jonathon Solnik, head of gynecology and minimally invasive surgery at Mount Sinai in Toronto, speaks with hosts Dr. Mark Hoffman and Dr. Amy Park about the significant differences between the healthcare systems in the US and Canada. --- SYNPOSIS The doctors cover financial incentives and constraints faced by hospitals in the US vs. Canada, the role of insurance companies, and how resource limitations impact clinical practice. Dr. Solnik shares insights from his career journey, emphasizing the challenges and opportunities he has encountered in Canada, including longer wait times for elective surgeries and the intricacies of the Canadian global budget system. The conversation also covers the impact of robotics in surgery, standardization of care, and the differences in the handling of high-acuity medical cases. The episode provides an insightful discussion on how different healthcare models affect patient care, physician practices, and hospital administration. --- TIMESTAMPS 00:00 - Introduction 01:39 - Dr. Solnik’s Career Journey 03:30 - Healthcare System Differences: US vs Canada 09:57 - Balancing Quality and Volume in Healthcare 12:18 - Private Practice in Canada 25:03 - Wait Times and Capacity Issues 34:44 - Oncology and Semi-Salaried Positions 39:03 - Negotiating CPT Codes and RVUs 42:14 - Access to Care in Remote Areas 44:42 - Robotics in Surgery 55:09 - Incentives and Productivity in Healthcare Systems 01:01:33 - Concluding Thoughts

How can we streamline the proper diagnosis and treatment of female urinary incontinence? The solution often lies in bridging comprehensive patient workup to pelvic floor physical therapy. Learn more in this BackTable OBGYN brief with Dr. Sarah Boyles and host Dr. Suzette Sutherland!  Key topics include what to look for during a pelvic exam, the importance of external skin inspection, prolapse evaluation, urethra assessment, and pelvic floor muscle strength testing. The doctors also address effective treatment options, the necessity (or lack thereof) of specific diagnostic tests, the significant role of bladder diaries, and the benefits of pelvic floor physical therapy. Practical advice for behavioral management, therapy for stress and urgency incontinence, and the reasons for structured evaluation methodologies are also highlighted. TIMESTAMPS 00:00 - Introduction 00:30 - Conducting a Thorough Pelvic Exam 02:45 - Evaluating Pelvic Floor Muscle Strength 04:28 - Initial Diagnostic Workup 06:07 - The Role of Bladder Diaries 09:49 - Treatment Algorithms for Urinary Incontinence 15:03 - Conclusion CHECK OUT THE FULL EPISODE OBGYN Ep. 61: Evaluating Female Urinary Incontinence: Essential Steps for the Generalist https://www.backtable.com/shows/obgyn/podcasts/61/evaluating-female-urinary-incontinence-essential-steps-for-the-generalist

Urinary incontinence can greatly impact our patients’ quality of life. It’s essential to recognize the different types and treat them appropriately. In this BackTable OBGYN Brief, Dr. Sarah Boyles and Dr. Suzette Sutherland provide an overview of female urinary incontinence for their general practice and specialized physician colleagues. The conversation dives into the different types of incontinence, including stress, urgency, mixed, and overflow incontinence, and the importance of accurate diagnosis and appropriate treatment plans. The discussion also emphasizes essential diagnostic steps, including urinalysis and measuring post-void residuals, and points out the importance of patient education and expectation management. TIMESTAMPS 00:00 - Introduction 00:30 - Prevalence of Female Urinary Incontinence 01:25 - Impact on Quality of Life 03:01 - Types of Urinary Incontinence 07:35 - Diagnostic Approaches CHECK OUT THE FULL EPISODE OBGYN Ep. 61: Evaluating Female Urinary Incontinence: Essential Steps for the Generalist https://www.backtable.com/shows/obgyn/podcasts/61/evaluating-female-urinary-incontinence-essential-steps-for-the-generalist

What skills and disciplines can a surgeon take from their training to succeed in a new leadership / hospital administration role? In this episode of BackTable OBGYN, Dr. Mark Hoffman discusses his transition from a minimally invasive gynecologic surgeon to the Chief Medical Officer at his hospital with co-host Dr. Amy Park. --- SYNPOSIS The doctors cover the importance of high-functioning teams, the unexpected challenges of hospital administration, and the impact of clinical experience on decision-making. Additionally, they explore the broader responsibilities and skill sets required for effective leadership in a hospital setting, and offer advice for others considering a similar career shift. Dr. Hoffman emphasizes the value of servant leadership, the benefits of focusing on strengths, and the necessity of building strong, resilient teams. --- TIMESTAMPS 00:00 - Introduction 05:16 - Transitioning to Hospital Administration 07:17 - Balancing Workload 10:33 - Teamwork and Leaning into Strengths 13:30 - Decision Making in Administration 26:20 - Unique Challenges for OBGYNs in Hospital Administration 31:48 - Engagement in Leadership 35:03 - Focusing on People to Improve Patient Care 44:18 - Building Effective Leadership Teams 45:25 - Transitioning to Hospital Administration 52:07 - Finding Joy in Leadership and Mentorship

There are many challenges when it comes to operating on a post-hysterectomy patient, especially when they have endometriosis. In this episode of BackTable OBGYN, Dr. Emad Mikhail, an associate professor of OBGYN at the University of South Florida, discusses the intricacies of treating endometriosis after a hysterectomy. --- SYNPOSIS Dr. Mikhail shares his journey from medical school in Egypt to his current expertise in deep endometriosis surgery in Tampa, Florida. The conversation covers preoperative evaluation, the importance of understanding patient history, and surgical approaches for complex cases. He emphasizes the need for multidisciplinary collaboration, advanced imaging, and specialized surgical techniques to ensure optimal patient outcomes. --- TIMESTAMPS 00:00 - Introduction 05:52 - The Role of Hysterectomy in Endometriosis 08:58 - The Role of Ovaries in Endometriosis 11:12 - Surgical Techniques and Considerations 18:11 - Evaluating Deep Endometriosis 24:32 - Post-Hysterectomy Pain and Symptoms 31:26 - Surgical Approaches Post-Hysterectomy 39:49 - The Importance of Continuous Learning 43:09 - Scar Tissue vs. Lesion 51:47 - Comprehensive Preoperative Assessment 53:59 - Conclusion and Final Thoughts

There are tangible ways to advocate for health equity and address demographic disparities in patient care and the healthcare workforce. In this episode of the BackTable OBGYN Podcast, Dr. Teni Brown, an assistant professor of OBGYN at Northwestern University's Feinberg School of Medicine, speaks with hosts Dr. Amy Park and Dr. Mark Hoffman about DEI efforts and ways she has made real change. --- SYNPOSIS Dr. Brown shares her journey from Nigeria to the United States, detailing her path from middle school teacher to a leading advocate in diversity, equity, and inclusion (DEI) within the medical field. The conversation touches on systemic barriers in healthcare, the impact of historical practices like redlining, and practical steps institutions can take to foster a culture of equity. Dr. Brown emphasizes the importance of sustained engagement, multi-level interventions, and action-oriented solutions to create a more diverse and inclusive medical workforce. --- TIMESTAMPS 00:00 - Introduction 05:44 - Equity in OBGYN: Workforce and Patient Care 08:41 - Advocacy for Medication Access 15:25 - Systemic Barriers and Social Determinants of Health 20:22 - Understanding Redlining and Its Impact 25:10 - Efforts to Address Inequities 34:14 - Equity and Diversity in Healthcare 36:39 - The Role of Leadership in Promoting Equity 44:08 - AI and Technology in Addressing Gaps 50:00 - Vision for a More Equitable Future 58:26 - Final Thoughts and Encouragement

OBGYN Briefs - Bridging the Orgasm Gap Female sexual wellness is a topic that deserves more research, education, and attention, both for our patients and for providers. In this BackTable OBGYN Brief, Dr. Kelly Casperson speaks with host Dr. Suzette Sutherland about a range of issues related to women's sexual health. The conversation highlights the disparities between men's and women's sexual health resources and focuses on the gaps in sex education, communication, and healthcare training. Dr. Casperson emphasizes the biological, psychological, and social aspects of female sexual dysfunction and draws attention to the lack of adequate research and resources for women. The episode explores the importance of understanding the clitoris, the biases in sexual pleasure, and the role of informed consent in surgical procedures affecting sexual function. These insights aim to destigmatize female sexual health issues and promote better awareness and education. TIMESTAMPS 00:00 - Introduction 00:24 - Challenges in Women's Sexual Health 01:01 - Sex Education, Communication Gaps, and Bias 02:29 - Prevalence and Misconceptions 03:23 - Education about Clitoral Stimulation 03:59 - Impact of Medications and Relationships 07:16 - Orgasm Gap and Pleasure Inequality 09:23 - Understanding the G-Spot and Clitoral Anatomy 10:35 - Sling Surgery and Sexual Function CHECK OUT THE FULL EPISODE OBGYN Ep. 44: https://www.backtable.com/shows/obgyn/podcasts/44/urologys-role-in-advancing-female-sexual-health

Proper pain management after surgery is essential to promote healing and improve patient satisfaction. In this BackTable OBGYN Brief, Dr. Steven McCarus and Dr. Paula Bilica discuss how to advocate for non-opioid analgesia following OBGYN surgery. The discussion focuses on the importance of reducing opioid use in women's health through various strategies, including the use of Exparel and ERAS protocols. Dr. McCarus and Dr. Bilica share compelling arguments for covering costs and enhancing patient satisfaction, and also touch on hospital administration's role in adopting non-opioid analgesics. The doctors emphasize the need for a team approach and the presence of a dedicated champion to advocate for better pain management practices in women's health. TIMESTAMPS 00:00 - Introduction 00:44 - Advocating for Better Pain Management 02:09 - Opioid Use and Women's Health 04:45 - Benefits and Safety of Exparel 07:03 - Team Approach to Pain Management 08:12 - ERAS Protocols and Exparel 12:45 - Getting Healthcare Administration Buy-In CHECK OUT THE FULL EPISODE OBGYN Ep. 67: https://www.backtable.com/shows/obgyn/podcasts/67/non-opiod-pain-management-in-gyn-surgery

Curious about how to leave your mark as a mentor and leader in the field of OBGYN? In this episode of the BackTable OBGYN Podcast, Dr. Starr Hampton, a professor of OBGYN and Senior Associate Dean for Medical Education at Warren Alpert Medical School at Brown University, discusses her journey from a newly appointed faculty member to a leader in medical education. --- SYNPOSIS Dr. Hampton emphasizes the importance of kindness, mentorship, and taking opportunities when offered new roles. The conversation covers topics such as transitioning from medical school to residency to practice, fostering a supportive educational environment, and international health work. Dr. Hampton shares valuable insights on creating a culture of psychological safety and the significance of giving corrective yet supportive feedback to trainees. --- TIMESTAMPS 00:00 - Introduction 02:43 - Early Career and First Leadership Roles 12:09 - Navigating National Organizations 24:15 - Mentorship and Sponsorship 28:34 - The Value of Kindness and Psychological Safety 32:14 - Changing Culture 33:48 - Balancing Wellness and Professional Life 39:57 - Advice for Seeking out Mentorship and Positive Experiences 45:21 - Naming Your Work 50:09 - Transitioning to New Jobs/Roles 56:06 - Global Health Initiatives and Personal Growth 01:01:17 Conclusion and Future Topics

Blind biopsies leave questions unanswered. In this episode of BackTable OBGYN, host Dr. Mark Hoffman welcomes back Dr. Linda Bradley, an expert in obstetrics, gynecology, and hysteroscopy from the Cleveland Clinic, to discuss the benefits and advancements of direct visualized endometrial sampling over traditional blind biopsy techniques. ---This podcast is supported by:Medtronichttps://www.medtronic.com/en-us/healthcare-professionals/specialties/gynecology/product-portfolio.html---SYNPOSISDr. Bradley emphasizes the importance of hysteroscopy for accurate diagnosis and treatment of various gynecological issues, including abnormal uterine bleeding. They explore the limitations of blind biopsies and the advantages of hysteroscopy in detecting focal lesions, avoiding unnecessary hysterectomies, and ensuring patient safety. The discussion also touches on the economic and procedural challenges in adopting hysteroscopy more widely in clinical practice.---TIMESTAMPS00:00 - Introduction 03:30 - The Evolution of Hysteroscopy at Cleveland Clinic04:49 - Challenges and Innovations in Hysteroscopy06:30 - Clinical Insights: Direct Visualized Endometrial Sampling12:03 - Case Studies and Practical Applications15:46 - The Importance of Visual Examination in Gynecology20:03 - Advocating for Hysteroscopy in Medical Practice31:07 - Patient History and Trauma Considerations31:34 - Cancer Detection and Missed Diagnoses32:14 - Challenges with Unscheduled Bleeding32:56 - Case Study: Blood Transfusions and Hysterectomy33:38 - Importance of Hysteroscopy34:43 - Hysteroscopy Techniques and Best Practices37:41 - Ultrasound and SIS (Saline Infusion Sonohysterography) for Imaging38:45 - Post-Operative Care and Follow-Up47:41 - Environmental and Economic Considerations in Healthcare52:51 - Final Thoughts and Patient Advocacy

Operating on the pregnant patient can be intimidating, but there are many ways to do so safely. In this episode of the BackTable OBGYN podcast Dr. Jamal Mourad, a MIG surgeon at Mayo Clinic, joins hosts Dr. Mark Hoffman and Dr. Amy Park to discuss the nuances of robotic surgery, particularly in the pregnant patient. --- SYNPOSIS Dr. Mourad shares his extensive experience with robotic platforms and his techniques for addressing complex cases such as transabdominal cerclage in pregnant patients and the management of endometriosis and uterine niche. The conversation covers best practices, the importance of continuous learning through observations and video analysis, and practical tips for improving surgical outcomes. The episode also emphasizes the importance of interdisciplinary collaboration and mentorship in advancing surgical skills and patient care. --- TIMESTAMPS 00:00 - Introduction 04:05 - Single Port vs. Multi-Port Approach 06:08 - Robotic Surgery on Pregnant Patients 08:20 - Anesthesia During Pregnancy 10:39 - Transabdominal Cerclage Techniques 19:27 - Techniques for C-section Scar Ectopic Pregnancy 23:45 - Surgical Considerations in the Pregnant Patient 28:37 - Diagnosing and Treating Ovarian Torsion 32:20 - Managing Placenta Accreta Spectrum 35:29 - Innovations in Robotic Surgery 39:26 - Mentorship and Continuous Learning 54:50 - Concluding Thoughts and Advice for Early Learners

Postoperative pain control is an essential aspect of patient recovery and satisfaction. While pain management is important in all surgical settings, C-sections, hysterectomies, and myomectomies are particularly frequent, accentuating the need for reliable non-opioid alternatives in OBGYN. Dr. Steven McCarus and Dr. Paula Bilica discuss the efficacy of multimodal pain control options in gynecologic and obstetric surgeries, including Exparel, a non-opioid liposomal bupivacaine. The doctors highlight the opioid epidemic and the need for alternative pain relief methods. They share insights on how the introduction of Exparel has transformed their practices by reducing the reliance on opioids, enhancing patient recovery post-surgery, and improving overall patient outcomes. Specific techniques and procedures for using Exparel in various types of surgeries such as C-sections, hysterectomies, and myomectomies are detailed, along with the benefits observed in clinical practices. TIMESTAMPS 00:00 - Introduction 00:42 - The Opioid Epidemic and Pain Management 02:46 - The Role of Exparel in Pain Management 04:53 - Multimodal Pain Control 06:12 - Techniques for Using Exparel 10:08 - Patient Outcomes and Benefits CHECK OUT THE FULL EPISODE OBGYN Ep. 67: https://www.backtable.com/shows/obgyn/podcasts/67/non-opiod-pain-management-in-gyn-surgery

Peer review can be a daunting process as a physician, but there are ways to focus the process on constructive feedback and quality improvement rather than criticism and punishment. In this episode of the BackTable OBGYN Podcast, host Dr. Amy Park welcomes urogynecologist Dr. Maggie Mueller to discuss how we can improve the peer review process in the field of obstetrics and gynecology. --- SYNPOSIS Dr. Mueller delves into her personal involvement in peer review, the challenges faced by providers, and the importance of these processes. Key topics include shifting from a punitive to a quality improvement focus, best practices for peer review committees, the integration of human and system factors, the role of multidisciplinary teams, and transparency. The conversation also highlights the ethical considerations and the impact of peer review on provider well-being, emphasizing the need for structured support systems. Dr. Mueller shares insights into the future trends in peer review, advocating for higher physician involvement and leadership in creating more effective and transparent processes. --- TIMESTAMPS 00:00 - Introduction 02:21 - Diving into Peer Review 04:14 - The Peer Review Process Explained 07:07 - Challenges and Improvements in Peer Review 13:14 - Changing the Culture Around Peer Review 21:14 - Moving Away from a Punitive Mindset 25:12 - Education to Become a Reviewer 31:39 - Legal Considerations 32:42 - Ethical Considerations 38:31 - Future Trends in Peer Review 41:20 - Closing Remarks

Human trafficking is a complex health issue, with many providers unsure how best to detect, counsel, and care for victims and survivors of human trafficking. In this episode of the BackTable OBGYN Podcast, hosts Dr. Amy Park and Dr. Mark Hoffman are joined by Dr. Julia Geynisman-Tan, a urogynecologist at Northwestern, to discuss signs of human trafficking and resources for caring for this patient population. --- SYNPOSIS Dr. Geynisman-Tan shares her extensive experience in caring for survivors of human trafficking and discusses the complexities surrounding this issue. She emphasizes the importance of trauma-informed care, recognizing signs of trafficking, and providing support to survivors. The conversation covers her journey into this field, the challenges faced by survivors, and practical steps that healthcare professionals can take to aid these vulnerable patients. The episode underscores the need for multidisciplinary approaches and the critical role of healthcare providers in identifying and assisting those affected by human trafficking. --- TIMESTAMPS 00:00 - Introduction 05:08 - Identifying Signs of Human Trafficking in Patients 09:14 - Referral and Support Systems for Trafficking Survivors 11:31 - Common Health Issues Among Trafficking Survivors 13:17 - Understanding the Complexities of ‘The Life’ 18:13 - Immigration and Human Trafficking 20:48 - Providing Trauma-Informed Care 25:55 - Identifying Resources for Victims 29:23 - Healthcare Protocols 32:50 - Addressing Needs and Building Trust 36:58 - Psychosomatic Effects of Trauma 40:50 - Impact on Pregnancy 42:55 - Supporting Survivors and Long-Term Rehabilitation 48:30 - Conclusions --- RESOURCES Human Trafficking Hotline: https://humantraffickinghotline.org/en HEAL Trafficking: https://healtrafficking.org/

Surgical approaches to endometriosis continue to move towards greater levels of precision and efficacy as we learn more about the intricacies of this complex condition. Still, endometriosis continues to challenge gynecologic surgeons worldwide. How has endometriosis surgery evolved, and how can we apply what we’ve learned to continue to improve patient outcomes? In this episode of BackTable OBGYN, Dr. Tommaso Falcone, a renowned surgeon and expert in reproductive endocrinology and fertility, discusses the past, present, and future of endometriosis surgery. --- SYNPOSIS Dr. Falcone shares his journey from McGill University to his current roles at the Cleveland Clinic, offering insights into advancements in minimally invasive surgery, the role of teamwork in medical innovation, and the complexities of treating endometriosis. The episode covers the evolution of surgical techniques, postoperative care, and fertility strategies, emphasizing the importance of managing patient expectations and the future directions for research and treatment. --- TIMESTAMPS 00:00 - Introduction 02:09 - Dr. Falcone’s Journey and Career 08:09 - Evolution of REI and MIGS 13:35 - Innovations in Endometriosis Treatment 20: 45 - Excision vs Ablation 25:30 - Challenges and Future Directions in Endometriosis Research 32:39 - Understanding the Placebo Effect in Chronic Pain 34:18 - Exploring Fibrosis in Endometriosis 35:31 - Challenges in Diagnosing and Treating Endometriosis 40:57 - Innovations in Surgical Techniques 53:56 - Managing Patient Expectations and Complications 56:06 - Concluding Thoughts

Endometriosis is a very difficult disease to diagnose and manage, but effective imaging can make all of the difference. In this episode of the BackTable OBGYN podcast, Mayo Clinic radiologist Dr. Wendaline VanBuren and gynecologist Dr. Tatnai Burnett discuss the complexities of diagnosing, imaging, and surgically treating endometriosis. --- SYNPOSIS The doctors delve into the importance of advanced imaging techniques such as MRI and dedicated protocols, the critical need for a multidisciplinary approach with radiologists and GYN surgeons, and the future potential of imaging in improving endometriosis diagnosis, treatment, and surgical planning. The discussion also covers the upcoming International Endometriosis Imaging Congress aimed at advancing standardized care and collaboration in the field. --- TIMESTAMPS 00:00 - Introduction 05:15 - Dr. VanBuren’s Journey to Endometriosis Imaging 08:24 - Dr. Burnett’s Surgical Training and Insights 11:57 - Challenges in Diagnosing and Understanding the Pathophysiology of Endometriosis 13:24 - The Role of Imaging in Surgical Planning 25:51 - Imaging Follow-Up, Monitoring for Malignant Transformation 32:03 - Protocol for MRI Imaging of Endometriosis 34:47 - The Role of Radiologists in Endometriosis 36:12 - The Complexity of Bowel Endometriosis 48:02 - The Future of Endometriosis Imaging --- RESOURCES International Endometriosis Imaging Congress-March 8-9, 2025 https://eice.ltd/international-endometriosis-imaging-congress/

Stay up to date on the latest advancements in gynecologic surgery. In this episode of the BackTable OBGYN Podcast, hosts Dr. Amy Park and Dr. Mark Hoffman invite Dr. Johnny Yi, a pioneer in the field of minimally invasive surgery and urogynecology, to discuss the latest advancements in, benefits of, and challenges with single port robotic gynecologic surgery. --- SYNPOSIS The discussion covers evolutionary strides in robotic-assisted surgeries such as sacral colpopexy and myomectomies, the transition from traditional laparoscopy, and the intricacies of handling large uteri procedures. The episode also navigates the global adoption of these technologies, particularly in South Korea and Japan, and the varying applications in different specialties. Key topics include surgical skill requirements, training needs, innovative techniques, FDA approvals, and the future potential of single port surgeries. Overall, this discussion provides a well-rounded perspective on the current state and forward-looking innovations in the field of gynecologic surgery. --- TIMESTAMPS 00:00 - Introduction 03:57 - Single Port Robotic Surgery 08:27 - Benefits of Robotics with Sacral Colpopexy 11:37 - Technical Aspects of Single Port Surgery 14:40 - Training for Single Port Surgery 19:43 - Global Adoption and Future Potential of Single Port Surgery 25:35 - Access into the Abdomen 29:39 - Challenges and Innovations in Single Port Surgery 31:34 - Evaluating Risks and Success Rates 33:16 - Cost Analysis 35:16 - Training and Simulation for Single Port Surgery 39:35 - Future of Single Port and vNOTES Surgery 45:05 - Patient Reactions and Satisfaction 46:34 - Closing Techniques 52:14 - Future Prospects and Final Thoughts --- RESOURCES Oh S, Yi J, Song AY, Jee J, Bae N, Shin JH. Intraoperative Complications and Perioperative and Surgical Outcomes of Single-Port Robotics-Assisted Sacrocolpopexy. Int Urogynecol J. 2024 Jul; 35 (7):1521-1526 Epub 2024 June 20.

How can we address barriers to care for women with genitourinary syndrome of menopause? In this episode, host Dr. Suzette Sutherland and Dr. Rachel Rubin discuss the challenges and misconceptions around Genitourinary Syndrome of Menopause (GSM). They identify the severity of symptoms such as pain, urinary issues, and recurrent infections that are often inadequately addressed. Dr. Rubin advocates for the use of vaginal estrogen, emphasizing that its benefits outweigh any perceived risks, contrasting it with other treatments like tamoxifen. The discussion includes the efforts to create guidelines for GSM through the American Urological Association (AUA) to standardize care, and the use of systemic and localized hormonal therapies, particularly in cancer patients. The session highlights the importance of updated medical practices and shared decision-making in treating GSM and related conditions. TIMESTAMPS 00:00 - Understanding Genitourinary Syndrome of Menopause (GSM) 01:33 - Challenges, Misconceptions, and Advocacy 02:31 - Developing GSM Guidelines 04:34 - Hormonal Replacement Therapy and GSM 05:46 - Vaginal Rings 06:59 - Cancer Survivors and Vaginal Estrogen 09:17 - Shared Decision Making CHECK OUT THE FULL EPISODE OBGYN Ep. 33 - Genitourinary Syndrome of Menopause (GSM): Improving a DRY Topic https://www.backtable.com/shows/obgyn/podcasts/33/genitourinary-syndrome-of-menopause-gsm-improving-a-dry-topic

How can we educate women about vaginal estrogen for genitourinary syndrome of menopause, especially given the black box warning? In this Brief, Dr. Rachel Rubin and host Dr. Suzette Sutherland discuss misconceptions around the use of estrogen creams and suppositories, particularly focusing on dosage and application for safe, effective treatment. They address common factors leading to inadequate results and the safety of low-dose vaginal estrogen. The doctors emphasize the importance of patience with treatment, correct understanding of hormone products, and education of patients to combat misinformation. Dr. Rubin and Dr. Sutherland also challenge misleading black box warnings associated with vaginal estrogen and stress the necessity for advocacy to update these labels and educate patients. TIMESTAMPS 00:00 - Introduction 00:20 - Debunking Myths About Estrogen Cream Usage 04:10 - Safety and Proper Usage/Dosage of Estrogen Products 05:48 - Patient Education and Compliance 08:23 - Addressing the Black Box Warning on Vaginal Estrogen 10:48 - Conclusion CHECK OUT THE FULL EPISODE OBGYN Ep. 33 - Genitourinary Syndrome of Menopause (GSM): Improving a DRY Topic https://www.backtable.com/shows/obgyn/podcasts/33/genitourinary-syndrome-of-menopause-gsm-improving-a-dry-topic

Everyone knows about the dangers of opioids, but how can physicians provide quality postoperative pain control without opioids? This episode of the BackTable OBGYN podcast, hosted by Dr. Amy Park, features a discussion with experts Dr. Steven McCarus and Dr. Paula Bilica on non-opioid pain control in obstetric and gynecologic surgery. --- This podcast is supported by: Pacira https://www.pacira.com/ --- SYNPOSIS Highlighting the use of Exparel, a liposomal bupivacaine formulation, the discussion addresses how it has transformed post-operative pain management by reducing opioid exposure. The episode covers techniques for Exparel application in surgeries such as hysterectomies and C-sections, with positive patient outcomes noted. The conversation also emphasizes the importance of collaboration among healthcare professionals to advocate for better pain management protocols and patient satisfaction, spotlighting upcoming initiatives like the No Pain Act. --- TIMESTAMPS 00:00 - Introduction 04:47 - Introduction to Liposomal Bupivacaine (Exparel) 07:10 - Techniques and Applications of Exparel 20:13 - The No Pain Act 25:07 - Patient Success Stories with Exparel 26:30 - Administrative Hurdles and Solutions 30:24 - Safety and Efficacy of Exparel 32:42 - Educating Staff and Implementing Protocols 38:05 - Final Thoughts

When radiology meets surgery, endometriosis care becomes more precise, personalized, and proactive. In this BackTable OBGYN Brief, host Dr. Mark Hoffman is joined by Dr. Wendaline VanBuren, an associate professor of radiology at Mayo Clinic, and Dr. Tatnai Burnett, a minimally invasive GYN surgeon at Mayo Clinic, to discuss the complexities of diagnosing and managing endometriosis. The discussion covers the roles of advanced imaging techniques like MRI and ultrasound, the importance of pre-surgical planning, and the need for multidisciplinary collaboration. They share their approach to managing symptomatic and asymptomatic patients, the use of hormonal treatments, and the significance of monitoring potential malignant transformations in endometrioma cases. The episode underscores the critical role of imaging in planning effective surgical interventions for patients while highlighting the progression of endometriosis management protocols. TIMESTAMPS 00:00 - Introduction  01:07 - Discussing Endometriosis Management 02:18 - Imaging Techniques and Their Importance 04:24 - Interdisciplinary Collaboration 05:40 - Advanced Imaging Protocols 08:12 - Monitoring and Follow-Up Strategies 08:50 - Concerns About Malignancy 11:04 - Future Directions CHECK OUT THE FULL EPISODE OBGYN Ep. 69 https://www.backtable.com/shows/obgyn/podcasts/69/imaging-protocols-to-guide-endometriosis-treatment