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Explore every episode of the podcast Behind The Knife: The Surgery Podcast
Dive into the complete episode list for Behind The Knife: The Surgery Podcast. Each episode is cataloged with detailed descriptions, making it easy to find and explore specific topics. Keep track of all episodes from your favorite podcast and never miss a moment of insightful content.
| Title | Pub. Date | Duration | |
|---|---|---|---|
| Association of Out Surgeons & Allies (AOSA) - Episode 5: After Gender Affirming Surgery, What You Need to Know | 29 Aug 2024 | 00:50:28 | |
Join for the fifth episode in the Association of Out Surgeons and Allies (AOSA) series for a comprehensive discussion of what the general surgeon needs to know prior to operating on a patient who has previously undergone gender affirming surgery. Host: Dan Scheese, MD Andrew Schlussel, DO, Colorectal and General Surgeon, Charlie Norwood VA Medical Center Guests: Dr. Megan Lane (She/her) megalane@med.umich.edu Dr. Lane is a plastic surgery resident at the University of Michigan who is planning on going into Gender Affirming Surgery and general reconstruction. She completed a research fellowship in the National Clinician Scholars Program and focused primarily on patient-reported outcomes in gender affirming surgery. Dr. Amy Suwanabol pasuwan@med.umich.edu Dr. Suwanabol is a colorectal surgeon at the University of Michigan and the Ann Arbor VA. She assists the gender affirming surgeons at the University of Michigan in performing robotic-assisted vaginoplasty. Her research focuses on optimizing quality of life among surgical patients and their families, surgeon well-being, and cancer survivorship. Dr. Monica Llado-Farrulla lladorfar@ohsu.edu Dr. Llado-Farrulla was born and raised in Puerto-Rico, completed general surgery residency followed by plastic surgery residency at Tulane and Penn, respectively. She pursued a year of training in advanced gender surgery and is now currently at OHSU. Her practice largely focuses on facial feminization, chest affirming surgeries, phalloplasty, autologous breast reconstruction, and limb salvage. Learn more and get involved with AOSA: https://www.outsurgeons.org Twitter/X: @OutSurgeons Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen | |||
| Journal Review in Surgical Palliative Care: 2023 Pediatric & Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline | 26 Aug 2024 | 00:35:07 | |
Have you ever been confused about the concept of brain death, or struggled to explain brain death to a patient’s family or your fellow clinicians? Join the Behind the Knife Surgical Palliative Care team and our special guest, neurologist & neurointensivist Dr. Sarah Wahlster, as we explore the 2023 Pediatric & Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline and what this updated guideline means for our practice in surgical palliative care! Hosts: Dr. Katie O’Connell (@katmo15) is an Associate Professor of Surgery at the University of Washington in the division of Trauma, Burn, and Critical Care Surgery. She is a trauma surgeon, palliative care physician, Director of Surgical Palliative Care, and founder of the Advance Care Planning for Surgery Clinic at Harborview Medical Center in Seattle, WA. Dr. Virginia Wang is a PGY-3 General Surgery resident at the University of Washington. Guest: Dr. Sarah Wahlster (@SWahlster) is an Associate Professor of Neurology at the University of Washington. She is a neurologist, neurointensivist, and Program Director of the Neurocritical Care Fellowship at Harborview Medical Center in Seattle, WA. Learning Objectives: · Understand the concept of assent and how it can be helpful in communicating with families of patients who have sustained brain death · Explain the main steps required for diagnosis of brain death (prerequisites, clinical exam, apnea testing, ancillary testing) · Understand key differences between the 2023 guideline and previous (2010 & 2011) guidelines · Be able to name the 3 accepted modalities of ancillary testing for brain death · Know basic communication best practices with families of patients who have sustained brain death from the surgical palliative care perspective (consistency of language & messaging; avoidance of phrases such as “life-sustaining treatment”, “comfort-focused measures”) References: 1. Greer, D. M., Kirschen, M. P., Lewis, A., Gronseth, G. S., Rae-Grant, A., Ashwal, S., Babu, M. A., Bauer, D. F., Billinghurst, L., Corey, A., Partap, S., Rubin, M. A., Shutter, L., Takahashi, C., Tasker, R. C., Varelas, P. N., Wijdicks, E., Bennett, A., Wessels, S. R., & Halperin, J. J. (2023). Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline. Neurology, 101(24), 1112–1132. https://doi.org/10.1212/WNL.0000000000207740 2. Lewis, A., Kirschen, M. P., & Greer, D. (2023). The 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline: A Comparison With the 2010 and 2011 Guidelines. Neurology. Clinical practice, 13(6), e200189. https://doi.org/10.1212/CPJ.0000000000200189 3. AAN Interactive Brain Death/Death by Neurologic Criteria Evaluation Tool – https://www.aan.com/Guidelines/BDDNC 4. AAN Brain Death/Death by Neurologic Criteria Checklist – https://www.aan.com/Guidelines/Home/GetGuidelineContent/1101 5. Kirschen, M. P., Lewis, A., & Greer, D. M. (2024). The 2023 American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine Pediatric and Adult Brain Death/Death by Neurologic Criteria Determination Consensus Guidelines: What the Critical Care Team Needs to Know. Critical care medicine, 52(3), 376–386. https://doi.org/10.1097/CCM.0000000000006099 6. Greer, D. M., Shemie, S. D., Lewis, A., Torrance, S., Varelas, P., Goldenberg, F. D., Bernat, J. L., Souter, M., Topcuoglu, M. A., Alexandrov, A. W., Baldisseri, M., Bleck, T., Citerio, G., Dawson, R., Hoppe, A., Jacobe, S., Manara, A., Nakagawa, T. A., Pope, T. M., Silvester, W., … Sung, G. (2020). Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project. JAMA, 324(11), 1078–1097. https://doi.org/10.1001/jama.2020.11586 7. Lele, A. V., Brooks, A., Miyagawa, L. A., Tesfalem, A., Lundgren, K., Cano, R. E., Ferro-Gonzalez, N., Wongelemegist, Y., Abdullahi, A., Christianson, J. T., Huong, J. S., Nash, P. L., Wang, W. Y., Fong, C. T., Theard, M. A., Wahlster, S., Jannotta, G. E., & Vavilala, M. S. (2023). Caseworker Cultural Mediator Involvement in Neurocritical Care for Patients and Families With Non-English Language Preference: A Quality Improvement Project. Cureus, 15(4), e37687. https://doi.org/10.7759/cureus.37687 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen | |||
| Journal Review in Thoracic Surgery: Health Consequences of Thymectomy in Adults | 25 Jul 2024 | 00:25:32 | |
Does the adult thymus have a purpose and function? Are there any long-term health effects of thymectomy? Tune in to another Swedish Thoracic surgery journal review where we discuss the recent paper out of the NEJM which reports on the health consequences of thymus removal in adults. This paper has been widely picked up by the media and our patients frequently bring it into the office. Listen as we discuss the study population, methods, and potential applications of this paper. Learning Objectives: - Review the purpose and function of the thymus. - Discuss the population, methods, and results of this trial. - Discuss the application of this paper and how it may or may not impact clinical practice for thoracic surgeons. Hosts: Chloe E. Hanson, MD, PGY-3 Kelly Daus MD, PGY-4 Peter White, MD, Thoracic Surgery Attending Brian Louie, MD, Thoracic Surgery Attending Reference Material: Kooshesh KA, Foy BH, Sykes DB, Gustafsson K, Scadden DT. Health Consequences of Thymus Removal in Adults. N Engl J Med. 2023;389(5):406-417. https://pubmed.ncbi.nlm.nih.gov/37530823/ Lin TM, Chang YS, Hou TY, et al. Risk of incident autoimmune diseases in patients with thymectomy. Ann Clin Transl Neurol. 2020;7(7):1072-1082. https://pubmed.ncbi.nlm.nih.gov/32478484/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen | |||
| Clinical Challenges in Endocrine Surgery: Autofluorescence in Endocrine Surgery | 23 Nov 2023 | 00:30:36 | |
Making a discovery that changes how we practice is one of the most exciting things about the fields of medicine and surgery. In this episode, join endocrine surgeons Drs. Barb Miller, John Phay, Priya Dedhia, and Surgical Oncology Fellow Dr. Samantha Ruff from The Ohio State University. Hear Dr. Phay tell the story of how parathyroid autofluorescence was discovered and the work that has gone on since that day. The group discusses several articles focusing on intraoperative adjuncts used to identify parathyroid tissue during thyroid and parathyroid surgery. Hosts: Barbra S. Miller, MD (Moderator), Clinical Professor of Surgery, John Phay, MD, Clinical Professor of Surgery, Priya H. Dedhia, MD, PhD, Assistant Professor of Surgery, Samantha Ruff, MD, Surgical Oncology Fellow, Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio. Twitter handles: Barbra Miller - @OSUEndosurgBSM John Phay – @JohnPhayMD Priya Dedhia – @priyaknows Samantha Ruff - @SamRuff_MD Learning objectives: 1) Understand the background of the discovery of parathyroid autofluorescence 2) Describe various intraoperative adjuncts utilized to identify parathyroid tissue 3) Compare and contrast the advantages and disadvantages of using autofluorescence versus indocyanine green for identification of parathyroid tissue 4) Recognize the impact of use of intraoperative imaging adjuncts on postoperative hypocalcemia (short and long-term) 5) Understand the general safety issues for the parathyroid imaging techniques discussed References: 1. Benmiloud, F., G. Godiris-Petit, R. Gras, et al., Association of Autofluorescence-Based Detection of the Parathyroid Glands During Total Thyroidectomy With Postoperative Hypocalcemia Risk: Results of the PARAFLUO Multicenter Randomized Clinical Trial. JAMA Surg, 2020. 155(2): p. 106-12 DOI: 10.1001/jamasurg.2019.4613. https://pubmed.ncbi.nlm.nih.gov/31693081/ 2. Kahramangil, B. and E. Berber, Comparison of indocyanine green fluorescence and parathyroid autofluorescence imaging in the identification of parathyroid glands during thyroidectomy. Gland Surg, 2017. 6(6): p. 644-8 DOI: 10.21037/gs.2017.09.04. https://pubmed.ncbi.nlm.nih.gov/29302480/ 3. Paras, C., M. Keller, L. White, et al., Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt, 2011. 16(6): p. 067012 DOI: 10.1117/1.3583571. https://pubmed.ncbi.nlm.nih.gov/21721833/ 4. Vidal Fortuny, J., V. Belfontali, S.M. Sadowski, et al., Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery. Br J Surg, 2016. 103(5): p. 537-43 DOI: 10.1002/bjs.10101. https://pubmed.ncbi.nlm.nih.gov/26864909/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other Behind the Knife endocrine episodes: https://behindtheknife.org/podcast-category/endocrine/ | |||
| Journal Review in Vascular Surgery: Chronic Limb Threatening Ischemia: BEST-CLI and BASIL-2 Trials | 20 Nov 2023 | 00:25:36 | |
What is the best surgical treatment for a vasculopathy with critical limb threatening ischemia? In this episode of Behind the Knife the vascular surgery subspecialty team discusses two pivotal trials (BEST-CLI and BASIL-2) and how the findings of these trials can help answer this question. In this episode, we will discuss the age old question: open bypass versus best endovascular treatment. Hosts:
Learning Objectives
References
If you liked this episode, check out other vascular surgery episodes: https://behindtheknife.org/podcast-category/vascular/ | |||
| Clinical Challenges in Minimally Invasive Surgery: MIS in the Pregnant Patient | 16 Nov 2023 | 00:39:45 | |
If you operate for long enough, chances are you will come across the unique, and potentially daunting scenario of operating on a pregnant patient. If, and when, you do, would you know what to do? Join University of Washington and MIS faculty Drs. Andrew Wright, Nicole White, and Nick Cetrulo, and residents Drs. Ben Vierra and Paul Herman as they discuss non-obstetric surgery in the pregnant patient so that you will be better informed when the challenge arises. Hosts: 1. Andrew Wright, UW Medical Center—Montlake and Northwest, @andrewswright 2. Nick Cetrulo, UW Medical Center—Northwest, @Trules25 3. Nicole White, UW Medical Center—Northwest, @NicoleWhiteTho1 4. Paul Herman, UW General Surgery Resident PGY-3, @paul_herm 5. Ben Vierra, UW General Surgery Resident PGY-2 Learning Objectives 1. Describe important physiologic changes in pregnancy that are relevant for the surgeon to know. 2. Review the epidemiology of non-obstetric general surgery in the pregnant patient. 3. Discuss specific imaging considerations in the pregnant patient. 4. Become more familiar with the technical aspects of approaching a typical surgical case in a pregnant patient. References 1. Pearl, J.P., Price, R.R., Tonkin, A.E. et al. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 31, 3767–3782 (2017). https://doi.org/10.1007/s00464-017-5637-3 2. Vasileiou G, Eid AI, Qian S, Pust GD, Rattan R, Namias N, Larentzakis A, Kaafarani HMA, Yeh DD; EAST Appendicitis Study Group. Appendicitis in Pregnancy: A Post-Hoc Analysis of an EAST Multicenter Study. Surg Infect (Larchmt). 2020 Apr;21(3):205-211. https://pubmed.ncbi.nlm.nih.gov/31687887/ 3. Dongarwar D, Taylor J, Ajewole V, Anene N, Omoyele O, Ogba C, Oluwatoba A, Giger D, Thuy A, Argueta E, Naik E, Salemi JL, Spooner K, Olaleye O, Salihu HM. Trends in Appendicitis Among Pregnant Women, the Risk for Cardiac Arrest, and Maternal-Fetal Mortality. World J Surg. 2020 Dec;44(12):3999-4005. https://pubmed.ncbi.nlm.nih.gov/32737556/ 4. Fong ZV, Pitt HA, Strasberg SM, Molina RL, Perez NP, Kelleher CM, Loehrer AP, Sicklick JK, Talamini MA, Lillemoe KD, Chang DC; California Cholecystectomy Group. Cholecystectomy During the Third Trimester of Pregnancy: Proceed or Delay? J Am Coll Surg. 2019 Apr;228(4):494-502.e1. https://pubmed.ncbi.nlm.nih.gov/30769111/ 5. Hong J, Yang J, Zhang X, Su J, Tumati A, Garry D, Docimo S, Bates AT, Spaniolas K, Talamini MA, Pryor AD. Considering delay of cholecystectomy in the third trimester of pregnancy. Surg Endosc. 2021 Aug;35(8):4673-4680. https://pubmed.ncbi.nlm.nih.gov/32875420/ 6. ACOG Committee Opinion No. 775: Nonobstetric Surgery During Pregnancy. Obstet Gynecol. 2019 Apr;133(4):e285-e286. https://pubmed.ncbi.nlm.nih.gov/30913200/ 7. Ashbrook M, Cheng V, Sandhu K, Matsuo K, Schellenberg M, Inaba K, Matsushima K. Management of Complicated Appendicitis During Pregnancy in the US. JAMA Netw Open. 2022 Apr 1;5(4):e227555. https://pubmed.ncbi.nlm.nih.gov/35426921/ 8. Capella CE, Godovchik J, Chandrasekar T, Al-Kouatly HB. Nonobstetrical Robotic-Assisted Laparoscopic Surgery in Pregnancy: A Systematic Literature Review. Urology. 2021 May;151:58-66. https://pubmed.ncbi.nlm.nih.gov/32445766/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other Behind the Knife minimally invasive surgery episodes: https://behindtheknife.org/podcast-category/minimally-invasive/ | |||
| Journal Review in Hernia Surgery: Artificial Intelligence and Hernia Outcome Prediction | 13 Nov 2023 | 00:26:04 | |
Join the Hernia Team from Carolinas Medical Center as they discuss applications of artificial intelligence in predicting outcomes for patients undergoing abdominal wall reconstruction. Emerging technologies are allowing us to understand hernia patients who are at risk for increased surgical complexity and postoperative complications – find out more in this Journal Review episode. Hosts:
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out more Behind the Knife hernia episodes: https://behindtheknife.org/podcast-category/hernia/ | |||
| Medical Student Mentorship – Leveraging mentorship into scholarship | 09 Nov 2023 | 00:31:19 | |
We’re all told to find mentors in medical training, but how does this actually work when you’re a new medical student interested in surgery? And how do you leverage those relationships into getting research experience and lines on your CV? Hosts: Nina Clark, MD Jessica Millar, MD Jon Williams, MD Guests: Michael Englesbe, MD, University of Michigan Erika Bisgaard, MD, University of Washington Some tips from the episode: Get involved
If you liked this episode, check out our Medical Student Intern Survival Guide Series: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/ | |||
| Medical Student Mentorship – Who they are, what they do. | 06 Nov 2023 | 00:34:15 | |
We’re all told to find mentors in medical training, but how does this actually work when you’re a new medical student interested in surgery? In this episode, our surgical education fellows and two expert mentors talk through the ins and outs of mentors – who are they, what can they do for you, how do you find one, and what do you do once you have one. Hosts: Nina Clark, MD Jessica Millar, MD Jon Williams, MD Guests: Michael Englesbe, MD, University of Michigan Erika Bisgaard, MD, University of Washington Some tips from the episode: Mentorship teams: think about 4-5 people who can help you in different ways.
If you liked this episode, check out our Medical Student Intern Survival Guide Series: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/ | |||
| Clinical Challenges in Surgical Education: Ob/Gyn ResidencyCAS - Creation of a New Independent Residency Application System | 02 Nov 2023 | 00:28:45 | |
Challenges continue to plague the residency application process, with programs receiving increased application volume that makes holistic review difficult, and medical student applicants burdened with application costs and uncertainty about what programs best align with their values. As a specialty, Ob/Gyn is facing these problems head on, and have united within their field to create a new independent residency application system, ResidencyCAS. While substantial changes to an already stressful process can be intimidating, the new platform offers many advantages that hope to improve the residency application experience for applicants, programs, and the Ob/Gyn community as a whole. We’re joined by Dr. Maya Hammoud and Dr. AnnaMarie Connolly, two of the leaders in this effort, to break down the creation of ResidencyCAS, plans for its implementation starting in the 2024-2025 application cycle, and the reaction of the Ob/Gyn and medical education communities to this change.
Learning Objectives 1. Listeners will describe current challenges to applicants and programs in the residency application process. 2. Listeners will identify the coming changes to the Ob/Gyn residency application process, with awareness of the planned design and use of the ResidencyCAS system. 3. Listeners will describe the value of potential changes to the residency application process. 4. Listeners will explain the barriers and efforts required to coordinate large-scale changes within medical education like the creation and implementation of ResidencyCAS. 5. Listeners will consider how changes to the residency application process could affect and improve their own field, program, or application. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our other Surgical Education Episodes: https://behindtheknife.org/podcast-category/surgical-education/ | |||
| Journal Review in Trauma Surgery: Direct Peritoneal Resuscitation | 30 Oct 2023 | 00:32:40 | |
Direct Peritoneal Resuscitation! We’re not just dumping fluids into the open abdomen. What is DPR? Why do it? Who should get it? Does it work? Come try and stay awake for some basic science talk before then learning all about why you should consider adopting DPR into your Trauma/EGS practice? Join Drs. Cobler-Lichter, Kwon, Meizoso, Urréchaga, and Rattan as they guide you through all this and more! Hosts: Michael Cobler-Lichter, MD, PGY2: University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @mdcobler (twitter) Eva Urrechaga, MD, PGY6/R4: University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @urrechisme (twitter) Eugenia Kwon, MD, Trauma/Surgical Critical Care Fellow: University of Miami/Jackson Memorial Hospital/Ryder Trauma Center Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery, 3 years in practice University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @jpmeizoso (twitter) Rishi Rattan, MD, Attending Surgeon in Trauma/Critical Care, 7 years in practice Legacy Emanuel Medical Center @DrRishiRattan (twitter) Learning Objectives: - State the proposed benefits of DPR - Identify who can benefit from DPR - Demonstrate the proper way to set up a DPR circuit - Discuss the proposed basic science mechanism for DPR’s efficacy Quick Hits: 1. Consider DPR in all your open abdomens in EGS/Trauma. You never know when you’re going to be able to close some of these patients. 2. The principal of DPR is to allow the fluid to dwell in the abdomen as long as possible. Keep the catheter deep and don’t put holes in your dressing. 3. DPR is ideal for patients with packing, who are in discontinuity, and for fresh anastomoses. These will only benefit from DPR, not be harmed by it. 4. Make sure these patients are receiving hourly I/Os. Nursing by-in is huge for this procedure. 5. DPR is associated with higher rates of fascial closure, reduces inflammation, and improves blood flow to the abdomen. References
If you liked this episode, check out our recent episode here: https://behindtheknife.org/listen/ | |||
| Pelvic Exenteration Surgery Series Episode 2: Anterior compartment tumors | 26 Oct 2023 | 00:27:14 | |
Join Professor Michael Solomon, Dr Kilian Brown and Dr Jacob Waller from Royal Prince Alfred Hospital in Sydney, Australia, for this special four part series on pelvic exenteration surgery for locally advanced and recurrent rectal cancer. Learn about these ultra-radical procedures which go beyond the traditional TME planes that we learn during surgical training, and into all compartments of the pelvis. Episode 2 outlines the radical technical approaches to anteriorly invasive tumours, including en bloc cystectomy, perineal urethrectomy, inter-labial vaginectomy and radical pubic bone resections. Each episode in this series features a different international guest surgeon. In episode 2, the RPA team are joined by Dr Paul Sutton from The Christie Hospital, Manchester, UK. Technical videos: Solomon MJ, Däster S, Loizides S, Sutton P, Brown KGM, Austin KKS, Lee PJ. Access to the anterior pelvic compartment in pelvic exenteration in women-the interlabial approach: video vignette. Br J Surg. 2021 Aug 19;108(8):e268-e269. doi: 10.1093/bjs/znab127. Solomon MJ, Alahmadi R, Lee PJ, Austin KKS. En bloc partial pubic bone excision with complete soft tissue pelvic exenteration. Br J Surg. 2022 Jun 14;109(7):640-641. doi: 10.1093/bjs/znac122. PMID: 35485605. References: Solomon MJ, Austin KK, Masya L, Lee P. Pubic Bone Excision and Perineal Urethrectomy for Radical Anterior Compartment Excision During Pelvic Exenteration. Dis Colon Rectum. 2015 Nov;58(11):1114-9. doi: 10.1097/DCR.0000000000000479. Check our more high-yield colorectal surgery content from Behind the Knife. | |||
| Pelvic Exenteration Surgery Series Episode 1: Principles of Patient Selection and Surgery | 23 Oct 2023 | 00:29:07 | |
Join Professor Michael Solomon, Dr Kilian Brown and Dr Jacob Waller from Royal Prince Alfred Hospital in Sydney, Australia, for this special four part series on pelvic exenteration surgery for locally advanced and recurrent rectal cancer. Learn about these ultra-radical procedures which go beyond the traditional TME planes, that we learn during surgical training, and into all compartments of the pelvis. Episode 1 provides listeners with an overview of the principles of exenteration surgery and preoperative patient assessment and selection. Each episode in this series features a different international guest surgeon. In episode 2, the RPA team are joined by Dr Elaine Burns from St Mark's Hospital, London, UK. References and further reading: -Burns EM, Quyn A; Lexicon Collaboration of UKPEN and the ACPGBI Advanced Cancer subcommittee. The 'Pelvic exenteration lexicon': Creating a common language for complex pelvic cancer surgery. Colorectal Dis. 2023 May;25(5):888-896. doi: 10.1111/codi.16476. -Brown KGM, Solomon MJ. Decision making, treatment planning and technical considerations in patients undergoing surgery for locally recurrent rectal cancer. Seminars in Colon and Rectal Surgery. 2020;31(3):100764 -van Kessel CS, Solomon MJ. Understanding the Philosophy, Anatomy, and Surgery of the Extra-TME Plane of Locally Advanced and Locally Recurrent Rectal Cancer; Single Institution Experience with International Benchmarking. Cancers. 2022 Oct 15;14(20):5058. doi: 10.3390/cancers14205058 -PelvEx Collaborative. Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative. Cancers (Basel). 2022 Feb 24;14(5):1161. doi: 10.3390/cancers14051161 Check out more high-yield colorectal surgery content from Behind the Knife: https://behindtheknife.org/podcast-category/colorectal/ | |||
| Big T Trauma Series Ep. 19 - Multimodal Pain Control | 22 Jul 2024 | 00:28:36 | |
Did you know that 13% of trauma patients who go home with an opioid prescription will develop opioid dependence? Multimodal pain regimens not only reduce opioid consumption, but also improve pain control. On this episode of the BIG T TRAUMA series, we explore a multimodal approach to pain management...and tackle some surgical dogma along the way. Hosts:
1. Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open 2020: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767637 2. Traumatic injuries and persistent opioid use in the USA: findings from a nationally representative survey. Injury Prevention 2017: https://pubmed.ncbi.nlm.nih.gov/27597400/ 3. Ketamine For Acute Pain After Trauma (KAPT): A Pragmatic, Randomized Clinical Trial. J Trauma 2024: https://pubmed.ncbi.nlm.nih.gov/38689402/ 4. EAST PMG: Efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute pain after orthopedic trauma (2023): https://www.east.org/education-resources/practice-management-guidelines/details/efficacy-and-safety-of-nonsteroidal-antiinflammatory-drugs-nsaids-for-the-treatment-of-acute-pain-af 5. Systematic Review and Meta-Analysis of the Association Between Non-Steroidal Anti-Inflammatory Drugs and Operative Bleeding in the Perioperative Period. JACS 2021: https://pubmed.ncbi.nlm.nih.gov/33515678/ 6. Is the use of nonsteroidal anti-inflammatories after bowel anastomosis in trauma safe? J Trauma 2023: https://pubmed.ncbi.nlm.nih.gov/36728125/ 7. University of Texas at Houston Multimodal Pain Guideline: https://med.uth.edu/surgery/acute-trauma-pain-multimodal-therapy/ 8. ACS TRAUMA QUALITY PROGRAMS BEST PRACTICES GUIDELINES FOR ACUTE PAIN MANAGEMENT IN TRAUMA PATIENTS: https://www.facs.org/media/exob3dwk/acute_pain_guidelines.pdf Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen | |||
| Association of Out Surgeons & Allies (AOSA) – Episode 2: The Medical Student and Resident Perspective | 19 Oct 2023 | 00:30:50 | |
This week, we discuss the experiences of residents and medical students in surgery who identify as LGBTQIA+. We discuss the question of disclosure during interviews, how to identify programs that are welcoming to diverse identities, and how AOSA has grown the community of trainees and faculty mentors and hopes to continue to support them in the future. Hosts:
https://www.outsurgeons.org Twitter/X: @OutSurgeons Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out episode one in this series: https://behindtheknife.org/podcast/association-of-out-surgeons-allies-aosa-episode-1/ | |||
| BIG T Trauma Series Ep. 18 – Rib Plating Update | 16 Oct 2023 | 00:28:52 | |
Has the pendulum swung too far? Is it time to put the drill down?? Or, drill, baby, drill! While the number of rib plating cases has exploded the data supporting the practice is less-than-stellar. On this episode of the BIG T Trauma series Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill bring you up to speed on rib plating. If you haven’t already, we recommend you listen to Behind the Knife episode 298, published in May 2020. (https://behindtheknife.org/podcast/big-t-trauma-series-ep-10-rib-fractures/) This episode covers comprehensive management of rib fractures, including multimodal pain control, regional blocks, pulmonary toilet, BiPAP, etc. REFERENCES: GUIDELINES EAST PMG Rib Plating (2017): https://www.east.org/education-resources/practice-management-guidelines/details/rib-fractures-open-reduction-and-internal-fixation-of-update-in-process EAST PMG Rib Fracture Non-Surgical Management (2022): https://www.east.org/education-resources/practice-management-guidelines/details/nonsurgical-management-and-analgesia-strategies-for-older-adults-with-multiple-rib-fractures-a-systematic-review-metaanalysis Chest Wall Injury Society Guidelines (2020): https://cwisociety.org/wp-content/uploads/2020/05/CWIS-SSRF-Guideline-01102020.pdf FLAIL/UNSTABLE CHEST Operative vs Nonoperative Treatment of Acute Unstable Chest Wall Injuries: A Randomized Clinical Trial, JAMA 2022: https://jamanetwork.com/journals/jamasurgery/fullarticle/2796556 Prospective randomized controlled trial of operative rib fixation in traumatic flail chest, JACS 2013: https://pubmed.ncbi.nlm.nih.gov/23415550/ Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status, Interact Cardiovasc Thoracic Surg 2005: https://pubmed.ncbi.nlm.nih.gov/17670487/ Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients, J Trauma 2002: https://pubmed.ncbi.nlm.nih.gov/11956391/ Surgical Rib Fixation of Multiple Rib Fractures and Flail Chest: A Systematic Review and Meta-analysis, J Surg Research 2022: https://pubmed.ncbi.nlm.nih.gov/35390577/ Surgical versus nonsurgical interventions for flail chest, Cochrane Review 2015: https://pubmed.ncbi.nlm.nih.gov/26222250/ NON-FLAIL CHEST Randomized Controlled Trial of Surgical Rib Fixation to Nonoperative Management in Severe Chest Wall Injury, Ann Surgery 2023: https://pubmed.ncbi.nlm.nih.gov/37317861/ Rib fixation in non-ventilator-dependent chest wall injuries: A prospective randomized trial, J Trauma 2022: https://pubmed.ncbi.nlm.nih.gov/35081599/ A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (NONFLAIL), J Trauma 2020: https://pubmed.ncbi.nlm.nih.gov/31804414/ Operative versus nonoperative treatment of multiple simple rib fractures: A systematic review and meta-analysis, Injury 2020: https://pubmed.ncbi.nlm.nih.gov/32650981/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out the rest of the BIG T Trauma episodes here: https://behindtheknife.org/podcast-series/big-t-trauma/ | |||
| Clinical Challenges in Colorectal Surgery: Management of Horseshoe Abscess | 12 Oct 2023 | 00:35:35 | |
You have a young patient with a horseshoe abscess. How should you address the abscess initially? What is the best approach to drain it? Now that it is drained, what do I do with all the drains? Tune in to figure out how to best approach the most challenging of perianal abscesses.
Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Julia Saraidaridis as they discuss the management of horseshoe abscess and complicated perianal fistula. Learning Objectives 1. Describe the evaluation for perianal abscesses and fistula. 2. Discuss the different surgical options in managing horseshoe abscesses and post operative care to definitive management 3. Explain the rationale behind use of different fistula surgeries in complex perianal fistulas Link to episode video: https://behindtheknife.org/video/clinical-challenges-in-colorectal-surgery-management-of-horseshoe-abscess/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. Our Colorectal Surgery Oral Board Audio Review includes 51 high-yield scenarios designed for Colorectal Surgeons by Colorectal Surgeons. Learn more here: https://behindtheknife.org/premium | |||
| Journal Review in Bariatric Surgery: Mesenteric Defect Closure and Internal Hernia Evaluation/Management | 09 Oct 2023 | 00:28:48 | |
To close or not to close - that is the question! Internal hernias following bariatric surgery can be a vexing source of delayed postoperative morbidity. Join Drs. Matthew Martin, Kunoor Jain-Spangler, Adrian Dan, and Vincent Cheng for this EXCELLENT Journal Review in Bariatric Surgery. Article #1: Stenberg 2023 - Long-term Safety and Efficacy of Closure of Mesenteric Defects in Laparoscopic Gastric Bypass Surgery
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. | |||
| Association of Out Surgeons & Allies (AOSA) - Episode 1 | 05 Oct 2023 | 00:24:43 | |
This week we sat down with the Association of Out Surgeons & Allies (AOSA) leadership in the first installment of a BTK/AOSA collaboration addressing issues important to LGBTQ+ surgeons, patients, and allies. We are joined by Guest Host Dr. Andrew Schlussel, BTK Members Drs. Nina Clark and Jason Bingham, and AOSA Leaders Drs. Nicole Goulet, Alexis Moren, and Courtney Collins. More information about AOSA and how to get involved can be found at https://www.outsurgeons.org. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/ | |||
| Clinical Challenges in Surgical Oncology: Gastrointestinal Stromal Tumors (GISTs) | 02 Oct 2023 | 00:33:05 | |
Join the Behind the Knife Surgical Oncology Team as we discuss the presentation, work-up, and management of gastrointestinal stromal tumors (GISTs)! Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist and current HPB fellow at MD Anderson Connor Chick, MD (@connor_chick) is a Surgical Oncology fellow at Ohio State University. Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-6 General Surgery resident at Brooke Army Medical Center Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-5 General Surgery resident at Brooke Army Medical Center Learning Objectives: In this episode, we review the basics of gastrointestinal stromal tumors (GISTs), how to evaluate patients with presenting mass consistent with GIST, initial work-up, staging, and management. We discuss key concepts including the genetic background of these tumors and high-yield targeted therapies that are relevant both in direct patient care and board exams. Reference: Gold JS, Gönen M, Gutiérrez A, Broto JM, García-del-Muro X, Smyrk TC, Maki RG, Singer S, Brennan MF, Antonescu CR, Donohue JH, DeMatteo RP. Development and validation of a prognostic nomogram for recurrence-free survival after complete surgical resection of localised primary gastrointestinal stromal tumour: a retrospective analysis. Lancet Oncol. 2009 Nov;10(11):1045-52. doi: 10.1016/S1470-2045(09)70242-6. Epub 2009 Sep 28. PMID: 19793678; PMCID: PMC3175638. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our surgical oncology oral board exam review here: https://behindtheknife.org/premium/ | |||
| Journal Review in Hernia Surgery: Smoking in Elective Open Ventral Hernia Repair | 28 Sep 2023 | 00:26:58 | |
How do you counsel the patient with a large painful hernia who still smokes a pack of cigarettes every day? Join Drs. Michael Rosen, Clayton Petro, Sara Maskal, and Ryan Ellis as they discuss some of the highlights in the literature on smoking and its impact on postoperative outcomes in elective, clean open ventral hernia repairs. Hosts: - Michael Rosen, Cleveland Clinic - Clayton Petro, Cleveland Clinic - Sara Maskal, Cleveland Clinic - Ryan Ellis, Cleveland Clinic, @ryanellismd Learning objectives: - Evaluate historical data on smoking in surgery - Compare with newer literature specific to contemporary ventral hernia repairs - Understand how the historical and new data can be applied in clinical practice References: Møller AM, Villebro N, Pedersen T, Tønnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet. 2002 Jan 12;359(9301):114-7. doi: 10.1016/S0140-6736(02)07369-5. PMID: 11809253. Kubasiak JC, Landin M, Schimpke S, Poirier J, Myers JA, Millikan KW, Luu MB. The effect of tobacco use on outcomes of laparoscopic and open ventral hernia repairs: a review of the NSQIP dataset. Surgical Endoscopy. 2017 Jun;31:2661-6. DeLancey JO, Blay Jr E, Hewitt DB, Engelhardt K, Bilimoria KY, Holl JL, Odell DD, Yang AD, Stulberg JJ. The effect of smoking on 30-day outcomes in elective hernia repair. The American Journal of Surgery. 2018 Sep 1;216(3):471-4. Sørensen LT. Wound healing and infection in surgery: the clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Archives of surgery. 2012 Apr 1;147(4):373-83. Petro CC, Haskins IN, Tastaldi L, Tu C, Krpata DM, Rosen MJ, Prabhu AS. Does active smoking really matter before ventral hernia repair? An AHSQC analysis. Surgery. 2019 Feb;165(2):406-411. doi: 10.1016/j.surg.2018.07.039. Epub 2018 Sep 13. PMID: 30220485. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out more hernia episodes here: https://behindtheknife.org/podcast-category/hernia/ | |||
| Clinical Challenges in Surgical Palliative Care: “When the horse is out of the barn: Skills to avoid offering surgical overtreatment at the end of life" | 25 Sep 2023 | 00:22:20 | |
Surgeons are trained to, well…do surgery, but is that always the right treatment for the patient? Not offering surgery can be a challenge, especially when you’re consulted about a sick patient in the middle of the night and the clinical momentum is moving toward the OR. Join Drs. Katie O’Connell, Ali Haruta, Lindsay Dickerson, and Virginia Wang from the University of Washington as we discuss how to recognize when a surgery is potentially not beneficial and communicate serious news with the patient and consulting team. Hosts: Dr. Katie O’Connell (@katmo15) is an assistant professor of surgery at the University of Washington. She is a trauma surgeon, palliative care physician, director of surgical palliative care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA. Dr. Ali Haruta is a PGY7 current palliative care fellow at the University of Washington, formerly a UW general surgery resident and Parkland trauma/critical care fellow. Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY5 general surgery resident and current surgical oncology fellow at the University of Washington. Dr. Virginia Wang is a PGY2 general surgery resident at the University of Washington. Learning Objectives: Identify when a patient’s disease course is unlikely reversible by surgery Learn to avoid defaulting to offering potentially non-beneficial surgical treatment for patients at the end-of-life Learn to recommend comfort-focused treatments for patients at the end-of-life Develop the communication skill of delivering serious news References: 1. Cooper Z, Courtwright A, Karlage A, Gawande A, Block S. Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution. Ann Surg. Dec 2014;260(6):949-57. doi:10.1097/SLA.0000000000000721 2. VitalTalk. One page Guides. https://www.vitaltalk.org/guides/ 3. VitalTalk. Using Ask-Tell-Ask to Make a Recommendation. https://www.vitaltalk.org/using-ask-tell-ask-to-make-a-recommendation/ 4. VitalTalk. What's a Headline? https://www.vitaltalk.org/whats-a-headline/ 5. Zaza SI, Zimmermann CJ, Taylor LJ, Kalbfell EL, Stalter L, Brasel K, Arnold RM, Cooper Z, Schwarze ML. Factors Associated With Provision of Nonbeneficial Surgery: A National Survey of Surgeons. Ann Surg. 2023 Mar 1;277(3):405-411. doi: 10.1097/SLA.0000000000005765. Epub 2022 Nov 24. PMID: 36538626; PMCID: PMC9905263. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other surgical palliative care episodes here: https://behindtheknife.org/podcast-category/palliative-care/ | |||
| Clinical Challenges in Burn Surgery: Electrical Burns - Part 2 of 2 | 21 Sep 2023 | 00:26:27 | |
While on your burn rotation, the emergency department calls due to a patient who may have been injured at his job site, coming in contact with a high-voltage line. Join Drs. Tam Pham, Clifford Sheckter, Alex Morzycki and Jamie Oh as they discuss the work-up, management, resuscitation, and subsequent complications and reconstruction for electrical injuries. Hosts: - Dr. Tam Pham: UW Medicine Regional Burn Center - Dr. Clifford Sheckter: Stanford Medicine, Santa Clara Valley Medical Center - Dr. Alex Morzycki: UW Medicine Regional Burn Center - Dr. Jamie Oh: UW Medicine Regional Burn Center Learning Objectives: - Review the epidemiology and common mechanisms for electrical injuries - Understand the impact of electrical injuries on different organ systems, including skin, musculoskeletal, cardiac, neurologic, and renal systems - Be able to guide initial work-up and resuscitation of acute electrical injuries including upper extremity compartment evaluation and release - Recognize possible long-term complications of electrical injuries and their subsequent management References: 1. Daskal Y, Beicker A, Dudkiewicz M, Kessel B. [HIGH VOLTAGE ELECTRIC INJURY: MECHANISM OF INJURY, CLINICAL FEATURES AND INITIAL EVALUATION.]. Harefuah. 2019 Jan;158(1):65-69. Hebrew. PMID: 30663297. 2. Pawlik AM, Lampart A, Stephan FP, Bingisser R, Ummenhofer W, Nickel CH. Outcomes of electrical injuries in the emergency department: a 10-year retrospective study. Eur J Emerg Med. 2016 Dec;23(6):448-454. doi: 10.1097/MEJ.0000000000000283. PMID: 25969345. 3. Davis C, Engeln A, Johnson EL, McIntosh SE, Zafren K, Islas AA, McStay C, Smith WR, Cushing T; Wilderness Medical Society. Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update. Wilderness Environ Med. 2014 Dec;25(4 Suppl):S86-95. doi: 10.1016/j.wem.2014.08.011. PMID: 25498265. 4. Zemaitis MR, Foris LA, Lopez RA, et al. Electrical Injuries. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448087/ 5. Leversedge F, Moore T, Peterson B, Seiler J; Compartment syndrome of the upper extremity. J Hand Surg. 2011; 36(4):P544-559. doi: https://doi.org/10.1016/j.jhsa.2010.12.008 6. Arnoldo B, Klein M, Gibran NS. Practice guidelines for the management of electrical injuries. J Burn Care Res 2006, 27(4): 439-47 7. Pilecky D, Vamos M, Bogyi P, et al. Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients. Clin Res Cardiol 2019, 108(8): 901-908 8. Soar J, Perkins GD, Abbas G, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2010, 81(10): 1400-33 9. Kaergaard A, Nielsen KJ, Casrtensen O, Biering K. Electrical injury and the long-term risk of cataract: A prospective matched cohort study. Acta Ophthalmologica 2023, e88-e94 10. Richard F. Edlich, MD, PhD and others, TECHNICAL CONSIDERATIONS FOR FASCIOTOMIES IN HIGH VOLTAGE ELECTRICAL INJURIES, The Journal of Burn Care & Rehabilitation, Volume 1, Issue 2, November-December 1980, Pages 22–26. 11. Lee DH, Desai MJ, Gauger EM. Electrical injuries of the hand and upper extremity. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2019 Jan 1;27(1):e1-8. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/ | |||
| Clinical Challenges in Burn Surgery: Electrical Burns - Part 1 of 2 | 18 Sep 2023 | 00:20:17 | |
While on your burn rotation, the emergency department calls due to a patient who may have been injured at his job site, coming in contact with a high-voltage line. Join Drs. Tam Pham, Clifford Sheckter, Alex Morzycki and Jamie Oh as they discuss the work-up, management, resuscitation, and subsequent complications and reconstruction for electrical injuries. Hosts: - Dr. Tam Pham: UW Medicine Regional Burn Center - Dr. Clifford Sheckter: Stanford Medicine, Santa Clara Valley Medical Center - Dr. Alex Morzycki: UW Medicine Regional Burn Center - Dr. Jamie Oh: UW Medicine Regional Burn Center Learning Objectives: - Review the epidemiology and common mechanisms for electrical injuries - Understand the impact of electrical injuries on different organ systems, including skin, musculoskeletal, cardiac, neurologic, and renal systems - Be able to guide initial work-up and resuscitation of acute electrical injuries including upper extremity compartment evaluation and release - Recognize possible long-term complications of electrical injuries and their subsequent management References: 1. Daskal Y, Beicker A, Dudkiewicz M, Kessel B. [HIGH VOLTAGE ELECTRIC INJURY: MECHANISM OF INJURY, CLINICAL FEATURES AND INITIAL EVALUATION.]. Harefuah. 2019 Jan;158(1):65-69. Hebrew. PMID: 30663297. 2. Pawlik AM, Lampart A, Stephan FP, Bingisser R, Ummenhofer W, Nickel CH. Outcomes of electrical injuries in the emergency department: a 10-year retrospective study. Eur J Emerg Med. 2016 Dec;23(6):448-454. doi: 10.1097/MEJ.0000000000000283. PMID: 25969345. 3. Davis C, Engeln A, Johnson EL, McIntosh SE, Zafren K, Islas AA, McStay C, Smith WR, Cushing T; Wilderness Medical Society. Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update. Wilderness Environ Med. 2014 Dec;25(4 Suppl):S86-95. doi: 10.1016/j.wem.2014.08.011. PMID: 25498265. 4. Zemaitis MR, Foris LA, Lopez RA, et al. Electrical Injuries. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448087/ 5. Leversedge F, Moore T, Peterson B, Seiler J; Compartment syndrome of the upper extremity. J Hand Surg. 2011; 36(4):P544-559. doi: https://doi.org/10.1016/j.jhsa.2010.12.008 6. Arnoldo B, Klein M, Gibran NS. Practice guidelines for the management of electrical injuries. J Burn Care Res 2006, 27(4): 439-47 7. Pilecky D, Vamos M, Bogyi P, et al. Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients. Clin Res Cardiol 2019, 108(8): 901-908 8. Soar J, Perkins GD, Abbas G, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2010, 81(10): 1400-33 9. Kaergaard A, Nielsen KJ, Casrtensen O, Biering K. Electrical injury and the long-term risk of cataract: A prospective matched cohort study. Acta Ophthalmologica 2023, e88-e94 10. Richard F. Edlich, MD, PhD and others, TECHNICAL CONSIDERATIONS FOR FASCIOTOMIES IN HIGH VOLTAGE ELECTRICAL INJURIES, The Journal of Burn Care & Rehabilitation, Volume 1, Issue 2, November-December 1980, Pages 22–26. 11. Lee DH, Desai MJ, Gauger EM. Electrical injuries of the hand and upper extremity. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2019 Jan 1;27(1):e1-8. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/ | |||
| Journal Review in Vascular Surgery: Updates on Size Threshold for Repair of Abdominal Aortic Aneurysms | 18 Jul 2024 | 00:27:08 | |
A 70 year old healthy female is referred to you with a 5.7 cm abdominal aortic aneurysm. As an astute clinician you are aware that current guidelines support surgical repair for her AAA. What if there was new data to suggest this patient may not benefit from repair? What would be the optimal size threshold that she would benefit from AAA repair? Tune into this episode of Behind the Knife, where the vascular surgery subspecialty team discusses a paper that challenges current size threshold guidelines for AAA repair. Hosts: Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan and the Program Director of the Integrated Vascular Surgery Residency Program as well as the Vascular Surgery Fellowship Program at the University of Michigan. Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan Dr. Drew Braet is a PGY-5 Integrated Vascular Surgery Resident at the University of Michigan Learning Objectives - Review the current size threshold guidelines for surgical repair of abdominal aortic aneurysms - Understand the limitations of the aforementioned guidelines - Understand the methodology, findings, limitations, and clinical applications of the manuscript “Size thresholds for repair of abdominal aortic aneurysms warrant reconsideration.” References 1. Columbo JA, Scali ST, Jacobs BN, et al. Size thresholds for repair of abdominal aortic aneurysms warrant reconsideration. Journal of Vascular Surgery. 2024;79(5):1069-1078.e8. doi:10.1016/j.jvs.2024.01.017 https://pubmed.ncbi.nlm.nih.gov/38262565/ 2. Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. Journal of Vascular Surgery. 2018;67(1):2-77.e2. doi:10.1016/j.jvs.2017.10.044 https://pubmed.ncbi.nlm.nih.gov/29268916/ 3. Wanhainen A, Van Herzeele I, Bastos Goncalves F, et al. Editor’s Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. European Journal of Vascular and Endovascular Surgery. 2024;67(2):192-331. doi:10.1016/j.ejvs.2023.11.002 https://pubmed.ncbi.nlm.nih.gov/38307694/ 4. The UK Small Aneurysm Trial Participants, Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet 1998;352 (9141) 1649- 1655 https://pubmed.ncbi.nlm.nih.gov/9853436/ 5. Lederle FAWilson SEJohnson GR et al. Aneurysm Detection and Management Veterans Affairs Cooperative Study Group, Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 2002;346 (19) 1437- 1444 https://pubmed.ncbi.nlm.nih.gov/12000813/ 6. United Kingdom EVAR Trial Investigators; Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D. Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med. 2010 May 20;362(20):1872-80. doi: 10.1056/NEJMoa0911056. Epub 2010 Apr 11. PMID: 20382982. https://pubmed.ncbi.nlm.nih.gov/20382982/ 7. Lederle FA, Johnson GR, Wilson SE, Ballard DJ, Jordan WD Jr, Blebea J, Littooy FN, Freischlag JA, Bandyk D, Rapp JH, Salam AA; Veterans Affairs Cooperative Study #417 Investigators. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA. 2002 Jun 12;287(22):2968-72. doi: 10.1001/jama.287.22.2968. PMID: 12052126. 8. Lancaster EM, Gologorsky R, Hull MM, Okuhn S, Solomon MD, Avins AL, Adams JL, Chang RW. The natural history of large abdominal aortic aneurysms in patients without timely repair. J Vasc Surg. 2022 Jan;75(1):109-117. doi: 10.1016/j.jvs.2021.07.125. Epub 2021 Jul 26. PMID: 34324972. https://pubmed.ncbi.nlm.nih.gov/34324972/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen | |||
| Clinical Challenges in Surgical Education: Thriving as a Surgical Intern | 14 Sep 2023 | 00:29:55 | |
Surgical residency is hard. In some ways, intern year may be the hardest. We’ve been there. We’re a group of surgical residents formally known as the Collaboration of Surgical Education Fellows (CoSEF), a multi-institutional organization of surgical education research fellows working together to foster peer mentorship, networking, and scholarly collaboration. We’ve collectively reflected on our experiences as surgical interns across the country. Join Drs. Ananya Anand, Joe L’Huillier, and Rebecca Moreci as they discuss three tips for thriving as a surgical intern. Hosts: –Dr. Ananya Anand, Stanford University, @AnanyaAnandMD –Dr. Joseph L’Huillier, University at Buffalo, @JoeLHuillier101 –Dr. Rebecca Moreci, Louisiana State University, @md_moreci –COSEF: @surgedfellows Learning Objectives: Listeners will: – List CoSEF’s three tips for thriving as a surgical intern – Challenge their definition of patient ownership – Recall the “Golden Rule” of treating others how you want to be treated – Appreciate the importance of self-care in surgical residency References: L’Huillier, Joseph C. MD; Lund, Sarah MD; Anand, Ananya MD; Jensen, Rachel M. MD; Williamson, Andrea J.H. MD; Clanahan, Julie M. MD, MHPE; Moreci, Rebecca MD; Gates, Rebecca S. MD, MMHPE. Thriving as a Surgical Intern: Three Tips From the Collaboration of Surgical Education Fellows (CoSEF). Annals of Surgery Open 4(3):p e306, September 2023. | DOI: 10.1097/AS9.0000000000000306 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/ Ad referenced in episode: https://jomi.com/ | |||
| Journal Review in Hepatobiliary Surgery: Advances in Liver Venous Deprivation and Hypertrophy | 11 Sep 2023 | 00:32:41 | |
For patients with insufficient future liver remnant (FLR) volume, adequate hypertrophy after Portal Venous Embolization (PVE) is associated with reduced likelihood of post-operative hepatic insufficiency. But what happens when PVE isn’t enough to obtain adequate volume prior to surgery? In this episode from the HPB team at Behind the Knife, listen in on the discussion about advances in venous deprivation techniques that can potentially increase resection rates and hypertrophy Hosts Anish J. Jain MD (@anishjayjain) is a T32 Research Fellow at the University of Texas MD Anderson Cancer Center within the Department of Surgical Oncology. Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology. He is also the associate program director of the HPB fellowship at the University of Texas MD Anderson Cancer Center. Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center Learning Objectives: - Develop an understanding of Portal Venous Embolization (PVE) - Develop an understanding of Sequential Hepatic Venous Embolization (HVE) - Develop an understanding of Radiological Simultaneous Porto-hepatic Venous Embolization (RASPE) - Develop an understanding of the traditional two-stage hepatectomy with PVE - Develop an understanding of the Fast Track Two-Stage Hepatectomy Papers Referenced (in the order they were mentioned in the episode): 1) Niekamp AS, Huang SY, Mahvash A, Odisio BC, Ahrar K, Tzeng CD, Vauthey JN. Hepatic vein embolization after portal vein embolization to induce additional liver hypertrophy in patients with metastatic colorectal carcinoma. Eur Radiol. 2020 Jul;30(7):3862-3868. doi: 10.1007/s00330-020-06746-4. Epub 2020 Mar 7. PMID: 32144462. 2) Laurent C, Fernandez B, Marichez A, Adam JP, Papadopoulos P, Lapuyade B, Chiche L. Radiological Simultaneous Portohepatic Vein Embolization (RASPE) Before Major Hepatectomy: A Better Way to Optimize Liver Hypertrophy Compared to Portal Vein Embolization. Ann Surg. 2020 Aug;272(2):199-205. doi: 10.1097/SLA.0000000000003905. PMID: 32675481. 3) Nishioka Y, Odisio BC, Velasco JD, Ninan E, Huang SY, Mahvash A, Tzeng CD, Tran Cao HS, Gupta S, Vauthey JN. Fast-track two-stage hepatectomy by concurrent portal vein embolization at first-stage hepatectomy in hybrid interventional radiology / operating suite. Surg Oncol. 2021 Dec;39:101648. doi: 10.1016/j.suronc.2021.101648. Epub 2021 Aug 16. PMID: 34438236. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/ | |||
| BTK Surgical Oncology Oral Board Review - Sample Episode 2 - Pancreatic Adenocarcinoma | 07 Sep 2023 | 00:28:51 | |
Our Surgical Oncology Oral Board Audio Review includes 46 high-yield scenarios that cover all of the SCORE CGSO topics designed for Surgical Oncology Surgeons by Surgical Oncology Surgeons. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as surgical oncology surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test. Learn more about the course and see all the episode topics here: https://behindtheknife.teachable.com/p/btk-surgical-oncology-oral-board-review-course Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more. | |||
| BTK Surgical Oncology Oral Board Review - Sample Episode 1 - Ductal Carcinoma In Situ | 04 Sep 2023 | 00:16:17 | |
Our Surgical Oncology Oral Board Audio Review includes 46 high-yield scenarios that cover all of the SCORE CGSO topics designed for Surgical Oncology Surgeons by Surgical Oncology Surgeons. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as surgical oncology surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test. Learn more about the course and see all the episode topics here: https://behindtheknife.teachable.com/p/btk-surgical-oncology-oral-board-review-course Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more. | |||
| Clinical Challenges in Cardiac Surgery: Common Post-Op Cardiac Surgery Problems | 31 Aug 2023 | 00:33:26 | |
We know cardiac surgery can seem a bit daunting on the surface. However, most surgeons will come across cardiac surgery patients at some point whether in the OR, ICU, ED, etc. As the FIRST cardiac surgery specialty team for Behind the Knife, we are excited to bring you episodes focused on high-yield topics to help you navigate common cardiac surgery challenges, discuss relevant literature to help you in practice, and help our listeners feel more comfortable around cardiac surgery patients. In this episode we’ll discuss common cardiac surgery post-op problems. Whether you're on a cardiac surgery rotation or just covering an ICU with cardiac surgery patients for the night, these common post-op problems are bound to occur. Hosts: - Jessica Millar, MD- PGY-5 General Surgery Resident, University of Michigan, @Jess_Millar15 - Aaron William, MD- Cardiothoracic Surgery Fellow, Duke University, @AMWilliamsMD - Nick Teman, MD- Assistant Profressor of Thorasis and Cardiovascular Surgery, University of Virginia, @nickteman Learning objectives: - Understand the workup and management strategies for post-operative bleeding in the post-cardiac surgery patient. - Understand how to recognize and manage post-cardiotomy cardiogenic shock in the post-cardiac surgery patient. - Understand the workup, short-term, and long-term management for post-cardiac surgery atrial fibrillation. Helpful Resources: - 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000665 - 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures, Executive summary: https://www.jtcvs.org/article/S0022-5223(14)00835-6/fulltext For episode ideas/suggestions/feedback feel free to email Jessica Millar at: millarje@med.umich.edu Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our 4 Part Cardiac Surgery Crash Course Series here: https://behindtheknife.org/podcast/cardiac-surgery-crash-course-series-episode-1-intro-to-the-cardiac-or/ | |||
| Continuing Medical Education (CME) - What? When? How? | 28 Aug 2023 | 00:30:27 | |
CME - What is it? Why do I need it? How do I get it? How much do I need? How do I keep track of credits? Listen to BTK's Dr. Kevin Kniery's interview with the CEO of ACCME, Dr. Graham McMahon, to learn about the nuts and bolts of CME as well as recent changes to the program. Helpful Links: Behind the Knife's FREE CME: https://behindtheknife.org/cme/ CME Passport: CMEpassport.org CME Passport/Behind the Knife: https://www.cmepassport.org/activity/search?specialty=behind%20the%20knife Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/ | |||
| Innovations in Surgery: PEG Tube | 24 Aug 2023 | 00:33:55 | |
In the fifth episode of the “Innovation in Surgery” series, Dan Scheese sits down with Dr. Jeffrey Ponsky to discuss his innovation, the PEG tube. Dr. Ponsky shares many stories about his work with endoscopy in the late 1970s and how the idea for the PEG tube originated. “The Development of PEG: How it was” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136860/ “Following the light: A history of the percutaneous endoscopic gastrostomy tube” https://www.facs.org/media/cyrndd5u/07_gastrostomy_tube.pdf Dr. Ponsky completed his surgical training at University Hospitals of Cleveland in 1976. In 1979, he became the Director of the Department of Surgery at The Mount Sinai Medical Center in Cleveland, where he remained through 1997. In 1997, Dr Ponsky joined The Cleveland Clinic as the Director of Endoscopic Surgery and Executive Director of the Minimally Invasive Surgery Center. In 2005, he assumed the Oliver H. Payne Professorship and Chair of the Department of Surgery at Case Western University School of Medicine. He returned to The Cleveland Clinic as Director of Developmental Endoscopy in 2014. Dr Ponsky has served as president of many organizations including the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) and the American Society for Gastrointestinal Endoscopy (ASGE). Additionally, Dr. Ponsky has received numerous awards and has published over 300 original articles and book chapters. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other innovation episodes here: https://behindtheknife.org/podcast-series/innovations-in-surgery/ | |||
| Clinical Challenges in Colorectal Surgery: Let’s Talk Ostomies! | 21 Aug 2023 | 00:32:14 | |
Have you ever struggled choosing which type of stoma to mature in an anatomically or medically challenging patient? What about wrestled with the associated postoperative complications? Join Drs. Galandiuk, Bolshinsky, Kavalukas, and Simon as they discuss ostomy creation and management of stoma complications. Hosts: - Susan Galandiuk MD, University of Louisville, Louisville, Kentucky, @DCREdInChief - Vladimir Bolshinsky MD, Peninsula Health, Victoria, Australia, @bolshinskyv - Sandy Kavalukas MD, University of Louisville, Louisville, Kentucky, @sandykava - Hillary Simon DO, University of Louisville, Louisville, Kentucky, @HillaryLSimon Producer: - Manasa Sunkara MS3, University of Louisville, Louisville, Kentucky, @manasasunkara12 Learning objectives: - Review pre-operative stoma marking and ostomy education. - Understand “bail-out” ostomy creation options in medically and anatomically challenging patients. - Discuss common postoperative ostomy complications and management. - Review common peristomal skin pathology and treatment options. Video References: - Colwell, Janice C. A.P.R.N., C.W.O.C.N.1; Williams, Toyia M.S.N., R.N.2. Management of the Patient With a Prolapsed Ileostomy. Diseases of the Colon & Rectum 65(12):p e1073, December 2022. | DOI: 10.1097/DCR.0000000000002605 https://www.youtube.com/watch?v=Wx83CpRLkqk Non-operative management of stoma prolapse/reduction - Colwell, Janice C. A.P.R.N.. Management of the Patient With a Retracted Loop Ileostomy Located in a Crease. Diseases of the Colon & Rectum 65(3):p e182-e183, March 2022. | DOI: 10.1097/DCR.0000000000002367 https://www.youtube.com/watch?v=mc6o7nG1fsQ Management of a retracted stoma, in a crease, with peristomal skin breakdown - Watanabe, Kazuhiro M.D., Ph.D.; Kohyama, Atsushi M.D., Ph.D.; Suzuki, Hideyuki M.D., Ph.D.; Kajiwara, Taiki M.D., Ph.D.; Karasawa, Hideaki M.D., Ph.D.; Ohnuma, Shinobu M.D., Ph.D.; Kamei, Takashi M.D., Ph.D.; Unno, Michiaki M.D., Ph.D.. Slug Method: A Technique for Stoma Prolapse Reduction Using High Osmolality of the 50% Glucose Solution. Diseases of the Colon & Rectum 63(12):p e565, December 2020. | DOI: 10.1097/DCR.0000000000001798 https://cdn-links.lww.com/permalink/dcr/b/dcr_1_1_2020_09_01_watanabe_20-00282_sdc1.mp4 Osmotic reduction Other References: - Baker ML, Williams RN, Nightingale J.. Causes and management of a high-output stoma. Colorectal Dis. 2011;13(2):191–197. doi: 10.1111/j.1463-1318.2009.02107.x. - Behrenbruch, C., Carr, G., Johnston, M. and Woods, R. (2019), Three-point stapled fixation technique to manage ileostomy spout retraction. ANZ Journal of Surgery, 89: 423-424. doi: 10.1111/ans.15006 - O’Brien, Stephen J. M.B. B.Ch., B.A.O.; Ellis, C. Tyler M.D., M.S.C.R.. The Management of Peristomal Pyoderma Gangrenosum in IBD. Diseases of the Colon & Rectum 63(7):p 881-884, July 2020. | DOI: 10.1097/DCR.0000000000001701 - Paquette IM, Solan P, Rafferty JF, Ferguson MA, Davis BR.. Readmission for dehydration or renal failure after ileostomy creation. Dis Colon Rectum. 2013;56(8):974–979. doi: 10.1097/DCR.0b013e31828d02ba - Steele S, Hull Tracy, Hyman N, Maykel J, Read T, and Whitlow C. The ASCRS Textbook of Colon and Rectal Surgery. 4th Edition. Volume II. Springer, Switzerland AG, 2022. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other recent Colorectal Surgery Episodes here: https://behindtheknife.org/podcast-category/colorectal/ | |||
| Clinical Challenges in Thoracic Surgery: Complex Pleural Effusions & Empyema - Part 2 of 2 | 17 Aug 2023 | 00:22:33 | |
In this two-part episode our team debates management of complex pleural effusions and empyema. Our surgical team is joined by Dr. Jed Gorden, an interventional pulmonologist, as we explore the nuances of deciding on fibrinolytic therapy (part 1) versus surgical management (part 2). Part 1: https://behindtheknife.org/podcast/clinical-challenges-in-thoracic-surgery-complex-pleural-effusions-empyema-part-1-of-2/ Learning Objectives: -Discuss the pros and cons of small bore versus large bore chest tubes for complex pleural effusions -Review the evidence for fibrinolytic therapy for management of complex pleural effusions -Describe the surgical management of a complex pleural effusion including VATS, open thoracotomy, empyema tube, Eloesser flap, and Clagett window -Create a framework for shared-decision making with patients regarding management of a complex pleural effusion Hosts: Kelly Daus MD, Peter White MD, Jed Gorden, MD and Brian Louie MD Referenced Material https://pubmed.ncbi.nlm.nih.gov/15745977/ Maskell NA, et al. First Multicenter Intrapleural Sepsis Trial (MIST1) Group. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005 Mar 3;352(9):865-74. doi: 10.1056/NEJMoa042473. Erratum in: N Engl J Med. 2005 May 19;352(20):2146. PMID: 15745977. https://pubmed.ncbi.nlm.nih.gov/21830966/ Rahman NM, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011 Aug 11;365(6):518-26. doi: 10.1056/NEJMoa1012740. PMID: 21830966. https://pubmed.ncbi.nlm.nih.gov/35830586/ Wilshire CL, et al. Comparing Initial Surgery versus Fibrinolytics for Pleural Space Infections: A Retrospective Multicenter Cohort Study. Ann Am Thorac Soc. 2022 Nov;19(11):1827-1833. doi: 10.1513/AnnalsATS.202108-964OC. PMID: 35830586. https://pubmed.ncbi.nlm.nih.gov/37043201/ Wilshire CL, et al. Effect of Intrapleural Fibrinolytic Therapy vs Surgery for Complicated Pleural Infections: A Randomized Clinical Trial. JAMA Netw Open. 2023 Apr 3;6(4):e237799. doi: 10.1001/jamanetworkopen.2023.7799. PMID: 37043201; PMCID: PMC10098968. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out more thoracic surgery episodes here: https://behindtheknife.org/podcast-category/cardiothoracic/ | |||
| Clinical Challenges in Thoracic Surgery: Complex Pleural Effusions & Empyema - Part 1 of 2 | 14 Aug 2023 | 00:27:59 | |
In this two-part episode our team debates management of complex pleural effusions and empyema. Our surgical team is joined by Dr. Jed Gorden, an interventional pulmonologist, as we explore the nuances of deciding on fibrinolytic therapy (part 1) versus surgical management (part 2). Learning Objectives: -Discuss the pros and cons of small bore versus large bore chest tubes for complex pleural effusions -Review the evidence for fibrinolytic therapy for management of complex pleural effusions -Describe the surgical management of a complex pleural effusion including VATS, open thoracotomy, empyema tube, Eloesser flap, and Clagett window -Create a framework for shared-decision making with patients regarding management of a complex pleural effusion Hosts: Kelly Daus MD, Peter White MD, Jed Gorden, MD and Brian Louie MD Referenced Material https://pubmed.ncbi.nlm.nih.gov/15745977/ Maskell NA, et al. First Multicenter Intrapleural Sepsis Trial (MIST1) Group. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005 Mar 3;352(9):865-74. doi: 10.1056/NEJMoa042473. Erratum in: N Engl J Med. 2005 May 19;352(20):2146. PMID: 15745977. https://pubmed.ncbi.nlm.nih.gov/21830966/ Rahman NM, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011 Aug 11;365(6):518-26. doi: 10.1056/NEJMoa1012740. PMID: 21830966. https://pubmed.ncbi.nlm.nih.gov/35830586/ Wilshire CL, et al. Comparing Initial Surgery versus Fibrinolytics for Pleural Space Infections: A Retrospective Multicenter Cohort Study. Ann Am Thorac Soc. 2022 Nov;19(11):1827-1833. doi: 10.1513/AnnalsATS.202108-964OC. PMID: 35830586. https://pubmed.ncbi.nlm.nih.gov/37043201/ Wilshire CL, et al. Effect of Intrapleural Fibrinolytic Therapy vs Surgery for Complicated Pleural Infections: A Randomized Clinical Trial. JAMA Netw Open. 2023 Apr 3;6(4):e237799. doi: 10.1001/jamanetworkopen.2023.7799. PMID: 37043201; PMCID: PMC10098968. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out more thoracic surgery episodes here: https://behindtheknife.org/podcast-category/cardiothoracic/ | |||
| Lung in a Box: The Present and Future of Lung Preservation for Transplant | 15 Jul 2024 | 00:46:05 | |
Take a listen into the wild and fascinating world of lung transplantation! One of the biggest challenges for any transplant is organ preservation to provide the best possible recovery and outcome for recipients. That’s especially important for lung transplant, which remains one of the most complex and challenging areas in the field of transplantation. This episode takes a deep dive into the lung transplant landscape and discusses new technologies and innovations that are revolutionizing the field. Jon Williams is joined by Dr. Elliot Wakeam, MD, a thoracic surgeon and lung transplant expert from University of Toronto to discuss the advent of ex-vivo lung perfusion (EVLP) systems and how that and other preservation techniques may impact the future of lung transplantation. Also, Dr. Wakeam provides unique perspectives as faculty from one of the best lung transplant programs in the world. If you have any questions or comments, or find the episode interesting and want to learn more, feel free to reach out to us at hello@behindtheknife.org. Dominate the Day! Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen | |||
| Entrustable Professional Activities (EPAs)- They’re Here, Now What | 10 Aug 2023 | 00:50:22 | |
Entrustable Professional Activities, or EPAs, is a term you may have heard…or maybe not. EPAs represent a tectonic shift in surgical training and how residents will be evaluated. So, what are EPAs? How will they affect you? And what do you need to know? We sat down with Dr. George Sarosi, previous member of the ABS EPA Advisory Council and current General Surgery Residency Program Director at the University of Florida, to answer all of our questions now that EPAs are here. Guests: George Sarosi, MD- Professor of Surgery and General Surgery Residency Program Director- University of Florida Patrick Georgoff, MD- Trauma Surgery and Surgical Critical Care- WakeMed Hospital; Co-director and Host of Behind the Knife Jessica Millar, MD- General Surgery Resident- University of Michigan; Education Fellow- Behind the Knife Daniel Scheese, MD- General Surgery Resident- Virginia Commonwealth University; Education Fellow- Behind the Knife Helpful Websites: Resources Page - ABS EPA resources page for Programs and Trainees: https://www.absurgery.org/default.jsp?eparesources - FAQs about EPAs and the ABS EPA Project (continuously updated so be sure to check back periodically): https://www.absurgery.org/xfer/epaprogfaqs.pdf - ABS EPA Program Timeline for program engagement (includes webinars, suggestions for activities for programs to consider, and an expected timeframe for the distribution of additional implementation resources): https://www.absurgery.org/xfer/absepaprogtimeline.pdf - Checklists for Program directors/Residency administrators/Faculty (https://www.absurgery.org/xfer/epaimplementationchecklist_programs.pdf) and for Residents (https://www.absurgery.org/xfer/epaimplementationchecklist_residents.pdf) to guide and sequence implementation priorities and timing If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/ | |||
| Journal Review in Emergency General Surgery: Clostridium Difficile Infection | 07 Aug 2023 | 00:23:18 | |
An ever-present spectre looming over the hearts of general surgeons everywhere! Please join our Emergency General Surgery team for a journal review about Clostridium difficile (C. diff) infection. Dr. Ashlie Nadler and Dr. Jordan Nantais are joined by guest Dr. Marika Sevigny, recent graduate of trauma and acute care surgery at the University of Toronto, as Dr. Graham Skelhorne-Gross prepares for his upcoming fellowship at Harborview. Paper 1: Ahmed et al. Risk factors of surgical mortality in patients with Clostridium difficile colitis. A novel scoring system. Eur J Trauma Emerg Surg. 2022 Jun. - Risk score development study using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) - 525 adult (18-89) patients undergoing colectomy between 2012 and 2016 - Split data into training (80%) and testing (20%) datasets - Identified mortality risk factors to create and validate a scoring system - Scores ranged from 0 to 37 with the highest score predicting an 83.9% risk of mortality - This scoring system appears relatively straight-forward and methodically sound but the lack of a currently available calculator limits use to some degree Paper 2: McKechnie et al. Total Abdominal Colectomy Versus Diverting Loop Ileostomy and Antegrade Colonic Lavage for Fulminant Clostridioides Colitis: Analysis of the National Inpatient Sample 2016-2019. J Gastrointest Surg. 2023 Apr 20. - Retrospective cohort study of adults (18+) in the National Inpatient Sample (NIS) admitted between Jan 2016 and Dec 2019 for C. difficile colitis, undergoing either a total abdominal colectomy (TAC) or diverting loop ileostomy (DLI) with antegrade vancomycin enemas - Focus on not only mortality and complications but also admission cost and length of stay - 886 TAC and 409 DLI patients were identified - Multivariable logistic regression analysis showed no difference in mortality or overall complications - TAC patients had shorter admissions (mean difference 4.06 days) and lower cost (mean difference $79,715.34) - Study was limited as it considered only the initial admission and is unable to provide data on outcomes and costs beyond this time - Furthermore, there is consideration for disease severity in the analysis, which may impede the ability to compare the two operative approaches Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our other Emergency General Surgery episodes here: https://behindtheknife.org/podcast-category/emergency-general-surgery/ | |||
| Dominate the Match – Episode 5: "Meet the Match-2024” | 03 Aug 2023 | 00:27:54 | |
It’s that time of year (again!)- when medical students across the country are preparing their residency applications. The process can be a bit daunting, and there have been a number of changes to process for the 2024 application cycle. Join our education fellow, Dr. Jessica Millar, and Dr. David Hughes as they review the “nuts and bolts” of this year’s residency application cycle. Guests: David Hughes, MD- Clinical Associate Professor of Endocrine Surgery, General Surgery Residency Program Director- University of Michigan Important Dates: - June 7, 2023: ERAS application opens at 9 a.m. ET. - September 6, 2023: Residency applicants may begin submitting MyERAS applications to programs at 9 a.m. ET. - September 15, 2023: Registration for the NRMP Match Opens - September 27, 2023: Residency programs may begin reviewing MyERAS applications, MSPEs, and supplemental ERAS application data (if applicable) at 9 a.m. ET. - October 26-31, 2023: Common Interview Release Window - January 31, 2024: Registration for the NRMP Match Closes Previous DOMINATE the Match Episodes: Episode 2- “Choose Me” (Personal Statements and Letters of Recommendations) https://behindtheknife.org/podcast/dominate-the-match-episode-2-choose-me/ Episode 3- “The Interview” https://behindtheknife.org/podcast/dominate-the-match-episode-3-the-interview/ Episode 4- “Rank and Match” https://behindtheknife.org/podcast/dominate-the-match-episode-4-rank-and-match/ Residency Program Lists: - FREIDA Residency and Fellowship Database: https://freida.ama-assn.org/ - Doximity: https://www.doximity.com/residency/?utm_campaign=marketing_resnav_competitor_broad_20210520&utm_source=google&utm_medium=cpc&gclid=CjwKCAjwt52mBhB5EiwA05YKo1J47BLAtTPtsJBmVvXGP2pDXLLqgDIwM0pgkSYjoBhFUOO1ktXDYRoC2bkQAvD_BwE Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our intern bootcamp series here: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/ | |||
| BTK Throw Down: Trauma Vascular Access | 31 Jul 2023 | 00:59:56 | |
The first BTK THROW DOWN! A spicy debate…a war of words…a battle of ideas! This fiery episode features leaders in the field of trauma surgery discussing the optimal approach to vascular access in trauma patients. A recent study titled “Moving the Needle on Time to Resuscitation: An EAST Prospective multicenter study of vascular access in hypotensive injured patients using trauma video review” concluded that intraosseous access should be considered a first line therapy in hypotensive trauma patients. Is this appropriate? Crazy? Just so crazy it might work? Let’s get ready to ruuuummmmbbbbbbllllllleeeee! Hosts: Patrick Georgoff, MD (@georgoff) Nina Clark, MD (@clarkninam) Guests: Ryan Dumas, MD – UT Southwestern (@RPDumasMD) Michael Vella, MD, MBA – University of Rochester (@MichaelVella32) Bellal Joseph, MD – University of Arizona (@TopKnife_B) Moving the Needle on Time to Resuscitation: An EAST Prospective multicenter study of vascular access in hypotensive injured patients using trauma video review. - Dumas RP, Vella MA, Maiga AW, Erickson CR, Dennis BM, da Luz LT, Pannell D, Quigley E, Velopulos CG, Hendzlik P, Marinica A, Bruce N, Margolick J, Butler DF, Estroff J, Zebley JA, Alexander A, Mitchell S, Grossman Verner HM, Truitt M, Berry S, Middlekauff J, Luce S, Leshikar D, Krowsoski L, Bukur M, Polite NM, McMann AH, Staszak R, Armen SB, Horrigan T, Moore FO, Bjordahl P, Guido J, Mathew S, Diaz BF, Mooney J, Hebeler K, Holena DN. Moving the needle on time to resuscitation: An EAST prospective multicenter study of vascular access in hypotensive injured patients using trauma video review. J Trauma Acute Care Surg. 2023 Jul 1;95(1):87-93. doi: 10.1097/TA.0000000000003958. Epub 2023 Apr 4. PMID: 37012624. Time to early resuscitative intervention association with mortality in trauma patients at risk for hemorrhage. - Deeb AP, Guyette FX, Daley BJ, Miller RS, Harbrecht BG, Claridge JA, Phelan HA, Eastridge BJ, Joseph B, Nirula R, Vercruysse GA, Sperry JL, Brown JB. Time to early resuscitative intervention association with mortality in trauma patients at risk for hemorrhage. J Trauma Acute Care Surg. 2023 Apr 1;94(4):504-512. doi: 10.1097/TA.0000000000003820. Epub 2023 Jan 11. PMID: 36728324; PMCID: PMC10038862. Comparison of ultrasound guidance with palpation and direct visualisation for peripheral vein cannulation in adult patients: a systematic review and meta-analysis - van Loon FHJ, Buise MP, Claassen JJF, Dierick-van Daele ATM, Bouwman ARA. Comparison of ultrasound guidance with palpation and direct visualisation for peripheral vein cannulation in adult patients: a systematic review and meta-analysis. Br J Anaesth. 2018 Aug;121(2):358-366. doi: 10.1016/j.bja.2018.04.047. Epub 2018 Jul 2. PMID: 30032874. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/ | |||
| Journal Review in Endocrine Surgery: AAES Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism - Part 2 of 2 | 27 Jul 2023 | 00:42:15 | |
In this two-part series, we come to you LIVE! from the 2023 Annual meeting of the American Association of Endocrine Surgeons in Birmingham, Alabama. If you think evaluating and managing patients with primary hyperparathyroidism is difficult, patients with secondary and tertiary hyperparathyroidism can be even more difficult to evaluate and manage. Join Drs. Barb Miller, Sophie Dream, Jessica Liu McMullin, and Herb Chen as they break down the controversies and complexities associated with evaluation and management of these patients and discuss the recently published AAES guidelines on the definitive surgical management of patients with secondary and tertiary renal hyperparathyroidism. Part 1 focuses on the impetus for creation of these guidelines, the differences in evaluation and indication for surgery when seeing patients with renally mediated hyperparathyroidism, and preoperative planning. Part 2 focuses on intraoperative and postoperative management, parathyroid autotransplantation, and renal transplant recipients. Hosts: - Barbra S. Miller, MD (Moderator), Clinical Professor of Surgery, The Ohio State University, @OSUEndosurgBSM - Sophie Dream, MD, Assistant Professor of Surgery, Medical College of Wisconsin, @SDreamMD, - Jessica Liu McMullin, MD, Endocrine Surgery Fellow, University of Alabama – Birmingham, @jess_mcmullin - Herbert Chen, MD, Professor and Chair of Surgery, University of Alabama – Birmingham, @herbchen Learning objectives: - Understand the epidemiology and pathogenesis of kidney-related parathyroid disease and how these entities differ from primary hyperparathyroidism - Describe the diagnosis of kidney-related hyperparathyroidism and its different presentations - Define the indications for surgical intervention - Recognize the different approaches and extents of surgery for treating the different types of renally mediated hyperparathyroidism including thymectomy and parathyroid autotransplantation - Detail methods for safe and effective perioperative management References: - Dream S, Kuo LE, Kuo JH, Sprague SM, Nwariaku FE, Wolf M, Olson JA Jr, Moe SM, Lindeman B, Chen H. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism. Ann Surg. 2022 Sep 1;276(3):e141-e176. doi: 10.1097/SLA.0000000000005522. Epub 2022 Jul 18. PMID: 35848728. - Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons Guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 2016;151:959–968. - Ketteler M, Block GA, Evenepoel P, et al. Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guideline Update: what’s changed and why it matters. Kidney Int. 2017;92:26–36. - Andress DL, Coyne DW, Kalantar-Zadeh K, et al. Management of secondary hyperparathyroidism in stages 3 and 4 chronic kidney disease. Endocr Pract. 2008;14:18–27. - Cozzolino M, Brancaccio D, Gallieni M, et al. Pathogenesis of parathyroid hyperplasia in renal failure. J Nephrol. 2005;18:5–8. - Lau WL, Cobi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism. Clin J Am Soc Nephrol. 2018;13:952–961. - Parfrey PS, Chertow GM, Block GA, et al. The clinical course of treated hyperparathyroidism among patients receiving hemodialysis and the effect of cinacalcet: the EVOLVE trial. J Clin Endocrinol Metab. 2013;98:4834–4844. - Costa-Hong V, Jorgetti V, Gowdak LH, et al. Parathyroidectomy reduces cardiovascular events and mortality in renal hyperparathyroidism. Surgery. 2007;142:699–703. - McManus C, Oh A, Lee JA, et al. Timing of parathyroidectomy for tertiary hyperparathyroidism with end-stage renal disease: a cost-effectiveness analysis. Surgery. 2021;169:94–101. - Finnerty BM, Chan TW, Jones G, et al. Parathyroidectomy versus cinacalcet in the management of tertiary hyperparathyroidism: surgery improves renal transplant allograft survival. Surgery. 2019;165:129–134. Suture Kit: Purchase on suturekit.com Purchase on Amazon How-to Video Series Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other endocrine episodes here: https://behindtheknife.org/podcast-category/endocrine/ | |||
| Journal Review in Endocrine Surgery: AAES Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism - Part 1 of 2 | 24 Jul 2023 | 00:33:01 | |
In this two-part series, we come to you LIVE! from the 2023 Annual meeting of the American Association of Endocrine Surgeons in Birmingham, Alabama. If you think evaluating and managing patients with primary hyperparathyroidism is difficult, patients with secondary and tertiary hyperparathyroidism can be even more difficult to evaluate and manage. Join Drs. Barb Miller, Sophie Dream, Jessica Liu McMullin, and Herb Chen as they break down the controversies and complexities associated with evaluation and management of these patients and discuss the recently published AAES guidelines on the definitive surgical management of patients with secondary and tertiary renal hyperparathyroidism. Part 1 focuses on the impetus for creation of these guidelines, the differences in evaluation and indication for surgery when seeing patients with renally mediated hyperparathyroidism, and preoperative planning. Part 2 focuses on intraoperative and postoperative management, parathyroid autotransplantation, and renal transplant recipients. Hosts: - Barbra S. Miller, MD (Moderator), Clinical Professor of Surgery, The Ohio State University, @OSUEndosurgBSM - Sophie Dream, MD, Assistant Professor of Surgery, Medical College of Wisconsin, @SDreamMD, - Jessica Liu McMullin, MD, Endocrine Surgery Fellow, University of Alabama – Birmingham, @jess_mcmullin - Herbert Chen, MD, Professor and Chair of Surgery, University of Alabama – Birmingham, @herbchen Learning objectives: - Understand the epidemiology and pathogenesis of kidney-related parathyroid disease and how these entities differ from primary hyperparathyroidism - Describe the diagnosis of kidney-related hyperparathyroidism and its different presentations - Define the indications for surgical intervention - Recognize the different approaches and extents of surgery for treating the different types of renally mediated hyperparathyroidism including thymectomy and parathyroid autotransplantation - Detail methods for safe and effective perioperative management References: - Dream S, Kuo LE, Kuo JH, Sprague SM, Nwariaku FE, Wolf M, Olson JA Jr, Moe SM, Lindeman B, Chen H. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism. Ann Surg. 2022 Sep 1;276(3):e141-e176. doi: 10.1097/SLA.0000000000005522. Epub 2022 Jul 18. PMID: 35848728. - Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons Guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 2016;151:959–968. - Ketteler M, Block GA, Evenepoel P, et al. Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guideline Update: what’s changed and why it matters. Kidney Int. 2017;92:26–36. - Andress DL, Coyne DW, Kalantar-Zadeh K, et al. Management of secondary hyperparathyroidism in stages 3 and 4 chronic kidney disease. Endocr Pract. 2008;14:18–27. - Cozzolino M, Brancaccio D, Gallieni M, et al. Pathogenesis of parathyroid hyperplasia in renal failure. J Nephrol. 2005;18:5–8. - Lau WL, Cobi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism. Clin J Am Soc Nephrol. 2018;13:952–961. - Parfrey PS, Chertow GM, Block GA, et al. The clinical course of treated hyperparathyroidism among patients receiving hemodialysis and the effect of cinacalcet: the EVOLVE trial. J Clin Endocrinol Metab. 2013;98:4834–4844. - Costa-Hong V, Jorgetti V, Gowdak LH, et al. Parathyroidectomy reduces cardiovascular events and mortality in renal hyperparathyroidism. Surgery. 2007;142:699–703. - McManus C, Oh A, Lee JA, et al. Timing of parathyroidectomy for tertiary hyperparathyroidism with end-stage renal disease: a cost-effectiveness analysis. Surgery. 2021;169:94–101. - Finnerty BM, Chan TW, Jones G, et al. Parathyroidectomy versus cinacalcet in the management of tertiary hyperparathyroidism: surgery improves renal transplant allograft survival. Surgery. 2019;165:129–134. Suture Kit: Purchase on suturekit.com Purchase on Amazon How-to Video Series Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other endocrine episodes here: https://behindtheknife.org/podcast-category/endocrine/ | |||
| Clinical Challenges in Trauma Surgery: Approach to Stab Wounds of the Torso | 20 Jul 2023 | 00:32:04 | |
The anterior abdominal stab wound! Who gets explored? When do you get imaging? Who gets serial abdominal exams? How does this change depending on the location of injury? Join Drs. Cobler-Lichter, Kwon, Meizoso, and Urréchaga in their first episode as the new Miami Trauma team - as they discuss how to navigate the nuances of stab wounds to the torso! Hosts: - Michael Cobler-Lichter, MD, PGY2: University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @mdcobler (twitter) - Eva Urrechaga, MD, PGY6/R4: University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @urrechisme (twitter) - Eugenia Kwon, MD, Trauma/Surgical Critical Care Fellow: University of Miami/Jackson Memorial Hospital/Ryder Trauma Center - Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @jpmeizoso (twitter) Learning Objectives: - Identify the differences in management of abdominal/thoracoabdominal stab wounds depending on location of injury - Identify who needs immediate operative intervention and who can undergo further evaluation - Define the management pathways for patients with abdominal stab wounds without an immediate indication for the OR - Define thoracoabdominal stab wound and when to evaluate for thoracic injuries - Discuss the role of diagnostic imaging when evaluating a patient with a stab to the torso Quick Hits: 1. Don’t forget about the blunt trauma that may be associated with an assault! 2. Don't miss injuries- always start with the ABCs and do a thorough head to toe exam 3. For stab wounds to the torso- hemodynamic instability, evisceration, peritonitis, impalement, or gross blood should go to the OR. 4. The three general clinical pathways for patients without a clear indication for the OR, include serial abdominal exams, local wound exploration, or diagnostic imaging. 5. Serial abdominal exams require frequent monitoring ideally by the same team member every time to detect changes early. 6. Local wound exploration requires adequate lighting and retraction to visualize the anterior rectus fascia. A negative LWE rules out an intra-abdominal injury, but a positive LWE does not necessarily rule it in. 7. Left thoracoabdominal stab wounds require evaluation of the diaphragm to rule out a traumatic diaphragm injury. 8. If there are no clear indications for the OR, diaphragm evaluation should be performed via laparoscopy after a period of 8 - 12 hours from injury. 9. A negative pericardial ultrasound does not rule out a cardiac injury in patients with a left-sided hemothorax. 10. Patients with flank and back stab wounds should be evaluated with CT scan to rule-out retroperitoneal injuries References 1. Martin MJ, Brown CVR, Shatz DV, Alam HB, Brasel KJ, Hauser CJ, de Moya M, Moore EE, Rowell SE, Vercruysse GA, Baron BJ, Inaba K. Evaluation and management of abdominal stab wounds: A Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg. 2018 Nov;85(5):1007-1015. doi: 10.1097/TA.0000000000001930. PMID: 29659472. 2. Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, Ivatury RR, Scalea TM. Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma. 2010 Mar;68(3):721-33. doi: 10.1097/TA.0b013e3181cf7d07. PMID: 20220426. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this trauma episode, check out our BIG T Trauma Series here: https://behindtheknife.org/podcast-series/big-t-trauma/ | |||
| Innovations in Surgery: LifeFlow | 17 Jul 2023 | 00:41:07 | |
In the fourth episode of the “Innovation in Surgery” series, Drs. Patrick Georgoff and Dan Scheese sit down with Dr. Mark Piehl to discuss his innovation, LifeFlow. Additionally, Dr. Piehl covers multiple other topics in this episode, including circulation-first resuscitation and the process of innovation from the physician’s perspective. 410 Medical Website: https://410medical.com Reel Emergency trauma podcast: https://www.youtube.com/watch?v=unog3YkFSOE Prehospital emergency care case report from the episode: https://pubmed.ncbi.nlm.nih.gov/36703273/ Dr. Piehl’s Resuscitation review article: https://link.springer.com/content/pdf/10.1007/s40138-021-00237-6.pdf Dr. Piehl’s Shock article on circulation-first resuscitation in trauma: https://pubmed.ncbi.nlm.nih.gov/36703273/ Preliminary data on prehospital trauma resuscitation with LifeFlow (Larger version of this with historical controls to be presented at AAST): https://410medical.com/app/uploads/2023/04/ESO-Poster-Presentation-April-2023.pdf “Unraveling the Fluid Confusion in Sepsis” webinar: https://www.youtube.com/watch?v=yip3AhEezA0 Dr. Mark Piehl is a pediatric critical care physician at WakeMed in Raleigh, NC, and a Medical Director with the WakeMed Mobile Critical Care transport team. Mark is also Founder and Chief Medical Officer of 410 Medical, a company focused on improving resuscitation in shock, sepsis, and trauma. He previously served as Medical Director of the WakeMed Children's Hospital and Director of Pediatrics at WakeMed. He has numerous Department of Defense grants funding the development of technology to improve trauma care. Mark is also Founder of the Samaritan Health Center, a clinic for the homeless and uninsured in Durham, NC. Suture Kit: Purchase on suturekit.com Purchase on Amazon How-to Video Series Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other innovation episodes here: https://behindtheknife.org/podcast-series/innovations-in-surgery/ | |||
| Clinical Challenges in Vascular Surgery: Aortic Graft Infections | 13 Jul 2023 | 00:27:31 | |
In this episode of Behind the Knife the vascular surgery subspecialty team discusses a case of an infected endovascular aortic graft. Although rare, aortic graft infections remain a devastating complication. What options do you have to fix this problem? In this episode, we will cover the who is at risk of this, how they present, and what options you have to fix it. Hosts: Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan Dr. David Schechtman is a Vascular Surgery Fellow at the University of Michigan Dr. Drew Braet is a PGY-3 Integrated Vascular Surgery Resident at the University of Michigan Learning Objectives · Understand the incidence of and the relevant risk factors for aortic graft infections · Review the spectrum of presenting symptoms and relevant workup for aortic graft infections · Understand surgical treatment options including options for in-situ bypass and extra-anatomic bypass · Review the different conduits that can be used for in-situ and extra-anatomic reconstruction · Discuss relevant post-operative considerations for patients undergoing operative intervention for aortic graft infection References · Chiesa R, Astore D, Frigerio S, Garriboli L, Piccolo G, Castellano R, Scalamogna M, Odero A, Pirrelli S, Biasi G, Mingazzini P, Biglioli P, Polvani G, Guarino A, Agrifoglio G, Tori A, Spina G. Vascular prosthetic graft infection: epidemiology, bacteriology, pathogenesis and treatment. Acta Chir Belg. 2002 Aug;102(4):238-47. doi: 10.1080/00015458.2002.11679305. PMID: 12244902. · Bisdas T, Bredt M, Pichlmaier M, Aper T, Wilhelmi M, Bisdas S, Haverich A, Teebken OE. Eight-year experience with cryopreserved arterial homografts for the in situ reconstruction of abdominal aortic infections. J Vasc Surg. 2010 Aug;52(2):323-30. doi: 10.1016/j.jvs.2010.02.277. Epub 2010 Jun 8. PMID: 20570473. · PereraG. B.FujitaniR. M.KubaskaS. M.2006Aortic graft infection: Update on Management and Treatment Options.Vasc Endovascular Surg, 401Jan), 1101538-5744 · Hallett J., Marshall D.M., Petterson T.M., et. al.: Graft-related complications after abdominal aortic aneurysm repair: Population-based experience. J Vasc Surg 1977; 25: pp. 277-284. · Kieffer E, Sabatier J, Plissonnier D, Knosalla C. Prosthetic graft infection after descending thoracic/ thoracoabdominal aortic aneurysmectomy: management with in situ arterial allografts. J Vasc Surg. 2001 Apr;33(4):671-8. doi: 10.1067/mva.2001.112314. PMID: 11296316. · Gutowski P. Zakazenie aortalno-biodrowej protezy naczyniowej jako problem diagnostyczny i leczniczy [Aortoiliac graft infection as a diagnostic and treatment problem]. Ann Acad Med Stetin. 1998;Suppl 41:1-72. Polish. PMID: 9766086. · Capoccia L, Mestres G, Riambau V. Current technology for the treatment of infection following abdominal aortic aneurysm (AAA) fixation by endovascular repair (EVAR). J Cardiovasc Surg (Torino). 2014;55:381–389. · Setacci C, Chisci E, Setacci F, Ercolini L, de Donato G, Troisi N, Galzerano G, Michelagnoli S. How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair. Aorta (Stamford). 2014 Dec 1;2(6):255-64. doi: 10.12945/j.aorta.2014.14-036. PMID: 26798744; PMCID: PMC4682678. · Reinders Folmer E.I., Von Meijenfeldt G.C.I., Van der Laan M.J., Glaudemans A.W.J.M., Slart R.H.J.A., Saleem B.R., Zeebregts C.J. Diagnostic Imaging in Vascular Graft Infection: A Systematic Review and Meta-Analysis. Eur. J. Vasc. Endovasc. Surg. 2018;56:719–729. doi: 10.1016/j.ejvs.2018.07.010. · Rafailidis V., Partovi S., Dikkes A., Nakamoto D.A., Azar N., Staub D. Evolving clinical applications of contrast-enhanced ultrasound (CEUS) in the abdominal aorta. Cardiovasc. Diagn. Ther. 2018;8:S118–S130. doi: 10.21037/cdt.2017.09.09. · Hayes P.D., Nasim A., London N.J., et. al.: In situ replacement of infected aortic grafts with rifampicin-bonded prostheses: The Leicester experience (1992 to 1998). J Vasc Surg 1999; 30: pp. 92-98. · Oderich GS, Bower TC, Hofer J, Kalra M, Duncan AA, Wilson JW, Cha S, Gloviczki P. In situ rifampin-soaked grafts with omental coverage and antibiotic suppression are durable with low reinfection rates in patients with aortic graft enteric erosion or fistula. J Vasc Surg. 2011 Jan;53(1):99-106, 107.e1-7; discussion 106-7. doi: 10.1016/j.jvs.2010.08.018. PMID: 21184932. · Bisdas T., Bredt M., Pichlmaier M., et. al.: Eight-year experience with cryopreserved arterial homografts for the in situ reconstruction of abdominal aortic infections. J Vasc Surg 2010; 52: pp. 323-330. · O'Hara P.J., Hertzer N.R., Beven E.G., et. al.: Surgical management of infected abdominal aortic grafts: Review of a 25-year experience. J Vasc Surg 1986; 3: pp. 725-731. · Quiñones-Baldrich WJ, Hernandez JJ, Moore WS. Long-term Results Following Surgical Management of Aortic Graft Infection. Arch Surg. 1991;126(4):507–511. doi:10.1001/archsurg.1991.01410280111018 · Kieffer E., Gomes D., Chieche L., et. al.: Allograft replacement for infrarenal aortic graft infection: Early and late results in 179 patients. J Vasc Surg 2004; 39: pp. 1009-1017. · Zhou W., Lin P.H., Bush R.L., et. al.: In situ reconstruction with cryopreserved arterial allografts for management of mycotic aneurysms or aortic prosthetic graft infections: A multi-institutional experience. Texas Heart Institute J 2006; 33: pp. 14-18. 2006 · Ali AT, Modrall JG, Hocking J, Valentine RJ, Spencer H, Eidt JF, Clagett GP. Long-term results of the treatment of aortic graft infection by in situ replacement with femoral popliteal vein grafts. J Vasc Surg. 2009 Jul;50(1):30-9. doi: 10.1016/j.jvs.2009.01.008. PMID: 19563952. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other vascular episodes here: https://behindtheknife.org/podcast-category/vascular/ | |||
| Journal Review in Minimally Invasive Surgery: Robotic Emergency General Surgery | 10 Jul 2023 | 00:35:45 | |
Have you transitioned a portion of your practice to the robot, but would be hesitant to book an urgent/call case on the robot? Have you wondered if the robot might be useful in your emergency or acute care surgery practice? Join University of Washington MIS Surgeons, Drs. Andrew Wright, Nicole White, and Nick Cetrulo, and Resident Drs. Ben Vierra and Paul Herman as they discuss the growing use of the robot for acute cases and provide tips on appropriate case selection. Hosts: 1. Andrew Wright, UW Medical Center – Montlake and Northwest, @andrewswright 2. Nick Cetrulo, UW Medical Center - Northwest, @Trules25 3. Nicole White, UW Medical Center - Northwest 4. Paul Herman, UW General Surgery Resident PGY-3, @paul_herm 5. Ben Vierra, UW General Surgery Resident PGY-2 Learning objectives: - Describe the importance of the MIS approach in EGS - Review 3 articles on robotic EGS outcomes 1) Robotic surgery in emergency setting: 2021 WSES position paper 2) Emergent robotic versus laparoscopic surgery for perforated gastrojejunal ulcers: a retrospective cohort study of 44 patients 3) Urgent robotic subtotal colectomy for severe acute ulcerative colitis has comparable periop outcomes to laparoscopic surgery - Discuss factors influencing appropriate case selection for urgent/emergent robotic cases - Discuss value as it pertains to robotic EGS References 1. Havens JM, Peetz AB, Do WS, Cooper Z, Kelly E, Askari R, Reznor G, Salim A. The excess morbidity and mortality of emergency general surgery. J Trauma Acute Care Surg. 2015 Feb;78(2):306-11. doi: 10.1097/TA.0000000000000517. PMID: 25757115. 2. Scott JW, Olufajo OA, Brat GA, Rose JA, Zogg CK, Haider AH, Salim A, Havens JM. Use of National Burden to Define Operative Emergency General Surgery. JAMA Surg. 2016 Jun 15;151(6):e160480. doi: 10.1001/jamasurg.2016.0480. Epub 2016 Jun 15. PMID: 27120712. 3. Arnold M, Elhage S, Schiffern L, Lauren Paton B, Ross SW, Matthews BD, Reinke CE. Use of minimally invasive surgery in emergency general surgery procedures. Surg Endosc. 2020 May;34(5):2258-2265. doi: 10.1007/s00464-019-07016-1. Epub 2019 Aug 6. PMID: 31388806. 4. Sheetz KH, Claflin J, Dimick JB. Trends in the Adoption of Robotic Surgery for Common Surgical Procedures. JAMA Netw Open. 2020 Jan 3;3(1):e1918911. doi: 10.1001/jamanetworkopen.2019.18911. PMID: 31922557; PMCID: PMC6991252. 5. de'Angelis N, Khan J, Marchegiani F, Bianchi G, Aisoni F, Alberti D, Ansaloni L, Biffl W, Chiara O, Ceccarelli G, Coccolini F, Cicuttin E, D'Hondt M, Di Saverio S, Diana M, De Simone B, Espin-Basany E, Fichtner-Feigl S, Kashuk J, Kouwenhoven E, Leppaniemi A, Beghdadi N, Memeo R, Milone M, Moore E, Peitzmann A, Pessaux P, Pikoulis M, Pisano M, Ris F, Sartelli M, Spinoglio G, Sugrue M, Tan E, Gavriilidis P, Weber D, Kluger Y, Catena F. Robotic surgery in emergency setting: 2021 WSES position paper. World J Emerg Surg. 2022 Jan 20;17(1):4. doi: 10.1186/s13017-022-00410-6. PMID: 35057836; PMCID: PMC8781145. 6. Robinson TD, Sheehan JC, Patel PB, Marthy AG, Zaman JA, Singh TP. Emergent robotic versus laparoscopic surgery for perforated gastrojejunal ulcers: a retrospective cohort study of 44 patients. Surg Endosc. 2022 Feb;36(2):1573-1577. doi: 10.1007/s00464-021-08447-5. Epub 2021 Mar 24. PMID: 33760973. 7. Anderson M, Lynn P, Aydinli HH, Schwartzberg D, Bernstein M, Grucela A. Early experience with urgent robotic subtotal colectomy for severe acute ulcerative colitis has comparable perioperative outcomes to laparoscopic surgery. J Robot Surg. 2020 Apr;14(2):249-253. doi: 10.1007/s11701-019-00968-5. Epub 2019 May 10. PMID: 31076952. 8. Gangemi A, Danilkowicz R, Bianco F, Masrur M, Giulianotti PC. Risk Factors for Open Conversion in Minimally Invasive Cholecystectomy. JSLS. 2017 Oct-Dec;21(4):e2017.00062. doi: 10.4293/JSLS.2017.00062. PMID: 29238153; PMCID: PMC5714218. 9. Bhama AR, Wafa AM, Ferraro J, Collins SD, Mullard AJ, Vandewarker JF, Krapohl G, Byrn JC, Cleary RK. Comparison of Risk Factors for Unplanned Conversion from Laparoscopic and Robotic to Open Colorectal Surgery Using the Michigan Surgical Quality Collaborative (MSQC) Database. J Gastrointest Surg. 2016 Jun;20(6):1223-30. doi: 10.1007/s11605-016-3090-6. Epub 2016 Feb 3. PMID: 26847352. 10. https://www.east.org/about-east/news-and-events/news/details/320/east-robotic-surgery-for-the-acute-care-surgeon-webinar-series Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other MIS episodes here: https://behindtheknife.org/podcast-category/minimally-invasive/ | |||
| Clinical Challenges in Surgical Education: Precision Surgical Education | 11 Jul 2024 | 00:31:16 | |
As we move towards a model of Competency-Based Surgical Education, individualization of training may be needed. How can we get the right education to the right trainee at the right time? How can we link education to actual patient outcomes? Precision education aims to do just that, while leveraging technology, data, and analytics to decrease burden on assessors. While this approach offers a lot of promise to advance surgical education, it can be difficult to conceptualize how this would be implemented in practice. We’re joined by an expert in the field of precision medical education, Dr. Jesse Burk-Rafel, to break down what precision education is and how it might integrate into our current system of surgical education
Join hosts Nicole Brooks MD, Judith French PhD, and Jeremy Lipman MD, MHPE for this exciting conversation with Jesse Burk-Rafel MD. Learning Objectives 1. Listeners will define precision education. 2. Listeners will describe examples of how precision medical or surgical education is being used currently. 3. Listeners will explain barriers that must be addressed with the implementation of precision surgical education, including bias and issues with data sharing. 4. Listeners will consider how precision surgical education will evolve, including possible use within their own institution to completement competency-based surgical education. References Desai SV, Burk-Rafel J, Lomis KD, et al. Precision Education: The Future of Lifelong Learning in Medicine. Academic Medicine. 2024;99(4). https://pubmed.ncbi.nlm.nih.gov/38277444/ Richardson J, Santen SA, Mejicano GC, et al. Learner Assessment and Program Evaluation: Supporting Precision Education. Academic Medicine. 2024;99(4). https://pubmed.ncbi.nlm.nih.gov/38166211/ Perrone KH, Abdelaal AE, Pugh CM, Okamura AM. Haptics: The Science of Touch As a Foundational Pathway to Precision Education and Assessment. Academic Medicine. 2024;99(4). https://pubmed.ncbi.nlm.nih.gov/38109654/ Sukhera J. Precision Education and Equity: A Participatory Framework to Advance Equitable Assessment. Academic Medicine. 2024;99(4). https://pubmed.ncbi.nlm.nih.gov/38109658/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen | |||
| Intern Bootcamp - Dominate Intern Year | 07 Jul 2023 | 00:12:46 | |
Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.
In this last episode of the intern bootcamp mini-series, we’ll talk about tips & tricks as well as good habits to establish in order to dominate intern year. Hosts: Shanaz Hossain, Nina Clark Tips for New Interns: GENERAL TIPS FOR SUCCESS ON THE WARDS
HOW TO LEARN IN THE OR
MAINTAIN YOUR PERSONAL SANITY
If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/ | |||
| Intern Bootcamp - Scary Pages | 06 Jul 2023 | 00:23:18 | |
Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency. Today, we’re hitting the wards and tackling some of the scary clinical scenarios you will see as an intern. Hosts: Shanaz Hossain, Nina Clark Tips for new interns: THINGS TO REMEMBER · BREATHE. In most cases, you have a little bit of time – at least enough to take a breath and calm down outside the room before heading into an emergency. Panic doesn’t help anybody. · See the patient. Getting a bunch of pages? Worried about someone? Confused as to what’s going on? Go see the patient and chat with the bedside team. · Know your toolbox. There are a ton of people around who can help you in the hospital, and knowing the basic labs/imaging studies and when to use them can help you to triage even the sickest patients. · Load the boat. You’ve heard this one from us all week! Loop senior level residents in early. HYPOTENSION · Differential: measurement error, patient’s baseline, and don’t miss – SHOCK. - Etiologies of shock: hemorrhagic, hypovolemic, · On the phone: full set of vitals, accurate I/Os, · On the way: recent notes, PMH/PSH including from this hospital stay, and vitals/I&Os/studies from earlier in the day · In the room: ABCDs – rapidly gives you a sense of how high acuity the patient is · Get more info: labs, consider imaging, work up specific types of shock based on clinical concern. · Initial management: depends on etiology of hypotension; don’t forget to consider peripheral or central access, foley catheterization for close monitoring of urine output, and level of care HYPOXEMIA · Differential: atelectasis, baseline pulmonary disease, pneumonia, PE, hemo/pneumothorax, volume overload · On the phone: full set of vitals, amount of supplemental oxygen required and delivery device, rate of escalation in oxygen requirement · On the way: review PMH/PSH, known injuries (known hemothorax/pneumothorax? Rib fractures? Chest tubes in already?), risk factors for DVT/PE, review I/Os for evidence of volume status, vitals and labs for evidence of infection · In the room: ABCDs, pulmonary and cardiac exam, volume status exam · Get more info: basic labs, ABG if worried about oxygenation, CXR, consider bedside US of the lungs/heart, if high suspicion for PE consider CTA chest · Initial Management: supplemental O2, higher level of care, consider intubation or other supplemental oxygenation adjuncts, additional management dependent on suspected etiology · ABG Vs VBG (IBCC): https://emcrit.org/ibcc/vbg/ ALTERED MENTAL STATUS · Differential: stroke, medication effect, hypoxemia or hypercarbia, toxic or medication effect, endocrine/metabolic, stroke or MI, psychiatric illness, or infections, delirium · On the way: review PMH/PSH, recent notes for evidence of altered mentation or agitation, or signs hinting at above etiologies · In the room: ABCDs, focal neuro deficits?, alert/oriented? Be sure the patient’s mental status is adequate for airway protection! · Get more info: basic labs, blood gas/lactate, CT head noncontrast if concerned for stroke. · Initial management: rule out above; if concerned about delirium, optimize sleep/wake cycles, pain control, and lines/drains/tubes. OLIGURIA · Differential: prerenal due to hypovolemia or low effective circulating volume, intrinsic renal disease, post-renal obstruction · On the phone: clarify functional foley or bladder scan results, full set of vitals · On the way: review PMH/PSH, known injuries (known hemothorax/pneumothorax? Rib fractures? Chest tubes in already?), risk factors for DVT/PE, review I/Os for evidence of volume status, vitals and labs for evidence of infection · In the room: ABCDs, confirm functioning foley catheter · Get more info: basic labs, urine electrolytes, consider fluid challenge to evaluate responsiveness, consider adjuncts including renal US · Initial management: typically consider IVF bolus initially, but if patient not volume responsive, don't overload them -- look for other etiologies! TACHYCARDIA · Differential: sinus tachycardia (pain, hypovolemia, agitation, infection), cardiac arrhythmia, MI, PE · On the phone: full set of vitals, acuity of change in heart rate, updated I/Os · On the way: Review PMH/PSH, known cardiac history, cardiac and PE risk factors, volume resuscitation, signs concerning for infection, updated I/Os · In the room: ABCDs, cardiac/pulmonary exam, evaluate for any localizing signs for infection · Get more info: basic labs, EKG, consider CXR, troponins · Initial management: depends heavily on etiology Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/ | |||
| Intern Bootcamp - Consults | 05 Jul 2023 | 00:14:57 | |
Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.
This episode, we’ll talk about how to give and receive consults in the hospital like a pro. We’ll also provide some tips on how to make those long call days a little more manageable. Hosts: Shanaz Hossain, Nina Clark Tips for New Interns: GIVING CONSULTS
RECEIVING CONSULTS
CALL SHIFTS
If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/ | |||
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