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Please join BTK education fellow, Nina Clark, MD (University of Washington) along with Elina Serrano, MD, MPH (University of Washington) and Minerva Romero Arenas, MD (Weill Cornell Medicine) for a discussion inspired by the experience of trainees who are underrepresented in medicine.  

Latino Surgical Society: https://www.latinosurgicalsociety.org/
Society of Black Academic Surgeons: https://www.sbas.net/

References: 
Yeo HL, Abelson JS, Symer MM, Mao J, Michelassi F, Bell R, Sedrakyan A, Sosa JA. Association of Time to Attrition in Surgical Residency With Individual Resident and Programmatic Factors. JAMA Surg. 2018 Jun 1;153(6):511-517. doi: 10.1001/jamasurg.2017.6202. PMID: 29466536; PMCID: PMC5875388.

McFarling, U.L. ‘It was stolen from me’: Black doctors are forced out of training programs at far higher rates than white residents. STAT. 6/20/2022. Accessed online: 10/1/2022. https://www.statnews.com/2022/06/20/black-doctors-forced-out-of-training-programs-at-far-higher-rates-than-white-residents/

Haruno LS, Chen X, Metzger M, et al. Racial and Sex Disparities in Resident Attrition Among Surgical Subspecialties. JAMA Surg. Published online February 08, 2023. doi:10.1001/jamasurg.2022.7640

**Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7

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

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

In this episode the Endocrine Surgery team at BTK goes over two cases to review the American Association of Endocrine Surgeons Guidelines for Adrenalectomy. 

Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established. 

Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department

Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department 

Dr. Na Eun Kim is an Endocrine Surgery Fellow at UCLA in his first year of fellowship

Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research 

Dr. Max Schumm is a PGY-5 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon. 

Important Papers 

Yip L, Duh QY, Wachtel H, Jimenez C, Sturgeon C, Lee C, Velázquez-Fernández D, Berber E, Hammer GD, Bancos I, Lee JA, Marko J, Morris-Wiseman LF, Hughes MS, Livhits MJ, Han MA, Smith PW, Wilhelm S, Asa SL, Fahey TJ 3rd, McKenzie TJ, Strong VE, Perrier ND. American Association of Endocrine Surgeons Guidelines for Adrenalectomy: Executive Summary. JAMA Surg. 2022 Oct 1;157(10):870-877. doi: 10.1001/jamasurg.2022.3544. PMID: 35976622; PMCID: PMC9386598.

Schumm M, Hu MY, Sant V, Kim J, Tseng CH, Sanz J, Raman S, Yu R, Livhits M. Automated extraction of incidental adrenal nodules from electronic health records. Surgery. 2023 Jan;173(1):52-58. doi: 10.1016/j.surg.2022.07.028. Epub 2022 Oct 4. PMID: 36207197.

M. Conall Dennedy, Anand K. Annamalai, Olivia Prankerd-Smith, Natalie Freeman, Kuhan Vengopal, Johann Graggaber, Olympia Koulouri, Andrew S. Powlson, Ashley Shaw, David J. Halsall, Mark Gurnell, Low DHEAS: A Sensitive and Specific Test for the Detection of Subclinical Hypercortisolism in Adrenal Incidentalomas, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 3, 1 March 2017, Pages 786–792, https://doi.org/10.1210/jc.2016-2718

Amar, L., Pacak, K., Steichen, O. et al. International consensus on initial screening and follow-up of asymptomatic SDHx mutation carriers. Nat Rev Endocrinol 17, 435–444 (2021). https://doi.org/10.1038/s41574-021-00492-3

**Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7

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

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

In this episode the Critical Care BTK Team tackles nutrition in the ICU. High-yield journal articles will be presented, discussed, and reviewed. ICU nutrition myths will be busted, and listeners will learn about enteral nutrition, parenteral nutrition and other ICU nutrition pearls.
References
1.         Casaer, M.P., et al., Early versus Late Parenteral Nutrition in Critically Ill Adults. New England Journal of Medicine, 2011. 365(6): p. 506-517.
2.         Compher, C., et al., Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. Journal of Parenteral and Enteral Nutrition, 2022. 46(1): p. 12-41.
3.         McClave, S.A., et al., Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient. Journal of Parenteral and Enteral Nutrition, 2016. 40(2): p. 159-211.

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

If you liked this episode, check out other Surgical Critical Care episodes here: https://behindtheknife.org/podcast-category/surgical-critical-care/

In the third episode of the “Innovations in Surgery” series, Behind the Knife’s surgery education fellow, Dan Scheese, sits down with Adam Sachs and Dr. Igor Belyansky to discuss the current state and future of surgical robotics. They discuss the start up of Vicarious Surgical and how they are working to improve the current state of surgical robotics with their innovative ideas. 

Link for the Vicarious Surgical website which includes a short video demonstration of their single port design: https://www. vicarioussurgical.com/

Adam Sachs is the CEO and Co-founder of Vicarious surgical, a surgical robotics company founded in 2014. As an MIT trained roboticist, Adam has combined his passion for robots with this passion for helping patients and enhancing the work environment for surgeons through the development of proprietary surgical robotics. 

Dr. Igor Belyanksy, an internationally-recognized expert in the field of abdominal wall reconstruction and complex laparoscopic and robotic hernia repair. Dr. Belyansky has earned his medical degree from Virginia Commonwealth University, completed his residency at MedStar Union Memorial Hospital, and completed a minimally invasive fellowship at Carolinas Medical Center. Dr. Belyanksy is currently the Medical Director of Anne Arundel Medical Center in Annapolis Maryland.

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

If you liked this episode, check out other Innovations in Surgery episodes here: https://behindtheknife.org/podcast-series/innovations-in-surgery/

You have a patient who underwent local excision of a rectal cancer. Final pathology demonstrates a T2 lesion. What is the rate of local recurrence? Is excision alone sufficient? Should the patient undergo radical resection or should chemoradiation be offered? Tune in to find out!
Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Jose Guillem MD, MPH, MBA as they discuss high yield papers discussing local excision for Rectal Cancer.

You may follow along with the slides mentioned in this episode here: https://behindtheknife.org/video/journal-review-in-colorectal-surgery-local-excision-for-rectal-cancer/

Learning Objectives
1. Describe the features that increase risk of lymph node involvement in early stage rectal cancer
2. Discuss the different options for management of early-stage rectal cancer
3. Describe patient related factors that favor local excision of rectal cancer

References:
Kidane B, Chadi SA, Kanters S, Colquhoun PH, Ott MC. Local resection compared with radical resection in the treatment of T1N0M0 rectal adenocarcinoma: a systematic review and meta-analysis. Dis Colon Rectum. 2015 Jan;58(1):122-40. doi: 10.1097/DCR.0000000000000293. PMID: 25489704.

Garcia-Aguilar J, Renfro LA, Chow OS, Shi Q, Carrero XW, Lynn PB, Thomas CR Jr, Chan E, Cataldo PA, Marcet JE, Medich DS, Johnson CS, Oommen SC, Wolff BG, Pigazzi A, McNevin SM, Pons RK, Bleday R. Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol. 2015 Nov;16(15):1537-1546. doi: 10.1016/S1470-2045(15)00215-6. Epub 2015 Oct 22. PMID: 26474521; PMCID: PMC4984260.
Friel CM, Cromwell JW, Marra C, Madoff RD, Rothenberger DA, Garcia-Aguílar J. Salvage radical surgery after failed local excision for early rectal cancer. Dis Colon Rectum. 2002 Jul;45(7):875-9. doi: 10.1007/s10350-004-6320-z. PMID: 12130873.
Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum. 2002 Feb;45(2):200-6. doi: 10.1007/s10350-004-6147-7. PMID: 11852333.
O’Neill CH, Platz J, Moore JS, Callas PW, Cataldo PA. Transanal Endoscopic Microsurgery for Early Rectal Cancer: A Single-Center Experience. Dis Colon Rectum. 2017 Feb;60(2):152-160. doi: 10.1097/DCR.0000000000000764. PMID: 28059911.
 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

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

DO NOT MISS THIS EPISODE! Need a little inspiration? Tune in for Dave’s story. Links from the show: 

Chasing My Cure: https://chasingmycure.com/ CDCN: https://cdcn.org/
Every Cure: https://everycure.org/
AMF: https://healgrief.org/actively-moving-forward/young-adult-grief/

David Fajgenbaum, MD, MBA, MSc, FCPP, is an Assistant Professor of Medicine in Translational Medicine & Human Genetics at the University of Pennsylvania, Founding Director of the Center for Cytokine Storm Treatment & Laboratory (CSTL), Associate Director, Patient Impact of the Penn Orphan Disease Center, and Co-Founder/President of the Castleman Disease Collaborative Network (CDCN) and co-founder of Every Cure. He is also the national bestselling author of ‘Chasing My Cure: A Doctor’s Race to Turn Hope Into Action’ and a patient battling idiopathic multicentric Castleman disease (iMCD). He is in his longest remission ever thanks to a precision treatment that he identified, which had never been used before for iMCD. He has also identified and/or advanced 9 other treatment approaches for iMCD and cancer. 

One of the youngest individuals ever appointed to the faculty at Penn Medicine and in the top 1 percent youngest awardees of an NIH R01 grant, Fajgenbaum has published scientific papers in high-impact journals such as the New England Journal of Medicine, Journal of Clinical Investigation, and Lancet, been recognized with awards such as the 2016 Atlas Award along with then Vice President Joe Biden, and profiled in a cover story by The New York Times as well as by Good Morning America, CNN, Forbes 30 Under 30, and the Today Show. An authority on cytokine storms and their treatment, Fajgenbaum currently leads over 20 translational research studies including the CORONA Project, which is the world’s largest effort to identify, track, and advance COVID-19 treatments. He also serves on the Board of Directors for the Reagan-Udall Foundation for the FDA, co-Chair of the Advisory Board for the CURE Drug Repurposing Collaboratory, and co-Chair of the Scientific Advisory Board for the CDCN. 

Dr. Fajgenbaum earned a BS in Human Sciences with Distinction from Georgetown University, where he was USA Today Academic All-USA First Team and a Quarterback on the Division I football team, a MSc in Public Health from the University of Oxford as the 2007 Joseph L. Allbritton Scholar, a MD from the Perelman School of Medicine at the University of Pennsylvania, where he was a 21st Century Gamble Scholar, and a MBA from The Wharton School, where he was awarded the Joseph Wharton Award, Core Value Leadership Award, Kissick Scholarship, Wharton Business Plan Competition Social Impact Prize, Eilers Health Care Management Award, Mandel Fellowship, and Commencement Speaker.

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

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

How do we actually improve wellness?  How do surgery trainees advocate for themselves as both learners and employees?  In this final surgical education episode with Matt Chia MD MS and Karl Bilimoria MD MS, we review two articles discussing unions and wellness in surgical training.  We’re joined by Meg Smith MD MS, Brian Brajcich MD MS, and Darci Foote MD MS to tackle this difficult topic and open the discussion for what’s next in surgical education.

Learning Objectives:

·       Identify potential benefits and limitations of unionization in surgery training

·       Describe strategies used by program leadership to improve wellness in surgery

References:

National Evaluation of the Association Between Resident Labor Union Participation and Surgical Resident Well-being https://doi.org/10.1001/jamanetworkopen.2021.23412 

How Program Directors Understand General Surgery Resident Wellness – https://doi.org/10.1016/j.jsurg.2022.07.022 

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

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

Join the Behind the Knife HPB team as we dive deeper into the complex world of IPMNs with a journal article review of a recent JAMA Surgery publication and the first author of the article!

Learning Objectives: In this episode, we discuss the article, “Progression vs Cyst Stability of Branch-Duct Intraductal Papillary Mucinous Neoplasms After Observation and Surgery.”  This article describes a multicenter retrospective study of centers in Italy, Korea, Singapore, and the US that specifically assessed what dynamic variables are associated with malignant progression in pathologically proven IMPNs under at least a year of initial surveillance. 

Hosts:
Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center

Daniel Nelson, DO, FACS (@DWNelsonHPB) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center

Connor Chick, MD (@connor_chick) is a PGY-6 General Surgery resident at Brooke Army Medical Center

Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-5 General Surgery resident at Brooke Army Medical Center

Beth Carpenter, MD (@elizcarpenter16) is a PGY-4 General Surgery resident at Brooke Army Medical Center

Guest: 
Dr. Giovanni Marchegiani is a pancreas surgeon within the department of general and pancreatic surgery at the University of Verona in Italy.  His research interests include exocrine and cystic neoplasms of the pancreas.  He is the first author of the study discussed in the episode in addition to over 100 additional scientific, peer-reviewed articles.

Journal Article:
1.     Marchegiani G, Pollini T, Andrianello S, et al. Progression vs Cyst Stability of Branch-Duct Intraductal Papillary Mucinous Neoplasms After Observation and Surgery. JAMA Surg. 2021;156(7):654–661. doi:10.1001/jamasurg.2021.1802

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

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

Our Vascular Surgery Oral Board Audio Review includes 72 high-yield scenarios that cover the majority of the VSCORE topics designed for Vascular Surgeons by Vascular Surgeons.  
Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as vascular surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.

Learn more about the full set of 24 scenarios here: https://behindtheknife.org/premium/vascular-surgery-oral-review/

Our Vascular Surgery Oral Board Book is available on Amazon here: https://www.amazon.com/Vascular-Surgery-Oral-Board-Review/dp/0578382296/ref=sr_1_4?crid=VUNDNTCJOH8M&keywords=behind+the+knife&qid=1675087641&sprefix=behind+the+knif%2Caps%2C82&sr=8-4&ufe=app_do%3Aamzn1.fos.f5122f16-c3e8-4386-bf32-63e904010ad0

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

Our Vascular Surgery Oral Board Audio Review includes 72 high-yield scenarios that cover the majority of the VSCORE topics designed for Vascular Surgeons by Vascular Surgeons.  

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

Learn more about the full set of 24 scenarios here: https://behindtheknife.org/premium/vascular-surgery-oral-review/

Our Vascular Surgery Oral Board Book is available on Amazon here: https://www.amazon.com/Vascular-Surgery-Oral-Board-Review/dp/0578382296/ref=sr_1_4?crid=VUNDNTCJOH8M&keywords=behind+the+knife&qid=1675087641&sprefix=behind+the+knif%2Caps%2C82&sr=8-4&ufe=app_do%3Aamzn1.fos.f5122f16-c3e8-4386-bf32-63e904010ad0

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

Surgery is a contact sport and can cause injuries that prevent us from taking care of our patients and even threaten our careers. Join Drs. Mike Weykamp, Nicole White, Nick Cetrulo, and Andrew Wright for a discussion on the ergonomic challenges of open, laparoscopic, and robotic surgery as well as some tips, tricks, and resources on how to protect yourself and your practice. 

*We apologize for some distracting background noise throughout the episode.*

Referenced Articles & Websites: 
1.     Wells, A. C., Kjellman, M., Harper, S. J., Forsman, M., & Hallbeck, M. S. (2019). Operating hurts: a study of EAES surgeons. Surgical endoscopy, 33, 933-940.
2.     Davis, W. T., Fletcher, S. A., & Guillamondegui, O. D. (2014). Musculoskeletal occupational injury among surgeons: effects for patients, providers, and institutions. Journal of surgical research, 189(2), 207-212.
3.     Wright, A.S. Ergonomic Injury and Surgery: The Hidden Epidemic.  Harkins Symposium at The University of Washington. October 21, 2022. https://www.youtube.com/watch?v=o1G1qGj4WaA 
4.     The Society of Surgical Ergonomics. https://www.societyofsurgicalergonomics.org/ 
5.     OR Stretch. https://www.mayo.edu/research/labs/human-factors-engineering/or-stretch/or-stretch-videos 

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

If you liked this episode, check out other MIS episodes here: https://behindtheknife.org/podcast-category/minimally-invasive/

Vascular surgery is full of awesome anatomy and big open vessel exposures, but endovascular surgery is here to stay and can be hard to get into, particularly as a learner. The basics of endovascular surgery share very little with the basics of open surgery and getting up to speed can be a big challenge. This episode is an introduction to all things endovascular surgery, from wires, catheters and sheaths to balloons and stents. Take a listen to get up to speed quickly in prep for an upcoming vascular rotation and skip the pain of trying to follow your attendings words so you can instead pay attention to the actual case.

Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan.

Dr. Craig Brown is a PGY-7 in the General Surgery program and the upcoming 2023 vascular surgery fellow at the University of Michigan.

Check out the accompanying video for this episode available here: https://behindtheknife.org/video-playlists/podcast-clips/

Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed robotic general surgery procedures. If you are a general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs,  reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com for more information on how you could be compensated $500 per video submitted of each (up to $1000 per surgeon).

To check out our Vascular Surgery Oral Board Audio Review and Book, please visit: https://behindtheknife.org/premium/

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

Interview season is over! There’s just one last hurdle in this residency application process to overcome- ranking and matching! Join our education fellow, Dr. Jessica Millar, and Dr. Charles Friel as they pull back the curtain on the ranking process and discuss how tooptimize your success in the match! 

Guest:
Charles Friel, MD- Professor of Colorectal Surgery, Surgical Director – Digestive Center of Excellence, Chief – Section of Colon & Rectal Surgery, and General Surgery Residency Program Director- University of Virginia, Charlottesville, VA

“How the NRMP Matching Algorithm Works”: https://www.youtube.com/watch?v=kvgfgGmemdA&list=PLr0LH_NifZSpvQTwTqXVYn9jXfUKOTFN6&index=11

Important Dates 
1.     Ranking opens 2/1 at 12PM 
2.     Rank lists are due 3/1 at 9PM 
3.     Match status available 3/13 at 10AM  
4.     Match day results available 3/17 at 12PM EST

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

If you liked this episode, check out the rest of our “Dominate the Match Series” here: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/

In this episode, our team discusses the recent paper from JAMA Surgery Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers. Join us as we explore some of the history of blood transfusions, how we got to where we are today, and the role whole blood transfusion may play going forward

Hosts: 
Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST) and editor-in-chief of Trauma Surgery and Acute Care Open.

Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins. 

David Sigmon, MD, MMEd, a PGY-7 resident at the University of Illinois at Chicago who will be a fellow at Lincoln Medical Center in the Bronx next year. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education. 

LITERATURE

  1. Torres CM, Kent A, Scantling D, Joseph B, Haut ER, Sakran JV. Association of whole blood with survival among patients presenting with severe hemorrhage in US and Canadian adult civilian trauma centers. JAMA Surg. Published online January 18, 2023.
     https://pubmed.ncbi.nlm.nih.gov/36652255/
  2. Sperry JL, Guyette FX, Brown JB, et al. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. N Engl J Med. 2018;379(4):315-326.
    https://pubmed.ncbi.nlm.nih.gov/30044935/
     
  3. Moore HB, Moore EE, Chapman MP, et al. Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial. Lancet. 2018;392(10144):283-291.
    https://pubmed.ncbi.nlm.nih.gov/30032977/
     
  4. Cannon JW, Khan MA, Raja AS, et al. Damage control resuscitation in patients with severe traumatic hemorrhage: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):605-617.
    https://pubmed.ncbi.nlm.nih.gov/28225743/
     
  5. Howley IW, Haut ER, Jacobs L, Morrison JJ, Scalea TM. Is thromboelastography (Teg)-based resuscitation better than empirical 1:1 transfusion? Trauma Surg Acute Care Open. 2018;3(1):e000140.
    https://pubmed.ncbi.nlm.nih.gov/29766129/
     
  6. Guyette FX, Brown JB, Zenati MS, et al. Tranexamic acid during prehospital transport in patients at risk for hemorrhage after injury: a double-blind, placebo-controlled, randomized clinical trial. JAMA Surg. 2020;156(1):11-20.
    https://pubmed.ncbi.nlm.nih.gov/33016996/
     
  7. Smart BJ, Haring RS, Zogg CK, et al. A faculty-student mentoring program to enhance collaboration in public health research in surgery. JAMA Surg. 2017;152(3):306-308.
    https://pubmed.ncbi.nlm.nih.gov/27973649/
     
  8. National Academies of Sciences E. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths after Injury.; 2016.
    https://nap.nationalacademies.org/catalog/23511/a-national-trauma-care-system-integrating-military-and-civilian-trauma
     
  9. Braverman MA, Smith A, Pokorny D, et al. Prehospital whole blood reduces early mortality in patients with hemorrhagic shock. Transfusion. 2021;61 Suppl 1:S15-S21.
     https://pubmed.ncbi.nlm.nih.gov/34269467/

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

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

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

Join Patrick Georgoff and Kevin Kniery for a special conversation with the king and queen of medical comedy Dr. Will Flanary, aka Dr. Glaucomflecken (@drglaucomflecken), and Kristin Flanary, aka Lady Glaucomflecken (@Lglaucomflecken).

Will is a practicing ophthalmologist and social media personality with over 4 million followers. During his 3rd year of medical school, he was diagnosed with testicular cancer, and he began using humor as a coping mechanism. Following a second bout with cancer three years into his medical career, he created a Twitter account under the pseudonym “Dr. Glaucomflecken”— because it is arguably the funniest word in ophthalmology. A cardiac event and near-death experience in 2020 only fueled his creativity. Kristin is formally trained in cognitive neuroscience and social psychology and now works in marketing and communications. Kristin is best known internationally as her social media alter ego, “Lady Glaucomflecken,” where she shares stories from her unique perspective of the healthcare system. She has been a patient, “married to medicine” through the entire medical training journey and beyond, a lay responder and CPR provider to her husband, and a caregiver and “co-survivor” of his two cancer occurrences and a sudden cardiac arrest. And, if that’s not enough, they also have a brand-new podcast called Knock, Knock – Hi! where they discuss quirky and unexpectedly hilarious medical stories.  Check out their website herehttps://glaucomflecken.com/

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

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

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

Did you miss this year’s Eastern Association for the Surgery of Trauma meeting?  Don’t sweat it!  Behind the Knife has got you covered.  In this episode we discuss “Scientific Papers that Should Change Your Practice” with EAST manuscript and literature committee members Drs. Laura Brown (@laurarbrownMD), Brittany Bankhead (@bbankheadMD), and Julia Coleman (@juliacolemanMD).  

Universal blunt cerebrovascular screening?  Early renal replacement therapy?  Artificial intelligence in emergency general surgery?  This episode is PACKED with high-yield material.  

To learn more about all the good things happening at EAST visit www.east.org

Papers discussed: 
1.     Do not forget the platelets: The independent impact of red blood cell to platelet ratio on mortality in massively transfused trauma patients (https://pubmed.ncbi.nlm.nih.gov/35313325/)
2.     The 35-mm rule to guide pneumothorax management: Increases appropriate observation and decreases unnecessary chest tubes (https://pubmed.ncbi.nlm.nih.gov/35125448/)
3.     Timing of thromboprophylaxis in patients with blunt abdominal solid organ injuries undergoing nonoperative management (https://pubmed.ncbi.nlm.nih.gov/33048907/)
4.     Universal screening for blunt cerebrovascular injury (https://pubmed.ncbi.nlm.nih.gov/33502144/)
5.     A three-step support strategy for relatives of patients during in the intensive care unit: a cluster randomized trial (https://pubmed.ncbi.nlm.nih.gov/35065008/)
6.     Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest (https://pubmed.ncbi.nlm.nih.gov/34133859/)
7.     Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury (https://pubmed.ncbi.nlm.nih.gov/32668114/)
8.     Disparities in Spatial Access to Emergency Surgical Services in the US (https://pubmed.ncbi.nlm.nih.gov/36239953/)
9.     Validation of the AI-based Predictive Optimal Trees in Emergency Surgery Risk (POTTER) Calculator in Patients 65 Years and Older (https://pubmed.ncbi.nlm.nih.gov/33378309/)
10.  Accuracy of Risk Estimation for Surgeons Versus Risk Calculators in Emergency General Surgery (https://pubmed.ncbi.nlm.nih.gov/35594615/)

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Please join Drs. Brian Gray, Amanda Jensen, and Manisha Bhatia from Indiana University as they discuss Hirschsprung disease in regard to variability of the transition zone and surgical operative and pathologic diagnosis reporting in pediatric surgery.
Journal Article links: 
Veras LV, Arnold M, Avansino JR, Bove K, Cowles RA, Durham MM, et al. Guidelines for synoptic reporting of surgery and pathology in Hirschsprung disease. J Pediatr Surg 2019;54(10):2017-23.
https://pubmed.ncbi.nlm.nih.gov/30935730/
Thakkar HS, Blackburn S, Curry J, De Coppi P, Giuliani S, Sebire N, et al. Variability of the transition zone length in Hirschsprung disease. J Pediatr Surg 2020;55(1):63-6.
https://pubmed.ncbi.nlm.nih.gov/31706615/
Coyle D, O’Donnell AM, Tomuschat C, Gillick J, Puri P. The Extent of the Transition Zone in Hirschsprung Disease. J Pediatr Surg 2019;54(11):2318-24.
https://pubmed.ncbi.nlm.nih.gov/31079866/

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Join the Surgical Oncology team from UTSouthwestern and the University of Miami as they tackle a case of intrahepatic cholangiocarcinoma along with the data guiding current treatment paradigms. Listen in as they also review recent clinical trials changing the options available for patients with this dismal biliary tract cancer.
Learning Objectives: 
In this episode, we review the workup and diagnostic approach to intrahepatic cholangiocarcinoma with emphasis on the role and benefits of biopsy, lymphadenectomy, operative approach, and the current treatment strategies involving chemotherapy, immunotherapy, and targeted therapies against actionable mutations.
Hosts: 
Adam Yopp, MD, FACS (@AdamYopp) is an Associate Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program.
Caitlin Hester, MD (@CaitlinAHester) is a recent graduate of the MD Anderson Complex General Surgical Oncology fellowship and is now a new faculty member in the Division of Surgical Oncology within the Sylvester Cancer Center at the University of Miami where she specializes in surgery for cancers of the liver, pancreas, and other gastrointestinal sites. 
Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-4 Research Fellow and General Surgery Resident at the UT Southwestern Medical Center. He is studying the pancreatic tumor microenvironment and targeted therapies in the lab of Rolf Brekken within the Hamon Center for Therapeutic Oncology Research.

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Who is a candidate for metabolic and bariatric surgery and what has changed in the past 30 years? Find out in this review!

Journal articles:
Bariatric Surgery versus Intensive Medical Therapy for Diabetes – 5 Year Outcomes. https://pubmed.ncbi.nlm.nih.gov/28199805/.

Association of Metabolic Surgery with Major Adverse Cardiovascular Outcomes in Patients with Type 2 Diabetes and Obesity. https://pubmed.ncbi.nlm.nih.gov/31475297/.

Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents. https://pubmed.ncbi.nlm.nih.gov/26544725/.

2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. https://pubmed.ncbi.nlm.nih.gov/36336720/.

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You are faced with a patient complaining of pelvic fullness. On DRE, you feel a submucosal bulge without palpating a tumour in the lumen. A CT scan confirms a pelvic mass. The biopsy reveals a spindle cell type gastrointestinal stromal tumour (GIST) positive for CD117. 
Join Dr. Carole Richard, Dr. François Dagbert and Dr. Maher Al Khaldi in their conversation about the diagnosis and management of rectal GIST. 
Learning objectives 
–       To explain the origin of rectal GISTs
–       To recognize the prognostic factors associated with rectal GISTs
–       To understand the management of rectal GISTs in the era of Imatinib 
–       To list the surgical approaches for rectal GIST resection

*Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed robotic general surgery procedures. If you are a general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs,  reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com for more information on how you could be compensated $500 per video submitted of each (up to $1000 per surgeon).

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In this episode, our transplant team will discuss an article that reviews normothermic machine perfusion including how it has evolved over the years, current benefits and challenges, as well as future directions. 
Learning objectives:
·      Understand the current role of machine perfusion in renal transplantation
·      Describe historical and current limitations of machine perfusion for abdominal organ transplantation
·      Review the benefits of improved and expanded preservation techniques

References:
1.     Hamelink, T. L., Ogurlu, B., de Beule, J., Lantinga, V. A., Pool, M. B. F., Venema, L. H., Leuvenink, H. G. D., Jochmans, I., & Moers, C. (2022). Renal Normothermic Machine Perfusion: The Road Toward Clinical Implementation of a Promising Pretransplant Organ Assessment Tool. In Transplantation (Vol. 106, Issue 2). https://doi.org/10.1097/TP.0000000000003817

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Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

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Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

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Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

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Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

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Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

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Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

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Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

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Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

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Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

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Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

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Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

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Welcome to the fifth of a six-part series focused on the integration of palliative care into the practice of surgery.   In this episode, we discuss nonbeneficial surgery (and how best to avoid it) as well as care of the imminently dying patient.

Nonbeneficial surgery is best defined as surgery that fails to meet the goals of the patient.   As our surgical patients become older and more medically complex, we must be aware of the factors which lead to nonbeneficial surgery – including patient, surrogate, system, and surgeon factors – and how best to approach each of these to avoid causing harm to our patients.  Nonbeneficial surgery not only causes harm to the patient, but can also cause harm to the surgical team, in the form of moral distress/injury.  Focusing on patients’ goals of care can help us to avoid nonbeneficial surgery.

One of the benefits of integrating palliative medicine into the practice of surgery is that there is never “nothing left to do.”  By learning how to recognize and then care for the imminently dying patient, as well as by having a basic understanding of the Medicare hospice benefit, we can support and care for the patient (and the family) beyond the operating room. 

Non-Beneficial Surgery:

Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution.
https://pubmed.ncbi.nlm.nih.gov/24866541/

Surgeons’ perspectives on avoiding nonbeneficial treatments in seriously ill older patients with surgical emergencies: a qualitative study.
https://pubmed.ncbi.nlm.nih.gov/27105058/

The association between factors promoting beneficial surgery and moral distress: a national survey of surgeons.
https://pubmed.ncbi.nlm.nih.gov/33214444/

The Imminently Dying Patient and Hospice:

Fast Fact #3:  Syndrome of Imminent Death
https://www.mypcnow.org/fast-fact/syndrome-of-imminent-death/

Fast Fact #82:  Medicare Hospice Benefit – Part 1: Eligibility and Treatment
https://www.mypcnow.org/wp-content/uploads/2019/01/FF-82-Medicare-Hospice.-1-3rd-Ed-1.pdf

Fast Fact #87:  Medicare Hospice Benefit – Part 2: Places of Care and Funding 
https://www.mypcnow.org/wp-content/uploads/2019/01/FF-87-Medicare-Hospic-2-4th-Ed.pdf

Fast Fact #140:  Medicare Hospice Benefit – Levels of Hospice Care
https://www.mypcnow.org/fast-fact/medicare-hospice-benefits-levels-of-hospice-care/

Dr. Red Hoffman (@redmdnd) is an acute care surgeon and associate hospice medical director in Asheville, North Carolina, host of the Surgical Palliative Care Podcast (@surgpallcare) and co-founder of the recently launched Surgical Palliative Care Society (www.spcsociety.org). 

Dr. Zara Cooper (@zaracMD) is an acute care surgeon at Brigham and Women’s Hospital where she serves as Kessler Director for the Center of Surgery and Public Health (@csph_bwh).  She is a Professor of Surgery at Harvard Medical School, associate faculty at Adriane Labs, and adjunct faculty at the Marcus Institute for Aging Research.  

Dr. Amanda Stastny (@manda_plez) is a PGY-2 in the General Surgery program at Mountain Area Health Education Center (MAHEC) in Asheville, NC.

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Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

We do apologize for the overall audio quality!  We were spread out over a couple states and sometimes talk over one another.

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Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

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Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

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Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

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Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

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Join us for the BTK Throwback episode!  Dr. Kenneth Mattox, a US legend in Trauma surgery, discusses retroperitoneal hematomas and the ever changing field of surgery.

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Emergency abdominal wall surgery is a common scenario for all general surgeons. Decision making with regard to operative approach and mesh utilization can be confusing. This podcast will review the common circumstances and highlight advanced decision making.  

·       Dr. Vahagn Nikolian is an Assistant Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair. 
·       Dr. Sean Orenstein is an Associate Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair.

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Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2

If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.   

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

Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2

If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.   

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

Dipping your toes in the water of surgical education research can be a daunting task if you have no prior experience, even if you have done basic or clinical research before. How do you create a good surgical education research project? How can clinicians get involved in and find mentors for surgical education research? Is formal postgraduate training becoming necessary for a career in surgical education? Luckily, we invite Dr. Jon Sherbino and Dr. Lara Varpio, hosts of the successful KeyLIME (Key Literature in Medical Education) podcast to share their valuable insights on medical education research with us. Check out KeyLIME on their website at https://keylimepodcast.libsyn.com/ and subscribe to KeyLIME on iTunes, Spotify, or Google podcasts!

Learning Objectives
1.     Listeners will identify that surgical education applies the same rigor as other areas of research.
2.     Listeners will describe how observations within clinical practice and review of literature can lead to creation of a good research question.
3.     Listeners will describe how research questions should align with theory and methodology, which then align with conclusions for a research project.
4.     Listeners will identify that collaboration with colleagues with expertise in surgical education research, including education scientists, is important for successful completion of research with high rigor. 
5.     Listeners will recognize advantages and disadvantages to formal training in education research, including fellowship and master’s degree programs.

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

If you liked this episode, check out other Surgical Education videos here: https://behindtheknife.org/podcast-category/surgical-education/

Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2

If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.   

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

Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2

If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.   

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

Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2

If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.   

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

Join our Miami Trauma team including Drs. Urréchaga, Neeman, and Rattan as they dive into the literature regarding a topic that has become all too common to the US news cycle- gun violence. They will go over a recent paper from JAMA and include other important literature while trying to understand this complex problem that has been grappling US public policy. 

Quick Hits:

1.     Firearm injury is the leading cause death in the US among ages 1-19
2.     For every person killed violently by someone else with a firearm, there are 3 survivors. 
3.     Gun ownership triples the risk of homicide
4.     Permit laws and preventing people convicted of a violent crime from owning a firearm decrease firearm-related death and have a positive ripple effect even outside state borders. In short, for effective reductions of firearm-related injury and death, federal legislation will be more effective than state-by-state

References

1.     Liu, Y, Siegel, M, Sen, B. Association of State-Level Firearm-Related Deaths With Firearm Laws in Neighboring States. JAMA Network Open. 2022;5(11):e2240750. doi:10.1001/jamanetworkopen.2022.40750
2.     Goldstick, JE, Cunningham, RM, Carter, PM. Current Causes of Death in Children and Adolescents in the United States. N Engl J Med. 2022 May 19;386(20):1955-1956. doi: 10.1056/NEJMc2201761. 

3.     Kellermann, AL, Rivara, FP, Rushforth, NB, Banton, JG, Reay, DT, Francisco, JT, Locci, AB, Prodzinski, J, Hackman, BB, Somes, G. Gun Ownership as a Risk Factor for Homicide in the Home. N Engl J Med 1993; 329:1084-1091. DOI: 10.1056/NEJM199310073291506

4.     Liu Y, Siegel, M, Sen, B. Neighbors do matter: between-state firearm laws and state firearm-related deaths in the US, 2000-2017. Am J Prev Med. 2020;59(5):648-657. doi:10.1016/j.amepre.2020.06.022
5.     Siegel, M, Pahn, M, Xuan, Z, et al. Firearm-related laws in all 50 US states,1991-2016. Am J Public Health.2017; 107(7):1122-1129. doi:10.2105/AJPH.2017.303701
6.     Kalesan, B, Mobily, ME, Keiser, O, Fagan, J, Galea, S. Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study. Lancet. 2016 Apr 30;387(10030):1847-55. doi: 10.1016/S0140-6736(15)01026-0.

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

If you liked this episode, check out other Journal Review episodes here: https://behindtheknife.org/podcast-series/journal-review/

Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2

If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.

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

Behind the Knife ABSITE 2023 – high yield learning to help you DOMINATE the exam.

Don’t forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2

If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.   

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

De novo metastatic breast cancer represents 6% of all new breast cancer diagnoses. This figure has not changed at all over the past 20 years; however, systemic therapy options have evolved dramatically during this time and have significantly increased life expectancy for these patients. While surgical management of the primary tumor in the setting of metastatic disease has typically been reserved for palliative indications, surgeons are now being asked to consider resecting the primary tumor to potentially increase overall survival. In this episode, we will use a case study to examine the data that should inform our conversations and decisions when we encounter patients with metastatic breast cancer who are interested in having their primary tumor resected.

Links:
§  Khan, S.A., S. Schuetz, and O. Hosseini (2022). Primary-Site Local Therapy for Patients with De Novo Metastatic Breast Cancer: An Educational Review. Ann Surg Oncol; 29: 5811-5820. https://link.springer.com/article/10.1245/s10434-022-11900-x
§  Khan, S.A. et al (2022). Early Local Therapy for the Primary Site in De Novo Stage IV Breast Cancer: Results of a Randomized Clinical Trial (E2108). J Clin Oncol; 40(9): 978-987. https://ascopubs.org/doi/10.1200/JCO.21.02006?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
§  Badwe, R. et al (2015). Locoregional treatment versus no treatment of the primary tumor in metastatic breast cancer: an open-label randomized controlled trial. Lancet Oncol; 16: 1380-1388. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00135-7/fulltext
§  Fitzal, F. et al (2019). Impact of Breast Surgery in Primary Metastasized Breast Cancer: Outcomes of the Prospective Randomized Phase III ABCSG-28 POSYTIVE Trial. Ann Surg; 269(6): 1163-1169. https://journals.lww.com/annalsofsurgery/Abstract/2019/06000/Impact_of_Breast_Surgery_in_Primary_Metastasized.24.aspx
§  Soran, A. et al (2018). Randomized Trial Comparing Resection of Primary Tumor with No Surgery in Stage IV Breast Cancer at Presentation: Protocol MF07-01. Ann Surg Oncol; 25: 3141-3149. https://link.springer.com/article/10.1245/s10434-018-6494-6

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

If you liked this episode, check out our other clinical challenges episodes here: https://behindtheknife.org/podcast-series/clinical-challenges/

The cardiac OR can be a daunting place for any medical student or resident who finds themself on a cardiac surgery rotation. Have no fear, this Cardiac Surgery Crash Course is a short series focused on high-yield topics to help introduce students and residents to cardiac surgery prior to or during a cardiac surgery rotation. In this episode join Dr. Aaron Williams and our education fellow Dr. Jessica Millar as they break down ICU monitoring and hemodynamics of post-op cardiac surgery patients. 
If you have any suggestions or requests for this series, please feel free to reach out to us by email: 
Jessica Millar: millarje@med.umich.edu
Inotrope/Pressor Reference Card: 
https://i0.wp.com/emcrit.org/wp-content/uploads/2020/02/pressortable.jpg?resize=1536%2C1345&ssl=1

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

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

The cardiac OR can be a daunting place for any medical student or resident who finds themself on a cardiac surgery rotation. Have no fear, this Cardiac Surgery Crash Course is a short series focused on high-yield topics to help introduce students and residents to cardiac surgery prior to or during a cardiac surgery rotation. In this episode join Dr. Aaron Williams and our education fellow Dr. Jessica Millar as they break down the principles of Coronary Artery Bypass Grafting (CABG). 
If you have any suggestions or requests for this series, please feel free to reach out to us by email: 
Jessica Millar: millarje@med.umich.edu

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

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

The cardiac OR can be a daunting place for any medical student or resident who finds themself on a cardiac surgery rotation. Have no fear, this Cardiac Surgery Crash Course is a short series focused on high-yield topics to help introduce students and residents to cardiac surgery prior to or during a cardiac surgery rotation. In this episode join Dr. Nick Teman and our education fellow Dr. Jessica Millar as they break down the principles of cardiopulmonary bypass. 
If you have any suggestions or requests for this series, please feel free to reach out to us by email: 
Jessica Millar: millarje@med.umich.edu
Helpful Images: 
Cannula Insertion for Cardiopulmonary Bypass
https://www.uptodate.com/contents/image?imageKey=CARD%2F97188
Cardiopulmonary Bypass Machine
https://www.ebme.co.uk/images/arts/cpb/cardiopulmonary-bypass-machine-2.jpg

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

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

The cardiac OR can be a daunting place for any medical student or resident who finds themself on a cardiac surgery rotation. Have no fear, this Cardiac Surgery Crash Course is a short series focused on high-yield topics to help introduce students and residents to cardiac surgery prior to or during a cardiac surgery rotation.  We will cover several of the most frequently performed operations, post-operative management, common consults, and other topics to help you ace your cardiac rotation.  In this episode join Dr. Nick Teman and our education fellow Dr. Jessica Millar as they introduce you to the cardiac OR. 
If you have any suggestions or requests for this series, please feel free to reach out to us by email: 
Jessica Millar: millarje@med.umich.edu

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

If you liked this episode, check out our collection of episodes here: https://behindtheknife.org/listen/all-series/

Historically, a paucity of data has existed in the most appropriate modality of critical care management of brain dead organ donors prior to organ harvest. In this episode, Drs. Bankhead, Dumas, and Park are joined by special guest Dr. Ashley McGinity, a director in the donor management unit the Center for Life at the UT Health Science Center in San Antonio, joins us to discuss modern and current practices in the management of these patients to maximize the gift for patients and families. 

References: 
https://pubmed.ncbi.nlm.nih.gov/24980425/ https://pubmed.ncbi.nlm.nih.gov/25978154/ 
https://pubmed.ncbi.nlm.nih.gov/31957104/ https://pubmed.ncbi.nlm.nih.gov/23116641/ https://pubmed.ncbi.nlm.nih.gov/28318674/ https://pubmed.ncbi.nlm.nih.gov/25056510/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145376/ 

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

If you liked this episode, check out other surgical critical care episodes here: https://behindtheknife.org/podcast-category/surgical-critical-care/

The dreaded Surgical Site Complications! Join Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross from our Emergency General Surgery Team as they discuss surgical site complications and prevention techniques.
Paper 1: Arnold et. al. (2019) Not a Routine Case, Why Expect the Routine Outcome? Quantifying the Infectious Burden of Emergency General Surgery Using the NSQIP. American Surgeon 

– NSQIP database 2005-2016 (>800,000 patients) including open/laparoscopic cholecystectomies, ventral hernia repairs, and partial colectomies 
– Comparing outcomes in emergent vs elective cases
– Primary outcome: aggregate of SSIs which includes wound disruption, superficial SSI, deep SSI, and organ space SSI 
– Results:
— ↑SSI in the emergency group (5.3% vs 3.6%) 
— When controlling for multiple variables, emergency surgery associated with more SSIs (OR 1.15).  

Paper 2: Lakhani et. al. (2022) Prophylactic negative pressure wound dressings reduces wound complications following emergency laparotomies: A systematic review and meta-analysis. Surgery 

– NPWD remove excess fluid from subcutaneous space, ↓ collections/contaminants, promote angiogenesis, fibroblast infiltration  
– Literature review 2005-2022 (NPWD, laparotomy, SSI) 
– 1199 patients included (566 NPWD, 633 standard dressings) 
– Results:
— NPWD ↓ wound infection (OR 0.43) and wound breakdown (OR 0.36) 
— No change in LOS, readmission

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

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

In this episode, our team provides a comprehensive review of the differential diagnosis for mediastinal masses, their workup, and biopsy considerations. Listen as we dive deeper into the perioperative planning and operative approach for resection of these masses with special considerations for patients with thymoma. 

Learning Objectives:

-Discuss the differential diagnosis of a mediastinal mass

-Review the workup of a mediastinal mass

-Outline indications for biopsy and describe the various approaches

-Describe the operative techniques for thymectomy, pearls & potential pitfalls  

Hosts:

 Megan Lenihan MD, Kelly Daus MD, Peter White MD, and Brian Louie MD

Referenced Material

https://pubmed.ncbi.nlm.nih.gov/21847052/

Detterbeck FC, Nicholson AG, Kondo K, Van Schil P, Moran C. The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol. 2011 Jul;6(7 Suppl 3):S1710-6. doi: 10.1097/JTO.0b013e31821e8cff. PMID: 21847052.

https://pubmed.ncbi.nlm.nih.gov/33468329/

Ahmad U. The eighth edition TNM stage classification for thymic tumors: What do I need to know? J Thorac Cardiovasc Surg. 2021 Apr;161(4):1524-1529. doi: 10.1016/j.jtcvs.2020.10.131. Epub 2020 Nov 13. PMID: 33468329.

https://pubmed.ncbi.nlm.nih.gov/34695605/

Marx A, et al. The 2021 WHO Classification of Tumors of the Thymus and Mediastinum: What Is New in Thymic Epithelial, Germ Cell, and Mesenchymal Tumors? J Thorac Oncol. 2022 Feb;17(2):200-213. doi: 10.1016/j.jtho.2021.10.010. Epub 2021 Oct 22. PMID: 34695605.

https://pubmed.ncbi.nlm.nih.gov/22882218/

Meriggioli MN, Sanders DB. Muscle autoantibodies in myasthenia gravis: beyond diagnosis? Expert Rev Clin Immunol. 2012 Jul;8(5):427-38. doi: 10.1586/eci.12.34. PMID: 22882218; PMCID: PMC3505488.

https://pubmed.ncbi.nlm.nih.gov/34339670/

Raja SM, Guptill JT, McConnell A, Al-Khalidi HR, Hartwig MG, Klapper JA. Perioperative Outcomes of Thymectomy in Myasthenia Gravis: A Thoracic Surgery Database Analysis. Ann Thorac Surg. 2022 Mar;113(3):904-910. doi: 10.1016/j.athoracsur.2021.06.071. Epub 2021 Jul 30. PMID: 34339670.

Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed general surgery procedures. If you are a PGY4/5 general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com, for more information on how you could be compensated up to $400 for recording and submitting those videos.

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

If you liked this episode, check out other clinical challenge episodes here: https://behindtheknife.org/podcast-series/clinical-challenges/

In this episode from the Endocrine Surgery team at BTK we discuss how Dr. Yeh built the section of endocrine surgery at UCLA. From Sydney, Australia to Santa Monica, he discusses the risks and challenges involved in becoming a leader in academic endocrine surgery. In this podcast we answer the question “why endocrine surgery,” and mention tips for success at all level of training from medical students to early faculty. Finally, we take a moment to honor and remember Dr. Orlo Clark.

Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.

Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. Na Eun Kim is an Endocrine Surgery Fellow at UCLA in her first year of fellowship
Dr. Rivfka Shenoy is a PGY-6 General Surgery Resident at UCLA who has completed two years of research
Dr. Max Schumm is a PGY-6 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon.
Important Papers
Krishnamurthy VD, Gutnick J, Slotcavage R, Jin J, Berber E, Siperstein A, Shin JJ. Endocrine surgery fellowship graduates past, present, and future: 8 years of early job market experiences and what program directors and trainees can expect. Surgery. 2017 Jan;161(1):289-296. doi: 10.1016/j.surg.2016.06.069. Epub 2016 Nov 17. PMID: 27866719.
Krishnamurthy VD, Jin J, Siperstein A, Shin JJ. Mapping endocrine surgery: Workforce analysis from the last six decades. Surgery. 2016 Jan;159(1):102-10. doi: 10.1016/j.surg.2015.08.024. Epub 2015 Oct 9. PMID: 26456130.
Kulaylat AN, Kenning EM, Chesnut CH 3rd, James BC, Schubart JR, Saunders BD. The profile of successful applicants for endocrine surgery fellowships: results of a national survey. Am J Surg. 2014 Oct;208(4):685-9. doi: 10.1016/j.amjsurg.2014.03.013. Epub 2014 Jun 21. PMID: 25048570; PMCID: PMC4639920.

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

If you liked this episode, check out other Endocrine Surgery episodes here: https://behindtheknife.org/podcast-category/endocrine/

You have a young patient with longstanding Crohn’s disease with a history of small bowel resections presenting with recurrent obstructions from a stricture. The patient has exhausted all medical options and requires surgery. How should you work up this patient prior to surgery? Should you perform a bowel resection or perform a strictureplasty? Which strictureplasty do you choose and why? 
Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Fabrizio Michelassi as they discuss the management of small bowel strictures in Crohn’s disease. 
Learning Objectives
1. Describe the evaluation for small bowel strictures and indications for operating in patients with Crohn’s disease 
2. Discuss the different surgical options in managing small bowel strictures 
3. Explain the rationale behind use of different strictureplasty approaches

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

If you liked this episode, check out other Colorectal Surgery episodes here: https://behindtheknife.org/podcast-category/colorectal/

On this episode of the BIG T Trauma series Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill discuss hemodynamically unstable pelvic fractures.  These patients are sick!!  Really sick.  Join us for a practical discussion about the best way to manage gnarly pelvic fractures.  From binders to angioembolization to pelvic packing to REBOA, we cover it all.

Papers:

  1. Burlew et al, Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures. J Trauma 2017: https://pubmed.ncbi.nlm.nih.gov/27893645/
  2. McDonogh et al, Preperitoneal packing versus angioembolization for the initial management of hemodynamically unstable pelvic fracture: A systematic review and meta-analysis. J Trauma 2022: https://pubmed.ncbi.nlm.nih.gov/34991126/
  3. Li et al, Role of pelvic packing in the first attention given to hemodynamically unstable pelvic fracture patients: a meta-analysis, J ournal of Orthopaedics and Traumatology 2022: https://pubmed.ncbi.nlm.nih.gov/35799073/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

If you liked this episode, check out the rest of the BIG T trauma series here: https://behindtheknife.org/podcast-series/big-t-trauma/

In the second episode of the “Innovations in Surgery” series, Behind the Knife’s surgical education fellow, Dr. Dan Scheese, sits down with Dr. Michael Amendola and Dr. Diana Otoya to discuss 3D Printing and its role in medicine and surgery. They speak on the history of this technology and the current utility in preoperative planning and intraoperative application. 
Looking for information on getting involved in 3D Printing?
Link to the VHA Office of Advanced Manufacturing: https://www.innovation.va.gov/oam/views/about/whoweare.html
Link to information regarding the 3D printing fellowship: https://www.innovation.va.gov/oam/views/training/training.html
Additionally, you can contact Dr. Michael Amendola or Dr. Diana Otoya for more information regarding the 3D printing surgical fellowship.
Dr. Michael Amendola: michael.amendola@va.gov
Dr. Diana Otoya: Diana.Otoya@vcuhealth.org
Dr. Amendola also has a website for mentorship and other information: https://michaelamendola.com/
Download free 3D designs that are ready to print at https://www.thingiverse.com/
Lastly, anyone that has access to a VA can take the TMS module Dr. Amendola created. TMS: 3D Printing in the VA Health Care System: Building the Hospital of the Future. Item: 45343
Goes through history, types of printers, and basic medical information you need for 3D printing. Good intro lecture/ free education to any trainee within the VA. 
https://www.tms.va.gov/SecureAuth35/
Dr. Amendola has received his medical degree, completed his general surgery residency and vascular surgery fellowship at Virginia Commonwealth University. He is board certified by the American Board of Surgery in both general and vascular surgery. In 2021 he was inducted into the American College of Surgeons Academy of Master Surgeon Educators. He maintains privileges at Central Virginia VA Health Care System in Richmond, Virginia and is a Professor of Surgery at VCU-SOM.  Additionally, he is the program director of the Office of Advance Manufacturing’s Central Virginia VA Health Care System based 3D Printing Surgical Fellowship. 
Dr. Diana Otoya is a third-year general surgery resident at VCU. She spent her first research year as a Veterans Health Administration (VHA) Chief Resident in Quality and Safety at the Central Virginia Health Care System while also becoming the inaugural fellow for the VHA 3D Printing Surgical Fellowship. She is now currently in her second year in the 3D Printing fellowship program. 

Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed general surgery procedures. If you are a PGY4/5 general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com, for more information on how you could be compensated up to $400 for recording and submitting those videos.

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

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

Join our surgical education fellow, Dr. Dan Scheese as he kicks off a brand new BTK series titled “Innovations in Surgery.” This series will take a deeper look into past, present, and future innovations that have, or will, revolutionize the field of surgery. In this inaugural episode, Dr. Scheese and Dr. Patrick Georgoff sit down with a leader in the surgical artificial intelligence field, Dr. Daniel Hashimoto. They cover what surgical artificial intelligence is, go over some common terminology used in AI, talk about current applications of AI in the OR, and finally discuss the future of AI in surgery.

Artificial Intelligence in Surgery: Promises and Perils” – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995666/

Video – Application of AI in the OR – https://youtu.be/kabcjtdI308

Daniel Hashimoto is assistant professor of surgery at the Hospital of the University of Pennsylvania and director of the Penn Computer Assisted Surgery and Outcomes (PCASO) Laboratory. He received his MD and MS in translational research from the University of Pennsylvania and completed his general surgery training at Massachusetts General Hospital and Harvard Medical School, where he was also associate director of research of the Surgical AI & Innovation Laboratory. He is vice-chair and co-founder of the Global Surgical AI Collaborative, a nonprofit that oversees and manages a global data-sharing and analytics platform for surgical data. His work focuses on the use of computer vision for the delivery of intraoperative decision support and assessment of surgical performance. He is editor of the textbook Artificial Intelligence in Surgery: Understanding the Role of AI in Surgical Practice, which provides a nontechnical foundation on key concepts in artificial intelligence as it applies to surgical care.

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

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

You get called to the ED to evaluate a patient with abdominal pain who is in extreme pain but without any helpful physical exam findings. Time is gut in mesenteric ischemia, so how do you prioritize your workup, initial treatment, and what do you do once you’ve made the diagnosis? In this episode of Behind the Knife, the vascular surgery team discusses all this and more by walking through a real case and talking through the principles of management as well as some helpful tips on how to actually get through these tough clinical scenarios. 

Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan and the Program Director of the Integrated Vascular Surgery Residency Program as well as the Vascular Surgery Fellowship Program at the University of Michigan.

Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan.

Dr. Craig Brown is a PGY-7 in the General Surgery program and recently matched 2023 vascular fellow at the University of Michigan.

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

Check out our Vascular Surgery Oral Board Review Book here: https://www.amazon.com/Vascular-Surgery-Oral-Board-Review/dp/0578382296/ref=sr_1_3?crid=1IF8LX547EOEA&keywords=behind+the+knife&qid=1666184084&qu=eyJxc2MiOiIxLjM3IiwicXNhIjoiMC43MCIsInFzcCI6IjAuNTgifQ%3D%3D&sprefix=behind+the+knife%2Caps%2C57&sr=8-3&ufe=app_do%3Aamzn1.fos.f5122f16-c3e8-4386-bf32-63e904010ad0

What’s the one clinical scenario where you can really save a patient’s life with a pancreatectomy? An IPMN with high-grade dysplasia! Join the Behind the Knife HPB Team for a deep dive into the complex decision-making surgical management of IPMNs.
Learning Objectives
In this episode, we review the basics of intraductal papillary mucinous neoplasms, how to evaluate patients with a cystic mass of the pancreas, guidelines for surveillance, and indications for resection. We discuss key concepts such as Worrisome Features and High-Risk Stigmata and how those influence surgical decision-making, and tackle a few of the most challenging scenarios surgeons may face when treating patients with IPMNs.

Hosts
:
Timothy Vreelant, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center
Daniel Nelson, DO, FACS (@DWNelsonHPB) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center
Connor Chick, MD (@connor_chick) is a PGY-6 General Surgery resident at Brooke Army Medical Center
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-5 General Surgery resident at Brooke Army Medical Center
Beth Carpenter, MD (@elizcarpenter16) is a PGY-4 General Surgery resident at Brooke Army Medical Center

Links to Papers Referenced in this Episode
Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas
Pancreatology. 2017 Sep-Oct;17(5):738-753.
https://pubmed.ncbi.nlm.nih.gov/28735806/
Number of Worrisome Features and Risk of Malignancy in Intraductal Papillary Mucinous Neoplasm. 
J Am Coll Surg. 2022 Jun 1;234(6):1021-1030. 
https://pubmed.ncbi.nlm.nih.gov/35703792/
Extent of Surgery and Implications of Transection Margin Status after Resection of IPMNs. 
Gastroenterology Research and Practice 2014, 1–10.
https://pubmed.ncbi.nlm.nih.gov/25276122/

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

If you liked this episode, check out other Hepatobiliary Surgery episodes here: https://behindtheknife.org/podcast-category/hepatobiliary/

Gallbladders – bread and butter cases or underestimated challenges? Join Dr. Patrick Georgoff and Dr. Shanaz Hossain as they sit down with Dr. Eric Knauer to discuss difficult gallbladders. In this episode, we discuss the SAGES Safe Cholecystectomy program that were created in an effort to decrease the incidence of bile duct injuries. The six strategies outlined in the program include: 
1.    Use the Critical View of Safety (CVS) method of identification of the cystic duct and cystic artery during laparoscopic cholecystectomy.

2.    Understand the potential for aberrant anatomy in all cases.

3.    Make liberal use of cholangiography or other methods to image the biliary tree intraoperatively.

4.    Consider an Intra-operative Momentary Pause during laparoscopic cholecystectomy prior to clipping, cutting or transecting any ductal structures.

5.    Recognize when the dissection is approaching a zone of significant risk and halt the dissection before entering the zone. Finish the operation by a safe method other than cholecystectomy if conditions around the gallbladder are too dangerous.

a.    Subtotal Cholecystectomies – Learn more with this landmark paper: http://dx.doi.org/10.1016/j.jamcollsurg.2015.09.019

6.    Get help from another surgeon when the dissection or conditions are difficult.

Take a look at all their great explanations and catch all the important points by completing the online program: https://www.sages.org/safe-cholecystectomy-program/

Dr. Eric Knauer is an assistant professor surgery at Emory University. He has recently published regarding the management of laparoscopic common bile duct stones in General Surgery News and, more importantly, was awarded the junior residents’ teaching award. Check out his great educational videos to learn more:
·      Cholecystectomy: https://youtu.be/_oMNRINPY5I
Laparoscopic Common Bile Duct Exploration: https://youtu.be/mXl11I7mya0

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

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

Does surgery have a leaky pipeline problem?  What is it like for LGBTQ+ students, trainees, and faculty to be in the field of surgery?  In this Journal Club episode, we review recent research and calls to action that illuminate these and other questions in the field.  We’re joined by a panel of guests from all levels of training, including Eric Pillado MD MS, Christopher Digesu MD, Jessica Halem MBA, and Michaela West MD PhD. 
Learning Objectives:
·       Identify hazards for LGBTQ+ trainees in surgery
·       Describe potential actions to improve LGBTQ+ inclusivity in surgery
·       Correlate the provision of LGBTQ+ health care and the wellbeing of LGBTQ+ staff
References:
Experiences of LGBTQ+ Residents in US General Surgery Training Programs – https://doi.org/10.1001/jamasurg.2021.5246 
Invited Commentary – Discrimination, Harassment, and Bullying Is Reported to Be High by LGBTQ+ Surgical Residents – https://doi.org/10.1001/jamasurg.2021.5272 
LGBTQ+ Inclusivity in Surgery—A Call to Action – https://doi.org/10.1001/jamasurg.2021.6777 
Being queer without proximal or distal control – https://vascularspecialistonline.com/being-queer-without-proximal-or-distal-control/

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

If you liked this episode, check out other Surgical Education episodes herehttps://behindtheknife.org/podcast-category/surgical-education/

In this episode, our team discusses the management of traumatic rib fractures including pearls and pitfalls. Join as we discuss the current standards of treatment as well as controversies in how to manage these patients!

Hosts: 
Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST) and incoming editor-in-chief of Trauma Surgery and Acute Care Open.
Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins. 
David Sigmon, MD, MMEd, a PGY-7 resident at the University of Illinois at Chicago who will be a fellow at Lincoln Medical Center in the Bronx next year. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education. 

LITERATURE

  1. Terry SM, Shoff KA, Sharrah ML. Improving blunt chest wall injury outcomes: introducing the pic score. J Trauma Nurs. 2021;28(6):386-394.
    https://pubmed.ncbi.nlm.nih.gov/34766933/
  2. Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surg Acute Care Open. 2017;2(1):e000064.
    https://tsaco.bmj.com/content/2/1/e000064
  3. Utter GH, McFadden NR. Rib fractures, the evidence supporting their management, and adherence to that evidence base. JAMA Netw Open. 2020;3(3):e201591-e201591.
    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2763488
  4. Dehghan N, Nauth A, Schemitsch E, et al. Operative vs nonoperative treatment of acute unstable chest wall injuries: a randomized clinical trial. JAMA Surgery. Published online September 21, 2022.
    https://jamanetwork.com/journals/jamasurgery/article-abstract/2796556
  5. Kasotakis G, Hasenboehler EA, Streib EW, et al. Operative fixation of rib fractures after blunt trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):618-626.
    https://pubmed.ncbi.nlm.nih.gov/28030502/

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

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

On the University of Washington Minimally Invasive Surgery team’s search for value no piggy bank is safe and no couch cushion will be left unturned. Tune in to hear Drs. Mike Weykamp, Nicole White, Nick Cetrulo, and Andrew Wright discuss the state of the literature regarding the cost-effectiveness of robot assisted surgery. 
Referenced Articles: 
1.     Ye L, Childers CP, de Vigilio M, Shenoy R, Mederos MA, Mak SS, Begashaw MM, Booth MS, Shekelle PG, Wilson M, Gunnar W, Girgis MD, Maggard-Gibbons M. Clinical Outcomes and Cost of Robotic Ventral Hernia Repair: Systematic Review. BJS Open. 2021. 
https://pubmed.ncbi.nlm.nih.gov/34791049/ 
2.     Finlayson SRG and Birkmeyer JD. Cost-effectiveness Analysis in Surgery. Surgery. 1998
https://pubmed.ncbi.nlm.nih.gov/9481400/
3.     Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu R, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 Explanation and Elaboration: A Report of the ISPOR CHEERS II Good Practices Task Force. Value Heatlh. 2022. 
https://pubmed.ncbi.nlm.nih.gov/35031088/ 

Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed general surgery procedures. If you are a PGY4/5 general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com, for more information on how you could be compensated up to $400 for recording and submitting those videos.

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
If you liked this episode, check out other minimally invasive episodes here: https://behindtheknife.org/podcast-category/minimally-invasive/
You’ve finally submitted your ERAS application! As residency programs start to review your application, it’s time to start preparing for the next step- the interview. Join our education fellow, Dr. Jessica Millar, and Dr. Jeremy Lipman as they go over all the ways to start preparing to dominate your interviews. 
Guests:
Jeremy Lipman, MD, MHPE- Professor of Colorectal Surgery, Designated Institutional Official, Director of Graduate Medical Education, and previous General Surgery Residency Program Director- Cleveland Clinic, OH
Most Commonly Asked Interview Questions: 
·      “Tell me about yourself”- have a 2-3 minute “elevator talk” rehearsed 
·      “Where do you see yourself in 5/10-years”
·      “Why surgery?”
·      “Tell me about a challenge you’ve had to overcome” 
·      “Tell me about a difficulty patient/team situation you’ve witnessed”- key here is to not throw anyone under the bus
·      “Why are you interested in our program” 
AAMC List of Common Interview Questions: 
https://students-residents.aamc.org/interviewing-residency-positions/questions-frequently-asked-applicants-during-interviews

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

If you liked this episode, check out the rest of our “Dominate the Match Series” here: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/

The number of patients seeking evaluation for revisional bariatric surgery is increasing. Wondering how to approach the work-up for these patients and what surgical options may be best for them? An introduction to the work-up and potential revisional bariatric surgery options are included in this episode from your bariatric surgery team at UNMC!

Hosts:
Ivy Haskins, MD
Corrigan McBride, MD
Tiffany Tanner, MD

Journal Articles discussed:

1.     Berger ER, Clements RH, Morton JH, Huffman KM, Wolfe BM, Nguyen NT, Ko CY, Hutter MM. The Impact of Different Surgical Techniques on Outcomes in Laparoscopic Sleeve Gastrectomies: The First Report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Ann Surg. 2016; 264.3: 464-473.
2.     Haskins IN, Jackson HT, Graham AE, Chen S, Sparks AD, Lin PP, Vaziri K. The Effect of Bougie Size and Distance from the Pylorus on Dehydration after Laparoscopic Sleeve Gastrectomy: An Analysis of the ACS-MBSAQIP Database. Surg Obes Relat Dis. 2019; 15.10: 1656-1661.
3.     Toro JP, Lin E, Patel AD, Davis SS, Sanni A, Urrego HD, Sweeney JF, Srinivasan JK, Small W, Mittal P, Sekhar A, Moreno CC. Association of Radiographic Morphology with Early Gastroesophageal Reflux Disease and Satiety Control after Sleeve Gastrectomy. J Am Coll Surg. 2014; 219.3: 430-438.
4.     Maselli DB, Alqahtani AR, Dayyeh BKA, Elahmedi M, Storm AC, Matar R, Nieto J, Teixeira A, Al Khatry M, Neto MG, Kumbhari V, Vargas EJ, Jaruvongvanich V, Mundi MS, Deshumkh A, Itani MI, Farha J, Chapman CG, Sharaiha R. Revisional Endoscopic Sleeve Gastroplasty of Laparoscopic Sleeve Gastrectomy: An International, Multicenter Study.
5.     Campos GM, Mazzini GS, Altieri MS, Docimo S, DeMaria EJ, Rogers AM. ASMBS Position Statement on the Rationale for Performance of Upper Gastrointestinal Endoscopy Before and After Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2021; 17.5: 837-847.

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

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

In this episode we discuss two interesting cases in transplant surgery. In the first, we review a case in which a renal cell carcinoma was discovered during the backbench portion of a deceased donor kidney transplant procedure. In the second, we examine the unique challenges that are presented by simultaneous heart-liver transplantation.
Learning Objectives:
– Discuss renal cell carcinoma in the immunosuppressed patient
– Review some of the logistical components that accompany dual organ transplants
– Examine the clinical challenge of a heart-liver transplant
Hosts:
– Megan Lombardi, MD
– Sasha McEwan, MD
– Guilherme de Oliveira, MD
– Alexander Toledo, MD
– David Gerber, MD

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

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

You are faced with a young patient with ileal Crohn’s disease. He requires an ileocolic resection. Which type of anastomosis do you perform? You also see another patient with complex perianal fistulas and the patient asks about the safety and efficacy of stem cells for fistula closure. What do you tell the patient?
Join Dr. Carole Richard, Dr. François Dagbert and Dr. Maher Al Khaldi in their conversation about the Kono-S anastomosis after ileocolic resections and stem cell therapy for perianal complex fistulas for Crohn’s disease. 
Learning objectives 
–       To understand the rationale for the Kono-S anastomosis and the way it is fashioned. 
–       To explain the possible advantages of the Kono-S anastomosis following ileocolic resection.
–       To explain the possible advantages of stem cell therapy for complex perianal fistulas.
–       To understand which patient population might be eligible for future stem cell therapy for complex perianal fistulas. 
References
In order throughout the episode:
Article 1: Luglio G, Rispo A, Imperatore N, Giglio MC, Amendola A, Tropeano FP, Peltrini R, Castiglione F, De Palma GD, Bucci L. Surgical Prevention of Anastomotic Recurrence by Excluding Mesentery in Crohn’s Disease: The SuPREMe-CD Study – A Randomized Clinical Trial. Ann Surg. 2020 Aug;272(2):210-217. doi: 10.1097/SLA.0000000000003821. PMID: 32675483. 
Article 2: Panés J, García-Olmo D, Van Assche G, Colombel JF, Reinisch W, Baumgart DC, Dignass A, Nachury M, Ferrante M, Kazemi-Shirazi L, Grimaud JC, de la Portilla F, Goldin E, Richard MP, Leselbaum A, Danese S; ADMIRE CD Study Group Collaborators. Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn’s disease: a phase 3 randomised, double-blind controlled trial. Lancet. 2016 Sep 24;388(10051):1281-90. doi: 10.1016/S0140-6736(16)31203-X. Epub 2016 Jul 29. PMID: 27477896.

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

If you liked this episode, check out our library of colorectal episodes and videos here: https://behindtheknife.org/podcast-category/colorectal/

Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss  management of congenital diaphragmatic hernia in pediatric surgery. 
Journal Article links: 
Jancelewicz T, Brindle ME. Prediction tools in congenital diaphragmatic hernia. Semin Perinatol 2020;44(1):151165.
https://pubmed.ncbi.nlm.nih.gov/31676044/

Deprest JA, Benachi A, Gratacos E, Nicolaides KH, Berg C, Persico N, et al. Randomized Trial of Fetal Surgery for Moderate Left Diaphragmatic Hernia. N Engl J Med 2021;385(2):119-29.
https://pubmed.ncbi.nlm.nih.gov/34106555/

Deprest JA, Nicolaides KH, Benachi A, Gratacos E, Ryan G, Persico N, et al. Randomized Trial of Fetal Surgery for Severe Left Diaphragmatic Hernia. N Engl J Med 2021;385(2):107-18.
https://www.nejm.org/doi/full/10.1056/NEJMoa2027030

Guner Y, Jancelewicz T, Di Nardo M, Yu P, Brindle M, Vogel AM, et al. Management of Congenital Diaphragmatic Hernia Treated With Extracorporeal Life Support: Interim Guidelines Consensus Statement From the Extracorporeal Life Support Organization. ASAIO J 2021;67(2):113-20.
https://pubmed.ncbi.nlm.nih.gov/33512912/

Yang MJ, Russell KW, Yoder BA, Fenton SJ. Congenital diaphragmatic hernia: a narrative review of controversies in neonatal management. Transl Pediatr 2021;10(5):1432-47.
https://pubmed.ncbi.nlm.nih.gov/34189103/

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

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

What is the value of completion lymph node dissection for patients with melanoma with sentinel-node metastases?
The Multicenter Selective Lymphadenectomy Trial-1 (MSLT-1) confirmed that SLNB is an important part in the treatment of patients with melanoma, but what needed to be done beyond that in managing the axilla? 
Learning Objectives: 
In this episode, we review perioperative chemotherapy regimens for locally advanced, resectable Gastric cancer, standard of care, and the future role for immunotherapy. 
Hosts: 
Adam Yopp, MD, FACS (@AdamYopp) is an Associate Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program.
Caitlin Hester, MD (@CaitlinAHester) is a new Assistant Professor of Surgery at the University of Miami
Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-4 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research.
Papers Referenced in this Episode:
Final Trial Report of Sentinel-Node Biopsy versus Nodal Observation in Melanoma
Morton et al.
https://www.nejm.org/doi/full/10.1056/nejmoa1310460
Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma
Faries et al.
https://www.nejm.org/doi/full/10.1056/nejmoa1613210

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

If you liked this episode, check out our Journal Review Series here: https://behindtheknife.org/podcast-series/journal-review/

Our oral board review course includes 92 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.

Learn more about the Oral Board Review episodes at https://behindtheknife.org/premium/

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

Our oral board review course includes 92 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.

Learn more about the Oral Board Review episodes at https://behindtheknife.org/premium/

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

Welcome to the second Surgical Palliative Care Journal Club, number four of a six-part series focused on the integration of palliative care into the practice of surgery.  Join us as we discuss the value of utilizing an advance care planning video during surgical oncologic care and define the similarities and differences between advance care planning and serious illness communication.  We then explore how a multidisciplinary committee may improve perioperative decision making and discuss the importance of the interdisciplinary palliative care team.   
Please use the links below to learn more about advance care planning and serious illness conversation.
Integrating Advance Care Planning Videos into Surgical Oncologic Care:  A Randomized Clinical Trial
https://pubmed.ncbi.nlm.nih.gov/30964385/
A Multidisciplinary High-Risk Surgery Committee May Improve Perioperative Decision Making for Patients and Physicians
https://pubmed.ncbi.nlm.nih.gov/34851187/
What’s Wrong with Advance Care Planning?
https://pubmed.ncbi.nlm.nih.gov/34623373/
Shifting to Serious Illness Conversation
https://pubmed.ncbi.nlm.nih.gov/34994773/
Serious Illness Care Program/ Serious Illness Communication Guide
https://www.ariadnelabs.org/serious-illness-care/serious-illness-care-program/
Dr. Red Hoffman (@redmdnd) is an acute care surgeon and associate hospice medical director in Asheville, North Carolina, host of the Surgical Palliative Care Podcast (@surgpallcare) and co-founder of the recently launched Surgical Palliative Care Society (www.spcsociety.org). 
Dr. Zara Cooper (@zaracMD) is an acute care surgeon at Brigham and Women’s Hospital where she serves as Kessler Director for the Center of Surgery and Public Health (@csph_bwh).  She is a Professor of Surgery at Harvard Medical School, associate faculty at Adriane Labs, and adjunct faculty at the Marcus Institute for Aging Research.  
Dr. Amanda Stastny (@manda_plez) is a PGY-3 in the General Surgery program at Mountain Area Health Education Center (MAHEC) in Asheville, NC.

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

If you liked this episode, check out other Palliative Care episodes here: https://behindtheknife.org/podcast-category/palliative-care/

Surgical training is evolving, and with advancing surgical techniques, the traditional “time-served” model of residency may not best serve the needs of our learners or patients.  In this episode, we discuss recent efforts at the Indiana University surgical education program to implement a comprehensive laparoscopic cholecystectomy that utilizes all of the best practices of competency-based education.  We’re joined by first author Dr. Betsy Huffman, along with her mentors Drs. Jennifer Choi, Matthew Ritter, and Dimitrios Stefanidis for a practical review of their pioneering work.
Learning Objectives:
·       Review challenges to the current paradigm of surgical education
·       Define competency-based education
·       Discuss practical challenges facing surgical educators when implementing new curricula
References:
A competency-based laparoscopic cholecystectomy curriculum significantly improves
general surgery residents’ operative performance and decreases skill variability – https://doi.org/10.1097/SLA.0000000000004853
Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed general surgery procedures. If you are a PGY4/5 general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com, for more information on how you could be compensated up to $400 for recording and submitting those videos.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out additional BTK surgical education episodes here: https://behindtheknife.org/podcast-category/surgical-education/
Ductal carcinoma in situ, or DCIS, is a precursor lesion to invasive breast cancer; however, not all DCIS becomes invasive cancer. Given our inability to accurately determine which DCIS lesions will progress, current clinical management consists of surgical resection for everyone with the possible additions of radiation and endocrine therapy. Multiple clinical trials and leaders in the field of breast surgical oncology are challenging our assumptions about the uniform approach to DCIS and are attempting to design treatment based on biology— tune in to hear about the evolving approach to management of DCIS!
Hosts:
Alexa Glencer, MD
Michael Alvarado, MD
Rita Mukhtar, MD
Laura Esserman, MD

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

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

We are facing a difficult case tonight: stab wound to the base of the left neck. Hope you know your anatomy well and are ready for a ride. Let’s see how one manages a patient whose injury is life threatening, a challenge to correctly diagnose, approach and repair.

Join Drs. Urréchaga, Neeman, and Rattan from Ryder Trauma Center in Miami as they go through a real case trying to save a life and dominate the day.

Learning Objectives:

  • Reviewing thoracic outlet anatomy.
  • Simplifying primary survey and immediate care for penetrating great vessel injuries.
  • Discussing possible surgical approaches for various great vessel injuries, incisions, extensions, tips and tricks.
References
1) Feliciano DV, DuBose JJ. Cardiac, great vessel, and pulmonary injuries. In: Rasmussen TR, Tai NRM, eds. Rich’s Vascular Trauma. 4th ed. Philadelphia: Elsevier, 2022: 171-198.
2) Karmy-Jones R, Namias N, Coimbra R, et al. Western Trauma Association critical decisions in trauma: penetrating chest trauma. J Trauma Acute Care Surg. 2014;77(6):994-1002.
3) Sperry JL, Moore EE, Coimbra R, et al. Western Trauma Association critical decisions in trauma: penetrating neck trauma. J Trauma Acute Care Surg. 2013;75(6):936-940.
4) Wall MJ, Ghanta RK, Mattox KL. Heart and thoracic vessels. In: Feliciano DV,           Mattox K L, Moore EE, eds. Trauma. 9th ed. New York: McGraw-Hill, 2021: 599-         628.

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

If you liked this episode, check out our Big T Trauma Series here: https://behindtheknife.org/podcast-series/big-t-trauma/

Personal Statements and Letters of Recommendations- two things that can make or break any residency or fellowship application. Join our education fellow, Dr. Jessica Millar, Dr. David Hughes, and Dr. Gifty Kwakye as they discuss what makes a truly great personal statement and how to compile a strong team for your letters of recommendation.
Guests:
David Hughes, MD- Clinical Associate Professor of Endocrine Surgery, General Surgery Residency Program Director- University of Michigan
GIfty Kwakye, MD, MPH- Clinical Assistant Professor of Colon and Rectal Surgery, Surgical Clerkship Director- University of Michigan

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

If you liked this episode, check out our Medical Student and Intern Survival Guide here: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/

It’s that time of year- when medical students across the country are preparing their residency applications. The process can be a bit daunting, and there have been a number of changes to process over the past few years. Join our education fellow, Dr. Jessica Millar, and Dr. David Hughes as they review the “nuts and bolts” of this year’s residency application cycle. 
Guests:
David Hughes, MD- Clinical Associate Professor of Endocrine Surgery, General Surgery Residency Program Director- University of Michigan 
Important Dates: 
·      June 8, 2022: ERAS application opens at 9 a.m. ET.
·      August 1, 2022: Supplemental ERAS application opens for applicants.
·      September 7, 2022: Residency applicants may begin submitting ERAS applications to programs at 9 a.m. ET.
·      September 16, 2022: Supplemental ERAS application closes for applicants at 5 p.m. ET.
·      September 28, 2022: Residency programs may begin reviewing ERAS applications, MSPEs, and supplemental ERAS application data at 9 a.m. ET.

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

If you liked this episode, check out our Medical Student and Intern Survival Guide here: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/

Bringing back an oldie but a goodie – Join Dr. Patrick Georgoff and Dr. Vahagn Nikolian as they discuss common and critical intern dilemmas.  This episode is Part 2 of 2.

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

If you liked this episode, check out our entire Medical Student and Intern Survival Guide series here – https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/

Bringing back an oldie but a goodie – Join Dr. Patrick Georgoff and Dr. Vahagn Nikolian as they discuss common and critical intern dilemmas.  This episode is Part 1 of 2.

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

If you liked this episode, check out our entire Medical Student and Intern Survival Guide series here – https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/

Pilonidal cysts – a simple disease or a sneaky nuanced problem? Drs. Shanaz Hossain,  Patrick Georgoff and Scott Steele sit down to discuss the difficulties encountered in the management of pilonidal cysts and the myriad of treatment options available, ranging from non-operative management to outpatient pit picking to major operations involving flaps.
Dr. Steele dropped his “8 Key Principles for Pilonidal Cyst Management”:
1.    Control Sepsis
2.    Do the Least Amount of Work Possible
3.    Avoid Too Much Excision
4.    Remove All Hair, Un-Roof All Disease, and Debride Granulation Tissue
5.    Use Off-Midline Excision and Closure
6.    Tension Must Be Minimized with Primary Wound Closure
7.    Change the Anatomy – Flatten the Natal Cleft
8.    Never Underestimate the Impact of Postoperative Care
Tune in for detailed insights regarding management and learn about all the options for surgical treatment!
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
If you liked this episode, check out our recent episode on Necrotizing Soft-Tissue Infections here.  
Join our Emergency General Surgery team as they discuss Necrotizing Soft-Tissue Infections. Hosted by Drs. Jordan Nantais, Ashlie Nadler, Stephanie Mason and Graham Skelhorne-Gross.

Necrotizing Soft-Tissue Infections:
– Also known as “flesh eating disease”, gas gangrene, necrotizing fasciitis/myositis, Fournier’s gangrene.
– Early findings are non-specific
– Rapidly fatal – diagnostic delay can lead to tremendous additional morbidity and mortality

Classification:
– Type 1 – polymicrobial category (most common) found in immunosuppressed or elderly
– Type 2 – monomicrobial infection [Group A Streptococcus > Methicillin-resistant Staphylococcus aureus (MRSA)]
– Type 3 – monomicrobial infection (Vibrio or Clostridium)
– Type 4 – fungal (rare) in immunocompromised or after penetration or trauma from candida or Zygomycetes.
Initial Workup
– History: (comorbidities, immunosuppression, recent infections or trauma)
– Exam: swelling, open lesions, drainage, erythema, crepitus, and pain out of proportion
– Most common: swelling, pain, erythema
– Bullae, skin necrosis, crepitus are less common
– Labs: Hb, wbc, Na, Creat, glucose, and CRP
– Imaging: CT, MRI *sensitive and specific but may not change management
– Cut-down: bedside vs in OR
– Gm stain
Management
– Initially: two large bore IVs, foley catheter, aggressive fluid resuscitation, broad spectrum antibiotics, vasopressors PRN
– Abx choices: carbopenem or piperacllin-tazobactam or cefotaxime plus metronidazole. Clindamycin (antitoxin effect) and vancomycin (MRSA) should be considered.
– OR: must debride all dead/infected tissue, involve other surgical specialties as needed
– Mark edge of cellulitis and use as initial debridement
– Healthy dermis – pearly and white
– Healthy fat – pale, yellow, glistening
– Healthy fascia – should bleed, doesn’t easily separate from muscle
– Healthy muscle – contract with cautery
– Dressing: betadine-soaked gauze on the wound
– Most patients will need at least 3 ORs (second OR generally 8-12 hours after the first)
– No VAC or stoma at first OR
References: 
1.    Pelletier J, Gottlieb M, Long B, Perkins JC Jr. Necrotizing Soft Tissue Infections (NSTI): Pearls and Pitfalls for the Emergency Clinician. J Emerg Med. 2022 Apr;62(4):480-491. doi: 10.1016/j.jemermed.2021.12.012. Epub 2022 Jan 31.
2.    Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg. 2009 Feb;208(2):279-88.
3.    Edlich RF, Cross CL, Dahlstrom JJ, Long WB 3rd. Modern concepts of the diagnosis and treatment of necrotizing fasciitis. J Emerg Med. 2010 Aug;39(2):261-5
4.    Hoesl V, Kempa S, Prantl L, Ochsenbauer K, Hoesl J, Kehrer A, Bosselmann T. The LRINEC Score-An Indicator for the Course and Prognosis of Necrotizing Fasciitis? J Clin Med. 2022 Jun 22;11(13):3583
5.    Bulger EM, May A, Bernard A, Cohn S, Evans DC, Henry S, Quick J, Kobayashi L, Foster K, Duane TM, Sawyer RG, Kellum JA, Maung A, Maislin G, Smith DD, Segalovich I, Dankner W, Shirvan A. Impact and Progression of Organ Dysfunction in Patients with Necrotizing Soft Tissue Infections: A Multicenter Study. Surg Infect (Larchmt). 2015 Dec;16(6):694-701.
6.    LRINEC Score from: https://www.mdcalc.com/calc/1734/lrinec-score-necrotizing-soft-tissue-infection#:~:text=Patients%20were%20classified%20into%20three,%25%20and%20NPV%20of%2096%25. Retrieved July 2022.

If you liked this episode, check out our recent episode titled, “Journal Review in Colorectal Surgery: Timing of Biologics and Surgery in the Setting of Crohn’s Disease” which can be found here.

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

You get consulted on a 34-year-old with ileocolic Crohn’s disease on Humira. You determine he needs surgery for recurrent partial obstructions. When do you do the surgery? How long should he be off his biologic medication? When to restart it post op? Join Drs. Abelson, Marcello and Aulet as they take us through two articles to help us figure it out!
Learning Objectives:
1.     Describe the complications of biologic medications in the peri-operative period
2.     List the different classifications of medications for Crohn’s disease
3.     Discuss the approach to managing timing of surgery for patients with crohn’s disease
Articles:
Cohen BL, Fleshner P, Kane SV et al. Prospective Cohort Study to Investigate the Safety of Preoperative Tumor Necrosis Factor Inhibitor Exposure in Patients With Inflammatory Bowel Disease Undergoing Intra-abdominal Surgery. Gastroenterology. 2022 Apr 10;S0016-5085(22)00359-6. doi: 10.1053/j.gastro.2022.03.057. Online ahead of print.
Brouquet A, Maggiori L, Zerbib P, Lefevre JH, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Munoz-Bongrand N, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Guillon F, Vicaut E, Benoist S, Panis Y; GETAID chirurgie group. Anti-TNF Therapy Is Associated With an Increased Risk of Postoperative Morbidity After Surgery for Ileocolonic Crohn Disease: Results of a Prospective Nationwide Cohort. Ann Surg. 2018 Feb;267(2):221-228. doi: 10.1097/SLA.0000000000002017. PMID: 29300710.
Steele S, et al. The ASCRS Textbook of Colon and Rectal Surgery, fourth ed. 2022.  https://link.springer.com/book/10.1007/978-3-030-66049-9
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Episode Title: Journal Review in Colorectal Surgery: Timing of Biologics and Surgery in the Setting of Crohn’s Disease
Want to learn more about achalasia and its procedural management? Excited about the POEM procedure?  Learn what the current literature says when it comes to recommending POEM or the tried-and-true Heller myotomy from the Swedish Thoracic surgery team.

Learning objectives
–        Review basics of achalasia
–        Discuss the current literature comparing POEM and Heller myotomy with fundoplication
–        Understand the major differences in outcomes for these procedures

Hosts:
Peter White, MD
Megan Lenihan, MD
Brian Louie, MD
Kelly Daus, MD

Referenced Material
Werner YB, Hakanson B, Martinek J, et al. Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia. N Engl J Med. 2019 Dec 5;381(23):2219-2229. doi: 10.1056/NEJMoa1905380. PMID: 31800987.

Gu L, Ouyang Z, Lv L, et al. Safety and efficacy of peroral endoscopic myotomy with standard myotomy versus short myotomy for treatment-naïve patients with type II achalasia: a prospective randomized trial. Gastrointest Endosc. 2021 Jun;93(6):1304-1312. doi: 10.1016/j.gie.2020.10.006. Epub 2020 Oct 13. PMID: 33058884.

Shemmeri E, Aye RW, Farivar AS, Bograd AJ, Louie BE. Use of a report card to evaluate outcomes of achalasia surgery: beyond the Eckardt score. Surg Endosc. 2020 Apr;34(4):1856-1862. doi: 10.1007/s00464-019-06952-2. Epub 2019 Jul 8. PMID: 31286258.

Mota RCL, de Moura EGH, de Moura DTH, Bernardo WM, de Moura ETH, Brunaldi VO, Sakai P, Thompson CC. Risk factors for gastroesophageal reflux after POEM for achalasia: a systematic review and meta-analysis. Surg Endosc. 2021 Jan;35(1):383-397. doi: 10.1007/s00464-020-07412-y. Epub 2020 Mar 23. PMID: 32206921.

McKay SC, Dunst CM, Sharata AM, Fletcher R, Reavis KM, Bradley DD, DeMeester SR, Müller D, Parker B, Swanström LL. POEM: clinical outcomes beyond 5 years. Surg Endosc. 2021 Oct;35(10):5709-5716. doi: 10.1007/s00464-020-08031-3. Epub 2021 Jan 4. PMID: 33398572.

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

The utilization of point-of-care ultrasound and other non-invasive cardiac output monitoring technologies varies because of knowledge, resource availability and cultural practices. In this  Clinical Challenge in Surgery episode from the Surgical Critical Care team at Behind the Knife, we provide a brief history of the use of cardiac-output monitoring in the ICU, introduce a few clinical scenarios in the context of point of care ultra-sound and other less-invasive cardiac-output monitoring technologies.
Learning Objectives: 
In this episode, we review the historical uses of central venous pressure monitoring, pulmonary-artery catheters and the more frequently utilized point-of-care-ultrasound (or POCUS) in managing complex ICU patients. We review the outcomes behind these technologies, describe the views and utility of POCUS, and introduce less-invasive or completely non-invasive ways to measure cardiac-output monitoring. 

Hosts:

Brittany Bankhead, MD, MS (@BBankheadMD) is an Assistant Professor of Surgery at Texas Tech University Health Sciences Center.
Ryan Dumas, MD, FACS (@PMH_Trauma_RPD) is an Assistant Professor of Surgery at the University of Southwestern Medical Center and Parkland Memorial Hospital.
Caroline Park, MD, MPH, FACS (@CPark_MD) is an Assistant Professor of Surgery at the University of Southwestern Medical Center and Parkland Memorial Hospital.
Links to Papers Referenced in this Episode:
National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006 May 25;354(21):2213-24. doi: 10.1056/NEJMoa061895. Epub 2006 May 21. PMID: 16714768.
Yildizdas D, Aslan N. Ultrasonographic inferior vena cava collapsibility and distensibility indices for detecting the volume status of critically ill pediatric patients. J Ultrason. 2020 Nov;20(82):e205-e209. doi: 10.15557/JoU.2020.0034. Epub 2020 Sep 28. PMID: 33365158; PMCID: PMC7705480.
Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990 Aug 15;66(4):493-6. doi: 10.1016/0002-9149(90)90711-9. PMID: 2386120.
Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med. 2013 Jul;41(7):1774-81. doi: 10.1097/CCM.0b013e31828a25fd. PMID: 23774337.
Acknowledgements: 
We would like to acknowledge Dr. Hassan Mashbari and the Department of Surgical Critical Care and Anesthesia at the Massachusetts General Hospital and Dr. Christopher Choi and the Department of Anesthesiology at the University of Texas Southwestern for their ultra-sound video contributions.

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

Dr. Jordan Frey, a Plastic Surgeon in Buffalo NY, joins us to talk about how he uses investments in real estate to diversify his portfolio. 
We discuss: 
-Types of real estate investments and the pros and cons
-Books to read on real estate investing
-How to get started in real estate
-Criteria he uses to choose a property and more
Books recommended:
The Millionaire Real Estate Investor – Gary Keller
Doctor’s Guide to Real Estate Investing – Cory Fawcett
Find Dr. Frey at his website or on social media.
or @JordanFreyMD

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