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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: [email protected]
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: [email protected]

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: [email protected]
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: [email protected]

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 [email protected], 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: [email protected]
Dr. Diana Otoya: [email protected]
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 [email protected], 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 [email protected], 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 [email protected], 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.

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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.

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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

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Dr. Jill Streams, Trauma Surgeon at Vanderbilt, takes us through the ins and outs of understanding your first contract and how and when to negotiate. 
In this episode we cover
-When/how to apply for your first job
-Break down each part of a contract
-Why you should negotiate
-What and how to negotiate
-Salary expectations
-Contract landmines and more!
You can connect with Dr. Streams on Twitter @JCRStreams
Read more at WCI https://www.whitecoatinvestor.com/things-to-ask-for-in-a-physician-contract/

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Kevin interviews Dr. Adam Tanious a Vascular Surgeon at MUSC about the ins and outs of managing student debt.
Adam is passionate about personal finance and student debt and is happy to discuss further with our listeners, please reach out at [email protected] .
Want to learn more at student debt? Check out White Coat Investor resources on student debt. 
https://www.whitecoatinvestor.com/ultimate-guide-to-student-loan-debt-management-for-doctors/

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Kevin Kniery and Jason Bingham interview Larry Keller of Physician Financial Services on how and when to choose the right disability policy.
You can reach Larry here
or at his website. 
White Coat Investor Article breaking down Disability Insurance

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Kevin Kniery and Jason Bingham interview Dr. Jason Mizell, a colorectal surgeon at University of Arkansas and pioneer in finance education for surgeons. He won the 2020 White Coat Investor Award for excellence in financial education.
In this episode they discuss how to invest, and what to invest in, also cover topics regarding real estate, and biggest financial regrets. 
Links to articles discussed
Financial Waterfall for Docs
Backdoor Roth IRA Point/Counter Point
Simple Path to Wealth
Dr. Mizell can be reached at [email protected]

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Kevin Kniery and Jason Bingham interview Dr. Jason Mizell, a colorectal surgeon at University of Arkansas and pioneer in finance education for surgeons. He won the 2020 White Coat Investor Award for excellence in financial education.
In this episode they discuss his lecture “How to Resuscitate Your Critically Ill Finances”. 
Dr. Mizell can be reached at [email protected]
Book Recommendation:

The Psychology of Money 
https://www.amazon.com/Psychology-Money-Timeless-lessons-happiness/dp/0857197681

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In this episode from the Endocrine Surgery team at BTK we invited Dr. Kepal Patel to join us to discuss two endocrine surgery cases while discussing pertinent literature. We discuss the work-up and surgical decision making for a case of medullary thyroid cancer and a Bethesda III thyroid nodule. 
            
Dr. Kepal Patel is the Chief of the Division of Endocrine Surgery and a Professor of Surgery, Otolaryngology and Biochemistry at NYU Langone Health.

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

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

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

Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship

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

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

Important Papers 

Miyauchi, A., Matsuzuka, F., Hirai, K., Yokozawa, T., Kobayashi, K., Ito, Y., … & Yamaguchi, K. (2002). Prospective trial of unilateral surgery for nonhereditary medullary thyroid carcinoma in patients without germline RET mutations. World journal of surgery, 26(8), 1023-1028.

Cibas, E. S., Baloch, Z. W., Fellegara, G., LiVolsi, V. A., Raab, S. S., Rosai, J., … & Alexander, E. K. (2013). A prospective assessment defining the limitations of thyroid nodule pathologic evaluation. Annals of internal medicine, 159(5), 325-332.

Papazian, M. R., Dublin, J. C., Patel, K. N., Oweity, T., Jacobson, A. S., Brandler, T. C., & Givi, B. (2022). Repeat Fine-Needle Aspiration With Molecular Analysis in Management of Indeterminate Thyroid Nodules. Otolaryngology–Head and Neck Surgery, 01945998221093527.
 
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The grind of surgical training has been celebrated in the past, but to what end? With mounting evidence that supports a high prevalence of burnout in the surgical community, surgical educators and leaders are often called to develop initiatives to address the detrimental and potentially irreversible effects on trainees’ wellness during surgical training. We invite Dr. David Rogers, who has personally experienced burnout, to share his insight and expertise in improving workplace wellness. Spoiler: it’s not as easy as group yoga sessions and daily donuts.

Hosts:
Dr. David Rogers
Dr. Jeremy Lipman
Dr. Judith French
Dr. Amy Han

Learning Objectives
1.     Listeners will be able to define wellness in the context of surgical training.
2.     Listeners will be able to better characterize and recognize signs of burnout among surgeons and surgical trainees.
3.     Listeners will be able identify strategies for overcoming burnout. 
4.     Listeners will be able to apply conceptual frameworks from workplace wellness outside of medicine that can guide developing effective programs that promote wellness in surgical education community.

References:

Torres-Landa S, Moreno K, Brasel KJ, Rogers DA. Identification of Leadership Behaviors that Impact General Surgery Junior Residents’ Well-being: A Needs Assessment in a Single Academic Center. J Surg Educ. 2022;79(1):86-93. doi:10.1016/j.jsurg.2021.07.017

Coverdill JE, Bittner IV JG, Park MA, Pipkin WL, Mellinger JD. Fatigue as impairment or educational necessity? Insights into surgical culture. Acad Med. 2011;86:S69-72.

Dyrbye LN, Thomas MR, Harper W, et al. The learning environment and medical student burnout: a multicentre study. Med Educ. 2009;43(3):274-282. doi:10.1111/j.1365-2923.2008.03282.x

Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016;50(1):132-149. doi:10.1111/medu.12927

Bordage G. Conceptual frameworks to illuminate and magnify. Med Educ. 2009;43(4):312 319. doi:10.1111/j.1365-2923.2009.03295.x

Bakker AB, de Vries JD. Job Demands–Resources theory and self-regulation: New explanations and remedies for job burnout. Anxiety, Stress, & Coping. 2021;34: 1-21.

Georgiadis F. Author Dr Amit Sood: Rising Through Resilience; Five Things You Can Do To Become More Resilient. Medium. https://medium.com/authority-magazine/author-dr-amit-sood-rising-through-resilience-five-things-you-can-do-to-become-more-resilient-673b0a1e9f2a. Published 2020. Accessed May 10, 2022.

Gino F. Are You Too Stressed to Be Productive? Or Not Stressed Enough? Harvard Business Review. Published October 5, 2017. https://hbr.org/2016/04/are-you-too-stressed-to-be-productive-or-not-stressed-enough

Goleman D. Primal Leadership, with a New Preface by the Authors : Unleashing the Power of Emotional … Intelligence.Harvard Bus Review Press; 2016.

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
Colorectal liver metastasis (CRLM) is a complex clinical situation requiring multidisciplinary management. In this episode from the Hepato-Pancreato-Biliary team at Behind the Knife, we review the genomics of CRLM, discuss a journal article investigating the frequency and impact of these mutations on survival in patients with stage IV disease, and interview the senior author Dr. Jean-Nicholas Vauthey about this research and his career in HPB.
Hosts:
Timothy Vreeland, MD, FACS (@vreelant) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center
Daniel Nelson, DO, FACS (@DWNelsonHPB) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center
Connor Chick, MD (@connor_chick) is a PGY-5 General Surgery resident at Brooke Army Medical Center
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-4 General Surgery resident at Brooke Army Medical Center
Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-3 General Surgery resident at Brooke Army Medical Center
Guest:
Jean-Nicholas Vauthey, MD (@VautheyMD) is a Professor of Surgical Oncology, Chief of HPB, and Dallas/Fort Worth Living Legend Chair for Cancer Research at MD Anderson.  He is the Principal Investigator of the study discussed in the episode in addition to numerous other articles describing the genomics of colorectal liver metastases.
Learning Objectives: In this episode, we review basic mutations found in metastatic colorectal cancer and broadly discuss these in a clinical context.  We review a journal article from Kawaguchi et al. in which authors analyze prognostic relevance of signaling pathways in patients undergoing resection of CRLM, later validated in an external cohort of unresected patients.  We conduct an interview with the senior author of the study regarding relevant methodologic details, next steps in his research, and how to apply this information now and in the future to the care of patients with CRLM.
Links to Papers Referenced in this Episode:
Journal Article:
Kawaguchi Y, Kopetz S, Kwong L, Xiao L, Morris JS, Tran Cao HS, Tzeng CD, Chun YS, Lee JE, Vauthey JN. Genomic Sequencing and Insight into Clinical Heterogeneity and Prognostic Pathway Genes in Patients with Metastatic Colorectal Cancer. J Am Coll Surg. 2021 Aug;233(2):272-284.e13. doi: 10.1016/j.jamcollsurg.2021.05.027. Epub 2021 Jun 7. PMID: 34111531; PMCID: PMC8666966.
Recommended Additional Podcasts on CRLM:
The AHPBA Podcast:
1.     Episode 1: Dr. Jean Nicolas Vauthey – Colorectal Liver Metastases (https://podcasts.apple.com/us/podcast/episode-1-dr-jean-nicolas-vauthey-colorectal-liver/id1501441845?i=1000467381474)
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Acute limb ischemia is simultaneous one of the most fun but frustrating diseases to treat in vascular surgery. In this episode of Behind the Knife, the vascular surgery team gives a concise overview of the diagnosis/workup and treatment of patients with acute limb ischemia and talks about some of the difficult decision making regarding treatment modality given all the exciting technology available today.

Dr. Nicholas Osborne is an Associate Professor of Vascular Surgery at the University of Michigan and the Chief of Vascular Surgery at the Ann Arbor Veteran’s Affairs Healthcare System.

Dr. Frank Davis is a Chief Resident in the Integrated Vascular Surgery program at the University of Michigan.

Dr. Craig Brown is a PGY-6 in the General Surgery program at the University of Michigan.

Papers discussed in this Episode:
AHA/ACC/SVS, etc Guidelines on the Management of Patients with Lower Extremity Peripheral Artery Disease
https://pubmed.ncbi.nlm.nih.gov/27851992/

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It’s 1AM and the emergency department is calling about *insert terrifying foregut problem you haven’t seen since you were an intern here* and you wake up in a cold sweat to realize it was just a dream…this time. Tune in to this clinical challenge episode for some tips and tricks for managing foregut nightmares with Drs. Mike Weykamp, Nicole White, Andrew Wright, and Nick Cetrulo from the University of Washington’s Minimally Invasive Surgery team. 

Referenced articles and videos: 

1.     Rodriguez-Garcia HA, Wright AS, Yates RB. Managing obstructive gastric volvulus: challenges and solutions. Open Access Surgery. 2017
2.     Yates RB. Giant PEH: Management Principles for Unique Clinical Circumstances. 2017 SAGES Annual Meeting. Houston, TX. 2017
3.     Millet I, Orliac C, Alili C, Guillon F, Taourel P. Computed tomography findings of acute gastric volvulus. Eur Radiol. 2014. 
4.     Mazaheri P, Ballard DH, Neal KA, Raptis DA, Shetty AS, Raptis CA, Mellnick VM. CT of Gastric Volvulus: Interobserver Reliability, Radiologists’ Accuracy, and Imaging Findings. AJR Am J Roentgenol. 2019. 
5.     Barmparas G, Alhaj Saleh A, Huang R, Eaton BC, Bruns BR, Raines A, Bryant C, Crane CE, Scherer EP, Schroeppel TJ, Moskowitz E, Regner JL, Frazee R, Campion EM, Bartley M, Mortus JR, Ward J, Margulies DR, Dissanaike S. Empiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulcer. Trauma Surg Acute Care Open. 2021.
6.     Horn CB, Coleoglou Centeno AA, Rasane RK, Aldana JA, Fiore NB, Zhang Q, Torres M, Mazuski JE, Ilahi ON, Punch LJ, Bochicchio GV. Pre-Operative Anti-Fungal Therapy Does Not Improve Outcomes in Perforated Peptic Ulcers. Surg Infect (Larchmt). 2018.
7.     Wee JO. Gastric Volvulus in Adults. In: UpToDate, Louie BE (Ed), UpToDate, Waltham, MA. (Accessed on May 15, 2022.)
https://www.uptodate.com/contents/gastric-volvulus-in-adults

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Determining when to order imaging for blunt cerebrovascular injury is a diagnostic quandary that has long engendered controversy. Today we discuss a paper that introduced universal CT angiogram of the neck to screen for BCVI in all blunt trauma patients and then compared the result to what would have happened if some of the current screening guidelines were utilized. Join us as we discuss their fascinating results and what it means for blunt trauma patients going forward.

Hosts: 
Elliott R. Haut, MD, Ph.D., a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST). 
Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Master’s in Education in the Health Professions from Johns Hopkins. 
David Sigmon, MD, MMEd, a PGY-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education. 

LITERATURE
  1. Black JA, Abraham PJ, Abraham MN, et al. Universal screening for blunt cerebrovascular injury. J Trauma Acute Care Surg. 2021;90(2):224-231.
    https://pubmed.ncbi.nlm.nih.gov/33502144/
  2. Kim DY, Biffl W, Bokhari F, et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020;88(6):875-887. https://pubmed.ncbi.nlm.nih.gov/32176167/
  3. Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Elliott JP, Burch JM. Optimizing screening for blunt cerebrovascular injuries. (1999) American journal of surgery. 178 (6): 517-22.
    https://pubmed.ncbi.nlm.nih.gov/10670864/
  4. Geddes AE, Burlew CC, Wagenaar AE, Biffl WL, Johnson JL, Pieracci FM, Campion EM, Moore EE. Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated. (2016) American journal of surgery. 212 (6): 1167-1174. https://pubmed.ncbi.nlm.nih.gov/27751528/
  5. Ciapetti M, Circelli A, Zagli G et-al. Diagnosis of carotid arterial injury in major trauma using a modification of Memphis criteria. Scand J Trauma Resusc Emerg Med. 2010;18 (1): 61.
    https://pubmed.ncbi.nlm.nih.gov/21092211/

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Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss TEF management and the use of a post-operative transanastomotic feeding tubes in pediatric surgery.

Journal Article links: 
Wang, C., Feng, L., Li, Y., & Ji, Y. (2018). What is the impact of the use of transanastomotic feeding tube on patients with esophageal atresia: a systematic review and meta-analysis. BMC Pediatr, 18(1), 385. doi:10.1186/s12887-018-1359-5
Bence, C. M., Rymeski, B., Gadepalli, S., Sato, T. T., Minneci, P. C., Downard, C., . . . Midwest Pediatric Surgery, C. (2021). Clinical outcomes following implementation of a management bundle for esophageal atresia with distal tracheoesophageal fistula. J Pediatr Surg, 56(1), 47-54. doi:10.1016/j.jpedsurg.2020.09.049

LaRusso, K., Joharifard, S., Lakabi, R., Nimer, N., Shahi, A., Kasasni, S. M., . . . Emil, S. (2022). Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula: The Quebec experience. J Pediatr Surg, 57(1), 41-44. doi:10.1016/j.jpedsurg.2021.09.014
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
Join Shreya Gupta, MD and Jonathan Abelson, MD as they discuss highlights from the American Society of Colon and Rectal Surgeons.  Dr. Sharon Stein and Dr. Erin King-Mullins are the guest speakers. They are discussing female leadership, diversity and inclusion topics, and much more! This is episode 2 of 2.

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*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform ***

Subjective and objective GERD are common amongst bariatric surgery patients. Is weight loss alone enough to improve GERD symptoms? Is the vertical sleeve gastrectomy really associated with worsening GERD? What technical factors of the vertical sleeve gastrectomy lead to improved or worsening GERD? Listen to find out!

Journal articles:

The Impact of Sleeve Gastrectomy on Gastroesophageal Reflux Disease in Patients with Morbid Obesity https://pubmed.ncbi.nlm.nih.gov/35048247/

Effect of Concomitant Laparoscopic Sleeve Gastrectomy and Hiatal Hernia Repair on Gastroesophageal Reflux in Patients with Obesity: A Systematic Review and Meta-Analysis https://pubmed.ncbi.nlm.nih.gov/34254259/

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How do you decide if a pancreatic head mass is resectable? Does vascular involvement matter? What impacts survival? Join the Surgical Oncology team as they dive into operative considerations when operating on borderline resectable and locally advanced pancreatic cancer. Break the nihilism and find out about the options available for patients with this dreaded malignancy.

Learning Objectives: 
In this episode, we review the various definitions for resectability in pancreatic cancer, as well as the various prognostic markers and decision points to consider when deciding which patients may benefit from an operation. 

Hosts: 
Adam Yopp, MD, FACS (@AdamYopp) is an Assistant Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program.

Caitlin Hester, MD (@CaitlinAHester) is a 2nd Year Complex General Surgical Oncology Fellow at the MD Anderson Cancer Center.

Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-3 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research.

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

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In January 2022, the University of Maryland Medical Center performed the world’s first transplant involving a genetically modified animal heart. Join Behind the Knife as we discuss this significant transplant milestone with the 2 surgeons who led this historic case – Dr. Bartley Griffith and Dr. Muhammad M. Mohiuddin! Dr. Bartley Griffith is the Thomas E. and Alice Marie Hales Distinguished Professor in Transplant Surgery at UMSOM. Dr. Muhammad Mohiuddin is a Professor of Surgery at UMSOM and established the Cardiac Xenotransplantation Program with Dr. Griffith, the first in the United States.  Tune in to learn about the history of xenotransplantation and the barriers that have been overcome to make xenotransplantation a reality.

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Inspired by recent transplant surgery headlines, in this episode we briefly review the history and challenges of xenotransplantation. We discuss an article recently published in the American Journal of Transplantation describing the transplant of a porcine kidney into a human decedent model.

Learning Objectives
·       Understand the timeline of xenotransplantation and its historical challenges
·       Review a recent article that describes the transplantation of a genetically-modified porcine kidney into a brain-dead human model
·       Discuss ongoing obstacles to successful xenotransplantation and next steps

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You are faced with a young patient with an advanced colon cancer. You suspect Lynch syndrome. He asks if he should undergo total colectomy as opposed to segmental colectomy. How do you approach such a patient? 

Join Dr. Carole Richard, Dr. François Dagbert and Dr. Maher Al Khaldi in their conversation about Lynch syndrome, also known as Hereditary Non-polyposis Colorectal Cancer (HNPCC). 

Learning objectives 
–       To understand the rationale for universal testing for MMR deficiency of newly diagnosed colorectal cancers. 
–       To know when to recommend screening for CRC for patients with LS and to those who have undergone resection  
–       To understand the prevalence of cancers other than CRCs associated with Lynch syndrome, especially endometrial cancer. 

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The landscape of surgery is shifting, reflecting the diverse composition of graduating medical students and the efforts to recruit the most talented people into the field.  It is one thing to have a diverse group of people within surgery, but it is an entirely different thing to ensure a welcoming, supportive environment for them.  In this Journal Club episode, we review these topics from the perspective of eminent surgeons Drs. Caprice and Jake Greenberg, who share with us their insights on recent articles examining the experience of women surgeons and trainees.  We’re joined by Dr. Cary Schlick, who authored one of these articles, to shed light on a key issue for the field. 

Learning Objectives:
·       Identify some of the challenges for women in surgical training programs
·       Discuss how stereotype threat can impact performance
·       Suggest ways to advocate for equity in surgery

References:
Experiences of Gender Discrimination and Sexual Harassment Among Residents in General Surgery Programs Across the US – https://doi.org/10.1001/jamasurg.2021.3195
Effects of Gender Bias and Stereotypes in Surgical Training: A Randomized Clinical Trial – https://doi.org/10.1001/jamasurg.2020.1127
Gender Bias and Stereotypes in Surgical Training: Is It Really Women Residents We Need to Worry About? – https://doi.org/10.1001/jamasurg.2020.1561
The effect of gender on operative autonomy in general surgery residents – https://doi.org/10.1016/j.surg.2019.06.006

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Mattox Vegas TCCACS 2022: Ep. 2 

The Trauma, Critical Care, and Acute Care Surgery conference (aka the MATTOX conference, named after trauma surgery legend Kenneth L Mattox) is the longest running show in Las Vegas at 55 consecutive years.  The MATTOX conference is unique in its focus on clinical topics.  Every talk, every panel, and every case discussion is relevant and practical.  Join Behind the Knife as we use case-based discussions to hammer home key points from lectures given by some of the biggest names in trauma, critical care, and acute care surgery.  This is episode 2 of 2.  

The lineup:  

  1. Hasan Alam, MD (@DrHasanAlam) 
  2. Scott Steele, MD (@ScottRSteeleMD) 
  3. Joseph Dubose, MD (check out his exceptional podcast here: https://www.tiger-country.org/
  4. Mathew Martin, MD (@docmartin22) 
  5. Red Hoffman, MD (@redMDND, check out her amazing podcast here: https://thesurgicalpalliativecarepodcast.buzzsprout.com/
  6. Bellal Joseph, MD (@TopKnife_B) 
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
The Trauma, Critical Care, and Acute Care Surgery conference (aka the MATTOX conference, named after trauma surgery legend Kenneth L Mattox) is the longest running show in Las Vegas at 55 consecutive years.  The MATTOX conference is unique in its focus on clinical topics.  Every talk, every panel, and every case discussion is relevant and practical.  Join Behind the Knife as we use case-based discussions to hammer home key points from lectures given by some of the biggest names in trauma, critical care, and acute care surgery.  This is episode 1 of 2.

The lineup:

  1. Dennis Kim, MD (@traumaicurounds, check out his amazing podcast here: https://www.traumaicurounds.ca/)
  2. Ali Salim, MD (@alisalimMD)
  3. Jason Smith, MD (@DrJTrauma)
  4. Andre Campbell, MD (@TraumaDocSF)
  5. Meghan Lewis, MD
  6. Demetrios Demetriades, MD
  7. Alexander Eastman, MD (@PMHTrauma_ALE)
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The mortality rate for unstable pelvic hemorrhage due to blunt trauma remains around 30 percent. However, technological advances promise to finally make a dent. But on the cutting edge, it’s not clear which treatments should be used when to maximize lives saved. With life-threatening pelvic exsanguination, time is critical. Do you know when to rush to pack the pelvis? Do you know when to deploy a REBOA instead? Are there scenarios where you should do both? Join Drs. Urréchaga, Neeman, and Rattan from Ryder Trauma Center in Miami as they try to tease out answers using two studies hot off the presses with seemingly contradictory results.

Learning Objectives: Blunt Pelvic Hemorrhage

·       Expanding knowledge of management strategies for blunt pelvic hemorrhage
·       Describe propensity score matching and its use in non-randomized studies
·       Compare outcomes of REBOA and preperitoneal pelvic packing (PPP)
·       Critically appraise study design and methods of studies

References
1.     S. Mikdad, I.A.M. van Erp, M.E. Moheb, et al. Pre-peritoneal pelvic packing for early hemorrhage control reduces mortality compared to resuscitative endovascular balloon occlusion of the aorta in severe blunt pelvic trauma patients: A nationwide analysis. Injury. 2020; 51:1834–1839. doi.org/10.1016/j.injury.2020.06.003
2.     S. Asmar, L. Bible, M. Chehab, et al. Resuscitative Endovascular Balloon Occlusion of the Aorta vs Pre-Peritoneal Packing in Patients with Pelvic Fracture. Journal of the American College of Surgeons. 2021; 232(1):17-26. doi.org/10.1016/j.jamcollsurg.2020.08.763
3.     B. Joseph, M. Zeeshan, J.V. Sakran, et al. Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. JAMA Surg. 2019;154(6):500-508. doi:10.1001/jamasurg.2019.0096

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

EPAs are coming in 2023. This isn’t about your carbon emissions, but it will dramatically impact surgery training programs. Join Drs. Karen Brasel, Jeremy Lipman, Judith French, and Amy Han as they discuss Entrustable Professional Activities (EPAs) and how they will change the way we assess trainees.

Learning Objectives
1.     Listeners will be able to define entrustable professional activities (EPAs) within the context of competency-based education during General Surgery residency training
2.     Listeners will be able to understand the impetus behind adopting EPA assessments for surgical trainees. 
3.     Listeners will be able to interpret and apply EPA assessment data based on the discussion of the example scenarios.

References:
Brasel KJ, Klingensmith ME, Englander R, Grambau M, Buyske J, Sarosi G, Minter R. Entrustable professional activities in general surgery: development and implementation. Journal of surgical education. 2019 Sep 1;76(5):1174-86.

Lindeman B, Brasel K, Minter RM, Buyske J, Grambau M, Sarosi G. A Phased Approach: The General Surgery Experience Adopting Entrustable Professional Activities in the United States. Acad Med. 2021;96(7S):S9-S13.

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Dr. Michael Rosen returns to Behind the Knife – this time to discuss his RCT investigating biologic vs. synthetic mesh for single-stage repair of contaminated ventral hernias. Read the full article here in JAMA Surgery: https://jamanetwork.com/journals/jamasurgery/article-abstract/2788222

Dr. Rosen is the director for the Center of Abdominal Core Health at the Cleveland Clinic and has written the “Atlas of Abdominal Wall Reconstruction”. Want to learn more about his work and the Hernia Quality Collaborative? Catch up on Dr. Rosen’s previous episode on Behind the Knife: 

Episode #21 (August 15, 2015): Hernias, Abdominal Wall Reconstruction, and Quality Collaboratives
https://behindtheknife.org/podcast/21-hernias-abdominal-wall-recon-and-quality-collaboratives-dr-michael-rosen/

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Welcome to the third of a six-part series focused on the integration of palliative care into the practice of surgery.  Malignant bowel obstructions occur in 5-43 percent of patients with a diagnosis of advanced primary or metastatic intra-abdominal malignancy and both acute care surgeons and surgical oncologists are called upon to manage this condition. Using the case of an elderly gentleman with gastric outlet obstruction secondary to gastric cancer, in this episode we discuss how to approach a patient with a malignant bowel obstruction, review the medical and surgical options for management, discuss the importance of primary palliative care, define palliative surgery and conclude with a short rant about the necessity of being cognizant of one’s feelings and of taking the time and creating the space to discuss them. 

Fast Fact #45:  Medical Management of Bowel Obstructions

Chapter 8, Malignant Bowel Obstruction in Surgical Palliative Care: A Resident’s Guide

Palliative surgery and the surgeon’s role in the palliative care team: a review.

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

Dr. Fabian Johnston (@fabianjohnston) is Associate Professor of Surgery and Oncology and Chief, Division of GI Surgical Oncology at Johns Hopkins University.

Dr. Amanda Stastny (@manda_plez) is a PGY-2 in the General Surgery program at Mountain Area Health Education Center (MAHEC) in Asheville, NC.
 
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Umbilical hernias a common diagnoses that general surgeons must manage. Though these hernias are considered relatively simple problems to resolve, certain populations of patients are prone to higher rates of complications. As abdominal wall surgery has advanced, so to have the options that exist in management of primary umbilical hernias. The session will review common clinical circumstances and high-risk patient presentations. We will generally review the approaches to repair and the thought processing and data driving decision making.  
·       Dr. Vahagn Nikolian is an Assistant Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair. 
·       Dr. Sean Orenstein is an Associate Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair.
·       Dr. Shahrose Rahman is a resident in General Surgery at Oregon Health & Science University. 

Seminal Papers in Umbilical Hernia Management
Guidelines for treatment of umbilical and epigastric hernias (Henriksen et al. Br J Surg. 2020.): https://pubmed.ncbi.nlm.nih.gov/31916607/

Hernia-Neck Ratio: Predicting Factors for Complications of Umbilical Hernias (Fueter et al. WJS. 2016.): https://pubmed.ncbi.nlm.nih.gov/27194561/

Safety and effectiveness of umbilical hernia repair in patients with cirrhosis (Hew et al. Hernia. 2018.):https://pubmed.ncbi.nlm.nih.gov/29589135/

Fix it while you can…Mortality after umbilical hernia repair in cirrhotic patients (Hill et al. Amer Journal of Surgery. 2020.): https://pubmed.ncbi.nlm.nih.gov/32988606/

Postoperative complications with retromuscular mesh placement in emergency incisional hernia repair (Juul et al. Scand J Surg. 2021.): https://pubmed.ncbi.nlm.nih.gov/33092472/

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

Warning!  There is magic contained in this podcast.  Real magic.  The kind of magic that allows you to understand how to manage the axilla in breast cancer patients.   Join Drs. Rita Mukhtar and Michael Alvarado from the University of California San Francisco for a top-notch show on an important topic. 

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Join our Emergency General Surgery Team as they discuss EGS in patients > 65. 

Introduction

– > 65 = 40% of EGS admissions 
– In-hospital mortality for EGS in older adults is approximately 7-12% and the one-year mortality is around 30-38%.
– High risk due to decreased reserve, poor nutritional status, and chronic medical conditions 
– Frailty correlates with poor post-operative outcomes

Paper #1: Mehta A, Dultz LA, Joseph B, Canner JK, Stevens K, Jones C, Haut ER, Efron DT, Sakran JV. Emergency general surgery in geriatric patients: A statewide analysis of surgeon and hospital volume with outcomes. J Trauma Acute Care Surg. 2018 Jun;84(6):864-875. 

– retrospective population-based cross-sectional study using administrative data. 
– looks at the association between surgeon and hospital annual experience with outcomes in geriatric patients with EGS conditions.
– Note Table 2 provides outcomes broken down by type of surgery
– Key finding: patients operated on by a low-volume surgeon had about twice the odds of mortality, and 1.7X the odds of failure to rescue

Paper #2: Guttman MP, Tillmann BW, Nathens AB, Saskin R, Bronskill SE, Huang A, Haas B. Alive and at home: Five-year outcomes in older adults following emergency general surgery. J Trauma Acute Care Surg. 2021 Feb 1;90(2):287-295. 

– large-scale population-based retrospective cohort study looking at long-term outcomes of older adults with admissions for emergency general surgery diagnoses
– primary outcome of interest is “aging in place” or being able to reside in one’s home for as long as possible. 
– Key finding: being admitted for an EGS diagnosis reduces your survival and time in your home by about 7 months.
– Very little reduction in low-risk diagnoses (acute appendicitis/cholecystitis)
– 57% of patients were alive and in their home 5 years later

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

Thoughts of esophageal perforations keeping you up at night? Actual esophageal perforations keeping you up at night?  Drs. Brian Louie, Peter White, and Megan Lenihan discuss both the tried-and-true and the cutting-edge management of this challenging problem.

Learning Objectives

– Understand basic principles of management

– Review differences in management based on different underlying pathology and location

– Learn indications and techniques for advanced endoscopic interventions for perforations

– Discuss nutrition planning 

Referenced Material

– Thornblade LW, Cheng AM, Wood DE et al. A Nationwide Rise in the Use of Stents for Benign Esophageal Perforation. Ann Thorac Surg 2017; 104(1):227-233. DOI: 10.1016/j.athoracsur.2017.03.069
http://dx.doi.org/10.1016/j.athoracsur.2017.03.069

– Watkins JR and Farivar AS. Endoluminal Therapies for Esophageal Perforations and Leaks. Thorac Surg Clin 2018; 28(4):541-554. DOI: 10.1016/j.thorsurg.2018.07.002
https://doi.org/10.1016/j.thorsurg.2018.07.002

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A trauma patient rolls into the bay.  CPR started 10 minutes ago.  They are pulseless, the entire trauma team is looking to you for leadership, and the thoracotomy tray is prepped and ready.  Do you pick up the knife and cut?  

Welcome back to the BIG T TRAUMA series.  Join Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill for a high-level discussion on the one surgical procedure that trumps them all – the ED thoracotomy.  This is episode 2 of 2.  In episode 1 we discussed who should get an ED thoracotomy.  Today, we cover how to do it.   

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
A trauma patient rolls into the bay.  CPR started 10 minutes ago.  They are pulseless, the entire trauma team is looking to you for leadership, and the thoracotomy tray is prepped and ready.  Do you pick up the knife and cut?  

Welcome back to the BIG T TRAUMA series.  Join Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill for a high-level discussion on the one surgical procedure that trumps them all – the ED thoracotomy.  This is episode 1 of 2.  In episode 1 we discuss who should get an ED thoracotomy and in episode 2 we cover how to do it.   

Listen to learn about the guidelines, signs of life, ultrasound, survival, and when NOT to do an ED thoracotomy.   

WakeMed Blunt Pulseless Trauma Resuscitation Guideline: https://www.wakemed.org/assets/documents/general-surgery-guidelines/trauma-guidelines/blunt-pulseless-arrest.pdf 

Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
In the episode we will cover the following learning objectives:

·       Listeners should be able to describe the evolution and changes in definitions sepsis over the past three decades
·       Listeners should be familiar with the three randomized controlled trials that studies early-goal directed therapy
·       Listeners should be able to describe the major changes in the new 2021 SCCM Sepsis Guidelines
·       Listeners should be able to describe the fundamental principles of sepsis management in the ICU

References:

https://www.nejm.org/doi/full/10.1056/nejmoa1401602

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

You are seeing a young female patient in the clinic with rectal prolapse. When do you offer surgery?  Does she get a perineal approach or a transabdominal approach?  Open or minimally invasive?  Mesh or no mesh?  Sigmoid resection or no resection?  Join Drs. Abelson, Marcello and Aulet as they take us through the wide world of rectal prolapse!

Learning Objectives:
1.     Describe the difference between rectal prolapse and hemorrhoidal prolapse
2.     List the different approaches to surgical management of rectal prolapse
3.     Discuss the approach to recurrent rectal prolapse

Be sure to check out the associated video below. 

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

In this episode from the Endocrine Surgery team at BTK we go through three controversial topics in endocrine surgery and cite pertinent articles during a lively debate format. We debate the role of four-gland exploration versus focused exploration for parathyroid disease. Indications for parathyroidectomy are hotly contested. And finally, we discuss the role and relevance of using a nerve monitor. Tune in to see if Dr. Yeh and Dr. Wu remain collegiate after recording this episode… 
            
Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established. 

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

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

Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship

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

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

Important Papers 

Norlén O, Wang KC, Tay YK, Johnson WR, Grodski S, Yeung M, Serpell J, Sidhu S, Sywak M, Delbridge L. No need to abandon focused parathyroidectomy: a multicenter study of long-term outcome after surgery for primary hyperparathyroidism. Ann Surg. 2015 May;261(5):991-6. doi: 10.1097/SLA.0000000000000715. PMID: 25565223.

Schneider DF, Mazeh H, Sippel RS, Chen H. Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1,000 cases. Surgery. 2012 Dec;152(6):1008-15. doi: 10.1016/j.surg.2012.08.022. Epub 2012 Oct 12. PMID: 23063313; PMCID: PMC3501613.

Jinih M, O’Connell E, O’Leary DP, Liew A, Redmond HP. Focused Versus Bilateral Parathyroid Exploration for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis. Ann Surg Oncol. 2017 Jul;24(7):1924-1934. doi: 10.1245/s10434-016-5694-1. Epub 2016 Nov 28. PMID: 27896505.

Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med. 1999 Oct 21;341(17):1249-55. doi: 10.1056/NEJM199910213411701. Erratum in: N Engl J Med 2000 Jan 13;342(2):144. PMID: 10528034.

Seib CD, Meng T, Suh I, Harris AHS, Covinsky KE, Shoback DM, Trickey AW, Kebebew E, Tamura MK. Risk of Fracture Among Older Adults With Primary Hyperparathyroidism Receiving Parathyroidectomy vs Nonoperative Management. JAMA Intern Med. 2022 Jan 1;182(1):10-18. doi: 10.1001/jamainternmed.2021.6437. PMID: 34842909; PMCID: PMC8630642.

Yeh MW, Zhou H, Adams AL, Ituarte PH, Li N, Liu IL, Haigh PI. The Relationship of Parathyroidectomy and Bisphosphonates With Fracture Risk in Primary Hyperparathyroidism: An Observational Study. Ann Intern Med. 2016 Jun 7;164(11):715-23. doi: 10.7326/M15-1232. Epub 2016 Apr 5. PMID: 27043778.

Zanocco K, Butt Z, Kaltman D, Elaraj D, Cella D, Holl JL, Sturgeon C. Improvement in patient-reported physical and mental health after parathyroidectomy for primary hyperparathyroidism. Surgery. 2015 Sep;158(3):837-45. doi: 10.1016/j.surg.2015.03.054. Epub 2015 May 29. PMID: 26032828.

Barczyński M, Konturek A, Cichoń S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg. 2009 Mar;96(3):240-6. doi: 10.1002/bjs.6417. PMID: 19177420.

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.  
The Vascular Surgery Oral Board Review Book has 60 of the highest yield scenarios that cover the majority of the VSCORE topics in an easy-to-read question and answer format that highlights the most important clinical concepts, concise procedural descriptions, and common surgical complications that everyone should know about the field of Vascular Surgery. Whether you are looking to excel on the wards or crush the boards, this book was created to help you Dominate the Day.

https://behindtheknife.org/premium/

https://www.amazon.com/dp/0578382296?ref_=pe_3052080_397514860

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With more and more EVAR comes more and more endoleaks. But when do they matter and what can/should we do about them? In this episode, we present a case of a stubborn endoleak and use the course to illustrate a simple path towards the management of endoleaks following endovascular aneurysm repair.

Dr. Nicholas Osborne is an Associate Professor of Vascular Surgery at the University of Michigan and the Chief of Vascular Surgery at the Ann Arbor Veteran’s Affairs Healthcare System.

Dr. Frank Davis is a Chief Resident in the Integrated Vascular Surgery program at the University of Michigan.

Dr. Craig Brown is a PGY-6 in the General Surgery program at the University of Michigan.

Guidelines around Endoleak Management

Society for Vascular Surgery Practice Guidelines on the Care of Patients with an Abdominal Aortic Aneurysm:
Conservative Management of Type II Endoleaks:
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.  
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.  
Description: Metachronous colorectal liver metastasis (CRLM) is a complex clinical situation requiring multidisciplinary management. In this episode from the Hepato-Pancreato-Biliary team at Behind the Knife, we discuss a patient presenting with metachronous CRLM and how management may change with varying clinical scenarios.
Learning Objectives: In this episode, we review the initial workup and pre-operative considerations in a patient presenting with metachronous CRLM.  We discuss key aspects of resectability of CRLM, including physiologic and hepatic fitness, biology of the disease, and technical considerations.  We review the timing and common regimens of systemic treatment for differing clinical scenarios, as well as when adjuncts to treatment may be useful (e.g., portal venous embolization).  Finally, we highlight important aspects of intraoperative and postoperative management.

Hosts:

Timothy Vreeland, MD, FACS (@vreelant) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center
Daniel Nelson, DO, FACS (@DWNelsonHPB) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center
Connor Chick, MD (@connor_chick) is a PGY-5 General Surgery resident at Brooke Army Medical Center
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-4 General Surgery resident at Brooke Army Medical Center
Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-3 General Surgery resident at Brooke Army Medical Center 
Links to Papers Referenced in this Episode:
NCCN Guidelines for Colon Cancer
Mutation Status of RAS, TP53, and SMAD4 is Superior to Mutation Status of RAS Alone for Predicting Prognosis after Resection of Colorectal Liver Metastases. Clin Cancer Res. 2019 Oct 1;25(19):5843-5851. doi: 10.1158/1078-0432.CCR-19-0863. Epub 2019 Jun 20. PMID: 31221662; PMCID: PMC6774854.
Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2013 Nov;14(12):1208-15. doi: 10.1016/S1470-2045(13)70447-9. Epub 2013 Oct 11. PMID: 24120480.
FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as first-line treatment of patients with metastatic colorectal cancer: updated overall survival and molecular subgroup analyses of the open-label, phase 3 TRIBE study. Lancet Oncol. 2015 Oct;16(13):1306-15. doi: 10.1016/S1470-2045(15)00122-9. Epub 2015 Aug 31. PMID: 26338525.
Phase II Randomized Trial of Sequential or Concurrent FOLFOXIRI-Bevacizumab Versus FOLFOX-Bevacizumab for Metastatic Colorectal Cancer (STEAM). Oncologist. 2019 Jul;24(7):921-932. doi: 10.1634/theoncologist.2018-0344. Epub 2018 Dec 14. PMID: 30552157; PMCID: PMC6656450.
Bevacizumab plus mFOLFOX-6 or FOLFOXIRI in patients with initially unresectable liver metastases from colorectal cancer: the OLIVIA multinational randomised phase II trial. Ann Oncol. 2015 Apr;26(4):702-708. doi: 10.1093/annonc/mdu580. Epub 2014 Dec 23. PMID: 25538173.
Recommended Additional Podcasts on CRLM:
The AHPBA Podcast:
1.     Episode 1: Dr. Jean Nicolas Vauthey – Colorectal Liver Metastases (https://podcasts.apple.com/us/podcast/episode-1-dr-jean-nicolas-vauthey-colorectal-liver/id1501441845?i=1000467381474)
2.     Episode 12:Dr D’Angelica – Colorectal Liver Metastases and Hepatic Artery Infusion Pumps (https://podcasts.apple.com/us/podcast/episode-12-dr-dangelica-colorectal-liver-metastases/id1501441845?i=1000521718184)
Behind the Knife:
1.     Surgical Oncology-Hepatic Artery Infusion Pump (https://podcasts.apple.com/ye/podcast/surgical-oncology-hepatic-artery-infusion-pump/id980990143?i=1000525833877)

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

Few audiences appreciate the importance of a properly functioning sphincter like surgeons. Magnetic sphincter augmentation using the LINX device, however, is one area that is beyond the sphincter-related expertise of most surgeons and surgical trainees. Drs. Mike Weykamp, Nicole White, Andrew Wright, and Nick Cetrulo review the literature surrounding the use of the LINX device for gastroesophageal reflux disease and how the device stacks up against the current gold standard in anti-reflux surgery, laparoscopic fundoplication, on this journal review episode of Behind the Knife. 

References
1. Skubleny D, Switzer NJ, Dang J, et al. LINX(®) magnetic esophageal sphincter augmentation versus Nissen fundoplication for gastroesophageal reflux disease: a systematic review and meta-analysis. Surg Endosc. Aug 2017;31(8):3078-3084. doi:10.1007/s00464-016-5370-3
2. Bonavina L, Horbach T, Schoppmann SF, DeMarchi J. Three-year clinical experience with magnetic sphincter augmentation and laparoscopic fundoplication. Surg Endosc. Jul 2021;35(7):3449-3458. doi:10.1007/s00464-020-07792-1
3. Ferrari D, Asti E, Lazzari V, Siboni S, Bernardi D, Bonavina L. Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease. Sci Rep. Aug 13 2020;10(1):13753. doi:10.1038/s41598-020-70742-3
4. Alicuben ET, Bell RCW, Jobe BA, et al. Worldwide Experience with Erosion of the Magnetic Sphincter Augmentation Device. J Gastrointest Surg. Aug 2018;22(8):1442-1447. doi:10.1007/s11605-018-3775-0
5. Perry KA. Alternatives to Fundoplication. Presented at SAGES Meeting 2018/16th World Congress of Endoscopic Surgery. April 2018. 
6. Dominguez RV. LINX in GERD. The evolution of the technique. From none to full dissection of the crura. Presented at SAGES Meeting April 2019. 

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In this episode, our team discusses the management of penetrating liver trauma both before, during, and after surgery. Listen in for helpful tips such as how to perform an intraoperative air cholangiogram, creating an occlusion catheter from a red rubber and a Penrose, and much more!
Hosts:
Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST).

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

David Sigmon, MD, MMEd, a PGY-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.

LITERATURE
1.     Murphy PB, de Moya M, Karam B, et al. Optimal timing of venous thromboembolic chemoprophylaxis initiation following blunt solid organ injury: meta-analysis and systematic review. Eur J Trauma Emerg Surg. Published online September 18, 2021. https://pubmed.ncbi.nlm.nih.gov/34537859/

2.     Kozar RA, Crandall M, Shanmuganathan K, et al. Organ injury scaling 2018 update: Spleen, liver, and kidney. J Trauma Acute Care Surg. 2018;85(6):1119-1122.
3.     Kodadek LM, Efron DT, Haut ER. Intrahepatic balloon tamponade for penetrating liver injury: rarely needed but highly effective. World J Surg. 2019;43(2):486-489.
https://pubmed.ncbi.nlm.nih.gov/30280221/

4.     EAST Practice Management Guidelines: Selective Nonoperative Management of Hepatic Injury, Blunt
6.   THE JOURNAL OF TRAUMA AND ACUTE CARE SURGERY 3-MINUTE EXPERT CONSULT VIDEO: “BALLOON TAMPONADE FOR PENETRATING LIVER TRAUMA.
https://journals.lww.com/jtrauma/Pages/videogallery.aspx?videoId=13

7.     Coccolini F, Coimbra R, Ordonez C, et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020;15:24.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106618/

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What is one of the most energy-intensive and waste-generating areas of the hospital? The operating room! In the new BTK/Annals of Surgery Journal Club, we talk to Dr. Elizabeth Yates and Dr. Louis Nguyen about their new article – “Empowering Surgeons, Anesthesiologists, and Obstetricians to Incorporate Environmental Sustainability in the Operating Room.” They review the impact ORs have on the environment, the consequences this has for patients, and ways surgeons lead efforts to “green” the operating room. As the topic of environmental sustainability becomes a growing concern with each passing year, the surgical workplace is going to play a big role in moving in the right direction. Join us for a great discussion!  

Dr. Yates earned her medical degree from the University of Michigan Medical School. She is currently a General Surgery resident at Brigham and Women’s Hospital where she is now completing two years of protected research time at the Center for Surgery and Public Health while also pursuing a Masters in Public Health focused on Occupational and Environmental Health. She conducts interdisciplinary research examining the interface between surgery, sustainability, and climate change.

Dr. Nguyen is a vascular surgeon at Brigham and Women’s Hospital and associate professor of surgery at Harvard Medical School. He earned his medical and business degrees from the University of Chicago Pritzker School of Medicine, completed his General Surgery residency at Barnes-Jewish Hospital in St. Louis, and completed a vascular surgery fellowship at the Brigham as well. He also currently serves as Vice Chair of Digital Health Systems in the Department of surgery. He is a recognized leader in health services research and outcomes implementation, where he utilizes econometric analyses to better understand clinical outcomes.

Climate change and equity issues permeate all aspects of our life and work.  If you are (or know) a current general surgery resident, help us understand the equity and environmental impacts of residency interviews!

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In this episode we will explore two challenging transplant surgery cases. In the first, we discuss Nutcracker syndrome and the unique ethical questions that accompanied a living donor case. In the second, we examine a perplexing post-operative development in a complicated liver transplant patient. 

Learning Objectives
·       Understand the presentation and general treatment strategies for renal nutcracker syndrome
·       Discuss protocol and ethical considerations for living donor renal transplants
·       Review portal hypertension physiology, clinical manifestations, and options for treatment

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Chemotherapy or surgery first? What is the contemporary management for patients with locally advanced, resectable gastric cancer, and what does the data show? In this episode from the Surgical Oncology team at Behind the Knife, join the discussion on perioperative treatment of locally advanced gastric cancer and future advances that will benefit surgical patients. 

Learning Objectives: 
In this episode, we review perioperative chemotherapy regimens for locally advanced, resectable Gastric cancer, standard of care, and the future role for immunotherapy. 

Hosts: 
Adam Yopp, MD, FACS (@AdamYopp) is an Assistant Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program.

Caitlin Hester, MD (@CaitlinAHester) is a 2nd Year Complex General Surgical Oncology Fellow at the MD Anderson Cancer Center.

Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-3 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research.

Papers Referenced in this Episode:
Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial
Al Batran et al

Efficacy and Safety of Pembrolizumab or Pembrolizumab Plus Chemotherapy vs Chemotherapy Alone for Patients With First-line, Advanced Gastric Cancer. The KEYNOTE-062 Phase 3 Randomized Clinical Trial
Shitara et al

First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial
Janjigian et al

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Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss neuroblastoma management in pediatric surgery.

Journal Article links: 
Croteau N, Nuchtern J, LaQuaglia MP. Management of Neuroblastoma in Pediatric Patients. Surg Oncol Clin N Am 2021;30(2):291-304.
Madonna MB, Newman E. Handbook for Children with Neuroblastoma. Updated Spring 2018. Cancer Committee American Pediatric Surgical Association. 2018. https://www.pedsurglibrary.com/apsa/ub?cmd=repview&type=682-76&name=4_1884004_PDF
Newman EA, Abdessalam S, Aldrink JH, Austin M, Heaton TE, Bruny J, et al. Update on neuroblastoma. J Pediatr Surg 2019;54(3):383-9.
Nuchtern JG, London WB, Barnewolt CE, Naranjo A, McGrady PW, Geiger JD, et al. A prospective study of expectant observation as primary therapy for neuroblastoma in young infants: a Children’s Oncology Group study. Ann Surg 2012;256(4):573-80.
https://pubmed.ncbi.nlm.nih.gov/22964741/

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You are faced with a young patient with low rectal cancer who is a complete responder to neoadjuvant chemoradiotherapy. He asks if he should undergo surgical resection despite the absence of visible tumour. How do you approach such a question? 

Join Dr. Carole Richard, Dr. François Dagbert and Dr. Maher Al Khaldi in their conversation about the Watch and Wait strategy for rectal cancer, also known as the Organ Preservation strategy. 

Learning objectives 

–       To understand the rationale for Watch and Wait Strategy and the proportion of patients who become complete clinical responders. 
–       To explain how patients under the Watch and Wait Strategy protocol should be followed up and when to consider a patient a clinical nonresponder.
–       To understand the inclusion criteria for patients in the Watch and Wait Strategy

References

In order throughout the episode [1–3]:

1. Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U, Sousa AHS e, et al. Operative Versus Nonoperative Treatment for Stage 0 Distal Rectal Cancer Following Chemoradiation Therapy. Transactions Meet Am Surg Assoc. 2004;122(NA;):309–16.
2. Valk MJM van der, Hilling DE, Bastiaannet E, Kranenbarg EM-K, Beets GL, Figueiredo NL, et al. Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study. Lancet. 2018;391(10139):2537–45.

3. Fernandez LM, Julião GPS, Figueiredo NL, Beets GL, Valk MJM van der, Bahadoer RR, et al. Conditional recurrence-free survival of clinical complete responders managed by watch and wait after neoadjuvant chemoradiotherapy for rectal cancer in the International Watch & Wait Database: a retrospective, international, multicentre registry study. Lancet Oncol. 2021;22(1):43–50.

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