EP. 664 •
Oct 2
• 32 MIN
Search for a podcast, video, resource, or blog post
For this CRS Virtual Education episode, please join Dr. Amy Lightner for a discussion on New Treatments for Anal Fistulas .
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Ian S. Soriano for a discussion on Ergonomics.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Matthew R. Albert for a discussion on Mastering TAMIS.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Kelly Wright for a discussion on Endometriosis – What you need to know.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Join the discussion to hear Colorectal Surgery mock oral boards to help prepare for the Colorectal Surgery Oral Board Exam.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Teresa deBeche-Adams for a discussion on Functional Outcomes After Rectal Cancer.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join for a discussion on How to be a Successful Fellow in Colorectal Surgery.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Avery Walker for a discussion on APDCRS Robotic Surgery Training Program: Complications & Complex Situations.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Giovanna da Silva for a discussion on Sacral Neuromodulation for Fecal Incontinence.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Laila Rashidi for a discussion on Troubleshooting with a Bedside Assist.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
How to do a Liver Transplant with Dr. Shah and Dr. Dageforde
Listen to the accompanying podcast episode at behindtheknife.org
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Douglas K. Rex for a discussion on Detection in Colonoscopy.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Emily Steinhagen for a discussion on Hereditary Polyposis Syndromes.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Nicole M. Saur for a discussion on the Roadmap for Integrating Geriatric Optimization and Patient-Centered Outcomes into Your Colorectal Surgery Practice.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Meagan Costedio for a discussion on Pediatric Colorectal Maladies and the Transition to Adulthood.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Mark Soliman for a discussion on Social Media for the Surgeon.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This video series includes how-to videos from the Behind the Knife team for right and left-handed learners. Worried about your performance in the operating room? Don’t be! These videos cover everything you need to know with clear, easy-to-follow instructions. From two-handed knot tying to a running subcuticular stitch to closing a laparoscopic port site, we’ve got your back (lefties too).
The suture kit contains everything you need to hone your surgical skills, including high-quality surgical instruments, multiple different kinds of suture, and a best-in-class suture pad. The Knot Tying Simulator is designed for beginners and for those with more advanced skills.
The simulator includes a free-standing hook ideal for high repetition knot tying practice, a hook set within a cylinder to replicate tying knots in a deep body cavity, and adjustable bands to simulate tying knots under tension.
Available on Amazon: https://www.amazon.com/dp/B0BYMMZ1QL?ref=myi_title_dp
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This video series includes how-to videos from the Behind the Knife team for right and left-handed learners. Worried about your performance in the operating room? Don’t be! These videos cover everything you need to know with clear, easy-to-follow instructions. From two-handed knot tying to a running subcuticular stitch to closing a laparoscopic port site, we’ve got your back (lefties too).
The suture kit contains everything you need to hone your surgical skills, including high-quality surgical instruments, multiple different kinds of suture, and a best-in-class suture pad. The Knot Tying Simulator is designed for beginners and for those with more advanced skills.
The simulator includes a free-standing hook ideal for high repetition knot tying practice, a hook set within a cylinder to replicate tying knots in a deep body cavity, and adjustable bands to simulate tying knots under tension.
Available on Amazon: https://www.amazon.com/dp/B0BYMMZ1QL?ref=myi_title_dp
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This video series includes how-to videos from the Behind the Knife team for right and left-handed learners. Worried about your performance in the operating room? Don’t be! These videos cover everything you need to know with clear, easy-to-follow instructions. From two-handed knot tying to a running subcuticular stitch to closing a laparoscopic port site, we’ve got your back (lefties too).
The suture kit contains everything you need to hone your surgical skills, including high-quality surgical instruments, multiple different kinds of suture, and a best-in-class suture pad. The Knot Tying Simulator is designed for beginners and for those with more advanced skills.
The simulator includes a free-standing hook ideal for high repetition knot tying practice, a hook set within a cylinder to replicate tying knots in a deep body cavity, and adjustable bands to simulate tying knots under tension.
Available on Amazon: https://www.amazon.com/dp/B0BYMMZ1QL?ref=myi_title_dp
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This video series includes how-to videos from the Behind the Knife team for right and left-handed learners. Worried about your performance in the operating room? Don’t be! These videos cover everything you need to know with clear, easy-to-follow instructions. From two-handed knot tying to a running subcuticular stitch to closing a laparoscopic port site, we’ve got your back (lefties too).
The suture kit contains everything you need to hone your surgical skills, including high-quality surgical instruments, multiple different kinds of suture, and a best-in-class suture pad. The Knot Tying Simulator is designed for beginners and for those with more advanced skills.
The simulator includes a free-standing hook ideal for high repetition knot tying practice, a hook set within a cylinder to replicate tying knots in a deep body cavity, and adjustable bands to simulate tying knots under tension.
Available on Amazon: https://www.amazon.com/dp/B0BYMMZ1QL?ref=myi_title_dp
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This video series includes how-to videos from the Behind the Knife team for right and left-handed learners. Worried about your performance in the operating room? Don’t be! These videos cover everything you need to know with clear, easy-to-follow instructions. From two-handed knot tying to a running subcuticular stitch to closing a laparoscopic port site, we’ve got your back (lefties too).
The suture kit contains everything you need to hone your surgical skills, including high-quality surgical instruments, multiple different kinds of suture, and a best-in-class suture pad. The Knot Tying Simulator is designed for beginners and for those with more advanced skills.
The simulator includes a free-standing hook ideal for high repetition knot tying practice, a hook set within a cylinder to replicate tying knots in a deep body cavity, and adjustable bands to simulate tying knots under tension.
Available on Amazon: https://www.amazon.com/dp/B0BYMMZ1QL?ref=myi_title_dp
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This video series includes how-to videos from the Behind the Knife team for right and left-handed learners. Worried about your performance in the operating room? Don’t be! These videos cover everything you need to know with clear, easy-to-follow instructions. From two-handed knot tying to a running subcuticular stitch to closing a laparoscopic port site, we’ve got your back (lefties too).
The suture kit contains everything you need to hone your surgical skills, including high-quality surgical instruments, multiple different kinds of suture, and a best-in-class suture pad. The Knot Tying Simulator is designed for beginners and for those with more advanced skills.
The simulator includes a free-standing hook ideal for high repetition knot tying practice, a hook set within a cylinder to replicate tying knots in a deep body cavity, and adjustable bands to simulate tying knots under tension.
Available on Amazon: https://www.amazon.com/dp/B0BYMMZ1QL?ref=myi_title_dp
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This video series includes how-to videos from the Behind the Knife team for right and left-handed learners. Worried about your performance in the operating room? Don’t be! These videos cover everything you need to know with clear, easy-to-follow instructions. From two-handed knot tying to a running subcuticular stitch to closing a laparoscopic port site, we’ve got your back (lefties too).
The suture kit contains everything you need to hone your surgical skills, including high-quality surgical instruments, multiple different kinds of suture, and a best-in-class suture pad. The Knot Tying Simulator is designed for beginners and for those with more advanced skills.
The simulator includes a free-standing hook ideal for high repetition knot tying practice, a hook set within a cylinder to replicate tying knots in a deep body cavity, and adjustable bands to simulate tying knots under tension.
Available on Amazon: https://www.amazon.com/dp/B0BYMMZ1QL?ref=myi_title_dp
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This video series includes how-to videos from the Behind the Knife team for right and left-handed learners. Worried about your performance in the operating room? Don’t be! These videos cover everything you need to know with clear, easy-to-follow instructions. From two-handed knot tying to a running subcuticular stitch to closing a laparoscopic port site, we’ve got your back (lefties too).
The suture kit contains everything you need to hone your surgical skills, including high-quality surgical instruments, multiple different kinds of suture, and a best-in-class suture pad. The Knot Tying Simulator is designed for beginners and for those with more advanced skills.
The simulator includes a free-standing hook ideal for high repetition knot tying practice, a hook set within a cylinder to replicate tying knots in a deep body cavity, and adjustable bands to simulate tying knots under tension.
Available on Amazon: https://www.amazon.com/dp/B0BYMMZ1QL?ref=myi_title_dp
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This video series includes how-to videos from the Behind the Knife team for right and left-handed learners. Worried about your performance in the operating room? Don’t be! These videos cover everything you need to know with clear, easy-to-follow instructions. From two-handed knot tying to a running subcuticular stitch to closing a laparoscopic port site, we’ve got your back (lefties too).
The suture kit contains everything you need to hone your surgical skills, including high-quality surgical instruments, multiple different kinds of suture, and a best-in-class suture pad. The Knot Tying Simulator is designed for beginners and for those with more advanced skills.
The simulator includes a free-standing hook ideal for high repetition knot tying practice, a hook set within a cylinder to replicate tying knots in a deep body cavity, and adjustable bands to simulate tying knots under tension.
Available on Amazon: https://www.amazon.com/dp/B0BYMMZ1QL?ref=myi_title_dp
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This video series includes how-to videos from the Behind the Knife team for right and left-handed learners. Worried about your performance in the operating room? Don’t be! These videos cover everything you need to know with clear, easy-to-follow instructions. From two-handed knot tying to a running subcuticular stitch to closing a laparoscopic port site, we’ve got your back (lefties too).
The suture kit contains everything you need to hone your surgical skills, including high-quality surgical instruments, multiple different kinds of suture, and a best-in-class suture pad. The Knot Tying Simulator is designed for beginners and for those with more advanced skills.
The simulator includes a free-standing hook ideal for high repetition knot tying practice, a hook set within a cylinder to replicate tying knots in a deep body cavity, and adjustable bands to simulate tying knots under tension.
Available on Amazon: https://www.amazon.com/dp/B0BYMMZ1QL?ref=myi_title_dp
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This video series includes how-to videos from the Behind the Knife team for right and left-handed learners. Worried about your performance in the operating room? Don’t be! These videos cover everything you need to know with clear, easy-to-follow instructions. From two-handed knot tying to a running subcuticular stitch to closing a laparoscopic port site, we’ve got your back (lefties too).
The suture kit contains everything you need to hone your surgical skills, including high-quality surgical instruments, multiple different kinds of suture, and a best-in-class suture pad. The Knot Tying Simulator is designed for beginners and for those with more advanced skills.
The simulator includes a free-standing hook ideal for high repetition knot tying practice, a hook set within a cylinder to replicate tying knots in a deep body cavity, and adjustable bands to simulate tying knots under tension.
Available on Amazon: https://www.amazon.com/dp/B0BYMMZ1QL?ref=myi_title_dp
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This video series includes how-to videos from the Behind the Knife team for right and left-handed learners. Worried about your performance in the operating room? Don’t be! These videos cover everything you need to know with clear, easy-to-follow instructions. From two-handed knot tying to a running subcuticular stitch to closing a laparoscopic port site, we’ve got your back (lefties too).
The suture kit contains everything you need to hone your surgical skills, including high-quality surgical instruments, multiple different kinds of suture, and a best-in-class suture pad. The Knot Tying Simulator is designed for beginners and for those with more advanced skills.
The simulator includes a free-standing hook ideal for high repetition knot tying practice, a hook set within a cylinder to replicate tying knots in a deep body cavity, and adjustable bands to simulate tying knots under tension.
Available on Amazon: https://www.amazon.com/dp/B0BYMMZ1QL?ref=myi_title_dp
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This video series includes how-to videos from the Behind the Knife team for right and left-handed learners. Worried about your performance in the operating room? Don’t be! These videos cover everything you need to know with clear, easy-to-follow instructions. From two-handed knot tying to a running subcuticular stitch to closing a laparoscopic port site, we’ve got your back (lefties too).
The suture kit contains everything you need to hone your surgical skills, including high-quality surgical instruments, multiple different kinds of suture, and a best-in-class suture pad. The Knot Tying Simulator is designed for beginners and for those with more advanced skills.
The simulator includes a free-standing hook ideal for high repetition knot tying practice, a hook set within a cylinder to replicate tying knots in a deep body cavity, and adjustable bands to simulate tying knots under tension.
Available on Amazon: https://www.amazon.com/dp/B0BYMMZ1QL?ref=myi_title_dp
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This video series includes how-to videos from the Behind the Knife team for right and left-handed learners. Worried about your performance in the operating room? Don’t be! These videos cover everything you need to know with clear, easy-to-follow instructions. From two-handed knot tying to a running subcuticular stitch to closing a laparoscopic port site, we’ve got your back (lefties too).
The suture kit contains everything you need to hone your surgical skills, including high-quality surgical instruments, multiple different kinds of suture, and a best-in-class suture pad. The Knot Tying Simulator is designed for beginners and for those with more advanced skills.
The simulator includes a free-standing hook ideal for high repetition knot tying practice, a hook set within a cylinder to replicate tying knots in a deep body cavity, and adjustable bands to simulate tying knots under tension.
Available on Amazon: https://www.amazon.com/dp/B0BYMMZ1QL?ref=myi_title_dp
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This video series includes how-to videos from the Behind the Knife team for right and left-handed learners. Worried about your performance in the operating room? Don’t be! These videos cover everything you need to know with clear, easy-to-follow instructions. From two-handed knot tying to a running subcuticular stitch to closing a laparoscopic port site, we’ve got your back (lefties too).
The suture kit contains everything you need to hone your surgical skills, including high-quality surgical instruments, multiple different kinds of suture, and a best-in-class suture pad. The Knot Tying Simulator is designed for beginners and for those with more advanced skills.
The simulator includes a free-standing hook ideal for high repetition knot tying practice, a hook set within a cylinder to replicate tying knots in a deep body cavity, and adjustable bands to simulate tying knots under tension.
Available on Amazon: https://www.amazon.com/dp/B0BYMMZ1QL?ref=myi_title_dp
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This video series includes how-to videos from the Behind the Knife team for right and left-handed learners. Worried about your performance in the operating room? Don’t be! These videos cover everything you need to know with clear, easy-to-follow instructions. From two-handed knot tying to a running subcuticular stitch to closing a laparoscopic port site, we’ve got your back (lefties too).
The suture kit contains everything you need to hone your surgical skills, including high-quality surgical instruments, multiple different kinds of suture, and a best-in-class suture pad. The Knot Tying Simulator is designed for beginners and for those with more advanced skills.
The simulator includes a free-standing hook ideal for high repetition knot tying practice, a hook set within a cylinder to replicate tying knots in a deep body cavity, and adjustable bands to simulate tying knots under tension.
Available on Amazon: https://www.amazon.com/dp/B0BYMMZ1QL?ref=myi_title_dp
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Crystal Koerner for a discussion on Preparing for your First Year of Robotic Surgery Practice.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
This spectacular keynote address was given by Dr. David Knott at the “Mattox” Trauma Conference in 2023.
Mattox Vegas TCCACS: https://www.trauma-criticalcare.com/
War Doctor: https://www.amazon.com/War-Doctor-Surgery-Front-Line/dp/1419744240/ref=asc_df_1419744240/?tag=hyprod-20&linkCode=df0&hvadid=508953752346&hvpos=&hvnetw=g&hvrand=15602939439351749599&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9009673&hvtargid=pla-906115140419&psc=1
The David Nott Foundation: https://davidnottfoundation.com/
Dr. Nott on BTK July 1, 2020: https://behindtheknife.org/podcast/war-doctor-david-nott-on-surgery-in-war-zones/
David gained his medical degree from Manchester University and in 1992 gained his FRCS from the Royal College of Surgeons of England to become a Consultant Surgeon.
He is a Consultant Surgeon at St Mary’s Hospital where he specialises in vascular and trauma surgery and also performs cancer surgery at the Royal Marsden Hospital. David is an authority in laparoscopic surgery and was the first surgeon to combine laparoscopic and vascular surgery.
For the past 30 years David has taken unpaid leave to work for the aid agencies Médecins Sans Frontières, the International Committee of the Red Cross and Syria Relief. He has provided surgical treatment to patients in conflict and catastrophe zones in Bosnia, Afghanistan, Sierra Leone, Liberia, Ivory Coast, Chad, Darfur, Yemen, the Democratic Republic of Congo, Haiti, Iraq, Pakistan, Libya, Syria, Central African Republic, Palestine, Nepal and Ukraine
As well as treating patients affected by conflict and catastrophe and raising hundreds of thousands of pounds for charitable causes, David teaches advanced surgical skills to local medics and surgeons when he is abroad. In Britain, he set up and led the teaching of the Surgical Training for the Austere Environment (STAE) course at the Royal College of Surgeons.
In 2015 David established the David Nott Foundation with his wife Elly. The Foundation supports surgeons in developing their operating skills for war zones and austere environments and has now trained over 900 doctors through their bespoke Hostile Environment Surgical Training (HEST) course. In 2019, Picador published David’s bestselling memoir, War Doctor.
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 episode list here: https://behindtheknife.org/listen/
For this CRS Virtual Education episode, please join Jeffrey Barton, MD, FACS FASCRS for a discussion on Clostridioides Difficile.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Shubham Gupta discuss Genital Gender Affirmation Surgery.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Mark Soliman for a discussion on Intracorporeal Anastomoses.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Dr. Cunningham is the section head of the Massachusetts General Hospital Endocrine Surgery unit, a NIH-funded researcher, and the immediate past-president of the Association for Academic Surgery. This video is a recording of her presidential address at their annual Academic Surgical Congress.
Guest
Dr. Carrie Cunningham, MD, MPH
Associate Professor of Surgery, Harvard Medical School
Learn More
Association for Academic Surgery: https://www.aasurg.org/
Dr. Lorna Breen Heroes foundation: https://drlornabreen.org/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Joseph Terlizzi, MD, FASCRS discuss Anal Cancer Screening and Prevention.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Choledochoscopy can be utilized to push stones through the ampulla, snare and crush or extract with nitinol baskets under direct visualization or fragment into smaller pieces for flushing with lithotripsy. This video provides stepwise instructions for utilization of this powerful common bile duct exploration adjunct.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
To facilitate ease of intervention, assembling a cart to centralize and store all of the supplies is essential. This video describes common items kept on a common bile duct exploration cart.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
The correct balloon must be selected to avoid complications and facilitate ease of intervention. This video walks through the details on how to select the right catheter.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Balloon dilation of the Sphincter of Oddi with over-the-wire non-compliant balloon catheters allows for antegrade clearance of common bile duct stones by primarily utilizing Seldinger technique which is familiar to most general surgeons. This video provides step-by-step instructions on how to perform this procedure.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Small stones may be amenable to simple power flushing in close proximity to the stones/sludge. This video provides a stepwise technique to this intervention.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
LCBDE must be efficient and simple to lower the threshold to intervention. This video describes a “wire-ready cholangiography” set-up that allows for the immediate next step in intervention after identification of stones without time consuming catheter exchanges.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
These educational videos will describe the necessary equipment, methods of managing equipment inventory, and various methods for “wire-ready cholangiography” as a set up to several interventional techniques for transcystic laparoscopic common bile duct exploration.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Beatrice Dionigi, MD for a discussion on Re-do J Pouch: The Art of Pelvic Surgery.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join David M. Schwartzberg, MD for a discussion on The Ileal Pouch: Ideal Design & Technical Concerns.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Jeffrey A. Sternberg, MD, FACS, FASCRS for a discussion on Pilonidal Disease: Myths, Truths, and Pearls.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Garrett Friedman, MD for a discussion on Mastering Splenic Flexure.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Tracy Hull, MD for a discussion on the management of Reco-Ano-Vaginal Fistula.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Liliana Bordeianou, MD, MPH for a discussion on Tailoring Surgery Along the Rectal Prolapse Spectrum of Disease.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Amanda McClure, MD, FACS, FASCRS for a discussion on robotic total mesorectal excision.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
You have a patient who underwent local excision of a rectal cancer. Final pathology demonstrates a T2 lesion. What is the rate of local recurrence? Is excision alone sufficient? Should the patient undergo radical resection or should chemoradiation be offered? Tune in to find out!
Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Jose Guillem MD, MPH, MBA as they discuss high yield papers discussing local excision for Rectal Cancer.
Learning Objectives
1. Describe the features that increase risk of lymph node involvement in early stage rectal cancer
2. Discuss the different options for management of early-stage rectal cancer
3. Describe patient related factors that favor local excision of rectal cancer
References:
Kidane B, Chadi SA, Kanters S, Colquhoun PH, Ott MC. Local resection compared with radical resection in the treatment of T1N0M0 rectal adenocarcinoma: a systematic review and meta-analysis. Dis Colon Rectum. 2015 Jan;58(1):122-40. doi: 10.1097/DCR.0000000000000293. PMID: 25489704.
Garcia-Aguilar J, Renfro LA, Chow OS, Shi Q, Carrero XW, Lynn PB, Thomas CR Jr, Chan E, Cataldo PA, Marcet JE, Medich DS, Johnson CS, Oommen SC, Wolff BG, Pigazzi A, McNevin SM, Pons RK, Bleday R. Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol. 2015 Nov;16(15):1537-1546. doi: 10.1016/S1470-2045(15)00215-6. Epub 2015 Oct 22. PMID: 26474521; PMCID: PMC4984260.
Friel CM, Cromwell JW, Marra C, Madoff RD, Rothenberger DA, Garcia-Aguílar J. Salvage radical surgery after failed local excision for early rectal cancer. Dis Colon Rectum. 2002 Jul;45(7):875-9. doi: 10.1007/s10350-004-6320-z. PMID: 12130873.
Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum. 2002 Feb;45(2):200-6. doi: 10.1007/s10350-004-6147-7. PMID: 11852333.
O’Neill CH, Platz J, Moore JS, Callas PW, Cataldo PA. Transanal Endoscopic Microsurgery for Early Rectal Cancer: A Single-Center Experience. Dis Colon Rectum. 2017 Feb;60(2):152-160. doi: 10.1097/DCR.0000000000000764. PMID: 28059911.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Vascular surgery is full of awesome anatomy and big open vessel exposures, but endovascular surgery is here to stay and can be hard to get into, particularly as a learner. The basics of endovascular surgery share very little with the basics of open surgery and getting up to speed can be a big challenge. This episode is an introduction to all things endovascular surgery, from wires, catheters and sheaths to balloons and stents. Take a listen to get up to speed quickly in prep for an upcoming vascular rotation and skip the pain of trying to follow your attendings words so you can instead pay attention to the actual case.
Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan.
Dr. Craig Brown is a PGY-7 in the General Surgery program and the upcoming 2023 vascular surgery fellow at the University of Michigan.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Patricia Sylla, MD, FACS, FASCRS for a discussion on Transanal TME: A Story of Collaborative Innovation.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Daniel I. Chu for a discussion on Health Literacy in Colorectal Surgery.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
For this CRS Virtual Education episode, please join Dr. Avery Walker discuss Anorectal Pearls – Part 2.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Please join Stefan D. Holubar MD MS for a discussion on Heineke-Mikulicz Strictureplasty in Diffuse Jejunoileal Crohn’s Disease.
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Please join Mary Anne Obst, BSN, RN, CWON, CCRN, CWS for a discussion on Managing Difficult Stomas and Fistulas: Keys to Success for this CRS Virtual Education episode.
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Please join Dr. Jennifer Davids for a discussion on Perspectives on Building Gender Equity in Surgery for this CRS Virtual Education episode.
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Please join Dr. Alessandra Gasior for a discussion on Pediatric Colorectal Surgery.
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For this CRS Virtual Education episode, please join Dr. Avery Walker discuss Anorectal Pearls.
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Please join Dr. Ocuin to discuss the Surgical Management of Colorectal Cancer Liver Metastases.
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Join the discussion to hear Colorectal Surgery mock oral boards to help prepare for the General Surgery Oral Board Exam.
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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
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If you liked this episode, check out other Colorectal Surgery episodes here: https://behindtheknife.org/podcast-category/colorectal/
This video supplements our podcast episode titled “Innovations in Surgery: Artificial Intelligence “.
This video is an example of the application of artificial intelligence in the OR.
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.
Join Dr. David Kleiman for a discussion on the Colonoscopy in Colorectal Practice: The Good, the Bad, the Essential as part of our CRS Virtual Education Series.
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Join Dr. Uma Mahadeven for a discussion on the Management of IBD as part of our CRS Virtual Education Series.
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Please join Dr. Rahila Essani to discuss Less than 24 Hours Or Ambulatory Colectomy – Is it really a thing in colorectal surgery?
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Join Dr. Eric Dozois for a discussion on Presacral Tumors: Recognition, Evaluation, Technical Considerations.
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FULL Patient History Below: (Video starts a bit late and does not include full history)
60F w/intense anal itching + burning for 1 mo. Tried using witch hazel + Prep H. No fiber, no laxatives, Western diet. 2 BM per day. No incontinence. Well-controlled DM. Anxiety, no medications. Monogamous, sexually active, no hx STI. CSP 7 years prior.
Exam: external excoriations. No masses. Normal tone.
Flex sig: no proctitis, masses
Causes?
Dietary
Systemic illnesses
Autoimmune + dermatologic conditions
Contact dermatitis (ex: fragrances in her hygiene regimen)
Topical steroid
1 mo. F/U w/o improvement
Consider stopping Metformin
Other treatment options?
Topical capsaicin, refer to Dermatology
Intra-dermal methylene blue injection using 27 Gg, non-hair bearing portion, 1:10 dilution
Complications?
Anaphylaxis, necrosis, temporary incontinence
Alternative: 2 cm perianal lesion distal to anal verge, erythematous + scaly
Poss. Paget’s? Punch BX w/local anesthesia
Inguinal exam
CSP (-)
OR: anal mapping
WLE w/2 mm margin + leave open
Other options? Raise flaps on either side + primarily close
Alternative: CSP showed 3.5 cm mass in rectum 7 cm from anal verge, ant.
BX: adenoCA
Stage w/MRI, CT C/A/P (-)
MRI: T2N0M0
Pathologic features: no adverse
Assess continence
Council re robotic LAR w/DLI
How to treat Paget’s w/rectal CA? APR
Alternative: 85F w/Paget’s only – topical treatment
Alternative: 60F w/pruritis found 3 cm ulcerated lesion in anal verge, tender, soiling, can’t get good exam in office
Additional Qs?
Gyn hx, abnormal paps, HPV vaccine, TOB or XRT, anoreceptive intercourse
Book for EUA w/BX
No invasion in vagina, invades into IAS
Path: SCC
HIV testing
Staging: MRI, CT C/A/P, CEA?
No inguinal LN
p16 (+), what does that mean?
HPV-related
Multiple BL liver lesions suspicious for mets
Refer to Med + RadOnc for neoadjuvant chemoTX w/checkpoint inhibitors
T2N0M0 stage 2
Neoadjuvant Nigro protocol 54Gy XRT, 5-FU, MMC
5 weeks post-TX F/U lesion smaller but wait until 3 mo.
Mass gone but scar remains
MRI, endoscopy
BX? No
Surveillance protocol
MRI, CT at 6 mo. w/anoscopy + exam/CEA Q6 mo.
Mass decreased in size at 3 mo.
Possibly grew at 6 mo.
Re-stage w/MRI + CT
Salvage APR
Metachronous inguinal LAD unilaterally
PET: isolated L groin
L lymphadenectomy – refer to Surg Onc
Inguinal + primary disease
Radiate groin
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Please join Dr. Sharon Stein to review the treatment of Enterocutaneous Fistula.
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Please join Dr. Jean Asburn to learn about Reoperative Surgery of the Abdomen and Pelvis.
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Join us to hear Tips and Tricks for Success in Colorectal Fellowship from former Colorectal Fellows.
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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.
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.
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.
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.
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“Applying for Colon and Rectal Surgery Residency – Nuts and Bolts” — Sponsored by ASCRS Residents Committee Webinar (6/12/22)
Presented by Dr. Elizabeth Carpenter, MD (San Antonio Military Medical Center)
Please review SCORE’s TWIS module on Pancreaticoduodenectomy (https://www.surgicalcore.org/modulecontent.aspx?id=145049)
Join Dr. Scott Steele for his famous “Little Man” talk describing rectal anatomy in all of its glory.
Presented by Dr. Elizabeth Carpenter, MD (San Antonio Military Medical Center)
Please review SCORE’s TWIS modules on Breast: Mastectomy – Simple, Modified Radical, and Radical (https://surgicalcore.org/modulecontent.aspx?ID=1000772&currID=1&currTopID=509)
Dr. Jonathan Abelson is well-known to the CRS Education Series as a founding member of the organization. He is an assistant professor of surgery at Lahey Hospital & Medical Center. He completed his residency at Weill Cornell Medical Center in General Surgery followed by a fellowship in Colon and Rectal Surgery at Washington University in St. Louis. He has a special interest in rectal cancer and will be discussing an extremely important topic for all CRS and general surgeons.
This week, Dr. Peter Marcello shares with us “Lessons from an Old Guy” describing how to remain relevant in an ever changing practice environment, tips and tricks for challenging situations, and thoughts from recent DCR journal articles. Dr. Marcello is the Chairman of the Division of Colon and Rectal Surgery at the Lahey Hospital and Medical Center in Burlington, Massachusetts. He has performed more than 3000 laparoscopic colorectal procedures including participation in the COST and ACOSOG trials. He has organized more than 160 postgraduate courses teaching laparoscopic colorectal surgery and more than 20 advanced endoscopic courses. He is currently working on innovations in the endoluminal resection of colorectal neoplasia.
Presented by Dr. Madhuri Nagaraj, MD (UTSW)
Please review SCORE’s TWIS modules on abdominal trauma.
Please review SCORE’s TWIS module on Vascular Access for Dialysis (https://www.surgicalcore.org/modulecontent.aspx?id=133775) and Arteriovenous Graft/Fistula (https://www.surgicalcore.org/modulecontent.aspx?id=133899)
This week is our Spring CRS Mock Oral Boards. Dr. Carrie Peterson, Associate Professor of Surgery and CRS at Medical College of Wisconsin, and Dr. Jonathon Abelson, Assistant Professor of Surgery and CRS at Lahey Medical Center provide excellent scenarios and teaching points for our two examinees, Drs. Fazaldin Moghul and Joceline Vu.
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
Presented by Dr. Roberto Mares País, MD (Regional General Hospital 180, Mexico)
Please review SCORE’s TWIS module on Tracheobronchial and Lung Injury: https://www.surgicalcore.org/modulecontent.aspx?id=1000541
Dr. Justin Maykel is Professor and Chief of Colorectal Surgery at the University of Massachusetts Memorial Medical Center in Worcester, MA. Dr. Maykel has a special interest in Transanal Total Mesorectal Excision and will be discussing this very challenging and important topic with us this week!
This week we host Dr. Stefan Holubar, who is a staff Colorectal Surgeon and Director of IBD Multidisciplinary Team Conference and IBD Surgical Research at the Cleveland Clinic in Cleveland, Ohio. Dr. Holubar is one of the emerging leaders in surgery in clinical and translational research and is working on breakthroughs in the pathophysiology of rectal cancer and treatment of patients with inflammatory bowel disease.
Dr. Lauren E. Henke, MD is an assistant professor of radiation oncology. Her clinical practice and research interests include motion management in the treatment of gastrointestinal cancers, adaptive radiation therapy, advanced image-guided radiation therapy, MRI-guided radiation therapy, technology development, and clinical trial design. This week, she discusses the multi-disciplinary management of rectal cancer.
Dr. Feza Remzi is a colorectal surgeon at NYU Langone and is an expert in the surgical management of inflammatory bowel disease. As a national and international expert in colorectal surgery, he has published many articles and book chapters on the surgical management of inflammatory bowel disease, ileal J-pouch surgery, and reoperative abdominopelvic surgery. This week, he discusses technical and real life pearls for IPAA reconstruction.
Dr. Sean Langenfeld MD, is an Associate Professor and Section Chief of Colon and Rectal Surgery in the Department of Surgery at the University of Nebraska Medical Center in Omaha, Nebraska. Dr. Langenfeld serves are on several editorial boards including the Journal of Surgical Education, Journal of Gastrointestinal Surgery, and is currently Section Editor for Selected Abstracts for Diseases of the Colon and Rectum. This week, he joins us to discuss the the complex management diverticulitis, an important topic for any general surgeon or colon and rectal surgeon.
Presented by Dr. Jordan D. Raine, MD (University of Tennessee Chattanooga)
Please review SCORE’s TWIS module on Extremity Injuries: https://www.surgicalcore.org/modulecontent.aspx?id=1000464
Presented by Dr. Shivani Bajpai, MD (Anne Arundel Medical Center)
Please review SCORE’s TWIS module on Ultrasound Use for Intravascular Access: https://surgicalcore.org/modulecontent.aspx?id=163873
Presented by Dr. Tamanie Yeager, MD (Mount Sinai Hospital)
Please review SCORE’s TWIS module on Parathyroidectomy: https://www.surgicalcore.org/modulecontent.aspx?id=1000787
Presented by Dr. Christina Theodorou, MD (UC Davis Medical Center)
Please review SCORE’s TWIS module on Pediatric Trauma: https://www.surgicalcore.org/modulecontent.aspx?id=143135
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Join Behind the Knife’s very own Dr. Scott Steele, Chairman of the Department of Colorectal Surgery at Cleveland Clinic, for a high-level talk on the treatment of T2N0 rectal cancer.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
Presented by Dr. Brianna Spencer, MD (Penn State Hershey Medical Center)
Please review SCORE’s TWIS module on Ulcerative Colitis: https://www.surgicalcore.org/modulecontent.aspx?id=129440
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