Emergency abdominal wall surgery is a common scenario for all general surgeons. Decision making with regard to operative approach and mesh utilization can be confusing. This podcast will review the common circumstances and highlight advanced decision making.   ·       Dr. Vahagn Nikolian is an Assistant Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair.  ·       Dr. Sean Orenstein is an Associate Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair. 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/

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam. Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2 If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.    Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam. Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2 If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.    Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Dipping your toes in the water of surgical education research can be a daunting task if you have no prior experience, even if you have done basic or clinical research before. How do you create a good surgical education research project? How can clinicians get involved in and find mentors for surgical education research? Is formal postgraduate training becoming necessary for a career in surgical education? Luckily, we invite Dr. Jon Sherbino and Dr. Lara Varpio, hosts of the successful KeyLIME (Key Literature in Medical Education) podcast to share their valuable insights on medical education research with us. Check out KeyLIME on their website at https://keylimepodcast.libsyn.com/ and subscribe to KeyLIME on iTunes, Spotify, or Google podcasts! Learning Objectives 1.     Listeners will identify that surgical education applies the same rigor as other areas of research. 2.     Listeners will describe how observations within clinical practice and review of literature can lead to creation of a good research question. 3.     Listeners will describe how research questions should align with theory and methodology, which then align with conclusions for a research project. 4.     Listeners will identify that collaboration with colleagues with expertise in surgical education research, including education scientists, is important for successful completion of research with high rigor.  5.     Listeners will recognize advantages and disadvantages to formal training in education research, including fellowship and master’s degree programs. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other Surgical Education videos here: https://behindtheknife.org/podcast-category/surgical-education/

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam. Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2 If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.    Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam. Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2 If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.    Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam. Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2 If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.    Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Join our Miami Trauma team including Drs. Urréchaga, Neeman, and Rattan as they dive into the literature regarding a topic that has become all too common to the US news cycle- gun violence. They will go over a recent paper from JAMA and include other important literature while trying to understand this complex problem that has been grappling US public policy.  Quick Hits: 1.     Firearm injury is the leading cause death in the US among ages 1-19 2.     For every person killed violently by someone else with a firearm, there are 3 survivors.  3.     Gun ownership triples the risk of homicide 4.     Permit laws and preventing people convicted of a violent crime from owning a firearm decrease firearm-related death and have a positive ripple effect even outside state borders. In short, for effective reductions of firearm-related injury and death, federal legislation will be more effective than state-by-state References 1.     Liu, Y, Siegel, M, Sen, B. Association of State-Level Firearm-Related Deaths With Firearm Laws in Neighboring States. JAMA Network Open. 2022;5(11):e2240750. doi:10.1001/jamanetworkopen.2022.40750 2.     Goldstick, JE, Cunningham, RM, Carter, PM. Current Causes of Death in Children and Adolescents in the United States. N Engl J Med. 2022 May 19;386(20):1955-1956. doi: 10.1056/NEJMc2201761.  3.     Kellermann, AL, Rivara, FP, Rushforth, NB, Banton, JG, Reay, DT, Francisco, JT, Locci, AB, Prodzinski, J, Hackman, BB, Somes, G. Gun Ownership as a Risk Factor for Homicide in the Home. N Engl J Med 1993; 329:1084-1091. DOI: 10.1056/NEJM199310073291506 4.     Liu Y, Siegel, M, Sen, B. Neighbors do matter: between-state firearm laws and state firearm-related deaths in the US, 2000-2017. Am J Prev Med. 2020;59(5):648-657. doi:10.1016/j.amepre.2020.06.022 5.     Siegel, M, Pahn, M, Xuan, Z, et al. Firearm-related laws in all 50 US states,1991-2016. Am J Public Health.2017; 107(7):1122-1129. doi:10.2105/AJPH.2017.303701 6.     Kalesan, B, Mobily, ME, Keiser, O, Fagan, J, Galea, S. Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study. Lancet. 2016 Apr 30;387(10030):1847-55. doi: 10.1016/S0140-6736(15)01026-0. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other Journal Review episodes here: https://behindtheknife.org/podcast-series/journal-review/

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam. Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2 If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.    Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Behind the Knife ABSITE 2023 - high yield learning to help you DOMINATE the exam. Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/0578802767/ref=sr_1_2?keywords=behind+the+knife+podcast&qid=1639489872&sr=8-2 If you like the work that Behind the Knife is doing please leave us a review wherever you listen to podcasts.    Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

De novo metastatic breast cancer represents 6% of all new breast cancer diagnoses. This figure has not changed at all over the past 20 years; however, systemic therapy options have evolved dramatically during this time and have significantly increased life expectancy for these patients. While surgical management of the primary tumor in the setting of metastatic disease has typically been reserved for palliative indications, surgeons are now being asked to consider resecting the primary tumor to potentially increase overall survival. In this episode, we will use a case study to examine the data that should inform our conversations and decisions when we encounter patients with metastatic breast cancer who are interested in having their primary tumor resected. Links: §  Khan, S.A., S. Schuetz, and O. Hosseini (2022). Primary-Site Local Therapy for Patients with De Novo Metastatic Breast Cancer: An Educational Review. Ann Surg Oncol; 29: 5811-5820. https://link.springer.com/article/10.1245/s10434-022-11900-x §  Khan, S.A. et al (2022). Early Local Therapy for the Primary Site in De Novo Stage IV Breast Cancer: Results of a Randomized Clinical Trial (E2108). J Clin Oncol; 40(9): 978-987. https://ascopubs.org/doi/10.1200/JCO.21.02006?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed §  Badwe, R. et al (2015). Locoregional treatment versus no treatment of the primary tumor in metastatic breast cancer: an open-label randomized controlled trial. Lancet Oncol; 16: 1380-1388. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00135-7/fulltext §  Fitzal, F. et al (2019). Impact of Breast Surgery in Primary Metastasized Breast Cancer: Outcomes of the Prospective Randomized Phase III ABCSG-28 POSYTIVE Trial. Ann Surg; 269(6): 1163-1169. https://journals.lww.com/annalsofsurgery/Abstract/2019/06000/Impact_of_Breast_Surgery_in_Primary_Metastasized.24.aspx §  Soran, A. et al (2018). Randomized Trial Comparing Resection of Primary Tumor with No Surgery in Stage IV Breast Cancer at Presentation: Protocol MF07-01. Ann Surg Oncol; 25: 3141-3149. https://link.springer.com/article/10.1245/s10434-018-6494-6 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our other clinical challenges episodes here: https://behindtheknife.org/podcast-series/clinical-challenges/

The cardiac OR can be a daunting place for any medical student or resident who finds themself on a cardiac surgery rotation. Have no fear, this Cardiac Surgery Crash Course is a short series focused on high-yield topics to help introduce students and residents to cardiac surgery prior to or during a cardiac surgery rotation. In this episode join Dr. Aaron Williams and our education fellow Dr. Jessica Millar as they break down ICU monitoring and hemodynamics of post-op cardiac surgery patients.  If you have any suggestions or requests for this series, please feel free to reach out to us by email:  Jessica Millar: [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:  Helpful Resources:  https://www.tsranet.org/resources/tsra-resources-for-residents/ 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:  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/ 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/ 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 here:  https://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 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/ 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 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 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 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/

Join BTK's Dr. Scott Steele and Dr. Jason Bingham as they discuss coding and billing with Dr. Sarah Vogler.  Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our Financial Principles for Surgeons series here: https://behindtheknife.org/podcast-series/financial-principles-for-surgeons/

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/ Vital Talk https://www.vitaltalk.org/ 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 https://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 - https://behindtheknife.org/podcast/clinical-challenges-in-emergency-general-surgery-necrotizing-soft-tissue-infections/  

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" - https://behindtheknife.org/podcast/journal-review-in-colorectal-surgery-timing-of-biologics-and-surgery-in-the-setting-of-crohns-disease/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.