The utilization of point-of-care ultrasound and other non-invasive cardiac output monitoring technologies varies because of knowledge, resource availability and cultural practices. In this  Clinical Challenge in Surgery episode from the Surgical Critical Care team at Behind the Knife, we provide a brief history of the use of cardiac-output monitoring in the ICU, introduce a few clinical scenarios in the context of point of care ultra-sound and other less-invasive cardiac-output monitoring technologies. Learning Objectives:  In this episode, we review the historical uses of central venous pressure monitoring, pulmonary-artery catheters and the more frequently utilized point-of-care-ultrasound (or POCUS) in managing complex ICU patients. We review the outcomes behind these technologies, describe the views and utility of POCUS, and introduce less-invasive or completely non-invasive ways to measure cardiac-output monitoring.  Hosts: Brittany Bankhead, MD, MS (@BBankheadMD) is an Assistant Professor of Surgery at Texas Tech University Health Sciences Center. Ryan Dumas, MD, FACS (@PMH_Trauma_RPD) is an Assistant Professor of Surgery at the University of Southwestern Medical Center and Parkland Memorial Hospital. Caroline Park, MD, MPH, FACS (@CPark_MD) is an Assistant Professor of Surgery at the University of Southwestern Medical Center and Parkland Memorial Hospital. Links to Papers Referenced in this Episode: National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006 May 25;354(21):2213-24. doi: 10.1056/NEJMoa061895. Epub 2006 May 21. PMID: 16714768. Yildizdas D, Aslan N. Ultrasonographic inferior vena cava collapsibility and distensibility indices for detecting the volume status of critically ill pediatric patients. J Ultrason. 2020 Nov;20(82):e205-e209. doi: 10.15557/JoU.2020.0034. Epub 2020 Sep 28. PMID: 33365158; PMCID: PMC7705480. Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990 Aug 15;66(4):493-6. doi: 10.1016/0002-9149(90)90711-9. PMID: 2386120. Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med. 2013 Jul;41(7):1774-81. doi: 10.1097/CCM.0b013e31828a25fd. PMID: 23774337. Acknowledgements:  We would like to acknowledge Dr. Hassan Mashbari and the Department of Surgical Critical Care and Anesthesia at the Massachusetts General Hospital and Dr. Christopher Choi and the Department of Anesthesiology at the University of Texas Southwestern for their ultra-sound video contributions. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Dr. Jordan Frey, a Plastic Surgeon in Buffalo NY, joins us to talk about how he uses investments in real estate to diversify his portfolio.  We discuss:  -Types of real estate investments and the pros and cons -Books to read on real estate investing -How to get started in real estate -Criteria he uses to choose a property and more Books recommended: The Millionaire Real Estate Investor - Gary Keller https://www.amazon.com/Millionaire-Real-Estate-Investor/dp/0071446370 Doctor's Guide to Real Estate Investing - Cory Fawcett https://www.amazon.com/Dr-Cory-S-Fawcett/e/B01FGK0IC8/ref=aufs_dp_fta_dsk Find Dr. Frey at his website or on social media. Prudentplasticsurgeon.com  or @JordanFreyMD Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

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

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

Kevin Kniery and Jason Bingham interview Larry Keller of Physician Financial Services on how and when to choose the right disability policy. You can reach Larry here [email protected] or at his website.  https://www.physicianfinancialservices.com/ White Coat Investor Article breaking down Disability Insurance https://www.whitecoatinvestor.com/what-you-need-to-know-about-disability-insurance/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Kevin Kniery and Jason Bingham interview Dr. Jason Mizell, a colorectal surgeon at University of Arkansas and pioneer in finance education for surgeons. He won the 2020 White Coat Investor Award for excellence in financial education. In this episode they discuss how to invest, and what to invest in, also cover topics regarding real estate, and biggest financial regrets.  Links to articles discussed Financial Waterfall for Docs https://www.whitecoatinvestor.com/financial-waterfalls-for-new-residents-and-attendings/ Backdoor Roth IRA Point/Counter Point https://www.physicianonfire.com/the-backdoor-roth/ Simple Path to Wealth https://jlcollinsnh.com/stock-series/ Dr. Mizell can be reached at [email protected] Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Kevin Kniery and Jason Bingham interview Dr. Jason Mizell, a colorectal surgeon at University of Arkansas and pioneer in finance education for surgeons. He won the 2020 White Coat Investor Award for excellence in financial education. In this episode they discuss his lecture "How to Resuscitate Your Critically Ill Finances".  Dr. Mizell can be reached at [email protected] Book Recommendation: The Psychology of Money  https://www.amazon.com/Psychology-Money-Timeless-lessons-happiness/dp/0857197681 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Join the BTK leadership team for a quick update on what's happening at Behind the Knife! Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

In this episode from the Endocrine Surgery team at BTK we invited Dr. Kepal Patel to join us to discuss two endocrine surgery cases while discussing pertinent literature. We discuss the work-up and surgical decision making for a case of medullary thyroid cancer and a Bethesda III thyroid nodule.               Dr. Kepal Patel is the Chief of the Division of Endocrine Surgery and a Professor of Surgery, Otolaryngology and Biochemistry at NYU Langone Health. Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.  Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department  Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department  Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research  Dr. Max Schumm is a PGY-5 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon.  Important Papers  Miyauchi, A., Matsuzuka, F., Hirai, K., Yokozawa, T., Kobayashi, K., Ito, Y., ... & Yamaguchi, K. (2002). Prospective trial of unilateral surgery for nonhereditary medullary thyroid carcinoma in patients without germline RET mutations. World journal of surgery, 26(8), 1023-1028. Cibas, E. S., Baloch, Z. W., Fellegara, G., LiVolsi, V. A., Raab, S. S., Rosai, J., ... & Alexander, E. K. (2013). A prospective assessment defining the limitations of thyroid nodule pathologic evaluation. Annals of internal medicine, 159(5), 325-332. Papazian, M. R., Dublin, J. C., Patel, K. N., Oweity, T., Jacobson, A. S., Brandler, T. C., & Givi, B. (2022). Repeat Fine-Needle Aspiration With Molecular Analysis in Management of Indeterminate Thyroid Nodules. Otolaryngology–Head and Neck Surgery, 01945998221093527.   Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

The grind of surgical training has been celebrated in the past, but to what end? With mounting evidence that supports a high prevalence of burnout in the surgical community, surgical educators and leaders are often called to develop initiatives to address the detrimental and potentially irreversible effects on trainees’ wellness during surgical training. We invite Dr. David Rogers, who has personally experienced burnout, to share his insight and expertise in improving workplace wellness. Spoiler: it’s not as easy as group yoga sessions and daily donuts. Hosts: Dr. David Rogers Dr. Jeremy Lipman Dr. Judith French Dr. Amy Han Learning Objectives 1.     Listeners will be able to define wellness in the context of surgical training. 2.     Listeners will be able to better characterize and recognize signs of burnout among surgeons and surgical trainees. 3.     Listeners will be able identify strategies for overcoming burnout.  4.     Listeners will be able to apply conceptual frameworks from workplace wellness outside of medicine that can guide developing effective programs that promote wellness in surgical education community. References: Torres-Landa S, Moreno K, Brasel KJ, Rogers DA. Identification of Leadership Behaviors that Impact General Surgery Junior Residents' Well-being: A Needs Assessment in a Single Academic Center. J Surg Educ. 2022;79(1):86-93. doi:10.1016/j.jsurg.2021.07.017 Coverdill JE, Bittner IV JG, Park MA, Pipkin WL, Mellinger JD. Fatigue as impairment or educational necessity? Insights into surgical culture. Acad Med. 2011;86:S69-72. Dyrbye LN, Thomas MR, Harper W, et al. The learning environment and medical student burnout: a multicentre study. Med Educ. 2009;43(3):274-282. doi:10.1111/j.1365-2923.2008.03282.x Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016;50(1):132-149. doi:10.1111/medu.12927 Bordage G. Conceptual frameworks to illuminate and magnify. Med Educ. 2009;43(4):312 319. doi:10.1111/j.1365-2923.2009.03295.x Bakker AB, de Vries JD. Job Demands–Resources theory and self-regulation: New explanations and remedies for job burnout. Anxiety, Stress, & Coping. 2021;34: 1-21. Georgiadis F. Author Dr Amit Sood: Rising Through Resilience; Five Things You Can Do To Become More Resilient. Medium. https://medium.com/authority-magazine/author-dr-amit-sood-rising-through-resilience-five-things-you-can-do-to-become-more-resilient-673b0a1e9f2a. Published 2020. Accessed May 10, 2022. Gino F. Are You Too Stressed to Be Productive? Or Not Stressed Enough? Harvard Business Review. Published October 5, 2017. https://hbr.org/2016/04/are-you-too-stressed-to-be-productive-or-not-stressed-enough Goleman D. Primal Leadership, with a New Preface by the Authors : Unleashing the Power of Emotional ... Intelligence.Harvard Bus Review Press; 2016. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

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

Acute limb ischemia is simultaneous one of the most fun but frustrating diseases to treat in vascular surgery. In this episode of Behind the Knife, the vascular surgery team gives a concise overview of the diagnosis/workup and treatment of patients with acute limb ischemia and talks about some of the difficult decision making regarding treatment modality given all the exciting technology available today. Dr. Nicholas Osborne is an Associate Professor of Vascular Surgery at the University of Michigan and the Chief of Vascular Surgery at the Ann Arbor Veteran’s Affairs Healthcare System. Dr. Frank Davis is a Chief Resident in the Integrated Vascular Surgery program at the University of Michigan. Dr. Craig Brown is a PGY-6 in the General Surgery program at the University of Michigan. Papers discussed in this Episode: AHA/ACC/SVS, etc Guidelines on the Management of Patients with Lower Extremity Peripheral Artery Disease https://pubmed.ncbi.nlm.nih.gov/27851992/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

It’s 1AM and the emergency department is calling about *insert terrifying foregut problem you haven’t seen since you were an intern here* and you wake up in a cold sweat to realize it was just a dream…this time. Tune in to this clinical challenge episode for some tips and tricks for managing foregut nightmares with Drs. Mike Weykamp, Nicole White, Andrew Wright, and Nick Cetrulo from the University of Washington’s Minimally Invasive Surgery team.  Referenced articles and videos:  1.     Rodriguez-Garcia HA, Wright AS, Yates RB. Managing obstructive gastric volvulus: challenges and solutions. Open Access Surgery. 2017 https://www.dovepress.com/getfile.php?fileID=35414 2.     Yates RB. Giant PEH: Management Principles for Unique Clinical Circumstances. 2017 SAGES Annual Meeting. Houston, TX. 2017 https://www.youtube.com/watch?v=vq6cZL2-pho 3.     Millet I, Orliac C, Alili C, Guillon F, Taourel P. Computed tomography findings of acute gastric volvulus. Eur Radiol. 2014.  https://pubmed.ncbi.nlm.nih.gov/25278244/ 4.     Mazaheri P, Ballard DH, Neal KA, Raptis DA, Shetty AS, Raptis CA, Mellnick VM. CT of Gastric Volvulus: Interobserver Reliability, Radiologists' Accuracy, and Imaging Findings. AJR Am J Roentgenol. 2019.  https://pubmed.ncbi.nlm.nih.gov/30403524/ 5.     Barmparas G, Alhaj Saleh A, Huang R, Eaton BC, Bruns BR, Raines A, Bryant C, Crane CE, Scherer EP, Schroeppel TJ, Moskowitz E, Regner JL, Frazee R, Campion EM, Bartley M, Mortus JR, Ward J, Margulies DR, Dissanaike S. Empiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulcer. Trauma Surg Acute Care Open. 2021. https://pubmed.ncbi.nlm.nih.gov/34079912/ 6.     Horn CB, Coleoglou Centeno AA, Rasane RK, Aldana JA, Fiore NB, Zhang Q, Torres M, Mazuski JE, Ilahi ON, Punch LJ, Bochicchio GV. Pre-Operative Anti-Fungal Therapy Does Not Improve Outcomes in Perforated Peptic Ulcers. Surg Infect (Larchmt). 2018. https://pubmed.ncbi.nlm.nih.gov/30036134/ 7.     Wee JO. Gastric Volvulus in Adults. In: UpToDate, Louie BE (Ed), UpToDate, Waltham, MA. (Accessed on May 15, 2022.) https://www.uptodate.com/contents/gastric-volvulus-in-adults Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Determining when to order imaging for blunt cerebrovascular injury is a diagnostic quandary that has long engendered controversy. Today we discuss a paper that introduced universal CT angiogram of the neck to screen for BCVI in all blunt trauma patients and then compared the result to what would have happened if some of the current screening guidelines were utilized. Join us as we discuss their fascinating results and what it means for blunt trauma patients going forward. Hosts:  Elliott R. Haut, MD, Ph.D., a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST).  Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Master's in Education in the Health Professions from Johns Hopkins.  David Sigmon, MD, MMEd, a PGY-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.  LITERATURE Black JA, Abraham PJ, Abraham MN, et al. Universal screening for blunt cerebrovascular injury. J Trauma Acute Care Surg. 2021;90(2):224-231. https://pubmed.ncbi.nlm.nih.gov/33502144/ Kim DY, Biffl W, Bokhari F, et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020;88(6):875-887. https://pubmed.ncbi.nlm.nih.gov/32176167/ Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Elliott JP, Burch JM. Optimizing screening for blunt cerebrovascular injuries. (1999) American journal of surgery. 178 (6): 517-22. https://pubmed.ncbi.nlm.nih.gov/10670864/ Geddes AE, Burlew CC, Wagenaar AE, Biffl WL, Johnson JL, Pieracci FM, Campion EM, Moore EE. Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated. (2016) American journal of surgery. 212 (6): 1167-1174. https://pubmed.ncbi.nlm.nih.gov/27751528/ Ciapetti M, Circelli A, Zagli G et-al. Diagnosis of carotid arterial injury in major trauma using a modification of Memphis criteria. Scand J Trauma Resusc Emerg Med. 2010;18 (1): 61. https://pubmed.ncbi.nlm.nih.gov/21092211/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss TEF management and the use of a post-operative transanastomotic feeding tubes in pediatric surgery. Journal Article links:  Wang, C., Feng, L., Li, Y., & Ji, Y. (2018). What is the impact of the use of transanastomotic feeding tube on patients with esophageal atresia: a systematic review and meta-analysis. BMC Pediatr, 18(1), 385. doi:10.1186/s12887-018-1359-5 https://pubmed.ncbi.nlm.nih.gov/30541487/ Bence, C. M., Rymeski, B., Gadepalli, S., Sato, T. T., Minneci, P. C., Downard, C., . . . Midwest Pediatric Surgery, C. (2021). Clinical outcomes following implementation of a management bundle for esophageal atresia with distal tracheoesophageal fistula. J Pediatr Surg, 56(1), 47-54. doi:10.1016/j.jpedsurg.2020.09.049 https://pubmed.ncbi.nlm.nih.gov/33131776/ LaRusso, K., Joharifard, S., Lakabi, R., Nimer, N., Shahi, A., Kasasni, S. M., . . . Emil, S. (2022). Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula: The Quebec experience. J Pediatr Surg, 57(1), 41-44. doi:10.1016/j.jpedsurg.2021.09.014 https://pubmed.ncbi.nlm.nih.gov/34666898/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Join Shreya Gupta, MD and Jonathan Abelson, MD as they discuss highlights from the American Society of Colon and Rectal Surgeons.  Dr. Sharon Stein and Dr. Erin King-Mullins are the guest speakers. They are discussing female leadership, diversity and inclusion topics, and much more! This is episode 2 of 2. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform *** Join Shreya Gupta, MD and Jonathan Abelson, MD as they discuss highlights from the American Society of Colon and Rectal Surgeons.  This is episode 1 of 2.   Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform *** Subjective and objective GERD are common amongst bariatric surgery patients. Is weight loss alone enough to improve GERD symptoms? Is the vertical sleeve gastrectomy really associated with worsening GERD? What technical factors of the vertical sleeve gastrectomy lead to improved or worsening GERD? Listen to find out! Journal articles: The Impact of Sleeve Gastrectomy on Gastroesophageal Reflux Disease in Patients with Morbid Obesity https://pubmed.ncbi.nlm.nih.gov/35048247/ Effect of Concomitant Laparoscopic Sleeve Gastrectomy and Hiatal Hernia Repair on Gastroesophageal Reflux in Patients with Obesity: A Systematic Review and Meta-Analysis https://pubmed.ncbi.nlm.nih.gov/34254259/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform *** How do you decide if a pancreatic head mass is resectable? Does vascular involvement matter? What impacts survival? Join the Surgical Oncology team as they dive into operative considerations when operating on borderline resectable and locally advanced pancreatic cancer. Break the nihilism and find out about the options available for patients with this dreaded malignancy. Learning Objectives:  In this episode, we review the various definitions for resectability in pancreatic cancer, as well as the various prognostic markers and decision points to consider when deciding which patients may benefit from an operation.  Hosts:  Adam Yopp, MD, FACS (@AdamYopp) is an Assistant Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program. Caitlin Hester, MD (@CaitlinAHester) is a 2nd Year Complex General Surgical Oncology Fellow at the MD Anderson Cancer Center. Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-3 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform *** In January 2022, the University of Maryland Medical Center performed the world’s first transplant involving a genetically modified animal heart. Join Behind the Knife as we discuss this significant transplant milestone with the 2 surgeons who led this historic case - Dr. Bartley Griffith and Dr. Muhammad M. Mohiuddin! Dr. Bartley Griffith is the Thomas E. and Alice Marie Hales Distinguished Professor in Transplant Surgery at UMSOM. Dr. Muhammad Mohiuddin is a Professor of Surgery at UMSOM and established the Cardiac Xenotransplantation Program with Dr. Griffith, the first in the United States.  Tune in to learn about the history of xenotransplantation and the barriers that have been overcome to make xenotransplantation a reality. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform *** Inspired by recent transplant surgery headlines, in this episode we briefly review the history and challenges of xenotransplantation. We discuss an article recently published in the American Journal of Transplantation describing the transplant of a porcine kidney into a human decedent model. Learning Objectives ·       Understand the timeline of xenotransplantation and its historical challenges ·       Review a recent article that describes the transplantation of a genetically-modified porcine kidney into a brain-dead human model ·       Discuss ongoing obstacles to successful xenotransplantation and next steps   References Porrett, P. M., Orandi, B. J., Kumar, V., Houp, J., Anderson, D., Cozette Killian, A., Hauptfeld-Dolejsek, V., Martin, D. E., Macedon, S., Budd, N., Stegner, K. L., Dandro, A., Kokkinaki, M., Kuravi, K. v., Reed, R. D., Fatima, H., Killian, J. T., Baker, G., Perry, J., … Locke, J. E. (2022). First clinical-grade porcine kidney xenotransplant using a human decedent model. American Journal of Transplantation, 22(4). https://doi.org/10.1111/ajt.16930 Schlich, T., & Lutters, B. (2022). Historical perspectives on xenotransplantation. The Lancet, 399(10331). https://doi.org/10.1016/s0140-6736(22)00529-3 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform *** You are faced with a young patient with an advanced colon cancer. You suspect Lynch syndrome. He asks if he should undergo total colectomy as opposed to segmental colectomy. How do you approach such a patient?  Join Dr. Carole Richard, Dr. François Dagbert and Dr. Maher Al Khaldi in their conversation about Lynch syndrome, also known as Hereditary Non-polyposis Colorectal Cancer (HNPCC).  Learning objectives  -       To understand the rationale for universal testing for MMR deficiency of newly diagnosed colorectal cancers.  -       To know when to recommend screening for CRC for patients with LS and to those who have undergone resection   -       To understand the prevalence of cancers other than CRCs associated with Lynch syndrome, especially endometrial cancer.  Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

The landscape of surgery is shifting, reflecting the diverse composition of graduating medical students and the efforts to recruit the most talented people into the field.  It is one thing to have a diverse group of people within surgery, but it is an entirely different thing to ensure a welcoming, supportive environment for them.  In this Journal Club episode, we review these topics from the perspective of eminent surgeons Drs. Caprice and Jake Greenberg, who share with us their insights on recent articles examining the experience of women surgeons and trainees.  We’re joined by Dr. Cary Schlick, who authored one of these articles, to shed light on a key issue for the field.  Learning Objectives: ·       Identify some of the challenges for women in surgical training programs ·       Discuss how stereotype threat can impact performance ·       Suggest ways to advocate for equity in surgery References: Experiences of Gender Discrimination and Sexual Harassment Among Residents in General Surgery Programs Across the US - https://doi.org/10.1001/jamasurg.2021.3195 Effects of Gender Bias and Stereotypes in Surgical Training: A Randomized Clinical Trial - https://doi.org/10.1001/jamasurg.2020.1127 Gender Bias and Stereotypes in Surgical Training: Is It Really Women Residents We Need to Worry About? - https://doi.org/10.1001/jamasurg.2020.1561 The effect of gender on operative autonomy in general surgery residents - https://doi.org/10.1016/j.surg.2019.06.006 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Mattox Vegas TCCACS 2022: Ep. 2  The Trauma, Critical Care, and Acute Care Surgery conference (aka the MATTOX conference, named after trauma surgery legend Kenneth L Mattox) is the longest running show in Las Vegas at 55 consecutive years.  The MATTOX conference is unique in its focus on clinical topics.  Every talk, every panel, and every case discussion is relevant and practical.  Join Behind the Knife as we use case-based discussions to hammer home key points from lectures given by some of the biggest names in trauma, critical care, and acute care surgery.  This is episode 2 of 2.   The lineup:   Hasan Alam, MD (@DrHasanAlam)  Scott Steele, MD (@ScottRSteeleMD)  Joseph Dubose, MD (check out his exceptional podcast here: https://www.tiger-country.org/)  Mathew Martin, MD (@docmartin22)  Red Hoffman, MD (@redMDND, check out her amazing podcast here: https://thesurgicalpalliativecarepodcast.buzzsprout.com/)  Bellal Joseph, MD (@TopKnife_B)  Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

The Trauma, Critical Care, and Acute Care Surgery conference (aka the MATTOX conference, named after trauma surgery legend Kenneth L Mattox) is the longest running show in Las Vegas at 55 consecutive years.  The MATTOX conference is unique in its focus on clinical topics.  Every talk, every panel, and every case discussion is relevant and practical.  Join Behind the Knife as we use case-based discussions to hammer home key points from lectures given by some of the biggest names in trauma, critical care, and acute care surgery.  This is episode 1 of 2.   The lineup:   Dennis Kim, MD (@traumaicurounds, check out his amazing podcast here: https://www.traumaicurounds.ca/)  Ali Salim, MD (@alisalimMD)  Jason Smith, MD (@DrJTrauma)  Andre Campbell, MD (@TraumaDocSF) Meghan Lewis, MD   Demetrios Demetriades, MD  Alexander Eastman, MD (@PMHTrauma_ALE)  Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

The mortality rate for unstable pelvic hemorrhage due to blunt trauma remains around 30 percent. However, technological advances promise to finally make a dent. But on the cutting edge, it’s not clear which treatments should be used when to maximize lives saved. With life-threatening pelvic exsanguination, time is critical. Do you know when to rush to pack the pelvis? Do you know when to deploy a REBOA instead? Are there scenarios where you should do both? Join Drs. Urréchaga, Neeman, and Rattan from Ryder Trauma Center in Miami as they try to tease out answers using two studies hot off the presses with seemingly contradictory results. Learning Objectives: Blunt Pelvic Hemorrhage ·       Expanding knowledge of management strategies for blunt pelvic hemorrhage ·       Describe propensity score matching and its use in non-randomized studies ·       Compare outcomes of REBOA and preperitoneal pelvic packing (PPP) ·       Critically appraise study design and methods of studies References 1.     S. Mikdad, I.A.M. van Erp, M.E. Moheb, et al. Pre-peritoneal pelvic packing for early hemorrhage control reduces mortality compared to resuscitative endovascular balloon occlusion of the aorta in severe blunt pelvic trauma patients: A nationwide analysis. Injury. 2020; 51:1834–1839. doi.org/10.1016/j.injury.2020.06.003 2.     S. Asmar, L. Bible, M. Chehab, et al. Resuscitative Endovascular Balloon Occlusion of the Aorta vs Pre-Peritoneal Packing in Patients with Pelvic Fracture. Journal of the American College of Surgeons. 2021; 232(1):17-26. doi.org/10.1016/j.jamcollsurg.2020.08.763 3.     B. Joseph, M. Zeeshan, J.V. Sakran, et al. Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. JAMA Surg. 2019;154(6):500-508. doi:10.1001/jamasurg.2019.0096 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

EPAs are coming in 2023. This isn’t about your carbon emissions, but it will dramatically impact surgery training programs. Join Drs. Karen Brasel, Jeremy Lipman, Judith French, and Amy Han as they discuss Entrustable Professional Activities (EPAs) and how they will change the way we assess trainees. Learning Objectives 1.     Listeners will be able to define entrustable professional activities (EPAs) within the context of competency-based education during General Surgery residency training 2.     Listeners will be able to understand the impetus behind adopting EPA assessments for surgical trainees.  3.     Listeners will be able to interpret and apply EPA assessment data based on the discussion of the example scenarios. References: Brasel KJ, Klingensmith ME, Englander R, Grambau M, Buyske J, Sarosi G, Minter R. Entrustable professional activities in general surgery: development and implementation. Journal of surgical education. 2019 Sep 1;76(5):1174-86. Lindeman B, Brasel K, Minter RM, Buyske J, Grambau M, Sarosi G. A Phased Approach: The General Surgery Experience Adopting Entrustable Professional Activities in the United States. Acad Med. 2021;96(7S):S9-S13. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Dr. Michael Rosen returns to Behind the Knife – this time to discuss his RCT investigating biologic vs. synthetic mesh for single-stage repair of contaminated ventral hernias. Read the full article here in JAMA Surgery: https://jamanetwork.com/journals/jamasurgery/article-abstract/2788222 Dr. Rosen is the director for the Center of Abdominal Core Health at the Cleveland Clinic and has written the “Atlas of Abdominal Wall Reconstruction”. Want to learn more about his work and the Hernia Quality Collaborative? Catch up on Dr. Rosen’s previous episode on Behind the Knife:  Episode #21 (August 15, 2015): Hernias, Abdominal Wall Reconstruction, and Quality Collaboratives https://behindtheknife.org/podcast/21-hernias-abdominal-wall-recon-and-quality-collaboratives-dr-michael-rosen/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Welcome to the third of a six-part series focused on the integration of palliative care into the practice of surgery.  Malignant bowel obstructions occur in 5-43 percent of patients with a diagnosis of advanced primary or metastatic intra-abdominal malignancy and both acute care surgeons and surgical oncologists are called upon to manage this condition. Using the case of an elderly gentleman with gastric outlet obstruction secondary to gastric cancer, in this episode we discuss how to approach a patient with a malignant bowel obstruction, review the medical and surgical options for management, discuss the importance of primary palliative care, define palliative surgery and conclude with a short rant about the necessity of being cognizant of one’s feelings and of taking the time and creating the space to discuss them.  Fast Fact #45:  Medical Management of Bowel Obstructions https://www.mypcnow.org/fast-fact/medical-management-of-bowel-obstructions/ Chapter 8, Malignant Bowel Obstruction in Surgical Palliative Care: A Resident’s Guide https://www.facs.org/~/media/files/education/palliativecare/surgicalpalliativecareresidents.ashx Palliative surgery and the surgeon’s role in the palliative care team: a review. https://apm.amegroups.com/article/download/72758/pdf Dr. Red Hoffman (@redmdnd) is an acute care surgeon and associate hospice medical director in Asheville, North Carolina, host of the Surgical Palliative Care Podcast (@surgpallcare) and co-founder of the recently launched Surgical Palliative Care Society (www.spcsociety.org).  Dr. Fabian Johnston (@fabianjohnston) is Associate Professor of Surgery and Oncology and Chief, Division of GI Surgical Oncology at Johns Hopkins University. Dr. Amanda Stastny (@manda_plez) is a PGY-2 in the General Surgery program at Mountain Area Health Education Center (MAHEC) in Asheville, NC.   Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Umbilical hernias a common diagnoses that general surgeons must manage. Though these hernias are considered relatively simple problems to resolve, certain populations of patients are prone to higher rates of complications. As abdominal wall surgery has advanced, so to have the options that exist in management of primary umbilical hernias. The session will review common clinical circumstances and high-risk patient presentations. We will generally review the approaches to repair and the thought processing and data driving decision making.   ·       Dr. Vahagn Nikolian is an Assistant Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair.  ·       Dr. Sean Orenstein is an Associate Professor of Surgery at Oregon Health & Science University, focused on abdominal wall reconstruction and hernia repair. ·       Dr. Shahrose Rahman is a resident in General Surgery at Oregon Health & Science University.  Seminal Papers in Umbilical Hernia Management Guidelines for treatment of umbilical and epigastric hernias (Henriksen et al. Br J Surg. 2020.): https://pubmed.ncbi.nlm.nih.gov/31916607/ Hernia-Neck Ratio: Predicting Factors for Complications of Umbilical Hernias (Fueter et al. WJS. 2016.): https://pubmed.ncbi.nlm.nih.gov/27194561/ Safety and effectiveness of umbilical hernia repair in patients with cirrhosis (Hew et al. Hernia. 2018.):https://pubmed.ncbi.nlm.nih.gov/29589135/ Fix it while you can...Mortality after umbilical hernia repair in cirrhotic patients (Hill et al. Amer Journal of Surgery. 2020.): https://pubmed.ncbi.nlm.nih.gov/32988606/ Postoperative complications with retromuscular mesh placement in emergency incisional hernia repair (Juul et al. Scand J Surg. 2021.): https://pubmed.ncbi.nlm.nih.gov/33092472/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Warning!  There is magic contained in this podcast.  Real magic.  The kind of magic that allows you to understand how to manage the axilla in breast cancer patients.    The standard of care approach to management of the axilla in patients with breast cancer has evolved rapidly. While a complete axillary dissection was historically indicated following identification of any positive nodes, that is no longer the case; indeed, axillary dissections are now uncommonly performed. Join Drs. Michael Alvarado, Rita Mukhtar, and Alexa Glencer as they discuss the impact of the ACOSOG Z0011, AMAROS, and ACOSOG Z1071 trials in defining the role of sentinel lymph node dissection and radiotherapy in patients with early-stage breast cancer with limited lymph node involvement as well as the approach when neoadjuvant chemotherapy has been received. Learning Objectives: ·       Describe the study design and results of the ACOSOG Z0011 trial and its impact on the use of sentinel lymph node biopsy as an alternative to complete axillary lymph node dissection in clinically node-negative patients with T1 or T2 breast cancer ·       Describe the study design and results of the AMAROS trial and its implications for use of axillary radiation as an alternative to axillary lymph node dissection for patients with clinically node-negative T1 or T2 breast cancer ·       Understand the risk of lymphedema related to complete axillary lymph node dissection, as demonstrated by the AMAROS trial ·       Describe the study design and results of the ACOSOG Z1071 trial and how interpretation of its subgroup analysis has been applied to our approach of offering sentinel lymph node biopsy as a means of staging the axilla following neoadjuvant chemotherapy in patients with clinical node-positive disease at the time of diagnosis Journal Article Links: ACOSOG Z0011: https://jamanetwork.com/journals/jama/article-abstract/2653737 AMAROS: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70460-7/fulltext ACOSOG Z1071: https://jamanetwork.com/journals/jama/fullarticle/1748149%20 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Join our Emergency General Surgery Team as they discuss EGS in patients > 65.  Introduction - > 65 = 40% of EGS admissions  - In-hospital mortality for EGS in older adults is approximately 7-12% and the one-year mortality is around 30-38%. - High risk due to decreased reserve, poor nutritional status, and chronic medical conditions  - Frailty correlates with poor post-operative outcomes Paper #1: Mehta A, Dultz LA, Joseph B, Canner JK, Stevens K, Jones C, Haut ER, Efron DT, Sakran JV. Emergency general surgery in geriatric patients: A statewide analysis of surgeon and hospital volume with outcomes. J Trauma Acute Care Surg. 2018 Jun;84(6):864-875.  - retrospective population-based cross-sectional study using administrative data.  - looks at the association between surgeon and hospital annual experience with outcomes in geriatric patients with EGS conditions. - Note Table 2 provides outcomes broken down by type of surgery - Key finding: patients operated on by a low-volume surgeon had about twice the odds of mortality, and 1.7X the odds of failure to rescue Paper #2: Guttman MP, Tillmann BW, Nathens AB, Saskin R, Bronskill SE, Huang A, Haas B. Alive and at home: Five-year outcomes in older adults following emergency general surgery. J Trauma Acute Care Surg. 2021 Feb 1;90(2):287-295.  - large-scale population-based retrospective cohort study looking at long-term outcomes of older adults with admissions for emergency general surgery diagnoses - primary outcome of interest is “aging in place” or being able to reside in one’s home for as long as possible.  - Key finding: being admitted for an EGS diagnosis reduces your survival and time in your home by about 7 months. - Very little reduction in low-risk diagnoses (acute appendicitis/cholecystitis) - 57% of patients were alive and in their home 5 years later Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Thoughts of esophageal perforations keeping you up at night? Actual esophageal perforations keeping you up at night?  Drs. Brian Louie, Peter White, and Megan Lenihan discuss both the tried-and-true and the cutting-edge management of this challenging problem. Learning Objectives - Understand basic principles of management - Review differences in management based on different underlying pathology and location - Learn indications and techniques for advanced endoscopic interventions for perforations - Discuss nutrition planning  Referenced Material - Thornblade LW, Cheng AM, Wood DE et al. A Nationwide Rise in the Use of Stents for Benign Esophageal Perforation. Ann Thorac Surg 2017; 104(1):227-233. DOI: 10.1016/j.athoracsur.2017.03.069 http://dx.doi.org/10.1016/j.athoracsur.2017.03.069 - Watkins JR and Farivar AS. Endoluminal Therapies for Esophageal Perforations and Leaks. Thorac Surg Clin 2018; 28(4):541-554. DOI: 10.1016/j.thorsurg.2018.07.002 https://doi.org/10.1016/j.thorsurg.2018.07.002 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more. 

A trauma patient rolls into the bay.  CPR started 10 minutes ago.  They are pulseless, the entire trauma team is looking to you for leadership, and the thoracotomy tray is prepped and ready.  Do you pick up the knife and cut?   Welcome back to the BIG T TRAUMA series.  Join Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill for a high-level discussion on the one surgical procedure that trumps them all – the ED thoracotomy.  This is episode 2 of 2.  In episode 1 we discussed who should get an ED thoracotomy.  Today, we cover how to do it.    Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

A trauma patient rolls into the bay.  CPR started 10 minutes ago.  They are pulseless, the entire trauma team is looking to you for leadership, and the thoracotomy tray is prepped and ready.  Do you pick up the knife and cut?   Welcome back to the BIG T TRAUMA series.  Join Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill for a high-level discussion on the one surgical procedure that trumps them all – the ED thoracotomy.  This is episode 1 of 2.  In episode 1 we discuss who should get an ED thoracotomy and in episode 2 we cover how to do it.    Listen to learn about the guidelines, signs of life, ultrasound, survival, and when NOT to do an ED thoracotomy.    EAST: https://www.east.org/education-career-development/practice-management-guidelines/details/emergency-department-thoracotomy  WTA: https://www.westerntrauma.org/wp-content/uploads/2020/08/Resuscitative-Thoracotomy_FINAL.svg  WakeMed Blunt Pulseless Trauma Resuscitation Guideline: https://www.wakemed.org/sites/default/files/hg_features/mercury_standard_layout/031abaa9027e1685ad340ac8f662e86a.pdf Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

In the episode we will cover the following learning objectives: ·       Listeners should be able to describe the evolution and changes in definitions sepsis over the past three decades ·       Listeners should be familiar with the three randomized controlled trials that studies early-goal directed therapy ·       Listeners should be able to describe the major changes in the new 2021 SCCM Sepsis Guidelines ·       Listeners should be able to describe the fundamental principles of sepsis management in the ICU References: https://www.nejm.org/doi/full/10.1056/nejmoa1500896 https://www.nejm.org/doi/full/10.1056/nejmoa1404380 https://www.nejm.org/doi/full/10.1056/nejmoa1701380 https://www.nejm.org/doi/full/10.1056/nejmoa1401602 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more. 

You are seeing a young female patient in the clinic with rectal prolapse. When do you offer surgery?  Does she get a perineal approach or a transabdominal approach?  Open or minimally invasive?  Mesh or no mesh?  Sigmoid resection or no resection?  Join Drs. Abelson, Marcello and Aulet as they take us through the wide world of rectal prolapse! Learning Objectives: 1.     Describe the difference between rectal prolapse and hemorrhoidal prolapse 2.     List the different approaches to surgical management of rectal prolapse 3.     Discuss the approach to recurrent rectal prolapse Be sure to check out the associated video below.  Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

In this episode from the Endocrine Surgery team at BTK we go through three controversial topics in endocrine surgery and cite pertinent articles during a lively debate format. We debate the role of four-gland exploration versus focused exploration for parathyroid disease. Indications for parathyroidectomy are hotly contested. And finally, we discuss the role and relevance of using a nerve monitor. Tune in to see if Dr. Yeh and Dr. Wu remain collegiate after recording this episode…               Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.  Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department  Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department  Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research  Dr. Max Schumm is a PGY-5 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon.  Important Papers  Norlén O, Wang KC, Tay YK, Johnson WR, Grodski S, Yeung M, Serpell J, Sidhu S, Sywak M, Delbridge L. No need to abandon focused parathyroidectomy: a multicenter study of long-term outcome after surgery for primary hyperparathyroidism. Ann Surg. 2015 May;261(5):991-6. doi: 10.1097/SLA.0000000000000715. PMID: 25565223. Schneider DF, Mazeh H, Sippel RS, Chen H. Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1,000 cases. Surgery. 2012 Dec;152(6):1008-15. doi: 10.1016/j.surg.2012.08.022. Epub 2012 Oct 12. PMID: 23063313; PMCID: PMC3501613. Jinih M, O'Connell E, O'Leary DP, Liew A, Redmond HP. Focused Versus Bilateral Parathyroid Exploration for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis. Ann Surg Oncol. 2017 Jul;24(7):1924-1934. doi: 10.1245/s10434-016-5694-1. Epub 2016 Nov 28. PMID: 27896505. Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med. 1999 Oct 21;341(17):1249-55. doi: 10.1056/NEJM199910213411701. Erratum in: N Engl J Med 2000 Jan 13;342(2):144. PMID: 10528034. Seib CD, Meng T, Suh I, Harris AHS, Covinsky KE, Shoback DM, Trickey AW, Kebebew E, Tamura MK. Risk of Fracture Among Older Adults With Primary Hyperparathyroidism Receiving Parathyroidectomy vs Nonoperative Management. JAMA Intern Med. 2022 Jan 1;182(1):10-18. doi: 10.1001/jamainternmed.2021.6437. PMID: 34842909; PMCID: PMC8630642. Yeh MW, Zhou H, Adams AL, Ituarte PH, Li N, Liu IL, Haigh PI. The Relationship of Parathyroidectomy and Bisphosphonates With Fracture Risk in Primary Hyperparathyroidism: An Observational Study. Ann Intern Med. 2016 Jun 7;164(11):715-23. doi: 10.7326/M15-1232. Epub 2016 Apr 5. PMID: 27043778. Zanocco K, Butt Z, Kaltman D, Elaraj D, Cella D, Holl JL, Sturgeon C. Improvement in patient-reported physical and mental health after parathyroidectomy for primary hyperparathyroidism. Surgery. 2015 Sep;158(3):837-45. doi: 10.1016/j.surg.2015.03.054. Epub 2015 May 29. PMID: 26032828. Barczyński M, Konturek A, Cichoń S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg. 2009 Mar;96(3):240-6. doi: 10.1002/bjs.6417. PMID: 19177420. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

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

The Vascular Surgery Oral Board Review Book has 60 of the highest yield scenarios that cover the majority of the VSCORE topics in an easy-to-read question and answer format that highlights the most important clinical concepts, concise procedural descriptions, and common surgical complications that everyone should know about the field of Vascular Surgery. Whether you are looking to excel on the wards or crush the boards, this book was created to help you Dominate the Day. https://behindtheknife.org/premium/ https://www.amazon.com/dp/0578382296?ref_=pe_3052080_397514860 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

With more and more EVAR comes more and more endoleaks. But when do they matter and what can/should we do about them? In this episode, we present a case of a stubborn endoleak and use the course to illustrate a simple path towards the management of endoleaks following endovascular aneurysm repair. Dr. Nicholas Osborne is an Associate Professor of Vascular Surgery at the University of Michigan and the Chief of Vascular Surgery at the Ann Arbor Veteran’s Affairs Healthcare System. Dr. Frank Davis is a Chief Resident in the Integrated Vascular Surgery program at the University of Michigan. Dr. Craig Brown is a PGY-6 in the General Surgery program at the University of Michigan. Guidelines around Endoleak Management Society for Vascular Surgery Practice Guidelines on the Care of Patients with an Abdominal Aortic Aneurysm: https://pubmed.ncbi.nlm.nih.gov/29268916/ Conservative Management of Type II Endoleaks: https://pubmed.ncbi.nlm.nih.gov/25042332/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

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

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

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

Description: Metachronous colorectal liver metastasis (CRLM) is a complex clinical situation requiring multidisciplinary management. In this episode from the Hepato-Pancreato-Biliary team at Behind the Knife, we discuss a patient presenting with metachronous CRLM and how management may change with varying clinical scenarios.  Learning Objectives: In this episode, we review the initial workup and pre-operative considerations in a patient presenting with metachronous CRLM.  We discuss key aspects of resectability of CRLM, including physiologic and hepatic fitness, biology of the disease, and technical considerations.  We review the timing and common regimens of systemic treatment for differing clinical scenarios, as well as when adjuncts to treatment may be useful (e.g., portal venous embolization).  Finally, we highlight important aspects of intraoperative and postoperative management. Hosts: Timothy Vreeland, MD, FACS (@vreelant) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center Daniel Nelson, DO, FACS (@DWNelsonHPB) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center Connor Chick, MD (@connor_chick) is a PGY-5 General Surgery resident at Brooke Army Medical Center Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-4 General Surgery resident at Brooke Army Medical Center Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-3 General Surgery resident at Brooke Army Medical Center  Links to Papers Referenced in this Episode: NCCN Guidelines for Colon Cancer https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf Mutation Status of RAS, TP53, and SMAD4 is Superior to Mutation Status of RAS Alone for Predicting Prognosis after Resection of Colorectal Liver Metastases. Clin Cancer Res. 2019 Oct 1;25(19):5843-5851. doi: 10.1158/1078-0432.CCR-19-0863. Epub 2019 Jun 20. PMID: 31221662; PMCID: PMC6774854. https://pubmed.ncbi.nlm.nih.gov/31221662/ Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2013 Nov;14(12):1208-15. doi: 10.1016/S1470-2045(13)70447-9. Epub 2013 Oct 11. PMID: 24120480. https://pubmed.ncbi.nlm.nih.gov/24120480/ FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as first-line treatment of patients with metastatic colorectal cancer: updated overall survival and molecular subgroup analyses of the open-label, phase 3 TRIBE study. Lancet Oncol. 2015 Oct;16(13):1306-15. doi: 10.1016/S1470-2045(15)00122-9. Epub 2015 Aug 31. PMID: 26338525. https://pubmed.ncbi.nlm.nih.gov/26338525/ Phase II Randomized Trial of Sequential or Concurrent FOLFOXIRI-Bevacizumab Versus FOLFOX-Bevacizumab for Metastatic Colorectal Cancer (STEAM). Oncologist. 2019 Jul;24(7):921-932. doi: 10.1634/theoncologist.2018-0344. Epub 2018 Dec 14. PMID: 30552157; PMCID: PMC6656450. https://pubmed.ncbi.nlm.nih.gov/30552157/ Bevacizumab plus mFOLFOX-6 or FOLFOXIRI in patients with initially unresectable liver metastases from colorectal cancer: the OLIVIA multinational randomised phase II trial. Ann Oncol. 2015 Apr;26(4):702-708. doi: 10.1093/annonc/mdu580. Epub 2014 Dec 23. PMID: 25538173. https://pubmed.ncbi.nlm.nih.gov/25538173/ Recommended Additional Podcasts on CRLM: The AHPBA Podcast: 1.     Episode 1: Dr. Jean Nicolas Vauthey - Colorectal Liver Metastases (https://podcasts.apple.com/us/podcast/episode-1-dr-jean-nicolas-vauthey-colorectal-liver/id1501441845?i=1000467381474) 2.     Episode 12:Dr D'Angelica - Colorectal Liver Metastases and Hepatic Artery Infusion Pumps (https://podcasts.apple.com/us/podcast/episode-12-dr-dangelica-colorectal-liver-metastases/id1501441845?i=1000521718184) Behind the Knife: 1.     Surgical Oncology-Hepatic Artery Infusion Pump (https://podcasts.apple.com/ye/podcast/surgical-oncology-hepatic-artery-infusion-pump/id980990143?i=1000525833877) Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Few audiences appreciate the importance of a properly functioning sphincter like surgeons. Magnetic sphincter augmentation using the LINX device, however, is one area that is beyond the sphincter-related expertise of most surgeons and surgical trainees. Drs. Mike Weykamp, Nicole White, Andrew Wright, and Nick Cetrulo review the literature surrounding the use of the LINX device for gastroesophageal reflux disease and how the device stacks up against the current gold standard in anti-reflux surgery, laparoscopic fundoplication, on this journal review episode of Behind the Knife.  References:  1. Skubleny D, Switzer NJ, Dang J, et al. LINX(®) magnetic esophageal sphincter augmentation versus Nissen fundoplication for gastroesophageal reflux disease: a systematic review and meta-analysis. Surg Endosc. Aug 2017;31(8):3078-3084. doi:10.1007/s00464-016-5370-3 2. Bonavina L, Horbach T, Schoppmann SF, DeMarchi J. Three-year clinical experience with magnetic sphincter augmentation and laparoscopic fundoplication. Surg Endosc. Jul 2021;35(7):3449-3458. doi:10.1007/s00464-020-07792-1 3. Ferrari D, Asti E, Lazzari V, Siboni S, Bernardi D, Bonavina L. Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease. Sci Rep. Aug 13 2020;10(1):13753. doi:10.1038/s41598-020-70742-3 4. Alicuben ET, Bell RCW, Jobe BA, et al. Worldwide Experience with Erosion of the Magnetic Sphincter Augmentation Device. J Gastrointest Surg. Aug 2018;22(8):1442-1447. doi:10.1007/s11605-018-3775-0 5. Perry KA. Alternatives to Fundoplication. Presented at SAGES Meeting 2018/16th World Congress of Endoscopic Surgery. April 2018.  Hyperlink: https://www.youtube.com/watch?v=GXczKZxOg9Y 6. Dominguez RV. LINX in GERD. The evolution of the technique. From none to full dissection of the crura. Presented at SAGES Meeting April 2019.  Hyperlink: https://www.youtube.com/watch?v=uhhXZmsBd5c Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

In this episode, our team discusses the management of penetrating liver trauma both before, during, and after surgery. Listen in for helpful tips such as how to perform an intraoperative air cholangiogram, creating an occlusion catheter from a red rubber and a Penrose, and much more! Hosts:  Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST).  Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.  David Sigmon, MD, MMEd, a PGY-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.  LITERATURE 1.     Murphy PB, de Moya M, Karam B, et al. Optimal timing of venous thromboembolic chemoprophylaxis initiation following blunt solid organ injury: meta-analysis and systematic review. Eur J Trauma Emerg Surg. Published online September 18, 2021. https://pubmed.ncbi.nlm.nih.gov/34537859/ 2.     Kozar RA, Crandall M, Shanmuganathan K, et al. Organ injury scaling 2018 update: Spleen, liver, and kidney. J Trauma Acute Care Surg. 2018;85(6):1119-1122. https://pubmed.ncbi.nlm.nih.gov/30462622/ 3.     Kodadek LM, Efron DT, Haut ER. Intrahepatic balloon tamponade for penetrating liver injury: rarely needed but highly effective. World J Surg. 2019;43(2):486-489. https://pubmed.ncbi.nlm.nih.gov/30280221/ 4.     EAST Practice Management Guidelines: Selective Nonoperative Management of Hepatic Injury, Blunt https://www.east.org/education-career-development/practice-management-guidelines/details/hepatic-injury-blunt-selective-nonoperative-management-of 5.     WEST Nonoperative Management of Adult Blunt Hepatic Trauma Algorithm https://www.westerntrauma.org/wp-content/uploads/2020/08/Non-Operative-Management-of-Adult-Blunt-Hepatic-Trauma-Algorithm_FINAL.svg 6.   THE JOURNAL OF TRAUMA AND ACUTE CARE SURGERY 3-MINUTE EXPERT CONSULT VIDEO: “BALLOON TAMPONADE FOR PENETRATING LIVER TRAUMA. https://journals.lww.com/jtrauma/Pages/videogallery.aspx?videoId=13 7.     Coccolini F, Coimbra R, Ordonez C, et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020;15:24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106618/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

What is one of the most energy-intensive and waste-generating areas of the hospital? The operating room! In the new BTK/Annals of Surgery Journal Club, we talk to Dr. Elizabeth Yates and Dr. Louis Nguyen about their new article – “Empowering Surgeons, Anesthesiologists, and Obstetricians to Incorporate Environmental Sustainability in the Operating Room.” They review the impact ORs have on the environment, the consequences this has for patients, and ways surgeons lead efforts to “green” the operating room. As the topic of environmental sustainability becomes a growing concern with each passing year, the surgical workplace is going to play a big role in moving in the right direction. Join us for a great discussion!   Dr. Yates earned her medical degree from the University of Michigan Medical School. She is currently a General Surgery resident at Brigham and Women’s Hospital where she is now completing two years of protected research time at the Center for Surgery and Public Health while also pursuing a Masters in Public Health focused on Occupational and Environmental Health. She conducts interdisciplinary research examining the interface between surgery, sustainability, and climate change. Dr. Nguyen is a vascular surgeon at Brigham and Women’s Hospital and associate professor of surgery at Harvard Medical School. He earned his medical and business degrees from the University of Chicago Pritzker School of Medicine, completed his General Surgery residency at Barnes-Jewish Hospital in St. Louis, and completed a vascular surgery fellowship at the Brigham as well. He also currently serves as Vice Chair of Digital Health Systems in the Department of surgery. He is a recognized leader in health services research and outcomes implementation, where he utilizes econometric analyses to better understand clinical outcomes. Link to article: https://journals.lww.com/annalsofsurgery/Abstract/2021/06000/Empowering_Surgeons,_Anesthesiologists,_and.15.aspx Climate change and equity issues permeate all aspects of our life and work.  If you are (or know) a current general surgery resident, help us understand the equity and environmental impacts of residency interviews! https://redcap.link/gensurginterview Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.