Join BTK founders, Dr. Jason Bingham and Dr. John McClellan, as they discuss bariatric emergencies for the general surgeon.  This is Part 2 of 2.   Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Large diameter 26-32Fr chest tubes are the treatment of choice at many institutions for the treatment of traumatic hemothorax, but does the currently available data support that? Are there better options available? Join our team as we discuss the The Small 14-French (Fr) Percutaneous Catheter vs. Large (28-32Fr) Open Chest Tube for Traumatic Hemothorax (P-CAT): A Multi-center Randomized Clinical Trial by Dr. N Kulvatunyou et al to address this question.  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.  Journal Articles The Small 14-French (Fr) Percutaneous Catheter vs. Large (28-32Fr) Open Chest Tube for Traumatic Hemothorax (P-CAT): A Multi-center Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/33843831/  Randomized Clinical Trial of 14-French (14F) Pigtail Catheters versus 28-32F Chest Tubes in the Management of Patients with Traumatic Hemothorax and Hemopneumothorax. https://pubmed.ncbi.nlm.nih.gov/33415448/ Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. https://pubmed.ncbi.nlm.nih.gov/24375295/  14 French pigtail catheters placed by surgeons to drain blood on trauma patients: is 14-Fr too small? https://pubmed.ncbi.nlm.nih.gov/23188235/  A Prospective Study of 7-Year Experience Using Percutaneous 14-French Pigtail Catheters for Traumatic Hemothorax/Hemopneumothorax at a Level-1 Trauma Center: Size Still Does Not Matter https://pubmed.ncbi.nlm.nih.gov/28795207/  A History of Thoracic Drainage: From Ancient Greeks to Wound Sucking Drummers to Digital Monitoring https://www.ctsnet.org/article/history-thoracic-drainage-ancient-greeks-wound-sucking-drummer s-digital-monitoring Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Join BTK founders, Dr. Jason Bingham and Dr. John McClellan, as they discuss bariatric emergencies for the general surgeon.  This is Part 1 of 2.   Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Peripheral Artery Disease – What the $#^% are we talking about? Peripheral Artery Disease is all about saving peoples legs and lives, but we often don’t talk about PAD lesions with a common clinical language. In this episode of Behind the Knife, the vascular surgery team introduces the Global Vascular Guidelines anddiscusses the WIfI, TASC, and GLASS classifications systems designed to standardize our conversations about PAD lesions and how these fit into treatment decisions. 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: Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365864/ Society for Vascular Surgery App: https://apps.apple.com/app/id1014644425 Please visit behindtheknife.org to access our massive library of high-yield surgical education podcasts, videos and more.  

The Colorectal Surgery Virtual Education team is back with Mock Oral exams.  This is episode 2 of 2 and includes 2 high-yield cases. Also available in video format at www.behindtheknife.org. For more information on the Colorectal Surgery Virtual Education initiative visit www.crsvirtualed.org.  

Learning Objectives: ·       Describe the role of portal vein embolization and how it is currently utilized in the setting of metastatic colon cancer ·       Understand adequate functional volume and delineate different methods of increasing a future liver remnant ·       Identify the leading causes of drug-induced liver failure and recognize how these have changed over time Journal Articles: ·       Dueland, et al. “Survival Outcomes After Portal Vein Embolization and Liver Resection Compared With Liver Transplant for Patients With Extensive Colorectal Cancer Liver Metastases.” JAMA Surgery. 2021;156(6):550-557. https://doi.org/10.1001/jamasurg.2021.0267 ·       Ghabril, et al. “Eight fold increase in the dietary supplement related liver failure leading to transplant waitlisting over the last quarter century in the US.” Liver Transplantation. 31 July 2021. https://doi.org/10.1002/lt.26246 Please visit behindtheknife.org to access our massive library of high-yield surgical education podcasts, videos and more.  

The Colorectal Surgery Virtual Education team is back with Mock Oral exams.  This is episode 1 of 2 and includes 2 high-yield cases.  Also available in video format at www.behindtheknife.org. For more information on the Colorectal Surgery Virtual Education initiative visit www.crsvirtualed.org.  

Description:   A patient being surveilled for untreated hepatitis C presents to your clinic for a newly identified liver mass. Hepatocellular carcinoma (HCC) accounts for ~90% of new liver cancers and infection by hepatitis B and hepatitis C viruses are the main risk factors. Non-alcoholic steatohepatitis associated with metabolic syndrome and diabetes mellitus, however, have contributed to HCC becoming the fastest growing solid organ tumor in the United States. In this episode from the Surgical Oncology team at Behind the Knife, join the discussion on a surgeons approach to this growing patient population. Learning Objectives:  In this episode, we review risk factors for hepatocellular carcinoma, key steps in the diagnostic work-up with a focus on pre-operative planning for hepatectomy in cirrhotic patients. We will cover interventions available preoperatively, options and considerations once in the operating room, as well as treatment strategies and shifting paradigms following successful resection.  Hosts:  Adam Yopp, MD, FACS (@AdamYopp) is an Assistant Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program. Caitlin Hester, MD (@CaitlinAHester) is a 2nd Year Complex General Surgical Oncology Fellow at the MD Anderson Cancer Center. Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-3 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research. Papers Referenced in this Episode: Importance of low preoperative platelet count in selecting patients for resection of hepatocellular carcinoma: a multi-institutional analysis J Am Coll Surg. 2011 Apr;212(4):638-48; discussion 648-50. doi: 10.1016/j.jamcollsurg.2011.01.004. PMID: 21463803  https://pubmed.ncbi.nlm.nih.gov/21463803/ Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology J Natl Compr Canc Netw. 2021 May 1;19(5):541-565. doi: 10.6004/jnccn.2021.0022. PMID: 34030131 https://pubmed.ncbi.nlm.nih.gov/34030131/ Sequential arterial and portal vein embolizations before right hepatectomy in patients with cirrhosis and hepatocellular carcinoma Br J Surg. 2006 Sep;93(9):1091-8. doi: 10.1002/bjs.5341. PMID: 16779884 https://pubmed.ncbi.nlm.nih.gov/16779884/ Application of controlled low central venous pressure during hepatectomy: A systematic review and meta-analysis J Clin Anesth. 2021 Aug 1;75:110467. doi: 10.1016/j.jclinane.2021.110467. Online ahead of print. PMID: 34343737 https://pubmed.ncbi.nlm.nih.gov/34343737/ Portal vein embolization: rationale, technique and future prospects Br J Surg. 2001 Feb;88(2):165-75. doi: 10.1046/j.1365-2168.2001.01658.x. PMID: 11167863 https://pubmed.ncbi.nlm.nih.gov/11167863/ Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes: toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant J Am Coll Surg. 2013 Feb;216(2):201-9. doi: 10.1016/j.jamcollsurg.2012.10.018. Epub 2012 Dec 7. PMID: 23219349  https://pubmed.ncbi.nlm.nih.gov/23219349/ IMbrave 050: a Phase III trial of atezolizumab plus bevacizumab in high-risk hepatocellular carcinoma after curative resection or ablation Future Oncol. 2020 May;16(15):975-989. doi: 10.2217/fon-2020-0162. Epub 2020 Apr 30. PMID: 32352320 https://pubmed.ncbi.nlm.nih.gov/32352320/ Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection Is Associated With Increased Survival in Patients With a History of Hepatocellular Carcinoma Gastroenterology. 2019 Nov;157(5):1253-1263.e2. doi: 10.1053/j.gastro.2019.07.040. Epub 2019 Jul 30. PMID: 31374215 https://pubmed.ncbi.nlm.nih.gov/31374215/

Ever wonder why some bariatric patients received extended VTE prophylaxis and others do not? Or what the ideal chemical VTE prophylaxis is for bariatric patients? All of your questions answered in this journal review discussion! Journal articles: A single-center comparison of extended and restricted thromboprophylaxis with LMWH after metabolic surgery: https://pubmed.ncbi.nlm.nih.gov/31641983/ Risk factors for postdischarge venous thromboembolism among bariatric surgery patients and the evolving approach to extended thromboprophylaxis with enoxaparin: https://pubmed.ncbi.nlm.nih.gov/33814315/

You’re faced with a challenging case of a patient with rectal cancer and synchronous liver lesion. Where do you start: chemotherapy, chemoradiotherapy, upfront surgery, liver first, rectum first?  Join Drs. Carole Richard, François Dagbert and Maher Al Khaldi as they discuss the management of a patient with rectal cancer with a synchronous hepatic metastasis.  Learning objectives In this episode, we discuss the workup of a rectal tumour associated with synchronous liver metastases, indications for resection of the hepatic lesion, neoadjuvant and adjuvant treatment modalities, survival benefit of resection and patient follow-up.   Reference list: Moulton C-A, Gu C-S, Law CH, Tandan VR, Hart R, Quan D, et al. Effect of PET Before Liver Resection on Surgical Management for Colorectal Adenocarcinoma Metastases: A Randomized Clinical Trial. JAMA. 2014;311(18):1863–9. Bahadoer RR, Dijkstra EA, Etten B van, Marijnen CAM, Putter H, Kranenbarg EM-K, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021;22(1):29–42.

"The eyes do not see what the mind does not know." Trauma surgery is riddled with pitfalls.  Take your guard down for a minute and BAM, you are eating humble pie.  Don't let this happen to you!   Join Drs. Bryan Cotton, Teddy Puzio, Krislynn Mueck, and host Patrick Georgoff for a fun, high-yield review.  In this episode (2 of 2), we cover:  Splenic pseudoaneurysm Compartment syndrome Urogenital injury Diaphragm injury Esophageal injury

Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss ovarian mass in pediatric surgery. Journal Article links:  Madenci AL, Vandewalle RJ, Dieffenbach BV, Laufer MR, Boyd TK, Voss SD, et al. Multicenter pre-operative assessment of pediatric ovarian malignancy. J Pediatr Surg 2019;54(9):1921-5. https://pubmed.ncbi.nlm.nih.gov/30867096/ Dasgupta R, Renaud E, Goldin AB, Baird R, Cameron DB, Arnold MA, et al. Ovarian torsion in pediatric and adolescent patients: A systematic review. J Pediatr Surg 2018;53(7):1387-91. https://pubmed.ncbi.nlm.nih.gov/29153467/

"The eyes do not see what the mind does not know." Trauma surgery is riddled with pitfalls.  Take your guard down for a minute and BAM, you are eating humble pie.  Don't let this happen to you!   Join Drs. Bryan Cotton, Teddy Puzio, Rushabh Dev, and host Patrick Georgoff for a fun, high-yield review.  In this episode (1 of 2), we cover:  Extraperitoneal rectal injury Blunt cerebrovascular injury Chance fractures Cardiac injuries with a negative FAST exam Missed injuries during trauma ex lap

The chief residents in your program are at their wits end with some of their colleagues. Residents are yelling at nurses, skin closures look like they’re from a horror movie and a patient almost died because of a delay in being seen. How can the chiefs and program director help these struggling residents? Join Drs. Kyla Terhune, Jeremy Lipman, Judith French and Amy Han as they discuss how to identify and support the struggling surgical resident. Learning objectives: After listening to this episode, the participant will be able to: Recall some of the assessment tools available to identify struggling residents Discuss strategies for identifying struggling surgical residents Provide guidance to a struggling surgical resident who is struggling

Tune in to listen to two of the BTK original founders, Dr. Jason Bingham and Dr. Scott Steele, as they discuss clinical challenges in colorectal surgery, specifically large bowel obstruction.   Want to win a free Behind the Knife ABSITE review book?  Simply leave us a review on Apple Podcasts before September 1st and you will be entered into the drawing.  Be sure to include your Twitter or Instagram handle in the review.  Or email us at [email protected] to let us know that you showed BTK some love.  DOMINATE THE DAY!

Incisional hernia is one of the most common long-term complications associated with surgical interventions. In this episode from the Hernia and Abdominal Wall Reconstruction team at Behind the Knife, we discuss evidence-based decision making to reduce incisional hernia rates following laparotomy. We review preoperative factors associated with hernia occurrence, intraoperative decision making related to fascial closure technique, and review literature on prophylactic mesh augmentation.  ·       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. Emaad Iqbal is a resident in General Surgery at Columbia University Medical Center.  ·       Dr. Shahrose Rahman is a resident in General Surgery at Oregon Health & Science University.  Seminal Papers in Hernia Prevention Techniques STITCH Trial: https://pubmed.ncbi.nlm.nih.gov/26188742/ PRIMAAT Trial: https://pubmed.ncbi.nlm.nih.gov/26943336/ PRIMA Trial: https://pubmed.ncbi.nlm.nih.gov/28641875/   Want to win a free Behind the Knife ABSITE review book?  Simply leave us a review on Apple Podcasts before September 1st and you will be entered into the drawing.  Be sure to include your Twitter or Instagram handle in the review.  Or email us at [email protected] to let us know that you showed BTK some love.  DOMINATE THE DAY!

Welcome to the first of a six-part series focused on the integration of palliative care into the practice of surgery.  Dr. Geoffrey Dunn defines Surgical Palliative Care as “the treatment of suffering and the promotion of quality of life for seriously ill or terminally ill patients under surgical care.”  He has proposed that the Family Meeting is like a surgical procedure in which we “Prepare, Do and Close.”  Using the case of a geriatric trauma patient in multi-system organ failure, in this episode we discuss how to run a family meeting, how to discuss code status and how to discuss goals of care. Family Meeting: Fast Fact #16:  Moderating the Family Meeting https://www.mypcnow.org/fast-fact/moderating-an-end-of-life-family-conference/ Fast Fact #222:  The Family Meeting Part 1- Preparing https://www.mypcnow.org/fast-fact/the-family-meeting-part-1-preparing/ Fast Fact #223: The Family Meeting Part 2- Starting the Conversation https://www.mypcnow.org/fast-fact/the-family-meeting-part-2-starting-the-conversation/ Fast Fact #227: The Family Meeting Part 6-  Goal Setting and Future Planning https://www.mypcnow.org/fast-fact/the-family-meeting-part-6-goal-setting-and-future-planning/ In-hospital CPR: CPR in adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation https://pubmed.ncbi.nlm.nih.gov/12969608/ Development and validation of the good outcome following attempted resuscitation (GO-FAR) score to predict neurologically intact survival after in-hospital cardiopulmonary resuscitation https://pubmed.ncbi.nlm.nih.gov/24018585/ 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.   FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLSfxhjxgCE9Ek263XuGkpqqbaNiK9sVnu3M7_LFYUZxhr38SZw/viewform Want to win a free Behind the Knife ABSITE review book?  Simply leave us a review on Apple Podcasts before September 1st and you will be entered into the drawing.  Be sure to include your Twitter or Instagram handle in the review.  Or email us at [email protected] to let us know that you showed BTK some love.  DOMINATE THE DAY!

Behind the Knife – ACS Cancer Surgery Standards Program Host: Shreya Gupta, MD (@shreyaguptaMD)  Guests: Mediget Teshome, MD, MPH, FACS (@drmediget) is an Assistant Professor in the Department of Breast Surgical Oncology at the University of Texas MD Anderson Cancer Center. She is the Chair of the Education Committee of the Cancer Surgery Standards Program (CSSP). Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center. He is the Vice Chair of the Education Committee of the CSSP. Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-4 General Surgery resident at Brooke Army Medical Center and a member of the Education Committee of the CSSP. Description: The American College of Surgeons Cancer Surgery Standards Program is an initiative to improve the quality of cancer surgery by implementing evidence-based operative standards and its associated documentation. This episode discusses the CSSP’s role in not only enhancing the quality of care for patients, but also providing educational tools for trainees, resources for community surgeons caring for cancer patients, and a vehicle for research.  Learning Objectives In this episode, we learn about the mission and vision of the American College of Surgeons Cancer Surgery Standards Program and the associated operative standards. We discuss the current rollout of standards 5.7 and 5.8, concerning synoptic pathology reporting of total mesorectal excision for mid/low rectal cancer and mediastinal and hilar lymph node sampling in lung cancer. In addition, we discuss future implementation of synoptic operative reporting standards for melanoma, breast cancer, and colon cancer. These standards are important not only for the sub-specialist, but also to surgical residents and any general surgeon that cares for cancer patients. Resources Referenced in this Episode The ACS CSSP homepage: facs.org/cssp Operative Standards for Cancer Surgery – find it on Amazon!             Volume 1: Breast, Lung, Pancreas, Colon             Volume 2: Thyroid, Gastric, Rectum, Esophagus, Melanoma Follow CSSP on Twitter at @AmColSurgCancer, with the hashtag #CSSP FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLSfxhjxgCE9Ek263XuGkpqqbaNiK9sVnu3M7_LFYUZxhr38SZw/viewform Want to win a free Behind the Knife ABSITE review book?  Simply leave us a review on Apple Podcasts before September 1st and you will be entered into the drawing.  Be sure to include your Twitter or Instagram handle in the review.  Or email us at [email protected] to let us know that you showed BTK some love.  DOMINATE THE DAY!

A young woman is referred urgently to your breast surgical oncology clinic for a second opinion. She has been told that she needs to have an urgent mastectomy for a palpable triple negative breast cancer with suspicious axillary lymphadenopathy. Are there other options she should consider? Join Drs. Michael Alvarado, Rita Mukhtar, and Alexa Glencer as they discuss the multidisciplinary management of a patient with triple negative breast cancer. In this episode, we review the diagnosis and classification of triple negative breast cancer, its biologic implications, surgical management including the role of sentinel lymph node biopsy vs axillary dissection, and the role of targeted chemotherapy including the recent FDA approval of immunotherapy for triple negative breast cancer in the neoadjuvant setting and indication for adjuvant chemotherapy for patients with residual disease following neoadjuvant therapy. Links: Enhanced recurrence and survival benefit of adjuvant chemotherapy for hormone receptor negative breast cancer compared to hormone receptor positive breast cancer Berry et al (2006). Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA; 295(14): 1658-1667. https://jamanetwork.com/journals/jama/fullarticle/202666 Neoadjuvant pembrolizumab for triple negative breast cancer Schmid et al (2020). Pembrolizumab for early triple negative breast cancer. New England J of Medicine; 382(9): 810-821.  https://www.nejm.org/doi/pdf/10.1056/NEJMoa1910549?articleTools=true ACOSOG 1071: Sentinel lymph node biopsy for patients who received neoadjuvant chemotherapy Boughey at al (2013). Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG 1071 (Alliance) clinical trial. JAMA; 310(14): 1455-1461. https://jamanetwork.com/journals/jama/fullarticle/1748149 Adjuvant capecitabine for triple negative breast cancer patients with residual disease following neoadjuvant chemotherapy: Masuda et al (2017). Adjuvant capecitabine for breast cancer after preoperative chemotherapy. New England J of Medicine; 376(22): 2147-2159. https://www.nejm.org/doi/pdf/10.1056/NEJMoa1612645?articleTools=true FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLSfxhjxgCE9Ek263XuGkpqqbaNiK9sVnu3M7_LFYUZxhr38SZw/viewform

Medical students - do you want to DOMINATE your surgery clerkship?  Of course you do!  Tune in and find out how.  In this episode we introduce Behind the Knife’s 5 Principles for Clerkship DOMINATION, we hear from clerkship directors at top-notch surgery programs around the country, and we review the primary learning environments in surgery and how you can excel in each of these environments.   Hosts: Drs. Patrick Georgoff (@georgoff) and Amir Motameni (@motameniA) Special guests: Drs. Gifty Kwakye, Luigi Pascarella, Mackenzie Cook, and Alodia Gabre-Kidan.  Behind the Knife’s 5 Principles for Clerkship DOMINATION:  1.  Be prepared 2. Take a proactive role in your education 3. Show enthusiasm and be engaged 4. Give quality presentations with thoughtful assessments and plans 5. Seek out feedback and incorporate it into what you do. Systems based surgery plan: •Neuro: Pain control, unneeded narcotics, sleep, home psych meds  •Cardiovascular: HR, BP, home cardiac meds •Pulmonary: Supplemental O2, pulmonary toilet (e.g. incentive spirometry), home inhalers •GI: Diet, return of bowel function, bowel regimen, ostomy care •GU/FEN: Urine output, foley catheter, IV fluids, electrolytes  •Endocrine: Blood glucose •ID: Identify and treat infections, duration of antibiotics  •Heme: DVT chemoprophylaxis, anemia •Skin: Wound care, pressure ulcers •MSK: Activity restrictions, out of bed, PT/OT •Lines: Central line, arterial line •Disposition: PT/OT, social work, case management  FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLSfxhjxgCE9Ek263XuGkpqqbaNiK9sVnu3M7_LFYUZxhr38SZw/viewform

Your patient is pregnant in her third trimester and she has acute cholecystitis...a relatively common but unnerving scenario.  What do you do?!  Do you operate?  Do you observe?  What about the baby?  Tune in and get the information you need to best care for this patient.  Hosts: Drs. Graham Skelhorne-Gross, Ashlie Nadler and Jordan Nantais.  Papers reviewed:  1) Fong, Z. et. al. Cholecystectomy during the third trimester of pregnancy: proceed or delay? J Am Coll Surg. 2019. 228 (4): 494-502. 2) Hong. J. et. al. Considering delay of cholecystectomy in the third trimester of pregnancy. Surg Endosc. 2020. Online ahead of print. FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLSfxhjxgCE9Ek263XuGkpqqbaNiK9sVnu3M7_LFYUZxhr38SZw/viewform

Dr. Yue-Yung Hu, Dr. Ryan Ellis, and Dr. Rhami Khorfan discuss two key new papers discussing optimizing resident achievement and well-being. Check out the papers at these links! https://pubmed.ncbi.nlm.nih.gov/33605580/ https://pubmed.ncbi.nlm.nih.gov/33491973/

Episode Description The timing of renal replacement therapy remains controversial and may be influenced by local resources, availability and institutional practices. In this episode from the Surgical Critical Care team at Behind the Knife, we provide a brief overview, introduce a clinical scenario and discuss two contemporary articles on the timing of initiation.  Learning Objectives:  In this episode, we review the indications for renal replacement therapy, the different modalities of continuous replacement therapy, and discuss two randomized control trials that may help us answer the question of dialysis initiation. Hosts: Brittany Bankhead-Kendall, 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 at the University of Southwestern Medical Center and Parkland Memorial Hospital. Caroline Park, MD, MPH, FACS (@CPark_MD) is an Assistant Professor at the University of Southwestern Medical Center and Parkland Memorial Hospital. Links to Papers Referenced in this Episode: Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis. N Engl J Med. 2018 Oct 11;379(15):1431-1442. doi: 10.1056/NEJMoa1803213. https://pubmed.ncbi.nlm.nih.gov/30304656/ Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. N Engl J Med. 2020 Jul 16;383(3):240-251. doi: 10.1056/NEJMoa2000741. https://pubmed.ncbi.nlm.nih.gov/32668114/

Intro:  Join Drs. Brian Louie, Peter White, and Megan Lenihan as they discuss the management of spontaneous pneumothorax in its various presentations. Learning Objectives -        Management of primary spontaneous pneumothorax -        Management of secondary spontaneous pneumothorax -        Operative intervention -        Nonoperative intervention -        Recognition and management of uncommon causes of pneumothorax Referenced Material ACCP guidelines for spontaneous pneumothorax:  https://journal.chestnet.org/article/S0012-3692(15)38241-6/ BTS guidelines for spontaneous pneumothorax:  https://thorax.bmj.com/content/65/Suppl_2/ii18

Couldn’t log on to the American Association of Endocrine Surgeons Annual Meeting this year? No need to have FOMO, in this episode from the Endocrine Surgery team at Behind the Knife, we review key abstract presentations from the meeting. We discuss the strengths and limitations of the studies, and how the results translate to clinical practice. Specifically, we go into screening and surgery for primary hyperparathyroidism after a diagnosis of nephrolithiasis, and the role of prophylactic central lymph node dissection, radioactive iodine, and radiofrequency ablation for papillary thyroid carcinoma.                    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. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research  Important Papers  Viola, D., Materazzi, G., Valerio, L., Molinaro, E., Agate, L., Faviana, P., Seccia, V., Sensi, E., Romei, C., Piaggi, P. and Torregrossa, L., 2015. Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study. The Journal of Clinical Endocrinology & Metabolism, 100(4), pp.1316-1324. Sippel, R.S., Robbins, S.E., Poehls, J.L., Pitt, S.C., Chen, H., Leverson, G., Long, K.L., Schneider, D.F. and Connor, N.P., 2020. A randomized controlled clinical trial: No clear benefit to prophylactic central neck dissection in patients with clinically node negative papillary thyroid cancer. Annals of Surgery, 272(3), pp.496-503. Alore, E.A., Suliburk, J.W., Ramsey, D.J., Massarweh, N.N., Balentine, C.J., Singh, H., Awad, S.S. and Makris, K.I., 2019. Diagnosis and management of primary hyperparathyroidism across the Veterans Affairs health care system. JAMA internal medicine, 179(9), pp.1220-1227. Ganesan, C., Weia, B., Thomas, I.C., Song, S., Velaer, K., Seib, C.D., Conti, S., Elliott, C., Chertow, G.M., Tamura, M.K. and Leppert, J.T., 2020. Analysis of primary hyperparathyroidism screening among US veterans with kidney stones. JAMA surgery, 155(9), pp.861-868.

You find a 2.3 cm polyp in the right colon during a screening colonoscopy.  Does this patient need a colectomy? Is polypectomy ok? What should I do?? Join Drs. Peter Marcello, Jonathan Abelson and Tess Aulet as they discuss the endoscopic management of advanced colorectal polyps.  Be sure to check out Behind the Knife's YouTube channel for the VideoCast version of this high-yield case: https://www.youtube.com/c/BehindTheKnifeTheSurgeryPodcast.   Interested in learning more about specific topics in Colorectal Surgery? Check out the Virtual Education Series in Colorectal Surgery on Sunday Evenings at 7 pm EST @CRSVirtualEd or visit our website at http://jc.kethman.org. References: Cohan JN, Donahue C, Pantel HJ, Ricciardi R, Kleiman DA, Read TE, Marcello PW. Endoscopic Step Up: A Colon-Sparing Alternative to Colectomy to Improve Outcomes and Reduce Costs for Patients With Advanced Neoplastic Polyps. Dis Colon Rectum. 2020 Jun;63(6):842-849. doi: 10.1097/DCR.0000000000001645. PMID: 32118624. https://pubmed.ncbi.nlm.nih.gov/32118624/ NCCN guidelines: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1428 Kudo Classification: Kudo S, Tamura S, Nakajima T, Yamano H, Kusaka H, Watanabe H. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996; 44: 8-14 [PMID:8836710] UpToDate. Chromoendoscopy. Author:Marcia Irene Canto, MD, MHSSection Editor:John R Saltzman, MD, FACP, FACG, FASGE, AGAFDeputy Editor:Kristen M Robson, MD, MBA, FACG. Literature review current through: May 2021. | This topic last updated: Jan 14, 2021. Haggit and Kikuchi classification: Haggitt RC, Glotzbch RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology 1985; 89: 328-36. 

Minimally Invasive Surgery Journal Review   Evaluating the Robot Platform for use in General Surgery: ROLARR & RIVAL The debate about whether or not robotic surgery has a place in mainstream general surgery practice has been raging years with critics highlighting concerns about cost and a lack of high-level evidence showing benefit in patient outcomes while proponents suggest benefits in visualization, dexterity, and ergonomics that have not yet been borne out in rigorous trials. Hosts, Drs. Mike Weykamp, Andrew Wright, and Nick Cetrulo use two recent JAMA articles to frame the debate surrounding the platform and offer insight into the future of robotic and minimally invasive surgery. Learning objectives:  In this episode we review the current landscape of the literature surrounding robot assisted surgery with a particular focus on how to thoughtfully evaluate emerging surgical technologies, the need to consider the broader concept of value rather than simply healthcare costs, and the role of surgeon-focused outcomes including ergonomics.  Selected Articles:  Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomized Clinical Trial Link: https://pubmed.ncbi.nlm.nih.gov/29067426/ Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair: The RIVAL Randomized Clinical Trial Link: https://pubmed.ncbi.nlm.nih.gov/32186683/ RIVAL Author Interview with JAMA Surgery: https://edhub.ama-assn.org/jn-learning/audio-player/18318110

Dr. Shailesh Agarwal from Brigham and Women's Hospital in Boston joins us once more on the podcast! This time he lends us his expertise in the surgical management of lymphedema. Come listen to how Dr. Agarwal is improving the lives of patients with this terrible, chronic condition, often produced as a result of prior surgery.

On this episode we are joined by Dr. Gretchen Schwarze, Associate Professor of Vascular Surgery at the University of Wisconsin in Madison.  Dr. Schwarze is an expert in surgical decision making, informed consent, advance directives, and end-of-life care, and in this episode we pick her brain for practical tips on how to talk to patients about surgery and end of life decisions.  Tune in to hear Dr. Schwarze’s 7 Habits for Highly Effective Surgery Communication, created just for Behind the Knife.   1.     Be clear about the goal 2.     Stay away from anatomy and physiology 3.     Remember the downsides of surgery are more than just complications 4.     Help patients to anticipate and prepare 5.     Ask people about their hopes and fears 6.     Make a recommendation and show your work 7.     Attend to emotion The Patient Preferences Project: https://patientpreferences.org/

On this episode we talk about an extremely important topic - end of life care and decision making.  We are lucky to be joined by Dr. Gretchen Schwarze, Associate Professor of Vascular Surgery at the University of Wisconsin in Madison.  Dr. Schwarze is the creator of the Best Case Worst Case tool, an incredibly useful resource.  The Best Case Worse Case tool helps improve communication between older patients and their surgeons so that patients can avoid unwanted treatment and make decisions that align with their values, preferences, and goals.  As most of our listeners know, these conversations are not easy.  Tune in and learn how to do better.   Whiteboard video: https://www.youtube.com/watch?v=FnS3K44sbu0 The Patient Preferences Project: https://patientpreferences.org/ Managing Uncertainty — Harnessing the Power of Scenario Planning: https://www.nejm.org/doi/full/10.1056/NEJMp1704149

Description: Pancreatic adenocarcinoma is a highly lethal cancer with a dismal long-term prognosis requiring complex multidisciplinary planning in order to optimize outcomes. In this episode from the Hepato-Pancreato-Biliary team at Behind the Knife, we discuss a patient presenting with a borderline resectable pancreatic head mass.  Learning Objectives: In this episode, we review risk factors for pancreatic adenocarcinoma, key steps of the diagnostic work-up and pre-operative planning, and definitions of resectable, borderline resectable, and unresectable tumors. The history of chemotherapy for pancreatic cancer is briefly reviewed, highlighting the importance of multi-agent regimens and role of neoadjuvant therapy. Finally, we highlight the critical steps of the Whipple procedure. Hosts: Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center Daniel Nelson, DO, FACS (@usarmydoc24) 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-4 General Surgery resident at Brooke Army Medical Center Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-3 General Surgery resident at Brooke Army Medical Center Links to Papers Referenced in this Episode Treatment sequencing for resectable pancreatic cancer: influence of early metastases and surgical complications on multimodality therapy completion and survival J Gastrointest Surg. 2014 Jan;18(1):16-24 https://pubmed.ncbi.nlm.nih.gov/24241967/  Preoperative biliary drainage for cancer of the head of the pancreas N Engl J Med. 2010 Jan 14;362(2):129-37 https://pubmed.ncbi.nlm.nih.gov/20071702/ 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience J Gastrointest Surg. 2006 Nov;10(9):1199-210; discussion 1210-1. https://pubmed.ncbi.nlm.nih.gov/17114007/  Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial JAMA. 2013 Oct 9;310(14):1473-81.  https://pubmed.ncbi.nlm.nih.gov/24104372/ Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial Lancet. 2017 Mar 11;389(10073):1011-1024 https://pubmed.ncbi.nlm.nih.gov/28129987/ FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer N Engl J Med. 2018 Dec 20;379:2395-2406 https://www.nejm.org/doi/full/10.1056/NEJMoa1809775  Surgical Outcome Results From SWOG S1505: A Randomized Clinical Trial of mFOLFIRINOX Versus Gemcitabine/Nab-paclitaxel for Perioperative Treatment of Resectable Pancreatic Ductal Adenocarcinoma Ann Surg. 2020 Sep 1;272(3):481-486.doi: 10.1097/SLA.0000000000004155 https://pubmed.ncbi.nlm.nih.gov/32740235/ ASCO Guidelines Potentially Curable Pancreatic Adenocarcinoma https://www.asco.org/research-guidelines/quality-guidelines/guidelines/gastrointestinal-cancer#/12146 NCCN Guidelines Pancreatic Adenocarcinoma https://www.nccn.org/guidelines/nccn-guidelines/guidelines-detail?category=1&id=1455

Today we have a very special guest on Behind the Knife- Dr Michael D’Angelica. He discusses surgical oncology with his HPB focus along with colorectal liver metastases. The episode digs in deeper on the origin of hepatic artery infusion pump, its surgical technique and common complications and much more. Enjoy! https://jamanetwork.com/journals/jamasurgery/article-abstract/2735967

Clinical Challenges in Trauma Surgery: Penetrating Cardiac Trauma A patient presents with a stab wound to the THE BOX.  What do you do?  X-ray?  FAST?  Heal with steel?  In this episode, the BTK trauma team discusses your options and gives you a few pro tips along the way. Join Drs. Haut, Feinman, and Sigmon for a high-yield clinical challenge. Hosts: Elliott 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-5 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. Papers: Inaba K, Chouliaras K, Zakaluzny S, et al. FAST ultrasound examination as a predictor of outcomes after resuscitative thoracotomy: a prospective evaluation. Ann Surg. 2015;262(3):512-518; discussion 516-518.  https://pubmed.ncbi.nlm.nih.gov/26258320/ Teeter W, Haase D. Updates in traumatic cardiac arrest. Emerg Med Clin North Am. 2020;38(4):891-901. https://pubmed.ncbi.nlm.nih.gov/32981624/ Israr S, Cook AD, Chapple KM, et al. Pulseless electrical activity following traumatic cardiac arrest: Sign of life or death? Injury. 2019;50(9):1507 1510. https://pubmed.ncbi.nlm.nih.gov/31147/183/

Clinical Challenge in Surgery – Carotid Artery Stenosis Carotid endarterectomy is a great option for most patients, but what do you do when the lesion extends high in the neck or the neck has been irradiated? In this episode from the Vascular Surgery team at Behind the Knife, we discuss carotid artery stenosis using a real patient case from the University of Michigan. We touch on diagnosis and imaging as well as medical and surgical management of carotid disease with a special discussion about Transcarotid Artery Revascularization (TCAR), a new technique available for the treatment of carotid lesions. 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. Seminal Papers in Carotid Artery Stenosis The MRC European Carotid Surgery Trial (ECST): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)09292-1/fulltext Endarterectomy for Asymptomatic Carotid Artery Stenosis (ACAS Trial): https://jamanetwork.com/journals/jama/article-abstract/388335 The North American Symptomatic Carotid Endarterectomy Trial (NASCET Trial): https://www.ahajournals.org/doi/epub/10.1161/01.STR.30.9.1751 Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure (ROADSTER Trial): https://pubmed.ncbi.nlm.nih.gov/26506270/ ROADSTER 2 Trial: https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.030550

“If you could go back to your very first day of intern year and tell yourself one thing, what would it be?"   In this episode, AlleaBelle Gongola joins Scott Steele, Kevin Kniery, and Patrick Georgoff to discuss this very question. Tune in to hear wise answers from previous BTK episodes and fill up on inspiration as we head into a new academic year.  

Go to greenchef.com/90surgery with code "90surgery" to get 90 dollars off some fantastic meals and help support Behind The Knife. Host: Kevin Kniery Guests: Alexis Lauria and Alec Kersey

Go to greenchef.com/90surgery with code "90surgery" to get 90 dollars off some fantastic meals and help support Behind The Knife.  Host: Kevin Kniery Guest Hosts: Alexis Lauria and Alec Kersey For more details on vascular trauma discussion check previous episodes with Dr. Rasmussen. 

Go to HelloFresh.com/Surgery12 to get up to 12 free meals and support Behind The Knife. Host: Kevin Kniery Guest Hosts: Alexis Lauria and Alec Kersey Check our YouTube tutorial on REBOA https://bit.ly/3uSxLXb For more in detail vascular trauma discussions check out our previous episodes with Dr. Todd Rasmussen. 

In this episode, we host the Joint Commission who tell us about their efforts to improve healthcare disparities and healthcare provider diversity. We first briefly discuss structural racism before pivoting to how COVID has revealed how deep the roots of inequity travel. Finally we discuss the ways that Joint Commission are tackling the problem. Dr. Ana McKee, Executive Vice President and Chief Diversity, Equity, and Inclusion Officer of the Joint Commission joins our discussion, along with return guest Dr. Fabian Johnston from Johns Hopkins University. Dr. McKee mentions the Bernard J Tyson National Award for Excellent in the Pursuit of Healthcare Equity in this episode! Applications open on May 17. Please see go to THIS LINK to learn more about the process!

In this episode, we follow up with our friends at COVIDSurg (https://globalsurg.org/covidsurg/).  While the pandemic has been raging they have been hard at work, studying the interface between COVID and all things surgery.  They’ve produced some amazing work, most of which impacts the day to day lives of surgeons around the country.   How long should you wait to operate on a patient who has had COVID?  And what do you tell your patients about this?  What about vaccines?  Should your next patient undergoing elective surgery be vaccinated before you take them to the operating room?  Find out!

Clinical Challenges in Surgery: ARDS It's the middle of the night...the ventilator is alarming, the patient is hypoxic, and the nurse wants to know if you would like to paralyze the patient.  What do you do?!  Join Drs. Matt Martin, John McClellan, and Patrick Georgoff as they discuss the management of a real patient with severe Acute Respiratory Distress Syndrome.  From paralytics and proning to steroids and ECMO, this episode has got you covered. 

Note: We couldn't upload the video version to your podcast player because the file was just way too big! That's because the operative video is so high quality! Please go our YouTube channel to watch it! Or click this link: https://youtu.be/xx7JMIe2d_o In the first of our Surgical Technique video series, Mass Gen Transplant surgeons take us step by step through a kidney transplant! This is Part 2 of the series. We are joined by Dr. Leigh Anne Dageforde, Dr. Anushi Shah, and Dr. Ashley Aaron. Just in time for National Donate Life Month!

Note: We couldn't upload the video version to your podcast player because the file was just way too big! That's because the operative video is so high quality! Please go our YouTube channel to watch it! Or click this link: https://youtu.be/xx7JMIe2d_o In the first of our Surgical Technique video series, Mass Gen Transplant surgeons take us step by step through a kidney transplant! This is Part 1 of the series. We are joined by Dr. Leigh Anne Dageforde, Dr. Anushi Shah, and Dr. Ashley Aaron. Just in time for National Donate Life Month!

Dr. Anton Fries, Chief of Plastic Surgery at UT San Antonio, joins the podcast to give us all a primer on all we need to know about flap-based reconstruction. Don’t forget to visit GreenChef.com and use promo code 90Surgery to get $90 off your first organic, delivered meals. It’s a great way to support your body and the podcast!

Check out the articles discussed in today's podcast here ATTRACT Trial  https://www.nejm.org/doi/full/10.1056/NEJMoa1615066 Dual Antiplatelets Following Lower Extremity Bypass https://pubmed.ncbi.nlm.nih.gov/32777321/

Discussing a REAL TRAUMA CASE that happened just a few months ago, Patrick Georgoff, John McClellan, and Hasan Alam come together to detail their thought process in managing a patient with a gunshot wound to the abdomen.

We brought Dr. Mary Klingensmith and Dr. Amit Joshi on the show, executive leaders on the Surgical Council on Resident Education. Listen to them discuss the history of SCORE, how it has improved over time, and how these two leaders in surgical education anticipate residency training changing over the next decade!

Diverticulitis has got to be one of the most classic problems encountered by surgeons and medical students in their surgery rotation. In this inaugural "Clinical Challenges" episode, colorectal surgeons Scott Steele and Joshua Bleier join acute care and trauma surgeon Patrick Georgoff to discuss the important clinical pearls, starting from when you meet the patient, all the way to when you're taking care of them after their surgery.