Behind The Knife: The Surgery Podcast

Historically, a paucity of data has existed in the most appropriate modality of critical care management of brain dead organ donors prior to organ harvest. In this episode, Drs. Bankhead, Dumas, and Park are joined by special guest Dr. Ashley McGinity, a director in the donor management unit the Center for Life at the UT Health Science Center in San Antonio, joins us to discuss modern and current practices in the management of these patients to maximize the gift for patients and families.  References:  https://pubmed.ncbi.nlm.nih.gov/24980425/ https://pubmed.ncbi.nlm.nih.gov/25978154/  https://pubmed.ncbi.nlm.nih.gov/31957104/ https://pubmed.ncbi.nlm.nih.gov/23116641/ https://pubmed.ncbi.nlm.nih.gov/28318674/ https://pubmed.ncbi.nlm.nih.gov/25056510/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145376/  Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other surgical critical care episodes here: https://b

The dreaded Surgical Site Complications! Join Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross from our Emergency General Surgery Team as they discuss surgical site complications and prevention techniques. Paper 1: Arnold et. al. (2019) Not a Routine Case, Why Expect the Routine Outcome? Quantifying the Infectious Burden of Emergency General Surgery Using the NSQIP. American Surgeon  - NSQIP database 2005-2016 (>800,000 patients) including open/laparoscopic cholecystectomies, ventral hernia repairs, and partial colectomies  - Comparing outcomes in emergent vs elective cases - Primary outcome: aggregate of SSIs which includes wound disruption, superficial SSI, deep SSI, and organ space SSI  - Results: -- ↑SSI in the emergency group (5.3% vs 3.6%)  -- When controlling for multiple variables, emergency surgery associated with more SSIs (OR 1.15).   Paper 2: Lakhani et. al. (2022) Prophylactic negative pressure wound dressings reduces wound complications following emergency laparotomies: A sys

In this episode, our team provides a comprehensive review of the differential diagnosis for mediastinal masses, their workup, and biopsy considerations. Listen as we dive deeper into the perioperative planning and operative approach for resection of these masses with special considerations for patients with thymoma.  Learning Objectives: -Discuss the differential diagnosis of a mediastinal mass -Review the workup of a mediastinal mass -Outline indications for biopsy and describe the various approaches -Describe the operative techniques for thymectomy, pearls & potential pitfalls   Hosts:  Megan Lenihan MD, Kelly Daus MD, Peter White MD, and Brian Louie MD Referenced Material https://pubmed.ncbi.nlm.nih.gov/21847052/ Detterbeck FC, Nicholson AG, Kondo K, Van Schil P, Moran C. The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol. 2011 Jul;6(7 Suppl 3):S1710-6. doi: 10.1097/JTO.0b013e31821e8cff. PMID: 21847052. https://pubmed.ncbi.nlm

In this episode from the Endocrine Surgery team at BTK we discuss how Dr. Yeh built the section of endocrine surgery at UCLA. From Sydney, Australia to Santa Monica, he discusses the risks and challenges involved in becoming a leader in academic endocrine surgery. In this podcast we answer the question “why endocrine surgery,” and mention tips for success at all level of training from medical students to early faculty. Finally, we take a moment to honor and remember Dr. Orlo Clark.               Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.  Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department  Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department  Dr. Na Eun Kim is an Endocrine Surgery Fellow at UCLA in her first year of fellowship Dr. Rivfka Shenoy is a PGY-6 General Surgery Resident at UCLA who has completed

You have a young patient with longstanding Crohn’s disease with a history of small bowel resections presenting with recurrent obstructions from a stricture. The patient has exhausted all medical options and requires surgery. How should you work up this patient prior to surgery? Should you perform a bowel resection or perform a strictureplasty? Which strictureplasty do you choose and why?  Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Fabrizio Michelassi as they discuss the management of small bowel strictures in Crohn’s disease.  Learning Objectives 1. Describe the evaluation for small bowel strictures and indications for operating in patients with Crohn’s disease  2. Discuss the different surgical options in managing small bowel strictures  3. Explain the rationale behind use of different strictureplasty approaches Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other Co

On this episode of the BIG T Trauma series Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill discuss hemodynamically unstable pelvic fractures.  These patients are sick!!  Really sick.  Join us for a practical discussion about the best way to manage gnarly pelvic fractures.  From binders to angioembolization to pelvic packing to REBOA, we cover it all.   Papers:  Burlew et al, Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures. J Trauma 2017: https://pubmed.ncbi.nlm.nih.gov/27893645/ McDonogh et al, Preperitoneal packing versus angioembolization for the initial management of hemodynamically unstable pelvic fracture: A systematic review and meta-analysis. J Trauma 2022: https://pubmed.ncbi.nlm.nih.gov/34991126/ Li et al, Role of pelvic packing in the first attention given to hemodynamically unstable pelvic fracture patients: a meta-analysis, J ournal of Orthopaedics and Traumatology 2022: https://pubmed.ncbi.nlm.nih.gov/35799073/

In the second episode of the “Innovations in Surgery” series, Behind the Knife’s surgical education fellow, Dr. Dan Scheese, sits down with Dr. Michael Amendola and Dr. Diana Otoya to discuss 3D Printing and its role in medicine and surgery. They speak on the history of this technology and the current utility in preoperative planning and intraoperative application.  Looking for information on getting involved in 3D Printing? Link to the VHA Office of Advanced Manufacturing: https://www.innovation.va.gov/oam/views/about/whoweare.html Link to information regarding the 3D printing fellowship: https://www.innovation.va.gov/oam/views/training/training.html Additionally, you can contact Dr. Michael Amendola or Dr. Diana Otoya for more information regarding the 3D printing surgical fellowship. Dr. Michael Amendola: michael.amendola@va.gov Dr. Diana Otoya: Diana.Otoya@vcuhealth.org Dr. Amendola also has a website for mentorship and other information: https://michaelamendola.com/ Download free 3D designs th

Join our surgical education fellow, Dr. Dan Scheese as he kicks off a brand new BTK series titled “Innovations in Surgery.” This series will take a deeper look into past, present, and future innovations that have, or will, revolutionize the field of surgery. In this inaugural episode, Dr. Scheese and Dr. Patrick Georgoff sit down with a leader in the surgical artificial intelligence field, Dr. Daniel Hashimoto. They cover what surgical artificial intelligence is, go over some common terminology used in AI, talk about current applications of AI in the OR, and finally discuss the future of AI in surgery. “Artificial Intelligence in Surgery: Promises and Perils” - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995666/ Video – Application of AI in the OR – https://youtu.be/kabcjtdI308 Daniel Hashimoto is assistant professor of surgery at the Hospital of the University of Pennsylvania and director of the Penn Computer Assisted Surgery and Outcomes (PCASO) Laboratory. He received his MD and MS in translational re

You get called to the ED to evaluate a patient with abdominal pain who is in extreme pain but without any helpful physical exam findings. Time is gut in mesenteric ischemia, so how do you prioritize your workup, initial treatment, and what do you do once you’ve made the diagnosis? In this episode of Behind the Knife, the vascular surgery team discusses all this and more by walking through a real case and talking through the principles of management as well as some helpful tips on how to actually get through these tough clinical scenarios.  Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan and the Program Director of the Integrated Vascular Surgery Residency Program as well as the Vascular Surgery Fellowship Program at the University of Michigan. Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan. Dr. Craig Brown is a PGY-7 in the General Surgery program and recently matched 2023 vascular fellow at the University of Michig

What’s the one clinical scenario where you can really save a patient’s life with a pancreatectomy? An IPMN with high-grade dysplasia! Join the Behind the Knife HPB Team for a deep dive into the complex decision-making surgical management of IPMNs. Learning Objectives In this episode, we review the basics of intraductal papillary mucinous neoplasms, how to evaluate patients with a cystic mass of the pancreas, guidelines for surveillance, and indications for resection. We discuss key concepts such as Worrisome Features and High-Risk Stigmata and how those influence surgical decision-making, and tackle a few of the most challenging scenarios surgeons may face when treating patients with IPMNs.   Hosts: Timothy Vreelant, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center Daniel Nelson, DO, FACS (@DWNelsonHPB) is an Associate Professor of Surgery at the Uniformed Services University of the Hea

Gallbladders – bread and butter cases or underestimated challenges? Join Dr. Patrick Georgoff and Dr. Shanaz Hossain as they sit down with Dr. Eric Knauer to discuss difficult gallbladders. In this episode, we discuss the SAGES Safe Cholecystectomy program that were created in an effort to decrease the incidence of bile duct injuries. The six strategies outlined in the program include:  1.    Use the Critical View of Safety (CVS) method of identification of the cystic duct and cystic artery during laparoscopic cholecystectomy. 2.    Understand the potential for aberrant anatomy in all cases. 3.    Make liberal use of cholangiography or other methods to image the biliary tree intraoperatively. 4.    Consider an Intra-operative Momentary Pause during laparoscopic cholecystectomy prior to clipping, cutting or transecting any ductal structures. 5.    Recognize when the dissection is approaching a zone of significant risk and halt the dissection before entering the zone. Finish the operation by a safe method o

Does surgery have a leaky pipeline problem?  What is it like for LGBTQ+ students, trainees, and faculty to be in the field of surgery?  In this Journal Club episode, we review recent research and calls to action that illuminate these and other questions in the field.  We’re joined by a panel of guests from all levels of training, including Eric Pillado MD MS, Christopher Digesu MD, Jessica Halem MBA, and Michaela West MD PhD.  Learning Objectives: ·       Identify hazards for LGBTQ+ trainees in surgery ·       Describe potential actions to improve LGBTQ+ inclusivity in surgery ·       Correlate the provision of LGBTQ+ health care and the wellbeing of LGBTQ+ staff References: Experiences of LGBTQ+ Residents in US General Surgery Training Programs - https://doi.org/10.1001/jamasurg.2021.5246  Invited Commentary - Discrimination, Harassment, and Bullying Is Reported to Be High by LGBTQ+ Surgical Residents – https://doi.org/10.1001/jamasurg.2021.5272  LGBTQ+ Inclusivity in Surgery—A Call to Action – https://d

In this episode, our team discusses the management of traumatic rib fractures including pearls and pitfalls. Join as we discuss the current standards of treatment as well as controversies in how to manage these patients! Hosts:  Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST) and incoming editor-in-chief of Trauma Surgery and Acute Care Open. Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.  David Sigmon, MD, MMEd, a PGY-7 resident at the University of Illinois at Chicago who will be a fellow at Lincoln Medical Center in the Bronx next year. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s i

On the University of Washington Minimally Invasive Surgery team’s search for value no piggy bank is safe and no couch cushion will be left unturned. Tune in to hear Drs. Mike Weykamp, Nicole White, Nick Cetrulo, and Andrew Wright discuss the state of the literature regarding the cost-effectiveness of robot assisted surgery.  Referenced Articles:  1.     Ye L, Childers CP, de Vigilio M, Shenoy R, Mederos MA, Mak SS, Begashaw MM, Booth MS, Shekelle PG, Wilson M, Gunnar W, Girgis MD, Maggard-Gibbons M. Clinical Outcomes and Cost of Robotic Ventral Hernia Repair: Systematic Review. BJS Open. 2021.  https://pubmed.ncbi.nlm.nih.gov/34791049/  2.     Finlayson SRG and Birkmeyer JD. Cost-effectiveness Analysis in Surgery. Surgery. 1998 https://pubmed.ncbi.nlm.nih.gov/9481400/ 3.     Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu R, Staniszewska S. Consolidated Health Economic Evaluation Reporting

You’ve finally submitted your ERAS application! As residency programs start to review your application, it’s time to start preparing for the next step- the interview. Join our education fellow, Dr. Jessica Millar, and Dr. Jeremy Lipman as they go over all the ways to start preparing to dominate your interviews.  Guests: Jeremy Lipman, MD, MHPE- Professor of Colorectal Surgery, Designated Institutional Official, Director of Graduate Medical Education, and previous General Surgery Residency Program Director- Cleveland Clinic, OH Most Commonly Asked Interview Questions:  ·      “Tell me about yourself”- have a 2-3 minute “elevator talk” rehearsed  ·      “Where do you see yourself in 5/10-years” ·      “Why surgery?” ·      “Tell me about a challenge you’ve had to overcome”  ·      “Tell me about a difficulty patient/team situation you’ve witnessed”- key here is to not throw anyone under the bus ·      “Why are you interested in our program”  AAMC List of Common Interview Questions:  https://students-resident

The number of patients seeking evaluation for revisional bariatric surgery is increasing. Wondering how to approach the work-up for these patients and what surgical options may be best for them? An introduction to the work-up and potential revisional bariatric surgery options are included in this episode from your bariatric surgery team at UNMC! Hosts: Ivy Haskins, MD Corrigan McBride, MD Tiffany Tanner, MD Journal Articles discussed: 1.     Berger ER, Clements RH, Morton JH, Huffman KM, Wolfe BM, Nguyen NT, Ko CY, Hutter MM. The Impact of Different Surgical Techniques on Outcomes in Laparoscopic Sleeve Gastrectomies: The First Report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Ann Surg. 2016; 264.3: 464-473.  2.     Haskins IN, Jackson HT, Graham AE, Chen S, Sparks AD, Lin PP, Vaziri K. The Effect of Bougie Size and Distance from the Pylorus on Dehydration after Laparoscopic Sleeve Gastrectomy: An Analysis of the ACS-MBSAQIP Database. Surg Obes Relat Dis. 2019;

In this episode we discuss two interesting cases in transplant surgery. In the first, we review a case in which a renal cell carcinoma was discovered during the backbench portion of a deceased donor kidney transplant procedure. In the second, we examine the unique challenges that are presented by simultaneous heart-liver transplantation. Learning Objectives: - Discuss renal cell carcinoma in the immunosuppressed patient - Review some of the logistical components that accompany dual organ transplants - Examine the clinical challenge of a heart-liver transplant Hosts: - Megan Lombardi, MD - Sasha McEwan, MD - Guilherme de Oliveira, MD - Alexander Toledo, MD - David Gerber, MD Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other transplant surgery episodes here: https://behindtheknife.org/podcast-category/transplant/

You are faced with a young patient with ileal Crohn’s disease. He requires an ileocolic resection. Which type of anastomosis do you perform? You also see another patient with complex perianal fistulas and the patient asks about the safety and efficacy of stem cells for fistula closure. What do you tell the patient? Join Dr. Carole Richard, Dr. François Dagbert and Dr. Maher Al Khaldi in their conversation about the Kono-S anastomosis after ileocolic resections and stem cell therapy for perianal complex fistulas for Crohn’s disease.  Learning objectives  -       To understand the rationale for the Kono-S anastomosis and the way it is fashioned.  -       To explain the possible advantages of the Kono-S anastomosis following ileocolic resection. -       To explain the possible advantages of stem cell therapy for complex perianal fistulas. -       To understand which patient population might be eligible for future stem cell therapy for complex perianal fistulas.  References In order throughout the episode: A

Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss  management of congenital diaphragmatic hernia in pediatric surgery.  Journal Article links:  Jancelewicz T, Brindle ME. Prediction tools in congenital diaphragmatic hernia. Semin Perinatol 2020;44(1):151165. https://pubmed.ncbi.nlm.nih.gov/31676044/ Deprest JA, Benachi A, Gratacos E, Nicolaides KH, Berg C, Persico N, et al. Randomized Trial of Fetal Surgery for Moderate Left Diaphragmatic Hernia. N Engl J Med 2021;385(2):119-29. https://pubmed.ncbi.nlm.nih.gov/34106555/ Deprest JA, Nicolaides KH, Benachi A, Gratacos E, Ryan G, Persico N, et al. Randomized Trial of Fetal Surgery for Severe Left Diaphragmatic Hernia. N Engl J Med 2021;385(2):107-18. https://www.nejm.org/doi/full/10.1056/NEJMoa2027030 Guner Y, Jancelewicz T, Di Nardo M, Yu P, Brindle M, Vogel AM, et al. Management of Congenital Diaphragmatic Hernia Treated With Extracorporeal Life Support: Interim Guidelines Consensus Statement From the Ex

What is the value of completion lymph node dissection for patients with melanoma with sentinel-node metastases? The Multicenter Selective Lymphadenectomy Trial-1 (MSLT-1) confirmed that SLNB is an important part in the treatment of patients with melanoma, but what needed to be done beyond that in managing the axilla?  Learning Objectives:  In this episode, we review perioperative chemotherapy regimens for locally advanced, resectable Gastric cancer, standard of care, and the future role for immunotherapy.  Hosts:  Adam Yopp, MD, FACS (@AdamYopp) is an Associate Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program. Caitlin Hester, MD (@CaitlinAHester) is a new Assistant Professor of Surgery at the University of Miami Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-4 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic On