Behind The Knife: The Surgery Podcast

Upon encountering a patient who develops an anastomotic leak after a straight-forward low anterior resection, you are taken aback, as the patient is healthy and has no apparent risk factors. This prompts you to consider whether the microbiota may have played a role in causing the leak. Join Dr. Carole Richard, Dr. François Dagbert, Dr. Maher Al Khaldi, and Dr. Roy Hajjar in their conversation about the impact of gut microbiota on anastomotic healing and leak.  Learning objectives  - To list the known risk factors for anastomotic leak. - To understand how preoperative gut microbiota influence anastomotic healing and could lead to leak.  Reference Hajjar R, Gonzalez E, Fragoso G, et al. Gut microbiota influence anastomotic healing in colorectal cancer surgery through modulation of mucosal proinflammatory cytokines. Gut. Published Online First: 30 December 2022. doi: 10.1136/gutjnl-2022-328389 Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based met

Dr. Cunningham is the section head of the Massachusetts General Hospital Endocrine Surgery unit, a NIH-funded researcher, and the immediate past-president of the Association for Academic Surgery. This episode is a recording of her presidential address at their annual Academic Surgical Congress.  Guest Dr. Carrie Cunningham, MD, MPH Associate Professor of Surgery, Harvard Medical School Learn More Association for Academic Surgery: https://www.aasurg.org/ Dr. Lorna Breen Heroes foundation: https://drlornabreen.org/  Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

While you are likely aware of BRCA mutations as a significant risk factor for development of breast cancer (60-80% lifetime risk), there are many other pathogenic gene variants that have been identified in recent years. The surgical treatment of women with hereditary breast cancer differs from that of women with sporadic breast cancer, and women with hereditary breast cancer are also eligible for prophylactic mastectomy or intensive surveillance protocols. In this episode of BTK, we examine current national consensus guidelines for management of hereditary breast cancer, discuss a recent population-based study that establishes risk associated with various genes, and address both surgical and surveillance strategy for patients without breast cancer but with known pathogenic gene variants. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other breast surgery episodes here: https://behindtheknife.org/podcast-

Calling all surgeons! It’s time to take back common bile duct stones! Join our surgical education fellow, Shanaz Hossain, as she talks about laparoscopic common bile duct exploration (LCBDE) with Drs. Maggie Bosley, Lucas Neff, and Byron Fernando Santos. Dr. Bosley is a graduating chief resident at Wake Forest and incoming MIS fellow at Washington University in St. Louis. Dr. Neff is an assistant professor of pediatric surgery with Wake Forest Baptist Health and Brenner’s Children’s Hospital. Dr. Santos is an assistant professor of surgery at Dartmouth-Hitchcock Medical Center. As a research resident at Northwestern University, he co-invented a LCBDE simulator that is used to train surgeons in these techniques. He is also a member of the SAGES Safe Cholecystectomy Task Force and has led numerous LCBDE courses.  Join us for a discussion on LCBDE indications, implementation, techniques, and tips for incorporation into patient care. If you’re interested in learning more, check out the instructional video from

Hernias are some of the most common problems treated by general surgeons. The field of abdominal wall surgery has rapidly evolved as a result of innovation and the development of new techniques. In this podcast, Drs. Charlotte Horne and Jenny Shao join Vahagn Nikolian to discuss their decision to pursue careers as abdominal wall specialists, the role that hernia surgeons play in modern day surgical programs, and the pathway to becoming a hernia surgeon.  ·       Dr. Charlotte Horne is an Assistant Professor of Surgery at Pennsylvania State University. ·       Dr. Jenny Shao is an Assistant Professor of Surgery at the University of Michigan. ·       Dr. Vahagn Nikolian is an Assistant Professor of Surgery at Oregon Health & Science University. Recommended Reading: Shulkin JM, Mellia JA, Patel V, Naga HI, Morris MP, Christopher A, Heniford BT, Fischer JP. Characterizing hernia centers in the United States: what defines a hernia center? Hernia. 2022 Feb;26(1):251-257. doi: 10.1007/s10029-021-02411-x. Epub

To operate or not to operate, to drain the urine leak or to not drain it, those are the questions. Join our Miami Trauma team including Drs. Urréchaga, Neeman, and Rattan- in their final episode together! - as they discuss how to navigate the ins and outs of renal trauma!  Learning Objectives:  ·       Define the different renal injury grades and how to manage each, ·       Identify when to take the renal trauma patient to the operating room, ·       Discuss when to involve IR for urinary drainage or embolization. ·       Explain when and how to perform a nephrectomy. ·       Debate the treatment of penetrating zone two injuries- to explore or not explore? Quick Hits: 1.     Most kidney injuries, the vast majority, can be non-operatively managed.  2.     For pretty much all AAST grade of injury, the choice to go to the OR immediately lies in whether the patient is stable or unstable.  3.     If there is a urinary leak seen on imaging, it can usually just be observed and followed with repeat imaging to deter

Have a grand idea for how to improve education and patient safety in surgery, but unsure how to make it a reality? Perhaps the OR Black Box can inspire you and set you on your path as an innovator. We are joined by Dr. Teodor Grantcharov, one of its creators. The OR Black Box is a system that collects, stores, and analyzes a large amount of data from the operating room beyond just surgical video, such as video and audio of the operating room and patient physiology data. Using the system for feedback through self-directed review, coaching, and integrated AI analysis has changed the way we can learn and teach in surgery, and may have implications for the future of evaluation and credentialing.  Learning Objectives Listeners will describe the value that accessible data review and analysis adds to surgical education. Listeners will describe how review of operative data could be utilized for more objective evaluation and credentialing, and how this can be used for continuous improvement. Listers will recognize c

Please join BTK's Dr. Nina Clark and Dr. Shreya Gupta for a discussion with Dr. Edward Barksdale on the important and sensitive topic of the underrepresented in medicine.   Society of Black Academic Surgeons: https://www.sbas.net/ References:  Yeo HL, Abelson JS, Symer MM, Mao J, Michelassi F, Bell R, Sedrakyan A, Sosa JA. Association of Time to Attrition in Surgical Residency With Individual Resident and Programmatic Factors. JAMA Surg. 2018 Jun 1;153(6):511-517. doi: 10.1001/jamasurg.2017.6202. PMID: 29466536; PMCID: PMC5875388. McFarling, U.L. ‘It was stolen from me’: Black doctors are forced out of training programs at far higher rates than white residents. STAT. 6/20/2022. Accessed online: 10/1/2022. https://www.statnews.com/2022/06/20/black-doctors-forced-out-of-training-programs-at-far-higher-rates-than-white-residents/ Haruno LS, Chen X, Metzger M, et al. Racial and Sex Disparities in Resident Attrition Among Surgical Subspecialties. JAMA Surg. Published online February 08, 2023. doi:10.1001/jamas

Please join Drs. Graham Skelhorne-Gross, Jordan Nantais and Ashlie Nadler from our Emergency General Surgery Team for a discussion on cirrhotic patients.   Child-Pugh Score (https://www.mdcalc.com/calc/340/child-pugh-score-cirrhosis-mortality) ·      Bilirubin, albumin, INR, ascites, encephalopathy ·      Used to predict operative mortality based on cirrhosis severity ·      Mortality in EGS: - Child-Pugh A: 10% electively and 22% emergently - Child-Pugh B: 30% electively and 38% emergently - Child-Pugh C: 80% electively and up to 100% emergently Model for End Stage Liver Disease (MELD) (https://www.mdcalc.com/calc/10437/model-end-stage-liver-disease-meld?utm_source=site&utm_medium=link&utm_campaign=meld_12_and_older) ·      creatinine, bilirubin, INR, and sodium ·      MELD < 20 – 1% increase in mortality with each point increase ·      MELD > 20 – 2% increase in mortality with each point increase Pre-operative Planning ·      Identification of cirrhosis with physical examination, bloodwork

In this episode, our team discusses the Checkmate 577 trial, the landmark paper which approved the use of nivolumab for adjuvant treatment of stage II & III esophageal & GE junction cancer. Listen as our team reviews the study population, methods and results of this trial & discusses its clinical application as well as potential areas of future research. Learning Objectives: -Review the staging and treatment of esophageal and GEJ cancer -Discuss the population, methods, and results of the Checkmate 577 trial -Understand the mechanism of action of nivolumab and the PD1 pathway -Discuss the implications of the Checkmate 577 trial in clinical practice and areas of future research Hosts: Kelly Daus MD, Megan Lenihan MD, Peter White MD, and Brian Louie MD Referenced Material https://www.nejm.org/doi/full/10.1056/NEJMoa2032125 Kelly RJ, Ajani JA, Kuzdzal J, et al. Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer. N Engl J Med. 2021;384(13):1191-1203. doi:10.1056/NEJMoa203

Please join BTK education fellow, Nina Clark, MD (University of Washington) along with Elina Serrano, MD, MPH (University of Washington) and Minerva Romero Arenas, MD (Weill Cornell Medicine) for a discussion inspired by the experience of trainees who are underrepresented in medicine.   Latino Surgical Society: https://www.latinosurgicalsociety.org/ Society of Black Academic Surgeons: https://www.sbas.net/ References:  Yeo HL, Abelson JS, Symer MM, Mao J, Michelassi F, Bell R, Sedrakyan A, Sosa JA. Association of Time to Attrition in Surgical Residency With Individual Resident and Programmatic Factors. JAMA Surg. 2018 Jun 1;153(6):511-517. doi: 10.1001/jamasurg.2017.6202. PMID: 29466536; PMCID: PMC5875388. McFarling, U.L. ‘It was stolen from me’: Black doctors are forced out of training programs at far higher rates than white residents. STAT. 6/20/2022. Accessed online: 10/1/2022. https://www.statnews.com/2022/06/20/black-doctors-forced-out-of-training-programs-at-far-higher-rates-than-white-residents/ Ha

In this episode the Endocrine Surgery team at BTK goes over two cases to review the American Association of Endocrine Surgeons Guidelines for Adrenalectomy.  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 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  Yip L, Duh QY, Wachtel H, Jimenez C, Sturgeon C, Lee C, Velázquez-Fernández D, Berber E, Hammer GD, Bancos I, Lee JA, Marko J, Morris-Wiseman LF, Hughes MS, Livhit

In this episode the Critical Care BTK Team tackles nutrition in the ICU. High-yield journal articles will be presented, discussed, and reviewed. ICU nutrition myths will be busted, and listeners will learn about enteral nutrition, parenteral nutrition and other ICU nutrition pearls. References 1.         Casaer, M.P., et al., Early versus Late Parenteral Nutrition in Critically Ill Adults. New England Journal of Medicine, 2011. 365(6): p. 506-517. 2.         Compher, C., et al., Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. Journal of Parenteral and Enteral Nutrition, 2022. 46(1): p. 12-41. 3.         McClave, S.A., et al., Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient. Journal of Parenteral and Enteral Nutrition, 2016. 40(2): p. 159-211. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos

In the third episode of the “Innovations in Surgery” series, Behind the Knife’s surgery education fellow, Dan Scheese, sits down with Adam Sachs and Dr. Igor Belyansky to discuss the current state and future of surgical robotics. They discuss the start up of Vicarious Surgical and how they are working to improve the current state of surgical robotics with their innovative ideas.  Link for the Vicarious Surgical website which includes a short video demonstration of their single port design: https://www. vicarioussurgical.com/ Adam Sachs is the CEO and Co-founder of Vicarious surgical, a surgical robotics company founded in 2014. As an MIT trained roboticist, Adam has combined his passion for robots with this passion for helping patients and enhancing the work environment for surgeons through the development of proprietary surgical robotics.  Dr. Igor Belyanksy, an internationally-recognized expert in the field of abdominal wall reconstruction and complex laparoscopic and robotic hernia repair. Dr. Belyansk

You have a patient who underwent local excision of a rectal cancer. Final pathology demonstrates a T2 lesion. What is the rate of local recurrence? Is excision alone sufficient? Should the patient undergo radical resection or should chemoradiation be offered? Tune in to find out! Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Jose Guillem MD, MPH, MBA as they discuss high yield papers discussing local excision for Rectal Cancer. You may follow along with the slides mentioned in this episode here: https://behindtheknife.org/video/journal-review-in-colorectal-surgery-local-excision-for-rectal-cancer/ Learning Objectives 1. Describe the features that increase risk of lymph node involvement in early stage rectal cancer 2. Discuss the different options for management of early-stage rectal cancer 3. Describe patient related factors that favor local excision of rectal cancer References: Kidane B, Chadi SA, Kanters S, Colquhoun PH, Ott MC. Local resection compared with radical res

DO NOT MISS THIS EPISODE! Need a little inspiration? Tune in for Dave's story. Links from the show:  Chasing My Cure: https://chasingmycure.com/ CDCN: https://cdcn.org/ Every Cure: https://everycure.org/ AMF: https://healgrief.org/actively-moving-forward/young-adult-grief/ David Fajgenbaum, MD, MBA, MSc, FCPP, is an Assistant Professor of Medicine in Translational Medicine & Human Genetics at the University of Pennsylvania, Founding Director of the Center for Cytokine Storm Treatment & Laboratory (CSTL), Associate Director, Patient Impact of the Penn Orphan Disease Center, and Co-Founder/President of the Castleman Disease Collaborative Network (CDCN) and co-founder of Every Cure. He is also the national bestselling author of 'Chasing My Cure: A Doctor's Race to Turn Hope Into Action' and a patient battling idiopathic multicentric Castleman disease (iMCD). He is in his longest remission ever thanks to a precision treatment that he identified, which had never been used before for iMCD. He has also i

How do we actually improve wellness?  How do surgery trainees advocate for themselves as both learners and employees?  In this final surgical education episode with Matt Chia MD MS and Karl Bilimoria MD MS, we review two articles discussing unions and wellness in surgical training.  We’re joined by Meg Smith MD MS, Brian Brajcich MD MS, and Darci Foote MD MS to tackle this difficult topic and open the discussion for what’s next in surgical education. Learning Objectives: ·       Identify potential benefits and limitations of unionization in surgery training ·       Describe strategies used by program leadership to improve wellness in surgery References: National Evaluation of the Association Between Resident Labor Union Participation and Surgical Resident Well-being https://doi.org/10.1001/jamanetworkopen.2021.23412  How Program Directors Understand General Surgery Resident Wellness - https://doi.org/10.1016/j.jsurg.2022.07.022  Please visit https://behindtheknife.org to access other high-yield surgic

Join the Behind the Knife HPB team as we dive deeper into the complex world of IPMNs with a journal article review of a recent JAMA Surgery publication and the first author of the article! Learning Objectives: In this episode, we discuss the article, “Progression vs Cyst Stability of Branch-Duct Intraductal Papillary Mucinous Neoplasms After Observation and Surgery.”  This article describes a multicenter retrospective study of centers in Italy, Korea, Singapore, and the US that specifically assessed what dynamic variables are associated with malignant progression in pathologically proven IMPNs under at least a year of initial surveillance.  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 (@DWNelsonHPB) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Bea

Our Vascular Surgery Oral Board Audio Review includes 72 high-yield scenarios that cover the majority of the VSCORE topics designed for Vascular Surgeons by Vascular Surgeons.   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 vascular 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 full set of 72 scenarios here: https://behindtheknife.org/premium/vascular-surgery-oral-review/ Our Vascular Surgery Oral Board Book is available on Amazon here: https://www.amazon.com/Vascular-Surgery-Oral-Board-Review/d

Our Vascular Surgery Oral Board Audio Review includes 72 high-yield scenarios that cover the majority of the VSCORE topics designed for Vascular Surgeons by Vascular Surgeons.   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 vascular 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 full set of 72 scenarios here: https://behindtheknife.org/premium/vascular-surgery-oral-review/ Our Vascular Surgery Oral Board Book is available on Amazon here: https://www.amazon.com/Vascular-Surgery-Oral-Board-Review/