Behind The Knife: The Surgery Podcast

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 BTKpodcast@gmail.com 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 Univers

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-conve

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 epis

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 negat

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

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 Medi

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 Surger

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.n

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-

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 (@usa

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 h