Behind The Knife: The Surgery Podcast

The ABSITE score report is changing… what does it mean? CEO of the American Board of Surgery Dr. Jo Buyske discusses ABSITE and MUCH more. Hosts: Dr. Scott Steele, Dr. Nina Clark, Dr. Jessica Millar Guest: Dr. Jo Buyske, President/CEO of the American Board of Surgery Resources: Announcement - ABSITE Percentiles: https://www.absurgery.org/wp-content/uploads/2024/02/ABSITE-Percentiles.pdf ABSITE Data Tools: https://sandbox.absurgery.org/default.jsp?publicdata Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

In this episode our team dives into the diagnosis, workup and management of malignant pleural mesothelioma. Listen as we debate the pros and cons of surgical management of this disease with extrapleural pneumonectomy versus pleural decortication and discuss the nuances of choosing the right approach for the right patient. Learning Objectives - Describe the workup and staging of a patient with malignant pleural mesothelioma - List the subtypes of malignant pleural mesothelioma, characteristics of resectable disease, and patient factors which impact surgical candidacy - Describe the approach to an extrapleural pneumonectomy and pleural decortication - Analyze which surgical approach is best for various subsets of patients - Describe the adjuvant treatment for malignant pleural mesothelioma Hosts Kelly Daus MD, Adam Bograd MD, Peter White MD, Brian Louie MD Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out more recent episodes: https://app.behindtheknife.org/listen

Can appendicitis wait until the morning? Join Drs. Ashlie Nadler, Jordan Nantais, Graham Skelhorne-Gross, and Marika Sevigny from our Emergency General Surgery Team as they discuss the role of deferring appendectomies from overnight to the next morning. Paper 1: Patel SV, Zhang L, Mir ZM, Lemke M, Leeper WR, Allen LJ, Walser E, Vogt K. Delayed Versus Early Laparoscopic Appendectomy for Adult Patients With Acute Appendicitis: A Randomized Controlled Trial. Ann Surg. 2024 Jan 1;279(1):88-93. https://pubmed.ncbi.nlm.nih.gov/37436871/ -Non-inferiority randomized controlled trial comparing delayed appendectomy group with surgery taking place after 0600 the morning following a decision to operate versus the immediate appendectomy group with surgery taking place between 8pm and 4am and within 6 hours of a decision to operate -A priori non-inferiority margin of 15% for 30-day complications -Intention-to-treat analysis with risk difference -12% in favor of the delayed group (p < 0.001) -Superiority as on per protocol analysis -Underpowered at 91% due to early closure of study due to loss of reliable day time emergency triage operating time Paper 2: Jalava K, Sallinen V, Lampela H, Malmi H, Steinholt I, Augestad KM, Leppäniemi A, Mentula P. Role of preoperative in-hospital delay on appendiceal perforation while awaiting appendicectomy (PERFECT): a Nordic, pragmatic, open-label, multicentre, non-inferiority, randomised controlled trial. Lancet. 2023 Oct 28;402(10412):1552-1561. https://pubmed.ncbi.nlm.nih.gov/37717589/ -Non-inferiority randomized controlled trial comparing appendectomy within 8 hours versus 24 hours -No difference in rate of perforation on intention-to-treat or per protocol analyses Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out more recent episodes: https://app.behindtheknife.org/listen

Before 1952, open heart surgery was considered science fiction. The heart was off limits to surgeons despite more than half a million Americans dying annually from heart disease. Doing nothing was the strategy. However, the status quo would soon change thanks to a few brave and imaginative surgeons who dared to break the most rigid of medical taboos: Do not touch the human heart. We sat down with Dr. Gerald Imber, author of the new book “Cardiac Cowboys: The Heroic Invention of Heart Surgery” to discuss how five men raced to invent an entirely new field of surgery. Guests: Jessica Millar, MD- General Surgery Resident- University of Michigan; Education Fellow- Behind the Knife Nick Teman, MD- Associate Professor of Cardiac Surgery and Critical Care- University of Virginia Gerald Imber- Assistant Clinical Professor of Plastic surgery at the Weill-Cornell Medical Center, Attending Surgeon at New York-Presbyterian Hospital, and Director of a private clinic in New York City, NY; Author of “Wendell Black, MD”, “Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted”, and “Cardiac Cowboys: The Heroic Invention of Heart Surgery”. Want to hear more from Dr. Imber- be sure to check out his podcast series, Cardiac Cowboys, based on Dr. Imber’s book. You can listen to an introduction of the Cardiac Cowboys series here: https://shorturl.at/rKLM8 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out more recent episodes: https://app.behindtheknife.org/listen

Join Drs. Galandiuk, Bolshinsky, Kavalukas, and Simon as they discuss Management of Advanced and Malignant Polyps. Come with us as we navigate through sessile serrated lesions, pathology reports, and rectal polyp nuances. Hosts: - Susan Galandiuk, University of Louisville, Louisville, Kentucky, @DCREdInChief - Vladimir Bolshinsky, Peninsula Health, Victoria, Australia, @bolshinskyv - Sandy Kavalukas, University of Louisville, Louisville, Kentucky, @sandykava - Hillary Simon, University of Louisville, Louisville, Kentucky, @HillaryLSimon Producer: - Manasa Sunkara MS3, University of Louisville, Louisville, Kentucky, @manasasunkara12 Learning objectives: - Review colorectal cancer screening for the average risk patient. - Understand what a malignant polyp is defined as and management strategies. - Discuss the pathology review and re-review processes. References: - Church J, et al. Keeping the Cecum Clean: A Randomized, Prospective, Placebo-Controlled Trial of Loperamide as Part of Preparation for Colonoscopy. Diseases of the Colon & Rectum 56(1):p 120-125, January 2013. https://pubmed.ncbi.nlm.nih.gov/23222289/ - Fan C, et al. Management of Serrated Polyps of the Colon. Curr Treat Options Gastroenterol 16(1):182-202, March 2018. https://pubmed.ncbi.nlm.nih.gov/29445907/ - Gupta S, et al. Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. The American Journal of Gastroenterology 115(3): 415-434, March 2020. https://pubmed.ncbi.nlm.nih.gov/32039982/ - Hyman N, Waye JD. Endoscopic four quadrant tattoo for the identification of colonic lesions at surgery. Gastrointest Endosc 37:56–58, 1991. https://pubmed.ncbi.nlm.nih.gov/1706283/ - Kaltenbach T, et al. Endoscopic Removal of Colorectal Lesions—Recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastrointestinal Endoscopy 91(3): 486-519, March 2020. https://pubmed.ncbi.nlm.nih.gov/32067745/ - Keswani R, et al. AGA Clinical Practice Update on Strategies to Improve Quality of Screening and Surveillance Colonoscopy: Expert Review. Gastroenterology, 161(2): 701 – 711, Aug 2021. https://pubmed.ncbi.nlm.nih.gov/34334168/ - Shaukat A, et al. Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps: Recommendations of the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 159(5): 1916 - 1934.e2, Nov 2020. https://pubmed.ncbi.nlm.nih.gov/33159840/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent epispdes here: https://app.behindtheknife.org/listen

Join for the third episodes in the Association of Out Surgeons & Allies (AOSA) series for a discussion on LGBTQIA+ healthcare providers and their patients. Host: Nina Clark, MD Guests: - Andrew Schlussel, DO, Colorectal and General Surgeon, Charlie Norwood VA Medical Center - Dr. James Taylor, Assistant Professor of Colorectal Surgery at Montefiore Medical Center - Dr. Alex Bonte, General Surgery PGY4 at Hackensack University Medical Center in Hackensack NJ. - Dr. Paige Tannhauser, General Surgery PGY3 (completed) at Allegheny General Hospital in Pittsburgh PA, and currently finishing up a post-doctoral research fellowship at the University of Virginia. Learn more and get involved with AOSA: https://www.outsurgeons.org Twitter/X: @OutSurgeons Resources Mentioned This Episode: "Gender Unicorn" schema for terminology: https://transstudent.org/gender/ LGBTQ Healthcare Directory: https://lgbtqhealthcaredirectory.org/ CDC Recommendations in LGBTQ Health: https://www.cdc.gov/lgbthealth/index.htm WPATH Resources: https://www.wpath.org/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/

Listen to another episode by the Hernia Team from Carolinas Medical Center as they discuss their approach to open preperitoneal ventral hernia repair. Although uncommonly performed, a preperitoneal approach offers several advantages including the ability to achieve large mesh overlap without the need for myofascial release. The team discusses their tips and tricks for utilizing the preperitoneal space in even the most challenging hernia cases. Hosts: - Dr. Sullivan “Sully” Ayuso, Chief Resident, Carolinas Medical Center, @SAyusoMD (Twitter) - Dr. Todd Heniford, Chief of GI & MIS, Carolinas Medical Center, @THeniford (Twitter) - Dr. Vedra Augenstein, Professor of Surgery, Carolinas Medical Center, @VedraAugenstein (Twitter) - Dr. Monica Polcz, Attending Surgeon, Baptist Health (Miami, FL) Learning Objectives: - Review standard methods of herniorraphy in open abdominal wall reconstruction - Introduce the concept of open preperitoneal ventral hernia repair - Discuss the advantages as well as the standard tips and tricks for performing an open preperitoneal repair - Review outcomes for preperitoneal hernia repair over time Podcast Video Clip: https://www.youtube.com/watch?v=3pMvB0rnokQ References: - Novitsky et al, Open Preperitoneal Retrofascial Mesh Repair for Multiply Recurrent Ventral Incisional Hernias, JACS, 2006 https://pubmed.ncbi.nlm.nih.gov/36280505/ - Heniford et al, Preperitoneal Ventral Hernia Repair: A Decade Long Prospective Observational Study with Analysis of 1023 Patient Outcomes, Annals of Surgery, 2020 https://pubmed.ncbi.nlm.nih.gov/30080725/ - Katzen et al, Open Preperitoneal Ventral Hernia Repair: Prospective Observational Outcomes of Quality Improvement Outcomes Over 18 Years and 1,842 Patients, Surgery, 2023 https://pubmed.ncbi.nlm.nih.gov/36280505/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other recent episodes here: https://app.behindtheknife.org/listen

Eat when you can, sleep when you can, and don’t F with the pancreas! What happens when that third rule goes wrong, and why do people say pancreas injuries are like eating crawfish? Whether you love the pancreas or just the mention of the P-word strikes fear in your heart, or if you just want the answer to the aforementioned questions, join Drs. Cobler-Lichter, Kwon, and Meizoso, as they guide you through all this and more! Hosts: - Michael Cobler-Lichter, MD, PGY3, University of Miami/Jackson Memorial Hospital/Ryder Trauma Center, @mdcobler (twitter) - Eugenia Kwon, MD, Trauma/Surgical Critical Care Fellow, University of Miami/Jackson Memorial Hospital/Ryder Trauma Center -Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery, 4 years in practice, University of Miami/Jackson Memorial Hospital/Ryder Trauma Center, @jpmeizoso (twitter) Learning Objectives: - Describe the AAST grading system for pancreatic injuries - Come up with a treatment plan for each grade of pancreatic injury - Identify commonly associated injuries with pancreatic trauma - List potential complications of pancreatic trauma and/or surgery Quick Hits: 1. Pancreas injuries do not all require a trip to the operating room. Low grade injuries should be managed with a trial of nonoperative management if there are no other operative indications 2. CT is the best initial imaging modality, although it has low sensitivity. If there is high concern for a pancreas injury based on mechanism or associated injuries, further investigation is required. 3. Pancreas injuries are like crawfish: suck the head and eat the tail. 4. Injuries to the left of the SMV can generally be treated with distal pancreatectomy and splenectomy, whereas injuries to the right of the SMV are usually drained. 5. Its important to identify and address any concomitant injuries, with duodenal injuries being the most common in higher grade injuries. 6. In the case of the dreaded grade 5 injury, the safe answer is to come back and do your reconstruction at a later time. References 1. https://www.westerntrauma.org/western-trauma-association-algorithms/management-of-pancreatic-injuries/ 2. Bassi, Claudio et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery, Volume 161, Issue 3, 584 – 591 https://pubmed.ncbi.nlm.nih.gov/28040257/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Join us for another episode of our Global Surgery series, where we have a special focus on trauma care in resource-limited settings. Traumatic injury remains one of the largest burdens of disease and causes of mortality internationally. The WHO estimates that 4.4 million lives are lost to traumatic injuries per year, accounting for approximately 8% of all deaths. Notably, traumatic injuries are the top killer of children, adolescents, and young adults, compounding the patient-years lost. Trauma is ubiquitous–accidents and injuries happen all over the globe, and thus differences in trauma incidence and mortality is often a function of health systems and infrastructure. Jon Williams is joined by Dr. Anthony Charles. Dr. Charles is a trauma surgeon at University of North Carolina, Chapel Hill. Additionally, he holds professorships in the medical school and school of public health at UNC, as well as serving as the director of the adult ECMO program and the director of global surgery at the UNC Institute of Global Health and Infectious Diseases. He leads the Malawian Surgical Initiative, designed to train and support local surgeons in the country of Malawi where he has established a longstanding partnership with UNC. Having been raised in Nigeria, Dr. Charles completed medical school at the University of Lagos, and subsequently underwent general surgery residency training in London at North Middlesex University Hospital and subsequently at Charles Drew University in Los Angeles. Upon completion of trauma and critical care fellowship at University of Michigan, he took a faculty position at UNC where he has remained since and grown the global surgery presence to what it is today. Key Points: We now have over 725 episodes! The easiest way to find specific topics or episodes is on our website https://app.behindtheknife.org/home or on our new Apple/Android app. You can search or browse by topic, podcast series, etc., making it much easier to navigate than podcast players. iOS: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android: https://play.google.com/store/apps/details?id=com.btk.app PREMIUM BUNDLE: https://app.behindtheknife.org/bundle/95 Please email hello@behindtheknife.org to learn more about our premium bundle and institutional discounts. Premium Bundle Includes: General Surgery Oral Board Audio Review Trauma Surgery Video Atlas Colorectal Surgery Oral Board Audio Review Surgical Oncology Surgery Oral Board Audio Review Vascular Surgery Surgery Oral Board Audio Review Cardiothoracic Surgery Surgery Oral Board Audio Review

Join us for a new edition of our global surgery series! On this episode, Dr. Jon Williams is joined by Dr. Sudha Jayaraman and Dr. Justina Seyi-Olajide to discuss how we define global surgery today and how health infrastructure interacts with global surgical care. Dr. Jayaraman is a trauma and acute care surgeon at University of Utah, and the director of the Center for Global Surgery. After attending UC Davis for medical school, Dr. Jayaraman completed general surgery residency at UCSF, during which time she obtained a masters in public health in developing countries from the London School of Hygiene and Tropical Medicine. During this time, her efforts were dedicated to researching and implementing trauma systems development in Uganda. After residency she then completed a trauma and critical care fellowship at Brigham and Women’s, during which she received the Harvard Medical School Health Disparities Fellowship to continue her trauma systems work in Rwanda. Her ongoing work investigating injury burden and trauma systems in low and middle income countries has been well funded by the NIH, DOD, and others and published in numerous forums, as she is a well-renowned expert in this field. Dr. Justina Seyi-Olajide is a pediatric surgeon at the Lagos University Teaching Hospital in Lagos, Nigeria. She completed her medical school training at the Ahmadu Bello University in Zaria, Nigeria and subsequently her general surgical and pediatric surgical training at the Lagos University Teaching Hospital, earning the Fellowship of West African College of Surgeons in Pediatric Surgery and the Alinta Nwako prize for best graduating pediatric surgical trainee. Dr. Seyi-Olajide’s vision is to provide equitable pediatric surgical care in resource-limited settings, and has been highly influential for developing initiatives such as the National Surgical, Obstetric, Anesthesia and Nursing Plan for Nigeria. Additionally, she is a member of the Global Initiative for Children’s Surgery and is well published for her original research on topics regarding access to pediatric surgical care in low and middle income countries. Have any feedback for the global surgery content, or have any suggestions for future episodes? Please feel free to reach out to us at hello@behindtheknife.org. We now have over 725 episodes! The easiest way to find specific topics or episodes is on our website https://app.behindtheknife.org/home or on our new Apple/Android app. You can search or browse by topic, podcast series, etc., making it much easier to navigate than podcast players. iOS: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android: https://play.google.com/store/apps/details?id=com.btk.app PREMIUM BUNDLE: https://app.behindtheknife.org/bundle/95 Please email hello@behindtheknife.org to learn more about our premium bundle and institutional discounts. Premium Bundle Includes: General Surgery Oral Board Audio Review Trauma Surgery Video Atlas Colorectal Surgery Oral Board Audio Review Surgical Oncology Surgery Oral Board Audio Review Vascular Surgery Surgery Oral Board Audio Review Cardiothoracic Surgery Surgery Oral Board Audio Review

With the increasing popularity of artificial intelligence, its uses are quickly becoming not only a part of everyday life, but also training in surgery. Those of us without much understanding of the technology might be intimidated by this nebulous topic, or worry that we won’t be able to comprehend the advancements to come to the field. Luckily, we’re joined by a leading expert in the use of AI in surgery, Dr. Dan Hashimoto. He breaks down some examples of how AI is being used in surgical education, the role surgeons should play in these advancements, and some tips for how we can critically appraise work in the field of AI if we don’t understand the technology ourselves. Join hosts Nicole Brooks, MD, Judith French, PhD and Jeremy Lipman, MD, MHPE for this exciting conversation. Learning Objectives 1. Listeners will describe how AI is being applied to surgical education. 2. Listeners will identify the roles surgeons without training in AI can play in developing the use of AI in surgery. 3. Listeners will explain the regulatory and ethical considerations that must be addressed with the implementation of AI in surgical education. 4. Listeners will consider principles for critically evaluating research or technology in AI for application or use in their own educational or surgical practice. References Laplante S, Namazi B, Kiani P, Hashimoto DA, Alseidi A, Pasten M, Brunt LM, Gill S, Davis B, Bloom M, Pernar L, Okrainec A, Madani A. Validation of an artificial intelligence platform for the guidance of safe laparoscopic cholecystectomy. Surg Endosc. 2023 Mar;37(3):2260-2268. doi: 10.1007/s00464-022-09439-9. Epub 2022 Aug 2. PMID: 35918549. https://pubmed.ncbi.nlm.nih.gov/35918549/ Hashimoto DA, Varas J, Schwartz TA. Practical Guide to Machine Learning and Artificial Intelligence in Surgical Education Research. JAMA Surg. 2024 Jan 3. doi: 10.1001/jamasurg.2023.6687. Epub ahead of print. PMID: 38170510. https://pubmed.ncbi.nlm.nih.gov/38170510/ We now have over 725 episodes! The easiest way to find specific topics or episodes is on our website https://app.behindtheknife.org/home or on our new Apple/Android app. You can search or browse by topic, podcast series, etc., making it much easier to navigate than podcast players. iOS: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android: https://play.google.com/store/apps/details?id=com.btk.app PREMIUM BUNDLE: https://app.behindtheknife.org/bundle/95 Please email hello@behindtheknife.org to learn more about our premium bundle and institutional discounts. Premium Bundle Includes: General Surgery Oral Board Audio Review Trauma Surgery Video Atlas Colorectal Surgery Oral Board Audio Review Surgical Oncology Surgery Oral Board Audio Review Vascular Surgery Surgery Oral Board Audio Review Cardiothoracic Surgery Surgery Oral Board Audio Review

The Fellowship of the Snow kept it interesting this year…both on and off the slopes! On this episode, Patrick Georgoff discusses the Western Trauma Association’s updated resuscitative thoracotomy algorithm with Ron Tesoriero, the results of a WTA multicenter trial exploring chest tube irrigation for the prevention of retained hemothorax with Thomas Carver, and prehospital blood administration with Juan Duchesne. ** Algorithms and papers are pending final review and are therefore not available to link to this episode. Ron Tesoriero, MD: Associate Professor of Surgery, Director of the Acute Care Surgery Fellowship, and Co-Director of the SICU at UCSF. Thomas Carver, MD: Associate Professor of Surgery, Director of the Acute Care Surgery Fellowship, and Senior Medical Director of Critical Care Services at the Medical College of Wisconsin. Juan Duchesne, MD: Professor of Surgery and Chief of Trauma and Acute Care Surgery at Tulane university. Resuscitative Thoracotomy: The Who (Episode 475): https://app.behindtheknife.org/podcast/big-t-trauma-series-ep-14-ed-thoracotomy-the-who Resuscitative Thoracotomy: The How (Episode 476): https://app.behindtheknife.org/podcast/big-t-trauma-series-ep-15-ed-thoracotomy-the-how Innovation Lifeflow (Episode 642): https://app.behindtheknife.org/podcast/innovations-in-surgery-lifeflow We now have over 725 episodes! The easiest way to find specific topics or episodes is on our website https://app.behindtheknife.org/home or on our new Apple/Android app. You can search or browse by topic, podcast series, etc., making it much easier to navigate than podcast players. iOS: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android: https://play.google.com/store/apps/details?id=com.btk.app PREMIUM BUNDLE: https://app.behindtheknife.org/bundle/95 Please email hello@behindtheknife.org to learn more about our premium bundle and institutional discounts. Premium Bundle Includes: General Surgery Oral Board Audio Review Trauma Surgery Video Atlas Colorectal Surgery Oral Board Audio Review Surgical Oncology Surgery Oral Board Audio Review Vascular Surgery Surgery Oral Board Audio Review Cardiothoracic Surgery Surgery Oral Board Audio Review

In this episode of Behind the Knife the vascular surgery subspecialty team discusses a few case scenarios of patients with dialysis associated hand ischemia (or steal syndrome). Although a rare, steal syndrome can be detrimental to patients with end stage renal disease and result in not only risk of losing dialysis access but even their limb. What options do you have to fix this problem? In this episode, we will cover the who is at risk of this, and what options you have to fix it. Hosts: 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. David Schectman is a Vascular Surgery Fellow at the University of Michigan Dr. Drew Braet is a PGY-4 Integrated Vascular Surgery Resident at the University of Michigan Learning Objectives - Review high-yield topics regarding hemodialysis access - Understand the incidence of and the relevant risk factors for dialysis associated steal syndrome - Review the spectrum of presenting symptoms and relevant workup for dialysis associated steal syndrome - Understand surgical treatment options for dialysis associated steal syndrome References Please review the journal article below for helpful pictures and depictions of the operations we describe in this episode. - Al Shakarchi J, et al. Surgical techniques for haemodialysis access-induced distal ischaemia. J Vasc Access. 2016 Jan-Feb;17(1):40-6. https://pubmed.ncbi.nlm.nih.gov/26349875/ Other helpful references - Kordzadeh A, Parsa AD. A Systematic review of distal revascularization and interval ligation for the treatment of vascular access-induced ischemia. J Vasc Surg 2019; 70:1364. https://pubmed.ncbi.nlm.nih.gov/31153703/ - Huber TS, Larive B, Imprey PB, et al. Access-related hand ischemia and the Hemodialysis Fistula Maturation Study. J Vasc Surg 2016;64:1050. https://pubmed.ncbi.nlm.nih.gov/27478007/ - Sidawy An, Spergel LM, Besarab A, et al. The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg 2008; 48:2S. https://pubmed.ncbi.nlm.nih.gov/19000589/ ***Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9*** Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Join BTK eduction fellows, Drs. Nina Clark and Jon Williams along with guests Drs. Sharmila Dissanaike and Paula Ferrada for a discussion on whether it’s time for a paradigm shift toward a circulation-first approach to trauma resuscitation. Hosts: Nina Clark, MD and Jon Williams, MD Guests: Sharmila Dissanaike, MD - Texas Tech University Health Sciences Center, Lubbock, TX Paula Ferrada, MD - Inova, Fairfax, VA References: Ferrada P, Dissanaike S. Circulation First for the Rapidly Bleeding Trauma Patient-It Is Time to Reconsider the ABCs ofTrauma Care. JAMA Surg. 2023 Aug 1;158(8):884-885. doi: 10.1001/jamasurg.2022.8436. PMID: 37195675. https://pubmed.ncbi.nlm.nih.gov/37195675/ Ferrada P, Ferrada R, Jacobs L, Duchesne J, Ghio M, Joseph B, Taghavi S, Qasim ZA, Zakrison T, Brenner M,Dissanaike S, Feliciano D. Prioritizing Circulation to Improve Outcomes for Patients with Exsanguinating Injury: ALiterature Review and Techniques to Help Clinicians Achieve Bleeding Control. J Am Coll Surg. 2024 Jan 1;238(1):129-136. doi: 10.1097/XCS.0000000000000889. Epub 2023 Nov 28. PMID: 38014850; PMCID: PMC10718219. https://pubmed.ncbi.nlm.nih.gov/38014850/ ***Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9*** Please visit https://app.behindtheknife.org/home to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here https://app.behindtheknife.org/listen

Join the Behind the Knife Surgical Oncology Team as we discuss “One versus Three Years of Adjuvant Imatinib for Operable Gastrointestinal Stromal Tumor: A Randomized Trial,” the randomized trial guiding duration of imatinib treatment for gastrointestinal stromal tumors (GIST). 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 Surgical Oncologist and current HPB fellow at MD Anderson. - Connor Chick, MD (@connor_chick) is a Surgical Oncology fellow at Ohio State University. - Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-6 General Surgery resident at Brooke Army Medical Center. - Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-5 General Surgery resident at Brooke Army Medical Center. Learning Objectives: In this episode, we discuss the article “One versus Three Years of Adjuvant Imatinib for Operable Gastrointestinal Stromal Tumor: A Randomized Trial” published in JAMA in 2012. This study demonstrated that 3 years of imatinib led to improved recurrence-free and overall survival compared to 1 year. Links to Paper Referenced in this Episode https://jamanetwork.com/journals/jama/fullarticle/1105116 ***Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9*** Please visit https://app.behindtheknife.org/home to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here https://app.behindtheknife.org/listen

Though relatively rare, lateral abdominal wall hernias present a unique challenge to surgeons. Join Drs. Ajita Prabhu, Lucas Beffa, Sara Maskal and Ryan Ellis as they talk through their approach to these difficult cases. Hosts: · Ajita Prabhu, MD, Cleveland Clinic, @aprabhumd1 · Lucas Beffa, MD, Cleveland Clinic, @BeffaLukeMD · Ryan Ellis, MD, Cleveland Clinic, @EllisMD2020 · Sara Maskal, MD, Cleveland Clinic Learning Objectives: · Review anatomy of lateral abdominal wall hernias · Review pitfalls of operating in the retroperitoneum · Review surgical approaches to repair defects based on algorithmic assessment References: · Montelione KC, Petro CC, Krpata DM, Lau B, Shukla P, Olson MA, Tamer R, Rosenblatt S, Rosen MJ, Prabhu AS. Open Retromuscular Lateral Abdominal Wall Hernia Repair: Algorithmic Approach and Long-Term Outcomes at a Single Center. J Am Coll Surg. 2023 Jan 1;236(1):220-234. doi: 10.1097/XCS.0000000000000419. Epub 2022 Dec 15. PMID: 36106747. https://pubmed.ncbi.nlm.nih.gov/36106747/ · Beffa LR, Margiotta AL, Carbonell AM. Flank and Lumbar Hernia Repair. Surg Clin North Am. 2018 Jun;98(3):593-605. doi: 10.1016/j.suc.2018.01.009. Epub 2018 Mar 12. PMID: 29754624. https://pubmed.ncbi.nlm.nih.gov/29754624/ ***Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9*** Please visit https://app.behindtheknife.org/home to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here https://app.behindtheknife.org/listen

Do the words “Is there a doctor on board” fill you with anxiety? For Dr. Thomas Doyle, responding to in flight medical events is just another day at the office. As the medical director for STAT-MD, him and his team provide on the ground consultation for passengers experiencing medical events at 35,000 feet. In this episode we talk about what events are most common, what equipment is on board, what are the rules/regulations around providing medical assistance, and what ground consultation services like STAT-MD can help offer to you so you’re never alone if you hear that phrase “Is there a doctor on board?” Guests: Thomas J. Doyle, MD, MPH- Clinical Associate Professor of Emergency Medicine- University of Pittsburgh Medical Center; Medical Director, STAT-MD Jessica Millar, MD- General Surgery Resident- University of Michigan; Education Fellow- Behind the Knife Major John McClellan, MD- Acute Care and Trauma Surgeon- University of North Carolina Chapel Hill Want to learn more from Dr. Doyle about in-flight medical events- you can check out one of his previous lectures here: https://www.upmcphysicianresources.com/cme-courses/emergencies-at-35000-feet-is-there-a-medical-provider-on-board **Introducing Behind the Knife's Trauma Surgery Video Atlas - https://app.behindtheknife.org/premium/trauma-surgery-video-atlas/show-content The Trauma Surgery Video Atlas contains 24 scenarios that include never-before-seen high-definition operative footage, rich, original illustrations, and practical, easy-to-read pearls that will help you dominate the most difficult trauma scenarios. ***Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9*** Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out more recent episodes here: https://app.behindtheknife.org/listen

You have a patient referred to you for a history of anal dysplasia and found to have an anal lesion on colonoscopy. How do you evaluate this? What are the risk factors? How will you perform surveillance afterwards? Does everyone need HRA? Tune in to find out! Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Lisa Breen as they discuss high yield papers discussing Anal Dysplasia. Learning Objectives 1. Describe the different types of anal dysplasia and pathologic categorization 2. Describe high risk populations for development of anal squamous cell cancer 3. Discuss the different options and recommendations for surveillance and treatment of anal dysplasia Video Link: https://www.youtube.com/watch?v=YdOjV1Gcqvk **Introducing Behind the Knife's Trauma Surgery Video Atlas - https://app.behindtheknife.org/premium/trauma-surgery-video-atlas/show-content The Trauma Surgery Video Atlas contains 24 scenarios that include never-before-seen high-definition operative footage, rich, original illustrations, and practical, easy-to-read pearls that will help you dominate the most difficult trauma scenarios. ***Fellowship Application - https://forms.gle/5fbYJ1JXv3ijpgCq9*** Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out more recent episodes here: https://app.behindtheknife.org/listen

You get called to see a consult in the middle of the night. It is a middle-aged woman with a bariatric history, and she says her stomach is smaller but doesn’t know the name of the operation. She developed worsening abdominal pain after dinner and it’s been getting worse. She’s not peritonitic, but she’s clearly in discomfort. Is it cholecystitis, diverticulitis, pancreatitis, marginal ulcer, or an internal hernia? What do you do? Join Drs. Matthew Martin, Adrian Dan, and Paul Wisniowski on a discussion about initial evaluation and management of bariatric patients with internal hernias. Show Hosts: Matthew Martin Adrian Dan Paul Wisniowski Video companion: https://app.behindtheknife.org/video/clinical-challenges-in-bariatric-surgery-internal-hernia Show Notes 1. Initial Evaluation a. Focused history and physical, labs, and imaging i. Presenting symptoms may vary and include: nausea, emesis, and abdominal pain ranging from vague to severe. ii. A basic lab panel can aid in developing the diagnosis and guide resuscitation. iii. CT of the abdomen and pelvis with IV and oral contrast can assist in identifying intra-abdominal pathology iv. Reviewing the previous operative report is beneficial to have a framework of the anatomy, i.e. type of bariatric surgery, and configuration of small bowel limbs (ante- vs retro-gastric and ante- vs retro-colic). 1. According to a 2019 study, 40-60% of closed defects had reopened at time of re-exploration v. If the patient is peritonitic with abdominal pain, they should be treated similarly to any patient with an acute abdomen with emergent exploration. b. CT Imaging i. A mesenteric swirl sign with twisting of the soft tissue and mesenteric vessels with surrounding fat attenuation has been shown to have a sensitivity of 78-100% and specificity of 80-90%. Other findings include: a Bird’s beak, dilation of roux or biliopancreatic limbs, SMV narrowing, and displacement of JJ limb to the RUQ and can be used to support the diagnosis of internal hernia ii. An experienced radiologist familiar with bariatric anatomy has been shown to have a positive predictive value to 81% and negative predictive value to 96% at radiologically diagnosing internal hernia. iii. A CT scan can provide insight for a suspected diagnosis but it cannot rule out internal hernia c. Nasogastric/Esophageal Tube i. Use judiciously based on patient’s presenting symptoms ii. Placement should be done by the surgical team iii. This may mitigate the risk of aspiration during intubation. 2. Operative Management a. Entry should be dependent on the comfort of the operating surgeon. i. Veress entry into the abdomen with dilated bowels may lead to increased injuries. ii. Optiview allows for direct visualization of each layer of the abdominal wall. Focusing on twisting the trochar and limiting perpendicular pressure. iii. Hasson entry also allows for direct visualization but may be limiting in bariatric patients with thick abdominal walls b. Exploration – a systematic approach i. Start with evaluation of the gastric pouch and run the roux limb to the jejunojejunostomy, and examine Petersen’s and mesojejunal defects. ii. Follow the biliopancreatic limb to the ligament of Treitz iii. Lastly, identify the terminal ileum at the sail of Treves and run backwards to the jejunojejunostomy iv. This will allow for examination of all possible defect and possible intussusception at the jejunostomy c. Defect Management i. All defects should be closed, with studies demonstrating reduced rates of internal hernia when defects are closed with a running suture. There is no strong evidence to support the use of a specific suture material. 1. The use of suture is superior to other methods of closure such as metallic clips, fibrin glue, mesh, or abrasive pads. 2. A barbed suture can be considered. d. In a patient with unfavorable anatomy or those unable to tolerate pneumoperitoneum surgeons should consider early conversion...

We know cardiac surgery can seem a bit daunting on the surface. However, most surgeons will come across cardiac surgery patients at some point whether in the OR, ICU, ED, etc. As the FIRST cardiac surgery specialty team for Behind the Knife, we are excited to bring you episodes focused on high-yield topics to help you navigate common cardiac surgery challenges, discuss relevant literature to help you in practice, and help our listeners feel more comfortable around cardiac surgery patients. In this episode we’ll discuss mitral valve disease. We’ll review important physiologic differences in patients with mitral valve disease, the most common surgical approaches to address mitral valve disease, and how to work up and address acute mitral regurgitation due to acute papillary muscle rupture. Hosts: - Jessica Millar, MD- PGY-5 General Surgery Resident, University of Michigan, @Jess_Millar15 - Aaron William, MD- Cardiothoracic Surgery Fellow, Duke University, @AMWilliamsMD - Nick Teman, MD- Assistant Professor of Thoracic and Cardiovascular Surgery, University of Virginia, @nickteman Learning objectives: - Understand the physiologic differences that occur with mitral valve stenosis and regurgitation. - Understand the basic principles of mitral valve repair and replacement strategies. - Understand the presentation, work-up, and acute management of acute mitral valve regurgitations due to acute papillary muscle rupture/MI. For episode ideas/suggestions/feedback feel free to email Jessica Millar at: millarje@med.umich.edu **Introducing Behind the Knife's Trauma Surgery Video Atlas - https://app.behindtheknife.org/premium/trauma-surgery-video-atlas/show-content The Trauma Surgery Video Atlas contains 24 scenarios that include never-before-seen high-definition operative footage, rich, original illustrations, and practical, easy-to-read pearls that will help you dominate the most difficult trauma scenarios.