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Behind The Knife: The Surgery Podcast

Behind The Knife: The Surgery Podcast

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Behind the Knife is the world’s #1 surgery podcast.  From high-yield educational topics to interviews with leaders in the field, Behind the Knife delivers the information you need to know.  Tune in for timely, relevant, and engaging content designed to help you DOMINATE THE DAY! Behind the Knife is more than a podcast.  Visit www.behindtheknife.org to learn more.

Siste episoder av Behind The Knife: The Surgery Podcast podcast

Side 1 av 10
  1. Clinical Challenges in Vascular Surgery: Type B Aortic Dissections (TBAD) (00:30:04)

    A silent danger lurks within the descending thoracic aorta. While most Type B aortic dissections are managed medically, up to half of these patients will either require life-saving surgery or die within just five years. So how do we separate those who will quietly recover from those on the edge of catastrophe? How do we protect the spinal cord, bowel, and limbs from the devastating consequences of malperfusion? Join the University of Michigan Department of Vascular Surgery as they tackle the high-stakes decisions behind managing this unpredictable disease—where timing is critical, interventions are evolving, and lives hang in the balance. Hosted by the University of Michigan Department of Vascular Surgery: ·       Robert Beaulieu, Program Director ·       Frank Davis, Assistant Professor of Surgery ·       Luciano Delbono, PGY-5 House Officer ·       Andrew Huang, PGY-4 House Officer ·       Carolyn Judge, PGY-2 House Officer Learning Objectives: 1.         Discuss general approach to diagnosis and management of TBAD. 2.         Identifying high-risk features in uncomplicated TBAD and understanding their role in determining the need for surgical management. 3.         Review endovascular techniques for managing malperfusion of the limbs, viscera, and spinal cord and discuss associated decision making. References:  Authors/Task Force Members, Czerny, M., Grabenwöger, M., Berger, T., Aboyans, V., Della Corte, A., Chen, E. P., Desai, N. D., Dumfarth, J., Elefteriades, J. A., Etz, C. D., Kim, K. M., Kreibich, M., Lescan, M., Di Marco, L., Martens, A., Mestres, C. A., Milojevic, M., Nienaber, C. A., … Hughes, G. C. (2024). EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. The Annals of Thoracic Surgery, 118(1), 5–115. https://doi.org/10.1016/j.athoracsur.2024.01.021 de Kort, J. F., Hasami, N. A., Been, M., Grassi, V., Lomazzi, C., Heijmen, R. H., Hazenberg, C. E. V. B., van Herwaarden, J. A., & Trimarchi, S. (2025). Trends and Updates in the Management and Outcomes of Acute Uncomplicated Type B Aortic Dissection. Annals of Vascular Surgery, S0890-5096(25)00004-4. https://doi.org/10.1016/j.avsg.2024.12.060 Eidt, J. F., & Vasquez, J. (2023). Changing Management of Type B Aortic Dissections. Methodist DeBakey Cardiovascular Journal, 19(2), 59–69. https://doi.org/10.14797/mdcvj.1171 Lombardi, J. V., Hughes, G. C., Appoo, J. J., Bavaria, J. E., Beck, A. W., Cambria, R. P., Charlton-Ouw, K., Eslami, M. H., Kim, K. M., Leshnower, B. G., Maldonado, T., Reece, T. B., & Wang, G. J. (2020). Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. Journal of Vascular Surgery, 71(3), 723–747. https://doi.org/10.1016/j.jvs.2019.11.013 MacGillivray, T. E., Gleason, T. G., Patel, H. J., Aldea, G. S., Bavaria, J. E., Beaver, T. M., Chen, E. P., Czerny, M., Estrera, A. L., Firestone, S., Fischbein, M. P., Hughes, G. C., Hui, D. S., Kissoon, K., Lawton, J. S., Pacini, D., Reece, T. B., Roselli, E. E., & Stulak, J. (2022). The Society of Thoracic Surgeons/American Association for Thoracic Surgery Clinical Practice Guidelines on the Management of Type B Aortic Dissection. The Annals of Thoracic Surgery, 113(4), 1073–1092. https://doi.org/10.1016/j.athoracsur.2021.11.002 Papatheodorou, N., Tsilimparis, N., Peterss, S., Khangholi, D., Konstantinou, N., Pichlmaier, M., & Stana, J. (2025). Pre-Emptive Endovascular Repair for Uncomplicated Type B Dissection—Is This an Option? Annals of Vascular Surgery, S0890-5096(25)00007-X. https://doi.org/10.1016/j.avsg.2025.01.003 Trimarchi, S., Gleason, T. G., Brinster, D. R., Bismuth, J., Bossone, E., Sundt, T. M., Montgomery, D. G., Pai, C.-W., Bissacco, D., de Beaufort, H. W. L., Bavaria, J. E., Mussa, F., Bekeredjian, R., Schermerhorn, M., Pacini, D., Myrmel, T., Ouzounian, M., Korach, A., Chen, E. P., … Patel, H. J. (2023). Editor’s Choice - Trends in Management and Outcomes of Type B Aortic Dissection: A Report From the International Registry of Aortic Dissection. European Journal of Vascular and Endovascular Surgery: The Official Journal of the European Society for Vascular Surgery, 66(6), 775–782. https://doi.org/10.1016/j.ejvs.2023.05.015 Writing Committee Members, Isselbacher, E. M., Preventza, O., Hamilton Black Iii, J., Augoustides, J. G., Beck, A. W., Bolen, M. A., Braverman, A. C., Bray, B. E., Brown-Zimmerman, M. M., Chen, E. P., Collins, T. J., DeAnda, A., Fanola, C. L., Girardi, L. N., Hicks, C. W., Hui, D. S., Jones, W. S., Kalahasti, V., … Woo, Y. J. (2022). 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology, 80(24), e223–e393. https://doi.org/10.1016/j.jacc.2022.08.004 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

  2. Journal Review in Thoracic Surgery: The Prehab Prescription- Evidence, Implementation, and Advocacy (00:22:24)

    What if we could train patients for surgery the way elite athletes train for game day? In this episode, we review the science, shed light on the disparities, explore real-world challenges, and honor the behind-the-scenes workers that facilitate prehabilitation in thoracic cancer care. Join attending surgeon Doctor Jinny Ha, 3rd year general surgery resident Doctor Kyla Rakoczy, and Community Outreach Patient Navigator, Leslie Ricks Chandler, in discussing prehabilitation in thoracic surgery. Hosts:  Dr. Jinny Ha, MD, MHS, assistant professor of surgery and thoracic surgeon at Johns Hopkins Leslie Ricks Chandler, Community Outreach Program Advisor Johns Hopkins Thoracic Surgery Dr. Kyla Rakoczy, MD, 3rd year general surgery resident at Johns Hopkins LinkedIn: Kyla Rakoczy Learning objectives:  After listening to this episode, participants will be able to: Define the role and components of prehabilitation in the context of thoracic oncology and ERAS/ESTS guidelines. Interpret key findings from recent clinical trials on prehabilitation, including outcomes related to functional capacity and readmission rates. Identify socioeconomic and structural barriers to prehabilitation participation and discuss strategies to improve equitable access to these interventions. Apply evidence-based criteria to assess which patients may benefit most from preoperative nutrition and exercise interventions. Recognize the importance of interdisciplinary collaboration—including social work and patient navigation—in optimizing surgical readiness and long-term outcomes. References:  Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery: A Randomized Clinical Trial - PubMed https://pmc.ncbi.nlm.nih.gov/articles/PMC12070588/ https://pubmed.ncbi.nlm.nih.gov/39775660/ https://ccts.amegroups.org/article/view/68030/html https://pubmed.ncbi.nlm.nih.gov/36435646/ https://www.sciencedirect.com/science/article/abs/pii/S1043067918301643?via%3Dihub https://pubmed.ncbi.nlm.nih.gov/30304509/ https://pubmed.ncbi.nlm.nih.gov/28385477/ https://pubmed.ncbi.nlm.nih.gov/27226400/ https://pubmed.ncbi.nlm.nih.gov/38546649/  https://pubmed.ncbi.nlm.nih.gov/38614212/ https://www.hopkinsmedicine.org/surgery/specialty-areas/thoracic-surgery/patient-education  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

  3. Journal Review in Endocrine Surgery: Parathyroidectomy for Fracture Risk (00:29:03)

    Primary hyperparathyroidism is an underdiagnosed condition which leads to decreased bone mineral density, fracture, renal disease, among other symptoms that can decrease the quality of a patient’s life. Moreover, once diagnosed, only a small fraction of patients with the diease end up being offered surgery. Whether it is because of misunderstood indications and benefits of surgery, non-localization of disease, or various other reasons, we thought it was worthwhile to review relevant literature. Hosts: Dr. Becky Sippel is an endowed professor of surgery at Division Chief of endocrine surgery at University of Wisconsin Madison and she is the most recent past president of the AAES.  She is an internationally recognized leader in the field of endocrine surgery. She has over 250 publications. She was the PI for a RCT which studies prophylactic central neck dissections which is a widely read and quoted study in endocrine surgery. Dr. Amanda Doubleday is a fellowship trained endocrine surgeon in private practice with an affiliation to UW Health. Her primary practice is with Waukesha Surgical Specialists in Waukesha WI.  Dr. Simon Holoubek is a fellowship trained endocrine surgeons affiliated with UW Health. He works for UW Health with privileges at UW Madison and UW Northern Illinois. His clinical interests are aggressive variants of thyroid cancer, parathyroid autofluorescence, and nerve monitoring.  Learning Objectives: 1 Understand the natural history of primary hyperparathyroidism and how the disease process can affect bone mineral density. 2 Learn about fracture risk associated with primary hyperparathyroidism. 3 Learn about decreased fracture risk in patients with primary hyperparathyroidism who have parathyroidectomy compared to those who are observed.  References: 1 Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, Udesky J, Silverberg SJ. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab. 2008 Sep;93(9):3462-70. doi: 10.1210/jc.2007-1215. Epub 2008 Jun 10. PMID: 18544625; PMCID: PMC2567863. https://pubmed.ncbi.nlm.nih.gov/18544625/ 2 Frey S, Gérard M, Guillot P, Wargny M, Bach-Ngohou K, Bigot-Corbel E, Renaud Moreau N, Caillard C, Mirallié E, Cariou B, Blanchard C. Parathyroidectomy Improves Bone Density in Women With Primary Hyperparathyroidism and Preoperative Osteopenia. J Clin Endocrinol Metab. 2024 May 17;109(6):1494-1504. doi: 10.1210/clinem/dgad718. PMID: 38152848. https://pubmed.ncbi.nlm.nih.gov/38152848/ 3 VanderWalde LH, Liu IL, Haigh PI. Effect of bone mineral density and parathyroidectomy on fracture risk in primary hyperparathyroidism. World J Surg. 2009 Mar;33(3):406-11. doi: 10.1007/s00268-008-9720-8. PMID: 18763015. https://pubmed.ncbi.nlm.nih.gov/18763015/ 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

  4. Behind the Knife General Surgery Oral Board Review – Sample Episode 10 - Abdominal Wall Defects - Gastroschisis/Omphalocele (00:18:46)

    Behind the Knife's General Surgery Oral Board Review Course includes 123 Audio Scenarios + 10 Interactive Video Scenarios + 97 Operative Descriptions that cover all SCORE topic. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. 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 general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test. All of our premium courses are available via our website and apps (iOS and Android).  Users can take notes, pin chapters and download content for offline viewing.  Learn more about the General Surgery Oral Board Review Course at https://app.behindtheknife.org/premium/general-surgery-oral-board-review **Institutional Discounts Available - Please email hello@behindtheknife.org to learn more.** Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

  5. Behind the Knife 2025 Brief Update (00:06:11)

    In this episode, the Behind the Knife team shares exciting updates, including updates to the General Surgery Oral Board Review with 123 expert-commentary scenarios, 10 interactive videos, and 97 operative descriptions. They announce upcoming projects such as an AI-powered oral board simulator, Spanish-language review, a free pediatric surgery resource, and detailed surgical instrument flashcards. The team also introduces Dominate Surgery courses for medical students and advanced practice providers, designed to modernize and elevate surgical education. ***Choledocholithiasis wtih Gastric Bypass Video Scenario Link: https://app.behindtheknife.org/video/behindtheknife-general-surgery-oral-board-review-video-sample-choledocholithiasis-w-gastric-bypass --- Behind the Knife's General Surgery Oral Board Review Course includes 123 Audio Scenarios + 10 Interactive Video Scenarios + 97 Operative Descriptions that cover all SCORE topic. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. 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 general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test. All of our premium courses are available via our website and apps (iOS and Android).  Users can take notes, pin chapters and download content for offline viewing.  Learn more about the General Surgery Oral Board Review Course at https://app.behindtheknife.org/premium/general-surgery-oral-board-review **Institutional Discounts Available - Please email hello@behindtheknife.org to learn more.** Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

  6. Behind the Knife General Surgery Oral Board Review – Sample Episode 9 - Axillary Management of Breast Cancer (00:15:12)

    Behind the Knife's General Surgery Oral Board Review Course includes 123 Audio Scenarios + 10 Interactive Video Scenarios + 97 Operative Descriptions that cover all SCORE topic. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. 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 general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test. All of our premium courses are available via our website and apps (iOS and Android).  Users can take notes, pin chapters and download content for offline viewing.  Learn more about the General Surgery Oral Board Review Course at https://app.behindtheknife.org/premium/general-surgery-oral-board-review **Institutional Discounts Available - Please email hello@behindtheknife.org to learn more.** Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

  7. Behind the Knife General Surgery Oral Board Review – Sample Episode 8 - Trauma Resuscitation and ED Thoracotomy (00:16:59)

    Behind the Knife's General Surgery Oral Board Review Course includes 123 Audio Scenarios + 10 Interactive Video Scenarios + 97 Operative Descriptions that cover all SCORE topic. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. 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 general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test. All of our premium courses are available via our website and apps (iOS and Android).  Users can take notes, pin chapters and download content for offline viewing.   Learn more about the General Surgery Oral Board Review Course at https://app.behindtheknife.org/premium/general-surgery-oral-board-review **Institutional Discounts Available - Please email hello@behindtheknife.org to learn more.** Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

  8. Clinical Challenges in Emergency General Surgery: Open Cholecystectomy - “A Lost Art” (00:33:53)

    When the gallbladder turns hostile, sometimes you must do more than just pause—you have to call in a senior partner for help. Join the Behind the Knife EGS team at Mizzou as we dive into the art and grit of open cholecystectomy. From fundus-first dissection to navigating the “barrier to happiness,” this episode is packed with surgical pearls, tough love, and the kind of wisdom only scars can teach. Participants: Dr. Rushabh Dev FACS (Moderator, Surgical Attending) – Assistant Professor of Surgery, Associate PD ACS & SCCM Fellowship, SICU Medical Director, Lieutenant Commander United States Navy Reserve  Dr. Jeffery Coughenour FACS (Surgical Attending) – Professor of Surgery and Emergency Medicine, Trauma Medical Director at the University of Missouri SOM Dr. Christopher Nelson FACS (Surgical Attending) – Associate Professor of Surgery, Medical Director of Emergency General Surgery at the University of Missouri SOM Dr. Micah Ancheta (ACS Fellow) – Major, United States Airforce  Dr. Desra Fletcher (3rd year general surgery resident) Learning Objectives:  ·      Recognize Indications for Conversion Identify clinical and intraoperative factors that necessitate conversion from laparoscopic to open cholecystectomy. ·      Apply Risk Stratification Tools Utilize grading systems (e.g., Parkland, Tokyo, AAST) to assess cholecystitis severity and predict surgical difficulty. ·      Implement Safe Cholecystectomy Techniques Describe the six steps of the SAGES Safe Cholecystectomy Program to minimize bile duct injury. ·      Understand Bailout Strategies Differentiate between fenestrating and reconstituting subtotal cholecystectomy techniques and their respective risks. ·      Master Key Operative Steps Outline the essential components of open cholecystectomy: positioning, incision, exposure, and dissection. ·      Navigate High-Risk Anatomy Recognize “zones of danger” and use the B-SAFE mnemonic to reorient and ensure safe progression. ·      Develop Intraoperative Judgment Demonstrate when to proceed with subtotal techniques, convert to open, or call for assistance. ·      Perform Technical Nuances Safely Identify proper dissection planes, manage gallbladder bed inflammation, and secure cystic structures with confidence. ·      Prevent and Manage Complications Understand the risks of bile leaks, bilomas, and subcostal hernias—and how to mitigate them through technique and closure. ·      Foster Surgical Maturity Emphasize humility, collaboration, and mentorship in difficult operations—knowing when to ask for help is a skill. References: 1.     Dhanasekara, C. S., Shrestha, K., Grossman, H., Garcia, L. M., Maqbool, B., Luppens, C., ... & Dissanaike, S. (2024). A comparison of outcomes including bile duct injury of subtotal cholecystectomy versus open total cholecystectomy as bailout procedures for severe cholecystitis: A multicenter real-world study. Surgery, 176(5), 605–613. https://doi.org/10.1016/j.surg.2024.03.057 2.     Motter, S. B., de Figueiredo, S. M. P., Marcolin, P., Trindade, B. O., Brandao, G. R., & Moffett, J. M. (2024). Fenestrating vs reconstituting laparoscopic subtotal cholecystectomy: A systematic review and meta-analysis. Surgical Endoscopy, 38, 7475–7485. https://doi.org/10.1007/s00464-024-11225-8 3.     Brunt, L. M., Deziel, D. J., Telem, D. A., Strasberg, S. M., Aggarwal, R., Asbun, H., ... & Stefanidis, D. (2020). Safe cholecystectomy multi-society practice guideline and state of the art consensus conference on prevention of bile duct injury during cholecystectomy. Surgical Endoscopy.https://www.sages.org/publications/guidelines/safe-cholecystectomy-multi-society-practice-guideline/ 4.     Elshaer, M., Gravante, G., Thomas, K., Sorge, R., Al-Hamali, S., & Ebdewi, H. (2015). Subtotal cholecystectomy for “difficult gallbladders”: Systematic review and meta-analysis. JAMA Surgery, 150(2), 159–168. https://doi.org/10.1001/jamasurg.2014.1219 5.     Koo, S. S. J., Krishnan, R. J., Ishikawa, K., Matsunaga, M., Ahn, H. J., Murayama, K. M., & Kitamura, R. K. (2024). Subtotal vs total cholecystectomy for difficult gallbladders: A systematic review and meta-analysis. The American Journal of Surgery, 229(1), 145–150. https://doi.org/10.1016/j.amjsurg.2023.12.022 6.     Strasberg, S. M., Pucci, M. J., Brunt, L. M., & Deziel, D. J. (2016). Subtotal cholecystectomy—“Fenestrating” vs “reconstituting” subtypes and the prevention of bile duct injury: Definition of the optimal procedure in difficult operative conditions. Journal of the American College of Surgeons, 222(1), 89–96. https://doi.org/10.1016/j.jamcollsurg.2015.09.019 7.     Ahmed, O., & Walsh, T. N. (2020). Surgical trainee experience with open cholecystectomy and the Dunning-Kruger effect. Journal of Surgical Education.https://doi.org/10.1016/j.jsurg.2020.03.025 8.     Seshadri, A., & Peitzman, A. B. (2024). The difficult cholecystectomy: What you need to know. The Journal of Trauma and Acute Care Surgery, 97(3), 325–336. https://doi.org/10.1097/TA.0000000000004156 9.     Invited commentary on “A comparison of outcomes including bile duct injury of subtotal cholecystectomy versus open total cholecystectomy as bailout procedures for severe cholecystitis: A multicenter real-world study”. (2024). Surgery, 176(5), 614–615. https://doi.org/10.1016/j.surg.2024.05.003 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

  9. Journal Review in Burn Surgery: Fluid Resuscitation (00:22:48)

    You’re on call at a level I trauma center and you get called that you’re receiving a large TBSA burn patient – you’re not working at a burn center! You remember hearing about some controversy surrounding burn resuscitation – was it the parkland formula? Consensus formula? ABSITE asked about the Modified Brooke Formula?!? Join Dr. Kathleen Romanowski, Dr. Laura Johnson, Dr. Victoria Miles, and Dr. Lauren Nosanov to discuss modern burn fluid resuscitation! Hosts:  ·      Kathleen Romanowski – University of California Davis Hospital, Shriners Hospital Sacramento ·      Laura Johnson – Grady Memorial Hospital ·      Lauren Nosanov – Grady Memorial Hospital ·      Victoria Miles – Louisiana State University Health Science Center, University Medical Center New Orleans Learning Objectives: ·      Review the basics of initial burn fluid resuscitation ·      Evaluate the literature informing national burn fluid resuscitation guidelines ·      Consider the causes of failed burn resuscitation and strategies for identifying these complications References: ·      Pham TN, Cancio LC, Gibran NS. American Burn Association Practice Guidelines Burn Shock Resuscitation. J Burn Care Res. 2008: 257-266. doi:10.1097/jbcr.0b013e31815f3876. https://pubmed.ncbi.nlm.nih.gov/18182930/ ·      Rizzo JA, Coates EC, Serio-Melvin ML, et al. Higher Initial Formula for Resuscitation After Severe Burn Injury Means Higher 24-Hour Volumes. J Burn Care Res. 2023:1017-1022. doi:10.1093/jbcr/irad065. https://pubmed.ncbi.nlm.nih.gov/37339255/  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

  10. Journal Review in Minimally Invasive Surgery: Achalasia (00:19:48)

    Today, we’re diving into a condition that’s as fascinating as it is complex: Achalasia—where the esophagus stops playing nice, and swallowing becomes a daily challenge. We’re breaking down the latest evidence, comparing POEM, pneumatic dilation, and Heller myotomy, and digging into what actually matters when deciding how to treat each achalasia subtype. Join show hosts Drs. Jake Greenberg, Dana Portenier, Zach Weitzner, and Joey Lew as they discuss the past, present, and future of Achalasia management. Whether you're a medical student or a seasoned attending, this episode will arm you with the tools to think critically about diagnosis, tailor your treatment strategy, and stay ahead of the curve on the future of achalasia care. Hosts:  ·      Jacob Greenberg, MD, EdM, MIS Division Chief and Vice Chair for Education, Duke University ·      Dana Portenier, MD, MIS Fellowship Director, Duke University ·      Zachary Weitzner, MD, Minimally Invasive and Bariatric Surgery Fellow, Duke University, @ZachWeitznerMD ·      Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actually Learning Goals:  By the end of this episode, listeners will be able to: ·      Describe the pathophysiology and key diagnostic criteria for achalasia, including the role of manometry, EGD, and esophagram. ·      Differentiate between the three subtypes of achalasia based on the Chicago Classification and understand the clinical significance of each. ·      Compare treatment options for achalasia—pneumatic dilation, Lap Heller myotomy, and POEM—including indications, efficacy, and long-term outcomes. ·      Interpret landmark studies (e.g., European Achalasia Trial, JAMA POEM trial) and their impact on treatment decision-making. ·      Recognize patient-specific factors (age, comorbidities, achalasia subtype) that influence the choice of therapy. ·      Discuss evolving technologies and future directions in achalasia management, including endoluminal robotics, ARMS, and combined anti-reflux strategies. ·      Outline a basic treatment algorithm for newly diagnosed achalasia, incorporating diagnostic steps and tailored interventions. ·      Appreciate the multidisciplinary approach to achalasia care, including the roles of MIS surgeons, gastroenterologists, and emerging procedural skillsets. References: ·      Boeckxstaens G, Elsen S, Belmans A, Annese V, Bredenoord AJ, Busch OR, Costantini M, Fumagalli U, Smout AJPM, Tack J, Vanuytsel T, Zaninotto G, Salvador R; European Achalasia Trial Investigators. 10‑year follow-up results of the European Achalasia Trial: a multicentre randomised controlled trial comparing pneumatic dilation with laparoscopic Heller myotomy. Gut. 2024 Mar;73(4):582‑589. doi: 10.1136/gutjnl‑2023‑331374. PMID: 38050085 https://pubmed.ncbi.nlm.nih.gov/38050085/ ·      He J, Yin Y, Tang W, Jiang J, Gu L, Yi J, Yan L, Chen S, Wu Y, Liu X. Objective Outcomes of an Extended Anti‑reflux Mucosectomy in the Treatment of PPI‑Dependent Gastroesophageal Reflux Disease (with Video). J Gastrointest Surg. 2022 Aug;26(8):1566–1574. doi:10.1007/s11605‑022‑05396‑9. PMID: 35776296 https://pubmed.ncbi.nlm.nih.gov/35776296/ ·      Modayil RJ, Zhang X, Rothberg B, et al. Peroral endoscopic myotomy: 10-year outcomes from a large, single-center U.S. series with high follow-up completion and comprehensive analysis of long-term efficacy, safety, objective GERD, and endoscopic functional luminal assessment. Gastrointest Endosc. 2021;94(5):930-942. doi:10.1016/j.gie.2021.05.014. PMID: 33989646. https://pubmed.ncbi.nlm.nih.gov/33989646/ ·      Ponds FA, Fockens P, Lei A, Neuhaus H, Beyna T, Kandler J, Frieling T, Chiu PWY, Wu JCY, Wong VWY, Costamagna G, Familiari P, Kahrilas PJ, Pandolfino JE, Smout AJPM, Bredenoord AJ. Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-naive patients with achalasia: a randomized clinical trial. JAMA. 2019 Jul 9;322(2):134–144. doi:10.1001/jama.2019.8859. PMID: 31287522. https://pubmed.ncbi.nlm.nih.gov/31287522/ ·      Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT; ACG Clinical Guidelines Committee. ACG clinical guidelines: Diagnosis and management of achalasia. Am J Gastroenterol. 2020 Sep;115(9):1393–1411. doi:10.14309/ajg.0000000000000731. PMID: 32773454; PMCID: PMC9896940 https://pubmed.ncbi.nlm.nih.gov/32773454/ ·      West RL, Hirsch DP, Bartelsman JF, de Borst J, Ferwerda G, Tytgat GN, Boeckxstaens GE. Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol. 2002;97(6):1346-1351. doi:10.1111/j.1572-0241.2002.05771.x. PMID:12094848. https://pubmed.ncbi.nlm.nih.gov/12094848/ 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

  11. Mattox Conference Pro-Con Debate 2025: Direct to OR Resuscitation (00:29:46)

    Every spring for over 50 years, the Trauma, Critical Care, and Acute Care Surgery conference, best known simply as the MATTOX conference, is held in Las Vegas (https://www.trauma-criticalcare.com/).  The conference is unique in that it is entirely focused on practice-changing clinical education. It’s a damn good time too!  A favorite feature is the annual debates.  Today, we are featuring a showdown between Drs. Teddy Puzo and Joseph Dubois as they battle it out over the use of a DIRECT TO OR TRAUMA RESUSCITATION STRATEGY.  You can listen on the podcast or watch the debate with accompanying slides on our website or app.  Let's get ready to RUMMMBLLLEEEE! Video Link: https://www.youtube.com/watch?v=-DTTGBaLcHo TRAUMA SURGERY VIDEO ATLAS: https://app.behindtheknife.org/course-details/trauma-surgery-video-atlas Preparing for the deadliest injuries is challenging, and currently available resources are limited. That is why we created the Behind the Knife Trauma Surgery Video Atlas. Be ready for the most complex injuries, like penetrating trauma to the neck, audible bleeding from the IVC, and pelvic hemorrhage, with 24 scenarios.  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

  12. Mattox Conference Pro-Con Debate 2025: Trauma Video Review (00:31:04)

    Every spring for over 50 years, the Trauma, Critical Care, and Acute Care Surgery conference, best known simply as the MATTOX conference, is held in Las Vegas (https://www.trauma-criticalcare.com/).  The conference is unique in that it is entirely focused on practice-changing clinical education. It’s a damn good time too!  A favorite feature is the annual debates.  Today, we are featuring a showdown between Drs. Ryan Dumas and Bellal Joseph (@TopKniFe_B) as they battle it out over the use of TRAUMA VIDEO REVIEW.  You can listen on the podcast or watch the debate with accompanying slides on our website or app.  Let's get ready to RUMMMBLLLEEEE! Video Link: https://app.behindtheknife.org/video/mattox-conference-pro-con-debate-2025-trauma-video-review TRAUMA SURGERY VIDEO ATLAS: https://app.behindtheknife.org/course-details/trauma-surgery-video-atlas Preparing for the deadliest injuries is challenging, and currently available resources are limited. That is why we created the Behind the Knife Trauma Surgery Video Atlas. Be ready for the most complex injuries, like penetrating trauma to the neck, audible bleeding from the IVC, and pelvic hemorrhage, with 24 scenarios.  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

  13. BIG T Trauma Ep. 24 - Trauma Video Review (00:39:36)

    In this episode of the Big T Trauma Series, Dr. Patrick Georgoff (@georgoff) and Dr. Jason Brill dive into the evolving world of Trauma Video Review (TVR) with special guests Dr. Michael Vella and Dr. Ryan Dumas. Together, they explore how TVR is transforming trauma care by offering unprecedented insight into both technical and non-technical performance in the trauma bay. The conversation covers everything from implementation logistics and HIPAA concerns to cultural shifts and emerging AI applications. Whether you're curious about getting started or wondering if TVR should be part of trauma verification, this episode delivers essential insights from two national leaders in the space. Don’t miss it! Dr. Ryan Dumas is an associate professor of surgery at Baylor College of Medicine in Houston Texas where he serves as the Section Chief of Acute Care Surgery.  Dr. Dumas conducts and publishes research in trauma surgery and artificial intelligence, with a specific emphasis on video technology to capture and review trauma resuscitations. He has helped develop and run several Trauma Video Review programs across the country and utilizes video review as a tool for quality improvement, education, and research. Dr. Dumas is a consultant for Teleflex and Surgical Safety Technologies. Dr. Michael Vella is an associate professor of surgery, division of acute care surgery and trauma, at the university of Rochester medical center in Rochester, NY and the trauma medical director of the Kessler Level I trauma center.  He currently serves as chair of the New York State Committee on Trauma.  He has a clinical and research interest in trauma video review, particularly as it relates to trauma team dynamics and initial resuscitation.  Dr. Dumas is a consultant for Teleflex. This episode of Big T Trauma was sponsored by Teleflex, a global provider of medical devices. Learn more at teleflex.com and at the Teleflex Trauma and Emergency Medicine LinkedIn page. 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

  14. Clinical Challenges in Colorectal Surgery: Early Onset Colorectal Cancer (00:38:35)

    The incidence of early onset colorectal cancer (EOCRC) has been rising prompting the change in change in screening guidelines to 45 years of age for average risk patients. Join us for an in-depth discussion with guest speakers Dr. Andrea Cercek and Dr. Nancy You, where we provide a comprehensive look at the growing challenge of EOCRC. Hosts: - Dr. Janet Alvarez - General Surgery Resident at New York Medical College/Metropolitan Hospital Center - Dr. Wini Zambare – General Surgery Resident at Weill Cornell Medical Center/New York Presbyterian - Dr. Phil Bauer, Graduating Colorectal Surgical Oncology Fellow at Memorial Sloan Kettering Cancer Center  - Dr. J. Joshua Smith MD, PhD, Chair, Department of Colon and Rectal Surgery at MD Anderson Cancer Center - Dr. Andrea Cercek - Gastrointestinal Medical Oncologist at Memorial Sloan Kettering Cancer Center - Dr. Y. Nancy You, MD MHSc - Professor, Department of Colon and Rectal Surgery at MD Anderson Cancer Center Learning objectives:  - Describe trends in incidence of colorectal cancer, with emphasis on the rise of EOCRC. - Identify age groups and demographics most affected by EOCRC. - Summarize USPSTF recommendations for colorectal cancer screening. - Distinguish between screening methods (e.g., colonoscopy, FIT-DNA) and their sensitivity. - Understand treatment approaches for colon and rectal cancer (CRC) - Understand the role of mismatch repair (MMR) status in guiding treatment. - Outline the importance of genetic counseling and testing in young patients. - Discuss racial, ethnic, and socioeconomic disparities in CRC incidence and outcomes. - Describe the impact of cancer treatment on fertility and sexual health. -  Review fertility preservation options. - Identify the value of integrated care teams for young CRC patients. References: 1.         Siegel, R. L. et al. Colorectal Cancer Incidence Patterns in the United States, 1974–2013. JNCI J. Natl. Cancer Inst. 109, djw322 (2017). https://pubmed.ncbi.nlm.nih.gov/28376186/ 2.         Abboud, Y. et al. Rising Incidence and Mortality of Early-Onset Colorectal Cancer in Young Cohorts Associated with Delayed Diagnosis. Cancers 17, 1500 (2025). https://pubmed.ncbi.nlm.nih.gov/40361427/ 3.         Phang, R. et al. Is the Incidence of Early-Onset Adenocarcinomas in Aotearoa New Zealand Increasing? Asia Pac. J. Clin. Oncol.https://pubmed.ncbi.nlm.nih.gov/40384533/ 4.         Vitaloni, M. et al. Clinical challenges and patient experiences in early-onset colorectal cancer: insights from seven European countries. BMC Gastroenterol. 25, 378 (2025). https://pubmed.ncbi.nlm.nih.gov/40375142/ 5.         Siegel, R. L. et al. Global patterns and trends in colorectal cancer incidence in young adults. (2019) doi:10.1136/gutjnl-2019-319511. https://pubmed.ncbi.nlm.nih.gov/31488504/ 6.         Cercek, A. et al. A Comprehensive Comparison of Early-Onset and Average-Onset Colorectal Cancers. J. Natl. Cancer Inst. 113, 1683–1692 (2021). https://pubmed.ncbi.nlm.nih.gov/34405229/ 7.         Zheng, X. et al. Comprehensive Assessment of Diet Quality and Risk of Precursors of Early-Onset Colorectal Cancer. JNCI J. Natl. Cancer Inst. 113, 543–552 (2021). https://pubmed.ncbi.nlm.nih.gov/33136160/ 8.         Standl, E. & Schnell, O. Increased Risk of Cancer—An Integral Component of the Cardio–Renal–Metabolic Disease Cluster and Its Management. Cells 14, 564 (2025). https://pubmed.ncbi.nlm.nih.gov/40277890/ 9.         Muller, C., Ihionkhan, E., Stoffel, E. M. & Kupfer, S. S. Disparities in Early-Onset Colorectal Cancer. Cells 10, 1018 (2021). https://pubmed.ncbi.nlm.nih.gov/33925893/ 10.       US Preventive Services Task Force. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 325, 1965–1977 (2021). https://pubmed.ncbi.nlm.nih.gov/34003218/ 11.       Fwelo, P. et al. Differential Colorectal Cancer Mortality Across Racial and Ethnic Groups: Impact of Socioeconomic Status, Clinicopathology, and Treatment-Related Factors. Cancer Med. 14, e70612 (2025). https://pubmed.ncbi.nlm.nih.gov/40040375/ 12.       Lansdorp-Vogelaar, I. et al. Contribution of Screening and Survival Differences to Racial Disparities in Colorectal Cancer Rates. Cancer Epidemiol. Biomarkers Prev. 21, 728–736 (2012). https://pubmed.ncbi.nlm.nih.gov/22514249/ 13.       Ko, T. M. et al. Low neighborhood socioeconomic status is associated with poor outcomes in young adults with colorectal cancer. Surgery 176, 626–632 (2024). https://pubmed.ncbi.nlm.nih.gov/38972769/ 14.       Siegel, R. L., Wagle, N. S., Cercek, A., Smith, R. A. & Jemal, A. Colorectal cancer statistics, 2023. CA. Cancer J. Clin. 73, 233–254 (2023). https://pubmed.ncbi.nlm.nih.gov/36856579/ 15.       Jain, S., Maque, J., Galoosian, A., Osuna-Garcia, A. & May, F. P. Optimal Strategies for Colorectal Cancer Screening. Curr. Treat. Options Oncol. 23, 474–493 (2022). https://pubmed.ncbi.nlm.nih.gov/35316477/ 16.       Zauber, A. G. The Impact of Screening on Colorectal Cancer Mortality and Incidence: Has It Really Made a Difference? Dig. Dis. Sci. 60, 681–691 (2015). https://pubmed.ncbi.nlm.nih.gov/25740556/ 17.       Edwards, B. K. et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 116, 544–573 (2010). https://pubmed.ncbi.nlm.nih.gov/19998273/ 18.       Cercek, A. et al. Nonoperative Management of Mismatch Repair–Deficient Tumors. New England Journal of Medicine 392, 2297–2308 (2025). https://pubmed.ncbi.nlm.nih.gov/40293177/ 19.       Monge, C., Waldrup, B., Carranza, F. G. & Velazquez-Villarreal, E. Molecular Heterogeneity in Early-Onset Colorectal Cancer: Pathway-Specific Insights in High-Risk Populations. Cancers 17, 1325 (2025). https://pubmed.ncbi.nlm.nih.gov/40282501/ 20.       Monge, C., Waldrup, B., Carranza, F. G. & Velazquez-Villarreal, E. Ethnicity-Specific Molecular Alterations in MAPK and JAK/STAT Pathways in Early-Onset Colorectal Cancer. Cancers 17, 1093 (2025). https://pubmed.ncbi.nlm.nih.gov/40227607/ 21.       Benson, A. B. et al. Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Cancer Netw. JNCCN 19, 329–359 (2021). https://pubmed.ncbi.nlm.nih.gov/33724754/ 22.       Christenson, E. S. et al. Nivolumab and Relatlimab for the treatment of patients with unresectable or metastatic mismatch repair proficient colorectal cancer. https://pubmed.ncbi.nlm.nih.gov/40388545/ 23.       Dasari, A. et al. Fruquintinib versus placebo in patients with refractory metastatic colorectal cancer (FRESCO-2): an international, multicentre, randomised, double-blind, phase 3 study. The Lancet 402, 41–53 (2023). https://pubmed.ncbi.nlm.nih.gov/37331369/ 24.       Strickler, J. H. et al. Tucatinib plus trastuzumab for chemotherapy-refractory, HER2-positive, RAS wild-type unresectable or metastatic colorectal cancer (MOUNTAINEER): a multicentre, open-label, phase 2 study. Lancet Oncol. 24, 496–508 (2023). https://pubmed.ncbi.nlm.nih.gov/37142372/ 25.       Sauer, R. et al. Preoperative versus Postoperative Chemoradiotherapy for Rectal Cancer. N. Engl. J. Med. 351, 1731–1740 (2004). https://pubmed.ncbi.nlm.nih.gov/15496622/ 26.       Cercek, A. et al. Adoption of Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer. JAMA Oncol. 4, e180071 (2018). https://pubmed.ncbi.nlm.nih.gov/29566109/ 27.       Garcia-Aguilar, J. et al. Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy. J. Clin. Oncol. 40, 2546–2556 (2022). https://pubmed.ncbi.nlm.nih.gov/35483010/ 28.       Schrag, D. et al. Preoperative Treatment of Locally Advanced Rectal Cancer. N. Engl. J. Med. 389, 322–334 (2023). https://pubmed.ncbi.nlm.nih.gov/37272534/ 29.       Kunkler, I. H., Williams, L. J., Jack, W. J. L., Cameron, D. A. & Dixon, J. M. Breast-Conserving Surgery with or without Irradiation in Early Breast Cancer. N. Engl. J. Med. 388, 585–594 (2023). https://pubmed.ncbi.nlm.nih.gov/36791159/ 30.       Jacobsen, R. L., Macpherson, C. F., Pflugeisen, B. M. & Johnson, R. H. Care Experience, by Site of Care, for Adolescents and Young Adults With Cancer. JCO Oncol. Pract. (2021) doi:10.1200/OP.20.00840. https://pubmed.ncbi.nlm.nih.gov/33566700/ 31.       Ruddy, K. J. et al. Prospective Study of Fertility Concerns and Preservation Strategies in Young Women With Breast Cancer. J. Clin. Oncol. (2014) doi:10.1200/JCO.2013.52.8877. https://pubmed.ncbi.nlm.nih.gov/24567428/ 32.       Su, H. I. et al. Fertility Preservation in People With Cancer: ASCO Guideline Update. J. Clin. Oncol. 43, 1488–1515 (2025). https://pubmed.ncbi.nlm.nih.gov/40106739/ 33.       Smith, K. L., Gracia, C., Sokalska, A. & Moore, H. Advances in Fertility Preservation for Young Women With Cancer. Am. Soc. Clin. Oncol. Educ. Book 27–37 (2018) doi:10.1200/EDBK_208301. https://pubmed.ncbi.nlm.nih.gov/30231357/ 34.       Blumenfeld, Z. How to Preserve Fertility in Young Women Exposed to Chemotherapy? The Role of GnRH Agonist Cotreatment in Addition to Cryopreservation of Embrya, Oocytes, or Ovaries. The Oncologist 12, 1044–1054 (2007). 35.       Bhagavath, B. The current and future state of surgery in reproductive endocrinology. Curr. Opin. Obstet. Gynecol. 34, 164 (2022). 36.       Ribeiro, R. et al. Uterine transposition: technique and a case report. Fertil. Steril. 108, 320-324.e1 (2017). 37.       Yazdani, A., Sweterlitsch, K. M., Kim, H., Flyckt, R. L. & Christianson, M. S. Surgical Innovations to Protect Fertility from Oncologic Pelvic Radiation Therapy: Ovarian Transposition and Uterine Fixation. J. Clin. Med. 13, 5577 (2024). 38.       Holowatyj, A. N., Eng, C. & Lewis, M. A. Incorporating Reproductive Health in the Clinical Management of Early-Onset Colorectal Cancer. JCO Oncol. Pract. 18, 169–172 (2022). ***Behind the Knife Colorectal Surgery Oral Board Audio Review: https://app.behindtheknife.org/course-details/colorectal-surgery-oral-board-audio-review 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

  15. Journal Review in Artificial Intelligence: Four Times Better Than Us (00:22:33)

    You have probably seen recent headlines that Microsoft has developed an AI model that is 4x more accurate than humans at difficult diagnoses. It’s been published everywhere, AI is 80% accurate compared to a measly 20% human rate, and AI was cheaper too! Does this signal the end of the human physician? Is the title nothing more than clickbait? Or is the truth somewhere in-between? Join Behind the Knife fellow Ayman Ali and Dr. Adam Rodman from Beth Israel Deaconess/Harvard Medical School to discuss what this study means for our future.       Studies: Sequential Diagnosis with Large Language Models: https://arxiv.org/abs/2506.22405v1 METR study: https://metr.org/blog/2025-07-10-early-2025-ai-experienced-os-dev-study/ Hosts: Ayman Ali, MD Ayman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital in his academic development time where he focuses on applications of data science and artificial intelligence to surgery.  Adam Rodman, MD, MPH, FACP, @AdamRodmanMD Dr. Rodman is an Assistant Professor and a practicing hospitalist at Beth Israel Deaconess Medical Center. He’s the Beth Israel Deaconess Medical Center Director of AI Programs. In addition, he’s the co-director of the Beth Israel Deaconess Medical Center iMED Initiative. Podcast Link: http://bedside-rounds.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://app.behindtheknife.org/listen

  16. Clinical Challenges in Robotic Bariatric Surgery: The Robot is Here to Stay! (00:43:31)

    Join us as we dissect the use of robotics in bariatric surgery – where precision meets programming, and the scalpel gets a software upgrade. Video Clip Link: https://app.behindtheknife.org/video/clinical-challenges-in-robotic-bariatric-surgery-the-robot-is-here-to-stay This videos includes: - Robotic RYGB - Robotic Sleeve Gastrectomy - SADI: Single Anastomosis Duodenoileostomy Hosts:  - Matthew Martin, trauma and bariatric surgeon at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) - Adrian Dan, bariatric and MIS surgeon, program director for the advanced MIS bariatric and foregut fellowship at Summa Health System (Akron, Ohio) -  Crystal Johnson Mann, bariatric and foregut surgeon at the University of Florida (Gainesville, Florida) - Katherine Cironi, general surgery resident at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) Learning objectives:  Strengths of the robot:  Surgical robots are at the forefront of technology and continue to improve with detailed, precision cameras and the ability to remove baseline tremors Allows for smooth movements, fine dissection, and precise tissue handling  Ergonomics are more advantageous to the surgeon when compared to laparoscopy Weaknesses of the robot: The loss of haptic feedback can be challenging for surgeons early in their learning curve Emphasis on surgical robots means some trainees may be losing exposure to laparoscopic techniques Longer operative time when working robotically, and more time under anesthesia for the patient  Increased cost for robotic surgery  Outcomes data:  Mixed data from the MBSA QIP database (metabolic and bariatric surgery accreditation and quality improvement program) The most recent study looked at 824,000 patients from 2015-2022 who had a sleeve gastrectomy or RNY gastric bypass, either laparoscopically (lap sleeve 61%, lap RYGB 24%) or robotically (robo sleeve 11%, robo RYGB 4%). Robotic sleeves were reported to have higher complication rates compared to laparoscopy, seen as higher overall morbidity and an increased rate of leaks  While the robotic RYGBs have lower overall complications, including decreased morbidity and bleeding. Robotic RYGB can be especially advantageous with revisional surgeries when compared to lap.   Setting up for success Train your eyes to determine tension on tissue, since there is no haptic feedback Learn how to assist yourself (manipulating the camera and effectively utilizing the fourth arm) Understand how techniques of the surgery change when doing it robotically, as compared to laparoscopy  Experienced operating room team  When learning, recommend putting all cases feasible on the robot (including easier cases), to master the straightforward cases before moving to technically challenging revision cases. Don’t hesitate to add an additional trocar or assistant port when needed  Education in Robotic learning  Learning by observation/mirroring – ex: robotic bilateral inguinal hernia (mirroring the attending/instructor)  Easy for the attending/instructor in the case to switch instruments seamlessly, then give them back intermittently at the appropriate time  Helpful when the attending annotates the screen to depict where to go  Data-driven teaching tools on the Davinci system  Tips for robotic sleeve gastrectomy:  Of the robotic bariatric surgeries, sleeve gastrectomy is most similar to its laparoscopic procedure 30-40 degrees of reverse Trendelenburg Liver hammock stitch instead of a liver retractor (one less trocar), which makes a total of 4 trocars needed for the case Green staple load for the first firing, then the rest are typically blue loads Mixed opinions on reinforced staple loads versus non-reinforced staple loads and oversewing the staple line (discussed cost-benefit)  Tips for robotic gastric bypass:   Watch videos from colleagues to learn what they do Gastric bypass is a multi-quadrant surgery; thus, you must set yourself up for success so that your arms are not fighting when moving through different quadrants  A size 12 trocar on the left can make the formation of  the gastric pouch easier GJ and JJ anastomosis formed with a linear fire, then a two-layer closure with absorbable barb suture Don’t forget to close the mesenteric defect (non-absorbable braided suture) Tips for robotic DS and SADI:   If doing a duodenal anastomosis hand-sewn, then recommend planning the exact number of sutures and locations of each for ease Hand-sewn anastomosis can have less bleeding and fewer strictures for patients, and is completed in a much more seamless fashion with the robot   Future of Robotics  Haptic feedback Integrated visual overlays to identify anatomical structures/serve as an intraoperative map Artificial intelligence integration  Telesurgery – ex, small surgical robot deployed to space  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

  17. Clinical Challenges in Vascular Surgery: The Risk & Reality of EVAR Complications (00:26:55)

    It’s 2 a.m. The on-call resident’s voice is shaky. The CT shows an 18cm abdominal aortic aneurysm with a Type 1B endoleak. There’s gas in the sac, fluid in the belly, and the patient has a defibrillator on both sides of his chest. Is it a rupture? A graft infection? An aortoenteric fistula? All of the above? You’re the vascular surgeon, what do you do?  This episode dives deep into decision-making when EVAR fails, when infection strikes, and when the patient might not survive a definitive repair. Let’s talk about what happens when clinical textbooks meet real-world chaos. Hosts: ·      Christian Hadeed -PGY 4 General Surgery, Brookdale Hospital Medical Center ·      Paul Haser -Division chief, Vascular Surgery, Brookdale Hospital Medical Center ·      Andrew Harrington, Vascular surgery, Brookdale Hospital Medical Center ·      Lucio Flores, Vascular surgery, Brookdale Hospital Medical Center Learning objectives: · Understand the clinical implications and management of late EVAR complications, including Type 1B endoleak and aortoenteric fistula. · Explore the decision-making process in critically ill patients with multiple comorbidities and infected aortic grafts. · Compare endovascular vs open surgical approaches in the setting of infected AAA, and when each is appropriate. · Recognize the role of multidisciplinary collaboration in complex vascular cases. · Discuss the ethical considerations and goals-of-care planning in high-risk, potentially terminal vascular patients. · Highlight the importance of long-term surveillance after EVAR and the consequences of noncompliance. References ·       Karl Sörelius et al.Nationwide Study of the Treatment of Mycotic Abdominal Aortic Aneurysms Comparing Open and Endovascular Repair.Circulation. 2016;134(22):1822–1832. PubMed: https://pubmed.ncbi.nlm.nih.gov/27799273/ pubmed.ncbi.nlm.nih.gov+15pubmed.ncbi.nlm.nih.gov+15researchgate.net+15 ·       PARTNERS Trial (OVER Trial).Outcomes Following Endovascular vs Open Repair of Abdominal Aortic Aneurysm: A Randomized Trial.JAMA. 2009;302(14):1535–1542. PubMed: https://pubmed.ncbi.nlm.nih.gov/19826022/ pubmed.ncbi.nlm.nih.gov+6pubmed.ncbi.nlm.nih.gov+6jamanetwork.com+6 ·       B.T. Müller et al.Mycotic Aneurysms of the Thoracic and Abdominal Aorta and Iliac Arteries: Experience with Anatomic and Extra-anatomic Repair in 33 Cases.J Vasc Surg. 2001;33(1):106–113. PubMed: https://pubmed.ncbi.nlm.nih.gov/11137930/ sciencedirect.com+5pubmed.ncbi.nlm.nih.gov+5periodicos.capes.gov.br+5 ·       Chung‑Dann Kan et al.Outcome after Endovascular Stent Graft Treatment for Mycotic Aortic Aneurysm: A Systematic Review.J Vasc Surg. 2007 Nov;46(5):906–912. PubMed: https://pubmed.ncbi.nlm.nih.gov/17905558/ researchgate.net+15pubmed.ncbi.nlm.nih.gov+15pubmed.ncbi.nlm.nih.gov+15 ·       Hamid Gavali et al.Outcome of Radical Surgical Treatment of Abdominal Aortic Graft and Endograft Infections Comparing Extra‑anatomic Bypass with In Situ Reconstruction: A Nationwide Multicentre Study.Eur J Vasc Endovasc Surg. 2021;62(6):918–926. PubMed: https://pubmed.ncbi.nlm.nih.gov/34782231/ pubmed.ncbi.nlm.nih.gov+6pubmed.ncbi.nlm.nih.gov+6diva-portal.org+6  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

  18. Clinical Challenges in Hepatobiliary Surgery: Necrotizing Pancreatitis, Time to Step Up! (00:31:00)

    In the corner of the ICU, on multiple pressors, distended, oliguric, and intubated you’ll find the necrotizing pancreatitis patient. Sounds intimidating, but with the persistence, patience, and the proper care these patients can make it! In this episode from the HPB team at Behind the Knife listen in as we discuss the Step-Up approach, when to surgically intervene, various approaches to pancreatic Necrosectomy, and additional aspects of the multidisciplinary care required for the successful treatment of necrotizing pancreatitis.  Hosts Anish J. Jain MD (@anishjayjain) is a current PGY3 General Surgery Resident at Stanford University and a former T32 Research Fellow at the University of Texas MD Anderson Cancer Center. Jon M. Harrison is a 2nd year HPB Surgery Fellow at Stanford University. He will be joining as faculty at the Massachusetts General Hospital in Boston, MA at the conclusion of his fellowship in July 2024.    Learning Objectives ·      Develop an understanding of the severity of necrotizing pancreatitis and the proper indications to surgical intervene on this often-tenuous patients.  ·      Develop an understanding of the Step-Up approach and key aspects (reimaging, clinical status, physiologic status, etc.) that determine when to “step-up” treatment for patients with necrotizing pancreatitis. ·      Develop an understanding of long term sequalae and complications associated with necrotizing pancreatitis and operative management ·      Develop an understanding of multidisciplinary care and long-term follow-up necessary for adequate treatment of patients suffering from necrotizing pancreatitis. Suggested Reading Maurer LR, Fagenholz PJ. Contemporary Surgical Management of Pancreatic Necrosis. JAMA Surg. 2023;158(1):81–88. doi:10.1001/jamasurg.2022.5695 https://pubmed.ncbi.nlm.nih.gov/36383374/ Harrison JM, Day H, Arnow K, Ngongoni RF, Joseph A, Aldridge T, Wheeler KJ, DeLong JC, Bergquist JR, Worth PJ, Dua MM, Friedland S, Park W, Eldika S, Hwang JH, Visser BC. What's Behind it all: A Retrospective Cohort Study of Retrogastric Pancreatic Necrosis Management. Ann Surg. 2024 Sep 3. doi: 10.1097/SLA.0000000000006521. https://pubmed.ncbi.nlm.nih.gov/39225420/ Harrison JM, Visser BC. Not Dead Yet: Managing the Abdominal Catastrophe in Necrotizing Pancreatitis. Pancreas. 2025 May 20. doi: 10.1097/MPA.0000000000002512. https://pubmed.ncbi.nlm.nih.gov/40388698/ Harrison JM, Li AY, Sceats LA, Bergquist JR, Dua MM, Visser BC. Two-Port Minimally Invasive Nephrolaparoscopic Retroperitoneal Debridement for Pancreatic Necrosis. J Am Coll Surg. 2024 Dec 1;239(6):e7-e12. doi: 10.1097/XCS.0000000000001152. https://pubmed.ncbi.nlm.nih.gov/39051721/ van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H, Schaapherder AF, van Eijck CH, Bollen TL, van Ramshorst B, Nieuwenhuijs VB, Timmer R, Laméris JS, Kruyt PM, Manusama ER, van der Harst E, van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, van Leeuwen MS, Buskens E, Gooszen HG; Dutch Pancreatitis Study Group. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010 Apr 22;362(16):1491-502. doi: 10.1056/NEJMoa0908821. https://pubmed.ncbi.nlm.nih.gov/20410514/ Bang JY, Arnoletti JP, Holt BA, Sutton B, Hasan MK, Navaneethan U, Feranec N, Wilcox CM, Tharian B, Hawes RH, Varadarajulu S. An Endoscopic Transluminal Approach, Compared With Minimally Invasive Surgery, Reduces Complications and Costs for Patients With Necrotizing Pancreatitis. Gastroenterology. 2019 Mar;156(4):1027-1040.e3. doi: 10.1053/j.gastro.2018.11.031. https://pubmed.ncbi.nlm.nih.gov/30452918/ Zyromski NJ, Nakeeb A, House MG, Jester AL. Transgastric Pancreatic Necrosectomy: How I Do It. J Gastrointest Surg. 2016 Feb;20(2):445-9. doi: 10.1007/s11605-015-3058-y. https://pubmed.ncbi.nlm.nih.gov/26691148/ 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

  19. Intern Bootcamp: Dominate Intern Year (00:12:46)

    RE-RELEASE This was first published in 2023 but it's so good we are running it back! Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.  In this last episode of the intern bootcamp mini-series, we’ll talk about tips & tricks as well as good habits to establish in order to dominate intern year. Hosts: Shanaz Hossain, Nina Clark Tips for New Interns:  GENERAL TIPS FOR SUCCESS ON THE WARDS Spend time with the patient! Trust, but verify. Be kind to everyone. Stay humble. Be flexible. Seek and apply feedback. HOW TO LEARN IN THE OR Double scrub as many cases as you can. Write down/record everything after a case. MAINTAIN YOUR PERSONAL SANITY Figure out your stress outlets and what brings you joy. Decompress after work. Maintain work/life boundaries. Keep in touch with loved ones. Vacations are meant for relaxation.Repeat after me: NO WORK ON VACATION! Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/

  20. Intern Bootcamp: Scary Pages (00:23:18)

    RE-RELEASE This was first published in 2023 but it's so good we are running it back! Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency. Today, we’re hitting the wards and tackling some of the scary clinical scenarios you will see as an intern. Hosts: Shanaz Hossain, Nina Clark Tips for new interns: THINGS TO REMEMBER ·       BREATHE. In most cases, you have a little bit of time – at least enough to take a breath and calm down outside the room before heading into an emergency. Panic doesn’t help anybody. ·       See the patient. Getting a bunch of pages? Worried about someone? Confused as to what’s going on? Go see the patient and chat with the bedside team. ·       Know your toolbox. There are a ton of people around who can help you in the hospital, and knowing the basic labs/imaging studies and when to use them can help you to triage even the sickest patients. ·       Load the boat. You’ve heard this one from us all week! Loop senior level residents in early. HYPOTENSION ·       Differential: measurement error, patient’s baseline, and don’t miss – SHOCK.            - Etiologies of shock: hemorrhagic, hypovolemic, ·       On the phone: full set of vitals, accurate I/Os, ·       On the way: recent notes, PMH/PSH including from this hospital stay, and vitals/I&Os/studies from earlier in the day ·       In the room: ABCDs – rapidly gives you a sense of how high acuity the patient is ·       Get more info: labs, consider imaging, work up specific types of shock based on clinical concern. ·       Initial management: depends on etiology of hypotension; don’t forget to consider peripheral or central access, foley catheterization for close monitoring of urine output, and level of care HYPOXEMIA ·       Differential: atelectasis, baseline pulmonary disease, pneumonia, PE, hemo/pneumothorax, volume overload ·       On the phone: full set of vitals, amount of supplemental oxygen required and delivery device, rate of escalation in oxygen requirement ·       On the way: review PMH/PSH, known injuries (known hemothorax/pneumothorax? Rib fractures? Chest tubes in already?), risk factors for DVT/PE, review I/Os for evidence of volume status, vitals and labs for evidence of infection ·       In the room: ABCDs, pulmonary and cardiac exam, volume status exam ·       Get more info: basic labs, ABG if worried about oxygenation, CXR, consider bedside US of the lungs/heart, if high suspicion for PE consider CTA chest ·       Initial Management: supplemental O2, higher level of care, consider intubation or other supplemental oxygenation adjuncts, additional management dependent on suspected etiology ·       ABG Vs VBG (IBCC): https://emcrit.org/ibcc/vbg/ ALTERED MENTAL STATUS ·       Differential: stroke, medication effect, hypoxemia or hypercarbia, toxic or medication effect, endocrine/metabolic, stroke or MI, psychiatric illness, or infections, delirium ·       On the way: review PMH/PSH, recent notes for evidence of altered mentation or agitation, or signs hinting at above etiologies ·       In the room: ABCDs, focal neuro deficits?, alert/oriented? Be sure the patient’s mental status is adequate for airway protection! ·       Get more info: basic labs, blood gas/lactate, CT head noncontrast if concerned for stroke. ·       Initial management: rule out above; if concerned about delirium, optimize sleep/wake cycles, pain control, and lines/drains/tubes. OLIGURIA ·       Differential: prerenal due to hypovolemia or low effective circulating volume, intrinsic renal disease, post-renal obstruction ·       On the phone: clarify functional foley or bladder scan results, full set of vitals ·       On the way: review PMH/PSH, known injuries (known hemothorax/pneumothorax? Rib fractures? Chest tubes in already?), risk factors for DVT/PE, review I/Os for evidence of volume status, vitals and labs for evidence of infection ·       In the room: ABCDs, confirm functioning foley catheter ·       Get more info: basic labs, urine electrolytes, consider fluid challenge to evaluate responsiveness, consider adjuncts including renal US ·       Initial management: typically consider IVF bolus initially, but if patient not volume responsive, don't overload them -- look for other etiologies! TACHYCARDIA ·       Differential: sinus tachycardia (pain, hypovolemia, agitation, infection), cardiac arrhythmia, MI, PE ·       On the phone: full set of vitals, acuity of change in heart rate, updated I/Os ·       On the way: Review PMH/PSH, known cardiac history, cardiac and PE risk factors, volume resuscitation, signs concerning for infection, updated I/Os ·       In the room: ABCDs, cardiac/pulmonary exam, evaluate for any localizing signs for infection ·       Get more info: basic labs, EKG, consider CXR, troponins ·       Initial management: depends heavily on etiology Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/

  21. Intern Bootcamp: Consults (00:14:57)

    RE-RELEASE This was first published in 2023 but it's so good we are running it back! Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.  This episode, we’ll talk about how to give and receive consults in the hospital like a pro. We’ll also provide some tips on how to make those long call days a little more manageable. Hosts: Shanaz Hossain, Nina Clark Tips for New Interns:  GIVING CONSULTS Clear and Concise Question! Develop a script, such as: “Hi, this is XX with the general surgery team. We’re calling to request an evaluation for a patient presenting with XX. I can give you the MRN whenever you are ready…” Follow this with a brief H&P. If you are asking another team to perform a procedure on your patient, be prepared with the following information: NPO Status Ability to Consent or Proxy Contact Blood Thinners Urgency of Procedure RECEIVING CONSULTS Make sure you are clear on what the team is asking of you as a consultant. Clarify if the patient is expecting to receive a surgery before talking to them about an operation! Quickly gather information about the patient and their hospital course from the consultant, electronic medical record, and, most importantly, the patient! Note the callback number on the primary team and call them with the plan after you have staffed the patient with your attending. If you are asked to perform a procedure as a consultant, clarify the following information: NPO Status Ability to Consent or Proxy Contact Blood Thinners Urgency of Procedure Develop a system to stay organized and keep track of your to-do list with consults! CALL SHIFTS Bring a survival bag with toothbrush/toothpaste, face wash, deodorant, change of clothes, etc to reset. Try to nap when you can, but: PM round to address non-urgent pages ahead of time Set alarms! Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/

  22. Intern Bootcamp: Medical Students (00:17:11)

    RE-RELEASE This was first published in 2023 but it's so good we are running it back! Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.  You’ve been a doctor for about 3.5 seconds, and suddenly that bright eyed, bushy-tailed medical student on service is looking to you for advice? Don’t fret, in this episode we’ll give you some tips for how to handle it. Hosts: Shanaz Hossain, Nina Clark Tips for new interns: REMEMBER HOW INTERNS DO AND DO NOT TEACH - Nobody, not even the med students, expect you to be an expert in everything or give a fully-planned formal lecture - You WILL however spend a ton of time working with students on your team – and via modeling and teachable moments, you can help them learn how it’s done! MODELING - Remember how hard everything has been in the few days since you started residency? Think about all the information you’ve picked up, tips and tricks you’re developing for efficiency, and best practices you’re learning in the care of your patients. ALL of these are things you can pass on to students. - Presentations, case prep, answering questions from senior members of the team are ALL excellent opportunities to teach (and show students how you learn yourself, so they can do it independently). TEACHABLE MOMENTS - Find small topics that you know or are getting to know well – things like looking at a CXR, CT scan, etc. - Once you’re getting more comfortable caring for specific disease processes, think about high yield lessons for students: - Acute trauma evaluation and management (ABCDE’s), appendicitis, diverticulitis, benign biliary disease all make great 5 minute chalk talks that you can have in your back pocket IN THE OR - Watch students practice skills, and try to give some feedback and tips that you use (you learned knot tying and suturing more recently than ANYONE else in the OR and probably have some tips that you’re still using to improve) - If you’re not sure where or why the student is struggling with a particular skill (like tying a knot), model doing it yourself in slow motion while watching them do it – often the side by side comparison can help you identify where they’re going astray BE THE RESIDENT YOU WISH YOU HAD - Refer to EVERYONE with respect - Model being a kind, conscientious, and curious physician - Try to find universal lessons and crossover topics that non-surgeons need to know - A great student makes their interns look even better – be explicit about how they can be successful, then advocate for them to have opportunities to show everything they’re learning! Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/

  23. Intern Bootcamp: Resource Overload (00:18:03)

    RE-RELEASE This was first published in 2023 but it's so good we are running it back! Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.  This episode, we’ll tackle the resources that you should know about to support your own learning throughout residency. Hosts: Shanaz Hossain, Nina Clark Tips for new interns: STRUCTURE YOUR STUDYING - 2 things you need to do: (1) develop a knowledge base and (2) answer questions - Knowledge base Pick a level-appropriate textbook, read it (ideally all of it) yearly.  Ideally, lead a little bit every day - 10 pages/day is a good goal to start with and you may need to adjust.  - Questions Do some questions every week – 50/week is a good goal to start Plan to do more questions closer to ABSITE! Consider storing everything you learn in one place – either a notebook you carry with you or a cloud-based note app Share this with others, use it to take notes while reading, doing cases, getting feedback, or gaining experience while taking care of patients every day. SPECIFIC RESOURCES  - Textbooks Sabiston: big book, very dense, with a lot of great information. Schwartz: shorter chapters, clinically oriented, ideal for junior residents Cameron: shorter chapters, clinically oriented, ideal for senior residents - ABSITE review books Fiser: Classic, packed with facts but can be difficult to read, good for looking things up quickly BTK ABSITE Companion: https://www.amazon.com/Behind-Knife-ABSITE-Review-Companion-ebook/dp/B0CLBZ273F/ref=sr_1_2?crid=3382SFZ81ZHKA&keywords=absite+review+behind+the+knife&qid=1698106031&sprefix=absite+review+behind+the+knife%2Caps%2C64&sr=8-2 - Question banks TrueLearn: high quality, can be pricy depending on program  SCORE: written/edited by ABS, free for subscribing programs LEARN HOW TO OPERATE?? - Carry suture and a needle driver with you and practice basic moves - Consider a home suture kit for practice when you don’t want to be in sim lab – BTK released one this year - Use VIDEOS to ensure learning things the correct way! Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/

  24. Intern Bootcamp: The First Day (00:15:43)

    RE-RELEASE This was first published in 2023 but it's so good we are running it back! Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency. First up, the first day of intern year. Hosts: Shanaz Hossain, Nina Clark Tips for new interns: BRING WHAT YOU NEED Name badge Scrubs, white coat, and extra clinic clothes Comfortable shoes - even on clinic days Pager Phone Pen Bonus stuff that’s good to keep in your bag: Snacks, extras of everything, toothbrusth/toothpaste/deodorant, suture  STAY ORGANIZED Preround purposefully and systematically  Look at the same things in the same order every day on every patient Write data in the same physical location on your sheet so you can quickly find information on the fly  Keep track of to-do’s from rounds Check box system:  Nina’s system: empty = not done, half full = ordered/needs follow up, full = completely done and followed up on  Don’t forget to look at the results of imaging studies, labs, or consults after they are entered!  Prioritize urgent/emergent things first, then consults and discharges, then routine orders, then notesAs you get more efficient, start drafting your notes as you pre-round – it will save you lots of time later in the afternoon!  OWN THE FLOOR  During the day, be ready to shift your priorities as urgent issues arise.  Develop a system for remembering what happened after rounds so you can quickly update seniors Shanaz’s system: One color for AM rounds, a different color for afternoon events Load the boat! Your team is there to help you. If you are concerned about someone or have a question, ask. There is truly no better time than as an intern. Master the art of getting your seniors’ attention in the OR - be conscientious, be clear in what you’re asking, and be prepared to report back about urgent findings!  Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our new how-to video series on suture and knot-tying skills - https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/

  25. Journal Review in Surgical Education: Resident Autonomy in the Good Ole Days (00:40:19)

    In this surgical education episode, the Cleveland Clinic General Surgery Education Team explores the past, present, and future of resident autonomy in the operating room. With guest colorectal surgeons Dr. Tracy Hull (recently retired) and Dr. David Rosen (early career faculty), we discuss how autonomy was granted in “the good ole days,” how educational culture and institutional pressures shape current practice, and what thoughtful autonomy looks like moving forward. Through candid stories—from emergent cases and missed enterotomies to thumbtacks pulled off the wall to stop bleeding—we get a nuanced look at what surgical independence really means, and how to responsibly develop it. Join hosts Pooja Varman, MD, Judith French, PhD, and Jeremy Lipman, MD, MHPE, for this conversation about what it means to train competent, confident, and independent surgeons. Learning Objectives By the end of this episode, listeners will be able to  1.     Define operative autonomy and its educational value in surgical training 2.     Identify barriers to providing resident autonomy in modern surgical environments 3.     Discuss strategies for tailoring autonomy to the skill level and readiness of the trainee 4.     Describe approaches to communicating resident involvement to patients References 1.     Sehat AJ, Oliver JB, Yu Y, Kunac A, Anjaria DJ. Declining Surgical Resident Operative Autonomy in Acute Care Surgical Cases. J Surg Res. 2023;281(k7b, 0376340):328-334. doi:10.1016/j.jss.2022.08.041 https://pubmed.ncbi.nlm.nih.gov/36240719/ 2.     Teman NR, Gauger PG, Mullan PB, Tarpley JL, Minter RM. Entrustment of General Surgery Residents in the Operating Room: Factors Contributing to Provision of Resident Autonomy. J Am Coll Surg. 2014;219(4):778-787. doi:10.1016/j.jamcollsurg.2014.04.019 https://pubmed.ncbi.nlm.nih.gov/25158911/ 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

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