Behind The Knife: The Surgery Podcast

Join Drs. Michael Rosen, Clayton Petro, and Sara Maskal as they review their recently published randomized controlled trial comparing open retromuscular Sugarbaker and Keyhole approaches to parastomal hernia repair   Hosts:    - Sara Maskal, MD, Cleveland Clinic  - Clayton Petro, MD, Cleveland Clinic  - Michael Rosen, MD, Cleveland Clinic  Learning Objectives:   - Understand the trial design - Review trial outcomes - Understand how to apply the outcomes to patients with parastomal hernias References:  - Maskal SM, Ellis RC, Fafaj A, et al. Open Retromuscular Sugarbaker vs Keyhole Mesh Placement for Parastomal Hernia Repair: A Randomized Clinical Trial. JAMA Surg. Published online June 12, 2024. doi:10.1001/jamasurg.2024.1686 https://pubmed.ncbi.nlm.nih.gov/38865142/ - Maskal SM, Thomas JD, Miller BT, Fafaj A, Zolin SJ, Montelione K, Ellis RC, Prabhu AS, Krpata DM, Beffa LR, Costanzo A. Open retromuscular keyhole compared with Sugarbaker mesh for parastomal hernia repair: Early results of a randomized clinical trial. Surgery. 2024 Mar 1;175(3):813-21. https://pubmed.ncbi.nlm.nih.gov/37770344/ - Moreno-Matias J, Serra-Aracil X, Darnell-Martin A, Bombardo-Junca J, Mora-Lopez L, Alcantara-Moral M, Rebasa P, Ayguavives-Garnica I, Navarro-Soto S. The prevalence of parastomal hernia after formation of an end colostomy. A new clinico-radiological classification. Colorectal Dis. 2009 Feb;11(2):173-7. doi: 10.1111/j.1463-1318.2008.01564.x. Epub 2008 May 3. PMID: 18462232. https://pubmed.ncbi.nlm.nih.gov/18462232/ ***SPECIALTY TEAM APPLICATION LINK: https://docs.google.com/forms/d/e/1FAIpQLSdX2a_zsiyaz-NwxKuUUa5cUFolWhOw3945ZRFoRcJR1wjZ4w/viewform?usp=sharing Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

You are planning to perform an APR on a patient with rectal cancer. How will you create your permanent stoma? Is there a role for prophylactic mesh? Post operatively at one year surveillance they have developed a parastomal hernia, when do you fix it and how? Join Drs. Abelson, Marcello and Aulet and special guest Dr. Paul Sturrock as they discuss key management considerations.  Learning Objectives: 1.     Describe the different types of parastomal hernia repairs 2.     List indications for repair of parastomal hernias 3.     Discuss the approach to managing parastomal hernias Articles: Steele S, et al. The ASCRS Textbook of Colon and Rectal Surgery, fourth ed. 2022.  https://link.springer.com/book/10.1007/978-3-030-66049-9 J C Goligher, Extraperitoneal colostomy or ileostomy, British Journal of Surgery, Volume 46, Issue 196, September 1958, Pages 97–103, https://doi.org/10.1002/bjs.18004619602   ***SPECIALTY TEAM APPLICATION LINK: https://docs.google.com/forms/d/e/1FAIpQLSdX2a_zsiyaz-NwxKuUUa5cUFolWhOw3945ZRFoRcJR1wjZ4w/viewform?usp=sharing Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

In this episode, Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill are joined by special guest Dr. Pat Murphy, who helps us delve into the evolving field of acute care surgery (ACS), exploring its history, challenges, and the nuances of defining full-time employment in this demanding specialty. The discussion highlights the origins of ACS as a response to unmet emergency surgical needs and its three foundational pillars: trauma surgery, emergency general surgery, and surgical critical care, with additional roles like surgical rescue evolving over time. Dr. Murphy share insights into the workload, including night shifts, call schedules, and the toll on surgeons' health, emphasizing the importance of fair compensation, equitable shift distribution, and transparency in job expectations. The episode underscores the value ACS surgeons bring to hospitals, likening them to essential infrastructure like firefighters, with their impact often unrecognized in traditional productivity metrics like RVUs.    Dr. Murphy would like to thank the many collaborators who made this volume of work possible including the many acute care surgeons who have taken the time to participate in the research and their dedication to patient care and surgeon wellbeing Learning Objectives: 1)        Define and understand the evolution of acute care surgery as a surgical subspecialty, including its historical development, key components (trauma, surgical critical care, emergency general surgery, surgical rescue), and its unique role within the surgical landscape. 2)        Analyze the concept of "full-time equivalent" (FTE) for acute care surgeons, considering factors such as call schedules, shift length, service demands, and the impact of varying case volumes and intensities on workload. 3)        Discuss the challenges of defining and measuring the value of acute care surgeons, considering factors beyond traditional productivity metrics (e.g., RVUs) such as the impact of surgical rescue, patient safety, and the value of 24/7 availability in preventing adverse outcomes. 4)        Explore the importance of recognizing the unique demands and contributions of acute care surgeons, including the impact of high-stress environments, irregular schedules, and the importance of work-life balance and clinician well-being on long-term sustainability within the specialty. 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. ***SPECIALTY TEAM APPLICATION LINK: https://docs.google.com/forms/d/e/1FAIpQLSdX2a_zsiyaz-NwxKuUUa5cUFolWhOw3945ZRFoRcJR1wjZ4w/viewform?usp=sharing 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 BIG T Trauma Series: https://app.behindtheknife.org/podcast-series/big-t-trauma

Dr. Michael Ujiki, a leading minimally invasive surgeon, shares insights on the necessity for surgeons to master endoscopic skills, highlighting how these techniques evolve surgery towards less invasive solutions. Dr. H. Masson Hedberg emphasizes the enhanced anatomical understanding gained through endoscopy, promoting a well-rounded surgical approach. Dr. Trevor Crafts discusses his fellowship experiences with therapeutic endoscopy and the growing demand for these skills in future surgical practices, showcasing innovative case management techniques throughout.

In this episode, Behind the Knife fellow Ayman Ali, and Dr. Patrick Georgoff introduce a new series on Behind the Knife – Artificial Intelligence for the Clinician. Over the course of a few episodes, we aim to go over all things AI, with a particular focus on how you can use AI today to enhance your quality of life as a clinician, with just enough detail to understand key concepts.  This first episode features guest Dr. Monica Agrawal, an expert in artificial intelligence and a pioneer in large language models. She recently joined Duke after completing a PhD in Computer Science at MIT in the clinical machine learning group and is a co-founder of Layer Health, a healthcare AI company. With her expertise, we’ll define some key terms and give a brief introduction to what artificial intelligence is and is not, as well as some examples and use cases.  ***SPECIALTY TEAM APPLICATION LINK: https://docs.google.com/forms/d/e/1FAIpQLSdX2a_zsiyaz-NwxKuUUa5cUFolWhOw3945ZRFoRcJR1wjZ4w/viewform?usp=sharing 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

Research is so critical to the field of surgery worldwide. But how does the world of academic surgery compare in the UK? Join BTK fellow Jon Williams and ASGBI partner Jared Wohlgemut  for another installment of our BTK/ASGBI collaborative series where we take a deep dive investigating the many facets of surgical research–everything from getting started, funding, collaboration, mentorship, and sage advice from two incredibly successful academic surgeons. Professor Susan Moug represents the UK while Dr. Lesly Dossett represents the US in this excellent episode for any trainee or surgeon who is academically-inclined. After listening, you get to decide–who does it better?? UK or US? Professor Moug is an Honorary Professor at the University of Glasgow, Scotland. She is a Consultant Colorectal and Robotic surgeon at Golden Jubilee National University Hospital in Clydebank, and at the Royal Alexandra Hospital in Paisley, Scotland. She is also the Director of Research for the Association of Surgeons of Great Britain and Ireland since 2021, and the Surgical Specialty Lead for Colorectal Research at the Royal College of Surgeons of England. She has been awarded a Senior Fellowship from the Chief Scientist Office of the Scottish Government, and was the chief investigator for the Emergency Laparotomy in Frailty multicentre study, and the No-Laps follow-on study. Essentially, she is one of the leading researchers in emergency surgery in the UK, having been awarded over 1 million in grant funding for this under-researched and underfunded area. Dr. Dossett is an associate professor and surgical oncologist at the University of Michigan. After completing her undergraduate degree at Western Kentucky University, She completed both medical school and her general surgery residency at Vanderbilt University in Nashville, TN, during which she obtained an Agency for Healthcare Research and Quality training grant as well as a Masters in Public Health during research time. Following residency, she served as an active duty staff surgeon in the US Navy for several years before pursuing surgical oncology fellowship training at Moffitt Cancer Center. In 2016 she came on to University of Michigan as faculty and has since held numerous academic leadership roles both institutionally and nationally, including vice chair for faculty development, chief of the division of surgical oncology, and president of the Surgical Outcomes Club. Dr. Dossett has an impressive portfolio of research work focusing on implementation and de-implementation of comprehensive cancer care, which is funded through multiple NIH grants.  If you enjoyed this episode, stay tuned for more upcoming BTK/ASGBI collaborative content. If you have any questions or comments, please feel free to reach out to us at hello@behindtheknife.org.  ***SPECIALTY TEAM APPLICATION LINK: https://docs.google.com/forms/d/e/1FAIpQLSdX2a_zsiyaz-NwxKuUUa5cUFolWhOw3945ZRFoRcJR1wjZ4w/viewform?usp=sharing

Join University of Washington’s surgical palliative care team for another engaging role play episode, where we tackle the challenging goals-of-care conversation. Using the VitalTalk REMAP framework, we explore effective communication strategies, highlight common pitfalls, and simulate two real-world scenarios: an on-call surgeon discussing goals of care with a complex patient facing an emergent surgical issue, and a team member facilitating a family meeting about goals of care in the surgical ICU. Hosts:  Dr. Katie O’Connell (@katmo15) is an associate professor of surgery at the University of Washington. She is a trauma surgeon, palliative care physician, director of surgical palliative care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA. Dr. Ali Haruta is an assistant professor of surgery at the University of Washington. She is a trauma and emergency general surgeon and palliative care physician. Ali recently completed fellowships in palliative care at the University of Washington and Trauma and Critical Care fellowship at Parkland.  Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY6 general surgery resident at the University of Washington, with an interest in surgical oncology.  Dr. Virginia Wang is a PGY3 general surgery resident at the University of Washington. Learning Objectives: • Identify questions that elicit patients’ goals and values, particularly during emotionally charged conversations.   • Name the three categories of patient values in the values triad. • Describe the importance of aligning with patients’ and families’ values and demonstrate techniques to achieve alignment.   • Develop a treatment plan that reflects patients’ stated values.   References: “REMAP.” VitalTalk. Accessed December 2nd. https://www.vitaltalk.org/guides/transitionsgoals-of-care/ ***SPECIALTY TEAM APPLICATION LINK: https://docs.google.com/forms/d/e/1FAIpQLSdX2a_zsiyaz-NwxKuUUa5cUFolWhOw3945ZRFoRcJR1wjZ4w/viewform?usp=sharing

Discover the key to mastering the Glasgow Coma Scale and preventing secondary brain injuries. Learn about ARDS diagnosis and severity grading. Dive into the world of topical burn agents and their effects. Explore crucial concepts in ICU nutrition including the respiratory quotient. Get insights on managing rectal injuries and hepatic bleeding in trauma cases. Plus, uncover strategies for renal lacerations and aortic dissection. This episode is packed with high-yield surgical insights to enhance your exam prep!

Dive into a whirlwind of surgical knowledge, covering esophageal anatomy and ideal surgical access points. Unpack the complexities of Zenker's diverticulum and its repair, alongside the latest in esophageal cancer epidemiology. Explore the intricacies of stomach blood supply and the vital role of parietal cells in acid secretion. Tune in for insights on post-gastric bypass nutrient deficiencies and hepatic anatomy, with a focus on liver tumors and essential management strategies. This episode is packed with high-yield surgical education!

In this discussion, Nina Clark, a surgical education fellow specializing in hematology and vascular topics, and Dan Sheese, focusing on small intestine and colorectal areas, dive deep into essential ABSITE knowledge. Nina breaks down complex concepts like congenital hypercoagulability and HIT management, while Dan highlights nutrient absorption in the small bowel and key colorectal cancer screening guidelines. They cover critical examination topics, including carotid stenosis interventions and the rules of Meckel's diverticulum, making this a high-yield learning session for aspiring surgeons.