Surgical residency is hard. In some ways, intern year may be the hardest. We’ve been there. We’re a group of surgical residents formally known as the Collaboration of Surgical Education Fellows (CoSEF), a multi-institutional organization of surgical education research fellows working together to foster peer mentorship, networking, and scholarly collaboration. We’ve collectively reflected on our experiences as surgical interns across the country. Join Drs. Ananya Anand, Joe L’Huillier, and Rebecca Moreci as they discuss three tips for thriving as a surgical intern.  Hosts: –Dr. Ananya Anand, Stanford University, @AnanyaAnandMD –Dr. Joseph L’Huillier, University at Buffalo, @JoeLHuillier101 –Dr. Rebecca Moreci, Louisiana State University, @md_moreci –COSEF: @surgedfellows Learning Objectives:  Listeners will:  – List CoSEF’s three tips for thriving as a surgical intern – Challenge their definition of patient ownership – Recall the “Golden Rule” of treating others how you want to be treated – Appreciate the importance of self-care in surgical residency  References:  L’Huillier, Joseph C. MD; Lund, Sarah MD; Anand, Ananya MD; Jensen, Rachel M. MD; Williamson, Andrea J.H. MD; Clanahan, Julie M. MD, MHPE; Moreci, Rebecca MD; Gates, Rebecca S. MD, MMHPE. Thriving as a Surgical Intern: Three Tips From the Collaboration of Surgical Education Fellows (CoSEF). Annals of Surgery Open 4(3):p e306, September 2023. | DOI: 10.1097/AS9.0000000000000306 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/ Ad referenced in episode: https://jomi.com/

For patients with insufficient future liver remnant (FLR) volume, adequate hypertrophy after Portal Venous Embolization (PVE) is associated with reduced likelihood of post-operative hepatic insufficiency. But what happens when PVE isn’t enough to obtain adequate volume prior to surgery? In this episode from the HPB team at Behind the Knife, listen in on the discussion about advances in venous deprivation techniques that can potentially increase resection rates and hypertrophy  Hosts Anish J. Jain MD (@anishjayjain) is a T32 Research Fellow at the University of Texas MD Anderson Cancer Center within the Department of Surgical Oncology. Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology. He is also the associate program director of the HPB fellowship at the University of Texas MD Anderson Cancer Center.  Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center Learning Objectives: - Develop an understanding of Portal Venous Embolization (PVE)  - Develop an understanding of Sequential Hepatic Venous Embolization (HVE) - Develop an understanding of Radiological Simultaneous Porto-hepatic Venous Embolization (RASPE) - Develop an understanding of the traditional two-stage hepatectomy with PVE - Develop an understanding of the Fast Track Two-Stage Hepatectomy Papers Referenced (in the order they were mentioned in the episode): 1) Niekamp AS, Huang SY, Mahvash A, Odisio BC, Ahrar K, Tzeng CD, Vauthey JN. Hepatic vein embolization after portal vein embolization to induce additional liver hypertrophy in patients with metastatic colorectal carcinoma. Eur Radiol. 2020 Jul;30(7):3862-3868. doi: 10.1007/s00330-020-06746-4. Epub 2020 Mar 7. PMID: 32144462. 2) Laurent C, Fernandez B, Marichez A, Adam JP, Papadopoulos P, Lapuyade B, Chiche L. Radiological Simultaneous Portohepatic Vein Embolization (RASPE) Before Major Hepatectomy: A Better Way to Optimize Liver Hypertrophy Compared to Portal Vein Embolization. Ann Surg. 2020 Aug;272(2):199-205. doi: 10.1097/SLA.0000000000003905. PMID: 32675481. 3) Nishioka Y, Odisio BC, Velasco JD, Ninan E, Huang SY, Mahvash A, Tzeng CD, Tran Cao HS, Gupta S, Vauthey JN. Fast-track two-stage hepatectomy by concurrent portal vein embolization at first-stage hepatectomy in hybrid interventional radiology / operating suite. Surg Oncol. 2021 Dec;39:101648. doi: 10.1016/j.suronc.2021.101648. Epub 2021 Aug 16. PMID: 34438236. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/

The podcast covers a high-yield oral board review for surgical oncology. It includes tactics, styles, tips, and tricks to help dominate challenging scenarios. One chapter focuses on diagnosing and staging pancreatic adenocarcinoma. Another discusses patient recovery, treatment plans, and surveillance for pancreatic adenocarcinoma. There is also a chapter on determining the feasibility of surgical resection. They highlight the standard of care and surveillance monitoring for pancreatic adenocarcinoma.

This podcast focuses on Surgical Oncology Oral Board Review. It covers high-yield scenarios, tips, and tricks for passing the oral exam. The most interesting topics include the diagnosis and treatment options for ductal carcinoma in situ, discussing various treatment options, including surgery, surveillance, and radiation therapy for preventing local recurrence.

Explore common post-op cardiac surgery problems such as bleeding, low cardiac output syndrome, and post-operative atrial fibrillation. Learn about the management strategies, diagnostic tests, and treatment options for these conditions. Discover the use of mechanical circulatory support and the prophylaxis against post-operative AFib in cardiac surgery patients.

CME - What is it? Why do I need it? How do I get it?  How much do I need?  How do I keep track of credits? Listen to BTK's Dr. Kevin Kniery's interview with the CEO of ACCME, Dr. Graham McMahon, to learn about the nuts and bolts of CME as well as recent changes to the program. Helpful Links: Behind the Knife's FREE CME: https://behindtheknife.org/cme/ CME Passport: CMEpassport.org CME Passport/Behind the Knife: https://www.cmepassport.org/activity/search?specialty=behind%20the%20knife Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/

In the fifth episode of the “Innovation in Surgery” series, Dan Scheese sits down with Dr. Jeffrey Ponsky to discuss his innovation, the PEG tube. Dr. Ponsky shares many stories about his work with endoscopy in the late 1970s and how the idea for the PEG tube originated. “The Development of PEG: How it was” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136860/ “Following the light: A history of the percutaneous endoscopic gastrostomy tube” https://www.facs.org/media/cyrndd5u/07_gastrostomy_tube.pdf Dr. Ponsky completed his surgical training at University Hospitals of Cleveland in 1976. In 1979, he became the Director of the Department of Surgery at The Mount Sinai Medical Center in Cleveland, where he remained through 1997. In 1997, Dr Ponsky joined The Cleveland Clinic as the Director of Endoscopic Surgery and Executive Director of the Minimally Invasive Surgery Center. In 2005, he assumed the Oliver H. Payne Professorship and Chair of the Department of Surgery at Case Western University School of Medicine. He returned to The Cleveland Clinic as Director of Developmental Endoscopy in 2014. Dr Ponsky has served as president of many organizations including the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) and the American Society for Gastrointestinal Endoscopy (ASGE). Additionally, Dr. Ponsky has received numerous awards and has published over 300 original articles and book chapters. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other innovation episodes here: https://behindtheknife.org/podcast-series/innovations-in-surgery/

Have you ever struggled choosing which type of stoma to mature in an anatomically or medically challenging patient? What about wrestled with the associated postoperative complications? Join Drs. Galandiuk, Bolshinsky, Kavalukas, and Simon as they discuss ostomy creation and management of stoma complications. Hosts: - Susan Galandiuk MD, University of Louisville, Louisville, Kentucky, @DCREdInChief - Vladimir Bolshinsky MD, Peninsula Health, Victoria, Australia, @bolshinskyv - Sandy Kavalukas MD, University of Louisville, Louisville, Kentucky, @sandykava - Hillary Simon DO, University of Louisville, Louisville, Kentucky, @HillaryLSimon Producer: - Manasa Sunkara MS3, University of Louisville, Louisville, Kentucky, @manasasunkara12 Learning objectives:  - Review pre-operative stoma marking and ostomy education.  - Understand “bail-out” ostomy creation options in medically and anatomically challenging patients.  - Discuss common postoperative ostomy complications and management. - Review common peristomal skin pathology and treatment options.  Video References: - Colwell, Janice C. A.P.R.N., C.W.O.C.N.1; Williams, Toyia M.S.N., R.N.2. Management of the Patient With a Prolapsed Ileostomy. Diseases of the Colon & Rectum 65(12):p e1073, December 2022. | DOI: 10.1097/DCR.0000000000002605 https://www.youtube.com/watch?v=Wx83CpRLkqk  Non-operative management of stoma prolapse/reduction   - Colwell, Janice C. A.P.R.N.. Management of the Patient With a Retracted Loop Ileostomy Located in a Crease. Diseases of the Colon & Rectum 65(3):p e182-e183, March 2022. | DOI: 10.1097/DCR.0000000000002367 https://www.youtube.com/watch?v=mc6o7nG1fsQ  Management of a retracted stoma, in a crease, with peristomal skin breakdown - Watanabe, Kazuhiro M.D., Ph.D.; Kohyama, Atsushi M.D., Ph.D.; Suzuki, Hideyuki M.D., Ph.D.; Kajiwara, Taiki M.D., Ph.D.; Karasawa, Hideaki M.D., Ph.D.; Ohnuma, Shinobu M.D., Ph.D.; Kamei, Takashi M.D., Ph.D.; Unno, Michiaki M.D., Ph.D.. Slug Method: A Technique for Stoma Prolapse Reduction Using High Osmolality of the 50% Glucose Solution. Diseases of the Colon & Rectum 63(12):p e565, December 2020. | DOI: 10.1097/DCR.0000000000001798  https://cdn-links.lww.com/permalink/dcr/b/dcr_1_1_2020_09_01_watanabe_20-00282_sdc1.mp4  Osmotic reduction Other References: - Baker ML, Williams RN, Nightingale J.. Causes and management of a high-output stoma. Colorectal Dis. 2011;13(2):191–197. doi: 10.1111/j.1463-1318.2009.02107.x. - Behrenbruch, C., Carr, G., Johnston, M. and Woods, R. (2019), Three-point stapled fixation technique to manage ileostomy spout retraction. ANZ Journal of Surgery, 89: 423-424. doi: 10.1111/ans.15006 - O’Brien, Stephen J. M.B. B.Ch., B.A.O.; Ellis, C. Tyler M.D., M.S.C.R.. The Management of Peristomal Pyoderma Gangrenosum in IBD. Diseases of the Colon & Rectum 63(7):p 881-884, July 2020. | DOI: 10.1097/DCR.0000000000001701 - Paquette IM, Solan P, Rafferty JF, Ferguson MA, Davis BR.. Readmission for dehydration or renal failure after ileostomy creation. Dis Colon Rectum. 2013;56(8):974–979. doi: 10.1097/DCR.0b013e31828d02ba - Steele S, Hull Tracy, Hyman N, Maykel J, Read T, and Whitlow C. The ASCRS Textbook of Colon and Rectal Surgery. 4th Edition. Volume II. Springer, Switzerland AG, 2022. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other recent Colorectal Surgery Episodes here: https://behindtheknife.org/podcast-category/colorectal/

In this two-part episode our team debates management of complex pleural effusions and empyema. Our surgical team is joined by Dr. Jed Gorden, an interventional pulmonologist, as we explore the nuances of deciding on fibrinolytic therapy (part 1) versus surgical management (part 2). Part 1: https://behindtheknife.org/podcast/clinical-challenges-in-thoracic-surgery-complex-pleural-effusions-empyema-part-1-of-2/ Learning Objectives: -Discuss the pros and cons of small bore versus large bore chest tubes for complex pleural effusions  -Review the evidence for fibrinolytic therapy for management of complex pleural effusions -Describe the surgical management of a complex pleural effusion including VATS, open thoracotomy, empyema tube, Eloesser flap, and Clagett window -Create a framework for shared-decision making with patients regarding management of a complex pleural effusion Hosts: Kelly Daus MD, Peter White MD, Jed Gorden, MD and Brian Louie MD Referenced Material https://pubmed.ncbi.nlm.nih.gov/15745977/ Maskell NA, et al. First Multicenter Intrapleural Sepsis Trial (MIST1) Group. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005 Mar 3;352(9):865-74. doi: 10.1056/NEJMoa042473. Erratum in: N Engl J Med. 2005 May 19;352(20):2146. PMID: 15745977. https://pubmed.ncbi.nlm.nih.gov/21830966/ Rahman NM, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011 Aug 11;365(6):518-26. doi: 10.1056/NEJMoa1012740. PMID: 21830966. https://pubmed.ncbi.nlm.nih.gov/35830586/ Wilshire CL, et al. Comparing Initial Surgery versus Fibrinolytics for Pleural Space Infections: A Retrospective Multicenter Cohort Study. Ann Am Thorac Soc. 2022 Nov;19(11):1827-1833. doi: 10.1513/AnnalsATS.202108-964OC. PMID: 35830586. https://pubmed.ncbi.nlm.nih.gov/37043201/ Wilshire CL, et al. Effect of Intrapleural Fibrinolytic Therapy vs Surgery for Complicated Pleural Infections: A Randomized Clinical Trial. JAMA Netw Open. 2023 Apr 3;6(4):e237799. doi: 10.1001/jamanetworkopen.2023.7799. PMID: 37043201; PMCID: PMC10098968. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out more thoracic surgery episodes here: https://behindtheknife.org/podcast-category/cardiothoracic/

In this two-part episode our team debates management of complex pleural effusions and empyema. Our surgical team is joined by Dr. Jed Gorden, an interventional pulmonologist, as we explore the nuances of deciding on fibrinolytic therapy (part 1) versus surgical management (part 2). Learning Objectives: -Discuss the pros and cons of small bore versus large bore chest tubes for complex pleural effusions  -Review the evidence for fibrinolytic therapy for management of complex pleural effusions -Describe the surgical management of a complex pleural effusion including VATS, open thoracotomy, empyema tube, Eloesser flap, and Clagett window -Create a framework for shared-decision making with patients regarding management of a complex pleural effusion Hosts: Kelly Daus MD, Peter White MD, Jed Gorden, MD and Brian Louie MD Referenced Material https://pubmed.ncbi.nlm.nih.gov/15745977/ Maskell NA, et al. First Multicenter Intrapleural Sepsis Trial (MIST1) Group. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005 Mar 3;352(9):865-74. doi: 10.1056/NEJMoa042473. Erratum in: N Engl J Med. 2005 May 19;352(20):2146. PMID: 15745977. https://pubmed.ncbi.nlm.nih.gov/21830966/ Rahman NM, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011 Aug 11;365(6):518-26. doi: 10.1056/NEJMoa1012740. PMID: 21830966. https://pubmed.ncbi.nlm.nih.gov/35830586/ Wilshire CL, et al. Comparing Initial Surgery versus Fibrinolytics for Pleural Space Infections: A Retrospective Multicenter Cohort Study. Ann Am Thorac Soc. 2022 Nov;19(11):1827-1833. doi: 10.1513/AnnalsATS.202108-964OC. PMID: 35830586. https://pubmed.ncbi.nlm.nih.gov/37043201/ Wilshire CL, et al. Effect of Intrapleural Fibrinolytic Therapy vs Surgery for Complicated Pleural Infections: A Randomized Clinical Trial. JAMA Netw Open. 2023 Apr 3;6(4):e237799. doi: 10.1001/jamanetworkopen.2023.7799. PMID: 37043201; PMCID: PMC10098968. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out more thoracic surgery episodes here: https://behindtheknife.org/podcast-category/cardiothoracic/