You have a young patient with longstanding Crohn’s disease with a history of small bowel resections presenting with recurrent obstructions from a stricture. The patient has exhausted all medical options and requires surgery. How should you work up this patient prior to surgery? Should you perform a bowel resection or perform a strictureplasty? Which strictureplasty do you choose and why?  Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Fabrizio Michelassi as they discuss the management of small bowel strictures in Crohn’s disease.  Learning Objectives 1. Describe the evaluation for small bowel strictures and indications for operating in patients with Crohn’s disease  2. Discuss the different surgical options in managing small bowel strictures  3. Explain the rationale behind use of different strictureplasty approaches Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other Colorectal Surgery episodes here: https://behindtheknife.org/podcast-category/colorectal/

On this episode of the BIG T Trauma series Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill discuss hemodynamically unstable pelvic fractures.  These patients are sick!!  Really sick.  Join us for a practical discussion about the best way to manage gnarly pelvic fractures.  From binders to angioembolization to pelvic packing to REBOA, we cover it all.   Papers:  Burlew et al, Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures. J Trauma 2017: https://pubmed.ncbi.nlm.nih.gov/27893645/ McDonogh et al, Preperitoneal packing versus angioembolization for the initial management of hemodynamically unstable pelvic fracture: A systematic review and meta-analysis. J Trauma 2022: https://pubmed.ncbi.nlm.nih.gov/34991126/ Li et al, Role of pelvic packing in the first attention given to hemodynamically unstable pelvic fracture patients: a meta-analysis, J ournal of Orthopaedics and Traumatology 2022: https://pubmed.ncbi.nlm.nih.gov/35799073/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out the rest of the BIG T trauma series here: https://behindtheknife.org/podcast-series/big-t-trauma/

In the second episode of the “Innovations in Surgery” series, Behind the Knife’s surgical education fellow, Dr. Dan Scheese, sits down with Dr. Michael Amendola and Dr. Diana Otoya to discuss 3D Printing and its role in medicine and surgery. They speak on the history of this technology and the current utility in preoperative planning and intraoperative application.  Looking for information on getting involved in 3D Printing? Link to the VHA Office of Advanced Manufacturing: https://www.innovation.va.gov/oam/views/about/whoweare.html Link to information regarding the 3D printing fellowship: https://www.innovation.va.gov/oam/views/training/training.html Additionally, you can contact Dr. Michael Amendola or Dr. Diana Otoya for more information regarding the 3D printing surgical fellowship. Dr. Michael Amendola: michael.amendola@va.gov Dr. Diana Otoya: Diana.Otoya@vcuhealth.org Dr. Amendola also has a website for mentorship and other information: https://michaelamendola.com/ Download free 3D designs that are ready to print at https://www.thingiverse.com/ Lastly, anyone that has access to a VA can take the TMS module Dr. Amendola created. TMS: 3D Printing in the VA Health Care System: Building the Hospital of the Future. Item: 45343 Goes through history, types of printers, and basic medical information you need for 3D printing. Good intro lecture/ free education to any trainee within the VA.  https://www.tms.va.gov/SecureAuth35/ Dr. Amendola has received his medical degree, completed his general surgery residency and vascular surgery fellowship at Virginia Commonwealth University. He is board certified by the American Board of Surgery in both general and vascular surgery. In 2021 he was inducted into the American College of Surgeons Academy of Master Surgeon Educators. He maintains privileges at Central Virginia VA Health Care System in Richmond, Virginia and is a Professor of Surgery at VCU-SOM.  Additionally, he is the program director of the Office of Advance Manufacturing’s Central Virginia VA Health Care System based 3D Printing Surgical Fellowship.  Dr. Diana Otoya is a third-year general surgery resident at VCU. She spent her first research year as a Veterans Health Administration (VHA) Chief Resident in Quality and Safety at the Central Virginia Health Care System while also becoming the inaugural fellow for the VHA 3D Printing Surgical Fellowship. She is now currently in her second year in the 3D Printing fellowship program.    Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed general surgery procedures. If you are a PGY4/5 general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com, for more information on how you could be compensated up to $400 for recording and submitting those videos. Please visit https://behindtheknife.org/ to access other high-yield surgical education podcasts, videos, and more. If you liked this episode, check out our latest episodes here: https://behindtheknife.org/listen/

Join our surgical education fellow, Dr. Dan Scheese as he kicks off a brand new BTK series titled “Innovations in Surgery.” This series will take a deeper look into past, present, and future innovations that have, or will, revolutionize the field of surgery. In this inaugural episode, Dr. Scheese and Dr. Patrick Georgoff sit down with a leader in the surgical artificial intelligence field, Dr. Daniel Hashimoto. They cover what surgical artificial intelligence is, go over some common terminology used in AI, talk about current applications of AI in the OR, and finally discuss the future of AI in surgery. “Artificial Intelligence in Surgery: Promises and Perils” - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995666/ Video – Application of AI in the OR – https://youtu.be/kabcjtdI308 Daniel Hashimoto is assistant professor of surgery at the Hospital of the University of Pennsylvania and director of the Penn Computer Assisted Surgery and Outcomes (PCASO) Laboratory. He received his MD and MS in translational research from the University of Pennsylvania and completed his general surgery training at Massachusetts General Hospital and Harvard Medical School, where he was also associate director of research of the Surgical AI & Innovation Laboratory. He is vice-chair and co-founder of the Global Surgical AI Collaborative, a nonprofit that oversees and manages a global data-sharing and analytics platform for surgical data. His work focuses on the use of computer vision for the delivery of intraoperative decision support and assessment of surgical performance. He is editor of the textbook Artificial Intelligence in Surgery: Understanding the Role of AI in Surgical Practice, which provides a nontechnical foundation on key concepts in artificial intelligence as it applies to surgical care. Please visit https://behindtheknife.org/ to access other high-yield surgical education podcasts, videos, and more. If you liked this episode, check out our latest episodes here: https://behindtheknife.org/listen/

You get called to the ED to evaluate a patient with abdominal pain who is in extreme pain but without any helpful physical exam findings. Time is gut in mesenteric ischemia, so how do you prioritize your workup, initial treatment, and what do you do once you’ve made the diagnosis? In this episode of Behind the Knife, the vascular surgery team discusses all this and more by walking through a real case and talking through the principles of management as well as some helpful tips on how to actually get through these tough clinical scenarios.  Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan and the Program Director of the Integrated Vascular Surgery Residency Program as well as the Vascular Surgery Fellowship Program at the University of Michigan. Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan. Dr. Craig Brown is a PGY-7 in the General Surgery program and recently matched 2023 vascular fellow at the University of Michigan. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   Check out our Vascular Surgery Oral Board Review Book here: https://www.amazon.com/Vascular-Surgery-Oral-Board-Review/dp/0578382296/ref=sr_1_3?crid=1IF8LX547EOEA&keywords=behind+the+knife&qid=1666184084&qu=eyJxc2MiOiIxLjM3IiwicXNhIjoiMC43MCIsInFzcCI6IjAuNTgifQ%3D%3D&sprefix=behind+the+knife%2Caps%2C57&sr=8-3&ufe=app_do%3Aamzn1.fos.f5122f16-c3e8-4386-bf32-63e904010ad0

What’s the one clinical scenario where you can really save a patient’s life with a pancreatectomy? An IPMN with high-grade dysplasia! Join the Behind the Knife HPB Team for a deep dive into the complex decision-making surgical management of IPMNs. Learning Objectives In this episode, we review the basics of intraductal papillary mucinous neoplasms, how to evaluate patients with a cystic mass of the pancreas, guidelines for surveillance, and indications for resection. We discuss key concepts such as Worrisome Features and High-Risk Stigmata and how those influence surgical decision-making, and tackle a few of the most challenging scenarios surgeons may face when treating patients with IPMNs.   Hosts: Timothy Vreelant, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center Daniel Nelson, DO, FACS (@DWNelsonHPB) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center Connor Chick, MD (@connor_chick) is a PGY-6 General Surgery resident at Brooke Army Medical Center Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-5 General Surgery resident at Brooke Army Medical Center Beth Carpenter, MD (@elizcarpenter16) is a PGY-4 General Surgery resident at Brooke Army Medical Center Links to Papers Referenced in this Episode Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas Pancreatology. 2017 Sep-Oct;17(5):738-753. https://pubmed.ncbi.nlm.nih.gov/28735806/ Number of Worrisome Features and Risk of Malignancy in Intraductal Papillary Mucinous Neoplasm.  J Am Coll Surg. 2022 Jun 1;234(6):1021-1030.  https://pubmed.ncbi.nlm.nih.gov/35703792/ Extent of Surgery and Implications of Transection Margin Status after Resection of IPMNs.  Gastroenterology Research and Practice 2014, 1–10. https://pubmed.ncbi.nlm.nih.gov/25276122/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other Hepatobiliary Surgery episodes here: https://behindtheknife.org/podcast-category/hepatobiliary/

Gallbladders – bread and butter cases or underestimated challenges? Join Dr. Patrick Georgoff and Dr. Shanaz Hossain as they sit down with Dr. Eric Knauer to discuss difficult gallbladders. In this episode, we discuss the SAGES Safe Cholecystectomy program that were created in an effort to decrease the incidence of bile duct injuries. The six strategies outlined in the program include:  1.    Use the Critical View of Safety (CVS) method of identification of the cystic duct and cystic artery during laparoscopic cholecystectomy. 2.    Understand the potential for aberrant anatomy in all cases. 3.    Make liberal use of cholangiography or other methods to image the biliary tree intraoperatively. 4.    Consider an Intra-operative Momentary Pause during laparoscopic cholecystectomy prior to clipping, cutting or transecting any ductal structures. 5.    Recognize when the dissection is approaching a zone of significant risk and halt the dissection before entering the zone. Finish the operation by a safe method other than cholecystectomy if conditions around the gallbladder are too dangerous. a.    Subtotal Cholecystectomies – Learn more with this landmark paper: http://dx.doi.org/10.1016/j.jamcollsurg.2015.09.019 6.    Get help from another surgeon when the dissection or conditions are difficult. Take a look at all their great explanations and catch all the important points by completing the online program: https://www.sages.org/safe-cholecystectomy-program/ Dr. Eric Knauer is an assistant professor surgery at Emory University. He has recently published regarding the management of laparoscopic common bile duct stones in General Surgery News and, more importantly, was awarded the junior residents’ teaching award. Check out his great educational videos to learn more: ·      Cholecystectomy: https://youtu.be/_oMNRINPY5I Laparoscopic Common Bile Duct Exploration: https://youtu.be/mXl11I7mya0 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other hepatobiliary episodes here: https://behindtheknife.org/podcast-category/hepatobiliary/

Does surgery have a leaky pipeline problem?  What is it like for LGBTQ+ students, trainees, and faculty to be in the field of surgery?  In this Journal Club episode, we review recent research and calls to action that illuminate these and other questions in the field.  We’re joined by a panel of guests from all levels of training, including Eric Pillado MD MS, Christopher Digesu MD, Jessica Halem MBA, and Michaela West MD PhD.  Learning Objectives: ·       Identify hazards for LGBTQ+ trainees in surgery ·       Describe potential actions to improve LGBTQ+ inclusivity in surgery ·       Correlate the provision of LGBTQ+ health care and the wellbeing of LGBTQ+ staff References: Experiences of LGBTQ+ Residents in US General Surgery Training Programs - https://doi.org/10.1001/jamasurg.2021.5246  Invited Commentary - Discrimination, Harassment, and Bullying Is Reported to Be High by LGBTQ+ Surgical Residents – https://doi.org/10.1001/jamasurg.2021.5272  LGBTQ+ Inclusivity in Surgery—A Call to Action – https://doi.org/10.1001/jamasurg.2021.6777  Being queer without proximal or distal control - https://vascularspecialistonline.com/being-queer-without-proximal-or-distal-control/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other Surgical Education episodes here:  https://behindtheknife.org/podcast-category/surgical-education/

In this episode, our team discusses the management of traumatic rib fractures including pearls and pitfalls. Join as we discuss the current standards of treatment as well as controversies in how to manage these patients! Hosts:  Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST) and incoming editor-in-chief of Trauma Surgery and Acute Care Open. Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.  David Sigmon, MD, MMEd, a PGY-7 resident at the University of Illinois at Chicago who will be a fellow at Lincoln Medical Center in the Bronx next year. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.  LITERATURE Terry SM, Shoff KA, Sharrah ML. Improving blunt chest wall injury outcomes: introducing the pic score. J Trauma Nurs. 2021;28(6):386-394. https://pubmed.ncbi.nlm.nih.gov/34766933/ Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surg Acute Care Open. 2017;2(1):e000064. https://tsaco.bmj.com/content/2/1/e000064 Utter GH, McFadden NR. Rib fractures, the evidence supporting their management, and adherence to that evidence base. JAMA Netw Open. 2020;3(3):e201591-e201591. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2763488 Dehghan N, Nauth A, Schemitsch E, et al. Operative vs nonoperative treatment of acute unstable chest wall injuries: a randomized clinical trial. JAMA Surgery. Published online September 21, 2022. https://jamanetwork.com/journals/jamasurgery/article-abstract/2796556 Kasotakis G, Hasenboehler EA, Streib EW, et al. Operative fixation of rib fractures after blunt trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):618-626. https://pubmed.ncbi.nlm.nih.gov/28030502/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other trauma episodes here: https://behindtheknife.org/podcast-category/trauma/

On the University of Washington Minimally Invasive Surgery team’s search for value no piggy bank is safe and no couch cushion will be left unturned. Tune in to hear Drs. Mike Weykamp, Nicole White, Nick Cetrulo, and Andrew Wright discuss the state of the literature regarding the cost-effectiveness of robot assisted surgery.  Referenced Articles:  1.     Ye L, Childers CP, de Vigilio M, Shenoy R, Mederos MA, Mak SS, Begashaw MM, Booth MS, Shekelle PG, Wilson M, Gunnar W, Girgis MD, Maggard-Gibbons M. Clinical Outcomes and Cost of Robotic Ventral Hernia Repair: Systematic Review. BJS Open. 2021.  https://pubmed.ncbi.nlm.nih.gov/34791049/  2.     Finlayson SRG and Birkmeyer JD. Cost-effectiveness Analysis in Surgery. Surgery. 1998 https://pubmed.ncbi.nlm.nih.gov/9481400/ 3.     Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, Caulley L, Chaiyakunapruk N, Greenberg D, Loder E, Mauskopf J, Mullins CD, Petrou S, Pwu R, Staniszewska S. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 Explanation and Elaboration: A Report of the ISPOR CHEERS II Good Practices Task Force. Value Heatlh. 2022.  https://pubmed.ncbi.nlm.nih.gov/35031088/  Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed general surgery procedures. If you are a PGY4/5 general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com, for more information on how you could be compensated up to $400 for recording and submitting those videos. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other minimally invasive episodes here: https://behindtheknife.org/podcast-category/minimally-invasive/