Behind The Knife: The Surgery Podcast

Our oral board review course includes 92 scenarios that meticulously cover 115 SCORE core topics. 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. Learn more about the Oral Board Review episodes at https://behindtheknife.org/premium/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Our oral board review course includes 92 scenarios that meticulously cover 115 SCORE core topics. 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. Learn more about the Oral Board Review episodes at https://behindtheknife.org/premium/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Description: Metachronous colorectal liver metastasis (CRLM) is a complex clinical situation requiring multidisciplinary management. In this episode from the Hepato-Pancreato-Biliary team at Behind the Knife, we discuss a patient presenting with metachronous CRLM and how management may change with varying clinical scenarios.  Learning Objectives: In this episode, we review the initial workup and pre-operative considerations in a patient presenting with metachronous CRLM.  We discuss key aspects of resectability of CRLM, including physiologic and hepatic fitness, biology of the disease, and technical considerations.  We review the timing and common regimens of systemic treatment for differing clinical scenarios, as well as when adjuncts to treatment may be useful (e.g., portal venous embolization).  Finally, we highlight important aspects of intraoperative and postoperative management. Hosts: Timothy Vreeland, MD, FACS (@vreelant) is an Associate 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-5 General Surgery resident at Brooke Army Medical Center Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-4 General Surgery resident at Brooke Army Medical Center Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-3 General Surgery resident at Brooke Army Medical Center  Links to Papers Referenced in this Episode: NCCN Guidelines for Colon Cancer https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf Mutation Status of RAS, TP53, and SMAD4 is Superior to Mutation Status of RAS Alone for Predicting Prognosis after Resection of Colorectal Liver Metastases. Clin Cancer Res. 2019 Oct 1;25(19):5843-5851. doi: 10.1158/1078-0432.CCR-19-0863. Epub 2019 Jun 20. PMID: 31221662; PMCID: PMC6774854. https://pubmed.ncbi.nlm.nih.gov/31221662/ Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2013 Nov;14(12):1208-15. doi: 10.1016/S1470-2045(13)70447-9. Epub 2013 Oct 11. PMID: 24120480. https://pubmed.ncbi.nlm.nih.gov/24120480/ FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as first-line treatment of patients with metastatic colorectal cancer: updated overall survival and molecular subgroup analyses of the open-label, phase 3 TRIBE study. Lancet Oncol. 2015 Oct;16(13):1306-15. doi: 10.1016/S1470-2045(15)00122-9. Epub 2015 Aug 31. PMID: 26338525. https://pubmed.ncbi.nlm.nih.gov/26338525/ Phase II Randomized Trial of Sequential or Concurrent FOLFOXIRI-Bevacizumab Versus FOLFOX-Bevacizumab for Metastatic Colorectal Cancer (STEAM). Oncologist. 2019 Jul;24(7):921-932. doi: 10.1634/theoncologist.2018-0344. Epub 2018 Dec 14. PMID: 30552157; PMCID: PMC6656450. https://pubmed.ncbi.nlm.nih.gov/30552157/ Bevacizumab plus mFOLFOX-6 or FOLFOXIRI in patients with initially unresectable liver metastases from colorectal cancer: the OLIVIA multinational randomised phase II trial. Ann Oncol. 2015 Apr;26(4):702-708. doi: 10.1093/annonc/mdu580. Epub 2014 Dec 23. PMID: 25538173. https://pubmed.ncbi.nlm.nih.gov/25538173/ Recommended Additional Podcasts on CRLM: The AHPBA Podcast: 1.     Episode 1: Dr. Jean Nicolas Vauthey - Colorectal Liver Metastases (https://podcasts.apple.com/us/podcast/episode-1-dr-jean-nicolas-vauthey-colorectal-liver/id1501441845?i=1000467381474) 2.     Episode 12:Dr D'Angelica - Colorectal Liver Metastases and Hepatic Artery Infusion Pumps (https://podcasts.apple.com/us/podcast/episode-12-dr-dangelica-colorectal-liver-metastases/id1501441845?i=1000521718184) Behind the Knife: 1.     Surgical Oncology-Hepatic Artery Infusion Pump (https://podcasts.apple.com/ye/podcast/surgical-oncology-hepatic-artery-infusion-pump/id980990143?i=1000525833877) Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Few audiences appreciate the importance of a properly functioning sphincter like surgeons. Magnetic sphincter augmentation using the LINX device, however, is one area that is beyond the sphincter-related expertise of most surgeons and surgical trainees. Drs. Mike Weykamp, Nicole White, Andrew Wright, and Nick Cetrulo review the literature surrounding the use of the LINX device for gastroesophageal reflux disease and how the device stacks up against the current gold standard in anti-reflux surgery, laparoscopic fundoplication, on this journal review episode of Behind the Knife.  References:  1. Skubleny D, Switzer NJ, Dang J, et al. LINX(®) magnetic esophageal sphincter augmentation versus Nissen fundoplication for gastroesophageal reflux disease: a systematic review and meta-analysis. Surg Endosc. Aug 2017;31(8):3078-3084. doi:10.1007/s00464-016-5370-3 2. Bonavina L, Horbach T, Schoppmann SF, DeMarchi J. Three-year clinical experience with magnetic sphincter augmentation and laparoscopic fundoplication. Surg Endosc. Jul 2021;35(7):3449-3458. doi:10.1007/s00464-020-07792-1 3. Ferrari D, Asti E, Lazzari V, Siboni S, Bernardi D, Bonavina L. Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease. Sci Rep. Aug 13 2020;10(1):13753. doi:10.1038/s41598-020-70742-3 4. Alicuben ET, Bell RCW, Jobe BA, et al. Worldwide Experience with Erosion of the Magnetic Sphincter Augmentation Device. J Gastrointest Surg. Aug 2018;22(8):1442-1447. doi:10.1007/s11605-018-3775-0 5. Perry KA. Alternatives to Fundoplication. Presented at SAGES Meeting 2018/16th World Congress of Endoscopic Surgery. April 2018.  Hyperlink: https://www.youtube.com/watch?v=GXczKZxOg9Y 6. Dominguez RV. LINX in GERD. The evolution of the technique. From none to full dissection of the crura. Presented at SAGES Meeting April 2019.  Hyperlink: https://www.youtube.com/watch?v=uhhXZmsBd5c Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

In this episode, our team discusses the management of penetrating liver trauma both before, during, and after surgery. Listen in for helpful tips such as how to perform an intraoperative air cholangiogram, creating an occlusion catheter from a red rubber and a Penrose, and much more! 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).  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-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. 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 1.     Murphy PB, de Moya M, Karam B, et al. Optimal timing of venous thromboembolic chemoprophylaxis initiation following blunt solid organ injury: meta-analysis and systematic review. Eur J Trauma Emerg Surg. Published online September 18, 2021. https://pubmed.ncbi.nlm.nih.gov/34537859/ 2.     Kozar RA, Crandall M, Shanmuganathan K, et al. Organ injury scaling 2018 update: Spleen, liver, and kidney. J Trauma Acute Care Surg. 2018;85(6):1119-1122. https://pubmed.ncbi.nlm.nih.gov/30462622/ 3.     Kodadek LM, Efron DT, Haut ER. Intrahepatic balloon tamponade for penetrating liver injury: rarely needed but highly effective. World J Surg. 2019;43(2):486-489. https://pubmed.ncbi.nlm.nih.gov/30280221/ 4.     EAST Practice Management Guidelines: Selective Nonoperative Management of Hepatic Injury, Blunt https://www.east.org/education-career-development/practice-management-guidelines/details/hepatic-injury-blunt-selective-nonoperative-management-of 5.     WEST Nonoperative Management of Adult Blunt Hepatic Trauma Algorithm https://www.westerntrauma.org/wp-content/uploads/2020/08/Non-Operative-Management-of-Adult-Blunt-Hepatic-Trauma-Algorithm_FINAL.svg 6.   THE JOURNAL OF TRAUMA AND ACUTE CARE SURGERY 3-MINUTE EXPERT CONSULT VIDEO: “BALLOON TAMPONADE FOR PENETRATING LIVER TRAUMA. https://journals.lww.com/jtrauma/Pages/videogallery.aspx?videoId=13 7.     Coccolini F, Coimbra R, Ordonez C, et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020;15:24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106618/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

What is one of the most energy-intensive and waste-generating areas of the hospital? The operating room! In the new BTK/Annals of Surgery Journal Club, we talk to Dr. Elizabeth Yates and Dr. Louis Nguyen about their new article – “Empowering Surgeons, Anesthesiologists, and Obstetricians to Incorporate Environmental Sustainability in the Operating Room.” They review the impact ORs have on the environment, the consequences this has for patients, and ways surgeons lead efforts to “green” the operating room. As the topic of environmental sustainability becomes a growing concern with each passing year, the surgical workplace is going to play a big role in moving in the right direction. Join us for a great discussion!   Dr. Yates earned her medical degree from the University of Michigan Medical School. She is currently a General Surgery resident at Brigham and Women’s Hospital where she is now completing two years of protected research time at the Center for Surgery and Public Health while also pursuing a Masters in Public Health focused on Occupational and Environmental Health. She conducts interdisciplinary research examining the interface between surgery, sustainability, and climate change. Dr. Nguyen is a vascular surgeon at Brigham and Women’s Hospital and associate professor of surgery at Harvard Medical School. He earned his medical and business degrees from the University of Chicago Pritzker School of Medicine, completed his General Surgery residency at Barnes-Jewish Hospital in St. Louis, and completed a vascular surgery fellowship at the Brigham as well. He also currently serves as Vice Chair of Digital Health Systems in the Department of surgery. He is a recognized leader in health services research and outcomes implementation, where he utilizes econometric analyses to better understand clinical outcomes. Link to article: https://journals.lww.com/annalsofsurgery/Abstract/2021/06000/Empowering_Surgeons,_Anesthesiologists,_and.15.aspx Climate change and equity issues permeate all aspects of our life and work.  If you are (or know) a current general surgery resident, help us understand the equity and environmental impacts of residency interviews! https://redcap.link/gensurginterview Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

In this episode we will explore two challenging transplant surgery cases. In the first, we discuss Nutcracker syndrome and the unique ethical questions that accompanied a living donor case. In the second, we examine a perplexing post-operative development in a complicated liver transplant patient.  Learning Objectives ·       Understand the presentation and general treatment strategies for renal nutcracker syndrome ·       Discuss protocol and ethical considerations for living donor renal transplants ·       Review portal hypertension physiology, clinical manifestations, and options for treatment Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Chemotherapy or surgery first? What is the contemporary management for patients with locally advanced, resectable gastric cancer, and what does the data show? In this episode from the Surgical Oncology team at Behind the Knife, join the discussion on perioperative treatment of locally advanced gastric cancer and future advances that will benefit surgical patients.  Learning Objectives:  In this episode, we review perioperative chemotherapy regimens for locally advanced, resectable Gastric cancer, standard of care, and the future role for immunotherapy.  Hosts:  Adam Yopp, MD, FACS (@AdamYopp) is an Assistant Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program. Caitlin Hester, MD (@CaitlinAHester) is a 2nd Year Complex General Surgical Oncology Fellow at the MD Anderson Cancer Center. Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-3 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research. Papers Referenced in this Episode: Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial Al Batran et al https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32557-1/fulltext Efficacy and Safety of Pembrolizumab or Pembrolizumab Plus Chemotherapy vs Chemotherapy Alone for Patients With First-line, Advanced Gastric Cancer. The KEYNOTE-062 Phase 3 Randomized Clinical Trial Shitara et al https://jamanetwork.com/journals/jamaoncology/fullarticle/2769922 First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial Janjigian et al https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00797-2/fulltext Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss neuroblastoma management in pediatric surgery. Journal Article links:  Croteau N, Nuchtern J, LaQuaglia MP. Management of Neuroblastoma in Pediatric Patients. Surg Oncol Clin N Am 2021;30(2):291-304. https://pubmed.ncbi.nlm.nih.gov/33706901/ Madonna MB, Newman E. Handbook for Children with Neuroblastoma. Updated Spring 2018. Cancer Committee American Pediatric Surgical Association. 2018. https://www.pedsurglibrary.com/apsa/ub?cmd=repview&type=682-76&name=4_1884004_PDF https://www.pedsurglibrary.com/apsa/ub?cmd=repview&type=682-76&name=4_1884004_PDF Newman EA, Abdessalam S, Aldrink JH, Austin M, Heaton TE, Bruny J, et al. Update on neuroblastoma. J Pediatr Surg 2019;54(3):383-9. https://pubmed.ncbi.nlm.nih.gov/30305231/ Nuchtern JG, London WB, Barnewolt CE, Naranjo A, McGrady PW, Geiger JD, et al. A prospective study of expectant observation as primary therapy for neuroblastoma in young infants: a Children's Oncology Group study. Ann Surg 2012;256(4):573-80. https://pubmed.ncbi.nlm.nih.gov/22964741/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

You are faced with a young patient with low rectal cancer who is a complete responder to neoadjuvant chemoradiotherapy. He asks if he should undergo surgical resection despite the absence of visible tumour. How do you approach such a question?  Join Dr. Carole Richard, Dr. François Dagbert and Dr. Maher Al Khaldi in their conversation about the Watch and Wait strategy for rectal cancer, also known as the Organ Preservation strategy.  Learning objectives  -       To understand the rationale for Watch and Wait Strategy and the proportion of patients who become complete clinical responders.  -       To explain how patients under the Watch and Wait Strategy protocol should be followed up and when to consider a patient a clinical nonresponder. -       To understand the inclusion criteria for patients in the Watch and Wait Strategy References In order throughout the episode [1–3]: 1. Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U, Sousa AHS e, et al. Operative Versus Nonoperative Treatment for Stage 0 Distal Rectal Cancer Following Chemoradiation Therapy. Transactions Meet Am Surg Assoc. 2004;122(NA;):309–16. 2. Valk MJM van der, Hilling DE, Bastiaannet E, Kranenbarg EM-K, Beets GL, Figueiredo NL, et al. Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study. Lancet. 2018;391(10139):2537–45. 3. Fernandez LM, Julião GPS, Figueiredo NL, Beets GL, Valk MJM van der, Bahadoer RR, et al. Conditional recurrence-free survival of clinical complete responders managed by watch and wait after neoadjuvant chemoradiotherapy for rectal cancer in the International Watch & Wait Database: a retrospective, international, multicentre registry study. Lancet Oncol. 2021;22(1):43–50. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.