The podcast discusses the multidisciplinary management of triple negative breast cancer. Topics covered include diagnostic workup, chemotherapy regimens and immunotherapy, surgical approaches and breast reconstruction, and surveillance and follow-up recommendations for patients.

Medical students - do you want to DOMINATE your surgery clerkship?  Of course you do!  Tune in and find out how.  In this episode we introduce Behind the Knife’s 5 Principles for Clerkship DOMINATION, we hear from clerkship directors at top-notch surgery programs around the country, and we review the primary learning environments in surgery and how you can excel in each of these environments.   Hosts: Drs. Patrick Georgoff (@georgoff) and Amir Motameni (@motameniA) Special guests: Drs. Gifty Kwakye, Luigi Pascarella, Mackenzie Cook, and Alodia Gabre-Kidan.  Behind the Knife’s 5 Principles for Clerkship DOMINATION:  1.  Be prepared 2. Take a proactive role in your education 3. Show enthusiasm and be engaged 4. Give quality presentations with thoughtful assessments and plans 5. Seek out feedback and incorporate it into what you do. Systems based surgery plan: •Neuro: Pain control, unneeded narcotics, sleep, home psych meds  •Cardiovascular: HR, BP, home cardiac meds •Pulmonary: Supplemental O2, pulmonary toilet (e.g. incentive spirometry), home inhalers •GI: Diet, return of bowel function, bowel regimen, ostomy care •GU/FEN: Urine output, foley catheter, IV fluids, electrolytes  •Endocrine: Blood glucose •ID: Identify and treat infections, duration of antibiotics  •Heme: DVT chemoprophylaxis, anemia •Skin: Wound care, pressure ulcers •MSK: Activity restrictions, out of bed, PT/OT •Lines: Central line, arterial line •Disposition: PT/OT, social work, case management  FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLSfxhjxgCE9Ek263XuGkpqqbaNiK9sVnu3M7_LFYUZxhr38SZw/viewform

Your patient is pregnant in her third trimester and she has acute cholecystitis...a relatively common but unnerving scenario.  What do you do?!  Do you operate?  Do you observe?  What about the baby?  Tune in and get the information you need to best care for this patient.  Hosts: Drs. Graham Skelhorne-Gross, Ashlie Nadler and Jordan Nantais.  Papers reviewed:  1) Fong, Z. et. al. Cholecystectomy during the third trimester of pregnancy: proceed or delay? J Am Coll Surg. 2019. 228 (4): 494-502. 2) Hong. J. et. al. Considering delay of cholecystectomy in the third trimester of pregnancy. Surg Endosc. 2020. Online ahead of print. FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLSfxhjxgCE9Ek263XuGkpqqbaNiK9sVnu3M7_LFYUZxhr38SZw/viewform

Dr. Yue-Yung Hu, Dr. Ryan Ellis, and Dr. Rhami Khorfan discuss two key new papers discussing optimizing resident achievement and well-being. Check out the papers at these links! https://pubmed.ncbi.nlm.nih.gov/33605580/ https://pubmed.ncbi.nlm.nih.gov/33491973/

Episode Description The timing of renal replacement therapy remains controversial and may be influenced by local resources, availability and institutional practices. In this episode from the Surgical Critical Care team at Behind the Knife, we provide a brief overview, introduce a clinical scenario and discuss two contemporary articles on the timing of initiation.  Learning Objectives:  In this episode, we review the indications for renal replacement therapy, the different modalities of continuous replacement therapy, and discuss two randomized control trials that may help us answer the question of dialysis initiation. Hosts: Brittany Bankhead-Kendall, MD, MS (@BBankheadMD) is an Assistant Professor of Surgery at Texas Tech University Health Sciences Center. Ryan Dumas, MD, FACS (@PMH_Trauma_RPD) is an Assistant Professor at the University of Southwestern Medical Center and Parkland Memorial Hospital. Caroline Park, MD, MPH, FACS (@CPark_MD) is an Assistant Professor at the University of Southwestern Medical Center and Parkland Memorial Hospital. Links to Papers Referenced in this Episode: Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis. N Engl J Med. 2018 Oct 11;379(15):1431-1442. doi: 10.1056/NEJMoa1803213. https://pubmed.ncbi.nlm.nih.gov/30304656/ Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. N Engl J Med. 2020 Jul 16;383(3):240-251. doi: 10.1056/NEJMoa2000741. https://pubmed.ncbi.nlm.nih.gov/32668114/

Intro:  Join Drs. Brian Louie, Peter White, and Megan Lenihan as they discuss the management of spontaneous pneumothorax in its various presentations. Learning Objectives -        Management of primary spontaneous pneumothorax -        Management of secondary spontaneous pneumothorax -        Operative intervention -        Nonoperative intervention -        Recognition and management of uncommon causes of pneumothorax Referenced Material ACCP guidelines for spontaneous pneumothorax:  https://journal.chestnet.org/article/S0012-3692(15)38241-6/ BTS guidelines for spontaneous pneumothorax:  https://thorax.bmj.com/content/65/Suppl_2/ii18

In this podcast, the UCLA Endocrine Surgery team reviews key abstract presentations from the American Association of Endocrine Surgeons Annual Meeting. They discuss topics such as missed opportunities in diagnosing primary hyperparathyroidism, limitations of database studies in parathyroidectomies, radioactive iodine treatment for aggressive variants of papillary thyroid cancer, and gender representation and racial disparities in endocrine surgery.

You find a 2.3 cm polyp in the right colon during a screening colonoscopy.  Does this patient need a colectomy? Is polypectomy ok? What should I do?? Join Drs. Peter Marcello, Jonathan Abelson and Tess Aulet as they discuss the endoscopic management of advanced colorectal polyps.  Be sure to check out Behind the Knife's YouTube channel for the VideoCast version of this high-yield case: https://www.youtube.com/c/BehindTheKnifeTheSurgeryPodcast.   Interested in learning more about specific topics in Colorectal Surgery? Check out the Virtual Education Series in Colorectal Surgery on Sunday Evenings at 7 pm EST @CRSVirtualEd or visit our website at http://jc.kethman.org. References: Cohan JN, Donahue C, Pantel HJ, Ricciardi R, Kleiman DA, Read TE, Marcello PW. Endoscopic Step Up: A Colon-Sparing Alternative to Colectomy to Improve Outcomes and Reduce Costs for Patients With Advanced Neoplastic Polyps. Dis Colon Rectum. 2020 Jun;63(6):842-849. doi: 10.1097/DCR.0000000000001645. PMID: 32118624. https://pubmed.ncbi.nlm.nih.gov/32118624/ NCCN guidelines: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1428 Kudo Classification: Kudo S, Tamura S, Nakajima T, Yamano H, Kusaka H, Watanabe H. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996; 44: 8-14 [PMID:8836710] UpToDate. Chromoendoscopy. Author:Marcia Irene Canto, MD, MHSSection Editor:John R Saltzman, MD, FACP, FACG, FASGE, AGAFDeputy Editor:Kristen M Robson, MD, MBA, FACG. Literature review current through: May 2021. | This topic last updated: Jan 14, 2021. Haggit and Kikuchi classification: Haggitt RC, Glotzbch RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology 1985; 89: 328-36. 

Minimally Invasive Surgery Journal Review   Evaluating the Robot Platform for use in General Surgery: ROLARR & RIVAL The debate about whether or not robotic surgery has a place in mainstream general surgery practice has been raging years with critics highlighting concerns about cost and a lack of high-level evidence showing benefit in patient outcomes while proponents suggest benefits in visualization, dexterity, and ergonomics that have not yet been borne out in rigorous trials. Hosts, Drs. Mike Weykamp, Andrew Wright, and Nick Cetrulo use two recent JAMA articles to frame the debate surrounding the platform and offer insight into the future of robotic and minimally invasive surgery. Learning objectives:  In this episode we review the current landscape of the literature surrounding robot assisted surgery with a particular focus on how to thoughtfully evaluate emerging surgical technologies, the need to consider the broader concept of value rather than simply healthcare costs, and the role of surgeon-focused outcomes including ergonomics.  Selected Articles:  Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomized Clinical Trial Link: https://pubmed.ncbi.nlm.nih.gov/29067426/ Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair: The RIVAL Randomized Clinical Trial Link: https://pubmed.ncbi.nlm.nih.gov/32186683/ RIVAL Author Interview with JAMA Surgery: https://edhub.ama-assn.org/jn-learning/audio-player/18318110

Dr. Shailesh Agarwal from Brigham and Women's Hospital in Boston joins us once more on the podcast! This time he lends us his expertise in the surgical management of lymphedema. Come listen to how Dr. Agarwal is improving the lives of patients with this terrible, chronic condition, often produced as a result of prior surgery.