Behind The Knife: The Surgery Podcast

Explore the complexities of achalasia, a condition hindering swallowing. Delve into the latest treatment options like POEM, pneumatic dilation, and Heller myotomy. Discover how the Chicago Classification defines achalasia subtypes, influencing tailored therapies. The hosts highlight long-term outcomes, including a unique analysis of 10-year data comparing treatments. Gain insights into the trade-offs between dysphagia relief and managing post-treatment GERD. Plus, look ahead at emerging therapies shaping the future of achalasia management.

Every spring for over 50 years, the Trauma, Critical Care, and Acute Care Surgery conference, best known simply as the MATTOX conference, is held in Las Vegas (https://www.trauma-criticalcare.com/).  The conference is unique in that it is entirely focused on practice-changing clinical education. It’s a damn good time too!  A favorite feature is the annual debates.  Today, we are featuring a showdown between Drs. Teddy Puzo and Joseph Dubois as they battle it out over the use of a DIRECT TO OR TRAUMA RESUSCITATION STRATEGY.  You can listen on the podcast or watch the debate with accompanying slides on our website or app.  Let's get ready to RUMMMBLLLEEEE! Video Link: https://www.youtube.com/watch?v=-DTTGBaLcHo TRAUMA SURGERY VIDEO ATLAS: https://app.behindtheknife.org/course-details/trauma-surgery-video-atlas Preparing for the deadliest injuries is challenging, and currently available resources are limited. That is why we created the Behind the Knife Trauma Surgery Video Atlas. Be ready for the most complex injuries, like penetrating trauma to the neck, audible bleeding from the IVC, and pelvic hemorrhage, with 24 scenarios.  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

Every spring for over 50 years, the Trauma, Critical Care, and Acute Care Surgery conference, best known simply as the MATTOX conference, is held in Las Vegas (https://www.trauma-criticalcare.com/).  The conference is unique in that it is entirely focused on practice-changing clinical education. It’s a damn good time too!  A favorite feature is the annual debates.  Today, we are featuring a showdown between Drs. Ryan Dumas and Bellal Joseph (@TopKniFe_B) as they battle it out over the use of TRAUMA VIDEO REVIEW.  You can listen on the podcast or watch the debate with accompanying slides on our website or app.  Let's get ready to RUMMMBLLLEEEE! Video Link: https://app.behindtheknife.org/video/mattox-conference-pro-con-debate-2025-trauma-video-review TRAUMA SURGERY VIDEO ATLAS: https://app.behindtheknife.org/course-details/trauma-surgery-video-atlas Preparing for the deadliest injuries is challenging, and currently available resources are limited. That is why we created the Behind the Knife Trauma Surgery Video Atlas. Be ready for the most complex injuries, like penetrating trauma to the neck, audible bleeding from the IVC, and pelvic hemorrhage, with 24 scenarios.  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

In this episode of the Big T Trauma Series, Dr. Patrick Georgoff (@georgoff) and Dr. Jason Brill dive into the evolving world of Trauma Video Review (TVR) with special guests Dr. Michael Vella and Dr. Ryan Dumas. Together, they explore how TVR is transforming trauma care by offering unprecedented insight into both technical and non-technical performance in the trauma bay. The conversation covers everything from implementation logistics and HIPAA concerns to cultural shifts and emerging AI applications. Whether you're curious about getting started or wondering if TVR should be part of trauma verification, this episode delivers essential insights from two national leaders in the space. Don’t miss it! Dr. Ryan Dumas is an associate professor of surgery at Baylor College of Medicine in Houston Texas where he serves as the Section Chief of Acute Care Surgery.  Dr. Dumas conducts and publishes research in trauma surgery and artificial intelligence, with a specific emphasis on video technology to capture and review trauma resuscitations. He has helped develop and run several Trauma Video Review programs across the country and utilizes video review as a tool for quality improvement, education, and research. Dr. Dumas is a consultant for Teleflex and Surgical Safety Technologies. Dr. Michael Vella is an associate professor of surgery, division of acute care surgery and trauma, at the university of Rochester medical center in Rochester, NY and the trauma medical director of the Kessler Level I trauma center.  He currently serves as chair of the New York State Committee on Trauma.  He has a clinical and research interest in trauma video review, particularly as it relates to trauma team dynamics and initial resuscitation.  Dr. Dumas is a consultant for Teleflex. 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. 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

Dr. Andrea Cercek, a gastrointestinal medical oncologist and director of a young-onset GI cancer center, joins Dr. Y. Nancy You, a professor in colon and rectal surgery, to discuss the alarming rise of early-onset colorectal cancer. They explore the importance of new screening guidelines and the implications of MMR-deficient tumors. The conversation highlights the need for genetic counseling, the critical role of multidisciplinary care, and how fertility concerns impact young patients. Their insights shed light on the urgent need for tailored approaches in combating this growing health challenge.

You have probably seen recent headlines that Microsoft has developed an AI model that is 4x more accurate than humans at difficult diagnoses. It’s been published everywhere, AI is 80% accurate compared to a measly 20% human rate, and AI was cheaper too! Does this signal the end of the human physician? Is the title nothing more than clickbait? Or is the truth somewhere in-between? Join Behind the Knife fellow Ayman Ali and Dr. Adam Rodman from Beth Israel Deaconess/Harvard Medical School to discuss what this study means for our future.       Studies: Sequential Diagnosis with Large Language Models: https://arxiv.org/abs/2506.22405v1 METR study: https://metr.org/blog/2025-07-10-early-2025-ai-experienced-os-dev-study/ Hosts: Ayman Ali, MD Ayman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital in his academic development time where he focuses on applications of data science and artificial intelligence to surgery.  Adam Rodman, MD, MPH, FACP, @AdamRodmanMD Dr. Rodman is an Assistant Professor and a practicing hospitalist at Beth Israel Deaconess Medical Center. He’s the Beth Israel Deaconess Medical Center Director of AI Programs. In addition, he’s the co-director of the Beth Israel Deaconess Medical Center iMED Initiative. Podcast Link: http://bedside-rounds.org/ 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

Join us as we dissect the use of robotics in bariatric surgery – where precision meets programming, and the scalpel gets a software upgrade. Video Clip Link: https://app.behindtheknife.org/video/clinical-challenges-in-robotic-bariatric-surgery-the-robot-is-here-to-stay This videos includes: - Robotic RYGB - Robotic Sleeve Gastrectomy - SADI: Single Anastomosis Duodenoileostomy Hosts:  - Matthew Martin, trauma and bariatric surgeon at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) - Adrian Dan, bariatric and MIS surgeon, program director for the advanced MIS bariatric and foregut fellowship at Summa Health System (Akron, Ohio) -  Crystal Johnson Mann, bariatric and foregut surgeon at the University of Florida (Gainesville, Florida) - Katherine Cironi, general surgery resident at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) Learning objectives:  Strengths of the robot:  Surgical robots are at the forefront of technology and continue to improve with detailed, precision cameras and the ability to remove baseline tremors Allows for smooth movements, fine dissection, and precise tissue handling  Ergonomics are more advantageous to the surgeon when compared to laparoscopy Weaknesses of the robot: The loss of haptic feedback can be challenging for surgeons early in their learning curve Emphasis on surgical robots means some trainees may be losing exposure to laparoscopic techniques Longer operative time when working robotically, and more time under anesthesia for the patient  Increased cost for robotic surgery  Outcomes data:  Mixed data from the MBSA QIP database (metabolic and bariatric surgery accreditation and quality improvement program) The most recent study looked at 824,000 patients from 2015-2022 who had a sleeve gastrectomy or RNY gastric bypass, either laparoscopically (lap sleeve 61%, lap RYGB 24%) or robotically (robo sleeve 11%, robo RYGB 4%). Robotic sleeves were reported to have higher complication rates compared to laparoscopy, seen as higher overall morbidity and an increased rate of leaks  While the robotic RYGBs have lower overall complications, including decreased morbidity and bleeding. Robotic RYGB can be especially advantageous with revisional surgeries when compared to lap.   Setting up for success Train your eyes to determine tension on tissue, since there is no haptic feedback Learn how to assist yourself (manipulating the camera and effectively utilizing the fourth arm) Understand how techniques of the surgery change when doing it robotically, as compared to laparoscopy  Experienced operating room team  When learning, recommend putting all cases feasible on the robot (including easier cases), to master the straightforward cases before moving to technically challenging revision cases. Don’t hesitate to add an additional trocar or assistant port when needed  Education in Robotic learning  Learning by observation/mirroring – ex: robotic bilateral inguinal hernia (mirroring the attending/instructor)  Easy for the attending/instructor in the case to switch instruments seamlessly, then give them back intermittently at the appropriate time  Helpful when the attending annotates the screen to depict where to go  Data-driven teaching tools on the Davinci system  Tips for robotic sleeve gastrectomy:  Of the robotic bariatric surgeries, sleeve gastrectomy is most similar to its laparoscopic procedure 30-40 degrees of reverse Trendelenburg Liver hammock stitch instead of a liver retractor (one less trocar), which makes a total of 4 trocars needed for the case Green staple load for the first firing, then the rest are typically blue loads Mixed opinions on reinforced staple loads versus non-reinforced staple loads and oversewing the staple line (discussed cost-benefit)  Tips for robotic gastric bypass:   Watch videos from colleagues to learn what they do Gastric bypass is a multi-quadrant surgery; thus, you must set yourself up for success so that your arms are not fighting when moving through different quadrants  A size 12 trocar on the left can make the formation of  the gastric pouch easier GJ and JJ anastomosis formed with a linear fire, then a two-layer closure with absorbable barb suture Don’t forget to close the mesenteric defect (non-absorbable braided suture) Tips for robotic DS and SADI:   If doing a duodenal anastomosis hand-sewn, then recommend planning the exact number of sutures and locations of each for ease Hand-sewn anastomosis can have less bleeding and fewer strictures for patients, and is completed in a much more seamless fashion with the robot   Future of Robotics  Haptic feedback Integrated visual overlays to identify anatomical structures/serve as an intraoperative map Artificial intelligence integration  Telesurgery – ex, small surgical robot deployed to space  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

Delve into the chaotic world of vascular surgery as the team navigates a complex case of an 18cm abdominal aortic aneurysm with a Type 1B endoleak. Explore the decision-making process during critical interventions, from ICU resuscitation to multidisciplinary planning. Discover treatment strategies such as endovascular temporization versus open repair, while grappling with ethical considerations for high-risk patients. The discussion uncovers the delicate balance between immediate action and long-term outcomes in life-threatening scenarios.

Explore the complexities of necrotizing pancreatitis in critically ill patients. The discussion highlights a step-up approach for intervention, emphasizing timely physiologic optimization and the importance of collaboration in care. Listeners learn about the nuances of various treatment options, including endoscopic and surgical techniques. Insights into managing complications, nutritional support, and the timing of gallbladder removal provide a comprehensive overview of this challenging condition. Patience and proactive care are key to patient recovery.

RE-RELEASE This was first published in 2023 but it's so good we are running it back! Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.  In this last episode of the intern bootcamp mini-series, we’ll talk about tips & tricks as well as good habits to establish in order to dominate intern year. Hosts: Shanaz Hossain, Nina Clark Tips for New Interns:  GENERAL TIPS FOR SUCCESS ON THE WARDS Spend time with the patient! Trust, but verify. Be kind to everyone. Stay humble. Be flexible. Seek and apply feedback. HOW TO LEARN IN THE OR Double scrub as many cases as you can. Write down/record everything after a case. MAINTAIN YOUR PERSONAL SANITY Figure out your stress outlets and what brings you joy. Decompress after work. Maintain work/life boundaries. Keep in touch with loved ones. Vacations are meant for relaxation.Repeat after me: NO WORK ON VACATION! Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/