Behind The Knife: The Surgery Podcast

Open the capsule, quit the cigarettes, and know when to cut: the essentials of managing marginal ulcers after bypass. Marginal ulcers are among the most common complications after Roux-en-Y gastric bypass, with a pooled prevalence around 4.6%, and they span everything from mild postprandial pain to perforation with peritonitis. In this episode, our expert panel works through three clinical scenarios (an uncomplicated early ulcer, a refractory ulcer with recurrent stricture, and a perforated ulcer with peritonitis) to build a practical framework for prevention, workup, medical therapy, and surgical escalation. 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 1. Identify the established and debated risk factors for marginal ulcers. Recognize smoking, diabetes, NSAIDs, and larger pouch size as key contributors. Appreciate that the role of H. pylori remains unsettled because of heavy heterogeneity across meta-analyses. 2. Perform a complete etiologic workup for a new marginal ulcer. Assess NSAID and immunosuppressant use, smoking (including cotinine test), H. pylori status, and visible suture or staple material at the anastomosis, and know that endoscopy, not CT, is the diagnostic tool of choice unless perforation is suspected. 3. Optimize first-line medical management. Use PPI therapy with instructions to open the capsules for faster healing, understand the limited evidence for adding sucralfate, confirm healing with repeat endoscopy, and individualize treatment duration, including when lifelong prophylaxis is reasonable. 4. Define and evaluate the refractory ulcer. Apply the 6- to 12-month definition of refractory disease, rule out gastrogastric fistula, hypersecretory states (serum gastrin), and PPI rapid metabolism (CYP2C19), and recognize ulcer-related gastrojejunal stricture and the perforation risk of serial dilation. 5. Weigh escalation options for refractory disease. Compare endoscopic suturing and stenting, truncal vagotomy, and GJ revision, including their mixed durability data, and address nutritional optimization and remnant access before reoperation. 6. Manage a perforated marginal ulcer. Prioritize resuscitation, antibiotics, and IV PPI; take unstable patients straight to the OR, use primary repair with omental patch as the default approach, and reserve revision or damage control for select patients based on physiology, tissue quality, and expertise. 7. Counsel patients on long-term recurrence risk. Communicate substantial recurrence rates after both repair and revision and emphasize that quitting smoking early (more than a year before surgery) meaningfully lowers reoperation risk. 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-review Surgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-review ABSITE Question Bank: https://behindtheknife.org/premium/absite-question-bank EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

It’s 2 a.m. and a patient with a GSW to the thigh is rolling into the trauma bay. He’s hypotensive, tachycardic, and has a tourniquet in place. Do you get a CTA or go straight to the OR? What do you do with the tourniquet? Join us as we work through this and two other cases of extremity vascular trauma and break down the literature to answer these questions and discuss how we should approach these challenging injuries. Hosts: · Christian Hadeed - PGY 5 General Surgery, Brookdale Hospital Medical Center · Paul Haser -Division Chief, Vascular Surgery, Brookdale Hospital Medical Center · Andrew Harrington – Division Chief, Vascular surgery, Richmond University Medical Center · Lucio Flores - Vascular surgery, Brookdale Hospital Medical Center Learning Objectives: · Apply the X-ABCDE approach to patients with extremity vascular trauma, including the role of early hemorrhage control and tourniquets. · Recognize the hard and soft signs of extremity arterial injury and determine when additional vascular imaging is indicated. · Describe the role of the ankle-brachial index, CT angiography, and conventional angiography in the evaluation of suspected extremity vascular injury. · Discuss the principles of operative management of extremity vascular injuries, including temporary shunting, vascular repair, and restoration of limb perfusion. · Briefly discuss mangles extremities and when saving the limb may not be appropritate References: · American College of Surgeons Committee on Trauma. (2025). Advanced trauma life support (ATLS®) student course manual (11th ed.). American College of Surgeons. · Lynch, K., & Johansen, K. (1991). Can Doppler pressure measurement replace “exclusion” arteriography in the diagnosis of occult extremity arterial trauma? Annals of Surgery, 214(6), 737–741. https://doi.org/10.1097/00000658-199112000-00016 · Inaba, K., Branco, B. C., Reddy, S., Park, J. J., Green, D., Plurad, D., Talving, P., Lam, L., & Demetriades, D. (2011). Prospective evaluation of multidetector computed tomography for extremity vascular trauma. Journal of Trauma, 70(4), 808–815. https://doi.org/10.1097/TA.0b013e3182118384 · Polcz, J. E., White, J. M., Ronaldi, A. E., Dubose, J. J., Grey, S., Bell, D., White, P. W., & Rasmussen, T. E. (2021). Temporary intravascular shunt use improves early limb salvage after extremity vascular injury. Journal of Vascular Surgery, 73(4), 1304–1313. https://doi.org/10.1016/j.jvs.2020.08.137 · Asensio, J. A., Kessler, J. J., Miljkovic, S. S., Kotaru, T. R., Dabestani, P. J., Kalamchi, L. D., Wenzl, F. A., Sanford, A. P., & Rowe, V. L. (2020). Brachial artery injuries: Operative management and predictors of outcome. Annals of Vascular Surgery, 69, 146–157. https://doi.org/10.1016/j.avsg.2020.05.049 · Barnes, C. J., Pietrobon, R., & Higgins, L. D. (2002). Does the pulse examination in patients with traumatic knee dislocation predict a surgical arterial injury? A meta-analysis. Journal of Trauma, 53(6), 1109–1114. https://doi.org/10.1097/00005373-200212000-00013 · Mills, W. J., Barei, D. P., & McNair, P. (2004). The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: A prospective study. Journal of Trauma, 56(6), 1261–1265. https://doi.org/10.1097/01.TA.0000068995.63201.0B · Weinberg, D. S., Scarcella, N. R., Napora, J. K., & Vallier, H. A. (2016). Can vascular injury be appropriately assessed with physical examination after knee dislocation? Clinical Orthopaedics and Related Research, 474, 1453–1458. https://doi.org/10.1007/s11999-016-4730-6 Sponsor URL: https://www.goremedical.com/ 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-review Surgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-review ABSITE Question Bank: https://behindtheknife.org/premium/absite-question-bank EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

This mini-series on Behind the Knife will discuss the technical aspects of the Operative Standards for Cancer Surgery, developed through the American College of Surgeons Cancer Research Program and Cancer Surgery Standards Program. This episode highlights total mesorectal excision for rectal cancer. Host: Jason Lizalek, MD (@JasonLizalekMD) is a Surgical Oncology fellow at Moffitt Cancer Center in Tampa, FL. Guests: Sean J Langenfeld, MD, FACS, FASCRS (@seanlangenfeld) is a professor of surgery and the chief of the division of colon and rectal surgery at the University of Nebraska Medical Center in Omaha, NE Larissa Temple, MD, FACS, FASCRS is a professor of surgery and the chief of colon and rectal surgery at the University of Rochester in Rochester, NY. Learning Objectives: - Understand the relevant pelvic anatomy that makes TME challenging. - Develop a step-by-step approach to TME that avoids major pitfalls and allows for a sfe low pelvic anastomosis. - Learn tips and tricks for exposure and progress in the more difficult cases. Links to Papers Referenced in this Episode: Operative Standards for Cancer Surgery, Volume 1: Breast, Lung, Pancreas, Colon https://www.facs.org/quality-programs/cancer-programs/cancer-surgery-standards-program/operative-standards-for-cancer-surgery/purchase/ Kindle edition: https://www.amazon.com/Operative-Standards-Cancer-Surgery-Section-ebook/dp/B07MWSNFSB The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer 2023 Supplement https://pubmed.ncbi.nlm.nih.gov/37647138/ NCCN Guidelines for Rectal Cancer https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1461 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-review Surgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-review ABSITE Question Bank: https://behindtheknife.org/premium/absite-question-bank EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

It’s postoperative day four after surgery for a perforated colon. The source appears controlled, but the patient is still intubated, the white count is eighteen, and nobody feels comfortable stopping piperacillin–tazobactam. Is four days really enough? Does the ICU buy another four—or is it time to ask what we’re missing? Join Drs. Rushabh Dev, Skye Shultz, Kelly Ray, Desra Fletcher, and Brycen Ratcliffe from the Emergency General Surgery team in Tiger Country at Mizzou as they revisit STOP-IT and examine what more than a decade of evidence has added to the management of complicated intra-abdominal infection. In this EGS Journal Review, the team appraises the landmark trial, explores its subgroup analyses and limitations, and puts contemporary SIS, IDSA, AAST, and Surviving Sepsis guidance into context. The discussion moves from source control and antibiotic duration to resistant organisms, cultures, de-escalation, ICU dosing, and the role of procalcitonin. For most complicated intra-abdominal infections, approximately four days after adequate source control remains the default. Persistent illness should prompt a search for failed source control, ineffective therapy, or another diagnosis before simply extending the stop date. Hosts Dr. Rushabh Dev, MD, FACS – Moderator and Acute Care Surgeon, University of Missouri Dr. Skye Shultz – Surgical Critical Care Fellow, University of Missouri Dr. Kelly Ray – General Surgery Resident; STOP-IT appraisal and antimicrobial selection Dr. Desra Fletcher – General Surgery Resident, University of Missouri; post-STOP-IT evidence and implementation Dr. Brycen Ratcliffe – General Surgery Resident; society guidance and microbiology Learning Objectives By the end of this episode, listeners should be able to: · Describe the design, principal results, strengths, and limitations of STOP-IT, including why adequate source control is essential to applying its findings. · Apply short-course therapy after adequate operative or percutaneous source control and explain why sepsis alone, obesity, or diabetes does not automatically require a longer course. · Distinguish the four-day default from the weaker SIS recommendation supporting up to eight days in selected critically ill patients after adequate source control. · Recognize persistent or worsening illness that warrants reassessment of source control, drain function, microbiology, drug exposure, or alternative diagnoses. · Differentiate the treatment scope of SIS guidance from the diagnostic and microbiology focus of IDSA 2024, the AAST surgical ICU consensus, and broader sepsis and antimicrobial-resistance guidance. · Select and de-escalate antimicrobials using infection setting, resistance risk, cultures, local susceptibility data, and patient-specific dosing considerations. · Explain the limited adjunctive role of procalcitonin in antibiotic discontinuation when duration remains uncertain, including the implications of ADAPT-Sepsis. References 1. Sawyer RG, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015;372:1996–2005. STOP-IT. Article / guideline 2. Huston JM, et al. The Surgical Infection Society Guidelines on the Management of Intra-Abdominal Infection: 2024 Update. Surg Infect. 2024;25:419–435. Article / guideline 3. Rattan R, et al. Patients with complicated intra-abdominal infection presenting with sepsis do not require longer duration of antimicrobial therapy. J Am Coll Surg. 2016;222:440–446. Article / guideline 4. Rattan R, et al. Percutaneously drained intra-abdominal infections do not require longer duration of antimicrobial therapy. J Trauma Acute Care Surg. 2016;81:108–113. Article / guideline 5. Montravers P, et al. Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomized clinical trial. Intensive Care Med. 2018;44:300–310. Article / guideline 6. IDSA. 2024 Guideline Update on Complicated Intra-Abdominal Infections: Risk Assessment, Diagnostic Imaging, and Microbiological Evaluation. Article / guideline 7. Nohra E, et al. Fever and infections in surgical intensive care: an AAST Critical Care Committee clinical consensus document. Trauma Surg Acute Care Open. 2024;9:e001303. Article / guideline 8. IDSA. 2026 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections. Article / guideline 9. Prescott HC, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Med. 2026. Article / guideline 10. Dark P, et al. Biomarker-guided antibiotic duration for hospitalized patients with suspected sepsis: the ADAPT-Sepsis randomized clinical trial. JAMA. 2025;333:682–693. Article / guideline After adequate source control, most complicated intra-abdominal infections need approximately four days of antibiotics. If the patient is not improving, reassess the source and the treatment—not just the calendar. Sponsor Disclosure: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-review Surgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-review ABSITE Question Bank: https://behindtheknife.org/premium/absite-question-bank EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Enlace del curso: https://behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general Behind the Knife es el podcast quirúrgico líder en el mundo y una plataforma de educación quirúrgica. Nuestra misión es crear contenido innovador de educación quirúrgica que sea accesible para todos. Estamos muy emocionados de expandirnos al público hispanohablante y ofrecerles 4 episodios de muestra de nuestro Curso de Repaso para el examen de certificación de Cirugía General. Hoy, escucharás un caso de muestra de este curso de repaso en audio, que incluye 100 escenarios. El curso tiene un formato emocionante y completamente único. Cada uno de los 100 caso consta de dos partes. La primera parte es un caso oral perfectamente ejecutado que imita la realidad. Cada caso tiene una duración de cinco a siete minutos e incluye una variedad de tácticas y estilos. Si logras alcanzar este nivel de desempeño en tu preparación, seguramente aprobarás el examen de certificación con éxito. La segunda parte introduce comentarios de alto rendimiento para cada escenario. Estos comentarios incluyen consejos y trucos para ayudarte a dominar los escenarios más desafiantes, además de una enseñanza práctica y fácil de entender que cubre los temas más confusos que enfrentamos como cirujanos generales. Estamos seguros de que encontrarás este enfoque único de doble formato como una forma altamente efectiva de prepararte para el examen. Nuestro contenido está disponible en nuestras aplicaciones para iOS y Android y en nuestro sitio web (behindtheknife.org). Por favor, consulta las notas del programa para más información. Nos encantaría escuchar tus comentarios sobre este episodio enviando un correo electrónico a hello@behindtheknife.org y apreciamos tu ayuda para difundir la palabra entre tus colegas si disfrutas del material. Este contenido incluye 97 descripciones operatorias para todos los procedimientos comunes —y la mayoría de los poco comunes— incluidos en el Currículo de Cirugía General SCORE. Cada descripción está diseñada para ayudar a los candidatos a prepararse de manera eficaz para el Examen de Certificación en Cirugía General. presentadores de podcast: - Auri P. Garcia Gonzalez, MD PhD nació en San Juan, Puerto Rico, y se trasladó a los Estados Unidos en el 2012 para sus estudios graduados. Actualmente, es estudiante de post-grado en cirugía general en Duke University. - Diego Schaps, MD, MPH es un residente de cirugía general en Duke y nació en Miami, en el estado de la Florida. Sus padres nacieron en El Salvador. Disclaimer: Los productos de contenido de Behind the Knife son únicamente para fines educativos. No diagnosticamos, tratamos ni ofrecemos consejos específicos para pacientes. ------ Behind the Knife is the world's leading surgical podcast and surgical education platform. Our mission is to create innovative surgical education content that is accessible to all. We are very excited to expand into the spanish audience and bring you 4 sample episodes of our General Surgery Oral Board Review Course which will be released over the course of the next week. Today, you'll hear a sample scenario from this comprehensive audio review course which includes 100 scenarios. The course has an exciting and entirely unique format. Each of the 100 scenarios includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are five to seven minutes long and include a variety of tactics and styles. If you're 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 that 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. The course contains crisp, concise operative descriptions that cover all SCORE common topics and and most SCORE uncommon topics. Our content is available on our iOS and Android apps and website (behindtheknife.org). Please check the show notes for more information. We would love to hear your feedback by emailing hello@behindtheknife.org and appreciate your help spreading the word to your colleagues if you enjoy the material. Hosts: - Auri P. Garcia Gonzalez, MD PhD was born and raised in San Juan, Puerto Rico and moved to the US in 2012 for graduate studies. At present, she is a surgical resident at Duke University. - Diego Schaps, MD, MPH is a general surgery resident at Duke and was born in Miami, Florida. His parents were born in El Salvador. 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

Calcified peripheral artery disease (PAD) remains one of the most challenging problems in endovascular intervention. Calcium limits vessel expansion, increases the risk of dissection and procedural failure, and can ultimately lead to bailout stenting. The Disrupt PAD III program provided important evidence for a different approach: intravascular lithotripsy (IVL) as a vessel-preparation strategy. In this episode, we examine the randomized Disrupt PAD III trial published by Tepe and colleagues and the large, real-world observational analysis led by Armstrong and colleagues. Together, these studies explore whether IVL can make treatment of heavily calcified lesions more predictable, reduce the need for stenting, and support a “leave-nothing-behind” strategy. Hosts: Dr. Robert Beaulieu Dr. Frank Davis Dr. Luciano Delbono Dr. Andrew Huang Dr. Carolyn Judge Learning Objectives By the end of this episode, listeners should be able to: Explain the challenges posed by moderate to severe vascular calcification during peripheral endovascular intervention and the rationale for dedicated vessel-preparation strategies. Describe the design, patient population, endpoints, and primary findings of the randomized Disrupt PAD III trial comparing IVL with conventional PTA. Interpret the procedural and longer-term outcomes associated with IVL, including residual stenosis, dissection rates, bailout stenting, and primary patency. Evaluate how the Disrupt PAD III observational study complements the randomized trial by examining IVL in a larger, more complex, real-world population and across multiple vascular beds. Identify the practical implications, limitations, and remaining unanswered questions surrounding IVL, including its role relative to other calcium-modification strategies such as atherectomy. References Tepe G, Brodmann M, Werner M, et al. Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Randomized Disrupt PAD III Trial. JACC Cardiovasc Interv. 2021;14(12):1352-1361. doi:10.1016/j.jcin.2021.04.010. https://pubmed.ncbi.nlm.nih.gov/34167675/ Tepe G, Brodmann M, Bachinsky W, et al. Intravascular Lithotripsy for Peripheral Artery Calcification: Mid-term Outcomes From the Randomized Disrupt PAD III Trial. J Soc Cardiovasc Angiogr Interv. 2022. https://pubmed.ncbi.nlm.nih.gov/39131928/ Armstrong EJ, Adams G, Soukas PA, et al. Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Disrupt PAD III Observational Study. J Endovasc Ther. 2026;33(2):853-862. doi:10.1177/15266028241283716. https://pubmed.ncbi.nlm.nih.gov/39422234/ Sponsor URL: https://www.goremedical.com/ 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-review Surgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-review ABSITE Question Bank: https://behindtheknife.org/premium/absite-question-bank EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Breast cancer risk varies widely across patients, and surgeons play a central role in recognizing elevated risk and guiding appropriate management. In this episode, we review the spectrum of breast cancer risk and discuss practical strategies for risk assessment and risk reduction. We’ll cover surveillance, lifestyle interventions, risk-reducing medications, high-risk breast lesions, and prophylactic surgery—with an emphasis on translating the available evidence into individualized clinical care. Hosts: - Rashmi Kumar, MD, PhD Resident, University of Michigan General Surgery Residency Program Twitter/X: @RashmiJKumar - Melissa Pilewskie, MD Attending Breast Surgical Oncologist, Co-Director of the Weiser Family Center for Breast Cancer, Michigan Medicine Twitter/X: @MPilewskie - Stephanie Downs-Canner, MD Attending Breast Surgical Oncologist & Physician-Scientist, Memorial Sloan Kettering Cancer Center, Program Director of the Breast Surgical Oncology Fellowship Training Program Twitter/X: @SDownsCanner Learning Objectives: Identify major modifiable and nonmodifiable breast cancer risk factors, including genetic predisposition, family history, breast density, high-risk lesions, prior chest radiation, and lifestyle factors. Select and interpret commonly used breast cancer risk-assessment tools—including the Gail, Tyrer-Cuzick, and BCSC models—while recognizing their important limitations. Recommend appropriate risk-management strategies based on a patient’s risk level, including enhanced surveillance, lifestyle interventions, genetic evaluation, and endocrine risk-reducing therapy. Explain the indications, benefits, limitations, and tradeoffs of managing high-risk breast lesions and pursuing risk-reducing surgery, including bilateral mastectomy and salpingo-oophorectomy. References: Risk-Assessment Tools National Cancer Institute. Breast Cancer Risk Assessment Tool.https://bcrisktool.cancer.gov/ National Breast Cancer Foundation. What is the Tyrer-Cuzick model?https://www.nationalbreastcancer.org/blog/tyrer-cuzick-model/ Breast Cancer Surveillance Consortium. BCSC Breast Cancer Risk Calculator.https://tools.bcsc-scc.ucdavis.edu/BC5yearRisk/#/ Chemoprevention Guideline Bevers TB, Ward JH, Arun BK, et al. Breast cancer risk reduction, version 2.2015. J Natl Compr Canc Netw. 2015;13(8):880-915. doi:10.6004/jnccn.2015.0105 CDC Overview of Risk Factors Centers for Disease Control and Prevention. Breast cancer risk factors. https://www.cdc.gov/breast-cancer/risk-factors/index.html Emerging Techniques in Risk Assessment Breastcancer.org. Polygenic risk score may help predict invasive breast cancer risk. https://www.breastcancer.org/news/polygenic-risk-score-invasive-cancer-risk Breast Cancer Research Foundation. Clairity Breast: The first FDA-authorized AI platform to predict breast cancer risk from a mammogram. https://www.bcrf.org/blog/clairity-breast-ai-artificial-intelligence-mammogram-approved/ Risk reduction Pilewskie ML, Dimick JB. Bariatric Surgery for Breast Cancer Risk Reduction—Benefit May Not Be One Size Fits All. JAMA Surg. 2023;158(6):641–642. doi:10.1001/jamasurg.2023.0534 https://pubmed.ncbi.nlm.nih.gov/37043229/ Boraka Ö, Klintman M, Rosendahl AH. Physical Activity and Long-Term Risk of Breast Cancer, Associations with Time in Life and Body Composition in the Prospective Malmö Diet and Cancer Study. Cancers (Basel). 2022 Apr 13;14(8):1960. doi: 10.3390/cancers14081960. PMID: 35454864; PMCID: PMC9025884. https://pubmed.ncbi.nlm.nih.gov/35454864/ Tzenios N, Tazanios ME, Chahine M. The impact of BMI on breast cancer - an updated systematic review and meta-analysis. Medicine (Baltimore). 2024 Feb 2;103(5):e36831. doi: 10.1097/MD.0000000000036831. PMID: 38306546; PMCID: PMC10843423. https://pubmed.ncbi.nlm.nih.gov/38306546/ Hartmann LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. New England Journal of Medicine 1999; 340(2):77-84. https://pubmed.ncbi.nlm.nih.gov/9887158/ Domchek SM, Friebel TM, Singer CF, et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA 2010; 304(9):967–975. https://pubmed.ncbi.nlm.nih.gov/20810374/ Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: The PROSE Study Group. Journal of Clinical Oncology 2004; 22(6):1055-1062. https://pubmed.ncbi.nlm.nih.gov/14981104/ Matteo Lazzeroni et al. Randomized Placebo Controlled Trial of Low-Dose Tamoxifen to Prevent Recurrence in Breast Noninvasive Neoplasia: A 10-Year Follow-Up of TAM-01 Study. J Clin Oncol 41, 3116-3121(2023). Elizabeth S. McDonald et al. GLP-1 Agonists Are Associated With a Significant Reduction in Breast Cancer Incidence in Women. JCO Oncol Pract 22, 1341-1348(2026). 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-review Surgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Ever wonder how a mountain of clinical data transforms into a clinical practice guideline, or whether deviating from one puts you at legal risk? Join us as we pull back the curtain on guidelines methodology, decode the fine print, and put the evidence into practice. Hosts: Scott Steele, MD, MBA – Colon and Rectal Surgeon at Cleveland Clinic Nicole L. Petcka, MD, MHPE – General Surgery Resident at Emory University Guests: Bethany Slater, MD – Pediatric Surgeon at Mount Siani, SAGES Guidelines Committee Chair Francesco Palazzo, MD – Minimally Invasive Surgeon at Jefferson Health, SAGES Guidelines Committee Co-chair Elisa Calabrese, MD – General Surgery Resident at UCSF-East Bay, SAGES/RACS Guidelines Fellow Resources: Kumar, S. S., Collings, A. T., Wunker, C., Athanasiadis, D. I., DeLong, C. G., Hong, J. S., Ansari, M. T., Abou-Setta, A., Oliver, E., Berghella, V., Alli, V., Hassan, I., Hollands, C., Sylla, P., Slater, B. J., & Palazzo, F. (2024). SAGES guidelines for the use of laparoscopy during pregnancy. Surgical endoscopy, 38(6), 2947–2963. https://doi.org/10.1007/s00464-024-10810-1 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-review Surgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

You stayed late again, the service is still short-staffed, and when you finally say something, the answer is: you just need to be more efficient. More resilient. That's the go-to explanation for almost everything hard about residency — but what if the problem isn't your resilience at all? In the finale of Beyond the Match, Mckenzie Roebuck, Carl Engelke, Michael Brinton, and Omer Hassan of CoSEF look downstream at what happens after residents match: working conditions, culture and mental health, the practical barriers that make transferring so difficult, why residents may not trust existing reporting systems, and what real accountability and resident voice would require. Hosts: Dr. Mckenzie Roebuck, CoSEF BTK Lead, Inova Fairfax Medical Campus, mckenzie.rowe@inova.org Dr. Carl Engelke, The Ohio State University, Carl.Engelke@osumc.edu Dr. Michael Brinton, Medical College of Wisconsin, mbrinton@mcw.edu Dr. Omer Hassan, University of Calgary/Alberta Children's Hospital, omerh91@gmail.com CoSEF: X @surgedfellows, cosef.org Learning objectives: Summarize the real problems the congressional report identifies in working conditions, mistreatment reporting, and resident mental health Distinguish necessary difficulty in residency training from preventable system dysfunction, and describe its relationship to resident well-being and reporting Explain the practical barriers to resident mobility, including position availability, training requirements, funding, visa status, professional risk, and stigma Describe local and national accountability mechanisms — including program reporting, GMECs, ACGME pathways, and unions — and the limitations of each Identify strategies to strengthen resident voice, psychological safety, anti-retaliation protections, and institutional accountability rather than relying on individual resilience alone. References: House Committee on the Judiciary. Medical Mis-Match: How a Residency Hiring Monopoly Harms Patients, Doctors, and the American Public. Published online March 27, 2026. Gianakos AL, Freischlag JA, Mercurio AM, et al. Bullying, Discrimination, Harassment, Sexual Harassment, and the Fear of Retaliation During Surgical Residency Training: A Systematic Review. World J Surg. 2022;46(7):1587-1599. doi:10.1007/s00268-021-06432-6 PubMed Link: https://pubmed.ncbi.nlm.nih.gov/35006329/ Mata DA, Ramos MA, Bansal N, et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA. 2015;314(22):2373-2383. doi:10.1001/jama.2015.15845 PubMed Link: https://pubmed.ncbi.nlm.nih.gov/26647259/ Malone TL, Zhao Z, Liu TY, Song PXK, Sen S, Scott LJ. Prediction of Suicidal Ideation Risk in a Prospective Cohort Study of Medical Interns. PLoS One. 2021;16(12):e0260620. doi:10.1371/journal.pone.0260620 PubMed Link: https://pubmed.ncbi.nlm.nih.gov/34855821/ Drolet BC, Schwede M, Bishop KD, Fischer SA. Compliance and Falsification of Duty Hours: Reports From Residents and Program Directors. J Grad Med Educ. 2013;5(3):368-373. doi:10.4300/JGME-D-12-00375.1 PubMed Link: https://pubmed.ncbi.nlm.nih.gov/24404298/ National Resident Matching Program. The Match Agreement. Accessed August 2026. https://www.nrmp.org/intro-to-the-match/the-match-agreement/. Intealth (ECFMG). J-1 Physicians Training in the US (infographic). Accessed August 2026. https://www.intealth.org/pdfs/J-1_US_Infographic.pdf. (Note: Institutional PDF; no PubMed entry available). Foote DC, Rosenblatt AE, Amortegui D, et al. Experiences With Unionization Among General Surgery Resident Physicians, Faculty, and Staff. JAMA Netw Open. 2024;7(7):e2421676. doi:10.1001/jamanetworkopen.2024.21676 PubMed Link: https://pubmed.ncbi.nlm.nih.gov/39018072/ Accreditation Council for Graduate Medical Education. Report an Issue. https://www.acgme.org/residents-and-fellows/report-an-issue/?utm_source. 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-review Surgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

You matched into your dream program... but only after submitting 80 applications, spending thousands of dollars, and losing sleep wondering if anyone was even reading yours. Meanwhile, on the other side of the screen, a program director is staring down a thousand applications for six spots, trying to figure out who's actually serious about coming. Sound familiar? Join Mckenzie Roebuck, Milanie Milan, Sarah Lund, and Bryanna Stukes of CoSEF as they unpack the residency application arms race: why uncertainty drives overapplication, what preference signaling and application caps actually solve, the trade-offs of virtual versus in-person interviews, and how better transparency, advising, holistic review, and even AI might help applicants and programs find the right fit. Hosts: Dr. Mckenzie Roebuck, CoSEF BTK Lead, Inova Fairfax Medical Campus, mckenzie.rowe@inova.org, insta @mrowemd, X @mrowemd1 Dr. Milanie Milan, Cleveland Clinic, milanie.milan98@gmail.com, insta @m.mdgram Dr. Sarah Lund, Mayo Clinic, slund@alum.mit.edu, X @DrSarahLund Dr. Bryanna Stukes, UT Southwestern bryanna.stukes@UTSouthwestern.edu CoSEF: X @surgedfellows, cosef.org Learning objectives: Explain how uncertainty across the residency selection process drives overapplication and distinguish the Match algorithm from the broader application ecosystem Describe how preference signaling, application caps, and interview format affect applicant and program behavior, including equity trade-offs Identify ways programs can improve both competitiveness and program-level transparency Discuss how investment in holistic review and mission-specific selection criteria may improve application review while introducing new challenges. References: House Committee on the Judiciary. Medical Mis-Match: How a Residency Hiring Monopoly Harms Patients, Doctors, and the American Public. Published online March 27, 2026. National Resident Matching Program. Advance Data Tables: 2026 Main Residency Match. NRMP. Published March 20, 2026. Accessed August 2026. https://www.nrmp.org/match-data/2026/03/advance-data-tables-2026-main-residency-match/. Ulin L, Bernstein SA, Nunes JC, et al. Improving Transparency in the Residency Application Process: Survey Study. JMIR Form Res. 2023;7:e45919. doi:10.2196/45919 PubMed Link: https://pubmed.ncbi.nlm.nih.gov/38145482/ American Medical Association. Transparency in the Resident Physician Application Process (Issue Brief). Published online November 2023. Accessed August 2026. https://www.ama-assn.org/system/files/cme-issue-brief-resident-application-process.pdf. Nilsen K, Walling A, Callaway P, et al. "The End Game" — Students' Perspectives of the National Residency Matching Program: A Focus Group Study. Med Sci Educ. 2018;28(4):729-737. doi:10.1007/s40670-018-0627-1 PubMed Link: https://pubmed.ncbi.nlm.nih.gov/34646549/ Weissbart SJ, Kim SJ, Feinn RS, Stock JA. Relationship Between the Number of Residency Applications and the Yearly Match Rate: Time to Start Thinking About an Application Limit? J Grad Med Educ. 2015;7(1):81-85. doi:10.4300/jgme-d-14-00270.1 PubMed Link: https://pubmed.ncbi.nlm.nih.gov/26217439/ Angus SV, Williams CM, Kwan B, et al. Drivers of Application Inflation: A National Survey of Internal Medicine Residents. Am J Med. 2018. doi:10.1016/j.amjmed.2018.01.002 PubMed Link: https://pubmed.ncbi.nlm.nih.gov/29355512/ Lund S, Santucci NM, Zarate Rodriguez J, et al. Message Received? Applicant Insights on Preference Signals in General Surgery Residency Recruitment. J Surg Educ. 2026;83(9):104096. doi:10.1016/j.jsurg.2026.104096 PubMed Link: https://pubmed.ncbi.nlm.nih.gov/42418854/ Woodward JM, Gan CY, Foote DC, et al. Thanks for the Signal—Now What? Program Director Perspectives on How Preference Signals Are Shaping General Surgery Residency Recruitment. J Surg Educ. 2026;83(9):104061. doi:10.1016/j.jsurg.2026.104061 PubMed Link: https://pubmed.ncbi.nlm.nih.gov/42418853/ Mullens CL, Picart JK, Dualeh SHA, et al. A Practical Approach for Implementing Holistic Review for General Surgery Resident Recruitment. J Surg Educ. 2026;83(9):104069. doi:10.1016/j.jsurg.2026.104069 PubMed Link: https://pubmed.ncbi.nlm.nih.gov/42436210/ 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-review Surgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

What does it say about a training system when childcare can eat up almost half a resident’s monthly salary — and the physicians doing essential clinical work have almost no ability to negotiate their pay or benefits? A recent House Judiciary Committee report argues that the Match suppresses resident compensation and bargaining power. But if the Match disappeared tomorrow, would residents actually get paid more? Join Mckenzie Roebuck, Maya Hunt, Nicole Santucci, and Michael Kabbash of CoSEF as they unpack resident pay and benefits, where GME funding actually goes, why residency is not a normal labor market, and where real leverage for change might come from. Hosts: Dr. Mckenzie Roebuck, CoSEF BTK Lead, Inova Fairfax Medical Campus, mckenzie.rowe@inova.org, insta @mrowemd, X @mrowemd1 Dr. Maya Hunt, Indiana University, mayahunt@iu.edu Dr. Nicole Santucci, Washington University in St. Louis, snicole@wustl.edu Dr. Michael Kabbash, University of Florida, michel.kabbash@surgery.ufl.edu, X @MichaelKabbash CoSEF: X @surgedfellows, cosef.org Learning objectives: Summarize the congressional report’s arguments about resident compensation and bargaining power Explain how GME funding supports residency and why federal GME dollars do not map directly onto resident salaries Describe how salary and benefit structures affect residents’ financial well-being, family planning, and quality of life Identify institutional, policy, and collective strategies to strengthen resident compensation and bargaining power. References: House Committee on the Judiciary. Medical Mis-Match: How a Residency Hiring Monopoly Harms Patients, Doctors, and the American Public. Published online March 27, 2026. Association of American Medical Colleges. AAMC Survey of Resident/Fellow Stipends and Benefits. https://www.aamc.org/data-reports/students-residents/report/aamc-survey-resident/fellow-stipends-and-benefits. Centers for Medicare and Medicaid Services. Direct Graduate Medical Education (DGME). https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/direct-graduate-medical-education-dgme. Foote DC, Rosenblatt AE, Amortegui D, et al. Experiences With Unionization Among General Surgery Resident Physicians, Faculty, and Staff. JAMA Netw Open. 2024;7(7):e2421676. doi:10.1001/jamanetworkopen.2024.21676 https://pubmed.ncbi.nlm.nih.gov/39018072/ Tomei KL, Selby LV, Kirk LM, et al. Beyond Training the Next Generation of Physicians: The Unmeasured Value Added by Residents to Teaching Hospitals and Communities. Acad Med. 2022;97(11):1592-1596. https://pubmed.ncbi.nlm.nih.gov/35731593/ doi:10.1097/ACM.0000000000004792 Accreditation Council for Graduate Medical Education. Common Program Requirements. Accessed August 2026.https://www.acgme.org/programs-and-institutions/programs/common-program-requirements/. Rigged or Right? The Residency Match Under Fire | podcast. Behind the Knife. https://behindtheknife.org/podcast/rigged-or-right-the-residency-match-under-fire. 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-review Surgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Introducing Behind the Knife Surgical Critical Care Review! DOMINATE THE ICU with our comprehensive course that includes audio + simulator + question bank. Master the management of the critically ill patient with Behind the Knife's all-new Surgical Critical Care Review. Built for high-yield, real-world application, this comprehensive multimedia program gives residents, fellows, and practicing surgeons everything they need to confidently manage the sickest patients in the hospital. What's included: 38 High-Yield Podcasts — Expert-led discussions spanning the full SCORE curriculum for Surgical Critical Care. AI Case Simulator — Test your judgment against our one-of-a-kind interactive simulator, built to recreate the pressure of high-stakes clinical scenarios. 110 simulator credits included with purchase. Comprehensive Question Bank — Rigorous, board-style multiple-choice questions to sharpen your performance on rounds and on exam day. Get Instant Access Here: https://behindtheknife.org/premium/surgical-critical-care-review Enjoy this sample episode from the course.

Introducing Behind the Knife Surgical Critical Care Review! DOMINATE THE ICU with our comprehensive course that includes audio + simulator + question bank. Master the management of the critically ill patient with Behind the Knife's all-new Surgical Critical Care Review. Built for high-yield, real-world application, this comprehensive multimedia program gives residents, fellows, and practicing surgeons everything they need to confidently manage the sickest patients in the hospital. What's included: 38 High-Yield Podcasts — Expert-led discussions spanning the full SCORE curriculum for Surgical Critical Care. AI Case Simulator — Test your judgment against our one-of-a-kind interactive simulator, built to recreate the pressure of high-stakes clinical scenarios. 110 simulator credits included with purchase. Comprehensive Question Bank — Rigorous, board-style multiple-choice questions to sharpen your performance on rounds and on exam day. Get Instant Access Here: https://behindtheknife.org/premium/surgical-critical-care-review Enjoy this sample episode from the course.

Introducing Behind the Knife Surgical Critical Care Review! DOMINATE THE ICU with our comprehensive course that includes audio + simulator + question bank. Master the management of the critically ill patient with Behind the Knife's all-new Surgical Critical Care Review. Built for high-yield, real-world application, this comprehensive multimedia program gives residents, fellows, and practicing surgeons everything they need to confidently manage the sickest patients in the hospital. What's included: 38 High-Yield Podcasts — Expert-led discussions spanning the full SCORE curriculum for Surgical Critical Care. AI Case Simulator — Test your judgment against our one-of-a-kind interactive simulator, built to recreate the pressure of high-stakes clinical scenarios. 110 simulator credits included with purchase. Comprehensive Question Bank — Rigorous, board-style multiple-choice questions to sharpen your performance on rounds and on exam day. Get Instant Access Here: https://behindtheknife.org/premium/surgical-critical-care-review Enjoy this sample episode from the course.

Introducing Behind the Knife Surgical Critical Care Review! DOMINATE THE ICU with our comprehensive course that includes audio + simulator + question bank. Master the management of the critically ill patient with Behind the Knife's all-new Surgical Critical Care Review. Built for high-yield, real-world application, this comprehensive multimedia program gives residents, fellows, and practicing surgeons everything they need to confidently manage the sickest patients in the hospital. What's included: 38 High-Yield Podcasts — Expert-led discussions spanning the full SCORE curriculum for Surgical Critical Care. AI Case Simulator — Test your judgment against our one-of-a-kind interactive simulator, built to recreate the pressure of high-stakes clinical scenarios. 110 simulator credits included with purchase. Comprehensive Question Bank — Rigorous, board-style multiple-choice questions to sharpen your performance on rounds and on exam day. Get Instant Access Here: https://behindtheknife.org/premium/surgical-critical-care-review Enjoy this sample episode from the course.

This episode offers a practical, case-based approach to one of the most common intraoperative challenges in GI surgery: constructing a stoma that just won't cooperate. The discussion covers preoperative marking and stoma siting in the obese and non-elective patient, technical maneuvers to gain length and reduce tension on the stoma, strategies for the foreshortened small bowel mesentery, and considerations for maturing a stoma in a massively dilated, thick-walled colon. Join Drs. Elissa Dabaghi, Jared Hendren, Joseph Trunzo, Ajaratu Keshinro, and David Rosen as they discuss this clinical challenge in colorectal surgery. Hosts: · Elissa Dabaghi, MD, Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio · Jared Hendren, MD, Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio · Joseph Trunzo, MD, Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, X/Twitter @joseph_trunzo · Ajaratu Keshinro, MD, Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, X/Twitter- @AJKesh · David Rosen, MD, Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, X/Twitter- @davidrrosenmd Learning Objectives: By the end of this episode, listeners will be able to: 1. Describe preoperative marking strategies and intraoperative technical adaptations for stoma siting and construction in obese and non-elective patients. 2. Apply strategies for managing a foreshortened small bowel mesentery when constructing an end or loop ileostomy. 3. Recognize technical considerations for maturing a stoma in a massively dilated, thick-walled colon and identify associated long-term risks Sponsor Disclaimer: Visit https://www.goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

What does it take to build a national surgical education apparatus from scratch? In this episode, we sit down with Dr. Ajit Sachdeva, the former Senior Vice President for Education at the American College of Surgeons—a role he held for 24 years before passing the torch in fall 2025. When Dr. Sachdeva arrived at the ACS in 2001, there was no division, no script, and almost no structure. Over the course of his tenure, he created an ecosystem that now touches surgeons at every stage of their careers, from the first year of medical school to the last year of practice. Dr. Sachdeva reflects on competence, excellence, and the value of surgical educators. He discusses the structural shifts that have shaped modern surgical training, including simulation standards, competency-based curricula, the ACS Accredited Education Institutes, and the Academy of Master Surgeon Educators. He also shares his thoughts on the challenges that remain: resource constraints, the tension between clinical productivity and educational investment, and the gap between national standard-setting and local implementation. Join hosts Pooja Varman, MD, Judith French, PhD, and Jeremy Lipman, MD, MHPE to reflect on Dr. Sachdeva’s impact on surgical education. Learning Objectives By the end of this episode, listeners will be able to 1. Distinguish between competence, proficiency, expertise, and mastery in the context of surgical training and career development. 2. Identify key structural initiatives from the ACS Division of Education and describe their impact on surgical education at the national level. 3. Discuss the challenges of sustaining and funding surgical education infrastructure and articulate strategies for aligning educational goals with institutional priorities. References 1. ACS Accredited Education Institutes: https://www.facs.org/for-medical-professionals/education/programs/accredited-education-institutes/ 2. Dr. Ajit Sachdeva Describes a Career of Distinction in Practice and Surgical Education | ACS. Accessed March 27, 2026. https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/acs-brief/october-21-2025-issue/dr-ajit-sachdeva-describes-a-career-of-distinction-in-practice-and-surgical-education/ 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

It’s 0300 and you encounter a rapidly expanding zone 1 retroperitoneal haematoma. Time to enter “tiger country”. What can you do to make this a more familiar expedition? • Hosts: Bulleted list of host names, including title, institution, & social media handles if indicated 1. Mr Prashanth Ramaraj. ST5 General Surgery, George Hospital, Western Cape / Southeast Scotland Deanery. @LonTraumaSchool 2. Dr Roisin Kelly. Medical Officer, Emergency Medicine, Sydney, Australia. 3. Mr Max Marsden. Consultant Trauma and UGI Surgeon, Royal London Hospital. @maxmarsden83 4. Mr Christopher Johnston. Consultant Liver Transplant Surgeon and Transplant Surgery Fellowship Lead, Edinburgh Transplant Unit. @cjcjohnston • Learning objectives: Bulleted list of learning objectives. A) To understand the rationale for thoracic aortic clamping in resuscitative trauma surgery and how this is performed. B) To understand how to access the retroperitoneal structures by means of medial visceral rotation and how this is performed. C) To understand the haemostatic ladder for liver trauma and considerations in hepatic exclusion. 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

There are many acceptable approaches to adrenalectomy. Hypercortisolism with adrenal origin is a challenging topic especially in a population where obesity is incredibly common. A thorough biochemical workup involving endocrinologists and endocrine surgeons is key to offering the best surgery. Large adrenal tumors with indeterminate imaging characteristics have historically been removed with an open surgical approach. However, with modern robotic technology, it is possible to remove these successfully using a minimally invasive approach with a high-volume surgeon. Today we will discuss some clinically challenging adrenal cases addressing the above issues, and include tips and tricks from an expert, high-volume robotic adrenal endocrine surgeon. Hosts: - Amanda Doubleday, DO, MBA, Assistant Professor, Waukesha Surgical Specialists, ProHealth Care. Affiliated with University of Wisconsin School of Medicine and Public Health, Department of Surgery. - Simon Holoubek, DO, MPH, Assistant Professor, University of Wisconsin School of Medicine and Public Health, Department of Surgery. - John R. Porterfield, Jr., MD, MSPH, FACS, President of Clarus Surgery, President of Apex PA Surgical Services and Founder & Chief Medical Officer of Informed Surgical 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

This mini-series on Behind the Knife will delve into the technical aspects of the Operative Standards for Cancer Surgery, developed through the American College of Surgeons Cancer Research Program. This third episode highlights the Hepato-Pancreato-Biliary cancer operative standard. Hosts: Eliza W. Beal, MD, FACS (X: @ElizaWBealMD) is a Hepato-Pancreato-Biliary surgeon at the Barbara Ann Karmanos Cancer Institute in Detroit. She is also an associate professor of Oncology and Surgery at Wayne State University School of Medicine. Morgan Jackson, MD is a general surgery resident at the Detroit Medical Center and Wayne State University in Detroit, MI. Daniel Nelson, MD, FACS, FSSO (X: @DWNelsonHPB) is a Hepato-Pancreato-Biliary surgeon at the University of Tennessee Health Science Center - Chattanooga. Hop Sanderson Tran Cao, MD, FACS (X: @HopSTranCao) is a Hepato-Pancreato-Biliary surgeon at MD Anderson Cancer Center. Guest: Alice Wei, MD is a Hepato-Pancreato-Biliary surgeon at Memorial Sloan Kettering and associate professor of surgery at Weill Cornell School of Medicine. Dr. Wei contributed to the development of the operative standards for HPB surgery. Learning Objectives: The goals of this podcast are to provide education about the standards, generate discussion, and offer technical pearls to both oncologic specialists and general surgeons, to all of whom these standards apply. In this podcast we discuss the operative standards for liver resection for hepatocellular carcinoma, which includes that the surgeon should: (1) perform a thorough inspection of the liver and abdomen, either laparoscopically or open, including performing liver ultrasound, and (2) should resect all lesions to macroscopically negative margins, preferably with an anatomic resection. Our guest Dr. Wei also provides technical tips, pearls for improving skills performing and interpreting liver ultrasound, and discusses the role of lymphadenectomy in patients with hepatocellular carcinoma. References: Operative Standards for Cancer Surgery, Volume 3: Sarcoma, Adrenal, Neuroendocrine, Peritoneal, Urothelial, Hepatobiliary https://www.facs.org/quality-programs/cancer-programs/cancer-surgery-standards-program/operative-standards-for-cancer-surgery/purchase/ 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this episode, we discuss all things abdominal wall reconstruction. What is this new developing field, just patching “holes” with meshes or something more? We delve into the impact of the robot in transforming this speciality in new ways. We also explore the reasons that make the field of abdominal wall reconstruction so special (the creativity in surgical planning and the unique patient-provider relationship). Joining BTK fellow Agnes Premkumar and ASGBI hosts Elizabeth McLennan and Gita Lingam are Dr. Conrad Ballecer and Dr. Akash Mehta. Dr. Conrad Ballecer is an internationally renowned minimally invasive surgeon, focused on abdominal wall reconstruction. He currently works at Creighton University in Phoenix with complex hernias and frequently publicizes his surgical videos for education! Mr. Mehta is a consultant colorectal surgeon at St. Mark’s Hospital in London, United Kingdom. He is interested in intestinal failure and rehabilitation surgery. He is also the lead for the region's abdominal wall multidisciplinary team and has successfully established a minimally invasive abdominal wall surgery program. This episode is dedicated to Professor Neil Smart, a visionary surgeon from the UK who was a lifelong advocate for hernia surgery and patients. His legacy lives on. Let us know what you think! And be on the lookout for more ASGBI/BTK collaborative episodes. 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this surgical endoscopy episode, the BTK team introduces endoscopic surgical procedures that are perhaps less well known. They cover primary endoscopic treatments for gastroesophageal reflux, esophageal plication, intestinal resurfacing procedures, and magnet-assisted enteric anastomoses. Endoscopic options may be viable alternatives to surgical treatment, especially in case where the surgical alternatives may significantly increase morbidity. Video: https://behindtheknife.org/watch/surgical-endoscopy-series-ep-5-novel-endosurgical-techniques Hosts: · Dr. Sullivan “Sully” Ayuso, Minimally Invasive Surgeon, Dell Medical School, University of Texas at Austin (Austin, TX), @SAyusoMD (Twitter) · Dr. H. Mason Hedberg, Minimally Invasive Surgeon, Endeavor Health (Evanston, IL), · Dr. Trevor Crafts, Minimally Invasive Surgeon, Rocky Mountain VA Medical Center (Denver, CO), @CraftsTrevor (Twitter) · Dr. Zachary Callahan, Minimally Invasive Surgeon, The Surgical Clinic (Nashville, TN), @zmcallahan (Twitter) 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Digital surgery has morphed from buzzword into ubiquitous high-impact technology. In this episode, the BTK MIS team steps into the rapidly evolving ecosystem of cameras, sensors, robotics, and software that are turning surgical operations into structured, analyzable datasets. From AI segmentation to real-time telepresence, don’t miss this opportunity to catch up on what’s new and what’s next, what’s exciting and what’s terrifying, just on the horizon of your surgical career. Hosts: · James Jung, MD, PhD, Assistant Professor of Surgery, Duke University · Jacob Greenberg, MD, EdM, MIS Division Chief and Vice Chair for Education, Duke University · Zachary Weitzner, MD, Minimally Invasive and Bariatric Surgery Fellow, Duke University, @ZachWeitznerMD · Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actually Learning Goals: By the end of this episode, listeners will be able to: · Define “digital surgery” and describe its core components, including video capture, instrumentation, robotics, data analytics, and system connectivity. · Discuss current and emerging applications of digital surgery in surgical education, including video-based self-assessment, procedural segmentation, and structured feedback models. · Describe how digital tools can be used to improve OR efficiency and resource utilization, including instrumentation usage, operative time analysis, and workflow optimization. · Summarize current telepresence and teleproctoring technologies and their clinical use cases, including augmented reality–based collaboration across institutions and geographic boundaries. · Identify key ethical, legal, and operational challenges in digital and tele-surgery, including credentialing, cross-state licensure, liability, and trust in remote expertise. · Discuss how digital surgery may reshape surgical training and competency-based assessment, including implications for autonomy, deliberate practice, and feedback frequency. · Recognize future directions of digital surgery integration, including predictive analytics, simulation using patient-specific imaging, and AI-assisted intraoperative decision support. References: Balvardi S, Semsar-Kazerooni K, Kaneva P, et al. Validity of video-based general and procedure-specific self-assessment tools for surgical trainees in laparoscopic cholecystectomy. Surg Endosc. 2023;37(3):2281-2289. doi:10.1007/s00464-022-09466-6 [https://pubmed.ncbi.nlm.nih.gov/36307525/] Hospital Utilizes Intraoperative Idle Time Metrics to Improve Surgical Safety and Efficiency. Theator | The Surgical Intelligence Company. Accessed March 20, 2026. https://theator.io/customer-story/hospital-utilizes-intraoperative-idle-time-metrics-to-improve-surgical-safety-and-efficiency/ Campbell KK, Abreu AA, Zeh HJ, et al. Using OR Black Box Technology to Determine Quality Improvement Outcomes for In-situ Timeout and Debrief Simulation. Ann Surg. 2026;283(1):122. doi:10.1097/SLA.0000000000006438 [https://pubmed.ncbi.nlm.nih.gov/38317208/] Al Abbas AI, Meier J, Daniel W, et al. Impact of team performance on the surgical safety checklist on patient outcomes: an operating room black box analysis. Surg Endosc. 2024;38(10):5613-5622. doi:10.1007/s00464-024-11064-7 [https://pubmed.ncbi.nlm.nih.gov/39069926/] Proximie’s telepresence platform helps surgeons across the globe grow and exchange experience in real-time. World Health Expo Insights. Accessed March 20, 2026. https://www.worldhealthexpo.com/insights/telemedicine/proximie-s-telepresence-platform-helps-surgeons-across-the-globe-grow-and-exchange-experience-in-real-time Hassan AE, Desai SK, Georgiadis AL, Tekle WG. Augmented reality enhanced tele-proctoring platform to intraoperatively support a neuro-endovascular surgery fellow. Interv Neuroradiol. 2022;28(3):277-282. doi:10.1177/15910199211035304 [https://pubmed.ncbi.nlm.nih.gov/34538166/] SAGES Digital Surgery Working Group; Ali JT, Yang G, Green CA, Reed BL, Madani A, Ponsky TA, Hazey J, Rothenberg SS, Schlachta CM, Oleynikov D, Szoka N. Defining digital surgery: a SAGES white paper. Surg Endosc. 2024 Feb;38(2):475-487. doi: 10.1007/s00464-023-10551-7. Epub 2024 Jan 5. PMID: 38180541. [https://pubmed.ncbi.nlm.nih.gov/38180541/] 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Navigating the path to becoming a surgeon in the US as an International Medical Graduate (IMG) can definitely have its hurdles. In this episode we sit down with Professor of Surgery, Dr. Ourania Preventza about her journey as an IMG, and how to break down the barriers in one of the most competitive surgical subspecialties. Dr. Preventza teaches us why sponsorship is invaluable, and how we as a surgical community can help support this vulnerable group of providers. With years of experience to offer, both as an IMG herself, and now as a fierce advocate and mentor for trainees, this interview with Dr. Preventza is not one to miss. References: https://www.jtcvsopen.org/article/S2666-2736(25)00059-2/fulltext The current landscape and challenges facing international medical graduates in cardiothoracic surgery training https://pubmed.ncbi.nlm.nih.gov/39886768/ International Medical Graduates in Academic Cardiothoracic Surgery https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S2666273625002840?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2666273625002840%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F A career in cardiothoracic surgery in the United States: Guidance and resources for international medical graduates https://jtd.amegroups.org/article/view/38164/html US women in Thoracic Surgery: Reflections on the Past and Opportunities for the Future 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Join our burn team as they dive into the complex world of skin substitutes in burn care, breaking down a practical four-axis framework to help clinicians navigate product selection, patient factors, and clinical goals when managing massive burn injuries. Hosts: - Kathleen Romanowski – University of California Davis Hospital, Shriners Hospital Sacramento - Laura Johnson – Grady Memorial Hospital - Lauren Nosanov – Grady Memorial Hospital - Victoria Miles – Louisiana State University Health Science Center, University Medical Center New Orleans Learning objectives: 1. Classify skin substitutes along four axes: layer replaced, cellularity, origin, and duration. 2. Integrate wound, patient, phase-of-care, and goal factors to select an appropriate skin substitute or combination strategy. 3. Critically appraise the evidence base for skin substitutes, including industry influence and the distinction between adjunctive tools and definitive autologous coverage. If you would like the table mentioned in the episode, please email hello@behindtheknife.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://behindtheknife.org/listen Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this episode of the Behind the Knife Global Surgery Series, we take a closer look at the real-world complexity of global surgery partnerships between high-income institutions and partners in the Global South. Words like equity, bidirectionality, partnership, and decolonization are used often in global surgery—but what do they actually mean when funding, mobility, research access, publication opportunities, and institutional power are unequally distributed? Host Mike Mallah is joined by Dr. Hugo Stark from George Hospital in South Africa and Dr. Sydney Bertram from Emory for a candid discussion about the benefits and tensions of collaborations in an unequal world. Together, they explore how global surgery partnerships can create meaningful educational and clinical value, how good intentions can still reproduce unequal systems, and how surgeons can build partnerships that are locally useful, honest about power, and ultimately centered on better surgical care for patients. Hosts/Guests: - Mike M. Mallah, MD, FACS, FICS Director of Global Surgery at Medical University of South Carolina @MikeMMallahMD @MUSCGlobalSurg mallahm@musc.edu - Hugo Stark, MD Head of Department - Surgery, George Hospital, Western Cape, South Africa Head of Surgical Services, Central Karoo Region Sydney Bertram, MD General Surgery Resident, Emory University Trainee Advisory Council, Consortium of Universities for Global Health @Sydney_Bertram Learning objectives: • Describe how global surgery partnerships can provide educational, clinical, professional, and research value for both high-income and Global South partners. • Identify how asymmetries in funding, mobility, publication access, and institutional agenda-setting can create inequity within otherwise well-intentioned global surgery partnerships. • Discuss practical principles for ethical global surgery engagement, including centering local needs, avoiding extraction, building durable partnerships, and focusing on patient access to surgical decision-making. 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Immune checkpoint inhibitors have rapidly reshaped care for triple-negative breast cancer (TNBC)—but surgical teams increasingly encounter their downstream perioperative consequences. In this episode, we define immunotherapy through the lens of checkpoint biology, review the landmark evidence supporting pembrolizumab in metastatic PD‑L1–positive TNBC (KEYNOTE‑355) and curative-intent stage II–III TNBC (KEYNOTE‑522), and translate immune-related adverse events (irAEs) into practical periop recognition, triage, and timing decisions—especially for endocrine, pulmonary, hepatic, dermatologic, and GI toxicities. Hosts: - Rashmi Kumar, MD, PhD Resident, University of Michigan General Surgery Residency Program Twitter/X: @RashmiJKumar - Melissa Pilewskie, MD Attending Breast Surgical Oncologist, Co-Director of the Weiser Family Center for Breast Cancer, Michigan Medicine Twitter/X: @MPilewskie - Stephanie Downs-Canner, MD Attending Breast Surgical Oncologist & Physician-Scientist, Memorial Sloan Kettering Cancer Center, Program Director of the Breast Surgical Oncology Fellowship Training Program Twitter/X: @SDownsCanner Learning Objectives: Define immunotherapy and immune checkpoint inhibition in breast cancer Summarize current clinical indications and pivotal evidence for pembrolizumab in TNBC Equip perioperative clinicians to identify and manage immune-related adverse events (irAEs) or side effects of immunotherapy. Rationale for Immunotherapy in Breast Cancer Review Selecting Triple Negative Breast Cancer Patients for Immunotherapy: https://pubmed.ncbi.nlm.nih.gov/37714640/ Landmark Clinical Trials Discussed in this Episode KEYNOTE-355: https://pubmed.ncbi.nlm.nih.gov/33232653/ KEYNOTE-522: https://pubmed.ncbi.nlm.nih.gov/33232642/ IMpassion130: https://pubmed.ncbi.nlm.nih.gov/30345906/ IMpassion131: https://pubmed.ncbi.nlm.nih.gov/33930478/ Assessment of Surgical Outcomes in patients receiving chemoimmunotherapy Surgical outcomes after neoadjuvant chemoimmunotherapy in triple-negative breast cancer: https://pubmed.ncbi.nlm.nih.gov/38332314/ Immune Related Adverse Events and Management Schneider BJ, et al. Management of immune-related adverse events: https://pubmed.ncbi.nlm.nih.gov/34724392/ Brahmer JR, et al. SITC clinical practice guideline: https://pubmed.ncbi.nlm.nih.gov/34177534/ 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review OBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-review EPA Playbook: https://behindtheknife.org/course/epa-playbook Surgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcards ABSITE Review: https://behindtheknife.org/course/absite-2026-exam-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Join our OHSY Hernia team to review the current landscape of bioresorbable meshes and a conversation considering “are they worth it?" Hosts: Dr. Maggie Bosley - @MBosleyMD Dr. Sean Orenstein - @OrensteinSean Dr. Amber Sandoval Dr. Peter Ferrin Institution: Oregon Health & Science University References: - Long-Term, Prospective, Multicenter Study of Poly-4-Hydroxybutyrate Mesh (Phasix Mesh) for Hernia Repair in Cohort at Risk for Complication: 60-Month Follow-Up https://pubmed.ncbi.nlm.nih.gov/36102523/ - Multicenter, Prospective, Longitudinal Study of the Recurrence, Surgical Site Infection, and Quality of Life After Contaminated Ventral Hernia Repair Using Biosynthetic Absorbable Mesh: The COBRA Study https://pubmed.ncbi.nlm.nih.gov/28009747/ - A prospective, multicenter trial of a long-term bioabsorbable mesh with Sepra technology in cohort of challenging laparoscopic ventral or incisional hernia repairs (ATLAS trial) https://pubmed.ncbi.nlm.nih.gov/34976385/ - Biosynthetic mesh in hernia repair: A systematic review and meta-analysis https://journals.lww.com/rhaw/fulltext/2024/07020/biosynthetic_mesh_in_hernia_repair__a_systematic.2.aspx 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Circulating tumor DNA (ctDNA), a minimally invasive blood-based biomarker, has emerged as one of the most promising advances in cancer surveillance. Today, we will explore how ctDNA is transforming the management of colorectal cancer and anal squamous cell cancer across the disease continuum—from risk stratification and adjuvant therapy decision-making to surveillance and early detection of recurrence. Through landmark clinical trials, real-world applications, and emerging research, we will examine how ctDNA is helping move cancer care closer to the goal of truly personalized medicine. Hosts: · Dr. Janet Alvarez - General Surgery Resident at New York Medical College/Metropolitan Hospital Center · Dr. Wini Zambare – General Surgery Resident at Weill Cornell Medical Center/New York Presbyterian · Dr. Philip Bauer, Assistant Professor of Surgery, Division of Colon and Rectal Surgery, The Ohio State University Wexner Medical Center, Arthur G. James Cancer Hospital · Dr. J. Joshua Smith MD, PhD, Chair, Department of Colon and Rectal Surgery at MD Anderson Cancer Center Guests: Dr. Paul Romessor · Director of Colorectal and Anal Cancer, Department of Radiation Oncology · Associate Attending Radiation Oncologist Memorial Sloan Kettering Cancer Center Dr. Jeanne Tie · Medical Oncologist | Lower GI Unit · Lower GI Research Lead · Chair | Lower GI Working Party | GI Cancer Trials Peter MacCallum Cancer Centre Dr. Takayuki Yoshino · Professor, Global Center of Research Excellence for Advanced Medicine (G-CORE), Keio University School of Medicine · Executive Advisor to Hospital East Director · Director, Department of Global Oncology · Chief, Department of Gastrointestinal Oncology National Cancer Center Hospital East Learning Objectives: · Describe the biological basis and clinical applications of circulating tumor DNA (ctDNA) as a biomarker of minimal residual disease (MRD) in colorectal cancer. · Interpret the prognostic significance of postoperative and longitudinal ctDNA testing and its role in predicting recurrence risk across stages of colorectal cancer. · Evaluate evidence from landmark clinical trials, including DYNAMIC and GALAXY, supporting ctDNA-guided treatment de-escalation and escalation strategies in colorectal cancer. · Discuss emerging applications of ctDNA monitoring in personalized cancer care, including surveillance, treatment response assessment, and future clinical trial directions. References: · Ando, K. et al. (2026). Molecular Residual Disease and Recurrence in Rectal Cancer Patients Undergoing Upfront Surgery: A Prospective Cohort Study. Annals of Surgery. https://pubmed.ncbi.nlm.nih.gov/39854721/ (Note: If direct access is limited, the article is available via PMC: PMC12695342) · Romesser, P. B. et al. (2026). Tumor-informed circulating tumor DNA stratifies recurrence risk and survival in anal squamous cell carcinoma. Nature Communications. https://pubmed.ncbi.nlm.nih.gov/38347209/ · Tie, J. et al. (2025). Circulating tumor DNA analysis guiding adjuvant therapy in stage II colon cancer: 5-year outcomes of the randomized DYNAMIC trial. Nature Medicine. https://pubmed.ncbi.nlm.nih.gov/39943485/ · Tie, J. et al. (2025). Circulating tumor DNA-guided adjuvant therapy in locally advanced colon cancer: the randomized phase 2/3 DYNAMIC-III trial. Nature Medicine. https://pubmed.ncbi.nlm.nih.gov/39974258/ 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

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. Bryan A. Cotton, MD, MPH and Marty A. Schreiber, MD, FACS, FCCM, FCRST (Hon), COL, MC, USAR as they debate REBOA as a Life-Saving Intervention in Hemorrhagic Shock. You can listen on the podcast or watch the debate with accompanying slides on our website or app. Let's get ready to RUMMMBLLLEEEE! TRAUMA SURGERY VIDEO ATLAS: https://behindtheknife.org/premium/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://behindtheknife.org/listen Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

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. Carlos V.R. Brown, MD, FACS and Katie W. Russell, MD as they debate WHETHER OR NOT PEDIATRIC PANCREATIC INJURIES CAN BE MANAGED NON-OPERATIVELY. You can listen on the podcast or watch the debate with accompanying slides on our website or app. Let's get ready to RUMMMBLLLEEEE! TRAUMA SURGERY VIDEO ATLAS: https://behindtheknife.org/premium/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://behindtheknife.org/listen Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Join us as we discuss research on mental health and wellbeing in the surgical workforce with Drs. Yang and Collins. The episode explores key findings from recent national surveys showing that nearly one in seven surgeons report suicidal ideation in the past year, with depression, anxiety, and PTSD affecting 15–20% of the surgical population. The conversation highlights protective factors—professional fulfillment, resilience, self-valuation, and connection—while distinguishing between healthy resilience and normalized suffering. Dr. Yang and Dr. Collins discuss systemic barriers including time constraints, out-of-pocket mental health costs, and persistent stigma, alongside actionable institutional interventions: protecting dedicated wellbeing time, establishing peer support and psychological first aid programs, ensuring free mental health access, and expanding research to understand what helps surgeons thrive. The episode emphasizes that self-care is essential to patient safety and invites listeners to become advocates, engage with the literature, and help drive culture change within their institutions. For more information about the AAS wellbeing survey, please email Dr. Yang at CJYANG@MGH.HARVARD.EDU. Host: Steven Thornton, MD (General Surgery Resident at Duke University) Agnes Premkumar (General Surgery Resident at Creighton) Guests: Jeff Yang, MD (Massachusetts General Hospital) Reagan Collins, MD (University of Pennsylvania) Publications Discussed: Hughes TM, Collins RA, Cunningham CE. Depression and Suicide Among American Surgeons-A Grave Threat to the Surgeon Workforce. JAMA Surg. 2024 Jan 1;159(1):7-8. doi: 10.1001/jamasurg.2023.4658. PMID: 37792380. [https://pubmed.ncbi.nlm.nih.gov/37792380/] Collins RA, Herman T, Snyder RA, Haines KL, Stey A, Arora TK, Geevarghese SK, Phillips JD, Vicente D, Griggs CL, McElroy IE, Wall AE, Hughes TM, Sen S, Valinejad J, Alban A, Swan JS, Mercaldo N, Jalali MS, Chhatwal J, Gazelle GS, Rangel E, Yang CJ, Donelan K, Gold JA, West CP, Cunningham C. Unspoken Truths: Mental Health Among Academic Surgeons. Ann Surg. 2024 Mar 1;279(3):429-436. doi: 10.1097/SLA.0000000000006159. Epub 2023 Nov 23. PMID: 37991182. [https://pubmed.ncbi.nlm.nih.gov/37991182/] Yaghmour NA, Bynum WE 4th, Hafferty FW, Könings KD, Richter T, Brigham TP, Nasca TJ. Causes of Death Among US Medical Residents. JAMA Netw Open. 2025 May 1;8(5):e259238. doi: 10.1001/jamanetworkopen.2025.9238. Erratum in: JAMA Netw Open. 2025 Jul 1;8(7):e2523489. doi: 10.1001/jamanetworkopen.2025.23489. PMID: 40366660; PMCID: PMC12079293. [https://pubmed.ncbi.nlm.nih.gov/40366660/] Nasca BJ, Hunt ML, Ramirez RT, Eng JS, Li RD, Agarwal G, Bilimoria KY, Hu YY. One is too many: suicidality among general surgery residents. Acad Med. 2025 Dec 24:wvaf105. doi: 10.1093/acamed/wvaf105. Epub ahead of print. PMID: 41819820. [https://pubmed.ncbi.nlm.nih.gov/41819820/] 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

INTRODUCING Behind the Knife OBGYN Oral Board Review! The oral boards aren't just about knowledge—they are about executing under pressure. This course is designed to give you the structure and confidence to command the room. We have curated 98 high-yield scenarios covering the "Big Three" of the exam: Obstetrics, Gynecology, and Office Practice. Whether it’s a surgical emergency or a complex clinic workup, we will walk you through exactly how to articulate your plan, defend your decisions, and pass this exam. Each scenario includes 2 parts. The first part is a perfectly executed scenario. 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 are confident you will find this unique, dual format approach a highly effective way to prepare for the test. Please check out the preview episodes below that include Parts A and B, with and without commentary. This course includes access to our Oral Board Simulator. Step into the hot seat and experience the pressure of the real exam and receive detailed, actionable feedback with the most advanced oral board prep available. 3-Month Purchase - 10 exams 6-Month Purchase - 22 exams 12-Month Purchase - 46 exams Learn More: https://behindtheknife.org/premium/obgyn-oral-board-review DOMINATE THE DAY!

Join Drs. Georgoff, Burke, and Premkumar in this episode of the EPA Playbook as they break down a practical, repeatable framework for managing patients in the trauma bay, one of the most high-pressure environments in surgical training. This episode focuses on the critical first minutes of evaluation, anchored in a structured primary survey. We emphasize how to recognize and immediately address life-threatening injuries, while maintaining situational awareness and clear communication with your team. From airway and hemorrhage control to adjuncts like FAST and early imaging, we highlight what matters most when time is critical. ***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbook Simply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library. For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/. BTK Resources: Trauma Video Playlist (FAST, How to Read a CT, and more!) https://behindtheknife.org/video-playlists/trauma-videos Big T Trauma Podcasts https://behindtheknife.org/podcast-series/big-t-trauma Trauma Surgery Video Atlas (Premium) https://behindtheknife.org/premium/trauma-surgery-video-atlas

Join Drs. Georgoff, Burke, and Premkumar in this episode of EPA Playbook, where we tackle the evaluation and management of small bowel obstruction. Through a realistic series of scenarios, we walk step-by-step through how junior residents can approach this diagnosis using an evidence-based approach. We break down the key components of the small bowel obstruction EPA, from rapid initial assessment and focused physical exam to early resuscitation, recognizing when to go straight to the OR, and post-operative care. Along the way, we highlight critical teaching points you’ll actually use on call. Whether you’re a new intern or an early resident looking to build confidence, this episode is designed to help you act decisively and move one step closer to entrustment. ***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbook Simply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library. For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/. BTK Resources: Nasogastric Tube (NGT) Management Video https://behindtheknife.org/video/behind-the-knife-nasogastric-tube-ngt-management Nasogastric Tube (NGT) Placement Video https://behindtheknife.org/video/behind-the-knife-nasogastric-tube-ngt-placement Ostomy Marking Video https://behindtheknife.org/video/behind-the-knife-ostomy-marking How to Change an Ostomy Appliance Video https://behindtheknife.org/video/behind-the-knife-how-to-change-an-ostomy-appliance How to Manage a Challenging Ostomy Video https://behindtheknife.org/video/behind-the-knife-how-to-manage-a-challenging-ostomy Cited Studies: National prospective cohort study of the burden of acute small bowel obstruction https://doi.org/10.1002/bjs5.50136 Management and short-term outcomes of patients with small bowel obstruction in Denmark: a multicentre prospective cohort study https://doi.org/10.1007/s00068-022-02171-y Multi-institutional, prospective, observational study comparing the Gastrografin challenge versus standard treatment in adhesive small bowel obstruction https://doi.org/10.1097/ta.0000000000001499 Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline https://doi.org/10.1097/ta.0b013e31827019de

In this episode of EPA Playbook, Drs. Jason Bingham, Emma Burke, and Agnes Premkumar discuss the evaluation and management of inguinal hernias through a case-based approach that reinforces key EPA concepts for surgical trainees. We specifically highlight the importance of a thorough history and physical exam, emphasize risk stratification, and indications for surgery versus watchful waiting. We briefly review a few postoperative considerations as well. ***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbook Simply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library. For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/. Cited studies: Miserez M, et al. "Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients." Hernia. 2014;18(2):151-163. PubMed ID: 24504225 Carrick MA, et al. "Smoking and anaesthesia." BJA Educ. 2019;19(1):1-6. PubMed ID: 33456860 Amid PK, et al. "Local anesthesia for inguinal hernia repair step-by-step procedure." Ann Surg. 1994;220(6):735-737. PubMed ID: 7979603 Huy TC, et al. "Reoperation for chronic postoperative inguinal pain." JAMA Surg. 2025;160(9):984-991. PubMed ID: 39855588

In this episode of EPA Playbook, Drs. Kevin Kniery, Emma Burke, and Agnes Premkumar discuss management of critically ill surgical patients, using case-based discussions to reinforce core principles of shock, resuscitation, and ICU care. We first review the four major types of shock. We then discuss two cases centered around managing a patient in septic shock and cardiogenic shock, delving into the nuances on how management differs between the two. Additionally, we underscore a physiology-driven approach to critical care, the importance of multidisciplinary collaboration, and the need to align treatment decisions with patient goals and values. ***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbook Simply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library. For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/.

Join Drs. Steele, Burke, & Premkumar in this episode of EPA Playbook, where we tackle a core general surgery EPA: the evaluation and management of benign and malignant colon disease. From common presentations like diverticulitis and lower GI bleeding to the diagnosis and workup of colon cancer, this episode provides a structured framework you can use on the wards, in clinic, and on call. Using case-based discussions, we walk through how to distinguishing benign from malignant processes, selecting appropriate imaging and endoscopy, and recognizing when a patient needs urgent intervention versus outpatient workup. We also cover key principles of colon cancer management, including staging, surgical planning, and multidisciplinary care, alongside high-yield management of benign conditions. ***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbook Simply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library. For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/. Cited Studies: Gustafsson, U.O., Scott, M.J., Hubner, M. et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg 43, 659–695 (2019). https://doi.org/10.1007/s00268-018-4844-y BTK Resources: Ostomy Marking Video https://behindtheknife.org/video/behind-the-knife-ostomy-marking How to Change an Ostomy Appliance Video https://behindtheknife.org/video/behind-the-knife-how-to-change-an-ostomy-appliance How to Manage a Challenging Ostomy Video https://behindtheknife.org/video/behind-the-knife-how-to-manage-a-challenging-ostomy

Two years into the EPA era — are we actually training surgeons differently, or just checking new boxes? In this episode, Behind the Knife co-director and Duke Trauma Surgeon Dr. Patrick Georgoff and Behind the Knife surgical education fellows Dr. Agnes Premkumar and Dr. Emma Burke sit down with Dr. Ruchi Thanawala, thoracic surgeon at OHSU, informatician, and founder of Firefly Labs, to get an honest look at the state of competency-based surgical education. We dig into why surgery is uniquely hard to assess, what the data are actually showing (spoiler: significant skewing, and we're not ready to make promotion decisions off it yet), and why collecting assessments is only 25% of the work. If you've ever wondered whether EPAs are moving the needle or just adding noise, this one's for you ***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbook Simply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library. 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this episode, we use the recent SAGES guidelines to tackle one of the most common and controversial questions in general surgery. Through a case-based discussion, our experts review the evidence for intraoperative biliary imaging, discuss strategies for difficult anatomy, and compare IOC with other imaging modalities. Join us as we translate the latest recommendations into practical lessons that can be applied in the operating room. Take Home Points: Routine IOC is supported; however, this remains a conditional recommendation that should be individualized based on anatomy, surgeon experience, and available resources. Use a selective approach to IOC in special populations, including pediatric and pregnant patients, where risks and benefits may differ. Alternative imaging modalities including ICG fluorescence and laparoscopic ultrasound have complementary roles. Routine IOC may help maintain surgeon and team proficiency, and trainees should learn both IOC performance and interpretation Hosts: Jason Bingham, MD – General and Bariatric Surgeon Nicole L. Petcka, MD, MHPE – General Surgery Resident at Emory University Guests: Emily Miraflor, MD – General and Colorectal Surgeon at UCSF East Bay, Senior Author on the SAGES Guidelines Kevin El-Hayek, MD - HPB and Foregut Surgeon at MetroHealth and Professor of Surgery at Case Western Reserve School of Medicine, Chair of the SAGES HPB/Solid Organ Committee Dena Shehata, MD - SAGES Guideline Fellow, Co-first author on the SAGES Guidelines Resources: Kumar, S. K., Shehata, D. G., Cetrulo, L. N., Ignacio, R., Chiu, J., Davis, B. R., McDonald, M., Bloom, M. B., Ayloo, S., Kchaou, A., Orthopoulos, G., Pucher, P. H., Oliphant, U., Hallowell, P. T., Serrot, F., Overby, D., Moreno-Paquentin, E., Slater, B. J., & Miraflor, E. (2025). SAGES guidelines for the use of intraoperative imaging of the common bile duct. Surgical endoscopy, 39(11), 7091–7102. https://doi.org/10.1007/s00464-025-12142-0 SAGES Safe Cholecystectomy Program - https://www.sages.org/safe-cholecystectomy-program/ 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Join our Hernia Team for a review of the current controversy around preoperative optimization and the practical implications. Hosts: Dr. Maggie Bosley - @MBosleyMD Dr. Sean Orenstein - @OrensteinSean Dr. Amber Sandoval Dr. Peter Ferrin Institution: Oregon Health & Science University References: Adverse Events after Ventral Hernia Repair: The Vicious Cycle of Complications https://pubmed.ncbi.nlm.nih.gov/26206646/ Risk factors for postoperative wound infections and prolonged hospitalization after ventral/incisional hernia repair https://pubmed.ncbi.nlm.nih.gov/24030572/ lack of association between glycated hemoglobin and adverse outcomes in diabetic patients undergoing ventral hernia repair: an ACHQC study https://pubmed.ncbi.nlm.nih.gov/35969297/ Impact of preoperative haemoglobin A1c levels on postoperative outcomes in adults undergoing major noncardiac surgery: A systematic review https://pubmed.ncbi.nlm.nih.gov/38853752/ Does active smoking really matter before ventral hernia repair? An AHSQC analysis https://pubmed.ncbi.nlm.nih.gov/30220485/ Abstinence from smoking reduces incisional wound infection: a randomized controlled trial https://pubmed.ncbi.nlm.nih.gov/12832959/ The Association of Nicotine Replacement Therapy With Outcomes Among Smokers Hospitalized for a Major Surgical Procedure https://pubmed.ncbi.nlm.nih.gov/31790653/ Is weight trajectory a better marker of wound complication risk than BMI in hernia patients with obesity? https://pubmed.ncbi.nlm.nih.gov/38082008/ Gender, racial, and socioeconomic disparity of preoperative optimization goals in ventral hernia repair https://pubmed.ncbi.nlm.nih.gov/37658198/ Limited or Lasting: Is Preoperative Weight Loss as Part of Prehabilitation Maintained after Open Ventral Hernia Repair? https://pubmed.ncbi.nlm.nih.gov/39907236/ The impact of preoperative optimization for abdominal wall reconstruction on long-term glucose control and smoking cessation https://pubmed.ncbi.nlm.nih.gov/40739418/ Watchful waiting as a treatment strategy for patients with a ventral hernia appears to be safe https://pubmed.ncbi.nlm.nih.gov/26838293/ 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

As colorectal cancer rates rise among younger adults, surgeons are increasingly caring for patients with rectal cancer who are pregnant or hoping to preserve future fertility. With more individuals delaying childbearing, balancing effective cancer treatment with fertility preservation and maternal–fetal safety has become an important clinical challenge. This timely topic was recently highlighted by Dr. Sharon Suwanabol during a presentation at the American Society of Colon and Rectal Surgeons annual meeting 2026. In this episode, we explore the intersection of rectal cancer, fertility, and pregnancy through a multidisciplinary, case-based discussion. We review how surgery, chemotherapy, and pelvic radiation can affect fertility and sexual function in both men and women, and why early counseling and referral to reproductive endocrinology specialists are essential. The discussion also emphasizes that evaluation and treatment during pregnancy can often be performed safely, with care individualized based on tumor stage, gestational age, and the patient’s goals and values. Hosts and discussants · Dr. Betelhem Yohannes, General surgery resident at the University of Washington · Dr. Griffen Allen, General surgery resident at the University of Washington · Dr. Raga Siddharthan, Assistant Professor of Surgery in the Section of Colorectal Surgery at the University of Washington · Dr. Stacey Cohen, Professor in the Division of Hematology and Oncology at the University of Washington and a gastrointestinal medical oncologist at Fred Hutch Cancer Center, specializing in colorectal and other GI cancers. Learning objectives · Describe the impact of rectal cancer surgery on fertility, sexual function, and future childbearing potential. · Review the effects of chemotherapy and pelvic radiation on reproductive health and fertility preservation. · Discuss available fertility preservation strategies and the importance of early pre-treatment counseling and referral. · Recognize the diagnostic challenges of rectal cancer during pregnancy, including overlapping gastrointestinal symptoms. · Review appropriate staging and workup considerations for suspected rectal cancer in pregnant patients. · Discuss multidisciplinary management strategies for rectal cancer during pregnancy, including individualized treatment sequencing. · Examine ethical and patient-centered considerations when balancing maternal cancer treatment and fetal outcomes. References Siegel RL, Wagle NS, Star J, Kratzer TB, Smith RA, Jemal A. Colorectal cancer statistics, 2026. CA Cancer J Clin. 2026;76(2):e70067. doi:10.3322/caac.70067 [https://pubmed.ncbi.nlm.nih.gov/38240409/] Pregnancy at Age 35 Years or Older: ACOG Obstetric Care Consensus No. 11. Obstet Gynecol. 2022;140(2):348-366. doi:10.1097/AOG.0000000000004873 [https://pubmed.ncbi.nlm.nih.gov/35640237/] Stal J, YI SY, Cohen-Cutler S, et al. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist. 2022;27(7):579-586. doi:10.1093/oncolo/oyac052 [https://pubmed.ncbi.nlm.nih.gov/35708892/] Druvefors E, Myrelid P, Andersson RE, Landerholm K. Female and Male Fertility after Colectomy and Reconstructive Surgery in Inflammatory Bowel Disease: A National Cohort Study from Sweden. J Crohns Colitis. 2023;17(10):1631-1638. doi:10.1093/ecco-jcc/jjad079 [https://pubmed.ncbi.nlm.nih.gov/37341355/] Ito M, Tsukada Y, Watanabe J, et al. Long-term survival and functional outcomes of laparoscopic surgery for clinical stage I ultra-low rectal cancers located within 5 cm of the anal verge: A prospective phase II trial (Ultimate trial). Ann Surg. Published online April 1, 2024. doi:10.1097/SLA.0000000000006290 [https://pubmed.ncbi.nlm.nih.gov/38629555/] Teh WT, Stern C, Chander S, Hickey M. The impact of uterine radiation on subsequent fertility and pregnancy outcomes. Biomed Res Int. 2014;2014:482968. Johnson GGRJ, Park J, Helewa RM, Goldenberg BA, Nashed M, Hyun E. Total neoadjuvant therapy for rectal cancer: a guide for surgeons. Can J Surg. 2023 Apr 21;66(2):E196-E201. doi: 10.1503/cjs.005822. PMID: 37085291; PMCID: PMC10125160. [https://pubmed.ncbi.nlm.nih.gov/37085291/] Naren G, Guo J, Bai Q, Fan N, Nashun B. Reproductive and developmental toxicities of 5-fluorouracil in model organisms and humans. Expert Rev Mol Med. 2022 Jan 31;24:e9. doi: 10.1017/erm.2022.3. PMID: 35098910; PMCID: PMC9884763. [https://pubmed.ncbi.nlm.nih.gov/35098910/] National Comprehensive Cancer Network. (2026). NCCN Clinical Practice Guidelines in Oncology: Rectal Cancer (Version 2.2026). Retrieved from NCCN Guidelines for Rectal Cancer [https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1449] Oktay, Kutluk M.D., Ph.D.. Expert Commentary on Fertility Preservation in Colorectal Cancers: Current State and Practical Tips for the Cancer Practitioner. Diseases of the Colon & Rectum 63(6):p 726-727, June 2020. | DOI: 10.1097/DCR.0000000000001688 [https://pubmed.ncbi.nlm.nih.gov/32479532/] Stal J, YI SY, Cohen-Cutler S, et al. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist. 2022;27(7):579-586. doi:10.1093/oncolo/oyac052 [https://pubmed.ncbi.nlm.nih.gov/35708892/] Gentile G, Ciccarone M. Management of fertility preservation in young female patients with gastrointestinal cancer: A case series and systematic literature review. Curr Probl Cancer. 2025;57:101221. doi:10.1016/j.currproblcancer.2025.101221 [https://pubmed.ncbi.nlm.nih.gov/39598263/] Saif MW. Management of colorectal cancer in pregnancy: a multimodality approach. Clin Colorectal Cancer. 2005;5(4):247-256. doi:10.3816/ccc.2005.n.035 [https://pubmed.ncbi.nlm.nih.gov/16183863/] Rogers JE, Dasari A, Eng C. The Treatment of Colorectal Cancer During Pregnancy: Cytotoxic Chemotherapy and Targeted Therapy Challenges. Oncologist. 2016 May;21(5):563-70. doi: 10.1634/theoncologist.2015-0362. Epub 2016 Mar 21. PMID: 27000464; PMCID: PMC4861360. [https://pubmed.ncbi.nlm.nih.gov/27000464/] Jiang Q, Hua H. Fertility in young-onset colorectal patients with cancer: a review. Oncologist. 2024;29(10):e1237-e1245. doi:10.1093/oncolo/oyae141 [https://pubmed.ncbi.nlm.nih.gov/39292850/] Dolmans MM, Hollanders de Ouderaen S, Demylle D, Pirard C. Utilization rates and results of long-term embryo cryopreservation before gonadotoxic treatment. J Assist Reprod Genet. 2015;32(8):1233-1237. doi:10.1007/s10815-015-0533-z [https://pubmed.ncbi.nlm.nih.gov/26162569/ Moawad NS, Santamaria E, Rhoton-Vlasak A, Lightsey JL. Laparoscopic Ovarian Transposition Before Pelvic Cancer Treatment: Ovarian Function and Fertility Preservation. J Minim Invasive Gynecol. 2017;24(1):28-35. doi:10.1016/j.jmig.2016.08.831 [https://pubmed.ncbi.nlm.nih.gov/27599763/] Fish R. Ovarian transposition in rectal cancer: uncertain benefit at a high price. Colorectal Dis. 2022;24(6):706-707. doi:10.1111/codi.16086 [https://pubmed.ncbi.nlm.nih.gov/35191146/] Ribeiro R, Baiocchi G, Moretti-Marques R, Linhares JC, Costa CN, Pareja R. Uterine transposition for fertility and ovarian function preservation after radiotherapy. Int J Gynecol Cancer. 2023;33(12):1837-1842. Published 2023 Dec 4. doi:10.1136/ijgc-2023-004723 [https://pubmed.ncbi.nlm.nih.gov/38104863/] Haggar F, Pereira G, Preen D, et al. Maternal and neonatal outcomes in pregnancies following colorectal cancer. Surg Endosc. 2013;27(7):2327-2336. doi:10.1007/s00464-012-2774-6 [https://pubmed.ncbi.nlm.nih.gov/23645367/] 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Why do millions of patients qualify for bariatric surgery, yet only a fraction ever make it to the operating room? 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: This episode explores disparities in access to bariatric surgery through three key studies examining eligibility, referral patterns, and weight stigma. References: Article #1: Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis (2010, Martin et al.) https://pubmed.ncbi.nlm.nih.gov/19782647/ Analyzed national U.S. datasets to compare patients eligible for bariatric surgery with those who underwent surgery. Although more than 22 million Americans met criteria for bariatric surgery, only about 0.4% underwent surgery in 2006. Patients eligible for surgery were more likely to be female, uninsured, lower income, and from racial and ethnic minority groups, while those receiving surgery were disproportionately Caucasian women with private insurance. This discussion highlights insurance coverage as one of the largest structural barriers to care. Article #2: Investigating racial disparities in bariatric surgery referrals (2019, Johnson-Mann et al.) https://pubmed.ncbi.nlm.nih.gov/30824334/ This study focused on referral patterns within a primary care network. Among nearly 4,700 eligible patients, only 5% were referred to bariatric surgery. Referral disparities were seen across sex, ethnicity, and insurance status. Hispanic patients were significantly less likely to be referred and were far more likely to be uninsured or self-pay. The study emphasizes that disparities begin long before the operating room, often at the level of primary care referral and institutional access policies. Article #3: Assessing Weight Stigma Interventions: A Systematic Review of Randomized Controlled Trials (2025, Wang et al.) https://pubmed.ncbi.nlm.nih.gov/40227369/ Examined interventions designed to reduce weight stigma. Across 56 randomized controlled trials, most interventions demonstrated improvements in attitudes toward obesity. Effective approaches included emphasizing the biologic and environmental causes of obesity, promoting weight-inclusive healthcare, fostering empathy through shared narratives, and using cognitive dissonance strategies to challenge implicit bias. However, changing attitudes does not necessarily translate into improved clinical behavior or patient outcomes. Together, these studies demonstrate that disparities in bariatric surgery occur at multiple stages: eligibility, referral, access, and treatment. Structural barriers, provider bias, insurance limitations, and societal stigma all contribute to inequitable care. Herein, we emphasize the importance of expanding access pathways, improving provider education, and actively reducing weight stigma to ensure equitable surgical care for all eligible patients. 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Prehospital blood is one of the hottest debates in trauma resuscitation — and the evidence just got a lot more interesting. In this episode, Drs. Patrick Georgoff and Ayman Ali sit down with Dr. Ed Barnard, UK defense professor of emergency medicine and author of the landmark SWIFT trial, and Dr. Juan De Chesney, trauma surgeon and pioneer in prehospital blood programs, to break down what we actually know about getting blood to patients before they hit the doors. The SWIFT trial — the largest prehospital whole blood RCT to date — found no superiority of whole blood over component therapy, but the story is far more nuanced than a negative headline suggests. From the logistics of carrying blood on a helicopter to the stark reality that only 1.8% of US ground EMS carries any blood products at all, this conversation exposes both the progress and the enormous gaps that remain. Hosts: Ayman Ali, MD: Ayman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital. Patrick Georgoff, MD @georgoff: Patrick Georgoff is faculty in the Department of Surgery at the Duke University School of Medicine where he serves as an Associate Professor of Trauma, Acute, and Critical Care Surgery and Trauma Medical Director. He is a leading educator and creator for Behind the Knife, a premier digital education platform and podcast advancing surgical training through innovative, high-yield multimedia content. Juan Duchesne, MD: Juan Duchesne is a trauma surgeon and Professor of Surgery serving as the Trauma Medical Director and Division Chief at the University of Mississippi Medical Center. His pioneering contributions to the field—particularly in whole blood and balanced resuscitation practices—have been honored with numerous accolades. Ed Barnard, PhD FRCEM FIMC RCSEd, @edbarn @DefProfEM: Ed Barnard is an emergency physician and UK Defence Professor of Emergency Medicine, RCEM/NIHR Associate Professor, and Affiliated Assistant Professor at the University of Cambridge. He has sub-specialty training in pre-hospital and academic emergency medicine and possesses extensive experience in trauma, anaesthesia, and critical care across both civilian and military settings. His contributions to the field have been honored with five national research awards and a PhD - undertaken with the US Army in San Antonio, TX. This episode 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://behindtheknife.org/listen Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Join the Behind the Knife Surgical Oncology Team as we discuss clinical challenges through case-based examples including the diagnosis, workup, and management of patients with cutaneous melanoma. Learning Objectives: In this episode, we review the workup and management of patients with cutaneous melanoma and both microscopic and macroscopic nodal disease. References used in the making of this episode: Reijers, I.L.M., Menzies, A.M., van Akkooi, A.C.J. et al. Personalized response-directed surgery and adjuvant therapy after neoadjuvant ipilimumab and nivolumab in high-risk stage III melanoma: the PRADO trial. Nat Med 28, 1178–1188 (2022). https://doi.org/10.1038/s41591-022-01851-x Christian U. Blank et al. Neoadjuvant nivolumab plus ipilimumab versus adjuvant nivolumab in macroscopic, resectable stage III melanoma: The phase 3 NADINA trial.. J Clin Oncol 42, LBA2-LBA2(2024). DOI:10.1200/JCO.2024.42.17_suppl.LBA2 Faries MB, Thompson JF, Cochran AJ, et al. Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. N Engl J Med. 2017;376(23):2211-2222. doi:10.1056/NEJMoa1613210 https://pubmed.ncbi.nlm.nih.gov/28591523/ National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Cutaneous Melanoma. Version 1.2026. Accessed April 8, 2026. NCCN Guidelines PDF 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 Behind the Knife Premium: https://behindtheknife.org/premium Oral Board Review: https://behindtheknife.org/oral-board Oral Board Simulator: https://behindtheknife.org/oral-board/simulator General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US