It’s a brave new world people!  There has been an extraordinary and historic change in the way society interacts with information.  With the COVID pandemic raging misinformation and conspiracy theories have taken off like wildfire.  But why?  And what can we as providers do about it?  Join Drs. Patrick Georgoff and Brian Southwell for this timely discussion.   Dr. Southwell is Senior Director of the Science in the Public Sphere Program at the RTI International’s Center for Communication Science. He is also Adjunct Professor at Duke University and Adjunct Associate Professor in Health Behavior at the University of North Carolina at Chapel Hill.  Dr. Southwell has published widely on topics such as public understanding of science and emerging infectious diseases. He co-founded the Duke Program on Medical Misinformation, a clinician training initiative to improve patient-provider conversations about misinformation. He also has organized several summits on trust in science and medical misinformation, such as the Misinformation Solutions Forum. In addition, Dr. Southwell created and hosts The Measure of Everyday Life, a public radio show that translates research for general audiences on WNCU, a station based at North Carolina Central University in Durham, NC.    Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Behind The Knife: The Surgery Podcast

Misinformation, Conspiracy Theories, and COVID: A Reckoning

Journal Review in HPB – Surgical Outcomes of the SWOG S1505 Trial Description: Neoadjuvant chemotherapy remains a controversial topic for resectable pancreatic adenocarcinoma. This randomized trial examines surgical and clinical outcomes from peri-operative regimens, mFOLFIRNOX and gem-Abraxane. The HPB Behind the Knife team dives into the specifics of the trial design and findings, as well as sits down with the Principal Investigator Dr. Syed Ahmad himself to ask about the behind-the-scenes decision-making and the investigations yet to come.  Links to Papers Reviewed in this Episode Surgical Outcome Results from SWOG S1505: A Randomized Clinical Trial of mFOLFIRINOX Versus Gemcitabine/Nab-paclitaxel for Perioperative Treatment of Resectable Pancreatic Ductal Adenocarcinoma Ann Surg. 2020 Sep;272(3):481-486 https://pubmed.ncbi.nlm.nih.gov/32740235/ Efficacy of Periopertive Chemotherapy for Resectable Pancreatic Adenocarcinoma: A Phase 2 Randomized Clinical Trial JAMA Oncol. 2021 Mar;7(3):421-427 https://pubmed.ncbi.nlm.nih.gov/33475684/  Guest:  Syed Ahmad, MD (@SyedAAhmad5) is a Professor of Surgery and Chief of the Division of Surgical Oncology at the University of Cincinnati College of Medicine, and the Director of the UC Cancer Center. He is the surgical chair of SWOG, and a co-Principal Investigator of the SWOG S1505 study in addition to numerous other national trials for pancreatic cancer. Hosts: Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center Daniel Nelson, DO, FACS (@usarmydoc24) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center Connor Chick, MD (@connor_chick) is a PGY-4 General Surgery resident at Brooke Army Medical Center Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-3 General Surgery resident at Brooke Army Medical Center Other References from this Episode FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer N Engl J Med. 2018 Dec 20;379:2395-2406 https://www.nejm.org/doi/full/10.1056/NEJMoa1809775 APACT: phase III, multicenter, international, open-label, randomized trial of adjuvant nab-paclitaxel plus gemcitabine (nab-P/G) vs gemcitabine (G) for surgically resected pancreatic adenocarcinoma J Clin Oncol. 2019 May 20;37:no. 15 suppl:4000. https://ascopubs.org/doi/10.1200/JCO.2019.37.15_suppl.4000 Operative Standards in Cancer Surgery: Pancreatoduodenectomy: Superior Mesenteric Artery Dissection American College of Surgeons. 2020 Jun 18. https://www.facs.org/quality-programs/cancer/acs-crp/oscs https://www.youtube.com/watch?v=bs8xlCr5XyE The AHPBA Podcast  The Americas Hepato-Pancreato-Biliary Association https://podcasts.apple.com/us/podcast/the-ahpba-podcast/id1501441845   Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Journal Review in Hepatopancreaticobiliary Surgery: Surgical Outcomes of the SWOG S1505 Trial

Join BTK founders, Dr. Jason Bingham and Dr. John McClellan, as they discuss bariatric emergencies for the general surgeon.  This is Part 2 of 2.   Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Clinical Challenges in Bariatric Surgery: Bariatric Emergencies for the General Surgeon Part 2

Large diameter 26-32Fr chest tubes are the treatment of choice at many institutions for the treatment of traumatic hemothorax, but does the currently available data support that? Are there better options available? Join our team as we discuss the The Small 14-French (Fr) Percutaneous Catheter vs. Large (28-32Fr) Open Chest Tube for Traumatic Hemothorax (P-CAT): A Multi-center Randomized Clinical Trial by Dr. N Kulvatunyou et al to address this question.  Hosts:  Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST).  Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.  David Sigmon, MD, MMEd, a PGY-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.  Journal Articles The Small 14-French (Fr) Percutaneous Catheter vs. Large (28-32Fr) Open Chest Tube for Traumatic Hemothorax (P-CAT): A Multi-center Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/33843831/  Randomized Clinical Trial of 14-French (14F) Pigtail Catheters versus 28-32F Chest Tubes in the Management of Patients with Traumatic Hemothorax and Hemopneumothorax. https://pubmed.ncbi.nlm.nih.gov/33415448/ Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. https://pubmed.ncbi.nlm.nih.gov/24375295/  14 French pigtail catheters placed by surgeons to drain blood on trauma patients: is 14-Fr too small? https://pubmed.ncbi.nlm.nih.gov/23188235/  A Prospective Study of 7-Year Experience Using Percutaneous 14-French Pigtail Catheters for Traumatic Hemothorax/Hemopneumothorax at a Level-1 Trauma Center: Size Still Does Not Matter https://pubmed.ncbi.nlm.nih.gov/28795207/  A History of Thoracic Drainage: From Ancient Greeks to Wound Sucking Drummers to Digital Monitoring https://www.ctsnet.org/article/history-thoracic-drainage-ancient-greeks-wound-sucking-drummer s-digital-monitoring Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Journal Review in Trauma Surgery: Pigtail Catheters for Traumatic Hemothorax

Join BTK founders, Dr. Jason Bingham and Dr. John McClellan, as they discuss bariatric emergencies for the general surgeon.  This is Part 1 of 2.   Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Clinical Challenges in Bariatric Surgery: Bariatric Emergencies for the General Surgeon Part 1

Peripheral Artery Disease – What the $#^% are we talking about? Peripheral Artery Disease is all about saving peoples legs and lives, but we often don’t talk about PAD lesions with a common clinical language. In this episode of Behind the Knife, the vascular surgery team introduces the Global Vascular Guidelines anddiscusses the WIfI, TASC, and GLASS classifications systems designed to standardize our conversations about PAD lesions and how these fit into treatment decisions. Dr. Nicholas Osborne is an Associate Professor of Vascular Surgery at the University of Michigan and the Chief of Vascular Surgery at the Ann Arbor Veteran’s Affairs Healthcare System. Dr. Frank Davis is a Chief Resident in the Integrated Vascular Surgery program at the University of Michigan. Dr. Craig Brown is a PGY-6 in the General Surgery program at the University of Michigan. Papers discussed in this Episode: Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365864/ Society for Vascular Surgery App: https://apps.apple.com/app/id1014644425 Please visit behindtheknife.org to access our massive library of high-yield surgical education podcasts, videos and more.   

Journal Review in Vascular Surgery: Peripheral Artery Disease

The Colorectal Surgery Virtual Education team is back with Mock Oral exams.  This is episode 2 of 2 and includes 2 high-yield cases. Also available in video format at www.behindtheknife.org. For more information on the Colorectal Surgery Virtual Education initiative visit www.crsvirtualed.org.  

Colorectal Surgery Virtual Education Series: Mock Oral Exam Part 2

Learning Objectives: ·       Describe the role of portal vein embolization and how it is currently utilized in the setting of metastatic colon cancer ·       Understand adequate functional volume and delineate different methods of increasing a future liver remnant ·       Identify the leading causes of drug-induced liver failure and recognize how these have changed over time Journal Articles: ·       Dueland, et al. “Survival Outcomes After Portal Vein Embolization and Liver Resection Compared With Liver Transplant for Patients With Extensive Colorectal Cancer Liver Metastases.” JAMA Surgery. 2021;156(6):550-557. https://doi.org/10.1001/jamasurg.2021.0267 ·       Ghabril, et al. “Eight fold increase in the dietary supplement related liver failure leading to transplant waitlisting over the last quarter century in the US.” Liver Transplantation. 31 July 2021. https://doi.org/10.1002/lt.26246 Please visit behindtheknife.org to access our massive library of high-yield surgical education podcasts, videos and more.   

Journal Review in Transplant Surgery: New Topics in Liver Transplantation

The Colorectal Surgery Virtual Education team is back with Mock Oral exams.  This is episode 1 of 2 and includes 2 high-yield cases.  Also available in video format at www.behindtheknife.org. For more information on the Colorectal Surgery Virtual Education initiative visit www.crsvirtualed.org.  

Colorectal Surgery Virtual Education Series: Mock Oral Exam Part 1

Description:   A patient being surveilled for untreated hepatitis C presents to your clinic for a newly identified liver mass. Hepatocellular carcinoma (HCC) accounts for ~90% of new liver cancers and infection by hepatitis B and hepatitis C viruses are the main risk factors. Non-alcoholic steatohepatitis associated with metabolic syndrome and diabetes mellitus, however, have contributed to HCC becoming the fastest growing solid organ tumor in the United States. In this episode from the Surgical Oncology team at Behind the Knife, join the discussion on a surgeons approach to this growing patient population. Learning Objectives:  In this episode, we review risk factors for hepatocellular carcinoma, key steps in the diagnostic work-up with a focus on pre-operative planning for hepatectomy in cirrhotic patients. We will cover interventions available preoperatively, options and considerations once in the operating room, as well as treatment strategies and shifting paradigms following successful resection.  Hosts:  Adam Yopp, MD, FACS (@AdamYopp) is an Assistant Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program. Caitlin Hester, MD (@CaitlinAHester) is a 2nd Year Complex General Surgical Oncology Fellow at the MD Anderson Cancer Center. Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-3 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research. Papers Referenced in this Episode: Importance of low preoperative platelet count in selecting patients for resection of hepatocellular carcinoma: a multi-institutional analysis J Am Coll Surg. 2011 Apr;212(4):638-48; discussion 648-50. doi: 10.1016/j.jamcollsurg.2011.01.004. PMID: 21463803  https://pubmed.ncbi.nlm.nih.gov/21463803/ Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology J Natl Compr Canc Netw. 2021 May 1;19(5):541-565. doi: 10.6004/jnccn.2021.0022. PMID: 34030131 https://pubmed.ncbi.nlm.nih.gov/34030131/ Sequential arterial and portal vein embolizations before right hepatectomy in patients with cirrhosis and hepatocellular carcinoma Br J Surg. 2006 Sep;93(9):1091-8. doi: 10.1002/bjs.5341. PMID: 16779884 https://pubmed.ncbi.nlm.nih.gov/16779884/ Application of controlled low central venous pressure during hepatectomy: A systematic review and meta-analysis J Clin Anesth. 2021 Aug 1;75:110467. doi: 10.1016/j.jclinane.2021.110467. Online ahead of print. PMID: 34343737 https://pubmed.ncbi.nlm.nih.gov/34343737/ Portal vein embolization: rationale, technique and future prospects Br J Surg. 2001 Feb;88(2):165-75. doi: 10.1046/j.1365-2168.2001.01658.x. PMID: 11167863 https://pubmed.ncbi.nlm.nih.gov/11167863/ Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes: toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant J Am Coll Surg. 2013 Feb;216(2):201-9. doi: 10.1016/j.jamcollsurg.2012.10.018. Epub 2012 Dec 7. PMID: 23219349  https://pubmed.ncbi.nlm.nih.gov/23219349/ IMbrave 050: a Phase III trial of atezolizumab plus bevacizumab in high-risk hepatocellular carcinoma after curative resection or ablation Future Oncol. 2020 May;16(15):975-989. doi: 10.2217/fon-2020-0162. Epub 2020 Apr 30. PMID: 32352320 https://pubmed.ncbi.nlm.nih.gov/32352320/ Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection Is Associated With Increased Survival in Patients With a History of Hepatocellular Carcinoma Gastroenterology. 2019 Nov;157(5):1253-1263.e2. doi: 10.1053/j.gastro.2019.07.040. Epub 2019 Jul 30. PMID: 31374215 https://pubmed.ncbi.nlm.nih.gov/31374215/

Clinical Challenges in Surgical Oncology: Curative Options for Hepatocellular Carcinoma

Ever wonder why some bariatric patients received extended VTE prophylaxis and others do not? Or what the ideal chemical VTE prophylaxis is for bariatric patients? All of your questions answered in this journal review discussion! Journal articles: A single-center comparison of extended and restricted thromboprophylaxis with LMWH after metabolic surgery: https://pubmed.ncbi.nlm.nih.gov/31641983/ Risk factors for postdischarge venous thromboembolism among bariatric surgery patients and the evolving approach to extended thromboprophylaxis with enoxaparin: https://pubmed.ncbi.nlm.nih.gov/33814315/ 

Journal Review in Bariatric Surgery: Controversies Surrounding Extended VTE Prophylaxis

You’re faced with a challenging case of a patient with rectal cancer and synchronous liver lesion. Where do you start: chemotherapy, chemoradiotherapy, upfront surgery, liver first, rectum first?  Join Drs. Carole Richard, François Dagbert and Maher Al Khaldi as they discuss the management of a patient with rectal cancer with a synchronous hepatic metastasis.  Learning objectives In this episode, we discuss the workup of a rectal tumour associated with synchronous liver metastases, indications for resection of the hepatic lesion, neoadjuvant and adjuvant treatment modalities, survival benefit of resection and patient follow-up.   Reference list: Moulton C-A, Gu C-S, Law CH, Tandan VR, Hart R, Quan D, et al. Effect of PET Before Liver Resection on Surgical Management for Colorectal Adenocarcinoma Metastases: A Randomized Clinical Trial. JAMA. 2014;311(18):1863–9. Bahadoer RR, Dijkstra EA, Etten B van, Marijnen CAM, Putter H, Kranenbarg EM-K, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021;22(1):29–42.

Clinical Challenges in Colorectal Surgery: Colorectal Cancer with Synchronous Colorectal Cancer Liver Metastasis

"The eyes do not see what the mind does not know." Trauma surgery is riddled with pitfalls.  Take your guard down for a minute and BAM, you are eating humble pie.  Don't let this happen to you!   Join Drs. Bryan Cotton, Teddy Puzio, Krislynn Mueck, and host Patrick Georgoff for a fun, high-yield review.  In this episode (2 of 2), we cover:  Splenic pseudoaneurysm Compartment syndrome Urogenital injury Diaphragm injury Esophageal injury 

Big T Trauma Series Ep. 13 - Pitfalls in Trauma #2

Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss ovarian mass in pediatric surgery. Journal Article links:  Madenci AL, Vandewalle RJ, Dieffenbach BV, Laufer MR, Boyd TK, Voss SD, et al. Multicenter pre-operative assessment of pediatric ovarian malignancy. J Pediatr Surg 2019;54(9):1921-5. https://pubmed.ncbi.nlm.nih.gov/30867096/ Dasgupta R, Renaud E, Goldin AB, Baird R, Cameron DB, Arnold MA, et al. Ovarian torsion in pediatric and adolescent patients: A systematic review. J Pediatr Surg 2018;53(7):1387-91. https://pubmed.ncbi.nlm.nih.gov/29153467/ 

Journal Review in Pediatric Surgery: Pediatric Ovarian Mass

"The eyes do not see what the mind does not know." Trauma surgery is riddled with pitfalls.  Take your guard down for a minute and BAM, you are eating humble pie.  Don't let this happen to you!   Join Drs. Bryan Cotton, Teddy Puzio, Rushabh Dev, and host Patrick Georgoff for a fun, high-yield review.  In this episode (1 of 2), we cover:  Extraperitoneal rectal injury Blunt cerebrovascular injury Chance fractures Cardiac injuries with a negative FAST exam Missed injuries during trauma ex lap 

Big T Trauma Series Ep. 12 - Pitfalls in Trauma #1

Behind the Knife is a podcast aimed for everyone interested in not only an in-depth look at the broad range of surgical topics, but a "behind the scenes" look at the interesting, controversial and humanistic side of surgery from some of the giants in the field. Come along with Kevin Kniery, Jason Bingham, John McClellan and Scott Steele on a journey that explores all the disciplines of General Surgery in this informal discussion and interview format. We feel that this is the perfect medium not only to cover important educational topics for all stages of your professional career, but allow you to listen to a first-hand account of not only where we have been from those that pioneered the way, but also an opportunity to explore where we are now and are headed in the not so distant future from surgical leaders.

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Behind The Knife: The Surgery Podcast

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