BackTable OBGYN BackTable

In the modern era of rapid technological progress and AI, the medical community is abuzz with discussions on how medicine will change and how practice will adapt. In this episode of the BackTable OBGYN podcast, hosts Dr. Mark Hoffman and Dr. Amy Park welcome Dr. Arnold Advincula, a leading figure in minimally invasive and robotic surgery, to discuss the evolution and impact of robotic surgery in the field of gynecology.

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SYNPOSIS

Dr. Advincula shares his journey from training to pioneering robotic-assisted procedures, emphasizing the benefits and challenges faced along the way. The conversation delves into the future of robotics, including the potential of AI in surgery and the integration of digital tools to enhance surgical outcomes. Listeners gain insights into the importance of ergonomic surgery, the advancements in robotic technology, the future of minimally invasive gynecologic surgery, and the collaborative efforts required to elevate patient care in gynecology.

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TIMESTAMPS

00:00 - Introduction
06:05 - Pioneering Robotic Surgery
12:50 - Challenges and Innovations
24:43 - Allure of Robotic Surgery
28:05 - Challenges in Rural Healthcare
35:00 - Future of Minimally Invasive Surgery
42:00 - Advancements in Surgical Training
43:35 - Ergonomics
49:28 - The Future of Gynecologic Surgery
53:06 - Closing Thoughts

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RESOURCES

BackTable OBGYN Ep. 2: Surgeon Ergonomics
https://www.backtable.com/shows/obgyn/podcasts/2/surgeon-ergonomics

In this BackTable OBGYN Brief, Dr. Mark Hoffman and Dr. Ted Lee discuss the clinical approach to diagnosing endometriosis through physical exam and imaging, and the collaborative surgical approach to treating it. 

Dr. Lee explains the importance of detailed patient history and various examination techniques, including palpation and rectovaginal exams, to identify potential signs of endometriosis. He emphasizes the specificity of these exams in differentiating endometriosis pain from other causes. The discussion also covers the role of imaging, such as MRI, particularly in advanced cases, and the collaborative approach with colorectal surgeons for bowel-related complications. Dr. Lee shares insights on the use of physical therapy and managing musculoskeletal pain related to endometriosis, highlighting the importance of multi-disciplinary care for optimal patient outcomes.

TIMESTAMPS

00:00 - Introduction
00:15 - Initial Patient Assessment for Endometriosis
01:00 - Detailed Physical Exam Techniques
07:00 - Imaging and Further Diagnostic Steps
10:55 - Collaborative Surgical Approach

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BackTable OBGYN Ep. 30: Ambulatory Workup of Endometriosis Patients
https://www.backtable.com/shows/obgyn/podcasts/30/ambulatory-workup-of-endometriosis-patients

In this episode of the BackTable OBGYN podcast, host Dr. Mark Hoffman is joined by MIGS specialist Dr. Uchenna Acholonu to discuss the intricacies of complex gynecologic surgeries, focusing particularly on handling large uteruses during total laparoscopic hysterectomy (TLH).

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SYNPOSIS

The discussion begins with talk of the doctors’ practices and friendship. They then cover comprehensive patient evaluations and various surgical techniques, including skeletonizing the uterines, colpotomy tricks, uterine manipulators, and morcellation. Dr. Acholonu also shares his personal routines and preferences, including the use of a flexible scope to get around the big uterus. The duo exchange insights on surgical techniques, patient-centered care, and the continuous learning necessary in the medical field. They emphasize the significance of safety, adequate planning, and the benefits of engaging in community networks for better surgical outcomes. The conversation concludes with a light-hearted note on their shared experiences and camaraderie, offering both educational value and a glimpse into the dynamic relationship between two seasoned professionals.

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TIMESTAMPS

00:00 - Introduction
04:01 - Building a Subspecialty Practice
07:34 - Patient Referrals
12:41 - Surgical Approach
16:06- The Big Uterus
28:36 - Surgical Steps in TLH, Skeletonizing the Uterines
32:56 - Challenges and Solutions
36:49 - Energy Sources and Surgical Tools
42:34 - Colpotomy
44:43 - Tissue Extraction and Morcellation
50:27 - Closing and Post-Operative Care
52:05 - Use of Lupron
53:16 - Final Thoughts

In this BackTable OBGYN Brief, host Dr. Mark Hoffman interviews Dr. Jan Baekelandt from Belgium about vNOTES (vaginal natural orifice transluminal endoscopic surgery) incision placement to allow future vaginal deliveries and prevent dyspareunia. 

First, Dr. Hoffman discusses the nuances of laparoscopy, particularly the preference for smaller incisions to reduce hernia rates and postoperative pain. The conversation covers the specifics of performing colpotomy and the risks associated with different types of incisions, including vaginal and abdominal. Dr. Baekelandt emphasizes the importance of proper training and starting with simpler cases when introducing new surgical techniques like vNOTES.

TIMESTAMPS

00:00 - Introduction
00:32 - Concerns About Hernia Rates and Incisions
01:05 - Vaginal Incisions and Their Implications
02:35 - Vaginal Deliveries After vNOTES
03:55 - Dyspareunia After vNOTES
04:13 - Technical Details on Incision Placement
05:53 - Closing Techniques
06:45 - Advice for Surgeons Introducing vNOTES

CHECK OUT THE FULL EPISODE

BackTable OBGYN Ep 31: The vNOTES Procedure
https://www.backtable.com/shows/obgyn/podcasts/31/the-vnotes-procedure

In this BackTable OBGYN Brief, host Dr. Mark Hoffman speaks with Dr. Jan Baekelandt about the specific challenges and complications associated with vNOTES, as well as contraindications to be mindful of.

They discuss the nuances of uterine artery management and the benefits and risks of the Alexis ring, especially for hemostasis. The doctors go on to discuss contraindications for vNOTES, including complex endometriosis and pelvic scarring. Dr. Baekelandt also shares insights on avoiding ureteric and bladder injuries and future direction of vNOTES.

TIMESTAMPS

00:00 - Introduction
00:14 - Understanding vNOTES Complications
00:50 - Techniques for Uterine Artery Management
02:13 - Hemostasis
03:24 - Challenges with Ureter and Bladder Management
09:44 - Contraindications to vNOTES
12:07 - Future Directions

CHECK OUT THE FULL EPISODE

BackTable OBGYN Ep 31: The vNOTES Procedure
https://www.backtable.com/shows/obgyn/podcasts/31/the-vnotes-procedure

Gynecologic oncology experts Dr. Matthew Powell from Washington University School of Medicine and Dr. Amanda Fader from Johns Hopkins Hospital discuss the increasing rates of endometrial cancer along with future directions of treatments and screenings.

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SYNPOSIS

First, the physicians discuss trends in endometrial cancer rates and delve into the factors driving these trends, such as the obesity epidemic and aging population. They explore the differences between endometrioid and non-endometrioid cancers, along with the impact of racial and geographic disparities. The conversation also covers advances in diagnostics and treatments—including immunotherapy and targeted therapies—and the critical need for better awareness, screening practices, and research funding to combat this public health threat.

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TIMESTAMPS

00:00 - Introduction
03:11 - Types of Endometrial Cancer
04:44 - Rising Rates and Risk Factors
08:03 - Disparities in Endometrial Cancer Care
10:37 - Symptoms and Diagnosis
13:52 - Ultrasound vs. Biopsy
16:17 - Challenges in Biopsies
20:58 - Management/Treatment Approaches
23:03 - Geographic Disparities/Access to Care
26:07 - Vaginal Brachytherapy
32:11 - Innovations in Treatment and Research
40:34 - Future Directions: Endometrial Screening
43:54 - AI in Gynecologic Oncology

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RESOURCES

Beavis, A. L., Blechter, B., Najjar, O., Fader, A. N., Katebi Kashi, P., & Rositch, A. F. (2023). Identifying women 45 years and younger at elevated risk for endometrial hyperplasia or cancer. Gynecologic Oncology, 174, 98–105. https://doi.org/10.1016/j.ygyno.2023.04.019

Mirza, M. R., Sharma, S., Roed, H., Landrum, L. M., Gilbert, L., Gold, M. A., Novák, Z., Edelson, M., Meirovitz, M., Diaz, J. P., Huygh, G., Buscema, J., Pothuri, B., Eshed, H. D., Coleman, R. L., Slomovitz, B. M., Kostadinov, R., Stevens, S., Ronzino, G., & Powell, M. A. (2024). Post hoc analysis of progression-free survival (PFS) and overall survival (OS) by mechanism of mismatch repair (MMR) protein loss in patients with endometrial cancer (EC) treated with Dostarlimab plus chemotherapy in the ruby trial. Journal of Clinical Oncology, 42(16_suppl), 5606–5606. https://doi.org/10.1200/jco.2024.42.16_suppl.5606

Society of Gynecologic Oncology (SGO):
https://www.sgo.org/