Behind The Knife: The Surgery Podcast Behind The Knife: The Surgery Podcast

It’s that time of year (again!)- when medical students- both US and International- are preparing their residency applications. In this episode, we will focus on the special challenges International Medical Graduates face when applying to US surgical residency positions and discuss tips and tricks for making IMG residency applicants standout to program directors in the US. 

Guests:
David Hughes, MD- Clinical Associate Professor of Endocrine Surgery and General Surgery Residency Program Director- University of Michigan
Krishnan Raghavendran, MBBS- Professor of Acute Care Surgery and Critical Care- University of Michigan

Link to video: 
You can watch Dr. Hughes’s full presentation here: https://youtu.be/iQ0CzH7xHwE

Previous DOMINATE the Match Episodes: 

Episode 2- “Choose Me” (Personal Statements and Letters of Recommendations)
https://behindtheknife.org/podcast/dominate-the-match-episode-2-choose-me/

Episode 3- “The Interview”
https://behindtheknife.org/podcast/dominate-the-match-episode-3-the-interview/

Episode 4- “Rank and Match”
https://behindtheknife.org/podcast/dominate-the-match-episode-4-rank-and-match/

Residency Program Lists: 
- FREIDA Residency and Fellowship Database: https://freida.ama-assn.org/
- Doximity: https://www.doximity.com/residency/?utm_campaign=marketing_resnav_competitor_broad_20210520&utm_source=google&utm_medium=cpc&gclid=CjwKCAjwt52mBhB5EiwA05YKo1J47BLAtTPtsJBmVvXGP2pDXLLqgDIwM0pgkSYjoBhFUOO1ktXDYRoC2bkQAvD_BwE

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Laparoscopic cholecystectomy was introduced approximately 30 years ago and quickly became the gold standard due to multiple benefits over open cholecystectomy. It ushered in the laparoscopic revolution but also increased the number of bile duct injuries. Through the dedicated efforts of many the rate of bile duct injury has been reduced, now mirroring open cholecystectomy. The robotic surgery revolution is well underway and unsurprisingly this technology has been applied to cholecystectomy. Given the devastating nature of bile duct injury and the history of increased injury with the last major shift in operative approach, we examine the current literature on the comparative safety of robotic-assisted cholecystectomy vs. laparoscopic cholecystectomy.

1.     Andrew Wright, UW Medical Center – Montlake and Northwest, @andrewswright 
2.     Nick Cetrulo, UW Medical Center - Northwest, @Trules25 
3.     Nicole White, UW Medical Center - Northwest 
4.     Paul Herman, UW General Surgery Resident PGY-3, @paul_herm 
5.     Ben Vierra, UW General Surgery Resident PGY-2 @benvierra95 

Learning objectives:  

1.     Examine the history of the laparoscopic cholecystectomy and review the efforts to reduce bile duct injury (SAGES Safe Cholecystectomy Task Force and Multi-Society Practice Guideline) 
2.     Review literature on causes and prevention of bile duct injury 
3.     Review a recent article on robotic cholecystectomy vs laparoscopic cholecystectomy outcomes 
4.     Describe precautions that might mitigate expected increase in bile duct injury as a new approach is applied 

References 
1.     https://www.sages.org/publications/guidelines/safe-cholecystectomy-multi-society-practice-guideline/
2.     https://www.sages.org/safe-cholecystectomy-program/ 
3.     MacFadyen BV Jr, Vecchio R, Ricardo AE, Mathis CR. Bile duct injury after laparoscopic cholecystectomy. The United States experience. Surg Endosc. 1998 Apr;12(4):315-21. doi: 10.1007/s004649900661. PMID: 9543520. https://pubmed.ncbi.nlm.nih.gov/9543520/
4.     Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD006231. doi: 10.1002/14651858.CD006231. PMID: 17054285. https://pubmed.ncbi.nlm.nih.gov/17054285/
5.     Way LW, Stewart L, Gantert W, Liu K, Lee CM, Whang K, Hunter JG. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg. 2003 Apr;237(4):460-9. doi: 10.1097/01.SLA.0000060680.92690.E9. PMID: 12677139; PMCID: PMC1514483. https://pubmed.ncbi.nlm.nih.gov/12677139/
6.     Kalata S, Thumma JR, Norton EC, Dimick JB, Sheetz KH. Comparative Safety of Robotic-Assisted vs Laparoscopic Cholecystectomy. JAMA Surg. 2023;158(12):1303–1310. doi:10.1001/jamasurg.2023.4389 https://pubmed.ncbi.nlm.nih.gov/37728932/

 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Join for the forth episode in the Association of Out Surgeons & Allies (AOSA) series for a discussion on gender affirming care and gender affirming surgery.

Host:
Dan Scheese, MD
Andrew Schlussel, DO, Colorectal and General Surgeon, Charlie Norwood VA Medical Center

Guests:
1. Dr. Megan Lane (She/her)
megalane@med.umich.edu
Dr. Lane is a Plastic Surgery resident at the University of Michigan who is planning on going into Gender Affirming Surgery and general reconstruction, she completed a research fellowship in the National Clinician Scholars Program and focused primarily on patient-reported outcomes in gender affirming surgery. 

2. Dr. Scott Chaiet (he/him/his/himself)
chaiet@surgery.wisc.edu
Dr. Chaiet is double board certified by the American Board of Otolaryngology and the American Board of Facial Plastic & Reconstructive Surgery and is currently at the University of Wisconsin. His areas of expertise include rhinoplasty and facial gender surgery. He also practices reconstructive surgery including facial paralysis reanimation. His gender affirming practice includes all areas of the face and Adam’s apple except for hair.

3. Dr. Amy Suwanabol 
pasuwan@med.umich.edu
Amy Suwanabol is a colorectal surgeon at the University of Michigan and the Ann Arbor VA. She assists the gender affirming surgeons at the University of Michigan in performing robotic assisted vaginoplasty. Her research focuses on optimizing quality of life among surgical patients and their families, surgeon well being, and cancer survivorship.  

4. Dr. Monica Llado-Farrulla
lladofar@ohsu.edu
Dr. Llado-Farulla was born and raised in Puerto Rico, completed a residency in general surgery and then plastic surgery at Tulane and Penn, respectively. She pursued a year of training in advanced gender surgery and is now currently at OHSU, her practice largely focuses on facial feminization, chest affirming surgeries, phalloplasty, autologous breast reconstruction, and limb salvage. 

5. Dr. Michele “Mike” Fascelli (he/him/his)
FASCELM2@ccf.org
Dr. Fascelli is a practicing reconstructive urologist at Cleveland Clinic.  He comppleted his urology training at the Cleveland Clinic in Ohio and then fellowship in urogenital gender affirming surgery with the urology team at OHSU with Dr. Llado-Farulla. He is now the Director of Urogenital Reconstruction and Co-Director of the Gender Affirming Surgery Program at Cleveland Clinic.  He is very committed to LGBTQIA+ urologic access and actively works to protect and expand care to the rainbow community, and to our trans and gender diverse patients.  His practice is currently focused on queer urologic health concerns and genital gender surgery (i.e. vaginoplasty, metoidioplasty and phalloplasty).    

Learn more and get involved with AOSA: https://www.outsurgeons.org

Twitter/X: @OutSurgeons
 
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

Interested in cardiac surgery? The training paradigm for cardiac surgery has changed significantly over the past decade and we know may students often struggle when deciding what pathway is best for them. For this episode, we assembled a robust team of attendings, fellows, and residents to discuss their journey as well as some of the research that has been conducted about these different pathways to help guide students navigating this decision. 

Hosts: 
- Jessica Millar, MD- PGY-5 General Surgery Resident, University of Michigan, @Jess_Millar15

Guests: 
- Nick Teman, MD- Assistant Professor of Thoracic and Cardiovascular Surgery, University of Virginia, @nickteman

- Jolian Dahl, MD, MSc- Integrated Thoracic Surgery Resident (PGY-6), University of Virginia, @JolianDahl

- Lyndsey Wessels, MD- Traditional Thoracic Surgery Resident (CT-1), University of Virginia, @LyndseyWessels 

Articles Referenced: 

- Pathways to Certification: https://www.abts.org/ABTS/CertificationWebPages/Pathways%20to%20Certification.aspx

- Narahari AK, Patel PD, Chandrabhatla AS, Wolverton J, Lantieri MA, Sarkar A, Mehaffey JH, Wagner CM, Ailawadi G, Pagani FD, Likosky DS. A Nationwide Evaluation of Cardiothoracic Resident Research Productivity. Ann Thorac Surg. 2024 Feb;117(2):449-455. doi: 10.1016/j.athoracsur.2023.08.011. Epub 2023 Aug 26. PMID: 37640148; PMCID: PMC10842395
https://pubmed.ncbi.nlm.nih.gov/37640148/

- Bougioukas L, Heiser A, Berg A, Polomsky M, Rokkas C, Hirashima F. Integrated cardiothoracic surgery match: Trends among applicants compared with other surgical subspecialties. J Thorac Cardiovasc Surg. 2023 Sep;166(3):904-914. doi: 10.1016/j.jtcvs.2021.11.112. Epub 2022 Mar 22. PMID: 35461707.
https://pubmed.ncbi.nlm.nih.gov/35461707/

For episode ideas/suggestions/feedback feel free to email Jessica Millar at: millarje@med.umich.edu

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

Bariatric surgery is an evolving field with new procedures, or variations of old ones, being developed to meet the needs of patients with obesity. The single anastomosis duodenoileal bypass (SADI) and one anastomosis gastric bypass (OAGB) are two such procedures which have recently entered the mainstream conversation. In this episode we will give a brief overview of the SADI and OAGB, go over some short and long term studies evaluating safety and efficacy, and discuss current sentiments about these options and how they may fit into bariatric practice. 

Show Hosts:
Matthew Martin, MD
Adrian Dan, MD
Crystal Johnson-Mann, MD
Paul Wisniowski, MD

Article #1: Chao 2024 - Outcomes of SADI and OAGB Compared to RYGB from the Metabolic and Bariatric Surgery Quality Improvement Program: The North American Experience


Roux-en-Y gastric bypass (RYGB) and duodenal switch are well described procedure for weight loss; however, associated postoperative complications have led to the development of simpler techniques
Single anastomosis duodenoileal bypass (SADI) - modification of the duodenal switch where by a loop of ileum of the bilopancreatic limb approximately 200-300cm from the ileal cecal valve is anastomosed to the distal duodenal cuff of a tubularized stomach
One anastomosis gastric bypass (OAGB) – modification of the RYGB where a loop of jejunum of the bilopancreatic limb approximately 150-200cm from the ligament of treitz is anastomosed to the distal end of a gastric pouch.



There is increasing interest in these procedures given the perceived reduced risk reduction associated with one fewer anastomosis
Currently, there is insufficient data on the safety of these procedures compared to the established RYGB. 
The article utilizes the MBSAQIP database to evaluate each procedure against the RYGB 
Matched groups: SADI vs RYGB and OAGB vs RYGB 
Matched against age, sex, BMI, operative time, and ASA classification
30-day outcomes included complications and health care utilization
Results were analyzed with univariate comparative analysis, and significant outcomes were examined with logistic regression
SADI vs RYGB: SADI independently associated INCREASED odds with staple line leak, sepsis, organ space infection, and pneumonia. 
OAGB vs RYGB: OAGB independently associated with REDUCED odds of SSI, transfusion requirement/GI bleed, ICU admission, bowel obstruction, and healthcare utilization (reoperation, readmissions, and reinterventions)
No significant differences in mortality



Limitation: Article generally reviews technical complications of procedures. Unable to address significant bariatric outcomes such as weight loss and metabolic profile, as well as long term outcomes. 
https://pubmed.ncbi.nlm.nih.gov/38170422/




Article #2: Maud 2019 - Efficacy and safety of OAGB vs RYGB for obesity (YOMEGA trial): A multicentre, randomized, open label, non-inferiority trial





Limited long-term evidence on OAGB
Mostly arising from retrospective analyses and one meta-analysis
Two randomized clinical trials but with poor power and questionable methodology. 



This is a randomized non-inferiority trial of in patients undergoing bariatric surgery  
Randomized into 2 groups: OAGB vs RYGB with 117 patients per group
Patients were followed for 2 years with a loss to follow up of 21% in OAGB and 24% in RYGB cohorts
The primary outcome was weight loss with a noninferiority threshold of 7% assuming 60% weight loss at 2 years. Secondary outcomes included complications and metabolic outcomes
Groups were compared with Student’s T and Wilcoxon tests for quantitative data, and chi-squared and Fischer’s exact for qualitative endpoints. 
Cohorts were analyzed with the intention to treat, and missing data on the primary endpoint was imputed with prediction-based modeling. 



Highlighted Outcomes
Mean percent excess BMI loss of 87.9% in OAGB group compared to 85.8% in RYGB group demonstrating non-inferiority in terms of weight loss
Increas

Join Drs. Jason Bingham (@BinghamMd) and Patrick Georgoff (@georgoff) for a thought-provoking discussion with titans of hernia surgery Drs. Todd Heniford (@THeniford) and Michael Rosen (@MikeRosenMD).  You don't want to miss this one!  This episode goes deep, touching on some of the most vexing questions in the world of abdominal wall reconstruction.  

Highlights: 


Hernia is chronic disease process.  Surgeons should act like it and patients need to understand this.  
Follow-up data is hard to come by and therefore limited.  Studies must be interpreted with this in mind.
Hernia surgery is sexy, which is both exciting and concerning.
"Technology is not useful until it is boring."  New techniques and devices can hurt patients.  
Complicated hernias should be sent to hernia centers.  Otherwise, general surgeons are more than capable of doing the repair.

Link to paper: https://jamanetwork.com/journals/jamasurgery/fullarticle/2816986

Link to ACHQC: https://achqc.org/

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen