Behind The Knife: The Surgery Podcast

Join the Behind the Knife Surgical Oncology Team as we discuss the MATTERHORN trial and the addition of perioperative immunotherapy to FLOT for resectable gastric and gastroesophageal junction adenocarcinoma!

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 and Surgical Oncologist at the University of Tennessee Health Science Center, Chattanooga. Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a Surgical Oncologist at Brooke Army Medical Center. Joe (Joseph...

In this episode of the Behind the Knife Global Surgery Series, we explore what it actually takes to build a meaningful career in global surgery. Global surgery is not a single specialty or job title—it is a broad field that intersects with clinical care, education, research, policy, advocacy, implementation science, and health-system strengthening. So how do trainees and early-career surgeons find their place in it?
Host Mike M. Mallah is joined by Dr. Barnabas Alayande and Dr. Lacey LaGrone for a candid discussion about the personal and professional paths that brought them into global surgery. Dr. Alayande shares ho...

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

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 Ch...

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:

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 complica...

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...

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...

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 Onco...

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...

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 an...

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...

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...

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:

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:

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:

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:

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: Depar...

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...

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

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 robo...

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 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 abdomi...

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...

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...

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...

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. 
...

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...

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 Pilewsk...

Join our OHSY Hernia team to review the current landscape of bioresorbable meshes and a conversation considering “are they worth it?"

Hosts: 

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 Her...

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...

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 podcas...

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...

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 s...

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...

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...

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 inte...

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.

...

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...

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...