Behind The Knife: The Surgery Podcast

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
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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
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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
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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
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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
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Oral Board Review: https://behindtheknife.org/oral-board
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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
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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
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General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
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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:
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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