Behind The Knife: The Surgery Podcast

What happens when the world of GLP-1s collides with the operating room? Today, we’re diving into the new era of obesity care. 
Hosts
·       Matthew Martin, trauma and bariatric surgeon at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) @docmartin2
·       Adrian Dan, bariatric and MIS surgeon, program director for the advanced MIS bariatric and foregut fellowship at Summa Health System (Akron, Ohio) @DrAdrianDan
·       Crystal Johnson Mann, bariatric and foregut surgeon at the University of Florida (Gainesville, Florida) @crys_noelle_
·       Katherine Cironi, general surgery resident at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) @cironimacaroni
Learning objectives
1.          Understand the evolving role of OMMs in bariatric surgical practice
·       Recognize how widespread GLP-1 and dual-incretin therapies have reshaped patient presentations, expectations, and referral patterns.
·       Appreciate current evidence comparing surgery to GLP-1 therapy, including the JAMA Surgery study out of Allegheny Health (2025), noting:
o   Superior weight loss with bariatric surgery (~28% TBWL vs ~10% with GLP-1s)
o   Higher health-care utilization and cost in GLP-1–treated patients.
·       Frame OMMs not as alternatives but as complementary tools within a chronic disease model when treating obesity.
2.           Review pharmacologic classes and their expected efficacy
·       Surgeons should be able to articulate the mechanisms, efficacy, and limitations of:
o   GLP-1 receptor agonists – incretin-based satiety; 5–12% TBWL.
o   Dual GIP/GLP-1 agonists – most potent agents; 15–22% TBWL.
o   Sympathomimetics – norepinephrine-driven appetite suppression; 3–7% TBWL.
o   Combination agents (bupropion-naltrexone, phentermine-topiramate) – 5–12% TBWL depending on regimen.
o   Emerging therapies – retatrutide, maritide, oral GLP-1s, with promising TBWL in phase 2 trials
3.          Apply OMMs strategically in the preoperative phase
·       Integrate OMMs without compromising surgical eligibility—OMM-related weight loss does not negate the indication for surgery.
·       Counsel patients that medication response does not equal disease resolution; surgery remains the most durable intervention.
·       Manage delayed gastric emptying and aspiration risk:
o   Pause weekly GLP-1 or dual agonists for ≥1 week pre-op (longer if symptomatic).
o   Collaborate closely with the anesthesia/OR teams
·       Screen for nutritional depletion before surgery, especially protein deficits exacerbated by appetite suppression.
·       Navigate insurance barriers that may paradoxically approve surgery but deny medication continuation.
4.          Implement postoperative OMMs safely and effectively
·       Establish criteria for OMM introduction:
o   Typical initiation at 6–12 months, once the diet stabilizes and the physiologic curve flattens.
o   Earlier initiation (4–6 weeks) may be appropriate in pediatric or select high-risk populations.
·       Recognize altered pharmacokinetics after sleeve and bypass:
o   Injectables may be preferred due to altered absorption of oral agents.
·       Prevent postoperative nutritional compromise:
o   Monitor protein intake, hydration, and micronutrient status (including iron, B12, and fat-soluble vitamins).
o   Titrate doses slowly to minimize nausea/vomiting that can precipitate malnutrition.
·       Frame OMM use as a tool for disease persistence (plateau/regain), not as a marker of failure.
5.          Identify systems-level barriers and the implementation of coordinated care
·       Understand insurance inconsistencies—coverage for surgery is often not paired with coverage for long-term medical therapy.
·       Clearly document disease persistence and medical necessity when appealing denials.
·       Avoid fragmented care: establish shared-care pathways between bariatric surgery, obesity medicine, and primary care.
·       Use patient-centered language emphasizing complementary therapy, not hierarchy or competition between surgery and medications.
6.          Counsel patients ethically and accurately within a chronic disease model
·       Set expectations: sustained success requires surgery + medication + behavioral change.
·       Educate patients that postoperative OMM use does not imply surgical failure.
·       Normalize long-term multimodal management of obesity, analogous to diabetes or hypertension models.
*Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content.  Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only 
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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In surgical residency, cases are long, expectations are high, and patient care always comes first. But then you become a parent, and suddenly you’re navigating pregnancy risk, parental leave, and lactation logistics in a system that wasn’t built for it. We’ve made meaningful progress over the past decade, but too many trainees still face becoming parents in residency without clear, consistent support. 
In this episode, join Dr. Kara Button with Dr. Arielle Kanters and Dr. Sarah Shubeck as they ask: How do we build a surgical workforce that’s skilled, resilient—and genuinely supported as surgeon-parents? They’ll share practical, evidence-based steps programs can take to make parental support the norm—not the exception.
Hosts:
Kara Button, DO — General Surgery Resident, Maine Medical Center; Behind the Knife Surgical Education Fellow
Arielle Kanters, MD — Colorectal Surgeon; Associate Program Director, Colorectal Surgery Fellowship, Cleveland Clinic
Dr. Sarah Shubeck, MD — Assistant Professor of Surgery; Breast Surgical Oncologist, University of Chicago
References:
Bamdad MC, Hughes DT, Englesbe M. Safe and supported pregnancy: A call to action for surgery chairs and program directors: A call to action for surgery chairs and program directors. Ann Surg. 2022;275(1):e1-e2. doi:10.1097/SLA.0000000000005181 https://pubmed.ncbi.nlm.nih.gov/34433187/

Castillo-Angeles M, Atkinson RB, Easter SR, et al. Pregnancy during surgical training: Are residency programs truly supporting their trainees? J Surg Educ. 2022;79(6):e92-e102. doi:10.1016/j.jsurg.2022.06.011 https://pubmed.ncbi.nlm.nih.gov/35842402/

Castillo-Angeles M, Smink DS, Rangel EL. Perspectives of general surgery program directors on paternity leave during surgical training. JAMA Surg. 2022;157(2):105-111. doi:10.1001/jamasurg.2021.6223 https://pubmed.ncbi.nlm.nih.gov/34851404/

Kanters AE, Shubeck SP. The importance of parental leave and lactation support for surgeons. Clin Colon Rectal Surg. 2023;36(5):333-337. doi:10.1055/s-0043-1764288 https://pubmed.ncbi.nlm.nih.gov/37564351/

Kling SM, Slashinski MJ, Green RL, Taylor GA, Dunham P, Kuo LE. Parental leave experiences for the non-childbearing general surgery resident parent: A qualitative analysis. Surgery. 2024;176(5):1320-1326. doi:10.1016/j.surg.2024.04.035 https://pubmed.ncbi.nlm.nih.gov/38910045/

Mann H, Glazer T. Current state of safe pregnancy policies for the US surgical trainee. OTO Open. 2024;8(3):e172. doi:10.1002/oto2.172 https://pubmed.ncbi.nlm.nih.gov/39036338/

Rangel EL, Smink DS, Castillo-Angeles M, et al. Pregnancy and motherhood during surgical training. JAMA Surg. 2018;153(7):644-652. doi:10.1001/jamasurg.2018.0153 https://pubmed.ncbi.nlm.nih.gov/29562068/

Rangel EL, Castillo-Angeles M, Easter SR, et al. Incidence of infertility and pregnancy complications in US female surgeons. JAMA Surg. 2021;156(10):905-915. doi:10.1001/jamasurg.2021.3301 https://pubmed.ncbi.nlm.nih.gov/34319353/

https://www.nytimes.com/2019/12/20/science/doctors-surgery-motherhood-medical-school.html

https://behindtheknife.org/podcast/family-leave-during-surgical-training-a-discussion-with-abs-president-dr-jo-buyske

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:
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
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You’re in the middle of surgical residency, and you realize you need more than a few weeks away from clinical responsibilities. Maybe you need more time to be a parent, recover from an illness, care for family, learn a new skill, or simply create space to reflect and reset. What if you could complete five years of training over six calendar years by spreading that time out in a way that fits your life?  
Join Dr. Kara Button with Dr. Joe Buyske, and Dr. Bridget Olson as they break down the 5-in-6 pathway including how it works, who it’s for, and the real-world logistics that matter.
Hosts:
Kara Button, DO — General Surgery Resident, Maine Medical Center; Behind the Knife Surgical Education Fellow
Jo Buyske, MD — President & CEO, American Board of Surgery
Dr. Bridget Olsen, MD — General Surgery Resident, Maine Medical Center
References:
Bamdad MC, Hughes DT, Englesbe M. Safe and supported pregnancy: A call to action for surgery chairs and program directors: A call to action for surgery chairs and program directors. Ann Surg. 2022;275(1):e1-e2. doi:10.1097/SLA.0000000000005181 https://pubmed.ncbi.nlm.nih.gov/34433187/

Castillo-Angeles M, Atkinson RB, Easter SR, et al. Pregnancy during surgical training: Are residency programs truly supporting their trainees? J Surg Educ. 2022;79(6):e92-e102. doi:10.1016/j.jsurg.2022.06.011 https://pubmed.ncbi.nlm.nih.gov/35842402/

Castillo-Angeles M, Smink DS, Rangel EL. Perspectives of general surgery program directors on paternity leave during surgical training. JAMA Surg. 2022;157(2):105-111. doi:10.1001/jamasurg.2021.6223 https://pubmed.ncbi.nlm.nih.gov/34851404/

Kanters AE, Shubeck SP. The importance of parental leave and lactation support for surgeons. Clin Colon Rectal Surg. 2023;36(5):333-337. doi:10.1055/s-0043-1764288 https://pubmed.ncbi.nlm.nih.gov/37564351/

Kling SM, Slashinski MJ, Green RL, Taylor GA, Dunham P, Kuo LE. Parental leave experiences for the non-childbearing general surgery resident parent: A qualitative analysis. Surgery. 2024;176(5):1320-1326. doi:10.1016/j.surg.2024.04.035 https://pubmed.ncbi.nlm.nih.gov/38910045/

Mann H, Glazer T. Current state of safe pregnancy policies for the US surgical trainee. OTO Open. 2024;8(3):e172. doi:10.1002/oto2.172 https://pubmed.ncbi.nlm.nih.gov/39036338/

Rangel EL, Smink DS, Castillo-Angeles M, et al. Pregnancy and motherhood during surgical training. JAMA Surg. 2018;153(7):644-652. doi:10.1001/jamasurg.2018.0153 https://pubmed.ncbi.nlm.nih.gov/29562068/

Rangel EL, Castillo-Angeles M, Easter SR, et al. Incidence of infertility and pregnancy complications in US female surgeons. JAMA Surg. 2021;156(10):905-915. doi:10.1001/jamasurg.2021.3301 https://pubmed.ncbi.nlm.nih.gov/34319353/

https://www.nytimes.com/2019/12/20/science/doctors-surgery-motherhood-medical-school.html

https://behindtheknife.org/podcast/family-leave-during-surgical-training-a-discussion-with-abs-president-dr-jo-buyske

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:
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-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
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This new 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 second episode highlights the thyroid cancer operative standard.
Hosts:
Tracy Wang, MD, MPH, FACS is a Professor of Surgery and Vice-Chair of Strategic and Professional Development at the Medical College of Wisconsin with a clinical focus on endocrine surgical oncology. 
Vladmir Neychev, MD, PhD is a Professor of Surgery at the University of Central Florida College of Medicine with a clinical focus on endocrine surgical oncology.
Jack Sample, MD (@JackWSample) is a General Surgery Resident at Mayo Clinic Rochester.
Guests:

Elizabeth Grubbs, MD (@EGrubbsMD) is a Professor of Surgical Oncology at MD Anderson where she specializes in endocrine tumors, with expertise in cancer of the thyroid.
David Hughes, MD is a Clinical Associate Professor of Surgery at University of Michigan, where he focuses on surgical diseases of the endocrine system, including a particular focus on the diagnosis and management of papillary thyroid cancer.
Learning Objectives: Understand key preoperative and intraoperative aspects of the evaluation and treatment of patients with biopsy-proven papillary thyroid carcinoma (PTC) greater than or equal to 1 cm. Define factors that guide decision making regarding the extent of surgical resection (lobectomy versus total thyroidectomy) for PTC.
Links to Papers Referenced in this Episode

Operative Standards for Cancer Surgery, Volume 2: Thyroid, Gastric, Rectum, Esophagus, Melanoma
https://www.facs.org/quality-programs/cancer-programs/cancer-surgery-standards-program/operative-standards-for-cancer-surgery/purchase/

Kindle edition:
Amazon.com: Operative Standards for Cancer Surgery: Volume 2, Section 1: Thyroid eBook : Program, American College of Surgeons Clinical Research, Katz, Matthew HG: Kindle Store

Impact of Extent of Surgery on Survival for Papillary Thyroid Cancer Patients Younger Than 45 years. 
https://pubmed.ncbi.nlm.nih.gov/25337927/ 
Extent of Surgery Affects Survival for Papillary Thyroid Cancer. 
https://pubmed.ncbi.nlm.nih.gov/17717441/
Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content.  Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only
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:
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-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
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Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam.

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Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series.  Medtronic has a rich history of supporting surgical education, and we couldn’t be happier that they chose to partner with Behind the Knife.  Learn more at https://www.medtronic.com/en-us/index.html

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

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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Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review

Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review

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