As our patients' age progresses, so should our definition of 'recovery'. In this episode of BackTable OBGYN, Dr. Mary Ackenbom, associate professor of urogynecology and reconstructive pelvic surgery at the University of Michigan, is welcomed by host Dr. Amy Park to discuss improving outcomes for older surgical patients.

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SYNPOSIS

Dr. Ackenbom shares her journey from studying finance at Ohio State to ultimately specializing in urogynecology. The conversation mainly focuses on perioperative cognitive health, particularly in aging populations, and how conditions like frailty and comorbidities impact surgical risk and recovery. Dr. Ackenbom highlights the importance of individualized patient care, early mobility, enhanced recovery protocols, and prehabilitation in improving postoperative outcomes. The episode also explores the prevalence of postoperative cognitive decline and offers practical insights on counseling and managing older patients undergoing urogynecologic surgery.

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TIMESTAMPS

00:00 - Introduction
02:18 - Dr. Ackenbom’s Journey to Urogynecology
04:47 - Research on Brain Fog
06:18 - Personal Support and Hobbies
09:54 - Age vs Frailty in Surgery
13:05 - Procedures with Perioperative Complexity
16:11 - Counseling on Operative Risk
20:10 - ERAS and Earlier Discharge
23:35 - Patient Goals and Tradeoffs
27:53 - Surgical Clearance and Preop Consults
33:30 - Prehabilitation Basics
36:24 - Minimally Invasive Surgery Benefits
37:15 - Surgical Cognitive Complications with Age
41:42 - Finding the Surgery Window
46:05 - Cognitive and Frailty Screening
50:01 - Guidelines for Perioperative Care
52:52 - Future Research
54:07 - Conclusion

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RESOURCES

Incidence of postoperative cognitive dysfunction in older women undergoing pelvic organ prolapse surgery
https://pubmed.ncbi.nlm.nih.gov/32827107/

ACS NSQIP/AGS Optimal Perioperative Care of the Geriatric Patient
https://www.facs.org/media/y5efmgox/acs-nsqip-geriatric-2016-guidelines.pdf

Trouble with bowel or bladder function? It might be time to partner with a specialist. In this episode of BackTable OBGYN, hosts Dr. Amy Park and Dr. Mark Hoffman are joined by Dr. Shannon Wallace and Dr. Anna Spivak, experts from the Cleveland Clinic specializing in pelvic floor disorders. They dive into the complex world of combined colorectal and urogynecological issues, discussing the importance of a multidisciplinary approach to treat conditions such as rectal prolapse, constipation, and incontinence.

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SYNPOSIS

The conversation covers detailed diagnostic methods like manometry and defecography, various surgical options, and the crucial role of pelvic floor physical therapy in patient recovery. They also provide insights into setting up effective multidisciplinary clinics and emphasize the need for teamwork and administrative support in delivering optimal patient care. This episode is a valuable resource for both specialists and generalists aiming to enhance their understanding and treatment of pelvic floor dysfunctions.

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TIMESTAMPS

01:05 - Introduction
05:40 - Multi-Compartment Prolapse & Second Opinions
08:14 - Pelvic Floor Compartments Explained
10:36 - When Internal Prolapse Becomes Surgical
11:56 - Incomplete Emptying, Splinting, Fragmentation & Leakage
16:55 - Fluoro vs MRI and When to Order It
23:47 - Anorectal Manometry
26:56 - Physical Therapy, Biofeedback, Meds, Injections, & Motility Workup
29:08 - Robotic Mesh Repairs vs Vaginal/Perineal Approaches
34:43 - When (and Why) to Consider Biologics
36:46 - Resection Rectopexy
38:10 - Treating Ehlers-Danlos syndromes (EDS) & Eating Disorders
42:55 - Pelvic Floor PT After Surgery and Recovery Timelines
47:29- Perineal Prolapse Repairs (Altemeier vs Delorme)
49:53 - Symptom Improvement vs Retraining the 'New Normal'
52:20 - Fecal Incontinence & Sacral Neuromodulation
57:08 - Diarrhea-Driven Incontinence
58:56 - Building a Multidisciplinary Pelvic Floor Program
01:04:04 - Conclusion

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RESOURCES

Pelvic Floor Disorders Consortium (American Society of Colon & Rectal Surgeons) https://fascrs.org/Web/Web/My-ASCRS/Education/Pelvic-Floor-Disorders-Consortium.aspx

From diagnosis to treatment, hysteroscopy plays a pivotal role in modern gynecologic care. In this episode of BackTable OBGYN, Dr. Christina Salazar, a minimally invasive gynecologic surgeon and associate professor at Dell Medical School in Austin, Texas, joins hosts Dr. Mark Hoffman and Dr. Amy Park to discuss the value of hysteroscopy in managing complex intrauterine pathology.

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SYNPOSIS

Dr. Salazar shares her introduction to hysteroscopy and the mentors who shaped her early training. She discusses her expertise in hysteroscopic surgery and its broad applications, with a focus on the complexities of Asherman syndrome, dysmorphic uteri, and the critical role of endometrial health assessment. The conversation also covers surgical techniques, post-operative care, and emerging technologies in hysteroscopic and reproductive care. Dr. Salazar concludes by emphasizing the need for improved classification systems for Asherman syndrome and future directions in reproductive health innovation.

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TIMESTAMPS

00:00 - Introduction
05:34 - Training and Mentorship in Hysteroscopy
11:21 - Dr. Salazar's Practice and Techniques
14:00 - Challenges and Trends in Surgical Practices
18:58 - Referral Practices and Advanced Hysteroscopy
21:58 - Understanding Dysmorphic Uterine Population
24:08 - T-Shaped Uteri Description
26:09 - Hysteroscopic Metroplasty: Methods and Risks
29:17 - Innovations in Hysteroscopy
32:38 - Value of Ultrasound in Hysteroscopy
36:35 - Post-Operative Management and Estrogen Therapy
39:23 - Challenges and Future Directions in Hysteroscopy
44:23 - Concluding Thoughts

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RESOURCES

The epidemiology, clinical burden, and prevention of intrauterine adhesions (IUAs) related to surgically induced endometrial trauma: a systematic literature review and selective meta-analyses
https://academic.oup.com/humupd/article/31/6/588/8248883

Hysteroscopy Newsletter
https://hysteroscopynewsletter.com/

Learn how ACOG turns advocacy into action, supports clinicians, and creates community. Plus, get tips on how you can get involved. In this episode of BackTable OBGYN, Dr. Sivani Aluru from Endeavor Health in Chicago shares her journey and involvement with ACOG, from her medical school days to her current role as the national JFCAC Chair.

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SYNPOSIS

Dr. Aluru describes her experiences on various task forces, including the ACOG 75th Anniversary Task Force, and emphasizes the importance of education, advocacy, and community within the organization. She offers insights into the challenges and benefits of participating in ACOG, provides tips for getting involved, and highlights the ongoing efforts to address critical issues in women's health. The conversation also touches on adapting to the changes brought by the COVID-19 pandemic and the value of staying organized and connected in a demanding field.

Find out what ACOG is working on, how it benefits patient care, how it benefits provider education and resources, how it builds community. Get involved! Go to meetings! There are so many roles. If you don’t get your role on the first go, try again. Showing up is huge!

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TIMESTAMPS

00:00 - Introduction
03:41 - Residency and Early Involvement in ACOG
07:29 - Advocacy and Government Affairs
18:40 - Balancing Professional and Organizational Work
24:28 - Listening to Members' Needs
26:36 - Challenges and Value of ACOG Membership
29:00 - The Importance of In-Person Meetings
34:45 - ACOG's Legislative Advocacy and Future Plans
35:48 - Advice for Getting Involved with ACOG
40:16 - Conclusion

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RESOURCES

ACOG (American College of Obstetricians and Gynecologists)
https://www.acog.org/

ACOG CAARE Delegation https://www.acog.org/about/diversity-equity-and-inclusive-excellence/collective-action-strategy/caare-delegation

ACOG CREOG (Council on Resident Education in Obstetrics and Gynecology) https://www.acog.org/education-and-events/creog/about

Some of the biggest advances in women’s health start with a simple question: why hasn’t this been fixed yet? In this episode of BackTable OBGYN, Dr. Tess Kim, a minimally invasive gynecologic surgeon at Massachusetts General Hospital and the founder of Fruits of Labor, a women's health medical device innovation company, joins host Dr. Amy Park.

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SYNPOSIS

Dr. Kim’s educational journey began with medical school at Emory, followed by residency at Beth Israel Deaconess Hospital, and fellowship training at MGH. She discusses the founding of Fruits of Labor, which began with the Perry Peach—a warm compress device designed to reduce severe perineal tearing during childbirth and now acquired by Medicines360. Dr. Kim also talks about her creative process, the importance of addressing historically neglected areas in women's health, and the potential impact of her new project, Mellomallows, which aims to reduce discomfort during gynecological procedures such as IUD placement. The conversation concludes with a discussion of the challenges and opportunities in women's health innovation, the significance of supportive networks, and the role of passion and commitment in driving meaningful change.

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TIMESTAMPS

00:00 - Introduction
02:03 - The Birth of PeriPeach: Addressing Severe Tearing
06:51 - New Medical Devices: Mellomallows
08:41 - The Creation and Mechanism of PeriPeach
11:11 - Company Development: Mentorship and Resources
17:37 - Pitching Practice and Experience
19:26 - Project Funding and Working with Medicines360
21:51 - Advice for Aspiring Innovators
23:52 - Concerns About AI in Healthcare
26:48 - Innovations in Women's Health
29:06 - Challenges in Academic Medicine
32:01 - The Importance of Female Innovators
34:00 - Forming a Startup in Women's Health
36:10 - Parting Advice for Future Innovators
37:37 - The Future of Women's Health Innovations
40:10 - Conclusion

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RESOURCES

Fruits of Labor website:
https://www.fruitsoflabormed.com/home

PeriPeach website:
https://www.peripeach.com/

Fibroid care: how it was, how it’s changing, and where it’s headed next. In this episode of BackTable OBGYN, hosts Dr. Mark Hoffman and Dr. Amy Park welcome minimally invasive GYN surgeon Dr. Arleen Song to discuss the evolving landscape of fibroid care.

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SYNPOSIS

Dr. Song, a veteran in the field with nearly 20 years of experience, shares her journey from Michigan to Duke, current treatments in fibroid management, and the importance of personalized care. The team explores new surgical techniques, the role of medical therapies such as Ella GnRH antagonists, and the importance of patient education. They also address challenges such as access to care, the significance of research funding, and the evolving understanding of fibroid genetics and long-term management. This episode provides a comprehensive overview of the state of fibroid care and the strides being made in this vital aspect of women's health.

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TIMESTAMPS

00:00 - Introduction
02:21 - Evolution of Fibroid Treatment
05:50 - Advancements in Minimally Invasive Surgery
08:47 - Longitudinal Care and Personalized Treatment
13:00 - Modern Approaches to Fibroid Treatment
21:15 - New Technologies and Procedures
27:01 - Preoperative Assessment and Imaging
31:15 - Preoperative Counseling and Risk Assessment
33:14 - Medications for Fibroid and Endometriosis
37:59 - Challenges in Access to Care
38:43 - Racial Disparities in Fibroid Research
42:35 - The Importance of Specialized Care
49:22 - Future Directions in Fibroid Treatment

Vaginal rejuvenation is often misunderstood, misrepresented, and overdue for honest conversations in medicine. In this crossover episode between BackTable Urology and BackTable OBGYN, Dr. Nirit Rosenblum, a urology and OBGYN professor at NYU Langone Medical Center, is joined by Dr. Karyn Eilber, Chair of the Cedars-Sinai Medical Group Department of Surgery, and Dr. Ariana Smith, Chief of Urology at Pennsylvania Hospital. Together, they bring a multidisciplinary lens to one of the most misunderstood areas of women’s health.

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This podcast was developed in collaboration with:

Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU)
https://sufuorg.com/home.aspx

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SYNPOSIS

The discussion revolves around the broad definition of vaginal rejuvenation, distinguishing between medical and cosmetic interventions. They address common misconceptions, the roles of different health professionals, and emphasize the importance of pelvic floor physical therapy and the appropriate use of systemic and vaginal estrogen therapy. The conversation also highlights critical gaps in research surrounding laser and radiofrequency interventions, underscoring the need for stronger evidence, clearer patient education, and continued advocacy around menopause care and sexual function.

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TIMESTAMPS

00:00 - Introduction
02:11 - Defining Vaginal Rejuvenation
04:35 - Common Procedures and Misconceptions
10:04 - Insurance and Coverage of Procedures
12:04 - Laser and Radiofrequency Therapies
18:10 - Vaginal Estrogen and Lift of Black Box Warning
19:59 - The Role of Systemic Hormone Therapy
26:56 - Vaginal Rejuvenation Misconceptions
32:21 - Pelvic Floor Physical Therapy and Timing of Procedures
34:24 - Regional Variations in Therapeutic Availability
38:40 - Gender Inequity in Healthcare
40:16 - Final Thoughts

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RESOURCES

Joint Report on Terminology for Cosmetic Gynecology
https://journals.lww.com/fpmrs/abstract/2022/06000/joint_report_on_terminology_for_cosmetic.2.aspx

Who should consider fertility preservation, when is the right time, and what are the risks? In this episode of BackTable OBGYN, Dr. Amy Park interviews Dr. Mindy Christianson, the section head of Reproductive Endocrinology and Infertility at the Cleveland Clinic, who shares how fertility preservation is evolving for patients planning families and those facing fertility-impacting treatments.

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SYNPOSIS

Dr. Christianson discusses her journey into the field of fertility preservation, inspired by an early encounter with a breast cancer patient. The conversation covers various aspects of fertility preservation, including the preservation of eggs, embryos, ovarian and testicular tissue, and planned fertility preservation. Dr. Christianson elaborates on the protocols, patient demographics, and the evolving collaboration between oncology and reproductive endocrinology. The discussion also highlights technologies like ovarian tissue transplantation and in vitro maturation, as well as practical tips for healthcare providers on improving patient access to fertility preservation services.

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TIMESTAMPS

00:00 - Introduction
03:34 - Understanding Fertility Preservation
07:56 - Consultation Process for Fertility Preservation
17:36 - Advancements in Egg Freezing Technology
25:55 - Egg Freezing Recommendations
26:34 - Collaboration Between Oncology and REI
26:52 - Pediatric Oncology and Fertility Preservation
28:58 - Ovarian Tissue Transplantation
33:17 - Uterine Transposition Surgery
40:05 - Gene Editing and Fertility Preservation
43:01 - Financial and Emotional Aspects of Fertility Preservation
48:02 - Practical Advice for OBGYNs
51:12 - Resources and Final Thoughts

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RESOURCES

Livestrong Fertility
https://livestrong.org/how-we-help/livestrong-fertility/

Resolve: The National Infertility Association
https://resolve.org/

Society for Assisted Reproductive Technology
https://www.sart.org/

American Society for Reproductive Medicine
https://www.asrm.org/

A physician’s expertise can extend beyond the exam room and into the courtroom. In this episode of BackTable OBGYN, Dr. Elizabeth Moore, a general OBGYN and founder of MooreExperts, joins host Dr. Mark Hoffman to share her expertise on the intricacies of medical-legal work.

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SYNPOSIS

They cover Dr. Moore's journey into expert witness work, including how the pandemic shifted her career focus and ultimately led to the creation of a platform to assist OBGYNs in navigating legal cases. They discuss the challenges of managing extensive medical records, the importance of adhering to the standard of care, and the unique nature of obstetrics cases. They also emphasize the need for precise, evidence-based report writing to avoid unnecessary trials and address the emotional and financial toll legal processes can take on physicians. Finally, the episode explores the need for better systems to protect both patients and healthcare providers while offering insight into future challenges, including AI and private equity involvement in legal cases.

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TIMESTAMPS

00:00 - Introduction
05:08 - First Experiences in Medical-Legal Work
08:57 - The Role of Education in Legal Cases
11:37 - Challenges and Rewards of Medical-Legal Work
13:58 - Understanding Standard of Care and Malpractice
15:59 - The Importance of Detailed Reports and Depositions
20:02 - The Jury System and Its Challenges
25:45 - Balancing Professional and Personal Life
29:43 - Getting Started in Medical-Legal Work
32:07 - Recognizing Patterns in Medical Litigation
33:51 - Educating Attorneys for Fair Trials
36:33 - Concerns and Improvement of Medical Expert Testimonies
45:54 - The Role of Systems in Reducing Medical Errors
51:52 - Future Challenges and Opportunities in Medical Legal Work
56:07 - Final Thoughts

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RESOURCES

ACOG Technical Bulletin 365: Seeking and Giving Consultation
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2007/05/seeking-and-giving-consultation

MooreExperts OBGYN Consulting Medical Legal Expert Witness Masterclass
https://www.mooreexperts.com/

Bless This Mess: A Picture Story of Healthcare by Dr. Stephen Klasko
https://www.amazon.ae/Bless-This-Mess-Picture-Healthcare/dp/1483479625

What if the key to improving obstetrical surgery outcomes isn’t a new technology, but rethinking who’s in the operating room? In this episode of BackTable OBGYN, host Dr. Mark Hoffman and co-host Dr. Amy Park welcome Dr. Sony Singh, a prominent figure in the field of minimally invasive gynecologic surgery (MIGS) and obstetrics, to share perspectives on the emerging role of MIG surgeons in obstetrical surgery.

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SYNPOSIS

Dr. Singh shares his extensive career journey, from his education in Canada and Australia to his current role as department chair of OBGYN at the Ottawa Hospital. The conversation delves into the integration of MIGS into obstetric surgery, including procedures like laparoscopic cerclages, placenta accreta management, and cesarean scar pregnancies. The hosts and guest discuss the challenges and importance of building a robust team, regionalization of care, maintaining work-life balance, and the eventual transition of leadership roles to sustain the high standards of care. This episode highlights the crucial role of minimally invasive specialists in advancing OBGYN practices while promoting a sustainable work culture.

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TIMESTAMPS

00:00 - Introduction
02:08 - Dr. Singh’s Journey
07:37 - The Role of MIG Surgeons in Obstetrical Surgery
16:06 - Building a Collaborative Team
18:38 - Challenges and Best Practices
25:26 - Expanding the Scope of MIG Surgeons
30:19 - The Evolution of Urogynecology and MIGS
31:31 - Leadership and Building Programs
37:54 - Scaling Up and Regionalization of Care
42:53 - Balancing Work and Personal Life
54:37 - Concluding Thoughts

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RESOURCES

Canadian Society for Advancement of Gynecologic Excellence
https://cansage.org/about/

From Strength to Strength, by Arthur Brooks
https://www.arthurbrooks.com/books