Endometriosis and fibroids don't have to block your patient’s path to pregnancy. In this episode of BackTable OBGYN, host Dr. Mark Hoffman welcomes Dr. Jim Robinson, Director of Reproductive Surgery at Shady Grove Fertility in Maryland, to share his guidance on reproductive surgery applications and reproductive health.

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SYNPOSIS

The conversation explores the management of endometriosis and fibroids, the use of office hysteroscopy, and the intricacies of hysteroscopic and laparoscopic procedures. Dr. Robinson covers the importance of individualized patient care, the latest advancements in reproductive technology, and insights from his unique career blending academic medicine with a focus on enhancing fertility outcomes. Listeners will gain a comprehensive understanding of the critical role surgical interventions play in reproductive endocrinology and the nuanced approach required to optimize patient outcomes.

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TIMESTAMPS

00:00 - Introduction
05:17 - Understanding Reproductive Surgery
08:51 - Hysteroscopy in Reproductive Surgery
16:28 - Endometriosis and Infertility
23:50 - Diagnosing and Treating Adenomyosis
28:10 - Surgical Interventions for Reproductive Health
33:52 - Balancing Endometrioma Removal and Fertility
35:49 - Surgical Approaches and Patient Goals
36:46 - Complexities of Fertility Consultations
42:48 - Impact of Fibroids on Reproductive Health
45:33 - Adhesion Prevention in Myomectomy
48:33 - Innovations in Fibroid Ablation
52:10 - Understanding Isthmoceles and Their Impact
58:11 - Concluding Thoughts

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RESOURCES

ReceptivaDx: What does it mean to test positive for high levels of bcl6
https://receptivadx.com/what-does-it-mean-to-test-positive-for-high-levels-of-bcl6/

Impact of hysteroscopic surgery for isthmocele associated with cesarean scar syndrome: https://pubmed.ncbi.nlm.nih.gov/28892298/

Ever wondered what it’s like to train and practice obstetrics and gynecology across New Zealand and Australia? In this episode of BackTable OBGYN, Dr. Amy Park sits down with Dr. Michael Wynn-Williams, a renowned gynecologist and endometriosis specialist. Dr. Wynn-Williams discusses his extensive training across New Zealand, Australia, the UK, and Scotland, emphasizing his role in minimally invasive gynecology.
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SYNPOSIS
The conversation covers the nuances of gynecology and obstetrics training in Australia and New Zealand, the balance between public and private healthcare systems, and the cultural differences in medical practice. Dr. Wynn-Williams also sheds light on issues like medical-legal environments, insurance, the impact of geography on healthcare delivery, and the integration of advanced ultrasound practices in endometriosis care. The episode provides valuable insights for those considering a career in gynecology in these regions.
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TIMESTAMPS
00:00 - Introduction
07:35 - Training in Australia and New Zealand
15:05 - Public and Private Healthcare Systems
20:25 - Challenges and Equity in Healthcare
24:39 - Balancing Public and Private Practice
28:48 - Inpatient Services and Day Case Hysterectomy
29:46 - City vs. Rural Practices and Equity Issues
31:55 - Staffing Challenges in New Zealand
33:57 - Living and Working in New Zealand and Australia
35:25 - Navigating Medical Practice Transfers
40:10 - Medical-Legal Environment in Australia and New Zealand
43:31 - Gender-Based Reimbursement and Training Challenges
51:41 - Endometriosis Ultrasound Scanning and Collaboration
52:27 - Final Thoughts
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RESOURCES
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the professional body responsible for training, accreditation, and standards in obstetrics and gynecology in both countries
https://ranzcog.edu.au/

Not all pain is visible and not all solutions are obvious, especially in chronic pelvic pain. In this episode of BackTable OBGYN, host Dr. Mark Hoffman welcomes Dr. Aakriti Carrubba, an expert in minimally invasive gynecological surgery and pelvic pain from the Mayo Clinic, to talk through the evaluation and treatment of chronic pelvic pain.
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SYNPOSIS
Dr. Carrubba shares her journey from Kentucky to Florida, detailing her extensive training and interest in managing pelvic pain. The discussion covers the evaluation of pelvic pain, the significance of a thorough patient history and systematic pelvic exams, and the role of interdisciplinary approaches, including physical therapy and pain management. Dr. Carrubba emphasizes the importance of addressing central sensitization and chronic pain syndromes, explaining that not all pain can be attributed solely to structural abnormalities. The episode also touches on the integration of advanced AI tools in medical practice to enhance patient documentation and overall care.
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TIMESTAMPS
00:00 - Introduction
01:09 - Dr. Carrubba’s Background and Journey
03:54 - Fellowship Experience and Pelvic Pain Focus
06:44 - Approach to Chronic Pelvic Pain
14:04 - Detailed Pelvic Pain Exam Techniques
17:14 - Trigger Point Injections and Their Role
21:33 - Challenges in Pain Management and Education
26:34 - Role of Central Sensitization in Chronic Pelvic Pain
29:35 - Approach to Central Sensitization and Screening
33:13 - Approaches to Excision Surgery
36:04 - Post-Surgery Management and Hormonal Suppression
38:19 - Teaching and Training in Pelvic Pain Management
41:35 - Pain Rehabilitation Clinic for Central Sensitization
44:59 - Teaching Pelvic Pain Anatomy to Trainees
48:24 - Advancements in AI for Medical Documentation
52:26 - Reflections on Pelvic Pain Training and Education
56:00 - Final Thoughts

No money, no mission. Understanding coding is the key to funding care and making your practice sustainable. In this episode of BackTable OBGYN, host, Dr. Mark Hoffman, chats with Dr. Jon Hathaway, associate professor at IU School of Medicine and coding specialist. They discuss the intricacies of medical billing, the impact of coding knowledge on revenue, and the systemic gaps in residency training regarding financial literacy.
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SYNPOSIS
Dr. Hathaway shares his journey from mastering coding to becoming a national expert, providing a crash course on CPT, RVU, and ICD codes, and emphasizing the importance of accurate billing for the sustainability of healthcare practices. The episode offers valuable insights into the challenges and opportunities in medical coding and the broader financial aspects of healthcare.
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TIMESTAMPS
00:00 - Introduction
02:03 - Dr. Hathaway's Journey into Coding
04:11 - Understanding the Financial Side of Healthcare
07:10 - The Disconnect in Healthcare Payments
11:26 - The Complexity of Medical Billing
18:11 - The Role of CPT, RVU, and ICD Codes
24:03 - The Process of Approving New Procedures
32:38 - Understanding the Value Update Process
33:47 - Case Study: Cystoscopy in Hysterectomy Codes
35:26 - Survey Participation and Its Impact
36:12 - Roles and Responsibilities in ACOG
38:12 - Challenges of RVU-Based Compensation
42:08 - Specialty-Specific RVU Valuation
48:42 - Comparing OB and GYN Reimbursements
50:02 - Envisioning an Ideal Healthcare System
55:10 - Maximizing Billing Efficiency
59:46 - Final Thoughts

The future of gynecologic surgery is less invasive, more precise, and closer than you think. In this episode of the BackTable OBGYN podcast, host Dr. Mark Hoffman welcomes Dr. Noam Smorgick, Director of Minimally Invasive Gynecologic Surgery at Shamir Hospital in Israel. They discuss Dr. Smorgick’s journey into the field of OBGYN and her innovative approaches to intrauterine adhesion management and hysteroscopic surgery for complex pathologies.
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SYNPOSIS
Topics include the advantages of hysteroscopic management over traditional methods, the importance of maintaining fertility, the nuances of the Israeli healthcare system, and the development of new surgical instruments and procedures. The episode also highlights shared decision-making in patient care and looks ahead to the future direction of gynecologic surgery. Dr. Smorgick shares insights from recent studies and her experiences, making it a valuable listen for practitioners and anyone interested in gynecologic surgery advancements.
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TIMESTAMPS
00:00 - Introduction
02:05 - Dr. Smorgick’s Journey to Medicine
05:01 - Insights into Israeli Healthcare System
10:20 - Intrauterine Adhesions and Hysteroscopic Management
11:28 - Research on Retained Products of Conception
15:07 - Comparing Management of Pregnancy Loss
22:02 - Future Directions in Hysteroscopic Surgery
23:46 - Infertility Treatments in Israel
25:50 - Managing Uterine Septums and Adhesions
28:03 - Shared Decision Making in Surgery
32:03 - Techniques and Tools for Metroplasty
33:08 - Adhesion Prevention Strategies
35:35 - Postoperative Care and Follow-Up
36:59 - Office Hysteroscopy Procedures
38:05 - Reusable vs. Disposable Instruments
45:51 - Future of Hysteroscopy
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RESOURCES
Netherlands Publication: Prevalence of intrauterine adhesions after the application of hyaluronic acid gel after dilatation and curettage in women with at least one previous curettage: short-term outcomes of a multicenter, prospective randomized controlled trial: https://pubmed.ncbi.nlm.nih.gov/28390688/
Dr. Smorgick’s Publications: A comparison of reproductive outcomes following hysteroscopic management versus dilatation and curettage of retained products of conception: https://pubmed.ncbi.nlm.nih.gov/24997472/
Hysteroscopy-assisted suction curettage for early pregnancy loss: does it reduce retained products of conception and postoperative intrauterine adhesions?: https://pubmed.ncbi.nlm.nih.gov/37782418/

When radiology meets surgery, endometriosis care becomes more precise, personalized, and proactive. In this BackTable OBGYN Brief, host Dr. Mark Hoffman is joined by Dr. Wendaline VanBuren, an associate professor of radiology at Mayo Clinic, and Dr. Tatnai Burnett, a minimally invasive GYN surgeon at Mayo Clinic, to discuss the complexities of diagnosing and managing endometriosis.

The discussion covers the roles of advanced imaging techniques like MRI and ultrasound, the importance of pre-surgical planning, and the need for multidisciplinary collaboration. They share their approach to managing symptomatic and asymptomatic patients, the use of hormonal treatments, and the significance of monitoring potential malignant transformations in endometrioma cases. The episode underscores the critical role of imaging in planning effective surgical interventions for patients while highlighting the progression of endometriosis management protocols.

TIMESTAMPS

00:00 - Introduction 

01:07 - Discussing Endometriosis Management

02:18 - Imaging Techniques and Their Importance

04:24 - Interdisciplinary Collaboration

05:40 - Advanced Imaging Protocols

08:12 - Monitoring and Follow-Up Strategies

08:50 - Concerns About Malignancy

11:04 - Future Directions

CHECK OUT THE FULL EPISODE

OBGYN Ep. 69

https://www.backtable.com/shows/obgyn/podcasts/69/imaging-protocols-to-guide-endometriosis-treatment

Blind biopsies leave questions unanswered. In this episode of BackTable OBGYN, host Dr. Mark Hoffman welcomes back Dr. Linda Bradley, an expert in obstetrics, gynecology, and hysteroscopy from the Cleveland Clinic, to discuss the benefits and advancements of direct visualized endometrial sampling over traditional blind biopsy techniques.
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This podcast is supported by:
Medtronic
https://www.medtronic.com/en-us/healthcare-professionals/specialties/gynecology/product-portfolio.html
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SYNPOSIS
Dr. Bradley emphasizes the importance of hysteroscopy for accurate diagnosis and treatment of various gynecological issues, including abnormal uterine bleeding. They explore the limitations of blind biopsies and the advantages of hysteroscopy in detecting focal lesions, avoiding unnecessary hysterectomies, and ensuring patient safety. The discussion also touches on the economic and procedural challenges in adopting hysteroscopy more widely in clinical practice.
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TIMESTAMPS
00:00 - Introduction
03:30 - The Evolution of Hysteroscopy at Cleveland Clinic
04:49 - Challenges and Innovations in Hysteroscopy
06:30 - Clinical Insights: Direct Visualized Endometrial Sampling
12:03 - Case Studies and Practical Applications
15:46 - The Importance of Visual Examination in Gynecology
20:03 - Advocating for Hysteroscopy in Medical Practice
31:07 - Patient History and Trauma Considerations
31:34 - Cancer Detection and Missed Diagnoses
32:14 - Challenges with Unscheduled Bleeding
32:56 - Case Study: Blood Transfusions and Hysterectomy
33:38 - Importance of Hysteroscopy
34:43 - Hysteroscopy Techniques and Best Practices
37:41 - Ultrasound and SIS (Saline Infusion Sonohysterography) for Imaging
38:45 - Post-Operative Care and Follow-Up
47:41 - Environmental and Economic Considerations in Healthcare
52:51 - Final Thoughts and Patient Advocacy

When radiology meets surgery, endometriosis care becomes more precise, personalized, and proactive. In this BackTable OBGYN Brief, host Dr. Mark Hoffman is joined by Dr. Wendaline VanBuren, an associate professor of radiology at Mayo Clinic, and Dr. Tatnai Burnett, a minimally invasive GYN surgeon at Mayo Clinic, to discuss the complexities of diagnosing and managing endometriosis.

The discussion covers the roles of advanced imaging techniques like MRI and ultrasound, the importance of pre-surgical planning, and the need for multidisciplinary collaboration. They share their approach to managing symptomatic and asymptomatic patients, the use of hormonal treatments, and the significance of monitoring potential malignant transformations in endometrioma cases. The episode underscores the critical role of imaging in planning effective surgical interventions for patients while highlighting the progression of endometriosis management protocols.

TIMESTAMPS

00:00 - Introduction 

01:07 - Discussing Endometriosis Management

02:18 - Imaging Techniques and Their Importance

04:24 - Interdisciplinary Collaboration

05:40 - Advanced Imaging Protocols

08:12 - Monitoring and Follow-Up Strategies

08:50 - Concerns About Malignancy

11:04 - Future Directions

CHECK OUT THE FULL EPISODE

OBGYN Ep. 69

https://www.backtable.com/shows/obgyn/podcasts/69/imaging-protocols-to-guide-endometriosis-treatment

When it comes to menopause care, the facts are better than the fears. In this Urology/OBGYN crossover episode of the BackTable Podcast, host Dr. Suzette Sutherland welcomes renowned urologist Dr. Rachel Rubin to explore various aspects of sexual health and hormone replacement therapy (HRT), particularly for menopausal women.

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SYNPOSIS

Dr. Rachel Rubin shares her career journey, expertise in sexual health, and the critical role of hormone replacement therapy (HRT) in managing menopause. She addresses common challenges and misconceptions, particularly around estrogen use, by demystifying the Women’s Health Initiative studies and emphasizing the proven safety and benefits of systemic and vaginal HRT. Dr. Rubin offers practical guidance on prescribing estrogen, progesterone, testosterone, and DHEA, while highlighting her advocacy to remove outdated FDA black box warnings on vaginal estrogen. Through personal anecdotes and professional insights, she empowers practitioners with evidence-based strategies and underscores the importance of education and research in advancing women’s health.

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TIMESTAMPS

00:00 - Introduction
03:41 - Challenges in Menopause Medicine
07:21 - Misconceptions and Risks of HRT
15:35 - Understanding Bioidentical Hormones
18:48 - WHI Studies and Their Impact
23:21 - Practical Guide to Prescribing HRT
33:47 - Understanding Estrogen Levels and Risks
36:04 - Debating Gels vs. Patches
37:51 - Concerns with Compounded Products and Pellets
38:50 - Patient Education and Meeting Them Where They Are
42:12 - Progesterone Benefits and Sensitivities
46:38 - Testosterone Therapy for Women
51:36 - The Importance of Lab Tests
55:39 - DHEA and Vaginal Health
57:14 - Advocacy for Accurate Hormone Therapy Information
01:00:05 - Conclusion and Final Thoughts

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RESOURCES

The Peter Attia Drive episode with Dr. Rachel Rubin:
https://peterattiamd.com/rachelrubin/

FDA Expert Panel on Menopause and Hormone Replacement Therapy for Women:
https://www.youtube.com/live/_2ZRlOivC5M?si=-Xynb_BmWz2sWf4m
Dr. Rachel Rubin’s Hormone Therapy for Early Adopters Course:
https://rachelrubinmd.thinkific.com/courses/MHTCME

The guidelines are in and the myths are out. In this episode of the BackTable Podcast, Dr. Suzette Sutherland hosts Dr. Melissa Kaufman and Dr. Giulia Ippolito to discuss the new 2025 AUA/SUFU guidelines on genitourinary syndrome of menopause (GSM).
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SYNPOSIS
The doctors delve into what GSM is, its symptoms, and the new evidence-based clinical guidelines for screening, diagnosing, and treating this condition. The episode emphasizes shared decision-making, safe use of local low-dose vaginal estrogen, and addresses concerns related to hormone therapy and cancer risks. Additionally, the doctors cover non-hormonal interventions, the role of vaginal moisturizers and lubricants, and the use of vaginal lasers. The importance of follow-up and ongoing patient education is also highlighted. The conversation aims to equip clinicians with the knowledge to better manage GSM and improve patient outcomes.
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TIMESTAMPS
00:00 - Introduction
01:35 - Overview of the 2025 AUA/SUFU Guidelines
02:27 - Guideline Development Process
05:48 - Categories of Guidelines
07:03 - Understanding GSM: Symptoms and Diagnosis
10:28 - Patient Education and Shared Decision Making
15:22 - Hormonal Interventions and Safety Concerns
17:17 - Local Vaginal Estrogen: Recommendations and Usage
23:12 - Compounded Estrogens and Alternative Therapies
25:48 - Understanding Estrogen Dosage Forms
26:11 - Introduction to DHEA and Its Benefits
27:15 - Exploring Ospemifene as an Alternative
28:05 - Guidelines for Treating GSM Symptoms
30:11 - The Role of Vaginal Estrogen in UTI Prevention
33:01 - Non-Hormonal Interventions for GSM
35:39 - Laser Treatments for GSM
39:59 - Addressing Cancer Risks with Vaginal Estrogen
44:48 - Endometrial Surveillance and Follow-Up
49:14 - Advocating for Vaginal Estrogen Use
51:13 - Conclusion and Final Thoughts