BackTable Women's Health

In this BackTable OBGYN Brief, host Dr. Mark Hoffman and Dr. Jan Baekelandt explore the benefits of vNOTES, especially in certain patient populations – obese patients, patients with a history of multiple abdominal surgeries, and those with a large uterus.

Dr. Baekelandt highlights the aesthetic advantages of minimized scarring in vNOTES alongside clinical benefits such as reduced postoperative pain, lower analgesia use, and shorter hospitalization times. They discuss the outcomes of randomized controlled trials that compare vNOTES with laparoscopy and the specific groups of patients who benefit most from vNOTES. The episode also delves into the technical aspects of vNOTES and its potential advantages in oncology procedures.

TIMESTAMPS

00:00 - Introduction

00:14 - Benefits of vNOTES

03:21 - Special Patient Groups

06:10 - Technical Aspects and Surgical Techniques

08:31 - Oncology Applications and Future Potential

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BackTable OBGYN Ep 31: The vNOTES Procedure

https://www.backtable.com/shows/obgyn/podcasts/31/the-vnotes-procedure

In this BackTable OBGYN Brief, host Dr. Mark Hoffman interviews Dr. Jan Baekelandt about the basics and history of vaginal natural orifice transluminal endoscopic surgery (vNOTES), including its learning curve for surgeons.

Dr. Baekelandt explains the benefits of performing gynecological operations through the vagina rather than the abdominal wall, allowing for quicker recovery and reduced invasiveness. They discuss the historical context of vNOTES, the integration of laparoscopic tools, and the challenges and learning curves associated with mastering this dual-skillset procedure.

TIMESTAMPS

00:00 - Introduction

00:14 - Understanding vNOTES

02:10 - Dr. Baekelandt’s Journey with vNOTES

04:03 - History and Technological Advancements

05:00 - TLH vs. vNOTES

07:36 - Challenges and Learning Curve in vNOTES

CHECK OUT THE FULL EPISODE

BackTable OBGYN Ep 31: The vNOTES Procedure

https://www.backtable.com/shows/obgyn/podcasts/31/the-vnotes-procedure

This episode of the BackTable OBGYN podcast features Dr. Barbara Levy, an OBGYN and seasoned expert in medical coding and reimbursement, discussing the nuances of medical billing, the process of creating medical codes, and how medical practices and expenses are valued differently.

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Cerene Cryotherapy

https://cerene.com/healthcare-professionals/

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SYNPOSIS

Key topics from this episode include the impact of indirect practice expenses, the role of different organizations in surveying costs and implementing new codes, the importance of coding for procedure reimbursement, and a task force’s findings on gender disparities in coding. The conversation transitions into the practical implications of where procedures are performed (office vs. surgical center vs. hospital) and how this impacts payment and patient costs. Dr. Levy emphasizes the efficiency and patient benefits of office-based procedures, exemplified by the Cerene cryotherapy ablation device. The complexities of the reimbursement system, including work Relative Value Units (RVUs), facility fees, and the push towards bundling services, are unpacked. The episode underscores the importance of understanding healthcare economics to advocate effectively for patient care improvements.

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TIMESTAMPS

00:00 - Introduction

02:24 - History of Medical Coding

11:32 - The Process of Medical Code Creation

21:15 - Understanding RVUs and Practice Expenses

26:35 - Challenges of Accurately Valuing Procedures

32:05 - Changing Codes/Reimbursement: Endometriosis Example

36:06 - The Art and Science of Medical Coding

39:26 - Site of Service and Facility Fees

51:15 - Benefits of Outpatient Procedures

55:46 - Example: Cerene Cryoablation

58:14 - Addressing Gender Disparities in Medical Reimbursement

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RESOURCES

ACOG Resources on Coding and Billing:

https://www.acog.org/practice-management/coding

In this episode of the BackTable OBGYN podcast, Drs. Kimberly (Kim) Kenton and Margaret (Maggie) Mueller discuss advancements in patient recovery guidelines, particularly after gynecologic surgeries.

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SYNPOSIS

The discussion first covers the evolution of post-operative care protocols, emphasizing the lack of evidence behind traditional post-op restrictions and highlighting recent studies that suggest liberal post-operative activities might lead to better recovery outcomes without compromising surgical results. Additionally, the episode touches on the impact of minimally invasive surgical techniques, such as single port surgeries, on patient recovery times and hospital system efficiencies. Finally, the conversation delves into the shift towards team-based care, where nurses and nurse practitioners actively participate in pre-op counseling, educating patients, and enhancing the overall healthcare team’s efficiency. The overarching theme is the crucial role of evidence-based practice in improving patient care and recovery in obstetrics and gynecology.

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TIMESTAMPS

00:00 - Introduction

02:57 - Exploring Postoperative Restrictions in Gynecologic Surgery

20:56 - Adapting Postoperative Visits

26:02 - Recovery Times, Hospital Stays, and the Impact on Patients and Healthcare

35:58 - Team-Based Care and Communication Strategies

44:38 - Surgical Techniques and Recovery Insights

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RESOURCES

Mueller MG, Kenton K. Activity Restrictions After Gynecologic Surgery. Obstet Gynecol. 2024 Mar 01; 143(3):378-382. PMID: 38207325; PMCID: PMC10863662.

In this crossover episode of BackTable Urology and OBGYN, Dr. Suzette Sutherland interviews three urological/gynecologic innovators, Dr. Ali Haessler, Dr. Jay Shakuri-Rad, and Dr. Tova Weiss, who are all at different career stages and product development phases.

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SYNPOSIS

Dr. Tova Weiss, a urology resident at the University of Washington, discusses her development of a safer urinary catheter so that if a patient were to pull out their catheter, the distal part would disconnect from the catheter inside the urethra, preventing urethral trauma. Dr. Jay Shakuri-Rad, a practicing urologist specializing in robotics and neuromodulation, shares his creation of the Foramen Finder to enhance sacral neuromodulation procedures. Dr. Allie Haessler, a practicing urogynecologist, talks about her invention of a novel vaginal ring aimed at providing neuromodulation therapy for pelvic floor issues. They each discuss the inspiration behind their inventions, challenges faced, and the importance of failure in the path to innovation. The episode emphasizes the role of physicians in identifying healthcare gaps, collaborating across disciplines, and pushing the boundaries of medical technology to improve patient care.

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TIMESTAMPS

00:00 - Introduction

01:54 - Dr. Tova Weiss and the Urinary Catheter Accessory

08:49 - Dr. Jay Shakuri-Rad and the Foramen Finder

22:04 - Dr. Allie Haessler and the Neuromodulation Vaginal Ring

27:29 - Navigating the Patent Process and Protecting Innovation

29:52 - The Path to FDA Approval

37:11 - Advice for Aspiring Innovators in Medicine

40:52 - Embracing Failure and the Inventor’s Mindset

This episode of BackTable OBGYN features an extensive discussion with Dr. Keith Isaacson, a specialist in Reproductive Endocrinology and Infertility, regarding the complexities of diagnosing and treating adenomyosis, emphasizing surgery, medical treatments, and research in the field.

Dr. Isaacson describes the pivots in the field’s understanding of adenomyosis and endometriosis, including the impact of these conditions on fertility and potential treatment pathways. Adenomyosis has been redefined in the past five years as a disease that affects women of all reproductive ages and causes dysmenorrhea, heavy menstrual bleeding, and infertility. Because the disease is found in the myometrium of the uterus, it has historically been difficult to diagnose unless through pathology following hysterectomy; however, imaging has since improved and there are now criteria seen on ultrasound that are consistent with adenomyosis.

Dr. Isaacson then discusses the differences and misconceptions about adenomyosis compared to endometriosis. Additionally, the episode touches on the evolution of treatment strategies over the years, including medical therapy versus surgery. Furthermore, Dr. Isaacson highlights the crucial role of research in uncovering disease pathophysiology and new therapeutic approaches.

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SHOW NOTES

00:00 - Introduction

04:06 - Definitions, Symptoms, and Insights

11:33 - Exploring Treatment Options for Adenomyosis and Infertility

21:30 - The Intersection of Endometriosis and Adenomyosis

30:09 - Imaging, Surgery, and Pathology

36:31 - The Future of Research and Patient-Centric Care

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RESOURCES

Moawad G, Fruscalzo A, Youssef Y, Kheil M, Tawil T, Nehme J, Pirtea P, Guani B, Afaneh H, Ayoubi JM, Feki A. Adenomyosis: An Updated Review on Diagnosis and Classification. J Clin Med. 2023 Jul 21;12(14):4828. doi: 10.3390/jcm12144828. PMID: 37510943; PMCID: PMC10381628.

This episode features host Dr. Mark Hoffman and guest Dr. Jessica Ritch as they discuss the lack of menopause education and research during medical training, and the necessity for practitioners to learn more about menopausal symptoms and management strategies.

The episode begins with Dr. Ritch, a minimally invasive gynecologic surgeon, describing her path into menopause care, including the development of her podcast, EnRitched Menopause. She touches on the role of laboratory workup in menopause, but emphasizes the patient’s symptoms are more important to address than numerical values on labs. She then delves into treatment options, including the complexities of hormone replacement therapy, and the multifactorial nature of sexual function issues. Most importantly, the physicians emphasize listening to patients, offering comprehensive care beyond hormone therapy, and utilizing resources like podcasts to educate both practitioners and patients. Finally, they explore new treatments and the potential future advancements in menopause care.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/I7Ougz

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SHOW NOTES

00:00 - Introduction

08:52 - The EnRitched Menopause Podcast: A Resource for Patients and Practitioners

15:22 - Common Patient Presentations of Menopause

20:43 - The Role of Laboratory Evaluation of Hormone Levels

24:20 - Testosterone in the Menopausal Patient

27:13 - Navigating Hormone Therapy: Estrogen, Progesterone, and Testosterone

31:03 - Physiologic Hormonal Changes in Menopause

35:00 - Shared Decision-Making

39:00 - Exploring Sexual Function and Libido in Menopause

45:38 - The Power of a Physician’s Support and Trusted Advice

50:09 - Innovative Approaches and Future Directions in Menopause Care

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RESOURCES

EnRitched Menopause Podcast:

https://podtail.com/en/podcast/enritched-menopause/welcome-to-enritched-menopause/

Rosy App:

https://play.google.com/store/apps/details?id=com.rosywellness&pli=1 (Google)

https://apps.apple.com/us/app/rosy-womens-sexual-health/id1444780510 (Apple)

In this episode of BackTable OBGYN, renowned reproductive endocrinologist and minimally invasive gynecologic surgeon Dr. Charles (Chuck) Miller delves into the topic of isthmoceles, a common yet often overlooked complication of C-sections, and shares his best practices for repair.

Dr. Miller shares his extensive experience in diagnosing and treating isthmoceles, discussing various surgical techniques including hysteroscopic, laparoscopic, and robotic-assisted resection. He emphasizes the importance of an aggressive surgical approach for achieving higher success rates in terms of future fertility and resolving symptoms such as abnormal bleeding. Moreover, Dr. Miller highlights the need for standardized treatment protocols and reflects on the mentorship, the ongoing journey of learning and adapting in medicine, and the noble profession of healthcare. The episode offers insightful perspectives on a lesser-known gynecologic issue, underscores the value of experience and mentorship in medicine, and advocates for concerted efforts toward establishing best practices in surgical procedures.

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SHOW NOTES

00:00 - Introduction

07:18 - Defining Isthmocele and the History of Isthmocele

10:00 - The Diagnosis of Isthmocele and Its Impact on Fertility

19:31 - Exploring Surgical Techniques for Isthmocele Repair

27:54 - Understanding Hysteroscopic Resection

30:12 - Addressing C-Section Ectopics and Isthmocele Repairs

36:46 - Adapting the Surgical Approach to Different Patient Scenarios

39:35 - Postoperative Complications and Safety Measures

40:55 - The Future of Isthmocele: Surgical Standardization

50:51 - Closing Thoughts and Acknowledgements

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RESOURCES

Ban Y, Shen J, Wang X, Zhang T, Lu X, Qu W, Hao Y, Mao Z, Li S, Tao G, Wang F, Zhao Y, Zhang X, Zhang Y, Zhang G, Cui B. Cesarean Scar Ectopic Pregnancy Clinical Classification System With Recommended Surgical Strategy. Obstet Gynecol. 2023 May 1;141(5):927-936. doi: 10.1097/AOG.0000000000005113. Epub 2023 Apr 5. PMID: 37023450; PMCID: PMC10108840.

In this episode of the BackTable OBGYN Podcast, hosts Dr. Mark Hoffman and Dr. Amy Park discuss how cultivating an effective team culture in surgery can mitigate complications.

The physicians emphasize that how surgical teams treat each other can significantly affect patient outcomes. They suggest under-promising and over-delivering to patients, their family, and members of the surgical team. The doctors recommend having a care culture, allowing everyone to voice their concerns without fear of reprisals. They also discuss the importance of self-management, leadership, and taking responsibility inside and outside the OR for complications and places where the surgery could have gone smoother. They agree that those who nurture a positive OR culture have higher success rates, noting that complications demand more than technical skills to handle - it takes emotional intelligence, humility, and a good support network.

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SHOW NOTES

00:00 - Introduction

02:07 - Dealing with Surgical Complications

04:24 - The Emotional Impact of Complications on Surgeons

07:24 - The Importance of Patient Communication and Care Post-Complication

08:35 - The Role of Consent and Preoperative Counseling in Managing Complications

11:18 - The Importance of a Supportive and Open Culture in Medicine

15:32 - The Importance of Learning from Mistakes in Medicine

24:28 - The Role of Leadership and Teamwork in the Operating Room

29:56 - The Value of Familiarity in a Medical Team

30:38 - The Importance of Recognizing and Appreciating All Roles in a Medical Team

34:31 - The Role of Care and Empathy in Medical Practice

37:28 - The Role of Preparation in Avoiding Complications

40:53 - The Importance of Scheduling and Time Management in Medical Practice

50:31 - The Impact of Culture on Reporting and Addressing Adverse Events

51:19 - The Importance of Feedback and Self-Reflection in Medical Practice