Vaginal estrogen is not the enemy. Outdated data is. In this crossover episode of the BackTable Urology and OBGYN podcasts, Dr. Suzette Sutherland and Dr. Yahir Santiago-Lastra delve into the persistent challenges and ongoing advocacy efforts surrounding the FDA's black box warning on vaginal estrogen.

---

SYNPOSIS

They explore the historical context and far-reaching influence of the 1990s Women’s Health Initiative (WHI) study, asserting that its misinterpretation continues to shape misconceptions and hinder effective menopause care. The discussion highlights recent data refuting the risks associated with vaginal estrogen therapies and underscores the urgent need for updated, evidence-based guidelines to support women throughout menopause. Dr. Santiago-Lastra also draws attention to gender-based inequities in hormone treatment, the robust evidence contradicting the current black box warning, and the multi-faceted advocacy required to bring about change. This episode is part of a broader series focused on various aspects of menopause.

---

TIMESTAMPS

00:00 - Introduction
02:01 - Menopause Series Overview
03:55 - History of the Black Box Warning on Estrogen
07:26 - Understanding the Black Box Warning
12:11 - The Citizen's Petition and FDA Process
18:11 - Gender Inequity in Medical Treatment
22:45 - Factors Resulting in Gender Inequity
29:02 - Genital Urinary Syndrome of Menopause (GSM)
29:32 - Benefits of Vaginal Estrogen
33:33 - Legislative Advocacy and Medicare
34:43 - Professional and Patient Advocacy
36:35 - Challenges and Progress in Label Change
43:35 - Historical Context and Gender Equity
45:07 - Recap and Future Directions

Step inside the evolving world of fetal therapy where precision, teamwork, and full-spectrum care matter most. In this episode of the BackTable OBGYN Podcast, Dr. Anthony Shanks, Vice Chair of Education in the OB department at Indiana University School of Medicine, interviews Dr. Hiba Mustafa, a distinguished maternal-fetal medicine specialist and fetal interventionalist at Riley Children's Hospital. They discuss Dr. Mustafa's expertise in fetal diagnosis and therapy, her training journey through various fellowships, and her role in directing multiple fetal medicine programs.

---

SYNPOSIS

Dr. Mustafa elaborates on the intricacies of fetal interventions, including procedures for complications in monochorionic twins, spina bifida repair, and new emerging therapies. They also touch on research methodologies like the Delphi consensus technique and summarize key findings from recent studies on conditions such as hemolytic disease, gastroschisis, lower urinary tract obstructions, and preterm birth in twin pregnancies. Dr. Mustafa shares insights on how to stay sharp in the field, the importance of teamwork in surgical procedures, and advice for those aspiring to enter the field of fetal therapy.

---

TIMESTAMPS

00:00 - Introduction
02:45 - The Role of a Fetal Interventionalist
04:00 - Dr. Mustafa’s Training Journey
07:42 - Fetal Surgery Fellowships
16:43 - Conditions Treated by Fetal Interventionalists
21:17 - Monitoring and Referrals for Monochorionic Twins
30:04 - Understanding Percutaneous Procedures
31:10 - Navigating the Equator in Fetal Surgery
32:31 - Laser Surgery Techniques and Outcomes
33:18 - The Importance of Placenta Delivery
33:47 - In Utero Spina Bifida Repair
36:19 - Minimally Invasive Techniques for Spina Bifida
38:28 - Maintaining Skills in Fetal Interventions
42:11 - Delphi Consensus Technique in Medical Research
46:19 - Key Takeaways from Recent Research
51:55 - Future of Fetal Therapy and Personal Insights

Real innovation? It’s not just the tools and techniques you use, it’s how you think. In this episode of the BackTable OBGYN podcast, hosts Dr. Mark Hoffman and Dr. Amy Park welcome Dr. Kevin Stepp, a MIGS surgeon and urogynecologist in Charlotte, North Carolina, and an OBGYN professor at Wake Forest University School of Medicine. Dr. Stepp shares his journey into the field, including his serendipitous start in single-port laparoscopy and the many surgical innovations that he has pioneered.

---

SYNPOSIS

The conversation highlights the importance of anatomical knowledge, thinking beyond conventional surgical approaches, and the significance of teamwork and efficiency in the operating room. A central focus is placed on the development and application of single-port techniques, highlighting the associated learning curves and the evolving role of robotic surgery. The discussion also explores how surgical team dynamics, effective communication, and ongoing innovation collectively contribute to better patient outcomes and advancement in the medical field.

---

TIMESTAMPS

00:00 - Introduction
03:50 - Pioneering Single Port Laparoscopy
10:10 - Challenges and Advantages of Single Port Surgery
13:52 - Cosmetic Considerations and Incision Techniques
27:27 - Innovative Approaches and Future Directions
30:40 - Understanding 3D Anatomy in GYN Surgery
32:10 - Sustaining Innovation in Urogynecology
33:53 - Efficiency in Surgical Procedures
39:20 - Advancement of Surgical Educational Materials
42:47 - Single Port and Robotic Procedures
50:50 - Building a Team through Positive Surgical Culture
01:02:13 - Continuous Improvement and Humility in Surgery

What if surgery isn’t the only answer to pelvic pain? In this episode of the BackTable podcast, host Dr. Mark Hoffman and co-host Dr. Amy Park welcome Dr. Frank Tu, Vice Chair for Quality at Endeavor Health and Director of the Division of Gynecological Pain and Minimally Invasive Surgery. The episode explores the complexity of chronic pelvic pain, emphasizing its multifactorial origins and individualized treatment approaches.
---
SYNPOSIS
Dr. Tu shares insights into the persistence and treatment of chronic pelvic pain, the role of trauma, and the evolving understanding of endometriosis and other gynecological conditions. The discussion covers patient treatment modalities, the potential of artificial intelligence in medical diagnostics, and the significant role of non-surgical interventions like physical therapy. Dr. Tu's reflections on interdisciplinary collaborations, preventative approaches, and the future directions of gynecologic pain management provide a comprehensive overview of this complex field.
---
TIMESTAMPS
00:00 - Introduction
05:21 - Mentorship and Influences
07:01 - Research and Innovations in Pelvic Pain
09:21 - Preventative Approaches to Chronic Pain
14:15 - Exploring Pain Mechanisms and Treatments
26:32 - The Role of Sensory Reintroduction
30:20 - The Importance of Mental Health
30:49 - Challenges in Treating Chronic Pelvic Pain
31:24 - The Role of Surgery and Mental Health in Pain Management
34:00 - Barriers to Effective Pelvic Floor Physical Therapy
35:40 - The Complexity of Treating Dysmenorrhea
44:11 - Exploring Personalized Medicine and AI in Pain Management
51:22 - The Future of Pain Management and AI
54:25 - The Role of Big Data and AI in Medical Research
59:25 - Final Thoughts

Equity is not just a box to check; it is the framework for lasting change. In this week's BackTable podcast, guest host Dr. Veronica Lerner speaks with Dr. Ebony Carter, a high-risk obstetrician and Division Director for Maternal-Fetal Medicine at the University of North Carolina at Chapel Hill. Dr. Carter shares insights into her career journey, which was influenced by her mother's activism in health equity, her work on reproductive health disparities, and community engagement projects.
---
SYNPOSIS
The conversation underscores the importance of patient participation and agency in clinical decision-making. Dr. Carter and Dr. Lerner also discuss the development of an equity rubric for peer-reviewed journals, highlighting the need for inclusive and intentional research practices. They explore practical applications of the rubric, including the proper acknowledgment of contributors to foundational concepts. The episode further delves into Dr. Carter’s mentorship initiatives at the Green Journal and her guiding philosophy of pursuing impactful, community-driven work rooted in passion and purpose.
---
TIMESTAMPS
00:00 - Introduction
02:06 - Dr. Carter's Journey and Inspiration
05:19 - Community Engagement and Health Equity
06:19 - Patient Advocacy and Shared Decision Making
08:54 - Collaborative Research and Community Partnerships
16:58 - Addressing Bias in Medical Practice
22:12 - Equity in Academic Publishing
28:26 - Diversifying the Peer Review Pool
30:33 - Creating and Implementing the Equity Rubric
31:17 - The Impact and Application of the Equity Rubric
33:31 - Personal Reflections on Equity and Research
35:25 - Citing Foundational Work
38:48 - Mentorship and Training Future Leaders
47:05 - Career Transitions and Future Goals
52:36 - Final Thoughts and Advice for Aspiring Professionals
---
RESOURCES
Full Equity Rubric:
https://journals.lww.com/greenjournal/Documents/OnG_Equity_Rubric_1.pdf ​
Equity Rubric Introduction Video:
https://youtu.be/Jh5_L-pYkuE?si=JREjSSCr98jqjVVB
Equity Rubric Introduction Video Slide Deck:
https://journals.lww.com/greenjournal/Documents/Green%20Journal%20Equity%20Rubric%20YouTube_final_2022_01_16%20(Slides).pdf

Curious how cross-specialty teamwork is reshaping endometriosis care? In this episode of BackTable OBGYN, host Dr. Mark Hoffman speaks with Dr. Peter Movilla, Associate Medical Director at Newton Wellesley Hospital, and Dr. Anuradha Shenoy-Bhangle, Assistant Professor of Radiology at Harvard Medical School, about their collaborative efforts in advancing endometriosis care.

---

SYNPOSIS

The discussion covers the development and benefits of monthly multidisciplinary conferences that include gynecologists, radiologists, colorectal, urologic, and thoracic surgeons. The conferences aim to improve preoperative planning, intraoperative accuracy, and postoperative care through detailed imaging techniques, primarily MRI. They also highlight the importance of educating fellows and colleagues, the role of ultrasound screening, and future directions like AI and PET imaging. The episode emphasizes the challenges and rewards of treating endometriosis and fostering better patient outcomes through teamwork and innovation.

---

TIMESTAMPS

00:00 - Introduction

01:55 - The Journey to Specialization

07:02 - Building a Multidisciplinary Team

15:07 - The Value of Postoperative Reviews

22:49 - Patient Counseling and Personalized Care

29:36 - Challenges in Endometriosis Treatment

31:00 - Educating Beyond the Clinic

33:05 - Innovations in Imaging

46:22 - Future Directions in Endometriosis Research

53:15 - Conference Highlights and Final Thoughts

---

RESOURCES

Recommendations for MRI technique in the evaluation of pelvic

endometriosis: consensus statement from the Society of Abdominal

Radiology endometriosis disease‑focused panel:

https://drive.google.com/file/d/1VRBpw5V3AH-rWGEG43K1CMCx2flCXl2M/view?usp=sharing

When should you consider surgical management of chronic pelvic pain conditions? In this episode of the BackTable OBGYN podcast, Dr. Mark Dassel, a MIGS surgeon at Intermountain Health in Salt Lake City, joins hosts Dr. Mark Hoffman and Dr. Amy Park to discuss medical and surgical management strategies for chronic pelvic pain, particularly endometriosis.

---

SYNPOSIS

Dr. Dassel emphasizes the importance of stopping the hormonal triggers associated with pain and explores various medical treatments, including hormonal therapies and the role of contraceptives. He also highlights his approach to surgical interventions such as endometriosis excision, endometrioma removal, and hysterectomy, and the importance of holistic treatment plans involving pelvic floor physical therapy and central pain modulators. The episode also covers the complexities of diagnosing and treating pelvic pain, the role of early intervention, and the value of multidisciplinary care.

---

TIMESTAMPS

00:00 - Introduction

07:55 - Differentiating Causes of Chronic Pelvic Pain

10:13 - Multidisciplinary Care and Costs

14:26 - Acute vs Chronic Pain

17:00 - Centralized Pain

18:46 - When to Offer Surgery

23:42 - Fertility and Endometriosis

33:25 - Hormonal Suppression Post-Surgery

37:24 - Pelvic Floor Botox and Physical Therapy

44:42 - Hysterectomy for Pelvic Pain

51:53 - Nerve Ablation and Pain Management

57:10 - Final Thoughts

Endometrial ablation has become a cornerstone procedure in the treatment of abnormal uterine bleeding, but is it the right solution for every patient that meets the indication? In this episode of the BackTable OBGYN Podcast, Dr. Ted Anderson from Vanderbilt University joins host Dr. Mark Hoffman to discuss the evolution of endometrial ablation and its contemporary utilization, including patient selection, technical considerations, and alternative treatments for abnormal uterine bleeding.

---

SYNPOSIS

Dr. Anderson begins by detailing the history of abnormal uterine bleeding alongside the evolution of the endometrial ablation techniques that have been used to treat it. Shifting focus to current day practice, he then shares his approach to endometrial ablation, covering patient selection and the technical aspects of his approach.

Throughout the conversation, Dr. Anderson emphasizes the importance of how we define success in endometrial ablation, explaining that eumenorrhea (normal bleeding that no longer interferes with life events) is the goal, as opposed to the more traditional view that amenorrhea is the target outcome. The episode closes with a discussion on the role of alternative treatments, such as the Mirena IUD and hysterectomy for abnormal uterine bleeding.

---

TIMESTAMPS

00:00 - Introduction

09:29 - History of Abnormal Uterine Bleeding and Endometrial Ablation

23:31 - Evolution of Endometrial Ablation Devices/Techniques

31:11 - Selecting the Right Patient for Ablation Success

34:38 - Post-Tubal Sterilization Ablation Syndrome

38:27 - The Role of IUDs in Managing AUB

44:07 - Reevaluating Endometrial Ablation Success Metrics

49:55 - Innovative Ablation Techniques: Cryoablation and Steam

51:48 - Adenomyosis and Fertility-Sparing Treatments

57:28 - Final Thoughts

What surgical techniques and safety measures are important to consider when operating in a pregnant patient? In this episode of the BackTable OBGYN podcast, Dr. Craig Sobolewski, a minimally invasive GYN surgeon at Duke, speaks with host Dr. Mark Hoffman about the intricacies of laparoscopic surgery in pregnant patients.

---

SYNPOSIS

The surgeons delve into the critical importance of understanding anatomy and ensuring proper exposure during surgeries, particularly the challenges and techniques for operating during pregnancy. Key discussions include the use of liver retractors, the management of symptomatic ovarian cysts, and the methods for performing and evaluating abdominal cerclages. They also explore the physiological changes in pregnant patients and the adjustments needed for anesthesia, laparoscopic entry, pressures during surgery, and pre/post-operative care.

---

TIMESTAMPS

00:00 - Introduction

07:20 - Laparoscopy in Pregnant Patients

11:23 - Common Surgeries During Pregnancy

15:56 - Laparoscopic Surgery Techniques

24:04 - Physiologic Changes in Pregnancy

27:33 - Access Methods and Pressure Considerations

28:53 - Managing Torsion and Cysts in Pregnancy

30:21 - Energy Use and Safety in Pregnant Patients

31:38 - Preoperative and Postoperative Care

34:15 - Cerclage Procedures and Counseling

47:46 - Professional Reflections and Conclusions

How does gynecology care in the United States compare to Canada? In this episode of the BackTable OBGYN podcast, Dr. Jonathon Solnik, head of gynecology and minimally invasive surgery at Mount Sinai in Toronto, speaks with hosts Dr. Mark Hoffman and Dr. Amy Park about the significant differences between the healthcare systems in the US and Canada.

---

SYNPOSIS

The doctors cover financial incentives and constraints faced by hospitals in the US vs. Canada, the role of insurance companies, and how resource limitations impact clinical practice. Dr. Solnik shares insights from his career journey, emphasizing the challenges and opportunities he has encountered in Canada, including longer wait times for elective surgeries and the intricacies of the Canadian global budget system. The conversation also covers the impact of robotics in surgery, standardization of care, and the differences in the handling of high-acuity medical cases. The episode provides an insightful discussion on how different healthcare models affect patient care, physician practices, and hospital administration.

---

TIMESTAMPS

00:00 - Introduction

01:39 - Dr. Solnik’s Career Journey

03:30 - Healthcare System Differences: US vs Canada

09:57 - Balancing Quality and Volume in Healthcare

12:18 - Private Practice in Canada

25:03 - Wait Times and Capacity Issues

34:44 - Oncology and Semi-Salaried Positions

39:03 - Negotiating CPT Codes and RVUs

42:14 - Access to Care in Remote Areas

44:42 - Robotics in Surgery

55:09 - Incentives and Productivity in Healthcare Systems

01:01:33 - Concluding Thoughts