BackTable Women's Health

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.

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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.

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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.

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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.

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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.

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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.

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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

How can we streamline the proper diagnosis and treatment of female urinary incontinence? The solution often lies in bridging comprehensive patient workup to pelvic floor physical therapy. Learn more in this BackTable OBGYN brief with Dr. Sarah Boyles and host Dr. Suzette Sutherland! 

Key topics include what to look for during a pelvic exam, the importance of external skin inspection, prolapse evaluation, urethra assessment, and pelvic floor muscle strength testing. The doctors also address effective treatment options, the necessity (or lack thereof) of specific diagnostic tests, the significant role of bladder diaries, and the benefits of pelvic floor physical therapy. Practical advice for behavioral management, therapy for stress and urgency incontinence, and the reasons for structured evaluation methodologies are also highlighted.

TIMESTAMPS

00:00 - Introduction

00:30 - Conducting a Thorough Pelvic Exam

02:45 - Evaluating Pelvic Floor Muscle Strength

04:28 - Initial Diagnostic Workup

06:07 - The Role of Bladder Diaries

09:49 - Treatment Algorithms for Urinary Incontinence

15:03 - Conclusion

CHECK OUT THE FULL EPISODE

OBGYN Ep. 61: Evaluating Female Urinary Incontinence: Essential Steps for the Generalist

https://www.backtable.com/shows/obgyn/podcasts/61/evaluating-female-urinary-incontinence-essential-steps-for-the-generalist

Urinary incontinence can greatly impact our patients’ quality of life. It’s essential to recognize the different types and treat them appropriately. In this BackTable OBGYN Brief, Dr. Sarah Boyles and Dr. Suzette Sutherland provide an overview of female urinary incontinence for their general practice and specialized physician colleagues.

The conversation dives into the different types of incontinence, including stress, urgency, mixed, and overflow incontinence, and the importance of accurate diagnosis and appropriate treatment plans. The discussion also emphasizes essential diagnostic steps, including urinalysis and measuring post-void residuals, and points out the importance of patient education and expectation management.

TIMESTAMPS

00:00 - Introduction

00:30 - Prevalence of Female Urinary Incontinence

01:25 - Impact on Quality of Life

03:01 - Types of Urinary Incontinence

07:35 - Diagnostic Approaches

CHECK OUT THE FULL EPISODE

OBGYN Ep. 61: Evaluating Female Urinary Incontinence: Essential Steps for the Generalist

https://www.backtable.com/shows/obgyn/podcasts/61/evaluating-female-urinary-incontinence-essential-steps-for-the-generalist

What skills and disciplines can a surgeon take from their training to succeed in a new leadership / hospital administration role? In this episode of BackTable OBGYN, Dr. Mark Hoffman discusses his transition from a minimally invasive gynecologic surgeon to the Chief Medical Officer at his hospital with co-host Dr. Amy Park.

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SYNPOSIS

The doctors cover the importance of high-functioning teams, the unexpected challenges of hospital administration, and the impact of clinical experience on decision-making. Additionally, they explore the broader responsibilities and skill sets required for effective leadership in a hospital setting, and offer advice for others considering a similar career shift. Dr. Hoffman emphasizes the value of servant leadership, the benefits of focusing on strengths, and the necessity of building strong, resilient teams.

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TIMESTAMPS

00:00 - Introduction

05:16 - Transitioning to Hospital Administration

07:17 - Balancing Workload

10:33 - Teamwork and Leaning into Strengths

13:30 - Decision Making in Administration

26:20 - Unique Challenges for OBGYNs in Hospital Administration

31:48 - Engagement in Leadership

35:03 - Focusing on People to Improve Patient Care

44:18 - Building Effective Leadership Teams

45:25 - Transitioning to Hospital Administration

52:07 - Finding Joy in Leadership and Mentorship

There are many challenges when it comes to operating on a post-hysterectomy patient, especially when they have endometriosis. In this episode of BackTable OBGYN, Dr. Emad Mikhail, an associate professor of OBGYN at the University of South Florida, discusses the intricacies of treating endometriosis after a hysterectomy.

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SYNPOSIS

Dr. Mikhail shares his journey from medical school in Egypt to his current expertise in deep endometriosis surgery in Tampa, Florida. The conversation covers preoperative evaluation, the importance of understanding patient history, and surgical approaches for complex cases. He emphasizes the need for multidisciplinary collaboration, advanced imaging, and specialized surgical techniques to ensure optimal patient outcomes.

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TIMESTAMPS

00:00 - Introduction

05:52 - The Role of Hysterectomy in Endometriosis

08:58 - The Role of Ovaries in Endometriosis

11:12 - Surgical Techniques and Considerations

18:11 - Evaluating Deep Endometriosis

24:32 - Post-Hysterectomy Pain and Symptoms

31:26 - Surgical Approaches Post-Hysterectomy

39:49 - The Importance of Continuous Learning

43:09 - Scar Tissue vs. Lesion

51:47 - Comprehensive Preoperative Assessment

53:59 - Conclusion and Final Thoughts

There are tangible ways to advocate for health equity and address demographic disparities in patient care and the healthcare workforce. In this episode of the BackTable OBGYN Podcast, Dr. Teni Brown, an assistant professor of OBGYN at Northwestern University's Feinberg School of Medicine, speaks with hosts Dr. Amy Park and Dr. Mark Hoffman about DEI efforts and ways she has made real change.

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SYNPOSIS

Dr. Brown shares her journey from Nigeria to the United States, detailing her path from middle school teacher to a leading advocate in diversity, equity, and inclusion (DEI) within the medical field. The conversation touches on systemic barriers in healthcare, the impact of historical practices like redlining, and practical steps institutions can take to foster a culture of equity. Dr. Brown emphasizes the importance of sustained engagement, multi-level interventions, and action-oriented solutions to create a more diverse and inclusive medical workforce.

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TIMESTAMPS

00:00 - Introduction

05:44 - Equity in OBGYN: Workforce and Patient Care

08:41 - Advocacy for Medication Access

15:25 - Systemic Barriers and Social Determinants of Health

20:22 - Understanding Redlining and Its Impact

25:10 - Efforts to Address Inequities

34:14 - Equity and Diversity in Healthcare

36:39 - The Role of Leadership in Promoting Equity

44:08 - AI and Technology in Addressing Gaps

50:00 - Vision for a More Equitable Future

58:26 - Final Thoughts and Encouragement

OBGYN Briefs - Bridging the Orgasm Gap

Female sexual wellness is a topic that deserves more research, education, and attention, both for our patients and for providers. In this BackTable OBGYN Brief, Dr. Kelly Casperson speaks with host Dr. Suzette Sutherland about a range of issues related to women's sexual health.

The conversation highlights the disparities between men's and women's sexual health resources and focuses on the gaps in sex education, communication, and healthcare training. Dr. Casperson emphasizes the biological, psychological, and social aspects of female sexual dysfunction and draws attention to the lack of adequate research and resources for women. The episode explores the importance of understanding the clitoris, the biases in sexual pleasure, and the role of informed consent in surgical procedures affecting sexual function. These insights aim to destigmatize female sexual health issues and promote better awareness and education.

TIMESTAMPS

00:00 - Introduction

00:24 - Challenges in Women's Sexual Health

01:01 - Sex Education, Communication Gaps, and Bias

02:29 - Prevalence and Misconceptions

03:23 - Education about Clitoral Stimulation

03:59 - Impact of Medications and Relationships

07:16 - Orgasm Gap and Pleasure Inequality

09:23 - Understanding the G-Spot and Clitoral Anatomy

10:35 - Sling Surgery and Sexual Function

CHECK OUT THE FULL EPISODE

OBGYN Ep. 44: https://www.backtable.com/shows/obgyn/podcasts/44/urologys-role-in-advancing-female-sexual-health