BackTable Women's Health

Proper pain management after surgery is essential to promote healing and improve patient satisfaction. In this BackTable OBGYN Brief, Dr. Steven McCarus and Dr. Paula Bilica discuss how to advocate for non-opioid analgesia following OBGYN surgery.

The discussion focuses on the importance of reducing opioid use in women's health through various strategies, including the use of Exparel and ERAS protocols. Dr. McCarus and Dr. Bilica share compelling arguments for covering costs and enhancing patient satisfaction, and also touch on hospital administration's role in adopting non-opioid analgesics. The doctors emphasize the need for a team approach and the presence of a dedicated champion to advocate for better pain management practices in women's health.

TIMESTAMPS

00:00 - Introduction

00:44 - Advocating for Better Pain Management

02:09 - Opioid Use and Women's Health

04:45 - Benefits and Safety of Exparel

07:03 - Team Approach to Pain Management

08:12 - ERAS Protocols and Exparel

12:45 - Getting Healthcare Administration Buy-In

CHECK OUT THE FULL EPISODE

OBGYN Ep. 67: https://www.backtable.com/shows/obgyn/podcasts/67/non-opiod-pain-management-in-gyn-surgery

Curious about how to leave your mark as a mentor and leader in the field of OBGYN? In this episode of the BackTable OBGYN Podcast, Dr. Starr Hampton, a professor of OBGYN and Senior Associate Dean for Medical Education at Warren Alpert Medical School at Brown University, discusses her journey from a newly appointed faculty member to a leader in medical education.

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SYNPOSIS

Dr. Hampton emphasizes the importance of kindness, mentorship, and taking opportunities when offered new roles. The conversation covers topics such as transitioning from medical school to residency to practice, fostering a supportive educational environment, and international health work. Dr. Hampton shares valuable insights on creating a culture of psychological safety and the significance of giving corrective yet supportive feedback to trainees.

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TIMESTAMPS

00:00 - Introduction

02:43 - Early Career and First Leadership Roles

12:09 - Navigating National Organizations

24:15 - Mentorship and Sponsorship

28:34 - The Value of Kindness and Psychological Safety

32:14 - Changing Culture

33:48 - Balancing Wellness and Professional Life

39:57 - Advice for Seeking out Mentorship and Positive Experiences

45:21 - Naming Your Work

50:09 - Transitioning to New Jobs/Roles

56:06 - Global Health Initiatives and Personal Growth

01:01:17 Conclusion and Future Topics

Operating on the pregnant patient can be intimidating, but there are many ways to do so safely. In this episode of the BackTable OBGYN podcast Dr. Jamal Mourad, a MIG surgeon at Mayo Clinic, joins hosts Dr. Mark Hoffman and Dr. Amy Park to discuss the nuances of robotic surgery, particularly in the pregnant patient.

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SYNPOSIS

Dr. Mourad shares his extensive experience with robotic platforms and his techniques for addressing complex cases such as transabdominal cerclage in pregnant patients and the management of endometriosis and uterine niche. The conversation covers best practices, the importance of continuous learning through observations and video analysis, and practical tips for improving surgical outcomes. The episode also emphasizes the importance of interdisciplinary collaboration and mentorship in advancing surgical skills and patient care.

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TIMESTAMPS

00:00 - Introduction

04:05 - Single Port vs. Multi-Port Approach

06:08 - Robotic Surgery on Pregnant Patients

08:20 - Anesthesia During Pregnancy

10:39 - Transabdominal Cerclage Techniques

19:27 - Techniques for C-section Scar Ectopic Pregnancy

23:45 - Surgical Considerations in the Pregnant Patient

28:37 - Diagnosing and Treating Ovarian Torsion

32:20 - Managing Placenta Accreta Spectrum

35:29 - Innovations in Robotic Surgery

39:26 - Mentorship and Continuous Learning

54:50 - Concluding Thoughts and Advice for Early Learners

Postoperative pain control is an essential aspect of patient recovery and satisfaction. While pain management is important in all surgical settings, C-sections, hysterectomies, and myomectomies are particularly frequent, accentuating the need for reliable non-opioid alternatives in OBGYN. Dr. Steven McCarus and Dr. Paula Bilica discuss the efficacy of multimodal pain control options in gynecologic and obstetric surgeries, including Exparel, a non-opioid liposomal bupivacaine.

The doctors highlight the opioid epidemic and the need for alternative pain relief methods. They share insights on how the introduction of Exparel has transformed their practices by reducing the reliance on opioids, enhancing patient recovery post-surgery, and improving overall patient outcomes. Specific techniques and procedures for using Exparel in various types of surgeries such as C-sections, hysterectomies, and myomectomies are detailed, along with the benefits observed in clinical practices.

TIMESTAMPS

00:00 - Introduction

00:42 - The Opioid Epidemic and Pain Management

02:46 - The Role of Exparel in Pain Management

04:53 - Multimodal Pain Control

06:12 - Techniques for Using Exparel

10:08 - Patient Outcomes and Benefits

CHECK OUT THE FULL EPISODE

OBGYN Ep. 67: https://www.backtable.com/shows/obgyn/podcasts/67/non-opiod-pain-management-in-gyn-surgery

Peer review can be a daunting process as a physician, but there are ways to focus the process on constructive feedback and quality improvement rather than criticism and punishment. In this episode of the BackTable OBGYN Podcast, host Dr. Amy Park welcomes urogynecologist Dr. Maggie Mueller to discuss how we can improve the peer review process in the field of obstetrics and gynecology.

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SYNPOSIS

Dr. Mueller delves into her personal involvement in peer review, the challenges faced by providers, and the importance of these processes. Key topics include shifting from a punitive to a quality improvement focus, best practices for peer review committees, the integration of human and system factors, the role of multidisciplinary teams, and transparency. The conversation also highlights the ethical considerations and the impact of peer review on provider well-being, emphasizing the need for structured support systems. Dr. Mueller shares insights into the future trends in peer review, advocating for higher physician involvement and leadership in creating more effective and transparent processes.

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TIMESTAMPS

00:00 - Introduction

02:21 - Diving into Peer Review

04:14 - The Peer Review Process Explained

07:07 - Challenges and Improvements in Peer Review

13:14 - Changing the Culture Around Peer Review

21:14 - Moving Away from a Punitive Mindset

25:12 - Education to Become a Reviewer

31:39 - Legal Considerations

32:42 - Ethical Considerations

38:31 - Future Trends in Peer Review

41:20 - Closing Remarks

Human trafficking is a complex health issue, with many providers unsure how best to detect, counsel, and care for victims and survivors of human trafficking. In this episode of the BackTable OBGYN Podcast, hosts Dr. Amy Park and Dr. Mark Hoffman are joined by Dr. Julia Geynisman-Tan, a urogynecologist at Northwestern, to discuss signs of human trafficking and resources for caring for this patient population.

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SYNPOSIS

Dr. Geynisman-Tan shares her extensive experience in caring for survivors of human trafficking and discusses the complexities surrounding this issue. She emphasizes the importance of trauma-informed care, recognizing signs of trafficking, and providing support to survivors. The conversation covers her journey into this field, the challenges faced by survivors, and practical steps that healthcare professionals can take to aid these vulnerable patients. The episode underscores the need for multidisciplinary approaches and the critical role of healthcare providers in identifying and assisting those affected by human trafficking.

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TIMESTAMPS

00:00 - Introduction

05:08 - Identifying Signs of Human Trafficking in Patients

09:14 - Referral and Support Systems for Trafficking Survivors

11:31 - Common Health Issues Among Trafficking Survivors

13:17 - Understanding the Complexities of ‘The Life’

18:13 - Immigration and Human Trafficking

20:48 - Providing Trauma-Informed Care

25:55 - Identifying Resources for Victims

29:23 - Healthcare Protocols

32:50 - Addressing Needs and Building Trust

36:58 - Psychosomatic Effects of Trauma

40:50 - Impact on Pregnancy

42:55 - Supporting Survivors and Long-Term Rehabilitation

48:30 - Conclusions

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RESOURCES

Human Trafficking Hotline:

https://humantraffickinghotline.org/en

HEAL Trafficking:

https://healtrafficking.org/

Surgical approaches to endometriosis continue to move towards greater levels of precision and efficacy as we learn more about the intricacies of this complex condition. Still, endometriosis continues to challenge gynecologic surgeons worldwide. How has endometriosis surgery evolved, and how can we apply what we’ve learned to continue to improve patient outcomes? In this episode of BackTable OBGYN, Dr. Tommaso Falcone, a renowned surgeon and expert in reproductive endocrinology and fertility, discusses the past, present, and future of endometriosis surgery.

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SYNPOSIS

Dr. Falcone shares his journey from McGill University to his current roles at the Cleveland Clinic, offering insights into advancements in minimally invasive surgery, the role of teamwork in medical innovation, and the complexities of treating endometriosis. The episode covers the evolution of surgical techniques, postoperative care, and fertility strategies, emphasizing the importance of managing patient expectations and the future directions for research and treatment.

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TIMESTAMPS

00:00 - Introduction

02:09 - Dr. Falcone’s Journey and Career

08:09 - Evolution of REI and MIGS

13:35 - Innovations in Endometriosis Treatment

20: 45 - Excision vs Ablation

25:30 - Challenges and Future Directions in Endometriosis Research

32:39 - Understanding the Placebo Effect in Chronic Pain

34:18 - Exploring Fibrosis in Endometriosis

35:31 - Challenges in Diagnosing and Treating Endometriosis

40:57 - Innovations in Surgical Techniques

53:56 - Managing Patient Expectations and Complications

56:06 - Concluding Thoughts

Endometriosis is a very difficult disease to diagnose and manage, but effective imaging can make all of the difference. In this episode of the BackTable OBGYN podcast, Mayo Clinic radiologist Dr. Wendaline VanBuren and gynecologist Dr. Tatnai Burnett discuss the complexities of diagnosing, imaging, and surgically treating endometriosis.

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SYNPOSIS

The doctors delve into the importance of advanced imaging techniques such as MRI and dedicated protocols, the critical need for a multidisciplinary approach with radiologists and GYN surgeons, and the future potential of imaging in improving endometriosis diagnosis, treatment, and surgical planning. The discussion also covers the upcoming International Endometriosis Imaging Congress aimed at advancing standardized care and collaboration in the field.

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TIMESTAMPS

00:00 - Introduction

05:15 - Dr. VanBuren’s Journey to Endometriosis Imaging

08:24 - Dr. Burnett’s Surgical Training and Insights

11:57 - Challenges in Diagnosing and Understanding the Pathophysiology of Endometriosis

13:24 - The Role of Imaging in Surgical Planning

25:51 - Imaging Follow-Up, Monitoring for Malignant Transformation

32:03 - Protocol for MRI Imaging of Endometriosis

34:47 - The Role of Radiologists in Endometriosis

36:12 - The Complexity of Bowel Endometriosis

48:02 - The Future of Endometriosis Imaging

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RESOURCES

International Endometriosis Imaging Congress-March 8-9, 2025

https://eice.ltd/international-endometriosis-imaging-congress/

Stay up to date on the latest advancements in gynecologic surgery. In this episode of the BackTable OBGYN Podcast, hosts Dr. Amy Park and Dr. Mark Hoffman invite Dr. Johnny Yi, a pioneer in the field of minimally invasive surgery and urogynecology, to discuss the latest advancements in, benefits of, and challenges with single port robotic gynecologic surgery.

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SYNPOSIS

The discussion covers evolutionary strides in robotic-assisted surgeries such as sacral colpopexy and myomectomies, the transition from traditional laparoscopy, and the intricacies of handling large uteri procedures. The episode also navigates the global adoption of these technologies, particularly in South Korea and Japan, and the varying applications in different specialties. Key topics include surgical skill requirements, training needs, innovative techniques, FDA approvals, and the future potential of single port surgeries. Overall, this discussion provides a well-rounded perspective on the current state and forward-looking innovations in the field of gynecologic surgery.

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TIMESTAMPS

00:00 - Introduction

03:57 - Single Port Robotic Surgery

08:27 - Benefits of Robotics with Sacral Colpopexy

11:37 - Technical Aspects of Single Port Surgery

14:40 - Training for Single Port Surgery

19:43 - Global Adoption and Future Potential of Single Port Surgery

25:35 - Access into the Abdomen

29:39 - Challenges and Innovations in Single Port Surgery

31:34 - Evaluating Risks and Success Rates

33:16 - Cost Analysis

35:16 - Training and Simulation for Single Port Surgery

39:35 - Future of Single Port and vNOTES Surgery

45:05 - Patient Reactions and Satisfaction

46:34 - Closing Techniques

52:14 - Future Prospects and Final Thoughts

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RESOURCES

Oh S, Yi J, Song AY, Jee J, Bae N, Shin JH. Intraoperative Complications and Perioperative and Surgical Outcomes of Single-Port Robotics-Assisted Sacrocolpopexy. Int Urogynecol J. 2024 Jul; 35 (7):1521-1526 Epub 2024 June 20.

How can we address barriers to care for women with genitourinary syndrome of menopause? In this episode, host Dr. Suzette Sutherland and Dr. Rachel Rubin discuss the challenges and misconceptions around Genitourinary Syndrome of Menopause (GSM).

They identify the severity of symptoms such as pain, urinary issues, and recurrent infections that are often inadequately addressed. Dr. Rubin advocates for the use of vaginal estrogen, emphasizing that its benefits outweigh any perceived risks, contrasting it with other treatments like tamoxifen. The discussion includes the efforts to create guidelines for GSM through the American Urological Association (AUA) to standardize care, and the use of systemic and localized hormonal therapies, particularly in cancer patients. The session highlights the importance of updated medical practices and shared decision-making in treating GSM and related conditions.

TIMESTAMPS

00:00 - Understanding Genitourinary Syndrome of Menopause (GSM)

01:33 - Challenges, Misconceptions, and Advocacy

02:31 - Developing GSM Guidelines

04:34 - Hormonal Replacement Therapy and GSM

05:46 - Vaginal Rings

06:59 - Cancer Survivors and Vaginal Estrogen

09:17 - Shared Decision Making

CHECK OUT THE FULL EPISODE

OBGYN Ep. 33 - Genitourinary Syndrome of Menopause (GSM): Improving a DRY Topic

https://www.backtable.com/shows/obgyn/podcasts/33/genitourinary-syndrome-of-menopause-gsm-improving-a-dry-topic