Cold Steel: Canadian Journal of Surgery Podcast

Dr. Jonathan Meakins is former Chair of the Department of Surgery at McGill and is an Officer of the Order of Canada for his outstanding work in immunobiology, laparoscopic surgery, and transplantation. Among his many interests is his love of art, and at the age of 73 Dr. Meakins has gone back to school to obtain his Masters in Fine Arts.

Check out the links to see some of the fascinating work Dr. Meakins has done to demonstrate how the critical viewing of art can perhaps make us better clinicians. 

Links:

1. Wide-ranging textbook of surgical research. https://www.thelancet.com/journals/lancet/article/PIIS0140673610614717/fulltext?rss=yes

2. Surgical Infection in Art. https://jamanetwork.com/journals/jamasurgery/article-abstract/596694

3. Reflective of the physician’s eye. https://www.cmaj.ca/content/cmaj/183/10/1176.full.pdf

4. Renowned surgeon Jonathan Meakins goes for master’s in art history. http://www.theseniortimes.com/renowned-surgeon-jonathan-meakins-goes-for-masters-in-art-history/

5. Art at the McGill University Health Centre. https://www.cmaj.ca/content/190/49/E1457

Bio (from https://muhc.ca/news-and-patient-stories/news/dr-jonathan-l-meakins-inducted-canadian-medical-hall-fame#:~:text=For%20his%20contributions%2C%20he%20was,of%20the%20McGill%20University%2C%20Dr.):

Dr. Jonathan L. Meakins is an expert in immunobiology and surgical infections. Former Chair of the Department of Surgery at McGill University (1989-1993, 1998-2002) and former Surgeon-in-Chief of the Royal Victoria Hospital (1988-1998), he has safely and effectively advanced surgical technologies and demonstrated a relationship between compromised immune responses and poor surgical outcomes, leading to significant improvements in clinical assessments and nutritional supports for surgical patients.

Over the course of his career, he has published over 225 articles and edited or co-edited 6 books. He was co-editor of the Canadian Journal of Surgery for 10 years. For his contributions, he was named an Officer of the Order of Canada, as a leader in the development of laparoscopic surgery and transplantation surgery in 2000.

Third generation of his family to work in the field of medicine for the Faculty of Medicine of the McGill University, Dr. Meakins now oversees the Jonathan Campbell Meakins and Family Memorial Scholarship program, originally established by his father, Dr. Jonathan Fayette Meakins. This is a scholarship that recognizes excellence in medical education.

An art-loving doctor, Dr. Meakins has worked for many years to develop the arts within the MUHC. He plays an active role in the MUHC's Arts and Heritage Centre as Director, helping to bring the arts into clinical settings. He believes that art within the institution helps to humanize the sometimes sterile hospital environment and can have an impact on patients and their families.

Dr. Pat Sylla (https://twitter.com/patsyllamd?s=20&t=_w5QG96wjQE-0ttVJJaUmw) is a minimally invasive and colorectal surgeon at Mount Sinai Hospital in New York. She is a world famous innovator and was the first surgeon in the world to perform a transanal total mesorectal excision for rectal cancer. We caught up with her in-person (!) at the recent Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) annual meeting. Shout out to SAGES for putting on a great conference! 

Links:

1. Pat Sylla talk on Truths, Half-Truths, Fake News about taTME https://www.youtube.com/watch?v=ahWOaKa5WeQ

2. Sylla P, Rattner DW, Delgado S et al.  NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 2010;24:1205–10. https://pubmed.ncbi.nlm.nih.gov/20186432/

3. Urethral Injury and Other Urologic Injuries During Transanal Total Mesorectal Excision: An International Collaborative Study. https://pubmed.ncbi.nlm.nih.gov/31567502/

4. Consensus on structured training curriculum for transanal total mesorectal excision (TaTME). https://pubmed.ncbi.nlm.nih.gov/28462478/

5. SAGES 2022 Presidential Address with Dr. Liane Feldman: https://vimeo.com/showcase/9362041/video/689727749

6. SAGES 2022 Gerald Mark Lecture by KMarie King: https://vimeo.com/showcase/9362041/video/689071108

7. SAGES 2022 General Session on Worldwide Variation in TME. Dr. Sylla is one of the panelists: https://vimeo.com/showcase/9362041/video/689468095

Bio (from https://www.mountsinai.org/profiles/patricia-sylla)

Dr. Sylla has been a leader in developing minimally invasive approaches to the surgical treatment of colon and rectal cancer. She joins Mount Sinai from Massachusetts General Hospital, where she practiced for seven years within the Division of General and Gastrointestinal Surgery and was an Assistant Professor of Surgery at Harvard Medical School. While there, Dr. Sylla developed a research and clinical program using Natural Orifice Translumenal Endoscopic Surgery (NOTES). NOTES represents an innovative approach to transanal surgery, which may allow for faster recovery and fewer operative complications. In 2009, Dr. Sylla performed the first-ever rectal cancer surgery on a human using this approach. She has since extended this in a pilot study and is helping train surgeons in this technique. Dr. Sylla’s clinical interests include laparoscopic and robotic surgery for colon and rectal cancer, diverticulitis, rectal prolapse, ulcerative colitis and Crohn’s disease, transanal endoscopic microsurgery (TEM), and treatment of benign anorectal disorders.
Dr. Sylla received a Bachelor of Science degree Cum Laude in Biology from Georgetown University. She earned a Doctor of Medicine from Weill Cornell Medical College. Dr. Sylla completed residency training in Surgery at Columbia University Medical Center. Subsequently, she completed two fellowship training programs; Colon & Rectal Surgery at The Mount Sinai Hospital and Minimally Invasive Surgery at Massachusetts General Hospital.

Furthermore, Dr. Sylla has is highly trained and experienced in treating rectal prolapse and performing transanal endoscopic surgery.

Dr. Eric Pauli is a surgical endoscopist at Penn State. He has a very varied and novel practice, including abdominal wall reconstruction, endoscopy and general surgery. We had a great talk with him about surgical endoscopy and his work on endoscopic management of anastomotic leaks.

This is also our very first video version of the podcast! Check it out on the CJS YouTube page: https://www.youtube.com/watch?v=SoA36iqiB-4

Links:

1. Endoscopic Management of Postoperative Complications. https://www.sciencedirect.com/science/article/pii/S0039610920301031?via%3Dihub

2. Endoscopic management of colovesical and colovaginal fistulas with over-the-scope clips: A single-institution case series.https://pubmed.ncbi.nlm.nih.gov/34762356/

3. A Handy Tool to Teach Segmental Liver Anatomy to Surgical Trainees. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061562/

Bio:

Dr. Elizabeth Clement (https://twitter.com/LizClementMD?s=20&t=l43U6ZXhsJgw39faiXIpQQ), colorectal surgery fellow at St. Paul's Hospital in Vancouver, put together a fantastic set of mock oral exams. These were delivered at the Alberta Association of General Surgeons (AAGS) annual meeting in Banff in November 2021.  We were grateful to be able to use some of the recordings to share with you some more mock orals.

Thanks again to the brave residents who allowed us to use their recordings!

Links:

1. AAGS website: https://www.aags.ca/

2. Tony Maclean's tips on examsmanship: https://soundcloud.com/cjs-podcast/e10-tony-maclean-on-examsmanship

This week we were joined by Dr. Bill Kent, a cardiac surgeon at the University of Calgary, to talk about minimally invasive techniques in cardiac surgery. We were curious to learn from him where MIS techniques fit in an era of rapid evolution in cardiac surgery and particularly with the advent of new catheter based techniques. Dr. Kent had a number of important insights into the introduction of new technologies in surgery and the challenges associated with trying something new.

Links:

1. Minimally invasive cardiac surgery and the importance of qualitative patient-centered metrics to guide innovations. https://www.sciencedirect.com/science/article/pii/S0022522319304507?via%3Dihub

Bio:

Dr. William Kent is a cardiac surgeon whose practice focuses on valve surgery and mechanical circulatory support. A Fellow of the Royal College of Surgeons of Canada and a member of the International Society for Minimally Invasive Cardiothoracic Surgery, the Society of Thoracic Surgeons, the Canadian Society of Cardiac Surgeons and the American College of Surgeons, Dr. Kent is particularly interested in minimally invasive mitral valve repair and aortic valve surgery, including aortic valve and root repair as well as the Ross procedure.

Dr. Kent completed his undergraduate BA and MSc degrees in Neuroscience at Western University before obtaining his MD and FRCSC in General Surgery at Queen’s University. He began his Cardiac Surgery training at the University of Alberta and then continued his residency training at the University of Calgary. Dr. Kent then completed a Fellowship in complex valve surgery, transplant and mechanical circulatory support at Northwestern University in Chicago, before joining the Libin Cardiovascular Institute in 2013.

 His current position is Clinical Assistant Professor in the Section of Cardiac Surgery. He leads the Minimally Invasive Valve Surgery Program and is Surgical Director of the Mechanical Circulatory Support Program.

In this episode, we chatted with Drs. Wesley Francis, Don Major, and Greg Padmore. These fantastic surgeons came from the Carribean to train in North America, and we were curious to explore what their experience was like and how they used their training to improve surgical care when they returned home. 

Links:

1. https://www.ahpba.org/

2. Cancer Surgery Centre Bahamas - https://cancersurgerybahamas.com/

3. https://www.barbadosadvocate.com/news/qeh-surgeon-breakthrough-cancer-operation

Bios:

Dr. Wesley Francis is a graduate of the University of the West Indies (Mona). He did his surgical residency at Wayne State University (Detroit, MI) and completed a Surgical Oncology Fellowship at Tom Baker Cancer Center in Calgary Alberta. He is currently a Consultant Surgical Oncologist at the Princess Margaret Hospital in Nassau Bahamas where he also serves as the Director of Operating Room. He also serves as the Director of the Bahamas National Cancer Registry.

Dr. Don Major is a graduate of University of the West Indies (St Augustine). He did his surgical residency at UWI Bahamas where he became the first Bahamian to complete the UWI Bahamas surgical residency program. He completed his surgical oncology and hepatobiliary (HPB) fellowship at the Tom Baker Cancer Center in Calgary Alberta. He is currently a Consultant Surgical Oncologist and Hepatobiliary surgeon at the Princess Margaret Hospital.

Dr. Greg Padmore, a 2011 MBBS graduate who completed his pre-clinical years at The UWI Mona Campus and his clinical years at the Cave Hill Campus in Barbados. He is finishing up a two-year Fellowship at the University of Calgary, Canada, where he is undergoing subspecialty training in Hepato-pancreato-biliary Surgery to be followed by Surgical Oncology. 
He was the 2012 Intern of the Year in Barbados.

We were delighted this week to have Dr. Tarek Razek (https://twitter.com/Trazek) on the podcast with us. Dr. Razek is a trauma surgeon at McGill University and really a major figure in global surgery in Canada, and he pondered with us the questions with us of how we can best make an impact in global surgery without repeating the colonialism of the past. His approach is beautifully summarized in his piece published in the Lancet in 2015, where he wrote, “However, now that increasing attention is being paid to surgery in public health, we must also capitalise on this opportunity to move beyond descriptive studies.” Please enjoy our conversation with Dr. Razek. 

Links:

1. Tarek Razek on ICRC deployment: http://www.cnis.ca/img/Press_Clipping_-_2009_Jan_-_Outpost_-_Dr._Tarek_Razek.pdf

2. Global access to surgical care: moving forward. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)00004-2/references

3. Association Between Real-time Electronic Injury Surveillance Applications and Clinical Documentation and Data Acquisition in a South African Trauma Center. https://jamanetwork.com/journals/jamasurgery/fullarticle/2674877

Bio(from: https://www.mcgill.ca/generalsurgery/tarek-razek#:~:text=Biography%3A,University%20of%20Pennsylvania%20in%20Philadelphia)
Dr. Tarek Razek is trauma/general surgeon and intensivist who is the current Director of the Adult Trauma Program at the McGill University Health Centre (MUHC). He completed his surgical training at McGill University and his trauma surgery/ICU fellowship at the University of Pennsylvania in Philadelphia.

He is a co-director of the Centre for Global Surgery at the MUHC. He actively participates in surgical and trauma development programs in Tanzania, Rwanda, Mozambique, Ethiopia, Malawi, Ukraine, Haiti, Chile, Uruguay, Nepal and Mexico.

Dr. Su-Yin MacDonell (https://twitter.com/MacdonellSu?s=20&t=x_rOcGb83XcxYyWjb0ow2g) is an anesthetist specializing in periop medicine at St. Paul’s Hospital in Vancouver. She is particularly interested in the concept of noise in the OR, and how that can affect decision-making and focus in the OR. We were privileged to hear about her research around noise in the OR, and her thoughts around how we can improve the OR environment and communication across the drapes. 

Links:

1. Noise in the operating room during induction of anesthesia: impact of a quality improvement initiative. https://pubmed.ncbi.nlm.nih.gov/35014000/

2. Effect of noise on auditory processing in the operating room. https://pubmed.ncbi.nlm.nih.gov/24246628/

Bio (from http://periopcongress.org/wp content/uploads/2019/10/MacDonell.pdf)

Su-Yin started her career as a professional ballet dancer before completing her BSN at UVIC (2005). After two years as a medical-surgical Registered Nurse, she obtained her MD at UBC(2011). Her Residency in Anesthesiology at UBC (2017) was lengthened slightly by having two daughters. Following residency, Su-Yin had additional training in Perioperative Vascular Medicine in Hamilton, Ontario and Point of Care Ultrasound (POCUS) certification through CHEST. Su-Yin completed her masters in Perioperative Medicine, through the
University College of London.

As a staff Anesthesiologist at St. Paul’s Hospital (Vancouver), she is part of the ERAS working group, Perioperative Anesthesia group and is the Perioperative Medicine Fellowship Director (Anesthesia). 

Outside of medicine, Su-Yin continues to dance, reluctantly cleans up after husband and two young children, and tries to read before falling asleep with the light on.

This week we were joined again by Dr. Colin Schieman for a masterclass on paraesophageal hernias! Dr. Schieman is a previous guest on the podcast and is a thoracic surgeon in Calgary. In this episode we discuss types of paraesophageal hernia, the management of gastric volvulus, as well as operative approaches to repair.

Links: 

1. Colin Schieman on Direct Entry Training: https://soundcloud.com/cjs-podcast/e76-colin-schieman-on-direct-entry-training-and-intra-operative-teaching

2. Colin Schieman on Lung Nodules: https://soundcloud.com/cjs-podcast/e77-masterclass-with-colin-schieman-on-lung-nodules-and-lung-cancer-screening

3. Paraesophageal hernia: clinical presentation, evaluation, and management controversies. https://pubmed.ncbi.nlm.nih.gov/20112630/

Bio:

Dr. Colin Schieman is a Clinical Associate Professor at the University of Calgary in the section of thoracic surgery. He did medical school, residency, and thoracic surgery fellowship at the University of Calgary. He then went on to do additional thoracic surgery training at Mayo Clinic, and subsequently practiced at St. Joseph's Hospital in Hamilton, Ontario. He came back to the University of Calgary as Assistant Professor in 2016, and is now the Program Director for the Thoracic Surgery Fellowship program.

In this episode we had a great conversation with Dr. Sam Minor. Dr. Minor is a general surgeon in Halifax, Nova Scotia at Dalhousie. Dr. Minor has helped develop in situ trauma simulations that help not just residents but also staff surgeons prepare for major traumatic injuries. Dr. Minor also tells us about what it’s like to practice in Halifax and about some of his other research interests. 

1. Prospective study of single-stage repair of contaminated hernias with the novel use of calcium sulphate antibiotic beads in conjunction with biologic porcine submucosa tissue graft. https://pubmed.ncbi.nlm.nih.gov/33180691/

2. Minor S, Schroder C, Heland D. Utilizing the Intensive Care Unit to Teach End-of-Life Skills to Rotating Junior Residents. American Journal of Surgery Am J Surg 2008 Sep 11

Bio (https://medicine.dal.ca/departments/department-sites/critical-care/our-people/faculty/samuel-minor.html):

Dr. Minor has developed various programs at the Dalhousie Surgical Skills Center including percutaneous tracheostomy insertion, critical care skills (difficult airway management, percutaneous chest tube insertion, US guided interventions), open abdomen management and abdominal wall reconstruction. He also teaches crisis resource management at the Atlantic Canada Simulation Center which focuses on ACLS and ATLS utilizing the SimMan 3G.

Research activities are in the areas of medical education, open abdomen management and post tracheostomy care.