School of Surgery

In part 1 @CleoKenington, ASGBI lead for Sustainability, told us about the huge problem healthcare has with greenhouse emissions and what to do about improving pathways to minimise healthcare impact, In this eposode Cleo tell us what each of us can do once the patient gets to theatre. Practical solutions for all surgeons to embrace. Be part of the solution! Useful links: Resources for how to offer lifestyle advice to prevent disease: http://makingeverycontactcount.co.uk/training/healthy-lifestyle-information/ https://www.e-lfh.org.uk/programmes/making-every-contact-count/ To promote Shared decision making and improved perioperative see Centre for Perioperative care: https://cpoc.org.uk/about-cpoc Lean Healthcare pathways https://sustainablehealthcare.org.uk/what-we-do/green-surgery-challenge Companies that produce reusable kit: Hybrid Laparoscopic Ports, scissors & Clip applicators https://www.surginno.com/resposable-8-2/ Reprocessed Harmonic scalpels https://www.vanguard-medical.com/harmonic-scalpel/ The zero waste operating theatre: https://www.ecoquip.eu/procurement-projects/towards-zero-waste-operating-theatres.html

In the UK, the National Health Service accounts for 5.4% of the carbon emissions for the whole country! Surgery accounts for 5-10% of this total. The target is an 80% reduction in greenhouse emissions by 2028. Find out what's going on and what you and your unit can do to save slow global warming in this podcast by @CleoKenington, Emergency Surgeon and ASGBI lead for sustainability. This is everyone's problem - be part of the solution! Links to helpful sites below: Resources for how to offer lifestyle advice to prevent disease: http://makingeverycontactcount.co.uk/training/healthy-lifestyle-information/ https://www.e-lfh.org.uk/programmes/making-every-contact-count/ To promote Shared decision making and improved perioperative see Centre for Perioperative care: https://cpoc.org.uk/about-cpoc Lean Healthcare pathways https://sustainablehealthcare.org.uk/what-we-do/green-surgery-challenge Companies that produce reusable kit: Hybrid Laparoscopic Ports, scissors & Clip applicators https://www.surginno.com/resposable-8-2/ Reprocessed Harmonic scalpels https://www.vanguard-medical.com/harmonic-scalpel/ The zero waste operating theatre: https://www.ecoquip.eu/procurement-projects/towards-zero-waste-operating-theatres.html

All you need to know about investigation and treatment of this common and serious condition. Indications for pneumatic or hydrostatic reduction, plus operative intervention and complications are all covered. There are fantastic, beautifully handwritten notes to accompany both podcasts that you can download here: https://drive.google.com/file/d/1BTNoeYe-csn0X2mTsb3rGJ38o5KKyQdy/view?usp=sharing Shalinder Singh is a consultant in Paediatric Surgery in Nottingham, UK, and David Kiely is a trainee in Paediatric Surgery in the East Midlands of the UK

David Kiely asks Shalinder Singh about intussusception, a common and serious cause of abdominal pain in children aged 3 months to 3 years. This podcast covers all you need to know about the incidence, history and examination of intussusception. Part 2 covers investigation and treatment. Accompanying notes can be downloaded from here https://drive.google.com/file/d/1BTNoeYe-csn0X2mTsb3rGJ38o5KKyQdy/view?usp=sharing

You'll need to operate on about 1/3 patients with SBO. Matt Lee tells you what approach is best and when, and how to look after your patients after the operation Matt Lee is Clinical Lecturer in Surgery at the University of Sheffield and a recognised leader in the management of SBO

Who's going to settle with drip and suck and who isn't? Matt Lee tells you how to tell, who to operate on and when and not to forget that patients with small bowel obstruction need feeding! Further reading: https://bmjopen.bmj.com/content/9/7/e029235.abstract

Once you've diagnosed small bowel obstruction, Matt Lee tells us the best initial management Matt Lee is Clinical Lecturer in Surgery at the University of Sheffield and a world expert in small bowel obstruction

Matt Lee talks about causes of small bowel obstruction, important points in the history and examination. Matt Lee (@wannabehawkeye) is a Clinical Lecturer in Surgery at the University of Sheffield

If the National Audit of Small Bowel Obstruction was a car, Matt Lee is the engine and most of the other moving parts. In this podcast Matt (@wannabehawkeye) talks about NASBO and its main findings and recommendations. Further reading here: https://academic.oup.com/bjsopen/article/3/3/354/6060819

All you need to know about the management of this complex abdominal wall defect of the newborn. Similar to but different from exomphalos (listen to our other episode on that condition). With David Kiely and Shalinder Singh

All you need to know about the management of this complex abdominal wall defect of the newborn. With David Kiely and Shalinder Singh

Learn about pre-operative resuscitation and operative management of pyloric stenosis. Essential listening for anyone who is learning to operate on children. With David Kiely and Mike John.

All you need to know about the aetiology, history, examination and investigation of pyloric stenosis. Essential listening for anyone who treats children, be you surgeon, paediatrician, ED doctor or GP/family doctor. With David Kiely, Mike John and those squeaky chairs again

All you need to know about management of the acute scrotum in children. With David Keily, Mike John and 2 squeaky chairs!

All you need to know about the diagnosis and management of hydrocoele in children. How it is different from hydrocoeles in adults and the central importance of the processus vaginalis, differential diagnosis, investigations and treatment are all covered. Special cases of hydrocoele of the Canal of Nuck and the abdomino-scrotal hydrocoele are also covered, as well as the acute hydrocoele and implications. In addition, learn about the fantastically named "spring back balls sign"! With David David Keily and Shalinder Singh.

In part 2 of this podcast learn how to deal with emergency presentations of inguinal hernia in children, top tips on how to reduce an inguinal hernia in children, indications and timing of surgery and what to tell parents. Operative approach and special considerations for females with inguinal hernia are also discussed. Essential listening for trainees in paediatric surgery and emergency department doctors. David Keily is a trainee in paediatric surgery in the East Midlands, UK, and Shalinder Singh is a consultant paediatric surgeon and FRCS(Paed) examiner working at University Hospitals Nottingham, UK

Inguinal hernias are one of the most common conditions in paediatric surgery and this podcast is essential listening for anyone dealing with hernais in children in primary of secondary care. How paediatric hernias different are from adult hernias, predisposing factors for hernia and the central importance of the patient processus vaginalis are discussed, along with presentation, tricks to aid diagnosis in children and the differential diagnosis of lumps on the groin of a child. Complications of inguinal hernia in children are classified and explained. David Keily is a trainee in paediatric surgery in the East Midlands, UK, and Shalinder Singh is a consultant paediatric surgeon and FRCS(Paed) examiner working at University Hospitals Nottingham, UK

Now you know how much fluid to give, Shalinder Singh tells David Keily what fluid to use and why in a range of settings from trauma to pyloric stenosis to maintenance fluids in children. When and why to use crystalloid or colloid is explained. Side effects of using the wrong fluids are also covered, including acid/base balance problems and ARDS. Essential listening for anyone prescribing IV fluids for children. David Keily is a trainee in paediatric surgery in the East Midlands, UK, and Shalinder Singh is a consultant paediatric surgeon and FRCS(Paed) examiner working at University Hospitals Nottingham, Uk

Prescribing fluids in paediatric surgical patients can be daunting. This podcast tells you easy to remember ways of recognising the degree of fluid loss, why signs like diastolic hypertension are important and a method of calculating how much fluid to prescribe whatever the age of your patient. David Keily talks to Shalinder Singh about dehydration, on going fluid loss and maintenance fluids in children. After this podcast you will never be daunted again. David Keily is a trainee in Paediatric Surgery in the East Midlands of the UK, and Shalinder Singh is a consultant Paediatric Surgeon and Examiner for FRCS(Paed) working in University Hospitals, Nottingham, UK

How to recognise and interpret a normal ECG, with Dr. Julia Baron. All you need to know

Third podcast in the ECG series this is an easy to follow, step by step way to recognise and interpret ECGs (EKGs) in acute coronary syndromes, ST-elevation myocardial infarction, and non ST-elevation myocardial infarction. Dr. Julia Baron's legendary teaching captured in a podcast

All you need to know about the treatment of haemorrhoids with Professor Steve Brown, the brains behind the HubBLe trail. Definitions, conservative, outpatient and operative treatments in standard and special situations are covered, and the evidence for each. Steve also tells us why we should use the same outcome parameters in future trials in haemorrhoids

Helen Mercer shows Jon Lund how to scrub and put on gloves and a gown for an operation. Essential viewing for medical students and nursing students

Learn the basics of the ECG - why it looks like it does, how each of the chest and limb leads "look at" the heart, what the P, Q R, S and T waves represent in the heart itself and how to work out the axis of the ECG amongst a load of other essential basics you need to know before you can begin to interpret an ECG further. Hannah Phillips talks to Julia Baron, Consultant Cardiologist at the Royal Derby Hospital, UK

Recorded at the International Conference of Anal Fistula Treatment in Rome 2018, Techniques in Coloproctology interview Phil Tozer, a consultant at the world famous St Mark's Hospital, UK about current treatments for anal fistula. Phil takes us through why not to place a seton in the acute setting, the 5 factors preventing healing of fistulas, and the pros and cons of the whole range of fistula treatment including plugs, fibrin glue, permacol, LIFT, the place of sphincter repair, restoring the contour of the anus, VAAFT (including "palliative VAAFT and delta VAAFT"), FiLAC and finally the promise of stem cells in fistula. Essential listening for anyone who treats anal fistula.

Professor Susan Anderson helps you recognise and understand the similarities and differences between the microscopic appearances of skeletal, cardiac and smooth muscle. All you need to know. Susan Anderson is Professor of Pathology at the University of Nottingham, UK

Professor Susan Anderson shows you the microscopic structure of the largest organ in the body - the skin. All you need to know about the structure and the cells of the skin and associated glands and hairs. Great for learning, revising for exams or if you're just interested to see what you look like down the microscope

Professor Susan Anderson shows us what the layers of cells that cover our outsides and our insides look like down the microscope. Learn how to recognise each type of epithelium and why they need to be different. Also learn the suprising meaning of the word epithelium...

Take a microscopic tour down the urinary tract from the kidney to the bladder with Professor Susan Anderson. See the unique transitional cell epithelium and the muscular arrangement of the organs. All you need to know for exams or to amaze your friends.

Susan Anderson shows you the layers of the kidney, and how the function of the kidney depends on its microscopic anatomy. SHe takes you on a tour of the glomerulus, Bowman's capsule, the juxtaglomerular apparatus, loop of Henle and the collecting ducts, telling you all you need to know about the structure and cell types involved. Susan Anderson is Professor of Pathology at the University of Nottingham

The management of early rectal cancer is becoming increasingly complex.Find out all you need to know about diagnosis, staging, treatment, follow up and prognosis in this podcast. Steve Schlichtemeier is the colorectal robotic surgical fellow at the Royal Derby Hospital, UK and Bill Speake is a consultant colorectal surgeon and recent past ECAG lead for the East Midlands of the UK

In the second podcast on radiotherapy, Sindu Vivekanandan explains to Keaton Jones what is meant by the terms adjuvant and neoadjuvant, what the 3 main ways of delivering radiotherapy are, in which tumour radiotherapy is effective and in which it isn't, and the limiting factors and side effects associated with radiotherapy. Essential listening for anyone who's patients receive radiotherapy as part of their treatment. Keaton Jones is an academic surgeon at the University of Oxford, UK and Sindu Vivekanandan is a consultant oncologist.

Keaton Jones asks Sindu Vivekanandan what is radiotherapy, how it works and why we use it. Dose and fractionation are explained along with the '4Rs' of radiobiology: repair, reassortment, repopulation and reoxygenation. Toxicity is discussed as well as methods for increasing the effect of treatment on target tissues. Essential listening for surgeons and anyone who's patients receives radiotherapy as part of their treatment. Keaton Jones is an academic surgeon at the University of Oxford, UK and Sindu Vivekanandan is a consultant oncologist.

Rick Nelson knows more about anal fissure than almost anyone in the world and has recently published a comprehensive meta-analysis of the evidence supporting treatment for anal fissure in the leading journal, Techniques in Coloproctology. There are some surprises that will challenge what you think you know about efficacy of topical treatments, anal stretch, and the much lower than previously thought incidence of impairment of continence after sphincterotomy. Invaluable listening for updating knowledge or revising for an exam. You can read the full paper at http://bit.ly/2yeyCEZ A systematic review and meta-analysis of the treatment of anal fissure. Techniques in Coloproctology August 2017, Volume 21, Issue 8, pp 605–625

How to recognise and immediately manage complications of sleeve gastrectomy and gastric bypass are discussed in the second part of this podcast. Understand why bariatric patients clinical examination might be unreliable, why vomiting or jaundice are danger symptoms which may need emergency intervention, why NSAIDs and smoking are very dangerous in bypass patients and many more things you're going to find very useful when on call or in an exam! Mapped to the 2016 General Surgery syllabus. Cat Boereboom is a trainee in surgery in the East Midlands, UK and Sherif Awad is a consultant in bariatric surgery at the East Midlands Bariatric Institute, based at the Royal Derby Hospital, UK

You're not a bariatric surgeon, but you need to know how the immediate management of complications of bariatric surgery because they might well come in to your hospital, even if its not a bariatric surgical centre. In the first of 2 podcasts, Cat Boereboom talks to Sherif Awad about recognition of complications of gastric band and what to do when you see them. You'll also be able to recognise when a band is in the right place and when it has slipped, what a Huber needle is and what to do with it and what to do if you don't have one, port infection and lots more. Part 2 covers sleeve gastrectomy and gastric bypass. Mapped to the General Surgery 2016 syllabus. Cat Boereboom is a trainee in the East Midlands, UK and Sherif Awad is a consultant bariatric surgeon at the East Midlands Bariatric Institute based at the Royal Derby Hospital, UK

For decades the only real option for perforated diverticular disease was a Hartmann's procedure, but there has been a lot of interest in the less invasive and stoma saving laparoscopic lavage and drainage procedure as an alternative. But is it effective? Jon Lund talks to David Humes about the background and the evidence for and against peritoneal lavage as a treatment for this common colorectal emergency. David Humes is Associate Professor of Surgery at the University of Nottingham, UK and an NIHR Postdoctoral Fellow. Get the meta-analysis referred to in the podcast here (http://bit.ly/2peBO1J)

A host of practical tips on difficult urethral catheter insertion, changing a suprapubic catheter, managing a 3-way catheter, what to do when you're called about testicular pain, paraphimosis or a nephrostomy. When you have listened to this podcast by Philly Horner and Suzie Hall you will be much more confident about how to manage these common problems yourself and be able to do it safely, knowing when you should ask for help. Essential listening for all foundation doctors, interns, and medical students, whatever your speciality

Dr Ruediger Prosst, Director of The Proctological Institute in Stuttgart, Germany, tells Jon Lund about his experience in treating the often challenging problem of high and complex anal fistula using a novel, sphincter sparing clipping device. This podcast links to Tech Coloproctol (2016) 20: 753. doi:10.1007/s10151-016-1537-0

All you need to know about the classification, presentation, diagnosis, investigation and treatment of causes of haematuria: Philly Horner talks to Simon Williams, Consultant Urological Surgeon

"Doctor, Mrs Smith's calcium is 2.9, what do you want me to do?" Cat Boereboom talks to Roger Stanworth about all aspects of the presentation, diagnosis and treatment of both high and low calcium. Once you've listened to this podcast you will know how to manage any calcium disorder. Mapped to the General Surgery 2016 curriculum, this podcast is also very useful listening to those taking MRCS or FRCS, as well as medical school finals. Cat Boereboom is a trainee in General Surgery, and Roger Stanworth is Clinical Lead for Diabetes and Endocrinology at the Royal Derby Hospital, UK

Philly Horner talks to Gill Tierney about the presentation, diagnosis and treatment of small bowel obstruction, a very common condition presenting as an emergency. This podcast contains all you need to know if you're a medical student, foundation doctor (intern), or early years trainee in surgery. Sorry about the sound in places, this was recorded on location without our usual high quality mic. Best on headphones.

All you need to know about how to interpret the results of a meta analysis in 14 minutes and 15 seconds. If you find yourself in an exam and asked to review a meta analysis in an interview or an exam, or even if you're reading one in a journal to inform your clinical practice, this will be the best 1/4 hour you have spent in ages. If you want a more detailed explanation and to properly understand the process, then download our other podcast about meta analysis, which gives the background to all you see here. With Brett Doleman and Jon Lund

When you are doing surgery you need to know what the instruments are called and what they are used for. In this easy to follow guide, Jon Lund and June Brown take you through the instruments you will find on a basic surgical tray, the most common tray you will use when you are starting surgery. You'll learn the names of the instruments, why there are that shape, what they are used for, and some top tips on how to use them. Essential for medical students, people starting surgical training and student nurses on theatre placement.

A is the first letter of ABC and is the first thing to get right when managing a trauma patient. It can be very challenging and time is pressured. In this advanced level podcast for anaesthetists and surgeons involved in trauma management, Andrew Deytrikh talks to Craig Morris about how to manage the airway in critically ill and unstable patients, those with unstable cervical spines, patients with severe facial injury, burns and other injuries with airway implications. What to do when standard measures fail is also discussed, including the when, who and how of surgical airway formation. Listen now, so that you know what to do when you're in this situation.

Meta analysis is a very common way of bringing together data to help us decide which treatments might be best. BUT, you have to take care when interpreting them - there's a lot more to it than just looking which side of the line the little black diamond is on! How do you construct a search for a systematic review?Can you trust the result of a meta analysis? How do you know if it has been done well? How to recognise different kinds of bias, how to interpret a forest plot, and funnel plot and a bubble plot. What is the I squared statistic and what does it tell you about the data and how much to trust the result? These and many more things to do with these common but complex analyses is explained by Brett Doleman, statistical guru! Star in national selection academic station and FRCS academic viva

Knowing how to chose the correct statistical test is essential if you're analysing data, reading a paper or sitting in the academic stations of the FRCS or National Selection. Watch this podcast by statistical guru Brett Doleman and you'll know how to chose the right test or know if the right one has been chosen. Using a step by step, easy to follow decision tree, Brett takes you to the correct test for the type of data you have. Statistical tests demystified forever!

Functional Constipation is a really challenging condition to treat in gastroenterology and surgery. In this podcast Jon Lund asks Robin Spiller about the condition, the underlying physiology, how to differentiate from IBS constipation and the range of treatments for FC. This podcast will tell you all you need to know and more. Robin Spiller is Professor of Gastroenterology at the University of Nottingham, UK, former editor of GUT, author of the Rome III criteria and world leading expert in this field

See if you can get to the correct answers before James Cassidy does in the third and final part of Naomi Laskar's interactive teaching video on causes of chest pain you might see when covering the wards. Really useful things to know in the middle of the night when there's no-one else around!

Naomi Laskar puts James Cassidy through his paces again in the second case of chest pain you are likely to come across as an F1/intern on a surgical or other ward. See if you can get the right answers before James in this interactive teaching video. All the benefits of small group teaching without the pain!

Naomi Laskar teaches James Cassidy in an interactive video on chest pain on the surgical ward. Using a series of cases common causes of chest pain are discussed and the video will help you to develop a structured approach to reviewing chest pain and understand the basic management of chest pain. Common life threatening and non life threatening causes are covered, with important points in the history, examination, investigation, treatment and prognosis explained, with plenty of acronyms to help you remember. Pause the video as you go to write down what you think are the correct answers. All the benefits of small group teaching without any of the pain!