Surgical techniques in gynecology vary widely between surgeons, creating both excitement and frustration for residents trying to learn the "right way" to perform procedures. Howard and guest host Maddie White discuss this and more:

• Trocar placement during laparoscopy requires careful consideration of patient factors and potential adhesions
• Elevating the abdomen during trocar placement remains standard practice, though definitive evidence on its necessity would require studies of over 100,000 patients
• Surgeons should understand power analysis to recognize when studies are underpowered to detect meaningful differences in rare complications
• Visceral slide technique using ultrasound can identify adhesions and determine the safest entry point for laparoscopic surgery
• Palmer's point may no longer be the safest entry point for many patients given the prevalence of bariatric surgeries
• Jain's point (lateral to the umbilicus) may now be statistically safer for many patients with complex surgical histories
• Vaginal cuff dehiscence rates are 6-10 times higher with laparoscopic/robotic hysterectomy compared to vaginal approaches
• The higher dehiscence rate stems from using energy devices for colpotomy rather than cold scalpel techniques
• Barbed sutures simplify cuff closure but don't reduce dehiscence rates compared to standard suturing techniques
• Surgery consists of "a thousand little things done well" - mastering these micro-skills distinguishes excellent surgeons

00:00:00 Surgical Techniques: Excited and Frustrated

00:08:00 Elevation During Trocar Placement

00:17:00 Evidence and Power Analysis

00:21:35 Visceral Slide Technique

00:35:10 Alternative Trocar Entry Points

00:40:10 Cuff Closure and Dehiscence Risk

00:51:45 Laparoscopic vs Vaginal Colpotomies

01:03:00 First Accredited OB-GYN Residency Program

Follow us on Instagram @thinkingaboutobgyn.

Howard Herrell and Antonia Roberts explore evidence-based practices in obstetrics and gynecology, examining both established protocols and emerging research with critical perspectives on medical misinformation.

• Serial cervical length monitoring after LEEP procedures lacks evidence for improving outcomes despite being common practice
• SMFM's 2016 recommendation explicitly advises against routine cervical length screening for patients with history of cervical procedures
• Retrospective studies on induction timing require careful interpretation due to inherent biases in methodology
• Understanding the difference between intent-to-treat and per-protocol analysis is crucial when evaluating medical research
• Pseudoscience and alternative medicine have gained mainstream acceptance over decades through celebrity endorsements and media platforms
• Reusable surgical instruments like stainless steel uterine manipulators offer both economic and environmental advantages over disposable options
• Plus, Learn the history of The Green Journal's distinctive color

Be sure to check out thinkingaboutobgyn.com for more information and follow us on Instagram. We'll be back in two weeks.

00:00:35 Monitoring Cervical Length After LEEP

00:10:30 Understanding Intent-to-Treat Analysis

00:28:54 MAHA Movement and Medical Misinformation

00:53:49 Carbon Footprint of Uterine Manipulators

00:57:30 History of the Green Journal

Follow us on Instagram @thinkingaboutobgyn.

Cervical cancer represents a success story in developed countries due to screening and vaccination, yet remains a significant global health problem with over 340,000 deaths annually worldwide. We explore the current state of cervical cancer prevention, screening, and treatment while discussing exciting advances that could eventually eliminate this disease.

• Different levels of prevention for cervical cancer: primordial, primary, secondary, tertiary, and quaternary
• HPV vaccination as the most effective primary prevention method, with Australia on track to make cervical cancer rare by 2035
• Evolution from Pap smears to primary HPV testing, with potential future urine-based screening options
• Less radical surgical approaches for early-stage disease, improving quality of life without compromising outcomes
• Immunotherapy advances showing 6-12 month survival benefits in metastatic disease
• Howard Kelly's pioneering work with radium in the early 1900s, establishing foundations for radiation therapy
• Importance of addressing healthcare disparities, as rural Americans are 25% more likely to develop cervical cancer and 42% more likely to die from it

Visit our website at thinkingaboutobgyn.com for more information and follow us on Instagram for updates.

00:00:00 Introduction to Cervical Cancer

00:08:10 Prevention Strategies Explained

00:18:02 HPV Screening Evolution

00:26:51Treatment of Early-Stage Disease

00:37:09Advances in Locally Advanced Disease

00:50:31 Radium and Howard Kelly's History

01:02:48 Final Thoughts on Prevention

Follow us on Instagram @thinkingaboutobgyn.