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Surgical Pioneering Podcast

Surgical Pioneering Podcast

By: Dr. Reza Lankarani
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 "Surgical Pioneering Surgical Frontiers: Pioneering Tech Transforming Surgical Care" Mission Statement: Welcome to Surgical Frontiers, a global nexus for surgeons, researchers, engineers, and healthcare innovators dedicated to advancing surgical care through groundbreaking technology. This group is not just a platform—it’s a movement. Here, we explore, debate, and champion the innovations redefining the art and science of surgery. From AI-driven diagnostics to robotic-assisted procedures, augmented reality (AR) surgical navigation, and bioengineered implants, we are the vanguard of a new era in medicine. If you’re driven by curiosity, excellence, and the relentless pursuit of better patient outcomes, you belong here. --- Our Core Values: 1. Innovation First Surgery is no longer confined to scalpels and sutures—it’s a fusion of biology, engineering, and data science. We prioritize discussions on emerging technologies (e.g., nanorobotics, AI-powered predictive analytics, 3D bioprinting) and their real-world applications. Share prototypes, clinical trial results, or even bold hypotheses—if it pushes boundaries, we want to hear it. 2. Collaboration Over Competition Breakthroughs happen when diverse minds unite. Surgeons, engineers, ethicists, and entrepreneurs are all equal stakeholders here. Whether you’re a seasoned robotic surgeon or a startup founder developing smart OR tools, your perspective matters. Let’s dismantle silos and co-create solutions. 3. Evidence-Based Excellence Pioneering doesn’t mean reckless. We demand rigor. Posts about new tools or techniques should be grounded in peer-reviewed research, clinical data, or transparent case studies. Anecdotes are welcome, but they must spark deeper inquiry, not replace it. 4. Patient-Centric Ethics Technology is a means, not an end. Every innovation must answer: How does this improve patient safety, accessibility, or outcomes? We encourage tough conversations about cost, equity, and unintended consequences. Glorifying "tech for tech’s sake" has no place here. 5. Global Perspective Surgical challenges vary wildly between a high-resource urban hospital and a rural clinic. Share insights from low-income regions, disaster zones, or underserved communities. Innovation thrives when we solve for the margins, not just the mainstream. --- What You’ll Find Here : - Breakthrough Technologies: Deep dives into robotics, AI/ML applications, AR/VR surgical training, IoT-enabled devices, and beyond. - Expert Insights: Q&As with thought leaders, interviews with FDA regulators, and AMAs (Ask Me Anything) with pioneers. - Case Studies: How a hospital in Kenya adopted portable robotic tools, or how a Boston team used AI to reduce post-op infections by 40%. - Ethical Debates: Should AI diagnose surgical complications? Who owns data from smart implants? - Resource Sharing: Grants, conferences (e.g., SAGES, AACR), and regulatory updates. --- Why Join? - Learn: Weekly summaries of JAMA Surgery or Annals of Surgery highlights. - Influence: Shape the future by beta-testing tools, joining global consortia, or advising startups. - Grow: Mentorship threads for residents, grants for underrepresented innovators, and hackathons. --- The Future We’re Building: Imagine a world where: - A surgeon in Mumbai receives real-time AR guidance from a specialist in Toronto. - Bioprinted organs eliminate transplant waitlists. - AI predicts surgical complications before the first incision. "This isn’t science fiction—it’s the horizon we’re sprinting toward." Let’s pioneer responsibly. Let’s operate fearlessly. Post, comment, and collaborate. The next surgical revolution starts here. — Reza Lankarani M.D Founder & Curator, Surgical Frontiers "Surgical Pioneering Surgical Frontiers: Pioneering Tech Transforming Surgical Care"

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Episodes
  • "MitraClip Procedure Overview"

    "MitraClip Procedure Overview"
    Jul 19 2025
    Authored by Dr. Reza Lankarani, General Surgeon MitraClip™ is a minimally invasive transcatheter edge-to-edge repair (TEER) device designed to treat mitral regurgitation (MR), a condition where the mitral valve fails to close properly, causing blood to leak backward into the heart. Inspired by the Alfieri surgical technique, which sutures the valve leaflets to create a double orifice, the MitraClip uses a small metal clip to grasp and coapt the leaflets, reducing regurgitation . It is the first FDA-approved transcatheter mitral valve repair therapy and has been used in over 200,000 patients globally.------------------------------------------------------------Indications: - Primary (Degenerative) MR: For patients at prohibitive surgical risk due to age, frailty, or comorbidities (e.g., severe COPD, renal failure) . - Secondary (Functional) MR: For patients with heart failure and persistent symptoms despite optimal guideline-directed medical therapy (GDMT), LVEF 20–50%, and LVESD ≤70 mm . Contraindications:- Active endocarditis, rheumatic mitral disease, or blood clots in the heart/inferior vena cava . - Allergies to device materials (nickel, titanium, polyester) or inability to tolerate anticoagulation .------------------------------------------------------------Procedure Overview: The MitraClip procedure is performed under general anesthesia with fluoroscopic and transesophageal echocardiography (TEE) guidance.Key steps include: 1. Transseptal Puncture: Accessing the left atrium via the femoral vein, with the puncture site optimized for clip alignment . 2. Clip Delivery: A steerable catheter guides the clip to the mitral valve. The clip is opened, advanced into the left ventricle, and used to grasp the leaflets . 3. Assessment: Real-time TEE evaluates regurgitation reduction and mitral stenosis risk (target gradient ≤5 mmHg). Additional clips may be placed if needed . 4. Deployment: The clip is released, and the catheter is withdrawn. Most procedures take 1–3 hours, with a hospital stay of 1–3 days .------------------------------------------------------------Clinical Outcomes: - Survival and Hospitalization: - In the COAPT trial, MitraClip reduced heart failure hospitalizations by 47–51% and mortality risk by 33% over 2–3 years . - Patients with secondary MR showed improved survival compared to medical therapy alone . - Quality of Life: - 2.5× higher likelihood of significant improvement in Kansas City Cardiomyopathy Questionnaire (KCCQ) scores . - Symptoms like shortness of breath and fatigue improved in 95% of cases . - Durability: - EVEREST II trial demonstrated sustained MR reduction and reverse LV remodeling at 5 years . Risks and Complications:- Procedural Risks: - Vascular complications (3–13% requiring transfusion), atrial septal defects, or pericardial effusion . - Single-leaflet detachment (1–3%) or device embolization (rare) . - Post-Procedural Risks: - Mitral stenosis (if gradients exceed 5 mmHg) or residual MR . - Overall 30-day complication rate: 15–19% Device Innovations:The MitraClip G4 System (4th generation) offers: - Four Clip Sizes: NT (9 mm), NTW (12 mm), XT (15 mm), and XTW (18 mm) for tailored repairs . - Controlled Gripper Actuation: Allows independent leaflet grasping for complex anatomies . - Enhanced Imaging Integration: Improved delivery system stability for precise placement . ------------------------------------------------------------Guidelines and Recommendations:- 2022 AHA/ACC/HFSA Guidelines: Class 2a recommendation for TEER in secondary MR patients with LVEF 20–50% and persistent symptoms despite GDMT . - Patient Selection: Requires a multidisciplinary heart team to evaluate surgical risk, anatomy, and comorbidities . Post-Procedure Care:- Medications: Aspirin (lifelong) and clopidogrel (30 days) for antiplatelet therapy; anticoagulants for atrial fibrillation . - Activity Restrictions: Avoid strenuous activity for 7 days; follow-up echocardiograms at 30 days and annually . ------------------------------------------------------------Conclusion:MitraClip™ represents a paradigm shift in treating MR for high-risk patients, offering survival benefits, symptom relief, and faster recovery compared to surgery. Ongoing innovations, such as the G4 system, continue to expand its applicability. However, careful patient selection and procedural expertise remain critical for success . Reza Lankarani M.D#mitraclip#mitraclip procedure#mitraclip therapy#mitral valve repair#minimally invasive heart procedure#mitral regurgitation#heart valve treatment#interventional cardiology#cardiac catheterization#mitraclip benefits#mitraclip risks#mitraclip recovery#mitraclip screening#mitraclip procedure steps#heart health#valve repair surgery #Surgical Pioneering #Reza Lankarani Get full access to Reza Lankarani at lankarani.substack.com/subscribe
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    22 mins
  • "Association Between Triglyceride-Glucose Index and Breast Cancer: A Systematic Review and Meta-Analysis"

    "Association Between Triglyceride-Glucose Index and Breast Cancer: A Systematic Review and Meta-Analysis"
    Jul 18 2025

    Reviewed by Reza Lankarani M.D

    ------------------------------------------------------------

    Zooravar et al., Cancer Reports (2025)

    https://doi.org/10.1002/cnr2.70194

    ------------------------------------------------------------

    This academic article presents a systematic review and meta-analysis examining the Triglyceride-Glucose (TyG) index in relation to breast cancer. It evaluates the TyG index as a potential indicator for breast cancer risk, progression, and its ability to differentiate between malignant and benign breast lesions. While cohort studies did not establish a strong predictive link for initial breast cancer development, case-control and cross-sectional studies suggested a significant association between elevated TyG index and increased risk. The research highlights the TyG index's utility in distinguishing malignant from benign lesions, proposing its value as an accessible diagnostic tool in clinical settings.

    Conclusion

    This review strengthens TyG’s role as a metabolic biomarker for BC diagnosis, particularly in distinguishing malignant lesions. While cohort studies refute its utility for risk prediction, TyG reflects tumor-driven metabolic dysfunction with implications for prognosis. For surgical practice, TyG could optimize preoperative stratification and postoperative metabolic management. Future studies should prioritize standardized thresholds and validate TyG in multimodal diagnostic algorithms.

    Reza Lankarani M.D



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    12 mins
  • "Burns and Mental Health: A Matched Cohort Study"

    "Burns and Mental Health: A Matched Cohort Study"
    Jul 16 2025

    Reviewed by Reza Lankarani M.D

    ------------------------------------------------------------

    Published online June 2025

    DOI: 10.1097/SLA.0000000000006270

    Annals of Surgery

    ------------------------------------------------------------

    This large-scale matched cohort study investigates the long-term association between burn injuries and mental health hospitalizations over 33 years. Analyzing 23,726 burn patients and 223,626 controls from Quebec, Canada, the study found that burn survivors had a 1.76-fold increased risk of mental health hospitalization compared to controls, with risks persisting up to 30 years post-injury. Severe burns (≥50% body surface area, third-degree burns, skin graft requirements) were linked to higher risks (HR: 2.00–3.29). Notably, burn patients exhibited elevated risks for eating disorders (HR: 3.14), substance use disorders (HR: 2.27), and suicide attempts (HR: 2.42), particularly within the first 5 years after injury.

    Comprehensive Data Linkage:

    - Utilizing population-based registries allowed for accurate tracking of hospitalizations and covariates, including socioeconomic status and preexisting conditions. This reduces selection bias and enhances generalizability within publicly funded healthcare systems.

    Subgroup Analyses:

    - Detailed stratification by burn severity (e.g., body surface area, degree, graft requirements) and mental health outcomes strengthens the validity of associations. For example, severe burns requiring grafts showed a 2-fold higher risk of hospitalization, highlighting the dose-response relationship between injury severity and mental health outcomes .

    -----------------------------

    Comparison with Recent Studies:

    - Short-Term vs. Long-Term Risk:

    Earlier studies (e.g., Bich et al., 2021) reported elevated psychiatric risks up to 5 years post-burn , while this study extends the timeline to 30 years, corroborating longitudinal data from Abouzeid et al. (2022) on chronic mental health decline .

    - Severity Gradient:

    Consistent with Logsetty et al. (2016), severe burns requiring grafts showed the highest mental health risks, emphasizing the need for targeted interventions in this subgroup .

    - Substance Use Disorders:

    The observed 2.14-fold increased risk for alcohol-related hospitalizations aligns with Mason et al. (2017), who linked burn-related chronic pain and opioid prescriptions to substance misuse .

    -------------------------------

    In conclusion, this study exemplifies the value of population-based cohort designs in uncovering the chronic impacts of surgical conditions. It sets a foundation for future research aimed at improving holistic burn care. Burn units should adopt lifelong mental health monitoring protocols, with intensified surveillance in the first 5 years post-injury. Pain management strategies must balance efficacy with addiction prevention to mitigate substance use risks .

    --

    Reza Lankarani M.D

    #burnsandmentalhealth #mentalhealthresearch #burninjurypsychologicalimpact #burnsurvivorsmentalhealth #mentalhealthstudy #cohortstudy #burntraumaandpsychology #psychologicaleffectsofburns #mentalhealthsupport #burninjuryrecovery #mentalhealthawareness #traumaandmentalhealth #psychologicalresilienceburns #burninjurymentalhealthanalysis #healthresearch #mentalhealthoutcomes #burnrehabilitation #mentalhealthinterventions #healthcareresearch



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    2 mins

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