Surgery Commons^™

Surgery Myths And Facts, Heli Patel

Gibbon Surgical Review

Throughout social media, television shows, movies, and “public perception”, surgical residents and attendings are often stereotyped into a personality that is most often incorrect. Unless you are a surgeon, it is often hard to understand what exactly the life entails. Add in some Hollywood drama and social media, and what you get is a wildly disproportionate picture of what surgeons’ personalities are like. As a medical student, it is often difficult to separate fact from fiction, so here are some of the most common myths debunked.

John H. Gibbon, Jr., Md

Gibbon Surgical Review

Dr. John Heysham Gibbon, Jr. graduated from Jefferson Medical College in 1927, and in a brief series of events, he was named Fellow at Massachusetts General Hospital. In 1930, he found himself assisting Dr. Edward Churchill in an emergency pulmonary embolectomy. At that time the procedure was one of desperation, as no patient in the U.S. had survived the removal of blood clots in open-heart surgery. As Dr. Gibbon recorded the patient’s waning vital signs prior to the procedure he thought, “If only we could remove the blood from her body by bypassing her lungs, and oxygenate it, then return …

Gibbon Surgical Review, Volume 3, Issue 1, 2020

Gibbon Surgical Review

Table of Contents

4 - Interview with Dr. Geoffrey Krampitz

8 - Primum Non Nocere: Surgeons and the Politics of Firearm Trauma

10 - General Surgery 101: Nissen Fundoplication

14 - Interview with Dr. Dawn Salvatore

16 - The Utility of Surgical Simulation in Student Education

18 - Bedside to Bench: Basic Science Research During General Surgery Residency

20 - Longevity in Surgery: A Conversation with Two Temple Surgeons About How They Continually Find Joy in Their Careers

22 - Surgery Myths and Facts

24 - Gibbon Surgical Society

25 - John H. Gibbon Jr., MD

26 - Editorial Board …

Modern Ventilator Management In Surgical/Trauma Patients, Errington C. Thompson

Marshall Journal of Medicine

Physicians have a lot to consider when they place a patient on the ventilator. This article reviews the literature and provides the physician with a clear guide to managing the ventilator in the ICU. This manuscript is meant to be a practical guide to managing the ventilator at the patient's bedside.

Surgeons’ Views On Shared Decision-Making, Suraj Kannan, Jayhyun Seo, Kevin R. Riggs, Gail Geller, Emily F. Boss, Zackary D. Berger

Journal of Patient-Centered Research and Reviews

Purpose: Shared decision-making (SDM) has a significant role in surgical encounters, where decisions are influenced by both clinician and patient preferences. Herein, we sought to explore surgeons’ practices and beliefs about SDM.

Methods: We performed a qualitative study consisting of semi-structured individual interviews with 18 surgeons from private practice and academic surgery practices in Baltimore, Maryland. We purposively sampled participants to maximize diversity of practice type (academic vs private), surgical specialty, gender, and experience level. Interview topics included benefits and challenges to patient involvement in decision-making, communicating uncertainty to patients, and use of decision aids. Interviews were audio-recorded and transcribed. …

Opioid Tolerance Influences Outcomes After Lumbar Fusion In Patients With Degenerative Pathology, Noah Levy, Max Detweiler, Dhruv K.C. Goyal, Ariana Reyes, Alexander R. Vaccaro

Phase 1

Introduction: Extended opioid use prior to surgery has been implicated in poorer postoperative outcomes. However, it remains unclear if there is a significant difference in postoperative outcomes among preoperative opioid-naïve and opioid-tolerant patients who undergo lumbar spinal fusion. The purpose of this study was to determine the effect of preoperative opioid use on patient-reported outcome measures in patients undergoing lumbar spinal fusion.

Methods: This retrospective cohort analysis identified 260 patients who underwent lumbar spinal fusion at a high-volume, single institution. There were two cohorts: patients who were opioid-naïve (defined as total opioid consumption of ≤ 7 days in …

3d Printed Liver Models As A Tool To Improve Pre-Surgical Consultation And Enhance Patient Consent, Miranda Sill, Nathan Ott, Robert S. Pugliese, Pharmd, Bcps

Phase 1

Background: 3D printing has recently emerged as an effective, cost-efficient tool for healthcare innovation. We propose the fabrication of 3D printed, patient-specific liver models as a pre-surgical planning and communication tool for liver resection surgery.

Methods: Creation of the model began with the segmentation of the patient's abdominal CT scan, where specific sections of their anatomy, including the blood vessels (portal and hepatic systems), gallbladder, and tumor (when applicable), were digitally segmented. Each structure was then printed in a unique color using polylactic acid (PLA) plastic filament on an Ultimaker 5s printer. Once printed the components were arranged anatomically and …

Evaluating An Incentive Program To Improve Teamwork And Productivity In The Operating Room, Christopher Bejil

Walden Dissertations and Doctoral Studies

The operating room (OR) is a complex system that must run efficiently to remain profitable and of value to its multiple stakeholders who include the patient, surgeon, OR staff member, and hospital administration. The OR at the practice site struggled with teamwork and efficiency in the areas of first-case on-time starts, turnover time, and last-case out times, resulting in a less than favorable impact on the organizational bottom line. The practice-focused question asked if a performance-based incentive bonus program can improve OR efficiency in the department’s three major problem areas. Using Gittell’s relational coordination theory as a framework, the practice …

Renewing Hearts: Catholic Perspectives In Valve Replacement Surgery For Those Who Use Intravenous Drugs, Kimberly Feeney, Robert Perkel, Md

Phase 1

Introduction: The incidence of infectious endocarditis has been increasing, particularly among those with a history of intravenous drug use (IVDU). Although current bioethics literature supports valve surgery as treatment for this patient population, clinical guidelines and literature continues to provide unclear recommendations for physicians. Catholic bioethics may provide a different perspective to re-contextualize the recommendations of secular ethics.

Methods: A PubMed search was used to gain background information regarding the incidence of infectious endocarditis and current treatment guidelines, as well as historical and current ethical considerations. Search terms included: “infectious endocarditis,” “IE,” “intravenous drug use,” “IVDU,” “ethics.” Related citations were …

The Effect Of The Surgery Rotation Sequence On Surgery And Emergency Medicine Nbme Scores, Anna Lin, Gerald Isenberg, Md, Chaiya Laoteppitaks, Md

Phase 1

Purpose: Within a school, the formerly fourth year emergency medicine clerkship was added to the third year curriculum in a sequence with general surgery and surgical subspecialty clerkships. Together, a student can be placed in any permutation of the three clerkships, but a student will take the Surgery and EM NBME exam after the completion of the respective clerkship regardless of the order of clerkships. The purpose of this project was to look to see if there was a significance difference in NBME scores between four different sequences of clerkships and to see if sequence of a third year student’s …

Pulmonary Resection In Complicated Primary Pediatric Pulmonary Tuberculosis: An Evidence-Based Case Report, Hendra Wibowo, Suprayitno Wardoyo, Dhama Shinta

The New Ropanasuri Journal of Surgery

Introduction. Paediatric pulmonary tuberculosis incidence was increasing, with many undetected cases. Antituberculosis regiments are known to be the treatment of choice for tuberculosis. Even though pulmonary resection for pulmonary tuberculosis has reduced in daily practice, it remains continues to play an important role in several advanced conditions and complications. Currently, there are no specific practical guidelines concerning surgical indications and approaches for pulmonary tuberculosis. We report a case with complicated primary paediatric pulmonary tuberculosis underwent resection and looking for the literature of the best evidence.

Method. A case report completed with a discussion based on the best evidence. …

Impact Of Best Practice Guideline Statement On Anesthesia Practice In Rural Mississippi Hospitals With Obese Patients Undergoing Total Knee Arthroplasty, Steven Hodnett

Doctoral Projects

The aim of this best practice guideline (BPG) was to be a resource for anesthesia providers practicing with obese patients undergoing total knee arthroplasty (TKA) and to measure the knowledge of these providers. After dissemination of an executive summary to anesthesia providers in two hospitals in rural Mississippi, an anonymous online survey was provided via Qualtrics software for voluntary participation. The survey consisted of 10 questions. The data collection period was five weeks. Respondents are noted at N=2, and the data was reviewed and categorized into one of three domains (i.e., knowledge, practice, and safety). In the domain of knowledge, …

Current Management Of Glioma In Pakistan, Umme E Hani Abdullah, Altaf Ali Laghari, Muhammad Usman Khalid, Huzaifa Bin Rashid, Fatima Ali, Adnan Jabbar, Asim Hafiz, Muhammad Shahzad Shamim, Ather Enam

Section of Neurosurgery

To date, information on the management of specific neurosurgical tumors, such as glioma, in Pakistan remains scattered and scarce. Our review synthesizes the predicaments of glioma management routinely presented to the neurosurgery, medical oncology, radiation oncology, and radiology departments in Pakistan. Expert opinions were integrated from each of the relevant fields in the form of personal citations. The data presented in our review were collected from various PubMed and non-PubMed indexed articles, coupled with various health reports from the Government of Pakistan along with the World Health Organization. Through these data, it was postulated that the utilization of innovative and …

Graves, Guthrie Yochlee, 1903-1967 (Sc 3449), Manuscripts & Folklife Archives

Manuscript Collection Finding Aids

Finding aid only for Manuscripts Small Collection 3449. Typescript of an article dated in pencil 4/22/50 and titled "Congenital Subtotal Duodenal Stenosis" by Dr. Guthrie Y. Graves of Bowling Green, Kentucky. Includes three x-rays of an infant’s abdominal section and a copy of the bill from Bowling Green's City Hospital for $132. The x-rays and bill, dated 1946, were for one of the patients mentioned in the article, the case of Baby Wanda Faye Pearson of Bowling Green. Also includes a proof for an article by Drs. Graves and Henry S. Harris titled "Carcinoma of the Male Breast with Axillary …

Comparison Of Surgical Outcomes Of The Posterior And Combined Approaches For Repair Of Cervical Fractures In Ankylosing Spondylitis., Panya Luksanapruksa, Paul William Millhouse, Victor Carlson, Thanase Ariyawatkul, Joshua Heller, Christopher K. Kepler

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Retrospective cohort study.

PURPOSE: To evaluate surgical outcomes and complications of cervical spine fractures in ankylosing spondylitis (CAS) patients who were treated using either the posterior (P) or combined approach (C).

OVERVIEW OF LITERATURE: Ankylosing spondylitis typically causes progressive spinal stiffness that makes patients susceptible to spinal fractures. CAS is a highly unstable condition. There is contradictory evidence regarding which treatment option, the posterior or the combined approach, yields superior clinical results.

METHODS: A single institution database was reviewed for data in the period 1999 to 2015. All CAS patients who underwent posterior or combined instrumented fusion were …

Postoperative Cholecystitis From Nathanson Liver Retractor During Robotic-Assisted Laparoscopic Partial Nephrectomy, Lauren D. Gleich, Mihir G. Thaker, Gordon A. Brown

Rowan-Virtua Research Day

Proper visualization of the surgical field during any procedure is one of the most imperative elements of surgery. The tools used to obtain this goal come with their own set of risks. This report describes a patient who developed postoperative acalculous cholecystitis (PAC) after use of a Nathan liver retractor. PAC is a rare complication of urologic surgery and is often more severe than acalculous cholecystitis (AC), leading to significant morbidity.

Download Entire Issue: Gibbon Surgical Review, Volume 2, Issue 1, 2019

Gibbon Surgical Review

Table of Contents

4 - The Gibbon Surgical Externship: A Student’s Perspective

6 - Invited Article: The PCOM Wisely Surgical Association and the Philadelphia Surgery Conference

8 - Interview With Thomas Jefferson Cardiothoracic Surgeon, H. Todd Massey, MD

12 - The Life of a Rwandan Surgical Resident

14 - Role Of Technological Advancement In The Context Of Surgical Planning And Execution: Perspective Of Jefferson Surgical Faculty

16 - Interview with William B. Hughes, MD, Director of the Thomas Jefferson University Hospital Burn Center

19 - Women in Surgery: An Interview with Dr. Karen Chojnacki, Vice Chair of Surgical Education at …

Sensory Outcomes In Digital Nerve Repair Techniques: An Updated Meta-Analysis And Systematic Review, Zachary J. Herman, Bs, Asif M. Ilyas, Md

Phase 1

Introduction: Injuries to the digital nerves are common with trauma to the hand; surgery is often required to repair injured nerves. Surgical management of digital nerve injuries includes neurorrhaphy or use of allograft, autografts, and conduits.

Objective: In light of the increasing availability and utilization of digital nerve repair constructs, an updated meta-analysis was undertaken in order to comparatively review the available evidence to determine differences in outcomes.

Methods: We reviewed the most current literature on sensory outcomes of various digital nerve repair techniques using static two-point discrimination (S2PD), moving two-point discrimination (M2PD), Semmes Weinstein–Monofilament testing (SWMF) and complication rates …

Assessing The Operative Log Data Of Traditional (5+2) Vs. Integrated (0+5) Vascular Training Programs, Ernest Gillan, Bs, Anthony Feghali, Md, Tuong Nguyen, Md, Dawn Salvatore, Md, Paul Dimuzio, Md, Babak Abai, Md

Phase 1

Introduction: In 2006, the Accreditation Council for Graduate Medical Education (ACGME) approved an integrated 5 year vascular surgery residency program. Operative experience can be used as a surrogate marker for success in the evolving field of vascular surgery training.

Objective: The purpose of this study is to compare the operative experience of those graduating from the traditional (5+2) vascular training program with the integrated (0+5) program.

Methods: National operative case log data supplied by the ACGME was gathered and organized for vascular surgery residents graduating between 2013 and 2018. Mean case numbers were compared between integrated vascular residents and traditional …

First Series Of Minimally Invasive, Robot-Assisted Tracheobronchoplasty With Mesh For Severe Tracheobronchomalacia, R. Lazzaro, B. Patton, P. Lee, J. Karp, E. Mihelis, S. Vatsia, S. J. Scheinerman

Journal Articles

No abstract provided.

Consensus Statement From The International Consensus Meeting On The Role Of Decompressive Craniectomy In The Management Of Traumatic Brain Injury: Consensus Statement, P. J. Hutchinson, A. G. Kolias, T. Tajsic, A. Adeleye, A. T. Aklilu, T. Apriawan, A. H. Bajamal, E. J. Barthelemy, J. S. Ullman, F. Servadei, +41 Additional Authors

Journal Articles

No abstract provided.

Effect Of Negative Pressure Wound Therapy On Wound Complications Post-Pancreatectomy, M. P. Kuncewitch, A. U. Blackham, C. J. Clark, R. M. Dodson, G. B. Russell, E. A. Levine, P. Shen

Journal Articles

No abstract provided.

Implantable Biomaterials To Provide Local Immunotherapy Following Surgical Resection., Michael J Gough, Jason R Baird, R Bryan Bell

Articles, Abstracts, and Reports

No abstract provided.

Opioid-Prescribing Practices For Post-Operative Patients In Otolaryngology: A Multiphasic Quality Improvement Project In A Single Large Institution, Zachary Gandee, Sophia Dang, Alexander N. Duffy, Jonathan C. Li, Tanvi Rana, Brittany Gunville, Tingting Zhan, Elizabeth Cottrill, Md, David Cognetti, Md

Phase 1

Objectives:

In otolaryngology, postoperative pain management lacks evidence-based guidelines. We investigated opioid prescription and consumption for common procedures to develop prescribing guidelines at our institution.

Study Design:

Prospective, survey study.

Methods:

Patients who underwent surgery between July and September were given surveys upon discharge and at first follow-up visit. We assessed opioid usage and pain using the visual analog scale and opioid consumption throughout the postoperative period. Opioid prescriptions were converted to a standardized unit of 5 mg Oxycodone pills for reporting. Four procedures (transoral robotic surgery resection [TORS], sialendoscopy, parathyroidectomy/thyroidectomy, and parotidectomy) were selected for isolated analysis.

Results: …

Download Entire Issue: Gibbon Surgical Review, Volume 1, Issue 2, 2018

Gibbon Surgical Review

Table of Contents

• Forward by Charles J. Yeo, MD, FACS
• PERSPECTIVE - An Interview with Dr. Theresa Yeo, Co-Director of the Jefferson Pancreas Tumor Registry (JPTR)
• A PGY-1's Perspective: Conducting Pancreatic Cancer Research as a Medical Student
• INTERVIEW - Jonathan Brody, PhD - Pancreatic Cancer Specialist
• RESEARCH SPOTLIGHT - The Journal of Pancreatic Cancer
• Pancreatic Cancer Research at Jefferson: The Mary Halinski Pancreatic Cancer Research Fund
• The Gibbon Surgical Society
• Contributors
• Samuel D. Gross Professor of Surgery: Charles J. Yeo, MD, FACS

Functional Radical Cervical Dissection For Differentiated Thyroid Cancer: The Experience Of A Single Center, Tulin Adrian, Lucian Alecu, Catalina Poiana, Luminita Tomescu, Iulian Slavu, Raluca Tulin, Silviu Pituru, Cristina Orlov, Radu Jecan, Balalau Cristian, Anca Pantea Stoian, Razvan Hainarosie, Cornelia Nitipir

Journal of Mind and Medical Sciences

There is ongoing debate regarding the role of neck dissection in differentiated thyroid cancer, about its usefulness in elective settings, and the increased costs regarding morbidity and operative time. This retrospective study aimed to determine the rate of metastases in cervical lymph nodes, to examine the morbidity of this surgery, and to assess whether a pattern of distribution of tumor cells concerning neck lymphatic compartments exists. The most frequent type of cancer to metastasize was papillary cancer, the majority of patients were young with a median of 30 years, predominantly females. Differentiated thyroid cancer frequently metastasizes to the central and …

Quality Of Life After Functional Endoscopic Sinus Surgery In Patients With Chronic Rhinosinusitis, Sadaf Qadeer, Shabbir Akhtar, Montasir Junaid, Muhammad Sohail Halim

Section of Otolaryngology, Head & Neck Surgery

Chronic Rhinosinusitis (CRS) is a group of disorders characterized by the inflammation of mucosa of the nasal passages and paranasal sinuses. It includes chronic rhinosinusitis with polyps, CRS without polyps and Allergic Fungal Sinusitis (AFS). This debilitating disease causes negative impact on quality of life (QOL) of patients. Functional endoscopic sinus surgery (FESS) is the mainstay of surgical treatment for patients and improves QOL of patients. This subjective assessment of QOL can be measured by disease specific questionnaires. SNOT-22 questionnaire is widely used and validated questionnaire for this purpose. Prospective study was done on 54 patients. Data were collected using …

A Variant Of The Sciatic Nerve And Its Clinical Implications., Graham Dupont, Florence Unno, Joe Iwanaga, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Variants of gluteal neural anatomy are important to consider, especially during surgical approaches to the hip. During the routine dissection of the gluteal region, a variant of the sciatic nerve was found where the nerve left the pelvis fully split into its tibial and common fibular components. Intrapelvically and extrapelvically, there was no splitting of the two components by the piriformis muscle. Distally, the two parts of the nerve were draped over the medial and lateral edges of the ischial tuberosity. To avoid iatrogenic injury to the sciatic nerve during invasive or surgical approaches to this region, all possible anatomical …

Standardized Discharge Instructions And Their Impact On Post Operative Patient Knowledge, Nikolaus Hjelm, Md, Gregory Epps, Md, Ryan Rimmer, Md, Lauren Bogdan, Md, Erin Reilly, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

After every surgery, surgeons send their patients home with discharge instructions. The information is intended to educate the patients about their postoperative care and how to safely care for themselves upon returning home. Each surgeon reviews and approves the discharge instructions before they are given to their patients. This information is once again reviewed by the patient’s nurse before the patient leaves the hospital.

Within a large hospital, there are often several surgeons within each specialty that perform the same surgeries. The department of Otolaryngology at Thomas Jefferson University Hospital is no exception. Within otolaryngology there are several subspecialties. At …

Benchmarking Rectal Cancer Care: Institutional Compliance With A Longitudinal Checklist., William C. Chapman, Pamela Choi, Alexander T. Hawkins, Steven R. Hunt, Matthew L. Silviera, Paul E. Wise, Matthew G. Mutch, Sean C. Glasgow

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: In 2012, the American Society of Colon and Rectal Surgeons published the Rectal Cancer Surgery Checklist, a consensus document listing 25 essential elements of care for all patients undergoing radical surgery for rectal cancer. The authors herein examine checklist adherence in a mature, multisurgeon specialty academic practice.

MATERIALS AND METHODS: A retrospective medical record review of patients undergoing elective radical resection for rectal adenocarcinoma over a 23-mo period was conducted. Checklists were completed post hoc for each patient, and these results were tabulated to determine levels of compliance. Subgroup analyses by compliance and experience levels of the treating surgeon …