Surgical Procedures, Operative Commons^™

Endoscopic Transventricular "Inside-Out" Corpus Callosotomy: Illustrative Case, Michael Baumgartner, Elias Atallah, Kathleen Galligan, Pamela Mcdonnell, Benjamin Kennedy

Department of Neurosurgery Faculty Papers

BACKGROUND: Tonic and atonic "drop attack" seizures are a classic and morbid semiology in Lennox-Gastaut syndrome, resulting in frequent injuries and emergency room visits, in addition to neurocognitive sequelae. Recent years have seen a growing interest in less invasive techniques for performing the classic surgical treatment for drop attacks in Lennox-Gastaut syndrome, that is, corpus callosotomy.

OBSERVATIONS: A 5-year-old boy with Lennox-Gastaut syndrome presented for surgical evaluation. He experienced up to 20 daily tonic seizures despite multiple antiseizure medications. Preoperative imaging revealed highly abnormal anatomy with severe ventriculomegaly and thinning of the cortex and corpus callosum. Open microsurgery or an …

Microvascular Autologous Breast Reconstruction With The Lateral Thigh Perforator Flap, Stefania M.H. Tuinder, Joep A.F. Van Rooij, Robert J. Allen

School of Medicine Faculty Publications

The lateral thigh perforator flap is an excellent alternative to the deep inferior epigastric artery perforator (DIEP) flap for patients with absolute or relative contraindications for a DIEP flap and adequate volume at the lateral thigh. Preoperative physical examination, preoperative markings, and radiological perforator mapping are essential for adequate surgical preparation. The flap is based on septocutaneous perforators of the lateral circumflex femoral artery, located in the posterior septum between the tensor fascia latae and the gluteus medius muscle. Being relatively stiff, septocutaneous perforators are sensitive to kinking and compression, which is important to keep in mind during flap inset. …

Changing Landscape Of Liver Transplant In The United States—Time For A New Innovative Way To Define And Utilize The “Non-Standard Liver Allograft”—A Proposal, Rashmi Seth, Kenneth Andreoni

Department of Surgery Faculty Papers

Since the first liver transplant was performed over six decades ago, the landscape of liver transplantation in the US has seen dramatic evolution. Numerous advancements in perioperative and operative techniques have resulted in major improvements in graft and patient survival rates. Despite the increase in transplants performed over the years, the waitlist mortality rate continues to remain high. The obesity epidemic and the resultant metabolic sequelae continue to result in more marginal donors and challenging recipients. In this review, we aim to highlight the changing characteristics of liver transplant recipients and liver allograft donors. We focus on issues relevant in …

Clinical Implementation Of Tissue-Sparing Posterior Cervical Fusion: Addressing Market Access Challenges, Morgan Lorio, Pierce Nunley, Joshua Heller, Bruce Mccormack, Kai-Uwe Lewandrowski, Jon Block

Department of Neurosurgery Faculty Papers

Background: The traditional open midline posterior cervical spine fusion procedure has several shortcomings. It can cause soft tissue damage, muscle atrophy, compromise of the lateral masses and painful prominent posterior cervical instrumentation or spinous process if there is dehiscence of the fascia. Additionally, patients frequently experience the rapid development of adjacent segment disease, which can result in the reemergence of debilitating pain and functional impairment. Clinical relevance: Tissue-sparing posterior cervical fusion is an alternative method for treating patients with symptomatic cervical degenerative disc disease. However, widespread clinical adoption has been challenged by ambiguity, misunderstandings and misinterpretations regarding appropriate procedural reimbursement …

Advanced Visualization In Minimally Invasive Spine Surgery: The Ergonomics, Economics, And Evolution Of Camera-Based Tubes And Retractors, Advith Sarikonda, Ahilan Sivaganesan, Sheeraz Qureshi

SKMC Student Presentations and Publications

BACKGROUND: Tubular spine surgery has emerged as a hallmark of minimally invasive spine (MIS) procedures. In recent years, thanks to technological advances, tubular dilators and retractors have been integrated with digital cameras to allow for ergonomic, high-definition visualization of the surgical field.

OBJECTIVE: To detail the evolution, ergonomics, economics, and outcomes of camera-based tubular spine surgery, spanning the origins of MIS tubular techniques to the current use of operative microscopes and tube-mounted digital cameras (TMDCs).

METHODS: This is a narrative review of studies examining the evolution of tubular spine surgery as well as its most recent advances, with a particular …

Technical Considerations In Robotic Aberrant Right Subclavian Artery Resection For Dysphagia Lusoria, Luke Meredith, Emily Isch, Mohammed Ali, Michael Nooromid, Olugbenga Okusanya

Department of Surgery Faculty Papers

Dysphagia lusoria occurs due to compression of the esophagus as an aberrant right subclavian artery (ARSA) crosses the mediastinum. Surgical management includes open, hybrid, and endovascular techniques, with no consensus gold standard. There are few reports of robotic-assisted ARSA resection. We describe the innovative technique and outcomes for two patients who successfully underwent robotic-assisted transthoracic resection of an ARSA after right carotid–subclavian bypass for dysphagia lusoria. Both patients experienced improvement or resolution of their dysphagia and no major complications. In select patients with a noncalcified origin of the ARSA without aneurysmal degeneration, the robotic-assisted approach represents a viable option.

Staged Endovascular And Open Surgical Approach For Treatment Of A Giant Left Upper Back Arteriovenous Malformation, Nitya Venkat, Avinash Saraiya, M. Irfan Ali, Matthew Jenkins, Stavropoula Tjoumakaris, Babak Abai

Department of Surgery Faculty Papers

We present a case of a symptomatic, giant, left upper back arteriovenous malformation that was treated through a staged endovascular and open approach. Through a series of embolizations, followed by resection, we were able to preserve the limb and upper back neurovascular supply, demonstrating an approach to preserve sensation and function and improving quality of life.

Comparison Of Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction With Allograft Versus Autograft: A Matched-Cohort Analysis, Jeffrey Henstenburg, Josuhu Pezzulo, Dominic Farronato, Emma Johnson, John Bodnar, Philip Petrucelli, Christopher Dodson, Kevin Freedman, Steven Cohen, Sommer Hammoud

Rothman Institute Papers

BACKGROUND: Disruption of the medial patellofemoral ligament (MPFL) may lead to recurrent lateral patellar dislocation and patellofemoral chondral injury. Despite significant previous work investigating numerous performance parameters, the optimal graft choice for MPFL reconstruction for patellar instability remains unclear.

PURPOSE: To compare functional outcomes scores, subjective recurrent instability, and revision rates between autograft and allograft in MPFL reconstruction.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Patients who underwent MPFL reconstruction with autograft between 2013 and 2018 were identified. A 2:1 comparison group of patients who underwent MPFL reconstruction with allograft was matched by sex, age (±3 years), and …

Social Vulnerabilities In Head-Neck Melanoma Care: A Retrospective Cohort Study In The United States, Lillian Mccampbell, David Jun Fei-Zhang, Daniel Chelius, Ling-Lun Bob Hsia, Robert Dellavalle, Jill D'Souza, David Bentrem, Jeffrey Wayne, Jeffrey Rastatter, Anthony Sheyn

School of Medicine Faculty Publications

BACKGROUND: Studies addressing social determinants of health (SDH) in head-neck melanomas (HNM) have only assessed socioeconomic factor impact but not a wider scope of SDH. OBJECTIVE: Utilizing the Social Vulnerability Index (SVI), to assess the influence of specific SDH and their quantifiable associations with HNM management disparities across the varied community contexts in the United States. METHODS: This retrospective cohort study analyzed adults diagnosed with HNM from 1975 to 2017 from the Surveillance, Epidemiology, and End Results Program database. RESULTS: A total of 374,138 HNM in adults from 1975 to 2017 were assessed for disparities affiliated with increasing overall vulnerability/SVI …

Electrocautery Wire Fenestration Prior To Thoracic Endovascular Aortic Repair To Optimize The Distal Landing Zone In Thoracic Aortic Dissections, Nicola Habash, Gaurang Joshi, Mohammed Ali, Michael Nooromid, Babak Abai

Department of Surgery Faculty Papers

Successful thoracic endovascular aortic repair (TEVAR) for type B aortic dissections (TBAD) relies on securing the stentgraft’s distal landing zone to prevent retrograde flow and false lumen pressurization. We describe a 60-year- old male with a TBAD undergoing TEVAR with electrocautery-wire fenestration of the dissection septum, providing a controlled method to enhance the distal landing zone for graft placement. Postoperatively, the patient experienced spinal cord ischemia, resolving with the placement of a lumbar drain and increasing mean arterial pressures. Follow-up imaging demonstrated a well-sealed repair without endoleaks. This case highlights the importance of surgical technique selection and postoperative monitoring for …

Randomized Controlled Trial Of Enhanced Recovery After Surgery Protocols In Live Kidney Donors: Eraskt Study, Jacob Saks, Uzung Yoon, Natalie Neiswinter, Eric Schwenk, Stephen Goldberg, Linh Nguyen, Marc Torjman, Elia Elia, Ashesh Shah

Department of Anesthesiology Faculty Papers

BACKGROUND: Enhanced recovery after surgery (ERAS) pathways represent a comprehensive approach to optimizing perioperative management and reducing hospital stay and cost. In living donor kidney transplantation, key impediments to postoperative discharge include pain, and opioid associated complications such as nausea, vomiting, and the return of gastrointestinal function.

METHODS: In this randomized controlled trial, living kidney transplantation donors were assigned to either the ERAS or control group. The ERAS group patients received 15 preoperative, 17 intraoperative, 19 postoperative element intervention. The control group received standard care. The ERAS group received a multimodal opioid sparing pain management including an intraoperative transverse abdominis …

Editorial: Management Of Pji/Ssi After Joint Arthroplasty, Li Cao, Javad Parvizi, Xiaogang Zhang, Xianzhe Liu, Wierd Zijlstra, Saad Tarabichi

Rothman Institute Papers

The management of periprosthetic joint infection (PJI) and surgical site infection (SSI) after joint arthroplasty poses a major challenge in orthopedic surgery. This Editorial provides an overview of the studies published in the special issue "Management of PJI/SSI after Joint Arthroplasty", summarizing the key findings from these studies, which cover a wide range of topics, including stringent preventive strategies, comprehensive diagnostic methods, and personalized treatment modalities. The authors concluded the editorial with their perspectives regarding the status quo of research in this field and future directions for research, such as the development of novel antibiotics, biofilm research, patient-specific risk factors, …

Combining Novel Thrombectomy Devices For Intracardiac Mass Extraction: The Kong And Godzilla Of Mass Extraction, Hussam Al Hennawi, Ahmad Abulshamat, Ali Sheikh, Hisham Qandeel, Kiril Zakharov, Appa Bandi, Mohammed Qintar

Abington Jefferson Health Papers

Transcatheter extraction of an intracardiac mass is a newer approach that may lead to nonsurgical treatment of complex cardiac masses. We present a case in which thrombectomy devices were combined to extract a right atrial mass, which highlights new frontiers in the treatment of complex transcatheter mass extraction. The combined use of two transcatheter thrombectomy devices (Kong and Godzilla) may provide a powerful addition to the existing armamentarium.

Automated Orthopedic Impactor, Joshua P. Kannankunni, Maria F. Fletcher, Olivia K. Kam

Biomedical Engineering

We were tasked by Dr. Dimitri Delagrammaticas, an orthopedic surgeon, to develop an automatic impaction device to use in hip arthroplasties. The goal of this project is to create and design the mechanical internals for an electric impactor device to aid in the impaction of orthopedic devices and reduce the risk of surgeon injuries. The stakeholders include our sponsor Dimitri Delagrammaticas and other orthopedic surgeons, patients in need of hip arthroplasty, hospitals, and Dr. Berg-Johansen. Dr. Berg-Johansen will be reviewing the design process and documentation for the duration of the senior design project. The Automated Orthopedic Impactor will solely focus …

The Practice Experience Of An Adult Reconstruction Surgeon: A Cross-Sectional Analysis And Survey Of The American Association Of Hip And Knee Surgeons Membership, David E. Demik, Anna Cohen-Rosenblum, David C. Landy, Joshua Kerr, Justin T. Deen, Prem N. Ramkumar, Jenna Bernstein

School of Medicine Faculty Publications

BACKGROUND: As demand for total hip arthroplasty and total knee arthroplasty increases, more surgeons have pursued subspecialty training in adult reconstruction. However, little information is available regarding the practice environment in which these fellowship-trained surgeons practice. The purpose of this study was to describe the practice environments of contemporary adult reconstruction surgeons. METHODS: A survey was developed and distributed to members of the American Association of Hip and Knee Surgeons from December 2022 to January 2023. Information was collected on surgeon demographics, practice setting, call requirements, and educational debt. Responses were recorded using frequencies and proportions. RESULTS: A total of …

Occipital Nerve Block For Headaches: A Narrative Review., William H. Arata, Rajiv K. Midha, Giustino Varrassi, Kelly Sala, Michael J. Plessala, Jared Brodtmann, Kylie Dufrene, Zachary Palowsky, Patricia Griffin, Shahab Ahmadzadeh, Sahar Shekoohi, Alan D. Kaye

School of Medicine Faculty Publications

The occipital nerve block involves the injection of a local anesthetic and possibly a corticosteroid near the occipital nerves at the base of the skull and aims at providing relief from chronic headaches by temporarily numbing or reducing inflammation around the occipital nerves. It has proven to be efficacious in treating chronic headaches, especially those that are refractory to medication; it is both diagnostic and therapeutic with symptom abatement from weeks to months. Occipital nerve blocks can be utilized alone or with standard-of-care therapy for various other headache conditions, such as cluster headaches, episodic headaches or chronic migraines. This review …

Development And External Validation Of The 'Global Surgical-Site Infection' (Glossi) Predictive Model In Adult Patients Undergoing Gastrointestinal Surgery, Viren P. Punja, Melanie K. Sion, Michael S. Weinstein

Department of Medicine Faculty Papers

Background: Identification of patients at high risk of surgical-site infections may allow surgeons to minimize associated morbidity. However, there are significant concerns regarding the methodological quality and transportability of models previously developed. The aim of this study was to develop a novel score to predict 30-day surgical-site infection risk after gastrointestinal surgery across a global context and externally validate against existing models. Methods: This was a secondary analysis of two prospective international cohort studies: GlobalSurg-1 (July-November 2014) and GlobalSurg-2 (January-July 2016). Consecutive adults undergoing gastrointestinal surgery were eligible. Model development was performed using GlobalSurg-2 data, with novel and previous scores …

Pain Outcomes In Adolescents With Surgically Confirmed Endometriosis: A Single Site Retrospective Cohort Analysis, Madeline Ross, Samantha Janssen, Priya Suvarna, Adam Booser, Ashli Lawson

Research Days

Background: In adolescents with significant dysmenorrhea, empiric therapy via analgesics and hormonal medications is considered gold standard. However, those with refractory pain may have endometriosis. Thus, it is recommended to engage in shared medical decision making with these patients regarding diagnostic laparoscopy. If endometriosis is detected intraoperatively, these lesions are often fulgurated or excised. There currently is a paucity of data regarding the benefits of diagnostic laparoscopy and destruction of lesions in the adolescent population.

Objectives/Goal: To evaluate long-term pain management outcomes and care patterns in adolescent patients undergoing surgical evaluation for endometriosis.

Methods/Design: This was a single-site, retrospective cohort …

Case Of An Adolescent Girl With Familial Vulvar Leiomyoma, Madeline Ross, Charlene Dekonenko, Rebecca Rentea, Tazim Dowlut-Mcelroy

Research Days

Background

While uterine leiomyomas remain a common occurrence affecting nearly 30% of adult women above 35yo, leiomyomas can arise anywhere smooth muscle cells are located in the body. Vulvar leiomyomas are a particularly rare diagnosis, often misdiagnosed as Bartholin gland cyst, comprising 0.07% of vulvar tumors, and thought to arise from smooth muscle within the round ligament, erectile tissue, and dartos muscle. Even more rare is the presentation of vulvar leiomyoma in the adolescent population and family history of vulvar leiomyoma.

Case

We present the case of a 16yo girl who noticed a painless vulvar mass that had increased in …

An Unexpected Finding During A Breast Excisional Biopsy: A Case Report, Emily Forester, Anjeanette Brown

Rowan-Virtua Research Day

Background: Pacemaker leads within the breast are rare. Although it is infrequent, there are some reports of implanted cardiac devices or wires migrating into breast tissue or through the chest wall. To the best of our knowledge, there are no current reports of pacemaker leads within the breast tissue of a patient with concurrent breast cancer. This case aims to detail the surgical management of this rare phenomenon.

Case Presentation: A pacemaker-dependent, female patient presented to the operating room for a left breast excisional biopsy. Intraoperatively, two epicardial leads were unexpectedly found within the center of the patient’s breast tissue. …