Surgery Commons^™

Transoral Endoscopic Stapled Diverticulotomy For Pediatric Esophageal Diverticulum: A Case Report, Nadeen Alturki, Huma Quraishi, Keith A. Kuenzler

Manuscripts, Articles, Book Chapters and Other Papers

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Introduction

Pharyngoesophageal diverticula are rare in the pediatric population and are typically managed with open surgical approaches. Minimally invasive surgical (MIS) approaches are well established in adults however, to date, no MIS technique for pediatric esophageal diverticula has been described in the literature.

Case presentation

A 12-year-old female presented with neck and chest pain, dysphagia, and difficulty breathing and speaking following ingestion of food from a broken glass jar. Imaging demonstrated a retropharyngeal abscess with a retained foreign body requiring thoracoscopic drainage. The patient subsequently developed a cervical esophageal diverticulum associated with persistent symptoms. She underwent transoral endoscopic stapled diverticulotomy …

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Transforaminal Endoscopic Lumbar Decompression: Defining Its Scope And Limitations, Kai-Uwe Lewandrowski, Álvaro Dowling, Jun Ho Lee, Benedikt W Burkhardt, Óscar L. Alves, Avelino Parajón, Jorge Felippe Ramirez, Nicola Montemurro, Alex R. Vaccaro, Morgan P. Lorio

Department of Orthopaedic Surgery Faculty Papers

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BACKGROUND: Transforaminal endoscopic lumbar decompression (TELD) has emerged as a minimally invasive alternative for managing lumbar stenosis and disc herniations. While the literature consistently reports favorable outcomes, real-world adoption remains variable, with discrepancies often linked to surgeon experience and case complexity.

OBJECTIVE: To evaluate surgeon perspectives on the clinical applicability of TELD across different pathologies and compare these findings with published evidence.

METHODS: An international cross-sectional survey was conducted among spine surgeons. Responses were analyzed using Rasch modeling to assess consensus levels, with agreement categorized as strong, moderate, weak, or disagreement. Differential Item Functioning (DIF) and correlation analyses were applied …

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An Unusual Case Of Bilateral Upper And Lower Oral Cavity Cysts In A Newborn, Frances Rodriguez Lara, Jillian L. Chen, Jennifer N. Shehan, Jessica R. Levi

HCA Healthcare Journal of Medicine

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Background

Oral mucosal lesions in newborns have a broad differential diagnosis, ranging from benign, transient conditions to potential early signs of systemic disease. Most of these lesions are resolved without intervention, but delayed recognition can lead to complications, such as airway obstruction. Early identification is crucial for appropriate management. This case report discusses an unusual presentation of multiple oral mucosal cysts in a newborn, emphasizing the challenges of diagnosis and management.

Case Presentation

A 1-day-old male was evaluated at Boston Medical Center for cystic oral lesions identified during newborn screening. The infant was born at 36 weeks and 2 days’ …

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Using Mohs Micrographic Surgery To Treat A Large, Pedunculated Trichoblastoma On The Upper Cutaneous Lip, Richard G. Bindernagel Jr., Addie Walker, Richard Miller

HCA Healthcare Journal of Medicine

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Trichoblastomas are uncommon adnexal tumors that usually occur on the face. We report a case of a 62-year-old White man with a large, asymptomatic, slow-growing lesion that had been on his right upper cutaneous lip for 15 years. A 2 cm pink, pedunculated nodule with telangiectasia was seen on examination. A shave biopsy was consistent with trichoblastoma: a circumscribed-appearing dermal tumor of basaloid cells arranged in cords and islands within a cellular stroma, focal epidermal connection, and papillary mesenchymal bodies. The patient elected for treatment with Mohs micrographic surgery (MMS) given the length of time that the tumor had been …

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Effect Of Androgen Receptor Polymorphism On Hypogonadism Severity And Efficacy Of Testosterone Replacement Therapy, Nelson W Mills, Beatriz S Hernandez, Peyton J Coady, Arnaav Walia, Gal Saffati, Daniela Orozco Rendon, Dalia Khera, Nadia Khera, Weitao Song, Mohit Khera

Faculty, Staff and Students Publications

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Background: The preferred treatment for hypogonadism, testosterone replacement therapy (TRT), has a varying efficacy that is currently not fully understood. This observation may be explained by polymorphism of the androgen receptor (AR), a ligand-binding transcription factor whose polyglutamine tract length affects various health conditions and androgen sensitivity. It has been theorized that this polymorphism may also affect the severity of hypogonadism. This study sought to determine a correlation between hypogonadism severity, TRT efficacy, and number of CAG trinucleotide repeats in the AR gene.

Methods: One hundred sixty-two males presenting to a single institution with symptoms of hypogonadism were recruited for …

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Targeted Inhibition Of Atr Kinase Promotes Antitumor Immunity In Hnscc Through Enhanced Sting Activation And T Cell Function, Fabio Hb Da Costa, Mutsuki Kawabe, Tsung-You Tsai, Kento Okamoto, Mason D Bartels, Sofia Cortes, Ratna Veeramachaneni, Roberto Rangel, Mitchell J Frederick, Vlad C Sandulache, Andrew G Sikora, Jeffrey N Myers, Abdullah A Osman

Faculty, Staff and Students Publications

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Objectives: Oral cavity head and neck squamous cell carcinoma (HNSCC) represents a major global health burden, with over 40,000 new cases annually in the United States and >500,000 worldwide. Despite advances in surgery, radiation therapy, chemotherapy, and immunotherapy, overall survival rates have remained largely stagnant over the past three decades, and over half of patients ultimately die from the disease. Although immune checkpoint inhibitors (ICIs) have improved outcomes for a subset of patients with recurrent or metastatic HNSCC, the majority gain limited benefit. Thus, novel therapeutic strategies that enhance responses to immunotherapy are urgently needed. The ATR-CHK1 signaling pathway has …

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Management Algorithm For Vasoplegic Shock After Cardiac Surgery: An Interdisciplinary Collaboration, Subhasis Chatterjee, Jamel Ortoleva, Rakesh C Arora, Kelci R Dalton, Daniel T Engelman, Natalia Ivascu Girardi, Michael C Grant, Travis J Miles, Marc R Moon, Orlando R Suero, Erica Wittwer, Patrick M Wieruszewski

Faculty, Staff and Students Publications

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Background: Vasoplegic shock is distributive shock that follows cardiopulmonary bypass, characterized by hypotension, low systemic vascular resistance, and catecholamine resistance despite preserved or elevated cardiac output. Reported incidence ranges from 5% to 50%. Associated adverse outcomes include acute kidney injury, prolonged intensive care unit stay, and mortality. A single, universally accepted consensus definition is lacking, and few evidence-based best-practice management strategies exist.

Methods: A panel of 12 clinicians-cardiac surgeons, anesthesiologists, intensivists, and pharmacists-from 6 institutions conducted a structured expert review. PubMed and Embase were searched for research studies, including clinical trials, retrospective analyses, and mechanistic studies covering epidemiology, risk factors, …

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Isr 84 - Improving Documentation Accuracy Of Surgical Site Infection Prevention Bundles Using Implementation Science Frameworks, Laura Fraser, Lynn M. Sackett-Hodge, Michelle Schaeffer, Pamela S. Bozigar

Conference Presentation Abstracts

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Accurate documentation of Surgical Site Infection (SSI) prevention bundle components is essential for quality improvement and patient safety. In National Healthcare Safety Network (NHSN)-reported colon (COLO) and hysterectomy (HYST) procedures, incomplete or inconsistent documentation undermines bundle fidelity and limits evaluation of outcomes. This initiative aims to determine whether embedding evidence-based interventions within implementation science frameworks improves documentation accuracy and ensures sustainability.

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Financial Implications Of Vascular Surgery Conference Fees, Alexandra Kats, Gerard M. Martin, Sanath Patil, Joshua R. Chen, Paul J. Dimuzio, Dawn Salvatore, Michael Nooromid, Babak Abai

Department of Surgery Faculty Papers

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BACKGROUND: Conferences are an important venue for trainees and students to engage in scholarly activities and networking. However, cost presents a significant consideration for students looking to attend conferences as institutional funding varies. In this study, we analyze the attendance costs of vascular conferences.

METHODS: Thirty-one vascular surgery conferences were identified with 12 regional and 6 national, and 13 international. Invitation-only conferences were excluded from the analysis. Cost of attendance was stratified by early and regular registration timing and attending, trainee, and student status. Additionally, conference websites were queried individually for scholarship opportunities. Data was presented descriptively and compared using …

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Outcomes In Single Versus Two-Stage Surgical Stabilization Of Complex Bilateral Chest Wall Injury: A Single-Center Experience., Alexis A Schweibinz, Jaya S Varre, Anna Graham, William B Devoe

Surgery Articles

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INTRODUCTION: Surgical stabilization of rib fractures (SSRF) continues to show benefit for severe chest wall injury (CWI) with improvement in morbidity and mortality following stabilization. Complex bilateral injuries pose a clinical and technical challenge. Currently, there is no formal recommendation for an approach to repair such injuries, whether that be bilateral SSRF within the index case or staged repair. We sought to describe our institutional experience with this subset of patients, identify factors that may influence the decision to pursue single- versus two-stage procedures, and assess the potential benefit of combined bilateral SSRF during the index operation.

METHODS: A retrospective, …

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Notch1 Acts As A Tumor Suppressor That Induces Early Differentiation In Head And Neck Cancer, Chenfei Huang, Shhyam Moorthy, Qiuli Li, Kazi M Ahmed, Kalil Saab, Defeng Deng, Jiping Wang, Xiayu Rao, Jiexin Zhang, Yuanxin Xi, Jing Wang, Zhiyi Liu, Noriaki Tanaka, David A Wheeler, Eve Shinbrot, Rami Saade, Curtis R Pickering, Tong-Xin Xie, Adel K El-Naggar, Abdullah A Osman, Kunal Rai, Patrick A Zweidler-Mckay, John V Heymach, Lauren A Byers, Faye M Johnson, Vlad C Sandulache, Jeffrey N Myers, Pedram Yadollahi, Mitchell J Frederick

Faculty, Staff and Students Publications

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Inactivating NOTCH1 mutations in head and neck squamous cell carcinoma (HNSCC) were described over a decade ago, suggesting a tumor suppressor function - unlike its oncogenic role in other tumors. Today, much debate persists regarding a putative oncogenic role in HNSCC as well, with reports that NOTCH1 signaling drives tumor growth and a cancer stem cell (CSC) phenotype. In this work, comprehensive experiments unequivocally demonstrate that NOTCH1 is a tumor suppressor in HNSCC regardless of mutation or activation status and that it reduces CSC frequency. We developed a signature of NOTCH1 activation showing the pathway is associated with very early …

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Impact Of Lumen Origin And Gap Distance On Target Vessel Outcomes Following Fenestrated-Branched Endovascular Aortic Repair Of Postdissection Thoracoabdominal Aortic Aneurysms, Armin Tabiei, Jesse Chait, Andrea Vacirca, Randall R Demartino, Emanuel R Tenorio, Fahad Shuja, Dora Babocs, Guilherme B B Lima, Naveed Saqib, Gustavo S Oderich, Bernardo C Mendes

Faculty, Staff and Students Publications

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Background: This study evaluated the role of target vessel (TV) lumen origin and fenestration gap (FG) distance between the endograft and the aortic wall on TV outcomes following fenestrated-branched endovascular aortic repair (FB-EVAR) for postdissection thoracoabdominal aortic aneurysms (PD-TAAAs).

Methods: A multicenter review of prospectively and retrospectively collected data of patients undergoing FB-EVAR for PD-TAAAs between 2013 and 2023 was performed. Lumen origin was retrospectively analyzed on preoperative imaging studies and classified as true lumen (TL) only, false lumen (FL) only, or both TL and FL. The FG distance was retrospectively measured on postoperative imaging studies and included as a …

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Artelon Graft Augmentation In Revision Anterior Cruciate Ligament Reconstruction: Surgical Technique Guide., Taylor Manes, Morgan Turnow, Trent Davis, Anthony Perugini, Michael Anderson, Benjamin Taylor

Surgery Articles

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INTRODUCTION: Revision anterior cruciate ligament (ACL) procedures are becoming more prevalent. Variable grafts for ACL reconstruction are available, including autograft, allograft, and synthetic graft options. Various augmentation techniques are also available and typically consist of synthetic material such as Artelon graft. This type of synthetic material has been used and shown to produce safe and reliable augmentation in ligament injuries. The purpose of this study was to describe our unique revision ACL reconstruction technique utilizing Artelon graft augmentation and report our short-term results.

MATERIALS AND METHODS: We retrospectively reviewed patients undergoing revision ACL reconstruction with Artelon graft augmentation, a Flexband …

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Robotic-Assisted Pedicle Screw Placement Achieves High Accuracy And Narrows The Experience Gap: A Preclinical Evaluation, Anna T. Reza, Matthias Walper, Mitchell K. Ng, Paul G. Mastrokostas, Andrew S. Lee, Rafael G. Rafael, Kornelis A. Poelstra, Ratliff K. John, Rajiv K. Sethi, Michael A. Mont

Rothman Institute Papers

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To assess a robotic-assisted system versus open manual techniques to: (1) compare pedicle screw accuracy between fellows and attendings with and without robotic assistance, and (2) evaluate executed versus planned trajectory fidelity relative to prior reports. Robotic-assisted spine systems aim to improve the accuracy, reproducibility, and safety of pedicle screw placement. Limited evidence compares outcomes across differing surgeon experience levels. A total of 255 thoracolumbar pedicle screws were placed in synthetic torsos simulating adult degenerative anatomy. Four surgeons (two fellows, two attendings) each placed half their screws using open fluoroscopy-guided techniques and half using a minimally invasive percutaneous approach with …

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Cancer Workforce-A Global Crisis: A Lancet Oncology Commission, Hedvig Hricak, Zachary Ward, Fabio Moraes, Andrew Scott, Farouk Dako, Wilfred Ngwa, Cynthia Villarreal-Garza, May Abdel-Wahab, Stephen Avery, Miriam Mutebi

General Surgery, East Africa

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No abstract provided.

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Impact Of Gum Chewing On Postoperative Ileus Following Open Heart Surgery At Swedish Cherry Hill, Jacinta Smith

All Podium Presentations

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No abstract provided.

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Lymph Node Dissection And Postoperative Complications After Lung Cancer Resection, Isheeta Madeka, Khaled Noueihed, Jacob Woodroof, Shale Mack, Hamza Rshaidat, Gregory L Whitehorn, Sneha Alaparthi, Scott H. Koeneman, Tyler R. Grenda, Nathaniel R. Evans, Iii, Olugbenga T. Okusanya

Department of Surgery Faculty Papers

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Importance: Current lung cancer guidelines recommend lymph node sampling (LNS) with the 3 + 1 rule, which recommends station-based sampling with at least 3 N2 (mediastinal) and 1 N1 (hilar) nodal stations. Although there is oncologic benefit to rigorous LNS, potential negative impacts on surgical outcomes have not been well investigated. As adoption of the 3 + 1 rule increases given its formalization as guideline-concordant care, associations with adverse outcomes are crucial to characterize.

Objective: To evaluate whether satisfying the 3 + 1 rule is associated with increased postoperative complications.

Design, setting, and participants: This retrospective cohort study used the …

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Beyond Regulation: Why Europe Must Lead Ai Stewardship In Health, Luca Saba, Ignazio R. Marino

Department of Surgery Faculty Papers

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No abstract available

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Outcomes After Elective Total Aortic Arch Replacement: Does Obesity Matter?, Vicente Orozco-Sevilla, Michael Tyler Guinn, Ivan Murrieta-Alvarez, Veronica A Glover, Susan Y Green, Subhasis Chatterjee, Scott A Lemaire, Marc R Moon, Joseph S Coselli

Faculty, Staff and Students Publications

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Objective: Obesity is a chronic disease linked to high mortality and morbidity after cardiac procedures, but its relationship to outcomes after total aortic arch replacement (TAR) remains unclear. We examined TAR data to determine whether obesity is associated with greater perioperative risk.

Methods: Among 787 TARs performed from 1990 to 2023, we excluded patients who lacked body mass index (BMI) data, had nonelective or nonstandard repairs, or were underweight (BMI < 18.5 kg/m2). The remaining 521 patients did not have obesity (18.5 ≤BMI < 30; n = 389) or did (BMI ≥30; n = 132). Patients with obesity were class 1 (30 ≤ BMI < 35), class 2 (35 ≤ BMI < 40), or class 3 (BMI ≥40). We compared preoperative and perioperative variables for BMI ≥30 (obesity) versus BMI < 30. Adverse events were operative mortality, persistent stroke, spinal cord deficit, and renal failure. We performed multivariable logistic regression and Kaplan-Meier survival analysis.

Results: Patients with obesity had greater rates of obstructive sleep apnea, transient spinal cord deficit, and acute renal dysfunction than patients with normal weight. During repair, the use of antegrade …

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The American Association For Thoracic Surgery Medical Student Opportunity Scholarship In Its Fifth Year: Are We Making Progress?, Marc R Moon

Faculty, Staff and Students Publications

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No abstract provided.

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