Surgery Commons^™

Analysis Of Patients Who Undergo Index Arthroscopy With Biopsy But Not Implantation For Staged Chondrocyte Cell Transplantation, Bryson R. Kemler, Emma E. Johnson, Brad M. Evert, Azra N. Dees, Alec M. Giakas, Adeeb Jacob Hanna, Taylor D'Amore, Kevin B. Freedman, Sommer Hammoud

Rothman Institute Papers

BACKGROUND: Autologous chondrocyte implantation (ACI) and matrix-induced autologous chondrocyte implantation (MACI) are 2-stage procedures requiring an index full-thickness cartilage biopsy. Only a portion of patients ultimately undergo second-stage ACI/MACI.

PURPOSE: To identify patients with articular cartilage defects who underwent arthroscopic debridement with biopsy for ACI/MACI and compare those who did with those who did not proceed with implantation within 2 years after biopsy. Additionally, the authors sought to identify why patients did not proceed with implantation.

STUDY DESIGN: Case-control study; Level of evidence, 3.

METHODS: Patients who underwent arthroscopy and autologous chondrocyte biopsy from January 1, 2015, to December 31, …

Endovascular Aneurysm Repair-First Strategy For Ruptured Abdominal Aortic Aneurysm Might Not Be Applicable To All Cases, Omkar Pawar, Anuja Sarode, Benjamin D. Colvard, Jae S. Cho

Faculty Scholarship

Background: We evaluate the relationship between the hospital case volume (HCV) and mortality outcomes after open aortic repair (OAR) and endovascular aortic repair (EVAR) of intact (iEVAR) and ruptured (rEVAR) abdominal aortic aneurysm (AAA) using a contemporary administrative database. Methods: The Healthcare Cost and Utilization Project Database for New York (2016) and New Jersey/Maryland/Florida (2016–2017) were queried using International Classification of Disease-10th edition to identify patients who had undergone OAR and EVAR. The hospitals were categorized into quartiles (Q) per overall (EVAR + OAR) volume, OAR-alone volume and EVAR-alone volume. Cox regression adjusted for confounding factors was used to estimate …

Simple And Epididymal-Sparing Orchiectomy For Surgical Castration In Stage Iv Prostate Cancer, Harrison Travis, Michael Dubic, Joseph Bardot, Blane Edwards, Jessie R. Gills, Scott E. Delacroix, Stephen Lacour, Matthew Mutter, Donald Bell, Mary E. Westerman

School of Medicine Faculty Publications

Background: Androgen deprivation therapy, the mainstay of treatment for patients with advanced prostate cancer, can be either medical or surgical. Surgery has cost benefits compared to medical treatment. In this study, we evaluated the use of simple and epididymal-sparing orchiectomy in 2 different practice settings for the treatment of metastatic prostate cancer. Methods: We reviewed patients who underwent surgical castration for metastatic prostate cancer between 2011 and 2022. The primary outcome was achieving castration-level total testosterone of /dL. We also compared the characteristics of patients who were seen at a public academic teaching hospital vs those who were seen at …

Work Where You Live Or Live Where You Work? Resident Work And Sleep Patterns While On "Home Call", David T Mitchell, Noa G Koppin, Michael T Talanker, Mohin A Bhadkamkar, Erik S Marques, Matthew R Greives, David C Hopkins

Faculty, Staff and Student Publications

Background: Unlike in-house call, the Accreditation Council for Graduate Medical Education (ACGME) does not require a postcall day for "home call" shifts. Despite this, we hypothesize that on-call residents are still in the hospital for the majority of their shift despite having the luxury of home call and, thus, are not protected by ACGME postcall duty hour regulations.

Methods: A prospective single center survey study was conducted by surveying junior and senior residents who completed overnight call shifts from January 2023 to April 2023 at one of the busiest level 1 trauma centers in the United States. Data include number …

American Association Of Plastic Surgeons Consensus On Breast Implant-Associated Anaplastic Large-Cell Lymphoma, Mark W Clemens, Terence M Myckatyn, Arianna Di Napoli, Andrew L Feldman, Elaine S Jaffe, Cara L Haymaker, Steven M Horwitz, Kelly K Hunt, Marshall E Kadin, Colleen M Mccarthy, Roberto N Miranda, H Miles Prince, Fabio Santanelli Di Pompeo, Sari D Holmes, Linda G Phillips

Faculty, Staff and Student Publications

BACKGROUND: In the absence of high-quality evidence, there is a need for guidelines and multidisciplinary consensus recommendations on breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). The purpose of this expert consensus conference was to evaluate the existing evidence regarding the diagnosis and management of BIA-ALCL caused by textured implants. This article aims to provide evidence-based recommendations regarding the management and prevention of BIA-ALCL.

METHODS: A comprehensive search was conducted in the MEDLINE, Cochrane Library, and Embase databases, and supplemented by manual searches of relevant English-language articles and "related articles" sections. Studies focusing on breast surgery and lymphoma associated with breast implants …

Artificial Intelligence-Based Segmentation Of Residual Pancreatic Cancer In Resection Specimens Following Neoadjuvant Treatment (Isgpp-2): International Improvement And Validation Study, Boris V Janssen, Bart Oteman, Mahsoem Ali, Pieter A Valkema, Volkan Adsay, Olca Basturk, Deyali Chatterjee, Angela Chou, Stijn Crobach, Michael Doukas, Paul Drillenburg, Irene Esposito, Anthony J Gill, Seung-Mo Hong, Casper Jansen, Mike Kliffen, Anubhav Mittal, Jas Samra, Marie-Louise F Van Velthuysen, Aslihan Yavas, Geert Kazemier, Joanne Verheij, Ewout Steyerberg, Marc G Besselink, Huamin Wang, Caroline Verbeke, Arantza Fariña, Onno J De Boer, Pancreatobiliary And Hepatic Artificial Intelligence Research (Phair) Consortium, International Study Group Of Pancreatic Pathologists (Isgpp);

Faculty, Staff and Student Publications

Neoadjuvant therapy (NAT) has become routine in patients with borderline resectable pancreatic cancer. Pathologists examine pancreatic cancer resection specimens to evaluate the effect of NAT. However, an automated scoring system to objectively quantify residual pancreatic cancer (RPC) is currently lacking. Herein, we developed and validated the first automated segmentation model using artificial intelligence techniques to objectively quantify RPC. Digitized histopathological tissue slides were included from resected pancreatic cancer specimens from 14 centers in 7 countries in Europe, North America, Australia, and Asia. Four different scanner types were used: Philips (56%), Hamamatsu (27%), 3DHistech (10%), and Leica (7%). Regions of interest …

Performance Of 5 Prominent Large Language Models In Surgical Knowledge Evaluation: A Comparative Analysis, Adam M. Ostrovsky, Joshua R. Chen, Vishal N. Shah, Babak Abai

Department of Surgery Faculty Papers

No abstract provided.

Rare Right-Sided Posterolateral Diaphragmatic Hernia In An Adult Presenting As An Incarcerated Large Bowel Obstruction: A Case Report, Tanya J. T. Starr, Andrew G. Nicholson, Maximillian J. H. Starr, Jessica A. Traxler, Peter Y. Chu

HCA Healthcare Journal of Medicine

Introduction

A diaphragmatic hernia (DH) is a defect within a part of the diaphragm that allows intra-abdominal contents to enter the thoracic cavity. Diaphragmatic hernias can be congenital or acquired later in life. The most common congenital DH is the Bochdalek hernia (posterolateral hernia), but the most commonly acquired DH is due to traumatic injury. These hernias are rare in adults and are typically diagnosed incidentally. Surgical repair is the standard of care; however, data regarding the surgical approach is scarce. We report a case of a rare right posterolateral DH in an adult female patient who presented with acute …

David Taylor Memorial Lecture: Insights Into The Origins Of Intracardiac Surgery, James K. Kirklin

The VAD Journal

David Taylor was an eminent luminary in the field of advanced heart failure and transplantation. As past president of the International Society for Heart and Lung Transplantation, he significantly impacted the field and was a mentor to many young heart failure cardiologists. In addition to many professional activities, David was an integral part of Brano meetings, including numerous eastern European trips promoting education and training in advanced heart failure, mechanical circulatory support, and transplantation

Recurrent High Grade Serous Endometrial Cancer With Brain Metastases: Immunotherapy Confers Improved Quality Of Life And Survival, Kierany B. Shelvin, Jill Vincent, Shawna Morron, Michael Morin, Aaron Mammoser, Navya Nair

School of Medicine Faculty Publications

No abstract provided.

Heartmate 3 As A Bridge To Transplant In An Adult With Failing Fontan Circulation, Kengo Z. Soghoyan, Stephen Cook, Maya Guglin

The VAD Journal

Mechanical circulatory support devices have demonstrated efficacy in adult congenital patients with biventricular repairs. The off-label use of ventricular assist devices may be invaluable for managing end-stage single ventricle failure. We present the case of a 27-year-old male who developed heart failure, congestive hepatopathy, and, ultimately, cardiogenic shock. He received a HeartMate 3 (Abbott, Chicago, IL, USA) without complications one year after the surgery.

Pancreaticoduodenectomy After Endoscopic Ultrasound-Guided Lumen Apposing Metal Stent (Lams): A Case Series Evaluating Feasibility And Short-Term Outcomes: Whipple After Lumen Apposing Metal Stent, Luke Meredith, David Baek, Alisha Agarwal, Faisal Kamal, Anand R. Kumar, Alexander Schlachterman, Thomas E. Kowalski, Charles J. Yeo, Harish Lavu, Avinoam Nevler, Wilbur B. Bowne

Department of Surgery Faculty Papers

Introduction

Endoscopic ultrasound (EUS)-guided lumen-apposing metal stents (LAMS) represent a novel tool in therapeutic endoscopy. However, the presence of LAMS may dissuade surgeons from operations with curative-intent. We report three clinical scenarios with deployment of LAMS in patients that subsequently underwent pancreaticoduodenectomy (PD).

Methods

Six patients identified from our IRB-approved pancreas cancer database had EUS-LAMS placement prior to PD. Patient, tumor, treatment-related variables, and outcomes are herein reported.

Results

Two patients underwent a LAMS gastrojejunostomy (GJ) for duodenal obstruction. Another patient underwent LAMS choledochoduodenostomy (CDS) for malignant biliary obstruction. In three patients, a LAMS gastrogastrostomy or jejunogastrostomy was deployed post …

Team-Centered Care After Trauma Patient Death: Promoting Healers’ Healing By Humanizing Our Roles, Sydni Au Hoy, Carlie J. Arbaugh, Caitlin P. Bungo, Amanda J. Deutsch, Bonnie E. Chow, Kristen Gallegos, Nerissa Alansalon, Emmanuel Jisrawi, Al’Ai Alvarez, Brooke Gurland, Joseph Forrester

Journal of Wellness

Introduction: Recurrent exposures to adverse patient events, including death, affect all members of the care team and can have long-term effects on clinician performance, personal well-being, and patient safety. Recognizing the impact of patient deaths on care teams is essential to mitigating potential risks of increased clinician burnout. We share the outcomes of a three-month pilot wellness intervention implemented at a busy academic hospital, directed explicitly toward resuscitation care teams managing patients who die from traumatic injuries.

Approach: A collaborative group from Stanford’s Trauma Surgery, Emergency Department (ED), and well-being leadership developed an integrated workflow to connect with …

Challenges In Traumatic Spinal Cord Injury Care In Developing Countries - A Scoping Review, Mohammad Hosein Ranjbar Hameghavandi, Elaheh Khodadoust, Mahgol Sadat Hassan Zadeh Tabatabaei, Farzin Farahbakhsh, Zahra Ghodsi, Sabra Rostamkhani, Shahryar Ghashghaie, Mahkame Abbaszade, Arash Arbabi, Seyedeh Maede Hossieni, Mohsen Sadeghi-Naini, Rasha Atlasi, Samuel Berchi Kankam, Alexander Vaccaro, James Guest, Michael Fehlings, Vafa Rahimi-Movaghar

Department of Neurosurgery Faculty Papers

OBJECTIVE: To evaluate the leading challenges in developing countries' traumatic spinal cord injury (TSCI) care.

METHODS: We conducted a systematic search in electronic databases of PubMed, SCOPUS, Web of Science, EMBASE, and Cochrane Library on 16 April 2023. Studies that investigated challenges associated with the management of TSCI in developing countries were eligible for review. We extracted related outcomes and categorized them into four distinct parts: injury prevention, pre-hospital care, in-hospital care, and post-hospital care.

RESULTS: We identified 82 articles that met the eligibility criteria including 13 studies on injury prevention, 25 on pre-hospital care, 32 on in-hospital care, and …

Prospective Analysis Of Stratafix™ Symmetric Pds Plus Suture For Fascial Closure In Spinal Surgery: A Pilot Study, Steven R. Glener, Pious D. Patel, Stephanie N. Serva, Dwight Mitchell Self, Joshua E. Heller

Department of Neurosurgery Faculty Papers

Wound closure is an integral part of every spinal procedure. Effective and secure wound closure is paramount in the prevention of infection, wound dehiscence and the preservation of cosmesis. Barbed suture technologies such as STRATAFIX™ Symmetric have been studied and are used in a variety of specialties, including obstetrics and orthopedic surgery, but is underutilized in neurosurgery. This study aims to assess the time and rate of closure using STRATAFIX™ Symmetric technology for fascial closure and compare this method to the more traditionally used method of fascial closure using braided absorbable sutures below the epidermis. 20 patients were recruited for …

Local Antibiotic Infusion In Periprosthetic Joint Infection Following Total Hip Arthroplasty, Atthakorn Jarusriwanna, Wenbo Mu, Javad Parvizi

Rothman Institute Papers

Local antibiotic infusion has emerged as a promising adjunctive therapy, delivering high concentrations of antibiotics directly to the infection site. This approach aims to enhance eradication of pathogens while minimizing systemic side effects associated with prolonged antibiotic use. This narrative review encompassed 10 articles focused on all three procedures of surgical intervention for periprosthetic joint injection (PJI) following total hip arthroplasty (THA): debridement, antibiotics, and implant retention (DAIR), single-stage revision arthroplasty, and two-stage revision arthroplasty. Recent studies report success rates ranging from 90 to 100% in patients undergoing DAIR, 82 to 100% in single-stage revision arthroplasty, and 80% in two-stage …

Aso Author Reflections: Comparison Of Hospital Volume And Risk-Standardized Mortality Rate As A Proxy For Hospital Quality In Complex Oncologic Hepatopancreatobiliary Surgery, William T. Julian, Lee M. Ocuin

Faculty Scholarship

No abstract provided.

In Reply: Can Artificial Intelligence Make The Cut? Dissecting Large Language Model’S Surgical Exam Performance, Adam M. Ostrovsky, Joshua R. Chen, Vishal N. Shah, Babak Abai

Department of Surgery Faculty Papers

No abstract provided.

Vascular Surgeons Widely Underrepresented In Online News Regarding Vascular Pathologies, Joshua R. Chen, Adam M. Ostrovsky, Robert Tatum, Sanath Patil, Dawn Salvatore, Paul J. Dimuzio, Michael Nooromid, Babak Abai

Department of Surgery Faculty Papers

Background: Vascular surgeons have traditionally been under-represented in various media platforms. Our study aims to characterize vascular surgeon involvement in online news coverage as it relates to vascular pathologies. Methods: Google news was queried for news articles published between July 31, 2022, and August 1, 2023, using 11 keywords (“carotid stenosis,” “carotid artery disease,” “dialysis fistula,” “abdominal aortic aneurysm,” “aortic dissection,” “varicose vein,” “deep vein thrombosis,” “peripheral vascular disease,” “peripheral arterial disease,” “limb ischemia,” and “claudication). Unrelated articles and medical press under a paywall were excluded. Article and represented physician demographic information were collected. Representation was defined as being the …

Brain-Targeted Intranasal Delivery Of Protein-Based Gene Therapy For Treatment Of Ischemic Stroke, Jee-Yeon Ryu, Christian D. Cerecedo-Lopez, Hongkuan Yang, Ilhwan Ryu, Rose Du

School of Medicine Publications

Gene therapy using a protein-based CRISPR system in the brain has practical limitations due to current delivery systems, especially in the presence of arterial occlusion. To overcome these obstacles and improve stability, we designed a system for intranasal administration of gene therapy for the treatment of ischemic stroke.

Methods: Nanoparticles containing the protein-based CRISPR/dCas9 system targeting Sirt1 were delivered intranasally to the brain in a mouse model of ischemic stroke. The CRISPR/dCas9 system was encapsulated with calcium phosphate (CaP) nanoparticles to prevent them from being degraded. They were then conjugated with β-hydroxybutyrates (bHb) to target monocarboxylic acid transporter 1 (MCT1) …