Anchorage, AK, United States
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Walsh C.P.,Detroit Medical Center Providence Hospital Orthopaedic Surgery Residency Program | Hubbard J.C.,Wayne State University | Nessler J.P.,St. Cloud Orthopaedics | Markel D.C.,Providence Surgery Centers
Journal of Arthroplasty | Year: 2015

Modular neck femoral stems have been associated with adverse local tissue reactions (ALTR), leading to a voluntary recall, but these effects have not been well-characterized. A retrospective review of intraoperative findings and cobalt/chromium levels was performed in 103 hips undergoing revision for ALTR. The average preoperative serum cobalt level was 7.6. μg/L (range 1.1-23. μg/L) and chromium level was 1.8. μg/L (range 0.1-6.8. μg/L). Metallic sludge was noted in 100%, synovitis in 98%, pericapsular rind in 82%, and calcar erosion in 85%. An osteotomy was required for removal in 44%. We concluded that revision of modular neck femoral stems is associated with increased preoperative metal ion levels and stem-neck corrosion. Despite advanced stem explantation techniques, osteotomy was frequently required, leading to increased morbidity. © 2014 Elsevier Inc.


Molli R.G.,Providence Surgery Centers | Anderson K.C.,Providence Surgery Centers | Buehler K.C.,The Center Orthopedic and Neurosurgery Care and Research | Markel D.C.,Providence Surgery Centers
Journal of Arthroplasty | Year: 2011

The purpose of this study was to evaluate the effectiveness of software advancements in improving total knee component positioning and limb alignment when using computer-aided navigation. A single total joint fellowship-trained surgeon performed unilateral total knee arthroplasty on 315 patients using conventional techniques or with assistance from computer navigation software. Preoperative and postoperative x-ray measurements were taken and analyzed. Our previous work demonstrated a statistically significant improvement (P < .02) in limb alignment (±3° of biomechanical neutral) when using version 2.0 software (93%) when compared with conventional techniques (82%). Further improvement was demonstrated with the version 3.1 software (99%, P < .03). The tourniquet times were recorded for each group and showed a significant improvement with the 3.1 software (conventional = 74 minutes, 2.0 navigation = 90 minutes, and 3.1 navigation = 73 minutes). The Stryker 2.0 software (Stryker Orthopedics, Mahwah, NJ) tourniquet time was statistically significantly longer than either the conventional or the 3.1 group (P < .001). Outcomes-based studies will be required to see if these factors will lead to improved patient function and/or prolonged prosthetic survival rates. © 2011 Elsevier Inc.


Subhas G.,Providence Surgery Centers | Gupta A.,Providence Surgery Centers | Mittal V.K.,Providence Surgery Centers
American Journal of Surgery | Year: 2010

Background: The Residency Review Committee for Surgery has recently increased the required number of cases needed to achieve competency in endoscopy training. Methods: A 10-question survey was sent to program directors for general surgery residencies. Endoscopic training patterns, facilities, perspectives, and residents' performance were examined. Results: Seventy-one surgery programs (30%) responded to the survey. Of these, 42% (n = 30) had a program size of 3 to 4 residents. Ten percent (n = 7) of all programs could not fulfill the minimum Accreditation Council for Graduate Medical Education (ACGME) requirements. Only 55% (n = 39) of programs had a dedicated rotation in endoscopy and an endoscopic skills training laboratory in their program. Few programs had their residents performing more than 100 cases of gastroscopy (18%) and colonoscopy (21%). Conclusions: Future endoscopy training for surgical residents needs to be improved to comply with the new requirements. This would include provision of an endoscopic skills laboratory, dedicated endoscopic rotations, and increasing the number of staff surgeons who perform endoscopic procedures. © 2010 Elsevier Inc. All rights reserved.


Macedo F.I.,Providence Surgery Centers
World Journal of Hepatology | Year: 2013

Nonparasitic hepatic cysts consist of a heterogeneous group of disorders, which differ in etiology, prevalence, and manifestations. With improving diagnostic techniques, hepatic cysts are becoming more common. Recent advancements in minimally invasive technology created a new Era in the management of hepatic cystic disease. Herein, the most current recommendations for management of noninfectious hepatic cysts are described, thereby discussing differential diagnosis, new therapeutic modalities and outcomes. © 2013 Baishideng.


Subhas G.,Providence Surgery Centers | Mittal V.K.,Providence Surgery Centers
HPB | Year: 2011

Background: There has been an increasing role of advanced minimally invasive procedures in hepatopancreatobilliary (HPB) surgery. However, there are no set minimum laparoscopic case requirements. Methods: A 14-question electronic survey was sent to 82 worldwide HPB fellowship programme directors. Results: Forty-nine per cent (n = 40) of the programme directors responded. The programmes were predominantly university based (83%). Programmes had either one (55%) or two fellows (40%) each year. Programmes (35-48%) had average annual volumes of 51-100 hepatic, 51-100 pancreatic and 25-50 biliary cases. For many programmes, <10% of hepatic (48%), pancreatic (40%) and biliary (70%) cases were done laparoscopically. The average annual fellow case volumes for hepatic, pancreatic and biliary surgeries were 25-50 (62%), 25-50 (47%) and <25 (50%), respectively. The average annual number of hepatic, pancreatic and biliary cases done laparoscopically by a fellow was 9, 9 and 4, which constitutes 36%, 36% and 16%, respectively, of the International Hepato-Pancreato-Billiary Association (IHPBA) requirement. Conclusion: We surmise that the low average number of surgeries performed by minimally-invasive techniques by HPB fellows is not sufficient in today's practice. Should there be an increase in the minimal number of hepatic, pancreatic and complex biliary cases to 50, 50, and 25, with at least 50% of these performed laparoscopically? © 2010 International Hepato-Pancreato-Biliary Association. © 2011 International Hepato-Pancreato-Biliary Association.


Taggarshe D.,Providence Surgery Centers | Mittal V.,Providence Surgery Centers
Journal of Surgical Education | Year: 2012

OBJECTIVE: The American Board of Surgery (ABS) provides program directors with ABS In-Training Examination (ABSITE) scores in the following forms: Percent correct score and percentile score. It is of interest to note how residency programs utilize the different forms of ABSITE scores in assessment of surgical residents for progression in training. We conducted a survey of program directors to ascertain the present situation. METHODS: A structured questionnaire was sent to all program director members of the Association of Program Directors in Surgery. RESULTS: 114/210 program directors (54%) answered the survey. To assess residents, 3 programs used only the percentage correct score, 23 programs used only the percentile score, and 88 programs used both scores. The majority (70/89 or 79%) of the programs used a 30th percentile score as the minimum passing score. 88/111 (79%) programs had a remedial process for residents with poor performance on ABSITE. 60 percent of the programs had never used poor ABSITE performance to defer individual resident promotion. Programs that used ABSITE performance for remediation and deferral of promotion did it based on percentile score rather than percent correct score. Program directors felt that the better indicator of a resident's knowledge and progression in surgical residency was percent correct score (42%) vs percentile score (32%), while 10% felt that neither was an adequate indicator. CONCLUSIONS: ABSITE score is being used as one of the measures to assess residents. Programs need to ensure that an effective remedial process is in place to assist residents with poor performance. © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.


Macedo F.I.B.,Providence Surgery Centers | Mittal V.K.,Providence Surgery Centers
Surgical Oncology | Year: 2015

Introduction Consensus guidelines have recommended total thyroidectomy for papillary thyroid carcinoma (PTC) > 1 cm. However, the optimal surgical approach for small and unilateral (1 cm) PTC remains controversial. Methods A meta-analysis was performed using MEDLINE and EMBASE databases to identify all studies investigating at thyroid surgery options, total thyroidectomy (TT) versus thyroid lobectomy (TL), for PTC ; 1 cm. The primary endpoints were locoregional recurrence and mortality rates. Results The initial literature search identified 305 publications (1980-2014). Six studies met the inclusion criteria comprising 2939 patients (2002-2013). Among these patients, 2134 (72.6%) underwent TT and 805 (27.4%) underwent TL. Mean follow-up was 10.9 ± 3.4 years (range, 1 month to 54 years). Overall, the recurrence rate was 5.4%: 4.4% in the TT group and 8.3% in the TL group (p < 0.001; RR 0.50, 95% CI 0.37-0.67). The mortality rates were 0.3% (8 cases) versus 1.1% (9 cases) in TT and TL groups, respectively (p = 0.14; RR 0.43, 95% CI 0.17-1.09). Conclusion TT was associated with lower recurrence rates, possibly due to a more complete nodal dissection of the central neck compartment at the time of initial surgery. Based on these data, it is unclear to establish a definitive correlation between the extent of thyroid resection and long-term survival rates due to the small number of mortality events. However, there is a trend toward lower mortality rates in the TT group. Other factors need to be taken into consideration while planning thyr oid resection for small PTC, such as multifocality, locoregional involvement, mode of presentation and age at diagnosis. Refinement of current guidelines for the optimal surgical management of PTC <1 cm may be warranted. © 2015 Elsevier Ltd. All rights reserved.


Macedo F.I.B.,Providence Surgery Centers | Makarawo T.,Providence Surgery Centers
World Journal of Hepatology | Year: 2014

The approach for colorectal hepatic metastasis has advanced tremendously over the past decade. Multidrug chemotherapy regimens have been successfully introduced with improved outcomes. Concurrently, adjunct multimodal therapies have improved survival rates, and increased the number of patients eligible for curative liver resection. Herein, we described major advancements of surgical and oncologic management of such lesions, thereby discussing modern chemotherapeutic regimens, adjunct therapies and surgical aspects of liver resection. © 2014 Baishideng Publishing Group Inc.


Subhas G.,Providence Surgery Centers | Mittal V.K.,Providence Surgery Centers
American Surgeon | Year: 2011

The field of postgraduate minimally invasive surgery training has undergone substantial growth and change. A survey was sent to all program directors in surgery. Minimally invasive training patterns, facilities, their views, and performance of residents were examined. Ninety-five directors (38%) responded to the questionnaire. Of these, 51 per cent (n = 48) had a program size of three to four residents and 33 per cent (n = 31) had a program size of five to six residents. In 3 per cent of programs (n = 3), residents could not achieve the minimum Accreditation Council for Graduate Medical Education required numbers for advanced laparoscopic cases. Only 47 per cent of programs (n = 45) had dedicated rotations in minimally invasive surgery, ranging from 2 to 11 months. Up to 10 per cent (n = 9) of program directors felt that the current training in minimally invasive surgery was insufficient. Fifty-five per cent (n = 52) felt that laparoscopic adhesiolysis was an advanced laparoscopic procedure, and 33 per cent (n = 31) felt that there should be a separate minimum requirement for each of the commonly performed basic and advanced laparoscopic cases by Accreditation Council for Graduate Medical Education. Fifty-six per cent (n = 53) of programs were performing robotic surgery. Minimally invasive surgery training for surgical residents needs to increase opportunities so that they are able to perform laparoscopic procedures with confidence. There should be specific number requirements in each category of individual basic and advanced laparoscopic procedures.


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