1
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Stottlemyre RL, Notrica DM, Cohen AS, Sayrs LW, Naiditch J, St Peter SD, Leys CM, Ostlie DJ, Maxson RT, Ponsky T, Eubanks JW, Bhatia A, Greenwell C, Lawson KA, Alder AC, Johnson J, Garvey E. Hemodilution in pediatric trauma: Defining the expected hemoglobin changes in patients with liver and/or spleen injury: An ATOMAC+ secondary analysis. J Pediatr Surg 2023; 58:325-329. [PMID: 36428184 DOI: 10.1016/j.jpedsurg.2022.10.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Many children with blunt liver and/or spleen injury (BLSI) never bleed intraperitoneally. Despite this, decreases in hemoglobin are common. This study examines initial and follow up measured hemoglobin values for children with BLSI with and without evidence of intra-abdominal bleeding. METHODS Children ≤18 years of age with BLSI between April 2013 and January 2016 were identified from the prospective ATOMAC+ cohort. Initial and follow up hemoglobin levels were analyzed for 4 groups with BLSI: (1) Non bleeding; (2) Bleeding, non transfused (3) Bleeding, transfused, and (4) Bleeding resulting in non operative management (NOM) failure. RESULTS Of 1007 patients enrolled, 767 were included in one or more of four study cohorts. Of 131 non bleeding patients, the mean decrease in hemoglobin was 0.83 g/dL (+/-1.35) after a median of 6.3 [5.1,7.0] hours, (p = 0.001). Follow-up hemoglobin levels in patients with and without successful NOM were not different. For patients with an initial hemoglobin >9.25 g/dL, the odds ratio (OR) for NOM failure was 14.2 times less, while the OR for transfusion was 11.4 times less (p = 0.001). CONCLUSION Decreases in hemoglobin are expected after trauma, even if not bleeding. A hemoglobin decrease of 2.15 g/dL [0.8 + 1.35] would still be within one standard deviation of a non bleeding patient. An initial low hemoglobin correlates with failure of NOM as well as transfusion, thereby providing useful information. By contrast, subsequent hemoglobin levels do not appear to guide the need for transfusion, nor correlate with failure of NOM. These results support initial hemoglobin measurement but suggest a lack of utility for routine rechecking of hemoglobin. LEVEL OF EVIDENCE Level II Prognostic Study.
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Affiliation(s)
- Rachael L Stottlemyre
- Phoenix Children's, Phoenix, AZ 85016, United States; University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - David M Notrica
- Phoenix Children's, Phoenix, AZ 85016, United States; University of Arizona College of Medicine Phoenix, Phoenix, AZ 85004, United States; Mayo Clinic College of Medicine and Science, Phoenix, AZ 85054, United States.
| | - Aaron S Cohen
- University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Lois W Sayrs
- Children's Hospital of Orange County Research Institute, Orange, CA 92868, United States
| | | | | | - Charles M Leys
- American Family Children's Hospital, Madison, WI 53792, United States
| | - Daniel J Ostlie
- Phoenix Children's, Phoenix, AZ 85016, United States; American Family Children's Hospital, Madison, WI 53792, United States
| | - R Todd Maxson
- Arkansas Children's Hospital, Little Rock, AR 72202, United States
| | - Todd Ponsky
- Dell Children's Medical Center, Austin, TX 78723, United States; Akron Children's Hospital, Akron, OH 44308, United States
| | - James W Eubanks
- Le Bonheur Children's Hospital, Memphis, TN 38103, United States
| | - Amina Bhatia
- Children's Healthcare of Atlanta, Atlanta, GA 30303, United States
| | | | - Karla A Lawson
- Dell Children's Medical Center, Austin, TX 78723, United States
| | - Adam C Alder
- Children's Medical Center Dallas, Dallas, TX 75235, United States
| | - Jeremy Johnson
- The Children's Hospital at OU Medical Center, Oklahoma City, OK 73104, United States
| | - Erin Garvey
- Phoenix Children's, Phoenix, AZ 85016, United States; University of Arizona College of Medicine Phoenix, Phoenix, AZ 85004, United States; Mayo Clinic College of Medicine and Science, Phoenix, AZ 85054, United States
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2
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Holcomb GW, Tam PKH, Pakarinen M, Davenport M, Ponsky T, Laje P. JPS Open: The Beginning of a New Era. J Pediatr Surg 2022; 57:491. [PMID: 36243466 DOI: 10.1016/j.jpedsurg.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- George W Holcomb
- Editor-In-Chief, Journal of Pediatric Surgery, Nashville, Tennessee.
| | - Paul K H Tam
- Regional Editor for Pacific Region, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Mikko Pakarinen
- Regional Editor for Europe, Children's Hospital, University of Helsinki, Helsinki, Finland
| | - Mark Davenport
- Regional Editor for the British Isles, Kings College Hospital, London, United Kingdom
| | - Todd Ponsky
- Editor for Social and Digital Media, Akron Children's Hospital, Akron, Ohio
| | - Pablo Laje
- Associate Editor for Latin America, The Children's Hospital of Philadephia, Philadelphia, Pennsylvania
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3
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Baird R, Puligandla P, Lopushinsky S, Blackmore C, Krishnaswami S, Nwomeh B, Downard C, Ponsky T, Ghani MO, Lovvorn HN. Virtual curriculum delivery in the COVID-19 era: the pediatric surgery boot camp v2.0. Pediatr Surg Int 2022; 38:1385-1390. [PMID: 35809106 PMCID: PMC9455938 DOI: 10.1007/s00383-022-05156-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluated the impact of a virtual Pediatric Surgery Bootcamp curriculum on resource utilization, learner engagement, knowledge retention, and stakeholder satisfaction. METHODS A virtual curriculum was developed around Pediatric Surgery Milestones. GlobalCastMD delivered pre-recorded and live content over a single 10-h day with a concluding social hour. Metrics of learner engagement, faculty interaction, knowledge retention, and satisfaction were collected and analyzed during and after the course. RESULTS Of 56 PS residencies, 31 registered (55.4%; 8/8 Canadian and 23/48 US; p = 0.006), including 42 learners overall. The virtual BC budget was $15,500 (USD), 54% of the anticipated in-person course. Pre- and post-tests were administered, revealing significant knowledge improvement (48.6% [286/589] vs 66.9% [89/133] p < 0.0002). Learner surveys (n = 14) suggested the virtual BC facilitated fellowship transition (85%) and strengthened peer-group camaraderie (69%), but in-person events were still favored (77%). Program Directors (PD) were surveyed, and respondents (n = 22) also favored in-person events (61%). PDs not registering their learners (n = 7) perceived insufficient value-added and concern for excessive participants. CONCLUSIONS The virtual bootcamp format reduced overall expenses, interfered less with schedules, achieved more inclusive reach, and facilitated content archiving. Despite these advantages, learners and program directors still favored in-person education. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Robert Baird
- Department of Pediatric Surgery, BC Children’s Hospital University of British Colombia, Ambulatory Care Bldg, K0-134, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada
| | - Pramod Puligandla
- Department of Pediatric Surgery, Montreal Children’s Hospital, McGill University, Montreal, CA Canada
| | - Steven Lopushinsky
- Section of Pediatric Surgery, Alberta Children’s Hospital, University of Calgary, Calgary, CA Canada
| | - Christopher Blackmore
- Division of Pediatric General and Thoracic Surgery, IWK Health Centre, Dalhousie University, Halifax, NS Canada
| | - Sanjay Krishnaswami
- Division of Pediatric Surgery, Doernbecher Children’s Hospital, Oregon Health and Science University, Portland, OR USA
| | - Benedict Nwomeh
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Ohio State University, Columbus, OH USA
| | - Cynthia Downard
- Division of Pediatric Surgery, Hiram C Polk, Jr, MD Department of Surgery, University of Louisville, Norton Children’s Hospital, Louisville, KY USA
| | - Todd Ponsky
- Division of Pediatric Surgery, Cincinnati Children’s Hospital, University of Cincinnati, Cincinnati, OH USA
| | - Muhammad O. Ghani
- Department of Pediatric Surgery, Monroe Carell, Jr. Children’s Hospital at Vanderbilt, Nashville, TN USA
| | - Harold N. Lovvorn
- Department of Pediatric Surgery, Monroe Carell, Jr. Children’s Hospital at Vanderbilt, Nashville, TN USA
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4
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Holcomb Iii GW, Davenport M, Pakarinen M, Tam PKH, Laje P, Ponsky T. Important information for our authors and readers. J Pediatr Surg 2022; 57:1. [PMID: 34809960 DOI: 10.1016/j.jpedsurg.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Affiliation(s)
| | - Mark Davenport
- Regional Editor for the British Isles, Kings College Hospital, London, United Kingdom
| | - Mikko Pakarinen
- Regional Editor for Europe, Children's Hospital University of Helsinki, Helsinki, Finland
| | - Paul K H Tam
- Regional Editor for Pacific Region, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Pablo Laje
- Associate Editor for Latin America, The Children's Hospital of Philadephia, Philadelphia, Pennsylvania, United States
| | - Todd Ponsky
- Editor for Social and Digital Media, Akron Children's Hospital, Akron, Ohio, United States
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5
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Gerardo R, Lele P, Sundaram K, Ponsky T. Surgical telementoring: Feasibility, applicability, and how to. J Surg Oncol 2021; 124:241-245. [PMID: 34245573 DOI: 10.1002/jso.26511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/11/2022]
Abstract
Surgical training does not end at the conclusion of residency training. Expansions in medical technology and surgical technique have created a steep learning curve for the young attending surgeon. The emergence of intraoperative telementoring has allowed experienced surgeons to guide learners through complex surgical cases remotely with the assistance of streaming video technology. Here, we describe the basics of telementoring, financial and legal considerations, and recommend hardware specifications for optimal use.
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Affiliation(s)
- Rodrigo Gerardo
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Prachi Lele
- Department of Surgery, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Krithika Sundaram
- Department of Surgery, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Todd Ponsky
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Surgery, Northeast Ohio Medical University, Rootstown, Ohio, USA
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6
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Sanger T, Chang A, Feaster W, Taraman S, Afari N, Beauregard D, Dethlefs B, Ghere T, Kabeer M, Tolomiczenko G, Billig M, Brophy J, Eskandanian K, Espinoza J, Farrugia S, Harrison M, Horvat C, Hoyen C, Koh C, Komiyama A, Nelson K, Kulkarni O, Levy R, Maher K, O'Donnell M, Ponsky T, Richmond F, Richter J, Roy S, Samir S, Suresh S, Stallworth C, Thekkedath U, Toman K, Wall J, West L, Wolff D. Opportunities for Regulatory Changes to Promote Pediatric Device Innovation in the United States: Joint Recommendations From Pediatric Innovator Roundtables. IEEE J Transl Eng Health Med 2021; 9:4800105. [PMID: 34327067 PMCID: PMC8313015 DOI: 10.1109/jtehm.2021.3092559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/14/2021] [Accepted: 06/18/2021] [Indexed: 11/07/2022]
Abstract
Objective: The purpose of this report is to provide insight from pediatric stakeholders with a shared desire to facilitate a revision of the current United States regulatory pathways for the development of pediatric healthcare devices. Methods: On August 5, 2020, a group of innovators, engineers, professors and clinicians met to discuss challenges and opportunities for the development of new medical devices for pediatric health and the importance of creating a regulatory environment that encourages and accelerates the research and development of such devices. On January 6, 2021, this group joined regulatory experts at a follow-up meeting. Results: One of the primary issues identified was the need to present decision-makers with opportunities that change the return-on-investment balance between adult and pediatric devices to promote investment in pediatric devices. Discussion/Conclusion: Several proposed strategies were discussed, and these strategies can be divided into two broad categories: 1. Removal of real and perceived barriers to pediatric device innovation; 2. Increasing incentives for pediatric device innovation.
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Affiliation(s)
- Terence Sanger
- Children's Hospital of Orange County (CHOC)OrangeCA92868USA.,University of California IrvineIrvineCA92697USA
| | - Anthony Chang
- Children's Hospital of Orange County (CHOC)OrangeCA92868USA
| | | | - Sharief Taraman
- Children's Hospital of Orange County (CHOC)OrangeCA92868USA.,University of California IrvineIrvineCA92697USA.,CognoaPalo AltoCA94306USA
| | - Nadine Afari
- Children's Hospital of Orange County (CHOC)OrangeCA92868USA.,University of California IrvineIrvineCA92697USA
| | | | - Brent Dethlefs
- Children's Hospital of Orange County (CHOC)OrangeCA92868USA
| | - Tiffani Ghere
- Children's Hospital of Orange County (CHOC)OrangeCA92868USA
| | - Mustafa Kabeer
- Children's Hospital of Orange County (CHOC)OrangeCA92868USA
| | | | | | - Jon Brophy
- Cincinnati Children's Hospital Medical CenterCincinnatiOH45229USA
| | | | - Juan Espinoza
- Children's Hospital of Los AngelesLos AngelesCA90027USA.,West Coast Consortium for Technology & Innovation in PediatricsLos AngelesCA94612USA
| | | | - Michael Harrison
- University of California at San FranciscoSan FranciscoCA94143USA.,UCSF-Stanford PDCSan FranciscoCA94158USA
| | - Christopher Horvat
- University of PittsburghPittsburghPA15260USA.,UPMC Children's Hospital of PittsburghPittsburghPA15224USA
| | - Claudia Hoyen
- University Hospitals Rainbow Babies and Children's HospitalClevelandOH44106USA.,Case Western Reserve University School of MedicineClevelandOH44106USA
| | - Chester Koh
- Texas Children's HospitalHoustonTX77030USA.,Southwest National Pediatric Device ConsortiumHoustonTX77030USA
| | | | | | | | - Robert Levy
- Children's Hospital of PhiladelphiaPhiladelphiaPA19104USA
| | - Kevin Maher
- Children's Healthcare of AtlantaAtlantaGA30329USA
| | - Michael O'Donnell
- University of California at San FranciscoSan FranciscoCA94143USA.,UCSF-Stanford PDCSan FranciscoCA94158USA.,University of California at BerkeleyBerkeleyCA94720USA
| | - Todd Ponsky
- Cincinnati Children's Hospital Medical CenterCincinnatiOH45229USA
| | - Frances Richmond
- International Center for Regulatory ScienceUniversity of Southern CaliforniaLos AngelesCA90007USA
| | | | - Shuvo Roy
- University of California at San FranciscoSan FranciscoCA94143USA.,UCSF-Stanford PDCSan FranciscoCA94158USA
| | | | - Srinivasan Suresh
- University of PittsburghPittsburghPA15260USA.,UPMC Children's Hospital of PittsburghPittsburghPA15224USA
| | | | - Usha Thekkedath
- University of California at San FranciscoSan FranciscoCA94143USA.,UCSF-Stanford PDCSan FranciscoCA94158USA
| | - Kara Toman
- Texas Children's HospitalHoustonTX77030USA.,Southwest National Pediatric Device ConsortiumHoustonTX77030USA
| | - James Wall
- Stanford Children's HealthLucile Packard Children's HospitalPalo AltoCA94304USA
| | - Leanne West
- Children's Healthcare of AtlantaAtlantaGA30329USA.,Georgia Tech Research Institute (GTRI)AtlantaGA30318USA
| | - Dawn Wolff
- Children's Mercy HospitalKansas CityMO64108USA
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7
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Notrica DM, Sussman BL, Sayrs LW, St Peter SD, Maxson RT, Alder AC, Eubanks JW, Johnson JJ, Ostlie DJ, Ponsky T, Naiditch JA, Leys CM, Lawson KA, Greenwell C, Bhatia A, Garcia NM. Early vasopressor administration in pediatric blunt liver and spleen injury: An ATOMAC+ study. J Pediatr Surg 2021; 56:500-505. [PMID: 32778447 DOI: 10.1016/j.jpedsurg.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/23/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND No prior studies have examined the outcomes of early vasopressor use in children sustaining blunt liver or spleen injury (BLSI). METHODS A planned secondary analysis of vasopressor use from a 10-center, prospective study of 1004 children with BLSI. Inverse probability of treatment weighting (IPTW) was used to compare patients given vasopressors <48 h after injury to controls based on pretreatment factors. A logistic regression was utilized to assess survival associated with vasopressor initiation factors on mortality and nonoperative management (NOM) failure. RESULTS Of 1004 patients with BLSI, 128 patients were hypotensive in the Pediatric Trauma Center Emergency Department (ED); 65 total patients received vasopressors. Hypotension treated with vasopressors was associated with a sevenfold increase in mortality (AOR = 7.6 [p < 0.01]). When excluding patients first given vasopressors for cardiac arrest, the risk of mortality increased to 11-fold (AOR = 11.4 [p = 0.01]). All deaths in patients receiving vasopressors occurred when started within the first 12 h after injury. Vasopressor administration at any time was not associated with NOM failure. CONCLUSION After propensity matching, early vasopressor use for hypotension in the ED was associated with an increased risk of death, but did not increase the risk of failure of NOM. LEVEL OF EVIDENCE Level III prognostic and epidemiological, prospective.
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Affiliation(s)
| | | | | | | | | | - Adam C Alder
- Children's Medical Center part of Children's Health(SM)
| | | | | | - Daniel J Ostlie
- Phoenix Children's Hospital; American Family Children's Hospital
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8
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Lamoshi A, Gibbons A, Williams S, Ponsky T. Barriers to the implementation of new guidelines among pediatric surgeons: online survey. Pediatr Surg Int 2020; 36:1103-1109. [PMID: 32588118 DOI: 10.1007/s00383-020-04707-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify barriers that prevent pediatric surgeons from implementing updated practice guidelines. METHODS An online survey targeting pediatric surgeons was conducted on the StayCurrent MD Application (SCMA) and Pediatric Surgery Education Facebook page (PSE FBP). The survey results for pediatric surgeons of underdeveloped countries (PSUC) and pediatric surgeons of developed countries (PSDC) was compared and analyzed. RESULTS Based on the number of active members on PSE FBP and SCA, the response rate was 32.3% (174/539), 66.3% of responses were from PSUC. The majority of PSUC (73%) wanted to have convincing guidelines and the plurality of PSDC (46%) wanted to see approval by the American Pediatric Surgical Association (APSA) for implementation of new guidelines. Lack of resources was the number one response (78%) for PSUC not implementing the most up to date guidelines and about 40% of the PSDC responded "concerned about malpractice liability." CONCLUSIONS PSUC and PSDC identified very different barriers to implementation of new guidelines. It is reassuring that accessibility to treatment is not the primary issue, though resistance to implementation is a resounding concern. Identifying the barriers will highlight areas that need to be addressed, and awareness may help resolve some of the barriers.
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Affiliation(s)
- Abdulraouf Lamoshi
- Department of Pediatric Surgery, Kaleida Health Facility, John R. Oishei Children's Hospital, Conventus 5th Floor, 5324, 1001 Main Street, Buffalo, NY, 14202, USA.
| | - A Gibbons
- Department of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA
| | - S Williams
- Department of Pediatric Surgery, Kaleida Health Facility, John R. Oishei Children's Hospital, Conventus 5th Floor, 5324, 1001 Main Street, Buffalo, NY, 14202, USA
| | - T Ponsky
- Department of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA
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9
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Abstract
BACKGROUND Recent advances in telecommunication technology and video conferencing systems have opened a new avenue for surgical instruction called "surgical telementoring." This report from the Technology Working Group of the SAGES Project 6 Summit reviews the telementoring technology that currently exists and proposes recommendations for minimum technology requirements and future technology development. While also providing insight in regulatory considerations, this review offers what prospective surgical telementoring participants need to know about the underlying technology with a specific focus on safety, reliability, transmission quality, ease of use, and cost. METHODS Content experts from around the world, in minimally invasive surgery, surgical mentoring and telementoring, surgical education, business development, healthcare innovation, and regulation were invited to attend a 2-day summit in Los Angeles, USA to outline the current state of surgical telementoring and chart the challenges and opportunities going forward. This article summarizes the discussion, conclusions, and recommendation of the technology group with regard to telementoring technology. RESULTS This article reviews the technical requirements which can be divided into the following categories: (1) safety, (2) reliability, (3) transmission quality, (4) ease of use, and (5) cost. CONCLUSION Telementoring applications are technology driven. Given the pace of change of technology, guiding principles in technology design and selection are warranted (Table 4). Telementoring technologies require two basic components, video capturing and display devices at the transmitting and receiving end, and a telecommunication link between them. Many additional features can be added to this basic setup including multiple cameras or video sources, remote camera zoom and pan, recording and storage of videos and images, and telestration capabilities to mention just a few. In general, the cost of these technologies is feature driven. The education framework for each specific application should determine the need for these features (Schlachta in Surg Endosc https://doi.org/10.1007/s00464-016-4988-5 ).
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Affiliation(s)
- Etai M Bogen
- Department of Clinical Medicine, Faculty of Health Sciences - University of Tromsø, Tromsø, Norway.
| | - Christopher M Schlachta
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Todd Ponsky
- Division of Pediatric Surgery, Akron Children's Hospital Akron, One Perkins Square, Akron, OH, 44308, USA
- Department of Pediatric Surgery, Cincinnati Children's Hospital, Cincinnati, USA
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10
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Harting MT, Wheeler A, Ponsky T, Nwomeh B, Snyder CL, Bruns NE, Lesher A, Pandya S, Dickie B, Shah SR. Telemedicine in pediatric surgery. J Pediatr Surg 2019; 54:587-594. [PMID: 29801660 DOI: 10.1016/j.jpedsurg.2018.04.038] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/13/2018] [Accepted: 04/28/2018] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Telemedicine is an emerging strategy for healthcare delivery that has the potential to expand access, optimize efficiency, minimize cost, and enhance patient satisfaction. OBJECTIVE To review the current spectrum, potential strategies, and implementation process of telemedicine in pediatric surgery. DESIGN Review and opinion design. SETTING n/a. PARTICIPANTS n/a. MAIN OUTCOMES AND MEASURES: n/a. RESULTS n/a. CONCLUSIONS AND RELEVANCE Telemedicine is an emerging approach with the potential to facilitate efficient, cost-effective delivery of pediatric surgical services. BRIEF ABSTRACT Telemedicine is an emerging strategy for healthcare delivery that has the potential to expand access, optimize efficiency, minimize cost, and enhance patient satisfaction. The objectives of this review are to explore common terms in telemedicine, provide an overview of current legislative and billing guidelines, review the current state of telemedicine in surgery and pediatric surgery, and provide basic themes for successful implementation of a pediatric surgical telemedicine program. TYPE OF STUDY Review. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Matthew T Harting
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and Children's Memorial Hermann Hospital, Houston, TX.
| | - Austin Wheeler
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and Children's Memorial Hermann Hospital, Houston, TX
| | - Todd Ponsky
- Division of Pediatric Surgery, Akron Children's Hospital, Akron, OH
| | - Benedict Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Chuck L Snyder
- Department of Pediatric Surgery, Childrens Mercy Hospital, Kansas City, MO
| | - Nicholas E Bruns
- Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Aaron Lesher
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Samir Pandya
- Division of Pediatric Surgery, Department of Surgery, UT Southwestern Medical Center and Children's Medical Center, Dallas, TX
| | - Belinda Dickie
- Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Sohail R Shah
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
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11
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Bogen EM, Schlachta CM, Ponsky T. White paper: technology for surgical telementoring—SAGES Project 6 Technology Working Group. Surg Endosc 2019; 33:684-690. [DOI: 10.1007/s00464-018-06631-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022]
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12
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Cardella L, Carman T, Ponsky T. Giant jejunal mesenteric lymphangioma causing acute small bowel volvulus. Journal of Pediatric Surgery Case Reports 2018. [DOI: 10.1016/j.epsc.2017.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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13
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Augestad KM, Han H, Paige J, Ponsky T, Schlachta CM, Dunkin B, Mellinger J. Educational implications for surgical telementoring: a current review with recommendations for future practice, policy, and research. Surg Endosc 2017; 31:3836-3846. [DOI: 10.1007/s00464-017-5690-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/20/2017] [Indexed: 01/14/2023]
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14
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Linnaus ME, Notrica DM, Langlais CS, St Peter SD, Leys CM, Ostlie DJ, Maxson RT, Ponsky T, Tuggle DW, Eubanks JW, Bhatia A, Alder AC, Greenwell C, Garcia NM, Lawson KA, Motghare P, Letton RW. Prospective validation of the shock index pediatric-adjusted (SIPA) in blunt liver and spleen trauma: An ATOMAC+ study. J Pediatr Surg 2017; 52:340-344. [PMID: 27717564 DOI: 10.1016/j.jpedsurg.2016.09.060] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/20/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Age-adjusted pediatric shock index (SIPA) does not require knowledge of age-adjusted blood pressure norms, yet correlates with mortality, serious injury, and need for transfusion in trauma. No prospective studies support its validity. METHODS A multicenter prospective observational study of patients 4-16years presenting April 2013-January 2016 with blunt liver and/or spleen injury (BLSI). SIPA (maximum heart rate/minimum systolic blood pressure) thresholds of >1.22, >1.0, and >0.9 in the emergency department were used for 4-6, 7-12 and 13-16year-olds, respectively. Patients with ISS ≤15 were excluded to conform to the original paper. Discrimination outcomes were compared between SIPA and shock index (SI). RESULTS Of 1008 patients, 386 met inclusion. SI was elevated in 321, and SIPA elevated in 282. The percentage of patients with elevated index (SI or SIPA) and blood transfusion within 24 hours (30% vs 34%), BLSI grade ≥3 requiring transfusion (28% vs 32%), operative intervention (14% vs 16%) and ICU admission (64% vs 67%) was higher in the SIPA group. CONCLUSION SIPA was validated in this multi-institutional prospective study and identified a higher percentage of children requiring additional resources than SI in BLSI patients. SIPA may be useful for determining necessary resources for injured patients with BLSI. LEVEL OF EVIDENCE Level II prognosis.
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Affiliation(s)
- Maria E Linnaus
- Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016, USA
| | - David M Notrica
- Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016, USA.
| | | | - Shawn D St Peter
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, USA
| | - Charles M Leys
- American Family Children's Hospital, 1675 Highland Ave, Madison, WI 53792, USA
| | - Daniel J Ostlie
- Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016, USA; American Family Children's Hospital, 1675 Highland Ave, Madison, WI 53792, USA
| | - R Todd Maxson
- Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR 72202, USA
| | - Todd Ponsky
- Akron Children's Hospital, 1 Perkins Sq, Akron, OH 44308, USA
| | - David W Tuggle
- Dell Children's Medical Center, 4900 Mueller Blvd, Austin, TX 78723, USA
| | - James W Eubanks
- LeBonheur Children's Hospital, 50 N Dunlap St, Memphis, TN 38103, USA
| | - Amina Bhatia
- Children's Healthcare of Atlanta, 1975 Century Blvd NE#6, Atlanta, GA 30345, USA
| | - Adam C Alder
- Children's Medical Center Dallas, part of Children's Health(SM), 1935 Medical District Dr, Dallas, TX 75235, USA
| | - Cynthia Greenwell
- Children's Medical Center Dallas, part of Children's Health(SM), 1935 Medical District Dr, Dallas, TX 75235, USA
| | - Nilda M Garcia
- Dell Children's Medical Center, 4900 Mueller Blvd, Austin, TX 78723, USA
| | - Karla A Lawson
- Dell Children's Medical Center, 4900 Mueller Blvd, Austin, TX 78723, USA
| | - Prasenjeet Motghare
- The Children's Hospital at OU Medical Center, 940 NE 13th St, #1b1306, Oklahoma City, OK 73104, USA
| | - Robert W Letton
- The Children's Hospital at OU Medical Center, 940 NE 13th St, #1b1306, Oklahoma City, OK 73104, USA
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15
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Vaughan N, Tweed J, Greenwell C, Notrica DM, Langlais CS, Peter SDS, Leys CM, Ostlie DJ, Maxson RT, Ponsky T, Tuggle DW, Eubanks JW, Bhatia A, Greenwell C, Garcia NM, Lawson KA, Motghare P, Letton RW, Alder AC. The impact of morbid obesity on solid organ injury in children using the ATOMAC protocol at a pediatric level I trauma center. J Pediatr Surg 2017; 52:345-348. [PMID: 27707653 DOI: 10.1016/j.jpedsurg.2016.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/06/2016] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Obesity is an epidemic in the pediatric population. Childhood obesity in trauma has been associated with increased incidence of long-bone fractures, longer ICU stays, and decreased closed head injuries. We investigated for differences in the likelihood of failure of non-operative management (NOM), and injury grade using a subset of a multi-institutional, prospective database of pediatric patients with solid organ injury (SOI). METHODS We prospectively collected data on all pediatric patients (<18years) admitted for liver or splenic injury from September 2013 to January 2016. SOI was managed based upon the ATOMAC protocol. Obesity status was derived using CDC definitions; patients were categorized as non-obese (BMI <95th percentile) or obese (BMI ≥95th percentile). The ISS, injury grade, and NOM failure rate were calculated among other data points. RESULTS Of 1012 patients enrolled, 117 were identified as having data regarding BMI. Eighty-four percent of patients were non-obese; 16% were obese. The groups did not differ by age, sex, mechanism of injury, or associated injuries. There was no significant difference in the rate of failure of non-operative management (8.2% versus 5.3%). Obesity was associated with higher likelihood of severe (grade 4 or 5) hepatic injury (36.8% versus 15.3%, P=0.048) but not a significant difference in likelihood of severe (grade 4 or 5) splenic injury (15.3% versus 10.5%, P=0.736). Obese patients had a higher mean ISS (22.5 versus 16.1, P=0.021) and mean abdominal AIS (3.5 versus 2.9, P=0.024). CONCLUSION Obesity is a risk factor for more severe abdominal injury, specifically liver injury, but without an associated increase in failure of NOM. This may be explained by the presence of hepatic steatosis making the liver more vulnerable to injury. A protocol based upon physiologic parameters was associated with a low rate of failure regardless of the pediatric obesity status. LEVEL OF EVIDENCE Level II prognosis.
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Affiliation(s)
| | - Jeff Tweed
- Children's Medical Center Dallas, Dallas, TX 75235
| | | | | | | | | | | | - Daniel J Ostlie
- Phoenix Children's Hospital, Phoenix, AZ 85016; American Family Children's Hospital, Madison, WI 53792
| | | | | | | | | | - Amina Bhatia
- Hughes Spalding Children's Hospital, Atlanta, GA 30303
| | | | | | | | | | - Robert W Letton
- The Children's Hospital at OU Medical Center, Oklahoma City, OK 73104
| | - Adam C Alder
- Children's Medical Center Dallas, Dallas, TX 75235.
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16
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Alemayehu H, Clifton M, Santore M, Diesen D, Kane T, Petrosyan M, Franklin A, Lal D, Ponsky T, Nalugo M, Holcomb GW, St. Peter SD. Minimally Invasive Surgery for Pediatric Trauma—A Multicenter Review. J Laparoendosc Adv Surg Tech A 2015; 25:243-7. [DOI: 10.1089/lap.2014.0288] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Matthew Clifton
- Children's Healthcare of Atlanta at Egleston, Emory University, Atlanta, Georgia
| | - Matthew Santore
- Children's Healthcare of Atlanta at Egleston, Emory University, Atlanta, Georgia
| | | | - Timothy Kane
- Children's National Medical Center, Washington, D.C
| | | | | | - Dave Lal
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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17
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Esposito C, Najmaldin A, Schier F, Yamataka A, Ferro M, Riccipetitoni G, Czauderna P, Ponsky T, Till H, Escolino M, Iaquinto M, Marte A, Saxena A, Settimi A, Rothenberg S. Work-related upper limb musculoskeletal disorders in pediatric minimally invasive surgery: a multicentric survey comparing laparoscopic and sils ergonomy. Pediatr Surg Int 2014; 30:395-9. [PMID: 24292427 DOI: 10.1007/s00383-013-3437-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Surgeons are at risk for developing work-related musculoskeletal symptoms (WMS). The present study aims to compare laparoscopy and SILS ergonomy among pediatric surgeons. METHODS A questionnaire formed by 17 questions was mailed to 14 pediatric surgeons, seven with a large experience in laparoscopy and seven in SILS. All surgeons completed the survey. The questionnaires were focused on the type of laparoscopic or SILS activity, location and type of pain, need for drugs and its physical consequences. Results were analyzed using χ(2) test. RESULTS Results indicated a similar incidence of WMS with shoulder symptoms (>75%) in both groups. In laparoscopic group this pain is evident only after a long lasting procedure, while in SILS group the pain is present after each procedure performed. SILS surgeons used painkillers and other therapies statistically more frequently than laparoscopic group (χ(2) = 0.001). CONCLUSIONS This study confirms there is a strong association between WMS and MIS surgery. The incidence of pain is similar in both groups. Pain was present only after long lasting procedures in laparoscopic group, while SILS surgeons have pain after each procedure performed. In addition SILS surgeons use more frequently painkillers and other therapies compared to laparoscopic surgeons. In conclusion, it seems that SILS has a worse ergonomy compared to laparoscopy.
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Affiliation(s)
- Ciro Esposito
- "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy,
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18
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Abstract
This article discusses the potential benefits and challenges of minimally invasive surgery for infants and small children, and discusses why pediatric minimally invasive surgery is not yet the surgical default or standard of care. Minimally invasive methods offer advantages such as smaller incisions, decreased risk of infection, greater surgical precision, decreased cost of care, reduced length of stay, and better clinical information. But none of these benefits comes without cost, and these costs, both monetary and risk-based, rise disproportionately with the declining size of the patient. In this review, we describe recent progress in minimally invasive surgery for infants and children. The evidence for the large benefits to the patient will be presented, as well as the considerable, sometimes surprising, mechanical and physiological challenges surgeons must manage.
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Affiliation(s)
- Thane Blinman
- Children's Hospital of Philadelphia, 34th and Civic Center, Philadelphia, PA 19083, USA.
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19
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Affiliation(s)
- Shannon Acker
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Corinne Bazella
- Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH
| | - Todd Ponsky
- Department of Pediatric Surgery, Case Western Reserve University, Cleveland, OH
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20
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Rothenberg SS, Yoder S, Kay S, Ponsky T. Initial Experience with Surgical Telementoring in Pediatric Laparoscopic Surgery Using Remote Presence Technology. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:S219-22. [DOI: 10.1089/lap.2008.0133.supp] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Suzanne Yoder
- Rocky Mountain Hospital for Children, Denver, Colorado
| | - Saundra Kay
- Rocky Mountain Hospital for Children, Denver, Colorado
| | - Todd Ponsky
- Rocky Mountain Hospital for Children, Denver, Colorado
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21
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Nikfarjam M, Rosen M, Ponsky T. Early management of traumatic pancreatic transection by spleen-preserving laparoscopic distal pancreatectomy. J Pediatr Surg 2009; 44:455-8. [PMID: 19231557 DOI: 10.1016/j.jpedsurg.2008.09.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 09/22/2008] [Accepted: 09/24/2008] [Indexed: 12/13/2022]
Abstract
Pancreatic trauma is a common cause of acute pancreatitis in children and is often treated by conservative measures alone. Conservative measures are more likely to fail when there is complete pancreatic duct disruption. We report a case of complete transaction of the pancreatic neck following blunt trauma in a 14-year-old boy. Complete duct disruption was confirmed by endoscopic retrograde pancreatography. The patient was successfully managed by a laparoscopic spleen-preserving distal pancreatectomy and recovered quickly without complications. The merit of a laparoscopic approach to severe pancreatic injury in children is discussed.
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22
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Rothenberg SS, Yoder S, Kay S, Ponsky T. Initial Experience with Surgical Telementoring in Pediatric Laparoscopic Surgery Using Remote Presence Technology. J Laparoendosc Adv Surg Tech A 2008. [DOI: 10.1089/lap.2008.0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Brody F, Holzman M, Tarnoff M, Oleynikov D, Marks J, Ramshaw B, Ponsky T. Summaries of the SAGES 2007 reoperative minimally invasive surgery symposium. Surg Endosc 2007; 22:232-44. [PMID: 18085332 DOI: 10.1007/s00464-007-9695-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Accepted: 10/26/2007] [Indexed: 11/25/2022]
Abstract
This manuscript represents a compilation of summaries from the reoperative symposium at the SAGES 2007 conference in Las Vegas, Nevada. The symposium addressed reoperative laparoscopy for several common diseases including colorectal disease, gastroesophageal reflux, hernias, bariatric, and pediatric surgery. The preoperative assessment is crucial to the success of each procedure. Prior to any intervention the underlying functional, mechanical, or pathophysiological disorder must be identified to ensure the success of the reoperative laparoscopic procedure. The ensuing manuscript summarizes the oral presentations and discusses several technical aspects for each disorder.
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Affiliation(s)
- Fred Brody
- Department of Surgery, The George Washington University Medical Center, Washington, DC 20037, USA.
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24
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Affiliation(s)
- Edward Pucci
- Department of Surgery, The George Washington University Medical Center, Washington, DC, USA
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25
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Abstract
Inflammatory bowel disease (IBD) is a general term used to describe two chronic bowel disorders, Crohn's disease (CD) and ulcerative colitis (UC), both of which are characterized by autoimmune-related inflammation of the intestines. UC is limited to the colonic mucosa, whereas CD can involve any part of the intestinal tract from the mouth to the anus. The true etiology of UC and CD is still unknown, although extensive research has identified some genetic and environmental factors. This article discusses current clinical concepts of both diseases in the pediatric population.
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Affiliation(s)
- Todd Ponsky
- Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010-2970, USA
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26
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Khanna PC, Ponsky T, Zagol B, Lukish JR, Markle BM. Sonographic appearance of canal of Nuck hydrocele. Pediatr Radiol 2007; 37:603-6. [PMID: 17453186 DOI: 10.1007/s00247-007-0481-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2007] [Revised: 03/11/2007] [Accepted: 03/23/2007] [Indexed: 11/30/2022]
Abstract
We present a case of a relatively uncommon entity in a 17-year-old girl who presented to the emergency department with right inguinal pain and discomfort. On sonography, she was thought to have a hydrocele of a patent processus vaginalis, although differentials could not be excluded. The hydrocele was subsequently confirmed at surgery. Because this is an uncommonly reported condition, a high index of suspicion must be maintained in the appropriate clinical setting. We present various sonographic appearances and techniques that have been proposed in the literature.
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Affiliation(s)
- Paritosh C Khanna
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, George Washington University, Washington DC, USA.
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27
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Abstract
Inferior shoulder dislocation or luxatio erecta is an exceedingly rare form of shoulder dislocation and compromises less than 0.5% of all shoulder dislocations. Furthermore, bilateral luxatio erecta is reported only nine times in the English literature. This paper documents the tenth case of bilateral luxatio erecta. This tenth patient suffered an axial load injury to his outstretched arms and displaced both humeral heads inferiorly. After closed reduction, the patient was discharged home on hospital day two. However, he developed an axillary vein thrombosis 3 days later and required anticoagulation therapy. This report reviews the mechanisms of injury associated with inferior shoulder dislocations as well as the presentation and treatment of luxatio erecta. The complication of axillary vein thrombosis and its treatment in this patient are discussed also.
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Affiliation(s)
- Ryan Garcia
- Department of Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
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28
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Newman K, Ponsky T, Kittle K, Dyk L, Throop C, Gieseker K, Sills M, Gilbert J. Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals. J Pediatr Surg 2003; 38:372-9; discussion 372-9. [PMID: 12632352 DOI: 10.1053/jpsu.2003.50111] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND/PURPOSE To improve clinical results and resource utilization in the care of appendicitis in children, the authors examined the current practice and outcomes of 30 pediatric hospitals. METHODS The Pediatric Health Information System (PHIS) database consists of comparative data from 30 free-standing Children's hospitals. The study population of 3,393 children was derived from the database by selecting the "Diagnosis Related Group Code" for appendicitis (APRDRGv12 164), ages 0 to 17 years, using discharges between October 1, 1999 and September 30, 2000. Data are expressed as the range and median for individual hospital outcomes. RESULTS The nonpositive appendectomy rate ranged from 0 to 17% at the 30 hospitals (median, 2.6%). Ruptured appendicitis varied from 20% to 76% (median, 36.5%). The median length of stay (LOS) for nonruptured appendicitis was 2 days (range, 1.4 to 3.1 days), ruptured appendicitis varied from 4.4 to 11 days (median, 6 days). The median readmission rate within 14 days was 4.3% (0 to 10%). Laparoscopic appendectomy varied from 0 to 95% in the 30 hospitals (mean, 31%) The LOS did not vary significantly in laparoscopic versus open for nonruptured (2.3 v 2.0 days) or ruptured appendicitis (5.5 v 6.2 days). Days on antibiotics for ruptured appendicitis ranged from 4.6 to 7.9 days (median, 5.9 days) Children receiving any study varied from 18% to 89% (median, 69%). Ultrasound scan and computed tomography (CT) were comparable in both nonruptured (13% ultrasound scan v 14%) and ruptured appendicitis (14% ultrasound scan v 21% CT). CONCLUSIONS Significant variability in practice patterns and resource utilization exists in the management of acute appendicitis in pediatric hospitals. Clinical outcomes could be improved by collaborative initiatives to adopt evidence-based best practices.
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Affiliation(s)
- Kurt Newman
- Department of Surgery, Children's National Medical Center and George Washington University School of Medicine, Washington, DC, USA
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29
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Abstract
In contrast to that in adults, hypertension in children is frequently amenable to surgical therapy. With advancing techniques in imaging, surgery, and anesthesia, the outcomes of surgery are excellent for children with endocrine tumors causing hypertension.
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Affiliation(s)
- Kurt D Newman
- Departments of Surgery and Pediatrics, Children's National Medical Center, 111 Michigan Avenue NW, Washington, D.C. 20010, USA.
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30
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Youngelman DF, Marks JM, Ponsky T, Ponsky JL. Comparison of bile duct pressures following sphincterotomy and endobiliary stenting in a canine model. Surg Endosc 1997; 11:126-8. [PMID: 9069142 DOI: 10.1007/s004649900313] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cystic duct (CD) leaks following laparoscopic cholecystectomy may be diagnosed and managed with ERCP. Treatment options include endoscopic sphincterotomy (ES) and/or endobiliary stenting (Stent). This study was undertaken to determine if ES or Stent is more effective in lowering bile duct pressures by disrupting the pressure gradient created by the sphincter of Oddi and therefore more beneficial in the management of CD. METHODS Mongrel dogs underwent midline laparotomy and antegrade cannulation of the common bile duct (CBD) with an umbilical artery catheter. Baseline CBD pressures were measured following duodenotomy; 5 Fr and 7 Fr stents measuring 2.5 cm, 4.5 cm, and 7 cm were inserted retrograde into the CBD. CBD pressure was measured after each stent insertion. A 1-cm sphincterotomy was the performed using a double channel papillotome. RESULTS Insertion of both 5 Fr and 7 Fr stents significantly lowered CBD pressure as compared to sphincterotomy alone, p < 0.05. There was no significant difference in the reduction in CBD pressure following the insertion of either the 5 Fr or 7 Fr stents of varying lengths. Sphincterotomy alone did not significantly decrease CBD pressure as compared to baseline pressure. The insertion of a stent following sphincterotomy also caused a significant decrease in CBD pressure as compared to sphincterotomy alone, p = 0.034. CONCLUSION Stent placement or ES with Stent placement significantly reduced CBD pressure as compared to ES alone. Stent diameter and length were not significant variables in this study. These results support the use of Stent or ES with Stent rather than ES alone in the management of CD leaks.
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Affiliation(s)
- D F Youngelman
- Department of Surgery, The Mt. Sinai Medical Center, One Mt. Sinai Drive, Cleveland, OH 44106, USA
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