Not deep enough: Modeling the effect of shallow placement of the DaVinci Xi "bariatric" long trocar on the muscular abdominal wall.

Introduction: The DaVinci Xi Robotic Surgical System (Xi) long cannula (Intuitive Surgical Company, Sunnyvale, CA) provides five additional centimeters of distal length compared to the standard Xi trocar. The extra length allows the cannula to traverse prohibitively thick body wall tissue. Our aims are to quantitatively model the consequences of not preserving the rotational centerpoint of motion (RCM) at the muscular abdominal wall.

Management of Hypercalcemic Crisis due to Primary Hyperparathyroidism During Pregnancy.

Primary hyperparathyroidism is the third most common endocrine disorder following diabetes and thyroid disease. Women are affected by primary hyperparathyroidism twice as often as men. The first reported case of hyperparathyroidism during pregnancy was in 1931.

Comparing Severely Injured Trauma Patients Admitted to Investor-Owned versus Public and Not-For-Profit Hospitals Reveals Opportunities for Improvement in the US.

Background: Non-elderly trauma patients represent the largest portion of preventable years of life loss in the US. The purpose of this study was to compare outcomes in patients admitted to investor-owned vs public and not-for-profit hospitals across the US.

Material And Methods: The Nationwide Readmissions Database 2018 was queried for trauma patients with an Injury Severity Score greater than 15 and age 18-65 years.

Comparing Payments to Surgeons From Drug and Medical Device Corporations Reveals Inequalities Between Genders and Specialties.

Introduction: Maintaining trust in the patient-doctor relationship requires transparency in the details of the financial relationships between physicians and drug and medical device corporations. These details are publicly available through the Open Payments database, and patients are encouraged to ask surgeons to interpret their implications. The purpose of this study was to better equip surgeons in responding to these inquiries and to compare the distribution of these payments by gender and specialty.

From Palm Leaves to Thermoplastic Polyurethanes-The History of Vascular Catheter Development and Use.

Vascular catheterization procedures are performed on millions of patients in the United States annually. Diagnostic and therapeutic, these procedures allow for the detection and treatment of diseased vessels. The use of catheters, however, is no new phenomenon.

Diagnostics in a Surgeon's Pocket-The History of Telepaque and Oral Cholecystograms.

Biliary diseases such as cholelithiasis, choledocholithiasis, and cholecystitis all rely on imaging modalities to help make diagnoses. In modern times, ultrasound, computer tomography, and nuclear medicine scans help precisely visualize biliary and hepatic anatomy and pathology. The predecessor of these imaging modalities was the cholecystogram.

Financial Toxicity in Emergency General Surgery: Novel Propensity-Matched Outcome Comparison.

Background: Financial toxicity describes the harmful effect of individual treatment costs and fiscal burdens that have a compounding negative impact on outcomes in surgery. While this phenomenon has been widely studied in surgical oncology, the purpose of this study was to perform a novel exploration of the impact of financial toxicity in emergency general surgery (EGS) patients throughout the US.

Study Design: The Nationwide Readmissions Database for January and February 2018 was queried for all EGS patients aged 18 to 65 years.

Portal Hypertension Due to a Traumatic Arteriovenous Fistula in a Patient With a Celiac Artery Aneurysm.

This article describes a rare case of a traumatic splenic arteriovenous fistula (AVF) causing portal hypertension in a patient presenting with abdominal pain, diarrhea, and melena. A 78-year-old was admitted to the hospital with abdominal pain. The patient's history was notable for prior laparotomy and left nephrectomy for a gunshot wound.

Nationwide Analysis of Hospital Admissions Prior to Hartmann's Procedure for Acute Diverticulitis.

Introduction: Diverticular disease is one of the most common gastrointestinal diseases that require hospital admission. This study aims to identify trends in prior hospital admissions for patients that ultimately require a Hartmann's procedure for complicated diverticulitis.

Methods: The Nationwide Readmissions Database for 2010-2014 was queried for all patients aged 18 years or older admitted with an ICD-9 code for colonic diverticulitis and end colostomy creation.

Under the Microscope: The Evolution of Surgical Loupes.

Fine motor movements of the surgeon's hands are limited by the resolution of the eye. Surgical loupes have allowed the profession of surgery to surpass this threshold. This is a review of the historical milestones that lead up to the development of the modern-day loupes.

The Evolution of Bariatric Surgery-From Sewing Lips to Constructing the Sleeve.

Bariatric surgery remains the most durable weight loss option to address morbid obesity, providing lasting reduction of debilitating chronic comorbidities. This is a review of the historical milestones that led up to the development of this surgical practice. We explore perceptions and interventions for obesity as early as the 10 century, as well as pre-modern surgical perceptions and advancements in foregut and obesity surgery.

Hospital Readmissions for Hyperparathyroidism After Bariatric Surgery in the United States: A National Database Review.

Introduction: The incidence and significance of hyperparathyroidism in patients after bariatric surgery have been established to some degree; however, the impact it has on the national healthcare system has not. We sought to assess the risk of readmission and related comorbidities in this patient population.

Methods: The Healthcare Cost and Utilization Project Nationwide Readmission Database was queried for all patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG).

Not all laparoscopic adrenalectomies are equal: analysis of postoperative outcomes based on tumor functionality.

Background: Laparoscopic adrenalectomy is known to have a low complication rate; however, the influence of functional tumor subtype on postoperative outcomes is not well defined.

Methods: Patients undergoing laparoscopic adrenalectomy for benign adrenal tumors between 2009 and 2017 were selected from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Patient demographics, postoperative outcomes, and length of stay were compared between tumor subtypes.

Fulminant Ischemic Pancolitis: A Severe Variant of Ischemic Colitis.

We present the case of a 75-year-old female with abdominal pain and a sudden change in mental status. She progressed rapidly with manifestations of acidosis without episodes of bloody bowel movements or diarrhea. The patient underwent emergent exploratory laparotomy, and a diagnosis of fulminant ischemic pancolitis was made with visual confirmation of infarcted colon from cecum to proximal rectum leading to subtotal colectomy and ileostomy.

Thoracic Duct Embolization in Post-neck Dissection Chylous Leakage: A Case Series of Six Patients and Review of the Literature.

Chylous leak is a serious complication of neck dissection. Patients are often managed conservatively, and failure of conservative management necessitates surgical management, which adds to their morbidity. We present a case series demonstrating the value of thoracic duct embolization (TDE) in management of patients with chylous leaks following neck dissection who have failed conservative management and to review the literature on this specific application of TDE.

Incarcerated Spigelian Hernias: A Rare Cause of a High-grade Small Bowel Obstruction.

A Spigelian hernia is a very rare hernia, making up approximately 0.1% of all abdominal wall hernias. This hernia goes through a defect in the Spigelian fascia which is the part of the transversus abdominis aponeurosis lateral to the rectus muscle, often at the level of the arcuate line, where the fascia is widest and weakest.

Does Aggressive Variant Histology Without Invasive Features Predict Overall Survival in Papillary Thyroid Cancer?: A National Cancer Database Analysis.

Objective: We aimed to clarify whether aggressive histology of papillary thyroid cancer (PTC) impacts overall survival (OS).

Summary Background Data: Aggressive variants of PTC (AVPTC) are associated with invasive features. However, their behavior in the absence of these features is not well characterized.

Dual inhibition of BRAF and MEK increases expression of sodium iodide symporter in patient-derived papillary thyroid cancer cells in vitro.

Background: The majority of papillary thyroid cancers are driven by acquired mutations typically in the BRAF or RAS genes that aberrantly activate the mitogen-activated protein kinase pathway. This process leads to malignant transformation, dedifferentiation, and a decrease in the expression of the sodium-iodide symporter (NIS; SLC5A5), which results in resistance to radioactive iodine therapy. We sought to determine whether inhibition of aberrant mitogen-activated protein kinase-signaling can restore NIS expression.

Insights into the biology and treatment strategies of pancreatic neuroendocrine tumors.

Pancreatic neuroendocrine tumors (PNETs) are the second most common primary pancreatic neoplasms after pancreatic ductal adenocarcinoma. PNETs present with widely various clinical manifestation and unfavorable survival rate. The recent advances in next generation sequencing have significantly increased our understanding of the molecular landscape of PNETs and help guide the development of targeted therapies.

Insurance Status Is Associated with Extent of Treatment for Patients with Papillary Thyroid Carcinoma.

Health insurance has been shown to be a key determinant in cancer care, but it is unknown as to what extent insurance status affects treatments provided to papillary thyroid cancer (PTC) patients. We hypothesized that insured patients with PTC would have lower-risk tumors at diagnosis and be more likely to receive adjuvant therapies at follow-up. The American College of Surgeons' National Cancer Database was queried to identify all patients diagnosed with PTCs >2 mm in size from 2004 to 2015.

Comparing Machine Learning Algorithms for Predicting Acute Kidney Injury.

Prior studies have used vital signs and laboratory measurements with conventional modeling techniques to predict acute kidney injury (AKI). The purpose of this study was to use the trend in vital signs and laboratory measurements with machine learning algorithms for predicting AKI in ICU patients. The eICU Collaborative Research Database was queried for five consecutive days of laboratory measurements per patient.

National Risk Factors for Child Maltreatment after Trauma: Failure to Prevent.

The purpose of this study was to identify the risk factors for hospital readmission for child maltreatment after trauma, including admissions across different hospitals nationwide. The Nationwide Readmissions Database for 2010-2014 was queried for all patients younger than 18 years admitted for trauma. The primary outcome was readmission for child maltreatment.

The 2015 American Thyroid Association guidelines are associated with an increasing rate of hemithyroidectomy for thyroid cancer.

Background: In an attempt to prevent overly aggressive treatment of low-risk thyroid cancers, the American Thyroid Association changed guideline recommendations in late 2015 to state that either hemithyroidectomy or total thyroidectomy are acceptable operations for these patients. We hypothesized that surgeons would increasingly perform hemithyroidectomy after the release of these guidelines.

Methods: The database of the National Surgery Quality Improvement Program was queried to identify all patients with thyroid cancer who were undergoing thyroidectomy between 2009 and 2017.