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Vakil E, Dumoulin E, Stollery D, Gillson AM, MacEachern P, Dhaliwal I, Mitchell M, Li P, Schieman C, Romatowski N, Chee AC, Tyan CC, Fortin M, Hergott CA, Tremblay A. Molecular analysis of endobronchial ultrasound needle aspirates in patients with non-small cell lung cancer: Results from the SCOPE database. Cytopathology 2024; 35:378-382. [PMID: 38349229 DOI: 10.1111/cyt.13367] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/12/2024] [Accepted: 02/02/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE Molecular subtyping of non-small cell lung cancer (NSCLC) is critical in the diagnostic evaluation of patients with advanced disease. This study aimed to examine whether samples from endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) of intrathoracic lymph nodes and/or lung lesions are adequate for molecular analysis across various institutions. METHODS We retrospectively reviewed all cases of linear EBUS-TBNA with a final bronchoscopic diagnosis of NSCLC entered in the Stather Canadian Outcomes registry for chest ProcEdures database. The primary outcome was specimen inadequacy rate for each molecular target, as defined by the local laboratory or pathologist. RESULTS A total of 866 EBUS-TBNA procedures for NSCLC were identified. Specimen inadequacy rates were 3.8% for EGFR, 2.5% for ALK-1 and 3.5% for PD-L1. Largest target size was not different between adequate and inadequate specimens, and rapid onsite evaluation did not increase specimen adequacy rates. One centre using next-generation sequencing for EGFR had lower adequacy rates than 2 others using matrix-assisted laser desorption/ionization time-of-flight mass spectrophotometry. CONCLUSION EBUS-TBNA specimens have a very low-specimen inadequacy rate for molecular subtyping of non-small cell lung cancer.
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Affiliation(s)
- Erik Vakil
- Division of Respirology, University of Calgary, Calgary, Alberta, Canada
| | - Elaine Dumoulin
- Division of Respirology, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Stollery
- Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ashley-Mae Gillson
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Paul MacEachern
- Division of Respirology, University of Calgary, Calgary, Alberta, Canada
| | | | - Michael Mitchell
- Division of Respirology, Western University, London, Ontario, Canada
| | - Pen Li
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Colin Schieman
- Section of Thoracic Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Alex C Chee
- Division of Respirology, Alberta Health Services, Calgary, Alberta, Canada
| | - Chung Chun Tyan
- Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Marc Fortin
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | | | - Alain Tremblay
- Division of Respirology, University of Calgary, Calgary, Alberta, Canada
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Ball CG, Schieman C, Harvey EJ. The art of the second opinion. Can J Surg 2023; 66:E337-E338. [PMID: 37369444 DOI: 10.1503/cjs.007423] [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] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- Chad G Ball
- Coeditors-in-chief, CJS (Ball, Harvey); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Schieman); and the Department of Surgery, McGill University, Montreal, Que. (Harvey)
| | - Colin Schieman
- Coeditors-in-chief, CJS (Ball, Harvey); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Schieman); and the Department of Surgery, McGill University, Montreal, Que. (Harvey)
| | - Edward J Harvey
- Coeditors-in-chief, CJS (Ball, Harvey); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Schieman); and the Department of Surgery, McGill University, Montreal, Que. (Harvey)
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Ball CG, Schieman C, Harvey EJ. L’art de donner un deuxième avis. Can J Surg 2023; 66:E339-E340. [PMID: 37523677 PMCID: PMC10310338 DOI: 10.1503/cjs.007623] [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] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- Chad G Ball
- Corédacteurs en chef, CJS (Ball, Harvey); Département de chirurgie, Université de Calgary, Calgary, Alb. (Ball, Schieman); Département de chirurgie, Université McGill, Montréal, Qc (Harvey)
| | - Colin Schieman
- Corédacteurs en chef, CJS (Ball, Harvey); Département de chirurgie, Université de Calgary, Calgary, Alb. (Ball, Schieman); Département de chirurgie, Université McGill, Montréal, Qc (Harvey)
| | - Edward J Harvey
- Corédacteurs en chef, CJS (Ball, Harvey); Département de chirurgie, Université de Calgary, Calgary, Alb. (Ball, Schieman); Département de chirurgie, Université McGill, Montréal, Qc (Harvey)
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Romatowski NPJ, Gillson AM, Stollery D, Dumoulin E, Vakil E, Dhaliwal I, MacEachern P, Hergott CA, Tyan CC, Mitchell M, Schieman C, Fortin M, Tremblay A. Endobronchial Ultrasound Transbronchial Needle Aspiration With a 19-Gauge Needle vs 21- and 22-Gauge Needles for Mediastinal Lymphadenopathy. Chest 2022; 162:712-720. [PMID: 35381259 DOI: 10.1016/j.chest.2022.03.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/03/2021] [Revised: 02/18/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is commonly used to evaluate mediastinal lymphadenopathy. Studies focusing on malignant lymphadenopathy have compared 21- and 22-gauge (21G and 22G, respectively) needles and have not identified an advantage of one needle size over the other in terms of diagnostic yield. RESEARCH QUESTION Does the 19-gauge (19G) EBUS needle offer greater diagnostic yield and sensitivity vs the 21G and 22G EBUS needles for a diagnosis of sarcoidosis, lymphoma, or mediastinal lymphadenopathy not yet diagnosed? STUDY DESIGN AND METHODS This study retrospectively examined records of 730 patients from the Stather Canadian Outcomes Registry for Chest Procedures (SCOPE) database who underwent EBUS-TBNA for a diagnosis of suspected sarcoidosis, lymphoma, or mediastinal lymphadenopathy not yet diagnosed. A propensity score analysis of two groups was performed. One group comprised patients undergoing EBUS-TBNA with a 19G needle, the other with a 21G or 22G needle. Cases for analysis were selected with a 1:2 ratio of 19G vs 21/22G using logistic regression and random matching with all eligible 19G cases included. RESULTS There were 137 patients (312 targets) in the 19G group and 274 patients (631 targets) in the 21/22G group in the propensity score analysis. The diagnostic yield was 107 of 137 (78.1%) in the 19G group vs 194 of 274 (70.8%) in the 21/22G group (difference, 7.3%; 95% CI, -1.9 to 15.6; P = .116). The sensitivity of EBUS-TBNA for sarcoidosis was 80 of 84 (95.2%) in the 19G group vs 150 of 156 (96.2%) in the 21/22G group (difference, 1.0%; 95% CI, -4.2 to 8.2; P = .71). In patients with a final diagnosis of lymphoma, EBUS was diagnostic in 10 of 13 (76.9%) in the 19G group vs 12 of 12 (100%) in the 21/22G group (difference, 23.1%; 95% CI, -5.4 to 50.3; P = .08). INTERPRETATION The study did not identify an advantage of the 19G EBUS needle over the 21/22G EBUS needles for diagnostic yield nor sensitivity for sarcoidosis or lymphoma.
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Affiliation(s)
| | | | | | - Elaine Dumoulin
- Department of Medicine, Division of Respirology, University of Calgary Cumming School of Medicine
| | - Erik Vakil
- Division of Respirology, University of Calgary Faculty of Medicine, Medicine
| | | | - Paul MacEachern
- Department of Medicine, Division of Respirology University of Calgary Faculty of Medicine
| | - Christopher A Hergott
- Department of Medicine, Division of Respirology University of Calgary Faculty of Medicine
| | - Chung Chun Tyan
- Department of Medicine, Division of Respirology, Critical Care and Sleep Medicine University of Saskatchewan College of Medicine
| | - Michael Mitchell
- Department of Medicine, Division of Respirology, London Health Sciences Centre
| | - Colin Schieman
- Division of Thoracic Surgery, University of Calgary Faculty of Medicine
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Tremblay A, Chee AC, Dhaliwal I, Dumoulin E, Gillson A, MacEachern PR, Mitchell M, Schieman C, Stollery D, Li P, Fortin M, Tyan CC, Vakil E, Hergott C. Protocol for the Stather Canadian Outcomes Registry for Chest ProcedurEs (SCOPE). BMJ Open Respir Res 2021; 8:8/1/e000834. [PMID: 33509788 PMCID: PMC7845675 DOI: 10.1136/bmjresp-2020-000834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction The Stather Canadian Outcomes registry for chest ProcedurEs (SCOPE registry) is a Canadian multicentre registry of chest procedures. Methods and analysis The SCOPE registry is designed as a multicentre prospective database of specific bronchoscopic or other pulmonary procedures. Each procedure of interest will be associated with a registry module, and data capture designed to evaluate effectiveness of procedures on relevant patient outcomes. Participating physicians will be asked to enter data for all procedures performed in a given module. The anonymised dataset will be housed in a web-based electronic secure database. Specific modules included will be based on participating physician suggestions, capacity and consensus of the steering committee and relevance of hypotheses/research potential. Ethics and dissemination The central registry is under approval from the Conjoint Health Research Ethics Board at the University of Calgary. We aim for registry data to lead to publication of manuscripts in international medical journals as the primary mode of dissemination. Data may also be used by local investigators for personal and/or institutional quality control purposes as well as to inform health policies. Data requests from non-participating investigators for use under ethics approved research protocols can be considered.
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Affiliation(s)
- Alain Tremblay
- Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alex C Chee
- Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Ashley Gillson
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Michael Mitchell
- Medicine, University of Western Ontario, London, Ontario, Canada
| | - Colin Schieman
- Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Pen Li
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Marc Fortin
- Respiratory Medicine, Universite Laval, Quebec, Québec, Canada
| | - Chung C Tyan
- Medicine, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Erik Vakil
- Medicine, University of Calgary, Calgary, Alberta, Canada
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Butler J, Finley C, Norell CH, Harrison S, Bryant H, Achiam MP, Altman AD, Baxter N, Bentley J, Cohen PA, Chaudry MA, Dixon E, Farrell R, Fegan S, Hashmi S, Hogdall C, Jenkins JT, Kwon J, Mala T, McNally O, Merrett N, Nelson G, Nordin A, Park J, Porter G, Reynolds J, Schieman C, Schnack T, Spigelman A, Svendsen LB, Sykes P, Thomas R. New approaches to cancer care in a COVID-19 world. Lancet Oncol 2020; 21:e339-e340. [PMID: 32615112 PMCID: PMC7324090 DOI: 10.1016/s1470-2045(20)30340-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 12/25/2022]
Affiliation(s)
- John Butler
- Department of Gynecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK; Policy & Information, Cancer Research UK, London, E20 1JQ, UK
| | - Christian Finley
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada; Canadian Partnership Against Cancer, Toronto, ON, Canada
| | | | | | - Heather Bryant
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | - Michael P Achiam
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen, Denmark
| | - Alon D Altman
- Department of Gynecologic Oncology, University of Manitoba, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Nancy Baxter
- Department of Surgery and LiKa Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - James Bentley
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS, Canada
| | - Paul A Cohen
- Department of Gynaecologic Oncology, St John of God Subiaco Hospital, Subiaco, WA, Australia
| | - M Asif Chaudry
- Department of Gastrointestinal Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Elijah Dixon
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Rhonda Farrell
- Gynaecological Oncology Department, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Scott Fegan
- Department of Obstetrics and Gynaecology, The Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Salila Hashmi
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Claus Hogdall
- Department of Gynaecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John T Jenkins
- Department of Surgery, St. Mark's Hospital, Middlesex, UK
| | - Janice Kwon
- Department of Obstetrics and Gynaecology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Tom Mala
- Department of Gastrointestinal and Paediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Orla McNally
- Oncology and Dysplasia Service, The Royal Women's Hospital, Melbourne, VIC, Australia
| | - Neil Merrett
- Faculty of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Gregg Nelson
- Department of Gynecologic Oncology, University of Calgary, Calgary, AB, Canada
| | - Andy Nordin
- East Kent Gynaecological Centre, East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - Jason Park
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Geoff Porter
- Canadian Partnership Against Cancer, Toronto, ON, Canada; Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - John Reynolds
- Department of Surgery, Trinity Translational Medicine Institute, St. James's Hospital, Dublin, Ireland
| | - Colin Schieman
- Section of Thoracic Surgery, University of Calgary, Calgary, AB, Canada
| | - Tine Schnack
- Department of Gynaecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Allan Spigelman
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Lars Bo Svendsen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen, Denmark
| | - Peter Sykes
- Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand
| | - Robert Thomas
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
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Ahmadi N, Mbuagbaw L, Hanna WC, Finley C, Agzarian J, Wen CK, Coret M, Schieman C, Shargall Y. Development of a clinical score to distinguish malignant from benign esophageal disease in an undiagnosed patient population referred to an esophageal diagnostic assessment program. J Thorac Dis 2020; 12:191-198. [PMID: 32274084 PMCID: PMC7139012 DOI: 10.21037/jtd.2020.02.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Esophageal cancer is associated with poor prognosis. Diagnosis is often delayed, resulting in presentation with advanced disease. We developed a clinical score to predict the risk of a malignant diagnosis in symptomatic patients prior to any diagnostic tests. Methods We analyzed data from patients referred to a regional esophageal diagnostic assessment program between May 2013 and August 2016. Logistic regression was performed to identify predictors of malignancy based on patient characteristics and symptoms. Predicted probabilities were used to develop a score from 0 to 10 which was weighted according to beta coefficients for predictors in the model. Score accuracy was evaluated using a receiver operating characteristic (ROC) curve and internally validated using bootstrapping techniques. Patients were classified into low (0–2 points), medium (3–6 points), and high (7–10 points) risk groups based on their scores. Pathologic tissue diagnosis was used to assess the effectiveness of the developed score in predicting the risk of malignancy in each group. Results Of 530 patients, 363 (68%) were diagnosed with malignancy. Factors predictive of malignancy included male sex, family history of cancer and esophageal cancer, fatigue, chest/throat/back pain, melena and weight loss. These factors were allocated 1–2 points each for a total of 10 points. Low-risk patients had 70% lower chance of malignancy (RR =0.28, 95% CI: 0.21–0.38), medium-risk had 50% higher chance of malignancy (RR =1.5, 95% CI: 1.26–1.77), and high-risk patients were 8 times more likely to be diagnosed with malignancy (RR =8.2, 95% CI: 2.60–25.86). The area under the ROC curve for malignancy was 0.82 (95% CI: 0.77–0.87). Conclusions A simple score using patient characteristics and symptoms reliably distinguished malignant from benign diagnoses in a population of patients with upper gastrointestinal symptoms. This score might be useful in expediting investigations, referrals and eventual diagnosis of malignancy.
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Affiliation(s)
- Negar Ahmadi
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Centre for the Development of Best Practices in Health, Yaoundé, Cameroon
| | - Waël C Hanna
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Christian Finley
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - John Agzarian
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Chuck K Wen
- Division of Thoracic Surgery, University of British Columbia, Surrey, BC, Canada
| | - Michal Coret
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Colin Schieman
- Section of Thoracic Surgery, University of Calgary, Calgary, AB, Canada
| | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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Turner SR, Lai H, Nasir BS, Yasufuku K, Schieman C, Huang J, Bédard ELR. Development and Pilot Testing of an Assessment Tool for Performance of Anatomic Lung Resection. Ann Thorac Surg 2019; 109:1922-1930. [PMID: 31706874 DOI: 10.1016/j.athoracsur.2019.09.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/22/2019] [Revised: 08/15/2019] [Accepted: 09/16/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND To meet the need for competency assessment in thoracic surgery education, we developed and tested an instrument to assess trainees' ability to perform anatomic lung resection for cancer. METHODS The Thoracic Competency Assessment Tool-Anatomic Resection for Lung Cancer (TCAT-ARC) was developed through a multistep process involving logical analysis, expert review, and simulation-based and clinical pilot testing. Validity evidence was gathered during a 6-month clinical study of trainees performing anatomic lung resections and assessments of practicing surgeons. Feedback was gathered via post-encounter questionnaires. RESULTS A 35-item instrument was developed and was tested in the clinical validation study. Seven trainees in 4 North American institutions participated and completed 64 anatomic lung resections. Reliability was high (α = 0.93). Interobserver reliability (k = 0.73) and correlation with an existing global competency scale (k = 0.68) were moderately high. Item analysis revealed the most difficult and discriminatory items, which matched well with a conceptual understanding of lung resection. Both trainees and assessors viewed the instrument as highly educationally effective and user-friendly. Practicing surgeons outperformed trainees. CONCLUSIONS The TCAT-ARC demonstrated early evidence of validity and reliability in assessing performance of anatomic lung resection. The instrument may be most useful early in training and as a means for providing fine-grained formative feedback about which steps have been mastered and which still require improvement. The TCAT-ARC may be used in training programs to aid in the development of trainees' competency and as a part of an aggregate assessment of trainees' overall mastery of the procedure and readiness for independent practice.
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Affiliation(s)
- Simon R Turner
- Division of Thoracic Surgery, University of Alberta, Edmonton, Canada.
| | - Hollis Lai
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Basil S Nasir
- Division of Thoracic Surgery, Université de Montréal, Montréal, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, University of Toronto, Toronto, Canada
| | - Colin Schieman
- Division of Thoracic Surgery, University of Calgary, Calgary, Canada
| | - James Huang
- Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric L R Bédard
- Division of Thoracic Surgery, University of Alberta, Edmonton, Canada
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Turner SR, Nasir BS, Lai H, Yasufuku K, Schieman C, Louie BE, Bédard ELR. Development and Pilot Testing of an Assessment Tool for Performance of Invasive Mediastinal Staging. Ann Thorac Surg 2019; 108:590-596. [PMID: 31009628 DOI: 10.1016/j.athoracsur.2019.03.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/30/2018] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND To develop and evaluate a surgical trainee competency assessment instrument for invasive mediastinal staging, including cervical mediastinoscopy and endobronchial ultrasound (EBUS), a comprehensive instrument was developed, the Thoracic Competency Assessment Tool-Invasive Staging (TCAT-IS), using expert review and simulated and clinical pilot-testing. METHODS Validity and reliability evidence were collected, and item analysis was performed. Initially, a 27-item instrument was developed, which underwent expert review with members of the Canadian Association of Thoracic Surgeons (n = 86) in 2014 to 2015 (response rate, 57%). TCAT-IS was refined to 29 items in 4 competency areas: preoperative, general operative, mediastinoscopy, and EBUS. Further refinements were made based on simulated use. The final version was then used to assess competency of 5 thoracic trainees performing invasive mediastinal staging in live patients. RESULTS Participants were assessed during 20 mediastinoscopy and 8 EBUS procedures, with 47 total assessments completed. Reliability (Cronbach's alpha = 0.94), interrater reliability (κ = 0.80), and correlation with an established global competency scale (κ = 0.75) were high. The most difficult items were "set up and adjust EBUS equipment" and "identify vascular anatomy (EBUS)." Feedback questionnaires from trainees (response rate, 80%) and surgeons (response rate, 100%) were consistently positive regarding user friendliness, utility as an assessment tool, and educational benefit. Participants believed the tool "facilitated communicating feedback to the trainee with specific areas to work on." CONCLUSIONS TCAT-IS is an effective tool for assessing competence in invasive staging and may enhance instruction. This initial test establishes early validity and reliability evidence, supporting the use of TCAT-IS in providing structured, specific, formative assessments of competency.
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Affiliation(s)
- Simon R Turner
- Department of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Basil S Nasir
- Department of Thoracic Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Hollis Lai
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kazuhiro Yasufuku
- Department of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Colin Schieman
- Department of Thoracic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Brian E Louie
- Department of Thoracic Surgery, Swedish Cancer Institute and Medical Center, Seattle, Washington
| | - Eric L R Bédard
- Department of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
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10
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Agzarian J, Bessissow A, Srinathan S, Devereaux PJ, Neary J, Decher W, Gandy L, Schneider L, Finley CJ, Schieman C, Hanna WC, Shargall Y. The effect of colchicine administration on postoperative pleural effusion following lung resection: a randomized blinded placebo-controlled feasibility pilot study. Eur J Cardiothorac Surg 2019; 53:822-827. [PMID: 29186389 DOI: 10.1093/ejcts/ezx401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/31/2017] [Accepted: 09/21/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This substudy of the colchicine for prevention of perioperative atrial fibrillation (COP-AF) pilot trial seeks to assess the effect of colchicine administration on the volume of postoperative pleural drainage, duration of chest tube in situ and length of stay following lung resection. METHODS Between April 2014 and April 2015, 100 patients undergoing lung resection at 2 tertiary care centres participated in a pilot blinded randomized trial comparing perioperative twice daily 0.6 mg of colchicine orally (n = 49) or placebo (n = 51) twice daily for 10 days. The primary outcome was total pleural drainage volume, which was recorded in 8-h intervals for the first 2 postoperative days per standardized protocol. RESULTS Only 1 patient did not complete the trial. The mean volume of pleural drainage at 40-h mark postoperation was significantly less in the colchicine group (550.9 ml) compared with the placebo group (741.3 ml, P = 0.039). Compared with the placebo group, the colchicine group showed significantly less mean pleural drainage on postoperative Day 2 (583.8 vs 763.3 ml, P = 0.039) and beyond. There were no differences in mean time to chest tube removal (6.8 days for the colchicine group vs 5.9 days for the placebo group, P = 0.585) and mean hospital length of stay (7.4 vs 6.9 days, P = 0.641). CONCLUSIONS Oral colchicine is potentially effective in diminishing the amount of pleural drainage following lung resection and can be considered in patients at high risk of large postoperative pleural effusion. A full-scale, prospective placebo-controlled randomized trial is needed to assess the clinical significance of perioperative colchicine administration following oncological lung resection.
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Affiliation(s)
- John Agzarian
- Department of Surgery, McMaster University, Faculty of Health Sciences, Hamilton, ON, Canada
| | - Amal Bessissow
- Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Sadeesh Srinathan
- Department of Surgery, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Philip J Devereaux
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - John Neary
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - William Decher
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Linda Gandy
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Laura Schneider
- Department of Surgery, McMaster University, Faculty of Health Sciences, Hamilton, ON, Canada
| | - Christian J Finley
- Department of Surgery, McMaster University, Faculty of Health Sciences, Hamilton, ON, Canada
| | | | - Waël C Hanna
- Department of Surgery, McMaster University, Faculty of Health Sciences, Hamilton, ON, Canada
| | - Yaron Shargall
- Department of Surgery, McMaster University, Faculty of Health Sciences, Hamilton, ON, Canada
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Schieman C, Seder CW, D'Amico TA, Grondin SC. General thoracic surgical training in North America: Contrasting general thoracic surgery residencies in Canada and the United States. J Thorac Cardiovasc Surg 2018; 156:2379-2387. [DOI: 10.1016/j.jtcvs.2018.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/18/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
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Schieman C, Ujiie H, Donahoe L, Hanna W, Malthaner R, Turner S, Czarnecka K, Yasufuku K. Developing a National, Simulation-Based, Surgical Skills Bootcamp in General Thoracic Surgery. J Surg Educ 2018; 75:1106-1112. [PMID: 29246590 DOI: 10.1016/j.jsurg.2017.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The use surgical simulation across all subspecialties has gained widespread adoption in the last decade. A number of factors, including the small number of trainees, identified gaps in surgical skill training from cross-sectional surveys, increased national collaboration, and support from the national specialty committee identified a need to construct a surgical skills "bootcamp" in thoracic surgery in Canada. OBJECTIVE The goals of the surgical skills bootcamp, as identified by the residency training program directors and the national specialty committee were to create a national, centralized, simulation-based skills workshop that focused on key foundational procedures within thoracic surgery, particularly those identified as areas of weakness by former residents; to smooth the transition to intraoperative teaching; to provide exposure to important but not necessarily universally available procedures such as advanced endoscopy; to teach non-medical expert competencies, and lastly to provide a venue for networking for residents across the country. DESIGN The curriculum committee has constructed a 3.5 day curriculum, with a focus on hands-on skills simulation, as well as lectures, on a breadth of topics including benign esophageal disorders, lung cancer staging, minimally invasive lung surgery, crisis management and advanced bronchoscopy and endoscopy. All residents across the country attend as well as faculty from a variety of institutions. SETTING The course is hosted centrally at the University of Toronto, Ontario over 3.5 days. A combination of auditorium and both animal and human operating room facilities are utilized. METHODS A needs-assessment based on a formal meeting of the program directors, as well feedback from surveys identified the target areas for curriculum development. A committee of interested faculty developed the content as well as the local construct and logistics required. Iterative feedback has evolved the duration and content over the initial 3 years. RESULTS Through formal resident feedback, national subspecialty committee review, and program director meetings the support for the bootcamp has been overwhelmingly positive. Specific resident feedback for structure, content and specific simulations has been favorable, but has also been used to modify the program. CONCLUSION In response to identified weaknesses in training, with the support of the national specialty committee, the residency program directors, and the faculty at the University of Toronto, an intensive simulation based thoracic surgery bootcamp has successfully been created for Canadian thoracic surgery residents.
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Affiliation(s)
- Colin Schieman
- Section of Thoracic Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada.
| | - Hideki Ujiie
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Laura Donahoe
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Waël Hanna
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Richard Malthaner
- Division of Thoracic Surgery, Schulich School of Medicine, Western, London, Ontario, Canada
| | - Simon Turner
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kasia Czarnecka
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada; Toronto Interventional Thoracic Surgery Program, University of Toronto, Toronto, Ontario, Canada
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Malik PRA, Fahim C, Vernon J, Thomas P, Schieman C, Finley CJ, Agzarian J, Shargall Y, Farrokhyar F, Hanna WC. Incentive Spirometry After Lung Resection: A Randomized Controlled Trial. Ann Thorac Surg 2018; 106:340-345. [PMID: 29702071 DOI: 10.1016/j.athoracsur.2018.03.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 01/10/2018] [Revised: 02/26/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Incentive spirometry (IS) is thought to reduce the incidence of postoperative pulmonary complications (PPC) after lung resection. We sought to determine whether the addition of IS to routine physiotherapy following lung resection results in a lower rate of PPC, as compared with physiotherapy alone. METHODS A single-blind prospective randomized controlled trial was conducted in adults undergoing lung resection. Individuals with previous lung surgery or home oxygen were excluded. Participants randomized to the control arm (PHY) received routine physiotherapy alone (deep breathing, ambulation and shoulder exercises). Those randomized to the intervention arm (PHY/IS) received IS in addition to routine physiotherapy. The trial was powered to detect a 10% difference in the rate of PPC (β = 80%). Student's t test and chi-square were utilized for continuous and categorical variables, respectively, with a significance level of p = 0.05. RESULTS A total of 387 participants (n = 195 PHY/IS; n = 192 PHY) were randomized between 2014 and 2017. Baseline characteristics were comparable for both arms. The majority of patients underwent a pulmonary lobectomy (PHY/IS = 59.5%, PHY = 61.0%; p = 0.84), with no difference in the rates of minimally invasive and open procedures. There were no differences in the incidence of PPC at 30 days postoperatively (PHY/IS = 12.3%, PHY = 13.0%; p = 0.88). There were no differences in rates of pneumonia (PHY/IS = 4.6%, PHY = 7.8%; p = 0.21), mechanical ventilation (PHY/IS = 2.1%, PHY = 1.0%; p = 0.41), home oxygen (PHY/IS = 13.8%, PHY = 14.6%; p = 0.89), hospital length of stay (PHY/IS = 4 days, PHY = 4 days; p = 0.34), or rate of readmission to hospital (PHY/IS = 10.3%, PHY = 9.9%; p = 1.00). CONCLUSIONS The addition of IS to routine postoperative physiotherapy does not reduce the incidence of PPC after lung resection.
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Affiliation(s)
- Peter R A Malik
- Division of Thoracic Surgery, McMaster University, Hamilton, Canada
| | - Christine Fahim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Jordyn Vernon
- Division of Thoracic Surgery, McMaster University, Hamilton, Canada
| | - Priya Thomas
- Division of Thoracic Surgery, McMaster University, Hamilton, Canada
| | - Colin Schieman
- Section of Thoracic Surgery, University of Calgary, Calgary, Canada
| | | | - John Agzarian
- Division of Thoracic Surgery, McMaster University, Hamilton, Canada
| | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University, Hamilton, Canada
| | - Forough Farrokhyar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Waël C Hanna
- Division of Thoracic Surgery, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
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Kaur MN, Xie F, Shiwcharan A, Patterson L, Shargall Y, Finley C, Schieman C, Dalimonte T, Fahim C, Hanna WC. Robotic Versus Video-Assisted Thoracoscopic Lung Resection During Early Program Development. Ann Thorac Surg 2018; 105:1050-1057. [DOI: 10.1016/j.athoracsur.2017.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/26/2017] [Accepted: 11/06/2017] [Indexed: 01/02/2023]
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Carver DA, Bressan AK, Schieman C, Grondin SC, Kirkpatrick AW, Lall R, McBeth PB, Dunham MB, Ball CG. Management of haemothoraces in blunt thoracic trauma: study protocol for a randomised controlled trial. BMJ Open 2018; 8:e020378. [PMID: 29502092 PMCID: PMC5855202 DOI: 10.1136/bmjopen-2017-020378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Haemothorax following blunt thoracic trauma is a common source of morbidity and mortality. The optimal management of moderate to large haemothoraces has yet to be defined. Observational data have suggested that expectant management may be an appropriate strategy in stable patients. This study aims to compare the outcomes of patients with haemothoraces following blunt thoracic trauma treated with either chest drainage or expectant management. METHODS AND ANALYSIS This is a single-centre, dual-arm randomised controlled trial. Patients presenting with a moderate to large sized haemothorax following blunt thoracic trauma will be assessed for eligibility. Eligible patients will then undergo an informed consent process followed by randomisation to either (1) chest drainage (tube thoracostomy) or (2) expectant management. These groups will be compared for the rate of additional thoracic interventions, major thoracic complications, length of stay and mortality. ETHICS AND DISSEMINATION This study has been approved by the institution's research ethics board and registered with ClinicalTrials.gov. All eligible participants will provide informed consent prior to randomisation. The results of this study may provide guidance in an area where there remains significant variation between clinicians. The results of this study will be published in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER NCT03050502.
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Affiliation(s)
- David A Carver
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
- Foothills Medical Centre, Calgary, Alberta, Canada
| | - Alexsander K Bressan
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
- Foothills Medical Centre, Calgary, Alberta, Canada
| | - Colin Schieman
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
- Foothills Medical Centre, Calgary, Alberta, Canada
| | - Sean C Grondin
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
- Foothills Medical Centre, Calgary, Alberta, Canada
| | - Andrew W Kirkpatrick
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
- Foothills Medical Centre, Calgary, Alberta, Canada
| | - Rohan Lall
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
- Foothills Medical Centre, Calgary, Alberta, Canada
| | - Paul B McBeth
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
- Foothills Medical Centre, Calgary, Alberta, Canada
| | - Michael B Dunham
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
- Foothills Medical Centre, Calgary, Alberta, Canada
| | - Chad G Ball
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
- Foothills Medical Centre, Calgary, Alberta, Canada
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Shargall Y, Hanna W, Wen C, Mbuagbaw L, Schneider L, Coghlan M, Coret M, Reynolds E, Finley C, Schieman C, Demay S. F-030DEVELOPMENT OF A CLINICAL SCORE TO DISTINGUISH MALIGNANT FROM BENIGN OESOPHAGEAL DISEASE IN AN UNDIAGNOSED PATIENT POPULATION REFERRED TO AN OESOPHAGEAL DIAGNOSTIC ASSESSMENT PROGRAMME. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Al Khalifa A, McMaster WG, Schieman C, Whitlock R, Ricci C, Danter M. Gastrointestinal Bleed from a Left Ventricle to Colonic Interposition Graft Fistula following an Esophagectomy. Thorac Cardiovasc Surg Rep 2017; 6:e22-e24. [PMID: 28761801 PMCID: PMC5532055 DOI: 10.1055/s-0037-1603989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/24/2017] [Indexed: 11/20/2022] Open
Abstract
Colonic interposition grafts are commonly used as an esophageal conduit following esophageal resection. Significant morbidity is associated with this reconstruction due to the nature of the operation. Many of the complications associated with this procedure have clear management strategies; however, there is a paucity of data when it comes to managing rare complications. In this report, we discuss the presentation, operative intervention, and postoperative care of a patient who presented with a left ventricle to esophageal colonic interposition graft fistula.
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Affiliation(s)
| | | | - Colin Schieman
- Division of Thoracic and Esophageal Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Richard Whitlock
- Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christopher Ricci
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Danter
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN
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18
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Ujiie H, Kato T, Hu HP, Bauer P, Patel P, Wada H, Lee D, Fujino K, Schieman C, Pierre A, Waddell TK, Keshavjee S, Darling GE, Yasufuku K. Development of a novel ex vivo porcine laparoscopic Heller myotomy and Nissen fundoplication training model (Toronto lap-Nissen simulator). J Thorac Dis 2017; 9:1517-1524. [PMID: 28740664 DOI: 10.21037/jtd.2017.05.84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Surgical trainees are required to develop competency in a variety of laparoscopic operations. Developing laparoscopic technical skills can be difficult as there has been a decrease in the number of procedures performed. This study aims to develop an inexpensive and anatomically relevant model for training in laparoscopic foregut procedures. METHODS An ex vivo, anatomic model of the human upper abdomen was developed using intact porcine esophagus, stomach, diaphragm and spleen. The Toronto lap-Nissen simulator was contained in a laparoscopic box-trainer and included an arch system to simulate the normal radial shape and tension of the diaphragm. We integrated the use of this training model as a part of our laparoscopic skills laboratory-training curriculum. Afterwards, we surveyed trainees to evaluate the observed benefit of the learning session. RESULTS Twenty-five trainees and five faculty members completed a survey regarding the use of this model. Among the trainees, only 4 (16%) had experience with laparoscopic Heller myotomy and Nissen fundoplication. They reported that practicing with the model was a valuable use of their limited time, repeating the exercise would be of additional benefit, and that the exercise improved their ability to perform or assist in an actual case in the operating room. Significant improvements were found in the following subjective measures comparing pre- vs. post-training: (I) knowledge level (5.6 vs. 8.0, P<0.001); (II) comfort level in assisting (6.3 vs. 7.6, P<0.001); and (III) comfort level in performing as the primary surgeon (4.9 vs. 7.1, P<0.001). The trainees and faculty members agreed that this model was of adequate fidelity and was a representative simulation of actual human anatomy. CONCLUSIONS We developed an easily reproducible training model for laparoscopic procedures. This simulator reproduces human anatomy and increases the trainees' comfort level in performing and assisting with myotomy and fundoplication.
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Affiliation(s)
- Hideki Ujiie
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Tatsuya Kato
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hsin-Pei Hu
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Patrycja Bauer
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Priya Patel
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hironobu Wada
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Daiyoon Lee
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kosuke Fujino
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Colin Schieman
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Pierre
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thomas K Waddell
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Gail E Darling
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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De Waele M, Agzarian J, Hanna WC, Schieman C, Finley CJ, Macri J, Schneider L, Schnurr T, Farrokhyar F, Radford K, Nair P, Shargall Y. Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?-A prospective randomized trial. J Thorac Dis 2017; 9:1598-1606. [PMID: 28740674 DOI: 10.21037/jtd.2017.05.78] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prolonged air leak and high-volume pleural drainage are the most common causes for delays in chest tube removal following lung resection. While digital pleural drainage systems have been successfully used in the management of post-operative air leak, their effect on pleural drainage and inflammation has not been studied before. We hypothesized that digital drainage systems (as compared to traditional analog continuous suction), using intermittent balanced suction, are associated with decreased pleural inflammation and postoperative drainage volumes, thus leading to earlier chest tube removal. METHODS One hundred and three [103] patients were enrolled and randomized to either analog (n=50) or digital (n=53) drainage systems following oncologic lung resection. Chest tubes were removed according to standardized, pre-defined protocol. Inflammatory mediators [interleukin-1B (IL-1B), 6, 8, tumour necrosis factor-alpha (TNF-α)] in pleural fluid and serum were measured and analysed. The primary outcome of interest was the difference in total volume of postoperative fluid drainage. Secondary outcome measures included duration of chest tube in-situ, prolonged air-leak incidence, length of hospital stay and the correlation between pleural effusion formation, degree of inflammation and type of drainage system used. RESULTS There was no significant difference in total amount of fluid drained or length of hospital stay between the two groups. A trend for shorter chest tube duration was found with the digital system when compared to the analog (P=0.055). Comparison of inflammatory mediator levels revealed no significant differences between digital and analog drainage systems. The incidence of prolonged post-operative air leak was significantly higher when using the analog system (9 versus 2 patients; P=0.025). Lobectomy was associated with longer chest tube duration (P=0.001) and increased fluid drainage when compared to sub-lobar resection (P<0.001), regardless of drainage system. CONCLUSIONS Use of post-lung resection digital drainage does not appear to decrease pleural fluid formation, but is associated with decreased prolonged air leaks. Total pleural effusion volumes did not differ with the type of drainage system used. These findings support previously established benefits of the digital system in decreasing prolonged air leaks, but the advantages do not appear to extend to decreased pleural fluid formation.
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Affiliation(s)
- Michèle De Waele
- Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - John Agzarian
- Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Waël C Hanna
- Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | | | - Christian J Finley
- Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Joseph Macri
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton General Hospital, Hamilton, ON L8L 2X2, Canada
| | - Laura Schneider
- Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Terri Schnurr
- Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Forough Farrokhyar
- Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Katherine Radford
- Department of Medicine, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Parameswaran Nair
- Department of Medicine, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Yaron Shargall
- Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
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Grondin SC, Schieman C. Thoracic surgery education in Canada. J Thorac Cardiovasc Surg 2017; 153:493-497. [DOI: 10.1016/j.jtcvs.2016.09.082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 09/04/2016] [Accepted: 09/22/2016] [Indexed: 11/25/2022]
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Agzarian J, Linkins LA, Schneider L, Hanna WC, Finley CJ, Schieman C, De Perrot M, Crowther M, Douketis J, Shargall Y. Practice patterns in venous thromboembolism (VTE) prophylaxis in thoracic surgery: a comprehensive Canadian Delphi survey. J Thorac Dis 2017; 9:80-87. [PMID: 28203409 DOI: 10.21037/jtd.2017.01.38] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The incidence of venous thromboembolic events (VTE) after resection of thoracic malignancies can reach 15%, but prophylaxis guidelines are yet to be established. We aimed to survey Canadian practitioners regarding perioperative risk factors for VTE, impact of those factors on extended prophylaxis selection, type of preferred prophylaxis, and timing of initiation and duration of thromboprophylaxis. METHODS A modified Delphi survey was undertaken over three rounds with thoracic surgeons, thoracic anesthesiologists and thrombosis experts across Canada. Participants were asked to rate each parameter on a ten-point scale. Agreement was determined a priori as an item reaching a coefficient of variation of ≤30% (0.3), with the item then discontinued from later rounds. RESULTS In total, 72, 57 and 50 respondents participated in three consecutive rounds, respectively. Consensus was reached on previous VTE, age, cancer diagnosis, thrombophilia, poor mobilization, extended resections, and pre-operative chemotherapy as risk factors. Consensus on risk factors impacting extended prophylaxis decisions was achieved on cancer diagnosis, obesity, previous VTE and poor mobilization. With respect to perioperative prophylaxis, once daily low-molecular-weight heparin (LMWH) was the only parameter that demonstrated agreement as a common practice pattern. No agreement was achieved regarding the role of mechanical prophylaxis, unfractionated heparin (UFH) or timing of initiation of peri-operative treatment. VTE prophylaxis until discharge reached agreement but there was substantial variability regarding the role of extended prophylaxis. CONCLUSIONS There is agreement between Canadian clinicians treating patients with thoracic malignancies regarding most risk factors for VTE, but there is no agreement on timing of initiation of prophylaxis, the agents used or factors mandating usage of extended prophylaxis.
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Affiliation(s)
- John Agzarian
- Department of Surgery, Faculty of Health Sciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Lori-Ann Linkins
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Laura Schneider
- Department of Surgery, Faculty of Health Sciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Waël C Hanna
- Department of Surgery, Faculty of Health Sciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Christian J Finley
- Department of Surgery, Faculty of Health Sciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Colin Schieman
- Department of Surgery, Faculty of Health Sciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Marc De Perrot
- Department of Surgery, Faculty of Medicine, University of Toronto, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Mark Crowther
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - James Douketis
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Yaron Shargall
- Department of Surgery, Faculty of Health Sciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
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Vernon J, Andruszkiewicz N, Schneider L, Schieman C, Finley CJ, Shargall Y, Fahim C, Farrokhyar F, Hanna WC. Comprehensive Clinical Staging for Resectable Lung Cancer: Clinicopathological Correlations and the Role of Brain MRI. J Thorac Oncol 2016; 11:1970-1975. [DOI: 10.1016/j.jtho.2016.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/10/2016] [Accepted: 06/12/2016] [Indexed: 12/25/2022]
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Bessissow A, Agzarian J, Srinathan S, Schneider L, Devereaux P, Neary J, Dechert W, Gandy L, Finley C, Hanna W, Schieman C, Shargall Y. F-073THE EFFECT OF COLCHICINE ADMINISTRATION ON POSTOPERATIVE PLEURAL EFFUSION FOLLOWING THORACIC SURGERY: A RANDOMIZED, DOUBLE BLIND, PLACEBO-CONTROLLED, FEASIBILITY PILOT STUDY. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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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Isfahanian N, Nguyen NT, Vansantvoort J, Wright J, Hanna W, Swaminath A, Shargal Y, Schieman C, Finley C, Wierzbicki M, Chow T, Okawara G, Quan K, Tsakiridis T. 159: Phase I Study of NEO-Adjuvant Stereotactic Body Radiotherapy (SBRT) in Operable Patients with Borderline Resectable Locally Advanced Non-Small Cell Lung Cancer (LA-NSCLC) (Linnearre I Study: NCT02433574). Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33558-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Shargall Y, Hanna WC, Schneider L, Schieman C, Finley CJ, Tran A, Demay S, Gosse C, Bowen JM, Blackhouse G, Smith K. The Integrated Comprehensive Care Program: A Novel Home Care Initiative After Major Thoracic Surgery. Semin Thorac Cardiovasc Surg 2016; 28:574-582. [DOI: 10.1053/j.semtcvs.2015.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/11/2022]
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Abstract
We report an extremely rare case of a thymic carcinoma occurring in the subcarinal location of the middle mediastinum, masquerading as subcarinal adenopathy. A 6.2 × 5 cm mass was detected on computed tomography scan and found to be hypermetabolic on positron emission tomography scan. Transbronchial biopsy was performed and the mass was found to be suspicious for malignancy. A thoracoscopic resection of the mass was performed and found to be thymic carcinoma. The patient underwent a course of adjuvant radiation. To the best of our knowledge, this is the first reported case of a thymic carcinoma resected from the middle mediastinum.
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Affiliation(s)
- Jordyn Vernon
- Division of Thoracic Surgery, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | - Colin Schieman
- Division of Thoracic Surgery, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | - Laura Schneider
- Division of Thoracic Surgery, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | - Waël C Hanna
- Division of Thoracic Surgery, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
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Schneider L, Farrokhyar F, Schieman C, Shargall Y, D'Souza J, Camposilvan I, Hanna WC, Finley CJ. Pneumonectomy: The Burden of Death After Discharge and Predictors of Surgical Mortality. Ann Thorac Surg 2014; 98:1976-81; discussion 1981-2. [DOI: 10.1016/j.athoracsur.2014.06.068] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 06/06/2014] [Accepted: 06/24/2014] [Indexed: 11/26/2022]
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Schneider L, Farrokhyar F, Schieman C, Hanna WC, Shargall Y, Finley CJ. The burden of death following discharge after lobectomy. Eur J Cardiothorac Surg 2014; 48:65-70. [DOI: 10.1093/ejcts/ezu427] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/25/2014] [Indexed: 02/06/2023] Open
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Ball CG, Grondin SC, Schieman C, Feliciano DV, Dixon E, Kirkpatrick AW, Ivatury RR, Salomone JP, Reed LR. Trauma surgery associations and societies: which organizations match your goals? J Trauma Manag Outcomes 2014; 8:6. [PMID: 24955111 PMCID: PMC4065540 DOI: 10.1186/1752-2897-8-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 06/05/2014] [Indexed: 11/18/2022]
Abstract
This focused summary is a multi-institutional, multi-national, and multi-generational project designed to briefly summarize current academic trauma societies for both trainees and faculty alike. The co-authorship is composed of former and/or current presidents from most major trauma organizations. It has particular relevance to trainees and/or recent graduates attempting to navigate the multitude of available trauma organizations.
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Affiliation(s)
- Chad G Ball
- Departments of Surgery, University of Calgary, Foothills Medical Center, Calgary, Alberta, Canada
| | - Sean C Grondin
- Departments of Surgery, University of Calgary, Foothills Medical Center, Calgary, Alberta, Canada
| | | | | | - Elijah Dixon
- Departments of Surgery, University of Calgary, Foothills Medical Center, Calgary, Alberta, Canada
| | - Andrew W Kirkpatrick
- Departments of Surgery, University of Calgary, Foothills Medical Center, Calgary, Alberta, Canada
| | - Rao R Ivatury
- Departments of Surgery, University of Calgary, Foothills Medical Center, Calgary, Alberta, Canada
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Schneider L, Farrokhyar F, Bassili A, Shargall Y, Schieman C, Hanna WC, Finley CJ. O-030 * THE BURDEN OF DEATH FOLLOWING DISCHARGE AFTER LOBECTOMY. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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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Manohar S, Hanna WC, Shargall Y, Schieman C, Schneider L, John Finley C. F-070 * LESS IS MORE: THE DECREASING RATE OF THORACOTOMY AND PNEUMONECTOMY IN LUNG CANCER SURGERY WITHIN CANADA. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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De Waele M, Schieman C, Finley CJ, Schneider L, Schnurr T, Farrokhyar F, Hanna WC, Nair P, Shargall Y. F-057 * DOES THE USAGE OF A DIGITAL CHEST DRAINAGE SYSTEM REDUCE PLEURAL INFLAMMATION AND VOLUME OF PLEURAL EFFUSION AFTER MAJOR LUNG RESECTIONS FOR CANCER? A PROSPECTIVE, RANDOMIZED STUDY. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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33
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Edwards JP, Schofield A, Paolucci EO, Schieman C, Kelly E, Servatyari R, Dixon E, Ball CG, Grondin SC. Identifying areas of weakness in thoracic surgery residency training: a comparison of the perceptions of residents and program directors. J Surg Educ 2014; 71:360-366. [PMID: 24797852 DOI: 10.1016/j.jsurg.2013.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/25/2013] [Accepted: 11/04/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To identify core thoracic surgery procedures that require increased emphasis during thoracic surgery residency for residents to achieve operative independence and to compare the perspectives of residents and program directors in this regard. METHODS A modified Delphi process was used to create a survey that was distributed electronically to all Canadian thoracic surgery residents (12) and program directors (8) addressing the residents' ability to perform 19 core thoracic surgery procedures independently after the completion of residency. Residents were also questioned about the adequacy of their operative exposure to these 19 procedures during their residency training. A descriptive summary including calculations of frequencies and proportions was conducted. The perceptions of the 2 groups were then compared using the Fisher exact test employing a Bonferroni correction. The relationship between residents' operative exposure and their perceived operative ability was explored in the same fashion. RESULTS The response rate was 100% for residents and program directors. No statistical differences were found between residents' and program directors' perceptions of residents' ability to perform the 19 core procedures independently. Both groups identified lung transplantation, first rib resection, and extrapleural pneumonectomy as procedures for which residents were not adequately prepared to perform independently. Residents' subjective ratings of operative exposure were in good agreement with their reported operative ability for 13 of 19 procedures. CONCLUSION This study provides new insight into the perceptions of thoracic surgery residents and their program directors regarding operative ability. This study points to good agreement between residents and program directors regarding residents' surgical capabilities. This study provides information regarding potential weaknesses in thoracic surgery training, which may warrant an examination of the curricula of existing programs as well as a reconsideration of what the scope of practice of a general thoracic surgeon should entail.
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Affiliation(s)
- Janet P Edwards
- Division of Thoracic Surgery, University of Calgary, Calgary, Alberta, Canada.
| | - Adam Schofield
- Division of General Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Elizabeth Oddone Paolucci
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Colin Schieman
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth Kelly
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ramin Servatyari
- Division of Thoracic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Elijah Dixon
- Division of General Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Chad G Ball
- Division of General Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Sean C Grondin
- Division of Thoracic Surgery, University of Calgary, Calgary, Alberta, Canada
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Grondin SC, Schieman C, Kelly E, Darling G, Maziak D, Mackay MP, Gelfand G. A look at the thoracic surgery workforce in Canada: how demographics and scope of practice may impact future workforce needs. Can J Surg 2013; 56:E75-81. [PMID: 23883508 DOI: 10.1503/cjs.008412] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The purpose of this study is to describe the demographics, training and practice characteristics of physicians performing thoracic surgery across Canada to better assess workforce needs. METHODS We developed a questionnaire using a modified Delphi process to generate questionnaire items. The questionnaire was administered to all Canadian thoracic surgeons via email (n = 102) or mail (n = 35). RESULTS In all, 97 surgeons completed the survey (71% response rate). The mean age of respondents was 47.7 (standard deviation 9.1) years; 10.3% were older than 60. Ninety respondents (88.7%) were men, 95 (81.1%) practised in English and 93 (76%) were born in Canada. Most (90.4%) had a medical school affiliation, with an equal proportion practising in community or university teaching hospitals. Only 18% of respondents reported working fewer than 60 hours per week, and 34% were on call more than 1 in 3. Three-quarters of work hours were devoted to clinical care, with the remaining time split among research, administration and teaching. Malignant lung disease accounted for 61.2% of practice time, with the remaining time equally split between benign and malignant thoracic diseases. Preoperative testing (49.4%) and insufficient operating time (49.5%) were the most common factors delaying delivery of care. More than 80% of respondents reported being satisfied with their careers, with 62.1% planning on retiring after age 60. CONCLUSION This survey characterizes Canadian thoracic surgeons by providing specific demographic, satisfaction and scope of practice information. Despite challenges in obtaining adequate resources for providing timely care, job satisfaction remains high, with a balanced workforce supply and demand anticipated for the foreseeable future.
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Affiliation(s)
- Sean C Grondin
- Division of Thoracic Surgery, Department of Surgery at the University of Calgary, Calgary, Alta.
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35
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Schieman C, Wigle DA, Deschamps C, Nichols FC, Cassivi SD, Shen KR, Allen MS. Salvage Resections for Recurrent or Persistent Cancer of the Proximal Esophagus After Chemoradiotherapy. Ann Thorac Surg 2013; 95:459-63. [DOI: 10.1016/j.athoracsur.2012.10.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 10/10/2012] [Accepted: 10/15/2012] [Indexed: 12/13/2022]
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Abstract
Esophagectomy has one of the highest mortality rates among all surgical procedures. We investigated the type and frequency of complications associated with perioperative mortality after esophagectomy. We performed a retrospective review of all perioperative deaths following esophagectomy for esophageal cancer at the Mayo Clinic, Rochester from 1993 through 2009. Of 1522 esophagectomies, perioperative mortality occurred in 45 (3.0%). The majority who died were male (82%); median age was 72 years (range 46-92). The median age-adjusted Charlson comorbidity score was 6. Twenty-three (51%) underwent neoadjuvant chemoradiotherapy. The type of esophagectomy was transthoracic in 27 patients (60%), transhiatal in eight (18%), tri-incisional in seven (16%), left thoracoabdominal in one (2%), and transabdominal in one (2%). A mean of 3.2 major complications occurred prior to death (median 2.5, range 1-8), with the most common being pulmonary complications occurring in 30 patients (67%) and anastomotic complications in 20 (44%). The primary underlying cause of death was pulmonary complications and anastomotic complications in 18 patients (40%) each, respectively, abdominal sepsis in three (7%), fatal hemorrhage in three (7%), and pulmonary embolism, stroke and multisystem organ failure in one each (2%), respectively. Patients died a median of 19 days (range 3-98) following esophagectomy. Most patients who died following esophagectomy experienced multiple serious complications rather than a single causative event. Major pulmonary and anastomotic complications were implicated in the vast majority of perioperative mortality, and should remain the focus of efforts to improve clinical outcomes.
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Affiliation(s)
- C Schieman
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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37
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Schieman C, MacGregor JH, Kelly E, Graham A, McFadden SP, Gelfand G, Grondin SC. Can preoperative computed tomography of the chest predict completeness of the major pulmonary fissure at surgery? Can J Surg 2011; 54:252-6. [PMID: 21651837 DOI: 10.1503/cjs.007910] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND An incomplete major pulmonary fissure can make anatomic lung resection technically more difficult and may increase the risk of complications, such as prolonged postoperative air leak. The objective of this study was to determine if preoperative computed tomography (CT) of the chest could accurately predict the completeness of the major pulmonary fissure observed at the time of surgery. METHODS From October 2008 to June 2009, patients at a single university institution were enrolled if they underwent surgery for a pulmonary nodule, mass or known cancer. At the time of surgery, completeness of the major pulmonary fissure was graded 1 if pulmonary lobes were entirely separate, 2 if the visceral cleft was complete with an exposed pulmonary artery at the base with some parenchyma fusion, 3 if the visceral cleft was only evident for part of the fissure without a visible pulmonary artery and 4 if the fissure was absent. The preoperative CT scan of each patient was graded by a single, blinded chest radiologist using the same scale. We used the Pearson χ2 test with 2-tailed significance to test the independence of the operative and radiologic grading. RESULTS In 48% (29 of 61) of patients, the radiologic and operative grading were the same. Of those graded differently, 94% (30 of 32) were within 1 grade. Despite this agreement, we observed no statistically significant correlation between the operative and radiologic grading (p = 0.24). CONCLUSION The major fissure can often be well-visualized on a preoperative CT scan, but preoperative CT cannot accurately predict the completeness of the major pulmonary fissure discovered at surgery.
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Affiliation(s)
- Colin Schieman
- Division of Thoracic Surgery, Faculty of Medicine, University of Calgary, Calgary, Alta.
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Schieman C, Grondin SC, Gelfand GAJ. Thoracic surgery associations, societies, and clubs: which organizations are right for you? Thorac Surg Clin 2011; 21:383-7. [PMID: 21762862 DOI: 10.1016/j.thorsurg.2011.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Determining which organizations to join can be challenging given the wide selection of associations, societies, and clubs available to practicing thoracic surgeons. This article briefly reviews 7 important North American thoracic surgery organizations (the American Association for Thoracic Surgery, the Canadian Association of Thoracic Surgeons, the General Thoracic Surgical Club, the Society of Thoracic Surgeons, the Southern Thoracic Surgical Association, the Western Thoracic Surgical Association, and Women in Thoracic Surgery). The authors also review the criteria that may assist in deciding which organizations best meet a surgeon's career goals and personal expectations.
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Affiliation(s)
- Colin Schieman
- Division of General Thoracic Surgery, Mayo Clinic, 200 First Street SW Rochester, Rochester, MN 55905, USA
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Edwards J, Kelly E, Schieman C, Gelfand G, Grondin SC. Do new thoracic surgeons feel ready to operate? Self-reported comfort level of thoracic surgery trainees and junior thoracic surgeons with core thoracic surgery procedures. J Surg Educ 2011; 68:270-281. [PMID: 21708363 DOI: 10.1016/j.jsurg.2011.02.004] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 02/03/2011] [Accepted: 02/08/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate and compare self-reported surgical experience and comfort levels of Canadian thoracic surgery trainees and junior thoracic surgeons (<5 years in practice) with respect to core thoracic surgery procedures. METHODS A modified Delphi process was used to create a survey that was distributed electronically to all Canadian thoracic surgery residents and newly graduated thoracic surgeons. A descriptive summary, including calculation of frequencies, means, proportions, and standard deviations was conducted. Associations between reported experience and comfort level for residents and surgeons were explored separately using the Pearson product moment correlation. The differences between resident and junior surgeons' rating of experience and comfort for each procedure were explored using Fisher exact tests. RESULTS The response rates were 50% for residents and 85% for staff. Adequate or better experience was reported by residents for 9 of 18 core thoracic surgical procedures and by staff for 10 of 18 procedures. A significant difference in self-reported experience level was found between groups for only 1 of 18 procedures. Staff reported that they would confidently perform 7 of 18 procedures independently at the end of their training. The mean resident response did not reach this level of comfort for any of the 18 procedures. Eight of 16 staff had completed extra training, primarily for personal interest, whereas 4 of 6 residents were planning on further training because of job market factors. DISCUSSION The results of this study help to characterize the comfort levels of thoracic trainees and new attending thoracic surgeons with core thoracic procedures and might assist training programs in identifying and improving areas of weakness.
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Affiliation(s)
- Janet Edwards
- Division of General Surgery, University of Calgary, Calgary, Alberta, Canada
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Schieman C, Kelly E, Gelfand G, Graham A, McFadden SP, Edwards J, Grondin SC. Thoracic surgery training in Canada according to the residents: the thoracic surgery resident survey, of the Canadian thoracic manpower and education study (T-Med). J Surg Educ 2010; 67:325-334. [PMID: 21035774 DOI: 10.1016/j.jsurg.2010.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Revised: 06/18/2010] [Accepted: 07/08/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The resident component of the Canadian Thoracic Manpower and Education Study (T-MED) was conducted to understand the basic demographic of Canadian thoracic surgery residents, the factors influencing their selection of training programs, current work conditions, training and competencies, and opinions in regard to the manpower needs for the specialty. DESIGN A modified Delphi process was used to develop a survey applicable to thoracic surgery residents. In May and June 2009, residents completed the voluntary anonymous Internet-based survey. All Canadian residents participated in the survey, providing a 100% response rate. RESULTS Most respondents were male (11/12), and the average age was 34 years old with an anticipated debt greater than $50,000 on graduation. All residents worked more than 70 hours per week, with most doing 1 : 3 or 1 : 4 on-call. Two-thirds of respondents reported being satisfied or very satisfied with their training program. Rates of anticipated competence in performing various thoracic surgeries on graduation differed between residents and program directors. Two-thirds (8/12) of residents planned to practice thoracic surgery exclusively, and hoped to practice in an academic setting. Most residents (10/12) agreed or strongly agreed that not enough jobs are available in Canada for graduating trainees and that the number of residency positions should reflect the predicted availability of jobs. CONCLUSIONS This study has provided detailed information on thoracic surgery resident demographics and training programs. Most thoracic surgery residents are satisfied with their current training program but have concerns about their job prospects on graduation, and they believe that the number of training positions should reflect potential job opportunities. This survey represents the first attempt to characterize the current state of thoracic surgery training in Canada from the resident's perspective and may help in directing educational and manpower planning.
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Affiliation(s)
- Colin Schieman
- Division of Thoracic Surgery, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Schieman C, Pasieka JL, McFadden SD, Cole M, Graham AJ. Resolution of chronic diarrhea after resection of a localized pulmonary carcinoid tumor. Ann Thorac Surg 2010; 89:1275-6. [PMID: 20338354 DOI: 10.1016/j.athoracsur.2009.08.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/20/2009] [Revised: 08/12/2009] [Accepted: 08/17/2009] [Indexed: 11/25/2022]
Abstract
Pulmonary carcinoid tumors are rarely associated with symptoms of the carcinoid syndrome, such as flushing and diarrhea. When present, these symptoms virtually always represent extensive hepatic metastases. In this article we describe the presentation, perioperative management, and presumed mechanisms of a patient with a localized pulmonary carcinoid with associated chronic diarrhea that resolved after operation.
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Affiliation(s)
- Colin Schieman
- Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Schieman C, Graham A, Gelfand G, McFadden SP, Tiruta C, Hill MD, Grondin SC. Weather and chinook winds in relation to spontaneous pneumothoraces. Can J Surg 2009; 52:E151-E155. [PMID: 19865545 PMCID: PMC2769134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2009] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Spontaneous pneumothorax (SP) results from the rupture of blebs or emphysematous bullae. Rapid changes in weather may precipitate this process. The city of Calgary is well suited to examine the effects of weather and specifically the rapid changes in weather associated with a chinook event and the occurrence of SP. METHODS We performed a retrospective chart review of all cases of SP in the Calgary Health Region from 2001 to 2005. We obtained local hourly weather data over the same period from Environment Canada. We then compared the rates of SP on chinook and nonchinook days. Further, we compared mean daily temperature, humidity, wind speed and atmospheric pressure on chinook and nonchinook days. RESULTS In all, 220 SP events from 149 patients occurred during the 4.5-year study period. There was no significant difference in the rate of SP on chinook days versus nonchinook days (p = 0.80). Similarly, there was no significant difference in the rate of SP in each of the 4 seasons (p = 0.30). We observed significantly higher average wind speed and lower mean atmospheric pressure on days with SP versus days without (p = 0.009, p = 0.020, respectively). There was no difference in mean temperature or mean relative humidity when comparing days with SP versus days without. CONCLUSION We found no association between SP and chinook events. We observed significantly higher wind speeds and lower atmospheric pressures on days with SP versus days without.
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Affiliation(s)
| | | | | | | | | | - Michael D. Hill
- Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, Alta
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Schieman C, Rudmik LR, Dixon E, Sutherland F, Bathe OF. Complementary and alternative medicine use among general surgery, hepatobiliary surgery and surgical oncology patients. Can J Surg 2009; 52:422-426. [PMID: 19865579 PMCID: PMC2769094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2008] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The use of complementary and alternative medicine (CAM) is becoming more common, particularly among cancer patients. We sought to define the frequency of CAM use among general surgery, hepatobiliary and surgical oncology patients and to define some of the determinants of CAM use in patients with benign and malignant disease. METHODS We asked all patients attending the clinics of 3 hepatobiliary/surgical oncology surgeons from 2002 to 2005 to voluntarily respond on first and subsequent visits to a questionnaire related to the use of CAM. We randomly selected patients for review. RESULTS We reviewed a total of 490 surveys from 357 patients. Overall CAM use was 27%. There was significantly more CAM use among cancer (34%) versus noncancer patients (21%; p = 0.008), and the use of CAM was more common in patients with unresectable cancer (51%) than resectable cancer (22%; p < 0.001). There was no significant difference in use between men and women. There did not appear to be a change in CAM use with progression of cancer. The most common CAM was herbs or supplements (58% of all users), which were most frequently used by patients with malignant disease. Among the 27 herbs reported to be ingested, 10 are associated with bleeding and hepatotoxicity, as described in the literature. CONCLUSION Prospective studies evaluating surgical outcomes related to CAM use are needed.
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Affiliation(s)
| | | | | | | | - Oliver F. Bathe
- Departments of Surgery and
- Oncology, University of Calgary, Calgary, Alta
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Nenshi R, Kennedy E, Baxter NN, Saskin R, Sutradhar R, Urbach DR, Sroka G, Feldman LS, Vassiliou MC, Kaneva PA, Fayez R, Fried GM, Krajewski SA, Brown CJ, Hur C, McCrea PH, Mitchell A, Porter G, Grushka J, Razek T, Khwaja K, Fata P, Martel G, Moloo H, Picciano G, Boushey RP, Poulin EC, Mamazza J, Haas B, Xiong W, Brennan-Barnes M, Gomez D, Nathens AB, Yang I, Forbes SS, Stephen WJ, Loeb M, Smith R, Christoffersen EP, McLean RF, Westerholm J, Garcia-Osogobio S, Farrokhyar F, Cadeddu M, Anvari M, Ponton-Carss A, Hutchison C, Violato C, Segedi M, Mittleman M, Fisman D, Kinlin L, Rousseau M, Saleh W, Ferri LE, Feldman LS, Stanbridge DD, Mayrand S, Fried GM, Pandya A, Gagliardi A, Nathens A, Ahmed N, Tran T, Demyttenaere SV, Polyhronopoulos G, Seguin C, Artho GP, Kaneva P, Fried GM, Feldman LS, Demyttenaere SV, Bergman S, Anderson J, Mikami DJ, Melvin WS, Racz JM, Dubois L, Katchky A, Wall WJ, Faryniuk A, Hochman D, Clarkson CA, Rubiano AM, Clarkson CA, Boone D, Ball CG, Dixon E, Kirkpatrick AW, Sutherland FR, Feliciano DV, Wyrzykowski AD, Nicholas JM, Dente CJ, Ball CG, Feliciano DV, Ullah SM, McAlister VC, Malik S, Ramsey D, Pooler S, Teague B, Misra M, Cadeddu M, Anvari M, Kaminsky M, Vergis A, Gillman LM, Gillman LM, Vergis A, Altaf A, Ellsmere J, Bonjer HJ, Klassen D, Orzech N, Palter V, Aggarwal R, Okrainec A, Grantcharov TP, Ghaderi I, Feldman LS, Sroka G, Kaneva PA, Fried GM, Shlomovitz E, Reznick RK, Kucharczyk W, Lee L, Iqbal S, Barayan H, Lu Y, Fata P, Razek T, Khwaja K, Boora PS, White JS, Vogt KN, Charyk-Stewart T, Minuk L, Eckert K, Chin-Yee I, Gray D, Parry N, Humphrey RJ, Bütter A, Schmidt J, Grieci T, Gagnon R, Han V, Duhaime S, Pitt DF, Palter V, Orzech N, Aggarwal R, Okrainec A, Grantcharov TP, Dubois L, Vogt KN, Davies W, Schlachta CM, Shi X, Birch DW, Gu Y, Moser MA, Swanson TW, Schaeffer DF, Tang BQ, Rusnak CH, Amson BJ, Vogt KN, Dubois L, Hobbs A, Etemad-Rezai R, Schlachta CM, Claydon E, McAlister V, Grushka J, Sur W, Laberge JM, Tchervenkov J, Bell L, Flageole H, Labidi S, Gagné JP, Gowing R, Kahnamoui K, McAlister CC, Marble A, Coughlin S, Karanicolas P, Emmerton-Coughlin H, Kanbur B, Kanbur S, Colquhoun P, Trottier DC, Doucette S, Huynh H, Soto CM, Poulin EC, Mamazza J, Boushey RP, Jamal MH, Rousseau M, Meterissian S, Snell L, Racz JM, Davies E, Aminazadeh N, Farrokhyar F, Reid S, Naeeni A, Naeeni M, Kashfi A, Kahnamoui K, Martin K, Weir M, Taylor B, Martin KM, Girotti MJ, Parry NG, Hanna WC, Fraser S, Weissglas I, Ghitulescu G, Bilek A, Marek J, Galatas C, Bergman S, Chiu CG, Nguyen NH, Bloom SW, Wiebe S, Klassen D, Bonjer J, Lawlor D, Plowman J, Ransom T, Vallis M, Ellsmere J, Menezes AC, Karmali S, Birch DW, Forbes SS, Eskicioglu C, Brenneman FD, McLeod RS, Fraser SA, Bergman S, Garzon J, Gomez D, Lawless B, Haas B, Nathens AB, Lumb KJ, Harkness L, Williamson J, Charyk-Stewart T, Gray D, Malthaner RA, Van Koughnett JA, Vogt KN, Gray DK, Parry NG, Teague B, Cadeddu M, Anvari M, Misra M, Pooler S, Malik S, Swain P, Chackungal S, Vogt KN, Yoshy C, Etemad-Rezai R, Cunningham I, Dubois L, Schlachta CM, Scott L, Vinden C, Okrainec A, Henao O, Azzie G, Deen S, Hameed M, Ramirez V, Veillette C, Bray P, Jewett M, Okrainec A, Pagliarello G, Brenneman F, Buczkowski A, Nathens A, Razek T, Widder S, Anderson I, Klassen D, Saadia R, Johner A, Hameed SM, Qureshi AP, Vergis A, Jimenez CM, Green J, Pryor AD, Schlachta CM, Okrainec A, Perri MT, Trejos AL, Naish MD, Patel RV, Malthaner RA, Stanger J, Stewart K, Yasui Y, Cass C, Damaraju S, Graham K, Bharadwaj S, Srinathan S, Tan L, Unruh H, Finley C, Miller L, Ferri LE, Urbach DR, Darling G, Spicer J, Ergun S, McDonald B, Rousseau M, Kaneva P, Ferri LE, Spicer J, Andalib A, Benay C, Rousseau M, Kushner Y, Marcus V, Ferri LE, Hunt I, Gazala S, Razzak R, Chuck A, Valji A, Stewart K, Tsuyuki R, Bédard ELR, Bottoni DA, Campbell G, Malthaner RA, Rousseau M, Guevremont P, Chasen M, Spicer J, Eckert E, Alcindor T, Ades S, Ferri LE, McGory R, Nagpal D, Fortin D, Inculet RI, Malthaner RA, Ko M, Shargall Y, Compeau C, Razzak R, Gazala S, Hunt I, Veenstra J, Valji A, Stewart K, Bédard ELR, Davis PJ, Mancuso M, Mujoomdar AA, Gazala S, Bédard ELR, Lee L, Spicer J, Robineau C, Sirois C, Mulder D, Ferri LE, Cools-Lartigue J, Chang SY, Mayrand S, Marcus V, Fried GM, Ferri LE, Perry T, Hunt I, Allegretto M, Maguire C, Abele J, Williams D, Stewart K, Bédard ELR, Grover HS, Basi S, Chiasson P, Basi S, Gregory W, Irshad K, Schieman C, MacGregor JH, Kelly E, Gelfand G, Graham AJ, McFadden SP, Grondin SC, Croome KP, Chudzinski R, Hanto DW, Jamal MH, Doi SA, Barkun JS, Wong SL, Kwan AHL, Yang S, Law C, Luo Y, Spiers J, Forse A, Taylor W, Apriasz I, Mysliwiec B, Sarin N, Gregor J, Moulton CE, McLeod RS, Barnett H, Nhan C, Gallinger S, Demyttenaere SV, Nau P, Muscarella P, Melvin WS, Ellison EC, Wiseman SM, Melck AL, Davidge KM, Eskicioglu C, Lipa J, Ferguson P, Swallow CJ, Wright FC, Edwards JP, Kelly EJ, Lin Y, Lenders T, Ghali WA, Graham A, Francescutti V, Farrokhyar F, Tozer R, Heller B, Lovrics P, Jansz G, Kahnamoui K, Spiegle G, Schmocker S, Huang H, Victor C, Law C, Kennedy ED, McCart JA, Aslani N, Swanson T, Kennecke H, Woods R, Davis N, Klevan AE, Ramsay JA, Stephen WJ, Smith M, Plourde M, Johnson PM, Yaffe P, Walsh M, Hoskin D, Huynh HP, Trottier DC, Soto C, Auer R, Poulin EC, Mamazza J, Boushey RP, Moloo H, Huynh HP, Trottier DC, Soto C, Moloo H, Poulin EC, Mamazza J, Boushey RP, Nhan C, Driman DK, Smith AJ, Hunter A, McLeod RS, Eskicioglu C, Fenech DS, Victor C, McLeod RS, Trottier DC, Huynh H, Sabri E, Soto C, Scheer A, Zolfaghari S, Moloo H, Mamazza J, Poulin EC, Boushey RP, Hallet J, Guénette-Lemieux M, Bouchard A, Grégoire RC, Thibault C, Dionne G, Côté F, Langis P, Gagné JP, Raval MJ, Phang PT, Brown CJ, Kuzmanovic A, Planting A, Raval MJ, Phang PT, Brown CJ, Huynh HP, Trottier DC, Moloo H, Poulin EC, Mamazza J, Friedlich M, Stern HS, Boushey RP, Tang BQ, Moloo H, Bleier J, Goldberg SM, Alsharif J, Martel G, Bouchard A, Sabri E, Ramsay CR, Mamazza J, Poulin EC, Boushey RP, Richardson D, Porter G, Johnson P, Al-Sukhni E, Ridgway PF, O'Connor B, McLeod RS, Swallow CJ, Forbes SS, Urbach DR, Sutradhar R, Paszat L, Rabeneck L, Baxter NN, Chung W, Ko D, Sun C, Brown CJ, Raval M, Phang PT, Pao JS, Woods R, Raval MJ, Phang PT, Brown CJ, Power A, Francescutti V, Ramsey D, Kelly S, Stephen W, Simunovic M, Coates A, Goldsmith CH, Thabane L, Reeson D, Smith AJ, McLeod RS, DeNardi F, Whelan TJ, Levine MN, Al-Khayal KA, Buie WD, Wallace L, Sigalet D, Eskicioglu C, Gagliardi A, Fenech DS, Victor C, McLeod RS. Abstracts of presentations to the Annual Meetings of the Canadian Association of General Surgeons Canadian Association of Thoracic Surgeons Canadian Hepato-Pancreato-Biliary Society Canadian Society of Surgical Oncology Canadian Society of Colon and Rectal Surgeons: Victoria, BC Sept. 10-13, 2009. Can J Surg 2009; 52:S1-S48. [PMID: 35488397 PMCID: PMC2726442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- R Nenshi
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - E Kennedy
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - N N Baxter
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - R Saskin
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - R Sutradhar
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - D R Urbach
- From the Institute for Clinical and Evaluative Sciences, Toronto, Ont
| | - G Sroka
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - M C Vassiliou
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - P A Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - R Fayez
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montréal, Que
| | - S A Krajewski
- From the Department of Surgery, University of British Columbia, Vancouver, BC, and the Institute for Technology Assessment, Massachusetts General Hospital, Boston, Mass
| | - C J Brown
- From the Department of Surgery, University of British Columbia, Vancouver, BC, and the Institute for Technology Assessment, Massachusetts General Hospital, Boston, Mass
| | - C Hur
- From the Department of Surgery, University of British Columbia, Vancouver, BC, and the Institute for Technology Assessment, Massachusetts General Hospital, Boston, Mass
| | - P H McCrea
- From the Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - A Mitchell
- From the Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - G Porter
- From the Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - J Grushka
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - T Razek
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - K Khwaja
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - P Fata
- From the Division of General Surgery, Montréal General Hospital, McGill University, Montréal, Que
| | - G Martel
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - G Picciano
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - B Haas
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - W Xiong
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - M Brennan-Barnes
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - D Gomez
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - A B Nathens
- From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, and the Children's Hospital of Eastern Ontario, Ottawa, Ont
| | - I Yang
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - S S Forbes
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - W J Stephen
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - M Loeb
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - R Smith
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - E P Christoffersen
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - R F McLean
- From the Departments of Surgery and Anesthesiology, McMaster University, Hamilton Health Sciences, Hamilton, Ont
| | - J Westerholm
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - S Garcia-Osogobio
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - M Anvari
- From the Centre for Minimal Access Surgery, McMaster University, Hamilton, Ont
| | - A Ponton-Carss
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - C Hutchison
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - C Violato
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - M Segedi
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - M Mittleman
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - D Fisman
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - L Kinlin
- From the Harvard School of Public Health, Beth Israel Deaconess Medical Center, Boston, Mass., the University of British Columbia, Vancouver, BC, and The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - M Rousseau
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - W Saleh
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - D D Stanbridge
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - S Mayrand
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - A Pandya
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Gagliardi
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Nathens
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - N Ahmed
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - T Tran
- From the Department of Surgery, McGill University, Montréal, Que
| | - S V Demyttenaere
- From the Department of Surgery, McGill University, Montréal, Que
| | | | - C Seguin
- From the Department of Surgery, McGill University, Montréal, Que
| | - G P Artho
- From the Department of Surgery, McGill University, Montréal, Que
| | - P Kaneva
- From the Department of Surgery, McGill University, Montréal, Que
| | - G M Fried
- From the Department of Surgery, McGill University, Montréal, Que
| | - L S Feldman
- From the Department of Surgery, McGill University, Montréal, Que
| | - S V Demyttenaere
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Bergman
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - J Anderson
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - D J Mikami
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - W S Melvin
- From the Department of Surgery, Ohio State University, Columbus, Ohio, and the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - J M Racz
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - L Dubois
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - A Katchky
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - W J Wall
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - A Faryniuk
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - D Hochman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - C A Clarkson
- From the Neiva City University Hospital, Neiva, Huila, Colombia
| | - A M Rubiano
- From the Neiva City University Hospital, Neiva, Huila, Colombia
| | - C A Clarkson
- From the Department of Surgery, Memorial University of Newfoundland, St. John's, NL
| | - D Boone
- From the Department of Surgery, Memorial University of Newfoundland, St. John's, NL
| | - C G Ball
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - E Dixon
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - A W Kirkpatrick
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - F R Sutherland
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - D V Feliciano
- From the Departments of Surgery, Emory University, Atlanta, Ga., and the University of Calgary, Calgary, Alta
| | - A D Wyrzykowski
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - J M Nicholas
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - C J Dente
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - C G Ball
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - D V Feliciano
- From the Department of Surgery, Emory University, Atlanta, Ga
| | - S M Ullah
- From the Division of Clinical Anatomy, Department of Anatomy and Cell Biology, Department of Surgery, University Hospital, University of Western Ontario, London, Ont
| | - V C McAlister
- From the Division of Clinical Anatomy, Department of Anatomy and Cell Biology, Department of Surgery, University Hospital, University of Western Ontario, London, Ont
| | - S Malik
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - D Ramsey
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - S Pooler
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - B Teague
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Misra
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Anvari
- From the Centre for Minimal Access Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ont
| | - M Kaminsky
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine and Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Vergis
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine and Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - L M Gillman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine and Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - L M Gillman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine, Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Vergis
- From the Department of Surgery, University of Manitoba, Winnipeg, Man., the Department of Critical Care Medicine, Regional Trauma Services, University of Calgary, Calgary, Alta., and the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Altaf
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - J Ellsmere
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - H J Bonjer
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - D Klassen
- From the Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - N Orzech
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - V Palter
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - R Aggarwal
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - A Okrainec
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - T P Grantcharov
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, University of Toronto, Toronto, and the Department of Biosurgery and Surgical Technology, Imperial College, London, Ont
| | - I Ghaderi
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - L S Feldman
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - G Sroka
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - P A Kaneva
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - G M Fried
- From the Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que., and the University of Western Ontario, London, Ont
| | - E Shlomovitz
- From the Departments of Surgery and Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - R K Reznick
- From the Departments of Surgery and Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - W Kucharczyk
- From the Departments of Surgery and Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - L Lee
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - S Iqbal
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - H Barayan
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - Y Lu
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - P Fata
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - T Razek
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - K Khwaja
- From the Departments of Surgery and Medicine, McGill University Health Centre, Montréal, Que
| | - P S Boora
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - J S White
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - K N Vogt
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - T Charyk-Stewart
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - L Minuk
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - K Eckert
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - I Chin-Yee
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - D Gray
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - N Parry
- From the Divisions of General Surgery and Hematology, Trauma Program, London Health Sciences Centre, London, Ont
| | - R J Humphrey
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - A Bütter
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - J Schmidt
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - T Grieci
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - R Gagnon
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - V Han
- From the Departments of Surgery and Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - S Duhaime
- From the University of Ottawa, Ottawa, Ont
| | - D F Pitt
- From the University of Ottawa, Ottawa, Ont
| | - V Palter
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - N Orzech
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - R Aggarwal
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - A Okrainec
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - T P Grantcharov
- From the Departments of Surgery, St. Michael's Hospital, Toronto Western Hospital, Toronto, and Imperial College, London, Ont
| | - L Dubois
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - W Davies
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - C M Schlachta
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - X Shi
- From the Centre for the Advancement of Minimally Invasive Surgery, Edmonton, Alta
| | - D W Birch
- From the Centre for the Advancement of Minimally Invasive Surgery, Edmonton, Alta
| | - Y Gu
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask
| | - M A Moser
- From the Department of Surgery, University of Saskatchewan, Saskatoon, Sask
| | - T W Swanson
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - D F Schaeffer
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - B Q Tang
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - C H Rusnak
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - B J Amson
- From the Department of Surgery, Royal Jubilee Hospital, Victoria, BC, University of British Columbia, Vancouver, BC
| | - K N Vogt
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - L Dubois
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - A Hobbs
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - R Etemad-Rezai
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - C M Schlachta
- From the Divisions of General Surgery and Radiology, London Health Sciences Centre, London, Ont
| | - E Claydon
- From the Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - V McAlister
- From the Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont
| | - J Grushka
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - W Sur
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - J-M Laberge
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - J Tchervenkov
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - L Bell
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - H Flageole
- From the Divisions of Pediatric Surgery and Nephrology, Department of Pediatrics, Montréal Children's Hospital, and the Department of Surgery, McGill University, Montréal, Que
| | - S Labidi
- From the Québec Centre for Minimally Invasive Surgery, Centre hospitalier universitaire de Québec, Québec, Que
| | - J P Gagné
- From the Québec Centre for Minimally Invasive Surgery, Centre hospitalier universitaire de Québec, Québec, Que
| | - R Gowing
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - K Kahnamoui
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - C C McAlister
- From the University of Toronto, Toronto, Ont., Dalhousie University, Halifax, NS
| | - A Marble
- From the University of Toronto, Toronto, Ont., Dalhousie University, Halifax, NS
| | - S Coughlin
- From the University of Western Ontario, London, Ont
| | | | | | - B Kanbur
- From the University of Western Ontario, London, Ont
| | - S Kanbur
- From the University of Western Ontario, London, Ont
| | - P Colquhoun
- From the University of Western Ontario, London, Ont
| | - D C Trottier
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - S Doucette
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Huynh
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - C M Soto
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E C Poulin
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - R P Boushey
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - M H Jamal
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - M Rousseau
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - S Meterissian
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - L Snell
- From the Centre for Medical Education, Division of General Surgery, McGill University, Montréal, Que
| | - J M Racz
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - E Davies
- From the Department of Surgery, University of Western Ontario, London, Ont
| | - N Aminazadeh
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - S Reid
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - A Naeeni
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M Naeeni
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - A Kashfi
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - K Kahnamoui
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - K Martin
- From the London Health Sciences Centre, London, Ont
| | - M Weir
- From the London Health Sciences Centre, London, Ont
| | - B Taylor
- From the London Health Sciences Centre, London, Ont
| | - K M Martin
- From the London Health Sciences Centre, Children's Hospital of Western Ontario, London, Ont
| | - M J Girotti
- From the London Health Sciences Centre, Children's Hospital of Western Ontario, London, Ont
| | - N G Parry
- From the London Health Sciences Centre, Children's Hospital of Western Ontario, London, Ont
| | - W C Hanna
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Fraser
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - I Weissglas
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - G Ghitulescu
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - A Bilek
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - J Marek
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - C Galatas
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - S Bergman
- From the Department of Surgery, Jewish General Hospital, McGill University, Montréal, Que
| | - C G Chiu
- From the Richmond Hospital, Richmond, BC
| | - N H Nguyen
- From the Richmond Hospital, Richmond, BC
| | - S W Bloom
- From the Richmond Hospital, Richmond, BC
| | - S Wiebe
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - D Klassen
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - J Bonjer
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - D Lawlor
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - J Plowman
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - T Ransom
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - M Vallis
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - J Ellsmere
- From the Queen Elizabeth II Health Sciences Centre (QEIIHSC), Halifax, NS
| | - A C Menezes
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Alberta Health Services, Department of Surgery, University of Alberta, Edmonton, Alta
| | - S Karmali
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Alberta Health Services, Department of Surgery, University of Alberta, Edmonton, Alta
| | - D W Birch
- From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Alberta Health Services, Department of Surgery, University of Alberta, Edmonton, Alta
| | - S S Forbes
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - C Eskicioglu
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - F D Brenneman
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - S A Fraser
- From the Department of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Que
| | - S Bergman
- From the Department of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Que
| | - J Garzon
- From the Department of General Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Que
| | - D Gomez
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - B Lawless
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - B Haas
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - A B Nathens
- From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - K J Lumb
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - L Harkness
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - J Williamson
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - T Charyk-Stewart
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - D Gray
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - R A Malthaner
- From the Department of Surgery, Trauma Program, London Health Sciences Centre, London, Ont
| | - J A Van Koughnett
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - D K Gray
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - N G Parry
- From the Division of General Surgery, University of Western Ontario, London, Ont
| | - B Teague
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - M Cadeddu
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - M Anvari
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - M Misra
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - S Pooler
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - S Malik
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - P Swain
- From the Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
| | - S Chackungal
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - K N Vogt
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C Yoshy
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - R Etemad-Rezai
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - I Cunningham
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - L Dubois
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C M Schlachta
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - L Scott
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C Vinden
- From the Division of General Surgery, Department of Radiology, Lawson Health Research Institute, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - A Okrainec
- From the Toronto Western Hospital, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - O Henao
- From the Toronto Western Hospital, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - G Azzie
- From the Toronto Western Hospital, University Health Network, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - S Deen
- From the Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - M Hameed
- From the Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - V Ramirez
- From the University Health Network, University of Toronto, Toronto, Ont
| | - C Veillette
- From the University Health Network, University of Toronto, Toronto, Ont
| | - P Bray
- From the University Health Network, University of Toronto, Toronto, Ont
| | - M Jewett
- From the University Health Network, University of Toronto, Toronto, Ont
| | - A Okrainec
- From the University Health Network, University of Toronto, Toronto, Ont
| | - G Pagliarello
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - F Brenneman
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A Buczkowski
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A Nathens
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - T Razek
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - S Widder
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - I Anderson
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - D Klassen
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - R Saadia
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A Johner
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - S M Hameed
- From the Departments of Surgery, University of British Columbia, Vancouver, BC, University of Alberta, Edmonton, University of Calgary, Calgary, Alta, University of Toronto, Toronto, Ont., McGill University, Montréal, Que, Dalhousie University, CAGS Committee on Acute Surgery and Critical Care, Halifax, NS
| | - A P Qureshi
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - A Vergis
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - C M Jimenez
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - J Green
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - A D Pryor
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - C M Schlachta
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - A Okrainec
- From the Division of General Surgery, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, the Departments of Surgery and Oncology, University of Western Ontario, London, Ont., and Duke University Medical Center, Durham, NC
| | - M T Perri
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - A L Trejos
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - M D Naish
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - R V Patel
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - R A Malthaner
- From CSTAR, Division of Thoracic Surgery, University of Western Ontario, London, Ont
| | - J Stanger
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - K Stewart
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - Y Yasui
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - C Cass
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - S Damaraju
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - K Graham
- From the Department of Surgery, Cross Cancer Institute, University of Alberta, Edmonton, Alta
| | - S Bharadwaj
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - L Tan
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - H Unruh
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - C Finley
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - L Miller
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - L E Ferri
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - D R Urbach
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - G Darling
- From the Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ont
| | - J Spicer
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - S Ergun
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - B McDonald
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - M Rousseau
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - P Kaneva
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - J Spicer
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - A Andalib
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - C Benay
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - M Rousseau
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - Y Kushner
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - V Marcus
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Division of Thoracic Surgery, Department of Pathology, McGill University Health Centre, Montréal, Que
| | - I Hunt
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - S Gazala
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - R Razzak
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - A Chuck
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - A Valji
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - K Stewart
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - R Tsuyuki
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - E L R Bédard
- From the Division of Thoracic Surgery, Departments of Surgery and Cardiology, University of Alberta, Institute of Health Economics, Edmonton, Alta
| | - D A Bottoni
- From the Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - G Campbell
- From the Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - R A Malthaner
- From the Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - M Rousseau
- From the McGill University Health Centre, Montréal, Que
| | - P Guevremont
- From the McGill University Health Centre, Montréal, Que
| | - M Chasen
- From the McGill University Health Centre, Montréal, Que
| | - J Spicer
- From the McGill University Health Centre, Montréal, Que
| | - E Eckert
- From the McGill University Health Centre, Montréal, Que
| | - T Alcindor
- From the McGill University Health Centre, Montréal, Que
| | - S Ades
- From the McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the McGill University Health Centre, Montréal, Que
| | - R McGory
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - D Nagpal
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - D Fortin
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - R I Inculet
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - R A Malthaner
- From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont
| | - M Ko
- From the Division of Thoracic Surgery, St. Joseph's Health Centre, University of Toronto, Toronto, Ont
| | - Y Shargall
- From the Division of Thoracic Surgery, St. Joseph's Health Centre, University of Toronto, Toronto, Ont
| | - C Compeau
- From the Division of Thoracic Surgery, St. Joseph's Health Centre, University of Toronto, Toronto, Ont
| | - R Razzak
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - S Gazala
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - I Hunt
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - J Veenstra
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - A Valji
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - K Stewart
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - E L R Bédard
- From the Division of Thoracic Surgery, University of Alberta, Edmonton, Alta
| | - P J Davis
- From the Division of General Surgery, Department of Surgery, The Moncton Hospital, Moncton, NB, and Dalhousie University, Halifax, NS
| | - M Mancuso
- From the Division of General Surgery, Department of Surgery, The Moncton Hospital, Moncton, NB, and Dalhousie University, Halifax, NS
| | - A A Mujoomdar
- From the Division of General Surgery, Department of Surgery, The Moncton Hospital, Moncton, NB, and Dalhousie University, Halifax, NS
| | - S Gazala
- From the University of Alberta, Edmonton, Alta
| | | | - L Lee
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - J Spicer
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - C Robineau
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - C Sirois
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - D Mulder
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - L E Ferri
- From the Division of Thoracic Surgery, McGill University Health Centre, Montréal, Que
| | - J Cools-Lartigue
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - S-Y Chang
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - S Mayrand
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - V Marcus
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - G M Fried
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - L E Ferri
- From the Departments of Surgery, Pathology and Medicine, McGill University, Montréal, Que
| | - T Perry
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - I Hunt
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - M Allegretto
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - C Maguire
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - J Abele
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - D Williams
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - K Stewart
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - E L R Bédard
- From the Departments of Surgery and Diagnostic Imaging, University of Alberta, Edmonton, Alta
| | - H S Grover
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - S Basi
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - P Chiasson
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - S Basi
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - W Gregory
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - K Irshad
- From the Division of Thoracic Surgery, Department of Surgery, William Osler Health Centre, Brampton, McMaster University, Hamilton, Ont
| | - C Schieman
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - J H MacGregor
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - E Kelly
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - G Gelfand
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - A J Graham
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - S P McFadden
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - S C Grondin
- From the Division of Thoracic Surgery, Departments of Surgery and Diagnostic Imaging, University of Calgary, Calgary, Alta
| | - K P Croome
- From the Department of General Surgery, University of Western Ontario, London, Ont., Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, and the Department of Epidemiology, Harvard University, Boston, Mass
| | - R Chudzinski
- From the Department of General Surgery, University of Western Ontario, London, Ont., Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, and the Department of Epidemiology, Harvard University, Boston, Mass
| | - D W Hanto
- From the Department of General Surgery, University of Western Ontario, London, Ont., Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, and the Department of Epidemiology, Harvard University, Boston, Mass
| | - M H Jamal
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., School of Population Health, University of Queensland, Brisbane, Australia
| | - S A Doi
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., School of Population Health, University of Queensland, Brisbane, Australia
| | - J S Barkun
- From the Department of Surgery, McGill University Health Centre, Montréal, Que., School of Population Health, University of Queensland, Brisbane, Australia
| | - S L Wong
- From the Department of Surgery, Health Science Centre, St. John's, NL
| | - A H L Kwan
- From the Department of Surgery, Health Science Centre, St. John's, NL
| | - S Yang
- From the Sunnybrook Health Sciences Centre, Toronto, Ont
| | - C Law
- From the Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Y Luo
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - J Spiers
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - A Forse
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - W Taylor
- From the Hôtel-Dieu Grace Hospital, Windsor, Ont
| | - I Apriasz
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - B Mysliwiec
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - N Sarin
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - J Gregor
- From the Departments of General Surgery and Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ont
| | - C E Moulton
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - R S McLeod
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - H Barnett
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - C Nhan
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - S Gallinger
- From Cancer Care Ontario HPB Surgical Oncology Community of Practice, Department of Surgery, University of Toronto, Surgical Oncology Program, Cancer Care Ontario, Toronto, Ont
| | - S V Demyttenaere
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - P Nau
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - P Muscarella
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - W S Melvin
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - E C Ellison
- From the Department of Surgery, Ohio State University Medical Centre, Columbus, Ohio
| | - S M Wiseman
- From St. Paul's Hospital, Department of Surgery, University of British Columbia, Vancouver, BC
| | - A L Melck
- From St. Paul's Hospital, Department of Surgery, University of British Columbia, Vancouver, BC
| | - K M Davidge
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - C Eskicioglu
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - J Lipa
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - P Ferguson
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - C J Swallow
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - F C Wright
- From the Divisions of Plastic, Orthopedic, and General Surgery, University of Toronto, Toronto, Ont
| | - J P Edwards
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - E J Kelly
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - Y Lin
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - T Lenders
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - W A Ghali
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - A Graham
- From the Department of Surgery, Medicine, Community Health Sciences, Health Information Network Calgary, Centre for Health Policy Studies, University of Calgary, Calgary, Alta
| | - V Francescutti
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - F Farrokhyar
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - R Tozer
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - B Heller
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - P Lovrics
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - G Jansz
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - K Kahnamoui
- From the Division of General Surgery, Department of Medical Oncology, McMaster University, Hamilton, Ont
| | - G Spiegle
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - S Schmocker
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - H Huang
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C Victor
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C Law
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - E D Kennedy
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - J A McCart
- From the Department of Surgery, Toronto General Hospital, Sunnybrook Health Science Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - N Aslani
- From the British Columbia Cancer Agency, Vancouver, BC
| | - T Swanson
- From the British Columbia Cancer Agency, Vancouver, BC
| | - H Kennecke
- From the British Columbia Cancer Agency, Vancouver, BC
| | - R Woods
- From the British Columbia Cancer Agency, Vancouver, BC
| | - N Davis
- From the British Columbia Cancer Agency, Vancouver, BC
| | - A E Klevan
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - J A Ramsay
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - W J Stephen
- From the Departments of Surgery, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - M Smith
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - M Plourde
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P M Johnson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P Yaffe
- From the Departments of Medical Sciences, Surgery, Pathology, and Microbiology and Immunology, Dalhousie University, Halifax, NS
| | - M Walsh
- From the Departments of Medical Sciences, Surgery, Pathology, and Microbiology and Immunology, Dalhousie University, Halifax, NS
| | - D Hoskin
- From the Departments of Medical Sciences, Surgery, Pathology, and Microbiology and Immunology, Dalhousie University, Halifax, NS
| | - H P Huynh
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D C Trottier
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C Soto
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Auer
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H P Huynh
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D C Trottier
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C Soto
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C Nhan
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - D K Driman
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - A J Smith
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - A Hunter
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - R S McLeod
- From the Surgical Oncology Program, Cancer Care Ontario, the Department of Surgery, University of Toronto, Toronto, and the Department of Pathology, University of Western Ontario, London, Ont
| | - C Eskicioglu
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D S Fenech
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - C Victor
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D C Trottier
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Huynh
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E Sabri
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - C Soto
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - A Scheer
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - S Zolfaghari
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - H Moloo
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - E C Poulin
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - R P Boushey
- From the Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - J Hallet
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - M Guénette-Lemieux
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - A Bouchard
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - R C Grégoire
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - C Thibault
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - G Dionne
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - F Côté
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - P Langis
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - J-P Gagné
- From the Centre de chirurgie minimalement invasive de Québec, Centre hospitalier universitaire de Québec, Université Laval, Québec, Que
| | - M J Raval
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - C J Brown
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - A Kuzmanovic
- From the Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - A Planting
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - M J Raval
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C J Brown
- From the Department of Colorectal Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - H P Huynh
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D C Trottier
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - M Friedlich
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - H S Stern
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - B Q Tang
- From the Department of Surgery, Division of General Surgery, Royal Jubilee Hospital, Vancouver Island Health Authority, Victoria, BC
| | - H Moloo
- From the Department of Colorectal Surgery, University of Minnesota, Minneapolis, Minn., the Department of Surgery, University of Ottawa, Ottawa, Ont., and the Department of Colorectal Surgery, University of Pennsylvania, Philadelphia, Pa
| | - J Bleier
- From the Department of Colorectal Surgery, University of Minnesota, Minneapolis, Minn., the Department of Surgery, University of Ottawa, Ottawa, Ont., and the Department of Colorectal Surgery, University of Pennsylvania, Philadelphia, Pa
| | - S M Goldberg
- From the Department of Colorectal Surgery, University of Minnesota, Minneapolis, Minn., the Department of Surgery, University of Ottawa, Ottawa, Ont., and the Department of Colorectal Surgery, University of Pennsylvania, Philadelphia, Pa
| | - J Alsharif
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - G Martel
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - A Bouchard
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E Sabri
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - C R Ramsay
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- From the Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - D Richardson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - G Porter
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - P Johnson
- From the Division of General Surgery, Dalhousie University, Halifax, NS
| | - E Al-Sukhni
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - P F Ridgway
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - B O'Connor
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C J Swallow
- From the Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - S S Forbes
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - D R Urbach
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - R Sutradhar
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - L Paszat
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - L Rabeneck
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - N N Baxter
- From the Department of Surgery, University of Toronto, Toronto, Ont
| | - W Chung
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - D Ko
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C Sun
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C J Brown
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - M Raval
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - P T Phang
- From the Division of General Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - J S Pao
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - R Woods
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - M J Raval
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - P T Phang
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - C J Brown
- From the Department of Surgery, St. Paul's Hospital, BC Cancer Agency, Vancouver, BC
| | - A Power
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - V Francescutti
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - D Ramsey
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - S Kelly
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - W Stephen
- From the Department of Surgery, McMaster University, Hamilton, Ont
| | - M Simunovic
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - A Coates
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - C H Goldsmith
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - L Thabane
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - D Reeson
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - A J Smith
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - R S McLeod
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - F DeNardi
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - T J Whelan
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - M N Levine
- From the Department of Surgery, Clinical Epidemiology and Biostatistics, Hamilton Health Sciences, McMaster University, Hamilton, Ont
| | - K A Al-Khayal
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - W D Buie
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - L Wallace
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - D Sigalet
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - C Eskicioglu
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - A Gagliardi
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - D S Fenech
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - C Victor
- From the Division of General Surgery, University of Toronto, Toronto, Ont
| | - R S McLeod
- From the Division of General Surgery, University of Toronto, Toronto, Ont
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Datta I, Ball CG, Rudmik LR, Paton-Gay D, Bhayana D, Salat P, Schieman C, Smith DF, Vanwijngaarden-Stephens M, Kortbeek JB. A multicenter review of deep venous thrombosis prophylaxis practice patterns for blunt hepatic trauma. J Trauma Manag Outcomes 2009; 3:7. [PMID: 19493337 PMCID: PMC2698879 DOI: 10.1186/1752-2897-3-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 06/03/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND Non-operative management of blunt hepatic trauma is successful in the majority of hemodynamically stable patients. Due to the risk of recurrent hemorrhage, pharmacologic deep venous thrombosis (DVT) prophylaxis is often delayed. The optimal timing of prophylaxis is unclear. A multi-centre, retrospective review of patients with blunt hepatic injuries presenting between 2000 and 2004 was performed. All patients had an ISS >/= 12 and a CT scan confirming hepatic trauma. Patients were categorized into: (1) early DVT prophylaxis (</= 48 hrs of admission), (2) delayed prophylaxis (>48 hrs), and (3) no prophylaxis. METHODS AND RESULTS Thirty-seven (25%) and 45 (42%) patients received early and delayed DVT prophylaxis respectively. The remainder (32%) received none. Mean hepatic injury grades were lower in the early prophylaxis group (II) compared to the delayed and no prophylaxis cohorts (III)(p = 0.002). The number of patients requiring post-admission blood transfusions was highest in the delayed group (44%) compared to the early (26%) and no prophylaxis (6%) groups (p = 0.03). No patient in the early prophylaxis cohort developed a DVT or required delayed angiographic or operative intervention. Two patients in the delayed group failed non-operative management. Eight (18%) patients in the delayed group developed a clinically significant DVT; 1 (2%) progressed to a PE. CONCLUSION Practice patterns indicate that chemical DVT prophylaxis initiated within 48 hours of admission may be safe in patients with significant blunt hepatic trauma. Delays in prevention result in venothromboembolic events, but not in fewer blood transfusions or a decreased need for subsequent angiographic or operative therapies.
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Affiliation(s)
- Indraneel Datta
- Department of Surgery, University of Calgary, Calgary, Canada.
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46
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Ball CG, Lord J, Laupland KB, Gmora S, Mulloy RH, Ng AK, Schieman C, Kirkpatrick AW. Chest tube complications: how well are we training our residents? Can J Surg 2007; 50:450-458. [PMID: 18053373 PMCID: PMC2386217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Thoracic trauma is commonly treated with tube thoracostomy. The overall complication rate associated with this procedure is up to 30% among all operators. The primary purpose of this study was to define the incidence and risk factors for complications in chest tubes placed exclusively by resident physicians. The secondary objective was to outline the rate of complications occult to postinsertional supine anteroposterior (AP) chest radiographs (CXRs). METHODS Over a 12-month period at a regional trauma centre, we retrospectively reviewed all severely injured trauma patients (injury severity score >or= 12) who underwent tube thoracostomy (338/761 patients). Insertional, positional and infective complications were identified. Patients were assessed for complications on the basis of resident operator characteristics, patient demographics, associated injuries and outcomes. Thoracoabdominal CT scans and corresponding CXRs were also used to determine the rate of complications occult to postinsertional supine AP CXR. RESULTS Of the patients, 338 (44%) had CXR and CT imaging. Out of 76 (22%) chest tubes placed by residents in 61 (18%) patients (99% of whom had blunt trauma injuries), there were 17 complications; 6 (35%) were insertional; 9 (53%) were positional and 2 (12%) were infective. Tube placement outside the trauma bay (p = 0.04) and nonsurgical resident operators (p = 0.03) were independently predictive of complications. The rates of complications according to training discipline were as follows: 7% general surgery, 13% internal and family medicine, 25% other surgical disciplines and 40% emergency medicine. Resident seniority, time of day and other factors were not predictive. Six of 11 (55%) positional and intraparenchymal lung tube placements were occult to postinsertional supine AP CXR. CONCLUSIONS Chest tubes placed by resident physicians are commonly associated with complications that are not identified by postinsertional AP CXR. Thoracic CT is the only way to reliably identify this morbidity. The differential rate of complications according to resident specialty suggests that residents in non-general surgical training programs may benefit from more structured instruction and closer supervision in tube thoracostomy.
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Affiliation(s)
- Chad G Ball
- Department of Surgery, Foothills Medical Centre, Calgary, AB, Canada
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Devon KM, Vergara O, Victor JC, Swallow CJ, Cohen Z, Gryfe R, MacRae HM, McLeod RS, Murata A, Phang PT, Jones K, Merritt N, Belliveau P, Hurlbut D, Scheer A, Sabri E, Moloo H, Poulin EC, Mamazza J, Boushey R, Brown CJ, Zhang H, Gallinger S, Gryfe R, McLeod RS, Walters TD, Steinhart AH, Bernstein C, Tremaine W, Wolff BG, Ross S, Parkes R, McKenzie M, McLeod RS, Richardson D, deMontbrun S, McIntyre PB, Johnson PM, Shum J, Colquhoun PHD, Taylor BM, Polyhronopoulos GN, Feldman LS, McCluney AL, Buithieu J, Martinie J, Metrakos P, Fried GM, Chiasson PM, Burpee SE, Corrigan R, Manson P, Omiccioli A, Singh R, Hegge SG, McKinley CA, Lemieux P, Rhéaume P, Lévesque I, Bujold E, Brochu G, Mrad BA, Stoklossa CJ, Birch DW, Chen J, Christou NV, Turcotte S, Forget MA, Beauseigle D, Lapointe R, Garzon PM, Shah SA, Wei AC, Girgrah N, Levy GA, Wong P, Lilly LB, Grant DR, Cattral MS, McGilvary I, Greig PD, Tawadros PS, Wang Z, Birch S, Szaszi K, Kapus A, Rotstein OD, Mihailovic A, Nansamba C, Coyte P, Howar A, Urbach D, Govindarajan A, Cranford V, Wirtzfeld D, Gallinger S, Law CHL, Smith AJ, Gagliardi AR, Haggar F, Moloo H, Grimshaw J, Poulin EC, Mamazza J, Boushey RP, McConnell Y, Johnson P, Porter G, Govindarajan A, Kiss A, Rabeneck L, Smith AJ, Hodgson D, Law CHL, White C, Taylor MC, Borowiec AM, Fedorak RN, Polyhronopoulos GN, Feldman LS, Kaneva PA, Fried GM, Keshoofy M, Gutauskas A, Smith RF, Christou NV, Al-Sabah S, Ladouceur M, Christou NV, Thompson SK, Ruszkiewicz AR, Jamieson GG, Wijnhoven BPL, Game PA, Devitt PG, Watson DI, Poole B, Ehlen TG, Davis NL, Tuma F, Smith T, Hamoud M, Elfeitori A, Boushey R, Poulin E, Mamazza J, MacKenzie JR, Teel W, Reinhartz A, Schieman J, Brophy J, Hsu KE, Ferri LE, Feldman LS, Fried GM, Hsu KE, Man FY, Gizicki RA, Feldman LS, Fried GM, Taylor MC, Bruce S, Burtally A, Brochu G, Gagné JP, Martel G, Poulin EC, Mamazza J, Boushey RP, Deen S, Griffith O, Masoudi H, Wiseman SM, Cox H, Pasieka JL, Parr ZE, Thompson SK, Jamieson GG, Myers JC, Game PA, Devitt PG, Bélanger M, Brochu G, Moloo H, Haggar F, Grimshaw J, Coyle D, Graham ID, Sabri E, Poulin EC, Mamazza J, Balaa F, Stern H, Boushey RP, Moloo H, Sabri E, Wassif E, Haggar F, Poulin EC, Mamazza J, Boushey RP, Reso A, Estifanos D, Church N, Mitchell P, O'Neill C, Colquhoun P, Schlachta CM, Etemad-Rezai R, Jayaraman S, Passi R, Hodder AS, Pace DE, Chuah TK, Wirtzfeld D, Lee TYY, Pollett W, Trottier D, May G, Moloo H, Haggar F, Boushey R, Poulin E, Mamazza J, Singh R, Boutross-Tadross O, Deif B, Elias R, Stephen WJ, Omiccioli A, Singh R, Hegge SG, McKinley CA, Singh R, Omiccioli A, Hegge SG, McKinley CA, Sampath S, Segal BE, Carter JJ, Nguyen NH, Frimer M, Houston G, Bloom SW, Lemieux P, Couture C, Simard S, Lebel S, El Fitori A, Sabri E, Wassif E, Mamazza J, Poulin E, Boushey R, Warnock GL, Waddell J, Proctor G, Krajewski SA, Brown JA, Phang PT, Raval MJ, Brown CJ, Simunovic M, Major D, Qui F, To T, Baxter N, Urbach D, McGuire A, George R, Berg R, George R, Hristov H, McAlister ED, George R, Jones K, Bardell A, Isotalo P, Stotland PK, Chia S, Cyriac JS, Hagen JA, Klein LV, Hodgson N, Holowaty E, Lee G, Sussman J, Whelan T, Simunovic M, Apriasz I, Mohan S, Mccreery G, Patel R, Schlachta CM, Schlachta CM, Sorsdahl AK, Lefebvre KL, McCune ML, Hebbard PC, Wirtzfeld DA, Huynh QHP, Klein LV, Hagen JA, Xeroulis G, Dubrowski A, Leslie K, Mihailovic A, Howard A, Willan A, Coyte P, Urbach D, Sawisky G, Stoklossa CJ, Birch DW, Dickie BH, Stoklossa CJ, Davey D, Birch DW, Bohacek L, Pace DE, Karanicolas PJ, Colquhoun PH, Dahlke E, Guyatt GH, Butler MS, de Gara CJ, Boutros M, Zabalotny B, Charlin B, Meterissian S, Finley C, Clifton J, Fitzgerald M, Yee J, Quadri S, Knox J, Wong R, Xu W, Hornby J, Keshavjee S, Darling G, Schieman C, Tiruta C, Blitz M, Graham A, Gelfand G, McFadden S, Grondin S, de Perrot M, Anraku M, Feld R, Bezjak A, Burkes R, Roberts H, Cho J, Visbal A, Leighl N, Keshavjee S, Johnston M, Villeneuve PJ, Sundaresan RS, Gray DA, Rakovich G, Brigand C, Gaboury L, Martin J, Ferraro P, Duranceau A, Low D, Huang J, Cantone N, Schembre D, Mohan S, Trejos AL, Bassan H, Lin AW, Patel RV, Malthaner RA, Blitz M, Graham AJ, Gelfand G, McFadden SD, Grondin SC, Kondra J, Clifton J, Suarez G, Ross B, Evans K, Finley RJ, Yee J, Sugimura H, Spratt EH, Compeau CG, Shargall Y, Lara-Guerra H, Leighl N, Salvarrey A, Sakurada A, Paul N, Boerner S, Geddie W, Pond G, Shepherd FA, Tsao MS, Waddell TK. Abstracts of presentations to the Annual Meetings of the Canadian Society of Colon and Rectal Surgeons Canadian Association of General Surgeons Canadian Association of Thoracic Surgeons: Canadian Surgery Forum, Toronto, Ont., September 6-9, 2007. Can J Surg 2007; 50:1-32. [PMID: 37353894 PMCID: PMC10390043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Affiliation(s)
- K M Devon
- Dr. Zane Cohen Digestive Diseases Research Unit, Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - O Vergara
- Dr. Zane Cohen Digestive Diseases Research Unit, Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - J C Victor
- Dr. Zane Cohen Digestive Diseases Research Unit, Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - C J Swallow
- Dr. Zane Cohen Digestive Diseases Research Unit, Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - Z Cohen
- Dr. Zane Cohen Digestive Diseases Research Unit, Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - R Gryfe
- Dr. Zane Cohen Digestive Diseases Research Unit, Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - H M MacRae
- Dr. Zane Cohen Digestive Diseases Research Unit, Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - R S McLeod
- Dr. Zane Cohen Digestive Diseases Research Unit, Samuel Lunenfeld Research Institute, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - A Murata
- Division of General Surgery, University of British Columbia, Vancouver, BC
| | - P T Phang
- Division of General Surgery, University of British Columbia, Vancouver, BC
| | - K Jones
- Departments of Surgery and Pathology, Kingston General Hospital, Queen's University, Kingston, Ont
| | - N Merritt
- Departments of Surgery and Pathology, Kingston General Hospital, Queen's University, Kingston, Ont
| | - P Belliveau
- Departments of Surgery and Pathology, Kingston General Hospital, Queen's University, Kingston, Ont
| | - D Hurlbut
- Departments of Surgery and Pathology, Kingston General Hospital, Queen's University, Kingston, Ont
| | - A Scheer
- Department of General Surgery, Ottawa Hospital, Ottawa, Ont
| | - E Sabri
- Department of General Surgery, Ottawa Hospital, Ottawa, Ont
| | - H Moloo
- Department of General Surgery, Ottawa Hospital, Ottawa, Ont
| | - E C Poulin
- Department of General Surgery, Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- Department of General Surgery, Ottawa Hospital, Ottawa, Ont
| | - R Boushey
- Department of General Surgery, Ottawa Hospital, Ottawa, Ont
| | - C J Brown
- University of British Columbia, Vancouver, BC, University of Toronto, Toronto, Ont
| | - H Zhang
- University of British Columbia, Vancouver, BC, University of Toronto, Toronto, Ont
| | - S Gallinger
- University of British Columbia, Vancouver, BC, University of Toronto, Toronto, Ont
| | - R Gryfe
- University of British Columbia, Vancouver, BC, University of Toronto, Toronto, Ont
| | - R S McLeod
- University of British Columbia, Vancouver, BC, University of Toronto, Toronto, Ont
| | - T D Walters
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - A H Steinhart
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - C Bernstein
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - W Tremaine
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - B G Wolff
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - S Ross
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - R Parkes
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - M McKenzie
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - R S McLeod
- University of Toronto, Toronto, Ont., University of Manitoba, Winnipeg, Man., Mayo Clinic, Rochester, NY, University of Calgary, Calgary, Alta., Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - D Richardson
- Department of Surgery, Dalhousie University, Halifax, NS
| | - S deMontbrun
- Department of Surgery, Dalhousie University, Halifax, NS
| | - P B McIntyre
- Department of Surgery, Dalhousie University, Halifax, NS
| | - P M Johnson
- Department of Surgery, Dalhousie University, Halifax, NS
| | - J Shum
- London Health Sciences Centre, University of Western Ontario, London, Ont
| | - P H D Colquhoun
- London Health Sciences Centre, University of Western Ontario, London, Ont
| | - B M Taylor
- London Health Sciences Centre, University of Western Ontario, London, Ont
| | - G N Polyhronopoulos
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - L S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - A L McCluney
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - J Buithieu
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - J Martinie
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - P Metrakos
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - G M Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - P M Chiasson
- Southern Arizona Center for Minimally Invasive Surgery, Northwest Medical Center, Tucson, Ariz., USA
| | - S E Burpee
- Southern Arizona Center for Minimally Invasive Surgery, Northwest Medical Center, Tucson, Ariz., USA
| | - R Corrigan
- Southern Arizona Center for Minimally Invasive Surgery, Northwest Medical Center, Tucson, Ariz., USA
| | - P Manson
- Southern Arizona Center for Minimally Invasive Surgery, Northwest Medical Center, Tucson, Ariz., USA
| | - A Omiccioli
- Centre for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - R Singh
- Centre for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - S G Hegge
- Centre for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - C A McKinley
- Centre for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - P Lemieux
- Surgery Department, CHUQ (St-François d'Assise and CHUL pavilions), Université Laval, Québec, Que
| | - P Rhéaume
- Surgery Department, CHUQ (St-François d'Assise and CHUL pavilions), Université Laval, Québec, Que
| | - I Lévesque
- Surgery Department, CHUQ (St-François d'Assise and CHUL pavilions), Université Laval, Québec, Que
| | - E Bujold
- Surgery Department, CHUQ (St-François d'Assise and CHUL pavilions), Université Laval, Québec, Que
| | - G Brochu
- Surgery Department, CHUQ (St-François d'Assise and CHUL pavilions), Université Laval, Québec, Que
| | - B A Mrad
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - C Johnson Stoklossa
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - D W Birch
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - J Chen
- Section of Bariatric Surgery, Division of General Surgery, McGill University, Montréal, Que
| | - N V Christou
- Section of Bariatric Surgery, Division of General Surgery, McGill University, Montréal, Que
| | - S Turcotte
- Immuno-oncology Laboratory, Institut du cancer de Montréal, Centre hospitalier de l'Université de Montréal, CHUM Research Center and Department of Surgery, Université de Montréal, Montréal, Que
| | - M-A Forget
- Immuno-oncology Laboratory, Institut du cancer de Montréal, Centre hospitalier de l'Université de Montréal, CHUM Research Center and Department of Surgery, Université de Montréal, Montréal, Que
| | - D Beauseigle
- Immuno-oncology Laboratory, Institut du cancer de Montréal, Centre hospitalier de l'Université de Montréal, CHUM Research Center and Department of Surgery, Université de Montréal, Montréal, Que
| | - R Lapointe
- Immuno-oncology Laboratory, Institut du cancer de Montréal, Centre hospitalier de l'Université de Montréal, CHUM Research Center and Department of Surgery, Université de Montréal, Montréal, Que
| | - P M Garzon
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - S A Shah
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - A C Wei
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - N Girgrah
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - G A Levy
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - P Wong
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - L B Lilly
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - D R Grant
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - M S Cattral
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - I McGilvary
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - P D Greig
- Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ont
| | - P S Tawadros
- St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Z Wang
- St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - S Birch
- St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - K Szaszi
- St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - A Kapus
- St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - O D Rotstein
- St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - A Mihailovic
- Departments of Surgery and Health Policy Management and Evaluation, University of Toronto, Toronto, Ont., Injury Control Center - Uganda, Kampala, Uganda
| | - C Nansamba
- Departments of Surgery and Health Policy Management and Evaluation, University of Toronto, Toronto, Ont., Injury Control Center - Uganda, Kampala, Uganda
| | - P Coyte
- Departments of Surgery and Health Policy Management and Evaluation, University of Toronto, Toronto, Ont., Injury Control Center - Uganda, Kampala, Uganda
| | - A Howar
- Departments of Surgery and Health Policy Management and Evaluation, University of Toronto, Toronto, Ont., Injury Control Center - Uganda, Kampala, Uganda
| | - D Urbach
- Departments of Surgery and Health Policy Management and Evaluation, University of Toronto, Toronto, Ont., Injury Control Center - Uganda, Kampala, Uganda
| | - A Govindarajan
- Division of General Surgery, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ont., Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - V Cranford
- Division of General Surgery, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ont., Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - D Wirtzfeld
- Division of General Surgery, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ont., Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - S Gallinger
- Division of General Surgery, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ont., Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - C H L Law
- Division of General Surgery, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ont., Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - A J Smith
- Division of General Surgery, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ont., Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - A R Gagliardi
- Division of General Surgery, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ont., Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - F Haggar
- University of Ottawa, Ottawa Hospital, Ottawa, Ont
| | - H Moloo
- University of Ottawa, Ottawa Hospital, Ottawa, Ont
| | - J Grimshaw
- University of Ottawa, Ottawa Hospital, Ottawa, Ont
| | - E C Poulin
- University of Ottawa, Ottawa Hospital, Ottawa, Ont
| | - J Mamazza
- University of Ottawa, Ottawa Hospital, Ottawa, Ont
| | - R P Boushey
- University of Ottawa, Ottawa Hospital, Ottawa, Ont
| | - Y McConnell
- Division of General Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - P Johnson
- Division of General Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - G Porter
- Division of General Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - A Govindarajan
- Department of General Surgery, Institute for Clinical Evaluative Sciences, Toronto Sunnybrook Regional Cancer Centre, Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ont
| | - A Kiss
- Department of General Surgery, Institute for Clinical Evaluative Sciences, Toronto Sunnybrook Regional Cancer Centre, Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ont
| | - L Rabeneck
- Department of General Surgery, Institute for Clinical Evaluative Sciences, Toronto Sunnybrook Regional Cancer Centre, Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ont
| | - A J Smith
- Department of General Surgery, Institute for Clinical Evaluative Sciences, Toronto Sunnybrook Regional Cancer Centre, Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ont
| | - D Hodgson
- Department of General Surgery, Institute for Clinical Evaluative Sciences, Toronto Sunnybrook Regional Cancer Centre, Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ont
| | - C H L Law
- Department of General Surgery, Institute for Clinical Evaluative Sciences, Toronto Sunnybrook Regional Cancer Centre, Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ont
| | - C White
- Department of Surgery, University of Manitoba, Winnipeg, Man
| | - M C Taylor
- Department of Surgery, University of Manitoba, Winnipeg, Man
| | - A M Borowiec
- Departments of General Surgery and Gastroenterology, University of Alberta, Edmonton, Alta
| | - R N Fedorak
- Departments of General Surgery and Gastroenterology, University of Alberta, Edmonton, Alta
| | - G N Polyhronopoulos
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - L S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - P A Kaneva
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - G M Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montréal, Que
| | - M Keshoofy
- Department of General Surgery, Ottawa Hospital, Ottawa, Ont
| | - A Gutauskas
- Department of General Surgery, Ottawa Hospital, Ottawa, Ont
| | | | - N V Christou
- Section of Bariatric Surgery, Division of General Surgery, McGill University, Montréal, Que
| | - S Al-Sabah
- Section of Bariatric Surgery, Division of General Surgery, McGill University Health Centre, Montréal, Que
| | - M Ladouceur
- Section of Bariatric Surgery, Division of General Surgery, McGill University Health Centre, Montréal, Que
| | - N V Christou
- Section of Bariatric Surgery, Division of General Surgery, McGill University Health Centre, Montréal, Que
| | - S K Thompson
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - A R Ruszkiewicz
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - G G Jamieson
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - B P L Wijnhoven
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - P A Game
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - P G Devitt
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - D I Watson
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - B Poole
- Department of Surgical Oncology, BC Cancer Agency, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - T G Ehlen
- Department of Surgical Oncology, BC Cancer Agency, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - N L Davis
- Department of Surgical Oncology, BC Cancer Agency, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - F Tuma
- Department of Head and Neck Surgery, St. Clare's Mercy Hospital, St. John's, Nfld
| | - T Smith
- Department of Head and Neck Surgery, St. Clare's Mercy Hospital, St. John's, Nfld
| | - M Hamoud
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - A Elfeitori
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Boushey
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E Poulin
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J R MacKenzie
- Occupational Health Clinic for Ontario Workers, Sarnia, Ont
| | - W Teel
- Occupational Health Clinic for Ontario Workers, Sarnia, Ont
| | - A Reinhartz
- Occupational Health Clinic for Ontario Workers, Sarnia, Ont
| | - J Schieman
- Occupational Health Clinic for Ontario Workers, Sarnia, Ont
| | - J Brophy
- Occupational Health Clinic for Ontario Workers, Sarnia, Ont
| | - K E Hsu
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - L E Ferri
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - L S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - G M Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montréal, Que
| | - K E Hsu
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Department of Surgery, McGill University, Montréal, Que
| | - F Y Man
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Department of Surgery, McGill University, Montréal, Que
| | - R A Gizicki
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Department of Surgery, McGill University, Montréal, Que
| | - L S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Department of Surgery, McGill University, Montréal, Que
| | - G M Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Department of Surgery, McGill University, Montréal, Que
| | - M C Taylor
- Manitoba Centre for Health Policy and the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - S Bruce
- Manitoba Centre for Health Policy and the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - A Burtally
- Québec Centre for Minimally Invasive Surgery, Centre Hospitalier Universitaire de Québec, Québec, Que
| | - G Brochu
- Québec Centre for Minimally Invasive Surgery, Centre Hospitalier Universitaire de Québec, Québec, Que
| | - J P Gagné
- Québec Centre for Minimally Invasive Surgery, Centre Hospitalier Universitaire de Québec, Québec, Que
| | - G Martel
- Minimally Invasive Surgery Group, Division of General Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- Minimally Invasive Surgery Group, Division of General Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- Minimally Invasive Surgery Group, Division of General Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- Minimally Invasive Surgery Group, Division of General Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - S Deen
- Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - O Griffith
- Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - H Masoudi
- Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - S M Wiseman
- Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - H Cox
- Department of Surgery, University of Calgary, Calgary, Alta
| | - J L Pasieka
- Department of Surgery, University of Calgary, Calgary, Alta
| | - Z E Parr
- Departments of Surgery, Foothills Hospital, Calgary, Alta., Royal Adelaide Hospital, Adelaide, SA, Australia
| | - S K Thompson
- Departments of Surgery, Foothills Hospital, Calgary, Alta., Royal Adelaide Hospital, Adelaide, SA, Australia
| | - G G Jamieson
- Departments of Surgery, Foothills Hospital, Calgary, Alta., Royal Adelaide Hospital, Adelaide, SA, Australia
| | - J C Myers
- Departments of Surgery, Foothills Hospital, Calgary, Alta., Royal Adelaide Hospital, Adelaide, SA, Australia
| | - P A Game
- Departments of Surgery, Foothills Hospital, Calgary, Alta., Royal Adelaide Hospital, Adelaide, SA, Australia
| | - P G Devitt
- Departments of Surgery, Foothills Hospital, Calgary, Alta., Royal Adelaide Hospital, Adelaide, SA, Australia
| | - M Bélanger
- Service de chirurgie générale, CHUL-CHUQ, Québec, Que
| | - G Brochu
- Service de chirurgie générale, CHUL-CHUQ, Québec, Que
| | - H Moloo
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - F Haggar
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - J Grimshaw
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - D Coyle
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - I D Graham
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - E Sabri
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - E C Poulin
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - F Balaa
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - H Stern
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - R P Boushey
- Department of Surgery, Ottawa Hospital, Department of Epidemiology, University of Ottawa, Ottawa, Ont
| | - H Moloo
- Ottawa Hospital, Ottawa, Ont
| | - E Sabri
- Ottawa Hospital, Ottawa, Ont
| | | | | | | | | | | | - A Reso
- Division of General Surgery, Peter Lougheed Centre, Calgary, Alta
| | - D Estifanos
- Division of General Surgery, Peter Lougheed Centre, Calgary, Alta
| | - N Church
- Division of General Surgery, Peter Lougheed Centre, Calgary, Alta
| | - P Mitchell
- Division of General Surgery, Peter Lougheed Centre, Calgary, Alta
| | - C O'Neill
- Division of General Surgery and Department of Diagnostic Radiology and Nuclear Medicine, Schulich School of Medicine and Dentistry, London, Ont
| | - P Colquhoun
- Division of General Surgery and Department of Diagnostic Radiology and Nuclear Medicine, Schulich School of Medicine and Dentistry, London, Ont
| | - C M Schlachta
- Division of General Surgery and Department of Diagnostic Radiology and Nuclear Medicine, Schulich School of Medicine and Dentistry, London, Ont
| | - R Etemad-Rezai
- Division of General Surgery and Department of Diagnostic Radiology and Nuclear Medicine, Schulich School of Medicine and Dentistry, London, Ont
| | - S Jayaraman
- Division of General Surgery and Department of Diagnostic Radiology and Nuclear Medicine, Schulich School of Medicine and Dentistry, London, Ont
| | - R Passi
- Division of General Surgery and Department of Diagnostic Radiology and Nuclear Medicine, Schulich School of Medicine and Dentistry, London, Ont
| | - A S Hodder
- Division of General Surgery, Memorial University, St. John's, Nfld
| | - D E Pace
- Division of General Surgery, Memorial University, St. John's, Nfld
| | - T K Chuah
- Discipline of Surgery, Health Sciences Centre, Memorial University, St. John's, Nfld
| | - D Wirtzfeld
- Discipline of Surgery, Health Sciences Centre, Memorial University, St. John's, Nfld
| | - T Y Y Lee
- Discipline of Surgery, Health Sciences Centre, Memorial University, St. John's, Nfld
| | - W Pollett
- Discipline of Surgery, Health Sciences Centre, Memorial University, St. John's, Nfld
| | - D Trottier
- Department of Surgery, University of Ottawa, Ottawa, Department of Gastroenterology, St. Michael's Hospital, Toronto, Ont
| | - G May
- Department of Surgery, University of Ottawa, Ottawa, Department of Gastroenterology, St. Michael's Hospital, Toronto, Ont
| | - H Moloo
- Department of Surgery, University of Ottawa, Ottawa, Department of Gastroenterology, St. Michael's Hospital, Toronto, Ont
| | - F Haggar
- Department of Surgery, University of Ottawa, Ottawa, Department of Gastroenterology, St. Michael's Hospital, Toronto, Ont
| | - R Boushey
- Department of Surgery, University of Ottawa, Ottawa, Department of Gastroenterology, St. Michael's Hospital, Toronto, Ont
| | - E Poulin
- Department of Surgery, University of Ottawa, Ottawa, Department of Gastroenterology, St. Michael's Hospital, Toronto, Ont
| | - J Mamazza
- Department of Surgery, University of Ottawa, Ottawa, Department of Gastroenterology, St. Michael's Hospital, Toronto, Ont
| | - R Singh
- Departments of Surgery and Pathology, McMaster University, Hamilton, Ont
| | - O Boutross-Tadross
- Departments of Surgery and Pathology, McMaster University, Hamilton, Ont
| | - B Deif
- Departments of Surgery and Pathology, McMaster University, Hamilton, Ont
| | - R Elias
- Departments of Surgery and Pathology, McMaster University, Hamilton, Ont
| | - W J Stephen
- Departments of Surgery and Pathology, McMaster University, Hamilton, Ont
| | - A Omiccioli
- The Center for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - R Singh
- The Center for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - S G Hegge
- The Center for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - C A McKinley
- The Center for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - R Singh
- The Centre for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - A Omiccioli
- The Centre for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - S G Hegge
- The Centre for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - C A McKinley
- The Centre for Minimal Access Surgery, North Bay General Hospital, North Bay, Ont
| | - S Sampath
- Department of Surgery, Richmond Hospital, Richmond, BC
| | - B E Segal
- Department of Surgery, Richmond Hospital, Richmond, BC
| | - J J Carter
- Department of Surgery, Richmond Hospital, Richmond, BC
| | - N H Nguyen
- Department of Surgery, Richmond Hospital, Richmond, BC
| | - M Frimer
- Department of Surgery, Richmond Hospital, Richmond, BC
| | - G Houston
- Department of Surgery, Richmond Hospital, Richmond, BC
| | - S W Bloom
- Department of Surgery, Richmond Hospital, Richmond, BC
| | - P Lemieux
- Surgery and Pathology Departments, Hôpital Laval, Université Laval, Québec, Que
| | - C Couture
- Surgery and Pathology Departments, Hôpital Laval, Université Laval, Québec, Que
| | - S Simard
- Surgery and Pathology Departments, Hôpital Laval, Université Laval, Québec, Que
| | - S Lebel
- Surgery and Pathology Departments, Hôpital Laval, Université Laval, Québec, Que
| | - A El Fitori
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E Sabri
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E Wassif
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - J Mamazza
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - E Poulin
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - R Boushey
- Department of Surgery, Ottawa Hospital, University of Ottawa, Ottawa, Ont
| | - G L Warnock
- Department of Surgery, University of British Columbia, Vancouver, BC, Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ont., Canadian Medical Association, Ottawa, Ont
| | - J Waddell
- Department of Surgery, University of British Columbia, Vancouver, BC, Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ont., Canadian Medical Association, Ottawa, Ont
| | - G Proctor
- Department of Surgery, University of British Columbia, Vancouver, BC, Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ont., Canadian Medical Association, Ottawa, Ont
| | - S A Krajewski
- Departments of Surgery and Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - J A Brown
- Departments of Surgery and Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - P T Phang
- Departments of Surgery and Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - M J Raval
- Departments of Surgery and Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - C J Brown
- Departments of Surgery and Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC
| | - M Simunovic
- McMaster University, Hamilton, Ont., Institut national de santé publique du Québec, Québec, Que., Institute for Clinical Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - D Major
- McMaster University, Hamilton, Ont., Institut national de santé publique du Québec, Québec, Que., Institute for Clinical Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - F Qui
- McMaster University, Hamilton, Ont., Institut national de santé publique du Québec, Québec, Que., Institute for Clinical Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - T To
- McMaster University, Hamilton, Ont., Institut national de santé publique du Québec, Québec, Que., Institute for Clinical Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - N Baxter
- McMaster University, Hamilton, Ont., Institut national de santé publique du Québec, Québec, Que., Institute for Clinical Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - D Urbach
- McMaster University, Hamilton, Ont., Institut national de santé publique du Québec, Québec, Que., Institute for Clinical Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - A McGuire
- Departments of Surgery and Oncology, Queen's University, Kingston, Ont
| | - R George
- Departments of Surgery and Oncology, Queen's University, Kingston, Ont
| | - R Berg
- Departments of Surgery and Oncology, Queen's University, Kingston, Ont
| | - R George
- Departments of Surgery and Oncology, Queen's University, Kingston, Ont
| | - H Hristov
- Departments of Surgery and Oncology, Queen's University, Kingston, Ont
| | - E D McAlister
- Department of Surgery and Oncology and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ont
| | - R George
- Department of Surgery and Oncology and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ont
| | - K Jones
- Department of Surgery and Oncology and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ont
| | - A Bardell
- Department of Surgery and Oncology and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ont
| | - P Isotalo
- Department of Surgery and Oncology and Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ont
| | - P K Stotland
- Minimally Invasive Surgery Program, Department of Surgery, University of Toronto, Humber River Regional Hospital, Toronto, Ont
| | - S Chia
- Minimally Invasive Surgery Program, Department of Surgery, University of Toronto, Humber River Regional Hospital, Toronto, Ont
| | - J S Cyriac
- Minimally Invasive Surgery Program, Department of Surgery, University of Toronto, Humber River Regional Hospital, Toronto, Ont
| | - J A Hagen
- Minimally Invasive Surgery Program, Department of Surgery, University of Toronto, Humber River Regional Hospital, Toronto, Ont
| | - L V Klein
- Minimally Invasive Surgery Program, Department of Surgery, University of Toronto, Humber River Regional Hospital, Toronto, Ont
| | - N Hodgson
- Department of Surgery, Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Cancer Care Ontario, Toronto, Ont
| | - E Holowaty
- Department of Surgery, Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Cancer Care Ontario, Toronto, Ont
| | - G Lee
- Department of Surgery, Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Cancer Care Ontario, Toronto, Ont
| | - J Sussman
- Department of Surgery, Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Cancer Care Ontario, Toronto, Ont
| | - T Whelan
- Department of Surgery, Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Cancer Care Ontario, Toronto, Ont
| | - M Simunovic
- Department of Surgery, Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Cancer Care Ontario, Toronto, Ont
| | - I Apriasz
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont
| | - S Mohan
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont
| | - G Mccreery
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont
| | - R Patel
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont
| | - C M Schlachta
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont
| | - C M Schlachta
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont., Stratford General Hospital, Stratford, Ont
| | - A K Sorsdahl
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont., Stratford General Hospital, Stratford, Ont
| | - K L Lefebvre
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont., Stratford General Hospital, Stratford, Ont
| | - M L McCune
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), Lawson Health Research Institute, Schulich School of Medicine and Dentistry, London, Ont., Stratford General Hospital, Stratford, Ont
| | - P C Hebbard
- Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - D A Wirtzfeld
- Department of Surgery, Memorial University of Newfoundland, St. John's, Nfld
| | - Q H P Huynh
- The Minimally Invasive Surgery Program, Humber River Regional Hospital, Department of Surgery, University of Toronto, Toronto, Ont
| | - L V Klein
- The Minimally Invasive Surgery Program, Humber River Regional Hospital, Department of Surgery, University of Toronto, Toronto, Ont
| | - J A Hagen
- The Minimally Invasive Surgery Program, Humber River Regional Hospital, Department of Surgery, University of Toronto, Toronto, Ont
| | - G Xeroulis
- Department of Surgery, Division of General Surgery, University of Western Ontario, London, Ont
| | - A Dubrowski
- Department of Surgery, Division of General Surgery, University of Western Ontario, London, Ont
| | - K Leslie
- Department of Surgery, Division of General Surgery, University of Western Ontario, London, Ont
| | - A Mihailovic
- Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Hospital for Sick Children, Toronto, Ont
| | - A Howard
- Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Hospital for Sick Children, Toronto, Ont
| | - A Willan
- Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Hospital for Sick Children, Toronto, Ont
| | - P Coyte
- Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Hospital for Sick Children, Toronto, Ont
| | - D Urbach
- Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Hospital for Sick Children, Toronto, Ont
| | - G Sawisky
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - C Johnson Stoklossa
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - D W Birch
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - B H Dickie
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - C Johnson Stoklossa
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - D Davey
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - D W Birch
- Department of Surgery, University of Alberta, Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta
| | - L Bohacek
- Department of Surgery, Memorial University, St. John's, Nfld
| | - D E Pace
- Department of Surgery, Memorial University, St. John's, Nfld
| | - P J Karanicolas
- Department of Surgery, University of Western Ontario, London, Ont., Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont
| | - P H Colquhoun
- Department of Surgery, University of Western Ontario, London, Ont., Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont
| | - E Dahlke
- Department of Surgery, University of Western Ontario, London, Ont., Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont
| | - G H Guyatt
- Department of Surgery, University of Western Ontario, London, Ont., Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont
| | - M S Butler
- Department of General Surgery, Royal Alexandra Hospital and University of Alberta Hospital, Edmonton, Alta
| | - C J de Gara
- Department of General Surgery, Royal Alexandra Hospital and University of Alberta Hospital, Edmonton, Alta
| | - M Boutros
- Centre for Medical Education and the Division of General Surgery, McGill University, Centre for Medical Education, Univeristé de Montréal, Montréal, Que
| | - B Zabalotny
- Centre for Medical Education and the Division of General Surgery, McGill University, Centre for Medical Education, Univeristé de Montréal, Montréal, Que
| | - B Charlin
- Centre for Medical Education and the Division of General Surgery, McGill University, Centre for Medical Education, Univeristé de Montréal, Montréal, Que
| | - S Meterissian
- Centre for Medical Education and the Division of General Surgery, McGill University, Centre for Medical Education, Univeristé de Montréal, Montréal, Que
| | - C Finley
- Vancouver General Hospital and the University of British Columbia, Vancouver, BC
| | - J Clifton
- Vancouver General Hospital and the University of British Columbia, Vancouver, BC
| | - M Fitzgerald
- Vancouver General Hospital and the University of British Columbia, Vancouver, BC
| | - J Yee
- Vancouver General Hospital and the University of British Columbia, Vancouver, BC
| | - S Quadri
- Toronto General Hospital, Princess Margaret Hospital, Toronto, Ont
| | - J Knox
- Toronto General Hospital, Princess Margaret Hospital, Toronto, Ont
| | - R Wong
- Toronto General Hospital, Princess Margaret Hospital, Toronto, Ont
| | - W Xu
- Toronto General Hospital, Princess Margaret Hospital, Toronto, Ont
| | - J Hornby
- Toronto General Hospital, Princess Margaret Hospital, Toronto, Ont
| | - S Keshavjee
- Toronto General Hospital, Princess Margaret Hospital, Toronto, Ont
| | - G Darling
- Toronto General Hospital, Princess Margaret Hospital, Toronto, Ont
| | - C Schieman
- Division of Thoracic Surgery, University of Calgary, Calgary, Alta
| | - C Tiruta
- Division of Thoracic Surgery, University of Calgary, Calgary, Alta
| | - M Blitz
- Division of Thoracic Surgery, University of Calgary, Calgary, Alta
| | - A Graham
- Division of Thoracic Surgery, University of Calgary, Calgary, Alta
| | - G Gelfand
- Division of Thoracic Surgery, University of Calgary, Calgary, Alta
| | - S McFadden
- Division of Thoracic Surgery, University of Calgary, Calgary, Alta
| | - S Grondin
- Division of Thoracic Surgery, University of Calgary, Calgary, Alta
| | - M de Perrot
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - M Anraku
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - R Feld
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - A Bezjak
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - R Burkes
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - H Roberts
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - J Cho
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - A Visbal
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - N Leighl
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - S Keshavjee
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - M Johnston
- Toronto General Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ont
| | - P J Villeneuve
- Centre for Cancer Therapeutics, Ottawa Health Research Institute, Division of Thoracic Surgery, University of Ottawa, Ottawa, Ont
| | - R S Sundaresan
- Centre for Cancer Therapeutics, Ottawa Health Research Institute, Division of Thoracic Surgery, University of Ottawa, Ottawa, Ont
| | - D A Gray
- Centre for Cancer Therapeutics, Ottawa Health Research Institute, Division of Thoracic Surgery, University of Ottawa, Ottawa, Ont
| | - G Rakovich
- Service de chirurgie thoracique, Service anatomo-pathologie, Centre hospitalier de l'Université de Montréal, Montréal, Que., Service chirurgie digestive, CHU Strasbourg, Strasbourg, France
| | - C Brigand
- Service de chirurgie thoracique, Service anatomo-pathologie, Centre hospitalier de l'Université de Montréal, Montréal, Que., Service chirurgie digestive, CHU Strasbourg, Strasbourg, France
| | - L Gaboury
- Service de chirurgie thoracique, Service anatomo-pathologie, Centre hospitalier de l'Université de Montréal, Montréal, Que., Service chirurgie digestive, CHU Strasbourg, Strasbourg, France
| | - J Martin
- Service de chirurgie thoracique, Service anatomo-pathologie, Centre hospitalier de l'Université de Montréal, Montréal, Que., Service chirurgie digestive, CHU Strasbourg, Strasbourg, France
| | - P Ferraro
- Service de chirurgie thoracique, Service anatomo-pathologie, Centre hospitalier de l'Université de Montréal, Montréal, Que., Service chirurgie digestive, CHU Strasbourg, Strasbourg, France
| | - A Duranceau
- Service de chirurgie thoracique, Service anatomo-pathologie, Centre hospitalier de l'Université de Montréal, Montréal, Que., Service chirurgie digestive, CHU Strasbourg, Strasbourg, France
| | - D Low
- Departments of Thoracic Surgery and Gastroenterology, Virginia Mason Medical Center, Seattle, Wash., USA
| | - J Huang
- Departments of Thoracic Surgery and Gastroenterology, Virginia Mason Medical Center, Seattle, Wash., USA
| | - N Cantone
- Departments of Thoracic Surgery and Gastroenterology, Virginia Mason Medical Center, Seattle, Wash., USA
| | - D Schembre
- Departments of Thoracic Surgery and Gastroenterology, Virginia Mason Medical Center, Seattle, Wash., USA
| | - S Mohan
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), University of Western Ontario, London, Ont
| | - A L Trejos
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), University of Western Ontario, London, Ont
| | - H Bassan
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), University of Western Ontario, London, Ont
| | - A W Lin
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), University of Western Ontario, London, Ont
| | - R V Patel
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), University of Western Ontario, London, Ont
| | - R A Malthaner
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), University of Western Ontario, London, Ont
| | - M Blitz
- Division of Thoracic Surgery, Department of Surgery, University of Calgary, Calgary, Alta
| | - A J Graham
- Division of Thoracic Surgery, Department of Surgery, University of Calgary, Calgary, Alta
| | - G Gelfand
- Division of Thoracic Surgery, Department of Surgery, University of Calgary, Calgary, Alta
| | - S D McFadden
- Division of Thoracic Surgery, Department of Surgery, University of Calgary, Calgary, Alta
| | - S C Grondin
- Division of Thoracic Surgery, Department of Surgery, University of Calgary, Calgary, Alta
| | - J Kondra
- Department of Thoracic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - J Clifton
- Department of Thoracic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - G Suarez
- Department of Thoracic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - B Ross
- Department of Thoracic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - K Evans
- Department of Thoracic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - R J Finley
- Department of Thoracic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - J Yee
- Department of Thoracic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC
| | - H Sugimura
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, St. Joseph's Health Centre, Toronto, Ont
| | - E H Spratt
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, St. Joseph's Health Centre, Toronto, Ont
| | - C G Compeau
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, St. Joseph's Health Centre, Toronto, Ont
| | - Y Shargall
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, St. Joseph's Health Centre, Toronto, Ont
| | - H Lara-Guerra
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - N Leighl
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - A Salvarrey
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - A Sakurada
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - N Paul
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - S Boerner
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - W Geddie
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - G Pond
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - F A Shepherd
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - M S Tsao
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
| | - T K Waddell
- Departments of Thoracic Surgery, Medical Oncology, Laboratory Medicine, Diagnostic Imaging, University Health Network, University of Toronto, Toronto, Ont
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Abstract
Incisional hernia is a common long-term complication of abdominal surgery. Historically the open repair with or without mesh was the mainstay of treatment. However, many recently published laparoscopic repair studies have challenged surgeons to re-evaluate which technique provides the best short and long-term outcomes. A Medline search of all English-language literature was performed using the keywords 'incisional', 'ventral', 'hernia', 'laparoscopic', and 'open'. Further references were obtained by cross-referencing the bibliography in each paper. Current evidence suggests that the laparoscopic incisional hernia repair is the optimal surgical treatment. A laparoscopic repair appears to shorten hospital stay, decrease perioperative complication rates, and decrease recurrence rates. However, there is no randomized trial utilizing a standardized complication grading system making it difficult to draw a definitive conclusion as to which repair is best.
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Affiliation(s)
- L R Rudmik
- Department of Surgery, University of Calgary, Calgary, AB, Canada.
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