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Article ; Online: Conventional Robotic Endoscopic Thyroidectomy for Thyroid Cancer.

Garstka, Meghan E / Alameer, Ehab S / Awwad, Saad Al / Kandil, Emad

Endocrinology and metabolism clinics of North America

2018 Volume 48, Issue 1, Page(s) 153–163

Abstract: The conventional robotic endoscopic remote access techniques detailed in this article have been discussed in a series of increasing volumes in the literature, including for the treatment of thyroid cancer. Lower-volume centers now perform most robotic ... ...

Abstract	The conventional robotic endoscopic remote access techniques detailed in this article have been discussed in a series of increasing volumes in the literature, including for the treatment of thyroid cancer. Lower-volume centers now perform most robotic thyroidectomies in the United States and are responsible for recent increases in utilization patterns despite higher complication rates. These trends highlight the importance of increasing surgeon exposure to and experience with these techniques in order to improve procedure safety. Additional large-volume, multicenter studies to define patients who will most benefit from these conventional robotic endoscopic procedures for thyroid cancer are needed.
MeSH term(s)	Endoscopy/methods ; Humans ; Robotic Surgical Procedures/methods ; Thyroid Neoplasms/surgery ; Thyroidectomy/methods
Language	English
Publishing date	2018-12-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	92116-6
ISSN	1558-4410 ; 0889-8529
ISSN (online)	1558-4410
ISSN	0889-8529
DOI	10.1016/j.ecl.2018.10.005
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Article ; Online: Robotic Neck Surgery in the Pediatric Population.

Wu, Eric L / Garstka, Meghan E / Kang, Sang-Wook / Kandil, Emad

JSLS : Journal of the Society of Laparoendoscopic Surgeons

2018 Volume 22, Issue 3

Abstract: Introduction: Thyroid, parathyroid, and thymus surgeries are traditionally performed via a cervical approach. However, robot-assisted procedures can provide a safe alternative for neck surgeries. We report our experiences with robotic transaxillary and ... ...

Abstract	Introduction: Thyroid, parathyroid, and thymus surgeries are traditionally performed via a cervical approach. However, robot-assisted procedures can provide a safe alternative for neck surgeries. We report our experiences with robotic transaxillary and retroauricular approaches in pediatric patients. Case presentation: We conducted a retrospective review of pediatric patients who underwent robot-assisted neck surgery by a single surgeon between April 2010 and May 2017. Patient demographics and surgical outcomes including operative time, incidence of complications, and length of hospital stay were evaluated. Management and outcomes: Nine surgeries in 7 female patients were reviewed (mean age, 16.0 ± 1.58 years; mean body mass index, 22.5 ± 0.75). Two thyroid lobectomies, 2 complete thyroidectomies, 1 subtotal thyroidectomy, 1 thyroid lobectomy with thymectomy, 2 subtotal parathyroidectomies with thymectomy, and 1 dermoid cyst excision were performed. Two surgeries with the retroauricular approach had a mean surgical time of 142.0 ± 6.13 minutes. Seven surgeries with the transaxillary approach had a mean surgical time of 146.1 ± 21.01 minutes. There were no reported conversions, permanent vocal cord paralysis, permanent hypoparathyroidism, hematoma, or seroma. There was 1 case (11%) of temporary shoulder hypoesthesia and 2 cases of temporary vocal cord paresis (22%). Discussion: This series on robot-assisted neck surgeries in children describes procedures performed with robotic transaxillary and retroauricular approaches. In the hands of a high-volume surgeon the techniques are feasible and safe options for operations in the neck in a select group of pediatric patients.
MeSH term(s)	Adolescent ; Child ; Feasibility Studies ; Female ; Humans ; Length of Stay ; Male ; Operative Time ; Outcome Assessment, Health Care ; Retrospective Studies ; Robotic Surgical Procedures/methods ; Thymectomy/methods ; Thyroidectomy/methods
Language	English
Publishing date	2018-09-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2011211-7
ISSN	1938-3797 ; 1086-8089
ISSN (online)	1938-3797
ISSN	1086-8089
DOI	10.4293/JSLS.2018.00012
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Article ; Online: The Sunshine Act and Surgeons: A Nation-Wide Analysis of Industry Payments to Physicians.

Garstka, Meghan E / Monlezun, Dominique / DuCoin, Christopher / Killackey, Mary / Kandil, Emad

The Journal of surgical research

2018 Volume 233, Page(s) 41–49

Abstract: Background: The Physician Payments Sunshine Act mandates the submission of payment records between medical providers and industry. We used the Open Payments Program database to compare industry payments to surgeons and nonsurgeons, as well as among ... ...

Abstract	Background: The Physician Payments Sunshine Act mandates the submission of payment records between medical providers and industry. We used the Open Payments Program database to compare industry payments to surgeons and nonsurgeons, as well as among surgical specialties, and to identify geographic distribution of payments. Materials and methods: We included all reported industry payments in the Centers for Medicare and Medicaid Services' Open Payments Program in the United States, 2014-2015. Multivariable regression fixed effects panel analysis of total payments was conducted among surgeons, adjusting for surgeon specialty, payor type, payment category, and state. A geographic heat map was created. Results: Of 2,097,150 subjects meeting criteria, 1,957,528 (45.66%) were physicians. The mean standard deviation (SD) payment overall was $232.64 ($6262.00), and the state with the highest mean (SD) payment was Vermont at $2691.61 ($11,508.40). Surgeons numbered 153,916 (7.86%). The specialty with the highest mean (SD) payment was orthopedic surgery at $2811.50 ($33,632.71, P < 0.001). Among 2,097,150 subjects meeting criteria, in multivariable regression fixed effects panel analysis, orthopedic compared to general surgeons were significantly likely to receive more industry payments (beta $1065.34 [95% CI $279.00-1851.00, P = 0.008), even controlling for payor, payment type, and state. Significant geographic disparities in payment were noted as 12 states received the top mean ($24.52-$500,000.00), leaving seven states with the lowest ($0.00-$12.56). Conclusions: There are significant differences in industry payments to surgeons versus nonsurgeons and among surgical specialties, as well geographic distribution of payments. These data may prompt further investigation into trends and their causality and effects on research and practice.
MeSH term(s)	Centers for Medicare and Medicaid Services (U.S.)/statistics & numerical data ; Cohort Studies ; Databases, Factual/statistics & numerical data ; Health Care Sector/economics ; Health Care Sector/statistics & numerical data ; Health Care Sector/trends ; Insurance, Health, Reimbursement/economics ; Insurance, Health, Reimbursement/statistics & numerical data ; Insurance, Health, Reimbursement/trends ; Patient Protection and Affordable Care Act/economics ; Spatial Analysis ; Specialties, Surgical/economics ; Specialties, Surgical/statistics & numerical data ; Specialties, Surgical/trends ; United States
Language	English
Publishing date	2018-08-16
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Multicenter Study
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2018.07.004
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Article ; Online: Somatosensory evoked potential: Preventing brachial plexus injury in transaxillary robotic surgery.

Huang, Shuo / Garstka, Meghan E / Murcy, Mohammed A / Bamford, Jeremey A / Kang, Sang-Wook / Randolph, Gregory W / Kandil, Emad

The Laryngoscope

2019 Volume 129, Issue 11, Page(s) 2663–2668

Abstract: Objectives/hypothesis: The potential for brachial plexopathy due to arm positioning is a major concern regarding the robotic transaxillary approach. Intraoperative nerve monitoring via somatosensory evoked potential (SSEP) has been suggested to prevent ... ...

Abstract	Objectives/hypothesis: The potential for brachial plexopathy due to arm positioning is a major concern regarding the robotic transaxillary approach. Intraoperative nerve monitoring via somatosensory evoked potential (SSEP) has been suggested to prevent such injury. In this study, we examined the use of SSEP in detecting imminent brachial plexus traction during robotic transaxillary thyroid and parathyroid surgery. Study design: Retrospective case series. Methods: A analysis was performed for all patients undergoing robotic transaxillary surgery with continuous intraoperative SSEP monitoring at a North American institution between 2015 and 2017. A significant intraoperative SSEP change was defined as a decrease in signal amplitude of >50% or an increase in latency of >10% from baseline established during preoperative positioning. Results: One hundred thirty-seven robotic transaxillary surgeries using SSEP monitoring were performed on 123 patients. Seven patients (5.1%) developed significant changes, with an average SSEP amplitude reduction of 73% ± 12% recorded at the signals' nadir. Immediate arm repositioning resulted in recovery of signals and complete return to baseline parameters in 14.3 ± 9.2 minutes. There was no difference in age (40.4 ± 9.4 years vs. 44.5 ± 13.4 years; P = .31) or body mass index (27.3 ± 3.7 kg/m Conclusions: SSEP is a novel, safe, and reliable tool in detection of position-related brachial plexus neuropathy. Intraoperative monitoring using SSEP can play a vital role in early recognition and prevention of injury during robotic transaxillary thyroid and parathyroid surgery. Level of evidence: 4 Laryngoscope, 129:2663-2668, 2019.
MeSH term(s)	Adult ; Axilla/innervation ; Axilla/surgery ; Brachial Plexus/injuries ; Brachial Plexus/surgery ; Brachial Plexus Neuropathies/etiology ; Brachial Plexus Neuropathies/prevention & control ; Endocrine Surgical Procedures/adverse effects ; Endocrine Surgical Procedures/methods ; Evoked Potentials, Somatosensory ; Female ; Humans ; Intraoperative Neurophysiological Monitoring/methods ; Male ; Middle Aged ; Parathyroid Glands/surgery ; Patient Positioning/adverse effects ; Retrospective Studies ; Robotic Surgical Procedures/adverse effects ; Robotic Surgical Procedures/methods ; Thyroid Gland/surgery
Language	English
Publishing date	2019-01-23
Publishing country	United States
Document type	Evaluation Study ; Journal Article
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.27611
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Article ; Online: Remote-Access Thyroidectomy: A Multi-Institutional North American Experience with Transaxillary, Robotic Facelift, and Transoral Endoscopic Vestibular Approaches.

Russell, Jonathon O / Razavi, Christopher R / Garstka, Meghan E / Chen, Lena W / Vasiliou, Elya / Kang, Sang-Wook / Tufano, Ralph P / Kandil, Emad

Journal of the American College of Surgeons

2018 Volume 228, Issue 4, Page(s) 516–522

Abstract: Background: Many remote-access approaches (RAAs) to the thyroid have been described to circumvent anterior neck scarring, including the transaxillary, robotic facelift, and transoral endoscopic vestibular approaches. These techniques have been ... ...

Abstract	Background: Many remote-access approaches (RAAs) to the thyroid have been described to circumvent anterior neck scarring, including the transaxillary, robotic facelift, and transoral endoscopic vestibular approaches. These techniques have been popularized in Asia, but adoption has been slow in North America. We aimed to examine multi-institutional North American outcomes with RAA thyroidectomy in the context of these institutions' transcervical approach (TCA) outcomes. Study design: Cases of lobectomy and total thyroidectomy via transaxillary, robotic facelift, and transoral endoscopic vestibular approaches were reviewed. Demographic characteristics, outcomes, and complications were compared with the same measures in patients undergoing lobectomy and total thyroidectomy via TCA by the primary RAA surgeons at each institution. Patients who underwent parathyroidectomy or other concomitant neck dissection procedures were excluded. Results: Two hundred and sixteen RAA thyroidectomies were attempted (92 transoral endoscopic vestibular approaches, 70 transaxillary, and 54 robotic facelift) and 410 TCA thyroidectomies were performed. There was no difference in mean index nodule sizes between RAA (2.8 ± 1.6 cm) and TCA (2.9 ± 1.9 cm) cohorts (p = 0.72). Median operative times for lobectomy were 146 minutes (range 60 to 343 minutes) and 90 minutes (range 25 to 247 minutes) for the RAA and TCA cohorts, respectively (p < 0.0001). Median operative time for total thyroidectomy was 170 minutes (range 100 to 398 minutes) vs 126.5 minutes (range 51 to 260 minutes) for the RAA and TCA cohorts, respectively (p < 0.0001). There was no difference in the rates of permanent recurrent laryngeal nerve injury between the RAA (0 of 216 [0%]) and TCA (0 of 410 [0%]) cohorts (p = 0.99). Conclusions: Remote-access approach thyroidectomy can be performed in a select North American patient population with outcomes comparable with TCA.
MeSH term(s)	Adult ; Aged ; Axilla ; Female ; Humans ; Male ; Middle Aged ; Natural Orifice Endoscopic Surgery/methods ; North America ; Outcome Assessment, Health Care ; Retrospective Studies ; Robotic Surgical Procedures/methods ; Thyroidectomy/methods
Language	English
Publishing date	2018-12-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	1181115-8
ISSN	1879-1190 ; 1072-7515
ISSN (online)	1879-1190
ISSN	1072-7515
DOI	10.1016/j.jamcollsurg.2018.12.005
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Article ; Online: Thyroid surgery and obesity: Cohort study of surgical outcomes and local specific complications.

Farag, Mahmoud / Ibraheem, Kareem / Garstka, Meghan E / Shalaby, Hosam / DuCoin, Christopher / Killackey, Mary / Kandil, Emad

American journal of surgery

2018 Volume 217, Issue 1, Page(s) 142–145

Abstract: Introduction: Obesity is associated with numerous complications after elective general surgeries. The aim is to compare surgical outcomes and local specific complications in obese and non-obese patients after thyroid surgery.: Methods: Retrospective ... ...

Abstract	Introduction: Obesity is associated with numerous complications after elective general surgeries. The aim is to compare surgical outcomes and local specific complications in obese and non-obese patients after thyroid surgery. Methods: Retrospective study over a 3-year period at a North American academic institution. Outcome measures were operative time, estimated blood loss, hospital length of stay, and local specific complications (hypocalcemia, recurrent laryngeal nerve injury, wound hematoma, wound seroma, and chyle leakage). Results: A total of 469 patients were included (mean [SD] age, 50.11 [15.01] years; mean [SD] BMI, 30.5 [8.3] kg/m Conclusions: Obesity is not associated with adverse outcomes in patients undergoing thyroid surgery.
MeSH term(s)	Adult ; Aged ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Obesity/complications ; Operative Time ; Postoperative Complications/epidemiology ; Retrospective Studies ; Thyroid Diseases/complications ; Thyroid Diseases/pathology ; Thyroid Diseases/surgery ; Thyroidectomy/adverse effects ; Treatment Outcome
Language	English
Publishing date	2018-07-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2018.07.038
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Article ; Online: Effectiveness of systems changes suggested by simulation of adverse surgical outcomes.

Garstka, Meghan E / Slakey, Douglas P / Martin, Christopher A / Simms, Eric R / Korndorffer, James R

BMJ simulation & technology enhanced learning

2015 Volume 1, Issue 3, Page(s) 83–86

Abstract: Background: Simulation of adverse outcomes (SAO) has been described as a technique to improve effectiveness of root cause analysis (RCA) in healthcare. We hypothesise that SAO can effectively identify unsuspected root causes amenable to systems changes.! ...

Abstract	Background: Simulation of adverse outcomes (SAO) has been described as a technique to improve effectiveness of root cause analysis (RCA) in healthcare. We hypothesise that SAO can effectively identify unsuspected root causes amenable to systems changes. Methods: Systems changes were developed and tested for effectiveness in a modified simulation, which was performed eight times, recorded and analysed. Results: In seven of eight simulations, systems changes were effectively utilised by participants, who contacted anaesthesia using the number list and telephone provided to express concern. In six of seven simulations where anaesthesia was contacted, they provided care that avoided the adverse event. In two simulations, the adverse event transpired despite implemented systems changes, but for different reasons than originally identified. In one case, appropriate personnel were contacted but did not provide the direction necessary to avoid the adverse event, and in one case, the telephone malfunctioned. Conclusions: Systems changes suggested by SAO can effectively correct deficiencies and help improve outcomes, although adverse events can occur despite implementation. Further study of systems concepts may provide suggestions for changes that function more reliably in complex healthcare systems. The information gathered from these simulations can be used to identify potential deficiencies, prevent future errors and improve patient safety.
Language	English
Publishing date	2015-12-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2799014-X
ISSN	2056-6697 ; 2056-6697
ISSN (online)	2056-6697
ISSN	2056-6697
DOI	10.1136/bmjstel-2015-000055
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Article ; Online: Using simulation to improve root cause analysis of adverse surgical outcomes.

Slakey, Douglas P / Simms, Eric R / Rennie, Kelly V / Garstka, Meghan E / Korndorffer, James R

International journal for quality in health care : journal of the International Society for Quality in Health Care

2014 Volume 26, Issue 2, Page(s) 144–150

Abstract: Objective: The purpose of this study was to develop and test a simulation method of conducting investigation of the causality of adverse surgical outcomes.: Design: Six hundred and thirty-one closed claims of a major medical malpractice insurance ... ...

Abstract	Objective: The purpose of this study was to develop and test a simulation method of conducting investigation of the causality of adverse surgical outcomes. Design: Six hundred and thirty-one closed claims of a major medical malpractice insurance company were reviewed. Each case had undergone conventional root cause analysis (RCA). Claims were categorized by comparing the predominant underlying cause documented in the case files. Three cases were selected for simulation. Setting: All records (medical and legal) were analyzed. Simulation scenarios were developed by abstracting data from the records and then developing paper and electronic medical records, choosing appropriate Study participants: including test subjects and confederates, scripting the simulation and choosing the appropriate simulated environment. Intervention: In a simulation center, each case simulation was run 6-7 times and recorded, with participants debriefed at the conclusion. Main outcome measures: Sources of error identified during simulation were compared with those noted in the closed claims. Test subject decision-making was assessed qualitatively. Results: Simulation of adverse outcomes (SAOs) identified more system errors and revealed the way complex decisions were made by test subjects. Compared with conventional RCA, SAO identified root causes less focused on errors by individuals and more on systems-based error. Conclusions: The use of simulation for investigation of adverse surgical outcomes is feasible and identifies causes that may be more amenable to effective systems changes than conventional RCA. The information that SAO provides may facilitate the implementation of corrective measures, decreasing the risk of recurrence and improving patient safety.
MeSH term(s)	Humans ; Insurance Claim Review ; Medical Errors/classification ; Outcome and Process Assessment (Health Care) ; Patient Simulation ; Postoperative Complications/classification ; Root Cause Analysis/methods ; Safety Management/methods
Language	English
Publishing date	2014-04
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1194150-9
ISSN	1464-3677 ; 1353-4505
ISSN (online)	1464-3677
ISSN	1353-4505
DOI	10.1093/intqhc/mzu011
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Article ; Online: Gender disparities are present in academic rank and leadership positions despite overall equivalence in research productivity indices among senior members of American Head and Neck Society (AHNS) Fellowship Faculty.

Garstka, Meghan E / Randolph, Gregory W / Haddad, Antoine B / Nathan, Cherie-Ann O / Ibraheem, Kareem / Farag, Mahmoud / Deot, Neal / Adib, Hania / Hoof, Marcus / French, Kaley / Killackey, Mary T / Kandil, Emad

Head & neck

2019 Volume 41, Issue 11, Page(s) 3818–3825

Abstract: Background: This study aims to examine potential disparities in scholarly performance based on sex, academic rank, leadership positions, and regional distribution of faculty in accredited Head and Neck Surgery fellowships in the United States.: ... ...

Abstract	Background: This study aims to examine potential disparities in scholarly performance based on sex, academic rank, leadership positions, and regional distribution of faculty in accredited Head and Neck Surgery fellowships in the United States. Methods: Online faculty listings for 37 accredited fellowships were organized according to academic rank, leadership position, sex, and institutional location. Academic productivity was measured with three bibliometric indices: h-index, m-index, and the weighted relative citation ratio. Results: A total of 732 faculty members were included, of which 153 (21%) were female. Fifty-eight males (89.2%) held leadership positions, compared to seven females (10.8%). There was no significant difference in overall productivity between male and female senior faculty. There were regional differences in productivity by sex. Conclusions: Females are underrepresented in senior faculty and within three common leadership positions, although scholarly productivity for male and female senior faculty and for those in leadership positions is similar.
MeSH term(s)	Bibliometrics ; Biomedical Research/statistics & numerical data ; Efficiency ; Faculty, Medical/statistics & numerical data ; Fellowships and Scholarships/statistics & numerical data ; Female ; Humans ; Internship and Residency/statistics & numerical data ; Leadership ; Male ; Otolaryngology/education ; Otolaryngology/statistics & numerical data ; Sex Factors ; Sex Ratio ; United States
Language	English
Publishing date	2019-08-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	645165-2
ISSN	1097-0347 ; 0148-6403 ; 1043-3074
ISSN (online)	1097-0347
ISSN	0148-6403 ; 1043-3074
DOI	10.1002/hed.25913
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Article ; Online: Can simulation improve the traditional method of root cause analysis: a preliminary investigation.

Simms, Eric R / Slakey, Douglas P / Garstka, Meghan E / Tersigni, Steven A / Korndorffer, James R

Surgery

2012 Volume 152, Issue 3, Page(s) 489–497

Abstract: Introduction: The Joint Commission on Accreditation of Healthcare Organizations recommendations for conducting root cause analysis (RCA) include identifying "root causes" and "common-cause variation" rather than "proximate causes" and "special-cause ... ...

Abstract	Introduction: The Joint Commission on Accreditation of Healthcare Organizations recommendations for conducting root cause analysis (RCA) include identifying "root causes" and "common-cause variation" rather than "proximate causes" and "special-cause variation" to create interventions. Simulation for health care RCA is a novel technique but has not been compared with traditional RCA methods. Methods: All of the RCAs of adverse events conducted at Tulane Hospital between September 2010 and September 2011 were reviewed. A case of missed postprocedural, preoperative hemorrhage resulting in death was chosen. Hospital records were analyzed to identify the presumed root causes. A simulation of the event was developed and conducted. Six test subjects (preoperative and postanesthesia care unit nurses) participated in the simulation. Root causes identified by simulation analysis were compared with those identified by traditional RCA. Results: In 2 of 6 simulations, the adverse event was duplicated. The root cause identified by standard RCA technique was inattention to signs of bleeding in the patient/ lack of appropriate monitoring of the patient by nursing staff ("special-cause variation"). Simulation-based RCA revealed that the root cause was not only inadequate monitoring, but also the lack of physical presence of physicians in the care environment ("common-cause variation"). Simulation-based RCA identified root causes more amenable to intervention. Discussion: This study demonstrates that simulation-based RCA can identify additional root causes amenable to making health care interventions when compared with traditional RCA.
MeSH term(s)	Joint Commission on Accreditation of Healthcare Organizations ; Louisiana ; Models, Organizational ; Outcome and Process Assessment (Health Care)/methods ; Outcome and Process Assessment (Health Care)/organization & administration ; Root Cause Analysis ; United States
Language	English
Publishing date	2012-09
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2012.07.029
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