Clinical Focus

  • Pediatric Surgery
  • Surgery, Pediatric

Academic Appointments

Administrative Appointments

  • Surgical Director, Lucile Packard Children's Hospital Intestinal Rehabilitation Program (2006 - Present)
  • Surgical Director, Multidisciplinary Initiative for Surgical Technology Research - Advanced Laboratory (MISTRAL) (2006 - Present)
  • Director, Stanford Surgical Skills Curriculum (2005 - 2010)
  • Associate Director, Goodman Center for Simulation in Medicine (2005 - 2010)
  • Member, Center for Immersive and Simulation-Based Learning Committee (2005 - 2010)

Honors & Awards

  • Pediatric Research Fund, Lucile Packard Children's Hospital (2005 - 2006)

Professional Education

  • Fellowship:St Joseph's Hospital (2002) Canada
  • MBA, Stanford Graduate School of Business (2013)
  • Residency:Dalhousie University (2001) Canada
  • Board Certification: Pediatric Surgery, Royal College of Physicians and Surgeons of Canada (2004)
  • Board Certification: General Surgery, Royal College of Physicians and Surgeons of Canada (2001)
  • Fellowship:Hospital for Sick Children (2004) Canada
  • Fellowship:Centre for Minimal Access Surgery - McMaster University (2002) Canada
  • Internship:Dalhousie University (1997) Canada
  • Medical Education:University of Calgary (1996) Canada
  • FACS, American College of Surgeons, Pediatric Surgery (2007)
  • FAAP, American Academy of Pediatrics, Pediatric Surgery (2007)
  • FRCSC, University of Toronto, Pediatric Surgery (2004)
  • Fellowship, McMaster Univ., Laparoscopic Surgery (2002)
  • FRCSC, Dalhousie University, General Surgery (2001)
  • MA, University of Illinois, Surgical Education (1999)
  • MD, University of Calgary, Medicine (1996)

Research & Scholarship

Current Research and Scholarly Interests

Minimal Access and Scarless Surgery

Hirschsprung Disease

Esophageal Atresia

Liver and Bile Duct Surgery

Surgical Management of Hereditary Spherocytosis

Short Bowel Syndrome

Surgical Innovation and Emerging Technologies

Surgical Education and Simulation

Clinical Trials

  • Sutureless vs Sutured Gastroschisis Closure Recruiting

    This study aims to prospectively assess outcomes of sutureless versus sutured gastroschisis closure with a randomized control trial. The parameters of this trial were determined using our retrospective study as pilot data. Primary outcome measures will be time on ventilator and time to initiating enteral feeds. Other outcome measures will include cosmetic outcome, length of hospital stay and the associated rate of complications, including bowel resection, sepsis, and death.

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2014-15 Courses


Journal Articles

  • AKI in Hospitalized Children: Comparing the pRIFLE, AKIN, and KDIGO Definitions. Clinical journal of the American Society of Nephrology Sutherland, S. M., Byrnes, J. J., Kothari, M., Longhurst, C. A., Dutta, S., Garcia, P., Goldstein, S. L. 2015; 10 (4): 554-561


    Although several standardized definitions for AKI have been developed, no consensus exists regarding which to use in children. This study applied the Pediatric RIFLE (pRIFLE), AKI Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO) criteria to an anonymized cohort of hospitalizations extracted from the electronic medical record to compare AKI incidence and outcomes in intensive care unit (ICU) and non-ICU pediatric populations.Observational, electronic medical record-enabled study of 14,795 hospitalizations at the Lucile Packard Children's Hospital between 2006 and 2010. AKI and AKI severity stage were defined by the pRIFLE, AKIN, and KDIGO definitions according to creatinine change criteria; urine output criteria were not used. The incidences of AKI and each AKI stage were calculated for each classification system. All-cause, in-hospital mortality and total hospital length of stay (LOS) were compared at each subsequent AKI stage by Fisher exact and Kolmogorov-Smirnov tests, respectively.AKI incidences across the cohort according to pRIFLE, AKIN, and KDIGO were 51.1%, 37.3%, and 40.3%. Mortality was higher among patients with AKI across all definitions (pRIFLE, 2.3%; AKIN, 2.7%; KDIGO, 2.5%; P<0.001 versus no AKI [0.8%-1.0%]). Within the ICU, pRIFLE, AKIN, and KDIGO demonstrated progressively higher mortality at each AKI severity stage; AKI was not associated with mortality outside the ICU by any definition. Both in and outside the ICU, AKI was associated with significantly higher LOS at each AKI severity stage across all three definitions (P<0.001). Definitions resulted in differences in diagnosis and staging of AKI; staging agreement ranged from 76.7% to 92.5%.Application of the three definitions led to differences in AKI incidence and staging. AKI was associated with greater mortality and LOS in the ICU and greater LOS outside the ICU. All three definitions demonstrated excellent interstage discrimination. While each definition offers advantages, these results underscore the need to adopt a single, universal AKI definition.

    View details for DOI 10.2215/CJN.01900214

    View details for PubMedID 25649155

  • Clinical outcomes of splenectomy in children: Report of the splenectomy in congenital hemolytic anemia registry. American journal of hematology Rice, H. E., Englum, B. R., Rothman, J., Leonard, S., Reiter, A., Thornburg, C., Brindle, M., Wright, N., Heeney, M. M., Smithers, C., Brown, R. L., Kalfa, T., Langer, J. C., Cada, M., Oldham, K. T., Scott, J. P., St Peter, S., Sharma, M., Davidoff, A. M., Nottage, K., Bernabe, K., Wilson, D. B., Dutta, S., Glader, B., Crary, S. E., Dassinger, M. S., Dunbar, L., Islam, S., Kumar, M., Rescorla, F., Bruch, S., Campbell, A., Austin, M., Sidonio, R., Blakely, M. L. 2015; 90 (3): 187-192


    The outcomes of children with congenital hemolytic anemia (CHA) undergoing total splenectomy (TS) or partial splenectomy (PS) remain unclear. In this study, we collected data from 100 children with CHA who underwent TS or PS from 2005 to 2013 at 16 sites in the Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium using a patient registry. We analyzed demographics and baseline clinical status, operative details, and outcomes at 4, 24, and 52 weeks after surgery. Results were summarized as hematologic outcomes, short-term adverse events (AEs) (≤30 days after surgery), and long-term AEs (31-365 days after surgery). For children with hereditary spherocytosis, after surgery there was an increase in hemoglobin (baseline 10.1 ± 1.8 g/dl, 52 week 12.8 ± 1.6 g/dl; mean ± SD), decrease in reticulocyte and bilirubin as well as control of symptoms. Children with sickle cell disease had control of clinical symptoms after surgery, but had no change in hematologic parameters. There was an 11% rate of short-term AEs and 11% rate of long-term AEs. As we accumulate more subjects and longer follow-up, use of a patient registry should enhance our capacity for clinical trials and engage all stakeholders in the decision-making process. Am. J. Hematol. 90:187-192, 2015. © 2014 Wiley Periodicals, Inc.

    View details for DOI 10.1002/ajh.23888

    View details for PubMedID 25382665

  • Quantitative Measurement of Fixation Stability During RareBit Perimetry and Humphrey Visual Field Testing. Journal of glaucoma Lin, S. R., Lai, I. N., Dutta, S., Singh, K., Chang, R. T. 2015; 24 (2): 100-104


    To compare fixation stability and fixation loss between the Humphrey Field Analyzer (HVF, static fixation target) and the RareBit computer-based perimeter (RBP, kinetic fixation target) during visual field testing.Fourteen healthy volunteer subjects wore an ASL Mobile Gaze Tracker as they completed HVF 10-2 and RareBit central field tests in a random order. Fixation stability, defined as the average distance from the fixation target to the subject's gaze location, was calculated using data from the processed video capture. Fixation loss, defined as eye closure or a deviation of >20 degrees from the fixation target, was also measured. All subjects were surveyed regarding test preference.Use of the RBP kinetic target was associated with 18% improved fixation stability compared with the HVF static target (P=0.02). Nine of 14 study subjects demonstrated better fixation with RBP compared with HVF. Subjects demonstrated decreased fixation loss during RBP (0.9 s) compared with HVF (10.0 s) (P=0.002). Eighty-six percent of study subjects preferred RBP over HVF.Use of the RBP kinetic fixation target is associated with consistent fixation stability and decreased fixation loss compared with the HVF static target. This improvement in fixation stability may result from decreased perception interference (Ganzfeld, Troxler, and binocular rivalry effects), and may help account for the greater comfort reported with RBP compared with HVF.

    View details for DOI 10.1097/IJG.0b013e31829d9b41

    View details for PubMedID 25642647

  • Less invasive pedicled omental-cranial transposition in pediatric patients with moyamoya disease and failed prior revascularization. Neurosurgery Navarro, R., Chao, K., Gooderham, P. A., Bruzoni, M., Dutta, S., Steinberg, G. K. 2014; 10: 1-14


    Patients with moyamoya disease and progressive neurologic deterioration despite previous revascularization pose a major treatment challenge. Many have exhausted typical sources for bypass or have ischemia in areas that are difficult to reach with an indirect pedicled flap. Omental-cranial transposition has been an effective, but sparingly used technique because of its associated morbidity.We have refined a laparoscopic method of harvesting an omental flap that preserves its gastroepiploic arterial supply.The pedicled omentum can be lengthened as needed by dividing it between the vascular arcades. It is transposed to the brain via skip incisions. The flap can be trimmed or stretched to cover ischemic areas of the brain. The cranial exposure is performed in parallel with pediatric surgeons. We performed this technique in 3 pediatric moyamoya patients (aged 5 to 12 years) with prior STA-MCA bypasses and progressive ischemic symptoms. In 1 patient, we transposed omentum to both hemispheres.Blood loss ranged from 75 to 250 ml. After surgery, patients immediately tolerated a diet and were discharged in 3 to 5 days. All 3 children's ischemic symptoms resolved within 3 months postoperatively. MRI at 1 year showed improved perfusion and no new infarcts. Angiography showed excellent revascularization of targeted areas and patency of the donor gastroepiploic artery.Laparoscopic omental harvest for cranial-omental transposition can be performed efficiently and safely. Moyamoya patients appear to tolerate this technique much better than laparotomy. With this method we can achieve excellent angiographic revascularization and resolution of ischemic symptoms.

    View details for DOI 10.1227/NEU.0000000000000119

    View details for PubMedID 23921707

  • A Prospective Randomized Trial of Ultrasound- vs Landmark-Guided Central Venous Access in the Pediatric Population JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS Bruzoni, M., Slater, B. J., Wall, J., St Peter, S. D., Dutta, S. 2013; 216 (5): 939-943


    The purpose of this prospective randomized study was to compare landmark- to ultrasound-guided central venous access when performed by pediatric surgeons. The American College of Surgeons advocates for use of ultrasound in central venous catheter placement; however, this is not universally embraced by pediatric surgeons. Complication risk correlates positively with number of venous cannulation attempts.With IRB approval, a randomized prospective study of children under 18 years of age undergoing tunneled central venous catheter placement was performed. Patient accrual was based on power analysis. Exclusion criteria included known nonpatency of a central vein or coagulopathy. After randomization, the patients were assigned to either ultrasound-guided internal jugular vein access or landmark-guided subclavian/internal jugular vein access. The primary outcomes measure was number of attempts at venous cannulation. Secondary outcomes measures included: access times, number of arterial punctures, and other complications. Continuous variables were compared using 2-tailed Student's t-test. Discrete variables were analyzed with chi-square. Significance was defined as p < 0.05.There were 150 patients enrolled between April 2008 and September 2011. There was no difference when comparing demographic data. Success at first attempt was achieved in 65% of patients in the ultrasound group vs 45% in the landmark group (p = 0.021). Success within 3 attempts was achieved in 95% of ultrasound group vs 74% of landmark group (p = 0.0001).Ultrasound reduced the number of cannulation attempts necessary for venous access. This indicates a potential to reduce complications when ultrasound is used by pediatric surgeons.

    View details for DOI 10.1016/j.jamcollsurg.2013.01.054

    View details for Web of Science ID 000318680500013

  • Ventral Abdominal Wall Defects Neoreviews Kastenberg, Z. J., Dutta, S. 2013
  • Intestinal malrotation and catastrophic volvulus in infancy. journal of emergency medicine Lee, H. C., Pickard, S. S., Sridhar, S., Dutta, S. 2012; 43 (1): e49-51


    Intestinal malrotation in the newborn is usually diagnosed after signs of intestinal obstruction, such as bilious emesis, and corrected with the Ladd procedure.The objective of this report is to describe the presentation of severe cases of midgut volvulus presenting in infancy, and to discuss the characteristics of these cases.We performed a 7-year review at our institution and present two cases of catastrophic midgut volvulus presenting in the post-neonatal period, ending in death soon after the onset of symptoms. These two patients also had significant laboratory abnormalities compared to patients with more typical presentations resulting in favorable outcomes.Although most cases of intestinal malrotation in infancy can be treated successfully, in some circumstances, patients' symptoms may not be detected early enough for effective treatment, and therefore may result in catastrophic midgut volvulus and death.

    View details for DOI 10.1016/j.jemermed.2011.06.135

    View details for PubMedID 22325550

  • Chest wall reconstruction using implantable cross-linked porcine dermal collagen matrix (Permacol) JOURNAL OF PEDIATRIC SURGERY Lin, S. R., Kastenberg, Z. J., Bruzoni, M., Albanese, C. T., Dutta, S. 2012; 47 (7): 1472-1475


    Chest wall reconstruction in children is typically accomplished with either primary tissue repair or synthetic mesh prostheses. Primary tissue repair has been associated with high rates of scoliosis, whereas synthetic prostheses necessitate the placement of a permanent foreign body in growing children. This report describes the use of biologic mesh (Permacol; Covidien, Mansfield, MA) as an alternative to both tissue repair and synthetic prostheses in pediatric chest wall reconstruction.A retrospective chart review was performed identifying patients undergoing chest wall reconstruction with biologic mesh at our tertiary referral children's hospital between 2007 and 2011. Data collection included patient demographics, indication for chest wall resection, number of ribs resected, the administration of postoperative radiation, length of follow-up, postoperative complications, and the degree of spinal angulation (preoperatively and at most recent follow-up).Five patients (age, 9.0-21.7 years; mean, 15.4 years) underwent resection for primary chest wall malignancy followed by reconstruction with biologic mesh (Permacol) during the study period. There were no postoperative mesh-related complications, and none of the patients developed clinically significant scoliosis (follow-up, 1.1-2.6 years; mean 1.9 years).Biologic mesh offers a safe and dependable alternative to both primary tissue repair and synthetic mesh in pediatric patients undergoing chest wall reconstruction.

    View details for DOI 10.1016/j.jpedsurg.2012.05.002

    View details for Web of Science ID 000306523300039

    View details for PubMedID 22813819

  • Single-site umbilical laparoscopic splenectomy SEMINARS IN PEDIATRIC SURGERY Bruzoni, M., Dutta, S. 2011; 20 (4): 212-218


    Laparoscopic splenectomy was first described in children in 1993. Since then, it has become a commonly performed procedure in children because of reduced discomfort and hospitalization and significantly improved cosmesis compared with the open approach. With the advent of single-site laparoscopic surgery, it is only natural that this approach be used for splenectomy. This article will describe the reasons that the single-site approach might be useful for splenectomy and also the technique used at the author's institution. Moreover, a brief review of the current literature in children will be presented.

    View details for DOI 10.1053/j.sempedsurg.2011.05.005

    View details for Web of Science ID 000296043500006

    View details for PubMedID 21968157

  • A modification of the laparoscopic transcutaneous inguinal hernia repair to achieve transfixation ligature of the hernia sac JOURNAL OF PEDIATRIC SURGERY Kastenberg, Z., Bruzoni, M., Dutta, S. 2011; 46 (8): 1658-1664


    The proposed benefits of laparoscopic inguinal hernia repair in the pediatric population include less postoperative pain, smaller scars, and easier access to the contralateral groin. This is countered by slightly higher recurrence rates reported in some series. These differences are attributable to variation in the laparoscopic technique, surgeon experience, and certain anatomic features. We describe a modification of the laparoscopic-assisted transcutaneous hernia repair that achieves transfixation ligature of the hernia sac and that may further reduce recurrence.Institutional review board approval was obtained, and a retrospective chart review of all patients undergoing repair of symptomatic hernias using this new technique was carried out. Data collection included demographics, laterality of hernia, operative time, recurrence rate, and complications.Twenty-one patients (age 1-144 months) underwent hernia repair between October 2009 and October 2010 using a novel technique of transcutaneous transfixation ligature of the neck of the hernia sac. The mean operative time was 18 minutes (8-35 minutes). Follow-up was from 1 to 12 months. There was no intraoperative or postoperative complication and no recurrences to date.The technique described is a modification of the existing laparoscopic-assisted transcutaneous inguinal hernia repair that more closely approximates the criterion standard open repair. The technique addresses some prevailing concerns with the initially described method of transcutaneous repair, and short-term outcomes are positive. Long-term outcomes remain to be defined.

    View details for DOI 10.1016/j.jpedsurg.2011.03.022

    View details for Web of Science ID 000293950100040

    View details for PubMedID 21843740

  • Seasonal variation of hypertrophic pyloric stenosis: a population-based study PEDIATRIC SURGERY INTERNATIONAL Zamakhshary, M. F., Dutta, S., To, T., Stephens, D., Langer, J. C., Wales, P. W. 2011; 27 (7): 689-693


    Seasonal variation in the incidence of hypertrophic pyloric stenosis (HPS) has been long debated. The goal of this study was to determine if seasonal variation exists in the incidence of pyloric stenosis.A population-based cohort consisted of all infants in the province of Ontario, Canada with HPS from 1993 to 2000. The incidence of HPS per season was adjusted by birth rate and expressed as number of pyloromyotomies per 100,000 infants less than 12 months of age. One-way analysis of variance was used to compare HPS incidence between seasons. Further time series and spectral analysis were performed to examine for seasonal variation.There were 1,777 infants included in the population-based cohort. June was the month with the highest rate of HPS. The highest rate of pyloromyotomy occurred in the summer 14.92 and the lowest in the winter 10.73, this difference was statistically significant (p = 0.01). Spectral analysis showed that June was the month with the highest rate and February had the lowest rates p = 0.0014.Hypertrophic pyloric stenosis more commonly presents in the summer. Seasonal variation suggests a possible etiological role for environmental factors.

    View details for DOI 10.1007/s00383-011-2857-9

    View details for Web of Science ID 000291694400004

    View details for PubMedID 21293866

  • Guidelines for Innovation in Pediatric Surgery JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Kastenberg, Z., Dutta, S. 2011; 21 (4): 371-374


    Surgical innovation involves the conceptualization, research, and translation of a novel idea into a viable procedure or device. The technological advancements made within the field of pediatric surgery over the last century have led to major improvements in patient care and outcomes. There has, however, been a parallel increase in the complexity of the regulatory bodies governing research and device implementation. This article briefly outlines the history of innovation in pediatric surgery, describes the existing regulatory bodies governing surgical research and device development (i.e., Department of Health and Human Services, Food and Drug Administration), and offers a set of guidelines for the pediatric surgeon planning to incorporate a new procedure or device into clinical practice.

    View details for DOI 10.1089/lap.2010.0342

    View details for Web of Science ID 000290557500017

    View details for PubMedID 21443434

  • Effects of a Surgical Skills Boot Camp Reply JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS Dutta, S., Plerhoples, T. 2010; 211 (5): 692-692
  • Institutional experience with laparoscopic partial splenectomy for hereditary spherocytosis JOURNAL OF PEDIATRIC SURGERY Slater, B. J., Chan, F. P., Davis, K., Dutta, S. 2010; 45 (8): 1682-1686


    Moderate to severe hereditary spherocytosis (HS) is treated with splenectomy. However, total splenectomy leads to decreased immunologic function with the risk of overwhelming postsplenectomy sepsis. Splenic preservation is postulated as a method to avoid this potentially fatal complication. Although mainly performed through laparotomy, we report our experience with a laparoscopic approach to partial splenectomy for HS.A retrospective review was conducted on 9 laparoscopic partial splenectomies performed for HS at our institution. Follow-up was from 1 to 3.5 years. Data included preoperative and postoperative hemoglobin, absolute reticulocyte count, splenic size, operative time, complications, and length of stay.All patients successfully underwent laparoscopic partial splenectomy with a radiologically determined upper-pole remnant of 10% to 30% and preservation of the blood supply through the upper short gastric arteries. The mean preoperative spleen length was 13 cm. Mean hospital stay was 3.6 days (range, 1-6 days). There was 1 intraoperative complication (a small bowel tear during spleen extraction) and 2 minor postoperative complications (ileus and wound infection). One patient underwent completion total splenectomy 2 years after partial splenectomy.Laparoscopic partial splenectomy is a feasible and effective procedure that addresses the hematologic consequences of HS while retaining a portion of functional spleen, in addition to conferring the advantages of laparoscopy.

    View details for DOI 10.1016/j.jpedsurg.2010.01.037

    View details for Web of Science ID 000280933100018

    View details for PubMedID 20713220

  • A comparison of laparoscopic and robotic assisted suturing performance by experts and novices SURGERY Chandra, V., Nehra, D., Parent, R., Woo, R., Reyes, R., Hernandez-Boussard, T., Dutta, S. 2010; 147 (6): 830-839


    Surgical robotics has been promoted as an enabling technology. This study tests the hypothesis that use of the robotic surgical system can significantly improve technical ability by comparing the performance of both experts and novices on a complex laparoscopic task and a robotically assisted task.Laparoscopic experts (LE) with substantial laparoscopic and robotic experience (n = 9) and laparoscopic novices (LN) (n = 20) without any robotic experience performed sequentially 10 trials of a suturing task using either robotic or standard laparoscopic instrumentation fitted to the ProMIS surgical simulator. Objective performance metrics provided by ProMIS (total task time, instrument pathlength, and smoothness) and an assessment of learning curves were analyzed.Compared with LNs, the LEs demonstrated significantly better performance on all assessment measures. Within the LE group, there was no difference in smoothness (328 +/- 159 vs 355 +/- 174; P = .09) between robot-assisted and standard laparoscopic tasks. An improvement was noted in total task time (113 +/- 41 vs 132 +/- 55 sec; P < .05) and instrument pathlengths (371 +/- 163 vs 645 +/- 269 cm; P < .05) when using the robot. This advantage in terms of total task time, however, was lost among the LEs by the last 3 trials (114 +/- 40 vs 118 +/- 49 s; P = .84), while instrument pathlength remained better consistently throughout all the trials. For the LNs, performance was significantly better in the robotic trials on all 3 measures throughout all the trials.The ProMIS surgical simulator was able to distinguish between skill levels (expert versus novice) on robotic suturing tasks, suggesting that the ProMIS is a valid tool for measuring skill in robot-assisted surgery. For all the ProMIS metrics, novices demonstrated consistently better performance on a suturing task using robotics as compared to a standard laparoscopic setup. This effect was less evident for experts who demonstrated improvements only in their economy of movement (pathlength), but not in the speed or smoothness of performance. Robotics eliminated the early learning curve for novices, which was present when they used standard laparoscopic tools. Overall, this study suggests that, when performing complex tasks such as knot tying, surgical robotics is most useful for inexperienced laparoscopists who experience an early and persistent enabling effect. For experts, robotics is most useful for improving economy of motion, which may have implications for the highly complex procedures in limited workspaces (eg, prostatectomy).

    View details for DOI 10.1016/j.surg.2009.11.002

    View details for Web of Science ID 000278532300011

    View details for PubMedID 20045162

  • Stealth surgery: subcutaneous endoscopic excision of benign lesions of the trunk and lower extremity JOURNAL OF PEDIATRIC SURGERY Pricola, K. L., Dutta, S. 2010; 45 (4): 840-844


    Benign subcutaneous lesions of the trunk are typically excised through overlying skin incisions, which can result in permanent, potentially disfiguring scars. We previously reported our experience with transaxillary subcutaneous endoscopic approach for removal of benign lesions of the neck. Here we report a similar approach for removing benign lesions of the trunk and lower extremity.A retrospective review was conducted on 4 consecutive subcutaneous endoscopic procedures for benign truncal and lower extremity lesions from November 2006 to October 2008. The lesions included an anterior chest wall epidermal inclusion cyst, anterior midsternal dermoid cyst, left posterior chest wall giant lipoma, and a lipoma extending from the right gluteal crease onto the thigh. Outcome measures included need for conversion, cosmetic outcome, and complications.All procedures were successfully completed using the endoscopic approach without conversion to open excision. There were no intraoperative complications. Postoperative complications included a 1 cm seroma at cyst site, axillary port site wound infection, and punctate dermal thinning secondary to adherent dermoid cyst, all resolved by 2 weeks postoperatively. All wounds healed with excellent cosmetic result at 1-month follow-up.A subcutaneous endoscopic approach can be applied effectively to a variety of benign lesions of the trunk and lower extremities with adequate exposure for dissection and resulting in a quick recovery. Truncal and lower extremity scarring is absent, with small scars well hidden in either the axilla or the buttock, respectively.

    View details for DOI 10.1016/j.jpedsurg.2009.12.016

    View details for Web of Science ID 000276523500031

    View details for PubMedID 20385299

  • Outcomes of sutureless gastroschisis closure JOURNAL OF PEDIATRIC SURGERY Riboh, J., Abrajano, C. T., Garber, K., Hartman, G., Butter, M. A., Albanese, C. T., Sylvester, K. G., Dutta, S. 2009; 44 (10): 1947-1951


    A new technique of gastroschisis closure in which the defect is covered with sterile dressings and allowed to granulate without suture repair was first described in 2004. Little is known about the outcomes of this technique. This study evaluated short-term outcomes from the largest series of sutureless gastroschisis closures.A retrospective case control study of 26 patients undergoing sutureless closure between 2006 and 2008 was compared to a historical control group of 20 patients with suture closure of the abdominal fascia between 2004 and 2006. Four major outcomes were assessed: (1) time spent on ventilator, (2) time to initiating enteral feeds, (3) time to discharge from the neonatal intensive care unit, and (4) rate of complications.In multivariate analysis, sutureless closure of gastroschisis defects independently reduced the time to extubation as compared to traditional closure (5.0 vs 12.1 days, P = .025). There was no difference in time to full enteral feeds (16.8 vs 21.4 days, P = .15) or time to discharge (34.8 vs 49.7 days, P = .22) with sutureless closure. The need for silo reduction independently increased the time to extubation (odds ratio, 4.2; P = .002) and time to enteral feeds (odds ratio, 5.2; P < .001). Small umbilical hernias were seen in all patients.Sutureless closure of uncomplicated gastroschisis is a safe technique that reduces length of intubation and does not significantly alter the time required to reach full enteral feeds or hospital discharge.

    View details for DOI 10.1016/j.jpedsurg.2009.03.027

    View details for Web of Science ID 000271331700014

    View details for PubMedID 19853753

  • Early experience with single incision laparoscopic surgery: eliminating the scar from abdominal operations JOURNAL OF PEDIATRIC SURGERY Dutta, S. 2009; 44 (9): 1741-1745


    Single incision laproscopic surgery (SILS) involves performing abdominal operations with laparoscopic instruments placed through a single, small umbilical incision. The primary goal is to avoid visible scarring. This is the first report of SILS cholecystectomy in children and the first report in the literature of SILS splenectomy.A retrospective chart review was performed in 20 consecutive inpatient SILS procedures (13 males, 7 females; ages 2-17 years) from May to December 2008. Outcome measures included need for conversion, operative time, time to oral analgesia, length of hospitalization, cosmetic outcome, and complications.There were 4 total splenectomies, 3 cholecystectomies, 2 combined splenectomy/cholecystectomies, and 11 appendectomies performed. All procedures were completed successfully without need for conversion to standard laparoscopy or open surgery. Mean operative time was 90 minutes for splenectomy, 68 minutes for cholecystectomy, 165 minutes for combined splenectomy/cholecystectomy, and 33 minutes for appendectomy. Mean hospital stay was 1 day for appendectomy, 1 day for cholecystectomy, and 2.5 days for splenectomy. One splenectomy patient received 1 U packed red blood cell transfusion. All appendectomy patients were converted to oral analgesia within 24 hours and splenectomy patients within 48 hours. All families were very pleased with the cosmetic outcome.Single incision laparoscopic surgery is feasible for a variety of pediatric general surgical conditions, allowing for scarless abdominal operations. This early experience suggests that outcomes are comparable to standard laparoscopic surgery but with improved cosmesis, however, a larger series is necessary to confirm these findings and to determine if there are any benefits in pain or recovery. Surgeons performing SILS should have a firm foundation of advanced minimal access surgical skills and a cautious, gradated approach to attempting the various procedures. Technological refinements will further enable SILS.

    View details for DOI 10.1016/j.jpedsurg.2008.12.024

    View details for Web of Science ID 000270065100018

    View details for PubMedID 19735818

  • Short- and Long-Term Outcomes of Necrotizing Enterocolitis in Infants With Congenital Heart Disease PEDIATRICS Pickard, S. S., Feinstein, J. A., Popat, R. A., Huang, L., Dutta, S. 2009; 123 (5): E901-E906


    Congenital heart disease is a significant risk factor for necrotizing enterocolitis in the term infant. We compared the short- and long-term necrotizing enterocolitis-specific outcomes of infants with congenital heart disease with those of neonates without congenital heart disease.A retrospective study of 202 patients with necrotizing enterocolitis treated at our center from May 1999 to August 2007 was conducted. Infants with necrotizing enterocolitis were grouped according to the presence (n = 76) or absence (n = 126) of congenital heart disease. Demographic and necrotizing enterocolitis-specific outcomes were recorded. The groups were compared by nonparametric and chi(2) analyses. Univariate and multivariate odds ratios were determined for each outcome.The average birth weight and gestational age of the 2 groups were not significantly different. The initial necrotizing enterocolitis severity, as determined by Bell stage, was less for necrotizing enterocolitis subjects with congenital heart disease compared with those without congenital heart disease. When controlling for birth weight and gestational age, the congenital heart disease group had decreased risk of perforation, need for a bowel operation, strictures, need for a stoma, sepsis, and short bowel syndrome compared with the non-congenital heart disease group. Although not statistically significant, subjects with congenital heart disease had a trend toward decreased risk of death from necrotizing enterocolitis, recurrent necrotizing enterocolitis, and need for peritoneal drainage.Infants with congenital heart disease and necrotizing enterocolitis have decreased risk of major short- and long-term negative outcomes associated with necrotizing enterocolitis compared with neonates without congenital heart disease. Differences in initial severity, range of age at diagnosis, and prognoses between subjects with necrotizing enterocolitis with and without cardiac disease suggest that necrotizing enterocolitis in the cardiac patient is a distinct disease process and should be labeled cardiogenic necrotizing enterocolitis.

    View details for DOI 10.1542/peds.2008-3216

    View details for Web of Science ID 000265528900048

    View details for PubMedID 19403484

  • Neonatal Malrotation with Midgut Volvulus Mimicking Duodenal Atresia AMERICAN JOURNAL OF ROENTGENOLOGY Gilbertson-Dahdal, D. L., Dutta, S., Varich, L. J., Barth, R. A. 2009; 192 (5): 1269-1271


    The purpose of this study was to describe the clinical, imaging, and surgical findings in the cases of four neonates with radiographic findings suggesting duodenal atresia (double-bubble sign) who were subsequently found to have malrotation with midgut volvulus.When the surgical treatment of a patient with the double-bubble sign is to be delayed, an upper gastrointestinal radiographic or ultrasound study is needed to evaluate for malrotation with midgut volvulus.

    View details for DOI 10.2214/AJR.08.2132

    View details for Web of Science ID 000265387300020

    View details for PubMedID 19380551

  • Transcutaneous laparoscopic hernia repair in children: a prospective review of 275 hernia repairs with minimum 2-year follow-up SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Dutta, S., Albanese, C. 2009; 23 (1): 103-107


    Inguinal hernia in children is traditionally repaired through a groin incision by dissecting the hernia sac from the spermatic cord and suture ligating its base. A laparoscopic modification of this procedure involves placement of a transcutaneous suture around the neck of the sac through a 2-mm stab incision under visualization with an umbilically placed 2.7-mm 30 degrees lens. We reviewed the clinical outcome of this novel procedure at our institution.Prospective review of 275 hernias in 187 children (144 male, 43 female) performed laparoscopically by a single surgeon between September, 2002 and June, 2005. Data analyzed included side of hernia, incarceration, prematurity, recurrence rate, and complications.30 left, 69 right, and 25 bilateral hernias were repaired. Sixty-three unilateral hernias had a contralateral patent processus vaginalis that was repaired. Mean operative time for a bilateral repair was 17 min. Two procedures were for recurrence after open repair. Forty-nine patients were ex-premature infants, accounting for 79 repairs. Fifteen cases followed reduction of incarcerated hernias, nine of whom were in preterm infants. Four out of 275 hernias (1.5%) recurred in four patients (mean age 4.5 years; 3 male, 1 female). There were four superficial wound infections, two umbilical granulomas, two hydroceles, and six self-resolving hematomas. There were no spermatic cord injuries, testicular atrophy, or symptoms of ilioinguinal nerve injuries.This novel laparoscopic inguinal hernia repair is an effective method in children, with recurrence rates comparable to the traditional approach. Advantages of the laparoscopic operation include a "no-touch" approach to the spermatic cord structures, a virtually virgin operative field in cases of recurrence, and excellent cosmesis. Disadvantages include peritoneal access and nonhermetic seal in males.

    View details for DOI 10.1007/s00464-008-9980-2

    View details for Web of Science ID 000262089300017

    View details for PubMedID 18528614

  • Perioperative management of ventriculoperitoneal shunts during abdominal surgery SURGICAL NEUROLOGY Li, G., Dutta, S. 2008; 70 (5): 492-497


    Patients with ventriculoperitoneal shunts (VPSs) inserted for a variety of disorders may subsequently undergo gastrointestinal or urologic operations, and surgeons must determine the appropriate perioperative management to minimize the risk for shunt malfunction or infection. There is currently no established set of guidelines for this scenario. The objective of this study was to determine the risks and standard of practice for patients with VPSs undergoing abdominal surgery.A retrospective review of the charts of patients with VPSs who underwent abdominal or urologic surgery at the Stanford University Medical Center between 1995 and 2003 was performed. Data regarding type of abdominal surgery, level of contamination, choice of antibiotic therapy, perioperative management of the VPS, and outcomes were obtained.Twenty-six patient charts were reviewed, for a total of 39 operations (5 urologic, 23 upper gastrointestinal, and 11 lower gastrointestinal). Of these, 3 were clean, 34 were clean-contaminated, and 2 were dirty operations. Seven cases were laparoscopic, whereas 32 were open. Thirty-four cases required opening the bowel or urologic system. No patient had preoperative shunt externalization. All except one patient received pre- and postoperative antibiotics, but the duration and type of antibiotics were widely variable. The remaining patient had an inguinal hernia repair and received only one preoperative dose of cephalexin. Purulent fluid was found in 2 cases. One VPS found lying in purulent material next to an anastomotic leak was externalized and subsequently revised. However, in another patient, a VPS found lying next to a purulent jejunal tear was not externalized. This patient returned 2 months later with a VPS malfunction. In the remaining 35 cases, no VPS infection or malfunction was noted over 2 to 10 years of follow-up.The data suggest that there is minimal risk for VPS malfunction or infection among patients undergoing routine clean and clean-contaminated abdominal and urologic surgeries. Patients with VPSs undergoing these operations do not need externalization of their shunt. None of the patients in this study had a contaminated procedure. For dirty procedures, surgeons should opt to externalize the shunt. Future studies will aim to better standardize the perioperative management of VPSs during abdominal surgery.

    View details for DOI 10.1016/j.surneu.2007.08.050

    View details for Web of Science ID 000270846100009

    View details for PubMedID 18207538

  • "Stealth surgery": transaxillary subcutaneous endoscopic excision of benign neck lesions JOURNAL OF PEDIATRIC SURGERY Dutta, S., Slater, B., Butter, M., Albanese, C. T. 2008; 43 (11): 2070-2074


    Benign neck lesions are traditionally removed through an overlying incision. The resultant scar can be aesthetically displeasing. We previously reported our experience with a transaxillary subcutaneous endoscopic approach for management of torticollis. We now report a similar technique for removal of benign lesions of the neck.The study uses a retrospective review of 5 elective transaxillary endoscopic procedures from March to December 2006. The lesions included an enlarged cervical lymph node, thyroglossal duct cyst, dermoid cyst, ectopic dilated neck vein, and a parathyroid adenoma. Outcome measures included need for conversion, cosmetic outcome, and complications.All procedures were successfully completed using the endoscopic approach. Postoperative pain was controlled with acetaminophen, and all patients were discharged from the hospital the same day. There were no intraoperative complications. The patient who had a thyroglossal cyst removed developed a postoperative seroma that resolved spontaneously. All families were pleased with the cosmetic results.A transaxillary subcutaneous endoscopic approach can be applied effectively to a variety of benign lesions of the neck, allowing adequate exposure for dissection, and resulting in a quick recovery. Neck scarring is absent, with small scars well hidden in the axilla.

    View details for DOI 10.1016/j.jpedsurg.2008.03.031

    View details for Web of Science ID 000260802800019

    View details for PubMedID 18970942

  • Laparoscopic partial vs total splenectomy in children with hereditary spherocytosis JOURNAL OF PEDIATRIC SURGERY Morinis, J., Dutta, S., Blanchette, V., Butchart, S., Langer, J. C. 2008; 43 (9): 1649-1652


    Open partial splenectomy provides reversal of anemia and relief of symptomatic splenomegaly while theoretically retaining splenic immune function for hereditary spherocytosis. We recently developed a laparoscopic approach for partial splenectomy. The purpose of the present study is to compare the outcomes in a group of patients undergoing laparoscopic partial splenectomy (LPS) with those in a group of children undergoing laparoscopic total splenectomy (LTS) over the same period.Systematic chart review was conducted of all children with hereditary spherocytosis who had LTS or LPS from 2000 to 2006 at the Hospital for Sick Children, Toronto, Ontario, Canada. T tests were used for continuous data, and chi(2) for proportional data; P value of less than .05 was considered significant.There were 9 patients (14 males) in each group. Groups were similar in sex, age, concomitant cholecystectomy, and preoperative hospitalizations, transfusions, and spleen size. Estimated blood loss was greater in the LPS group (188 + 53 vs 67 + 17 mL; P = .02), but transfusion requirements were similar (1/9 vs 0/9). Complication rate was similar between groups. The LPS group had higher morphine use (4.1 + 0.6 vs 2.4 + 0.2 days; P = .03), greater time to oral intake (4.4 + 0.7 vs 2.0 + 0.2 days; P = .01), and longer hospital stay (6.3 + 1.0 vs 2.7 + 0.3 days; P = .005) than the LTS group. Nuclear scan 6 to 8 weeks postoperatively demonstrated residual perfused splenic tissue in all LPS patients. No completion splenectomy was necessary after a mean follow-up of 25 months.These data suggest that LPS is as effective as LTS for control of symptoms. However, LPS is associated with more pain, longer time to oral intake, and longer hospital stay. These disadvantages may be balanced by retained splenic immune function, but further studies are required to assess long-term splenic function in these patients.

    View details for DOI 10.1016/j.jpedsurg.2008.02.012

    View details for Web of Science ID 000260359100012

    View details for PubMedID 18779001

  • Thoracoscopic ligation versus coil occlusion for patent ductus arteriosus: A matched cohort study of outcomes and cost SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Dutta, S., Mihailovic, A., Benson, L., Kantor, P. F., Fitzgerald, P. G., Walton, J. M., Langer, J. C., Cameron, B. H. 2008; 22 (7): 1643-1648


    Coil occlusion (CO) and video-assisted thoracoscopic surgery (VATS) have both emerged as minimal access therapies for patent ductus arteriosus (PDA). These techniques have not previously been statistically compared.Twenty-four consecutive children undergoing VATS for PDA were each retrospectively matched by PDA diameter and child weight to two children undergoing CO (total 48) during the same time period. The two modalities were compared with respect to outcome and cost. Statistical analysis was performed using a Student's t-test and Mantel-Haenszel relative risk. Cost analysis from an institutional perspective was used to compare resource consumption.Mean PDA diameter was 3.6 +/- 1.2 mm in both groups. Mean age and weight for VATS and CO children were 2.7 and 2.9 yrs and 13.2 and 13.1 kg, respectively. Mean surgical times were 94 +/- 34 min for VATS and 50 +/- 23 min for CO (p < 0.0001). Mean length of stay was 1.6 +/- 0.2 days for VATS and 0.6 +/- 0.2 days for CO (Mantel-Haenszel RR (95% CI) = 0.15 [0.07, 0.29], p < 0.0001). Mean fluoroscopy time with CO was 13 +/- 7 min. No VATS or CO children required conversion to open surgical ligation. Two children in each arm (8% VATS, 4% CO) required indefinite antibiotic endarteritis prophylaxis for a persistent shunt. The cost per child was C$ 4282.80 (Canadian dollars) for VATS and C$ 3958.08 for CO.VATS is as efficacious for PDA closure as CO but requires longer surgical times and lengths of stay. Costs for each procedure are similar.

    View details for DOI 10.1007/s00464-007-9674-1

    View details for Web of Science ID 000256530000019

    View details for PubMedID 18027029

  • Factors affecting survival to intestinal transplantation in the very young pediatric patient TRANSPLANTATION Mian, S. I., Dutta, S., Le, B., Esquivel, C. O., Davis, K., Castillo, R. O. 2008; 85 (9): 1287-1289


    Very young pediatric patients awaiting intestinal transplantation have a high mortality rate due to long waiting times, scarcity of appropriate size donor organs, and mortality due to sepsis and liver failure. To investigate specific risk factors impacting survival to intestinal transplantation, we performed a 4-year institutional retrospective study comparing children who received grafts by age 18 months with children 18 months or younger who died while on the waiting list.Twelve children comprised the transplanted group and had the underlying diagnoses: necrotizing enterocolitis, gastroschisis, Hirschsprung's disease, and omphalocele. Ten children comprised the deceased group and had the underlying diagnoses: intestinal atresia, necrotizing enterocolitis, gastroschisis, and midgut volvulus. Multiple risk factors were assessed in these groups.No differences in residual small bowel length, presence of the colon, number of line infections, or number of central lines were found. The average body weight of the transplanted group trended higher, whereas the deceased group had more impairment of hepatic function. Intestinal atresia was the most common diagnosis in the deceased group while none of the transplanted group carried this diagnosis. Ileocecal valve was retained in 80% of the deceased group and in none of the transplanted group.In children younger than 18 months, risk factors affecting survival to intestinal transplantation include small body size and advanced liver disease. A primary diagnosis of intestinal atresia and the presence of the ileocecal valve may confer additional risk to these very young children.

    View details for DOI 10.1097/TP.0b013e31816dd236

    View details for Web of Science ID 000255904400012

    View details for PubMedID 18475185

  • Advances in pediatric minimal access therapy: A cautious journey from therapeutic endoscopy to transluminal surgery based on the adult experience JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION Isaza, N., Garcia, P., Dutta, S. 2008; 46 (4): 359-369

    View details for Web of Science ID 000254540000003

    View details for PubMedID 18367946

  • Laparoscopic adjustable gastric banding in a morbidly obese 18-year-old with hypertrophic cardiomyopathy OBESITY SURGERY Waipa, J., Dutta, S., Albanese, C. T., Morton, J. M. 2008; 18 (3): 332-335


    In this case report, we present an 18-year-old morbidly obese male with complicating hypertensive cardiomyopathy who underwent laparoscopic adjustable gastric band surgery. The patient had multiple comorbidities associated with his obesity, including obstructive sleep apnea, systemic hypertension, asthma, and depression. Given the severity of his underlying cardiac pathology and multiple previously unsuccessful attempts at weight loss with conventional medical and behavioral therapy, the patient opted to proceed with surgical intervention. We present this laparoscopic adjustable gastric banding surgical case to demonstrate the impact of surgical weight reduction on cardiac risk factors in a morbidly obese adolescent, highlighting the viability of this surgery for patients with existing cardiac dysfunction.

    View details for DOI 10.1007/s11695-007-9330-9

    View details for Web of Science ID 000253627700016

    View details for PubMedID 18193180

  • Transaxillary subcutaneous endoscopic release of the sternocleidomastoid muscle for treatment of persistent torticollis JOURNAL OF PEDIATRIC SURGERY Dutta, S., Albanese, C. T. 2008; 43 (3): 447-450


    Surgical correction of torticollis is occasionally necessary to curtail the facial deformity that can result from this condition. The resultant neck scar can be of suboptimal cosmesis, with consequent psychological distress for the child. We have previously described an endoscopic approach to forehead and brow lesions through scalp incisions. We now describe a transaxillary subcutaneous endoscopic approach to division of the fibrotic sternocleidomastoid muscle.This study involved a retrospective chart review of 3 consecutive outpatient procedures (male-to-female ratio, 1:2; age range, 8 months to 7 years) from March to October of 2005. The 2 older patients had established sternocleidomastoid fibrosis, and 1 had complicated torticollis refractory to medical management. All procedures were performed using standard 3-mm-laparoscopic instrumentation through hidden incisions in the ipsilateral axilla. Outcome measures included need for conversion, operative time, cosmetic outcome, and complications.All patients were successfully treated endoscopically. Mean operative time was 50 minutes (range, 45-55 minutes). There were no intraoperative or postoperative complications. All families were pleased with the cosmetic outcome.This case series demonstrates the simplicity and effectiveness of a transaxillary endoscopic subcutaneous approach to torticollis.

    View details for DOI 10.1016/j.jpedsurg.2007.10.008

    View details for Web of Science ID 000254803500007

    View details for PubMedID 18358280

  • Providing metrics and performance feedback in a surgical simulator COMPUTER AIDED SURGERY Sewell, C., Morris, D., Blevins, N. H., Dutta, S., Agrawal, S., Barbagli, F., Salisbury, K. 2008; 13 (2): 63-81


    One of the most important advantages of computer simulators for surgical training is the opportunity they afford for independent learning. However, if the simulator does not provide useful instructional feedback to the user, this advantage is significantly blunted by the need for an instructor to supervise and tutor the trainee while using the simulator. Thus, the incorporation of relevant, intuitive metrics is essential to the development of efficient simulators. Equally as important is the presentation of such metrics to the user in such a way so as to provide constructive feedback that facilitates independent learning and improvement. This paper presents a number of novel metrics for the automated evaluation of surgical technique. The general approach was to take criteria that are intuitive to surgeons and develop ways to quantify them in a simulator. Although many of the concepts behind these metrics have wide application throughout surgery, they have been implemented specifically in the context of a simulation of mastoidectomy. First, the visuohaptic simulator itself is described, followed by the details of a wide variety of metrics designed to assess the user's performance. We present mechanisms for presenting visualizations and other feedback based on these metrics during a virtual procedure. We further describe a novel performance evaluation console that displays metric-based information during an automated debriefing session. Finally, the results of several user studies are reported, providing some preliminary validation of the simulator, the metrics, and the feedback mechanisms. Several machine learning algorithms, including Hidden Markov Models and a Naïve Bayes Classifier, are applied to our simulator data to automatically differentiate users' expertise levels.

    View details for DOI 10.1080/10929080801957712

    View details for Web of Science ID 000256418000001

    View details for PubMedID 18317956

  • Multiple magnet ingestion as a source of severe gastrointestinal complications requiring surgical intervention ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Dutta, S., Barzin, A. 2008; 162 (2): 123-125


    To raise awareness of the dangers associated with magnet ingestion in children.Case report and review of the literature.Tertiary care children's hospital. Patient Four-year-old boy with minimal physical findings but with a clinical history and imaging suggesting complications from multiple magnet ingestion. Intervention Laparoscopic removal of magnets and repair of magnet-induced enterotomies. Outcome Measure Clinical course.Full recovery after surgical intervention.Ingestion of multiple magnets can cause minimal initial physical examination findings but result in significant complications, including bowel perforation, volvulus, ischemia, and death. Early surgical intervention can prevent significant morbidity and mortality. Clinical vigilance should be exercised in these cases and early surgical consultation with an aggressive surgical approach is recommended. Parents should be warned against the dangers of children's toys that contain these powerful magnets.

    View details for Web of Science ID 000252859800004

    View details for PubMedID 18250235

  • I-123 MIBG mapping with intraoperative gamma probe for recurrent neuroblastoma MOLECULAR IMAGING AND BIOLOGY Iagaru, A., Peterson, D., Quon, A., Dutta, S., Twist, C., Daghighian, F., Gambhir, S. S., Albanese, C. 2008; 10 (1): 19-23


    Intraoperative gamma probe guidance has become widely utilized for sentinel lymph node dissection in patients with breast cancer and melanoma, using (99m)Tc sulfur colloid. However, new indications are possible and need to continue to be investigated. We report the use during a wedge liver biopsy of a new hand-held gamma probe designed for (123)I intraoperative guidance. The patient studied is a 5-year-old boy with history of stage 4 high-risk neuroblastoma. Anatomic imaging (CT, MRI), (99m)Tc bone scintigraphy and 2-deoxy-2-[F-18]fluoro-d-glucose-positron emission tomography/computed tomography (FDG-PET/CT) were negative, but the (123)I MIBG scintigraphy suggested recurrent liver disease. A decision was made to biopsy these lesions to obtain histopathological confirmation. Intraoperative gamma probe mapping of the liver identified areas with signal above the background, but these were prove to be hemosiderin deposits on histo-pathology examination.

    View details for DOI 10.1007/s11307-007-0116-1

    View details for Web of Science ID 000252107800002

    View details for PubMedID 17975716

  • National trends in adolescent bariatric surgical procedures and implications for surgical centers of excellence JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS Schilling, P. L., Davis, M. M., Albanese, C. T., Dutta, S., Morton, J. 2008; 206 (1): 1-12


    Bariatric surgery is indicated for severely obese adolescents who have failed nonsurgical treatment. Our objective was to examine national trends in the use of bariatric operations among adolescents.The Kids' Inpatient Database was used to identify bariatric surgery patients in the pediatric population (age younger than 18 years) for 1997, 2000, and 2003. Patients were identified by procedure codes for bariatric operations with confirmatory diagnosis codes for obesity. Nationally representative estimates of trends in bariatric procedures, patient characteristics, hospital characteristics, and in-hospital complication rates were calculated. We augmented our analysis with the 2003 Nationwide Inpatient Sample, to ascertain hospitals' overall bariatric surgical volume (adolescents and adults).From 1997 to 2003, the estimated number of adolescent bariatric procedures performed nationally increased 5-fold from 51 to 282 (p < 0.01). More than 100 hospitals performed bariatric procedures on adolescents in 2003, most of which (87%) performed 4 or fewer adolescent bariatric operations annually. Operations were predominantly performed in adult hospitals (85%). Although most hospitals had high overall bariatric operation volumes (> 200 bariatric procedures for patients of any age), 39% of adolescent bariatric procedures were performed at lower-volume centers. Patients were predominantly Caucasian (68%) and female (72%), with a mean age of 16 years (minimum age 12 years). In-hospital complications occurred in 6% of patients. There were no in-hospital deaths.Our findings indicate a recent, rapid increase in the frequency of adolescent bariatric procedures. Most hospitals that performed bariatric procedures on adolescents had limited experience with adolescent bariatric patients, although many of these hospitals appear to have been experienced adult centers with high overall bariatric volume (adolescents and adults). Future research must better clarify the institutional qualifications considered mandatory for treatment of eligible adolescents.

    View details for DOI 10.1016/j.jamcollsurg.2007.07.028

    View details for Web of Science ID 000252109200001

    View details for PubMedID 18155562

  • Thoracoscopic repair of a type D esophageal atresia in a newborn with complex congenital heart disease JOURNAL OF PEDIATRIC SURGERY Rice-Townsend, S., Ramamoorthy, C., Dutta, S. 2007; 42 (9): 1616-1619


    This report describes a case of thoracoscopic repair of esophageal atresia with a rare type D tracheoesophageal fistula in a child with complex congenital heart disease. We demonstrate the feasibility of thoracoscopic repair and anesthetic management in a child with complex congenital heart disease.

    View details for DOI 10.1016/j.jpedsurg.2007.05.013

    View details for Web of Science ID 000249746100028

    View details for PubMedID 17848260

  • The STEP procedure: Defining its role in the management of pediatric short bowel syndrome JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION Dutta, S. 2007; 45 (2): 174-175

    View details for Web of Science ID 000248318400005

    View details for PubMedID 17667710

  • Use of a prosthetic patch for laparoscopic repair of Morgagni diaphragmatic hernia in children JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Dutta, S., Albanese, C. T. 2007; 17 (3): 391-394


    Morgagni hernias are well suited to laparoscopic repair. A primary suture closure may result in tension on the repair, thereby predisposing the patient to a recurrence. A prosthetic patch (PP) can be used to provide a tension-free repair. In this study, we reviewed our experience with the laparoscopic PP repair of Morgagni hernias in children.A retrospective chart review of all patients undergoing a laparoscopic Morgagni hernia repair using a PP was undertaken between November 2002 and January 2006. Outcome measures included age, gender, defect size, use of mesh, and outcome. The time of follow-up was from 6 to 37 months.Seven (7) patients (6 male, 1 female) underwent a laparoscopic repair of Morgagni hernia during this time period. Six (6) patients had a congenital hernia, and 1 patient was thought to have an iatrogenic hernia following a sternotomy for heart surgery. Defect size ranged from 4 to 7 cm in maximum dimension. All operations were completed laparoscopically, no patients presented with recurrence, and no PP complications were encountered.The laparoscopic repair of Morgagni hernia using a PP can be performed with relative ease and with a positive outcome, and may prevent future recurrence by effecting a tension-free repair.

    View details for DOI 10.1089/lap.2006.0113

    View details for Web of Science ID 000247349500028

    View details for PubMedID 17570796

  • Laparoscopic resection of a benign liver tumor in a child JOURNAL OF PEDIATRIC SURGERY Dutta, S., Nehra, D., Woo, R., Cohen, I. 2007; 42 (6): 1141-1145


    Laparoscopy for the resection of liver masses in children has remained undeveloped despite the wide acceptance of laparoscopy in the field of pediatric surgery. The authors report a case of nonanatomical laparoscopic hepatic resection of a large mesenchymal hamartoma in a 2-year-old boy. The procedure was performed using an innovative approach with a combination of different technologies that allowed for a safe and precise resection. This case demonstrates the feasibility of a nonanatomical laparoscopic hepatic resection, even for very large tumors. Both technical expertise and use of novel technologies are necessary to ensure a precise and controlled resection.

    View details for DOI 10.1016/j.jpedsurg.2007.01.045

    View details for Web of Science ID 000247536300044

    View details for PubMedID 17560238

  • Minimal access portoenterostomy: Advantages and disadvantages of standard laparoscopic and robotic techniques JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Dutta, S., Woo, R., Albanese, C. T. 2007; 17 (2): 258-264


    Minimal access portoenterostomy (Kasai procedure) for biliary atresia represents a technically challenging operation. The standard laparoscopic approach yields results comparable to the open technique. After an initial experience with standard laparoscopy, we assessed the potentially superior optics and dexterity of a surgical robotic system for performing portoenterostomy. We reviewed our experience with minimal access portoenterostomy to compare the relative advantages and disadvantages of standard laparoscopic and robotic approaches to biliary atresia.We reviewed the charts of all patients who underwent either laparoscopic or robotic portoenterostomy at our institution between October 2002 and October 2005. Outcome measures included the need to convert to laparotomy, complications, functional outcome expressed either as the direct bilirubin at most recent follow-up (> or = 3 months) or age at transplant, and density of adhesions at transplant. Surgeons' impressions of the two minimal access modalities were also reviewed.A total of 10 patients underwent minimal access portoenterostomy (7 standard laparoscopy; 3 robotic-assisted). Mean follow-up was 20 months (range, 1-36 months). There were no conversions to laparotomy and no intraoperative complications. There was one port site infection that resolved with antibiotics. Five patients (4 laparoscopic, 1 robotic) had progressed to transplantation at the time of follow-up. At transplant, one patient had mild adhesions and two had dense adhesions. Adhesions were not noted for 2 patients.We believe both surgical modalities are feasible from a technical point of view. However, the optical and dexterity advantages of the robotic system were offset by the large instrument size and lack of force feedback.

    View details for Web of Science ID 000246005000025

    View details for PubMedID 17484663

  • Clinical resolution of severely symptomatic pseudotumor cerebri after gastric bypass in an adolescent SURGERY FOR OBESITY AND RELATED DISEASES Chandra, V., Dutta, S., Albanese, C. T., Shepard, E., Farrales-Nguyen, S., Morton, J. 2007; 3 (2): 198-200


    Pseudotumor cerebri is a disease characterized by increased intracranial pressure, often manifested by headaches, and occasionally leading to severe visual impairment or even blindness. Most cases in adolescents, as in adults, are associated with obesity. We report a 16-year-old morbidly obese adolescent girl (body mass index 42.3 kg/m(2)) with severely symptomatic pseudotumor cerebri who had progressive visual field deficits and elevated intracranial pressure (opening pressure on lumbar puncture of 50 cm H(2)O) despite intensive medical management and placement of both ventriculoperitoneal and lumboperitoneal shunts. Six months after she underwent gastric bypass surgery, she had lost 43% of her excess body weight and had had near complete regression of her visual field deficits, along with normalization of her intracranial pressures. This case demonstrates the dramatic reversal of symptoms of pseudotumor cerebri with surgically induced weight loss. Gastric bypass should be considered as a treatment option for adolescents with severe and progressive pseudotumor cerebri.

    View details for DOI 10.1016/j.soard.2006.11.015

    View details for Web of Science ID 000261097100020

    View details for PubMedID 17324634

  • Double reverse intestinal malrotation: a novel rotational anomaly and its surgical correction JOURNAL OF PEDIATRIC SURGERY Nehra, D., Zeineh, M., Rodriguez, F., Dutta, S. 2007; 42 (3): 578-581


    Reverse intestinal rotation is the rarest developmental anomaly of intestinal rotation and fixation. We present a case of an adolescent girl with chronic intermittent abdominal pain who was found to have a novel rotational abnormality that we have termed "double reverse intestinal malrotation." The imaging studies, operative findings, and the surgical correction are presented.

    View details for DOI 10.1016/j.jpedsurg.2006.10.061

    View details for Web of Science ID 000245002900028

    View details for PubMedID 17336206

  • IPEG panel on clinical investigation JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Morton, J., Albanese, C. T., Barnhart, D., Dutta, S. 2007; 17 (1): 67-76

    View details for DOI 10.1089/lap.2006.9998

    View details for Web of Science ID 000245056900015

    View details for PubMedID 17362183

  • Validating Metrics for a Mastoidectomy Simulator MEDICINE MEETS VIRTUAL REALITY 15 Sewell, C., Morris, D., Blevins, N. H., Agrawal, S., Dutta, S., Barbagli, F., Salisbury, K. 2007; 125: 421-426


    One of the primary barriers to the acceptance of surgical simulators is that most simulators still require a significant amount of an instructing surgeon's time to evaluate and provide feedback to the students using them. Thus, an important area of research in this field is the development of metrics that can enable a simulator to be an essentially self-contained teaching tool, capable of identifying and explaining the user's weaknesses. However, it is essential that these metrics be validated in able to ensure that the evaluations provided by the "virtual instructor" match those that the real instructor would provide were he/she present. We have previously proposed a number of algorithms for providing automated feedback in the context of a mastoidectomy simulator. In this paper, we present the results of a user study in which we attempted to establish construct validity (with inter-rater reliability) for our simulator itself and to validate our metrics. Fifteen subjects (8 experts, 7 novices) were asked to perform two virtual mastoidectomies. Each virtual procedure was recorded, and two experienced instructing surgeons assigned global scores that were correlated with subjects' experience levels. We then validated our metrics by correlating the scores generated by our algorithms with the instructors' global ratings, as well as with metric-specific sub-scores assigned by one of the instructors.

    View details for Web of Science ID 000270613800095

    View details for PubMedID 17377316

  • The influence of psychological factors on the outcomes of laparoscopic Nissen fundoplication. Annals of surgical innovation and research Biertho, L., Sanjeev, D., Sebajang, H., Antony, M., Anvari, M. 2007; 1: 2-?


    Psychological factors play a role in a variety of gastrointestinal illness, including gastroesophageal reflux disease (GERD). Their impact on the surgical outcomes of antireflux surgery is unknown.This is a single institution prospective controlled trial, comparing patients undergoing a laparoscopic Nissen fundoplication for GERD (LNF Group, n = 17) to patients undergoing an elective laparoscopic cholecystectomy for biliary colic (Control Group, n = 10). All patients had a psychological assessment before surgery, at 3 months and 6 months after surgery (i.e. Symptom CheckList-90-R somatization subset (SCL-90-R), Depression Anxiety Stress Scales, Anxiety sensitivity index, Illness attitude scale and Beck Depression Inventory II). GERD symptoms were recorded in the LNF Group using a standardized questionnaire (score 0-60). Patients with post-operative GERD symptoms score above 12 at 6 months were evaluated specifically. Statistical analysis was performed using a Student T test, and statistical significance was set at 0.05.There was no significant difference in preoperative and postoperative psychological assessment between the two groups. In the LNF Group, 7 patients had persisting GERD symptoms at 6 months (GERD score greater than 12). The preoperative SCL-90-R score was also significantly higher in this subgroup, when compared to the rest of the LNF Group (18.2 versus 8.3, p < 0.05) and to the Control Group (18.2 versus 7.9, p < 0.05). There was no significant difference for the other psychological tests.The SCL-90-R Somatization Subset, reflecting the level of somatization in a patient, may be useful to predict poor outcomes after antireflux surgery. Cognizance of psychological disorders could improve the selection of an optimal treatment for GERD and help reduce the rate of ongoing symptoms after LNF.

    View details for PubMedID 17411450

  • Prosthetic esophageal erosion after mesh hiatoplasty in a child, removed by transabdominal endogastric surgery JOURNAL OF PEDIATRIC SURGERY Dutta, S. 2007; 42 (1): 252-256


    Although there is evidence in the adult surgical literature to suggests that the use of mesh prosthesis during laparoscopic hiatal hernia repair results in much reduced recurrence rates, there remains a real potential for esophageal and gastric mesh erosion. A 12-year-old boy presented with esophageal obstruction from an eroded polytetrafluoroethylene prosthesis used to buttress a hiatal hernia repair 9 years earlier. A laparoscopic endogastric approach was used to remove the mesh. Great caution must be exercised in the decision to use mesh for hiatal hernia repair in children who must live with such a prosthesis for a lifetime and risk erosion. Mesh should be reserved only for those children who have extremely large defects with no chance of primary closure and for those with recurrent hernias and friable crural tissue. In all cases, the family must be informed of the potential for eventual erosion. Removal of eroded mesh using minimal access techniques can be simple and effective.

    View details for DOI 10.1016/j.jpedsurg.2006.09.043

    View details for Web of Science ID 000243707100044

    View details for PubMedID 17208576

  • Surgical robotics and image guided therapy in pediatric surgery: emerging and converging minimal access technologies. Seminars in pediatric surgery Chandra, V., Dutta, S., Albanese, C. T. 2006; 15 (4): 267-275


    Minimal access surgery (MAS) is now commonplace in the armamentarium of the pediatric surgeon, and is being applied to a growing list of pediatric surgical diseases. Robot-assisted surgery and image guided therapy (IGT) have evolved as innovative minimal access approaches, and hold the promise of advancing MAS far beyond what is currently possible. The aims of this article are to describe the currently available robotic, and image guided therapy systems, review their present and potential applications, and discuss the future directions of these converging technologies.

    View details for PubMedID 17055957

  • Endoscopic excision of benign forehead masses: a novel approach for pediatric general surgeons JOURNAL OF PEDIATRIC SURGERY Dutta, S., Lorenz, H. P., Albanese, C. T. 2006; 41 (11): 1874-1878


    Benign tumors of the brow and forehead are commonly managed by pediatric general surgeons by excision through an overlying incision. Cosmetic results in children can be suboptimal. Plastic surgeons have used endoscopic brow-lift techniques for the removal of these lesions. We review our experience after adopting this endoscopic technique in a pediatric general surgery practice.We conducted a retrospective chart review of 9 consecutive outpatient procedures (5 girls and 4 boys; age range, 5 months to 12 years) between March and October 2005. Seven patients had lesions located on the lateral brow (left, n = 4; right, n = 3), 1 patient had a lesion on the left mid forehead, and 1 patient had a nasoglabellar cyst. All procedures were performed using endoscopic brow-lift equipment through a single small scalp incision 2 cm posterior to the hairline. Outcome measures included need for conversion, operative time, cosmetic outcome, and complications.All lesions (6 dermoid cysts and 3 pilomatrixomas) were successfully excised endoscopically. The mean operative time was 56 minutes (range, 22-90 minutes). There was no intraoperative or postoperative complication. All families were pleased with the cosmetic outcomes.This case report shows that endoscopic excision of forehead masses is a safe and efficacious procedure in the hands of pediatric general surgeons.

    View details for DOI 10.1016/j.jpedsurg.2006.06.047

    View details for Web of Science ID 000242395200017

    View details for PubMedID 17101362

  • A laparoscopic approach to partial splenectomy for children with hereditary spherocytosis SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Dutta, S., Price, V. E., Blanchette, V., Langer, J. C. 2006; 20 (11): 1719-1724


    Partial splenectomy is sometimes used for children with hereditary spherocytosis (HS) to reduce hemolysis while retaining some splenic immune function. Previous reports have described a partial splenic resection through a laparotomy incision. Whereas laparoscopic total splenectomy for HS is well-established, laparoscopic partial splenectomy (LPS) has not been described. The authors have developed a novel LPS technique that combines the benefits of partial splenectomy with those of a laparoscopic approach.A chart review was conducted for three children with HS who underwent LPS, with approximately one-fourth of the spleen left on the basis of the short gastric arterial supply.The mean preoperative spleen size was 17.6 cm. The mean preoperative hemoglobin count was 100 g/l, and the postoperative hemoglobin count was 133 g/l. All three patients reported reduced malaise and increased energy levels. There was no recurrent anemia at the 1- to 2-year follow-up evaluation.The LPS procedure is a safe and effective approach to HS that resolves anemia, potentially retains some splenic immunity, and confers the benefits of a minimal access technique.

    View details for DOI 10.1007/s00464-006-0131-3

    View details for Web of Science ID 000242379400017

    View details for PubMedID 17024531

  • Natural orifice translumenal endoscopic surgery (NOTES). Seminars in pediatric surgery Shafi, B. M., Mery, C. M., Binyamin, G., Dutta, S. 2006; 15 (4): 251-258


    Surgery has rapidly evolved as new technologies are adopted. With the introduction of laparoscopic surgery, patient outcomes have improved, with faster recovery from smaller incisions. In an effort to continually improve these outcomes and offer alternative options to higher risk patients, a number of investigators have proposed the concept of operating in the peritoneal space through natural orifices, obviating the need for any abdominal skin incisions. Natural orifice translumenal endoscopic surgery (NOTES) offers the same advantages as laparoscopic surgery without skin incisions, and possibly without general anesthesia. This article gives a conceptual and technical description of NOTES, discusses its challenges and potential pitfalls, reviews the early efforts at NOTES-specific device development, and predicts potential future directions of this exciting new area of surgery.

    View details for PubMedID 17055955

  • Methamphetamine use following bariatric surgery in an adolescent OBESITY SURGERY Dutta, S., Morton, J., Shepard, E., Peebles, R., Farrales-Nguyen, S., Hammer, L. D., Albanese, C. T. 2006; 16 (6): 780-782


    Bariatric surgery is increasingly popular as a therapeutic strategy for morbidly obese adolescents. Adolescence represents a sensitive period of psychosocial development, and children with considerable weight loss may experience greater peer acceptance, accompanied by both positive and negative influences. Substance abuse exists as one of these negative influences. We present the case of an adolescent bariatric surgical patient who abused methamphetamines in the postoperative period, with consequent nutritional instability. A concerted effort must be made in the preoperative assessment of adolescent bariatric patients to delineate a history of illicit drug use, including abuse of diet pills and stimulants. Excessive postoperative weight loss or micronutrient supplementation non-compliance should raise a suspicion of stimulant use and appropriate screening tests should be performed. The consequent appetite suppression may manifest with signs of malnutrition such as bradycardia, hypotension, and weakness. Inpatient nutritional rehabilitation and psychiatric assessment should be considered.

    View details for Web of Science ID 000238156200019

    View details for PubMedID 16756743

  • The prevention and treatment of bacterial infections in children with asplenia or hyposplenia: Practice considerations at the Hospital for Sick Children, Toronto PEDIATRIC BLOOD & CANCER Price, V. E., Dutta, S., Blanchette, V. S., Butchart, S., Kirby, M., Langer, J. C., Ford-Jones, E. L. 2006; 46 (5): 597-603


    Children born without a spleen or who have impaired splenic function, due to disease or splenectomy, are at significantly increased risk of life-threatening bacterial sepsis. The mainstays of prevention are education, immunization, and prophylactic antibiotics. The availability of conjugate 7-valent pneumococcal vaccines for use in children to age 9 years at least, as well as conjugate meningococcal C vaccine in some countries, for use beginning in infancy, appear to represent beneficial additions, but not substitutions, to previous recommendations for the use of polysaccharide 23-valent pneumococcal and quadrivalent A, C, Y, W-135 vaccines. Routine immunization against H. influenzae type b should continue with non-immunized children older than age 5 years receiving two doses 2 months apart, similar to children who have not previously received conjugate pneumococcal vaccine in infancy. Annual influenza immunization, which reduces the risk of secondary bacterial infection, is also recommended for asplenic children and their household contacts. Many experts continue prophylaxis indefinitely although prophylaxis of the penicillin allergic child remains suboptimal.

    View details for DOI 10.1002/pbc.20477

    View details for Web of Science ID 000236536900011

    View details for PubMedID 16333816

  • To simulate or not to simulate what is the question? ANNALS OF SURGERY Dutta, S., Gaba, D., Krummel, T. M. 2006; 243 (3): 301-303
  • Simulation: a new frontier in surgical education. Advances in surgery Dutta, S., Krummel, T. M. 2006; 40: 249-263


    Simulation offers a new frontier in surgical education that promises to enhance the current approaches to training. It addresses the operational and fiscal realities of current healthcare deliveries while adhering to principles of educational psychology. Challenges for educators include systematic validation of simulation methods, attracting research funding agencies to support this cause, and development of appropriate funding mechanisms for the sometimes high facility and hardware costs. The greatest challenge, however, is instituting simulation into the minds of a surgical community that is already steeped in a long and entrenched tradition of Halstedian surgical training.

    View details for PubMedID 17163107

  • Does laparoscopic Nissen fundoplication prevent the progression of Barrett's oesophagus? Is the length of Barrett's a factor? Journal of minimal access surgery Bamehriz, F., Dutta, S., Pottruff, C. G., Allen, C. J., Anvari, M. 2005; 1 (1): 21-28


    Recent studies have suggested that both laparoscopic and open anti-reflux surgery may produce regression of Barrett's mucosa. MATERIAL AND METHODS;: We reviewed 21 patients (13M: 8F, mean age 46.7±3.18 years) with documented Gastroesophageal Reflux Disease (GERD) and Non-dysplastic Barrett's esophagus (15 patients ?3 cm segment, 6 patients < 3 cm segment) on long term proton pump inhibitor therapy who underwent laparoscopic Nissen fundoplication (LNF) between 1993 and 2000. All patients had undergone pre and yearly postoperative upper GI endoscopy with 4 quadrant biopsies every 2 cm. All patients also underwent pre- and 6 months postoperative 24-hr pH study, esophageal manometry, SF36, and GERD symptom score. The mean duration of GERD symptoms was 8.4±1.54 years pre-operative. The mean follow-up after surgery was 39±6.32 months.Postoperatively, there was significant improvement in reflux symptom score (37.5 ± 3.98 points versus 8.7 ± 2.46 points, P = 0.0001), % acid reflux in 24 hr (26.5 ± 3.91% versus 2.1 ± 0.84%, P< 0.0001) and an increase in lower esophageal sphincter pressure (3.71 ± 1.08 mmHg versus 12.29 ± 1.34 mmHg, P = 0.0053). Complete or partial regression of Barrett's mucosa occurred in 9 patients. All patients with complete regression had <4 cm segment of Barrett's. Progression or cancer transformation was not observed in any of the patients.LNF in patients with Barrett's oesophagus results in significant control of GERD symptoms. LNF can prevent progression of Barrett's oesophagus and in patients with Barrett's <4 cm may lead to complete regression.

    View details for DOI 10.4103/0972-9941.15242

    View details for PubMedID 21234140

  • Does laparoscopic Nissen fundoplication prevent the progression of Barrett's esophagus? Is the length of Barrett's a factor? J Min Access Surg Bamehriz F, Dutta S, Pottruff C, Allen CJ, Anvari M 2005; 197 (1)
  • Serial transverse enteroplasty for management of the proximal dilated segment in jejunoileal atresia. J Pediatr Surg Wales PW, Dutta S 2005; 40 (3)
  • The impact of latency on surgical precision and task completion during telerobotic surgery Comput Aided Surg Anvari M, Broderick T, Stein H, Chapman T, Ghodoussi M, Birch DW, McKinley C, Trudeau P, Dutta S, Goldsmith CH 2005; 10 (2)
  • The two-week pediatric surgery rotation: Is it time wasted? JOURNAL OF PEDIATRIC SURGERY Dutta, S., Wales, P. W., Fecteau, A. 2004; 39 (5): 717-720


    With increasing medical school emphasis on generalist training and decreasing enrollment in surgical residency, the authors assessed the adequacy of a 2-week pediatric surgery rotation on meeting the learning and competency objectives outlined in The Canadian Association of Pediatric Surgeons' Self-Directed Evaluation Tool.A prospective survey was conducted of 39 clinical clerks. An anonymous self-assessment scale measuring competency objectives (medical and psychosocial) was administered pre-and postrotation. Also, exposure to pediatric surgical conditions from a list of "essential" and "nonessential" learning objectives was measured. Statistical analysis was performed using paired t test with significance at.05 level.Response rate was 77% and 54% for the competency and learning objectives, respectively. Students reported improvement in medical (P <.00001; 95% CI, 1.30, 1.90) and psychosocial (P =.00036; 95% CI 0.64, 1.28) competency objectives after the rotation. Almost all "essential" learning objectives were met. Overall, students reported an increased awareness of the breadth of pediatric surgical practice (P <.0001; 95% CI 2.06, 3.18).A 2-week rotation in pediatric surgery appears adequate in fulfilling most competency and learning objectives, but discussion is needed about how to best assess student competency, which topics are considered essential, and the long-term effect on recruitment to the profession.

    View details for DOI 10.1016/j.jpedsurg.2004.01.041

    View details for Web of Science ID 000221621500012

    View details for PubMedID 15137005

  • Minimal access surgical approaches in infants and children. Advances in surgery Dutta, S., Langer, J. C. 2004; 38: 337-361

    View details for PubMedID 15515626

  • Outcome of laparoscopic redo fundoplication Surgical Endoscopy Dutta S, Bamehriz F, Boghossian T, Gill-Pottruff C, Anvari M 2004; 18 (3)
  • Does laparoscopic antireflux surgery prevent the occurrence of transient lower esophageal sphincter relaxtion? SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Bahmeriz, F., Dutta, S., Allen, C. J., Pottruff, C. G., Anvari, M. 2003; 17 (7): 1050-1054


    Transient lower esophageal sphincter relaxation (TLESR) is the most common mechanism underlying gastroesophageal reflux disease (GERD), causing 70% to 100% of the reflux episodes in normal subjects and 63% to 74% of the reflux episodes in patients with reflux disease. This study aimed to evaluate the effect of laparoscopic Nissen fundoplication on TLESR in patients with proven GERD.We prospectively followed 73 consecutive patients (13 men and 60 women; mean age, 43.7 +/- 1.72 years) with proven diagnosis of GERD and reported TLESRs found during a 40-min esophageal manometric study. These patients had repeat testing 6 months after undergoing laparoscopic Nissen fundoplication.Laparoscopic Nissen fundoplication increased the basal and nadir lower esophageal sphincter (LES) pressure and significantly reduced the number of TLESRs during the manometric study. No patients after surgery exhibited TLESR with nadir less than 2 mmHg. However, 8 of the 73 patients (11%) exhibited TLESR to a nadir exceeding 50% of basal pressure (mean nadir, 5.0 +/- 1.07 mmHg).The number of TLESRs is reduced significantly by antireflux surgery. Even accounting for increased basal and nadir pressures, the incidence of TLESR is reduced, suggesting that there may be additional mechanisms involved in this process.

    View details for DOI 10.1007/s00464-002-8839-1

    View details for Web of Science ID 000185626000008

    View details for PubMedID 12728383

  • Therapeutic endoluminal laparoscopic resection of a villous adenoma of the duodenum. Surg Endosc Sample C, Dutta S, Anvari M 2003; 17 (2)
  • And doctor, no residents please! Journal of the American College of Surgeons Dutta S, Blanchard M, Dunnington GL, Spielman B, Da Rosa D, Joehl R 2003; 197 (6)
  • Total Intracorporeal Resection of Ileocolic Crohn?s Disease in Children J. Pediatr. Surg. Dutta S, Rothenberg SS, Chang J, Bealer J 2003; 38 (5)
  • An evaluation of study habits of third-year medical students in a surgical clerkship AMERICAN JOURNAL OF SURGERY Boehler, M. L., Schwind, C. J., Folse, R., Dunnington, G., Markwell, S., Dutta, S. 2001; 181 (3): 268-271


    This study was developed to assess study habits of medical students in a third-year surgical clerkship and to determine the relationship of these study habits to performance outcomes.A questionnaire designed to assess medical student study habits was administered at the end of five consecutive 10-week multidisciplinary surgical clerkships. The results of questionnaires from 81 students were analyzed in respect to results on the National Board of Medical Education (NBME) surgical subtest and the multiple stations clinical examination (MSCE) given at the end of each clerkship.Although only 18 of the total 81 students reported studying in formal but self-directed groups, students who reported studying in a group on average scored 4 points higher on the MSCE than those who did not study in a group (P = 0.001). However, no significant differences or correlations were discovered between any of the study habits and the individual results on the NBME.Students may benefit from collaborative studying when it comes to clinical experience as demonstrated by improved performance on the MSCE.

    View details for Web of Science ID 000168869400016

    View details for PubMedID 11376584

  • A ten-year analysis of surgical education research AMERICAN JOURNAL OF SURGERY Derossis, A. M., DaRosa, D. A., Dutta, S., Dunnington, G. L. 2000; 180 (1): 58-61


    Surgical education peer-reviewed publications have markedly increased over the last decade. The purpose of this study was to review the surgical education literature published over the last 10 years and address the following questions: What subjects in surgical education tend to be studied? What are the most to least commonly employed research designs and statistics? Has there been a change in how research data are collected? Where are these studies published?A literature search encompassing surgical education papers published between January 1988 and August 1998 was performed. Four investigators coded qualifying abstracts on journal type, subject of research, data collection methods, research design, and statistics. Each investigator was asked to code 10 articles at the start of the study to assess interrater reliability.A total of 420 abstracts were evaluated. Interrater reliability yielded percent agreements ranging from 82% to 96%. Curriculum and teaching were the most frequent topics studied (40%), followed by assessment (23%) and program evaluation (18%). Most research designs used were descriptive (41%). Experimental design has progressively increased from 2% in 1988-89 to 16% in 1998. A total of 551 statistical methods were accounted for in the 420 abstracts. The most common statistical analyses used were descriptive statistics (32%). The predominant mode of data collection was through testing or direct observations (34%). Survey instruments followed closely as a popular data collection method at 27%. The majority of papers were published in peer-reviewed surgical journals (64%),followed by medical education journals (22%) and "other" journals (14%).An analysis of the surgical education literature demonstrates the growing emphasis on the use of educational research to explore relevant issues and problems. Descriptive research is most popular, with an increasing trend in experimental research. Publication of educational research in peer-reviewed surgical journals is becoming more popular. This study informs those interested in the surgical education research literature of current trends, and what they need to know for a more critical appraisal of this body of literature.

    View details for Web of Science ID 000089757100015

    View details for PubMedID 11036143

  • Factors contributing to success in surgical education research AMERICAN JOURNAL OF SURGERY Dutta, S., Dunnington, G. L. 2000; 179 (3): 247-249


    Surgeons who have demonstrated excellence through extensive publication in the medical education literature can provide valuable guidance for new surgeons interested in educational research.National databases identified members of the Association for Surgical Education (ASE) who have accumulated the greatest number of peer-reviewed, original educational research publications. The top 15 surgeons completed an open-ended survey exploring surgical education research issues.The top three factors contributing to success in this field were (1) chair support, (2) collaboration with peers and mentors, and (3) participation in the ASE. The top three barriers were (1) perception at their institution of educational research as lacking credibility, (2) lack of adequate funding, and (3) lack of time. Eighty-five percent (11 of 13) reported having tenure or equivalent, of which 45% reported educational research as playing a significant role. All respondents advised formal training in education.Credibility of educational research is bolstered by quality research and a supportive chair. Scholarly work in this field can form the basis for an academic career.

    View details for Web of Science ID 000087285700021

    View details for PubMedID 10827330

  • Liposomal tacrolimus and intestinal drug concentration. Transpantation Proceedings Dutta S, Mezei M, Lee TDG, McAllister V 1998; 30
  • Computerized data acquisition and analysis applied to chemiluminescence detection of nitric oxide in headspace gas. J. of Pharmacological and Toxicological Methods O'Neill SK, Dutta S, Triggle CR 1993; 29
  • Quantitation of nitric oxide by a computerized chemiluminescence detector measurement of photolytic degradation of streptozotocin and sodium nitroprusside to release nitric oxide. Proceedings of the Western Pharmacology Society O'Neill, S. K., Dutta, S., Triggle, C. R. 1993; 36: 203-207

    View details for PubMedID 8378379

Conference Proceedings

  • Early, Intermediate, and Late Effects of a Surgical Skills "Boot Camp" on an Objective Structured Assessment of Technical Skills: A Randomized Controlled Study Parent, R. J., Plerhoples, T. A., Long, E. E., Zimmer, D. M., Teshome, M., Mohr, C. J., Ly, D. P., Hernandez-Boussard, T., Curet, M. J., Dutta, S. ELSEVIER SCIENCE INC. 2010: 984-989


    Surgical interns enter residency with variable technical abilities and many feel unprepared to perform necessary procedures. We hypothesized that interns exposed to a preinternship intensive surgical skills curriculum would demonstrate improved competency over unexposed colleagues on a test of surgical skills and that this effect would persist throughout internship.We designed a 3-day intensive skills "boot camp" with simulation-based training on 10 topics. Interns were randomized to an intervention group (boot camp) or a control group (no boot camp). All interns completed a survey including demographic information, previous experience, and comfort with basic surgical skills. Both groups completed a clinical skills assessment focused on 4 topics: chest tube insertion, central line placement, wound closure, and the Fundamentals of Laparoscopic Surgery peg transfer task. We assessed both groups immediately (month 0), early postcurriculum (month 1), and late postcurriculum (month 6).Fifteen participants were in the intervention group and 13 were in the control group. Before boot camp, mean comfort levels were similar for the groups. All participants had minimal prior experience. Competency for chest tube insertion and central line placement were considerably higher for the boot camp group at months 0 and 1, although much of this difference disappeared by month 6. There was no substantial difference between the 2 groups in the Fundamentals of Laparoscopic Surgery peg transfer and wound closure skills.A surgical skills boot camp accelerates the learning curve for interns in basic surgical skills as measured by a technical skills examination for some skills, although these improvements diminished over time. This can augment traditional training and translate into fewer patient errors.

    View details for DOI 10.1016/j.jamcollsurg.2010.03.006

    View details for Web of Science ID 000278649100013

    View details for PubMedID 20510808

  • Fundoplication and gastrostomy versus image-guided gastrojejunal tube for enteral feeding in neurologically impaired children with gastroesophageal reflux Wales, P. W., Diamond, I. R., Dutta, S., Muraca, S., Chait, P., Connolly, B., Langer, J. C. W B SAUNDERS CO-ELSEVIER INC. 2002: 407-411


    Neurologically impaired children with gastroesophageal reflux (GER) usually are treated with a fundoplication and gastrostomy (FG); however, this approach is associated with a high rate of complications and morbidity. The authors evaluated the image-guided gastrojejunal tube (GJ) as an alternative approach for this group of patients.A retrospective review of 111 neurologically impaired patients with gastroesophageal reflux was performed. Patients underwent either FG (n = 63) or GJ (n = 48). All FGs were performed using an open technique by a pediatric surgeon, and all GJ tubes were placed by an interventional radiologist.The 2 groups were similar with respect to diagnosis, age, sex and indication for feeding tube. Patients in the GJ group were followed up for an average of 3.11 years, and those in the FG group for 5.71 years. The groups did not differ statistically with respect to most complications (bleeding, peritonitis, aspiration pneumonia, recurrent gastroesophageal reflux [GER], wound infection, failure to thrive, and death), subsequent GER related admissions, or cost. Children in the GJ group were more likely to continue taking antireflux medication after the procedure (P <.05). Also, there was a trend for GJ patients to have an increased incidence of bowel obstruction or intussusception (20.8% v 7.9%). Of the FG patients 36.5% experienced retching, and 12.7% experienced dysphagia. Eighty-five percent of patients in the GJ group experienced GJ tube-specific complications (breakage, blockage, dislodgment), and GJ tube manipulations were required an average of 1.68 times per year follow-up. Nine patients (14.3%) in the FG group had wrap failure, with 7 (11.1%) of these children requiring repeat fundoplication. In the GJ group, 8.3% of patients went on to require a fundoplication for persistent problems. A total of 14.5% of GJ patients had their tube removed by the end of the follow-up period because they no longer needed the tube for feeding.Image-guided gastrojejunal tubes are a reasonable alternative to fundoplication and gastrostomy for neurologically impaired children with GER. The majority can be inserted without general anesthesia. This technique failed in only 8.3% patients, and they subsequently required fundoplication. A total of 14.5% of GJ patients showed some spontaneous improvement and had their feeding tube removed. Each approach, however, still is associated with a significant complication rate. A randomized prospective study comparing these 2 approaches is needed.

    View details for DOI 10.1053/jpsu.2002.30849

    View details for Web of Science ID 000174160700033

    View details for PubMedID 11877658

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