Abstract: The use of computer navigation was first described in the surgical resection of pelvic tumors in 2004. It was developed to improve surgical accuracy with the goal of achieving clear resection margins and better oncologic results. During the past few years, there has been tremendous advancement of computer-assisted tumor surgery (CATS) in the field of orthopedic oncology. Currently, CATS with image fusion offers preoperative three-dimensional surgical planning and allows surgeons to reproduce the intended bone resections in musculoskeletal tumors. The technique is reported to be useful in technically demanding resections, such as in pelvic and sacral tumors; joint-preserving intercalated and multiplanar tumor resection; and complex reconstruction with custom computer-aided design prostheses or allografts. This article provides an up-to-date review of the recent developments and key features in CATS, its current status in clinical practice, and future directions in its development.

Abstract: Despite advances in medical technology and surgical care, the management of enterocutaneous fistulas remains one of the most challenging problems faced by physicians. Success depends on an expert multidisciplinary team, access to long-term enteral and parenteral nutrition support, advanced wound care, optimal medical management and meticulous, methodical, surgical decision-making and technique. Management is complex and multiphasic. Improved survival rates for many morbid problems have resulted in a growing population of patients with increasingly complex fistulas. This article reviews the etiologies as well as classic and evolving management strategies for this problem.

Abstract: The incidence of esophageal cancer and, more specifically, of esophageal adenocarcinoma, continues to increase in the United Sates (US), mostly affecting white male patients. The mainstay of curative treatment for localized disease is surgery, typically after neoadjuvant chemoradiotherapy. However, esophagectomy remains a procedure burdened by significant rates of mortality and morbidity. Over the last two decades minimally invasive techniques have been adapted to esophageal resection, with the goal of improving postoperative outcomes without compromising oncological success. Numerous reports have documented the safety and feasibility of minimally invasive esophagectomy (MIE), and several centers have gained considerable experience in the technique and gathered a large case series. The overall advantage of MIE over open techniques in regards to improved outcomes and cost effectiveness remains controversial. The aim of the present work is to review the key aspects of MIE and compare the results with open surgery.

Abstract: While myoelectric prosthetic devices have been used for decades in the upper extremities, only recently have motorized knee and ankle components proven durable and effective enough for use in the lower extremity amputee. The control schemes developed to capitalize on these prosthetic advances must take into account the biomechanical differences between upper and lower extremity function. Already a valuable adjunct for the myoelectric control of upper extremity prostheses, targeted muscle reinnervation in the transfemoral amputee offers the potential to further enhance lower extremity prosthesis control and may simultaneously address post-amputation neuroma pain. Current strategies for lower extremity prosthesis control are discussed, along with a review of the transfemoral TMR technique and early clinical experience.

Abstract: The goals of pelvic tumor treatment are first, to obtain clear margins and prevent tumor recurrence, and second, to preserve limb function whenever possible. Treatment of tumors around the pelvis remains a difficult problem. Challenges include both tumor resection and pelvic reconstruction. We have made significant advances in both treatment and reconstructive efforts over the last decade with advances in imaging techniques and prosthetic design. Nevertheless, reconstruction after pelvic tumor resection must be individualized for each patient. One must consider age, functional status, and the extent of the tumor before deciding on the best reconstruction option. The aim of this paper is to outline the available reconstructive techniques and to discuss our current preferred strategy for reconstruction of the pelvis after tumor resection.

Abstract: Hemobilia is an uncommon source of significant gastrointestinal bleeding resulting from a communication between the vascular and biliary systems. Iatrogenic injury to the liver and the biliary system from percutaneous transhepatic techniques is currently the leading cause of hemobilia. Trauma, operative injury, malignancy, and inflammatory diseases of the hepatobiliary system are other rare, but important, etiologies for clinically significant hemobilia. While diagnostic CT angiography can be used in clinically stable patients, interventional angiography and transcatheter percutaneous endovascular techniques are the standard for diagnosis and treatment of hemobilia. Operative intervention is not required for management in the vast majority of the patients. Appropriate biliary drainage must be ensured after bleeding is addressed.

Abstract: Thyroidectomy under local anesthesia was common historically. With improvements in general anesthesia, local anesthesia techniques are now restricted to patients deemed too ill to undergo general anesthesia or to those who live in extremely resource-poor locations. In the last few decades there has been renewed interest in thyroidectomy under local anesthesia, and the few published series reveal morbidity outcomes are equivalent to those for thyroidectomy under general anesthesia. Limited data on the cost of the procedure indicate thyroidectomy under local anesthesia is cost-effective.

Abstract: The past 2 decades have witnessed the most significant developments in thyroid surgery since the time of Kocher. Improved understanding of physiology, anatomy and perioperative management have resulted in faster, safer operations on an outpatient basis without the use of drains, while advances in surgical technology have permitted surgeons to explore minimally invasive techniques, resulting in less dissection, decreased postoperative discomfort, faster recovery times and smaller anterior cervical scars. Another important trend over this time has been the rise in remote access surgery, which seeks to remove the scar from the neck completely. Of these remote access techniques, the robotic facelift thyroidectomy is rapidly emerging as a safe, attractive approach to thyroid surgery for patients interested in completely avoiding a visible neck scar. A number of peer-reviewed publications have established the safety and efficacy of the approach, and as a result the technique is now performed at several centers around the world.

Abstract: Diffusion-weighted magnetic resonance imaging (DWI) has recently been proposed as an alternative to surgical exploration for suspected recurrent or residual cholesteatoma. A second-look surgery is often planned for extensive disease in ears where the posterior canal wall has been left intact. Alternatively, granulation tissue with chronic otorrhea in a patient with a history of cholesteatoma is highly suspicious for recurrence. Computerized tomography imaging is excellent for showing bony definition details of the temporal bone but cannot differentiate between soft tissue types. Cholesteatoma has unique signaling characteristics on DWI that can help distinguish between inflammatory tissue and residual or recurrent disease.

Abstract: Surgical treatment of metastatic disease to bone continues to evolve. Advances have been made in diagnosis, improved surgical outcomes, and minimally invasive procedures. Improved prediction of risk for bone fracture continues to evolve with CT-based techniques including structural rigidity analysis and finite element modeling. Improved surgical outcomes have been seen in treatment of proximal femoral pathologic lesions and fractures with the pendulum swinging toward more use of endoprosthetic devices over internal fixation, humeral lesions with a wide variety of techniques, and acetabular lesions with the use of tantalum acetabular cups and augments. Minimally invasive techniques including osteoplasty, radiofrequency ablation, cryoablation, and high-intensity ultrasound offer alternatives to open surgical treatment. Despite this evolution, the goals of treatment remain the same: pain relief, immediate stability, local disease control, and maintenance or restoration of function.

Abstract: Blunt cerebrovascular injuries (BCVI) have been shown to affect the pediatric population and have long term neurologic morbidity. The reported incidence is low which likely represents under diagnosis due to poor screening efforts. No large prospective studies have been conducted to specifically address practice guidelines for children with BCVI. Increased awareness and knowledge is needed to improve quality of care and patient outcomes.

Abstract: Standard magnetic resonance imaging techniques provide only anatomic information without information regarding central nervous system connectivity Overcoming this limitation, diffusion tensor imaging (DTI) can demonstrate the structural integrity and white matter tracts of the brain In this paper, we will overview the basic principles and techniques of DTI We will also review the application of DTI in neurosurgery, particularly its application in the resection of gliomas Tractography provides visualization of the motor tracts and language tracts, which has been corroborated using subcortical mapping/direct stimulation Furthermore, DTI can also provide information about the arrangement of visual fibers in relation to tumors Given these advantages, DTI is becoming increasingly used as a surgical planning tool DTI may provide a safer means for tumor resection by minimizing iatrogenic injury of important functional tracts Some studies suggest that the use of DTI in tumor surgery may lead to greater Karnofsky performance status scores, greater extent of tumor resection, and increased overall survival

Abstract: Gastric outlet obstruction (GOO) can be due to a variety of causes of both benign and malignant sources. As the etiology of GOO shifts from mostly benign to mostly malignant, treatment options have also evolved. Traditional options have only included surgery, but an increase in technology has seen the emergence of endoscopic alternatives. For benign disease, such as peptic ulcer disease, endoscopic balloon dilation has reduced the number of patients needing to undergo larger and more invasive surgical procedures. It has also proven successful in treating obstruction from stricture following bariatric surgery, but surgical revision or reversal remains the gold standard. Numerous surgical procedures have shown effectiveness when treating GOO, with new procedures constantly emerging. When malignancy is the cause, the procedural focus shifts from curative to palliative with the main focus being resumption of oral intake. Endoscopic stenting provides a viable alternative to gastro-jejunostomy, but due to problems with re-obstruction and stent migration, it should be reserved for patients with shorter life expectancies.

Abstract: There are many barriers that prevent the use of traditional acoustic amplification including anatomic and medical conditions and patient preference. Implantable hearing devices typically avoid the use of the ear canal and can overcome many of these barriers. Current options include partially and fully implantable devices, devices that make use of bone conduction, devices that directly couple to the ossicular chain, and those that provide more direct cochlear stimulation. This article reviews the major devices that are currently available or in development providing information regarding clinical indications, device components, the general surgical procedure, and typical outcomes. This review should help the clinician understand device options to fit specific patient anatomy and amplification needs.

Abstract: Adrenal venous sampling (AVS) is used to distinguish unilateral from bilateral aldosterone hypersecretion as a cause of primary hyperaldosteronism (PHA). This distinction is critical because unilateral disease is treated, and often cured, by adrenalectomy, whereas bilateral hypersecretion should be managed medically. In this article, we review the epidemiology and etiologies of PHA, present screening guidelines for hypertensive patients with suspected PHA, assess the utility and pitfalls of cross-sectional imaging, and discuss the indications for and interpretation of AVS.

Abstract: Locally advanced tumors, originating from organs and structures of the pelvis and the pelvic floor may compromise the lower urinary tract. The aim of this review is to display the diagnosis and treatment of the most com- mon malignancies infiltrating the lower urinary tract. A review was performed of the literature in PubMed over the last two decades. The most common nonurological pelvic tumors infiltrating the lower urinary tract are colorectal cancer, gynecological tumors, and sarcomas. For diagnosis, multiple non-invasive and invasive options are available and their use is partially tumor-specific. If infiltration to adjacent structures is given, en bloc resection should be performed to achieve clear margins. However, despite oncological con- siderations a bladder-sparing resection is often possible. Neoadjuvant or adjuvant therapy approaches are also tumor- specific. The overall 3-year survival rate is about 40 %. Nonurological tumors that infiltrate the lower urinary tract should be given multidisciplinary treatment. The patient's personal decision regarding acceptance of the surgical extent with possibly persistent disability should be considered.

Abstract: Surgical resection offers the only treatment associated with long-term survival for colorectal cancer (CRC) with hepatic metastasis. Imaging studies are paramount for the identification of potential surgical candidates. Synchronous hepatic disease is identified at presentation in 20–30 % of patients and ultimately, hepatic metastases occur in over 50 % of patients diagnosed with CRC. Computed tomography (CT) has been the imaging standard to identify patients with hepatic metastasis, but the array of preoperative imaging has expanded over the past several years. Currently, ultrasound, CT, magnetic resonance imaging, and positron emission tomography all play a vital role in the management and treatment of stage IV CRC. In addition, patient characteristics such as steatosis and treatment such as neoadjuvant chemotherapy affect imaging of hepatic metastases. The goal of this review is to discuss the current standing of imaging modalities used in the perioperative care of patients with colorectal liver metastasis.

Abstract: Short-term ventricular assist devices (VADs), percutaneous or surgical, are used in the settings of cardiogenic shock (CS) refractory to medical management, as bridges to myocardial recovery, heart transplantation, durable long-term devices, and in the aid of high-risk PCIs. Recent innovations in continuous-flow pump technology have contributed to the development of various short-term VADs with many impressive features. These include the CentriMag VAD and percutaneous VADs such as the Impella and TandemHeart VAD systems. With these and other advances in mechanical circulatory support, it is highly likely that the significant morbidity and mortality associated with CS are improving. However, clinical evidence supporting the use of these devices remains at the level of small case series. Rigorous clinical investigation is warranted to better quantify the contributions of device therapy to the management of CS.

Abstract: The optimal management of fulminant or complicated diverticulitis is the subject of debate in recent literature. The most common management strategy remains resection and end colostomy or Hartmann’s procedure, first introduced in the 1940s, despite the introduction of more current approaches supported by decreased morbidity and mortality by various studies. The purpose of this paper is to provide a review of the strategies described for the management of fulminant diverticulitis and the most recent evidence available to support these approaches. We discuss the advantages and disadvantages of the Hartmann’s procedure approach, as well as the most current management strategies, and offer both citation and review of relevant recent studies.

Abstract: The incidence of locally advanced prostate cancer has decreased in the last few decades since the introduction of screening programmes. Despite earlier detection and treatment, there is still a proportion of late presentation and/or recurrences (around 10 %) of locally advanced prostate cancer. Additionally, sporadic reports of synchronous pelvic neoplasms have been published with various treatment strategies to optimize patient survival. Pelvic exenteration is a technically demanding surgical procedure that is performed for locally advanced, recurrent or synchronous pelvic malignancies. The role of pelvic exenteration in locally advanced prostate cancer has been controversial, as there is a lack of strong statistical evidence to support its role. Despite this, studies have outlined benefits of this procedure, especially in the presence of synchronous pelvic cancers or for palliative indications. Despite advances in surgical care and techniques, pelvic exenteration remains a high-risk procedure with troublesome complications. However, with better patient selection, multi-disciplinary team (tumour board) involvement and surgery being performed in specialist high volumes centres, rates of morbidity and mortality have substantially reduced.

Abstract: The management of thyroid nodules with indeterminate cytology has traditionally been diagnostic thyroidectomy. However most nodules are benign, and for nodules that demonstrate histologic malignancy, two-stage thyroidectomy may be necessary. Molecular markers have emerged as an adjunct to preoperative FNAB cytology evaluation that can improve diagnostic accuracy. In this review, we discuss the latest methodologies and review diagnostic performance parameters of recent molecular marker techniques.

Abstract: Blunt abdominal trauma (BAT) can produce serious intra-abdominal injuries (IAI) in children. An early diagnosis is important to reduce morbidity and mortality, but pediatric patients sustaining BAT rarely require an operative intervention. Although the computed tomography (CT) scan is currently the best diagnostic tool to detect IAI, increased awareness of the risks of radiation exposure, high costs, and low utility has led to efforts to reduce the use of CT in the workup of pediatric trauma patients. Focused assessment with sonography for trauma (FAST) is an accurate, noninvasive, and rapid method of evaluating patients with BAT. Many institutions have developed criteria using physical signs and common biochemical markers of abdominal injury in combination with FAST as a screening tool to prevent the overuse of CT in children. We review the use of FAST and scoring systems as tools to limit CT imaging in the evaluation of the pediatric abdominal trauma patient.

Abstract: Intraoperative parathyroid hormone (iPTH) monitoring has significantly altered the approach to surgical management of hyperparathyroidism, from the traditional four-gland exploration to minimally invasive parathyroidectomy. Several published criteria for iPTH predict operative cure with good accuracy, though iPTH should always be interpreted against the background of a surgeon’s suspicion for multigland disease. Preoperative calcium and PTH levels as well a thorough understanding of the preoperative imaging modalities and their limitations is crucial. Current surgical strategies and iPTH utilization for four distinct patient populations are discussed.

Abstract: Resection of colorectal liver metastases (CRLM) represents the best chance for cure, but appropriate selection of patients can present challenging clinical scenarios. The PubMed database was searched for articles relevant to CRLM published between 1990 and December 2013. The ability to safely achieve curative resection depends heavily on the adequacy of the future liver remnant (FLR). The FLR volume can be improved through several techniques including portal vein embolization and surgical portal vein ligation with in situ liver split (ALPPS). Disappearing liver metastases (DLM) may develop as a result of robust response to chemotherapy. Concordance between radiographic DLM and true pathologic response is poor and up to 85 % of DLM that undergo resection will demonstrate viable tumor on pathological examination. The rate of true pathologic response for lesions treated with hepatic artery infusion may be higher. Modern chemotherapeutics and techniques to improve the FLR have increased the number of patients who are candidates for potentially curative resection. In cases of DLM, curative resection should aim to include all sites of disease present prior to systemic chemotherapy if possible.

Abstract: Novel GERD treatment modalities have emerged over the past decade as alternatives to proton pump inhibitors or traditional laparoscopic Nissen fundoplication. Four new devices—LINX, TIF, EndoStim and Stretta—have attempted to improve upon the limitations of these traditional therapies. While each is promising, only the LINX device addresses the patient’s symptoms, achieves objective control of acid and has limited the need for additional therapies. Further comparative research and longer term follow-up are necessary to determine the role of these therapies in the algorithm of GERD management.

Abstract: Primary bone tumors are rare, but their treatments have enjoyed considerable improvements in life expectancy because of chemotherapy. When combined with advances in surgery, patients can now expect lives and limbs to behave with greater longevity and normality. The challenge now is how to raise the plateau of survival, and that means finding a successful way to treat metastatic or unsalvageable local disease. It is clear that conventional chemotherapy has limitations and that the answer may lie in a better understanding of the intricate molecular workings of cancer and the pathways that lead to the latter’s growth, invasion, and dissemination. There have been great strides made in dissecting out the metastatic cascade with numerous important pathways and molecular switches identified. This has led to the introduction of a number of new drugs and molecules aimed at targeting the molecular vulnerabilities of cancer, allowing greater control of growth, invasion, and metastasis. Some of these have had a large impact on musculoskeletal malignancies. Future successes in treatment will require multimodal targeting of tumors whose signatures will be a composite of histologic and molecular markers that will pave the way for personalization of treatment strategies.

Abstract: Brain metastasis is associated with a poor overall prognosis, but combination therapies have emerged that may prevent recurrence or serve as palliative therapies. There is a wide range of treatment options for those with 1–3 intracranial metastases and stable disease, including combinations of surgery, whole brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS). Those with few, small metastases may be served well by SRS and adjuvant WBRT, whereas those with larger metastases that are amenable to resection may be treated with surgical excision and adjuvant WBRT. Whole brain radiation alone is reserved for individuals with greater than three brain metastases or unstable disease. A number of studies have been conducted to clarify the optimal treatment regimen for patients with varying intracranial disease. This review aims to synthesize the most current findings pertaining to the neurosurgical treatment of brain metastases.

Abstract: The contemporary management of hepatic colorectal adenocarcinoma metastasis relies on the multidisciplinary use of both local operative resection and systemic chemotherapy. This article will discuss the principles and data that are of relevance in determining the optimal way to combine these treatment modalities. In so doing, we will explore the issue of when and whether to administer chemotherapy for patients with resectable hepatic metastases.

Abstract: In the 1970s, the use of cardiopulmonary bypass at the bedside for critically ill patients with respiratory failure began and was termed extracorporeal membrane oxygenation (ECMO). Later, in the 1980s, applications for extracorporeal technology expanded, and included oxygenation, CO2 removal, and hemodynamic support. However, early studies regarding the use of ECMO for acute lung failure provided less than optimistic results. Today, recent research has created a renewed interest in such technology. There have been progressive advancements in artificial lung technology, and ECMO serves as a form of life support and as a bridge to transplantation for critically ill patients when traditional supportive care is no longer effective. These progressive advancements in artificial lung technology provide another tool in the critical care physician’s arsenal to combat this often fatal injury.