As introduced in last month's newsletter, we are quickly moving forward towards Accreditation of our Residency Training Programs in the Department of Surgery at the University of Toronto.  The dates of the Accreditation process will be April 8 – 12, 2013, and I should like to encourage all Chairs, Program Directors, and faculty to set those important dates aside to be available for meetings as they arise.  We have 10 programs which typically undergo review every six years by the Royal College.   We have learned that Orthopaedics and Vascular Surgery will not be reviewed next April because of recent programmatic changes.  And there is a small possibility that other Divisions will be exempt from on-site review based on the status of their Pre-Survey Questionnaires (PSQ’s).  This is part of a new pilot project the Royal College will be embarking on this year with the University of Toronto as a “test case”.
As most of you know, the General Standards of Accreditation are called the "B Standards", and are applicable to all residency programs.  These have been recently revised, and there a number of new standards to which all programs must adhere.  Some of these include the following:
1.  The residency program committee (RPC) must communicate regularly with members of the committee, the department or division, and residents. 
2.  The RPC or a subcommittee thereof must organize appropriate remediation or probation for any resident who is experiencing difficulties meeting the appropriate level of competence.  
3.  The RPC must make sure that the residents are aware of available services for appeals, ongoing career counselling, and stress management, and how to access them.
4.  There must be an effective mechanism to provide teaching staff in the program with honest and timely feedback on their performance.
5.  The learning environment of each component of the program must be evaluated.  
6.  The program must have effective mechanisms in place to manage issues of perceived lack of resident safety.
For those of you interested, the annotated version of the revised B Standards can be found at the following weblink:
Suffice it to say that I would like to see all our programs pass the Royal College Accreditation process, just as we did successfully 6 years ago in 2007.  With next month’s issue of Excelsior, I plan to review some additional new B Standards with you so that we can all be prepared for the site visit by the Royal College next April.  When it comes to matters such as this, in my opinion, repetition is a good thing!

James T. Rutka, MD, PhD, FRCSC
RS McLaughlin Chair


Department of Surgery University Rounds

Friday, December 7, 2012
7:30 a.m. – 8:30 a.m.

Clinical Epidemiology University Rounds
Selwyn O. Rogers, Jr., MD, MPH, FACS
George S. Peters, MD and Louise Peters
Professor and Chair in the Department of Surgery
At Temple University School of Medicine
Surgeon-in-Chief, Temple University Health Systems
 “Disparities in Surgical Care”
Hollywood Theatre, 1st Floor Elm Wing
Hospital for Sick Children
555 University Avenue
Department of Surgery University Rounds
January 11, 2013 - Research & Science Rounds - "Building a Better Operation:  Engineering in Surgery", Women’s College Hospital, Auditorium
Warren C.W. Chan, PhD
CRC in Bionanotechnology
IBBME University of Toronto
James M Drake, MD

Hospital for Sick Children
Victor Yang, MD, PhD
CRC in Bioengineering and Biophotonics
Department of Electrical and Computer Engineering, Ryerson University


Teodor Grantcharov, Jim Rutka, and Ren-Ke Li
2012 Lister and George Armstrong-Peters Prize Presentations (University Rounds) were held on Friday, November 2nd, 2012 at Li Ka Shing Knowledge Institute, St. Michael’s Hospital.  Dr’s Ren-Ke Li who received the Lister Award spoke on “Cardiac Rejuvenation”; and Teodor Grantcharov who received the George Armstrong-Peters Prize spoke on “Enhancing surgical performance and outcomes using simulation”.
Review of the Surgical Skills Centre at Mount Sinai for its American College of Surgeons (ACS) Accreditation took place on November 8th by Dr. Talboy from Kansas City.  The results of this review will be made known in the near future.  But special thanks are given to Lisa Satterthwaite, and Dr Oleg Safir for all the preparation and effort that went into preparing the documents for review by the ACS.
Inaugural Paintball Competition was held in the Division of Plastic & Reconstructive Surgery at Sergeant Splatters, Monday November 12th
Resident Leaders of Undergraduate Education dinner event and awards presentation was held November 8th at the Li Ka Shing Knowledge Institute.  Special thanks are given to George Christakis, Ron Levine, Ron Kodama, and Shibu Thomas for organizing the event.  
Continuing Appointment Reviews (CARS)

The following Continuing Appointment Reviews (CARs) took place this month under the leadership of Ori Rotstein, Associate Chair, Department of Surgery:
Jeremy Hall
Jeremy is a Surgeon Educator who joined the Division of Orthopaedic Surgery at St. Michael's Hospital in July 2009. His clinical interests include complex orthopaedic trauma and upper extremity reconstruction.  Jeremy graduated from the University of Toronto Medical School and Orthopaedic Residency Program in 2004. He undertook a fellowship with Dr. Michael McKee at St. Michael's Hospital in Upper Extremity Reconstruction, Trauma and Ilizarov Reconstruction. Thereafter, he worked as a Clinical Associate at St. Michael's for 4 years. During that time, he completed his M.Ed at the Ontario Institute for Studies in Education (OSIE/U of T).  Jeremy's research interests center around education and simulation as well as clinical trials. He was involved in the development of the fracture module of the groundbreaking Competency Based Curriculum in Orthopaedic Surgery and is well known for his teaching.  Photo from left to right:  J. Rutka, O. Rotstein, J. Hall, T. Daniels.
Gregory Borschel
Greg joined the Division of Plastic and Reconstructive Surgery at The Hospital for Sick Children in 2009 after spending 3 years on staff at Washington University, St. Louis, Missouri under the guidance of a former Toronto professor, Dr. Susan Mackinnon. In 1997, Greg enrolled in the Integrated Plastic Surgery Program at the University of Michigan, Ann Arbor. After graduation in 2005, he and his family moved to Toronto for sub-specialty training in Pediatric Plastic Surgery at the Hospital for Sick Children under Dr. Christopher Forrest. Greg has built up an impressive array of accolades, not the least of which is the American Association of Plastic Surgeons / KLS Academic Scholarship Award given only every two years to an outstanding new surgeon. He has rapidly developed an international reputation in the area of peripheral nerve injuries and repair.  Photo from left to right:  C. Pang, C. Forrest, J. Wright, G. Borschel.  

New Appointments to the Department of Surgery
I am pleased to announce the appointment of the following new faculty member in the Department of Surgery!
Dr. Jaskarndip Chahal has joined the Division of Orthopaedics/Sports Medicine at Women’s College Hospital. Jas is an orthopaedic sports medicine surgeon with a special interest in cartilage restoration and joint-preserving procedures.  His research expertise is in the realm of clinical epidemiology and he is also interested in translational research with the ultimate aim of providing the most effective and cutting-edge cartilage and ligament therapy that can be offered to patients.

Dr. Hugh G. Thomson (Emeritus, Plastic and Reconstruction Surgery) passed away November 17, 2012 at the age of 82. 
Dr. Thomson received his MD degree from the University of Toronto in 1954 and completed his training in Plastic Surgery in the Gallie Program at the University of Toronto in 1960 before doing a preceptorship under the supervision of Dr. H. Campbell in 1961.  He commenced his position at the Hospital for Sick Children in 1961, became a full Professor in 1982 and remained in active practice until 2000.  During his academic career, he gave over 140 presentations and invited lectures and published 102 peer reviewed publications and book chapters.
Dr. Thomson contributed significantly to the Canadian Society of Plastic Surgery. He served as the Society President in 1980 and was instrumental in the development of the “Resident’s Corner” which for most, is the focal point of the annual meeting. In addition to creating the Society logo, he should be recognized for establishing the "Beyond the Knife" segment of the Annual Canadian National Meeting.  This recognizes the extracurricular activities of the members of our Society and once more typifies the thoughtful nature of this individual who feels that play is as crucial to well-being as work.   

In 2009, Dr. Thomson was awarded the highest accolade by the Canadian Society of Plastic Surgeons, the Lifetime Achievement Award at its annual meeting in Kelowna, BC.

Ben Alman (Orthopaedics) received a grant from the U.S. Department of Defense Neurofibromatosis Research Program of the Office of the Congressionally Directed Medical Research Programs (CDMRP) for his project entitled “Discovery of novel drugs to improve bone health in Neurofibromatosis Type-1:  The Wnt/ β-catenin pathway in fracture repair and pseudarthrosis.
Bharati Bapat (Urology) recently received an award from the GAP Movember group for her project entitled “Global Urine Biomarker Project”. This award will utilize the biobank specimens as part of a global network of prostate biomarker discovery.
Anna Gagliardi, Bhattacharyya O, Brouwers M (General Surgery) received a one year Canadian Institutes of Health Research grant for her work on “Harmonizing and prioritizing implementability research with Canadian guideline developers, implementers and researchers”.
Anna Gagliardi, Umoquit M, Webster F, Brouwers MC, Baxter N, Finelli A, Gallinger S. (General Surgery) received a one year grant from CCO-OICR Health Services Research Program – Knowledge Translation Research Network for her project entitled “How does context influence knowledge exchange?: an ethnographic study to identify strategies for improving researcher-research user collaboration”.
Anna Gagliardi, Stuart-McEwan T, Gilbert J, Dobrow M, Hoch J, Wright FC, Brouwers MC, Meertens E, Kaan M, Campbell B, McCready M, Waddell T, McKnight S, Lacourciere J, McFadyen C, Berry M, Kaune S, Doiron G. (General Surgery) received a 3 year grant from the Canadian Breast Cancer Foundation – Ontario Chapter for their work entitled “Enhancing inter-professional collaborative care for cancer: Evaluation of diagnostic assessment programs”.
Ren-Ke Li (Thoracic Surgery) received a Queen Elizabeth II Diamond Jubilee Award.  This medal is awarded to those who have made significant contributions to their community or to Canada during their careers.  
Andres Lozano (Neurosurgery) is the recipient of the 2012 Olivecrona Medal from the Karolinska Institutet. The institute honors an international neurosurgeon annually for his or her contribution to brain and spinal cord surgery or research.
Robert Mustard (General Surgery) was the recipient of the Waddell Mentorship Award which recognizes surgeons with excellent character who serve as mentors for students, residents and Junior Faculty.
Avery Nathens (General Surgery) has been re-elected to the Board of Governors of the American College of Surgeons (ACS) as a Governor-at-Large representing the ACS Fellows in Ontario, 2012-2015.
Allan Okrainec (General Surgery) received an Association for Surgical Education (ASE) Center for Excellence in Surgical Education (CESERT) grant for his project entitled “The Reliability of Remote Fundamentals of Laparascopic Surgery Certification Using Web-Based Technology”.
Jim Rutka (Neurosurgery) gave the inaugural Ab Guha Lecture at the Society for Neuro-Oncology Annual Meeting in Washington DC, November 16, 2012; his presentation was entitled “Glioblastoma invasion:  Advances from the leading edge”.
Ranil Sonnadara (Surgical Skills Centre) and his team have received the 2013 Association for Surgical Education (ASE) Award for Excellence in Innovation.  This award is given annually to a group of individuals who have demonstrated exemplary performance in surgical education with the intent to recognize novel ideas and/or methods for improving teaching and learning.  Their award was received for the development of the University of Toronto Orthopaedic Boot Camp (TOBC) project. 
Alex Zlotta (Urology) received a European Association of Urology Platinum Award for dedication and innovation in urological research and practice.

Ahmed N, Conn LG, Chiu M, Korabi B, Qureshi A, Nathens AB, Kitto S.  Career Satisfaction Among General Surgeons in Canada: A Qualitative Study of Enablers and Barriers to Improve Recruitment and Retention in General Surgery.  Acad Med. 2012 Nov;87(11):1616-1621.
Blankstein M, Byrick RJ, Nakane M, Bang AK, Freedman J, Garvey MB, Zdero R, Schemitsch EH.  A Preliminary Study of Platelet Activation After Embolization of Marrow Contents.  J Orthop Trauma. 2012 Nov;26(11):e214-e220.
Brar SS, Seevaratnam R, Cardoso R, Law C, Helyer L, Coburn N.  A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer.  Gastric Cancer. 2012 Sep;15 Suppl 1:S89-99.
Brar SS, Seevaratnam R, Cardoso R, Yohanathan L, Law C, Helyer L, Coburn NG.  Multivisceral resection for gastric cancer: a systematic review.  Gastric Cancer. 2012 Sep;15 Suppl 1:S100-7.
Cardoso R, Bocicariu A, Dixon M, Yohanathan L, Seevaratnam R, Helyer L, Law C, Coburn NG.  What is the accuracy of sentinel lymph node biopsy for gastric cancer? A systematic review.  Gastric Cancer. 2012 Sep;15 Suppl 1:S48-59.
Cardoso R, Coburn NG, Seevaratnam R, Mahar A, Helyer L, Law C, Singh S.  A systematic review of patient surveillance after curative gastrectomy for gastric cancer: a brief review.  Gastric Cancer. 2012 Sep;15 Suppl 1:S164-167.
Cardoso R, Coburn N, Seevaratnam R, Sutradhar R, Lourenco LG, Mahar A, Law C, Yong E, Tinmouth J.  A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer.  Gastric Cancer. 2012 Sep;15 Suppl 1:S19-26.
Coburn NG.  Current issues in gastric cancer management.  Gastric Cancer. 2012 Sep;15 Suppl 1:S1.
Daddi N, Nakajima T, Tagawa T, Yasufuku K.  Transcervical resection of an ectopic mediastinal parathyroid adenoma.  Ann Thorac Surg. 2012 Nov;94(5):1740. doi: 10.1016/j.athoracsur.2012.04.011.
Erwin MW, Islam D, Eftekarpour E, Inman RD, Karim MZ, Fehlings MG.  Intervertebral Disc-Derived Stem Cells: Implications for Regenerative Medicine and Neural Repair.  Spine (Phila Pa 1976). 2012 Jul 4. [Epub ahead of print]
Furse A, Miller BJ, McCann C, Kachura JR, Jewett MA, Sherar MD.  Radiofrequency Coil for the Creation of Large Ablations: Ex Vivo and In Vivo Testing.  J Vasc Interv Radiol. 2012 Nov;23(11):1522-1528.
Gagliardi AR, Brouwers MC. Integrating guideline development and implementation: Analysis of guideline development manual instructions for generating implementation advice. Implementation Science 2012; 7: 67.
Gagliardi AR. “More bang for the buck”:  Exploring optimal approaches for guideline implementation. BMC Health Services Research 2012; 12: 404.
Gagliardi AR, Bhattacharyya O, Brouwers M. The Guideline Implementability Research and Application Network (GIRAnet): an international collaborative to support knowledge exchange. Implementation Science 2012; 7: 26.
Gagliardi AR. How can we improve mental health guideline implementation and impact? Epidemiology and Psychiatric Sciences, special issue on Implementation Science in Mental Health. April 2012; 21(3): 231-6.
Gandhi R, Santone D, Takahashi M, Dessouki O, Mahomed NN.  Inflammatory predictors of ongoing pain 2 years following knee replacement surgery.  Knee. 2012 Nov 14. doi:pii: S0968-0160(12)00208-6. 10.1016/j.knee.2012.10.015. [Epub ahead of print]
Gomez D, Haas B, de Mestral C, Sharma S, Hsiao M, Zagorski B, Rubenfeld G, Ray JG, Nathens AB.  Institutional and provider factors impeding access to trauma center care: An analysis of transfer practices in a regional trauma system.  J Trauma Acute Care Surg. 2012 Nov;73(5):1288-1293.
Grant RC, Sandhu L, Dixon PR, Greig PD, Grant DR, McGilvray ID.  Living vs. deceased donor liver transplantation for hepatocellular carcinoma: a systematic review and meta-analysis.  Clin Transplant. 2012 Nov 15. doi: 10.1111/ctr.12031. [Epub ahead of print]
Hill MD, Martin RH, Mikulis D, Wong JH, Silver FL, terBrugge KG, Milot G, Clark WM, Macdonald RL, Kelly ME, Boulton M, Fleetwood I, McDougall C, Gunarsson T, Chow M, Lum C, Dodd R, Poublanc J, Krings T, Demchuk AM, Goyal M, Anderson R, Bishop J, Garman D, Tymianski M.  Safety and efficacy of NA-1 in patients with iatrogenic stroke after endovascular aneurysm repair (ENACT): a phase 2, randomized, double-blind, placebo-controlled trial.  The Lancet Neurology: 11(11): 942-950, 2012.
Ibrahim GM, Fallah A, Snead OC, Rutka JT.  Changing global trends in seizure outcomes following respective surgery for tuberous sclerosis in children with medically intractable epilepsy.  Epilepsy Research and Treatment, October 30, 2012,Volume 2012, Article ID 135364.  Doi:10.1155/2012/135364. [Epub ahead of print]
Janis JE, Oʼneill AC, Ahmad J, Zhong T, Hofer SO.  Acellular dermal matrices in abdominal wall reconstruction: a systematic review of the current evidence.  Plast Reconstr Surg. 2012 Nov;130(5 Suppl 2):183S-193S.
Jeganathan R, Armstrong S, Al-Alao B, David T.  The Risk and Outcomes of Reoperative Tricuspid Valve Surgery.  Ann Thorac Surg. 2012 Oct 25. doi:pii: S0003-4975(12)01890-5. 10.1016/j.athoracsur.2012.08.058. [Epub ahead of print]
Jeganathan R, Maganti M, Badiwala MV, Rao V.  Concomitant mitral valve surgery in patients undergoing surgical ventricular reconstruction for ischaemic cardiomyopathy.  Eur J Cardiothorac Surg. 2012 Sep 14. [Epub ahead of print]
Kang K, Sun L, Xiao Y, Li SH, Wu J, Guo J, Jiang SL, Yang L, Yau TM, Weisel RD, Radisic M, Li RK.  Aged human cells rejuvenated by cytokine enhancement of biomaterials for surgical ventricular restoration.  J Am Coll Cardiol. 2012 Nov 20;60(21):2237-2249.
Kraft R, Herndon DN, Finnerty CC, Hiyama Y, Jeschke MG.  Association of Postburn Fatty Acids and Triglycerides with Clinical Outcome in Severely Burned Children.  J Clin Endocrinol Metab. 2012 Nov 12. [Epub ahead of print]
Leake PA, Cardoso R, Seevaratnam R, Lourenco L, Helyer L, Mahar A, Law C, Coburn NG.  A systematic review of the accuracy and indications for diagnostic laparoscopy prior to curative-intent resection of gastric cancer.  Gastric Cancer. 2012 Sep;15 Suppl 1:S38-47.
Leake PA, Cardoso R, Seevaratnam R, Lourenco L, Helyer L, Mahar A, Rowsell C, Coburn NG.  A systematic review of the accuracy and utility of peritoneal cytology in patients with gastric cancer.  Gastric Cancer. 2012 Sep;15 Suppl 1:S27-37.
Lwu S, Goetz P, Monsalves E, Aryaee M, Ebinu J, Laperriere N, Menard C, Chung C, Millar BA, Kulkarni AV, Bernstein M, Zadeh G.  Stereotactic radiosurgery for the treatment of melanoma and renal cell carcinoma brain metastases.  Oncol Rep. 2012 Nov 14. doi: 10.3892/or.2012.2139. [Epub ahead of print]
Macdonald RL.  Fish Oil for Subarachnoid Hemorrhage - this is not Snake Oil.  World Neurosurg. 2012 Nov 14. doi:pii: S1878-8750(12)01309-5.
Mahar AL, Brar SS, Coburn NG, Law C, Helyer LK.  Surgical management of gastric perforation in the setting of gastric cancer.  Gastric Cancer. 2012 Sep;15 Suppl 1:S146-52.
Mahar AL, Coburn NG, Karanicolas PJ, Viola R, Helyer LK.  Effective palliation and quality of life outcomes in studies of surgery for advanced, non-curative gastric cancer: a systematic review.  Gastric Cancer. 2012 Sep;15 Suppl 1:S138-145.
Mahar AL, Coburn NG, Singh S, Law C, Helyer LK.  A systematic review of surgery for non-curative gastric cancer.  Gastric Cancer. 2012 Sep;15 Suppl 1:S125-137.
Mansouri A, Fallah A, Cusimano MD, Das S.  Vasospasm post pituitary surgery: systematic review and 3 case presentations.  Can J Neurol Sci. 2012 Nov;39(6):767-73.
Nakajima T, Anayama T, Koike T, Shingyoji M, Castle L, Kimura H, Yoshino I, Yasufuku K.  Endobronchial Ultrasound Doppler Image Features Correlate with mRNA Expression of hif1-α and vegf-c in Patients with Non-Small-Cell Lung Cancer.  J Thorac Oncol. 2012 Nov;7(11):1661-1667.
Pippi Salle JL, Jesus LE, Lorenzo AJ, Romão RL, Figueroa VH, Bägli DJ, Reda E, Koyle MA, Farhat WA.  Glans amputation during routine neonatal circumcision: Mechanism of injury and strategy for prevention.  J Pediatr Urol. 2012 Nov 5. doi:pii: S1477-5131(12)00235-5. 10.1016/j.jpurol.2012.09.012.
Raziee HR, Cardoso R, Seevaratnam R, Mahar A, Helyer L, Law C, Coburn N.  Systematic review of the predictors of positive margins in gastric cancer surgery and the effect on survival.  Gastric Cancer. 2012 Sep;15 Suppl 1:S116-124.
Roberts P, Seevaratnam R, Cardoso R, Law C, Helyer L, Coburn N.  Systematic review of pancreaticoduodenectomy for locally advanced gastric cancer.  Gastric Cancer. 2012 Sep;15 Suppl 1:S108-115.
Seevaratnam R, Bocicariu A, Cardoso R, Mahar A, Kiss A, Helyer L, Law C, Coburn N.  A meta-analysis of D1 versus D2 lymph node dissection.  Gastric Cancer. 2012 Sep;15 Suppl 1:S60-9.
Seevaratnam R, Cardoso R, Mcgregor C, Lourenco L, Mahar A, Sutradhar R, Law C, Paszat L, Coburn N.  How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer?  A meta-analysis.  Gastric Cancer (2012) 15 (Suppl 1):S3-S18. 
Seevaratnam R, Coburn N, Cardoso R, Dixon M, Bocicariu A, Helyer L.  A systematic review of the indications for genetic testing and prophylactic gastrectomy among patients with hereditary diffuse gastric cancer.  Gastric Cancer. 2012 Sep;15 Suppl 1:S153-163.
Wei AC, Sandhu L, Devitt KS, Gagliardi AR, Kennedy ED, Urbach DR, Gallinger S, Baxter NN.  Practice Patterns for the Management of Hepatic Metastases from Colorectal Cancer: A Mixed Methods Analysis.  Ann Surg Oncol. 2012 Nov 3. [Epub ahead of print]
Wong SS, Roche-Nagle G, Oreopoulos G.  Acute thrombosis of an abdominal aortic aneurysm presenting as cauda equina syndrome.  J Vasc Surg. 2012 Oct 11. doi:pii: S0741-5214(12)01533-9. 10.1016/j.jvs.2012.06.092. [Epub ahead of print]
Zhong T, Wong KW, Cheng H, Ojha M, Srinivas C, McCluskey SA, Clarke H, Jacks L, Hofer SO.  Transversus abdominis plane (TAP) catheters inserted under direct vision in the donor site following free DIEP and MS-TRAM breast reconstruction: A prospective cohort study of 45 patients.  J Plast Reconstr Aesthet Surg. 2012 Nov 8. doi:pii: S1748-6815(12)00573-6. 10.1016/j.bjps.2012.09.034. [Epub ahead of print]
Zywiel MG, Johnson AJ, Mont MA.  Graduated introduction of orthopaedic implants: encouraging innovation and minimizing harm.  J Bone Joint Surg Am. 2012 Nov 7;94(21):e1581-1585. 
Have a new high impact paper in press or published?  Let us know at
For further information on divisional events, please go to the Surgery Bulletin Board