Surgery

The Department of Surgery’s formal Divisions—Orthopedic Surgery, Plastic Surgery, Urology, and General Surgery—provide an academic structure that facilitates the clinical work of the Department within functional programs, including breast reconstruction, transition-related surgery, endocrine surgery, orthopedic sports medicine, ambulatory joint replacement, and breast cancer surgery.

The team pioneers approaches for health system transformation to ambulatory surgical care, including outpatient breast reconstruction, thyroid cancer surgery, total joint replacement, and gastrointestinal surgery. They continuously develop innovative care pathways and technological solutions such as digital tools and care apps to create safe models for ambulatory surgery. They also implement new programs to address care needs of a marginalized populations that historically had been neglected within the public hospital system, such as the transition-related surgery program.

The clinical faculty are committed to an academic mission and have made significant contributions to education scholarship and research, with over $3 million in competitive grant funding from federal agencies between 2016 and 2021.

  • General Surgery (surgical ethics; thyroid cancer surgery, gastrointestinal surgery, health system transformation – single entry models, shortening surgical wait times.)
  • Orthopedic Surgery (same day total joint replacement surgery; the use of orthobiologics in the treatment of osteoarthritis; virtual care follow up after knee arthroscopic surgery; clinical research in sports medicine)
  • Plastic and Reconstructive Surgery (outpatient breast reconstruction; clinical outcomes of breast implants used in aesthetic and reconstructive breast surgery)
  • Urology (Transition-Related Surgery Program; male reproductive medicine and surgery)

Our Team

  • David Urbach MD, MSc, FRCSC, FACS, Vice President and Lead Medical Executive (Interim); Head, Department of Surgery
  • Karen Devon MD, FRCSC, Surgeon-Ethicist; Medical Director, Endocrine Surgery
  • David Lim MDCM MEd PhD FRCSC, Clinical Associate; Medical Director, Breast Surgical Oncology (Acting)

  • John Semple MD, MSc, FRCSC, FACS, LLD, Head, Division of Plastic and Reconstructive Surgery
  • Kathleen (Katie) Armstrong MD MSc FRCSC, Surgeon-Investigator
  • Mitch Brown MD MEd FRCSC Surgeon-Teacher

  • Jas Chahal MD, FRCSC, MSc, MBA, Head, Division of Orthopedic Surgery
  • John Theodoropoulos MD, FRCSC, MSc o Tim Dwyer MD, FRCSC, MBBS, FRACS, PhD
  • Sam Park MD, MASc, FRCSC
  • Danny Whelan MD, MSc, FRCSC

  • Ethan Grober MD, MEd, FRCSC, Head, Division of Urology
  • Yonah Krakowsky MD, FRCSC, Surgeon-Teacher; Assistant Program Director, Urology;
  • Medical Director, Transition-Related Surgery Program
  • Alexandra (Alexi) Millman, Clinical Associate
  • Emery Potter NP-PHC Nurse Practitioner, Transition-Related Surgery Program
  • Marudan Sivagurunatha PhD, Post-doctoral Fellow, Transition-Related Surgery Program

  • Julie Takata MA, CCRP, Research Lead

Active Studies

  • Using real-world data to simulate the effects of efficient referral strategies on wait times for elective surgery in Canada. David Urbach (PI)
  • Women’s Virtual Care Research Laboratory. David Urbach (PI)
  • The characterization and impact of patient, tumour and treatment disparities on survival outcomes for invasive lobular breast cancer (ILC): a population-based observational cohort study. David Lim (PI)

  • Let’s Stop OA: Development and feasibility testing of an intervention to manage knee osteoarthritis risk factors after anterior cruciate ligament injury. Jas Chahal (PI)
  • Establishing the relationship between post-operative pudenal nerve palsy and table traction during hip arthroscopy in adults: A prospective cohort. Tim Dwyer (PI)
  • Establishing predictive factors of success for non-operative management of femoroacetabular impingement in a prospective cohort. Jas Chahal (PI)
  • The STaR Trial – Surgical Timing and Rehabilitation for Multiple Ligament Knee Injuries:A Multicenter Integrated Clinical Trial Funded by the US Department of Defense (DoD). Danny Whelan (Site PI) o STABILITY 2: ACL Reconstruction +/- Lateral Tenodesis with Patellar vs. Quad Tendon Funded by Canadian Institute for Health Research (CIHR). Danny Whelan (Site PI)

  • An International Multiphase Program of Research to Develop and Implement a Patient-Reported Outcome Measure for Gender-Affirming Treatments (GENDER-Q). John Semple (Co-I)

  • Neovaginal health for transfeminine people: the microbiome, inflammation, and post-vaginoplasty outcomes. Emery Potter (Site PI), Yonah Krakowsky (Co-I)
  • Exploring the relationship between gender, body image and pain – a mixed models approach. Emery Potter (Site PI)
  • Trans(forming) the Medical Gaze: a Hermeneutic Phenomenology of Transgender Patients’ Lived Experiences Accessing Transition-Related Surgery and Their Health Care Interactions. David Urbach, Marudan Sivagurunathan, Yonah Krakowsky (Co-Is)

Key Findings & Publications

  • Ellison CE, Ferreres A, Angelos P, Devon KM, McLeod R. A Moment to Reflect on the Importance of Ethical Leadership in Academic Medicine. Annals of Surgery. 2021; 273:e46-49.
  • Canadian Thyroid Cancer Active Surveillance Study Group Investigators. Decision-making on surgery or active surveillance for low-risk papillary thyroid cancer during the COVID-19 pandemic. Cancers. 2021;13(3):371
  • Devon KM. Valete e Plaudite. Journal of Clinical Oncology. 2020:38:3971-72. Principal Author.
  • Devon KM, Sade R. How I Teach It: Ethics. Annals of Thoracic Surgery. 2020;110:1805-8. Principal Author.
  • Nemetz E, Urbach D, Devon KM. The art of surgery: balancing compassionate with virtual care. Journal of Medical Internet Research. 2020;22(8):e22417 Senior Responsible Author.
  • Naderi B, Roshanaei V, Begen MA, Aleman DM, Urbach DR. Increased surgical capacity without additional resources: Generalized operating room planning and scheduling. Production and Operations Management. 2021. Epub ahead of print. https://doi.org/doi:10.111/poms.13397.
  • Elnahas AI, Doumouras AG, Anvari M, Schlachta CM, McClure A, Alkhamesi NA, Hawel JD, Urbach DR. Access to bariatric surgery among older patients in a publicly funded regionalized care system. Surg Endosc. 2021 Jan 4. Epub ahead of print. Senior Responsible Author.
  • Segall RE, Takata JL, Urbach DR. Wait-time reporting systems for elective surgery in Canada: a content analysis of provincial and territorial initiatives. CMAJ Open. 2020 Dec 10:8(4):E844-E851. Senior Responsible Author.
  • Sapisochin G, Muaddi H, Baxter NN, Stukel TA, Lawless B, Urbach DR. Implementation of Critical Care Response Teams in Ontario: Impact on the Outcome of Surgical Patients. Ann Surg. 2020 Nov 17. Epub ahead of print. Senior Responsible Author.
  • Urbach DR, Martin D. La chirurgie en crise à l’ère de la COVID-19: changements transformationnels en vue. CMAJ. 2020 Nov 9;192(45):E1432-E1433. Principal Author.

  • Hoit G, Whelan DB, Dwyer T, Ajrawat P, Chahal J. Physiotherapy as an Initial Treatment Option for Femoroacetabular Impingement: A Systematic Review of the Literature and Meta-analysis of 5 Randomized Controlled Trials. Am J Sports Med. 2020 Jul;48(8):2042-2050. doi: 10.1177/0363546519882668. Epub 2019 Nov 27. PMID: 31774704.
  • Dwyer T, Whelan D, Shah PS, Ajrawat P, Hoit G, Chahal J. Operative Versus Nonoperative Treatment of Femoroacetabular Impingement Syndrome: A Meta-analysis of Short-Term Outcomes. Arthroscopy. 2020 Jan;36(1):263-273. doi: 10.1016/j.arthro.2019.07.025. PMID: 31864588.
  • Hoit G, Farag J, Whelan DB. Neurologic Assessment and Management of the Multiple Ligament Injured Knee: A Review and Synthesis of Current Evidence. J Knee Surg. 2020 Apr;33(4):339-345. doi: 10.1055/s-0039-3401828. Epub 2019 Dec 24. PMID: 31874466.
  • Dwyer T, Zochowski T, Ogilvie-Harris D, Theodoropoulos J, Whelan D, Chahal J. Determining the Patient Acceptable Symptomatic State for Patients Undergoing Arthroscopic Partial Meniscectomy in the Knee. Am J Sports Med. 2020 Mar;48(4):847-852. doi: 10.1177/0363546520904017. PMID: 32167840.
  • Wengle L, Betsch M, Theodoropoulos J, Chahal J, Leroux T. The Effects of Blood Flow Restriction in Patients Undergoing Knee Surgery: A Systematic Review and Meta-Analysis. The American Journal of Sports Medicine. 2021 Feb. Accepted.
  • Tat Ji, Tat Je, Theodoropoulos J. Clinical applications of ultrasonography in the shoulder for the Orthopedic Surgeon: A systematic review. Orthopaedics & Traumatology: Surgery & Research. 2020 Jun. Accepted.
  • Dwyer T, Chahal J, Murnaghan L, Theodoropoulos J, Cheung J, McParland A, Ogilvie-Harris D. Development of a certification examination for Orthopaedic Sports Medicine Fellows. Canadian Journal of Surgery. 2020 May.
  • Petrera M, Ogilvie-Harris DJ, Theodoropoulos JS, Chahal J, Wasserstein D, Veillette C, Linda D, Dwyer T. Inter-surgeon variability in the identification of clock face landmarks when placing suture anchors during arthroscopic Bankart Repair Shoulder Elbow. 2019 Dec;11(6):419-423. doi: 10.1177/1758573218797964.
  • Dwyer T, Zochowski T, Ogilvie-Harris D, Theodoropoulos J, Whelan D, Chahal J. Determining the patient acceptable symptomatic state for patients undergoing arthroscopic partial meniscectomy in the knee. Am J Sports Med. 2020 Mar;48(4):847-852. doi: 10.1177/0363546520904017.
  • J Higgins, J Chang, G Hoit, J Chahal, T Dwyer, J Theodoropoulos. Conventional Follow-up Versus Mobile App Home Monitoring for Post-Operative ACL Reconstruction Patients: A Randomized Controlled Trial. Arthroscopy. March 28, 2020.
  • Jeyaseelan L, Park SS, Al-Rumaih H, Veljkovic A, Penner M, Wing K, Younger A. Outcomes following total ankle arthroplasty: A review of the registry data and current literature. Orthop Clin North Am. 2019 Oct;50(4):539-548.
  • Park SS, Zhang L, Attia T, Salat P, Banks K, Willett T, Grynpas M. Pre-clinical evaluation of bone allograft toughened with a novel sterilization method: An in vivo rabbit study. J Orthop Res. 2019 Apr;37(4):832-844.

  • Armstrong KA, von Schroeder H, Zhong T, Baxter N, Huang A, McCabe S. (2019). Stable rates of operative treatment of distal radius fractures in Ontario, Canada: a population based retrospective cohort study (2004-2013).Canadian Journal of Surgery. 62(6): 016218.
  • Armstrong KA, Coyte PC, Brown M, Beber B, Semple JL. Effect of Home Monitoring via Mobile App on the Number of In-Person Visits Following Ambulatory Surgery: A Randomized Clinical Trial. JAMA Surgery. 2017;152(7):622-627.

  • Grober ED (Guidelines Chair), et al. Canadian Urological Association Clinical Practice Guideline – Testosterone Deficiency in Men: Evidence-Based Q&A. Canadian Urological Association Journal (CUAJ) 2021 (Accepted Dec 2020, in press)
  • Gupta A, Lawendy B, Goldenberg MG, Grober ED, Lee JY, Perlis N. Can video games enhance surgical skills acquisition for medical students? A systematic review. Surgery. 2021 Jan 5:S0039-6060(20)30819-9. doi:10.1016/j.surg.2020.11.034. Epub ahead of print. PMID: 33419578.
  • Grober ED, Tobe S. Microscopic evaluation of the vasal fluid for sperm at the time of vasectomy reversal: Do we really need to check? Can Urol Assoc J. 2021 Jan 4. doi: 10.5489/cuaj.6980. Epub ahead of print. PMID: 33410743.
  • Kwong JCC, Krakowsky Y, Grober E. Testosterone Deficiency: A Review and Comparison of Current Guidelines. J Sex Med. 2019 Jun;16(6):812-820. doi: 10.1016/j.jsxm.2019.03.262. Epub 2019 May 9. PMID: 31080101.
  • Anderson K, Krakowsky Y, Potter E, Hudson J, Cox AR. Adult transgender care: A review for urologists. Can Urol Assoc J. 2021 Oct;15(10):345-352. doi: 10.5489/cuaj.6949. PMID: 33750518; PMCID: PMC8525536.
  • Domes T, Najafabadi BT, Roberts M, Campbell J, Flannigan R, Bach P, Patel P, Langille G, Krakowsky Y, Violette PD. Canadian Urological Association guideline: Erectile dysfunction. Can Urol Assoc J. 2021 Oct;15(10):310-322. doi: 10.5489/cuaj.7572. PMID: 34665713; PMCID: PMC8525522.
  • Francis C, Grober E, Potter E, Blodgett N, Krakowsky Y. A Simple Guide for Simple Orchiectomy in Transition-Related Surgeries. Sex Med Rev. 2020 Jul;8(3):492-496. doi: 10.1016/j.sxmr.2019.11.004. Epub 2020 Jan 17. PMID: 31959532.
  • Britt D, Blankstein U, Lenardis M, Millman A, Grober E, Krakowsky Y. Availability of platelet-rich plasma for treatment of erectile dysfunction and associated costs and efficacy: A review of current publications and Canadian data. Can Urol Assoc J. 2021 Jun;15(6):202-206. doi: 10.5489/cuaj.6947. PMID: 33212009; PMCID: PMC8195577.
  • Millman AL, Rebullar K, Millman RD, Krakowsky Y. Female Sexual Dysfunction – Awareness and Education Among Resident Physicians. Urology. 2021 Apr;150:175-179. doi: 10.1016/j.urology.2020.05.055. Epub 2020 Jun 9. PMID: 32531465.
  • Krakowsky Y, Potter E, Hallarn J, Monari B, Wilcox H, Bauer G, Ravel J, Prodger JL. The Effect of Gender-Affirming Medical Care on the Vaginal and Neovaginal Microbiomes of Transgender and Gender-Diverse People. Front Cell Infect Microbiol. 2022 Jan 21;11:769950. doi: 10.3389/fcimb.2021.769950. PMID: 35127550; PMCID: PMC8814107.
  • MacKinnon KR, Ashley F, Kia H, Lam JSH, Krakowsky Y, Ross LE. Preventing transition “regret”: An institutional ethnography of gender-affirming medical care assessment practices in Canada. Soc Sci Med. 2021 Dec;291:114477. doi: 10.1016/j.socscimed.2021.114477. Epub 2021 Oct 11. PMID: 34666278.
  • Shiff B, Blankstein U, Hussaen J, Jarvi K, Grober E, Lo K, Lajkosz K, Krakowsky Y. The impact of cannabis use on male sexual function: A 10-year, single-center experience. Can Urol Assoc J. 2021 Dec;15(12):E652-E657. doi: 10.5489/cuaj.7185. PMID: 34171210; PMCID: PMC8631840.
  • Aditya I, Kwong JCC, Krakowsky Y, Grober ED. Non-conventional therapies for Peyronie’s disease: what is the evidence for efficacy? Transl Androl Urol. 2020 Mar;9(Suppl 2):S295-S302. doi: 10.21037/tau.2019.09.36. PMID: 32257870; PMCID: PMC7108993.
  • MacKinnon KR, Grober E, Krakowsky Y. Lost in transition: Addressing the absence of quality surgical outcomes data in gender-affirming surgeries. Can Urol Assoc J. 2020 Jun;14(6):157-158. doi: 10.5489/cuaj.6610. PMID: 32525796; PMCID: PMC7654671.
  • Hana T, Raveendran L, Grober E, Potter E, Blodgett N, Krakowsky Y. Initial clinical experience with simple orchiectomy procedures in the context of transition-related surgeries. Int J Transgend Health. 2020 Jun 9;21(4):403-409. doi: 10.1080/26895269.2020.1774030. PMID: 34993518; PMCID: PMC8726671.\
  • Kronk CA, Everhart AR, Ashley F, Thompson HM, Schall TE, Goetz TG, Hiatt L, Derrick Z, Queen R, Ram A, Guthman EM, Danforth OM, Lett E, Potter E, Sun SED, Marshall Z, Karnoski R. Transgender data collection in the electronic health record: Current concepts and issues. J Am Med Inform Assoc. 2022 Jan 12;29(2):271-284. doi: 10.1093/jamia/ocab136. PMID: 34486655; PMCID: PMC8757312.