TAG: "Surgery"

Docs who rock


Band of surgeons, started at UCLA, plays gigs to raise money for charity.

From left: Drs. Solomon Poyourow, Phuong Nguyen, Jason Roostaeian and Robert Kang.

Watch out Weezer and Smashing Pumpkins. Help the Doctor, an indie rock band made up of four surgeons moonlighting as hip musicians, is generating cutting-edge buzz.

A project that began as a much-needed release from their demanding careers has become a successful band, complete with a fan base, a sold-out performance at the House of Blues and gigs at the Troubadour, the Roxy, the Viper Room and the Dragonfly.

UCLA plastic surgeon Dr. Jason Roostaeian

Dr. Jason Roostaeian, a plastic surgeon on staff at Reagan UCLA Medical Center, performs on bass and vocals alongside his colleagues and fellow plastic surgeons Dr. Robert Kang, with vocals and guitar, and Dr. Phuong Nguyen, adding lead vocals and guitar. Completing the fab four is oral surgeon Dr. Solomon Poyourow on drums.

The four surgeons met during their residency training at the medical center in 2011 and discovered they shared a passion for music that started long before they became doctors. They had all played for different bands.

So they decided to put their talents to work to help raise funds for organizations like “Facing Forward,” which provides pro bono surgeries for children with severe facial and skull deformities. “Being able to create music together is the fun part, but now having the opportunity to help raise money for charities has made it truly special for us,” Roostaeian said.

The group decided to use the title, “Help the Doctor,” based on a common operating room experience, Roostaeian said in an email. “As surgeons, you would give each other flack if your assistant surgeon or nurses were not helping the way you saw fit.”

At first, the band members used aliases on stage — Jay Roost, Rip Towns, P. Danger and Sol Power.  “We wanted to separate our professional names from stage names because we feared it would give patients the wrong impression,” Roostaeian said. “However, at this point, most of our patients appreciate the fact that we perform and give to charity so we’d rather use our real names.”

Coordinating practice time for four busy doctors can be challenging. While Roostaeian works at UCLA, the others are in private practice, at City of Hope and at the University of Toronto temporarily doing a fellowship.

Typically, they squeeze in jam sessions when they can, usually after full days of surgery when everyone shows up in scrubs, said Kang. “It’s not easy, but the end product has been well worth it!” Roostaeian said.

For their next gigs, the UCLA plastic surgeon said they are looking at possible dates in late November. Meanwhile, fans, many of whom are UCLA doctors, nurses and staff, can listen to their music on the band’s Facebook page and iTunes.

But don’t look for Help the Doctor to go on tour soon. “I wouldn’t call the band a second career,” said Roostaeian. “Plastic surgery is my career. Creating music is a passion of mine that I have always had, and I am just happy to be able to continue it, especially with such a great group of guys and for charity. It really doesn’t get any better.”

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UC Davis opens clinic to treat thoracic outlet syndrome


Rare condition most often the outcome of trauma, repetitive movements or extra ribs.

Julie Freischlag, UC Davis

UC Davis Health System has opened a clinic dedicated to treating a rare and complex condition called thoracic outlet syndrome (TOS), which occurs when blood vessels or nerves running from the upper body through the arm become compressed, causing problems ranging from reduced mobility and pain to life- and limb-threatening blood clots. It is most often the outcome of trauma, repetitive movements or extra ribs that are present at birth.

The clinic is led by Julie Freischlag, who, in addition to being an internationally recognized vascular surgeon and TOS expert, is vice chancellor for human health sciences and dean of the School of Medicine at UC Davis. Freischlag is known for advancing a surgical treatment for TOS that involves removing the anterior scalene muscle in the neck and first rib through an incision in the armpit to reduce compression and restore use of the limbs.

The procedure helped one of the clinic’s first patients, Amy Leach, who experienced ongoing pain, swelling and tiredness for years following an automobile accident that broke her neck and ribs. As part of a comprehensive exam, Leach was asked to hold her hands above her head and move her fingers for two minutes. One hand turned white — a sign of limited circulation and distinguishing feature of TOS.

Leach’s symptoms significantly improved following her surgery on July 3.

“I feel unbelievably different, not just in my arm but overall, too,” she said. “Simple, everyday tasks that were extremely difficult are now possible and my energy is returning. I’m having a hard time pacing myself as I recover.”

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Advancing brain surgery to benefit patients


Minimally invasive brain surgery at UC San Diego Health System.

Clark Chen, UC San Diego

In a milestone procedure, neurosurgeons at UC San Diego Health System have integrated advanced 3-D imaging, computer simulation and next-generation surgical tools to perform a highly complex brain surgery through a small incision to remove deep-seated tumors. This is the first time this complex choreography of technologies has been brought together in an operating room in California.

“Tumors located at the base of the skull are particularly challenging to treat due to the location of delicate anatomic structures and critical blood vessels,” said neurosurgeon Clark C. Chen, M.D., Ph.D., UC San Diego Health System. “The conventional approach to excising these tumors involves long skin incisions and removal of a large piece of skull. This new minimally invasive approach is far less radical. It decreases the risk of the surgery and shortens the patient’s hospital stay.”

“A critical part of this surgery involves identifying the neural fibers in the brain, the connections that allow the brain to perform its essential functions. The orientation of these fibers determines the trajectory to the tumor,” said Chen, vice chairman of academic affairs for the Division of Neurosurgery at UC San Diego School of Medicine. “We visualized these fibers with restriction spectrum imaging, a proprietary technology developed at UC San Diego. Color-coded visualization of the tracts allows us to plot the safest path to the tumor.”

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Pancreatic surgery complications and impact on hospital costs


UC Davis research challenges current strategies.

Rick Bold, UC Davis

When it comes to a specific type of pancreatic surgery, post-operative complications have a far greater impact on total cost than does how long the patient stays in the hospital, according to a published paper by UC Davis researchers.

The finding, published in JAMA Surgery, challenges current cost-cutting strategies routinely used by administrators and insurers that emphasize shorter lengths of stay in the hospital. Results of the new study point to a different, potentially more effective approach: a focus on reducing surgery complications.

The surgery examined for this study was the pancreaticoduodenectomy, a major operation that involves removal of parts of the stomach, duodenum, pancreas, bile duct and gallbladder. The surgery is performed to remove cancerous tumors or to deal with an inflamed pancreas.

“Hospitals are increasingly motivated to implement clinical care pathways as a method of improving quality of care, with a focus on elimination of excess resource utilization and shortening the hospital length of stay,” said lead author Richard Bold, professor and chief of surgical oncology at the UC Davis Comprehensive Cancer Center. “This study’s results reveal that addressing post-operative complications should be a critical component of these pathways.”

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Robot-assisted technique improves surgeons’ ability to remove kidney tumors


UCLA-led study finds the approach may shorten surgeries, could reduce risk of complications.

Schematic showing the robotic device's proper position during surgery. (Image by Eric Treat, UCLA)

Roughly 50,000 Americans are diagnosed with kidney cancer each year. Most of them have small tumors that doctors discover while screening for other health problems.

The surgeries to remove renal tumors can be difficult, particularly if the cancer is on the posterior side of the kidney and if patients have had previous abdominal surgery, because scar tissue from previous operations usually makes it hard for surgeons to distinguish the normal parts of the body from one another.

Now, a study led by Dr. Jim Hu and researchers at UCLA’s Jonsson Comprehensive Cancer Center has shown that a newer surgical technique called robot-assisted retroperitoneoscopic partial nephrectomy is more effective than other current techniques to remove kidney tumors when the masses are located on the back of the kidney or when a patient has had previous abdominal surgery. RARPN is a minimally invasive laparoscopic procedure in which surgeons use precise robotic arms and magnified, high-definition 3-D cameras.

The study, published online in European Urology, was the largest multicenter study to date on this technique. The five-year project reviewed surgeries for 227 patients whose average age was 60, with most between ages 52 and 66.

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Rapid surgical innovation puts patients at risk for medical errors


UC San Diego surgeons call for national safety measures to protect patients.

Kellogg Parsons, UC San Diego

Researchers at the UC San Diego School of Medicine have found that the risk of patient harm increased twofold in 2006 – the peak year that teaching hospitals nationwide embraced the pursuit of minimally invasive robotic surgery for prostate cancer. Results of the study are published in the July 2 online issue of JAMA Surgery.

“This study looked at the stages of innovation and how the rapid adoption of a new surgical technology—in this case, a surgical robotic system — can lead to adverse events for patients,” said Kellogg Parsons, M.D., M.H.S., surgical oncologist, UC San Diego Health System and first author of the paper. “There is a real need for standardized training programs, rules governing surgeon competence and credentialing, and guidelines for hospital privileging when novel technologies reach the operating rooms of teaching and community hospitals.”

In 2003, there were an estimated 617 minimally invasive robotic prostatectomies (MIRPs) performed in the United States. By 2009, this number increased to 37,753 procedures. In 2005, patients were twice as likely to experience an adverse event if they were undergoing MIRPs compared to a traditional open surgical procedure. The following year – 2006 – was considered the tipping point for the adoption of MIRP when it equaled or exceeded 10 percent of all cases.

“The trend observed here is not new to robotic surgery. The same phenomena occurred with the move to minimally invasive approaches to gallbladder and kidney surgeries, both surgeries that are now well documented to improve safety and outcomes,” said Christopher Kane, M.D., professor of surgery and interim chair of the Department of Surgery, UC San Diego School of Medicine, who was not involved with the study. “Whenever a new technology is adopted, there is a temporary period where there may be an increased risk to the patient. This can be reduced by extensive surgical training, vigorous credentialing standards and extended mentorship by experienced surgeons.  This report should encourage the adoption of more rigorous credentialing standards proposed by professional organizations rather than by individual hospitals.”

Kane added that robotic prostatectomy by experienced surgeons has proven to be beneficial to the patient with less blood loss, reduced infections and shorter hospital stays.

“A responsibility of deploying a surgical technology should include the responsibility to monitor it as it diffuses throughout the real world to ensure safety,” said David C. Chang, Ph.D., M.P.H., M.B.A., director of outcomes research at UC San Diego School of Medicine and the paper’s senior author.  “Surveillance of surgical safety should be ongoing, much like the Centers for Disease Control monitor changes in trends of infectious diseases across the country.”

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UC Davis names chief of trauma surgery


Joseph Galante selected.

Joseph Galante, UC Davis

Joseph Galante has been named chief of the UC Davis Division of Trauma, Surgical Critical Care and Acute Care Surgery. He previously served as the division’s trauma medical director and interim chief, in addition to serving as vice chair for education and director of the general surgery residency program for the Department of Surgery.

Galante is a fellow of the American College of Surgeons and a member of the American Association for the Surgery of Trauma. After receiving his medical degree from Temple University, he received his general surgical training and completed his trauma and critical care fellowship at UC Davis, where he received the Outstanding Chief Resident Award. In 2012, he was named by the Sacramento Business Journal as one of its “40 under 40,” an annual recognition of up-and-coming professionals who have made important community contributions. He also received the Department of Surgery Outstanding Faculty Teaching Award in 2013.

In addition to his work at UC Davis, Galante is a member of the U.S. Naval reserves who has served with distinction both in the U.S., Western Pacific and Afghanistan. His research focuses on improving medical treatment in response to disasters and utilizing military medical technology to benefit civilian practice. As a teacher and mentor, he is training health-care providers who treat those in the armed forces. Among his many military honors are the Navy Commendation Medal, three Navy and Marine Corps Achievement medals and the Military Outstanding Volunteer Service Medal.

Galante has served as a team physician to the FBI SWAT team in Sacramento and as a physician member of the disaster medical assistance team in the California region of the Federal Emergency Management Agency.

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Surgical biopsy proves safe for selected late-stage lung cancer patients


UC Davis findings should promote use of targeted treatments.

David Cooke, UC Davis

Researchers at UC Davis have determined that surgical biopsies can be safely performed on select patients with late-stage non-small cell lung cancer, which should enhance their access to drugs that target specific genetic mutations such as epidermal growth factor receptor (EGFR).

The findings, which will be published in the July issue of General Thoracic Surgery, address a common problem in treatment for advanced lung cancer: insufficient tumor tissue available for molecular analysis, which is required before prescribing targeted therapy.

“We will be allowing more people to be eligible for clinical trials, and ultimately that will provide value to the patient and access to treatments they may not have had otherwise,” said study lead author David T. Cooke, assistant professor and head of general thoracic surgery at UC Davis Medical Center.

In many cases of late-stage lung cancer, surgical biopsy is deemed too dangerous, so less invasive approaches are used, including fine needle aspiration and core needle biopsies.

“With clinical trials of new targeted therapies, an exhausting level of testing is performed,” Cooke said.  “With non-invasive biopsies, often there is not enough volume of cells collected to do the molecular testing.”

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Peer feedback through social media helps resident improve surgery skills


The process gives surgeons an ‘egoless’ opportunity to refine techniques.

Jim Hu, UCLA

Surgical residents who received anonymous feedback from their peers through a social networking site showed greater improvement in their robotic surgery skills than those who received no such feedback, a UCLA study shows.

The study, published in the early online edition of Annals of Surgery, is the first to examine the use of social networking to facilitate peer review of surgical procedure videos, said senior author Dr. Jim Hu, the Henry E. Singleton Professor of Urology and director of robotic and minimally invasive surgery in the urology department at the David Geffen School of Medicine at UCLA.

Research participants included 41 urology and gynecology residents from UCLA and the University of Michigan who used a robotic surgery simulator to sew and tie two tubes together. The residents were randomized into one of two groups — an intervention group in which the residents videotaped their efforts and posted the videos on a Google Plus group forum for anonymous review and comment by their peers in the same group, and a control group in which participants did not videotape or post their work for review.

The residents performed the same simulated robotic procedure three times. The study found that residents in the intervention group improved their technique in subsequent attempts, had shorter completion times and earned better scores from the simulator for technical efficiency, accuracy and economy of motion.

“We have demonstrated that social networking can be a viable forum for coaching, both for residents honing their craft and for practicing surgeons,” Hu said. “Technique matters, regardless of what type of surgery you’re doing. Surgeons who invest time in reviewing their techniques on video and seek the feedback and coaching of others ultimately will do better in terms of performance.”

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Joint Commission certifies UC Irvine hip, knee replacement programs


Gold Seal of Approval denotes commitment to highest quality patient care.

UC Irvine Health has earned The Joint Commission’s Gold Seal of Approval for its hip and knee joint replacement programs by demonstrating compliance with the organization’s national standards for health care quality and safety in disease-specific care.

UC Irvine Health underwent a rigorous on-site review in May. A Joint Commission expert evaluated the programs for compliance with standards of care specific to the needs of patients and families, including infection prevention and control, leadership and medication management.

The commitment to these standards is reflected in the UC Irvine Health Joint Replacement Surgical Home. Developed at UC Irvine Medical Center, this model coordinates the roles of orthopaedic surgeons, anesthesiologists and nursing staff before, during and after surgery to ensure that patients receive the most efficient and comprehensive care available. The surgical home model has measurable standards for perioperative care and ensures that potential improvements are identified and incorporated into the program.

“The ability to achieve such high level of care and patient satisfaction is only possible due to the dedication and hard work put in daily by our joint replacement surgical home team,” said Ran Schwarzkopf, M.D., assistant clinical professor, UC Irvine Health Department of Orthopaedic Surgery and head of the hip and knee surgery service. “It is this team work that allows us to be a center of excellence in total hip and knee replacement surgery.”

The Joint Commission’s Disease-Specific Care Certification Program, launched in 2002, is designed to evaluate clinical programs across the continuum of care. Certification requirements address three core areas: compliance with consensus-based national standards; effective use of evidence-based clinical practice guidelines to manage and optimize care; and an organized approach to performance measurement and improvement activities.

“In achieving Joint Commission certification, UC Irvine Health has demonstrated its commitment to the highest level of care for its patients undergoing knee or hip joint replacement,” says Jean Range, M.S., R.N., C.P.H.Q. executive director, Disease-Specific Care Certification, The Joint Commission. “Certification is a voluntary process and I commend UC Irvine Health for successfully undertaking this challenge to elevate its standard of care and instill confidence in the community it serves.”

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UCLA physicians use Google Glass to teach surgery abroad


Teaching surgeons can watch operation and comment via this tech tool.

Imagine watching a procedure performed live through the eyes of the surgeon. That’s exactly what surgical leaders in the United States were able to do while overseeing surgeons training in Paraguay and Brazil with the help of UCLA doctors and Google Glass.

UCLA surgeon Dr. David Chen and surgical resident Dr. Justin Wagner have made it their mission to teach hernia surgery around the world and are harnessing the latest technologies to help.

“Hernia repair is the most common operation performed worldwide,” said Chen, assistant clinical professor of general surgery at the David Geffen School of Medicine at UCLA. “From a global health perspective, it is as cost-effective as immunizations because it allows patients to regain function and resume work and other daily activities.”

It is also an easily teachable procedure that lends itself to the advent of this kind of technology, according to Chen, associate director of surgical education and clinical director of the Lichtenstein Amid Hernia Clinic at UCLA.

The team used Google Glass, which is worn like conventional glasses, but houses a tiny computer the size of a Scrabble tile outfitted with a touch-pad display screen and high-definition camera that can connect wirelessly to stream live.

With Chen and Wagner’s help, local surgeons at a hospital in Paraguay in late May wore Google Glass while performing adult surgeries to repair a common type of hernia in which an organ or fatty tissue protrudes through a weak area of the abdominal wall in the groin. This type of hernia is commonly found in both children and adults.

Through Google Glass, the surgeries were viewed “live” via wireless streaming in the United States to a select group of leading surgeons who could watch and oversee the procedures. The experts could also transmit their comments to the surgeon, who could read them on the Google Glass monitor. The surgeries are also being archived for later training purposes as well. Chen added that the educational program ensures competency and quality of the operations.

“We are one of the first to use Google Glass in teaching and training surgeons from outside a country,” said Chen. And he says hernia surgery is just the beginning.

“Our goal is to utilize the latest technologies like Google Glass, Facebook and Twitter in connecting everyone in medicine worldwide for educational purposes that can help improve medical care in resource-poor countries,” said Chen. “These cost-effective applications can ultimately be used for other surgical procedures and medical training as well.”

The UCLA team also visited Brazil, where they used Google Glass during three hernia surgeries and also streamed a live debriefing session afterwards. The team plans to train 15 surgeons from around the country in September. These surgeons will then become trainers to teach other surgeons at several regional hospitals for underserved patients. Similar programs will be implemented in Haiti, the Dominican Republic, Guatemala and Ecuador this fall.

These training projects are part of an educational arm of Hernia Repair for the Underserved, a nonprofit organization dedicated to providing free hernia surgery to children and adults in the Western Hemisphere. Chen, who serves on the organization’s board, is spearheading these educational projects with the UCLA team to help “train the trainers” and increase the number of surgeons performing this procedure in underprivileged countries in the Western Hemisphere.

Chen and Wagner also work closely with UCLA’s Center for Advanced Surgical and Interventional Technology (CASIT) in developing new ways to help educate doctors remotely.

They have even streamed surgical lectures to Haiti from UCLA Medical Center, Santa Monica.

“We are developing practical applications for these technologies so that surgeons in any setting can have access to the global surgical community from within their own operating rooms,” said Wagner. “Even after the training is over, local surgeons can be teleproctored remotely so they will remain connected to experts worldwide.”

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Study supports use of bone-stabilizing devices for sternal repairs


Standard approach to repairing sternum fractures has been wire ‘stitches.’

Michael Wong, UC DavisDevices made of metal plates and screws that can precisely align and stabilize fractured bones as they heal can safely and effectively repair the sternum, according to a review of UC Davis surgeries published in the May issue of the Annals of Plastic Surgery.

Over the past five decades, the standard approach to repairing sternum fractures has been wire “stitches,” according to Michael Wong, professor of surgery at UC Davis and senior author of the journal paper.

“Chest surgeons have been reluctant to make the transition from wire closure to rigid sternal fixation, even though it has become the standard-of-care for other bone reconstructions,” said Wong, a specialist in plastic and reconstructive surgery. “Our study adds to growing evidence that it can be beneficial for the breastbone, too.”

To get a cumulative view of their experiences with rigid sternal fixation, Wong and his colleagues evaluated risk factors and outcomes for 57 patients at UC Davis Medical Center between 2006 and 2012. The patients included males and females between the ages of 16 and 70 who needed breastbone reconstruction or stabilization for a variety of reasons.

Thirty-five patients had sternotomies, or surgical divisions of the breastbone, during open chest surgery. All of them were at high risk for developing mediastinitis — a potentially fatal inflammation of the space around the heart — because of obesity, diabetes, COPD or other medical factors. An additional 14 had prior sternal reconstructions that failed, four had sternums damaged due to trauma and four had congenital abnormalities of the sternum.

The outcomes showed that none of the patients developed mediastinitis, which may occur in up to 15 percent of high-risk patients following chest surgery that uses the breastbone for access to the heart. Fourteen patients had mostly minor post-operative complications. Only three of them (fewer than 1 percent) had complications that warranted reoperations to remove or adjust the sternal plating hardware.

“All surgical techniques can have complications, but a growing portion of our work is treating complications of wire closures with sternal plates and screws,” said Wong. “It’s time to start considering rigid techniques first when it comes to repairing the sternum, at the very least among patients at higher risk for complications.”

This study is one of a series from Wong on rigid fixation. In 2012, he showed that the sternal devices resulted in shorter healing times and reduced pain when compared to wire closures, and he will soon publish a cost comparison of both approaches. He is also working with UC Davis cardiothoracic surgeon Broadus Zane Atkins on studies to determine which type of rigid device works best for patients with osteoporosis, a notoriously challenging condition for surgeons given that it can make patients’ bones more brittle and difficult to repair.

The current study — titled “Rigid Fixation for the Prevention and Treatment of Sternal Complications: A Review of Our Experience” — had no external funding. Wong’s co-authors were UC Davis plastic surgery residents Rahim Nazerali and Katharine Hinchcliff.

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