TAG: "Surgery"

UC Davis names chief of pediatric general, thoracic and fetal surgery


Shinjiro Hirose joins from UCSF.

Shinjiro Hirose

Shinjiro Hirose, a nationally recognized fetal and pediatric surgeon, has joined the faculty of the UC Davis School of Medicine as chief of the newly established Division of Pediatric General, Thoracic and Fetal Surgery in the Department of Surgery.

Before joining UC Davis, Hirose was the lead pediatric surgeon at the UC San Francisco Benioff Children’s Hospital and its Fetal Treatment Center, specializing in minimally invasive surgery for gastrointestinal, biliary, liver and thoracic disorders in fetuses in utero and children. He and his mentor, internationally renowned pediatric surgeon Diana Farmer, were key in developing the Fetal Treatment Center.

“With Shin’s arrival at UC Davis, we can now forge ahead in creating the first comprehensive fetal diagnosis and therapy center in the Sacramento region. Our ‘dream team’ is complete,” said Farmer, who is chair of the Department of Surgery and surgeon-in-chief at UC Davis Children’s Hospital.

“We are establishing a world-class center to serve the needs of the children in the Sacramento region, the Central Valley and beyond,” Hirose said. “I will be partnering with our existing pediatric surgery group to expand our specialty surgical services. I met with so many families from this area when I worked at UC San Francisco. Now, those families can receive the same level of expertise and care that they received in the Bay Area, but much closer to home.”

Hirose is one of the creators of the University of California Fetal Therapy Consortium, a statewide collaboration at all five of the fetal treatment programs at the University of California campuses with medical centers at Davis, San Francisco, Los Angeles, Irvine and San Diego.

In addition to his background in fetal medicine, he is a nationally recognized children’s cancer surgeon and an expert in the development and use of surgical robotics in children.

Hirose also has a joint appointment as director of pediatric surgery at Shriners Hospitals for Children – Northern California, where he will develop a surgical program to serve children with complex colorectal and pelvic floor anomalies and a bowel-management program.

Hirose earned his bachelor’s of science degree in mechanical engineering at the Massachusetts Institute of Technology and his medical doctorate from New York Medical College. He completed surgical residencies at UC Davis and UC San Francisco, a fellowship in fetal diagnosis and therapy at UC San Francisco, and a  fellowship in pediatric surgery at Columbia University in New York.

Read more

For more health news, visit UC Health, subscribe by email or follow us on Flipboard.

CATEGORY: NewsComments Off

Surgical residents sharpen skills in special lab


UCLA emeritus pediatric neurosurgeon passes on his love of anatomy.

UCLA neurosurgery residents Drs. Andrew Yew (left) and Ausaf Bari (right) observe as Dr. Warwick Peacock (center) demonstrates the skills he learned over his four-decade-long career as a pediatric neurosurgeon. (Photo by Ann Johansson)

Under the glare of operating-room lights, six UCLA neurosurgery residents embarked on a rare adventure into the human body. As they started cutting into three bodies, Dr. Warwick Peacock, professor of surgery, encouraged them onward. “That should be the linea alba,” he said in his gentle South African accent. “There are some adhesions. Always stick your finger in to make sure you’re not cutting into the bowel. It spoils the day.”

Incisions made, the residents approached the spine from the front, sawing through the sternum, moving beyond the lungs and following the rib head to the pedicle, then removing a thoracic disc on each body — in two hours.

Completing a discectomy in two hours on a living patient would be extraordinary. But this was no OR. The bodies are cadavers, and the bitter and antiseptic scent of embalming fluid, not blood, fills the air. In UCLA’s Surgical Science Laboratory — one of the few of its kind dedicated to the training of surgical residents — the fledgling surgeons can practice and make mistakes. They bubble with excitement, viewing anatomy rarely seen in this era of minimally invasive surgery and computer modeling: lungs, the front of the spine, the aorta.

For Dr. Peacock, an emeritus pediatric neurosurgeon — who developed new techniques for treating children with cerebral palsy by first trying these techniques out on cadavers — teaching residents and exploring the human body on a daily basis has been “one of the most fascinating parts of my life. It is a novel experience every time.”

Engaging and passionate about his subject matter, Peacock is a born teacher. In 2013, he received the first Distinguished Service in Education Award from the David Geffen School of Medicine at UCLA. Colleagues called him a “master educator” and a “visionary,” who is “revolutionizing surgical-anatomy instruction.”

“The most important aspect of teaching is not the transmission of fact,” said the tall, thin man with blue eyes. “It’s the transmission of enthusiasm.”

That enthusiasm, it turns out, is infectious among his students. “Dr. Peacock is an amazing teacher,” said Dr. Rich Everson, a neurosurgery resident. “He includes just the right amount of detail; it’s clinically oriented. He was a practicing neurosurgeon. There’s nobody better to teach us than someone like that.”

Medical students learn the basic structures of the human body, but a surgical resident must know how to reach his or her target without damaging anything along the way. Surgeons “are athletes of the small muscles,” Dr. Peacock said, and it takes hour upon hour of practice and repetition to train those muscles to perform the way they must.

At UCLA, they do that — and more — in the Surgical Science Laboratory, which opened in April 2012 under Peacock’s direction.

“I don’t think anyone has anything quite like what UCLA does and what Dr. Peacock does,” said noted pediatric and fetal surgeon Diana Farmer, chair of the Department of Surgery at UC Davis Medical Center. “It’s brilliant and it’s clever, and it wouldn’t surprise me if it becomes the standard throughout the country.”

Read more

For more health news, visit UC Health, subscribe by email or follow us on Flipboard.

CATEGORY: NewsComments Off

Bariatric center accreditation linked to improved patient outcomes


UC Irvine’s Ninh Nguyen co-leads study of surgery center performance.

Ninh Nguyen, UC Irvine

Patients who underwent weight loss operations in recent years, when most bariatric surgical centers were accredited, had fewer postoperative complications and were 2.3 times less likely to die in the hospital than patients who had bariatric procedures performed before a national movement toward facility accreditation occurred, according to a study published in the September issue of the Journal of the American College of Surgeons.

Study authors said the findings suggest that accreditation of bariatric surgery centers contributes to improved safety for patients who undergo weight loss operations and saves lives. “The patient’s most important concern is, am I going to survive this operation?” said study co-investigator Ninh T. Nguyen, M.D., professor of surgery and chief of gastrointestinal Surgery, at UC Irvine Medical Center in Orange.  “We found that death is very uncommon when the operation takes place at an accredited facility, meaning it has met rigorous standards for high-quality surgical care.”

A surgical approach is now widely considered a very effective treatment for severe obesity.  Potential benefits of bariatric operations include substantial long-term weight loss, an improvement or reversal of Type 2 diabetes, and improved risk factors for heart disease, according to the American Society for Metabolic and Bariatric Surgery (ASMBS).  Common bariatric procedures include the Roux-en-Y gastric bypass, gastric banding, and sleeve gastrectomy.

Read more

For more health news, visit UC Health, subscribe by email or follow us on Flipboard.

CATEGORY: NewsComments Off

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.”

View original article

CATEGORY: SpotlightComments Off

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.”

Read more

For more health news, visit UC Health, subscribe by email or follow us on Flipboard.

CATEGORY: NewsComments Off

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.”

Read more

CATEGORY: NewsComments Off

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.”

Read more

For more health news, visit UC Health, subscribe by email or follow us on Flipboard.

CATEGORY: NewsComments Off

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.

Read more

For more health news, visit UC Health, subscribe by email or follow us on Flipboard.

CATEGORY: NewsComments Off

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.”

Read more

For more health news, visit UC Health, subscribe by email or follow us on Flipboard.

CATEGORY: NewsComments Off

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.

View original article

CATEGORY: NewsComments Off

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.”

Read more

For more health news, visit UC Health, subscribe by email or follow us on Flipboard.

CATEGORY: NewsComments Off

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.”

Read more

For more health news, visit UC Health, subscribe by email or follow us on Flipboard.

CATEGORY: NewsComments Off