TAG: "Surgery"

UCSF urologist wins coveted Barringer Medal

Peter Carroll honored for his work.

Peter Carroll, UC San Francisco

The American Association of Genitourinary Surgeons awarded its 2014 Barringer Medal to Peter R. Carroll, M.D., M.P.H., chair of the UCSF Department of Urology, during the April annual meeting. This award recognizes a younger member of the organization who is achieving “distinguished accomplishments” and is meant to encourage and stimulate his or her continued work.

Marshall Stoller, M.D., professor and vice chair of the UCSF Department of Urology, presented the Barringer Medal to Carroll.

“Peter’s tireless effort in promoting active surveillance as a viable and safe option of treatment for men with low-risk prostate cancer is commendable,” Stoller said.

Created in 1954, the award honors Benjamin S. Barringer, the first chief of urology at Memorial Hospital in New York City. Barringer was an early innovator of brachytherapy in 1915 where he placed radium needles for treatment of prostate cancer. UCSF urologist Frank Hinman Jr., M.D., is the first and only other UCSF faculty member to have won the Barringer Medal, when he was honored in 1984.

Carroll is currently co-investigator or principal investigator on numerous research studies including a grant of almost $10 million from the Department of Defense called the “Transformative Impact Award.” Carroll’s past awards include the 2010 Eugene Fuller Triennial Prostate Award from the American Urological Assocation (AUA), and the SUO Medal from the Society of Urologic Oncology (SUO). He is also the Ken and Donna Derr Chevron Distinguished Professor in the Department of Urology; and associate dean and director of clinical services and strategic planning in the UCSF Helen Diller Family Comprehensive Cancer Center.

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MRI-guided biopsy for brain cancer improves diagnosis

Approach — a California first — increases accuracy of diagnosis.

Neurosurgeons at UC San Diego Heath System have, for the first time, combined real-time magnetic resonance imaging (MRI) technology with novel non-invasive cellular mapping techniques to develop a new biopsy approach that increases the accuracy of diagnosis for patients with brain cancer.

“There are many different types of brain cancer. Making an accurate diagnosis is paramount because the diagnosis dictates the subsequent course of treatment,” said Clark C. Chen, M.D., Ph.D., vice chairman of research, division of neurosurgery, UC San Diego School of Medicine. “For instance, the treatment of glioblastoma is fundamentally different than the treatment for oligodendroglioma, another type of brain tumor.”

Chen said that as many as one third of brain tumor biopsies performed in the traditional manner can result in misdiagnosis. He cited two challenges with conventional biopsy.

“First, because distinct areas of brain tumors exhibit different cell densities and higher cell densities are generally associated with higher tumor grade, biopsies taken from one region may yield a different diagnosis than if another area is biopsied,” said Chen. “Second, because tumors are hidden within the brain, surgeons must use mathematical algorithms to target where the biopsy should occur. As with all calculations, the process is subject to errors that the surgeon cannot easily correct in real time once the biopsy has begun.”

Chen’s team applied an MRI technique called Restriction Spectrum Imaging (RSI) to visualize the parts of the brain tumor that contain different cell densities.

“RSI allows us to identify the regions of the cell that are most representative of the entire tumor,” said Chen. “By targeting biopsies to these areas, we minimize the number of biopsies needed but still achieve a sampling that best characterizes the entire tumor.”

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Children with Down syndrome have better heart surgery outcomes

Mortality rates for congenital heart disease repairs are lower in kids with Down syndrome.

Jacqueline Evans, UC Davis

Researchers at UC Davis Children’s Hospital have shown that children with Down syndrome have significantly better in-hospital survival rates after surgeries for congenital heart disease (CHD) than their genetically typical peers.

While post-surgical mortality rates for children with Down syndrome have been studied before, this is by far the most comprehensive effort to date. Using the Kids’ Inpatient Database (KID), the researchers looked at results from almost 80 different procedures, performed on more than 50,000 children across the United States during 2000, 2003, 2006 and 2009.

The overall in-hospital mortality rate for children with Down children was 1.9 percent as compared with 4.3 percent for children without Down syndrome. The paper was published in the journal Circulation: Cardiovascular Quality and Outcomes.

“We’ve known for some time that children with Down syndrome do better after certain procedures,” said lead author Jacqueline Evans, assistant professor at UC Davis Children’s Hospital. “But even when you correct for surgical risk, prematurity, the presence of a major non-cardiac structural abnormality and age at the time of surgery, children with Down syndrome have lower in-hospital mortality rates across a wide spectrum of repairs.”

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MRI-guided laser treatment for brain cancer a first in state

Technology helps treat malignant tumor deep inside a patient’s brain.

Neurosurgeon Clark Chen treats recurrent brain cancer with MRI-guided laser technology at UC San Diego Health System.

Using a novel magnetic resonance imaging (MRI)-guided laser technology, neurosurgeons at UC San Diego Health System have successfully treated a malignant tumor deep inside a patient’s brain. This is the first time that this FDA-approved laser-based treatment has been performed in California.

“The patient’s brain tumor was located in the thalamus. Normally, to access a tumor in this region, the surgeon would have to remove considerable healthy brain tissue, thus subjecting the patient to significant neurologic injury,” said neurosurgeon Clark C. Chen, M.D., Ph.D., vice chairman of research, UC San Diego Division of Neurosurgery.  “This MRI-guided laser technology helps neurosurgeons preserve healthy brain tissues while allowing treatment of tumors that would otherwise be inoperable.”

Chen and his team used a technique called laser interstitial thermal therapy. The procedure is performed inside an MRI machine while the patient is under general anesthesia.  A dime-size hole is created in the patient’s skull to access the tumor. A laser probe is then inserted into the tumor under real-time MRI monitoring and computer guidance. When the tumor is reached, the laser beam is activated, heating and destroying tumor cells.

“It is well-known that MRI can be used to generate detailed images of the brain. What is less known is that MRI can also be used to measure the internal temperature of the brain,” said Chen. “With this application, I can view the tumor in real time as it is being destroyed while customizing the effects of the laser to the tumor without injuries to the surrounding normal brain. This incredible visualization allows neurosurgeons to preserve billions of neuronal connections that are essential for normal brain function.”

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The future of ophthalmology

New UC Davis facility advances the skills of eye surgeons.

Medical students and residents in the new ophthalmology training lab are able refine their surgical skills for procedures that require the use of high-powered microscopes.

The UC Davis Eye Center has opened a new state-of-the-art facility for teaching microsurgery techniques to the next generation of surgeons. Called the Lanie Albrecht Foundation Microsurgical Training Laboratory, the facility allows medical students and residents in ophthalmology and other specialties – including neurosurgery, orthopaedics, plastic surgery and veterinary medicine – to finesse their skills at performing surgeries that require the use of high-powered microscopes.

“This lab is all about enhancing the quality of patient care,” said Thomas Nesbitt, associate vice chancellor for strategic technologies and alliances at UC Davis.

“By establishing this technology-enabled learning environment, our medical residents can further refine their skills before entering the operating room.”

Funded entirely through a generous gift from the Lanie Albrecht Foundation, the new facility has seven fully equipped learning stations that ophthalmology residents can use to practice procedures such as corneal and retinal surgeries, cataract surgery and restorative oculoplastic surgery using grapes or animal eyes. Their work can be projected onto a high-resolution screen so faculty physicians can guide the process. Training sessions also can be recorded for analysis or to track milestones in each trainee’s progress.

“Practice in a controlled environment is a crucial part of becoming a skilled surgeon, and the new lab makes that possible,” said ophthalmology resident Natasha Kye.

“Residents have always gained high quality surgical training at UC Davis,” added Mark Mannis, chair of the Department of Ophthalmology. “But this wonderful new facility enables us to nurture the next generation of surgeons at a whole new level.”

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Improving knee replacements

UC San Diego first in nation to use device that boosts surgical precision and accuracy.

Francis Gonzales, UC San Diego

Each year, approximately 600,000 total knee replacement procedures are performed in the United States, a number that is expected to rise exponentially in the next decade as the population ages. Successful surgeries require precise alignment in the knee, a challenging task made even more daunting by the expected rise in procedures. To help meet this demand, UC San Diego Health System is the first in the nation to use iASSIST, a computer navigation system with Bluetooth-like technology that improves surgical precision and accuracy in total knee replacements, decreasing the need for revision surgery.

The FDA-approved iASSIST device, designed by Zimmer Holdings Inc., allows the surgeon to verify each surgical step, such as bone cuts and overall alignment, in real time, reducing mechanical errors during total knee replacements. The device is made up of small electronic pods, which are essentially mini-computers with wireless technology similar to smartphones. These electronic pods snap onto conventional instruments used in knee replacement surgery. By simply moving the knee in different positions during surgery, the device registers the anatomic axis of the leg unique to that patient, which guides each bone cut and ultimately places the knee implant in a more accurate alignment.

“This innovative technology allows us to deliver a more personalized knee to the patient and provide extreme accuracy in implant placement. Studies have shown that total knee replacement surgery has a higher failure rate when the knee is mal-aligned. This device enables orthopedic surgeons to restore a patient’s normal alignment with precision in a reproducible fashion, decreasing revision surgery and providing a more natural feel of the implant for the patient,” said Francis Gonzales, M.D., with the Department of Orthopedic Surgery.

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Lifesaving surgery makes for an extra special Valentine’s Day

Minimally invasive heart procedure followed by lung transplant.

All smiles, Mike Boyle and his wife, Ellen, are looking forward to celebrating a special Valentine's Day.

Mike Boyle has good reason to give his wife and family extra hugs on Valentine’s Day.

Just two months ago, he was slowly suffocating from pulmonary fibrosis, a condition with no cure that causes scar tissue build-up in the lungs, making it difficult to breathe. In addition, his main heart valve was so clogged with calcium deposits that it couldn’t open wide enough to adequately pump blood through his body.

Feeling exhausted, the Thousand Oaks resident had curtailed all his activities and needed to carry around an oxygen tank to help him breathe.

Given his declining heart condition, it was too risky for him to receive a much needed lung transplant, a factor that the UCLA lung transplant committee took into consideration before turning him down. Given that UCLA handles the most advanced, serious patient cases and he still didn’t qualify, it looked like Boyle had truly run out of options.

But fortunately, there was one left. The heart team at UCLA was offering a new procedure that is designed for patients who are too sick to have the conventional surgery needed to replace the main heart valve. Luckily, Boyle qualified.

The minimally invasive procedure, called Transcatheter Aortic Valve Replacement (TAVR), involves far fewer surgical risks. TAVR allows doctors for the first time to replace the aortic valve without open heart surgery. It’s an attractive alternative for patients like Boyle, who aren’t candidates for traditional surgery.

The usual TAVR approach is to deliver the valve to the heart via an artery in the groin using a catheter, which is a hollow delivery tube. But in Boyle’s case, these arteries had blockages that made this approach impossible. Alternatively, a small incision is made on the side of the chest, and the valve is delivered through the lowest part of the heart called the apex. Once in place, the valve is opened, and it starts working immediately.

Boyle had the TAVR procedure using this alternative approach last June with a heart team led by Dr. Richard Shemin, chief of cardiothoracic surgery, and Dr. William Suh, assistant clinical professor of medicine and interventional cardiology, both with UCLA’s David Geffen School of Medicine and UCLA Health System.

Boyle’s heart was doing so well after the valve replacement that he was encouraged to try to get listed again for a lung transplant. This time he was approved by the UCLA committee and received his lifesaving lung transplant in late November with a team led by Dr. Abbas Ardehali, a professor of cardiothoracic surgery and director of the heart and lung transplantation program at UCLA.

Today, Boyle is progressing nicely, say his doctors — and he couldn’t be happier.

“I don’t feel as physically limited as before and have a new lease on life,” said Boyle, who doesn’t need to carry oxygen anymore and has started to exercise as well.

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UCLA awarded $6M to study ways to restore hand movement after paralysis

Promising therapy uses electrical impulses to stimulate dormant pathways within spinal cord.

Daniel Lu, UCLA

The National Institute of Biomedical Imaging and Bioengineering has awarded UCLA researchers Dr. Daniel Lu (Brentwood) and Dr. Reggie Edgerton (Bel Air) a $6 million, five-year grant to explore new therapies for the approximately 273,000 Americans living with spinal-cord injuries. Some 12,000 Americans suffer such injuries each year.

The UCLA research will focus on restoring hand function to patients paralyzed from the neck down. Cervical spinal-cord injuries — those involving the neck — make up more than half of the cases in the U.S.

“Spinal-cord injury typically strikes people in the prime of their lives, with nearly half between ages 16 and 30,” said Lu, an assistant professor of neurosurgery at the David Geffen School of Medicine at UCLA and a clinician at the UCLA Spine Center. “Currently there are no effective treatments for spinal-cord injury, and the resulting paralysis has been viewed as permanent. We are exploring ways to change that.”

In seeking to help people with cervical spinal-cord injuries regain the use of their hands, the UCLA team is looking to build on findings from Edgerton’s earlier work, conducted with Russian scientist Yury Gerasimenko, on lumbar spinal-cord injuries — those to the lower spine.

V. Reggie Edgerton, UCLA

“Recovering the ability to use one’s hands is a top priority for people with cervical spinal-cord injury,” said Lu, who grew up in Palos Verdes. “We aim to restore patients’ independence by returning their ability to type on a keyboard, open doors and transfer themselves between their bed and wheelchair.”

The most promising therapy uses electrical impulses to stimulate dormant pathways within the spinal cord, allowing the brain’s previously unrecognized signals to reach past the injured area.

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Immune system drives pregnancy complications after fetal surgery in mice

Possible clue to high rate of preterm labor after human fetal surgery.

Tippi Mackenzie, UC San Francisco

Tippi Mackenzie, UC San Francisco

As a fetal surgeon at UC San Francisco, Tippi MacKenzie, M.D., has long known that conducting surgery on a fetus to correct a problems such as spina bifida often results in preterm labor and premature birth.

Now, MacKenzie and her UCSF colleagues have shown that, in mice at least, pregnancy complications after fetal surgery are triggered by activation of the mother’s T cells – the same T cells that cause the body to reject a donor organ after transplant surgery

“Here at UCSF, the birthplace of fetal surgery, preterm labor has been described as the ‘Achilles’ heel’ of the field because it diminishes the benefit of the surgery itself,” said MacKenzie, an associate professor of surgery and director of research at the UCSF Fetal Treatment Center. “However, specific treatments have not been developed because until now, the biological triggers responsible for preterm birth have been unknown.”

If the same fetal rejection mechanism is occurring in humans, she said, “we have the ability to design specific medical treatments to prevent it – for example, by using medications that target some of the pathways involved in T cell-mediated rejection.”

The study was published online on Jan. 15 in the Journal of Immunology and will be printed in the Feb. 15 issue.

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Minimally invasive surgery rates triple nationally for pancreatic disease

The growing trend points to improved patient outcomes.

Jason Sicklick, UC San Diego

Jason Sicklick, UC San Diego

Researchers at UC San Diego School of Medicine report a threefold increase in the use of minimally invasive surgery (MIS) across the nation for patients with pancreatic disease.  Although adaptation of MIS for this difficult-to-reach gland is recent, the growing trend points to improved patient outcomes, such as reduced bleeding and infections. Now published online, the paper will appear in the March print edition of JAMA Surgery.

“For the first time, we show a nationwide tripling of keyhole pancreatic surgery rates for benign and malignant pancreatic disease from 2.4 percent in 1998 to 7.3 percent in 2009. Both laparoscopic and robotic approaches for distal pancreas removal are associated with lower rates of inpatient complications and shorter hospital stays,” said Jason Sicklick, M.D., assistant professor of surgery, UC San Diego School of Medicine, and surgical oncologist at UC San Diego Health System.  “Patients should know that select approaches for minimally invasive pancreatic operations are safe depending upon the lesion’s size and location in the pancreas.”

The pancreas is a large gland located deep in the abdomen, behind the stomach and next to the spleen. The gland produces digestive juices and hormones that regulate blood sugar. To a surgeon’s hand, the pancreas has a soft consistency. Due to its fragility and location near major vascular structures, the pancreas has been one of the last organs to be part of the MIS trend.

Sicklick added that with increased surgeon experience performing complex pancreatic and hepatobiliary operations, the application of minimally invasive techniques has slowly diffused from academic hospitals to the community setting. However, it has yet to reach its maximum potential.

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Football fans team up for organ match

Random stadium seat assignment leads to lifesaving transplant surgery.

Louis Munoz (left) donated one of his kidneys to William Lynch - the match between the childhood friends occurred after they happened to sit next to each other at a Chargers game.

Louis Munoz (left) donated one of his kidneys to William Lynch - the match between the childhood friends occurred after they happened to sit next to each other at a Chargers game.

In October, Louis Munoz donated one of his kidneys to William Lynch. The organ match would not have occurred without a bit of serendipity and a big love of football. Munoz and Lynch had been childhood friends, but hadn’t seen each other in years – then they found themselves randomly seated next to each other at a Chargers game.

“Louis and I knew each other as kids and then lost touch. Years later, by surprise, we ended up sitting right next to each other at Chargers games,” said William, a middle school teacher. “When I started missing games, Louis asked me why and I explained that due to kidney complications, I’d been unwell. His wife half-jokingly suggested that he give me a kidney.”

Louis immediately volunteered to be tested as a possible donor. William initially declined his friend’s offer, believing another donor would come through. But when that didn’t happen, Louis followed through and proved to be a match.

“I am so blessed that Louis has chosen to give me this new lease on life,” said William. “I can’t express to him how grateful I am. I promised Louis I will take care of this kidney the best that I can.”

Prior to the transplant surgery, William had been on dialysis, a treatment option to filter the blood and rid the body of harmful wastes and excess salt and water. Dialysis is a tough regimen that requires a patient to be tethered to a machine three to four times per week for hours at a time.

“I had been on dialysis for more than two years. Mentally and physically it was the hardest part I had to endure,” said William whose kidney failure was caused by a rare disease that attacks the organ’s filtering system. “Getting off of dialysis is wonderful.”

William and Louis had their surgeries performed at UC San Diego Health System, which boasts the region’s largest kidney transplant program. The program has performed more than 2,270 kidney transplants. Approximately 35 percent of the donations come from living donors.

“In San Diego, of all the people waiting for an organ transplant, more than 85 percent need a kidney,” said Alan Hemming, M.D., transplant surgeon, UC San Diego Health System. “Living donors can dramatically shorten the time to wait for a donated kidney. The gift is truly lifesaving.”

Currently, there are more than 770 patients at UC San Diego Health System awaiting a kidney transplant. Nearly 98,000 people in the United States are on kidney transplant wait lists, including 17,784 in California. The average wait for a kidney from a deceased donor is typically six years in San Diego and ten years in Los Angeles.

The transplant surgery was performed in two phases in adjacent operating rooms. In one room, the kidney was carefully removed from Louis; in the second, it was transplanted into William.

Santiago Horgan, M.D., chief of minimally invasive surgery at UC San Diego Health System, removed the kidney aided by a robot. With robotic guidance, the vessels of the kidney were precisely isolated and the kidney was removed with less trauma. And because smaller incisions were made, the risk of subsequent pain was also reduced. Hemming then transplanted the removed kidney into William during a two-hour procedure.

“I am excited for William,” said Louis. “I think the decision to donate is pretty simple. I don’t think too much about it – just a little inconvenience to help somebody out who really needs it.”

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Men don’t seek obesity surgery as soon as they should

Obese women more likely to seek weight-loss surgery.

Mohamed Ali, UC Davis

Mohamed Ali, UC Davis

Even though obesity affects women and men equally, a UC Davis study shows that obese women are four times more likely than obese men to seek weight-loss surgery. When they do see a bariatric surgeon, male patients tend to be older, more obese and sicker than women.

“It is important for men to realize that obesity poses a serious threat to their health and lifespans,” said Mohamed Ali, senior author of the study and chief of bariatric surgery at UC Davis. “A patient who is 100 pounds or more above his ideal body weight poses a therapeutic dilemma and should be referred to a surgeon.”

For the study, published in the December issue of Surgical Endoscopy, Ali and his colleagues collected information from 1,368 patients who were evaluated for bariatric surgery at UC Davis between 2002 and 2006.

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