TAG: "Surgery"

A neurosurgeon with rare perspective


An engineering background informs UC Irvine doctor’s skill in deep-brain stimulation.

Frank Hsu, UC Irvine

Frank Hsu, UC Irvine

Treating diseases of the brain may seem vastly different from tinkering with computers and electronic devices. But Dr. Frank P.K. Hsu has been making a connection between the two fields for almost 25 years.

Hsu, professor and acting chair of the UC Irvine School of Medicine’s Department of Neurological Surgery, is one of the few neurosurgeons in Southern California who treat patients with Parkinson’s disease and other conditions with an advanced technique called “deep brain stimulation.”

His achievements grew from his studies as an undergraduate in electrical engineering and computer science at Johns Hopkins University. He went on to earn a doctoral degree in mechanical engineering and a medical degree from the University of Maryland.

“As surgeons, we view things a certain way,” says Hsu, who leads the UC Irvine Health neurosurgery team. “Having an engineering background enhances my understanding of how to bring technology into the process earlier to solve a problem.”

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‘Ender’s Game’ movie features surgical robot built at UC Santa Cruz


Raven II is used to simulate brain surgery on one of the main characters.

The character Bonzo Madrid undergoes robotic surgery in a scene from "Ender's Game." (Image courtesy of Summit Entertainment)

The character Bonzo Madrid undergoes robotic surgery in a scene from "Ender's Game." (Image courtesy of Summit Entertainment)

The Raven II surgical robot developed in Jacob Rosen’s Bionics Lab at UC Santa Cruz makes a cameo appearance in the new movie “Ender’s Game,” which opens today (Nov. 1) in theaters across the country.

“Ender’s Game,” starring Harrison Ford and Asa Butterfield and directed by Gavin Hood, is based on the 1980s science-fiction novel by Orson Scott Card. In a scene around the movie’s 58-minute mark, the Raven II is used to simulate brain surgery on one of the main characters, Bonzo Madrid, played by actor Moisés Arias. The scene, which deviates from the book’s plot, includes most of the movie’s main characters.

Rosen, a professor of computer engineering at UCSC’s Baskin School of Engineering, helped develop the first Raven surgical robot and worked on the next-generation Raven II in collaboration with researchers at the University of Washington. With funding from the National Science Foundation, a set of identical Raven II systems were designed and built at UC Santa Cruz, with electronics designed by the UW team. The robotic surgery systems are now being used at about a dozen research universities across the country.

The Raven II used in the movie was provided and operated by UW researchers. UW graduate student Hawkeye King, who operated the robot from off set during filming, told NBC News that “despite filming from 8 a.m. to 10 p.m., it [got] less than 12 seconds on screen.”

The Raven robots are not yet used in clinics for surgery, although that is the eventual goal. Researchers are mainly using them to design and test new hardware and software for telesurgery procedures. The robots are designed to have state-of-the-art motion control and to fit in a standard operating room.

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UC network conducting leading-edge research on fibroid treatment


UC-wide clinical trial to test efficacy of minimally invasive fibroid ablation.

Elaine Waetjen, UC Davis

Elaine Waetjen, UC Davis

A University of California-wide clinical trial is testing the long-term efficacy of ablating uterine fibroids ― benign non-cancerous uterine tumors ― using high-frequency radio waves that heat, shrink and kill the fibroid tissues during minimally invasive laparoscopic surgery.

While many uterine fibroids are asymptomatic, some can cause pain during sexual intercourse and menstruation, as well as heavy bleeding and urinary frequency and urgency. The clinical study is named ULTRA ― Uterine Leiomyoma (fibroid) Treatment with Radiofrequency Ablation. Its aim is to evaluate how women’s fibroid symptoms change over three years following minimally invasive fibroid ablation, using a new U.S. Food and Drug Administration-approved device called the Acessa System.

The device allows clinicians to insert a small electrode array into the fibroid, which then heats, necrotizes and ultimately shrinks the fibroid. The investigators’ main goal will be to determine the long-term efficacy of the use of Acessa by evaluating the rate of re-treatment for symptomatic fibroids after the procedure.

Baahareh Nejad, UC Davis

Baahareh Nejad, UC Davis

If long-term relief is achieved, the procedure would be an important alternative for women with fibroids who desire uterine conservation to avoid hysterectomy and the risk of major surgery. Ultimately, this treatment may be appropriate for women who wish to preserve their fertility. Researchers also are seeking to determine such factors as procedure duration, complications, blood loss, post-operative pain and the time from surgery to return to normal activities in patients treated with radiofrequency fibroid ablation.

The study is being conducted through the University of California Fibriod Network (UCFN) and led at UC Davis by professor Elaine Waetjen and assistant clinical professor Bahareh Nejad, both of the Department of Obstetrics and Gynecology.

“Uterine fibroids are a common condition affecting thousands of women in the United States that can cause debilitating bleeding and pain as well as affect a woman’s fertility,” Waetjen said. “Despite the high prevalence of fibroids, treatment options are limited.

“We are excited to participate in this University of California-wide research initiative which, we hope, will offer important and timely information for physicians and their patients on the effectiveness of novel fibroid treatment technologies as they emerge in medical practice.”

The researchers will follow the study participants for three years after undergoing the procedure. The participants will be asked to complete questionnaires every three months for the first year, then every six months for the second and third years of participation.

Women interested in participating in the study must be at least 21 years old, have fibroids, and be able to participate in laparoscopic surgery. For further information about the ULTRA Study at UC Davis, please contact study coordinator Sarah Steimer, (916) 734-6846, sarah.steimer@ucdmc.ucdavis.edu.

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Google Glass delivers new insight during surgery


UCSF surgeon is first to receive clearance for use of the tech device in the operating room.

UC San Francisco cardiothoracic surgeon Pierre Theodore, M.D., goes into the operating room with one main goal: getting his patient in and out of surgery safely and efficiently.

Technology has offered vast improvements to that process and a new technology gadget, the Google Glass, is taking that a giant step further.

Google Glass, a 1.8-ounce computer configured like a pair of eyeglasses, already is gaining popularity in the medical world as a teaching tool, recording surgeries from the surgeon’s point of view and live-streaming that view to colleagues or students. But Theodore has found another application for Google Glass that he believes could transform the way doctors perform surgery.

Theodore pre-loads CT and X-ray images needed for a procedure, and calls them up in his Google Glass to compare a medical scan with the actual surgical site.

“Often one will remove a tumor that may be deeply hidden inside an organ – the liver, the lung – for example,” said Theodore, who’s also an associate professor in the UCSF School of Medicine. “To be able to have those X-rays directly in your field without having to leave the operating room or to log on to another system elsewhere, or to turn yourself away from the patient in order to divert your attention, is very helpful in terms of maintaining your attention where it should be, which is on the patient 100 percent of the time.”

Theodore is the first surgeon to receive clearance for the use of the tech device as an auxiliary surgical tool in the operating room, by a local Institutional Review Board (IRB), an independent ethical review board designated to approve, monitor and review biomedical research involving human subjects. He was introduced to the idea by Nate Gross, M.D., co-founder and medical director of Rock Health, a San Francisco-based startup company focused on the future of digital health.

While wearing the Google Glass, data on the “screen” appears in the wearer’s peripheral vision, Gross explained.

“If my vision is a tic-tac-toe board, it would take one of those upper corners,” he said. “It feels like looking in the rearview mirror of your car. That rear view is always there when I need it, but it’s not there when I don’t.”

UCSF and health care providers across the U.S. are increasingly introducing new technology to transform health. UCSF launched the Center for Digital Health Innovation last year in part to validate the functionality and accuracy of new digital health devices, diagnostics, mobile health applications and sensor-based technologies and to evaluate whether they bring value and improve outcomes for patients in the ever-evolving health care delivery system.

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Endocrine surgeon brings new expertise to UC Davis


Michael Campbell specializes in treating patients with thyroid and pancreas disorders.

Michael Campbell, UC Davis

Michael Campbell, UC Davis

Michael Campbell recently joined UC Davis Health System as its first fellowship-trained endocrine surgeon. Campbell specializes in the evaluation and management of patients with thyroid, parathyroid, adrenal and pancreas disorders.

“Adding Dr. Campbell to our team fits with our goal of providing first-rate specialty surgery care,” said Diana Farmer, chair of the UC Davis Department of Surgery. “He will be an excellent resource for patients who otherwise would have to travel out of the area for an expert of his caliber.”

Campbell comes to UC Davis following his fellowship training at UC San Francisco Helen Diller Family Comprehensive Cancer Center and residency training at Virginia Mason Medical Center in Seattle. He chose to specialize in endocrine surgery because of the mix of intricate decision making and the challenging operations it involves.

“Diseases of the hormone-producing glands range from subtle to serious and the workup and treatment options are extremely complex,” he said.

Campbell recalls a patient, for instance, who came to him with a large goiter — an enlarged thyroid gland — that interfered with his breathing, swallowing and sleeping and made it hard for him to do his job. Several surgeons told the patient that removing it would require open-chest surgery and a long, difficult recovery. But with his training and experience, Campbell was able to perform the operation through a relatively small neck incision. The patient went home the next day, symptom free.

“He was so happy to find a surgeon who could help,” said Campbell. “That kind of gratitude truly makes my job worthwhile.”

In addition to goiters, Campbell specializes in the evaluation and management of thyroid nodules, thyroid cancer, Graves’ disease, hyperparathyroidism, adrenal tumors (such as adrenal cortical cancer, pheochromocytomas, aldosteronomas and Cushing’s syndrome) and endocrine tumors of the pancreas. He is an expert in minimally invasive parathyroid and thyroid surgery as well as complex laparoscopic adrenal surgery. He currently sees patients at the Comprehensive Cancer Center and the Cypress Building on the Sacramento campus of UC Davis, and at the UC Davis Medical Group site in Elk Grove.

For referral information, call 1-800-2UCDAVIS (1-800-282-3284) or visit the Department of Surgery website.

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Lung surgery milestone


UC San Diego surgeons perform 3,000th lifesaving lung surgery, lowest mortality worldwide.

Surgeons at UC San Diego Health System have performed their 3,000th pulmonary thromboendarterectomy (PTE), a lifesaving surgery to clear the lung’s arteries of scar-like tissue that robs patients of their ability to breathe. During the extraordinary eight- to 10-hour surgery, the patient is put into a form of suspended animation in which the heart and blood circulation is completely stopped and the brain ceases activity while surgeons clear the pulmonary arteries of disease.

“Patients arrive at UC San Diego Sulpizio Cardiovascular Center from all over the world seeking this safe, highly specialized surgery. Some patients walk in unaided while others arrive by wheelchair or air ambulance,” said Nick Kim, M.D., pulmonologist and director of pulmonary vascular medicine at UC San Diego Health System. “They all share a common burden: breathlessness. The clots cause chronic thromboembolic pulmonary hypertension, which not only leads to shortness of breath, but in most cases, progression to end-stage heart failure, and death, if not effectively treated.”

The surgery is a feat for the patient and the surgeon. In order for the clots to be removed, the surgeon must be able to see clearly into the lung’s tiny arteries. This requires operating without any blood present. To achieve this environment, the patient’s body is cooled and the blood is completely drained while the patient is on a heart-lung machine. The bypass machine is then stopped for 20 minutes while the surgeon races against the clock to remove the blockages. During this time, both heart and brain wave monitors are flat lined.

Using sophisticated techniques and special long, slender instruments, the surgeon rapidly dissects out the chronic clots without perforating the paper-thin artery wall. The clots look like white scar tissue, which when arranged on a surgical table takes the shape of the intricate inner branches of the lung’s arteries.

“With a multidisciplinary team, we have developed a comprehensive program that cares for patients from diagnosis through treatment,” said Michael Madani, M.D., cardiac surgeon, clinical chief of cardiothoracic surgery, and director of UC San Diego Sulpizio Cardiovascular Center – Surgery. “UC San Diego is able to offer this procedure to almost all patients suffering from chronic thromboembolic pulmonary hypertension while providing the best possible outcomes. It is deeply gratifying to cure these patients and to see them go home — free to breathe, free to enjoy life.”

UC San Diego Health System has performed more PTE procedures than any other institution in the world. For the past two years, the program has reported a mortality rate of less than 1 percent   ̶  the lowest known postoperative mortality rate worldwide. The procedure can reverse heart failure and is considered the most effective way to treat chronic thromboembolic pulmonary hypertension (CTEPH), better than any medical therapy or lung transplantation.

The PTE program was established in 1970 by Kenneth Moser, M.D., who pioneered the diagnosis and treatment of CTEPH. Together with Stuart Jamieson, M.B., F.R.C.S., Distinguished Professor of Surgery and chief of cardiothoracic surgery at the UC San Diego School of Medicine, they advanced the field and UC San Diego’s reputation globally in the treatment of this debilitating condition. Jamieson, the international authority on the surgical treatment of pulmonary thromboendarterectomy, is the surgical director of the UC San Diego PTE program. Under his leadership, the UC San Diego PTE program has mentored and trained surgeons globally who now perform this procedure in their home countries.

The UC San Diego PTE program is the first program to be nationally designated as a Center of Excellence by the American College of Chest Physicians. The program represents the extraordinary efforts of a team of physicians, surgeons, anesthesiologists, nurses, respiratory therapists and social workers who combine their expertise and passion into a world-class program. Throughout the year, the team receives emails, letters and text messages from patients who celebrate the anniversary of their surgery. With a new ability to breathe, some patients declare their surgery date their new birthday.

CTEPH is often misdiagnosed or unrecognized because the primary symptom – shortness of breath – is non-specific. Patients are often incorrectly treated for asthma or COPD.  It has been reported that as high as 3.8 percent of individuals with first-time pulmonary embolism may develop CTEPH. This suggests there may be thousands of new cases of CTEPH in the United States annually. Improving awareness of CTEPH may lead to more patients being cured of this life-threatening condition.

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UC Irvine professor elected VP of hand surgery society


Neil Jones is an expert in the reconstruction of children’s hand deformities.

Neil Jones, UC Irvine

Neil Jones, UC Irvine

Neil Jones, M.D., chief of hand surgery and professor in the UC Irvine Department of Orthopaedic Surgery and Division of Plastic and Reconstructive Surgery, was elected vice president of the American Society for Surgery of the Hand at the society’s annual meeting in October.

A renowned hand surgeon, Jones is among the world’s foremost experts in the reconstruction of children’s hand deformities with microsurgical toe-to-hand transfers and complex microsurgical reconstruction of the forearm, wrist and hand.

After his yearlong term as ASSH vice president, Jones will become president-elect next year and president in 2015.

Jones came to UC Irvine in 2008 from UCLA, where he had been chief of hand surgery for 15 years, to become director of the UC Irvine Health Center for Hand and Upper Extremity Surgery. He specializes in hand surgery and reconstructive microsurgery, with a major emphasis on nerve problems, tendon injuries, tendon transfers, arthritis, children’s hand deformities and microsurgical reconstruction of the upper extremity. His research has focused on limb transplantation and nerve transplantation, areas that may potentially lead to improved techniques for reconstruction of severe upper extremity injuries in the future.

Jones graduated from Trinity College, Oxford University and Oxford University Medical School in England. He trained in general surgery and orthopaedic surgery in England, becoming a fellow of the Royal College of Surgeons. After completing a further residency in plastic and reconstructive surgery at the University of Michigan, he returned to England for a fellowship in plastic and reconstructive surgery at the Royal London Hospital and St. Bartholomew’s Hospital in London. He completed a second fellowship in orthopedic hand surgery and microsurgery at the Massachusetts General Hospital and Harvard Medical School. He has previously served as president of the American Society for Reconstructive Microsurgery in 2008-09.

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UC San Diego expands robotic surgery program to treat stomach cancer


Health system surgeons perform region’s first robotic gastrectomy.

Kaitlyn Kelly, UC San Diego

Kaitlyn Kelly, UC San Diego

Surgeons at UC San Diego Health System have performed the region’s first robotic gastrectomy, a potentially lifesaving procedure to remove a section of the stomach after a diagnosis of gastric cancer. Aided by a da Vinci robot, surgeons remove the diseased tissue, perform a delicate reconstruction and remove local lymph nodes for further testing.

“To treat the gastric cancer, we remove part or all of the stomach with five small incisions,” said Kaitlyn Kelly, M.D., surgical oncologist at UC San Diego Health System. “The goal of the robotic approach is to remove the cancer and carefully extract nearby lymph nodes in a highly precise way to achieve a more accurate cancer staging.”

Kelly’s patient, a woman of Korean descent, was diagnosed with stomach cancer after reporting upper abdominal pain to her physician. Korean men and women are five to seven times more likely than Caucasians to develop gastric cancer, which is the fourth most common cancer worldwide.

Also known as an adenocarcinoma, stomach cancer arises from the mucus-producing cells of the stomach lining. Early detection and accurate staging are essential to the patient’s long-term survival. Staging describes the extent or severity of a person’s cancer. Patients with a diagnosis of gastric cancer typically complain of upper stomach pain, persistent and severe heartburn or stomach fullness shortly after eating.

“What is special about the robotic approach is the ability to carefully remove the lymph nodes around large blood vessels without causing damage to the nodes or vessels. This robotic approach can potentially offer a better specimen for pathologists to evaluate,” said Santiago Horgan, M.D., chief of minimally invasive surgery at UC San Diego Health System and director of the Center for the Future of Surgery at UC San Diego School of Medicine.

Kelly added that minimally invasive surgery techniques, both robotic and laparoscopic, lead to a speedier recovery, which is important for cancer patients, many of whom require  additional chemotherapy after surgery to complete their comprehensive cancer treatment.

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Martinez boy’s injuries capture the public’s hearts


UC Davis Children’s Hospital patient well enough to recover at home.

Hunter Kilbourn with Ginger Layton, UC Davis Children's Hospital child life fellow

Hunter Kilbourn with Ginger Layton, UC Davis Children's Hospital child life fellow

David Sahar was at home with his family at around 1 p.m. on Sunday, Aug. 11, when, as the on-call plastic surgeon at UC Davis Children’s Hospital, he received a page. His heart sank as he read it. A 10-year-old boy from Martinez had been brutally mauled by two pit bull dogs while visiting a friend’s home in the nearby San Francisco Bay Area suburb of Antioch. The child had experienced multiple severe injuries to his face, head and arms and would require reconstructive surgery.

His name was Hunter Kilbourn. He was en route to the Pediatric Trauma Center at UC Davis via helicopter and would arrive shortly. Hunter was not the only patient who Sahar had treated for animal bites and, sadly, most of those attacks had involved pit bull dogs and children.  As he left home, he feared the worst but hoped for the best.

Sahar performed his internship and residency at UC San Francisco – East Bay, and a postdoctoral fellowship in craniofacial disease and development at Stanford University. He had completed his plastic surgery training at the University of Texas at San Antonio. He has been a member of the faculty at UC Davis Medical Center for three years. “Still, nothing can prepare you for treating a young child for a dog attack, no matter how many times you’ve seen them,” he said.

“Our daughter is 10 years old, the same age as Hunter” Sahar said. “With kids it’s always difficult, really gut wrenching. It touches home, it’s personal.

“When a person is bitten by an animal,” he continued, “time is of the essence. Infection always is a huge concern. Often there is significant tissue loss, so skin grafting may be necessary, complicating the reconstruction.”

In Hunter’s case the attack, while severe, could have resulted in far greater damage, Sahar said. The dogs had bitten the child on both sides of his face and had removed tissue, including a portion of his eyelid, right temple and right ear. Nevertheless, there was no damage to the underlying bone or his eyes, for example. He retained most of his facial expression capacity on the right side of his face.

“One of the things that we worry about most with facial injuries is damage to the facial nerve, which controls facial expression. That’s how we express our emotions, give other people non-verbal cues, and smile. If that’s injured it has really important social developmental implications, especially for a young child,” Sahar said.

Hunter entered the operating room at 4:29 p.m. and would not leave until approximately 8 p.m., Sahar said. During that time Sahar and his team meticulously cleansed his many wounds and rushed to preserve the damaged facial tissue where possible.

“We repaired wounds on the right side of the face, the right ear, performed a flap to the left cheek, and repaired wounds on posterior scalp and left forearm. Hunter had lost the lateral third of his eyebrow, part of his eyelid, and a portion of the right temple area in the front of his ear was gone. The laceration essentially extended from the middle of his forehead, rightward across his nose, extending multiple lacerations around his right ear. Essentially we performed five procedures at once,” he said.

Two days later, the reconstructive surgery team would treat Hunter in a second procedure, grafting an approximately 10 centimeter skin graft onto the right side of his face where the dogs had removed tissue. Hunter’s face was bandaged to compress it and encourage the graft to adhere to the graft location and encourage blood vessels to connect from the skin graft to the recipient site to form collagen and heal.

“There was a lot of thought that went into how we cared for Hunter,” Sahar said. “We presented this case between the first and the second surgeries to multiple plastic surgeons here at UC Davis and our community plastic surgeons during our grand rounds, to come up with a consensus decision on how we should treat the patient. Because we are a large academic medical center we have a unique environment in which we can treat very complex, difficult problems.”

Sahar said that it’s too early to tell how much scarring Hunter will have, but it will be significant.

“If you have scarring and you’re a younger person, you tend to heal better,” Sahar said. “We can do certain things for scar management, such as lasers and compression garments that we can use to help improve aesthetic outcome, and that’s something that we can entertain as we go forward in collaboration with our plastic surgery colleagues at Shriner’s hospital for Children.”

Hunter left the hospital to return home on Aug. 20, but he will return many times in the days and weeks ahead to manage his recovery. His case has captured the thoughts and prayers of the people of Northern California, including the Oakland A’s, who sent memorabilia including a signed picture and baseball from outfielder Josh Reddick. Reddick has even invited Hunter to take batting practice with the team when he is feeling better.

“We are gratified to be the ‘go to’ hospital for complex reconstructive surgery, especially for children like Hunter,” said Diana Farmer, chair of the Department of Surgery and surgeon-in-chief for the children’s hospital at UC Davis. “Our single-minded goal is to put the latest science and surgical techniques to work so children can return to health and their normal lives quickly as possible.”

The two dogs involved in the mauling have been quarantined at the Antioch Animal Shelter and their owners have requested a hearing regarding whether they should be euthanized.

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Doctors successfully ‘vacuum’ 2-foot blood clot out of patient’s heart


UCLA is first in state to perform minimally invasive alternative to open-heart surgery.

Part of clot taken from heart

Part of clot taken from heart

Todd Dunlap, 62, arrived at Ronald Reagan UCLA Medical Center’s emergency room on Aug. 8 suffering from shortness of breath, fatigue and extreme cold. When a CT scan revealed a 24-inch clot stretching from his legs into his heart, doctors feared the mass could break loose and lodge in his lungs, blocking oxygen and killing him instantly.

Dr. John Moriarty gave his patient a choice. Dunlap could have open-heart surgery or undergo a new minimally invasive procedure using a device called AngioVac to vacuum the massive clot out of his heart. The catch? The procedure had never been successfully performed in California.

A new grandfather, Dunlap didn’t hesitate to choose the second option and underwent the procedure on Aug. 14. A week later, he was home, full of energy and eager to play on the floor with his 9-month-old grandson.

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International surgeons boost skills at UCSF summit


Global institute leads training to help traumatic injury victims in developing countries.

Trauma surgeon Samir Soomro, M.D., traveled more than 7,600 miles to San Francisco with the singular goal of helping patients back home in his native Pakistan.

“Our trauma patients are mostly from auto traffic accidents,” said Soomro, who practices out of Larkana, a city in the southeastern portion of Pakistan. “And apart from road traffic accidents, we have bomb blasts injuries and firearm injuries.”

He, along with more than 50 international surgeons from 17 developing countries, came to San Francisco General Hospital and Trauma Center last week to attend UC San Francisco’s trauma summit, led by UCSF orthopaedic surgeons and plastic surgeons.

“Our thought was we do a good job of trying to teach techniques of fixing bones, but we need to do a better job of helping orthopaedic surgeons deal with soft tissue – the muscles, the skin – that gets damaged,” said R. Richard Coughlin, M.D., M.P.H., a UCSF orthopaedic surgeon and founder of the Institute for Global Orthopaedics and Traumatology (IGOT). “These surgeons take home a skill set that they immediately can apply to a number of patients that are sitting under their care in these hospital beds.”

Soomro and others made the trek halfway around the world to learn techniques from UCSF surgeons that could save their patients’ limbs – and in some cases, lives. IGOT, which sponsors this trauma course, was started by faculty and residents of UCSF in 2006 to improve the health care of underserved populations affected by orthopaedic disease and trauma. The goal of this institute is to partner with educational institutions at home and abroad to develop strategies to lessen the burden of musculoskeletal conditions.

“They’re teaching us tissue transfer technology and how we can improve our surgical technology with the resources we already have,” Soomro said. “So that’s what got me interested in coming here.”

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Clinical trial evaluates new minimally invasive rectal cancer surgery


UC San Diego team is first in U.S. to integrate two novel minimally invasive techniques to treat rectal cancer.

Elisabeth McLemore, UC San Diego

Elisabeth McLemore, UC San Diego

Surgeons at the UC San Diego School of Medicine are evaluating a new, combined surgery technique to remove cancerous tumors from the rectum. The hybrid technique uses the body’s natural opening to remove malignancies and diseased tissue while also performing reconstruction. UC San Diego Health System’s surgical team is the first in the United States – in a clinical trial setting – to integrate two novel minimally invasive techniques to treat rectal cancer.

“By operating through the rectum, and with one small abdominal incision, we are able to perform an effective operation to remove the cancer, and to visualize and identify pelvic structures that are vital to normal bladder and sexual function,” said Elisabeth McLemore, M.D., colorectal surgeon at UC San Diego Health System and principal investigator of the study. “With this advanced approach, we reduce the number of incisions from six to one. This can result in less blood loss, less pain and a shorter hospital stay for the patient.”

Santiago Horgan, UC San Diego

Santiago Horgan, UC San Diego

This clinical trial surgery combines a technique called natural orifice translumenal endoscopic surgery (NOTES) with laparoscopic total mesorectal excision (TME), a form of rectal surgery. The NOTES technique allows the surgeons to operate through the rectum to remove tumors and TME ensures that a section of normal tissue around the tumor is also safely removed to reduce the chance of cancer recurrence.

“This study is evaluating both the safety and efficacy of the surgery, as well as pain levels, cosmetic outcomes, operative costs and logistical outcomes,” said Santiago Horgan, M.D., chief of minimally invasive surgery at UC San Diego Health System and director of the UC San Diego Center for the Future of Surgery. “Our goal is to expand the range of minimally invasive techniques that can be performed for patients with any form of digestive cancer.”

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