TAG: "Surgery"

Robotic surgery technique developed to treat head and neck cancer

Pioneering method, developed at UCLA, gives patients new hope to live cancer-free lives.

By Peter Bracke, UCLA

In a groundbreaking new study, UCLA researchers have advanced a robotic surgical technique to successfully access a previously unreachable area of the head and neck.

This pioneering method can now be used safely and efficiently in patients to remove tumors that many times were previously considered inoperable, or that necessitated the use of highly invasive surgical techniques in combination with chemotherapy or radiation therapy.

Abie Mendelsohn, UCLA

Developed by Dr. Abie Mendelsohn, UCLA Jonsson Comprehensive Cancer Center member and director of head and neck robotic surgery at UCLA, this new approach provides the surgical community with a leading-edge technology roadmap to treat patients who had little or no hope of living cancer-free lives.

“This is a revolutionary new approach that uses highly advanced technology to reach the deepest areas of the head and neck,” said Mendelsohn, lead author of the study. “Patients can now be treated in a manner equivalent to that of a straightforward dental procedure and go back to leading normal, healthy lives in a matter of days with few or even no side effects.”

The parapharyngeal space is pyramid-shaped area that lies near the base of the human skull and connects several deep compartments of the head and neck. It is lined with many large blood vessels, nerves and complex facial muscles, making access to the space via traditional surgical options often impossible or highly invasive.

Current surgical techniques can necessitate external incisions be made to the patient’s neck, or the splitting of their jaw bone or areas close to the voice box. Chemotherapy and radiation therapy are also often required, further complicating recovery and potentially putting patients at risk for serious (or even lethal) side effects.

Approved by the U.S. Food and Drug Administration in 2009, Trans Oral Robotic Surgery (or TORS) utilizes the Da Vinci robotic surgical system, the state-of-the-art technology that was developed at UCLA by the specialized surgical program for the head and neck. TORS uses a minimally invasive procedure in which a surgical robot, under the full control of a specially trained physician, operates with a three-dimensional, high-definition video camera and robotic arms.

These miniature “arms” can navigate through the small, tight and delicate areas of a person’s mouth without the need for external incisions. A retraction system allows the surgeon to see the entire surgical area at once. While working at an operating console just steps away from the patient’s bed, every movement of the surgeon’s wrists and fingers are transformed into movements of the surgical instruments.

Over the course of the robotic program’s development, Mendelsohn refined, adapted and advanced the TORS techniques to allow surgical instruments and the 3-D imaging tools to at last reach and operate safely within the parapharyngeal space and other recessed areas of the head and neck.

Currently, Mendelsohn’s new procedure largely benefits patients with tumors located in the throat near the tonsils and tongue, but it continues to be adapted and expanded in scope and impact.

“We are tremendously excited about the possibilities for the surgical community with this new advancement of TORS,” said Mendelsohn. “Now patients have options they never had before, and we can even develop potential applications for the procedure beyond the surface of the head and neck.”

The study was published online ahead of print in the journal Head and Neck.

David Alpern: one patient’s story

UCLA patient David Alpern and son. Alpern is now cancer-free after his throat tumor was removed using Dr. Abie Mendelsohn’s breakthrough robotic surgery technique.

In 2012, David Alpern received devastating news. He was diagnosed with throat cancer, and the treatment options given to him by his doctors sounded worse than the disease.

“They described a procedure where your face is split in half and it’s basically reconstructive surgery. I was completely freaked out,” said Alpern, a husband and father of two.

After careful examination and imaging at UCLA, Mendelsohn determined that Alpern was a perfect candidate for TORS. Alpern was up and about just days after the procedure. Like the more than 100 similar TORS surgeries performed with Mendelsohn at the controls, Aplern’s tumor was removed and he’s now cancer free.

“I try not to get too cocky or excited that I beat cancer, but I think I did,” Alpern said. “There are no side effects at this point. My hopes are just to watch my kids grow up and enjoy my family and my life.”

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Healing the human instrument

When words fail, a highly specialized center at UCLA helps patients find their voice.

Dr. Dinesh Chherti is an otolaryngologist who specializes in swallowing disorders at UCLA's Voice Center for Medicine and the Arts. Among those who have sought help with their vocal instruments have been Celine Dion and John Mayer. (Photo by Ann Johansson/U Magazine)

By Joan Voight, U Magazine

When Erik Laurence transferred in 2009 to Shanghai, China, as vice president of a software company, he thought his biggest challenge would be improving his Mandarin-language skills and learning the nuances of the Chinese business scene. But his vocal cords, not the foreign nation, turned out to be his undoing.

Laurence, who was in his mid-40s at the time, had struggled for about 20 years with a mild case of spasmodic dysphonia (SD), intermittently losing his voice at odd times. It’s a neurological disorder that involves spasms of the vocal cords, which cause the voice to break up or have a strained or strangled  quality.

“Work demands and trying to speak a new language aggravated all my vocal problems,” Laurence said. “It came to a head at a meeting where I was called on to speak to about 250 people. My voice was horrible, cracking and missing words. I wanted to crawl away and hide.”

Laurence, who was trained as an engineer, methodically scoured the latest medical research and took a week’s vacation in New York to confer with specialists. That’s when he learned about otolaryngologist Dr. Gerald Berke, chair of the Department of Head and Neck Surgery and founder of UCLA’s Voice Center for Medicine and the Arts. He performs a specialized surgery that severs the nerve pathway between the brain and vocal cord and grafts a new nerve from the neck. It essentially rewires the larynx.

For patients who have baffling problems with talking, breathing, singing or swallowing, the UCLA Voice Center for Medicine and the Arts can be an oasis in a desert of inconclusive tests, endless doctors’ appointments and despair. “Your voice is how you express yourself to others,” said Berke, an international authority on the physiology of the larynx. “If it’s compromised, it impairs your personality and how you interact with the world, which can be overwhelmingly frustrating.”

In addition to patients like Laurence, world-class singers such as Celine Dion and John Mayer have asked Dr. Berke for help with their ailing vocal instruments and then gone public in support of his work. “Through his medical care, I learned that the voice is an instrument … and nobody sees that as delicately and carefully as Dr. Berke and his colleagues at UCLA,” Mayer told an audience last January  at a fundraising gala for the Department of Head and Neck Surgery.

The Voice Center for Medicine and the Arts is known for novel treatments for such disorders as vocal-cord paralysis, airway stenosis and the SD surgery that Laurence underwent. In-office laser therapy, digital-video endoscopes and minimally invasive approaches are used to treat myriad complex and common disorders of the larynx and trachea.Berke started the center in 2004 with Bruce Gerratt, a speech and language pathologist, and Dr. Dinesh Chhetri, an otolaryngologist who specializes in swallowing disorders. The younger generation of physicians at the center now includes otolaryngologists Dr. Jennifer Long and Dr. Abie Mendelsohn.

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Grant will aid patients suffering from severe pulmonary hypertension

$7.6M grant helps launch a nationwide patient registry to improve CTEPH practices.

Imagine trying to take a deep breath, but feeling like you’re sucking air through a straw. That’s how some patients with chronic thromboembolic pulmonary hypertension (CTEPH) describe living with the condition, which is estimated to affect several thousand Americans yearly but is commonly misdiagnosed. UC San Diego Health System is a world leader in CTEPH, and now with a $7.6 million grant, has helped launch the first national CTEPH registry to improve best practices and patient care.

The United States CTEPH registry, funded by Bayer Healthcare Pharmaceuticals, is a centralized electronic database that will involve 30 sites across the nation. UC San Diego Health System will manage the registry with the goal of enrolling 750 newly diagnosed patients over the next six years. It will allow physicians to follow the short- and long-term outcomes of patients and learn more about CTEPH.

CTEPH is believed to be a complication of a common blood clot condition called pulmonary embolism. It has been reported that as much 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.

“Currently, the number of patients in the United States with CTEPH is unknown. Because the symptom of shortness of breath is nonspecific, many CTEPH patients may be misdiagnosed as having more common diseases like asthma or COPD,” said Kim Kerr, M.D., principal investigator and pulmonologist at UC San Diego Health System. “Using data collected from the registry, we will identify barriers to patients receiving the correct diagnosis and treatment of their CTEPH. This registry will also allow us to assess the effectiveness of established and evolving therapies of this disease.”

UC San Diego Health System is the pioneer of pulmonary thromboendarterectomy (PTE) surgery, a life-saving procedure that removes the blood clots from the lungs’ arteries that rob patients of their ability to breathe.

“The registry will serve as an educational tool for physicians and centers to learn more about the disease and its prognosis and outcomes, especially as it relates to surgical techniques used for PTE and the benefits to the patient,” said Michael Madani, M.D., co-investigator and cardiac surgeon, chief of cardiothoracic surgery and director of UC San Diego Sulpizio Cardiovascular Center – Surgery. “People from around the US suffering from CTEPH are referred to UC San Diego Health System for PTE but usually after discharge we do not have the resources to follow up long-term. Another critical part of the registry is that it will give us a more thorough understanding of how PTE truly improves a patient’s overall quality of life, even if they live 2,000 miles away.”

Nick Kim, M.D., pulmonologist and director of pulmonary vascular medicine at UC San Diego Health System, adds that the registry will enrich physicians’ understanding of all aspects of CTEPH in the U.S., including the subset of patients deemed not operable and treated with medical therapy instead.

“Centers across the nation working as a team will not only help health providers improve their approach to CTEPH, it will ultimately give patients more options, knowledge and empowerment in how their disease is managed,” said Kim.

For more information on pulmonary vascular medicine at UC San Diego Health System, please visit heartcenter.ucsd.edu.

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Building the future of health care

More than 1,000 donors give $131M in support of UC San Diego Jacobs Medical Center.

By Judy Piercey and Jade Griffin, UC San Diego

Committed to fostering the future of health care in San Diego, more than 1,000 donors have contributed $131 million to UC San Diego’s Jacobs Medical Center. Included in the total are gifts that matched a donation of $25 million, meeting the Challenge goal of the initiative.

Today (Nov. 20), the campus announced that the Challenge donation, originally anonymous, was made by Joan and Irwin Jacobs. They provided a $75 million lead gift for the new facility in 2010; with the Challenge gift, that brings their contributions to the Jacobs Medical Center to a total of $100 million. Continued private support will help fund the completion of the new medical center, which is the largest hospital project currently underway in Southern California.

Under construction and projected to open in 2016, Jacobs Medical Center is a $839 million, 10-story facility on the university’s La Jolla campus, which will include three new clinical care units in one location: The A. Vassiliadis Family Hospital for Advanced Surgery, The Pauline and Stanley Foster Hospital for Cancer Care and the Hospital for Women and Infants.

“We are deeply grateful to Joan and Irwin Jacobs for their generosity, including the recent $25 million match challenge,” said UC San Diego Chancellor Pradeep K. Khosla. “We also thank Carol Vassiliadis and Pauline Foster, who made leadership gifts, as well as all of the other donors who participated in meeting this challenge. These visionaries support UC San Diego’s commitment and vision to create a healthier world through new science, new medicine and new cures.”

“Jacobs Medical Center is part of a multibillion dollar university investment in the future of health care for the region,” said Dr. David A. Brenner, vice chancellor for Health Sciences and dean of the UC San Diego School of Medicine. “I want to thank all of the donors who have helped make this extraordinary medical center a reality.”

Irwin and Joan Jacobs

“When we came here in 1966, the medical school was just starting,” said Irwin Jacobs, co-founder, former chairman and CEO of Qualcomm Inc. and UC San Diego founding faculty member, who served as a professor in electrical and computer engineering from 1966 to 1972. “There was no hospital, just a school. So it’s very exciting to make Jacobs Medical Center possible. More and more, we’re learning how to bring results from basic research in biology and engineering to medicine, and to the clinic. I think this medical center is going to show how effective that can be. The innovations will spread out from San Diego, and go all around the world.”

The 509,500-square-foot facility will house 245 patient beds and be connected on multiple floors with the existing John M. and Sally B. Thornton Hospital on UC San Diego’s La Jolla campus, in the heart of the area’s nexus of biomedical research centers. Jacobs Medical Center has been designed with the patient in mind. From spacious private rooms to soothing color schemes and artwork, to next-generation medical equipment, the vision and needs of patients, doctors and nurses, all aspects of the Jacobs Medical Center have been fully integrated. Each floor will combine all the necessary healing elements while achieving optimal safety and efficient delivery of care.

“Soon we will have the largest, most technologically advanced hospital in the region, dedicated to offering specialized care for every kind of patient, in every phase of life,” said Paul Viviano, CEO of UC San Diego Health System.

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New approach proposed to heart surgery for infants

Would potentially reduce the number of surgeries single-ventricle patients have to undergo.

A computer simulation showing how a clipped shunt would connect an artery off the aorta to the superior vena cava.

Engineers at the UC San Diego are proposing a new surgical intervention for children born with a single ventricle in their heart — instead of the usual two. The new approach would potentially reduce the number of surgeries the patients have to undergo in the first six months of life from two to just one. If successful, it would also create a more stable circuit for blood to flow from the heart to the lungs and the rest of the body within the first days and months of life.

Engineers ran computer simulations of the surgery and found it would reduce the workload on the patient’s heart by as much as half. It would also increase blood flow to the lungs and increase the amount of oxygen the body receives.

The surgery would introduce a radical change in the way infants with a single ventricle are treated. Currently, they undergo three surgeries by age three. Babies born with a single ventricle are severely deprived of oxygen, which makes their skin turn blue, and requires immediate medical intervention.

The research group, led by Alison Marsden, a professor of mechanical engineering, is working in collaboration with cardiothoracic surgeon Tain-Yen Hsia, of the Great Ormond Street Hospital for Children and UCL Institute of Cardiovascular Science in London.  They reported their findings in an October issue of the Journal of Thoracic and Cardiovascular Surgery.

“Even when surgeries are successful, these babies live with a circulation that is very taxing on the one heart pump they have,” Dr. Hsia said.  “So there is a need to find a better solution.”

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Perioperative surgical homes improving results for patients, hospitals

UC Irvine Health anesthesiologists spearhead effort.

UC Irvine Health physicians continue to be leaders for a model of surgical care that may drive down hospital costs and, more importantly for patients, results in better outcomes and fewer complications.

At the recent annual meeting of the American Society of Anesthesiologists, Dr. Zeev Kain discussed the perioperative surgical home concept and UC Irvine’s experience in front of more than 5,000 participants during the meeting’s opening session.

“The perioperative surgical home delivers better patient outcomes, enhances safety and reduces costs,” said Kain, M.D., M.B.A., chairman of the UC Irvine Department of Anesthesiology & Perioperative Care and Chancellor’s Professor of Anesthesiology, Pediatrics and Psychiatry. “That’s not wishful thinking, it’s hard data.”

“Readmission rates are between 8 and 12 percent for the U.S. Our readmission rate from the [perioperative surgical home] is 0.5 percent,” he said.

Noting that half of all hospital costs occur in the postoperative period, Kain said avoidable complications such as pneumonia, urinary tract infections or the delirium some patients experience as they emerge from anesthesia can add $10,000 to the cost of treatment.

In addition, UC Irvine Health anesthesiologists made more than two dozen presentations, including Minimizing Postoperative ICU Complications with Drs. Trung Q. Vu and William Wilson, Optimization of the High-Risk Surgery Patient in the Era of Enhanced Recovery After Surgery and Perioperative Surgical Home with Dr. Maxime Cannesson and Kain, and Total Joint Perioperative Surgical Home at UC Irvine Health: A Cost Analysis with Drs. Darren R. Raphael, Cannesson, Leslie M. Garson, Shermeen B. Vakharia, Kain, Ran Schwarzkopf and Ranjan Gupta.

This perioperative care model, which refers to the period before, during and after surgery, spans the patient’s entire surgical experience, starting with the decision to have surgery through 30 to 90 days after hospital discharge. The care pathway is a mapped out by a clinical team that includes surgeons, anesthesiologists, nurses and to the medical device specialists to the rehabilitation therapists, such that there is complete continuity of care as well as standardization of practices to enhance patient safety.

Kain and Cannesson summed up the reasons for their surgical home efforts in the May issue of the journal Anesthesia & Analgesia:

Interestingly, with the recent changes occurring in the health care system in the United States, the American Society of Anesthesiologists has endorsed the concept of the Perioperative Surgical Home (PSH) and has recommended including it as part of affordable care organizations and hospitals. It is widely recognized that our current perioperative system in the United States is costly, fragmented, and often driven by focus on hospital reimbursement as well as culture and tradition rather than on quality and service. …  Because it has been shown that most perioperative complications are related to a lack of coordination of care and a wide variability in the way care is delivered, a model such as the PSH is much needed.

UC Irvine Health physicians published several other articles about the perioperative surgical home in the May Anesthesia & Analgesia, including a review of the university’s experience with orthopaedic surgeon Schwarzkopf and the model’s implementation for total hip and total knee replacement surgeries.

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Carol Vassiliaidis names hospital with $8.5M to Jacobs Medical Center

New UC San Diego facility to be home to A. Vassiliadis Family Hospital for Advanced Surgery.

Carol Vassiliadis surveys the construction site of Jacobs Medical Center, which will be home to the A. Vassiliadis Family Hospital for Advanced Surgery. (Photo by Paul Turang)

People give to UC San Diego for many different reasons, but for local philanthropist Carol Vassiliadis, her reason is simple. “It’s the people,” she said. “The people at UC San Diego truly believe in what they are doing. And if, with the Jacobs Medical Center, we are helping people survive, we are doing something very important.”

That is why Vassiliadis has designated gifts totaling $8.5 million to the future UC San Diego Jacobs Medical Center. In honor of her support, the new facility — to be opened in 2016 — will be home to the “A. Vassiliadis Family Hospital for Advanced Surgery.” A portion of Vassiliadis’ support was also matched by an anonymous donor as part of a Jacobs Medical Center Challenge grant, for a total of $12 million in gifts.

Vassiliadis, like so many others, has faced the loss of a loved one from disease. Her husband, Alkiviadis or “Laki,” passed away from colon cancer in 2002. Carol began her tradition of philanthropy at UC San Diego initially to honor her late husband’s legacy with a fellowship for cancer prevention, followed by support for the Healthy Eating and Living Program at UC San Diego Moores Cancer Center. Now, she has chosen to name the A. Vassiliadis Family Hospital for Advanced Surgery, housed on the second and third floors of the Jacobs Medical Center, for her husband and family.

“Thanks to Carol Vassiliadis’s visionary support, the A. Vassiliadis Family Hospital for Advanced Surgery will be among the most technologically advanced surgical facilities in the nation,” said UC San Diego Chancellor Pradeep K. Khosla. “UC San Diego is proud to offer state-of-the-art health care options for patients who need them. Together, with generous donors like Carol, we are creating a healthier world, one patient at a time.”

“We express our sincere gratitude to Carol for this transformative gift to UC San Diego,” said David Brenner, M.D., vice chancellor for health sciences and dean of the UC San Diego School of Medicine. “This investment in Jacobs Medical Center will also help accelerate translational research so that discoveries can be delivered to patients in real time. With Jacobs Medical Center, the Altman Clinical and Translational Research Institute, Shiley Eye Center, Sulpizio Cardiovascular Center, and Moores Cancer Center, we will have one place where the strengths of academic medicine – excellent patient care, cutting-edge research and teaching – come together in one location to best serve patients.”

The A. Vassiliadis Family Hospital for Advanced Surgery will offer patients access to more than 200 surgeons who specialize in complex procedures for all medical conditions. Examples of surgeries to be offered include MRI-guided gene therapy for brain cancer, heated intraperitoneal chemotherapy for abdominal cancers, and complex spine and joint reconstruction. A robust robotics program will continue to treat thyroid, esophageal, prostate, colon, kidney and bladder cancers. Delicate microsurgery to restore voice and hearing and reanimation of the paralyzed face and extremities will also be performed. Minimally invasive surgical options will be available to treat cancer, obesity and a range of other conditions.

“We are deeply grateful to Carol for her extraordinary generosity in naming the Hospital for Advanced Surgery at UC San Diego Jacobs Medical Center,” said Paul Viviano, CEO, UC San Diego Health System. “With her gift, we will be able to invest in the kind of lifesaving surgical techniques, technologies, devices and therapies that are only available inside the nation’s leading academic health systems.”

The A. Vassiliadis Hospital for Advanced Surgery will house the region’s only intraoperative magnetic resonance imaging (MRI) machines. With this technology, surgeons will be able to image tumors in real-time during surgery to be certain that malignancies, such as glioblastoma in the brain, have been removed — without ever having to leave the operating room. Repeat MRIs can be performed throughout the surgery, which is critical to removing malignant tissue while sparing healthy tissue. MRI guidance can also be used for more accurate biopsies, for laser therapy to destroy tumors and to deliver gene therapy as a potential treatment for brain tumors.

“This hospital will help support patients so that cancer, as well as other diseases and ailments, are things patients can live through,” said Vassiliadis. “Great advancements are being made quickly so that fewer and fewer cancers will be fatal.”

Additionally, the hospital will be the only hospital in the United States using a proprietary MRI technique called Restriction Spectrum Imaging (RSI) to create color coded maps of the brain, fiber by fiber, for accurate surgery planning.

The hospital will also have 14 new, 650-square-foot operating rooms. These rooms are larger than a standard OR and the ideal size to accommodate rapid changes in technology. The operating room designs incorporate input from the UC San Diego Center for the Future of Surgery, which was established to research, design and teach the most safe and effective surgeries.

“UC San Diego’s surgical care is not only recognized as among the most innovative and technically advanced but also among the safest in the country,” said Christopher Kane, M.D., professor and interim chair of the Department of Surgery. “Our new surgical hospital is designed to enhance efficiency, quality and outcomes for patients. Surgeons were involved in every step of the design process so we are thrilled with the enhancements in surgical care that this new facility will enable us to deliver to the San Diego community.”

In addition to supporting Jacobs Medical Center and Moores Cancer Center at UC San Diego, Vassiliadis has supported a wide range of areas on campus. She established the Alkiviadis Vassiliadis Chair in Byzantine Greek History and helped garner support for two other Greek history chairs at UC San Diego, in honor of her husband’s strong ties to his ancestral heritage. She still plays an active role in San Diego’s Greek Orthodox community. Vassiliadis is also a trustee of the UC San Diego Foundation Board and member of the UC San Diego Moores Cancer Center Advisory Board.

“My hope is to leave the world a slightly better place than it was when I was born,” said Vassiliadis. “I think this hospital is going to change lives.”

The Jacobs Medical Center, currently under construction and projected to open in 2016, is a 10-story facility that will include three important clinical care units in one location: the A. Vassiliadis Family Hospital for Advanced Surgery; The Pauline and Stanley Foster Hospital for Cancer Care; and the Hospital for Women and Infants. There are still numerous naming opportunities in the center, ranging from nurses stations and a family lounge to the main courtyard and more. Visit jmc.ucsd.edu for more information.

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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.

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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.”

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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.

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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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