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Continuum Achieving Broad-Based Excellence Department of Surgery Annual Report 2012 Department of Surgery Annual Report 2012 Letter from the Chairman 1 Introduction 2 Our Heritage 4 Division of Public Health Sciences 8 Division of General Surgery Section of Acute and Critical Care Surgery 10 Section of Colon and Rectal Surgery 12 Section of Endocrine and Oncologic Surgery 14 Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery 16 Section of Minimally Invasive Surgery 18 Section of Transplant Surgery 20 Section of Vascular Surgery 22 Division of Cardiothoracic Surgery Section of Cardiac Surgery 24 Section of General Thoracic Surgery 26 Section of Pediatric Cardiothoracic Surgery 28 Division of Pediatric Surgery 30 Division of Plastic and Reconstructive Surgery 32 Division of Urologic Surgery 34 Education 36 Research 38 Clinical Operations 40 Giving 42 Faculty 44 Letter from the Chairman THE SUCCESSFUL ACADEMIC DEPARTMENT train our leadership. More recently, we began work- OF SURGERY OF THE FUTURE will be built on the groups on surgical quality and effectiveness, clinical tradition and values of the past, but will plan for the quality of care, and innovations in surgical education. future. This idea summarizes my presidential address In this report, you will see surgeon-scientists to the American Surgical Association in April 2012, continuing in the tradition of their predecessors, yet and I drew from our own department’s experience adapting to the new realities of the research environ- as an example of how such a model can work. ment; surgeons participating in multidisciplinary centers and engaging in well-controlled clinical trials, quality and outcomes initiatives; and educators creating of Robert Brookings, president of the Washington new paradigms for surgical education through early University Board of Trustees, led to a modernized specialization and the academy model, which moves medical school with a full-time faculty model. One of away from learning by osmosis. the school’s first full-time leaders was Evarts Graham, TIM PARKER Past leaders in the medical school and our Department of Surgery laid a strong foundation. The vision Timothy Eberlein, MD Mark Twain once said, “Plan for the future, because MD, Bixby Professor and chairman of the Department that is where you are going to spend the rest of your of Surgery, a surgeon-scientist who helped develop the life.” Our faculty has heeded this advice by embracing oral cholecystogram and performed the first successful change, building on the past and focusing on the future. single-stage total pneumonectomy. Later in this report, there is a profile of the past leaders of the department Timothy Eberlein, MD and their exceptional record of contributions to surgery. William K. Bixby Professor of Surgery In recent years, our department has continued to Chairman, Department of Surgery evolve and innovate in response to outside forces such Director, Alvin J. Siteman as declining clinical reimbursement, increased compe- Cancer Center tition for peer-reviewed funding, and higher levels of professional and personal stress. To address these realities, six years ago, we created a program to first examine the viewpoints of our faculty and then create a more supportive environment, and enhance and formally Department of Surgery Annual Report 2012 1 Continuum Introduction TIM PARKER 2 surgery.wustl.edu Achieving BROAD-BASED EXCELLENCE The Department of Surgery at Washington University School of Medicine is fortunate to have a rich history of success on which to build. As it moves forward to meet the challenges of the current academic health care environment, the department draws upon its historic strengths in collaboration and research to foster excellence in research, education and patient care across all surgical subspecialties. The department’s comprehensive research efforts range from conducting basic science to leading major national multicenter clinical trials to engaging in public health, quality improvement and patient safety research. An interdisciplinary approach to investigation allows the department’s physician-scientists to address increasingly complex issues more effectively than would otherwise be possible and to more quickly translate findings into clinical solutions. Building on the success of the past, the department offers comprehensive clinical care in every surgical subspecialty; it aims to increase its impact regionally and nationally through geographic expansion and emphasis on interdisciplinary, team-based care. In education, department faculty are leading the development of innovative, efficient approaches to surgical training. Its collective strengths in all three missions create a synergistic momentum that positions the department to meet the challenges ahead as it continues working to improve human health. Department of Surgery Annual Report 2012 3 Our Heritage: GROUNDED IN RESEARCH Chairs of the Department of Surgery Frederick Murphy performing Barnes Hospital’s first operation in 1914 1914-19 1919-51 Frederick Murphy, MD Evarts Graham, MD THE DEPARTMENT OF SURGERY Washington University President historically has been a leader in clinical Robert S. Brookings created a full-time innovations, research and graduate faculty model for the medical school, medical education and is positioned to Murphy did not agree and abruptly remain an influential force in academic resigned. With the help of Brookings, surgery in the critical years ahead. the medical school engaged philan- The medical field was changing thropist William Bixby, who helped when the department was established, endow a full-time chair of surgery, just as it is today. Frederick Murphy, and Evarts Graham, MD, was selected MD, recruited from Harvard, was the as the first William K. Bixby Professor first surgeon-in-chief and performed and chair. Another benefactor, Mary Barnes Hospital’s first operation (an Culver, endowed the department, appendectomy) in 1914. But when which is today known as the Mary Culver Department of Surgery. McMillan Hospital, circa 1940 Graham is known for the development of the oral cholecystogram, HISTORICAL PHOTOS COURTESY BECKER MEDICAL LIBRARY ARCHIVES performing the first single-stage total pneumonectomy in which the patient survived, and research linking cigarette smoking to lung cancer. The chairs who have followed — Carl Moyer, MD; Walter Ballinger, MD; Samuel Jessie Ternberg, MD, PhD, right, taught hundreds of surgical interns, urging them to have “the eye of an eagle, the heart of a lion, and the hand of a lady.” Evarts Graham, MD, circa 1953 4 surgery.wustl.edu Wells Jr., MD, and Timothy Eberlein, MD — have also made important 1967-78 1981-97 1998-Present Carl Moyer, MD Walter Ballinger, MD Samuel Wells Jr., MD Timothy Eberlein, MD AoRTic traNscathetER) Trials, inves- ing graduate medical education. All Clinical Innovation, Collaboration and Prevention have been leaders in their field with In 1933, James Gilmore, a Pittsburgh and high-risk patients with aortic Graham, Wells and Eberlein serving obstetrician, was admitted to the stenosis. Cardiac surgeons have as presidents of the American Surgical chest clinic at Barnes Hospital with a worked together with car- Association. Many other Washington suspected lung abscess and a collapsed diologists in these trials. University surgeons, including Eugene lung. Doctors diagnosed squamous Bricker, MD, who developed the ileal cell carcinoma, and Graham per- ment advances have also conduit for urinary diversion and was formed the first successful removal of come from collaborative president of the American Surgical an entire lung. Gilmore led a long life, efforts. This integrated Association, also have helped shape and for more than 20 years after the approach, pioneered by the field of surgery. operation, Gilmore and Graham cor- Bricker and embraced responded with and visited each other. by Ballinger and Wells, contributions: in medical and surgical treatment, research and/or shap- Today, academic departments of surgery face many challenges to The introduction of new treat- TIM PARKER 1951-65 tigating the placement of an aortic valve using a catheter in inoperable Many other treat- can be seen today in the their historic missions. These include ments — including the use of silver Washington University lower reimbursement, threats from nitrate solution to treat acute burns, and Barnes-Jewish Heart other disciplines, increased competi- made possible by Moyer’s research, & Vascular Center, which tion for peer-reviewed funding, and a and the development of the Cox-Maze incorporates cardiology, dramatic increase in monitoring and procedure to treat atrial fibrillation cardiac surgery and vascular surgery; oversight. At Washington University, — continues to benefit patients in and the Washington University and the Department of Surgery is explor- the current era. Recently, Washington Barnes-Jewish Transplant Center, ing key opportunities to remain at the University has been a leading enroller with specialists in surgery and medi- leading edge of academic surgery. for two PARTNER (Placement of cine. Eberlein also uses this model The Center for Advanced Medicine, which opened in fall 2001, houses 18 outpatient clinical centers that provide collaborative specialty services. Department of Surgery Annual Report 2012 5 Points of Distinction Performed first successful surgical removal of a lung (Evarts Graham, 1933) Developed Maze procedure, the first surgical cure for atrial fibrillation (James Cox, John Boineau, Richard Schuessler, 1987) Performed first nerve transplant using nerve tissue from a cadaver donor (Susan Mackinnon, 1988) in directing the Alvin J. Siteman Research ing the gene responsible for the of the first mouse model of lung Cancer Center at Barnes-Jewish Department of Surgery chairs have MEN syndromes — which result transplantation to help understand Hospital and Washington University carried on a strong tradition as in thyroid cancer — led to the first the molecular mechanisms that School of Medicine, an international scientists wanting to solve practical surgical prevention of cancer based control lung transplant rejection; the leader in cancer treatment, research, problems. Graham performed impor- on genetic testing. And Eberlein, a study of ATP channel heart muscle prevention, education and commu- tant work in gallbladder imaging and surgical oncologist, has helped to cell contractility and the potential smoking, and Moyer in the study of establish Siteman as an international use of a drug to lessen the impact of silver nitrate for burns; in addition, leader in clinical trials, basic science myocardial stunning; and the work become important benchmarks, and Ballinger was well regarded for his and translational research, including of several faculty members with a will become even more critical in the nity outreach. Quality care and prevention have studies in the pathophysiology work with Washington University’s world-renowned biomedical engineer coming years. Surgeon Bruce Hall, of gastrointestinal diseases such as Genome Institute to sequence the in the development of photoacoustic MD, plays a key role in the American ulcers. The work of Wells in identify- first cancer genome. imaging to screen for precancerous In recent years, College of Surgeons National Surgical collaboration — esophagus, to identify the sentinel NSQIP®), and renowned epidemi- among surgical lymph node in breast cancer patients, ologist Graham Colditz, MD, DrPH, faculty and with and to identify single-cell melanoma oversees the Division of Public Health scientists in other tumor cells in planning a wide exci- Sciences, formed in 2011 to promote departments — sion for melanoma. disease prevention and improve qual- has led to a critical ity and access to health care. mass in a number Education of groundbreaking Graham was an early leader in surgical projects. These in- residency education who stressed the clude development importance of the basic sciences in the The BJC Institute of Health at Washington University School of Medicine houses several interdisciplinary research centers dedicated to translational research. 6 tissue in patients with Barrett’s Quality Improvement Program (ACS surgery.wustl.edu Performed first laparoscopic kidney removal (Ralph Clayman, 1990) In work on thyroid cancer, developed first surgical prevention of cancer based on genetic testing (Samuel Wells, 1994) Today, ranks among the top U.S. academic surgery departments in annual National Institutes of Health (NIH), non-federal and corporate-supported grants (2012) training of surgeons and believed that G. Phillips City Hospital, one of of the first to introduce a surgical the study of general surgery should only three institutions at the time skills lab. Klingensmith now serves constitute a large share of the time where this type of training occurred. as vice chair of education and leads spent in preparing for a career in a Wells took surgical training a step efforts to look at early specializa- surgical specialty. further, transitioning the department tion in all subspecialty fellowships. to a completely full-time model Michael Awad, MD, the newly for faculty. appointed general surgery Moyer was best known as a wonderful teacher who took great For most of the 20th century, residency program director, is superb role model. He also had the motto of general surgery overseeing design of a residency a strong social conscience and residency training was “see one, do web portal and migration to an supported the education of African- one, teach one,” and residents spent academy model in which general American physicians at the Homer long hours in surgical training. As surgery residents discuss goals these trends began with a faculty member, receive to change at the mil- feedback and undergo a formal lennium, former assessment. Both Eberlein and General Surgery Klingensmith are leading a Residency Program national initiative to create a Director Mary new model of more efficient Klingensmith, MD, and effective surgery training. led the adoption of duty-hour restrictions and was one Caption ST. LOUIS CHILDREN’S HOSPITAL interest in his students and was a The School of Medicine’s affiliated hospitals, Barnes-Jewish Hospital and St. Louis Children’s Hospital, are both ranked among the best in the nation and are an integral component of the Department of Surgery’s ongoing success. Trauma fellows and general surgery residents benefit from the involvement of Douglas Schuerer, MD, in national patient safety initiatives. Schuerer, second from left, is director of the Surgical Critical Care Fellowship. Department of Surgery Annual Report 2012 7 Division of Public Health Sciences Master’s degree program: SHARPENING RESEARCH SKILLS Highlights Washington University researchers reported that more than half of all cancer is preventable in a review article in Science Translational Medicine. Graham Colditz, MD, DrPH, and co-authors found that lifestyle choices play a significant role in causing cancer, with smoking alone responsible for a third of all U.S. cases and excess body weight accounting for another 20 percent. Kimberly Kaphingst, ScD, is collaborating with Jennifer Ivanovich, MS, and researcher Paul Goodfellow, PhD, in a proposed study to examine how to communicate genome sequencing results to young breast cancer patients. A grant from the Centers for Disease Control and Prevention enables the Young Women’s Breast Cancer Program (YWBCP) to provide support and education services for women 45 and younger diagnosed with breast cancer. Program director Jennifer Ivanovich, MS, is principal investigator. The YWBCP is also developing a genetics navigation tool to help young survivors understand their family-based cancer, learn about new developments in genetic testing and prepare them for the next wave of clinical genetic testing, specifically gene panels and whole exome sequencing. Bettina Drake, PhD, MPH, extended her community-based research on minority recruitment into clinical studies to include the participation of African-American men in pancreas cancer trials. African-American men have a higher incidence of pancreas cancer but less involvement in studies than whites. Public health researchers created a health app called Zuum, which provides risk estimates for heart disease, stroke, diabetes, lung cancer and colon cancer, breast cancer and prostate cancer. The tool, available on iTunes, also explains how to lower risk and to see the impact of positive changes on future risk. Instructor Su-Hsin Chang, PhD, is working with bariatric surgeon Esteban Varela, MD, MPH, to study the costeffectiveness of various forms of weight-loss surgery. 8 surgery.wustl.edu As a student in the Master of Population Health Sciences program, Lola Fayanju, MD, MPHS, left, worked with MPHS instructor Aimee James, PhD, MPH, to hone her skills in studying breast cancer care disparities. THE MASTER of Population Health the late stages of the disease. And Sciences (MPHS) degree program was Fayanju had been struck by treatment launched by the Division of Public disparities on a number of rotations Health Sciences to give clinicians a she had served. strong foundation in clinical effec- “I had seen striking, systematic tiveness and outcomes research. The differences among patients with program, which began in 2010, has different socioeconomic status,” already opened such a pathway for Fayanju says. medical students, residents and fellows. The next year, Fayanju chose For one surgical resident, the program to do a research elective with provided the expertise to interpret Margenthaler, who had joined the the data,” says Fayanju. “It’s notable and apply research findings to better faculty as a breast surgeon. With a that women are actually getting address disparities in treating breast grant from the Program for the mammograms at a fairly high rate. cancer patients. Elimination of Cancer Disparities But there are other points along the at the Alvin J. Siteman Cancer time line of care at which to inter- Center at Barnes-Jewish Hospital vene and improve outcomes.” Oluwadamilola “Lola” Fayanju, MD, MPHS, and breast surgeon Julie Margenthaler, MD, Washington University breast surgeon at BarnesJewish Hospital, met when Fayanju was a third-year medical student and Washington “I used the skills I acquired in the MPHS program to do justice to the data.” Lola Fayanju, MD, MPHS and Margenthaler Graham Colditz, MD, DrPh, University School chief of the Division of Public of Medicine, the Health Sciences and the Niess-Gain two launched a Professor in the School of Medicine, research project says Margenthaler, in her work with to interview Fayanju and another surgery resident women about who entered the MPHS program this their health year, is helping the next generation of history prior to breast surgeons focus on the causes was a breast disease fellow at their diagnosis with breast cancer. of and solutions for disparities in Washington University. Working Fayanju continued the project as a breast cancer treatment. at a ConnectCare clinic for low- resident through her first residency income patients, Margenthaler research year, which she used to perspective with her. “It’s had already observed that a high complete the MPHS degree in 2011. a lifelong commit- percentage of women with breast cancer were first being seen in “I used the skills I acquired in Lola Fayanju, MD, MPHS, left, works with breast surgeon Julie Margenthaler, MD, to study barriers to breast cancer screening. Fayanju will take this ment,” she says. the MPHS program to do justice to Department of Surgery Annual Report 2012 9 Division of General Surgery Section of Acute and Critical Care Surgery Secondary brain injury: PURSUING PREVENTION Highlights The Washington University and Barnes-Jewish Trauma Center recently received Level I designation from the State of Illinois. The program is now designated as a Level I trauma center in both Missouri and Illinois, and was also re-verified by the American College of Surgeons (ACS) as a Level I trauma center. The ACS designation is considered a gold standard for trauma centers. Barnes-Jewish cares for approximately 14,500 trauma patients a year. BJC HEALTHCARE The Surgical and Wound Care Clinic moved into the new Barnes-Jewish Center for Outpatient Health, which provides upgraded facilities for patients and physicians. Formerly located on the first floor of Barnes-Jewish Hospital, the clinic treats acute care surgery patients and many other patients with wounds. Among its new services is hyperbaric oxygen therapy, used to treat wounds that won’t heal as a result of diabetes or radiation injury. The Section of Acute and Critical Care Surgery welcomes Robert Winfield, MD, as an assistant professor. He joins the section after completing a fellowship in trauma surgery and critical care at the University of California-San Diego and a surgical residency at the University of Florida in Gainesville. Winfield’s practice includes a full range of critical care, trauma surgery and acute care surgery. Douglas Schuerer, MD, Barnes-Jewish Hospital director of trauma, has been elected chair of the East Central Region Emergency Medical Services (EMS) Committee. As a subcommittee of the state advisory council of the Missouri Department of Health and Senior Services, the committee serves as a liaison to the regional emergency medical services and hospital community. Husband-and-wife team Grant Bochicchio, MD, MPH, right, and senior research administrator Kelly Bochicchio, RN, MS, evaluates the diabetes drug glyburide for its potential to prevent secondary brain injury resulting from trauma. 10 surgery.wustl.edu THE IMPACT of improvised explosive used to treat diabetes that blocks the devices (IEDs) and other blast injuries SUR1 ion channel in the brain. This trial comple- has been devastating for American medication has been shown to pre- ments the efforts soldiers in Iraq and Afghanistan. Many vent secondary brain injury in animal of Washington times, when there is trauma to the studies performed by Marc Simard, University plastic head, it is not the initial blast that kills MD, PhD, and Bochicchio. As the ba- and reconstruc- the soldier; rather, he or she dies from sic science research continues in ani- tive surgeons, secondary effects to the brain. This mals, a human trial will soon begin to who have created has prompted Grant Bochicchio, MD, study whether this drug can be given a website showing surgeons how MPH, chief of the Section of Acute safely to healthy adults who are un- nerve transfer techniques can be and Critical Care Surgery, to study dergoing physical exercise to simulate used to restore function in the the sequelae of traumatic brain injury the characteristic activities of soldiers limbs of soldiers injured in explo- and has led to a clinical trial testing in the military. Bochicchio will serve sions and combat. the safety of a promising drug that as principal investigator may diminish the effects of traumatic of this randomized trial, brain injury. which will recruit healthy, “First, you have the initial trauma non-diabetic volunteers — the contusion from the event itself,” to exercise on a treadmill says Bochicchio, also the Harry Edison three times a day under Professor of Surgery. “However, over careful medical supervi- the next 24 to 48 hours, you have sion to guard against any swelling that occurs, which is really potential side effects. what causes death in a lot of patients Basic research by Grant Bochicchio, MD, MPH, right, shown with staff scientist Christopher Davis, revealed the potential for a diabetes drug to prevent brain injury. “We hope someday to give this medication in order to prevent secondary brain injury and potentially save lives.” Grant Bochicchio, MD, MPH “Results of this or soldiers. And in those who do important work may also survive, it can cause permanent and be applicable to brain injury in the debilitating brain damage.” civilian world,” says Bochicchio. “If Bochicchio is the co-principal The clinical patients are in a bad car crash, we investigator of a Department of hope someday to give this medication Defense grant evaluating the impact in order to prevent secondary brain of glyburide, a medication originally injury and potentially save lives.” Department of Surgery Annual Report 2012 11 TI M R PA KE R Division of General Surgery Section of Colon and Rectal Surgery Highlights The section welcomes back former fellow Paul Wise, MD, as an associate professor of surgery. Wise received his medical degree from Johns Hopkins University and completed a general surgery residency at Vanderbilt University, where he had served on the faculty since 2004. The former president of the Collaborative Group of the Americas on Inherited Colorectal Cancer, Wise will direct Washington University’s Inherited Colorectal Cancer and Familial Polyposis Registry. His clinical practice focuses on colorectal cancer treatment and inheritance, inflammatory bowel disease and benign anorectal diseases. Elisa Birnbaum, MD, is rolling out the online colorectal education system for the American Society of Colon and Rectal Surgeons (ASCRS). The system will encompass all of the educational material owned by the society — about 60 modules — including the ASCRS textbook, journal, post-graduate courses and self-assessments. IMPROVE QUALITY OF LIFE IN THE 1970s, the Washington removing the rectum and without an University colon and rectal surgery abdominal incision. service became one of the earliest to “We began using the TEM pro- offer radiation therapy in combina- cedure for polyps in 2006,” says Hunt. tion with surgery to treat rectal cancer. “In the early stages, we only used the Operative treatment has since evolved, procedure in rectal cancer patients who improving patients’ quality of life, we did not think would survive a large and stands at the threshold of several abdominal operation.” new frontiers. “In the earliest days, if you had But when the medical literature showed TEM alone could be curative cancer in the lower part of the rectum, for early-stage rectal cancer, Hunt you ended up with a colostomy bag — began offering it. And now that studies because the technology didn’t allow us show TEM with chemoradiation may to take out very small tumors without be effective for some advanced rectal using this option,” says Steven Hunt, cancers, its use may be expanded in MD, Washington University colorectal coming years. As chairman of the ASCRS Committee for Self-Assessment, Matthew Mutch, MD, is in charge of producing the latest edition of the Colon and Rectal Surgery Educational Program. surgeon at Barnes-Jewish Hospital. “We’ve come a long way in avoiding in rectal cancer treatment at Alvin J. Under the leadership of Ira Kodner, MD, Washington University colorectal surgeons oversee residents and provide services to low-income patients at ConnectCare. these types of resection.” Siteman Cancer Center at Barnes-Jewish Sekhar Dharmarajan, MD, received the Career Development Award from the ASCRS Research Foundation. It will fund his project with Nicholas Davidson, MD, on the study of liver fatty acid binding protein and its effect on polyp development in a mouse model. Section Chief James Fleshman Jr., MD, was named an associate editor of the Annals of Surgery. He is also a member of an American College of Surgeons Board of Governors committee that is developing educational materials on stress, substance abuse and other health issues for surgeons. 12 Minimally invasive techniques surgery.wustl.edu Although open surgery has TEM is not the only advancement Hospital and Washington University improved to preserve bowel function School of Medicine. Radiation oncolo- in many cases, the use of a minimally gist Parag Parikh, MD, is now work- invasive technique — transanal endo- ing with colorectal surgeons to offer scopic microsurgical (TEM) exci- patients a one-week radiation course, sion — is further transforming rectal followed by early chemotherapy, before cancer surgery. During this procedure, surgery. This compares to a traditional a 20-cm-long proctoscope placed through the anus allows surgeons to visualize and resect tumors without regimen of about three months before surgery, which may allow some cancers to spread to the liver and other organs. Letha Nell and Richard Stallard Healthy Retirement Richard Stallard, 71, of Granite City, Ill., is back to riding his trike motorcycle, fishing and spending retirement with his wife, Letha Nell, after successful treatment of appendiceal cancer that had spread to his abdomen. TIM PARKER Steven Hunt, MD, performs a transanal endoscopic microsurgical (TEM) excision. The minimally invasive tumor removal technique preserves function and is one of many advances improving quality of life for rectal cancer patients. A new technology called gene Clinic to see whether the technique can expression profiling may also shape identify who will benefit from radiation the future of treatment. Washington and chemotherapy, and what regimen University colorectal surgeon Mat- to use. “If we can accomplish that, we will Matthew Kalady, MD, of the Cleveland develop a therapeutic trial,” Mutch says. TIM PARKER thew Mutch, MD, is collaborating with In April 2010, Section Chief James Fleshman Jr., MD, operated to remove Stallard’s appendix, colon and rectum and enrolled him in a trial at Siteman Cancer Center to treat carcinomatosis of the abdomen. The trial combined the current standard of care – debulking the cancer, stripping the lining of the abdominal cavity and chemotherapy – with surgical insertion of catheters into both sides of the abdomen. Chemotherapy was administered intravenously and via the catheters. Stallard did not receive the full course of catheter treatment because of pain but responded well overall. When tests showed there was no return of the cancer, Fleshman removed the catheters, created a new rectum out of small intestine, and created a diverting ileostomy. Three months later, the ileostomy was closed to restore normal bowel function. Today, Stallard is cancer free and enjoying retirement once again. Department of Surgery Annual Report 2012 13 National initiatives target Division of General Surgery PATIENT SAFETY AND OUTCOMES Section of Endocrine and Oncologic Surgery Highlights Julie Margenthaler, MD, has been named surgical director of the Joanne Knight Breast Health Center in the Center for Advanced Medicine. At the center in 2011, Margenthaler and colleagues evaluated and treated roughly 560 new breast cancer patients and more than 1,500 new patients with other breast disorders. As surgical director, Margenthaler organizes the surgical services for breast patients, including clinical, research, patient education and training components. She also serves as the liaison between the surgical services and other sections. A randomized study led by Rebecca Aft, MD, PhD, found TIM PARKER that zoledronic acid (Zometa®) administered with chemotherapy improves disease-free and overall survival in the subset of patients with estrogen receptor-negative stage II and III breast cancer. Findings will appear in the British Journal of Cancer. A clinical trial is under way to test whether photoacoustic tomography is effective in finding the sentinel lymph node in breast cancer patients. The new technology couples ultrasound and a laser system to identify the sentinel node. Julie Margenthaler, MD, collaborated with Lihong Wang, PhD, the Gene K. Beare Distinguished Professor of Biomedical Engineering, to develop the technology. Rebecca Aft, MD, PhD, and medical oncologist Cynthia Ma, MD, PhD, will open a randomized clinical trial evaluat- TIM PARKER ing the effect of a potential anti-cancer drug called hedgehog inhibitor LDE225 on bone marrow-disseminated tumor cells in women with early stage estrogen receptor-negative and HER2-negative breast cancer. LDE225 is known to be a potent inhibitor of the Hh signaling pathway, which has been implicated in the development and maintenance of breast cancer. Bruce Hall, MD, PhD, MBA, center, spearheads Barnes-Jewish Hospital’s quality improvement efforts with chief medical officer John Lynch, MD, Mitzi Hirbe, RHIA, CPHQ, hospital president Richard Liekweg, surgical clinical reviewer Louise Schrama and others. He also is involved with national efforts of the American College of Surgeons. 14 surgery.wustl.edu Coreen Jones is grateful for the scientific breakthrough and resulting treatment she and her daughters have received at Washington University. OVER THE PAST SEVERAL YEARS, Washington University endocrine reimbursement for Medicare and surgeon Bruce Hall, MD, PhD, MBA, Medicaid to quality issues have come has helped to advance the growing to the forefront in the past seven to movement to measure and improve eight years,” says Hall. “I would say surgical patient safety and outcomes it’s a sea change.” at Barnes-Jewish Hospital and beyond. He serves as a leader and surgeon Barnes-Jewish Hospital was one of the original 14 hospitals par- to collect data on surgical complications, which hospitals can analyze and use for guidance in fixing ticipating in ACS “The profession of surgery has a very strong history in measuring quality.” Bruce Hall, MD, PhD, MBA problem areas and NSQIP®, which began in 2001 and now includes roughly 500 hospitals. As the hospital’s surgeon care across all institutions will become champion for the better, as well as more consistent and program, Hall is standardized,” Hall says. improving overall care. Hall is also working with surgical leaders and Hall also serves as a liaison to working to expand this data collec- hospital administrators to address both the National Quality Forum tion and to advance quality initiatives specific concerns, such as surgical site (NQF) and the Centers for Disease within BJC HealthCare hospitals and urinary tract infections. As the Control (CDC). and nationally. surgical quality information officer for The American College of Sur- Data collection for ACS NSQIP® BJC HealthCare, he is also working to at Barnes-Jewish, which began with geons National Surgical Quality expand ACS NSQIP from three BJC general and vascular surgery, has been Improvement Program (ACS NSQIP®) hospitals to the remaining institutions. expanded to include all specialties “The goal is to establish a BJC- within the Department of Surgery. collects data on surgical infection rates and other postoperative compli- ® wide surgical collaborative, so surgical In addition, the department has cations. Hall describes the program launched a Clinical Effectiveness as having a vital role in the emerging Group to develop quality improve- trend to link reimbursement to ment initiatives. performance measures. Coreen Jones, of Portland, Ore., knew where to go for help when her daughters were born with Multiple Endocrine Neoplasia Type 2A (MEN 2A), a rare inherited syndrome that leads to aggressive thyroid cancer and other endocrine diseases. Coreen herself was an early beneficiary of a successful MEN 2A treatment developed at Washington University — genetic testing and surgical removal of the thyroid. So when her daughters were diagnosed with the same condition, she made an appointment with Jeffrey Moley, MD, chief of the Section of Endocrine and Oncologic Surgery. COURTESY JEFFREY MOLEY, MD champion of a national program Successful prevention a family affair “Government efforts to tie Abilene, 8, and Madison, 6, had their thyroids removed by Moley on Dec. 23, 2012, and were soon back to normal life. The treatment is the result of research conducted more than 20 years ago by Washington University’s Samuel Wells, MD, Moley, and others. They identified the gene for the MEN syndromes, leading to development of genetic testing and the preventive-surgery treatment approach — the first surgical prevention of cancer based on genetic testing. Coreen, who also has MEN 2A, came from Seattle as a teenager to have her parathyroid glands removed by Wells; her thyroid had been removed by another surgeon when she was 7. Department of Surgery Annual Report 2012 15 Pancreatic cancer: Division of General Surgery IMPROVING OUTCOMES Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery Highlights Ryan Fields, MD, has received the American Surgical Association Research Foundation Fellowship Award to compare the genetic differences between primary and metastatic colorectal cancers in individual patients. The ultimate goal is to determine mechanisms of metastasis with the hope of using genetic information to improve and guide treatments. Fields is also collaborating with David Curiel, MD, PhD, director of the Biologic Therapy Core and an expert in gene therapy, and has received a grant from the Siteman Cancer Center to treat patients with advanced extremity melanoma with a novel viral gene therapy/isolated limb infusion approach. William Hawkins, MD, received an R01 grant from the National Institutes of Health (NIH) to study a novel treatment for pancreas cancer using sigma-2 receptors, which are over-expressed in proliferating cancer cells. He has developed and will be testing several novel drugs where a ligand of the sigma-2 receptor is utilized to target and kill pancreas cancer cells. Steven Strasberg, MD, is principal investigator of the Drug Eluting Bead, Irinotecan (DEBIRI) Trial at Siteman Cancer Center. The treatment is for liver cancer that has metastasized from colon cancer. The beads are given directly to the liver tumor through interventional radiology techniques to shrink the tumor for surgical removal. TIM PARKER Three Washington University teams received a $400,000 grant from the Foundation for Barnes-Jewish Hospital to study mechanisms of chemotherapy resistance in pancreas cancer. David Linehan, MD, is leading the grant, with David DeNardo, PhD, of the Molecular Oncology Section of the Department of Pathology and Immunology. David Linehan, MD, right, performing surgery with Steven Strasberg, MD, says the HPB section strives to reduce surgical morbidity for pancreatic cancer and to advance earlier diagnosis. It also aims to enroll all patients in clinical trials. 16 surgery.wustl.edu COURTESY WILLIAM HAWKINS, MD INCREDIBLE PROGRESS has been very safe at Washington University event after surgery is recorded. made in the safety of operations for and other major treatment centers. The result was only two higher- “Two main things have improved level complications and no years. Washington University hepato- the mortality rate for the Whipple biliary-pancreatic and GI (HPB-GI) procedure,” says Steven Strasberg, surgeons have contributed to this ad- MD, HPB-GI surgeon at Barnes- HPB-GI surgeons, led by vancement — especially in the area of Jewish Hospital. “The first is a better William Hawkins, MD, also reducing complications — and contin- overall understanding of patient recently reported on the use ue to look at ways to improve operative selection, operative care, anesthesia, of mesh to reduce leakage in a outcomes and patient survival. post-operative care and the general procedure for adenocarcinoma health of patients. The other factor of the pancreas body and tail. is a better understanding of how to These improvements are Most pancreatic cancers are adenocarcinomas — aggressive tumors — that appear in the head of the pancreas and spread to other organs. In the 1930s, surgeon Allen Whipple modified the pancreato-duodenectomy procedure for pancreatic cancer, “Washington University is a leader in multi-modality cancer therapy.” David Linehan, MD in which the head of deaths in the first 75 patients. Washington University perform the proce- incremental steps as doctors dure safely.” seek to improve a five-year Since 1990, survival rate of just six percent major improvements for all pancreatic cancers. Section have occurred in the Chief David Linehan, MD, says rate of postopera- surgeons have begun to perform tive fistulas, or leaks pancreatic resections laparoscopi- — complications cally, further reducing morbidity. that cause sickness in patients. In 2002, the pancreas, the gallbladder, portions Washington University HPB-GI of the stomach and small intestine, surgeons reported on a new tech- and the bile duct are removed. In 1945, nique that resulted in a fistula rate of when Whipple converted the operation just 1.5 percent, the lowest reported from a two- to a one-stage procedure, in any large surgical series. In August patient mortality was 31 percent. 2011, these surgeons and Barnes- Today, the Whipple procedure — the Jewish Hospital nurses implemented definitive operation for cancer of the an intensive postoperative plan head of the pancreas — is considered in which every negative COURTESY IHPBA pancreatic cancer over the past 70 “Washington University is a leader in multi-modality cancer therapy,” says Linehan. Steven Strasberg, MD, right, receives an international lifetime achievement award. Strasberg Receives International Award Steven Strasberg, MD, the Pruett Professor of Surgery and Carl Moyer Departmental Teaching Coordinator, has received the Lifetime Achievement Award/Gold Medallion of the International HepatoPancreato-Biliary Association (IHPBA) for his numerous contributions to the field of HPB surgery. Strasberg received the award at the 10th World Congress of the IHPBA, held in Paris on July 1-5. A number of other faculty members from the sections of HPB-GI Surgery and Transplant Surgery also attended the meeting. A leading academic surgeon, Strasberg is the author of nearly 250 peer-reviewed journal articles, some of which are among the most highly cited in the HPB field; has given 120 invited talks around the world; is a current or former member of the executive committees of several national and international organizations, including the IHPBA; and is a past president of the American HepatoPancreato-Biliary Association. Department of Surgery Annual Report 2012 17 Division of General Surgery Section of Minimally Invasive Surgery Sports hernia treatment GETS ATHLETES BACK TO FORM Highlights A clinical trial will test whether photoacoustic endoscopy is more effective than biopsies in detecting precancerous tissue in patients with Barrett’s esophagus. Brent Matthews, MD, will conduct the trial. Collaborator Lihong Wang, PhD, the Gene K. Beare Distinguished Professor of Biomedical Engineering invented photoacoustic endoscopy, which applies photoacoustic tomography by way of an endoscope. Brent Matthews, MD, was elected treasurer and secretary of the American Hernia Society, which serves as a professional forum for the exchange of information about the diagnosis and treatment of abdominal wall abnormalities. Matthews will become president-elect of the organization in March 2013. The biomaterials lab of Corey Deeken, PhD, is developing a synthetic mesh for hernia repair. The mesh is made of polycaprolactone, a material that will trigger a biologic response in the body to aid soft tissue repair. Deeken and Matthew MacEwan, an MD/PhD student, received a Bear Cub grant from Washington University to develop the mesh. Deeken has spent two years analyzing specifications of FDAapproved meshes; the ultimate goal is to develop a commercially available mesh. Michael Awad, MD, PhD, was named program director of the Washington University General Surgery Residency (see page 37) and elected to represent the Association of Program Directors in Surgery to the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Education is a core mission of SAGES, a worldwide community of surgeons that promotes minimal-access surgery, endoscopy and other emerging techniques. A multidisciplinary approach combines surgery with an innovative rehabilitation program to return athletes to their pre-injury performance level. Above, Michael Brunt, MD, left, consults with diagnostic radiologist David Rubin, MD. 18 surgery.wustl.edu COURTESY RICK BARNES, DO Although sports hernias, also called athletic pubalgia, can occur in recreational athletes, they are more common among professional and college athletes. The condition differs from a true hernia in that there is no hole in the abdominal wall, but rather a weakening. It can be repaired in an open procedure. MICHAEL BRUNT, MD, is a familiar or a tear in the rectus sheath where it face to many Midwestern professional attaches onto the pubic bone. and collegiate athletes who have suf- Brunt began offering surgical fered what are commonly known as treatment for these injuries in the early sports hernias. In many cases, these 1990s and has been the St. Louis Blues injuries could be career-limiting, but team general surgeon for 18 years. the use of surgery over non- with proper treatment and rehabilita- Over the past 10 years, referrals have operative management for athletes tion, the athlete can return to the field increased substantially, and he esti- with chronic groin pain in whom or the rink at full strength. mates only two or three other centers other causes have been excluded. “Hockey, soccer and football are the three most common sports for in the United States have a similar Surgeons who treat athletic pub- “It’s probably related to the sudden accelerating movements, the change of direction that’s required in improving treatment of athletic case volume. these types of injuries,” says Brunt. “The biggest opportunity for improving treatment of athletic pubalgia may be prevention.” Michael Brunt, MD says Brunt. “Athletes do a lot of understand weight training. They get out of other injuries balance between their lower body, in the hip and thigh muscles and abdomen, and pelvis and be this creates an imbalance across able to rule the pubis. Better recognition of them out. some of the risk factors in training When Brunt could help prevent this.” lar sports. It’s less common in baseball pubalgia and surgery is indicated, he and basketball, but can be seen in usually performs an inguinal floor almost any sport.” repair using tension-free mesh as an The sports hernia, more accurately called an athletic pubalgia, occurs Rick Barnes, DO, 48, an ENT surgeon, is typical of the patients seen by surgeon Michael Brunt, MD, for sports injuries. A former runner at the University of Mississippi, Barnes continues to run competitively and compete in triathlons and raced in a stage of the Tour de France in the summer of 2010. But it was a backwards flip and spill down a Black Diamond hill while snow skiing that tore his rectus abdominis muscle and led Barnes to seek out Brunt. After the accident, it was very painful to run, and Brunt operated on Barnes’ athletic pubalgia in July 2011. Barnes was back to racing competitively three months later and did not feel limited less than a year after the surgery. open procedure. Brunt works with a multidisciplinary team including when there is chronic exertional lower sports orthopedists, athletic trainers, abdominal or inguinal pain that affects physical therapists and radiologists. Most groin injuries respond CK BA RN ES ,D O says, trials support RI but there is a weakening and deterio- SY management. But, Brunt TE to rest and more conservative sense that there is not a hernia bulge, UR level. It is not a true hernia, in the CO an athlete’s ability to perform at a high pubalgia may be prevention,” algia must diagnoses a those particu- “The biggest opportunity for Back on Track ration of tissue in the inguinal floor Department of Surgery Annual Report 2012 19 Division of General Surgery Section of Transplant Surgery Cross training promotes BROADER PERSPECTIVE Highlights Yiing Lin, MD, PhD, joined the faculty after completing a general surgery residency and transplant surgery fellowship at Washington University. Lin will focus his research on the genetics of hepatocellular carcinoma. He will be involved in all areas of abdominal transplantation. Providing vascular access for kidney dialysis — and the high failure rate of arteriovenous fistulas, which are created surgically to connect a vein and an artery to increase blood flow — is a major cost and health care issue. Juxta-anastomotic stenosis (JAS), or narrowing of a vein at the connection of the artery to the vein, is a major cause of arteriovenous fistula failure and occurs in up to 65 percent of cases. Surendra Shenoy, MD, PhD, was the senior author of an article in the Journal of Vascular Surgery showing that a novel technique, the piggyback Straight Line Onlay Technique (pSLOT), significantly reduces JAS and improves the maturation of arteriovenous fistulas. Transplant surgeons are working with hepatologists Thomas Kerr, MD, PhD, and Jacquelyn Fleckenstein, MD, who recently joined Washington University Physicians, to expand access to liver transplant services to more patients outside the St. Louis region. Jeffrey Crippin, MD, medical director of liver transplantation, already sees patients in Cape Girardeau, Mo. TIM PARKER Transplant surgery is one of the most active specialties within the Division of General Surgery to offer clinical trials to patients. Transplant surgeons currently offer more than 30 trials, including trials of immunosuppressive drugs, liver cancer therapy, and novel hemostatic techniques during liver surgery to limit blood loss after resection. Washington University is a top enroller in one of the hemostasis trials with more than 40 patients. Hepatobiliary-pancreatic surgeon Steven Strasberg, MD, mentored former transplant fellow Yiing Lin, MD, PhD, as part of a new cross-training program that gives fellows in both specialties a broader understanding of the other service. 20 surgery.wustl.edu Hepatobiliary-pancreatic fellow Kamran Idrees, MD, consults with Julie Colicchio, MSN, RN, NP-C, nurse practitioner on the transplant service. A NEW ARRANGEMENT between participating in transplant confer- two fellowship programs — transplant ences, he also developed critical surgery and hepatobiliary-pancreatic thinking skills that will allow him to (HPB) surgery — allows trainees to assess the appropriate treatment for spend a two-month rotation cross liver cancer patients, with options Lin says he also gained valuable such as resection or downstaging arrangement has broadened trainees’ experience in working with cancer perspectives and strengthened both patients during all phases of treatment. William Chapman, MD, programs, according to fellows and “How they deal with issues in chief of the Section of Transplant program leaders. The approach makes sense because the two specialties are closely related and treat many similar conditions, especially in the area of liver disease. Surgery and the Eugene M. Bricker I am going to practice in the future,” Professor of Surgery, says the says Lin. Transplant Fellowship is the first in ed an HPB fellowship in 2012, helped “I spent several weeks with each of the HPB surgeons and participated in liver, pancreas and bile duct surgeries,” says Yiing Lin, “How they deal with issues in their specialty really informs the way I am going to practice in the future.” MD, PhD, who the cancer before transplant. their specialty really informs the way Kamran Idrees, MD, who complet- Yiing Lin, MD, PhD completed the the United States to offer certification by both the American Society procure organs of Transplant Surgeons and the from donors American Hepato-Pancreato-Biliary with irrevers- Association. The cross-training has ible brain helped make both fellowships damage at highly competitive, which is Mid-America especially important in the trans- Transplant plant field, where a number of Services in fellowships go unfilled. This is St. Louis partly because prospective fellows and also see that the number of openings for transplant fellowship in June 2012 took part in liver, kidney and transplant surgeons is limited by and has since joined the transplant pancreas transplants. the scarcity of donor organs. faculty. “There are some unique aspects Idrees says even the kidney to surgery with both groups. For transplants were valuable because they example, with liver transplants, the involved sewing blood vessels and way transplant surgeons handle and creating anastomoses, or connections, cut through the liver is different than between vessels, which is also the techniques used by non-transplant required during pancreas hepatobiliary surgeons.” tumor removal. By TIM PARKER training on the other service. The Chapman Receives Endowed Chair William Chapman, MD, chief of the Division of General Surgery and the Section of Transplant Surgery, was installed as the Eugene M. Bricker Chair of Surgery in July. Chapman became the transplant surgery section chief in 2002 and the general surgery division chief in 2007. He worked with BarnesJewish Hospital Transplant Center Program Director Gene Ridolfi and Jeffrey Crippin, MD, medical director of liver transplantation, to organize the five organ transplant programs — liver, kidney, pancreas, heart and lung — under one center. Under his leadership, the abdominal transplant programs have seen growth in volume with excellent survival rates despite treating patients with the most challenging conditions. In research, he worked with a team of biomedical engineers to develop an imageguidance system for liver surgery that has improved pre-operative imaging and enables surgeons to better track anatomical location of instruments. The chair was named in honor of Bricker, an internationally renowned surgeon whose career at Washington University spanned more than 35 years. Department of Surgery Annual Report 2012 21 Antibiotic holds promise to Division of General Surgery CONTROL ANEURYSM GROWTH Section of Vascular Surgery Highlights COURTESY LUIS SANCHEZ, MD A clinical trial of a new “off-the-shelf” fenestrated stent graft that could broaden the ability of vascular surgeons to treat patients with complex aneurysms began accepting patients at Washington University in the spring of 2012. Fenestrated stents are designed for patients with aneurysms close to the arteries that feed the kidneys and feature small openings that can be strategically positioned to allow blood to pass into the renal arteries. Currently, only custom-made devices are available in a few referral centers like Barnes-Jewish Hospital. The section enrolled the first intern of the new Vascular Surgery Residency program in June 2012. The five-year program (known as a 0+5 track) focuses training after medical school exclusively on vascular surgery, endovascular surgery and the management of patients with vascular disease. The residents will learn the necessary skills from general, vascular and critical care surgeons. They will also receive important specific training in radiology and benign hematology, among other areas. The section will maintain a traditional fellowship (5 + 2 track) — two years of specialized training in vascular surgery after a five-year general surgery residency. Brian Rubin, MD, worked with Barnes-Jewish Hospital to produce a video on peripheral vascular disease, which was used as part of a campaign to raise awareness of the condition and treatment available from Washington University vascular surgeons. Patrick Geraghty, MD, was elected as secretary of the Midwestern Vascular Surgical Society, which promotes the advancement of diagnosis and treatment of vascular disease and has members in 12 Midwestern states. Jeffrey Jim, MD, was the lead author of an article in the Journal of Vascular Surgery that addressed the possible future shortage of vascular specialists in the country; he also worked on the Society for Vascular Surgery Fellowship Development Task Force to address this important issue. Basic research by Robert Thompson, MD, and John Curci, MD, lays the foundation for a promising clinical trial to evaluate an antibiotic as a potential non-surgical method to control the growth of abdominal aortic aneurysms. 22 surgery.wustl.edu RESEARCH BEGUN in the 1990s of the national principal investigators, by Washington University vascular and his laboratory will perform the surgeons may lead to the first non- blood analyses. surgical treatment to control the “Patients will receive treatment growth of small aortic aneurysms, for at least two years from enrollment,” if a multicenter clinical trial now says Thompson. “Even if doxycycline under way proves successful. successfully slows the rate of growth Work by Robert Thompson, MD, John Curci, MD, hopes a common antibiotic will reduce the need for surgical placement of stent grafts to treat abdominal aortic aneurysm. of aneurysms, we’re going to be left activation of MMP-9 in human and John Curci, MD, Washington with questions about dose, duration of aneurysm tissue. University vascular surgeons at Barnes- treatment and other variables. Further- Jewish Hospital, showed in mice and more, if it works, it’s potentially a huge the Non-Invasive Treatment of humans that the antibiotic doxycycline breakthrough in the clinical treatment Abdominal Aortic Aneurysm inhibits an enzyme called matrix me- of aneurysms.” Clinical Trial (N-TA3CT), will track talloproteinase 9 (MMP-9), important in aneurysm formation; further, they found that doxycycline actually suppresses the formation of aortic aneurysms in mice. Doxycycline is now being tested in MMP-9 degrades structural components of the aortic wall such “If it works, it’s potentially a huge breakthrough in the clinical treatment of aneurysms.” Robert Thompson, MD humans with aneurysm growth through computed tomography scans conducted every six months in patients given and elastin, either doxycycline or a placebo. thus con- Through blood samples, investiga- tributing to tors will check levels of doxycycline aneurysms. and analyze blood biomarkers of Thompson’s aneurysm disease. testing doxy- lion patients in the country at any one time who have these small aneurysms,” says Curci, “Most of a National Institute on Aging ran- tetracycline class — in rat and mouse will eventually grow to rupture or domized clinical trial at Washington models of aneurysm disease; they require surgery. If we have some- University and 15 other sites. chose doxycycline because tetracyclines thing to slow or stop the growth of Thompson is lead investigator were already known to inhibit MMPs. aneurysms, so they never rupture or of the Washington Curci, then in postgraduate train- need surgical treatment, it revolu- University trial. ing, helped conduct animal research tionizes aneurysm therapy. They can and a later study showing that even be screened with an ultrasound and reduced the expression and TIM PARKER cycline — a cheap, commonly used drug in the brief treatment with doxycycline Section Chief Luis Sanchez, MD, and Department Chair Timothy Eberlein, MD, unveil Gregorio Sicard’s portrait. “There are likely half a mil- abdominal aortic aneurysms as part Curci is one Gregorio Sicard, MD, the founding vascular surgery chief, was honored for 35 years of leadership and service in May 2012. A symposium titled “The Past, Present and Future of Vascular Surgery” drew national and international speakers and focused on education and aortic, carotid and peripheral vascular disease. Sicard became the first chief of vascular surgery in 1983 and served in that role until 2011, when he transitioned leadership to Luis Sanchez, MD. Sanchez also became the first Gregorio A. Sicard Distinguished Professor of Vascular Surgery. The national trial, called as collagen lab started Gregorio Sicard Honored treated with a drug, reducing both risk and cost for the patient.” Department of Surgery Annual Report 2012 23 Advanced treatment through Division of Cardiothoracic Surgery MULTIDISCIPLINARY APPROACH Section of Cardiac Surgery Highlights TIM PARKER The FDA approved the use of a transcatheter aortic valve — which is placed by threading a catheter from the femoral artery in the leg to the heart — in patients who cannot undergo an open operation to replace the valve. Washington University has been a leading enroller at Barnes-Jewish Hospital for both the first PARTNER (Placement of AoRTic traNscathetER) Trial, which investigated the valve for inoperable patients, and the second PARTNER Trial, which is investigating the use of next-generation valves in both inoperable and high-risk patients. Heart surgeons also performed 415 open valve procedures, almost double the number of cases in 2007. They work closely with cardiologists in the treatment of valve disease and offer a minimally invasive approach to valve surgery using small incisions made in the chest. Washington University was the largest enroller in the Concomitant Utilization of Radio Frequency Energy for Atrial Fibrillation (CURE-AF) Study, which demonstrated that radiofrequency ablation used in a modified Cox-Maze procedure can safely and effectively treat patients with atrial fibrillation. The set of lesions used in the trial were developed by Cardiac Surgery Chief Ralph Damiano Jr., MD, for the Cox Maze IV procedure. the Division of Vascular Surgery and Thoracic Aorta was established in 2001 the Gregorio A. Sicard Distinguished as a referral center for patients with Professor of Vascular Surgery, and all acute and chronic aortic dissections, of the other vascular surgeons; and thoracic aortic aneurysms and Marfan cardiologist Alan Braverman, MD, the syndrome. Its success stems not only Alumni Endowed Professor of Cardio- from the advanced treatments offered vascular Disease in Medicine, all play at a major academic center, but from an active role in evaluating patients. the collaboration of a multidisciplinary mary care physician or cardiologist, and with the primary care physicians the team may recommend surgical and cardiologists who refer patients. intervention, endovascular intervenpressure control and long-term sur- nists to keep up with the latest treat- veillance. Moon surgically treats aortic ment options,” says Marc Moon, MD, conditions in the ascending aorta, but Washington University cardiothoracic works together with vascular surgeons surgeon at Barnes-Jewish Hospital and on problems in the descending and surgical director of the center. “It’s not thoracoabdominal aorta. our goal to take over care of the entire “Patients now present with more patient, but we provide support and complex aneurysms than they did input into decisions of how to treat years ago, due in part to our ability to these uncommon diseases.” get them through an acute pathologi- Patients who are referred to the cal state,” says Moon. “We can offer center generally already have been not only an open approach or endo- diagnosed with an aneurysm or a dis- vascular approach, but a combined section — a potentially life-threatening approach that brings together all the condition in which there is bleeding positives that both the thoracic and into and along the wall of the aorta. vascular surgeons can contribute.” of Surgery; Luis Sanchez, MD, chief of surgery.wustl.edu tion or a medical approach with blood fairly rare, and it’s difficult for inter- Moon, the Joseph Bancroft Professor 24 Working with the patient’s pri- team of specialists — with each other “Diseases of the thoracic aorta are COURTESY PAMELA WOODARD, MD The volume of heart surgery cases continued to grow in 2011. Heart surgeons performed more than 1,300 major cases — an increase of eight percent over 2010. Heart transplants and ventricular-assist device implantations have also steadily increased. Surgeons performed 35 heart transplants in 2011, compared to 29 in 2010, and 93 surgeries to implant ventricular assist devices, 15 more than in 2010. THE CENTER for Diseases of the Yet Moon says medical prevention is the most important piece of Throughout the department, trainees are taught a highly collaborative and multidisciplinary approach to medicine — an approach that prepares them well as the next generation of leaders in the field. Above, research fellow Shoichi Okada, MD, right, confers with cardiothoracic surgeon Marc Moon, MD. the puzzle. Hypertension is the most common risk factor for the development of aneurysms and aortic dissections, with the patient’s primary care The Center for Diseases of the Thoracic Aorta offers advanced multidisciplinary treatment. Cardiothoracic and vascular surgeons work with primary care physicians to offer surgical or medical interventions and long-term surveillance. physician or cardiologist playing an intimate role in controlling this aspect of the disease. “Our combined approach brings together all the positives that both the thoracic and vascular surgeons can contribute.” TI M PA R KE R Marc Moon, MD Department of Surgery Annual Report 2012 25 Lung cancer studies evaluate Division of Cardiothoracic Surgery LONGEVITY, QUALITY OF LIFE Section of General Thoracic Surgery Highlights COURTESY TRAVES CRABTREE, MD Traves Crabtree, MD, was the lead author in a study showing that a patient education process may alleviate the emotional and physical difficulties lung cancer patients face before and after surgery. He and co-authors reported that lung procedure patients who watched a 30-minute preparation video reported less anxiety about the procedure, less physical pain after the operation and higher overall satisfaction with the operative experience. The study, comparing 136 patients who were given the video with 134 patients who received only the standard physician’s consultation and written materials, was published in the Journal of the American College of Surgeons. Varun Puri, MD, is leading a clinical trial in the Prevention of Post-Operative Pneumonia (POPP). In this trial, patients undergoing a major thoracic operation first undergo an intensive oral hygiene regimen to reduce pathogenic bacteria in the mouth and lessen the impact of aspiration that may occur at the time of surgery. Goals are to improve survival and decrease the cost and length of hospitalization. TIM PARKER Traves Crabtree, MD, served as the 2012 co-director of STS University, an educational program held at the Society of Thoracic Surgeons Annual Meeting. This program allows thoracic surgeons to try new technology and to receive input from expert surgeons. Crabtree organized the thoracic courses, which included a simulated version of video-assisted thoracic surgery (VATS) lobectomy and techniques for esophageal and bronchial interventions. STS University drew hundreds of participants at the 2012 Annual Meeting. In clinical trials, radiation oncologist Jeffrey Bradley, MD, and thoracic surgeons Varun Puri, MD, and Bryan Meyers, MD, MPH, are comparing the relative merits of surgery versus stereotactic radiation therapy for early-stage lung cancer. 26 surgery.wustl.edu WASHINGTON UNIVERSITY thoracic surgeons continue to break new ground in advancing more effective lung cancer therapies, drawing on recent studies comparing widely used “We are studying what patients’ lives are like after different treatments of stage I lung cancer, not simply how long they live.” Stephen Broderick, MD of treating the disease. All six thoracic surgeons have joined radiation oncologists at the which you don’t randomly assign therapies to patients. We are quite eager to support the new prospective trial and get an unbiased answer.” to establish within that middle ground, where do patients fall?” Within the past year, the thoracic Stephen Broderick, MD, who joined the faculty in July 2012 after completing a cardiothoracic surgery Alvin J. Siteman Cancer Center surgery section has reported on two fellowship at Washington University, at Barnes-Jewish Hospital and retrospective studies comparing treat- is looking at yet another angle in the Washington University School of ment options for patients with stage I treatment of lung cancer: the qual- Medicine in a multicenter lung cancer lung cancer. One study found that ity of life resulting from different clinical trial. The trial randomly stereotactic body radiation therapy therapies. “We are studying what assigns patients with stage I non-small was less costly, but patients eligible patients’ lives are like after different cell lung cancer and diminished lung for surgical intervention had longer treatments of stage I lung cancer, function to either surgical removal of survival than those not eligible, and not simply how long they live.” a portion of the lung or stereotactic surgery appeared to meet reasonable body radiation therapy. standards for cost effectiveness. The tradition of Washington University other concluded that, for patients who thoracic surgeons in the treatment clearly fall into one of three categories,” cannot undergo removal of an entire of lung cancer. Evarts Graham, says Varun Puri, MD, Washington lobe of the lung, sublobar resection MD, the first chairman of the University thoracic surgeon at Barnes- looks comparable to and competitive Department of Surgery, performed Jewish Hospital. “The first includes with stereotactic radiotherapy. the first successful removal of an removal of a lobe, which remains the Bryan Meyers, MD, MPH, chief gold standard. At the other end are of the Section of Thoracic Surgery patients who are clearly poor operative and the Patrick and Joy Williamson candidates and are suitable for stereo- Professor of Surgery. “But there tactic radiation therapy. This trial tries is always concern about bias R best to overcome selection bias,” says KE status and can undergo surgical entire lung in 1933. PA R “In both studies, we tried our M individuals who are good performance Evarts Graham, MD, published the first evidence linking smoking with lung cancer in 1950. The paper is now considered the seminal contribution to research on smoking and cancer. All of the studies continue the TI “Early-stage lung cancer patients COURTESY BECKER MEDICAL LIBRARY ARCHIVE treatment options and a long history in retrospective studies in Department of Surgery Annual Report 2012 27 Artificial heart provides Division of Cardiothoracic Surgery BRIDGE TO TRANSPLANT Section of Pediatric Cardiothoracic Surgery Highlights The Section of Pediatric Cardiothoracic Surgery welcomes Umar Boston, MD, as an associate professor. Boston served as director of the Adult Congenital Heart Surgery Program at LeBonheur Children’s and Methodist University Hospitals in Memphis, Tenn. At Washington University, he continues his work with adult patients who underwent congenital heart surgery while treating the full range of children with heart and lung conditions at St. Louis Children’s Hospital. TIM PARKER Pediatric Cardiothoracic Surgery Chief Pirooz Eghtesady, MD, joined with Alec Patterson, MD, chief of the Division of Cardiothoracic Surgery, and Varun Puri, MD, to perform what — to the surgeons’ knowledge — was the first lung autotransplantation in a patient who had undergone a previous lung transplant. The 9-year-old boy had developed life-threatening complications after a surgeon had transplanted both lungs into his left chest cavity, reasoning that the chest cavity on the right side was too small. During the 14-hour operation, the surgeons removed the right lung from the left side of the chest, reconstructed the anatomy and placed the lung in the correct side. The patient is doing well. TIM PARKER The Washington University and Barnes-Jewish Heart & Vascular Center — which comprises caregivers in pediatric cardiothoracic surgery, pediatric cardiology, critical care and anesthesiology — has developed a scorecard with nearly 300 metrics as team members focus on quality of care. ST. LOUIS CHILDREN’S HOSPITAL The volume of on-pump, open-heart surgeries increased dramatically in early 2012 over the number performed in January-March 2011. This happened, in part, because of new insurance agreements made by Children’s Hospital that expand coverage in other states and the number of children who were referred for transplant but received an alternative surgical approach. Pirooz Eghtesady, MD, left, shown with cardiothoracic surgery colleague Umar Boston, MD, heads a team that annually performs roughly 300 open congenital cardiac repairs, 100 closed procedures and 25 heart transplants. 28 surgery.wustl.edu TIM PARKER TIM PARKER STANISLAW “STAS” BARTLETT was gravely ill when he was transported to St. Louis Children’s Hospital by medi- The FDA had recently approved help Stas. With limited options, cal helicopter in November 2011. A few the use of the Berlin Heart, a ventricu- Stas’ family agreed to try the months short of his fourth birthday, he lar-assist device, as a bridge to trans- device, and Eghtesady performed already had undergone two surgeries plant in children. But the device had a 12-hour operation in which he for a congenital heart defect. He was not been used very effectively in pa- modified the implantation. listed for heart transplantation, but tients with single-ventricle physiology. Rebecca Bartlett saw Stas needed extensive therapy to bridge him Instead, doctors started Stas on drugs improve after the Berlin implanta- to a successful transplant in April 2012. to help his heart contract and later tion, and he received his new heart 27 days later. She reported Stas circulation continued to deteriorate, was gaining strength and behav- Eghtesady, MD, chief of pediatric doctors tried implanting the Impella ing like a normal 4-year-old two cardiothoracic surgery at The St. Louis cardiac-assist device, which caused months after the surgery. Children’s and Washington University kidney dysfunction, then removed it Heart Center. “Essentially, part of his and employed a different cardiac-sup- single ventricle anatomy to be heart never formed completely, and port technique called extracorporeal bridged successfully to heart the blood flow to his lungs was membrane oxygenation (ECMO). transplantation. He also is unusual “Stas was born with single- dependent on passive circulation. ECMO is only used for short-term “Stas is the first child with in that he was sicker than most There was no chamber pumping cardiac support and wasn’t helping children who undergo heart blood through his lungs.” much. The Berlin Heart offered a way transplant,” says Eghtesady. “But to restore circulation and organ func- I’m happy to say that his long- tion, but there was a risk it would not term prognosis is now similar to Two months after he was born, Stas had undergone a procedure to prepare his heart for a second correc- that of any other child receiving tive surgery he would need a few years a heart transplant.” COURTESY BARTLETT FAMILY placed him on a ventilator. When his ventricle anatomy,” says Pirooz A ventricular-assist device supported circulation for Stanislaw Bartlett until he could receive a heart transplant at age 4. later to correct his heart physiology. Shortly after that second surgery in October 2011, his heart began to fail. In November, his mother, Rebecca, took him to Children’s Hospital & Medical Center in Omaha, Neb., and KE PA R M TI Children’s Hospital. R from there he was flown to St. Louis Department of Surgery Annual Report 2012 29 Division of Pediatric Surgery Pediatric Acute Wound Service: MEETING CHILDREN’S NEEDS Highlights The Division of Pediatric Surgery welcomes Adam Vogel, MD, as an assistant professor of surgery. Vogel completed a general surgery residency at the University of Chicago and a pediatric surgery fellowship and surgical critical care fellowship at the University of Texas in Houston. Vogel will work with the Extracorporeal Membrane Oxygenation (ECMO) Program and serve as the pediatric surgery representative in the Vascular Malformations Clinic at St. Louis Children’s Hospital. The American College of Surgeons (ACS) has verified Children’s Hospital as a Level 1 Pediatric Trauma Center. During the verification process, the ACS confirms the presence of resources for the optimal care of injured patients. Children’s is the only ACSverified Level 1 pediatric hospital in Missouri and Illinois. Pediatric surgeon Marty Keller, MD, and adult thoracic surgeon Alexander Krupnick, MD, are spearheading a multidisciplinary effort in the treatment of chest wall deformities, such as pectum excavatum and pectus carinatum. Others involved in the care of pediatric patients include specialists in radiology, orthopedics, cardiology and pulmonary medicine. A prosthetist offers non-surgical options to children. Inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis affect all aspects of children’s lives. Pediatric surgeons provide surgical consultation and work as part of a team with pediatric gastroenterologists, nurses, dietitians, radiologists and social workers to provide a full range of care to patients in the Inflammatory Bowel Disease Center at St. Louis Children’s Hospital. The Pediatric Acute Wound Service (PAWS) at St. Louis Children’s Hospital offers comprehensive care for skin wounds to meet the special needs of children. Above, Kate Bernabe, MD, treats a burn on a young patient. 30 surgery.wustl.edu Intensive diagnostics and treatment by Kate Bernabe, MD, and the PAWS unit laid the foundation for Adi Hayes to begin recovering from a persistent foot infection. children includes putting atric surgeons at St. Louis Children’s a gel roll under the head, Hospital have taken on long-standing using special mattresses, medical challenges in recent years. frequent turning, and They have improved survival for infants good nutrition. Bernabe born with congenital diaphragmatic is working through the hernia and are part of a national Skin and Wound quality-improvement program analyz- Committee at St. Louis Children’s ing outcomes of surgical procedures. Hospital, as well as communicating Most recently, they stepped up efforts directly with caregivers, to raise to help some of the sickest children awareness of the problem. with skin wounds. “The patients at highest risk for TIM PARKER WASHINGTON UNIVERSITY pedi- “Nurses are at the forefront of detecting these because part of their skin wounds are the sickest patients, daily assessments is a skin exam of the and many times it’s not possible to entire body,” says Bernabe. “They want do a normal skin care routine for to take good care of these patients, those patients to prevent any skin but more education needs to be done breakdown, whether it’s a pressure to recognize the starting of a pressure ulcer or device skin breakdown or ulcer, and then how to take care of it, an IV infiltration breakdown,” says so it doesn’t progress.” Kate Bernabe, MD, surgical director The scientific literature on of the Pediatric Acute Wound Service pressure ulcers in children is sparse at St. Louis Children’s Hospital and and does not entirely reflect different Missouri Baptist Medical Center. weights and body size proportions. The problem of pressure ulcers has By tailoring wound care to pediatric typically been associated with older patients, Bernabe is continuing the adults, but Bernabe says they have tradition of adopting surgical care become a greater issue at pediatric to the special needs of children hospitals since Medicaid has TIM PARKER narrowed its criteria for coverage. The gold started by Jessie Ternberg, MD, PhD, who pioneered surgical care at St. Louis standard for treating Children’s Hospital. Specialized Wound Care for Kids Adi Hays, 13, was referred to Kate Bernabe, MD, director of the Pediatric Acute Wound Service (PAWS), because of a persistent infection in her foot that had continued on and off for several years. Adi has spina bifida with poor circulation in her lower extremities. Bernabe says Adi’s case is an example of the type of complex wound often seen on the PAWS Unit. Simpler wound care over the course of nine months had not been effective, so Bernabe suggested Adi undergo an MRI. When the MRI showed a deeper bone infection, doctors expanded Adi’s antibiotic regimen to include intravenous antibiotics. The wound healed enough that it became easier for Adi to walk, but infection persisted. The next step was a bone biopsy to learn more about the infection and the type of treatment that may eliminate it. Since then, Adi has been placed on a new intravenous antibiotic, and her orthopedic surgeon is continuing her care. Bernabe believes the diagnostic work and treatment she received on the PAWS Unit helped move Adi and her family along the path to healing. TI M R PA KE R Department of Surgery Annual Report 2012 31 Division of Plastic and Reconstructive Surgery Peripheral nerve transfer RESTORES HAND FUNCTION Highlights The faculty welcomes Amy Moore, MD, and Alison Snyder-Warwick, MD, as assistant professors of surgery. Both completed plastic surgery residencies at Washington University. Moore, who spent last year as a hand surgery fellow at the Mayo Clinic, joins Amy Kells, MD, and Ida Fox, MD, with a focus on complex nerve and wrist surgery. Snyder-Warwick, after completing a pediatric plastic fellowship at the Hospital for Sick Children in Toronto, joins Pediatric Plastic Surgery Chief Albert Woo, MD, and Kamlesh Patel, MD, adding depth to the management of complex pediatric nerve injuries and facial reanimation expertise. Division Chief Susan Mackinnon, MD, received both the Clinician of the Year award and the Award for Outstanding Achievement in Basic & Translational Research at the 2012 Annual Meeting of the American Association of Plastic Surgeons. She was also one of three U.S. physicians to be honored with a Clinical Excellence Award by Castle Connolly Medical Ltd., which publishes America’s Top Doctors and other guides to choosing physicians. lowest bone in the neck. Instead of and reconstructive surgeons have operating on the spine itself, the sur- restored some hand function in a geons rerouted working nerves in the quadriplegic patient with a spinal upper arms. These nerves still “talk” cord injury at the C7 vertebra, the to the brain because they attach to the spine above the injury. Following the surgery, performed at Barnes-Jewish Hospital, and one C7 year of intensive physical therapy, the patient regained some hand function, specifically the ability to bend the thumb and index finger. He can now feed himself bite-size pieces of food and write with assistance. The case study, published online in the Journal of Neurosurgery, Nerve Transfer is, to the authors’ knowledge, the first reported case of using nerve transfers to restore the ability to flex the thumb and index finger after a spinal cord injury. “This procedure is unusual for treating quadriplegia because we do not attempt to go back into the spinal cord where the injury is,” says plastic surgeon Ida Fox, MD. “Instead, we go out to where we know things work — in this case the elbow — so that we ERIC YOUNG A website developed by Washington University plastic and reconstructive surgeons to serve as an open-access, educational resource for surgeons treating persons with complex peripheral nerve trauma has been visited by physicians world-wide. The site was originally created in response to concern about the number of soldiers returning from Iraq and Afghanistan with nerve injuries impairing use of their arms, legs and hands. Andrew Yee, who served as videographer of the surgeries on the site, presented a paper on assessing the development of the website at the American Society for Peripheral Nerve Annual Meeting in January 2012. WASHINGTON UNIVERSITY plastic A groundbreaking new peripheral nerve transfer procedure developed by Susan Mackinnon, MD, has restored limited hand function in one patient with C7 spinal cord injury. The technique is appropriate for C6 and C7 injuries. 32 surgery.wustl.edu can borrow nerves there and reroute injuries to peripheral nerves, she has them to give hand function. If we pioneered similar surgeries to return can restore the ability to pinch function to injured arms and legs. between the thumb and index Mackinnon operated in the finger, it can return some very upper arms; she took a non-working basic independence.” nerve that controls the ability to The surgery was developed pinch and plugged it into a working and performed by the study’s senior nerve that drives one of two muscles author Susan Mackinnon, MD, the that flex the elbow. After the surgery, Sydney M. Shoenberg Jr. and Robert the bicep still flexes the elbow, but the H. Shoenberg Professor and chief nerve to the brachialis muscle, which of the Division of Plastic and Re- also flexes the elbow, now bends the constructive Surgery. Specializing in thumb and index finger. Mackinnon does not anticipate a Ida Fox, MD limited window of time for performing the surgery. Spinal cord injury, unlike peripheral nerve injury, allows for repair in the right circumstances JOURNAL OF NEUROSURGERY “If we can restore the ability to pinch between the thumb and index finger, it can return some very basic independence.” even years after injury. But it will not benefit patients with higher injuries, in vertebrae C1 through C5, and it cannot restore leg or bowel/ bladder function. After surgery to restore hand function, intensive physical therapy is required to retrain the brain to communicate with new nerve connections. Department of Surgery Annual Report 2012 33 Division of Urologic Surgery PSA screening data suggest NUANCED APPROACH Highlights Seth Strope, MD, MPH, presented findings on a long-term study of follow-up care to bladder cancer at the American Urological Association Annual Meeting in May 2012. He and collaborators found that patients who get some follow-up care generally do better, but that visiting the doctor — urologists, primary care and other specialists — has more impact on survival than cross-sectional imaging. Gino Vricella, MD, became the first fellow in the Pediatric Urology Fellowship, which was launched on July 1, 2012. Vricella joined the program after a urologic surgery residency at Case Western Reserve University. Douglas Coplen, MD, director of pediatric urology, is the program director for the two-year, ACGME-accredited fellowship, which consists of a clinical and a research year. Erica Traxel, MD, is working to implement early specialization and improved skills assessment for urology residents. The approach would allow trainees to complete the residency and one of four urologic fellowships at Washington University a year earlier. The residency will begin requiring Fundamentals of Laparoscopic Surgery (FLS) certification; educators are looking at further ways to assess competency. Seth Strope, MD, MPH, won the Scholar’s Abstract Award for a poster presentation at the conference Translational Science 2012: Improving Health Through Research and Training, held in April 2012 in Washington, DC. The research from a large database of hospitals showed laser therapy for benign prostatic hyperplasia had better short-term outcomes, but transurethral resection of the prostate (TURP) had a lower re-treatment rate over four years. 34 surgery.wustl.edu THE U.S. PREVENTIVE SERVICES who could potentially be harmed,” says Task Force recommendations against Andriole. “On the other hand, if you routine PSA testing for healthy screen only men who are at higher risk men age 50 and older drew spirited for dying of prostate cancer — about opposition among many urologists 10 to 15 percent — there is a greater and advocates for those with prostate percentage of men who stand to ben- cancer. Washington University Chief efit and commensurately fewer who of Urologic Surgery Gerald Andriole stand to be harmed.” Jr., MD — a leading expert in prostate In the journal European Urology, cancer screening — believes it would Andriole and other scientists advo- be a mistake to universally dismiss the cated a risk-based approach that would screening test and argues men are best encourage PSA testing for served with a more nuanced approach. African-American men, the ethnic Andriole acknowledges that group at highest risk for prostate widespread testing has led many men cancer; men with a strong family with slow-growing tumors to be over history of prostate cancer; and those diagnosed and over treated with ag- with additional risk factors related to gressive therapies. For these men, who age, other illnesses, prostate volume are unlikely to die from their prostate and previous biopsy status. cancer, the cost and side effects of Andriole, the Robert K. Royce biopsies and treatments outweigh the Distinguished Professor of Uro- benefits of PSA testing. logic Surgery, has played a key role in “If you screened all men, since only about three out of 100 are going to die of prostate cancer, there are only three men who would potentially benefit and 97 developing prostate cancer screening guidelines as chairman of the prostate committee for the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Trial. The first systematic evaluation found that annual prostate cancer of the PSA test was conducted by screening does not reduce deaths from Washington University urologists the disease, even among men in their more than 20 years ago. Since then, 50s and 60s and those with underlying the division’s urologists have contin- health conditions. ued to evaluate use of the test. TIM PARKER This major national study has “Mass screening is not the way to go. We have to take a more nuanced approach.” From left, Brian Benway, MD, clinical fellow Youssef Tanagho, MD, resident Elizabeth Roth, MD, and research fellow Jonathan Mobley, MD, try out new 3-D technology. Gerald Andriole, MD 3-D Tools Provide Edge in Laparoscopy It seems intuitive that 3-D eyewear would help surgeons better visualize laparoscopic surgery. Washington University urologists have taken a scientific look at their value and reported results at the American Urologic Association Meeting in May 2012. The study had subjects with various ability levels — from expert surgeons to people with no medical training — perform three tasks from the Fundamentals of Laparoscopic Surgery skill set developed by the Society of American Gastrointestinal and Endoscopic Surgeons: using laparoscopic instruments to transfer an object from one peg to another, cutting a piece of pre-traced gauze, and suturing and knot tying. PHIL SHOULBERG “We found that, overwhelmingly, the 3-D imaging confers an advantage,” says Brian Benway, MD, who led the study. “Tasks were completed more quickly and there were fewer errors in 3-D. Advantages were seen for all groups, and the side effects of 3-D such as headaches, dizziness and disorientation were no more common than with standard 2-D.” Since performing the large-scale clinical trials that launched the prostate specific antigen (PSA) test into clinical practice in the 1990s, Washington University urologists led by Gerald Andriole, MD, have continued refining its use. Department of Surgery Annual Report 2012 35 Early specialization Education STREAMLINES TRAINING Highlights Three surgeons have been appointed associate program directors of the General Surgery Residency: Hepatobiliarypancreatic and GI surgeon Ryan Fields, MD, director of resident research, meets with junior residents before their lab year to guide them in selecting appropriate research or other options. Breast surgeon Amy Cyr, MD, provides breast education and helps residents prepare for boards. Colorectal surgeon Bashar Safar, MD, supervises residents in the ConnectCare Clinic, which provides medical care to underserved populations. The Nexus Project, an online resource to help U.S. medical schools, surgical residencies and surgical fellowships develop curricula, launched in April 2012. General Surgery Residency Program Director Michael Awad, MD, is spearheading the project, funded by the U.S. Department of Education. 36 surgery.wustl.edu COURTESY MARY KLINGENSMITH, MD Mary Klingensmith, MD, Mary Culver Distinguished Professor of Surgery, received the 2012 Parker J. Palmer Courage to Teach Award at the ACGME 2012 Educational Conference. The award recognizes those who exemplify the spirit of Palmer, an author and educator who encourages other educators to “give heart” and have “the courage to explore one’s ignorance as well as insight, to yield some control in order to empower the group, to evoke other people’s lives as well as reveal one’s own.” Klingensmith also was elected as a director of the American Board of Surgery and as a director of the American Board of Thoracic Surgery. COURTESY MICHAEL BRUNT, MD Michael Brunt, MD, was inducted into the Alpha Omega Alpha Honor Medical Society as faculty, along with Susan Pitt, MD, chief resident, general surgery, and Washington University medical students who are going into a surgical specialty. Residents hone laparoscopy skills: Above, assistant professor Erica Traxel, MD, instructs urology chief resident Shaun Grewal, MD; below, professor Mary Klingensmith works with research resident Lindsey Saint, MD. Surgical residents gain hands-on robotics training from Michael Awad, MD, PhD, in the surgical skills laboratory. says Mary Klingensmith, MD, postgraduate medical education vice chair for education and the are undergoing significant transfor- Mary Culver Distinguished Professor mations within the Department of of Surgery. “And there is a lot of Surgery, with a faculty workgroup concern that medical students are serving as a springboard and forum not interested in surgical training provided synergy as educators look on ideas to increase training efficiency. because it takes so long.” at early specialization, preparedness The department’s training takes In addition to the early special- RAY MARKLIN TRADITIONAL MODELS of for practice and other issues. Educa- place at Barnes-Jewish Hospital and ization programs in vascular and tors in the urology residency and the St. Louis Children’s Hospital. cardiothoracic surgery, the plastic colorectal, hepatobiliary-pancreatic The department already had surgery residency moved to a six-year and minimally invasive surgery taken a lead in the trend toward early integrated program in 2011-12, rather fellowships are developing innova- than require three tive ways to allow trainees to reach years of general subspecialty training earlier. Work- surgery and three group members are seeking ways to years of plastic improve measuring proficiency. specialization with programs that allow general surgery residents to begin fellowships in vascular or cardiothoracic surgery a year early. When the American Board of Surgery approved early specialization for almost all specialties, other surgical fellowship “As medical care becomes increasingly complex, it’s evident that not every individual needs to learn the entire breadth of surgery.” surgery training. Mary Klingensmith, MD directors began looking at ways to adopt the model. “As medical care becomes increasingly complex, it’s evident And the vascular is piloting an “academy model” surgery fellowship in which, akin to medical school took a step further courses, general surgery residents in 2012-13 by discuss goals with a faculty member offering a track in as they begin a rotation, receive mid- which trainees do term feedback and undergo a formal not enter a general assessment at the end. The model surgery residency, contrasts with current advancement but rather spend based on time spent in training. five years learning vascular surgery, with some general surgical skills taught early in the program. that not every individual For all training programs, needs to learn the entire an Innovations in Surgical breadth of surgery,” The general surgery residency Education Workgroup has “We are going to see changes in general surgery residency education, the likes of which we haven’t seen in the last 50 years,” says General Surgery Residency Program Director Michael Awad, MD, PhD. Awad Directs General Surgery Residency Michael Awad, MD, PhD, has been appointed program director of the General Surgery Residency Program at Washington University. He assumed his new role in February 2012, succeeding Mary Klingensmith, MD, who now serves full-time as the department’s vice chair for education. Awad earned a medical degree from Brown University and completed a surgical residency at The Johns Hopkins Hospital. He completed a fellowship in laparoscopic and endoscopic surgery at Legacy Health Systems in Portland, Ore., before joining the Washington University faculty in 2009. As an associate program director for the general surgery residency, Awad served as director of the Surgical Skills Laboratory. In 2010, he received a grant from the U.S. Department of Education to develop an online resource to help educators in U.S. medical schools, surgical residencies and surgical fellowships develop curricula and meet national accreditation requirements. Klingensmith began as program director of the general surgery residency in 2001. Under her leadership, the program introduced one of the earliest surgical skills labs for general surgery residents, implemented duty hour restrictions before they were mandated, and worked in concert with cardiothoracic and vascular fellowships to introduce early specialization programs. Department of Surgery Annual Report 2012 37 Research Surgeon-scientists MEET CHALLENGES OF RESEARCH COURTESY RICHARD SCHUESSLER, PHD John P. Boineau, MD Heart researchers in the Division of Cardiothoracic Surgery lost a friend and colleague, and the field of electrophysiology a giant, when John Boineau, MD, 78, died of leukemia on Nov. 7, 2011. Boineau was a pioneer in the surgical treatment of Wolf-Parkinson-White (WPW) syndrome, a heart condition that can lead to episodes of rapid heart rate, and atrial fibrillation (AF), a condition where the heart rhythm is irregular and too fast. At Washington University, he was involved in the development of the Cox-Maze procedure to treat AF. Boineau joined the faculty in 1984 as a professor of surgery and of medicine and co-director of the Cardiothoracic Surgery Research Laboratories. In addition, he was director of the Department of Medicine’s Pacemaker Center and Outpatient Pacemaker Services and medical director of cardiac rehabilitation at the Heart Care Institute at Barnes-Jewish West County Hospital. Surgery who are meeting these in basic science and translational re- challenges to make major contribu- search bring a unique clinical perspec- tions in the treatment of disease. tive to the laboratory, but more than MD, who joined the faculty in 2007, can make this component of their life’s had a unique pathway to a major work difficult. Namely, it is difficult to multicenter research project on pelvic balance clinical duties with a whole- pain, the cause of which often eludes hearted approach to research, fund- doctors. Unlike many other young ing has become scarcer, and there is a researchers, Lai did not get his start strong movement toward more collab- through a National Institutes of orative work, with surgeon-scientists Health (NIH) career development doing less basic science research. award; he recruited researchers from Three surgeonscientists are among a sizeable group of faculty members in the Department of Richard Schuessler, PhD, research professor of surgery, who worked with Boineau and Cox on the development of the surgical treatment of AF in the mid-1980s, describes Boineau as a brilliant scientist who came up with hundreds of ideas every week. “John was a superb and caring physician,” says Schuessler. “He was an outstanding mentor to me and hundreds of cardiology, surgery, and biomedical engineering students, residents and fellows.” Boineau earned a medical degree from Duke University School of Medicine and completed a residency in cardiology at Georgetown University School of Medicine. He returned to Duke for a fellowship in adult and pediatric cardiovascular disease, and then served on the faculty until 1972. Prior to joining the Washington University faculty, Boineau was on the faculties at the University of Southern California and the Medical College of Georgia. Henry Lai, MD 38 surgery.wustl.edu Urologic surgeon Henry Lai, ever, they are facing challenges that TIM PARKER James Cox, MD, Emeritus Evarts A. Graham Professor of Surgery, credits Boineau as among the first to describe the mechanisms of the WPW syndrome, ventricular tachycardia/fibrillation and atrial flutter/fibrillation. “Ninety-nine percent of all arrhythmias fall into one of those three categories,” says Cox. “That’s 30 percent of all heart disease. I think that’s a pretty good legacy.” SURGEONS WHO ARE IMMERSED other departments and submitted a has an R01 NIH grant and has joined successful U01 grant application with with colleagues Andrew Gelman, the National Institute of Diabetes PhD, and Alexander Krupnick, and Digestive and Kidney Diseases MD, to study innate and adaptive (NIDDK) for his basic science research immune responses in the lung. and clinical studies on pelvic pain Gillanders has worked collabora- phenotypes and epidemiology. tively with basic scientists to develop Thoracic surgeon Daniel Kreisel, a clinical trial of a mammaglobin-A MD, PhD, and breast cancer sur- DNA vaccine for breast cancer geon William Gillanders, MD, both patients with metastatic disease received NIH career development and to explore the use of genomics grants and were able to build on the to develop personalized breast to do research, but at the same time, will be perceived as a purely early departmental support. Kreisel cancer vaccines. I think if surgeons are not involved technical field,” says Kreisel. “It’s certainly more challenging in basic research, our specialty “We have a lot of insight from taking care of patients on a daily basis. I think we should be at the forefront of doing research into surgical diseases.” TIM PARKER Daniel Kreisel, MD, PhD William Gillanders, MD Department of Surgery Annual Report 2012 39 Clinical Operations New facilities and faculty KEYS TO CLINICAL GROWTH INITIATIVES TO GROW clinical In recent years, expansion of clini- As the Alvin J. Siteman Cancer volume continued to yield favorable cal practices to outlying areas and the Center at Barnes-Jewish Hospital results for the Department of Surgery addition of new faculty members and and Washington University School of in the 2012 fiscal year as the number services have helped sustain growth. Medicine has opened new facilities, of visits and procedures grew for the This trend held true in 2012 and holds various services have expanded to eighth consecutive year. promise for the new year. treat patients at these centers. Colorectal and hepatobiliary-pancreaticGI (HPB-GI) surgeons travel to offer treatment at Siteman’s West County facility in Creve Coeur, Mo., while a thoracic and a breast cancer surgeon are based at Siteman’s location in St. Peters, Mo. These services have made it possible for patients to receive advanced cancer care from top specialists close to home. In early 2013, when Siteman opens a new facility in South St. Louis County, four surgical specialties will work with medical and radiation oncologists to treat patients in this highly populated area. Colorectal, HPB-GI, thoracic and urologic surgeons will offer consultations at the new facility, where patients can undergo their initial visit, chemotherapy and radiation therapy. MARK GILLILAND From left, Hersh Maniar, MD, Ralph Damiano Jr., MD, Mitchell Faddis, MD, and Philip Cuculich, MD, exemplify the team approach needed for advanced care. With joint expertise in cardiac surgery, cardiology and electrophysiology, they provide leading-edge treatment for atrial fibrillation. 40 surgery.wustl.edu New Clinical Services In 2012, the department added four new surgeons, some of whom offer services that were previously unavailable. Surgeon Combines Plastics, Trauma Care BSA LIFESTRUCTURES HPB-GI surgeon Ryan Fields, Artist’s rendering of Siteman Cancer Center South County MD, treats not only liver and gastrointestinal disease but skin cancer, a leadership role in the American including melanoma, Merkel cell College of Surgeons’ surgical quality carcinoma, and basal and squamous improvement programs, which gather cell carcinoma. Plastic and reconstruc- data on surgical complications at tive surgeon Amy Kells, MD, PhD, Barnes-Jewish Hospital and St. Louis uses her skills in hand and microsur- Children’s Hospital, and remains com- gery to treat patients who come to mitted to addressing areas of concern. With fellowship training in both hand and trauma surgery, plastic and reconstructive surgeon Amy Kells, MD, PhD, brings a high level of expertise to an important part of her practice: treating patients who come to the emergency department with severe injuries to the extremities. While on call with the emergency departments of Barnes-Jewish Hospital and St. Louis Children’s Hospital, Kells treats such injuries as severed hands and fingers, electrical and other types of burns, and crush injuries. “I focus from the shoulder down,” says Kells. Recent patients include an Arkansas man who got his hand caught in a cement mixer, whose treatment saved three of his fingers, and a young man with electric burns on both hands and arms, who was Amy Kells, MD, PhD treated with a fasciotomy to improve circulation to the injured tissue. Kells estimates her work in the emergency department makes up about 50 to 75 percent of her practice. She also treats problems in the hand such as carpal tunnel syndrome and performs general and lower-extremity reconstruction. Kells completed a trauma fellowship at the University of Maryland, hand surgery fellowships at New York University and SUNY Syracuse, and a plastic surgery residency at the University of Texas Branch Hospitals in Galveston, Texas. the emergency room with limbthreatening injuries — treating patients at an earlier stage than other reconstructive surgeons. And the D e p a r t ment o f Su rger y Clinic al Ac t ivit y Wound Healing Program — based in the new Center for Outpatient Health in the Central West End — began offering hyperbaric oxygen to treat wounds that won’t heal as a result of diabetes or radiation injury. Challenges Ahead Despite positive growth, the Department of Surgery faces the dual challenges of decreased overall reimbursement and the trend toward tying reimbursement to performance measures. The department has played Visits Ancillary Procedures Work RVUs The Department of Surgery’s growth in clinical activity includes increased volume at off-site facilities. Department of Surgery Annual Report 2012 41 Giving Ballinger honored through EDUCATIONAL ENDOWMENT “He was the consummate gentleman, a very astute thinker and a real Renaissance man.” Timothy Eberlein, MD 42 surgery.wustl.edu clinical experience on their path to the Department of Surgery. He didn’t honoring the late Walter Ballinger, becoming surgical leaders. Faculty and take sides, but was always genuinely MD, a former chair of the Depart- friends of the department have made concerned about you, much the way ment of Surgery, and his wife, Mary gifts to the fund, as well. your grandfather would be about your Randolph, was recently established “He was the consummate gentle- career or schooling. He was a real to benefit surgical residents in the man, a very astute thinker and a real steward of the department and took coming years. Renaissance man,” says Timothy extraordinary pride in hearing about what the department was doing.” Ballinger, professor emeritus of Eberlein, MD, who became the Bixby surgery, died in April 2011 at the age Professor of Surgery and chair of the of 85. The Ballingers established the Department of Surgery in 1998 and University School of Medicine in 1967 fund to help residents who wish to developed a friendship with Ballinger at age 42 as the Bixby Professor, chair devote additional time to scholarly over the years. “He had a real, genuine of the department and surgeon-in- activities over and above the standard love of Washington University and chief at Barnes Hospital. He stepped Washington University Medical Center enjoyed considerable growth during the tenure of Walter Ballinger, MD, as chair of the Department of Surgery from 1967 to 1978. circa 1978 Ballinger arrived at Washington PHOTOS COURTESY BECKER MEDICAL LIBRARY ARCHIVES circa 1966 AN EDUCATIONAL ENDOWMENT Walter Ballinger’s decades of dedication and service to the department are being honored through establishment of an educational fund to support surgical resident training. eliminated diabetes in a primate by and retired as a surgeon in 1991, but transplanting insulin-producing continued to teach in the school’s for- cells called islets of Langerhans from mer Health Administration Program. a healthy primate pancreas. A general surgeon, most of COURTESY BECKER MEDICAL LIBRARY ARCHIVES down as department chair in 1978 Ballinger earned a medical Ballinger’s work was in intestinal and degree from the University of vascular surgery; his research focused Pennsylvania. He completed on the effects of surgery on the vagus residencies at Bellevue Hospital and nerve in the small intestine. In the Columbia-Presbyterian Medical College in Philadelphia before be- mid-1970s, Ballinger and the late Center in New York. He was a cap- coming associate professor of surgery Paul Lacy, MD, a world leader in tain in the medical corps of the U.S. at The Johns Hopkins University the study of the physiopathology Army in the early 1950s. He spent School of Medicine, where he was of insulin-dependent diabetes, several years at Jefferson Medical a Markle Scholar. Gifts to the Department of Surgery Dr. James Adams Dr. Charles Anderson The Bakewell Foundation Mr. David Ballinger Mrs. Mary Randolph Ballinger Bank of America Charitable Foundation Dr. Jay Belani Ms. Lori Bell Dr. Thomas Blanke Dr. and Mrs. Isaac Boniuk Dr. Richard Bradley Mr. and Mrs. Stephen Brauer Dr. James Barrett Brown Foundation Dr. Ross Brownson Drs. Michael and Elizabeth Brunt Dr. James Clanahan Mr. Jerry Clinton Dr. John Dillon Dr. Steven Dresner Mr. and Mrs. John Dubinsky Dr. Harry Ellis Dr. Thomas Ferrer Dr. Leonard Furlow Jr. Dr. Henning Gaissert Mr. and Mrs. Thomas Gallagher Mr. and Mrs. Kamran Hakim Dr. David Hardy Ms. Lottie Hardy Dr. Charles Janda Mr. Parviz Kamangar Ms. Sandy Kaplan Mrs. Raymond Keltner Dr. Gilbert Lee Dr. LaSalle Leffall Jr. Dr. and Mrs. Lee Liberman Dr. Harry Lichtwardt Dr. Zelig Lieberman Dr. Charles Manley Dr. James Miller Dr. Joseph Misischia Dr. Seymour Nash Dr. George Oliver Dr. Havner Parish Jr. Dr. James Patton Ms. Kimberly Perry Mr. and Mrs. Raymond Peters II Mrs. Janelle Phillips Dr. Richard Prinz Dr. George Reinhardt Dr. Joseph Reinkemeyer Dr. Robert Royce Mr. and Mrs. Marc Rubenstein Mr. Harvey Saligman Mr. James Schiele Dr. Kathleen Schwarz Mr. Donald Sher Dr. Gregorio Sicard Dr. Mark Siegel Dr. Alan Stein Mr. Howard Stephens Dr. and Mrs. Paul Stockmann Dr. Jessie Ternberg Dr. Lewis Thomas Jr. Mr. Joseph Thomure Vein Institute of New Jersey Dr. Wesley Walker Dr. Virginia Weldon WTFC Organization, Inc. Walter Ballinger, front row center, and surgical colleagues, circa 1970 To Make a Gift The Department of Surgery welcomes your support. Ways to make a gift include annual unrestricted giving such as membership in the Eliot Society, gifts for education of residents and fellows, support for research and endowment, and planned gifts and bequests. For additional information, please contact the Office of Medical Alumni and Development at (314) 935-9690. Department of Surgery Annual Report 2012 43 Faculty Section of Cardiac Surgery Section of General Thoracic Surgery Critical Care Service in the Cardiothoracic Intensive Care Unit Michael S. Avidan, MBBCh, FCA, Chief Associate Professor of Anesthesiology and Surgery Timothy J. Eberlein, MD, Chairman William K. Bixby Professor of Surgery; Director, Alvin J. Siteman Cancer Center Gregorio A. Sicard, MD Executive Vice Chair Ralph J. Damiano Jr., MD John M. Shoenberg Chair in Cardiovascular Disease; Vice Chair for Clinical Services Mary E. Klingensmith, MD Mary Culver Distinguished Professor of Surgery; Vice Chair for Education Robert W. Thompson, MD Vice Chair for Research Division of Cardiothoracic Surgery Ralph J. Damiano Jr., MD, Chief John M. Shoenberg Chair in Cardiovascular Disease Marc R. Moon, MD Joseph C. Bancroft Professor of Cardiothoracic Surgery William A. Gay Jr., MD Jennifer S. Lawton, MD Nabil A. Munfakh, MD Michael K. Pasque, MD Professors of Surgery Richard B. Schuessler, PhD Research Professor of Surgery Thomas B. Ferguson, MD Professor Emeriti of Surgery Scott C. Silvestry, MD Associate Professor of Surgery Brian P. Cupps, PhD Research Associate Professor of Surgery Michael Crittenden, MD Associate Professor of Surgery; Chief of Cardiothoracic Surgery, St. Louis VA Medical CenterJohn Cochran Division G. Alexander Patterson, MD, Chief Evarts Ambrose Graham Professor of Surgery Bryan F. Meyers, MD, MPH, Chief Patrick and Joy Williamson Chair in Cardiothoracic Surgery G. Alexander Patterson, MD Evarts Ambrose Graham Professor of Surgery; Director of Lung Transplantation Charles L. Roper, MD Professor Emeritus of Surgery Daniel Kreisel, MD, PhD Associate Professor of Surgery Traves D. Crabtree, MD Andrew E. Gelman, PhD Alexander S. Krupnick, MD Varun Puri, MD Assistant Professors of Surgery surgery.wustl.edu Heidi K. Atwell, DO Daniel A. Emmert, MD, PhD Thomas J. Graetz, MD Isaac P. Lynch, MD* Adnan Sadiq, MD Assistant Professors of Anesthesiology and Surgery Division of General Surgery Stephen Broderick, MD* Instructor in Surgery Section of Pediatric Cardiothoracic Surgery Jeffrey Bailey, MD Kareem D. Husain, MD Robert E. Southard, MD Robert D. Winfield, MD* Assistant Professors of Surgery Thomas Blanke, MD Stephanie Bonne, MD* Stephen Eaton, MD* Instructors in Surgery Section of Colon and Rectal Surgery William C. Chapman, MD, Chief Eugene M. Bricker Professor of Surgery Section of Acute and Critical Care Surgery Hersh S. Maniar, MD Sunil M. Prasad, MD Stefano Schena, MD, PhD Assistant Professors of Surgery James W. Fleshman Jr., MD, Chief Professor of Surgery Elisa H. Birnbaum, MD Professor of Surgery Sekhar Dharmarajan, MD Steven R. Hunt, MD Bashar Safar, MBBS, MRCS Assistant Professors of Surgery Grant V. Bochicchio, MD, MPH, Chief Harry Edison Professor of Surgery Bradley D. Freeman, MD John E. Mazuski, MD, PhD Professors of Surgery Julie A. Margenthaler, MD Associate Professor of Surgery Amy E. Cyr, MD Assistant Professor of Surgery Cancer Research Paul J. Goodfellow, PhD Yian Wang, MD, PhD Professors of Surgery Timothy P. Fleming, PhD Research Professor of Surgery Jennifer L. Ivanovich, MBA, MS Research Assistant Professor of Surgery Section of HepatobiliaryPancreatic and Gastrointestinal Surgery Matthew G. Mutch, MD Paul E. Wise, MD* Associate Professors of Surgery Section of Endocrine and Oncologic Surgery Pirooz Eghtesady, MD, PhD, Chief Professor of Surgery; Cardiothoracic Surgeon-inChief, St. Louis Children’s Hospital; Co-Director, St. Louis Children’s and Washington University Heart Center Rebecca L. Aft, MD, PhD William E. Gillanders, MD Bruce Lee Hall, MD, PhD, MBA Professors of Surgery Peter S. Goedegebuure, PhD Research Associate Professor of Surgery Ira J. Kodner, MD Solon and Bettie Gershman Chair in Colon and Rectal Surgery Wenjun Li, MD Research Assistant Professor of Surgery Umar S. Boston, MD Associate Professor of Surgery 44 Charl J. de Wet, MBChB Michael H. Wall, MD Associate Professors of Anesthesiology and Surgery John P. Kirby, MD Tiffany M. Osborn, MD Douglas J.E. Schuerer, MD Associate Professors of Surgery Jeffrey F. Moley, MD, Chief Professor of Surgery Timothy J. Eberlein, MD William K. Bixby Professor of Surgery; Chairman, Department of Surgery David C. Linehan, MD, Chief Professor of Surgery Steven M. Strasberg, MD Pruett Family Professor of Surgery; Carl Moyer Departmental Teaching Coordinator David P. Jaques, MD Professor of Surgery; Vice President of Surgical Services, Barnes-Jewish Hospital William G. Hawkins, MD Associate Professor of Surgery Ryan C. Fields, MD Assistant Professor of Surgery Dirk M. Spitzer, PhD Research Instructor in Surgery Sabarinathan Ramachandran, PhD Research Instructor in Surgery Christopher R. Erwin, PhD Research Associate Professor of Surgery Section of Vascular Surgery Kathryn Q. Bernabe, MD Jacqueline M. Saito, MD Adam M. Vogel, MD* Assistant Professors of Surgery Jun Guo, PhD Research Assistant Professor of Surgery Section of Minimally Invasive Surgery Brent D. Matthews, MD, Chief Professor of Surgery Mary E. Klingensmith, MD Mary Culver Distinguished Professor of Surgery Luis A. Sanchez, MD, Chief Gregorio A. Sicard Distinguished Professor of Vascular Surgery John A. Curci, MD Patrick J. Geraghty, MD Associate Professors of Surgery J. Christopher Eagon, MD J. Esteban Varela, MD, MPH Associate Professors of Surgery Jeffrey Jim, MD Kathleen G. Raman, MD, MPH Assistant Professors of Surgery Corey R. Deeken, PhD Research Instructor in Surgery Section of Transplant Surgery Division of Pediatric Surgery William C. Chapman, MD, Chief Eugene M. Bricker Professor of Surgery Thalachallour Mohanakumar, PhD Jacqueline G. and William E. Maritz Chair in Immunology and Oncology Jeffrey A. Lowell, MD Surendra Shenoy, MD, PhD Professors of Surgery Maria B. Majella Doyle, MD Yiing Lin, MD, PhD* Jason R. Wellen, MD Assistant Professors of Surgery Division of Plastic and Reconstructive Surgery Brian G. Rubin, MD Gregorio A. Sicard, MD Robert W. Thompson, MD Professors of Surgery L. Michael Brunt, MD Professor of Surgery Michael M. Awad, MD, PhD Assistant Professor of Surgery Division of Public Health Sciences Brad W. Warner, MD, Chief Jessie L. Ternberg, MD, PhD Distinguished Professor of Pediatric Surgery; Surgeon-inChief, St. Louis Children’s Hospital Patrick A. Dillon, MD Martin S. Keller, MD Associate Professors of Surgery Graham A. Colditz, MD, DrPH, Chief Neiss-Gain Professor in the School of Medicine; Associate Director, Prevention and Control, Siteman Cancer Center; Deputy Director, Institute for Public Health Ross C. Brownson, PhD Professor of Surgery and Professor, George Warren Brown School of Social Work Susan E. Mackinnon, MD, Chief Sydney M. Jr. and Robert H. Shoenberg Chair in Plastic and Reconstructive Surgery Keith E. Brandt, MD William G. Hamm Professor of Plastic Surgery Donald V. Huebener, DDS, MS, MA Ed Professor of Surgery Terence M. Myckatyn, MD Thomas H. Tung, MD Associate Professors of Surgery Ida K. Fox, MD Philip J. Johnson, PhD Amy F. Kells, MD, PhD Amy M. Moore, MD* Kamlesh B. Patel, MD Alison K. Snyder-Warwick, MD* Marissa M. Tenenbaum, MD Albert S. Woo, MD Assistant Professors of Surgery Sarah Gehlert, PhD Professor of Surgery; E. Desmond Lee Professor of Racial and Ethnic Diversity, George Warren Brown School of Social Work Jeff Gill, PhD, MBA Professor of Surgery; Director, Center for Applied Statistics; Professor, Department of Political Science Matthew W. Kreuter, PhD, MPH Professor of Surgery; Professor, George Warren Brown School of Social Work Margaret Olsen, PhD, MPH Associate Professor of Surgery; Research Associate Professor of Medicine Yan Yan, MD, PhD Research Associate Professor of Surgery Bettina F. Drake, PhD, MPH Melody S. Goodman, MS, PhD Christine M. Hoehner, PhD, MSPH Aimee S. James, PhD, MPH Kimberly A. Kaphingst, ScD, ScM, MA Rebecca Lobb, ScD, MPH Mary C. Politi, PhD Katherine A. Stamatakis, PhD, MPH Siobhan Sutcliffe, PhD, MHS, ScM Adetunji T. Toriola, MD, MPH, PhD* Erika Waters, PhD, MPH Kathleen Y. Wolin, ScD Assistant Professors of Surgery Jenifer E. Allsworth, PhD Assistant Professor of Surgery; Assistant Professor of Obstetrics and Gynecology Kenneth Carson, MD Assistant Professor of Surgery; Assistant Professor of Medicine Pamela L. Owens, PhD Assistant Professor of Surgery; Research Assistant Professor of Medicine Jean S. Wang, MD, PhD Assistant Professor of Surgery; Assistant Professor of Medicine Joaquin Barnoya, MD Research Assistant Professor of Surgery Su-Hsin Chang, PhD* Ying Liu, MD, PhD Instructors in Surgery Division of Urologic Surgery Gerald L. Andriole Jr., MD, Chief Robert Killian Royce, MD, Distinguished Professor of Urologic Surgery R. Sherburne Figenshau, MD Taylor Family and Ralph V. Clayman Chair in Minimally Invasive Urology; Professor of Surgery Jeffrey M. Arbeit, MD Steven B. Brandes, MD Arnold D. Bullock, MD Carl G. Klutke, MD Professors of Surgery Paul F. Austin, MD Sam B. Bhayani, MD Douglas E. Coplen, MD Associate Professors of Surgery Brian M. Benway, MD Alana C. Desai, MD Robert L. Grubb III, MD H. Henry Lai, MD Seth A. Strope, MD, MPH Erica J. Traxel, MD Assistant Professors of Surgery Zhi Hong Lu, PhD Research Assistant Professor of Surgery David A. Hardy, MD Instructor in Surgery *Joined faculty in fiscal year 2013 FACULTY PHOTOS BY TIM PARKER Department of Surgery Annual Report 2012 45 For More Information about the Department of Surgery, Contact: Timothy J. Eberlein, MD William K. Bixby Professor and Chairman Department of Surgery Washington University School of Medicine Campus Box 8109 660 S. Euclid Ave. St. Louis, MO 63110 Phone: (314) 362-8020 Fax: (314) 454-1898 Jamie Sauerburger Executive Director, Business Affairs Phone: (314) 362-6770 surgery.wustl.edu Other Contact Information Division of Cardiothoracic Surgery (314) 362-6025 Section of Cardiac Surgery (314) 362-7327 Section of General Thoracic Surgery (314) 362-8598 Section of Pediatric Cardiothoracic Surgery (314) 454-6165 Division of General Surgery (314) 362-7792 Section of Acute and Critical Care Surgery (314) 362-9347 Section of Colon and Rectal Surgery (314) 454-7183 Section of Endocrine and Oncologic Surgery (314) 747-0064 Section of HepatobiliaryPancreatic and Gastrointestinal Surgery (314) 747-2938 Section of Minimally Invasive Surgery (314) 454-7195 Section of Transplant Surgery (314) 362-7792 Section of Vascular Surgery (314) 362-7408 Division of Pediatric Surgery (314) 454-6066 Division of Plastic and Reconstructive Surgery (314) 362-4586 Division of Public Health Sciences (314) 454-7940 Division of Urologic Surgery (314) 362-8212 OUR PARTNER INSTITUTIONS Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. Barnes-Jewish Hospital St. Louis Children’s Hospital The Alvin J. Siteman Cancer Center Barnes-Jewish Hospital, a 1,158-bed facility, has been listed on the elite U.S. News & World Report Honor Roll of America’s best hospitals for 20 consecutive years. St. Louis Children’s Hospital is listed on U.S. News & World Report‘s Honor Roll of America’s best hospitals and is ranked fifth in the nation by Parents magazine. The Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine is the only National Cancer Institute comprehensive cancer center within 240 miles. All photographs by Robert Boston unless otherwise noted. Washington University encourages and gives full consideration to all applicants for admission, financial aid and employment. 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