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D E PA R T M E N T O F S U R G E R Y Annual Report 2013 1 2013 Annual Report of the Department of Surgery at the University of Vermont and Fletcher Allen Health Care Research Education Innovation Quality

1 2 4 10 14 16 22 26 32 36 42 48 54 58 62 66 72 76 80 86 90 91 92 95 96 108 2 A Letter from the Chair Surgical Education Innovation Quality Division of Cardiothoracic Surgery Division of Dentistry, Oral Maxillofacial Surgery Division of Emergency Medicine Division of General Gastrointestinal Surgery Division of Neurosurgery Division of Ophthalmology Division of Otalaryngology, Head Neck Surgery Division of Pediatric Surgery Division of Plastic Reconstructive Surgery Division of Surgical Onc

A LET TER FROM THE CH A IR E I have the distinct honor of being the interim Chair for the Department of Surgery at the University of Vermont. We are a high quality hospital in a rural setting. The University of Vermonts College of Medicine has a close alliance with Fletcher Allen Health Care. We carry on our proud tradition of being expert educators, researchers, and innovators. Our faculty continues to grow as we recruit faculty with premiere training and expertise. Since our last Annual Report

S U R G I C A L E D U C AT I O N 4

The Department of Surgery has a rich history of education at all levels of learning. From the entering novice medical student to the most experienced practitioner, the educational contribution of our department significantly and positively impacts the quality of care throughout Vermont and the areas throughout the country where our graduates practice. The major focus of our educational programs lies in Medical Student Education, Resident Education, Continuing Medical Education and Skills Labs. B

S U R G I C A L E D U C AT I O N 6 The department currently sponsors five residencies General Surgery, Otolaryngology Head Neck Surgery, Neurosurgery, Urology and Dentistry. All programs are fully accredited and the graduates compete successfully for highly competitive fellowships and practice opportunities. General Surgery Julie Adams, MD Director The surgical residency program at the University of Vermont has been continuously accredited since 1955 and has a long history of producing leader

S U R G I C A L E D U C AT I O N an active cerebrovascular laboratory and a fully equipped skull base dissection laboratory. Each year one of the neurosurgery residents steps into the laboratory to focus on clinical and basic science projects. Recent work has included publications and presentations on traumatic brain injury, cerebral blood flow, and malignancies. Otolaryngology Head Neck Surgery OHNS Donna Millay, MD Program Director This residency program is the crown jewel of our division.

S U R G I C A L E D U C AT I O N 8 John H. Davis, M.D. Endowed Lectureship in Surgery Stanley W. Ashley, MD, Frank Sawyer Professor of Surgery, Harvard Medical School, Chief Medical Officer Senior Vice President for Medical Affairs, Brigham Womens Hospital Hoyt, MD, FACS, Professor Emeritus, Surgery, University of California, Irvine, Executive Director, American College of Surgeons, The Norman J. Snow, M.D.70 Annual Lecture in Thoracic Surgery Robert W. Battle, MD, Associate Professor of

S U R G I C A L E D U C AT I O N The Clinical Skills Lab has designated facilities for virtual reality and laparoscopic training, task training, and team training using high fidelity simulators in a variety of clinical scenarios. Students have the opportunity to improve their skills in basic surgical procedures as well as laparoscopic tasks, dissecting skills, and management of complex wounds. Residents have the opportunity to practice and learn the basic surgical and laparoscopic skills as wel

I N N O VAT I O N 10 ROBOTICS Roboticassisted surgery provides surgeons with what may be the most effective, least invasive surgical treatment option available today. It enables surgeons to perform even the most complex and delicate procedures through very small incisions with unmatched precision. Through tiny, 12 cm incisions, surgeons can operate with greater precision and control, minimizing the pain and risk associated with large incisions while increasing the likelihood of a fast recovery

I N N O VAT O I N for minimally invasive treatment of descending thoracic aortic aneurysms using catheterbased technology. The Division has embarked on a program of robotassisted coronary artery bypass grafting for the combined treatment of coronary artery disease in selected patients which will grow with the development of the hybrid operating room and continued collaboration with the Division of Cardiology in a Heart Team approach. The Heart Team model has had overwhelming success in the trea

I N N O VAT I O N 12 surgical times and faster healing. The Division continues on the success of its participation in VIEW 1, a phase III clinical trial of the use Eylea, an antiVegF compound to treat AMD and Central Vein Occlusion, now approved by the FDA. continues with its pioneering and innovative work in the development and use of sentinel node biopsy techniques for treatment of breast cancer and melanoma. They are also utilizing ultrasound in innovative ways in the clinic and OR for impr

I N N O VAT I O N ments of a 3D phenomenon using 2D images. Along these lines innovative means are being explored to measure collagen organization in the microenvironment of breast tumor specimens. In addition, in collaboration with the Division of Oncology, studies are ongoing for the development of peptides and antibodies specific for individual patients cancers, and the use of Bcells derived from sentinel lymph nodes of patients with cancers to generate tumor specific antibodies. Other areas

QUALIT Y The past year has been significant for Department of Surgery quality initiatives. We introduced several programs to improve outcomes and lessen complications in our patients. VTE Prophylaxis. The prevention of venous thromboembolism both DVT and PE has always been a priority for surgeons. In a multidisciplinary effort with the Department of Medicine, the Jeffords Institute, the PRISM team, and others, we were able to create a PRISMbased FAHCwide program of best practice alerts and ord

QUALIT Y have been started by surgeons, such as reducing readmission for cancer patients, patientspecific risk estimates on consent forms in Cardiac Surgery, care pathways for ruptured AAA in Vascular Surgery, and patient shared decisionmaking and determinants of outcome in Neurosurgery. Perioperative Quality Committee continues to serve as a forum for many Participation in national and regional subspecialty outcome databases continues for cardiothoracic, trauma, vascular, and plastic surgery

CARDIOTHOR ACIC SURGERY 16

CARDIOTHOR ACIC SURGERY The Division of Cardiothoracic Surgery at Fletcher Allen Healthcare and the University of Vermont College of Medicine has been providing care for patients in Vermont and northern New York state with cardiac and thoracic related diseases for over sixty years. During that time, we have tried to establish a reputation for providing consistently high quality patient care in a welcoming and safe environment. Every day we rededicate ourselves to this mission. We strongly belie

CARDIOTHOR ACIC SURGERY 2012 was a particularly satisfying year as 2 of our residents one former and one current matched in the cardiothoracic surgical programs at two renown Boston Institutions, the Brigham and Womens Hospital and the Massachusetts General Hospital. 18 Licensed Nurse Assistant Jessica Menard cares for a patient in the Cardiothoracic Surgery Clinic superb surgical experience during his or her tenure on our service. The division members also mentor residents and students with a

CARDIOTHOR ACIC SURGERY Highly skilled surgeons, experienced OR staff and cutting edge technology and are all intergral parts of our Cardiothoracic Surgery Program gation and duty to provide patients with myriad treatment options from the newest, most creative operative approaches to the most time tested techniques. In addition to performing all types of adult cardiac and thoracic surgery, both simple and complex, we have, over the past year, expanded our experience in small incision surgery in

CARDIOTHOR ACIC SURGERY 20 resulted in the publication of multiple peer review articles relating to the myriad factors that affect surgical outcomes. We have participated in all of these studies and have shared authorship in many of the publications. By most metrics, our performance this past year has been excellent, but there is always room for improvement. We are also in the process of joining the STS Society of Thoracic Surgeons database and this should be fully operational by the beginning

CARDIOTHOR ACIC SURGERY quality, outcomes and patient satisfaction will be far more important than pure volume. Consequently, we are in the process of reevaluating our approach to all aspects of clinical care so that we can provide our patients and their families with the safest, most satisfying and successful cardiac surgical experience. We have maintained a 100 Provider Recommendation in our patient satisfaction surveys for the last two years year with a similar number of thoracic operations

D E N T I S T R Y, O R A L M A X I L L O FA C I A L S U R G E R Y 22

D E N T I S T R Y, O R A L M A X I L L O FA C I A L S U R G E R Y Dentistry and Oral and Maxillofacial Surgery has over a 60 year history of contributing to the mission of Fletcher Allen Health Care to deliver high quality academic health care in a rural environment. Our division members include practitioners in the areas of general practice, oral and maxillofacial surgery, periodontics, endodontics, pedodontics, orthodontics, orofacial pain and prosthodontics. Members of our division have con

D E N T I S T R Y, O R A L M A X I L L O FA C I A L S U R G E R Y experience of having practiced general dentistry in Chittenden County for 32 years. In addition she has served on the Vermont Board of Dental Examiners and been examiner for the Northeast Regional Board Currently there are four dental residents in our program who came from Carolyn Austin, CDA left assists Sarah Evans, DDS in providing dental care to a patient three different schools, all graduating in the top half of their de

D E N T I S T R Y, O R A L M A X I L L O FA C I A L S U R G E R Y lington on practice management techniques reviewing scheduled cases prior to treatment for the day to provide better treatment experiences for the patients, staff and dentists. Our residents are also conducting an ongoing journal review of new techniques and materials. Most recently the residents studied microabrasion for treatment of lesions on anterior teeth which will be incorporated into their clinical experience and reviewe

EMERGENCY MEDICINE 26

EMERGENCY MEDICINE Emergency Medicine is a discipline that defines itself through clinical excellence in an unstable, highrisk environment. This difficult task requires the highest levels of professionalism and dedication, and our staff of emergency physicians, physicians assistants, nurses, technicians, secretaries, and clerks are there, 24 hours a day, to provide the best possible care for patients with every imaginable emergency. Our division takes great pride in providing this frontline car

EMERGENCY MEDICINE This year marks the 20th anniversary of Physician Assistant participation in patient care in the Emergency Department. 28 emergencies related to mental health crisis, alcohol, and substance abuse. Our daily challenge is to balance the time required to properly and respectfully care for every patient who arrives on our doorstep with the intensity of our environment and the unavoidable need to triage. providers. PAs work collaboratively with the Emergency Medicine Physicians t

EMERGENCY MEDICINE Our medical student clinical rotation was developed by Mario Trabulsy, MD, a veteran of our staff who has received numerous teaching awards and is involved with medical education from the very first year. She works tirelessly to ensure a valuable experience for all of our students in this required rotation. Other attendings in our division serve on the Admissions Committee, as well as in the clinical correlation groups that prepare students for their first clinical rotations.

EMERGENCY MEDICINE 30 cation as centers of excellence. One area in which we excel is our Left Without Being Seen rate has been significantly below the national average of 2 for several years running addition to working to develop and enhance our ultrasound capabilities has for many years coordinated and developed our annual emergency Alain Burnet, RN, is one of the many nurses providing exemplary care in the Emergency Department HUMANITARIAN WORK In addition, many of our providers are invol

I N I T I AT I V E F O R R U R A L E M E R G E N C Y M E D I C A L S E R V I C E S I R E MS The Initiative for Rural Emergency Medical Services IREMS is a program of the University of Vermont College of Medicine Department of Surgery. Through education and related outreach efforts, IREMS supports Emergency Medical Services EMS agencies, related health care institutions and the communities served by EMS. At the heart of IREMS is the educational program for emergency prehospital care providers. C

GENER AL G ASTROINTESTINAL SURGERY 32

GENER AL G ASTROINTESTINAL SURGERY The Division of General and Gastrointestinal Surgery has ten fulltime faculty, eight on the Fletcher Allen campus in Burlington, and two on the Central Vermont Hospital campus in Berlin. We cover a broad area of surgery including general surgery such as hernia repairs, but our main focus is on surgery of the gastrointestinal tract. Dr. James Hebert continues his work in hepatobiliary surgery, focusing on pancreatic and gastric cancer. Drs. Neil Hyman, Peter C

GENER A L G ASTROINTESTIN A L SURGERY Year after year, our division also provides a large part of the resident education here at UVM Fletcher Allen Health Care. Residents in the PGY 1,2,3,5 levels rotate on our service during the year, getting a broad surgical experience in general and gastrointestinal surgery. This also includes time in the endoscopy suite where we teach Green Gold Professor in Colon Rectal Surgery 2005. RESEARCH Our Division is also busy with numerous research endeavors

GENER AL G ASTROINTESTINAL SURGERY Dr. Hebert continues his many years as an examiner of the American Board of Surgery, while Drs. Hyman and Cataldo both serve as examiners of the American Board of Colorectal Surgery. Dr. Ziedens is current president of the Vermont Chapter of the ACS, while Dr. Hebert in the governor to the ACS from the state of Vermont. For the ninth year, Dr. Cataldo missioned in Haiti at the Hospital Sacre Coeur in the town of Milot, providing medical services and performin

NEUROSURGERY 36

NEUROSURGERY At the Vermont Center for Neurological Surgery CNS at Fletcher Allen Health Care FAHC, our team of providers and support staff strive to provide the highest quality, compassionate, patientcentered neurosurgical care available in Northern New England. We are the preeminent regional center for minimally invasive approaches to brain tumors, vascular disorders, epilepsy and movement disorders as well as complex spinal problems. We are committed to providing state of the art neurosurgic

NEUROSURGERY The Donaghy Cerebrovascular and Skull Base Laboratory, run by Dr. Horgan, is the only facility of its kind in New England and is used to train residents throughout New England in handson open surgical techniques as well as novel minimally invasive endoscopic techniques. Physicians assistant Kathleen Maloney left and senior resident Dr. Richard Murray Landrigan in the division of otolaryngology. Every year, we are visited by a complement of world renowned faculty to assist us in t

NEUROSURGERY in primary brain tumors and acetate supplementation as adjuvant chemotherapy while also collaborating with Dr. Christopher Jones studying the costs in treating anticoagulantrelated intracranial hemorrhage. Dr. Horgan continues his collaboration with Dr. Kalev Freeman in Emergency Medicine studying traumatic brain injury while overseeing the development of miniDr. Michael Horgan consults with a patient mally invasive skull specific interests range from novel treatment of brain tum

NEUROSURGERY Dr. Penar has gained a national reputation in quality and recently began serving on the AANSCNS Washington Office Quality Improvement Workgroup, as national neurosurgerys representative to the National Quality Forum. 40 formed Department of Neurosciences to form a Center of Neurosurgical Excellence that will be disease focused and provide our patients with multidisciplinary care in a single setting. This is the most important aspect of care that we will provide our patients and it

NEUROSURGERY call the surgeon directly, available at all times, through the hospital operator for any concerns or questions. Fletcher Allen Health Care, in affiliation with the University of Vermont, has provided us with state of the art infrastructure found at only the best hospitals in the world. sistance of the highest quality physician assistants, nursing staff and support personnel. Patients with brain related disorders will typically see one of our physician providers with one week and of

OPHTH A LMOLOGY 42

OPHTH A LMOLOGY With the demand for primary and tertiary referral eye care increasing at astounding rates, the Division of Ophthalmology remains dedicated to providing quality services to an ever expanding and enlarging patient base. As the need increases, so too does our dedication to the community and the patients we care for. Our faculty is made up of highly specialized eye surgeons who have trained at the premier institutions across the country. In addition to our clinical positions at Flet

OHPTHALMOLOGY Our medical students continue to get into sought after competitive ophthalmology residency programs. Last year three of our medical students went into ophthalmology, and each student received their first choice in the residency match program. 44 EDUCATION The surgical subspecialties including ophthalmology are exciting and fascinating areas of medical practice. Though there certainly is a need for primary care, we feel that a career in of Ophthalmology has torqued up its ophthalm

OPHTH A LMOLOGY continues to be a leader in the New England area in clinical trials of severe eye disease. Participation in these trials allows our patients access to cutting edge therapy, years before they are available as routine care. Our trials are carefully selected so as to best serve the needs of our patients. Our clinical trials office is housed within our clinic, to allow seamless integration of clinical research into our daily practice. In the past year, we have completed participati

OHPTHALMOLOGY In the past year, we have completed participation in two landmark trials, both focused on age related macular degeneration. Age related macular degeneration remains the leading cause of vision loss in patients older than 60. 46 dard of care in treating patients with macular degeneration. Approved for use by the FDA last year, our patients have benefitted from this treatment for nearly six years now. collaboration necessary for these studies is another example of integrated care t

OPHTH A LMOLOGY address issues which have been brought to our attention from SAFE reports, or from the Fletcher Allen Patient and Family Advocacy section. For purposes of improved quality of care, the Division of Ophthalmology is compiling a database of surgical complications, with a complications reporting form completed for all procedures done by Fletcher Allen surgeons at the Fanny Allen and MCHV sites. All complications of procedures done in the Ophthalmology clinic are also tracked in this

O T O L A R Y N G O L O G Y, H E A D N E C K S U R G E R Y 48

O T O L A R Y N G O L O G Y, H E A D N E C K S U R G E R Y The Division of OtolaryngologyHead and Neck Surgery OHNS is comprised of twelve faculty members with subspecialty interests in head and neck oncology, otologyneurotology, rhinologyallergy, laryngology, facial plastic and reconstructive surgery, surgery for obstructive sleep apnea, and pediatric otolaryngology. We have five audiologists who perform diagnostic testing for a full spectrum of hearing and balance disorders and, in conjuncti

O T O L A R Y N G O L O G Y, H E A D N E C K S U R G E R Y The division of OHNS sponsors monthly grand rounds with visiting professors from leading academic institutions from across the country Dr. Richard Hubell, our pediatric surgeon, consults with a patients mother The division of OHNS sponsors monthly grand rounds with visiting professors from leading academic institutions from across the country. We offer continuing medical education credit for physicians who attend these conferences. I

O T O L A R Y N G O L O G Y, H E A D N E C K S U R G E R Y Dr. Sofferman directed the American College of Surgeons exported ultrasound course at the AAOHNS again this year in Washington DC. Dr. Brundage was also a faculty member. Dr. Couch completed her term as President of the Society of University Otolaryngologists and presided over the annual meeting in Chicago in November. Dr. Silverman was elected President of the newlyformed Vermont Otolaryngology Society which held its inaugural meeting

O T O L A R Y N G O L O G Y, H E A D N E C K S U R G E R Y Cochlear Implants are one of the most exciting in novative surgeries we are proud ot offer in the OHNS division. There are internal components, and external components. The external components are a sound processor, battery, cable, and transmitting coil with a magnet in center. An audiologist activates the implant 1 to 4 weeks after surgery time line determined by sugeonaudiologist by programming the processor. Programming follow up i

O T O L A R Y N G O L O G Y, H E A D N E C K S U R G E R Y surgery at the skull base and combine minimallyinvasive surgery with novel medical treatments for chronic rhinosinusitis. As the director of the Vermont Voice Center, Dr. Silverman and his colleagues in speech and language pathology at Fletcher Allen Health Care and The University of Vermont employ a multidisciplinary approach with stateoftheart diagnostic and therapeutic techniques to care for voice problems in patients including prof

P E D I AT R I C S U R G E R Y 54

P E D I AT R I C S U R G E R Y The Division of Pediatric Surgery at the University of Vermont provides surgical care to children from birth to adolescence as part of our mission to support the activities of the Vermont Childrens Hospital. Our division is staffed by two board certified pediatric surgeons, Dr. Kennith Sartorelli and Dr. John Lawrence. acute surgical problems throughout childhood surgical management of pediatric tumors and coordination of trauma care for children. Our division pe

P E D I AT R I C S U R G E R Y Resident, Dr. Jennifer Covino during a patient consultation ric Surgery to participate in a twoday series of lectures and conferences in Burlington which students, residents and faculty can all benefit from and participate in. An additional component of our educational mission is directed to the families and and demonstrating how our efforts represent a model for others to emulate. Our research activities include participation with our Anesthesia colleagues in el

P E D I AT R I C S U R G E R Y benefits of regional anesthesia in surgery for newborns, an area for which UVM has long been on the forefront in advocating for. Additionally, our division participates in research investigations in the topics of head injury in children, intraabdominal injury in pand the applicability of this mode of anesthesia for our pediatric patients. QUALIT Y Finally, the Division of Pediatric Surgery is an active participant in departmental quality efforts. Through Dr. Ke

PL AST IC RECONST RUCT I V E SURGERY 58

PL AST IC RECONST RUCT I V E SURGERY The Division of Plastic and Reconstructive Surgery at the University of Vermont and Fletcher Allen Health Care consists of four plastic surgeons board certified by the American Board of Plastic Surgery and members of the American Society of Plastic Surgery Donald R. Laub, Jr., MD David W. Leitner, MD Susan E. MacLennan, MD and Robert D. Nesbit, MD. The division also includes certified physicians assistants Emily Kavouksorian and Nicholas Brenny. overall su

PL AST IC RECONST RUCT I V E SURGERY clinic. In addition, the residents and students get handson instruction in wound care and suturing. also published the article A survey of multidisciplinary cleft palate and craniofacial team examination formats with Amir Ajar MD, an otolaryngology resident, in the Journal of Craniofacial Surgery in July of 2012. Dr. Laub is also the editor of the forthcoming textbook Congenital Anomalies of the Upper Extremity Causes and Treatments with a list of prominen

PL AST IC RECONST RUCT I V E SURGERY Cosmetic Surgery The division of Plastic and Reconstructive Surgery offers many procedures using the latest techniques. The division is working with the Division of Dermatology to offer patients the availability of CO2RE fractional laser system, a minimally invasive treatment option which can help with sundamaged skin, age spots, fine lines and wrinkles. In addition, the division also offers dermal fillers, like BOTOX, Juvderm and Restylane. Hand Surgery Dr

SURGICAL ONCOLOCY 62

SURGICA L ONCOLOGY The Division of Surgical Oncology DSO is known for its commitment to the multidisciplinary care of patients with cancer. Our division has been instrumental in the development of the Fletcher Allen Health Care Breast Care Center, which has become an institutional model for the management of patients with all forms of cancer. The DSO has been an international leader in the developing new surgical techniques for the treatment of breast cancer and melanoma. Our division has the o

SURGICAL ONCOLOCY RESEARCH GRANTS ACTIVE OR AWARDED IN 2012 1. Stephanie Pero PhD. American Association for Cancer Research A Novel Ultra HTS Cytotoxic Assay for Discovery of Human Cancer Antibodies. David Krag MD, Yuling Luo PhD., NIH Automated systems for detection and molecular characterization of circulating tumor cells. David Krag, MD., Richard and Deborah L. Tarrant Foundation David Krag antibodiesBCell Cancer Research. Giselle Sholler MD., David Krag MD Dept of Defense CDMRP Marrowd

SURGICA L ONCOLOGY Care Center was the first center in the state to use Nurse Navigators for assisting patients through the complex process of multidisciplinary care for cancer. Our current navigators Susan Bouffard RN, and Maggie MacLeay RN continue this tradition of excellence. QUALIT Y The DSO, through the work of Dr. James, has been on the cutting edge in the assessment of quality care in the management of breast cancer patients. His participation in a large multicenter consortium has now

SURGICAL RESE ARCH 66

SURGICAL RESE ARCH The mission of the Division of Surgical Research is to enhance patient care through the advancement of biomedical knowledge, and to employ cuttingedge technologies to pursue new therapeutic breakthroughs. The research in the Division spans a variety of disciplines, and encompasses clinical, basic, and translational research. ogy on a project using radiolabelled tracer to map the lymphatic drainage of the human brain. Dr. Charles Parsons conducted research in the Weiss Medici

SURGICAL RESE ARCH young people offering patients the opportunity to participate in cutting edge research. In addition, faculty within the division engage in a variety Zvara was the recipient of a Vermont EPSCoR SBIR Phase 0 Award, Evaluating the Host Tissue Response to Bioceramic Particles, a Potential New Bulking Agent for Treatment of Stress Urinary Incontinence. His labroatory published a number of articles in respected, peerreviewed journals, and he has established an ongoing internationa

SURGICAL RESE ARCH after TBI. His laboratory is using stateofthe art experimental techniques in calcium signaling, endothelial function, nitric oxide, and ion channels, to elucidate the molecular mechanisms and functional consequences of vascular responses to traumatic brain injury. In addition, clinical investigations using structural and functional MRI are providing new insight into the nature and progression of concussions and may direct the development of novel therapies to improve patient

SURGICAL RESE ARCH 70 healthcare innovations, with a focus on price variation. Brian Sprague, PhD is an epidemiologist whose research focuses on reducing breast cancer incidence by identifying modifiable lifestyle and environmental risk factors, informing breast cancer detection strategies by assessing the beneficial and harmful effects of screening, and reducing the risk of recurrence and improving quality of life among breast cancer Graduate Student Vicki DeVault survivors. Much of Dr. Sprag

SURGICAL RESE ARCH It is becoming clear that increasingly sensitive imaging techniques result in the detection of a large number of DCIS lesions perhaps as many as half that would never have harmed the life of the woman. However, we are currently unable to discriminate the harmless ones from those that are dangerous. Thus, all women with DCIS are treated rather aggressively with surgery, radiation, often hormone therapy. Working closely with the University of Vermont Office Of Health Promotion

SURGICA L TR A NSPL A NT IMMUNOLOGY 72

SURGICA L TR A NSPL A NT IMMUNOLOGY The Transplant Team is headed by doctors Antonio di Carlo and Jon Kai Yamaguchi, in coordination with Shirley Chang, Director of Transplant Medicine in the Division of Transplant Nephrology, Ann Guillot, Director of Pediatric Nephrology, Transplant Coordinators Stephyne Burke, Katherine Devine, Teresa Toby Rockwood, Marta Taylor, and Meghan Millett, Eileen EDUCATION The transplant team is committed to providing education to residents and students to ensure

SURGICA L TR A NSPL A NT IMMUNOLOGY of Transplant Surgery ASTS online educational curriculum spectacular success of organ transplantation over the last few decades has saved, lengthened and immeasurably improved thousands of lives. The first transplant at Fletcher Allen occurred on March 6th, 1972. RESEARCH The field of Transplantation Surgery is evolving at a tremendous rate. The We are actively involved in transplant immunosuppression research studies to ensure that our patients have acce

SURGICA L TR A NSPL A NT IMMUNOLOGY Dr. di Carlo is assisted in the OR by Dr. Patrick Mannal Additionally, pancreas transplantation in any of the following combinations may be offered Simultaneous KidneyPancreas, Pancreas after Kidney and Pancreas alone. These pancreas transplants are done for patients with Type 1 diabetes mellitus who have secondary complications. A successful pancreas transplant means that the recipients glucose remains normal without insulin injections. We are actively inv

TR AUMA, BURN CRITICAL CARE 76

TR AUMA, BURN CRITICAL CARE The Division of Trauma and Surgical Critical is comprised of a highly skilled team of three board certified surgeons certifications in surgery and surgical critical care, one Physician Assistant, an advanced practice nurse, a critical care Pharm. D, and a research physician. We work together with a trauma nurse coordinator, case managers, social workers, an injury prevention specialist, and a data registrar to provide comprehensive services in the area of trauma, bu

TR AUMA, BURN CRITICAL CARE 78 EDUCATION Our faculty is committed to educating medical students, residents, pharmacy residents, and established physicians. We utilize the University We also offer a highly successful, annual critical care conference, attended by physicians, physician assistants, pharmacists, respiratory therapist, nurses and the occasional hospital administrator. We have offered workshops that teach a variety of skills including critical care ultrasound, difficult airway manag

TR AUMA, BURN CRITICAL CARE We are actively working on novel ways to bring high fidelity physiologic simulation into wide use. Graduate Medical Education We have developed and launched a ResidentNurse council that addresses a variety of quality issues. This council meets monthly and has served as a model for practice that will be broadly applied to graduate medical education at Fletcher Allen Healthcare QUALIT Y Our trauma program participates in the American College of Surgeons Trauma Qualit

UROLOGY 80

UROLOGY The past year for the Division of Urology in the University of Vermont UVM Medical Group represented a year of both renewal and growth. The Divison successfully completed the recruitment of several faculty after the departure of several faculty over the past few years. At present the Division is in the fortunate position to only have one position open left for recruitment in order to complete the subspecialty care offerings expected of an academic group. The physician demographics both

UROLOGY urologic and other physicians in surrounding are hospitals remain of great importance to us with more formal relationships being both examined and forged at this time. Fetcher Allen Partners, with the intendant integration of health care delivery across a region, represents the foundation for which the Division will seek to best ensure integrated urologic care delivery for patients allowing for the proverbial right care at the right time at the right place. The complexity of both health

UROLOGY participate on numerous important committees in service to the medical centers broad pursuits. regular attendance by both students and community urologists. The training of residents at Vermonts Without this, our responsibility to train the next generation of physicians would not be met. only academic medical center, in an increasingly underserved specialty both local and regionally, represents a very important impetus for the State of Vermont given the often evidenced under supply o

UROLOGY 84 and response to traumatic brain injury as well as social stress, examination of factors important for the decision for prostate cancer treatment, novel markers for prostate cancer as a measure for its potential aggressiveness, as well as new minimally invasive surgical approaches. Both local and federal funding programs have served to support of this work and despite the extremely challenging funding environment, the Divisions efforts continue the necessary symbiosis of academic med

UROLOGY The Quality of Care and Education philosophy we hope to promulgate to our surrounding medical care community is central to our efforts to deliver the highest quality urologic patient care. Dr. Brian Irwin left and Dr. Scott Perrapato with the DaVinci Robot in the OR aggregate evaluation and adjudication of all adverse patient clinical care outcomes. Again, with the residency training program at the care, monthly meetings are held to specifically review and address quality of care issues

VA S C U L A R S U R G E R Y 86

VA S C U L A R S U R G E R Y The past 15 years has seen incredible change in the treatment of patients with peripheral vascular disease. Less invasive alternatives to treat aneurysmal and obstructive disease, new methods of treating patients with venous disease, and noninvasive imaging of vascular pathologies have all combined to make the treatment of vascular pathologies more patient will help us to avoid clinical situations where resources are not well utilized. EDUCATION Both medical stude

VA S C U L A R S U R G E R Y left to right Dr. Andrew Stanley, Medical Assistant Lindsey Branco, RN Jessica Beebe and Dr. Scott Wasilko We are also currently involved in several clinical trials investigating the efficacy of several new medical devices ORION TRIAL Studying the EPICTM Nitinol Stent System in treating blocked arteries SuperNOVA TRIAL Studying the INNOVATMBare Metal Stent in treating blocked arteries OVERPAR TRIAL Investigating whether open repairs of aneurysms of the legs ar

VA S C U L A R S U R G E R Y matic vascular injuries can now be performed using less invasive technologies that rely on highdefinition imaging. This will diminish the number and severity of complications in our patients. group VSGNE since 2003. This group is dedicated to the improvement in care of vascular patients through careful riskweighted measurement of outcomes. In the past 3 years our group has taken evidence from this database and translated it into changes in our clinical practice. U

SURGERY OUTRE ACH Neurosurgery Many divisions within the Department of Surgery are actively engaged with hospitals, health systems and agencies in Vermont and New York to respond to the needs of colleagues and patients across the region. General Surgery Otolaryngology Burlington Pediatric Urologic Surgery Urologic Surgery Vascular Surgery Berlin Plastic Surgery Pediatric Surgery Neurosurgery General Surgery Community Health Center, Burlington, VT Central Vermont Medical Center, Berlin, V

ENDOWED PROFESSORSHIPS Roger H. Allbee, MD31 Professorship in Surgery 2000 Jonathon Boyson, PhD Albert G. Mackay, MD32 and H. Gordon Page, MD45 Professor in Surgical Education 2005 James Hebert, MD Samuel B. and Michelle D. Labow Green Gold Professor in Colon Rectal Surgery 2005 Neil Hyman, MD Frank P. Ittleman Professor 2013 Frank Ittleman, MD Elliot W. Shipman Professorship in Ophthalmology 1934 Brian Kim, MD S.D. Ireland Family Professorship in Surgical Oncology 1999 David N. Krag, MD

H U M A N I TA R I A N 92 BRUCE J. LEAVITT, MD was invited this year to be a cardiac surgeon in Rwanda with TeamHeart www.teamheart.org. TeamHeart is a non profit medical missionary organization founded by Ceeya Patton Bolman RN and Chip Bolman MD. gram. TeamHeart operated at King Faisal Hospital in Kigali, the capital of Rwanda. They transported to Rwanda all of their supplies that were donated by companies and hospitals. Over 40 volunteers participated in this years mission. Dr. Leavitt was

H U M A N I TA R I A N RAY E. KELLER, MD has traveled every summer for the past 8 years to Guatemala, Honduras, or Nicaragua. One of his daughters always accompanies him. For the past 4 years, he has gone with a nongovernmental organization NGO that undertakes service projects and conducts a medical clinic in Santa Maria de Jesus Guatemala. One of Dr. Kellers goals is to improve public health. He provides parasite medication and nutritional supplements to families. He also provide on going medi

PHIL ANTHROPY Dr. Frank Ittleman FRANK P. ITTLEMAN ENDOWED PROFESSORSHIP IN CADIOTHORACIC SURGERY This past year, through an extremely generous 1 million dollar gift, the Frank P. Illteman endowed Professorship in Cadiothoracic Surgery was established. The creation of this Professorship will be used to help The College of Medicine and Fletcher Allen Health Care attract and retain a nationally recognized cardiothoracic surgeon in the future. The donor, who wishes to remain anonymous, and an acqu

PHIL ANTHROPY PETER WEIMERSHEIMER ENDOWED PROFESSORSHIP IN EMERGENCY MEDICINE A grateful donor has established a million dollar endowed Professorship in the Emergency Medicine Division to honor the work of Dr. Peter Weimersheimer, an Associate Professor in that division. This Professorship will enable the faculty members in that Division to pursue educational and research endeavors. This is the first endowed Professorship for the Emergency Medicine Division and it demonstrates appreciation for

PHIL ANTHROPY BUILDING A LEGAC Y OF GI V ING L A OHNS SUPPORTS MEDICAL STUDENTS The members of the Division of Otolaryngology, Head and Neck Surgery formally recognized their deep commitment to medical education with a group gift of 10,000 to the College of Medicine Fund, which primarily supports medical student scholarships and activities. This gift is commemorated with four named student lockers in the Given Building. HONORING THE LEGACY OF JOHN DAVIS, MD The John H. Davis, M.D. Endowment w

GREEN GOLD PROFESSORSHIPS Presentation at the UVM Foundation Board Meeting on October 3, 2013. The Department of Surgery donates 4.5 million for 14 Green Gold Professorships and for the Ittleman Professorship. Presenting the donation to UVM President Thomas Sullivan were Dr. Marion Couch, Dr. John Fortune, Dr. William Brundage, Dr. Ray Keller, Dr. Peter Weimersheimer, Dr. Ramsey Herrington, Dr. James Hebert, Dr. Mitchell Norotsky, Dr. Andrew Stanley, and Dr. Frank Ittleman. Also present were

P U B L I C AT I O N S CARDIOTHORACIC SURGERY Ittleman F, Hebert J. A tribute to John Davis, MD. In Memoriam Announcement. J Trauma Acute Care Surg. 2012 June72614631464. Likosky DS, Goldberg JB, DiScipio AW, Kramer RS, Groom RC, Leavitt BJ, Surgenor SD, Baribeau YR, Charlesworth DC, Helm RE, Frumiento C, Sardella GL, Clough RA, MacKenzie TA, Malenka DJ, Olmstead EM, Ross CS Northern New England Cardiovascular Disease Study Group. Variability in surgeons perioperative practices may influence th

P U B L I C AT I O N S Garcia AJ, Shi Q, Thomas Cr Jr., Chan E, Cataldo P, et al. A phase II trial of neoadjuvant chemoradtion and local excision for T2N0 rectal cancer preliminary results of the ACOSOG Z6041 trial. Ann Surg Oncol. 2012 Feb19238491. Shantha Kumara HM, Tohme ST, Yan X, Nasar A, Senagore AJ, Kalady MF, Hyman N, Kim IY, Whelan RL. Plasma from the second and third weeks after opencolorectal resection for cancer. Stimulates in vitro endothelial cell growth, migration, and invasion.

P U B L I C AT I O N S Kuruvilla K, Osler T, Hyman N. A comparison of the quality of life of ulcerative colitis patients after ileal pouchanal anastomosis vs ileostomy. Dis Colon Rectum, 2012 Nov551111311137. Kelz RR, Reinke CE, Cofer JB, Ashley SW, Hebert JC, Ko CY. APDS panel session IV intersection of surgical outcomes and medical education. J Surg Educ. 2012 NovDec69668792. Caulfield H, Hyman NH. Anastomotic leak after low anterior resection a spectrum of clinical entities. JAMA Surg. 2013

P U B L I C AT I O N S Rughani AI, Tranmer BI, Dumont TM. Response to Comparation of artificial neural network and logistic regression models for predicting clinically relevant outcome. World Neurosurg. 2012 Jul 11. Dumont TM, Tranmer BI, Horgan MA, Rughani AI. Trends in neurosurgical complication rates at teaching vs. nonteaching hospitals following dutyhour restrictions. Neurosurgery. 2012 Nov71510416. Tsen AR, Long PM, Driscoll HE, Davies MT, Teasdale BA, Penar PL, Pendlebury WW, Spees JL, L

P U B L I C AT I O N S Seigel JK, Stadler ME, Lombrano JL, Almony JS, Couch ME, Belhorn TH. Chromobacterium violaceum necrotizing fasciitis a case report and review of the literature. Ear Nose Throat J. 2012 Nov911147983. DerTorossian H, Gourin CG, Couch ME. Translational implications of novel findings in cancer cachexia the use of metabolomics and the potential of cardiac malfunction. Curr Opin Support Palliat Care. 2012 Dec6444650 PEDIATRIC SURGERY Rowland PA, Trus TL, Lang NP, Henriques H,

P U B L I C AT I O N S Blackburn E, Laub DR Jr. Finger Tip Injuries and Coverage in The American Society for Surgery of the Hand ASSH Hand and Upper Extremity Surgery Textbook, R Berger, AP Weiss, eds. ASSH Chicago. in press 2012 Giricz O, Calvo V, Pero SC, Krag DN, Sparano JA, Kenny PA. GRB7 is required for triplenegative breast cancer cell invasion and survival. Breast Cancer Res Treat. 2012 Jun133260715. Pesek S, Ashikaga T, Krag LE, Krag D. The falsenegative rate of sentinel node biopsy in

P U B L I C AT I O N S Shukla GS, Krag DN, Peletskaya EN, Pero SC, Sun YJ, Carman CL, McCahill LE, Roland TA. Intravenous infusion of phagedisplayed antibody library in human cancer patients enrichment and cancerspecificity of tumorhoming phageantibodies. Cancer Immunol Immunother. 2013 Aug6281397410 administration among patients treated for warfarinrelated major bleeding an analysis of electronic health records. Thromb Haemost. 2012 Apr107466272. King BJ, Plante MK, Kida M, MannGow TK, Odlan

P U B L I C AT I O N S overactivity and afferent nerve excitation in mice. J Urol. 2012 Nov1885198692. Qian F, Osler TM, Eaton MP, Dick AW, Hohmann SF, Lustik SJ, Diachun CA, Pasternak R, Wissler RN, Glance LG. Variation of blood transfusion in patients undergoing major noncardiac surgery. Ann Surg. 2013 Feb257226678. Moore HB, Loomis SB, Destigter KK, MannGow T, Dorf L, Streeter MH, Ebert GM, Crookes BA, Leffler SM, OKeefe MF, Freeman K. Airway, breathing, computed tomographic scanning duplica

P U B L I C AT I O N S SURGICAL RESEARCH CONT. Fenton JJ, Onega T, Zhu W, Balch S, SmithBindman R, Henderson L, Sprague BL, Kerlikowske K, Hubbard RA. Validation of a Medicare Claimsbased Algorithm for Identifying Breast Cancers Detected at Screening Mammography. Med Care. 2013 Aug 6 Epub ahead of print Sprague BL, McLaughlin V, Hampton JM, Newcomb PA, TrenthamDietz A. Diseasefree survival by treatment after a DCIS diagnosis in a populationbased cohort study. Breast Cancer Res Treat. 2013 Aug14

P U B L I C AT I O N S Outcomes of Adult Trauma Patients Admitted to Trauma Centers in Pennsylvania, 20002009. Arch Surg. 2012 Aug14787327. Fortune JB. Chpt 54 Insuries to the Stomach, Duodenum, and Small Bowel in Yeo CJ ed. Shackelfords Surgery of the Alimentary Tract 7th ed., Saunders, Philadelphia, 676690, 2012 Aug. Glance LG, Dick AW, Osler TM, Mukamel DB, Li Y, Stone PW. The association between nurse staffing and hospital outcomes in injured patients. BMC Health Serv Res. 2012 Aug 912247.

P U B L I C AT I O N S VASCULAR SURGERY Suckow BD, Goodney PP, Cambria RA, Bertges DJ, EldrupJorgensen J, Indes JE, Schanzer A, Stone DH, Kraiss LW, Cronenwett JL Vascular Study Group of New England. Predicting functional status following amputation after lower extremity bypass. Ann Vasc Surg. 2012 Jan2616778. Hirashima F, Patel RB, Adams JE, Bertges DJ, Callas PW, Steinthorsson G, McSorley J, Stanley AC. Use of a postoperative insulin protocol decreases wound infection in diabetics undergoing

P U B L I C AT I O N S Donaldson CW, Schneider DJ, Bertges DJ, Adams JE, Elgharib NZ, Mueller EL, Prabhu W, Ashikaga T, Dauerman HL. Increased local cytokine production at culprit superficial femoral artery plaques. J Thromb Thrombolysis. 2013 Oct3632939. Photo Captions Top Left Dr. Patrick Forgione, Director of the Bariatric Surgery Program, Top Right ED Tech Chad Lewber, Lower Left Michelle MayerReid, Executive Assistant, Surgery Administration. 109 2013 Annual Report of the Department of S

DIVISION MANAGERS 110 CARDIOTHORACIC SURGERY Mark Sutton Interim Practice Supervisor, Assistant Dir Faculty Practice PEDIATRIC SURGERY Beth Nadeau Surgical Clinical Office Assistant DENTISTRY, ORAL MAXILLOFACIAL SURGERY Janet Thomason Miccolo, MD Program Director Clinic Manager for Residents PLASTIC RECONSTRUCTIVE SURGERY Scott Flieger, MBA Practice Supervisor SURGICAL ONCOLOGY Nicholas Jaidar Practice Supervisor EMERGENCY MEDICINE Peter Weimersheimer, MD ED Ultrasound Director SURGICA

LAYOUT DESIGN CONTENT PHOTOGRAPHY Troy Simpkins Graphic Design Communications Professional Julie Paris Business Manager Department Administrator David Seaver Chief Photographer David Seaver Photography Top Attending Surgeon, Dr. Neil Hyman right, performs a gastrointestinal surgery assisted by Dr. Adrian Seah 111 2013 Annual Report of the Department of Surgery at the University of Vermont and Fletcher Allen Health Care

NonProfit Org. U.S. Postage PAID Permit No. 143 Burlington, VT UVM Surgery E118 Given 89 Beaumont Ave. Burlington, VT 05405 In service to the PATIENT, COMMUNITY and MEDICINE since 1879. 112 SM UVM.EDUMedicineSurgery

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