Posted by Stony Brook Surgery on October 29, 2014
Study Finds Increase in Patients, Once Deemed High Risk, Who May Be Eligible for Immediate Reconstruction
Breast reconstruction can be performed at many different time points following care for breast cancer. Immediate breast reconstruction means surgery is done at the same time, while delayed reconstruction is carried out months or years later, once all oncologic care is complete. National rates of breast reconstruction following mastectomy have risen over the past decade.
Here at Stony Brook Medicine, we reconstruct approximately 90% of our patients who have mastectomy. However, surprisingly, this rate is still below 40% across the country.
Both methods of breast reconstruction — implant-based and autologous (using a patient's own tissues) — have seen a significant increase.
This observed increase is due to many factors, including the passage of the Women's Health and Cancer Rights Act; more prophylactic mastectomies; a greater acceptance of breast implants following the FDA's lifting of the silicone implant ban; and state laws that mandate that breast surgeons inform their patients about reconstructive options.
An important study, titled "Diminishing Relative Contraindications for Immediate Breast Reconstruction," was published this month in the Journal of the American College of Surgeons by the team at Memorial Sloan Kettering Cancer Center. It is an exciting multi-center study that supports and underscores what we do here in Stony Brook's state-of-the-art breast reconstruction program.
This well-executed retrospective study, encompassing data from 1,040,088 patients over a 14-year period, verified that more women are having reconstruction surgery at the time of surgical treatment for their breast cancer. Even more remarkably, there is a rise in patients who were once considered too high risk for the reconstruction.
Patients, their breast surgeons, and their plastic surgeons are, as a team,
Features considered high risk are: age over 60; stage III or IV breast cancer; and history of, or present need for, radiation therapy to the chest wall.
As little as ten years ago, the need for postoperative radiation was considered by many to be an absolute contraindication to immediate reconstruction. Fortunately, this is no longer the case.
The authors of the study concluded that a leading force behind the change is plastic surgeons' willingness to perform reconstruction in these high-risk patients. The authors believe that increased experience with high-risk patients has given plastic surgeons the knowledge to push the boundaries of what can be achieved.
This forward thinking is important because nearly half of all newly diagnosed patients fall into one of the high-risk categories. The good news is that the overall reconstructive success rate in this population was found to be greater than 88%. Adverse events the authors discussed were tissue expander loss, permanent implant removal, and complications with the autologous flaps.
Not only do the study authors believe that the increased rate is due to plastic surgeons who are willing to attempt breast reconstruction following mastectomy, but even more importantly, they believe that there is an increased acceptance on the part of patients. The risks of failure of immediate reconstruction are often outweighed by the tremendous benefits including an improved body image and higher quality of life.
There are data demonstrating a greater satisfaction with quality of life in the first two years following mastectomy if reconstruction was performed.
What does all this mean for our patients at Stony Brook Medicine? It means progress. Rates of breast reconstruction have gone up in high-risk patients. Reasons that patients should not have immediate reconstruction are shrinking. This is because of patients, their breast surgeons, and their plastic surgeons, who, as a team, are willing to push the envelope in order to improve care.
At Stony Brook Medicine, we strongly believe that all women have the right to learn about and potentially proceed with reconstruction which may improve self-image, self-esteem, and quality of life.
Read the abstract of the MSKCC study provided by the National Library of Medicine. Please call 631-444-4666 for an appointment to discuss reconstruction options with Dr. Huston and our other breast reconstruction specialists.
Posted by Stony Brook Surgery on October 22, 2014
Odds Were against Officer Surviving Traumatic Head Injury from Hit-Run Driver
The Suffolk police officer who was critically injured by a hit-run driver in Huntington on September 22nd was discharged last Friday from Stony Brook University Hospital.
Officer Nicholas Guerrero, 36, was escorted out of the hospital front lobby with applause from more than 100 fellow officers along with physicians, nurses, and other medical staff as he made his way into an ambulance that would transport him to a local rehabilitation facility.
"Statistically, he had only a one-in-three chance of surviving," said James A. Vosswinkel, MD, chief of our Trauma, Emergency Surgery, and Surgical Critical Care Division and medical director of the Stony Brook Trauma Center.
"We are all ecstatic today at his great recovery. However, throughout this process, if it were not for Nick's character, his strength, and his will, as well as the overwhelming support of his immediate family and his extended family of the police department, I truly don't believe any of this could have happened."
Officer Guerrero, a four-year veteran of the Suffolk County Police, spent weeks in a medically-induced coma after suffering a serious head injury.
"One of our Heroes, Police Officer Nick Guerrero, who suffered life-threatening injuries from attempting to stop some of the bad guys out there doing harm in our community, will leave Stony Brook University Hospital today on the road to recovery," said Suffolk County Executive Steve Bellone.
"Officer Guerrero's injuries could have been much worse and fatal if it was not for the swift, immediate action from his colleagues, first responders, and the outstanding medical team here at Stony Brook University Hospital."
Stony Brook University Hospital is the only Regional (Level I) Trauma Center for Suffolk County.
Our trauma specialists coordinate the initial evaluation and treatment of all injured patients transported by ambulance or helicopter to the ER. Stony Brook Medicine's trauma program has been recognized as being in the top 4% nationally, and is the top-ranked center in the care of pedestrian trauma.
Officer Guerrero is expected to make a full recovery, and there is even hope that he will return to the police force.
Watch this video clip (0:17 min) of Officer Guerrero leaving University Hospital in the ambulance that would transport him to a local rehabilitation facility:
Posted by Stony Brook Surgery on October 15, 2014
New Study Finds Daytime Better for Minimally Invasive Surgery for Acute Cholecystitis
Laparoscopic gallbladder removal — cholecystectomy — was introduced in the late 1980s, and has largely replaced the open procedure for the majority of the 770,000 cholecystectomies performed annually in the United States. Indeed, laparoscopic cholecystectomy is currently the most commonly performed major abdominal procedure in Western countries.
This procedure generally decreases post-op pain, decreases the need for post-op pain medication, and speeds recovery and the patient's return to full activity, compared with open cholecystectomy. It also provides less scarring, and it is associated with improved patient satisfaction as compared with the open procedure.
However, certain circumstances in the operating room may necessitate converting to an open procedure, thus depriving patients of the benefits of the laparoscopic technique. Last month, the American Journal of Surgery published a news-making study based on a large retrospective analysis comparing daytime versus nighttime laparoscopic cholecystectomy for acute cholecystitis.
Here, Purvi Y. Parikh, MD, assistant professor of surgery, who is a leader on our exigent general surgery service, provides commentary on this study, and explains how the study findings relate to the newly established special protocol and resources for optimum treatment of acute cholecystitis at Stony Brook Medicine.
With the current emphasis on outcomes-based surgery, the cholecystectomy study just published in the American Journal of Surgery is important to help establish guidelines for optimal timing for surgery, as the optimal timing of surgery for acute cholecystitis remains controversial.
One area of uncertainty remains whether patients should undergo early (same hospitalization) versus delayed (six or more weeks after discharge) cholecystectomy. Studies have found that delayed cholecystectomy was associated with higher rates of conversion to open surgery and longer hospital stay.
In a systematic review of randomized controlled trials, 18% of patients randomized to delayed cholecystectomy experienced recurrent symptoms necessitating emergent cholecystectomy, and that subset of patients experienced a 45% conversion rate to open surgery.
A large review of laparoscopic cholecystectomy for acute cholecystitis found incrementally worse outcomes for each day surgery is delayed during the hospitalization. Patients that undergo cholecystectomy within 48-72 hours of admission for acute cholecystitis were associated with reduced conversion rate, operative time, length of stay, and hospital costs.
The so-called Tokyo guidelines, a consensus statement developed by hepato-biliary-pancreatic specialists, recommend early cholecystectomy for acute cholecystitis, and only delayed cholecystectomy in select high-risk patients. Considering these findings, some institutions perform cholecystectomy at night to avoid an excessive delay in time to operation.
At Stony Brook we believe the best treatment for acute cholecystitis is early
In this present study, nighttime (7 pm to 7 am) cholecystectomy was associated with an increased conversion rate to open surgery but had a similar length of stay and complication rate as daytime (7 am to 7 pm) cholecystectomy.
The observed increase in conversion rate during nighttime cholecystectomy was not associated with worse severity of disease or patient condition.
The study presumed that the increased conversion rate was attributable to system-based factors, such as limited operating room availability during daytime hours, limited nighttime resources and personnel, and anticipation of trauma cases at trauma centers that may influence provider decision-making at night that would increase conversion rate to open surgery.
The authors of the study concluded that because of the elevated conversion rate, laparoscopic cholecystectomy for acute cholecystitis should be delayed until regular daytime hours.
We believe that early cholecystectomy for acute cholecystitis is the best treatment for the patient.
With the establishment of the Department of Surgery's new exigent general surgery service, we have developed a protocol for patients with acute cholecystitis.
Patients with acute cholecystitis are streamlined from initial presentation in the emergency room, to exigent general surgery service evaluation, to a dedicated exigent general surgery service operating room during daytime hours, then to the post-anesthesia care unit and discharge home within 24 hours.
For more complicated patients, the exigent general surgery service is able to direct preoperative optimization so that the time-interval to surgery may be decreased. Our goal is to overall decrease patient duration until surgery, length of stay, and hospital costs, while providing the best care for the patient.
See abstract of the article, "Can It Wait until Morning? A Comparison of Nighttime versus Daytime Cholecystectomy." For consultations/appointments with Dr. Parikh concerning general surgery, please call 631-444-4545.
Posted by Stony Brook Surgery on October 8, 2014
October is National Breast Cancer Awareness Month and a special time for us to promote breast cancer awareness and provide information on the disease.
Established in 1985, this awareness month, now an international health observance, has from the start aimed to promote mammography as the most effective weapon in the fight against breast cancer. Since then, breast cancer research has also become an important weapon in this fight.
At Stony Brook Medicine, breast cancer is the focus of a comprehensive, academic program — the only one of its kind on Long Island. At its core is our multidisciplinary breast cancer team.
Here, Brian J. O'Hea, MD, chief of breast surgery and director of Stony Brook's Carol M. Baldwin Breast Care Center, answers some of the frequently asked questions women raise after they have been diagnosed with breast cancer. The bottom line is that every woman's situation is different, and treatment needs to be tailored to the type of cancer, personal and family history, tolerance levels for treatment, and personal preferences.
Dr. O'Hea's perspective, as one of the area's premier breast cancer surgeons, gives women information to serve as discussion points with their doctors.
Breast cancer is the most common cancer among American women, other than skin cancer.
Q: What is a lumpectomy and is it safe?
A: A lumpectomy is the removal of a tumor from the breast along with some of the surrounding normal tissue.
When a lumpectomy is recommended, many women consider whether a mastectomy might be a safer choice in terms of recurrence and survival. Long-term studies have demonstrated that a lumpectomy provides survival rates equivalent to a mastectomy while preserving the breast.
A lumpectomy is often recommended to treat a single tumor that is small to medium in size. Patients with a large tumor or multiple tumors are often treated with a mastectomy. Also, the location, type of tumor, and other factors all must be considered with your doctor when making this important treatment decision.
Q: Why do lumpectomies require follow-up radiation?
A: Even when lumpectomies show totally “clean" (cancer-free) margins after surgery, radiation is required because of the natural distribution pattern that breast cancer takes. Not all the cancer stays together.
Some tiny, isolated cells may migrate to other parts of the breast beyond the scope of the surgery. This has nothing to do with the skill of your surgeon, but everything to do with the nature of breast cancer and how it manifests.
Q: If lymph nodes are “clean" (cancer-free) following surgery, why is chemotherapy needed?
A: Think of chemotherapy as an insurance policy against future cancer. This form of treatment circulates a powerful drug or a combination of drugs through all parts of the body to kill any cells that may have floated away from the cancer site and lodged in other areas.
Whether this actually happens depends on the characteristics of the tumor; some tumors can put women at a higher risk for scattered cells. This is why chemotherapy is the recommended precautionary measure.
Are you worried about the cost of mammography? CDC offers free or low-cost mammograms.
Q: If a doctor recommends a mastectomy on just one breast, wouldn't it be safer to have a bilateral mastectomy (removal of both breasts)?
A: Long-term studies show that there is a 15% risk of a woman developing cancer in the opposite breast. However, women at higher risk may need to consider the bilateral mastectomy because their odds of developing cancer in the healthy breast are much higher.
These risk factors include a strong family history of breast cancer and the presence of the BRCA gene, which indicates a genetic disposition to breast cancer.
Q: Are there any new options when it comes to reconstruction?
A: Fortunately, because of dramatic improvements in imaging and screening technology, we are more able to find cancer in its earliest stages, which offers some women an opportunity for breast conservation instead of mastectomy.
At Stony Brook, 65% of the women treated for breast cancer have breast preservation surgery. Our surgeons work closely with plastic and reconstructive surgeons to maximize cosmetic outcomes.
Techniques include inserting AlloDerm®, a type of collagen, along with the tissue expander to give a more natural shape to the breast; smaller and more limited incisions that preserve as much of the natural breast skin as possible to facilitate a more natural reconstruction; and a new total skin- and nipple-sparing technique that leaves all of the breast skin in place, which also helps achieve the most natural result available.
However, the nipple-sparing technique is possible in only a small group of highly selected patients requiring a mastectomy [see our FAQs about nipple-sparing mastectomy].
As an academic medical center and accredited breast care center, Stony Brook works to continually refine techniques to make them more widely available for more patients.
Special events for Breast Cancer Awareness Month: Stony Brook University Cancer Center and the Town of Brookhaven are partnering to "Turn the Town Pink." CDC fact sheet, "Breast Cancer: What You Need to Know."
Posted by Stony Brook Surgery on October 1, 2014
Providing Special Guidance and Support to Female Medical Students
The Stony Brook Medicine Student Branch of the American Medical Women's Association (AMWA) sponsors a mentoring program for medical students to provide them with special guidance and support. Faculty in the Department of Surgery are active in the program, and of the 28 school-wide faculty matched this year to provide mentor oversight, five (18%) are from our department.
At the start of each academic year, the AMWA mentoring program pairs female faculty members with female students in Stony Brook's School of Medicine, providing them with opportunities to gain insight into their fields of interest from the perspectives of professional women who have gone through the process.
A common focus is placed on work/life balance, as well as long-term professional career development, scholarly endeavors, and life-long learning skills.
AMWA focuses on effective mentor-mentee interactions balancing three key elements:
The Department of Surgery's faculty that matched as mentors this year are: Paula I. Denoya, MD, assistant professor of surgery; Angela A. Kokkosis, MD, assistant professor of surgery; Melissa M. Mortensen, MD, assistant professor of surgery; Aurora D. Pryor, MD, professor of surgery and chief of general surgery; and A. Laurie W. Shroyer, PhD, MSHA, professor of surgery and vice chair for research.
Dr. Shroyer says, "I strongly support this program, and I am very excited to see the very high participation rate of our Department of Surgery's female faculty members."
Eight students have been assigned to these mentors for the current academic year. Four are first-year students — Chelsea Dahl, Danielle Fassler, Malack Hamade, and Kelli Summers — and the others are second-year students — Sydney Beck, Nicole Golbari, Jessica Johl, and Lydia Liu.
One of Dr. Shroyer's several long-time mentees is Brianne Sullivan, a fourth-year student, who is applying to surgical residency programs this year. She is a former co-president of Stony Brook's AMWA Student Branch.
About her experience in the mentoring program, Ms. Sullivan says: "This program is wonderful, and I think it is very important for those seeking guidance and mentorship, especially when relating to some of the unique challenges faced by females in medicine. The program gave me a glimpse at my potential future, and made me realize that to a degree I needed to be considering future goals and plans. It gave me a rough idea of what to expect in the years to come.
"We have a potluck dinner where the faculty mentors come to meet the students, and they discuss a little bit about their personal and professional life and how they got to where they are today.
Mentees are encouraged to look for opportunities to expand their network of colleagues
"I think this exposure is invaluable. I could look at successful women who at one point were in my shoes, wondering where medicine was going to take them, and hear about their journey. Their stories gave me confidence that I would make it to, and made me excited for the ride.
"Dr. Shroyer lent unconditional support and advice throughout my four years of medical school. Having a person like that to reach out to is very reassuring, and I am very grateful to have been involved in this program and to have met her.
"For me, surgery more fell into place once I did my third-year rotation and realized that I had the same passion for the OR and surgeries as the vascular surgeon I spoke to at the potluck dinner."
Commenting on the importance of the department's contribution to the AMWA mentoring program, Mark A. Talamini, MD, professor and chairman of surgery, says: "The specialty of surgery, unfortunately, is late in its appropriate incorporation of women at all levels into the field. There are reasons for this which are inherent in the specialty itself.
"We have made it difficult for women to both have a successful career in surgery and be effective in their family roles. This has been a deficit and a loss both for our patients and for our profession. We are in the process of correcting this, and the mentorship by our spectacular women surgeons and scientists will go a long way, person to person, to address the profession's shortfall."
About AMWA and Its Presence at Stony Brook
AMWA is a professional organization that functions at the local, national, and international level to advance women in medicine and improve women's health. It fulfills its mission by providing and developing leadership, advocacy, education, expertise, strategic alliances, and mentoring.
Founded in 1915, AMWA began when women physicians were an under-represented minority. As women in medicine increase in numbers, new issues arise that were not anticipated. AMWA has been addressing these issues for nearly a century. Its membership comprises women physicians, medical students, and others dedicated to the advancement of women in medicine.
AMWA's Student Branches provide support and resources for their members, plus valuable leadership and mentoring opportunities. Branches organize local events and facilitate interactions and connection with national AMWA initiatives and leadership. Branch leaders also act as the face of AMWA on their medical school campuses.
At Stony Brook, women physicians on the faculty established AMWA's presence here soon after the School of Medicine was established. Last year, the Student Branch renewed its official affiliation with the national organization. It is run by medical students themselves, with a faculty advisor.
"We will continue to seek venues and ways to attract women to our field, and to our department
The mentoring program sponsored by our Student Branch was started in the 1990s.
Jadry Gruen, one of the branch's current co-presidents, says, "In addition to matching interested students with female physicians at Stony Brook through our mentoring program, we also host events like an annual student-faculty potluck, lectures on women in medicine/the workforce, preview documentaries, and host panel discussions and any number of events that promote insightful conversation about the role of women in leadership and in medicine."
"Several of our members are helping to organize an upcoming regional AMWA event held in New York," adds Ms. Gruen. "AMWA members from Stony Brook have participated in this regional conference in the past, and we have even hosted the event at the SBU campus."
Most of the current female faculty in the Department of Surgery have participated in the Stony Brook AMWA mentoring program. Some not matched in the current academic year continue to mentor students from previous years. New faculty intend to join.
All told, the department is doing its part to provide special guidance and support to female medical students here through AMWA, and to encourage them to pursue careers in surgery.
While the gender gap remained particularly large among surgeons throughout the 20th century, the new century has seen the number of women attending US medical schools reach that of men, and the gap is apparently closing among graduates entering general surgery training programs, according to a recent study published in the Journal of the American College of Surgeons.
"We will continue to seek venues and ways to attract women to our field, and to our department here at Stony Brook," says Dr. Talamini. "Fortunately, we have a nucleus of absolutely outstanding women surgeons and scientists on our faculty who are naturally attractive as role models to our learners here at Stony Brook."
Posted by Stony Brook Surgery on September 24, 2014
Varicose veins affect approximately 40% of the adult population. They are superficial vessels that are abnormally lengthened, twisted, or dilated, and are seen most often on the legs and thighs.
Varicose veins bulge and rise above the skin's surface. They may be uncomfortable and result in swelling of the legs. If left untreated, varicose veins may lead to more serious medical problems, such as phlebitis (swelling and inflammation of a vein) or leg ulcers.
Here, Angela A Kokkosis, MD, assistant professor of surgery (Vascular Surgery Division) who practices at the Stony Brook Vein Center, answers questions about endovenous laser treatment for varicose veins. Dr. Kokkosis and her vascular colleagues also offer free screenings at the Vein Center to discuss these and other related questions; see contact info below.
Q: What is endovenous ablation?
A: Endovenous ablation is a treatment for closing the saphenous vein in the leg, which is typically the main superficial vein associated with varicose veins. This treatment can be performed with either laser or radiofrequency (RF) technology.
Q: How does endovenous ablation work? What does it do to a varicose vein?
A: A thin catheter (flexible tube) is inserted into the vein through a tiny skin puncture, and the entire length of the vein is treated with laser or radiofrequency through the catheter, thus "injuring" the vein's wall.
At the Stony Brook Vein Center, we use the latest technology to treat varicose veins with
Sclerotherapy involves the injection of a specially-developed solution (Sotradecol) into the varicose vein. The solution then hardens, causing the vein to close up or collapse.
Microphlebectomies involve the removal of the vein by tiny punctures or incisions along the path of the enlarged vein. Through these tiny holes, we use a surgical hook to remove the varicose vein, which results in minimal scarring.
Q: Does loss of a laser-treated vein create a health problem in any way?
A: The leg has two systems of veins, the deep and the superficial. Between these two systems there are many collateral pathways to enable normal venous blood flow. When the diseased superficial system is treated, the blood gets redirected into the deep system without affecting blood flow in the leg.
Q: What is the recovery time after endovenous laser treatment?
A: Patients are encouraged to start walking immediately after the procedure, but they should avoid any strenuous exercises involving the legs (such as weight training) for two to three weeks, to enable adequate time for healing and for the treated veins to remain closed. There is bruising and mild discomfort in the treated leg for two to four weeks.
Q: How much time does it take to see the results after the laser procedure?
A: Within one week patients may start to notice a difference in the prominence of their varicose veins, but complete results may take weeks to months. Additionally, some patients may require adjunctive procedures depending on the severity of their varicose veins, as mentioned above.
Q: What is the risk of recurrence of varicose veins after endovenous ablation treatment?
A: Varicose veins are the result of a progressive disease, and while we can treat the problematic veins now, it is up to the individual patient, their genetics, and their lifestyle which dictate whether other varicosities will develop over time.
Q: What are the risks and potential complications of the laser/RF procedure?
A: The goal of the endovenous procedure is to thrombose, or clot, the saphenous vein (a superficial vein). Rarely, there are situations where the clot can extend into the deep vein system and cause a DVT (deep venous thrombosis).
Q: How does laser/RF treatment compare with other treatment options, including surgery?
A: Previous generations performed the tradition “vein stripping" in which the entire saphenous vein would be removed through large skin incisions, with less than cosmetic results. With the current endovenous ablation, there is no need for skin incisions to obtain excellent results of varicose vein resolution.
Q: Will insurance cover the laser procedure?
A: Many insurance companies cover the endovenous ablation procedure with or without the adjunctive sclerotherapy or microphlebectomy procedures based on various criteria. In our practice at Stony Brook, an individualized discussion takes place with the patient regarding this process.
Q: Why is the Stony Brook Vein Center the place to go for endovenous ablation treatment? What makes it special there?
A: Our staff and vascular surgeons manage a large population of patients with venous disease, and we manage a variety of both common and complex cases. The unique needs of patients with varicose veins are recognized by everyone at our practice, and we strive for exceeding the expectations of our patients.
We use the latest technology to treat varicose veins with endovenous ablation, and we also are leaders in using minimally invasive treatments, such as the new drug therapy called Varithena, which we are the first on Long Island to offer.
Click here for more information about varicose veins and their treatment. For consultations/appointments with Dr. Kokkosis and our other vein specialists, please call 631-444-VEIN (8346).
Posted by Stony Brook Surgery on September 17, 2014
Boxer Travels from Greece to Be Treated by Our Doctors to Get Back in the Ring
For the past five years, 17-year-old Nikoleta Pita of Piraeus, Greece, has dreamed of making her country's Olympic boxing team. As a two-year national team member with a strong won-lost record, her dream was getting close to becoming a reality.
But almost a year ago, after a period of intense weight training, her right arm and shoulder suddenly swelled up and became very painful. And she developed numbness in her fingers.
Doctors in Greece told her she had clotted her right subclavian and axillary veins, the main veins draining the arm, and to stop everything — making her dream to become an Olympian come to a sudden halt.
Ms. Pita was diagnosed with thoracic outlet syndrome (TOS), a disorder that occurs when the blood vessels or nerves of the arm become compressed in the space between the collarbone and the first rib (thoracic outlet).
She was offered only conservative treatment with blood thinners by her doctors in Greece, who strongly suggested that she should completely abandon boxing or any other sport that involves intense weight training of the arms.
The boxer in Ms. Pita was hit hard by all this, but she wasn't going to give up.
With the support of her family she found out that a surgical treatment could help her keep her boxing career alive, but she would have to travel abroad to get the treatment she needed.
Through a family friend who had visited Stony Brook Medicine as an observing physician, Ms. Pita and her parents — Archilleas and Agapi Pita — learned of a doctor that could take care of her problem in the United States.
Apostolos K. Tassiopoulos, MD, professor of surgery and chief of vascular and endovascular surgery, who was in Athens for a scientific meeting, met with Ms. Pita and her family, and he discussed the surgical treatment that could get their daughter back in the ring.
Ms. Pita arrived in New York on August 31. The next day, Dr. Tassiopoulos and his colleague Thomas V. Bilfinger, MD, ScD, professor of surgery and director of thoracic surgery, performed the surgery together to remove the first rib and free the attached muscles in order to free the compressed vein.
The surgeons made an incision in the armpit, and then removed the rib and the muscle attached to it, which allowed for more space around the vein. Patients usually need physical therapy after surgery to get their strength back.
One day after surgery, Ms. Pita felt great and ready to get back to her dream. "I'm feeling really strong, physically and mentally," she said. "This has definitely changed my life — Stony Brook saved my career, saved my dream."
Just after one week in the United States, Ms. Pita and her parents flew back to Greece.
About Thoracic Outlet Syndrome
Common causes of TOS can include physical trauma from a car accident, repetitive injuries from job- or sports-related activities, certain anatomical defects (such as having an extra rib), and pregnancy. However, often doctors cannot determine the exact cause of this syndrome.
TOS symptoms can vary, depending on which structures are compressed.
When nerves are compressed, signs and symptoms of TOS include wasting in the fleshy base of the thumb (Gilliatt-Sumner hand); numbness or tingling in the arm or fingers; pain or aches in the neck, shoulder, or hand; and weakening grip.
The hallmark of venous compression is painful swelling of the forearm and back of the hand particularly, often accompanied by a bluish discoloration of the skin. Symptoms may include numbness, tingling, aching, swelling of the extremity and fingers, and weakness of the neck or arm.
The purpose of thoracic outlet surgery is to release or remove
When arteries are compressed, the most prominent features are change in color and cold sensitivity in the hands and fingers, swelling, heaviness, paresthesias (tingling, tickling, or burning sensation of the skin), and poor blood circulation in the arms, hands, and fingers.
TOS is more common in women. The onset of symptoms usually occurs between the ages of 20 and 50. Doctors usually recommend nerve conduction studies, electromyography, or imaging studies to confirm or rule out a diagnosis of TOS.
Common treatment for TOS usually involves physical therapy and pain relief measures. Often, when only nerves are compressed but blood vessels are intact, patients will improve with these approaches.
However, when clots develop in the blood vessels or when pain from nerve compression is not improved with conservative measures, doctors usually recommend surgery.
The purpose of thoracic outlet surgery is to release or remove the structures causing compression of the nerve or blood vessels. TOS is known to affect athletes, particularly overhead athletes such as swimmers and baseball players. With appropriate care, these athletes can return to full activity within three to four months from surgery.
Click here for more information about thoracic outlet syndrome. For consultations/appointments with our surgical specialists, please call 631-444-4545.
Posted by Stony Brook Surgery on September 15, 2014
Our Chairman Talks about the Power of Innovation and Excellence at Stony Brook
Mark A. Talamini, MD, professor and chairman of surgery, just appeared as the featured guest on BlogTalkRadio's "Strategies of Success." Host Brian A. Cohen interviews him, focusing on how Dr. Talamini identified his career goals, and how he has pursued them to the max.
Dr. Talamini explains that Stony Brook Medicine and Stony Brook University attracted him as an opportunity to further his career goals by joining a dynamic multidisciplinary team committed to advancing healthcare through technological innovation.
Dr. Talamini also discusses his role in the advances in surgical care that have been made through the development of minimally invasive endoscopic surgery, as well as advances in treating inflammatory bowel disease, specifically, Crohn's and colitis, where he is a specialist.
Mr. Cohen's program, "Strategies of Success," explores actionable ideas leading to success. His guests come from different places, he says, but they all share the goal of developing the right strategies of success for them.
BlogTalkRadio produces audio podcasts as a social radio network with independent experts hosting shows on every kind of topic — from politics and current affairs, entertainment and sports to health and finance.
Click here to listen to the entire interview (31:04 min).
Posted by Stony Brook Surgery on September 10, 2014
What Can Actress Farrah Fawcett Teach Us about Anal Cancer?
One of the cancers that receives less attention than others but is just as important to be aware of is anal cancer, which occurs in 1 in 600 adults nationwide.
According to the American Society of Colon and Rectal Surgeons, the number of patients that develop anal cancer each year is slowly increasing, especially in some higher risk groups.
Survival rates are greatly affected by how early this cancer is detected. Awareness is thus important.
Here, Paula I. Denoya, MD, assistant professor of surgery and a member of our Colon and Rectal Surgery Division, answers a few of the frequently asked questions about anal cancer and what people can do about it.
Q: What are the signs and symptoms of anal cancer?
A: The symptoms of the most common type of anal cancer, squamous cell carcinoma, tend to be similar to those of hemorrhoids. Because of this — and its relative low rate of occurrence in relation to other cancers — it tends to be misdiagnosed or overlooked. See your doctor if you experience any of the following:
Q: People may feel uncomfortable talking about these symptoms: what do you suggest as the best approach?
A: I urge people not to be embarrassed to go to the doctor. We are talking about a body part like any other. Your doctor will be very matter-of-fact with you; remember, he or she has seen it all before. Their major concern will about your health and how to best help you — and to do so in a way that makes you feel comfortable.
Try to be as open as possible and to share all of your concerns because the earlier anal cancer is detected, the better the survival rates. For example, when detected in stage 1, the five-year survival rate is 70%. However, at stage 4, it drops to 20%.
Q: Who is at risk for anal cancer?
A: Anal cancer occurs in both men and women, although is slightly more prevalent in women. Risk factors include:
Q: Are there any prevention measures I can take?
A: It is important to have regular checkups that include a digital rectal exam. Check your stool for the presence of blood, and see your doctor if you detect any. You can also protect yourself by not smoking, having safe sex and getting the HPV vaccine. People who are at high risk, such as the HIV positive population, can now get anal pap smears to screen for the precancerous cells that can develop before anal cancer.
Q: How is anal cancer diagnosed?
A: If your personal physician suspects a problem, you should get referred to a colorectal surgeon who can run a number of tests. This includes a physical exam, a digital exam, a palpable groin exam, an anoscopy and a full colonoscopy. If we uncover any lesions, we can biopsy them. At Stony Brook University Cancer Center, we also use CT and PET scanning for testing, as well as to evaluate if the cancer has metastasized or invaded any other structures around the anus.
Q: What treatment options are available?
A: Approximately 80% of patients respond to chemotherapy and/or radiation therapy. At Stony Brook, we take a multidisciplinary team approach to cancer treatment. We have a highly specialized team that focuses exclusively on cancers of the colon, rectal, and anus, which includes:
Team members have the experience, knowledge, and compassion to deliver expert and highly personalized care coordinated across the full spectrum, from diagnosis through discharge and beyond. Upon completion of the course of treatment, we follow the patient at regular intervals — checking though ultrasound and anoscopy for the presence of additional cancer cells. If cancer remains or recurs, we can perform what is called an abdominal perineal resection (APR) to remove the anus and surrounding tissue.
At Stony Brook, we believe that we can offer patients what they most need: high-level cancer care close to home. Not only do we offer the type of specialized care typically only found in urban areas, but it also is comfortable and convenient for patients. Nearly all services — diagnostics, chemotherapy, radiation therapy, surgery, follow-up appointments, and support groups — are located in the Cancer Center or Stony Brook University Hospital.
For consultations/appointments with our colorectal specialists, please call 631-638-1000. Watch this preview video (1:36 min) of "Farrah's Story" about actress Farrah Fawcett (1947-2009) and her battle with anal cancer:
Posted by Stony Brook Surgery on August 27, 2014
Learn about Our Surgical Advances & Why Patients Come to Us from around the NationRead POST-OP online now. To receive a complimentary free subscription to POST-OP (printed), please send request with your complete postal mailing address.
Posted by Stony Brook Surgery on August 20, 2014
Daughter to Run 26.2-Mile Marathon to Benefit Haitian Hospital Serving the Underserved
The founding chief of our trauma service, David J. Kreis Jr., MD, died young (age 38) from cancer a quarter century ago. He was a founding father of our Department of Surgery — and of the life-saving Stony Brook Trauma Center, the only designated Level 1 regional trauma center in Suffolk County.
Dr. Kreis was also the father of two girls, who were little girls when he passed away. Now grown up, one of them, Sandra (Sandy) Kreis, 32, has taken upon herself the challenge of running the Maine Marathon in Portland, ME, this coming October in memory of him.
More than a challenging race, Sandy will run this major marathon to raise funds to benefit a Haitian hospital where her father once volunteered.
Sandy explains it this way: "On October 5, 2014, I will run the Maine Marathon — a distance of 26.2 miles — in memory of my dad."Why Maine? Because he liked to camp there. Why that weekend? Because it marks the 25th year of his passing. Why run? Because he was a runner, and one of my only memories of him is of playing with his yellow walkman earbuds. Why a marathon? Because I have found that it forces me to exert myself to my individual limit, both physically and mentally.
Please help me raise $6,000 to build a well that will serve 500 people
"In the late 1970s, my dad provided volunteer medical services at Hôpital Albert Schweitzer (HAS), the only full-service hospital within a 610-square-mile area in Haiti's Artibonite Valley. Haiti has the highest rates of infant mortality and maternal mortality in the entire Western Hemisphere. It is the poorest country in the Americas, and half the population lives without access to clean water.
"Every dollar I raise in memory of my dad will go to HAS to build a well that will serve 500 people with fresh and safe drinking water year-round."
Jane E. McCormack, RN, our trauma nurse manager, worked closely with Dr. Kreis, and she remembers him with great affection and admiration. In her tribute to him at the presentation of our first annual David J. Kreis Jr. Award for Excellence in Trauma Surgery, in 2000, she described him as follows:
"David Kreis was the first chief in the Division of Trauma. He came to Stony Brook in 1986 with a simple mission — to build a world-class trauma center. He was well on his way to that end when his life was cut short by cancer and he passed away in 1989, at age 38.
"Dr. Kreis left behind the foundation upon which the Trauma Center at Stony Brook rests today.
"He was the force behind the Medevac helicopter in the county. He created the trauma research laboratory. He brought the ATLS [Advanced Trauma Life Support] course to the region. He had a hand in many other programs too numerous to mention.
"Even with these many accomplishments, Dave Kreis remained down to earth — a regular guy.
"Dave Kreis was the ultimate team player. He knew each and every member of the trauma team, from the sub-specialty attendings to the housekeepers. He made sure we all did our best. He held us to high standards, provided instruction if we needed it, and set us straight if we needed to be set straight. He led by example and never asked of us what he himself was not willing to do.
"He was an unparalleled leader, and an important figure in trauma surgery both nationally and locally."
Through stories about him over the years since his passing, Sandy's father came to represent for her a "keen sense of right and wrong, of moral rectitude." That, she adds, "is within my fibers."
Summing up the reasons for her marathon run and fundraiser to benefit the Schweitzer Hospital, she says, "I run not just for my dad, but for what he practiced."
Sandy, who grew up in the local Three Village community, graduated from Georgetown University and subsequently from the Fletcher School of Law and Diplomacy. She currently works under Governor Deval Patrick of Massachusetts as the international business advisor with a focus on clean energy and water innovation.
Posted by Stony Brook Surgery on August 13, 2014
New Study Expands Role of Patient-Centered Treatment Option for Women with Breast Cancer
The surgical treatment of breast disease is rapidly evolving. The desire to develop treatments that are less invasive and afford a higher level of cosmesis for patients is strong.
One of our faculty, Dr. Tara L. Huston, assistant professor of surgery and a member of our plastic and reconstructive surgery team, just published a scientific paper detailing her study of patients who had undergone prior breast surgery to see if it was safe and feasible to perform nipple-sparing mastectomy in this group.
The peer-reviewed article appears online in Annals of Plastic Surgery, the only independent journal devoted to general plastic and reconstructive surgery. This journal serves as a forum for current scientific and clinical advances in plastic surgery.
Dr. Huston's work shows that patients who have scarring from prior breast surgery can successfully undergo nipple-sparing mastectomy with immediate reconstruction. Here, she explains how her findings may benefit patients who come to our Carol M. Baldwin Breast Care Center.
On Long Island, one in nine women will be faced with the diagnosis of breast cancer in her lifetime. The number of women undergoing mastectomy is increasing. Fortunately, the field of plastic and reconstructive surgery has evolved dramatically over the past thirty years to keep up.
The trend for immediate breast reconstruction after mastectomy has grown from 10% in the 1980s to about 90% today here at Stony Brook. Most recently, our breast surgeons have adopted the technique of nipple-sparing mastectomy, preserving the nipple-areola complex as well as all of the breast skin.
This is a method that we employ when both the oncologic and reconstructive surgeon believe it is safe and feasible.
As we have begun performing more and more nipple-sparing mastectomies with immediate reconstruction, our empowered patients here at Stony Brook continue to encourage us to expand the indications for this surgery.
At this time, the ideal patients for this procedure from an oncologic perspective are those undergoing risk-reducing mastectomies or those with small, well-differentiated tumors located far from the nipple.
Patients with scarring from prior lumpectomy do not have a higher rate of compromised blood flow
From a reconstructive standpoint, we find that smaller cup sizes, with minimal ptosis (drooping) and breasts which have not yet undergone radiation or surgery are the best candidates. However, with each passing year, we expand the scope of the nipple-sparing mastectomy procedure, and are able to offer this procedure to more and more women.
For many years, we have known that nipple-sparing mastectomy can provide superior cosmesis with a high level of patient satisfaction. Because of concerns for nipple-areolar complex survival using this technique, selection criteria can be limited.
In my study reported in Annals of Plastic Surgery, we evaluated the impact of scarring from prior lumpectomy on nipple-areolar complex viability.
A total of 318 nipple-sparing mastectomies were performed over a six-year period. We compared 122 breasts with prior lumpectomy incisions/scars to 196 breasts without prior surgery. All nipple-sparing mastectomies in this study were followed by implant-based reconstruction.
Factors analyzed included reasons for surgery, technical details of the operation, co-existing medical conditions, and whether or not additional radiation or chemotherapy was needed.
In this study, approximately 20% of the nipples studied had some degree of compromised blood flow. However, there was no statistically significant difference in the rates between the two groups.
Of all of these patients in the study, only two actually required return to the operating room for debridement; that is, removal of damaged tissue to improve the healing potential of the remaining healthy tissue. The great majority healed with conservative management consisting of dressing changes.
At an average follow-up of one and a half years, patient satisfaction was very high. The take-home message is that patients with scarring from prior lumpectomy do not have a higher rate of nipple-areolar complex ischemia, and may be considered for this procedure.
Read the abstract of Dr. Huston's study of nipple-sparing mastectomy in patients with scarring from prior lumpectomy. For consultations/appointments with her, please call 631-444-4666.
Posted by Stony Brook Surgery on August 6, 2014
FREE Vascular Screening on Saturday, September 27, 2014, at Stony Brook Heart Institute
Aortic disease is serious and potentially life-threatening, often occurring "silently" without any symptoms.
For this reason early detection and treatment are crucial. It's important for people to understand that when affected by disease, the blood vessel (artery) called the aorta can split (dissection) or bulge (aneurysm) and, in either case, the rupture may have fatal results.
Here, Apostolos K. Tassiopulos, MD, professor of surgery, chief of our Vascular Surgery Division and co-director of the Stony Brook Aortic Center, and Shang A. Loh, MD, assistant professor of surgery and also a leader of the Aortic Center, answer questions about aortic disease and about the care we provide for it.
Q: What should I know about the aorta and aortic problems?
A: The aorta is the main vessel carrying oxygenated blood from the left ventricle of the heart to other parts of the body. The aorta ascends from the top of the heart, arches up and over it, descends through the chest behind the lungs and in front of the spine to the abdomen, and then branches off at the pelvis.
Aortic diseases can occur for many reasons and often develop in tandem with coronary artery disease. The biggest risk factors for aortic diseases are being male, over age 55, a smoker and having high blood pressure or heart disease — but anyone can develop an aortic condition at any age.
When your doctor suspects an aortic problem, rest assured: your destination
Q: What conditions do you treat?
A: We treat patients with the full spectrum of aortic problems, including those with co-existing conditions and other high-risk factors.
The most common aortic problem is an aneurysm, which is a blood-filled bulge in a blood vessel resulting from a weakening in the vessel wall. Small aortic aneurysms often can be managed medically and monitored for change; larger aortic aneurysms usually require treatment either with surgery or by using a stent graft to bridge the damaged area.
We repair aneurysms located anywhere on the aorta, with the most common being abdominal aortic aneurysms, also known as AAAs. We also treat all other clinical problems related to the aorta or to the arteries that branch from it to the gastrointestinal tract, the kidneys, and the extremities.
Q: Is it true that many advanced procedures are minimally invasive?
A: Yes. At Stony Brook, we can offer lifesaving options to otherwise inoperable patients and treat a wider spectrum of patients with shorter hospital stays and fewer postoperative complications.
In fact, the vast majority of the AAAs done at Stony Brook are minimally invasive and we now provide incisionless repair of AAAs for patients meeting the criteria.
A regional referral center serving Long Island and beyond, the Stony Brook
Q: What procedures put you at the forefront of care?
A: Customized AAA stent grafts. We are the only providers in Suffolk County offering custom-built endovascular stent grafts for patients who cannot be treated with a standard stent graft, either because of a complex anatomy or the location of the aneurysm.
This unique capability requires highly sophisticated imaging technology and the collaboration of surgeons and radiologists. Together, they develop a complex 3D model of the area of the patient's aorta requiring repair, and a stent graft is then custom built to match it.
Incisionless repair of abdominal and thoracic aneurysms. We can now repair abdominal and thoracic aortic aneurysms without a surgical incision. Both procedures — percutaneous EVAR (endovascular aneurysm repair) and TEVAR (thoracic endovascular aneurysm repair) — result in less discomfort for the patient and less potential for wound infection.
Endovascular and hybrid thoracic aortic aneurysm repairs. We repair aneurysms of the thoracic aorta with endovascular techniques using stent grafts similar to the AAA procedure, or in more complex cases, we offer a hybrid open endovascular procedure that helps reduce the magnitude of surgery and the patient's recovery time.
Minimally invasive treatment of acute aortic dissections. Aortic dissection repairs also may be treated with stent grafts — a significant advance over what once was a dangerous open surgery.
An aortic dissection occurs when the thinly layered walls of the aorta tear or separate, causing blood to travel between the layers. Acute dissections may require emergency surgery to avoid rupture and restore blood flow to the organs and legs.
Our group of specialists collaborates to treat all of these conditions in the most safe and effective way.
Posted by Stony Brook Surgery on July 30, 2014
Using the Latest Advance in Minimally Invasive Surgery to Meet a Therapeutic Challenge
Sialolithiasis, or salivary duct stones, is the most common cause of swelling of the salivary glands. Symptoms of stones include pain (often worse at the mere thought of food), intermittent swelling of the gland, and possibly severe infection.
The current standard in most institutions for treating salivary duct stones has been surgical removal of the gland, which entails an incision in the neck and an overnight stay in the hospital.
The conventional "open" operation carries with it the potential complications of scarring, wound infection, and facial nerve injury resulting in facial paralysis.
Salivary endoscopy is a relatively new minimally invasive gland-preserving procedure — available on Long Island only at Stony Brook Medicine — that allows for salivary surgery in a safe and effective way, and is done on an outpatient basis.
However, this procedure is limited to stones smaller than roughly a quarter inch. Stones as big as two inches long have been reported, though such "megaliths" are rare. The majority of stones are less than half an inch in size.
Robot-assisted stone removal with sialendoscopy is a minimally invasive,
The success rate of salivary endoscopy in treating sialolithiasis is over 90%, as reported in the current literature, with less than 5% recurrence. Recovery time is much faster than with an open technique, and patients may return to a normal diet the same day.
Large salivary gland stones (bigger than a quarter inch) have always been a therapeutic challenge. Several factors can make removal of large stones technically challenging, including a small mouth opening, large teeth, and obesity, which limit access and exposure.
Limited exposure also greatly complicates the identification and preservation of the lingual nerve — the nerve that provides sensation to the tongue — as well as the placement of sutures to repair the salivary duct if necessary.
The development of robotic surgical technology has led to the latest advance in the minimally invasive removal of salivary stones.
Stony Brook Medicine acquired the da Vinci robot — the only available robotic surgical system worldwide — seven years ago. In fact, our medical center was the first on Long Island to acquire the most technically advanced model of this robot. We now have two of them.
The da Vinci robot provides magnified 3D high-definition vision, which greatly helps to meet the challenge of removing large stones. In view of the level of expertise required to perform robotic salivary gland stone removal, few medical centers nationwide provide it.
Robot-assisted stone removal with sialendoscopy represents
In fact, Stony Brook Medicine is one of only two centers nationwide now providing salivary stone removal with robotics. The other center is located in Louisiana.
Our salivary endoscopy program is led by head and neck surgeon Mark F. Marzouk, MD, who joined our faculty in 2010. He performed the first salivary endoscopy ever done on Long Island.
Dr. Marzouk and his colleague, Ghassan J. Samara, MD, have been successfully using the da Vinci robot to remove large salivary gland stones.
Their recent study conducted here, titled "Robot-Assisted Sialolithotomy with Sialoendoscopy: A Novel Approach to Management of Large Submandibular Gland Stones," documents the largest patient series to be described so far.
They presented the study last month at the Department's of Surgery's annual Research Day, and this fall they will present it at the annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery, to be held in Orlando, FL.
Commenting on our use of salivary stone removal with robotics, Dr. Marzouk says: "The robot-assisted sialolithotomy [stone removal] procedure involves utilizing the latest robotic technology available, namely, the da Vinci robot.
"This technology ensures superb visualization of the important structures — in particular, the lingual nerve — and more precise surgical access to a difficult area to reach deep inside the mouth.
"The robot provides a safe, minimally invasive access to large stones. The robotic procedure is an excellent alternative to the traditional approach of removing the gland, which carries the risk of injuring the facial nerve, resulting in significant morbidity [facial paralysis].
"Most of the patients we have treated for stones have had a functioning salivary gland. They got to keep it with a very low risk of recurrence of stones. Our recent study found patient satisfaction to be more than 98%."
Click here for more information about our otolaryngology-head and neck surgery services. For consultations with our head and neck surgery specialists who have robotic expertise, please call 631-444-4121.
Posted by Stony Brook Surgery on July 23, 2014
Answering Questions about the Final Moments of Doomed Passengers on Malaysia Flight 17
The downing of Malaysia Airlines Flight 17 last week left the world in a state of shock and disbelief. Why was it shot down? Who did it? Why did 298 innocent people — men, women, and children — have to lose their lives?
These questions following the event have been swirling around the globe like desperate wraiths.
Other questions concern the experience of the plane's passengers after it was hit by the lethal missile: Did they die right away, or endure the horror of the plane's crash? Were they conscious as they fell through the sky until they hit the ground?
Not morbid curiosity but a compassion for suffering souls can motivate such haunting questions about the final moments of the passengers of Flight 17. To know the end came swiftly, to know the horror was momentary — this would give a measure of comfort to the world.
For answers, Bloomberg News turned to Stony Brook Medicine and our trauma specialist, James A. Vosswinkel, MD, chief of our Trauma, Emergency Surgery, and Surgical Critical Care Division and medical director of the Stony Brook Trauma Center.
"No one was conscious or experienced that fall."
Bloomberg News disseminated a wire story featuring its interview with Dr. Vosswinkel, and news media around the world picked it up, publishing it both in print and online. The story opens this way:
"The blast force from the missile that slammed into a Malaysian plane over Ukraine, combined with the plane's dramatic deceleration, probably instantly rendered everyone on board unconscious or dead.
"That's the best guess of James Vosswinkel, a trauma surgeon who led a definitive study of TWA Flight 800 that exploded and crashed off New York's Long Island in 1996, killing all 230 on the flight."
Dr. Vosswinkel's study mentioned by Bloomberg was conducted with members of our trauma team, and published in 1999 in the Journal of Trauma. He was a resident at the time in our general surgery training program. (He was the first recipient, in 2000, of our annual David J. Kreis Jr. Award for Excellence in Trauma Surgery.)
The Bloomberg story, titled "Instant Death or Blackout: Likely Fate of Passengers on Jet Shot Out of Sky," continues:
"Vosswinkel's research found that trauma in a mid-air explosion occurs from three sources, the force of the blast, the massive deceleration when a plane going 500 miles an hour stops in mid-air, and the impact of the fall. Additionally, the loss of cabin pressure can cause hypoxia [oxygen deprivation] within seconds at 33,000 feet, leading to loss of consciousness.
"You have such horrific forces that it's essentially unsurvivable … No one was conscious or experienced that fall."
Tragedies like Flight 17 require factual information, together with different ways and stages of grieving, to process them both intellectually and emotionally. At best, we learn to live with the fact they occur in our world.
Dr. Vosswinkel joined our faculty in 2002, following his fellowship training in trauma and surgical critical care at Yale University. He was appointed chief of the newly formed Trauma, Emergency Surgery, and Surgical Critical Care Division in May 2013.
Read "final moments" Flight 17 story on Bloomberg News website, which includes additional information about the passengers' fate and also about Dr. Vosswinkel's research. Learn about Stony Brook Medicine's Trauma Center and its services.
Posted by Stony Brook Surgery on July 11, 2014
Ours Is the Only Accredited Vein Center on Long Island and a National Leader in Vein Care
IAC accreditation is a trusted "seal of approval" in healthcare today, and demonstrates our commitment to providing quality vein care to our patients.
"Our Vein Center is among only 12 in the United States and the two in New York State to obtain IAC accreditation," says Antonios P. Gasparis, MD, professor of surgery and director of the Vein Center.
Dr. Gasparis adds that at present the IAC has received more than 70 applications for vein center accreditation.
Our Vein Center specializes in providing the most sophisticated diagnosis and treatment — both surgical and non-surgical — for superficial venous disorders, including varicose and spider veins of the leg, among other vein-related conditions.
The purpose of IAC accreditation is to ensure high-quality patient care and to promote healthcare by providing a mechanism to encourage and recognize the provision of quality imaging diagnostic evaluations by the accreditation process.
Through the accreditation process, facilities assess every aspect of daily operation and its impact on the quality of healthcare provided to patients. While completing the accreditation application, facilities often identify and correct potential problems, revise protocols, and validate quality improvement programs.
Because accreditation is renewed every three years, a long-term commitment to quality and self-assessment is developed and maintained. Facilities may use IAC accreditation as the foundation to create and achieve realistic quality care goals.
The IAC provides accreditation programs for vascular testing, echocardiography, nuclear/PET, magnetic resonance imaging (MRI), diagnostic computed tomography (CT), dental CT, carotid stenting, and vein treatment and management.
The IAC incorporated all of its divisions into one IAC organization in 2008, but its history began more than 20 years ago with the inception of the first of the IAC accreditation divisions, IAC Vascular Testing (formerly, the Intersocietal Commission for the Accreditation of Vascular Laboratories).
Modeled after the success of IAC Vascular Testing, IAC Vein Center was created last year to accredit vein centers, becoming the seventh member division of the IAC.
IAC information about vein center accreditation aimed at informing patients about vein care and the importance of accredited facilities. For consultations/appointments with our vein specialists, please call 631-444-VEIN (8346).
Posted by Stony Brook Surgery on June 18, 2014
Using the Latest Technology to Provide More Effective Surgery & Lead the Way in Patient Care
Despite the demonstrated advantages of laparoscopic surgery for treating colorectal conditions, some limitations continue to exist and call for improvement.
Robot-assisted colorectal surgery is addressing most of the shortcomings of the standard laparoscopic approach, and the robotic technique has proved its safety profile in both colon and rectal surgery.
Indeed, robotic technology has during the past decade revolutionized minimally invasive surgery in several surgical specialties, including cardiothoracic surgery, otolaryngology-head and neck surgery, and general (gastrointestinal) surgery, among others, and it is also advancing minimally invasive surgery in the colorectal field.
Our Colon and Rectal Surgery Division has been providing robotic colorectal surgery with great success, and is a leader in the use of robotic technology.
Roberto Bergamaschi, MD, PhD, professor of surgery and chief of colon and rectal surgery, who is an internationally renowned specialist in laparoscopic surgery, is leading our colorectal robotic surgery program. He has been specially trained and certified to operate with the robot.
The surgeon — not the "robot" — performs the surgery, and
The surgeon is in full control of the robotic system, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside the patient's body.
The development of robotic surgical technology took off in the mid-1980s with remote surgery (also known as telesurgery) being the major driving force. Since that time, several robotic devices have been developed. The da Vinci system — the first system approved by the Food and Drug Administration in 2000 — is now the only available robotic surgical system worldwide.
Stony Brook Medicine acquired the da Vinci system seven years ago. In fact, our medical center was the first on Long Island to acquire the most technically advanced model of the robot.
The first report about robotic colorectal surgery was published in the medical literature in 2002. Since then, more and more surgeons have become interested in robotic surgery, and the number of articles about robotic colorectal surgery has been markedly increasing.
The study of robotic colorectal resection as an alternative treatment option for colorectal cancer is of particular interest.
We provide robotic colorectal surgery for colon cancer,
Instead of a large abdominal incision used in open surgery, surgeons using the robotic system make a few small incisions, similar to what's done in traditional laparoscopy. The robotic system features a magnified 3D high-definition vision system and special wristed instruments that bend and rotate far greater than the human wrist.
As a result, the robotic system enables the colorectal surgeon to operate with enhanced vision, precision, dexterity, and control.
Operative experience with the robot is important for the successful performance of robotic colorectal surgery.
Another member of our Colon and Rectal Surgery Division who is skilled at robotic colorectal surgery is Paula I. Denoya, MD, assistant professor of surgery.
We provide robotic colorectal surgery for colon cancer, rectal cancer, diverticulitis, and inflammatory bowel disease (ulcerative colitis and Crohn's disease).
Robotic surgery for rectal cancer provides better margins
Commenting on the use of robotic colorectal surgery at Stony Brook, Dr. Bergamaschi says: "The robot represents a major advance in colon and rectal surgery that offers patients more benefits of the minimally invasive approach.
"We are the first to have published evidence that robotic surgery for rectal cancer provides a radial resection margin larger than the margin laparoscopic or traditional surgery can offer. This is very important because radial resection margin is the metric that predicts survival."
Colon Cancer Surgery
Robotic colectomy (removal of all or part of the colon) offers the following potential benefits:
Rectal Cancer Surgery
Robotic low anterior resection (rectal cancer surgery) offers precise removal of cancerous tissue as well as the following potential benefits when compared to conventional open surgery:
When compared to traditional laparoscopy, robotic low anterior resection offers the following potential benefits:
Laparoscopic surgery is now considered by many experts as the approach of choice for the surgical treatment of both benign and malignant colorectal diseases.
Advancing the laparoscopic approach, the robot is gaining acceptance supported by clinical studies, and its use is providing patients more benefits of minimally invasive surgery.
For consultations/appointments with our colorectal robotic specialists, please call 631-444-4545 (Surgical Care Center) or 631-638-1000 (Cancer Center).
Posted by Stony Brook Surgery on June 11, 2014
Our Residency Programs Train Physician-Scientists to Both Practice and Advance Surgery
The Department of Surgery's Fifth Annual Research Day took place on June 5 at the Charles B. Wang Center on west campus of Stony Brook University. This year's program was another success, as the event continues to grow, with more presentations.
The morning forum showcased ongoing and completed research projects by way of oral platform presentations, as well as a poster competition by our residents, medical students, and faculty.
"Stony Brook Medicine is geared for making research happen," said Mark A. Talamini, MD, professor and chairman of surgery, in his opening remarks at the program. "Our Research Day celebrates our discoveries. Not only that, it demonstrates a truly impressive breadth of interests and research capabilities for our department."
The program included nearly 50 posters presenting study abstracts, plus five oral presentations moderated by faculty discussants, and it attracted more than a hundred attendees from Stony Brook Medicine and the University community.
The keynote speaker was F. Charles Brunicardi, MD, vice chair of the Department of Surgery at the University of California, Los Angeles. His talk, "Patient-Based Leadership Training and Personalized Surgery," addressed the need for leadership training for surgical residents, and why surgeons who must function as leaders will benefit.
Discussing his own research, Dr. Brunicardi talked about personalized genomic medicine and surgery, which represents a new approach to healthcare that customizes patients' medical treatment according to their own genetic information.
A. Laurie W. Shroyer, PhD, MSHA, professor of surgery and vice chair for research, who oversees Research Day, said that "it takes a village — an entire department — to foster research, and Research Day shows our commitment to advancing scientific knowledge in order to improve patient care and population health."
All categorical residents in our general surgery residency program are now required to conduct at least one research project each year, and to present their studies at the Research Day program. All of our residency programs are committed to training physician-scientists who can both practice and advance surgery in their careers after they graduate from Stony Brook.
Established in 2010, Research Day is an opportunity for our residents as well as our faculty and medical students to present their surgical research. The focus of the program, which takes place from 8:00 am to noon, is moving the science of surgery forward. The program offers continuing medical education (CME) credit; this activity is designated for a maximum of 3.5 AMA PRA Category 1 Credits™.
2014 Research Day Posters
Here are the titles and authors of the posters exhibited at this year's Research Day program, which demonstrate the range of research activity within the Department, and the remarkable productivity of our residents:
Next year's Research Day will take place on Thursday, June 4, from 8:00 am to noon, at the Wang Center. For more information, please call 631-444-7875.
Posted by Stony Brook Surgery on June 3, 2014
All through an Extraordinary Act of Giving by Stony Brook Medicine and Its Doctors
After one year in the United States and ten reconstructive surgeries at Stony Brook Children's Hospital, Saline Atieno, a 12-year-old Kenyan girl, will soon be going home with a transformed face, a new ability to smile, and a future with promise.
At age 3, Saline was diagnosed with noma, a devastating bacterial necrosis that develops in the mouth and ravages the faces of victims. According to the World Health Organization, some 140,000 new cases of noma are diagnosed annually in developing countries.
Noma affects primarily young children. The disease is called the "face of poverty" because it results from poor water sources, hygiene, and/or malnutrition. Ninety percent of the children who contract noma die from it. Somehow Saline managed to survive but was left with a severely deformed face. So disfigured, Saline found eating food became more difficult, and the ability to smile impossible.
Alexander B. Dagum, MD, professor of surgery and chief of our Plastic and Reconstructive Surgery Division, led the team in the ten surgeries at Stony Brook Children's. The series of surgeries involved major reconstructions of Saline's lips, mouth and nose. A hole in her face was sealed, and Dr. Dagum created a palate that separated her oral and nasal cavities so Saline could eat and speak normally again. With grafts from Saline's ribs, Dr. Dagum recreated her missing nose. He used tissue from her lower lip to help create a new upper lip.
It was not possible to successfully treat Saline in Kenya, and thankfully
"All severe facial deformities are difficult to treat and are devastating to the children affected and their families," says Dr. Dagum, who has traveled worldwide on many medical missions to treat children affected by noma and other facial deformities. "It was not possible to successfully treat Saline in Kenya, and thankfully she was able to come to the United States and to Stony Brook. Here we saw her transform not only physically, but emotionally and socially, from a shy girl who'd cover her face to a girl who plays and enjoys life."
In June 2013, Leon S. Klempner, DDS, assistant clinical professor of dentistry, who assisted Dr. Dagum during all of the surgeries, led the process to bringing Saline to Stony Brook.
When Dr. Klempner visited Nairobi, Kenya, in 2010, it became a tipping point in his efforts to help children with cleft palates and other dental deformities. Upon learning about a young girl named Saline who suffered from the effects of noma, he decided to start his own non-profit organization to help kids like her. The following year, the Smile Rescue Fund for Kids became a reality. The fund enabled Saline to come to the U.S and Stony Brook.
On his fateful 2010 trip to Kenya, Dr. Klempner was accompanied by his wife, Laurie Klempner, RN, who works in the antepartum unit at Stony Brook University Hospital, and Dr. Dagum. Now Dr. Dagum serves on the board of directors of the Smile Rescue Fund for Kids.
According to Dr. Klempner, in Saline's case, the progression of the bacteria was "somehow self-limiting" but the bacteria left scar tissue. Kenyan surgeons performed a microvascular free-flap reconstruction, but it failed. Her condition was too severe to be assisted by any of the world's known charities, including the Smile Train organization, which referred her to Dr. Klempner. So he decided to start his own non-profit organization with the mission to "help one kid at a time."
Here we saw her transform not only physically, but emotionally and socially,
From June 2013 to June 2014, Saline's life would dramatically change. Under the direction of Dr. Dagum, the Departments of Surgery, Anesthesia and Pediatrics performed the work free of charge as a designated School of Medicine teaching case. Three local families stepped forward to house Saline, including of Douglas Muller, PA, of Dr. Dagum's division. Saline's mother remained in Kenya with her older sister; two other siblings and her father are deceased.
The complicated procedures, and time needed for healing in between each reconstructive surgery, extended the need for Saline to remain in the United States. What was projected to take several or perhaps six months took one year.
Saline had no problem with being on Long Island for one year, as she looked beyond the toil of enduring all those procedures and embraced her host families. Not knowing a word of English when she came, Saline now understands English quite a bit and speaks some too. While living the past few months with Jennifer Crean's family in Hauppauge, NY, she went skiing, ice skating, and fishing. Just before leaving for Kenya, Saline went on a roller coaster for the first time.
Ms. Crean said Saline is like any pre-teen who loves to do things, has a lot of energy, and plays video games too. Proud of her face, Saline is now enjoying smiling and looking forward to a new adventure in Kenya — attending a boarding school arranged by donors and volunteers via the Smile Rescue Fund for Kids.
Watch this news clip (1:00 min) about the story from FiOS1 Long Island News:
Posted by Stony Brook Surgery on May 30, 2014
Earning Yearlong Bragging Rights for Best Surgical Residency Program in State
We are very pleased to announce that our resident Jeopardy team — William Gioia, DO (PGY-2), and Brett Phillips, MD (PGY-5) — won first place in the Second Annual Resident Jeopardy Competition sponsored by the New York Chapter of the American College of Surgeons.
This is the first year we entered the statewide competition. Harlem Hospital's team were the reigning champs, and we beat them in the first round. We played Lenox Hill in the final round and won on the final jeopardy question.
The final question was: What is the anatomical landmark for an unsuccessful complete vagotomy? And the winning response: What is the "criminal nerve" of Grassi?
The competition took place on May 18 at Albany Medical Center in Albany, NY. Each Jeopardy team consisted of two residents; one PGY-1 or -2 and one PGY-3, -4, or -5. First-place winners won $1000 to split, and second-place won $500 to split.
Surgical Jeopardy is modeled in format after the popular TV show and in content by a game created by the American College of Surgeons to test and increase surgeons' knowledge.
As of 2014, the college has held Surgical Jeopardy at its Annual Clinical Congress for over a decade. The game tests general and specialty surgery knowledge of residents around the country, and has been a great success.
Our residents and faculty faced off in our first annual Jeopardy game here at Stony Brook in 2008, with questions on "All the World's a Stage" (tumor staging), "Tons of Fun" (bariatric surgery), and "Odds and Ends" (colorectal surgery), among other categories.
Established in 1975, a total of 214 physicians to date have completed their residency training in general surgery at Stony Brook. Click here for information about our residency program.
Posted by Stony Brook Surgery on May 14, 2014
Full Approval as a Comprehensive Bariatric Facility Granted to Stony Brook Medicine
Stony Brook Medicine has just been granted full accreditation as a comprehensive bariatric facility by the new Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) of the American College of Surgeons and American Society of Metabolic and Bariatric Surgery.
MBSAQIP accreditation demonstrates our Bariatric and Metabolic Weight Loss Center's commitment to delivering the highest-quality care for bariatric surgery patients.
To earn MBSAQIP accreditation, Stony Brook University Hospital met the essential criteria that ensure its ability to support a bariatric surgical care program and measure up to the institutional performance requirements outlined by the MBSAQIP accreditation standards.
MBSAQIP accreditation is an important way to verify that a hospital has
Accredited bariatric surgery centers provide both the hospital resources necessary for optimal care of morbidly obese patients and the support and resources necessary to address the entire spectrum of care and needs of bariatric patients, both pre- and post-operatively.
"We are very pleased to receive accreditation from the American College of Surgeons," says Aurora D. Pryor, MD, professor of surgery, and director of the Stony Brook Bariatric and Metabolic Weight Loss Center. "They were very impressed with our entire staff and the Stony Brook facilities. Our group should be commended for their team effort and attention to detail as acknowledged by the surveyor."
Dr. Pryor emphasizes, "Accreditation is an important way for patients to verify that a practice has access to all the key resources necessary for optimal care, and we are proud to be acknowledged here for our excellence at Stony Brook Medicine."
MBSAQIP is administered by the American College of Surgeons. In 2012, the college and the American Society of Metabolic and Bariatric Surgery announced plans to combine their respective national bariatric surgery accreditation programs into a single unified program to achieve one national accreditation standard for bariatric surgery centers. This joint effort resulted in MBSAQIP, which is designed to achieve a single national accreditation standard for all bariatric surgery programs.
MBSAQIP accreditation is awarded in categories, each with its own criteria that must be met. Facilities undergo a site visit by an experienced bariatric surgeon, who reviews the facilities' structure, process, and data quality. Because optimal surgical care requires documentation using reliable outcomes measures, accredited bariatric surgery centers are required to report their outcomes data to the MBSAQIP Data Registry Platform.
Stony Brook Medicine received the highest level of accreditation possible
In the United States, more than 15 million people suffer from severe obesity, and the numbers continue to increase. Obesity increases the risks of morbidity and mortality because of the diseases and conditions that are commonly associated with it, such as type 2 diabetes, hypertension, and cardiovascular disease, among other health risks. At present, weight loss surgery provides the only effective, lasting relief from severe obesity.
Therefore, the American College of Surgeons believes it is of utmost importance to extend its quality initiatives to accrediting bariatric surgery centers so that it can assist the public in identifying those facilities that provide optimal surgical care for patients who undergo this surgical procedure.
The American College of Surgeons is a scientific and educational association of surgeons that was founded in 1913 to raise the standards of surgical education and practice, and to improve the quality of care for the surgical patient. Its achievements have placed it at the forefront of American surgery, and have made the college an important advocate for all surgical patients. With more than 79,000 members, the college is the largest organization of surgeons in the world.
The American Society of Metabolic and Bariatric Surgery is the largest organization for metabolic and bariatric surgeons in the world. It is a not-for-profit organization that works to advance the art and science of metabolic and bariatric surgery, and is committed to educating medical professionals and the lay public about metabolic and bariatric surgery as an option for the treatment of morbid obesity, as well as the associated risks and benefits.
The society encourages its members to investigate and discover new advances in metabolic and bariatric surgery while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for morbidly obese patients. It should be noted that Dr. Pryor is a leader in the society, and will serve as program chair of its 2015 national meeting.
For more information about the Stony Brook Bariatric and Metabolic Weight Loss Center, please call Christine Erickson, bariatric administrator, at 631-444-BARI (2274).
Posted by Stony Brook Surgery on May 7, 2014
Varicose veins affect millions in the United States — over 20% of the adult population. They are superficial vessels that are abnormally lengthened, twisted, or dilated, and are seen most often on the legs and thighs. Women are twice as likely as men to develop varicosities.
Varicose veins bulge and rise above the skin’s surface. They may often be uncomfortable and result in swelling of the legs. If left untreated, varicose veins may lead to more serious medical problems, such as phlebitis, inflammation, or leg ulcers.
Now, our vascular specialists are providing a non-surgical treatment that involves the injection of a foam drug; specifically, polidocanol endovenous microfoam (PEM; Varithena).
PEM injection requires no anesthesia or sedation, and is the most minimally invasive treatment option for varicose veins. The treatment only requires an ultrasound machine and standard medical supplies, in addition to the foam solution.
This advance in the treatment of varicose veins is the result of a successful research effort that involved multicenter clinical trials in which the principal investigator at Stony Brook Medicine was Antonios P. Gasparis, MD, professor of surgery (Vascular Surgery Division) and director of the Stony Brook Vein Center.
Varicose leg veins can be more than just a cosmetic problem, and when symptoms are present,
Results of the U.S. phase 3 trial of PEM in 2012 showed a high degree of statistical significance.
PEM is the first and only foam drug approved by the Food and Drug Administration (FDA) for the treatment of incompetent veins and visible varicosities of the great saphenous vein (GSV) system.
"Varithena sets a new standard for the treatment of both the symptoms and the appearance of varicose veins," says Dr. Gasparis. "It provides comprehensive therapy for the widest range of varicose veins — incompetent GSV, accessory saphenous veins, and visible varicosities of the GSV system both above and below the knee."
"Patients undergoing treatment with Varithena can return to normal activities and work following administration of the drug."
Patients are encouraged to walk/mobilize the same day with minimal restrictions. The only restrictions post-treatment are to wear compression stockings for two weeks and to avoid heavy exercise for one week and extended periods of inactivity for one month.
PEM is a sclerosant, that is, a chemical (drug) that causes veins to close. This sclerosant has been made into foam of very small bubbles to create microfoam.
Patients with varicose leg veins treated with PEM (Varithena) in the doctor's office can return
PEM is intended to act as follows: (1) the foam displaces blood from the vein to be treated and (2) the polidocanol then scleroses the endothelium (inner lining of vein).
Varicose veins often require treatment for symptoms including leg pain, aching, heaviness, restless legs, cramps, throbbing, fatigue, itchiness, tingling, and edema.
These symptoms are frequently the cause of absenteeism from work, disability, and decreased quality of life.
Varicose veins are a clinical presentation of superficial venous insufficiency — a condition in which veins are inefficient in returning blood to the heart because of venous hypertension. One-way valves that normally direct blood towards the heart are damaged or missing, and instead, some blood refluxes (moves in the opposite direction) and often pools in the vein.
Current treatments for varicose veins include thermal ablation and surgery, both of which are excellent options with proven long-term results.
PEM provides an effective alternative that should appeal to patients who are candidates. It was approved by the FDA in November 2013.
For an appointment with one of our vascular specialists to learn more about PEM (Varithena) and/or for a free varicose vein screening, please call 631-444-VEIN (8346).