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Stony Brook Surgery Blog

Posted by Stony Brook Surgery on April 4, 2018

The Multidisciplinary Appointment Makes Care Better for Patients

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Our head and neck specialists (l to r) Drs. Ghassan J. Samara and Lukasz Czerwonka with nurse navigator Gerty Fortune. (Click photo to enlarge.)

Stony Brook University Cancer Center has used the team approach for many years. Specialists from different areas — surgery, medical oncology, radiation oncology, and nursing — work closely together as a team to evaluate the best course of treatment for each individual patient.

Ghassan J. Samara, MD, associate professor of surgery and leader of the head and neck, thyroid oncology team, explains that for new patients who have been diagnosed with a head and neck cancer, a multidisciplinary appointment is set up so that these patients can see all of their specialists at the same location on the same day in one single visit.

Keeping the patient's needs and convenience in mind, our nurse navigator Gerty Fortune, RN, coordinates appointments so the patient can be seen by different specialists on the team in one block of time.

Patients can hear from all the specialists involved with their treatment and receive
all of the information about it at once.

On the appointment day, one specialist — for example, the surgeon — may explain the specifics of the procedure he will provide, and be followed by another — for example, the radiation oncologist — who will discuss that treatment approach.

In some cases, two different specialists may meet with the patient together to explain how their treatments will be coordinated.

This collaboration is particularly important in head and neck cancers because they may require consideration of complex factors to be handled at the same time, such as dental, swallowing, speech, cosmetic, and other specialized areas of treatment.

The quality-of-life benefits to patients make the multidisciplinary appointment better for them.

The multidisciplinary appointment model used by our head and neck cancer team will serve as the care model for all Stony Brook Cancer Center's teams in the near future.

Our Head and Neck Cancer Team

Cancers of the head and neck region are diagnosed and treated by our specialized multidisciplinary team of surgeons, radiation oncologists, medical oncologists, endocrinologists, pathologists, radiologists, and speech-language pathologists. Our team's focus is on malignancies of: 

  • Thyroid and parathyroid glands
  • Salivary glands
  • Aerodigestive tract, including:
    • Hypopharynx
    • Larynx
    • Nasal cavity
    • Oral cavity (mouth)
    • Oropharynx (tonsil and tongue base)
    • Sinuses
    • Skull base 

The Stony Brook Cancer Center is the only center in Suffolk County that offers patients a multidisciplinary appointment, which not only allows them the opportunity to hear from multiple specialists in one day, but allows our team to quickly establish a treatment plan and act on it.

Given the complexities of multimodality treatment for patients with head and neck cancer, the rationale for the use of multidisciplinary teams (MDTs) to define individual optimal treatment strategies on a per-patient basis is apparent. Increased use of guideline-directed approaches, reduced time to treatment and improved outcomes, which result from use of an MDT approach in head and neck cancer, have been documented.
— "Evaluation of the Benefit and Use of Multidisciplinary Teams in the Treatment of Head and Neck Cancer," Oral Oncology (2016)

Learn about head and neck cancers. For consultations/appointments with our head and neck specialists, please call 631-444-4121.

Posted by Stony Brook Surgery on April 2, 2018

Educate Yourself on the Risk Factors, Signs, and Symptoms

RESCHEDULED! Due to the bad weather, the Oral Cancer Awareness Month screening event is canceled for today. Please stay tuned for a new event date, or schedule a free screening at the Dental Care Center on any Tuesday and Thursday in April by calling 631-638-7965.

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Approximately 50,000 people in the U.S. will be diagnosed this year with oral cancer (cancer of the mouth).

One hundred thirty-two new people every day will be diagnosed with an oral cancer, and one person every hour of the day will die from it — that's nearly 9,000 deaths from oral cancer every year.

Of the people newly diagnosed with oral cancer, only about 60% will live longer than 5 years.

Moreover, many who do survive suffer long-term problems such as severe facial disfigurement or difficulties eating and speaking. The death rate associated with oral cancer remains high because the cancer tends to be discovered late in its development.

Oral cancer awareness in the American public is low. While smoking and tobacco use are major risk factors, the fastest growing segment of oral cancer patients is young, healthy, nonsmoking individuals due to the connection to the human papillomavirus (HPV). The only hope to save lives is public awareness.

"Early cancer diagnosis saves lives. If detected early, oral cancer has an 80% survival rate. The most effective way to manage oral cancer is to combine early diagnosis with timely and appropriate treatment," says David K. Lam, MD, DDS, PhD, professor of surgery and oral and maxillofacial surgery.

The fastest-growing cause of oral, head and neck cancers is HPV. In fact, if you have HPV, you're 30 times more likely to develop oral cancer.

Oral cancer can be treated when detected early. People can learn how to examine themselves for possible signs and symptoms (see instructions). If one is detected, they should see their dentist, oral and facial surgeon, or other healthcare professional immediately.

Some of the most common oral cancer signs and symptoms include:

  • Persistent mouth sore: a sore in the mouth that does not heal is the most common symptom of oral cancer
  • Pain: persistent mouth pain is another common oral cancer sign
  • A lump or thickening in the cheek
  • A white or red patch on the gums, tongue, tonsil, or lining of the mouth
  • A sore throat or feeling that something is caught in the throat that does not go away
  • Difficulty swallowing or chewing
  • Difficulty moving the jaw or tongue
  • Numbness of the tongue or elsewhere in the mouth
  • Jaw swelling that makes dentures hurt or fit poorly
  • Loosening of the teeth
  • Pain in the teeth or jaw
  • Voice changes
  • A lump in the neck
  • Weight loss
  • Persistent bad breath

If any of these oral cancer signs or symptoms are present for days or weeks, your doctor may recommend tests to check for oral cancer. As with any cancer, having your cancer diagnosed as soon as possible will help ensure that any treatment is as effective as possible.

Free screening for oral cancer will be provided on Monday, April 2, in front of Stony Brook University Hospital within the School of Dental Medicine's Mobile Dental Clinic, a specially equipped mobile van, between 9 am and 4 pm. Additional free screenings will be available on Tuesdays and Thursdays throughout April at the Stony Brook Dental Care Center by calling 631-638-7965. Early detection is key!

Screening takes less than 10 minutes. A clinician looks over the inside of the mouth to check for white patches or mouth sores, feels the tissues in your mouth to check for lumps or other abnormalities, and uses a state-of-the-art non-invasive scope device that emits a harmless, bright blue light to see mouth tissue changes not visible under normal white light examination.

For consultations/appointments with our oral cancer specialists, please call 631-632-8975 for Dr. David K. Lam and 631-444-8410 for Dr. Lukasz Czerwonka and Dr. Ghassan J. Samara.

Posted by Stony Brook Surgery on March 21, 2018

Communicating Science and Improving Care of Pain: Responding to the Cry for Help

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Dr. David K. Lam

David K. Lam, MD, DDS, PhD, professor of surgery and oral and maxillofacial surgery, is one of twelve experts in pain science and care to be selected as fellows of the Mayday Pain and Society Fellowship.

Dr. Lam and the other fellows in June will attend a four-day, intensive workshop in Washington, DC, where they will learn skills to effectively communicate and advocate for the translation of scientific research and evidence-based best practices in pain care and management.

"The need for the expert voices of pain researchers and clinicians to improve pain care in the U.S. and Canada is greater than ever," says Christina Spellman, executive director of the MAYDAY Fund.

"The Mayday Fellowship will help this year's fellows develop the skills to bring their knowledge of the latest in pain research and evidence-based care to the public, healthcare practitioners, and policymakers.

"Their messages will help shape conversations about access to care, pain research, emerging pain treatments, clinical practice improvements, disparities in care, and the progress that is being made in knowledge about pain and its impact."

The leadership of the MAYDAY Fund believes that public education and the support of quality science are essential to improving the way that pain is understood and treated.

The MAYDAY Fund was established in 1992 to further Shirley Steinman Katzenbach's commitment to social and medical causes. The trustees decided to adopt her special interest in the treatment of pain as the fund's mission.

The name MAYDAY commemorates the date of her birth, and is the international word signaling a cry for help, taken from the French "m'aidez" or "help me."

About Dr. Lam — a Unique Physician

Dr. Lam joined our faculty and practice last fall as section chief of oral and maxillofacial surgery, and holds a joint appointment in the School of Dental Medicine, where he is professor and chairman of oral and maxillofacial surgery. He contributes a new dimension to the care provided by Stony Brook Surgical Associates.

Board certified in oral and maxillofacial surgery, Dr. Lam specializes in the comprehensive surgical management of patients with cancer, pathology, pain, and trigeminal nerve injury.

Dr. Lam comes to Stony Brook from the University of Toronto, where he headed the Department of Oral and Maxillofacial Surgery since 2013.

As a member of Stony Brook Surgical Associates, Dr. Lam will practice at the Stony Brook Cancer Center. His clinical interests and expertise, which demonstrate his multidisciplinary experience and training, are:

  • Maxillofacial oncology
  • Facial trauma
  • Reconstructive surgery
  • Trigeminal nerve injuries
  • Oral and maxillofacial pathology
  • Head and neck surgery
  • Pain management

"I can channel knowledge from science to the patient's bedside and back again because I split my time and interests between clinical practice and research."

An active scholar as well as clinician, Dr. Lam has to date more than 50 publications to his credit. In a personal statement about his work as a pain specialist, Dr. Lam says:

"Being a surgeon and a neuroscientist provides me with a unique perspective on pain management, both focal and global. It is the perspective I gain in helping an individual patient that allows me to potentially help populations of patients.

"I can channel knowledge from science to the patient's bedside and back again because I split my time and interests between clinical practice and research.

"This allows me to play an important role in bridging the bench-to-bedside translational gap since I can readily translate my research results into the clinic and develop research questions based on clinical issues I encounter in practice.

"As a result, my research and clinical programs are closely integrated, and my research addresses the many challenges I face in the clinical management of patients with a focus on pain from head and neck disorders, cancer, trauma, and trigeminal nerve injury."

Dr. Lam earned his MD at the University of California, Davis (2013) and his DDS and PhD at the University of Toronto (2001 and 2008, respectively).

He completed his residency training in oral and maxillofacial surgery and anesthesia at the University of Toronto, and his fellowship training in maxillofacial oncology at the University of California, San Francisco Medical Center.

"My unique multidisciplinary experience and training in medicine, dentistry, anesthesia, neurophysiology, and surgery allows me to ensure optimal care for patients with evidence-based and solutions-focused management, as well as innovative therapies." — Dr. David K. Lam

Learn more about trigeminal nerve pain. For consultations/appointments with Dr. Lam, please call 631-632-8975.

Posted by Stony Brook Surgery on March 13, 2018

Dr. Andrew T. Bates

Hernias are a common health problem, with more than one million hernia repairs performed each year in the United States. Approximately 800,000 are done to fix hernias in the groin, and the rest are for other types of hernias in the abdomen.

A hernia occurs when there is a weakness, or opening, in the muscle and connective tissue that surround the belly area. Patients may feel a slight bulge, discomfort, or pressure as organs push out through this weakness.

While hernias are a common problem, their true incidence is unknown. It is estimated that 5% of the population will develop an abdominal wall hernia, but the prevalence may be even higher.

About 75% of all hernias occur in the groin. The prevalence of hernias increases with age. The likelihood of a life-threatening strangulated hernia, in which the blood supply to the bulging part of the intestine is cut off, also increases with age.

Here, Andrew T. Bates, MD, director of the Stony Brook Comprehensive Hernia Center, answers frequently asked questions about hernias and their treatment.

Q: What exactly is a hernia?

A: The abdomen is held together by a layer of tough connective tissue called fascia. A hernia is a gap, or weak spot, in this fascia that allows internal contents of the abdomen to sneak through.

Q: What are the symptoms?

A: Possible symptoms include: a slight bulge or lump in the affected area; a lump on either side of the pubic bone where the groin and the thigh meet; burning, gurgling, or aching sensations where the bulge is; a heavy feeling in the abdomen; pain or discomfort (usually in the lower abdomen), especially when bending over, coughing or lifting.

Sometimes the person doesn't feel any symptoms at all, and the hernia is discovered during a routine physical or a medical exam for an unrelated problem.

Q: How does a hernia happen?

A: Some hernias are present at birth and lie dormant for years, suddenly "popping out" during straining or pushing. Other hernias develop slowly from accumulated strain, such as repeated heavy lifting. For most patients, it's a combination of the two.

The abdominal wall has several natural weak spots, such as the belly button and the groin (in men), and hernias sometimes happen there. If you have ever had abdominal surgery, your old incision is a place where a hernia could form.

Hernia repairs done by experienced surgeons like ours provide the best results
with low recurrence rates and minimal post-op pain.

Q: Are hernias dangerous?

A: They can be. A hernia can become an emergency medical situation if abdominal contents, especially intestine, herniate through the gap and become stuck. If that happens, the stuck contents can cut off their own blood flow.

Typically, if a hernia is painful, the pain rarely resolves without surgery and will probably get worse.

For patients with a hernia that does not bother them, we must make the decision whether or not to perform surgery. We do know that a significant percentage of patients who have no pain now will develop symptoms later on and require repair.

Q: How are hernias fixed?

A: When it comes to hernias, one size certainly does not fit all. Hernias in the groin often require different surgeries from those on the abdominal wall.

Depending on the size, location, and configuration, your surgeon may use various prosthetic meshes or closure techniques. The most appropriate repair for your hernia may be a traditional open surgery, laparoscopic or even robotic.

The best way for your surgeon to advise you is to have a detailed conversation about your medical and surgical history and perform a complete physical exam.

Q: What type of repair is best?

A: Research has shown that what matters most is your surgeon's experience with a particular technique. The best open surgeon is better than a mediocre laparoscopic surgeon, and vice versa.

Traditional and laparoscopic surgeries produce similar and excellent outcomes when performed by a well-trained surgeon.

Q: Is it bad to use surgical mesh in repairing hernias?

A: In short, no. Hernia mesh is very different than the mesh discussed in some advertisements that can alarm patients. (See my more detailed response about the mesh question.)

Although non-mesh options exists, using a prosthetic mesh for hernia repair is the standard of care in most cases. Using a patch made of surgical mesh lowers the chance of the hernia coming back after surgery, which has been proven consistently by several research studies nationwide.

Most meshes are permanent and will become incorporated in the abdominal wall, adding permanent strength.

Suturing the patient's own tissue back together, without using a mesh patch, is done in the procedure called the Shouldice repair.

Our experienced hernia experts work together as a team to design the best treatment plan possible so patients can get back quickly to their normal lives and daily activities.

Q: Can a "hernia belt" sold in medical supply stores help?

A: This is called a hernia truss. It provides pressure on the hernia so it does not pop out. Although this can prevent an emergency, it does not fix the underlying problem and surgery is still recommended.

Q: What is a "sports hernia"?

A: A sports hernia is actually a ligament/tendon injury in the groin. It may mimic the discomfort of a true hernia. Depending on severity and type, these hernias can be treated via surgery, anti-inflammatory medication/injections, or physical therapy.

Q: What is the advantage of having a hernia repair done at Stony Brook?

A: The advantage is two-fold: academic and comprehensive. By having your repair at an academic institution like Stony Brook Medicine, you take advantage of a surgery faculty that utilizes the newest techniques and, in many cases, is driving the field forward.

Our surgeons present their work at national societies, and have published countless articles about their research projects in respected surgical journals. As academic surgeons, we are committed to making surgery better.

"Comprehensive" means that all of your needs are addressed under one roof, delivered by a collaborative team dedicated to excellent patient outcomes.

Our center includes open, laparoscopic, and robotic surgery specialists. We work closely with plastic surgeons for those patients that may require complex repair.

We have also integrated pain management specialists into our treatment protocols for those patients suffering from debilitating hernia-related pain. When patient care is seamless as done here at Stony Brook, outcomes improve.

The Stony Brook Comprehensive Hernia Center — distinguished by Stony Brook Medicine's multidisciplinary approach to patient care — offers a wide range of options to diagnose and treat most types of hernias. Our experienced hernia experts work together as a team to design the best treatment plan possible so patients can get back quickly to their normal lives and daily activities. Patients can see our hernia specialists at our Suffolk County offices in Centereach, East Setauket, Smithtown, and Commack.

For consultations/appointments with our hernia specialists, please call 631-638-0054. Visit the website of the Comprehensive Hernia Center for more information about it.

Posted by Stony Brook Surgery on March 7, 2018

March Is National Colorectal Cancer Awareness Month! Colorectal cancer screening saves lives. If everyone 50 years old or older were screened regularly, as many as 60% of deaths from this cancer could be avoided.

Paula I. Denoya, MD, a Stony Brook colorectal surgeon
Dr. Paula I. Denoya

Colorectal cancer — also known as colon cancer — is the second leading cause of cancer-related deaths in the United States. It affects both men and women. Every year, more than 140,000 Americans are diagnosed with colorectal cancer, and more than 50,000 people die from it.

Awareness of colorectal cancer and its common signs is well worth it, because when detected early this cancer can be treated effectively.

Here, Paula I. Denoya, MD, a member of the faculty of our Colon and Rectal Surgery Division, answers frequently asked questions about colorectal cancer, with special attention to its common warning signs, detection, and treatment.

Q: What is colorectal cancer?

A: Colorectal cancer arises from the lining of the colon or rectum, usually from cells that secrete mucus. In many cases, it starts out as a polyp, which is a premalignant, benign lesion or an overgrowth in the lining of the colon. If left alone, a polyp can grow into cancer. However, with screening, polyps can be detected and removed, thus preventing cancer altogether.

Q: What are the signs and symptoms?

A: Colorectal cancer is often symptomless, which is why screening is so important. Some people do experience telltale signs, however. Ten warning signs of colorectal cancer are:

  • Blood in stool
  • Persistent diarrhea
  • Persistent vomiting
  • Cramping abdominal pain
  • Persistent bloating
  • Unexplained weight loss
  • Decreased stool size
  • Unexplained fatigue
  • Change in bowel habits
  • Incomplete emptying of bowel

Anyone experiencing these symptoms should speak with their primary care physician.

Q: Who is at risk?

A: According to the American Cancer Society (ACS), colorectal cancer is the third most common cancer in men and women. Gender does not seem to be a factor, but age is, and risk increases after age 50.

People considered to be at higher risk include those with a family history of polyps, colon cancer, or uterine cancer; individuals with inflammatory bowel disease; anyone with a personal history of polyps; and persons with inherited syndromes such as familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer.

The ACS recommends that people undergo screenings starting at age 50, with a follow-up every 10 years if no polyps are detected. Individuals at high risk should start screenings earlier and have more frequent follow-ups.

Colorectal cancer can be prevented, and it is extremely curable if caught early.

Colon Anatomy | From Gray's Anatomy (1918)
The colon, as depicted in Gray's Anatomy (1918;
click on image to enlarge).

Q: How is colorectal cancer detected?

A: Colonoscopy is considered the gold standard because it is the only test that can identify and treat polyps in the entire colon. Further, if a polyp is detected during screening, it often can be removed and biopsied at that time, eliminating the need for additional procedures. (See our 2012 blog post, "New Report Affirms Lifesaving Role of Colonoscopy: Death Risk Is Cut in Half.")

While people often dread undergoing a colonoscopy, it is important to know that recent changes make it a gentler experience. For example, Stony Brook uses many different kinds of bowel preparations — some are even in pill form. The patient's physician will determine which preparation the patient will best tolerate.

In the past, patients remained awake for the procedure, but now, with innovations in anesthesia, patients undergo a short, fast-working, and deep sedation that has minimal side effects including no memory of the procedure.

Stony Brook offers additional screening methods, including flexible sigmoidoscopy, barium enemas, fecal occult blood testing, and CT colonography, also known as virtual colonoscopy.

Virtual colonoscopy was invented at Stony Brook in the 1980s. While less invasive than a traditional colonoscopy because it uses a CT scan to look at the lining of the colon, it still requires bowel preparation. It is generally used with patients who may have an existing colon blockage or for whom a colonoscopy carries risks, for example, from anesthesia. Unlike a colonoscopy, in which a polyp can be removed during the screening procedure, during a virtual colonoscopy, if a polyp is detected, the patient will need an additional procedure to treat and biopsy it.

Q: If cancer is detected, how is it treated?

A: Colorectal cancers respond well to treatment, and often treatment is relatively uncomplicated. About 30% of cases can be treated with surgery alone. Cancers in later stages respond well to chemotherapy and radiation, and overall, the five-year survival rate approaches 65%.

Colorectal cancer is treatable — know your options.

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Q: What distinguishes Stony Brook's approach?

A: Stony Brook Medicine offers the latest protocols and treatments for colorectal cancers — delivered by a multidisciplinary team — including the new transanal endoscopic microsurgery, a less invasive procedure than the traditional approach for reaching lesions high up in the rectum.

We are renowned leaders in the use of minimally invasive laparoscopic surgery for treating colorectal cancer, which offers patients considerable benefits.

Using the da Vinci® Si robotic surgical system, our surgeons offer patients another option beyond traditional open surgery and laparoscopic procedures. The major advantage of this minimally invasive technique is that it provides surgeons with enhanced visibility and mobility.

This improves accuracy, provides cleaner "margins" (which means that no cancer cells are seen at the outer edge of the tissue that was removed) and helps ensure that all the lymph nodes (difficult to see and reach by conventional methods) can be removed during the procedure.

Benefits to the patient having robotic surgery include less bleeding, less scarring, less pain, and a lowered risk of infection.

In addition, we are working to advance the practice of medicine through clinical trials and testing. We currently are participating in a multi-institution trial run by the American College of Surgeons Oncology Group to pioneer a minimally invasive laparoscopic treatment for rectal cancers.

For standard treatment approaches, we work closely with oncologists, radiologists, pathologists, and other specialists on the colorectal cancer multidisciplinary team at Stony Brook University Cancer Center to provide comprehensive cancer care to our patients.

If you are over age 50 and have not yet had a colonoscopy, schedule one soon by calling Stony Brook's Direct Access Screening Colonoscopy Program at 631-444-COLON (2656) . You can request an appointment online, too.

Americans of African descent are approximately 40% more likely to die from colon cancer, compared to individuals who are of Caucasian descent. Because of this health disparity, researchers from Stony Brook University have created a partnership with SUNY Downstate and Cold Spring Harbor Laboratory to launch a program to assess gastrointestinal cancer biology in patients. Watch video (4:55 min) that explains.

Watch this 1-minute video featuring Meryl Streep who explains why screening for colorectal cancer is a smart thing to do:

Watch this News 12 LI news clip (1:55 min) featuring Minsig Choi, MD, director of medical oncology at Stony Brook Cancer Center:

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Posted by Stony Brook Surgery on February 8, 2018

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Dr. Christopher S. Muratore

Pediatric surgeons specialize in the diagnosis, preoperative, operative, and postoperative management of surgical problems in children, and they operate on children whose development ranges from before birth through the teenage years.

Of the estimated 4 million babies born in the United States annually, about 120,000 (3%) have a complex birth defect.

Some medical conditions in unborn children are possibly life-threatening or just not compatible with a good quality of life unless these problems are corrected surgically, often requiring multiple operations over a period of time.

In cooperation with maternal-medicine specialists and radiologists, pediatric surgeons use ultrasound and other technologies such as MRI during the fetal stage of a child's development to detect and clarify possible abnormalities.

Prenatal diagnosis of a surgically correctible problem may lead to fetal surgery in select cases, if the condition threatens the fetal gestation. An increasing number of fetal surgical techniques are currently being developed.

Fetal evaluation and management is provided at Stony Brook Children's Hospital to treat a range of conditions and birth defects before delivery, further showing how Stony Brook Medicine leads the way in patient care.

Here, Christopher S. Muratore, MD, professor of surgery and Knapp Swezey chair in pediatric surgery, who is a specialist in prenatal/fetal surgery, answers frequently asked questions about it.

Q: When was prenatal surgery developed?

A: Prenatal surgery has evolved over the past three decades into a multidisciplinary and collaborative medical specialty better regarded as fetal medicine or fetal diagnosis and management.

During this time, physicians dedicated to fetal medicine and fetal surgery have learned the power of a cooperative community dedicated to improving outcomes for inpatients diagnosed with fetal anomalies.

Through these collaborations several multicenter, randomized, controlled clinical trials had been successfully completed which has allowed clinicians to accurately identify complex anomalies, stratify their severity, and provide consultation for expectant families identified with a fetus who has an anomaly to be given accurate outcomes, so that they may make the most informed decisions about her pregnancy and delivery plans.

Q: What conditions can now be treated with prenatal surgery?

A: Prenatal surgery represents a spectrum of fetal interventions that can be performed on the fetus to correct a life-threatening situation or to prevent the progressive physiologic organ damage that occurs from a congenital anomaly.

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Fetal MRI of 21-week fetus with congenital diaphragmatic hernia, showing abnormal liver (*) and bowel (**) in chest. (Click to enlarge.)

Conditions now treated with prenatal surgery include airway and lung malformations, diaphragmatic hernia, twin-to-twin transfusion syndrome, select heart defects, spina bifida, and unique tumors, among others.

Historically, fetal surgery involved a maximally invasive operation on the mother, who is the innocent bystander, to open the womb in order to gain access to the fetus and operate on the fetus while still connected to the placenta.

Techniques used in fetal intervention have evolved to more minimally invasive procedures through keyhole surgeries in the mother and the womb, using tiny incisions, to access the fetus and surgically correct the congenital anomaly in question.

Philosophically, fetal therapy has moved away from the historic idea of correcting the anatomic issue to a strategy of manipulating the fetal physiology in most cases to alter the developmental consequences of the congenital anomaly.

These fetal interventions have become important options for the fetus that would otherwise not survive gestation, or that would endure significant problems after delivery.

Stony Brook Children's fetal medicine team allows for families on Long Island
to get the very best care close to home for their unborn child.

Q: What is the role of advanced fetal diagnostic testing?

A: Without question, advances in fetal imaging and diagnosis have allowed clinicians to more accurately identify complex anomalies prenatally and to stratify their severity.

Prenatal ultrasound is routinely used as initial fetal survey imaging which oftentimes may identify a worrisome fetal anomaly. Fetal MRI is often used to better clarify or define the anomaly in question.

Both techniques have evolved significantly over the past 30 years to allow excellent identification and accurate diagnosis.

Q: How is prenatal surgery performed? Is it open surgery or laparoscopic?

A: The goal of prenatal surgery was always to correct a known or identified congenital anomaly that would be life-threatening to the fetus or pose significant health problems to the baby once delivered. The idea of correcting such a lesion prenatally to allow for normal development has always been the Holy Grail.

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Fetal MRI of fetus with abdominal wall defect (*), i.e., gastroschisis. (Click to enlarge.)

Early attempts at prenatal surgery were generally maximally invasive through an open surgery on the mother and opening of the uterus or womb, termed hysterotomy. This poses a significant risk to the continuation of pregnancy, oftentimes leading to prenatal delivery and prematurity of the baby, as well as complications for the mother.

Over the years, with the development of laparoscopic surgical technique and skill sets, physicians have utilized a more minimally invasive approach to correcting the fetal anomaly. Called fetoscopic surgery, mini keyhole incisions can be used to create tiny incisions in the uterus to attempt correction of the fetal condition with a camera inserted into the womb.

Today, some conditions still require open hysterotomy and open fetal surgery for very select situations.

The approach to the fetus can also be purely minimally invasive through the mother, through the uterus into the womb, with a catheter inserted into the fetal chest or abdomen to attempt correction of a problem. Oftentimes this will be done under ultrasound guidance for fetal imaging and monitoring.

Q: What kind of special technology is required to do prenatal surgery?

A: The most important special technology required to do prenatal surgery is a team of multidisciplinary individuals with expertise, who are dedicated to collaboratively working together, bringing all of the available resources and knowledge to the family and fetus to provide the best diagnostic accuracy to develop a prenatal and/or postnatal management plan.

Specific technology includes a 3-D and 4-D ultrasound, fetal MRI, and fetal echocardiography. Miniaturized surgical telescopes, catheter-delivery access, and laser technologies also are important instruments to a multidisciplinary fetal management team.

Q: Is fetal analgesia necessary during prenatal surgery?

A: Many intravenous anesthetics given to the mother will be transported across the placenta to the fetus. Other anesthetics can be given directly to the fetus, generally similar to an intramuscular injection.

Techniques in fetal intervention have evolved to more minimally invasive procedures
to access the fetus and surgically correct congenital anomalies.

Q: What is image-guided fetal surgery?

A: Oftentimes a fetal condition that needs to be addressed might be a mass or space-occupying lesion such as a cystic fluid collection that can significantly harm the fetus if not drained or decompressed.

Under such circumstances, ultrasound guidance through the womb can allow for access through a needle incision in the mother and the womb to allow passage of a catheter under ultrasound guidance into the fetal mass in question.

Q: How is the multidisciplinary approach used in prenatal surgery?

A: The multidisciplinary approach used in a fetal care team is built up on the strategy that each medical specialty brings a specific set of expertise to the table to allow for the best outcome for the fetus and family. Generally speaking, the fetal care team comprises a director or team leader with a number of co-directors to manage the fetal treatment program.

A dedicated fetal care coordinator or nurse navigator is essential to provide streamlined concierge service to the family and help coordinate the many subspecialty visits and consults that are required. An active fetal care database is also essential for continuity and careful examination of patient outcomes.

Core members of the fetal care team include maternal-fetal medicine specialists and pediatric cardiologists who also perform fetal echocardiogram to examine fetal heart conditions. (Read about Stony Brook's maternal-fetal medicine specialists and pediatric cardiologists.)

Fetal surgeons are often pediatric surgeons or a perinatologist/maternal-fetal medicine specialist.

Genetic counselors are essential to the team and family education. Pediatric radiologists and neonatologists also are key members of the interdisciplinary team.

When a fetal intervention is deemed necessary, the inclusion of an obstetric and pediatric anesthesiologist familiar with fetal surgery and physiology is crucial.

Additional specialists such as neurologists, neurosurgeons, urologists, and orthopedic surgeons should be part of the extended care team as necessary.

Finally, by no means last, a social work specialist provides essential continuity care and rounds off the multidisciplinary care team to assist the prenatal and oftentimes postnatal transition for the family.

Q: What is the advantage of having prenatal surgery done at Stony Brook Children's Hospital?

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In utero fetoscopic view of the fetal left hand. (Click to enlarge.)

A: The advantage of having a dedicated multidisciplinary fetal medicine team at Stony Brook Children's allows us to provide education to Long Island families whose fetus is identified to potentially have a condition that requires prenatal or postnatal care.

As pregnancies are always exciting and stressful times, the diagnosis of a possible worrisome fetal condition really requires a dedicated team to quickly determine the level of fetal concern and assist the family with understanding and education. This is best done in an environment that's close to their home, their friends, their family, and their resources.

It's very disrupting for the family to have to pick up and drive many hours or move to another location, as well as to have multiple interruptions in work and/or school or day care arrangements.

Thus, having Stony Brook's fetal medicine team available to provide consultative services prenatally allows for families on Long Island to get the very best care for their family close to home for their unborn child.

Another important advantage of Stony Brook Children's is that, as part of an academic medical center, we are dedicated to making fetal medicine better and to advancing prenatal surgical care. This is what distinguishes us from other hospitals in our region.

Maternal-fetal surgery is performed on two patients, the pregnant patient and the fetal patient. Ethics is therefore an essential dimension of maternal-fetal surgery. From its beginnings in only a few centers, various procedures have become available in highly specialized centers in developed countries. Innovation and research have played an indispensable role in the development of maternal-fetal surgery and will continue to do so. — Seminars in Fetal and Neonatal Medicine (2017)

Click here for more information about prenatal surgery. For consultations/appointments with Dr. Muratore, please call 631-444-4545.

Posted by Stony Brook Surgery on January 11, 2018

Dr. Andrew T. Bates

Hernias are a common health problem, with more than one million hernia repairs performed each year in the United States. Approximately 800,000 are done to fix hernias in the groin, and the rest are for other types of hernias in the abdomen.

A hernia occurs when there is a weakness, or opening, in the muscle and connective tissue that surround the belly area. Patients may feel a slight bulge, discomfort, or pressure as organs push out through this weakness.

However, many patients may have this opening/weakness even if organs aren’t actively pushing through. Over time, this bulge or area of weakness can grow in size. Occasionally, intestine can become trapped in the hernia, which requires emergency medical attention.

Not only are there different kinds of hernias, different methods and surgical approaches are currently used to repair them. Today, a "mesh" product is commonly used in hernia repairs.

Hernia mesh has been around for over 50 years, and earlier versions of it have long been regarded as the "gold standard" to use in repairs. However, some websites today make claims that mesh is unsafe, and that repairing hernias without mesh is better.

Here, Andrew T. Bates, MD, director of the Stony Brook Comprehensive Hernia Center, answers frequently asked questions about hernias and the mesh used to repair them.

Q: Must a hernia be repaired?

A: All hernias have the potential for trapping abdominal contents, such as intestine, which is why we typically recommend repair in patients who are acceptable surgical candidates.

Not all hernias, though, are the same, and so we often employ a different approach based on the location of the hernia, such as groin or abdominal wall.

In the case of groin (inguinal) hernias, surgeons in the recent past advocated for "watchful waiting" for hernias that were not particularly bothersome.

However, based on newer research, we now know that a large percentage of these hernias will later become bothersome and require repair, possibly emergent, and therefore we advocate for repair.

Q: Does hernia repair require mesh?

A: Not necessarily, but usually. In the right patients, some groin hernias can be repaired without mesh and still have acceptable success rates. Additionally, some small hernias at the belly button can be repaired with suture alone. Most repairs, though, do utilize prosthetic mesh to achieve a successful repair.

When patient care is seamless as done here, outcomes improve.

Q: What exactly is mesh?

A: The term "mesh" is used to describe a flat sheet of prosthetic material that is used to cover, or "patch," a hernia.

Q: Are there different kinds of mesh? How are they different?

A: There is a sizable industry devoted to a large array of hernia meshes. Some are made of various plastics; some are made of biologic materials. Some are permanent and some are designed to degrade over time.

The most common type of mesh is made of a plastic material and closely resembles a window screen in appearance. Some meshes are also made with protective coatings that allow them to be placed in the abdomen near the abdominal organs.

Q: What are the advantages of using mesh in hernia repair?

A: Decades ago, hernia repairs were performed by simply suturing the hernia closed. For some types of hernias, this repair resulted in 25-50% of hernias later returning. Mesh changed that. By using mesh, the chance of hernia recurrence dropped to the low single-digits.

Q: Does mesh cause problems in hernia repair?

A: In most cases, using mesh is the acceptable standard of care. However, there can certainly be complications related to the mesh.

Q: What specific problems are associated with mesh?

A: Mesh is a foreign body that your body incorporates to help strengthen the repair. However, being a foreign body, it can also become infected if it becomes contaminated either at the time of surgery or later. This may require mesh removal.

Mesh placed inside the abdomen can also lead to scar tissue, or adhesion, formation that can predispose patients to bowel obstruction down the road.

However, all patients who have had surgery in the abdomen also form these adhesions, so this is not a problem specific to the mesh itself.

Most brands and models of mesh have excellent safety profiles.

Q: Why are mesh companies being sued now?

A: There are many sizes and shapes of mesh, all with different strengths and flexibility. Some lightweight meshes were removed from the market after cases of breakage were reported, but most brands and models of mesh have excellent safety profiles.

There were also other surgeries that used mesh, such as vaginal sling surgery, which regrettably had a high complication rate but is a completely different surgery altogether. In the vast majority of cases, complications are the result of surgical technique and not the mesh used.

Q: When mesh is required, is traditional open surgery or minimally invasive laparoscopic surgery better?

A: This is impossible to answer because every patient is different and every hernia is different. What is right for one patient may not be best for another.

For this reason, an individualized approach is key. What our research has shown is that surgeon experience with a particular technique is the most important factor, whether it is laparoscopic or open.

Q: What do the latest major scientific studies say about mesh? Is there a consensus?

A: In most hernias, mesh is the standard of care. This is what the science clearly indicates, and it is backed up by well-designed clinical trials as well as retrospective studies.

Q: What is the advantage of having a hernia repair with mesh done at Stony Brook?

A: The advantage is two-fold: academic and comprehensive. By having your repair at an academic institution like Stony Brook Medicine, you take advantage of a surgery faculty that utilizes the newest techniques and, in many cases, is driving the field forward.

Our surgeons present their work at national societies, and have published countless articles about their research projects in respected surgical journals. As academic surgeons, we are committed to making surgery better.

"Comprehensive" means that all of your needs are addressed under one roof, delivered by a collaborative team dedicated to excellent patient outcomes.

Our center includes open, laparoscopic, and robotic surgery specialists. We work closely with plastic surgeons for those patients that may require complex repair.

We have also integrated pain management specialists into our treatment protocols for those patients suffering from debilitating hernia-related pain. When patient care is seamless as done here at Stony Brook, outcomes improve.

The Stony Brook Comprehensive Hernia Center — distinguished by Stony Brook Medicine's multidisciplinary approach to patient care — offers a wide range of options to diagnose and treat most types of hernias. Our experienced hernia experts work together as a team to design the best treatment plan possible so patients can get back quickly to their normal lives and daily activities. Patients can see our hernia specialists at our Suffolk County offices in Centereach, East Setauket, Smithtown, and Commack.

Learn more about inguinal hernias. For consultations/appointments with our specialists at the Stony Brook Comprehensive Hernia Center, please call 631-638-0054.

Posted by Stony Brook Surgery on January 3, 2018

Our Trauma Chief Recognized as Asset for Suffolk County and Our Community

James A. Vosswinkel, MD
Dr. James A. Vosswinkel

James A. Vosswinkel, MD, chief of our Trauma, Emergency Surgery, and Surgical Critical Care Division, and medical director of the Stony Brook Trauma Center, has been chosen the 2017 Times Beacon Record News Media "Person of the Year."

Published last Friday, the TBR article announcing the high honor, titled "Stony Brook Trauma Care Surgeon Is an Asset for Suffolk County," opens this way:

When they come to him, they need something desperately. He empowers people, either to help themselves or others, in life and death situations or to prevent the kinds of traumatic injuries that would cause a crisis cascade.

Dr. James Vosswinkel, an assistant professor of surgery and the chief of trauma, emergency surgery and surgical critical care, as well as the medical director of the Stony Brook Trauma Center, is driven to help people through, or around, life-threatening injuries.

Vosswinkel speaks to people in traffic court about the dangers of distracted driving and speeding, encourages efforts to help seniors avoid dangerous falls and teaches people how to control the bleeding during significant injuries, which occur during mass casualty crisis.

For his tireless efforts on behalf of the community, Vosswinkel is a Times Beacon Record News Media Person of the Year.

"If you are transferred because of the seriousness of your trauma or the location of your trauma and you end up at Stony Brook, you can be well assured that you'll receive state-of-the-art care."

Kenneth Kaushansky, MD, senior vice president, health sciences, and dean, Stony Brook University School of Medicine, says: "Dr. Vosswinkel is the quarterback for developing all the resources and making sure the quality of those individuals is up to very, very high standards.

"He's a very fine trauma surgeon, who has assembled a team of additional fine surgeons. If he's ever needed, he's always available, whether he's on call or not."

Mark A. Talamini, MD, MBA, professor and chairman of surgery, and chief of surgical services, Stony Brook Medicine, says: "Dr. Vosswinkel will come to the hospital to help a member of his team at any hour of the night. When his people need help, he's there."

Scott Coyne, MD, chief surgeon and medical director of the Suffolk County Police Department, has only good things to say about Dr. Vosswinkel, who recently was promoted to chief consulting police surgeon by the SCPD:

"He's a very valuable adjunct to our police department. If you are transferred because of the seriousness of your trauma or the location of your trauma and you end up at Stony Brook, you can be well assured that you'll receive state-of-the-art care. Dr. Vosswinkel is one of the leaders in the delivery of that surgical care."

About Dr. Vosswinkel

Born and raised on Long Island, Dr. Vosswinkel received his medical degree from the SUNY Upstate Medical University in 1995, and completed his residency training in general surgery at Stony Brook. Subsequently, he gained fellowship training in trauma/surgical critical care at Yale University.

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Dr. Vosswinkel, in 2000, when a resident here.

As a resident here, Dr. Vosswinkel in 2000 was the first to receive the David J. Kreis Jr. Award for Excellence in Trauma Surgery, an annual award given to a senior (fourth-year) surgical resident by the Trauma, Emergency Surgery, and Surgical Critical Care Division in honor of the late Dr. Kreis, the founding chief of our trauma and surgical critical care service, who served with distinction on our faculty from 1986 until his untimely death in 1989.

On completing his training at Yale, Dr. Vosswinkel returned to Long Island and joined the faculty of our Department of Surgery in 2002 as a traumatologist and general surgeon. Over the next decade, he distinguished himself with his clinical skills and leadership, and in 2013, he was appointed chief of the Trauma, Emergency Surgery, and Surgical Critical Care Division.

Dr. Vosswinkel was instrumental in overseeing Stony Brook's recent verification as a Level 1 Regional Trauma Center by the American College of Surgeons (read more). Stony Brook is Suffolk County's only Level 1 Trauma Center for both adults and children, which is the highest level of trauma care possible.

Over the last few years, Dr. Vosswinkel has earned recognition from several groups. He was named the Physician for Excellence in 2016 by the Suffolk Regional Emergency Medical Services Council (read more).

Last September, for his exceptional leadership at the Trauma Center, Dr. Vosswinkel was invested as the Lillian and Leonard Schneider Endowed Professor in Trauma Surgery — the first endowed professorship in the Department of Surgery (read more).

"What's different about Dr. Vosswinkel," says Jane E. McCormack, RN, BSN, our trauma program manager, is that "a lot of people talk about working harder, but he does it. He's an intense guy who is very passionate about what he does."

Read the article written by Daniel Dunaief about Dr. Vosswinkel published in the Times Beacon Record. Learn about the many lifesaving programs provided by the Stony Brook Trauma Center.

Posted by Stony Brook Surgery on January 2, 2018

Our Thyroid Specialists Use a Multidisciplinary Approach to Managing Thyroid Disorders

The Thyroid Grand | January Is Thyroid Awareness Month
The thyroid is just below the Adam's apple.

An estimated 20 million Americans suffer from a thyroid disorder, and many more go undiagnosed every year. Now is a good time to become aware of your thyroid and its relationship to your health — and how best to take care of it.

Thyroid nodules and enlarged thyroid glands are common problems, and they can harbor cancers within them. They require proper evaluation and treatment.

When detected, patients with these thyroid disorders are usually referred for further work-up to an endocrinologist, or to an experienced head and neck surgeon, like one of the head and neck surgeons at Stony Brook Medicine.

January is national Thyroid Awareness Month that aims to bring to the public's attention the need to take good care of this important tiny gland in the neck.

Following a thorough work-up, the patient may need to undergo thyroidectomy (removal of part or all of the thyroid gland) for several reasons — for removal of thyroid cancer, removal of part of the thyroid gland for definitive diagnosis, treatment of a hyperactive thyroid gland, or an enlarged thyroid gland that is causing breathing or swallowing difficulties.

The thyroid gland is a small, butterfly-shaped gland located in the base of the neck just below the Adam's apple. Although relatively small, the thyroid gland influences the function of many of the body’s most important organs, including the heart, brain, liver, kidneys, and skin. Ensuring that the thyroid gland is healthy and functioning properly is important to the body's overall well-being.

Surgical intervention is the gold standard in thyroid cancer; there are no other options to cure it.

Since thyroid cancers are highly curable, it is extremely important for the patient to undergo proper treatment and close follow-up. The initial treatment for most thyroid cancers is removal of the thyroid gland, and sometimes removal of lymph nodes which may contain metastatic cancer.

In the hands of a highly-skilled, experienced surgeon, the procedure can usually be done on an outpatient basis and with a low risk of complications. Depending on the type of cancer, some patients may require treatment with radioactive iodine after surgery.

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Our thyroid specialists, (l to r) Drs. Lukasz Czerwonka, Melissa M. Mortensen, and Ghassan J. Samara.

Also essential is close follow-up by the patient's endocrinologist for tumor surveillance and regulation of the thyroid hormone.

Our thyroid specialists take a multidisciplinary approach to providing care for patients with thyroid disorders. The team of physicians consists of surgeons, endocrinologists, radiation oncologists, radiologists, and pathologists.

Management decisions are often made jointly among the team members. Such a team approach has ensured long-term successful outcomes for our patients at Stony Brook Medicine.

Hyperthyroidism is a sustained overly active thyroid gland, which may result in anxiety, nervousness, rapid heartbeat, weight loss, and high blood pressure. The causes of hyperthyroidism include Grave's disease and toxic nodular goiter. This condition is treated with medications, radioactive iodine, or thyroidectomy.

The advantage of surgery is that the condition can be treated quickly and effectively, minimizing the risk of recurrence. In the past, non-surgical treatment has been the primary approach to patient care because of potential complications associated with the surgery. Now, with surgical expertise and advances in technology at Stony Brook Medicine, more patients are undergoing surgery with minimal complications.

In the past, goiter was treated with medication, but that was proved not to be effective. Patients with goiter now have surgery to alleviate the pressure symptoms on the trachea and the esophagus.

Thyroidectomy is performed for nodules and cancer of the thyroid gland. It is also performed in some patients with overactive thyroid glands.

Stony Brook Medicine provides patients state-of-the-art thyroid care using the multidisciplinary team approach, distinguished by highly experienced surgical specialists capable of treating all forms of thyroid conditions.

The thyroid gland is a small, butterfly-shaped gland located in the base of the neck just below the Adam's apple. Although relatively small, the thyroid gland influences the function of many of the body’s most important organs, including the heart, brain, liver, kidneys, and skin. The blue paisley ribbon icon is the universal symbol of thyroid disease awareness and advocacy. Paisley was chosen because it resembles a cross-section of thyroid follicles, the tiny spheres that the thyroid gland is made of.

Perform the do-it-yourself thyroid neck check. Watch this video (1:00 min) about thyroid awareness from the American Association of Clinical Endocrinologists:

Posted by Stony Brook Surgery on December 13, 2017

Many of the Burns Associated with the Holiday Season Can Be Prevented

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Dr. Steven Sandoval

The holiday season is one of the busiest times of the year for the Suffolk County Volunteer Firefighters Burn Center at Stony Brook University Hospital.

As the holidays approach, doctors at our Burn Center are urging people to take extra precautions and to eliminate potential dangers that could lead to serious burn injuries.

"Between Thanksgiving and New Year's Day, we see a significant increase in patients coming in with burns," says Steven Sandoval, MD, assistant professor of surgery and medical director of the Suffolk County Volunteer Firefighters Burn Center.

"Holiday celebrations should be full of joy, but if not careful, could quickly turn tragic." Dr. Sandoval says many of these burns and injuries can be preventable and shares some tips for a safe holiday season.

Meals and the holidays go hand and hand, but Dr. Sandoval says the Burn Center sees more and more cooking injuries each year.

"People aren't used to cooking such large meals on a regular basis," says Dr. Sandoval.

"Scalding is one of the most common burn injuries patients come in with. From large pots filled with boiling water, to boiling hot juices spilling out of meat pans, people need to take extra precautions in the kitchen."

Take extra precautions and eliminate potential dangers that could lead to serious burn injuries.

Some cooking safety tips:

  • Keep potholders, wooden utensils, towels, and food packaging away from the stovetop.
  • Deep-fried turkeys have become increasingly popular, but extreme caution should be exercised when choosing this method. Turkey fryers should be used outdoors and kept a safe distance away from homes and structures. Never leave the fryer unattended, and do not overfill it with oil.
  • Keep children away from chaffing dishes filled with hot water and gel-fueled burners.
  • Take extra precautions when removing large dishes out of the oven; they are often heavier than we're used to and can spill over burning hands, forearms, or others.

Each year, Christmas trees are involved in hundreds of fires. According to the U.S. Fire Administration, Christmas tree fires are not common but are likely to be serious, resulting in deaths, injuries, and property loss and damage. (Fact: One of every three home Christmas tree fires is caused by electrical problems.)

Some tips for preventing Christmas tree fires:

  • When purchasing an artificial tree, look for a "fire resistant" label.
  • Check for freshness when purchasing a live tree. A fresh tree is green; the needles are hard to pull; the trunk should be sticky with resin; and when hit, the tree should not lose many needles.
  • Heated rooms will dry live trees quickly, so keep the stand filled with water. A well-watered tree is usually safe, but dry trees can be ablaze in seconds.
  • Place trees at least 3 feet away from all heat sources, including fireplaces, radiators, and space heaters.
  • Don't use electrical ornaments or light strings on artificial trees with metallic leaves or branch coverings.
  • Make sure lights aren't damaged: look for cracked cords, loose connections, damaged sockets, and loose or bare wires. Throw away any strands that are in poor condition.
  • No more than three strands of incandescent lights should be strung together at a time.
  • Make sure to spread lights across multiple electrical outlets to ease the wattage load on them.
  • Make sure anything that requires electricity has been tested for safety. Safe holiday decorations will have a label from one of the independent testing laboratories, such as Underwriters Laboratories (see list of federally recognized labs).

Other reminders to have a safe and prevent burns this holiday season:

  • Do not burn wrapping paper in the fireplace, as it can ignite suddenly and burn intensely.
  • Never leave candles unattended, and place them away from trees and other decorations where they cannot be knocked over, and out of reach from children and pets. (Fact: December is the peak time of year for home candle fires.)
  • Keep children away from fireplaces. Many families will place enclosures to keep children away, but those can heat up quickly and little hands can get burned if touched.
  • Throughout the year, test smoke detector batteries and always have a fire extinguisher within easy reach.
  • Use clips, not nails, to hang lights so the cords don't get damaged.
  • Keep matches and lighters up high in a locked cabinet.
  • Blow out lit candles when you leave the room or go to bed.

First-aid for burns: The first-aid treatment for first-degree burns (skin is reddened) and second-degree burns (it's blistered) is the same, according to the American Academy of Family Physicians: Soothe the burn under cool running water long enough to reduce the pain, usually 15 to 20 minutes. Don't put ice directly on a burn. Once the burn cools, apply a moisturizer to the area, but don't use butter, which can cause infection. Cover the burn with sterile gauze. Take an over-the-counter pain reliever. Don't break blisters.

Watch this video (1:31 min) that shows just how quickly Christmas tree fires can turn devastating and deadly:

        A live Christmas tree burn conducted by the U.S. Consumer Product Safety Commission shows just how quickly a dried out Christmas tree fire burns, with flashover occurring in less than 1 minute, as compared to a well-watered tree, which burns at a much slower rate.

Posted by Stony Brook Surgery on December 6, 2017

Magnets Are Associated with an Alarming Increase in Pediatric Ingestion Injuries

Chest X-Ray of Little Boy Showing Toy Part Lodged in His Esophagus
X-ray of 4-year-old boy showing toy part
(arrow) lodged in his esophagus.

Children's toys are potentially dangerous, and it's that time of the year to be especially mindful of this fact. Listen to our chief of pediatric surgery Christopher S. Muratore, MD, who in an interview on WSHU, offers advice to parents and caregiver.

Foreign body ingestion by children represents a major challenge to the treating physicians and to the parents/guardians. Diagnosis can often be challenging because not all ingested objects can be seen by routine x-ray exams.

Only metallic objects can be seen by x-ray. Objects made out of plastic and glass can be easily missed. Diagnosis, therefore, is often made by direct observation with a history of choking, or new onset of certain symptoms.

Of the many ingestion injuries treated by our Pediatric Surgery Division, one involved a little boy who had sudden chest pain and was brought to our ER: he had swallowed a toy part that lodged in his esophagus (see x-ray at right).

Treatment of a swallowed or inhaled foreign body is dependent on the location and the type of the foreign body. In the digestive tract, if the object is stuck in the esophagus and fails to pass into the stomach, it must be removed using endoscopic techniques.

A foreign body that passes into the stomach can be observed without intervention, because it will usually pass through the intestine and exit with stool. Even sharp objects such as pins can pass without perforating the intestine. The passage into stool can take up to one to two weeks.

Certain types of ingested objects represent a major concern: button batteries and supermagnets (neodymium magnets; typically 10 to 20 times stronger than traditional magnets) are two of the most common types.

Button batteries can be easily swallowed, and these batteries release corrosive chemicals that can erode through the esophagus and intestine if they fail to move. Therefore, our Pediatric Surgery Division tries to remove all of such batteries when seen in the esophagus. Once a battery passes into the intestine, it can only be watched, with the hope it will pass out with the stool without damaging result.

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The majority (72%) of pediatric magnet ingestions occurred after the year 2010. ("Surgical Management and Morbidity of Pediatric Magnet Ingestions.")

Magnets are another type of object that has been identified as especially dangerous. In recent years, many reports of ingested small magnets eroding through the bowel by magnetic force have appeared in the medical literature.

A 2015 study, titled "Surgical Management and Morbidity of Pediatric Magnet Ingestions," demonstrated "the increasing need for magnet regulations and public awareness to prevent potentially serious complications.

Another recent study, titled "Pediatric Magnet Ingestions: The Dark Side of the Force," published in the American Journal of Surgery, found that injuries caused by children ingesting magnets are increasing. The authors conclude that "magnet safety standards are needed to decrease risk to children."

Stony Brook Children's is the only hospital in Suffolk County with board-certified pediatric surgeons who treat children with toys ingested into the airway and digestive tract.

Magnets that are swallowed can clump together on opposite sides of the intestinal wall, and their pinching action can be so tight that holes are made in the intestine, thus creating a dangerous problem.

The current standard of care for children who have more than one magnet is to consider performing emergency abdominal surgery.

A foreign body inhaled into the airway by children is a surgical emergency. Many objects have been identified as high risk for inhalation by young children. These include popcorn seeds, peanuts, latex balloons, etc. Unusual inhaled objects seen at Stony Brook Children's include a broken Monopoly piece and a screw.

Observing choking with an object in the mouth may be the only history. Sometimes, it is a child with new onset wheezing. Chest x-ray may not necessarily make the diagnosis. Rigid bronchoscopy is the utilized for both diagnosis and treatment.

Children's Toys May Be Hazardous to Their Health; Prevent Ingestion Injuries During the holiday season, children's gifts need to be age appropriate for many reasons. Prevention of foreign body aerodigestive ingestion is one of them. However, this is a problem seen throughout the entire year at Stony Brook Children's Hospital.

Stony Brook Children's is the only hospital in Suffolk County with a team of fellowship-trained pediatric surgeons who treat children with toys ingested into the airway and digestive tract. We also have specialists from our pediatric emergency department who can make the diagnosis, and pediatric otolarygologists who can perform all of the above procedures in children.

Foreign body ingestion injuries related to toys often happen when parents overestimate their child’s level of development and make the mistake of buying a toy beyond the suggested age range: toys designed for older children may contain parts that are choking hazards.

A compelling recent study of foreign body ingestion injuries in children ("Toys in the Upper Aerodigestive Tract") found that despite the adoption of preventive strategies, including product modification by manufacturers, which have decreased the mortality rate due to choking, preventive strategies imposing regulations on industrial production, even if fundamental, are not sufficient.

In addition to these strategies, it was concluded that what's needed is other preventive intervention aimed at improving parents' awareness of foreign body ingestion injuries and at increasing their watchfulness of their children.

Harmful If Swallowed

Here's a very partial list of toy types/parts that young children have swallowed and that have sent them to the emergency room:

  • Ball bearings
  • Board game pieces
  • Button batteries
  • Doll shoes
  • Lego-type toys (interlocking bricks)
  • Round small toys
  • Toy insects
  • Toy soldiers
  • Toy train signs
  • Wheels of toy cars & other vehicles
ALERT: Children under the age of 3 should not play with toys that could fit inside a toilet paper roll. Read magnets safety alert of U.S. Consumer Product Safety Commission. Check to make sure your children's toys are not recalled products.

Watch this video (1:03 min) about a toddler who swallowed 42 magnets and was saved because of prompt diagnosis and treatment:

Ask your teenager to watch this video (just over half a minute) about magnet safety produced by the U.S. Consumer Product Safety Commission:

Posted by Stony Brook Surgery on November 30, 2017

Our Second Endowed Faculty Appointment in the Department of Surgery

Dr. Christopher Muratore (center) with (left to right) Dean Kenneth Kaushansky, William Knapp, Jane Knapp, Dr. Margaret McGovern, Dr. Esther Takeuchi, Michele Knapp, David Knapp, Danielle Knapp-SanGiovanni, Jesse SanGiovanni, and President Samuel Stanley Jr.

We are very pleased to share the news that our new chief of pediatric surgery, Christopher S. Muratore, MD, has been appointed Knapp Swezey Chair in Pediatric Surgery.

Two other Stony Brook professors who are leaders in their fields were appointed as endowed faculty at the investiture ceremony held recently on campus:

Margaret M. McGovern, MD, PhD, professor of pediatrics and physician-in-chief at Stony Brook Children's Hospital, was named Knapp Chair in Pediatrics, and Esther S. Takeuchi, PhD, SUNY distinguished professor of materials science and chemical engineering, was named William and Jane Knapp Chair in Energy and the Environment.

The three new endowed faculty positions were funded by philanthropic gifts from the Knapp family through the Knapp Swezey Foundation, Island Outreach Foundation, and Jane and William Knapp, respectively.

"From the start of my tenure at Stony Brook, it has been my goal to create 100 endowed faculty positions across a wide range of disciplines to help the university compete with our aspirational peers for the best and brightest faculty," said Stony Brook University President Samuel L. Stanley Jr.

"I am most grateful that through the generosity of the Knapp family and others, we are almost there."

We need to make children's healthcare services and children's surgical services a national priority.

"Chris is new to Stony Brook Children's Hospital," said Kenneth Kaushansky, MD, dean of Stony Brook University School of Medicine, in his introduction of Dr. Muratore. "But he is a longstanding national leader in pediatric surgery and education."

Dr. Muratore joined our faculty in September as our new chief of pediatric surgery. He came to Stony Brook from the Warren Alpert Medical School of Brown University, where since 2013 he had been associate professor of surgery and pediatrics.

While on the faculty at Brown, Dr. Muratore was an attending surgeon at two major hospitals in Providence: Hasbro Children's Hospital, a division of Rhode Island Hospital — the major teaching hospital of Brown's medical school — and Women and Infants Hospital of Rhode Island.

He served as medical director of Rhode Island Hospital's extracorporeal membrane oxygenation (ECMO) program, the only extracorporeal life support program in the region, functioning as a regional referral service and caring for neonatal, pediatric, adult, and cardiac patients in a multidisciplinary fashion.

At Hasbro Children's Hospital, he served as surgical director of the pediatric intensive care unit, and as co-director of the multidisciplinary vascular anomalies clinic treating both pediatric and adult patients.

A dedicated educator, Dr. Muratore had been the program director of Brown's pediatric surgery residency program.

Dr. Muratore brings years of training in pediatric surgical research laboratories investigating the fetal treatment of congenital diaphragmatic hernia (CDH).

He is a key investigator on the FDA-sponsored investigational device exemption for in utero tracheal occlusion for severe CDH, and he collaborated locally and nationally to advance fetal treatment, having served as chair of the fetal diagnosis and treatment committee of the American Pediatric Surgical Association.

A children's hospital as part of a larger hospital system is the crown jewel in an academic medical center.

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In his remarks, Dr. Muratore noted that across the country, the "vast majority" of children's surgical care is being provided in non-children's hospitals by specialists in adults.

"We need to make children's healthcare services and children's surgical services a national priority," he said.

"A children's hospital as part of a larger hospital system is the crown jewel in an academic medical center.

"The Knapp family and the Knapp Swezey Foundation and all of your collective contributions will no doubt allow Stony Brook Children's Hospital to rise to the occasion and be the stimulus for change."

For more than 25 years, said Dexter A. Bailey Jr., senior vice president for University Advancement, the Knapp family's generosity has impacted areas all across Stony Brook's campus, including the arts, nursing research, alumni programming, and tick-borne disease research, as well as the University's first endowed chair in pharmacological sciences, among others.

Most significant has been the Knapp's transformative investments in children's health, by way of an extraordinary gift in June 2016 to help build a new best-in-class children's hospital that will transform clinical care, pediatric medical education, and research at Stony Brook Children's.

"The Knapps's investment in Stony Brook," said Mr. Bailey, "is a reflection of their confidence in the pioneering spirit of the university."

Addressing the standing-room-only audience, William Knapp revealed his family's motivation for their philanthropy to Stony Brook.

"We have family members who would not be alive today were it not for the world-class medical care available at Stony Brook University Hospital. And we give here so the wider community can share the peace of mind that comes with having this tremendous facility here.

"I do not want to think about what this hospital and university would be like without philanthropic support."

For information on the various ways to give philanthropic support to the Department of Surgery, please call Emily K. LaClair, director of development for surgery and trauma, at 631-638-2481.

Posted by Stony Brook Surgery on November 21, 2017

How to Avoid a Gallbladder Attack from All the Delicious Thanksgiving Food

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Dr. Mark A. Talamini

Most surgeons on-call during the Thanksgiving holiday and the subsequent holiday season are not surprised when a patient visits the ER complaining of upper right side, abdominal pain, and tenderness radiating through to the back.

There are also no surprises when an ultrasound shows a dilated gallbladder, possibly with a thickened wall, and gallstones ranging from the size of a pebble to the size of a marble or even an egg. At this point, surgery is the next logical step — a cholecystectomy, or gallbladder removal, which is one of the most common surgical procedures in the United States.

At Stony Brook University Hospital, we usually see a spike in the number of emergency cholecystectomies that are performed over the Thanksgiving holiday weekend.

Here, Mark A. Talamini, MD, MBA, professor and chairman of surgery and chief of surgical services at Stony Brook Medicine, who is a renowned gastrointestinal (GI) surgeon, shares a few practical tips on how to prevent a visit to the ER, and keep you at home with your family during the Thanksgiving holiday:

  • Eat smaller portions of high-fat, high-sugar foods: Thanksgiving celebrations are traditionally filled with buttery mashed potatoes, festively fatty appetizers, gooey desserts, and cheerfully spirited cocktails. Take it easy at the Thanksgiving dinner; not only will it spare you a possible trip to the hospital, but you will avoid packing on those extra end-of-the-year pounds. Researchers say many gallbladder symptoms stem from our Western diet, full of refined carbohydrates and saturated fats. "If you're having symptoms from gallstones, it's because as your gallbladder tries to squeeze, some of the gallstones are blocking the outflow of bile that is stored in your gallbladder," Dr. Talamini says. "You're basically squeezing against a closed door, and that's where the pain comes from. When you eat fatty foods that makes the gallbladder squeeze more."
  • Stay hydrated: During the cold months, our indoor environment is often warm and dry, making us sweat more fluid than we might expect, therefore causing dehydration. Overdoing it on holiday cocktails can accentuate dehydration. Staying hydrated also keeps the blood flowing to all organs, including the gallbladder.
  • Eat more fruits and vegetables: Eating fruits and vegetables increases the ratio of fiber to nutrients, which improves overall digestion and decreases the proportion of fat. Fat will stimulate the gallbladder.
  • Get some exercise: Exercise increases overall blood flow and motility, the ability to move food through the gut. After your Thanksgiving meal, get out with the family for a walk!
  • Understand your gallbladder: Watch this video (1:48 min).

According to the National Institute of Diabetes and Digestive and Kidney Diseases, 20 million Americans have gallstones. The majority of those people are unaware of the disease, and show no symptoms.

The average American has one gallbladder attack in their life that typically lasts 1 to 4 hours. However, if the attack is severe or there is a second attack, it may put the person at risk for having future attacks. Three common treatments for gallstones are a "wait and see" approach, nonsurgical removal of the stones, or cholecystectomy.

A visit to the ER may be indicated if you have the following symptoms of a serious gallbladder attack:

  • Abdominal pain that lasts more than 5 hours
  • Clay-colored stools
  • Fever or chills
  • Nausea and vomiting
  • Yellowish color of the skin or of the whites of the eyes

In case of an emergency. The ER at the Stony Brook Trauma Center is here to help around the clock. With the establishment of the Department of Surgery's exigent general surgery (XGS) service, there is a special protocol in place for patients with acute cholecystitis, or gallbladder attack.

Patients with acute cholecystitis are streamlined from initial presentation in the ER, to XGS evaluation, to a dedicated XGS operating room during daytime hours, then to the post-anesthesia care unit and discharge home within 24 hours.

For more complicated patients, the XGS 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.

Learn more about gallstones and how to prevent a gallbladder attack. And don't let heartburn be a GI holiday spoiler, either: see our prevention tips blog for GERD Awareness Week, which is Thanksgiving week.

Posted by Stony Brook Surgery on November 15, 2017

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Dr. Salvatore Docimo Jr.

Achalasia is a motility disorder in the esophagus that is rare, affecting 1 person in 100,000. The term motility denotes the contraction of the muscles that mix and propel contents in the digestive tract, of which the esophagus is the segment that follows the mouth and goes to the stomach.

Achalasia can occur at any age. Patients often have the following symptoms: difficulty swallowing (dysphagia), vomiting, regurgitation of food, weight loss, and even chest pain.

Normally, the lower esophageal sphincter remains closed to prevent food and acid from refluxing back up into the esophagus. When you swallow, this sphincter will relax, allowing food to enter into the stomach.

In achalasia, the lower esophageal sphincter is tight, and will not allow passage of food into the stomach.

Achalasia is believed to be caused by a loss of Auerbach's nerve plexus, which results in the lower esophageal sphincter failing to relax during swallowing. In most achalasia patients, their esophagus will have poor motility, and the esophagus will not push the food down toward the stomach.

To combat this disorder, various treatment modalities are available for patients.

Here, Salvatore Docimo Jr., DO, MS, of our Bariatric, Foregut, and Advanced Gastrointestinal Surgery Division, answers questions regarding the diagnosis and treatment of achalasia.

Q: How is achalasia diagnosed?

A: After a thorough history, a patient will undergo an esophagogastroduodenoscopy (EGD). The EGD will likely show a dilated esophagus with retained food and fluid with an increased resistance or difficulty in passage of the endoscope — a thin flexible tube with tiny video camera — through the gastroesophageal junction (GEJ).

An EGD will also allow for the diagnosis of other possible problems such as a tumor or esophagitis.

A contrast esophagram will also be performed. The patient will swallow a contrast solution, and x-rays are taken to evaluate the esophagus. Features such as a dilated esophagus or absence of a gastric air bubble can be seen.

an image is here         The so-called bird's beak, seen in this x-ray, refers to the tapering of the lower esophagus in achalasia. Although it generally occurs in actual (primary) achalasia, it can also occur in pseudo-achalasia as the result of a tumor involving the gastroesophageal junction, where the esophagus connects with the stomach.

An esophageal manometry will also need to be performed. This study measures the function of the lower esophageal sphincter and the esophagus itself. If positive for achalasia, it will likely demonstrate an absent relaxation of the lower esophageal sphincter.

Q: What are some non-invasive treatment options?

A: Medications, such as calcium channel blockers and long-acting nitrates, are a medicinal treatment. However, most of the time, any improvement in symptoms is short-lived.

Botulinum (Botox) injection is where an EGD is performed, and botulinum is injected to allow the lower esophageal sphincter muscles to relax. This method of treatment has shown to work in nearly 75% of patients. However, the positive benefits are short-lived, usually lasting only 2-4 months.

Pneumatic dilation is a method of treatment where a balloon is placed across the GEJ and inflated. The cylinder-shaped balloon will rupture the muscle fibers of the lower esophageal sphincter, thereby making passage of food and fluid easier. However, concern for perforation is present, as it occurs in 4% to 7% of patients.

Patients experiencing any of the symptoms described above should arrange for a consultation with one of our specialists to discuss all of these treatment options to find out which one is right for them.

Q: What is a laparoscopic Heller myotomy?

A: A minimally invasive laparoscopic Heller myotomy is currently the gold standard for treatment of achalasia. It involves usually five small incisions — each between a quarter of an inch and half an inch long — in the abdomen. This procedure is performed by a surgeon. The esophagus and stomach are exposed via a tiny camera inside the abdomen and visualized on a computer screen. The myotomy is then performed with miniature surgical tools to cut the same problematic muscle as in a POEM.

The surgeon will then pass an endoscope down the esophagus to ensure the tight lower esophageal sphincter is now loose.

One major advantage of a laparoscopic Heller myotomy approach is the ability to perform an anti-reflux procedure (a fundoplication) to prevent post-procedural reflux. Patients usually require an overnight stay, and are sent home the next day.

Q: What is per-oral endoscopic myotomy (POEM)?

A: Per-oral (PO-) means were are working through the mouth; endoscopic (E-) means we are using an endoscope, and myotomy (M) means we are cutting muscle.

POEM is a minimally invasive endoscopic approach to perform a myotomy, or cutting the muscle at the lower esophageal sphincter. The technique, which originated in Japan, is relatively new. POEM is performed with an endoscope; that is, a flexible tube passed down the esophagus.

The endoscope is gently pushed down into the esophagus. A cut is made in the lining or mucosa. A tunnel is made in the wall of the esophagus, and the muscle layer is then cut (the myotomy) with a special knife passed through the endoscope. The opening to the tunnel is then closed using clips or suture material.

Patients who have the POEM procedure are usually sent home the following day after being admitted to the hospital for an overnight stay.

The procedure is attractive because it limits the scars on the abdominal wall (if a laparoscopic Heller myotomy is performed) and offers a quick recovery time as well as less pain.

A study I published this year demonstrates less pain with a POEM (read abstract). We believe POEM will provide a long-term benefit to patients. However, reflux has been reported by patients after a POEM, and this currently is being studied.

Q: What is the advantage of being treated for achalasia at Stony Brook Medicine?

A: We offer patients both leading-edge diagnostic technology and surgical expertise in the management of achalasia. Our surgeons are national leaders in minimally invasive laparoscopic procedures that generally provide a shorter hospital stay, less pain, minimal scarring, and faster recovery so that patients can return to their normal activity.

Learn more about achalasia. For consultations/appointments with our specialists in the management of this swallowing disorder, please call 631-444-4545.

Posted by Stony Brook Surgery on November 8, 2017

Read about How We Are Leading the Way in Patient Care, Education, and Research

an image is here POST-OP, our semi-annual newsletter, provides an update on all kinds of new developments in our department, plus health news of interest to the Long Island community and beyond:
  • Expanding Our Services throughout Suffolk County
  • Introducing Our New Chief of Pediatric Surgery
  • More New Faculty: Breast Surgeon + Colorectal Surgeon + General/Bariatric Surgeon + Pediatric Surgeons + Phlebologists (Vein Care) + Plastic Surgeon + Research Scientist + Surgical Oncologist + Vascular Surgeon
  • Study Shows High-Volume Surgeons Get Best Results with Mitral Valve Surgery
  • Providing the Famous Shouldice Hernia Repair — Offering the Experience for Optimum Results
  • A HIPEC Patient Story: From Spain to Stony Brook for Lifesaving Treatment
  • New Otolaryngology and Integrated Plastic Surgery Residency Programs
  • Residency Update & Alumni News
  • Division Briefs … Plus More!

"Now, with Stony Brook Medicine’s acquisition of Southampton Hospital in Southampton, on the South Fork of the East End, we have entered a new age in the healthcare of Eastern Long Island when it comes to surgery. This historic development expands the Stony Brook Medicine healthcare system in a major way. What’s more, the expansion is further enhanced by Stony Brook’s current affiliations with Eastern Long Island Hospital in Greenport on the North Fork, and with Brookhaven Memorial Hospital Medical Center in Patchogue on the South Shore. These three hospitals are welcoming our department’s faculty, and their patients are welcoming them, as well. We are adding a new dimension to the surgical care they have been offering their communities for decades." — From the "Chairman's Message" by Mark A. Talamini, MD, MBA

Read POST-OP online now. To receive a complimentary free subscription to the print edition of POST-OP, please send request with your complete postal mailing address.

Posted by Stony Brook Surgery on October 25, 2017

Leading the Way in Patient Care with the Latest Technology

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Left to right: Eugene Deal, RN, CNOR, hybrid OR clinician; Donna Hoffman, RN, associate director of nursing, perioperative services; Mary Catalano, CASC, administrative director, perioperative services; Apostolos Tassiopoulos, MD, director, Stony Brook Vascular Center and chief, vascular and endovascular surgery; Shang Loh, MD, program director, vascular and endovascular surgery and associate director, Aortic Center; Mark Talamini, MD, chairman of surgery and chief, surgical services; Carol Gomes, chief operating officer; Tong Joo Gan, MD, chairman of anesthesiology; Kenneth Rosenfeld, MD, director, perioperative services; and Allyson Silver, MPH, associate director of operations, surgical services. (Click on image to enlarge.)

Stony Brook University Hospital just opened two fully-equipped hybrid operating rooms (ORs) to provide patients with minimally invasive surgical procedures that are shorter, safer, and more convenient.

Our new hybrid ORs feature the most up-to-date, technologically sophisticated equipment. Called the Siemens Artis Pheno, it has the most dynamic imaging capabilities available today. Stony Brook is the first hospital in the Northeast — and the third hospital in the country — that currently uses this type of imaging equipment.

The hybrid ORs, which are each about twice as large as traditional ORs, have the usual surgical equipment plus a large complement of very sophisticated imaging technology that normally isn't located in a traditional OR. Having imaging capabilities, such as the latest CT scanners, in the OR allows surgeons to perform complex procedures with real-time image guidance.

The Important Advantages of Stony Brook's Hybrid OR

Hybrid ORs are specially designed and equipped to make today's surgeries safer and easier for patients and the medical professionals who are in the OR with the patient:

  • Having advanced imaging equipment available during surgery allows for faster, more precise placement of surgical tools and implants.
  • Surgeries generally proceed more quickly because everything the surgeon needs is right in the room. There's no need to move to another location for additional procedures or imaging.
  • The newest technologies require less radiation and less contrast material — the dye that is needed to give doctors a better view of tissues. This means greater safety for patients.
  • Results for patients may be enhanced due to the shorter surgical times, smaller incisions needed for minimally invasive procedures and the greater imaging accuracy.
  • If surgeons determine that other procedures, including traditional open surgery, are needed for an individual patient, the open surgery can be done safely and immediately in the same room.

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Inside one of our new hybrid ORs. Note the image of the aorta on the scanners; it's an example of what the surgeon can view with the patient lying on the table having a cardiovascular procedure. (Click on image to enlarge.)

Today's Most Advanced Imaging Equipment

Our hybrid ORs feature the most sophisticated imaging capabilities available today. The Siemens Artis Pheno allows surgeons to use fluoroscopic imaging — advanced x-rays — with special capabilities, such as the DynaCT system, which offers:

  • Computerized tomography (CT or CAT scan) that combines a series of images from different angles to create detailed cross-sections of different structures in the body.
  • Rotational imaging and 3D reconstructions, so the surgeon can see the patient's internal structures, including the veins, arteries, and heart from all angles, and confirm exact, correct placement of stents, valves, and other implants.
  • The ability to fuse different images and imaging studies to see true 3D images.
  • Higher resolution images to make diagnosis and treatment more accurate.
  • A reduction in the amount of contrast that the patient needs, which makes the procedures safer.
  • About a 30% reduction in the amount of radiation that patients and surgical personnel are exposed to, which increases safety for everyone.
  • Accurate final images at the procedure's completion, which can enhance overall results for the patient.
  • Shorter procedure time, which may reduce the amount of anesthesia needed.
  • A possible reduction in overall costs to patients due to shorter operation times and less anesthesia.

A Wide Range of Procedures

Stony Brook's new hybrid ORs are predominantly used for cardiac and vascular procedures, but will also be equipped for trauma, spine, and urology surgeries.

The technology in these specialized ORs allows cardiovascular surgeons to safely and efficiently perform minimally invasive procedures, such as:

  • Percutaneous (through the skin) valve replacements or repairs such as transcatheter aortic valve replacement (TAVR) that are done instead of open heart surgery.
  • Cardiac catheterization and coronary interventions — to identify and open a blocked artery in the heart with angioplasty and stenting.
  • Electrophysiology — tests to assess and treat the heart's electrical system.
  • Endovascular procedures (using a catheter inserted through the skin to diagnose and treat vascular disease), such as:
    • Endovascular repair of aortic aneurysms in the abdomen or chest (EVAR, TEVAR).
    • Endovascular repair of aortic dissections.
    • Stent graft implantations.
    • Endovascular treatment of peripheral artery disease (PAD) with angioplasty and stenting.
    • Embolization of visceral artery aneurysms and vascular malformations.
    • Hybrid (part open and part endovascular) intervention to treat complex vascular problems.

Depending on the procedure, patients may have sedation or general anesthesia. Some will be able to go home the same day and others will stay in the hospital for a short time.

Stony Brook's Dedication to Excellence in Patient Care. The hybrid ORs are part of Stony Brook's commitment to offer the best possible care for patients. We're committed to leading the way in patient care with the latest technology. Our new ORs are staffed by a multidisciplinary team of highly-trained and experienced specialists, including surgeons, interventionalists, nurses, anesthesiologists, and technicians. The new rooms are located in University Hospital on the fourth floor adjacent to the traditional OR. Stony Brook also has a hybrid OR at Stony Brook Southampton Hospital.

For an appointment to have a consultation with our cardiac surgeons, please call 631-444-1820. For an appointment to have a consultation with our vascular surgeons, please call 631-638-1670.

Posted by Stony Brook Surgery on October 9, 2017

Promoting Breast Health Education and the Importance of Early Detection

Dr. Brian J. O'Hea Reading a Mammogram
Dr. Brian J. O'Hea reading a mammogram.

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.

Four Important Things Every Woman Can Do about Breast Cancer:
1. Be scrupulous about scheduling annual screening mammograms and clinical exams after the age of 40.
2. Perform monthly breast self-examinations.
3. If you have a strong family history of breast or ovarian cancer, seek BRCA genetic testing. Once you know your risk, you can take preventive measures and risk-reduction steps that may prevent cancer from occurring.
4. If you are scheduled to have a surgical biopsy, inquire about having a needle biopsy instead. Core needle biopsy is the preferred initial breast biopsy method.

Community Update: The Latest Treatments for Patients with Breast Cancer
Hear Stony Brook physicians discuss the latest treatment and surgical advances, including minimally invasive techniques and reconstructive surgery. Hosted by Dr. O'Hea. Community members, patients, family members, caregivers, and healthcare professionals are welcome. Tuesday, October 17, 6 to 9 pm, at the Hilton Garden Inn on the campus of Stony Brook University (see map). Free. Reservation required. RSVP to 631-444-4000.

Learn more about breast cancer and how to avoid it from the American Cancer Society. Find out how to help find a cure for breast cancer: The Carol M. Baldwin Breast Cancer Research Fund.

Posted by Stony Brook Surgery on September 21, 2017

Advancing Patient Care with Robotics in Minimally Invasive Surgery

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Dr. Joseph Kim (left) and Dr. Georgios V. Georgakis

Last week, the Department of Surgery became the first on Long Island to perform an entire, totally robotic Whipple procedure. The procedure was done by Joseph Kim, MD, and Georgios V. Georgakis, MD, PhD, of our Surgical Oncology Division.

By early this week, the patient was home and doing well. That's a benefit of the minimally invasive surgery.

Formally known as pancreatico-duodenectomy, the Whipple procedure — named after surgeon Allen Whipple, MD, who refined it — is performed by surgical oncologists to remove pancreatic tumors and other types of gastrointestinal (GI) tumors (learn more).

The Whipple procedure is one of hardest GI procedures to perform, either by means of conventional open surgery, or by the minimally invasive laparoscopic approach. Performing this procedure successfully with the robot is a significant surgical feat from the technical point of view, and it offers patients considerable benefits.

The surgeon — not the robot — performs the surgery, and is in full control of the robotic system and the procedure.

In general, the new minimally invasive procedures using robotics offer patients the possibility of diminished postoperative pain, less scarring, fewer complications post-surgery, and earlier discharge from the hospital.

Robotic Whipple is making big news. U.S. News & World Report just did an article featuring it, describing how surgeons work with the da Vinci robot like the one we use at Stony Brook Medicine:

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In the OR, positioning the arms of the da Vinci robot.

“Instead of bending over an operating table, surgeons sit in front of a console nearby with a magnified 3-D screen that gives them a much better view than regular laparoscopic or open incisions.

“They operate by moving two controllers that manipulate robotic arms equipped with tiny surgical instruments so intricate they can sew together a grape peel. Computer software takes the place of actual hand movements, making movements very precise."

This new robotic approach may also help patients heal quicker, which may be crucial if they need to undergo additional treatment such as chemotherapy or radiation. During the Whipple procedure, a portion of the pancreas — the first portion of the intestine and the last portion of the bile duct — is removed to treat tumors of these organs.

Despite the laparoscopic instrumentation used in the minimally invasive approach to performing the Whipple, the surgeon is often not able to complete the procedure effectively enough, particularly the reconstruction of the intestinal system.

But the use of the da Vinci surgical robot allows reconstruction to be performed accurately and in a more minimally invasive way. At Stony Brook, increasing numbers of patients with cancer are being treated with surgery using robotics, and are benefiting from this advance in care.

Leading the Way in Patient Care

This story is just the latest example demonstrating how the Department of Surgery is on the cutting edge of using advanced technologies to enhance patient care, safety, and operational sustainability. Here are a few other examples of our leadership:

  • Hybrid Operating Rooms: These rooms are among the most advanced environments anywhere to provide surgical care with advanced imaging matched with advanced surgical procedures. Southampton Hospital has had a hybrid operating room for over a year with Stony Brook Medicine support and direction. This month, Stony Brook University Hospital will be opening two hybrid ORs with the newest generation of hybrid equipment.
  • Minimally Invasive Surgery: Advanced technology is used increasingly for sophisticated surgical procedures. An example is abdominal aortic aneurysm repairs at Stony Brook Southampton Hospital and Stony Brook University Hospital in which the vascular team performs a procedure with vascular stents that in the past involved significant mortality, loss of blood, and lengthy post-op stays (usually including ICUs). Now patients go home in a day or two, with greater activity and fewer post-op issues.
  • Robotics: We have been leaders with this form of minimally invasive surgery made possible by our use of the da Vinci robot, which allows for much finer control of the operative procedure. A decade ago, our Cardiothoracic Surgery Division was among the first to integrate this technology into patient care, as well as to train other surgeons from around the country in how to use it. Other divisions in our department — our Colon and Rectal Surgery Division and Otolaryngology-Head and Neck Surgery Division — have been leaders in using the da Vinci robot, as well.

In this particular case, a major oncologic procedure that previously required major interventions and potential complications now has the potential for longer time in the OR but far less time in the hospital, with reduced mortality and morbidity.

"The next generation of robots will help surgeons even more: The technology will rely on the science of haptics to simulate for the doctors at the controls the sense of touch that they lose by not holding the instruments, and allow them to overlay scans taken just before the patient enters the OR on the real-time images of his or her anatomy. Such augmented reality will guide surgeons in ways that are unimaginable today. That's the future, and it's going to happen." — Herbert J. Zeh III, MD, chief of gastrointestinal surgical oncology at the University of Pittsburgh Medical Center, as reported in U.S. News & World Report.

Read more about our use of robotics to treat gastrointestinal cancer. Learn about the history of robotic surgery. For consultations with our specialists in robotic GI cancer surgery, please call 631-444-8086.

Posted by Stony Brook Surgery on September 13, 2017

First Endowed Professorship in the Department of Surgery


At the investiture ceremony, (l to r) Dr. Michael F. Paccione, trauma surgeon; Dr. Daniel N. Rutigliano, trauma surgeon; Lillian Schneider, benefactor; Dr. James A. Vosswinkel, trauma surgeon and chief; Dr. Stephen A. Kottmeier, orthopedic surgeon and orthopedic trauma liaison; and Dr. Jerry A. Rubano, trauma surgeon.

Last Thursday, James A. Vosswinkel, MD, assistant professor of surgery and chief of trauma, emergency surgery, and surgical critical care, who serves as medical director of the Stony Brook Trauma Center and also the surgical intensive care unit, became the Lillian and Leonard Schneider Endowed Professor in Trauma Surgery.

Dr. Vosswinkel was honored at the investiture ceremony that took place at the university's Sunwood Estate in Old Field.

The Lillian and Leonard Schneider Endowed Professorship is the first endowed professorship in the Department of Surgery. It was established by Lillian Schneider in grateful recognition of the care she received at Stony Brook Medicine and in memory of her late husband Leonard Schneider.

In July 2016, Ms. Schneider was involved in a serious car accident on the East End, and was airlifted to the Stony Brook Trauma Center, where Dr. Vosswinkel and his team saved her life.

"The creation of the Lillian and Leonard Schneider Endowed Professorship in Trauma Surgery will have a profound effect on advancing Stony Brook's mission of providing world-class care and service to the residents of our county."

In his speech at the investiture ceremony (see full speech below), Dr. Vosswinkel said:

"The creation of the Lillian and Leonard Schneider Endowed Professorship in Trauma Surgery will have a profound effect on advancing Stony Brook's mission of providing world-class care and service to the residents of our county.

"Education programs such as 'PHTLS,' where we provide state-of-the-art trauma training and education to our volunteer EMS agencies, and 'BCON,' the potentially lifesaving hemorrhage control course that we've provided to many public-school districts, will expand.

"Injury prevention efforts such as 'Staying Independent for Life,' aimed at helping seniors prevent falls and be safe or 'Impact Teen Drivers,' which encourages drivers to make the right decisions while avoiding the dangers of distracted or impaired driving, will advance.

"Research efforts which are designed to further advance the care that we provide will flourish. And now, due to this generous gift, these programs will continue in perpetuity."

Board certified in surgery and surgical critical care, Dr. Vosswinkel joined the faculty of the Department of Surgery in 2002. He received his MD from the SUNY Upstate Medical University in 1995, and completed his residency training in general surgery at Stony Brook. Subsequently, he completed a fellowship in trauma/surgical critical care at Yale University.

Dr. Vosswinkel's clinical expertise includes traumatology, conventional and minimally invasive laparoscopic surgery, and the pre- and post-operative critical care of adult surgical patients. He also practices general surgery.

Among his previous honors are the Stony Brook University Physicians Award for Excellence in Clinical Practice (2011), Physician Hero Award of Long Island Business News (2014), and Physician of Excellence Award, Suffolk Regional Emergency Medical Services Council (2017).

As a resident here, Dr. Vosswinkel earned the first David J. Kreis Jr. Award for Excellence in Trauma Surgery, an annual award given to a senior (fourth-year) surgical resident by the Division of Trauma, Emergency Surgery, and Surgical Critical Care in honor of the late Dr. Kreis, the founding chief of our trauma and surgical critical care service.

In addition to his duties and responsibilities at Stony Brook, Dr. Vosswinkel is currently the chair of the Suffolk County Regional Trauma Advisory Committee and an active member of the New York State Trauma Advisory Committee.

Dr. Vosswinkel's Investiture Speech

Here is Dr. Vosswinkel's full speech delivered at the investiture ceremony, in which he spotlights the remarkable Lillian Schneider and her story, as well as the team of the Stony Brook Trauma Center, Suffolk County’s only verified Level 1 Trauma Center for adults and kids:

"Thank you, Drs. Stanley and Kaushansky, Lillian, colleagues, and invited guests.

"Tonight, we are here to honor Lillian and the team that is Stony Brook University, Stony Brook Medicine, and the Stony Brook Trauma Center.

"It was just last summer when a horrific car crash occurred in Montauk. A pick-up truck had crashed into the driver's side of Lillian's car. As the first responders arrived at the scene, they realized the gravity of the situation. The driver suffered extensive injury and was in shock. She required immediate lifesaving care. They summoned the SCPD air ambulance to transport Lillian to the Regional Level 1 Trauma Center, namely, Stony Brook.

"Upon arrival at Stony Brook, a trauma activation was called and the comprehensive group of staff and resources that make up our Trauma Center were mobilized and brought to Lillian's bedside.

"Without going into detail, Lillian had suffered trauma to multiple vital regions. When these injuries were summarized and graded, it was noted that the totality of this trauma put her in the most critically injured category. Survival and recovery for your average patient would be a very tall order.

"Well, as we all know, Lillian isn't your average person. Despite spending over 3 weeks in the ICU and over 1.5 months in the hospital, with additional time in rehab, Lillian returned back to her normal state of health.

"Lillian, you are truly one amazing person!

"Now if the story ended here, a critically injured patient making an against-all-odds full recovery, that would have been more than enough for any of us here at Stony Brook. It is this type of remarkable story that makes all of us eager to get up every morning, as well as in the middle of the night, to come to work and do our jobs.

"However, as we all know, the story doesn't end here and that is why we are all gathered tonight. We are here to celebrate and recognize your incredible generosity and the gift you have given. To quote your very humble words: 'I just wanted to give something back.' Well, I see it a bit differently. You are paying for something tremendous to move forward.

"The creation of the Lillian and Leonard Schneider Endowed Professorship in Trauma Surgery will have a profound effect on advancing Stony Brook's mission of providing world-class care and service to the residents of our county. Education programs such as 'PHTLS,' where we provide state-of-the-art trauma training and education to our volunteer EMS agencies, and 'BCON,' the potentially lifesaving hemorrhage control course that we've provided to many public-school districts, will expand.

"Injury prevention efforts such as 'Staying Independent for Life,' aimed at helping seniors prevent falls and be safe or 'Impact Teen Drivers,' which encourages drivers to make the right decisions while avoiding the dangers of distracted or impaired driving, will advance. Research efforts which are designed to further advance the care that we provide will flourish. And now, due to this generous gift, these programs will continue in perpetuity.

"Lillian, thank you. Words cannot truly express my gratitude.

"Many have heard the famous proverb that it takes a village to raise a child, which implies that a child has the best ability to become a healthy adult if the entire community takes an active role in contributing to the rearing of the child.

"Well, here at Stony Brook, we see trauma care in a similar light. It truly takes a 'center' to care for an injured patient. Even though I may now be the most visible member of the Trauma Center, none of this is really about me. It is about the team that is Stony Brook.

"Briefly before I end my remarks, I would like to recognize some of those in attendance tonight. These team members play crucial roles in a center that is truly made up of hundreds of faculty and staff. Disciplines and departments, from nursing to physical therapy to social work and beyond, integrate at Stony Brook to provide the highest quality of care to all of those who are in need.

"Dr. Stephen Kottmeier, the vice chairman of the Department of Orthopedics and the orthopedic trauma liaison. Thank you for your surgical skills, tireless work ethic, and academic acumen. More than half of all hospitalized trauma patients have one or more musculoskeletal injuries. A high level of commitment to providing state-of-the-art care is necessary to avoid these injuries from being limb-threatening or resulting in significant functional impairment.

"Dr. Mark Schweitzer, the chairman of radiology and the radiology liaison to the trauma center. Thank you for your commitment to the 24/7 immediate needs of our patients and the advancement of trauma imaging. Radiological services are critical in the management of severely injured patients. Conventional radiography, complex imaging studies, and interventional procedures are vital to providing the highest quality of care.

"Dr. Mark Henry, the chairman of emergency medicine. Thank you for your long-standing commitment to the development of our trauma program and the NYS trauma system. Emergency medicine and emergency physicians are important components of the trauma system and trauma team. They work hand in hand with trauma surgeons. Proficiency in the performance of both diagnostic and resuscitative procedures is required for optimal patient care.

"Dr. Daryn Moller, the anesthesia liaison to the Trauma Center. Thank you for your clinical expertise, team work and steadfast contributions. Anesthesiology services are critical in the management of severely injured patients. Establishing airway control, assisting with resuscitation, providing preoperative and postoperative cardiorespiratory support and assisting with pain control are essential components of patient care.

"Dr. Mark Talamini, the chairman of surgery, and Ms. Carol Gomes, the COO of Stony Brook University Hospital. Thank you for your mentorship and invaluable daily attention to the support and operation of the trauma program. In addition to your many other responsibilities, your dedication to ensuring that the trauma program has all the necessary resources continues to reaffirm Stony Brook's promise to provide the highest quality of care to our patients.

"Ms. Jane McCormack, the trauma program manager. Thank you for your 23 years of commitment to the development and maturation of our trauma program and the county and state trauma system. The trauma program manager is fundamental and the cornerstone to the development, implementation, and integration of the trauma program. Essentially, from the inception of our trauma program, you have been the constant beacon and guiding light.

"Drs. Randeep Jawa, Michael Paccione, Steven Sandoval, Marc Shapiro, Jerry Rubano, and Dan Rutigliano, my colleagues and partners in the Division of Trauma, Emergency Surgery, and Surgical Critical Care. Thank you for your devotion and undying conviction to providing the highest level of care to all our injured and critical ill patients. The critical care surgeon is the foundation of a trauma hospital's trauma program. They lead the trauma team and are responsible for the overall care of trauma patients, including coordinating care with other specialties and maintaining the continuity of care.

"Additionally, I would like to thank Dr. Stanley and Dr. Kaushansky, for your leadership, guidance, support and commitment to excellence. Injury is a public health problem of enormous magnitude, whether measured by years of productive lives lost, prolonged or permanent disability, or financial cost. A Level 1 Regional Trauma Center is the tertiary care facility central to the trauma care system. In Suffolk County, that is a system that comprises 106 volunteer ambulance agencies which provide care for 1.5 million people. It requires large personnel and facility resources for optimal patient care, education, and research.

"And lastly, I need to thank my wife of 15 years, Regina. Thank you for our gorgeous three daughters. Thank you for the innumerous sacrifices that you have made. Thank you for your undying patience and understanding with the unpredictability of my duties. And most importantly, thank you for always being there — for me and our family."

Learn more about the Stony Brook Trauma Center and its many programs dedicated to saving lives and preventing injuries. Visit the webpages of our Division of Trauma, Emergency Surgery, and Surgical Critical Care.

Posted by Stony Brook Surgery on August 28, 2017

Aiming to Advance Heart Surgery for Aortic Valve Replacement

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Drs. Thomas V. Bilfinger (left) and Henry J. Tannous, our surgeons participating in the Low-Risk TAVR trial with Stony Brook Medicine interventional cardiologists.

Aortic stenosis — narrowing of the aortic valve opening — is now the most frequently diagnosed heart valve disease. It is a potentially life-threatening condition, with a long latency period followed by rapid progression after the appearance of symptoms.

Left untreated, 50% of patients with aortic stenosis die within two years of having symptoms.

Surgical replacement of the aortic valve reduces symptoms and improves survival in patients with this illness, and in the absence of serious co-existing medical issues, the procedure is associated with very good outcomes.

However, 30% of patients with severe aortic stenosis can’t undergo the conventional valve replacement surgery, because of their advanced age and/or the presence of multiple other illnesses.

The appeal of TAVR is no surgical incision, less pain, a shorter or
no ICU stay, and faster return to normal activity.

For these high-risk patients, a less invasive treatment had been sought and, finally, the technology to achieve it was developed.

The new technology, approved by the FDA in the fall of 2011, is an aortic valve replacement device that's implanted without conventional “open heart" surgery.

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Placement of the valve device is done from within the aorta, via catheter, without open heart surgery.

The innovative procedure delivers the replacement valve via catheter (thin tube) while the heart is still beating. Called transcatheter aortic valve replacement (TAVR), it is performed in team fashion by cardiovascular surgeons and cardiologists working closely together.

Recovery time averages from one to two weeks. Patient selection and follow-up care involve a collaborative effort between referring physicians and our valve specialists.

Use of TAVR in patients deemed at low risk for conventional surgical valve replacement is now being studied, and in February 2017, members of Stony Brook University Heart Institute joined a multicenter clinical trial of it. Nine other select hospitals nationwide are participating.

In 2012, Stony Brook Medicine was the first in Suffolk County to offer TAVR for high-risk patients.

The co-principal investigators of the Low-Risk TAVR (LRT) trial at Stony Brook are cardiothoracic surgeon Thomas V. Bilfinger, MD, ScD, professor of surgery, and interventional cardiologist Luis Gruberg, MD, professor of medicine and director of Cardiovascular Catheterization Laboratories, who initiated the trial here.

Henry J. Tannous, MD, associate professor of surgery, of our Cardiothoracic Surgery Division is also an investigator in the study, along with four additional Stony Brook interventional cardiologists, including Puja B. Parikh, MD, MPH, assistant professor of medicine and medical director of the TAVR program.

Two different transcatheter aortic replacement valves are being used in the study at Stony Brook; namely, the CoreValve and the Sapien, as the devices are called.

"The LRT study is the first US Food and Drug Administration-approved Investigational Device Exemption prospective multicenter feasibility trial of TAVR in low-risk patients. Patients determined to be low risk by the Heart Team will be enrolled to undergo TAVR with a commercially available balloon-expandable or self-expandable device. A propensity score-matched, site-specific cohort of historical surgical aortic valve replacement patients will serve as a control group treated during the site's enrollment period or within the prior 3 years.… Enrollment commenced in 2016 and results are expected in 2018." — Feasibility of transcatheter aortic valve replacement in low-risk patients with symptomatic severe aortic stenosis, American Heart Journal (July 2017).

Read about the TAVR program at the Stony Brook Heart Institute. For more information about the TAVR trial at Stony Brook, please call study coordinator Ruth Tenzler Stein at 631-444-3309. Watch this video (5:22 min):

Posted by Stony Brook Surgery on August 15, 2017

Stony Brook Medicine in Collaboration with Brookhaven National Laboratory

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Dr. Joseph Kim and Dr. Cathy S. Cutler

Gastric (stomach) cancer is a devastating condition with mostly poor survival. It is the second most common cause of cancer-related deaths worldwide. About 28,000 people in the United States are told every year they have this cancer, according to the American Cancer Society.

Major advances in personalized therapies including monoclonal antibodies (mAbs) have improved survival for many cancers, but the benefits remain marginal for gastric cancer.

One gap in treatment is that effective mAbs for gastric cancer may already exist in clinical practice, but have yet to be tested in gastric cancer. However, it would take exorbitant costs to test all of these drugs in gastric cancer.

The second gap in treatment is that the efficacy of a gastric cancer therapy may be unique only to select patients.

The essence of personalized medicine: taking a patient’s tumor … and
testing drugs to see which one would be most effective for that individual patient.

Joseph Kim, MD, associate professor of surgery and member of our Surgical Oncology Division, and Cathy S. Cutler, PhD, director of the Medical Isotope Research and Production Program at Brookhaven National Laboratory (BNL), have teamed up to conduct a research project titled "Development of Radiolabeled Drugs to Study Novel Gastric Cancer Models."

Their project — funded by a Stony Brook–BNL seed grant awarded in June — aims to establish an accurate and expeditious diagnostic platform that provides data to make actionable clinical decisions on mAbs for gastric cancer.

To this end, they will build upon their prior work and develop gastric cancer organoids for gastric cancer patients and use radiolabeled antibodies to select optimal therapeutic drugs.

Dr. Kim explains, "Our study is the essence of personalized medicine: taking a patient's tumor, creating a cancer model, and testing drugs to see which one would be most effective for that individual patient."

The Stony Brook–BNL seed grant program serves to foster collaborative efforts between scientists at the university and BNL. It is a key element for developing synergistic activities that can grow joint research programs that are aligned with the strategic plans of both institutions.

The program was started in 1999. Scientists from both institutions work in conjunction with colleagues to bring their ideas to life. The collaboration of Drs. Kim and Cutler capitalizes on the clinical and translational science expertise of Stony Brook Medicine and BNL.

What is a monoclonal antibody? Simply put, in clinical practice, it is a drug that targets a specific protein. It circulates throughout the body until it can find and hook onto the target protein. Oncologists generally use it as a homing device to take a chemotherapy agent or a radioactive particle directly to cancer cells. In recent decades, the use of different types of mAbs in various ways has helped to advance cancer care.

Learn more about gastric cancer from the American Cancer Society, as well as about monoclonal antibodies to treat cancer. For consultations/appointments with Dr. Kim, please call 631-444-8086.

Posted by Stony Brook Surgery on August 9, 2017

By Mark A. Talamini, MD, MBA, Chairman of Surgery, Stony Brook Medicine

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Dr. Mark A. Talamini

Most everyone has an iPhone, or equivalent, in their pocket these days. So, it's pretty easy to record a conversation without the other person knowing. Surgeon's visits can be stressful. Unfortunately, they are often far too hurried, but critical information is being presented.

Patients often tell me that they had questions that weren't answered, either because they didn't think of them until later, or because of the stress of the visit.

Surgeons want their patients to have as much information as possible about their situation, and about the risks and benefits of surgery, but the communications of surgeons are not always perfect, and sometimes things are not as clear as they could be.

So, why not record the conversation?

Having a conversation or interaction be recorded without your knowledge is not a pleasant situation. It is easy to feel like you have been tricked, and you immediately wonder if what you said with the best of intentions might be used against you. It is almost impossible to not feel defensive if this happens to you.

But do patients record their surgeon visits? Do they do so without informing the doctor? Are there cases where doctors are recording the appointment conversation without the patient knowing? These questions bear on all concerned.

Now we have some data to speak to the issue of recording doctor's visits. A new article in JAMA, titled "Can Patients Make Recordings of Medical Encounters? What Does the Law Say?," addresses this issue head-on. It presents data from the United Kingdom showing that 15% of patients had secretly recorded their doctor's visit.

Recording doctor's visits should probably be okay, particularly if all agree,
but there are likely even better ways to better educate patients.

Eleven percent of physicians reported being aware of someone covertly recording an appointment.

Although I am not a lawyer, my understanding of the legal concerns associated with the issue is that the laws regarding the recording of private conversations vary from state to state.

In some states, all parties must consent for a recording to be legal (California, for instance). New York is a "single consent" state, meaning that an individual can record a conversation without obtaining the consent of the other participant(s) in the conversation.

However, what is legal and what is best for an effective physician-patient relationship is another matter.

Any physician recorded without their knowledge is likely to be upset on learning of the occurrence, suspecting an attempt at gaining a legal advantage for a lawsuit. However, as the JAMA article points out, patients have some very legitimate reasons for recording.

Doctor's visits are high-anxiety events for most patients. Details are easily forgotten. The volume of new information is often overwhelming.

It seems perfectly reasonable that a patient would want a means of better understanding their health situation following a doctor's visit. In 2017, with a recording device in virtually every pocket, it is no surprise that patients resort to recording.

How can this situation be improved? I would suggest that if patients want to record their visits, they should simply tell their physicians that is what they wish to do, and why. Most physicians will easily agree. They can also make the situation of their patients better by providing them with enduring materials with key information, either on paper or on the web.

Patient education materials are often best provided prior to the doctor's visit, so that the visit can focus on important questions as well as transmitting information. Recording doctor's visits should probably be okay, particularly if all agree, but there are likely even better ways to better educate patients.

Clearly, the challenge of how best to provide patients and those who care about them with all the information they need from their doctor's visits has to be addressed fully and carefully in order to advance patient care.

"Patients' prime motivation for recording is to enhance their experience of care, and to share it with others. Patients know that recording challenges the 'ceremonial order of the clinic,' and so some decide to act covertly. Patients wanted clearer, more permissive policies to be developed." — Elwyn G, Barr PJ, Grande SW. Patients recording clinical encounters: a path to empowerment? BMJ Open 2015;5:e008566. [This study is the source of the data cited above, and is the first to estimate the extent to which patient recording of medical encounters, covertly or openly, is occurring in the UK.]

Dr. Talamini invites comments from the public, as well as from the medical community, on the issue of recording doctor's visits. What do you think about it?

Posted by Stony Brook Surgery on July 31, 2017

By Mark A. Talamini, MD, MBA, Chairman of Surgery, Stony Brook Medicine

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Dr. Mark A. Talamini

Here's a question you might not have been pondering: If you have a hernia repair with mesh, are you less likely to have children than someone who has not had such an operation?

Why would this question even be a consideration? When you fix an inguinal (groin) hernia, the operation of necessity involves the blood vessels, nerves, and structures that transport sperm from the testicle "out." They are only very rarely injured during a hernia repair (particularly a first-time hernia repair).

But now that mesh is used so frequently, could it be having an effect overall on fertility?

These are the types of questions for which we can now begin to get at least partial answers by using large databases. These databases are the fruit of electronic medical records and government care systems.

By using large databases in our research, we can answer many questions
about operations and better inform patients about them.

A group from the Department of Surgery at the University of Copenhagen used a set of five linked comprehensive registers to look into the effect of hernia repair upon male fertility. They just reported their findings.

These researchers examined the records of over 32,000 men between the ages of 18 and 55 who had undergone one or more hernia repairs between 1988 and 2012. They specifically looked at two types of repairs that both use mesh, a groin incision-based (Lichtenstein) approach and a laparoscopic approach.

Bottom line: neither type of hernia repair decreased the number of children fathered by the patients compared to the population that did not have a hernia repair.

As surgeons, having information like this helps us better inform patients as they consider surgery as an option, in this case for a hernia.

"Although the effect of inguinal hernia repair on male fertility has previously been investigated through indirect measures, no previous studies have evaluated the final measure of male fertility, which is the number of children fathered by patients. Analyzing data from five comprehensive Danish linked registers, we found that patients who underwent inguinal hernia repair using Lichtenstein technique or laparoscopic approach did not father fewer children than expected. Thus, inguinal hernia repair using these approaches did not impair male fertility." — Kohl AP, Andresen K, Rosenberg J. Male fertility after inguinal hernia mesh repair: a national register study. Ann Surg 2017 Jul 12. Epub ahead of print.

Read about RECORD: The REporting of studies Conducted using Observational Routinely collected health Data, and how such data are increasingly used for research to advance evidence-based medicine.

Posted by Stony Brook Surgery on July 28, 2017

Providing Vascular Tests at No Cost for the Health of Our Community

3 Simple Tests
Click on image to enlarge.

The Vascular and Endovascular Surgery Division provides free vascular screenings throughout the year, and they continue to save lives through the early detection of vascular disease.

The most common forms of vascular disease are abdominal aortic aneurysm (AAA), carotid artery disease, and peripheral artery disease (PAD) — all serious and life-threatening, often occurring "silently" without any symptoms. For this reason, early detection and treatment are crucial.

Aneurysms and strokes — common conditions caused by vascular disease — can strike suddenly and without warning. That's why it's best to identify and treat underlying causes before symptoms appear.

The screening process for all three tests that we perform is quick — about 10 minutes for each test — and painless.

Are you 60 or older? Or, do you have one or more of the following risk factors for aneurysm, stroke, or vascular disease?

  • Current or past smoker
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Heart disease
  • Family history of aortic aneurysm

If yes, please call the office of our vascular nurse navigator Olympia Christoforatos at 631-444-2041 to learn about our upcoming screening dates and locations, as well as to register for your screening.

Vascular diseases are conditions that affect the blood vessels — arteries and veins — that carry blood throughout the body. Vascular disease that affects the arteries is most often caused by atherosclerosis, a process resulting from a buildup of fatty deposits (plaque) on the inner lining of the arteries.

As the buildup of plaque progresses, blood flow can become restricted or the artery may dilate and become aneurismal, like a bubble on an inner tube. Narrowing or blockages of arteries can occur in the arteries near the heart (cardiovascular disease), or in arteries farther from the heart, such as those in the arms, legs, and brain.

At our screening we perform three non-innasive tests to identify the presence of vascular disease: carotid ultrasound, to check for clogged carotid arteries in the neck, which can lead to stroke; abdominal aortic ultrasound, to test for aortic aneurysms, which can burst if reaching a large size; and, ankle-brachial index, to check for PAD, which may pose a threat to the health of the legs and is often a sign of heart disease. (Learn about ultrasound.)

The Department of Surgery provides a range of special clinical and educational services to the Long Island community to fulfill its mission of excellence in community service.

Click here to learn more about our vascular screening program. Watch these new videos about the program and two of our grateful patients:


Why Our Vascular Screening Program (0:30 min)
                                       
Testimonials of Two Grateful Patients (5:20 min)

Posted by Stony Brook Surgery on July 25, 2017

By Mark A. Talamini, MD, MBA, Chairman of Surgery, Stony Brook Medicine

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Dr. Mark A. Talamini

The American Board of Surgery sent out a very important email recently, announcing "a new direction for our program of lifelong learning and continuous certification."

The most potent piece of information in this email related to the written examination that all holders of an American Board of Surgery certificate have had to take every ten years since 1976.

The email details that "diplomates [board-certified surgeons] will be offered alternatives to the ten-year recertification examination in general surgery," with those alternatives not yet determined.

This news came right home for me, as I was about to figure out how I would block out study time for the exam later this year.

All of us who have periodically taken this exam know the drill. Drop everything for a few weeks and memorize testable details regarding the broad field of general surgery. Then go to a testing center, empty your pockets into a small locker, and take a tough multi-hour exam.

Surgery must have a means of communicating to the public that surgeons are
competent throughout their surgical careers, not just at the beginning of their careers.

Not requiring this exam is a massive change. What has brought it about?

There has been a recent physician backlash against the ever-increasing and ever-expensive requirements that doctors feel burdened by. The focus has been internal medicine. As a result, legislation has been introduced in numerous statehouses to make requirement of board recertification for hospital privileging illegal.

The drama is unwelcome. Surgery must have a means of communicating to the public that surgeons are competent throughout their surgical careers, not just at the beginning of their careers when they have just passed a series of rigorous examinations.

But the model of a multiple choice test every ten years can definitely be improved upon.

So how should the public read this? To some degree, it is an important work force (surgeons and physicians) making clear the increasing regulatory, administrative, and financial burdens of the current practice of medicine are taking a toll.

The patience of the American physician workforce is not limitless.

I believe the more important message is that the American Board of Surgery, with the support of the vast majority of surgeons, is committed to lifelong learning and assessment of skills. They will take the current bit of turmoil as an opportunity to create a much better means of doing so.

The American Board of Surgery is an independent, nonprofit organization founded in 1937 to assess the qualifications of individuals in the field of surgery. It offers primary board certification in surgery (general surgery) and vascular surgery, and secondary certification in several related specialties. Not all surgeons are board certified. Board certification is a voluntary process that demonstrates a surgeon's commitment to professionalism, lifelong learning, and quality patient care. Approximately 30,000 surgeons are currently board certified by the American Board of Surgery.

Read more about certification provided by the American Board of Surgery — why it matters and how it's obtained.

Posted by Stony Brook Surgery on June 26, 2017

Patients More Likely to Receive Repair Than Replacement from Most Experienced Surgeons

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Dr. Joanna Chikwe

The mitral valve is the most complex of the heart's four valves, and is the one most commonly associated with disease. It is located between the left heart chambers (left atrium and left ventricle). In mitral valve disease, it doesn't work properly.

There are three main conditions that affect the valve: obstruction (stenosis), leakage (regurgitation), and bulging backward during valve closure (prolapse).

Prolapse is the most common, occurring in up to 5% of the population, whereas stenosis is the least common, accounting for less than 1% of cardiac diagnoses in the United States, although it is more frequently seen in developing nations.

A faulty mitral valve that is not causing symptoms — cough, shortness of breath, swollen feet or legs, chest pain, fatigue, lightheadedness — may not need any treatment. Mild symptoms may be treated with medicine. With more severe symptoms, surgery may be required.

Most mitral valve surgeries have a low rate of complications, according to the Society of Thoracic Surgeons. However, potential complications include bleeding, infection, blood clots, irregular heart rhythm, or heart attack.

The contribution of surgeon-specific factors in the outcomes of mitral valve surgery is poorly defined. Thus, Joanna Chikwe, MD, our chief of cardiothoracic surgery and co-director of the Stony Brook Heart Institute, and her colleagues at Mount Sinai Heart, conducted a study to evaluate the influence of surgeon case volume.

The study, of which Dr. Chikwe is lead author, was published last month in the Journal of the American College of Cardiology, titled "Relation of Mitral Valve Surgery Volume to Repair Rate, Durability, and Survival." It was featured on TCTMD. The findings were simultaneously presented at the American Association for Thoracic Surgery Centennial meeting in Boston.

"Look at not just the number of mitral valve operations in the surgeons,
but what his or her repair rates actually are."

"We were able to show that durability of repair was actually about three times as good in patients operated on by surgeons doing more than 25 mitral valve operations per year," Dr. Chikwe says.

"And that translates into even better survival at one year. More patients were likely to be alive at one year if they had their mitral valve repair done by a high-volume surgeon."

Dr. Chikwe adds that volume is used as a surrogate for expertise, but it doesn't tell the full story: "On its own, the number [of mitral valve surgeries] doesn't necessarily predict that you'll have a good repair.

"I think what we're really trying to encourage with referring physicians and patients is to look at not just the number of mitral valve operations in the surgeons, but what his or her repair rates actually are."

Guidelines in the U.S. and Europe recommend valve repair instead of valve replacement when possible, according to the researchers, although they mentioned mitral valve replacement remains common in patients with degenerative valve disease.

The Study Itself

This study included 5,475 adults who underwent primary mitral valve operations in New York between 2002 and 2013 and were part of the Statewide Planning and Research Cooperative System, an all-payer, administrative database.

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Illustration of heart from Gray's Anatomy showing location of bicuspid valve, another name for mitral valve (click on image to enlarge).

The researchers reviewed all of the patient data before the operation and followed up patients for at least 12 months after the procedure. They also identified 313 surgeons from 41 institutions who met their eligibility criteria.

Patients who saw surgeons with less than 25 operations in a year were significantly more likely to present as urgent admissions and were more likely to have congestive heart failure, chronic kidney disease, or chronic airway disease, compared with patients who were operated on by surgeons with higher total annual surgeon volumes.

After the researchers adjusted for multiple variables, they found that the total annual surgeon volume was independently associated with the probability of mitral valve repair. They mentioned the probability of repair increased by 13% for every 10-case increment in total annual surgeon volume.

Patients who were operated on by surgeons with a total annual surgeon volume of more than 50 operations were more than three times as likely to undergo mitral valve repair compared with those who were operated on by surgeons with an annual surgeon volume of 10 or fewer operations.

They also found a significant association between low surgeon volume and increased risk of mitral valve reoperation within 12 months of follow-up after mitral valve repair.

The cumulative incidence of reoperation at 12 months was 1.3% for patients operated on by a surgeon with a total annual surgeon volume of 25 or more operations, compared with 3.6% for patients operated on by a surgeon with total annual surgeon volume of less than 25 operations.

Although mitral repair was significantly associated with better survival compared with mitral replacement, the total annual surgeon volume remained a significant independent predictor among patients undergoing mitral replacement, according to Dr. Chikwe and her colleagues.

"This study adds further clarity to the American Heart Association and American College of Cardiology guidelines, which already recognize that patients with degenerative mitral valve disease should be referred to experienced mitral surgeons whenever feasible," says senior study author David H. Adams, MD, who is cardiac surgeon-in-chief at Mount Sinai. "Our study found for the first time that individual surgeon volume was directly linked to freedom from reoperation and survival after one year in patients operated on for degenerative mitral valve disease."

See Dr. Chikwe's study in the Journal of the American College of Cardiology. For consultations/appointments with her and our other experienced mitral surgeons, please call 631-444-1820.

Posted by Stony Brook Surgery on June 14, 2017

Immediate Complete Lymph-Node Dissection Does Not Improve Melanoma-Specific Survival

By Tara L. Huston, MD, Assistant Professor of Surgery and Dermatology,
and Leader, Melanoma Management Team

Dr. Tara L. Huston | Stony Brook Plastic Surgeon
Dr. Tara L. Huston

The New England Journal of Medicine just published the results of the Multicenter Selective Lymphadenectomy Trial (MSLT-II). The report includes data from patients who have participated here at Stony Brook Medicine, and is very interesting for a good reason.

MSLT-II is the follow-up to MSLT-I, which provided the basis for utilizing sentinel node biopsy in patients with melanoma (see my 2014 commentary on MSLT-I).

Lymph nodes are tiny, pea-sized structures throughout the body that work as filters for harmful substances; they contain immune cells that can help fight infection and disease (read more).

The sentinel node biopsy tests the lymph node that drains the melanoma and the skin around it for evidence of cancer. If the sentinel node is unaffected, the cancer is highly unlikely to have spread to surrounding lymph nodes or distant sites in the body.

This study, titled "Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma," sought to answer the question of how to manage metastases (cancer spread) in the sentinel lymph node. Up until now, the treatment was to perform a completion lymph-node dissection; that is, full removal of all lymph nodes in the vicinity of a melanoma skin cancer .

Completion lymph-node dissections risk permanent and debilitating limb swelling. Historically, we know that only about 15% of patients whose melanoma has spread to the sentinel node will have additional disease. That means 85% of patients will not have any further disease, and are subjected to the completion lymph-node dissection.

So, the question we attempted to answer was, Can we safely do follow-up evaluations on these patients, instead of doing invasive surgery on them?

MSLT-II was a prospective, randomized, international, phase 3 (tests safety and efficacy) trial with 1,939 patients. Patients with melanoma in the sentinel node were randomized into immediate completion dissection versus active surveillance with ultrasound of the nodal basin every six months.

Removing all lymph nodes in the vicinity of a melanoma skin cancer was found to
not increase a patient's overall chances for melanoma-specific survival.

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Full lymph-node removal surgery did not increase melanoma-specific survival more than observation with frequent nodal ultrasound.

This study confirmed that, among patients with melanoma and sentinel-node spread of the cancer, immediate full lymph-node removal surgery increased the rate of regional disease control, and provided prognostic information. However, it did not increase melanoma-specific survival.

The probability of melanoma-specific survival was similar in both the observation and the dissection (removal surgery) groups as far as ten years out from randomization. There was no statistically significant difference. The risk of complications from the lymph-node dissection was nearly 24% in the dissection group versus only 6% in the observation group. The difference in complications was statistically significant.

These findings are important for several reasons. First, they confirm that performing a delayed completion dissection when disease manifests does not result in losing control of the disease. Second, they demonstrate that active surveillance of the nodal basin is a safe and efficient way to identify patients who are most likely to benefit from delayed completion lymph-node dissection.

Lastly and most significantly, they prove no melanoma-specific survival benefit of early completion lymph-node dissection.

Our melanoma program at the Stony Brook University Cancer Center continues to offer the most up-to-date treatment options for our patients. This latest research supports our current practice of offering sentinel node biopsy for patients with melanoma deeper than 1 mm (thickness of a dime).

Currently, there are minimal data to support sentinel node biopsy for thin melanomas less than 1 mm deep, although its use may be considered in certain high-risk patients.

The findings of this study are a game-changer that will protect patients from the debilitating consequences of unnecessary surgery, says Daniel G. Coit, MD, a surgical oncologist at Memorial Sloan Kettering Cancer Center, in his editorial published along with the report. This new study clearly defines the proper role of surgery, Dr. Coit explains. He states, "The findings of the second Multicenter Selective Lymphadenectomy Trial (MSLT-II) … are definitive, unequivocal, and completely consistent both with the published results of retrospective series and with the published results of one previous prospective, randomized, clinical trial."

Click here to read the abstract of the study in the New England Journal of Medicine. For consultations/appointments with the surgical specialists of the Stony Brook Melanoma Management Team, please call 631-444-4666.

Posted by Stony Brook Surgery on June 12, 2017

Our Residency Programs Train Physician-Scientists to Both Practice and Advance Surgery

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Winner of Outstanding Poster Competition (click to enlarge).

This year's Research Day program took place last Thursday at Stony Brook University's Charles B. Wang Center, and was another great success, as the event continues to grow, and the quality of the research stays at an incredibly high level.

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 committed to making research happen," said Mark A. Talamini, MD, professor and chairman of surgery, and chief of surgical services at Stony Brook Medicine, in his opening remarks at the program.

"Our Research Day celebrates our discoveries. It also demonstrates that as academic surgeons we not only have the job to take care of patients, but to make surgery better. This is what sets us apart."

Research Day demonstrates how we're making surgery better and what sets us apart.

The program included over 50 posters presenting study abstracts, plus five oral presentations moderated by faculty discussants, and it attracted over a hundred attendees from Stony Brook Medicine and the University community.

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Dr. Eric A. Rose

The keynote speaker was Eric A. Rose, MD, Edmond A. Guggenheim professor and chairman of population health science and policy, associate director for Clinical Outcomes at Mount Sinai Heart, and professor of cardiothoracic surgery, medicine (cardiology), and surgery at the Icahn School of Medicine at Mount Sinai, in New York. Previously, he was professor and chairman of surgery at Columbia University.

A world-renowned surgeon and scientist, Dr. Rose — who made history in 1984 when he performed the first successful pediatric heart transplant — has a long record of leading-edge research. He has authored or co-authored more than 300 peer-reviewed publications on topics such as cardiovascular surgery, ventricular assist devices, and cardiac transplantation.

Dr. Rose's talk, "Understanding Translational Research: Insights from Adventures in Interventional Biology," focused on the challenges of bringing problems from the bedside to the laboratory, and returning laboratory advances to the bedside — a process that, as he demonstrated with his own research, can take decades to complete.

He emphasized that it is "incumbent on any clinician and on every surgeon to learn the fundamentals of clinical trials." His talk illustrated how translational research bridges discovery to clinical delivery, and that in moving from problem to solution, it requires the development of an intervention.

He explained: "Classical 'bench to bedside' translational research is responsible for many important advances, but cannot account for many others, which begin with clinical observations. My personal involvement in translational research has ranged from exploration of long-term mechanical circulatory support devices to amelioration of the progression of Alzheimer's disease to the pharmacologic cure of smallpox."

Dr. Rose's experience has taught him that translational research is, in his words, largely opportunistic, inefficient, and frustratingly slow. He concluded: "Understanding of the process and complexity of translational research may help us to do it faster and better."

Commenting on the purpose of Research Day, A. Laurie W. Shroyer, PhD, MSHA, professor of surgery and vice chair for research, who oversees the event, says: "Research Day shows the commitment of our department to advancing scientific knowledge in order to improve patient care and population health.

"Residents and fellows, as well as junior faculty, utilize their research projects to address important clinical questions that they face each day, fostering their curiosity and building their excitement and enthusiasm for current and future biomedical research.

"By networking at events such as Research Day, they gain new opportunities for collaborative multidisciplinary team projects. Most important, our Research Day lights the pathway for trainees to envision a future career in academics."

Research Day lights the pathway for trainees to envision a future career in academics.

All categorical residents in our general surgery residency program are 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 is moving the science of surgery forward.

The Research Day program offers continuing medical education (CME) credit; this activity is designated for a maximum of 3.0 AMA PRA Category 1 Credits™.

2017 RESEARCH DAY POSTERS

Here are the titles/authors of the posters exhibited at this year's Research Day. Together, they demonstrate the range of research activity within the Department of Surgery, and the impressive productivity of our residents and students:

  • Aberrations in peripheral arterial ultrasound as a marker of underlying cardiac disease | Karim S, Labropoulos N.
  • Admission of older blunt thoracic trauma patients directly to the intensive care unit improves outcomes | Pyke O, Rubano J, Vosswinkel J McCormack J, Huang E, Jawa R.
  • Aortioliac anatomic characteristics predisposing to type 1B endoleaks and limb occlusion after EVAR | Tzavellas G, Monastiriotis S, Jaskinski P, Tassiopoulos A.
  • Assessing the effect of New York State (NYS) legislation on autologous tissue based post-mastectomy reconstruction rates | Gooch J, O'Hea B, Telem D, Yang J, Park J, Bui D, Khan S.
  • Characterizing epidemiological trends among New York City preterm infants with apnea | Regenbogen E, Zhang S, Yang J, Shroyer AL, Zhu C, DeCristofaro J.
  • The combined use of prophylactic serum PTH and intraoperative reduction of serum PTH to predict the development of clinically symptomatic hypocalcemia following parathyroidectomy for primary hyperparathyroidism | Fleury M.
  • Comparison of etiologies for primary functional fistula failure in newly created arteriovenous fistulae | Nzeribe A, Kokkosis A.
  • Correlation between pelvic congestion syndrome and body mass index | Jasinski P, Nanavati R, Adrahtas D, Gasparis A, Labropoulos N.
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  • Coverage of the left subclavian artery in blunt thoracic aortic injury is not necessary to achieve aortic healing in patients with short proximal landing zones | Skripochnik E, Novikov D, Loh S.
  • Current trends and effectiveness in percutaneous lecystostomy tube utilization | Zhao K, Kim J, Telem D, Yang J, Parikh P.
  • Delayed thrombophlebitis of the great saphenous vein after endovenous ablation | Garcia R, Gasparis A, Labropoulos N.
  • Development and utilization of a patient decision aid for management of thyroid nodules | Chao E, Amadi C, Maxwell C, Czerwonka L.
  • Differences between males and females with intermittent claudication undergoing percutaneous angioplasty in the greater New York Vascular Quality Initiative | Jasinski P, Labropoulos N, Tassiopoulos A, Kokkosis A.
  • Diverse management of isolated calf deep vein thrombosis in a university hospital | Garcia R, Probeck K, Elitharp D, Gasparis A, Labropoulos N. Finalist in Outstanding Poster Competition.
  • Do traffic law violators have differing attitudes about their driving behaviors? | Ladowski K, Vosswinkel J, McCormack J, Clouston S, Jawa R.
  • Elective medical management of three patients with an acute type A aortic dissection: case series and a review of the literature | Rabenstein A, Gioia W, Salhab K.
  • Endoscopic evaluation of the postoperative bariatric surgery patient | Svestka M, Docimo S.
  • Evaluation of compliance with recommendations for VTE prophylaxis and the impact of alternate regimens on post-operative bleeding and thrombotic complications following bariatric surgical procedures | Altieri M, Yang J, Hajagos J, Park J, Gasparis A, Konstantinos S, Shroyer AL, Talamini M.
  • Evolution of type II endoleaks based on different ultrasonographically identified patterns | Monastiriotis S, Lau I, Loh S, Ferretti J, Tassiopoulos A, Labropoulos N.
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  • Eye-tracking devices: a novel communication method for mechanically ventilated ICU patients | Pasternak D, Garry J, Duffy E, Fitzgerald D, Grant K, Minardi C, Dookram M, Vosswinkel J, Jawa R.
  • Gastrostomy tube utilization in transoral robotic surgery with neck dissection | Frenkel C, Yang J, Zhans M, Ferrara A, Telem D, Samara G. Finalist in Outstanding Poster Competition.
  • Hernia-related mesh infection: when does it happen and who gets it? | Groves D, Bates A, Yang J, Zhu C, Spaniolas K, Docimo S, Talamini M, Pryor A. Finalist in Outstanding Poster Competition.
  • Identifying factors causing suboptimal outcomes of enhanced recovery after surgery (ERAS) protocol on elective colorectal surgical patients: retrospective observational study | Choi H, Denoya P.
  • The impact of learning curve on robotic rectal cancer surgery on outcomes | Simon J, Abbas SK, Yelika SB, You K, Lee KP, Bergamaschi R.
  • The impact of PTSD on health outcomes in veterans receiving treatment for prostate cancer | Tchou W, Bevilaqua L, Romeiser J, Agrawal N, Ni X, Laimit T, Shroyer AL.
  • Increasing common bile duct injury and decreasing utilization of intraoperative cholangiogram and common bile duct exploration over 14 years. An analysis of outcomes in New York State | Altieri M, Yang J, Talamini M, Pryor M.
  • Increasing efficacy and efficiency in treatment and discharge for patients with uncomplicated and complicated appendicitis | Karim S, Shah A, Schnur J.
  • Inguinal pain and fullness due to an intravascular leiomyoma in the external iliac vein | Terrana L, Skripochnik E, Labropoulos N, Henretta M, Griffin T, Loh S.
  • An innovative irrigating wound protector for colorectal surgery | Chantachote C, Yelida S.
  • Key factors in predicting cephalic vein graft usage in autologous breast reconstruction | Mukit M, Trostler M, Kelly R, Dhillon S, Klein G, Huston T, Gelfand M, Khan S, Bui D.
  • Latrogenic esophageal perforation in neonates | Hesketh A, Behr C, Soffer S, Hong A, Glick R.
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  • Mechanical and biological characterization of tissue-engineered blood vessels | Varghese E, Singh G, Liang K, Cordero J, Wiles B, Marmorat C, Rafailovich M, Labropoulos N, Bui D, Khan S, Simon M, Clark R, Dagum A.
  • Outcomes of Roux-en-Y gastric bypass and sleeve gastrectomies depending on 1st assistant training level | Goldberg I, Choi H, Spaniolas K, Pryor A.
  • Parallel stent graft for hypogastric aneurysm repair with flow preservation of distal pelvic circulation | Spentzouris G, Kelli L, Summers BS, Sikalas N, Labropoulos N, Loh S.
  • Patterns of reoperation after failed fundoplication: an analysis of 9,462 patients | Obeid N, Altieri M, Yang J, Park J, Price K, Bates A, Pryor A.
  • Proposed adjunct to an alternative and less invasive approach to surgical therapy for severe C. diff colitis Lee K.
  • Pulmonary contusions in elderly blunt trauma are infrequently seen on CXR and are highly morbid | Bader A, Morris M, Lewis J, McCormack J, Huang E, Vosswinkel J, Jawa R.
  • Racial disparities in mitral valve repair vs. mitral valve replacement: a review of the literature and a descriptive analysis of patient data at Stony Brook University Medical Center | Petit-Frere W.
  • Recurrent carotid stenosis due to thrombus formation | Kim P, Hines G.
  • Retrospective evaluation of plastic surgery reconstruction in lower extremity trauma | Marquez J, Trostler M, Dagum A, Bui D.
  • Risk analysis for post-operative complications after immediate tissue expander breast reconstruction (TE-IBR) | Klein G, Landford W, Yang J, Shroyer AL, O'Hea B, Dagum A, Bui D, Khan S.
  • Risk of death in elderly blunt trauma patients: complications count | Gahlawat V, Chaudhary N, Vosswinkel J, Singer A, Shapiro M, McCormack J, Huang E, Jawa R.
  • Single center prospective analysis of diaphragmatic function pre- and post-cardiac surgery | Dickler C, Holecek W, Kowal R, Grecu L, Bilfinger T.
  • Socioeconomic and gender disparities in liver and intrahepatic bile duct cancer diagnosis and treatment | Guzman C.
  • Spatial and temporal characterization as it pertains to deep vein thrombosis | Chandrashekar A, Garry J, Singh G, Labropoulos N, Sikalas N.
  • Targeting the immune checkpoint pathway produces direct binding, uptake and cytotoxicity in pancreatic cancer | Gao M, Turkman N, Choi M, Vacirca J, Sasson A, Kim J.
  • Transcarotid artery revascularization as a novel method for carotid artery stenosis: a single clinical center's real-world experience | Drakos P, Tassiopoulos A, Kokkosis A.
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  • Traumatic blunt cardiac rupture | Gioia W, Fahd A.
  • Trends in pre-hospital cervical spine immobilization and cervical spine injury rates over 6 years at an American College of Surgeons Level 1 Trauma Center | Laskowski R, McCormack J, Jawa R, Chaudhary N.
  • The use of computed tomography versus clinical acumen in diagnosing appendicitis in the pediatric population — interim report | El-Gohary Y, Gulamhussein T, Lacey R, Scriven R, Shapiro M.
  • Use of per oral endoscopic myotomy (POEM) in pediatric patients as a primary or rescue therapy for achalasia | Stvropoulos S, Sosulski A, Modayil R, Gurram K, Brathwaite C, Charles C, Boinpally H, Grendell J.
  • Using digital image speckle correlation to optimize botox injection sites: a prospective crossover trial | Klein G, Verma R, Xu Y, Rafaelovich M, Khan S, Bui D, Dagum A. Winner of Outstanding Poster Competition.
  • Utilization of reconstructive procedures following weight loss surgery: a study of 37,806 patients | Altieri, M, Yang J, Park J, Novikov D, Kang L, Konstantinos S, Talamini M, Pryor A.
  • Venous thromboembolism risk using Caprini scores amongst outpatient aesthetic surgery patients who receive no chemoprophylaxis | Janssen P, Trostler M, Pannucci C, Khan S.
Next year's Research Day will take place on Thursday, May 31, from 8:00 am to noon, at the Wang Center. For more information, please call 631-444-1820.

Posted by Stony Brook Surgery on June 2, 2017

Suffolk's Only Joint Commission–Certified VAD Program Recognized as Top Level

The Joint Commission's Gold Seal of Approval®
The Joint Commission's Gold Seal of Approval®

Stony Brook University Heart Institute's ventricular assist device (VAD) program has once again earned recertification from The Joint Commission after a rigorous two-day evaluation, after which the examiner spoke to the exceptional quality of our program and the outstanding care provided by our entire team.

The award recognizes the hospital's dedication to compliance with The Joint Commission's national standards for healthcare quality and safety in disease-specific care. Our VAD program's has now received recertification for an unprecedented third time after initial certification in 2011.

An independent, not-for-profit organization, The Joint Commission is the nation's oldest and largest standards-setting and accrediting body in healthcare.

"VAD certification — The Joint Commission's Gold Seal of Approval — lets patients in need of a VAD know that they are in capable hands when they come to Stony Brook Heart Institute," says Allison J. McLarty, MD, associate professor of surgery and co-director of the VAD program.

Hal A. Skopicki, MD, PhD, assistant professor of medicine, director of the Heart Failure and Cardiomyopathy Center, and co-director of the VAD program, says, "Dr. McLarty and I are very proud to work with such an outstanding team of professionals who consistently go beyond the usual standard of care to deliver the best possible patient experience and strive to achieve the best outcomes for our patients.

"Our physicians, consultants, nurse practitioners, clinical staff nurses, technologists, coders, therapists, nutritionists, case managers, perfusionists, members of the continuous quality improvement, and IT communities have pooled their energies and talents to provide excellent care to the most vulnerable of cardiac patients with outstanding outcomes."

A left ventricular assist device (LVAD) is a surgically implanted, electrically (battery) powered pump
that helps a failing heart's left ventricle pump adequate amounts of blood to the body.

Drs. Hal Skopicki and Allison McLarty holding the HeartMate II VAD implanted in the patient, over the actual image of the patient's chest on the computer screen.
Drs. Hal Skopicki and Allison McLarty holding the HeartMate II VAD implanted in the patient, over the actual image of the patient's chest on the computer screen (click to enlarge).

"Congratulations to the entire VAD team," says Reuven Pasternak, MD, CEO of Stony Brook University Hospital, and vice president for Health Systems. "At the closing conference, they received accolades from the reviewer for their work and accomplishments above and beyond their peers. A wonderful team."

In addition to Drs. McLarty and Skopicki, our VAD includes: Michelle Weisfelner Bloom, MD, director of the Outpatient Heart Failure and Cardiomyopathy Center; Stephen Handzel, RN, MS, assistant director of nursing for noninvasive cardiology; Ellen McCarty-Santoro, MSN, CANP, LVAD coordinator; Peter Reilly, NP, LVAD coordinator; Jillian Fitzgerald, RN, LVAD coordinator Philip Travaglia, RN, clinical documentation specialist; Suzzette C. Smookler, MS, RD, CDN, director of clinical nutrition and dducation; and Denise Schaeffer, LMSW, social worker.

University Hospital was the first hospital on Long Island to implant a HeartMate II VAD in 2010, and is the only certified VAD destination therapy program in Suffolk County. To date, 68 patients have received VADs. Several of these patients have gone on to have successful heart transplants.

Destination therapy uses VAD technology as the final treatment option for selected patients whose hearts require mechanical assistance to pump blood. Once used only as a temporary device for heart failure patients awaiting transplants (bridge-to-transplant therapy), VAD technology in its advanced state now helps more patients extend their lives and also improve their quality of life.

To achieve certification, VAD programs are evaluated on standards in The Joint Commission's Disease-Specific Care Certification Manual. Programs must demonstrate conformity with clinical practice guidelines or evidence-based practices. They are also required to collect and analyze data on specific performance measures related to clinical practice guidelines (read more).

Founded in 1951, The Joint Commission seeks to continuously improve healthcare for the public, in collaboration with other stakeholders, by evaluating healthcare organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. The Joint Commission accredits and certifies more than 20,500 healthcare organizations and programs in the United States.

Stony Brook University Heart Institute continues to earn The Joint Commission's Gold Seal of Approval for its ventricular assist device–destination therapy program by demonstrating compliance since 2011 with The Joint Commission's national standards for healthcare quality and safety in disease-specific care. The certification award recognizes our dedication to continuous compliance with The Joint Commission's state-of-the-art standards. The duration of the certification is two years.

Learn about heart failure and the treatments for it. More about the ventricular assist device — artificial heart technology — used at Stony Brook Heart Institute for destination therapy to treat heart failure.

Posted by Stony Brook Surgery on May 30, 2017

Cytoreductive Surgery with HIPEC Offers Hope When Hope Is Needed Most in the Fight against Cancer

Stony Brook University Hospital is the only hospital on Long Island to provide cytoreductive surgery (CRS) and HIPECheated intra-peritoneal chemotherapy — for the treatment of advanced abdominal cancers.

The CRS-HIPEC procedure is an aggressive combination of surgery and chemotherapy to eradicate abdominal tumors. The goal of CRS and HIPEC is to perform radical surgery to remove all disease, but also to enable return to regular daily activities.

In select patients, HIPEC may increase survival time significantly. It offers patients hope when hope is needed most. It's a special form of surgery and intraoperative chemotherapy first performed in 1979, and further developed since then.

With the recruitment in 2015 of surgical oncologist Joseph Kim, MD, patients are coming to Stony Brook from afar for CRS-HIPEC treatment by him. Many of these patients were told by physicians elsewhere that nothing more could be done for them.

Here, we share one of the stories and testimonials of patients who have come to Stony Brook Cancer Center for this leading-edge care provided by Dr. Kim. It's a story of hope against all odds.

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Mrs. Rosa M back in Spain, after surgery with HIPEC provided by Dr. Joseph Kim.

Mrs. Rosa M is a 71-year-old Spanish woman who had a mucinous appendix tumor, a rare and poorly understood disease. Her initial symptoms included abdominal fullness and pain. She sought treatment with her physicians in Spain who diagnosed her with cancer that spread throughout the abdominal cavity.

The doctors there were uncertain of the cancer's exact origin, but they felt that she was inoperable and placed her on chemotherapy to relieve her symptoms.

Mrs. M's children brought her to the United States where they sought second opinions. They were told that chemotherapy was the only treatment option at one cancer center, and at another center, they were told that surgery would likely fail to remove all the disease.

She came to Stony Brook where extensive cytoreduction with HIPEC was successfully performed to remove all the disease.

Although the operation was complex and the hospitalization long, Mrs. M and her husband are now enjoying her disease-free days back in Spain. Her only complaint is the nerve damage from the unnecessary chemotherapy that she received. We have asked her a few questions about her experience with this complicated disease.

"My doctors in Spain told me there was no treatment for my cancer."

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CT scan images show the changes in abdominal distension before (A) and after (B) cytoreduction and HIPEC. On the left (A), the patient has the classic "jelly belly" appearance with protrusion of the abdomen from massive accumulation of mucin. There is mucin around the liver and in the pelvis (red arrows). There is a large omental cake at the anterior abdominal wall (blue arrow). On the right (B), several liters of mucin were removed during surgery leading to a flat abdominal wall. The mucin is no longer present anywhere in the abdomen, and the omental cake has been removed. (Click on image to enlarge.)

Q: What did your original physicians tell you about your disease and its likely course?

A: I was diagnosed in November 2015 with peritoneal carcinomatosis. I was told it probably originated in an ovary or in my small bowel. It was deemed untreatable, and I was given six to nine months to live. I was placed on palliative chemotherapy (Folfox 6).

Q: Were you ever told that there was no more possible treatment for your disease?

A: Yes, my doctors in Spain told me there was no treatment for my cancer. I was later told the same in consultations at both Dana Farber in Boston (where the doctor told me straight out "this is a life-ending event") and at Memorial Sloan Kettering Cancer Center in New York, where they originally concurred with my Spanish doctors in continuing with chemotherapy adding Avastin.

Later, a surgeon at Sloan suggested a laparoscopy to do exploratory surgery to determine if complete cytoreduction were possible, and if not, to do partial surgery and follow with chemo.

Q: How did you learn about cytoreduction surgery and HIPEC at Stony Brook?

A: I learned about cytoreduction with HIPEC by reading about treatment options for peritoneal carcinomatosis, and came across Dr. Paul Sugarbaker's work in the area. I only learned of Dr. Joseph Kim and Stony Brook Medicine the week before my consultation in October 2016. To this day, I can't really explain how, as he had never before come up in my many Internet searches for treatment. Thank God, he finally did!

Q: What is your current level of activity? Is it back to baseline or close to getting there?

A: My level of activity is at, or slightly better than, where it was just before surgery, though I'm still suffering the effects and damage of the neuropathy caused by chemotherapy. But I'm regaining strength on a daily basis.

Stony Brook gastrointestinal surgical oncologist Joseph Kim, MD, is an international CRS-HIPEC leader with vast experience in the procedure and major scholarly publications about it, including the book chapter "Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Mucinous Tumors of the Gastrointestinal Tract" (2016) published in Gastrointestinal Cancers: Prevention, Detection and Treatment (Nova Science); the book chapter "Diseases of the Peritoneum and Retroperitoneum" (2014) published in ACS Surgery: Principles and Practice (Decker), the only textbook bearing the imprimatur of the American College of Surgeons; the peer-reviewed article "Data from ACS NSQIP on CRS-HIPEC" (2014) published in JAMA Surgery by the American Medical Association; and the peer-reviewed article "Reduced Morbidity Following Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemoperfusion" (2004) published in Annals of Surgical Oncology by the Society of Surgical Oncology. Dr. Kim directs the CRS-HIPEC program at Stony Brook Medicine.

Read more stories and testimonials of patients treated with cytoreductive surgery and HIPEC by Dr. Joseph Kim. For consultations/appointments with him, please call 631-444-8086.

Posted by Stony Brook Surgery on May 22, 2017

Our Trauma Chief Recognized for Improving Trauma Care throughout Suffolk County

James A. Vosswinkel, MD
Dr. James A. Vosswinkel

We are very pleased to announce that our James A. Vosswinkel, MD, medical director of the Stony Brook Trauma Center, and chief of the Division of Trauma, Emergency Surgery, and Surgical Critical Care, has been selected as Physician of Excellence for 2016 by the Suffolk Regional Emergency Medical Services Council (REMSCO).

Dr. Vosswinkel has been instrumental in overseeing Stony Brook's recent verification as a Level 1 Regional Trauma Center by the American College of Surgeons (read more). Stony Brook is Suffolk County's only Level 1 Trauma Center for both adults and children, which is the highest level of trauma care possible.

As medical director of the Trauma Center, he has strengthened relationships with EMS providers through outreach and education, by serving on the REMAC, and by assisting in the development of trauma related EMS protocols.

Among achievements cited in the award nomination, Dr. Vosswinkel:

  • Created the position of EMS Education & Outreach coordinator at the Trauma Center to improve educational programs, enhance communication, and facilitate patient care.
  • Instituted regular "Call Review" program with EMS agencies to review trauma cases with pre-hospital care providers.
  • Instituted routine follow-up letters to the EMS Agency for all trauma activation patients.
  • Began Pre-Hospital Trauma Life Support (PHTLS) courses at Trauma Center, and set the expectation that the trauma surgeons would attend PHTLS and become certified as PHTLS Instructors.
  • Leads the Regional Trauma Advisory Committee which developed and rolled out a regional Trauma Pre-Notification program and a "30-second silence for EMS report" in each trauma center.
  • Serves as a regular member on the Regional Emergency Medical Advisory Committee (REMAC).
  • Was instrumental in bringing bleeding control (B-Con) to Suffolk County and through partnerships has trained over 800 civilians in bleeding control techniques.

In fact, Dr. Vosswinkel is very involved in conducting B-Con training programs for the community. These 2.5-hour training sessions are offered to teachers, students, firefighters, and emergency workers, as well as community citizens. Participants learn how to use tourniquets, gauze packs, and other materials that stop bleeding. Hands-on simulations are part of each class. (Read more on AP News.)

The Suffolk REMSCO was established and carries out its responsibilities pursuant to Article 30 of the New York State Public Health Law and Part 800 of the NYS CCRR.

This 30-member council has representation from out-of-hospital emergency medical care providers from the fire service; community volunteer, and commercial ambulance service sectors; physicians; nurses; health planning agencies; hospitals; police services; county government; the business community; and other constituencies promoting good health.

By statute, the council is charged with several responsibilities including coordination of emergency medical services in the Suffolk region.

Learn more about the Stony Brook Trauma Center and its programs to benefit our region: click here.

Posted by Stony Brook Surgery on May 12, 2017

New Study Confirms Benefits to Patients of Varithena Foam Treatment

Antonios P. Gasparis, MD
Dr. Antonios P. Gasparis

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.

Our vein specialists led by Antonios P. Gasparis, MD, professor of surgery (Vascular and Endovascular Surgery Division) and director of the Stony Brook Center for Vein Care, in 2014 were the first on Long Island to provide a new non-surgical treatment that involves the injection of a foam drug; specifically, polidocanol endovenous microfoam (PEM; Varithena).

This month, Dr. Gasparis published the report of his recent study of PEM in the journal Phlebology, titled "A Multicenter, Randomized, Placebo-Controlled Trial of Endovenous Thermal Ablation with or without Polidocanol Endovenous Microfoam Treatment in Patients with Great Saphenous Vein Incompetence and Visible Varicosities."

This study, of which Dr. Gasparis was co-principal investigator, confirms the effectiveness of PEM when used with endovenous ablation. He provides the following explanation of the study:

Leg of patient in Varithena trial before (left) and after treatment.
Leg of patient in Varithena trial before (left) and after treatment. (Click on image to enlarge.)

Vein disease often involves backwards flow in the saphenous vein in the leg as well as the superficial visible varicose veins. While disease in the saphenous vein may cause various symptoms, unsightly varicose veins are what patients are often concerned about.

Treatment of the saphenous vein with endovenous ablation, either laser or radiofrequency, will improve symptoms but also will regress the visible varicose veins. In up to 40% of patients, varicose veins may not regress and still be visible when not treating the varicose veins directly.

This study was done to evaluate if direct treatment of the varicose veins with PEM (Varithena) would improve the appearance of varicose veins.

Assessment was done by both treating physician and patient at 8 weeks after treatment. A total of 117 patients received treatment with PEM or placebo. Physician-rated vein appearance at week 8 was significantly better with PEM versus placebo. Patient-assessed appearance trended similarly.

We concluded that treatment of the varicose veins with Varithena at the same time as endovenous ablation significantly improved physician-assessed appearance at week 8, increased the proportion of patients with a clinically meaningful change in appearance, and reduced need for additional treatment.

The leading scientific journal devoted entirely to venous disease, Phlebology is the official journal of several international societies devoted to the subject. It publishes on all aspects of diseases of the veins including the latest treatment procedures and patient outcomes (read more about it).

Varicose leg veins can be more than just a cosmetic problem, and when symptoms are present, they're deemed a medical condition for which treatment is covered by most insurance. At the IAC accredited Stony Brook Center for Vein Care, we manage a large population of patients with venous disease, with 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, and are leaders in using minimally invasive treatments.

Click here to read the entire report of Dr. Gasparis's study. For consultations/appointments with our vein specialists at the Stony Brook Center for Vein Care, please call 631-444-VEIN (8346).

Posted by Stony Brook Surgery on May 5, 2017

Offering Surgical Experience Plus Multidisciplinary Team Approach

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Hernia Center co-directors (l to r) Drs. Andrew T. Bates, Sami U. Khan, and Michael F. Paccione lead a team of more than 15 general/gastrointestinal, minimally invasive, and reconstructive plastic surgeons.

Hernias are a common health problem, with more than one million hernia repairs performed each year in the United States. Approximately 800,000 are done to fix hernias in the groin, and the rest are for other types of hernias in the abdomen.

Our newly established comprehensive Hernia Center — distinguished by Stony Brook Medicine's multidisciplinary approach to patient care — offers a wide range of options to diagnose and treat most types of hernias.

Our experienced hernia experts work together as a team to design the best treatment plan possible so patients can get back quickly to their normal lives and daily activities.

A hernia occurs when there is a weakness, or opening, in the muscle and connective tissue that surround the belly area. Patients may feel a slight bulge, discomfort, or pressure as organs push out through this weakness.

However, many patients may have this opening/weakness even if organs aren't actively pushing through. Over time, this bulge or area of weakness can grow in size. Occasionally, intestine can become trapped in the hernia, which requires emergency medical attention.

Hernia repairs done by experienced surgeons provide the best results
with low recurrence rates and minimal post-op pain.

Some hernias are inguinal, which means they develop in the groin area. Another type is ventral hernias, which can start anywhere on the front of the belly wall. Some patients have incisional hernias, occurring at the incision site of a previous surgery or hernia repair.

Inguinal hernias are the most common type of hernia. They represent approximately two thirds of adult hernias, and are much more common in men than in women.

A strangulated hernia, in which the blood supply to the bulging part of the intestine is cut off, can be very dangerous, even fatal, and they are surgical emergencies. The incidence rate of strangulated inguinal hernias varies between 0.29% and 2.9%, and the mortality rate ranges between 2.6% and 9%.

Andrew T. Bates, MD, assistant professor of surgery and co-director of the Hernia Center, says: "There are several different ways to treat hernias effectively today. Our surgeons provide all of them for our patients.

"Our hernia surgeons work together with plastic surgeons and pain management specialists, so they can collaborate on the most suitable, individualized treatment plus follow-up care that helps patients recover with minimal pain and complications."

Some of our procedures use a mesh patch, made of synthetic or natural material, to close the gap where the hernia protrudes. Suturing the patient's own tissue back together, without the mesh patch, is another option (see FAQs about the Shouldice repair).

We also do hernia repairs that are minimally invasive, using the latest technology to limit surgical incisions and, thereby, speed recovery.

Consult us with any questions or concerns about hernia surgery and
recovery, before your hernia becomes an emergency.

Reconstructive plastic surgeon Sami U. Khan, MD, associate professor of surgery and co-director of the Hernia Center, adds, "The multidisciplinary collaborative approach we use allows us to offer our patients the most comprehensive clinical expertise for repair of everything from simple hernias to the most complex abdominal wall reconstructions."

"We encourage people to consult us with any questions or concerns they might have about hernia surgery and recovery, before their condition becomes an emergency," says Dr. Bates. "Our surgeons can help patients decide which of our many hernia repair options is the right choice for them."

Although "the first fix is the best fix," we are also highly skilled at treating patients who have a recurring hernia after having surgery somewhere else.

Emphasizing one of the benefits of our multidisciplinary team approach, Michael F. Paccione, MD, assistant professor of surgery and co-director of the Hernia Center, notes, "For patients who experience chronic groin pain after inguinal hernia repair — and it is estimated that at least 10% of patients have this problem — our pain management specialists provide a range of solutions."

Patients can see our hernia specialists at our Suffolk County offices in Centereach, East Setauket, Smithtown, and Commack. Every location offers a team approach, from experienced experts sharing their expertise and skills to deliver the most effective treatment.

Some Common Signs and Symptoms of Abdominal Wall Hernias*
  • A bulge or lump in the affected area
  • Lump on either side of the pubic bone where the groin and thigh meet
  • Weakness, pressure, or a feeling of heaviness in the abdomen
  • Pain or discomfort in the affected area (usually the lower abdomen), especially when bending over, coughing, or lifting
  • Burning, gurgling, or aching sensation at the site of the bulge
* In some cases, hernias have no symptoms, and may show up during a routine physical or a medical exam for an unrelated problem.

Learn more about inguinal hernias. For consultations/appointments with our specialists at the Stony Brook Hernia Center, please call 631-638-0054.

Posted by Stony Brook Surgery on April 28, 2017

It's Good for Your Health to Know about the Dark Side of the Sun

Skin Cancer ABCD + E for Evolution
Courtesy of National Cancer Institute (click on image to enlarge).

Skin cancer — including melanoma and basal and squamous cell carcinomas — is the most common of all cancer types.

The American Cancer Society estimates that in the United States this year there will be about 87,110 new cases of melanoma, the most dangerous form of skin cancer, and 9,730 deaths from it. The rates of melanoma have been rising for at least 30 years.

The number of cases of the more frequent skin cancers, basal cell carcinoma and squamous cell carcinoma, has been increasing for many years. According to one estimate, about 3.5 million cases of them are diagnosed annually (80% are basal cell).

Most of these three types of skin cancer are caused by exposure to ultraviolet (UV) light primarily from the sun. However, only a little over half of American adults use sun-protection measures.

The good news is that if diagnosed and treated early, skin cancer can often be cured. But if the disease is allowed to progress, it can result in disfigurement and possibly death.

Here, Tara L. Huston, MD, assistant professor of surgery and dermatology, and leader of Stony Brook's Melanoma Management Team, explains what can be done to help prevent skin cancer and how to detect its early signs.

May is National Skin Cancer and Melanoma Awareness Month.

Q: What should people know about protecting themselves against skin cancer?

A: Skin cancer is usually the result of sun exposure and blistering sunburns that occur in childhood and also cumulative sun exposure. The most important thing we can do is to protect our children from early sun exposure, although it's never too late to reduce your own risk for skin cancer. Eliminating ongoing sun damage is very important.

The good news is that most people with skin cancer are going to be fine. The majority of skin cancers are either basal cell or squamous cell carcinomas. Only 4% of all skin cancers are melanoma, the most serious type of skin cancer.

Q: Besides early sun exposure, what are some other risk factors for skin cancer?

A: Skin type has a lot to do with it. Fair skin, light hair, and light eyes are risk factors for melanoma. Sun exposure is by far the most common risk factor. The use of tanning salons is also a risk factor. Self-tanning lotions do not pose a risk.

Q: What are the symptoms of skin cancer, and what should people look for?

A: ABCDE is the key. This applies to new or changing moles. A is for asymmetry; B is for irregular borders; C is for color variation; D is for a diameter greater than 6 millimeters (about the size of a pencil eraser); and E is for evolution, or any change in a mole, including itching or bleeding. Any new lesion that bleeds or scabs and does not go away over four weeks should be brought to your physician's attention.

When in doubt about a mole, get it checked out … What to look for.

Q: How often should people do self-body checks for changing moles, and how often should they get clinical checkups?

A: People should be aware of their skin and look for any changing moles on a daily basis. People who don't have any history of skin cancer should have a complete skin examination annually by a physician. Those with a history of skin cancer, especially melanoma, should be evaluated at least twice a year by a dermatologist and do skin self-checks monthly. It's a lifetime of follow-up evaluations with your doctor, not just because of possible melanoma recurrence, but because of the possibility of other skin cancers as well.

Q: How can people protect themselves against the UVA and UVB rays of the sun?

A: Plan your outdoor activities before 10 am and after 4 pm. Use a broad-spectrum sunscreen with SPF of 30 or higher, and apply over all exposed skin about ten minutes before going out, and reapply every two hours, or sooner if swimming.

There is also clothing that now has UV protection in them, including bathing suits for kids. And be sure to wear a hat to protect the scalp and ears. Sun-exposed areas such as the nose and ears are very common spots where skin cancer can develop.

Q: How is skin cancer treated?

A: If you have a lesion that you're worried about, the first step is to see your dermatologist, who will remove it if it looks suspicious. Most of the basal and squamous cell cancers are handled with local removal by a dermatologist or plastic surgeon, and that's all the treatment needed.

When outside, seek shade, cover up, wear a hat and sunglasses, and use sunscreen.

If there is a diagnosis of melanoma, a melanoma surgeon will become involved, and the treatment depends on the depth of the melanoma. If it's what we call a thin melanoma, which is less than one millimeter deep (1/25 of an inch), the treatment is removal of some normal skin around the melanoma.

Once the melanoma is more than one millimeter deep or demonstrates concerning features on pathology exam, in addition to removing normal skin around the melanoma, we also sample the lymph node, because the deeper the melanoma, the greater the chance of lymph node involvement.

Q: What distinguishes Stony Brook from other centers in treating skin cancer?

A: Stony Brook provides comprehensive, multidisciplinary care to patients with melanoma. We offer screening, surgery, and the option to participate in local and national clinical trials. In addition, we conduct basic science and translational research, and also provide community education.

While clinical trials are not for everyone and participation in them is strictly voluntary, the availability of these trials serves as a hallmark of our ability to offer leading-edge treatment. For many patients, this is the only opportunity available in Suffolk County to benefit from such studies.

Several trials are currently underway at Stony Brook. We also participate in the Multicenter Selective Lymphadenectomy Trial (MSLT 2) that is evaluating the role of completion lymph node surgery in melanoma, in order to determine the optimum care for patients.

Our dedicated team of pathologists, dermatologists, medical oncologists, and melanoma surgeons meets once a month to review each melanoma case, and thus ensures that our patients receive the benefits of multidisciplinary care.

Editor's note: Dr. Huston and Alexander B. Dagum, MD, her departmental colleague and fellow melanoma surgical expert, bring years of experience and excellent outcomes to the management of skin cancer.

FREE Skin Cancer Screening and Melanoma Educational Program

When: Saturday, May 6, 8 to 11 am.
Where: Stony Brook Cancer Center, 3 Edmund D. Pellegrino Road, Stony Brook, NY 11794 (map/directions).

Are you 18 or older? Was your last skin cancer screening by a dermatologist more than a year ago? If so, call 631-444-4000 for an appointment.

For more information about skin cancer and its prevention, please visit the Centers for Disease Control and Prevention. Another good online resource is the Skin Cancer Foundation.

Posted by Stony Brook Surgery on April 6, 2017

Read about How We Are Leading the Way in Patient Care, Education, and Research

an image is here POST-OP, our semi-annual newsletter, provides an update on all kinds of new developments in our department, plus health news of interest to the Long Island community and beyond:
  • New Office in Commack Facilitates Access to Our Services
  • Verification as Adult/Pediatric Level 1 Trauma Center
  • Introducing New Faculty
  • Hernia Center Established to Provide Multidisciplinary Team Care to Patients
  • Centerfold Map of Practice Locations and Services throughout Suffolk County
  • Offering Less Invasive Carotid Artery Surgery, First on Long Island
  • Streamlining Delivery of Acute Care Surgery to the Benefit of Patients
  • Providing Our Colorectal Surgery Services on Eastern Long Island
  • Weight Loss Center Reaccredited for Treating Adolescents 13 and Older
  • Alumni News & Division Briefs … Plus More!

"At Stony Brook, our faculty believe they have two jobs: providing excellent and innovative patient care, and always thinking about how the team can do it even better the next time. In this edition of POST-OP, our Level 1 Trauma designation (new for New York trauma centers) is a clear reflection of excellence. The TCAR procedure being performed by our vascular surgeons, described here, is an example of excellence and innovation applied directly to improve patient care. These are but a few of many examples in our department. 'Excellence and Innovation.' That is the Stony Brook Surgery way." — From the "Chairman's Message" by Mark A. Talamini, MD

Read 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 March 23, 2017

FDA Has Updated Its Understanding of Breast Implant-Associated Cancer

By Tara L. Huston, MD, of the Stony Brook Plastic and Reconstructive Surgery Division

Dr. Tara L. Huston | Stony Brook Plastic Surgeon
Dr. Tara L. Huston

This week the FDA released a statement (read it) regarding an incredibly rare type of cancer associated with breast implants known as anaplastic large cell lymphoma (ALCL). The big question women with implants are asking is, "Do I need to worry?"

The possible association between breast implants and ALCL has been known since 2011. There are approximately 300 reported cases in the world literature. To put this in perspective, in just the United States, it is estimated that over 5 million women currently have breast implants.

ALCL is almost always associated with textured implants and very rarely with the smooth. It has been found in patients who have had reconstruction as well as those who underwent cosmetic augmentation. It is not a breast cancer, but a rare malignancy in the immune system. It is possibly related to a low-grade infection around the implant.

If your breast implants are not bothering you, no action needs to be taken now.

The treatment is removal of the breast implant — a complete capsulectomy. This tissue and any fluid in the breast are then examined for the presence of the CD30 marker. In very rare instances, chemotherapy and radiation have been required. Implant-related ALCL seems to be less aggressive than ALCL from other causes.

If you are living with your implants and they are not bothering you, no action needs to be taken. If you have breast implants and symptoms such as pain, lumps, asymmetry, change in breast shape, or swelling, especially many years after your surgery, contact your physician.

To return to the question above, the answer is NO! You need not worry. It is important to be armed with good information, know what to look for, and be aware of your health. If you have questions, reach out to a board-certified plastic surgeon for further guidance.

"Before getting breast implants, make sure to talk to your healthcare provider about the benefits and risks of textured-surface vs. smooth-surfaced implants. If you already have breast implants, there is no need to change your routine medical care and follow-up." — Food and Drug Administration (March 21, 2017)

Learn more about ALCL from the American Society of Plastic Surgeons. Please call 631-444-4666 for an appointment to discuss questions with Dr. Huston and our other plastic surgeons.

Posted by Stony Brook Surgery on March 10, 2017

Our Success with Bariatric Surgery in Teens Is in Giving Them Back a Normal Life

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Our patient Kristen Valenti six months post-op having lost 67 pounds. Click on image below to watch the News 12 L.I. video of her weight loss story.

The Stony Brook Bariatric and Metabolic Weight Loss Center has received its renewed accreditation as a Comprehensive Center for Adolescents from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) of the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery.

This is good news, as the percentage of children with obesity in the United States has more than tripled since the 1970s. Today, about one in five school-aged children (ages 6-19) has obesity.

MBSAQIP accreditation demonstrates our Bariatric and Metabolic Weight Loss Center's commitment to delivering the highest-quality care for bariatric surgery patients.

Our center was the first MBSAQIP-accredited comprehensive bariatric center in our community.

Aurora D. Pryor, MD, professor of surgery and chief of our Bariatric, Foregut, and Advanced Gastrointestinal Surgery Division, who is the center's director, says:

"With the renewal of both adolescent and adult MBSAQIP accreditations, the Stony Brook Metabolic and Bariatric Weight Loss Center has been recognized for excellence in the comprehensive delivery of care for obesity and the metabolic syndrome, for adolescents and adult patients alike.

"As noted during the recent accreditation visit, our center has been outperforming the national average in terms of safety and patient risk. This is a testament to our multidisciplinary approach to patient safety and commitment to excellent patient- and family-centered care."

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.

About Childhood Obesity

Childhood obesity is growing at an epidemic rate, along with that of adults. More than one-third (36.5%) of U.S. adults have obesity, according to the Centers for Disease Control. Nationwide, 23.9 million children ages 2 to 19 are overweight or obese; 33.0% of boys and 30.4% of girls.

Childhood obesity is a condition where excess body fat negatively affects a child's health or well-being. As methods to determine body fat directly are difficult, the diagnosis of obesity is often based on body mass index, known as BMI.

Since 1980, the childhood obesity rates (ages 2 to 19) have tripled — with the rates of obese 6- to 11-year-olds more than doubling (from 7% to 17.5%) and rates of obese adolescents (ages 12 to 19) quadrupling from 5% to 20.5%.

One out of every six adolescents ages 12 to 19 is overweight, and one out of every three is at risk.

In Suffolk County alone, there are more than 5,000 obese students in middle and high school.

Commenting on obesity in adolescents and the benefit of bariatric surgery, Konstantinos Spaniolas, MD, associate professor surgery and new member of our Bariatric, Foregut, and Advanced Gastrointestinal Surgery Division, says:

"Obesity and associated diseases (metabolic, psychologic, orthopedic, etc.) have a deleterious effect in adolescents with severe future cardiovascular risks. It is likely that an early intervention in this age group can disrupt the progression of disease, and lead to long-lasting benefit.

"Recent published evidence demonstrates profound and sustained weight loss in adolescents that is maintained at least 3 years after metabolic surgery. Importantly, 95% of adolescents with type 2 diabetes experience lasting remission at 3 years."

At present, weight loss surgery provides the only effective, lasting relief from severe obesity.

Obesity most commonly begins between the ages of 5 and 6, or during adolescence. Studies have shown that a child who is obese between the ages of 10 and 13 has an 80% chance of becoming an obese adult.

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.

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.

In 2014, Stony Brook Medicine was first granted full accreditation as a comprehensive bariatric facility by the MBSAQIP, then a newly established program of the American College of Surgeons and American Society of Metabolic and Bariatric Surgery.

Every member of our large multidisciplinary team is committed to our program, and this commitment is the key of our success. We are all extremely proud of the work we do, and proud of this ongoing recognition by the MBSAQIP.

Individualized assessment and care are crucial for the long-term success of weight loss treatment. At Stony Brook Medicine, our bariatric specialists welcome any pediatric/adolescent patient over the age of 13 for evaluation.

With the close involvement of specialized pediatricians, dieticians, and psychologists, a thorough assessment of patient and family allows for proper guidance.

We offer the full gamut of weight loss options, and many patients will be successful with lifestyle and behavioral modification alone. Bariatric surgery or other interventions are sometimes offered to further assist with weight loss and control of co-existing medical problems.

For consultations/appointments with our bariatric specialists, please call 631-444-BARI (2274). Click on the image below to watch the News 12 L.I. video of the weight loss story of 15-year-old Kristen Valenti treated by our team:

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Posted by Stony Brook Surgery on March 8, 2017

Operating at Eastern Long Island Hospital in the Village of Greenport

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Dr. Roberto Bergamaschi and Dr. Paula I. Denoya

Two of our colorectal surgeons, Roberto Bergamaschi, MD, PhD, professor of surgery, and Paula I. Denoya, MD, associate professor of surgery, have recently joined the medical staff at Eastern Long Island Hospital (ELIH) in Greenport, NY, where — in addition to their practices at Stony Brook University Hospital and Stony Brook Cancer Center — they will provide a full range of colon and rectal surgery services to the community of Eastern Long Island.

An international leader in the field of colorectal surgery, Dr. Bergamaschi joined our faculty in 2008 and later that year became the founding chief of our Colon and Rectal Surgery Division.

Dr. Bergamaschi specializes in the treatment of diseases associated with a wide range of colorectal disorders, including abscesses, bowel obstructions, polyps, colitis, diverticulitis, hemorrhoids, colon cancer, constipation, incontinence, Crohn's disease, rectal cancer, and anal cancer.

Patients on Eastern Long Island who require the expertise of trained colorectal
surgeons can receive all the care they need close to home.

Dr. Bergamaschi was one of the first colorectal surgeons in the United States to master laparoscopic colorectal surgery, and he offers several options for patients undergoing surgery for colorectal cancers.

In addition, Dr. Bergamaschi is one of the few colorectal surgeons in the country who can perform a minimally invasive procedure known as intracorporeal laparoscopic colorectal surgery, which requires extensive and highly specialized training because it takes place entirely inside the body.

"Though both conventional open surgery and laparoscopic-assisted surgery are safe and common procedures, there is less bleeding, less risk of infection, less pain, and less scarring for the patient who undergoes the intracorporeal laparoscopic procedure," Dr. Bergamaschi says.

"Dr. Bergamaschi is internationally recognized for his expertise in laparoscopic surgery for colorectal diseases. We are very fortunate to have a surgeon of this caliber available to our patients on the East End of Long Island," Paul J. Connor, III, president/CEO of ELIH, says.

Dr. Bergamaschi is a leader in our one-year residency program in colorectal, and trains surgeons to perform intracorporeal laparoscopic surgery, as well as other colorectal surgical procedures.

ELIH CEO welcomes the addition to its medical staff of Stony Brook Medicine
colorectal surgeons for their high level of surgical expertise.

Dr. Bergamaschi received his MD from the University of Milan, Italy, and his PhD from the University of Bergen, Norway, in the field of colorectal cancer.

Dr. Bergamaschi holds board certifications from several countries, including Italy, Denmark, France, and Norway. He is a fellow of the Royal College of Surgeons in London and a fellow of the American Society of Colon and Rectal Surgeons, as well as the American College of Surgeons.

Dr. Denoya, who joined our faculty in 2009, is a graduate of New York University and received her MD from the Mount Sinai School of Medicine. She subsequently completed a fellowship in colorectal surgery at the Cleveland Clinic of Florida. She is board certified by both the American Board of Surgery and the American Board of Colon and Rectal Surgery.

Dr. Denoya's practice comprises all aspects of colon and rectal surgery, along with anal surgery and pelvic floor dysfunction. Her interests include minimally invasive surgery, colorectal cancer, Crohn's disease and ulcerative colitis, diverticulitis, reoperative surgery, fecal incontinence, and anorectal reconstruction.

Dr. Denoya is the recipient of several awards from the Mount Sinai School of Medicine, including the Eugene W. Friedman MD Award for Clinical Excellence.

In addition to her clinical duties and responsibilities at Stony Brook Medicine, Dr. Denoya is the program director of our colorectal surgery residency program, training surgeons to become colorectal specialists. Our program is fully accredited by the American Board of Colon and Rectal Surgery, which confers board certification in the field of colon and rectal surgery.

"Dr. Denoya is a wonderful addition to the surgical team," Mr. Connor says. "A surgeon with this specialty will provide a high level of surgical expertise for the patients we serve."

"I am excited about joining the medical staff at ELIH," says Dr. Denoya. "It will be my pleasure to meet and care for patients on the East End of Long Island."

Dr. Denoya works closely with Dr. Bergamaschi. Both are part of a subspecialty group that will be providing colorectal surgical care on the North Fork.

March is National Colorectal Cancer Awareness Month! … Know these ten warning signs of colorectal cancer:
  • Blood in stool
  • Persistent diarrhea
  • Persistent vomiting
  • Cramping abdominal pain
  • Persistent bloating
  • Unexplained weight loss
  • Decreased stool size
  • Unexplained fatigue
  • Change in bowel habits
  • Incomplete emptying of bowel
> See Dr. Paula I. Denoya's FAQs about colorectal cancer for more valuable life-saving information.

Learn more about Eastern Long Island Hospital. For consultations/appointments with Dr. Bergamaschi and Dr. Denoya, please call 631-444-1825.

Posted by Stony Brook Surgery on March 1, 2017

Stony Brook Medicine's New Multispecialty Center Offers "One-Stop Shop" Convenience

Stony Brook Medicine just opened its new multispecialty center in Commack that gives residents more choice and flexibility when looking for quality medical care. This beautiful facility includes a dedicated suite for our department's clinical practice.

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Called Advanced Specialty Care, the center offers nine medical specialties designed to meet the majority of most families' medical needs.

Stony Brook Surgical Associates, our department's clinical practice, is represented by specialists in the following areas:

  • Bariatric/Weight Loss Surgery
  • General/Gastrointestinal Surgery
  • Hernia Care
  • Otolaryngology (Adult/Pediatric)
  • Vascular/Endovascular Surgery
  • Vein Care

Future plans for our own multispecialty practice include the addition of our specialists in plastic and reconstructive surgery.

Other physicians located in the Commack facility include primary and specialty care internists and pediatricians; gynecologists and obstetricians; dermatologists, orthopedists, and urologists; and neurosurgeons.

With so many different specialties on-site, patients may be able to have all their outpatient
medical needs met in this single, new state-of-the-art facility.

There is also a complete imaging center on-site to provide x-rays, mammograms, ultrasounds, bone densitometry, CTs, and MRIs.

For busy families in the area, Advanced Specialty Care means that, in a single building, patients can expect to receive the high level of expertise and compassionate care Stony Brook Medicine physicians are known to provide.

If surgery or other specialty care is needed, patients can go to Stony Brook University Hospital without any disruption in the continuity of their care.

"Clearly, this is no ordinary doctors' office," says Reuven Pasternak, MD, chief executive officer of Stony Brook University Hospital.

"As its name implies, Advanced Specialty Care connects consumers to Stony Brook Medicine's primary care doctors and specialists, who provide access to cutting-edge research, clinical trials, and advanced technology, as part of Suffolk County's only academic medical center."

Convenient Location, Plenty of Parking

Advanced Specialty Care is located at 500 Commack Road in Commack (see map).

Stony Brook Medicine is occupying over 110,000 square feet of space in the new state-of-the-art ambulatory care facility, allowing room for expansion as additional services are added.

The location is just minutes away from the Long Island Expressway, Sunken Meadow Parkway (Sagtikos), and Northern State Parkway.

Learn more about Advanced Specialty Care. For consultations/appointments with the specialists there, please call the phone numbers listed on this page.

Posted by Stony Brook Surgery on February 24, 2017

Suffolk County's Only Adult and Pediatric Level 1 Trauma Center

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Suffolk County Police helicopter ambulance coming in for landing at University Hospital.
The American College of Surgeons (ACS) just formally verified Stony Brook Trauma Center as the highest-level trauma center for adults and children after a rigorous survey visit this past fall. This makes Stony Brook Suffolk County's only Adult and Pediatric Level 1 Trauma Center.

Although Stony Brook already serves as a New York State-designated regional trauma center for adults and children, as well as a regional burn center, this additional verification required us to meet quality and safety standards set by the ACS.

It further establishes Stony Brook's place in the community as the highest-level trauma center, capable of providing total care for every aspect of injury — from prevention through rehabilitation for the most severely impacted patients.

Meeting the high standards of care set forth by the ACS proves that we are prepared
to care for the most injured and most vulnerable patients at all times.

Led by our faculty members James A. Vosswinkel, MD, chief of trauma, emergency surgery, and surgical critical care, and Richard J. Scriven, MD, chief of pediatric surgery, all Stony Brook practitioners in the Trauma Center are committed, fully trained, and immediately available, providing timely care to patients when needed most.

The team is leading the way with research on the care of trauma patients and continues to shine with top quality scores as compared to more than 300 other trauma centers nationwide.

Stony Brook's participation in a national quality program provides evidence that patients who were seriously injured and then treated in our trauma center were less likely to die or to develop a major complication.

Life-threatening injuries, as a result of vehicular accidents, falls, or other trauma, are the leading cause of death for all Americans under age 45.

Comprehensive, excellent trauma care can save lives. Meeting the high standards of care set forth by the ACS proves that we are prepared to care for the most injured and most vulnerable patients at all times.

What distinguishes a Level 1 Trauma Center has a lot to do with 24/7
access to in-house, board-certified, critical care specialists, and trauma surgeons.

What distinguishes a Level 1 Trauma Center from other levels of trauma care? One key difference is having 24/7 access to in-house, board-certified, critical care specialists, and trauma surgeons.

Having this in-house expertise available around the clock means immediate treatment of all types of traumatic and complex injuries.

What's more, Stony Brook University Hospital has 20 operating rooms, plus CT scanners and MRI machines right in the Emergency Department, with ready access to blood products through its blood bank.

Another differentiating feature of Level 1 Trauma Centers is enhanced outreach and teaching programs. Stony Brook Trauma Center focuses on injury prevention by offering a number of special programs designed to keep community members safe.

These program include teddy bear clinics, senior falls prevention programs, traffic violator education programs, and courses that teach bleeding control for the injured.

We also provide sports safety clinics, teen driving Initiatives, Safe Kids “Safety Games,” parent information sessions, and more to organizations in the community — all free of charge.

During the verification process, the ACS evaluates whether a facility meets criteria put forth in its Committee on Trauma's manual, Resources for Optimal Care of the Injured Patient. Administered by the Verification, Review, and Consultation Program (VRC), the verification process is designed to help hospitals improve trauma care. After the completion of a pre-review questionnaire, the VRC visits the site and compiles a report of its findings. If successful, the trauma center receives a certificate of verification that is valid for three years. The ACS created its VRC Program in 1987, and today more than 400 trauma centers have achieved the ACS verification seal of approval.

Learn more about the Stony Brook Trauma Center and its many programs aimed at keeping the 1.5 million residents of Suffolk County safe and alive.

Posted by Stony Brook Surgery on February 13, 2017

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The long-term consequences of poor voice care can range from strained vocal cords and chronic hoarseness to deadly head and neck cancers.

The voice specialists of our Otolaryngology–Head and Neck Surgery DivisionMelissa M. Mortensen, MD, otolaryngologist-laryngologist; Elliot Regenbogen, MD, otolaryngologist-laryngologist; and Marilyn D. Baricevac, MS, CCC-SLP, speech pathologist — provide a range of services aimed at voice health and wellness.

Dr. Mortensen was interviewed this morning by Jay Oliver on LI News Radio 103.9 FM. Click on the image above to hear their conversation about voice health, and the advice she has to offer.

For consultations/appointments with our voice specialists, please call 631-444-4121.

Posted by Stony Brook Surgery on January 18, 2017

New Procedure Reverses Blood Flow Temporarily to Help Reduce Risk of Stroke

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Plaque buildup in the carotid artery impeding blood flow to the brain (click on image to enlarge).

Every year, more than 300,000 people in the U.S. are diagnosed with blockages in their carotid arteries, which can lead to a dangerous stroke.

A potential complication of both surgery (carotid endarterectomy, or CEA) and stenting for stroke prevention in patients with carotid artery disease is a stroke occurring during the procedure itself. Studies have shown a higher risk of stroke during conventional stenting as compared to surgery.

Now, there is a new, safer procedure to clear the carotid arteries.

Leading the way in patient care in our region, our Vascular and Endovascular Surgery Division have treated the first patients on Long Island with the new minimally invasive transcarotid artery revascularization (TCAR) procedure.

The TCAR procedure offers patients a safer method of carotid stenting through a small incision at the base of the neck and direct carotid artery access along with neuro-protective flow reversal during delivery of the stent.

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(l to r) Drs. Apostolos Tassiopoulos, Angela Kokkosis, and George Koullias.

TCAR not only obviates the need to navigate catheters through the aortic arch (a step linked to stroke during carotid stenting through the groin), but also prevents fragments of plaque released during stenting from travelling with the bloodstream to the brain and causing small or bigger strokes.

The first TCAR procedures at Stony Brook Medicine were performed by Apostolos K. Tassiopoulos, MD, professor of surgery and chief of vascular and endovascular surgery, Angela A. Kokkosis, MD, assistant professor of surgery, who is the division's director of carotid interventions, and George J. Koullias, MD, PhD, assistant professor surgery.

Commenting on the surgery, Dr. Tassiopoulos says: "At the Stony Brook Vascular Center we treat all aspects of vascular disease frequently including high-risk patients that are turned away by other physicians and hospitals.

"Offering this new minimally invasive treatment option for our patients with carotid artery blockage is advancing patient care here by dramatically reducing the risk of stroke and heart attack during and after carotid interventions.

"In contrast to conventional carotid endarterectomy surgery, TCAR requires a smaller incision resulting in decreased risk for nerve damage and a faster recovery time. With its ingenious flow-reversal system, TCAR also has been shown to have fewer stroke complications compared to carotid stenting performed through the groin."

About the Procedure

TCAR uses a special transcarotid neuro-protection system (NPS), and is designed to reduce the risk of stroke during the insertion of the stent.

The novel NPS device allows the surgeon to directly access the common carotid artery in the neck and initiate high-rate temporary blood flow reversal to protect the brain from stroke while delivering and implanting the stent.

The TCAR procedure is performed through a small incision at the neckline just above the clavicle. This incision is much smaller than a typical CEA incision. The surgeon places a tube directly into the carotid artery and connects it to the NPS that directs blood flow away from the brain, to protect against plaque that may come loose reaching the brain.

The patient's blood flows through the NPS and any material is captured in a filter outside the body. The filtered blood is then returned through a second tube in the patient's upper leg. After the stent is placed successfully, flow reversal is turned off and blood flow resumes in its normal direction.

"This report presents the 30-day results of the Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure (ROADSTER) multicenter trial and evaluates the safety and efficacy of ENROUTE Transcarotid NPS (Silk Road Medical Inc, Sunnyvale, Calif), a novel transcarotid neuroprotection system that provides direct surgical common carotid access and cerebral embolic protection via high-rate flow reversal during carotid artery stenting (CAS).… The results of the ROADSTER trial demonstrate that the use of the ENROUTE Transcarotid NPS is safe and effective at preventing stroke during CAS. The overall stroke rate of 1.4% is the lowest reported to date for any prospective, multicenter clinical trial of CAS." — Kwolek CJ, Jaff MR, Leal JI, et al. Results of the ROADSTER multicenter trial of transcarotid stenting with dynamic flow reversal. Journal of Vascular Surgery 2015;62:1227-34.

For consultations/appointments with our vascular surgeons, please call 631-638-1670. Watch this video animation (3:53 min) of the TCAR procedure (see patient stories):

Posted by Stony Brook Surgery on January 11, 2017

The Thyroid Grand | January Is Thyroid Awareness Month
The thyroid is just below the Adam's apple.

More than 30 million Americans suffer from a thyroid disorder, and many more go undiagnosed every year. Now is a good time to become aware of your thyroid and its relationship to your health — and how best to take care of it.

Thyroid nodules and enlarged thyroid glands are common problems, and they can harbor cancers within them. They require proper evaluation and treatment.

When detected, patients with these thyroid disorders are usually referred for further work-up to an endocrinologist, or to an experienced head and neck surgeon, like one of the head and neck surgeons at Stony Brook Medicine.

January is national Thyroid Awareness Month that aims to bring to the public's attention the need to take good care of this important tiny gland in the neck.

Following a thorough work-up, the patient may need to undergo thyroidectomy (removal of part or all of the thyroid gland) for several reasons — for removal of thyroid cancer, removal of part of the thyroid gland for definitive diagnosis, treatment of a hyperactive thyroid gland, or an enlarged thyroid gland that is causing breathing or swallowing difficulties.

The thyroid gland is a small, butterfly-shaped gland located in the base of the neck just below the Adam's apple. Although relatively small, the thyroid gland influences the function of many of the body’s most important organs, including the heart, brain, liver, kidneys, and skin. Ensuring that the thyroid gland is healthy and functioning properly is important to the body's overall well-being.

Surgical intervention is the gold standard in thyroid cancer; there are no other options to cure it.

Since thyroid cancers are highly curable, it is extremely important for the patient to undergo proper treatment and close follow-up. The initial treatment for most thyroid cancers is removal of the thyroid gland, and sometimes removal of lymph nodes which may contain metastatic cancer.

In the hands of a highly-skilled, experienced surgeon, the procedure can usually be done on an outpatient basis and with a low risk of complications. Depending on the type of cancer, some patients may require treatment with radioactive iodine after surgery.

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Our thyroid specialists, (l to r) Drs. Lukasz Czerwonka, Melissa M. Mortensen, Elliot Regenbogen, and Ghassan J. Samara.

Also essential is close follow-up by the patient's endocrinologist for tumor surveillance and regulation of the thyroid hormone.

Our thyroid specialists take a multidisciplinary approach to providing care for patients with thyroid disorders. The team of physicians consists of surgeons, endocrinologists, radiation oncologists, radiologists, and pathologists.

Management decisions are often made jointly among the team members. Such a team approach has ensured long-term successful outcomes for our patients at Stony Brook Medicine.

Hyperthyroidism is a sustained overly active thyroid gland, which may result in anxiety, nervousness, rapid heartbeat, weight loss, and high blood pressure. The causes of hyperthyroidism include Grave's disease and toxic nodular goiter. This condition is treated with medications, radioactive iodine, or thyroidectomy.

The advantage of surgery is that the condition can be treated quickly and effectively, minimizing the risk of recurrence. In the past, non-surgical treatment has been the primary approach to patient care because of potential complications associated with the surgery. Now, with surgical expertise and advances in technology at Stony Brook Medicine, more patients are undergoing surgery with minimal complications.

In the past, goiter was treated with medication, but that was proved not to be effective. Patients with goiter now have surgery to alleviate the pressure symptoms on the trachea and the esophagus.

Thyroidectomy is performed for nodules and cancer of the thyroid gland. It is also performed in some patients with overactive thyroid glands.

Stony Brook Medicine provides patients state-of-the-art thyroid care using the multidisciplinary team approach, distinguished by highly experienced surgical specialists capable of treating all forms of thyroid conditions.

The thyroid gland is a small, butterfly-shaped gland located in the base of the neck just below the Adam's apple. Although relatively small, the thyroid gland influences the function of many of the body’s most important organs, including the heart, brain, liver, kidneys, and skin. The blue paisley ribbon icon is the universal symbol of thyroid disease awareness and advocacy. Paisley was chosen because it resembles a cross-section of thyroid follicles, the tiny spheres that the thyroid gland is made of.

Perform the do-it-yourself thyroid neck check. Watch this video (1:00 min) about thyroid awareness from the American Association of Clinical Endocrinologists:

Posted by Stony Brook Surgery on January 4, 2017

Williams Demonstrates the Poetic Can Be Found Everywhere around Us

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William Carlos Williams as intern at Nursery and Child's Hospital.

This year marks the centennial of the famous poem "January Morning" by America's great physician-poet William Carlos Williams (1883–1963). A masterpiece of modernist verse, this poetic sequence — he subtitled it "Suite" — presents moments in his daily life, including his life as a pediatrician and obstetrican at Passaic General Hospital in Passaic, NJ.

"January Morning" first appeared in Williams's book, Al Que Quiere! (1917; "To Him Who Wants It!"; Centennial Edition forthcoming from New Directions). His voice in it remains totally vibrant. The New York Review of Books recently said, "It seems clear that Williams is the 20th-century poet who has done most to influence our very conception of what poetry should do."

The young doctor is dancing with happiness / in the sparkling wind, alone / at the prow of the ferry! — "January Morning"

Williams lived his entire life in Rutherford, NJ, the small town where he was born and raised. It is where he maintained his medical office in his home — where most people knew him simply as "Doc" without knowing he was a man of letters and leader of modernism. He often spent time in Manhattan with fellow artists, crossing the Hudson River by ferry. Al Que Quiere! was his third book but the first to present his unique poetic voice, as found in "January Morning."

All told, Williams published during his lifetime some 20 books of poetry as well as 17 books of prose, including novels, and he delivered more than 3,000 babies. Throughout his career he used his clinical gaze to his advantage as a poet:

January Morning (Suite)

I

I have discovered that most of
the beauties of travel are due to
the strange hours we keep to see them:

the domes of the Church of
the Paulist Fathers in Weehawken
against a smoky dawn—the heart stirred—
are beautiful as Saint Peters
approached after years of anticipation.

II

Though the operation was postponed
I saw the tall probationers*
in their tan uniforms
                                  hurrying to breakfast!

III

—and from basement entries
neatly coiffed, middle aged gentlemen
with orderly moustaches and
well-brushed coats

IV

—and the sun, dipping into the avenues
streaking the tops of
the irregular red houselets,
                                                        and
the gay shadows dropping and dropping.

V

—and a young horse with a green bed-quilt
on his withers shaking his head:
bared teeth and nozzle high in the air!

VI

—and a semicircle of dirt-colored men
about a fire bursting from an old
ash can,

VII

                       —and the worn,
blue car rails (like the sky!)
gleaming among the cobbles!

VIII

—and the rickety ferry-boat "Arden"!
What an object to be called "Arden"
among the great piers,—on the
ever new river!
                         "Put me a Touchstone
at the wheel, white gulls, and we'll
follow the ghost of the Half Moon
to the North West Passage—and through!
(at Albany!) for all that!"

IX

Exquisite brown waves—long
circlets of silver moving over you!
enough with crumbling ice crusts among you!
The sky has come down to you,
lighter than tiny bubbles, face to
face with you!
                        His spirit is
a white gull with delicate pink feet
and a snowy breast for you to
hold to your lips delicately!
X

The young doctor is dancing with happiness
in the sparkling wind, alone
at the prow of the ferry! He notices
the curdy barnacles and broken ice crusts
left at the slip's base by the low tide
and thinks of summer and green
shell-crusted ledges among
                                the emerald eel-grass!

XI

Who knows the Palisades as I do
knows the river breaks east from them
above the city—but they continue south
—under the sky—to bear a crest of
little peering houses that brighten
with dawn behind the moody
water-loving giants of Manhattan.

XII

Long yellow rushes bending
above the white snow patches;
purple and gold ribbon
of the distant wood:
                      what an angle
you make with each other as
you lie there in contemplation.

XIII

Work hard all your young days
and they'll find you too, some morning
staring up under
your chiffonier at its warped
bass-wood bottom and your soul—
out!
—among the little sparrows
behind the shutter.

XIV

—and the flapping flags are at
half-mast for the dead admiral.

XV

All this—
                was for you, old woman.
I wanted to write a poem
that you would understand.
For what good is it to me
if you can't understand it?
                But you got to try hard—
But—
            Well, you know how
the young girls run giggling
on Park Avenue after dark
when they ought to be home in bed?
Well,
that's the way it is with me somehow.

* Nursing students.
WCW's mother, who rejected his modernist poetry.
Street in Rutherford, NJ, near WCW's home.

William Carlos Williams practiced pediatrics and obstetrics for over 40 years. He was a physician of immense integrity, who regarded allegiance to humanism as important as excellence in medical science. He now serves as a role model, and medical students read him (The Doctor Stories) to learn how he labored to get the "right picture" of patients — much like artists do with paint on canvas, and photographers with cameras; what today we call the holistic approach.

At Stony Brook Medicine, Williams is read in The Center for Medical Humanities, Compassionate Care, and Bioethics. Established in 2008 to expand and succeed the Institute for Medicine in Contemporary Society, the Center is dedicated to furthering the School of Medicine's long tradition of emphasizing humanism in medical education, and serving as "a place where the human side of medicine is elevated, examined, and revered."

Listen to Allen Ginsberg (4:16 min), whom Williams mentored, reading from and commenting on "January Morning." For more biographical info, see our post "Remembering William Carlos Williams."