A publication for friends and colleagues of Jefferson’s Department of Fall 2013 SurgicalSolutions Volume 8, Number 2 Care Center Welcomes New Leadership, Offers Latest Surgical Techniques

the position of Director of Outpatient Surgeon Speaks Breast Services at the Smilow Cancer Hospital Network, after spending more “After , a woman can than a decade at Johns Hopkins. His undergo reconstructive surgery using practice has been focused exclusively breast implants or using her own tissue. on breast surgery for some 20 years. “Implants remain a viable option, but As he notes, women with a known they are not free of risk. Women with predisposition to are implants may experience shell rupture, increasingly choosing prophylactic infection and/or visible rippling over mastectomy. Dr. Tsangaris has gained time. Also, implants have an average expertise in mastectomy that can lifespan of just 10 years. Thus, some cosmetically preserve the nipple. He women, particularly younger patients, has also honed techniques designed to simply aren’t comfortable using respect the anatomical boundaries of implants. Other women have previously breast tissue. undergone , leaving their skin unsuitable for an implant- As the most recent addition to the team, based reconstruction. Dr. Tsangaris sees tremendous value and “In such cases, using a woman’s own In August, Theodore Tsangaris, MD, (second from right) was appointed the new Surgical Director of the potential in the Jefferson Breast Care Jefferson Breast Care Center. The Center’s surgical team includes plastic surgeons Stephen Copit, MD, tissue for reconstructive surgery may and Patrick Greaney, MD, (see sidebar) and breast surgeons Anne Rosenberg, MD, Adam Berger, MD, and Center: “Ours is not a ‘virtual’ breast be the best choice. In the past, this type Melissa Lazar, MD. center. It’s an actual center with one of surgery required use of large muscle physical location where specialists come tissue – typically an abdominal muscle With a team of top medical oncologists, MD, FACS, and plastic surgeons together and see patients in tandem. with skin attached to it. With free-flap reconstruction, we are often able to surgeons, plastic surgeons, radiation Steven E. Copit, MD, Director of We have breast imaging one floor above perform reconstruction without using oncologists and pathologists, the the Division of Plastic Surgery, and the Center, and at any given time, we have a medical oncologist, surgeon or muscle tissue. Instead, we harvest skin Jefferson Breast Care Center has long Patrick J. Greaney, MD. and fat from a patient’s belly, buttock radiation oncologist seeing patients provided high-quality, integrated care or thigh. to women with diseases of the breast. “Ours is not a ‘virtual’ breast here.” Looking to the future, he would like to explore opportunities to extend “Free-flap reconstruction, offered With the recent appointment of new center. It’s an actual center through the Jefferson Breast Care leadership – Massimo Cristofanilli, MD, the Center’s capabilities beyond Center with one physical location City – offering patients care closer to Center, is typically a more complex surgery than implant-based as Director of the Breast Care Center where specialists come together where they live and work. and Deputy Director of Translational reconstruction. However, for many and see patients in tandem.” women, this option produces a very Research at the Kimmel Cancer Center “Our patients benefit from our specially trained support teams that include natural, comfortable and long-lasting and Theodore N. Tsangaris, MD, FACS, Offering the most advanced screening nurses, social workers, therapists and result.” as Surgical Director – the Center is and treatment options, the Center has techs,” says Dr. Cristofanilli, whose poised for further growth and evolution. extensive experience in inflammatory research centers on inflammatory breast cancer, breast cancer during The Center has also welcomed Melissa breast cancer, locally advanced breast pregnancy, breast cancer in young Lazar, MD, a Jefferson residency cancer, and genomic and biomarkers women, breast cancer in men and program graduate who recently development – with a focus of rare breast tumors, as well as early completed fellowship training in Breast developing better, more personalized and advanced breast cancer. It also Oncology at Northwestern Memorial therapies. “We work hard to provide offers surgical expertise in nipple- Hospital. Drs. Cristofanilli, Lazar and coordinated, personalized treatment sparing mastectomy with free-flap Tsangaris have joined a well-established and care to all of our patients.” reconstruction (see “Surgeon Speaks”). team of surgeons and clinicians – including breast surgeons Adam Berger, Dr. Tsangaris joined Jefferson from the To learn more visit: Patrick J. Greaney, MD MD, FACS, and Anne Rosenberg, Yale School of Medicine where he held www.jeffersonhospital.org/breast Assistant Professor

Clinical Integration On the Job In this issue Robotic Technology in General Surgery – Page 2 Eleanor Fitzpatrick, RN, MSN, CCRN – Page 3 Changing Lives Through Research Those Who Give High School Student’s Summer of DNA – Page 3 The Pasquarellas Support Transplant Institute – Page 4

THOMAS JEFFERSON UNIVERSITY AND HOSPITALS Overview Clinical Integration

Robotic Technology in General Surgery Procedures – Including Innovative Single-Incision Cholecystectomy Charles J. Yeo, MD, FACS Since their introduction some 30 years ago, Samuel D. Gross Professor and laparoscopic techniques have become the Chair, Department of Surgery standard for a number of general surgery procedures – enabling patients to enjoy less scarring, shorter hospital stays and Surgeons Cataldo Doria, MD, PhD, Karen Chojnacki, MD, Harish Lavu, MD, Francesco Palazzo, MD Honor Roll! and Michael Pucci, MD utilize the da Vinci® Surgical System (shown in the background) for a variety Congratulations to the faculty, staff, faster recoveries. Today, Jefferson surgeons of general surgery procedures. residents and fellows here at Jefferson. are using the latest robotic technology to actually offer a higher degree of freedom To date, the Food and Drug Administration We have achieved a distinction obtained by perform many laparoscopic procedures, than the human wrist. At present, the (FDA) has approved da Vinci® SingleSite® less than 0.5% of all American hospitals – including adrenalectomy, cholecystectomy this July we were notified that we have (gallbladder removal), Heller myotomy, single-site instruments have only two Surgery only for gallbladder removal, joined the U.S.News & World Report Best liver resection, thymectomy, repair of degrees of freedom, but we expect the benign hysterectomy, and removal of the Hospitals Honor Roll. This represents a hiatal hernia, and distal pancreatectomy wristed instruments to be available in fallopian tubes and ovaries (salpingo- major accomplishment, led and enabled for tumors in the tail of pancreas. the future.” oophorectomy). But Dr. Chojnacki believes by Thomas Jefferson University Hospitals there is tremendous potential for single- Results for single-incision cholecystectomy President David McQuaid, FACHE, and At this time, six surgeons in the Department incision surgery: “As the technology have been excellent. Among the potential Jefferson Medical College Dean Mark of Surgery are using the robot, which is improves, there will clearly be opportunities benefits: a low rate of major complications Tykocinski, MD, and brought to reality by manufactured by da Vinci®. They include to use this technique for gastrectomies and a low conversion rate to open surgery. the many Jeffersonians who contribute to Karen Chojnacki, MD, FACS, Associate (stomach resection), liver resection, bile While the small “keyhole” scars of multi- patient care at Jefferson. This is a big deal. Professor and Residency Program Director; duct procedures and pancreatectomy,” port laparoscopic surgery were once Enjoy it! Cataldo Doria, MD, PhD, FACS, Nicoletti she says. “The possibilities are virtually considered a breakthrough, single-incision We in the Department of Surgery touch Family Professor of Transplant Surgery limitless.” many of the 12 specialty areas ranked as and Director, Division of Transplantation surgery through the navel can virtually the nation’s best such as Orthopedics (#7), Surgery; Nathaniel R. Evans, MD, FACS, eliminate surgical scarring. Pulmonology (#14), Cancer (#17), Diabetes FCCP, Assistant Professor, and Director, and Endocrinology (#18), Gastroenterology Minimally Invasive Thoracic Surgery Meet Our Surgical Interns (#21), Gynecology (#28), and Neurology/ Program; Francesco Palazzo, MD, FACS, Neurosurgery (#32). Our Acute Care Assistant Professor and interim Vice Chair, Surgery Division cares for surgical Department of Surgery; Michael J. Pucci, patients in all these specialty areas, and MD, Assistant Professor; and Ernest our thoracic and transplant surgeons, general surgeons, colorectal surgeons, and (Gary) Rosato, MD, FACS, Professor and minimally-invasive surgeons serve patients Director, Division of General Surgery. with cancer, chest diseases and alimentary At Jefferson, the robot was first used for tract diseases. So, although “Surgery” per general surgery procedures in 2007 – to se has never been a specific and defined date over 115 robotic general surgery component for the 24 years of rankings, procedures have been performed. In early we should all be proud of this recognition. September 2013, Dr. Palazzo completed the The Jefferson medical community will first general surgery robotic procedure – a persist in our efforts to achieve superior cholecystectomy – at Methodist Hospital patient care, focused innovative research where he is the interim Chief of Surgery. and exceptional educational opportunities for our student and resident learners. SingleSite® Surgery The Honor Roll. This is a big deal! Now, Jefferson is among the first hospitals in the bar is set high – and we must redouble Philadelphia to use da Vinci® SingleSite® our attention to quality initiatives, patient Surgery – which allows surgeons to safety, compassionate care at the highest perform a cholecystectomy with a single, The Department has welcomed an impressive new group of categorical interns, selected level, and innovation in the clinics and the two-centimeter incision in the patient’s from over one thousand applicants to our program. These doctors, who recently matched labs. We want to become a fixture of the belly button. As Dr. Chojnacki explains, with Jefferson, started on June 20, 2013. Just a few months into their Jefferson surgical Honor Roll. the da Vinci system delivers a magnified, residency, we have all noticed their dedication to patient care, their energy and their three-dimensional and high-definition view excitement in joining the Jefferson community. and includes instruments suitable for single-site surgery. Front row: Katerina Dukleska, MD, University of Medicine and Dentistry of New Jersey; Jessica Latona, MD, University of Medicine and Dentistry of New Jersey; Anisha Dr. Chojnacki notes that the single-site Kshetrapal, MD, Florida International University, Allison Aka, MD, Loma Linda University. instruments are not yet as sophisticated as those she and her colleagues use with Back row: Brock Hewitt, MD, Texas Tech University and Andrew Brown, MD, Jefferson the robot during traditional laparoscopic Medical College. procedures: “When using the robot with We are also pleased to welcome back the following Jefferson Medical College 2013 multiple incisions, the wristed instruments graduates as preliminary interns in general surgery: Harold Hsu, MD and Wei Phin Tan, MD. Changing Lives Through Research On the Job

Eleanor Fitzpatrick, RN, MSN, CCRN Eleanor “Elly” Fitzpatrick joined Jefferson in 1987 as a clinical nurse specialist. Initially serving in the Intermediate Surgical Intensive Care Unit (ISICU), she soon became clinical nurse specialist for the Surgical ICU (SICU), as well. While her title has stayed the same, over the past 26 years Fitzpatrick has embraced and championed significant changes in nursing care – most recently, the growing emphasis on evidence-based initiatives. With primary responsibility for staff education, Fitzpatrick trains and supports new nurses coming into the units. The two critical-care units are staffed by more than 80 nurses; at one time or another, Fitzpatrick also remains an active clinician Fitzpatrick has worked closely with every with a strong commitment to patient- one of them. Fitzpatrick also develops and centric care. When working directly with communicates policies and procedures for patients, she strives to provide the level new equipment, tools and techniques. She of care she would want for her own loved Liz Enyenihi, 15, of Knoxville, TN, spent last summer working in a basic science laboratory in the Department of Surgery as a participant in the national Physician Scientist Training Program. serves as co-chair of the central venous ones. And she enjoys not only the human catheter safety committee and represents connection of patient care, but also the her units as part of the ongoing Magnet direct experience with ever-evolving re-designation process. The Magnet nursing tools and procedures. Recognition Program® recognizes health Tennessee High School Finally, Fitzpatrick appreciates the chance care organizations for quality patient care, to participate in nursing research projects, nursing excellence and innovations in including a study of early and progressive professional nursing practice. Student Spends Summer mobility after surgery (which resulted Fitzpatrick takes a highly collaborative in a reduction in ventilator days and a Sequencing DNA approach to her multi-faceted role. slight reduction in SICU length of stay) She is quick to praise the intelligence and another focused on limiting sedation Many students spend summer at camp to prepare her to work in a real lab. and dedication of Jefferson’s nursing on ventilated patients to support early or the pool. Not Liz Enyenihi – now According to the Jefferson scientists professionals: “Our staff nurses know breathing tube removal. “Nursing research a 15-year-old sophomore at Farragut she worked alongside, Enyenihi was what it’s like to do the work, and is driving the evidence-based approach, High School outside Knoxville, TN. She indeed well prepared to jump in they’re unbelievably smart. I welcome and the way we do things is changing their insights and talents in helping rapidly,” Fitzpatrick concludes. “Keeping spent her summer working eight-hour and participate. During her time in educate other nurses and in developing nurses aware of best practices is more days in the laboratory of Jefferson’s Philadelphia, she worked on DNA procedures.” important than ever.” Director of Surgical Research, Jonathan subcloning using polymerase chain R. Brody, PhD, and living in a reaction (PCR) to amplify DNA. University of Pennsylvania dormitory. “I also did a lot of DNA sequencing Enyenihi is part of the Physician in order to subclone a piece of mutant “It was great to have a front- “It was great to have a front-row seat to Scientist Training Program (PSTP) DNA,” Enyenihi says. “By sequencing row seat to Liz’s development Liz’s development into a young scientist offered by the Distance Learning DNA, we were trying to identify a during the summer,” says Dr. Brody. Center – a nonprofit organization into a young scientist during mutation.” She notes that she also had “I think she came away with an ‘I can dedicated to developing and supporting the summer... she came away really do this or anything’ type attitude, a chance to perform gel electrophoresis the next generation of minority with an ‘I can really do this or which is what makes this program so – a technique used to separate DNA students in science, technology, anything’ type attitude, which special to be a part of.” He will have the based on its size. “Before the summer, engineering, and math. The PSTP chance to work with Enyenihi again, I’d learned about gel electrophoresis, is what makes this program so supports a national pool of minority as she returns to his laboratory next but I had never actually done it – or special to be a part of.” child prodigies across a 10-year regimen summer. used the centrifuge, microcentrifuge, (typically from seventh grade through Enyenihi demonstrated a great deal of Though she’s long planned to become the college senior year). With a multi- and incubators,” she says. “It was scary knowledge and perseverance in the lab, a physician, Enyenihi says her summer institutional approach, the program at first, but it all went well.” and despite being a self-described “shy in Philadelphia exposed her to a new rotates these “whiz kids” through basic She adds that she was pleasantly person,” she also excelled at presenting world: the life of a scientist. “Until this science labs in academia, the National surprised by the autonomy she enjoyed her key findings. She delivered the experience, I never really understood Institutes of Health (NIH), and the during the program: “Although I presentation twice – once to more than what a scientist does. I had only learned pharmaceutical industry. received a great deal of support from 40 PSTP staff and students in a large about it in class and in textbooks. Enyenihi joined the program after Dr. Brody and his team, no one from University of Pennsylvania lecture hall I really enjoyed doing the work in eighth grade and spent the summer of PSTP was looking over my shoulder,” and again to the laboratory faculty the lab, and now I’m considering an 2012 at Southern Methodist University, she recalls. “Only at the end – when and staff at Jefferson. She received MD-PhD program,” she concludes where she took science courses and I delivered my presentation, abstract, top marks for her PSTP talk and left – adding that she hasn’t made a final classes about research writing, giving paper, and poster – did they see what I her Jefferson mentor and co-workers decision. (That can wait until she’s at presentations, and statistics. The goal: had gained from the experience.” equally impressed. least 16!)

For an appointment with a Jefferson Surgeon, call 1-800-JEFF-NOW Those Who Give Art and Gail Pasquarella Support Jefferson Transplant Institute transplant for Art’s late father, Valentino H. ‘entertainer’ at our family dinners, and my With their generous donation, the Pasquarellas Pasquarella, Sr., in the mid-1990s. “Jefferson daughters and nephews are quick to indicate hope to change more lives by supporting did a fabulous job for my father,” Art recalls, their disappointment if their Uncle Val is going Cataldo Doria, MD, PhD, FACS, the Nicoletti “That started our family’s affinity toward to miss a family dinner.” Family Professor of Transplant Surgery and Jefferson.” Director, Division of Transplant Surgery, in When he isn’t enjoying time with his family, developing and implementing the Transplant Some 15 years later, Art’s oldest brother, Art works as executive vice president and Institute. As Dr. Doria explains, the Transplant Valentino H. Pasquarella, Jr., was suffering chief operating officer of Equus Capital Institute represents a multi-institutional from another type of kidney disease, which Partners, Ltd., in Center City. Since 2006, alignment of the transplant programs within had developed from an illness during infancy. he has also been active with the National the Jefferson Health System: “Our goal is Art and his other brother, Joe, underwent the Kidney Foundation. For two years, he served for participating hospitals to collaborate battery of tests to determine compatibility. as chair of the Delaware Valley Board of the Art Pasquarella is a donor in every sense of After discovering that he was a 100 percent on strategic, clinical, quality and financial the word. He gave a kidney as a living donor National Kidney Foundation. In 2011, he joined match, Art signed on to be a living donor. In initiatives – thereby strengthening our to one of his brothers. He gives his time as a the National Board of the National Kidney November 2010, Adam Frank, MD, FACS, and collective performance,” he says. “The volunteer for the National Kidney Foundation. Foundation and will soon become chair of the Carlo Gerardo Ramirez, MD, FACS, operated on Institute will work to promote standardized And he and his wife, Gail, have made a very National Board’s Development Committee. Art and Val, respectively. The operations were clinical pathways and protocols and to deliver generous gift to support the vision for the both successful, and today the Pasquarella “It’s one thing to support a charity by writing a streamlined experience for the patient.” Jefferson Transplant Institute. family continues to enjoy spending time checks and soliciting for donations,” he says. For information about planned giving, or to make a As Art explains, the Pasquarellas had more together. Art is thankful that his big brother “Being a living donor has brought it all really contribution to the Department of Surgery, please than one reason to support transplant services still joins him at the table: “Val has one heck close to home. You realize you have the contact Lara Goldstein in the Jefferson Foundation at Jefferson. The first reason was a kidney of a sense of humor,” Art laughs. “He’s the opportunity to actually change someone’s life.” at 215-955-8797 or [email protected]

620 Curtis Building Non Profit Org. 1015 Walnut Street US Postage Philadelphia, PA 19107 PAID Phila., PA SurgicalSolutions Permit #276 Jefferson Department of Surgery Editorial Board 620 Curtis Building Adam Berger, MD 1015 Walnut Street Jonathan Brody, PhD Philadelphia, PA 19107 www.JeffersonHospital.org/surgery Cataldo Doria, MD, PhD

Adam Frank, MD

Jefferson Surgical Solutions Gerald Isenberg, MD is published by Charles J. Yeo, MD Thomas Jefferson University and Lara Allan Goldstein Thomas Jefferson University Hospital. Florence Williams Jennifer Brumbaugh, MA, Editor-in-Chief Susan Murphy, Writer Robert Neroni, Photography Information in Surgical Solutions is not intended to provide advice on personal medical matters or to substitute for consultation JG 14-0276 with a physician. MC 13-06502

News in Brief

Michael R. Kammerer, MD, has joined the Division of Ashesh P. Shah, MD, has joined the Division of Transplant General Surgery. Dr. Kammerer completed residency Surgery. Dr. Shah completed residency training and a two-year training at Orlando Regional Medical Center in Florida and Transplant Surgery Fellowship at Indiana University. He was a Bariatric Surgery Fellowship at Jefferson. He specializes an Assistant Professor of Surgery at Indiana University School in bariatric surgery and will practice in Center City and at of Medicine before being recruited to Jefferson. He will practice Methodist Hospital. at Jefferson, Lankenau Hospital, and the Alfred I. duPont Hospital for Children.

Michael J. Pucci, MD, has joined the Division of General Save the Date: Surgery. Dr. Pucci (JMC ’07) began residency training at Jefferson will host its 8th Annual Pancreatic Cancer and Related Diseases St. Vincent’s Hospital and Medical Center in New York and Symposium on Saturday, November 9, 2013 from 9 a.m. to 2 p.m. The event gives completed training at Jefferson where he remained for an patients and their loved ones an opportunity to connect with expert physicians, Advanced Gastrointestinal, Hepatopancreaticobiliary and scientists and staff and learn about the latest developments in research and Minimally Invasive Surgery Fellowship. He specializes in treatment. Seating is limited for this free event. Registration is required. Please minimally invasive surgery and will practice in Center City contact [email protected] (215-955-9100) by November 1, 2013. and at Methodist Hospital. For more information, visit www.jeffersonhospital.org/pancreasevent