A publication for friends and colleagues of Jefferson’s Department of Surgery Fall 2013 SurgicalSolutions Volume 8, Number 2 Breast 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 mastectomy, 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 breast cancer 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 radiation therapy, 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.