CCRS 2013 Report Card

Center for Colon & Rectal Surgery

2013 Report Card

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Surgical Team Assistant Director and Clinical Instructor, Colorectal Fellowship Program

Interim Director, Colorectal Fellowship Program

Clinical Associate Professor, Florida State University College of Medicine

Clinical Associate Professor, Florida State University College of Medicine

Clinical Professor, University of Central Florida College of Medicine

Clinical Professor, University of Central Florida College of Medicine

Associate Professor, NOVA Southeastern University

Matthew Albert, MD, FACS, FASCRS

Sam B. Atallah, MD, FACS, FASCRS

Medical Director, Center for Colon & Rectal Surgery

Director of Research and Innovation, Center for Colon & Rectal Surgery

Matthew.Albert.MD@Flhosp.org

Sam.Atallah.MD@flhosp.org

Assistant Director, Colorectal Fellowship Program

Assistant Director, Colorectal Fellowship Program

Clinical Associate Professor, University of Central Florida College of Medicine

Clinical Associate Professor, University of Central Florida College of Medicine

Teresa H.deBeche-Adams, MD, FACS

George Nassif, Jr., DO

Director of Pelvic Floor Center, Center for Colon & Rectal Surgery

Director of Academic Affairs, Center for Colon & Rectal Surgery

Teresa.H.debeche-Adams.MD@flhosp.org

George.Nassif.DO@flhosp.org

Administrative Staff Leslee Cunnion, Office Manager | Jenny Moody, Director of Practice Operations | Lakesha Laws, Clerical Supervisor

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2013 Report Card About Us The physicians at the Center for Colon & Rectal Surgery (CCRS) all have specialized training in colon and rectal surgery and are board certified or eligible in both general surgery and colon and rectal surgery. This fourphysician group covers a broad geographic area which includes Orlando, Altamonte Springs, Winter Park, as well as the East Orlando region thereby providing care throughout Orange and Seminole Counties. The priority for the surgical team is providing patients with the best possible surgical care, and because minimally-invasive approaches (such as laparoscopy and robotics) result in improved outcomes and quick healing, these approaches are offered to more than 95% of patients undergoing elective colorectal surgery.

In addition to patient care, all the physicians are actively involved in surgical innovation. Most notably, the group is the sole pioneer of Transanal Minimally Invasive Surgery (TAMIS) and Robotic Transanal Surgery (RTS)— techniques which have now been adopted world-wide.

Research is also an important area of focus for the practice, and over the past three years alone, the team has published 22 peer-reviewed articles, accounting for a significant fraction of all publications from Florida Hospital. Furthermore, each surgeon fosters an academic approach in their practice, providing subspecialty training in colon and rectal surgery for two candidates per year in an ACGME-accredited fellowship program.

International fellows, medical students and PA students also train with the team on an ongoing basis.

The team has helped to establish Centers of Excellence in colorectal oncology and pelvic floor disorders. With regular participation in multi-disciplinary conferences—such as pelvic floor, pathology and GI tumor board—the physicians in our practice bring a true team approach to solving complex problems of the colon and rectum.

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Key Contributions and Innovations Highlights of Latest Research TAMIS (Transanal Minimally Invasive Surgery) was developed by our

(biologic) mesh for reinforcement, which may ultimately decrease

physicians in 2009. We currently have the largest series of TAMIS for the local

recurrence rates.

excision of rectal neoplasia (n=100). The technique has been adopted worldwide, and there are now two devices which are FDA approved specifically for TAMIS. Since the date the team at the Center for Colon & Rectal Surgery (CCRS) introduced TAMIS, 16 peer-reviewed publications have been reported by investigators in Europe, America and Asia. Combined, these publications demonstrated that 179 TAMIS cases have been successfully performed and both feasibility and efficacy have been proven time and time again.

Surgeons at CCRS were the first to report Robotic Transanal Surgery (RTS) in a cadaveric model. They were then able to successfully carry out this complex operation in a patient for local excision of rectal cancer. They were also the first in the world to describe robotic-assisted transanal proctectomy for curative-intent resection of locally advanced rectal cancer. These key areas of advancement are expected to grow and develop further over the next decade.

The technique for creating an ‘incisionless’ laparoscopic stoma (ileostomy or colostomy) was first reported by CCRS, and has now been duplicated elsewhere.

Surgical drains are often used after complex laparoscopic and open abdominal surgery. CCRS doctors were the first to describe the use of a surgical drain for bed-side ‘drainoscopy’ and presented their work at a major national surgical conference (SAGES, Podium Presentation, San Antonio, TX, 2011).

Stereotaxy and intra-operative navigation has been described for neurological surgery. The CCRS physicians, however, are the first to employ this navigational approach to pelvic surgery. Frameless, image-guided stereotactic surgery for transanal total mesorectal excision has been successfully performed by CCRS and publication of this novel method is currently pending.

TAMIS has opened the gateway for a new era in rectal cancer surgery: Transanal TME. Around the world, there are currently less than five centers with expertise in this unique approach, which has a particular advantage over more conventional approaches to proctectomy, especially in morbidly obese patients where access the pelvis is difficult. The CCRS physicians have submitted their work on the initial 20 patients who have undergone

Transperineal rectosigmoidectomy (Altemeier Procedure) for treatment of

transanal TME using TAMIS and this work has been accepted for publication

rectal prolapse had not undergone modification for more than 45 years,

in a peer-reviewed journal.

until the CCRS physicians performed and described the use of xenograft

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2013 Report Card Surgical Methods and Case Volume Numbers of Surgical Procedures In 2012, the three Center for Colon & Rectal Surgery practicing physicians

laparoscopic approach. The Center for Colon & Rectal Surgery conversion

performed 439 abdominal colon and rectal operations at four of the seven

rate (laparoscopic to open) is estimated to be less than 8%. At the CCRS,

Florida Hospital Campuses. This volume is projected to increase by 25%

median discharge from the hospital after elective colon surgery is four days2.

to 548 over the next three years with the addition of the group’s fourth surgeon, Dr. George Nassif. Of the 439 cases performed, 185 resections were completed for colorectal malignancy. This accounts for approximately 35% of all colon and rectal cancer resections performed at Florida Hospital’s seven campuses (n = 535). Of the n = 185 resections for malignancy performed by CCRS, 40% (n=75) were resections of the rectum or anus1.

In 2012, The Florida Hospital Cancer Institute (FHCI) conducted a focus study workshop on rectal cancer resection to independently assess surgeon compliance with NCCN guidelines. This data revealed that of the 10 surgeons performing rectal cancer surgery at Florida Hospital, Center for Colon & Rectal Surgery physicians had ranked 1st and 2nd in terms of compliance with standardized NCCN guidelines. Furthermore, the number

At Center for Colon & Rectal Surgery, more than 95% of elective resections

of rectal cancer resections performed by the three Center for Colon & Rectal

for benign and malignant diseased are performed laparoscopically, which

Surgery surgeons exceeded the volume of all other rectal cancer cases

compares favorably to the national average whereby an estimated 20-

performed by the remaining seven surgeons3.

30% of colon and rectal surgery is performed using a minimally invasive Source 1. FH Cancer Registry (2013) 2. CCRS database and Practice Patient Registry (2013) 3. Data from FHCI focus study group (2012)

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The Practice at a Glance Early discharge and fast-track protocol with all elective surgery Leading center for implantation of sacral nerve stimulator (SNS) for fecal

One of the few centers in Central Florida to perform High Resolution Anoscopy for early detection and surveillance of AIN

incontinence, with 46 implanted devices in 2012-2013. This is more than

100 robotic assisted colon and rectal resections for cancer

any other group in all of Central Florida1

100 TAMIS resections for early stage rectal cancer and polyps

Leading center for minimally invasive surgery for hemorrhoids, such as Transanal Hemorrhoidal Dearterialization (THD)

185 oncologic resections in 2012 95% of elective abdominal surgery performed laparoscopically

Current Research Ongoing Projects, Studies and Clinical Trials Detection of Occult Fecal Incontinence with a Bowel Control Satisfaction Survey Gore Anal Fistula Plug Trial Lapros Study: International, Multi-Institutional Study Comparing Resection Rectopexy vs. Ventral Rectopexy PROSPECT Rectal Cancer Trial, MSK, University of Chicago TAMIS: A Retrospective Review of our First 100 Patients Tissue Array Development: Cancer Biomarker Studies, Florida Hosptial Cancer Institute Transanal Minimally Invasive Surgery for Total Mesorectal Excision (TAMIS-TME) Source 1. 2013 Industry estimates from Medtronic, Inc. SNS introduce to USA March 1st, 2011 for treatment of fecal incontinence

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2013 Report Card Peer-Reviewed Publications (2010-2013) Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a

Atallah S, Parra-Davila E, deBeche-Adams T, Albert M, and Larach S (2012)

giant leap forward. Surg Endosc 24 (9): 2200-2205. Epub 21 Feb 2010.

Excision of a rectal neoplasm using robotic transanal surgery (RTS): a

Harvey KP, Lin YH, Albert MR. Laparoscopic resection of metastatic mucosal

description of the technique. Tech Coloproctol Oct; 16(5): 389-392.

melanoma causing jejunal intussusception. Surg Laparosc Endosc Percutan

Atallah SB, Debeche-Adams T. Incisionless laparoscopic stoma construction

Tech. 2010 Apr;20(2):e66-8.

using a 12-mm Hasson trocar. Am Surg. 2012 Nov;78(11):E495-7.

Ross, H, Steele, S, Whiteford, M, Lee, S, Albert, M, Mutch, M Rivadeneira,

Albert S. DeNittis, John Marks, Filip Troicki, Erik L. Zeger, George Nassif,

D, Marcello, P. Early Multi-institution Experience With Single-Incision

Gerald J. Marks (2012) Treatment of distal rectal cancer with preoperative

Laparoscopic Colectomy. Dis Colon & Rectum (Feb 2011) Vol. 54. No2. p

intensity-modulated radiation therapy (IMRT) combined with

187-192.

chemotherapy: Updated 5-year results of 42 patients. J Clin Oncol 30, 2012

Atallah S, Albert M, Larach S. Technique for constructing an incisionless

(suppl; abstr e14157).

laparoscopic stoma. 2011 Sep;15(3):345-7. Epub 2011 Jun 16 Tech

Felix O, Albert M, MD., Izfar S, MD., Atallah S,MD., DeBeche-Adams, MD.,

Coloproctol.

Larach S, MD., Cawich SO. Laparoscopic colectomy for acute complicated

Atallah SB, Albert MR, deBeche-Adams TH, Larach SW (2011) Robotic TransAnal Minimally Invasive Surgery in a cadaveric model. Tech Coloproctol.

Dec;15(4):461-4. Epub 2011 Sep 28.

Atallah S, Albert M., T. deBeche-Adams, Larach S. The Altemeier Procedure Using Biologic Mesh. October 2011 [epub, ahead of print] Tech Coloproctol.

Atallah S. Different surgeons find same solution for minimally invasive stoma construction. Dis Colon Rectum. 2012 Jul; 55(7):e302.

Marks J, Nassif G, Frenkel, J. (2012) Minimally Invasive Colorectal Surgery.

Minerva Gastroenterologica e Dietologica September;58 (3):201-11.

diverticulitis: Feasibility and safety of a totally laparoscopic single stage approach. West Ind Med J. 2012; 61(S4): 52-53.

Cawich SO, Albert M, MD., Mohanty SK, Singh Y, Dan D, Walrond M, Francis W, Amir S, Simpson LK, Bonadie KO, Williams EW, Dapri G. Single Incision Laparoscopic Cholecystectomy: A Multi-Centre Audit. West Ind Med J. 2012; 61(S3): 12.

Atallah S, Nassif G, Polavarapu H, deBeche-Adams T, Ouyang J, Albert M, Larach S. (2013) Robotic-assisted transanal surgery for total mesorectal excision (RATS-TME): A description of a novel surgical approach with video demonstration. Tech Coloproctol. DOI: 10.1007/s10151-013-1039-2.

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Peer-Reviewed Publications (2010-2013), continued Atallah S, Albert M, Debeche-Adams T, Nassif G, Polavarapu H, Larach S.

Atallah SB, Larach S, Debeche-Adams TC, Albert MR. (2013) Transanal

(2013) Transanal minimally invasive surgery for total mesorectal excision

Minimally Invasive Surgery (TAMIS): A Technique That Can be Used for

(TAMIS-TME): a stepwise description of the surgical technique with video

Retrograde Proctectomy. Dis Colon Rectum. Jul;56(7):931. doi: 10.1097/

demonstration. Tech Coloproctol. 17:321-325.

DCR.0b013e318292ed7e.

Atallah S, Albert M, Felix O, Izfar S, Debeche-Adams T, Larach S. The technical

Atallah SB, Albert MR. (2013) Transanal minimally invasive surgery (TAMIS)

approach to laparoscopic colectomy in patients who have undergone prior

versus transanal endoscopic microsurgery (TEM): Is one better than the

abdominoplasty. Tech Coloproctol. 2013 Feb;17(1):111-6.

other? Surg Endosc. Jul 27. [Epub ahead of print].

Albert M, Atallah S, deBeche-Adams T, Izfar S, Larach S. (2013) Transanal

Atallah S. (2013) Transanal minimally invasive surgery for total mesorectal

Minimally Invasive Surgery (TAMIS) for local excision of benign neoplasms

excision. Minim Invasive Ther Allied Technol. Sep 1. [Epub ahead of print].

and earl-stage rectal cancer: Efficacy and outcomes in the first 50 patients.

Dis Colon Rectum. Mar;56(3):301-7.

Marks J, Nassif G, Schoonyoung H, Denittis A, Zeger E, Mohiuddin M, Marks G. (2013) Sphincter-sparing surgery for adenocarcinoma of the distal 3 cm

Albert, M, Atallah, S, Larach, S, MD, deBeche-Adams, T. (2013) Minimally

of the true rectum: results after neoadjuvant therapy and minimally invasive

Invasive Anorectal Surgery: From Parks Local Excision to Transanal

radical surgery or local excision. Surg Endosc. 2013 Sep 21. [Epub ahead of

Endoscopic Microsurgery to Transanal Minimally Invasive Surgery. Seminars

print] PMID: 24057070.

in Colon & Rectal Surgery.Volume 24, Issue 1, Pages 42-49, March.

Atallah S, Martin-Perez B, Albert M, deBeche-Adams, T, Nassif G, Hunter L,

Atallah, S. Albert, M, deBeche-Adams, T., Larach S. (2013) Transanal

Larach S. Transanal minimally invasive surgery for total mesorectal excision

Minimally Invasive Surgery (TAMIS): applications beyond local Excision Tech

(TAMIS-TME): results and experience with the first 20 patients undergoing

Coloproctology Apr; 17(2): 239-43.

curative-intent rectal cancer surgery at a single institution. Tech Coloproct

Atallah SB, Albert MR, deBeche-Adams TC, Izfar S, Larach S. Application

[epub ahead of print Nov 2013].

of laser-assisted indocyanine green fluorescent angiography for the assessment of tissue perfusion of anodermal advancement flaps. Dis Colon Rectum. 2013 Jun;56(6):797.

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2013 Report Card Published Educational and Teaching Work Book Chapters Larach, SW. Corman’s Textbook of Colorectal Surgery (2012) 6th Edition. Laparoscopic Colon and Rectal Surgery: Transanal Minimally Invasive Surgery. Chapter 19 pp 594-595.

Atallah, S, Albert R. Robotics in General Surgery. Chapter 23. Robotic Transanal Surgery [pending publication – Anticipated Nov, 2013].

Raymond S. Sinatra, MD, PhD, Sergio Larach, MD, and Sonia Ramamoorthy, MD. Surgeon’s Guide to Postsurgical Pain Management: Colorectal and Abdominal Surgery. First Edition.

(2012) Professional Communications, Inc. ISBN: 978-1-932610-72-7.

Albert, M. Operative Techniques in Surgery. Hand assisted Right Colectomy. 2012.

Lippincott, Williams, & Williams.

Marks J, Nassif G, Marks G. (2012) Intersphincteric resection for low rectal tumors. Chapter Trananal abdominal transanal procto-sigmoidectomy with descending coloanal anastomosis (the TATA procedure ) for low rectal cancer treated with chemoradiation. Editor(s) Schiessel & Metzger ISBN: 978-3-70910928-1 (Print) 978-3-7091-0929-8 p153-158.

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TAMIS – Countries where this new procedure developed by CCRS physicians is now being performed (countries indicated in blue/green shading)

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2013 Report Card Hands on Educational Initiatives TAMIS is Taught Around the Globe The surgical team has been invited to several cities, both in the United States and internationally, to teach and train other colorectal surgeons on TAMIS. While the number of destinations is expanding, in 2013 the current list of locations that the Center for Colon & Rectal Surgery surgeons have traveled to train other surgeons in this specialized technique is listed below: Abu Dhabi, United Arab Emirates

Houston, TX, USA

Phoenix, AZ, USA

Atlanta, GA, USA

London, ON, Canada

San Antonio, TX, USA

Cairns, Australia

London, UK

San Diego, CA, USA

Celebration, FL, USA

Newark, NJ, USA

St. Louis, MO, USA

Dallas, TX, USA

New York, NY, USA

Syracuse, NY, USA

Dublin, Ireland

Orlando, FL, USA

Tampa, FL, USA

Hollywood, FL, USA

Vancouver, BC, Canada

Map Legend TAMIS Training by CCRS Physicians in the United States

TAMIS Training by CCRS Physicians abroad

Countries where TAMIS is now being performed

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Presentations at Major National Surgical Conferences (SAGES and ASCRS) Podium Presentations (2012-2013) Atallah S, deBeche-Adams T, Albert M, Nassif G, Polavaropu H, Larach S. TAMIS Repair of Rectourethral Fistula. Podium presentation (2013). American Society of Colon & Rectal Surgeons (ASCRS) Annual Scientific Meeting. Pheonix, AZ, April 27-May 1, 2013.

Atallah S, Parra-Davila E, deBeche-Adams T, Albert M, Larach S. Robotic Transanal Surgery. Podium presentation (2013). Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Annual Scientific Meeting. Baltimore, MD. April 17-20, 2013.

Albert M, Atallah S, Larach S, Izfar S, Felix O, deBeche-Adams T. Transanal Minimally Invasive Surgery: Efficacy proven in the first 50 consecutive resections.

Podium presentation (2012). American Society of Colon & Rectal Surgeons (ASCRS) Annual Scientific Meeting. San Antonio, TX. June 2-6, 2012.

Atallah S, Larach. S, deBeche-Adams, T, Albert M, Izfar S. TAMIS Proctectomy†. Podium presentation (2012). American Society of Colon & Rectal Surgeons (ASCRS) Annual Scientific Meeting. San Antonio, TX. June 2-6, 2012.

Atallah S, Albert M, Larach S, deBeche-Adams T, Felix O, and Izfar S. Anodermal Cutaneous Flap Perfusion Using Fluorescent Angiography. Podium presentation (2012). American Society of Colon & Rectal Surgeons (ASCRS) Annual Scientific Meeting. San Antonio, TX. June 2-6, 2012.

Poster Presentations (2012-2013) Nassif G, Polavaropu H, Monroy A, deBeche-Adams T, Larach S, Albert M, and Atallah S. Application of the TAMIS Platform for Complete Pelvic Resection. Poster presentation (2013). Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Annual Scientific Meeting. Baltimore, MD. April 17-20, 2013.

Polavaropu H, Nassif G, Monroy A, deBeche-Adams T, Atallah S, Albert M, Larach S. Short-term outcomes comparing laparoscopic versus robotic colectomies.

Poster presentation (2013). Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Annual Scientific Meeting. Baltimore, MD. April 17-20, 2013.

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2013 Report Card Presentations at Major National Surgical Conferences (SAGES and ASCRS) Poster Presentations (2012-2013), continued Izfar,S.,deBeche-Adams, T, Atallah S, Albert, M.,Clancy,J. ARNP, Karla Miller, Omar, F, MBBS, Larach,S., Early Laparoscopic Single-Stage Resection for the Treatment of Acute Diverticulitis.† Poster presentation 2012. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Scientific Session and Postgraduate Course, San Diego, CA.† March 7-10, 2012.Atallah,S., Albert,M, deBeche-Adams,T., Izfar,S., Larach, S.,.†Transanal Minimally Invasive Surgery (TAMIS): First Cancer Resection with Two Year Follow-Up Endoscopy. Video poster presentation (2012). Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Scientific Session and Postgraduate Course, San Diego, CA.† March 7-10, 2012.

Lin YA, Izfar S, Barcelos-Desouza M, Atallah S, deBeche-Adams T, Felix O, Albert M, Larach SW. Long-term Outcomes after Stapled Hemorrhoidopexy. Poster presentation (2012). American Society of Colon & Rectal Surgeons (ASCRS) Annual Scientific Meeting. San Antonio, TX. June 2-6, 2012.

Izfar S, Felix O, deBeche-Adams T, Albert M, Larach S, Atallah S. High-Dose Botulinum Injection for the Treatment of Chronic Anal Fissure†† Poster presentation (2012). †American Society of Colon & Rectal Surgeons (ASCRS) Annual Scientific Meeting. San Antonio, TX. June 2-6, 2012.

Izfar S, Felix O, Atallah S, Albert M, deBeche-Adams T, Parra-Davila E, and Larach SW. The Orlando Experience with Robotic Surgery: The First 100 Patients Resected for Colorectal Neoplasia., Poster presentation (2012). American Society of Colon & Rectal Surgeons (ASCRS) Annual Scientific Meeting. San Antonio, TX. June 2-6, 2012.

Nassif G, Polavarapu H, deBeche-Adams T, Atallah S, Albert M, and Larach S. TAMIS Total Mesorectal Excision for Distal Rectal Cancer: Early experience with shortterm outcomes. Poster presentation (2013). American Society of Colon & Rectal Surgeons (ASCRS) Annual Scientific Meeting. Pheonix, AZ, April 27-May 1, 2013.

Polavarapu H, Pradenas S, Nassif G, deBeche-Adams T, Atallah S, Albert M, Larach SW. Long-term Outcomes of Rectocele Repairs Comparing Transperineal, Transanal, Stapled Transanal Rectal Resection, and Transvaginal Approaches. Poster presentation (2013). American Society of Colon & Rectal Surgeons (ASCRS) Annual Scientific Meeting. Pheonix, AZ, April 27-May 1, 2013.

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Training the Next Generation of Health Care Providers ACGME-Accredited Colorectal — Surgery Fellowship Program Graduates and Trainees (to date) TTeresa H.deBech-Adams, MD (2010-2011) Seema Izfar, MD (2011-2012) George Nassif, DO (2012-2013) Harsha Polavarapu, MD (2012-2013) Francisco Quinteros, MD (2013-2014) Henry Schoonyoung, MD (2013-2014) International Research Fellows Antonio Alves, MD

Graziela Fernandes, MD

Gabriela Domingues Andrade-Ribeiro, MD

Beatriz Martin-Perez, MD

Sabastian Bayer, MD

Andres Monroy, MD

Omar Felix, MBBS

Luciane H. Oliveira, MD

Fabiana Fernandes, MD

Kumaran Thiruppathy, MD

Medical Students

PA Students

Adam McCowan, PA-S

Amanda Roubik, PA-S

Emmanuel Bassily, MS, III

William Adamy, PA-S

Anita Morin, PA-S

Nancy Sanfrancesco, PA-S

Daut Elshani, MS, IV

David Alverez, PA-S

Sherin Nazmi-Mubarak, PA-S

Michael Sulewski, PA-S

Nicholas McKenna, MS, III

Kaitlin Colella, PA-S

Brandon Nieves, PA-S

Jaimie Thompson, PA-S

Jennifer Morgan, MS, III

Lindsay Garrison, PA-S

Phi Nquyen, PA-S

Nathan Wade, PA-S

Sohaib Shamsi, MS, III

Saleem Ghorayeb, PA-S

Nalita Rajkumar, PA-S

Ashley Watson, PA-S

Rebecca Heniser, PA-S

Alex Rodriquez, PA-S

Beth Woodford, PA-S

Research Assistants / Student Rotatos Yasmin Duquesne, BA Lawna Hunter, BA Krista Miller, BA

In addition, the Center for Colon & Rectal Surgery has general surgery residents, family medicine residents, MIS-GYN fellows and other student learners rotate on their service regularly.

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2013 Report Card Other Educational Initiatives Innovations in Colorectal Surgery The Center for Colon & Rectal Surgery, together with Florida Hospital, sponsored a three-day, first-annual international meeting on Innovations in Colorectal Surgery, held October 30 – November 1, 2013. Learn more at www.NicholsonCenter.com or scan this QR code. 4 The Center for Colon & Rectal Surgery physcians have built and maintain a website designed for the education of colorectal fellows and other student learners. It includes the largest online photo library of colorectal images in high resolution, didactic videos and learning modules, and other important educational resources that can be shared by our trainees.

Links to other social media sites, such as Facebook, YouTube and Twitter can be found on this website www.OrlandoColon.com or scan the QR code, to the left.

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