February 2023 Department of Surgery Newsletter

SURGERY NEWS

February 2023

NOTES FROM THE CHAIR

Each year brings us new opportunities for innovation, growth, and change. Our use of the technology available to us expands as we look at innovative ways to utilize 3-D printing and ongoing training on robotic surgical techniques to increase access to kidney transplants. We continue to be a record-breaking, award-winning department of surgery. We are setting records with the number of transplants our surgeons perform, winning awards for new devices, and more.

We continue to welcome exceptional new hires across a variety of disciplines, expanding our diversity of thought and experience throughout the work of the department.

I appreciate the contributions of each individual to these accomplishments, and I hope you enjoy reading about them in the following pages.

Richard D. Schulick, MD, MBA Professor & Chair, CU Department of Surgery Director, CU Cancer Center The Aragón/Gonzalez-Gíustí Chair

PREVENTING ACUTE KIDNEY INJURY

Patients receiving cardiac surgery are at higher risk for acute kidney injury following the procedure, which is why the University of Colorado Department of Surgery has implemented a new preoperative pathway to identify patients who are more likely to suffer acute kidney injury.

CU CARDIAC SURGEONS DEVELOP PATHWAY TO PREVENT ACUTE KIDNEY INJURY AFTER SURGERY

Patients receiving cardiac surgery are at higher risk for acute kidney injury following the procedure, which is why the University of Colorado Department of Surgery has implemented a new preoperative pathway to identify patients who are more likely to suffer acute kidney injury (AKI) following elective cardiac surgery and prevent that injury from occurring.

Muhammed Aftab, MD Associate Professor Cardiothoracic Surgery

“My research focus is the prevention of acute kidney injury after cardiac surgery,” says Muhammad Aftab, MD, associate professor of cardiothoracic surgery, who led the effort to create the new pathway. “It’s an important problem to address because acute

kidney injury is a multisystem problem. Once patients get kidney failure after surgery, everything gets affected — their mortality, their morbidity. The risk of infection increases significantly, their hospital length of stay increases, and their ICU length of stay increases. We know this is a big problem that needs to be addressed.”

While the AKI pathway has only been in use for a few months, it already has shown benefits for patients.

Muhammad Aftab, MD, led development of the protocol that identifies patients at highest risk after cardiac surgery.

Greg Glasgow

CU SURGEONS SET RECORDS FOR TRANSPLANTS IN 2022

2022 was a record-breaking year for the number of transplants performed by the organ transplant team at the University of Colorado Department of Surgery, with more than 300 kidney transplants, more than 130 liver transplants, more than 60 heart transplants, and 40 lung transplants performed over the past 12 months.

“We’re one of the largest transplant programs in the U.S. — and certainly the largest in this region,” says Elizabeth Pomfret, MD, PhD, chief of the Division of Transplant Surgery and the Igal Kam, MD, Endowed Chair of Transplant Surgery.

Surgical Resident Wins Award for Best Cardiac Presentation

Cenea Kemp, MD, a general surgery resident in the Department of Surgery at the University of Colorado School of Medicine, took home the award for Best Oral Cardiac Presentation at the annual meeting of the Eastern Cardiothoracic Surgical Society in October.

Kemp was recognized for her research titled An Analysis of Aortic Remodeling in TEVAR for Aortic Dissection: Balloon Flap Fracture vs. the Traditional Method.

BUTTON HUGGIE WINS SHARK TANK AWARD AT NASPGHAN

An innovative device designed to secure gastrostomy buttons won the Shark Tank challenge at the 2022 North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) annual meeting.

The Button Huggie, co-invented by Steve Moulton, MD, a professor of pediatric surgery in the Department

of Surgery, and Tyler Mironuck, an engineering graduate of the Design Center Colorado program at CU Boulder, is designed to reduce or eliminate gastrostomy button dislodgements, excessive movement, leaking, and skin irritation or infection.

Rachel Sauer

Greg Glasgow

Greg Glasgow

WELCOME NEW HIRES

FACULTY

Jacob Erickson, MSN - Acute Care NP Instructor

Urology

Gregory Gleckler, PA-C Instructor

GI, Trauma, and Endocrine Surgery

Jessica Graham, PNP-AC Instructor

Pediatric Surgery

Shon Hernandez, NP Instructor

Surgical Oncology

Casey Johnson, NP Instructor

Surgical Oncology

Molika Keeler-Carroll, PA-C Instructor

GI, Trauma, and Endocrine Surgery

Caroline Kirby, PA Instructor

GI, Trauma, and Endocrine Surgery

Corinne Lesieur-Garland, MSN, NP-C Instructor

Urology

Hannah Martin, PA Instructor

Pediatric Surgery

Nina Mikkilineni, MD Assistant Professor

Urology

Amber Morrison, PA-C Instructor

GI, Trauma, and Endocrine Surgery

Pedro Neves, MD Visiting Researcher

Vascular Surgery

Jessica Outten, PNP-AC Instructor

Pediatric Surgery

Kara Posewick, PA-C Instructor

Plastic and Reconstructive Surgery

Ana Rocio Lopez, MS, MPH Research Instructor

Transplant Surgery

Audrey Sindic, MS, PA-C Instructor

GI, Trauma, and Endocrine Surgery

Angela Smith, PA-C Instructor

GI, Trauma, and Endocrine Surgery

Stella Westfall, MSN, AGACNP Instructor

GI, Trauma, and Endocrine Surgery

John Wiersch, MD Assistant Professor Pediatric Surgery

STAFF

Corie Campbell

Administrative Assistant III

GI, Trauma, and Endocrine Surgery

Melissa Chavez

Administrative Assistant III Urology

Zari Dumanian

Laboratory Sciences Professional Plastic and Resconstructive Surgery

Pei Foong

Finance and Business Operations Manager

Surgical Oncology

Lauren Gunter

Administrative Coordinator

Urology

Rita Holland

Finance and Accounting

Reporting Specialist

Finance and Administration

Aloha Hoppin

Finance and Accounting Reporting

Senior Specialist

GI, Trauma, and Endocrine Surgery

Alex Ling

Senior Research Services Professional

GI, Trauma, and Endocrine Surgery

Julianna Linton

Business Services Financial Professional

Transplant Surgery

Anna Ludwig

Administrative Assistant III

GI, Trauma, and Endocrine Surgery

Keriayn O’Donnell

Administrative Assistant III

Plastic and Reconstructive Surgery

Joanne Penny, MHA

Director of Operations

Finance and Administration

Elisabetta Poli

Financial and Business Analyst

Urology

Elexis Sellner Pierre

HR and Operational Professional

GI, Trauma, and Endocrine Surgery

Mamadou Seye

Research Services Clinical Science

Senior Professional

Vascular Surgery

Brian Shimamoto

Human Resources Program Manager

Finance and Administration

Claudia Vazquez

Business Services Senior Professional

Pediatric Surgery

Jessica Wu

Business Services Professional

Plastic and Reconstructive Surgery

Huiping Zhang

Research Services Senior Professional

Plastic and Reconstructive Surgery

ANNOUNCING NEW CHIEF OF CARDIOTHORACIC SURGERY

Joseph Cleveland Jr., MD, brings extensive experience in research and collaborative care to his role in the Division of Cardiothoracic Surgery.

The Division of Cardiothoracic Surgery in the University of Colorado Department of Surgery has named Joseph Cleveland Jr., MD, as the new division chief.

In his new role, Cleveland brings a commitment to growing diversity, equity, and inclusion in cardiothoracic surgery, supporting surgical research, and increasing the division’s profile locally, regionally, nationally, and internationally.

Cleveland began his career with the CU Department of Surgery in 1991 as a surgical intern and also completed his residency and a thoracic and cardiac fellowship in the department. In 2001,

he joined the faculty as an assistant professor and started the mechanical circulatory support/left ventricular assist device (LVAD) program. He was named surgical director of cardiac transplantation in 2003.

Cleveland has also pursued research interests that include clinical trials for structural heart disease and mechanical circulatory support. He serves as one of the national principal investigators for the MOMENTUM 3 trial, which is the largest randomized trial ever conducted with LVADs.

PEDIATRIC SURGERY DIVISION WELCOMES NEW CHIEF

Ankush Gosain, MD, PhD, brings clinical and

research

expertise

in

pediatric colorectal disease and pediatric surgical oncology.

The Division of Pediatric Surgery in the University of Colorado Department of Surgery welcomes a new chief, one who brings a strong commitment to growing diversity and equity in pediatric surgery and supporting surgeons as research scientists.

Ankush Gosain, MD, PhD, joins the division from the University of Tennessee Health Science Center, where he served as vice chair for academic affairs, senior surgical advisor for quality and safety, and director of surgical research.

Gosain made the decision to come to Colorado because “it’s a really exciting opportunity,” he says. “Children’s Hospital Colorado is a top five children’s hospital widely recognized for clinical excellence, and the Division of Pediatric Surgery is the same. When I look at the people in the division – faculty, advanced practice providers, and staff – there’s so much talent and so much potential there.

Rachel Sauer

Rachel Sauer

Joseph Cleveland Jr., MD Division Chief Cardiothoracic Surgery

Ankush Gosain, MD, PhD

Division Chief Pediatric Surgery

RONNIE HILLMAN’S DEATH HIGHLIGHTS RARE CANCER THAT DISPROPORTIONATELY AFFECTS YOUNG BLACK MEN

Rachel Sauer

Ronnie Hillman, who was a 2012 thirdround draft pick out of San Diego State University, was the Broncos’ leading rusher in 2015, the season in which the team won Super Bowl 50. He played four seasons with the Broncos before being released by the team in 2016.

Further, RMC is closely linked with hemoglobinopathies, specifically sickle cell trait and sickle cell disease. Approximately 8% of Americans who are Black have sickle cell trait, so the disease has particularly impacted Black communities.

Nicholas Cost, MD Associate Professor Urology

On December 21, his family announced on Instagram that he had been diagnosed in August with renal medullary carcinoma (RMC), a rare kidney cancer first described in 1995 that primarily affects adolescents and young adults – most patients are diagnosed between ages 11 and 39. Males are affected in 2-to-1 ratio

We spoke with Nicholas Cost, MD, an associate professor of urology in the CU Department of Surgery and kidney cancer researcher, to learn more about this rare but deadly disease.

with the disease.

The former Denver Broncos running back died December 21, 2022, at age 31, of renal medullary carcinoma.

WHAT IS A GALLSTONE, ANYWAY?

Michael Cripps, MD, talks about gallbladder inflammation, cholecystectomies, gallbladder cancer, and more.

From COVID-19 to Opioids: Medical Students Highlight Studies Completed Through Summer Research Program

Gallstones are one of the most common problems affecting Americans and are more common the older you get. When gallstones get stuck in the bile ducts, they can cause the gallbladder to back up with bile and become inflamed, often leading to a cholecystectomy, or removal of the organ altogether.

Michael Cripps, MD, visiting associate professor of GI, trauma, and endocrine surgery in the University of Colorado Department

of Surgery, developed the Parkland Grading Scale that surgeons use to determine the severity of inflammation of the gallbladder, from ranging from one at the mildest to five at the most severe.

Cripps explains more about gallstones, gallbladder disease, and gallbladder cancer.

During a final symposium, more than a dozen students detailed research they completed with Department of Surgery mentors. Program participants’ research delved into topics as varied as health literacy among patients in safety net clinics to cannabis use and postoperative outcomes in patients undergoing hepatectomy, opioid prescribing trends, and mortality rates among patients with COVID-19 infection and stroke, among others.

ROBOTIC KIDNEY TRANSPLANTS OFFER NEW LEASE ON LIFE TO HIGH-BMI PATIENTS

Greg Glasgow

Historically, the outlook has been grim for obese patients who need kidney transplants. Due to the physical requirements of the operation, those with a body mass index (BMI) of 35 or higher typically have been denied access to the life-saving procedure. But that is changing as transplant surgeons at centers like the

Department of Surgery at the University of Colorado School of Medicine learn how to perform robotic transplant surgery on patients with high BMIs, giving new hope to patients who previously would have been ineligible for the surgery.

Rachel Sauer

Greg Glasgow

6 Years After Bile Duct Cancer Diagnosis, Focus Shifts to Not Wasting Time

Living Organ Donation Journey Inspires Doctor to Normalize the Experience for Others

Breast

A Better Understanding of Survival Rates for Lung Transplant Recipients

“One in a Billion Odds”: Receiving a liver transplant within 45 minutes of being added to the registry.

Explaining PSA Numbers

NEW BURN SURGERY FELLOWSHIP AT CU CONDENSES TWO YEARS OF TRAINING INTO ONE

The surgical critical care fellowship with a burn focus was just accredited by the American Council for Graduate Medical Education.

Bob Saget’s Death Brings Awareness of Signs to Look for Following Head Injury

Nurturing a Passion for Medicine that Was Born in the Midst of War

Multi-Faceted Treatment Helps Young Breast Cancer Patient Through Her Cancer Journey

Clinical Trial Allows Participants to Avoid an Ileostomy During Surgery for Rectal Cancer

The University of Colorado Department of Surgery recently received accreditation for a new burn surgery fellowship that will allow aspiring burn surgeons to enter the field faster.

The new surgical critical care fellowship with a burn focus, explains Arek Wiktor, MD, associate professor of GI, trauma, and endocrine surgery at the CU School of Medicine, combines the critical care and burn-specific training that are historically done in separate one-year fellowships into a one-year fellowship that offers comprehensive training in both areas. The new CU fellowship — recently accredited by the American Council for Graduate Medical Education — is a one-year program in which fellows will receive a burn care certificate and become board-certified in critical care medicine.

“In general, in order to be a burn surgeon, you can go down two paths,” says Wiktor, medical director of the UCHealth Burn and Frostbite Center.

“You can do a general surgery residency and then do a one-year burn fellowship, or you can do a plastic surgery residency followed by a one-year burn fellowship. Most burn surgeons also do a critical care fellowship, because critical care is such an important component of burn care. Patients are very sick. A burn surgeon needs to be able to understand critical illness in a variety of ways to be able to optimally treat their burn patients.”

Olivia Newton-John Dies After 30-Year

Cancer Battle

Greg Glasgow

IDEAS AND INSIGHTS HIGHLIGHTED AT SOCIETY OF CLINICAL SURGERY ANNUAL SCIENTIFIC MEETING

CU Department of Surgery hosted the annual meeting, which drew distinguished surgeons from across the U.S. and world.

Cardiac Arrest During NFL Game Brings Awareness to Importance of High-Quality Intervention

Buffalo Bills safety Damar Hamlin, 24, collapsed on the football field six minutes into the first quarter of a Monday night game against the Cincinnati Bengals on January 2.

Hamlin experienced cardiac arrest after tackling Bengals wide receiver Tee Higgins. The incident brought significant attention to not only sudden cardiac arrest, but the importance of immediate response when it happens.

Damar Hamlin has since been discharged from a Buffalo, New York, hospital and on January 28 released a video updating his fans and community on his recovery.

Muhammad Aftab, MD, an associate professor of cardiothoracic surgery in the Department of Surgery, explains more about sudden cardiac arrest and the necessity for a quick response.

From its founding in 1903, the Society of Clinical Surgery has pursued general advancement of surgery –seeking to stimulate its members to work along lines of original thought and investigation in the clinic, laboratory, or library.

In addition to its mission of opening the door of science to a new world, it is also a community of peers and ideas, a place to learn from each other in camaraderie and support. This was highlighted November 10-12 at the Society’s 178th Annual

Scientific Meeting, hosted by the University of Colorado Department of Surgery.

Hosting the meeting “is a wonderful opportunity to show the world and the country all the wonderful things going on at the Anschutz Medical Campus and in Colorado,” said Richard Schulick, MD, MBA, CU Department of Surgery chair. “This meeting is a place to showcase cutting-edge technology and to learn from each other.”

Rachel Sauer

Rachel Sauer

WORLD TRAVELER BOOKS CU ANSCHUTZ FOR PANCREATIC CANCER JOURNEY

Bonnie Dahl knows chance and circumstance played key roles in halting her pancreatic cancer, one of the most deadly and insidious forms of the disease.

Chance came when a keen radiologist spotted the tiny cyst on the CT scan her doctor had ordered of the longtime Boulder businesswoman’s lungs, not her pancreas.

Circumstance took over when Dahl called her brother, who was being treated for head and neck cancer at the University of Colorado Anschutz Medical Campus, before booking

with the local surgeon her gastroenterologist recommended.

“It just didn’t feel right,” Dahl said of questioning her first medical plan despite always having her health care in Boulder.

Today, after months of treatment at the CU Anschutz Medical Campus, Dahl’s tests show no signs of the disease, and her doctors say chances of the highly recurring cancer sneaking back unseen are lower than average.

Debra Melani

Luck, attitude, expertise add up to success for Boulder businesswoman.

February

USING HIS SPORTS TRAINING AS DIVISION

ADMINISTRATIVE

DIRECTOR FOR CARDIOTHORACIC

SURGERY

Christian Scott’s dream of working in the sports industry never materialized, but as administrative director for the Division of Cardiothoracic Surgery in the University of Colorado School of Medicine, he still gets to work with an all-star team dedicated to being the best in its field.

In his role in the cardiothoracic surgery division, Scott oversees all administrative responsibilities, from hiring to payroll to budgets. He also works with surgeons to block time in the clinic and set up educational outreach opportunities in the community.

Consistent Bathroom Habits Can Help Minimize UTI Risk in Children

Rachel Sauer

Urinary tract infections (UTI) are among the most commonly diagnosed bacterial infections in children. While the incidence of UTI is highest in a child’s first year, they can be a concern throughout childhood.

We asked Nina Mikkilineni, MD, an assistant professor of surgery in the University of Colorado Division of Urology, how parents and caregivers can recognize and help to prevent UTIs in children.

SURGERY TEAM DEVELOPS PROTOCOL TO LOWER NUMBER OF ASPIRATION EVENTS

Surgical patients under the care of clinicians at the University of Colorado Department of Surgery are at lower risk of complications brought on by an aspiration event, thanks to a new patient safety protocol led by the Office of Quality & Clinical Effectiveness of the Department of Surgery, as reported by Viviane Leite Abud, MD, a quality and

executive leadership resident in the department.

Aspiration events — which happen when food, liquid, saliva, vomit, or other material enters the airway and lungs by accident — are a significant risk for patients recovering from surgery

Greg Glasgow

Greg Glasgow

Research Finds That Life-Saving Intervention Is Not Risk-Free in Pediatric Patients

Shannon Acker, MD, led research looking at outcomes in pediatric oncology patients who had blood transfusions following solid tumor removal.

PURSUING UROLOGIC SURGERY TO HELP PATIENTS

Paul Maroni, MD, appreciates the long-term relationships he is able to develop with patients, and the shared decision-making that goes into their care.

Blood transfusion is a vital and lifesaving intervention in a broad range of scenarios, from trauma response to cancer treatment. However, it is not entirely without risk.

Recently published research found that blood transfusion is associated with adverse outcomes – including infection and higher rates of tumor recurrence – in pediatric solid tumor oncology patients following surgical removal of the tumor.

“Blood transfusion is obviously hugely important when used in the appropriate clinical scenario, but there are some downsides,” says study author Shannon Acker, MD, an assistant professor of pediatric surgery in the Department of Surgery. “It’s pro-inflammatory and suppresses the immune system because your body reacts to foreign tissue. It can be a vital intervention, but I think we’re starting to be a little more thoughtful about giving patients blood products.”

It was all his grandma’s doing, says Paul Maroni, MD.

When Maroni and his brother were young, their grandmother used to joke with them, telling them Paul would grow up to be a doctor and his brother, Peter, would grow up to be a lawyer.

“I think it was just the respect that those professions commanded that our family wanted us to consider those,” Maroni says. “I was pretty open-minded when I went to college. I did the premedical curriculum as my primary area of study, but I was open to the idea that something else may pique my interest, and I’d want to do that.”

But his grandmother’s words stuck in his head, and once Maroni went to medical school at the University of Illinois, his fate was sealed.

“Once I got into the anatomy lab and started picking apart human organs, that’s when I fell in love with surgery and realized the miracle

of the human body,” he says. “The way the chemistry and the anatomy and everything interacts is so spectacular, and the fact that we could actually get in there and do an operation and put somebody back together, and they heal up from that, and they do well? That was pretty amazing to me.”

Maroni came to the CU School of Medicine in 2000 for his residency. Aside from a yearlong fellowship in urologic oncology at the University of Indiana early in his career, he’s been in Colorado ever since. Now an associate professor of surgery in the Division of Urology, he also is coclinical director of urologic oncology for the CU Cancer Center, treating patients with prostate cancer, testicular cancer, bladder cancer, and kidney cancer.

Greg Glasgow

Rachel Sauer

DEVELOPING A STANDARD FOR LYMPHEDEMA THERAPY

Christodoulos Kaoutzanis, MD, is leading research studying which of three types of lymphedema treatment shows the greatest benefits for patients.

Lymphedema is a chronic disease that causes lymphatic fluid to build up in the body, especially in the legs, arms, genitals, face, neck, and chest wall. It can be painful and debilitating, and have significant negative impacts on a person’s quality of life.

Secondary lymphedema, which is acquired rather than genetic, affects approximately one in every 1,000 Americans.

An important treatment for lymphedema is manual lymphatic drainage (MLD), a massage-like technique that aims to relieve swelling by helping lymphatic fluid, or lymph, move to an area of the body with working lymph vessels. However, there currently are no universally accepted standards for how MLD is performed.

A current study led by Christodoulos Kaoutzanis, MD, an assistant professor of plastic and reconstructive surgery in the Department of Surgery, aims to develop scientifically based, datadriven guidelines that health care providers can follow to achieve consistent results and best outcomes for patients with lymphedema.

“Lymphedema is a disease that can have huge ramifications for those who are living with it, especially patients with lower extremity lymphedema,” Kaoutzanis says. “It’s important that we work toward standardizing treatment so each patient receives the best quality of care.”

Rare

Carotid Artery Blowout Emphasizes Need for Recognition of Symptoms and Swift Treatment

In a recent case study, Jeniann Yi, MD, details the experience of a 37-year-old kidneypancreas transplant patient.

Carotid artery blowout, while rare, is a life-threatening surgical emergency with a mortality rate approaching 60%. For the surgical team caring for a 37-year-old kidney-pancreas transplant patient who experienced carotid blowout (CB), this unexpected and extremely serious medical event highlighted the importance of prompt recognition and swift surgical treatment for CB.

In a recently published case study detailing the man’s CB, Ali Hakimi, a fourth-year medical student in the University of Colorado School of Medicine, and Jeniann Yi, MD, an assistant professor of vascular surgery in the CU Department of Surgery, outline this unexpected outcome for a patient with no known history of neck surgery or instrumentation.

Rachel Sauer

Rachel Sauer

PANCREATIC CANCER SURVIVOR IS ETERNALLY GRATEFUL FOR HER SURGERY WITH SCHULICK

Laura Foote shares her story to bring hope to others.