Department of Surgery Charleston Division
Annual Report 2012 - 2013
INSIDE General Surgery
Breast Surgery and Oncology
Colon and Rectal Surgery and Oncology
Trauma and Critical Care/Trauma Center of Excellence
Vascular and Endovascular Surgery/Vascular Center of Excellence
Core Clinical Faculty
Maxillofacial and Oral Surgery
General Surgery Residency
Vascular Surgery Residency
Quality and Safety
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Dear colleagues and friends: The Department of Surgery of West Virginia University/Charleston Division has been functioning in its current design for over 35 years. It continues to grow and mature, offering a wide range of services to the community, many of which are delivered through its partner hospital, Charleston Area Medical Center, a 900-bed tertiary care facility. In addition to General Surgical Services, the department has experts in Breast Surgery, Colo-Rectal Surgery, Endocrine Surgery, Surgical Oncology, Vascular Surgery, and Trauma and Critical Care. Every year, the 27 members of the faculty perform over 18,000 diagnostic and therapeutic interventions. Minimally invasive approaches, including Advanced Laparoscopic and Robotic operations, figure prominently in the armamentarium of our surgeons, and this is not a new skill. The Department of Surgery/Charleston is, in fact, responsible for the introduction of laparoscopic surgery in West Virginia, with the first patient ever operated in the state through a laparoscopic approach undergoing the procedure in March of 1990. West Virginia became then the 5th state in the nation to introduce this technique for the benefit of patients. Faculty members deliver their services promptly, in an efficient and compassionate manner, with safety at the core of their efforts. This is a reflection of the departmentâ€™s active involvement in quality improvement and safety initiatives, both independently and in association with Charleston Area Medical Center. The core mission of the department is education, and the facultyâ€™s commitment to this goal is facilitated by the abundant opportunities derived from a large volume of patients with the gamut of surgical presentations, and through a structured system of lectures and conferences designed to educate and update. A training program in Vascular Surgery has been recently inaugurated, under the direction of internationally known faculty. And so, the General and Vascular surgery training programs have become a competitive experience that attracts graduates from all over the country. The Residency Review Committee, the accrediting body that regulates all training programs in the nation, consistently awards high marks to our programs, solidifying its worth. Medical students are an integral part of the system, and they have continuously rotated through our campus since 1977. During their Surgical Clerkship, students are exposed to the various services within the department, and their experience is coordinated by a Clerkship Director who works closely with the Residency Program Director. Many of the students interested in a surgical career apply to enter the residency program, and ultimately some of the graduating surgeons are recruited to become part of the faculty. In this environment, the department has been vital to the development and success of the currently existing centers of excellence in Vascular, Breast and Trauma/Critical Care surgery. The faculty consistently engages in research which has been quite fruitful over the years, producing significant studies that have impacted and changed the paradigms of care in several surgical areas. As you read this report, you will find a few vignettes that describe what our surgeons actually do. We hope that you will find the following pages of interest. And we like you to know we are dedicated to assist you in caring for patients with surgical problems requiring the expertise that we proudly provide. Please, feel free to email us with questions or suggestions at firstname.lastname@example.org. With best regards, Roberto Kusminsky, MD, MPH, FACS Professor, Department of Surgery West Virginia University Charleston Division
Department of Surgery Charleston Division
GENERAL SURGERY The General Surgery Services are provided by all members of the department, with experts recognized for their ability to solve problems associated with complex surgical presentations. They provide state-of-the-art treatment for a multitude of conditions, and take care of patients referred from all corners of the state and beyond. Frequently, they work in teams to approach oncologic, endocrine and uncommon surgical problems requiring cutting edge know-how, with results that validate their technical skill and dedication to patient safety and satisfaction. The most current scientific knowledge is a staple of the faculty’s daily discussions regarding patient management, and the expertise of the surgeons in the department provides patients with diagnostic and treatment opportunities otherwise less commonly available in different settings. Such is the case, for instance, with complex reconstruction of abdominal wall defects, often performed nowadays by a technique known as “component separation,” that leads to an improvement of post-surgical function not consistently achieved with older methods.
At 7 p.m., when Dr. Richmond accepts the patient in transfer, he is told that Mr. H. W. had his appendix removed a few days ago. He’s not doing too well, he is told. He’s draining intestinal material through the abdominal wall, he is told. The ambulance carrying Mr. H.W. arrives at 11 p.m., and the patient is admitted directly to the ICU. At 1 in the morning, Richmond examines the patient. Mr. H.W. looks sick, malnourished. Skeletal, in fact. The abdominal dressings are soaked with a greenish fluid, its typical intestinal odor wafting into Richmond’s nostrils. Mr. H.W. and his wife are looking at Dr. Richmond expectantly, their mouths halfway open, waiting to hear the bad news, secretly hoping to hear everything will be okay. Mr. H.W. wants to return to his work as a ballroom dance instructor, he tells Dr. Richmond. Richmond looks at them. The resident on call stands next to Dr. Bryan Richmond Richmond, silent. Professor of Surgery “We have some work to do,” Richmond begins. His tone is Chief, Section of assertive, an incipient smile comforting the patient. General Surgery He looks directly into Mr. H.W. ’s eyes.“We’ll start by getting you in better shape, and then we’ll discuss what we need to do to get you fixed up.” With two sentences he imparts a message that delivers the facts and reduces anxiety. They understand what Richmond just said to them: there is a long road ahead, but their surgeon—this surgeon—knows how to fix the problem, and he can, and he will. Mr. H.W. spends many weeks in the hospital. The team of general surgeons knows him well. The nurses know him well. Everyone knows him well. Mr. H.W. has abscesses drained, Vicryl mesh inserted, small bowel removed, hyperalimentation delivered, physical therapy treatments, nasogastric feedings. And toward the end of his hospitalization, Richmond reconstructs Mr. H.W.’s abdominal wall. Mr. H.W. is fixed up. Today, Mr. H.W. is going home. He is going home steady on his feet. He is going home eating. His scars are healing well. The nurses dote on him, smiling. Mr. H.W. is happy. His wife is happy. Dr. Richmond is pleased. And Mr. H.W. is going home.
GENERAL SURGERY In any 12 month period, the departmentâ€™s surgeons perform approximately
6,000 diagnostic and general operative procedures.
A selection includes: Laparoscopic
Hernias (all types, including laparoscopic):
Incisional hernia (including component separation and laparoscopic): Small bowel procedures:
Fundoplasty (including laparoscopic hiatal hernia): Upper GI endoscopy:
Gastric neurostimulator (mostly diabetic patients):
RESEARCH Research by members of this section include: Issues regarding surgical site infections (Dr. B.Richmond) GIST tumors (Dr. Witsberger) 8
Members of the General Surgery Section (left to right): Dr. Kusminsky, Dr. Dyer, Dr. Richmond, Dr. Lohan, Dr. Witsberger, Dr. Trammell, Dr. Elmore, Dr. Cochran
BREAST SURGERY AND ONCOLOGY Teresa Snodgrass, the Department of Surgery Office Manager at Memorial Campus, walks into her office. The phone is ringing. She picks it up. At the other end, the patient explains.“I had a mammogram, and it showed something, and I can’t get anyone to see me, and . . . ” The patient’s voice trails off. “Just tell me what you need,” Teresa says, calm, reassuring. “Well, they gave me an appointment to see Dr. Smith, but I have to wait three weeks!” The patient is almost screaming now. “Three weeks! I can’t sleep,” she says. Teresa has heard this many times before. She smiles, and her smile reaches the other end of the line. “Would you like to come in today?” she asks. “Dr. Witsberger or one of our other breast surgeons would be happy to see you.” Silence. Then, timidly, the patient asks,“Today?” Teresa Snodgrass Teresa chuckles. “Yes, today.” Manager, Surgery Office Memorial Campus The patient is quiet for a moment. Her voice comes across so soft Teresa has to make an effort to hear her. “I . . . I have to take my child to the doctor today.” She’s embarrassed. “Could I come tomorrow?” “Of course. Let me tell you where and at what time,” Teresa says. The faculty in the section of Breast Surgery cares for the largest number of patients with breast diseases in West Virginia. They were responsible for the development of the Breast Center of Excellence that became the first of its kind in the state, and was the first to be fully accredited by the American College of Surgeons through its National Accreditation Program for Breast Centers. The accreditation validated the Breast Center already established standards of quality care that adhere to the most current scientific evidence. The Breast Surgeons from the department are able to examine and diagnose patients with breast concerns within 24 hours after the need is recognized, and commonly on the same day when patients call for an appointment. The section’s Breast Surgeons are certified by the American Society of Breast Surgeons to perform minimally invasive breast biopsies. These procedures are almost always carried out under ultrasound or x-ray guidance, so patients can go home shortly after undergoing any of these diagnostic maneuvers. Breast surgeons routinely present and discuss patients who have been diagnosed with breast cancer
A selection of procedures performed by the breast service during a 12-month period includes: Ultrasound guided
Sterotaxic biopsy: Excision of breast lesion: Mastectomy (all types): 10
1,250 179 85 137
in a weekly multidisciplinary conference. This meeting brings together experts in Medical Oncology, Radiology, Radiation Oncology, Pathology, Plastic Surgery and others who reach a consensus regarding the best options of treatment applicable to the patients being discussed. The Breast section of the West Virginia University Department of Surgery has a solid history of research in breast cancer. For example, the department was part of the original research conducted to identify the sentinel node in breast cancer, a landmark study published in the New England Journal of Medicine, which lead to a paradigm change in the care of breast cancer. Biopsy of the sentinel node is now a routine step in the algorithms used to make decisions of treatment in breast cancer patients.
The breast surgeons from the Department of Surgery offer patients: • Rapid access • Rapid diagnosis • Multidisciplinary decisionmaking • Best treatment options • Oncoplastic techniques for superior cosmetic results • Collaboration with Breast Plastic Surgeons • Education and Support
Dr. Todd Witsberger Associate Professor of Surgery Chief, Section of Breast Surgery and Oncology
Dr. W. Trammel Professor of Surgery Director, Breast Risk Clinic
BREAST SURGERY AND ONCOLOGY
RESEARCH Drs. Trammell, Witsberger and Kusminsky are involved in innovative research to identify the sentinel node in patients with breast cancer using ultrasonography.
A high risk clinic for patients with breast diseases is ready to open, under the direction of Dr. W.Trammell. Services will include genetic counseling and testing in a centralized area at the Breast Center.
Dr. Trammell performing a minimally invasive, ultrasound guided breast biopsy
COLON AND RECTAL SURGERY AND ONCOLOGY The section of Colon and Rectal surgery offers the most advanced diagnostic and therapeutic techniques currently available to treat any and all conditions affecting the lower GI tract. The section’s surgeons have abundant expertise in minimally invasive access, and they commonly employ laparoscopic and robotic approaches to a variety of procedures. The Colo-Rectal surgeons perform a large number of advanced diagnostic procedures, such as rectal ultrasound, which allows them to learn details of a patient’s disease otherwise not detected by traditional methods. They regularly see patients who have been told elsewhere that their surgery would require a permanent colostomy. Because of their expertise, the section’s surgeons are frequently able to avoid the use of a colostomy in patients with rectal cancer, using approaches that include: • Colo-anal anastomosis, in which the surgeon removes the affected colon and hooks what remains of it to the anus • Ileo-anal anastomosis, in which the surgeon hooks the small intestine to the anus after removing all of the colon • Creation of a rectal pouch, where the surgeon reconstructs the removed rectum with large or small intestine. • Transanal excision, where the surgeon removes a lesion from the inside of the rectum without removing the rectum itself. “I don’t want this thing anymore!” Mr. J.W. points at the plastic bag covering the stoma on his side. He’s 44, thin, looks ill. Dr. Lohan reviews the patient’s records. The first time Mr. J.W. was operated on, he had part of his colon removed, and they gave him a colostomy. During his second operation, he had his colon connected back together. After that, the connection broke down, and Mr. J. W. developed a fistula. So another operation followed, and once again he has a stoma covered with a bag. “I really want this gone,” Mr. J. W. insists. “I have to remove part of your colon,” Lohan says. “Okay, but will you be able to get rid of this bag?” Mr. J. W. asks. “I’ll have to fix this hernia you have next to the ileostomy,” Lohan says “Okay, but will you be able to get rid of this bag?” “I have to put a mesh here.” Lohan points at the spot in Mr. J. W.’s abdomen where he plans to implant the strengthening material. “Okay, but will you be able to get rid of this bag?” “And I’ll close the ileostomy.” “That’s what I want!” Mr. J.W. exclaims. “Dr Lohan explained things so When he operates, Lohan removes the diseased colon, hooks it back my wife and I could understand. together, closes the ileostomy, places a mesh. He hooked me up, and now I It’s been a month since the surgery. Lohan walks into the examining just feel wonderful.” room. Mr. J. W. smiles. He’s gained some weight. He doesn’t look sick anymore. “Hi Doc,” he says to Lohan,“I’m doing great.” “You’re eating okay?” “Like a horse.” Lohan examines him. The incision is well healed. The abdomen is firm, no sign of a hernia. “What you think, Doc?” “You’ll have to adjust to life without the bag,” Lohan jokes. Mr. J. W. grins.
COLON AND RECTAL SURGERY AND ONCOLOGY The patients treated by the surgeons of the ColoRectal Surgery section are supported by specialized staff, including enterostomal therapists, who are nurses familiar with colorectal diseases and the special operations performed to fix those problems. This means that patients undergoing colorectal surgery by the section’s experts receive specialized pre and postoperative care routinely. Dr. B. Dyer and Dr. J. Lohan
Some of the services provided by the section of Colon and Rectal Surgery include: • Diagnosis and treatment of patients with colon, rectal and anal cancer • Treatment of patients with complicated inflammatory bowel disease • Diagnosis and treatment of patients with diverticular disease • Diagnosis and treatment of patients with polyps and families with Familial Polyposis • Options for patients with rectal prolapse • Care of patients with simple and complex hemorrhoidal disease and fistulas • Non-surgical and surgical treatment of anal fissures • Colonoscopy • Rectal ultrasound • Emergency care of colorectal diseases
A selection of the procedures done in 12 months by the Colo-Rectal surgeons include: Colonoscopies: Rectal ultrasound: Colon operations, including laparoscopic procedures: Rectal prolapse: Care of patients with simple and complex hemorrhoidal disease: Care of patients with simple and complex fistulas: Care of patients with fissures, including chemodenervation of the sphincter: Care of patients with pylonidal disease
641 50 159 8 173 130 84 12
Dr. J. Lohan Assistant Professor of Surgery Chief, Section of Colon and Rectal Surgery
ENDOCRINE SURGERY The section of Endocrine Surgery incorporates the most modern technical approaches to the diagnosis and treatment of endocrine disorders requiring surgery. The experienced surgeons in this section handle a whole host of problems associated with thyroid and parathyroid diseases, which are the most common endocrine surgical disorders. Parathyroid surgery, in particular, is now modernized so patients can be treated with minimally invasive operations, frequently performed as outpatient procedures. Patients have surgery through a very small incision, usually not longer than an inch, so cosmetic results are superior, with scars that become almost invisible after a while.
Patient with recent parathyroidectomy: the scar is almost invisible.
The outcome of surgery is almost always known at the time of the operation, because the endocrine surgeons can monitor the level of hormone which was abnormal before surgery, and see that it comes down to a normal level during the procedure. This minimizes the chances of having a second operation, a situation which occurred sometimes in the past.
The specialists in this section routinely perform procedures that affect the thyroid, parathyroid, pancreas and adrenal glands. Thyroid nodules are routinely diagnosed by minimally invasive procedures, such as Fine Needle Aspiration and Biopsy, performed in an office setting with no more discomfort than can be expected from having blood drawn.
In a 12 month period, the surgeons of this section usually perform:
Thyroid resections: Parathyroid resections:
Dr. Richmond has produced meaningful research addressing the cytopathology of thyroid disease.
Additionally, surgeons perform yearly several pancreatectomies and laparoscopic adrenalectomies for endocrine disease.
Dr. Richmond, Dr. Witsberger and Dr. Elmore.
ONCOLOGIC SURGERY The section of oncologic surgery has advanced steadily over the years, supported by a long history of cutting-edge approaches to the treatment of solid tumors. The Oncologic Surgery faculty has frequently been the first in the state to introduce treatment modalities for complex surgical oncologic problems. Such was the case, for instance, with intra-arterial delivery of chemotherapy for patients with head and neck tumors, or the use of hyperthermic arterial infusions for melanoma, or the insertion of pumps in the hepatic artery to deliver chemotherapy to hepatic tumors. Every week the section’s surgeons treat patients with tumors of the breast, thyroid, colon, rectum, pancreas, liver, melanoma, and many others. The expertise in the areas of hepato-biliary surgery has been enhanced with the recruitment of Michael Elmore, MD, a Surgical Oncologist who has rapidly taken charge of patients with liver and biliary tumors. She is sitting on the examining table when Dr. Elmore opens the door, all 89 pounds of her. Elmore probably can surround her waist with the fingers of one hand. She stands up. Maybe five feet tall? Her wig is of indeterminate color, between brown with a reddish tint and some combination of black and grey. She is 68 years old. Elmore introduces himself, and gestures for her to sit down. “I want off chemotherapy,” she says. “How long have you been on it?” “Close to two years.” Elmore reviews her records. Long-term chemo. Lung mets, now undetectable. One liver met (only one?). She’s lying down quietly, waiting, while Elmore examines her. The nurse at the other side of the exam table watches, attentive to the patient’s every need. The moment Elmore is finished, she wraps the gown around the patient and helps her to sit up. “I think I can remove the spot you have in your liver,” Elmore says. “And I’ll be off the chemo?” “Probably. At least for a while.” A small pause.“Not sure, though.” She nods.“Okay. I want to do it.” Elmore performs a formal right hepatic lobectomy. Big operation, small patient. The surgery goes smoothly. She leaves the hospital in 8 days. Five weeks after the operation, the patient returns to see Elmore. This time she’s not wearing a wig. Her hair is healthy, short, mostly white. Elmore checks her incision.“It’s healed nicely.” He smiles.“I used the best superglue they had in the operating room to put you back together.” Dr. M. Elmore Assistant Professor of Surgery She smiles back.“You did well, Dr. Elmore,” she says. Her smile turns into a grin.“And I’m off the chemo.”
Dr. Michael Elmore is a surgical oncologist who specializes in surgery of hepatic and biliary tumors, many of which he approaches laparoscopically. Since he joined our department, he has successfully removed metastatic liver tumors using advanced techniques, such as Radio Frequency Ablation. When all tumor burden can thus be removed from the liver and treatment is coupled with chemotherapy, patients have a chance to survive that can be as high as 40% at 5 years, an outcome not commonly seen in years past.
Radiofrequency ablation is performed by inserting a needle into the tumor, through which electricity is delivered. In this manner, the tumor is destroyed and the spot treated turns into scar tissue.
(Left to right) Dr. Witsberger, Dr. Lohan, Dr. Richmond, Dr. Elmore, Dr. Dyer
For patients with unresectable liver tumors, surgical treatment options include insertion of hepatic arterial infusion pumps. The team of surgeons in this section consistently applies the latest technological advances used in surgery of solid tumors. Their outcomes in patients undergoing complex oncologic procedures are equal or better than the comparable reported national averages. A Whipple procedure is an intricate and highly complex operation where the removal of a pancreatic tumor requires excising part of the stomach, the duodenum, the pancreas, the spleen and part of the small intestine, followed by a delicate and difficult reconstruction. This operation has been traditionally associated with a high rate of complications and mortality. The experts in this section have performed the last 19 Whipple procedures in patients in all age groups without a single mortality.
PEDIATRIC SURGERY The infant is one week short of his first birthday. He smiles briefly and follows Dr. Torres with his eyes, as she leans over to feel his tummy. A few exclamations come out of his mouth when Torres removes the diaper, maybe protestations. Torres palpates carefully, taking her time. The mass in the right upper quadrant is easy to feel. The baby doesn’t complain. Torres reviews the scans, keeps her face neutral. The baby’s mother is holding her breath. “At this time I’m not thinking of surgery,” Torres says to the parents, looking mostly at the mother. “We’ll get other specialists consulted.” The mother starts crying. Torres and the oncologist check the scans together. The tumor involves kidney, adrenal, wraps around the superior mesenteric. “Not resectable,” Torres says. “Not resectable,” the oncologist agrees. It’s the baby’s first birthday when Torres places an access port in a in a central vein. Chemotherapy goes on for a while. The baby is now 20 months old. He has no hair. He looks at Torres as if he remembers the first time they met, some while back. Again, he says something when Torres removes his diaper to examine him. Torres palpates the baby’s abdomen. No mass. And the scans? The tumor looks a lot smaller, confined. The mother looks at Torres. “We’ll do surgery,” Torres says. The mother starts crying. Torres removes the adrenal gland, the kidney, the lymph nodes. Just the way she has done it too many times before.“Everything went very well,” she tells the mother. The mother starts crying. It’s been a year since the surgery. The baby is three months short of his third birthday. He’s in renal failure. The baby is in and out of the hospital, time and again. A living relative donates a kidney, and the child goes through the transplant with flying colors. ----------------Torres looks at the child. The child is no longer a child. He is 14 years old, his voice is changing. Torres examines his abdomen. Scars up and down and across. Torres smiles. No diaper. “Well,” Torres says, her infectious grin illuminating her face,“stay away from me.” The mother and the young boy laugh.
Dr. M. Torres Associate Professor of Surgery Chief, Section of Pediatric Surgery
On a given day, the pediatric surgeons might be removing a kidney, or a lung lobe, or a foreign body from the esophagus. Today, Dr. Margarita Torres, the head of the Pediatric Surgery section, is hurrying to the Emergency Room. A 2-year old boy has swallowed a quarter, and heâ€™s vomiting and not eating. And Dr Suson is checking a newborn with an omphalocele. And several paitents are waiting to the seen at the office.
A selection of procedures performed in one year: Care of children with simple and complex abscesses 80 Care of children in need of vascular access 116 Gastric and pyloric procedures (including laparoscopic Fundoplasty) 43 Inguinal hernia/hydrocele 97 Umbilical and epigastric hernias 30 Omphalocele 4 Care of children with colonic and small intestinal disease (including malrotation, intussusceptions, ostomies) 37 Orchiopexy 20 Circumcision 80 Lap appendectomy 20 20
Tammy Ashworth, MA, Dr. E. Suson and Dr. M. Torres
Dr. M. Hall Assistant Professor of Surgery Trauma and Critical Care
It’s Saturday morning, two hours past midnight, and Dr. Michael Hall falls onto the bed of the small call room, exhausted. The minute he places his head on the pillow, the phone rings. The voice at the other end says,“A priority one is on the way.” “What’s going on?” Hall asks. “You won’t believe it when I tell you.” “Just tell me.” “Okay. There was an explosion and a fire at the Institute plant. The paramedics are rushing over a man who was stabbed in the chest with a shard of some kind. And he might have been contaminated with we-don’t-know-what. Come quickly.” A click and then silence. Hall has not taken his scrub suit off. He stands up, washes his face and moves quickly out of the room. When he reaches Trauma Bay, everything is ready. Nurses, residents, techs, all in protective gear. The bed has clean linen. Monitors ready to measure: blood pressure, respiration, temperature, oxygen concentrations. They wait. It’s taking too long. A radiology tech appears. She looks at Hall.“They want you to come out to the ally.” Hall shakes his head. No point asking why. He hurries out into the ally. The dim light of a single bulb illuminates the scene. On the dock there is a gurney, and on the gurney a man is barely breathing, brown foam coming out of his mouth. His chest is covered with blood. Paramedics, nurses, an anesthesiologist and two techs are standing, silent, waiting for Hall to speak. The victim is making gurgling sounds with each inspiration. Hall reacts.“Move him into the bay! Now!” “Doc,” someone says,“we have to put him through the decontamination shower first, don’t we?” “After we save his life! Move!” The entourage rushes the patient into the bay. Hall barks an order to intubate the patient. He checks the man quickly. There is a large, irregular piece of metal sticking out of the right parasternal area. The blood pressure is low, the pulse is weak and fast, neck veins engorged. Cardiac tamponade, Hall says to no one in particular. Not a second to waste. The team pushes the gurney to the OR, running. Nurses are calling ahead to relay Hall’s instructions. The OR is ready. Hall has the sternal saw in his hand. It takes him less than a minute to open the chest. The pericardium is dark, distended, barely transmitting the heart beat. Hall incises the membranous tissue, evacuates the old blood, and sutures a hole in the heart. 21 The patient survives.
TRAUMA/CRITICAL CARE The trauma surgeons are prepared to deal with the direst emergencies on a momentâ€™s notice. Three times a year they are forced to perform an open cardiac massage in the Trauma Bay. Three times a year they have to create a pericardial window. Once a year they have to externally stabilize rib fractures. Twenty seven times a year they fix an extremely complex wound. Today, Dr. Umstot is rounding in the ICU taking care of critically ill patients. Dr. Lucente is draining an intraabdominal abscess and Dr. Powell is repairing a traumatic diaphragmatic laceration in a patient who survived a car wreck. And many of these uncommon circumstances are common for the group of surgeons from this section. And if they are lucky, they will be doing a bronchoscopy, or supervising a chest tube insertion, or the performance of a tracheostomy, or a percutaneous gastrostomy: that would be as close as possible to a routine day. But they donâ€™t have many routine days. The trauma section coordinates the care of patients with a multidisciplinary team that involves neurosurgeons, plastic surgeons, orthopedists, urologists, neurologists, and many others that care for these patients daily. The surgeons sleep in the hospital. They round. They worry about their patients. They discuss difficult problems of critical care while they check their ICU patients. They attend weekly trauma conferences, where they come up with ways to improve patient care. The section of Trauma and Critical Care made it possible to obtain accreditation by the American College of Surgeons as a Trauma Center of Excellence Level I. The standards required to receive approval must be constantly maintained for periodic reaccreditation. The Trauma Center receives an average of 2900 patients a year, and the trauma surgeons are ready to care for them 24/7. So, if you have the misfortune of being injured in an accident, you want to be taken care of by any of the surgeons in this group. They are here, so the community is safer. And they respond when they are called. Dr. Hall, Dr. Brown, Dr. Deluca, Dr. Peery, Dr. Umstot, Dr. Lucente, Dr. Powell
RESEARCH The sectionâ€™s involvement in research includes: Investigating Treatment for the Prevention of secondary Injury and Disability following Traumatic Brain Injury (Dr. F. Lucente) Pediatric Exposure to Radiation (Dr. W. Peery) Alcohol Withdrawal in trauma patients (Dr. W.Peery) Blunt bowel injury (Dr. R. Umstot) ADH response in the trauma patient (Dr. M. Powell) Penetrating Iliac artery, vein and uterine injuries in pregnant patients (Dr. M. Powell)
Dr. Lucente initiated the Rural Trauma Team program in West Virginia, a structured system to educate rural physicians in the care of trauma victims. He lectures extensively around the state and dictates ATLS, Rural Trauma and Advanced Trauma Operative Management courses.
The Section of Trauma and Critical Care offers: Experts in the most current care of trauma victims 24/7 availability Critical care expertise Coordination of care across multiple specialties Advance Trauma Life Support courses
Dr. F. Lucente Professor of Surgery Chief, Section of Trauma and Critical Care Medical Director, Trauma Center of Excellence Past Chair of the State Commitee on Trauma
VASCULAR AND ENDOVASCULAR SURGERY and VASCULAR MEDICINE VASCULAR CENTER of EXCELLENCE The Vascular Center of Excellence is unique. It is the only one of its type in West Virginia. And it is just one of a very few like this in the country. The Vascular Center of Excellence (VCOE) combines the skills of vascular surgeons, interventional cardiologists, vascular medicine specialists and many others who deliver a comprehensive and true multidisciplinary approach to patients with a multitude of complex vascular problems. This structure, which offers patients the benefit of all specialists needed to take care of any vascular problem, avoids the fragmentation of care that patients must endure when these services are not available in one place and in one stop, as they are here. The VCOE became a reality due to the vision and efforts of many who believed in the concept of a truly integrated group dedicated to the care of patients with vascular disease. The Vascular and Endovascular Surgery and Vascular Medicine section of the Department of Surgery functions out of the Vascular Center of Excellence. Leading this group is Ali AbuRahma, MD, FACS, an internationally known vascular surgeon, whose experience in vascular surgery has produced a large number of scientific research materials, now the basis of many of the therapeutic interventions in vascular surgery used worldwide. The center is co-directed by Dr. Mark Bates, an internationally known cardiologist who is frequently involved in complex endovascular reconstructions. Patients referred to the VCOE are studied and treated with state-of-the-art techniques and procedures, in an environment of comfort and privacy. On any day, the members of the VCOE might be treating a patient with a ruptured abdominal aortic aneurysm or someone with varicose veins. The physicians working in the VCOE perform angiographies, intravascular ultrasound, elective and emergency endovascular repairs, and the vascular medical specialists educate patients regarding the newest treatment and prevention opportunities. The most updated information and research on risk modification of atherosclerosis is applied during patient follow-up.
“Doc,” the 87-year-old patient tells Dr. Shadi.“I need to go back and mow my lawn.” “How big is your lawn?” asks Shadi. “Oh,” the 87-year-old replies,“about 3 by 2 square miles.” He’s not smiling, just matter-of-fact. Shadi is not sure he heard right.“Three miles?” “Yep. Just about.” Shadi just looks at the man and says nothing. His 87-year-old patient is in great shape, but he came in with abdominal pain. The work-up revealed he has a juxta-renal aneurysm, where the aortic dilatation extends up to but does not involve the renal arteries. Should an 87-year-old be fixed? Traditional surgery is too risky. A fenestrated graft would work, but . . . Maybe medical management is best, Shadi thinks. “I have pain,” the 87-year-old says. He has pain in the abdomen and back. He has thrown an embolus to the superior mesenteric artery. “Okay,” Shadi says.“I’ll try to fix it without surgery.” Shadi explains the procedure. --------------------------The 87-year-old is on the table, asleep. Shadi has on his cap, mask, sterile gloves and gown, over a lead apron that weighs heavy on his shoulders. The respirator is delivering the usual mix of anesthetic gases and oxygen. The 87-year-old is not visible under the sterile drapes. Shadi begins. He punctures the left femoral artery. An hour later, he’s done. He looks at the angiographic pictures, pleased. Everything worked fine, just fine. It’s been a month since the 87-year-old had the fenestrated graft inserted. “I’m doing great, Doc. No pain, no nothing. Can I mow my field? It’s getting pretty wild, you know.” “Three by two miles, you said?” Shadi asks. “Yep, just about.” “Okay, go ahead,” Shadi says, smiling.
(left to right) Dr. Srivastava, Dr. Haas, Dr. Stone, Dr. Bates, Dr. Shadi, Dr. Nanjundappa, Dr. Campbell, Dr. AbuRahma, Dr. Campbell, Dr. Mousa
Uncommon solutions are offered at the VCOE fairly commonly. One such situation is the use of fenestrated grafts, a way to repair more than one vessel simultaneously. The technique is new, it is difficult, and it requires carefully acquired and fine-tuned expertise.
The academic credentials of this group has resulted in the approval of a vascular residency program, and because the large clinical volume seen at the VCOE, it offers the fellows in training the opportunity of gaining a great deal of expertise in all aspects of vascular medicine and surgery.
Left panel: Fenestrated graft. Right panel: graft deployed
Every year, the VCOE surgeons perform an average of 2,000 major vascular and endovascular procedures. A sample includes: Endovascular repair of AAA:
Led by Dr. AbuRahma, the group publishes scientific research regularly, frequently producing propective randomized studies that provide high levels of evidence and influence strongly the guidelines that regulate the care of vascular diseases. The surgeons at the VCOE have pioneered many of the interventions currently used to treat conditions affecting the carotid artery. Over the years, they have been involved in more than ten prospective randomized national trials scrutinizing the best therapeutic options for patients with carotid disease.
Every year, Dr AbuRahma organizes a Vascular Conference, which brings together as speakers the best known vascular surgeons in the country. The conference gives surgeons in the state the opportunity to hear the latest information and research in the field, in the lovely setting of the Greenbrier Resort.
Mark Your Calendar! Please join us for the
22nd Annual West Virginia Vascular/Endovascular Surgery Symposium offered at the Greenbrier Resort, White Sulphur Springs, WV
Saturday and Sunday, October 13-14, 2012
Ali F. AbuRahma, MD, FACS, FRCS Professor of Surgery, Chief of Vascular/ Endovascular Surgery, West Virginia University Charleston Division
Directed by world-renowned faculty including
Associate Professor of Medicine and Surgery West Virginia University - Charleston Division
Enrico Ascher, MD Georgio Biasi, MD Edward Diethrich, MD Mark Eskandari, MD Wayne Johnston, MD Bruce Perler, MD Claudio Schonholz, MD Anton Sidawy, MD Gilbert Upchurch, Jr, MD Frank Veith, MD
Associate Professor of Surgery West Virginia University Charleston Division
New this year! Vascular Fellow Abstract Competition
Mark C .Bates, MD
Professor of Medicine and Surgery, West Virginia University Charleston Division
Aravinda Nanjundappa, MD
Patrick Stone, MD
The Greenbrier, an award-winning resort located in White Sulphur Springs, West Virginia, is recognized as a National Historic landmark. This renowned property has a vision that distinguishes itself through unparalleled facilities, matchless heritage and a world-class team who accept nothing less than the best, resulting
Dr. A. AbuRahma Professor of Surgery Chief, Section of Vascular and Endovascular Surgery Co-Director, Vascular Center of Excellence Program Director, Vascular Surgery Residency
RESEARCH Research by members of this section include: Critical analysis of renal duplex ultrasound to detect significant renal artery stenosis (Dr. AbuRahma) Should patients with chronic renal insufficiency undergo carotid intervention? (Dr. AbuRahma) Duplex ultrasound interpretation criteria for inferior mesenteric arteries (Dr. AbuRahma) Antibiotic-loaded beads for the treatment of vascular surgical site infections. (Dr. Stone) Malposition of a central venous catheter into the right internal mammary vein (Dr. Stone) A 10-year experience of infection following carotid endarterectomy with patch angioplasty (Dr. Stone) Percutaneous management of chronic critical limb ischemia. (Dr. Nanjundappa) Short- and long-term outcomes of percutaneous transluminal angioplasty (Dr. Mousa) The utilization of the double-bubble aortic configuration to seal infra-renal aortic aneurysms (Dr. Mousa) Pitfalls of embolic protection. (Dr. Bates, Dr. Campbell)
Dr. P. Stone Associate Professor of Surgery Vascular and Endovascular Surgery
CORE CLINICAL FACULTY Members of the core clinical faculty are an integral part of the overall educational experience delivered by the West Virginia University Department of Surgery/Charleston Division, as they have contributed to the department’s mission for many years. Their teaching expertise adds and complements many of the activities undertaken by the department’s surgeons in all areas of surgery. Their consistent presence adds value to the conferences and lecture series, and their instruction in clinical situations provides residents and students with an opportunity to see a larger volume and variety of surgical problems. The clinical faculty members are in sync with the University’s Department of Surgery in all areas of patient care, from procedural standards to quality measures, and they are actively involved in the development of the competencies surgical residents must acquire during their training.
General Surgery Stacey Copeland, MD, FACS Clinical Assistant Professor of Surgery Breast and General Surgery Dr. Copeland is a Board Certified surgeon with an appointment in the School of Medicine, whose expertise is focused in the diagnosis and treatment of Diseases of the Breast and in General Surgery. She is consistently involved in teaching medical students and residents. She is also involved in the hospital-wide system of quality assurance through her membership in the Peer Review Committee, and she is a member of the decision-making leadership group responsible for the operations of the Breast Center. Roland E. Hamrick, Jr., MD, FACS Clinical Associate Professor of Surgery General, Vascular and Breast Surgery Dr. Hamrick is a Board Certified General surgeon with an appointment in the School of Medicine, whose many accomplishments have added significant value to the experience of students and surgical residents rotating through his service. He has expertise in general, vascular, laparoscopic and breast surgery. Four times he has been the recipient of a distinguished award given to the surgeon contributing the most to resident education. His educational skills have impacted a large number of graduates during the 29 years that he has consistently served as a member of the teaching faculty. Edward H. Tiley, MD, FACS Clinical Professor of Surgery General, Vascular and Breast Surgery
Dr. Tiley is a Board Certified surgeon with an appointment in the School of Medicine, who is among the most experienced minimally invasive experts in the community. He has a vast experience performing robotic and laparoscopic repair of hiatal hernias, among others, and he is equally adept treating patients with general and breast surgical diseases. He is closely involved with the teaching of residents and medical students, an endeavor which he has regularly adhered to for over 20 years.
Maxillofacial and Oral Surgery David P. Wise, MD, DDS Clinical Assistant Professor of Surgery Director, Facial Surgery Center, Charleston-WV Dr. Wise is a Board Certified surgeon and dentist with appointments in both the School of Medicine and Dentistry and significant expertise in Facial Surgery who has been supporting trauma services and providing patients with specialized assistance since 1996. He has offered educational opportunities to general surgery and dental residents since his arrival in Charleston. His educational credentials are enhanced by his many contributions to the medical staff through scientific presentations and publications. â€œI enjoy teaching and feel that there is always something new to learn,â€? says Dr. Wise. Bruce B. Horswell, MD, DDS, MS, FACS Clinical Assistant Professor of Surgery Director, Regional Cleft and Craniofacial Program at CAMC Dr. Horswell is a Board Certified surgeon and dentist with appointments in both the School of Medicine and Dentistry, who consistently contributes to the educational mission of the department through lectures and research. Dr. Horswell regularly produces scholarly journal articles and book chapters reflecting his expertise in maxillofacial issues, including trauma and complex and acquired facial deformities in children. His teaching credits include international appearances in South America, Australia, and dozens of invitations to lecture locally and nationally. James M. Henderson, MD, DDS, FACS Clinical Assistant Professor of Surgery Dr. Henderson is a Board Certified surgeon and dentist with appointments in both the School of Medicine and Dentistry who consistently contributes to the education of residents and students. He regularly participates in the support given to trauma patients and his expertise in the care of the injured patient is reflected partly through his research and publications. He is a reviewer for the Journal of Oral and Maxillofacial Surgery, and was an Editor for the Oral and Maxillofacial Surgery section of the Yearbook of Dentistry.
Michael S. Jaskolka, MD, DDS Clinical Assistant Professor of Surgery Co-Director of the Cleft and Craniofacial Program Dr. Jaskolka is a Board Certified surgeon and dentist with appointments in both the School of Medicine and Dentistry, who regularly lectures residents and medical students. Dr. Jaskolka special interests include treatment of cleft and craniofacial conditions, corrective jaw surgery, facial reconstruction and computer aided surgical planning. He is involved in the support given to trauma services, and consistently participates in the educational experience of surgical residents.
Neurosurgery John Henry Schmidt, III, M.D., F.A.C.S. Clinical Professor of Surgery Chief, Section of Neurosurgery Dr. Schmidt is a neurosurgeon with an appointment in the School of Medicine who has been involved in the education of surgical residents and medical students for many years. He is a past Chief-of-Staff, and served as President of the West Virginia State Neurosurgical Society, President of the Kanawha County Medical Society and President of the West Virginia State Medical Association. His educational expertise has been recognized by his several nominations as the Clinical Faculty of the Year. At the core of his work is his interest in improving quality of care, an endeavor manifested through his involvement in a myriad of hospital committees. He has vast experience and knowledge in the treatment of head trauma, and he is also one of the foremost neurosurgical oncologists in our state. His contributions to the care of trauma victims are numerous, and his expertise is punctuated by his nationally recognized research: his innovative work in cerebral decompression was felt to be so significant that it was featured in the cover of the Journal of Neurosurgery in 2007.
The General Surgery Residency The surgical residency at West Virginia University/Charleston Area Medical Center aims at graduating a generalist, capable of caring for a myriad of surgical problems comfortably, in an effective, scientifically current, and safe manner. The general surgery training program at our institution provides uncommon opportunities to trainees. Why?
John Deluca, MD, FACS General Surgery Residency Program Director
The program is exceptional because surgical residents train in a system not usually available in larger metropolitan areas. Charleston Area Medical Center, a 900-bed institution, is located in the center of the state, and it is the only tertiary care facility providing a full range of services to an extremely large area. There are no competing institutions, there are no competing residencies, and there are no competing services in the area that could restrict residents from accessing surgical patients with any and all sorts of common and unusual presentations. Therefore, the significantly large clinical volume and the variety of pathology treated at CAMC allow physicians in training to accumulate an unparalleled experience.
At CAMC: More than 30,000 surgical procedures are performed every year The largest number of cancer cases in the state receives treatment at its American College of Surgeons accredited Cancer Center, with over 51,000 patient visits a year. More than 12,000 heart catheterizations are performed yearly 1,400 open heart procedures are performed yearly There are 105,000 emergency room patient-visits yearly The Institution: Is the only center for kidney transplantation in the state. Is the most important regional center for Neurosciences Has the only Level I Trauma Center in the region, accredited by the American College of Surgeons It has the first and oldest Breast Center in the state and the only one in the region accredited by the American College of Surgeons. THE GENERAL SURGERY RESIDENCY Program Director:
John Deluca, MD, FACS
Assistant Program Directors:
Benjamin Dyer, MD
Aaron Brown, MD
Ms. Ashley West
The surgical residents are exposed to an increasing level of responsibility commensurate with their level and performance, but their experience is vast and they rapidly become active participants in pre, intra and operative patient care. The programs exposes the residents to general and vascular surgery, trauma and critical care, neurosurgery, plastics, transplantation, thoracic surgery, pediatric surgery, and others, plus electives available at different levels. A surgical resident in this program performs approximately 1250 operations during 5 years of training, as Surgeon Chief, Surgeon Junior and Teaching Assistant. A significant percentage of procedures are done laparoscopically or robotically.
Ms. Ashley West General Surgery Residency Coordinator
THE GENERAL SURGERY RESIDENCY A selection of residentâ€™s cases includes: Lymphadenectomy, sentinel node for melanoma, other major skin/soft tissue: 46 24 Head and neck procedures: 51 Breast procedures: Major esophageal (esophagectomy, antireflux, others): 25 44 Gastric: 57 Small intestinal procedures: 75 Appendectomies: 73 Colectomy/Proctectomy: 193 Biliary procedures: 94 Hernia, open and laparoscopic: 14 Aneurysm repair: 35 Carotid endarterectomy: 39 Vascular peripheral/extremities, etc 39 Thyroid, parathyroid, adrenal
The above sample of their experience is augmented by exposure to Thoracic, Traumatic, Pediatric, GU, Plastic, Orthopedic, Neurosurgical and a variety of operations performed during elective rotations. The examples provided above do not include diagnostic procedures, such as endoscopy, bronchoscopy, endoscopic ultrasound, and others. Conferences are structured in a traditional manner, and residents attend weekly Grandrounds, Morbidity and Mortality conference, Surgical Curriculum, and others. All these conferences are well attended and the interaction is active and engaging. There is a weekly Trauma conference, Tumor Board and Breast Conference, plus monthly Journal Club, and Attending Physician resident lectures. The program graduates 3 Chief Residents every year, and plans are on the way to increase the contingent to four categorical positions.
THE VASCULAR SURGERY RESIDENCY The vascular residency enjoys the same advantages of the general surgery residency, with the most current approaches to vascular diseases presented to fellows in training in a dynamic environment that is balanced by clinical and research opportunities. Residents are guided by a committed and highly experienced faculty of 10 vascular experts, responsible for a program that has received accreditation by the American College of Graduate Medical Education for 3 years, the maximal period possible prior to reaccreditation inspections. They are exposed to rotations in Vascular and Endovascular Surgery, and they gain valuable experience in the Vascular Lab.
Every year, vascular fellows perform approximately 450 major procedures. A selection includes: Aneurysms repair: 95 Of these, open AAA repair, elective and ruptured: 28 Endovascular AAA repair: 55 Endovascular repair, thoracic: 5 Other aneurysms: 7 Carotid endarterectomy: 78 Carotid stents: 28 Aorto-ilio/femoral by pass, prosthetic: 22 Fem-pop: 20 Peripheral stents: 57 23 Renal artery stents:
A. AbuRahma, MD, FACS Vascular Surgery Residency, Program Director Dr. AbuRahma is an internationally renowned researcher with close to 200 original papers, many of which have produced material now incorporated in the routine care of vascular diseases. He is the current president of the Eastern Vascular Society. Dr. AbuRahma lectures consistently around the world.
THE VASCULAR SURGERY RESIDENCY
Program Director: Ali AbuRahma, MD, FACS, etc Residency Coordinator: Mr. Andrew Harmon Emails: email@example.com firstname.lastname@example.org P. Stone, MD, FACS Vascular Surgery Residency Assistant Program Director
Mr. Andrew Harman Vascular Surgery Residency Coordinator
MEDICAL STUDENTS Medical students have been part of the overall educational experience at the Charleston Campus since 1977. Their 8-week surgical clerkship is occupied with clinical activities, lectures, conferences, and limited oncall time. Students are exposed to general, oncologic, vascular and trauma surgery. Additionally, they have an opportunity to do an elective week, with access to specialties like Neurosurgery, Pediatric Surgery, ENT, Cardiac Surgery, and others. The lectures schedule is undergoing modifications to make it more pertinent to the student’s current and future needs, and efforts are underway to create a pool of substitute speakers for those occasions when the schedule is altered by the unpredictability of a surgical specialty. During the rotation, students enjoy the opportunity to have hands-on experience in some of the common surgical tasks, such as learning basic suturing techniques, and participating in the performance of many bedside procedures. The Department of Surgery/Charleston is actively engaged in efforts to make the student’s rotation productive and appealing. This year, the department activated a survey to explore the student’s perceptions and expectations, and their responses have been used to incrementally implement changes that have affected positively their experience during the rotation.
MEDICAL STUDENTS Clerkship Director: Robert Cochran, MD Student Coordinator: Ms. Erin Carter Emails: email@example.com firstname.lastname@example.org
R. Cochran, MD, FACS Medical Students Clerkship Director
Ms. Erin Carter Medical Students Coordinator
QUALITY AND SAFETY The West Virginia University Department of Surgery/Charleston Division strives to improve the total experience of their patients. We believe they deserve the best care, based on the most advanced and current scientific knowledge, applied with the best technology available today, and delivered in an atmosphere of thoughtfulness and meticulous attention to every detail that emphasizes and improves safety. The current Vice-Chief of Surgery, Dr Richard Umstot, is also the Quality Officer for the department, serving as the Chair of the hospital’s Peer Review Committee and acting as a link between our surgeons and the hospital to oversee many of the quality interests currently in place. The department’s members meet regularly to discuss ways to improve the quality of the surgical care rendered. The measures of quality are scrutinized consistently, and the department evaluates not just outcomes but processes as well: patient registration, phone systems, admission experience, diagnostic and procedural processes and their results, patient satisfaction, and more. The Department of Surgery actively implements quality indicators and reviews outcomes through: • Risk adjusted mortality rates • Surgical Care Improvement Program quality indicators • Mortality and Morbidity • Case by case peer-reviews • Process improvement efforts • Quality goals setting • Faculty development activities R. Umstot, MD, FACS Vice-Chief of Surgery Department’s Quality Officer
Some of the most common indicators used by the Department’s surgeons include the use of prophylactic antibiotics to prevent infections, deep vein thrombosis prevention, urinary tract infections prevention, measures to prevent pneumonia, use of beta blockers, and many others that are recognized nationally as part of the Surgical Care Improvement Project (or SCIP) quality improvement initiative. These and other measures parallel the initiatives of the department’s partner hospital, CAMC.
A sample of the statistics for January and February of 2012:
Colon surgery Appropriate antibiotic selection Prophylactic antibiotic received within 1 hour of incision Prophylactic antibiotic discontinued within 24 hours post-op
100% 100% 100%
Vascular surgery Appropriate antibiotic selection Prophylactic antibiotic received within 1 hour of incision
Prophylactic antibiotic discontinued within 24 hours post-op
The department spearheaded, in collaboration with CAMC, the implementation in 2006 of a standardized approach to the insertion of central lines using ultrasonographic guidance to reduce mechanical complication rates and infections: both goals met with clear success. A paper published by one of our surgeons who initiated this program of central venous access resulted in an invitation by the American College of Surgeons to speak about these issues at the College yearly national meeting. You can access a step-by-step description of Central Venous Catheterization Ultrasonographic Assisted Insertion and receive CME and Maintenance of Certification credit at http://camcinstitute.org/education/cvc
THE STAFF The complex operational elements of the department are efficiently, effectively and harmoniously handled by its Administrator, Jane Wiseman, and a capable and receptive staff of thirty-one people distributed over the Memorial, General and Women’s and Children’s campuses. Their responsibilities are monumental, and they too strive constantly to serve patients better. From phone calls to registration, scheduling appointments and operations, recording test results, accessing information and solving the multitude of daily problems and needs of patients, physicians, hospital’s departments, suppliers, residents and students, the staff is invariably at the front line of every activity the department carries out. The department’s Administrator, Managers and the Staff are consistently involved in quality improvement initiatives affecting all department processes.
Ms. Jane Wiseman Administrator, Department of Surgery
Ms. Mary Scragg, RN Manager, Surgery Office General Campus
Ms. Kelly Bryan Billing Manager
SIMULATION LABORATORY The simulation lab at CAMC is a state-of-the-art facility located in the fifth floor of the General Division, which has been entirely designed and exclusively dedicated for this purpose. The lab is a high-tech training site for students, surgical residents and experienced surgeons. It contributes to the educational mission of the Department of Surgery, intent in delivering an outstanding graduate teaching experience and providing optimal and safe patient care. Understanding clearly that rehearsal is essential to develop surgical skills and impacts heavily on safety, the doors of the Simulation Center opened in late 2003. The facility has been evolving and maturing since then, and it now has a clear and well designed position in the training experience of residents and students. The Surgical and Medical Skills Laboratory has manikin simulators to provide realistic situations in a variety of scenarios. Performances are frequently video recorded for analysis and corrections by faculty experts. The simulators provide computerized feedback about a significant range of clinical circumstances that can be programmed according to need. The trainers allow residents to perform an assortment of procedures, from the simplest to the most complex, allowing trainees to develop hand-eye coordination, depth perception, and ambidexterity. A robotic surgery console is available to train residents and attendings and provide an opportunity to satisfy credentialing criteria. In the Simulation Lab, first year residents learn skills that include central line insertion with ultrasound guidance, crycothyroidotomy, thoracoscopy, pericardiocentesis, paracentesis, FAST exam, peritoneal lavage, and others. Trainers allow for rehearsal of laparoscopic skills, stapling skills, and endoscopy. Appendectomy, laparoscopic cholecystectomy and laparoscopic suturing are common examples of the competences offered through the Simulation Laboratory. Additionally, residents receive training on ATLS, ACLS, PALS and CPR in the lab.
Top Left: ATLS training Top Right: Dr. AbuRahma during ATLS training Above: Residents training on the da Vinci robot. Below: One of several simulation rooms
Once a year, residents receive formal training in the Fundamentals of Laparoscopic Surgery, a program designed and proctored by SAGES and the American College of Surgeons.
Department of Surgery Charleston Division HOW DO YOU REACH US? For questions or referrals: General Surgery / Breast Surgery / Colo-Rectal Surgery Endocrine Surgery / Surgical Oncology (304) 556-3810 / (304) 347-1340 Trauma/Critical Care / General Surgery (304) 388-7270 Pediatric Surgery (304) 388-1542 Vascular Surgery/Endovascular Surgery Vascular Medicine / Vascular Center of Excellence Interventional Neuro-Radiology (304) 388-8199 Or email us: email@example.com
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Photographic credits: Jerry Handley CAMC Institute Production Specialist Preparation and design: Jeff Driggs WVU Charleston Division Director of Marketing and Communications Administrative assistance: Jane Wiseman Administrator, Department of Surgery Janet Anderson Adminstrative Assistant, Department of Surgery
Department of Surgery Charleston Division 3110 MacCorkle Avenue Charleston, WV 25304