Emory Surgery Newsletter | April 2013 - Department of Surgery ...

CONTENTS
Emory general surgery
residency to assess innovative
new training paradigm
Dr. Subramanian appointed
new Grady SICU Medical
Director as Dr. Rozycki leaves
for Indiana University
Emory Endosurgery Unit faculty
and fellows among the forefront
at SAGES annual meeting
Dr. Padala's international
research garners Leducq
Foundation praise
Faculty appointments and
awards: Dr. Lin, Dr. McConnell,
Dr. Thourani
New arrival: Bahaaldin Alsoufi,
MD
Save the date: Emory Surgery
Faculty Development Seminar
Upcoming events
Emory general surgery residency to assess
innovative new training paradigm
Dr. Keith Delman (center) with residents Swetha Ramakrishna and Harrell Lightfoot.
As a member of a 10-institution consortium that includes Brigham and Women's
Hospital, Cornell University, Johns Hopkins, Massachusetts General Hospital,
Northwestern University, Oregon Health and Science University, University of
Oklahoma, University of Southern California, and Washington University in Saint
Louis, the general surgery residency program of the Emory University School of
Medicine will role out a pilot program entitled Flexibility in Surgical Training
(FIST) in July 2013. By reviewing and collating their collective experiences with
FIST, the consortium will evaluate the impact of enacting the American Board of
Surgery's 2011-approved policy that allows up to 12 months of flexible rotations
in the last 36 months of general surgery training. In deviation from the focus of
traditional residencies, this type of specialty training gives program directors the
opportunity to tailor training to residents' future career interests.

"Up until this pilot, the early specialization training allowed by this flexibility rule
only comprised vascular or cardiothoracic surgery," says Dr. Keith Delman,
program director of Emory's general surgery residency. "Each of the FIST
centers will offer additional early specialization experiences, such as advanced
GI, acute care surgery, surgical oncology, endocrine and breast at MGH, or
transplant, breast, advanced GI, hepatobiliary, CRS, surgical critical care, and
pediatric surgery at Johns Hopkins. Emory will have residents pursuing flexibility
training in plastics, transplant, surgical oncology, endocrine, advanced GI,
comprehensive general surgery, and the early specialization versions of vascular
surgery and cardiothoracic surgery."
FIST trainees will be monitored and followed from training through certification in
their intended specialty. Outcomes criteria to be examined will include case
numbers; formative and summative assessments from components of the
particular training programs, such as operative performance rating systems;
annual ABSITE results for both participants and non-participants; completion of
specified core and specialty specific SCORE modules; and several other
measures. The pilot is expected to last a minimum of five years. "As we collect,
analyze, and report the data, we plan on sharing it with the RRC, ACGME, and
ABS to help formulate best practices in applying the flexibility rule," says Dr.
Delman.
One of the consortium's primary concerns is observing that the quality of nonparticipants'
training experience is unaffected by the presence of various focused
tracks. To qualify for the pilot, the host institutions had to have sufficient clinical
material to support the training of both participants and non-participants, and
those measures that encompass traditional general surgery residents and those
in specialized tracks—such as examination of case logs—will be inspected
closely to insure that nonparticipants are not adversely affected. In fact,
supporters of the flexibility ruling believe that the incorporation of focused
training into general surgery residencies will also benefit those pursuing general
surgery, which is in fact its own specialty, and improve their overall training
experience.
"We anticipate that the multi-institutional foundation of the pilot will let us
document the impact and outcome of the flexibility rule faster and more fully
than a single institution could," says Dr. Delman. "We also suspect that the pilot
will vindicate the concept that graduates with additional clinical experience in
their area of eventual practice will be more comfortable with independent
practice immediately following training, and that these graduates will be better
prepared to provide quality surgical care to their patients with improved
outcomes."
Dr. Subramanian appointed new Grady SICU
Medical Director as Dr. Rozycki leaves for Indiana
University
Dr. Rozycki
Several of the Emory general surgeons that staff the trauma/surgical critical care
service at Grady Memorial Hospital also did their trauma/surgical critical training
at the public hospital's Level I trauma center. One of these is Dr. Anuradha
Subramanian, the most recent appointee to the service, who completed her
trauma/surgical critical care fellowship at Grady in 2007. She then joined the
Baylor College of Medicine, served as director of medical student education, and
held various leadership roles at Michael E. DeBakey VA Medical Center. When

she returned to Grady in 2012 to be associate director of the Surgical Intensive
Care Unit and associate program director of the Trauma/Surgical Critical Care
Fellowship, she renewed her connection to the original source of her motivation
to serve patients who are critically ill.
When she was a trauma/surgical critical care trainee, Dr. Subramanian's primary
mentor at Grady was Dr. Grace Rozycki. Now, following Dr. Rozycki's
departure from Emory after 19 years of exemplary service, Dr. Subramanian will
assume Dr. Rozycki's former role as medical director of Grady's SICU. "Dr.
Rozycki was not only a clinical mentor for me, but she also taught me a great
deal about the administrative leadership required to run an ICU," says Dr.
Subramanian.
Dr. Subramanian
Upon returning to Grady, Dr. Subramanian engaged in various cooperative
efforts that highlighted her dedication to progressive patient care, research, and
education. She collaborated with the neurosurgery critical care and ICU services
on the development of a protocol for elevated intracranial pressure in traumatic
brain injury, partnered with members of Grady's internal medicine and ethics
services on a grant to the Emory Medical Care Foundation to study the effect of
incapacitated surrogateless status on physician decision-making, and initiated a
weekly lecture series for the trauma fellows. Her future plans include creating a
dedicated lecture series for the general surgery, emergency medicine, and oral
surgery residents and medical students that rotate in the SICU.
Dr. Rozycki's transition to executive vice chair of the Department of Surgery at
Indiana University School of Medicine and director of the Indiana Injury Institute
closes the chapter on her years at Emory transforming Grady's trauma,
emergency general surgery, and surgical critical care services as well as the
surgical critical care residency. During this time she developed surgeonperformed
ultrasound to the degree that it enhanced the practice of trauma
surgery on a national and international level, an achievement defined most
significantly by her origination of the FAST exam (Focused Assessment for
Sonography of Trauma) that uses an ultrasound transducer to detect the extent
of internal injury requiring immediate surgery. Her work in this area also
developed the application of ultrasound in the SICU and after trauma admission.
"It is with sincere gratitude that I thank Dr. Rozycki for her years of service to
Emory and the many roles she played at Grady," says Dr. Sheryl Gabram,
Emory Surgeon-in-Chief of Grady. "She will be missed. Thankfully, Dr.
Subramanian is an excellent choice to sustain and augment her legacy in the
Surgical Intensive Care Unit."
Emory Endosurgery Unit faculty and fellows
among the forefront at SAGES annual meeting
Dr. Lin
The Emory Endosurgery Unit's commitment to advancing minimally invasive
surgery through education was clearly demonstrated at the Society of American
Gastrointestinal and Endoscopic Surgeons (SAGES) 2013 Annual Meeting in
Baltimore, April 17-20. Entitled "Innovating the Present for the Future," the
conference highlighted technological innovations and medical breakthroughs in
the fields of general, gastrointestinal, minimally invasive, and robotic surgery,
and featured the latest hands-on surgical training and practice.
"I'm extremely proud of the quality of the presentations given by our faculty and
fellows," says Dr. Edward Lin, associate professor of surgery of Emory

University School of Medicine and director of the Endosurgery Unit. "The fact
that our program was one of the first of its type in the country when it was
formed in 1992 still drives us to be progressive and forward looking."
Emory faculty surgeon and innovator Dr. Juan Sarmiento and endosurgery
research fellow Dr. Juan Toro screened an enthusiastically received video
detailing the techniques involved with laparoscopic isolated caudate lobectomy
for hemangioma, a procedure that Dr. Sarmiento has been heavily involved with
refining at Emory. "Dr. Sarmiento has really lead the way in creating a
reproducible and consistent way of performing minimally invasive liver surgery. If
you shot a video of his procedure today and compared it with another from last
year, it would look almost identical," says Dr. Lin.
Dr. Sarmiento
Dr. Toro presented another video that described the Emory-based approach to
transanal microscopic surgery for removing rectal tumors, a technique that
features closure techniques developed by Dr. Lin, Dr. Virginia Shaffer, and Dr.
Patrick Sullivan. "Being able to perform low rectal tumor surgery using this
technique in selected patients often spares them very aggressive and debilitating
surgery," Dr. Lin comments. "The better we get at closure techniques, the more
we are able to do for these patients."
The unit's video presentations also included a video depicting techniques used
by Emory general surgeons to perform laparoscopic gastrectomy with D2
lymphadenectomy for stomach cancer that was shown and discussed by Emory
endosurgery clinical fellow Dr. Nathan Lytle.
Dr. Patel
Dr. Owen
"Can We Become Better Robot Surgeons Through Simulator Practice?" was
presented by Dr. Ankit Patel, an endosurgery fellow who will be joining the
faculty of the Department of Surgery this September. The paper described the
basic skills required for robotic surgery that can be introduced and exercised via
simulator training, and listed the skill-development benchmarks that should be
achieved by new surgeons who wish to adopt robot surgery platforms. "This
work was a collaborative effort with our business team and our surgeons," Dr.
Lin adds.
Dr. Rachel Owen, an Emory resident on research sabbatical who is involved
with a variety of quality projects, presented "Impact of Operative Duration on
Postoperative Pulmonary Complications in Laparoscopic vs. Open Colectomy"
during one of the conference's two plenary sessions. The paper described an
Emory study that evaluated the effect of operative duration in laparoscopic
colectomy (LC) and open colectomy (OC) on the development of postoperative
pulmonary complications (PPC). Among other conclusions, the study found that
LC was associated with significantly lower rates of PPC, even when operative
time was substantially longer than OC. On a quality level, these observations
could be particularly significant due to the fact that PPC is costly and increases
risk of patient readmission. "This work by Dr. Owens and lead author Dr. John
Sweeney was one of the top papers presented at this year's meeting," remarked
Dr. Lin.

Dr. Padala's international research garners
Leducq Foundation praise
Dr. Padala
"The Career Development Award was designed with investigators like you in
mind: engineers and others who could turn their expertise towards
cardiovascular disease, working in a multidisciplinary fashion on some of the
complex questions in the field. The foundation is impressed with what you have
accomplished, and proud to be supporting your work," reads the letter of
congratulations from Dr. David Tancredi, scientific director of the Leducq
Foundation, to Dr. Muralidhar Padala, director of the Structural Heart Disease
Research and Innovation Lab of the Emory University School of Medicine.
Located in Paris, France, the private, endowment-based Leducq Foundation is
dedicated to improving human health through funding and facilitating
international efforts to combat cardiovascular and neurovascular disease.
The letter follows Dr. Padala's presentation at the Leducq Foundation's annual
symposium in Nice, France, where he described his recent work as one of
several investigators in the international "Mitral Valve Disease: From Genetic
Mechanisms to Improved Repair" network. Dr. Padala's membership in the
network was initiated by his receipt of the 2010-2011 Leducq Career
Development Award, a recognition that supports the development of young
investigators in cardiovascular and/or neurovascular disease from Europe and
the United States by allowing them to engage in international, collaborative
research in one of the foundation's Transatlantic Networks of Excellence.
The international consortium of leading scientists of the mitral valve disease
group are studying the mysterious underlying biology of the mitral valve in hopes
of describing the factors which control its biological degeneration and to
encourage new thinking in the treatment of mitral valve disease. Dr. Padala's
role in the network is to investigate the connection that identified genetic
mutations have to altered mechanotransduction in the valve leaflets.
During his presentation, Dr. Padala detailed the efforts he has made related to
his career development award, particularly his work towards understanding the

impact of mutations in the gene that codes filamin A protein and its role in
helping the cells to sense mechanical forces and adapt to their surrounding
hemodynamic environment.
Dr. Padala's Emory lab is an interdisciplinary environment comprised of cardiac
surgeons, engineers, and molecular biologists, making it a concise, Emorybased
analog for the cooperative and open-bordered philosophy that the
Leducq Foundation espouses. As the lab's basic science and translational
pursuits continue to break new ground, contributing to the progress of Dr.
Padala's work for the Leducq mitral valve group in the process, Emory's affect
on the fight against heart disease goes world wide.
FACULTY APPOINTMENTS AND AWARDS
Dr. Lin appointed Editor-In-Chief of Bariatric Surgical
Practice and Patient Care
The original title of the journal
was Bariatric Surgical Patient
Care, which Dr. Lin has
changed to encompass
surgeons and the entire
bariatric team.
Dr. Edward Lin, surgical director of the Emory Bariatric Center among other
appointments, has been appointed editor-in-chief of Bariatric Surgical Practice
and Patient Care. Dr. Lin has authored numerous peer-reviewed articles and
chapters on topics involving bariatric and gastrointestinal surgery, metabolism,
and nutritional support, and also serves on the editorial board of Bariatric Times.
"I suspect the publishers wanted 'Emory' as much as someone from Emory,"
says Dr. Lin. "It is a testament to the work that Emory Bariatrics has done since
its inception in 1999."
Dr. McConnell awarded Shock Society Research
Fellowship
Dr. Kevin McConnell, who is a faculty attending of both the Acute and Critical
Care Surgery Service and Surgical Intensive Care Unit of Emory University
Hospital, has been awarded the Shock Society Research Fellowship for Early
Career Investigators. The award is given to support the career development of
new investigators in the areas of trauma, shock, and sepsis, and is applied to
funding a project that has intrinsic importance to the field while permitting the
recipient to learn the methodology, theory, and conceptualizations necessary for
developing into an outstanding independent researcher.
Dr. McConnell
Dr. McConnell arrived at Emory University School of Medicine in 2011 after
completing his surgical critical care fellowship at Barnes-Jewish Hospital,
Washington University Medical Center. His basic science and translational
research focuses on the trafficking of immune cells and the use of immune
modulating agents in trauma and critical illness.
Dr. Thourani receives prestigious McGoon Award
Dr. Thourani
Dr. Vinod Thourani has been honored with the 2013 Dr. Dwight C. McGoon
Award of the Thoracic Surgery Residents Association (TSRA). The McGoon
Award is based on nominations from cardiothoracic surgery residents all over
the country, and recognizes an outstanding young faculty member in
cardiothoracic surgery and his or her commitment to resident education and
mentorship. The nominees must be within the first ten years of their professional
career and have demonstrated remarkable interest and ability in resident
training.

In the announcement congratulating Dr. Thourani, Drs. Tom Nguyen and Samuel
Youssef of the TSRA wrote: “The letters we received from your residents reflect
upon your dedicated, tireless, and selfless commitment to resident education.
Recognizing you and the efforts you have put forth on behalf of your trainees is
one of the greatest privileges we as the TSRA can have in celebrating the most
sacred tradition of surgical education.”
New arrival: Bahaaldin Alsoufi, MD
Assistant Professor of Surgery, Division of Cardiothoracic Surgery, Department
of Surgery, Emory University School of Medicine
Dr. Alsoufi
Dr. Alsoufi completed his general surgery residency at the University of
Massachusetts, his cardiothoracic surgery residency at Oregon Health Science
University, his fellowship in adult cardiac surgery at Toronto General Hospital,
and his fellowship in congenital cardiac surgery at the Hospital for Sick Children
in Toronto. In 2006, he joined King Faisal Heart Institute, King Faisal Specialist
Hospital and Research Center, Riyadh, Saudi Arabia, as a consultant in
pediatric cardiac surgery. He also served as the chairman of mortality and
morbidity and quality director. Dr. Alsoufi is a well-published author and serves
on the editorial boards of BioMed Central Surgery and Journal of the Saudi
Heart Association. His clinical specialties are cardiac surgery in neonates and
children and congenital cardiac surgery in adults, while his research interests
include clinical outcomes research, valvular heart disease, and ECMO.
Save the Date: Emory Surgery Faculty
Development Seminar
May 11, 2013, 8:00 a.m. – 12:00 p.m., WHSCAB Auditorium
While all faculty are welcome, faculty who joined the Department of Surgery
after 2010 are strongly encouraged to attend this overview event for a series of
seminars dedicated to equipping faculty early in their careers with the tools to
be successful. Agenda items will include promotions, education, research, clinic
operations, quality, and communications resources. Single-topic seminars
covering most of these areas will be scheduled throughout the weeks to follow.
Please contact surgery.facultydevelopment@emory.edu with any questions or
concerns.
Upcoming events
EVENT DATE/TIME LOCATION
SURGICAL GRAND
7:00 - 8:00 a.m., May
ROUNDS
2, 2013
Decision-Making by Patients
and Clinicians
Presented by Theresa W.
Gillespie, PhD
– (Primary Appointment)
Associate Professor,
EUH auditorium

Department of Surgery, Emory
University School of Medicine
– (Joint Appointment)
Associate Professor,
Department of Hematology
and Medical Oncology, Emory
University School of Medicine
– (Secondary Appointment)
Clinical Associate, Nell
Hodgson Woodruff School of
Nursing, Emory University
– Co-Director, Health
Disparities Initiative, Winship
Cancer Institute
SURGICAL GRAND
ROUNDS
GI Mucosal Imaging and
Mucosal Resection: New
Frontiers in GI Cancer
Management
Presented by Kevin Woods,
MD
– Assistant Professor of
Medicine, Division of Digestive
Diseases, Department of
Medicine, Emory University
School of Medicine
Vascular Quality Initiative
Regional Meeting
Sponsored by the Florida–
Georgia Vascular Study
Group and hosted by Dr.
Yazan Duwayri and Emory
University Hospital.
SURGICAL GRAND
ROUNDS
13th Annual Gerald Zwiren
Lecture in Pediatric Surgery
Surviving Childhood
Cancer... The Rest of The
Story
Presented by Richard R.
Ricketts, MD
– Professor of Surgery,
Division of Pediatric Surgery,
Department of Surgery, Emory
University School of Medicine,
Emory-Children's Center
EUH Surgical Services
Performance Day
A quarterly review and
analysis of surgical services
performance among
anesthesia, surgery, and OR
staff of Emory University
Hospital.
7:00 - 8:00 a.m., May
9, 2013
10:00 a.m. - 4:00
p.m., May 9, 2013
7:00 - 8:00 a.m., May
16, 2013
7:00 - 8:00 a.m., May
23, 2013
EUH auditorium
EUH
download meeting
flier and agenda for
more details
EUH auditorium
EUH auditorium

Surgery Division Chiefs
Meeting
SURGICAL GRAND
ROUNDS
8th Annual H. Harlan Stone,
MD, Lecture in Trauma
Damage Control:
Revolution, Rejuvenation
and Recapitulation
Presented by Michael F.
Rotondo, MD
– Professor and Chairman,
Department of Surgery, Brody
School of Medicine, East
Carolina University
– Director, Center of
Excellence for Trauma and
Surgical Critical Care, Brody
School of Medicine
– Chief of Surgery, Pitt
County Memorial Hospital,
University Health Systems of
East Carolina
5:30 - 7:00 p.m., May
28, 2013
7:00 - 8:00 a.m., May
30, 2013
EUH Whitehead
Room
EUH auditorium