Spring/Summer 2012 - Health Care Professionals - Dartmouth ...

department of surgery newsletter SPRING/SUMMER 2012 

Department of Surgery 

NEWS 

SPRING/SUMMER 

2012 

CONTENTS 

A Note from the Chair......................................................................2 

12 D-H Surgeons Top Doctors in NH.................................................3 

Pancreas Autoislet Cell Transplant Program..................................... 4 

New Hope for Peripheral Artery Disease Patients............................ 6 

Care Path Update............................................................................. 8 

2012 Surgery Graduates.................................................................... 8 

2012 Internship/Residency Placements............................................. 9 

New Faculty....................................................................................10 

Grant, Clinical Trials & Research News........................................... 11 

Awards & Personal Accomplishments.............................................. 12 

Calendar of Events.......................................................................... 13 

In Memorium, Richard (Dick) Karl, MD............................................14 

VISIT THE DEPARTMENT OF SURGERY WEB SITE 

Newsletter contact: Jo-Ann.Dugdale@hitchcock.org 

1 

copyright © 2012, Dartmouth-hitchcock


chair’s note | Richard B. Freeman Jr., MD 

Dear Colleagues: 

As you will see from this second newsletter, 

the Department of Surgery is vibrant and vital 

here at Dartmouth with many new exciting 

developments. Notably, Dartmouth Medical 

School has been renamed The Geisel School of 

Medicine at Dartmouth in honor of Audrey and 

Theodor Geisel, and their generosity to Dartmouth 

Richard B. Freeman Jr., MD during their lifetimes and in their estate plan. 

Theodor Geisel, better known as Dr. Seuss, was a 

Dartmouth alumnus and long-time benefactor of Dartmouth. In time, the Geisel’s 

philanthropy will directly benefit students and faculty in our Department and 

across the School. In addition to this exciting development, you will see that the 

Department of Surgery at The Geisel School is growing and pursuing many new 

ventures, only some of which can we outline here. 

Cell-based therapies for surgical diseases have taken front stage in two 

separate areas in our Department. Dr. Richard Powell and the Section of 

Vascular Surgery have published interim results from the RESTORE trial 

(see page 6 ), showing improved limb salvage for patients with critical 

limb ischemia who received stem cells compared with placebo. These 

encouraging results suggest that there may be hope for patients with critical 

limb ischemia and who have no other revascularization options. Drs. David 

Axelrod and Kerrington Smith in collaboration with Dr. Tim Gardner from 

Gastroenterology performed our first auto islet cell transplant here at DHMC 

in May (see page 4). In this novel treatment, patients with intractable pain 

from chronic pancreatitis undergo total pancreatectomy, have their islet cells 

isolated from the excised pancreas and then have these insulin producing cells 

re-infused to prevent the brittle diabetes that usually complicates the total 

pancreatectomy procedure. This treatment can offer a good chance at curing 

the chronic pain with normal or near normal blood sugar control. 

In other developments, members of the Department 

visited Muhimbili University Medical Center in Dar 

Es Salaam Tanzania in April as part of an education 

exchange program and planed for a more robust 

exchange of faculty and residents in the future. 

Many surgeons are now involved in development of surgical care paths. 

These are defined patient trajectories in which documentation and orders are 

standardized along pre-defined process flow charts and for which outcomes 

are tracked in real time. These are a first step in meeting the need to “bundle” 

surgical care. 

Lastly, as federal funding for graduate medical education gets cut again, 

we are asking for your help. Our trainees need funding for research, travel 

to meetings, seminars, and a variety of other opportunities all aimed at 

enhancing their educational experiences. Please help to support resident 

research and education within the Department (see page 14). Your generosity 

will ensure our ability to continue to train the best and the brightest. 

2 



department of surgery 

NEWS 

12 Dartmouth-Hitchcock Surgeons Cited as Top Doctors in NH 

New Hampshire Magazine named 51 Dartmouth-Hitchcock physicians, 

spanning 40 different specialties, to its list of the leading physicians in New 

Hampshire, in the magazine’s April edition. 

symptoms, even if it can’t be fixed.” And she describes that understanding as 

a two-way street: “Medicine has limitations in what it can do. Sometimes we 

may fall short of their expectations—not due to any particular failings, but 

due to the fact that although we can try to improve quality of life, none of us 

will live forever.” 

The 2012 edition of “Top Doctors” also features Q & A sessions with cover 

photographs of six New Hampshire clinicians including ophthalmologist Susan 

M. Pepin, MD. In her response on the rewards of her profession, Pepin cites 

“helping a patient better understand what is going on with their health (or) 

12 Top Surgeons 

Rocco R. Addante, DMD, MD – Oral & Maxillofacial Surgery 

M. Shane Chapman, MD – Dermatology 

Lawrence Dacey, MD, MS - Cardiothoracic 

Anthony W. DiScipio, MD - Cardiothoracic 

Benoit J. Gosselin, MD – Otolaryngology 

Susan M. Pepin, MD – Ophthalmology 

Richard Powell, MD - Vascular Surgery 

David W.Roberts, MD - Neurosurgery 

Kari M.Rosenkranz, MD – Breast Surgery 

John D. Seigne, MD – Urology 

Rosalind A. Stevens, MD – Ophthalmology 

3 




NEWS 

Pancreas Autoislet Cell Transplant Program 

In 2012, DHMC initiated a new program for patients with a history of 

chronic pancreatitis who live with severe, unrelenting pain. Chronic 

pancreatitis is a life-long condition that results from a variety of factors 

including mutations in the CF gene, hypertriglyceridemia, abnormal 

ductal development and alcohol abuse. Patients frequently have severe 

pain resulting in chronic narcotic dependence, employment disability 

and depression. 

Chronic pancreatitis requires a multi-disciplinary care approach 

including pancreatology, interventional gastroenterology, pain 

management, social work and surgery. Medical management of 

this condition can improve nutrition, manage malabsorption from 

exocrine insufficiency, and improve pain management leading to 

reduced narcotic requirements. However, for patients who fail medical 

management, surgery offers improved pain control. Traditional surgical 

approaches for patients with chronic pancreatitis include procedures 

to improve drainage, partial resection of head of the pancreas or total 

pancreatectomy. As these procedures remove functional endocrine 

tissue, patients frequently develop brittle type I diabetes, further 

impairing their quality of life. 

Surgeons Kerrington 

Smith, MD (above) and 

David Axelrod, MD (left) 

performed Dartmouth- 

Hitchcock’s first 

autoislet transplant on 

May 2, 2012. 

The autoislet cell transplant procedure involves total or near total 

pancreatectomy, recovery of the islet cells from the resected specimen 

and reinfusion of the islets into the patient’s liver via the portal vein. 

The islets function within the liver restoring glycemic control. In the 

largest series, 2/3 of patients remained insulin free or required only a 

4 



Pancreas Autoislet Cell Transplant Program (continued) 

low dose of insulin. These patients are largely pain free or on minimal doses 

of narcotics. 

On May 2, 2012, DHMC performed our first autoislet transplant. Our patient 

was a young man who underwent a subtotal pancreatectomy for a disrupted 

pancreatic duct from severe pancreatitis. He underwent a series of complex 

endoscopic interventions by Tim Gardner MD. Despite these procedures, 

he had persistent pain. Surgeons Kerrington Smith, MD and David Axelrod, 

MD removed the distal 80% of the patient’s pancreas. Dr. Axelrod then drove 

the pancreas to our partners at Massachusetts General Hospital where the 

islets were recovered, while Dr. Smith completed the surgical reconstruction. 

Dr. Axelrod then returned and together they infused the islets into the liver. 

Interestingly, the patient developed hyperglycemia requiring insulin infusion 

during the time that the islets were being recovered. Following infusion, 

his insulin requirement abated. He is now insulin free, off narcotics and very 

satisfied. 

We have several additional patients who are currently completing their 

multidisciplinary evaluation and are being prepared for transplant. There 

are currently no other programs in the North Eastern United States actively 

pursuing this innovative approach. We anticipate a significant growth in 

the program given the large pancreatology care team led by Dr. Gardner in 

Gastroenterology. We are pleased to have developed a true, collaborative 

multidisciplinary team lead by Drs. Gardner, Axelrod and Smith. 

5 




NEWS 

Dartmouth-Hitchcock Research Offers New Hope for Patients with Critical Limb Ischemia (CLI) 

Research led by vascular surgeons at Dartmouth-Hitchcock may offer new hope 

to sufferers of peripheral artery disease, the cause of nearly 60,000 lower-limb 

amputations annually, through the use of a patient’s own stem cells. 

Richard J. Powell, MD, Chief of Vascular Surgery at Dartmouth-Hitchcock, 

is the principal investigator on a national study—involving 550 patients at 

80 sites around the country—of so-called “no option” patients, for whom 

the disease is so advanced that amputation is the only available treatment. 

Powell’s study is now a three-year, third-stage clinical trial, after second-stage 

trials showed remarkable success at treating patients with CLI. The final 

results of the second-stage clinical trial have been published in the April, 2012, 

issue of Molecular Therapy. 

Peripheral artery disease (PAD) afflicts more than 9 million patients in the 

United States. The condition results from blockage in blood vessels caused 

by atherosclerosis—hardening of the arteries—which can be a consequence 

of diabetes, high cholesterol, smoking, genetic predisposition and other 

circumstances. In many cases, endovascular therapies such as insertion of 

stents or bypass surgery – similar to surgical processes used to treat blockages 

in the arteries of the heart – are used to reintroduce blood flow to the legs. 

But in about 150,000 patients with the most-severe forms of CLI, the disease 

is so extensive that endovascular therapy isn’t an option. That’s where 

Powell’s stem cell study comes in. 

Richard J. Powell, MD, chats with a patient at Dartmouth-Hitchcock Medical 

Center. 

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Dartmouth-Hitchcock Research Offers New Hope for Patients with CLI (cont) 

“All of us have stem cells in our bone marrow, and these stem cells can be utilized to repair other 

parts of our bodies,” says Powell. “By taking the patient’s own stem cells and injecting them into 

the ischemia leg, our hope is that we will improve the blood flow in that part of the leg.” 

In the study, bone marrow is removed from the patient’s hip, and then sent to a lab where stem 

cells are separated from the marrow and incubated over a two-week period, allowing more stem 

cells to grow. The stem cells are then re-injected intramuscularly into about 20 different spots in 

the patient’s leg. 

“We found that patients who received the stem cell therapy had a significantly lower incidence of 

amputation at six months than patients who received a placebo,” said Powell. After six months of 

the second-stage trials, approximately half of the patients who received a placebo died, required 

an amputation or saw their leg wounds worsen. Of those receiving the stem cell therapy, only a 

quarter died, required amputation or saw wounds worsen. Many showed significant improvement 

in blood flow in the ischemic limb. 

The final results of the secondstage 

clinical trial have been 

published in the April, 2012, 

issue of Molecular Therapy. 

“What is truly remarkable was that it was a relatively small number of patients, but that we saw 

clinically significant improvement in the stem cell-treated patients” he says. “It’s compelling 

enough that there’s no question that the pivotal trial needs to be done as quickly as possible.” 

The phase three trial has just begun, in which half of the patients will receive stem cell therapy 

and half will receive the placebo, measuring incidents of amputation or death one year after 

the treatment. “We really want to see a therapy that’s effective out to a year.” says Powell. 

“Nonetheless, the results so far are really promising.” (See video of Dr. Powell discussing 

Peripheral Artery Disease and his study on Dartmouth-Hitchcock’s YouTube Channel at 

http://www.youtube.com/playlistlist 

7 




NEWS 

2012 surgery graduates 

Care Path Update 

2012 Surgery Graduates 

This has been an exciting year for the Department of Surgery’s Clinical 

Pathway Development Program. There are currently 13 teams participating in 

this year’s competition. The planned submission deadline is in mid-October, 

after which judging will commence. The prize remains at $25,000, to be 

awarded at a November 28 th ceremony. The Section of Otolaryngology, led 

by Section Chief Dan Morrison, MD, was the winner of last year’s inaugural 

competition for their Head and Neck Cancer submission. The ENT team has 

used their winnings to hire a microsystems expert, who has facilitated the 

implementation and methods of measurement for that pathway. 

We have developed a training guide and specific judging criteria to 

bring increased clarity of departmental expectations. Many sections 

have broadened their scope and are designing pathways that are truly 

multidisciplinary. The Value Institute has helped with facilitation and has 

begun providing Lean Greenbelt training, which will speed up pathway 

development and dissemination of data. 

This year’s competition put a stronger focus on measurement, which includes 

financial, process and outcomes-based data. Data will be obtained from 

a variety of sources including the National Surgical Quality Improvement 

Project (NSQIP), The University Health Consortium and from the electronic 

medical record itself. This data will help to better understand how we deliver 

care and will serve as an excellent tool for continuous process improvement. 

We look forward to sharing this data freely with all, and will continue to send 

updates on our progress as the months go on. 

General Surgery 

Kathyrn Davis, MD - Vascular Surgery, Emery 

Isak Goodwin, MD - Plastic Surgery, Utah 

Neurosurgery 

William (BJ) Spire, MD – Private practice. Billings, Montana 

Otolaryngology 

P. Tate Maddox, MD – Private practice. Abingdon ENT, Abingdon VA. 

Affiliated with Johnston Memorial Hospital 

Plastic Surgery 

Michael M. Van Vliet, MD – Critical Care & Burn Fellowship, University of 

Southern California & Los Angeles County 

Urology 

Peter Jones, MD – Private practice, Idaho 

Einar Sverrisson – Urologic Oncology, Moffitt Cancer Center, Tampa, FL 

8 



THE geisel school of medicine at dartmouth 

NEWS 

Surgery Clerkship Expands 

The Surgery Clerkship at The Geisel School of Medicine at Dartmouth 

underwent transformative changes for the 2012-2013 academic years. 

The third-year rotation expanded to an 8-week block, allowing the 

students to rotate on two services or surgical subspecialty. Expansion 

of faculty learning leaders, revision of didactic weekly sessions with 

a multidisciplinary approach, the addition of biopsy skills teaching to 

our suture course, and a great effort to provide timely and frequent 

feedback have improved the education we provide to our third-year 

clerkship. Dr. Gina Adrales joined Dr. Horace Henriques this year as 

co-director of the clerkship program. Dr. Kenneth Burchard remains an 

integral educator and Dr. Andrew Crockett has taken on a more active 

role. Our efforts in teaching and modeling communication skills have 

been recognized by Dr. Richard Simons, our new Senior Associate 

Dean for Medical Education. 

The Geisel School of Medicine at Dartmouth 

Class of 2012 

Internship/Residency Surgical Placements 


Dartmouth-Hitchcock Medical Center – 1 

UC Davis Medical Center – 1 

Dermatology 

Massachusetts General Hospital – 1 

Neurological Surgery 

Brigham & Women’s Hospital – 1 

Ophthalmology 

Massachusetts Eye and Ear Infirmary – 1 

Scheie Eye Institute – University of Pennsylvania – 1 


University of Texas Southwestern Medical School - 1 

Urology 

University of Connecticut Health Center – 1 

9 



New Faculty 


Pediatric Neurosurgery 

Konstantinos Spaniolas, MD 

David Bauer, MD 

Ophthalmology 

Urology 

Ronald Swendris, MD 

Elias Hyams, MD 

10 



Grant, Clinical Trials & Research News 

Neurosurgery 

5/4/12: Kimon Bekelis, MD – MRI/MRA Fusion Technique for Intraoperative 

Navigation during Microsurgical Resection of Cerebral Arteriovenous 

Malformations 

5/4/12: Kimon Bekelis, MD – Motor and Somatosensory Evoked Potential 

Monitoring during Aneurysm Surgery: Effect on Outcome and Surgical 

Strategy 

12/6/11: David Roberts, MD – Subdural Inter-hemispheric Grid Electrodes for 

Intracranial Epilepsy Monitoring: Feasibility, Safety and Utility 

Otolaryngology 

2/23/12: Eunice Chen, MD – The Role of Hypoxia and Hypoxia-Inducible 

Pathways in the Pathogenesis of Head and Neck Diseases 


7/30/12: Carolyn Kerrigan, MD – Evaluating Accuracy and Reliability of Hand 

Symptom Diagrams in the Diagnostic Workup of Carpal Tunnel Syndrome 

Vascular 

12/6/11: Mark Fillinger, MD – The Pivotal Study of Aptus Endovascular AAA 

Repair System 

4/5/12: Mark Fillinger, MD – Clinical Trial Protocol, CP-0004, Rev. 02. 

Prospective, Multicenter, Single Arm Safety and Effectiveness Trial of the 

Endologix Fenestrated Stent Graft System for the Endovascular Repair of the 

Juxtarenal/Pararenal Aneurysms 

5/9/12: Mark Fillinger, MD – INSPIRATION: A Multcenter, Open Label, 

Prospective, Non Randomized, Study of the INCRAFT Stent Graft System in 

Subjects with Abdominal Aortic Aneurysms 

6/26/12: Mark Fillinger, MD – ANCHOR: Aneurysm Treatment using the 

HeliFX Aortic Securement System Global Registry 

2/22/12: Richard Powell, MD – 55-1009-01 A Mutli-center Randomized 

Double-blind, Placebo-controlled Parallel Group Study to Evaluate the 

Efficacy, Safety, and Tolerability of Ixmyelocel-T in Subjects with Critical Limb 

Ischemia and No Options for Revascularization 

7/19/12: Richard Powell, MD – SuperNOVA: Stenting of the Superficial 

Femoral and Proximal Popliteral Arteries with the Boston Scientific INNOVA 

Self-Expanding Bare Metal Stent System 

5/11/12: Eva Rzucidlo, MD – Pivotal Study of the Safety and Effectiveness of 

Autologous Bone Marrow Aspirate Concentrate (BMAC) for the Treatment of 

Critical Limb Ischemia due to Peripheral Arterial Disease 

11 



awards & personal accomplishments 

Richard Barth JR., MD has been invited as a speaker for the GIST seminar 

at the ACS meeting in October. He has also been selected as a specialty 

physician in the top 1% nationally in the recent best hospital edition of the 

U.S.News and World Report 

Crichlow Award: Eunice Chen, MD – Otolaryngology – Correlation 

and assessment of tumor hypoxia and nanoparticle-based intracellular 

hyperthermia cancer treatment using murine and spontaneous pet animal 

head and neck tumor models. 

Dow Award: Eva Rzucidlo, MD – Vascular – Novel Targets of Statins in the 

Treatment of Intimal Hyperplasia. 

The Dartmouth College Board of Trustees is receiving an award to collaborate 

with 15 large health care systems around the country to hire Patient and 

Family Health Coaches (health coaches). The health coaches will be trained 

to engage in shared decision making with patients and their families, focusing 

on preferences and supplying sensitive care choices. Health coaches may 

work with patients at a single decision point or over multiple visits for those 

with chronic conditions. It is anticipated that this intervention will lead to 

a reduction in utilization and costs and provide invaluable data on patient 

engagement processes and effective decision making—leading to new 

outcomes measures for patient and family engagement in shared decision 

making. Dr. Vidal will play an important role as a shared decision making 

clinical innovation lead for the effort. 

Dale Collins Vidal, MD has received funding from the Informed Medical 

Decisions Foundation (formerly Foundation for Informed Medical 

Decision Making- FIMDM) to continue demonstration projects focused on 

implementing shared decision making in practice for patients in the spine, 

diabetes and primary care practices. This award also makes it possible to 

continue to provide high quality, evidence-based video decision aids for 

patients through the Center for Shared Decision Making (CSDM) located at 

3P. Visit the CSDM intranet site DHMC CSDM intranet for a list of available 

video decision aids (DAs), instructions for ordering DAs in EPIC, provider 

summary tools and clinician SDM resources. 

Jessica Wallaert, MD – Lead author and researcher: (Reuters Health) – One 

in five people who get artery-clearing surgery to prevent a stroke are likely too 

old and sick to live long enough to benefit from the procedure, according to a 

new study 

Ronald Yap, MD has created mobile apps “Prostate Pal” and “Bladder Pal” 

to empower patients worldwide to track urologic health. To date, there have 

been over 10,000 visits from 69 countries. Dr. Yap can be reached @ ryap@crhc. 

org 

Kathryn Zug, MD, Mari Paz Castanedo, MD(1 st year resident) and Courtney 

Kozlowski (Research Assistant) presented results on a study of results on a 

study from patch testing at the European Society on Contact Dermatitis in 

Sweden, June 2012 

12 



calendar of events 

TAKE NOTE 

Department of Surgery Grand Rounds 

9/14/12 Plastic Surgery Carolyn Kerrigan, MD – DHMC 

Dale Collins Vidal, MD – DHMC 

9/21/12 Neurosurgery Matthew A. Howard, III, MD – University of Iowa 

9/28/12 Vascular Surgery Cantwell Clark, MD – DHMC 

Steven Yule, PhD – Brigham and Women’s Hospital 

Dermatology Moving to Heater Road, Fall 2012 

Dartmouth-Hitchcock Heater Road, which is now 

under construction and scheduled to open in the 

fall of 2012, will house primary care, outpatient 

rehabilitation, functional restoration, dermatology, 

phlebotomy and the sleep disorders center. 

10/5/12 Teaching Teachers Robert Witherspoon – President, Performance and 

to Teach 

Leadership Development, Ltd 

Richard M. Frankel, PhD – University of Indiana 

Ann Davis, MD – The Geisel School of Medicine at Dartmouth 

Richard Simons, MD MBA – The Geisel School of Medicine 

at Dartmouth 

10/19/12 General Surgery Anthony J. Beisler, MD, MBS, FAC – Medical Director, 

Permedian, Inc. 

an HMS Company 

12/14/12 Transplant Robert Montgomery, MD – Johns Hopkins 

13 



in memoriam 

DONATE TO THE DEPT. OF SURGERY 

Richard (Dick) Karl, MD 

DOS Chair 1970 – 1980 

In 1970 Dr. Karl became 

the first Chair of the 

Department of Surgery 

at Dartmouth. In his role 

as clinical leader he was 

admired for his clear 

thinking and advocacy 

for medical students 

and residents. Dr. Karl 

served as chair for ten 

years and continued in a 

clinical capacity until his 

retirement in 1990. New 

Hampshire particularly suited Dick Karl. He and his wife, 

Lucy, held frequent dinners and gatherings at their house in 

Etna for residents and faculty. The Karl family hopes that you 

will make a contribution to your own life, take time to smell 

the flowers, enjoy your own gardens and savor time with your 

loved ones. 

Remember when . . . 

Think back to when you were a resident at Dartmouth-Hitchcock. Was there a 

professional meeting that you wanted to attend Was there a research question you 

were dying to sink your teeth into How did you find the money you needed to take 

advantage of such opportunities Surgical residents at Dartmouth-Hitchcock are 

eager for research, training, and networking opportunities. Right now, our residents 

are in need of funding to conduct research, to travel to professional meetings, do 

rotations in global surgery and further enrich this critical time in their professional 

lives. With a gift to the Department of Surgery at Dartmouth-Hitchcock, you can 

advance a young doctor’s career in real and meaningful ways. To make a gift today, 

go online to http://dartmouth-hitchcock.org/surgery donate or make a check out to 

the Surgical Educational Fund and mail it to: Office of Development / D-H and The 

Geisel School of Medicine / One Medical Center Drive, HB 7070 / Lebanon, NH, 

03756-0001. For more information, contact Rick Peck, Director of Gift Planning, at 

(603) 653-0735. Our residents and faculty thank you for your generosity. 

keep in touch 

Alumni News: We are interested in what you are up to now and any individual 

accomplishments. Send a quick note and your contact information to Jo-Ann. 

Dugdale@hitchcock.org 

14

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