2012 - Health Care Professionals - Dartmouth-Hitchcock

med.dartmouth.hitchcock.org
  • No tags were found...

2012 - Health Care Professionals - Dartmouth-Hitchcock

DEPARTMENT OF SURGERY ANNUAL REPORT 2012


TABLE OF CONTENTSMessage from the ChairDepartment of Surgery SectionsCardiothoracic SurgeryDermatologyGeneral SurgeryNeurosurgeryOphthalmologyOtolaryngology and AudiologyPediatric SurgeryPlastic SurgeryTransplantation SurgeryUrologyVascular SurgerySurgical Research LabMaxillofacial SurgeryOffice of Surgical EducationMedical Student Education ProgramGeneral Surgery Residency Training ProgramDermatology Residency Training ProgramNeurosurgery Residency Training ProgramOtolaryngology Residency Training ProgramPlastic Surgery Residency Training ProgramUrology Residency Training ProgramVascular Residency Training ProgramProgram Highlights1) Global Surgery Initiative2) Pancreas Autoislet Cell Transplant Program3) Stem Cell and Gene Therapy in the Treatment of CLIAwardsClinical Trials and ResearchPublications2468101214161820222426282930323334353638404243444649ADMINISTRATIONRichard Freeman, Jr, MDWilliam N. and Bessie Allyn Professorand Chair of SurgeryKerry RyanDirectorAdministrative Associate in SurgeryLinda BarieAdministrative ManagerAudrey CarrFinancial ManagerJo-Ann DugdaleAdministrative AssistantJohn HigginsData Center ManagerDarrin Michalak, PA-CCare Path AdministratorTerri NicholsonClerkship Program CoordinatorLaura StancsAssistant to the ChairChristina StarkProject Assistant IIIDEPARTMENT OF SURGERYTorry Cobb, PA-CInstructor in SurgeryPriscilla Marsicovetere, PA-CInstructor in SurgeryA. Maya McSpadden, PA-CInstructor in SurgerySarah Pletcher, MDAssistant Professor of SurgeryMedical Director, Center forTelehealthDARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 20121


MESSAGE FROM THE CHAIR2012 has brought new achievements, changes, and challenges to the Department of Surgery atDartmouth-Hitchcock and The Geisel School of Medicine at Dartmouth. Most noticeably,Dartmouth Medical School received a very generous endowment from the family of Theodor(Dr. Seuss) and Audrey Geisel and renamed the School in their honor. This will have a profoundimpact on shaping the future of our Medical School and helping to provide a stable foundationon which to build the medical school of the future. Parallel to this, we in the Department ofSurgery have been focusing on revamping, updating, and improving our medical student curriculumand overall teaching effort. Through the direction of Horace Henriques, MD, Gina Adrales, andAndrew Crockett, MD, the entire medical student clerkship schedule and curriculum have beencompletely revised. We have also appointed a new General Surgery Residency Program Director,Paul Kispert, MD and an Associate Director, Kari Rosenkranz, MD, who have already made asignificant and positive impact on our program through a very successful RRC review.Richard B. Freeman, Jr., MDWilliam N. and Bessie AllynProfessor and ChairDepartment of SurgeryThe Department’s commitment to define and improve the value of our clinical care remainsforemost through the “care path” development process. Surgical care paths are aimed atstreamlining and standardizing the delivery of surgical care, while reducing costs, for the routineprocedures we do most frequently. We awarded the second annual $25,000 prize to ThoracicSurgery Team for their “Esophageal Cancer Care” pathway this year. Every section had at leastone project in development.Two other cutting edge programs have been developed over the past year and are highlighted inthis report, both of which are developing cellular therapies for surgical diseases.1) Our Section of Vascular Surgery has reported preliminary findings for the application of bonemarrow derived stem cells for the treatment of critical limb ischemia. Significantly fewer patientsreceiving the stem cell infusions went on to limb amputation compared with patients treatedwith placebos. This new treatment has the potential to significantly reduce the number ofamputations that patients with critical limb ischemia require and, thereby, dramatically improvetheir quality of life.Kerry RyanDirector, Department of Surgery2) A multidisciplinary team from Gastroenterology and Surgery performed our first autoislet celltransplant after total pancreatectomy. Patients with severe pain from chronic pancreatitis oftenhave their pain markedly improved by total pancreatectomy; however, this leaves them withdifficult to control diabetes. By isolating the islet cells from the pancreas specimen retrieved atthe time of pancreatectomy and re-infusing them to the patient, the need for insulin can begreatly reduced or eliminated altogether. Dartmouth-Hitchcock is one of only a few centersaround the country that is doingthese procedures.We continue to strive for cuttingedge treatments within the valuebasedaccountable care world. Asyou will see in this report, theDartmouth-Hitchcock/GeiselSchool of Medicine Department ofSurgery is uniquely poised to meetboth needs while continuing toteach, train, and develop thesurgeons of the future.William N. and Bessie Allyn Professor and ChairDepartment of Surgery2


Department of Surgery Total Gross Professional RevenueDepartment of Surgery Total Cases$200M$150M$100M$50M16K12K8K4KFY07 FY08 FY09 FY10 FY11 FY12FY07 FY08 FY09 FY10 FY11 FY12DEPARTMENT STATISTICS 2012SectionFacultyAssociateProvidersResidentsClinical Trialsand ResearchPublicationsOutpatientAppointmentsOR CasesAudiology109,905CT Surgery66282,784827Dermatology983529,085General Surgery21333142512,2363,306Maxillofacial11,358165Neurosurgery54710205,819936Ophthalmology9261228,8441,085Otolaryngology92521313,6901,917Pediatric Surgery6313,814909Plastic Surgery7131466,5671,327Transplantation316152,575259Urology818123411,3631,204Vascular101850706,227975Surgical Res. Lab63119Dept. of Surgery341Total1033872171217139,85512,910DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 20123


CARDIOTHORACIC SURGERYLawrence J. Dacey, MDSection ChiefProfessor of Surgery andCommunity & Family MedicineKerry RyanDirector, Department of SurgeryIntroductionThe Section of CardiothoracicSurgery, consisting of the Divisionsof General Thoracic Surgery andCardiac Surgery, continues tooffer a full range of focused andinnovative surgical options to allpatients with surgical diseases ofthe thorax. With this increasedspecialization of the cardiothoracicsurgical faculty, the Section haswitnessed an increasingly complexcaseload with excellent outcomeswhile it continues to lead theInstitution in inpatient, outpatient,and referring physician satisfaction.Our continued involvement with theGeneral Surgical Residency TrainingProgram and the Geisel School ofMedicine allows medical students andsurgical residents to experience supervisedtraining in a busy outpatient clinic,inpatient consult and critical care service,and operating room.The Division of Cardiac SurgeryThe Division of Cardiac Surgery continuesto offer a full range of surgical proceduresfor patients with acquired adult cardiacdiseases. This includes standard cardiacsurgery procedures, i.e. coronary bypass,valve repair and replacement, as well asmore complex procedures such as valvesparing aortic valve surgery, and variousforms of left ventricular remodelingprocedures. In addition, we have recentlybegun Transcatheter Aortic ValveReplacement in collaboration with ourHeart and Vascular Center colleagues. Ourcontinued involvement in the NorthernNew England Cardiovascular Disease StudyGroup and participation in the Society ofThoracic Surgeons Cardiac SurgicalDatabase insures that our outcomes areclosely monitored and transparentlydisplayed against institutional, regional,and national standards. We are proud tocontinue to demonstrate some of thebest outcomes in the nation. Patientscan now access and review our surgicaloutcomes by logging ontowww.dhmc.org/qualityreports/list.cfm?metrics=CT.The Aortic Center at Dartmouth continuesto thrive under the directorship of AnthonyDiScipio, MD. This multidisciplinaryinitiative offers patients with complexdiseases of the thoracic aorta, many of themost sophisticated surgical interventionsperformed today. Patients with lifethreateningaortic diseases can now beevaluated and electively treated by themost advanced imaging and therapeuticmodalities available and by a team ofprofessionals dedicated to understandingand treating these conditions.In collaboration with our electrophysiologydepartment, James Yun, MD is helping tolead a laser-assisted lead extraction programfor aging or worn out pacemaker anddefibrillator leads. This program willaddress a mounting clinical problem asmore of these devices need to be removed.The Division of GeneralThoracic SurgeryThe Division of General Thoracic Surgerycontinues to be an integral part ofDartmouth-Hitchcock’s and Norris CottonCancer Center’s Comprehensive ThoracicOncology Program (CTOP). Thismultidisciplinary initiative offers all patientswith malignant diseases of the chest direct“one-stop” access to a multidisciplinaryteam of experts dedicated to betterunderstanding and treating these devastatingconditions. This program meets weeklyand combines a patient-centered clinicalconference, with a centralized clinic thatplaces clinicians from medical oncology,surgical oncology, pulmonary, diagnosticand interventional radiology, and pathologyin one location. This has offered bothpatients and clinicians the opportunity for“real-time” collaboration and consultation.The General Thoracic Division offers a fullrange of surgical procedures for patientswith benign and malignant diseases ofthe lung, esophagus, mediastinum, andpleural spaces. This includes, whereappropriate, video assisted thoracic surgery(VATS) including VATS lobectomy andesophagectomy. A workgroup headed byCherie Erkmen, MD is formulating a carepathway for esophageal cancer patients.This will provide optimum care in a timelyfashion.Research within the Section ofCardiothoracic SurgeryResearch opportunities for faculty andresidents continue within the Section.Under the direction of Joseph DeSimone,MD, we are enrolling patients into thePartner’s 2 trial for Transcatheter AorticValve Replacements. Dr. DeSimone alsocoordinates a large animal laboratory studylooking at the effects of pulsatile perfusionon organ systems. Finally, outcomes4


esearch remains through ourcollaboration with the NorthernNew England Cardiovascular DiseaseStudy Group (NNE) cardiac surgicaldatabase. The General ThoracicDivision participates with the NorrisCotton Cancer Center and themulti-institutional national oncologyresearch organization, Cancer andLeukemia Group B (CALGB). Thisprovides our patients access to themost innovative cancer treatmentsavailable and our residents and staff toparticipate in many institutional andnational treatment protocols. Underthe direction of Dr. Erkmen, theDivision of Thoracic Surgery hasan ongoing basic science researchinitiative studying immunofluorescencetumor marking in malignanciesand made available clinical researchopportunities through our clinicaloutcomes registry and membershipin the Society of Thoracic SurgeonsThoracic Surgical Database. Inaddition, Dr. Erkmen and WilliamBlack, MD, from our Department ofRadiology, are leading a Lung CancerScreening Program.Outcomes and the Future ofHealthcareCardiac surgery remains the mostscrutinized speciality in all ofmedicine. Since healthcare payersand their patients have insistedon increased accountability andtransparency in outcomes, theSection of Cardiothoracic Surgeryhas responded by making oursurgical outcomes transparent tothe public. DHMC now providespatient access to our surgical outcomesin a patient-friendly format(www.dhmc.org/qualityreports/list.cfm?metrics=CT).This initiative, combined withour continued involvement withthe Northern New EnglandCardiovascular Disease Study Group(www.nnecdsg.org), makes theSection of Cardiothoracic Surgery aninternational leader in understandingand improving healthcare outcomes.FACULTYCARDIAC SURGERYM. Adam Christopher, PA-CInstructor in SurgeryCurtis Cote, PAInstructor in SurgeryLawrence Dacey, MDProfessor of Surgery and Community& Family MedicineJoseph DeSimone, MDAssistant Professor of SurgeryAnthony DiScipio, MDAssistant Professor of SurgeryJamie McCormack, PA-CInstructor in SurgeryRobert Miljan, PAInstructor in SurgeryJames Yun, MDAssistant Professor of SurgeryTHORACIC SURGERYCherie Erkmen, MDAssistant Professor of Surgeryand MedicineElizabeth Maislen, APRNInstructor in SurgeryAnne McGowan, PAInstructor in SurgeryWilliam Nugent, Jr, MDProfessor of Surgery, Community& Family Medicine, andThe Dartmouth InstituteCardiothoracic Surgery Gross Professional RevenueCardiothoracic Surgery Cases$18M$16M$14M$12M$10M$8M$6M$4M$2M1,000800600400200FY07 FY08 FY09 FY10 FY11 FY12FY07 FY08 FY09 FY10 FY11 FY12DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 20125


DERMATOLOGYM. Shane Chapman, MDSection ChiefAssociate Professor of SurgeryAshley LuurtsemaAssociate Practice ManagerIntroductionMuch time has been spent this year onplanning our move into our new spacein the new medical office building onHeater Road in Lebanon. November12, 2012 is our scheduled date to start.We continue to meet and exceed ourproductivity benchmarks and are tryingto increase our efficiency and expandour services.Patient CareDermatology outpatient care continuesto achieve very high patient satisfaction,while improving our patient volumes.We have lost two full-time providers,but are maintaining our access withspecialty efficiency clinics, such asthe “spot clinic,” shared medicalappointments, and a “superdermefficiency clinic.” In addition to theabove clinics, we have begun aTelemedicine/Teledermatology Clinicwith Weeks Hospital and are planningto expand these services as quickly aspossible. We have maintained our highvolume per section and per FTE aswell as patient satisfaction. FaramarzSamie, MD, our new Mohs surgeon, hasestablished himself in the communityand is on his way to performing over700 skin cancer Mohs cases in his firstyear, which is a much needed servicein our community and region. Weare continuing to improve all of oursubspecialty clinics. Our focus isnot only to provide high qualitydermatology care, but also efficient,high-value care for specific patient careneeds.EducationOur Dermatology Residency TrainingProgram is stable, newly accredited, andmoving upward. Kathyrn Zug, MD isin her second year as Program Director.Dr. Zug has solidified our residencyand has renewed focus on academicproduction. Two of our residents,Aelayna Meyer, MD and JeffreyTiger, MD are applying for MohsFellowships. Our resident publicationsand presentations have increased 50%this year alone. We are again consideringadding a Pediatric Dermatology andMohs Surgery/Procedural Fellowship tothe Section, which will complement theDermatopathology Fellowship.ResearchOur Section continues to participatein multiple industry-sponsored clinicaltrials, and at this point focusing onnew and novel systemic psoriasismedications.Faculty HighlightsDenise Aaron, MD has assumed CourseDirectorship for the second-yeardermatology Scientific Basis ofMedicine Course, beginning in thewinter term, and will have her work cutout for her as this is a course that isconsistently ranked as one of the best.Dr. Zug and Mari-Paz Castanedo, MD(resident) presented their research oncontact allergy at the European Societyof Contact Dermatitis in Sweden. TheRichard D. Baughman EndowmentFund in Dermatology received a$150,000 gift in the name of MarshallGuill, MD from Mrs. Lillian Seward ofVermont. This gets the fund to a totalof $250,000.The Third Edition of Skin Disease:Diagnosis and Treatment, an allDartmouth-Hitchcock Dermatologytextbook, was released in 2012 andincludes a translation in Farsi. The previousSecond Edition, translated in sixlanguages other than English, was wildlysuccessful having sold over 25,000copies, the most for any dermatologytextbook produced by the publisher.6


Looking AheadWe have overcome several obstaclesand are now stabilized to add facultyand fellowship programs to theSection as we prepare to move intoour new space in the Heater RoadMedical Office Building.We wantto continue to make our sectiona leader in office innovation andefficiency, while maintaining highpatient satisfaction. Mohssurgery is also establishing itself asa model of in-office surgical/procedural efficiency.We want to continue improvingexisting programs and adding to oureducational and research productivity.We are also committed to makingthe Section of Dermatology a leaderin outpatient clinical efficiency.There is a renewed focus on theRichard D. Baughman EndowmentFund in Dermatology in order toestablish a long-lasting academicendowment for generations to come.FACULTYDERMATOLOGYDenise Aaron, MDAssistant Professor of SurgeryRichard Baughman, MDProfessor of SurgeryM. Shane Chapman, MDAssociate Professor of SurgeryMarshall Guill, MDAssistant Professor of SurgeryNicole Pace, MDAssistant Professor of SurgeryFaramarz Samie, MDAssistant Professor of SurgerySteven Spencer, MDProfessor of SurgeryDorothea Torti, MDAssistant Professor of Surgeryand PathologyDaniel Stewart, MDInstructor in SurgeryKathleen Zug, MDProfessor of SurgeryDermatology Gross Professional RevenueCardiothoracic Surgery Cases$16M$14M$12M$10M$8M$6M$4M$2M1,000800600400200FY05 FY06 FY07 FY08 FY09 FY10FY07 FY08 FY09 FY10 FY11 FY12DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 20127


GENERAL SURGERYRichard J. Barth, Jr., MDSection ChiefAssociate Professor of SurgeryCatherine Garfield LegareSenior Practice ManagerIntroductionThe Section of GeneralSurgery, on a daily basis, strivesto accomplish the Dartmouth-Hitchcock (D-H) mission:to advance health throughresearch, education, andclinical practice, providingeach patient the best care,in the right place, at theright time. We also strive tooptimize the job satisfactionof each of our providersand staff, realizing this isessential for us to collectivelyaccomplish our mission.Major InitiativesIn 2012, we implemented a long-range planwhich transforms the way we deliver care fortrauma and acute general surgery patients. Wenow have seven trauma and acute care surgicalfaculty, who are in-house day and nightMonday-Friday so as to provide optimalpatient care. Once we complete our currentopen search for an additional acute caresurgeon, we will offer 24/7 in-house attendinglevel care. Through the efforts of RajanGupta, MD and Kurt Rhynhart, MD, D-Hwas re-certified this year by the AmericanCollege of Surgeons as a Level 1 TraumaCenter. Dr. Rhynhart has now assumed theleadership of the Trauma Program. We areproud to be a highly regarded referral centerfor acute surgical care for our region.We have also initiated a new model forintegrated surgical care with our neighboringcommunity hospitals. Dartmouth generalsurgeons have begun, for the first time, toevaluate and operate on patients in nearbycommunity hospitals. We hope to optimizepatient care by providing ambulatory surgicalcare in the community setting, while fosteringreferrals to the academic center for morecomplicated conditions. Timothy Siegel, MDjoined our faculty this year and is leading thiseffort. When not at D-H, Dr. Siegel is caringfor patients and teaching medical students atAlice Peck Day Memorial Hospital. Due tothe success of this initiative, we are in theprocess of hiring two additional surgeons whowill jointly operate at D-H, Mt.AscutneyHospital, and New London Hospital.Patient CareGeneral Surgery providers performed 2,529operative cases in 2012 and 9,150 clinicappointments. Our patients continue to bevery satisfied with the care they receive.During 2012, our patient satisfaction scoreswere significantly above the DHMC mean.Eighty percent of all patients rated theirprovider overall as excellent.Substantial effort was expended to develop andcodify a Bariatric Care Pathway by MaureenQuigley,APRN and William Laycock, MD,and a Breast Cancer Pathway by KariRosenkranz, MD and Lisa McCabe,APRN.In fiscal year 2012, General Surgerycontributed $5.4 million dollars toward theD-H net operating margin. This is impactednot only by our significant volumes, but alsoexcellent post-surgical care by our outpatientnursing and provider team.EducationPaul Kispert, MD and Dr. Rosenkranzassumed the roles of General SurgeryResidency Program Director and AssociateDirector a year ago and have re-invigoratedand made several improvements in theProgram. Dr. Kispert enhances all of oureducation by leading the Morbidity andMortality conference with insight and humor.Horace Henriques, MD has been joined byGina Adrales, MD and Andrew Crockett, MDand together have implemented a newcurriculum for medical student teaching.Thadeus Trus, MD directs a thriving fellowshipin laparoscopic surgery. Kenneth Burchard,MD continues to work towards obtainingapproval for a Surgical Critical CareFellowship. Graduating chief residents thisyear entered fellowship training in VascularSurgery (Kentucky) and Plastic Surgery(Utah).ResearchThe Section continued to add new knowledgeto the surgical literature this past year.Kerrington Smith, MD has utilized hisRichard W. Dow Award to develop a murinemodel which allows him to grow humanpancreatic xenografts. Dr. Smith and DawnFischer, in the Surgical Lab, have shown forthe first time it is possible to grow tumors inmice from the small number of cells obtainedin fine needle aspirates. Dr. Rosenkranz is thePrincipal Investigator on a new breast cancerclinical trial activated by the NationalOncology Trial Group Alliance which willdetermine the local recurrence rate of breastconserving surgery in patients with multicentriccancers. Richard Barth, MD was awardeda $100,000 grant to perform a randomizedprospective study of the effect of a short term,pre-op, low calorie diet on hepatic steatosisand surgical outcomes after liver surgery.Drs. Rosenkranz and Barth reported novelobservations on higher than expected longterm complications seen after Mammosite8


achytherapy for breast cancer, and published a studyof the utility of MRI in patients with ductal carcinomain situ. Burton Eisenberg, MD, recognized nationallyfor his expertise with GI stromal tumors, published aclinical trial of treatment with neoadjuvant Gleevec.Drs.Trus and Henriques collaborated on a study ofcommunication effectiveness and the Board of Surgerycertifying exam. Stefan Holubar, MD led the Sectionlast year in the volume of publications with a total often. Dr. Holubar’s papers addressed clinical issues inthe care of patients with ulcerative colitis, Crohn’sdisease, and rectal cancer.Faculty HighlightsDr. Rosenkranz and John Murray, MD were chosen asthe Top Surgeons in their specialties by NH physicians,as reported in NH Magazine. Several section membersare playing prominent roles in national organizations:Dr. Gupta is chair of the Rural Trauma Committee ofthe Eastern Association for Trauma and serves on theAmerican College of Surgeons Committee on Trauma.Dr.Trus is leading the international laparoscopictraining efforts of SAGES, and Drs. Barth and Kisperthave leading roles in the New England SurgicalSociety. Thomas Colacchio, MD, having completedhis sojourn as Clinic President, is once again fullyclinically engaged in the treatment of patients withthyroid and pancreatic neoplasms. Eric Martin, MDhas expanded his role to include an EmergencyManagement Medical Directorship.Taking Stock and Looking AheadThe General Surgery leadership team: CatherineGarfield, Senior Practice Manager, Laurie O’Rourke,Nurse Manager, Jeanne Minasian, AdministrativeSupervisor, and Dr. Barth, Section Chief, wereencouraged by the positive feedback received in the2012 DHMC Employee Engagement Survey resultsand look forward to sustaining a productive andhappy section.FACULTYGENERAL SURGERYGina Adrales, MDAssociate Professor of SurgeryRichard Barth, MDAssociate Professor of SurgeryKenneth Burchard, MDProfessor of Surgery andAnesthesiologyThomas Colacchio, MDProfessor of SurgeryAndrew Crockett, MDAssistant Professor of SurgeryBurton Eisenberg, MDProfessor of SurgeryBenjamin Forbush, MDAssistant Professor of SurgeryNeil Ghushe, MDInstructor of SurgeryRajan Gupta, MDAssociate Professor of SurgeryHorace Henriques, III, MDAssociate Professor of SurgeryStefan Holubar, MDAssistant Professor of SurgeryPaul Kispert, MDAssistant Professor of Surgeryand AnesthesiologyWilliam Laycock, III, MDAssociate Professor of SurgeryJean Liu, MDAssistant Professor of SurgeryEric Martin, MDAssistant Professor of SurgeryElizabeth McCabe, APRNInstructor in SurgeryEllen McKinnon, APRNInstructor in SurgeryDarrin Mickalak, PA-CInstructor in SurgeryJohn Murray, MDAssociate Professor of SurgeryMaureen Quigley, APRNInstructor in SurgeryKurt Rhynhart, MDAssistant Professor of SurgeryKari Rosenkranz, MDAssistant Professor of SurgeryTimothy Siegel, MDAssistant Professor of SurgeryKerrington Smith, MDAssistant Professor of SurgeryThadeus Trus, MDAssociate Professor of SurgeryGeneral Surgery Gross Professional Revenue$30M$25M$20M$15M$10M$5MFY07 FY08 FY09 FY10 FY11 FY12General Surgery Cases3,5003,0002,5002,0001,5001,000500FY07 FY08 FY09 FY10 FY11 FY12DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 20129


NEUROSURGERYDavid W. Roberts, MDSection ChiefProfessor of Surgery and NeurologyAlma Hass Milham DistinguishedChair in Clinical Medicine, GeiselKevin D. WilliamsDirector, NeurosciencesIntroductionThe Section of Neurosurgery enjoyedanother full, productive, and successfulyear across its missions in clinical care,education, and discovery. Our residentsand students once again distinguishedthemselves regionally and nationally,and strong multidisciplinary programscontinued to serve as cornerstones tocomprehensive clinical services.Patient CareThe pace of clinical activity in the Sectionhas always been high, and the past academicyear was no exception. Work RVU-per-FTE activity came in at 128% relative tothe 60th percentile benchmark. The firsthalf of the year saw faculty serving inIraq or on medical leave, requiring an allhands-on-deckapproach to service needs.With the return of a neurosurgery teamat full strength at the mid-year, newinitiatives saw further growth. Our braintumor program completed its five-yearfluorescence-guided tumor resection studyand is moving into its next phase. Braintumor radiosurgery saw a 48% increaseover the preceding year. A new programin spinal radiosurgery has treated its firstpatients. Multidisciplinary programsin spine, epilepsy, cerebrovascular,peripheral nerve, and pituitary, in additionto tumor, serve as the backbone to ourcomprehensive, subspecialized patientcare activities. Our activities in thesouthern region, in the form ofneurosurgery outpatient clinics inManchester, entered their second year.Lastly, recruitment of a second pediatricneurosurgeon was successfully completed,and David Bauer, MD, who recentlycompleted his fellowship training at theUniversity of Washington, has broughtcomplementary expertise to that of ourown Susan Durham, MD.EducationResidents in the Dartmouth-HitchcockNeurosurgery Residency Program hadanother great year academically. Alltogether, there were 62 publications for2011-2012. The Program presented 35papers at regional and national meetings.Kimon Bekelis, MD, presenting his workanalyzing the diagnostic yield of CTangiography in non-subarachnoidintracranial hemorrhage, won the ScovilleAward for the best resident paper at thisyear’s New England Neurosurgical Societymeeting. He was also elected to theAANS Young Neurosurgeons Committee.Atman Desai, MD, who will be headed toJohns Hopkins for a Complex SpineSurgery Fellowship next July, gainednational media attention for his study onpopulation density of neurosurgeons andmotor vehicle accident mortality (lestthere be any misunderstanding, they areinversely correlated). Dr. Desai, who hadbeen valedictorian of his medical schoolclass at Cambridge, was inducted intoAOA this spring. Brandon Root, MD,an Honors graduate of Arizona StateUniversity School of Medicine, arrivedthis July as our new PGY-1. Geiselmedical student Pablo Valdes successfullydefended his PhD thesis on fluorescenceguidedintracranial tumor resection, won aHitchcock Foundation grant award, andspent the past year as a postdoctoral fellowin the Department. Ziev Moses, as afourth-year Geisel medical student, wonBest Resident Poster in the TumorSection of this past year’s Congress ofNeurological Surgeons for his work onthe correlation of microvessel density with5-ALA-induced tumor fluorescence.ResearchDr. Desai investigated the relationshipbetween neurosurgeon density and strokerelatedmortality in addition to the motorvehicle study noted above. Additionally,he continued his investigations in spinethrough the S.P.O.R.T. study database.The recipient of a Dandy Fellowship fromthe American Association of NeurologicalSurgeons (AANS), Dr. Bekelis continuedhis work on nanoparticle imaging inaneurysm inflammation. Faculty memberScott Lollis, MD, in collaboration withthe Thayer School of Engineering, hasongoing investigations in hydrocephalus,using the novel imaging technology ofmagnetic resonance elastography (MRE).Nathan Simmons, MD has been our10


institutional principal investigatorin a study of dural sealants and isworking on translational developmentof implantable resonators forEPR oximetry in deep tumors.Neurosurgery’s long-standingcollaboration with Keith Paulsen,PhD and colleagues from the ThayerSchool of Engineering continued itsNIH-supported work in the areaof computational modeling of thebrain, integrating intraoperativesparse data and 3D ultrasoundtechnologies, as well as opticalimaging. Alex Hartov, PhD, andSongbai Ji, PhD, actively participatedin this research program, andXiaoyao Fan earned her PhD for herwork in stereovision. FDA INDandRO1-supported investigationof tumor fluorescence continuedto push the frontier, successfullydemonstrating the high utility ofquantitative fluorescence as well asthe implementation of wide-fieldmultispectral imaging.Faculty HighlightsWe are indebted to and appreciativeof Major Lollis, MD, US ArmyReserve, for serving in Iraq this pastyear. This spring Dr. Lollis alsosuccessfully launched his iPhoneapp,“What’s the Data,” a referenceprogram putting the sentinelneurosurgical literature at neurosurgeonsfinger tips. Perry Ball, MD,this year served as President of theNew England Neurosurgical Society.Dr. Ball completed his tenure on theAANS Liability Committee andnow serves on the ExecutiveCommittee of the NeurosurgicalSociety of America as well aschairing its Long- Range PlanningCommittee. Dr. Ball was appointedAssociate Editor, General Topics,of the journal, Neurosurgery. Dr.Simmons presented his work on5-ALA in pituitary surgery this pastyear and was an invited speaker atthe Neuro-oncology Symposium inHackensack, NJ. Kadir Erkmen,MD participated as faculty at the St.Louis skull-base surgery course,directed our own skull-base cadaverworkshop, and laid the foundationfor our new medical student rotation.David Roberts, MD, continuesto serve on the American Boardof Neurological Surgeons, theExecutive Committee of the Societyof Neurological Surgeons, theEditorial or Advisory Boards ofNeurosurgery,World Neurosurgery,and the Journal of Neurosurgery,and as Editor of Stereotactic andFunctional Neurosurgery.Looking AheadWith a healthy and full complementof personnel, Neurosurgery is excitedabout upcoming prospects.Opening of the Advanced SurgeryCenter this spring, with two newoperating rooms and intraoperativeMRI and CT capability, will provideunprecedented opportunities forcurrent and new translational investigativeprograms.FACULTYNEUROSURGERYPerry Ball, MDAssociate Professor of Surgeryand AnesthesiologyKadir Erkmen, MDAssistant Professor of Surgeryand NeurologyS. Scott Lollis, MDAssistant Professor of SurgeryAmber Merrill, APRNInstructor in SurgerySharon Morgan, APRNInstructor in SurgeryDavid Roberts, MDProfessor of Surgery andNeurologyDavid Sargent, PAInstructor in SurgeryNathan Simmons, MDAssistant Professor of SurgeryJoellen Speaker, MSPAInstructor in SurgeryNeurosurgery Gross Professional Revenue$20M$15M$10M$5MFY07 FY08 FY09 FY10 FY11 FY12Neurosurgery Cases1,2001,000800600400200FY07 FY08 FY09 FY10 FY11 FY12DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201211


OPHTHALMOLOGYWilliam J. Rosen, MDSection ChiefAssociate Professor of SurgeryMichael R. BarringtonPractice ManagerIntroductionWith the aging population, we areseeing increased incidences of eyedisease. This past year, the Section ofOphthalmology provided services forover 20,000 patient visits. The Sectionis providing primary, secondary, andtertiary eye care, with subspecialty carein neuro-ophthalmology, pediatrics,glaucoma, oculoplastics, vitreo-retina,and cornea. We also offer state-of-theartcataract surgery. Our team alsohas an optometrist offering completeprimary eye care including contactlens wear.Patient Care/Faculty HighlightsMichael Zegans, MD provides surgicalcare for patients with complex cornealdisorders and uveitis syndromes.Dr. Zegans spends forty percent ofhis time doing research centered onthe microbiology of the eye.Donald Miller, MD provides cataractsurgery including the use of toricintraocular lenses for patients withsignificant astigmatism.David Campbell, MD serves asDirector of The Glaucoma Service.He is joined by Ronald Swendris, MDwho was in a private ophthalmic grouppractice in Missouri prior to joiningDHMC. Dr. Swendris offers the latestsurgical techniques available for treatingadvanced glaucoma.Susan Pepin, MD serves as Director ofNeuro-Ophthalmology and worksclosely with the Department ofNeurology, seeing those patients thathave neurological disorders affectingthe ocular system. In addition, she isa skilled cataract surgeon. Dr. Pepinspends fifty percent of her time asAssociate Dean for Diversity at theGeisel School of Medicine.Christopher Chapman, MD andRosalind Stevens, MD providecomprehensive medical and surgicalexpertise for patients with complexdisorders of the retina, vitreous andmacula, including trauma, and lasertreatment for premature infants withretinopathy of prematurity. CrystalColby, PA is now part of the team,assisting in patient evaluation andsurgery. Dr. Stevens is very involvedin the flying eye hospital, ORBIS,where she is Program Director.Erin Salcone, MD is a comprehensivepediatric ophthalmologist andtreats pediatric eye disease and adultstrabismus. She was a medical studentat Geisel before doing her residencyand fellowship at Mass Eye and Ear,and Children’s Hospital in Boston.In addition to being Section Chief,William Rosen, MD providescomprehensive ophthalmic care aswell as expertise in diseases of theeyelid, orbit, and lacrimal system.He is a diplomate of the AmericanSociety of Oculoplastics andReconstructive Surgeons.Cynthia Lawrence, OD providesprimary eye care and optometricservices as well as contact lens fittingand prescribing.EducationAll providers in the Section ofOphthalmology provide educationalopportunities onsite at Dartmouth-Hitchcock as well as regionally,nationally, and internationally. Dr.Stevens finished her MPH degree inInternational Ophthalmology fromJohns Hopkins, and is now an advisorfor Global Programming for ORBIS,the flying eye hospital.12


Our vibrant Grand RoundsProgram features nationally recognizedleaders in ophthalmology.Dr. Pepin serves as coordinatorof medical student and residenteducation. Dr. Campbell continuesto be an invited speaker at theLancaster Ophthalmology ReviewCourse. We are proud of ourcollective success in matchingGeisel Medical School studentseach year to competitive ophthalmologyresidency programs.Clinical Trials and ResearchDr. Zegans continues his researchin epidemiology and microbiologyand also is active in internationaleye care through the DickeyCenter at Dartmouth, and throughhis association with the AarivandEye Hospital in India. Dr. Pepinconducts several clinical trialsincluding therapeutic studiesinvolving multiple sclerosis,Alzheimer’s disease, and ischemicoptic neuropathy.Looking AheadThe Section of Ophthalmologyis constantly striving to improveour patient access and satisfaction,while we deliver state-of-thearttreatments in the most costeffectivemanner possible. Theaddition of Michael Barringtonas our Practice Manager is helpingus move forward. The principalthree-year goal of the Section isstarting a residency program. Allof the faculty view education andteaching as part of their missionand all desire a residency trainingprogram.FACULTYOphthalmologyDavid Campbell, MDProfessor of SurgeryChristopher Chapman, MDAssistant Professor of Surgeryand PediatricsCrystal Colby, PAInstructor in SurgeryCynthia Lawrence, ODInstructor in SurgeryDonald Miller, MDAssistant Professor of SurgerySusan Pepin, MDAssociate Professor of Surgeryand PediatricsWilliam Rosen, MDAssociate Professor of SurgeryErin Salcone, MDAssistant Professor of SurgeryRosalind Stevens, MDProfessor of SurgeryRonald Swendris, MDAssistant Professor of SurgeryMichael Zegans, MDProfessor of Surgery andMicrobiology & ImmunologyOphthalmology Gross Professional Revenue$20M$15M$10M$5MFY07 FY08 FY09 FY10 FY11 FY12Ophthalmology Cases1,4001,2001,000800600400200FY07 FY08 FY09 FY10 FY11 FY12DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201213


OTOLARYNGOLOGY AND AUDIOLOGYDaniel H. Morrison, Jr., MDSection ChiefAssistant Professor of SurgeryAnnette M. TietzPractice ManagerIntroductionThe Section of Otolaryngology andAudiology continues to grow andimprove to meet our patients’ needs andto fulfill our important role as a secondaryand tertiary care provider of otolaryngologyand audiology services for northernNew England.Patient CareWe are clearly focused on meeting ourpatients’ needs in every possible way. Everymember of our Section has been taskedwith not only doing their job, but withimproving the care we deliver. This chargehas been embraced, and we have providedmany members of the Section withadvanced training in quality improvementtechniques (via the Value Institute). Ourgoal is to lead the Institution in the breadthand depth of our patient care-specificquality initiatives. The Head and NeckCare Pathway Project continues to developand grow as we add more detail and dataextractioncapabilities to the underlyingstructure. The addition of Sheila Keating,RN, as Nurse Navigator for this patientpopulation, has been a major development.Other projects in development includecare pathways for pediatric otolaryngology,otology, and audiology.EducationMedical Students! We were delighted tolearn earlier this year of a change in thestructure of the Geisel School of Medicinethird-year surgery clerkship that wouldallow our participation. We have developeda comprehensive otolaryngology curriculumfor these students and are happily enmeshedin the day-to-day education of theseoutstanding learners.June 30th was a landmark day for theSection. On that date, our first resident,P. Tate Maddox, MD, graduated from ourprogram bound for a private practiceopportunity in Virginia. We are bothoverjoyed by Dr. Maddox’s (and ourResidency Program’s) accomplishment andsaddened by the departure of a cherishedpart of our fledgling residency. Ourresidency training program continues toevolve to meet the changing needs ofotolaryngology training and continues tostrengthen under the expert guidance ofthe Residency Program Director, MarkSmith, MD.ResearchThe Section continues to be wellrepresented at our national meetings withmultiple faculty members involved withpresentation of scientific papers and servingon important committees.Faculty HighlightsJames Saunders, MD has recently beendesignated by the American Academyof Otolaryngology as Coordinator forInternational Affairs.This is fittingrecognition of Dr. Saunders’s commitmentto international medicine. He is immediatepast chair of the Humanitarian EffortsCommittee and is involved in researchprojects studying otitis media in HIVinfected children in Tanzania, hearing lossin HIV infected children in Zimbabwe,and heavy metal hearing loss in Artesinalgold miners. Joseph Paydarfar, MD washappy to learn that his proposal to partnerwith the Thayer School of Engineeringon a new medical device project wasapproved. Dr. Paydarfar will be workingwith three Thayer students to develop anew robotically-controlled retractorsystem for use in TORS (transoral roboticsurgery) surgical procedures. DanielMorrison, MD completed his master’sdegree with TDI and is looking forwardto using his new skill set to help driveresearch in quality improvement, healthservices research, and decision analysis.Giri Venkatraman, MD, MBA has recentlybeen tapped by the Value Institute for anadministrative position overseeing aportfolio of projects related to quality14


assurance across the institution. This isa vitally important job as our systemsof care evolve to meet the mandates ofhealth care reform. It’s nice to knowthat we have such a capable person incharge of these projects.Looking AheadOver the next several years, wewill be making a deliberate moveto expand our services into theManchester/Nashua region. Wecurrently receive a large number ofreferrals from this area and would liketo have a greater physical presence toallow us to provide easier access toadvanced otolaryngology andaudiology care for patients in this area.Care pathway development andcontinuous quality improvement willcontinue to be an area of primaryfocus. We will be working toconsolidate our work on the headand neck cancer pathway and lookforward to automating data extractionfrom this pathway. Care pathwaydevelopment for our pediatricotolaryngology and audiologyservices will soon get underway.This will facilitate the developmentof a regional center for pediatricotolaryngology services with a baseof operations at CHaD, and ancillaryservices provided in Manchester.FACULTYOTOLARYNGOLOGYSharon Bry, APRNInstructor in SurgeryEunice Chen, MDAssistant Professor of Surgery andPediatricsLouise Davies, MDAssistant Professor of Surgery andThe Dartmouth InstitutePeter Dixon, PAInstructor in SurgeryJJ Benoit Gosselin, MDAssociate Professor of SurgeryRyan McCool, MDAssistant Professor of SurgeryDaniel Morrison, Jr, MDAssistant Professor of SurgeryJoseph Paydarfar, MDAssociate Professor of SurgeryJames Saunders, MDAssociate Professor of SurgeryMark Smith, MDAssistant Professor of Surgery andPediatricsGiridhar Venkatraman, MDAssistant Professor of SurgeryAUDIOLOGYKerry Gudlewski, AUDInstructor in SurgeryJulie Johnson, AUDInstructor in SurgeryMaria Stella McHugh, MSInstructor in SurgeryKatelyn Monaghan, MAInstructor in SurgeryLeah Mosenthal, MEdInstructor in SurgeryMichael Norris, AUDInstructor in SurgeryCynthia Nulton, MAInstructor in SurgeryAshley Perez, AUDInstructor in SurgeryErin Pospychala, CCC-A, SMInstructor in SurgeryCatherine Rieke, AUDInstructor in SurgeryOtolaryngology and AudiologyGross Professional Revenue$20M$15M$10M$5MFY07 FY08 FY09 FY10 FY11 FY12Otolaryngology Cases2,0001,8001,6001,4001,2001,000800600400200FY07 FY08 FY09 FY10 FY11 FY12DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201215


PEDIATRIC SURGERYLaurie A. Latchaw, MDSection ChiefAssociate Professor of Surgeryand PediatricsAnn C. KitsonPractice ManagerIntroductionThe Section of Pediatric Surgery, whichincludes Pediatric General and ThoracicSurgery, Pediatric Neurosurgery, andPediatric Urology, has been serving theinfants and children of New Hampshireand Vermont for over a decade. 2012was a transition year for the Section asold friends said goodbye and newproviders were welcomed.Patient CareStriving to provide outstanding surgicalhealth care to the children we serveremains the primary mission of theSection. Due to our commitment to thevalue metric of healthcare, some of ouroutreach clinics were discontinued. TheManchester/Bedford facilities have seenincreases in the General PediatricSurgery Clinics as some of the PediatricUrology Clinics were scaled back awaitingnew provider recruitment.Pediatric Trauma Program - In November,2011, the American College of Surgeonsverified the Pediatric Trauma Program asa Level 2 Pediatric Trauma Center. Thisis the only ACS designated PediatricTrauma Center in northern NewEngland. Laurie A. Latchaw, MD is thePediatric Trauma Medical Director andRenee Gaffney, RN is the PediatricTrauma Program Manager.The Chest Wall Deformity Program –For the past six years, Daniel Croitoru,MD has evaluated hundreds of patientswith Pectus Excavatum and PectusCarinatum in both Lebanon andManchester/Bedford Clinics. Dr.Croitoru is a nationally known expert inMinimally Invasive Pectus ExcavatumRepair and sees referrals from all overthe U.S.Minimally Invasive Surgery - Minimallyinvasive surgery continued to expand thispast year and can now be offered formany intraabdominal and intrathoracicsurgical procedures. Colonic resectionfor the treatment of Hirschsprung’sDisease can usually be accomplishedtransanally now without any abdominalincisions at all.Peripheral Nerve Clinic - Susan Durham,MD continued the only coordinated careof children and adults with peripheralnerve problems in northern NewEngland. This multidisciplinary clinicfacilitates the proper diagnosis andtreatment plan for these debilitatingconditions.Pediatric Brain Tumor Clinic - Thismultidisciplinary clinic involvingPediatric Neurosurgery, PediatricNeurology, and Pediatric Neuro-oncologywas instituted four years ago andcontinues to coordinate the surgicaland medical care and follow-up ofinfants and children with brain andspinal cord tumors.Pediatric Epilepsy and Spasticity Programs -David Bauer, MD is in the process ofestablishing programs in the surgicaltreatment of seizure disorders. He willbe mentored by David Roberts, MD,who runs the adult program. In addition,Dr. Bauer will also be offeringsurgical treatment for specific spasticitydisorders. This is a new service to beoffered at DHMC.Pediatric Genitourinary Robotic SurgeryProgram – Daniel Herz, MD continuedto expand the only pediatric roboticprogram in northern New England.Although Dr. Herz will be leaving theend of 2012 to run the MinimallyInvasive and Robotic Surgery Programat Columbus (OH) Children’s Hospital,David Chavez, MD, pediatric urologist,will be continuing the Program when hearrives in January, 2013.16


EducationMedical education of our patients andfamilies as well as present and futurehealth care providers continues to be atop priority of the Section. TheDivision of General and ThoracicPediatric Surgery remains one of thecore surgical teaching services for thethird-year Geisel medical studentsas well as offering a sub-internshipfor fourth-year students. All threeDivisions participate actively inresidency training programs. Dr.Latchaw spoke on Pediatric TraumaCare at the 2011 Northern NewEngland Rural Emergency Servicesand Trauma Symposium. Dr. Durhamspoke at the 2012 NeurosurgeryResearch Symposium. Bridget Logan,PhD,APRN was the invited speakerfor the Urologic Nursing Society andthe NH VNA.ResearchBridget Logan, PhD,APRN isinvolved in research correlatingpsychological and adverse childhoodexperiences with treatment of voidingdysfunction. Dr. Latchaw was one ofmany contributors to the PediatricTrauma Society’s “Guidelines for alcoholscreening in adolescent traumapatients” which has been accepted forpublication in the Journal of Trauma.Faculty HighlightsThe Section welcomes Dr. Bauer,pediatric neurosurgeon, who arrivedAugust, 2012 after completing hisfellowship in Pediatric Neurosurgeryat Seattle Children’s Hospital. Dr.Bauer will be bringing added expertisein the surgical treatment of epilepsyand spasticity. The Section has alsosuccessfully recruited David Chavez,MD pediatric urologist, who will bearriving early January 2013. Dr.Chavez, who trained in urology atDHMC and in pediatric urology atDuke University, has considerableexperience in robotic urologic surgery.He comes from a successful privatepractice in Billings, MT and eagerlylooks forward to rejoining academicpediatric urology.Looking AheadThe Pediatric Surgical SpecialtiesSection is actively recruiting a secondpediatric urologist and hopes to fillthat position in the next few months.Next year will continue to be achallenge as new health care initiativesand reimbursement options requireinnovative ways to care for the childrenof New Hampshire and Vermont.Cooperation and alliances with otherchildren’s hospitals in New Englandwill be paramount to our success.FACULTYPEDIATRIC GENERAL ANDTHORACIC SURGERYDaniel Croitoru, MDAssociate Professor of Surgeryand PediatricsScott Lannon, MSNInstructor in Surgery andPediatricsLaurie Latchaw, MDAssociate Professor of Surgeryand PediatricsPEDIATRIC NEUROSURGERYDavid Bauer, MDAssistant Professor of SurgerySusan Durham, MDAssociate Professor of Surgeryand PediatricsPEDIATRIC UROLOGYMary Gheen, PNPInstructor in Surgery andPediatricsDaniel Herz, MDAssociate Professor of Surgeryand PediatricsBridget Logan, NP-CInstructor in Surgery andPediatricsLeslie McQuiston, MDAssistant Professor of Surgeryand PediatricsPediatric Surgery Gross Professional Revenue$12M$10M$8M$6M$4M$2MFY07 FY08 FY09 FY10 FY11 FY12Pediatric Surgery Cases1,2001,000800600400200FY07 FY08 FY09 FY10 FY11 FY12DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201217


PLASTIC SURGERYDale C. Vidal, MDSection ChiefProfessor of Surgery, Community& Family Medicine, andThe Dartmouth InstituteBarbara E. RiesebergSenior Practice ManagerIntroductionThe Section of Plastic Surgeryis committed to continuousimprovement in the work wedo and services we provide toour patients, their families, andeach other. Their willingness todo so has led to many successesbeing recognized by others whohave invited us to present andparticipate in the Value Institute,Surgical Grand Rounds, andother sectional areas. We haveenjoyed sharing and learningthroughout the year.Patient CareOur work on creating a culture of patientand staff safety and satisfaction continuedthis year. We faced challenges aroundclinical redesign, optimizing the tools nowavailable to us in our still relatively newelectronic medical record, and our need tomeasure the work we do in many areas.Although this work is challenging, it isrewarding to watch the many metrics weare following improve even when anumber of new staff joined our team in2012. Using resources wisely and to theirfullest were major goals for us and meetingthese goals gave us great pride in theimprovement efforts undertaken duringthis time. Measuring for sustainability willbe important during the upcoming year;ensuring we can sustain the gains whenwe are facing further changes aroundmeaningful use,ACO requirements, EMR,patient and financial demands as well asanticipated staff and process re-design.This was a year of tremendous growthand camaraderie for us within and acrosssections – we look forward to much moreof the same.New to the Section this year was JohnNigriny, MD who joined us in January of2012. He brings a myriad of talents,working with and for Orthopeadics as wellas our own practice to provide superiorhand care to those we serve. His strengthin microsurgery has also resulted inimproved access for patients in needof these services, and he is assisting usto foster relationships and residentopportunities across sections we coordinatecare with -- Dermatology, GeneralSurgery, Otolaryngology, Orthopeadics,just to name a few. Dr. Nigriny is afabulous addition to our team!EducationOur ACGME accredited residency programgraduated Michael Van Vliet, MD this year,and he has taken a fellowship at USCBurn Center in Los Angeles. He willobtain not only burn training but criticalcare certification as well. This combinationwill make him unique among burnsurgeons, truly being able to providecomprehensive care.We have two second-year residentscontinuing, Sunny Chatterjee, MD andTom Kosowski, MD. Dr. Chatterjeecontinues to be productive academicallyand in October at the ACS meeting, hemade a presentation on surgeon paymentper unit time for common procedures.Dr. Kosowski is currently evaluatingoutcomes for breast reduction utilizing awell-developed and standardized patientquestionnaire with Carolyn Kerrigan, MDand on an endoscopic carpal tunnel andlatissimus dorsi flap harvest educationalsimulator with Joseph Rosen, MD.New to our residency program thisyear is Jeffrey Wu, MD who comes tous after completing his medical schooland general surgery residency at Universityof Connecticut.ResearchDale Collins Vidal, MD accepted a leadrole on Dartmouth’s groundbreakingaward from the Centers for Medicare andMedicaid Service (CMS) “EngagingPatients to Meet the Triple Aim.” Onegoal of this initiative is to improve care,improve health and reduce the cost of careby implementing shared decision making,and patient engagement interventions forpatients with preference-sensitive andchronic conditions. Dr.Vidal was alsoawarded a grant from the InformedMedical Decisions Foundation (formerlythe Foundation for Informed MedicalDecision Making) to continue importantwork of integrating shared decisionmaking into care pathways for patients atDartmouth-Hitchcock (D-H). Thefunding allows for continued access to afull library of patient decision aidsthrough the Center for Shared DecisionMaking (3P) and supports a projectfocusing on shared decision making forpatients with diabetes. Dr.Vidal iscollaborating with investigators at theUniversity of California, San Franciscoto expand the Patient Support Corps atD-H.This program deploys Dartmouth18


students into specialty clinics (includingPlastics and Orthopaedics) where theyhelp patients address their informationand communication needs to assurepatients are as informed and involved intheir treatment decisions as they wishto be. She is an oversight committeemember for the Clinical TranslationalResearch Science Award and supportsseveral junior faculty as mentor onsponsored research developmental awards.Dr. Kerrigan is collaborating withresearchers from Memorial SloanKettering to develop outcome measuresfor women undergoing breast surgery.She has also focused on clinical outcomesof needle aponeurotomy for Dupuytren’sand utilizing patient reported outcomesin common hand problems as a bedsidediagnostic tool. In addition, Dr. Kerriganspent much of the year participating inDartmouth’s new degree program:Masters in Health Care Delivery Science.She is also working to spread theintegration of patient reported measuresto more programs within D-H as wellas to other health systems, the latter incollaboration with the DartmouthInstitute (TDI). Mitchell Stotland, MD isexploring perceptual response to facialdifference; the effect of isolated muscleparalysis on emotional processing;shared decision making in adolescentscontemplating craniofacial reconstruction;and is involved in a new projectevaluating a novel approach to total earreconstruction. Emily Ridgway, MDpublished the following papers this year:“Staged scalp soft tissue expansion beforedelayed allograft cranioplasty: a technicalreport,” Neurosurgery. 2012 Sept; alongwith “Sternal nonunion: a novel approachto reconstruction,” Eplasty. 2012. Inaddition, she has submitted two bookchapters: one on TRAM Flap BreastReconstruction, and a Cleft PalateReview as well as two articles; allawaiting acceptance. Dr. Rosen has agrant entitled,“Armed Forces Instituteof Regenerative Medicine (AFIRM);” isthe Craniomaxillofacial Program Directorfor the Armed Forces Institute ofRegenerative Medicine, RutgersCleveland Clinic Consortium; is on theExecutive Committee of AFIRM; isChair of the Clinical and RehabilitativeAdvisory Team; and co-investigator on agrant focused on predicting surgicalerrors. Dr. Rosen led an internationalsurgical team to Vietnam and is developinga network-based telemedicine healthcaresystem for Vietnam called RICE(Remote Interaction ConsultationEpidemiology and ReconstructiveInternational Cooperation Exchange).Dr. Rosen also teaches two courses at theThayer School of Engineering.Faculty HighlightsDr. Kerrigan is a trustee of the AmericanSociety of Plastic Surgeons and anevaluator of examiners for the AmericanBoard of Plastic Surgery (ABPS). Dr.Rosen was named Chief Medical Officerof AFIRM. Dr. Stotland is Chair of theCHaD Development Committee, is anOral Board examiner for ABPS, andreceived research funding this year fromKLS Martin, LP for his project entitled,“Assessment of Morselized CartilageConstructs Implanted Within ResorbableMold.” As Chief of the Section ofPlastic Surgery, Professor of Surgery atGeisel School of Medicine, Directorof the Center for Informed Choice,and Medical Director of the Centerfor Shared Decision Making, Dr.Vidalis engaged in activities aimed atFACULTYPLASTIC SURGERYAlison Evans, APRNInstructor in SurgeryGary Freed, MDAssistant Professor of SurgeryCarolyn Kerrigan, MDCM, MScProfessor of Surgery andThe Dartmouth InstituteJohn Nigriny, MDAssistant Professor of SurgeryEmily Ridgway, MDAssistant Professor of SurgeryJoseph Rosen, MDProfessor of Surgery andRadiologyMitchell Stotland, MD, CMAssociate Professor of Surgeryand PediatricsDale Vidal, MDProfessor of Surgery, Community& Family Medicine, andThe Dartmouth Institutetransforming local, regional, and nationalenvironments for clinical and translationalscience. As a leader in Health CareTransparency and Shared Decision-Making, she continues as CurriculumCommittee Chair for the Masters ofHealth Care Delivery Science Programat Dartmouth. This role allows Dr.Vidalthe ability to effectively shepherd newadvances in health care delivery, overseequality improvement efforts in the use ofhealth information technology systems,and development of novel clinical andtranslational methodologies.Plastic Surgery Gross Professional Revenue$14M$12M$10M$8M$6M$4M$2MFY07 FY08 FY09 FY10 FY11 FY12Plastic Surgery Cases1,4001,2001,000800600400200FY07 FY08 FY09 FY10 FY11 FY12DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201219


TRANSPLANTATION SURGERY: KIDNEY AND PANCREAS TRANSPLANTDavid A. Axelrod, MDSection ChiefAssociate Professor of Surgery,Community & Family Medicine,and The Dartmouth InstituteKoren L. FayTransplant AdministratorIntroductionThe Section of Solid OrganTransplantation provides comprehensivecare to patients in northern NewEngland with end-stage organ failure.This year marks the 20th anniversary ofthe first kidney transplant here atDartmouth-Hitchcock (D-H). Sincethat time, the Section has experiencedtremendous growth in both its volumeand in the clinical programs it is able tooffer. The Section is actively involvedin both clinical and outcomes research,national leadership roles within themajor transplant organizations, andeducation for medical students, residents,and fellows.Patient CareKidney Transplant: Our Program hascontinued to expand transplant servicesto patients living in northern NewEngland. We have expanded services inthe D-H Manchester clinic to betterserve patients living in the southern partof the region. Patients can now be seenat D-H Manchester through all phasesof their transplant care.The D-H Transplantation Programcontinues to grow with an emphasis onexcellence of outcomes and improvedpatient quality of life. Through theappropriate use of living donorexchanges, and, most recently, the useof novel therapies to decrease antibodylevels to permit selected cross matchpositive transplants, we are bringingstate-of-the-art transplant care to ourpatients and significantly reducing theirtime waiting for a transplant. Ourtransplant rate is now two to three timesfaster than the average in our region andin the nation.Pancreas Transplant: D-H has the largestpancreas transplant program in NewEngland. As in our Kidney Program,pancreas patients are managed withoutcorticosteroids. Immunosuppression islimited to two medications (tacrolimusand mycophenolate mofetil) and is welltolerated by our patients. We are pleasedthat our first pancreas recipient is oversix years out and feeling very well.Autoislet Transplantation: We haverecently initiated a program of totalpancreatectomy and autoislet transplantfor patients with disabling chronicpancreatitis. In cooperation with theMassachusetts General Hospital (MGH),we will isolate their islets, reinfuse themin the liver, and substantially reducethe incidence of post-pancreatectomydiabetes.Liver Transplantation and HepatobiliarySurgery: At D-H, we offer state-of-theartcare for patients with hepatocellularcarcinoma, cirrhosis, or end-stage liverdisease in our multidisciplinary liver carecenter. Here surgeons, hepatologists,oncologists, and interventional radiologistsparticipate in a shared medicalappointment providing timely, integratedcare on a weekly basis. Liver care hasnow expanded to include the evaluationand post-operative care of liver transplantpatients in cooperation with the LaheyClinic and MGH. This integratedprogram allows for seamless continuitybetween the northern evaluation teamand the liver transplant programs. Ledby the members of the TransplantationSection, the Program has seen andevaluated over 300 liver patients.EducationThe Transplantation Section remainscommitted to the education of students,residents, fellows, patients, and thecommunity. Currently, fourth-yearsurgical residents spend three dedicatedmonths on the transplant serviceparticipating in all aspects of the service.We also train nephrology fellows,urology residents, medical students,and have recently developed a newtransplant medicine rotation for theinternal medicine residents. MichaelChobanian, MD, Medical Director ofTransplantation, won an award foroutstanding teaching.20


For our patients, the Section continuesto conduct outreach sessions and hassessions planned in Manchester,Portsmouth, and Nashua, NH. Thesesessions bring together health careprofessionals, local nephrologists, andtransplant patients in communitysessions designed to promote anunderstanding of transplant.Research:The Transplantation Section has beenactive in research. An investigatorinitiatedresearch program, led byDrs. Zuckerman and Chobanian, hasfocused on immune reconstitution inimmunosuppressed patients, with aspecific focus on regulatory T cells.David Axelrod, MD has been fundedby the NIH to examine strategiesto decrease disparities in access totransplantation. Section research hasrecently been presented at theAmerican Transplant Congress, theAmerican Society of Nephrology, andthe Winter Meeting of the AmericanSociety of Transplant Surgery.Faculty HighlightsMembers of the D-H faculty are activein the national transplant community.Dr. Axelrod serves as the Chairman ofthe National Pancreas TransplantCommittee of the United Networkfor Organ Sharing (UNOS).Richard Freeman, MD, Chair of theDepartment of Surgery and memberof the Transplantation Section, is thecurrent President of the InternationalLiver Transplant Society in recognitionof his long standing commitment todeveloping the art, science, and policiesthat govern liver transplantation in theUS and abroad. He also served asmember of the UNOS Board ofDirectors setting national transplantpolicy.Looking Forward:We anticipate continued growth in allaspects of the Transplantation Program.We continue to focus on improvingpatient outcomes and enhancing ourability to provide timely local care topatients in northern New England.We have embarked on expandedoutreach and clinical activities in thesouthern region to ensure access toefficient care for patients in this areaand expanded cooperation withreferring providers.FACULTYTRANSPLANTATION SURGERYDavid Axelrod, MDAssociate Professor of Surgery,Community & Family Medicine,and The Dartmouth InstituteMichael Chobanian, MDAssociate Professor of Surgeryand PediatricsRichard Freeman, Jr, MDProfessor of SurgerySarah Parmelee, FNPInstructor in SurgeryChristopher Simpkins, MDAssistant Professor of SurgeryTransplantation SurgeryGross Professional Revenue$4M$3M$2M$1MFY07 FY08 FY09 FY10 FY11 FY12Transplantation Surgery Cases35030025020015010050FY07 FY08 FY09 FY10 FY11 FY12Pancreas Kidney OtherDARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201221


UROLOGYWilliam Bihrle, III, MDSection ChiefAssociate Professor of SurgeryMichael R. BarringtonPractice ManagerThe Section of Urology maintains its roleas a regional tertiary service in oncology,lower urinary tract reconstruction,incontinence, and complex stone diseasethrough its assiduous attention to thedevelopment of relationships with ourreferring medical community. Theminimally invasive approach to thetreatment of prostate cancer, BPH, upperurinary tract malignancies, and stonedisorders is an example of the Section’sability to adopt state-of-the-art technologyin the delivery of urologic surgical care.Patient CareThe growth in the volume of renalsurgeries and cystectomies performed atDartmouth-Hitchcock (D-H) suggeststhat the comprehensive genitourinaryoncological initiative is resonating withour patients and referring physicians.Our high risk bladder cancer qualityimprovement pathway continues to evolve,ensuring timely, punctilious consultationand treatment to a population of patientswhose prognosis is dependent on speedyintervention.The Section remains on the forefront ofthe minimally invasive approach to thetreatment of genitourinary malignanciesand benign disorders of the upper urinarytract. Faculty provide state-of-the-artsurgical care to our prostate cancer patientswith the aid of the da Vinci roboticsurgical platform. Most nephrectomiesand nephron-sparing nephrectomiesare now performed with the aid oflaparoscopic and robotic-assistedtechniques. Dedicated PSA/prostatebiopsy, hematuria, vasectomy, and metabolicstone clinics represent models of efficient,patient-focused care for commongenitourinary problems.An investment in nursing and administrativesupport services continues to reward ourpatients and referring providers withimproved ambulatory access with anemphasis on personalized care. Our“nurse navigator” program has beenparticularly effective in coordinating theevaluation and treatment of patients withcomplex urological problems throughevery aspect of their healthcare experience.The Section is providing ambulatoryand surgical urological services at AlicePeck Day Hospital, administeringcost-effective care with our communityhospital colleagues.EducationThe transition to a five-year residencyprogram continues as we welcome ourinaugural group of PGY-2 urologytrainees. We believe that the revampedblock emphasizes the clinical strengthsof the Dartmouth program - surgicalmentoring based on a core urologicalsyllabus - without sacrificing theimportance of investigative scholarlyactivity. Elective flexibility allows residentsto gain experience in renal transplantation,urogynecology, and bench research. Seniorresidents rotate at the VAMC and ConcordHospital, pediatric experience is solidifiedat the junior and senior levels and ourchief residents oversee two adult servicesat D-H.The Section welcomes changes made tothe third-year surgical core curriculumgiving medical students exposure tosubspecialty surgery. Vernon Pais, MDnow coordinates both third- andfourth-year clerkship programs.FacultyThe Section welcomes Elias Hyams, MD,a recent graduate of the Johns Hopkinsprogram in minimally invasive surgery, toour faculty. Expert in robotic-assistedradical prostatectomy, Dr. Hyams fills someof the void created by the recent retirementof John Heaney, MD. David Chavez, MD,a graduate of the Dartmouth urologyprogram, is expected to join the Section ofPediatric Surgery in January. A fellowshiptrainedpediatric urologist, Dr. Chavez willbe active in our residency program.Section members remain active in regional22


and national organized urology. AnnGormley, MD is the Chair of theUrinary Incontinence Network,an investigative arm of the NIH.She is an examiner of the ABUExamination Committee andrecently became the President-electof the NES-AUA. John Seigne, MDserves on the AUA SuperficialBladder Cancer Guidelines Paneland is the Program Director of theGenitourinary Oncology Group atthe Norris Cotton Cancer Center.Dr. Pais, the Urological SectionEditor of Clinical Nephrology, is theNew Hampshire representative tothe New England Section of theAUA. David Barrett, MD, a formertrustee of the ABU, continues toserve as a board examiner. Allfaculty serve as reviewers for themajor urologic journals.ResearchCollaborating with Ryan Halter,PhD on Alex Hartoff ’s NIHfunded grant investigating the useof electrical impedance technologyin the accurate diagnosis andstaging of prostate cancer, membersof the Section are engaged inapplied research activity at theThayer School of Engineering.Dr. Pais is advancing our understandingof stone managementin pregnancy, the proper use ofultrasonagraphy in ureteral stonetreatment, and the role of 24-hoururinary risk factors in stone disease,to name a few. Dr. Pais recentlyreceived external funding toevaluate the role of endogenousurinary thiosulfate in stoneformation in pregnancy. TheSection of Urology had tenpresentations at this year’s NewEngland Urologic Annual Meeting,five presentations at the NationalAUA Meeting, and eightmanuscripts accepted in peerreviewedperiodicals.Looking AheadThe Section is exploring clinicalaffiliations with urologists at localmedical centers and working toprovide tertiary and supportservices to colleagues in a ruralenvironment.We look forward toinitiating a dedicated men’s healthclinic focusing on the urologicalproblems of a maturing population.FACULTYUROLOGYDavid Barrett, MDClinical Professor and Instructorin SurgeryWilliam Bihrle, MDAssociate Professor of SurgeryE. Ann Gormley, MDProfessor of SurgeryKelley Hamill Lemay, APRNInstructor in SurgeryJohn Heaney, MB, BChProfessor of SurgeryElias Hyams, MDAssistant Professor of SurgeryVernon Pais, MDAssistant Professor of SurgeryJohn Seigne, MB, BChAssociate Professor of SurgeryRodney Taylor, MDAssistant Professor of SurgeryUrology Gross Professional Revenue$15M$10M$5MFY07 FY08 FY09 FY10 FY11 FY12Urology Cases1,4001,2001,000800600400200FY07 FY08 FY09 FY10 FY11 FY12DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201223


VASCULAR SURGERYRichard J. Powell, MDSection ChiefProfessor of Surgery and RadiologyAlexander J. HorvathPractice ManagerPatient CareOur core focus remains the careof patients with vascular disease.Annual outpatient visits continueto increase. As the primaryreferral center for a geographicallylarge and rural area, we continueto implement various programs tobetter serve our patients. To dothis, we developed an outreachclinic at Cheshire Medical Centerin Keene, NH and are workingwith other community hospitalsin both New Hampshire andVermont to increase access tovascular care. This endeavor is acomponent in the development of amultidisciplinary Heart and Vascular Centerat Dartmouth-Hitchcock.In addition to developing relationships toincrease access to care, we have focusedsome effort in how we provide care bydeveloping clinical care paths. These carepaths have been developed with ourcolleagues from nursing, cardiology, andvascular surgery, along with The DartmouthInstitute, to develop comprehensiveardiovascular care that is evidence-based andcost effective.Our open surgical case volume remainssteady while our endovascular volume hasgrown over the last year by six percent.The Branched and Fenestrated Stent GraftProgram, for the repair of thoracoabdominalaortic aneurysms, which is led by MarkFillinger, MD, is one of only a handful ofcenters in the United States capable ofperforming this procedure.EducationOur Vascular Residency Training Program,led by Program Director Dr. Fillinger,continues to maintain its reputation as oneof the best in the nation. The fellowshipprogram continues to attract high qualityapplicants. Andy Hoel, MD and DavidKuwayama, MD, our 25th and 26thvascular fellows, completed their fellowshipand have taken academic surgery positionsat Northwestern University FeinbergSchool of Medicine and the University ofColorado-Denver, respectively. ReplacingDrs. Hoel and Kuwayama is Kristina Giles,MD who completed her general surgeryresidency at Beth Israel Deaconess. OurVascular Surgery Residency Program, thefirst in the nation, is now in its sixth yearand is about to graduate it’s first resident,Randy Demartino. The newest addition tothe Program is Ryan Svoboda, MD fromPenn State University of Medicine.Section faculty delivered over 45 international,national, and regional educationpresentations this year of which 30 were forvascular surgical society meetings. Researchactivity resulted in 23 peer reviewed articlesand five book chapters published by facultythis year.Vascular Surgery conferences are held eachMonday morning when faculty and traineeshave protected time to attend. Theseinclude multidisciplinary biweekly clinicalcase conferences, a biweekly morbidity andmortality conference, a monthly vascularlaboratory conference, clinical and basicscience research conference, and journal club.ResearchOngoing basic science bench research isled by Eva Rzucidlo, MD to study theregulation of smooth muscle cell phenotype.Dr. Rzucidlo has received aHitchcock Foundation Grant and theRichard W. Dow Career DevelopmentAward to investigate the role of connectivetissue growth factor in the regulation ofvascular smooth muscle cell phenotype.She is currently pursuing RO-I Fundingwith preliminary data based off of thisproposal. Dr. Rzucidlo is local principalinvestigator for stem cell trials for clinicallimb ischemia.Section members remain heavily involvedin industry sponsored clinical trials.Dr. Fillinger is the national principalinvestigator for the Pythagoras endoprosthesistrial for abdominal aortic aneurysmsand is the local principal investigator forseveral endoprosthesis trials for abdominalaortic aneurysms, thoracic aorticaneurysms, aortic dissection, and traumaticaortic injury. Richard Powell, MD is thenational and local principal investigator forstem cell therapy trials for the treatment ofcritical limb ischemia. He is also nationaland local principal investigator for peripheralarterial stent trials. In addition, Dr.Powell is the local investigator for multiplecarotid stent trials, including the ongoingNIH sponsored CREST Trial. DavidStone, MD is the local principal investigatorfor the Atrium iliac stent graft trial.24


Outcomes research is led by BrianNolan, MD and Philip Goodney, MDwho have worked closely withresearchers from The DartmouthInstitute for Health Policy and ClinicalPractice (TDI). Dr. Nolan has receivedmultiple sources of funding to comparethe outcomes of various treatmentmodalities in patients with critical limbischemia. Of particular note, Dr. Nolanis in his fourth year of a K-23 CareerDevelopment Award from the NationalHeart Lung and Blood Institute forresearch in quality of life of patientswith abdominal aortic aneurysms andhas applied for a matching grant fromthe American Vascular Association forthis project. Steven Woloshin, MD, MS,from TDI, serves as his primary mentor.This is an outstanding accomplishment.Dr. Goodney is now in his third yearon his K-08 proposal to study variationsin treatment of critical limb ischemia.Funding for his five-year proposal beganOctober 2010.Jack Cronenwett, MD continues to leadthe Vascular Study Group of NewEngland. This multi-institutional groupnow has more than 12,000 vascularsurgery operations analyzed to providehospital-specific feedback for improvingoutcomes.Faculty HighlightsDr. Cronenwett is the Editor of thetextbook “Rutherfords VascularSurgery.” Robert Zwolak, MD isPresident of the Society for VascularSurgery and has been appointedVice-Chair of AMA/Specialty SocietyRelative Value Committee Five-YearReview Workgroup. Dr. Zwolakhas also been elected Chair of theAmerican College of SurgeonsSocioeconomic Issues Committee.Lastly, Dr. Zwolak has been appointedto the Executive Board of the newlyestablished Patient Centered OutcomesResearch Institute (PCORI). He isthe only surgeon on the Board and thisis a tremendous accomplishment. Dr.Fillinger was elected Recorder of theNew England Society for VascularSurgery. Dr. Powell has been electedto serve on the NIH/NHLBI DataSafety Monitoring Board for theCLEVER Trial and has been electedto membership on the Surgery andBioengineering Study Section of theNIH.Overall, the members of the Sectioncontinue to perform at an outstandinglevel in their commitment to the careof patients with vascular disease and tothe educational and research missions ofthe Section.FACULTYVASCULAR SURGERYJack Cronenwett, MDProfessor of Surgery, Community& Family Medicine, andThe Dartmouth InstituteMark Fillinger, MDProfessor of SurgeryPhilip Goodney, MDAssistant Professor of Surgery andThe Dartmouth InstituteBrian Nolan, MDAssistant Professor of Surgery andThe Dartmouth InstituteRichard Powell, MDProfessor of Surgery and RadiologyEva Rzucidlo, MDAssociate Professor of Surgeryand PediatricsCarey Stillman, APRNInstructor in SurgeryDavid Stone, MDAssistant Professor of SurgeryDaniel Walsh, MDProfessor of SurgeryRobert Zwolak, MD, PhDProfessor of SurgeryVASCULAR RESEARCH LABMary Jo Mulligan-Kehoe, PhDAssociate Professor of SurgeryVascular Surgery Gross Professional Revenue$30M$25M$20M$15M$10M$5MFY07 FY08 FY09 FY10 FY11 FY12Vascular Surgery Cases1,1001,0501,000950900850FY07 FY08 FY09 FY10 FY11 FY12DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201225


SURGICAL RESEARCH LABORATORYP. Jack Hoopes, DVM, PhDProfessor of Surgery and MedicineAdjunct Professor of Engineeringand Senior LecturerDirector, Surgery and RadiationResearch LaboratoriesCo-Director NCCC CancerNanotechnology Working GroupMissionThe Surgical Research Laboratory(SRL) is a 10,000 sq. ft. researchlaboratory and experimental animalOR facility that is designed toperform basic/in vivo biology andin vivo translational research forimproved understanding of diseaseprocesses including identification andfacilitation of new medical imagingand therapeutic applications.Faculty and AdministrationImmediate supervision and oversightof the SRL rests with Department ofSurgery (DOS) Chair, RichardFreeman, MD. The DartmouthCollege Provost Office, the GeiselSchool of Medicine, the DartmouthCollege Center for ComparativeMedicine and Research, the NorrisCotton Cancer Center, and theThayer School of Engineeringare key research partners andadministrative collaborators of theSRL. The full-time SRL supportstaff includes three veterinarians, oneveterinary technician, two researchassociates, four laboratory/ORmanagers, and a part-time financialmanager. Four DOS professors havededicated laboratory space in the SRL.More than 25 DOS/D-H/Thayer Schoolsurgeons and faculty performed research inthe SRL in 2011-12. Twelve graduatestudents and post-doctoral fellows have aresearch home in the SRL and more than40 Dartmouth and non-Dartmouthundergraduates engaged in SRL researchprojects in 2011-12.FacilityThe basic science component of the SRL(six bench laboratories) includes a completearray of molecular biology instrumentationand techniques such as cell culture; DNAmicroarray; proteomics array; northern,western, and southern blots; ELISA; RT-PCR; autoradiography; etc. The SRL hasdedicated expertise in histologic preparationand staining/labeling techniques includinghistochemistry, immunohistochemistry, insitu-hybridization as well as fluorescentmicroscopy, and automated/computerbasedmicroscopic image analysis/quantification.A six room state-of-the-art experimentalanimal operating facility, which includes alead lined radiation suite, performs a widevariety of animal species ranging fromrodents to all commonly used large researchmodels including pigs, rabbits, sheep, andspontaneous canine tumors (pet dogs)treated with curative SRL surgical andimaging techniques include state-of-the-artanimal anesthesia delivery and monitoring,dedicated clinical fluoroscopy/angiography,ultrasound, and an ionizing radiationlaboratory. The facility contains fivepermanent and two mobile operatingmicroscopes, suitable for conventional andmicrosurgery applications.NCCC Director, Mark Israel, MD, SRLDirector, Professor Hoopes, and researchcolleagues recently developed a SmallAnimal Imaging Resource in the Centerfor Comparative Medicine and Research.This shared resource, which is staffed anddirected by the SRL faculty, includesrodent dedicated MRI, CT, PET, ultrasound,fluoroscopy/angiography andbioluminescence, and fluorescence imaginginstrumentation. Instrumentationcurrently available for large animalimaging includes MRI, CT, and PETas needed at D-H. Clinical ultrasoundand fluoroscopy/angiography imaging isdedicated in the SRL OR suite. The SRLstaff also has expertise in instrumentationfor endoscopy, laparoscopy, and radiationtherapy/treatment planning. Taken together,research animal based imaging and surgerytechnology and instrumentation is at theforefront of the national research effort inthis area. The NIH/D-H supportedAdvanced Surgical Center (ASC), fundedin 2010, is now scheduled for completionMarch, 2013. This facility, one of fifteen inthe USA, is a two-room OR facility forclinical patients and selected researchanimal subjects which includes built-inintraoperative MRI, CT, and bi-planarfluoroscopic/angiography technology. TheD-H facility is the only one in the USAand Canada to be dual-fitted for animalbasedsurgical research and clinical patients.SRL Resident and Non-ResidentFaculty (50 active Dartmouthfaculty users)Active, Resident SRL Faculty (11): MaryJo Mulligan-Kehoe, PhD, David Roberts,MD, Kathleen Martin, PhD (adjunct),Mark Savellano, PhD, Kimberly Samkoe,PhD, Karen Moodie, MS, DVM, BrianPogue, PhD, Eunice Chen, MD, PhD, EvaRzucidlo, MD, and P. Jack Hoopes, DVM,PhD. Four of these faculty members (Drs.Pogue, Samkoe, Roberts and Hoopes) haveprimary or adjunct appointments at theThayer School of Engineering.Active, Non-resident DOS Faculty (14):Scott Lollis, MD,Thadeus Trus, MD,Cherie Erkmen, MD, Mitchell Stotland,MD, Richard Powell, MD, Michael Zegans,MD, Christopher Chapman, MD, RajanGupta, MD, Joseph Rosen, MD, RichardFreeman, MD, Joseph Paydarfar, MD,Daniel Morrison, MD, Benoit Gosselin,MD, James Saunders, MD, and BurtEisenburg, MD.26


Active, Non-DOS D-H/Geisel Faculty(10): Dept. of Medicine (A. Kaplan, R.Rothstein, L. Jarvis, D. Gladstone, L.Lewis, B. Williams ), Dept. of Radiology(J.Weaver, B. Gimi, N. Khan, H. Swartz),Dept. of Orthopedics (S. Mirza), andDept. Microbiology and Immunology(S. Fiering).Active,Thayer School of EngineeringFaculty (15): K.D. Paulsen, P. Meaney,C.E. Sullivan, B.S.Trembly, F. Shubitidze,R. Halter, S. Davis, K. Griswold,T.Gerngross, J.C. Collier, D.Van Citters, U.Wegst, I. Baker,A. Hartov, and S. Diamond.Funded research projects include:• Antibody and non-antibody directediron oxide nanoparticle breast andovarian cancer treatment (NIH NCIU54,ACS/NCCC internal, NIH SBIRawards);• Development of iron/iron oxidenanoparticles (NIH U54 andfoundation award);• Natural Oriface TransluminalEndoscopic Surgery (NOTES)(CIMIT/NIH award);• Assessment of novel surgical meshmaterial (industry);• Noninvasive microwave imaging andheating techniques (ACS/NCCCinternal award);• Electron paramagnetic resonanceassessment of O2 levels in radiationtissue damage (NIH P01, U19 award,DOD award, Robert W. CrichlowCareer Development Award);• Radiation innovation and developmentresearch (NIH P30 award);• Assessment of novel electrocauterytechnology (industry);• Photodynamic therapy: treatmentefficacy and mechanism (NIH R01,P01, and K01 awards);• Use and development of fluorescenceand near infared (NIR) in cancerimaging, diagnosis, and treatment (threeNIH R01 awards);• Development and assessment ofinterventional cardiovascular modelsand technologies (NIH SBIR andindustry funding);• Anti-angiogenesis and associateddevelopmental biology (NIH R01 andfoundation awards);• Electrical impedance spectroscopy andtomography imaging technology(NIH-NCI P01 and R01 breast cancerimaging awards);• Protein engineering for diagnosis andtherapy of cancer and developmentaldisease (NIH U54, P20, and NSF);• Development and assessment ofabsorbable surgical staples(industry/OPUS-KSD Inc.);• Novel treatment of spinal cord injury(industry);• Use of novel preservation methods toimprove transplant organ health(industry/Somahlution Inc.).Educational/training activities:• Microsurgery GME course (plasticsurgery).• Medical student suture training course.• Introduction to aseptic trainingtechnique.• Advanced trauma surgery and lifesupport (ATLS) training course.• Animal surgery training (all Dartmouthresearchers who perform surgicaltechniques).• Head and Neck surgical training (oral,skull-base, throat).2011-12 Grant and ContractFundingResearch (2011-2012) associated directlywith the SRL facility and faculty issupported by 38 funded research grants(22 as Principle Investigator/PI).DOS-SRL research funding accountedfor more than $3 million annually. Themajority of this funding is provided bypeer review funding mechanisms. TheSRL continues to be the central researchfacility for an NCI Center of CancerNanotechnology Excellence (CCNE)grant awarded in 2010. The originalaward for this five-year grant was $12.8million, with total funding now over $3.5million annually. Ten CCNE faculty andstaff and eight graduate students, representingmore than 50% of the totalCCNE award, are associated with theSRL.Work is proceeding towards abreast cancer clinical trial, which will bedirected by Dr. Eisenburg, DOS surgeonand Deputy Director of the NCCC.2011-12 Publications: Resident SRLfaculty accounted for 107 publishedmanuscripts and more than 75 full-lengthpublished proceeding papers.SURGICAL RESEARCHLABORATORYFACULTYRyan Halter, PhDResearch Assistant Professorof EngineeringAdjunct Assistant Professor of SurgeryP. Jack Hoops, DVM, PhDProfessor of Surgery and MedicineAdjunct Professor of Engineeringand Senior LecturerDirector, Surgery and RadiationResearch LaboratoriesCo-Director NCCC CancerNanotechnology Working GroupKeith Paulsen, PhDProfessor of EngineeringProfessor of SurgeryBrian Pogue, PhDProfessor of EngineeringAdjunct Professor of SurgeryMark Savellano, PhDResearch Associate Professorof EngineeringResearch Associate Professorof SurgeryKimberley Samkoe, PhDResearch Assistant Professorof SurgeryAdjunct Assistant Professorof EngineeringDARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201227


MAXILLOFACIAL SURGERYRocco R. Addante, DMD, MDSection ChiefProfessor of Surgeryand AnesthesiologyBarbara RiesebergSenior Practice ManagerIntroductionOral and Maxillofacial Surgery providesa diverse spectrum of care rangingfrom primary to tertiary levels. We areseeing an increase in the number ofcomplex cases involving pathologicaland structural deformities of themaxillofacial region being referredto Dartmouth-Hitchcock from thetri-state area.Patient CareDr. Addante participates in a numberof D-H interdisciplinary care clinics.He is a key member of the CraniofacialAnomalies Clinic and interacts on theHead and Neck Cancer team andtumor board. He also provides carefor patients from the HematologyOncology Section who typically exhibitcoagulation disorders and immunesuppression along with their needfor oral surgery intervention. Casesinvolving the care of patients whohave undergone radiation therapyas a component of their head andneck cancer care or who developosteonecrosis as a consequence ofbisphosphonate use are also includedin the mix of patients with significantco-morbidities.EducationRocco Addante, DMD, MD remainsactive academically as a journal reviewerfor articles submitted for publication tothe Journal of Oral and MaxillofacialSurgery. In addition, he continuesto mentor students from Dartmouthwith an interest in careers combiningmedicine and dentistry and morerecently, fourth-year students fromHarvard Dental School who rotatethrough the Red Logan Dental Clinic.Dr. Addante hosts monthly meetingsfor D-H dental staff, and he regularlypresents lectures to members of thedental community on topics of mutualinterest. He serves on the AnesthesiaReview Committee for the State ofNew Hampshire which credentials oralsurgery offices and care providers forthe administration of sedation andanesthesia. He also lectures to theOperating Room Technicians Programgroup at D-H.Nationally, he has completed a longtenure on the Commission ofProfessional Conduct of the AmericanAssociation of Oral and MaxillofacialSurgeons and as a member of theExamination Committee for theAmerica Board of Oral andMaxillofacial Surgery. Although thereis no residency program in Oral andMaxillofacial Surgery at D-H, Dr.Addante maintains close affiliationswith the Sections of Plastic Surgeryand Otolaryngology and is an activecontributor to the training programsin each of these specialties.Maxillofacial Surgery Gross Professional Revenue$2M$1.5M$1M$.5MMaxillofacial Surgery Cases25020015010050FY07 FY08 FY09 FY10 FY11 FY12FY07 FY08 FY09 FY10 FY11 FY1228


MEDICAL STUDENT EDUCATION, SURGERY CLERKSHIPHorace F. Henriques III, MDSurgery Clerkship Co-Director,Trauma/Acute Care Surgery FacultyLearning LeaderAssociate Professor of SurgeryGina L. Adrales, MDSurgery Clerkship Co-Director,Minimally Invasive SurgeryLearning LeaderAssociate Professor of SurgeryTerri J. NicholsonClerkship CoordinatorMelissa A. Hoyt, MDConcord Clerkship ProgramDirectorAssistant Professor of SurgeryThe evolution of our medical schoolinto The Geisel School of Medicineat Dartmouth (GSM) has begunthe process of a change from thetraditional two-year basic science, thentwo-year clinical medical education,to a longitudinal (integrated) four-yearcurriculum. We are most excitedthat initial funding is in place. In thelongitudinal curriculum, Surgery willplay a role in the earliest developmentof a clinician in such areas as acute careassessment, communication skills, andinformed consent.The LCME re-accreditation process isfully underway with the formal reviewin March, 2013. The LCME processhas allowed us to adjust goals, expandour clinical offerings, and consequentlyimprove our flexibility for studentexperiences. Our clerkship educationalfocus remains on basic surgicalprinciples and acute care assessment.Otolaryngology, Orthopedics, Urology,a Community Surgery practice, andNeurosurgery are the newest part of ourrotations. This expansion allows us tokeep the surgery experience within TheGeisel School of Medicine/ Dartmouth-Hitchcock environment, and addsexperience opportunities as we evolve toa longitudinal curriculum. Exclusivelyin the Surgical Clerkship and in keepingwith the discipline of acute care, studentsare exposed to and actively participatein the Critical Care Units, EmergencyRoom, and with Anesthesia. Additionally,the interactive decision makingwith other “invasive” disciplines suchas Gastroenterology, Endoscopy, orInterventional Radiology offersperspective, broadens choices, andeducates students with respect to risksand benefits beyond just “pills or invasiveprocedures.”Gina Adrales, MD, a six-year memberof our faculty, has formally taken on aleadership role in the Clerkship. Herexperience in developing and instructingsimulation lab models is an importantaspect of longitudinal educationintegrating basic science and clinicalmedicine, as we guide the leastexperienced learners through importantprocedures and medical crises withoutthreatening patients in a high-fidelity,safe learning environment. Dr. Adrales’ssurgical focus is in Minimally InvasiveSurgery and Endoscopy.The 2012 Arthur Naitove SurgicalScholar, awarded by the Departmentof Surgery and based on: an honorsevaluation on the wards, a 95 percentileor greater NBME exam, and evidenceof participation in efforts to “better thegreater good,” was awarded to AnnaEley, who is taking her training at theUniversity of California at Davis, andplans a general surgical career. The Classof 2012 graduated with 31% of thestudents entering an acute care field:Anesthesia (9%), Emergency Medicine(4.5%), and Surgery (17%).In 2013, the Department of Surgerywill continue to foster a culture oflearning by providing diverse learningopportunities for students, residents, andattending surgeons. By supporting anenvironment in which feedback is freelygiven and welcomed, with the ultimategoal of providing the best patient care,we are reminded that at all levels we arelearners and strive for continuousimprovement.DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201229


GENERAL SURGERY RESIDENCY TRAINING PROGRAMConcord General Surgery ResidencyProgram DirectorJoseph P. Meyer, MDAdjunct Associate Professor of SurgeryConcord General Surgery ResidencyProgram FacultySharon I. Gunsher, MDAdjunct Assistant Professor of SurgeryRichard K. Murphy, MDAdjunct Assistant Professor of SurgeryNick P. Perencevich, MDClinical Associate Professor andInstructor of SurgeryJoseph R. Snow, MDAdjunct Assistant Professor of SurgeryRussell A. Strong, MDAdjunct Assistant Professor of SurgeryChristian P. Wilke, MDAdjunct Assistant Professor of SurgeryPaul H. Kispert, MDGeneral Surgery ResidencyProgram DirectorAssistant Professor of Surgeryand AnesthesiologyKari M. Rosenkranz, MDGeneral Surgery AssociateResidency Program DirectorAssistant Professor of SurgeryKaren G. LeePenny A. AthertonResidency Program CoordinatorsGENERAL SURGERYResidencyEstablished: 1946Prerequisite Training: 4 years of medicalschoolProgram Description: 5-year program,training in all division.Residents per year: 4FellowshipMinimally Invasive Surgery Fellowship: 1The General Surgery Residency Programtrains twenty categorical general surgeryresidents, including four residents at eachof the five levels of residency training.In addition, twelve more surgical residentsparticipate in the General Surgery Programpreliminary to entering other trainingprograms.Residents benefit from the rich arrayof surgical cases. As Mary HitchcockMemorial Hospital continues to grow,surgical cases have not only continued toincrease in number, but also in complexityas measured by case mix index and severityof injury for trauma patients.The Program draws on the strengths of acommitted departmental faculty and agrowing array of resources. Gina Adrales,MD serves as Director of SurgicalSimulation in Dartmouth-Hitchcock’sPatient Safety Training Center. Dr.Adrales’sresponsibilities include oversight andcoordination of the laparoscopic andtrauma simulations as well as training inbasic surgical skills. In addition, theProgram includes a weekly “academichalf-day.” This half day of didactics alsoincorporates a basic science curriculumdirected by Ken Burchard, MD and abroad-based simulation training curriculumdirected by Dr.Adrales. These sessionsprovide the surgical residents didactic,interactive, case-based learning in clinicaland basic surgical sciences. The didacticcurriculum is based on The ICU Book forPGY 1-2 residents and Sabiston’s Textbookof Surgery for the PGY 3-5 residents.The American College of SurgeonsSCORE Curriculum is available as aresource as well.The Program is supported by a growingarray of data centers that collect andanalyze information about procedures andoutcomes for surgical patients admittedto DHMC. These include registriesadministered by the Surgical OutcomesAssessment Program at Dartmouth, theNorthern New England CardiovascularDisease Study Group, and the VascularStudy Group of Northern New England.Specific complications are identified,collated, and sorted into defined categories.Data from these centers are made availablein a confidential manner to house officersand faculty, and can be used to inform thediscussion at the weekly Morbidity &Mortality conference. The Department ofSurgery participates in the AmericanCollege of Surgeons National SurgicalQuality Improvement Program (NSQIP).Expertise in epidemiology and statistical30


GENERAL SURGERY RESIDENCY TRAINING (Continued)analysis is available by dedicated faculty in the Department ofSurgery. Data from the Trauma Program is submitted to theNational Trauma Data Bank (NTDB), and national data is availablefor review.The Program consists of rotations at Dartmouth-Hitchcock,the Veteran’s Administration Medical Center, and a rotation atConcord Hospital (a large community hospital) for second- andthird-year surgical residents. This rotation at Concord Hospitalallows us to take further advantage of the robust clinical volumesand increasing case complexity occurring in southern NewHampshire.The teaching conference schedule within the Program remainsrobust. Conferences are available on a weekly basis on variousservices. These include GI Tumor Board,Trauma Rounds,Surgical Seminars, Surgical Grand Rounds, Morbidity & Mortalityconference, an interdisciplinary Gastrointestinal DiseaseConference, a monthly Journal Club as well as service-specificconferences. The Program hosted twelve visiting professors whopresented Grand Rounds and interacted with residents and faculty.The General Surgery Residency Program is an academic programthat encourages and supports resident research and teaching.Residents are encouraged to participate in clinical and/or basicscience investigation.Three funded positions are available forresidents to participate in full-time research activities usuallyfor two years between the third- and fourth-years of training.This has been highly successful with residents in the Programproducing numerous scientific presentations at national andregional meetings, multiple peer-reviewed publications, and evenmention in regional and national media. Resident teaching hasalso maintained its outstanding tradition with surgical residentsyearly receiving recognition from the medical students at TheGeisel School of Medicine for their outstanding efforts.Fellowship programs in laparoscopic surgery and vascular surgeryare supported by the Department. In addition, the opportunityexists to obtain fellowship training in our multidisciplinary criticalcare training fellowship.DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201231


DERMATOLOGY RESIDENCY TRAINING PROGRAMKathyrn A. Zug, MDDermatology Residency ProgramDirectorProfessor of Surgery, DermatologyPenny A. AthertonResidency Program CoordinatorDERMATOLOGYResidencyEstablished: 1950Prerequisite Training: 4 yearsmedical school and one yearpreliminary trainingProgram Description: 3-yearprogramResidents per year: 2In July 2012, two new residents,Kassie Haitz, MD andThomas Knackstedt, MDjoined our program. Theywere selected after a very competitivematch, as the Programreceived over 250 applicationsfor our two spots.Kathryn Zug, MD has beenProgram Director sinceNovember 2010. M. ShaneChapman, MD has beenSection Chief of Dermatologysince 2011. Both are graduatesof our program. DorotheaTorti, MD, a 2011 graduateof our program, entered adermatopathology fellowshipin July 2012 at our institution.The Dermatology Residency Program trains sixadvanced dermatology residents, two residents ateach of the three levels of residency training.Our three-year curriculum emphasizes graduatedclinical autonomy while maintaining a strongfocus on academic study. A Dartmouth-Hitchcock joint fellowship in Dermatopathology(with the Department of Pathology) graduated afellow last year.Our residents receive their training throughthe Dartmouth-Hitchcock (D-H) and the VeteransAffairs Medical Center (VA) in White RiverJunction,VT. Residents benefit from a rich arrayof dermatological cases, from the general dermatologyclinic, busy and challenging consult service,and specialty clinics at D-H and the VA.The Dermatology Residency Training Programdraws on the strengths of a committed sectionfaculty and a growing array of resources. Thedermatology residents rotate and actively participatein the Section's subspecialty clinics, including:• Contact and Occupational Dermatology Clinic(Dr. Zug, attending)• Cutaneous Lymphoma Clinic (interdisciplinarywith hematology/oncology) (Dr. Zug andFrederick Lansigan, MD attending)• Dermatology-Rheumatology Clinic(interdisciplinary with rheumatology) (Dr.Tortiand Lin Brown, MD rheumatology attending)• Pediatric Dermatology Clinic (Nicole Pace, MDattending)• Mohs and General Dermatologic Surgery Clinic(Faramarz Samie, MD, Director and attending)• Laser and Cosmetic Dermatology Clinic(Dr. Chapman, attending)• Vulvar Dermatology Clinic (interdisciplinarywith GYN) (Lynette Margesson, MD and DeborahBirenbaum, MD, OB/GYN attending)Residents quickly flourish in their clinical decisionmaking skills because of their continuity clinicexperience that begins in the first year and continuesthroughout their three program years. Residentsbenefit from graduated responsibility and increasedcomplexity of patients over the years.All residents are well aware of the six ACGMEcompetencies: 1) patient care, 2) medical knowledge,3) practice-based learning and improvement,4) systems-based practice, 5) interpersonal andcommunications skills, and 6) professionalism.Curriculum is based on these competencies, andresidents are taught and evaluated with respect tothese core competencies.The educational conference schedule within theDermatology Residency Training Programremains robust. Conferences include a noonconference on most days of the week (clinicalslides, didactic lectures, journal club, and dermatopathologypractical sessions at the microscope)and Melanoma Tumor Board.Dermatology Grand Rounds occurs twice amonth as well as a monthly interdisciplinaryCutaneous Lymphoma Tumor Board.The Dermatology Residency Training Programhosts visiting professors who present lecturesin their areas of interest. The visiting professorparticipates in Grand Rounds and interacts withresidents and faculty.We are an academic program and continue toencourage and support resident research andteaching. Our residents have continuouslyproduced numerous abstract presentations atnational and regional meetings and severalpeer-reviewed publications.Residents’ work accepted for publication2011-2012:Mari Paz Castanedo Tardan, MD – Castanedo-Tardan MP, Zug KA. Allergic Contact Dermatitis.In: Fitzpatrick's Dermatology in General Medicine.8th Ed. McGraw-Hill 2012.Aelayna Meyer, MD – Meyer A,Aaron D, PerryA, Guill M. Erythematous Reticular Patches:ARare Presentation of Mid-Dermal Elastolysis.Accepted to Journal of the American Academy ofDermatology in April 2012.Parisa Ravanfar, MD – Ravanfar P.,Wallace J, PaceNC. “Diaper Dermatitis:A Review and Update”.Current Opinion in Pediatrics. Accepted forPublication March 2012.Jill S.Wallace, MD – “Diaper Dermatitis: AReview and Update” accepted for publication inCurrent Opinions in Pediatrics.Residents’Abstracts and Presentations in 2011-2012:Mari Paz Castanedo Tardan, MDJoyce I. Imahiyerobo-Ip, MDJeffrey Tiger, MDJill Wallace, MD32


NEUROSURGERY RESIDENCY TRAINING PROGRAMDavid W. Roberts, MDNeurosurgery Residency ProgramDirectorProfessor of Surgery (Neurosurgery)and of NeurologySection Chief, NeurosurgeryAlma Hass Milham DistinguishedChair in Clinical Medicine, GeiselMelissa D. RobbResidency Program Coordinator &Administrative SupervisorNEUROSURGERYResidencyEstablished: 1947Prerequisite Training: 4 years ofmedical schoolProgram Description: 7-yearprogram, includes rotations inNeurology, Critical Care,Neuroradiology andNeuropathology, one year ofindependent research/training, and five years ofclinical neurosurgery,culminating in a one yearChief Resident experience.Residents per year: 1The Neurosurgical Residency Program hasbeen an approved training program since itsinception in 1947 by Henry Heyl, MD, laterthe editor of the Journal of Neurosurgery. Witha mission to provide the highest level ofacademic and clinical teaching, the Program hasproudly graduated neurosurgeons who havebeen successful across a wide range of endeavors.Over the past twenty-five years, more thanhalf have gone on to academic positions.The residency program in Neurosurgery trainsseven residents, one at each level of training.The seven-year curriculum begins at PGY-1with rotations in general surgery, neurology,critical care, and neurosurgery. The PGY 2-5rotations in clinical neurosurgery are interspersedwith dedicated blocks in pediatricneurosurgery as well as related neurosciencedisciplines, including neuroradiology andneuropathology. The PGY-6 year provides atwelve-month experience in the laboratory oron independent study, variably involving wetbenchresearch, clinical investigation, supplementaryclinical subspecialization, or study ina master’s degree program. Clinical instructionfollows graduated progression throughincreasing levels of intellectual growth,technical proficiency, and clinical responsibilityculminating in twelve months as chief resident.By the final year of training, the resident hasacquired a broad education, is capable ofteaching medical students and junior residents,and is able to operate across the full range ofneurosurgical disorders.The clinical neurosurgical service is foundedon a model of subspecialization withinNeurosurgery, functioning in multidisciplinaryprograms of the Medical Center. Residentsare fully integrated into the clinical service,each teamed with a faculty member. Residentsparticipate fully in the operating roombeginning in their first year and are givenprogressive responsibility through theirsucceeding years. All subspecialties ofNeurosurgery are represented in the Programby faculty with special training, clinicalexpertise, and investigative interest.The teaching conference schedule is rigorousand protected. Conferences includeNeurosurgery Journal Club, Grand Rounds,Clinical Case Conference, Morbidity andMortality, Neuro-Oncology Tumor Board,Neuropathology, Cerebrovascular Conference,Epilepsy Conference, Pediatric Trauma andTumor Board Conferences, and a weekly casepresentation conference with the ProgramDirector.An active visiting professor program bringsfour-to-six distinguished academicians eachyear. In the tradition of Dartmouth’s internationalreach, neurosurgery residents havejoined our faculty in recent medical educationinitiatives to Vietnam and Uruguay. Residentshave an opportunity to participate in nationalcourses and workshops, including thoseorganized by the AANS, the CNS, andthe Washington Neuroradiology &Neuropathology Review. Each resident,during their training, attends the Woods HoleRUNN course. Residents actively presentand publish their research and clinical investigativework. During 2011-2012, theProgram was responsible for 62 publications.Recent residents have won the ShulmanAward for the best resident paper at theAANS/CNS Pediatric Section meeting, theGildenberg Award for the best resident paperat the AANS/CNS Stereotactic andFunctional Section meeting, the CNS WalterDandy Research Fellowship, a CNS TravelAward, the Best Paper at the New EnglandNeurosurgical Society Annual Meeting,multiple NIH awards, and the RetziusNeuroanatomy competition.State-of-the-art facilities at Dartmouth-Hitchcock, the major teaching hospital of ahealth care delivery system covering northernNew England, include dedicated neurosurgeryand neurophysiology laboratories, theSimulation Center, the Advanced ImagingCenter, and (under construction) theAdvanced Surgical Center, comprised of twooperating rooms with intraoperative MRI,CT, and angiographic capability. TheDartmouth Institute for Health Policy andClinical Practice, the Norris Cotton CancerCenter, and the Biomedical EngineeringProgram at Dartmouth’s Thayer School ofEngineering provide outstanding educationaland investigational opportunities for residentsin our program.DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201233


OTOLARYNGOLOGY RESIDENCY TRAINING PROGRAMMark C. Smith, MD, FAAPOtolaryngology Residency ProgramDirectorAssistant Professor of Surgery,Pediatric OtolaryngologyChristina TrottierResidency Program CoordinatorOTOLARYNGOLOGYResidencyEstablished: 2008Prerequisite Training: 4 yearsof medical schoolProgram Description: 5-yearprogram with 6 months ofgeneral surgery rotations toinclude trauma, surgicaloncology, plastic surgery, andcardiothoracic surgery.Residents per year: 1The Residency Program in Otolaryngology-Head and Neck Surgery at Dartmouth-Hitchcock is designed to provide residentswith education in the comprehensive medicaland surgical care of patients with diseasesand disorders that affect the ears, the upperrespiratory and upper alimentary systems andrelated structures, and the head and neck.The Program includes the core knowledge,skills, and understanding of the basic medicalsciences relevant to the head and neck; theupper respiratory and upper alimentarysystems; the communication sciences,including the knowledge of audiology andspeech pathology and audiologic and speechrehabilitation; and the chemical senses andallergy, endocrinology, and neurology as theyrelate to the head and neck area.The Program also includes the clinical aspectsof diagnosis and the medical and/or surgicaltherapy for prevention of diseases, neoplasms,deformities, disorders and/or injuries ofthe ears, the upper respiratory and upperalimentary systems, the face, the jaws, andother head and neck systems; head and neckoncology; and facial plastic and reconstructivesurgery.Following completion of the Program,residents should be prepared to care forpatients of all ages with medical and surgicaldisorders of the ears, the upper respiratoryand upper alimentary systems and relatedstructures, and the head and neck; to carryout diagnostic evaluations of patients withotolaryngologic disorders; and to carry outthe surgical and nonsurgical managementof otolaryngologic disorders, includingrehabilitation and referral to subspecialistswhen appropriate.As a vital adjunct to the acquisition of therequired medical knowledge and patient careskills, the resident will acquire the skillsneeded to practice medicine in a complexmedical system. The interpersonal andcommunication skills needed for such apractice as well as expertise in systems-basedpractice are continually emphasized andevaluated throughout the residency. Properprofessional behavior is fostered as theresident masters the essential skills of practicebasedlearning that will prepare him or herfor a lifetime of learning.The ACGME granted approval forOtolaryngology to start a new residencyprogram in July of 2008. The Program isnow fully populated with five residents, onein each year of training. We graduated ourfirst chief resident in June 2012. Our mostrecent Residency Review Committee sitevisit granted us full approval with a 4-yearcycle length.Our residents are quite active in medicalstudent and intern education. Theyparticipate and present papers at the NewEngland Otolaryngological Society meetingsthree times per year and have each presentedpapers and posters at national meetings.34


PLASTIC SURGERY RESIDENCY TRAINING PROGRAMCarolyn L. Kerrigan, MDPlastic Surgery Residency ProgramDirectorProfessor of Surgery, Plastic SurgeryChristina TrottierResidency Program CoordinatorPLASTIC SURGERYResidencyEstablished: 1990Prerequisite Training forcombined program: medicalschoolProgram Description: 6-yeartraining beginning with 3years of general surgeryfollowed by the independentprogram (this path will bereplaced with a 6-yearintegrated program in 2012)Prerequisite training forindependent program:completion of a residency inanother surgical discipline.Program Description: 3-yeartraining with a period ofresearch integrated into theprogram.Residents per year: 1The residency program in PlasticSurgery trains three residents, one peracademic year in a three-year program.Dartmouth-Hitchcock (D-H) providesa comprehensive and broad-basedtraining experience through exposureto the outpatient clinics, minor surgerysuite, main operating room, outpatientsurgery center, and inpatient wards.Most of our faculty members havefellowship training and subspecialtyareas of clinical and research interest,permitting an exposure to a widespectrum of plastic surgery problems.We assign residents two half-daysupervised clinics per week, providingthem with a regular opportunityfor both new patient workups andfollow-up evaluations.During the final year of the program,the chief resident is given increasingresponsibility for coordinating andcustomizing the educational andclinical aspects of the Program.Residents at every level are involvedin the management of all plasticsurgical problems presenting throughthe Emergency Department. Researchelectives, throughout the residency,provide meaningful learning opportunities.During the chief resident year, theresident may also train overseas.There are twice-weekly conferences forresident education. In both settings,there is active participation by theresident and attending staff. Theseconferences address the weekly case log,a journal review, and discussion serieswhich are based on the core curriculumestablished by the American Board ofPlastic Surgery.The Program supplements theexperience at D-H with a dedicatedburn rotation at LAC/USC Hospital ina burn unit within the plastic surgerydivision. Additionally, exposure toprivate practice setting is achieved withrotations at a well-established group inMaine and a nationally recognizedcosmetic surgeon in Miami. Every yearour residents present at both nationaland regional society meetings.The graduates of the Program havebeen successful in pursuing fellowshippositions. Our most recent graduate,Michael van Vliet, MD, is going toUniversity of Southern California for aBurn and Critical Care Fellowship.DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201235


UROLOGY RESIDENCY TRAINING PROGRAME. Ann Gormley, MDUrology Residency Program DirectorProfessor of Surgery, UrologyAmanda L. CharbonoResidency Program CoordinatorConcord Urology ResidencyProgram FacultyScott J. Fabozzi, MDAdjunct Assistant Professor of SurgeryDavid F. Green, MDAdjunct Associate Professor of SurgeryWilliam F. Santis, MDAdjunct Assistant Professor of SurgeryPaul M. Snyder, MDAdjunct Assistant Professor of SurgeryRonald L. Yap, MDAdjunct Assistant Professor of SurgeryVeronica Triaca, MDAdjunct Assistant Professor of SurgeryUROLOGYResidencyEstablished: 1949Prerequisite Training: 4 years ofmedical school and 1 year ofgeneral surgeryProgram Description: 4-yearprogram. Training in pediatricand adult urology; includingoncology, female urology,BPH, reconstruction, stonedisease, and transplant. Ampleexperience is gained in open,laparoscopic, robotic, andendoscopic surgery.Residents per year: 2The Dartmouth-Hitchcock UrologyResidency Training Program was started in1949 by William McLaughlin, MD as atwo-year urology residency with oneresident accepted per year. In 1987, webecame a four-year program and in 2006,we were given approval to complete ourexpansion to two residents per year.Historically, our residents have completedtwo years of general surgery training priorto entering the urology residency program.As of this July 2012, our residents do oneyear of general surgery training, whichaligns us with most of the other urologyresidency programs in the Country.The Dartmouth-Hitchcock UrologyResidency Training Program is dedicatedto the overall mission of Dartmouth-Hitchcock (D-H) and strives to improve,through research and education, ourunderstanding of the causes, courses,management, and prevention of urologicdiseases.Eight full-time faculty members provide acomplete range of subspecialty urologictraining. Clinical urology training atDartmouth-Hitchcock is oriented aroundthe philosophy of resident exposure tocontinuity of patient care. Residents areassigned on an “apprenticeship basis” to ateam of two or three urology attendings.The Section emphasizes one-on-oneinteraction between the faculty and theresident fostering an apprenticeship styleallowing a resident to progress at his or herown pace, although there are expectationsfor what the resident should accomplishwithin each year. As we have expandedour resident numbers, we have alsoadapted certain aspects of a hierarchicalmodel where the Chief Resident runsthe in-patient service and is ultimatelyresponsible for assignment of operativecases.The Urology Residency Training Programalso involves the Veterans Affairs MedicalCenter (VA) in White River Junction,VTand Concord Urology in Concord, NH.While at the VA, the resident is responsiblefor the total patient care in the out-patientclinic, emergency room, and the in-patientward service. The resident operates onvirtually all urologic cases with appropriatefaculty supervision. The Concord rotationwas designed to give our residents exposureto a system that is more of a privatepractice model. While rotating atConcord, the resident, under supervision, ispotentially responsible for total patient careof all urological in-patients. The residentoperates three- or four-days per week and,therefore, completes the rotation havingimproved his or her surgical logs andclinical experience.The Urology Residency Training Programhas a robust conference schedule whichaffords residents protected educational time.Research meetings, journal club, urogynecology/femaleurology case conferences,and faculty led case conferences round outthe teaching program. During the summermonths, ethics conferences are held in placeof Urology Grand Rounds.Resident research is expected throughoutthe Urology Residency Program. Ourresidents routinely present at regional andnational meetings.In May we had three residents present atthe American Urologic Associationsannual meeting. The usual acceptancerate for abstracts, both poster and podiumpresentation, is approximately 30% withour program’s acceptance rate beingapproximately 70 %.The following residents were first authorson podium or poster presentations: BenHerrick, MD (3); Einar Sverrisson, MD(1); and Levi Deters, MD (1).Dr. Sverrisson’s poster was chosen as thebest poster in the session on bladder cancerbasic research. The Bladder Pal, a bladderdiary app, developed by Ron Yap, MD fromour Concord faculty and studied by Dr.Herrick is being promoted by the AUA aspart of their Over Active BladderAwareness Campaign.36


UROLOGY RESIDENCY TRAINING PROGRAMIn June we bid farewell to our two Chief Residents, Dr.Sverrisson and Peter Jones, MD. Dr. Sverrisson has started afellowship in Oncology at Moffit Cancer Institute in Tampa,FL and Dr. Jones has joined a private practice group inPocatello, ID. Both Drs. Jones and Sverrisson successfullypassed Part I of their American Board of Urology exam inJuly. In July, E. Ann Gormley, MD finished her term as theeditor on the AUA/ABU Exam Committee.Once again we had a very large contingent of residents andfaculty at the Annual Meeting of the New England Section.The meeting was held in Boston, September 6-8, 2012.Residents were first authors on eleven presentations. ScottWiener, GSM 2012, who is now a Urology Resident atUniversity of Connecticut, also presented work that he didwith Vernon Pais, MD. The following residents presented atthe annual meeting: Johann Ingimarsson, MD (1); BenHerrick, MD (2); Elizabeth Johnson, MD (2); Levi Deters,MD (1); Cullen Jumper, MD (1); Paholo Barboglio, MD (3);and Larry Dagrosa, MD (1).Dr. Herrick successfully completed a manuscript of hisresearch on socioeconomic status and stones, which qualifiedhim to compete in the residents’ prize essay contest. Wewere very pleased with Dr. Herrick’s first place finish in avery competitive field.Dr. Pais and Scott Fabozzi, MD, from our faculty atConcord, participated in a debate on the surgical treatmentof stones. Dr. Gormley moderated a debate on pelvic organprolapse, and William Bihrle, MD organized the socialprogram.Our residents are submitting abstracts to a variety ofsubspecialty programs that meet throughout the winter andto the 2013 American Urologic Association Annual Meetingin May.The Section of Urology is busy preparing for a celebrationto recognize John Heaney, MD’s contribution to residenteducation and to our Section. We will have scientificprograms on October 19th and 20th with all of thepresent faculty and many of Dr. Heaney’s former residentspresenting.Amanda Charbono, our Residency Program Coordinator,and Dr. Gormley are beginning to review the applicationsfor our program for 2013. We will be interviewing Oct31st, Nov 17th, and Nov 27th.Since the last Surgery newsletter, we have had major changesto our pediatric urology faculty. Leslie McQuiston, MD leftin May for a private practice position in Austin,TX andDaniel Herz, MD has announced his plans to move to theUniversity of Ohio in Columbus, OH at the end of the year.Fortunately, we have recruited David Chavez, MD, who willstart in January. Dr. Chavez graduated from our program in1995 and after completing fellowships in both endourologyand pediatrics, has been working in Montana. We arelooking forward to having Dr. Chavez join our urologyteaching faculty.DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201237


VASCULAR SURGERY RESIDENCY TRAINING PROGRAMMark F. Fillinger, MDVascular Surgery ResidencyProgram DirectorProfessor of Surgery, Vascular SurgeryChristina M. TrottierResidency Program CoordinatorVASCULAR SURGERYResidencyEstablished: 2007Prerequisite Training: 4 years ofmedical schoolProgram Description: 5-yearprogram, includes 26 monthsof vascular surgery, 10 monthsof interventional/endovascularsurgery, and 24 months of coregeneral surgery experience.Optional non-accreditedresearch education year(including option for formalcoursework at The DartmouthInstitute leading to master'sdegree in public health withfocus on outcomes research).Residents per year: 1FellowshipEstablished: 1988Prerequisite Training: 4 years ofmedical school, completion ofan accredited General SurgeryResidencyProgram Description: 2-yearprogram, includes 16months of vascularsurgery and 8 months ofinterventional/endovascularsurgery.Fellows per year: 1The residency program in Vascular Surgerycontinues to maintain its reputation as oneof the best in the nation. The overallVascular Surgery Residency TrainingProgram continues to have two optionsfor training pathways, with both thetraditional fellowship and the newerresidency program.The traditional vascular fellowship is acourse for residents in the “5+2” pathway,who have completed a five-year generalsurgery training program. The fellowshipcontinues to attract great applicants fromaround the country.Our five-year integrated Vascular SurgeryResidency Program is open for applicantswho will join after successful completionof an MD program, also known as the“0+5” training pathway. The Dartmouthintegrated program was the first approvedin the nation, and is now in its seventhyear. Our program had its first site visitin 2009 and achieved full five-yearreaccreditation by the ACGME. Ourmost recent resident joining the Programis Ryan M. Svoboda, MD, PGY1, whocomes to Dartmouth-Hitchcock fromPennsylvania State University College ofMedicine. Randall De Martino, MD isthe first resident to begin the Program,and is now in his fifth clinical year as ourChief Resident. Courtney J.Warner, MD,is in her research year pursuing a Mastersin Science at The Dartmouth Institute forHealth Policy and Clinical Practice.Both the residency and fellowshipprograms have robust training with regardsto case volume, variety, and complexity,with the complexity ranking among the90th percentile nationwide. The fullspectrum of research opportunities exist,including basic science, engineering, andoutcomes-related research, many of whichinclude NIH funding. A large number ofdatabases are available in this regard, rangingfrom the Section’s own database to theregional Vascular Study Group of NewEngland database (founded here by JackCronenwett, MD), to a regional andnational aortic aneurysm imaging databasevia M2S, as well as national NIS andMedicare databases. The vascular sectioncontinues to be active in nationwideclinical trials, with over thirty such trialscurrently in various stages. These trialsprovide patients and trainees access to thelatest technology, ranging from devicesfor endovascular repair of thoracic aorticaneurysms and dissections, to branchedfenestratedaneurysm repair of abdominalaortic aneurysms and iliac aneurysms,carotid artery stenting for strokeprevention, lower extremity and renalartery stenting, and even gene therapyfor lower extremity limb salvage.Training opportunities include dedicatedVascular Surgery conferences held eachMonday morning, when faculty andtrainees all have protected time to attend.These include multidisciplinary clinicalcase conferences, morbidity and mortalityconference, monthly vascular laboratoryconference, clinical and basic scienceresearch conferences, and journal clubs.Vascular laboratory training includesdedicated, supervised case reviewto complete the requirements forcredentialing as an MD reviewer. Theresidency has weekly joint conferenceswith the General Surgery ResidencyTraining Program as well as patientsimulation experiences built into thetraining program.The Vascular Programs at MHMH havebeen successful academically in manyregards. Residents and fellows haveproduced numerous scientificpresentations at regional, national,and international meetings, numerouspeer-reviewed publications, and awardsat our national meeting in multipleyears. The Program has been quitesuccessful in training academic vascularsurgeons, with the large majority ofour trainees joining the faculty atacademic teaching institutions.38


DARTMOUTH-HITCHCOCK — PERFECT BLEND OF HIGH TECHNOLOGY IN A RURAL SETTINGDARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201239


GLOBAL SURGERY INITIATIVEKurt K. Rhynhart, MDAssistant Professor of SurgeryGeneral SurgeryUnder the stewardship of RichardFreeman, MD, the Department of Surgeryis increasing its global surgery efforts. Incollaboration with Dartmouth College,Geisel School of Medicine, Dartmouth-Hitchcock (D-H), and Partners In Health(PIH), Dr. Freeman demonstrated hiscommitment to global surgery earlyin his tenure as Chair by deploying amultidisciplinary surgical team in responseto the Haitian earthquake of 2010. Sincethat initial effort, Rajan Gupta MD, Chiefof the Division of Trauma and AcuteSurgical Care, has continued to work withPIH by supporting the construction of anew hospital facility in the town ofMirebalais, Haiti.More recently, we have begun to focusadditional resources in Africa. At present,we are working with local physicians inTanzania; our goal is to advise and assistefforts to improve health care deliveryand to improve the quality of surgicaloutcomes in the developing world.Drs. Freeman, Finlayson, and Rhynharttravelled to Muhambili UniversityHospital in Dar es Salaam,Tanzania in thespring of 2012 as the guests of the Chiefof Surgery, Dr. Mchembe. We spent anumber of days touring their facility,meeting the staff, and learning abouthealth care in Tanzania. Aims of the tripwere to explore mutually beneficialcollaborations in the clinical, research, andeducational arenas. This initial trip forgedrelationships that resulted in a journeyto Dartmouth for a Tanzanian medicalstudent named Gloria Ngaiza. Ms. Ngaizaspent the summer of 2012 observingvarious surgical services including surgicaloncology and plastic surgery. As recentlyas August, 2012, Dr. Finlayson returned toTanzania to assist with a SAGES sponsoredlaparoscopic course which was wellreceived by the Tanzanian surgeons hementored. We look forward to supportingsimilar reciprocal exchanges of medicalstudents, surgical residents, and staffsurgeons in the coming years. We also aredeveloping relationships in Rwanda. TheHuman Resources for Health (HRH)Program was established to build thehealth education infrastructure and healthcare workforce in order to create asustainable quality health care system inRwanda. The HRH Program is aconsortium of academic institutions that40


GLOBAL SURGERY INITIATIVEare committed to sending full-time faculty to Rwanda toimprove teaching, research, curriculum development, andmentorship over a seven year period. Surgeons, internists,nurses, midwives, and dentists will be amongthe healthcare professionals included in thisendeavor. Drs. Finlayson and Freeman,in partnership with Lisa Adams, MD(Infectious Disease), who leads this efforthere at Dartmouth-Hitchcock, have securedpositions for surgeons as well. Geisel Schoolof Medicine has committed resources to theProgram including two full-time FTE’s fromthe Department of Surgery. NickPerencevich MD (DC ‘69 and DMS ‘72), a long timeDartmouth resident educator and surgeon at ConcordHospital, arrived in Rwanda representing Dartmouth-Hitchcock in August. Dr. Perencevichreports that despite some anticipatedgrowing pains, he has been up andoperating. He even performed a case lateon a Saturday night (apparently a rare eventin that hospital). I am not sure how totranslate Dr Perencevich’s nickname,“Nickat Night”, into Kinyarwanda, but we willlearn.DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 2012 41


PANCREAS AUTOISLET CELL TRANSPLANT PROGRAMKerrington D. Smith, MDAssistant Professor of SurgeryGeneral SurgeryIn 2012, Dartmouth-Hitchcock(D-H) initiated a new programfor patients with a history ofchronic pancreatitis who livewith severe, unrelenting pain.Chronic pancreatitis is a life-longcondition that results from avariety of factors includingmutations in the CF gene,hypertriglyceridemia, abnormalductal development, and alcoholabuse. Patients frequently havesevere pain resulting in chronicnarcotic dependence, employmentdisability, and depression.Chronic pancreatitis requiresa multi-disciplinary careapproach including pancreatology,interventional gastroenterology,pain management, social work,and surgery. Medical managementof this condition can improvenutrition, manage malabsorptionfrom exocrine insufficiency,and improve pain managementleading to reduced narcoticrequirements. However, forpatients who fail medicalmanagement, surgery offersimproved pain control.Traditional surgical approaches forpatients with chronic pancreatitis includeprocedures to improve drainage, partialresection of the head of the pancreas, ortotal pancreatectomy. As these proceduresremove functional endocrine tissue,patients frequently develop brittle type 1diabetes, further impairing their qualityof life.The autoislet cell transplant procedureinvolves total or near total pancreatectomy,recovery of the islet cells from theresected specimen, and reinfusion of theislets into the patient’s liver via the portalvein. The islets function within theliver restoring glycemic control. In thelargest series, two-thirds of patientsremained insulin free or required only alow dose of insulin. These patients arelargely pain free or on minimal doses ofnarcotics.On May 2, 2012, D-H performed ourfirst autoislet transplant. Our patient wasa young man who underwent a subtotalpancreatectomy for a disrupted pancreaticduct from severe pancreatitis. Heunderwent a series of complex endoscopicinterventions by Timothy Gardner, MD.Despite these procedures, he hadpersistent pain. Surgeons KerringtonSmith, MD and David Axelrod, MDremoved the distal, 80% of the patient’spancreas. Dr. Axelrod then drove thepancreas to our partners at MassachusettsGeneral Hospital where the islets wererecovered, while Dr. Smith completedthe surgical reconstruction. Dr. Axelrodthen returned and together they infusedthe islets into the liver. Interestingly,the patient developed hyperglycemiarequiring insulin infusion duringthe time that the islets were beingrecovered. Following infusion, hisinsulin requirement abated. He is nowinsulin free, off narcotics, and verysatisfied.We have several additional patientswho are currently completing theirmultidisciplinary evaluation and arebeing prepared for transplant. Thereare currently no other programs in theNorth Eastern United States activelypursuing this innovative approach. Weanticipate a significant growth in theProgram given the large pancreatologycare team lead by Dr. Gardner, inGastroenterology. We are pleased tohave developed a true, collaborative,multidisciplinary team lead by Drs.Gardner, Axelrod, and Smith.42


STEM CELL AND GENE THERAPY IN THE TREATMENT OFCRITICAL LIMB ISCHEMIARichard J. Powell, MDSection ChiefProfessor of Surgery and RadiologyApproximately eight million Americanssuffer from Peripheral Artery Disease(PAD) which is associated with a 5-yearcardiovascular death risk of 20% to 30%.In its most severe form, PAD manifests asCritical Limb Ischemia (CLI) which isdefined by severely impaired hemodynamicsand chronic ischemic rest pain,ulcers/tissue loss, or gangrene. Mortalityand morbidity due to CLI is high. Upto 20% of patients with CLI will diewithin the first 12 months followingdiagnosis. The 5-year mortality for CLIis in excess of 70%. As many as 40% to50% of patients will undergo major limbamputation within 12 months of diagnosis.The ability of this elderly patientpopulation, with many associated comorbidities,to successfully rehabilitateand maintain an independent livingstatus following major limb amputationis poor.Biologic therapy utilizes various angiogenicgrowth factors or autologous stemcells in an attempt to improve perfusionin areas of ischemia through the developmentof new blood vessels from preexistingblood vessels. This process hasbeen termed therapeutic angiogenesis.The Section of Vascular Surgery atDartmouth-Hitchcock has been nationalleaders in both gene therapy and stemcell therapy for patients with CLI. Todate, Richard Powell, MD has led severalphase II gene and stem cell therapy trialsin patients with critical limb ischemiawith no alternative options for revascularization.Currently, Dr. Powell is thenational PI on a gene therapy trial inCLI patients with poor options for revascularizationand a stem cell trial forpatients with no option for revascularization.The current techniques utilizeautologous stem cells obtained from thebone marrow of the patient. Two differenttechniques are being studied. Thefirst, a small quantity of bone marrow(50 ml) is removed from the iliac crestand sent to the sponsor during whichtime the mesenchymal stem cells areexpanded in a bioreactor over a twoweekperiod. Following this two-weekperiod, the cells are harvested andreturned to the study site at which pointthey are injected into the ischemic limb.The early phase 2 trial demonstrated adecrease in major amputation andwound worsening in treated patientscompared to placebo treated patients.The second technique involves harvesting250 ml of bone marrow. This is thenconcentrated in a proprietary cell separationsystem and then injected at thesame time into the ischemic limb.Preliminary results from the phase 2 trialwere promising.DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 2012 43


2012 AWARDSThe Arthur NaitoveDistinguishedTeaching AwardDavid W. Johnstone, MDThe Arthur Naitove DistinguishedTeaching Award was instituted bythe residents in l997 to recognizea faculty member’s commitmentto the housestaff. The Award ispresented to an attending stafffor their commitment to enhancethe residency educational experience.The 2012 recipient of the ArthurNaitove Distinguished TeachingAward is David W. Johnstone, MD.The Harmes SurgicalScholar AwardDavid Bauer, MDThe Harmes Surgical Scholar Awardis awarded annually to a facultymember(s) at the Assistant or AssociateProfessor level in the Department ofSurgery. The annual financial award isprovided over three years to facilitatecareer development by strengtheningindividual professional skills; enhancingcontributions to the academic, clinical,and administrative programs of theDepartment; improving the regionaland national visibility of DHMC;and increasing each individual’ssense of professional competenceand satisfaction. The Harmes ScholarAward for 2012 was awarded to DavidBauer, MD.The Surgical Chair’s AwardDaniel P. Croitoru, MDEach year, the Chair of the Departmenthas the opportunity to acknowledge thecontribution of an individual, or severalindividuals, through the Chair’s Award.The Award is intended to recognize anindividual’s accomplishments which haveespecially reflected the ideals or goals forthe Department. The 2012 Surgical Chair’sAward recipient is Daniel P. Croitoru, MD.44


2012 AWARDSThe Richard W. Dow CareerDevelopment Award in Surgeryand The Robert W. Crichlow CareerDevelopment Award in SurgeryThe purpose of these two researchawards is to provide protected time forup to 2 early career Department ofSurgery (DOS) faculty members todevelop research programs that willlead to independently funded careersin clinical, translational, or basicSurgical Sciences.These awards arepatterned after NIH MentoredResearch Scientist DevelopmentAwards (K01). The ultimate goalof these awards is to stimulate careerdevelopment in surgical research.The Richard W. Dow CareerDevelopment Award in SurgeryStefan D. Holubar, MDThe Robert W. Crichlow CareerDevelopment Award in SurgeryDavid H. Stone, MDDepartment of Surgery Care Path AwardSection of Thoracic SurgeryCARE PATH TEAM: Katie Abraham, RN, Konstantin Dragnev, MD,Cherie Erkmen, MD, Melissa Friedman, Marcia Lowes, Elizabeth Maislen, APRN,Anne McGowan, PA-C,Wendy Oliver, Ellen Parker, RN, Evelyn Schlosser, RN,Jennifer Snide, Bassem Zaki, MDAwarded to the Section of Thoracic Surgery for their “Esophageal Cancer Care:A Personalized Patient Care Pathway.”DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201245


CLINICAL TRIALS AND RESEARCHDavid A. Axelrod• Transplant Referral Network• Integrated OPTN-Medicare Data Base• VAD/Heart TransplantRichard J. Barth, Jr.• A Randomized Phase II Study of the Effect ofa Low Calorie Diet on Patients UndergoingLiver Resection• A Phase II Multicenter Randomized Trial ofSentinel Lymphadenectomy and CompleteLymph Node Dissection Versus SentinelLymphadenectomy Alone in Cutane• ACOSOG Studies Z10 and Z11M. Shane Chapman• Observational Post-marketing SafetySurveillance Registry of Enbrel (Etanercept)for Treatment of Psoriasis• A 10-Year, Post-marketing, ObservationalStudy of HUMIRA (Adalimumab) in Patientswith Chronic Plaque PsoriasisEunice Chen• Using Tissue Oxygen Profiling to OptimizeWound Healing in Irradiated Tissue• Theranostics for Head and Neck CancerUsing Hypoxia-targeted, FluorescentAntibody-labeled Nanoparticles (HyFAN)• Dartmouth Center of CancerNanotechnology Excellence Pilot Award,'Modulation of Hypoxia to EnhanceNanoparticle Uptake and Tumor pO2 GuidedRadiotherapy with Magnetic Hyperthermia• Identification and Treatment of HypoxicTumors with Nanoparticle HyperthermiaUsing Murine and Spontaneous Pet AnimalHead and Neck Cancer Tumor Models• EPR Oximetry for Enhancing Cancer Therapy• Dartmouth Center for Clinical andTranslational Science Pilot Project Award• Triological Society Career DevelopmentAward• SYNERGY Pilot and Collaborative StudiesAwardMichael C. Chobanian• Identifying Epigenetic Role of CNIs inDetermining Nephron Number and RenalDisease in Offspring of Female SOTRecipientsThomas Colacchio• Advanced Surgical Center for TranslationalResearch at DartmouthLouise Davies• Development of a Thyroid Nodule Registry• Improving Patient Outcomes via the ClinicalImprovement Work of Learners• Evaluation and Updating of the SQUIREGuidelines for Scholarly Reports of QualityImprovement Work• Correct Surgical Instrument Labeling: AQuality Improvement Initiative to PromotePatient SafetyJoseph P. DeSimone• Aortic Stenosis and Pulmonary HypertensionBurton L. Eisenberg• The Molecular Actions of Imatinib Mesylatein Gastrointestinal Stromal Tumors (GIST’s)Cherie P. Erkmen• Fluorescent Imaging Anastomosis ofEsophagectomyMark Fillinger• A Clinical Evaluation of the GORE EXCLUDERBifurcated Endoprosthesis-low Permeabilityin the Primary Treatment of InfrarenalAbdominal Aortic Aneurysms• A Clinical Study Comparing Use of theBifurcated EXCLUDER EndovascularProsthesis to Open Surgical Repair in thePrimary Treatment of Infrarenal AbdominalAortic Aneurysms (AAA)• A Clinical Study Evaluating the Use of theGore Excluder (R) BifurcatedEndoprosthesis-31 mm in the PrimaryTreatment of Infrarenal Abdominal AorticAneurysms (AAA)• A Phase III Evaluation of the Safety andEfficacy of the AneuRx Stent Graft System inthe Treatment of Abdominal AorticAneurysm (AAA)• A Prospective, Multicenter Study of the AribaStent Graft System for the Treatment ofAbdominal Aortic Aneurysms• Abdominal Aortic Aneurysms: Analysis ofPatient Characteristics and Anatomy Relatedto EVAR Treatment and Outcomes (AAA-CARE)• Aneurysm Rupture Risk Analysis• Branched-fenestrated Endograft Repair ofThoracoabdominal Aortic Aneurysms• “Characterization of Human AorticAneurysm Anatomy Project (CHAP)”, CriticalPath Initiative, US FDA• Detection of Aneurysm Size ChangeFollowing Endovascular Repair• Endologix Bifurcated Powerlink Stent SystemClinical Study (Size 34 mm InfrarenalBifurcated Stent Graft)• Endurant Stent Graft System US ClinicalStudy-A Prospective, Single-Arm, Non-Randomized, Multi-Center Clinical Study• Evaluation of EndoRefix EndovascularDelivery System and Staple Study• Evaluation of the Gore Conformable TAG®Thoracic Endoprosthesis for the PrimaryTreatment of Aneurysm of the DescendingThoracic Aorta, GORE TAG• Evaluation of the Safety and Efficacy of theMedtronic AVE Talent Thoracic Stent GraftSystem for the Treatment of Thoracic AorticAneurysms Medtronic AVE• Lifeline Foundation Post MarketingSurveillance Registry of EndovascularAneurysm Repair• Lifepath AAA Bifurcated Graft SystemClinical Study• “Multicenter Aneurysm Rupture Risk Study,”Medical Metrx Solutions• Post Approval Study Evaluating the LongTerm Safety and Effectiveness of theEndurant Stent Graft System (ENGAGE PAS)• PRESERVE – Zenith Iliac Branch SystemClinical Study• Prospective Aneurysm Trial: High AngleAorfix Bifurcated Stent Graft-PythagorasStudy• Prospective, Multicenter, RandomizedControlled Trial of Endovascular AneurysmRepair Using a Bilateral PercutaneousApproach (PEVAR) vs Standard Approach(SEVAR) Using the IntuiTrak EndovascularAAA Delivery System and the Prostar XL orPerclose ProGlide Suture-Mediated ClosureSystem• Prospective, Multicenter, Single Arm Safetyand Effectiveness Trial of the EndologixFenestrated Stent Graft System for theEndovascular Repair of Juxtarenal /Pararenal(JAA/PAA) Aneurysms• STARZ-TX2 (Study of Thoracic AorticAneurysm Repair with the Zenith TX2Thoracic TAA Endovascular Graft)• The Pivotal Study of the Aptus EndovascularAAA Repair System• Zenith TX2 Thoracic Aortic Aneurysm (TAA)Endovascular Graft Post-market ApprovalStudy• Zenith® Fenestrated AAA EndovascularGraft Clinical Study• Zenith® TX2® Low Profile TAA EndovascularGraft Clinical StudyRichard B. Freeman• Long Term Outcome for Liver Transplantationfor Heptocellular Carcinoma• Improve Preservation of KidneysPhilip Goodney• Towards Cost and Cost Effectiveness withCarotid Artery Stenting and Endarterectomy• Comparison of Open and EndovascularTreatment of Popliteal Aneurysms• Understanding Regional Variation inTreatment Intensity with PAD• Development of a Disease-specific Quality ofLife Measure for Patients with Critical LimbIschemia• Understanding Regional Variation inTreatment Intensity with PAD46


CLINICAL TRIALS AND RESEARCH• Development of a Glucose ManagementService for Vascular Surgery Patients• Development of Patient-centered OutcomesAssessment Tools for Patients with CriticalLimb Ischemia Following ExtremityRevascularization• Regional Variation in Treatment Intensitywith Lower Extremity PADE. Ann Gormley• Examining Outcomes IncludingComplications with PV Slings Done at theOSC• UITN Steering Committee ChairDaniel B. Herz• Creation of Longitudinal Database forChildren Born with Prenatal Hydronephrosisin the State of New Hampshire and Vermontfor the Quality Improvement and BestPractice OutcomesP. Jack Hoopes• Advanced Surgical Training Center (ASC) atDartmouth-Hitchcock• Biological and Physical Determinants forOptimal PDT• Brain Tumor Fluorescent as a Real-timeMarker for Brain Movement /Deformationduring Surgery• Clinical and Basic Science Investigations forIron Oxide Nanoparticle Hyperthermia andCancer Treatment• Dartmouth Center for CancerNanotechnology Excellence• Development and Assessment of a NovelCardiac/Respiratory Monitoring NeonatalFeeding Tube Combination• Electrical Impedance-based Imaging of BrainCompliance in an Animal Model• Evaluation of Healing, Inflammation, andStrength of a Novel Closure Device• Evaluation of Prototype ElectrosurgicalInstruments• Fluorescence Imaging to Optimize CancerTherapy• Modeling of Brain Deformation duringSurgery• Molecular Response and Imaging-basedCombination Strategies for Optimal PDT• Multi-project Institutional NanotechnologyGrant Focused on the Use of Antibody andNonantibody Targeted MagneticNanoparticles and AMF Treatment of Breastand Ovarian Cancer• Natural Oriface Transluminal Surgery Study• Noninvasive Biochemical-based CorneaReshaping• Spinal Cord cooling to Reduce Cord Injury• Whole Animal Optical and ComputedTomography• Improve Preservation of KidneysPaul Kispert• Fogarty International Clinical ResearchScholars Support Center @ Vanderbilt-AAMCMary Jo Mulligan-Kehoe• The Anti-Angiogenic Mechanisms of PAI-1Brian W. Nolan• Quality of Life Measures in Patients withAAAVernon M. Pais• Effect of Ureteral Access Sheath on RenalHemodynamics• Management of Ureteral Calculi usingUltrasound Guidance• 24-Hour Urinary Risk Parameters for StoneFormationSusan Pepin• Neuro-Ophthalmological Predictors ofPreclinical Alzheimer’s Disease: A StudyUsing Frequency Doubling Technology• A 24-Month Double-blind, Randomized,Multicenter, Placebo-controlled, ParallelgroupStudy Comparing the Efficacy andSafety of 0.5 mg and 1.25 mg Fingolimod(FTY720) Administered Orally Once Daily vs.Placebo in Patients with Relapsing-remittingMultiple Sclerosis• Functional MRI, Diffusion Tensor Imagingand Eye Movement Recordings of Patientswith Saccadic Palsies FollowingHypothermic Cardiac Arrest for AorticSurgerySarah N. Pletcher• Rural Health Care Services Outreach GrantProgramBrian Pogue• Micro CT/NIR Molecular Imaging of Cancer• NIRFAST• Alternative Breast Cancer ImagingModalities; Project IV• A Boundary Element Method for HighResolution MRI/NIR Imaging andMicroCT/Fluorescence Tomography• Frequency Domain Optical Imaging of BreastCancer• Optical Imaging Fused with Tomosynthesisfor Improved Breast Cancer• Molecular Response and Imaging-basedCombination Strategies for Optimal PDT• A Spatially-modulated Scatter ImagingSystem to Detect Tumor-Associated Stroma• Raman Markers of AllograftOsseointegration• Dartmouth Center for CancerNanotechnology Excellence (DCCNE)• Targeted Photoactivable Nancells ImagebasedDrug Delivery and Dosimetry in GBM• Fluorescence Imaging to Optimize CancerTherapyRichard J. Powell• Carotid Revascularization Endarterectomyvs. Stent Trial• Randomized Double-blind Placebocontrolled,Parallel-group Multicenter DoseSelection Study of Ad2/Hypoxia InducibleFactor-1 / vp16 in Patients with IntermittentClaudication• Phase II Double-blind, Randomized, PlaceboControlled Study to Assess the Safety andEfficacy of AMG0001 to Improve Perfusionin Critical Leg Ischemia in Subjects whohave Peripheral Ischemic Ulcer• Phase II trial; Use of Tissue Repair Cells(TRCs – Autlogous Bone Marrow Cells) inPatients with Peripheral Arterial Disease toTreat Critical Limb IschemiaDavid W. Roberts• Electrical Impedance-based Imaging of BrainCompliance in an Animal Model.• Magnetic Resonance Elastography inHydrocephalus.• RNS System Long Term Treatment ClinicalInvestigation• Microelectrodes in Epilepsy.• Coregistered Fluorescence-EnhancedResection of Malignant Glioma• Advanced Surgical Center for TranslationalResearch at Dartmouth• Mechanisms of Cognitive ImpairmentFollowing Early Life Seizures.• Preoperative Image Updating for GuidanceDuring Brain Tumor ResectionJoseph Rosen• AFIRMKari Rosenkranz• Need for Sentinel Node Biopsy in PapillaryCarcinoma of the Breast• Do Intraoperative Steroids Alter Outcomes inWomen with Breast Cancer• The Role of Local Anesthetic 'BATH' inWomen Undergoing Breast SurgeryEva Rzucidlo• Randomized Controlled Study ComparingTreatment of Femoropopliteal Disease withPrimary Stenting and Post Angioplasty vs.Primary Stenting and Post Cryoplasty• Statin Regulation of Connective TissueGrowth Factor in Restenosis• Effect of Smoking on the mTOR Pathway in aMouse Model• Role of CTGF in Vascular Remodeling• Determination of a Subpopulation of VSMChaving Elevated CTGFDARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201247


CLINICAL TRIALS AND RESEARCHJames E. Saunders• Automated System for DigitalMeasurements of Ear Canal Geometry• Chart Review of Semicircular CanalDehiscence: Review of Clinical andRadiographic Findings in 500 Patients• Cost Effectiveness Model for CochlearImplants in Low Resource Settings• Genetic Hearing Loss in Rural NicaraguanFamilies• Hearing Loss and Heavy Metal Exposure inArtesinal Gold Miners• Hearing Loss in HIV children in ZimbabweOtitis Media in HIV Children in Tanzania• Symptomatology and Quality of Life inAcoustic Neuroma Patients• Temporal Bone Abnormalities in Childrenwith CDH23 Hearing LossMark D. Savellano• New Strategies forPhotoimmunodetection/TherapyJohn D. Seigne• Electrical Property Based Image-guidedProstate Biopsy• Immunotherapy for Renal Cell Carcinoma• A Tumor Tissue Pharmacodynamic Study ofModified Neoadjuvant Chemotherapy forMuscle-invasive Non-metastatic TransitionalCell Bladder Carcinoma• Identification of Accessible Biomarkers ofBladder Cancer Treatment Response,Recurrence, and Progression• Development of a Multi-modal ImageGuidance System to Accurately IdentifyTumor Location within the Didney duringRobot-assisted Laparoscopic PartialNephrectomy (RALPN).• A Pilot Project to Investigate the Ability of• Atomic Force Microscopy to IdentifyMalignant Cells in the UrineNathan Simmons• Translational Development of ImplantableResonators for EPR Oximetry of DeepTumors and Tissues in a Large Animal Model• Co-registered Fluorescence–enhancedResection of Brian Tumors Stage I:Correlation with MR and BiopsyKerrington Smith• Dow Career Development Award in Surgery– Development of an In Vivo Platform forIndividualized Therapy for Pancreas Cancerat Dartmouth-HitchcockDavid H. Stone• Contemporary Results of Thoracic andThoracoabdominal Aneurysms inContemporary Practice• Depression, A Potential Novel Risk Factor forPeripheral Vascular Disease• SVS Clinical Seed GrantMitchell A. Stotland• Implicit Attitudes Towards Facial Difference• Prospective Cohort Study to DetermineManagement of Isolated Orbital FloorFractures• Adolescents Contemplating FacialReconstructive Surgery: Assessing the Needfor Decision Support• Botox Injection Interval and the PotentialPermanence of Targeted Muscle Paralysis• The Psychological and Social Effects ofGlabellar Botox Cosmetic (botulinum toxintype A)• fMRI Responses of Normal Adults to FacialCleft DisfigurementThadeus Trus• A Novel Laparoendoscopic AnastomoticDevice Development, Testing in a PorcineModel• Evaluation of Overstitch Tissue ClosureStrength, Bench Testing (Porcine SurvivalStudies will be Industry Funded)• Development of a Laparoendoscopic AntirefluxProcedure using Overstitch inDevelopment• Direct Drive Surgical SystemDale C. Vidal• Implementing Shared Decision Making inClinical Practice: Helping Patients withSpinal Stenosis Make a Treatment Decision:A Randomized Study Assessing the Benefitsof Health Coaching• Implementing Shared Decision Making inClinical Practice• Mastectomy Reconstruction OutcomesConsortium (MROC)• Quality of Life and Patient-reportedOutcomes of Reconstruction in BreastCancer Survivors• High Value Healthcare Collaborative:Engaging Patients to Meet the Triple Aim• Continued Access Study of the MentorContour Profile Gel• Study of the Safety and Effectiveness of theMentor Contour Profile Gel MammaryProsthesis in Subjects who are UndergoingPrimary Breast Augmentation, PrimaryBreast ReconstructionMichael E. Zegans• Standardization of Uveitis NomenclatureStudy (SUN)• Steroids for Corneal Ulcers Trial• Mycotic Ulcer Treatment TrialKathryn A. Zug• Genetic Predisposition to Allergic ContactDermatitis48


PUBLICATIONSCT SurgeryLawrence J. DaceyDacey LJ. Endoscopic Vein Harvest Is Safe forCABG Surgery (Editorial) JAMA 2012; 308(5): 512-513Goldberg JB, DeSimone JP, Kramer RS, DiScipioAW, Russo L, Dacey LJ, Leavitt BJ, Helm RE,Baribeau YR, Sardella G, DiPierro FV, Surgenor SD,Sorensen MJ, Ross CS, Olmstead EM, MacKenzieTA, Malenka DJ, Likosky DS. The Impact of Pre-Operative Left Ventricular Ejection Fraction onLong-Term Survival After Aortic ValveReplacement for Aortic Stenosis. Circ CardiovascQual Outcomes. (Accepted)Joseph P. DeSimoneGoldberg JB, DeSimone JP, Kramer RS, DiScipioAW, Russo L, Dacey LJ, Leavitt BJ, Helm RE,Baribeau YR, Sardella G, DiPierro FV, Surgenor SD,Sorensen MJ, Ross CS, Olmstead EM, MacKenzieTA, Malenka DJ, Likosky DS. The Impact of Pre-Operative Left Ventricular Ejection Fraction onLong-Term Survival After Aortic ValveReplacement for Aortic Stenosis. Circ CardiovascQual Outcomes. (Accepted)Anthony W. DiScipioLikosky DS, Goldberg JB, DiScipio AW, KramerRS, Groom R, Leavitt BJ, Surgenor SD, BaribeauYR, Charlesworth DC, Helm REJ, Frumiento C,Sardella GL, Clough RA, MacKenzie TA, MalenkaDJ, Olmstead EM, Ross CS. Variability in Surgeons’Perioperative Practices May Influence theIncidence of Low Output Failure After CoronaryArtery Bypass Grafting Surgery. Circ CardiovascQual Outcomes. 2012 (In press)Korach A, Di Eusanio M, Greason K, MontgomeryD, Voehringer M, Harris K, DiScipio A, Fillinger M,Fattor R, Trimarchi S, Conklin LD, Eagle K,Isselbacher E, Nienaber C, Gilon D. Long-TermFollow-Up in Marfan Patients After SuccessfulSurgery for Acute Type A Aortic Dissection. TheIrad Experience. J Am Coll Cariol.2012;59(13sl):E1900-E1900. Doi:10.1016/S0735-1097(12)61901-9Zlotnick D, Ouellette ML, Leavitt B, Malenka D,Baribeau Y, Helm R, DiScipio A, Sardella L, RussoL, Klemperer JD, Quinn, R, Sisto D, Likosky D,Olmstead EM, O’Rourke D. Severe PulmonaryHypertension is an Independent Predicator of In-Hospital Mortality and Acute Kidney Injury AfterAortic Valve Replacement for Severe AorticStenosis. J Am Coll Cardiol 2012;59(13sl):E894-E894. Doi:10/1016/S0735-1097(12)60895-XGoldberg JB, DeSimone JP, Kramer RS, DiScipioAW, Russo L, Dacey LJ, Leavitt BJ, Helm RE,Baribeau YR, Sardella G, DiPierro FV, Surgenor SD,Sorensen MJ, Ross CS, Olmstead EM, MacKenzieTA, Malenka DJ, Likosky DS. The Impact of Pre-Operative Left Ventricular Ejection Fraction onLong-Term Survival After Aortic ValveReplacement for Aortic Stenosis. Circ CardiovascQual Outcomes. (Accepted)Cherie P. ErkmenErkmen CP, Wang H, Czum J, Paydarfar JA. Useof Cervicothoracic Anatomy as a Guide forDirected Drainage of Descending NecrotizingMediastinitis. Ann Thorac Surg. 2012 Apr; 93(4):1293-1294DermatologyDenise M. AaronMeyer A, Aaron DM, Guill M, Perry A.Erythematous Reticular Patches: A RarePresentation of Mid-Dermal Elastolysis. Accepted.J Am Acad Derm. Nov 2011M. Shane ChapmanChapman MS. Vitamin H: History, Current Usesand Controversies. Semin Cutan Med Surg2012;31: 11-16Chapman MS. Medical Education on the Brink(Letter to the Editor). Texas Heart Institute Journal2012; 39:602Marshall A. GuillMeyer A, Aaron DM, Guill M, Perry A.Erythematous Reticular Patches: A RarePresentation of Mid-Dermal Elastolysis. Accepted.J Am Acad Derm. Nov 2011Faramarz H. SamieHirokawa D, Woldow AB, Nussen Lee S, Samie F.Treatment of Reecalcitrant Herpes Simplex Viruswith Topical Imiquimod. Curtis. 2011 Dec; 88(6):276-277General SurgeryGina L. AdralesGina L. Adrales. Giant Prosthesis Repair. InJones DB. (ed) Master Techniques in GeneralSurgery: Hernia Surgery. Lippincott, Williams andWilkins. 2012Richard J. Barth Jr.Pipas J, Zaki B, McGowan M, Tsapakos M,Suriawinata A, Ripple G, Tsongalis G, Colacchio T,Gordon S, Tarczewski S, Sutton J, Srivastava A,Smith K, Gardner T, Davis T, Korc M, MacKenzie T,Barth R. A Phase II Trial of Cetuximab, Twice-Weekly Gemcitabine, and Intensity ModulatedRadiotherapy in Patients with PancreaticAdenocarcinoma. Annuals of Oncology (In press)Davis K, Barth R, Gui J, Dann E, Rosenkranz K.The Use of MRI in the Pre-Operative Planning forWomen with Newly Diagnosed DCIS: Risk orBenefit? Annual of Surgical Oncology (In press)Barth RJ and Dietrich A. Colorectal Cancer. In:Rose M, DeVita V, Lawrence T and Rosenberg Sed. Oncology for the Primary Care Provider.Lippencott Williams and Wilkins, Phil PA, 2012 (Inpress)Kenneth W. BurchardBurchard KW. The Clinical Handbook forSurgical Critical Care, second edition. London:Informa Publishing, 2012Burchard KW, Braisel K, Cappela J, Pritts TA.Shock. In Essentials of General Surgery. FifthEdition (Editor: Lawrence PF), Williams andWilkins, 2012.Thomas A. ColacchioPipas J, Zaki B, McGowan M, Tsapakos M,Suriawinata A, Ripple G, Tsongalis G, Colacchio T,Gordon S, Tarczewski S, Sutton J, Srivastava A,Smith K, Gardner T, Davis T, Korc M, MacKenzie T,Barth R. A Phase II Trial of Cetuximab, Twice-Weekly Gemcitabine, and Intensity ModulatedRadiotherapy in Patients with PancreaticAdenocarcinoma. Annuals of Oncology (In press)Bertagnolli MM, Redston M, Compton CC,Niedzwiecki D, Mayer RJ, Goldberg RM,Colacchio TA, Saltz L, Warren RS. MicrosatelliteInstability and Loss of Heterozygosity atChromosome Location 18q: ProspectiveEvaluation of Biomarkers for State II and III ColonCancer – A Study of CALGB 9581 and 89803;Journal of Clinical Oncology 29 (23): 3153-3162,2011 AugBurton L. EisenbergVan den Abbeele AD, Eisenberg BL. ACRIN6665/RTOG 0132 – Phase II Trial of NeoadjuvantImatinib Mesylate for Operable MalignantGastrointestinal Stromal Tumor: Monitoring withFDGPET and Correlation with Genotype andGLUT4 Expression. J Nucl Med 2012; 53: 567-574.Kane JM, Harris J, Kraybill WG, Harmon DC,Ettinger DS, Lucas DR, Delaney TF, Wang D, CurranWJ, Eisenberg BL. Thromboembolic EventsAssociated with Thalidomide and MultimodalityTherapy for Soft Tissue Sarcomas: Results ofRTOG 0330. Sarcoma 10.1155/2012/659485 Epub2012 April 24.Horace F. HenriquesRowland PA, Trus TL, Lane NP, Henriques H,Reed WP, Sadighi PJ, Sutton JE, Alseidi AA,Cahalane MJ, Gauvin J, Pofahl WE, Sartorelli K,Goldin SB, Greenburg AG. The CertifyingExamination of the American Board ofSurgery: The Effect of ImprovingCommunications & Professional Competency:Twenty – Year Results. J. Surg Ed. 69(1): 118-125, 2012.Stefan D. HolubarWallaert J, De Martino RR, Marsicovetere P,Goodney P, Murray JJ, Finlayson SR,Holubar SD. Post-Operative ThromboembolicEvents after Surgery for Inflammatory BowelDisease: Are There Modifiable Risk Factors?Data from the ACS-NSQIP. Diseases of theColon Rectum (In press)DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201249


PUBLICATIONSHolubar SD. An Economic Analysis of Medicaland Surgical Therapy for Chronic UlcerativeColitis: A Population-Based Study in OlmsteadCounty, Minnesota. Mayo Clinic Master Thesis(In press)Selvasekar CR, Holubar SD, Pendlimari R,Kennedy GD, Harmsen WS, Harrington JR,Nelson H. Assessment of ScreeningColonoscopy Competency in Colon and RectalSurgery Fellows: A Single InstitutionExperience. J Surg Res 2011 Oct 14.Pendlimari R, Holubar SD, Dozois EJ, LarsonDW, Pemberton JH, Cima RR. TechnicalProficiency in Hand-Assisted LaparoscopicColon and Rectal Surgery: Determining HowMany Cases Are Required to Achieve Mastery.Arch Surg. 2011 Dec 19.Ziegenfuss JY, Burmeister KR, Harris A,Holubar SD, Beebe TJ. Telephone Follow-Upto a Mail Survery. When to Offer an InterviewCompared to a Reminder Call. BMC MedicalResearch. BMC Medical ResearchMethodology 2012, 12:32 doi.1186/1471-228-12-32. Published: 20 March 2012Chatterjee A, Holubar SD, Figy S, Chen L,Montagne SM, Rosen J, DeSimone J.Application of Total Care Time and Paymentper Unit Time Model for PhysicianReimbursement for Common General SurgeryOperations. JACS (In press)Paul H. KispertKispert PH. Major Hepatic Trauma: WhenFailure May be a Success. Accepted EditorialArchives of Surgery 2012Kari M. RosenkranzDavis K, Barth R, Gui J, Dann E, Rosenkranz K.The Use of MRI in the Pre-Operative Planningfor Women with Newly Diagnosed DCIS: Risk orBenefit? Annual of Surgical OncologyKerrington SmithPipas J, Zaki B, McGowan M, Tsapakos M,Suriawinata A, Ripple G, Tsongalis G, ColacchioT, Gordon S, Tarczewski S, Sutton J, SrivastavaA, Smith K, Gardner T, Davis T, Korc M,MacKenzie T, Barth R. A Phase II Trial ofCetuximab, Twice-Weekly Gemcitabine, andIntensity Modulated Radiotherapy in Patientswith Pancreatic Adenocarcinoma. Annuals ofOncology (In press)Thadeus L. TrusRowland PA, Trus TL, Lane NP, Henriques H,Reed WP, Sadighi PJ, Sutton JE, Alseidi AA,Cahalane MJ, Gauvin J, Pofahl WE, Sartorelli K,Goldin SB, Greenburg AG. The CertifyingExamination of the American Board of Surgery:The Effect of Improving Communications &Professional Competency: Twenty – YearResults. J. Surg Ed. 69(1):118-125, 2012.Greer S, Trus TL.Foreign Bodies and Bezoarsin the Small Intestine. In McFadden D (ed):Shackelford’s Surgery of the Alimentary Tract,7th Edition, Elsevier (In press)Honigsberg E, Trus TL. ParaescophagealHernia. In Dimick JB (ed): Clinical Scenarios inGeneral Surgery. Lippincott Williams & Wilkins.(In press)Kilbansky DA, Trus TL. Anemia, in ThompsonC (ed): Bariatric Endoscopy, Springer. (In press)NeurosurgeryPerry A. BallSteinmetz MP, McCormick W, Valadka A,Ball PA, Yazbek PA, Benzel EC. PenetratingSpinal Cord Injuries. In Benzel (ed): SpineSurgery. Techniques, Complications,Avoidance, and Management. Third Edition.Philadelphia: Elsevier, 2012Lollis SS, Ball PA: Medical Management of thePatient with Acute Spinal Cord Injury. In Benzel(ed): Spine Surgery: Techniques, ComplicationsAvoidance, and Management. Third Edition.Philadelphia: Elsevier, 2012Ball PA, Morone M. Spinal Traction. In Benzel(ed): Spine Surgery: Techinques, ComplicationsAvoidance, and Management. Third Edition.Philadelphia: Elsevier, 2012Fanciullo GJ, Ball PA. Spinal Cord Stimulationand Intraspinal Infusions for Pain. In Quinones-Hinojosa (ed): Schmidt & Sweet OperativeNeurosurgical Techniques: Indications,Methods, and Results. Six Edition. Philadelphia:Elsevier, 2012Stuart S. LollisLollis SS, Ball PA: Medical Management of thePatient with Acute Spinal Cord Injury. In Benzel(ed): Spine Surgery: Techniques, ComplicationsAvoidance, and Management. Third Edition.Philadelphia: Elsevier, 2012David W. RobertsValdes PA, Kim A, Leblond F, Conde O, HarrisBT, Paulsen KD, Wilson B, Roberts DW:Combined Fluorescence and ReflectanceSpectroscopy for in Vivo Quantification ofCancer Biomarkers in Low and High GliomaGrade Surgery. Journal Biomedical Optics16(11):11607-1-14, 2011Belden CJ, Valdes PA, Ran C, Pastel DA,Harris BT, Fadul CE, Israel MA, Paulsen KD,Roberts DW: Genetics of Glioblastoma: AWindow into its Imaging and HistopathologicVariability. Invited Review, Radiographics 2011Oct 31: 1717-1740. PMID: 21997991Leblond F, Ovanesyan Z, Davis SC, Valdes PA,Kim A, Wilson BC, Hartov A, Pogue BW, PaulsenKD, Roberts DW: Analytic Expression ofFluorescence Ratio Detection Correlates withDepth in Multi-Spectral Sub Surface Imaging.Review. Phys Med Biol 56(21): 6823-6837, 2011Valdes PA, Jacobs VL, Paulsen KD,Roberts DW, Leblond F: In Vivo FluorescenceDetection in Surgery: A Review of Principles,Methods, and Applications. Current MedicalImaging Reviews, 2011Konecky SD, Owen CM, Rice T, Valdes PA,Kolste K, Wilson BC, Leblond F, Roberts DW,Paulsen KD, Tromberg TJ: Spatial FrequencyDomain Tomography of Protoporphyrin IXFluorescence in Preclinical Glioma Models. JBiomed Optics 17(5): 056008. May, 2012Valdes PA, Leblond F, Kim A, Wilson BC,Paulsen KD, Roberts DW: A Spectrally-Constrained Normalization Technique forProtoporphyrin IX Qualification inFluorescence-Guided Surgery. Opt Lett: 37(11):1817-1819, 2012 June. PMID 22660039Bekelis K, Radwan TA, Desai A, Roberts DW:Frameless Robotic Sterotactic Biopsy:Feasibility, Diagnostic Yield and Safety. JNeurosurg 116(5): 1002-1006, 2012 MayDesai A, Bekelis K, Darcey TM, Roberts DW:Surgical Techniques for the Investigating theRole of the Insula in Epilepsy: A Review.Neurosurg Focus 32(3):E6, Mar 2012Evans LT, Morse R, Roberts DW: EpilepsySurgery in Tuberous Sclerosis: A Review.Neurosurg Focus 32(3);E5, Mar 201250


PUBLICATIONSJarvis LA, Simmons NE, Bellerive M, Erkmen K,Eskey CJ, Gladstone DJ, Hug EB, Roberts DW,Hartford AC: Tumor Bed Dynamics AfterSurgical Resection of Brain Metastases:Implications for Postoperative Radiosurgery. IntJ R (In press)Roberts DW, Valdes PA, Harris BT, Hartov A,Fan X, Ji S, Pogue BW, Leblond F, Tosteson TD,Wilson BC, Paulsen KD: Adjuncts forMaximizing Resection: 5-ALA. Neurosurg2012;59: 75-78.Hartford AC, Paravati AJ, Spire WJ, Jarvis LA,Fadul CE, Rhodes H, Erkmen K, Friedman J,Gladstone DJ, Hug EB, Roberts DW, SimmonsNE: Postoperative Sterotactic Radiosurgery(SRS) Without Whole-Brain Radiation Therapy(WBRT) for Brain Metastases: Potential Role ofPreoperative Tumor Size. IJROBP (In press)Nathan E. SimmonsJarvis LA, Simmons NE, Bellerive M, ErkmenK, Eskey CJ, Gladstone DJ, Hug EB, Roberts DW,Hartford AC: Tumor Bed Dynamics AfterSurgical Resection of Brain Metastases:Implications for Postoperative Radiosurgery. IntJ R (In press)Hartford AC, Paravati AJ, Spire WJ,Jarvis LA, Fadul CE, Rhodes H, Erkmen K,Friedman J, Gladstone DJ, Hug EB, Roberts DW,Simmons NE: Postoperative SterotacticRadiosurgery (SRS) Without Whole-BrainRadiation Therapy (WBRT) for Brain Metastases:Potential Role of Preoperative Tumor Size.IJROBP (In press)Hong J, Spire WJ, Simmons NE: Mini-OpenStabilization of a Sacral Fracture. Neurosurgery,(In press)Plastic SurgeryCarolyn L. KerriganChatterjee A, McCarthy JE, Montagne SA,Leong K, Kerrigan CL. A Cost, Profit, andEfficiency Analysis of Performing Carpal TunnelSurgery in the Operating Room versus theClinic Setting in the United States. Ann PlastSurg. 66(3): 245-248, 2011 March.Kerrigan CL, Desmarais T, Burdette T. RegionalBlock for Endoscopic Carpal Tunnel. PlastRecon Surg 127(6), online video, June 2011Burdette T, Kerrigan CL, Homa K. HarmonicScalpel vs Electrocautery in Breast ReductionSurgery. A Randomized Controlled Trial. PlastRecon Surg 128(4): 243(e)-249(e), Oct 2011Kerrigan CL, Slezak S. Evidence-BasedPractice of Breast Reduction: An Update andPractice Gap Analysis. Plast Recon Surg.(Accepted)Kerrigan CL. Video Discussion on“Assessment of Post-Operative VenousThromboembolism Risk in Plastic SurgeryPatients Using the 2005 and 2010 Caprini RiskScore.” (Accepted)Emily B. RidgwayKasper EM, Ridgway EB, Rabie A, Lee BT,Chen C, Lin SJ. Staged Scalp Soft TissueExpansion Prior to Delayed AllograftCranioplasty: A Technical Report. Neurosurgery.2011 Nov 21.OphthalmologySusan M. PepinPatel AV, Lahey TP, Pepin SM. River Blindness:The Value of an Ounce of Prevention.Infectious Diseases in Clinical Practice. 20(3):216-218, May 2012Risacher SL, WuDunn D, Pepin SM, MaGee TR,McDonald BC, Flashman LA, Wishart HA, PixleyHS, Rabin LA, Paré N, Englert JJ, Schwartz ES,Curtain JR, West JD, O’Neill DP, Santulli RB,Newman RW. Visual Contrast Sensitivity in AD,MCI, & Older Adults with Cognitive Complaints.Neurobiology of Aging. (In press)Michael E. ZegansSrinivasan M, Mascarenhas J, Rajaraman R,Ravindran M, Lalitha P, Glidden DV, Ray KJ,Hong KC, Oldenburg CE, Lee SM, Zegans ME,McLeod SD, Lietman TM, Acharya NR. Steriodsfor Corneal Ulcers Trial Group. The Steriods forCorneal Ulcers Trial: Study Design and BaselineCharacteristics. Arch Ophthalmol 2012 130(2):151 – 157.Sy A, Srinivasan M, Mascarenhas J, Lalitha P,Rajaraman R, Ravindran M, Oldenburg CE, RayKJ, Glidden D, Zegans ME, McLeod SD,Lietman TM, Acharya NR. PseudomonasAeruginosa Keratitis: Outcomes and Responseto Corticosteroid Treatment. InvestigativeOphthalmology & Visual Science. 2012 Jan.53(1): 267 -272.O’Toole GA, Wathier M, Zegans ME, ShanksRM, Kowalski R, Grinstaff MW. DiphosphoniumIonic Liquids as Broad-Spectrum AntimicrobialAgents. Corena Jan 10, 2012.Lalitha P, Srinivasan M, Manikandan P, Phil M,Bharathi MJ, Rajaraman R, Ravindran M,Cevallos V, Oldenburg CE, Ray KJ, Toutain-KiddCM, Glidden DV, Zegans ME, McLeod SD,Acharya NR, Lietman TM. Relationship of inVitro Susceptibility to Moxifloxacin and In VivoClinical Outcome in Bacterial Keratitis.Moxifloxacin Susceptibility and BacterialKeratitis Outcome. CID 2012 May; 54(10):1381 – 1387Lalitha P, Prajna V, Venkatesh N, Oldenburg C,Srinivasan M, Tiruvengada K, Jeena M,Vaitilingam CM, McLeod S, Zegans ME, PorcoT, Acharya N, Lietman T. Organism, MinimumInhibitory Concentration, and Outcome in aFungal Corneal Ulcer Clinical Trial. Cornea 2012Jun; 31(6): 662-667Prajna V, Krishnan T, Mascarenhas J, SrinivasanM, Oldenburg CE, Toutain-Kidd C, Sy A, McLeodSD, Zegans ME, Acharya N, Lietman TM, PorcoTC. Predictors of Outcome in Fungal Keratitis.Eye (29 June 2012) doi; 10.1038/eye.2012.99Zegans ME, Wozniak D, Griffin E, Toutain-KiddCM, Hammond JH, Garfoot A, Lam JS.Pseudomonas Aeruginosa ExopolysaccharidePs1 Promotes Resistance to the BiofilmInhibitor Polysorbate 80. Antimicrob. AgentsChemother. Published ahead of print 14 May2012, doi: 10.1128/AAC.00373-12.Lalitha P, Srinivasn M, Rajaraman R, MeenaskiR, Mascarenhas J, Priya JL, Sy A, Oldenburg CE,Ray KJ, Zegans ME, McLeod SD, Lietman TM.Nocardia Keratitis: Clinical Course and Effect ofCorticosteroids. AJO 2012 (Accepted)Pavan-Langston D, Welch K, Zegans ME.Ganciclovir Gel for CytomegalovirusKeratouveitis. Opthal 2012 (Accepted)Ford JR, Tsui E, Lahey T, Zegans ME.Ophthaproblem: Acute Retinal Necrosis.(Accepted)OtolaryngologyJoseph A. PaydarfarErkmen CP, Wang H, Czum J, Paydarfar JA.Use of Cervicothoracic Anatomy as a Guide forDirected Drainage of Descending NecrotizingMediastinitis. Ann Thorac Surg. 2012 Apr; 93(4):1293-1294Maddox PT, Davies L, Paydarfar JA.A 17 yearInstitutional Experience at a Rural AcademicMedical Center. Annals of Otolaryngology. AnnOtol Rhinol Laryngol 2012 Feb; 121(2): 100 –103.DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201251


PUBLICATIONSJames E. SaundersStachler RJ, Chandrasekhar SS, Archer SM,Rosenfeld RM, Schwartz SR, Barrs DM, BrownSR, Fife TD, Ford P, Ganiats TG, HollingsworthDB, Lewandowski CA, Montano JJ, SaundersJE,Tucci DL, Valente M, Warren BE, YaremchukKL, Robertson PJ. Clinical Practice Guideline:Sudden Hearing Loss. Otolaryngol Head NeckSurg. 2012 Mar; 146(3 Suppl): S1 – 35.Surgical Research LabMary Jo Mulligan-KehoeRobbins CS, Chudnovskiy A, Rauch PJ,Figueiredo J-L, IwamotoY, Gorbatov R, EtzrodtM, Weber G, van Rooijen N, Mulligan-KehoeMJ, Libby P, Higgins JM, Nahrendorf M, PittetMJ, Weissleder R, Swirski FK. ExtramedullaryHematopoiesis Generates Lesion-InfiltratingMonocytes in Murine Atherosclerosis.Circulation, 125:364-374, 2012.Mollmark J, Park A, Kim J, Wang T, , Shipman S,Katzenell S, Shipman S, Zagorchev L, SimonsM, Mulligan-Kehoe MJ. FGF-2 is Required forVasa Vasorum Plexus Stability inHypercholesterolemic Mice. Arteriogenesis,Thrombosis and Vascular Biology, 2012.(In press)Mulligan-Kehoe MJ, Anti-Angiogenic Activityof rPAI-123 and Vasa Vasorum Regression.Trends in Cardiovascular Medicine, 2012. (Inpress)P. Jack HoopesSamkoe KS, Gibbs-Strauss SL, Yang HH, KhanHekmatyar S, Hoopes PJ, O’Hara JA,Kauppinen RA, Pogue BW. Protoporphyrin IXFluorescence Contrast in InvasiveGlioblastomas is Lineraly Correlated with GdEnhanced Magnetic Resonance ImageContrast but has Higher Diagnostic Accuracy. JBiomed Opt 2011 Sept; 16(9): 096008 PMID21950922.Brian W. PogueVedantham S, Shi L, Karellas A, Michaelsen KE,Krishnaswamy V, Pogue BW, Paulsen KD.Semi-Automated Segmentation andClassification of Digital Breast TomosynthesisReconstructed Images. Conf Proc IEEE EngMed Biol Soc. 2011; 2011:618-91. PMID:22255752Tichauer KM, Samkoe KS, Sexton KJ, HextrumSK, Yang HH, Klubben WS, Gunn JR, Hasan T,Pogue BW. In Vivo Quantification of TumorReceptor Binding Potential with Dual-ReporterMolecular Imaging. Mol Imaging Biol. 2011 Dec28. PMID: 22203241.Tichauer KM, Holt RW, El-Ghussein F, Zhu Q,Dehghani H, Leblond F, Pogue BW. ImagingWorkflow and Calibration for CT-Guided Time-Domain Fluorescence Tomography. BiomedOpt Express. 2011 Nov 1;2(11): 3021 – 3036PMID: 22076264.Zhu Q, Dehghani H, Tichauer KM, Holt RM,Vishwanath K, Leblond F, Pogue BW.A Three-Dimensional Finite Element Model andImage Reconstruction Algorithm for Time-Domain Fluorescence Imaging in HighlyScattering Media. Phys Med Biol 2011 Dec7;56(23): 7419-7434. PMID: 22056913Pogue BW, Davis SC, Leblond F, MastandunoMA, Dehghani H, Paulsen KD. Implicit andExplicit Prior Information in Near-InfraredSpectral Imaging: Accuracy, Quantification, andDiagnostic Value. Philos Transact A Math PhysEng Sci. 2011 Nov 28; 369(1955): 4531-4557.PMID: 22006905.LeBlond F, Ovanesyan Z, Davis SC, Valdés PA,Kim A, Hartov A, Wilson BC, Pogue BW,Paulsen KD, Roberts DW. Analytic Expresssionof Fluorescence Ration Detection Correlateswith Depth in Multi-Spectral Sub-SurfaceImaging. Phys Med Biol. 2011 Nov 7; 56(21):6823-6837. PMID: 21971201Leblond F, Tichauer KM, Holt RW, El-Ghussein F,Pogue BW. Toward Whole-Body OpticalImaging of Rats Using Single-Photon CountingFluorescence Tomography. Opt Lett 2011 Oct 1:36(19): 3723-3725. PMID: 21964076Samkoe KS, Gibbs-Strauss SL, Yang HH, KhanHekmatyar S, Hoopes PJ, O’Hara JA, KauppinenRA, Pogue BW. Protoporphyrin IXFluorescence Contrast in InvasiveGlioblastomas is Lineraly Correlated with GdEnhanced Magnetic Resonance ImageContrast but has Higher Diagnostic Accuracy. JBiomed Opt 2011 Sept; 16(9): 096008 PMID21950922.Axelsson J, Davis SC, Gladstone DJ, Pogue BW.Cerenkov Emission Induced by External BeamRadiation Stimulates Molecular Fluorescence.Med Phys. 2011 Jul; 38(7): 4127-4132. PMID21859013Tichauer KM, Holt RW, Samkoe KS, El-GhusseinF, Gunn JR, Jermyn M, Dehghani H, Leblond F,Pogue BW. Computed Tomography-GuidedTime-Domain. Diffuse FluorescenceTomography in Small Animals for Localizationof Cancer Biomarkers. J Vis Exp. 2012 Jul; (65).Pii 4050. PMID 22847515Torosean S, Flynn B, Axelsson J, Gunn J,Samkoe KS, Hasan T, Doyley MM, Pogue BW.Nanoparticle Uptake in Tumors is Mediated bythe Interplay of Vascular and Collagen Densitywith Interstitial Pressure. Nanomedicine. 2012Jul 25. pii: S1549 – 9634 (12) 00403-0. PMID22841910Michaelsen K, Krishnaswamy V, Pogue BW,Poplack SP, Paulsen KD. Near-Infrared SpectralTomography Integrated with Digital BreastTomosynthesis: Effects of Tissue Scattering onOptical Data Acquisition Design. Med Phys.2012 Jul: 39(7): 4579-4587. PMID 22830789Holt RW, Tichauer KM, Dehghani H, Pogue BW,Leblond F. Multiple-Gate Time Domain DiffuseFluorescence Tomography Allows More SparseTissue Sampling Without Compromising ImageQuality. Opt Lett 2012 Jul 1; 37 (13): 2559-2561.PMID 22743454Tichauer KM, Samkoe KS, Sexton KJ, Gunn JR,Hasan T, Pogue BW. Improved Tumor ContrastAchieved by Single Time Point Dual-ReporterFluorescence Imaging. J Biomed Opt. 2012Jun: 17(6): 066001. PMID 22734757.Kanick SC, Krishnaswamy V, Gamm UA,Sterenborg HJ, Robinson DJ, Amelink A,Pogue BW. Scattering Phase FunctionSpectrum Makes Reflectance SpectrumMeasured From Intralipid Phantoms and TissueSensitive to the Device Detection Geometry.Biomed Opt. 2012 May 1;3(5): 1086 – 1100.Epub 2012 Apr 24. PMID: 22567598Bonfert-Taylor P, Leblond F, Holt RW, Tichauer K,Pogue BW, Taylor EC. Information Loss andReconstruction in Diffuse FluorescenceTomography. J Opt Soc Am Opt A Image Sci Vis.2012 Mar 1;29(3): 321-330. Doi:10.1364/JOSAA.29.000321. PMID: 22472763Glaser AK, Zhang R, Davis SC, Gladstone DJ,Pogue BW.Time-Gated Cherenkov EmissionSpectroscopy From Linear AccelerationIrradiation of Tissue Phantoms. Opt Lett. 2012Apr 1; 37(7): 1193-1195, doi: 10.1364/OL.37.001193. PMID: 22466192Axelsson J, Glaser AK, Gladstone DJ, PogueBW. Quantitative Cherenkov EmissionSpectroscopy for Tissue OxygenationAssessment. Opt Express. 2012 Feb 27; 20(5):5133-5142. Doi: 10.1364/OE.20.005133. PMID:2241831952


PUBLICATIONSTransplantDavid A. AxelrodGraff RJ, Xiao H, Duffy B, Schnitzler MA,Axelrod D, Lentine KL. Transplantation withPositive Complement-DependentMicrocytotoxicity Crossmatch inContemporary Kidney Transplantation. PracticePatterns and Associated Outcomes. Saudi JKidney Dis Transpl. 2012 March; 23(2): 234-245Schnitzler MA, Lentine KL, Axelrod D,Gheorghian A, You M, Kalsekar A, L’Italien G.Use of 12-Month Renal Function and BaselineClinical Factors to Predict Long-Term GraftSurvival: Application to BENEFIT and BENEFIT-EXT Trials. Transplantation 2012;93: 172-181.Schnitzler MA, Lentine KL, Gheorghian A,Axelrod D, Trivedi D, L’Italien G. RenalFunction Following Living, Standard CriteriaDeceased and Expanded Criteria DeceasedDonor Kidney Transplantation: Impact on GraftFailure and Death. Transpl Int. Volume 25, Issue2, 179-191. Feb 2012Massie AB, Caffo B, Gentry SE, Hall EC,Axelrod DA, Lentine KL, Schnitzler MA,Gheorghian A, Salvalaggio PR, Segev DL. MELDExceptions and Rates of Waiting ListOutcomes. Am J Transplant. 2011;11: 2362-2371.Michael C. ChobanianPetras ML, Dunbar NM, Filiano JJ, Braga M,Chobanian MC, Szczepiorkowski ZM.Therapeutic Plasma Exchange inStreptococcus Pneumonia-AssociatedHemolytic Uremic Syndrome: A Case Report. JClin Apheresis, 3 Feb 2012 I DOI: 10. 1002jca.21208Richard B. FreemanFreeman RB. The Limits of Altruism: SelectingLiving Donors. American Medical AssociationJournal of Ethics 2012; 14(3): 272-277Pruett TL, Blumberg EA, Cohen DJ, Crippin JS,Freeman RB, Hanto BW, Mulligan DC, GreenMD. A Consolidated Biovigilance System forBlood, Tissue, and Organs: One Size Does NotFit All. Am J Transplant. 2012; 12(5): 1099-1101Freeman RB. A Decade of Model for End-Stage Liver Disease: Lessons Learned andNeed for Re-Evaluation of Allocation Policies.Curr Opin Organ Transplant. 2012; 17(3): 211-215Freeman RB, Wiesner R. Should We Changethe Priority For Liver Allocation For PatientsWith the Highest MELD Score? Hepatology. Jan2012; 55(1): 14-15Freeman RB. Transplantation: Sharing ofDonated Livers is Not Equal. Nat RevGastroenterol Hepatol. 2012; 9(5): 248-249 (Inpress)Freeman RB. Liver Allocation. In LiverTransplantation. Neuberger JE, Ferguson J, andNewcome P. Eds. Wiley and Sons, 2012. (Inpress)Freeman RB and Bernat JL. Ethical Issues inOrgan Transplantation in Progress inCardiovascular Diseases, Butterly J ed (Inpress)Freeman RR. Variation in Health CareDelivery: The Example of Exception Awards inLiver Transplantation. AM J Tranplant. Nov2011; 11(11): 2271-2272.Christopher E. SimpkinsMontgomery RA, Lonze BE, King KE, Kraus ES,Kucirka LM, Locke JE, Warren DS, SimpkinsCE, Dagher NN, Singer AL, Zachary AA, SegevDL. Desensitization in HLA IncompatibleKidney Recipients and Survival. N Engl J Med.2011 Jul 28;365(4):318-326Lonze BE, Dagher NN, Liu M, Kucirka LM,Simpkins CE, Locke JE, Desai NM, CameronAM, Montgomery RA, Segev DL, Singer AL.Outcomes of Renal Transplants from Centersfor Disease Control and Prevention High RiskDonors with Prospective Viral Testing: A Single-Center Experience. Arch Surg. 2011 Nov;146(11):1261-1266UrologyWilliam Bihrle, IIISteinberg P, Bihrle W III: SurgicalManagement of Male and Female UrethralCancer. In: Glenn’s Urology: Saunders (inpress)E. Ann GormleyBrubaker L, Richter H, Norton P, Albo M,Zyczynski H, Chai T, Zimmern P, Kraus S, Sirls L,Kusek J, Stoddard A, Tennstedt S, Gormley E.Five Year Continence Rates, Satisfaction andAdverse Events of Burch Urethropexy andFascial Sling Surgery for Urinary Incontinence.J Urol, 2012 Apr; 187(4):1324-1330.Chai T, Kenton K, Xu Y, Sirls L, Zyczynski H,Wilson T, Rahn D, Whitcomb E. Hsu Y,Gormley E for the Urinary IncontinenceTreatment Network. Effects of ConcomitantSurgeries during Mid-Urethral Slings (MUS) onPost-Operative Complications, VoidingDysfunction, Continence Outcomes, andUrodynamic Variables. Urology 2012 Jun; 79(6):1256-1261 Epub 2012 Apr 25.Nager C, Brubaker L, Litman H, Zyczynski H,Varner RE, Amundsen C, Sirls L, Norton P,Arisco A, Chai T, Zimmern P, Barber M,Dandreo K, Menefee S, Kenton K, Lowder J,Richter H, Khandwala S, Nygaard I, Kraus S,Johnson H, Lemack G, Mihova M, Albo M,Mueller E, Sutkin G, Wilson T, Hsu Y, Rozanski T,Rickey L, Rahn D, Tennstedt S, Kusek J,Gormley EA.A Randomized Trial ofUrodynamic Testing before Stress-Incontinence Surgery Publication. N Engl JMed 2012 May 2. NEJM. 2012 May 24; 366(21):1987-1997.Richter H, Brubaker L, Stoddard A, Xu Y,Zyczynski H, Norton P, Sirls L, Kraus S, Chai T,Zimmern P, Gormley E, Kusek J, Albo M.Patient Related Factors Associated with Long-Term Urinary Continence After BurchColposuspension and Pubovaginal FascialSling Surgeries. J Urol. 2012 Aug; 188(2): 485-489. Epub 2012 Jun 15.Zyczynski H, Rickey L, Dyer K, Wilson T,Stoddard A, Gormley EA, Hsu Y, Kusek J,Brubaker L. Sexual Activity and Function inWomen Over 2 Years After Mid - Urethral SlingPlacement. Amer J Obstet Gynec, 2012 June27.Gormley EA. Evaluation and Management ofthe Failed Mid-Urethral Sling. CanadianUrology Association Journal, 2012. In pressGormley EA, Lightner D, Chai T, et al.Diagnosis and Treatment of Overactive Bladder(Non-Neurogenic) in Adults. AUA/SUFUGuideline, J. Urol, 2012. (In press)Johnson E, Gormley EA. Evaluation of thePatient with Stress Urinary Incontinence. AUAUpdates, 2012. (In press)Elias S. HyamsHyams ES, Perlmutter M, Stifelman MD. AProspective Evaluation of the Utility ofLaparoscopic Doppler Technology DuringMinimally Invasive Partial Nephrectomy.Urology. 2011 Mar; 77(3): 617-620.Semins MJ, Bartik L, Chew BH, Hyams ES,Humphreys M, Miller NL, Shah O, Paterson RF,Matlaga BR. Multicenter Analysis ofPostoperative CT Findings After PercutaneousNephrolithotomy: Defining Complication Rates.Urology.2011 Aug; 78(2): 291-294.Hyams ES, Nelms D, Silberman WS, Feng Z,Matlaga BR. The Incidence of UrolithiasisAmong Commercial Aviation Pilots. J Urol.2011 Sep; 186(3): 914-916.DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201253


PUBLICATIONSHyams ES, Pierorazio P, Proteek O, SukumarS, Wagner AA, Mechaber JL, Rogers C.Kavoussi L, Allaf M. Iatrogenic Vascular LesionsAfter Minimally Invasive Partial Nephrectomy:A Multi-Institutional Study of Clinical and RenalFunctional Outcomes. Urology. 2011 Oct; 78(4):820-826.Patel HD, Mullins JK, Pierorazio PM, HyamsES, Allaf ME. Laparoendoscopic Single-SiteSurgery of the Kidney: An Initial Experience.Can J Urol. 2011 Jun; 18(3): 5745-5750.Pierorazio PM, Patel HD, Feng T, Yohannan J,Hyams ES, Allaf ME. Robotic-Assisted VersusTraditional Laparoscopic Partial Nephrectomy:Comparison of Outcomes and Evaluation ofLearning Curve. Urology. 2011 Oct; 78(4): 813-819.Hyams ES, Pierorazio PM, Shah A, Lum YW,Black J, Allaf ME. Graft Reconstruction ofInferior Vena Cava for Renal Cell CarcinomaStage pT3b or Greater. Urology. 2011 Oct; 78(4):838-843.Hyams ES, Korley FK, Pham JC, Matlaga BR.Trends in Imaging Use During the EmergencyDepartment Evaluation of Flank Pain. J Urol.2011 Dec; 186(6): 2270 – 2774.Patel HD, Pierorazio PM, Mullins JK, HyamsES, Allaf ME. Radiofrequency Coagulation-Assisted Laparoscopic Partial NephrectomyWithout Hilar Clamping: A Feasible Techniquewith Excellent Outcomes in Highly SelectedPatients. J Endourol. 2012; 26(1): 58- 62.Hyams ES, Pierorazio P, Proteek O, Sroka M,Kavoussi LR, Allaf ME. LaparoscopicRetroperitoneal Lymph Node Dissection forClinical Stage 1 Nonseminomatous Germ CellTumor: A Large Single Institution Experience. JUrol 2012; 187(2): 487-492.Mullins JK, Feng T, Pierorazio PM, Patel HD,Hyams ES, Allaf ME. Comparative Analysis ofMinimally Invasive Partial NephrectomyTechniques in the Treatment Localized RenalTumors. Urology 2012 Jun 13. PMID: 22698464Pierorazio P, Hyams ES, Mullins JK, Allaf ME.Laparoscopic Radical Nephrectomy for LargeRenal Masses. Critical Assessment of thePerioperative and Oncologic Outcomes of T2aand T2b Tumors. Urology 2012 Mar; 79(3):570-575Mullins JK, Semins MJ, Hyams ES, BohlmanME, Matlaga BR. Half Fourier Single-Shot TurboSpin-Echo Magnetic Resonance Urography forthe Evaluation of Suspected Renal Colic inPregnancy. Urology June 2012; 79(6):1252-1255.Mullins JK, Hyams ES, Mitchell S, Allaf ME.Lymphangiography with Sclerotherapy: ANovel Therapy for Refractory Chylous Ascites.Can J Urol 2012 Jun; 19(3): 6255Johnson E, Krambeck A, White W, Hyams E,Matlaga B, Pais Jr VM. Obstetric Complicationsof Ureteroscopy. Journal of Urology 188:151-154, 2012Eisner BH, McQuaid JW, Hyams E, Matlaga BR.Urolithiasis: What Surgeons Need to Know. AJRAm J Roentgenol 2011; 196(6): 1274-1278Matlaga B, Hyams ES. Stones: Can the Guy’sStone Score Predict PNL Outcomes?Nat Rev Urol 2011 July; 8(7): 363-364Vernon Pais, Jr.Deters L, Jumper C, Steinberg P, Pais Jr. VM.Evaluation the Definition of “Stone Free” inContemporary Urologic Literature. ClinicalNephrology 76:354-357, 2011Berrondo C, Wason S, Pais V. UrologicSynechiae. Journal of Endourology 26:461-462,2012Johnson E, Krambeck A, White W, Hyams E,Matlaga B, Pais Jr VM. ObstetricComplications of Ureteroscopy. Journal ofUrology 188:151-154, 2012Eisner BH, Sheth S, Dretler SP, Herrick B,Pais Jr VM. Effect of Socioeconomic Statuson 24-Hour Urine Composition in Patients withNephrolithiasis. Urology 80:38-42, 2012Gershman B, Sheth S, Dretler SP, Herrick B,Lang K, Eisner BH, Pais Jr VM. TheRelationship Between Glomerular Filtrationand 24-Hour Urine Composition in Patientswith Nephrolithiasis. Urology 80: 43-47, 2012Eisner BH, Sheth S, Dretler SP, Herrick B,Pais VM, Sawyer M, Miller N, Hurd KJ,Humphreys MR. The Effects of AmbientTemperature, Humidity, and Season of Year on24-Hour Urine Composition in Patients WithNephrolithiasis. British Journal of Urology.AcceptedJohn SeigneFinkelstein SE, Rodriguez F, Dunn M, FarmelloMJ, Smilee R, Janssen W, Kang L, Chuang T,Seigne J, Pow-Sang J, Torres-Roca JF, HeysekR, Biagoli M, Shankar R, Scott J, Antonia S,Gabrilovich D, Fishman M. Serial Assessmentof Lymphocytes and Apoptosis in the ProstateDuring Coordinated Intraprostatic DendriticCell Injection and Radiotherapy.Immunotherapy, 2012 Apr;4(4): 378-382.PMID: 22512631Marotti JD, Seigne JD, Gutmann EJ. Presenceof Benign Germ Cells in a Fine Needle Aspirateof a Spermatocele. Diagn Cytopathol. 2011Nov. doi 10.1002/dc.21846. PubMed PMID:22045691VascularJack L. CronenwettGoodney PP, Travis L, Lucas FL, Fillinger MF,Goodman DC, Cronenwett JL, Stone DH.Survival After Open Versus EndovascularThoracic Aortic Aneurysm Repair in anObservational Study of the MedicarePopulation. Circulation, 2011 Dec 124(24):2661-2669Goodney PP, Wallaert JB, Scali ST, Stone DH,Patel V, Shaw P, Nolan BW, Cronenwett JL.Vascular Study Group of New England. Impactof Practice Patterns in Shunt Use DuringCarotid Endarterectomy with ContralateralCarotid Occlusion. J Vasc Surg 2012: 55(1): 61-71Suckow BD, Goodney PP, Cambria RA, BertgesDJ, Eldrup-Jorgensen J, Indes JE, Schanzer A,Stone DH, Kraiss LW, Cronenwett JL. VascularStudy Group of New England. PredictingFunctional Status Following Amputation AfterLower Extremity Bypass. Ann Vasc Surg. 2012;26(1): 67-78Cronenwett JL, Kraiss LW, Cambria RP. TheSociety for Vascular Surgery Vascular QualityInitiative. J Vasc Surg. 2012 May; 55(5): 1529 –1537.Simons JP, Schanzer A, Nolan BW, Stone DH,Kalish JA, Cronenwett JL, Goodney PP.Vascular Study Group of New England.Outcomes and Practice Patterns in PatientsUndergoing Lower Extremity Bypass. J VascSurg. 2012 Jun; 55(6): 1629-1636.Nolan BW, De Martino RR, Goodney PP,Schanzer A, Stone DH, Butzel D, Kwolek CJ,Cronenwett JL. Vascular Study Group of NewEngland. Comparison of CarotidEndarterectomy and Stenting in Real WorldPractice Using a Regional Quality ImprovementRegistry. J Vasc Surg. 2012 May 10.Robinson W, Schanzer A, Goodney PP, NolanBW, Li Y, Eslami M, Cronenwett JL, MessinaLL. Derivation and Validation of a Practical RiskScore for Prediction of Mortality After OpenRepair of Ruptured Abdominal AorticAneurysms in a Regional Cohort. J Vasc Surg2012 (In press)54


PUBLICATIONSBrooke BS, Stone DH, Fillinger MF,Cronenwett JL, Goodney PP. Early DischargeDoes Not Increase Readmission or MortalityRisk After High-Risk Vascular Surgery. J VascSurg 2012 (In press)Goodney PP, Brooke BS, Wallaert JB, Travis LL,Lucas FL, Goodman DG, Cronenwett JL,Stone DH. TEVAR, Race and Volume in ThoracicAneurysm Repair. J Vasc Surg 2012 (In press)Jones DW, Stone DH, Conrad MF, Baribeau YR,Westbrook BM, Likosky DS, Cronenwett JL,Goodney PP. Regional Use of CombinedCarotid Endarterectomy/Coronary BypassGraft and the Effect of Patient Risk J. Vasc Surg2012 May 10.Goodney PP, Travis LA, Lucas FL,Cronenwett JL, Goodman DC. Variation in theUse of Vascular Procedures in the Year Prior toAmputation. Circulation: CardiovascularQuality and Outcomes 2012 Jan; 5(1): 94- 102.Mark F. FillingerKorach A, Di Eusanio M, Greason K,Montgomery D, Voehringer M, Harris K,DiScipio A, Fillinger M, Fattor R, Trimarchi S,Conklin LD, Eagle K, Isselbacher E, Nienaber C,Gilon D. Long-Term Follow-Up in MarfanPatients After Successful Surgery for AcuteType A Aortic Dissection. The Irad Experience. JAm Coll Cariol. 2012;59(13sl):E1900-E1900.Doi:10.1016/S0735-1097(12)61901-9Sweet MP, Fillinger MF, Morrison TM, Abel D.The Influence of Gender and Aortic AneurysmSize on Eligibility for Endovascular AbdominalAortic Aneurysm Repair. J.Vasc. Oct 2011;54(4):931-937Goodney PP, Travis L, Lucas FL, Fillinger MF,Goodman DC, Cronenwett JL, Stone DH.Survival after Open Versus EndovascularThoracic Aortic Aneurysm Repair in anObservational Study of the MedicarePopulation. Circulation. Dec 13 2011;124(24):2661-2669Brooke BS, Stone DH, Fillinger MF,Cronenwett JL, Goodney PP. Early DischargeDoes Not Increase Readmission or MortalityRisk After High-Risk Vascular Surgery. J VascSurg 2012 (In press)Philip P. GoodneyRobinson W, Schanzer A, Goodney PP, NolanBW, Li Y, Eslami M, Cronenwett JL, Messina LL.Derivation and Validation of a Practical RiskScore for Prediction of Mortality After OpenRepair of Ruptured Abdominal AorticAneurysms in a Regional Cohort. J Vasc Surg2012 (In press)Jim J, Rubin BG, Ricotta JJ, Kenwood CT, SiamiFS, Sicard GA, Dillavou ED, Geraghty PJ,Goodney PP, Landis GS, Nguyen LL,Schermerhorn ML, White RA. Society forVascular Surgery. Vascular Registry Evaluationof Comparative Effectiveness of CarotidRevascularization Procedures Stratified byMedicare Age. J Vasc Surg 2012 May 55(5):1313 -1320.Schermerhorn ML, Fokkema M, Goodney PP,Dillavou E, Jim J, Kenwood CT, Siami FS, WhiteRA. The Impact of Centers for Medicare andMedicaid Services High Risk Criteria onOutcome After Carotid Endarterectomy andCarotid Stenting in the SVS Vascular Registry. JVasc Surg 2012 (In press)Brooke BS, Stone DH, Fillinger MF, CronenwettJL, Goodney PP. Early Discharge Does NotIncrease Readmission or Mortality Risk AfterHigh-Risk Vascular Surgery. J Vasc Surg 2012 (Inpress)Wallaert J, De Martino RR, Marsicovetere P,Goodney PP, Murray JJ, Finlayson SR, HolubarSD. Post-Operative Thromboembolic Eventsafter Surgery for Inflammatory Bowel Disease:Are There Modifiable Risk Factors? Data fromthe ACS-NSQIP. Diseases of the Colon Rectum(In press)Simons JP, Schanzer A, Nolan BW, Stone DH,Kalish JA, Cronenwett JL, Goodney PP.Vascular Study Group of New England.Outcomes and Practice Patterns in PatientsUndergoing Lower Extremity Bypass. J VascSurg 2012 Jun; 55(6): 1629- 1636Jones DW, Stone DH, Conrad MF, Baribeau YR,Westbrook BM, Likosky DS, Cronenwett JL,Goodney PP. Regional Use of CombinedCarotid Endarterectomy/Coronary BypassGraft and the Effect of Patient Risk. J Vasc Surg2012 May 10.Ghanami J, Andrews J, Corriere MC,Goodney PP, Hansen KJ, Edwards ME.Anesthesia-Based Evaluation of Outcomes ofLower Extremity Bypass Procedures. J VascSurg 2011 Nov 54 (5): 1273-1282.Goldberg J, Baker FB, Goodney PP.FocusingImprovement Efforts for Diabetic Patients atRisk for Amputation. J Vasc Surg 2012 (In press)Nolan BW, De Martino RR, Goodney PP,Schanzer A, Stone DH, Butzel D, Kwolek CJ,Cronenwett JL. Comparison of CarotidEndarterectomy and Stenting in Real-WorldPractice Using a Regional ImprovementRegistry. J Vasc Surg 2012 May 10Goodney PP. Response, Letter to the Editor. JVasc Surg 2012. 55(6): 1838-1839.Goodney PP. Invited Commentary: EVAR andOpen Surgical Repair. How much is Enough?VASA 2012 (In press)Huded CP, Goodney PP, Powell RJ, Nolan BW,Rzucidlo EM, Simone ST, Walsh DB, Stone DH.The Impact of Adjunctive Iliac Stenting onFemoral-Femoral Bypass in ContemporaryPractice. J Vasc Surg 2012 55(3): 739-745.Goodney PP, Fisher ES, Cambria RP. Roles forSpecialty Societies and Vascular Surgeons inAccountable Care Organizations (ACO’s). JVasc Surg 2012 55(3): 875-872.Goodney PP, Travis LA, Lucas FL, Fillinger MF,Cronenwett JL, Goodman DC, Stone DH.Survival Following Open End EndovascularThoracic Aneurysm Repair in the MedicarePopulation. Circulation 2011 Dec 13; 124(24):2661-2669.Goodney PP, Travis LA, Lucas FL, CronenwettJL, Goodman DC. Variation in the Use ofVascular Procedures in the Year Prior toAmputation. Circulation: CardiovascularQuality and Outcomes 2012 Jan; 5(1): 94- 102.Stone DJ, Nolan BW, Goodney PP. Letter tothe Editor. J Vasc Surg 2012 Mar 55(3): 890De Martino RR, Goodney PP, Spangler EL,Wallaert JB, Corriere MA, Rzucidlo EM, WalshDB, Stone DH. Variation in ThromboembolicComplications Among Patients UndergoingCommonly Performed Cancer Operations. JVasc Surg 2012 April; 55(4): 1035-1040.Suckow DB, Goodney PP, Cambria RA,Bertges DJ, Eldrup-Jorgensen J, Indes JE,Schanzer A, Stone DH, Kraiss LW, CronenwettJL. Predicting Functional Status FollowingAmputation After Lower Extremity Bypass. AnnVasc Surg 2012 Jan 26 (1): 61-78.Mazer L, Chiakoff E, Edwards MC,Goodney PP, Corriere MC. Single VersusMulti-Specialty Operative Teams: Associationwith Mortality Following EndovascularAbdominal Aortic Aneurysm Repair. TheAmerican Surgeon 2012 Feb 78(2): 207-212.Nallamothu BK, Gurm HS, Ting HH,Goodney PP, Rogers MA, Curtis JP, Dimick JB,Bates ER, Krumholz HM, Birkmeyer JD.Operator Experience and Outcomes withCarotid Stenting in Medicare Beneficiaries.JAMA 2011 Sept 28; 306(12): 1228-1243.Newton WB, Sagransky JM, Andrews JS,Hansen KJ, Corriere MA, Goodney PP,Edwards MS. Outcomes of RevascularizedAcute Mesenteric Ischemia in the AmericanCollege of Surgeons National QualityImprovement Program Database. Am Surg2011 Jul 77(7): 832-838.DARTMOUTH-HITCHCOCK MEDICAL CENTER DEPARTMENT OF SURGERY ANNUAL REPORT 201255


PUBLICATIONSGoodney PP, Wallaert JB, Scali ST, Stone DH,Patel V, Shaw P, Nolan BW, Cronenwett JL.Vascular Study Group of New England. Impactof Practice Patterns in Shunt Use DuringCarotid Endarterectomy with ContralateralCarotid Occlusion. J Vasc Surg 2012: 55(1):61-71Goodney PP, Brooke BS, Wallaert JB, Travis LL,Lucas FL, Goodman DG, Cronenwett JL, StoneDH. TEVAR, Race and Volume in ThoracicAneurysm Repair. J Vasc Surg 2012 (In press)Brian W. NolanSimons JP, Schanzer A, Nolan BW, Stone DH,Kalish JA, Cronenwett JL, Goodney PP. VascularStudy Group of New England. Outcomes andPractice Patterns in Patients UndergoingLower Extremity Bypass. J Vasc Surg 2012 Jun;55(6): 1629- 1636Nolan BW, De Martino RR, Goodney PP,Schanzer A, Stone DH, Butzel D, Kwolek CJ,Cronenwett JL. Comparison of CarotidEndarterectomy and Stenting in Real-WorldPractice Using a Regional ImprovementRegistry. J Vasc Surg 2012 May 10Huded CP, Goodney PP, Powell RJ, Nolan BW,Rzucidlo EM, Simone ST, Walsh DB, Stone DH.The Impact of Adjunctive Iliac Stenting onFemoral-Femoral Bypass in ContemporaryPractice. J Vasc Surg 2012 55(3): 739-745.Stone DJ, Nolan BW, Goodney PP. Letter tothe Editor. J Vasc Surg 2012 Mar 55(3): 890Goodney PP, Wallaert JB, Scali ST, Stone DH,Patel V, Shaw P, Nolan BW, Cronenwett JL;Vascular Study Group of New England. Impactof Practice Patterns in Shunt Use DuringCarotid Endarterectomy with ContralateralCarotid Occlusion. J Vasc Surg 2012 Jan; 55(1):61-71.el.Chang CK, Hubed CP, Nolan BW, Powell RJ.Prevalence and Clinical Significance of StentFracture and Deformation Following CarotidArtery Stenting. J Vasc Surg 2011 54(3): 685-690.Robinson W, Schanzer A, Goodney PP,Nolan BW, Li Y, Eslami M, Cronenwett JL,Messina LL. Derivation and Validation of aPractical Risk Score for Prediction of MortalityAfter Open Repair of Ruptured AbdominalAortic Aneurysms in a Regional Cohort. J VascSurg 2012 (In press)Richard J. PowellPowell RJ, Comerota AJ, Berceli SA, GuzmanR, Henry TD, Tzeng E, Velazquerz O, MartsonWA, Bartel RL, Longcore A, Stern T, Watling S:Interim Analysis Results From the RESTRORE-CLI, A Randomized, Double-Blind MulticenterPhase II Trial Comparing Expanded AutologousBone Marrow-Derived Tissue Repair Cells andPlacebo in Patients with Critical LimbIschemia. J Vasc Surg. 2011 54(4): 1032-1041.Epub 2011 July 31.Powell RJ: Update on Biological Therapies forCritical Limb Ischemia. Card Clin. 2011 29(3):411-417. Epub 2011 Jun 17. ReviewChang CK, Huded CP, Nolan BW, Powell RJ.Prevalence and Clinical Significance of StentFracture and Deformation Following CarotidArtery Stenting. J Vasc Surg 2011 54(3): 685-690.Huded CP, Goodney PP, Powell RJ, Nolan BW,Rzucidlo EM, Simone ST, Walsh DB, Stone DH.The Impact of Adjunctive Iliac Stenting onFemoral-Femoral Bypass in ContemporaryPractice. J Vasc Surg 2012 55(3): 739-745.Eva M. RzucidloHuded CP, Goodney PP, Powell RJ, Nolan BW,Rzucidlo EM, Simone ST, Walsh DB, Stone DH.The Impact of Adjunctive Iliac Stenting onFemoral-Femoral Bypass in ContemporaryPractice. J Vasc Surg 2012 55(3): 739-745.De Martino RR, Goodney PP, Spangler EL,Wallaert JB, Corriere MA, Rzucidlo EM, WalshDB, Stone DH. Variation in ThromboembolicComplications Among Patients UndergoingCommonly Performed Cancer Operations. JVasc Surg 2012 April; 55(4): 1035-1040.Ding M, Carrão AC, Wagner RJ, Xie Y, Jin Y,Rzucidlo EM, Yu J, Li W, Tellides G, Hwa J,Aprahamian TR, Martin KA. Vascular SmoothMuscle Cell-Derived Adiponectin: A ParacrineRegulator of Contractile Phenotype. J Mol CellCardiol. 2012 Feb; 52(2): 474-484. Epub 2011Sept 17. PMID: 21952104David H. StoneBrooke BS, Stone DH, Fillinger MF,Cronenwett JL, Goodney PP. Early DischargeDoes Not Increase Readmission or MortalityRisk After High-Risk Vascular Surgery. J VascSurg 2012 (In press)Goodney PP, Brooke BS, Wallaert JB, Travis LL,Lucas FL, Goodman DG, Cronenwett JL,Stone DH. TEVAR, Race and Volume inThoracic Aneurysm Repair. J Vasc Surg 2012(In press)Nolan BW, De Martino RR, Goodney PP,Schanzer A, Stone DH, Butzel D, Kwolek CJ,Cronenwett JL. Comparison of CarotidEndarterectomy and Stenting in Real-WorldPractice Using a Regional ImprovementRegistry. J Vasc Surg 2012 May 10Jones DW, Stone DH, Conrad MF, BaribeauYR, Westbrook BM, Likosky DS, Cronenwett JL,Goodney PP. Regional Use of CombinedCarotid Endarterectomy/Coronary BypassGraft and the Effect of Patient Risk. J Vasc Surg2012 May 10.Suckow BD, Goodney PP, Cambria RA, BertgesDJ, Eldrup-Jorgensen J, Indes JE, Schanzer A,Stone DH, Kraiss LW, Cronenwett JL.Predicting Functional Status FollowingAmputation After Lower Extremity Bypass. AnnVasc Surg 2012 Jan 26 (1): 61-78.Goodney PP, Travis LA, Lucas FL, Fillinger MF,Cronenwett JL, Goodman DC, Stone DH.Survival Following Open End EndovascularThoracic Aneurysm Repair in the MedicarePopulation. Circulation 2011 Dec 13; 124(24):2661-2669.De Martino RR, Goodney PP, Spangler EL,Wallaert JB, Corriere MA, Rzucidlo EM, WalshDB, Stone DH. Variation in ThromboembolicComplications Among Patients UndergoingCommonly Performed Cancer Operations. JVasc Surg 2012 April; 55(4): 1035-1040.Stone DH, Nolan BW, Goodney PP. Letter tothe Editor. J Vasc Surg 2012 Mar 55(3): 890Huded CP, Goodney PP, Powell RJ, Nolan BW,Rzucidlo EM, Simone ST, Walsh DB, Stone DH.The Impact of Adjunctive Iliac Stenting onFemoral-Femoral Bypass in ContemporaryPractice. J Vasc Surg 2012 55(3): 739-745.Goodney PP, Wallaert JB, Scali ST, Stone DH,Patel V, Shaw P, Nolan BW, Cronenwett JL.Vascular Study Group of New England. Impactof Practice Patterns in Shunt Use DuringCarotid Endarterectomy with ContralateralCarotid Occlusion. J Vasc Surg 2012: 55(1):61-71Simons JP, Schanzer A, Nolan BW, Stone DH,Kalish JA, Cronenwett JL, Goodney PP. VascularStudy Group of New England. Outcomes andPractice Patterns in Patients UndergoingLower Extremity Bypass. J Vasc Surg 2012 Jun;55(6): 1629- 1636Daniel B. WalshHuded CP, Goodney PP, Powell RJ, Nolan BW,Rzucidlo EM, Simone ST, Walsh DB, Stone DH.The Impact of Adjunctive Iliac Stenting onFemoral-Femoral Bypass in ContemporaryPractice. J Vasc Surg 2012 55(3): 739-745.De Martino RR, Goodney PP, Spangler EL,Wallaert JB, Corriere MA, Rzucidlo EM,Walsh DB, Stone DH. Variation inThromboembolic Complications AmongPatients Undergoing Commonly PerformedCancer Operations. J Vasc Surg 2012 April;55(4): 1035-1040.De Martino RR, Wallaert JB, Rossi AP, ZbehlikAJ, Suckow B, Walsh DB.A Meta-Analysis ofAnticoagulation for Calf Deep Vein Thrombosis.J Vasc Surg 56:228-237, 201256


This 2012 Annual Report was produced by the Department of Surgerywith contributions from numerous faculty and staff members.A special thank you to Laura Stancs and to Bob Hagen of The Hagen Group,Hanover, NH for all their efforts in coordinating this annual report.


DARTMOUTH-HITCHCOCK MEDICAL CENTEROne Medical Center Drive, Lebanon, NH 03756 www.dhmc.org©2012 Dartmouth-Hitchcock Medical Center

More magazines by this user
Similar magazines