Yale Bulletin and Calendar

September 17, 2004|Volume 33, Number 3

As chair of the Department of Surgery, Dr. Robert Udelsman has brought more than two dozen new surgeons to Yale.

In Focus: Department of Surgery

When the ship is going down, so the saying goes, it's helpful to have a surgeon on board -- not to operate, but to take command of the impending disaster.

"When we're in the operating room, the 'captain of the ship' mentality prevails," says Dr. Robert Udelsman, chair of the Department of Surgery and chief of surgery at Yale-New Haven Hospital. "I've heard it said that surgeons are almost always right, occasionally wrong, but absolutely never indifferent. When things go bad, it's a good thing to have a surgeon in charge."

In his three years as chair of surgery at the School of Medicine, Udelsman has had his share of opportunities to take charge. Chief among them was the threatened loss of accreditation of the surgical residency program soon after he arrived. The issue was successfully resolved, and the new surgical residency schedule now serves as a model for other schools.

Udelsman also has set a record in the number of top-notch physicians he has recruited since his appointment -- more than two dozen new surgeons.

In recruiting surgeons, Udelsman says, he looks for those who are versatile and can perform unusual procedures very, very well -- doctors who are at the top of their game, or who will be so within five to 10 years. These surgeons are specially trained, having completed one or more fellowships after their residencies. Many of them also hold a master's degree in public health or business administration, or a Ph.D. in the basic sciences.

Versatility is necessary in a discipline where the techniques have changed so dramatically over the last decade, notes Udelsman. Instead of large incisions with significant post-operative pain and lengthy hospitalization, the new minimally invasive procedures feature less pain and scarring, as well as a shorter recovery time. Surgeons use endoscopes, laparoscopes and endoluminal devices to examine and remove or repair diseased or cancerous tissue.

There have been other changes in the various surgical disciplines. According to Udelsman, the number of patients needing coronary artery bypass surgery has decreased by 40% principally for two reasons: statins and stents. The former are cholesterol-lowering medications; the latter are small, self-expanding, stainless steel mesh tubes that are placed within a coronary artery to keep the vessel open.

"Complex pediatric and adult cardiac surgery will become ever more prominent in our program," Udelsman says. The adult cardiac procedures include surgery for heart failure requiring mechanical assistance and heart transplants. In addition, children with congenital heart problems, who in the past might not have survived, will need further treatment and possibly surgery as they mature to adulthood.

Dr. John Elefteriades is professor and section chief of cardiothoracic surgery and is an internationally known aortic surgeon. New recruits in this area are heart transplant expert Dr. Michael Coady, who has a master's degree in public health and is a concert pianist, and thoracic surgeon Dr. Peter Barrett.

Oncology surgery is another major area of patient need and is one part of a much larger picture of cancer care, notes Udelsman. Dr. Ronald Salem leads the section of surgical oncology. A recent recruit, Dr. Julie Ann Sosa, is not only an accomplished surgeon, but also an international authority on outcomes analysis. Dr. Donald Lannin is director of the new Breast Center, which offers a totally contained clinic combining mammographers and surgeons in one location. The new center will be located in a self-contained unit within the Cancer Center. There will be a dedicated elevator going from the imaging center to the operating room to make the entire process more comfortable for patients.

"Most women who need a breast biopsy are healthy, but they think they have cancer and are going to die," Udelsman says. "We have to move quickly to find out the real answer for them. We can't make them wait two weeks. Our goal is to get that done in 48 hours."

The future for women with breast cancer is hopeful with improved imaging and ultrasound to detect growths at an earlier stage, says Udelsman. Needle biopsies, which are now routine, are also less invasive, with a shorter recovery time for the patient. Breast conservation and reconstruction is also eons ahead of where it was, which has prompted some women at high genetic risk of breast cancer to have their breasts removed and then reconstructed because of the highly enhanced results, Udelsman says.

A new recruit, Dr. Teresa Ponn, has been appointed to the Breast Center; she is returning to academia following 22 years as a practicing surgeon in the community. It is a path Udelsman hopes will be seen more often. Some of the best surgeons have left academic medical centers for private practice, notes Udelsman, but he hopes to lure them back to participate in a stimulating and professionally enriching environment.

Gastrointestinal surgery, a section directed by Dr. Walter Longo, has garnered more media attention than most other surgical disciplines due to the bariatric surgery for morbidly obese patients conducted by Dr. Robert Bell. Recruited in 2002, Bell performs a minimally invasive procedure known as laparascopic gastric bypass, in which the surgeon uses special instruments to create a small gastric pouch. He then attaches a y-shaped limb of small bowel to form the outlet to the intestines. Bell has conducted over 200 procedures in the past two years, and a second surgeon, Dr. Andrew Duffey, has been hired to work with him as well as to perform laparoscopic surgery.

Duffey, like many of Udelsman's recruits, has interests that extend beyond his speciality. Udelsman says Duffey would like to help establish a simulation center that would allow students, residents and attending surgeons to practice surgical techniques. The new simulators, like flight simulation programs, pose a variety of unexpected problems in order to mirror the actual conditions in an operating room.

Pediatric surgery is another area where new surgical instrumentation is highly visible, says Udelsman, noting that many of the new tools developed for adult patients must be scaled in size for infants. Dr. Lawrence Moss is the new section chief of pediatric surgery. Dr. Milissa McKee is heading up the pediatric minimally invasive surgical center where millimeter-sized instruments are used. Another new surgeon, Dr. Christopher Breuer, has a strong interest in tissue engineering in addition to pediatric surgery. Tissue engineering can create new tissue and, it is hoped at some point, new organs for cardiovascular and other transplant applications.

Transplantation surgery, under the general direction of Dr. Marc Lorber, has rapidly expanded with two new recruits, Drs. David Cronin and Sanjay Kulkarni, who will reestablish the Yale liver transplant program. Dr. Amy Friedman is recognized for performing laparoscopic donor nephrectomy, a less-invasive surgery for removing a donated kidney from a living donor.

The plastic and reconstructive surgery section focuses more on reconstruction due to injury or genetic deformity rather than on aesthetic surgery. Dr. John Pershing heads up the section. Pershing, Dr. Joseph Shin and other members have established themselves as international leaders in restoring the faces of children with severe deformities. Dr. Grant Thomson has developed a productive practice in hand surgery, an area where minimally invasive techniques have transformed the field. Dr. Deepak Narayan specializes in breast reconstruction and melanoma surgery.

At the front line of surgery are the trauma surgeons in surgical critical care and surgical emergency. These surgeons deal with real-time drama of life and death on a daily basis, notes Udelsman, referring to a recent case where a patient had been shot in the right and left ventricles of the heart and is now expected to make a full recovery.

A surgeon from the University is on the premises of Yale-New Haven Hospital 24 hours a days, seven days a week. Among the new appointees in this area are Dr. Lewis Kaplan, Dr. Joseph Portereiko and Dr. Horacio Hojman, who is a ballistics expert. Dr. Reuven Rabinovici, who was a tank commander in the Suez Canal and a combat surgeon in the Israeli army, heads this section.

Dr. Gail D'Onofrio was recently appointed the interim director of emergency medicine, a section of the department of surgery. In the space of only a few months, says Udelsman, she has demonstrated a sophisticated vision that will allow this section to achieve national recognition. New recruits include Dr. Asin Tarabar, a full-time toxicologist, and Dr. Jeffrey Arnold, a disaster planning expert. Their expertise enhances the emergency room's status as a Level 1 Trauma Center, says Udelsman.

Vascular surgery is also changing rapidly with minimally invasive techniques and endovascular procedures, notes Udelsman. Among the new recruits in this section are Dr. Lynne Kelley, the first endovascular surgeon at Yale, and Dr. Alan Dardik, who has won substantial funding for his research on the effects of hemodynamic forces on blood vessels. Vascular surgeons are now pairing with their colleagues in the Interventional Radiology Section to do endovascular procedures using tiny instruments to repair aneurysms. This cross-departmental collaboration is important as surgeons continue to pair with other specialties within Yale to deliver comprehensive care to patients with complex needs, says Udelsman. "We bring doctors to the patient in a convenient and time-sensitive manner."

Udelsman, a member of endocrine surgery, already has enhanced the unit's reputation nationally and internationally as one of the largest parathyroid centers in the world. Two additional surgeons, Dr. Julie Ann Sosa and Dr. Sanziana Roman, a classically trained singer, are leading the field in endocrine surgery. The surgeons use laparoscopic, endovascular and minimally invasive techniques in their procedures. Udelsman's forte is the minimally invasive parathryoidectomy -- which is removal of one or more of the four pea-sized endocrine glands in the neck. Roman, in collaboration with Dr. Linda Mayes of the Child Study Center, has initiated an important protocol analyzing the neurocognitive effects of parathyroidectomy in patients with hyperparathyroidism.

Otolaryngology, which is led by Dr. Clarence Sasaki, is known to take those patients other surgeons are reluctant to see -- those with very serious head and neck cancers with poor prognoses. Among the section members are Drs. John Joe, Douglas Ross, who is a sinus expert, and Steven Leder, who is an expert on problems with swallowing and communication.

Urology, under the guidance of Dr. Robert Weiss, is also growing with the addition of Dr. Edward Uchio. He and Dr. Charles Cha, in gastrointestinal and oncologic surgery, are devoting half their time to research with Dr. Edward Chu in the Cancer Center. Uchio is also a certified automotive service technician with a speciality in electronics. Dr. John Colberg, an acknowledged leader in urologic oncology, will direct the uro-oncology program in the new cancer center.

More than 50% of the surgeons also are conducting research with medical students, residents, and pre- and postdoctoral fellows from all over the world. This New Haven-based international collaboration produces more than 500 peer-reviewed publications per year, many published in the top science journals.

Among some of the current research areas are identifying and characterizing membrane proteins; developing ergonomic surgical instruments; analyzing immunological responses to heart, liver and kidney transplants; using synthetic vessel material; investigating age-dependent factors in ureteral-vesical functions; investigating diabetes-induced changes on the genitourinary tract; determining the inflammatory response to potential biological warfare agents; and performing emergency room screening and intervention for substance abuse.

Udelsman constantly emphasizes the three core missions of the Yale School of Medicine: patient care, teaching and research. "There is nothing more practical to patient care than basic research," he says, "and there is nothing more relevant to science than the treatment of disease."

-- By Jacqueline Weaver

T H I SW E E K ' SS T O R I E S

Yale employee's new home is the result of . . .

Neurologist Lo wins Presidential Early Career Award

Exhibit explore mysteries of the giant squid

Series will introduce new World Fellows to Yale community

Levin reports improvements in U.S. visa procedures

Grant funds study exploring the link between . . .

Yale professor's watercolors featured in JE exhibit

Bruce Carmichael is appointed an assistant provost

In Focus: Department of Surgery

Renowned writer Norman Mailer to make campus appearance

Scholars will examine the iconic career of pop star . . .

Life is portrayed as a messy affair in Rep's 'Clean House'

Fast-paced opera 'thriller' will make its American debut at Yale

Yale to give matching grant of $100,000 . . .

2003-2004 Yale United Way Donors

Artist's paintings explore common human bonds

Conference to celebrate birth of the 'founder of humanism'

Researchers find that the media's science reporting is politically biased

Grants will support two ongoing preservation projects at Yale Library

President appoints search committee for next dean of the School of Nursing

Study: Drug aprotinin reduces risk of stroke . . .

Yale scientists bring quantum optics to a microchip

IN MEMORIAM