Duke Surgery Newsletter - Spring '17 by Duke Surgery

SPRING 2017

OUT OF BODY EXPERIENCE Rejuvenating Organs Using Ex Vivo Perfusion

DUKE DEPARTMENT OF SURGERY Chair Allan D. Kirk, MD, PhD

Chief of Staff Cynthia K. Shortell, MD

Vice Chairs Gregory S. Georgiade, MD Ranjan Sudan, MD Shelley Hwang, MD

Clinical Practice Education Research

Chief of the Clinic Michael E. Lipkin, MD

Chief Administrator Katherine Stanley

Division Chiefs Debra L. Sudan, MD Theodore N. Pappas, MD Peter K. Smith, MD Charles J. Gerardo, MD Dana D. Portenier, MD Howard W. Francis, MD, MBA Henry E. Rice, MD Jeffrey R. Marcus, MD Kent J. Weinhold, PhD Cynthia K. Shortell, MD Glenn M. Preminger, MD Cynthia K. Shortell, MD

Abdominal Transplant Surgery Advanced Oncologic and Gastrointestinal Surgery Cardiovascular and Thoracic Surgery Emergency Medicine Metabolic and Weight Loss Surgery Head and Neck Surgery & Communication Sciences Pediatric General Surgery Plastic, Maxillofacial, and Oral Surgery Surgical Sciences Trauma and Critical Care Surgery Urology Vascular and Endovascular Surgery

Editorial Staff Editor in Chief Brooke Walker

Designer Scott Behm

Writers Scott Behm Brooke Walker

Medical Illustrator Lauren Halligan

Editor Ashley Morgan

Director Jill White

CONTENTS Message from the Chair

Out of Body Experience: Ex Vivo Perfusion

Duke Health Surgical Teams Perform Five Heart, Lung Transplants in 24 Hours

Duke’s Liver Transplant Program Shows Best-in-Nation Results

A Second Chance at Life: LVAD Clinical Trials

Grants, Clinical Trials, & Publications

Duke Surgery Introduces Ergonomics Program to Improve Surgeon Health

T32 Research Grant in Surgical Oncology

Duke Surgery Advanced Education Courses

Duke Surgery Appoints Two New Division Chiefs

Faculty: New Members, Promotions, & Awards

On the cover: Cardiothoracic surgeons Dr. Jacob Klapper and Dr. Nnamdi Nwaejike perform a double lung transplant. Shawn Rocco/Duke Health

content

MESSAGE FROM THE CHAIR

am pleased to present the newly redesigned spring 2017 issue of the Duke Department of Surgery newsletter. At Duke Surgery, we are committed to providing excellence in clinical care by continually seeking to improve life-saving treatments for patients. Our faculty are renowned for their discoveries, ranging from basic mechanistic and translational studies, to clinical innovations. This issue features several of the novel clinical trials led by Duke surgeons that hold tremendous promise for saving countless lives. First, we highlight the extraordinary work of our multidisciplinary transplant teams. Duke is a leading center for organ transplantation. In the past year, our surgeons transplanted over 450 organs, including heart, lung, kidney, liver, pancreas, intestine, thymus, and hand. The wait times for our transplant programs are among the shortest in the nation and our posttransplant survival rates rank among the best nationwide. In our cover story, we focus on ex vivo perfusion, a novel method of preserving,

and indeed improving, donor organs outside of the body. This technology has the potential to revolutionize medicine by preventing ischemia-reperfusion injury during transplantation. Our heart, lung, and liver transplant teams participate in several clinical trials to test these devices using expanded-criteria organs, a major goal in overcoming the critical organ shortage and expanding the donor pool. This issue also highlights two clinical trials led by the Duke Heart Failure team that were recently published in the New England Journal of Medicine. These highly impactful studies demonstrated improved outcomes with two novel left ventricular assist devices (LVADs). Duke has been at the forefront of LVAD technology, and the results of these studies move the field forward in developing new devices to prolong the lives of patients with advanced heart failure. In our education section, we feature a new ergonomics program pioneered by several of our General Surgery residents. We value the health of our residents and faculty, and this new initiative aims to educate the next

generation of surgeons on the importance of self-care. Finally, I would like to recognize two new division chiefs. Dr. Jeffrey Marcus is our new chief of the Division of Plastic, Maxillofacial, and Oral Surgery. Dr. Howard Francis joins Duke Surgery as our new chief of the Division of Head and Neck Surgery and Communication Sciences. Both Dr. Marcus and Dr. Francis are dynamic team leaders and we will all benefit from their expertise. Sincerely,

Allan D. Kirk, MD, PhD, FACS David C. Sabiston, Jr. Distinguished Professor and Chairman Department of Surgery Duke University School of Medicine Surgeon-in-Chief Duke University Health System

OUT OF BODY EXPERIENCE Out of the body and into a box, donated organs are kept alive using ex vivo perfusion.

ach day, tens of thousands of patients on waiting lists across the United States await a simple phone call: one that says a match has been found and an organ is available for transplant. Despite a growing demand for donors, organ shortages continue to hinder many patients’ chances in receiving their potentially life-saving call. The organ shortage has impacted several transplant teams at Duke. Carmelo Milano, MD, Professor, Division of Cardiovascular and Thoracic Surgery, says part of the reason for the shortage is the method used to preserve organs while in transit from donor to recipient. “Duke has performed over 1,000 heart transplants using cold static storage,” says Dr. Milano, Heart Transplant Surgical Director. “With this method, the heart is removed from the donor and cooled with a solution before it is transported, but lack of oxygen to the organ can cause graft failure.” Cold storage has been a staple of the transplant procedure for over 50 years. While this method is serviceable, it is far from ideal. Vital organs are sensitive to cold ischemia while stored on ice, as irreparable damage from a lack of oxygenated blood flow rapidly occurs. When a heart stops beating, or lungs stop breathing, the organ slowly dies. The cold slows down the deterioration process but not entirely, and this race against the clock severely limits organ availability. The heart is particularly sensitive to damage; Duke’s range of potential donors for heart transplants is

limited to those east of the Mississippi, according to Dr. Milano. The lung transplant team faces similar obstacles, says Matthew Hartwig, MD, Associate Professor, Division of Cardiovascular and Thoracic Surgery. Though the team has successfully transplanted lungs held in cold storage for longer than the conservative 4-hour window, Dr. Hartwig says doing so can create more complications. With such a small window of time, organ matches found a considerable distance away often go unused. THE ICE AGE MAY BE OVER The most logical answer to the cold storage problem is also the most challenging: keep a transplanted organ in a near-physiologic state while outside of the body, perfused with blood, and limit the amount of time the organ is kept on ice. Though the ability to keep an organ alive outside of the body may sound like something out of science fiction, a perfusion system makes this a reality. The device keeps an organ as fully functional as possible after surgical removal, during a process known as ex vivo perfusion. Rather than on ice, the device stores the organ at a normothermic temperature, causing less injury. Nutrient-rich blood taken from the donor filters through the organ, and the system allows close monitoring while the donated organ remains in a living state: beating, breathing, or functional. Several Duke teams are at the forefront of national clinical studies to examine the efficacy of these devices in transplant

patient care

Surgeons examine the pulmonary vessels during a lung transplant performed in April 2017.

procedures. The cardiac transplant team has partnered with TransMedics®, whose portable Organ Care System™ (OCS™) allows the heart to be perfused while in transit from donor to recipient. Dubbed the “heart in a box,” the device is sent with the procurement team to retrieve the heart, which is transported back to the transplant center. The first successful surgery at Duke using an organ transported via the OCS™ was performed in July 2016. The surgery would not have been possible without the new system due to the distance the organ had to travel, says Dr. Milano. Since then, surgeons have performed 8 more successful transplants using the OCS™. The lung transplant team has also had success using a device developed by XVIVO Perfusion, completing 25 successful transplants and enrolling more patients than any other center in the United States for the trial. Lungs are fragile organs at high risk for infection due to their role as a main filter of our outside environment. This fragility comes at a cost: the Organ Procurement and Transplantation Network reports only 1 in 4 donated lungs is viable for 6

transplant. Duke’s trial with the XVIVO system focused specifically on lungs that initially would not have been accepted for transplant. Using a perfusion device allows the lungs to breathe without straining, making the organ stronger and healthier outside of the body. The liver transplant team formed a third partnership with OrganOx. The manufacturer’s metra® device allows the donor’s liver to be preserved for up to 24 hours prior to transplant. This clinical trial began in February of 2017. “There are several benefits to using the device,” explains Andrew Barbas, MD, Assistant Professor, Division of Abdominal Transplant Surgery. “We can access the metabolic activity of the liver and restore energy levels in liver cells. We can also assess which organs will function better after transplant.” This evaluation period prior to the transplant procedure can be critical for a successful outcome, and perfusion devices offer the surgeon more breathing room to examine the organ fully before surgery begins.

Traditional Versus New Technology: Dr. Matthew Hartwig examines lungs preserved through traditional cold static storage.

patient care EXPANDING THE DONOR POOL When asked to share the overall goal of using perfusion systems in transplantation, all surgeons had the same answer: to increase the number of organs available. Longer preservation times allow organs to travel greater distances, offering a larger geographic area to search for matches. More important than geography is the ability to use “extended criteria organs,” says Jacob Schroder, MD, Assistant Professor, Division of Cardiovascular and Thoracic Surgery. “Extended criteria hearts have some feature that makes them imperfect— ventricular hypertrophy, minor coronary disease, advanced age of the donor, certain causes of death, or a long estimated ischemic time,” says Dr. Schroder. “The success rate for these hearts has traditionally been very low, but the OCS™ device allows us to take the ischemic time out of the question.” Whether heart, lung, or liver, when the threat of damage from cold storage is minimized, more organs become

viable options for patients in need. To put it simply, Dr. Schroder explains that utilizing the OCS™ is the equivalent of transplanting an organ from a donor found in Raleigh, rather than farther away. Less risk, and more positive outcomes. THE FUTURE OF EX VIVO PERFUSION While organ preservation was the main goal of cold storage, perfusion raises an interesting question about the ability to rehabilitate organs while outside of the body. Is it possible to transplant an organ in a better condition than when it was procured? Dawn Bowles, PhD, Assistant Professor, Division of Surgical Sciences, believes this may be a possibility. She has conducted biological therapy studies using porcine hearts perfused in the TransMedics® OCS™. “These devices answer questions about whether or not a heart can be rehabilitated while it is stored,” says Dr. Bowles. “It is possible that we could fix some things that need fixing in a heart before it is transplanted.”

While this type of therapy is still on the horizon, it highlights the potential of the new technology. Through a grant from the American Society of Transplant Surgeons, Dr. Barbas is using animal models to test the possibility of repairing damaged livers through perfusion. Repairing organs ex vivo may be another solution to the organ shortage problem. This potential application may already be a reality for lung transplants. Duke’s next trial with United Therapeutics will test the use of what Dr. Hartwig calls an “organ hospital”—a centralized location where organs are rehabilitated before transplantation. “This technology is still in its infancy, but I can see our program being able to use the devices to not only stabilize lungs while outside of the body, but to intervene and improve them,” says Dr. Hartwig. In the end, healthier organs in greater number available for transplant means more patients receiving the life-saving operations they need. For many patients awaiting a transplant, the wait for their phone call may be a short one.

Led by Debra L. Sudan, MD, the liver transplant team performed the first liver transplant using the OrganOx device in February.

Mani Daneshmand, MD, performs a double lung transplant in November 2015.

DUKE HEALTH SURGICAL TEAMS PERFORM

Heart, Lung Transplants hours in

William Stagg, Duke Health News

uke Health’s heart and lung transplant programs have a long history of performing complicated transplants with outstanding success. That reputation was put to a challenging test on December 1, when Duke surgeons and their teams at Duke University Hospital successfully performed three heart transplants and two double lung transplants within a 24-hour period. Despite a full schedule of important surgeries that day, the transplants were performed without impacting the ability of the scheduled surgeries to take place as planned. “It was business as usual throughout the Heart Center,” said Mani A. Daneshmand, MD, Assistant Professor, Division of Cardiothoracic Surgery, who performed one of the heart transplant procurements. “We have a systematic team, each with a ‘deep bench’ of committed staff who

made this possible. Because these transplants happened in such close proximity, it required the support of every member of the team—anesthesia, OR nursing, ICU nursing, critical care, perfusion, and surgery. Without everyone pulling together this would have been impossible.” Jacob Schroder, MD, implanted two of the hearts. Carmelo Milano, MD, implanted one. Jacob Klapper, MD, performed one of the double lung transplants. Matthew G. Hartwig, MD, MHS, who performed the other double lung transplant and is Associate Professor of Surgery and Surgical Director of Lung and Heart–Lung Transplantation, said that Duke makes a commitment to its patients to always pursue an appropriate donor organ, whenever it becomes available, for all potential recipients.

patient care

DUKE’S LIVER TRANSPLANT PROGRAM SHOWS BEST-IN-NATION RESULTS Sarah Avery, Duke Health News

uke University Hospital has the nation’s best outcomes for adult liver transplants from deceased donors, according to data from 2016. Duke’s transplant center, which in 1984 became the first in North Carolina to provide liver transplants, is among the nation’s most efficient centers. It moves patients from the waiting list to transplant more than 2.5 times faster than the national average. “That’s an important statistic, because about one-fourth of patients listed throughout the nation die without getting a transplant,” said Stuart Knechtle, MD, executive director of the Duke Transplant Center. Knechtle said Duke performed 98 liver transplants last year—the most in the state. Survival rates at Duke are also among the nation’s best. Measured at one and three years, survival for adults who

“The entire team pitches in when necessary to make sure everyone is taken care of safely and effectively. There’s no way to plan for when a donor organ will become available, and all members of the team have to be able to flex up at a moment’s notice to enable these surgeries to take place. I know the on-call operating room staff were pushed to their limits and beyond on December 1, and it would have been impossible to do this sort of thing without their support and commitment to the process,” says Dr. Hartwig. Duke’s heart transplant program is one of the nation’s largest, and has been named one of the highest performing heart transplant centers in the country. In 2014, Duke performed its 1,000th transplant—a significant milestone that has been achieved by only a handful of centers.

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Duke’s wait time on its lung transplant list averages about 14 days; the national average is 4 months.”

received deceased-donor livers at Duke is higher than at all other centers in the United States. “The chance of having a successful liver transplant is greatest at Duke compared to other centers in the country,” Knechtle said. Liver transplant is an option for people with end-stage liver disease, cancer and organ failure. Duke has been a pioneer in solid organ transplantation since establishing one of the nation’s first kidney transplant programs in 1965 and is among the nation’s leading centers for organ transplantation. The center now provides heart, lung and small bowel transplants in addition to liver and kidney. Last year, the transplant center became one of a few in the nation to also offer hand transplantation.

Duke’s lung transplant program is the largest lung transplant program in the United States. More than 1,600 lung transplants have been performed at Duke since 1992, with 108 occurring in 2015. Duke’s wait time on its lung transplant list averages about 14 days; the national average is four months. “Our transplant teams do incredible work every day,” said Jill Engel, DNP, RN, FNP, ANP, ACNP, CCRN-CSC, associate chief nursing officer of Heart Services. “Their dedication is an inspiration to all of us.” December 1 capped a busy three-day period in which four hearts and four double lungs were transplanted. It also came in the midst of a flurry of 28 transplants in the 10-day period between November 25 and December 6: five hearts, 11 kidney/kidney–pancreas/pancreas, five livers, and seven double lungs.

esearchers on the Duke Heart Failure team recently found that a new left ventricular assist device (LVAD) design was associated with improved 6-month outcomes in patients with advanced heart failure. Published in the New England Journal of Medicine, two clinical trials indicated a lower incidence of pump thrombosis and pump replacement in patients who received new centrifugalflow LVADs compared with patients who received an axial-flow LVAD, which is currently FDA approved. Heart failure is one of the most common causes of death worldwide. In 2016, approximately 5.7 million adults in the United States developed heart failure and approximately half of these patients will die within 5 years, according to the Centers for Disease Control and Prevention. Patients with advanced heart failure that no longer responds to medication have few treatment options available.

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A SECOND CHANCE AT

LIFE

Duke Researchers Find Improved Outcomes with Two Novel Left Ventricular Assist Devices “End-stage heart failure is something that we don’t have a cure for,” says study co-author Carmelo Milano, MD, Professor of Surgery, Division of Cardiovascular and Thoracic Surgery, and Surgical Director of the Duke LVAD program. “Heart transplantation is a very good treatment for end-stage heart failure, but there were 4,000 deaths due to chronic heart failure in North Carolina last year, and in the state approximately 100 heart transplants are performed each year. It’s still a number

Duke surgeons have performed more than 1,300 LVAD implants since the program began over 30 years ago.”

that’s insignificant relative to the 4,000 people who die in this state from heart failure.” Left ventricular assist devices, or LVADs, are a life-saving therapy for patients with advanced heart failure. LVADs are mechanical pumps that replace a weakened left ventricle. Blood is drained from the left ventricle and pumped into the aorta and throughout the body. Duke is a leading center for ventricular assist device implantation. Duke surgeons have performed more than 1,300 LVAD implants since the program began over 30 years ago. LVADs are most often used as a bridge to transplant. Once a donor heart becomes available, surgeons remove the device and patients receive a new heart. However, patients with end-stage heart failure who are not candidates for transplant have a low 1-year survival rate without LVAD support.

patient care

flow device design reduced the need for pump replacement due to thrombosis. Compared with the axial-flow pump, the centrifugal-flow pumps are smaller and use a magnetically levitated rotor instead of an impeller suspended by ruby bearings.

Carmelo Milano, MD

Joseph Rogers, MD

“Patients with advanced heart failure have a prognosis similar to advanced-stage cancer,” says study co-author Joseph Rogers, MD, Professor of Medicine, Division of Cardiology, Department of Medicine. “Several studies have demonstrated a 1-year survival rate of approximately 20%.” A LONGER-TERM SOLUTION In the two studies, Dr. Milano and Dr. Rogers investigated the use of LVADs as a permanent treatment strategy to prolong survival and improve quality of life in patients with advanced heart failure, known as destination therapy. “We have patients at this institution who have lived 8 or 9 years with LVAD support,” says Dr. Milano. “The LVADs help patients live longer and they also normalize their functional status to a point where a patient can perform most normal daily activity.” The current axial-flow design, in which blood flows across a rotor bearing in the device, commonly leads to thrombus formation around the bearing. When pump thrombosis occurs, the LVAD must be replaced, necessitating a second operation. According to Dr. Milano, approximately 10% of patients implanted with the HeartMate II (Thoratec-Abbott, Inc., Chicago, IL) axial-flow pump develop pump thrombosis. The Duke Heart Failure team sought to determine whether a new centrifugal-

In the MOMENTUM 3 trial, 152 patients received the HeartMate III device, a new centrifugal-flow pump, and 142 patients received the HeartMate II device, an axialflow pump. The authors found that just 1 patient in the centrifugal-flow pump group required reoperation for pump malfunction. Most importantly, pump thrombosis did not occur in any patients in the centrifugal-flow pump group but did occur in 14 patients in the axial-flow pump group. “With the HeartMate III, there were no pump thromboses,” says Dr. Milano. “There was no need for replacement for pump thrombosis, which is a major advance in terms of adverse events. It’s very encouraging. This design almost appears to have solved this issue of pump thrombosis.” The ENDURANCE trial assessed a different intrapericardial centrifugal-flow LVAD. In this trial, 297 patients received the centrifugal-flow HeartWare Ventricular Assist Device System (Medtronic, Inc., Minneapolis, MN) and 148 patients received the axial-flow HeartMate II. While the HVAD device had lower rates of pump thrombosis compared with the HeartMate II, the newer device was associated with a higher risk of stroke. After identifying that this risk was linked to higher blood pressure, the study sponsor repeated the trial with a protocol in place to reduce patient blood pressure. The results of the supplemental ENDURANCE trial indicate that blood pressure reduction led to a lower stroke rate for the HVAD device.

THE FUTURE OF LVADS LVADs are a promising treatment alternative for patients with end-stage heart failure when no other options are available. Future studies will continue to improve upon the design of LVADs to reduce the risk of adverse events in patients. “I think we will see clinicians begin to make decisions about matching a pump to a patient based on patient-specific characteristics,” says Dr. Rogers. “At the end of the day, there’s still a high number of important adverse events that occur with the pumps. Some are related to the device itself or to the way they are implanted while others are related to the way physicians are managing the pumps. Over the next few years, there will be an important focus on reducing adverse events in this patient population.” In addition to using LVADs as a bridge to transplant and a longer-term therapy, Dr. Milano and Dr. Rogers are investigating the use of LVADs as a bridge to recovery. For the small percentage of patients who recover normal function after wearing LVADs, the devices may be removed. “If you look at the clinical trials and the registries, the recovery rate is in the 1–3% range,” says Dr. Rogers. “Many of us believe that the real future of LVAD therapy is going to be a platform to support patients with advanced heart failure while we provide another therapy that will allow their heart to heal so that their intrinsic heart function will return to normal and the LVADs can be removed. That’s our longterm vision.” Duke is currently involved in an NIHsponsored, multicenter trial to study the injection of stem cells into the left ventricular muscle at the time of LVAD implantation to help improve the rate of recovery. 11

SURGERY RESEARCH GRANT ACTIVITY Andrew Barbas, MD, Assistant Professor of Surgery, Division of Abdominal Transplant Surgery, was awarded a grant from the American Society of Transplant Surgeons for “Enhancing Mitochondrial Quality Control Programs to Improve Organ Preservation by Normothermic Ex vivo Liver Perfusion.” Seth M. Cohen, MD, MPH, Associate Professor of Surgery, Division of Head and Neck Surgery and Communication Sciences, was awarded a grant from Vanderbilt University and the PatientCentered Outcomes Research Institute for “Treatment Alternatives in Adult Rare Disease; Assessment of Options in Idiopathic Subglottic Stenosis: NoAAC PR-02 Study.” Mitchell W. Cox, MD, Associate Professor of Surgery, Division of Vascular and Endovascular Surgery, was awarded a grant from InnaVasc Medical, Inc. and the National Institutes of Health for “A Bulletproof Vascular Graft to Prevent Dialysis Access Cannulation Injury.” Guido Ferrari, MD, Associate Professor of Surgery, Division of Surgical Sciences, was awarded a grant from IGM Biosciences, Inc. for “IGM Proposal.” Additionally, Dr. Ferrari received a grant from the University of Wyoming and the National Institutes of Health for “Impact of Fc N-glycan structure on HIV-specific antibody functions.” Matthew Hartwig, MD, Associate Professor of Surgery, Division of Cardiovascular and Thoracic Surgery, was awarded a grant from the University of Pennsylvania for “Clinical Risk Factors for Primary Graft Dysfunction.”

Allan D. Kirk, MD, PhD, Professor and Chair, Department of Surgery, was awarded a grant from the Benaroya Research Institute at Virginia Mason and the National Institutes of Health for the “Immune Tolerance Network.” Additionally, Dr. Kirk received a grant from Emory University and the National Institutes of Health for “Transplant Tolerance in Non-Human Primates.” Finally, Dr. Kirk received a grant from the University of California, San Francisco, for “Immunosuppression Withdrawal for Stable Pediatric Liver Transplant Recipients.” Stuart J. Knechtle, MD, Professor of Surgery, Division of Abdominal Transplant Surgery, was awarded a grant from Emory University and the National Institutes of Health for “Transplant Tolerance in Non-Human Primates.” Jaewoo Lee, PhD, Assistant Professor of Surgery, Division of Surgical Sciences, was awarded a grant from Columbia University for “Nucleic acid scavengers as mitigators of radiation-induced gastrointestinal syndrome.” Roberto J. Manson, MD, Assistant Professor of Surgery, Division of Vascular and Endovascular Surgery, was awarded a grant from InnaVasc Medical, Inc. for “A Self-Sealing Dialysis Graft that Prevents Cannulation Injury and Assures Successful Access.” Peter K. Smith, MD, Professor of Surgery, Division of Cardiovascular and Thoracic Surgery, was awarded a grant from the National Institutes of Health for “Core Clinical Centers for the CTSN.” Debara L. Tucci, MD, Professor of Surgery, Division of Head and Neck Surgery and Communication Sciences, was awarded a grant from the National Institutes of Health for “Addressing Barriers to Adult Hearing Healthcare.”

CLINICAL TRIALS Ellen D. Dillavou, MD, Associate Professor of Surgery, Division of Vascular and Endovascular Surgery, received an award from Humacyte, Inc. for “Humacyte-006.” Samuel J. Francis, MD, Assistant Professor of Surgery, Division of Emergency Medicine, received an award from Hospital Quality Foundation for “HQF - Safety of Oral Anticoagulants Registry.” Matthew G. Hartwig, MD, Associate Professor of Surgery, Division of Cardiovascular and Thoracic Surgery, received an award from Lung Bioengineering, Inc. for “A Phase 2, Multicenter, Open Label Study to Measure Safety Donor Lungs (EVLP).” G. Charles Hughes, MD, Associate Professor of Surgery, Division of Cardiovascular and Thoracic Surgery, received an award from W. L. Gore & Associates, Inc. for “Gore TAG (TBE Device).” Brant A. Inman, MD, Associate Professor of Surgery, Division of Urology, received an award from Roche for “A phase IB/II, openlabel study of the safety and pharmacology of atezolizumab administered with or without Bacille Calmette-Guérin in patients with high risk non-muscle-invasive bladder cancer.” Richard L. McCann, MD, Professor of Surgery, Division of Vascular and Endovascular Surgery, received an award from Humacyte, Inc. for “Humacyte PAD.” 12

John Migaly, MD, Associate Professor of Surgery, Division of Advanced Oncologic and Gastrointestinal Surgery, received an award from Lifebond for “Efficacy and Safety of LifeSeal Kit for Staple Line Sealing in Colorectal and Coloanal Anastomoses: A Prospective Randomized Study.” Chan W. Park, MD, Assistant Professor of Surgery, Division of Metabolic and Weight Loss Surgery, received an award from Teleflex, Inc. for “Psychology of Minimally Invasive Surgical Scars.” Edward N. Rampersaud Jr., MD, Assistant Professor of Surgery, Division of Urology, received an award from Fox Chase Cancer Center for “A Phase II Study of Sporadic Angiomyolipomas (AMLs) Growth Kinetics while on Everolimus Therapy.” Debra L. Sudan, MD, Professor and Chief, Division of Abdominal Transplant Surgery, received an award from OrganOx, Ltd. for “A multicenter randomized controlled trial to compare the efficacy of ex-vivo normothermic machine perfusion with static cold storage in human liver transplantation.” Additionally, Dr. Sudan received an award from Shire Human Genetics Therapies for “A Prospective, Open-Label, Long-Term Safety and Efficacy Study of Teduglutide.” Finally, Dr. Sudan received an award from The Bristol-Myers/Sanofi Pharmaceuticals, Inc. Partnership for “BMS-EnList.”

research

PUBLICATIONS IN HIGH IMPACT FACTOR JOURNALS* *Journals with an impact factor of 10.0 or higher The Changing Incidence of Thyroid Cancer. Kitahara CM, Sosa JA. Nat Rev Endocrinol. 2016 Nov;12(11):646-653. Envelope-Specific Antibodies and Antibody-Derived Molecules for Treating and Curing HIV Infection. Ferrari G, Haynes BF, Koenig S, Nordstrom JL, Margolis DM, Tomaras GD. Nat Rev Drug Discov. 2016 Dec;15(12):823-834. PIK3CA Mutations Enable Targeting of a Breast Tumor Dependency Through mTOR-Mediated MCL-1 Translation. Anderson GR, Wardell SE, Cakir M, Crawford L, Leeds JC, Nussbaum DP, Shankar PS, Soderquist RS, Stein EM, Tingley JP, Winter PS, Zieser-Misenheimer EK, Alley HM, Yllanes A, Haney V, Blackwell KL, McCall SJ, McDonnell DP, Wood KC. Sci Transl Med. 2016 Dec 14;8(369):369ra175. Radiation-Induced Angiosarcoma after Breast-Cancer Treatment. Plichta JK, Hughes K. N Engl J Med. 2017 Jan 26;376(4):367. Modification of host dendritic cells by microchimerismderived extracellular vesicles generates split tolerance. Bracamonte-Baran W, Florentin J, Zhou Y, Jankowska-Gan E, Haynes WJ, Zhong W, Brennan TV, Dutta P, Claas FH, van Rood JJ, Burlingham WJ. Proc Natl Acad Sci U S A. 2017 Jan 31;114(5):1099-1104. A Fully Magnetically Levitated Circulatory Pump for Advanced Heart Failure. Mehra MR, Naka Y, Uriel N, Goldstein DJ, Cleveland JC Jr, Colombo PC, Walsh MN, Milano CA, Patel CB, Jorde UP, Pagani FD, Aaronson KD, Dean DA, McCants K, Itoh A, Ewald GA, Horstmanshof D, Long JW, Salerno C; MOMENTUM 3 Investigators. N Engl J Med. 2017 Feb 2;376(5):440-450. Intrapericardial Left Ventricular Assist Device for Advanced Heart Failure. Rogers JG, Pagani FD, Tatooles AJ, Bhat G, Slaughter MS, Birks EJ, Boyce SW, Najjar SS, Jeevanandam V, Anderson AS, Gregoric ID, Mallidi H, Leadley K, Aaronson KD, Frazier OH, Milano CA. N Engl J Med. 2017 Feb 2;376(5):451-460.

Mimicry of an HIV broadly neutralizing antibody epitope with a synthetic glycopeptide. Alam SM, Aussedat B, Vohra Y, Ryan Meyerhoff RR, Cale EM, Walkowicz WE, Radakovich NA, Anasti K, Armand L, Parks R, Sutherland L, Scearce R, Joyce MG, Pancera M, Druz A, Georgiev IS, Von Holle T, Eaton A, Fox C, Reed SG, Louder M, Bailer RT, Morris L, Abdool-Karim SS, Cohen M, Liao HX, Montefiori DC, Park PK, Fernรกndez-Tejada A, Wiehe K, Santra S, Kepler TB, Saunders KO, Sodroski J, Kwong PD, Mascola JR, Bonsignori M, Moody MA, Danishefsky S, Haynes BF. Sci Transl Med. 2017 Mar 15;9(381). Staged induction of HIV-1 glycan-dependent broadly neutralizing antibodies. Bonsignori M, Kreider EF, Fera D, Meyerhoff RR, Bradley T, Wiehe K, Alam SM, Aussedat B, Walkowicz WE, Hwang KK, Saunders KO, Zhang R, Gladden MA, Monroe A, Kumar A, Xia SM, Cooper M, Louder MK, McKee K, Bailer RT, Pier BW, Jette CA, Kelsoe G, Williams WB, Morris L, Kappes J, Wagh K, Kamanga G, Cohen MS, Hraber PT, Montefiori DC, Trama A, Liao HX, Kepler TB, Moody MA, Gao F, Danishefsky SJ, Mascola JR, Shaw GM, Hahn BH, Harrison SC, Korber BT, Haynes BF. Sci Transl Med. 2017 Mar 15;9(381). The LINK-A lncRNA interacts with PtdIns(3,4,5)P3 to hyperactivate AKT and confer resistance to AKT inhibitors. Lin A, Hu Q, Li C, Xing Z, Ma G, Wang C, Li J, Ye Y, Yao J, Liang K, Wang S, Park PK, Marks JR, Zhou Y, Zhou J, Hung MC, Liang H, Hu Z, Shen H, Hawke DH, Han L, Zhou Y, Lin C, Yang L. Nat Cell Biol. 2017 Mar;19(3):238-251. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FG, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RA, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME. J Am Coll Cardiol. 2017 Mar 21;69(11):1465-1508. Trends in Thyroid Cancer Incidence and Mortality in the United States, 1974-2013. Lim H, Devesa SS, Sosa JA, Check D, Kitahara CM. JAMA. 2017;317(13):1338-1348. Listerism then and now. Barr J, Podolsky SH. Lancet. 2017;389(10073):1002-3.

DUKE SURGERY INTRODUCES

ER GO N O M I CS P R O G R A M TO IMPROVE SURGEON HEALTH A recent study found that 90% of surgeons surveyed had experienced ergonomic injury.

fter hearing a lecture on posture in the operating room (OR), all six of last year’s chief residents in General Surgery suddenly understood the cause of their persistent lower neck pain. The loupes they used to magnify and visualize the operative field did not fit properly, and this improper fit forced them to bend their necks at an awkward angle during long hours in surgery. Over years of training, the seemingly small error in fit had led to noticeable health issues. “As residents, we spend so much time focusing on learning about disease processes and anatomy, how to get through a case, and surgical technique, that posture is probably the last thing anybody worries about,” says Dr. Michael Lidsky, recent graduate of the Duke General Surgery Residency. “But, poor posture is probably one of the most detrimental things to a surgeon’s career, and can result in major injury.”

Dr. Georgios Kokosis, another recent graduate of the General Surgery Residency. “It’s something that we don’t really pay much attention to, but it does have clinical implications. Unless we find ways to prevent it in the future, it will be happening to generations of surgeons.” ERGONOMICS IN THE OPERATING ROOM In collaboration with the Duke Ergonomics Division and with support from Department of Surgery Chair Dr. Allan Kirk, several General Surgery residents initiated a program to teach junior residents and medical students about proper positioning in the OR. The program

includes an ergonomic loupe fitting initiative currently in development, ergonomics labs with residents, one-onone observation of the chief residents, and coach training for the rising chief residents. “Surgeon positioning should be a high priority in the OR,” says Marissa Pentico, ergonomics coordinator. “The ergonomics team identifies ergonomic risk factors when assessing general work tasks, including awkward postures and prolonged duration of tasks performed. The General Surgery residents are in surgery between 5 and 8 hours, so we make recommendations that will address those risk factors.” According to Ms. Pentico, these recommendations include avoiding awkward postures when performing surgery by adjusting the height and position of the patient and the operating table, alternating postures by sitting when feasible depending on the type of case, and selecting the most ergonomic equipment to use. “Certain instruments, if you use them a lot during a case, just the way you hold them in your hands, they’re not ergonomically optimized and it’s a one size fits all,” explains Dr. Lidsky. “What fits a 6 foot 5 male surgeon isn’t necessarily

Ergonomic stressors in the OR, such as maintaining awkward positions for extended periods of time, can lead to a variety of musculoskeletal problems. Surgeons often develop pain in their neck, shoulders, and back, which may become debilitating, forcing them to halt an operation or miss work entirely. If left unchecked over time, significant degenerative changes can manifest, possibly resulting in a career-ending injury. “We know that our senior surgeons have had health issues before,” says 14

Increased neck flexion with old loupes

Improved neck posture

education the best device for a 5 foot 3 female surgeon. A lot of that is industry based.” As part of the program, each resident is fitted with loupes that sit at a proper declination angle to minimize neck flexion. Maintaining neck flexion at less than or equal to 25 degrees can prevent spine and neck strain during long stints in the OR. Additionally, the ergonomics team suggests that residents use anti-fatigue mats and take microbreaks for stretches to reduce the risk of injury. PEER-BASED ERGONOMICS TRAINING The Duke Surgery ergonomics program is uniquely peer based and thus fosters collaborative learning. The program aims to have fifth-year General Surgery residents act as ergonomics “coaches” to train junior residents on correct postures during surgery. To ensure the continuation of the program, each year before they graduate, the chief residents will train rising chief residents to be the next group of coaches. “In addition to teaching surgical technique to junior residents and to each other, senior residents will also be cognizant of their own posture and the way they stand, the way they hold their hands, and the way they have their loupes fitted,” says Dr. Lidsky. “A lot of this is to promote good patterns, better posture, and improved technique early on, which is much easier than taking people like us who have spent a number of years in less optimal positions. It’s harder to change it that way.”

Early intervention is exactly what research resident Dr. Shanna Sprinkle hopes to do by targeting medical students before they form bad postural habits. Medical students spend a lot of time practicing their skills independently or at home without an instructor to observe and verbally correct them, explains Dr. Sprinkle. “When we surveyed some of our medical students, 78% of them rated their posture during surgical tasks as poor or very poor,” says Dr. Sprinkle. “What’s alarming though is that more than half of them say they regularly experience musculoskeletal pain while performing surgical skills.” Dr. Sprinkle and other residents in Duke’s Surgical Education Research Group (SERG) conducted a pilot study in which medical students practiced a suturing task multiple times while wearing a small device that attached to their shirt and sensed when they started to slouch. After measuring their baseline postures, half of the students then had their device set to vibrate every time they slouched. The other half were told that the device was continuously evaluating their posture. Both groups improved their posture at first, but the group that experienced the vibratory feedback maintained the correct posture 76% of the time, even after the vibrations were turned off, compared to only 42% of the time for the group that did not receive the feedback. Dr. Sprinkle presented the results of the study at the Association of Surgical Educators conference in April. “Ergonomics relies on establishing good habits early on,” says Dr. Cecilia Ong,

one of the co-authors on the project and another Duke General Surgery research resident. “These wearable devices provide continual feedback that can promote the development of good habits and their continual reinforcement throughout training.” COUNTERING THE SURGEON CULTURE A recent study in the Journal of the American College of Surgeons found that of 127 surgical oncologists surveyed, 90% experienced at least one symptom of ergonomic injury, and 28% reported an ergonomic injury or chronic condition. While guidelines for surgical ergonomics exist, a lack of awareness persists among the surgical community. Coupled with this nescience is a culture that prizes resilience under stressful situations, often conditioning residents to “work through the pain.” However, this mentality backfires when untreated injuries lead to major health problems later on in a surgeon’s career. A new focus on improving surgeon health with ergonomic training programs and interventions, such as wearable devices, will ultimately enhance surgeon longevity. “I think this is part of the surgeon’s culture that we don’t really focus on,” explains Dr. Kokosis. “We’re focused more on being great at what we do, but we don’t really focus on the appropriate posture. As long as we can start talking about it more and come up with ways to prevent it from happening, I think it will be a great start of a program that we hope will be our legacy.”

Working with back bent forward more than 30°

Working with neck bent more than 45° Examples of stressors (awkward postures) for surgeons

education

T32 RESEARCH GRANT IN SURGICAL ONCOLOGY

expertise in basic, translational, and clinical research, this multidisciplinary team spans the breadth of surgical oncology research to address research questions in three distinct tracks listed below.

The Duke Research Training Program in Surgical Oncology will develop surgeons and perioperative physicians into physicianscientists, which is critical to the multidisciplinary approach needed to investigate novel approaches to cancer. The program will be led by a leadership team of academic surgeon-scientists with expertise in surgical oncology, pathology, immunology, and health outcomes research. Supplemented by mentors with

The program will support three research fellows in its first year of funding and six research fellows each following year. Program participants will consist of surgical residents recruited from within as well as outside of Duke. Trainees will select a primary mentor from a highly experienced and diverse group of 37 researchers. Guided by their mentors, the trainees will each develop and execute a research project, which will be the basis of a future career development or independent research award application. Trainees will become skilled in research methods and will be prepared to pursue independent academic careers that will improve the health of patients with cancer or premalignant conditions.

he National Cancer Institute (NCI) has awarded the Duke Department of Surgery a five-year training grant to support translational research in surgical oncology. The grant is led by four principal investigators, including Kim Lyerly, MD, Division of Surgical Sciences, Shelley Hwang, MD, Division of Advanced Oncologic and Gastrointestinal Surgery, David Harpole, MD, Division of Cardiovascular and Thoracic Surgery, and John Stewart, MD, Division of Advanced Oncologic and Gastrointestinal Surgery.

CANCER BIOMARKERS AND BIOLOGY OF LOCAL DISEASE MENTORS:

CANCER IMMUNOTHERAPY MENTORS:

CLINICAL INVESTIGATION AND HEALTH SERVICES RESEARCH MENTORS:

David H. Harpole, MD (Track Leader) Benjamin A. Alman, MD Darell Doty Bigner, MD, PhD Wei Chen, PhD Christopher Counter, PhD Gayathri Devi, PhD David Kirsch, MD, PhD Corinne Linardic, MD, PhD Donald McDonnell, PhD Susan Murphy, PhD Ann Marie Pendergast, PhD Nirmala Ramanujam, PhD Hai Yan, MD, PhD

H. Kim Lyerly, MD (Track Leader) Gerard Blobe, MD, PhD Marc Caron, PhD Nelson Chao, MD Matthias Gromeier, MD Zachary Hartman, PhD Michael Morse, MD Smita Nair, PhD John Sampson, MD, PhD Xiao-Fan Wang, PhD Yiping Yang, MD, PhD

Shelley Hwang, MD, MPH (Track Co-Leader) John Stewart, MD, MBA (Track Co-Leader) Andrew Berchuck, MD Kimberly Lynn Blackwell, MD Peter E. Fecci, MD, PhD Susan Halabi, PhD Marilyn Hockenberry, PhD, RN Terry Hyslop, PhD Brant Inman, MD Evan Myers, MD, MPH Laura Porter, PhD Julie Ann Sosa, MD David Witsell, MD

The first three trainees will be supported on this grant beginning July 1, 2017. For more information, please visit https://surgery.duke.edu/research-training-surgical-oncology

DUKE SURGERY ADVANCED EDUCATION COURSES

Duke Surgery is dedicated to training surgeons using the latest surgical techniques and innovative approaches in minimally invasive surgery, microsurgery, and robotic surgery. Utilizing a combination of didactic lectures, live surgeries, video, and hands-on labs, hundreds of surgeons and allied health professionals from around the world have been trained at Duke Surgery. CME credit is available for a number of courses held throughout the year in a wide range of surgical specialties. Following are upcoming Duke Surgery advanced educational courses. For a complete list of all of Duke Surgeryâ&#x20AC;&#x2122;s educational initiatives, visit innovation. surgery.duke.edu/courses.

faculty

DUKE SURGERY APPOINTS TWO NEW DIVISION CHIEFS

he Duke Department of Surgery is pleased to announce the appointment of Jeffrey R. Marcus, MD, as the new Chief of the Division of Plastic, Maxillofacial, and Oral Surgery, and Howard W. Francis, MD, MBA, FACS, as the new Chief of the Division of Head and Neck Surgery and Communication Sciences.

candidates and eventually confirmed that the best candidate was already here.” “Dr. Marcus is an excellent clinical and academic surgeon, but most importantly, he has demonstrated himself to be a dynamic leader. His organizational skills exercised in his role as Chief of Children’s Surgery have been nothing short of masterful, and have benefited all children undergoing surgery at Duke. Importantly, the manner in which Dr. Marcus has practiced, and enriched the students, residents, faculty, and staff who have

and to further develop and grow the division’s academic interests in clinical outcomes, tissue engineering, surgical innovation and education, and vascularized tissue allotransplantation. Dr. Francis comes to Duke from Johns Hopkins University where he served as professor and vice director of the Department of Otolaryngology-Head and Neck Surgery (OHNS) and director of the Johns Hopkins Listening Center. Other roles at Johns Hopkins included director of the OHNS residency program, inaugural co-chair of the Johns Hopkins Ambulatory Patient Safety and Quality Task Force, and program development responsibilities within Johns Hopkins International in Trinidad and Tobago, and Southeast Asia.

Dr. Marcus is the Paul H. Sherman Endowed Associate Professor of Surgery and an Associate Professor “We are absolutely thrilled to have in Pediatrics at Duke. He has served someone of Dr. Francis’ stature as the Vice Chair of Surgery in join our already strong group,” Pediatric Surgical Affairs since 2009 says Dr. Kirk. “He has exceptional and was appointed Duke Children’s Howard W. Francis, Jeffrey R. Marcus, leadership skills and will help Chief of Surgery in 2015. Dr. Marcus MD, MBA, FACS MD propel our division to new levels is the director of the newly created of national prominence. There is Center for Children’s Surgery, one of uniform enthusiasm for his arrival. The only five centers in the country designated had the pleasure of working with him, is entire institution joins me in welcoming Dr. a Level 1 program for children’s surgical exemplary. His example will be made more Francis and his family to the Duke family.” care by the American College of Surgeons. apparent as Division Chief, and it will be to our collective benefit.” In his new role, Dr. Francis will grow the “I am so pleased to have Dr. Marcus clinical enterprise to serve the growing assume this critical leadership role,” In his new role, Dr. Marcus will grow population of the Triangle, recruiting says Dr. Allan D. Kirk, Chair of the the clinical enterprise of plastic and new talented clinicians to Head and Neck Department of Surgery. “He will follow reconstructive surgery and oral health Oncology, General Otolaryngology, and Dr. Gregory Georgiade, one of the most services across the Duke Health System, Ancillary services. Dr. Francis will also including the recruitment of surgeons outstanding surgeons ever to practice work to enhance and nurture the research and surgeon-scientists in reconstructive at Duke, who has led the division to program, building new collaborations microsurgery, breast surgery, oral surgery, a state of unprecedented stability. Dr. across the institution. Areas of focus will and aesthetic surgery. Dr. Marcus will work Marcus’ appointment comes as a result to foster new collaborations, to support include immunology, clinical research, and of a nationwide search that attracted an the ongoing research efforts of the faculty, exceptionally large number of outstanding communication sciences.

Duke Masters of Minimally Invasive Bariatric Surgery June 22-24, 2017 Orlando, FL Duke Tuesday in Urology July 18, 2017 Durham, NC Duke University and Hadassah International Otolaryngology Global Health Conference July 20-21, 2017 Jerusalem, Israel

Duke Cancer Review 2017 July 28-29, 2017 Cary, NC

Duke Solid-Organ Transplant Summit September 23, 2017 Durham, NC

Duke Fresh Cadaver Flap Dissection Course August 4-6, 2017 Durham, NC

Duke Tuesday in Urology November 7, 2017 Durham, NC

Duke Masters of Minimally Invasive Thoracic Surgery September 21-23, 2017 Orlando, FL

2018 Duke Urologic Assembly and Urologic Cancer Symposium April 5-8, 2018 Hilton Head, SC

FACULTY AWARDS ELLEN DILLAVOU, MD Associate Professor of Surgery, Division of Vascular and Endovascular Surgery, was appointed to the Editorial Board of the Journal of Vascular Surgery: Venous and Lymphatic Disorders. Dr. Dillavou was also elected President of the Vein Center Board of Directors for the Intersocietal Accreditation Commission.

STEPHANIE EUCKER, MD, PhD Assistant Professor of Surgery, Division of Emergency Medicine, was named a Senior Reviewer for Annals of Emergency Medicine.

OLUWADAMILOLA FAYANJU, MD Assistant Professor of Surgery, Division of Advanced Oncologic and Gastrointestinal Surgery, was selected as a KL2 Scholar through the Duke Clinical and Translational Science Institute. She was also selected by peer review as a Duke Health Fellow, which provides research support and career mentoring for faculty for their continued success as clinicianscientists.

RACHEL GREENUP, MD, MPH Assistant Professor of Surgery, Division of Advanced Oncologic and Gastrointestinal Surgery, received the Health Policy Scholarship provided by the American College of Surgeons and the American Society of Breast Surgeons.

Associate Professor of Surgery, Division of Vascular and Endovascular Surgery, was appointed to the Editorial Board of Vascular Medicine, the premier peer-reviewed journal of the Society of Vascular Medicine.

SCOTT HOLLENBECK, MD

TODD PURVES, MD, PhD

Associate Professor of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, was selected by peer review as a Duke Health Scholar, which provides research support and career mentoring for faculty for their continued success as clinician-scientists.

SANDHYA LAGOODEENADAYALAN,MD,PhD Associate Professor of Surgery, Division of Vascular and Endovascular Surgery, received the 2017 Leonard Tow Humanism in Medicine Award. This award is presented annually to a Duke faculty member who embodies compassion, sensitivity, respect for patients and colleagues, and clinical excellence.

JEFFREY MARCUS, MD Associate Professor of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, was appointed to the Editorial Boards for JAMA Facial Plastic Surgery and Aesthetic Plastic Surgery.

LEILA MUREEBE, MD

Associate Professor of Surgery, Division of Urology, was selected by peer review as a Duke Health Scholar, which provides research support and career mentoring for faculty for their continued success as clinician-scientists.

EILEEN RAYNOR, MD Associate Professor of Surgery, Division of Head and Neck Surgery and Communication Sciences, was selected as a participant in the Duke School of Medicineâ&#x20AC;&#x2122;s ALICE program. The Office for Faculty Development created the ALICE program in 2016 as a leadership development opportunity for mid-career women faculty in the School of Medicine.

APARNA REGE, MD Clinical Associate, Division of Abdominal Transplant Surgery, won the Organ Donation and Utilization publishing competition from the journal Cureus. Dr. Regeâ&#x20AC;&#x2122;s article focused on the trends and outcomes of expanded criteria donor kidney transplantation in the United States.

faculty

NEW FACULTY CYNTHIA SHORTELL, MD Professor and Chief, Division of Vascular and Endovascular Surgery, was named Chair of the Diversity Committee for the Southern Association for Vascular Surgery.

JOSHUA SNYDER, PhD Assistant Professor in Surgery, Division of Surgical Sciences, received the National Cancer Instituteâ&#x20AC;&#x2122;s Transition Career Development Award.

COURTNEY SOMMER, MD Assistant Professor of Surgery, Division of Trauma and Critical Care Surgery, was appointed to the Editorial Board for the Journal of Surgical Research.

FACULTY PROMOTION

LISA TOLNITCH, MD Assistant Professor of Surgery, Division of Advanced Oncologic and Gastrointestinal Surgery, received the Humanism in Medicine Award from the American Society of Breast Surgeons and the Arnold P. Gold Foundation.

GEORGIA TOMARAS, PhD Professor of Surgery, Division of Surgical Sciences, was selected as a participant in the Duke School of Medicineâ&#x20AC;&#x2122;s ALICE program. The Office for Faculty Development created the ALICE program in 2016 as a leadership development opportunity for mid-career women faculty in the School of Medicine.

ELISABETH TRACY, MD Assistant Professor of Surgery, Division of Pediatric General Surgery, was selected by peer review as a Duke Health Fellow, which provides research support and career mentoring for faculty for their continued success as clinician-scientists.

SMITA NAIR, PhD Division of Surgical Sciences, was promoted to Professor of Surgery.

KAREN C. BAKER, MD Associate Professor of Surgery, Urology Clinical interests include male fertility and microsurgery. Research interests include quantifying the impact of common medical conditions on male fertility and investigating their pathogenic effects on spermatogenesis and sperm function, delineating the impact of male factor infertility on outcomes of assisted reproductive techniques, and investigating the efficacy of medical therapy for male factor infertility. Dr. Baker is also interested in the social, psychological and health impacts of infertility.

WUNIMENGHE ORIYANHAN, MMed Medical Instructor, Plastic, Maxillofacial, and Oral Surgery Research interests include heterotopic (abdominal) heart transplantation, cardiac preservation, cardiac allograft chronic rejection, and posttransplantation ventricular performance.

KRISTAL RISKA, MD Medical Instructor, Head and Neck Surgery and Communication Sciences Clinical interests include improving the assessment and management of patients with vestibular and balance disorders. Research interests include refining and developing evidence-based vestibular assessment protocols to make them more cost effective and time efficient, developing and implementing evidencebased screening and decision support to frontline providers to help identify and better triage patients with suspected vestibular and balance disorders, and identifying and understanding factors that contribute to chronic dizziness symptoms.

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Department of Surgery DUMC 3704 Durham, NC 27710 4017669

MISSION Through sustainable, multidisciplinary teams we: •

Provide insight regarding the fundamental nature of patient health and disease

•

Empower all patients, trainees, and colleagues with knowledge

•

Provide safe and high-quality care based on an advanced understanding of and respect for our patients’ needs and guided by best practices

VISION

PARTNERS IN PHILANTHROPY A gift to the Duke Department of Surgery is a gift of knowledge, discovery, and life. Every dollar is used to further our understanding of surgical medicine, to develop new techniques, technology, and treatments, and to train the surgeons and researchers of the future.

Duke Surgery: United, for All Patients

If you would like to make a philanthropic investment in Duke Surgery, please contact Marcy Romary, Senior Major Gifts Officer, with Duke Health Development and Alumni Affairs at marcia. romary@duke.edu or visit surgery.duke.edu/gift.

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