Study: Robotic surgery lowers risk of a rare but serious complication of gastric bypass

The use of a robot to assist with the most commonly performed weight-loss surgery appears to significantly lower a patient’s risk of developing a rare but serious complication, according to a study published in the most recent edition of the Journal of Robotic Surgery.

Minimally-invasive surgeons at the Medical School statistically analyzed operative times, length of hospital stay and complications in 605 patients who either underwent laparoscopic Roux-en-Y gastric bypass or the same procedure with the assistance of a robot at Memorial Hermann – Texas Medical Center.

The one significant difference that stood out was the gastrointestinal leak rate. None of the patients in the robotic-assisted surgery group experienced a gastrointestinal leak, while six in the laparoscopy group suffered this complication within 90 days after their surgery.

Other results were similar. Robotically-assisted surgery took only 17 minutes longer than the laparoscopic procedure. Hospital stays were an average of three days in both groups, and the overall complication rate was 14 percent, with fewer than 4 percent being classified as major complications among the two groups of patients.

“While robotic surgery may take slightly longer and be more costly to use than traditional laparoscopy, we believe that the improved outcome and decreased leak rates may offset the cost to some extent,” said Dr. Erik Wilson, the study’s senior author and director of the Minimally Invasive Surgeons of Texas group.

A gastrointestinal leak, which can occur when the small intestine is reconnected to a small pouch created in the stomach, often produces symptoms of abdominal and chest pain, shortness of breath, fever, nausea, vomiting, and rarely, death. In this five-year study, there were no deaths in either group, and the rate for both gastrointestinal leaks and other complications was slightly lower than what has previously been reported in scientific journals.

Lead author Dr. Brad Snyder, assistant professor in the Department of Surgery, said the robotic technique offers numerous advantages to bariatric surgeons, and these advantages may play a role in the reduced leak rate.

“The most important advantage is that the robot allows for precise, ambidextrous forehand and backhand suture placement,” Snyder said. “The angles encountered during a laparoscopic gastric bypass are sometimes awkward and can make the surgical technique challenging. With the robot, this additional challenge is minimized and the bariatric surgeon can suture the area between the stomach and the section of the small intestine with confidence.”

Wilson, medical director of the bariatric surgery program at Memorial Hermann – TMC, said another advantage of robotics is the clear, three-dimensional view of the operative field which allows the surgeon to better visualize tissue planes and place more precise sutures.

“As a result, there is improved surgical performance and lower leakage rates,” Wilson said. “We believe this is the most important factor contributing to our zero percent leak rate. In addition, the robot allows us to work in tighter spaces, control our own camera, and have a very steady operative view even when magnified. Overall, we feel that this attribute gives us the ability to offer the safest, most effective surgery results for our patients who want to achieve successful, long-term weight loss.”

Wilson and Snyder conducted the study with minimally-invasive surgery fellow Dr. Todd Wilson and former faculty members Terry Scarborough, M.D., and Sherman Yu, M.D.

For information about robotic-assisted Roux-en-Y gastric bypass or an appointment with a surgeon who specializes in weight-loss procedures, call 713.892.5500. The UT Minimally Invasive Surgeons of Texas Clinic has a new Bellaire location at 6700 West Loop South, Suite 500.

-M. Raine

Student selected to train in applied epidemiology at CDC

Fourth-year medical student Scott Tolan has been selected to participate in The CDC Experience Applied Epidemiology Fellowship for physicians-in-training at the Centers for Disease Control and Prevention (CDC). The yearlong fellowship combines classroom instruction in epidemiology and public health science with hands-on public health work.

Tolan was competitively selected as one of eight fellows from 45 applicants and began his fellowship in August 2008. He has been assigned to the Enteric Diseases and Epidemiology Branch of CDC’s Division of Foodborne, Bacterial, and Mycotic Diseases. During the course of the fellowship, Tolan will conduct epidemiologic research, help design public health interventions, and participate in field investigations. He also will receive classroom training and special seminars on topics such as public health surveillance, biostatistics, and health policy.

Tolan is from San Antonio and completed his undergraduate education at Westmont College in Santa Barbara, Calif.

“While at Westmont, I went to Nigeria to get my feet wet in medicine considering I already took the MCAT but had almost no exposure to medicine at that time,” he said. “I ended up at a very rural missionary hospital participating in everything from routine clinic and pediatrics rounds to the ER, and was even first assist on a number of orthopedic and trauma surgeries. Most importantly, I learned then that medicine was a fit, a way to combine my privileges in education with a growing compassion for folks that could not help themselves for one reason or another. Although I also learned something else while in this setting. The patients came by the dozens and dozens every day and lined up for hours. I realized that the physician in the rural setting cares for the individual patient but also has the potential to impact the community at large. I asked myself, what can a physician do to reduce the exposed risks to the community preventatively in order improve people’s well-being, but also to utilize the limited resources available?”

Since that time, Tolan has traveled to Central and South America and developed an affinity for infectious diseases and those most affected by them.

“I knew that someday in the future I would be out on my own in a community with minimal resources and wanted to know the skills to identify a problem within the patient population, collect data, analyze the data at my kitchen table at night, and be able to implement an intervention in the morning for the folks in need,” he said. “I thought about applying for an MPH, but some of the folks who practice this sort of community medicine suggested that it's best to just get out and do it. That's when I came upon the CDC Experience, which is essentially much of the MPH degree translated into a year of mentorship and practice. The CDC Experience has also been referred to as an Epidemiology Intelligence Service (EIS) Residency for Med Students. The EIS officers are the shoe-leather disease detectives that track epidemics across the globe.”

The CDC Experience Applied Epidemiology Fellowship is funded by a grant to the CDC Foundation from Pfizer Inc and is designed to help strengthen the ties between the fields of medicine and public health by giving future physicians an in-depth understanding of applied epidemiology, the role of epidemiology in medicine, and the role of physicians in the public health system.

“The health system needs physicians with a broader, population-based perspective,” said Dr. Denise Koo, director of CDC’s Career Development Division. “The CDC Experience helps future leaders in the health care system understand how, as physicians, they can use epidemiology skills to improve the clinical treatment of individual patients, as well as protect the health of entire communities. Each new class of fellows makes valuable contributions to CDC and helps strengthen CDC’s ties to our partners in the medical community.”

Each fellow is responsible for performing a surveillance project, data analysis, developing a manuscript and submiting it for publication, and must participate on at least one EpiAID — an outbreak of typically a communicable disease that requires further assistance beyond the state public health officials to investigate the cause of the increased prevalence, identify and treat the exposed patients, and eliminate the cause, while making efforts for prevention in the future.

“One of the surveillance projects that I will likely work on is a correlation of Salmonella species trends mapped according to different variables such as climate, population density, socioeconomic status, geographic, or any other demographic or epidemiologic parameter using Geographic Information Systems (GIS) programming,” he said. “I was ecstatic to be accepted to this program and hope to learn a skill set here to be a patient focused primary care physician with the ability to systematically and effectively address the issues of the patient cohort that I care about.”

The application cycle for the 2010 fellowship program begins in October 2009. Applicants must be medical students currently completing their second or third year of medical school. For more information, please visit www.cdcfoundation.org/thecdcexperience.

-D. Brown

2008 Fun Fest set for Nov. 7

The 2008 Fun Fest will be held 2–6 p.m., Friday, Nov. 7, in a new location – the Texas Medical Center’s Grant Faye Park. All health science center staff, faculty, and students are invited to dust off their leather jackets and fluff up their poodle skirts to join in with this year’s theme, Rockin’ and Rollin’ to the ‘50s. Admission is free to anyone with a university ID badge, and dressing up to fit the 1950s theme is optional but encouraged! For more information, contact Rose.M.Betancourt-trevino@uth.tmc.edu, 713.500.3209.

 

School of Public Health to host health care leadership panel

The UT School of Public Health’s George McMillan Fleming Center for Healthcare Management will host its second moderated panel discussion from 11 a.m. to 1 p.m. Oct. 27 in the auditorium of the Reuel A. Stallones Building, 1200 Herman Pressler. The panel will be jointly sponsored by the local chapter of the American College of Healthcare Executives.

Jack Lynch, CEO of Main Line Health and former COO at St. Luke’s Episcopal Health System, will moderate “Healthcare Leadership Challenges: Balancing Institutional and Community Interests.” The panel of distinguished speakers will include Dr. David Fine (Hon.), president and CEO of St. Luke’s Episcopal Health System; Dr. Thomas C. Royer, president and CEO of CHRISTUS Health; and Dr. David Callender, president of The University of Texas Medical Branch at Galveston.

Dr. Osama Mikhail, director of the Fleming Center and senior vice president for strategic planning, will host the panel discussion and lunch buffet.

The Fleming Center was established in April 2008 in the name of the late George McMillan Fleming, a past president of the Texas Hospital Association and health care leader at numerous hospitals in the state, including The Methodist Hospital. Through the faculty and curriculum developed at the Fleming Center, the UT School of Public Health will offer MPH and DrPH/Ph.D. programs with a health care management concentration, providing students with effective tools for managing health care institutions while providing a public health context by linking to health policy and community well being. The new MPH major in health care management has received approval from the Texas Higher Education Coordinating Board, and it is anticipated that the first class of students will be enrolled in the fall of 2009.

The panel discussion is open to the public. For information about the event, call Shannon Larson, 713.500.3252. For more information about the degree programs, call James Langabeer II, the Fleming Center’s associate director, 713.500.9190.

-M. Raine

 

Science doctorates on the rise

According to a new survey report by the Council for Graduate Schools on doctorate degree conferral, health sciences continues to be the fastest-growing field of study, experiencing a 12 percent average annual growth compared to the three percent growth seen in other fields. The survey looked at both annual and 10-year trends and found that between 1997 and 2007, doctorate degrees awarded for biological sciences and health sciences increased by 11 percent and 18 percent, respectively. The representation of minorities in science has also steadily increased during this time period.

In the last year alone, enrollment for both African Americans and Hispanics in biological sciences grew seven percent, compared to a 1 percent increase for white, non-Hispanics.

Information: Go to http://www.cgsnet.org/Default.aspx?tabid=168

-AAMC

NIH seeks applicants for loan repayment programs

The National Institutes of Health (NIH) are accepting applications for extramural loan repayment programs (LRPs). The LRPs repay up to $35,000 of educational loan debt annually for individuals who commit to conducting at least two years of qualified biomedical or behavioral research at a nonprofit institution of their choice.

The NIH offers five LRPs: Clinical Research, Pediatric Research, Health Disparities Research, Contraception and Infertility Research, and Clinical Research for Individuals from Disadvantaged Backgrounds. To qualify, applicants must possess a doctoral-level degree (except for the Contraception and Infertility Research LRP); devote at least 20 hours per week to research funded by a domestic nonprofit organization or federal, state, or local government entity; have educational loan debt equal to or exceeding 20 percent of their institutional base salary; and be a U.S. citizen, national, or permanent resident.

Some 1,600 research scientists benefit from LRPs annually. Approximately 40 percent of all new LRP applications are funded. Applications are due Dec. 1.

Information: Go to http://www.lrp.nih.gov

 

Hurricane Heroes

Memorial Hermann celebrated the heroes of the hurricane at a lunch last week.