Stony Brook Surgery Blog

Patient Flies Back Home the Same Day His Problem Is Diagnosed and Treated with New Outpatient Procedure

Abraham Blass, 59, of Houston, TX, was having trouble swallowing. It was painful and getting worse. He also experienced recurrent swelling underneath his jaw, especially after eating. Doctors there were unable to make any diagnosis, not even with the aid of a CT scan, and Blass was unable to get the treatment he needed. He had to look elsewhere for better care.

The man's quest brought him to Stony Brook — some 1,700 miles from home — for salivary endoscopy, the new minimally invasive salivary gland procedure that can be used for both diagnosis and treatment, and that's performed by only a few surgeons in the United States.

Blass had read online about Stony Brook's head and neck surgeon Mark F. Marzouk, MD, who leads our program in salivary endoscopy. Specially trained in the procedure and with several years of experience, Dr. Marzouk is attracting patients from around the world who come to Stony Brook for this care.

Blass was treated in early April. During the procedure, Dr. Marzouk was able to make the diagnosis of salivary duct narrowing and also treat the problem at the same time. His narrowing was cured by the doctor using a balloon about one-eighth of an inch in size to dilate (widen) the duct. The procedure was done under local anesthesia with mild sedation and no incisions in the neck.

Blass tolerated the procedure well. In fact, he was able to fly back home to Texas the same day. This made the experience for him all the more positive.

"Mr. Blass's story is not uncommon," explains Dr. Marzouk. "As salivary endoscopy has evolved, many challenging cases have been encountered in which a diagnosis cannot be made with physical exam and imaging modalities."

Commenting on the care he received at Stony Brook, Blass says, "I highly recommend the sialendoscopy procedure. It was done under local anesthesia and less painful than going to the dentist for a tooth filling. Dr. Marzouk and his entire team were friendly, caring, and knowledgeable throughout the entire process."

In 2010, soon after Dr. Marzouk joined our faculty, he performed the first salivary endoscopy ever done on Long Island. This minimally invasive technique allows for the examination of the salivary ducts under endoscopic guidance. Treatments, such as stone removal, duct dilatation, and steroid injection, can be done at the same time.

Not only can duct narrowing be diagnosed and treated with salivary endoscopy. Sialolithiasis, or stone(s) in the salivary duct, is the most common disease of the salivary gland for which salivary endoscopy is done.

Sialolithiasis affects approximately 12 in 1,000 adults. Symptoms include pain, intermittent swelling of the gland, and possibly severe infection.

The success rate of salivary endoscopy in treating sialolithiasis is over 90%, as reported in the current literature, with less than 5% recurrence. Recovery time is much faster than with an open technique, and patients may return to a normal diet the same day.

Salivary endoscopy allows for salivary gland surgery in a safe and effective way, and is done on an outpatient basis. The current standard in most institutions for treating salivary duct stones has been surgical removal of the gland that entails an incision in the neck and an overnight stay in the hospital. The conventional "open" operation also carries with it the potential complications of scarring, wound infection, and nerve injury.

Originally developed in Switzerland, the salivary endoscopy procedure is truly one of the most fascinating and patient-centered innovations introduced in the recent years in the field of otolaryngology-head and neck surgery.

Stony Brook Medicine is the only institution in both Nassau and Suffolk counties currently providing this truly state-of-the-art service to patients. Read more about salivary endoscopy.

May is National Trauma Awareness Month that features the annual campaign to promote safety on our roads, in our work, and at our homes. In observance of it, our trauma team wants to share a set of facts provided by the American Trauma Society.* Take heed of them each day of this month, and be safe!

Day 1: Injuries are the number one cause of death among children. Car crashes, suffocation, drowning, poisoning, fires, and falls are some of the most common causes of injury.

Day 2: Every hour, one child dies from an injury.

Day 3: Car crashes, suffocation, drowning, poisoning, fires, and falls are some of the most common ways children are hurt or killed. Though death rates for most of these are dropping, suffocation and poisoning rates are on the rise.

Day 4: About one in five child deaths is due to injury.

Day 5: Every 4 seconds, a child is treated for an injury in an emergency department.

Day 6: Each year, one in every three adults age 65 and older falls. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death.

Day 7: Among older adults (those 65 or older), falls are the leading cause of injury death. They are also the most common cause of nonfatal injuries and hospital admissions for trauma.

Day 8: Falls are the most common cause of traumatic brain injury (TBI). In 2000, TBI accounted for 46% of fatal falls among older adults.

Day 9: Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities leading to reduced mobility and loss of physical fitness, which in turn increases their actual risk of falling.

Day 10: The chances of falling and of being seriously injured in a fall increase with age. In 2009, the rate of fall injuries for adults 85 and older was almost four times that for adults 65 to 74.

Day 11: Motor vehicle crashes are the leading cause of death among those aged 5-34 in the United States.

Day 12: The economic impact is also notable: the lifetime costs of crash-related deaths and injuries among drivers and passengers were $70 billion in 2005.

Day 13: U.S. adults drank too much and got behind the wheel about 112 million times in 2010.

Day 14: Alcohol-impaired drivers are involved in about one in three crash deaths, resulting in nearly 11,000 deaths in 2009.

Day 15: Motor vehicle crashes are the leading cause of death among those aged 5-34 in the United States.

Day 16: Adult seat belt use is the most effective way to save lives and reduce injuries in crashes. Yet millions of adults do not wear their seat belts on every trip.

Day 17: Motor vehicle crashes are the leading cause of death for U.S. teens, accounting for more than one in three deaths in this age group. In 2009, eight teens ages 16 to 19 died every day from motor vehicle injuries. Per mile driven, teen drivers ages 16 to 19 are four times more likely than older drivers to crash.

Day 18: Compared with other age groups, teens have the lowest rate of seat belt use. In 2005, 10.2% of high school students reported they rarely or never wear seat belts when riding with someone else.

Day 19: In 2008, 4,378 pedestrians were killed in traffic crashes in the United States, and another 69,000 pedestrians were injured. This averages one crash-related pedestrian death every 2 hours, and a pedestrian injury every 8 minutes.

Day 20: Pedestrians are 1.5 times more likely than passenger vehicle occupants to be killed in a car crash on each trip.

Day 21: Alcohol-impairment: either for the driver or for the pedestrian: was reported in 48% of the traffic crashes that resulted in pedestrian death. Of the pedestrians involved, 36% had a blood alcohol concentration (BAC) above the illegal limit of 0.08 grams per deciliter (g/dL) or higher.

Day 22: Each day, more than 15 people are killed and more than 1,200 people are injured in crashes that were reported to involve a distracted driver.

Day 23: There are three main types of distracted driving:

• Visual: taking your eyes off the road;
• Manual: taking your hands off the wheel; and
• Cognitive: taking your mind off what you are doing.

Day 24: In 2009, more than 5,400 people died in crashes that were reported to involve a distracted driver and about 448,000 people were injured. Among those killed or injured in these crashes, nearly 1,000 deaths and 24,000 injuries included cell phone use as the major distraction.

Day 25: Twenty-five percent of drivers in the United States reported that they "regularly or fairly often" talk on their cell phones while driving.

Day 26: Nine percent of drivers in the United States reported texting or emailing "regularly or fairly often" while driving.

Day 27: Every day, almost 30 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver. This amounts to one death every 48 minutes.

Day 28: In 2008, an estimated 7,000 people — an average of more than 19 people every day — were treated in emergency departments for injuries sustained from fireworks, and more than half of those injured were children.

Day 29: The annual cost of alcohol-related crashes totals more than $51 billion.

Day 30: The leading causes of TBI are:

• Falls (35.2%);
• Motor vehicle — traffic (17.3%);
• Struck by/against events (16.5%); and
• Assaults (10%).

Day 31: Prevention works!

• Seat belts have saved an estimated 255,000 lives between 1975 and 2008.
• School-based programs to prevent violence have cut violent behavior among high school students by 29%.
• Sobriety checkpoints have been shown to cut alcohol-related crashes and deaths by about 20%.
• Tai chi and other exercise programs for older adults have been shown to reduce falls by as much as half among participants.

For information about injury prevention programs in Suffolk County, please email our trauma nurse coordinator Jane E. McCormack. For injury prevention strategies, visit the National Center for Injury Prevention and Control.

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* For the information in this post we thank the American Trauma Society, which is dedicated to the prevention of trauma and improvement of trauma care.

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By Paula I. Denoya, MD, of the Stony Brook Colon and Rectal Surgery Division

A report just published in Archives of Surgery, titled "Effect of Laparoscopy on the Risk of Small-Bowel Obstruction," details a study of the effect of laparoscopy on the risk of bowel obstruction. Laparoscopy, or minimally invasive surgery, allows the surgeon to use a video camera and long thin instruments to perform complex surgery through several tiny incisions rather a large one.

The laparoscopic technique has several advantages, including generally faster recovery after surgery and less scarring. It is also believed that laparoscopy may cause less trauma to the intestines during surgery, which may prevent the formation of internal scar tissue called adhesions.

Adhesions can cause kinking and twisting of the intestine, leading to blockages, months to years after the initial operation.

The researchers who conducted the study looked at a registry kept by the Swedish National Board of Health, which keeps track of all hospitalizations of Swedish residents. They studied a total of 108,141 patients who underwent common operations and compared the ones who had conventional open surgery and the ones who had laparoscopic surgery.

They found that several factors including age, previous abdominal surgery, other medical problems, and the use of open surgery rather than laparoscopy all increased the risk of being hospitalized for a bowel obstruction in the future.

The researchers' conclusions are valid with some limitations. The number of patients studied is very large, and the information on each patient is recorded into the Registry prospectively, meaning at the time that it happens, which increases the likelihood that what is recorded is accurate.

However, the study looked at the data recorded previously and did not look into each patient's individual chart, so certain other factors which may influence the risk of obstruction may not be taken into account accurately.

Also, the percentage of open or laparoscopic surgeries that were done for certain types of operations were not equal. For example, most of the appendix surgeries were performed laparoscopically, whereas only 1-2% of colon surgery was performed laparoscopically, making it difficult to compare results.

The take-home message is that use of laparoscopy, along with several other factors, may help to prevent the future complication of bowel obstruction, but that the amount of risk reduction is still unclear and there is room for further study.

The new study appears in the April issue of Archives of Surgery. "This study shows that, beyond important factors such as age, previous abdominal surgery, and co-morbidity [co-existing illnesses], the surgical technique is the most important factor related to [small-bowel obstruction]," say the researchers in a news release from Archives of Surgery. "For surgeons, [the study] highlights another potential benefit of minimally invasive surgery and challenges us to continue to offer less invasive procedures whenever they are feasible," Dr. Luke Funk and Dr. Stanley Ashley, gastrointestinal surgeons at Harvard Medical School, say in their comment on the study that appears in an accompanying editorial published in the journal.

Click here to read the abstract of the study provided by the National Library of Medicine.

Jason C. Ganz, MD, joined our faculty four years ago as a member of our Plastic and Reconstructive Surgery Division. He came to Stony Brook from New York Medical College, where he practiced at Westchester Medical Center in Valhalla, NY.

Previously, Dr. Ganz had been on the faculty of Case Western Reserve University in Cleveland, OH, and on staff at University Hospitals/Case Western Medical Center, as well as at Louis Stokes Cleveland Veterans Affairs Medical Center, where he was chief of plastic surgery.

Board certified in plastic surgery and hand surgery, Dr. Ganz focuses his practice on reconstructive and aesthetic surgery and on hand surgery, including treatment of hand and wrist disorders, fractures, tendon injury, and nerve injury or compression (carpal tunnel syndrome).

Since joining our faculty in 2008, Dr. Ganz has made news on more than one occasion, performing rare and complicated limb reattachment surgery as well as toe-to-thumb transplant surgery, both requiring the most sophisticated reconstructive microsurgical expertise.

Dr. Ganz is a specialist in microsurgery; limb reattachment; breast reconstruction after cancer, breast reduction, and breast augmentation; nose surgery; treatment of facial fractures; reconstructive surgery for burn patients; facelift, general liposuction, and tummy-tuck surgery; and evaluation and surgical management of chronic wounds (skin grafting and soft-tissue flap coverage).

Dr. Ganz received his MD in 1998 from New York Medical College, where his outstanding performance earned him election to the Alpha Omega Alpha Honor Medical Society. He was trained in plastic surgery at Georgetown University in Washington, DC. Subsequently, he completed his fellowship training in hand surgery in the orthopaedics department here at Stony Brook.

Watch this news clip (2:03 min) aired on WPIX TV News about Dr. Ganz's successful 11-hour operation reattaching a severed hand (caution — graphic images):

Findings of News-Making Report Offer Hope for Many Afflicted with Sleep Disturbance Disorder

The use of proton pump inhibitors (PPIs) improves the sleep and daytime quality of life for sufferers of gastroesophageal reflux disease (GERD), according to a systematic literature review conducted by Elliot Regenbogen, MD, of our Otolaryngology-Head and Neck Surgery (ENT) Division, and colleagues here at Stony Brook Medicine. This research demonstrates our commitment to advancing patient care.

The report, titled "Esophageal Reflux Disease Proton Pump Inhibitor Therapy Impact upon Sleep Disturbance," was just published in the April issue of Otolaryngology-Head and Neck Surgery.

A 2003 Gallup survey linked GERD — also known as heartburn or reflux esophagitis — with frequent sleep disturbances. PPIs have proven to be an effective treatment therapy, and there are established criteria for treating reflux. However, there are no well-established clinical guidelines on how to treat the sleep disturbances with the resulting quality-of-life issues.

The objective of Dr. Regenbogen's review was to evaluate the impact of PPI treatment of GERD on sleep disturbance-related outcomes, as documented in the medical literature.

In addition to Dr. Regenbogen who is the first author, the co-authors of the report are Alex Helkin and Rachel Georgopoulos, two senior medical students in the School of Medicine; Tajender Vasu, MD, of the Pulmonary, Critical Care, and Sleep Medicine Division; and A. Laurie W. Shroyer, PhD, MSHA, vice chair of research of the Department of Surgery.

Together, the authors performed a systematic literature review using three databases — PubMed, Web of Science, and Cochrane Library — of all randomized placebo-controlled clinical trials from 1989 (when omeprazole became available) to October 2011. Additional relevant publications were identified based on the articles' citations.

The search strategy identified all randomized placebo-controlled clinical trials published in English; both PPI use and outcome measures of sleep disturbance were reported for GERD patients. Using a pre-established systematic review protocol and data extraction format, the four co-authors independently reviewed all articles.

Based on the review findings, the authors state in the report: "The existing evidence supports the use of PPI medications as a treatment to improve esophageal reflux disease symptoms and associated quality-of-life sleep disturbance-related outcomes."

"Although the improvements are likely secondary gains from reduction or elimination of nocturnal GERD symptoms, further research appears warranted to evaluate PPI treatment impact on polysomnography outcomes, as well as to examine the relationship of polysomnography versus nonpolysomnography outcomes, for GERD patients with sleep disturbance and sleep-disordered breathing," they add.

Dr. Regenbogen explains the value of the approach he used to conduct the study, as it relates to evidence-based medicine and high-quality healthcare:

"A systematic review of the literature presents a structured summary and critical appraisal of high-quality research evidence relevant to a focused question. Systematic reviews of high-quality randomized controlled trials are crucial to evidence-based medicine, and have become a cornerstone in the development of high-quality healthcare. The scope of systematic reviews is not limited to direct medical interventions but may also concern issues regarding public health and economic impact.

"To achieve this level of quality, the search strategy of a systematic review is clearly described, exhaustive, transparent, and reproducible. The databases and citation indexes, in this case PubMed, Web of Science, and the Cochrane Library, are searched, and studies meeting pre-stated criteria pertaining to the research question are included.

"By using an objective and transparent approach for research synthesis interpretation of results by the multiple reviewers involved are less prone to bias. The purpose of a review is synthesis: combine the reports from to create a 'greater whole.'"

Otolaryngology-Head and Neck Surgery is the official scientific journal of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), one of the oldest medical associations in the nation, which represents nearly 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck.

About Dr. Elliot Regenbogen

Dr. Regenbogen joined our Otolaryngology-Head and Neck Surgery Division in 2009 as assistant professor of surgery. He came to Stony Brook from Westchester County, where he had practiced general otolaryngology for 17 years, and also served as chairman of the otolaryngology department at Northern Westchester Hospital.

Dr. Regenbogen focuses his clinical practice on general otolaryngology-head and neck surgery, as well as on advanced diagnosis and treatment of voice and swallowing disorders. His practice also includes the diagnosis and treatment of chronic sinus conditions, postnasal drip, nasal obstruction, allergy, loss of smell and taste, reflux esophagitis, snoring and sleep apnea, hearing loss, and ear infections.

In addition to reflux esophagitis and its related sleep disturbance, Dr. Regenbogen's research interests include the development of ultra-high resolution immunofluorescent-based imaging systems for the detection and treatment of benign and malignant disorders of the vocal cords, head and neck, and paranasal sinuses.

Dr. Regenbogen received his MD in 1986 from Albert Einstein College of Medicine, where he subsequently completed his residency training. His training included a preceptorship at Japan's Kurume University Hospital under Minoru Hirano, MD, PhD, one of the founders of modern concepts in laryngology, as well as collaboration with Wilbur J. Gould, MD, and Stanley M. Blaugrund, MD, at the Ames Vocal Dynamics Laboratory of Lenox Hill Hospital in New York.

In 2010, Dr. Regenbogen was honored by his selection to receive a Cochrane Colloquium Grant and work as a Cochrane Scholar. The AAO-HNS annually provides three competitive travel grants to facilitate attendance at the annual Cochrane Colloquium for training in the conduct and publication of systematic literature reviews, with focus on state-of-the-art techniques for producing systematic reviews and meta-analyses.

Click here to see the abstract of the Regenbogen report on PubMed provided by the National Library of Medicine. And, watch this short video (0:54 min) to see how PPIs work:

With the arrival of spring come more opportunities for outdoor activities, some of which pose a risk for traumatic brain injuries. These injuries can be serious. According to the Centers for Disease Control and Prevention, they are responsible for an estimated 1.7 million deaths, hospitalizations, and emergency department visits each year in the United States, and they are contributing factor to a third of all injury-related deaths in this country.

Here, Marc J. Shapiro, MD, one of the leaders of our trauma/surgical critical care service, discusses what you need to know about traumatic brain injuries and, most important, how to prevent them.

Q: What is a traumatic brain injury?

A: A traumatic brain injury, which we call TBI for short, is any injury that occurs to the brain — often leading to devastating consequences that keep individuals from functioning at the same level as before the event occurred.

Most common causes of TBI include motor vehicle accidents, falls, and sports-related trauma. Despite multiple methods used to lower the incidence, TBI rates in the United States are on the rise.

Q: What can be done to help prevent TBI?

A: In many cases, TBIs can be prevented. There are many simple things an individual can do:

• If you ride a motorbike or motorcycle, wear a helmet. Statistics show that the number and severity of head injuries decrease with helmet use. States that have repealed their helmet laws show an increase in head injuries and, ironically, organ donation. Also, be sure that the helmet is crash-certified by the appropriate federal agencies.
• If you ride a bicycle, wear a helmet. It is estimated that between 74% and 85% of all bicycle-related head injuries could be prevented with helmets.
• Other outdoor activities that require wearing a proper helmet are using in-line skates, riding a skateboard or scooter, riding horses, and batting and running bases when playing baseball or softball.
• Avoid falls from ladders when outdoors by not using them during adverse weather conditions (e.g., high wind, rain) and when indoors by using a step-stool with a grab bar to reach objects on high shelves. Falls from portable ladders — step, straight, combination, and extension — are the cause of many TBIs. (See safety guidelines provided by U.S. Consumer Product Safety Commission.)
• Implement fall prevention strategies for children (tips here) and for seniors (tips here).
• Avoid drinking and driving. Alcohol is a factor in 50% of motor vehicle accidents where a death occurs. Not only does alcohol affect reaction time when driving, it could also interfere with the healthcare provider’s ability to assess and treat you properly.
• If you are taking any type of narcotic medication, ask your doctor if it is okay for you to drive. In fact, it is a good idea to ask your doctor this question when you start any new medications, as many can impair judgment and slow reaction times.
• Be sure that your car has a three-point restraining seatbelt; that is, one that has both a lap and shoulder component, and wear it at all times. During an accident, in order for the airbags to work properly you must be wearing a seatbelt. Otherwise, the deployed airbag acts as a kind of lever that can catapult passengers through the windshield.

Q: What are the symptoms of a traumatic brain injury, and when is it time to seek medical attention after a head injury?

A: TBI can have different kinds of physical and psychological effects. There is a wide range of symptoms associated with it. Some may appear right after the traumatic injury, while others may appear days or weeks later. (See partial list of symptoms.)

Watch for headaches, visual disturbances, droopy eyelids, or problems with arm or leg function. Should any of these symptoms emerge after any kind of blow to the head, call your physician immediately or go to an emergency room.

Q: How does Stony Brook University Hospital approach TBIs?

A: First and foremost, we advocate prevention and participate in a number of community initiatives aimed at preventing accidental injury, such as Safe Kids. However, if a brain injury occurs, you should know that Stony Brook is the only Level 1 Trauma Center in Suffolk County and a leader in trauma care — not just in New York, but in the nation.

Stony Brook was recently recognized among the top four percent of trauma centers nationally, as well as the top hospital in the country for treating pedestrians who have been hit by motor vehicles. In addition, Stony Brook coordinates trauma services for all of Suffolk County, and is instrumental in setting and maintaining the standard of care.

With sophisticated diagnostics and a collaborative, multidisciplinary team composed of emergency physicians, trauma surgeons, orthopedic surgeons, neurosurgeons, other specialists as needed, nurses, critical care doctors, and respiratory, physical, and occupational therapists, Stony Brook takes a comprehensive approach to all injuries, especially brain injuries.

Because a brain injury can worsen once it occurs, Stony Brook uses a number of early interventions to relieve pressure on the brain, such as draining fluid from the brain to decrease damage from swelling and to keep blood flow to the brain from being compromised.

Once patients are medically stable and can be discharged, Stony Brook physicians continue to monitor them, whether they are discharged home or to a rehabilitation center, to ensure that patients can return to as close to a pre-injury condition as possible. There is no greater gratification than when our patients visit with our healthcare team after making a remarkable recovery.

For more information about TBIs and how to prevent them, visit the Brain Trauma Foundation and the Centers for Disease Control and Prevention, and also see the NINDS Traumatic Brain Injury Information Page.

This week, the Cedric J. Priebe Jr., MD, Endowed Pediatric Surgery Lectureship presented its first program, featuring visiting professor Henri R. Ford, MD, surgeon in chief of Children's Hospital Los Angeles and vice dean of the Keck School of Medicine at the University of Southern California.

A world-renowned pediatric surgeon, Dr. Ford has demonstrated truly exceptional leadership in pediatric surgery, and has conducted the definitive studies on pediatric trauma in the United States.

Dr. Ford was active in Haiti in the post-earthquake rescue, for which his expertise in trauma was vital to saving the lives of many there just after the disaster occurred in 2010 (see video clip, Haitian Doctor Returns to His Homeland to Help). He remains active in the recovery and rebuilding efforts there.

Dr. Ford's investigative studies have generated new insights into the pathogenesis of necrotizing enterocolitis, the most common and the most lethal disorder affecting the gastrointestinal tract of newborn infants.

The two-day inaugural program started with Dr. Ford participating in a case presentation conference with our medical students and surgical residents.

On the morning of the second day, Dr. Ford gave the Cedric J. Priebe Jr., MD, Endowed Pediatric Surgery Lecture, titled "The Molecular Basis for the Pathogenesis of Necrotizing Enterocolitis," as part of our weekly Surgical Grand Rounds lecture series. The lecture focused on his leading-edge basic and translational research aimed at improving patient care.

Dr. Priebe himself participated in all the events with Dr. Ford, further demonstrating his tireless commitment to the education of our students and residents, on subjects related to pediatric surgery.

About the Priebe Lectureship

The launch of our campaign to establish the Cedric J. Priebe Jr., MD, Endowed Pediatric Surgery Lectureship took place in the spring of 2010. The Priebe Lectureship supports an annual visiting professor's presentation centering on a current clinical or research issue in pediatric surgery.

Support of the lectureship fund with charitable donations to the Stony Brook Foundation will help recognize the contribution of Dr. Priebe to pediatric surgical care for Long Island children and his long-standing educational commitment.

Dr. Priebe, who retired in 2007 from our full-time faculty, was the founding chief of our Pediatric Surgery Division. He started this division in 1982, and served as its chief for 25 years.

Now, with more than 3,000 outpatient visits and more than 1,000 surgeries annually, we have the largest pediatric surgery program in Nassau and Suffolk Counties.

Dr. Priebe's sustained desire to constantly improve the surgical care of children has been the dominant force guiding his life. Currently a member of a part-time faculty, he remains committed to our academic mission of excellence.

Thomas K. Lee, MD, our current chief of pediatric surgery, says, "The Priebe Lectureship will contribute to the strength of our educational program, and its inauguration was a tremendous event. It was clear that both students and residents were greatly stimulated by what they learned from Dr. Ford, our distiguished visiting professor."

Learn how you can support the Priebe Pediatric Surgery Lectureship endowment fund and, thereby, help advance the education of surgeons caring for children.

By Allison J. McLarty, MD, Co-Director, Ventricular Assist Device Program, Stony Brook Heart Institute

Former Vice President Dick Cheney, age 71, received a heart transplant this past weekend, after spending more than 20 months of being kept alive by a ventricular assist device (VAD) — artificial heart pump — that had been implanted in him to buy him time until he could have the transplant.

Prior to the VAD implantation, Mr. Cheney had suffered a total of five heart attacks, the first of which was in 1978 when he was 37 years old. After his last heart attack in early 2010, he was treated for advanced heart failure.

With progression of his heart failure, he was offered the option of VAD "bridge to transplant" therapy to support him while he waited for a heart transplant.

America watched as the former vice president reclaimed his life following the 2010 implantation of the VAD called HeartMate 2.

The HeartMate 2 supported Mr. Cheney until an appropriate donor heart became available for his transplant operation. Not only that, during the period he relied on this mechanical heart, he was living a full life out in the world.

This particular VAD represents a new generation of artificial heart technology that offers patients with end-stage heart failure, like Mr. Cheney, access to an important new treatment option. Approved by the FDA in 2010, it is the only VAD approved for use as a bridge to transplant, as in his case — and also for use as "destination therapy" for those patients ineligible for a heart transplant.

At Stony Brook we have observed similar dramatic improvement in quality of life in our patients in whom we have implanted the HeartMate 2. Many have returned to work, travel, and participate in a normal lifestyle with little limitation.

VADs can be used for months if not years to bridge or buy time for patients with heart failure, as they await a donor heart to become available. Often, as in the case of Mr. Cheney, donor hearts that are a "match" are not available for several months to years.

The HeartMate 2 is a surgically placed device that I implant next to the heart to help its main pumping chamber, the left ventricle, pump blood through the body.

The many months' support of Mr. Cheney on the HeartMate 2 VAD is a testimony to the durability and effectiveness of this life-saving technology.

Stony Brook Heart Institute's VAD program is the only program of its kind on Long Island to offer this leading-edge treatment of end-stage heart failure.

Our VAD program has been accredited by the Joint Commission, which further distinguishes it and the quality of care we provide here at Stony Brook.

We treat three types of advanced cardiac patients with VADs. Patients like Mr. Cheney, in whom the device is used as a temporary support until a heart transplant is arranged, in addition to patients who, because of their age or other concomitant diseases, are not eligible for transplantation but nonetheless have advanced cardiac disease.

In certain cases, the device has been reported to function in excess of nine years as a form of permanent support, that is, destination therapy. In other but rare cases, the VAD is placed in patients in whom we believe the device will one day be removed after the patient's own heart has recovered its normal function.

Our team of heart failure cardiologists, surgeons, and nurses follows our patients closely once they leave the hospital. In addition, Stony Brook has spearheaded a concerted outreach effort to educate our colleagues and community on Long Island about the effectiveness of VAD therapy, and to support the growing number of VAD patients and their families who now live here.

See "Heart Failure Patients Seek 'Cheney Pump'" story on ABC News. Watch this short video (1:20 min) about the HeartMate 2 VAD technology (see how it works):

Treating Cancer and Other Disorders with State-of-the-Art Technology

ENT-head and neck surgeons Ghassan J. Samara, MD, and Mark F. Marzouk, MD, of our Otolaryngology-Head and Neck Surgery Division, discuss two innovative minimally invasive techniques — robot-assisted surgery for ENT procedures and salivary endoscopy — and how they benefit patients with cancer and other disorders.

Q: What is the role of robot-assisted surgery for ENT procedures?

A: Although robot-assisted surgery has been used for heart, gastrointestinal, urinary, gynecologic, and other surgeries over the past decade, only recently has it become available for ear, nose, and throat surgery. The high-tech robotic platform employed by Stony Brook is called the da Vinci® S HDTM Surgical System.

Basically, our robotic system allows us to insert a 3D telescope about one quarter inch in size through the mouth. This gives excellent visibility, access, and magnification of areas that in the past were unreachable with surgical instruments. We can use it to diagnose and treat cancers of the mouth, throat, and tongue, remove tonsils with little or no blood loss, treat sleep apnea, and perform microsurgery in areas that were previously inaccessible.

Dr. Samara was the first physician on Long Island to use robot-assisted surgery for ENT procedures, performing the first case in the spring of 2011 (read all about it).

In the past, ENT surgeons needed to cut through the jawbone, lips, or neck to open up the throat, so the new robot-assisted procedure offers a huge advantage to patients in terms of minimizing blood loss, pain, and recovery times. It also gives surgeons an unprecedented perspective — almost as if you were standing inside the throat or mouth itself. The magnification is so great that not only do you see things much clearer, you also see things you never saw before.

Q: What is salivary endoscopy and what is it used for?

A: Salivary endoscopy is a minimally invasive technique that allows us to examine the salivary ducts (the place where saliva passes from the salivary gland into the mouth) through an endoscope and make a diagnosis. At the same time, we also can perform treatment; for example, removal of stones from the salivary gland (sialolithiasis), duct dilation and steroid injection, or removal of scar tissue caused from radiation or chemotherapy used in thyroid cancer treatments.

Dr. Marzouk was the first physician on Long Island to use salivary endoscopy, performing the first case in the fall of 2010 (read all about it).

This approach is ideal for patients because they do not need multiple procedures, and it can be done on an outpatient basis. Previous treatment involved surgical removal of the entire salivary gland, which entailed an incision in the neck and an overnight hospital stay.

The new procedure is most frequently used for sialolithiasis — a condition that affects approximately 12 in 1,000 adults. Salivary endoscopy spares the gland without risk to vital structures such as the tongue and facial nerves. Recovery time is also faster than with the previous open surgical technique, and patients may return to a normal diet the same day. Current literature reports the success rate of these procedures at 90%, with a less than 5% recurrence. (Click here to read more about salivary endoscopy.)

Q: Where are these minimally invasive techniques available?

A: In Suffolk County, only at Stony Brook University Hospital. The first salivary endoscopy procedure was performed in October 2010, and growing numbers of patients are benefitting from it. As for the robot-assisted surgery, fewer than 100 surgeons worldwide have been trained on the equipment, and there are just a few in New York State. Both of these techniques improve the patient's experience, promoting faster healing and a faster return to normal activities.

Q: Are there other breakthroughs that can benefit patients with head and neck cancer?

A: Yes, RapidArc® is a radiotherapy technology that is being used at Stony Brook for patients with head and neck cancer, and it is among the most advanced forms of intensity modulated radiation therapy. RapidArc delivers beams two to eight times faster than conventional radiotherapy, so patients do not have to hold still for long periods of time. This, in turn, makes patients more comfortable and improves the quality of care. There is also less of a chance that patients will shift or move, so the radiation is more highly targeted.

This precision of delivery means that the radiation goes to where it is needed — the tumor — and not the healthy tissue surrounding it. As a result, patients tend to have less intense side effects associated with treatment.

Come to our community update on head and neck cancers, to be held at the Stony Brook Cancer Center on Wednesday, May 23! Learn about surgical advances including minimally invasive techniques and reconstructive surgery for cancers of the thyroid, head, and neck. Radiation oncology treatment, speech pathology, and the latest research will also be discussed. A question-and-answer session will follow the presentation. Click here for details — see program announcement.

Please use our comments feature to submit your own questions to Drs. Marzouk and Samara about the procedures described here (see posted comments at bottom of page).

By Roberto Bergamaschi, MD, PhD, Chief of Colon and Rectal Surgery

I read with interest the article just published in The New England Journal of Medicine. In a National Polyp Study, Dr. Ann Zauber and her colleagues determined that colonoscopic polypectomy — that is, the removal of benign colorectal growths called polyps — prevents colorectal cancer deaths.

This observation and conclusion have been well established, but it is always a good idea to restate the importance of screening and prevention of this potentially highly curable malignancy.

What has improved are the methods of dealing with larger polyps, those which cannot safely be removed through the colonoscope.

Classically, a major abdominal operation with bowel resection has been required to remove these larger polyps. The colon and rectal surgery service at Stony Brook offers patients with such difficult polyps a less invasive approach to polyp removal.

This minimally invasive procedure takes place in the operating room, and involves two physicians working together. One physician watches the outside of the colon via a camera placed through the umbilicus (bellybutton), while the second physician uses a colonoscope to remove the difficult polyp.

This approach affords the physicians direct visualization of the colon to confirm that the full polyp was removed and that no damage has been done to the outside of the colon.

The new report, "Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths," shows that removing polyps during a screening colonoscopy not only prevents colon cancer from developing, but also prevents deaths from the disease. The scientists who conducted the study found that in patients tracked for as long as 20 years, the death rate from colon cancer was cut by 53% in those who had a colonoscopy and whose doctors removed the precancerous growths.

March is National Colorectal Cancer Awareness Month! Click here to learn more about the observance of this health month, plus find information about colorectal cancer and how to prevent it.

By Antonios P. Gasparis, MD, of the Stony Brook Vascular Surgery Division

Deep vein thrombosis (DVT) is a leading cause of death in the world. There are several factors that may increase a person’s risk of developing a life-threatening condition.

The most common risk factors for DVT include previous DVT, recent surgery, hospitalization, trauma, birth control pills, clotting conditions, prolonged travel time, immobility, and cancer. When exposed to these risk factors, several precautions can be taken to help prevent a DVT.

For years, travelers’ blood clots have erroneously been nicknamed “economy class syndrome.” In fact, it is not the location of one’s seat on an airplane that increases the risk of DVT, but the prolonged immobility during any form of travel.

For example, NBC reporter David Bloom died of a blood clot he developed while cramped for hours in an army tank recovery vehicle as he was reporting the news on the Iraq war.

According to the newly released American College of Chest Physicians Guidelines, flights lasting 8 hours or more carry the highest risk.

Although some claims have been made that DVT risk is increased by airplane window seats, the truth is, it is not these particular seats that increase the risk of developing DVT, but the inherit limitation that window passengers have in moving around the airplane. Window passengers who use appropriate preventive measures have the same risk as other passengers.

Most important, any type of travel — not only air travel — that has prolonged immobility carries with it an increased DVT risk.

Prolonged immobility when traveling increases the risk of DVT because blood in the deep veins becomes sluggish, pools, and is more prone to form a clot. Therefore, during long travel it is important to decrease this risk by taking a few simple steps:

• Doing frequent leg exercises
• Walking in the aisle
• Staying well hydrated
• Using prescribed compression stockings (higher risk people)

All these steps increase the calf pressure, which helps expel venous blood out of the leg.

For more information about DVT and how to prevent it, visit the Centers for Disease Control and Prevention.

Dr. Kevin T. Watkins Performs Procedure to Remove Tumor Previously Deemed Inoperable

The picture of good health — that is how Teri Breton, wife of Marc Breton, 53, of St. Paul, Minn., describes her husband of 10 years. All that changed on September 29, 2011, when doctors in Minnesota told him about a tumor they discovered in his pancreas via a CT scan. Marc had lost a significant amount of weight only a few short weeks before that time and had become jaundiced.

During the next two months, Marc's options seemed very limited. Surgeons in Minnesota determined that the tumor was inoperable, mainly because it was wrapped around a major artery and vein. He underwent chemotherapy, which did not appear to shrink the tumor to any significant degree, and he experienced other complications, such as a large abscess on his liver.

As a program manager for ISEEK.org, a Minnesota career, education, and job resource, Marc is savvy on the computer. He and his family members searched frantically for newer and innovative pancreatic cancer treatment options.

In their search, they discovered that our renowned surgical oncologist, Kevin T. Watkins, MD, chief of upper gastrointestinal and general oncologic surgery, is a pioneer using irreversible electroporation (IRE), a technique that selectively kills cancer by using electrical fields to generate pores in tumor cells, to remove pancreatic tumors.

Dr. Watkins was the first surgeon in the world to use IRE technology to treat pancreatic cancer. In the past two years he has treated more than 20 patients with pancreatic cancer at Stony Brook University Hospital with IRE, some who traveled thousands of miles to Stony Brook for the surgery. The treatment is a last-hope option for patients who have run out of other options, and whose cancer has not spread to other areas of the body.

Marc, a non-smoker and father of two, approached his oncologist, Steven E. McCormack, MD, about the IRE procedure and Dr. Watkins. Dr. McCormack agreed that IRE may be his best chance for extended survival and quality of life with pancreatic cancer. After a consult with Dr. Watkins, Marc was scheduled for surgery on January 11 of this year.

To remove the entire tumor, Dr. Watkins used a combination of surgical methods — the standard open Whipple procedure to excise cancerous tissue on the pancreas and remove parts of surrounding organs, which are then reattached; and the IRE procedure for the tumor surrounding the vessels.

"To incorporate both surgical methods is unusual, and this approach enabled me to obtain a complete resection of Marc's tumor," says Dr. Watkins.

On January 18, Marc's pathology reports indicated that not only were the tumor margins negative but all of his lymph node tissue was negative for cancer — results which Dr. Watkins refers to as "a best case scenario." Before surgery Marc's chance of beating pancreatic cancer was virtually zero, but now, according to Dr. Watkins, it is about 25%.

"At the time my tumor was detected my prognosis was grim," says Marc. "But now my prospects for longer-term survival appear much better, and I have a lot more hope."

Marc recovered quickly from his surgery and went home. He is back on Long Island now, and today he is returning to Stony Brook University Hospital for his first follow-up visit with Dr. Watkins.

P.S. Dr. Watkins answers FAQs about pancreatic cancer and its treatment. Watch this short video (1:58 min) to see the news-making story about Dr. Watkins helping Marc Breton reported later in the day on WLNY TV 10/55 News (courtesy of TV 10/55):