2014: A Year in Review

by Columbia Surgery on December 26, 2014


Using 3D printing technology to repair a baby’s heart, discovering new ways to preserve livers for transplantation, helping chemotherapy drugs find their way to treat pancreatic cancer, and performing surgery with robots through pinhole incisions are just some of the breakthroughs that stood out during 2014 at Columbia University Department of Surgery. Some of these innovations are already saving and improving lives, while others under investigation have demonstrated significant success in advancing our understanding of the science behind the medicine. All will have far-reaching impact for years to come

Read more about this year’s highlights:

Three-Dimensional Printed Heart Helps to Save Baby’s Life

Even the most ardent advocates for 3-D printing may have may have been stunned in late 2014 when Dr. Emile Bacha, Chief of the Congenital and Pediatric Heart Surgery, used the technology to save the life of a two-week old baby.

The baby was born with complex heart defects including many holes and malformations. Dr. Bacha’s surgical team printed a 3-D model of the heart based on a CT scan, which they were able to study before operating. This process enabled them to plan exactly how they would approach the procedure, including the order of steps and where they would put patches and sutures.

According to Dr. Bacha, “the baby went from having a limited life expectancy to normal life expectancy. And instead of needing three or four surgeries to repair the multiple defects, we were able to correct all the defects in a single surgery.”

See CNBC’s coverage of the story:

Tackling Pancreatic Cancer: New Strategy to Help Chemotherapy Drugs Reach their Target

Pancreatic cancers are notoriously resistant to chemotherapy drugs because their dense tissue blocks penetration of systemic drugs. Thanks to the persistence of determined researchers and significant funding from the National Institutes of Health, that barrier may soon be overcome. A study led by Dr. Kazuki Sugahara, who joined Columbia University College of Physicians and Surgeons as a research scientist and surgical resident in 2014, aims to create a new type of chemotherapy delivery system that will be far more effective than what has been available to date.

Building on his earlier discovery that found that small pieces of proteins called peptides are able to penetrate deeply into pancreatic cancers and other fibrotic tissue, Dr. Sugahara and his colleagues are now working to test the safety of using the peptides as carriers for cancer drugs.

According to Dr. Sugahara, a delivery system that gets through the tissue barrier and directly infiltrates the tumor cells could have tremendous therapeutic impact.  The work in the Sugahara laboratory is part of the Department of Surgery’s broad mission to tackle pancreatic cancer from every angle, which includes initiatives in early detection, prevention and genetic testing, and the full range of medical and surgical options.

Learn more about our efforts to fight pancreatic cancer at PancreasMD.org.

First Robotic Whipple Procedure for Pancreatic Cancer

Use of the surgical robot gained a significant foothold during 2014 when Drs. Yanghee Woo, Director of the Global Center of Excellence in Gastric Cancer Care and John Chabot, Chief of the Division of GI/Endocrine Surgery and Executive Director of the Pancreas Center, performed the first robotic Whipple procedures at the NewYork-Presbyterian/Columbia University Medical Center.

The Whipple procedure, a common surgical procedure to remove pancreatic tumors, was first developed in 1935 by Dr. Allen Whipple, a professor of surgery at Columbia University.  It involves removal of the head of the pancreas, the first part of small intestine (duodenum), the gallbladder, the end of the common bile duct, and sometimes a portion of the stomach.

The robotic surgical approach was initially used it to treat benign conditions and less advanced cancers before reaching patients with pancreatic cancer. While this process revealed it to be less useful in some operations, it has great benefit for a number of colorectal, liver, and gastric operations where it reduced surgical trauma, shorter hospital stays, and shorter recovery times. Because of the surgical robot’s freedom of movement, precision, and magnified 3-D imaging capability, Dr. Woo is confident that she is able to do complex gastric operations better with the robot than without, and that robots will become an integral part of the OR in the coming decades.

Read the full story on our previous blog post.

Preventing and Reversing Lymphedema after Breast Surgery

The treatment of lymphedema, a disfiguring, painful swelling of the arms and hands that can occur after removal of the lymph nodes during breast cancer surgery, saw much innovation with the Clinical Breast Cancer Program in 2014.

The Department of Surgery is the first in the U.S. to perform LYMPHA, a procedure at the time of lymph node removal that could potentially prevent the development of lymphedema. This surgical procedure creates a bypass to restore lymphatic flow by connecting lymph vessels to a branch of the axillary vein, significantly reducing the risk of developing the condition.

In addition, following the success of a similar study among English-speaking patients, a new study by the Clinical Breast Cancer Program aims to reduce the incidence and severity of lymphedema in the Chinese community through implementation of a Chinese language educational intervention. The program emphasizes specific breathing techniques, arm exercises, proper skin care and protection, and behavioral interventions to promote lymph flow, prevent inflammation and infection, and maintain optimal body weight.

Check out ABC 12 KSAT’s coverage of this story.

Hypothermic Liver Perfusion: Closing the Gap between Supply and Demand for Donor Livers

To increase the number of healthy donor livers available for transplant, experts at the Center for Liver Disease and Transplantation and the Molecular Therapies and Organ Preservation Laboratory of the Department of Surgery have been working to find ways to better preserve and protect donated livers, rendering them eligible for transplantation. Dr. James Guarrera, Surgical Director of Adult Liver Transplantation, and his team became the first anywhere to successfully use hypothermic machine perfusion (HMP) in the liver.

Whereas traditional cold perfusion involves preserving the donor organ at cold temperature, hypothermic machine perfusion (HMP) entails infusing the donor organ with oxygen and nutrients to simulate aliveness and reduce injury to the organ. The continuous flow of nutrients not only preserves the organ, which has shown better outcomes, shorter hospital stays, and fewer long-term complications, but it can also improve the function of an imperfect liver.

These were considered “orphan” livers that were initially deemed too compromised for transplant and likely would have been among the 600 donor livers discarded each year, but with these advances,  “we should be able to expand the liver donor pool, making transplant available to many more patients,” says Dr. Guarrera.

Learn more about HMP here.

TAVR offers Lifesaving Option for Patients Unable to withstand Open-heart Surgery

The Columbia Heart Valve Center at the Department of Surgery marked a milestone in cardiac care upon completing its 1,000th transcatheter aortic valve replacement (TAVR) in March, 2014.

TAVR is a catheter-based procedure for patients with aortic stenosis who need a new heart valve but are too sick to undergo open-heart surgery.  During TAVR, a replacement valve is inserted through the groin and advanced to the heart using a specially designed delivery catheter. With this technique, the aortic valve can be replaced without incisions and without stopping the heart.

“Before we had TAVR, many of our patients had no clinical options to treat their aortic stenosis, a potentially fatal condition,” says Dr. Susheel Kodali, Director of the Columbia Heart Valve Center. “As of today, we have been able to treat more than 1,200 patients with exceptional outcomes, thanks to this lifesaving procedure.”  With this milestone, he Columbia Heart Valve Center remains the highest volume center in the US and plays an integral role in the development of the technique.

See CBS’s coverage of the story:

Unprecedented Studies in Human Immunology

Because of the near-impossibility in obtaining human immune cells from healthy lymphoid tissues, research has generally been done on peripheral blood and mouse models, leaving 98% of the immune function (the lymphatic system) almost entirely unstudied and very poorly understood. A new multicenter study led by Columbia Center for Translational Immunology (CCTI) is now exploring this frontier with unprecedented access to human lymph tissues (the spleen and lymph nodes, lungs and intestines, and skin and liver) from deceased organ donors, provided through the first-ever collaboration with the New York Organ Donor Network.

The first part of the 4-part study, directed by Dr. Donna Farber of CCTI has already led to new discoveries about T cells that have the potential to yield paradigm changes in the effectiveness of vaccines and immunotherapies.  Other segments of the study investigate how to effectively target B cells in vaccines and immunotherapies and to develop new tissue repair strategies. A fourth segment, which includes collaboration with Dr. Megan Sykes, Director of CCTI, and Dr. Tomoaki Kato, Surgical Director of Liver and Intestinal Transplantation at the Department of Surgery, may yield new methods of achieving immune tolerance after organ transplantation.

According to Dr. Farber, “We now have the technological tools for high-throughput analysis and for probing molecules and proteins. With these tissue samples, we can go far beyond what we were ever able to do in studying human physiology.”

Reducing the Toll of Liver Disease: Education Matters

Treatment of liver disease is only the first step; the next most important task may be educating the public about it. In a host of speaking engagement, television appearances, and publications, Dr. Robert Brown, Jr., Medical Director of the Transplantation Initiative at the Department of Surgery, has contributed powerfully to public awareness of trends in hepatitis C and fatty liver disease during 2014.

October 2014 marked the arrival of a single tablet regimen (Sofosbuvir/Ledipasvir) for Hepatitis C that cures 95% of patients in 8 weeks, with extremely low side effects. This regimen marks a radical departure from painful injections of interferon and oral medications, which cure less than half of patients while causing side effects so serious that many patients refuse therapy. Dr. Brown asserts that the new, highly effective regimen “should herald a long-awaited milestone in medicine: the beginning of the end of hepatitis C, the most common and deadly chronic liver disease plaguing millions of Americans.” Unfortunately, the high cost of the therapy currently presents a deterrent to insurers, physicians, and patients. Dr. Brown presents critical insight on what appears to be a conflict between curing millions of patients and managing health care costs – and calls on the medical community to consider long-term costs, quality of care, and ethics in their equation.

Dr. Brown also addressed another common liver disease, non-alcoholic fatty liver disease (also called NASH), which affects approximately 80 million Americans. Speaking on the New England Cable Network in the fall of 2014, he informs listeners about the silent but growing epidemic and its relationship to obesity and diabetes.

Read the Dr. Brown’s article in Pacific-Standard Magazine.

See the NECN coverage on fatty liver disease:

Perfecting the Mechanical Heart: 25 Years of Innovation

Initiation of a study of the HeartMate III Left Ventricular Assist System (also called a left ventricular assist device, or LVAD) in 2014 marks 25 years of pioneering work in the field of ventricular support and heart failure management for the Department of Surgery.

Implantable LVADs take over the pumping action of the left ventricle in patients whose hearts are too weak to sustain themselves. Candidates for the HeartMate III trial include patients with advanced heart failure who need a device either as a bridge to heart transplantation, or who are ineligible for transplant and who will use the device indefinitely (called ‘destination therapy’).

The Mechanical Circulatory Support Program at the Department of Surgery is the only New York area surgical group to participate in the HeartMate III study. Having been one of the first surgical centers to pioneer heart transplantation (beginning in 1971), The Department of Surgery has played an integral role in the development of many groundbreaking devices and procedures, including the FDA approval of the HeartMate® II LVAS, the predecessor to the HeartMate III.

Learn more about the history of the artificial heart in the TIME Magazine feature.

Find out more about the current Heartmate III trial here.

Preventing Diabetes after Surgery for Pancreatitis

Beginning in 2014, the Pancreas Center at the Department of Surgery became the first New York surgical center to offer autologous pancreatic islet cell transplantation providing many patients an option to prevent diabetes after undergoing pancreatic surgery.

Every year, roughly 87,000 people in the United States receive surgical treatment for pancreatitis, a debilitating condition that causes intense abdominal pain and, potentially, diabetes. Pancreatitis can be so painful that in some cases, patients must have the entire pancreas removed. While surgery to remove the pancreas (pancreatectomy) relieves pain in 90% of cases, patients are left without the ability to produce insulin, causing a difficult-to-treat form of Type 1 diabetes known as “brittle diabetes.”

In auto islet transplantation, the patient’s islet cells, which produce hormones that regulate the endocrine system, are extracted from the pancreas after it is removed. The cells are then processed and re-infused into the patient’s liver, where they may eventually produce insulin to regulate blood sugar.

According to Dr. Beth Schrope, who spearheaded the auto islet transplant protocol at the Department of Surgery, about one third of patients require no insulin therapy after autologous islet transplantation, another third require some insulin therapy after the procedure, and the procedure is still unsuccessful in preventing diabetes in the remaining third. For two thirds of patients, the reduction of prevention of diabetes represents a tremendous advantage

Learn more in our previous blog posting and Healthpoints newsletter.

We’re looking for to 2015 as a year of continued scientific progress, clinical innovation, and care for our patients!  Keep informed by following us on Facebook and Twitter!



Are You a Good Candidate for Metabolic Surgery?

by Columbia Surgery on April 12, 2013

Metabolic syndrome is one of the fastest growing obesity-related health concerns in the United States. Currently over 50 million people can be diagnosed with metabolic syndrome. But as metabolic syndrome is still a relatively new term, many people are not yet familiar with what it means to them and its associated increased risk for the development of more serious, chronic conditions.

What is Metabolic Syndrome?Metabolic Syndrome

Metabolic syndrome is the combination of several medical problems associated with morbid obesity. In addition to obesity, these conditions include:

      • high blood pressure
      • glucose intolerance/insulin resistance
      • excess body fat
      • high cholesterol

In addition to the above conditions, people with metabolic syndrome are twice as likely to develop heart disease, and five times as likely to develop diabetes, compared to those who don’t have metabolic syndrome.

How is Metabolic Surgery Used in the Treatment of Metabolic Syndrome and Other Related Diseases?

Metabolic surgery is the treatment of metabolic abnormalities with surgical alteration of the gut anatomy, leading to improvement in the metabolic syndrome, fatty liver disease, and type 2 diabetes. Operations include bariatric surgeries such as:

      • Sleeve Gastrectomy
      • Roux-en-Y Gastric Bypass
      • Biliopancreatic Diversion/Duodenal Switch

For certain cases, studies have shown that surgically induced weight loss has been more successful than medical treatment in managing these diseases. Some of the success of the operations is due to the associated weight loss caused by the surgery but some of these operations induce changes in gut hormones, which is believed have a role in the development of type 2 diabetes.

What Do I Need to Know about Metabolic Surgery?  Who Can I Talk to if I Have Just Been Diagnosed with Metabolic Syndrome and am Considering Metabolic Surgery?

Join us April 19th at 2:00 PM/ET for our next Blog Talk Radio episode with:

Melissa Bagloo, MD

Melissa Bagloo, MD

      • Melissa Bagloo, MD, Assistant Professor of Clinical Surgery at NewYork-Presbyterian/Columbia’s Center for Metabolic and Weight Loss Surgery

How do I Participate in this Program? What will be Discussed?

Dr. Bagloo will be on the air answering your questions about metabolic surgery and how it benefits metabolic syndrome. Topics to be addressed include:

      • What are the risk factors and symptoms of metabolic syndrome?
      • What are my treatment options for metabolic syndrome and why should I consider metabolic surgery?
      • What are the different metabolic surgery options available and how do I know which one is right for me?
      • How quickly can I expect to see results from metabolic surgery?

To submit a question for Dr. Bagloo before the show, visit our question submission form or tweet an “@” reply to @columbiasurgery.

We are sorry, but this Blog Talk Radio show has already occurred. You can listen to an archived copy of this program in the player embedded below this message. Since this a recording, no one is available to answer calls or emails.

Listen to internet radio with ColumbiaSurgery on BlogTalkRadio


A Diabetes-Free Future for Patients after Pancreas Transplantation

March 26, 2013

TweetFor patients with type 1 diabetes, a pancreas transplant can mean a life free from testing blood sugar, taking insulin, and the constant threat of dangerous fluctuations in blood glucose. In February 2013,  NYP/Columbia’s Kidney and Pancreas Transplant Program performed three pancreas transplants within 36 hours. Read about two such patients whose lives had revolved […]

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What’s Your Diabetes Story?

October 31, 2012

TweetDo you have diabetes? If so, you can participate in a huge awareness and fundraising campaign sponsored by the American Diabetes Association. People are invited to post photographs on the American Diabetes Assocation Facebook page that capture what living with diabetes on a daily basis looks like. The photos, along with comments, are building a […]

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Everything You Need to Know About Pancreas Transplants: Part I

April 25, 2012

TweetWho Might Need a Transplant? Most candidates for a pancreas transplant fall into three main categories, all of which are related to diabetes, according to Lloyd E. Ratner, MD, Director of the NewYork-Presbyterian/Columbia Renal and Pancreatic Transplant Program. Most candidates have type 1 diabetes and kidney failure. They either need or already have had a […]

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Everything You Need to Know About Pancreas Transplants: Part II

April 25, 2012

TweetThree scenarios for getting a new pancreas are possible. You may receive both a pancreas and a kidney at the same time from the same deceased donor. You may first receive a kidney from a living donor, and then later have a pancreas transplant from a deceased donor. The small percentage of patients with hypoglycemic […]

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Study Begins to Explain Why Surgery Cures Type 2 Diabetes

June 9, 2011

TweetThe April 27, 2011 issue of Science Translational Medicine included a study titled “Differential Metabolic Impact of Gastric Bypass Surgery Versus Dietary Intervention in Obese Diabetic Subjects Despite Identical Weight Loss.” Melissa Bagloo, MD, Assistant Professor of Clinical Surgery at the Center for Metabolic and Weight Loss Surgery, NYP/Columbia, explains the context and importance of […]

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Vascular & Wound Innovations CME: Complex Reconstruction of the Diabetic Foot

April 25, 2011

TweetThe 2011 Vascular CME, Innovations in Complex Vascular & Endovascular Interventions, will include special sessions on management of non-healing wounds. Nationally recognized faculty from NewYork-Presbyterian Hospital will address topics including: Medical and surgical treatment of the infected foot with soft tissue and bone involvement, including antibiotic selection, surgical debridement, and reconstruction; Current approaches in management […]

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Diabetic Foot Ulcers Facts from Dr. Felix R. Ortega

October 25, 2010

Tweet As a follow-up our post on Screening for Diabetic Foot Ulcers, Director of the Wound Healing Center at NewYork-Presbyterian Hospital/Columbia University, Dr. Felix R. Ortega provided us with these facts on diabetic foot ulcers: Approximately 15% of New Yorkers have diabetes. 45% of New Yorkers with diabetes have very poor control of their blood […]

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Screening for Diabetic Foot Ulcers

October 8, 2010

TweetAbout one in every six patients with diabetes will develop a foot ulcer, and of those, one in four will require amputation. Beginning with even a small skin injury, a diabetic foot wound can worsen to include deeper layers of skin, muscle, and bone. Given the seriousness of diabetic ulcers, one might think that screening […]

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