The department of surgery reports on its six divisions and its education and research endeavors, as well as highlighting two of its faculty members.
A shorter version of this report appeared simultaneously in the September–December 2018 Alumni JOURNAL.
By Carlos A. Garberoglio, MD, Chair, Department of Surgery, LLUMC
A little over half a century ago a surgeon by the name of David B. Hinshaw Sr. ’47 served as dean of Loma Linda University (LLU) School of Medicine and as chair of the department of surgery at Loma Linda. The LLU Medical Center opened its doors in 1967 and the story developed to the present day. Dr. Hinshaw was chair of surgery from 1961 to 1975 and followed by Bruce W. Branson ’50, 1975–1992, and then Leonard L. Bailey ’69, 1992–2007. The leadership, vision, and innovation of these three individuals left a significant legacy that clearly represents the DNA of this department.
In 2007, the department of surgery was divided into nine departments: surgery, cardiovascular, orthopedics, urology, neurosurgery, plastics, ENT, gynecology and obstetrics, and ophthalmology. The new department of surgery was led by Antonio E. Robles ’72 from 2007 until 2009, when I became the chair. The division of the original department has helped significantly in the everyday dynamics, and more independence was created for recruitment and management of cost centers, development of a particular surgical clinical practice, and research for each service line. We still keep our common interests like operating room utilization, block assignments, regulations, etc., through regular meetings of the Surgical Chairs Committee that is chaired by the chief of surgery.
The department of surgery is composed of six divisions: general surgery, acute care surgery, surgical oncology, pediatric surgery, transplant surgery, and vascular surgery. The number of faculty has grown from 15 to 41 in the last few years.
Faculty of the Department of Surgery
Marcos Michelotti, MD (Chief)
Keith Scharf, DO (Director – Bariatric Program)
Jeffrey Quigley, DO
Aarthy Kannappan, MD
Esther Yung, MD
Daniel Srikureja, MD
Acute Care Surgery
David Turay, MD, PhD (Chief)
Sigrid Burruss, MD
Karen O’Bosky, MD
Lester Mohr, MD
Richard Catalano, MD
Kaushik Mukherjee, MD
Jessica Babcock, MD
Incoming: Lourdes Swentek, MD
Maheswari Senthil, MD (Chief)
Carlos Garberoglio, MD
Fabrizio Luca, MD
Nephtali Gomez, MD
Mark Reeves, MD
Naveen Solomon, MD
Jukes Namm, MD
Sharon Lum, MD (Director of the Breast Health Center)
Elizabeth Raskin, MD
Incoming: Matthew Selleck, DO
Donald Moores, MD (Chief)
Edward Tagge, MD
Joanne Baerg, MD
Incoming: Andrei Radulescu, MD
Faraz Khan, MD
Michael DeVera, MD (Chief)
Pedro Baron, MD
Philip Wai, MD
Charles Bratton, MD
Gwendolyn Garnett, MD
Ahmed Abou-Zamzam, MD (Chief)
Sheela Patel, MD
Moqueet Qureshi, MD
Sharon Kiang, MD
Theodore Teruya, MD
Christian Bianchi, MD
Incoming: Kristyn Mannoia, MD
Education, Training, and Research
The clerkship program for junior and senior medical students is directed by Nephtali R. Gomez ’04. Dr. Gomez is an expert in endocrine and pancreatic surgery. This is his fifth year serving as director.
The program sees 36–38 junior medical students come through every 10 weeks, and about 8 senior medical students every four weeks. With the invaluable help of clerkship coordinator Kristian Braun, the clerkship has been updated to include online content and added rotations, such as transplant surgery and burn ICU. In 2018, 13 LLU medical students matched into general surgery: nine categorical and four preliminary. Seven of the 13 students matched to LLU.
Jukes P. Namm ’05 has recently been appointed director of the general surgery residency program following 12 years of leadership by Mark E. Reeves, PhD, ’92. The program has 47 residents.
Dr. Namm graduated from Loma Linda University School of Medicine (LLUSM) and completed his residency training at our institution. He did a fellowship in Complex General Surgical Oncology as well as training in surgical ethics at the University of Chicago. He joined the Division of Surgical Oncology at Loma Linda in 2015. The large majority of graduating surgical residents will continue into distinguished fellowships around the country and others will join large private practice groups.
We believe surgical education is trending toward fellowships. Our pediatric and vascular surgery fellowships are running strongly. We have just graduated the first fellow from the complex general surgical oncology fellowship: Matthew Selleck, DO, who will remain with us as a junior attending for surgical oncology. Our minimally invasive and bariatric surgery fellowship also recently graduated its first fellow. Crystal Alvarez, DO, will continue her career at Central Maine Medical Center in Lewiston, Maine.
The first fellow from our recently developed global surgery fellowship will be graduating this year. Carl Lokko, MD, will spend his first few months out of fellowship in Malamulo, Malawi, as our surgical attending. We have placed significant emphasis in global surgery because we understand that this is part of our mission, our purpose, at Loma Linda University Health.
Complex General Surgical Oncology – Maheswari Senthil, MD
2 fellows (2 year program)
MIS/Bariatric Surgery – Keith Scharf, DO
1 fellow (1 year program)
Global Surgery – Carlos Garberoglio, MD
1 fellow (1 year program)
Pediatric Surgery – Edward Tagge, MD
1 fellow (2 year program)
Vascular Surgery – Ahmed Abou-Zamzam, MD
2 fellows (2 year program)
The department’s academic development and research is healthy. We have published around 100 papers in the past year. A recently renovated clinical lab (done in partnership with the division of transplant) in the medical center research wing will have a PhD lab coordinator and a few research associate fellows, with enough room for wet lab activities.
We have organized our research associate fellows in the following areas:
Juniors: Young physicians who are fresh from medical school that want to start their research activities very early or want to build their CV to get into a surgical residency program
Intermediate: Residents who spend a couple of years in the middle of their residency training and conduct research (similar to the surgical scholars program)
Seniors: Those who have finished their residency in general surgery (this would pertain to overseas physicians as well) and want to have extra training in research to aim for an academic career
The department has two fully endowed chairs: the Clifton and Sandra Reeves Chair in General Surgery and the Louis Smith, MD and David B. Hinshaw Sr., MD Endowed Chair for Surgical Research. These endowed chairs plus other research funds total about $3.5 million.
Clinical innovation has always been important to us. Overall, surgical services performed more than 1,000 robotic cases in 2017, and our department alone was responsible for about 50 percent of the total. These cases include esophagus, pancreas, liver, adrenal, colon, and rectal resections, as well as cholecystectomies, hiatal hernias, and other hernia repairs.
In the past year, general surgery has grown to six full-time surgeons, all fellowship-trained in minimally invasive surgery, including advanced robotic-assisted surgery. Three of them are also bariatric surgeons. They perform the bulk of the elective general surgery volume at LLU Medical Center, including advanced/revisional foregut surgery, complex abdominal wall reconstruction and interventional endoscopy. The permanent pursuit for innovation has positioned our group as a regional leader in surgery that attracts referrals at our five different clinic locations.
The educational commitment of the division extends also to the training of general surgery residents and medical students. The division’s research activity this year has produced 19 publications/presentations at national meetings and secured two educational/research grants.
The bariatric surgery program has grown over the years and now performs more than 250 procedures a year (inpatient and outpatient). It holds the designation of comprehensive bariatric center, the highest level of accreditation under the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). The MBSAQIP is a combined quality accreditation program overseen by the American College of Surgeons and the American Society of Metabolic and Bariatric Surgery. The program has also been designated a Blue Center of Distinction by Blue Shield for its volume and quality care. We have also obtained bariatric coverage for those patients covered by Risk Management.
We have experience in primary and revisional bariatric surgery. Almost 35 percent of bariatric cases performed at Loma Linda are revision cases that demand a high level of experience and quality care. We receive referrals for bariatric revision cases from community hospitals as well as other academic medical centers from all over California and from other states including Arizona, Oregon, Texas, and Utah. We continue to provide excellent quality care to our bariatric patients as well as offer the latest in minimally invasive and endoscopic techniques, including robotic surgery and endoscopic primary and revisional surgery.
Acute Care Surgery
The nearly decade-and-a-half-old concept of organizing an elite team of surgeons solely dedicated to responding to all general surgical emergencies, including management of the “severely injured patient” and with a 24/7 presence within the hospital, was birthed in the halls of the American College of Surgeons. This is a team of health care providers lead by a surgeon that is always prepared and immediately available to handle urgent surgical issues.
No sooner was I appointed chair of the department of surgery, than did I embark on implementing such a concept at Loma Linda University Health. The original team in July 2010 was made up of five full-time general and trauma surgeons led by veteran surgeon Richard Catalano, FACS, ’76-B and supported by another half dozen surgeons from diverse specialties with keen interest in managing surgical emergencies.
Under the leadership of David Turay, MD, the division of acute care surgery has grown to nine full-time surgeons, including former trainees of the surgery residency program. Recently, the trauma program achieved Level 1 status by the American College of Surgeons, making LLU one of only 13 institutions in the entire state with that designation. This is the highest level of accreditation for any medical center across the nation. As the only Level 1 trauma center serving the San Bernardino, Mono, and Inyo counties on the western border of the Mojave Desert, its catchment area spans over 30,000 square miles. Of the 3,500 adult and pediatric trauma patients treated at our facilities last year, nearly 20 percent originated from hospitals within this region transferring patients to us for a higher level of care.
Since the appointment of Maheswari Senthil, MD, as chief of the surgical oncology division, it has become one of the most successful divisions at LLU Health. The division now consists of 10 full-time faculty members who are leaders in their respective fields and dedicated teachers. This combination has resulted in us gaining the respect of our peers and the institutional leaders. Her vision for such a great division is to lead it into being nationally recognized for the clinical work, education, and research the group continues to do. This monumental success of the fellowship is due to the faculty’s devotion to education and teamwork. We believe that the fellowship, in the next few years will become one of the top training programs in the country, and its graduates will carry its flag as leaders in various cancer centers all around the country.
Dr. Senthil also directs the fellowship program, which has seen monumental success in recent years. Several clinical programs of the division are recognized as topnotch in the region, in particular the peritoneal surface malignancy program, also led by Dr. Senthil. The program brings in referrals from all over the state, due to its excellent outcomes. The reputation of the program is well known and attracts surgeons from various institutions to come to Loma Linda to observe these surgeries.
Research efforts have increased multifold in the last few years. Extensive collaboration with epidemiologist and basic science faculty has led to significant publications. We envision that our research efforts will be awarded with extramural funding. Enormous amounts of time and effort are dedicated to the success of research activities in the division.
Breast Health Center
The mission of the Breast Health Center at Loma Linda University Health is to provide evidence-based, multidisciplinary, whole person care for patients with breast diseases. Since 2017, breast cancer patients have received care at the Breast Health Center, a combined medical and surgical oncology clinic with shared navigation services operating under Loma Linda Cancer Center’s first organ-specific care model. Approximately 200 new breast cancer patients are seen annually in this seamless approach to integrated care that offers patients access to a portfolio of eight prospective clinical trials.
The center is directed by Sharon Lum, MD, associate professor of surgery. Dr. Lum has been a dedicated breast surgeon for nearly 20 years and serves on numerous regional and national organizations. She holds several positions with the American College of Surgeons including recorder for the Southern California Chapter, California State Chair for the Commission on Cancer, and member of the Commission on Cancer. She was recently named to the Board of Governors. Dr. Lum is also actively involved with the American Cancer Society, where she is a member of the Desert Coastal Area Board of Directors, covering seven counties in California and Nevada, and sits on the legislative committee of the American Society of Breast Surgeons.
The colorectal surgery division is dedicated to the treatment of diseases of the colon, rectum, and anus and is run by Fabrizio Luca, MD, and Elizabeth Raskin, MD.
The division has progressively increased the number of colorectal surgical procedures and has a particular expertise in the treatment of inflammatory bowel disease, rectal prolapse and in the conservative and functional treatment of colorectal cancer.
Technological innovation is one of the division’s main strengths. Minimally invasive surgical procedures and robotic-assisted surgery are performed routinely, in addition to the traditional laparoscopy and open surgery. Complex surgical procedures are regularly managed with specialists in urology, gynecology, and plastic surgery.
The division has been working on the implementation of an enhanced recovery after surgery protocol and will be the first surgery program to launch the program in August 2018. The protocol will be subsequently extended to the other divisions of the department of surgery.
The surgeons of colorectal surgery taught numerous lessons in the field of surgical oncology, benign colorectal diseases, and minimally invasive surgery for the general surgery residency program. They have also been involved in the Objective Structural Clinical Evaluation (OSCE) at the School of Medicine and have given multiple presentations at national and international forums.
The division of pediatric surgery is comprised of three pediatric surgeons, a nurse practitioner, and additional support staff. It is led by Donald C. Moores ’87, division chief and medical director of pediatric trauma services. Joanne Baerg, MD, is an associate director of the general surgery residency program and the director of the Surgical Scholars program. Ed Tagge, MD, is the program director for the pediatric surgery fellowship training program and will be spearheading the introduction of the National Surgical Quality Improvement Program to LLU Children’s Hospital.
In addition to their academic duties, the three surgeons perform approximately 1,600 operations per year, providing broad clinical experience for our fourth pediatric surgery fellow. We are pleased that our first three fellows were all recruited to excellent academic positions at the University of Michigan and in Greenville, North Carolina.
Anticipating our new hospital opening in 2020, we have hired two additional pediatric surgeons who will be starting this fall. Faraz Khan, MBBS, finished his training at the University of Florida in Gainesville and has a particular interest in critical care and gastrointestinal rehab. Andrei Radulescu, MD, is coming from the University of Alabama in Birmingham and has a special interest in research regarding necrotizing enterocolitis, a disease that affects neonates. He will be running a lab investigating this disorder. There are plans to add additional surgeons in the next couple of years.
We are excited that after a lot of hard work on the part of our entire trauma team, the American College of Surgeons has verified LLU Children’s Hospital as a Level 1 Pediatric Trauma Center. We believe this confirms that LLU Children’s Hospital provides the highest level of pediatric trauma care for our smallest and most vulnerable members of the population.
With the growth of the division, we anticipate resuming our outreach clinics in Murrieta, Riverside, and possibly San Antonio. Simply stated, the division continues to thrive, and we are excited about the possibilities that lie ahead.
In the division of transplant surgery, abdominal transplant volumes have increased tremendously in the last three years. In 2017, a record 62 liver, 195 kidney, and 11 pancreas transplants were performed by surgeons in the Transplant Institute. This year at the time of writing, we have performed 49 liver, 114 kidney, and five pancreas transplants and are on track to exceed last year’s volume.
This growth trend started two to three years ago and can be attributed to multiple factors. These factors include the hard work and commitment of the Transplant Institute physicians supported by a dedicated and committed staff, strong support from hospital and physician leadership, as well as teamwork and support from countless specialties in the medical center.
Two transplant surgeons—Charles Bratton, MD, and Gwendolyn Garnett, MD—joined the team in 2017, bringing our total to six. In addition, a transplant hepatologist and transplant nephrologist joined us in September, increasing the team to six transplant hepatologists and three transplant nephrologists within the Transplant Institute.
The division of vascular surgery at LLUH continues to follow its mission of providing state-of-the-art care for all manner of vascular disease in a compassionate, whole-patient centered environment. With innovation and experience treating all types of vascular disorders, the division of vascular surgery has led the way in the Inland Empire in pioneering minimally invasive techniques to treat complex acute and chronic diseases of the aorta and the peripheral vascular system. The division continues to adopt the leading endovascular techniques including angioplasty, atherectomy, and drug-eluting therapies, endovascular branched technology, and trans-cervical carotid stenting. Minimally invasive treatments for venous diseases are routinely performed in the outpatient setting.
Under the leadership of Ahmed Abou-Zamzam, MD, associate editor of the Annals of Vascular Surgery and medical director of the Southern California regional study group of the Society for Vascular Surgery Vascular Quality Initiative, the division contributes to academic meetings on the regional, national, and international level and participates in several multi-center clinical trials. The residency program continues to attract outstanding candidates nationally.
This year the division is adding a new faculty member, Kristyn A. Mannoia ’11. Dr. Mannoia offers new insight and experience to augment our team as we branch out into collaborative projects at LLU Medical Center and regionally.
SURGERY FACULTY HIGHLIGHTS
David S. Turay, MD
Dr. Turay became the chief of the division of acute care surgery and medical director of trauma services in July 2015. He is a native of Sierra Leone, in West Africa, and earned his medical degree from the University of Montemorelos School of Medicine in Mexico. He completed general surgery residency training at Loma Linda University (LLU) Medical Center and a fellowship in critical care at Massachusetts General Hospital and Harvard Medical School. During his “free” time, he earned his PhD in human anatomy at LLU.
When he became chief of acute care, Dr. Turay’s goal for the division was to become verified by the American College of Surgeons as a Level I Trauma Center, which it has. An example of the impact Dr. Turay and his team has had on the community is their response to the December 2015 mass shooting in San Bernardino. The tragic event resulted in the death of 14 innocent neighbors and fellow citizens, with another 22 wounded. Five of the most seriously wounded with major hemorrhaging were brought to LLUMC.
There Dr. Turay led the acute care surgery team, including those at home that day and additional members of the greater department of surgery, in performing major surgeries on the five patients, all of whom eventually made it home to their loved ones. This outstanding work was noticed by entities such as the California legislature, resulting in distinguished personal and institutional awards.
Maheswari Senthil, MD
Dr. Maheswari (Magi) Senthil earned her medical degree at Madurai Medical College in Tamilnadu, India, and went on to complete her general surgery residency at the University of Medicine and Dentistry of New Jersey. Carlos Garberoglio, MD, met Dr. Senthil when she was training at City of Hope as a surgical oncology fellow and knew right away she was outstanding and unique. When he became chair of the surgery department, he immediately began recruiting her.
Three years after Dr. Senthil came to Loma Linda, Mark E. Reeves ’92 and Dr. Garberoglio tasked her with starting a complex general surgical oncology fellowship. After her careful planning and evaluation, countless hours meticulously preparing the application for accreditation by the Accreditation Council for Graduate Medical Education, and the guidance of Drs. Reeves and Daniel W. Giang ’83 (associate dean, graduate medical education), she received the initial accreditation with commendation, which is an achievement by itself. During that time, we offered Dr. Senthil the opportunity to become chief of surgical oncology, an opportunity she embraced in spite of the demands and pressure that came with it. She aspires to lead with pride, respect, and integrity.
Since Dr. Senthil’s appointment as chief, the surgical oncology division has become one of the most successful divisions in Loma Linda University Health. It has grown to consist of 10 full-time faculty members, all leaders in their respective fields and dedicated teachers. Her vision is to lead the division to be nationally recognized for the clinical work, education, and research of the devoted faculty.