2012 Department of Surgery Annual Report Table of Contents Message from the Chair 2 Division of Cardiac Surgery 4 Division of General Surgery 7 Division of Neurosurgery 10 Division of Orthopaedic Surgery 12 Division of Otolaryngology - 17 Head & Neck Surgery Division of Pediatric Surgery 19 Division of Plastic Surgery 21 Division of Surgical Research 23 Division of Thoracic Surgery 25 Division of Urology 26 Education - Undergraduate, 28 Postgraduate & Graduate Studies Message from the Chair When looking back, it’s equally strategic planning. Armed with important to look forward. 2012 this new knowledge, I saw many accomplishments for understood how important it the department as well as would be to our department to challenges. I continue to be develop a strategic plan; not proud and inspired by the just for the remainder of my outstanding work of our faculty term, but well beyond into the and staff. At the same time, I future. appreciate the uncertainties we face and plan to meet our So while you read through challenges with successful these pages, you’ll see the outcomes. tremendous strength of our divisions, research, teaching The year saw the completion of and education; and know that my first term as chair of the the future will see a strategic Dr. Douglas Hedden department, as well as my plan in place, ensuring we and Surgical Foundations reappointment to another five continue to move forward to remains strong. The graduate year term. The process was where we want to be. program is thriving and one of reflection and forward research carries on as a thinking, as it included a We know there will be major strength. presentation before a peer obstacles and tough issues to review committee. In describing face. At our 2012 education As we move forward it’s what was accomplished during retreat we addressed two important to stay positive and those five years, it was hard not significant ones in reviewing celebrate our tremendous to feel proud and grateful for all restricted duty hours for strength in all areas of this the support and good work residents and looking at diverse department. We are within the department. It was competency based medical as strong as our people and I also a humbling experience, as education. We will also appreciate the hard work and I acknowledged areas for continue to adapt to dedication of our members improvement and took a hard reorganization at all levels and and support staff. Together look at changes necessary for work through ongoing budget we can forge ahead, keep our success. cuts. this department great and acknowledge opportunities to Planning new goals and In this report, you will see that make confident changes. accomplishments is always an despite our challenges, we exciting endeavor and I was persevere and maintain the inspired by a PMI course the great tradition of this department hosted on strategic department. Our candidates planning. Alongside fourteen for promotion enjoy continued Douglas M Hedden, MD FRCSC other department members, we success. The undergraduate Walter Stirling Anderson Professor learned about appreciative curriculum has kept our and Chair, Department of Surgery, inquiry, which focuses on a students scoring at the top of Faculty of Medicine & Dentistry, University of Alberta more positive approach to the national qualifying exam Division of Cardiac Surgery In 2012 the Division of Cardiac and open in 2013. Surgery hosted the annual Alberta Cardiac Surgery The division remains very active Resident Retreat and featured in research with our recent recruit, Dr. Rakesh Suri from the Mayo Dr. Jayan Nagendran, establish- Clinic as a distinguished guest. ing a basic science laboratory. All Dr. Suri is a North American members of the division partici- expert on minimally invasive pate in clinical studies supported mitral valve repair. Dr. Jonathan by the divisions expert in Clinical White also gave a presentation Epidemiology, Dr. Colleen Norris, on upcoming resident workload PhD. Currently there are eight issues at the retreat. active clinical trials with over 700 patient enrollments to date. The division was pleased to welcome Dr. Mohammad Awards Divisional Director Al Aklabi as a new staff surgeon specializing in pediatric cardiac Dr. Modry received a Member Dr. David Ross surgery. Dr. Al Aklabi did his Emeritus Distinction Award from residency in Edmonton followed the Alberta Medical Association by a year of fellowship in on September 21, 2012. congenital cardiac surgery with us before undertaking a travel- Dr. John Mullen & Dr. Arvind ling fellowship visiting a number Koshal received the Queen of top centres in North America Elizabeth II Diamond Jubilee as well as the UK. In addition to Medal. being a terrific addition to our clinical practice Mohammad has Dr. Steven Meyer received taken over the lead for organiz- Division Teacher of the Year ing the educational teaching for award for resident teaching. congenital cardiac surgery for the residents and fellows. Dr. Wei Wang received the Shab Puri award for overall outstanding 2012 saw continued growth in performance in the Training referrals and surgery for both Program. adults and children, constrained Program Director only by our physical resources. Dr. Jeevan Nagendran received Construction of a new hybrid 2nd prize for basic science at the Dr. Rod MacArthur operating room was started 2012 Departmental Tom Williams along with an additional six Resident Research Day. adult CVICU beds. Both these projects should be completed 4 Grants thur R, Townsend DR. Cesarean deliv- Dr. Jayan Nagendran Surgical Interventions for ery in a parturient with an anterior me- Alberta Transplant Institute Moderate Ischemic Mitral diastinal mass. Can J Anaesth. 2012 $250, 000 (Clinical) Regurgitation (MMR Trial) Nov 7. Dr. J Mullen: Start Date: Feb 8, University Hospital Foundation 2012:Funding Source: NHLBI, Feindel CM, Ouzounian M, Latham $250, 000 (Clinical) TB, Hendry P, Langlois Y, Peniston C, NINDS, and CIHR ($14,513.00 Hassan A, Macarthur R, Scully H, earned to date) Pfizer Ex-Vivo lung program Hirsch GM; Canadian Cardiac Surgery $100, 000 (Clinical) Workforce Committee. The Canadian Surgical Ablation Versus No Society of Cardiac Surgeons perspec- MAHI/UHF grant (Co-PI) Surgical Ablation for Patients tive on the cardiac surgery workforce in Canada. Can J Cardiol. 2012 Sep- $300, 000/2 yr (Pre-Clinical) with Persistent or Longstanding Oct;28(5):602-6. Persistent Atrial Fibrillation CIHR-CNTRP (Co-PI) Undergoing Mitral Valve $500, 000/5 yr (Pre-Clinical) Surgery (A-Fib Trial); Dr. J Nunes AJ, Buchholz H, Sinnadurai S, J Nagendran salary support Mullen,Start Date: January 24, MacArthur RG. Long-term mechanical circulatory support of an adult patient $150, 000 (Pre-Clinical) 2012;Funding Source: NHLBI, with Down syndrome. Ann Thorac NINDS, and CIHR ($18,450.00 Surg. 2012 Apr;93(4):1305-7. MAHI start-up funds earned to date) $100, 000 (Pre-Clinical) Garcia Guerra G, Robertson CM, Alton Publications GY, Joffe AR, Dinu IA, Nicholas D, UHF grant $35, 000 Ross DB, Rebeyka IM; Western Cana- (Pre-Clinical) dian Complex Pediatric Therapies Fol- Iida R, Welsh RC, Meyer SR, Tyrrell ECE grant $10, 000 low-up Group. Quality of life 4 years BD, Taylor DA, Shanks M. Pre- (Pre-Clinical) after complex heart surgery in infancy. dismissal surveillance echocardiogra- J Thorac Cardiovasc Surg. 2012 Apr phy second day after TAVR. JACC 14. Energy metabolism in the Cardiovasc Imaging. 2012 Nov;5 newborn heart. Lopaschuk (11):1182-4. Pockett CR, Dicken B, Rebeyka IM, GD, Rebeyka IM, Jaswal J, Ross DB, Ryerson LM. Heterotaxy Meyer SR, Suri RM, Wright RS, Jhangri G: Canadian Institutes syndrome: Is a prophylactic Ladd pro- Dearani JA, Orszulak TA, Daly RC, cedure necessary in asymptomatic of Health Research. ($160,724/ Burkhart HM, Park SJ, Schaff HV. patients? Pediatr Cardiol. 2012 May yr total group grant, 2012- Does metabolic syndrome influence 29. 2016). bioprosthetic mitral valve degenera- tion and reoperation rate? J Card Mutsuga M, Quiñonez LG, Mackie AS, Surg. 2012 Mar;27(2):146-51. In-human validation of a tech- Norris CM, Marchak BE, Rutledge JM, Rebeyka IM, Ross DB. Fast track ex- nique for measuring central Song Z, Lehr EJ, Wang S. An alterna- tubation after modified Fontan proce- aortic hemodynamics with pe- tive subcoronary implantation tech- dure. J Thorac Cardiovasc Surg. 2012 ripheral arterial wave- nique decreases the risk of complete Jun 26. heart block after stentless aortic valve forms.Investigators: Dr. J. replacement. Journal of Cardiovascu- Hahn, Co-investigator: Dr. S. Morgan CJ, Zappitelli M, Robertson lar Disease Research, 2012;3(1):46- CM, Alton GY, Sauve RS, Joffe AR, Wang: Heart and Stroke 51 Ross DB, Rebeyka IM; Western Cana- Foundation: Amount Awarded: dian Complex Pediatric Therapies Fol- $107,000 Date: July 1, 2012 (2 Roze des Ordons AL, Lee J, Bader E, low-Up Group. Risk factors for and Scheelar L, Achen B, Taam J, Macart years) outcomes of acute kidney injury in 5 neonates undergoing complex cardiac surgery. J Pediatr. Hansen G, Conradi A, Lequier L, Garcia Guerra G, 2012 Aug 7. Quinonez L, Ross DB, Rebeyka IM, Buchholz H. Safety of Berlin Heart EXCOR pump changes in the pediatric inten- Takahashi K, Mackie AS, Thompson R, Al-Naami G, sive care unit. Pediatr Crit Care Med 2013;14 Epub Inage A, Rebeyka IM, Ross DB, Khoo NS, Colen T, ahead of print Smallhorn JF. Quantitative real-time three-dimensional echocardiography provides new insight into the mecha- Gill RS, Cheung PY, Yu X, Aklabi MA, Nagendran J, nisms of mitral valve regurgitation post-repair of atrioven- Quinonez LG, Li YQ, Miller J, Ross DB, Rebeyka IM, Li J. β tricular septal defect. J Am Soc Echocardiogr. 2012 (3)-Adrenoceptor Antagonist SR59230A Attenuates the Nov;25(11):1231-44. Imbalance of Systemic and Myocardial Oxygen Transport Induced by Dopamine in Newborn Lambs. Clin Med In- Robertson CM, Alton GY, Bork KT, Joffe AR, Tawfik GC, sights Cardiol. 2012;6:45-51. Epub 2012 Feb 16. Sauve RS, Moddemann DM, Ross DB, Rebeyka IM. Bi- Oka T, Lam VH, Zhang L, Keung W, Cadete VJ, lateral sensory permanent hearing loss after palliative Samokhvalov V, Tanner BA, Beker DL, Ussher JR, Huqi A, hypoplastic left heart syndrome operation. Ann Thorac Jaswal JS, Rebeyka IM, Lopaschuk GD. Cardiac hypertro- Surg. 2012 Apr;93(4):1248-53. phy in the newborn delays the maturation of fatty acid β- oxidation and compromises postischemic functional recov- Bowman ME, Rebeyka IM, Ross DB, Quinonez LG, For- ery. Am J Physiol Heart Circ Physiol. 2012 May 1;302 gie SE. Risk factors for surgical site infection after de- (9):H1784-94. layed sternal closure. Am J Infect Control. 2012 Oct 23. Nagendran J, Sutendra G, Paterson I, Champion HC, Web- Ugaki S, Khoo NS, Ross DB, Rebeyka IM, Adatia I. Tri- ster L, Chiu B, Haromy A, Rebeyka IM, Ross DB, Miche- cuspid valve repair improves early right ventricular and lakis ED. Endothelin axis is upregulated in human and rat tricuspid valve remodeling in patients with hypoplastic left right ventricular hypertrophy. Circ Res. 2013 Jan 18;112 heart syndrome. J Thorac Cardiovasc Surg. 2012 Nov 14. (2):347-54. Epub 2012 Dec 10. Moustafa S, Patton DJ, Ross DB, Balon Y, Alvarez N. Schroeder MA, Lau AZ, Chen AP, Gu Y, Nagendran J, Unanticipated stenosis of the systemic arterial supply in Barry J, Hu X, Dyck JR, Tyler DJ, Clarke K, Connelly KA, scimitar syndrome. Eur Heart J Cardiovasc Imaging. 2012 Wright GA, Cunningham CH. Hyperpolarized 13C magnetic Nov 25. resonance reveals early- and late-onset changes to in vivo pyruvate metabolism in the failing heart. Eur J Heart Fail. Yu X, Larsen B, Urschel S, Cheung PY, Ross DB, Re- 2013 Feb;15(2):130-40. Epub 2012 Dec 19. beyka I, West L, Li J. The profile of inflammatory and metabolic response in children undergoing heart trans- Kienesberger PC, Pulinilkunnil T, Nagendran J, Dyck JR. plantation. Clin Transplant. 2012 Mar-Apr;26(2):E137-42. Myocardial triacylglycerol metabolism. J Mol Cell Cardiol. 2012 Jul 10. Clarke JR, Zvaigzne CG, Disler D, Giuffre M, Rebeyka IM, Patton DJ. Giant left atrial appendage aneurysm in a Nagendran J, Waller TJ, Dyck JR. AMPK signalling and the neonate. World Journal for Pediatric and Congenital control of substrate use in the heart. Mol Cell Endocrinol. Heart Surgery. 2012;3(3):392-395 2012 Jun 28. Jones LW, Antonelli J, Masko EM, Broadwater G, Lascola Yu X, Larsen B, Rutledge J, West L, Ross DB, Rebeyka CD, Fels D, Dewhirst MW, Dyck JR, Nagendran J, Flores IM, Buchholz H, Li, J. The profile of the systemic inflam- CT, Betof AS, Nelson ER, Pollak M, Dash RC, Young ME, matory response in children undergoing ventricular assist Freedland SJ. Exercise modulation of the host-tumor inter- device support. Cardiovasc Thorac Surg 2012;15(3);426- action in an orthotopic model of murine prostate cancer. J 431. Appl Physiol. 2012 Jul;113(2):263-72. Dehghani P, Atallah J, Rebeyka I, Ross D, Quinonez L, Kienesberger PC, Pulinilkunnil T, Sung MM, Nagendran J, Kantoch M, Heggie P, Taylor D, Alvarez N, Human D, Haemmerle G, Kershaw EE, Young ME, Light PE, Oudit Pausjenssen E, Tam JW, Vonder Muhll I. Management of GY, Zechner R, Dyck JR. Myocardial ATGL overexpression adults with congenital heart disease using videoconfer- decreases the reliance on fatty acid oxidation and protects encing across Western Canada: A three-year experience. against pressure overload-induced cardiac dysfunction. Mol Can J Cardiol 2012; August 24 Epub ahead of print. Cell Biol. 2012 Feb;32(4):740-50. 6 Division of General Surgery The Division of General Surgery Edmonton zone, including at the University of Alberta surgeons in Grand Prairie and remains committed to the Lethbridge. common goal of providing excellent patient care while Education has always been a continuing and strengthening priority within the division, with its tradition of teaching and faculty members providing count- research. The division has less hours of teaching to both continued to strive toward this undergraduate and postgraduate common goal during the past students. There was a significant year. increase in the number of medical students rotating through General The continued development of Surgery in their third year, and it acute care services at the Royal is through the efforts of all faculty Divisional Director Alexandra Hospital and Univer- members that they were able to sity of Alberta Hospital has obtain an excellent experience. Dr. David Williams been exciting for the division. There has been a very promising The quality of patient care has rise in interest on the part of increased, as have educational medical students in general and research opportunities. surgery as a career. This is Other sites are being looked at reflected in the number of for development of acute care students applying for general services, and this certainly is a surgery through the CaRMS progressive move forward. application process. Established programs within the Postgraduate education has seen division have continued to flour- the development of a rural ish, including transplantation, training stream, with the Queen hepatobiliary and pancreatic Elizabeth II Hospital in Grand surgery, colorectal surgery, Prairie being the rural training trauma, surgical oncology, site. This training model promises endocrine surgery, head and to increase the interest in rural neck surgery, vascular surgery General Surgery. The General and breast surgery. The clinical Surgery program is looking Program Director programs are being examined forward to an external review in Dr. Dan Schiller from a zone wide level, and June of 2013. Several progres- recruitment is being planned to sive changes have been made in help develop several of these the program, including great programs throughout the zone. opportunities for resident and faculty development. Clinical care delivery is also provided by faculty members The strong culture and surgical working in hospitals outside the research has the majority of 7 faculty members taking part in research The Division of General Surgery is a diverse and endeavors. The division continues its proud vibrant division, with a faculty dedicated to excel- and strong tradition of basic and clinical lence in patient care, education and research. science research. Members of the division hold 2012 has proven to be a successful year for the millions of dollars in grants and have produced division, and we can expect to see many more over 150 publications in 2012. accomplishments in the years to come. The division hosted many distinguished visitors Promotions in 2012 for its City Wide Rounds. These visitors included, Dr. Kenji Inaba from the University of Dr. Eric Bédard was promoted from Assistant Southern California, Dr. Arya Sharma from the Professor to Associate Professor University of Alberta, Dr. Harvey Hawes from the University of Texas, Dr. Chad Ball from the Awards University of Calgary, Dr. Dean Mikami from Ohio State University and Dr. Charles William Shandro Award for Teaching Excellence Brunicardi from University of California, Los in Clinical Surgery, Dr. Kal Ansari Angeles. Medical Students’ Association 2011-2012 At the division’s 2012 Resident Research Day, Discovery Learning Preceptor Excellence Award, visiting professor and judge, Dr. Michael Yeh Dr. Bryan Dicken presented City Wide Rounds on Managing Difficult Thyroid Cancers. Dr. Yeh is the Medical Students’ Association 2011-2012 Associate Professor of Surgery and Medicine Gilbert Scholars Preceptor Excellence Award, Chief, Section of Endocrine Surgery, at the Dr. Sandy Widder University of California. 8 Top 10 Teacher Awards 2012 1st Vanessa Davis - The Metabolic Signature of Pancreatic Cancer in Urine Dr. Erika Haase Dr. Ghassan Hadi 2nd Richdeep Gill - Cyclosporine Treatment Dr. Stewart Hamilton Improves Cardiac Function, Attenuates Dr. Ramesh Juta Myocardial Injury and Preserves Cardiac Dr. Shahzeer Karmali Mitochondrial Integrity during Resuscitation of Dr. Jacqueline Kennedy Asphyxiated lab models Dr. David Olson Dr. Dan Schiller 3rd David Al-Aldra - Chimerism Induction that Dr. Jonathan White Includes CD4 and CD8 and CD8T Cell Depletion Dr. David Williams Abrogates Split Tolerance in lab models Top Specialty Surgery Awards 2012 Clinical Science Dr. Hadi Seikaly 1st Shaheed Merani - Discharge Care Dr. Ken Stewart Requirements of Elderly Patients Admitted for Dr. Azim Valji Emergency Surgery Teaching Excellence 2012 2nd Ahmed Almamar -The Impact of Sleeve Gastrectomy as Compared to Adjustable Gastric RE Fraser Award for Excellence in Band on Active and Total Ghrelin and other GI Teaching - Dr. Basem Al-Shareef Hormones and their Influence on Satiety and Hunger George R. Graham Postgraduate Memorial Bursary - Dr. David Al-Adra 3rd Sayf Gazala - Do Post-operative Complications Affect Health Related Quality of Marshall C. Hunting Award in Vascular Life After Video Assisted Thoracoscopic Surgery - Dr. Chieh (Jack) Chiu Lobectomy for Patients with Lung Cancer: A Cohort Study Resident Awards Publications Stevens Norvell Prize Winners 2012 Adams D, Wu T, Yasui Y, Aung S, Vohra S. Sys- Dr. Usama Sarsam tematic reviews of TCM trials: how does inclu- 1st Prize, 1st Year of Residency sion of Chinese trials affect outcome? Journal of Evidence-Based Medicine. 2012 [epublished ahead of print] doi: 10.1111/j.1756- Dr. Amir Yousef Taheri 5391.2012.01173.x 1st Prize, 2nd Year of Residency Mandziuk K, Liu Y, Adams D, Vohra S. Acupunc- Dr. Andrey Vizhul ture for Cerebral Palsy. Focus on Alternative and 1st Prize, 3rd Year of Residency Complementary Therapies. 2012; 17(2): 85-90. Scott O, Galcia-Connolly E, Adams D, Surette S, Resident Research Day Awards 2012 Vohra S, Yager J. The safety of cruciferous plants in humans: A systematic review. Journal Basic Science of Biomedicine and Biotechnology Volume. 2012; 28. doi:10.1155/2012/503241 9 Division of Neurosurgery The Division of Neurosurgery has remains a highlight of our 13 members. In 2012 there were program and is one of the few two retirements / replacements. programs in the country with an Dr. Kenn Petruk became intraoperative MRI. In particular, Professor Emeritus and Dr. John the intraoperative MRI is a 3- McKean retired formally. Dr. tesla MRI, of which there are Tejas Sankar joined the only two in the country. neurosurgical faculty as a new recruit. Dr. Sankar is a functional Most members of the division neurosurgeon with a specific are involved in either collabora- interest in deep brain stimulation tive research or self-directed for movement disorders and research. The division holds 35 psychiatric illness. Dr. Tim grants (funded and non-funded), Darsaut also joined the faculty. with a total grant revenue of Dr. Darsaut is a neurovascular $1.75 million. The commitment surgeon with a specific interest in to research is exemplified in the Divisional Director minimally invasive endovascular publication record of the division. Dr. B. Matt Wheatley procedures. There were 57 papers published of which 46 were peer-reviewed All members of the division in 2012. There was one book participate in Undergraduate chapter authored. Medical Education contributing both to Discovery Learning and In addition, there were three Gilbert Scholar programs. There separate awards presented to are eight residents enrolled in the the division. Dr. Keith Aronyk Residency Program. The received two awards. He fellowship program continues to received an Undergraduate expand. There are three formal Medical Education Award for fellowship programs available. Preceptor Excellence and he The spine fellowship program also received the Medical Staff continues to recruit and train Association Humanism Award. spine fellows. There is now a In addition, Dr. Jeff Pugh pediatric neurosurgical received an award for Pre- fellowship, as well as an epilepsy Clinical Mentorship from Under- surgery fellowship. graduate Medical Education. Program Director With the recruitment of Dr. Tejas Dr. Cian O’Kelly After almost a decade of planning Sankar and Dr. Tim Darsaut, the and construction, the intraopera- research portfolio of the Division tive MRI was formally opened has been bolstered. These and the first patients were individuals continue to contribute operated on in 2012. This significantly to the academic 10