Southern Surgical Association Research Articles

Teletransformation: Global Telesolutions and the Transformation of Surgical Care and Education.

From the Department of Surgery, UTMB Cancer Center: The University of Texas Medical Branch at Galveston Cancer Center, Galveston, TX Disclosure Information: Nothing to disclose. Disclosures outside the scope of this work: Dr Klimberg receives editorial book royalties from Saunders, Elsevier, Wolters Kluwer, and Springer. Presented at the Southern Surgical Association 134th Annual Meeting, Palm Beach, FL, December 2022 Corresponding author: V. Suzanne Klimberg, MD PhD FACS UTMB/MDACC 301 University Blvd 6.136 McCullough Bldg Galveston, TX 77555-0001

Opportunity and the Southern Surgical Association.

Opportunity and the Southern Surgical Association.

The Southern Surgical Association and the Mayo Brothers of Rochester, Minnesota: An Enduring Legacy.

The Southern Surgical Association and the Mayo Brothers of Rochester, Minnesota: An Enduring Legacy.

75 Years of Excellence: The Story of Reconstructive Surgery

75 Years of Excellence: The Story of Reconstructive Surgery

Editorial introductions

Current Opinion in Organ Transplantation was launched in 1996. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of organ transplantation is divided into 18 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Srinath ChinnakotlaSrinath ChinnakotlaDr Srinath Chinnakotla is a Professor of Surgery and Transplant Surgeon, University of Minnesota Medical School. He also serves as the Surgical Director of the Liver Transplant Program at University of Minnesota M Health affiliated Hospitals. Dr Chinnakotla received his medical degree from Jawaharlal Institute of Post-Graduate Medical Education and Research in 1990 and did his initial surgical training in India before relocating to the United States for a multi-organ Transplant Surgery Fellowship at the University Of Nebraska Medical Center. Prior to moving to Minneapolis. Dr Chinnakotla spent 10 years as staff transplant surgeon at Baylor University Medical Center, Dallas. He also served as Surgical Director of Pediatric Liver and Intestinal Transplantation at Children's Medical Center from 2007–2010. Dr Chinnakotla has over 20 years of experience as a staff transplant surgeon and has performed over 900 liver transplants, in both adults and children. His special interests include pediatric transplantation, living donor transplantation, complex and high-risk liver transplants and multi-organ transplants. He is also nationally and internationally known for developing the technique of total pancreatectomy and islet auto transplantation for use in small pediatric patients. Dr Chinnakotla has published more than 130 peer reviewed articles as well as a number of book chapters and review articles. He is a reviewer for several scientific journals. He has given presentations on a wide range of transplant surgery topics nationally. He has served on the Board of Directors, UNOS/OPTN and as Councilor Region 7 UNOS. Dr Chinnakotla is a member of ASTS, Fellow of American College of Surgeons and Member of the Southern Surgical Association. On a personal note, he enjoys most being with his children and family. His hobbies include boating, fishing and complaining about Minnesota winters. Jonathan A. FridellJonathan A. FridellDr Jonathan A. Fridell, MD is the Chief of Abdominal Transplant Surgery at Indiana University (IU). Having completed medical school, surgical training and a Master's degree in Surgical Research (Xenotransplantation) at McGill University in Montreal, Canada and Abdominal Transplant Surgery Fellowship at the Thomas E. Starzl Transplant Institute / University of Pittsburgh Medical Center in Pittsburgh, PA, he joined the faculty at IU in 2002. He has actively participated in all aspects of the abdominal transplant program including adult and pediatric liver, kidney, intestine, multivisceral and pancreas transplantation. He is best known for his contributions in the field of pancreas transplantation. His research is mostly focused on outcomes following pancreas transplantation and he has authored over 150 manuscripts and book chapters and is currently the Deputy Editor for Pancreas and Islet Transplantation for the journal Clinical Transplantation and an Associate Editor for the American Journal of Transplantation. Dr. Fridell also has a long history of participation with the Organ Procurement and Transplantation Network and the United Network for Organ Sharing (OPTN/UNOS) including a double term as the Chair of the Pancreas Transplant Committee. Augusto LauroAugusto LauroDr Augusto Lauro, MD PhD FACS FRCS Eng is an Attending Surgeon (Consultant) working at St. Orsola University Hospital in Bologna and an Assistant Professor (Lecturer) working at La Sapienza University in Rome. He was deeply involved in adult small bowel-multivisceral transplantation from 2002 up to 2017, while since the last 3 years he has been devoted to the surgical intestinal rehabilitation (rescue) field. He has attended by podium and poster presentations the IRTA (Intestinal Rehabilitation and Transplant Association) meetings since 2005 and he has written so far 75 PubMed papers about intestinal rescue and transplantation.

The Surgical Legacy of Randolph Lee Clark, Jr, MD: First Director and Surgeon-in-Chief of University of Texas MD Anderson Cancer Center II. Surgical Practice and Leadership at University of Texas MD Anderson Cancer Center (1946-1978).

Dr. R. Lee Clark Jr brought a broad-based cancer surgery experience to MD Anderson Hospital for Cancer Research when he became its first Surgeon-in-Chief and full-time salaried physician in 1946. He performed major surgery until 1971 including major head and neck operations, thyroidectomy, mastectomy, radical melanoma and sarcoma surgery, gastric and abdominal-perineal resection, and even hemipelvectomy. He initiated major programs in radiation therapy and mammography breast screening, and organized teams of specialists in a group practice providing multidisciplinary cancer care. Dr. Clark was elected into membership by the James Ewing Society (currently the Society of Surgical Oncology), the Southern Surgical Association, and the American Surgical Association, and was a founding member of the Society of Head and Neck Surgery. The Society of Surgical Oncology honored him with the Lucy Wortham James Award in 1965 and the James Ewing Lecture Award in 1977. Dr. Clark also provided invaluable leadership in the American College of Surgeons, leading a fledgling Committee on Cancer into a robust organization that became the Commission on Cancer. The College of Surgeons honored him with their Distinguished Service Award in 1969. Dr. Clark recruited major surgical leaders and personally designed the new hospital that opened in 1954, described in Time magazine as "the most modern, most ingeniously designed hospital in the U.S." R. Lee Clark, Jr. was an accomplished and busy clinical surgeon, a visionary and charismatic leader, and an organizational genius. Indeed, he was one of the first pioneers in the specialty of surgical oncology.

Simulation in Surgical Education: Influences of and Opportunities for the Southern Surgical Association

Simulation in Surgical Education: Influences of and Opportunities for the Southern Surgical Association

Strategic Partnerships in Surgery: A Model for the US

I have considered it a great pleasure and tremendous honor to serve as the 129th president of the Southern Surgical Association (SSA). I'd like to share with you the impact of critical partnerships in American surgery, which have gone beyond societal and cultural norms of the times to empower the SSA to be an example and model for America in today's challenging times.

The Founding Fathers vs Jerome Cochran: Organization and Development of the Southern Surgical and Gynecological Association in Birmingham

The Founding Fathers vs Jerome Cochran: Organization and Development of the Southern Surgical and Gynecological Association in Birmingham

Southern Surgical Association: A Tradition of Mentorship in Translational Research

Southern Surgical Association: A Tradition of Mentorship in Translational Research

The Inseparable Histories of the Southern Surgical Association and Surgery for Portal Hypertension

The Inseparable Histories of the Southern Surgical Association and Surgery for Portal Hypertension

A Brief History of Aortic Aneurysm Surgery.

For centuries, aortic disease has been a major problem of mankind. Hieroglyphic texts from ancient Egypt attest to the presence of aortic aneurysms millennia before the birth of Christ. Although no medical solution for aneurysms was available in that era, the advice allegedly given for the care of affected patients was a passionate plea, which simply stated, “Do not abandon them.” As medical history reveals, the treatment of aortic aneurysms did not progress significantly until modern times. Most measures used to control these lesions were attempts to relieve pain and forestall inevitable rupture. Efforts to promote thrombosis by introducing foreign bodies, such as wire and other substances, were sometimes successful but more often ineffective. Other efforts were aimed at strengthening or reinforcing the wall of the aneurysm to retard its growth. Many different measures were tried, but their success was limited. A major advance took place in 1888, when Rudolph Matas reported an internal repair technique known as endoaneurysmorrhaphy for treating arterial lesions. In this approach, he excised the clot from the aneurysmal sac and sutured the orifices of the arteries that entered the sac, from within, reestablishing continuous blood flow. More aggressive or definitive treatment became available only in the second half of the 20th century. Encouraged by experience with the surgical treatment of wounds during World War II, surgeons began taking a more direct approach to cardiovascular lesions. A few case reports concerning the repair of small sacciform aneurysms appeared in the medical literature, but there were no recommendations for definitive surgery. In December 1951, I presented a paper that Dr. Michael DeBakey and I had written entitled, “Surgical Considerations of Intrathoracic Aneurysms of the Aorta and Great Vessels,” [1] at a meeting of the Southern Surgical Association (Fig. 1). The paper described six cases in which excision and aortorrhaphy had been performed. During the discussion that followed the presentation, the renowned surgeon Dr. Evarts Graham complimented us on our paper and suggested that it was a landmark in vascular surgery. Shortly afterward, I performed the first repair of a ruptured abdominal aneurysm [2]; the patient survived for 5 days, then died of kidney failure. I soon repaired four more ruptured aneurysms. In 1952, Dr. DeBakey and I were the first to use a homograft to repair a large aneurysm of the thoracoabdominal aorta [3]. Later, we successfully used homografts to replace the ascending aorta (1956) [4] and the aortic arch (1957) [5]. Figure 1. A leather-bound copy of the historic and seminal paper that I presented to the Southern Surgical Association in 1951, which is now prominently displayed in the Wallace D. Wilson Museum at the Texas Heart Institute. I am proud to have participated in the ... During the same period, many other surgeons made important contributions to aneurysm treatment. Among those pioneers were Henry Bahnson and his colleague, Frank Spencer, who began an active aortic surgery program at Johns Hopkins Hospital. Soon, many other surgeons and institutions established programs for treating aortic aneurysms and occlusive disease. Since that time, aortic disease has continued to hold widespread interest for surgeons and other specialists. Countless symposia and publications have resulted. Many advances in diagnosis and treatment have occurred, such as aortography, the introduction of vascular grafts and anticoagulants, and the techniques of cardiopulmonary bypass and induced hypothermia. More recently, noninvasive diagnostic methods have been introduced, including ultrasonography, computed tomography, and MRI. In the last part of the 20th century, the goal of treatment reverted to endoaneurysmorrhaphy, with use of a suitable graft to restore aortic continuity. Today, the emphasis is on catheter placement of prosthetic grafts, a less invasive approach to these lesions. It is highly appropriate now that Dr. John Elefteriades, of the Yale University School of Medicine, has created a specialty journal, AORTA, devoted entirely to aortic disease. Dr. Elefteriades has long been a world-renowned leader in cardiovascular surgery. I applaud this new journal and am sure that it will contain many articles of interest. Comment on this Article or Ask a Question

The Surgical Legacies of Hawkeye Pierce

The title of the story I want to tell today is “The Surgical Legacies of Hawkeye Pierce.” Hawkeye Pierce is the dedicated master surgeon, fun-loving romantic, acerbic observer of the foibles of his associates, and successful football team leader invented by Richard Hooker in his book, M*A*S*H. Richard Hooker was the pseudonym adopted by Richard Hornberger, a surgeon and alumnus of the Cornell Medical School. All of you know that the book later became a successful motion picture and a longrunning television series. Dr Otis Apel published a reallife account of a mobile Army surgical hospital (MASH) surgeon in his book MASH: An Army Surgeon in Korea. Hooker’s book joins a long line of darkly humorous works about war experiences, including the cartoons of Bill Mauldin and novels by such authors as Heller and Vonnegut. Recent additions to this lineage include an important comic novel about the war in Iraq entitled Fobbit by David Abrams. I became interested in the legend of Hawkeye Pierce when reading the obituary for Dr Keith Reemstma after his death in 2001. The obituary stated that Dr Reemstma had been the surgeon that Hooker had used as the model for Hawkeye. Of interest is the fact that I knew of at least 3 other surgeons who had been identified as the model for Hawkeye. One of them was a former member of the Southern Surgical Association and a valued friend, Dr Alvin Bronwell. It is unlikely that there was a single model for Hawkeye. In fact, in the author’s foreword he states that Hawkeye was a composite of personalities he had encountered in Korea and was not modeled after a single surgeon. The Southern Surgical Association has a history of supporting military surgeons during and after wars. In his Presidential Address in 1917, William D Haggard reflected on the patriotism of military medical personnel. Dr Haggard reminded the audience that the first American killed in World War I was a surgeon who was part of the staff of the Washington University Medical Unit

Application of the Core Competencies After Unexpected Patient Death: Consolation of the Grieved

To review and assess educational strategies and formats regarding communication with families/survivors in the aftermath of unexpected and untimely patient death. To propose an integrated curriculum designed and intended to foster proficiency, competence, confidence, and composure in relaying catastrophic information in the context of the professional experience of a cohort of seasoned surgeons. Unexpected and untimely patient death is emotionally and psychologically wrenching for families, surgeons, and healthcare providers. We have previously proffered that 2 distinct, but interactive, phases of response are relevant when communicating with a family before and after the event: a proactive phase intended to establish a positive therapeutic relationship with the family; and a reactive phase intended to respond to the family in a compassionate and respectful manner and to ensure self-care for the physicians and health care providers. Survey of a cohort of senior surgeons (membership of the Southern Surgical Association) and Surgical Residency Program Directors (membership of the Association of Program Directors in Surgery). Sixty percent of the senior surgeons surveyed had experienced unexpected patient death. They advised strategies to cope with that clinical situation commensurate with the core competencies of the Accreditation Council for Graduate Medical Education: Medical Knowledge: maximize objective information/data and minimize subjective opinion; Patient Care: critique the events and conduct postmortem analyses; Interpersonal and Communication Skills: honesty, empathy, and patience; Professionalism: provide emotional and psychological support to family and personnel with privacy and in a nonaccusatory manner; Practice-Based Learning and Improvement: preoperative discussion and documentation in the context of informed consent and advanced directives vis-á-vis risk-benefit, effort-yield, and benefit-burden analyses; and Systems-Based Practice: involve chaplains and hospital personnel. Thirty-six percent of the graduate surgical educational programs surveyed allegedly provided educational venues to enable surgical residents to cope with unexpected patient death, although the formats were not specified. Graduate, postgraduate, and continuing educational programs aspire to prepare physicians and surgeons for independent professional practice-scientifically, humanistically, and artistically. Incorporating educational strategies to enable graduates to cope with the emotional and psychological turmoil of unexpected patient death is relevant.

Hunter Holmes McGuire: Much More than Stonewall Jackson's Surgeon

Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC Correspondence address: Carl E Haisch, MD, FACS, Department of Surgery, 4S-10 Brody Building, East Carolina University, Greenville, NC 27834-4354 Submitted December 16, 2011; accepted December 20, 2011. Disclosure Information: Nothing to disclose. The author received the 2011 Joseph Donald Award for Surgical Historical Research, offered annually by the Southern Surgical Association. Presented at the Southern Surgical Association 123rd Annual Meeting, Hot Springs, VA, December 2011.

Looking to the Future on the Shoulders of Giants

I would like to begin by saying that it has been a tremendous honor and privilege to have served as the president of the Southern Surgical Association (SSA) for the past year. I have hosen to entitle this address, “Looking to the Future on he Shoulders of Giants.” Dr David Richardson once told e, “When you see a turtle on a fence post you can be retty sure he had some help getting there.” If I am the urtle on the fence post, I would like to acknowledge a umber of giants in the world of surgery who have been nstrumental in putting me on the post. These people have een mentors, role models, visionaries, and friends. First, ichard Myers, MD, and Robert Cordell, MD, the chairs f the Departments of General and Cardiothoracic Surery, respectively, at the Bowman Gray School of Medicine hen I was in training. Neither is with us anymore; both ere great surgeons and men who profoundly affected the ives of countless physicians and patients. Donald Trunkey, D has been a lifetime mentor, a great man whom I have lways tried to emulate, and the one who opened my eyes to rauma surgery after I had completed my education and raining in cardiothoracic surgery. Also, thanks to Richard Dean, MD, who was chairman of Surgical Sciences and eneral Surgery at Wake Forest University when I had my irst faculty position. He has been a great friend and menor, and handed me the reins to a wonderful department. here are too many friends in this organization for me to hank individually, but I truly appreciate your friendship nd all you have done for me and this organization along he way. I also want to thank an incredible faculty in the epartment of General Surgery at Wake Forest University ack home in Winston-Salem. They are a tremendous ource of pride, and a great help in getting me where I am oday. To my wife, Gayle, thank you for 37 magnificent ears of companionship and marriage. In November 2011, I found myself in New Orleans at he annual delegates meeting of the American Medical Asociation (AMA), where my father, Jesse H Meredith, (SSA 973) received the Distinguished Service Award, the high-

Fred W Rankin, MD: A Man of Medicine During a Time of War and Change

Department of Surgery, University of Kentucky College of Medicine, Lexington, KY Correspondence address: Joseph B Zwischenberger, MD, Department of Surgery, University of Kentucky College of Medicine, 800 Rose St, MN264, Lexington, KY 40536-0298 E-mail: [email protected] Submitted and accepted December 15, 2010. Disclosure information: Nothing to disclose. Supported by the Joseph M Donald Archival Collection and Endowment Fund of the Southern Surgical Association. Presented at Southern Surgical Association 122nd Annual Meeting, Palm Beach, FL, December 2010.

Cooperation in Clinical Trials

t N Thank you, Dr Urist, for your kind introduction. Fellows of the Southern, guests, my wonderful wife, Judy, one of my daughters, Kris, who is able to be present, and her husband, Michael, my son, Bill, and future presidents of the Southern . . . I begin by stating my humble but profound thanks for the honor of serving as the president of this Society . . . It is a great honor to follow in the footsteps of people whom I admire and many of whom I consider dear friends. Last year, President LD Britt magnificently made the point that the Southern Surgical Association is regional in name only. I must confess that the president lso presides in name only. The major responsibility for eading and directing our association falls on the council nd our secretary, not on your president. The late President rad Aust pointed out in his address that the presidential uties include such arduous matters as consulting on the inner menu and the wine and participating in the selecion of the scientific program abstracts. His major obligaion is the preparation of the Presidential Address. Presient James O’Neill kindly sent me a selection of prior residential addresses early in the year to assist me, and in he case of his own, perhaps intimidate me. You may have oticed that I included in my salutation, “and Future presdents of the Southern . . .” That is because virtually every residential address begins with the note that the prior residential addresses have just been read. I became sadly ware that future presidents read these addresses that they ave previously heard delivered because, like commenceent speeches, the carefully wrought, elegantly phrased tatements leave no imprint on the memory. One’s presiential address, like one’s funeral, requires that you be presnt with assembled family and friends. The great difference s that only for the presidential address do you need a manscript, but only what you say at your own funeral will be ong remembered. Choosing a topic proves difficult not because there are so ew options, but so many. There is a great temptation to ass on some great life lesson such as:

2010 SSO Presidential Address: Subspecialty Certificate in Advanced Surgical Oncology

To put things in perspective, let me briefly summarize the history of the American Board of Surgery (ABS). It was exactly 100 years ago, in 1910, that Dr. Abraham Flexner, supported by funds from the Carnegie Foundation, recorded the state of affairs of medical training in the USA at the beginning of the century: the quality of medical schools was extremely variable, with some of them based on scientific principles and others completely devoid of proper training, resulting in practitioners of vastly different education and quality. By the same token, there were no standards for training in medicine and surgery or any standards to verify and validate the quality of the individual trainee at the end of specialty training. The field of medicine was in disarray and needed standardization of educational quality and certification of individual competence. The idea of certification by a specialty board was first adopted by the ophthalmology organizations, which formed a specialty board, the American Board for Ophthalmic Examinations, which was incorporated in 1917. By 1933, the name was changed to the American Board of Ophthalmology. The otolaryngologists formed the American Board of Otolaryngology, which was incorporated in 1924. The American Board of Surgery, a private, nonprofit, autonomous organization, was incorporated in 1937. Today the American Board of Surgery is 1 of the 24 boards of the American Board of Medical Specialties (ABMS), and its principal objective is to evaluate the education, training, and knowledge of broadly qualified and responsible surgeons and to issue certificates to all candidates meeting the board’s requirements and satisfactorily completing its prescribed examinations. The ABS considers certification to be voluntary and limits its responsibilities to fulfilling the purposes stated above and not to designate privileges, credentialing or special recognition in the practice of surgery or its subspecialties. In doing so, the ABS serves the public, by guaranteeing that certified surgeons are highly qualified, and it serves the diplomates, by conferring on them recognition of their special skills, training, and knowledge. The founding organizations of the American Board of Surgery were the American College of Surgeons (ACS), the Surgical Section of the American Medical Association (AMA), and the American Surgical Association (ASA), each providing three representatives, plus four regional surgical societies, the New England Surgical Society, the Pacific Coast Surgical Association, the Southern Surgical Association, and the Western Surgical Association, each providing one representative. With the increase in workload created by the growing number of surgeons seeking certification and the process of recertification started in the early 1980s, the ABS has added to the number of directors over the years by inviting representation from other surgical societies: currently 22 national and regional surgical organizations and 3 surgical boards provide 32 directors Society of Surgical Oncology 2010

The Mississippi River and the Southern Surgical Association: Regional in Name Only (The Impact of the Southern Surgical Association on the Advancement of Trauma Management)

The Mississippi River and the Southern Surgical Association: Regional in Name Only (The Impact of the Southern Surgical Association on the Advancement of Trauma Management)