In his downtime, King Henry VIII was able to build up a department of surgery and hire the top barbers of the era in England to work in it, among other things.
Because barbers were competent with the principal surgical tool—a knife—it made sense at the time. As a result, surgery and grooming were combined into a single profession.
It was their job to extract teeth, remove gallstones and amputate limbs when called upon. If you are up for it, they could use the same knife to do a bloodletting and then cut a little from the top of your arm to relieve your temperature.
In the past, surgery was seen as a trade that could only be studied through apprenticeships. When Henry II of France was hit in the eye with a lance during a jousting contest in 1559, his brain was punctured by the lance. To treat the king’s injury, renowned barber-surgeon Ambroise Paré used cutting-edge neurosurgical techniques and concepts that impressed his peers. His fame rose and he became hailed as the father of modern surgery, even though the patient did not live.
The American Colonies imported this bizarre medical model from Europe. Because of this, by the mid-17th century they were no longer known as barber-surgeons but as hairdressers. Even though it took another 150 years or so to figure out exactly who in the medical community should be doing what, surgery was finally restricted to those who had received a formal education in the field.
David C. Linehan, MD, who has been the department’s chair since 2014 and also serves as the Seymour I. Scrufft Professor of Surgery, says the hyphen is a good way to describe the 21st century surgeon—the Surgeon-Scientist—who is skilled in performing complex surgeries, exploring novel therapies and leading major health care institutions while maintaining a “unrelenting focus on the patient.”
“Bold future” for the department means building on Rochester’s long history of clinical excellence, cutting-edge research, and educational innovation to instill in the next generation the value placed on the many skills that distinguish a Rochester Surgeon-Scientist from the rest of the medical community.
Linehan capitalized two words: CHANGE and MELIORA, in the department’s most recent annual report defining its strategic goals for the next five years. When Greek philosopher Heraclitus said that change is not just part of life, but also its core, it was more than 2,500 years ago, but it is now even more obvious how the two are linked. Surgical expertise, such as that required for immunotherapy and robotic assisted surgery, can only be reached by being open to new ideas.
Because of this, Linehan argues, the department cannot rest on its laurels. Seymour I. Schwartz, MD (Res ’57), the physician who co-wrote and edited the “surgeon’s Bible,” has been a part of the medical community for 60 years. Schwartz’s Principles of Surgery, which clocks in at 2,292 pages and eleven printings, is currently in its fifty-first year as a mandatory text in medical schools the world over. After serving as the department’s chairman from 1987 to 1998, physician Dr. Schwartz passed away in 2020 at the age of 92.
With people like Charles Rob [MD and former department chairman] and Sy Schwartz, the program was able to punch beyond its weight. As the chair of the Department of Surgery at New York-Presbyterian Hospital/ Columbia University Medical Center, Craig R. Smith Jr., MD (Res ’82, Flw ’82), explains, “You knew you would learn to operate.”
In 2004, Smith performed a quadruple bypass on former President Bill Clinton, after he had learned to operate.
John Fung, MD, PhD (Res ’88), a world-renowned transplant surgeon and director of the University of Chicago Medicine Transplantation Institute, states “Dr. Linehan has done a remarkable job keeping the program aligned with Dr. Schwartz’s vision and building on a strong hospital program and faculty.”
On the coffee table in his office, Linehan keeps a copy of Schwartz’s book, the fifth edition (issued in 1989). Surgeons from the Renaissance period are depicted on the cover of the canary-yellow leather cover. To emphasize that “80% of what is in this textbook is no longer true,” Linehan taps on the book while he discusses the department’s future plans. For the next half-century, what are we going to see?
The word “edge” frequently appears in Linehan’s descriptions of the division. As medical knowledge, technology, and surgical intricacy advance at an astounding rate, the need for cutting-edge thinking is becoming increasingly apparent.
Linehan’s view is bounded by a line denoting the state of knowledge regarding disease at the time. Research funding in the department has increased by 50% since 2015, making it a “powerhouse” once again, according to his plan. The Blue Ridge Institute for Medical Research has ranked the University as the 15th best place to conduct medical research. Linehan wants to get it into the top 10 this season.
A well-known surgical oncologist and expert in pancreatic cancer, Linehan adds, “My dream is for this research funding to improve outcomes and quality of life for patients with difficult-to-treat surgical problems.” “Clinical trials pique my interest because of my own experience with them. “There is still hope,” one reader wrote.
Linehan created the Center for Tumor Immunology Research five years ago to continue the hunt for new treatments for pancreatic cancer by comprehending the complicated interactions within the tumor microenvironment. Cancer-fighting cells can be stimulated to eradicate the tumor using this new strategy, which is based on stimulating the body’s immune system.
“It is a different way of thinking about cancer therapy—attacking cancer cells while also reprogramming immune cells to use the patient’s own immune system to fight their cancer,” explains Center director Linehan.
Although it has risen from 5 percent to 9 percent in the last five years, pancreatic cancer’s five-year survival rate is still in the single-digits.
More patients will be enrolled in the department’s ten ongoing trials, some of which were developed at Linehan’s lab. Only 5% of patients who are eligible to participate in clinical trials in the United States opt to do so. Everyone should participate in a clinical trial, according to Linehan.
Linehan calls it “astonishing” that the University played a substantial role in two of the most significant breakthroughs in cancer research in the last 50 years. The HPV vaccine, the first cancer vaccine, has proved 90% effective in preventing cervical cancer thanks to studies done by URMC scientists. There was also an advancement in chemotherapy-induced nausea research that looked at the issue from many different viewpoints, established the importance of anticipatory sickness, and provided the first evidence-based recommendations for utilizing antiemetic and analgesic medications in the treatment of nausea.
This discipline needs the greatest and brightest investigators, and we have been able to achieve that, according to Linehan, who appears in a film for the University of Rochester Medical Center (URMC). It is at that point when “the magic begins to happen.”
By converting breakthrough research into clinical trials and shepherding it through the lengthy administrative procedure, Linehan feels that it can be “impactful” for the patient.
The breakthroughs are not complete until we see them in individuals, Dr. Linehan tells us. “It is a new way of thinking,” Gerber explains. When it comes to translating research findings into clinical trials, Dr. Linehan is uniquely qualified. That is a little hard to come by.”
Linehan believes that combining the researcher doing the biological investigation with the physician knowledgeable of the patient’s unmet requirements is critical to expanding and diversifying the department’s research portfolio. According to Linehan, who compares his function to that of an orchestra conductor unifying the performers so that “the sum will be greater than the parts,” this fusion can shed light on why some treatments are more effective than others.
Since Gerber does much of her research on mice, she claims she has trouble empathizing with patients. When conducting research, it is important to speak with the patient. We have individuals that rely on us, and it really alters our perspective.”
The key, according to Linehan, is cooperation. In fact, it is been the key to our success. Teamwork is essential in research.
There are also ongoing experiments on novel melanoma, nerve regeneration, minimally invasive heart and liver surgery techniques and percutaneous approaches to treating vascular disease in the department, in addition to immunotherapy.
Graduate students and residents in the Surgical Health Outcomes and Research Enterprise (SHORE) are encouraged to spend one to two years undertaking research to prepare the next generation of Surgeon-Scientists (SHORE).
Yanjie Qi (MD ’06, Res ’14, Flw ’15), assistant program director for Curriculum and Simulation, argues, “Research is not just about the papers.” A better surgeon is one who has honed his or her critical thinking skills and is able to evaluate scientific evidence.
There was an increase in clinical cases even before COVID-19 patients flooded the hospital; in the previous five years, it has risen more than 20%. More than 28,000 patients were referred to the department last year, and 14,512 procedures were done. As a result, the department’s faculty has grown to 72, a third of them women, with 49 general surgery residents, 13 research fellows, and more than 300 staff members under Linehan’s leadership.
The department’s cultural diversity has also grown, thanks to the efforts of Linehan; faculty members come from 15 different nations. There are five da Vinci robots in the department, which are crucial in the department’s efforts to increase the use of minimally invasive procedures to speed up recovery time.
Since the department was established, the university has been supportive of its growth, adds Linehan. Linehan claims he is never had a problem finding new employees in the Flower City, despite what some have said.
“It is an honor for people to come and see what we have to offer,” he says. In the field of surgery, “everyone is aware that Schwartz’s department has a long history of excellence.”
The tsunami of COVID patients disturbed some of our attention to expansion. When it comes to dealing with such a terrible tragedy, the details of how the agency handled it are few and far between.
Hospitals around the world had to hustle to find ventilators, personal protective equipment (PPE), beds, and staff. The virus was treated by a dedicated emergency room staffed by volunteers from every surgical specialty.
“It was quite remarkable. There was no hesitation in terms of people signing up. ‘That speaks for itself,’ says Qi.
In spite of the fact that the epidemic is far from ending, the effects of past waves can still be felt. You might as well skip a boulder across the lake in order to get the same effect. The pandemic-exacerbated staffing shortages in health care across the country are impacting hospital capacity, patient volume, and surgical schedules all over the area in 2020.
If the global pandemic was not bad enough, the violent crime rate has risen as well, leading to an increase in the number of people who have been injured and require medical attention. As the only Level 1 Trauma Facility and confirmed burn center in the region, URMC receives the most critical and complex cases from across 17 counties.
According to Gestring, “the other change has been in the brazenness of this violence—midday, midweek—kids nearby.”
With a view to reducing the number of trauma patients being admitted, the division has stepped up its efforts to involve the community, partnering with local organizations in an effort to foster closer ties between residents and the institutions that support them. Participation in Stop the Bleed, a nationwide program for teaching basic first aid to bystanders, is another benefit of this program.
Trauma education is also provided to smaller hospitals in order to prepare them for transfer to the Medical Center, as the region’s sole trauma educator. In order to teach as many individuals as possible, a new “trauma truck” has been acquired by the division.
Although COVID-19’s meandering march around the country presents obstacles, the department marches to its own drum: deliver outstanding surgical solutions, such as the utilization of 3D-printed organs and minimally invasive surgery, and enhance patient outcomes. The only programs in juvenile cardiac surgery and living liver transplantation in the region are offered by the department, as are the only nationally accredited programs in rectal surgery and the only robotic surgical simulation program.
The only liver transplant center in upstate New York can be found at the Abdominal Transplant and Liver Surgery Division. During the five years since Roberto Hernandez-Alejandro, MD, took over as Division Chief, the number of liver transplants has doubled, reaching 103 last year. More than one hundred kidney transplants and fifty difficult hepatobiliary procedures are performed each year by this division, which is also a national leader in robotic kidney transplant surgery
Currently, Hernandez-Alejandro has created the region’s only living-donor liver surgery center, which performs 15 procedures a year, the second most in the state. Only two programs in the country offer liver transplants to patients with advanced colorectal liver metastases, giving patients with incurable liver disease new hope. Seven such procedures were carried out by the division last year. The division, which has just recruited two surgeons to its staff, attracts patients from all around the country.
Patients with advanced colorectal liver metastases are now treated by waiting to see how chemotherapy works. As Hernandez-Alejandro points out, cutting the treatment time in half considerably increases the likelihood of success and lessens patients’ suffering due to the disease and chemotherapy. The Cleveland Clinic and Toronto General Hospital have joined forces with him to find transplant candidates earlier in the process.
In the middle of the liver transplant waiting list, “life is difficult,” he says. “We are providing hope to patients so that they can enjoy a long and healthy life.”
