2021 Annual Report

In a year unlike any other, our clinicians in the Department of Surgery remained resolute in our effort to provide the best possible care to our patients.

With surgical faculty trained in the newest innovative, minimally invasive techniques, the opening of one of the most technologically advanced children's hospitals in the country, the new South Carolina Burn Center, capital investments in innovative operating rooms and five new da Vinci XI robotic surgical systems, our department was well positioned to deliver highly-specialized care even in the midst of a global pandemic.

With more clinic locations throughout the state and an increase in Telehealth visits, we were able to provide better access to care with the goal of reducing the impact of healthcare disparities invulnerable patient populations throughout the state.

Some particularly noteworthy departmental highlights from this past year include:

•    clinical growth across divisions• significant rise in robotic surgery
•    record-setting extramural research funding
•    improved surgical outcomes as a result of MUSC Health's quality improvements and the department's participation in the South Carolina Surgical Quality Collaborative
•    exciting research opportunities in artificial intelligence, thanks to a philanthropic gift from Brigadier General Harvey W. Schiller, USAF Ret., Ph.D., and his wife, Marcia
•    a new cardiogenic shock team
•    new leadership positions to create a path forward for greater diversity, equity and inclusion, health and wellness, and leadership development programming
•    impressive international and national recognitions.

As we continue to face challenges presented by the pandemic, we remain steadfast in our commitment to provide optimal patient care through clinical outreach, innovation, and education.

During these unprecedented times, I extend my deepest appreciation to the dedicated faculty, fellows, residents, staff and to our generous donors generous donors who have contributed to oursuccess.

Prabhakar Baliga, M.D. FACS

Professor and Chair
Department of Surgery
Medical University of South Carolina 

Our commitment to providing the highest level of compassionate patient care, best–in–class training forthe next generation of surgical leaders, and cutting-edge clinical, basic science and translational research are Changing What's Possible for our patients.

MUSC Health Expands to Provide Better Access to Complex Care

The only academic medical center in South Carolina and one of about 120 nationwide, MUSC Health has experienced growth and expansion over the past three years, providing better access to complex, high-end care for all South Carolinians. In 2019, MUSC Health welcomed four community hospitals to the system: Chester Regional Medical Center, Springs Memorial Hospital in Lancaster, Carolinas Hospital System – Florence and Carolinas Hospital System – Marion. The facilities have been renamed to: MUSC Health Chester Medical Center, MUSC Health Lancaster Medical Center, MUSC Health Florence Medical Center, and MUSC Health Marion Medical Center. In 2020, the new MUSC Shawn Jenkins Children’s Hospital and Pearl Tourville Women’s Pavilion opened. This facility is among the most well-equipped and technologically advanced facilities of its kind in the nation, transforming pediatric and women’s health care for the entire state and region for generations to come.

At the same time, the new R. Keith Summey Medical Pavilion, designed for pediatric sub-specialty care, opened in North Charleston. Other new facilities that opened in 2019 and 2020 include MUSC Health West Ashley Medical Pavilion, MUSC Health Grove Road(Greenville), and MUSC Health Nexton.2021 saw more growth and expansion with the announcement that the Medical University of South Carolina and Medical University Hospital Authority Board of Trustees voted to purchase Providence Health and Kershaw Health, currently part of LifePoint Health. The acquisition includes three community hospitals, a freestanding emergency department and affiliated physician practice locations serving communities in the Midlands. With these acquisitions and new facilities, we are increasing the reach of our network, enhancing our ability to deliver the highest-quality care at maximum efficiency as well as greater value for more communities statewide. Looking to the future, as our community continues to expand, the need for comprehensive health care services will increase and MUSC Health will be positioned to provide these services.

MUSC Health and MUSC Shawn Jenkins Children’s Hospital Ranked Number 1 Hospitals in South Carolina

MUSC Health was named the No. 1 hospital in South Carolina by U.S. News & World Report. The new rankings also placed the MUSC Shawn Jenkins Children’s Hospital in the No. 1 position for the state. Four specialty programs within the children's hospital have been singled out by U.S. News & World Report for national recognition: cardiology and heart surgery, nephrology (kidney), gastroenterology and gastrointestinal (GI) surgery and cancer. The cardiology program maintains its spot among the top 12 children’s heart programs in the United States. Criteria include children’s survival rate after complex heart surgery, along with the level of specialized staff, services and technologies, and the ability to prevent infections. The nephrology program at the MUSC Shawn Jenkins Children’s Hospital ranks No. 30 in the U.S. That means it excels when it comes to the survival rate of children who have kidney transplants, the management of dialysis and infection prevention, and other factors. The program maintains its status as the highest ranked children’s kidney program in South Carolina. The GI and GI surgery program is no stranger to the U.S. News & World Report rankings, either. For the 13thyear in a row, it made the grade, coming in at No. 42.Finally, the MUSC Shawn Jenkins Children’s Hospital’s cancer program ranks No. 44 on the list of "Best Children’s Hospitals for Cancer."

MUSC & Surgical Expertise Recognized Nationally

• Blue Cross Blue Shield Distinction® for Transplant in Adult Kidney Cadaveric, Adult Kidney Living, Pediatric Heart, Pediatric Kidney and Pediatric Liver
• Blue Cross Blue Shield Distinction® Center+ designation in Adult Heart Transplant
• Blue Cross Blue Shield Distinction® Center+ designation in Cardiac Care
• U.S. News & World Report recognizes MUSC Health as a High Performing Hospital for Aortic Valve Surgery
• MUSC Islet Transplantation Program is the second largest islet transplantation program in the world based on volume
• U.S. News & World Report children's cardiology and heart surgery program among the top 12 programs in the country
• MUSC Children’s Pediatric extracorporeal membrane oxygenation (ECMO) program is recognized as one of the top ten programs in the U.S. with Platinum Designation as an ELSO Center of Excellence
• The trauma center at MUSC Children’s Health has become the only kids’ trauma center in the state to achieve Level 1 verification from the American College of Surgeons
• MUSC Health is the only adult trauma center in the Lowcountry to receive Level 1 verification from the ACS
• Hollings Cancer Center receives NAPRC Certification for rectal surgery. We are one of twenty two centers in the U.S. to receive this designation.

Clinical Growth

With more than 30 new faculty joining our team over the past five years, capital investments in robotic and hybrid operating rooms, a new state-of-the-art children's hospital, clinic expansion across the state, and a positive downstream effect from the new organ allocation guidelines, the department experienced significant clinical growth in nearly all divisions.

Across the Continuum of Care: Our Commitment to Quality, Expertise and Culture

Since 2015, the South Carolina Surgical Quality Collaborative (SCSQC) has partnered with engaged surgical leaders across the state to establish a collaborative quality improvement structure designed to achieve measurable reductions in post-operative complications and lower general surgery costs. Mark Lockett, M.D. serves as surgeon lead for the SCSQC. Over the last six years, SCSQC member hospitals showed improved surgical outcomes and developed sustainability. Membership in SCSQC is supported by the BlueCross BlueShield of South Carolina Rewarding Excellence Program and the South Carolina Department of Health and Human Service’s value based payment program. Morbidity rates in member hospitals decreased 23% relative to rates when SCSQC started. Hospitals are also improving management protocols to get patients out of the hospital sooner, with less pain, and with lower need for opioid prescriptions.

This year the department has focused on strategic recruitment in surgical specialties to better serve our community and build our growing clinical expertise. We are committed to working with our community partners to improve the quality and value of care through innovation and collaboration.

OUR COMMITMENT IS REFLECTED IN A TANGIBLE WAY

We are steadfast in our commitment to improve our culture:

• creating an inclusive workforce with a diversity of backgrounds and perspectives,
• improving faculty, resident and staff wellness and resiliency, and
• supporting our faculty and trainees through mentorship and leadership development to become nationally-recognized surgical leaders.

Paving a path forward, Dr. Baliga created three new positions in the department: vice chair of Diversity, Equity and Inclusion, vice chair of Personal Development and Well-being, and vice chair of Faculty Development.

Creating a More Inclusive Culture

In order to better understand our patients' medical needs, we must also understand their backgrounds, including culture, ethnicity, race, gender identification, and religious beliefs. The Department of Surgery is dedicated to ensuring the voices of our patients, trainees, staff, faculty, and patients are heard, their thoughts respected and their feelings valued. Sharee Wright, M.D. joined the department in March 2021 as a clinical associate professor of vascular surgery and associate vice chair of Education in Diversity, Equity and Inclusion. To continue to expand our focus on diversity, equity and inclusion within our talented team, Dr. Wright has been named the vice chair of Diversity, Equity and Inclusion for FY-22. Dr. Wright is looking forward to sharing her experiences, mentoring aspiring minority and female physicians, and working with the faculty, residents and staff to create a more inclusive and equitable environment in the department and at MUSC.

Nurturing our Body and Souls

Andrea Abbott, M.D. MSCR has been a champion of wellbeing for our residents and fellows. Under her leadership, new initiatives in wellness improved resident and fellow satisfaction scores. Based on the successful resident programming and realizing we need to take care of ourselves to be able to take care of others, Dr. Abbott has been named the new vice chair of Personal Development and Well-being with the goal of increasing wellness and reducing faculty burnout.

Developing the Next Generation of Surgical  Leaders

As we continue to expand our surgical care team, providing a foundation for successful leadership development and mentorship is paramount. David Mahvi, M.D. was named the vice chair of Faculty Development. In his new role, he will lead the charge of programmatic development for leadership and mentorship, providing a strong foundation for our faculty to become nationally-recognized surgical leaders. The initial process will be a department wide Peer-to-Peer Mentoring program. Faculty will be paired with other faculty outside their divisions. Our hope is that this gives our surgeons another outlet for both mentoring and being mentored with a focus on clinical outcomes.

Our vision in the Department of Surgery is to create a dedicated center for surgical innovation that aims to improve patient outcomes and healthcare efficiencies.

That vision came to fruition thanks to a generous philanthropic gift from Brigadier General Harvey W. Schiller, USAF Ret., Ph.D., and his wife, Marcia, and the leadership of cardiothoracic surgeon Arman Kilic, M.D., an internationally recognized expert on Artificial Intelligence (AI) and machine learning (ML).Clinically, Kilic serves MUSC Health as Surgical Director of Heart Transplant and Heart Failure, and leads the Cardiogenic Shock Team.

Now, in his new role, Kilic will direct the Harvey and Marcia Schiller Surgical Innovation Center. The center will serve as an incubator, centralizing and facilitating collaboration between clinical experts, AI/ML experts, software engineers, clinical trialists, and innovation teams. Kilic is well equipped to lead the charge. He has 20 years of experience in risk modeling, advanced analytics, and using large multi-center data registries. He serves on the national Society of Thoracic Surgeons AI/ML Task Force, and has received funding from the National Institutes of Health and Thoracic Surgery Foundation for his work on AI in cardiac surgery. 

This centralized center will streamline the process of advancing data science and translate these advancements to academic funding and dissemination and commercial products that can have immediate impact on patientcare and healthcare delivery. It will include three pillars: surgical AI, investigator-initiated clinical trials, and human-centered design. Having these pillars in one centralized location and in close physical proximity will allow for internal collaboration, streamlining of projects, and shared resources and expertise. A major focus of the center will be in harnessing the massive quantities of healthcare data to develop predictive models that can be used for individualized patient care and for supporting clinical decision-making.

The center will also focus on developing algorithms that can accurately and in an automated fashion interpret imaging studies, and using AI/ML and natural language processing to accurately and rapidly extract data from the electronic health record. The impact will be to facilitate the creation of both personalized treatment plans and usable and innovative products that make healthcare better and more efficient. It will transform how surgery is performed, improve clinical care, and decrease costs for patients not only in South Carolina but across the United States.

As we pave the path forward towards the next era of surgical innovation, the division of research is poised to lead the charge. We are translating the latest developments, understanding and technology into improved surgical patient care resulting in shorter stays, enhanced post-operative quality of life and reduced overall healthcare cost to both patients and stakeholders.

The Department of Surgery had a very productive year. In FY21 our portfolio reached over $7 million in extramural funding, maintaining the significant increase we have seen year over year.

Human Centered Design Expands

The Human-Centered Design (HCD) Program led by David Mahvi, M.D., Michael Yost, Ph.D. and Joshua Kim, MS has been training surgical residents and medical students in design thinking, equipping them with the skillsets and tools to become medical innovators. Participants in the HCD program have worked on a variety of innovation projects since the program’s inception in the fall of 2019 and have recently created a medical device startup, Heartbeat Technologies, which is focused on improving CPR outcomes through the use of an innovative CPR adjunct device called The SAVER. The HCD Team won first place in the SC Innovates Competition and won an MUSC High Impact, High Innovation Award for The SAVER device. Recent partnerships and growth have connected the HCD team with Oklahoma State University and The Citadel. The Oklahoma State University collaboration saw a team of industrial design engineers work with Mahvi and Kim on creating solutions for improving operation room scheduling for the MUSC Department of Surgery. Collaborations with the Citadel involved working with the Baker School of Business Innovation Lab students, building a strong connection between business management andmedical innovation. Through collaboration with the Baker School of Business, the HCD Program, now an integral part of the Harvey and Marcia Schiller Surgical Innovation Center, aims to seamlessly integrate business development into the innovation workflow at MUSC.

Novel Molecule Protects and Repairs Cell Membranes on a Molecular Level

The Trauma and Acute Care Surgery Laboratory, led by Michael Yost, Ph.D., has developed a novel bioactive polymer that protects and repairs cell membranes on a molecular scale. Yost is working with colleagues across the state of South Carolina through the MADE in SC project sponsored by the National Science Foundation. They have simulated the polymer interaction with cell membranes using the super computer at Clemson University and collaborating with faculty and students at Furman University. This novel molecule has indications inburns, radiation exposure and ischemia reperfusion injury.

Investigating the Pathogenesis of Aortic Disease

The Cardiovascular Surgery Laboratory, led by Jeffrey Jones, Ph.D., is primarily focused on understanding the pathogenesis of aortic disease. Dr. Jones’ work has been directed toward understanding the roles played by various cell-types present in the thoracic aorta. It is generally understood that changes in cell behavior alter cellular responses to changes in general health, such as inflammation and high blood pressure. These changes in behavior cause the cells to produce harmful products that alter the structure of the vessel and lead to disease. The goal is to understand the signaling pathways that drive these changes and develop methods to correct them that can be used therapeutically to treat patients with aneurysms. Jean Marie Ruddy, M.D. and her team study similar types of responses and pathways within the abdominal aorta. Her studies are primarily directed toward interrupting the recruitment of specific blood cells to the dilated aortic wall. These blood cells play a critical role in changing the aortic structure and resident cellular function. The lab members maintain strong collaborations outside the laboratory and through collectively sharing their knowledge and experience, in the hopes to be able to translate their basic science discoveries into clinical strategies that address important clinical problems.

Research Drives Cures

Our scientists are at the forefront of cellular therapy research.

HONGJUN WANG, PH.D. RECEIVES $6.4 M IN NIH GRANTS FOR DIABETES RESEARCH

After a very promising first year of a clinical trial to study a therapeutic mesenchymal stem cell (MSC) infusion for treatment of type 1 diabetes, researcher Hongjun Wang, Ph.D., professor of Surgery and Center for Cellular Therapy (CCT) co-scientific director of Islet Processing and Stem Cell Therapy Programs, received full NIH renewal of the initial, contingent grant in April 2021, with an additional $3.2 million awarded for five more years. Wang, her clinical co-investigator Charlie Strange, M.D., and their teams have built an interlinked collaboration that allowed them to surpass the NIH’s enrollment requirements for a full grant extension. The full study will enroll 50 patients with newly diagnosed type 1 diabetes. Wang’s hope is that the treatment will not only stop the immune attack of the pancreas that occurs with diabetes but also prevent the remaining cells from death, and potentially even regenerate cells. With these goals in mind, it is essential to intervene early after diagnosis to give the organ the best chance for healing, so the study is recruiting type 1 diabetes patients within three months of diagnosis. In addition, in FY 22, Hongjun Wang, Ph.D., Katy Morgan, M.D., Charlie Strange, M.D., William Lancaster, M.D., and Gary Gilkeson, M.D. were awarded a $3.2M grant by the NIDDK to enroll 42 chronic pancreatitis patients to assess the safety and efficacy of autologous bone marrow mesenchymal stromal cells and islet co-transplantation in chronic pancreatitis patients.

RESEARCH AIMS TO MAKE CAR-T-CELL THERAPY SAFER AND MORE EFFECTIVE

A new project led by Shikhar Mehrotra, Ph.D., co-scientific director of the CCT Oncology and Immunotherapy Programs, and Hollings hematologist and oncologist Brian Hess, M.D. could significantly decrease the side effects associated with CAR-T-cell therapy and make the treatment available to more patients who could benefit. The project involves manufacturing a “purified” version of the CAR-T-cells currently used to treat patients with certain types of lymphoma and leukemia to reduce the side effects associated with treatment and potentially make the treatment more effective. The therapy will be given to patients as part of a clinical trial, including lymphoma and leukemia patients who don’t currently have approval from the Food and Drug Administration to receive CAR-T-cells.

Our trainees work side-by-side with nationally recognized experts, preparing for their future. As a leader in academic medicine, MUSC Health's overall growth and expansion provides increased resident rotation opportunities with greater exposure to community hospitals. This experience, aligned with the department's unprecedented growth in cutting-edge clinical and research expertise, provides a depth of training unparalleled in many academic medical centers.

This year, the division launched the Future Surgical Leaders Program, a first-of-its-kind surgical residency training program in the U.S. The program will measure both short and long-term outcomes and provide immediate feedback to the trainees. The innovative program aims to have sweeping downstream effects, including improved patient satisfaction and reduced medical malpractice claims. All trainees at the end of the program with a 75% attendance will be awarded a certificate of completion.

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Jon van Heerden, M.D. is an internationally known endocrine surgeon, educator and researcher. He retired in 2004 from the Mayo Clinic in Rochester, MN, where he was on faculty for nearly 40 years. During his tenure at Mayo, he trained hundreds of residents in both endocrine and general surgery. Known for his meticulous and compassionate patient care, the Mayo Clinic recognized his contributions to both resident education and surgical excellence with the creation of the Jon A. van Heerden Award, presented annually to an outstanding clinical resident in general surgery who renders the most meticulous patient care.

In 2004, the American Association of Endocrine Surgeons honored Dr. van Heerden for his contributions to academic medicine with the prestigious Oliver Cope Meritorious Achievement Award, a lifetime achievement award. Only ten such awards have been given in the past forty years.

His legendary reputation followed him when he retired to South Carolina in 2004. Within a few days of settling into his new home on Seabrook Island, Dr. van Heerden was invited to dinner by Fred Crawford, M.D., who was the chairman of the Department of Surgery. In attendance were David J. Cole, M.D. and David B. Adams, M.D. At the dinner, Dr. Crawford asked Dr. van Heerden to join the MUSC Department of Surgery to teach endocrine surgery to residents. He gladly joined on and eventually became the vice chair of Education.

“When Dr. Cole became chairman of the department, he created a vice chair of Education position and asked me to lead the new division,” said Dr. van Heerden. “And, with the guidance of Dr. Cole, the Curtis P. Artz MUSC Surgical Society was revitalized, providing greater opportunities for our graduates to network and build camaraderie.” During his tenure, Dr. van Heerden, in conjunction with Thomas Brothers, M.D. was instrumental in establishing Surgery Research Recognition Day, and he served for ten years as associate director of the Postgraduate Course in Surgery, led by Dr. Adams. In recognition of Dr. van Heerden's contributions to academic surgery and the Postgraduate Course in Surgery, the van Heerden Lecture leads the three-day conference.

When Dr. van Heerden stepped down from the vice chair position, Dr. Cole asked him to continue to teach and mentor trainees. He currently serves as an adjunct professor, teaching medical students rotation on their surgery clerkship. “We are so fortunate to have Dr. van Heerden actively engaged in our educational programs,” said Prabhakar Baliga, M.D., current chair of the Department of Surgery. “His educational impact goes far beyond surgery in ensuring that the next generation has the appropriate life values of patient centeredness, faith, humility and gratitude. He has been my personal role model for the last two decades.”

For Dr. van Heerden, the offer to teach and mentor MUSC surgical learners made so many years ago at that fateful dinner has enriched his life in more ways than he could have imagined and inspires him to give back. His years of service to educating the next generation of surgeons at MUSC has provided him an opportunity to live a purposeful life in retirement.      

“I am deeply grateful to Drs. Crawford, Cole, Adams, and Baliga for their mentorship and friendship over the years,” said Dr. van Heerden. “These leaders in the department gave me the opportunity for mental stimulation and a sense of purpose.”

This year, Dr. van Heerden gave his largest gift ever – to any institution or organization – with the creation of The Jon van Heerden Fund for General Surgery Loupes.

“I’ve always had a giving nature,” he said. “I like to pay it forward and by establishing the fund for surgical loupes, it is a tangible way of paying it forward.” He sees the daily struggle many residents face today with financing their surgical education. “I like to invest in the next generation,” he adds. “After all,  they are us in a very short time and if I can lighten their burden along the way, then I am happy to do so.”

Ravi Veeraswamy, M.D. was named the inaugural chair-holder of the Elliott-Robison Endowed Chair in Vascular Surgery. An endowed chair is the highest academic award that the University can bestow on a faculty member, and it lasts as long as the University exists. Thus, it is an honor to the recipient, a legacy for those for whom the Chair is named, and an enduring tribute to the donors who helped establish it.

Dr. Veeraswamy is Professor of Surgery and Chief in the Division of Vascular Surgery, where he leads a talented surgical team at one of the highest volume aortic centers in the country.  The division of vascular surgery is deeply committed to improving patient care through surgical innovation and discovery.

“In academic medicine, it is exceptionally challenging to find resources to support our scientific endeavors,” said Dr. Veeraswamy. “Philanthropic gifts such as Endowed Chairs significantly enable us to advance  medicine and ultimately improve patient’s lives.”  

The division currently has several research projects that are supported by the endowment. “We are using artificial intelligence to help identify patients at risk of stoke from their carotid arteries. In addition, we are exploring ways to identify patients with peripheral arterial disease much earlier in their disease process so we can help save their limbs from being amputated,” explained Dr. Veeraswamy. “These are significant public health issues in South Carolina that ultimately not only affects the individual patient, but the ability of our state to compete economically by having an able and capable workforce.”

It is through the generous philanthropic donors that support the endowment that make the future of vascular surgery at MUSC bright. A future only made possible by the strong foundation built on the vision of vascular surgeons Bruce Elliott, M.D. and Jacob “Jay” Robison, M.D. whose combined 60+ years of dedicated service to MUSC laid the groundwork for the division that exists today. Working together with a vision to bring modern vascular surgery to MUSC, they built a nationally recognized Division of Vascular Surgery and were instrumental in the creation of the country’s first RRC accredited integrated vascular residency programs. “When I joined MUSC, it was already a high-functioning, high-quality program,” he said. “It allowed me to take the baton and run with it. As we continue to build on this strong foundation, philanthropy is a critical part of our growth.”

The Elliott-Robison Endowed Chair in Vascular Surgery was created with generous support from the Joukowsky Family Foundation, the Department of Surgery, members of the MUSC Heart and Vascular Board of Directors, grateful patients, and MUSC faculty including Dr. Elliott and Dr. Robison.

To all the donors who support the Endowed Chair, Dr. Veeraswamy expresses deep gratitude. “Our promise to you is to give you the best return on your investment through good stewardship and improved patient care.”

Countless trainees have benefited from his wise advice over the past fifty years.

For more than fifty years, H. Biemann Othersen Jr., M.D. has been recognized as one of the most respected and loved physicians in South Carolina. A native of Charleston, Dr. Othersen earned his medical degree from the Medical College of South Carolina in 1953 and spent the next 12 years pursuing his post-graduate surgical training at Philadelphia General Hospital, the University of Pennsylvania, the Medical College of South Carolina, the Children's Hospital in Columbus, Ohio, and Massachusetts General Hospital. During this time, he also served two years in the U.S. Navy.

When he began his pediatric fellowship program in 1962 at the Children’s Hospital in Columbus, Ohio,  his wife, Janelle, who was a nurse on the pediatric ward, noticed many children could not pronounce his last name. She suggested he introduce himself as Dr. Bee (shortened for Biemann) and created a colorful emblem of a bee for his white coat. They found the emblem along with Dr. Othersen’s warm and friendly mannerism helped set the children at ease and aided in effective communications with their families.

In 1965, Dr. Othersen joined the faculty of the Medical University of South Carolina to serve as an assistant professor of surgery and as the university's first chief of pediatric surgery. At the time, he was the first pediatric surgeon in South Carolina and one of the first in the entire Southeast. One of his roles at MUSC was to run the medical orientation program, where he included information on the value of effective communications – and more importantly – the value of listening. From 1962 – 2005, the seed for a resident-training session to aid in communications with children and their families was planted and took roots. 

By 2005, Dr. Othersen started running thought-provoking weekly sessions to discuss journal articles with residents on their pediatric surgery rotation. The articles focused on effective communications for medical providers. These sessions were affectionately dubbed the Bee Hive Sessions. “Most communications is non-verbal,” said Othersen. “In these sessions we talk about three important things to do when entering a hospital room: introduce yourself with a smile, wash your hands, and sit down to meet the patient at their eye level. The sitting part is so important. To the patient, you are telling them that the time you have right now is exclusively theirs. You are more present.”

Othersen, who was 75 at the time, had partners in their 40’s and was educating young residents. He realized generational differences led to different learning styles and many residents preferred on line learning. A website was built to host the articles and provide for shared resources, which is still used to this day.

Countless residents have benefited from Dr. Othersen’s Bee Hive Sessions. Surgical alumna Vivian Jolley Bea, M.D., Section Chief of Breast Surgical Oncology at Weill – Cornell Medicine, said “During my fellowship in breast surgical oncology at the University of Texas MD Anderson Cancer Center, I quickly realized the first few years of surgical education is so important. One of the lessons I learned very early on was from Dr. Othersen's Bee Hive Session. He would ask us "When you go into a patient’s room, what do you do?" He would then instruct us: "You introduce yourself, you wash your hands, and you sit and listen to your patient."

"This simple act that Dr. Othersen teaches during his Bee Hive Sessions instills compassion in his trainees," comments Bea. "It is the foundation of the excellent patient care was recognized for during my fellowship, and continues with me every day in my surgical practice."

The Bee Hive Sessions have become so well known throughout the academic surgical community for their value in resident education that Dr. Othersen presented on the evolution of the Bee Hive Session during the 2021 Halsted Society Meeting. Now fully retired from academic medicine, the nonagenarian added a slide to his presentation: Dr. Bee’s Retirement Rules: Bee Prepared, Bee Kind, Bee Busy, Bee Active, Bee Appreciative and Bee Happy.

In the end, he says it’s the little things that count.

In addition to his weekly Bee Hive Sessions, Dr. Othersen continues to serve as Chairman of the Curtis P. Artz MUSC Surgical Society.

BETTER ACCESS IMPROVES PATIENT CARE AND REDUCES DISPARITIES

Transplant patients – many of whom are in end-stageorgan failure – no longer need to travel to Charlestonfor evaluation and post-transplant care. Our expandedTelehealth services and outpatient satellite clinic locationsthroughout the state now can accommodate mosttransplant patients for both pre- and post- transplantcare. The clinics are staffed by our advanced practiceproviders who are embedded in the community as wellas our clinical faculty. We also have strong relationshipswith our community partners who can perform the pretransplant With clinics in the upstate, the midlands, Florence,Myrtle Beach and Murrell’s Inlet, our local high-qualityaccess helps provide patients a better quality of life.For patients where local clinics are not available, wehave expanded our Telehealth services which affordstremendous benefits for patients undergoing atransplant evaluation so when the in-person visit occurs,it is a purposeful and efficient process. Now patientswho would otherwise have barriers to access, includingunderserved populations, have a more seamless andefficient transplant experience.process.

FIRST IN STATE: EXPANDING TREATMENT OPTIONS FORCHOLANGIOCARCINOMA PATIENTS

Liver transplant surgeon Jared White, M.D. collaborated with a multidisciplinary team of at the Hollings Cancer Center toperform the first liver transplant for unresectable cholangiocarcinoma in the state of South Carolina. Cholangiocarcinomais a rare, malignant tumor of the biliary system that can cause jaundice and liver dysfunction. Treatment optionsare often limited with low rates for surgical cure and a high rate for morbidity and mortality. Using a combination ofneoadjuvant chemoradiation therapy followed by liver transplantation, our highly specialized multi-disciplinary team canoffer an opportunity for a curative treatment in well-selected patients with unresectablecholangiocarcinoma.

VIRTUAL CROSSMATCHING IMPROVES QUALITYOF LIFE FOR KIDNEY TRANSPLANT PATIENTS

Virtual antibody crossmatching is a safe and efficient way of selecting kidneytransplant recipients. Two years after implementing the process, the MedicalUniversity of South Carolina division of transplant surgery concluded that thetechnique was just as accurate and sensitive as physical crossmatch, the currentgold standard, and much quicker. Virtual crossmatching reduced the timekidneys were kept on ice while awaiting identification of a suitable recipient,improved scheduling for surgeons and operating room staff, and alleviatedemotional and logistical stress on patients who were called to the hospital onlyto be sent home hours later after a more suitable recipient was identified.

Transplant surgeon Vinayak Rohan, M.D. is the lead author and DavidTaber, Pharm. D. is senior author, in collaboration with Omar Moussa, Ph.D.on the study of the virtual crossmatching process and its effects on clinicaland surgical practice outcomes that appeared in the Journal of the AmericanCollege of Surgeons. The study is a before-and-after comparison of patientoutcomes two years after the transplant surgery team implemented virtualcrossmatching. Standard measures of clinical quality were the same in bothgroups. The incidence of delayed graft function was 19% before and 17%after implementation; graft failure within a year was 4% before and 3% after;mortality within a year was 2% before and 1% after. The study also found thetime a donated organ is kept on ice for long-distance donor organs decreasedby 2.4 hours, and delayed graft function declined by 26%. Importantly, despite ahighly sensitized population, there were no hyperacute rejections. Additionally,the ability to schedule the operation even before the organ arrives provides animprovement to the surgeons' quality of life.

The Division of Hepato-Pancreato-Biliary (HPB) Surgery serves as a center of excellence with a focus on advancing innovation in care for all conditions of the pancreas, liver, and biliary system.

With telehealth and clinic expansion in Nexton, Myrtle Beach and Beaufort, the new division provides greater opportunity for our patients to have seamless access to care. HPB surgeons work with multidisciplinary teams at the Hollings Cancer Center in the treatment of cancers of the liver, stomach, bile duct, and pancreas and are nationally-recognized experts in the treatment of pancreatitis. 

FIRST IN LOWCOUNTRY TO PERFORM ROBOTIC WHIPPLE PROCEDURE

The Whipple Procedure, a highly complex surgery performed predominantly for pancreatic cancer patients, is typically done through a traditional open surgery. A leader in pancreatic surgery, Katy Morgan, M.D. has a high level of expertise in performing the traditional Whipple Procedure. Now, after intensive training on the da Vinci robot, she is the first pancreatic surgeon in the Lowcountry to perform the Whipple Procedure robotically. The robot provides the surgeon with more degrees of rotational freedom, rotating and bending beyond the capabilities of a human hand. And, the robot technology provides more precise movement, allowing for dissecting and sewing in tight areas. With the least invasive, more precise surgery, patients not only have faster recoveries, they have better outcomes. For cancer patients, they can now move more quickly to other treatments they may need.

IMPROVING CARE FOR PATIENTS WITH LIVER DISEASE

Surgery is often the best treatment for primary liver cancer when it's at an early stage and hasn't spread to nearby blood vessels. Traditionally, the surgery involves an open procedure with substantial morbidity. At MUSC Health, HPB fellowship-trained surgeon William Lancaster, M.D.is the first in the state to perform a robotic liver resection for the treatment of cancer. The expanded capabilities of the da Vinci Surgical System (robot) allow for decreased morbidity and a quicker recovery than traditional open surgery, providing an opportunity for patients to begin their postoperative chemotherapy sooner. Most secondary liver cancers start in the colon and rectum. Approximately 20 to 30 percent of patients with colorectal metastasis have disease confined to the liver, and this can be managed with surgery. Working with a multidisciplinary team at the Hollings Cancer Center and in collaboration with our colorectal surgeons, our HPB surgeons offer simultaneous colectomy and hepatectomy both robotically and open surgery. The simultaneous procedure allows the patient to have one operation versus two, reducing risk and improving recovery time.

LEADERS IN ISLET CELL TRANSPLANTATION FOR THE TREATMENT OF CHRONIC PANCREATITIS

For patients with chronic pancreatitis, islet cell auto-transplantation in combination with complete pancreatectomy treats the intense pain that coincides with the condition, but without the likelihood of developing diabetes that would occur with removal of the pancreas alone. With an islet cell transplant, a patient’s own islet cells are extracted from their pancreas and transplanted into their liver to continuously provide blood glucose regulatory function. MUSC surgeons have performed more than 275 islet cell transplant procedures since the program’s inception in 2009. The high volume islet cell transplantation is ranked the number 2 islet cell transplant program in the world by case load. Program clinical director Katy Morgan, M.D., and her partner David Adams, M.D., who has since retired, started the program over12 years ago, and since then have been joined by William Lancaster, M.D. Between Morgan and Lancaster, MUSC Health performs between 20 and 25of these surgeries per year. The multidisciplinary team that cares for patients undergoing islet transplantation includes Kelsey Cook, RN, nurse coordinator, Stephanie Owczarski, PA-C, patient care coordinator, as well as dieticians, interventional radiologists and therapeutic gastroenterologists.

MOVING NOVEL THERAPEUTICS FROM BENCH TO BEDSIDE

Hongjun Wang, Ph.D. is a nationally-recognized research scientist with an expertise in islet cell transplantation and cellular therapy. Her lab focuses on bench to bedside translational research for the prevention and treatment of diabetes and chronic pancreatitis. Major problems associated with islet cell transplantation are poor islet engraftment and survival after intraportal infusion. Because of these issues, only less than 30% of the non-diabetic chronic pancreatitis patients remain insulin-independent after surgery. Currently, interventional protocols to increase the survival of the islet graft following transplantation are empiric. The ongoing projects in the Islet Cell Transplantation Lab led by Dr. Hongjun Wang are focused on solving these problems. Working closely with surgeon-scientists Katy Morgan, M.D. and William Lancaster, M.D., and building on the strong foundation of the islet cell transplantation program built by David B. Adams, M.D., Wang and her research team are developing interventional procedures to improve islet yield quantity and quality in order to prevent onset of surgical diabetes after TP-IAT in patients with chronic pancreatitis. In FY 22, they are awarded a 3.2M grant by the NIDDK to enroll 42 chronic pancreatitis patients to assess the safety and efficacy of autologous bone marrow mesenchymal stromal cells and islet co-transplantation in TP-IAT patients.

In the division of Cardiothoracic Surgery, our nationally-recognized surgeons provide care to diagnose and treat cardiac and thoracic patients, working with colleagues in cardiology and vascular surgery to develop innovative strategies resulting in the highest level of complex care with the least invasive procedures. In 2020, Lucas Witer, M.D. and Nicolas Pope, M.D. joined our adult cardiothoracic surgery team and T. Konrad Rajab, M.D. joined the pediatric cardiac surgery team. This spring, Arman Kilic, M.D. joined as the surgical director of the Heart Transplant and Heart Failure Program and Z.A. Hashmi. M.D. joined the cardiothoracic surgery team. Most recently, Ian Bostock, M.D. MS joined our thoracic surgery team.

GROWTH IN EXPERTISE PROVIDES BETTER ACCESSTO COMPLEX CARDIAC AND THORACIC CARE

The multidisciplinary and highly-specialized adult cardiothoracic team performs aortic arch repair, robotic and transcatheter valve repairs and replacements, robotic lung and esophageal resections, robotic heart surgery, heart transplants and minimally invasive procedures for placement of mechanical circulatory assist devices. With the addition of four fellowship-trained adult cardiothoracic surgeons in FY21, the adult cardiac surgery volume grew 16% and our heart transplant program grew by 33%.MUSC Health is now the market leader in adult heart surgery for South Carolina. The statewide market has grown from FY17 to FY20 at a compound annual growth rate of 2%.

MORE DATA, BETTER OUTCOMESFOR CVICU PATIENTS

Sanford Zeigler, M.D., medical director for the Cardiovascular Intensive Care Unit (CVICU),is the Principal Investigator of a clinical study with Etiometry that will give our cardiac ICU doctors more data to support better decision making. The program is a continuous data visualization system that utilizes predictive analytics and artificial intelligence to help provide early warnings of unfavorable trends. Etiometry is a leader in clinical decision-support software for the intensive care environment and the MUSC Health CV ICU is among Etiometry’s first adult intensive care partners in the U.S.

NEW APPROACH TO PEDIATRIC HEARTVALVES GARNERS AWARDS

Pediatric Cardiac Surgeon T. Konrad Rajab, M.D. received the American Association for Thoracic Surgery Foundation Surgical Investigator Award. Rajab works with residents Brielle Gerry, M.D. and Jennie Kwon, M.D. on a project entitled “Partial Heart Transplantation: A New Approach to Deliver Growing Heart Valve Implants.” Partial heart transplantationinvolves transplantation of a heart valve only, which will grow with recipient babies similar to conventional heart transplants or Ross pulmonary autografts. If successful, this new type of transplant will deliver the first growing heart valve implant. Additionally, the transplanted valve will have the ability to self-repair and avoid thrombogenesis. His research also garnered the Darby Children’s Research Institute Pilot Grant Award, the South Carolina Clinical & Translational Research Institute High Innovation High Reward project grant, a VentureWell E-Team grant, a grant from the Emerson Rose Heart Foundation, philanthropy from Senator Paul Campbell, and the "I am an MUSC Innovator" Award.

SPOTLIGHT ON: BARRY GIBNEY, D.O.

Thoracic surgeon Barry Gibney, D.O. treats lung and esophageal cancers with a multidisciplinary team at the Hollings Cancer Center (HCC), the only NCI designated cancer institute in South Carolina. Additionally, he cares for end-stage lung disease patients as part ofa multidisciplinary lung transplant team at MUSC Health. With expertise in robotic and minimally invasive procedures, he has performed the first robotic sleeve lobectomy in the state – a complex cancer resection and reconstruction. For the past year, Dr. Gibney has been the sole thoracic surgeon in the division in a herculean effort to provide care to South Carolinians suffering from thoracic malignancies and end-stage lung disease. This year has seen the development of one of the highest volume robotic thoracic programs in the region, in addition tothe most lung transplants completed at MUSC Health in a year. He credits the success of the past year to the multidisciplinary teams in transplant and oncology, with a special note to the division’s dedicated Advanced Practice Providers, Margaret Ramsden, NP and Larisa Diffley, PA-C. With thoracic surgeon Ian Bostock, M.D., MS joining the team and plans to hire a section head in the near future, our thoracic oncology and lung transplant programs continue to grow, thanks in large part to Dr. Gibney.

DR. KILIC LEADS NEW CARDIOGENIC SHOCK TEAM

A new team at MUSC Health, led by cardiothoracic surgeon Arman Kilic, M.D., aims to help more people across the state survive cardiogenic shock– a life-threatening condition. Cardiogenic shock happens when the heart can’t pump enough blood to the organs. For decades, the rate of death has remained unchanged; about half of cardiogenic shock patients die. In recent years, heart doctors across the country have sought to standardize care and improve outcomes. The National Cardiogenic Shock Initiative, based in Detroit, announced trial results in April showing that doctors in 80 participating hospitals increased survival rates to 71%. Doctors at MUSC Health are hopeful that similar outcomes can be achieved in South Carolina.

CHILDREN'S HEART PROGRAM AMONG THEBEST IN THE U.S.

MUSC Children’s Heart Center has once again been recognized by U.S. News &World Report, ranking children’s cardiology and heart surgery 12th in the country. The Heart Center is led by Scott Bradley, M.D., section head for Pediatric Cardiac Surgery, and Eric Graham, M.D., chief of Pediatric Cardiology. Pediatric and congenital heart surgeon, Minoo Kavarana, M.D., serves MUSC Health as the surgical director of Pediatric Heart Transplantation and Mechanical Support. He has worked side-by-side with Bradley and the multidisciplinary team for more than ten years. This year, with the addition of pediatric cardiac surgeon T. Konrad Rajab, M.D. and the opening of the new state-of-the art children’s hospital, the pediatric cardiac team was able to care for more children in need of critical heart surgeries.

Surgeons in the Division of General, Acute Care, Trauma and Burn Surgery offer a full spectrum of highly specialized care using the least invasive procedures for both elective and emergent surgeries. This year, our General, Acute Care and Burn Surgeries saw a dramatic rise in surgical volume, with significantly more robotic and innovative burn surgeries.

ADVANCED TECHNOLOGY FOR COMPLEX BURNS

The South Carolina Burn Center serves as a regional referral center, offering leading-edge treatments using state of the art equipment, techniques and technologies. Nationally known researcher Steven Kahn, M.D., chief of Burn Surgery, leads the talented team of burn care specialists to provide comprehensive care for adults and children. The center recently hired burn surgeon Deepak Ozhathil, M.D., who completed fellowship training at the University of Texas Medical Branch and Shriners Children’s Texas. This year, the center made an important leap forward as the first U.S. center reported to successfully use a novel combination of two revolutionary products in a minimally invasive skin graft procedure. Patients undergoing treatment using Nexobrid® (an enzyme to remove burn wounds) and Recell® (a skin cell spray) together are less likely to need a skin graft. And, if they do need a graft, it’s about a third of the size. The less invasive treatment reduces risks of complications, and patients recover quicker with less pain and scarring. The burn program also opened a comprehensive laser scar management program for pediatric and adult burn survivors. A unique, advanced laser is used to deliver immunomodulator medications that thin out scars, make them less noticeable, improve range of motion, and decrease symptoms - such as pain and itch, dramatically improving quality of life after injury.

ROBOTIC SURGERY FOR EMERGENT CASES

The partnership with Intuitive Surgical and five new state-of-the-art da Vinci XI robots created opportunities to expand robotic access for emergency cases 24/7. Spearheaded by Bruce Crookes, M.D., launching the robotics program for emergency and trauma surgery at MUSC Health involved gaining institutional support, training surgical team members and staff, and collaborating with the Intuitive representative to provide quick acceleration. Crookes, along with his partners Stephen Fann, M.D. and  Heather Evans, M.D., MS, were able to get the program up and running within a short period of time. No longer reserved for elective surgery, the team is using robotic surgery for emergency cases to provide better care with reduced pain, quicker recovery, and less time in the hospital. In a busy Level 1 Trauma Center, shorter stays not only provide a cost saving to the patient, it also frees up space for another patient in need of care. In addition to improved patient care and reduced costs, our surgical residents and critical care fellows are gaining experience with the robot in emergent cases.

REGIONALLY RECOGNIZED RIB CLINIC

Evert Eriksson, M.D., trauma medical director and expert on chest wall injuries, leads the Rib Fracture Clinic at MUSC Health. The clinic treats patients suffering from chronic rib pain, including slipped ribs and non-healing ribs. The multidisciplinary team provides a complete continuum of care, offering diagnostics, testing and treatment options, including pain management, physical therapy and a highly-innovative rib fixation surgery. The new rib fixation technology uses a titanium plate and minimally invasive techniques to enable rib stabilization, leading to better respiration, lower rates of ventilator usage, decreased length of stay in the ICU and, ultimately, a return to normal activities. Recognized for surgical excellence in rib fixation throughout the Southeast, this year the clinic visits grew by 320% and referrals have come from as far away as NY, Texas and Indiana. Improving access to care, 58% of visits were performed via telemedicine .A renowned researcher in chest wall injuries, Eriksson serves on the national research committee for the Chest Wall Injury Society and was the MUSC Health Principal Investigator on a multi-centered clinical trial for rib fixation.

VIOLENCE INTERVENTION PROGRAM AIMS TO BREAK THE CYCLE AND PROMOTE RECOVERY

South Carolina has the 4th highest rate of firearm homicide in the United States, and for every individual that dies from a firearm assault, another 4-5 survive. Survivors of firearm injuries are not only likely to face adverse psychological, health and social outcomes, they are more likely to experience ongoing violence. The new MUSC Turning the Tide Violence Intervention Program, spearheaded by trauma surgeon Ashley Hink, M.D. MPH, is the first hospital-based violence intervention program in South Carolina that provides direct services through intensive support, mentorship, case management and community outreach to reduce risks of violence and promote recovery for victims and their families. Hink, an expert on firearm injuries and violence, leads a dedicated staff of violence intervention advocates who serve as a support system that extends beyond the patient’s care at MUSC. The new program serves youths and young adult victims of primarily community firearm violence.

“Transitioning into my clinical role was the relatively easy part of becoming a new faculty member. Being a public health researcher with a focus on firearm violence and implementing violence prevention programs - in South Carolina - is an incredible challenge, but also phenomenally rewarding. Having the support from the MUSC Department of Surgery has been vital to successfully take on the challenge and provoke meaningful change for our hospital, patients and community.”

-Ashley Hink, M.D., MPH, Assistant Professor General Surgery Residency, class of 2018