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Notable Grand Rounds

These assembled papers are edited transcripts of didactic lectures given by mainly senior residents, but also some distinguished attending and guests, at the Grand Rounds of the Michael and Marian Ilitch Department of Surgery at the Wayne State University School of Medicine.

Every week, approximately 50 faculty attending surgeons and surgical residents meet to conduct postmortems on cases that did not go well. That “Mortality and Morbidity” conference is followed immediately by Grand Rounds.

This collection is not intended as a scholarly journal, but in a significant way, it is a peer-reviewed publication by virtue of the fact that every presentation is examined in great detail by those 50 or so surgeons.

It serves to honor the presenters for their effort, to potentially serve as first draft for an article for submission to a medical journal, to let residents and potential residents see the high standard achieved by their peers and expected of them, and by no means least, to contribute to better patient care.

— David Edelman, M.D.

Surgical GI Endoscopy:
52 Years of Experience in the USA

Choichi Sugawa, MD, PhD, FACS, FASA, FASGE, FJGES
Professor Emeritus
Wayne State University
Dr. Sugawa describes and reflects upon his distinguished career in surgical endoscopy, a field in which he was one of the original and leading pioneers.

Legendary Recollections

Anna Ledgerwood, MD, FACS
Professor of Surgery
Wayne State University
Dr. Ledgerwood, a legend in her own right, acknowledges some of the contributions and recounts some of her experiences with the legendary Dr. Choichi Sugawa.

Overcoming Challenges in Surgical Training

David R. Farley, MD
Emeritus Professor of Surgery
Mayo Clinic College of Medicine and Science
What are the main challenges of surgical training and how we can counteract them in the midst of a perfect storm of pressure to make money for the institution, the growing complexity of surgery…

Global Surgery

Todd Lavery, MD, FACS
This paper seeks to elucidate the need globally for surgical care, to describe the challenge of getting global surgery accepted as an essential component of the global health conversation.

The Changing Face of Oncology: Modern Skill Sets for the Cancer Surgeon and Changing Scientific Paradigms

Donald W. Weaver, MD
Pemberthy Professor of Surgery and
Chair of the Department of Surgery
Wayne State University School of Medicine
The overall objective is to show how and why surgery and especially surgical oncology is changing. This paper looks at where surgery is going and where it’s been.

The Wonderful World of Calcium

Charles Lucas, MD
Professor of Surgery
Wayne State University School of Medicine
Calcium (Ca) is the most common element in the body. It is present primarily in bone. Non-skeletal ionized Ca (38%) is free, while protein-bound Ca accounts for 50% of the total.

Medical Malpractice for the Surgeon

John Webber, MD
Professor of Surgery
Wayne State University School of Medicine
This paper discusses medical malpractice as it relates to surgeons and what surgeons should know about it, especially residents just starting to practice.

Physician Impairment: Disruptive, Disabled, Duped & Depressed

Carl Christensen, MD, PhD, D-FASAM, cMRO
Clinical Associate Professor

Departments of Psychology and OB Gyn

Wayne State University
To the Joint Commission and the board of medicine, “impairment” means that a doctor is essentially unsafe. This paper examines the factors behind it and describes ways it is handled.

How to Build an Academic Career 
Focused on Research

Phillip D. Levy, MD MPH, FACEP, FAHA, FACC
Professor of Emergency Medicine 
and Assistant VP for Research

Wayne State University
Chief Innovation Officer – Wayne Health
Research is not the only way forward in a physician’s career, but if it is where your interest lies, there is a way to go about it in order to be successful.

Transcarotid Artery Revascularization for the Treatment of Cerebrovascular Disease in High-Risk Patients

Sun Kim, MD
Vascular Surgery Fellow
Detroit Medical Center/Wayne State University
Background and epidemiology of carotid artery stenosis & an overview of the transcarotid artery revascularization (TCAR) system.

“Back” to Basics:
Ergonomics and the OR

Ashley Malach, MD
General Surgery Resident
Are ergonomics important to surgeons as they operate in the OR? The answer is “very.” This paper explains why and suggests how to improve surgeons’ ergonomic health.

Mythbusters, Surgical Edition

Solhee Lee, MD
General Surgery Resident
This paper presents the current literature on common surgical misconceptions concerning C. diff, scrub caps, closing mesenteric defects, male and female surgeons, and surgical smoke.

Navigating the
Institutional Review Board

James H. Paxton, MD MBA
Associate Professor of Emergency Medicine
Understanding the IRB perspective may help researchers to successfully navigate the IRB review process.

Dr. Alexander J. Walt:
Historian, Philosopher,
and Surgical Educator

Dr. Charles Lucas
Professor of Surgery
Despite the tragedy of his family’s early history in Eastern Europe, Dr. Alexander Walt rose to become president of the American College of Surgeons and our own beloved chair.

Management of
Intrahepatic Cholangiocarcinoma

Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA
Professor and Chair, Department of Surgery
The Urban Meyer Ill and Shelley Meyer Chair in Cancer Research
Surgeon in Chief, The Ohio State University Wexner Medical Center
As chemotherapy gets better, previously inoperable patients will become operable. There will be better control of systemic disease enabling us to focus our surgical techniques on the disease.

Principles and Practice of Bariatric Surgery

Roozbeh Mansour, MD, FACS
Assistant Professor of Surgery
The physiology and complications of bariatric surgery, with an addendum on recent developments contributed by Dr. Alyssa Stroud.

Management of 
the Open Abdomen

Christopher Dente, MD, FACS
Professor of Surgery, Emory University
Chief, General Surgery, Emory at Grady
The evolution of management of the open abdomen from a technical standpoint and as it relates to changes in resuscitation paradigms over the last 20 years, with an appendix on institutional influence.

Gastric Cancer

Steve H. Kim, MD, FACS
Chief of Surgical Oncology, Karmanos Cancer Center
Professor of Surgery, Wayne State University School of Medicine
Karmanos Cancer Institute
This paper is primarily about gastric adenocarcinoma but touches also on two other gastric tumors often seen by general surgeons: GI stromal tumors (GIST) and gastric carcinoids.

Hepatocellular Carcinoma

Eliza W. Beal, MD
Surgical Oncologist

Karmanos Cancer Institute
Discusses the diagnosis and management of hepatocellular carcinoma (HCC) and research concerning barriers to surveillance for HCC that result in late diagnosis.

Missed Injuries 
in Pediatric Trauma 
and How to Avoid Them

Jonathan I. Groner MD
Professor of Surgery, The Ohio State University College of Medicine
Some injuries or conditions are difficult to detect in pediatric trauma. Dr. Groner discusses biases that increase the risk of missed injuries and a standardized approach to avoid missing them.

The History, Current Applications and 
Ethical Considerations of Robotic Surgery

Alyssa Stroud, MD
Chief Resident
A fascinating overview of a topic—robotic surgery—that seems poised to intrude more into surgery as robots grow in intelligence.

Two Dozen Years, Two PD’s and Top Lessons Learned From Surgical Education

Randall W. Smith MD, FACS
J. Scott Thomas MD, FACS
Baylor Scott & White – Temple
Highlights and lessons learned from the authors’ experiences as surgical residency program directors.

All About Mesh

Solhee Lee, MD
General Surgeon
Dr. Lee reviews the history, types, properties, clinical application, and other aspects of a material all general surgeons are likely to use at some point in their careers to repair a hernia.

Your Patient is On Fire

Muhammad Jaffar, MD, FASA, FCCM
Professor (Clinical)
Department of Anesthesiology
Dr. Jaffar explores the factors that contribute to surgical fires, focusing on both the personnel involved and the equipment utilized.

Update on Blunt Cerebrovascular Injuries

Jessica D. McGee, MD
Assistant Professor of Surgery
Signs and symptoms, diagnostic imaging, injury grading scale, incidence and treatment of BCVI

Liver Transplants: A Primer for the General Surgeon

Miguel Tobon, MD
Assistant Professor of Surgery
Wayne State University
Key things to know about liver transplants for general surgeons caring for patients who have had or will have a liver transplant

Wayne State
Surgical Society

The Wayne State Surgical Society (WSSS) was established during the tenure of Dr. Walt as the chairman of the Department of Surgery. WSSS was designed to create closer contact between the current faculty and residents with the former resident members in order to create a living family of all of the WSU Department of Surgery. The WSSS also supports department activities.
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Latest News and
Announcements

Connect With Us on Social

Notable Grand Rounds

These assembled papers are edited transcripts of didactic lectures given by mainly senior residents, but also some distinguished attending and guests, at the Grand Rounds of the Michael and Marian Ilitch Department of Surgery at the Wayne State University School of Medicine.

Every week, approximately 50 faculty attending surgeons and surgical residents meet to conduct postmortems on cases that did not go well. That “Mortality and Morbidity” conference is followed immediately by Grand Rounds.

This collection is not intended as a scholarly journal, but in a significant way, it is a peer-reviewed publication by virtue of the fact that every presentation is examined in great detail by those 50 or so surgeons.

It serves to honor the presenters for their effort, to potentially serve as first draft for an article for submission to a medical journal, to let residents and potential residents see the high standard achieved by their peers and expected of them, and by no means least, to contribute to better patient care.

— David Edelman, M.D.

Surgical GI Endoscopy:
52 Years of Experience in the USA

Choichi Sugawa, MD, PhD, FACS, FASA, FASGE, FJGES
Professor Emeritus
Wayne State University
Dr. Sugawa describes and reflects upon his distinguished career in surgical endoscopy, a field in which he was one of the original and leading pioneers.

Legendary Recollections

Anna Ledgerwood, MD, FACS
Professor of Surgery
Wayne State University
Dr. Ledgerwood, a legend in her own right, acknowledges some of the contributions and recounts some of her experiences with the legendary Dr. Choichi Sugawa.

Overcoming Challenges in Surgical Training

David R. Farley, MD
Emeritus Professor of Surgery
Mayo Clinic College of Medicine and Science
What are the main challenges of surgical training and how we can counteract them in the midst of a perfect storm of pressure to make money for the institution, the growing complexity of surgery…

Global Surgery

Todd Lavery, MD, FACS
This paper seeks to elucidate the need globally for surgical care, to describe the challenge of getting global surgery accepted as an essential component of the global health conversation.

The Changing Face of Oncology: Modern Skill Sets for the Cancer Surgeon and Changing Scientific Paradigms

Donald W. Weaver, MD
Pemberthy Professor of Surgery and
Chair of the Department of Surgery
Wayne State University School of Medicine
The overall objective is to show how and why surgery and especially surgical oncology is changing. This paper looks at where surgery is going and where it’s been.

The Wonderful World of Calcium

Charles Lucas, MD
Professor of Surgery
Wayne State University School of Medicine
Calcium (Ca) is the most common element in the body. It is present primarily in bone. Non-skeletal ionized Ca (38%) is free, while protein-bound Ca accounts for 50% of the total.

Medical Malpractice for the Surgeon

John Webber, MD
Professor of Surgery
Wayne State University School of Medicine
This paper discusses medical malpractice as it relates to surgeons and what surgeons should know about it, especially residents just starting to practice.

Physician Impairment: Disruptive, Disabled, Duped & Depressed

Carl Christensen, MD, PhD, D-FASAM, cMRO
Clinical Associate Professor

Departments of Psychology and OB Gyn

Wayne State University
To the Joint Commission and the board of medicine, “impairment” means that a doctor is essentially unsafe. This paper examines the factors behind it and describes ways it is handled.

How to Build an Academic Career 
Focused on Research

Phillip D. Levy, MD MPH, FACEP, FAHA, FACC
Professor of Emergency Medicine 
and Assistant VP for Research

Wayne State University
Chief Innovation Officer – Wayne Health
Research is not the only way forward in a physician’s career, but if it is where your interest lies, there is a way to go about it in order to be successful.

Transcarotid Artery Revascularization for the Treatment of Cerebrovascular Disease in High-Risk Patients

Sun Kim, MD
Vascular Surgery Fellow
Detroit Medical Center/Wayne State University
Background and epidemiology of carotid artery stenosis & an overview of the transcarotid artery revascularization (TCAR) system.

“Back” to Basics:
Ergonomics and the OR

Ashley Malach, MD
General Surgery Resident
Are ergonomics important to surgeons as they operate in the OR? The answer is “very.” This paper explains why and suggests how to improve surgeons’ ergonomic health.

Mythbusters, Surgical Edition

Solhee Lee, MD
General Surgery Resident
This paper presents the current literature on common surgical misconceptions concerning C. diff, scrub caps, closing mesenteric defects, male and female surgeons, and surgical smoke.

Navigating the
Institutional Review Board

James H. Paxton, MD MBA
Associate Professor of Emergency Medicine
Understanding the IRB perspective may help researchers to successfully navigate the IRB review process.

Dr. Alexander J. Walt:
Historian, Philosopher,
and Surgical Educator

Dr. Charles Lucas
Professor of Surgery
Despite the tragedy of his family’s early history in Eastern Europe, Dr. Alexander Walt rose to become president of the American College of Surgeons and our own beloved chair.

Management of
Intrahepatic Cholangiocarcinoma

Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA
Professor and Chair, Department of Surgery
The Urban Meyer Ill and Shelley Meyer Chair in Cancer Research
Surgeon in Chief, The Ohio State University Wexner Medical Center
As chemotherapy gets better, previously inoperable patients will become operable. There will be better control of systemic disease enabling us to focus our surgical techniques on the disease.

Principles and Practice of Bariatric Surgery

Roozbeh Mansour, MD, FACS
Assistant Professor of Surgery
The physiology and complications of bariatric surgery, with an addendum on recent developments contributed by Dr. Alyssa Stroud.

Management of 
the Open Abdomen

Christopher Dente, MD, FACS
Professor of Surgery, Emory University
Chief, General Surgery, Emory at Grady
The evolution of management of the open abdomen from a technical standpoint and as it relates to changes in resuscitation paradigms over the last 20 years, with an appendix on institutional influence.

Gastric Cancer

Steve H. Kim, MD, FACS
Chief of Surgical Oncology, Karmanos Cancer Center
Professor of Surgery, Wayne State University School of Medicine
Karmanos Cancer Institute
This paper is primarily about gastric adenocarcinoma but touches also on two other gastric tumors often seen by general surgeons: GI stromal tumors (GIST) and gastric carcinoids.

Hepatocellular Carcinoma

Eliza W. Beal, MD
Surgical Oncologist

Karmanos Cancer Institute
Discusses the diagnosis and management of hepatocellular carcinoma (HCC) and research concerning barriers to surveillance for HCC that result in late diagnosis.

Missed Injuries 
in Pediatric Trauma 
and How to Avoid Them

Jonathan I. Groner MD
Professor of Surgery, The Ohio State University College of Medicine
Some injuries or conditions are difficult to detect in pediatric trauma. Dr. Groner discusses biases that increase the risk of missed injuries and a standardized approach to avoid missing them.

The History, Current Applications and 
Ethical Considerations of Robotic Surgery

Alyssa Stroud, MD
Chief Resident
A fascinating overview of a topic—robotic surgery—that seems poised to intrude more into surgery as robots grow in intelligence.

Two Dozen Years, Two PD’s and Top Lessons Learned From Surgical Education

Randall W. Smith MD, FACS
J. Scott Thomas MD, FACS
Baylor Scott & White – Temple
Highlights and lessons learned from the authors’ experiences as surgical residency program directors.

All About Mesh

Solhee Lee, MD
General Surgeon
Dr. Lee reviews the history, types, properties, clinical application, and other aspects of a material all general surgeons are likely to use at some point in their careers to repair a hernia.

Your Patient is On Fire

Muhammad Jaffar, MD, FASA, FCCM
Professor (Clinical)
Department of Anesthesiology
Dr. Jaffar explores the factors that contribute to surgical fires, focusing on both the personnel involved and the equipment utilized.

Update on Blunt Cerebrovascular Injuries

Jessica D. McGee, MD
Assistant Professor of Surgery
Signs and symptoms, diagnostic imaging, injury grading scale, incidence and treatment of BCVI

Liver Transplants: A Primer for the General Surgeon

Miguel Tobon, MD
Assistant Professor of Surgery
Wayne State University
Key things to know about liver transplants for general surgeons caring for patients who have had or will have a liver transplant

Wayne State
Surgical Society

The Wayne State Surgical Society (WSSS) was established during the tenure of Dr. Walt as the chairman of the Department of Surgery. WSSS was designed to create closer contact between the current faculty and residents with the former resident members in order to create a living family of all of the WSU Department of Surgery. The WSSS also supports department activities.