Putting Innovation to Work – Surgery at Partners HealthCare

A behind the scenes look at surgical innovations across Partners HealthCare.

From image-guided operating rooms to whole organ regeneration, the departments of surgery at the Massachusetts General Hospital (MGH) and Brigham and Women's Hospital (BWH) are blazing new trails in surgical innovation. “The stereotypical surgeon is in the operating room, focusing on the best of patient care and the highest quality in terms of outcomes. A lot of surgeons, myself included, spent their whole lives doing that,” says Keith D. Lillemoe, MD, Chief of Surgery at the MGH, Surgeon-in-Chief of the MGH, and W. Gerald Austin Professor at Harvard Medical School (HMS). “But our department is not only dedicated to the highest level of care for today's patients—we're also looking at innovative ways to affect care of our patients in the future, even to the extent of eliminating the need for surgical care of disease.” The key to surgical innovation, Lillemoe says, is cross-disciplinary ingenuity—a quality both his department and the Department of Surgery at BWH take care to cultivate. “We've found ways to allow individuals to think outside the box,” he says. Take Mehmet Toner, PhD, a professor of surgery at the MGH and HMS, and founding director of the NIH-funded BioMEMS Resource Center at the MGH. “Toner works in a division that focuses on burns and critical care, yet his focus on microchip detection of circulating tumor cells has provided a valuable opportunity for not just for the MGH but for a number of different organizations to detect cancer cells in a fashion that's never been accomplished before,” says Lillemoe. Nearby at the BWH, the Advanced Multimodality Image-Guided Operating Room (AMIGO) is among the newest and most exciting surgical innovations. The AMIGO—a standard operating room with MRI at one end, CAT and PET scanners at another end, and a cath lab in the middle—allows surgeons to remove lesions like breast cancers or lung nodules without ever opening the patient up. “Brigham and Women's is the only hospital in the world where this is available,” says Michael Zinner, MD, FACS, Surgeon-in-Chief at Brigham and Women's Hospital. “You can see an image on a MRI and then, using the suite, you can pinpoint the affected area, take it out, and then reimage to make sure it's gone. Or you can look for a hotspot with a PET scan and see where the cancer is, go get it, and then make sure it's gone after you're done.” The applications of AMIGO are incredibly diverse: Michael Davidson, MD, works on strategies for the percutaneous placement of heart valves; Raphael Bueno, MD, uses AMIGO to perform thoracic surgery; Mehra Golshan, MD, focuses on breast surgery; and image-guided parathyroid surgery is led by Daniel Ruan, MD. Partnerships and collaborations are central to the success of surgical innovation at both MGH and BWH. A BWH-initiated collaborative known as Innovative Technology and Engineering for Advancement of Medicine, or ITEAM, is composed of MDs from the Harvard hospitals and engineers from Draper laboratories and MIT. The collaborative, established by BWH innovator Avi Tavakkoli, M.D., aims to address the unmet clinical needs of physicians and surgeons, attracting entrepreneurial physicians and clinically-focused engineers in the process. “We will refine a process of innovation that addresses high-impact problems and leads to the rapid creation of intellectual property and ultimate development of products,” says Dr. Tavakkoli, an assistant professor at Harvard Medical School and BWH. “This effort was started within the department of surgery at BWH and now includes members spanning several disciplines from the Harvard hospitals.” Elsewhere at the BWH, Dr. Yolanda Colson, M.D., Ph.D., is working on a drug delivery polymer platform to prevent cancer recurrence. The collaboration between BWH and Mark Grinstaff, a professor of biomedical engineering and chemistry at Boston University, began about 5 years ago and has inspired the two institutions to joint-issue a patent on the devices. “The primary focus is the development and testing of new polymers for delivering drugs in a controlled and focused manner,” notes Dr. Colson, Director of the Women's Lung Cancer Program at BWH. “Our goal is to prevent the locoregional recurrence of cancers following surgery, either locally at the original tumor site or within regional lymph nodes where cancers commonly spread first.” Dr. Colson is also working on technology for near-infrared imaging of cancer lymph nodes during surgery. The technology is available for lung, melanoma and esophageal cancer patients participating in BWH clinical trials. We are currently planning for a larger multi-institutional clinical trial in the next year or so, to determine if we can detect hidden cancers in the lymph nodes and improve survival using this technology,” Dr. Colson notes. “In general, we have a tremendous pipeline,” Lillemoe says. “Some of the brightest, most hardworking individuals come here and are provided with opportunities to do very special things—not just in the Department of Surgery but throughout the MGH and through our relationships with other organizations, such as HMS, Partners Innovation, and MIT.” Former trainee Harald Ott, MD—now a thoracic surgeon at the MGH and an assistant professor of surgery at the HMS—is known for his cross-cutting research in whole organ regeneration. He devised a method for decellularizing organs and repopulating the stromal framework with stem cells to create functional hearts, lungs, liver, kidneys, and pancreas. “He's done all of this while still a trainee in one of the most challenging programs here at the MGH: the cardiothoracic program. He's a phenomenal young man who has already made a great impact,” says Lillemoe. The work, in collaboration with the Transplant Research and Biology Center, could help replace the need for immunosuppression after transplantation and prevent organ shortage issues. “We're excited to work with Partners Innovation as we reach out to people in industry, entrepreneurship, and philanthropy who share our vision that the best people to solve the problems of the future are those who are solving problems now.”

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