Establishment and Expansion2001-20042005-The Present

 Establishment and Expansion

When cholecystectomy could be done as a minimally invasive procedure, the potential and the legitimization of laparoscopy began developing. Private practice responded to patient demand for the procedure by offering it routinely while most academic centers remained uncommitted. Convinced that laparoscopy would have a major impact on the future of surgery, Dr. William Wood and other departmental faculty believed that Emory should assume a leadership role in the burgeoning field. In 1992, Dr. Wood appointed Dr. John Hunter to establish, develop and direct the Emory Endosurgery Unit, one of the first programs of its type in the country.

Ethicon Endosurgery and Olympus were the unit's first corporate sponsors, supporting one surgeon and a research nurse's investigation of the application of laparoscopy as well as providing for the nation's first laparoscopic fellowship. In addition to giving young surgeons the opportunity to learn laparoscopy, the fellowship emphasized the study of patient outcomes with the goal of critically validating minimally invasive surgery. Ultimately, many who completed the fellowship joined other academic institutions and maintained similar research and education efforts.

The unit's model of investigation, education and application was then used to refine laparoscopic antireflux surgery and other applications to the esophagus. When its instrumental role in establishing laparoscopic foregut surgery as the gold standard in managing patients with GERD and other foregut conditions was recognized, the unit received international notice and increased demands for its resources.

The unit's scope widened to include solid organ, colon and inguinal hernia programs. Dr. C. Daniel Smith joined the unit as co-director in 1996 and contributed his experience in minimally invasive surgical areas outside of the foregut. In 1998, the unit moved beyond general surgery parameters by establishing initiatives in cardiac surgery and transplantation, catalyzed by a new association with United States Surgical Corporation (USSC) and Stryker Endoscopy.

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 2001-2004

Dr. Hunter resigned in May 2001 to become chairman of the Department of Surgery at Oregon Health Sciences University, with Dr. Smith assuming full directorship. The unit launched programs in live donor nephrectomy, laparoscopic management of polycystic kidney and liver disease, laparoscopic bariatric surgery, thoracoscopic sympathectomy for hyperhidrosis and laparoscopic access for spine surgery. Meanwhile, the demand for quality laparoscopic courses had declined because many general surgeons had become familiar with basic minimally invasive procedures and general surgery residencies had developed adequate laparoscopic training programs. Additionally, the newer methods associated with foregut, bariatrics and hernia had not yet been validated and were receiving minimal reimbursement, leading to limited interest by the general surgery community.

During the first half of 2001, USSC reaffirmed its commitment to supporting a wide variety of medical education programs for surgeons, allied health personnel and other members of healthcare teams by continuing to partner with leading medical institutions like Emory to provide quality learning experiences. Dr. Smith also directed the reorganization and restructuring of the unit so that it could better accommodate declining reimbursement while also guiding unit surgeons' significant documentation of the efficacy of the newer laparoscopic approaches to foregut, bariatrics and hernia procedures so that residents and professional surgeons could integrate these methods into their practice.

Various highlights:

• After it's inception in 2000, the Emory Bariatric Center, currently directed by Dr. Edward Lin, worked towards and realized its goal of becoming one of the leading centers of its type in the southeast. In addition to providing a comprehensive medical and Optifast weight loss program, both gastric bypass and lap band procedures are performed at the center by unit surgeons.

• By 2002, unit surgeons had successfully collaborated with renal transplant surgeons from the division of transplantation in the laparoscopic live kidney donor program, performing procedures with outcomes unparalleled in any other center in the country. Ideally, laparoscopic living-related donation of the liver will develop to the same degree. Specialists of the unit's solid organ program like Dr. Juan Sarmiento began applying laparoscopy to such pancreatic resections as distal pancreatectomy in 2004, yielding excellent results, particularly in reducing postoperative pain and shortening hospitalization.
  
  
• Unit faculty were essential to the establishment of the Emory Simulation, Training, and Robotics Center (ESTAR) in 2003 and its focus on developing, validating and applying simulation-based educational tools and devices, curricula, and robotics for use in medical education, training and patient care.
  
  
• By 2004, the unit's Hernia Institute had become a referral and consultation center for difficult hernia cases from throughout the southeastern US. Unit faculty are currently involved in some of the world's largest multi-institutional studies for laparoscopic ventral and inguinal hernia repairs.
  
  
• While the unit's endosurgery fellowship was originally the only program of its type, its successful paradigm gradually influenced the evolution of laparoscopic postgraduate programs into a common feature of many of today's relevant academic surgery centers.

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 2005-The Present

Progress continued:

• Unit surgeons became leaders in laparoscopic colon surgery, performing laparoscopic alternatives to treat diverticulitis, large pre-cancer polyps, bleeding lesions, inflammatory bowel disease and rectal prolapse.
  
  
• The unit's training program expanded to offer six-to-seven one and two-day didactic and practical courses per year in such areas as inguinal and ventral hernia repair, laparoscopic colon surgery and modern management of foregut diseases, all of which were endorsed by SAGES.
  
  
• In June 2005, unit surgeons were the first in Georgia and among the first in the nation to successfully treat a patient suffering from Barrett's esophagus with the HALO360 system, a device that uses bursts of radiofrequency energy to remove abnormal tissue without damaging healthy tissue.
  
  
• In April 2006, Dr. Smith presented the results of a clinical study validating the performance and efficacy of the HALO ablation systems for treating Barrett's esophagus at the SAGES Annual Meeting in Dallas.
  
  
• Dr. Matthew Shane, 2006-2007 Endosurgery Fellow, and Dr. Barbara Pettitt, Director of Education for the Emory Endosurgery Unit (among other titles), presented "Video Games and Laparoscopic Skills" at the SAGES April 2007 Annual Meeting.

In October 2006, Dr. Smith was appointed chairman of the Department of Surgery at The Mayo Clinic in Jacksonville, FL. Dr. Edward Lin, who joined the division of general and GI surgery in 2003 after completing his laparoscopic and GI surgery fellowship at Emory, took over direction of the unit — he had been serving as Associate Director of the Endosurgery Fellowship since 2005. In 2004 at Crawford Long Hospital, Dr. Lin performed the first endoscopic plication for GERD ever done in the US. Due to the recognition he received for his involvement in developing endoluminal procedures, Dr. Lin was able to initiate a collaborative effort with Boston Scientific in March 2006 that established training programs at Emory in endoscopic interventions and endoluminal surgery.

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