Surgical Firsts

mmc

Here's a look at some of the surgical milestones achieved at Monmouth Medical Center over the last three decades -

1975 - Monmouth Medical Center opens the region's first surgicenter. Michael A. Goldfarb, M.D., F.A.C.S., chief of surgery at Monmouth, introduces day stay surgery to central New Jersey.

1988 - Plastic surgeon Stephen Dudick, M.D., performs Monmouth Medical Center's first transverse abdominal flap (TRAM) breast reconstruction - a procedure still considered the state-of-the-art in breast reconstruction. The TRAM procedure uses muscle, skin and fat tissue from the abdomen rather than a saline implant to recreate a breast lost to mastectomy relatively symmetrical in size and shape to the existing breast.

1989 - Cochlear implant surgery, which involves placing an electrical device in the inner ear to help improve the hearing of the profoundly deaf, is performed at Monmouth, making it one of only three hospitals in New Jersey to offer the procedure.

1990 - Dr. Goldfarb leads a team of Monmouth-affiliated surgeons who are the first in the state to perform laparoscopic cholecystectomy - the removal of gallbladders through minimally invasive surgery.

1992 - This year saw Monmouth maintain its leadership position in surgery among area hospitals by bringing new minimally invasive procedures to the region. For example, orthopaedic surgeon Cary Clastein, M.D., was the first in New Jersey to perform laser-assisted spinal endoscopy for treating disc problems. A team of MMC urologists were the first in Monmouth County to perform video laser ablation prostatectomy to treat prostate enlargement. Several of Monmouth otolaryngologists introduced endoscopic sinus surgery as a new means of restoring sinus function. And the Department of Surgery formed the Section of Laparoscopic Surgery in recognition of the important role of minimally invasive surgery.

1993 - The Pain Management Center - led by Harris Bram, M.D., an anesthesiologist fellowship-trained in pain management - opened its doors. The region's first pain management center, it was designed to evaluate and treat patients with acute and chronic pain ailments. In 1996, Dr. Bram would team with orthopaedic surgeon Cary Glastein, M.D., to perform Monmouth's first surgical implantation of a spinal cord stimulation system, a state-of-the art procedure to treat chronic pain through an implant that stimulates nerves through tiny electrical pulses.

1994 - A multidisciplinary team of MMC surgeons comprising Dr. Gordon Donald, M.D., orthopaedic surgeon; Dr Goldfarb, M.D., F.A.C.S., and vascular surgeon George S. Constantinopoulos, M.D., set a milestone by becoming the first in New Jersey and the New York metropolitan area to perform laparoscopic spinal fusion surgery, which involves entering the patient's body laparoscopically through the abdomen. The minimally invasive procedure causes less damage to the surrounding tissue and muscle than if the surgery was performed through the back or through a larger abdominal incision using traditional surgical techniques.

1994 - Dr. Goldfarb introduces a state-of-the-art ultrasound device that allows them to enter and examine the patient's body through a tiny incision in the abdomen. Monmouth was the first hospital in the region to acquire the leading-edge system.

1995 - MMC neurosurgeon Jonathan Lustgarten, M.D. - who was later joined by his associate David Estin, M.D. - teams with neurosurgeons from Columbia-Presbyterian Medical Center's renowned Department of Neurosurgery to create a center of excellence in the treatment of brain tumors and disorders of the nervous system.

1995 - A new reconstructive surgical technique performed at MMC enables men who lose their urinary bladders to late-stage bladder cancer to return to a more normal lifestyle. This surgical breakthrough allows urologists to replace a cancerous organ with a new bladder that functions almost normally, making it possible for these men to urinate without the use of outside devices. The surgery, performed first at MMC by urologist Arnold Grebler, M.D., is refined so that a new bladder can be created from a patient's bowel and attached to his urethra so that he can urinate in a normal manner.

1996 -Monmouth Medical Center pediatric surgeon Saad A. Saad, M.D., and Dr. Goldfarb introduced an innovative surgical procedure that eliminates the need to make a second incision when performing hernia surgery on a child. Through the use of a bronchoscope - a telescope with working channels used to look inside the windpipe - he can explore the abdomen on the opposite side through the single incision used to repair the hernia.

1996 - Monmouth becomes the first hospital in the United States to perform a new incisionless surgical procedure that unblocks tear ducts of individuals whose eyes continuously water. The technique, performed by MMC ophthalmologist Ronald W. Kristan, M.D., is a new laser approach to dacryocystorhinostomy (DCR), the surgical creation of an opening between the lacrimal (tear) sac and the nasal cavity to create normal drainage of tears.

The procedure takes half the time of conventional surgery, and patients recover much more quickly and are less likely to suffer from bleeding, scarring, infection or other complications.

1997 - Monmouth Medical Center became a trial site to investigate a new form of chemotherapy for recurring malignant brain tumors - a major step in developing an effective therapy for brain cancer and improving the quality of life for these patients. The treatment involves placing a wafer-thin chip that delivers chemotherapy directly on the site where the brain tumor is removed, slowly dissolving into the surrounding brain tissue in an effort to delay or stop the development of additional tumors. Dr. Lustgarten was the principal investigator for the Monmouth Medical Center site of the trial of the drug, the Gliadel wafer.

1997 - An advanced laser procedure to correct nearsightedness was introduced to central New Jersey by ophthalmologist Daniel Goldberg, M.D. The new laser surgery, Lasik, offers rapid visual recovery, reduced discomfort and fewer side effects such as temporary blurred or hazy vision and makes it possible to correct higher degrees of nearsightedness than existing techniques.

1997 - Through the renowned Jacqueline M. Wilentz Comprehensive Breast Center, Monmouth offers advanced breast surgery led by a team of the region's finest general and plastic and reconstructive surgeons. Monmouth-affiliated surgeons were the first in the region to offer protocol-tested sentinel lymph node procedure - an alternative to major surgery in determining whether a woman's breast cancer has spread to her lymph nodes. Dr. Goldfarb served as principal investigator for the clinical research study of sentinel lymph node biopsy - a minimally invasive surgical technique that removes one or two lymph nodes, rather than the cluster of lymph nodes, in the armpit.

1998 - Orthopaedic surgeon Robert Grossman, M.D., performs a meniscal transplant - surgery that replaces the deteriorated c-shaped piece of cartilage in the kneecap with cartilage from a tissue donor - marking the first time this innovative procedure was performed at a New Jersey hospital outside of the medical school at the University of Medicine and Dentistry of New Jersey in Newark.

neuroscience 2000 - Monmouth is the first hospital in Monmouth and Ocean counties to introduce image-guided neurosurgery using a technology known as the StealthStation. The system helps surgeons plan and perform delicate procedures in the cranium and spine with greater accuracy, less patient trauma and in a less invasive manner. Also in 2000, Drs. Estin and Lustgarten would introduce an innovative minimally invasive surgical procedure to remove tumors from the base of the brain without making an incision. Monmouth was the first hospital in the tri-state area to introduce endoscopic surgery for the removal of pituitary and other tumors from the base of the brain. With this cutting-edge procedure, neurosurgeons and otolaryngologists (ear, nose and throat doctors) can use an endoscope - a surgical instrument that uses small fiberoptic tubes to visualize the tumor - to remove growths from this delicate cranial region through the nasal cavity.

2000 - Monmouth Medical Center becomes the first hospital in Monmouth and Ocean counties - and among a handful in the state - to introduce the new LandmarX Image Guidance System, making sinus surgery a more viable option for a growing number of adults and children. This ENT navigational tool allows otolaryngologists to better navigate the air-filled cavities within the fragile bones of the face during sinus surgery.

2001 - Monmouth introduces hand-assisted laparoscopic nephrectomy - a minimally invasive surgical technique which allows surgeons to remove the kidney through a three-inch incision - an opening large enough for a surgeon's hand to manipulate the diseased organ. This is an alternative to standard surgery, which requires a 10- to 20-inch incision in the abdomen and, frequently, the removal of the patient's 12th rib. Introduced at Monmouth by urologist Y. Samuel Litvin, M.D., and surgeon Frank J. Borao, M.D, director of the Center for Minimally Invasive Surgery at Monmouth, the procedure has proven very effective for treating the cancer while causing minimal discomfort to patients, who recover much quicker than those undergoing open procedures. Monmouth Medical Center is the first hospital in central New Jersey to offer patients this treatment option for kidney cancer.

2002 - Monmouth introduces the Center for Minimally Invasive Surgery. Led by fellowship-trained laparoscopist Frank J. Borao, M.D., the center brings cutting-edge surgical treatment options for morbid obesity, severe heartburn, benign and malignant colon disease, and a host of other disorders. Also in 2002, Monmouth unveils its Institute for Advanced Reconstructive Surgery - the only facility of its kind in the state. Led by plastic surgeon Andrew Elkwood, M.D., the institute offers a multidisciplinary approach to complex reconstructive and head and neck surgery. Through a joint effort of The Center for Minimally Invasive Surgery and Institute for Advanced Reconstructive Surgery, Dr. Borao performs the region's first grafting harvested from the patient's leg for use in a surral nerve transfer.

2003 - Dr Goldfarb completes a five-year study titled "How Good Are We? How Do We Know?" This review of surgical outcomes is one of the most complete investigations to analyze and implement changes to limit surgical complications. It has been adopted by other institutions already.

2004 - A unique video hookup at MMC makes timely collaboration among specialists easier than ever before. Monmouth chairman and residency program director of surgery, Michael Goldfarb, M.D., says Monmouth is the only hospital he knows of in which the operating rooms are connected via audio and video to the departments of pathology, radiology and emergency, the intensive care unit, auditorium and Internet. This technology, Dr. Goldfarb says, will change the culture of surgery because it allows additional specialists to be involved in subtle, yet significant, decisions that are made before, during and after surgery.

2004 - Monmouth is the first hospital in the Monmouth County region to introduce laparoscopic partial nephrectomy, which involves the removal of small renal tumors through several keyhole-sized incisions, leaving the kidney intact and able to function. This cutting-edge minimally invasive procedure is proving to be as effective in treating kidney cancer as totally removing the kidney, according to urologist Jules Geltzeiler, M.D., who has partnered to perform the cutting-edge technique with Frank J. Borao, M.D., director of minimally invasive surgery.

2004 - Patients with sinus conditions benefit from a new computer image guidance system that lets surgeons see what they’re doing more precisely than ever before — within one millimeter’s accuracy. The first hospital in New Jersey to employ the Landmarx Evolution ENT 3-D Image Guidance System in 2000, Monmouth Medical Center updates the imaging equipment to this latest version.

2004 - Monmouth Medical Center earns national accreditation for an extended five-year period for upholding the highest academic standards in graduate medical education. The Accreditation Council for Graduate Medical Education (ACGME) separately accredited Monmouth’s physician-in-training programs in general surgery, along with four other residency programs including internal medicine, obstetrics and gynecology, orthopaedic surgery and pediatrics, after an institutional review. ACGME granted accreditation for five years, rather than the standard four-year period, demonstrating what it calls its “added confidence in the ability (of an institution) to provide quality education” to nearly 100 residents in these medical disciplines.

2004 - Mobile extracorporeal shock wave therapy (ESWT), approved by the Food and Drug Administration in 2000 for the treatment of plantar fascitis, providing a noninvasive, nonsurgical treatment option for severe, chronic heel pain, is intrroduced at MMC. Based in Monmouth’s Cranmer Ambulatory Surgery Center, the system uses an ultrasound imaging system providing precise localization and excellent imaging quality, allowing the podiatrist to continuously observe the plantar heel spur and control therapy using real-time monitoring.

2005 - MMC neurosurgeons performed the region’s first “awake” craniotomy — a brain mapping procedure that allows patients to remain conscious during surgery. It is emerging as a highly effective technique to treat brain tumors and lesions previously determined to be inoperable or only partially resectable. MMC neurosurgeon Ty J. Olson, M.D., is one of only a handful ofneurosurgeons in the country to perform awake craniotomies.

2005 - The creation of a dedicated Bariatric Surgery Center is prompted by the remarkable success of Frank Borao, M.D., chief of Laparoscopic Surgery, in performing small-incision surgical techniques for dramatic weight loss. This success leads to Monmouth’s provisional status as a Center of Excellence for Bariatric Surgery.

2005 - MMC Surgery chairman and residency program director Michael A. Goldfarb, M.D., makes national headlines of his own when his quality-tracking system for improved patient safety was featured as the cover story in the May issue of General Surgery News. His work so impresses American Surgical Association (ASA) immediate past president Hiram C. Polk Jr., M.D., he personally visits MMC to congratulate Dr. Goldfarb and talk with MMC’s attending and resident surgeons.

2005 - Accomplishments marked in the surgical arena as 2005 drew to a close include the hospital’s first carotid stenting with angioplasty and the first minimally invasive esophagectomy in the region.

2006 - Monmouth Medical Center becomes the first hospital in Monmouth and Ocean counties to introduce the da Vinci Surgical S System — the first robotic system approved by the federal Food and Drug Administration for use in laparoscopic surgery.
Robotic technology’s entry into the operating room represents the latest advance in minimally invasive surgery, allowing operations to be performed with superior visualization, improved dexterity and a surgical precision never before possible.

2006 - Navigating through the complex twists and turns of the sinuses to open blocked passageways becomes easier through an innovative new surgical treatment unveiled at Monmouth. Heralded as the latest breakthrough in minimally invasive, endoscopic surgery to relieve chronic sinus problems, balloon sinuplasty is pioneered at Monmouth by Vin Prabhat, M.D. He is one of only two ear, nose and throat specialists in New Jersey — and among 220 physicians in the United States — who completed advanced training in the procedure, which is the first federally approved catheter-based tool designed specifically for endoscopic sinus surgery.

2007 - Following the da Vinci S Surgical System’s groundbreaking introduction last year, an increasing number of Monmouth Medical Center surgeons are delving into the pioneering field of robotic surgery. The system, which combines computer and robotic technologies with the skills of the surgeon, is being used as an alternative to both open and traditional small-incision methods in a host of surgical specialties, including:

  • Gynecologic: Hysterectomy, uterine fibroid removal, tubal ligation, ovarian and uterine cancer surgery, and pelvic floor reconstruction.
  • Urologic: Radical prostatectomy.
  • Gastrointestinal: Bowel surgery, gastric bypass, hiatal hernia repair, colectomy, and gallbladder, kidney, spleen and adrenal gland removal.
  • Thoracic: Lung cancer surgery.
  • Robotic-assisted operations are performed with greater precision, dexterity and control than typically offered through previous surgical methods. For many patients, this means fewer complications, a shorter hospital stay, quicker recovery and better clinical results.

2007 - The Leon Hess Cancer Center established a Center of Excellence in Gastrointestinal Cancer Care that focuses on multidisciplinary collaboration across the continuum to ensure high-quality care. Under the medical direction of Michael Arvanitis, M.D., chief of Colon and Rectal Surgery at Monmouth, the center has implemented the following three initiatives under guidelines established by the American Cancer Society for GI cancer screening, education and surveillance: a monthly GI Multidisciplinary Cancer Conference; a Familial Colorectal Cancer Registry Program, which offers a multispecialty team approach to the assessment of family risk, genetic counseling and testing, and the treatment of polyps and cancer; and the High Risk Colon Cancer Assessment Clinic offers high-risk colorectal patients “one-stop” assessment services.

2007- Andrew Elkwood, M.D., chief of the Division of Plastic Surgery at Monmouth Medical Center, assisted by a team of surgeons that included Michael Rose, M.D., and Matthew Kaufman, M.D., performs a rare nerve transplant for the first time on a stroke patient whose right side is paralyzed. During the six-hour procedure, the medical team utilized advanced technology to take nerves from the patient’s legs and attach nerves from his working side to nerves on his paralyzed side to restore function. The following day, “Good Morning America” aired this innovative story — a first not only for Monmouth Medical Center, but for the nation and world at-large. In addition to coverage by ABC’s Good Morning America, CBS News and WCBS Newsradio 880 also covered this groundbreaking procedure.

2008 - Anthony Squillaro, M.D., a board-certified cardiothoracic and vascular surgeon teams with Frank Borao, M.D., surgical director of the Center for Minimally Invasive Surgery at Monmouth, to perform laparoscopic Heller myotomies -the only team in the region performing this least invasive, most efficient method to treat patients with advanced achalasia. The minimally-invasive procedure to treat this disorder of the esophagus that makes it increasingly difficult to swallow solids and liquids requires just four five millimeter incisions which together total under an inch in length - a far cry from the full-length chest incision required with traditional surgery.

2008 - In a groundbreaking procedure at Monmouth Medical Center, neurosurgeon David Estin, M.D., performs cervical disk arthroplasty, or artificial disk surgery to replace a herniated disk in his patient's neck with a synthetic one - the first FDA-approved clinical artificial disk procedure in Monmouth County. Before the evolution of artificial disk surgery, patients often underwent spinal fusion surgery - traditional surgery involved removing the diseased disk, then fusing the vertebrae together with a bone graft.

2008 - Monmouth Medical Center becomes one of the first hospitals in the United States and the only hospital in New Jersey to offer a new incisionless procedure to reverse weight gain after gastric bypass surgery. Steven Gorcey, M.D., division chief of gastroenterology at Monmouth, and Frank Borao, M.D., chief of Minimally Invasive Surgery and medical director of Monmouth's Bariatric Surgery Program, perform the incision-free procedure, coined “ROSE” (Restorative Obesity Surgery, Endolumenal). ROSE reduces the size of a patient's stomach pouch and stoma to the original post-gastric bypass proportions to help them back onto the path of weight loss.

2008 - Monmouth Medical Center neurosurgeon David Estin, M.D., becomes the first physician in New Jersey to utilize the O-Arm Imaging System during a surgical case that involves a spinal fusion with screw and rod stabilization of the lumbar spine. Monmouth is the first hospital in New Jersey to acquire and implement the O-Arm Imaging System, a new device that can take CAT scan images of the body during surgery. Dr. Estin explains that placing screws in the spine usually requires estimating the precise location of the bone with simple X-rays. With the O-Arm, the accuracy is dramatically improved because of the real-time 3-D images provided by the device that can then be linked to an intraoperative navigation system called the “Stealth Station.”

2008 - Fifth-year resident Sotero Peralta, M.D., fourth-year resident Jack Needham, M.D., and third-year resident Jonas Mansson, M.D., win the statewide Surgical Jeopardy competition at the New Jersey Chapter of the American College of Surgeons December meeting. The Surgical Jeopardy competition pitted teams from the surgical residency programs in New Jersey as well as the Easton, Pa., program, and consisted of one chief resident and two other residents from each program.

2009 - Andrew Elkwood, M.D., a plastic and advanced reconstruction surgeon world-renowned in the field of nerve transplantation, performs a highly rare procedure, nerve grafting to relieve life-altering posterior pressure ulcers for a paraplegic. The surgery, performed by a New Jersey medical team under the direction of Dr. Dr. Elkwood, utilized his expertise in a way that can be life-altering for paraplegics worldwide whose lives are subjugated by acute posterior sores. During the procedure, surgeons took nerves from the patient's paralyzed leg and grafted from the rib to the sciatic nerve to restore sensation and prevent acute pressure ulcers - a common side effect associated with paraplegics that can relegate otherwise highly-functional handicapped people to be bedridden. The surgery was performed on a 49-year-old who became paralyzed after breaking his spinal cord in a dirt bike accident 10 years ago.

2010 - A new technology allows urologists at Monmouth Medical Center to leave the kidney in, while taking the cancer out. At Monmouth, urologists Arnold Grebler, M.D., and Ilan Waldman, M.D., perform the hospital’s first cryosurgical cases, a kidney-sparing alternative to traditional surgery to remove renal tumors.

From its earliest days, Monmouth Medical Center has been a leader in surgical advances. With a statewide reputation for excellence in the field, Monmouth has been and remains on the cutting edge as high technology has entered the operating room.

For more information on surgical services, or for a referral to a Monmouth-affiliated surgeon, please call our physician referral service at 888.724.7123.

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