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DECADE OF DISCOVERYCentre for

Minimal Access SurgeryHamilton, Ontario

Dr. Mehran Anvari, in the Skills Lab at CMAS

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Decade of DiscoveryORION Leadership Award Winner

Dr. Mehran AnvariCELEBRATING ONTARIO’SEXTRAORDINARYACCOMPLISHMENTS IN RESEARCH ANDEDUCATION

International researchcollaborations and innovationsthat are transforming surgery andmedical training, and takingresearch, teaching and learning tothe next level in virtual environments,were recognized with Ontario’sannual ORION Awards.

The ORION Awards, werepresented at the ORION Summit2010 at the MaRS Discovery

District on April 12th, inrecognition of individuals andgroups who have led andchampioned the use of advancedand collaborative technologies tosupport research, education anddiscovery in Ontario or on theglobal stage.

Winner of the 2010 ORIONAward for Leadership, Dr.Mehran Anvari is a Professor inthe Department of Surgery atMcMaster University, ScientificDirector and CEO of the Centrefor Surgical Invention andInnovation, and Director of theCentre for Minimal AccessSurgery (CMAS).

The winners also receivedacknowledgements from OntarioPremier Dalton McGuinty.

Some 35 leaders and organizationshave received the ORION Award,since their inception in 2005.

“This year’s ORION Awardwinners come from a widediversity of fields and reflect thegreat scope of innovation takingplace at Ontario institutions,”says Phil Baker, President andCEO of the Ontario Research andInnovation Optical Network(ORION). “It’s important that werecognize and celebrate ourhome-grown success stories thatare reinvigorating the way weteach, learn and conduct research.”

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10th AnniversaryCMAS: Decade of Distinction

MilestonesDR. ANVARI IS ONE OF THE FIRSTSURGEONS IN CANADA TO USEROBOTICS IN REMOTE SURGERY,ADAPTING THE USE OF COMPLEXSPACE ROBOTICS AND MINIMALACCESS SURGERY TECHNIQUES TOPROBE THE DELICATE INNER SPACESOF HUMAN ANATOMY.

In 2003 Dr. Anvari established the world’s firsttelerobotic surgical service linking St. Joseph’sHealthcare in Hamilton and North Bay GeneralHospital.

By expanding the physical boundaries of modernmedicine, it is hoped that the use of telerobotics willone day help to bring specialized surgical care toremote communities in Canada and deliveremergency services to areas stricken by disaster orravaged by war.

An accomplished surgeon, teacher and mentor, Dr.Anvari has worked to put his skills through rigoroustesting to advance the development of research andtest the applications specific technologies that willone day deliver critical medical care to remote anddistant sites. He envisions the uses to be diverse,from delivering medical expertise and assistance toremote rural communities to providing a lifeline tothose stationed in the outposts of space.

The quest has involved him as an integral part ofprojects and missions involving the jointparticipation of CMAS, the Canadian SpaceAgency, NASA and the Telemedicine and AdvancedTechnology Research Centre (TATRC).

Breaking new ground in his role as chief scientificofficer for the NEEMO 7 in 2004, he tested andevaluated the use of telerobotic and telementoringsurgery in the provision of diagnostic and surgicalemergency care by a non-physician surgeon toperform assisted surgery in a containedenvironment that simulates conditions in space.

Reprising the role in 2006, under Dr. Anvari’sdirection NEEMO 9 was an 18 day mission whichbuilt on the research from NEEMO 7 involving astudy of how the human brain adapts to increasinglatencies experienced during the remote controlperformance on a robotic platform.

The objective of the mission was to complete avariety of surgical and non surgical robotic tasksinvolving emergency medical and surgicalprocedures by non physicians using telementoringand telerobotic assistance that included anesthesia,radiology, orthopedics and fracture management.

Dr. Anvari’s research has established new frontiersin medicine, building on the expertise of theCanadian Space Program to expand the boundariesof medical expertise.

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Dr. Anvari conductstelerobotic surgery in theFlorida Keys as part of the Neemo Project.

Right: Telerobotic surgerywith Dr. Craig McKinley inNorth Bay, the first of itskind in Canada.

Our Vision is Three-Fold

Education and skills training toadvance the caliber and scope ofminimal access training;

Research and development inrobotics and surgical innovations;

Telehealth through the developmentof mission critical, telehealthapplications that will incorporatethe newly de veloped innovationsto support surgeons and thecommunities in which they practice.

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Above: Industry Minister Tony Clement with CMASIT specialist Trevor Chapman

Below: Dr. Mehran Anvari, lecturer, surgeon andmentor, acknowledged for his accomplishments inresearch and education accepts the ORION Award.

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CMAS Skills Lab The firstof its kind in Canadaopened in 1999 withcomputer stimulation and artificial cadavers.

Commitment to EducationCMAS Provides Continuing Education forSurgeons from all Specialties

A Decade of Distinction & CommitmentTIME MAGAZINE HAS PRAISED THECENTRE FOR MINIMAL ACCESSSURGERY (CMAS) AS “SCULPTING THENEXT FRONTIER OF MEDICINE.”

Through CMAS, the first of its kind in Canada, Dr.Anvari has promoted the use of minimal accesstechniques in all surgical specialties and hasfocused on improving patient outcomes, minimizingthe physical, emotional and financial impact ofsurgical procedures on patients while reducinghospital admissions and the associated costs.

In the past decade CMAS has provided continuingeducation courses for surgeons from all specialties,offering over 87 courses to 1,200 surgeons sincethe Centre opened it’s doors.

Dr. Mehran Anvari, Director of the Centre forMinimal Access Surgery (CMAS) is committed tomentoring surgeons and has personally devoted histime and expertise to this pursuit enabling others tobenefit from his passion for learning and his desireto push the boundaries of surgical knowledge andexpertise.

Dr. Anvari has mentored over 50 surgeons and is atireless speaker and lecturer who devotes a great deal of his own personal time to helping othersurgeons refine their skills.

The telementoring program was originallydeveloped through Cancer Care Ontario using acombination of on site mentoring followed bytelementoring to help train community basedsurgeons with the adoption of laparoscopic coloncancer surgery.

Telementoring provides increased access to thementor providing information in a timely mannereven after training is complete. This enables thementor to consult with surgeons when complexcases are attempted. It also eliminates wastedtravel time.

Along with the ambitious series of CME programs,CMAS has extensive experience in telementoringand telesurgery which has benefited communityhospitals in Niagara, Thunder Bay and Sarnia.

Dr. Anvari has worked tirelessly to hone his surgicalskills and to share his knowledge,understandingand expertise with an ambitious schedule thatincludes mentoring individual surgeons as well aslectures to health care audiences in hospitals anduniversities in Canada and beyond.

Dr. Anvari has also been involved in teachinglaparascopic bariatric procedures in Canada and isa faculty member for numerous internationalprograms including the European Institute ofTelesurgery in Strasbourg, France.

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Course participants watchlive surgery in oureducation theatre whileprocedure is moderatedby CMAS Faculty.

Making aDifferenceOne Patientat a Time

Dennis HongCMAS Surgeon

THE NEWEST ADDITION TO THE CMAS TEAM IS PROGRAM DIRECTOR,BARIATRICS, DR. DENNIS HONG,ASSISTANT PROFESSOR,DIVISION OF GENERALSURGERY, MCMASTERUNIVERSITY AND ST. JOSEPH'SHOSPITAL,HAMILTON.

Dr. Dennis Hong is a general surgeon highly skilled in minimal access surgicaltechniques. He regularly performs a variety of laparoscopic procedures involvinghernia, gall bladder and colorectal cases; however, 75% of his practice is focusedon bariatric surgery.

Captivated by the difference bariatric surgery can make in the life of a patientsuffering from obesity, Dennis has been committed to helping bariatric patientslose weight and conquer the associated diseased that plague overweight andobese patients including diabetes, cardiovascular disease and more. Dennis takespride in watching the evolution that occurs in patients committed to makingchanges that include healthy nutritional intake and a more active lifestyle.

He says that patients determined to achieve long term weight loss success have life long challenges that ensure the results of the surgical procedure areoptimized.

Keenly committed to patient centred care he has noted that although patients areknowledgeable and conversant with the issues surrounding weight loss surgerythe practice of bariatric surgery is still more prevalent in the United States.

This situation is rapidly changing with the establishment of the Bariatric Centres ofExcellence, the Bariatric Registry and the Bariatric Network. The Ministry ofHealth and Long Term Care (MOHLTC) has focused on creating better patientoutcomes, providing bariatric surgery at local centres of excellence which removethe need for patients to travel to the US to obtain bariatric procedures, and reducethe number of hospital admissions caused by the ancillary illness that are theresult of severe obesity.

Ideally positioned to assist in delivering the optimal care to bariatric patientslocally, Dennis has occupied staff positions with outstanding facilities withinCanada and the United States including:

• The Good Samaritan Hospital, Bariatric Surgery Program, Department ofSurgery, Portland, OR, Staff (2004-2007)

• Providence Portland Medical Center, Department of Surgery, Portland, OR,Staff (2004-2007) and Southwest Medical Center

• Weight Loss Surgery Program, Vancouver, WA, Staff (Jan 2007 - Apr 2007).

Dennis’s educational background include:

• Doctor of Medicine, University of Toronto, Ontario,• Masters of Science, Department of Clinical Epidemiology and Biostatistics -

Health Research Methodology, McMaster University, Hamilton, Ontario.

Dr. Hong is married and his wife Natasha is a surgeon on staff at Guelph GeneralHospital and is also skilled in performing minimal access surgery. Dennis andNatasha have one son, two year old Owen who is the light of their lives.

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“When I was exposed tobariatric surgery I wasamazed at the impact it hadon the quality of life of thepatients who had undergonethe procedure.”

Dr. Dennis Hong,CMAS Program Director, Bariatrics

Edward MatsumotoCommitted to Educating Surgeons

A dedicated and forward thinkingphysician and surgeon, Dr. EdwardMatsumoto is an Assistant Professor ofSurgery at McMaster University and astaff urologist at the McMaster Instituteof Urology, St. Joseph’s Healthcare,Hamilton. He is currently the Director ofthe Urological LaparoscopicFellowship, Assistant Director forUrology Residency Program atMcMaster University.

A native of Hamilton, Ontario, EdwardMatusumoto graduated from theUniversity of Toronto medical school in1996. He completed his residency aswell as a Masters of Health Educationin the Clinician Investigator Program atUniversity of Toronto.

Following his residency training inToronto he completed a fellowship inLaparoscopy and Endourology at theUniversity of Texas SouthwesternMedical Centre in Dallas, a centrerecognized as a world leader in thisfield of expertise.

He returned to Canada in 2004 andjoined the faculty at McMaster University.

Dr. Matsumoto’s major research areasare in surgical education with a focuson technical skills assessment, modelevaluation and simulator training.

In addition, he has a keen interest in theteaching, training and mentoring ofadvanced laparoscopic surgery topracticing urologists and is recognizedas one of Canada’s leading experts inlaparoscopic urological surgery andstone disease.

Dr. Matsumoto views his role withCMAS and McMaster as Director forUrology Fellowship as a perfect fit forhis goals of teaching advancedtechniques in laparoscopy andendourology, developing a curriculumusing bench models and simulation toadvance the learning curve.

Dr. Matsumoto is married and he andhis wife Jennifer live in Ancaster, withdaughters Katelyn and Emily.

Dr. Edward Matsumoto, Director of Urological Laparoscopic Fellowship

Margherita CadedduMinimal Access Surgery Changes Lives

Following her completion of aFellowship in Minimally InvasiveSurgery at the University of Toronto, St. Michael’s Hospital in 2000 Dr.Cadeddu joined the McMaster Facultyof Health Sciences where she is currently an Associate Professor and Associate Director of CMAS.Compassionate and caring, Dr. Cadeddu was drawn to minimalaccess surgery out of concern for herpatients. Minimal access surgeryenables her to perform major surgerieswith less trauma to the patient, lessdiscomfort to the abdominal wall andfaster recovery times.The results aresatisfying for Dr. Cadeddu, whose chiefmotivation in entering the field was astrong desire to “fix” problems whilecausing a minimum of distress to her patients.

The volumes of minimal access surgeryhave increased in all specialties fromgeneral surgery to urology, thoracic,gynecology, bariatric and more.

Dr. Cadeddu’s interest and expertise inminimally invasive surgery includesgeneral surgery procedures involvingthe upper and lower GI track and solidorgan surgery.

Committed to her role with CMAS as atrainer and educator, Dr. Cadeddu isdevoted to honing and upgrading herown skills by attending digestivedisease conferences and seminars toincorporate state-of-the-art proceduresinto her surgical, teaching andmentoring endeavours.

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Dr. Margherita Cadeddu, Associate Director, CMAS

Marie FairgrieveCMAS Manager

AS MANAGER OF THE CENTREFOR MINIMAL ACCESSSURGERY, MARIE FAIRGRIEVEHAS AN OUTSTANDINGCAPACITY FOR HANDLING THEMYRIAD OF DETAILS INVOLVEDIN SUCCESSFULLY MANAGINGA CENTRE DEVOTED TOADVANCING SKILL IN ALLSURGICAL SPECIALITIES.

Experienced and energetic, Marie Fairgrieve juggles a portfolio of prioritiesinvolving logistic planning, program scheduling for the ever growing roster ofCMAS continuing education programs and conferences, statistical and financialreporting, grant applications, website and partnerships outreach.

Marie started her career at McMaster University in 1985 with the Department ofObstetrics and Gynecology before moving on to work with Dr. Frank Baillie andDr. James Bain in the Department of Surgery.

She accepted the position of Program Administrator for the Clinical BehaviouralSciences Program in the Department of Education Services at McMaster in 2002before returning to the Department of Surgery in 2004 as Assistant Manager,Finance/AFP.

In 2009 she joined CMAS as Manager, hand picked by Dr.Anvari for herconsiderable skills in both management and administration.

Marie is a graduate of the Management Studies Program at McMaster Universityand is currently a student in the University’s part-time degree studies, Bachelor ofCommerce Program.

Contact Information:

Marie Fairgrieve

Email at: mfairgri@stjosham.on.caTelephone: 905-522-1155 Ext. 33185CMAS website: www.cmas.ca

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A decade of commitment to mentoring surgeons from allspecialities has enabled CMAS to play a leading role in thedevelopment of surgical talent and resources in Canada andbeyond. CMAS is viewed by surgeons as an essentialcomponent in their continuous quest for skills development.

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“Our goal is to providesurgeons and related healthcare professionals withexpertise and training in thelatest specialized techniquesin minimal access surgery andthe healthcare issuesassociated with theprocedures.”

Marie Fairgrieve

ACOSOG Z6051: A Phase III Prospective Randomized TrialComparing Laparoscopic - Assisted ResectionVersus Open Resection for Rectal Cancer

This ACOSOG (American College of SurgeonsOncology Group) funded, multi-centre, randomizedcontrolled trial is being conducted to test thehypothesis that laparoscopic-assisted resection forrectal cancer is not inferior to open rectal resection,based on a composite primary endpoint of oncologicfactors which are indicative of a safe and feasibleoperation.

Laparoscopic Bariatric Surgery for Treatment ofComplicated Type 2 Diabetes in Obese Patients: A Prospective Randomized Controlled Pilot Study

The purpose of this study is to compare laparoscopicgastric bypass (LGB), laparoscopic adjustable gastricbanding (LAGB), and intensive medical managementfor the treatment of Type 2 Diabetes in obeseindividuals (BMI 30 to 40 kg/m2) with poor glycemiccontrol, evidence of end organ damage and / orsignificantly impaired quality of life. The results of thispilot study will also be used to determine the samplesize necessary for a subsequent larger multi-centrerandomized controlled trial.

Isolation and Characterization of Enteric Glia from Human Intestine

The purpose of this study is to determine the optimalconditions under which enteric glia can be isolated,purified and cultured from human colon tissue whichis resected during surgical procedures. Oncecultured, these cells can potentially be used to repairinjured spinal cords in humans.

A Randomized Clinical Trial:Preo perative Carbohydrate Drink for the Preventionof Postoperative Nausea and Vomiting in LaparoscopicAbdominal Surgery

The objective of this study is to evaluate the efficacyand safety of preoperative carbohydrate drink indecreasing the postoperative nausea and vomitingand post-operative dehydration in patients undergoingelective laparoscopic surgery.

Colorectal Database

We are maintaining a colorectal database to studythe outcomes of colorectal surgery. The purpose ofthis database is to review and compare outcomesof laparoscopic and open colorectal surgeriesperformed at St. Joseph's Healthcare since 1992.

SILS Database

We are maintaining a Single Incision LaparoscopicSurgery (SILS) database. This database was createdto study the outcomes of SILS. SILS is a modifiedapproach to performing laparoscopic surgery thatallows completion of surgical procedure through onesmall incision. Potential benefits of this approachinclude improved cosmesis and decreasedpostoperative pain.The database collects short-termand long-termoutcomes of SILS.

A Clinical Study: Near Infrared Fluorescence Imaging, Using The SpyScope System, During Laparoscopic Surgery ofThe GastroIntestinal System.

The purpose of this study is to evaluate whethersystemically injected Indocyanine Green (ICG), when fluorescing in response to near infrared (NIR)illumination, can assist with the assessment of perfusionat the anastomotic sites during laparoscopic surgicalprocedures involving most parts of the gastrointestinaltract (esophagus, stomach, small bowel and colon).This finding may assist surgeons to minimize theoccurrence of leaks at the anastomotic site followingthis surgical procedure. This study will investigate the potential for the SPY Scope Imaging System (SPY Scope) to fill this clinical need. This study will also analyze the optimal dosage of ICG for imaging of each organ.

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For information visitthe CMAS website:www.cmas.ca

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Clinical ResearchCurrent Clinical Trials at CMAS

CMAS – CSiiPartners in Research and Education

THE FOUNDING DIRECTOR OF CMAS, DR. MEHRAN ANVARI ENVISIONEDCREATING NEW SURGICAL TOOLS THAT WOULD EXPAND THE CAPABILITIES OFSURGEONS, INCORPORATE IMAGE GUIDED ROBOTIC TECHNOLOGIES ANDADVANCED INFORMANTICS.

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As a result, in 2009, the Centre for SurgicalInvention and Innovation (CSii) was established toserve as a research accelerator and to work withindustry partners to develop advanced imageguided surgical tools to provide surgeons withgreater access and more dexterity, enablingsurgeons to perform highly targeted procedureswhile minimizing trauma to patients and reducinghospital admissions.

CSii, is funded by the Government of Canadathrough the National Centres of Excellence CECR

program and tasked with accelerating thedevelopment of outstanding research into tangibleproducts. CSii and CMAS share a symbioticrelationship as partners in research and education.

CMAS will continue to educate and train surgeonsto develop skills and expertise with new minimallyinvasive technologies, to develop new surgicalprotocols and embrace the new methodologies asthey emerge.

Above: Dr. Mehran Anvari showsScience and Technology MinisterGary Goodyear a surgical robotdesigned by MDA engineer Beny Yeung.

Right: Dr. Anvari, M.P.David Sweet, thehonourable GaryGoodyear and MDAengineer, Beny Yeung.

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SponsorsWorking with CMAS

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CMAS gratefully acknowledges our Corporate Sponsors, true partners in all of oureducation and research endeavours.

Thank you for joining in our quest to provide surgeons and associated healthcareprofessional with the means to obtain training in the latest techniques, hands onexperience with state of the art tools and outstanding mentors.

Your contribution is helping to create better healthcare outcomes for Canadians andfor patients world wide.

To all of our corporate and conference sponsors, your support as good corporatecitizens is gratefully appreciated by CMAS and all of our associated partners.

Conference Sponsors

Corporate Sponsors

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PHARMA

CMAS 2010Program OfferingsCourse Guide 2010

Registration and information online.Visit our website: www.cmas.ca

CMAS NEWSInformation:Tell us what you are interested in learning!

Participate in the CMAS discussions on Twitterand become a fan on Facebook.

CMASCentre for Minimal Access Surgery

St. Josephʼs Healthcare HamiltonJuravinski Tower, Room T214150 Charlton Ave, EastHamilton, ON L8N 4A6Phone: (905) 522-1155 Ext.35144Fax: (905) 521-6194Email: info@cmas.ca