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BARIATRIC FELLOWSHIP

The East Carolina University Bariatric Surgery and Minimally Invasive Fellowship provides advanced training in all phases of minimally invasive surgery. For years our Department has been a leader in the field bariatric surgery. Our surgeons have made significant contributions to the field of minimally invasive surgery over the past few years, particularly in the areas of Robotic Surgery. At the completion of this one year fellowship, the fellow will be prepared for a career in either private or academic practice minimally invasive surgery.

Research, education, and administrative activities in Bariatric and invasive surgery are essential to the fellowship. The goals of the fellowship are as follows:

  • provide advanced laparoscopic, thorascopic, and endoscopic training
  • prepare the fellow to train others in these skills
  • involvement in research and development of minimally invasive surgery and the surgical treatment of obesity
  • to include the fellow in the administrative process of managing a minimally invasive and bariatric surgery department.

The clinical activities during the year will involve rotation on the gastrointestinal and bariatric surgical service. Here he will be exposed to and trained in minimally invasive surgical technique for the surgical correction of obesity. The fellow will be involved in the evaluation of the bariatric surgical candidate, the surgery, and the follow up care of the patient. There will be opportunity to learn the fundamentals of setting up a bariatric program. At the completion of the year, the fellow should be able to independently perform bariatric surgery.

Advanced thorascopic surgery such as diagnostic and therapeutic thoracoscopy is obtained on the general and thoracic services. Procedures such as thorascopic wedge resection, decortication, and esophageal surgery are included.

Both upper and lower endoscopy experience is obtained during the fellowship year as well. By the completion of the year, the fellow should feel comfortable performing both therapeutic and diagnostic endoscopic procedures. This will include, but not be limited to biopsy, dilation, marking and other endoscopic procedures within the upper and lower gastrointestinal tracts.

The Brody School of Medicine has several animate labs that the surgery department uses for both research and training. The fellow will first obtain experience through the lab. The fellow will then initiate and develop minimally invasive skills labs for the general surgery residents. The fellow is expected to participate in the eduction of the residents and medical students.

The Metabolic and Obesity Research Institutes of East Carolina University have been instrumental in developments in obesity research over the past thirty years. It is through work with these departments that the fellow will be expected to complete a research project during his year.

The clinical experience will be obtained at Pitt County Memorial Hospital, the 750 bed tertiary care center for the Brody School of Medicine of East Carolina University, and the hospital’s outpatient surgery center. Both are JCAH accredited and the primary sites of practice for the program’s entire faculty. No off campus rotations are planned.

Curriculum

The fellowship is for one year (July 1 - June 30) The fellow can expect to perform close to 300 minimally invasive procedures during the year. These procedures shall include:

  • Gastrointestinal Surgery
  • Laparoscopic Heller myotomy
  • Laparoscopic fundoplication
    • reflux
    • hiatal hernia
    • revision
  • Laparoscopic cholecystectomy
    • laparoscopic common bile duct exploration
  • Laparoscopic hernia repair
    • hiatal
    • Incisional/ventral
    • inguinal
    • revision
  • Laparoscopic feeding access
    • gastrotomy tubes
    • jejunostomy tubes
  • Laparoscopic Obesity Surgery
    • Roux en Y Gastric Bypass
    • Obesity surgery Revision
  • Laparoscopic gastrectomy
  • Laparoscopic pyloroplasty
  • Laparoscopic colon surgery
  • Solid organ
  • Laparoscopic Splenectomy
  • Laparoscopic Adrenalectomy
  • Thoracic
  • Video Assisted thorascopic Surgery
  • Biopsy
  • Pleurodesis / decortication
  • Wedge resection
  • lobectomy
  • Endoscopy
  • Esophagogastroduodenoscopy
    • diagnostic
    • therapeutic
    • gastrotomy tube placement
  • Colonoscopy Flexible Sigmoidoscopy
    • diagnostic
    • therapeutic
  • Clinical duties
  • The fellow will attend clinic for one full day per week minimum. Here he or she will demonstrate the following:
    • Ability to obtain a relevant history and physical
    • Order appropriate diagnostic test in order to reach a diagnosis
    • Decide on the appropriate surgery for the patient
    • Formulate a proper evaluation and plan for the minimally invasive surgery
    • Development of a proper follow up plan for the patient and postoperative management

Daily activities

The fellow will be a clinical instructor with the department of surgery. He will round on all of the minimally invasive patients. The fellow will review the plan of care for the patient with the resident team daily. The Fellow will attend one full day of clinic per week. The fellow will have first right of refusal for any minimally invasive case. Participation in all educational and administrative conferences is mandatory. Arrangements for call will be established based on the minimally invasive surgery attendings.

Research

East Carolina University and the Brody School of Medicine offer a wide variety of research opportunities for the Minimally Invasive Surgery Fellow. Specifically, our thirty year history of performing obesity provides a wealth of retrospective as well as prospective clinical research on obesity and related diseases. Bench research is also being performed at our institution on obesity and related disease through ECU’s departments of biochemistry, physiology, exercise, and sport science, and the human performance laboratory. The surgery department collaborates with these departments in joint research projects through the Metabolic Institute of East Carolina University that is headed by Walter Pories M.D., FACS.

East Carolina University Brody School of medicine is the east coast training center for the Da Vinci Robotic System. With two robotic systems as well as a Laparoscopic training facility, there are ample resources for research in minimally invasive surgery education research. Past research project include comparing the learning curves of robotic assisted surgery to that of laparoscopic surgery. Our program produced some of the earliest reports on using the Da Vinci sytem in general surgery.

Education

As a clinical instructor, the Fellow will have several required teaching requirements. Daily contact with the residents and medical students should provide the fellow with opportunity for informal teaching at the bedside and in the operating room. The fellow will also be assigned a few lectures to give the medical students during their rotation on surgery. There is a formal GI conference every week involving the faculty, residents, and medical students on the General and Laparoscopic Surgery/ Bariatric Surgery service. The residents are responsible for the presentations at this conference, but the fellow is expected to facilitate this conference. Near the completion of the year, the fellow is required to present at grand rounds on the topic of their choice.

Current research activities

The role of incretins in type two diabetes. William Chapman, MD, G. Lynis Dohm PhD, Ying Chang MD, MPH, Edward Seidel, Ph.D., Hisham Barakat, Ph.D., Kenneth G. MacDonald, John Pender, MD, all of East Carolina University. Since the current understanding of a few gut hormones does not provide satisfactory answer, we are using genomic, proteomic, and metabolomic analyses to broadly search for unknown markers and to further understand the roles of the existing gut hormones. $490,000 research grant from Johnson and Johnson.

National Institute of Health collaborative. Longitudinal Assessment of Bariatric Surgery patients.

Other clinical research that is currently taking place includes studying the efficacy of certain preoperative work up for bariatric surgery patients, results of gastric bypass in patients with psychiatric disorders and fibromyalgia, comparing stricture rates between different gastric bypass techniques, preoperative glycemic control reduce the rate of wound infection in gastric bypass patients, and comparing complication rates among morbid obese and super obese.

Facilities and Staff

A. Pitt County Memorial Hospital, one of four academic medical centers in North Carolina, is the flagship hospital for University Health Systems of Eastern Carolina and serves as the teaching hospital for the Brody School of Medicine at East Carolina University. Pitt Memorial is a regional resource for all levels of health services and information.

The hospital is a tertiary referral center and provides acute, intermediate, rehabilitation and outpatient health services to more than 1.2 million people in 29 counties. In an average year, about 33,000 inpatients and more than 266,000 outpatients are treated in our facilities. Our clinical staff includes more than 500 physicians and 1,200 nurses.

Pitt Memorial is fully accredited by the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO). There are 26 operating rooms, 55 adult intensive care unit beds, and around seven hundred total beds.

B. At the SurgiCenter, physicians perform a wide range of elective outpatient surgical procedures in eight modern and well-equipped operating suites. This is a 32,500-square foot, freestanding ambulatory care facility.

The SurgiCenter serves patients who will recover and be ready to leave the center in fewer than 24 hours. For our patients' convenience, all surgeries are scheduled in advance. A six-bed Recovery Care Center is a comfortable, relaxed and home-like atmosphere for patients who have undergone surgery.

SurgiCenter Services of Pitt, Inc., is a not-for-profit subsidiary of Pitt County Memorial Hospital. It is a fully licensed facility accredited by the Joint Commission on the Accreditation of Health Care Facilities

C. The Brody School of Medicine’s main building is physically connected to the hospital. The animate laboratory is located within this building as well as the school of medicine’s Library. The surgery clinic space is located on the first floor of this building. Our clinics are staffed by nurses, nurse practitioners, nurse assistants and secretaries. Attendings usually have one and a half days of clinic time per week. The Edward Warren Research Facility is part of the school of medicine/hospital campus and houses the robotic skills lab among others for the cardiovascular insitiute.

D. There are 36 physicians with in the Department of Surgery at the Brody School of Medicine, East Carolina University. These surgeons and research staff make up seven divisions. Their offices are primarily in the medical school annex of the hospital. It is here that the fellow will have their own office with appropriate supplies, computer, ect. It is located across from the fellowship Director’s office.

E. Salary is at the PGY 6 level. Since the fellow is considered part of the faculty, School of Medicine benefits will apply to them, including health, dental, malpractice and disability insurance. The resident will have three weeks vacation per year. ACGME work hours will apply. One conference/meeting will be paid for during the fellowship. Any other meetings for the purpose of a presentation will be covered by the department. Parking is free on the staff parking deck. Lab coats will be provided.

Faculty

William H.H. Chapman, III M.D. (Fellowship Director)

John R. Pender IV, M.D.

Walter E. Pofahl II, M.D.

R. Fredrick Williams, Jr., M.D.

Summary

One of the oldest bariatric surgery programs in the county

Large volume of minimally invasive surgery cases

Two da Vinci Robot systems. Intuitive Surgical Center for robotic surgery training.

Established and funded research projects

Experienced faculty that are known world wide in their fields of expertise

Application process

Interested applicants can apply through the Minimally Invasive Fellowship Council’s web page at fellowshipcouncil.org