An accomplished neurotologist and skull base surgeon, Miller joined Cedars-Sinai in 2021 and serves as director of Neurotology for the Cedars-Sinai Acoustic Neuroma and Lateral Skull Base Surgery Center. Her expertise includes otology, neurotology, cochlear implantation, vestibular schwannoma and acoustic neuroma care, lateral skull base surgery, Ménière’s disease, and hearing restoration.

“My vision is to continue to develop each of our subspecialties to the highest standard of rigorous academics and education paired with clinical excellence,” said Miller, also the inaugural LuEllen Margaret Edwards Chair in Otology and Neurotology. "Every patient who comes to us deserves care from a team that is both deeply trained and fully committed to outstanding outcomes, and every trainee deserves an environment where they can grow into an exceptional clinician."

As an initial priority, Miller has hired Cedars-Sinai’s first otolaryngology PhD researcher to help lead the development of a hearing regeneration lab.

"We are delighted for Dr. Miller to step into the role of division director," said Cristina R. Ferrone, MD, chair of the Department of Surgery at Cedars-Sinai. "Her expertise as a surgeon, dedication to education and clear vision make her an ideal leader for this team. We look forward to the many ways she will strengthen patient care and mentor the physicians of tomorrow."

Miller earned her bachelor’s degree from Harvard University and her medical degree from Harvard Medical School. She completed her surgical internship and residency in head and neck surgery at UCLA, followed by fellowship training in neurotology and skull base surgery at the University of California, San Diego (UCSD). Prior to joining Cedars-Sinai, Miller served as director of the Center for Balance and Falls at the University of California, San Francisco (UCSF), where she led clinical and research initiatives. She also spent seven years as an associate at the House Ear Clinic.

Miller succeeds Gene Liu, MD, in the role of division director.

“Over the course of his years at Cedars-Sinai, Dr. Liu made outstanding contributions to the Department of Surgery, and we are grateful for his leadership,” Ferrone said. “Through his recruitment of 19 surgeons across the network and the establishment of the ENT residency, he provided a strong foundation of excellence in the academic and clinical footprint of the division for Dr. Miller to build on.”

Read more from the Cedars-Sinai Newsroom—TODAY: Treating Hearing Loss Can Protect Your Brain From Cognitive Decline

Katie Buchholz always knew that she wanted to be a dancer.

“I had been taking classes since I was 4,” Buchholz said. “By eighth grade, I told my parents that this is what I wanted to do with my life.”

After graduating from college with a degree in dance, Buchholz set off from her Texas hometown to pursue her dream in Los Angeles. She spent several years working at a professional dance studio, teaching dance classes for children. She also danced on an international tour with a well-known children’s entertainer. Buchholz was well on her way to the career of her dreams.

But on the night of July 3, 2024, one single moment changed everything.

A Life-Altering Incident

While driving home from an outing with friends, Buchholz sustained life-threatening injuries in a devastating, head-on car crash.  She was rushed by an emergency services team to Cedars-Sinai.

“Katie came to us as a polytrauma, meaning she had multiple serious injuries, and required immediate intervention,” said Yassar Hashim, MD, associate medical director of Trauma at Cedars-Sinai, who was the trauma surgeon on duty the night Buchholz arrived at the medical center. “She had to be intubated right away to secure her airway, and she received a massive blood transfusion to replace what she had lost due to her injuries from the accident.”  

Buchholz had major trauma to both legs, including a broken femur in her right leg and vascular and nerve injury in her left. She broke multiple ribs and her left wrist and had a traumatic brain injury from the impact of the crash.

As a Level I trauma center, Cedars-Sinai is equipped to handle complex injuries like Buchholz’s.

“It’s all about teamwork,” Hashim said. “Each individual, from the trauma surgeons to the Emergency Department physicians, our residents, nurses and more, has a specific role. We follow our protocols and are trained to support these critically injured patients in an environment where every second counts.”

Coordinated Care

As the attending trauma surgeon, Hashim had the role not only to save Buchholz’s life, but to also help coordinate the multidisciplinary care she would need to manage her various injuries.

“There were a lot of teams involved,” Hashim said. “Katie required care from my colleagues in orthopedics, vascular, plastic and reconstructive surgery, Surgical ICU, and more.”

One of the many doctors she would encounter was Mitchel Seruya, MD, director of the Peripheral Nerve and Microsurgery Fellowship and professor of Surgery in the Jim and Eleanor Randall Department of Surgery. Seruya was called upon to repair the severe nerve injury in her left leg.

“The nerve that was severed is an important one because it feeds sensation in the bottom of the foot,” Seruya said. “Especially because she’s a dancer, she needs the feedback of that sensation to be able to feel where her foot is in space. If we couldn’t repair it, the hope of getting back to a career in dance would have been out.”

By harvesting a graft from the nerve that feeds her outer calf and sewing under a microscope with a suture thread that is finer than a doll hair, Seruya was able to reconstruct the injured nerve. The fix is not immediate, though, as electricity goes through the graft at the rate of about an inch per month. As time goes on, sensation will return as it continues to improve.

Little by Little

After being discharged from Cedars-Sinai, Buchholz went home to Texas for several months to stay with her parents.

“I still needed so much help at the beginning,” Buchholz said.

She worked diligently with physical, occupational and speech therapists to improve her strength and coordination. Through her determination and positive attitude, she saw progress. By July 2025, just one year after her accident, she was able to move back to Los Angeles to restart her life and career, even if it looks a little different than what she initially imagined.

“I know this is a long journey, but I live by the mantra of ‘little by little,’” Buchholz said. “Whether it’s being able to blow my own nose, relearning how to walk, or being able to lift heavier weights, I celebrate every incremental step as a win.”

Even while she waits for the nerve regrowth to get full sensation back to her foot, she continues her therapies and has returned to teaching at a local children’s dance studio. She believes her passion influences her healing.

“I was a dancer; I am a dancer,” Buchholz said. “I have progressed so much physically and mentally because I am determined to get back eventually.”

Her physicians praise this positive outlook.

“It is priceless to have patients with this kind of glass-half-full attitude,” Seruya said. “Their mindset helps heal them.”   

Inspiring Others

Buchholz is sharing her story at Cedars-Sinai’s upcoming Trauma Survivors Reunion on Monday, June 8. For the first time, Cedars-Sinai is bringing together trauma survivors, physicians, nurses, social workers, emergency services professionals and other medical staff to celebrate the strength of their patients who overcame life-altering injuries.

At the reunion, she will be able to reconnect with Hashim, the trauma surgeon who helped save her life.

“Because of my brain injury, I have no memories from immediately before or after my accident,” Buchholz said. “I may not recognize the people who were there that night, but I’m excited to meet them and say, ‘Thank you.’”

Hashim is looking forward to the event as well.

“We receive critically injured patients and see them in their most vulnerable state, often with no one else but us to advocate for them,” Hashim said. “I am excited to see Katie again and see how far she has come. These kinds of things are what make my job so rewarding. She went from struggling for her life to speaking at our event. It’s remarkable.”

Read more from Cedars-Sinai Stories and Insights: Stop the Bleed Courses at Cedars-Sinai

Miranda was riding home from school on a motorized minibike when he was hit by a vehicle and then dragged by a semitruck, resulting in catastrophic injuries. Initially rushed to a nearby Level II trauma center to be stabilized, Miranda had injuries so extensive and life-threatening that physicians there decided the best chance to save his life was to transfer him to Cedars-Sinai.  

“As a Level I trauma center, Cedars-Sinai is prepared to deal with highly complex cases like Albert’s,” said Galinos Barmparas, MD, medical director of Trauma in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai. “Even with our team’s extensive resources and expertise, it’s still a miracle Albert is alive, with the injuries he sustained.”

Major crush injuries to Miranda’s left leg required an amputation up to his hip. He also had a broken pelvis, a damaged urethra, and he battled severe infections from wounds he suffered after he was dragged on the road. Miranda required more than 20 surgeries and the expertise of physicians across multiple specialties, including trauma, orthopedics, plastic and reconstructive surgery, urology, pediatrics, physical therapy, and more.

“I never thought I'd be in a situation like this in my entire life, but here we are,” Miranda said. “But after, like, a long way coming, I've met new people here who've treated me well. And I'm actually glad that they wanted to work with me. ... So it made [Cedars-Sinai] feel like home.”

Barmparas said more than 100 healthcare workers helped Miranda get to this point.

“Patients may survive the initial hit and the initial surgeries,” Barmparas said. “But if they don't have the specialists and the resources, they may not be able to make it.”

Electric and gas-powered bikes that can travel upward of 25 miles per hour, like the one Miranda was riding at the time of his accident, are a safety concern for Barmparas, who oversees trauma surgery at Cedars-Sinai.

“These vehicles are dangerous. I can tell you that I see motorized bike, e-bike and electric scooter injuries in the trauma bay on a regular basis,” he said. “Patients come in all the time with traumatic brain injuries, facial fractures and other life-altering trauma.”

The accident occurred in late September, so Miranda spent the winter holidays, as well as his 17^th birthday, in the hospital. But in that time, he has made tremendous strides in his recovery and has regained some mobility with the assistance of a wheelchair and walker.

“It feels a little surreal, I think, the progress that we have seen from him,” said Romina Kim, MD, a pediatric hospitalist with Cedars-Sinai Guerin Children’s. “From not even being able to get out of bed to now walking with the walker. He’s a completely different kid from the one that we saw six months ago. It’s quite a miracle.”

Now, after more than five months in the hospital, Miranda is finally being discharged from Cedars-Sinai to continue his recovery at a rehabilitation center.

“Next is actually the rehab,” Miranda said. “I don't know how long I'll be there, but I hope it's a short amount of time so I can just get home already.”

The Cedars-Sinai team recently celebrated Miranda’s discharge with a celebration walk and send-off tunnel, waving pompoms and cheering him on as he made his way down the hallway of Cedars-Sinai Guerin Children’s. His physicians are encouraged by his resilience and how far he’s come not only with his physical, but also mental recovery from this traumatic event.

“He has a lot of dreams and aspirations,” Kim said. “And with the kind of attitude that he has, he can really become whatever he wants. I think he's going to do great things.”

As for Miranda, he is looking forward to getting stronger so he can get back to his normal routine and spend time with his friends. Still, he says he’ll miss his Cedars-Sinai care team.  

“Everyone has been so supportive and that's what keeps me positive,” Miranda said. “You know, if they want something good for me, I want something good for me as well.”

Read more from Cedars-Sinai Stories and Insights: Stop the Bleed Courses at Cedars-Sinai

“We use our voice to express ourselves, whether it’s enthusiasm at our team scoring a buzzer-beater, or extreme disappointment when they miss the shot,” said Anca Barbu, MD, laryngeal surgeon and associate professor in the Jim and Eleanor Randall Department of Surgery, Division of Otolaryngology-Head and Neck Surgery at Cedars-Sinai. “And those expressions are fine, but the volume at which we’re doing so can put the vocal cords at risk of trauma.”

Barbu, who specializes in professional voice and voice disorders, recently spoke with the Cedars-Sinai Newsroom about tips for enjoying the upcoming NCAA Tournament, and other major sporting events, while maintaining vocal health.

What are the risks of screaming too much during sporting events? What short- and long-term damage can you do?

Vocal cord trauma, also known as phonotrauma, can occur when we overuse our voice, potentially causing damage to the cords. In the short term, this can present as a change or loss of voice. Typically, this type of injury should resolve itself in 24 to 48 hours.

In the long term, vocal cord damage can become chronic laryngitis if the voice doesn’t get a chance to rest and heal.

If you lose your voice all of a sudden, such as in the middle of talking or yelling, we worry about more of an acute event such as a vocal fold hemorrhage. If that happens, seek medical care.

What tips do you recommend for preventing vocal strain while cheering on your favorite team?

In already loud environments, such as a packed arena or even an in-home watch party with friends, people tend to get louder to project over the ambient noise, creating a greater risk of vocal cord strain. I always tell patients that during these times, you can still be animated by cheering with your hands and facial expressions or clapping and using other external noisemakers rather than projecting your voice. Signs and banners are a great option, too. Just think outside of the voice box, if you will.

Are there certain foods and drinks you should avoid to protect your voice?

When you think about the types of foods consumed at these kinds of sporting events or watch parties, they tend to be very reflux-inducing foods. Foods that are greasy, fatty or spicy, alongside alcohol and carbonated beverages, will tend to create more acid in your stomach, leading to heartburn and silent reflux, also known as laryngopharyngeal reflux [LPR]. This creates an environment in your throat where tissues may be swollen, which makes them more prone to trauma and can present as a sore throat the next day. If you’re planning to enjoy these foods that may trigger silent reflux, do so in moderation or consider taking an antacid to help avoid the issue.

Additionally, it is important to avoid other carcinogenic products like tobacco or vaping, as those can irritate your vocal cords and throat as well.

If you do overdo it, how can you recover?

If you lose your voice instantaneously or experience hoarseness following overuse, the best thing to do is to simply be quiet. Vocal rest, avoiding all talking, is recommended for at least 24 and up to 72 hours, depending on the severity of the laryngitis. Do not try to push through with your voice or even whisper, because that is when greater injuries may occur.

At what point should you consult a doctor for vocal issues?

If vocal rest has not resolved the issue in 72 hours, you should contact your primary care doctor.

However, if it's been three or more weeks of laryngitis from yelling and your voice has not returned to baseline, it’s important at that point to see an ENT [ear, nose and throat specialist] for an exam of your vocal cords. If you are someone, such as a singer or actor, who relies on their voice professionally, it would be recommended to specifically see a laryngologist—an ENT with specialized training for voice-related issues, including vocal cord swelling and trauma.

Read more from Cedars-Sinai Stories and Insights: The Science of Hangovers

The findings, published in JAMA Surgery, provide a framework to better manage ongoing follow-up care of patients whose cancer has not spread to their lymph nodes and who have had their tumors surgically removed.

“We now have a way to identify patients whose higher risk of recurrence may have been previously overlooked,” said Cristina R. Ferrone, MD, chair of the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai and corresponding author of the study. “This gives us the opportunity to change the way we care for this patient population in a meaningful way.”

Pancreatic neuroendocrine tumors are a less common and typically less aggressive form of pancreatic cancer. Patients whose cancer has not spread to the lymph nodes or outside the pancreas have a 91% five-year relative survival rate following surgical treatment, according to the American Cancer Society. However, the Cedars-Sinai study identified a distinct subset of those patients who remain at high risk for their cancer to return.

The multi-institutional study analyzed data from 770 patients across five high-volume institutions and found approximately 10% of patients without lymph node involvement would eventually experience a recurrence of their cancer, most commonly in the liver. This data allowed investigators to develop a 13-point risk score by identifying four key factors that predict a higher risk of recurrence: male sex, a tumor size of 3 centimeters or larger, World Health Organization grade of 2 or higher, and whether cancer cells had entered the blood or lymph vessels, called lymphovascular invasion.

By using the newly created risk score to stratify patients into low-, moderate- and high-risk groups, investigators say they can better predict which patients should receive more frequent and intensive monitoring.

“The current guidelines leave clinicians with a ‘one-size-fits-all’ approach, but it’s clear from our research that not all patients require the same intensity of surveillance,” Ferrone said. “The results address a critical gap in current practice and will hopefully influence future guideline development for well-managed, individualized and cost-effective care.”

Shlomo Melmed, MB, ChB, Cedars-Sinai’s dean of the Medical Faculty and executive vice president of Medicine and Health Sciences, who was not involved in the study, said the new risk score could help physicians and patients around the world.

“The exciting research outcomes of Dr. Ferrone and team will have a significant impact on enhancing the care and management of all patients with neuroendocrine tumors,” Melmed said.  

Additional Cedars-Sinai authors include Shahrzad Arya, MD; Liti Zhang, MD; Alexandra Gangi, MD; Andrew E. Hendifar, MD, MPH; Giulia Cattaneo, PhD; Luigi Liguori, MD; Arsen Osipov, MD; Nicholas N. Nissen, MD; and Kambiz Kosari, MD

Other authors include Marco Ventin, MD; Carlos Fernandez del-Castillo, MD; Motaz Qadan, MD, PhD; Francesco Sabbatino, MD, PhD; Keith D. Lillemoe, MD; Alice C. Wei, MD, MSc; Jin He, MD, PhD; and Amer H. Zureikat, MD

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

As a highlight of the symposium, Armando E. Giuliano, MD, division director of Breast Surgical Oncology in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai, will receive the William L. McGuire Memorial Lecture Award in recognition of his significant contributions to the field of breast cancer research.

“It is a great honor to receive the 2025 McGuire Award,” Giuliano said. “We’ve made tremendous progress in the surgical treatment of this disease, and I am especially grateful to the brave patients who participated in the trials that helped us develop new standards of care and improve the lives of patients with early metastatic breast cancer.”

Giuliano was instrumental in refining sentinel lymph node biopsy for breast cancer in the early 1990s, sparing many women from more invasive breast cancer surgery. This technique identifies and removes only the first lymph node where cancer is most likely to spread to determine whether removing additional nodes is medically necessary.

Through two large multicenter trials, ACOSOG Z0010 and ACOSOG Z0011, Giuliano and team validated the technique that led to establishing the less-invasive sentinel lymph node biopsy as the standard of care, as opposed to axillary lymph node dissection, which removed most or all nodes and is associated with increased surgical complications. The findings from these trials transformed surgical management of breast cancer.

“The pioneering contributions Dr. Giuliano has made to breast oncology have not only changed the field, but they have directly and positively impacted the lives of millions of women worldwide,” said Cristina Ferrone, MD, chair of the Department of Surgery at Cedars-Sinai. “It is a privilege to work alongside Dr. Giuliano, and I wholeheartedly congratulate him on this well-deserved honor.”

Giuliano, the Linda and Jim Lippman Chair in Surgical Oncology, associate director of the Samuel Oschin Comprehensive Cancer Institute and co-director of the Saul and Joyce Brandman Breast Center—A Project of Women’s Guild, will present his award lecture on Wednesday, Dec. 10, at 9 a.m. CT.

Additional Cedars-Sinai experts attending the meeting:

Yuan Yuan, MD, PhD, director of Breast Oncology and medical director of Breast Cancer Research, will present data on how patient-derived organoids—tiny groups of cells—can guide therapy in patients with metastatic breast cancer. She also will present research on AI-driven H&E slides predicting triple-negative breast cancer patients’ response to therapy, as well as data from an ongoing clinical trial of a novel PD1-VEGF bispecific antibody for early-stage triple-negative breast cancer.

Stephen Shiao, MD, PhD, professor of Radiation Oncology and radiation oncology director of the Breast Oncology Disease Research Group, will participate in a plenary talk regarding a randomized trial of no-, low- or high-dose preoperative radiation with pembrolizumab and chemotherapy in node-positive, HER2-negative breast cancer. He can also discuss the potential of GLP-1 receptor agonists in combination with radiotherapy to improve overall survival in triple-negative breast cancer. Luxi Chen, MD, who will present a poster detailing this research at the conference, is a recipient of a San Antonio Breast Cancer Symposium Young Investigator Award.

Scheduling interviews:

To schedule an interview with a Cedars-Sinai expert, please contact:

Jillian Scholten | 949-244-2561 | jillian.scholten@cshs.org

Read more in Cedars-Sinai Discoveries: Abreast of Trends in Cancer

What do all those changes have in common? The ability for trauma surgeons to be more deliberate when every second counts, said Margulies, director of Acute Care Surgery in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai.  

“One of the biggest advancements we’ve made is actually knowing when we can avoid an operation,” said Margulies, who joined Cedars-Sinai in the early 1990s and was medical director of Trauma for more than 25 years.

It was 1984 when Cedars-Sinai was first designated a Level I Adult Trauma Center and, after its most recent evaluation and recertification by the ACS COT, it continues to be one of the longest-running Level I centers in Los Angeles County.  

“Maintaining Level I status for our hospital ensures that patients in our community have access to a center capable of managing any injury, no matter the severity, with the full spectrum of subspecialty support,” said Galinos Barmparas, MD, medical director of Trauma at Cedars-Sinai. “Patients can expect coordinated, expert and compassionate care delivered by a team that lives and breathes trauma readiness.”

Advancements in Care

Early in Margulies’ career, trauma patients often required more invasive, exploratory surgery to determine a diagnosis, Margulies said. But as imaging technologies improved, the care team could make better-informed decisions.

“The increased quality and speed of CT scans have made a big difference,” Margulies said. “And bedside ultrasound also became more common in the ’90s with the focused abdominal sonography in trauma—or FAST—exam, which allows us to make more rapid assessments of critically ill patients and provide more minimally invasive care when appropriate.”

Aside from better treatment techniques and technologies, Margulies said the types of trauma injuries he sees have also shifted.

“Before seatbelt laws were strictly enforced and airbags were required in cars, we saw a lot of head injuries and extreme traumas from ejection following motor vehicle collisions,” Margulies said. “Now that some of those safety measures are in place, we actually see more pedestrians hit by cars, potentially due to distracted driving.”

Margulies also noted that, because the patient population is getting older, many traumas the team treats now are a result of falls.

The trauma team at Cedars-Sinai has grown over the past 40 years as well. In 1999, ACS rules for Level I trauma centers began requiring an attending surgeon to always be on-site, 24 hours a day, seven days a week, 365 days a year.

“There were five of us who were attendings at that time, so I practically lived at the hospital,” Margulies said.

Since then, the team has more than doubled to 11 attending surgeons on faculty, with the expectation to grow. Additionally, all Cedars-Sinai trauma surgeons have completed a fellowship in surgical critical care.

What the Future Holds

Cedars-Sinai will continue to be evaluated by the ACS COT every three years to be redesignated as a Level I center.

“This reverification is both a validation and a reminder of the tremendous daily effort by our trauma team. It represents not just excellence in meeting national standards but a sustained commitment to continuous improvement and compassion in trauma care,” Barmparas said. “Every verification cycle is an opportunity to reflect on how far we’ve come and how we can keep pushing the standard forward for our patients and community.”

Read more from the Cedars-Sinai Blog: Stop the Bleed Courses at Cedars-Sinai

Widely known as a pioneer in robot-assisted colorectal surgery, Pigazzi performed the world’s first robot-assisted tumor removal for rectal cancer more than 20 years ago. He has continued to advance the colorectal surgery field with his expertise in robot-assisted, laparoscopic and open surgical techniques to treat complex colorectal conditions such as recurrent and metastatic colorectal cancer.

Pigazzi brings to Cedars-Sinai a rich history of surgical leadership. Most recently, Pigazzi was division director of Colorectal Surgery at New York-Presbyterian/Weill Cornell Medical Center. He also was executive director for Surgical Services, vice chair of Clinical Network, and professor in the Department of Surgery at City of Hope Orange County.

In his new role at Cedars-Sinai, Pigazzi will concentrate on developing the academic colorectal practice, opening novel clinical trials and advancing translational research.

“Cedars-Sinai’s new Faculty Division of Colorectal Surgery will continue to build best-in-class, patient-centered care by staying on the forefront of the latest surgical techniques, clinical trials and clinical practices,” said Cristina Ferrone, MD, chair of the Department of Surgery at Cedars-Sinai. “Under Dr. Pigazzi’s esteemed leadership, we will also enrich our training programs as we develop the colorectal surgical leaders of tomorrow.”

In addition to his clinical practice, Pigazzi is involved in many significant research initiatives, including a translational research effort investigating the role dietary sugars play in the development of colorectal cancer. His extensive publication record includes more than 150 peer-reviewed articles and 16 book chapters. 

“Dr. Pigazzi’s innovative clinical work and research discovery for colorectal cancer aligns perfectly with our commitment to providing leading-edge expertise and care for our Cedars-Sinai Cancer patients,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer.  

Pigazzi earned both his medical and doctoral degrees at Boston University School of Medicine. He then completed his general surgery residency at New York-Presbyterian/Weill Cornell Medical College, followed by advanced fellowship training in minimally invasive surgery at Hackensack University Medical Center and in colorectal surgery at the University of California, Irvine.

“I’m grateful for the opportunity to bring my passion to this leadership role in the Department of Surgery at Cedars-Sinai,” Pigazzi said. “I look forward to growing the division to be the best in the region in terms of clinical, research and academic excellence.”

Read more on the Cedars-Sinai Blog: Taking the Fear Out of Colon Cancer Screening

After her moped was mowed down by an SUV 14 years ago, Cedars-Sinai trauma surgeons spent weeks rebuilding her body. As for rebuilding her life, Brown continues to do that on her own. Brown’s role as a peer support volunteer in Cedars-Sinai’s new Trauma Survivors Network, helping others healing from physical trauma, is the newest part of that recovery.

The Trauma Survivors Network, a program of the American Trauma Society, connects survivors and educates and empowers patients and their families during recovery. At Cedars-Sinai, Brown and a team of other volunteers connect with patients to listen, share, encourage and reassure.

“It’s a community,” said trauma educator Gregory Jones, RN, injury prevention and outreach coordinator for the Cedars-Sinai Trauma Program. “Going through physical trauma can feel isolating. We wanted to have Trauma Survivors Network programming here so patients can feel a broader range of support as they navigate healing and recovery, and to help them feel more connected.”

Cedars-Sinai is one of only four Level I adult trauma centers in Los Angeles County, which means it provides the highest-quality care for every aspect of injury—from prevention and emergency lifesaving surgeries and clinical care, to rehabilitation. In 2024, more than 1,600 patients were treated at the medical center for traumatic injuries.

A 2023 paper published in Trauma Surgery & Acute Care Open noted that while trauma care has significantly improved survival over the past 50 years, continued struggles with disabilities, emotional challenges and brain injuries are common for many.

With this in mind, Jazmin Perez, a clinical social worker in the Jim and Eleanor Randall Department of Surgery, ensures trauma patients and survivors are aware of Trauma Survivors Network resources—information about recovery, inpatient and outpatient support groups, and peer visitation opportunities.

“We also check in with patients after they’ve been discharged from the hospital to see how we can continue to help,” Perez said. “Healing continues long after they get home, so making sure they feel supported and a sense of belonging is vital.”

Improving the patient experience and fostering a sense of community is a key goal of the Trauma Survivors Network; another, Jones said, is connecting survivors with the providers who cared for them.

“We want to introduce survivors to their first responders, as well as reconnect them with their trauma team,” Jones said. “We want these providers to be reminded of how much what they do matters.”

More Awareness for Trauma

Trauma Survivors Network volunteer Louise Lund experienced debilitating injuries in 2024.

One minute she was driving home from work; the next, emergency responders were removing her through her car’s roof. Lund was unconscious, with a shattered hip, pelvis and sternum, 12 broken ribs, and a paralyzed leg. A driver had sped through a red light at more than 90 miles per hour, hitting Lund directly in the driver’s side.

She had five nine-hour surgeries in five weeks and was at Cedars-Sinai nearly three months. As her body healed, there were unexpected symptoms to manage—hair loss, which she learned is normal after trauma, and the more common signs of post-traumatic stress disorder.

She recalls a lonely road to recovery filled with uncertainty and sorrow, as well as a realization that the road also represented a path toward healing and hope. Today Lund is eager to assure patients they are not alone.

“I want to bring more awareness to what happens to a person not only physically, but mentally,” Lund said. “Being able to say to people recovering, ‘Your resilience is your superpower,’ is part of my new journey of healing.”  

Representation for Survivors

It was a full-circle moment when Corentin Villemeur, another Trauma Survivors Network volunteer, recently picked up his official volunteer jacket. He was hospitalized in 2018 after he was hit by a drunk driver while walking across the street. He felt well-supported during recovery, but at the same time, no one had been through what he had.

“It’s comforting to know you’re not the only one,” he said.

The Trauma Survivors Network also gives Villemeur the opportunity to express gratitude.

“I’ve struggled with how to say thank you to Cedars-Sinai in a meaningful way,” Villemeur said. “The providers don’t always get to see all the good work they’ve done. I’m back to nearly 100%, and I want them to see how my hard work and their hard work paid off.”

Jones commended the Trauma Survivors Network volunteers, saying, “They had a dynamic life before their injury, and they’re able to share how they’ve reclaimed that life. They’re even stronger now, and they’ve opted to come back and help us help others—which is what Cedars-Sinai is all about.”

Stronger now, Villemeur—who once feared he would no longer be able to stand—is back to Latin dancing and distance running.

Stronger now, Lund is walking on her own again.

Stronger now, Brown can enjoy playtime with her young daughter.

“For a long time,” Brown said, “I was trapped in a body and life I didn’t recognize. Now I’m passionate about helping others also find the strength to keep going and come out on the other side with a life they love.”

For more information or to participate in the Trauma Survivors Network, contact Jazmin Perez at jazmin.perez@cshs.org.

Read more in Cedars-Sinai Discoveries Magazine: Regenerative Medicine for Orthopedics

felt torn knowing the gases she used to make surgery painless for patients were actually hurting the environment.

“It was disturbing to me and hard to reconcile that here I am as a healthcare provider preserving human health, and yet I create a ton of pollution,” Ma said.

Climate change and air pollution are the biggest threats to human health, according to the World Health Organization, and cause—or worsen—a range of health threats, including infectious diseases spread by mosquitoes, ticks or fleas; respiratory illnesses; and heat exhaustion.

According to a study published in Health Affairs, the healthcare industry may be responsible for up to 8% of greenhouse gas emissions, and anesthetic gases account for more than half of the emissions generated during surgery. These gases are especially harmful because they are released directly into the atmosphere. Using the anesthetic gas desflurane for one hour, for example, produces the same carbon emissions as driving a gasoline-powered car for 190 miles.

Ma launched a Cedars-Sinai Medical Center initiative in 2021 to address anesthesiology’s role in the problem. After four years, she and her colleagues have significantly reduced the output of desflurane as well as nitrous oxide, while still maintaining the highest quality of care and safety for patients.

Caring for Patients, Cleaning the Air

In 2021, Ma and anesthesiologist Michael Kissen, MD, started spreading the word with their colleagues about anesthesiology’s role in climate change, and the environmental benefits of switching to alternative gases.

“Anesthesia is sometimes more of an art than a science,” Kissen said. “Every anesthesiologist has their routine and their medications that they lean on, but we wanted to make our colleagues aware of all the risk profiles of these gases beyond what we learned in an anesthesia textbook.”

Anesthesiologists used to rely on desflurane to provide general anesthesia for patients before surgery, but it has 20 times the carbon impact of its alternative, sevoflurane.

Under Ma’s guidance, Cedars-Sinai Medical Center and other Cedars-Sinai patient care centers moved away from desflurane, and in 2023, the hospital officially removed the gas from its approved list of drugs.

With these changes, Cedars-Sinai went from using 1,200 bottles of desflurane in 2021 to fewer than 12 in 2024—achieving a 99% reduction. Ma said the shift is equivalent to taking 250 cars off the road.

The initiative also targeted nitrous oxide—commonly known as laughing gas—which is frequently used by pediatric and obstetric anesthesiologists and for dental procedures. Experts have found that much of the gas is lost before reaching the patient, posing a hazard to the healthcare workers present during surgery and the environment. Nitrous oxide also lingers in the atmosphere for 100 years.

By gradually phasing out nitrous oxide, Cedars-Sinai reduced emissions from 1,111 metric tons of carbon dioxide in 2021 to 234 in 2024.

Eliminating both gases collectively removed about 2,200 metric tons of carbon dioxide emissions over the past four years—roughly equivalent to the annual emissions of 400 homes. The project has gained a champion in Michael Nurok, MB, ChB, PhD, co-chair of the Department of Anesthesiology.

“This initiative is emblematic of Cedar Sinai's commitment to being at the forefront of medical care and science,” Nurok said. “Beyond delivering excellent patient care and outcomes, our team is thinking about the impact of these gases on the environment, employees, and future generations.”

Expanding Eco-friendly Lens

Nurok has taken up the cause, looking for other ways to minimize pollution. He is working with Robert Kaplan, Marvin Bower Professor of Leadership Development Emeritus at the Harvard Business School, on creating a framework for measuring the impact of healthcare devices on the environment—such as implants, devices and medical equipment—as they are processed and transported through supply chains.

With a better understanding of the environmental costs of different approaches to a procedure, physicians will be able to make informed choices about which materials and processes they choose. Much like a nutrition label helps consumers to make wise decisions about what they eat.

For Anesthesiology’s next project, Nurok and Kissen are collaborating with the Department of Orthopaedics and others to measure and reduce the carbon impact of hip replacement procedures.

Bryan Croft, the medical center’s executive vice president and chief operating officer, said this work encourages Cedars-Sinai staff members to be good stewards of its resources and the environment.

“We are thrilled to be able to support anesthesiologists’ mission to reduce greenhouse gases, bettering the world we live in, and we look forward to continuing to support eco-friendly projects,” Croft said.

Read more on the Cedars-Sinai Blog: Cedars-Sinai Appoints Department of Anesthesiology Co-Chairs

A CT scan at Pulido’s community hospital revealed a large tumor on Pulido’s right ovary—roughly the size of a small basketball. Surgeons removed the cancerous mass, only to discover a smaller tumor on the left ovary, which was removed three months later. Believing the worst was behind her, Pulido returned to work.

But her sense of normalcy was short-lived. Within a month, sharp pains returned.

“I was getting the worst shoulder pain I could get on my left side,” Pulido said. “I went back to the emergency room, and they did another CT scan. Then they saw another tumor. It was much bigger than the first one.”

The doctors diagnosed Pulido—just 22 years old— with a rare condition known as growing teratoma syndrome. The condition occurs when tumor tissue continues to grow rapidly and uncontrollably, pressing on vital organs like the heart and lungs.

The third and largest tumor, about 14 centimeters, was located near Pulido’s liver. Doctors recommended chemotherapy to shrink the tumor, but it failed, and the mass kept growing at an alarming rate. The tumor had progressed so much in size that it was pressing up against her right lung, shifting her heart to the far-left side, essentially under Pulido’s armpit.

By May 2024, the tumor had reached 27 centimeters, weighed more than 40 pounds, and left her wheelchair-bound and dependent on oxygen.

Opting for High-Stakes Surgery Despite the Risks

When chemotherapy failed, surgically removing the tumor was the inevitable choice. After multiple surgery delays and six failed attempts to put Pulido under anesthesia, her original care team halted the procedure altogether.

“The doctors came out of the surgery and told my mom they couldn’t move forward with the surgery because I couldn’t go under anesthesia without flatlining,” Pulido said. “They said the next best step for me would be hospice care.”

Still, Pulido and her family refused to give up.

In their last push for hope, her family sought several opinions from various institutions, but ultimately chose to seek care from Cristina Ferrone, MD, chair of the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai.

Ferrone quickly assembled a team of experienced anesthesiologists and 13 surgeons from various specialties, including cardiothoracic and liver transplant teams, to perform the complex surgery.

“The tumor was so large and heavy, and it involved such essential blood vessels that if you injure them, it would be very, very difficult to repair them. And an injury like that could quickly lead to death on the operating room table,” Ferrone said.

Yet, Pulido was willing to take her chances.

“The only one that could decide if I do go or stay on that surgery table would be God,” Pulido said. “And I just had really high hopes and faith that I was going to make it through.”

Awake on the Operating Table

The surgical team included Tyler Gunn, MD, an assistant professor of Cardiac Surgery at Smidt Heart Institute at Cedars-Sinai. During the first half of the surgery, Gunn performed a critical procedure called preoperative extracorporeal membrane oxygenation, or ECMO, using only local anesthesia while Pulido was still awake in order to keep her respiration and heartbeat stable and to stop her from flatlining.

“When someone goes to sleep for surgery, their muscle tone decreases and the blood flow to the heart can decrease as well. And they can have trouble with their blood pressure, breathing and heart rate,” Gunn said.

Furthermore, as Pulido’s heart was unstable, lying flat on the operating table was not an option. To work around this, the team placed Pulido on an incline for the first half of the surgery.

“In my mind, I just kept saying, ‘You got this, just keep fighting, keep pushing,’” Pulido said.

The long, arduous surgery was a success.

“In the end, we spent over 14 hours operating with all of the different teams working together,” Ferrone said. “It’s a testament to the working environment of Cedars-Sinai. It is an incredibly collaborative institution and patient care comes first, no matter what.”

Within a week after the tumor removal, Pulido’s lungs were able to fully expand, and her heart was back in its rightful place. She was able to breathe on her own for the first time in six months. 

From Wheelchair to Walking Down the Aisle

Amid her harrowing healthcare journey, Pulido found a few uplifting moments, including an important life milestone. Last year, during the halftime show on Super Bowl Sunday, her longtime boyfriend, Jeffrey Chavez, who had stood by her through every challenge, surprised her with a proposal.

“He was always there every day with me, whether it was before work, after work, he was there and visiting me all the time at my mom's house,” Pulido said.

For Ferrone, watching Pulido through her demanding recovery process has been incredibly gratifying.

“When she returned to the clinic a month later, the entire staff and I were amazed. Just six weeks earlier, she had been wheeled in, in a wheelchair. Now she walked through the doors,” Ferrone said. “She's an incredibly strong young woman and has a wonderfully supportive family.”

On June 21, a little over a year after her life-changing surgery, Pulido walked down the aisle and tied the knot with Chavez in front of her close family and friends. While Pulido will need to continue to monitor her health closely, the newlywed is hopeful and looks forward to the next phase of life.  

“I feel really good. I feel like a new person. I see the world differently,” Pulido said. “Every day is a positive day.”

Read more on the Cedars-Sinai Blog: Women in Surgery at Cedars-Sinai.

Investigators coined the term surgical gestures to describe the smallest moment-to-moment movements made by a surgeon to complete a procedure.

“These surgical gestures are as minute as a single movement of an instrument, a single cut of tissue or a single retraction of tissue, for example,” said Andrew Hung, MD, a urologic surgeon, associate professor of Urology at Cedars-Sinai and senior author of the study. “The gestures work something like an alphabet. You can string them together to form a surgical procedure the way you string letters together to form words.”

Investigators reviewed surgical video of 157 patients undergoing robotic-assisted radical prostatectomy, then followed up to determine whether patients recovered their sexual function one year after the procedures.

“Radical prostatectomy is the most common treatment for localized prostate cancer and robotic-assisted prostatectomy is the most common surgical procedure performed in the U.S.,” said Hyung Kim, MD, chair of the Department of Urology at Cedars-Sinai. “These findings have the potential to change outcomes for tens of thousands of patients each year.”

During these procedures, where the prostate is removed but the nerves responsible for sexual function are preserved, the surgeon is faced with a task much like peeling an orange, Hung said.

“Imagine the nerves as the orange peel,” Hung said. “We are trying to separate the peel from the fruit without causing injury or harm and it is a delicate act. This is a procedure we’ve been doing for decades, yet 27% to 81% of patients do not recover their sexual function, so we have room to improve.”

Because it takes as much as a year of recovery to know whether a patient’s sexual function will return, it has been difficult for surgeons to connect the dots between actions during surgery and a patient’s outcome, Hung said. But robotic procedures, which are routinely recorded for training purposes, offer a unique opportunity to capture a surgeon’s-eye view. And investigators were able to link use of certain gestures—and avoidance of others—to recovery of sexual function in patients.

“One example is that during a procedure a surgeon might retract or stretch the nerves in order to move them aside, and we found that increased use of retraction was linked with patients’ failure to recover sexual function,” Hung said. “This could be because that pressure causes paralysis of the nerves even though they are physically preserved.”

The investigators’ goal is to build a library of evidence linking surgical gestures to patient outcomes, ultimately changing surgical practice and improving results.

“Technique is passed down from one generation of surgeons to the next, but without data to back up what mentors are teaching their students,” said Hung, who is also an associate professor of Computational Biomedicine. “Until now, we haven’t had the right tools to objectively assess surgical technique. This study is meant to connect the dots between what surgeons do and how well their patients recover.”

There are few surgical performance measures that accurately predict patient outcomes, according to Cristina Ferrone, MD, chair of the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai and interim co-director for Cancer Clinical Services at Cedars-Sinai Cancer.

“These findings and future studies that build on this study could eventually change our approach to surgery and training surgeons,” Ferrone said. “By developing a clear understanding of core elements that translate to positive outcomes, it might be possible to improve results for patients across the surgical spectrum.”

Additional Cedars-Sinai authors include John R. Heard, MD; Umar Ghaffar, MD; and Cherine H. Yang, BA.

Other authors include Runzhuo Ma, MD; Melissa Assel, PhD; Christian Wagner, MD; Geoffrey A. Sonn, MD; Alvin C. Goh, MD; Shady Saikali, MD; Vipul Patel, MD; Andrew Vickers, PhD; and Jim C. Hu, MD.

Funding: This project was supported by a grant from the National Cancer Institute (R01CA273031).

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a special type of treatment for patients with certain cancers that have spread to the abdominal cavity (peritoneum).

Unlike regular chemotherapy, which is often delivered through an intravenous (IV) drip and then circulates throughout the entire body, HIPEC is delivered during a surgical procedure. Also called “hot chemotherapy,” HIPEC involves delivering high doses of heated chemotherapy directly to the abdomen during the surgical procedure. The chemotherapy solution is heated to about 41 to 42 degrees Celsius (about 108 F).

“Bathing the peritoneal cavity with heated chemotherapeutic agents helps to target and kill cancer cells that might be too small to remove through surgery alone,” said Alexandra Gangi, MD, director of the Gastrointestinal Tumor and Cancer Regional Therapies programs at Cedars-Sinai Cancer and associate professor at the Jim and Eleanor Randall Department of Surgery.

Gangi recently spoke with the Cedars-Sinai Newsroom about how HIPEC works and who can benefit from the targeted surgical procedure.

What is HIPEC and who gets it?

HIPEC is a regional therapy used for patients with peritoneal disease, where cancer spreads to the peritoneum—the smooth membrane lining the abdominal wall and surrounding organs. When cancer from sites like the colon or the peritoneum itself spreads into the abdominal cavity, after removing visible tumors through surgery, heated chemotherapy is circulated in the abdomen to target and destroy remaining cancer cells at a cellular level.

Who is a good candidate for the HIPEC procedure?

Good candidates for HIPEC are patients with certain cancers that have spread within the peritoneum, a membrane that lines the inside of the abdomen and pelvis abdominal cavity. These patients have stage 4 cancer. This can include appendix cancer, colon and rectal cancer, mesothelioma, and primary peritoneal cancer. Some patients with gastric and ovarian cancer are eligible for the procedure, as well.

What does the HIPEC procedure involve?

The procedure typically begins with a cytoreductive surgery, where visible tumors are removed. Afterward, large catheters are placed into the abdominal cavity and the abdomen is closed. Heated chemotherapy is then circulated for 30 minutes to about an hour and a half at temperatures between 41 to 42 degrees Celsius—the solution is really hot.

Once that's done, we drain all the fluid from the belly and we open the patient back up. If there are any new surgical connections we may need to create, as in scenarios where we have removed some colon or intestine, we do that. We rinse the abdomen with saline, and then we close up the abdomen, and the patient goes to recovery.

How is HIPEC different from regular chemotherapy?

The procedure offers a more focused approach compared to regular chemotherapy, which circulates through your bloodstream throughout your body. Typically, patients won't see major fluctuations in their blood count, and they’re not necessarily considered immunocompromised. Unlike IV chemotherapy, which requires repeated sessions every few weeks, HIPEC is typically a one-time procedure, but can be repeated in some cases.

Systemic chemotherapy, which is given through an IV, relies on blood flow to reach tumors, but small tumors may not receive enough blood flow to be effectively treated this way. In HIPEC, chemotherapy is used after the visible disease is removed to kill any remaining cancer cells that exist at a cellular level since it only penetrates about three millimeters into the abdominal wall.

How does HIPEC improve survival rates?

For certain late-stage cancers, the survival rate is quite a bit lower, at around the 20% range. However, for certain mucinous tumors like pseudomyxoma peritonei, a type of appendix cancer, HIPEC can be life changing. The surgery significantly improves survival rate and can reduce the risk of recurrence. In some cases, survival without recurrence can be over 80%. It's a huge range but it is dependent on what type of cancer we're ultimately trying to treat and the patient's overall response to treatment.

What is the recovery process following the HIPEC procedure?

After surgery, some patients experience delayed return of bowel function, where the intestines take time to "wake up." This might lead to symptoms like reduced appetite, constipation or diarrhea, depending on what was removed during the surgery. Patients may also experience some discomfort or bloating. It’s best to avoid heavy lifting for about 6-8 weeks to allow proper healing. I typically advise patients that the first three months are kind of tough. And then you kind of start to feel more like your normal self. It’s a marathon, not a sprint.

Read more on the Cedars-Sinai Blog: The Need for Colorectal Cancer Screening in the Hispanic Community

Cedars-Sinai, part of a national multicenter consortium, will be responsible for developing protocols for the procurement and preservation of donor tissue as well as the eye transplant surgeries themselves. The Cedars-Sinai effort is being led by Curtis L. Cetrulo Jr., MD, vice chair of Research in the Jim and Eleanor Randall Department of Surgery and director of the Division of Plastic Surgery at Cedars-Sinai.

“Vision loss affects over 7 million Americans and this award represents an opportunity to really move the needle in our treatment of blindness. With this funding, I’m confident we can make progress toward eye transplantation,” Cetrulo said. “As the only clinically active vascularized composite allotransplantation program approved for face and eye transplantation on the West Coast, we are in a unique position to design the protocols that will allow for successful optic nerve connection and regeneration. We will also be addressing preservation of the donor eye tissue in transit to safeguard the optic nerve and retina, which are very sensitive to periods of decreased blood flow.”

Cedars-Sinai joins several partners, including the University of Colorado Anschutz Medical Campus, the effort’s primary award recipient. The other partners are Johns Hopkins University, University of Wisconsin, Indiana University, University of Southern California, the National Eye Institute and the Foundation for Fighting Blindness. The ARPA-H funding for the project totals up to $46 million, with up to $6 million dedicated to Cedars-Sinai’s clinical surgical efforts.

ARPA-H is a federal agency established to advance high-potential, high-impact biomedical and health research that cannot be readily accomplished through traditional research or commercial activity. 

In its clinical transplantation practice, Cedars-Sinai will employ the robotic Symani Surgical System, which was recently acquired by the hospital. Currently, Cedars-Sinai is the only institution on the West Coast utilizing this new and highly specialized robotic microsurgery technology, which scales down the surgeon’s movements significantly for extreme precision.

“This is just another example of how the Department of Surgery at Cedars-Sinai strives to be at the forefront of the most innovative and life-changing procedures,” said Cristina Ferrone, MD, chair of the Department of Surgery at Cedars-Sinai and the Linda and Jim Lippman Chair in Surgical Oncology. “The work our team is doing on this project has the potential to transform clinical practice and impact the lives of millions of people around the globe.”

Cedars-Sinai is a leader in treating eye disease with novel approaches. Previously, Clive Svendsen, PhD, professor of Biomedical Sciences and Medicine and executive director of the Cedars-Sinai Board of Governors Regenerative Medicine Institute, received a $10.5 million grant from the California Institute for Regenerative Medicine (CIRM) to launch a clinical trial testing treatments for retinitis pigmentosa, an inherited eye disease with no known cure.

Read more from the Cedars-Sinai Blog: Pioneering Advances in Surgery

In recognition of Lung Cancer Awareness Month, the Cedars-Sinai Newsroom sat down with Soukiasian to learn more about the recent surgical advances that are benefiting patients, including techniques he has pioneered.

What are some of the latest trends you have seen in lung cancer diagnosis?

While lung cancer remains the second-most common cancer in both men and women, as well as the leading cause of cancer death in the United States, we have been seeing an increased incidence of younger, nonsmoking women being diagnosed. This is a national trend, and we have also seen it in action here at Cedars-Sinai. In fact, the number of lung resections we have done for nonsmoking females during 2024 is higher than all of 2022 and 2023 combined, and the majority of those patients are women who are younger than 70 years old.

It’s a troubling trend to consider because current lung cancer screening guidelines outlined by the American Cancer Society are only geared toward individuals between the ages of 50 and 80 who are active smokers or have a smoking history of at least 20 pack years.

You pioneered an ‘all-in-a-day’ procedure that includes biopsy and resection for lung cancer masses. Can you tell us about this technique?

The Single Anesthetic Bronchoscopic Biopsy and Resection technique was developed in 2022 to allow for real-time, minimally invasive diagnosis via robotic bronchoscopy, followed by immediate resection when indicated. This means many patients will have to undergo just one procedure, instead of two.

We start with the patient under general anesthesia. Using the Ion bronchoscope—a scoping device directed through the patient’s mouth, into their airway and lungs—alongside a specialized CAT scan that recreates a 3D map of the patient’s airway, we can navigate directly to the mass of cancer cells, almost like we’re following Google Maps walking directions. Once we reach the mass, we biopsy it and send the tissue sample to the lab, where it can be quickly analyzed. This whole process typically takes less than an hour.

If the sample comes back as benign, the patient can be woken up and sent home with follow-up instructions. In this case, they have completely avoided unnecessary, invasive surgery. Alternatively, if the sample is determined to be malignant, the patient remains under anesthesia and, at that time, we perform a robotic-assisted resection.

This process allows a patient with early-stage, malignant disease to ultimately obtain a diagnosis as well as a therapeutic intervention within the same day and with the same anesthetic. This not only cuts down on wait times, but can also help to alleviate the mental anguish that goes along with a delay between biopsy/diagnosis and resection. The shorter the period of time a patient has cancer in their body, the better off they are both physically and psychologically.

This technique is becoming more common, and I have had the opportunity to train physicians all over the world in the practice.

What’s next for minimally invasive lung cancer surgery?

Standard robots used in minimally invasive lung procedures are multi-port, meaning they require four small incisions in the patient’s chest, through which all surgical instruments and a camera are inserted. However, Cedars-Sinai was recently part of a Food and Drug Administration (FDA) trial for single-port thoracic surgery, a technique that involves only a single incision.

The single-port robot that was studied in the trial is now FDA approved and, as the only institution in the Western United States using the device, we are the current leader in this field, performing the majority of robotic, single-site lung resections in the country.

Patients undergoing single-port thoracic surgery often experience reduced postoperative pain, shorter hospital stays and faster recovery times. The technique is gaining popularity due to its effectiveness and the improved outcomes it offers, making it a promising option for various thoracic conditions.

What else should readers know about lung cancer?

Early detection is key in this disease. When we can treat lung cancer surgically, before it has spread, we can greatly increase a patient’s survival rate. Some cases where we are able to fully resect the tumor to remove the cancer will go on to require additional chemotherapy or immunotherapy treatments.

This is why it is important to incorporate multidisciplinary care early in the diagnosis and treatment of the disease. The addition of immunotherapy and targeted therapy in the perioperative setting has led to improved survival for patients. Our multidisciplinary team of surgeons, medical oncologists, radiation oncologists, pulmonologists, radiologists and pathologists meet to discuss the appropriate therapy for each patient for a personalized approach.

That being said, data from the American Lung Association (ALA) says that only 1% of eligible California residents are screened for lung cancer. This is significantly lower than the national average of 6%. I am on the leadership board of the local Los Angeles chapter of the ALA, and one of our missions is to increase awareness for and access to lung cancer screening programs in the state.

Cedars-Sinai’s Lung Cancer Screening Program is an excellent local resource. I would encourage all eligible patients between the ages of 50 and 80 who are current smokers or who have quit smoking in the last 15 years to call our experts today for a screening consultation.

Read more from the Cedars-Sinai Blog: Lung Cancer Screening Demystified

Dr. Berci passed away on Aug. 30 at the age of 103, ending a distinguished career as a groundbreaking innovator who revolutionized the field of endoscopic surgery. A gifted violinist who chose medicine at his mother’s urging, Dr. Berci came to Cedars-Sinai in the 1970s and remained actively engaged into his 100s as an educator and senior director of Surgical Endoscopy and Innovation Research.

"George was a towering figure in our profession," said Edward H. Phillips, MD, executive vice chair of the Jim and Eleanor Randall Department of Surgery, a longtime collaborator with Dr. Berci and a close friend of the Berci family. “His profound legacy lives on in the hundreds—if not thousands—of medical students and surgeons influenced by his innovations and ideas."

Dr. Berci's designs and use of micro-instrumentation—including fiber optic-based lighting and cameras—paved the way for the development of endoscopic and laparoscopic surgery. Compared to traditional open surgical methods, the new, minimally invasive procedures required far smaller incisions, dramatically reducing patients’ pain and recovery times.

"The techniques Dr. Berci developed have had a profound impact on a generation of surgeons," said Bruce L. Gewertz, MD, Cedars-Sinai surgeon-in-chief and vice dean of Faculty Affairs and Clinical System Development. “He was a brilliant and creative physician, but beyond that he was one of the best medical educators we’ve ever seen.”

A familiar presence at the medical center for decades, the Hungarian-born immigrant always slept with a pen and a yellow notepad by his bed to draw surgical innovations as they came to him. He was known for his ingenuity, persistence and wry sense of humor.

Dr. Berci’s influence and achievement in the field are all the more extraordinary given that medicine was not his primary passion during his formative years. The son of the assistant conductor of the Vienna Philharmonic Orchestra, Dr. Berci showed considerable promise as a violinist and could play concertos by age 10.

A Conscripted Nazi Laborer

Following his mother's wishes, Dr. Berci would pursue a career in medicine, but his professional path was stalled by the outbreak of World War II, when he was forced to work as a laborer for the Nazis. During one especially grim winter assignment, he spent months in the Romanian mountains, digging into the cold, hard ground to build defensive fortifications. Later, Dr. Berci was transferred to a railway center near the Polish-Czech border, where he unloaded explosives for the Axis war effort.

"Unfortunately, I had a terrible early life in respect to being a Jew," said Dr. Berci, who often shared his story of survival with student groups at the Museum of Tolerance in Los Angeles. "The next generation needs to know about what happened."

Escape to the Underground

In the summer of 1944, Dr. Berci and hundreds of other conscripted Jewish laborers were packed onto a train destined for the death camps. The train stopped near the Hungarian capital during an air bombardment by British and American forces, which caused guards to flee.

"Everybody disappeared," Dr. Berci recalled. "So, we disappeared, too."

Soon Dr. Berci was recruited to work for the Hungarian underground and became part of a large-scale operation of forging papers. The network was organized by the Swiss Vice-Consul Carl Lutz, who helped save thousands of Hungarian Jews by issuing false protective letters.

During this period, Dr. Berci frequently carried false documents in a briefcase to deliver to Jews in hiding throughout the city. Had he been stopped by German or Hungarian fascists, he would have been killed. 

"This was extremely dangerous," he said. "But I did it because it had to be done."

Medical Degree and the Soviet Invasion

After the war, Dr. Berci remained in Hungary and earned a medical degree from the University of Szeged in 1950. He continued surgical training before moving in 1953 to Budapest, where he helped establish an experimental surgical division.

In 1956, the Soviet army marched into Budapest to crush the Hungarian revolt against its satellite Communist regime. After a fierce battle near the Parliament building, some 250 casualties poured into his nearby hospital, Dr. Berci recalled. After two straight days of administering treatment, doctors ran out of basic medical supplies and blood.

By 1957, Dr. Berci, who did not then speak English, moved to Australia after being awarded a Rockefeller Foundation fellowship in the Alfred and Royal Melbourne hospitals. There, he viewed the inside of a dilated common bile duct with an old cystoscope, the available instrument at the time that allowed a view of the inner duct but provided poor image quality. That experience propelled Dr. Berci into his life's work.

Recruited to Cedars-Sinai

In 1967, Dr. Berci was recruited to join the Cedars-Sinai Department of Surgery as a visiting scholar by Leon Morgenstern, MD, then the chair of Surgery. Several years later, Dr. Berci joined the faculty as full-time director of a multidisciplinary surgical endoscopy unit, a new idea at the time.

It was at Cedars-Sinai in the 1970s that Dr. Berci pioneered work that greatly improved illumination—a critical advancement that touched nearly every procedural specialty and led to new endoscopic applications in many areas.

Honors and Awards

Dr. Berci's vast contributions to medicine brought him significant acclaim. In 1992, he received Cedars-Sinai’s Pioneer in Medicine Award. In 2011, he was awarded the Jacobson Innovation Award from the American College of Surgeons. The honor recognizes surgeons who have provided a new development or technique in a surgical field.

In 2012, he was awarded an honorary doctorate from Semmelweis University in Budapest and had a building named in his honor. He was also a clinical professor emeritus of Surgery at the University of California and the University of Southern California. In June 2017, he received the inaugural Cedars-Sinai Lifetime Achievement Award.

Dr. Berci was a founding member of the International Biliary Association and a founding member and past president of the Society of American Gastrointestinal and Endoscopic Surgeons, which created the SAGES George Berci Lifetime Achievement Award in Endoscopic Surgery.

“Dr. Berci’s contributions have left an indelible mark on the medical community, and his legacy will continue to influence the practice of surgery for generations to come,” SAGES said in a message to members shortly after his passing. “His passing is a significant loss to all who knew him and to the broader medical field.”

Cristina R. Ferrone, MD, chair of the Randall Department of Surgery, remembered Dr. Berci as a remarkable figure whose influence continues to be felt throughout the surgical community.

“Dr. Berci spent more than half of his long and extraordinary life in service at Cedars-Sinai, where he will be remembered fondly for immeasurable contributions to the surgical field as well as his commitment and passion for medicine,” Ferrone said.

Dr. Berci is survived by four children and seven grandchildren.

But medication is not the only option for patients with obesity who need to lose weight to improve their health. Bariatric surgery has helped patients lose considerable weight—and keep it off—for decades.

“A significant benefit of surgery compared with medication management is that we expect the effect to endure decades into the future, if it’s accompanied by healthy lifestyle changes,” said bariatric surgeon Jeremy Korman, MD, medical director of the Cedars-Sinai Marina Weight Management Center.

Korman added that insurance typically covers surgery if a patient meets certain medical criteria. Pricey GLP-1s, sold under brand names like Ozempic and Wegovy, often are not covered by insurance for weight loss purposes and have become so popular they can be hard to find in pharmacies.

To better understand both of these powerful weight loss options, the Cedars-Sinai Newsroom spoke with Korman and Kulmeet Sandhu, MD, associate director of Minimally Invasive and Bariatric Surgery and associate professor in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai Medical Center.

Are there patients who would benefit from weight loss surgery rather than medications?

Sandhu: There are some patients who may benefit more from bariatric surgery, or weight loss surgery, rather than medical weight loss management, or taking medications for weight loss. Those include patients who have had side effects previously for medical weight loss, or who don't have effective results with medical weight loss. We also have some patients who have a much higher BMI [body mass index], which is where their weight is much higher, and they may not see as much effect from medications and may have better long-term benefits from surgery. We have also noticed that the most effective long-term weight loss solution is bariatric, or weight loss, surgery.

What are the most commonly performed types of weight loss surgery?

Korman: When we talk about bariatric, or weight loss, surgery, the two most popular options are sleeve gastrectomy and gastric bypass. The sleeve gastrectomy is an operation where we change the size and shape of the stomach only. The stomach is made narrower and more tube-shaped, looking almost like a banana. What's distinctive about sleeve gastrectomy, which is what makes it popular, is that we maintain the natural pathway from stomach to intestine without making new connections. This makes for slightly easier nutritional management for the patient.

For the gastric bypass, we are also changing the size and shape of the stomach, including making the stomach smaller. But we also create a new connection; we reroute the pathway from stomach into the intestine. This added, “malabsorptive,” element does make it a more powerful operation since we are short-circuiting some of the intestine. There is a drawback to altering the natural pathway since nutritional management becomes a bit more complex. There is then greater responsibility for vitamin supplementation and for monitoring in follow-up. However, for select patients this is a more effective option and therefore the appropriate choice.

What is a common misunderstanding about weight loss surgery?

Sandhu: One of the things I think holds people back from having surgery is concern about the risks of it. But the majority of my patients that have had surgery say the biggest regret they have is not having done it sooner. It's very effective, and it's also very safe. The long-term complications are quite minimal, and people do very well from surgery.

There also is a stigma around weight loss surgery that somebody has failed things like diet and exercise. But that's not the case. Patients may have the same diet as somebody else and not be able to lose weight because their biology is different. What surgery does, it just allows you to have another tool to be able to eat less and have more effective weight loss. And I think that's really important to realize.

What should patients know to help them achieve lasting results?

Korman: In addition to the treatments that we provide, the patients must change their lifestyle. That includes both nutritional and physical activity approaches to their lives. And with changing their lifestyle, they're absolutely going to be able to achieve their potential, the weight loss success that we expect. The odds of successful long-term weight loss increase to the 80% range. 

Sandhu: This is not a quick fix. It involves a long-term relationship with our patients. You know, when we become your doctors, we, as bariatric surgeons, say we become your doctors for life.

Read more from the Cedars-Sinai Blog: Bariatric Surgery Myths and Misconceptions

The gift establishes the Jim and Eleanor Randall Department of Surgery and marks a milestone in the medical center’s mission to serve the specialized needs of patients in Los Angeles and beyond.

“Eleanor and I believe deeply in Cedars-Sinai’s vision and the exceptional work being performed by the Department of Surgery team,” said Jim Randall. “We wish to continue fostering lifesaving campaigns and extend this gift with that full intention.” 

Cedars-Sinai is internationally known for its leading-edge surgical innovation and research across many specialties, including major lifesaving cancer, gastrointestinal, transplant, vascular, chest, trauma, otolaryngology (ENT) and reconstructive plastic surgeries. The medical center performs more than 32,000 operations each year across all disciplines and also is well known for its clinical expertise in gastroenterology, cancer, neurology, cardiology and pulmonary care.

“This amazing gift strengthens our research and training programs and provides critical resources to push the boundaries of surgical medicine,” said Cristina R. Ferrone, MD, chair of the Jim and Eleanor Randall Department of Surgery and the Linda and Jim Lippman Chair in Surgical Oncology.

The Randalls are longtime supporters of Cedars-Sinai and have partnered on several campaigns and enterprises. This gift also establishes the Jim and Eleanor Randall Chair in Surgery in honor of Edward H. Phillips, MD.

Phillips is executive vice chair of the Jim and Eleanor Randall Department of Surgery and the Dolly Parton Chair in Surgical Innovation in honor of Edward H. Phillips, MD. A pioneering authority in surgical medicine, Phillips has spent more than four decades leading Cedars-Sinai’s programs and is an internationally recognized developer of novel surgical techniques and laparoscopic instrumentation used in minimally invasive procedures.

“We are inspired by the dedication and trailblazing work of Dr. Ed Phillips, whose extraordinary commitment to excellence in patient care serves as an example to the medical world at large,” Jim Randall said.

Thomas M. Priselac, president and CEO of Cedars-Sinai and the Warschaw Law Chair in Healthcare Leadership, added, “This amazing gift from the Randall family reinforces Cedars-Sinai’s position as a leader in academic medicine. It also ensures we remain at the forefront in training future generations of surgical specialists. The Randalls’ visionary investment builds on this institution’s quest to pioneer new surgical methods and technology that will save lives.”

And when that emergency arises, anyone can be ready to save a life, said Gregory Jones, RN, injury prevention and outreach coordinator for the Cedars-Sinai Trauma Program.

“There are certain lifesaving steps everyone can take before help arrives,” Jones said, adding that it’s his mission to share those steps far and wide so people at the scene know what to do until health professionals can take over.

“A person can bleed to death in three to five minutes,” Jones said, “but it can take upwards of eight minutes for emergency help to arrive.”

Uncontrolled bleeding is the No. 1 cause of death after a mass shooting, stabbing, and other mass casualties. 

The techniques Jones teaches are part of Stop the Bleed, a program developed by the American College of Surgeons following the 2012 school shooting at Sandy Hook Elementary School, in which 26 people, most of them children, died.

Stop the Bleed methods are effective in all traumas that involve bleeding, whether it’s from natural disasters or car accidents, said Jones, who has taught Stop the Bleed to groups throughout Greater Los Angeles for the past seven years.   

If an emergency arises, the first step is to call 911, Jones said. After that, there are three basic techniques to stop bleeding until help arrives.

Technique No. 1

Find the wound that’s bleeding and cover it with gauze, or even a shirt or towel, if that’s all that’s handy. Then put one hand on top of the other and press on the wound and hold it there until help arrives.

Technique No. 2 

If blood is pouring out of the wound, you have to pack the wound. If you have gloves, put them on, then use gauze, a towel or a T-shirt to pack the wound. Stuff the material into the wound as far as it can go. After you’ve packed the wound as much as possible, press on it with a covering and both of your palms until help arrives.

Technique No. 3

If you have a tourniquet, place it about three inches above the wound. Tighten the tourniquet by turning the crank in either direction until the bleeding stops. This will be painful but it’s important to keep turning until the bleeding stops. When you’re done, make note of the time when you placed the tourniquet.

Those interested in learning more can find a class led by Cedars-Sinai trauma educators or take an interactive online course through Stop the Bleed.

Read more on the Cedars-Sinai Blog: Donating Blood During a Disaster--How It Helps

Millions tuned in to the ABC prime-time event, An Oprah Special: Shame, Blame and the Weight Loss Revolution, as Velazquez, other medical experts and Winfrey discussed obesity as a chronic disease and addressed the life-changing impact as well as side effects of weight loss medications.

“A multipronged approach is the way it has to be,” Velazquez told Winfrey. “I think a lot of times people think that they can just pick up the medication and take it without any other counseling. The key, however, is that you’re working with a healthcare team that is multidisciplinary.”

Velazquez emphasized that obesity is a complex medical condition, and diet or exercise alone may not be enough for a person to lose weight, keep it off long term and prevent weight-related diseases.

In the special, Winfrey talked about her own experience of feeling weight shamed for 25 years.  

“It is a very personal topic for me and for the hundreds of millions of people impacted around the globe who have for years struggled with weight and obesity,” said Winfrey, who also revealed that she began taking a prescription weight loss medication in the past year.

Velazquez explained that anti-obesity medications approved by the U.S. Food and Drug Administration—such as semaglutide (Ozempic)—have been shown to be safe, if taken correctly and long term.

“We have good trials showing that when patients stop medication, the disease comes back,” Velazquez said.  

Velazquez also was included in media coverage of the special, including in The New York Times, Oprah Daily, and Time.  

Read more on the Cedars-Sinai Blog: Weight-Loss Drugs, What to Know Now.

A car accident and follow-up CT scan to check for related injuries pinpointed the cause of her symptoms: a rare tumor called a pheochromocytoma in one of her two adrenal glands.

Adrenal glands sit on top of each kidney and produce hormones that control various functions in the body. The pheochromocytoma, a type of adrenal tumor (also called an adrenal nodule or adrenal adenoma), was not cancerous but was producing excess hormones that were causing Paez’s symptoms. Left untreated, pheochromocytomas have the potential to become cancerous and also can produce stress hormones like adrenaline that can lead to a severe increase in blood pressure and risk of heart attack or stroke.

Paez quickly sought out experts in the treatment of adrenal tumors and found Cedars-Sinai specialists Anat Ben-Shlomo, MD, an endocrinologist and associate professor of Medicine, and Yufei Chen, MD, an endocrine surgeon and assistant professor of Surgery in the Department of Surgery. The physicians are co-directors of Cedars-Sinai’s Multidisciplinary Adrenal Program, which offers the complete spectrum of care and treatment for patients with adrenal tumors.

While most adrenal tumors are harmless, some can cause adrenal disorders and symptoms that should be addressed by a skilled team.

“We respond with appropriate treatment recommendations based on each patient’s individual needs,” Chen said. “We collaborate between endocrinology and surgery, and we involve other subspecialties, including genetics, cardiology, pediatrics, pathology, interventional radiology, radiology and oncology, as needed. The multidisciplinary aspect of our program is unique.” 

Ben-Shlomo called the program a “one-stop shop” that benefits both patients and physicians.

“A powerful benefit of our program is that the patient doesn’t need to go all over the place visiting doctors—we have everything required to address an adrenal tumor, and all physicians on the patient’s care team are in constant communication,” she said. “Some patients with adrenal tumors will need treatment and monitoring for the rest of their lives, and we’re here for them for the duration.”

Ben-Shlomo reviewed Paez’s CT scan, ordered bloodwork and a urine test, and referred Paez to Chen to discuss surgery to remove the tumor and alleviate her symptoms.

Paez’s experience—having a noncancerous adrenal tumor discovered incidentally through unrelated imaging—is the norm. And while pheochromocytomas are not common, adrenal tumors overall are being discovered more commonly as people undergo imaging scans more frequently.

“About 4% of all imaging scans reveal an adrenal tumor,” Ben-Shlomo said. “And, because we human beings tend to grow nodules as we get older, that percentage can increase to 10% as we age. That’s a significant amount.”

Most adrenal tumors are “nonfunctioning,” meaning they do not produce excess hormones or cause symptoms. Although nonfunctioning tumors don’t require long-term monitoring, Ben-Shlomo and Chen encourage all patients with an adrenal tumor to be evaluated by a specialist.

“An imaging report will often note a ‘benign-appearing adrenal adenoma,’ and the word ‘benign’ can lead to the tumor being overlooked,” Ben-Shlomo said. “Instead, there is a real need for a functional evaluation by an endocrinologist and perhaps a surgeon. Every tumor should be evaluated for size, shape and functionality because they can lead to serious and sometimes life-threatening diseases. Not all of them need to be removed, but they may need to be monitored in case they grow or symptoms arise.”

By the time Diana Wan found Cedars-Sinai’s Multidisciplinary Adrenal Program, she had been facing infertility, “off-the-charts” high cholesterol, high blood pressure, uncharacteristic weight gain and prediabetes for more than a year. Despite exercising consistently and eating well, her health was not improving. One day she experienced sudden, excruciating, abdominal pain, which led to a CT scan. The scan revealed a benign-appearing adrenal tumor.

Ben-Shlomo diagnosed Wan with adrenal Cushing’s syndrome—a rare disease caused by an adrenal tumor’s production of too much cortisol, a steroid hormone that regulates metabolism, blood pressure, blood sugar, stress and more. Cushing’s syndrome causes many of the symptoms Wan was experiencing, including weight gain, high blood pressure and infertility. 

“You’re so lucky that we found this when we did,” Ben-Shlomo told Wan. “It’s very bad for your body, and it will worsen over time.”

Chen removed Wan’s adrenal gland and today, nearly a year later, she no longer has Cushing’s syndrome. Her experience reinforces the benefits of having every adrenal tumor expertly evaluated.

“A lot of patients have their lives dramatically changed post-surgery,” Chen said. “Just a bit of cortisol over-secretion, for example, can lead to weight gain and metabolic syndrome, which increases the risk of heart disease, diabetes, stroke, bone loss, anxiety and depression. If this is an issue for years, symptoms worsen, leading to early mortality. Aldosterone over-secretion, another adrenal hormone, can lead to hypertension and low potassium and is associated with arrhythmias, sleep apnea and fatigue. When we’re able to remove certain hormone-producing tumors, some patients can be completely cured of related conditions.”

Wan, who continues to see Ben-Shlomo for follow-up monitoring, said, “I had complete trust in my team at Cedars-Sinai throughout the process, and it is comforting to know that I was—and continue to be—in good hands there.”

Paez’s symptoms also improved after surgery. Chen removed her adrenal gland laparoscopically, through tiny incisions in the abdomen, during a minimally invasive procedure known as an adrenalectomy. Her tumor was 6 centimeters—adrenal tumors over 4 centimeters are considered large and have an increased risk of being cancerous. Other removal options include robotic surgery, retroperitoneoscopic “through-the-back” surgery, and subtotal or partial adrenalectomy, which only removes the tumor. Most are done on an outpatient basis.

“The tumor is gone, my bloodwork is normal, and everything is under control,” Paez said. “I’m grateful for Dr. Chen and Dr. Ben-Shlomo, who worked together as a team from my very first appointment and who will continue to monitor me in the coming years.”

Read more on the Cedars-Sinai Blog: Debunking Adrenal Fatigue

As a Level I trauma center, Cedars-Sinai offers advanced resources and technologies to serve Los Angeles County and beyond 24 hours a day, seven days a week, 365 days a year.

The Cedars-Sinai Newsroom sat down with Galinos Barmparas, MD, medical director of Trauma in the Cedars-Sinai Department of Surgery, to discuss how people can have a healthy holiday season and avoid life-changing injuries and accidents.

Do you see an uptick in trauma cases around this time of year?

We tend to see an increase in trauma cases on almost all holidays throughout the year and this season is not an exception. In fact, because it is a protracted holiday period, that allows for an even higher volume of patients and an increased chance that these patients may get injured to the point that they require admission to a trauma center.

What are some common cases the trauma surgery service sees during the holidays?

As the trauma surgery team, we see patients with the most serious injuries.

Some of the most common injuries we see around this time of year are falls from ladders as people try to decorate their homes or trees. Those falls may result in significant head, neck and spine injuries.

We also see injuries from new toys. Kids may receive things like scooters, skateboards or hoverboards as presents and, in their excitement and lack of experience with them, they use them without the proper protective equipment, which is extremely dangerous. We, unfortunately, see some very serious injuries related to this.

As people are spending more time at home, cooking and using their fireplaces, there also tends to be an increase in fires and burn-related injuries.

One thing I would be remiss if I did not mention is the impact of alcohol. This time of year, there are more opportunities to drink and often, people are drinking to excess. We, unfortunately, see an increase in motor vehicle collisions with drivers coming from holiday gatherings under the influence of alcohol or other substances, and the injuries caused to themselves and others can be catastrophic.

But it’s not only drugs and alcohol. During this season, people are busy and distracted. They may be rushing. It gets dark earlier. There’s more traffic. There are more people out walking. All of these factors combined can cause dangerous situations that result in traumatic injury.

What are some ways individuals can avoid traumatic injury and a hospital visit this time of year?

This advice is really for all times of year, not only for the holidays, and it’s simply to be proactive in preventing injury.

As a trauma surgeon, my mission is not only to treat the severely injured, but to prevent injuries. So, my message is to think before you act. Don’t climb a ladder carrying sharp tools or other instruments that may injure you in a fall. Be cautious when cooking, especially with young children around. Be mindful of tripping hazards, such as rugs or extension cords for lights, especially when elderly family members who may have balance issues are visiting your home. And, of course, always designate a sober driver.

If someone does happen to get injured, how should they determine whether to seek help at a hospital or trauma center versus urgent care?

Urgent care is a great option for minor injuries like simple lacerations. Things that would definitely require a hospital visit are falls from 10 feet or higher, falls from lower heights when you may have sustained a head injury and have an altered mental state or you are confused or have passed out, and any bleeding that is significant and not stopping. In any of those cases, you should call an ambulance and get to a hospital immediately to be evaluated and treated.

Is it difficult for members of the trauma surgery service to work during the holidays when most everyone else is enjoying time with family and friends?

My team covers trauma surgery, emergency general surgery and the surgical intensive care unit, and we have a duty to care for patients every day of the year. This is a mission, and we understand this. We are also fortunate to have a diverse team of individuals. We have different religious beliefs and may celebrate different holidays throughout the year, so that allows for some flexibility in on-call scheduling as well.  

But at the end of the day, we’re a team. And it’s not just the trauma surgeons alone. We have our surgical residents, our ICU staff, our nursing staff, our operating room staff. It’s really a trauma family, rather than just a trauma team. So maybe we’re not with our real family, but we’re with our trauma family, and that’s special too.

Read more from the Cedars-Sinai Blog: Stop the Bleed Courses at Cedars-Sinai

“I was miserable, depressed and didn’t have much of a life,” said Meth, who developed the painful condition called lymphedema after her second bout of breast cancer in 2014 and subsequent removal of lymph nodes from her right armpit. It worsened after multiple rounds of radiation therapy to treat the cancer.  

Lymphedema is caused when fluids, blocked from draining through the body’s lymphatic system, collect in the arms and legs and cause swelling. The normal drainage process can be blocked when lymph nodes are removed (a procedure called axillary lymph node dissection) during surgery for breast cancer.

According to the National Institutes of Health, lymphedema affects as many as 40% of breast cancer patients who have had axillary lymph node dissection. It also can affect people who have had other cancers and related surgery or radiation treatments. Sometimes it may not have a known underlying cause—and in rare cases, patients can develop lymphedema because of inherited genetics.

Like many patients with lymphedema, Meth knew little about the condition and had difficulty finding information about effective ways to treat it.

“I feel that the lymphedema patient community needs more information,” Meth said. “People need to know where to go for help. I had been to a physical therapist and had been wrapping my arm to help with the swelling, but that wasn’t working. I was losing hope.”

She began to regain hope after a healthcare provider referred her to plastic and reconstructive surgeon Ketan Patel, MD, a professor of Surgery in the Department of Surgery at Cedars-Sinai. Patel is one of the few U.S. physicians specializing in surgical treatment for lymphedema. He also helps coordinate nonsurgical treatment for patients, including complete decongestive therapy, in which specialized therapists perform manual lymphatic drainage massage and compression wrapping, guide patients through specific exercises, and more.

“There is no cure for lymphedema, so the goals of treatment are to improve symptoms and quality of life,” Patel said. “We put patients on the right treatment path for them, making appropriate referrals or performing surgery as needed. In many ways, we coordinate lymphedema care because not everyone is a surgical candidate.”

Meth was a candidate for surgery.

Patel first performed a vascularized lymph node transfer, moving lymph nodes from Meth’s abdomen to her right underarm to help rewire her lymphatic system. Three weeks after the surgery, Meth was able to fit her arm—significantly less swollen—into a dress she had previously been unable to wear. He also referred her for complete decongestive therapy, to help further reduce pain and swelling, and to help improve her arm movement and functionality.

Meth went on to have additional surgeries to further relieve lymphedema symptoms. Patel performed liposuction to remove extra fat in her arm caused by the condition. He also rerouted part of Meth’s lymphatic system during a procedure called a lymphovenous bypass. 

Each procedure, delicate and requiring extreme precision, called upon Patel’s expertise in advanced microsurgery and microsurgery techniques.

Meth wishes that, in preparing for breast cancer surgery, she had known that developing lymphedema was possible and that if she needed treatment, a range of options was available.

“I have a life now,” Meth said. “Before surgery, I was not managing well. Now, I am.”

Patel agrees that knowledge about lymphedema treatment options among many healthcare professionals and patients needs improvement but adds that awareness—and funding for lymphedema research—has increased over the past decade, and he expects that to continue.

He, along with other Cedars-Sinai surgeons and lymphedema-trained therapists, is focused on lymphedema awareness, prevention and earlier treatment options as part of expanding offerings for patients.

“Treatment for lymphedema has, for the most part, still been relegated to therapy,” Patel said. “There is no medical treatment administered by a doctor, so the surgical techniques that we offer are just starting to gain more traction.”

Patel also is working to improve patient care by emphasizing among physicians that being proactive about the possibility of patients developing lymphedema—and effectively getting ahead of it before it develops—is important.

“If we can identify patients who are at a higher risk of developing lymphedema,” Patel said, “then we can have them see a therapist before surgery, get them wrapped at the time of surgery, and basically treat patients like they already have lymphedema in hopes that we prevent long-term swelling. So, it’s not just rehab after the fact, but prehab, before the fact. In the future, we see this being at the forefront of lymphedema treatment planning for all at-risk patients.”

Cristina Ferrone, MD, chair of the Department of Surgery, said that Patel and team are working to make awareness, prevention and earlier treatment the standard of care for patients at risk of developing lymphedema.

“We hear from many patients that they did not know an operation for lymphedema was a possibility,” Ferrone said. “It’s important that patients are aware and that providers are aware. The more collaborative we can all be, the better it is for our patients. Lymphedema is a difficult medical condition to treat. Dr. Patel is a worldwide leader and pioneer in this area.”

Read more on the Cedars-Sinai Blog: Practical Advice for Breast Cancer Patients

That is, until May 2020, when his active lifestyle took a sudden downhill turn.

Two months after Mulholland’s high school junior varsity lacrosse season came to an abrupt end due to the COVID-19 pandemic, a playful roughhousing wrestling match with friends at a park ended with a devastating injury.

“I blew out my entire knee and tore everything–my ACL, my LCL, my PCL–my IT band tore off of my femur, my kneecap dislocated, and my peroneal nerve also tore,” said Mulholland. “After that, everything from my knee down was paralyzed.”

Mulholland’s right leg was left with damage to his peroneal nerve–a branch of the sciatic nerve located in the lower leg. After undergoing reconstructive knee surgery, Mulholland developed foot drop, a condition characterized by the inability to lift up and roll out the foot.

“As soon as I met with an orthopaedic surgeon, I found out that my athletic career would be pretty short-lived and that it was going to be really hard to recover from a nerve or foot drop injury,” said Mulholland.

The National Institutes of Health estimates that over 120,000 people are affected by foot drop each year. However, the actual number may be higher, as some patients may go unreported or undiagnosed.

Ten months after his knee surgery, Mulholland could still not move his foot and was advised by medical experts to wait to see if his peroneal nerve would reawaken on its own.

“There was a lot of waiting and no great solution. I became antsy,” said Mulholland’s mother, Jennifer Mulholland. “Here’s a three-sport athlete with remarkable physical and mental abilities, that I just knew if I asked for help a solution was out there.”

After speaking with more than 15 specialists from throughout the U.S, the solution began to unfold after a conversation with orthopaedic surgeon Glenn Pfeffer, MD, director of the Foot and Ankle Surgery Program at Cedars-Sinai.

“Dr. Pfeffer is our angel doctor,” Jennifer Mulholland said. “He personally called us and said, ‘I've got your guy,’ and that it wasn’t him, but one of his colleagues, Dr. Seruya.”

Thirty minutes later, the Mulhollands were talking with Mitchel Seruya, MD, director of the Peripheral Nerve and Microsurgery Fellowship at Cedars-Sinai  Medical Center and a pediatric plastic surgeon with Guerin Children’s.

“Dr. Seruya’s approach was not just surgical; it was a lifeline,” recalled Jennifer Mulholland.

A Window of Time

Seruya, who is among the few surgeons in the U.S. who perform innovative electrical bypass techniques called nerve transfers, saw the potential for recovery, but he’d be working against time.  

“Unfortunately, so many patients are told to give nerve injuries time to heal, but what they don’t realize is there is an expiration date, or a time clock, working against you,” said Seruya. “Meaning that by 12 to 18 months, these nerve injuries become irreversible.”

Although it had been 11 months since getting injured, Mulholland was a candidate for a nerve transfer surgery, a procedure that involves rerouting healthy and expendable nerves to compensate for damaged ones, effectively restoring the electrical signals needed for proper muscle function.

“It's a way of borrowing electricity from one functional nerve to restore movement in another area affected by nerve damage,” said Seruya. “In Riley’s case, we rerouted the nerve from his big toe to the paralyzed muscles in the front of the leg.”  

During surgery, Seruya went into Mulholland's inner calf area, found his toe electricity, isolated it, used a nerve stimulator to test and make sure the toes were bending strongly, then divided the electricity to route it from his inner calf area out to the front of the leg.

Learning to Walk

Six months post-surgery, Mulholland could flex his foot to lift up and roll out his ankle, the first step on the road to his recovery.

The process of walking is now completely different for Mulholland. Now, when Mulholland’s brain tells his toe to move, his foot moves instead. That’s because the nerve that was once connected to his big toe is now connected to the muscles that move his foot and ankle.

“I never knew that walking was so important or how much brain power it actually takes to do a stride,” said Mulholland. “Thinking about having to walk with every stride, ‘left, right, left, right,’ it doesn’t really wrap around your mind unless you experience it.”

Mulholland ultimately returned to the lacrosse field to go on to help the team win two back-to-back state championships, was crowned as the second-leading scorer, and made the all-state team his senior year.

Today, Mulholland is the only starting freshman on San Diego State University’s lacrosse team. As for his education, Mulholland is now studying neuroscience because of his passion for the mind-body connection, which all started with that fateful knee injury.

“This was my comeback kid,” Jennifer Mulholland said. “What he was able to overcome, how he overcame with the help of Dr. Seruya, really giving him this fortitude and the possibility to regain motion, regain the ability to walk normally again and regain the ability to play on the field and to absolutely shine like the most incredible star.”

Learn more about the Brachial Plexus and Peripheral Nerve Surgery program at Cedars-Sinai. 

Known for his innovative clinical care and research, Cetrulo is an international expert in complex adult and pediatric reconstructive microsurgery, hand surgery, breast reconstruction and burn reconstruction. He has pioneered procedures and treatments in the field of composite tissue transplants between individuals with different genotypes.

Cetrulo joins Cedars-Sinai from Massachusetts General Hospital, where, as associate professor of Surgery at Harvard Medical School, he served as director of the Reconstructive Transplantation Service and director of the Vascularized Composite Allotransplantation Laboratory at the Center for Transplantation Sciences.

As the leader of Massachusetts General’s hand transplantation effort, Cetrulo directed the surgical team that performed the institution’s first hand transplant in 2012. In 2016, he performed the first successful penis transplant in the U.S.

“Dr. Cetrulo brings great knowledge, experience and skill to his new leadership positions, and his arrival will strengthen our already formidable surgical teams,” said Cristina Ferrone, MD, chair of the Department of Surgery. “I wish him much success in advancing our renowned care for patients.”

Cetrulo has published research findings in more than 150 peer-reviewed journals, holds multiple patents in transplantation technology, and is co-founder of a nonprofit biotechnology company and founder of a cell therapy company.

He is a national leader with significant research contributions in xenotransplantation, the process of transplanting tissues or organs between different species. This pioneering technology, for which Cetrulo received an award from the American Burn Association, was applied in a first-in-human clinical trial at Massachusetts General, during which genetically modified laboratory pig skin was used to heal burn patients’ wounds.

A graduate of Stanford University, Cetrulo earned his medical degree from Tufts University School of Medicine in Boston. He completed his residency at Lahey Clinic Medical Center and his plastic surgery residency at Long Island Plastic Surgical Group/Nassau County Medical Center. Additionally, he completed fellowships at New York University’s Institute of Reconstructive Plastic Surgery, Craniofacial and Microsurgical Tissue Engineering Research and at The Buncke Clinic in San Francisco in hand and microsurgery.

“I am honored and thrilled to undertake these new leadership positions in the Department of Surgery at Cedars-Sinai,” Cetrulo said. “Together, we will bring highly specialized, world-class care to our patients.”

Read more on the Cedars-Sinai Blog: Cleft Lip and Cleft Palate | FAQ

Sherman was a pioneer in the field of microsurgery, a prominent expert in hand surgery and breast and limb reconstruction. His many innovative surgical techniques led to remarkable outcomes for reconstruction of previously untreatable birth defects and traumatic injuries.

Sherman died Tuesday, July 18, in an air traffic accident in Santa Fe, New Mexico. 

Over a long and distinguished career, he developed highly regarded clinical, research and training programs in plastic surgery in Los Angeles, first at the University of Southern California and, since 2015, at Cedars-Sinai. He held several distinguished positions at Cedars-Sinai, including vice chair of the Department of Surgery and director of the Division of Plastic Surgery.

“Randy was a loyal and generous friend and teacher,” said Cristina Ferrone, chair of the Department of Surgery at Cedars-Sinai. “He will be missed for his contributions to the field of surgery and for his impact on so many of us who benefitted from his great talent, leadership and compassion.” 

Sherman’s leadership and dedication to patient care earned him the William and Willa Dean Lyon Family Chair in Reconstructive and Plastic Surgery in Honor of Randolph Sherman, MD.

His influence was felt beyond Cedars-Sinai: Sherman mentored, taught and impacted many of the microsurgeons around the world.  He also played a role with Operation Smile, a surgical charity that cares for children with congenital and acquired deformities in disadvantaged countries. 

“Randy was dedicated to improving the lives of his patients, including children around the world through his selfless participation with Operation Smile,” said Bruce L. Gewertz, MD, Cedars-Sinai surgeon-in-chief and vice dean of Faculty Affairs and Clinical System Development. “His international surgical work was truly a reflection of his deep caring and compassion for his patients.”

Sherman was board certified by the American Board of Surgery, which also certified his expertise in hand surgery. He earned his medical degree at the University of Missouri School of Medicine in 1977, followed by residency programs at the University of California, San Francisco and the State University of New York, and a fellowship at USC Keck School of Medicine.

Aside from his love for surgery, Sherman also greatly enjoyed flying. He was a commercial pilot and flight instructor who served as an FAA-designated senior aviation medical examiner. He was a member of the board of directors for the Santa Monica Museum of Flying, the Lyon Air Museum and the American Air Museum.

Never, according to Russell Metcalfe Smith, Cedars-Sinai’s executive director of Simulation and Interprofessional Education, who helped establish the Women’s Guild Simulation Center for Advanced Clinical Skills at Cedars-Sinai Medical Center in 2013.

Ten years later, 150,000 health professionals—as well as thousands of medical school, high school and middle school students—have passed through its doors to learn new techniques, improve existing practices and heighten team performances.  

Metcalfe Smith describes the center–nicknamed the “Sim Center” by Cedars-Sinai staff members—as a place to practice very basic techniques like chest compressions or more complex procedures such as heart or robotic surgery.

“We want to make sure that we have well-prepared teams … it’s not just your physicians, it’s your nurses, technicians and everybody associated with the care of that patient,” said Metcalfe-Smith. “It’s a way to ensure that our workforce is much more prepared to deliver care to patients as it starts becoming increasingly complex and as our population is becoming older and sicker over time.”

During the COVID-19 pandemic, the Sim Center trained an estimated 4,000 to 5,000 healthcare professionals each month on how to use respirators, how to carefully put on and take off personal protective equipment (PPE) and how to manage cardiac arrest in patients with COVID-19. It also became a hub for testing new processes and equipment and even 3D printing necessary parts.

The 10,000-square-foot center contains two fully equipped and functioning operating rooms, adult and neonatal intensive care units, an obstetrics and gynecology room, and a trauma bay, along with classrooms and areas for education and skills training. In the computerized simulation room, physicians can practice almost every medical procedure, including robotic surgery and cardiovascular and ultrasound procedures, on computerized mannequins.

As technology advances, Metcalfe-Smith hopes there will be “more scalable and realistic use of virtual options as a way to augment the training” the Sim Center delivers.

Over the last decade, the Sim Center has partnered with the Los Angeles Clippers Mentorship Assist Zone to host special programs for high school students to get a closer look at healthcare careers. Metcalfe-Smith says he has seen students who appear to be disinterested but within minutes of learning proper procedures for administering CPR or suturing a wound, their entire attitude changes.

“It was like you turned on a light switch in that they could see ‘Wow, this is something that I could do as a career moving forward,’” Metcalfe-Smith said.

The American Society of Anesthesiologists and the Society for Simulation in Healthcare have endorsed the Sim Center, which is the only facility in California to be accredited by the National Association of Emergency Medical Technicians and the American College of Surgeons.

“Cedars-Sinai’s culture embraces career-long learning and what we provide to our staff is pretty exceptional,” said Metcalfe-Smith. “It’s very often one of the highlights of people joining the organization and experiencing for themselves how we help prepare staff.” 

Read more on the Cedars-Sinai Blog: Simulated Scenarios, Real Benefits

Physicians at Cedars-Sinai Cancer are using a unique chemotherapy delivery system that offers hope to colorectal cancer patients whose disease has spread and who now have inoperable liver tumors. Cedars-Sinai is one of the few centers in the area to offer the therapy, called hepatic artery infusion (HAI) pump chemotherapy.

“Many of these patients are not candidates for curative surgery and we now have a meaningful option for treating them,” said Cristina Ferrone, MD, chair of the Department of Surgery at Cedars-Sinai and a specialist in the care of patients with complex hepato-pancreato-biliary disorders. “This therapy has been shown to extend both life and quality of life.”

Colorectal cancer is the fourth-leading cause of cancer-related death in the U.S. In as many as 25% of patients diagnosed with the disease, the cancer spreads to the liver, where it can be difficult to treat. However, more than half of patients receiving hepatic artery infusion pump therapy go on to receive curative surgery, studies have shown.

Surgical oncologist Alexandra Gangi, MD, director of the Gastrointestinal Tumor Program at Cedars-Sinai Cancer and associate professor of Surgery at Cedars-Sinai, sat down with the Cedars-Sinai Newsroom to explain this lifesaving therapy.

How do the pumps work?

We surgically place the pump underneath the skin, outside of the abdominal cavity, and it is attached to tubing that enters the abdominal cavity and goes into the gastroduodenal artery. That artery feeds into the hepatic artery, which supplies blood to the liver. During surgery, we block blood flow from the gastroduodenal artery from going into portions of the small intestine so that the therapy flows only to the liver.

The pump has a soft center, allowing its internal reservoir to be filled through the skin via a syringe. After surgery, the patient comes in every two weeks and we refill the pump, which then allows the chemotherapy drug to flow directly into the liver via the arterial supply.

Which patients are likely to benefit from hepatic artery infusion pump therapy?

This therapy is designed for patients, based on the distribution of the metastatic disease (where are the tumors and how many), for whom curative surgery is not an option at the time of diagnosis. The best we had been able to offer these patients was lifelong chemotherapy that had potential systemic toxicities, and that never quite reduced their tumor size to the point that we could surgically remove it. This therapy offers an additional option for liver-directed therapy that can potentially make patients candidates for surgery by specifically targeting the liver disease.

What are the advantages of the hepatic artery infusion pump over traditional chemotherapy delivery?

A majority of these tumors derive their blood supply from the hepatic arterial system, and delivering chemotherapy to the tumors through the hepatic arterial system allows us to give higher doses of specific chemotherapeutic agents without exposing the patient to their systemic toxicities. Data shows that up to 60% of appropriately selected patients receiving hepatic artery infusion pump chemotherapy were then able to receive curative surgery. Patients can often continue receiving systemic chemotherapy in combination with hepatic artery infusion pump chemotherapy.

Are hepatic artery infusion pumps used to treat other types of liver cancer?

Some patients with cholangiocarcinoma are currently treated with HAI pumps, but this is not yet standard of care. Colon cancer is the second most common cancer, and colon cancer that has metastasized to the liver affects a significant number of patients. And we have seen good outcomes with those patients. Other types of cancers that metastasize to the liver are significantly more challenging to treat, and thus far, we don't think this therapy will benefit those patients.

Is this a new therapy?

Hepatic artery infusion pumps have actually been around for about 25 to 30 years, but until quite recently only a few medical centers were using them. But more and more centers are realizing that this therapy can truly benefit patients, and it is becoming more widely available.

Read more from Discoveries: The Liver/Cancer Connection