Annual Report

Minimally Invasive Surgery | 2020 Annual Report

Three images of WashU MIS faculty (from left to right), Francesca Dimou, MD, MS, with residents in the WISE Center, Sara Holden, MD, and Arnab Majumder, MD, and Michael Brunt, MD, with text overlay that reads "Ahead of the Curve Minimally Invasive Surgery.”

Minimally invasive specialists focus on upper gastrointestinal, hernia, solid organ and weight loss surgery. The section’s goal is to increase patient benefit by decreasing the size of surgical incisions. These efforts result in less pain and faster recovery. Faculty offer courses in laparoscopic procedures such as complex ventral hernia repair for practicing surgeons. The section offers a one-year fellowship, administered by the Fellowship Council. The section has a dedicated research laboratory and is active on the frontiers of research. Below highlights the Section’s notable accomplishments in 2020.

Section of Minimally Invasive Surgery | 2020 Annual Report

All About the Patient

Minimally invasive surgery (MIS) provides opportunities for improved patient care with fewer and smaller incisions, reduced healthcare costs and shorter recovery times than open procedures. In the past year, MIS surgeons at the School of Medicine have advanced patient care in robotic, laparoscopic and endoscopic procedures.

Jeffrey Blatnik, MD, Sara Holden, MD, and Arnab Majumder, MD, are leaders in treating abdominal wall hernias with robotic surgery. Blatnik, whose contributions were instrumental in developing the metrics of the Abdominal Core Health Quality Collaborative, is focused on providing the best care and education for patients in this nascent, growing field. In a study published in Surgical Endoscopy, Blatnik found that nearly all patients learned about procedures and devices, such as surgical mesh, through Internet and media sources. This media exposure impacted patients’ decision-making, emphasizing the importance of providing unbiased information for patients to help them make informed decisions and feel comfortable with their choices at the time of surgery.

Bariatric surgeons J. Chris Eagon, MD, Shaina Eckhouse, MD, and Francesca Dimou, MD, MS, offer laparoscopic procedures at the Weight Loss Surgery Program. Dimou has expanded the program’s offerings to include robotic gastric bypass and sleeve gastrectomy. Benefits of robotic weight loss surgery include enhanced visualization, access to targeted anatomy and improved ergonomics for surgeons when working with patients with high body mass index. Bariatric surgeons have further improved patient care through participation in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program’s Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) initiative. BSTOP enhances patient recovery and pain management while reducing reliance on opioids.

Since 2012, Michael Awad, MD, PhD, has offered therapeutic endoscopic procedures for conditions that affect a patient’s ability to eat and drink, such as achalasia. Procedures including peroral endoscopic myotomy (POEM), flexible endoscopic Zenker’s diverticulotomy and the G-POEM procedure for gastroparesis, restore normalcy to these patients’ lives. Awad and Blatnik have performed over 250 POEM procedures to date, providing relief to patients across the region. In an upcoming publication, Awad reports on longstanding patient outcomes with achalasia to ensure that all patients receive the best treatment.

“That’s what this is really about,” says Awad, “our patients and their experience.”

2020 Highlights




Minimally invasive surgeon Shaina Eckhouse, MD, is now Surgery Liaison for the Perioperative Services Leadership Team. Eckhouse leads a gender task force, working with members of each division and section to enhance and improve OR culture and develop a peer advocate system for healthcare workers. This system will create more supportive channels for members of the OR team to communicate their concerns to a peer advocate in a supportive and non-confrontational environment. “Ultimately, the process has the potential to help everyone in the operating room come together,” Eckhouse says. “We are all here to take care of the patient in the best way possible.”

Section Chief Michael Brunt, MD, led a three-year effort to develop evidence-based recommendations for safe cholecystectomy and prevention of bile duct injury (BDI). A 2018 conference assembled experts from five surgical societies to develop a consensus guideline. The results, recently published in the Annals of Surgery and Surgical Endoscopy, make strong recommendations for use of intraoperative biliary imaging for uncertainty of anatomy or suspicion of BDI, and referral of patients with confirmed or suspected BDI to an experienced surgeon or multidisciplinary team. Brunt, President of the Central Surgical Association, collaborated with a team of experts including HPB-GI surgeons Steven Strasberg, MD, and Chet Hammill, MD, to develop this guideline.

The School of Medicine is a pilot center for a new entrustable evaluation process for Advanced GI/MIS fellowships. “This higher level of evaluation allows us to assess the level of autonomy or entrustment of a trainee’s ability to carry out patient care and surgical procedures,” says Michael Brunt, MD, MIS Section Chief and Fellowship Program Director. MIS is a leader in surgical education. Surgeons Michael Awad, MD, PhD, Jeffrey Blatnik, MD, and Bethany Sacks, MD, MEd, serve as General Surgery Associate Program Directors. Sacks is the Director of the Integrated Medical Student Surgical Clerkship, and Brunt is President-Elect of the Fellowship Council. This Fellowship Council pilot evaluation process marks a new milestone in advanced training of future surgeons.

A novel study of remote virtual interviews during the COVID-19 pandemic, conducted by Minimally Invasive Surgery (MIS) faculty and published in the Journal of the American College of Surgeons (JACS), reveals a high degree of candidate satisfaction with the virtual process.

COVID-19 triggered rapid changes in medicine, including alterations to the interview process for surgical training. The Fellowship Council, which oversees the application and match process for all Advanced GI/MIS fellowships, issued an advisory in March 2020, stating that fellowship interviews should be conducted via alternative methods due to the pandemic. The Washington University Advanced GI/MIS Fellowship quickly pivoted from in-person interviews—scheduled for later that month—to Zoom virtual interviews.

Twenty total applicants—nine women and 11 men—were invited for interviews.

The JACS study, led by Arnab Majumder, MD, Shaina Eckhouse, MD, Michael Brunt, MD, and senior author Jeffery Blatnik, MD, describes the interview process, including the use of breakout rooms for one-on-one interviews, is one of the first pieces of research on virtual platforms for fellowship interviews.
“Our experience can serve as a template for other programs moving forward,” says Brunt.

Of the many adaptations that have taken place in response to COVID-19, Brunt, President-Elect of the Fellowship Council, anticipates that use of remote teleconferencing as an alternative to in-person interactions will likely endure.

Applicant responses to an anonymous voluntary survey suggest that remote virtual interviews are a feasible and favorable alternative or adjunct to traditional in-person interviews.

The majority of interviewees rated their interaction with the program director, faculty surgeons and current fellow using Zoom as being easy. Nearly 90% of candidates reported that the experience met or exceeded their expectations, and 70% noted little or no impact of not being able to conduct the interview in person.

The Advanced GI/MIS Fellowship had to rapidly shift to this virtual platform, but many other training programs in the department, School of Medicine and across the country have since followed suit. By sharing their experience and results, the MIS section exhibits a model for training programs to provide an experience comparable in most respects to the traditional interview setting.