Department of Surgery Spotlight: Experimental Surgical Services
The Department of Surgery, one of the largest in the University of Minnesota Medical School, has 11 divisions as well as a number of research programs, centers, and institutes. Each month, we will focus on the history, achievements, and role of one of those subunits of our department.
The Spotlight: Experimental Surgical Services
This month, the spotlight is on Experimental Surgical Services (ESS), where rigorous preclinical testing in animals ensures the safety of various devices before they are ready for implantation in human patients. We spoke with Peggy Norris, lab director, and Dick Bianco, program director and Department of Surgery professor. Norris has been with ESS for 9 years; Bianco has been at the helm for 37 years, since 1980.
Current Spotlight: Surgical Clinical Trials Office (SurgCTO)
What is ESS?
Experimental Surgical Services (ESS) is a preclinical research lab in the Department of Surgery that specializes in testing medical devices, biologics, and surgical techniques. Using animal models to advance medical technology through translational research, ESS has an international reputation as a leader in this unique field. When researchers have a surgical research question and subsequent project, ESS will help them fine-tune and test their hypothesis.
ESS became a formal research program in 1980 under Dick Bianco, a professor in the Department of Surgery who continues to serve as the program director. The lab was renovated in 2002.
What is its primary role?
Using a range of preclinical models, ESS is a research resource for undergraduate and graduate students, residents, fellows, and faculty. ESS provides logistical support to get research done within regulatory guidelines.
What resources are available to researchers?
- Expertise of ESS faculty and staff
- 5 state-of-the-art operating rooms
- Unlimited postoperative housing for animals
- Advanced surgical technology
- Access to a board-certified veterinary pathologist
- Leadership on animal welfare issues
- Full compliance with Good Laboratory Practice (GLP)
Seeing ESS in action
When asked what a typical day is like in the ESS lab, Norris points to a dry erase calendar whiteboard that takes up the expanse of a cinder block wall. She grins knowingly and explains that next week is a good illustration of the range of research conducted at ESS. To cite just a few examples, George Wilcox, PhD, a professor in the Department of Neuroscience, will be working on his latest project. Rosemary Kelly, MD, chief of our Division of Cardiothoracic Surgery, will have one of the operating rooms for a heart patch procedure. Her longtime colleague Ranjit John, MD will conduct physician training. Tony Azakie, MD, chief of the Division of Pediatric Cardiac Surgery, is also on the schedule for next week. So is Robert Schumacher, PhD, scientific director of the Center for Translational Medicine. A local medical device company will be testing a new device. A CT scan will help assess the effectiveness of a device implanted in a sheep a few months back.
The color-coded calendar is displayed in what could be called a surgical command post. Video screens loop into each of the 5 operating rooms. One screen zooms in on a heart operation, another on researchers closing an incision. Lab team members in scrubs come and go, while others are locked into work on computers.
As Norris is talking, a colleague picks up a dry erase pen and adds a procedure to the already filled calendar. Walking into the surgical suite area, Norris points to the first operating room, where surgical resident Yuriy Moklyak, MD, is completing a procedure. As seen through the window, the setup mirrors a typical hospital operating room, from the instruments on the table to the lighting and state-of-the-art equipment. What is different is that the patient is a large animal, rather than a human being.
Bianco, in scrubs, steps out of the second operating room. The surgery in progress involves an industry-sponsored project to test a new heart valve. About 15 minutes later, Bianco can be seen via video, inserting a new valve into the animal on the table. He later emerges again and points to the echocardiogram on the video screen that shows the implanted valve at work. “No leaks,” he explains. “That’s what we want.”
Testing heart valves is something ESS knows a lot about. Every heart valve approved for clinical use—in the United States and internationally—has been tested in the ESS lab. “We see valves approved 5 years after they were tested in our lab,” says Bianco. “Every heart valve on the market today got its start in the ESS lab.”
“We see valves approved 5 years after they were tested in our lab,” says Bianco. “Every heart valve on the market today got its start in the ESS lab.”
Tracing its roots to the advent of cross-circulation in 1954
Pioneering medical change has always been at the core of the research taking place in the ESS lab and operating rooms. The roots of ESS can be traced back to 1954, when Department of Surgery professor C. Walton Lillehei, MD, PhD, and his team devised a technique known as cross-circulation. Two years earlier, our department had become the birthplace of open-heart surgery when Department of Surgery professor F. John Lewis, MD, PhD, and his team used hypothermia for the world’s first successful repair of a heart defect under direct vision.
Lillehei’s research on dogs started in operating rooms that are now formally part of ESS. In the cross-circulation operations launched in March 1954, he and his team repaired, for the first time ever, the life-threatening congenital abnormality known as the tetralogy of Fallot. But the immense risk involved in open-heart surgery with either hypothermia or cross-circulation prompted Lillehei and others to continue research on making such surgery safer. The result was the world’s first successful heart-lung bypass machine, a bubble oxygenator developed by Department of Surgery animal attendant (and later professor) Richard DeWall, MD that revolutionized the field of open-heart surgery in 1955.
Why is this important? Because ESS is part of the academic health center at the University of Minnesota, researchers are able to collaborate across disciplines. “We also work closely with groups outside of our department: Dr. Robert Tranquillo in biomedical engineering, Dr. Andy Grande in neurosurgery, and a variety of investigators from the Center for Translational Medicine,” explains Norris. “We actively collaborate with Dr. Mel Graham of PCRC [the Preclinical Research Center] and Dr. Wanda Gordon-Evans of the College of Veterinary Medicine. These collaborations ensure that we maximize our research potential with our University colleagues."
"Moving this legacy forward to today," Bianco says, “We are the premier lab of its kind in the country, and I say that because we are academic based.”
Supporting faculty and students
In terms of academic research, the basic idea of ESS is this: a faculty member or student asks a question or has an idea, and ESS will help develop it into a viable research model.
Norris characterizes ESS as “a turnkey resource.” From study design to Food and Drug Administration (FDA) submission, ESS scientists will work with researchers to provide guidance and support every step of the way, whether on a proof of concept procedure or a final-phase Good Laboratory Practice (GLP) study. Or, ESS can simply provide support services for investigators who are managing their own research.
Norris adds that ESS currently supports the active research of Department of Surgery faculty members Sayeed Ikramuddin, MD, MHA, and Gregory Beilman, MD, in addition to the aforementioned Drs. Kelly and Azakie.
What started as a conversation between Norris and Ikramuddin about a research idea soon metamorphosed into a bench-to-bedside project using a mouse model of bariatric surgery. Norris and the ESS team provide guidance to Ikramuddin and Azakie on the logistics of how to get research done within regulatory guidelines, with the infrastructure already in place. Beilman’s work on trauma surgery, recently in the news (insert link), originated in the ESS lab.
Of note, ESS has ongoing access to a board-certified veterinary pathologist who can help evaluate the effectiveness of any device, product, or surgical technique tested, offering expertise on necropsies, imaging, and histopathologic processing.
Dick Bianco: 37 years
Mickey Dunning: 38 years
Matt Lahti: 23 years
Sally Brinkman: 31 years
John Carney: 9 years
Peggy Norris: 9 years
May Breitbach: 3 years
Teri Ulferts: 1 year
Ellorie Liljequist: less than 1 year
Megan Stuart: 1 year
Travis Navarro: 3 years
Cole Myers: less than 1 year
Lisa Solinger: 3 years
Gwen Kocher: 11 years
Mignon Finn: 18 years
Steff Yorek: 18 years
Jennifer Orloske: 1 year
Training the next generation of health care leaders
At the heart of ESS is the University of Minnesota Medical School’s mission: to educate health care leaders of the future. ESS employs 8 to 11 undergraduate students, primarily pre-med, pre-vet, and biomedical engineering majors, with other health-related fields amply represented as well.
“This is where these students learn responsibility, commitment, and the basics of research and medicine,” says Norris. “We are happy to contribute to the education of these students as they work toward their futures.” Bianco stresses that “about 90% of our undergraduate students get into the graduate school of their choice.”
Giving back to the Community
About 2 years ago, ESS began collaborating with the College of Veterinary Medicine to provide surgical training and services for treating companion dogs with heart conditions. Canine heart conditions, similar to those seen in humans, can often be corrected surgically. “Open-heart surgery is not part of the training veterinarians receive as part of their residency program,” Bianco explains. “We collaborate with veterinarians and teach them how to perform open-heart surgery. We see this as a public service, providing compassionate care for these companion pets.”
Nurturing employees and leaders
What makes ESS tick on a daily basis is the level of talent of all of its employees. Most regular staff members stay for years. Mickey Dunning, Sally Brinkman, and Matt Lahti have each been with ESS for more than 20 years. John Carney (like Norris) has been with ESS for 9 years. “Our people are what make us special,” says Norris. Currently, ESS comprises 9 scientific and 3 administrative staff members, along with 11 undergraduate students (see sidebar).
“The cumulative years of research represented by our staff and leaders are extraordinary,” Norris continues. “This experience is offered to the faculty of the Department of Surgery, and every other department, to ensure that research is done with skill and professionalism. We will support any PIs [principal investigators] research so that they can start and maintain their research with strict adherence to University regulations.”
Written by: Amanda Brower
Editor: Mary Knatterud, PhD
Photographer: Gerald Vincent