History of the Emory Endosurgery Unit

The legitimization of laparoscopy began when cholecystectomy could be done as a minimally invasive procedure. Due to patient demand, private practice responded by offering the procedure routinely, though most academic centers remained uncommitted. Convinced that laparoscopy would have a major impact on the future of surgery, Dr. William Wood, chair of the Department of Surgery from 1992-2009, appointed Dr. John Hunter to establish, develop, and direct the Emory Endosurgery Unit, one of the first programs of its type in the country.

The unit quickly initiated the nation's first laparoscopic fellowship. In addition to giving young surgeons the opportunity to learn laparoscopy, the fellowship emphasized the study of patient outcomes with the goal of critically validating minimally invasive techniques. Ultimately, many who completed the fellowship joined other academic institutions and pursued similar research and education efforts.

The unit's model of investigation, education, and application was then used to refine laparoscopic antireflux surgery and other applications to the esophagus. When the unit's role was recognized in establishing laparoscopic foregut surgery as the gold standard in managing patients with GERD and other foregut conditions, it received international notice and increased demands for its resources.

The unit's scope widened to include solid organ, colon, and inguinal hernia programs. Dr. C. Daniel Smith joined Dr. Hunter as co-director in 1996 and contributed his experience in minimally invasive surgical areas outside of the foregut. In 1998, the unit moved beyond general surgery parameters by establishing initiatives in cardiac surgery and transplantation. Dr. Smith assumed full directorship after Dr. Hunter resigned in May 2001 to chair the Department of Surgery at Oregon Health Sciences University.

The unit launched programs in live donor nephrectomy, laparoscopic management of polycystic kidney and liver disease, laparoscopic bariatric surgery, thoracoscopic sympathectomy for hyperhidrosis, and laparoscopic access for spine surgery. The newer laparoscopic methods associated with foregut, bariatrics, and hernia had yet to be validated and were receiving minimal reimbursement, leading to limited interest by the general surgery community.

Dr. Smith successfully guided unit surgeons' significant documentation of the efficacy of these procedures, and residents and professional surgeons began to integrate them into their practice. Highlights of this period included:

  • Establishment of the Emory Bariatric Center, one of the leading centers in the southeast offering both surgical and non-surgical long-term weight loss options.

  • Collaboration with the Division of Transplantation in 2002 on the development of a laparoscopic live kidney donor program that produced outcomes unparalleled by any other center in the country.

  • Establishment in 2003 of the Emory Simulation, Training, and Robotics Center (ESTAR), which focused on developing, validating, and applying simulation-based educational tools and devices, curricula, and robotics for use in medical education, training, and patient care. Training in laparoscopic and endoscopic techniques were fixtures of ESTAR's curriculum. In 2009, ESTAR's resources were assimilated into the Emory University School of Medicine's Center for Experiential Learning, or EXCEL.

  • Dr. Juan Sarmiento's application of laparoscopy to such pancreatic resections as distal pancreatectomy in 2004, which reduced postoperative pain and shortened hospitalization. As a specialist in the unit's solid organ program and director of hepaticopancreaticobiliary surgery at Emory University Hospital, Dr. Sarmiento also began developing and performing laparoscopic hepatic resection, particularly minor hepatectomy. He is now applying these methods to major liver resection.

  • Dr. Edward Lin's performance of the first endoscopic plication for GERD ever done in the U.S. at Emory University Hospital Midtown in 2004.

Unit surgeons became national leaders in laparoscopic colon surgery and laparoscopic methods of treating diverticulitis, large pre-cancer polyps, bleeding lesions, inflammatory bowel disease, and rectal prolapse. In June 2005, the unit was the first clinical program in Georgia and among the first in the nation to successfully treat a patient suffering from Barrett's esophagus with the HALO360 ablation system. Dr. Smith presented the results of a clinical study validating the performance and efficacy of the HALO system for treating Barrett's esophagus at the April 2006 SAGES Annual Meeting in Dallas.

The unit's training program expanded to offer six-to-seven one and two-day didactic and practical courses per year in such areas as inguinal and ventral hernia repair, laparoscopic colon surgery, and modern management of foregut diseases, all of which were endorsed by SAGES.

In October 2006, Dr. Smith was appointed chair of the Department of Surgery at the Mayo Clinic in Jacksonville, FL. Dr. Lin, who had been serving as associate director of the endosurgery fellowship since 2005, took over direction of the unit. Due to the recognition he had received for his involvement in developing endoluminal procedures, he was able to establish additional training in endoscopic interventions and endoluminal surgery.

During 2008 and 2009, unit surgeons refined single incision laparoscopic surgery for colon cancer, gall bladder, and appendix operations. Dr. Sarmiento guided the unit's implementation of a minimally invasive liver surgery program that included pioneering techniques for laparoscopic-assisted full right hepatectomies involving extremely small incisions, mirroring the transition from open gallbladder surgery to laparoscopic cholecystectomies in 1990.

In 2015, Dr. Scott Davis assumed directorship of the Emory Endosurgery Unit, and Dr. Lin returned to being the associate program director of the endosurgery fellowship.