Colorectal Surgery Overview
The Department of Colorectal Surgery is the epitomy of the growth. The department is internationally renowned for patient care, research and education, teaching, and training.
As we enter our 21st year in Florida, we owe a debt of gratitude to our patients, peers, residents and fellows, philanthropists, and corporate supporters. The collective trust which you have placed in us has allowed us to grow from four members of our department in 1988 to more than 50 in 2008.
As you peruse the information contained within the text to follow this introduction, you will note that tens of thousands of patient visits have resulted in the opportunity for our staff to assist through consultations and interventional procedures thousands of patients from throughout the world. In addition to directly improving the outcome for these individuals, we have indirectly touched the lives of many thousands more patients by training their physicians and surgeons when they have visited us from throughout the world.
Moreover, hundreds of medical students, residents, and fellows have spent periods ranging from one month to three years in our department to further their education and learn the methodology and techniques of evaluation and management of colorectal diseases at Cleveland Clinic in Florida.
Although these individuals were here to learn, they also helped to teach our staff by researching methods of improving outcomes. Specifically, they have helped us conduct prospective and prospective randomized trials as well as database and retrospectively review our results. By these labors, they have helped us to continually improve and expedite methods of diagnosis, reduce the adverse side effects of treatment, improve the curability of our therapeutic modalities, reduce recurrence rates, and improve the quality of life of patients throughout the world.
The fruits of these labors have yielded as an average one published manuscript per month in the medical literature over the last 20 years along with an average of one book chapter every three months during this same time period. Moreover, over the last several years, we have published approximately one textbook per year. All of these discoveries and innovations have enabled our staff and many of our former residents to become recognized as leaders within the field of colorectal surgery.
All of our staff and many of our former trainees have been asked to serve on important committees in regional, national, and international professional societies. They have been bestowed with honorary memberships and fellowships and have been recruited to travel throughout the world teaching the methodology developed and utilized in our department so that patients in other lands may benefit.
Sometimes one’s expertise is only recognized far from home; in proximity local politics and jealousies often sadly preclude utilizing the resources of even an internationally acclaimed individual. We are proud that in our local community our colleagues in colorectal surgery as well as in the allied fields of general surgery and gastroenterology have continually called upon our staff, both as a referral resource for their patients as well as an academic asset to further their education.
Our staff have been asked to organize the educational sessions for the South Florida Chapter of the American College of Surgeons, the Florida Chapter of the American College of Surgeons, the Florida Gastroenterologic Society, the Northeastern Society of Colon and Rectal Surgeons, the Welsh Surgical Society, and the Royal Society of Medicine Section of Coloproctology, as well as many other similarly prestigious societies.
Our doctors are recognized by our peers as “the best” in publications including The Best Doctors in America (national editions, 1994-2008), The Best Doctors in America (southeast edition, 1997-1998), Town and Country (1990), South Florida (1991), American Health (1996), Good Housekeeping (1999), Miami Metro (2000), Where to Find the Best Doctors (2000), America’s Top Doctors (2002-2007), and America’s Top Cancer Doctors (2005-2007).
From late 1987 through the opening of Cleveland Clinic in Florida on February 28, 1998 until July 2, 2001, Cleveland Clinic in Florida was split between two campuses.The hospital was located on A1A just south of Oakland Park Boulevard in Fort Lauderdale while the outpatient clinic facility was in a series of three buildings on West Cypress Creek Road and NW 31st Avenue in northwestern most Fort Lauderdale.
Through a variety of steps undertaken by our former CEO, Harry K. Moon, MD, Cleveland Clinic in Florida successfully relocated to a 68-acre unified campus in Weston, Florida. Weston is the geographic epicenter amongst Palm Beach, Broward, Miami-Dade, Lee, and Collier Counties.
This imminently convenient 500,000 square foot location includes the multi-million dollar interactive David G. Jagelman, MD Conference Center. Most of the 153 beds are in private rooms. Both the physical plant and level of service are far more akin to a five star hotel than to a conditional hospital.
The hospital has become a destination for both health care providers and patients from around the world. In fact, over 80% of the patients seeking surgery in the Department of Colorectal Surgery live outside of the five-county area of Monroe, Miami-Dade, Broward, Palm Beach, and Martin Counties. Despite the small size of the hospital, the colorectal service generally occupies 25% to 35% of the hospital census. On most days, 2 to 3 colorectal operating rooms are in session from 7:30 a.m. until some time in the evening serving an ever-increasing number of patients.
None of these accomplishments would have been possible without the efforts and visions of our founding late chairman, David G. Jagelman, MD Although more than five years have elapsed since David’s untimely passing, on August 9, 1993, his teachings are imparted to our residents and students on a daily basis. His energy and enthusiasm for our specialty continues to be transmitted and his name will live on forever.
Although he is not here with us in a corporeal sense, he continues to be our guiding light as we follow the path which he outlined to success. We are delighted that the multimillion dollar interactive conference facility in Weston is named “The David G. Jagelman, MD Conference Center.” It is a fitting tribute to a man who made so many innovations and touched in a positive way so many lives throughout the world.
None of the accomplishments in this department would have been possible without the participation of our patients by allowing us the privilege of serving their health care needs. We could not have treated these patients had our colleagues from communities throughout the world not relied upon us as a referral resource for these problems.
We could not have learned how to better treat the patients of these physicians had our clinical and research residents, fellows, and students not been here to continually stimulate us to work at our best and to mercilessly, and in a brutally honest fashion, scrutinize our results. These results could not have been properly analyzed, presented, and published without the financial support of our philanthropic patients and corporate donors.
Unfortunately, funding for research and education is increasingly difficult to secure. We must rely upon such altruism to continue our activities.
As you peruse the sections that follow this introduction, I ask you to think about the impact made on the quality of life for patients throughout the world by the advances made in our department. I would like you to reflect upon the importance of continuing to teach current and future generations of surgeons how to evaluate and manage these problems. Lastly, I would like you to volunteer to help us as best you can to perpetuate Dr. Jagelman’s legacy in providing the finest possible care for diseases of the colon, rectum, and anus.
In the acknowledgements section, you will find a list of our major donors to date. I hope to see your name on the next iteration of this list. I thank you in advance for your anticipated generosity.
Steven D. Wexner, MD, FACS, FRCSEd, FASCRS, FACG
Director, Digestive Disease Center
Chairman, Department of Colorectal Surgery
Professor of Surgery, The Cleveland Clinic Foundation Health Sciences Center of The Ohio State University
Clinical Professor, Department of Surgery, University of South Florida
Research Professor of Biomedical Science, Florida Atlantic University
21st Century Oncology Chair in Colorectal Surgery
History of the Cleveland Clinic Foundation
In 1921, the Cleveland Clinic Foundation was established by four physicians, Drs. George Crile, Frank Bunts, William Lower, and John Phillips. At that time, the group practice model was rare, only being found at the Mayo Clinic and in military units. Their mission was to establish a medical facility dedicated to quality patient care, education, and research into the diseases of the patients they treated. This mission culminated in the formation of the Cleveland Clinic.
Seventy years and two million patients later, that mission statement remains a guiding principle for the Cleveland Clinic Foundation, a not-for-profit group practice in which clinical care, research, and education are inextricably linked in order to provide each patient with the best possible care. Through the years, the Clinic has changed and grown and now is one of the world’s foremost leaders in healthcare.
Similarly, in 1988, Cleveland Clinic in Florida was established to provide similar care in a region where academic medicine and group practices were rare. Since 1988, Cleveland Clinic in Florida has grown in all aspects and is internationally recognized as a healthcare leader.
The Department of Colorectal Surgery is the epitomy of the growth. The department is internationally renowned for patient care, research and education, teaching, and training. Moreover, numerous publications and presentations as well as new and innovative techniques makes the department one of the most well respected academic colorectal units in the world.
History of the Department
As in all successful endeavors, an initial development person is usually behind that success. The case is no different in the Department of Colorectal Surgery at Cleveland Clinic in Florida.
Dr. David G. Jagelman
The late Dr. David G. Jagelman (1939-1993) was the driving force in the department. Dr. Jagelman was born in England where he received all of his undergraduate and graduate education. He trained at such prestigious institutions as Westminster Medical College, the Metropolitan Hospital, and St. Mark’s Hospital. Dr. Jagelman then trained as a fellow in colorectal surgery at the Cleveland Clinic Foundation in Ohio in 1974-1975 and remained on staff in the department. In 1987, he was recruited to begin to build the Department of Colorectal Surgery in Fort Lauderdale.
Dr. Jagelman was one of the founding fathers and Chairman of both the Department of Colorectal Surgery and the Division of Surgery. His world famous reputation and expertise in rectal cancer, inflammatory bowel disease and familial adenomatous polyposis (FAP) allowed the department to quickly blossom.
In Cleveland, Dr. Jagelman had established the polyposis registry which became one of the largest and most respected registries in the world. After entering 240 families into the registry, Dr. Jagelman set up an identical registry in Florida. Between 1988 and 1993, he entered 33 new families into the Florida registry. Dr. Jagelman remained chairman until his untimely death at the age of 53 in 1993.
In 1987, prior to Dr. Jagelman leaving Cleveland, he recruited Steven D. Wexner, MD, from the University of Minnesota, to help begin the vision of a world-class department. A native of New York, Dr. Wexner received his undergraduate education at Columbia University, his medical schooling at Cornell University, and his surgical training at The Roosevelt Hospital in New York.
In early 1988, when Cleveland Clinic in Florida opened, Dr. Wexner established the Anorectal Physiology Lab. At the time of its inception, the physiology lab was one of the first comprehensive interdisciplinary testing facilities in North America. Since that time, it has become one of the premier physiology laboratories in the world, evaluating hundreds of patients and training dozens of physicians each year.
In 1988, Drs. Jagelman and Wexner were among the first surgeons in the world to perform and disseminate the benefits of a new type of ileal pouch anal anastomosis called the double stapled technique. This exciting new modification to the pouch procedure revolutionized surgery for mucosal ulcerative colitis. It has been applied to almost 1000 patients in our department and has been adopted by countless surgeons worldwide, thereby benefiting many thousands of patients.
In 1991, Drs. Jagelman and Wexner began to pioneer laparoscopic colorectal surgery. That program has now developed into one of the most extensive of its type in the world. Thousands of surgeons from throughout the world have come to receive training while over 1000 patients at Cleveland Clinic in Florida and hundreds of thousands more worldwide have now undergone this impressive new technique. Other new and innovative procedures pioneered in total or in part at Cleveland Clinic in Florida in the Department of Colorectal Surgery include:
- sacral nerve stimulation for fecal incontinence
- stimulated graciloplasty for fecal incontinence
- the artificial bowel sphincter for fecal incontinence
- the use of sodium hyaluronate/carboxymethylcellulose bioresorbable membrane for prevention of postoperative adhesions
- a new technique of multilayered sphincter repair for fecal incontinence
- management of sigmoidoceles for chronic constipation
- graciloplasty for rectourethral and rectovaginal fistulas
- scoring systems for both fecal incontinence and chronic constipation developed at Cleveland Clinic im Florida have become the most commonly used validated scoring systems.
Dr. Steven Wexner
Since 1993, Dr. Wexner has been the Chairman of the Department of Colorectal Surgery as well as serving as Director of the Residency Program from 1989 to the present. He served as Vice-Chairman of the Division of Surgery until 1995 when he was appointed as Chairman of the Division of Research and Education.
He chaired the Institutional Review Board and the Continuing Medical Education Committee until November 1997 when he resigned from those positions to accept the appointment as Chief of Staff. His duties as Chief of Staff include Cleveland Clinic in Florida, and Cleveland Clinic Hospital, and currently include the additional responsibilities of Chairman of the Medical Executive Committee, and 21st Century Oncology Chair in Colorectal Surgery.
Dr. Wexner was also appointed Professor of Surgery at The Cleveland Clinic Foundation Health Sciences Center of The Ohio State University, Research Professor of Biomedical Science at Florida Atlantic University, and Clinical Professor in the Department of Surgery at the University of South Florida as well as honorary professor at the University of Siena in Siena, Italy, the University of Nanjing, China, University of Belgrade, Serbia, and Tokyo University, Japan.
Dr. Wexner is also a Visiting Professor at Hadassah University Medical Center in Jerusalem, Israel. He has also received fellowships from the Royal College of Surgeons in London and the Royal College of Surgeons in Edinburgh. Dr. Wexner has been president of numerous professional societies including the South Florida Chapter of the American College of Surgeons, the Florida Gastroenterologic Society, and the Section of Colon and Rectal Surgery of the Southern Medical Association.
From 2006-2007, Dr. Wexner was President of SAGES, the largest general surgery association in the USA with over 6000 surgeon-members. Other leadership roles have included the residency review committee for Colon and Rectal Surgery of the ACGME, the American Board of Colon and Rectal Surgeons, the executive council of the ASCRS, and a governor of the American College of Surgeons.
Dr. Wexner is on 19 editorial boards, has delivered thousands of lectures on 6 continents. He has authored or coauthored 26 books, 191 book chapters, 1025 abstracts, and 476 manuscripts.
Dr. Juan J. Nogueras
In 1991, Dr. Juan J. Nogueras was recruited from colorectal surgery training at the University of Minnesota. Born in Puerto Rico, Dr. Nogueras moved to New Jersey at the age of ten years. His undergraduate training was at Princeton University, and he attended medical school at Jefferson Medical College in Philadelphia, Pennsylvania. He completed his surgical residency training at Columbia-Presbyterian Medical Center of Columbia University in New York.
Dr. Nogueras is in charge of the Cleveland Clinic in Florida David G. Jagelman, MD Inherited Colorectal Cancer Registry as well as the surgical registries in the Department of Colorectal Surgery. Dr. Nogueras has significant interest in genetics and in familial colorectal cancer syndromes. Dr. Nogueras is one of the world experts in endoanal ultrasonography and has pioneered some of its current uses in benign diseases such as fistulas, incontinence, and anorectal pain.
Dr. Nogueras served as Chairman of the Medical Advisory Committee of the Gold Coast Chapter of the Crohn’s and Colitis Foundation of America. He chaired the Medical Student Education Committee and was the interim co-chair for the Cancer Center at Cleveland Clinic Florida. In addition, he has served on many important national committees including the Program Committee for the American Society of Colon and Rectal Surgeons. In addition, he is an honorary member in seven international surgical societies.
In January 1999, Dr. Nogueras was appointed as the Vice-Chairman of the Department of Colorectal Surgery and was also appointed as Associate Professor of Surgery of The Cleveland Clinic Foundation Health Sciences Center of the Ohio State University. Since 2000, Dr. Nogueras has served as Chairman of the Department of Surgery. His other leadership roles have included Secretary-treasurer of the South Florida Chapter of the American College of Surgeons.
Dr. Nogueras has delivered 233 lectures at 93 meetings in 16 countries on 3 continents. He has authored 23 book chapters, 150 abstracts, and 97 manuscripts.
Dr. Eric G. Weiss
In 1994, Dr. Eric G. Weiss was recruited after completing fellowship training in the Department of Colorectal Surgery at Cleveland Clinic Florida. Dr. Weiss, a New Mexico native, received his undergraduate education at Pennsylvania State University, his medical education at Temple University, and surgical training at the Albert Einstein Medical Center in Philadelphia.
As the first alumnus member of the department, Dr. Weiss is integrally important to the residency training program. He has interests in laparoscopy, endoanal ultrasonography, colonoscopy, colorectal cancer, and inflammatory bowel disease, in addition to other facets of colorectal surgery.
Dr. Weiss has chaired the Patient Education Committee at Cleveland Clinic Florida since its inception. He also plays important roles in many national societies including as a member of the Young Surgeons Committee of the American Society of Colon and Rectal Surgeons.
In 1998, Dr. Weiss was appointed as Associate Program Director of the Residency Training Program in the Department of Colorectal Surgery at Cleveland Clinic Florida, and in 2004 became the Residency Program Director. Since 1998, Dr. Weiss has also served as Chairman of the Graduate Medical Education committee.
Dr. Weiss served on many regional committees for several professional societies including SAGES and ASCRS. He was the representative from both these prestigious societies to the CPT coding panel of the American Medical Association and is a member of the residency review committee in colon and rectal surgery of the ACGME. Dr. Weiss is also a member of the executive council of the Program Directors Association in Colon and Rectal Surgery.
Dr. Weiss was also appointed as Assistant Professor of Surgery of The Cleveland Clinic Foundation Health Sciences Center of the Ohio State University. He has delivered 178 lectures worldwide. He has authored or co-authored 550 abstracts, 1 book, 36 book chapters, and 225 manuscripts.
Dr. Dana Sands
In 2002, Dr. Dana Sands joined the department after completing the Colorectal Surgery fellowship here at Cleveland Clinic Florida. Prior to coming to Cleveland Clinic Florida, she received her undergraduate education at Renssalear Polytechnical Institute in Troy, NY. She attended the Hahnemman University School of Medicine in Philadelphia, PA and completed general surgery residency training at Jackson Memorial Hospital in Miami, FL.
Since joining the department, she became director of the Colorectal Physiology Center in 2002, and has expertise in benign anorectal diseases, pelvic floor dysfunction, fecal incontinence, constipation, inflammatory bowel disease, and colorectal cancer. Dr. Sands has an extensive experience with transanal endoscopic microsurgery(TEMs).
Dr. Fabio Potenti
During 2006, Dr. Fabio Potenti was recruited as a member of the Faculty for the Residency Program. Dr. Potenti completed his general surgery training at Brown University and after two years on Faculty at Brown came to Florida where he successfully completed both a research and clinical year in the Department of Colorectal Surgery.
After serving on the Faculty at Brown University for an additional five years, Dr. Potenti returned to South Florida and established practice in Broward County. Because of his abilities, results, and enthusiasm for teaching, Dr. Potenti was invited to join the medical staff in the Department of Colorectal Surgery at Cleveland Clinic in Florida. He has become an invaluable resource for the residents and has his operative and “on call” schedules completely integrated with the other members of the Department.
In addition to the full time faculty and Dr. Potenti, since 1998, a variety of Clinical Associates have helped maintain the high volume of patients and of complex cases. These individuals have included Drs. Jay Singh, Josh Katz, Jonathon Efron, Susan Cera, Jenny Speranza, Jill Genua, and Christina Seo.
Dr. Susan Cera
Dr. Susan Cera (Clinical Associate from July 2004 to June 2005) attended medical school at Georgetown University and then completed her general surgery residency at the Carolinas Medical Center. After her Clinical Associate year, Dr. Cera replaced Dr. Efron at Cleveland Clinic in Florida Naples.
Since that facility has become Physicians Regional Medical Center, Dr. Cera has remained not only as a world-renowned surgeon but as an excellent and highly contributing member of the Faculty in the Department of Colorectal Surgery at Cleveland Clinic in Florida.
Dr. Lestor Rosen
Dr. Sowsan Rasheid