Renowned robotic urologic oncology surgeon Dipen J. Parekh, MD, was the first in the nation to test a new preoperative surgical rehearsal technology recently approved by the FDA for all genitourinary conditions. The kidney models, made by Lazarus 3D, provide an additional preparation tool for some surgical procedures.

“The company reached out to me, and the device sounded intriguing,” said Dr. Parekh, a member of Sylvester Comprehensive Cancer Center, founding director of the Desai Sethi Urology Institute and director of robotic surgery at UHealth – the University of Miami Health System. “I thought that this may be a technology that would be worth trying to see if it can add value.”

While surgeons routinely study MRI and CT scans to understand each patient’s unique anatomy, 3D models offer an added level of detail, as well as giving surgeons the ability to hold, rotate, examine and conduct actual practice surgeries.

The Lazarus 3D kidney surgical rehearsal models are created using imaging data and are made from pliable materials designed to replicate the look and feel of actual human tissue. The model organ is created with a novel 3D printing technology, and replicates the texture and pliability surgeons encounter in the human body.

“We use a range of proprietary silicone materials that are designed to simulate human tissue,” said Jacques Zaneveld, PhD, Lazarus 3D founder and CEO. “We can create materials that feel like skin, fat and organs. These materials are so lifelike, you can operate on them using the same tools and techniques used on real patients.”

Dr. Parekh used these models to prepare for two separate tumor surgeries, one of which required navigating some complex anatomy. “The test run showed me what to expect when I conducted the actual surgery,” he said.

Lazarus 3D leadership said these models can be especially helpful for residents and other early-career surgeons. They can also be used as teaching tools for patients, giving surgeons a visual aid to describe an organ’s anatomy and how they expect a surgery to proceed.

“For patients, it is an amazing communication tool and may help improve care,” Dr. Zaneveld said. “For physicians, it allows an opportunity to try different approaches and to better anticipate what the real surgery will be like.”

Testing is underway to expand the use of the modeling technology to other organ models, such as bladder and prostate. Prostate surgery can be particularly challenging, as doctors must avoid the bladder, musculature and important nerves, and and deal with other potential complexities.

“This may be a good simulation tool for patients who have a complex anatomy, such as an enlarged prostate or a median lobe, and require surgery,” Dr. Parekh said.

Articles

Renowned robotic urologic oncology surgeon Dipen J. Parekh, MD, was the first in the nation to test a new preoperative surgical rehearsal technology recently approved by the FDA for all genitourinary conditions.

Renowned Robotic Surgeon First to Use New 3D Kidney Model

Researchers at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine have joined forces with the University of Miami College of Engineering for Engineering Cancer Cures™, a collaborative initiative to develop and deploy innovative technologies for early detection, diagnosis, and treatment of cancer.

Sylvester Director Stephen D. Nimer, MD, and Dean of Engineering Pratim Biswas, PhD, co-created Engineering Cancer Cures, which is led by Shanta Dhar, PhD, assistant director for technology and innovation at Sylvester, and Ashutosh Agarwal, PhD, associate professor of biomedical engineering.

Engineering Cancer Cures aims to find innovative ways to tackle this multidimensional disease, which is heterogenous in terms of biology and disease evolution, according to Dr. Dhar.

“Through this collaborative partnership, we will be able to integrate cancer biology, clinical outcomes, and new pathways discovered with engineered therapeutics and diagnostics to advance cancer cures,” Dr. Dhar said.

While cancer clinicians know what cancer patients need, engineers help to fulfill those needs by designing innovative therapies, procedures, algorithms and more, according to Dr. Agarwal, who is associate director of UM’s Biomedical Nanotechnology Institute and a Sylvester member.

Engineering Cancer Cures includes three working groups — Intelligent Materials and Targeting, Cancer Tissue Engineering, and Artificial Intelligence/Machine Learning/Deep Learning-Based Imaging and Analytics — that are led by members of both partners. Initial research projects include looking at how to better reach tumor targets, therapeutic cell engineering, artificial intelligence (AI) in cancer imaging, and many others.

Dr. Agarwal, who is co-leading the initiative’s Cancer Tissue Engineering working group with Jashodeep Datta, MD, assistant professor of gastrointestinal surgical oncology, said they will focus on such things as the possible transition from classic therapies that can be taken or infused, such as chemotherapies, to treatment that involves placement of living tissue or cells in cancer patients.

“Therapies of the future are cell injections and tissue engineering that can go inside a body,” Dr. Agarwal said. “We are working with Sylvester’s cancer clinicians to develop engineered cells, engineered tissues, and engineered gene edits that can solve the incurable cancers of today.”

Engineering Cancer Cures will accelerate collaborative discoveries otherwise siloed in the cancer biology and engineering disciplines, according to Dr. Datta.

“As a cancer researcher focused on how innate immune cells in pancreatic cancer interact with tumor and stromal cells, I will leverage Dr. Agarwal’s expertise in biomimetic tissue engineering platforms to reconstruct the precise physiologic microarchitecture that allows tumor-stromal-immune interactions in the tumor microenvironment to instigate chemoresistance in pancreatic cancer,” Dr. Datta said.

The Intelligent Materials working group, co-led by Dr. Dhar and Sakhrat Khizroev, PhD, will look at targeting therapy to tumor cells with nanoparticles, while leaving healthy surrounding tissue unharmed. Other focuses of the group include identifying novel targets for imaging and therapy, cancer pain management, and more.

In the Artificial Intelligence/Machine Learning/Deep Learning-Based Imaging and Analytics working group, a team of clinicians and mathematicians are integrating and analyzing large datasets from genomic sequencing, tissue pathology, and radiologic tissue imaging.

“Here at Sylvester and at the University of Miami medical system, we are generating a lot of data in research and patient care,” said Stephan Schürer, PhD, a professor of pharmacology at the Miller School, who is co-leading the group with Mohamed Abdel-Mottaleb, PhD, professor and chair of the Department of Electrical and Computer Engineering. “It is critically important to be able to use the data to develop predictive models.”

The collaboration with engineering will result in infrastructures that allow optimal use of the data and development of novel solutions for patients and the health system, according to Dr. Schürer, who leads the Cancer Science Initiative and is director of digital drug discovery at UM’s Institute for Data Science and Computing.

While other respected U.S. cancer centers encourage collaboration between cancer center and engineering scientists, Sylvester stands out for its access to a diverse local population of cancer patients, according to Dr. Agarwal.

“This gives us a strategic advantage because we know that drugs and therapies approved in studies with predominately White patients might not work in Black or Hispanic patients, for example. It is very important to capture those racial differences,” Dr. Agarwal said.

The fight against cancer requires innovative transdisciplinary research models that work seamlessly without borders, said Wael El-Rifai, MD, PhD, professor and associate director of Program Development, co-leader of the Tumor Biology Program at Sylvester and Engineering Cancer Cures Steering Committee member.

“That is the essence of Engineering Cancer Cures,” Dr. El-Rifai said.

Researchers at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine have joined forces with the University of Miami College of Engineering for a collaborative initiative to develop and deploy innovative technologies for early detection, diagnosis, and treatment of cancer.

Sylvester Joins Forces with College of Engineering to Cure Cancer

Dorothy Graves, PhD, said she admired Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine years prior to being appointed Sylvester’s assistant vice president and associate director for administration in early 2022.

“I remember when Sylvester became NCI designated in 2019,” Dr. Graves said. “I was impressed with what Sylvester had built. It is especially well known for its community outreach and engagement, as well as its strong research programs.”

Dr. Graves spent five years in her previous leadership role as associate director for administration at Winthrop P. Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences. While in that role, Dr. Graves worked under the direction of three cancer institute directors and oversaw significant growth and development of the Institute’s administrative team to support all required infrastructure components for achieving NCI designation. She led recruitment of cancer research faculty and worked with cancer center and institutional leaders to secure a dedicated annual funding stream of more than $10 million to support efforts to attain NCI designation.

Dr. Graves was recruited as part of a national search led by Stephen D. Nimer, M.D., Sylvester director and holder of the Oscar de la Renta Endowed Chair in Cancer Research, Craig Moskowitz, M.D., physician in chief of the Oncology Service Line, Lazara Pagan, associate vice president and chief administrative officer, and additional Sylvester leadership. As associate director for administration at Sylvester, Dr. Graves oversees and supports the infrastructure needed to ensure that Sylvester remains one of 71 NCI-designated cancer centers in the U.S.

“We are delighted to welcome Dr. Dorothy Graves to the cancer center,” Dr. Nimer said. “Strong research operations are critical as Sylvester continues to evolve as a cancer center, create new research programs, further our clinical research services, recruit more outstanding faculty, and continue to improve our research facilities.”

Overseeing Infrastructure for Research Alignment

“NCI-designated cancer centers have distinct research programs that align all the different researchers and research projects within each center,” Dr. Graves said. “These designated centers have shared resources that support ongoing research, cancer research education and training programs, and community outreach engagement efforts. So, there are these different pieces that comprise an NCI-designated cancer center, and there must be an infrastructure to hold it together and facilitate growth and collaborations. As associate director for administration, I oversee that research infrastructure.”

Dr. Graves’ administrative responsibilities include facilitating clinical research, faculty recruitment, cancer research education and training, shared resources, research finance, grants management, scientific writing, internal communications, internal research funding programs, and direct support of the research programs and their collaborative efforts.

Dr. Graves works closely with the other associate directors and the research program leaders. She also collaborates with Sylvester oncology services and other UM areas, including communications, development, and government relations to ensure organization is in place for strategic growth.

“I oversee the administrative and operational piece for the scientific leaders to be sure that they can execute their vision and Sylvester’s strategic plan overall,” Dr. Graves said.

With a Ph.D. in microbiology and immunology from the University of Arkansas for Medical Sciences, Dr. Graves has a scientific background, in addition to her administrative experience. But she also has extensive experience in science communications. A recipient of a prestigious national science journalism fellowship from the American Association for the Advancement of Science, Dr. Graves spent years in broadcasting, working for NPR-affiliated stations covering beats from science to education and legislation. She later worked as the medical editor for a statewide newspaper in Arkansas. For 13 years she hosted a live talk show about science on an NPR-affiliate and moderated a companion monthly community forum. She not only communicated science, but also taught it as an instructor at the University of Arkansas at Little Rock.

“I’ve always been very information focused,” she said. “As I was getting my Ph.D., I realized I liked communicating and learning about science information more than being in the lab. I loved writing the grant and loved defending the grant in the dissertation process. What I love about research administration is it allows me to stay connected to the science. It allows me to help tell those stories. And most of all, I love being in a position where it’s my job to make it easy for our scientists to focus on what they do best.”

Dr. Graves said she is a big believer in systems improvement, and in the value of having a proactive, rather than a reactive, culture.

“It is a goal of mine to be strategic about how we are supporting our researchers, our science and our partnerships and collaborations moving forward,” she said. “It involves thinking about where we want to go next and having the systems and personnel in place to make that possible.”

Dorothy Graves, PhD, said she admired Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine years prior to being appointed Sylvester’s assistant vice president and associate director for administration in early 2022.


Dr. Dorothy Graves Joins Sylvester as Assistant Vice President and Associate Director for Administration

The Bristol Myers Squibb Foundation and National Medical Fellowships have selected Sylvester Comprehensive Cancer Center researcher Kristin E. Rojas, MD, FACS, for its inaugural Diversity in Clinical Trials Career Development Program, which includes a two-year $240,000 grant for her research “Effects of Perioperative Opioids on Gut Microbiome Composition in Breast Cancer Patients.”

The Clinical Trials Career Development Program recognizes community-oriented clinical researchers for their outstanding professional achievements and promise. Dr. Rojas, assistant professor of surgical oncology in the Dewitt Daughtry Department of Surgery and Sylvester Comprehensive Cancer Center, is among a distinguished group of physicians and one of six surgeons selected for the Foundation’s initiative to strengthen partnerships between clinical investigators and communities, increase the diversity of patients enrolled in clinical trials, and enhance the development of therapeutics for all populations.

Dr. Rojas’s research on opioid sparing strategies in breast cancer surgery have been published in the Annals of Surgical Oncology and other scientific journals.

“We have shown that opioid-sparing pain management in cancer surgery is safe, feasible and may actually improve postoperative pain control” Dr. Rojas said.

In fact, Dr. Rojas and colleagues have reported that pain control using non-opioid multimodal analgesia protocols with such medications as acetaminophen and nonsteroidal anti-inflammatory drugs result in less pain among surgical patients compared to patients prescribed traditional opioid-based regimens.

“This award will give me the resources to take our work to the next step by providing a mechanism in which opioids may worsen cancer outcomes through translational research. The first leg was a proof-of-concept, to show that there are alternatives to opioids in breast cancer surgery; this next step is to show that minimizing or eliminating opioids should be done in breast cancer surgery because it may impact oncologic outcome,” she said.

Sabita Roy, PhD, professor of surgery at Sylvester and a world leader in research looking at the impact of opioids on the microbiome, is mentoring Dr. Rojas for “Effects of Perioperative Opioids on Gut Microbiome Composition in Breast Cancer Patients.”

“Our group recently described how opioids promote carcinogenesis through pathogenic changes in the gut microbiome in preclinical cancer models,” according to the study’s abstract. “…there is a critical need to assess the effects of opioids in developing gut dysbiosis and its subsequent inflammatory cascade in a diverse cohort of cancer patients to better understand their role in promoting adverse oncologic outcomes.”

Preliminary work by Dr. Rojas and other researchers seems to have helped to lessen opioid use for patients having breast-conserving lumpectomy procedures.

“I was honored to contribute to the American Society of Breast Surgeons Pain Management Consensus Guidelines in 2020 that provided a framework for other breast surgeons to limit superfluous opioid prescribing,” she said. “But I think surgeons still prescribe opioids almost universally for patients undergoing mastectomy.”

Dr. Rojas and colleagues will study 48 South Florida breast cancer patients. Half will receive opioids to control pain related to breast cancer surgery and half will receive her opioid-sparing multimodal analgesia protocol for pain control. The researchers will stratify patients in the study by Hispanic and non-Hispanic ethnicity to account for differences in outcomes by ethnicity.

“The primary outcome is to prove that even short-term opioids given at the time of surgery have a negative impact on the gut microbiome,” she said. “We also need to be looking at ethnicity in order to account for all possible differences in microbiome composition.”

Sylvester and the University of Miami Miller School of Medicine are in the ideal location for such a study.

“Florida has been particularly hard hit by the opioid epidemic. We also have a richly diverse population and can contribute a diverse cohort to this research,” Dr. Rojas said. “This is critical for the future of quality research and one of the forces behind the Bristol Myers Squibb Foundation program. Our guidelines are based on studies of mostly white educated populations and that is not the only face of the patients that we treat. To provide the best care for cancer patients, we need to make sure that the treatments that we are studying and saying are best have been proven to be effective in the patients that we serve.”

The Bristol Myers Squibb Foundation funding also includes training and mentoring to support clinical investigators’ ability to advance health equity through research and mentoring. Dr. Rojas will be mentored in the first year of the program and, in the second year, will mentor a medical student that represents the next generation of diverse clinical researchers.

“This is exciting not only because my project is going to be funded, but also because I am part of a program that focuses on career development and promoting diversity among primary investigators,” Dr. Rojas said.

The Bristol Myers Squibb Foundation and National Medical Fellowships have selected Sylvester Comprehensive Cancer Center researcher Kristin E. Rojas, MD, FACS, for its inaugural Diversity in Clinical Trials Career Development Program.

Sylvester Comprehensive Cancer Center

Articles

Renowned Robotic Surgeon First to Use New 3D Kidney Model

Sylvester Joins Forces with College of Engineering to Cure Cancer

Dr. Dorothy Graves Joins Sylvester as Assistant Vice President and Associate Director for Administration

Bristol Myers Squibb Foundation Selects and Funds Sylvester Researcher for Its Diversity in Clinical Trials Career Development Program