What are your goals as SAGES incoming President?
Dr. Jones: Serving as President of SAGES this year is a tremendous personal honor for me. SAGES is the second largest surgical organization in the US after the American College of Surgeons, with over 6,000 members. SAGES attracts inventors, innovators, and early adopters of emerging technologies and procedures. SAGES has embraced endoscopy and laparoscopy, and continues to assess the benefits of NOTES and robotic surgery. SAGES has always had an emphasis on education, training, and research, hosting quality courses and producing amazing educational content such as FLS, FES, and FUSE.
As President, I want to encourage young surgeons to join SAGES and get engaged via committees. I also want to promote mentoring, collaboration, and networking using social media. Another goal is to challenge SAGES to lead in national healthcare advocacy and reform. I hope to see FUSE become a criterion for hospital privileging to promote patient safety, and I’d also like to see the SAGES Masters Program become accepted as a means of lifelong learning after fellowship. I want us to rethink how we use virtual reality simulation to teach and innovate. I want to tap the generosity and talents of SAGES members to grow the Go Global committee and program for teaching to underdeveloped countries.
I plan to collaborate closely with other organizations. In bariatric surgery, we will continue to work with the American Society for Metabolic and Bariatric Surgery (ASMBS) on guidelines and educational initiatives. We will similarly work with the American Hernia Society (AHS) and Association for Surgical Education (ASE). We will also reach out to the AAST for acute care surgeons and the Association of Women Surgeons for joint programming. We will partner with the American College of Surgeons and Society for Surgery of the Alimentary Tract (SSAT) to collaborate on advocacy and health reform.
On April 11 - 14, 2018, SAGES will be hosting its World Congress in Seattle. We hope to attract surgeons from around the globe to share their experiences. I anticipate that SAGES will have a bigger presence in robotic surgery of the pancreas, liver and colon. Program co-chairs (Robert Lim, John Marks, and Liane Feldman) are already at work to make this the most exciting SAGES meeting ever. I am confident it will be fun. Mark your calendars!
What do you consider to likely be your biggest challenge in the position?
Dr. Jones: The ASMBS Essentials App is an online educational program that seeks to teach all who care for patients of size. Log on to Essentials.ASMBS.org and register for free as a physician, nurse or dietician. After completing a pretest, you work through several modules (Preoperative Assessment, Intraoperative Considerations, Perioperative Care, Outcomes, etc) before taking a post-test. CME and CEU credit is optional for an additional fee.
I started the Essentials App with my wife, anesthesiologist Dr. Stephanie Jones, in Boston a decade ago. We were sponsored by the Harvard hospital malpractice carrier, CRICO-RMF. A few years ago, we took the project to ASMBS to update and rerelease, and it’s been widely adopted.
What are some of the most promising technologies on the horizon in surgery today?
Dr. Jones: Sleeve gastrectomy has become the platform of bariatric surgery worldwide and will continue to grow. I foresee that 80% of bariatric procedures will become sleeve gastrectomies.
Colleen: What is the biggest challenge for bariatric surgeons today and how does ASMBS meet that challenge?
Dr. Jones: There are many exciting new devices and procedures. I serve as an advisor for Allurion and The Medicines Company. Eight years ago, two third-year medical students rotated on my bariatric surgery service. Convinced that they could provide a safer operation than the laparoscopic gastric bypass, they took a leave from Harvard Medical School and founded Allurion. The Allurion intragastric balloon does not require endoscopy for insertion or removal and was recognized by SAGES as the best emerging technology last year.
Also, Drs. Phil Schauer and John Morton lead a research effort into a device to self-administer fentanyl after bariatric surgery. This technology by IONSYS is very interesting as a new concept in better and safer pain control.
Can you touch on Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)?
Dr. Jones: A decade ago, the ASMBS and ACS set up separate accreditation processes with the SRC and BSCN, respectively. I was part of the ACS BSCN. A few years ago, the ASMBS and ACS joined to establish the MBSAQIP. Dr. David Provost and I now serve as co-chairs of the Verification Committee. Today we have over 900 accredited centers that submit outcome data on 100% of bariatric operations. MBSAQIP centers assure facility infrastructure, personnel, sensitivity training, oversight, and quality initiatives.
What are your thoughts on social media surgeon groups?
Dr. Jones: Social media is a game changer. Today there are active Facebook sites for hernia surgeons (by Brian Jacobs) and for robotic surgery (by Yusef Kudsi). SAGES is building on their expertise to develop social media sites for hernia, foregut, biliary, colorectal, bariatric, acute care, endoscopy, and robotic surgery as part of the SAGES Masters Program. Surgeons will be able to submit video clips and obtain feedback using crowdsourcing.
What do you do for fun?
Dr. Jones: My wife and I like to travel abroad, except during the spring, when I try to make as many of my daughters’ lacrosse games as possible.
This year, we did block out a few days to join Phil Schauer’s MISS meeting in Las Vegas, and have an excuse to play a few slots after the scientific program!
Can you comment on the impact of the new diabetes surgery guidelines?
Dr. Jones: It makes sense to me that as operations get safer and safer, that we reassess the risk-benefit tradeoff for surgical versus medical therapy. For type 2 diabetes, the International Diabetes Summit determined that a lower BMI threshold for weight loss surgery was appropriate (Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016 Jun;39(6):861-77). Despite the success of placing diabetes into remission after weight loss surgery, most third party payers have been reluctant to embrace the new lower BMI standards. Meanwhile many patients will continue to inject insulin and suffer complications of diabetes.
What is your view of the new endoscopic procedures for weight loss?
Dr. Jones: More and more procedures can be done through an endoscope in skilled hands, and I strongly encourage my bariatric fellows to spend time with the GI endoscopist. The endoscopist can clip shut a fistula, tighten a gastrojejunostomy, shrink the gastric pouch, and mimic gastric bypass and sleeve operations. Endoscopy is needed for placement of most intragastric balloons and the endolumenal sleeve. However, until we have randomized, controlled long-term studies comparing endoscopic procedures to laparoscopic counterparts, I remain a bit skeptical.
How would you characterize the importance of training and education in bariatric surgery to improve outcomes?
Dr. Jones: Over the last 20 years, bariatric surgery training has evolved into a respected specialty. When I first joined ASBS, a surgeon had to be preceptored (observed) doing 8 gastric bypass operations. In the era of laparoscopy, we had weekend courses with pigs, then one-week mini-fellowships, and then finally one-year fellowships. During the year, fellows learn more than just the steps of an operation; they learn about clinical care pathways, MBSAQIP accreditation standards, and promoting quality initiatives. Today we have just about replaced the animal vivarium and cadaver lab with virtual reality and the simulation center.
What is your opinion on how to expand insurance coverage for bariatric surgery based on scientific evidence?
Dr. Jones: More than scientific evidence, we need to demonstrate the cost-benefit advantages of early treatment. As patient advocates, we need to make sure that metabolic and weight loss is a universally covered benefit in all health insurance plans. This will require physicians and patients advocating in the political arena.