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Usmaan Hameed wins Zane Cohen Award

Usmaan Hameed is the recent winner of the Zane Cohen award, which celebrates the clinical fellow in the Department of Surgery who has made the most significant achievement in any of the domains of medicine. Usmaan is currently in the inaugural class of the new Translational Research Program at IMS. His focus of study toward earning an MHSc degree will be intraoperative imageguided navigation for rectal cancer resection. The new Translational Research Program is intended to bridge the ‘valley of death’ between early research discoveries and their integration discovery and integration into clinical practice.

Usmaan has been interested in minimally invasive surgery throughout his general surgery residency. “Laparoscopic and open operations lack depth perception in critical areas. For instance, during an abdominoperineal resection (APR) for rectal cancer, it is often difficult to assess the planes between the prostate and the rectum, or the autonomic nerves during the dissection. Operative navigation could be used to compensate for this deficiency.” Usmaan will look at animal models during his Master’s program with Dr. Victor Yang, a neurosurgeon- engineer with an interest in image-guidance. He will be working in combination with the Sunnybrook Research Institute on the accuracy of intraoperative navigation for guiding rectal cancer resection.

Q: Why were you selected for the Zane Cohen award?

A: “I was heading for a fellowship in minimally invasive surgery but felt I received a lot of exposure to MIS during residency. I wanted to expand the use of minimally invasive and transanal techniques in advanced GI malignancy and became interested the surgical oncology fellowship directed by Frances Wright. The fellowship is a two-year Royal College accredited program. In first year the 3-month core rotations of the program, focused on colorectal, hepatobiliary, breast, melanoma and sarcoma treatment, is intended to provide a multidisciplinary understanding of cancer biology. The second year electives are chosen to focus in an area of interest for the fellows. Our faculty are particularly good at minimally invasive techniques in the G.I. area. Shady Ashamalla, Fayez Quereshy, and Peter Stotland were excellent mentors for me.


Usmaan with Prof. Joel Leroy at IRCAD, France.

In addition to my core rotations, I spent eight weeks with Prof. Joel Leroy at IRCAD in Strasbourg, France, a world leader in novel laparoscopic, transanal and endoscopic approaches. My clinical goal at IRCAD was to gain expertise in Transanal Minimally Invasive Total Mesorectal Excision (TAMIS-TME). This technique is particularly valuable in low rectal cancers to improve the exposure of dissection in a deep, narrow pelvis. TAMISTME is giving birth to a new era in sphincter preserving trans-anal surgery.

From an academic perspective, IRCAD also has experience with intraoperative surgical navigation in hepatobiliary surgery. While I was there we looked at a novel use of narrow-band imaging, which uses light of specific wavelengths other than the traditional white-light used in laparoscopy, to evaluate for bile leak intra-operatively. Similar techniques may be used in rectal cancer to better assess tumour regression following radiation.

“Patients with rectal cancer are often treated with neoadjuvant chemoradiation prior to surgery, and evidence has emerged that this treatment gives a complete clinical response in 20-30% of cases. A complete clinical response isn’t a pathological complete response. If we excise the radiation scar, up to 25% of these patients will still have viable tumor cells. Identifying better predictors of a sustained complete response in patients will allow us to more effectively determine which patients can safely avoid surgery. There are now trials randomizing patients to surgery versus watchful waiting after neoadjuvant treatment.

“The courses in the translational research program are flexible and unique –modules ranging from qualitative methods and clinical epidemiology to marketing, entrepreneurship and applied intellectual property. The program also encourages collaboration across disciplines such as engineering to help build device prototypes. This is a unique program that will hopefully foster a nurturing environment for surgical innovation in Toronto.”

Q: What about research ethics oversight?

A: “Ethics is of utmost importance in the area of innovation. Traditionally, after Health Canada approval, clinicians often use new devices in the clinical setting on patients outside a prospective study. Have these devices been appropriately tested and in what setting? Do patients know when we trial a new device for the first time in the OR? These are very relevant topics that we are looking to investigate with Karen Devon who is a surgeon and ethicist on faculty.”

Q: Are there animal models that are helpful?

A: “The model depends on the area investigated. Pig models are relatively close in anatomy to the human pelvis but are extremely expensive. Cadaveric models are helpful models for operative navigation. We can use mousetumour models to look at novel uses of contrast imaging. The translational program has a variety of participants and mentors – engineers, basic scientists, and clinicians – which allows us to tackle the same problem using different perspectives. The program directors include Joseph Ferenbok - an information scientist, and Stuart Berger - an immunologist” (http://trp.utoronto.ca/).

Q: Of the 200 or more fellows, how did you earn the Zane Cohen award?

A: “Zane Cohen enabled this generous award. It’s an honor to receive it, as there are many who deserve to be recognized. It is a very productive cohort of fellows and I was humbled to receive the award. In our fellowship there are 4 to 5 surgical oncology fellows per year, a total of 10 in the program. As co-chief fellow I helped organize the surgical oncology lecture curriculum and journal clubs, fellowship interviews and selection, and other administrative duties such as visiting professor lectures. This was in addition to teaching, research and clinical performance that contributed to the award.”

Q: Teaching seems to be a prominent part of your academic life based on the awards you received in residency.

A: “I really enjoy teaching residents and medical students. My parents were both educators so perhaps that is where my interest comes from. My mother was an elementary school teacher and principal who emigrated and helped bring her family to Canada as refugees during the Idi Amin crisis in Uganda. My father was a professor and scientist from Pakistan who later taught anatomy, microbiology and parasitology at the University of Alberta in Edmonton. Both were immigrants to Canada. As a result I’ve been interested in education and in international health and international travel.


Usmaan Hameed with his wife Daniela and their daughter Mia Grace

I have a very supportive wife, Daniela, whom I met during medical school at the University of British Columbia. She is a staff obstetrician-gynecologist at Humber River Hospital. We married in residency and have a two-year-old daughter, Mia Grace. In the past we have worked on global health projects in Zimbabwe, South Africa, Brazil and Tanzania. We hope to continue travelling with Mia to expose her to different cultures and to preserve the heritage of our families as we raise our daughter. I play ice hockey as a goalie a few times per month as well as on the General Surgery team in the Department of Surgery games Dr. Rutka facilitates. I’m not that big, so I try to use my cat-like reflexes instead of bulk to defend the goal.”

Q: What are you reading currently?

A: “All fellowship material for my Royal College exam right now, but I especially enjoyed reading Atul Gawande’s books Complications, and Better during residency, and most recently Being Mortal.”


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