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Dr. Laki Rousou

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Healthcare Heroes

Innovation in Healthcare

Chief of Thoracic Surgery, Chief of Robotic Surgery, and Medical Director of the Lung Cancer Screening Program, Mercy Medical Center

With Screening and Technology, He’s Improving Outcomes and Saving Lives

 

Dr. Laki Rousou

Dr. Laki Rousou

Robotic surgery has been one of the most significant medical developments of the past couple decades, one with impacts that are … well, deeply human.

“It allows you to do major operations through small incisions and, at the same time, protect some vital structures more easily than you could even if you’re doing non-robotic minimally invasive surgery,” said Dr. Laki Rousou, who has performed more than 1,000 surgeries on the da Vinci surgical platform — and earned him recognition as a Healthcare Hero in the Innovation category.

Raised in Longmeadow, Rousou grew up with a deep appreciation for the medical field. As a child, he saw the impact his father, Dr. John Rousou, retired chief of Cardiothoracic Surgery at Baystate Medical Center, had on the lives of his patients. Meanwhile, his brother, Dr. Tony Rousou, is a cardiothoracic surgeon who specializes in cardiac surgery at Baystate.

At Mercy, Dr. Laki Rousou has carved out an intriguing, multi-faceted role as chief of Thoracic Surgery, chief of Robotic Surgery, and medical director of the Lung Cancer Screening Program (more on that later).

“My father was a physician in this area for years, so it was always in the back of my mind as something I would want to do,” he told BusinessWest. “Right after college, I didn’t immediately decide that’s what I wanted to do, but I eventually came to that conclusion and went to medical school.”

Rousou was drawn to the physiology of the heart and lungs, and wanted to find a way to marry that interest to some technical skill, which would turn out to be thoracic surgery.

“The main operation I do is taking out a lobe of the lung for a lung cancer,” he said. “Then there’s the esophagus, which is also in the chest, and diaphragm hernias. But robotics helped me along in my career in that I was able to expand some of the things that we could do minimally invasively.”

Two examples are a thyectomy, the removal of the thymus gland in the middle of the chest, and esophagectomy, in which he removes a good portion of the esophagus. “All that can be done robotically.”

Robotic surgery — by which a surgeon controls a camera and mechanical instruments inside the body from … well, outside it — brings many advantages for both patient and doctor, Rousou told BusinessWest.

“For cancer operations, it allows you to do a more comprehensive lymph-node dissection and gives you better visualization so that you can make sure that you’re taking out everything that you can take out and you’re doing that safely,” he explained.

“Even for non-cancer operations — let’s say a hernia of the diaphragm — there’s a fair amount of sewing that goes into that. In some of these open operations, when we’re deep in a cavity and we’re sewing with our hands and not robotically, it’s hard to see. You’re stretching your arm out, and the angles aren’t quite right, but with the robot, you can make the angles perfect, and you can see perfectly.”

From the physician’s standpoint, robotic surgery brings a different set of advantages.

“If you’re doing open surgery — or even doing non-robotic, minimally invasive surgery — you’re standing, and a lot of times reaching, and you’re not in an ergonomic position. When we’re doing these robotic operations, we’re sitting in a chair in a perfect ergonomic position,” he explained.

“So, just from that standpoint, you can lengthen your career. I know plenty of surgeons who, as they get toward the end of their career, their knees hurt, their backs hurt, and they stop because of that. Maybe this allows you to continue. You may still stop at the same time, but you can do it on your terms, and not because your knee hurts or your back hurts or things like that.”

While he’s become proficient at robotic surgery, Rousou admits he was a skeptic of the technology at first. Then he started to learn about the potential good it could do for patients by decreasing pain, more accurately dissecting lymph nodes, and other reasons.

“I went into it saying, ‘all right, I’m going to find out for myself.’ So I tried it. I did the trainings, and I started doing it. And told myself, ‘I’m not going to commit totally for a year.’”

“I see future benefits coming down the pike, just by being able to use AI and various technologies that can be linked with the robot to help others get better, to help myself get better, and to better evaluate outcomes.”

But after that year, he was seeing clear benefits, especially as he became more adept at it. “Once I saw that benefit, I committed wholeheartedly to it, and now, six or seven years after fully committing to it, I see future benefits coming down the pike, just by being able to use AI and various technologies that can be linked with the robot to help others get better, to help myself get better, and to better evaluate outcomes.”

 

Breathing Easier

Rousou also heads up Mercy’s Lung Cancer Screening Program, but he wasn’t enamored with the idea at first, when he was asked by hospital leadership to launch the initiative.

“I thought, ‘I’m a surgeon. Why am I going to start a program like that?’ But I thought about it and said, ‘all right, I’ll do it’ — because I think, with any screening program, if it’s not done in a particular way, it can cause harm. And I didn’t want that.”

Robotic surgery is essentially performed away from the body

Robotic surgery is essentially performed away from the body, with better precision than open surgery in many cases.

He was joined in that endeavor shortly thereafter by Ashley LeBlanc, who was honored as a Healthcare Hero in the category of Emerging Leader just last year. “Together, we grew this program that we started,” he said before explaining how it works.

“It’s not just a CT scan; it’s a visit with a patient that might be eligible for screening. They’re eligible for screening if they have a certain smoking history, a certain age — and if they’ve quit, it’s got to be within 15 years. But it starts with a visit and a discussion, and then, typically that day, they get a CT scan.”

Those results are reviewed, especially if there’s a high-risk result, by a group comprised of oncologists, pulmonologists, surgeons, radiologists, and pathologists to recommend next steps. If the result is not high-risk, the patient is advised to return for a scan the following year.

“The idea was to have those eligible get screened, but also get information back quickly because, if there’s a risk or a potential for cancer, you don’t want to sit on it. So, they get information back quickly, positive or not, and the care ends up being multi-disciplinary, with much, much better outcomes.”

That’s a big difference from the past, when CT scans for lung cancer were typically reactive, not preventive.

“Before screening, the lung cancers that we caught were caught incidentally,” Rousou said. “They got a CT scan because they had pneumonia. Or they got a CT scan because someone thought they had a blood clot in their lung. And then you see this mass. The vast majority of those were stage 3 or 4 lung cancers. Stage 3 is very difficult to treat; stage 4 is not curable.

“The idea behind screening is you flip the script on that. So now, in the screening population, the majority of the cancers that we find are stage 1 or 2, and are not as difficult to treat. We’ve had a lot of success with it.”

Those early screens are especially critical considering that lung cancer is the leading cause of cancer death in the U.S. (and in most other countries as well), and second only to heart disease in total deaths. In fact, Rousou said, lung cancer causes more deaths than the next four cancers combined in both men and women.

“I grew up here. I’ve got skin in the game here. And one of my goals from the outset, coming back here, was — at least in thoracic surgery and thoracic oncology — to make Western Mass. the equivalent, or better than, some of the major medical centers.”

“So that’s the perfect scenario for screening because, if you do have symptoms, it’s late. And lung cancer is an aggressive cancer,” he added. “You can get diagnosed with late-stage lung cancer, and then you might be gone in six months. That’s not the case, necessarily, with stage 1 or 2.”

Rousou is encouraged that earlier screening, combined with diagnostic advances, new treatment technologies, and pharmaceutical breakthroughs, are resulting in many lives saved. “This is a pretty exciting time, in my opinion.”

Dr. Laki Rousou (center) celebrates his 1,000th da Vinci procedure with Mercy’s Chief of Surgery Dr. Dan Morrison (left), and Chief Medical Officer Dr. Asha Dhamija.

Dr. Laki Rousou (center) celebrates his 1,000th da Vinci procedure with Mercy’s Chief of Surgery Dr. Dan Morrison (left), and Chief Medical Officer Dr. Asha Dhamija.

While outlining the innovations, robotic and otherwise, that Rousou has been putting into play at Mercy, Mary Orr, the hospital’s Media and Communications specialist, also took time to praise his human side in nominating him to be a Healthcare Hero.

“In addition to being a highly qualified, proficient thoracic surgeon, Dr. Rousou is deeply committed to his patients, always putting them at the center of everything he does,” she wrote. “He not only keeps current on the latest developments regarding technological advances and best practices in patient care so that his patients have the best chance of a positive outcome, his bedside manner is second to none. It’s not unusual to find him taking extra time to make sure his patients and their families fully understand the care plan or calling a patient after offce hours to answer their questions or allay their fears.”

 

Surgical Milestone

Having recently completed his 1,000th robotic thoracic surgery using da Vinci Xi, Rousou is among the nation’s most frequent users of the da Vinci surgical system for thoracic surgery, and he has also completed the most da Vinci thoracic surgeries in all of Trinity Health, the parent organization of Mercy Medical Center, which boasts 36,500 physicians and clinicians across 27 states.

The technology is highly adaptable; da Vinci Xi can be used across a spectrum of minimally invasive surgical procedures, including gynecologic, urologic, thoracic, cardiac, and general surgeries. Rousou was instrumental in championing efforts for Mercy to acquire the da Vinci Xi surgical system earlier this year.

“They had the older version of the robot when I got here; at least for thoracic surgery, it wasn’t being used a lot,” he explained. “So, once I made that commitment, that bolstered the program for robotics, and when the next version of the DaVinci robot came into play, I was involved in making that happen. Now we have two, and I was one of many who pushed for that second version of the robot.”

To hear him tell it, these are not only his patients, but his community — one where he has deep roots and personal connections. It explains why he returned to Springfield in 2014 after a decade of surgical roles at New York University Medical Center, Yale-New Haven Hospital in Connecticut, and Concord Hospital in New Hampshire.

“I grew up here. I’ve got skin in the game here. And one of my goals from the outset, coming back here, was — at least in thoracic surgery and thoracic oncology — to make Western Mass. the equivalent, or better than, some of the major medical centers, like Boston, New York, Yale, those places.”

By doing so, he envisions people getting care at a smaller, more intimate health center and not having to travel to bigger cities — and having access here to the most recent innovations, including the most advanced robotic surgery possible.

“That’s been an overreaching goal, and still is, for us here — to make this top-of-the-line care in your backyard,” he said. “And we’re not done yet.”

Innovation in Healthcare: Gabriel Mokwuah and Joel Brito

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Joel Brito (left) and Gabe Mokwuah
Healthcare Heroes

Patient Safety Associates, Holyoke Medical Center

Their Lifesaving Actions Shine a Light on a New Position at HMC

Gabriel Mokwuah

Gabriel Mokwuah

Joel Brito

Joel Brito

When Gabe Mokwuah came to this country from Nigeria when he was 12 and heard people talking about ‘football,’ he thought about the sport played with a round ball that athletes try to kick into a net.

The other football, the one that is much more popular in this country? He didn’t know anything about it, and didn’t really want to know anything about it.

But that didn’t stop the football coach at his New York City high school from trying to convince the large, fast, and very athletic Mokwuah to try out for the team. Eventually, and we’re simplifying things here, he succeeded in those efforts. But even then, Mokwuah wasn’t really interested in the sport.

It wasn’t until he started hearing the word ‘scholarship’ and came to understand that football could be a means to an end — a college education and a ticket out of a high-crime area on Staten Island — that he began to really take it seriously.

Fast-forwarding through the next several years, Mokwuah did attend and graduate from American International College, while also playing defensive end and linebacker — so well, in fact, that he was drafted by the Green Bay Packers in the 11th round in 1992 (they only have seven rounds today).

He played in two exhibition games, was cut, tried to catch on with a few other teams, didn’t, and wound up working as a court officer at the Hampden County Jail and House of Correction, a job from which he retired several years ago.

All that adds up to just one of the intriguing backstories that can be told by those now working as patient safety associates (PSAs), or, in his case, patient safety coordinator, at Holyoke Medical Center (HMC).

Joel Brito has one of his own.

He was working for Hulmes Transportation, taking individuals to medical appointments and daily programs while also volunteering his time to help those with substance-abuse issues when he saw an ad posted on Indeed — Holyoke Medical Center was looking for patient safety associates.

“As soon as I saw it, I jumped on it, and here I am. This has always been my dream — I always wanted to be in the healthcare field,” he said, adding that his ambition is to become a certified nursing assistant.

Others now working as PSAs at HMC have backstories as well. Some are retired or semi-retired CNAs who succeeded in finding work that is rewarding on many levels. Others are getting started down the road to careers in healthcare and have taken this entry-level position to explore options and find out if healthcare is for them. Some are in pharmacy programs. One is studying for her MBA.

The PSA position is relatively new to HMC, and healthcare in general, and it represents an imaginative and innovative step forward from the ‘sitter’ or ‘patient observer’ role seen in most hospitals, said Margaret-Ann Azzaro, vice president of Patient Care Services and chief Nursing officer at HMC.

“As soon as I saw it, I jumped on it, and here I am. This has always been my dream — I always wanted to be in the healthcare field.”

Elaborating, she said the role involves not merely sitting with an at-risk patient, but engaging with them as a well, a position that brings more value to the patients and the hospital, but also those who assume that role.

“We thought, ‘let’s come up with a safety role to empower people to not only keep these patients safe, but engage with them as well,” she said. “We don’t have sitters here; we don’t have observers here — we have patient safety associates, and the idea is to give them some education and tools to enrich the experience while they’re sitting with a patient.”

Mokwuah and Brito embody the motivations behind the PSA position and also just how vital these individuals are — to a hospital, to the patients they serve, to initiatives to reduce falls and improve overall patient safety, and, sometimes, much more.

Indeed, both have been credited with saving lives in recent months — Mokwuah in April, by seeing something while in the virtual monitoring room and immediately calling for a team member to check on the patient, and Brito in July for performing the Heimlich maneuver on a patient he heard making sounds of distress while he was sitting with another patient. (More on both episodes later).

Both men were named employee of the month for their respective actions. That’s certainly an honor, and in October, they’ll be receiving another one: Healthcare Hero.

 

Not on Their Watch

There are actually three distinct roles within the PSA position, and individuals with that title handle all three on a rotating basis, noted Brian Toia, Nursing director of the ICU, RN float pool, and patient safety associates, adding that teamwork is what makes this innovative program so effective.

The first role involves one-on-one direct care — staying within arm’s length of a patient with a high safety risk, including those susceptible to falls, patients with dementia, and those who might be suicide risks. The second involves virtual monitoring. Utilizing a camera system placed in rooms of patients with potential safety risks, PSAs working in the virtual monitoring room can keep tabs on up to 12 patients at once.

From left, Margaret-Ann Azaro, Joel Brito, Gabe Mokwuah, and Brian Toia.

From left, Margaret-Ann Azzaro, Joel Brito, Gabe Mokwuah, and Brian Toia.

The third role is what those at HMC call a ‘rounder,’ one person dedicated to a unit who will frequently check on patients, respond to virtual monitoring calls, and also answer patient calls for assistance.

When asked which role he liked the most, Brito didn’t hesitate. “I like being a rounder. I love that it’s a non-stop job.”

But all these roles are vital to the overall mission of keeping at-risk patients safe, said Mokwuah, who coordinates the department and makes the daily assignments.

Before he talked about the PSAs and what they do, he put matters in their proper perspective. “The real heroes are the nurses, the doctors, and the administrators. And they have given us support for this program to take off. Our job is to keep people safe, and our program saves lives — we’ve proven that over and over again.”

“We thought, ‘let’s come up with a safety role to empower people to not only keep these patients safe, but engage with them as well.’”

Azzaro agreed, emphasizing, again, that PSAs are far more than the ‘sitters’ of years ago. These are individuals who can, and do, watch over patients. But they also engage them and help “enrich the experience,” as she put it, while offering some examples.

“We gave them dementia and Alzheimer’s education,” she explained, noting that this, like other aspects of the program, is fairly unique within the industry. “There are certain ways in which we can engage with patients that have dementia, that have Alzheimer’s. One thing that doesn’t help them is to not be stimulated. So the PSAs can read to them, they can play games with them, they can have conversations with them, they can read a book to them, they can put something on the TV or iPad and have the patient watch it with them.”

And while engaging with these patients, or watching them on the monitor, or coming to their assistance as a rounder, the PSAs are ultimately keeping them safe, said Azzaro, noting that there has been a measurable decrease in the number of falls recorded at HMC since the start of the program.

 

Changing Lives, Saving Lives

As he talked with BusinessWest outside the monitoring room, Mokwuah said the facility boasts a split screen showing more than a half-dozen patients in their beds. At this moment in time, all was quiet and normal.

That was not the case one afternoon back in April, when, while watching that same monitor, he noticed a patient that did not appear well, was acting differently, and had a noticeable status change.

He called for a rounder to immediately check on the patient, who, as it turned out, was experiencing a significant medical event, was unresponsive, and had no pulse. Staff quickly began performing basic life support, followed by advanced cardiovascular life support. After two rounds of CPR and cardiac medications, the patient’s own breathing and heartbeat returned.

Joel Brito (left) and Gabe Mokwuah

Joel Brito (left) and Gabe Mokwuah have both been credited with saving patients’ lives in recent months.
Staff Photo

Joel Rivas, director of Nursing Medical-Telemetry, who nominated Mokwuah for employee of the month, said at the time, “it is my professional opinion that, had the patient’s change in condition not been identified as early as it was, by Gabriel, we would not have had the positive outcome that we had.”

Similar things were said after another incident in early July, when Brito again showed the importance of HMC’s innovative PSA program.

He was serving as a rounder and sitting with a patient when another team member came in to provide patient care. During that time, Brito overheard a patient from another room making sounds of distress. Confirming that his one-on-one patient was safe and in the care of another team member, he stepped into the next room to check on what he’d heard.

“In the beginning, I didn’t pay too much attention to it, but something told me to get up and check that room, and when I did, I was really surprised because the lady was essentially purple,” he said, adding that he quickly positioned himself to perform the Heimlich maneuver and helped to dislodge the obstruction in the patient’s airway.

“This is a job where you have to be humble, you need to have some empathy, and you have to love people. That’s something my mom and my family instilled in me growing up, so I try to live my life that way and help people. This job gives me the opportunity to do that.”

Like Mokwuah, Brito was credited with saving a patient’s life, said Toia, adding that, had it not been for establishment of the rounder’s role within the PSA program, it’s unlikely that someone would have been able to respond as quickly to the situation as he did.

Looking back, Brito said he relied on his instincts and his training, and was thankful to be in a position where he could help people and make a difference in their lives — the most gratifying aspects of the PSA position.

Mokwuah said essentially the same thing.

“This is a job where you have to be humble, you need to have some empathy, and you have to love people,” he said. “That’s something my mom and my family instilled in me growing up, so I try to live my life that way and help people. This job gives me the opportunity to do that.”

 

Big-game Players

Gabe Mokwuah didn’t get to be a hero on the gridiron, at least at the pro level. But his life and career, especially this latest chapter, show that our heroes come from all walks of life. And they take all kinds of titles.

Patient safety associate is a relatively new one at Holyoke Medical Center, an innovative initiative that is helping to prevent falls, improve overall safety, and, as these cases show, save lives.

Mokwuah was right when he said that doctors, nurses, and administrators are heroes. But so are those with badges that read ‘patient safety associate,’ especially these two lifesavers and Healthcare Heroes.