Dhruv Singhal, MD
Assistant Professor of Surgery, Harvard Medical School
Director of Lymphatic Surgery, BIDMC
Andres Doval, MD
Sherise Epstein, MPH
Aaron Fleishman, MPH
Anna Rose Johnson, MPH
Leo Magrini, BS
Claire Rosenwasser, MS
Qing Ruan, MD
Bao Tran, MD
Over the last several years, my clinical and basic science research has primarily been focused on the surgical prevention and treatment of lymphedema. In addition, our clinical research group has recently been studying (1) the potential applications of integrative medicine in the care of the plastic surgery patient and (2) the impact of ergonomics on a surgeon’s well-being.
Surgical Prevention and Treatment of Lymphedema
Over the past year, in the midst of building a comprehensive clinical program in the surgical management of lymphedema, our group has worked in parallel to construct a complementary research program. Working closely with the FIRST team, we developed a robust quality improvement database that is capable of tracking patients and their outcomes longitudinally. Similarly, we have launched a unique biorepository that now houses healthy and diseased lymphatic tissue. Working closely with Dr. Timothy Padera at the Steele Laboratories at Massachusetts General Hospital (MGH), we are developing protocols for further tissue investigation.
In the laboratory, we have worked to develop the first animal model to investigate the physiology of preventing lymphedema surgically at the time of lymphadenectomy. Specifically, working in collaboration with Dr. Hak Soo Choi, Gordon Center for Imaging at MGH, we are utilizing unique lymphatic specific dyes to report real-time changes in lymphatic flow from an extremity. In doing so, we have demonstrated a 47% increase in lymphatic flow out of an extremity if a surgical lymphatic bypass is performed at the time of the lymphadenectomy.
Integrative Medicine and Plastic Surgery
Our clinical outcomes team has previously demonstrated that a high percentage of patients presenting to plastic surgery clinics have already demonstrated an interest and utilized integrative or complementary techniques within one year of presentation to our service. More recently, in collaboration with Dr. Gloria Yeh, we have been evaluating which natural products and mind-body techniques demonstrate high level evidence for efficacy in the peri-operative management of the plastic surgery patient. Most recently, working in collaboration with Dr. Yeh and Dr. Weidong Lu at the Zakim Center for Integrative Therapies at the Dana Farber Cancer Institute, we have been awarded a Pilot Grant from the Osher Institute to prospectively study the biologic changes of acupuncture on patients with breast cancer-related lymphedema. We began enrolling patients in March, 2018.
Over the past year, our clinical research team, in collaboration with Dr. Jack Dennerlein at the Harvard T.H. Chan School of Public Health, has studied and published on the significantly higher rate of work related musculoskeletal disorders in surgeons compared to the general population. We simultaneously evaluated the current state of ergonomic education provided to residents in surgical training, highlighting the need for the development of a more robust educational model.
I am currently the Director of Lymphatic Surgery at BIDMC. This past year I served on the Program Committee and Young Microsurgeon’s Committee for the American Society of Reconstructive Microsurgery.
In the fall of 2017, alongside Dr. Sumner Slavin, I co-chaired the first Lymphedema Symposium
at the BIDMC. The meeting was a tremendous success, with over 230 participants who traveled from around the world to attend. The two-day event included a separate pathway for clinicians and patients. The highlight for the entire event was a panel of patients that presented on their experience of undergoing lymphatic surgery at BIDMC.
I received a 2017 Boston Red Sox Medical All-Star Award for our team’s role in treating lymphedema patients in New England.
I am an ad hoc reviewer for: Plastic and Reconstructive Surgery, Annals of Plastic Surgery, Journal of Reconstructive Microsurgery, and the International Microsurgery Journal.
Dyes and lymphatic surgery, American Society for Reconstructive Microsurgeons, 2017
Early results in preventing lymphedema: A potential paradigm shift for lymphatic surgery, Academic Surgical Congress, 2017
Integrative medicine in plastic surgery: A systematic review of our literature, Society of Asian Academic Surgeons, 2017
Craniofacial neurofibromatosis – Guidelines for management, 30th World Congress of the International College for Maxillofacial Surgery, 2017
Fluorescein isothiocyanate: A novel application for intra-operative lymphatic imaging, 26th World Congress of Lymphology, 2017
A novel animal model for the surgical prevention of lymphedema: The power of molecular imaging, 26th World Congress of Lymphology, 2017
Early results in preventing lymphedema: A potential paradigm shift in lymphatic surgery, 26th World Congress of Lymphology, 2017
Referrals of plastic surgery patients to integrative medicine centers: A review of resource utility, Society of Asian Academic Surgeons, 2017
Early results in preventing lymphedema: A potential paradigm shift in lymphatic surgery, New England Society and Plastic and Reconstructive Surgery, 2017
Large animal model of modified lymphatic microsurgical preventative healing approach (LYMPHA), New England Society and Plastic and Reconstructive Surgery, 2017
Teaching, Training, and Education
I have been training medical students, general surgery and plastic surgery residents, clinical fellows, and research fellows for the past 5 years.
Selected Research Support
Acupuncture for breast cancer related lymphedema; Osher Center for Integrative Medicine, 2018-2019; PI: Dhruv Singhal, MD (Co-investigators: Gloria Yeh, MD, MPH, Weidong Lu, PhD)
Patel N, Pierson J, Lee T, Mast B, Estores I, Singhal D. Utilization and perception of integrative medicine among plastic surgery patients. Ann Plast Surg 2017; 78(5):557-561.
Tran BN, Singh M, Lee BT, Rudd R, Singhal D. Readability, complexity, and suitability of online lymphedema resources. J Surg Res 2017; 213:251-260.
Spiguel L, Shaw C, Katz A, Guo L, Chen HC, Lee BT, Singhal D. Fluorescein isothiocyanate: A novel application for lymphatic surgery. Ann Plast Surgery 2017;78(6S Suppl5):S296-S298.
Epstein S, Tran BN, Capone AC, Ruan QZ, Lee BT, Singhal D. Work-related musculoskeletal disorders among plastic surgeons: A systematic review. J Reconstr Microsurg 2017 In press.
Hahamoff M, Gupta N, Munoz D, Lee BT, Clevenger P, Shaw C, Spiguel L, Singhal D. Lymphedema surveillance for breast cancer patients reveal the promise of surgical prevention. J Surg Res 2018; In press.
Epstein S, Tran BN, Capone AC, Ruan QZ, Fukudome EY, Ricci JA, Testa MA, Dennerlein JT, Lee BT, Singhal D. The current states of surgical ergonomics education in U.S. surgical training: A survey study. Ann Surg 2018, In press.