Scholars@Duke
Alex David Michaels

Alex David Michaels

Assistant Professor of Surgery
Surgery, Minimally Invasive Surgery

Scholarly Works

Inguinal and Ventral Hernia Repair with the Hugo Robotic-Assisted Surgery System: A Prospective, Single-arm, Clinical Trial.

Journal article Ann Surg · May 11, 2026 OBJECTIVE: To determine the safety and efficacy of the Hugo robotic-assisted surgery (RAS) platform in the repair of inguinal and ventral hernias. SUMMARY BACKGROUND DATA: Robotic-assisted surgery has increasingly been utilized in inguinal and ventral hern ... Full text Link to item Cite

Associations of Computerized Tomography-Based Body Composition and Food Insecurity in Bariatric Surgery Patients.

Journal article Obes Surg · September 2025 INTRODUCTION: Food insecurity (FI) is associated with increased adiposity and obesity-related medical conditions, and body composition can affect metabolic risk. Bariatric surgery effectively treats obesity and metabolic diseases. The association of FI wit ... Full text Link to item Cite

Impact of metal vs non-absorbable, polymer clips during laparoscopic cholecystectomy.

Journal article Surg Endosc · April 2025 BACKGROUND: Titanium metal clips have classically been used to occlude the cystic artery and duct during laparoscopic cholecystectomy (LC). Non-absorbable, polymer clips are an alternative with a locking feature. There is limited research evaluating the ad ... Full text Link to item Cite

Surgery for Peptic Ulcer Disease

Book section · January 1, 2024 This chapter will provide the reader with a surgical perspective on ulcer disease management. Heighten your awareness of what peptic ulcer disease (PUD) complications may require surgery. Explain the differences between gastric and duodenal ulcer pathophys ... Full text Cite

Esophageal Surgery

Book section · January 1, 2024 This is a question-and-answer style chapter about esophageal surgical topics which includes the workup and management of achalasia, esophageal cancer, gastroesophageal reflux disease, and paraesophageal hernia. ... Full text Cite

A Novel Thyroid Ultrasound Proficiency Metric Designed Through a Multidisciplinary Delphi Approach.

Journal article Am Surg · February 2023 BACKGROUND: Thyroid ultrasounds extend surgeons' outpatient capabilities and are essential for operative planning. However, most residents are not formally trained in thyroid ultrasound. The purpose of this study was to create a novel thyroid ultrasound pr ... Full text Link to item Cite

Socioeconomic risk-adjustment with the Area Deprivation Index predicts surgical morbidity and cost.

Journal article Surgery · November 2021 BACKGROUND: There is a strong association between socioeconomic status and surgical outcomes; however, the optimal method for socioeconomic risk-stratification remains elusive. We aimed to compare 2 metrics of socioeconomic ranking by ZIP code, the Distres ... Full text Link to item Cite

Bariatric surgery reduces long-term rates of cardiac events and need for coronary revascularization: a propensity-matched analysis.

Journal article Surg Endosc · June 2020 BACKGROUND: Obesity and obesity-related comorbidities are associated with increased risk of coronary artery disease (CAD). Bariatric surgery results in durable weight loss and improvement in numerous CAD risk factors, yet limited data exist on CAD-related ... Full text Link to item Cite

Drp1 Promotes KRas-Driven Metabolic Changes to Drive Pancreatic Tumor Growth.

Journal article Cell Rep · August 13, 2019 Mitochondria undergo fission and fusion to maintain homeostasis, and tumors exhibit the dysregulation of mitochondrial dynamics. We recently demonstrated that ectopic HRasG12V promotes mitochondrial fragmentation and tumor growth through Erk phosphorylatio ... Full text Link to item Cite

CRISPR knockout screening identifies combinatorial drug targets in pancreatic cancer and models cellular drug response.

Journal article Nat Commun · October 15, 2018 Predicting the response and identifying additional targets that will improve the efficacy of chemotherapy is a major goal in cancer research. Through large-scale in vivo and in vitro CRISPR knockout screens in pancreatic ductal adenocarcinoma cells, we ide ... Full text Link to item Cite

Ten-year outcomes of Roux-en-Y gastric bypass are equivalent in patients with Medicare disability and non-Medicare patients.

Journal article Surgery · October 2018 BACKGROUND: Bariatric surgery is the most effective intervention for achieving durable weight loss and improvement of comorbidities in patients with obesity. Limited data exist on the impact of Medicare status in patients undergoing Roux-en-Y gastric bypas ... Full text Link to item Cite

Race is associated with completion of neoadjuvant chemotherapy for breast cancer.

Journal article Surgery · August 2018 BACKGROUND: Completion of prescribed neoadjuvant chemotherapy for breast cancer is paramount to patients obtaining full benefit from the treatment; however, factors affecting neoadjuvant chemotherapy completion are not known. We hypothesized that race is a ... Full text Link to item Cite

Ureteral stents increase risk of postoperative acute kidney injury following colorectal surgery.

Journal article Surg Endosc · July 2018 BACKGROUND: Ureteral stents are commonly placed before colorectal resection to assist in identification of ureters and prevent injury. Acute kidney injury (AKI) is a common cause of morbidity and increased cost following colorectal surgery. Although previo ... Full text Link to item Cite

Neoadjuvant Chemotherapy Is Associated with Lower Lymph Node Counts in Colon Cancer.

Journal article Am Surg · June 1, 2018 Adequate lymphadenectomy is associated with improved survival in patients who undergo oncologic resection of colorectal cancer and has been identified as a quality metric. Neoadjuvant chemotherapy has been found to be associated with collection of <12 lymp ... Link to item Cite

Neoadjuvant chemotherapy is associated with lower lymph node counts in colon cancer

Journal article American Surgeon · June 1, 2018 Adequate lymphadenectomy is associated with improved survival in patients who undergo oncologic resection of colorectal cancer and has been identified as a quality metric. Neoadjuvant chemotherapy has been found to be associated with collection of <12 lymp ... Cite

CD47 Blockade as an Adjuvant Immunotherapy for Resectable Pancreatic Cancer.

Journal article Clin Cancer Res · March 15, 2018 Purpose: Patients with pancreatic ductal adenocarcinoma (PDAC) who undergo surgical resection and adjuvant chemotherapy have an expected survival of only 2 years due to disease recurrence, frequently in the liver. We investigated the role of liver macropha ... Full text Link to item Cite

Patient travel for bariatric surgery: does distance matter?

Journal article Surg Obes Relat Dis · December 2017 BACKGROUND: Increasingly, patients are faced with greater travel distances to undergo bariatric surgery at high-volume centers. OBJECTIVES: This study sought to evaluate the impact of travel distance on access to care and outcomes after bariatric surgery. ... Full text Link to item Cite

Hypoglycemia Following Bariatric Surgery: Our 31-Year Experience.

Journal article Obes Surg · December 2017 PURPOSE: The purposes of this study are to identify the cumulative incidence of post-bariatric surgery hypoglycemia (PBSH), describe its symptomatology, and characterize treatment patterns at a large academic institution. MATERIALS AND METHODS: All patient ... Full text Link to item Cite

Unplanned Reoperation Following Colorectal Surgery: Indications and Operations.

Journal article J Gastrointest Surg · September 2017 AIM: Prior studies have demonstrated a reoperation rate ranging from 5.8 to 7.6% following colorectal surgery. However, the indications for reoperation have not been extensively evaluated. We aimed to describe the indications for reoperation and associated ... Full text Link to item Cite

Risk Associated With Complications and Mortality After Urgent Surgery vs Elective and Emergency Surgery: Implications for Defining "Quality" and Reporting Outcomes for Urgent Surgery.

Journal article JAMA Surg · August 1, 2017 IMPORTANCE: Given the current climate of outcomes-driven quality reporting, it is critical to appropriately risk stratify patients using standardized metrics. OBJECTIVE: To elucidate the risk associated with urgent surgery on complications and mortality af ... Full text Link to item Cite

Adoption of robotics in a general surgery residency program: at what cost?

Journal article J Surg Res · June 1, 2017 BACKGROUND: Robotic technology is increasingly being utilized by general surgeons. However, the impact of introducing robotics to surgical residency has not been examined. This study aims to assess the financial costs and training impact of introducing rob ... Full text Link to item Cite

Adoption of Robotics in a General Surgery Residency Program: At What Cost?

Journal article Journal of the American College of Surgeons · October 2016 Full text Cite

Post-Bariatric Surgery Hypoglycemia: Our Thirty Year Experience

Journal article Surgery for Obesity and Related Diseases · August 2016 Full text Cite

Patient travel for bariatric surgery: Does distance matter?

Journal article Surgery for Obesity and Related Diseases · August 2016 Full text Cite

The role of liver-directed surgery in patients with hepatic metastasis from primary breast cancer: a multi-institutional analysis.

Journal article HPB (Oxford) · August 2016 BACKGROUND: Data on surgical management of breast liver metastasis are limited. We sought to determine the safety and long-term outcome of patients undergoing hepatic resection of breast cancer liver metastases (BCLM). METHODS: Using a multi-institutional, ... Full text Link to item Cite

Ileal J-Pouch Volvulus Following Total Proctocolectomy for Ulcerative Colitis.

Journal article J Gastrointest Surg · May 2016 Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) allows restoration of continence in select patients with ulcerative colitis but is associated with significant morbidity. Well-known complications following IPAA include pouchitis, anastomotic ... Full text Link to item Cite

Declining Operative Experience for Junior-Level Residents: Is This an Unintended Consequence of Minimally Invasive Surgery?

Journal article J Surg Educ · 2016 INTRODUCTION: Our group has previously demonstrated an upward shift from junior to senior resident participation in common general surgery operations, traditionally performed by junior-level residents. The objective of this study was to evaluate if this tr ... Full text Link to item Cite

Risk Factors for Urinary Tract Infections in Cardiac Surgical Patients.

Journal article Surg Infect (Larchmt) · October 2015 BACKGROUND: Risk factors for catheter-associated urinary tract infections (CAUTIs) in patients undergoing non-cardiac surgical procedures have been well documented. However, the variables associated with CAUTIs in the cardiac surgical population have not b ... Full text Link to item Cite