Pediatric Surgery: The Cutting Edge

Dr. Mok's Notes July 2007

When I received the recent Children’s Hospital Division of Surgery report covering progress over the past two years, I thought back to the old tonsillectomy/adenoidectomy ward that is now the Kidney Center at The Children’s Hospital.  In my career as a pediatrician, diseases like chicken pox, invasive H. Flu B disease and severe rotavirus gastroenteritis are becoming rare occurrences. Slow changes over decades advance the art and science of every specialty as prevention, technology and definitions of disease change our understanding of what promotes children’s health. So what’s new in pediatric surgery? This issue of Mok’s Notes will highlight some amazing changes in that specialty.

Scoliosis has been the focus of a number of efforts in orthopedic surgery at TCH. New recruit Nancy Miller, MD, is an orthopedic surgeon/scientist who is heading up a National Institutes of Health-funded study looking at the possible genetic factors in idiopathic scoliosis. If genetic loci can be found to predict the development of scoliosis, perhaps earlier, less-invasive measures can be used to improve the prognosis for children with this disorder.

In children with thoracic insufficiency syndrome that results in severe chest and spine deformity, Dr. Mark Erickson has become certified in the use of the Vertical Expandable Prosthetic Titanium Rib (VEPTR). This implanted device allows periodic adjustment to allow the thorax to grow until the child reaches skeletal maturity.

Elise Benefield, RN, is the lead in a program called the High Risk Spinal Pathway. This comprehensive evaluation of children with severe scoliosis complicated by cognitive disability includes consultation by orthopedics, cardiology, pulmonology and bioethics to help families determine the pros and cons of major surgery for their child.

Another chest-related advance in surgery is performed by Dr. David Partrick, a general pediatric surgeon. This is the Nuss bar to correct pectus excavatum with cardiac, pulmonary or psychosocial effects. What used to be a much more involved surgery with prolonged recovery can now be done in a few hours, with return to full activity in three months.

I almost feel like a member of The Children’s Hospital Heart Institute with two heart transplant patients in my practice and one on the waiting list. TCH is an international leader in this procedure and continues to push the envelope in finding ways to increase organ donation and successful transplantation. The cardiology and surgery teams provide daily consultation to community clinicians who take care of these complicated patients.

The Children’s Hospital Comprehensive Epilepsy Center eagerly anticipates moving to the new TCH where capacity in the Epilepsy Monitoring Unit will expand to six beds.  The departments of neurology, neurosurgery and diagnostic imaging cooperate in mapping and excising epileptic foci in the brain to provide relief in patients with uncontrolled seizure disorders. New members of the Center include Kelly Knupp, MD, in neurology and Corbett Wilkenson, MD, in neurosurgery.

Another interdisciplinary team at TCH is involved in the treatment of anorectal malformations and complex colorectal disorders. The team is directed by Dr. Michael Allshouse and includes Dr. Marty Koyle, who performs the Malone Antegrade Continence Enema (MACE/ACE procedure) to treat recalcitrant bowel dysfunction.

Various pediatric specialists are using minimally invasive techniques such as the da Vinci Robot, during which the operating surgeon sits at a console to manipulate percutaneously inserted instruments. These techniques reduce post operative length of stay up to 50 percent.

It is hard to imagine what the future might bring as we seek to improve medical and surgical care for children. As technology improves, so does the challenge to stay personally connected to our patients and families. In general pediatric practice, we have the important responsibility to stay up to date on new advances, look critically at new therapies and help patients and parents understand their choices in today’s health care environment.

Comments and suggestions on how The Children’s Hospital can help you in your practice are always welcome. Contact me at (720) 777-6130 or mokrohisky.stefan@tchden.org.