Issue link: https://tmcpulse.uberflip.com/i/323757
t m c » p u l s e | j u n e 2 0 1 4 9 I was able to partner with them to help build our robotic and minimally invasive experience for children, because of what they had done in the adult world. It's a partnership that I greatly cherished. With the Texas Medical Center, I see the same opportunities for partnership here. For example, in March, we hosted the third annual Pediatric Urology Robotic Surgery Hands-on Training Course here in Houston after the first two years were held in Northern California. Part of having a hands-on training course is that you need a lot of robots. It is not just watching videos and observing other people doing robotic surgery. You can best learn when you are at the robotic console. So we needed a place that has enough of these multi-million dollar robots (we used six), and the training center to support them, and that is right here in the Texas Medical Center at MITIE at Houston Methodist Hospital, which is next door to Texas Children's Hospital. With an esteemed panel of expert pedi- atric urologic robotic surgeons from across the U.S., as well as Texas Medical Center-based experts including Dr. Alvin Goh from Houston Methodist, an adult urologic robotic surgeon who served as co-director of the course, we were able to host pediatric urologic surgeons including surgeons from Japan, Turkey, Canada, and others from institutions here in the U.S., where they came to Houston and the Texas Medical Center for hands-on robotic training. That was the type of partnership that I was envisioning that we were able to bring to reality. And I think that's a great example of collaboration for Texas Children's, Houston Methodist, and Baylor College of Medicine, as well as the Texas Medical Center. Q | You are about to surpass 100 robotic cases at Texas Children's Hospital. With all of the capabilities that you see today, what will the program look like in three years? A | We will keep moving towards the next frontiers. We already perform multiple-site robotic surgery, but we would like to eventually move toward virtually scar-less surgery all through a single incision in the belly button. The belly button looks like a scar already, hence the virtually scar-less description. In addition, for pediatrics, we also need smaller instruments for our patients, but those that can still perform the required tasks. We are using instruments that have been designed for adult patients, but we need instruments that are designed with the pediatric patient in mind. Over time, we will continue to see the expansion of pediatric urology cases for which the robot can be used, with expansion to other pediatric specialties as well. Q | Does moving to a single port require a complete revision of the triangulation approach that you use today? A | It may, but technology may help surgeons to overcome this. Surgeons understand the need for triangulation with minimally invasive cases, and some of the prototypes of future instru- ments are fantastic, where multiple instruments are traveling through a single channel, but then expand to a multi-pronged instrument inside the body cavity that provides triangula- tion. This again leads to the dilemma regarding medical devices in children. A lot of these are being built for adults, and may not be adaptable for use in children. For example, the curved instruments and ports that we often used for single-incision surgery have a fixed, built-in amount of curvature. In adult patients, these fixed articulation lengths are adequate when there is a lot of space in the body cavity. However, with pediatrics, you usually have a shorter working distance between the skin and, for example, the kidney. And if this curve is outside the body, you have lost all advantages of that instrument. We need new technology for single port and minimally invasive virtually scar- less surgery, but it should be adapted for children as well. Q | Most parents wouldn't know whether a program has a robotics program or not. What advice do you have for parents looking for the right surgical program for their child? A | Especially for pediatric patients, one feature can be surgical experience. Dr. Patricio Gargollo recently joined our pediatric urology division and together we have one of the largest pediatric robotic surgery experiences with over 500 robotic cases in children to date. However, this is only one factor. Surgery and especially robotic surgery, is a team effort, and the one guaran- tee that we can make is that the team at Texas Children's Hospital, which includes the nurses, the staff, and the rest of nearly 10,000-member family at the hospital, is dedicated to caring for children. This is reflected in everything that we do. Q | Relative to other programs, that's extremely large. When you look at the top programs in the country, what kind of volume are they seeing? A | Since pediatrics is a smaller world, a handful of places are going to reach 100 pediatric cases per year and usually at the larger children's hospitals, and it does take time to work up to that level. We've had a running start for our program, since both Dr. Gargollo and I are bringing our previous experience to Texas Children's, and serve as its physician champions. The fact that we reached a hundred cases in such a short amount of time is not surprising, since we have done it before. Q | Let's talk about technology. Industry does not put a lot of emphasis on pediatrics because of the lower patient volume compared to the adult market. Do you see potential within the Texas Medical Center for innovation in pediatric medical devices? A | Having been one of the co-founders of an, FDA-funded pediatric medical device consortium—the Southern California Center for Technology and Innovation in Pediatrics—and near a large number of medical device companies, I see the same necessary elements that we had in Southern California here in Houston as well. It's not only the amazing energy, but also the amazing talent and experience. I think the difference is that each place has varying strengths. Some of the strengths that I've learned about here in Houston are NASA / Johnson Space Center, and engineers at associated companies such as Jacobs. But we also have the engineers associated with the abundance of oil and gas engineering technology. This complements the medical and scientific talent within the Texas Medical Center, all next door to each other. There are great minds at work in Houston. So we have a lot of talent here, but there is also the commercializa- tion drive. One only needs to open the Houston Chronicle on a daily basis to learn about the growing number of startups and new companies.