March 17, 2015

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Dr. Patricio Gargollo, director of the Program for Complex Urogenital Reconstruction, was recently named associate medical director for pediatric surgery of the Simulation Center.

Gargollo’s role in the new position will be to collaborate with the Simulation Center’s medical director, Dr. Jennifer Arnold, to create an expansion of medical simulation education into the areas of pre-, peri- and post-operative care.

“In essence, we want to expand our center to include surgical simulation training,” Gargollo said. “This will include procedural training for residents, fellows, nurses and advanced practice providers. It will also allow us to use the hospital’s international reputation to reach out to an international surgical audience through telemedicine and live simulation courses.”

Lastly, Gargollo said “my hope is to replicate complex surgical cases through simulation in order to prepare surgeons and other providers who may not have the exposure to the type of difficult cases we encounter here at Texas Children’s Hospital.”

“I am very excited about working with Dr. Gargollo and about this new opportunity for the Simulation Center, our staff and our patients,” Arnold said. “It is vital that we identify leaders and champions in surgery in order to expand the educational and patient safety benefits of health care simulation to our perioperative providers and patients.”

The Pediatric Simulation Center at Texas Children’s Hospital is a multidisciplinary, hospital-based center providing hands-on pediatric and obstetric simulation training in a realistic environment to improve patient safety and patient care. In addition to the physical space, the hospital supports the center by allocating full-time personnel including a medical director, assistant director, lead physician, training specialist, systems specialist and now a surgical director.

The hospital’s dedication to the center stems from the fact that 70 percent of mistakes in medicine are due to human error, not lack of medical knowledge. The Simulation Center trains pediatric health care professionals to react and respond to high-risk pediatric and obstetric scenarios in a life-like simulated environment so that risk to patients is substantially lowered in real life situations.

Simulation is a guided technique that recreates a clinical environment and gives health care professionals exposure to high-risk scenarios without putting actual patients at risk. The simulation training experience includes:

  • Simulation exercises on high-fidelity mannequins that mimic real emergencies to facilitate team communication skills and real-time responses
  • Review of video-recorded simulation
  • Debriefing of learners to review and discuss simulation experience

Gargollo recently participated in the Mata conjoined twin separation simulation. During the simulation he, several other surgeons and operating room staff practiced several aspects the surgery, which ended up lasting just over 24 hours.

“Each and every simulation I’ve participated in has helped me prepare for whatever procedure I was about to perform,” Gargollo said. “The experience is truly invaluable and most definitely contributes to the quality of patient care we offer here at Texas Children’s Hospital.”

Gargollo was recruited to Texas Children’s Hospital to be the director of the Program for Complex Urogenital Reconstruction, which specializes in the care of patients with bladder and cloacal exstrophy, cloaca and neurogenic bladder. He also is the co-director of the Urology Robotic and Minimally Invasive Surgery Program. After earning his medical degree at Harvard Medical School, Gargollo completed a residency in general surgery followed by one in urology at Massachusetts General Hospital. He also did a fellowship at Children’s Hospital Boston.

March 10, 2015

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The Department of Surgery’s Physician Assistant Fellowship Program recently graduated its inaugural class of four fellows and welcomed its second class of six fellows in what the Association of Postgraduate Physician Assistant Programs has called an “innovative fellowship program.”

The only program of its kind in the United States for pediatric surgical services, the fellowship is a 12-month didactic and clinical program designed to extensively train physician assistants in all areas of pediatric surgery. After completing nine rotations in various surgical areas and one month in research, the fellows select two electives for which they want to receive additional training.

The inaugural class of four physician assistants – Lesley Davies, Jackie Guarino, Caitlin Justus, and Cassie Mueller – accepted positions at Texas Children’s Hospital. Davies is with Plastic Surgery and Guarino is with Urology. Mueller works in Trauma and Justus works with the surgical hospitalists at West Campus.

The Department of Surgery received 55 applications for the 2015 term, with 27 of those from outside Texas. Six fellows were chosen. They and their home states are: Chelsea Hartwig (Illinois), Brittney Knudson (Montana), Sara Mullinax (Georgia), Thian Nguyen (Texas), Abby Young (South Carolina) and Kelly Wiseman (Ohio).

“The Department of Surgery at Texas Children’s Hospital has taken a leadership role nationally in physician assistant fellowships, and we have received inquiries from other hospitals that want to establish programs and model their programs after ours,” said Dr. Larry Hollier, chief of Plastic Surgery and medical director of the Physician Assistant Fellowship Program.

Additional leaders of the fellowship program are: Ryan Krasnosky, director of the program; Kristen Daniels, academic director; and Jordan McAndrews, fellowship coordinator.

Applications for the 2016 fellowship program are now open. Candidates can apply online at Texas Children’s Hospital’s employment page.

To hear from members of the first Physician Assistant Fellowship Program class, read the following Texas Children’s blog posts:

March 3, 2015

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Texas Children’s Hospital recently hosted its first craniosynostosis reunion, bringing together 150 people who have been touched by a condition that causes one or more of the seams between the bones of a baby’s skull to close prematurely.

“For parents of babies with craniosynostosis, it is a scary and stressful time,” said Dr. Sandi Lam, a neurosurgeon and co-director of the Craniosynostosis Surgery Program at Texas Children’s. “Families want to know they are making the right choices for their little loved ones. Connecting them with other parents who are going through the same thing provides a level of support that is irreplaceable.”

At the February 7 reunion, patients who have had craniosynostosis surgery at Texas Children’s Hospital joined their families and gathered at the Meyer Building for a few hours of fun, games and camaraderie. Child Life specialists and volunteers from Neurosurgery and Plastic Surgery hosted sports-themed activities for the children while parents shared stories over coffee and kolaches. A group of mothers who had met and chatted about craniosynostosis online got to meet each other in person at the reunion and were thrilled to be invited to the same event.

“Families tell us this type of patient networking event is amazing because it proves they are not alone,” said Sandra Galvan, coordinator of the program. “They have no doubt we at Texas Children’s will be here for them, delivering superb care for their families, neighbors and friends in Houston and across the nation.”

Craniosynostosis affects one in 2,000 babies and usually requires surgery to separate the fused skull bones to achieve a normal appearance and to allow a baby’s brain to continue to grow and develop properly. Here at Texas Children’s, we have a team of specialists dedicated to treating craniosynostosis. Pediatric craniofacial plastic surgeons Dr. Laura Monson, Dr. David Khechoyan and Dr. Edward Buchanan and pediatric neurosurgeons Dr. Sandi Lam and Dr. Robert Dauser work together to provide the best care for children and their families.

In addition to having the highest quality surgeons on hand to correct the defect and a dedicated team to care for the children before and after surgery, Texas Children’s Hospital has formed a parent-to-parent network to match pre-operative patients’ families with post-operative patients’ families to support each other.

“It has been an incredible experience to see how generous, brave and wonderful our families are,” Lam said. “Many parents want to give back and share. The reunion gives them the opportunity to do just that.”

February 24, 2015

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During the early morning hours of February 17, Elysse Mata sat holding her babies tightly, kissing them as tears ran down her face. She was saying goodbye to her girls, conjoined for the last time before undergoing a historical surgery that would offer them their first chance at separate lives.

“We’ve been waiting for this moment for a year,” Elysse said. “Ever since we found out the twins were conjoined, we’ve been praying and hoping this day would come.”

Conjoined twins Knatalye Hope and Adeline Faith Mata – known by their family simply as Hope and Faith – were born at Texas Children’s Pavilion for Women on April 11, 2014 via Caesarean-section at 31 weeks gestation after weeks of extensive prenatal imaging, multidisciplinary consultation and planning at Texas Children’s Fetal Center. The babies each weighed 3 pounds, 7 ounces.

Surgeons allowed the girls to grow and gain strength for 10 months before undertaking the difficult task of separating them. During that time our comprehensive team of surgeons, physicians, nurses and support staff prepared for the day that had finally arrived. The lead surgeons had met and thoughtfully examined every aspect of their procedure, the simulation staff prepared the team for complications, and Critical Care nurses were readying the PICU for the girls post-surgery.

Letting go

In those quiet, prayerful moments before the surgery, Elysse’s husband, John Eric, and their 5-year-old son, Azariah, were also near, kissing the girls’ foreheads and squeezing their tiny hands while they anxiously awaited the start of the surgery that would change the girls’ lives forever. A group of extended family, friends and a Texas Children’s Hospital chaplain joined the Matas for an emotional prayer.

Lead surgeon Dr. Darrell Cass entered the room, gave the family a hug, and with the help of supporting operating room staff, escorted the girls to Texas Children’s Operating Room 12. Members of the girls’ NICU care team, who had been by their sides for almost a year, lined the hallways in an emotional show of support.

Just after 7 a.m., Hope and Faith were wheeled into the operating room where a team of 12 surgeons from seven specialties, six anesthesiologists, eight highly trained nurses and support staff spent nearly 24 hours performing an operation that would eventually separate the twins.

Surgery begins

During the first few hours of the procedure, Anesthesiologist Dr. Helana Karlberg and Surgical Nurse Audra Rushing prepped the girls for surgery. At 1:10 p.m., Chief of Plastic Surgery Dr. Larry Hollier made the first incision. For the next 18 hours, the surgical team worked in shifts to separate the twins, who shared a chest wall, pericardial sac (the lining of the heart), diaphragm, liver, intestines, bladder, uterus and pelvis.

As the surgeons continued the difficult task, family and friends gathered in a large, room praying and supporting the parents while they waited for updates from the surgical team.

“This is the (most difficult) feeling ever,” said John Eric Mata as he and Elysse waited for their first in-person update. “It’s giving me too much time to think. I’ll be a lot more comfortable when they say they are separated. I’m ready for that.”

At one point, the family was told there had been a rocky part in the procedure when the twin’s livers were being operated on. During that process, surgeons explained there was quite a bit of blood loss and that the anesthesiologists and cardiologist in the room had to keep up with that and maintain the girls’ blood pressure.

“At times it was difficult,” Hollier said. “But it was controlled very rapidly, allowing us to move on with the procedure.”

Hours later, Eric and Elysse heard the answer to months of prayers when Pediatric Surgeon Dr. Oluyinka Olutoye met them in a private consult room and delivered the good news – the twins had been successfully separated.

“This is the farthest they’ve been from each other,” Olutoye said when we greeted the family around 1 a.m. “They’re about 30 feet apart right now.”

They are two

Separate for the first time, the twins were taken to different operating rooms where surgeons continued to work on the girls’ critical organs. Just before 10 a.m., the surgery was complete, and the family visited their girls, apart for the first time in rooms next to each other in the PICU, where they are being cared for by a team of their NICU primary nurses and their new PICU nurses.

Elysse said she and her family are extremely grateful for the team that separated her babies, and the countless hours they put into understanding the girls’ condition, and how best to treat and care for them.

Cass and several of the other surgeons, including plastic surgeon Dr. Ed Buchanan, met the family in Adeline’s room to share in the family’s joy and relief. They gave the family a summary of the monumental procedure and explained what they should expect in the next few days.

“Thank you for your trust,” Cass said to the Mata family. “We are going to keep doing everything we can to get them through this. So far, so good.”

Hollier said that to the best we know this is the first time a case of this magnitude – conjoined twins connected at the chest, abdomen and pelvis – has ever been done.

“It could not have gone better,” he said. “It was phenomenal team work and great preparation on the part of the institution.”

Click on the photo to view a gallery showing the Mata’s journey to separation.
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A dream realized

By late morning Wednesday, February 19, Elysse and John Eric were again with their babies, watching over their girls, now in two beds, in adjoining PICU rooms. It was a moment they had been waiting for since more than a year ago when a routine ultrasound revealed that Elysse was carrying conjoined twins. They traveled from their hometown of Lubbock to Texas Children’s Fetal Center, where the next chapter of their journey began.

Today, their family has a promising new chapter, thanks to the compassionate expertise of our physicians, nurses and countless staff and employees.

“We love them,” Elysse said of the girls’ medical team. “They mean the world to us, and they will forever hold a special place in our hearts.”

Conjoined Twins Separation Surgical Team

  • Plastic Surgeon Dr. Ed Buchanan
  • Lead Pediatric Surgeon and Co-Director of Texas Children’s Fetal Center Dr. Darrell Cass
  • Chief of Pediatric Gynecology Dr. Jennifer Dietrich
  • Pediatric Urologist Dr. Patricio Gargollo
  • Transplant Services Surgeon Dr. John Goss
  • Anesthesiologist Dr. Kalyani Govindan
  • Chief of Plastic Surgery Dr. Larry Hollier
  • Lead Anesthesiologist Dr. Helena Karlberg
  • Plastic Surgeon Dr. David Khechoyan
  • Pediatric Urologist Dr. Chester Koh
  • Cardiovascular Surgeon Dr. Dean McKenzie
  • Pediatric Surgeon and Co-Director of Texas Children’s Fetal Center Dr. Oluyinka Olutoye
  • Anesthesiologist Dr. Olutoyin Olutoye
  • Chief of Orthopedics Dr. William Phillips
  • Lead Surgical Nurse Audra Rushing
  • Anesthesiologist Dr. Steve Stayer

Learn more about the Mata twins and the preparation Texas Children’s team took on to care for the girls:
Mata conjoined twins born at Texas Children’s
Tissue expander surgery allows twins to prepare for separation surgery
Mata twins’ care team helps create swing for baby girls
Radiology team helps prepare surgeons for separation surgery with 3D model

February 10, 2015

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In less than a month, a multidisciplinary team of surgeons here at Texas Children’s Hospital will embark on what could be a 36-hour procedure to separate 9-month-old conjoined twins, Knatalye Hope and Adeline Faith Mata.

During that time frame, surgeons from 13 subspecialties will conduct a series of well-orchestrated operations on the girls, who share a chest wall, lungs, pericardial sac (the lining of the heart), diaphragm, liver and pelvis. The separation team will start the surgery and the reconstruction team will complete the procedure.

“This is a huge undertaking,” said Dr. Darrell Cass, pediatric surgeon and co-director of Texas Children’s Fetal Center. “There’s been an extensive amount of involvement from many of the departments in the hospital, including radiology.”

With help from a Dallas printing company, Chief of Radiology Research and Cardiac Imaging Dr. Rajesh Krishnamurthy built a 3D model of the twins’ anatomy to help surgeons plan for the girls’ separation. The model was built using a computerized image data set of the twins and a 3D printer.

“It’s very useful for preoperative surgical planning,” Krishnamurthy said of the model. “Especially when it comes to conjoined twins.”

Twins, specifically conjoined twins, tend to have pretty complicated anatomy. In the case of the Mata twins, there is a large part of the body – the chest, the abdomen and the pelvis – that is fused. Having a 3D model of the girls has given surgeons insight into what they are going to encounter.

The model – which goes into a fair degree of detail, including a detachable, transparent liver – has been especially helpful in the planning of the pelvic portion of the surgery, which presents an interesting and challenging anatomical situation in that each girl has her own pelvic organs but each of those organs gets blood supply from each girl.

“We’re going to have to make some real decisions about which bladder goes to which girl, which uterus goes to which girl and which ovaries go to which girl,” Cass said. “That might be the more complex aspect of the operation.”

The 3D model of the twins was created in about a week. The process started with a high-quality computer tomography or CT scan. The image data set was transformed into a 3D segmentation that was color coded and converted into a printable form. That form was sent to Medcad in Dallas where the physical, 3D model was made under the leadership of Dr. Jayanthi Parthasarathy.

In addition to the conjoined twins, 3D modeling at Texas Children’s is regularly done in orthopedic cases, such as in the setting of hip dysplasia or unusual rotational abnormalities of the bone. It’s also used in some congenital heart disease cases and could be used in other areas as well.

“3D modeling is a visual representation of the complexity that surgeons might encounter during a procedure,” Krishnamurthy said. “This is very powerful when you are trying to come up with unique solutions to a particular case.”

Cass said the 3D model is one of many reasons why the Mata twins are at Texas Children’s Hospital.

“The Mata family did their homework,” he said. “They got to know different hospitals and different surgeons and they chose us. We’re incredibly grateful to them for putting their faith and trust in us and we’re very optimistic that we’ve done all the preparation needed to have a very good result.”

Elysse Mata, the twins’ mother, said she is excited about her girls’ upcoming separation.

“I can’t wait to hold two babies and be able to take them home,” she said.

Knatalye and Adeline were born April 11 at Texas Children’s Pavilion for Women. Delivered via Caesarean-section at 31 weeks gestation, the twins each weighed 3 pounds, 7 ounces.

The girls’ parents, Elysse and John Mata, and their 5-year-old brother, Azariah, learned during a routine ultrasound on January 13 that Elysse was carrying twins and they were conjoined. Subsequently, the family was referred from a physician in Lubbock, their hometown, to the Texas Children’s Fetal Center where they underwent extensive prenatal imaging, multidisciplinary consultation and development of plans to achieve a safe delivery and postnatal care.

Now 9 months old, the babies are doing well as they continue to be cared for by a team of specialists in the Level IV Neonatal Intensive Care Unit at Texas Children’s Hospital.

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Texas Children’s Hospital West Campus is proud to announce Dr. Allen Milewicz as chief surgical officer of the hospital. In his new role, Milewicz will be responsible for organizing Texas Children’s surgery within the community, focusing on Texas Children’s Hospital West Campus. Additionally, he will be working in conjunction with the entire Texas Children’s Department of Surgery to optimize surgical service for patients, families and referring physicians.

“I look forward to expanding surgical services in the community while ensuring that each patient receives the experience, expertise and clinical outcomes for which Texas Children’s is known,” Milewicz said.

Board-certified by the American Board of Pediatric Surgery, Milewicz received his undergraduate degree from City College of New York and earned his medical degree from New York University School of Medicine. After completing his general surgery residency program at The University of Texas Southwestern Medical Center, he went on to pursue specialized training in pediatric surgery. Milewicz is a member of the American Pediatric Surgery Association and a fellow of the American College of Surgeons. He also is an associate professor of pediatrics-surgery at Baylor.

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The first Cutting Edge of Pediatrics conference sponsored by the Department of Surgery was held January 24, providing 138 Houston-area pediatricians, family practice physicians and advanced practice providers an opportunity to learn about common pediatric surgical conditions from Texas Children’s surgeons.

From the first speaker to the last, the surgeons and pediatric providers engaged in lively discussions of the topics, which included anesthesia, ethics, adolescent gynecology, ophthalmology, orthopedics, otolaryngology, pediatric general surgery, plastic surgery and urology.

Following a welcome from Surgeon-in-Chief Dr. Charles D. Fraser, Jr., presenters included Dr. Dean Andropoulos, Dr. Jennifer Bercaw-Pratt, Dr. David Coats, Dr. Nicolette Janzen, Dr. Edward Lee, Dr. Mark Mazziotti, Dr. Julina Ongkasuwan, Dr. Scott Rosenfeld and Dr. Veeral Shah.

The conference’s planning committee included representatives from the Department of Surgery, Texas Children’s Pediatrics and Kelsey-Seybold. Committee members included Dr. Allen Milewicz (Chair), Dr. Ellis Arjmand, Dr. Carol Green, Dr. Anita Jimenez-Belinoski, Ryan Krasnosky, Dr. Megan May, Dr. David Roth and Dr. Stanley Spinner.