December 9, 2014

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Patients treated at the Texas Children’s Hospital Hand and Microvascular Surgery Clinic now benefit from not only two physicians whose focus is on hand and upper extremity care but also from a full-time certified hand therapist.

Plastic and reconstructive surgeons Dr. Mitchel Seruya and Dr. Thomas Hunt III formed a multidisciplinary team with certified hand therapist Tara Haas.

Seruya, Hunt and Haas work with registered nurses, occupational hand therapists and medical assistants to perform clinical evaluations, formulate diagnoses and provide treatment plans for patients.

Haas has been a certified hand therapist since 2008 and has primarily worked in academic medical centers, most recently at the University of Colorado Hospital. She has a Master’s in Occupational Therapy from Seton Hall University and completed the Evelyn J. Mackin Hand Therapy Fellowship at the Philadelphia Hand Center. Hass’ areas of interest are trauma, burns, and tendon lacerations and repairs.

Hunt, professor and chair of the department of Orthopedic Surgery at Baylor, has dedicated his career to treating sports injuries of the hand, wrist and forearm in athletes of all ages and at all levels of ability. He serves in the capacity of team physician for a national football league franchise, national medical advisor for professional golf and as a resource for elite athletes worldwide. Hunt is a graduate of Stanford University and Vanderbilt University School of Medicine. He completed his orthopedic surgery residency, along with a research fellowship focused on bone regeneration, at the University of Kansas. He also completed a fellowship in hand, upper extremity, and microsurgery at the Hospital of the University of Pennsylvania. Recently, he graduated with a Doctor of Science Degree in Administration-Health Services from University of Alabama in Birmingham. Hunt is a board-certified orthopedic surgeon who holds a certificate of added qualification in hand surgery. He is a member of numerous national and regional specialty societies including the American Society for Surgery of the Hand, American Association for Hand Surgery, American Orthopaedic Society for Sports Medicine, American Academy of Orthopaedic Surgeons and the American Orthopaedic Association.

Seruya, who also serves as assistant professor of Plastic Surgery at Baylor, received his undergraduate and medical degrees at Columbia University. He completed his residency at Georgetown University and his craniofacial and hand/microvascular fellowships at Royal Children’s Hospital in Melbourne, Australia. Seruya’s clinical interests include neonatal brachial plexus palsy, cerebral palsy, congenital hand anomalies and traumatic hand injuries. His research interests are focused on understanding clinical outcomes following pediatric upper extremity surgery and optimizing functional restoration. Seruya is a candidate member of the American Society of Plastic Surgeons and the American Society of Maxillofacial Surgeons.

Haas, Hunt and Seruya treat patients with hand and upper extremity problems developed at birth or from trauma or infection. Some of those conditions include cerebral palsy, webbed fingers and multiple joint contractors. Other services include microvascular surgery and distraction lengthening.

“The hallmarks of Texas Children’s Hand and Microvascular Surgery Clinic are centralized services and multidisciplinary care, allowing patients to be seen by all necessary specialists in the same location on the same day,” Seruya said. “This is more convenient for the patient and family and it also enhances quality and continuity of care.”

Located on the fifth floor of Texas Children’s Hospital West Campus, the Hand and Microvascular Surgery Clinic is open on Wednesday and Thursday, from 8:30 a.m. to 12:30 p.m. A fully functional radiology suite is adjacent to the clinic, streamlining the process from diagnosis to management.

November 11, 2014

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Chief of Plastic Surgery Dr. Larry Hollier has been appointed to two new and exciting positions in the Department of Surgery – surgical director of patient experience and surgical director of the operating rooms.

Patient experience and operating room efficiency are critical areas of focus in our aspiration to deliver the highest level of service and care to our patients. Hollier has been instrumental in catalyzing improvements in these areas and in collaborating with colleagues from surgery, anesthesia, and operating room leadership. These new roles formalize our structural commitment to these efforts.

As surgical director of patient experience, Hollier will continue the exceptional work being done to improve patient and family experience. To date, he has played a key leadership role in implementing same-day appointments and direct scheduling for the Department of Surgery. These initiatives have helped improve our Texas Children’s Pediatrics referral processes and time to the third available appointment. Hollier also has led the following pilot projects to improve the experience of a patient’s arrival on the day of surgery:

  • New wayfinding system to help families find the different surgical areas;
  • Streamlined pre-surgery instructions to ensure consistent messaging for families; and
  • Addition of greeters to help families upon their arrival at the hospital.

As surgical director of the operating rooms, Hollier will partner with Dr. Steve Stayer and Judy Swanson in leading our operating theaters. This team will continue to work to improve efficiency in scheduling and the implementation of best practices, including developing focused specialty teams of nurses, anesthesiologists, and surgical staff.

111214ChesterKoh175-2The Auxiliary to Texas Children’s Hospital recently awarded Dr. Chester Koh and Dr. Robert Williamson with $75,000 research awards.

Koh, a pediatric urologist at Texas Children’s and the director of the organization’s Robotic Surgery Program, earned the Denton A. Cooley Fellowship in Surgical Innovation Award, which is given to a physician whose surgical research focuses on innovative ways to help children and to save lives. Williamson, an otolaryngologist with Texas Children’s and a professor with Baylor College of Medicine, received the Outcomes Fellowship Award, which supports patient care, education and research.

Koh is an internationally recognized expert in minimally invasive surgery, and has been instrumental in developing minimally invasive techniques with both laparoscopic surgery and da Vinci® robotic surgery to treat children. The hospital’s program serves as a pediatric robotic surgery research and training center that collaborates with other institutions in the Texas Medical Center.

Williamson studies functional outcomes of cochlear implants and the effects of language spoken by the implant team and by the family of the child who receives the implant. Little data is available on outcomes in implant recipients where the native language spoken in the home is different from that spoken by members of the cochlear implant team.

Williamson’s study will retrospectively analyze and compare cochlear implant recipients from non-native English-speaking households to recipients from English-speaking households, and analyze outcomes from patients with similar clinical characteristics.

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Two research residents with the Department of Surgery were recently recognized at the International Pediatric Surgical Oncology and International Society of Pediatric Oncology meeting in Toronto.

Dr. Yan Shi won best overall paper for his work on “MDM4 is a Potential Novel Therapeutic Target in Hepatoblastoma.” Shi is a research resident in the lab of Dr. Sanjeev Vasudevan, a pediatric surgeon at Texas Children’s and an assistant professor in the Division of Pediatric Surgery at Baylor College of Medicine.

Dr. Yesenia Rojas’ paper, “Adrenocortical Carcinoma in Children: A Review of the National Cancer Database,” was chosen as one of four papers presented in the “Best of International Pediatric Surgical Oncology” session and will be fast-tracked for rapid publication in “Pediatric Blood and Cancer.” Rojas is a research resident in the lab of Dr. Jed Nuchtern, who is chief of pediatric surgery at Texas Children’s.

October 14, 2014

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Dr. Larry Hollier, Jr., chief of Plastic Surgery at Texas Children’s, was recently appointed chairman of Smile Train’s medical advisory board. Smile Train is the largest cleft charity in the world with a mission of identifying teams of physicians and healthcare providers worldwide who are capable of performing surgery on children with cleft lip and palate problems.

In his role as chairman of the organization’s medical advisory board, Dr. Hollier supervises a group of physicians and healthcare providers from countries around the world to ensure Smile Train provides the safest care for these children.

Dr. Hollier has been on numerous trips sponsored by Smile Train to Haiti, both before and after the earthquake in 2010. With the help of other local organizations, he also has traveled to Southeast Asia, Central America and Africa to care for children with cleft deformities and serious burn injuries. Texas Children’s plastic surgeons Dr. Laura Monson traveled to Egypt and Dr. Edward Buchanan traveled to Tanzania to treat these children as well.

Cleft deformities and serious burn injuries often are left untreated in less developed countries, leading to a lifetime of disfigurement. Smile Train tries to help resolve some of these issues and is involved in 87 countries with 2,100 partner surgeons in more than 1,100 hospitals. The organization’s team of physicians and healthcare providers have treated more than 1 million patients since Smile Train was created a decade ago. This year they already have cared for more than 120,000 children.

September 9, 2014

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Physicians at the Fetal Center completed their first fetoscopic procedure to repair spina bifida in-utero – an innovative approach that was developed by Dr. Michael Belfort, obstetrician and gynecologist-in-chief at Texas Children’s Pavilion for Women and Dr. William Whitehead, pediatric neurosurgeon at Texas Children’s.

“Our hope is that these types of innovations will lead us to a new era of fetal medicine and surgery,” Belfort said.

Myelomeningocele, or open neural tube defect (NTD), is a form of spina bifida and occurs in 3.4 out of every 10,000 live births in the U.S. and is the most common permanently disabling birth defect for which there is no known cure. Myelomeningocele is a developmental defect in which the spine is improperly formed and the spinal cord is open to, and fused with, the skin. It is usually associated with hydrocephalus, or the buildup of cerebrospinal fluid in the brain, which requires surgical treatment to drain the fluid via an implanted device called a shunt. Originally, closure of the defect occurred after the birth of the baby, which was associated with an 80-90 percent chance that a shunt would be required for life.

But after a breakthrough NICHD-funded study entitled the Management of Myelomeningocele Study (MOMS) demonstrated a significant decrease in the risk of hydrocephalus for select patients undergoing fetal closure of the spine, as well as possible improvement in lower extremity function, compared to patients who underwent standard closure after birth, the Fetal Center adopted this as a treatment option and began performing open fetal surgery to treat spina bifida. To date, we still have one of only a handful of centers in the country that is able to perform this complex in-utero repair. Texas Children’s Fetal Center has completed 23 of these surgeries since 2011, with excellent results.

This technique, the standard of care in the US, involves a uterine incision and can cause maternal complications. With this in mind, the team at the Fetal Center wanted to focus on reducing the risks to the mother and countering the risks of preterm delivery. Working in conjunction with Dr. Jose Luis Peiro and Dr. Elena Carreras of Vall D’Hebron Hospital in Barcelona, Spain, they developed a fetoscopic approach to the repair.

The surgery was over three years in the making and features an in-utero, single layer, sutured repair through only two, four millimeter incisions in the uterus (rather than the 5-6cm opening that is required for an open procedure). In order to practice and perfect performing the closure using a minimally invasive fetoscopic approach, the team built a simulator using a child’s kickball that replicated the mother’s uterus. Inside the kickball, a doll acted as the fetus including a spina bifida defect on the doll’s back. Drs. Belfort and Whitehead practiced closing the defect using a team approach in which they both carry out specific parts of the surgery in a coordinated fashion. The two surgeons performed more than 30 simulated procedures including two full simulations, gowned and gloved, under actual OR conditions with a full support team.

“We have a magnificent team of specialists from a number of departments working together in the best interests of our fetal and neonatal patients. I am incredibly proud to be a member of this outstanding team and to be able to play a role in this mission,” Belfort said.

With a multi-disciplinary structured program in place, clinical planning and training and full Institutional Review Board approval for this experimental procedure, the team performed the first in-utero spin bifida closure on their first patient on July 30, 2014. The procedure went as planned and so far mom and baby are doing well. Doctors are optimistic and are waiting to access the outcome of the repair once the baby has been delivered.

“It is important to note that this mother has not been exposed to a significant uterine incision and we are much less concerned about her risk of a ruptured uterus during this pregnancy than we are after an open repair,” Belfort said. “We look forward to an uneventful delivery and a healthy baby.”

In addition to an expert operating room team and nursing staff, a multidisciplinary team of specialists led this first surgery at Texas Children’s Fetal Center, including Dr. Michael Belfort, Dr. William Whitehead, Dr. Alireza Shamshirsaz, Dr. Oluyinka O. Olutoye, Dr. Olutoyin Olutoye, Dr. David Mann, and Dr. Rodrigo Ruano.

“With the ever-advancing technology and imaging capabilities and dedicated surgeons, I am excited to see what the future holds when it comes to repairing anomalies fetoscopically,” Belfort said. “I am so impressed by what can be achieved with our exceptional team.”

July 15, 2014

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Texas Children’s Hospital hosted a two-day training workshop on June 25-26 for the PumpKIN clinical trial protocol attended by cardiovascular surgeons and cardiologists from medical centers throughout the United States.

Texas Children’s Hospital is one of 22 hospitals selected as a clinical site in an NHLBI trial of new technology for children, infants and neonates with severe heart failure who need mechanical circulatory support. This study, PumpKIN (Pumps for Kids, Infants, Neonates), will randomize candidates to one of two types of advanced heart support devices as a bridge to transplant – the infant Jarvik 2000 system or the FDA-approved Berlin Heart Pediatric EXCOR® ventricular assist device (VAD).

Tim Baldwin, PhD, NHLBI project officer for contract research on pediatric ventricular devices, discussed the protocol, study design and trial eligibility for this five-year study. Dr. Robert Jarvik, designer and biomedical engineer of the first artificial heart used as a permanent implant in a human being, spoke on the development of the Jarvik 2000 device and noted the critical need for devices manufactured specially for children. The cardiovascular surgeons and cardiologists also participated in lab training.

“A critical need exists for long-term mechanical circulatory support for children with severe heart failure, many of whom die while waiting for a heart transplant. This clinical trial will hopefully give us another option in pediatric circulatory support devices so that we can continue to make progress in treating these sick children,” said Dr. Charles D. Fraser, Texas Children’s surgeon-in-chief.