Brown University

Pediatric Surgery @ Brown
WARREN ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY

The Warren Alpert Medical School of Brown University

 

Program Description
C. Faculty changes and recent accomplishments
Since obtaining Accreditation in 1997, several major changes have taken place within the Pediatric Surgery Residency Program. New initiatives in living related renal transplantation, pancreas transplantation, burn surgery, craniofacial and endocrine surgery have opened and provide increased exposure to these expanding areas to our training program.
A multidisciplinary ECMO program to support neonatal and pediatric cardiorespiratory failure was started by Dr. Muratore. Dr. Wills is now the Pediatric Director for ECMO, and the Pediatric Surgery Resident is expected to play a central role in the management of these patients. Recently, the ECMO program has developed a simulation curriculum to improve interdisciplinary team performance and protect patient outcomes. These novel ECMO simulation scenarios, which complement individual and team ECMO training, combine the current life-like medical simulation models with the ultra-specialized circumstances of extracorporeal life support. This project demonstrates ECMO Simulation's potential to improve team performance and patient outcome.

In 2000, the Alpert Medical School of Brown University sanctioned the University-wide Program in Fetal Medicine. Operation on twin fetusesThis initiative is the first such progam in the country and combines Pediatric Surgery, Maternal-Fetal Medicine and Neonatology and more than 15 Pediatric and Surgical subspecialties, representing 3 hospitals, for the teaching of medical students and training of residents and fellows.

The program is the academic counterpart of the clinically oriented Multidisciplinary Antenatal Diagnosis And Management ("MADAM") conference, held twice a month. It also provides an umbrella for novel basic and clinical science approaches to fetal treatment. This initiative served as the foundation for the Fetal Treatment Program of New England. Through this program, the first cases of in utero surgery were performed at Hasbro Children's Hospital in 2000. Since then, more than 150 fetal operations have been performed, including laser ablation of placental vessels for twin-to-twin transfusion syndrome, cord ligation for acardiac twins, EXIT procedures and fetal tracheal occlusion for severe diaphragmatic hernia. The Fetal Treatment Program has become the designated regional fetal surgery center for most New England institutions. Patient referral has extended as far as Georgia, Minnesota, Louisiana and North Dakota. An important aspect of this fetal surgery program is the active involvment of the pediatric surgery resident, who receives hands-on experience for each case.

There is a longstanding tradition of minimally invasive surgery at Rhode Island Hospital, where Dr. Joseph Amaral (who was the hospital's president from 2003 to 2007) was one of the developers of the harmonic scalpel. Since then, the institution has maintained a strong emphasis on laparoscopic and thoracoscopic procedures, not in the least through its ventures with industrial partners. In June 2012, the Hasbro Chidren's Hospital's operating rooms underwent renovations that include a fully digital, boom-supported technology platform for universal High-Definition displays.

In 2013, Dr. Hale Wills joined the faculty of the Division of Pediatric Surgery, following training at Cardinal Glennon Children's Hospital in St. Louis and a research fellowship in pediatric trauma. In addition to his skills and expertise in all aspects of general pediatric surgery (including minimally invasive surgery), Dr. Wills's particular interests lie in trauma care and trauma systems, including triage, regional networks and prehospital services. He is the Director of our American College of Surgeons' Committee on Trauma-verified Level I Pediatric Trauma Center, and the liaison for Hasbro Children's Hospital for Rhode Island Emergency Preparedness and other state- and regional trauma care initiatives.

Most recently, Dr. Elizabeth Renaud returned to her home state of Rhode Island, having previously been on staff in the Division of Pediatric Surgery at Albany Medical Center. Her expertise in laparoscopic and other minimally invasive surgical techniques have significantly strengthened the clinical excellence of our Division, and her particular experience and skills in bariatric surgery have allowed the Adolescent Weight Management Program (CHANGES) to boost its surgical program. Dr. Renaudís other interests include quality improvement, and she is actively engaged in a hospital-wide program to develop and enhance clinical pathways.


The Chairman of the Department of Surgery is Dr. William Cioffi. He is a national leader in Trauma, Critical Care and Burns. He was responsible for the formation and maintenance of our Level I Trauma Center (now led by Dr. Charles Adams). His expertise in burn surgery allowed him to recruit Dr. David Harrington to provide an added dimension for treatment of those infants and children with burns that now exceed 40% BSA. Hasbro Children's/Rhode Island Hospital is a Level I Burn Center, accredited by the American Burn Association.
Dr. Paul Morrisey has successfully maintained a living related renal transplant program. His is currently the busiest kidney transplant program in the region. The pediatric surgery resident participates in the pediatric transplant cases, which are cared for on the pediatric surgical service.

The multidisciplinary Airway Management Program is a collaboration between Drs. Sharon Gibson and Jan Groblewski, pediatric otorhinolaryngologists, and the pediatric surgery faculty. This program is yet another example of how the modern approach to medicine transcends divisional boundaries. It provides expert, long-term care for patients with tracheal stenosis and other congenital or acquired conditions of the upper respiratory tract. Special initiatives of the Airway Management team include a program for children with tracheostomies and the care of infants with life-threatening congenital high airway obstruction syndrome (CHAOS), salvaged at birth by EXIT procedures.

Several research initiatives have also been undertaken with the Division of Engineering at Brown. In addition to mentoring for study groups of Engineering and Economics students, members of the Division of Pediatric Surgery are collaborating with Engineering faculty members and industrial partners to develop novel systems of surgical imaging and non-invasive monitoring devices for fetal surgery.

In 2008, Dr. Luks received an Investigational Device Exemption from the FDA for the in utero treatment of severe congenital diaphragmatic hernia, using endoscopic fetal surgery and placement of a detachable tracheal balloon. This was the first such IDE granted for this device; since then, only two other institutions (UCSF and Baylor) received a similar approval; our institutions were the only three centers in the country where this procedure could be offered.

In 2017, Drs. Luks and Chun (Pediatric Emergency Medicine at Hasbro) were the recipients of a U34 Planning grant from NIDDK to prepare a large, multicenter randomized controlled study of non-opeartive management of acute appendicitis - the first such study in the U.S. Hasbro Children's Hospital is the lead institution for this study that also includes Boston Children's Hospital, the Children's Hospital of Philadelphia, Morgan-Stanley children's Hospital of New York and 4 other children's hospitals throughout the country.


 

 

 

 

 

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Pediatric Surgery at Hasbro Children's Hospital