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
In 2000, the
Alpert Medical School of Brown University sanctioned the University-wide
Program in Fetal Medicine. This 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
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.
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.