Pediatric Surgery @ Brown
WARREN ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY
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The surgical laboratories of the Division of Surgical Research are well equipped with the latest analytical tools and animal surgery areas, and the technical personnel are very attuned to interactions with surgical resident investigators. The Neonatology basic science laboratory facilities, in the Kilguss building, are also available to resident projects. In addition, the perinatal physiology laboratory has been the center for investigations by the Pediatric Surgical Faculty. The extent and content of the residency period precludes the initiation of a basic science program by the fellow. However, we will accommodate any visiting resident interested in Pediatric Surgery or allow a matched pediatric surgery fellow to start the program early to begin a research program which will be designed and mentored for completion during a three-year period.
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Dr. Honeyman joined the faculty in 2018. His primary research focuses on the genomic and transcriptomic characterization of tumors. While at Rockefeller University in New York City, it led to the identification of the novel chimeric kinase DNAJB1-PRKACA, an activating mutation that is specific to the fibrolamellar type of hepatocellular carcinoma. Since his arrival at Brown, he has sought to continue the characterization of individual tumors under the umbrella of precision medicine, which has opened the possibility of immediately impacting the care of cancer patients. Soft tissue sarcoma accounts for approximately 1% of solid tumors in adults and 7% of all pediatric solid tumors. While many sarcomas arise spontaneously, a subset is associated with a genetic predisposition or occurs after local trauma, such as radiation exposure or burn injury. Ionizing radiation is believed to have a causative role in less than 10% of all sarcomas, but these often represent secondary malignancies in which survival is significantly worse. The five-year survival rate for radiation-associated sarcoma has been reported to be between 10 and 50%. Further understanding of the biologic foundation of radiation-induced sarcomas is essential to identify risk classification to radiation exposure, to develop novel treatment strategies, and to improve survival rates. Predicting those patients who are at high risk of developing sarcoma after radiation exposure will permit appropriate pre-treatment counseling, efforts to limit radiation exposure, and tailored screening protocols for those patients who have been exposed. Dr. Kim joined the faculty in 2019. His research interests are to bring intelligence to surgery from concepts to products, with focus on intelligent computer vision, data strategy, and collaborative (autonomous) human-machine interface and decision support. Previous research has focused on endoscopic fetal surgery and access to the fetal trachea, in a large animal model (sheep). Projects have mainly centered around fetal lung development and mechanisms of accelerated lung growth after fetal tracheal occlusion. This was done in conjunction with the Pathology Department (Monique E. De Paepe, M.D.) and has been funded by the American Lung Association. In addition to the ovine model, a small animal model (fetal rabbit) and in vitro studies have been conducted into the fate of type II pneumocytes and the role of apoptosis in normal and accelerated fetal lung development. 
One or more undergraduate and medical students from Brown University are given the opportunity each year to participate in the various fetal research projects. Fetal research has focused on the pathophysiology of twin-to-twin transfusion syndrome (TTTS). Following the development of a clinical program in fetal surgery and our participation (as the only North-American center) in the randomized trial on treatment for TTTS, we are now pursuing more basic research in the mechanisms of TTTS, and are developing an animal model for the condition. Clinical research in this field includes the search for markers of outcome in TTTS. In 2009, the Program in Fetal Medicine received an Investigational Device Exemption (IDE) from the FDA for the in utero treatment of congenital diaphragmatic hernia, using endoscopic tracheal occlusion. New collaborations with the Division of Engineering have yielded research projects in non-invasive monitoring during fetal surgery and the development of advanced image display systems for laparoscopic surgery, in a partnership with Brown and the industry. The research is conducted with graduate students in Engineering and Economics, medical students and surgical residents, and grant support is being sought from the Science and Technology Advisory Committee of Rhode Island and the Food and Drug Administration. References: Luks FI 2009, Chang J 2006, De Paepe ME 1999, Papadakis K, 1998(a), Papadakis K 1998(b), De Paepe ME 1998, Luks FI 1997, Papadakis K 1997, Luks FI 1996(a), Luks FI 1996(b)
Dr. Monteagudo joined the faculty in 2019. Her previous basic science research focused on angiogenesis in vascular anomalies. Specifically, the effects of propranolol on lymphatic malformations and chylothoraces. She had the opportunity to translate findings from the lab to treat patients with lymphatic malformations and chylothoraces and now continues her work in this field directing the Vascular Anomalies Clinic here at Hasbro Children’s Hospital. Dr. Monteagudo completed an ECMO fellowship and has a strong interest in both clinical and lab research in this area. The focus of her current research in this field is on hemolysis. As the director of ECMO at Hasbro Children’s Hospital she is working to keep the program at the forefront of advances in neonatal and pediatric ECMO and enjoys collaboration which has allowed innovation to make ECMO safer and more effective for the children of Rhode Island. She is also involved in the Fetal Treatment Program with Dr. Luks and Dr. Renaud and is beginning some research in that area as well. Dr. Renaud was recruited from Albany Medical Center, to return to her home state of Rhode Island. Dr. Renaud's particular expertise includes bariatric surgery, and she is further developing a robust adolescent weight management program, with a strong emphasis on clinical research and excellence. Dr. Renaud is the Director of the Pediatric Trauma Program at Hasbro Children’s Hospital. In that capacity, she oversees many clinical research studies about injuries in children. Her strong interest and expertise in Quality Improvement and Clinical Outcomes has earned her national recognition, and she is a long-standing member of the Outcomes Committee of the American Pediatric Surgical Association (see Publications) Her expert laparoscopic skills are not only critical to this program in bariatric surgery, but in minimally invasive fetal surgery as well. Together with Dr. Luks and Dr. Monteagudo, she represents the surgical arm of the Fetal Treatment Program of New England, not only the oldest and most active such program in the region, but a pillar of fetal therapy nationwide. As such, the program has always been particularly active in multicenter research.
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