IPEG 2019 Highlights: From Virtual Reality and Magnets to Robots at the Bedside

Attending conferences, particularly those held on a different continent, is not a luxury afforded to every pediatric surgeon. So, to bring a little bit of IPEG 2019 to you, the Stay Current team interviewed a handful of speakers to highlight key research presented in Santiago Chile. Let's start it off with the award winners. Hi there, this is Alex Kasar here with Dr. Jordan Taylor from Stanford University. He happens to be the winner of the IPEG Research Award this year with his work Small Surgeries Big Smiles: Reducing Sedation Through Virtual Reality. Can you tell us a little bit about it? We've been using virtual reality headsets to help minimize the use of sedating medication during minor surgical procedures. We've been doing this for about a year now, and we've enrolled 19 patients thereabouts and been able to completely eliminate the I need for IV or sedating medications in these kids. How are the kids liking it? They like it a lot. You know, some of them really enjoy some of the games. Some of them enjoy some of the meditation apps that we use, but all of them have recommended it for future use, both if they were going to have the surgery again and if other kids were going to have it. What type of procedures have you used it for? Mostly, we've been focusing on using this in minor procedures that would typically require just a little bit of sedation medication. So we've been doing hormone implant exchanges as well as a, uh, cystostomy tube exchanges. Awesome. Well, thank you so much. This is Alex Giddens from Akron Children's Hospital. I'm here with Dr. Daniel Von Allmen from Cincinnati Children's Hospital, the winner of this year's innovation award. Dr. Von Allmen, could you please describe what exactly your project was for the people who were unable to make it this year? Thanks, Alex. So the concept that we've been working on is to use imaging combined with robotics to improve the insertion of needles into a specific place, whether that's a vessel or a lesion or whatever. Where do you kind of see the next steps are for this innovation? Vascular access can be a very challenging, time-consuming, potentially dangerous process, and the addition of robotics and the precision and accuracy that that adds allows people who don't necessarily have the experience or the training to do advanced vascular access, uh, allows them to do that in a setting like the ICU or the emergency department or the operating room. Right. I remember you mentioning this isn't so much the type of robotics that's replacing humans, but one that's just enhancing our own abilities. Exactly. So if you think about the spectrum of robotics and things like the intuitive robot, the Da Vinci, which is actually more really a telemanipulator, not necessarily a robot. And at the other end of the spectrum are the things you see on TV where the robots are building cars without anybody touching them. This is actually somewhere in between where it is providing clinicians at the bedside an assistant device that will help them to be better clinicians. Yeah, that's really amazing. Next, we caught up with surgeons from Switzerland to Saudi Arabia to the USA. This is Ray Hanke here with Dr. Bethany Slater. She's here to share with us an update on using magnets as a minimally invasive approach for anastomosis in esophageal atresia. Tell us all about it. Well, I presented a retrospective study on our work regarding 13 patients in which a catheter-based magnet device was placed at six different institutions for patients with a long gap esophageal atresia. All of the patients achieved anastomosis in an average of 6.3 days. All the patients had a stenosis afterwards requiring dilation. Six of the patients required stent placements and two underwent surgery, but 92% of the patients had full feeds at time of follow up, which was about 9.3 years of follow up. Oh wow. So that you followed them a little while then. This was a retrospective study over 17 years. So we are currently undergoing an FDA approved study from Cook in which we are studying the the benefits of the Flourish device, which is a catheter-based magnet device. And we're hoping to obtain 20 patients over the next two years for a prospective observational study. Awesome. Well, good luck. We look forward to seeing what you guys find. This is Alex Gibbons from Akron Children's Hospital. I'm here with Dr. Philip Savive from Lucerne, just discussing IPEG 2019 in Chile. Dr. Savive, is there anything, uh, at IPEG that you feel, particularly from a urology standpoint, that people who couldn't make it this year should know about? I mean, there were a reasonable number of people dealing with pyeloplasty, so I truly feel that pyeloplasty has evolved to become the gold standard in terms of taking care for UPJO obstruction. It's Alex Kasar again here with Dr. Ayed Al-Qahtani, who's the president of IPEG this year and gave a great presidential address about bariatric surgery. Dr. Al-Qahtani, tell us a little bit about your presentation. First of all, this meeting of IPEG has a lot of milestones. With regard to my presentation in this meeting, it concentrated mostly on innovations and challenges, and one of them is in bariatric surgery in children and adolescents, because it has been a subject of controversies. In my presentation, I tried to shed lights on these important four aspects. One is the age at which we do these surgery and we can do it at any age as long as there are comorbidities and we prove it's safe and effective. Second, we answer a question about diabetes, type two diabetes in children and adolescent, if they are obese and have this disease, they should go for bariatric surgery as long as they are obese, because it cured diabetes and it lasts for up to 10 years in our studies. The third one is growth, that they can grow. Bariatric surgery does not affect their growth. In fact, it improved their growth by almost 10cm in height in those who are from five to 10 to nine years. So this is very important. Then we answer the last question that when they lose weight and you provide the weight in early age, they can maintain their weight loss for almost up to 10 years. So these are the question we answer with regard to bariatric surgery in children and adolescent. Amazing. And I was impressed with all the pictures you had of your patients and their outcomes and your patient dancing. It was very involved. Thank you so much for sharing your thoughts and I hope to see you in Vienna next year. Thank you. Thank you. We heard from one of the pioneers in pediatric minimally invasive surgery as he talked about our worst nightmare. This is Ray Hanke here with Dr. Steven Rothenberg. Earlier tonight, we heard you speak on our worst nightmare. Can you tell us a little bit about what you shared with the people who could not make it to the conference? Sure. Thanks Ray. I think this is an incredibly important topic and it's one that's not really known. And it's the question about how we gain access for abdominal surgery in newborns and and babies who are four to six weeks of age. And I think there we're still training people to gain access directly through the umbilicus because people feel there's a natural defect there and they can go in safely and bluntly, put in a trocar and insufflate. And unfortunately, there are a number of reported cases now where people have done that and the patients have gotten air embolus because of unrecognized injury to the umbilical vein. And there's enough cases there that I think one, we need to make this widely known because I think most people think direct access through the center of the umbilicus is safe if you do it bluntly. And two, we can't have any of these cases. It's just an unacceptable outcome for the patient, the family, and for the physician. These are devastating cases. How do you think we can avoid it? I don't think we should go through the center of the umbilicus in anyone under six to eight weeks of age. I think that the risk of potency of the umbilical vein, no matter what technique you use, whether you use blunt dissection, insert a trocar, put a trocar in, put a scope in and look, there's still a risk of injury to the vein. And so I think the only safe way to do it is to do it through an infraumbilical ring incision, so you're below the vein and between the umbilical arteries. Even if it's just one case a year and we avoid it, I think it's worth for all of us to change. I I think that makes perfect sense and hopefully this will change practices around the world. I'm hopeful, or at least that we'll have the discussion. I don't think most people realize it's a potential complication. And it's a terrible one at that too. Yeah, your worst nightmare. And we sat down with one of our very own journal editors to hear a few tips on how to write a manuscript. This is Alex Kasar here with Dr. Holcomb who gave us a great talk about how to write a manuscript. Dr. Holcomb, what do you think are the highlights that people should know about? Probably the most important summary point is that you can teach this. Getting started, I think, is the biggest barrier to writing a manuscript. So I think the the best advice is either create an outline or write your abstract first. And then lock yourself in your office. This is what I do. Take a dictophone and just put something down and then you can always edit it. And you know, I'll edit something eight or nine times. I feel what you're saying this year with my JPS and JLAST deadlines. I almost waited till the last minute and then had to write everything out in a single run. What are the biggest mistakes people make when writing a manuscript? So, what I find uh, in my, uh, position with the Journal of Pediatric Surgery is a lot of times the authors don't necessarily read the instructions to authors, because there are some subtle differences, one journal to the other journal. If the authors will read those instructions, they'll better understand what's expected from our particular journal and then it'll be a better publication. And the biggest mistake I see is in the references, because a lot of the electronic reference manager software is not really in the same format that the Journal of Pediatric Surgery uses. Yet the authors use that and don't reformat it to the Journal of Pediatric Surgery. Some tips that I would give authors to make sure that the paper has good English grammar and syntax and also that the data is the same in the abstract and the paper. Well, Dr. Holcomb, thank you for all these excellent tips and we hope we see you next year at IPEC in Vienna. Great, probably be there. Now, we couldn't possibly cover everything that happened in lovely Santiago Chile. To be sure not to miss out on the fun, join the Stay Current team and the rest of the world at IPEC 2020 in Vienna. See you there. This chapter is created and edited by Todd Ponsky, Alex Kasar, Alex Gibbons, and myself, Ray Hanke. Remember, knowledge should be free.