Journal of Pediatric Surgery Article Review: February 2022 BAPS Issue
With Dr. Mark Davenport & Dr. Adrian Wolf & Dr. Kirsty Brennan & Dr. Mark Rinan · hosted by Dr. Rod Gerardo & Dr. Brittany Levy · StayCurrentMD
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Adrian Wolf is chair of pediatric science at the University of Manchester with main interest in understanding why babies are born without kidneys or with abnormal kidneys or lower urinary tract.
Researchers are creating renal organoids with glomerular differentiation to model human genetic kidney and urinary tract diseases and to explore growing whole new renal tracts from pluripotent stem cells.
The UK study on esophageal lengthening by traction (OLBT) for long gap esophageal atresia found that 16 out of 22 patients (73%) had successful esophageal anastomosis after the lengthening procedure.
In babies where OLBT did not work well, all managed to have cervical esophagostomy and survive, with reconstruction typically using gastric transposition.
There were three deaths after anastomosis in the OLBT study, which was surprising even though not completely a shock.
The Netherlands has 17 million people with about 30 to 40 cases of esophageal atresia per year and 6 pediatric surgical centers.
In 2014, the Netherlands began centralizing pediatric oncology surgery to a single hospital in Utrecht.
In 2015, abdominal, thoracic, and head and neck oncology cases were centralized in Utrecht.
In 2018, neurosurgical and orthopedic oncology were added to Utrecht, making every oncological diagnosis now done at that single hospital.
Of the 6 pediatric surgical centers in the Netherlands, only 1 hospital now does biliary atresia and choledochal cysts.
Esophageal atresia cases are now done in only 3 hospitals out of 6 in the Netherlands.
Anorectal malformations and Hirschsprung disease are done in 4 hospitals out of 6 in the Netherlands.
The centralized Utrecht center performs about 30 neuroblastomas per year and about 35 renal tumors per year.
Outcomes improved dramatically after centralization in the Netherlands, not just because surgeons got together but because they operate together and more often.
Kids Operating Room (KidSOR) aims to provide modern operating theater facilities for use by local surgeons in centers in sub-Saharan Africa and Latin America.
Kids OR has a base in the UK where everything is brought in, tested, packed, cleared for customs, and shipped from there.
Kids OR is sending a new operating room every 12 days.
Kids OR has opened 50 operating rooms in 22 different countries.
Kids OR supports pediatric surgery residency programs run by CSECSA (College of East, Central and Southern Africa) and the West African College of Surgeons.
Kids OR works closely with Smile Train and other partners.
Local teams unpack Kids OR equipment with local engineers who recommission all equipment, do local training, and train the local engineer, leaving a fully functioning operating room.
Kids OR provides remote technical support where local hospital engineers can do video calls for troubleshooting and remote diagnosis of equipment problems.
Kids OR will have 75 operating rooms open by the end of this year, but does not consider that the end point—the goal is enough capacity that every child can access care.
Potential applications of renal organoids include pediatric renal transplant replacement therapy and testing novel therapies on in vitro kidney models.
For children born with abnormal kidneys, researchers can identify the causative gene, make stem cells from blood samples, grow organoids in culture to reproduce the disease in a dish, and look for druggable targets.
Growing a ureter is pretty difficult, and without a ureter a kidney organoid cannot function as urine would have nowhere to go.
Kidney organoids are only a few millimeters across, so using them as renal replacement therapy would require implanting hundreds into a person.
Kidney organoids cannot be connected to a big artery, so glomeruli could never make much urine because they would lack high pressure, high flow.