Transcription:
Pediatric Thoracic Surgery

Melanie: There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels.

Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And today, we're talking about pediatric thoracic surgery at Weill Cornell Medicine. Joining me in this thought leader panel today is Dr. Shaun Steigman and Dr. Steven Oh. They're both assistant attending surgeons at New York Presbyterian Weill Cornell Medical Center and assistant professors of Surgery in Pediatric surgery at Weill Cornell Medical College. Doctors, thank you so much for joining us today.

And as we're speaking to parents, and not everybody knows what it is you guys really do. Dr. Oh, could you start for us please? And tell us a little bit about pediatric thoracic surgery at Weill Cornell Medicine and the full range of procedures that you perform. Tell us what that really is and what it entails.

Dr. Steve Oh: Sure I'm happy to do so. And thank you for having us on today, Melanie. It's a real pleasure to be able to speak about the work that we do. So the pediatric thoracic surgery program at Weill Cornell is one that was developed within our division of pediatric surgery. And over the last number of years, as our team has expanded, we've been able to provide more specialized focused care for the pediatric thoracic disease processes that we see in children. And that ranges anywhere from disorders that are noted prenatally before a child is born through ultrasound all the way up to the teenage years, that range in chest wall deformities.

So examples of common diseases that we treat are things like congenital pulmonary airway malformations that are abnormal growths within the lung or what are called foregut duplication cysts that are outpouching of balls of fluid that occur within the esophagus or within our airways all the way up to pectus disorders, which are when the chest wall is either curved all the way in or curved all the way out and to help with reforming that through reconstructions as part of our multidisciplinary comprehensive treatment team that goes from the pre-operative stage all the way to the part where they are out of surgery and we're able to care for them holistically.

Melanie: Isn't that amazing, what you can do for children and their families today? Thank you for telling us that. Now, Dr. Steigman, can you tell us how in addition your highly skilled and specially trained surgeons have a unique expertise in minimally invasive surgery for parents? And surgery is scary. I know my son had it. What does minimally invasive mean when it comes to children?

Dr. Shaun Steigman: Yes, certainly. Thank you, Melanie. And again, thank you for the opportunity to be here today. As a parent myself, I definitely recognize the fear and concern that many parents can have if their child needs surgery. And one of the advantages of doing minimally invasive surgery is that it facilitates a quicker recovery time, less pain, and potentially less complications at risk during and after the procedure.

So to that end, for thoracic surgery, I always like to define it as anything in the chest that is not the heart. Anything with the heart, it's a different group than us, a different specialty. But we will do things like repair an esophageal atresia, which means a piece of the esophagus is born in disconnection and we can attempt to repair that in a minimally invasive way. Instead of a big incision across the chest between the ribs that's maybe five or six inches long, that would be instead a few small incisions in the chest that are a few millimeters long with cameras and instruments working on the inside. That technique we can do for something like esophageal atresia. We can do it for something that Steven Oh mentioned for congenital pulmonary malformations. We can even do that for the acquired chest disorders, such as pectus excavatum, if that does need surgery, to apply that minimally invasive technique to really expedite the patient's recovery.

Dr. Steve Oh: I would also just like to add that minimally invasive for us has lots of benefits. Even in the generation before us, surgeons would have to make large incisions that would span the entirety of the chest wall, that when bring those edges and those ribs back together, it could create deformities where people would be leaning towards one side involuntarily. And so what we've been able to do is to be able to make incisions that are about the size of the width of our pinky nails to be able to put in instruments that are specially developed to really give precise control over the surgery itself. And not only has that improved the cosmetic appearance of the healing, but also reduce the amount of pain that children will feel after and also reduce the amount of time that's required in the hospital and also minimize the time away from resuming normal physical activities and bathing habits. So the minimally invasive does have multiple benefits from a recovery standpoint, a cosmetic standpoint, and just a maintenance standpoint afterwards.

Melanie: That really is fascinating what you can do now. So Dr. Oh, in your first question, you mentioned the multidisciplinary team. Can you tell us what that means for these patients and why it's so important for the patients and their families when you're talking about this team approach and all the different specialists and healthcare providers involved?

Dr. Steve Oh: Absolutely. These are specialized problems and disorders that do require an entire multidisciplinary team to handle because the children that we care for and the children that get prepared for surgery are ones where considerations are made towards the anesthetic component of how do we maintain a safe airway? Do we have all the right equipment? Do we have the proper recovery measures, the proper monitoring after as well as the pain regimens that will get a patient through an entire course or a hospital period most effectively?

And so our team includes communication from everyone that ranges from a pediatric radiologist, who is a specialized radiologist that looks at children's imaging to know exactly what to look for, to our pediatric anesthesia team and conferring with them as we coordinate for the day of surgery itself to our nursing team and our division nurse who helps coordinate the timing of the surgery as well as any questions that are answered leading up to the surgery.

So our nurses on our floor, having protocols that are set for how to maintain certain tubes that the child may come out with as well as the pain medication protocol to best control the pain afterwards, and then using and leveraging our office staff and the technology to be able to provide both in-person and virtual appointments for any additional communications that are needed afterwards for optimal maintenance.

So that's our entire team and how we're able to engage everyone from even before the surgery is planned to all the way up to months after surgery is completed so that we can ensure a complete recovery.

Dr. Shaun Steigman: I also like to add that for those with prenatally diagnosed conditions, our multidisciplinary team includes the obstetrician, the neonatology team, and this is all done through our fetal care center. So that's also a critical component for those with the prenatally diagnosed conditions.

Melanie: Well Dr. Oh. I'm glad you mentioned telehealth because that has been an interesting development since COVID and I don't personally think it's going anywhere. I think it's been a real interesting addition for you all doctors. But Dr. Steigman, as families here, that these children have to have surgery, what can they expect when they're coming in for surgery at Weill Cornell? How do they prepare their child, any siblings? Tell us a little bit about the process itself. How long is the typical stay? Give us a rundown of when you've had that discussion, what happens next?

Dr. Shaun Steigman: Yeah, that's a really great question. Our counseling for the patient and the parents and personally, I consider the parents the patient as much as the patient itself, the really the family unit, that conversation happens once we have decided that the patient needs surgery or once we're approaching that decision and we can do that in the telemedicine setting, oftentimes for the prenatal consultations. And that's been a wonderful addition to our repertoire for how patients see us. And we can do or they can do that in our clinical office setting.

We have an active child life service team at Cornell. And they come either to our clinic or they can participate in a telehealth visit as well before surgery to help really orient the patient at an age-appropriate level, as well as the parents for what to expect the day of surgery. And they engage them with them the day of surgery as well with distraction techniques or play techniques adjusted for the age and development of the patient. They continue their care throughout the patient's stay postoperatively in the hospital.

The day of surgery, the patient and the parents come to the preoperative holding, they check in. The parents stays with the patient throughout this time. They get to meet the anesthesiologist assigned to them. They get to see the surgeon as well. Again, a friendly face that they've met before. And then the parents can stay with the child all the way to the operating room, hold the child's hand as they start to go to sleep. That's the usual routine and that's one that we highly encourage. And then the parents step out. And then we find them in the family waiting area, which has stayed open through COVID specifically just for the pediatric patients and their families.

We find them in the waiting area when we're all done. We give them the good news. If it's a long operation, I like to give my parents an update every hour or two, just with a phone call from the nurse in the operating room. But we'll find them when we're done, give them the good news that everything went fine. And then after a little bit, they get to meet and greet their child in the recovery room.

Dr. Steve Oh: I would also add that one very important component to our group in this program is taking into consideration all the medical components and ensuring that those are all in place to ensure the best surgical outcome. But we're also parents, we're also family members. We have people in our lives who have undergone similar type of experiences in some medical setting. And so for us, it's very important to take all that into consideration. So we have the luxury of being able to time the surgeries as it works for people in their lives, acknowledging that people have work, people have school, people have activities, people have commitments that they have to tend to.

And for us, it's important to say that depending on what the surgery is, we try to time it in a way that doesn't disrupt family's life unnecessarily, things like planning for surgeries that are safely done during times of vacation for the optimal recovery time or providing notes for work for any sort of absences or providing notes for school, providing the child life services here that can allow for schooling in the hospital if there's extended absences. And so we try to take into account the entire experience of just having normal life patterns that can be disrupted by a surgery and trying to support that and buffer that as best we can.

Melanie: How reassuring you both are. And as I said, both my kids have had surgery. So I know as a parent, what that feels like when you go through those double doors and we're not allowed to follow that part. But it's so reassuring when you keep us updated and let us know that good news, as soon as we get it. Now, as far as getting our kids home, again for parents, that's a little scary. You know, we're looking at maybe a very small incision, but we have to keep it clean. We have to maybe change a dressing. What does a family expect from you? What's followup like after a child has gone home?

Dr. Steve Oh: So after child has gone home for the minimally invasive surgeries that we do in babies and younger children, they go home with two types of dressings. The first is typically either a liquid glue that's used to close the skin edges together because the incisions are small enough to be able to do that or to have a small strip and bandage on top of that dressing that is both waterproof and breathable.

Typically, we allow for our patients to be able to bathe normally within about a 72-hour period and there no restriction on positioning for the minimally invasive lung surgeries that we do in children. And so we hope and expect and support full return to activity pretty much as soon as they're discharged from the hospital.

For the older children, where we do the chest wall deformity reconstructions, we do spend some time before discharge going through the different positional considerations, different precautions to take, to make sure that the reconstruction we did doesn't become undone. And for that, there is a lot of education that is done prior to departure from the hospital to make sure that everyone's comfortable with those changes. But we are always accessible by phone, by email, or to be able to see patients after they leave within any period of time. But our typical visits are about two weeks after the surgery is completed.

Melanie: I'd like to give you each a chance for a final thought for parents here, because this is such an important topic and can be quite a scary time for parents and the siblings and the families. But you all have such reassuring voices and such a nice manner that I think that it's very encouraging for parents that do need to come in with their children for surgery.

So, Dr. Steigman, starting with you, how does a family schedule an appointment or consultation with one of your pediatric thoracic surgeons at Weill Cornell Medicine? And what would you like them to take away from this segment about your expertise and your specialty and how you care for these children, their families, and even the parents too?

Dr. Shaun Steigman: Sure. So simplest way to see any of our pediatric thoracic surgeons is for them to call to schedule an appointment through our office. We are based at Cornell, but we have offices throughout the New York City area including practices in Brooklyn, as well as in Queens as well as obviously the one in Manhattan. So we are proud of the fact that we offer a community-based setting that we come to where our patients are and not only the patients have to come into us.

I think that's innate to each of us in the group. A lot of it was what draws us to pediatric surgery, certainly for me. And I think that's really what drives it for us, is how we care and how we express that and the reassurance there. Just to add one thing that I often say to my patients and their parents is just because you're seeing a surgeon, it doesn't mean you have to have surgery. You may have a condition that surgery isn't needed for, or is not an option for. And so don't be too worried about it before you've spoken to us. And hopefully, after you've spoken with us, you're not too worried either.

Melanie: It's really about the worry, isn't it? I swear. We just all worry and it's so nice to hear you say that it doesn't always have to end with surgery. Sometimes there are other therapies available. And Dr. Oh, last word to you. What would you like parents to take away from this episode, this podcast today? And again, how you care for these children in these complex situations to reassure parents that what you're doing at Weill Cornell Medicine is the best care that they can get?

Dr. Steve Oh: You know, one thing that we really do take pride in is being able to consistently evolve and grow and to learn from our experiences. And so for us, we are constantly reevaluating and validating the care that we provide that it is the best care that we can. And so we review our cases together. We review our outcomes, our numbers. And anytime that there's an opportunity to modify a certain portion of that care to make it even better, we're constantly doing that. And I think we take that approach across the entire spectrum of when a patient enters our system to one day leave.

We also really like to be patient-centered and what that means for us is we put ourselves in the shoes of the families that are coming to see us. And we have the benefit that, based on our experiences with patients and our outcomes, that we have families who have volunteered to be resources, if any other family is going to undergo one of these surgeries to talk through with them what their experience was as families.

And so we try to really give what's needed for parents and families to best be supported through what's a very difficult and scary time as parents to have your child undergo surgery, but we do everything we can to be patient-centered in that approach and to give what the patients need, not just what we think they need. And so we're always taking that perspective.

Melanie: Well, I can certainly hear that and the passion in both of your voices. And thank you so much for joining us and really sharing your incredible expertise and taking the time to speak to parents today. So thank you, doctors. And you can see more at weillcornell.org/pedssurg. That's P-E-D-S-U-R-G. See more about these doctors and what they're doing at Weill Cornell Medicine.

And Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointment at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast. We'd like to thank our audience and invite you to download subscribe, rate, and review Kids Health Cast on Apple Podcast, Spotify and Google Podcast.

For more health tips, please go to weillcornell.org and search podcasts. And don't forget to check out our Back To Health. I'm Melanie Cole. Thanks so much for joining us today.

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