Pediatric Surgery

Name of Host Institution: Cincinnati Children’s Hospital Medical Center

Program Specialty / Subspecialty: Fetal Surgery Fellowship Training Program

Program Mailing Address:
Cincinnati Children’s Hospital Medical Center
MLC 2023
3333 Burnet Ave.
Cincinnati, OH 45229-3039

Program Phone Number: 513-636-7365

Program Fax Number: 513-636-7657

Program Email: foong.yen.lim@cchmc.org

Program Director: Foong-Yen Lim, MD

Associate Program Director: Mounira Habli, MD, MFM

Alternate Program Contact: Julie Ludwig, residency coordinator, julie.ludwig@cchmc.org

History

This program was approved by the Graduate Medical Education Committee in February 2004. The first trainee began in July 2004.

Duration

One year.

Prerequisite Training / Selection Criteria

The trainee must have completed at least three years of residency in general surgery and therefore would be eligible for application to a pediatric surgical training program. It is also possible that such an individual will have completed general surgery or a general pediatric surgery residency and now desires specialty training in fetal surgery.

Goals and Objectives

We have established a fetal surgery training program in which individuals participate in the broad clinical and academic experience now available in fetal surgery with the creation of the Fetal Care Center of Cincinnati, under the supervision of surgical director Foong-Yen Lim, MD and maternal-fetal medicine co-directors William Polzin, MD and James Van Hook, MD. This position could be filled by a general surgery-trained individual who comes for a one-year fetal surgery experience and would serve as the fetal surgery fellow, or by a trained pediatric surgeon who desires additional fetal surgery experience.

The goal of this position is to enable the trainee to gain expertise in fetology which will enhance opportunity for application for a more formal general pediatric surgery fellowship, or if he or she has completed training in pediatric general surgery, will enhance expertise in fetology in anticipation of a subspecialization in this area.

Program Certifications

None at this time.

Teaching Staff

• Pediatric Surgery – Maria Alonso-Peclet, Richard Azizkhan, Sean Barnett, Rebeccah Brown, Roshni Dasgupta, Richard Falcone, Victor Garcia, Michael Helmrath, Thomas Inge, Sundeep Keswani, Marc Levitt, Foong-Yen Lim, Jaimie Nathan, Alberto Peña, Frederick Ryckman, Gregory Tiao and Daniel von Allmen
• Obstetrics and Gynecology – William Polzin, Mounira Habli, Kim Brady, Ronald Jaekle, David Lewis and James Van Hook
• Genetics – Robert Hopkin
• Neonatology –Beth Haberman and Paul Kingma
• Cardiology – Erik Michelfelder and James Cnota
• Urology – Paul Noh, Pramod Reddy and Shumyle Alam
• Radiology –Beth Kline-Fath, Maria Calvo-Garcia, Kyuran Choe and Carolina Guiamaraes

The training program director, Lim, will coordinate all aspects of the fellowship training program for the fetal surgery fellow. All of the other listed faculty will be involved in specific training experiences. The surgical faculty will supervise the fetal surgery fellow on all operative cases as well as on inpatient and outpatient care.

Facilities

All training is conducted at Cincinnati Children’s, a private medical center providing 523 registered beds. The hospital is one of the largest children’s care facilities in the United States in several categories: number of beds, number of emergency room visits and number of operative procedures.

During the training period, this individual will be expected to participate in the fetal surgery educational programs, outpatient and inpatient care and routine and complex surgical procedures. The trainee will also be involved in clinical research projects. The trainee may also participate in shared general pediatric surgery clinical and educational experiences with our current pediatric surgery trainees when deemed to be beneficial.

The goal of this fellowship position is to enable the trainee to gain expertise in the diagnosis, medical and operative management of a wide spectrum of fetal abnormalities. This experience will expand the pool of specialists who will be able to care for these patients. In addition, this experience will permit the practitioner to enhance expertise in the treatment of fetal problems in anticipation of a subspecialization in this area.

The fellow will be expected to have completed the entire Selected Readings in Prenatal Diagnosis and Treatment specifically developed by the faculty for this fellowship.

The ultimate responsibility for care of the patients is the attending surgeon. No patient is admitted to the hospital, undergoes a procedure or has a consultation without the attending surgeon being made fully aware and assuming all responsibility. The fellows interact with the attendings on a daily basis to go over the patient’s progress or to raise any concerns. The attending surgeon is routinely called directly by the fellow. The fellows round with the attendings on all patients. There is frequent communication both at the bedside and in the department regarding patient management decisions.

The operative procedures and skills require at least three years of general surgery training or its equivalent. The trainees will participate in major surgical procedures including:

Open Fetal Surgery for:

• Resection of congenital pulmonary airway malformation (CPAM)
• Resection of sacrococcygeal teratoma
• Resection of pericardial and mediastinal teratoma
• Vesicostomy
• Cardiac pacemaker placement

Fetoscopic Surgery for:

• Laser treatment of TTTS
• Release of amniotic bands
• Treatment of chorioangioma
• Release of bladder outlet obstruction

Radiofrequency Ablation for:

• Twin reversed arterial perfusion sequence (TRAP)

Percutaneous Shunt Placement for:

• Fetal pleural effusions
• Congenital pulmonary airway malformation (CPAM)
• Bladder outlet obstruction

EXIT Procedures for:

• EXIT-to-resection for chest masses
• Neck masses (EXIT-to-airway)
• CHAOS (EXIT-to-airway)
• Micrognathia (EXIT-to-airway)
• Severe CDH (EXIT-to-airway and EXIT-to-ECMO)
• Severe congenital heart defects (EXIT-to-ECMO)
• Severe intrathoracic lesion (EXIT-to-airway / resection)

Daily

• Bedside rounds

Weekly

• Tumor Board
• UC Surgical Grand Rounds
• Pediatric Surgery Grand Rounds
• Pediatric Surgery / Radiology Conference
• Pediatric Surgery Morbidity and Mortality Conference
• Fetal Therapeutic Conference
• Fetal Morbidity / Mortality Report

Monthly

• Trauma Case Review
• Trauma Morbidity and Mortality Conference
• Fetal Therapy Grand Rounds
• Perinatal Research

Fellows are evaluated every three months by the program director, and a summary evaluation is conducted at the conclusion of the fellowship. In addition, the subspecialty residents are expected to provide formal evaluations of the individual faculty members, the program of learning and the program resources on an annual basis. This information is collated and presented to the faculty in an anonymous fashion.