2000 Presidential Address
Steven Rothenberg, MD
In 1989, at the same time that the Berlin wall was coming, down a small number of pediatric surgeons met in Berlin and under the guidance of Professor Waldschmidt had their first exposure to minimally invasive surgery in children. For some who have been so crucial to the development of IPEG this chance meeting would be the nucleus of rapid change in the surgery of infants and children. Over the next few years these colleagues would meet to explore and discuss the possible applications of minimally invasive surgery in pediatric surgery. They met again in Berlin in 1992 to present their experience and small series.
Clearly the dye had been cast and this small group of passionate visionaries would lead the way in what has been one of the most dramatic changes in the practice of pediatric surgery in the last century. They continued to meet and exchange ideas on a yearly basis and in 1994 the group met in Muenster, Germany, under the chairmanship of Professor Willital and formally agreed upon the idea of developing a group or society with a specific interest in pediatric minimally invasive surgery, and the seed that was to become IPEG was sown. I had my first exposure to IPEG the following year when the meeting was held in Orlando just prior to APSA and was chaired by Dr Keith Georgeson.
This meeting was the birth of IPEG in the United States and was the first broad exposure many American pediatric surgeons had to endoscopic surgery in children. It also correlated with the birth (to the day) of my son Zach, two profound events which have changed my life for the better ever since. This also marked the first time that the proceedings of IPEG would be published as Dr Thom Lobe arranged for a supplement to the Journal of Laparascopic and Advanced Surgical Techniques. This supplement would go on to become the society’s own journal “Pediatric Endosurgery and Innovative Techniques” under the excellent guidance of Dr Lobe as the Editor in Chief. A hands on lab was also run at this course and for many pediatric surgeons this was their first technical exposure to laparoscopic surgery. This would become another hallmark of IPEG, the direct preceptoring of surgeons eager to learn minimally invasive techniques.
The following year IPEG met in Vancouver and the beginning of the structure and charter of IPEG was formed. IPEG’s strength would be in its international appeal and it was agreed that the meeting would rotate between Europe, the Americas, and Asia and the Pacific Rim on a three-year cycle. Each region would have two officers a vice president and a representative with the presidency rotating with the site of meeting. The goal of the society was to disseminate information to as many pediatric surgeons as possible and support developments in endoscopic surgery throughout the world. Under the guidance of those early leaders IPEG was to become the focus of innovation and advancement for minimally invasive surgery in children. Over the next two years IPEG carried its mission to Tokyo and then Hong Kong where the first training course for pediatric surgeons in the Far East was held at The Chinese University. Under the guidance of Hoc Tan and C.K. Yueng, live surgery was performed by Drs. Borzi, Georgeson, Tan, Lobe, and myself and televised to a packed auditorium.
However, despite its broad appeal and innovation IPEG faced many problems and challenges. How to sustain a strong worldwide appeal and membership when it would meet in one region only every three years. How to convince industry that pediatric endosurgery was a worthwhile and viable cause and was warranted their investment in time and money to develop the special instrumentation required for infants and children.
How could we move beyond the “Look Ma no hands” presentation of simply documenting cases that we were able to accomplish laproscopically and add real science and data to what most of us passionately believed was a better way to operate on children.
In 1999 IPEG would return to Berlin, its true birthplace and address many of these issues. The meeting itself was full of high caliber papers, with more new and advanced procedures being demonstrated. We would view the future as presented to us by Dr. Jon Bowersox from UCSF who spoke of the future of robotics and computers in medicine and Dr. Klaas Bax would make us stop and take a look at what we were doing and why, what held scientific validity, what was backed by research or merely hearsay, and where should we direct our research endeavors in the future. And we had the opportunity to watch as history was made as the first thoracoscopic repair of a pure esophageal atresia was performed live at the meeting.
The board of IPEG also took a major stride last year by ratifying the constitution of IPEG. And perhaps our most important step was agreeing to hire a management company to give IPEG a central nervous system to go with its incredible heart and soul. Because of our diverse backgrounds, geographies and local needs; for IPEG to be strong and grow, and achieve our goals we must have a strong central core and our management company, BSC Management, has provided that central link.
To achieve our goals we must be strong not only in desire but also in numbers and finances. To achieve our goals we must be seen and heard as a unified international voice. Only then can we hope to influence the practice of pediatric surgeons all over the world, and only then can we convince our industry partners that we warrant their attention and support. In this last year we have made monumental strides in this regard.
But before I expound on this, why do we need another society, especially one which faces as many hurdles and challenges as IPEG? Surely we have enough pediatric surgical societies, there is APSA, AAP, BAPS, CAPS, PAPS, JAPS, European Association of pediatric surgeons, as well as numerous others. Why not expend our energies and moneys there? I surveyed the programs of the major Pediatric Surgical societies and looked for the number of papers dealing with minimally invasive surgery. For the upcoming APSA 2000 meeting there is 1 paper & 1 poster; APSA in 1999, 2 papers & 1 poster; BAPS in 1999 4 papers but only one published; CAPS in 1998, 1 paper; AAP in 1998, 1 paper.
Despite the fact that minimally invasive surgery is transforming how we practice faster than any other development in the last 50 years. Despite the fact that residents looking at fellowship describe it as their number one or two priority in evaluating programs.
Despite the fact that for many procedures we are approaching ten-year data that shows many of these techniques to be vastly superior to what was previously considered the gold standard. Minimally invasive surgery is still the poor stepsister at our major society meetings.
The turning point for me in Pediatric Surgery occurred three years ago at APSA when Dr. Georgeson was asked to hold a ½ day seminar on Sunday afternoon on Endoscopic Surgery in children, prior to the start of the general sessions. On that beautiful Sunday afternoon in Hilton Head that ballroom was packed with 100’s of surgeons for the entire afternoon . The audience, even those who had been our biggest detractors, watched and listened and learned and then went on to start to change the way they practice surgery.
Yet despite this shift we are still outnumbered by fetal wound healing papers 10 to 1. We need IPEG to allow us to further advance the frontiers of clinical medicine and endoscopic surgery in children. It deserves our best efforts, our support, our advances and publications. This is the organization which should continue through your participation and support to lead in advances in surgical therapy in the new millennium.
Is this a pipe dream, my pipe dream? I think not. Over the last few years and especially the last 12 months IPEG has become a stronger and more respected name with increasing recognition. IPEG now has over 250 registered members (most of whom have paid their dues). This year over 120 abstracts were submitted from 23 different countries. Over 200 surgeons have registered for the meeting. Our hands-on lab is sold out and we have an additional 70 people registered for the didactic portion of the course. We have expanded on a meet-the-experts-format which had been used at previous meetings by adding five panel discussions on cutting edge topics and emerging technologies presented by international experts in the field. I would like to take a minute to thank all of the panelists who have donated their time and given their expertise to make this one of the most exciting and far reaching meetings of the new millennium. I would also like to thank the panel chairs Drs. Lobe, Georgeson, Bax, Nuss and Wulkan for coordinating these talks. I would also like to take this time to thank Dr. Anthony Bufo who chaired our poster session and Dr. Craig Albanese who is director of the hands-on course. Without their hard work much of this meeting would not be possible.
Of increasing importance is our interaction with our colleagues in industry. They have come to recognize IPEG as the organization leading the way in Pediatric Endosurgery. Many of our leaders are already sought out to help define and plan for the next generation of endosurgical tools and techniques. Under the guidance of BSC and with the support of many of our board members we have received generous start up and educational grants which have helped us place IPEG in a position to achieve our goals and advance our field. These relationships need to be built upon and made stronger.
I would like to thank again those companies who have recognized the importance of IPEG and minimally invasive surgery in children. Without their monetary and technical support and their willingness to listen to, and believe in our mission, advancement would be impossible. Storz, USSC/Tyco, Aesculap, Circon, Interdyne, Ethicon, Jarot, Stryker, Valleylab, Sandhill, Scientific, Starion, Please visit their company booths and thank them for their support.
So where do we go from here? As the song says the future’s so bright “I gotta wear shades”. As you will experience at this meeting there are no limits to what we can accomplish but we do need to look objectively at what we do, we need to plan carefully for what we hope to accomplish in the future, we need to document our successes and failures and prove to those who are skeptical that we do indeed carry the Holy Grail.
IPEG needs your involvement. We need to set standards of practice. We need to support clinical and basic science research. We need to continue to strive to educate ourselves and our peers through our meetings, preceptor and proctorships, accredited courses and through our website and the internet. We should help set the standards for residents in training and work to offer fellowships for surgeons already in practice.
We must continue to work closely with industry as our advancement is integrally tied to advances in technology. IPEG needs your support and involvement. The nucleus has been laid by those dedicated and talented leaders who you have seen on the podium and who are seated around you. Now it is time to take up the charge and help us and yourself change the face of pediatric surgery. In the last decade we have started to take away much of the pain and morbidity associated with surgical procedures. We have seen the treatment of Hirschsprung’s Disease go from a multiple surgery, often year long ordeal with weeks to months of hospitalization, to a single stage procedure in a newborn often discharged in 2 to 3 days. We have seen patients return to normal activity within days following procedures such as Fundoplication, splenectomy, lung resections, often being hospitalized less than 24 hours.
No one who looks at the data objectively can doubt the benefit to the children whom we have dedicated our lives to treat. There is no greater calling than alleviating the suffering of others, especially children and there is no greater advancement in recent years to that end than those advancements pioneered by the surgeons who are seated around you today.
Continue that advancement and help make the society grow. If you’re not a member, join. If you are a member, get involved. If you are involved, then bring a colleague. Make a difference. IPEG will be what you make of it. Yesterday the Board voted to expand our scope and formed new committees in standards of practice, outcomes, and membership. If you would be interested in serving please contact me or the organization through our website at www.ipeg.org.
Before I release the podium I would like to take a minute to thank those who have made such a profound impact on my life and career.
First I would like to thank all of the past presidents and current and past board members of IPEG who allowed a relatively young and impetuous pediatric surgeon to be involved and find a home and haven in IPEG. You have welcomed me to your countries, homes, and hospitals and there has been no greater joy or honor than in sitting with you and exchanging ideas.
I would like to thank the staff of BSC management who have made this year possible and have helped position IPEG to be the preeminent society in Pediatric Endoscopic Surgery in the years to come.
On a more personal note, I would like to thank a few individuals who have had a strong impact through their support, critique and mentoring. First I would like to pay tribute to the memory of Bill Pokorny who was the Director of my Pediatric Surgery Residency. He allowed a somewhat brash resident to go take a three day three pig lap choli course sponsored by SAGES, our partners at this meeting, even though he really didn’t think it had application in Pediatric Surgery. I have sorely missed his friendship and mentorship. I would like to thank my partners Jack Chang and John Bealer who have given me untold support both physically and emotionally to pursue what for me what has been an undying passion. They have kept me grounded but also allowed me to soar.
I would like to thank Desmond Birkett, Nat Soper, and Jeff Peters as well as other members of the SAGES who were willing to listen to a relative nobody as he encouraged them to embrace our causes and make this Meeting of the Millennium possible.
I would like to thank Lee Hamby who, over the last 7 ½ years, has been my unyielding right hand. Lee is the surgical assistant who has been my cameraman and friend from my first lap Nissen to the TEF which you witnessed today. Much of what I have accomplished clinically would not have been possible without his excellent help. And, no, he is not for sale.
I need to extend a special thanks to two individuals. Tom Lobe whom all of you know and who has been a true pioneer in the field as well as a valued friend. And to Keith Georgeson who has been not only a friend but a mentor, a peer, and at times a student, and has given me unwavering support for God knows what reason. I learn something every time we interact, as I’m sure do many of you. I would not be here today were it not for his support.
And lastly but most importantly I need to thank my family. My wife, Susan, and my children Jessica, Cate, and Zach. As many of you know all too well they are the ones who give the greatest support and are asked to sacrifice the most. Because of their love and support I have been able to pursue my dream and passion in medicine and in IPEG. They are my strength and my greatest pride and joy.
Once again, welcome to the IPEG 2000 Annual Congress!