Glick spreads the word about surgery
Pediatric surgeon shows NYC meeting benefits of minimally invasive surgery via telecast

By LOIS BAKER
Contributing Editor

Pediatric surgeon Philip Glick is on a crusade to convince the medical community worldwide that minimally invasive surgery—which can lessen pain, hospitalization and recovery time for young patients, as well as lower health costs—should be the new surgical standard for treating conditions in children and adolescents.

	Phillip Glick (with headset) spreads the word about the benefits of minimally invasive surgery for children via a telecast of surgery performed last Friday in Buffalo to a meeting in New York.
	Photo: Jessica Kourkounis

One way he is spreading his message is through a 21st-century version of show-and-tell: the surgical equivalent of teleconferencing. Glick operates in Buffalo while an audience gathered at a distant site watches in real-time through the technology of fiberoptics.

Glick, professor and chair of surgery in the School of Medicine and Biomedical Sciences and surgeon-in-chief and clinical director of pediatric surgical services at Children's Hospital of Buffalo, is the visionary behind a $1.5 million Miniature Access Surgery Center (MASC) at Children's that has captured the attention of pediatric surgeons worldwide since its opening in October 2001.

Believed to be the most sophisticated facility of its kind in the world, the MASC is devoted to performing, teaching and researching minimally invasive surgical techniques and adapting them for children and adolescents. (Glick chose the term "miniature access" rather than "minimally invasive" in naming the center because it was more understandable to parents.)

Glick's first telecast was transmitted last October to a meeting of the American College of Surgeons in New Orleans. Last Friday, he corrected a congenital chest wall deformity called "funnel chest" in a teen-aged boy in surgery that was telecast in real-time to attendees at the Eighth World Conference of Endoscopic Surgery at the New York Hilton. The telecast was viewed at a demonstration booth sponsored by Stryker Communications Corp., which provided a grant to Children's Hospital to help equip the new surgical center.

As of press time, a Nissen Fundoplication—surgery to repair the esophagus in children who have reflux—was scheduled to be broadcast from Children's to a lecture Glick was to give Tuesday to the Mini Medical School class meeting in Butler Auditorium in Farber Hall on the South Campus.

The procedure performed on Friday, called minimally invasive pectus repair, involves inserting a removable metal strut into the patient's chest cavity through small incisions on either side of the chest. The strut supports the chest while the deformed cartilage is remodeled into a normal shape. Glick has performed the surgery on more than 50 children with excellent results.

Compared to the standard open-chest approach, the minimallly invasive technique causes significantly less pain to the child, cuts surgical time in half and hospitalization by 1 1/2 days, and shortens time to complete recovery by up to seven months, Glick said.

Marc Levitt, assistant professor of surgery and pediatrics and medical director of the new surgical center, moderated the procedure in New York City at the Stryker booth.

Glick, meanwhile, worked in an operating theater custom-designed for multidisciplinary, minimally invasive surgeries, including laparo-scopy, thoracoscopy, endoscopy, arthroscopy and cystoscopy. All equipment, suspended from ceiling booms, is controlled by voice-activated computer and directed by the surgeon speaking into a headset. Images from deep in the body transmitted from cameras embedded in the tips of endoscopes placed at the surgical site are projected on flat-screen televisions in the surgical suite.

Situated unobtrusively in the corner of each room is a communication control center that allows images captured by these cameras to be telecast to any location in the world equipped for teleconferencing and provides the MASC with expansive telesurgery and "telementoring" capabilities.

"One of the things that is different about our program in Buffalo compared to others around the country," said Glick, "is that our entire faculty has embraced the goal of converting over to minimally invasive surgery as a way to think about every operation."

At the time they began the transition, surgeons at Children's were applying minimally invasive surgical techniques to about 5 percent of their cases. That number is now more than 50 percent; the goal is to reach 100 percent. Convinced that these proven techniques provide a host of benefits to patients and their families, as well as savings in health-care costs, UB surgeons now want to do for other pediatric surgery training programs in the country what they've done for their own.

"There are some programs out there that are still at 5 percent, so the children in those cities are not benefiting from these great techniques," says Glick. "We'd like to help change that."