Surgeons at Brenner Children's Hospital are devoted to children, their families and their healing

Parents want the best for their children especially where health care is concerned. That’s why choosing a children’s hospital for both routine and complex surgery can make a critical difference in the care a child receives and in their recovery.

At Brenner Children’s Hospital, physicians work only with children all day, every day – it’s a unique characteristic that sets a children’s hospital above other healthcare options. Pediatricians and surgeons devoted to children, their families and their healing. At Brenner Children’s Hospital, we understand that children need to receive care in the context of the whole family. We’ve recently built an entire hospital dedicated to caring for the needs of patients and their families. And we didn’t stop there.

Each day, pediatricians trained in over 27 areas of medicine and surgery help patients recover from illnesses or injuries. When a child comes to Brenner Children’s Hospital with a heart condition, they see a cardiologist specifically trained to treat children. As the busiest pediatric surgical center in Western North Carolina, surgeons are experienced in a wide range of pediatric surgical procedures, helping to ensure each child receives the best care. Studies have shown that surgery, procedures and routine care delivered at children’s hospitals, is much safer with fewer complications and lower mortality rates, than care given in adult hospital settings.

“It just makes sense,” said Charles S. Turner, M.D., head of pediatric surgery at Brenner Children’s Hospital.  “When you come to a children’s hospital, every person who sees the patient -- from the nurse to the anesthesiologist to the respiratory therapist –is trained in the care of children. We see children every hour, every day. We understand medication dosages, have the equipment needed to treat smaller body frames and are familiar with most childhood ailments.”

In addition, the staff works to make family members comfortable during one of the most stressful times for a parent. There should be no question where to go for care when it comes to treating children. Brenner Children’s Hospital makes a world of difference in the treatment of any child.

Brenner Children’s Hospital offers a wide range of pediatric surgical subspecialties including the following:

Pediatric General Surgery

For years now, adults have had the option of laparoscopic surgery, a type of minimally-invasive surgery, which can cut recovery periods in half, reduce pain and a lengthy hospital stay, and leave minimal scarring.

Children have that option at Brenner Children’s Hospital, part of Wake Forest University Baptist Medical Center. With two board-certified pediatric general surgeons and brand-new pediatric operating rooms, Brenner Children’s Hospital offers infants and children advanced surgical techniques including minimally invasive laparoscopic surgery. Both general surgeons are fellowship-trained in using minimally invasive surgical techniques.

“Laparoscopic surgery is most commonly used to remove organs such as the gallbladder, spleen and appendix, in anti-reflux operations, to evaluate hernias and to place feeding tubes in infants and children,” said Thomas Pranikoff, M.D., a pediatric general surgeon, who uses the technique on patients ranging from newborns only days old to adolescents.

“Laparoscopic surgery is much easier on a child than other standard surgical procedures. Children who undergo this procedure get up and around more quickly, can return to a normal diet with fewer problems and have shorter stays in the hospital. Parents are relieved that the recovery times are shorter and the hospitalization is most times cut in half when compared to an open procedure.”

“We are able to treat some of the more complex malformations found in infants and correct them,” Pranikoff said. “For example, when an infant is diagnosed with gastroschisis, we are able to correct it quickly and help put the parents at ease and the baby on the road to a quick recovery.”

While the surgery may be similar in both children and adults, the equipment and techniques have to be modified for children.

“You obviously have less space to work with in children,” he said. “For example, when you remove a child’s spleen you need plenty of room to place the detached spleen into a bag for removal in order to complete the procedure. It can take a great amount of patience and maneuvering to keep the spleen from spilling into the abdominal cavity.”

Cost also may be reduced because patients who undergo laparoscopic procedures may spend fewer days in the hospital, Pranikoff said.

Expertise in pediatric surgery combined with the resources found at the area’s only children’s hospital help ensure that a patient receives the best care.

 “One of the benefits of performing this procedure in a children’s hospital is that we have all the components that are necessary to make the outcome both safe and successful,” he added. “We have anesthesiologists, nurses, and pharmacists all trained specifically to care for children. It makes for a much better outcome.”

Pediatric surgeons also use thorascopic surgery to treat chest infections and evaluate lung diseases and other chest disorders.

Orthopaedic Surgery

Two pediatric orthopaedic surgeons provide state-of-the-art treatments for scoliosis, cerebral palsy, spina bifida, pediatric trauma, congenital deformities and adolescent sports medicine. Multidisciplinary clinics combine the expertise of surgeons, rehabilitation and pediatric subspecialists to map out the best treatment plan for each child.

"This multi-disciplinary approach allows us to most expertly care for children with complex medical problems," said Jeff Shilt, M.D. an orthopaedic surgeon at Brenner Children’s Hospital.

Brenner Children’s Hospital is internationally renowned for the care of children with cerebral palsy.  Orthopaedic Surgeon Andrew Koman, M.D., and his colleagues were the first in the nation to treat spasticity with Botox.  This modality, along with baclofen pumps, neuromuscular blockade and orthopaedic surgery provide an entire spectrum of care to these children with special needs. 

Other unique capabilities include limb-lengthening services using automated, computer-driven external fixators to correct congenital deformities or traumatic injuries to extremities, thorascopic spinal surgery for scoliosis, and special growth plate preserving techniques in ACL reconstruction.

Pediatric Plastic Surgery

Handling cases nationally and internationally, Brenner Children Hospital’s pediatric program is recognized as one of the leading centers for the treatment of craniofacial deformities. Lisa David, M.D., and Louis Argenta, M.D., two internationally-renowned craniofacial surgeons, staff one of the largest and most active cleft lip and palate clinics in the United States.

Plastic and reconstructive surgeons at Brenner Children’s Hospital are also nationally recognized for the treatment of vascular abnormalities and soft tissue reconstruction. This team also developed novel treatment options for conditions such as positional plagiocephaly, one of the most common cranial abnormalities. Additionally, they have pioneered minimally invasive techniques (spring mediated cranioplasty) for the treatment of craniosynostosis which reduces the risk, time, extent, and recovery for the child compared to standard surgical techniques.

Pediatric Cardiothoracic Surgery

At Brenner Children’s Hospital, surgeons repair simple and complex heart defects in children of all ages and sizes, including premature infants weighing as little as one pound. Minimally-invasive techniques are used when possible, including ligation of a common defect known as patent ductus arteriosus, which is now treated through a scope without inpatient surgery.

Many procedures offered by our physicians are found in this region only at Brenner Children’s Hospital. Michael Hines, M.D., a pediatric cardiothoracic surgeon, is the only pediatric heart surgeon in the Southeast to offer minimally-invasive surgery to repair a patent ductus arteriosus, a common heart defect in children. The outpatient procedure – which requires only three or four small incisions in the chest – replaces major surgery to make the repair. It is offered at only a handful of hospitals in the United States. Hines has performed more than 230 of the outpatient procedures at Brenner Children’s since 1995.

“The child spends a few hours in the hospital and then goes home the same day,” said Hines.

At most other hospitals, doctors use an open chest surgery, which is more painful and has a longer recovery time. Patients having the open surgery are also at increased risk of developing scoliosis later in life.

In children whose heart function is poor or where defects cannot be repaired, cardiac transplantation is available. Clinical research is conducted in conjunction with specially trained, pediatric cardiac anesthesiologists to make both anesthesia and the heart lung machine even safer. Five pediatric intensivists help provide the best in postoperative care for these complex patients.  In addition, Brenner Children’s Hospital houses one of the busiest ECMO (extracorporeal membrane oxygenation) programs in the country, treating infants and children. Similar to the heart lung machine, ECMO takes over the work of the heart and/or lungs, giving them time to heal. The program is directed by a pediatric cardiacthoracic surgeon and two pediatric surgeons, who provide around-the-clock care. ECMO is used in patients with respiratory failure, but it is also used for heart and/or lung failure after surgery injuries or infection.

Pediatric Neurosurgery

Brenner Children’s Hospital is one of only two hospitals in the world offering a new treatment, called spring mediated cranioplasty, performed by pediatric neurosurgeons and plastic and reconstructive surgeons to treat craniosynostosis, a condition affecting cranial growth pattern.

Pediatric neurosurgeons treat a full range of pediatric brain tumors, perform complex spinal reconstructions and treat epilepsy with surgical procedures including hemispherectomy, temporal lobectomy, tailored focal resection and implantation of vagal nerve stimulators.

Brenner Children’s is North Carolina’s only children’s hospital offering direct and indirect cerebral vascular bypass to correct childhood diseases such as Moya Moya disease.

Pediatric Otolaryngology

 Brenner Children's Hospital serves as the only regional referral center for the care of children with complex airway problems and other complicated diseases of the head and neck.  Dan Kirse, M.D., a pediatric otolaryngologist, and his team routinely perform reconstructive and endoscopic surgery on the pediatric airway.  “These patients frequently require care in a pediatric intensive care unit staffed by highly trained physicians, nurses, and therapists,” Kirse said.  Children with congenital or neoplastic growths of the head and neck are cared for on a routine basis and frequently require the same high acuity of care.

Brenner Children’s Hospital houses the only organized pediatric cochlear implant program in the region. Children with hearing loss from a variety of diseases and children with more routine problems related to tonsil, ear, and sinus infections routinely seek care here.  Kirse and his team perform routine procedures such as tonsillectomy, adenoidectomy, and ear tube placement. “The same 'routine' surgical procedures are safely performed on children with special needs and complex medical problems on a daily basis,” Kirse said. “These patients can sometimes require the depth of resources at Brenner Children's Hospital to have a safe and successful passage through the peri-operative process.”

Pediatric Urologic Surgery

Two pediatric urologists provide the latest medical and surgical treatments for simple and complex genitourinary abnormalities involving the kidney (hydronephrosis, obstruction, tumors), ureter (reflux, ureteroceles), bladder (exstrophy, incontinence, infection), urethra (valves, hypospadias), testicles (undescended testis, hernias, hydroceles), and male and female genitalia (hypospadias, intersex).

Pediatric urologists use both open, laparoscopic, and robotic surgical techniques for many conditions. “Robotic surgery is the latest tool in the armamentarium of treatment options for pediatric urologic conditions,” said Joel Hutcheson, M.D., a pediatric urologist at Brenner Children’s Hospital. “The advantage of using advanced robotic techniques are not only the smaller incisions, which are the same as with laparoscopic surgery, but also the increased complexity of urologic conditions, which can be managed using minimally invasive techniques. The robot allows a much broader range of motion inside the body.  The incisions are smaller, the patients recover faster, and they can be discharged earlier from the hospital.”

Brenner Children’s Hospital is also the only hospital in the world offering regenerative medicine and tissue engineering techniques for the treatment of pediatric urologic conditions.  “If a patient’s organ is abnormal, it can be replaced or repaired using the patient’s own tissue,” said Anthony Atala, M.D., Chair of Urology, and the Director of the Institute for Regenerative Medicine.  “If a patient presents with an abnormal hypospadiac urethra, instead of using skin or oral mucosa for repair, we would reconstruct the patient with a scaffold that will regenerate into normal urethral tissue, thus avoiding future problems of tissue incompatibility. We have treated many patients using these techniques for different tissue types, with over an 8-year follow-up to date. Having tissues that belong there, rather than replacement tissues, is better for the patient long-term.”

Pediatric Emergency Department/Level I Trauma Center

Brenner Children’s Hospital houses the only Pediatric Emergency Department in the region and the only Level I pediatric trauma center – the highest level of trauma care -- in the state. The pediatric emergency department provides separate waiting areas for children and their families. Brenner Children’s Hospital’s trauma center has been verified as a Level I trauma center by the Committee on Trauma of the American College of Surgeons. A national accreditation, this designation is in addition to the Trauma Center’s Level I status, given by the North Carolina Office of Emergency Medical Services.

Key elements of a Level I trauma center include 24-hour, in-house availability by trauma surgeons and availability of care in specialties such as orthopaedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, and critical care. Other capabilities include cardiac, hand, pediatric and microvascular surgery, and hemodialysis. The Level I trauma center provides leadership in prevention, public education, and continuing education of the trauma team members.

Burns

Burn cases comprise approximately 10 percent of the trauma cases seen each year in the Emergency Department, with doctors at Brenner Children’s Hospital seeing an average of one burn patient each week. Cited as a “model emergency department for the state,” the Level I trauma center at Brenner Children’s Hospital is staffed with a variety of pediatric subspecialists, who can recognize and treat pediatric injuries quickly.

Advanced surgical techniques coupled with state-of-the-art wound care are also available at Brenner Children’s Hospital.

Sidebar:  Pediatric Expertise

• Brenner Children’s Hospital has the busiest pediatric surgical center in Western North Carolina.
• Handling cases nationally and internationally, Brenner Children Hospital’s pediatric program is recognized as one of the leading centers for the treatment of craniofacial deformities. Two internationally-renowned craniofacial surgeons staff one of the largest and most active cleft lip and palate clinics in the United States.

• Brenner Children’s Hospital is western North Carolina’s only full service pediatric facility. More than 70 pediatric specialists and subspecialists provide expert care for critically ill children from N.C., Tenn, Va. and S.C.
• Brenner Children’s Hospital is also the only hospital in the world offering regenerative medicine and tissue engineering techniques for the treatment of pediatric urologic conditions. 

• Brenner Children’s Hospital offers children highly specialized, minimally invasive procedures often not available elsewhere in the Southeast, such as outpatient heart surgery for patent ductus arteriosus. Pediatric specialists manage every aspect of care.

• Brenner Children’s neonatal intensive care nursery (the region’s only Level IV nursery) is one of 16 participants in a National Institutes of Health-sponsored neonatal research network, fostering new therapies and treatments. 

• The Level 1 Pediatric Trauma Center of N.C. Baptist Hospital, staffed by Brenner Children’s experts, was first in N.C. to be recognized by the Committee on Trauma of the American College of Surgeons.

• The ECMO (heart/lung) unit is one of only a few centers in the U.S. that supports newborns and children.