IPEG : Past , Present,
and Future
2000 Presidential Address
Steven Rothenberg, MD
Pictures from the IPEG
Gala at the Carter Museum
 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!
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