[Applause]
for generations the womb has been a
sacred environment where the fetus grows
and develops and the dark quiet sanctity
of the womb the child grows from a
cluster of cells into a full-grown baby
organs develop structures are needed
together as the fetus is fearfully and
wonderfully made far from the riches of
man with advances in technology we can
now look into the womb and see as the
fetus develops and grows with ultrasound
and MRI but in addition we can now
actually go into the womb to interact
with the fetus to provide treatment and
even surgery this has opened up the
world of fetal surgery the world that
I’m privileged and blessed to be part of
the very few things really that gets
many women more excited than the
realization that they’re pregnant but
the excitement and joy that comes where
the pregnancy can easily be caught
strong by realization that that fetus
may have an anomaly the hopes
expectations and dreams for our child
have put into question several questions
arise will this anomaly result in the
fetus not even making it through
pregnancy is this an anomaly that can be
corrected after birth
what personnel or facilities need to be
present at the time of delivery where
should this job be delivered can this be
collected at all can it be corrected
before birth
now with fetal surgery were able to
provide answers that did not used to
exist answers that we could hope that we
can offer for many of these families
that are faced with this condition my
journey into this world started halfway
around the globe in Nigeria where I was
born and raised
the other
as a young boy growing up in Lagos while
the student at King’s College Lagos I
had a very strong interest in science
and medicine in particular I was
fascinated by how the human body
developed I came across the biography of
a surgeon
Christian Barnard he’s renowned the
known for having performed the first
human to human heart transplant in the
world in 1967 in Cape Town South Africa
interestingly Christiaan Barnard
actually spent some time here in
Richmond at the Medical College of
Virginia where he learned some of the
skills that ended up you know leading to
his ability to accomplish this feat but
while reading his biography what really
interested me the most wasn’t just the
accomplishments that he did in the field
of transplantation and heart surgery but
buried within the text was some work he
had done as a young surgeon walking on
fiddle animals to improve our
understanding of how some anomalies
develop in the fetus you see some babies
are born with blockages to their
intestines or we call intestinal atresia
and dr. Bernard and his colleagues at
that time had been able to perform some
surgery on fetal animals to reproduce
those anomalies improving understanding
of how this occurs and helping us
therefore better understand how to treat
them but what I need what I really took
out of that whole biography was the
realization back then in 1980 that wow
it’s actually possible to go into the
uterus perform surgery and have the
pregnancy continued who knew I had no
idea that was possible I was intrigued I
was fascinated as I proceeded to medical
school still in I drew out above a mural
or university alayan idea I developed a
strong interest in in embryology that is
the study of how the fetus goes from
sperm and an egg all the way to a field
learn human but the intrigued from the
work of dr. Barnard and his colleagues
really pushed into me this sense of
wanting to engage in the research and
the discovery that could actually help
shape the outcomes now I knew how the
fetus was formed what about when things
don’t go right how can we correct those
anomalies so really had a very strong
interest in research and I knew I wanted
to be a surgeon
well I found my way here to Richmond
Virginia I was privileged to be in the
surgical residency program at the
Medical College of Virginia this was one
of the top surgical programs in the
country and I was honored to be mentored
by pediatric surgeons like uh Knoll
Salzburg who prepared me for a career
for the future in pediatric surgery but
in addition part of the fascination for
MCD then was the fact that I had the
opportunity to engage in research
research that led to a PhD at Virginia
Commonwealth University research in
fatal wound healing you see many of us
here probably have bruises and cuts that
were sustained along the way I just
sustained one this morning while shaving
but those cuts and bruises heal with a
scar a telltale sign of the encounter
that we’ve had are the from disease or
injuries or accidents many of the scars
would consider really inconsequential
but severe scars can form especially
from those who had burns with quite
deforming and disfiguring scars that
could be life-changing and also when
scars forming are internal organs from
disease and infection it can reduce
their function and reduce our life
expectancy is that what’s really unique
is that the fetus has an ability to heal
without score and turn the laboratory
then at MCV with my mentors Robert
Digman and Calvin Cohen who are actually
able to look into ways to help unravel
the mysteries of how the fetus is able
to heal for the outscore you see each
and every one of us at one point in our
development had the ability to heal
without scarring how nice would it be if
you could bring that back and apply and
help prevent the scars that we all
develop
so here I was in Richmond Virginia now
having the opportunity to study wound
healing in the fetus here was doing
fetal surgery in animal models the
science advanced and things improved
realized that not only now we’ll be able
to do surgery in in animal models but
fetal surgery could now actually be
performed in humans for life-threatening
conditions the time I spent here led now
to some work that I was able to do
additional training in Philadelphia
before finding myself in Houston in
Houston Texas at Texas Children’s
Hospital they are was fortunate to be
surrounded by a team of talented
surgeons obstetricians anesthesiologists
neonatologists cardiologists nurses and
many more as we set up a federal team
that could care for patients with some
of those complex conditions patients
like Lindley beamer he say I first met
Lindley when she well I first met
Lindley where she was just five months
pregnant within her mother weren’t well
her mother was not Mantegna within
so nearly was just 35 months into her
gestation when her mother presented to
Texas Children’s Hospital if they Lindy
had a tumor growing off her tailbone
this was a sacral coccygeal teratoma his
tumors can be quite huge they can grow
to huge sizes off the tailbone at times
even as big as the fetus itself you can
imagine the fetal heart now has to pump
blood not just to the tumor but also to
the rest of the body this could provide
this could really put a tremendous
strain on the heart and at times the
heart fails just overwhelmed by the
amount of work he has to do you see over
the years we’ve been able to figure out
which fetuses are likely to get in
trouble as the tumor gets bigger Lindy
was one of those fetuses we had to do
something if we didn’t intervene we knew
surely she was gonna die in her mother’s
womb bravely her mother Margaret agreed
to undergo fetal surgery
so Margaret one underwent fetal surgery
procedure actually that required us to
open her abdomen open her uterus gain
access to the fetus bring out Linley’s
hind side and look at the tumor my hands
are not small and it gives you a scale
just in the picture behind me how big
that mass was and again looking at the
little foot right next to it you can
imagine how big this tumor was
essentially sucking the life out of this
Navy were able to partially resect that
tumor
close back the uterus clothes back
Margaret’s abdomen and allow the
pregnancy to continue briefly Margaret
continued the pregnancy or another 13
weeks on tissues deliver by cesarean
section up close to 37 weeks gestation
Laney had been rescued from this huge
tumor that was taking her life she was
not able to live a normal vibrant life
as we see her here when she was a year
older
[Applause]
but fellow soldiers will not without
risks this is one of the few situations
where you can perform one procedure and
lose two patients
you see brave patients like Margaret
Lane Lee’s mother are the ones that make
this possible you can imagine we operate
on these fetuses at about the fifth
month of gestation from tumors like
lamely we have to make a huge incision
on the uterus just to get that mass out
we then have to close this in a very
meticulous manner and have the uterus
continue to stay closed as the pregnancy
continues now think about it for those
of you who have been pregnant at five
months the uterus is only so big it
continues to grow all the way to nine
months put in tremendous tension and
strain on the killing wound again if
we’re dealing here with a wound that’s
struggling to contain the stresses and
tension around it we’d never have to
balance the risk to the mother with a
potential benefit to the fetus because
these mothers have that risk not only
for that pregnancy but for all
subsequent pregnancies the risk is easy
to understand for life-threatening
conditions like Linley’s but now we’re
doing fado sorry for all the non
life-threatening conditions like spina
bifida these are conditions in which the
fetus has the spine exposed the spinal
cord exposed and over time there is
progressive injury to the nerves that
will result in loss of function loss of
ability to walk poor control of the
earring poor control also of stool an
accumulation of fluid within the brain
we know that if we can do the surgery
before birth and preserve the ongoing
injury we can restore function but now
performing more of this service for non
life-threatening conditions means we
need to weigh the risks and benefit to
the fetus and the mother we need to see
how we can improve the outcome for the
fetus while still limiting the risk to
the mother
we knew we have to do better so one of
the ways to find out from our knowledge
of wound healing
we know that the fetus not even in the
fetus
smaller wounds heal better than larger
ones so we had to find ways to avoid the
big incisions that we’re making on the
uterus of this women one thought was
actually to find a way that we could go
in again what we generally do in the
abdomen for those of had surgery or you
know of their gallbladder or different
things but to put little cameras but
this time into the uterus so this had to
be really small tiny cameras to
straw-like instruments into the uterus
that we can visualize the fetus but then
also perform this delicate surgeries
with time finding tiny firing
instruments to be able to perform the
surgery in the mothers to provide the
optimum result and benefit for the fetus
while still reducing the risk to the
mother you see my journey in the world
of fetal surgery has been a journey of
faith he started with a hidden
information buried in the text of the
biography of Christian Barnard about his
work on the fetus he started with the
hidden mysteries of fiddle wound healing
of unraveling the issues related to
wound healing and applying those to
other aspects of life of the work that
we do in him we know that the future of
fetal surgery is gonna be based on
research discovery and innovation as
that field continues to move forward
well for every one of you if you just
take a step back in your daily lives and
look at your career encounters your
interactions the things that you do on
everyday on on a daily basis things that
you interact with people you interact
with things you get to do that if you
just take a step back you can find some
hidden information in there that will
serve as the nidus to give solution to
the problems of tomorrow again I thank
you for your time
[Applause]
for generations the womb has been a
sacred environment where the fetus grows
and develops and the dark quiet sanctity
of the womb the child grows from a
cluster of cells into a full-grown baby
organs develop structures are needed
together as the fetus is fearfully and
wonderfully made far from the riches of
man with advances in technology we can
now look into the womb and see as the
fetus develops and grows with ultrasound
and MRI but in addition we can now
actually go into the womb to interact
with the fetus to provide treatment and
even surgery this has opened up the
world of fetal surgery the world that
I’m privileged and blessed to be part of
the very few things really that gets
many women more excited than the
realization that they’re pregnant but
the excitement and joy that comes where
the pregnancy can easily be caught
strong by realization that that fetus
may have an anomaly the hopes
expectations and dreams for our child
have put into question several questions
arise will this anomaly result in the
fetus not even making it through
pregnancy is this an anomaly that can be
corrected after birth
what personnel or facilities need to be
present at the time of delivery where
should this job be delivered can this be
collected at all can it be corrected
before birth
now with fetal surgery were able to
provide answers that did not used to
exist answers that we could hope that we
can offer for many of these families
that are faced with this condition my
journey into this world started halfway
around the globe in Nigeria where I was
born and raised
the other
as a young boy growing up in Lagos while
the student at King’s College Lagos I
had a very strong interest in science
and medicine in particular I was
fascinated by how the human body
developed I came across the biography of
a surgeon
Christian Barnard he’s renowned the
known for having performed the first
human to human heart transplant in the
world in 1967 in Cape Town South Africa
interestingly Christiaan Barnard
actually spent some time here in
Richmond at the Medical College of
Virginia where he learned some of the
skills that ended up you know leading to
his ability to accomplish this feat but
while reading his biography what really
interested me the most wasn’t just the
accomplishments that he did in the field
of transplantation and heart surgery but
buried within the text was some work he
had done as a young surgeon walking on
fiddle animals to improve our
understanding of how some anomalies
develop in the fetus you see some babies
are born with blockages to their
intestines or we call intestinal atresia
and dr. Bernard and his colleagues at
that time had been able to perform some
surgery on fetal animals to reproduce
those anomalies improving understanding
of how this occurs and helping us
therefore better understand how to treat
them but what I need what I really took
out of that whole biography was the
realization back then in 1980 that wow
it’s actually possible to go into the
uterus perform surgery and have the
pregnancy continued who knew I had no
idea that was possible I was intrigued I
was fascinated as I proceeded to medical
school still in I drew out above a mural
or university alayan idea I developed a
strong interest in in embryology that is
the study of how the fetus goes from
sperm and an egg all the way to a field
learn human but the intrigued from the
work of dr. Barnard and his colleagues
really pushed into me this sense of
wanting to engage in the research and
the discovery that could actually help
shape the outcomes now I knew how the
fetus was formed what about when things
don’t go right how can we correct those
anomalies so really had a very strong
interest in research and I knew I wanted
to be a surgeon
well I found my way here to Richmond
Virginia I was privileged to be in the
surgical residency program at the
Medical College of Virginia this was one
of the top surgical programs in the
country and I was honored to be mentored
by pediatric surgeons like uh Knoll
Salzburg who prepared me for a career
for the future in pediatric surgery but
in addition part of the fascination for
MCD then was the fact that I had the
opportunity to engage in research
research that led to a PhD at Virginia
Commonwealth University research in
fatal wound healing you see many of us
here probably have bruises and cuts that
were sustained along the way I just
sustained one this morning while shaving
but those cuts and bruises heal with a
scar a telltale sign of the encounter
that we’ve had are the from disease or
injuries or accidents many of the scars
would consider really inconsequential
but severe scars can form especially
from those who had burns with quite
deforming and disfiguring scars that
could be life-changing and also when
scars forming are internal organs from
disease and infection it can reduce
their function and reduce our life
expectancy is that what’s really unique
is that the fetus has an ability to heal
without score and turn the laboratory
then at MCV with my mentors Robert
Digman and Calvin Cohen who are actually
able to look into ways to help unravel
the mysteries of how the fetus is able
to heal for the outscore you see each
and every one of us at one point in our
development had the ability to heal
without scarring how nice would it be if
you could bring that back and apply and
help prevent the scars that we all
develop
so here I was in Richmond Virginia now
having the opportunity to study wound
healing in the fetus here was doing
fetal surgery in animal models the
science advanced and things improved
realized that not only now we’ll be able
to do surgery in in animal models but
fetal surgery could now actually be
performed in humans for life-threatening
conditions the time I spent here led now
to some work that I was able to do
additional training in Philadelphia
before finding myself in Houston in
Houston Texas at Texas Children’s
Hospital they are was fortunate to be
surrounded by a team of talented
surgeons obstetricians anesthesiologists
neonatologists cardiologists nurses and
many more as we set up a federal team
that could care for patients with some
of those complex conditions patients
like Lindley beamer he say I first met
Lindley when she well I first met
Lindley where she was just five months
pregnant within her mother weren’t well
her mother was not Mantegna within
so nearly was just 35 months into her
gestation when her mother presented to
Texas Children’s Hospital if they Lindy
had a tumor growing off her tailbone
this was a sacral coccygeal teratoma his
tumors can be quite huge they can grow
to huge sizes off the tailbone at times
even as big as the fetus itself you can
imagine the fetal heart now has to pump
blood not just to the tumor but also to
the rest of the body this could provide
this could really put a tremendous
strain on the heart and at times the
heart fails just overwhelmed by the
amount of work he has to do you see over
the years we’ve been able to figure out
which fetuses are likely to get in
trouble as the tumor gets bigger Lindy
was one of those fetuses we had to do
something if we didn’t intervene we knew
surely she was gonna die in her mother’s
womb bravely her mother Margaret agreed
to undergo fetal surgery
so Margaret one underwent fetal surgery
procedure actually that required us to
open her abdomen open her uterus gain
access to the fetus bring out Linley’s
hind side and look at the tumor my hands
are not small and it gives you a scale
just in the picture behind me how big
that mass was and again looking at the
little foot right next to it you can
imagine how big this tumor was
essentially sucking the life out of this
Navy were able to partially resect that
tumor
close back the uterus clothes back
Margaret’s abdomen and allow the
pregnancy to continue briefly Margaret
continued the pregnancy or another 13
weeks on tissues deliver by cesarean
section up close to 37 weeks gestation
Laney had been rescued from this huge
tumor that was taking her life she was
not able to live a normal vibrant life
as we see her here when she was a year
older
[Applause]
but fellow soldiers will not without
risks this is one of the few situations
where you can perform one procedure and
lose two patients
you see brave patients like Margaret
Lane Lee’s mother are the ones that make
this possible you can imagine we operate
on these fetuses at about the fifth
month of gestation from tumors like
lamely we have to make a huge incision
on the uterus just to get that mass out
we then have to close this in a very
meticulous manner and have the uterus
continue to stay closed as the pregnancy
continues now think about it for those
of you who have been pregnant at five
months the uterus is only so big it
continues to grow all the way to nine
months put in tremendous tension and
strain on the killing wound again if
we’re dealing here with a wound that’s
struggling to contain the stresses and
tension around it we’d never have to
balance the risk to the mother with a
potential benefit to the fetus because
these mothers have that risk not only
for that pregnancy but for all
subsequent pregnancies the risk is easy
to understand for life-threatening
conditions like Linley’s but now we’re
doing fado sorry for all the non
life-threatening conditions like spina
bifida these are conditions in which the
fetus has the spine exposed the spinal
cord exposed and over time there is
progressive injury to the nerves that
will result in loss of function loss of
ability to walk poor control of the
earring poor control also of stool an
accumulation of fluid within the brain
we know that if we can do the surgery
before birth and preserve the ongoing
injury we can restore function but now
performing more of this service for non
life-threatening conditions means we
need to weigh the risks and benefit to
the fetus and the mother we need to see
how we can improve the outcome for the
fetus while still limiting the risk to
the mother
we knew we have to do better so one of
the ways to find out from our knowledge
of wound healing
we know that the fetus not even in the
fetus
smaller wounds heal better than larger
ones so we had to find ways to avoid the
big incisions that we’re making on the
uterus of this women one thought was
actually to find a way that we could go
in again what we generally do in the
abdomen for those of had surgery or you
know of their gallbladder or different
things but to put little cameras but
this time into the uterus so this had to
be really small tiny cameras to
straw-like instruments into the uterus
that we can visualize the fetus but then
also perform this delicate surgeries
with time finding tiny firing
instruments to be able to perform the
surgery in the mothers to provide the
optimum result and benefit for the fetus
while still reducing the risk to the
mother you see my journey in the world
of fetal surgery has been a journey of
faith he started with a hidden
information buried in the text of the
biography of Christian Barnard about his
work on the fetus he started with the
hidden mysteries of fiddle wound healing
of unraveling the issues related to
wound healing and applying those to
other aspects of life of the work that
we do in him we know that the future of
fetal surgery is gonna be based on
research discovery and innovation as
that field continues to move forward
well for every one of you if you just
take a step back in your daily lives and
look at your career encounters your
interactions the things that you do on
everyday on on a daily basis things that
you interact with people you interact
with things you get to do that if you
just take a step back you can find some
hidden information in there that will
serve as the nidus to give solution to
the problems of tomorrow again I thank
you for your time
[Applause]
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