Standing on the shoulders of giants: a scientific journey from Singapore to stem cells

Audacious Goals - 2.0 The Global Initiative for Children's Surgery

This is the Presidential Address given at the 48th Annual Meeting of the American Pediatric Surgical Association (APSA) held in Hollywood, Florida, from May 4-7, 2017.

Congenital anomalies in the context of global surgery

Surgery is increasingly recognized as an essential component of global health development. This article will review the state of global pediatric surgery, utilizing congenital anomalies as a framework in which to discuss the promise of pediatric surgery in reducing the global burden of disease. Congenital anomalies are responsible for a substantial burden of morbidity and mortality in low- and middle-income countries (LMICs), as well as significant emotional and economic harms to the families of children with congenital anomalies. Limited pediatric surgical capacity in many LMICs has culminated in a devastating burden of avertable disability and death. Pediatric surgery is an effective and cost-effective means to reduce this burden. Pediatric surgeons must continue to drive the growth of global pediatric surgery by engaging in clinical practice, educational partnerships, and research initiatives.

Computer-assisted surgical planning and intraoperative guidance in fetal surgery: a systematic review

Fetal surgery has become a clinical reality, with interventions for twin‐to‐twin transfusion syndrome (TTTS) and spina bifida demonstrated to improve outcome. Fetal imaging is evolving, with the use of 3D ultrasound and fetal MRI becoming more common in clinical practise. Medical imaging analysis is also changing, with technology being developed to assist surgeons by creating 3D virtual models that improve understanding of complex anatomy, and prove powerful tools in surgical planning and intraoperative guidance.

We introduce the concept of computer‐assisted surgical planning, and present the results of a systematic review of image reconstruction for fetal surgical planning that identified six articles using such technology.

Indications from other specialities suggest a benefit of surgical planning and guidance to improve outcomes. There is therefore an urgent need to develop fetal‐specific technology in order to improve fetal surgical outcome. © 2015 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.

What's already known about this topic?

Fetal surgery has now become a clinical reality, with interventions such as laser treatment for twin‐to‐twin transfusion syndrome (TTTS) and open fetal surgery for spina bifida demonstrated in randomised control trials to improve neonatal outcome

Other specialities are increasingly utilising computer‐assisted surgical planning software, with evidence that this can improve outcome

What does this study add?

We feel that there is an urgent need to develop fetal‐specific technology for surgical planning as it is likely to play an important role in improving outcomes from fetal surgery