Former CHOC Patient is Cancer Free Thanks to Da Vinci Robotic Surgical System

Julia Shenkman is a healthy and accomplished 17-year-old. She has a second-degree black belt in Taekwondo, is a member of her high school’s science team, and is fourth in her senior class in academics. Julia has another distinction: She’s a former CHOC Children’s patient who underwent a surgical procedure that involved the use of the then-landmark Da Vinci robotic surgical system.

In late 2003, CHOC became the first pediatric hospital in California to begin offering robotic surgery for children. The Da Vinci robot was an improvement over minimally invasive laparoscopic surgery because it gave surgeons a better view inside the surgery site and allowed them to more precisely manipulate instruments, which translated to less pain, fewer complications and shorter recovery time for patients.

In January 2006, Julia, then 8, was whisked to the emergency department at St. Joseph Hospital for severe abdominal pain and frequent vomiting. Blood work and X-rays for appendicitis turned up negative. It wasn’t until Julia’s doctor at CHOC, Mustafa Kabeer, pediatric surgeon, ordered an ultrasound that the cause of her distress was found: a large mass in her right ovary. Using the Da Vinci system, Dr. Kabeer operated on Julia and successfully removed the tumor, which was malignant. After three months of chemotherapy, Julia recovered and remains cancer free.

Julia with Dr. Mustafa Kabeer, CHOC Children's pediatric surgeon.
Julia with Dr. Mustafa Kabeer, CHOC Children’s pediatric surgeon.

Pediatric surgeons at CHOC have performed about 100 robot-assisted surgeries, says Dr. Kabeer, who before coming to CHOC helped implement the world’s first pediatric surgery robotics program at Children’s Hospital of Michigan in 2001. Recently, Dr. Kabeer started using the Da Vinci system to perform complex operations through one incision in the belly button, such as for removal of the gallbladder. The Da Vinci system at CHOC was made possible by a $1.5 million sponsorship from Costco Wholesale Corp.

“This type of technology helps us perform a wide variety of surgeries — some of them very complex,” Dr. Kabeer says. “It takes time, commitment and vision to start and maintain such a program, but this is one of the unique things about CHOC: We want to do this, and we are committed to doing it.

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World’s First “Infusionarium” Comes to CHOC Children’s

Any parent who’s ever tried to get the attention of a child engrossed in a video game or NEW20140915_0307movie can certainly appreciate the concept. Our new, multi-screen “Infusionarium” is an innovative video experience offering a welcome distraction for young patients undergoing treatments that often last for hours.

The CHOC Children’s Infusionarium is the first program of its kind to combine immersive video technology with life-saving infusion therapy, such as chemotherapy or IV antibiotics. Located inside The Dhont Family Foundation Outpatient Infusion Center (OPI) at CHOC Children’s, the jumbo screens and fabric-draped interior look more like a deluxe home theater than a hospital treatment room.

Each patient chair is equipped with a laptop, headphones and wireless keyboard. Up to four patients, age 2 or older, may play at a time, together across four screens or individually. Patients may choose from an extensive menu of video options:

  • Watch popular movies
  • Play favorite Xbox video games
  • Skype with friends
  • Take “live” virtual tours, including the NASA Jet Propulsion Laboratory and Monterey Bay Aquarium
  • Surf the Internet, watch YouTube videos
  • Check email
  • Listen to music or podcasts using high-end, noise-canceling headphones

Parents may also use the Infusionarium to watch educational videos.

Therapy for Chemotherapy

The soothing space and mental distraction may help reduce the physical side effects of chemotherapy.

“One patient used to dread coming in for treatments due to intense bouts of nausea that required multiple medications,” said Leonard Sender, M.D. medical director of the Hyundai Cancer Institute at CHOC Children’s. “Today, when he undergoes treatment within the Infusionarium, he doesn’t even use anti-nausea medications.” Plans are underway to formally evaluate all possible patient benefits.

The Infusionarium was developed for CHOC by My Bridge 4 Life, a company that uses emerging technologies and digital media to create “immersive healing environments.” Founders Roger Holzberg and Allison Mills collaborated with Dr. Sender to launch a “pop-up” pilot Infusionarium at CHOC last summer. The results were so encouraging that CHOC moved forward with the new pod inside the OPI. Funding was made possible by proceeds from the Hyundai Hope on Wheels 5K Run/Walk.

Read more in The New York Times.

Learn more about the innovative programs taking place at the Hyundai Cancer Institute at CHOC Children’s.

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Bringing Together the Best Minds in Pediatric Cancer Care

CHOC Children’s is taking the concepts of second-opinion consultation and tumor board planning at least six steps further. The Virtual Pediatric Network (VPN) uses state-of-the-art video conferencing to allow pediatric cancer experts from six leading institutions to share best practices, research and expertise as if they were all in the same room.

“No one institution can be an expert in every cancer, but with the VPN, these hospitals can work together to bring the best care to patients wherever they may live,” said Dr. Leonard Sender, medical director, Hyundai Cancer Institute at CHOC.

Described as a “multidisciplinary second opinion,” the tumor board concept has become an important cancer-fighting resource at hospitals in recent years. Tumor board meetings typically involve staff from across medical, nursing, psychological and rehabilitative disciplines who evaluate, diagnose and plan treatment for individual patients.

In a similar fashion, the VPN is comprised of five medical centers and one research institute for genomic medicine: CHOC, Lucile Packard Children’s Hospital at Stanford, Kapi’olani Medical Center for Women & Children, Duke Children’s Hospital & Health Center, Rady Children’s Hospital-San Diego and the Translational Genomics Research Institute. With CHOC serving as the hub, all are connected through the CISCO TelePresence video conferencing system, a secure network made available by a grant from CISCO to the CHOC Children’s Foundation.

According to Dr. Sender, the TelePresence system offers the highest level of video conferencing technology available. Optimized for exceptional sound and picture quality, the system captures every expression, gesture and voice inflection, creating a collaborative environment that leads to deeper discussion, enhanced information sharing and improved decision making.

“The VPN is an opportunity to leverage technology to allow for greater collaboration and, hopefully, innovation between children’s hospitals and cancer programs,” Dr. Sender said. “This will lead to potentially better science and provide pediatric patients the greatest opportunities for survival and quality of life.”

The VPN has the potential to standardize and improve care for pediatric patients throughout the world, Dr. Sender added. CHOC and CISCO are already planning to expand the network to additional locations and specialties, including pediatric institutions in Australia and the United Kingdom.

Learn more about the Hyundai Cancer Institute at CHOC Children’s.

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Telemedicine

child with computerWHAT IS TELEMEDICINE?
“Telemedicine encompasses a broad range of different applications,” says Dr. Knight, CHOC’s Pediatric Transport and Telemedicine expert. In a nutshell, telemedicine, also sometimes called telehealth, is the delivery of health care services using telecommunications or electronic technology. Telemedicine can involve video and audio equipment to assess a patient remotely, patient portals, remote monitoring of vital signs, the use of smartphones and tablets and remote medical education efforts. Telehealth also can include giving consumers medical and health information via the Internet or wireless devices, including access to online discussion or peer support groups.

CHOC AND TELEMEDICINE
CHOC has become a leader in telemedicine nationwide. “The way we utilize telemedicine at CHOC is to help assess and triage patients in settings outside of our own walls. Most hospitals do not have telemedicine capabilities that would allow a pediatric specialist to provide assessment and triage remotely,” explained Dr. Knight. “Our experts can assess patients in emergency departments at other hospitals with a mobile telemedicine unit called the RP-Xpress that the CHOC transport team takes with them into the field. The RP-Xpress works through Wi-Fi or a cellular signal and allows a specialist back at CHOC to evaluate the patient using both video and audio. That assessment happens sooner than if we had waited until the patient arrived at CHOC and it may determine if the patient needs intervention right away.”

FAST FACTS

  • Estimated number of Americans who benefited from telemedicine services in 2013, according to the American Telemedicine Association: 10 million
  • Annual number of patients transported to CHOC in each of the past three years: 4,000 – 4,200
  • Percent increase over the past five years in the number of patients transported to CHOC Annually: 30 %

View the full feature on Telemedicine

Dr. Gurpreet Ahuja
Dr. Jason M. Knight
CHOC Pediatric
Transport and
Telemedicine expert 

PHYSICIAN FOCUS: Dr. Jason M. Knight

Dr. Knight is the Medical Director of the CHOC Emergency Transport Services Program and an Assistant Clinical Professor at UC Irvine. He completed his residency training, including a year as chief resident, at Harbor-UCLA Medical Center. He completed a three-year fellowship program in pediatric critical care medicine at Harbor-UCLA Medical Center and CHOC Children’s. Under Dr. Knight’s leadership, the CHOC Transport team has become one of the busiest pediatric transport teams in the nation, able to pick up patients from 130 different hospitals throughout California. The transport team also arranges long distance and out-of-state transports via both rotor and fixed-wing aircraft.

Dr. Knight’s philosophy of care: “I believe all children deserve to receive world-class care at a children’s hospital. For many children that care begins with CHOC’s Emergency Transport Services Team. Our team is truly an extension of CHOC and the Pediatric Intensive Care Unit, and I take great pride in our team’s ability to assess, resuscitate and stabilize patients before they arrive at CHOC.”

EDUCATION:
Eastern Virginia Medical School, Norfolk, Virginia

BOARD CERTIFICATIONS:
Pediatric Critical Care

More about Dr. Knight | CHOC Children’s Transport Services

This article was featured in the Orange County Register on April 21, 2014, and was written by Amy Bentley.

Robots Advance Telemedicine for Pediatric Patients

Telemedicine_CHOC_Knight
Dr. Knight demonstrates the RP Express, another device in CHOC’s telemedicine fleet that travels with the transport team.

Thanks to the power of telemedicine, CHOC Children’s physicians are able to remotely assess and monitor a patient from miles away.

CHOC began integrating telemedicine about seven years ago with the use of remote robots located in the Hoag Hospital Newport Beach Emergency Department, which allowed CHOC doctors to offer consultations for pediatric patients set to be transferred to CHOC, says Dr. Jason Knight, a critical care specialist and medical director of CHOC Children’s Emergency Transport Services.

CHOC is connected remotely to the robots, now also located in the emergency department at Hoag Hospital Irvine, by a control station in its pediatric intensive care unit. In addition, Dr. Knight has a control station at his home, on his laptop and on his iPad so he can communicate with the robot – and help the patient at Hoag – from a variety of locations.

Dr. Knight says both patients and their parents love the robotic concept. The robot, which is about 4 feet tall, displays a picture of the doctor’s face on the top of the device.

“The children think this technology is cool,” Dr. Knight says. “When I introduce myself via the robot as a pediatric specialist, it always puts the parents’ minds at ease because from that point forward, CHOC is involved with their child’s care.”

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  • Telemedicine
    Telemedicine, also sometimes called telehealth, is the delivery of health care services using telecommunications or electronic technology. Telemedicine can involve video and audio equipment to assess a patient remotely, patient ...
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    Thanks to CHOC Children’s telemedicine efforts, physicians can remotely care for children from miles away, or even while a patient is riding in an ambulance. In this video, Dr. Jason Knight, a ...
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    Did you know that doctors at CHOC can talk directly with patients and doctors at Hoag Hospital in Newport Beach without ever leaving the hospital in Orange? It’s true! Using robotic “telemedicine technology”, ...