Ladd Medal Award Presentation Honoring Dr. Steven Rothenberg's Pioneering Minimally Invasive Pediatric Surgery

Everybody knows in this room serves as the chief of pediatric surgery here in Denver. What a, what a great, uh, thing it is to be here in Denver, um, celebrating this as, as well as, uh, uh, participating in. He's internationally recognized for his relentless commitment to advancing surgical science, education, and innovation in the development and broad adoption of newmally invasive surgical techniques for children. His work has transformed the way many of us approach surgical operations today. Reducing the need for traditional open procedures and in doing so has helped. Recovery times, shortened hospital lengths of stay, and decreased. Countless notifications. A Denver native in many respects, Doctor Rothberg attended medical school and completed his general surgery residency here at the University of Colorado. He went on to complete his fellowship training in general thoracic surgery in the UK at the cardiothoracic Center. And later completed his formal pediatric surgery training at Texas Children's Hospital in Houston. It's during this time period that Steve really was able to develop an anchor, his passion for innovation that he has brought forward and is the reason. Talking about His great accomplish today. Doctor Rothenberg's contributions to pediatric minimally invasive surgery are rightfully considered to be unparalleled, including the first laparoscopic repair for TEF, the first horoscopic lobectomy in a child, and the first laparoscopic repair of duodenal atresia in the United States. It's through Steve's passion for education and generosity with his time that such pioneering procedures have become commonplace both here in the US and across the world. Um, I would also encourage all of you to, uh, uh, take a picture or scan those QR codes to read a little bit more about Steve, uh, leading up to this award in operative notes. And by the way, this takes you to the, uh, our section page of the AAP which has a full archive. Which is our newsletter that is put out by Yeah. great resource for And so like we. Steve's gift for teaching and for inspiring others to advance their operative mindset and skill has earned him the recognition all over the world, which I've already mentioned, and this is undoubtedly reflected by his frequent flyer miles that I am sure he must have and I'm quite jealous of. As recently as earlier this month, Steve had the honor of serving as a future faculty at the inaugural. medical forum meetings meeting in Beijing. Medical university in China where he also performed the first orthroscopic TEF and CPA resection 13 years ago. So truly truly. Beyond the operating room, Dr. Rothenborough's influence has been equally profound. Steve is a founding member and past president of IPEG and has served as the inaugural chair of the Pediatric Committee at SAGES. In addition to Steve's innovative approaches and collaborate collaborative work with industry to develop smaller instrumentation and equipment design that incorporates pediatric-specific features and is an undeniable form of patient advocacy, Steve is also Famously quoted as saying things like we have to push the industry to do better, and I'm sure he'll tell us uh uh about that. But this is really true. We do have to ask industry to do better as part of the advocacy for the patients that we are all entrusted to. Steve's authored over 150 peer-reviewed publications, delivered well over 300 invited lectures, and serves on the editorial awards of multiple leading journals, including GPS, Pediatric Surgery. last. When I was asked to present this award to Steve, um, I reached out to several people that know him well and, and by no means, uh, you know. Do I have the time, uh, to present, um, all the feedback that I got, but I, I grabbed a couple that I really wanted to share with you. Um, and the first had to be, um, Dan Ospin, who authored a great interview with Steve back in 2015, which I, I put the reference there, also worth reading, highlighted Steve's career and, um, insights on the development of minimally invasive approaches to horoscopic work. Thoracic surgery, really. I asked Dan to provide some reflection on Steve in the subsequent 10 years since that interview took place and was published in JL, and he said to me that Steve's been a pioneering force in bringing and advancing minimally invasive surgery in infants and children. His innovative approach and tireless dedication have not only revolutionized surgical techniques, but also highlighted the importance of the feasibility of MIS in our patients. Steve's international reputation as an innovator, a surgeon is well deserved and has played a crucial role. Surgeons from around the world sharing his expertise and passion for the field and his contributions have been profound. I have had it for Pediatric surgery, and he continues to inspire and mentor the next generation. Karen Diefenbach, who is here in the room and making you know, he's one of my, uh, wonderful partners, um, and I'm, I'm happy to say a dear friend, um, had this to say about Steve. Steve inspired me with his innovative approach to pediatric surgery. He's been a source of guidance and support over the years, and he's become a mentor and comrade in arms in the endeavor to advance pediatric surgical or pediatric minimally invasive surgery. Steve offers the same level of commitment and support to everyone he meets, which is completely true. Steve gives his time and expertise to surgeons across the globe in order to provide the smallest of patients the highest level of care, and its impact on pediatric surgery is a. And then finally, Everybody knows Todd Ponsky, and Todd himself has, has really helped to advance uh innovation in the world of pediatric surgery and currently serves as the chief innovation Officer at Cincinnati Children's and, and Todd was kind enough to also share some, I think, really personal comments about Steve that I really, I just had to share with you. Quoting, Everyone knows Steve for his gifted surgical skills and innovative contributions for pediatric surgery. What they don't know is how incredible of a human being he is. Steve has been my lifelong mentor, advisor, confidant, and most importantly, best friend. I love him. world. Or if you ask a colleague to say that about you. So thanks for those comments. To Todd's point, Steve is much more than just a surgeon, innovator, scholar, and mentor. Outside of his incredible career, a true sportsman, accomplished downhill skier, often spotted on the back trails of his favorite Colorado resorts. Steve has an opportunity, by the way, to share his love for skiing with anybody who is lucky enough to come up to the International MIS and Surgical Innovation Conference, commonly known as the Vail Conference, which happens annually and I think it's probably in its 20th or 21st year led by Steve, which is a great conference. The QR code again, for anybody interested in learning about that conference, I would highly encourage you to come. It's sometime in mid January this year. Again, a really great forum to discuss innovation. And push uh surgical science. And then finally, as I wrap up and hand it over to Steve, none of this, and I'm sure you would agree, could happen without recognizing Steve's family who've been supported, uh, who have supported Steve throughout. His wife Susie, his daughters Jessica and Catherine, his son Zach, and his son-in-law Eric, his father. His wife Bonnie are all here in back of the moon, so what a, what a great honor it is to have the entire extended. Um, they're here to celebrate Steve along with us and the accomplishment. And with that, I would like to, uh, again. Say what an honor it is to introduce Steve Rothenberg and I'll ask you. He's getting. Fortunately for you I have like um. This is really incredible and I can't. It is way out of anything I ever. Mary Beth, I got a message that Mary Beth had called me and something about the AP and I figured they must want somebody to do some crap that they need. And when she told me it was because I've been given the award. Sorry. So, I'd like to share with you. A little bit about the journey. Um, this is for the young surgeons. To know what is possible. What you have to push through. Um, and to all my great friends in the room, it's great to have. So Yeah. So This is one of my favorites. It's better to be lucky than good, even better if you can be a bit of both, and take advantage of unexpected opportunities. I was going to be a neurologist, a national neurology. I was going to be a urologist and then somehow in the middle of that and I'd be happy to buy you all a beer and talk about it. Most of these stories have way too much background for me to get into here, but I ended up going into pediatric surgery. Somebody who had a big part of that was this man, Michael Harrison, who you all know. I thought I was interested in pediatric surgery. I thought I was going to apply. I thought there's no way in hell I'd get in because I didn't spend 2 years in the lab and do all the other things, and I went to the Boston. It used to be a residents meeting. You now incorporate that here. It's really the fellows, but anybody who's interested in pediatric surgery went to a meeting and the Children's Hospital sponsored it, and I went to Boston to present my first time, and Michael Harrison gave a talk on. Developing fetal surgery. And it was the most amazing talk. I'd ever heard in my life and it was like I've got to do this. This is incredible. And then I went to dinner that night and you know, I'm in Boston. Nobody ever cares about some kid from Colorado and this very nice gentleman sat down next to me and started asking me about who I was and what I did. And I realized after about 10 minutes. Like cared who I was. What an incredible gift and I thought these are a group of people that I want to associate. And then because I applied to pediatric surgery late and I really didn't think I'd get in, I had a gap year and I fell into a fellowship in England, a thoracic fellowship, because I thought, I'm not going to get in, so I'm, I'm, what would I do if I was just a general surgeon? I'd love to do more thoracic, and if I got to do more thoracic, maybe I could. Um, if I did get in, it would help me in pediatric surgery, and by pure dumb luck, I got to go to England for a year and do a general thoracic fellowship, and this gentleman, Mr. Raymond Donnelly, was an amazing surgeon and mentor, and he taught me truly the beauty of thoracic surgery and enabled me to, I think, do what I was able to do later. And so the first lesson I have for you, the first thing I learned is be curious. And when I was there, I got exposed to a different healthcare system. Um, I was exposed to a different set of resources. We had one CAT scan in the whole of Liverpool. It took a month to get a CAT scan in a patient who had a lung nodule, um. I got exposed to different pre and post-op care. My thoracic patients couldn't go to the ICU, only the cardiac patients. Nobody had a central line. Nobody had an AART line. They used the bellows and for anesthesia, they were damn good at doing a single lung ventilation, and I got exposed to European football, which became a lifelong passion. And then I got very, very lucky because Texas Children's Hospital came online the year that I applied. If Texas Children's Hospital didn't come online, I would not be. Because I did not want to move to Texas, so they were at the bottom of my list, but somehow they graced me, was taking me, and these two gentlemen, uh, Bill McCourtney and Jim Harburg, um, were amazing, and thank God that Bill Piconey started a fellowship just in time for me. Um, but they were great and they were open to what I had to learn. And while I was in England, I learned about doing a muscle sparing to economy. Mr. Donalie said, I want you to develop this, and so I worked on it in adults, and I, I could tell there was a difference in the patients. I have a lot of patients who got bilateral for copies, and the ones who got a muscle sparing approach had a much better recovery. And so I talked the docs at Texas Children into letting me do it. And this was my first national presentation was at this meeting during the 2nd year of my fellowship when we presented our initial data on this, but it made me convinced that we could minimize the morbidity of what we do. I also learned that while I was there that you should seek out those smarter and better than you are and collaborate. One of the projects I had with us at Texas Children's was one day Bill McCorney came to me and he said, I want you to come do this dog lab on me. And so we went and we operated on a Bengal puppy, and I did an 80% hepatectomy using an eye cautery. That was the only energy source I had. And then he said, OK, this is your project, and I worked with a group. Did one of the first successful gene therapy projects projects, and we were able to cure factor 8 deficiency in factor 8 deficient dogs. And they put, and so they published it in Science and they thought what I did was so great that I could operate on these baby beagles and have them survive that they made me a second officer. I barely understood what they were doing. It did teach me is that to collaborate with those who are better than you to get better results, and they appreciated what I did and it was a great thing. And then we also did the first lap Foley at Texas Children's Hospital in 1990. When I trained as a general surgeon, there was no laparoscopic surgery that happened well. And I convinced Bill to let me try the first one, and we did it and we did it successfully, and it sort of cemented my belief that minimally invasive surgery. go. So, to the younger surgeons, and you guys are all doing it because you're here, ask questions and look for straightforward solutions. I try to keep them simple. I try to keep them universal. I honestly try to evaluate the solutions. And then avoid the temptation of social media. Don't publish before you've really proved something, and I see that happen. So this was one of my simple solutions. I spent the 1st 5 years of my career trying to figure out how you can get a liver retractor to do this so you could see everything. And then I realized that we had made circular retractors, fat retractors. You don't need any of that. You just need the shaft of an instrument that you can clamp to the diaphragm, and in 90% of the cases it holds liver, simple solution that became universal. One of the things I was very interested in was thoracic surgery. When I first got back to town, I thought I can do lung biopsies in children, and I found a general surgeon who was doing them in adults for interstitial lung disease. And interstitial lung disease is a huge problem in babies back then, but nobody was getting tissue because they thought the morbidity. This event, so I dragged the chief of pediatric pulmonology for National Jewish into an animal lab, took him to a pig lab, and showed him I could do a lung biopsy, and then I actually figured out how to do it in small patients, and we changed the care of interstitial lung disease because now everybody was willing to get tissue. And then from that, we went on to do much more complex surgery and lobectomies, which now every uh lobectomy done in in our hospital is done horoscopically, but uh we've been able to share that. I owe a huge debt to these two gentlemen. Um, one is my, was my partner when I joined Jack Chang. He unfortunately passed away, but he was my dad. He was an amazing surgeon. And I kept coming up with these crazy ideas, and he just protected me. He kept everybody away and provided and so I hope that you all have a chief who does that for you. And then Keith Jorgeson, who was a great friend, and he gave me academic. I was in private practice and still am, but he was the one who brought me into the academic realm. And for about 10 years, we would meet every 3 months teaching a course somewhere and exchange ideas and advance the field. So minimize the morbidity of what we do. This is my challenge to you. This is a born unable to swallow, and that's a site for patients who have esophageal atresia, and this is a note his mother allowed me to do, and it says panicking mother here. Basically, my son is great, except I never noticed, he never stands still long enough for me to notice that his chest is really asymmetric and he's got this curve in his spine. Can someone tell me what happened? And he had a muscle sparing thoracotomy for esophageal treatment. And there's an amazing study that Martin Larker and his group just came out with that showed the two videos at the bottom that the difference between a thoracoscopy and a thoracotomy, even if we think it's cosmetically well, there's significant diminished in chest wall movement and there is significant chest wall asymmetry in smaller volumes, so it matters. So your journey may not take you where you thought you were going, but and be ready for adversity. Uh, a number of years ago, my 15 year old daughter Kate, um, somehow talked me into climbing Kilimanjaro. I don't know where she came up with that idea. I have to tell you a beer. I do know where she came up with it, but we did it and it was beautiful to the final ascent. And we ended up ascending in a blizzard. I have no idea what it looks like at the top of Kilimanjaro. My daughter got altitude sickness and my wife accused me of trying to kill her, but we did it. And when she got down, she was extremely happy that we'd done it, that she got the gold certificate that said she'd made it to the summit. Take advantage of your opportunities. The first orthoscopic repair of pure oesophageal atresia was done in Berlin in 1999. It was the IPEC meeting. I was going to be the incoming president, and we got a call from, uh, Professor Waldschmidt, um, in Berlin. He called Tom Loeb, who's in the audience. Tom, it's great to see you, and myself, and he said, I have this patient with esophageal atresion. We've been dilating with metal lusions, and I think the two ends have come together. What do you think about doing in line while we're Uh, while you're here during the iPad meeting, and Tom and I talked and said, sure, why don't we go to a country where we don't speak the language, operate in an operating room where we You know what the instruments are, and do an operation that's never been done before. In front of 100 people live, you know, it sounds like a great idea. Uh, but Tom was great at doing, pushing things like that, and we did it, uh, and the patient did well, had a stricture, was dilated, um, but we accomplished something. And then almost a year to the day later, I waited for the right patient. I finally had a healthy large baby with a type C esophageal atresia. I told the parents, I think I can do this. Will you give me permission to try theroscopically? These are the benefits I think I have. They gave me permission and 2 hours later we had done the first orthoscopic TF and this is Connor. He was the first baby in the world to do it. He's now a chemist. This is an important lesson be curious but not judgmental. So I was very excited. We've done TEF. I presented. I've now had a series of about 15, and so I submitted it to ABSA thinking everybody has to know about this. Now that they didn't take the. I, I had run a Doctor Grossfeld, I think, at this meeting, and I said I submitted this. I think people need to know what should I do? He said, does that mean the man is. So he published it in JPS and then he Sort of took me under his wing, which was amazing to me. He was an amazing man. And about every year he would call me and say, Steve, I need you to go to Thailand. Steve, I need you to go to Serbia. Steve, I need you to go somewhere because I want you to teach people around the world what you're doing. And he got me involved in the Wolf A, and I will tell you, this is the map I have in my office. You can't quite see the pins, but it's all the places I've been invited to come lecture and teach, and it is the greatest gift. I have, and if you're not doing it, I encourage you to do it. The greatest thing about pediatric surgery is we are an international. And so take advantage of it. Uh, and I've been all over the world teaching. Again, be curious, not judgmental. Uh, a couple of years ago, Mark Davenport. Um, is a great pediatric surgeon in the UK, wrote this book, 50 Landmark Papers, and he called me up and he said, um, I'm putting, I want to put a couple of your papers in, and I want, uh, um, I want your comments. And so I thought it was this paper and Witt Holcomb and I and a group of others published in the Annals of Surgery. I presented it at the American Surgical. Uh, there was a rather loud critic in the audience. It was some guy who puts these topics together through multiple. economies. He didn't like how I did it, but it got published in this, and he said, no, that's not really the one I want you to talk about. I want you to talk about this one. And he said it was I published 220, um, I presented this to and talked about 220 consecutiveness and publication. And I said, Well, why? And he said, Well, something happened after you did that paper, and he was right. So I've been presenting small series and building it up, and I presented this series at ABSA. And before, whenever I presented, they were always critical of the technique. I, why are you taking so long? Well, I can do this through a 1-inch incision. I can do this this way or that way, you know, it makes no sense. And suddenly after 220. A series of 220. The questions totally shifted. No one questioned the technique was why are you doing so many misses? Try not to use instruments larger than the patient. This has been one of my mantras, and Mark showed. I've been very fortunate to work and collaborate with the industry, and that's another thing you need to fight for. There are so many regulations now that make it so hard, but industry are our best partners. We need them to be able to do what we do. But again, don't use instruments bigger than patients, and I, and I went around talking to all the companies trying to get them to make things smaller as many people in this room did. And finally a group to me. They had worked for Valley Lab, and when it was taken over by Clavidian or US Surgical or somebody, they left and they said, we've been listening to what you say. We think we can make what you want. And so we started a company to make a small vessel sealer, which I thought was critical in a small state. Um, it was an amazing journey. I would encourage you all not to do it. But I had the instruments I wanted for the last. And then collaborate. I've been very fortunate to have a strong collaboration with Columbia University. For reasons that again have nothing to do with patient care, I don't get to work with the university that's in my own city. That's crazy. But I have worked with at Columbia and and sort of got rammed down their threat drove by a guy named Dennis Baller who was Uh, but he He, Charlie Stoller and Bill Middlesworth and Steve St Stanos and all the surgeons listed graciously brought me in and allowed me to share their patience, and that volume allowed me to refine the techniques and also I learned how to teach people better. And then don't miss out on. So I've been able to travel all over the world with my family because of this and have amazing experiences. Share your knowledge. So when someone tells asks you to write a book, the first thing you should do is say no. My wife will tell you that it is The biggest time sink and worst thing you can do, uh, but it was an amazing experience and I made some incredible friends doing this. So if you have a passion, put it down. I know books are obsolete, you know, you can ask AI for anything now, but it really was an amazing thing. And then I've made some incredible friends along the way and I'm very grateful for that. And we've had surgeons from over 30 countries come visit us, um, in Colorado. And then don't lose sight of your other passions. Make the time for the things that are really important to you, uh, and do the things you do. And just remember, to get something you never had, you have to do something you never did. And the best part about pediatric surgery is I did this a month ago. So I've been practicing for 35 years, and I got to do something I've never done before, give inhaled ICT. What a great gift to change how we're doing surgery, and I learn something and do something new every year. I do nothing now the way I was trained, and I was trained great in Texas. But I knew nothing the way that I did then. And then if you can leave something behind. And I was very fortunate years ago to have a CEO and a division president who along with not just me, but a group of physicians advocated for a new children's hospital, and that's why Denver now has two children. And collaborate wherever you can. This isn't just that Steve can do it. There are these techniques are now used. I always like to show this slide. In 2004, I was um invited to Madrid to do the first arthroscopic lobectomy. I was a little baby with a CPAP, uh, and the parents were very grateful. And every year on the anniversary of that surgery, the mother sends me an email again and another picture of her daughter, thanking me again for coming. And so I've got to watch this young woman grow up over the last uh 20 years, uh, and I was just in Madrid last night. Last year she was going to come meet me, um, but she couldn't make it because she was studying for a college exam, so her mom came to meet me and we FaceTimed. But that is the gift of being a pediatrics. So this is my team. Uh, and they're all here. I'm very grateful. Uh, my daughter is Jessica Kay, and my son Zach, my dad and his wife Bonnie, um. And they have enabled me to do this, and they have sacrificed. So I can do this And my two partners, Tristan and Sandra, who aren't here today. I've had a lot of partners. They're the two who have withstood it all, and they have, as you've heard before, have supported me, put up with me, which is not always. Um, so thanks to all of them. Um And I was recently in Egypt. And I saw this death. And it's a pharaoh who's standing there looking forward, looking strong. And taking on the world. But when you look at it from the inside. And you see that he's not alone, but he has someone behind him. Supporting him And helping And I've had a partner in my entire life. So thank you, Susan. I don't know if you can hear the sound. She can't hear the sound. So I show this clip. This is a good doctor. Does anyone wants to be a doctor. I've never watched a doctor. About 20 years ago I went to, I went to um India and did a thoroscopic repair on TF and 3 years later I went back and there was a resident who presented a paper on horoscopic TEF and he won the award for the best paper and I was there to give it to him and then he wrote a book. On Thornton Scott said you have to read this book. Tell you to do that. Anyway, and he asked me to write a book, and I said I would love to do that. And then he said, Do you watch Good Doctor? And I said, No. He said, Well, they, there's an episode. They have a corroscopic TF on it and they use my video. The next And they, they showed the video of it. That is amazing. And then I thought It's on TV. Yet, so few TFA repaired orthoscopically. So this is my series. So I, this is the 25th anniversary of the first derroscopic DF. Just like the first series, I submitted this to ABSA, and they turned it down. your experience in shorts. So I'm showing it to you here get it free. Um, but what really concerns me is This was the newest consortium, and I think these are some of the best docs I know, and they put these papers together and less than 11% of 500 TFs are performed therthroscopically and less than 50%. CPAPs are performed arthroscopically. And I will tell you my hospital, not just me, but all my partners, we haven't done an open procedure in 20 years. So my challenge to you is when I come back to this meeting 5.5 years from now, I wanna see the numbers flow. Because it's not just that Steve can do it. There are people all over this room who are excellent surgeons, and the morbidity of the tho of the thoracotomy is significant, and we need to take that on and appreciate it. I know I've taken way too much time. I apologize. You gave me the podium, so that was your, uh, but I will share this with you, and this, this is what I've tried to achieve. I don't think I have, but it's a mastering the art of life draws no sharp distinction between work and play, their labor and leisure, their mind and body, their education and recreation. They hardly know which is which. They simply pursue their Excellence through whatever they're doing and leave others to determine whether they are working or playing. To them, they are always doing both, and to me this is the definition of a pediatric surgeon. So thank you again for this incredible honor and You're all good now.