1 00:00:00,440 --> 00:00:02,120 This is Crystal Olson with the Becker Healthcare 2 00:00:02,120 --> 00:00:02,839 care podcast. 3 00:00:03,639 --> 00:00:05,400 Thrilled to be joined by Doctor Joel Lil, 4 00:00:05,960 --> 00:00:08,359 Pediatric and fetal surgeon at Midwest fetal Care 5 00:00:08,359 --> 00:00:08,599 center, 6 00:00:09,414 --> 00:00:11,414 collaboration between Children's, Minnesota and Align of health. 7 00:00:12,134 --> 00:00:13,814 He is head of open fetal surgery at 8 00:00:13,894 --> 00:00:15,574 Children's, Minnesota and at the center. 9 00:00:16,069 --> 00:00:17,901 He's with us today to discuss topics that 10 00:00:17,901 --> 00:00:19,891 include the fetal care center success in treating 11 00:00:19,971 --> 00:00:21,665 My Men or M. 12 00:00:22,440 --> 00:00:23,953 Talk to. Thank you for joining us. 13 00:00:24,925 --> 00:00:25,804 Thanks for having me. 14 00:00:26,845 --> 00:00:29,085 Yes. Wonderful. Joe, what... If you don't mind, 15 00:00:29,324 --> 00:00:31,005 could you please introduce yourself and tell a 16 00:00:31,005 --> 00:00:31,885 bit about your background? 17 00:00:33,178 --> 00:00:35,165 Yeah. So, so I'm Joel Lil. 18 00:00:35,642 --> 00:00:37,787 1 of the pediatric and fetal surgeons at 19 00:00:37,787 --> 00:00:40,489 the Mid midwest fetal care center in Children's 20 00:00:40,807 --> 00:00:41,761 Minnesota and Line of health. 21 00:00:42,971 --> 00:00:43,608 1 of the 22 00:00:44,326 --> 00:00:46,079 privileges that I have is not only taking 23 00:00:46,079 --> 00:00:47,137 care of 24 00:00:47,514 --> 00:00:50,039 kids and operating on kids with surgical needs 25 00:00:50,479 --> 00:00:52,740 after they're born, I get a chance to 26 00:00:53,120 --> 00:00:54,659 meet with moms and families 27 00:00:55,200 --> 00:00:56,640 to address a lot of, 28 00:00:57,772 --> 00:01:01,692 important clinical issues, prior being born, making diagnoses, 29 00:01:02,146 --> 00:01:03,362 care plans and even, 30 00:01:04,452 --> 00:01:05,327 creating interventions, 31 00:01:06,217 --> 00:01:08,920 product kids being born in that sometimes involve 32 00:01:08,920 --> 00:01:09,317 surgeries. 33 00:01:10,430 --> 00:01:10,668 So, 34 00:01:11,304 --> 00:01:13,133 for me, this is what I spend the 35 00:01:13,133 --> 00:01:15,612 bulk of my professional life doing and probably 36 00:01:15,612 --> 00:01:17,040 the thing I'm most excited about. 37 00:01:18,786 --> 00:01:20,691 Thanks for that, Joe. Just to take the 38 00:01:20,691 --> 00:01:22,279 wider view for a second here, 39 00:01:23,009 --> 00:01:24,608 clearly really, someone in your position has a 40 00:01:24,608 --> 00:01:26,046 lot of things on their mind. Some of 41 00:01:26,046 --> 00:01:27,804 which you just laid out. But what would 42 00:01:27,804 --> 00:01:29,483 you say are the biggest issues that you're 43 00:01:29,483 --> 00:01:31,960 following in health for health care rather right 44 00:01:31,960 --> 00:01:32,520 at this moment. 45 00:01:34,772 --> 00:01:35,752 Yeah. So 46 00:01:36,290 --> 00:01:38,128 taking a step back. I mean, the answer 47 00:01:38,128 --> 00:01:40,206 to that question is kind of scale. Right? 48 00:01:40,445 --> 00:01:40,945 So 49 00:01:41,418 --> 00:01:44,598 like, nationally, it's pretty important and obvious to 50 00:01:44,598 --> 00:01:46,426 a lot of people that women's health and 51 00:01:46,426 --> 00:01:48,891 reproductive rights, especially how it affects 52 00:01:49,447 --> 00:01:50,663 our fetal care center 53 00:01:51,213 --> 00:01:53,627 are or are are big and on the 54 00:01:53,765 --> 00:01:54,505 the forefront 55 00:01:54,962 --> 00:01:55,360 for us. 56 00:01:56,318 --> 00:01:58,312 We also think about health care access and 57 00:01:58,312 --> 00:02:00,168 dollars used to subsidize 58 00:02:00,799 --> 00:02:02,400 health insurance plans and their, 59 00:02:03,280 --> 00:02:04,640 continued protection nationally. 60 00:02:05,599 --> 00:02:07,280 And then we also think about payers in 61 00:02:07,280 --> 00:02:10,675 their relationship with hospitals and providers, that dynamic 62 00:02:10,814 --> 00:02:11,935 is changing. 63 00:02:12,495 --> 00:02:13,715 It seems to change 64 00:02:14,814 --> 00:02:16,995 pretty rapidly even in my career. I've seen 65 00:02:17,055 --> 00:02:17,935 substantial changes in that. 66 00:02:18,588 --> 00:02:21,457 Improved access, but it comes with other changes. 67 00:02:22,094 --> 00:02:23,609 And you can think about things that you 68 00:02:23,609 --> 00:02:25,362 really affect our region in our state. 69 00:02:26,254 --> 00:02:28,883 Healthcare care organizations and their collaborations and ability 70 00:02:28,883 --> 00:02:30,020 to recruit talent 71 00:02:30,397 --> 00:02:30,897 to, 72 00:02:31,911 --> 00:02:34,004 sort of build in, a staff 73 00:02:34,858 --> 00:02:35,097 that, 74 00:02:36,226 --> 00:02:38,950 allows them to kind of meet care plans 75 00:02:39,005 --> 00:02:41,229 and patient needs. I think that is becoming 76 00:02:41,229 --> 00:02:41,967 an increasingly 77 00:02:42,341 --> 00:02:44,643 challenging problem in the current economic climate. 78 00:02:45,374 --> 00:02:47,208 And then you know, for our state, we 79 00:02:47,208 --> 00:02:48,644 both have a huge, like, 80 00:02:49,681 --> 00:02:52,552 metropolitan urban population, but we also serve a 81 00:02:52,552 --> 00:02:53,052 substantially, 82 00:02:53,828 --> 00:02:54,227 large, 83 00:02:54,786 --> 00:02:55,159 role 84 00:02:55,836 --> 00:02:56,734 populations. So 85 00:02:57,270 --> 00:02:59,658 we focus on and think about how our 86 00:02:59,658 --> 00:03:03,241 region will address significant budget constraints and how 87 00:03:03,241 --> 00:03:03,615 these 88 00:03:04,375 --> 00:03:06,534 programs that can be built to help our 89 00:03:06,534 --> 00:03:07,495 patients here immediately, 90 00:03:07,895 --> 00:03:09,974 will be able to not only reach the, 91 00:03:10,135 --> 00:03:12,294 sort of the greater metro area, but also, 92 00:03:12,789 --> 00:03:13,828 the rural communities. 93 00:03:14,307 --> 00:03:16,225 You know, in doing so, we have to 94 00:03:16,225 --> 00:03:19,181 build sustainable and meaningful programs that are beneficial 95 00:03:19,181 --> 00:03:19,660 the parents. 96 00:03:20,393 --> 00:03:23,101 And patients and have them be cost effective 97 00:03:23,101 --> 00:03:23,898 and sustainable. 98 00:03:25,093 --> 00:03:26,368 And the other thing that we think about 99 00:03:26,368 --> 00:03:28,200 a lot here, we have a pretty diverse 100 00:03:28,200 --> 00:03:29,497 patient population 101 00:03:29,808 --> 00:03:32,052 And we always... We think about 102 00:03:33,297 --> 00:03:35,676 equity within our health care system. And I 103 00:03:35,676 --> 00:03:37,207 think that that's 1 of the things that, 104 00:03:37,913 --> 00:03:39,987 our region is trying to overcome 105 00:03:40,466 --> 00:03:43,576 the psycho social logistical and financial obstacles of 106 00:03:43,576 --> 00:03:44,076 achieving 107 00:03:44,454 --> 00:03:45,672 excellent health care 108 00:03:46,208 --> 00:03:47,267 that is sustainable 109 00:03:47,659 --> 00:03:49,891 and and highly effective for our patients. 110 00:03:50,529 --> 00:03:51,963 And then I think about, like, things, and 111 00:03:52,043 --> 00:03:53,637 I know that our center talks about this 112 00:03:53,637 --> 00:03:55,311 and many of our providers think about this. 113 00:03:56,362 --> 00:03:58,431 Our role in our center in our hospital, 114 00:03:59,465 --> 00:04:00,283 realizing that 115 00:04:00,659 --> 00:04:03,682 we have a pretty substantial role within the 116 00:04:04,319 --> 00:04:06,880 the region and to be an effective tertiary 117 00:04:06,880 --> 00:04:09,288 quan center that provides 118 00:04:09,822 --> 00:04:10,641 partnerships to 119 00:04:11,175 --> 00:04:13,775 not only our local community, but our region 120 00:04:14,214 --> 00:04:17,010 so that we can, once again, build high 121 00:04:17,010 --> 00:04:19,327 value programs that can only be found at 122 00:04:19,327 --> 00:04:21,977 these centers that can bring a lot of 123 00:04:21,977 --> 00:04:23,115 patients and resources 124 00:04:23,572 --> 00:04:24,370 together to build, 125 00:04:25,167 --> 00:04:27,559 these complex care programs. And so I think, 126 00:04:28,755 --> 00:04:30,844 we're always trying to find creative ways to 127 00:04:30,844 --> 00:04:34,194 build solutions in this space. And I think 128 00:04:34,194 --> 00:04:36,347 that that's probably 1 of our biggest local 129 00:04:36,347 --> 00:04:39,298 challenges you know, to to strategize around those 130 00:04:39,298 --> 00:04:39,798 those 131 00:04:40,907 --> 00:04:41,803 those topics 132 00:04:42,335 --> 00:04:44,875 and move and move our programs forward in 133 00:04:44,875 --> 00:04:47,439 the fetal care center is very much 134 00:04:48,384 --> 00:04:51,185 sort of a an ama of of those 135 00:04:51,185 --> 00:04:51,425 issues. 136 00:04:53,105 --> 00:04:54,625 Thank you for laying out those balances as 137 00:04:54,625 --> 00:04:56,439 for us bill. No doubt a lot of 138 00:04:56,559 --> 00:04:58,313 your peers time relate to those and how 139 00:04:58,313 --> 00:04:59,211 you go about 140 00:04:59,667 --> 00:05:01,580 addressing them, but zooming me a little bit, 141 00:05:01,819 --> 00:05:03,254 the main reason we have you on the 142 00:05:03,254 --> 00:05:06,775 podcast today. Is to discuss the midwestern care 143 00:05:06,775 --> 00:05:09,187 center and all the success we've have in 144 00:05:10,439 --> 00:05:13,068 in M and addressing that. So you understand 145 00:05:13,068 --> 00:05:13,727 you have 146 00:05:14,118 --> 00:05:14,673 the 100 147 00:05:15,308 --> 00:05:15,943 Procedure in March? 148 00:05:17,371 --> 00:05:19,275 If you don't mind, could you please trial 149 00:05:19,275 --> 00:05:21,338 procedure and how it can improve the fe 150 00:05:21,338 --> 00:05:21,734 development? 151 00:05:22,942 --> 00:05:23,977 So many years ago, 152 00:05:25,013 --> 00:05:26,526 researchers at the University of 153 00:05:27,083 --> 00:05:28,698 of, San Francisco 154 00:05:29,393 --> 00:05:31,008 began to ask the question 155 00:05:31,478 --> 00:05:32,933 how can we improve 156 00:05:33,467 --> 00:05:37,922 the life of babies with significant fetal anomalies 157 00:05:37,922 --> 00:05:40,011 diagnosed to that we could make in euro, 158 00:05:40,489 --> 00:05:43,464 and which anomalies would benefit from an 159 00:05:44,081 --> 00:05:46,896 intervention and which would still be benefited by 160 00:05:47,049 --> 00:05:47,449 early, 161 00:05:47,928 --> 00:05:51,225 post care. The idea was is that Sp 162 00:05:51,604 --> 00:05:53,522 is a disease that 163 00:05:54,081 --> 00:05:54,581 became 164 00:05:55,693 --> 00:05:57,520 kind of an important target because it was 165 00:05:57,520 --> 00:06:00,538 a non lethal disorder that affected 1 in 166 00:06:00,538 --> 00:06:03,239 3000 patients, so a pretty significant number of 167 00:06:03,239 --> 00:06:03,739 patients 168 00:06:04,448 --> 00:06:06,444 worldwide in particular in North America, 169 00:06:07,003 --> 00:06:07,242 and, 170 00:06:08,040 --> 00:06:09,956 these patients in general are all going to 171 00:06:09,956 --> 00:06:12,212 be born but formed with substantial deficits 172 00:06:13,084 --> 00:06:15,077 when you think about the procedure, you sort 173 00:06:15,077 --> 00:06:16,055 of have to figure 174 00:06:16,592 --> 00:06:18,346 and and and why we do a fetal 175 00:06:18,346 --> 00:06:20,259 intervention, you have to figure... You have to 176 00:06:20,259 --> 00:06:22,427 understand the disease a little bit. The disease 177 00:06:22,427 --> 00:06:25,536 itself affects the brain by creating swelling and 178 00:06:25,536 --> 00:06:26,833 blockages in the brain 179 00:06:27,290 --> 00:06:29,522 because of loss of cerebral spinal fluid out 180 00:06:29,522 --> 00:06:29,921 the back. 181 00:06:30,812 --> 00:06:33,621 Where the defect is seen. It causes hernia 182 00:06:33,679 --> 00:06:33,838 of, 183 00:06:34,873 --> 00:06:37,103 important contents of the brain that can compress 184 00:06:37,103 --> 00:06:38,536 on critical centers of the brain. 185 00:06:39,348 --> 00:06:41,423 The defect itself in spin of if is 186 00:06:41,423 --> 00:06:42,142 a lack of, 187 00:06:42,780 --> 00:06:44,935 proper covering of the neural elements, the spinal 188 00:06:44,935 --> 00:06:46,132 cord to the nerves of the back. 189 00:06:46,771 --> 00:06:47,225 And 190 00:06:47,663 --> 00:06:50,377 that creates also nerve injury to all the 191 00:06:50,377 --> 00:06:53,010 levels of the nerves affected at the level, 192 00:06:53,090 --> 00:06:55,266 the defect and below. So if you have 193 00:06:55,578 --> 00:06:58,439 at a defect in the, lower back, which 194 00:06:58,439 --> 00:07:00,903 is the most common to see this, you 195 00:07:00,903 --> 00:07:02,834 can have substantial deficits 196 00:07:03,225 --> 00:07:05,644 and dysfunction with bowel bladder function 197 00:07:05,944 --> 00:07:08,904 and lower extremity, motor and sensory function where 198 00:07:08,904 --> 00:07:10,425 many of these kids, the majority of these 199 00:07:10,425 --> 00:07:11,245 kits are 200 00:07:11,959 --> 00:07:13,099 wheelchair bound in their, 201 00:07:13,479 --> 00:07:15,079 pre teen and in teen years, 202 00:07:16,039 --> 00:07:16,860 we requiring 203 00:07:17,240 --> 00:07:19,879 substantial medical intervention for bound bladder programs, 204 00:07:20,373 --> 00:07:23,418 and needing multiple neurosurgery and orthopedic surgeries 205 00:07:23,793 --> 00:07:24,531 to help 206 00:07:24,906 --> 00:07:25,406 maintain 207 00:07:25,940 --> 00:07:27,769 the best quality of life for these patients. 208 00:07:28,660 --> 00:07:30,259 So what we found is in, 209 00:07:30,819 --> 00:07:33,000 the early research that if we could 210 00:07:34,180 --> 00:07:36,259 close the back of these babies, much like 211 00:07:36,259 --> 00:07:37,699 we do after they're born, 212 00:07:38,514 --> 00:07:38,995 we can, 213 00:07:40,035 --> 00:07:43,735 improve the disease project... Trajectory or the disease 214 00:07:44,595 --> 00:07:45,955 path for these patients. 215 00:07:46,609 --> 00:07:48,446 And the reason being is that not only 216 00:07:48,446 --> 00:07:49,026 do you 217 00:07:49,724 --> 00:07:51,961 stop that leakage of cerebral spinal fluid as 218 00:07:51,961 --> 00:07:54,232 it leaks out the back, but You also 219 00:07:54,369 --> 00:07:56,279 protect the neural elements from, 220 00:07:56,995 --> 00:07:57,314 being, 221 00:07:58,508 --> 00:08:01,077 injured by the am antibiotic fluid that does 222 00:08:01,309 --> 00:08:02,608 pretty toxic to 223 00:08:03,387 --> 00:08:04,105 developing nerves. 224 00:08:04,745 --> 00:08:06,283 So if we 225 00:08:06,822 --> 00:08:07,461 create a, 226 00:08:08,260 --> 00:08:11,057 a closure technique, a water closure technique to 227 00:08:11,057 --> 00:08:12,011 those neuro elements, 228 00:08:13,203 --> 00:08:15,825 between 23 and 26 weeks, what we see 229 00:08:15,825 --> 00:08:17,438 is a significant improvement 230 00:08:18,223 --> 00:08:19,174 in the disease 231 00:08:19,808 --> 00:08:22,345 progression of these kids. It doesn't cure the 232 00:08:22,345 --> 00:08:24,486 disease, but it greatly am the disease. 233 00:08:25,534 --> 00:08:27,370 So the surgery is done 234 00:08:28,009 --> 00:08:29,366 now a couple different ways. 235 00:08:30,004 --> 00:08:31,282 Initially, it was done through, 236 00:08:31,920 --> 00:08:34,769 like, a lower abdominal typical c section incision 237 00:08:35,366 --> 00:08:37,754 where we would open up the abdomen a 238 00:08:37,754 --> 00:08:38,254 bomb 239 00:08:38,629 --> 00:08:41,017 and expose the uterus and find a place 240 00:08:41,017 --> 00:08:43,404 on the uterus a safe distance away from 241 00:08:43,404 --> 00:08:44,302 the placenta 242 00:08:44,615 --> 00:08:46,934 and create about a 6 to 8 centimeter 243 00:08:46,934 --> 00:08:49,415 opening in the uterus to expose the back 244 00:08:49,415 --> 00:08:51,335 of the baby and then in multiple layers, 245 00:08:51,909 --> 00:08:54,467 close the back of the baby, then close 246 00:08:54,467 --> 00:08:56,305 the uterus, close moms 247 00:08:56,784 --> 00:08:58,403 abdominal wall and let the baby 248 00:08:59,342 --> 00:09:01,440 continue ge dating for another 249 00:09:01,835 --> 00:09:03,195 10 to 13 weeks. 250 00:09:04,315 --> 00:09:06,575 We've since advanced our approach 251 00:09:06,955 --> 00:09:07,455 and 252 00:09:07,835 --> 00:09:10,408 begun doing things through a minimally invasive approach 253 00:09:10,408 --> 00:09:12,562 or ph approach where we can do all 254 00:09:12,562 --> 00:09:16,071 the same exact closure techniques, but through small 255 00:09:16,071 --> 00:09:18,783 little 5 millimeter incision, 3 of them, through 256 00:09:18,783 --> 00:09:19,341 the uterus. 257 00:09:20,074 --> 00:09:23,195 That ema a lot of the morbidity and 258 00:09:23,251 --> 00:09:24,625 potential morbidity for mom 259 00:09:25,316 --> 00:09:26,452 in future pregnancies 260 00:09:26,826 --> 00:09:28,891 and allows for moms to continue on their 261 00:09:28,891 --> 00:09:31,774 pregnancy and have at vaginal delivery whereas the 262 00:09:31,774 --> 00:09:32,274 open 263 00:09:32,890 --> 00:09:34,725 incision on the uterus means that mom needs 264 00:09:34,725 --> 00:09:36,480 to have a a future C section, 265 00:09:37,357 --> 00:09:39,431 and all future pregnancies need a c section. 266 00:09:40,563 --> 00:09:42,721 And when we do this, we know is 267 00:09:42,721 --> 00:09:44,558 a population of patients, 268 00:09:45,198 --> 00:09:47,809 we take and we improve their shu rates 269 00:09:47,929 --> 00:09:50,009 the need for draining that fluid from the 270 00:09:50,009 --> 00:09:50,250 brain, 271 00:09:51,450 --> 00:09:53,289 we reduce it substantially. 272 00:09:54,169 --> 00:09:56,990 And sometimes as much as 4 fold reduction 273 00:09:57,224 --> 00:09:59,074 in shu rates. We can 274 00:09:59,607 --> 00:10:02,070 improve dramatically the high brain hernia rate. We 275 00:10:02,070 --> 00:10:05,669 improve neuro scores or Iq scores and functioning 276 00:10:06,137 --> 00:10:08,996 we have substantial improvements in bladder program, 277 00:10:09,711 --> 00:10:10,822 or bladder function. 278 00:10:11,775 --> 00:10:13,681 And then we have... We doubled the number 279 00:10:13,681 --> 00:10:14,514 of una 280 00:10:15,045 --> 00:10:15,545 una 281 00:10:16,950 --> 00:10:19,173 in this patient population. So we were taking 282 00:10:19,173 --> 00:10:22,269 kids that would otherwise be severely affected needing 283 00:10:22,269 --> 00:10:25,536 assisted in their ambition, whether it's crutches or 284 00:10:25,536 --> 00:10:28,630 thought braces, where been wheelchairs, and we're doubling 285 00:10:28,630 --> 00:10:29,764 the number of kids 286 00:10:30,074 --> 00:10:32,252 who don't require any assistance in. 287 00:10:33,030 --> 00:10:35,208 So we're improving their life significantly. 288 00:10:36,066 --> 00:10:37,997 So that's that's the reason why we do 289 00:10:37,997 --> 00:10:39,673 it, that's kinda how we do it. 290 00:10:40,471 --> 00:10:43,104 And we're always looking as a as a 291 00:10:43,104 --> 00:10:44,881 as a field to improve 292 00:10:45,432 --> 00:10:47,819 not only the procedure decreasing the the risk 293 00:10:47,819 --> 00:10:49,728 to mom and baby, but to also improve 294 00:10:49,728 --> 00:10:50,444 our outcomes. 295 00:10:52,449 --> 00:10:55,086 Wow, doctor. This is just incredible that this 296 00:10:55,086 --> 00:10:57,744 procedure even exists really that you're able to 297 00:10:58,443 --> 00:11:00,920 improve children's lives in such a way before 298 00:11:00,920 --> 00:11:01,734 they born. 299 00:11:02,373 --> 00:11:03,572 Right looking ahead, 300 00:11:04,930 --> 00:11:07,667 now that you've seen that this procedure is 301 00:11:07,886 --> 00:11:08,386 successful 302 00:11:09,578 --> 00:11:11,667 what do you think might be the next 303 00:11:11,802 --> 00:11:13,232 evolution of treatment in this area? 304 00:11:14,265 --> 00:11:16,331 Well, for Spine, in particular, 305 00:11:17,205 --> 00:11:18,054 I think that 306 00:11:18,572 --> 00:11:20,902 understanding the path physiology or how spin 307 00:11:21,277 --> 00:11:21,516 develops, 308 00:11:22,789 --> 00:11:24,778 being able to prevent it or treated even 309 00:11:24,778 --> 00:11:27,166 earlier so that we can have improved outcomes. 310 00:11:27,818 --> 00:11:30,611 And treatment earlier, I think may involve non 311 00:11:30,611 --> 00:11:33,484 surgical means for treatment or even more minimally 312 00:11:33,484 --> 00:11:34,761 invasive means for treatment. 313 00:11:36,051 --> 00:11:37,802 And I think this is a hugely interesting 314 00:11:37,802 --> 00:11:40,746 topic thinking about providing coverage to those neural 315 00:11:40,746 --> 00:11:41,962 elements through 316 00:11:43,230 --> 00:11:45,950 cell based therapy approach that could be delivered 317 00:11:45,950 --> 00:11:47,310 with just a simple needle, 318 00:11:48,830 --> 00:11:51,470 instead of needing a more complex surgery, or 319 00:11:51,470 --> 00:11:53,239 thinking about how to, 320 00:11:54,274 --> 00:11:54,774 prevent 321 00:11:55,547 --> 00:11:58,115 the molecular mechanisms that lead to 322 00:11:58,968 --> 00:11:59,468 the 323 00:11:59,858 --> 00:12:02,639 the spin of bi defect itself. So I 324 00:12:02,639 --> 00:12:04,626 think that's the future for this. But I 325 00:12:04,626 --> 00:12:05,341 think in general, 326 00:12:06,374 --> 00:12:09,194 being able to do fetal surgery for by 327 00:12:09,492 --> 00:12:10,550 open the door 328 00:12:11,645 --> 00:12:14,277 to fetal surgery in general, being able to 329 00:12:14,277 --> 00:12:16,829 teach us how to not only perform the 330 00:12:16,829 --> 00:12:18,286 surgery as a field 331 00:12:18,759 --> 00:12:21,016 but also expand the number of 332 00:12:21,475 --> 00:12:24,271 potential diseases and targets that would benefit from 333 00:12:24,271 --> 00:12:24,910 fetal surgery. 334 00:12:25,485 --> 00:12:27,024 So now we do fetal surgery 335 00:12:27,485 --> 00:12:29,004 for other indications, sometimes, 336 00:12:29,565 --> 00:12:31,825 very large and impactful tumors that would be 337 00:12:32,205 --> 00:12:33,485 otherwise fatal for the fe us. 338 00:12:34,217 --> 00:12:37,005 We do fetal interventions for, a number of 339 00:12:37,005 --> 00:12:37,505 other 340 00:12:37,882 --> 00:12:40,692 indications such as twin pregnancies that, 341 00:12:41,068 --> 00:12:42,582 have un unbalanced sharing of blood, 342 00:12:43,235 --> 00:12:45,235 So there's a number of other indications that 343 00:12:45,235 --> 00:12:48,514 have really grown out of this, early fetal 344 00:12:48,514 --> 00:12:51,088 surgical experience. And I hope to in the 345 00:12:51,088 --> 00:12:53,241 future that we're able to target more fetal 346 00:12:53,241 --> 00:12:53,741 anomalies 347 00:12:54,119 --> 00:12:56,990 so that we can improve outcomes for patients 348 00:12:56,990 --> 00:12:59,383 and families, but also reduce the burden of 349 00:12:59,383 --> 00:13:01,389 health care costs within the system. 350 00:13:03,298 --> 00:13:04,810 Here's hoping a lot of those treatments that 351 00:13:04,810 --> 00:13:08,231 you mentioned, Doctor are going to arrive sooner 352 00:13:08,231 --> 00:13:09,918 rather of than later although See there's a 353 00:13:09,918 --> 00:13:11,615 lot of research and work to be done 354 00:13:12,073 --> 00:13:14,627 before that happens. Lastly, I simply wanna ask 355 00:13:14,627 --> 00:13:17,021 you as someone who is a leader in 356 00:13:17,021 --> 00:13:17,521 health 357 00:13:17,834 --> 00:13:19,685 What do you think leaders needs to be 358 00:13:19,900 --> 00:13:21,649 successful in the field in the next 2 359 00:13:21,649 --> 00:13:22,126 to 3 years? 360 00:13:23,318 --> 00:13:25,646 Yeah. I so, you know, I think about 361 00:13:25,782 --> 00:13:26,759 how even 362 00:13:27,468 --> 00:13:29,779 25 years ago, when when I thought about 363 00:13:29,779 --> 00:13:30,736 science and medicine, 364 00:13:31,215 --> 00:13:32,751 a lot of work was happening 365 00:13:33,367 --> 00:13:35,222 still in silos and 366 00:13:35,694 --> 00:13:37,765 people competed with programs, 367 00:13:38,483 --> 00:13:41,351 and they looked at how they could advance 368 00:13:41,351 --> 00:13:42,887 a particular area 369 00:13:43,278 --> 00:13:45,819 or a particular field, but in a very 370 00:13:45,819 --> 00:13:46,454 limited way. 371 00:13:47,169 --> 00:13:48,757 I think we're at a point now we've 372 00:13:48,757 --> 00:13:51,695 seen so much advancement in technology and our 373 00:13:51,695 --> 00:13:52,465 knowledge that 374 00:13:53,140 --> 00:13:55,765 healthcare leaders need to... From a science standpoint, 375 00:13:56,242 --> 00:13:58,150 be able to integrate the knowledge that we're 376 00:13:58,150 --> 00:14:00,615 developing between different fields, get out of our 377 00:14:00,615 --> 00:14:02,419 silos and be able to integrate 378 00:14:02,858 --> 00:14:05,890 usable solutions for patients. So basically translate our 379 00:14:05,890 --> 00:14:09,002 research to usable results to our patients. And 380 00:14:09,162 --> 00:14:11,095 I think you you all take that same 381 00:14:11,095 --> 00:14:12,534 theme from science and you apply it to 382 00:14:12,534 --> 00:14:14,694 the strategy of the business of running a 383 00:14:14,694 --> 00:14:16,054 hospital in a healthcare care system, 384 00:14:17,495 --> 00:14:20,570 patients need integrated care plans. And 385 00:14:21,429 --> 00:14:24,149 this also solves a second problem, which is 386 00:14:24,149 --> 00:14:26,470 to do things in a sustainable way. We 387 00:14:26,470 --> 00:14:29,049 need to have high value, high quality 388 00:14:29,364 --> 00:14:32,787 care plans and care programs for patients that 389 00:14:32,787 --> 00:14:33,685 can address 390 00:14:34,538 --> 00:14:37,188 a number of different patient populations 391 00:14:37,499 --> 00:14:38,928 And I think that if we do that, 392 00:14:39,167 --> 00:14:40,914 we'll be able to be able to to 393 00:14:40,914 --> 00:14:41,414 deliver 394 00:14:41,947 --> 00:14:44,410 these really complex care solutions and plans in 395 00:14:44,410 --> 00:14:47,031 a sustainable way rather than in a competitive 396 00:14:47,031 --> 00:14:49,857 or 1 off way that isn't very sustainable 397 00:14:49,995 --> 00:14:52,706 or really in the interest of program billing 398 00:14:52,706 --> 00:14:55,178 in collaboration, which is what our parent patients 399 00:14:55,178 --> 00:14:55,657 demand of us. 400 00:14:57,186 --> 00:14:59,498 Doctor Thank Being so generous through time and 401 00:14:59,498 --> 00:15:01,731 insights today. We absolutely cannot wait to share 402 00:15:01,731 --> 00:15:03,086 them with our audience, and we look forward 403 00:15:03,086 --> 00:15:04,442 to connecting with you again soon. 404 00:15:05,335 --> 00:15:07,335 Alright. Thank you so much. Appreciate it.