This is Crystal Olson with the Becker Healthcare
care podcast.
Thrilled to be joined by Doctor Joel Lil,
Pediatric and fetal surgeon at Midwest fetal Care
center,
collaboration between Children's, Minnesota and Align of health.
He is head of open fetal surgery at
Children's, Minnesota and at the center.
He's with us today to discuss topics that
include the fetal care center success in treating
My Men or M.
Talk to. Thank you for joining us.
Thanks for having me.
Yes. Wonderful. Joe, what... If you don't mind,
could you please introduce yourself and tell a
bit about your background?
Yeah. So, so I'm Joel Lil.
1 of the pediatric and fetal surgeons at
the Mid midwest fetal care center in Children's
Minnesota and Line of health.
1 of the
privileges that I have is not only taking
care of
kids and operating on kids with surgical needs
after they're born, I get a chance to
meet with moms and families
to address a lot of,
important clinical issues, prior being born, making diagnoses,
care plans and even,
creating interventions,
product kids being born in that sometimes involve
surgeries.
So,
for me, this is what I spend the
bulk of my professional life doing and probably
the thing I'm most excited about.
Thanks for that, Joe. Just to take the
wider view for a second here,
clearly really, someone in your position has a
lot of things on their mind. Some of
which you just laid out. But what would
you say are the biggest issues that you're
following in health for health care rather right
at this moment.
Yeah. So
taking a step back. I mean, the answer
to that question is kind of scale. Right?
So
like, nationally, it's pretty important and obvious to
a lot of people that women's health and
reproductive rights, especially how it affects
our fetal care center
are or are are big and on the
the forefront
for us.
We also think about health care access and
dollars used to subsidize
health insurance plans and their,
continued protection nationally.
And then we also think about payers in
their relationship with hospitals and providers, that dynamic
is changing.
It seems to change
pretty rapidly even in my career. I've seen
substantial changes in that.
Improved access, but it comes with other changes.
And you can think about things that you
really affect our region in our state.
Healthcare care organizations and their collaborations and ability
to recruit talent
to,
sort of build in, a staff
that,
allows them to kind of meet care plans
and patient needs. I think that is becoming
an increasingly
challenging problem in the current economic climate.
And then you know, for our state, we
both have a huge, like,
metropolitan urban population, but we also serve a
substantially,
large,
role
populations. So
we focus on and think about how our
region will address significant budget constraints and how
these
programs that can be built to help our
patients here immediately,
will be able to not only reach the,
sort of the greater metro area, but also,
the rural communities.
You know, in doing so, we have to
build sustainable and meaningful programs that are beneficial
the parents.
And patients and have them be cost effective
and sustainable.
And the other thing that we think about
a lot here, we have a pretty diverse
patient population
And we always... We think about
equity within our health care system. And I
think that that's 1 of the things that,
our region is trying to overcome
the psycho social logistical and financial obstacles of
achieving
excellent health care
that is sustainable
and and highly effective for our patients.
And then I think about, like, things, and
I know that our center talks about this
and many of our providers think about this.
Our role in our center in our hospital,
realizing that
we have a pretty substantial role within the
the region and to be an effective tertiary
quan center that provides
partnerships to
not only our local community, but our region
so that we can, once again, build high
value programs that can only be found at
these centers that can bring a lot of
patients and resources
together to build,
these complex care programs. And so I think,
we're always trying to find creative ways to
build solutions in this space. And I think
that that's probably 1 of our biggest local
challenges you know, to to strategize around those
those
those topics
and move and move our programs forward in
the fetal care center is very much
sort of a an ama of of those
issues.
Thank you for laying out those balances as
for us bill. No doubt a lot of
your peers time relate to those and how
you go about
addressing them, but zooming me a little bit,
the main reason we have you on the
podcast today. Is to discuss the midwestern care
center and all the success we've have in
in M and addressing that. So you understand
you have
the 100
Procedure in March?
If you don't mind, could you please trial
procedure and how it can improve the fe
development?
So many years ago,
researchers at the University of
of, San Francisco
began to ask the question
how can we improve
the life of babies with significant fetal anomalies
diagnosed to that we could make in euro,
and which anomalies would benefit from an
intervention and which would still be benefited by
early,
post care. The idea was is that Sp
is a disease that
became
kind of an important target because it was
a non lethal disorder that affected 1 in
3000 patients, so a pretty significant number of
patients
worldwide in particular in North America,
and,
these patients in general are all going to
be born but formed with substantial deficits
when you think about the procedure, you sort
of have to figure
and and and why we do a fetal
intervention, you have to figure... You have to
understand the disease a little bit. The disease
itself affects the brain by creating swelling and
blockages in the brain
because of loss of cerebral spinal fluid out
the back.
Where the defect is seen. It causes hernia
of,
important contents of the brain that can compress
on critical centers of the brain.
The defect itself in spin of if is
a lack of,
proper covering of the neural elements, the spinal
cord to the nerves of the back.
And
that creates also nerve injury to all the
levels of the nerves affected at the level,
the defect and below. So if you have
at a defect in the, lower back, which
is the most common to see this, you
can have substantial deficits
and dysfunction with bowel bladder function
and lower extremity, motor and sensory function where
many of these kids, the majority of these
kits are
wheelchair bound in their,
pre teen and in teen years,
we requiring
substantial medical intervention for bound bladder programs,
and needing multiple neurosurgery and orthopedic surgeries
to help
maintain
the best quality of life for these patients.
So what we found is in,
the early research that if we could
close the back of these babies, much like
we do after they're born,
we can,
improve the disease project... Trajectory or the disease
path for these patients.
And the reason being is that not only
do you
stop that leakage of cerebral spinal fluid as
it leaks out the back, but You also
protect the neural elements from,
being,
injured by the am antibiotic fluid that does
pretty toxic to
developing nerves.
So if we
create a,
a closure technique, a water closure technique to
those neuro elements,
between 23 and 26 weeks, what we see
is a significant improvement
in the disease
progression of these kids. It doesn't cure the
disease, but it greatly am the disease.
So the surgery is done
now a couple different ways.
Initially, it was done through,
like, a lower abdominal typical c section incision
where we would open up the abdomen a
bomb
and expose the uterus and find a place
on the uterus a safe distance away from
the placenta
and create about a 6 to 8 centimeter
opening in the uterus to expose the back
of the baby and then in multiple layers,
close the back of the baby, then close
the uterus, close moms
abdominal wall and let the baby
continue ge dating for another
10 to 13 weeks.
We've since advanced our approach
and
begun doing things through a minimally invasive approach
or ph approach where we can do all
the same exact closure techniques, but through small
little 5 millimeter incision, 3 of them, through
the uterus.
That ema a lot of the morbidity and
potential morbidity for mom
in future pregnancies
and allows for moms to continue on their
pregnancy and have at vaginal delivery whereas the
open
incision on the uterus means that mom needs
to have a a future C section,
and all future pregnancies need a c section.
And when we do this, we know is
a population of patients,
we take and we improve their shu rates
the need for draining that fluid from the
brain,
we reduce it substantially.
And sometimes as much as 4 fold reduction
in shu rates. We can
improve dramatically the high brain hernia rate. We
improve neuro scores or Iq scores and functioning
we have substantial improvements in bladder program,
or bladder function.
And then we have... We doubled the number
of una
una
in this patient population. So we were taking
kids that would otherwise be severely affected needing
assisted in their ambition, whether it's crutches or
thought braces, where been wheelchairs, and we're doubling
the number of kids
who don't require any assistance in.
So we're improving their life significantly.
So that's that's the reason why we do
it, that's kinda how we do it.
And we're always looking as a as a
as a field to improve
not only the procedure decreasing the the risk
to mom and baby, but to also improve
our outcomes.
Wow, doctor. This is just incredible that this
procedure even exists really that you're able to
improve children's lives in such a way before
they born.
Right looking ahead,
now that you've seen that this procedure is
successful
what do you think might be the next
evolution of treatment in this area?
Well, for Spine, in particular,
I think that
understanding the path physiology or how spin
develops,
being able to prevent it or treated even
earlier so that we can have improved outcomes.
And treatment earlier, I think may involve non
surgical means for treatment or even more minimally
invasive means for treatment.
And I think this is a hugely interesting
topic thinking about providing coverage to those neural
elements through
cell based therapy approach that could be delivered
with just a simple needle,
instead of needing a more complex surgery, or
thinking about how to,
prevent
the molecular mechanisms that lead to
the
the spin of bi defect itself. So I
think that's the future for this. But I
think in general,
being able to do fetal surgery for by
open the door
to fetal surgery in general, being able to
teach us how to not only perform the
surgery as a field
but also expand the number of
potential diseases and targets that would benefit from
fetal surgery.
So now we do fetal surgery
for other indications, sometimes,
very large and impactful tumors that would be
otherwise fatal for the fe us.
We do fetal interventions for, a number of
other
indications such as twin pregnancies that,
have un unbalanced sharing of blood,
So there's a number of other indications that
have really grown out of this, early fetal
surgical experience. And I hope to in the
future that we're able to target more fetal
anomalies
so that we can improve outcomes for patients
and families, but also reduce the burden of
health care costs within the system.
Here's hoping a lot of those treatments that
you mentioned, Doctor are going to arrive sooner
rather of than later although See there's a
lot of research and work to be done
before that happens. Lastly, I simply wanna ask
you as someone who is a leader in
health
What do you think leaders needs to be
successful in the field in the next 2
to 3 years?
Yeah. I so, you know, I think about
how even
25 years ago, when when I thought about
science and medicine,
a lot of work was happening
still in silos and
people competed with programs,
and they looked at how they could advance
a particular area
or a particular field, but in a very
limited way.
I think we're at a point now we've
seen so much advancement in technology and our
knowledge that
healthcare leaders need to... From a science standpoint,
be able to integrate the knowledge that we're
developing between different fields, get out of our
silos and be able to integrate
usable solutions for patients. So basically translate our
research to usable results to our patients. And
I think you you all take that same
theme from science and you apply it to
the strategy of the business of running a
hospital in a healthcare care system,
patients need integrated care plans. And
this also solves a second problem, which is
to do things in a sustainable way. We
need to have high value, high quality
care plans and care programs for patients that
can address
a number of different patient populations
And I think that if we do that,
we'll be able to be able to to
deliver
these really complex care solutions and plans in
a sustainable way rather than in a competitive
or 1 off way that isn't very sustainable
or really in the interest of program billing
in collaboration, which is what our parent patients
demand of us.
Doctor Thank Being so generous through time and
insights today. We absolutely cannot wait to share
them with our audience, and we look forward
to connecting with you again soon.
Alright. Thank you so much. Appreciate it.