Expert Voices: HCA Healthcare physician pioneers minimally invasive pediatric surgery techniques

Physicians have always been at the heart of HCA Healthcare – two of our three founders were physicians. In a new blog series, HCA Healthcare Expert Voices, we celebrate exemplary physicians across our organization who are championing the practice of medicine for a healthier world. Follow along as we introduce you to HCA Healthcare’s expert physicians who are breaking barriers and pioneering new care strategies to meet the unique, complex and critical needs of our patients.

Dr. Steven Rothenberg, Chief of Pediatric Surgery
Rocky Mountain Hospital for Children (Denver, Colorado)

From an early age, Dr. Steven Rothenberg knew he wanted to become a physician. His childhood was filled with intrigue about the human body and he was captivated by the idea of helping to heal the sick. His yearning to heal the sick with great skill and compassion set in motion a storied career in medicine for the now world-renowned physician.

Despite initially envisioning a career in cardiac surgery, his trajectory shifted during a pediatric surgery rotation where he discovered his calling. “Operating on the tiniest premature babies to the older kids and teenagers, I fell in love with the intricacies of this type of surgery and the kids themselves,” shared Dr. Rothenberg, chief of pediatric surgery at Rocky Mountain Hospital for Children.

At the beginning of his career, the landscape of pediatric surgery was vastly different than it is today. Traditional methods for life-saving pediatric surgery often involved large incisions, leading to prolonged recovery times for infants and small children. Yet, Dr. Rothenberg saw an opportunity to challenge the status quo and explore endoscopic and minimally invasive pediatric surgery techniques to help improve patient outcomes.

Today, Dr. Rothenberg’s dedication to developing and refining minimally invasive procedures tailored specifically for pediatric patients is making a difference. He was at the forefront of many groundbreaking surgeries, performing the first thoracoscopic repair of a tracheo-esophageal atresia in a neonate, the first thoracoscopic lobectomy in a child in the world and the first Duodenal atresia repair in an infant in the United States.

Dr. Rothenberg’s work hasn’t stopped there. Over the past three decades, he has executed more than 100 workshops and training programs to educate current practicing physicians on the techniques he has developed, in addition to training the next generation of pediatric surgeons.

Dr. Rothenberg is one of the founding members of the International Pediatric Endosurgical Group (IPEG), an organization that leads the charge in creativity, innovation and advances in minimally invasive surgery for children.

In 2015, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) honored him for his work in the field of medicine as the “SAGES Pioneer in Surgical Endoscopy.” The accolade is given periodically to a physician whose efforts have substantively changed and improved the field of endoscopy.

Under Dr. Rothenberg’s leadership, Rocky Mountain Hospital for Children became HCA Healthcare’s first children’s hospital to be verified as a Level 1 Children’s Surgery Center by the American College of Surgeons Children’s Surgery Verification Quality Improvement Program (ACS CSV).

“My Rocky Mountain Hospital for Children colleagues and I have been caring for some of the most difficult and complex cases in the region and, in some instances, the world,” Dr. Rothenberg explained. “I am incredibly proud of the efforts that went into receiving this formal verification, and more so for the work that has been ongoing at our hospital for decades that has changed the lives of thousands of children in our care.”

To explore Dr. Rothenberg’s area of expertise further, we sat down with him to learn about a surgical technique he developed for esophageal atresia.

What is esophageal atresia?

Esophageal atresia is a birth defect that affects about 1 in 5,000 babies born in the United States where a part of their esophagus, the tube that carries food from the mouth and into the body, does not develop properly. This development is supposed to take place inside the embryo when the esophagus and the trachea, also known as our airway, start as a common channel before they divide into separate channels. It often occurs with other birth defects but can present on its own.

There are four types of esophageal atresia: Type A, Type B, Type C and Type D.

• Type A is when the upper and lower parts of the esophagus do not connect and have closed ends. In this type, no parts of the esophagus attach to the trachea.
• Type B is very rare. In this type, the upper part of the esophagus is attached to the trachea, but the lower part of the esophagus has a closed end.
• Type C is the most common type. In this type, the upper part of the esophagus is attached to the trachea.
• Type D is the rarest and most severe. In this type, the upper and lower parts of the esophagus are not connected to each other, but each is connected separately to the trachea.

How is esophageal atresia diagnosed, treated and managed?

Improvements in maternal-fetal ultrasounds are now resulting in the prenatal diagnosis of esophageal atresia in a number of cases. Specialists can recognize this birth defect this way because it will show the fetus actively swallowing, but there will not be a stomach bubble present.

If a baby has esophageal atresia and is not diagnosed during pregnancy, the care team will likely recognize the signs soon after the baby is born and perform a test to confirm. As soon as there is a diagnosis, surgeons like Dr. Rothenberg can begin to craft a surgical plan.

“The technique I developed nearly 25 years ago allows physicians to treat esophageal atresia minimally invasively,” Dr. Rothenberg explained. “During the surgery, I make a number of tiny incisions instead of one large, open incision. I will then go in with a small telescope hooked up to a camera and a small instrument that we use in minimally invasive surgery to separate the esophagus and trachea.”

At Rocky Mountain Hospital for Children, Dr. Rothenberg says he is “very fortunate to have a great team of nurses, scrub techs and anesthesiologists, who are all focused on performing these procedures minimally invasively to improve outcomes, minimize pain and reduce scarring.”

As his patients leave the hospital, they are soon able to eat and breathe properly. Additionally, the unique quarter-inch incisions Dr. Rothenberg creates to perform this surgery nearly disappear with time.

What are your hopes for the future of esophageal atresia treatment?

Dr. Rothenberg has published over 200 papers on minimally invasive surgery, several of which highlight how esophageal atresia can be fixed minimally invasively. His hope for the future is that physicians will move to this method of treatment. “Performing the surgery this way has many benefits,” he shared. “Right now, less than 15% of these procedures are performed minimally invasively in the United States. While that percentage is small, it’s incredible to see the progress that’s been made over the last 25 years.”

For Dr. Rothenberg, it is not only about the future of treating esophageal atresia, but the future this surgery allows these small kids to have. “The parents are incredibly grateful and it’s very gratifying to see them be able to go home and do what we’re supposed to do for our babies, which is hold them, feed them and love them,” he shared. “In fact, I get letters every year from parents of former patients thanking me again for helping their children and showing how their kids are growing up and getting to live normal lives. It’s so very rewarding.”

For his 60th birthday, Dr. Rothenberg received a book of letters written by former patients and their families. His children reached out to his team to obtain letters of gratitude and pictures and heard back from 70 families. The book titled “Thank you, Dr. Rothenberg” tells the stories of healing he has been able to provide patients across decades. “Whenever I have a bad day, I just sit down with the book and open it up because it really is an incredible gift,” he shared. “I was very lucky that my kids did this for me and that all those families chose to respond to share how their kids have grown up and how they were doing today.”