Packard surgeon helps Vietnamese counterparts keep up with latest techniques

Erin Digitale

Pediatric surgeon Tran Thanh Tri (left) recently visited Packard Children’s surgeon Marilyn Butler from Vietnam to learn minimally-invasive surgical techniques pioneered here.

Courtesy of Marilyn Butler

Butler (right) performs a laparoscopic operation with a surgical team at Children’s Hospital #2 in Ho Chi Minh City, Vietnam, during one of her visits.

An international collaboration between Lucile Packard Children's Hospital and a surgical team from Vietnam is helping equalize the care offered to children in different parts of the world.

Kids who receive surgery at Packard Children's—from hernia repairs to organ transplants—get the benefit of brand-new operating rooms and the latest surgical procedures and tools. But on three recent trips to operate in Vietnam, Packard pediatric general surgeon Marilyn Butler, MD, saw patients who were not so lucky.

"The surgeons I work with in Vietnam have adequate technology to do what they need to do, and excellent skills," said Butler, who is also a clinical associate professor of surgery at Stanford's School of Medicine. Yet it's challenging for her Vietnamese counterparts to keep up with techniques and instruments being invented half a world away. That's why Butler recently hosted pediatric surgeon Tran Thanh Tri, MD, for a three-week visit to Packard Children's. Tri works at Ho Chi Minh City's Children's Hospital #2, a 1,000-bed facility that cares for kids from all over Vietnam. Butler has performed surgeries there on her visits overseas.

"We're trying to build capacity within the system they have in Vietnam," Butler said. She aimed to give Tri a mix of inspiring and practical ideas during his observational visit to Packard. "Some procedures, he can take home and do now, and some are things to do in the future."

During an April 15 interview at Butler's office, Tri was enthusiastic about everything he had seen.

"I'm learning a lot," he said. "I can observe how they prep the patient, organize the operating room, discuss cases and treat patients. A lot of things are different from Vietnam—there are many very high-tech machines and a lot of disposable things." Tri was especially intrigued by the harmonic scalpel, a surgical tool that uses sound waves to simultaneously cut and cauterize tissue. The instrument makes surgery faster and easier, but costs more than his hospital can currently afford.

Among the procedures Tri plans to bring back to Vietnam right away are several of the minimally-invasive methods Packard surgeons have developed. For dermoid cysts that appear as lumps under the eyebrow, Tri explained how he had watched Butler make a small cut above a patient's hairline, then burrow under the forehead skin to remove the extra tissue. "We can do it without a scar," he said, sounding pleased to have learned the new technique.

Butler is learning from the collaboration between Vietnam and California, too. She's getting ideas for how to make surgical innovation affordable everywhere. "We throw a lot away," she said. Non-disposable versions of tools, such as surgical staplers or bags for retrieving excised tissue, would be a good way to cut costs, she said.

Butler is also developing a Web site, the Global Paediatric Surgery Network, that will function as an information clearinghouse for pediatric surgeons from around the world. For those who want to volunteer in developing countries, the site will give information on where to go, whom to contact and what skills or techniques are in demand. For surgeons like Tri, the site will provide connections to international colleagues and links to resources such as surgery videos, conference proceedings and peer-reviewed scientific literature. She hopes to launch the site in May 2010.

"At Packard and Stanford, we're looking for ways to give back to the global community," Butler said. "We want to raise the quality of medical care worldwide, particularly for children, and we feel a responsibility to train the larger community of pediatric surgeons with our skills."

Butler, who plans to return to Vietnam in October, added that her visits overseas have reminded her that surgeons form their own universal culture. Though the surgeons she works with in Vietnam speak only a little English and Butler knows almost no Vietnamese, they haven't been hobbled by the language barrier.

"Surgery is such a visual thing," she said. "Once we operate, there are not a lot of words needed."