Jessica J. Kandel, MD
Mary Campau Ryerson Professor of Surgery
Surgeon-in-Chief, The University of Chicago Medicine Comer Children’s Hospital
Chief, Section of Pediatric Surgery
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Jessica J. Kandel, MD
Clinic for Pediatric Vascular Anomalies Navigates an Anomalous Year
Earlier this summer, Jessica J. Kandel, MD, Mary Campau Ryerson Professor of Surgery and Chief of the Section of Pediatric Surgery, was on a Zoom follow-up video visit. Her seven-year-old patient was with his family, vacationing on a boat on a lake in a nearby state.
Only a few weeks earlier, the patient had been on the operating room table, where Dr. Kandel and her team were treating him for a lymphatic malformation that had been misdiagnosed as a tumor. However, as his parents engaged in the Zoom call, the patient ran around and jumped straight into the lake.
He’s not the only one of Dr. Kandel’s patients whose natural exuberance returned after surgery; a four-year-old patient, bubbling with the natural energy of a prekindergartener, could not stand still during his follow-up video call.
“COVID-19 actually pushed our multidisciplinary clinic to be more seamless for the patients,” Dr. Kandel said. “Before telemedicine, it was hard to get all of the specialists into one room at the same time. Now, doing things virtually has opened the doors for our patients to be seen in a more convenient and streamlined way.”
Dr. Kandel is talking about the multidisciplinary Clinic for Pediatric Vascular Anomalies, where she sees patients alongside other pediatric specialists, including surgeons, cardiologists, hematologist-oncologists, dermatologists and others. Telemedicine has allowed the team to be a “one-stop shop” for patients—some of whom come from hundreds of miles away for treatment.
“COVID-19 actually pushed our multidisciplinary clinic to be more seamless for the patients.”
Jessica J. Kandel, MD
Mary Campau Ryerson Professor of Surgery and Chief of the Section of Pediatric Surgery
Calling out a silent threat
One area of focus is lymphatic malformations in children, which in some cases can be clinically silent until lymphatic flow increases, causing previously undetected balloon-like lesions to expand. Children with this malformation in the abdomen may appear to be asymptomatic, but may have potbellies—an indication of the fluid-filled masses that may have formed near their gut during early development.
Many of these patients are diagnosed initially with tumors and referred to hematology-oncology; only with the collaboration of pediatric radiologists and other physicians are they finally diagnosed with vascular anomalies. When they are diagnosed, they are almost always sent to see Dr. Kandel, a world-renowned expert in the field.
“If you are not familiar with these rare conditions, it’s hard to know what you are looking at,” she explained. When performing surgery, Dr. Kandel uses a minimally invasive approach with telescopes to remove 90 percent of the “balloon” wall while carefully protecting the critical blood vessels and nerves at the root of the gut, with the goal of preventing the lymphatic masses from returning again. She then follows her patients through adolescence to ensure that their condition does not cause problems again.
Separation anxiety: No small factor
While adults might be apprehensive about undergoing an operation like this, children’s fears are a little more unique. Dr. Kandel explained that children are most afraid of being separated from their parents, so she and her teammates connect child-life therapists to families of patients. They ensure that parents can say good-bye to their children at the last possible moment before the operation, so their experience of separation is very short.
Pediatric anesthesiologists on the team work to ensure that patients emerge as pain free as possible and allow parents to be at the bedside when their children wake up.
Replicating what works
Due to the success of our multidisciplinary pediatric vascular anomalies clinic, the Department of Surgery is building a similarly diverse clinic for chest wall reconstruction patients. Adult and pediatric surgeons who specialize in this condition have begun working together with colleagues from multiple disciplines across the University of Chicago Medicine to address this complex structural malformation so that patients and families feel supported holistically.
Such efforts “highlight the importance of building destination clinics for kids who have rare diagnoses, which can be hard for many practitioners to recognize,” said Dr. Kandel.
Professor of Surgery
Jessica J. Kandel, MD, Mary Campau Ryerson Professor of Surgery; Surgeon-in-Chief, The University of Chicago Medicine Comer Children’s Hospital; Chief, Section of Pediatric Surgery
Thomas K. Lee, MD, Professor of Surgery
Associate Professor of Surgery
Grace Mak, MD, Associate Professor of Surgery and Pediatrics; Program Director, Pediatric Surgery Fellowship; Medical Director, Comer Children’s Hospital Operating Rooms
Mark Slidell, MD, MPH, Associate Professor of Surgery; Director, Pediatric Trauma
Assistant Professor of Surgery
Nikunj K. Chokshi, MD, Assistant Professor of Surgery; Director, Surgical Critical Care Fellowship
Brian Jones, MD, Assistant Professor of Surgery
Deborah Loeff, MD, Assistant Professor of Surgery
Manish Raiji, MD, Assistant Professor of Surgery
Carmelle Romain, MD, Assistant Professor of Surgery
Kathryn Rowland, MD, MPHS, Assistant Professor of Surgery
Bethany Slater, MD, Assistant Professor of Surgery
Clinical Associate of Surgery
Arnold G. Coran, MD, Clinical Associate of Surgery
Research Assistant Professor
Sonia Hernandez, PhD, RD, Research Assistant Professor of Surgery
Jessica J. Kandel, MD, was invited to be the Byah Thomason Doxey–Sanford Doxey Distinguished Visiting Professor at the University of North Carolina School of Medicine. She was named the 2019 Northwestern University Women Faculty Organization’s 2019 Visiting Scholar. She was named a 2020 Top Doctor by Chicago magazine.
Deborah Loeff, MD, was a Fellow in the MacLean Center for Clinical Medical Ethics. She was named Director of Children’s Surgical Ethics in the Section of Pediatric Surgery and Chair of the American Pediatric Surgical Ethics Committee.
Carmelle Romain, MD, was nominated to the Leadership and Faculty Development Institute of the Society of Black Academic Surgeons.
Bethany Slater, MD, was appointed Site Program Director for the General Surgery Residency at Advocate Lutheran General Hospital.
Mark Slidell, MD, MPH, was elected to the Biological Sciences Division Faculty Advisory Committee (Clinical and Translational slate). He was appointed to the Research Committee and Publications Committee of the Pediatric Trauma Society.
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Rao A, Wagner ES, Wieck MM, et al. An Unusual Lung Mass of Heterotopic Pancreatic Tissue in a Neonate With an Elevated Immunoreactive Trypsinogen on Newborn Screen. Pediatr Dev Pathol. 2020; 23(2):163-166. doi: 10.1177/1093526619876820.
Slater BJ, Borobia P, Lovvorn HN, et al. Use of Magnets as a Minimally Invasive Approach for Anastomosis in Esophageal Atresia: Long-Term Outcomes. J Laparoendosc Adv Surg Tech A. 2019; 29(10):1202-1206. doi: 10.1089/lap.2019.0199.
Slater BJ, Pimpalwar A. Abdominal Wall Defects. Neoreviews. 2020; 21(6):e383-e391. doi: 10.1542/neo.21-6-e383.
Slater BJ, Vogel AM. The economics of a pediatric surgical ICU. Curr Opin Pediatr. 2020; 32(3):424-427. doi: 10.1097/MOP.0000000000000893.
Slidell MB, Kandel JJ, Prachand V, et al. Pediatric Modification of the Medically Necessary, Time-Sensitive Scoring System for Operating Room Procedure Prioritization During the COVID-19 Pandemic. J Am Coll Surg. 2020; 231(2):205-215. doi: 10.1016/j.jamcollsurg.2020.05.015.
Wieck MM, Kandel JJ, Mak GZ. Fighting the Moral Distress of Idleness [published online ahead of print, 2020 Jun 8]. J Surg Res. 2020; 254:348-349. doi: 10.1016/j.jss.2020.05.054.
Yan DH, Slidell MB, McQueen A. Using rapid cycle deliberate practice to improve primary and secondary survey in pediatric trauma. BMC Med Educ. 2020; 20(1):131. Published 2020 Apr 28. doi: 10.1186/s12909-020-02038-z.
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