First-Person Perspective

20 Years in Fetal Surgery

Laurie Scudder, DNP, NP; N. Scott Adzick, MD


June 20, 2015

Editorial Collaboration

Medscape &

Research is a critical part of what I do, and research is essential to what I have accomplished in helping develop fetal surgery, with grant support from the National Institutes of Health (NIH) for 30 years. I view myself as a surgical scientist, and frankly, there aren't many surgical scientists around. Nobel Prize laureate Dr Joseph Murray, the kidney transplant pioneer, taught me that "surgeons can be scientists but scientists can't be surgeons!"

Another big influence on me in medical school was Dr Francis D. Moore, an iconic giant in surgery who served as chief of surgery at the Peter Bent Brigham Hospital [which later merged with two other Boston teaching hospitals to become Brigham and Women's Hospital] for three decades, beginning in 1948. He taught me that there was a natural tension between clinical surgeons who do a lot of operations and those surgeons who want to do science to help overcome some of the unsolved problems. I have carried a quote from him in my wallet for years, and eventually I had a laminated card with the text made for my research and clinical pediatric surgery fellows. In his presidential address[1] to the Society of University Surgeons in 1958, Dr Moore said:

The surgical investigator must be a bridge tender, channeling knowledge from basic science to the patient's bedside and back again. He traces his origin from both sides of the bridge. He is just a bastard, and is called this by everybody. Those at one end of the bridge say that he is not a very good scientist, and those at the other say he does not perform enough operations. It is much harder to stay in the middle of the bridge than it is to retreat to one end or the other, but all of the fundamental advances in surgery from Vesalius to Halsted to Cushing have been made by those willing to maintain this uncomfortable posture, the bridge tender.

Medscape: What has surprised you most as your field has evolved? Has it been that difficulty in staying in the middle of the research vs the clinical spectrum?

Dr Adzick: It is very difficult to maintain that "uncomfortable posture" of the bridge tender. When I am asked what I aspire to do in the future, I say three things: cure, educate, and discover. It is very difficult to do clinical surgery and also do research, whether it is basic research or clinical research. The fact that it is almost impossible to do this may surprise some people. For me, I guess it's no surprise because I have lived it. It may be nearly impossible to do, but it is also incredibly important to do, because clinical advances spring from translational research.

When I was a general surgery resident at the Massachusetts General Hospital, I was set on doing a 2-year research fellowship with Dr Folkman at Boston Children's Hospital. Then I learned that a young pediatric surgeon named Dr Michael Harrison, at the University of California, San Francisco, wanted to repair life-threatening defects before birth and I instantly knew that that needed to be done. So with Dr Folkman's blessing and encouragement, and after I received some grant support from the NIH and the American College of Surgeons, I set out more than 30 years ago to do a 2-year research fellowship with my mentor and then pediatric surgery partner, Mike Harrison. Mike is a very creative surgical scientist. At that time, maternal-fetal ultrasound was being refined, and for the first time we were diagnosing birth defects in utero. As pediatric surgeons, Dr Harrison and I were frustrated by taking care of babies with life-threatening malformations causing such progressive and severe organ damage before birth that the babies didn't survive. These were fetuses with such problems as a huge congenital cystic adenomatoid malformation of the lung, lower urinary tract obstruction, congenital diaphragmatic hernia, very large sacrococcygeal teratoma, twin-to-twin transfusion syndrome, and so forth. Later we laid the groundwork for fetal surgery for spina bifida.


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