The innovation of success: the pediatric surgery and APSA response to “disruptive technologies”

In 1907, just more than 100 years ago, a landmark paperdescribed the work of French surgeon Pierre Fredet as hedefined the operation for hypertrophic pyloric stenosis [1],atechnique that has firmly withstood the test of time inproviding an optimal outcome for these patients. It was aremarkable innovation at that time, “a new intervention, notyet accepted as meeting the standards of safety, reliabilityand familiarity with its effects, side effects and complica-tions” [2]. In fact, it could more explicitly have been labeledas a “disruptive technology” or “revolutionary technology,”that introduced into our operative care paradigm a newstrategy or technique that revolutionized the care of childrenwith pyloric stenosis that subsequently has been sustained asthe treatment choice for a century [3].American pediatric surgery was born less than 20 yearsthereafter with William Ladd in Boston, Herbert Coe inSeattle, and Oswald Wyatt in Minneapolis, all nearlysimultaneously confining their practice exclusively to thesurgical care of children. “Organized” American pediatricsurgery took its origin soon thereafter with the developmentof the Surgical Section, American Academy of Pediatrics(AAP, 1948), the Advisory Council for Pediatric Surgery ofthe American College of Surgeons (ACS, 1969), theAmerican Pediatric Surgical Association (APSA, 1970),the Association of Training Program Directors in PediatricSurgery (ATPDPS) (1989), and the Pediatric Surgery Boardof the American Board of Surgery (PSB/ABS) (2000).Equally critical milestones along the way were the initiationof the Journal of Pediatric Surgery (1966) and theawarding of a Certificate of Added Qualification forPediatric Surgery from the American Board of Surgery(1975). These advances and the development of a field ofsurgical specialization within the aggregate of Americanmedicine have now culminated in a pediatric surgical visionfor the future. In 2006 to 2007, a strategic planning processoccurred at APSA; in 2007 to 2008, a strategic planningprocess occurred for the Surgical Section, and at thismeeting there has been an inaugural meeting of a “PediatricSurgery Council” that will attempt to bridge these disparategroups and align them into a congruent voice for thepediatric surgical care of children.The theme for this 39th meeting of APSA is “innovation”anditisappropriatethatweareonthecycletoconcomitantlyhost our International Society of Pediatric Oncologycolleagues. Innovation, “a new idea or device” [4], “achange that creates a new dimension in performance” [5],isnever a static phenomenon but rather it must become aninculcated cultural aspect of APSA as well as of our entirefield of pediatric surgery. It is my contention expressed as achallenge to myself, as well as to you my colleagues, that wemust continually “innovate our field”—our clinical caremission, our educational paradigm, our research and newdiscovery, and our advocacy responsibility for ourselves andthe children and their families who receive our care.Innovation could be as simple and as elegant as an operativeprocedure such as the pyloromyotomy described by Fredetthat has withstood 100 years of repeated testing, or it mightcomeasamuchmorecomplexsocialresponsetoachallengein the field of education, research, advocacy, or administra-tion. A common goal of pediatric surgeons and theprofession of pediatric surgery ought to be one of thetransformations of pediatric surgery, a change from a “verygood” field of professional endeavor to one of unbridled“greatness.” Our challenge is that such a transformationcannot be done in a static environment. Rather, we arecontinually confronted by a series of “disruptive” or