Groundbreaking 3-D Imaging and Pain Control Innovations Help Math Whiz Recover Quickly

William Lang, 16, loves math. He loves math so much that he woke up from his surgery at Lucile Packard Children’s Hospital Stanford reciting the quadratic formula—a formula all algebra students learn but few remember.

“They were the first words out of his mouth,” says William’s mom, Ann Marie Lang. “Dr. Chao said she didn’t quite remember the formula, but it sounded like he got it right.”

William and Stephanie Chao, MD, a pediatric general surgeon with Packard Children’s, share strong analytical minds. Dr. Chao and a multidisciplinary team of specialists are working on less invasive ways to conduct diagnostic imaging for their chest wall patients during their initial evaluation and better options for pain control after surgery.

Instead of CT scans to evaluate the chest contour—which mean radiation—the Chest Wall Program is piloting the use of a light scanner to print out 3-D images of their patients’ chests. Instead of an epidural spinal block, the Stanford University Pediatric Perioperative Pain & Regional Anesthesia (SUPRA) team—a specially trained team of anesthesiologists—uses a regional block to control pain. William and Ann Marie were thrilled to be on the receiving end of these novel innovations that are the first of their kind in the country, and perhaps the world.

“We are likely the only children’s hospital in the nation routinely using 3-D scanning for patients with chest wall malformations. We wanted to better assess our patients, so we came up with the idea and conducted a study right here in the Chest Wall Program,” says Dr. Chao.

William came to the program in 2017 seeking help for pectus excavatum, or sunken chest. It was something he had had since he was little, but he and his parents hoped it would go away as he grew older. William avoided sports where he had to take off his shirt and disliked changing in locker rooms.

“I thought if I exercised, I could make my chest bigger and it would go away. But it got worse,” says William.

Accelerated growth at puberty often accentuates the depression. Sometimes, it seems like it shows up overnight.

“Patients with chest wall malformations often deal with pain, social isolation or physical limitation for a long time. The goal of our Chest Wall Program at Packard Children’s is to improve each step of the process, from diagnosis to healing, and help patients move past their malformation with as little impact to their lives as possible,” Dr. Chao says.

In December 2017, William underwent a surgical treatment called the Nuss procedure where Dr. Chao inserted a metal support bar underneath his sternum to reverse the depression in his chest. The bar pushes up the sternum and expands the chest cavity.

“The results are immediate, but the pain is significant at first,” Dr. Chao says. “It almost feels like you are breaking a bone. The sternum has spent years growing downward, and within an hour you make it move in the opposite direction.”

The Chest Wall Program’s approach is to be as noninvasive as possible. Their goal is to minimize impacts on the child, which means using the lowest amount of radiation possible, controlling pain and reducing the length of hospital stay after surgery. From this philosophy, unique care practices were born.

“One of the practices that distinguish us is pain control,” Dr. Chao says. “With traditional spinal epidurals, kids stay in the hospital almost a week. Instead of this somewhat risky practice, we use a technique called erector spinae plane (ESP) block where the SUPRA team inserts catheters in nearby spinal muscles to continuously infuse local anesthesia, rather than inserting catheters next to the spinal cord as with spinal epidurals. It’s safer and more effective.”

With ESP blocks, patients often go home a day or two after surgery. William went home on day two and was able to walk out of the hospital. He felt discomfort for a few weeks, and then mostly nothing.

“Our team is the first to demonstrate that the ESP block can provide excellent pain relief and facilitate discharge readiness for patients with pectus excavatum undergoing the Nuss procedure,” says Chi-Ho Tsui, MD, the head of the SUPRA team and part of a team of doctors who published their successes in the World Journal of Surgery.

Ann Marie greatly appreciated the safer and more effective pain control method and the attentive follow-up care of the SUPRA team. She also was thrilled with the 3-D light scanner versus the cost of a CT scan and the added radiation.

“The new pain control technology really allowed William to bounce back quickly. He liked how the team mixed up a cocktail just for him in the recovery room. We were very impressed,” Ann Marie says. “We also loved the 3-D images and seeing the before and after pictures. We didn’t realize how deep the indent was before seeing the two side by side.”

Chao and her colleagues were pleased with the results of their 3-D optical imaging study, which was recently published in a medical journal. They determined that they could achieve nearly the same results with a light scanner as with a CT scan, with a small margin of error.

“My hope is insurance companies will approve it as an imaging option,” Dr. Chao says. “If they do, other children’s hospitals will likely follow suit. It’s simply a better option for kids.”

With the Nuss procedure, the metal bar is typically left in place for two to four years. William will get his out in 2020. He handled the surgery with grace and a positive attitude.

“I went in with a strange-looking chest and came out looking like a normal guy,” William says. “It gave me confidence. Now, when I work out in the school gym or play basketball, I have no problem taking my shirt off.”

A junior in high school, William is described by his classmates as someone who is super-smart and will do great things in the future. He currently attends Choate Rosemary Hall, a top-10 prep school in Connecticut. This summer, he’s away from his Santa Cruz home attending a math class at Harvard University as part of their precollege program for aspiring youth.

“I plan to be a math teacher when I’m older,” he says.

It’s likely that he’ll teach his students the quadratic formula—and much more.

To learn more about our Chest Wall program visit chestwall.stanfordchildrens.org