Fetal surgery is rare, but there are some patients who depend on lifesaving surgery before they are even born. MEDNAX-affiliated physician Corey Iqbal, MD, medical director of pediatric surgery and fetal surgery at Overland Park Regional Medical Center in Kansas, is among a small group of specially trained surgeons who treat certain rare conditions on babies still in the womb.
Twin-to-twin transfusion syndrome is the most frequent illness Dr. Iqbal and his team encounter. This is a disease of the placenta where identical twins receive disproportionate blood flow due to abnormal blood vessels. In roughly half of the cases, the severity of the blood flow will place both twins in danger, with a high risk of death. "In those cases, the benefits of fetal surgery often outweigh the risks," said Dr. Iqbal. Spina bifida is another condition that may benefit from fetal surgery, as well as less common cases such as in utero bladder obstruction or highly vascular tumors of the lung or tailbone that can cause heart failure.
In truth, fetal surgery may not always be the first or most appropriate course of action. Much of Dr. Iqbal's treatment is observation. "The reality is, many conditions are best left alone," he said. But while a mother and baby may never require surgery, fetal surgery programs such as Overland Park Regional Medical Center provide more than just a procedure. They also provide expert knowledge and experience.
"We are growing our program with the hope of becoming a hub for maternal and fetal care," said Dr. Iqbal. The practice focuses on a multidisciplinary approach that specifically seeks to work in tandem with a patient's referring physician.
The complications of being rare
Due to the rarity of fetal surgery, many medical centers are not equipped to handle a case when it arises. "There are not enough patients each year to sustain fetal surgery at most facilities across the country," said Dr. Iqbal. "Even the busiest medical centers may only perform 15 to 20 laser cases a year for twin transfusion." Fetal surgery requires specialized surgical technology and a multi-disciplinary team of maternal and pediatric specialists; resources that may not be realistic for most hospital programs. Moreover, fetal surgery training programs are also limited, which makes it more difficult for clinicians to acquire the skillset necessary for certain fetal surgical procedures. Currently, there is not even a board certification for this specialty.
Dr. Iqbal understands that problem firsthand. After completing his general and pediatric surgery fellowships, he struggled to find a program that would train him in fetal surgery. Few programs existed and most avoided Dr. Iqbal's request to learn because he was already advanced in his training. "I reached out to every who's who. I said: 'Let me come for a year. You don't even have to pay me." Two programs eventually responded, and Dr. Iqbal chose an unpaid fellowship at the University of California, San Francisco, working under Michael Harrison, MD, often called the "father" of fetal surgery.
The power of partnership
Advancements in communication and telemedicine make it possible for any referring physician to benefit from the expertise at Overland Park Regional Medical Center while still remaining the lead physician on a woman's care team. "Since there are not enough cases each year to sustain fetal surgery at facilities across the country, programs such as ours can serve in a support capacity," said Dr. Iqbal.
"Our goal is not to take over a case. Our goal is to provide advice, surgery when needed and keep families together," said Dr. Iqbal. The Overland Park team willingly coordinates with primary doctors for weekly monitoring and consultations, as necessary.
Dr. Iqbal also champions second opinions. "I don't want a family to have to travel for a second opinion. I also don't want them to feel like they cannot ask for another opinion beyond mine," he said. While many of his surgical cases involve a handful of the same conditions - such as twin-to-twin transfusion syndrome - Dr. Iqbal does not hesitate to tap into his own network of colleagues across the country for a condition that is less common. "Parents really appreciate that," he said. "They like to know information is available to them and that their case has been reviewed by internationally recognized experts without them having to travel."
This comfort with cooperation is what drives Dr. Iqbal and his team. "At Overland Park Regional Medical Center, we do more than just market ourselves as a fetal surgery center. We are a fetal surgery resource," said Dr. Iqbal. "I'm always just a phone call away."
About Corey Iqbal, MD
Dr. Iqbal is established as an expert in fetal surgery and prenatal counseling. He is also a respected pediatric surgeon with specific expertise in pediatric robotic surgery, chest wall deformities, and pediatric bioethics.
He earned his undergraduate and medical degrees in the six-year combined BA/MD program at the University of Missouri, Kansas City. He completed his general surgery fellowship at the Mayo School of Graduate Medical Education and his pediatric surgery fellowship at Children's Mercy Hospital in Kansas City. He completed his fetal surgery fellowship at the University of California, San Francisco. He is board certified in pediatric surgery. In addition to clinical practice, Dr. Iqbal is an active speaker and has published more than 65 peer-reviewed publications.