Partners in Solving Surgical Challenges

 Dr. Darren Orbach (M.D. ’98, Ph.D.), left, and Dr. Peter Weinstock (M.D. ’98, Ph.D.)

Ask good friends and colleagues Dr. Darren Orbach (M.D. ’98, Ph.D.) and Dr. Peter Weinstock (M.D. ’98, Ph.D.) what lessons they gleaned from their time in Weill Cornell Medicine’s Tri-Institutional MD-PhD program, and a few common themes emerge: They learned how to be curious, flexible and think outside the box.

Their work together at Boston Children’s Hospital reflects how they’ve used those skills to solve complex surgical challenges.

In April 2023, Dr. Orbach, chief of neurointerventional radiology, and Dr. Weinstock, executive program director of the Immersive Design Systems (IDS) program, collaborated to successfully perform the first ever in-utero fetal intracranial surgery to treat a life-threatening Vein of Galen Malformation (VOGM). The condition occurs when the blood vessel carrying blood from the brain to the heart develops incorrectly and can result in brain injuries and immediate heart failure after birth.

“Usually babies with VOGM are born and get very sick at the NICU,” says Dr. Orbach. “There are physiologic reasons to believe that it is better to treat them in utero and try to avoid them getting sick in the first place, which is why we designed this clinical trial.”

Uniquely housed within a hospital setting, IDS creates innovative models on the spot — speeding solutions directly to patients’ bedsides.

“Our goal is to create the best possible outcomes and the strongest program for patients and their families,” says Dr. Weinstock. “We use simulations to make sure we’re getting it right, and we’re optimizing every step of the process.”

Using models designed by Dr. Weinstock’s IDS team, Dr. Orbach was able to simulate the complex procedure and receive expedited FDA clearance to perform in-utero surgery on Denver Coleman of Baton Rouge, La.

During the VOGM procedure, surgeons need to carefully drill through the fetal skull in-utero, which requires extreme precision and control — best practiced ahead of time in a simulation. For Denver’s surgery, Dr. Weinstock’s team designed a fetal brain phantom, which simulates tissue and vascular targets in the brain, and fetal skull trainers, which model the fetal skull with varying degrees of thickness and hardness. Denver, now 15 months old, is thriving.

“It’s been an incredible joy to work with Darren,” says Dr. Weinstock. “We pinch ourselves that we are here collaborating.”

The VOGM procedure has been performed three times to date, and so far, the “early results [of the clinical trial] look fantastic,” says Dr. Orbach. “I’m very hopeful.”