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Tamir Keshen, M.D. — Colossal Results for Tiny Patients
Though developing at a slightly slower pace than its adult counterpart, pediatric minimally invasive surgery (MIS) seems to be in the midst of a rapid evolution thanks, at least in part, to trailblazers such as local pediatric surgeon Tamir Keshen, M.D.
Dr. Keshen, who is Chief of Pediatric Surgery/Director of Pediatric Advanced Minimally Invasive Surgery at Cottage Children’s Hospital, acknowledges that recent developments in appropriately sized instrumentation and minimal-access procedures have effectively changed the paradigm of the practice of pediatric surgery.
“Laparoscopic procedures modified for pediatrics have undoubtedly impacted the outcomes for these small patients in very positive ways,” he says. “In fact, children represent a unique group of patients who benefit tremendously from MIS. In some cases, we’re using incisions, which are as small as
1 millimeter, to access and repair sizeable problems inside the belly and chest. Precision technology and smaller instruments enable us to care for children with extremely complex diseases, yet with minimal trauma. This leads to high cure rates and less suffering — evidenced by diminished postoperative pain, smaller scars, shorter hospital stays, and a faster return to home, school and normal activities. This makes for healthier, happier children and their families, too.”
Dr. Keshen was sought out and specifically recruited by Cottage Children’s Hospital for not only his skills in pediatric MIS, but also his leadership, forward-thinking philosophy and extensive background in medical research.
Prior to his move
to the Tri-Counties,
Dr. Keshen served as assistant professor of surgery and director of pediatric minimally invasive surgery at Washington University School of Medicine in
St. Louis, MO. Board certified in both general surgery and pediatric surgery,
Dr. Keshen primarily practices surgical care for children 0 to 18 years of age and has a particular interest in minimally invasive chest and abdominal procedures to cure disease with the least amount of suffering for children. His work includes neonatal congenital anomalies, soft tissue tumors/oncology, gastroesophageal reflux and pectus excavatum. Dr. Keshen is a recognized researcher and author, and his fund of knowledge contributions have included subjects such as surgical metabolism, surgical treatment of inflammatory bowel disease and adolescent obesity.
One impetus for Dr. Keshen accepting the position at Cottage Children’s Hospital was the relative need for the service he provides in the Tri-Counties and his belief that families should not have to travel to seek subspecialty medical care outside
“Parents of the Central Coast used to feel that the only way to receive some of the types of specialized care for their children required traveling to San Francisco or Los Angeles,”
Dr. Keshen notes. “We live in a progressive, leading-edge medical community dedicated to providing personalized, compassionate care to children and families throughout the Central Coast and inland regions.”
Cottage Children’s Hospital and the other hospitals of Ventura County are widely recognized as regional referral centers for the medical needs of infants, toddlers and children in the area and have earned a reputation for excellence that draws some of the nation’s top pediatric specialists.
“Traveling for care is a hardship under the best of circumstances. When it involves a sick child, it becomes quite complicated and unsettling,” says
Dr. Keshen. “We have the staff, the expertise, the technology and the highly skilled surgeons right here, so our patients and their families can stay close to home. I’m excited and honored to be part of the growth and evolution of Cottage Children’s Hospital — and specifically our work in MIS — as we continue to expand and enhance our program.”
He also points out that he and the pediatric surgical staff are available for the more routine, less urgent procedures.
Surgeons, legend has it, are not typically known for having a great bedside manner, yet this is another area where, according to his patients and their families, Dr. Keshen excels. Part of this certainly may be due to the delicate nature of pediatric medicine.
“It’s a specialty that requires special training in working with parents and families,” Dr. Keshen explains. “You’re not only treating the patient, but his or her parents and family, as well.
“Of course, another important factor is the patient who can be as small as 400 grams or as large as 400 pounds, but even the older children who appear fully grown really are not. Their physical, emotional and social needs are very different from those of adults, and these are factors that affect how they recover from surgery. We have an excellent, empathetic and caring staff specifically trained in the special needs of our young patients,” he says.
Seven-year-old Kai Zukor and his family can attest to the validity of this statement. Scheduled with Dr. Keshen for surgery to correct an umbilical hernia, Kai and his family were invited to tour the hospital and, specifically, the areas where he would be treated.
On the day of the surgery, Kai wanted to bring along his favorite stuffed toy, a zebra (appropriately named “Zebra”), for added comfort. It wasn’t until he and his family were waiting in preop that he noticed the small leg on his toy was torn and hanging limply.
“Dr. Keshen came to talk with us in the preop room,” Kai’s mother, Linn, explains. “He was very calm and not only answered my questions, but also made it a point to engage Kai in conversation, which was really nice.”
It was during this time that Kai mentioned Zebra’s leg was falling off.
“Dr. Keshen immediately offered to take care of it,” says Linn. “I thought that he was just saying that; you know, it was a sweet thing to say. But when he came out after completing Kai’s surgery, he said, ‘Your son is doing great; he’s resting, and the zebra is fine, too.’ He had actually sutured the leg back on! I thought that spoke volumes.”
Fifteen year-old Joshua McElwee and his mother, Mia, have similar sentiments about the surgeon’s skills, as well as his exceptional patient interaction. Dr. Keshen performed pectus excavatum corrective surgery on Joshua using the minimally invasive Nuss procedure.
“As you might imagine, Joshua was very self-conscious of his appearance,” explains Mia. “Dr. Keshen came highly recommended as an outstanding surgeon who uses the most cutting-edge methods, but what was such a pleasant plus was how great he was interacting with my son. He seemed to know just how Joshua was feeling and talked to him — not at him or over him. The surgery went perfectly, and Joshua is healing nicely. It’s like he is a new kid.”
Dr. Keshen says that he knew what he wanted to do from the time he was just about Joshua’s age.
“I’ve always loved children and was mesmerized by my high school classes in anatomy and physiology,” he says. “It just seemed to make sense that pediatric surgery would be the choice for me.”
After attending the University of Virginia, Dr. Keshen attended New York Medical College and completed his postgraduate work at the University of Iowa Hospitals and Clinics in Iowa, where he performed his residency in general surgery. He then went on to Baylor College of Medicine, USDA/ARS Children’s Nutrition Research Center for a postdoctoral research fellowship in neonatal metabolism, followed by his pediatric surgical residency at the Children’s Hospital of Alabama. His skills as a surgeon are matched by those as researcher and respected author who contributes significant papers and chapters to such publications as Endoscopic Surgery in Infants and Children.
A family man, Dr. Keshen is married to an equally accomplished professional,
Dr. Roberta Sengelmann, a board-certified dermatologist who specializes in Mohs micrographic surgery, reconstruction and aesthetic enhancement. The couple has two young children, Kendall and Nathan, who are a tremendous source of joy and keep them happily occupied when not busy with their careers.
Dr. Keshen describes his small family as “water people” who also enjoy a variety of other outdoor activities, including hiking and mountain biking. He’s always enjoyed windsurfing and scuba diving and was a rower in college. His wife was a swimmer in college, so they share their love for the outdoors with their children. He’s also carrying on a family tradition that began with Roberta and her father, who was also a surgeon: taking the children to work and letting them see firsthand what daddy does.
“I recently took my daughter on rounds, and she got to see some of my patients. It was great to see the look in her eyes,” he says. “It’s a great feeling to be able to go home and tell them what I’ve done at work.”
Still quite passionate and engaged in all aspects of his work, whether it is teaching, research or surgery, Dr. Keshen says candidly, “I can’t imagine doing anything else! These children come to us sometimes only hours old, and when you have the ability to fix the problem, it means you’ve just saved a lifetime. I take that role quite seriously and sincerely feel it’s a true honor and privilege.”
For more information about Dr. Keshen or Cottage Children’s Hospital, please call (805) 563-6560. To reach Dr. Keshen’s Ventura office, please call (805) 652-6201.
Tamir Keshen, M.D., of Cottage Children's Hospital
MD News August 2011, Central Coast/Ventura County