A pioneer in the treatment of thoracic insufficiency syndrome, Dr. Robert Campbell was known for the development of the vertical expandable prosthetic titanium rib (VEPTR) and his advocacy for appropriate regulatory guidelines for pediatric devices.
Dr. Robert Campbell and the VEPTR device
Thoracic insufficiency syndrome (TIS) refers to a range of chest wall deformities that contribute to a progressive worsening of the rib cage and/or thoracic spine anatomy, which negatively impact respiratory function and lung growth. Thankfully like many pediatric diseases, TIS is rare and there are fewer than 4,000 children are born with the condition each year in the US. The small number of TIS patients negatively impacts the value proposition for medical device manufacturers, and thus reduces research and development of effective solutions. This issue remains all too common in the pediatric device field, and necessitates the steadfast efforts of pediatric medical devices pioneers such as the late Dr. Robert M. Campbell, M.D.
In 1987 Dr. Campbell was an orthopedic surgeon at Santa Rosa Children’s Hospital in San Antonio. An eight-month-old patient presented with respiratory insufficiency due to severe scoliosis and rib agenesis. The child was respirator dependent and long-term survival was not likely. The use of surgical pins, to create a chest wall prosthesis, demonstrated a profound improvement in the child’s respiratory function and they were soon removed from ventilation. However, the surgical pins would ultimately function as tethers for the growing ribs, and if adjustments were not made over time, the constrained ribcage would negatively impact the growth of the lungs and spine. There were only two solutions to this new problem. First, additional surgeries would be required to exchange the pins with more appropriately sized devices. An alternative solution, chosen by Dr. Campbell, required the development of an adjustable chest wall prosthesis that would allow for the expansion of device as the child grew. Such a device would require less surgical intervention, thereby reducing the chance of postoperative complications.
Dr. Campbell attempted to identify an orthopedic device manufacturer that would be willing to make a device that would support the chest wall and expand in response to the growing child. Technical issues associated with fabricating an expandable chest wall prosthesis for a small child, and the extremely small market size deterred almost all manufacturers from making a prototype. Dr. Campbell finally identified a contract manufacturer, Techmedica Corporation of Camarillo California, that agreed to fabricate an expandable rib prosthesis out of titanium. In 1989, the device was used to successfully replace the surgical pins in the original patient.
The success of this initial procedure, originally called the “Titanium Rib Project”, elicited a growing interest in its potential application to treat other patients with TIS. At times, the use of the Titanium Rib was modified to address the complexity of deformities of the spine and ribs, which cause TIS. However, a central technique using the vertical expandable prosthetic titanium rib (VEPTR) was developed and is used in at least 26 countries. Surgeons now use the VEPTR procedures to address the following condition: Fused ribs and scoliosis, absence of ribs and scoliosis, narrowing of the chest, symmetrically shortened chest, syndromic and neuromuscular scoliosis. As the developer of VEPTR, Dr. Campbell was an advocate for advancing the procedure to address TIS. He joined the faculty of the Children’s Hospital of Philadelphia in 2009 to establish the Center for Thoracic Insufficiency Syndrome (CTIS). He travelled throughout the world training surgeons on the VEPTR procedure.
In addition to leading the efforts on understanding and treating TIS, Dr. Campbell was an advocate for establishing appropriate regulatory guidelines for pediatric devices. This was driven by the fact that VEPTR did not receive Humanitarian Use Authorization in the U.S. until 2004. In contrast, the first non-investigational use of VEPTR was performed in Europe in 1992. The long delay in receiving device approval stemmed from the fact that there wasn’t a large population of patients with TIS and patient recruitment was slow. Seeing the issues surrounding pediatric device approval, Dr. Campbell spent great effort in changing the pediatric device approval processes. He lobbied Congress on behalf of children with rare medical conditions and on July 1, 2010 the 111th Congress passed Resolution 1499 honoring the achievements of Dr. Robert M. Campbell to provide children with lifesaving medical care. See Dr. Campbell testifying before congress about the VEPTR device here.
Dr. Campbell passed away on July 29, 2018. However, he has left an undeniable legacy as a pioneer in the field of pediatric medical devices. In recognition for his outstanding contributions, the Children’s Hospital of Philadelphia CTIS was named the Wyss/Campbell Center for Thoracic Insufficiency Syndrome. It is the first national, multidisciplinary program dedicated to the treatment of TIS.
VEPTR: past experience and the future of VEPTR principles. Robert J. Campbell. European Spine Journal (2013) 22 (Suppl 2):S106-S117
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