|
Minimally invasive surgery on the rise at pediatric hospitals
Healthcare Review
Minimally invasive surgery is a field of medical technology that's developing quite rapidly. The University of Chicago, the University of Kentucky and the University of Minnesota are just three facilities that have recently opened centers dedicated to minimally invasive procedures. Minimally invasive gallbladder replacement surgery was developed in the 1990s and is now on the rise. So is minimally invasive obesity treatment.
Concerns regarding length of hospital stay, lost work time, pain management and complications related to large incisions prompted many to improve minimally invasive surgery for adult patients.
Pediatric surgery, however, remained unchanged until the mid to late-1990s. That's when smaller laparoscopic equipment finally became available, and the benefits of minimally invasive surgery were passed on to children.
Today, minimally invasive surgery is on the rise in pediatric hospitals. At C.S. Mott Children's Hospital in Michigan, a new operating room designed specifically for minimally invasive operations--including laproscopic surgical procedures--has opened. Children's Hospital in Denver, CO, is conducting the first pediatric robotic surgeries in the world.
And at the Sibley Heart Center at Children's Healthcare of Atlanta, the number of minimally invasive procedures has risen steadily. Total interventional procedures rose from 175 in 2000 to 273 in 2002, while electrophysiology procedures rose from 261 in 2000 to 308 in 2003.
The benefits of 'keyhole surgery'
Minimally invasive surgery is performed using small endoscopic cameras and long, thin instruments that are inserted into the operating field through natural body openings or small incisions. Procedures are conducted through a keyhole-sized opening in the body, therefore, the process is often called "keyhole surgery."
When compared to open surgery, minimally invasive surgery has several advantages for the patient: decreased blood loss, less post-operative pain and discomfort, faster recovery times, decreased risk of infection, minimized scarring, and shorter hospital stays.
At Children's Hospital in Denver, pediatric robot surgery utilizes a five-millimeter instrument on the da Vinci Surgical System. The robot is used primarily in pediatric urology and cardiac surgery.
During a procedure, surgeons sit at a console several feet away from the patient, while a three-armed, 1,000-pound robot is positioned beside the patient. Two robotic hands hold surgical instruments while the other hand holds a microscope-like camera. Utilizing the robot allows more precise operative movements and reduced surgical trauma. Thanks to this instrumentation, the surgical incisions are as small as five millimeters long.
"Robotic surgery has the potential to revolutionize pediatric surgery," said Dr. David Partrick, MD, who completed this robot-assisted surgery. "This technology has now advanced to the point where instruments are small enough to be utilized in children. Our investment in the robot positions makes us a leader in providing the best health care outcomes for children."
Many different procedures
When considering minimally invasive surgery, many physicians think of laparoscopic surgery. However, in today's surgical environment, the term covers many more procedures.
Abdominal procedures. Laparoscopic cholecystectomies, appendectomies, and splenectomies are common and easily performed in pediatric surgery. Although a 10-millimeter port is often required, the other ports can be as small as three millimeters. These small ports are nearly insignificant in terms of post-operative pain, especially when compared to 10-millimeter or even five-millimeter ports. Even infants as small as 4.5 pounds can safely undergo a variety of laparoscopic procedures.
Thoracic procedures and thoracoscopy. In the past, nearly all thoracic procedures involved a large thoracotomy, a chest tube and a prolonged stay in the hospital. Thoracoscopy has revolutionized some of these basic procedures.
By using small instruments, the painful postoperative course associated with a thoracotomy can be drastically reduced. In addition, chest tubes can be directed to the ideal location with the aid of a thoracoscope. A multitude of procedures are now performed using thoracoscopy: lung biopsies of lesions in the periphery of the lung, blebectomies (performed on adolescents with spontaneous pneumothorax) and anterior spinal exposures for repairing scoliosis.
Cardiac procedures. It's been estimated that approximately 32,000 children will be born in this country with heart defects, and a large proportion of these will require intervention. Currently, more than half of the children undergoing cardiopulmonary bypass in North America are younger than 1 year of age.
In pediatric cardiac surgery, smaller incisions mean less tissue disruption and discomfort, faster recovery and better cosmetic results. In addition, there can be lower incidences of significant infection when using minimally invasive procedures.
The future of pediatric surgery
Minimally invasive pediatric surgery does come with its share of challenges. The smaller workspace can lead to decreased vision, less room for hands and instruments to work, and no room for an assistant's hand. In addition, many of the currently used instruments are simply too large to work within the confined space.
Despite these limitations in equipment and the increased demands it places on the surgeon, minimally invasive surgery is becoming the future of pediatric surgery.
Material from press releases was used in this story.
|
You are currently accessing this Site as a guest. Please login or register by clicking Here
Linear Mode
