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Pediatric urology at Connecticut Children’s Medical Center is also offering urologic procedures with Minimally Invasive surgical techniques.

As the words “minimally invasive” suggest, this type of surgery can significantly reduce the severity of many surgical procedures that are done within the kidney space on the back (retroperitonoscopy) and abdomen (laparoscopy).

MIS are urologic surgical procedures, which make use of endoscopic technology allowing urologic surgeons to insert a tiny telescope through a small incision and look at the surgical site on a television screen. With this insertion, urologists no longer need to make large incisions that are as big as the surgical area, instead the incisions are just large enough to fit the straw-sized instruments used in the procedure.

Since the incision area made during MIS procedures is greatly reduced, an obvious benefit of using this technology is that there is less damage to the muscles, skin, and nerves of the patient and generally a more pleasing cosmetic result.

Many patients experience a much more rapid recovery, less scarring, and generally significantly reduced amounts of pain. All of these factors together can lessen the psychological trauma that surgery can cause, particularly in younger patients. Another positive aspect of the MIS technique is that surgeons can get closer to the problem and work with it more effectively, particularly since the telescope can magnify and illuminate the affected area.

MIS can be used in many different therapeutic and diagnostic.

Who benefits from MIS?

Like everything else MIS is not for every child nor can it be applied to every type of surgery. Originally such procedures were only used in adult patients, however as medical technology has continued to evolve MIS has become more common and is being used in pediatric and even neonatal settings.

Laparoscopy

MIS of the abdomen or pelvic region is termed, laparoscopy. The incision for a laproscopic procedure is usually made through the belly button region and is as small as possible, averaging about ¼ inch or so. The uses of laparoscopy in children vary from diagnosing pelvic genital organs or non-palpable undescended testes to removing or repairing kidneys. One of the most common uses of therapeutic laparoscopy is in finding intraabdominal testes and bringing them down into the scrotum ( laparoscopic orchiopexy).

Examples of some Urologic Laproscopic procedures include:

Adrenalectomy-Removal of the adrenal gland, but a diagnostic biopsy for tumors in this area is much more common
Orchiopexy/Orchiectomy—Bring testis down into scrotum, or prepare it for bringing it down later (Staged Orchiopexy) or removing the testis, if markedly abnormal.
Gonadectomy--removal of abnormal sex organs if intersex problem requires surgical removal
Ovarian Cysectomy- -Drainage of ovarian cysts
Varicocelectomy—Clamp abnormally large veins from testis to correct varicocele

Nephrectomy—Remove abnormal scarred/ infected or non-functioning cystic kidney

Pyeloplasty- to repair a blocked segment of ureter(tube leaving kidney going to drain urine into bladder)

Cyst drainage—to drain abnormal cyst in kidney

Laparoscopy assisted open surgery—Technique used to harvest or prepare bowel for bladder reconstruction or augmentation; ACE(antegrade continent enema)-to prepare the appendix to bring up to skin for catherizable tube for bowel emptying with enemas or fluid.

CCMC First to Perform Robotic  Urologic Surgery on Children
Dr. Christina Kim, a pediatric urologist at Connecticut Children’s Medical Center, performed the first two robotic surgeries on children in Connecticut. Robotic surgery is a new and innovative option with many exciting elements. Currently, its primary limitation is accessibility. With less than ten children’s hospitals owning a robot, there is limited availability. CCMC is the only institution in Connecticut performing robotic surgery on children, and also has plans to obtain a Da.Vinci robotic unit solely for the use of CCMC for children.

Generally, the DaVinci robot currently at nearby Hartford Hospital is used to perform prostate surgery on adults. However, Dr. Kim has performed several robotic procedures, primarily the  pyeloplasty procedure, which reconstructed the drainage system of the kidney. This has been quite successful the children who underwent the robotic procedures.  It is a viable surgical option for children of all ages.

Dr. Kim trained on a DaVinci robotic system at Boston Children’s Hospital, and she also trained at Hartford Hospital in its Simulation Center.

Although Dr. Kim is an expert in minimally invasive surgery (commonly known as laparoscopic surgery) the advantage of the robotic surgery device is that it allows a 3-dimensional image inside the patient. Dr. Kim sits at a remote console looking through a binocular scope, and operates two joystick-like devices, and foot pedals, to manipulate the robotic arms performing the surgery.

Another advantage of the robotic device is that it provides more precision and range of motion when compared to laparoscopic surgery. Also, because of the smaller incisions, recovery time can be shorter that for traditional open surgery and the cosmetic results are quite favorable.

For a typical open pyeloplasty repair of the kidney, the patient may be in the hospital one or more days, and would be restricted from normal activity for about 3 weeks during recovery. For the robotic surgery patient, the patient is generally in the hospital for one day, and most are able to resume normal activity in a week, Dr. Kim said.

Her first robotic surgery patient was 3-year-old Saviyon Dawson of Hartford. His father, Randy Dawson, said about robotic surgery for his son, “I was nervous about it at first, but was receptive to the idea. He didn’t even need any pain meds after. He was home one day after the surgery and we are very happy with the results.”