What is minimal invasive surgery (MIS)?
MIS involves a less invasive approach to surgery than open surgery. MIS is done through little incisions using small surgical tools and telescopes. Some of the benefits of MIS are less surgical pain, less scarring, smaller incisions, quicker recovery with shorter hospital stays, and an earlier return to normal daily activities. Surgeons who perform this type of surgery have undergone extensive specialized training; however they also know how to perform the same operations in the traditional open manner.
MIS is not appropriate for all individuals. Your surgeon will be able to tell you in which cases it may be the best choice.
What are the types of MIS?
1. Laparoscopic surgery: This is a common form of MIS. In laparoscopy, surgeons create a number of small skin openings instead of one large cut and place instruments through these small openings. During a laparoscopic operation, instruments are passed through the body and guided by a lighted telescope with a camera on the end that allows the surgeon to see inside the body. Depending upon the operation needed and the surgeon's preferences, procedures can be performed from the front of the body, the side or the back.
This form of MIS has been used widely in children. In Pediatric Urology, this usually involves operations in the abdomen including surgery of the kidney, ureter, bladder and reproductive organs. This approach can sometimes create technical limitations for the instruments that surgeons use, such as a lack of dexterity and depth-perception.
2. Endoscopic procedures (endourology): This type of MIS typically involves using a scope passed through the body’s natural openings. In Pediatric Urology this mainly involves the structures of the urinary tract. These procedures include cystoscopy (looking inside the bladder), ureteroscopy (looking inside the ureter and kidney) and percutaneous nephroscopy (looking inside the kidney, by way of a small incision in the skin). Endoscopic procedures in Pediatric Urology are used to treat disorders such as kidney and bladder stones, urinary tract infections and vesicoureteral reflux, blockages of the urinary tract and for diagnostic purposes.
3. Robotic surgery: Pediatric robotic surgery is one of the most exciting and promising areas in the field of minimally invasive surgery. For certain types of surgery, the robot can give the surgeon more precise control and the ability to see what they would not be able to see with a laparoscope. Each subtle movement of the surgeon's wrists, hands and fingers is precisely translated to the surgical instruments inside the patient's body. This translation helps the surgeons perform complex pediatric surgical procedures and offer even more benefits to pediatric patients.
How is robotic surgery performed?
This surgery is performed by a trained surgeon using robotic technology. Similar to laparoscopy, robotic surgery is performed by placing instruments with a lighted telescope through small incisions in the skin. Surgeon who operates with the assistance of the robot does not stand over the patient as they traditional would. Instead, the surgery is performed with the surgeon sitting at a computer console in the operating room, and another surgeon is at your child's bedside.
What are the benefits of robotic surgery over laparoscopic surgery?
Robotic-assisted surgery can take less time even than laparoscopic surgical options. There is a relationship between time spent under anesthesia and complications after surgery. Faster surgery = less anesthesia and fewer complications. Surgeons can see the surgical field in three dimensions, unlike with traditional laparoscopic surgery where there is no depth perception.
Why would someone choose robotic surgery over open surgery?
With robotic surgery specially trained surgeons perform complex operations through very small openings, which can reduce pain, shorten recovery times and hospital stays and reduce scars. Also, by using a high-tech robot, many surgeons feel they can better visualize the procedure, which can lead to greater safety and fewer issues and complications.
Does the robot perform the surgery by itself?
The robot cannot make decisions or perform surgery on its own. It is a surgical tool that requires a trained surgeon to operate. The robotic technology is controlled by the surgeon at all times. You can think of the robot as an extension of the surgeon's hands.
How safe is robotic surgery?
At my hospital, robotic surgery is only performed for procedures where it has been studied extensively and proven to be both effective and more beneficial than traditional open surgery. With robotic procedures, surgeons have better visualization than they do with open surgery because they are actually repairing organs on the inside of the body. In addition, there is less suturing with robotic surgery, which eases pain, reduces recovery times and leads to fewer complications.
How do you know if your child is eligible for robotic surgery?
The best surgical technique will be determined for your child based on several factors including their physical examination, medical and surgical history and diagnosis. Each patient considering robotic surgery will need to have an examination by me.
What are the clinical applications of da Vinci system in pediatric urology?
There have been many robotic urological applications that have been shown to be feasible and safe in children. The most commonly performed procedure with robotic assistance is pyeloplasty for the ureteropelvic junction (UPJ) obstruction. Other procedures that are performed using the robotic platform are nephrectomies, heminephroureterectomies, intravesical and extravesical ureteral reimplantation, bladder diverticulectomy, augmentation ileocystoplasty and appendicovesicostomy, among other applications.
