Minimally Invasive Pediatric Surgery

Contact: Amanda White

Photo of Daniel Beals, M.D. and Joseph Iocono, M.D., pediatric surgeons
Daniel Beals, M.D. and Joseph Iocono, M.D., pediatric surgeons

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"As a result of the successful recruitment of outstanding pediatric surgery faculty, major advancements in technology that involves instruments less than half an inch in diameter, and the full support of UK Children’s Hospital, the goal of performing MIS surgery in infants and children with complex surgical diseases is now a reality.”

-- Robert M. Mentzer Jr.,
Frank C. Spencer professor and chairman,
Department of Surgery,
UK College of Medicine

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LEXINGTON, Ky. (March 4, 2004) -- University of Kentucky pediatric surgeons are performing a number of procedures using minimally invasive surgical (MIS) techniques in even the tiniest patients. Over the past three years, UK has been one of about a dozen hospitals in the country and the only hospital in Kentucky to perform complex pediatric procedures with advanced MIS techniques.

“Five years ago, the UK Department of Surgery embarked on a mission to develop a multidisciplinary minimally invasive surgery program,” said Robert M. Mentzer Jr., the Frank C. Spencer professor and chairman, Department of Surgery, UK College of Medicine. “The purpose was to enhance the outcomes and quality of life of adult patients undergoing surgery by performing operations through small one-inch incisions. This has now become a standard of care throughout our community. Our next goal, however, was to introduce this technology into the pediatric arena. As a result of the successful recruitment of outstanding pediatric surgery faculty, major advancements in technology that involves instruments less than half an inch in diameter, and the full support of UK Children’s Hospital, the goal of performing MIS surgery in infants and children with complex surgical diseases is now a reality.”

Daniel A Beals, M.D., associate professor, UK Division of Pediatric Surgery, performed UK's first pediatric MIS procedure in July 2001. The nation’s first pediatric MIS cases were reported in 1991.

“Pediatric surgeons always perform surgeries with the least trauma as possible to our patients,” said Andrew Pulito, M.D., professor and chief, Division of Pediatric Surgery, UK College of Medicine. “In a sense, pediatric surgeons have always been minimally invasive surgeons. As technology has advanced, we now have the ability to
complete even some of the most complex operative repairs with tinier incisions, less pain, better cosmesis, and quicker return to full activity.”

Many pediatric MIS procedures are modeled after those performed in the adult population. Some, however, are unique to conditions found only in infants and children. Minimally invasive procedures must be as good, or better than an open surgery. MIS procedures typically use smaller incisions, with some laparoscopic instruments being smaller than 2mm in size. The smaller incisions are associated with less pain and less need for pain medication. Plus, they allow for better cosmetic results. Patients who undergo MIS procedures typically have shorter hospital stays. Plus, the likelihood of future complications is decreased.

“Several studies suggest the formation of fewer intra-abdominal adhesions after laparoscopic procedures,” said Joseph A. Iocono, M.D., assistant professor, UK Division of Pediatric Surgery.

An adhesion is scar tissue that forms between two structures or organs that do not normally connect. Fewer adhesions reduce the risk of future postoperative bowel obstructions and possibly reduce postoperative pain.

“The goal in any operative procedure is to achieve the best possible treatment or correction of the underlying problem,” Pulito said. “When this can be accomplished with a technique that also provides a better cosmetic result, less post-op pain and quicker return to full function, it’s easy to see this is the wave of the future, and present.”

Since July 2003, over 100 pediatric MIS cases have been performed at UK.

Watterson Wells, 13, was diagnosed with Crohn’s disease at age 7. Suffering from chronic abdominal pain and having difficulty eating, Wells underwent a laparoscopic colon resection to remove a portion of his colon in February 2003. With traditional surgery, the procedure would have required an incision that extended almost the entire length of his abdomen and about six weeks of recovery time to return to full activity. Wells’ surgery, performed by Beals, required only five one-inch incisions. Wells returned to school 10 days after the procedure.

Crohn’s disease is a life-long disease and may require repeated operations.

“With less trauma from a minimally invasive approach, patients recover more quickly and are better able to return to normal activity,” Beals said.

Aaron Hall, 2, was born with a diaphragmatic hernia. However, his condition went undetected until he was admitted to UK Children’s Hospital for an upper respiratory infection in the summer of 2003. When doctors reviewed Hall’s chest X-ray, they noted that a portion of Hall’s intestine was herniated into his chest through a defect in his diaphragm. Congenital diaphragmatic hernias occur in between one in 2,000 and one in 5,000 births. The defect is caused by incomplete formation of the diaphragm, leaving a hole in it, allowing abdominal organs (intestine) to move into the chest. A small number of these cases escape diagnosis in the neonatal period. The most common symptoms are recurring respiratory infections and constipation. For Hall, after the upper respiratory infection was cured, the defect was electively repaired using MIS techniques with four quarter-inch incisions, performed by Iocono. Hall went home the day following the surgery.

“To be able to repair a complex defect in the diaphragm, making incisions that are barely noticeable, is very gratifying,” Iocono said. “When Aaron returned for his follow-up check-up after surgery, his mom admitted that it took her longer to recover from the operation than Aaron.”

Diagnoses that have been treated with pediatric minimally invasive surgery at UK over the past three years include appendicitis, cholelithiasis, chronic abdominal pain, chronic constipation, Crohn’s disease, diaphragmatic hernia, empyema, gastroesophageal reflux, gastrostomy tube placement, Hirschsprung’s disease, lung tumor, malrotation, Meckel’s Diverticulum, mediastinal pathology, ovarian torsion and cysts, pectus excavatum, pyloromyotomy, recurrent pneumothorax, splenic pathology, undescended testicle, ulcerative colitis, and inguinal hernia.

“We are excited that even the smallest patients at UK Children’s Hospital are receiving the most advanced surgical care available, today,” Iocono said. “We are always striving to push ahead and offer the latest technologies to our patients.”


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