Robotic Surgery Lessens Pain

Recognizing that robotic surgery for children would involve less pain after an operation but was still in the early days for use in pediatric medicine, a Nemours physician taught himself the skills needed for reconstructive procedures. "Robotics started to pick up in the early 2,000s, primarily driven by adult urology. Pediatrics has tended to be later in the evolutionary curve for these kinds of developments,” says Nemours surgeon and Chair of the Department of Surgery at the Nemours Children's Clinic in Jacksonville, Florida, Michael J. Erhard, MD.

Dr. Erhard puts the surgical advance in perspective. "Robotics is a type of minimally invasive surgery. This could mean endoscopy with telescopes and looking into airways through lenses, lights through flexible instruments or laparoscopy that involves the cavities of the body, the belly or the chest.”

Dr. Erhard continues, “The robot is the assistive device for a laparoscopic procedure that helps in many ways: it gives you 3-D imagery, steadies your hands without tremor, and provides 15-times magnification. It's an invaluable tool that takes a small field and makes it seem big."

Nemours' urology team was the first pediatric group in the Southeast to use the technology of the robot for procedures. The technology can be used by urologists, general surgeons, and for some cardiac, pulmonary and other laparoscopic procedures. In the case of Nemours urology, half the children are under two years of age.

The benefits are easy to list but difficult to quantify. Pain is less. "This is not painless surgery, but it is less painful. The narcotic requirement is less and by the third day the child may be taking nothing at all, which used to be unheard of. Even the infant and younger kids really rebound quickly even though they will have some pain requirements initially."

Dr. Erhard is helping to spread the word and "proctoring" other physicians within Nemours and elsewhere in Florida who want to learn about the potential for robotics to allow smaller incisions, smaller scars, faster healing time and less pain. "Yesterday, I operated on a six-month-old child who had a blocked kidney. She went home 4 hours ago. If you can imagine a six-month-old child who's so small that you're working in a space not bigger than an apple to get instruments in there, take the kidney apart, cut out what needed to be removed, and sew everything back together you've got an idea of how robotics can extend what we can do," all for better comfort, convenience, and results for children and families.