Modern technology makes it possible for our highly skilled Nemours surgeons to perform certain procedures in a “minimally invasive” way. In other words, some operations typically done with “open surgery” (which requires larger “open” incisions) can be performed using the patient’s natural openings (like the mouth and throat) or through tiny incisions an inch or smaller. And that means:
- shorter hospital stays
- quicker recovery times
- less pain and discomfort
- reduced chance of infection and bleeding
- much smaller scars
Minimally invasive procedures can be performed through either:
- Endoscopy, in which a small lighted telescope is passed through a body opening. The scope can be used to examine the inside of the body. Instruments can also be passed through the scope to remove small objects such as kidney stones or to take biopsies (when a piece of tissue is obtained for close examination). So, some procedures can be done without any cut at all – and the child can usually be sent home that very same day.
- Laparoscopy, which involves a few half-inch “keyhole” incisions rather than a large open incision, can be used for diagnosis (to figure out what the problem is) and/or treatment (to repair or remove a problem). One small incision is used for a tiny camera, which gives the surgeon a magnified view inside the body. The other incisions are used for inserting surgical instruments. The surgeon also inflates the abdomen with gas in order to see the inside of the body more clearly. Laparoscopy is often called “band-aid surgery” because the incisions are small enough that they can be covered with small bandages after surgery instead of a large dressing.
Basically, whenever you see or hear “oscopy” or “oscopic” at the end of a procedure’s name, it means “use of a scope” and sometimes other instruments to diagnose, inspect, and/or treat a problem.
How We Use Robotics
Robotic-assisted surgery simply takes minimally invasive surgery steps further. With robotic-assisted laparoscopy, the surgeon uses computer-controlled, specially jointed mechanical hands. This offers the surgeon more stable maneuvering and 3-D imagery (magnified by 15 times) of what’s going on inside the child’s body. Robotics can also be used for endoscopies – through telescopes, lenses, and lights using flexible instruments.
Among the first to offer breakthrough robotic surgeries about 10 years ago, the Nemours team has continued to evolve and learn new techniques in this area – all with the singular goal of making surgery easier and recovery times quicker for kids.
Addressing Each Child’s Specific Needs
Of course, doctors look at every child’s case individually to see if any type of minimally invasive surgery is an option – and whether it would be the best course of treatment. Whether or not your child can – or should – get this kind of surgery depends on a number of things, from your child’s condition to the complexity of the surgery needed.
When it applies and is in the best interest of the child, minimally invasive surgeries are offered at specific Nemours locations across a wide range of specialties, including:
Gastroenterology (digestive system)
- Diagnostic and therapeutic endoscopy (use of a scope and other instruments to inspect and treat the inside of the esophagus, stomach, and intestines)
- Percutaneous gastrostomy tube placement (placement of a “G tube” through the abdominal wall using a scope in the esophagus; also known as PEG)
General Surgery (procedures, mostly abdominal, involving any area but the brain, bones, and heart)
- Diagnostic laparoscopy (use of a scope to inspect the organs within the abdomen)
- Laparoscopic appendectomy (use of a scope and other instruments to remove the appendix)
- Laparoscopic bowel procedures (use of a scope and other instruments to treat bowel obstruction/blockage; to remove parts of the bowel, to treat Hirschsprung’s disease, or to evaluate a tumor and perform a biopsy)
- Laparoscopic exploration for hernias (use of a scope to inspect for hernias in the lower abdomen and groin)
- Laparoscopic Nissen fundoplication (use of a scope and other instruments to treat severe gastroesophageal reflux)
- Laparoscopic pyloromyotomy (use of a scope to treat pyloric stenosis -- overgrowth of the muscle at the end of the stomach)
- Laparoscopic removal of an organ (use of a scope and other instruments to remove organs such as the gallbladder, spleen, pancreas, ovary, and adrenal gland)
- Laparoscopic repair of diaphragmatic hernias (use of a scope and other instruments to repair an opening in the diaphragm muscle through which the intestines have passed into the chest)
- Thoracoscopy (use of a scope and other instruments to inspect and treat lung masses, cysts, chest infections, and lung collapse)
Orthopedics (bones, muscles, and joints)
- Arthroscopy of the hip, shoulder, knee, elbow, and ankle (use of a scope to see inside the joints)
- Video-assisted thoracoscopic (inside the chest) surgery (or VATS – a minimally invasive spine surgery)
Otolaryngology (ear, nose, and throat – or ENT)
- Diagnostic and therapeutic bronchoscopy (use of a scope and other instruments to inspect and treat the inside of the airways)
- Diagnostic and therapeutic laryngoscopy (use of a scope and other instruments to see and treat the inside of the upper airway)
- Endoscopic sinus surgery (use of a scope and other instruments to see and treat problems inside the sinuses)
Pulmonology (airways and lungs)
- Diagnostic and therapeutic bronchoscopy (using a scope and other instruments to inspect and treat the inside of the airways)
Urology (kidneys, ureters, and bladder)
- Diagnostic endoscopy (use of a scope to inspect the inside of the urinary tract)
- Diagnostic laparoscopy (use of a scope and other instruments to inspect the outside aspects of the kidneys, ureters, and bladder)
- Endoscopy for stones and strictures (use of a scope and other instruments to treat specific problems inside the urinary tract)
- Endoscopy for tumor treatment (use of a scope and other instruments to treat a tumor in the urinary tract)
- Laparoscopic nephrectomy (use of a scope and other instruments to remove part or all of a kidney)
- Robotic-assisted pyeloplasty (uses laparoscopy along with computer controlled instruments that allow the surgeon to repair blockages in the kidney)