Surgeons in Children's Hospital of Iowa at University of Iowa Hospitals and Clinics in Iowa City recently repaired a potentially lethal disorder in a six-day-old Iowa girl, making her the first patient to have this type of defect corrected with a robotic surgical system as a neonate, and the smallest person to ever receive robotic surgery of any kind anywhere in the world.
A team led by John Meehan, M.D., UI assistant professor (clinical) of surgery and a pediatric surgeon at Children's Hospital of Iowa, repaired a congenital diaphragmatic hernia (CDH) in 5.6-pound Amber Vairo of Chariton, Iowa, on Feb. 16. CDH can be a lethal condition in up to 25 percent of children born with the anomaly.
"Amber is doing very well. She is off the ventilator and tolerating feeds well," Meehan said.
Meehan performed the procedure using three tiny incisions only one-fifth of an inch long and one incision just one-eighth of an inch in length. Amber is now the smallest patient to undergo any robotic surgical procedure in the world. She is also the first patient to receive a Bochdalek CDH repair as a newborn using robotic surgery. Other hospitals have completed CDH repairs with the robot in much older children with Morgagni diaphragmatic hernias.
Specialists say their ability to conduct the procedure was largely due to the availability of a new five-millimeter camera system funded by Children's Miracle Network and a five-millimeter 30- degree camera donated by Intuitive Surgical.
"I want to thank Children's Miracle Network and Intuitive Surgical for their efforts in helping us provide the benefits of minimally invasive surgery to small infants and children," Meehan said.
Bochdalek CDH hernias are the most common type of such congenital defects and have a high mortality rate. A Bochdalek hernia usually develops on the left-side diaphragm. The hole in the diaphragm can allow the entire abdominal contents (stomach, small intestine, large intestine, spleen and sometimes other organs) to slip up into the chest and remain there during development. The extra bulk of organs in the chest prevents proper lung development on the affected side as the fetus develops in the womb. If a severe defect is present, the lung on the affected side can be nearly useless. This can lead to cardiopulmonary failure and may cause the child's death.
A Morgagni hernia is a central diaphragmatic defect which is much less common and often undetected until a patient is much older. Morgagni hernias don't affect the lungs because only a small portion of intestine slips into the defect and does not compress the lungs while they are developing.
The da Vinci robot is a complex surgical system that allows a surgeon to perform minimally invasive surgery. After establishing access into the body cavity, the physician sits at a computer console that offers a three-dimensional view of the area to be treated with magnification up to 12 times that of normal vision. The surgeon uses special hand controls to manipulate long, narrow, specially hinged surgical instruments that are inserted through the small incisions in the patient.
The complex instruments can be used in hard-to-reach areas and turned in ways that would be impossible with normal wrist dexterity. Altogether, these advantages allow the surgeon to work on a smaller scale and more precisely than standard laparoscopic surgery and even traditional open surgery. Information about the system can be viewed online at www.uihealthcare.com/daVinci.
The device currently is approved for use in surgeries in the abdomen, pelvis and chest. Meehan's surgical team was also the first to use a robotic system to perform a Nissen fundoplication and gastrostomy tube placement on the 5.7-pound baby boy on Sept. 17, 2004. In addition, UI Hospitals and Clinics was the first medical center in Iowa to use the da Vinci system to repair a mitral valve in the heart and to perform urological procedures such as radical prostatectomy for removing a cancerous prostate, and pyeloplasty for obstructed kidneys.
Children's Hospital of Iowa at UI Hospitals and Clinics in Iowa City is the state's longest-serving children's hospital. More than 130,000 children receive care at Children's Hospital of Iowa and its network of clinics across the state each year.
Children's Miracle Network is an international non-profit organization dedicated to helping children by raising funds and awareness for 170 children's hospitals throughout North America. Each year this network of premier facilities treat more than 14 million children suffering with all types of afflictions.
Children's Miracle Network partners with 135 radio stations and 200 television stations to help support critically ill and injured children. Since it inception in 1983, Children's Miracle Network has raised more than $2 billion for children's hospitals.
University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at http://www.uihealthcare.com.
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