小儿机器人辅助腹腔镜肾盂成形术波士顿儿童医院

Pediatric Robotic Assisted Laparoscopic Pyeloplasty Boston Children's Hospital

发布时间：2012-07-26

Boston Children's Hospital broadcasts a robotic assisted laparoscopic pyeloplasty live from the operating room. The procedure will remove an obstruction from a kidney, and reconnect the kidney's drainage system. The Webcast is part of Boston Children's ongoing effort to promote medical education, and allow consumers to see the latest and most innovative medical treatments available to them.

Craig Peters, MD, a urologic surgeon at Boston Children's and associate professor of surgery at Harvard Medical School, will perform the surgery. Alan Retik, MD, Surgeon-in-Chief and Urologist-in-Chief at Children's, will moderate the event to explain critical portions of the surgery and answer e-mail question from viewers during the live Webcast.

Using minimally invasive robotic methods, surgeons are able to perform the complete reconstructive surgery laparoscopically with very high precision, eliminating the need for a large surgical incision. "I find that with the three-dimensional imaging I can visualize more effectively, and perform more precise and complex reconstructive surgery inside the abdomen," says Peters.

"Although operative times have increased with the use of the robot compared to traditional open pyeloplasty, we are getting closer to open surgical times, and hospital stays have decreased from three days to one," says Peters. The robotic surgery also reduces blood loss, postoperative pain and allows for a quicker recovery from surgery.

While success rates of open and robotic assisted pyeloplasty are similar, robotic surgery has not been performed as long as the open procedure. Further analysis is needed to determine if the advantages outweigh the disadvantages, including cost and longer operative times. "I think robotic surgery is the way to go," says Peters. "With robotic assisted pyeloplasty leading the way, this technology has changed the way we do surgery and has allowed us to provide new treatment options to our patients. "

Sitting at a console in the operating room, a surgeon is able to study crisp, real-time 3-D video images of the operating site while grasping controls in each hand. Each subtle movement of the surgeon's wrists, hands, and fingers is translated precisely to the tiny surgical instruments inside the patient's body. "It's as though my hands are actually inside the patient, yet I'm working through a tiny surgical opening," says Hiep T. Nguyen, MD, co-director of the Center for Robotic Surgery and director of the Robotic Surgery Research and Training Program.

Alan B Retik, MD, FAAP, FACS, Surgeon-in-Chief, Urologist-in-Chief and Executive Director of the Advanced Fetal Care Center at Boston Children's, and Professor of Surgery at Harvard Medical School, will lead the LIVE Webcast with commentator Joseph Borer, MD, co-director of the Center for Robotic Surgery, director of the Center for Exstrophy and director of Neurourology, while Dr. Nguyen will perform the operation.

Normally, urine travels from the kidneys to the bladder via the ureters. Vesicoureteral reflux (VUR) occurs when urine that dwells in the bladder flows back into the ureters and often back into the kidneys. Children with VUR may present before birth as prenatal hydronephrosis (an abnormal widening of the ureter) or with a urinary tract infection. Some may be diagnosed because of a family history, even though they may be without symptoms. Others have VUR secondary to others abnormalities of the urinary tract such as posterior urethral valves, ureterocele and neurogenic bladder. During infancy, primary VUR is more common among boys because there is more pressure in their urinary tract; in early childhood, the abnormality is more common in girls. The concern with vesicoureteral reflux is that it can lead to damage or scarring of the kidneys when the reflux is associated with urinary tract infections. Treatment for VUR is based on the child's age, overall health, and medical history, the extent of the condition, the child's tolerance for specific medications, procedures, or therapies, and expectations for the course of the condition.