Robotic surgery has increasingly become a minimally invasive option for adults in recent years, but what about for children?
Learn when robotic surgery may be a choice for pediatric patients from a UVA specialist in pediatric urology surgeries.
When Children May Benefit from Robotic Surgery
Featured Speaker:
Dr. Sean Corbett
Dr. Sean Corbett is a fellowship-trained pediatric urologist whose specialties include caring for a wide range of kidney conditions in children.
Transcription:
When Children May Benefit from Robotic Surgery
Melanie Cole (Host): Robotic Surgery has increasingly become a minimally invasive option for adults in recent years, but what about for children? My guest is Dr. Sean Corbett. He’s a fellowship-trained pediatric urologist whose specialties include caring for a wide range of kidney conditions in children at UVA Children’s Hospital. Welcome to the show, Dr. Corbett. Tell us a little bit about robotic surgery, and what are some of the goals of using it?
Dr. Sean Corbett (Guest): Well, thanks Melanie, and thanks for this opportunity. Robotic surgery is one of the tools in our tool box which has expanded our ability to treat patients of all ages in a minimally invasive approach. The robot just facilitates what we used to or traditionally did with laparoscopic surgery, where it allows much greater range of movement and hand visibility with 10 times magnification, improved precision, high-definition 3D visualization. So it really facilitated our ability to do a lot of things that we’ve traditionally done laparoscopically but now are able to do robotically in a much easier fashion.
Melanie: Dr. Corbett, give us an example of some of the conditions that you’re using robotic surgery to treat.
Dr. Corbett: Sure. Well, there are number of conditions. And really, the envelope continues to be pushed by centers, with the greatest amount of experience here at UVA. Some of the conditions that we’ve treated are certainly most commonly what’s known as hydronephrosis or children with ureteropelvic junction obstruction. We’ve treated them with robotic-assisted laparoscopic pyeloplasty but also kidney reflux, duplicated kidney systems, ureteroceles, bladder surgery where we need to augment the bladder in the case of children with spina bifida. So really, a whole host of procedures across the board with regards to pediatric urologic condition.
Melanie: Now, what children might this be an option for? Are there some that really are not candidates for robotic surgery?
Dr. Corbett: I think that’s a very good question, Melanie. I think in the appropriate hand, the robot really facilitates robotic surgery across the board. Certainly, in my experience, for the really small child or infants, rather -- and we’re talking less than 5 kilograms, it becomes certainly a much greater challenge to perform a procedure on that smaller, infant, child laparoscopically or robotically. But aside from the size -- and there aren’t a lot of children that aren’t good candidates for robotic surgery unless they’ve had multiple previous abdominal surgeries. That might be the only other indication where robotic surgery is not the best first option.
Melanie: So, Dr. Corbett, let’s talk a little bit about some specific conditions. Hernia repair. This is quite common in children—boys, especially. Tell us a little bit about what’s involved in hernia repair. How would a parent spot a hernia in their child?
Dr. Corbett: Well, a hernia in a small child or an infant, it’s a very different disease condition that it might be in an adult. A hernia in a child is something that’s known as congenital abnormality, and the connection between the abdominal cavity and the scrotum remains open, which allows either fluid to communicate or even the intestines to herniate through. And that is a surgical condition that typically or certainly, traditionally, has been treated with an open incision in the groin in order to repair the defect. But more frequently, we are approaching this from a minimally invasive standpoint and a laparoscopic approach or a laparoscopic percutaneous approach is what I commonly employ in the infants that I’ve worked with. The robot, because the procedure is so quick and have a specific role as of yet in the treatment of this condition.
Melanie: What can parents expect after a hernia? Is there a long recovery period, or are the children pretty much great afterward?
Dr. Corbett: You know, it’s somewhat dependent on the age of the child. But most of the infants and children are back to their normal routine, really, within a day or two. That’s the great thing about the minimally invasive approach, especially, but also working with children infants, is that they tend to recover very quickly and even more so with the minimally invasive approach.
Melanie: Now, so with the robotic surgery, discuss one of the treatments that you use it directly for on children and what you’ve seen as the outcome.
Dr. Corbett: Sure. I mean the most common to these conditions that I would treat with the use of the robot is what’s called performing a pyeloplasty. So we do a robotic-assisted laparoscopic approach, and essentially, that’s a condition where the urine draining from the kidney is blocked at the junction between the kidney, essentially, and what’s called the ureter tube, which is the draining tube from the kidney. So there’s a congenital abnormality that results in a blockage there. So, with the robot, were able to go in, cut out that defect or the abnormal portion, so that you could portion this back together. The children do really well with this. The procedure itself takes about two hours, a little bit longer just in terms of the time that they’ve been in the operating room that’s until to put them to sleep to wake them up, to do the imaging studies at the beginning of the procedure. But the overall procedure is about two hours. The children usually stayed just overnight in the hospital and so, almost all of them will go home by the next morning, or certainly, early afternoon. And they recover very quickly. I mean it’s fantastic to see the difference between the way children recover. When I started this and we were doing all of these procedures through open flank incision—so, a generous incision through the flank underneath the ribcage—and now we do it with three smaller little incisions. So the children do fantastic with it and the repair rates are fantastic. I mean, they’re certainly comparable, if not better, I think in certain hands, then the traditional open or even the laparoscopic approach is.
Melanie: Dr. Corbett, you’re dealing with parents—worried, scared parents. What do you tell them when you say, “We’re going to use robotic surgery.” how do you calm their fears?
Dr. Corbett: Well, I mean I think that’s not significantly different irrespective of the type of procedure that’s being performed. Again, the robotic approach is a minimally invasive approach, just like the laparoscopic approach is, but the goals of the operation are the same, irrespective of how we’re approaching it, whether it’s a minimally invasive or if it’s an open procedure, a traditional open procedure. So, in talking to the parents, number one, I always try to put myself in their shoes and relate it to my own children, and certainly, if they needed this type of procedure, would I have it done on them. Obviously, I think not every child needs an operation, and we’re not going to push it if it’s not necessary. But in those children that are candidates, it’s reassuring to the parents to know that if it was my child, I would use the same technology. Again, we have the capability here at UVA to do it minimally invasively—that’s robotically or pure laparoscopically—or open. But again, I think the benefits of the robot are starting to prove themselves. And again, if it was my child, I would operate on them robotically or have it done robotically, I shouldn’t say. Personally, I think it’s a little hard to operate on your own children, but I think that helps relieve some of the fears or tensions they have to know that we’re doing the same operation irrespective of the approach. But the robot certainly offers a nice approach for them with the same outcomes as the other approaches.
Melanie: Dr. Corbett, in just the last minute, why should families come to UVA Children’s Hospital for their pediatric urologic care?
Dr. Corbett: Well, I think we’re fortunate here because we have some of the greatest specialists certainly in the state. We’re the only institution in the state that offers robotic surgery for pediatric urologic conditions, and so, the expertise that we’ve been able to develop here, I think, is a very nice option for families that want to first do a minimally invasive approach for management of disease conditions within their children.
Melanie: Well, thank you so very much. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening.
When Children May Benefit from Robotic Surgery
Melanie Cole (Host): Robotic Surgery has increasingly become a minimally invasive option for adults in recent years, but what about for children? My guest is Dr. Sean Corbett. He’s a fellowship-trained pediatric urologist whose specialties include caring for a wide range of kidney conditions in children at UVA Children’s Hospital. Welcome to the show, Dr. Corbett. Tell us a little bit about robotic surgery, and what are some of the goals of using it?
Dr. Sean Corbett (Guest): Well, thanks Melanie, and thanks for this opportunity. Robotic surgery is one of the tools in our tool box which has expanded our ability to treat patients of all ages in a minimally invasive approach. The robot just facilitates what we used to or traditionally did with laparoscopic surgery, where it allows much greater range of movement and hand visibility with 10 times magnification, improved precision, high-definition 3D visualization. So it really facilitated our ability to do a lot of things that we’ve traditionally done laparoscopically but now are able to do robotically in a much easier fashion.
Melanie: Dr. Corbett, give us an example of some of the conditions that you’re using robotic surgery to treat.
Dr. Corbett: Sure. Well, there are number of conditions. And really, the envelope continues to be pushed by centers, with the greatest amount of experience here at UVA. Some of the conditions that we’ve treated are certainly most commonly what’s known as hydronephrosis or children with ureteropelvic junction obstruction. We’ve treated them with robotic-assisted laparoscopic pyeloplasty but also kidney reflux, duplicated kidney systems, ureteroceles, bladder surgery where we need to augment the bladder in the case of children with spina bifida. So really, a whole host of procedures across the board with regards to pediatric urologic condition.
Melanie: Now, what children might this be an option for? Are there some that really are not candidates for robotic surgery?
Dr. Corbett: I think that’s a very good question, Melanie. I think in the appropriate hand, the robot really facilitates robotic surgery across the board. Certainly, in my experience, for the really small child or infants, rather -- and we’re talking less than 5 kilograms, it becomes certainly a much greater challenge to perform a procedure on that smaller, infant, child laparoscopically or robotically. But aside from the size -- and there aren’t a lot of children that aren’t good candidates for robotic surgery unless they’ve had multiple previous abdominal surgeries. That might be the only other indication where robotic surgery is not the best first option.
Melanie: So, Dr. Corbett, let’s talk a little bit about some specific conditions. Hernia repair. This is quite common in children—boys, especially. Tell us a little bit about what’s involved in hernia repair. How would a parent spot a hernia in their child?
Dr. Corbett: Well, a hernia in a small child or an infant, it’s a very different disease condition that it might be in an adult. A hernia in a child is something that’s known as congenital abnormality, and the connection between the abdominal cavity and the scrotum remains open, which allows either fluid to communicate or even the intestines to herniate through. And that is a surgical condition that typically or certainly, traditionally, has been treated with an open incision in the groin in order to repair the defect. But more frequently, we are approaching this from a minimally invasive standpoint and a laparoscopic approach or a laparoscopic percutaneous approach is what I commonly employ in the infants that I’ve worked with. The robot, because the procedure is so quick and have a specific role as of yet in the treatment of this condition.
Melanie: What can parents expect after a hernia? Is there a long recovery period, or are the children pretty much great afterward?
Dr. Corbett: You know, it’s somewhat dependent on the age of the child. But most of the infants and children are back to their normal routine, really, within a day or two. That’s the great thing about the minimally invasive approach, especially, but also working with children infants, is that they tend to recover very quickly and even more so with the minimally invasive approach.
Melanie: Now, so with the robotic surgery, discuss one of the treatments that you use it directly for on children and what you’ve seen as the outcome.
Dr. Corbett: Sure. I mean the most common to these conditions that I would treat with the use of the robot is what’s called performing a pyeloplasty. So we do a robotic-assisted laparoscopic approach, and essentially, that’s a condition where the urine draining from the kidney is blocked at the junction between the kidney, essentially, and what’s called the ureter tube, which is the draining tube from the kidney. So there’s a congenital abnormality that results in a blockage there. So, with the robot, were able to go in, cut out that defect or the abnormal portion, so that you could portion this back together. The children do really well with this. The procedure itself takes about two hours, a little bit longer just in terms of the time that they’ve been in the operating room that’s until to put them to sleep to wake them up, to do the imaging studies at the beginning of the procedure. But the overall procedure is about two hours. The children usually stayed just overnight in the hospital and so, almost all of them will go home by the next morning, or certainly, early afternoon. And they recover very quickly. I mean it’s fantastic to see the difference between the way children recover. When I started this and we were doing all of these procedures through open flank incision—so, a generous incision through the flank underneath the ribcage—and now we do it with three smaller little incisions. So the children do fantastic with it and the repair rates are fantastic. I mean, they’re certainly comparable, if not better, I think in certain hands, then the traditional open or even the laparoscopic approach is.
Melanie: Dr. Corbett, you’re dealing with parents—worried, scared parents. What do you tell them when you say, “We’re going to use robotic surgery.” how do you calm their fears?
Dr. Corbett: Well, I mean I think that’s not significantly different irrespective of the type of procedure that’s being performed. Again, the robotic approach is a minimally invasive approach, just like the laparoscopic approach is, but the goals of the operation are the same, irrespective of how we’re approaching it, whether it’s a minimally invasive or if it’s an open procedure, a traditional open procedure. So, in talking to the parents, number one, I always try to put myself in their shoes and relate it to my own children, and certainly, if they needed this type of procedure, would I have it done on them. Obviously, I think not every child needs an operation, and we’re not going to push it if it’s not necessary. But in those children that are candidates, it’s reassuring to the parents to know that if it was my child, I would use the same technology. Again, we have the capability here at UVA to do it minimally invasively—that’s robotically or pure laparoscopically—or open. But again, I think the benefits of the robot are starting to prove themselves. And again, if it was my child, I would operate on them robotically or have it done robotically, I shouldn’t say. Personally, I think it’s a little hard to operate on your own children, but I think that helps relieve some of the fears or tensions they have to know that we’re doing the same operation irrespective of the approach. But the robot certainly offers a nice approach for them with the same outcomes as the other approaches.
Melanie: Dr. Corbett, in just the last minute, why should families come to UVA Children’s Hospital for their pediatric urologic care?
Dr. Corbett: Well, I think we’re fortunate here because we have some of the greatest specialists certainly in the state. We’re the only institution in the state that offers robotic surgery for pediatric urologic conditions, and so, the expertise that we’ve been able to develop here, I think, is a very nice option for families that want to first do a minimally invasive approach for management of disease conditions within their children.
Melanie: Well, thank you so very much. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening.