Melanie Cole, MS (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole.

And joining me today is Dr. Mollie Freedman-Weiss. She's an Assistant Professor of Surgery in the Division of Pediatric Surgery and Pediatric Trauma at Weill Cornell Medical College, New York-Presbyterian Hospital/Weill Cornell Medical Center. And we're here today to talk about pediatric robotic surgery.

Welcome, Dr. Freedman-Weiss. I'm so glad you could join us today. I'd like you to speak a little bit about those words, pediatric robotic surgery. It's sort of grown onto the scene. It's changed the landscape of so many surgeries. It's really a game changer. Can you tell us a little bit about it and how it differs from what we've always thought of as traditional surgery?

Mollie R. Freedman-Weiss, MD: Definitely. First of all, thank you, Melanie, for having me. And I'm so excited to be here in talking about pediatric robotic surgery. But first, I want to sort of rewind into the options of surgery. So when we're talking about surgery in the chest or abdomen, I would say there's two main approaches. The first is that traditional open approach with a larger incision where we don't need any cameras or as much equipment to see the intestines or the chest, the lungs, whatever we're operating on.

The second is laparoscopic surgery where we go in with a camera and instruments the size of about chopsticks or the widths of my pinky finger. Robotic surgery is sort of a branch of that ladder laparoscopic surgery, meaning it's minimally invasive. It's a tool for laparoscopic surgery. So when I think about pediatric robotic surgery, I think about being able to operate in really small places with precision, with better visualization, and with a little bit more dexterity and mobility of my tools and instruments. I would say that's sort of the broad overviews, that it's a branch of this minimally invasive, laparoscopic surgery.

Melanie Cole, MS: That was an excellent explanation. Thank you so much. Now, for what conditions, and we're talking about tiny humans here, so as you said, minimally invasive, smaller, it's just much better for little people, but what conditions would you typically think of using it for?

Mollie R. Freedman-Weiss, MD: So again, with robotic surgery, the benefit is really on the surgeon in ways. Because I get a three-dimensional visualization of what I'm operating on, which is a contrast to laparoscopy, which is two-dimensional. Also, my wrists only move so much. With robotic instruments, my wrist with the use of the robot have much greater range of motion and mobility.

So when I think about the conditions that are best treated with robotic surgery, I think about those parts of the body where I really need that 3D visualization, where I really need that extra dexterity and ability to kind of go into a crevice or an area that's harder to reach. In Pediatric Surgery, that can be areas in the pelvis such as the rectum and the colon. Or in women and female patients, the ovaries. In Pediatric Surgery, we do operate on the ovaries actually quite often. And the robot is very helpful for that.

Other areas that we like to use the robot is with things that have to do with the liver or the gallbladder. So for example, we do a lot of robotic cholecystectomies or taking the gallbladder out for various reasons, whether the patient has gallstones or whether the patient has sickle cell or some issue where they're breaking down their red blood cells and creating a lot of stones and issues with their gallbladder. Similarly, we use the robot for rarer things, like things called choledochal cyst in older patients.

Lastly, one of the more common ways we'll use it is with inflammatory bowel disease and Crohn's disease to take out a segment that may have a long stricture or a lot of inflammation that's causing problems. But it's a really great tool that we can use when we operate on the diaphragm, the stomach, areas in the lung. So, it's really a tool that we would say, could this be used in this situation?

Now in Pediatric Surgery, we operate on the very, very, very little from premature babies to fully grown teenagers. And the robot is not appropriate for those really, really, really little babies, but we certainly can apply it to younger children. And so, I think the use of it is really broad.

Melanie Cole, MS: Thank you for telling us that. And I love those really, really little babies. They're so awesome. Anyway... So, thank you for telling us about the advantages of robotic surgery in pediatrics for the physician and the ergonomic advantages for you as physicians. What about for the patients themselves, the benefits? Do they aid in recovery? Do they make the surgery just a little bit easier for them?

Mollie R. Freedman-Weiss, MD: It's a great question, and the answer is partially yes, partially they may not even notice a difference. So, partially yes, because with the robot, we may not have to mobilize the colon as much. We may be able to keep things in their place, not move as much of the intestine in and out of the body. And for those surgeries, things like ileocecectomies for Crohn's disease.

The patient will have a huge benefit. Their recovery will be faster. They may be up and moving and eating a little bit sooner after surgery. Their incisions will be smaller. For things like gallbladders where we are very comfortable doing them laparoscopically as well, it might be a faster surgery with the robot. But the recovery will probably be about equivalent. I think, depending on the surgery, it may be that they recover a little bit faster, or it's just a safer, more precise surgery in the operating room.

Melanie Cole, MS: Dr. Freedman-Weiss, as one of the few hospitals in New York City to offer this service, tell us a little bit more about the surgery itself and the team that's involved when you're doing this.

Mollie R. Freedman-Weiss, MD: So, the surgery itself will look very similar coming to the hospital for any other surgery. We'll ask them to fast for several hours before the surgery. We'll meet you again in the preoperative area. You'll meet the team. You'll meet me if I'm operating with one my partners, you'll meet one my partners. You'll meet the rest of the surgery team and then the nursing team and anesthesia team.

And then, you come back to the operating room. And your child, and usually the parents are with them, will be there as they go off to sleep. And once the child is completely asleep, that's when we put the IVs in and get set up for the robotic case. The team includes somebody who's always at the bedside with the patient. I'm at the bedside as we get set up and get the robotic instruments in place. And then, I go over to a console, which is just a few feet away where I can control those iinstruments with my hand. And there's other people in the room, like techs and nurses who are very facile with the robot and help us move it around and help us with any issues that might come up. And so, there's a huge team of robotic experts really to help take care of your baby.

Melanie Cole, MS: Then what happens afterward? How soon do the parents get to see their child?

Mollie R. Freedman-Weiss, MD: We like to have the parents in the recovery room as we're coming out the operating room, so your child won't have a breathing tube and will be waking up, will still functionally be like they're taking a nap. And you'll be there through their sort of emergence from anesthesia.

Melanie Cole, MS: Dr. Freedman-Weiss, this is really exciting technology, and certainly for our little kiddos. It's really amazing what you're doing there, what qualifications or training should parents be looking for? What did you have to do? What is the learning curve on using these robots?

Mollie R. Freedman-Weiss, MD: More and more people are training to use the robot throughout their surgical training. So for example, I spent seven years at Yale doing general surgery, which was mostly adult general surgery. And throughout that time, I did about 50 to a hundred operations using the robot. And throughout those operations as well as courses designed to help teach and train people using the robot as well as hours and hours and hours and hours on the robotic simulator before we get to the patients. I was able to get my robotic surgery credentials. I then spent two years at Johns Hopkins doing my pediatric surgery fellowship where, in addition to just operating on babies 24/7, I was able to apply what I learned in the adult population from my adult robotic surgery training to the pediatric population, and I was able to continue to do many, many, many robotic pediatric surgeries to get my credentials to operate here at Cornell on a wide range of patients using the robot.

Melanie Cole, MS: Wow, you're really cool. I mean, that is a lot of training and it's really just awesome technology. Do you see it, Dr. Freedman-Weiss, becoming more of a wider patient selection to be using the robots for various conditions?

Mollie R. Freedman-Weiss, MD: I think so. I think as we get access to more robots as word gets out, it's very possible that we could use it for everyday things like appendectomies. Now, I do think in pediatric surgery, we're a little bit limited by patient size because again, it's not fully appropriate for the tiny tiniest of children. But I think as the technology changes and they come up with more and more resources for the smaller patient sizes, that it will be applied much more broadly for sure.

Melanie Cole, MS: Isn't this an interesting topic and what a time in your field, really an exciting time. As we get ready to wrap up, what would you like to tell parents, Dr. Freedman-Weiss, to expect not only with pediatric robotic surgery, but surgery in general? It's such a scary time for parents when their kids have to go in for surgery. I have been there and it's just frightening. What would you like to tell parents about your expertise, your team's expertise, and why they shouldn't worry as much because you're there for their little kiddos?

Mollie R. Freedman-Weiss, MD: Well, I would say it would be abnormal if I met a parent who wasn't worried about their child getting surgery. It's your job as a parent to worry and make sure that everything goes perfectly, but it's also my job to make sure that your child is in the safest hands at the safest place. And I always say surgery is a team sport. There are so many people, so many experts involved in the care of your child that for every one child, there's five or six people involved. People with years and decades of experience and training. And we would never take your child to the operating room unless we felt perfectly confident that we would do an excellent job of taking care of them and keeping them safe the whole time.

So, I always tell parents when I meet them in the office, and I remind them when I meet them in the preoperative area, I'm with them by their side from the moment they go off to sleep, to the moment that they wake up, at which point I can come talk to the parents. But I think it's very normal. It's very human to be terrified when your child goes off into somebody else's hands and you have no control over that. So, I think pick a surgeon, a group, a practice, an institution that has a tradition of safety, that has a culture of safety that you feel really comfortable and good with, and know that they're in great hands.

Melanie Cole, MS: That is great advice. Great information. And I can hear and see the passion and compassion with you. I bet your patients just absolutely love you. Thank you so much for joining us today and sharing your incredible expertise for parents. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcast, Spotify, iHeart, and Pandora. And for more health tips, go to weillcornell.org and search podcast. We have so many great ones there, including Back To Health, a lot of great ones there. I'm Melanie Cole. Thank you so much for joining us today.

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