Pediatric Minimally Invasive Surgery
While doing this website and my FaceBook page, I have come in contact with many World Class Surgeons, and I have chatted with hundreds over the last year 2017, trying to understand what they do as a job, and how they go about it, what in their view is the next step forward for the Children and adults like myself.
One thing has come up, as a topic, this has been about thoracic surgery, it is minimally invasive surgery, now if you’re like me you will be on google now trying to understand what I am talking about. It’s a set of techniques that allow a surgeon to operate through very small incisions. It involves the use of a surgical telescope (a small tube with a camera) and specially-designed instruments. This got my interest and I started to ask more question from the Doctors I had come to know. I then started to understand that a surgeon also may use computers and high-resolution video cameras.
Depending on the condition being treated, minimally invasive surgeries can be endoscopic (using a scope to see the digestive tract), laparoscopic (using a scope to see into the abdomen) or thoracoscopic (using a scope to see into the chest area). Having a child go through this type of surgery come’s a few big benefits which are, the incisions are small, patients experience less pain and scarring, there’s also less risk of infection, even gastroesophageal procedures like Nissen fundoplication for reflux, can be done. Because of this, I wanted to know more.
I have been involved in getting a Child from South Africa to the world famous Children’s Hospital in Boston USA, took three months, I personally gave the parents the email address of Miss South Africa, and a Famous DJ’s personal mobile phone number, from Johannesburg, this started the ball rolling for the Family who then worked very hard to raise the money for the child to reach, Dr. Jennings team.
So I started to ask more questions why does every Parent need to go to Boston, for Parents to raise the amount needed there had to be other Hospitals and teams around the world that could offer the same, or better? (I am not knocking Boston, I am thinking) The Focker procedure means major surgery, and long stay in a Hospital, bringing strain on any Family unit.
I needed to understand more about thoracic surgery, more question more time spent on my computer, then a name started to come up a lot from my google searches and the Doctors I was talking to. A Surgeon who didn’t like the tools he had to hand, adult ones for use on Children? but no company made Children size. So he set about making a company that did. When he started in this medical field, he was among a handful of surgeons worldwide performing minimally invasive surgery on infants and children. Until 2010, adult-sized instruments were the only surgical devices available for use in pediatric procedures. The large instruments interfered with a surgeon’s ability to clearly see and access the surgical site. To address this issue, he worked with a well-known medical device company to develop smaller instruments. Unfortunately, they weren’t able to develop all of the tools because of low market demand. So he co-founded a company to develop these devices. Occasionally, a child needs conventional surgery due to a quirk in anatomy or physiology. For the most part, pediatric minimally invasive surgery is their go-to method because it greatly improves a child’s immediate and long-term results. His team of surgeons has special expertise in neonatal laparoscopic surgery for newborns. They operate on babies who weigh as little as two pounds.
The team Dr. Steve Rothenberg has set up are Doctors Saundra Kay, Kristin Shipman and Sarah Lai, and himself work together to provide the latest techniques to other Pediatric surgeons from across the country and around the globe come to observe and learn the surgical techniques that he and his colleagues have pioneered. With his skilled partners in Denver, he is able to travel worldwide to teach the techniques to other surgeons. He is on the staff as professor of clinical surgery at Columbia University. Every month, he travels to New York City to teach these techniques to attend physicians so they can pass along the knowledge to surgical trainees.
Dr. Steve Rothenberg Talks you through this while he performs a thoracoscopic repair of a Type III Tracheoesophageal Fistula in a 2.6kg infant using the 3mm JustRight Sealer. I read something that I have had to recheck to make sure it was right. Dr. Steven Rothenberg, actually started helping design pediatric surgery instruments in about 1997, 2 yrs before he did the first thoracoscopic TOF.
Minimally Invasive Surgery for Children
When you want your child to be better, faster.
For every surgical patient (including newborns), our first question is always, “Can we use minimally invasive techniques to improve his/her immediate and long-term results?”
The minimally invasive surgery (MIS) program at RMHC offers new options for exceptional care, reduced pain, lower complications and a faster return to normal activity.
Minimally invasive is a term used to describe a way to perform many types of surgery. Our team utilizes advancements in technology and technique, many of which were pioneered by RMHC surgeons and now used worldwide, to successfully treat your child in the manner least disruptive to the body – meaning lower rates of complication, faster recovery, and reduced scarring.
He has been involved in many worldwide firsts involving minimally invasive procedures, including the first minimally invasive surgical repair of tracheoesophageal fistula and esophageal atresia in newborns. This is a serious condition where the esophagus and trachea don’t properly connect. It allows fluids to enter the airway and can interfere with breathing. They are now the world leaders in using minimally invasive procedures to correct this problem.
For more on this
In December 2017
Thoracic surgery at its best.
In December 2017 I was able to link together a Family with a child with long gap esophageal atresia, they wanted to fly halfway across the USA, yet 4 hours up the road was the hospital that could carry out the surgery their baby needed, and it was a new way of looking at this. At first, I didn’t think they would trust me enough to change their plans, but they took my advice and had their child taken to the Hospital that my intensive research had lead me to, Rocky Mountain Hospital for Children, link below.
I was in contact with the Family while they were in this Hospital, this was the info MUM shared with me. It was a long gap. 6 vertebrae I believe. Or 3cm. from Mum, I know the photo says fistula repair but he had no fistula. Just pure esophageal atresia.
He went into his first surgery on the 7th December 2017 and then surgery again on the 10th. (I found them looking for a Hospital who could undertake a long gap repair, but were struggling to find one until I told them about my research). Photos are from Mum. What I want you to look at is the size of the scar for a long gap repair, also note the child was due to leave Hospital before Christmas day meaning the child was in Hospital less than three weeks.
Makes USA TV Click the link below to see. Under Video, you can read more.
“We got really lucky that we found who we did,” said MUM.
To make my point here.
And I understand that the scars are healing better over time, these Parents have allowed me to use this photo of their Daughter, the info also sent was, She has TE Fistula and Esophageal Atresia. This was diagnosed at birth and she had her repair done at 23 hours old (October 8, 2013) here in Texas, USA. The surgeon, Dr. Barry Cofer, was able to do the connection during that surgery and she spent 5 weeks in the NICU learning how to eat. She has had several dilations done, but they have decreased as she has gotten older. She does have difficulties with swallowing since her esophagus doesn’t push the food down well. Her surgeon is located in San Antonio, Texas USA
This Photo is the child at 5 years old, with a much bigger scar.
This is Five Months after Dr. Steven Rothenerg did a thoracic surgery on this child, you can see NO SCAR.
Dr. Steve Rothenberg and his team can be found here.
Esophageal Atresia and Tracheoesophageal Fistula Treatment, Denver
Esophageal Atresia (EA) is the 25th most common birth defect, presenting in about 1 in 4,000 live births. It occurs when the esophagus (the tube connecting the mouth to the stomach) forms abnormally. It often is associated with tracheoesophageal fistula (TEF) in which the esophagus is connected to the trachea (windpipe). The experts at Rocky Mountain Hospital for Children are skilled in diagnosing and treating this condition. Our staff is specially trained to care for the needs of an EA and TEF newborn, and the pediatric surgeons of Rocky Mountain Pediatric Surgery are highly experienced in correcting this issue surgically.
This Quote from a world Leading Surgeon lead me to find Doctor Steve Rothenberg, (Look for Steven Rothenberg, he is a pioneer in thoracoscopic repair of esophageal atresia)
Meet the Doctor behind my Search
Dr. Steve Rothenberg,
Read This a medical paper on a TEF repair done via, thoracic surgery with photos
Improvements in fetal imaging have led to increased prenatal diagnoses of this condition. Prenatal ultrasound findings include a small or absent stomach bubble and polyhydramnios. After birth, patients with EA and distal fistula typically present with excessive salivation and regurgitation with feeds, respiratory distress, and an inability to pass an orogastric tube. Plain films demonstrate a nasogastric tube coiled in the upper esophageal pouch. Air in the stomach and distal bowel confirms the presence of a distal fistula. For H-type fistulas, patients usually choke with feeds or have cyanotic spells. Older infants may present with recurrent pneumonia. In isolated TEF, chest x-rays may show pneumonitis and gastric distension. The diagnosis may be made with a prone, pull-back esophagram. Surgical intervention is required to establish esophageal continuity as well as prevent aspiration and overdistension of the stomach. The minimally invasive approach to repair TEF is becoming increasingly popular and widespread. The first successful thoracoscopic repair of an esophageal atresia with distal TEF was performed in 2000 by Rothenberg.3 Subsequently, many series have been published demonstrating the feasibility of this technique.
Surgical Equipment for Pediatric Surgeons
JustRight Surgical equipment for pediatric surgeons
I have looked into this company and decided to post them here because to have a company making specialized equipment to work with very small Children has earned my respect.
JustRight Surgical, making a big difference in the lives of small children.
In the last 25 years, the general surgery market has made huge advancements in instrumentation and technology allowing for vast improvements in the quality of care given to patients. These products focus primarily on the adults, leaving the pediatric patient behind. Our most precious resource, our children, have been completely ignored.
Today’s pediatric surgeons have had to use open and minimally invasive instruments that were designed for adult patients, meaning instruments are routinely five to seven times the optimal size. This creates access, visualization, and mobilization issues. Pediatric surgeons have been forced to modify surgical procedures, instruments or both, leaving a tremendous, worldwide need for right-sized devices. manufactures and markets mini-laparoscopic instruments specifically engineered with the pediatric patient in mind. Our company proves that we can bring clinical solutions to the pediatric surgical community. Our goal is to deliver right-sized devices that can be used across varying surgical procedures. By collaborating with the pediatric surgical community, we continue to address surgeons’ and patients’ needs by downsizing existing technologies.
To demonstrate our commitment to pediatrics, JustRight Surgical was the first company to submit and receive clearance from the FDA for a pediatric-specific electrosurgical device. We subjected our 3mm vessel sealer to rigorous testing and it proved to be safe for use in extremely tight or small spaces found in teens, children, infants, and neonates. The new, low-power vessel sealing technology permanently fuses vessels while delivering significantly less energy. It was determined to be safe and effective for use in the smallest patients without risk of damaging critical, adjacent structures.
The Company behind an idea