For the first time, a surgical robot has been used to perform minimally invasive reconstructive surgery on five children whose bladder was dysfunctional because they were born with spina bifida [incomplete formation of the spine or spinal cord].
Researchers who presented a study at the 2009 Clinical Congress of the American College of Surgeons concluded that robotic surgery made it possible for the children to avoid the pain associated with a conventional operation. "Postoperative pain can be an issue with open surgery in these patients because surgeons cut the abdominal muscles and the surgery is extensive. But physicians can't give much morphine to control the pain because morphine dilates the intestines and recovery is slow. Another way to take care of postoperative pain is to give epidural analgesia, where you put a catheter into the spine and then administer the pain medication. But patients with spina bifida have a spinal column problem, so epidural drugs cannot be administered," explained Mohan S. Gundeti, MBBS, MCh, FRCS (Urol), FEAPU, assistant professor of surgery and pediatrics and chief and director of pediatric urology at the University of Chicago Medical Center Comer Children's Hospital.
The patients who underwent the robotic surgery required only 24 to 36 hours of post-operative oral analgesic treatment. The patients also recovered quickly. The children were started on a liquid diet less than eight hours after the operation and began eating regular food within a day.
Many aspects of the robotically assisted surgery were similar to those done during an open procedure. The surgeons increased the size of the bladder by adding a section of intestine. They created a new connection between the bladder and the skin by using the appendix, which was detached from the caecum with its blood supply intact, turning it into a tube and attaching one end to the bladder and the other to the lower right side of the abdomen.
However, the robot allowed the surgeons to decrease the size of the surgical incision. Instead of the standard eight to ten-inch long muscle-cutting, abdominal incision, the surgeons made four to five one-half inch incisions through which they inserted tiny cameras and robotic surgical instruments. The surgical robot provided a clear three-dimensional view of the surgi-cal field, and it helped the surgeons make the small and precise movements needed to guide the manipulation of the instruments in hard-to-reach areas.