Little miracles: The benefits of minimally invasive surgery

If your child needs surgery, you want the procedure to be as quick and pain-free as possible. In many cases, minimally invasive surgical procedures lead to faster recovery and less stress for the patient, and the parents.

“Minimally invasive surgery offers pediatric patients a host of benefits in comparison to traditional open surgery,” explains Eric Jelin, M.D., a pediatric surgeon with Johns Hopkins General Pediatric Surgery, located at Greater Baltimore Medical Center, and director of the Johns Hopkins Children's Center Fetal Program. “It allows our patients to have smaller incisions and scars, and also less pain. This enables them to get moving after surgery more quickly, and, in general, have a speedier recovery.”

By definition, “minimally invasive” refers to the use of a high-definition telescopic camera and light source that allow the surgeon to see and operate inside the patient’s abdomen or chest without making a large incision. Some of the most common minimally invasive pediatric procedures include appendectomies (appendix removal), cholecystectomies (gallbladder removal), splenectomies (partial or complete spleen removal), intestinal reconstruction, inguinal hernia repairs and treatment of chest wall deformities.

“To create a space to work, the body cavity the surgeon is operating in is gently filled with air,” Dr. Jelin says. “Very small ports are placed in strategic locations in the cavity; these allow the surgeon to place instruments in and out to perform the operation.”

Most babies and children are candidates for minimally invasive procedures unless they’ve already had an extensive number of surgeries or face challenges with the air pressure. While minimally invasive approaches are used for both pediatric and adult patients, the pediatric procedures use smaller cameras, ports and instruments.

Jeffrey Lukish, M.D., pediatric surgeon and associate professor of surgery at Johns Hopkins, says the goal of minimally invasive surgery is to safely repair or remove an abnormal structure or diseased organ through a small opening measuring just 3 to 5 millimeters — about the width of two to three pennies.

“Traditionally, we would have to make an incision in the adjacent structures, such as the abdominal wall or chest wall, via a large opening of 10 to 15 centimeters (4 to 6 inches) to provide access,” Dr. Lukish says. “Minimally invasive surgery allows the pediatric surgeon to expose, repair or remove diseased organs without injuring normal tissues in the process.”

In addition to faster healing, less pain and quicker recovery times, minimally invasive procedures offer a clear cosmetic advantage for patients.

“Minimally invasive surgery usually results in nearly invisible scars,” Dr. Lukish says. “Patients don’t have the stigma of a large scar as a result of the repair, and parents don’t have to feel anxious about the surgical scar in the future.”

New technological advancements in miniaturizing cameras, instruments and ports offer the promise of even better minimally invasive surgical results for babies and children in the future.

“The ability to create digital imaging via 3 millimeter telescopic cameras is the key technical advance that’s resulted in a rapid expansion of minimally invasive surgery in infants and children,” Dr. Lukish says. “These small devices allow us to peer into even smaller infants and children.”

Both Drs. Jelin and Lukish attest to the value minimally invasive surgery has added to their own scopes of expertise.

“These advances in digital and electronic imaging technology have resulted in a completely new and innovative approach to treating infants, children and adolescents with surgical problems,” Dr. Lukish says. “In many ways, this technology has allowed me and other pediatric surgeons to offer more efficient, safer surgical procedures with outstanding outcomes.”

“It has been a vision of pediatric surgery at Johns Hopkins to partner with an outstanding community center like GBMC,” Dr. Lukish continues. “It is the only place in the state of Maryland performing minimally invasive thoracoscopic ligation of the patent ductus arteriosis (an open hole in the heart) on fragile preemie infants.”

“As a pediatric surgeon trained in both traditional open and minimally invasive surgery, I’ve learned that it’s critical to be skilled in both techniques,” Dr. Jelin adds.

“I love working at a place like GBMC where I have the support to offer state-of-the-art surgical care to patients who live nearby and am excited to be able to offer patients as small as 6 pounds the possibility of a less traumatic and less stressful surgery with equal, if not superior, results,” Dr. Jelin says.

 

—Amy Lynch for Greater Baltimore Medical Center

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