Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Surgeons perform world's first pediatric robotic bladder reconstruction

24.11.2008
A 10-year-old Chicago girl born with an abnormally small bladder that made her incontinent has become the first patient to benefit from a new robotic-assisted bladder-reconstruction method developed by surgeons at the University of Chicago Medical Center.

The surgeons describe their innovative technique in the December 2008 issue of the journal Urology. They have now performed the operation, using the DaVinci robotic surgical system, six times, with good results and no significant complications.

The first patient, treated Feb. 21, 2008, suffered from a very small, spasmodic bladder, a birth defect that led to gradual kidney damage and loss of urinary control.

"We refer to this condition as neurogenic bladder," said team leader Mohan S. Gundeti, MD, assistant professor of surgery and chief of pediatric urology at the University of Chicago's Comer Children's Hospital. "Her bladder could barely hold six ounces. Worse, it produced frequent involuntary contractions, which forced the urine back up into the kidneys, where it slowly but inevitably causes damage, including frequent infections."

The girl always felt that she urgently had to go to the bathroom. She stopped drinking juice or soda. She even cut back on water, to less than two cups a day. Medication helped a little, but despite two years of trying different treatments, the problem continued to get worse and began to cause kidney damage, which made surgery necessary.

Although Gundeti had performed the operation to enlarge and relax a tiny spasmodic bladder many times, it had never been done robotically--an approach that has produced quicker recovery, less pain and minimal scars in other procedures.

"This is a major, lengthy operation," he said, "essentially five smaller procedures done in sequence."

Known as an augmentation ileocystoplasty with Mitrofanoff appendicovesicostomy, the surgery normally begins with a big incision, about six inches long, from above the navel down to the pubic area, followed by placement of retractors to pull the stomach muscles out of the way.

"The robotic approach enabled us to avoid that entire incision, which causes significant post-operative pain, presents an infection risk and leaves a big scar," Gundeti said.

Instead, the robotic tools enter the abdomen through five small, dime-sized holes. In this operation, the surgeons use about 12 inches of intestine to reconstruct a larger bladder, "more than twice the original size," said Gundeti. "Plus, it can no longer contract with the same force."

Then they converted the appendix into a "continent conduit," a drain for the new, expanded bladder, with one end implanted into the wall of the bladder and the other end leading outside the body through small outlet in the lower abdomen. A skin flap covers the fleshy appendix opening.

"No one had ever done the full operation this way," Gundeti said. "It requires a lot of familiarity with both the open operation and considerable laparoscopic experience."

This first case took about ten hours, compared to six-to-eight hours for an open procedure. The team included Gundeti and adult urologists Arieh Shalhav and Gregory Zagaja, as well as follows, residents and the nursing team. The team was able to reduce OR time in the subsequent cases.

After such a long, complicated operation, "I expected my daughter to be covered with bandages and gauze and tape, to have a big swollen belly with a big wound," the patient's mother recalled. "But there was none of that. I was stunned. Her belly was flat and normal, no bandages, not even a band-aid, just a few little cuts that looked like they had been covered with glue. Oh, I thought, she's going to like this. No big scars. She could wear a bikini."

"I would not want her to wear a bikini," she added, "but she could."

"Patients like surgery without significant scars," Gundeti said. "We also hope to show that in addition to the benefit of no big wound to heal, just five small punctures, there is less risk of infection, quick recovery and less pain."

Pain management for this case consisted of oral medications, rather than the traditional morphine and epidural anesthesia, which is contraindicated in young patients who have had previous spine surgery.

The patient started drinking clear liquids six hours after surgery and eating within 24 hours, which she "greatly appreciated," Gundeti said. She went home about four days after her surgery and within six weeks was completely continent, day and night. "This is a great benefit for the child and her family," Gundeti said.

Although she still has empty her bladder with a regular catheter, it is now easier to do and is far more reliable at retaining urine.

"She hasn't had a leak since then," her mother said. "She can drink water, or juice, even soda. She's enjoying the freedom she never had."

John Easton | EurekAlert!
Further information:
http://www.uchospitals.edu

More articles from Medical Engineering:

nachricht Reinforcement learning expedites 'tuning' of robotic prosthetics
18.01.2019 | North Carolina State University

nachricht Powerful microscope captures first image of nanoscaffold that promotes cell movement
14.01.2019 | Sanford Burnham Prebys Medical Discovery Institute

All articles from Medical Engineering >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Bifacial Stem Cells Produce Wood and Bast

Heidelberg researchers study one of the most important growth processes on Earth

So-called bifacial stem cells are responsible for one of the most critical growth processes on Earth – the formation of wood.

Im Focus: Energizing the immune system to eat cancer

Abramson Cancer Center study identifies method of priming macrophages to boost anti-tumor response

Immune cells called macrophages are supposed to serve and protect, but cancer has found ways to put them to sleep. Now researchers at the Abramson Cancer...

Im Focus: Ten-year anniversary of the Neumayer Station III

The scientific and political community alike stress the importance of German Antarctic research

Joint Press Release from the BMBF and AWI

The Antarctic is a frigid continent south of the Antarctic Circle, where researchers are the only inhabitants. Despite the hostile conditions, here the Alfred...

Im Focus: Ultra ultrasound to transform new tech

World first experiments on sensor that may revolutionise everything from medical devices to unmanned vehicles

The new sensor - capable of detecting vibrations of living cells - may revolutionise everything from medical devices to unmanned vehicles.

Im Focus: Flying Optical Cats for Quantum Communication

Dead and alive at the same time? Researchers at the Max Planck Institute of Quantum Optics have implemented Erwin Schrödinger’s paradoxical gedanken experiment employing an entangled atom-light state.

In 1935 Erwin Schrödinger formulated a thought experiment designed to capture the paradoxical nature of quantum physics. The crucial element of this gedanken...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Our digital society in 2040

16.01.2019 | Event News

11th International Symposium: “Advanced Battery Power – Kraftwerk Batterie” Aachen, 3-4 April 2019

14.01.2019 | Event News

ICTM Conference 2019: Digitization emerges as an engineering trend for turbomachinery construction

12.12.2018 | Event News

 
Latest News

How our cellular antennas are formed

22.01.2019 | Life Sciences

Proposed engineering method could help make buildings and bridges safer

22.01.2019 | Architecture and Construction

Bifacial Stem Cells Produce Wood and Bast

22.01.2019 | Life Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>