Hiep Nguyen, MD, practices with the robot.
Thirteen-year-old Adam Ravenelle isn't one to sit on the couch. The Sudbury, Mass. teen is an athlete, playing competitive baseball, basketball and soccer, a musician, playing trumpet for his school's band, and an accomplished student. So, when an undetected UPJ (ureteropelvic junction) obstruction inflated his kidney pelvis to three times its normal size and doubled him over in pain last August, his parents quickly researched the best way to keep him healthy and active.
Their research brought them to Children's Hospital Boston, where urologist Hiep Nguyen, MD, introduced them to the da Vinci Surgical System, also known as "the robot." By using the robot to reconstruct Adam's obstructed ureter, Nguyen offered the best of two surgical worlds—the precision of traditional surgery and the quick recovery from a minimally invasive procedure.
On November 9, Nguyen sat at the da Vinci console, a few feet away from Adam, where the surgeon viewed a three-dimensional internal image of his patient and maneuvered the system's three robotic arms. The entire procedure took approximately six hours, comparable to traditional surgery. The biggest difference was that by 6 p.m. the following day Adam was heading home where he recovered quickly and only missed one day of school. Three weeks later, he was back shooting hoops for the Curtis Cougars. Had he undergone the same procedure using traditional surgery, his recovery would have been three to four times longer.
"Making the decision to have major surgery wasn't easy because Adam had been almost completely asymptomatic," says Adam's mother, Edie Ravenelle. "In researching our options, we ultimately chose to proceed with the robotically-assisted pyeloplasty so Adam wouldn't risk future kidney damage or episodes of pain. Adam's age, the surgery's success rate and quicker recovery time made robotic surgery a good fit."
"Surgeons are using robots to perform more difficult surgeries than traditional minimally invasive technologies have allowed," says Nguyen, who was recently named co-director of Robotic Surgery and director of Robotic Research at Children's. In Urology alone, such procedures include complete and partial kidney removal, uretral reconstruction and correction of undescended testes.
A team led by Nguyen and urologist Joseph Borer, MD, the other co-director of Robotic Surgery, are also looking forward to the publication of several papers presented at the annual meeting of the American Urological Association in May, reporting data such as robotic surgery success, narcotic use as it relates to robotic surgery, as well as patients' return to school, and parents' return to work following robotic procedures.
The first institution in the country to introduce this technology for use in pediatric patients, Children's specialists have used the robot for procedures in Urology, Cardiology, Otolaryngology and General Surgery, and are developing applications for Neurosurgery and Fetal Surgery. In 2005, Children's surgeons trained in this technique performed 45 robotic surgeries. Thirty-six procedures have already been performed this year, and Nguyen expects the trend of growth to continue.