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, Dr. 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, Dr. 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. "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 Dr. Nguyen, who was recently named co-director of the Center for 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.
Developed by Intuitive
Surgical, the robot directly transcribes the surgeon's
handiwork at the console to "EndoWrists," which
replicate the surgeon's wrist joint movement, rotating as much as 270 degrees, and
allowing for the precise
movement of miniature surgical instruments introduced into the body through incisions as small as 5 millimeters.
"Reconstructive surgery was previously very difficult to perform with minimally invasive procedures," explains Dr. Nguyen. "Now, complicated repairs requiring dexterous
movements on the part of the surgeon are possible in the laparoscopic realm. The da Vinci system's two cameras allow for much better visualization, and the instruments are far more flexible."
A team led by Dr. Nguyen and his co-director, urologist Joseph Borer, MD, is also looking forward to the publication of several papers, 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.
"Generally speaking, there is less narcotic use and much quicker
recovery," says Dr. Nguyen. "And the surgical outcomes are comparable to that of traditional surgery."
Children's was the first institution in the country to introduce this
technology for use in pediatric patients. Our 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 Dr. Nguyen expects the trend of growth to continue.
