Pediatric Laparoscopic and Thoracoscopic Surgery
Initially, a small hole is made in the belly button to put a telescope and to infuse gas (generally carbon dioxide) into the belly. This inflates the belly and gives working space to the surgeon. Then through small holes, instruments are put to perform the procedure. A camera is attached to the telescope and is used to watch the procedure on a monitor in a magnified and more precise way. At the end of the surgery, the instruments are removed from the belly and one or two stitches are put within the skin to finish the procedure. These stitches need not be removed. It is amazing how extensive procedures can be performed with 3-4 key hole punctures.
For Thoracoscopic Surgery the key hole punctures are made in the chest in between the ribs to allow entry of tiny instruments and the telescope.
Pediatric Laparoscopy and Thoracosocpy is now available and can be safely used even in new born babies and children.
Common Conditions Managed by Laparoscopy in children are :
Hernias ( Usually a painless lump in the groin, on one side or both sides, which disappears when child is at rest and reappears on crying, passing urine etc. It can be dangerous if it is painful and not reducing and may need emergency surgical intervention.)
Undescended Testis ( Empty Scrotum either on one side or both sides – testis usually inside the belly – needs Surgery before 1 year of age for best results.)
Ano Rectal Malformations ( Abnormal location or absence of anus in boys or girls. Noticed soon after birth. May need staged operations for best results.)
Cardia Achalasia ( Difficulty in swallowing food due to a narrowing of lower end of food pipe.)
Acute Appendicitis ( To remove an acutely inflamed appendix or an already burst appendix.)
Empyema Thoracis ( Pus in the chest cavity. Early Thoracoscopic intervention can prevent many complications.)
Diaphragmatic Hernia ( Intestines usually migrate into the chest and cause respiratory compromise in the new born. Life threatening if lungs are immature.)
Choledochal Cyst Excision ( The pipe draining Bile from Liver to the Intestines is abnormal and causing damage to liver due to improper drainage.)
UPJ obstruction – Pyeloplasty ( The pipe draining urine from kidney to the bladder is partly obstructed near is origin causing a poor function of the affected kidney.)
Hirschsprung Disease – Intestinal Obstruction ( In selected cases in our country a single stage operation is possible. )
Diagnostic ( To diagnose unknown condition causing abdominal pain without cutting open the belly. )
Pediatric Bronchoscopy & Esophagoscopy
A bronchoscopy is a test performed to view and diagnose problems in the air passages and lungs. The examination is done using a bronchoscope, a device used to see the interior of the lungs without making any cuts on the body. Bronchoscopes can be either flexible or rigid. A Rigid Bronchoscopy is more frequently used in children as it allows more space to introduce working instruments. The Common indication of a bronchoscopy in children is a foreign body in the airway. Children tends to put everything in their mouth and inadvertently some small food particles or non food items slips into the wind pipe causing sudden choking. It can be life threatening and needs immediate bronchoscopy for the removal of the foreign body to save life. The examination can also be used to diagnose many other pulmonary conditions. The child is put to sleep for this procedure (General Anesthesia)
In children Esophagoscopy is also done under general Anesthesia and usually done to retrieve struck objects like coins, plastic whistles etc.
It is also used to widen the food pipe if due to any reason, congenital or acquired, some length has got permanently narrowed (stricture).
Pediatric Endo-Urology and Urology
Pediatric Endourology Techniques comprehensively cover many Urologic problems in children which can be managed without any cut on the skin. Majority of Endourology procedures are done through natural orifices of the body by very fine slender instruments whereas some procedures can be done by Minimal Access Surgery (Key hole Incisions) to minimize pain and discomfort.(Laparoscopic Endo urology)
These include a Cystoscopy, Management of Posterior Urethral Valves, Strictures and Stones in urinary tract, Ureteroceles, STING for Vesico Ureteric Reflux etc.
Many reconstructive Urology Operations are done by open method also which include Hypospadias (Urinary hole is not at its normal place but on the under surface of the penis), Exstrophy Epispadias, Pyeloplasty for UPJ Obstruction, etc.
Neonatal Surgery consists of the surgical care of newborn infants, especially those born with birth defects(Congenital Malformations). It is a hospital-based specialty, and is usually practiced in neonatal intensive care units (NICUs). Pediatric surgeons are specially interested in this field and many a challenging cases are given a new lease of life due to hard work and good surgical acumen of the pediatric surgeons and the neonatologist. The anaesthetists and well trained NICU staff also contribute to the survival of neonates in a big way.
Pediatric Neuro Surgery
Neurosurgery (or neurological surgery) is the specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spinal cord and the peripheral nerves.
Hydrocephalus and Meningomyelocele are the common conditions in new born and they can be easily managed by Pediatric Surgeons in the most optimum way.
General Surgery in pediatric age group
General surgery in Pediatrics deals with general operations in infants, children, and adolescents. The age limit usually ranges from birth up to 18 years.
A Pediatric Surgeon usually manage the cases of Hernia, Appendicitis, Laparoscopic procedures, Undescended Testis, Trauma etc.
Pediatric Plastic Surgery
Pediatric plastic surgery is plastic surgery performed on children. Its procedures are most often conducted for reconstructive or cosmetic purposes. In children, this line is often blurred, as many congenital deformities impair physical function as well as aesthetics. Children make up roughly 3% of all plastic surgery procedures, and the majority of these procedures correct a congenital deformity. Examples of Pediatric plastic Surgery are Repair of Cleft lips and palate, Hypospadias Repair, Management of burns or scalds, Revision of Scars in children etc.
Pediatric Cancer surgery is surgery performed on children who are suffering from solid tumors. Depending upon the cancer identified, Radical or palliative surgery is usually done.
e.g. : Wilm’s Tumour, Rhabdomyosarcomas, Neuroblastoma.
Pediatric trauma refers to a traumatic injury that happens to an infant, child or adolescent. Because of anatomical and physiological differences between children and adults the care and management of this population differs. There are significant anatomical and physiological differences between children and adults. For example, the internal organs are closer in proximity to each other in children than in adults; this places children at higher risk of traumatic injury.
Pediatric & Neonatal Surgical Intensive Care
A Neonatal or a Pediatric Intensive care Unit It is Equipped with state of the art equipments like Radiant Warmers, Patient Monitors, Phototherapy, Neonatal and infant ventilators etc. It is also manned by well trained and expert staff for round the clock care of critical patients.
Endoscopic Treatment of Vesicoureteral Reflux
Deflux Injection For VUR Available Here.
Avoid Major Surgery Save Kidneys From Reflux Disease.
In endoscopic treatment of vesicoureteral reflux, or VUR, the doctor uses a special viewing device, called a cystoscope, to see inside the bladder. The cystoscope is inserted through the urethra, the opening through which urine leaves the body. Then the doctor injects a small amount of a substance, called Deflux, into the wall of the bladder near the opening of one or both ureters, the tubes that carry urine from the kidney to the bladder. This creates a bulge in the tissue, making it harder for the urine to flow back up the ureter to the kidneys. There are no incisions made in the abdomen for this procedure.
Who can have this procedure?
Based on the success rates, this procedure is recommended for children with grade II, grade III, and possibly grade IV reflux. The treatment should not be used in patients who have:
- Two kidneys that don't work at all
- An abnormal pouch in the bladder wall
- An extra ureter (the tube that carries urine from the kidney to the bladder)
- Active urinary tract infection
- Active voiding dysfunction, or abnormal emptying of bladder