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Role Of Robotic Surgery In Children - Dr. Prashant Jain

Role Of Robotic Surgery In Children

This is an era of minimal-invasive surgery, which includes Laparoscopic Surgery and Robotic Surgery. Laparoscopic surgery has been used for more than three decades but still has its own limitations in the form of a long learning curve and limited range of movement, especially in children with small body cavities requiring reconstructive surgeries.

In robotic-assisted surgery (RAS), the surgeon sits beside the patient on a console and manipulates robotic arms with articulated instruments that are controlled by the surgeon’s hand. The surgeon’s hand movements are transmitted inside the patient's body to perform precise dissection and suture.

The RAS has the advantage of providing high definition and magnified 3D vision along with the 7 Degrees of freedom of movement.

This is an advantage, especially in children, because of their miniature size. This helps surgeons not only to perform surgery with great precision but also significantly reduces surgical stress.

Since 2002, when robotic surgery was started, its application in children has expanded in performing a wide range of pediatric urologist surgeries like pyeloplasty in pelvic-ureteric junction, obstruction ureteric reimplant in Vesicoureteric reflux, Heminephrectomy, Nephrectomy for renal tumors, etc. It is also being used now in Thoracic and gastrointestinal surgeries. RAS can be performed in all age groups, including newborns and infants.

The currently available studies suggest that the safety and outcome of RAS surgeries are almost the same compared to conventional surgeries.

Looking at the advantages of robotic surgery, it is important to make use of its benefits for the Paediatric population. RAS's safety and surgical outcome will undoubtedly revolutionize surgical management in children.

Tag = Best pediatric surgeon in Delhi, Best pediatric urologist in India, Pediatric Robotic Surgery in Delhi

For More Information http://www.pedsurgerydelhi.com/surgeries-treatments/pediatric-robotic-surgery/

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Thoracoscopic Surgery In Children: What Is It?

Thoracoscopic Surgery In Children: What Is It?

Thoracosopic surgery is a type of minimally invasive surgery that is appropriate for children who require surgery for a variety of chest diseases. Today, a variety of straightforward and complicated surgical chest problems are regularly treated with thoracoscopy. Small incisions allow for minimally invasive surgery, which prevents damage to the muscles and nerves of the chest wall. On the other hand, huge incisions like those utilized in open surgery are uncomfortable and may eventually result in chest wall deformities.

During a thoracoscopic surgery, to see the structures inside the chest, the surgeon uses a thorascope (a small tube with an eyepiece that the surgeon sees through during surgery) and/or an endoscope (a small video camera).

The surgeon can now do procedures that would often require big thoracotomy incisions by using an endoscope to view through them. In order to undergo surgery, patients must be put under general anaesthesia in an operating room.

What are the advantages of thoracoscopic surgery in children?

On the contrary, large incisions as used in open surgery are painful and can cause chest wall deformity in the long run. Patients who have had minimally invasive surgery report the following outcomes when compared to those of regular surgery:

Reduced postoperative discomfort

Reduction in hospital stay

Faster healing and return to work

Less bleeding and a lower chance of infection are two other advantages.

How does thoracoscopic surgery in children work?

Thoracoscopic surgery is carried out by paediatric laparoscopic surgeon. During this procedure, a small incision is made to allow the surgical team to introduce a trocar into an intercostal space. Pumping carbon dioxide into the thoracic cavity creates an interior area for the surgeon to work by separating the body wall from the organs. The surgeon next inserts a thorascope and/or endoscope to view the structures of the chest. The use of tiny instruments is made possible by a number of additional incisions or tiny ports.

For whom is minimally invasive surgery appropriate?

A minimally invasive procedure can be used to perform almost all conventional thoracic procedures.

If thoracic surgery needs to be done, a minimally invasive surgical approach is the first that is considered. However, some procedures are still best carried out using the conventional “open” method. Your surgeon will thoroughly examine you to decide the safest surgical procedure to be used to treat your ailment.

Various thoracoscopic surgery procedures:

Dr. Prashant Jain, one of the finest paediatric surgeons in Delhi, has had great success in removing chest malignancies using minimally invasive surgery. He also performs a few other procedures listed below:

Mediastinal tumor removal

Mediastinal cysts removal

Lung malformations

Empyema

Lung biopsy

Spontaneous Pneumothorax

How can I get a thoracoscopic surgery evaluation?

Your physical exam and treatment choices will be discussed when you visit the laparoscopic surgeon. He will go over the advantages and possible drawbacks of the surgery that is suggested for you.

Preoperative exams typically include:

Blood test

Pulmonary function test

MRI

Electrocardiogram

Depending on the kind of treatment being performed, your surgeon will decide if any extra preoperative testing is required. A cardiologist’s visit will be arranged if a cardiac (heart) assessment is required.

You will consult with an anesthesiologist as part of your preoperative evaluation. During this time, you will talk about postoperative pain management and anesthesia.

In Delhi, Dr. Prashant Jain is a well-known paediatric laparoscopic surgeon. Call (+91) 8766 350 320 to schedule an appointment and get all your questions answered from the expert.

Tag = Thoracoscopic Surgery In Children in Delhi, Pediatric laparoscopic surgeon in Delhi, Best pediatric surgeon in delhi

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Hernia surgery for child in Delhi | Hydrocele surgery for child in Delhi

How to differentiate between Inguinal hernia and hydrocele?

Inguinal hernia is usually a reducible swelling with cry/cough impulse while a hydrocele is a tense cystic, clinically irreducible swelling without any impulse. Transillumination test is not reliable as can be present in both the cases.

Why hydrocele is irreducible swelling?

The pathogenesis of both hernia and hydrocele is same that is persistence of processus vaginalis.

The neck of hydrocele is very narrow and so even if you try to compress the swelling, the fluid from processus vaginalis will not go into the abdominal cavity. The parents will give a characteristic history of swelling being less during morning and then gradually starts increasing in size. While the opening of hernia sac is large enough to allow the free reduction of contents.

For how long one can safely wait in hydrocele?

The hydrocele which are constant in size through out the day time are usually scrotal type hydrocele and are seen in newborns. They are called as non- communicating hydroceles. It is this type of non -communicating hydrocele which tends to resolve spontaneously.

The hydrocele in which parents gives the history of increase and decrease in the size of swelling are called as communicating hydrocele and will require surgery.

The condition can be safely observed till 18mths to 2 years of age as it is harmless. But one should be sure that they are not associated with hernia.

When one should advise for hernia surgery?

Inguinal hernias never go away without surgery. This is a condition in which surgery is advised to be done as early as possible as the risk of hernia getting incarcerated is as high as 30 to 40%. If not tackled in time it can lead to major complications of gut and testis necrosis. Also emergency anesthesia may further increase the risk for the child.

Tag = Hydrocele surgery for child in delhi, Hernia surgery for child in delhi, best pediatric surgeon in delhi

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Laparoscopic urology surgery in Delhi - Dr. Prashant Jain

Laparoscopic urology, also commonly known as keyhole surgery, is a minimally invasive surgery that has been recently developed in the field of urology. The patients who have undergone this surgery have the same diagnostic and therapeutic values as the open surgeries, but it also includes reduced postoperative pain, lesser duration of hospitalization, and better cosmetic benefit. Recently, even robotic technology is used in this field for the benefit of patients undergoing laparoscopic surgery. Laparoscopic urology is done for both benign and malignant conditions, and it has a faster recovery rate compared to open surgeries done before.

Laparoscopic Pyeloplasty:

Pyeloplasty is a surgical procedure that is done to treat a blockage of urine flow from the kidney, mostly in the ureteropelvic junction (UPJ). UPJ obstruction can present with symptoms of abdominal and flank pain, stones, infection, and deterioration of kidney function.

The surgery is performed under general anesthesia. The benefits of laparoscopic pyeloplasty include:

Reduced hospital stay and faster healing

Quicker return to normal activity

Lesser postoperative pain

Small incisions are made, so scarring is less.

Laparoscopic Nephrectomy:

Nephrectomy means the removal of one or both the kidneys. Hence, laparoscopic nephrectomy is a minimally invasive technique and an effective technique used to remove a diseased or cancerous kidney. The surgery is performed through three small incisions in the abdomen, and the kidney is removed. Apart from this, Laparoscopic partial nephrectomy is also done to remove small renal tumors. This method provides lesser discomfort and the same results as open surgeries.

The advantages of this surgery include:

Avoidance of potential bowel complications after surgery.

Reduced hospital stay

Lesser postoperative pain

Smaller incisions

Laparoscopic nephrectomy is suitable for patients with benign conditions, which results in end-stage kidney disease, also commonly known as kidney failure, the symptoms of which include infection, kidney stones, obstruction, dysplasia, etc.

Laparoscopic Orchiopexy:

Orchiopexy refers to a surgical method that is used to move an undescended testis into the scrotum and fix it in the scrotum permanently. This also typically describes the surgery used to resolve testicular torsion. This is done in children who have congenitally undescended testis.

Usage of laparoscopy in orchiopexy proves a reliable and safe therapeutic option to patients with impalpable testis. It was initially used as a method for the localization of the impalpable testes prior to exploration and now has made an immense area for itself due to its safer practice in this field. Laparoscopic orchiopexy is done in order to make fertility better in males and lower the risk of testicular cancer. It plays a significant role nowadays because of its extra benefits like reduced hospitalization from previously done surgeries.

As a whole, laparoscopic surgeries are used in the field of urology to improve the postoperative complications in the patients mainly and is a better and safe choice for the patients.

If you have any problem related to Laparoscopic urology you may consult the Best pediatric urologist in Delhi, Dr. Prashant Jain. He is one of the best pediatric urologists in India.

Tag = Pediatric laparoscopic surgeon in Delhi, Best pediatric urologist in Delhi, Best pediatric surgeon in India

For more information http://www.pedsurgerydelhi.com

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Phimosis Treatment In Delhi - Dr. Prashant Jain

What is Phimosis?

Phimosis is defined as the inability to retract prepuce.

Nonretractile foreskins are common among young boys and is a part of normal preputial development. The prepuce of new born is nonretractile and at the age of 3 years up to 10% remain non-retractile. It has been seen that 8% of boys at the age of 6 years and 1% at the age of 16 years still had non-retractile foreskin. The foreskin gradually becomes retractile secondary to intermittent erections and keratinization of the inner epithelium. That is most of the prepuce becomes retractile by adulthood.

It is important to understand that most of these phimosis are physiological and do not require any surgical intervention.

What is the difference between Pathological and physiological phimosis?

It is important to differentiate true pathologic phimosis from physiological phimosis. While physiologic phimosis consists of the pliant, unscarred preputial orifice, true pathological phimosis is characterized by the contracted white fibrous ring around the preputial orifice.

What is the treatment of Phimosis?

Most of the patients with phimosis require only reassurance and preputial hygiene. A short course of topical corticosteroids (0.15 triamcinolone/betamethasone/0.1% mometasone) twice daily for 6-8 wks has a success rate of 80-90% in separating preputial adhesions and can be given if the child has symptoms of straining and ballooning of prepuce.

The only indication of surgery (circumcision) is pathologic phimosis with scarred prepuce which is a result of recurrent balanitis.

Most of the phimosis is physiological and self-correcting by adulthood and does not require any treatment.

Tag = best pediatric surgeon in Delhi, best pediatric urologist in Delhi, Phimosis Treatment In Delhi

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Pediatric Robotic Surgery in Delhi

Introduction

Over the last few years, pediatric robotic surgery has revolutionized the management in pediatric urology.

Advantages of robotic surgery

The technology of the robot provides, 10 times magnification, 3 D visualization, and 360 degree rotation, making it unique for reconstructive surgeries. The technique allows to perform even challenging reconstructive pediatric urological procedures with results as good as open surgery with minimal trauma and surgical stress and with best cosmesis. The technique can be used even in infants which ensures decrease pain and shorter hospitalization. It is safe and cost effective.

Which surgery can be done via the robot?

The commonly performed pediatric robotic surgeries are pyeloplasty, ureteric reimplantation, nephrectomy, partial nephrectomy, mitrofanoff, choledochal cyst, bladder augmentation, etc. Robotic surgery uses the latest generation of Da Vinci Xi robotic system.

How is Robotic surgery performed?

Pediatric robotic surgery involves team work. 3 or 4 tiny incisions are required through which camera and surgical instruments are inserted. The surgeon sits a few feet away from the patient in a console and manipulates the instruments from there. The robotic arms functions as an extension of surgeons hand movement at the console. The console gives a 3 D magnified view of the surgical field.

Tag = pediatric robotic surgery in delhi, best pediatric surgeon in delhi

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Care after Hypospadias surgery in Delhi

Hypospadias is a common congenital problem which can be corrected by surgery. Post operative care of hypospadias surgery is equally important as it needs care of pain, infection, dressing and urinary tube (catheter).

Post operative care after hypospadias repair Includes :

The child will require analgesics, usually paracetamol for surgical site pain. He may have spasmodic pains because of the urinary catheter which can sometimes irritate the bladder wall. To prevent this child will be given anticholinergic drugs (Tropan).

Besides the child will be given antibiotics to prevent the risk of infection and laxatives in case of constipation.

The most important is to take care of urinary pipe (catheter). We prefer using double diaper in children less than 3 years old. The diaper which is inside needs to be changed if it gets soiled with stool while the outer diaper which soaks urine needs to be changed on regular basis. The purpose of using double diaper is to avoid mixing of stool and urine and thus avoiding the risk of infection.

Parents should ensure that the catheter is continuously draining urine. They can check this by changing the diaper regularly or emptying the urinary bag in regular intervals. In case the catheter is not draining the urine, one should check for any kinking of the catheter, if this is not the possibility then they have to contact the doctor or report in the emergency. Sometimes the blocked catheter may require flushing with saline.

In case if dressing gets soaked with urine you can use a hair dryer to make it dry (at same time ensure that the catheter is draining urine).

The child will be called after 7 to 10 days to remove the dressing and catheter (or before if it gets soaked with blood or urine.)

He will not be able to take bath till the time catheter is removed, but careful sponging can be done.

After the dressing is removed, he can take shower. He will be advised for sitz bath and application of local antibiotic ointments for 10 days.

You should contact doctor/emergency if the child has lot of pain, dressing gets soaked or has fallen off and if catheter is not draining urine.

Tag = best pediatric urologist in delhi, best pediatric urologist in india, best pediatric surgeon in india

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Dr. Prashant Jain performing pediatric robotic surgery in Delhi

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Pediatric Robotic Surgery in Delhi

Introduction

Over the last few years, pediatric robotic surgery has revolutionized the management in pediatric urology.

Advantages of robotic surgery

The technology of the robot provides, 10 times magnification, 3 D visualization, and 360 degree rotation, making it unique for reconstructive surgeries. The technique allows to perform even challenging reconstructive pediatric urological procedures with results as good as open surgery with minimal trauma and surgical stress and with best cosmesis. The technique can be used even in infants which ensures decrease pain and shorter hospitalization. It is safe and cost effective.

Which surgery can be done via the robot?

The commonly performed pediatric robotic surgeries are pyeloplasty, ureteric reimplantation, nephrectomy, partial nephrectomy, mitrofanoff, choledochal cyst, bladder augmentation, etc. Robotic surgery uses the latest generation of Da Vinci Xi robotic system.

How is Robotic surgery performed?

Pediatric robotic surgery involves team work. 3 or 4 tiny incisions are required through which camera and surgical instruments are inserted. The surgeon sits a few feet away from the patient in a console and manipulates the instruments from there. The robotic arms functions as an extension of surgeons hand movement at the console. The console gives a 3 D magnified view of the surgical field.

Tag = pediatric robotic surgery in delhi, best pediatric surgeon in delhi

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Conjoined Nigerian twins lead separate lives after rare surgery

For the Nigerian parents of conjoined twins — Hussaina and Hassana Badaru, watching their daughters celebrate their first birthday after a successful separation surgery is nothing short of a miracle and they have a team of Indian doctors to thank for it. Experts in Nigeria had given up hope of saving both the girls through a separation surgery that was needed to give them a normal life.

The twins shared their spinal cords, lower intestinal tract and genitourinary tracts. This meant that they had one common passage for fecal matter and another one for urination. Their parents come to know about such surgeries being successfully carried out in India. The twins were seven-months old when they were brought to BlK Super Specialty Hospital in the Capital.

“Separation of the Badaru twins was a big challenge as they had unusual sharing of alimentary canal, genitourinary system and nervous system. Rehearsals were carried out using dummies. Every surgical step was defined and rehearsed over and over again till it reached precision,” said Dr Prashant Jain, Consultant, Paediatric Surgery.

He said if not meticulously planned, the success rate in such cases is just 30 per cent. A team involving ten super specialities was formed to carry the separation procedure in three stages. The surgery lasted for about 13 hours after which the girls were moved to separate OTs for further reconstruction procedures.

This was followed by the actual separation of the spinal cords, intestine and genitourinary tract. Dr AK Bath, Plastic and Reconstructive Surgeon, constructed a new genitourinary tract with new genitalia for each of the girls.

http://www.pedsurgerydelhi.com/