Minimally Invasive Surgery
Expert answers frequently asked questions
Dr. Stephen Megison answers parents’ questions about minimally invasive surgery, its benefits in children and robotic surgery at Children’s. Dr. Megison is the director of Robotic Surgery and director of Trauma Services at Children’s, and professor of Surgery at UT Southwestern.
What is minimally invasive surgery?
Surgery has always been an invasive thing because it involves cutting someone’s body open. Minimally invasive surgery essentially describes the technology, techniques or instrumentation that accomplish the operation with as small incisions as possible.
How long has it been used?
The first minimally invasive surgeries took place about 20 years ago with gallbladder removals. Gynecologists, however, had been using small scopes to perform procedures about 10 years before that. Minimally invasive surgery began being used on children about 15 to 18 years ago. When the first laparoscopic instruments came out in the mid-1980s, they were too coarse and big to be used on children. So, new instruments were made to be used on children after the initial minimally invasive surgeries were proven effective on adults.
What are the benefits?
The first thing people think about is cosmetics, because the scars are smaller. That’s important, but more important is the effect on the body. Removing a gallbladder with minimally invasive surgery only requires patients to recover from four small punctures. The old-fashioned method would leave patients with a big, long incision along their right rib cage, which involves more inflammation and pain and takes longer to heal. It makes you feel worse, because your body has sustained more damage.
How common is it for children now?
Most departments at Children’s use some form of minimally invasive surgery on our patients. Almost every specialty that could conceivably use it has figured out a way to do their procedures with minimally invasive techniques.
What procedures are used at Children’s?
We have the expertise at Children’s to perform any minimally invasive procedure on children that’s needed. Basically, every service line uses some form of minimally invasive surgery if it is applicable. And we’re able to do more and more complicated surgeries using the new robot to perform delicate procedures on patients. View common diagnoses and procedures performed with minimally invasive surgery.
What is the robot?
The Da Vinci surgical robot is the latest generation of minimally invasive surgical tools. It allows us to reduce the size of scarring in more patients by allowing us to perform minimally invasive procedures on children with more complex problems than we have in the past. The robot gives surgeons a three-dimensional picture instead of a two-dimensional picture, just like the difference watching a movie in 3-D and watching an older two-dimensional movie. In an operating room, that third dimension allows for more precise movements so surgeons can perform more complex operations.
Why is robotic surgery at Children’s unique?
We are the only pediatric hospital in North Texas using a surgical robot. We are one of a few pediatric centers in the country performing routine procedures with the robot. Children’s is leading the move into pediatric robotic surgery in the region.
What are the risks?
There are fewer risks with smaller incisions. There is less risk that the incisions will get infected. There is less risk that the wound won’t heal correctly. The risk for the internal organs is about the same because the operation is the same, but the reduced risk of the smaller incisions makes minimally invasive surgery less risky overall.
When is traditional open surgery better?
Generally, open surgery is used in trauma situations. Minimally invasive surgery, because it’s so delicate, is a little slower. However, since minimally invasive procedures are becoming so routine, surgeons are becoming quicker and it is now useful in many emergency situations. There are also some situations where patients can’t tolerate the pressure caused by inflating the abdomen in order to perform minimally invasive surgery; so, it’s better to perform open surgery in those cases as well.
How much has it advanced?
A lot in the last 10 to 15 years in every aspect. The optics are better, which allows you to see more clearly to make more precise movements. We’re going to start using high-definition video in the Dallas campus this summer, which we already have at Children’s at Legacy. The instrumentation is better and smaller. And the technology is better. The operations are the same, but the fact of the matter is that better technology allows us to do more and more operations in a minimally invasive fashion.