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New technique eases gallbladder surgery for children

Nov. 6, 2014, 9:46 AM

Golf ball-sized gallstones camped out in Joseph Gray’s gallbladder had been causing him stomach discomfort for months.

An ultrasound study performed at Monroe Carell Jr. Children’s Hospital at Vanderbilt, where the 10-year-old Murfreesboro fourth grader had been referred, confirmed their presence.

Dai Chung, M.D., examines 10-year-old Joseph Gray, the first Monroe Carell Jr. Children’s Hospital at Vanderbilt patient to have his gallbladder removed using a new single-incision robotic surgery. (photo by Rex Perry)

The symptoms that had bothered Gray for several months were relieved promptly during a new innovative approach to removing the gallbladder through a small, single incision using robotic surgery.

Children’s Hospital is the first in Tennessee to perform a single-site incision robotic cholecystectomy, or gallbladder removal surgery, on a pediatric patient, reducing the number of incision sites for the procedure from four to one.

“I was kind of scared for him to be so young to have his gallbladder removed,” said his mother, Debor’ah Gray.

“He stayed overnight because they wanted to monitor him since he had been a stem cell transplant patient to treat sickle cell five years ago. But within two days he was up and running around, being a normal kid. He didn’t even want any more pain medicine.”

Dai Chung, M.D., Janie Robinson and John Moore Lee Professor of Pediatrics and chair of the Department of Pediatric Surgery, performed Joseph’s surgery.

He said because Joseph had a small surgical scar from a previous umbilical hernia repair, he was able to perform the gallbladder removal operation via the same small single incision, thereby avoiding multiple additional surgical incisions.

“The single-site robotic surgery uses a single 2.5 cm in diameter trocar (incision) via an infraumbilical approach. Using these specially designed tools for robot, we were able to perform the cholecystectomy on Joseph through one very small incision,” Chung said.

“Joseph was an ideal patient. Since then, he has been completely relieved of the worsening symptoms he experienced and returned to his normal activities in no time.”
Gallbladder removal surgery is becoming more common, in part because of increasing childhood obesity, Chung said, though Joseph did not fall into that category.

Children’s Hospital first began using the cutting-edge robotic device to perform minimally invasive pediatric surgeries in 2011. The first procedure performed was to repair a kidney blockage in an 8-year-old girl.

Now, surgeons are performing even more minimally invasive surgeries for specific conditions with this single-incision procedure.

The robot unites conventional laparoscopy and traditional open surgery, though at a more advanced level. A surgeon sits at a console directing the tool’s four arms, conducting delicate procedures with precise movements.

Potential benefits can include minimal scarring and a shortened recovery period. Children’s Hospital surgeons who use the device have had extensive training.

“As the robotic surgical community gains more experience and expands this approach for other surgical conditions, we’re in a prime position to lead the rest of the field.

“We’re at the forefront of this cutting-edge technology,” Chung said.

Joseph’s mother said he has been symptom-free since his surgery. He’s back to riding his bike, shooting hoops outside and doing his favorite thing, making people laugh. “You can’t even really see the scar,” she said.

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