小儿机器人辅助腹腔镜肾盂成形术 - 波士顿儿童医院 -

小儿机器人辅助腹腔镜肾盂成形术 - 波士顿儿童医院

Boston Children's Hospital broadcasts a robotic assisted laparoscopic pyeloplasty live from the operating room. The procedure will remove an obstruction from a kidney, and reconnect the kidney's drainage system. The Webcast is part of Boston Children's ongoing effort to promote medical education, and allow consumers to see the latest and most innovative medical treatments available to them.

Craig Peters, MD, a urologic surgeon at Boston Children's and associate professor of surgery at Harvard Medical School, will perform the surgery. Alan Retik, MD, Surgeon-in-Chief and Urologist-in-Chief at Children's, will moderate the event to explain critical portions of the surgery and answer e-mail question from viewers during the live Webcast.

Using minimally invasive robotic methods, surgeons are able to perform the complete reconstructive surgery laparoscopically with very high precision, eliminating the need for a large surgical incision. "I find that with the three-dimensional imaging I can visualize more effectively, and perform more precise and complex reconstructive surgery inside the abdomen," says Peters.

"Although operative times have increased with the use of the robot compared to traditional open pyeloplasty, we are getting closer to open surgical times, and hospital stays have decreased from three days to one," says Peters. The robotic surgery also reduces blood loss, postoperative pain and allows for a quicker recovery from surgery.
While success rates of open and robotic assisted pyeloplasty are similar, robotic surgery has not been performed as long as the open procedure. Further analysis is needed to determine if the advantages outweigh the disadvantages, including cost and longer operative times. "I think robotic surgery is the way to go," says Peters. "With robotic assisted pyeloplasty leading the way, this technology has changed the way we do surgery and has allowed us to provide new treatment options to our patients. "

Sitting at a console in the operating room, a surgeon is able to study crisp, real-time 3-D video images of the operating site while grasping controls in each hand. Each subtle movement of the surgeon's wrists, hands, and fingers is translated precisely to the tiny surgical instruments inside the patient's body. "It's as though my hands are actually inside the patient, yet I'm working through a tiny surgical opening," says Hiep T. Nguyen, MD, co-director of the Center for Robotic Surgery and director of the Robotic Surgery Research and Training Program.

Alan B Retik, MD, FAAP, FACS, Surgeon-in-Chief, Urologist-in-Chief and Executive Director of the Advanced Fetal Care Center at Boston Children's, and Professor of Surgery at Harvard Medical School, will lead the LIVE Webcast with commentator Joseph Borer, MD, co-director of the Center for Robotic Surgery, director of the Center for Exstrophy and director of Neurourology, while Dr. Nguyen will perform the operation.
Normally, urine travels from the kidneys to the bladder via the ureters. Vesicoureteral reflux (VUR) occurs when urine that dwells in the bladder flows back into the ureters and often back into the kidneys. Children with VUR may present before birth as prenatal hydronephrosis (an abnormal widening of the ureter) or with a urinary tract infection. Some may be diagnosed because of a family history, even though they may be without symptoms. Others have VUR secondary to others abnormalities of the urinary tract such as posterior urethral valves, ureterocele and neurogenic bladder. During infancy, primary VUR is more common among boys because there is more pressure in their urinary tract; in early childhood, the abnormality is more common in girls. The concern with vesicoureteral reflux is that it can lead to damage or scarring of the kidneys when the reflux is associated with urinary tract infections. Treatment for VUR is based on the child's age, overall health, and medical history, the extent of the condition, the child's tolerance for specific medications, procedures, or therapies, and expectations for the course of the condition.
波士顿儿童医院的广播机器人辅助腹腔镜肾盂成形术从手术室。这个过程将删除从一个肾脏，然后重新连接肾脏的排水系统阻塞。网络直播是波士顿儿童持续的努力，以促进医学教育，并让消费者以看到的最新和最具创新性的医疗护理提供给他们的一部分。克雷格·彼得斯，MD，一个泌尿外科医生在波士顿儿童和的外科副教授在哈佛医学院，将进行手术。艾伦Retik，MD，外科医生，中，行政和泌尿科医生，中，行政儿童，将温和的事件，以说明关键部分的手术和答案电子邮件问题从观众在网上直播。使用微创机器人的方法，外科医生能够执行完整的重建手术，腹腔镜手术具有很高的精度，消除了需要一个大的手术切口。“我找到的三维成像，我可以想像更有效地进行更精确和复杂的重建手术，腹部内的，”彼得斯说，“虽然相比传统的开放肾盂成形术，手术时间，增加了使用的机器人，我们正接近开放式手术时间和住院时间从三天减少到1，“彼得斯说。机器人手术也减少了术中出血量，术后疼痛，并允许更快的从手术中恢复。虽然开放和机器人辅助肾盂成形术的成功率是相似的，机器人手术还没有进行，只要开放的过程。需要进一步分析，以确定是否利多于弊，包括成本和手术时间较长。，“彼得斯说：”我认为，机器人手术的方式去。“随着机器人辅助肾盂成形术的带领下，这项技术已经改变了我们做的手术，使我们能够为我们的患者提供新的治疗方案。” 坐在控制台在手术室，外科医生可以是清晰的，真正的学习时间3-D视频图像的作业现场，同时抓控制在每手。精确地被翻译病人的身体内的微小的外科手术器械的外科医生的手腕，手和手指的每个细微的运动。“这是我的手在患者，但我的工作，通过一个微小的手术开口，说：”阮协T.，MD，机器人手术的机器人外科主任，研究和培训合作中心主任程序。艾伦乙Retik，医师在访谈中，流式细胞仪，外科医生，中，行政，在波士顿儿童的高级胎儿保健中心和哈佛医学院的外科教授泌尿科医生，中，行政及执行董事，将导致网上直播评论员约瑟夫化螟，MD，主任，机器人手术，中心主任为外翻和总监Neurourology的中心，而博士，阮将执行操作。通常情况下，尿液从肾脏输尿管膀胱通过。膀胱输尿管反流（VUR）发生时，住在膀胱的尿液回流到输尿管和经常进入肾脏。可能会出现在出生前的产前肾积水的输尿管）（异常扩大或尿路感染的患儿VUR。有些人可能会被诊断，因为一个家庭的历史，尽管他们可能没有任何症状。其他有的VUR二次如后尿道瓣膜，输尿管囊肿和神经性膀胱尿路异常。在起步阶段，是较常见的原发性膀胱输尿管返流之间的男孩，因为在他们的尿路有更多的压力，在婴幼儿期，异常多见于女孩。关注的是，它可能会导致损坏或疤痕时，回流与尿路感染的肾脏与膀胱输尿管返流。治疗膀胱输尿管逆流是根据孩子的年龄，整体健康状况和病史，条件的程度，特定的药物，程序或治疗，孩子的宽容，和期望的过程中的条件。


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