Minimally Invasive Surgery
Thanks to advances in medicine, many surgeries can be performed on children through an opening no bigger than a dime, and in many cases even smaller. Minimally invasive surgery (MIS) features the use of laparoscopic devices and remotely controlled instruments to perform surgical procedures. Instead of making large incisions as in the past, highly trained surgeons insert two small tubes into these openings. One carries a fiber optic camera with a light source while the other has miniaturized instruments. Thanks to MIS, the team at AdventHealth for Children, formerly Florida Hospital for Children, can perform very precise surgical procedures through very small holes, often requiring just a stitch or two to close.
Conditions and How We Treat Them
As a baby develops, there are occasions when an orifice doesn’t open properly or is entirely absent. This can include failures of the anus, nasal passages, intestine, larynx, aorta or pulmonary valve to develop properly. The surgeons at AdventHealth for Children monitor the baby for signs of atresia and correct these issues in surgery to restore functionality of these openings. In many cases, such as the anus, a surgery must be performed shortly after birth to allow fecal matter to pass from the child unimpeded.
- Congenital Cystic Adenomatoid Malformation (CCAM)
Caused by an overgrowth of abnormal lung tissue, CCAM is a congenital condition that is detected during a routine ultrasound by your doctor. Because the baby can have trouble breathing, your doctor will recommend that you deliver your baby at the hospital, which has a Neonatal Intensive Care Unit (NICU). Surgeons at AdventHealth for Children will remove this abnormal lung tissue, preferably when the child is three to six months old. The removal doesn’t affect your baby in the long term, since lungs continue to develop until your child is nine years old.
- Congenital Diaphragmatic Hernia
Several conditions can cause the baby’s diaphragm to develop abnormally. Surgery is required to repair this dome-shaped muscle that separates the chest cavity from the abdomen. Under general anesthesia, surgeons at AdventHealth for Children may repair the defect or hole thoracoscopically (through the chest), laparoscopically, or with a small abdominal incision. Often, this condition can be detected while the baby is still in the womb, allowing the family and medical team time to develop a plan for treatment after birth.
- Ex Utero Intrapartum Treatment (EXIT)
When a baby is born, his/her airway may be blocked or improperly developed. Surgeons at AdventHealth for Children access the airway using an ex utero intrapartum treatment, or EXIT. The baby remains connected to the mother through the umbilical cord while the airway is maintained. Our surgeons work in careful coordination with the mother’s physician and anesthesia to perform the EXIT procedure, providing exacting care to both the mother and the child throughout. Once completed, the rest of the delivery is treated as a standard C-section.
During development the intestines and occasionally other organs will develop outside of the baby. Known as gastroschisis, this defect can be detected by doctors at AdventHealth for Children using a detailed fetal ultrasound. Once the baby is born, our skilled surgeons will return the intestines and organs to the abdominal cavity. Depending on the complexity of the condition, the surgical team may opt to do this in a staged approach.
Similar to gastroschisis, omphalocele occurs when the intestines, liver and occasionally other organs are left outside the abdomen because of improper development of the muscles in the abdominal wall. Following birth, these organs are returned to the cavity by surgeons. In some situations, gravity does the hard work and the organs return to the cavity on their own. On rare occasions, surgery may be postponed to allow the baby’s abdominal cavity to grow big enough to house the organs.
- Pectus Carinatum
Depending on the severity of the condition, pectus carinatum, or pigeon chest, is either treated through surgery or through a custom fitted chest brace. Children with pigeon chest can often experience problems with utilizing their hearts and lungs optimally. The result can be reduced stamina. In rare cases, the condition can contribute to connective tissue disorders, abnormal growth or even the onset of arthritis. In most cases the custom fitted chest-wall brace will correct the problem.
- Pectus Excavatum
Usually present at birth, pectus excavatum, or funnel chest, is a deformity in the chest caused by the improper growth of the sternum and some of the ribs. It gives the chest a caved-in look, especially as the child reaches puberty. Left unchecked, funnel chest can impair the cardiac and respiratory functions or cause pain in the chest and back. To repair the deformity, surgeons at AdventHealth for Children use minimally invasive surgery to place steel bars in the chest under the sternum. These bars are left in the chest until the bones have solidified into their proper place. An open approach is also offered by our surgeons, and the best approach for your child will be discussed in depth during consultation.
When your baby is in the womb, it’s natural for him/her to swallow and absorb amniotic fluid in normal amounts. Unfortunately, there are times when the baby is unable to do this efficiently, either because of a birth defect or heart, intestinal, neurological or lung issues. The presence of polyhydramnios may be detected during your prenatal ultrasound. While a certain amount of variation is normal, your physician may recommend that you have the level of fluid reduced through amniocentesis.
Occasionally a piece of tissue in a developing baby turns into lung tissue that isn’t connected to the pulmonary blood supply or the bronchial airways. Known as a bronchopulmonary sequestration, this tissue is removed by surgeons at the hospital after birth ideally using minimally invasive surgical techniques. Removal is required to prevent long-term health issues, including infection and even cancer.
Located at the base of the tailbone, the neck or the abdomen, a teratoma is a common tumor in newborns. Physicians at AdventHealth for Children may detect the presence of the tumor during an ultrasound or through a blood test during pregnancy. Because surgery is required, your doctor will recommend that you have your child at a hospital with pediatric surgery expertise, such as AdventHealth for Children. Thanks to advances in treatment, your baby should make a full recovery.
- Undescended Testicles
As your baby develops inside the womb his testicles will descend into the scrotum shortly before birth. In some cases, they don’t descend. This condition, known as cryptorchidism isn’t uncommon, occurring in nearly one-third of boys born prematurely and about four percent of those born full term. If the testicles don’t descend on their own within the first six to 24 months of life, surgeons at AdventHealth for Children may perform surgery to reposition them in the scrotum. This is typically done on an outpatient basis.