Minimally invasive cardiac surgery using robotic technology was until now reserved for adult patients. This has changed. The Sant Joan de Déu hospital, in Barcelona, has performed operations of this type on children, for the first time in Spain. And they have been a success: less admission time and much faster recovery.
This pioneering surgical program is part of the new alliance between the Clínic and Sant Joan de Déu hospitals for the constitution of the Center for Congenital Pathologies, which will be responsible for monitoring patients throughout their life path, from birth to old age.
Based in the two hospitals, for pediatric and adult patients, the center has a team of 23 professionals that includes cardiologists, cardiovascular surgeons, pediatricians or anesthesiologists.
“We are making great progress in comprehensive and integrated care for these patients throughout their lives,” explained the Health Minister, Manel Balcells, at the presentation of the new center. Every year 600 children are born in Catalonia with congenital pathologies that require treatment, he stated.
Among children born with these malformations in the heart and great vessels, a third are serious cases and a third require surgery in the first year of life, explained surgeon Daniel Pereda, director of the center. Some 10,000 adults live in Catalonia with congenital malformations, a pathology that affects 1% of births. Thanks to the advances of recent decades, 95% of these children reach adulthood, but with very specific needs.
Minimally invasive or robotic-supported surgery is common in adults. The Clínic accumulates 243 interventions of this type, which avoid opening the entire chest and fracturing the sternum of patients: to access the organs, two small incisions are made.
The size of the instruments, designed for adults, and the patients has been making it difficult to apply this technology in children. But now professionals have pushed the limits and performed the first five pediatric operations. The first patient with robotic surgery was a 13-year-old girl from the Basque Country. The second, the Catalan Iu Teixidó.
Iu's brother, also with congenital heart disease, underwent surgery with the conventional technique. “I was very afraid because he has a very big scar,” the 15-year-old patient explained today. He has been two months since the operation and can lead a normal life, he does not take any medication and plays soccer. “He was worried if he could do somersaults to celebrate goals. He can. He is fully recovered. He is not limited by anything, which is our goal when we treat patients,” stated Esther Aurensanz, specialist in pediatric cardiology.
In three of the interventions carried out, the professionals have opted for thoracoscopic surgery, consisting of small incisions in the chest to introduce a device with a video camera and the instruments necessary for the intervention.
In the other two cases the doctors have opted for robotic surgery. Candidates to undergo this technology are those who suffer from interatrial problems that cannot be resolved with catheterization, problems with the mitral or tricuspid valves, or cardiac tumors.
The plan is to operate robotically on a dozen patients a year and begin with an annual activity of 20 thoracoscopic surgeries. The current minimum limit for candidates is 6 years and 30 kilos in weight. "A technological barrier that will evolve over the years," according to Pereda.
Previously, patients undergo a selection process to determine the most convenient surgical option. For adults, the most common robotic surgery is mitral valve repair, and patients are discharged in 3 to 4 days, in contrast to 12 days of hospitalization for conventional surgery.
The results are the same, what changes is the aggression that is carried out, which has an impact on recovery times and possible healing complications.
