Inside Pediatrics Spring 2023

NEXT-LEVEL CARE WITH NEW SURGICAL ROBOT, UROLOGY TEAM CAN BETTER SERVE PATIENTS

W hen Stacy Tanaka, M.D., arrived at Children’s of Alabama as the chief of pediatric urology, she resolved to bring in more technology. “I don’t want families of patients who need our services to go out of state because they think we can’t provide it,” she said at the time. That was in January 2022. By the end of her first year, one big piece of the puzzle—the da Vinci surgical robot— was in place. In the past, Children’s relied on the University of Alabama at Birmingham (UAB) for access to a surgical robot. The arrangement worked, but because UAB is an adult hospital, the environment wasn’t ideal for kids. Children’s, on the other hand, has nurses, anesthesiologists and other medical professionals who are trained to care for kids. The hospital also offers child life services designed to minimize stress on children and their families. A surgical robot, Tanaka says, was the missing piece. “Our overall level of care was already great. Now, the technology has caught up with it,” she said. The da Vinci robot arrived at Children’s in December 2022, and surgeons began using it in February 2023. It has generated a lot of enthusiasm among the surgical team. When Carmen Tong, D.O., the director of robotic surgery at Children’s, performed her first surgery with it, the procedure drew a lot of “spectators”—other surgeons and nurses who wanted to see the robot in use. “The energy is palpable,” Tong said. “Everyone is extremely excited.” And urology isn’t the only team benefitting from it. Other surgery teams have already used it, and for Tong, that’s proof that the robot makes the entire hospital better. “Everyone thought that this would just be a urology thing, and then we weren’t even the first ones to end up using it,” she said. “And I think that shows just how much more is open to Alabama kids now that the robot is here.” Tong says extensive training and preparation ensured that staff would be able to use the robot safely and effectively. Nurses, surgical technologists and anesthesiologists were all involved. “The surgical staff put in many, many hours to learn the technology,” she said. Administration also provided support, and the facilities team rearranged the operating room to provide adequate space for the robot.

The da Vinci robot provides an alternative to laparoscopic surgery, in which instruments are inserted through two or three small incisions. Laparoscopic surgery is minimally invasive, but the technique is not optimal. “The instruments don’t articulate at the wrist, so they don’t mimic actual hands in the body,” Tong said. This makes certain maneuvers, such as internal suturing, quite challenging. “It’s as though you’re using chopsticks,” she said. There is also a steep learning curve. The robot, however, “completely changed the landscape of minimally invasive surgery,” according to Tong. It provides a three-dimensional view with improved depth perception.

Stacy Tanaka, M.D., became the chief of pediatric urology at Children’s of Alabama in January 2022.

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