Surgery is the treatment of disease, injury, or other disorders by direct physical intervention, usually with instruments. Surgery involves cutting into the skin or other organs to accomplish any of the following goals:
- further explore the condition for the purpose of diagnosis
- take a biopsy of a suspicious lump
- remove diseased tissue or organs
- remove an obstruction
- reposition structures to their normal position
- redirect channels
- transplant tissue or whole organs or electronic devices
- improve physical appearance
A comprehensive level of care
The General Surgery Program at Boston Children's Hospital evaluates and treats infants, children, and young adults afflicted with acquired and congenital conditions that may require an operation.
Using state-of-the-art operative methods — including open procedures, minimally invasive surgery, and endoscopic techniques — we strive to improve the quality of life for each child entrusted to our care.
When is surgery an option?
You and your child's physician will discuss surgery as a way to correct your child's health problem after it is diagnosed. This decision is based on careful evaluation of your child's medical history and subsequent medical tests, such as blood tests, x-rays, MRI, CT scan, electrocardiogram, or other laboratory work performed to determine the exact diagnosis.
What are the different types of surgery?
Surgery can be classified as major or minor, depending on the seriousness of the illness, the parts of the body affected, the complexity of the operation, and the expected recovery time.
- Major surgery: These operations most often occur on the head, neck, chest, and abdomen, and can greatly affect the way the body functions. The recovery time can be lengthy and may involve a stay in intensive care or at least several days in the hospital. There is a higher risk of complications after such operations. In children, types of major surgery may include the following:
- removal of brain tumors or other solid tumors
- correction of bone malformations of the skull and face
- repair of congenital heart disease, transplantation of organs, and repair of intestinal malformations
- correction of spinal abnormalities and treatment of injuries sustained from major blunt trauma
- Minor surgery: Some procedures that children undergo are considered minor. The recovery time is short, and children return to their usual activities rapidly. These operations are most often done as an outpatient, and children can return home the same day or after an overnight hospital stay. Complications from these types of operations are rare. Examples of the most common types of minor surgery may include the following:
- placement of ear tubes
- hernia repairs
- correction of bone fractures
- removal of skin lesions
- biopsy of growths
- Elective surgery: These are procedures you decide your child should undergo, to assure a good quality of life for your child. An example might be to have a birthmark removed, or to circumcise your baby boy.
- Urgent or emergency surgery: This type of surgery is done in reaction to an urgent medical condition, such as correction of a life-threatening congenital heart malformation or repair of injured internal organs after an automobile accident, or a problem such as appendicitis.
- Required surgery: These are procedures that need to be done to make your child's life better in the future. An example might be having a spinal fusion to correct severe curvature of the spine. Required surgery, unlike emergency surgery, does not necessarily have to be done immediately and can allow you time to prepare your child for the experience.
How will my child's surgery be performed?
With technical advances today, surgery does not necessarily mean large incisions, as in the past. Depending on the type of surgery, there are several surgical methods that may be performed, including the following:
- Open surgery: An open operation means cutting skin and tissues so the surgeon has a full view of the structures or organs involved. Examples of open surgery include the removal of organs, such as the kidney.
- Minimally invasive surgery: Minimally invasive surgery refers to any surgical technique that does not require a large incision. This relatively new approach allows your child to recuperate faster and with less pain. Not all conditions are suitable for minimally invasive surgery. Some surgical techniques that are considered minimally invasive surgery include the following:
- Laparoscopy: A test that uses a tube with a light and a camera lens at the end (laparoscope) to examine organs and check for abnormalities. Laparoscopy is often used during surgery to look inside the body and avoid making large incisions. Tissue samples may also be taken for examination and testing. Procedures commonly done include gallbladder removal, appendix removal, and selected solid organ removal.
- Endoscopy: A test that uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of part of the digestive, respiratory, or urinary tract. Tissue samples from inside the digestive tract may also be taken for examination and testing.
- Bronchoscopy: Examining the bronchi (the main airways of the lungs) using a flexible tube. Bronchoscopy helps to evaluate and diagnose lung problems, assess blockages, obtain samples of tissue and/or fluid, and/or to help remove a foreign body.
- Cystoscopy: Examining the inside of the urethra and bladder cavity with a small, flexible tube with a light and a camera lens at the end.
- Gastroscopy: Examining the lining of the esophagus, stomach, and the first part of the small intestine with a small, flexible tube with a light and a camera lens at the end.
- Laryngoscopy: Inspecting the larynx (voice box) with a small, flexible tube with a light and a camera lens at the end (endoscope).
- Sigmoidoscopy: Examining the rectum and sigmoid colon with a small, flexible tube with a light and a camera lens at the end (endoscope).
New and improved robotic surgery
Since 2001, specially trained surgeons at Boston Children's Hospital have used a high-tech robot to perform complex and delicate operations through small surgical openings. For patients, this technology translates into less pain and faster recoveries; for surgeons, it offers better precision and superior visualization.
Boston Children's was the first institution in the country to introduce this technology for use in pediatric patients, and worked with engineers and medical device manufacturers to develop and refine the equipment for use in children. Since then, Boston Children's specialists have used the robot for procedures in Urology, Cardiology, Otolaryngology, and General Surgery, and are developing applications for Neurosurgery and Fetal Surgery.
In 2009, Boston Children's surgeons performed 75 robotic surgeries. Boston Children's Hospital has upgraded to the newest version of the robotic system, called the da Vinci Si. The new robot features enhanced high-definition three-dimensional vision and is much smaller, reducing set-up time. It also includes two consoles so that two surgeons can collaborate during a procedure. "The visualization is markedly improved and the clarity is beautiful," says Hiep Nguyen, MD, co-director of the Center for Robotic Surgery and director of Robotic Surgery Research and Training.
The new technology aids interaction and communication between surgeons and nurses, making for a safer operating room. In the short term, the system enables Boston Children's surgeons to operate on more diverse conditions with safety and efficiency; in the future, Nguyen hopes the robot may be utilized for fetal surgery and even remote surgery.
