Special programs
Minimally invasive procedures
Technological advancements have now allowed surgeons to do many surgical
procedures in a minimally invasive manner. Instead of traditional incisions,
which may require weeks for complete healing, minimally invasive procedures use
instruments that allow physicians to see inside the body and perform the needed
procedures with only small incisions for more rapid healing.
Thoracoscopic procedures involve the chest, while laparascopic procedures
involve the abdomen. Scopes used in either area are useful for diagnostic
testing, however many therapeutic interventions can also be done via scopes with
special instruments designed for use through access tubes.
Examples of procedures that lend themselves well to minimally invasive
surgery are some cases of appendectomy, many cases of intra-abdominal or
interthoracic biopsy, reconstruction of congenital lesions, identification and
descent of a non-descended testis, some forms of chest wall reconstruction and
diagnostic thoracoscopy/diagnostic laparoscopy. The technology for minimally
invasive procedures is changing rapidly, however, and the list of possible
procedures done with scopes is in constant revision.
There are a host of reasons why thoracoscopic/laparoscopic procedures may be
indicated or contraindicated for any given child. If a family is interested in
exploring these, a thorough discussion with the attending pediatric surgeon
should occur. In addition, surgeons will present these alternatives when they
think they are in the best interest of the child.
Extracorporeal membrane oxygenation (ECMO)
Extracorporeal Life Support (also known as extracorporeal membrane
oxygenation, ECMO) is cardiopulmonary bypass pumping done for prolonged periods
of time at a child's bedside. Cardiopulmonary bypass was originally developed to
allow surgery on the pediatric heart during "open heart surgery." However, we
have been able to adapt the technology to support children who suffer pulmonary
failure from a large variety of causes.
Children with overwhelming pneumonias, those born with severe congenital
anomalies such as diaphragmatic hernia with pulmonary hypoplasia, or children
who have heart failure following cardiac surgery may be candidates for ECMO
support. In all of these children, ECMO circulates a child's blood so that
oxygen can be supplied to the body and gaseous wastes removed, allowing time for
healing for a child's damaged lungs.
These highly complex procedures are done in the Neonatal Intensive Care Unit or the
Pediatric Intensive Care Unit at
Children's Memorial. Staff members in the Division of Pediatric General Surgery,
as well as a host of other supporting services, provide consultation. Full
parental consent is sought prior to the initiation of the ECMO procedure, which
generally lasts from several days to as long as three to four weeks.
Pediatric surgeons are available to families to keep them fully informed of a
child's progress when undergoing this innovative but technologically demanding
support. Ancillary care services and surgery are provided as necessary, and
pediatric surgery maintains long-term follow-up services for all of the children
who have undergone ECMO.
Pediatric trauma/burn care
Pediatric trauma remains the number one health care problem of children in
America. In fact, pediatric trauma deaths exceed the next most common cause of
childhood fatalities by four times.
Children's Memorial Hospital is a City of Chicago-designated level one
pediatric trauma center, which means that the hospital is staffed and equipped
to handle the most severely injured children. Approximately 800 trauma victims
are seen at the hospital each year; half are admitted to the hospital. Pediatric
general surgeons direct the trauma service and provide care via the immediate
response team. They admit the children to the hospital, with few exceptions, on
the pediatric surgery service for the first 24 to 48 hours of care.
Because trauma can involve a host of body parts and organ systems, the trauma
team draws on the expertise of all the hospital's specialists. The services of
orthopaedic surgery, neurosurgery, and intensive care are those services most
often used in concert with pediatric surgery for multiple-trauma victims. All
are available for care and consultation. However, pediatric surgeons, as the
initial providers of injury care, often take the lead in arranging care
conferences or consultations for children admitted for trauma to Children's
Memorial Hospital.