Using Robots to Assist in Adolescent Bariatric Surgery

How can robots help in pediatric surgery and how far can we expand our robotic-assisted surgery services?

In 1985, a robot — originally designed for automated manufacturing — made medical history by performing the first robotic surgery, precisely placing a needle for a brain biopsy. Aided by specialized computer software and fueled by a doctor’s bold vision, the impossible became a reality. Driven by the same innovative spirit, Children’s Hospital Colorado is becoming a leader in pediatric robotic-assisted surgery.

“We’re advancing right now on an accelerated scale,” says Jonathan Hills-Dunlap, MD. “So much so that I've been invited to serve as visiting faculty at our largest pediatric surgery robotics conference because of expertise we’ve gained in just the past 12 months.”

As the new Director of the Robotic Surgery Program, Dr. Hills-Dunlap is helping expand robotic-assisted surgery to new specialties, notably his own division of Pediatric Surgery. He and his team recently passed the 100-surgery milestone using robotic surgery and are now performing bariatric surgery using the da Vinci Xi Surgical System.

Annie Kulungowski, MD, is the latest recruit to the Robotic Surgery Program and has been using the technology for a variety of diseases within the Vascular Anomaly Center.

“Procedures that we have traditionally done laparoscopically, we’re now doing using the robot and bringing robotic surgery to pediatric surgery across the hospital,” Dr. Kulungowski explains.

Drs. Hills-Dunlap and Kulungowski have used the robot to perform pediatric surgeries like choledochal cyst resections, complex colorectal surgery for inflammatory bowel disease patients, splenectomies, cholecystectomies for gallbladder disease, pull-through procedures for Hirschsprung disease, anti-reflux surgery, and hernia repairs. They have also moved into adolescent bariatric surgery. As Dr. Hills-Dunlap explains, using robotic-assisted surgery for many of these cases isn’t new in the adult surgery world. It is, however, new to pediatric surgery.

“In the Denver metro area, more than 80% of all adult sleeve gastrectomies are being done with the surgical robot,” says Dr. Hills-Dunlap. “This is absolutely the standard of care in the adult world. We’re not reinventing the wheel here; this is proven technology — we’re just applying the newest technology to our adolescent patients.”

The Robotic Surgery Program is already getting international attention. Dr. Hills-Dunlap was recently invited to lecture at the 17th Curso Internacional de Pediatría, an international conference on pediatric medicine. Working with our International Center of Colorectal and Urogenital Care, Dr. Hills-Dunlap also performed a redo pull-through procedure for a baby from Columbia using robotic surgery. The family had been looking in Europe, South America and Central America for someone to perform the operation for their 10-month-old who aligned with their goals. They finally found the expertise they were looking for at Children’s Colorado.

“The program is off to a great start,” says Dr. Hills-Dunlap. “Several of my partners are now asking, ‘Can we do this surgery robotically or that surgery robotically?' And the answer is almost always, yes, we can. Or at the very least, we should consider it.”

Expansion into adolescent bariatric surgery is just the beginning. The team also sees potential for expanding robotic surgery into other pediatric surgical sub-specialties like thoracic surgery and surgical oncology. However, Dr. Hills-Dunlap is clear to say that the robot isn’t the right application for every surgery. For a simple operation like an appendectomy, for example, while he could use the robot, the same surgery can be performed laparoscopically, faster, with smaller incisions, and in a more cost-effective manner.

“Just because we can do an operation robotically doesn’t mean we should,” he says. “We always need to prioritize what is right for the patient and their family. If a robotic-assisted surgery is what I would want done for my own children, then I will offer a robotic approach to the patient and their family.”

For adolescent bariatric surgery, Children’s Colorado’s early robotic surgery experience has been tremendously positive. Patients are entering their early recovery with less pain and nausea, and with as good if not better early clinical outcomes. Dr. Hills-Dunlap says the robot uses more advanced stapling technology compared to traditional laparoscopic staplers — an important aspect of the sleeve gastrectomy procedure. It is more precise and more calculated in measuring tissue thickness and telling the surgeon in real time whether the appropriate stapler is being used.

“We’ve done more than a dozen adolescent bariatric surgeries using the surgical robot and have had zero major complications — no reoperations, very short hospital stays, and no hospital readmissions — and we’re hoping it stays that way,” Dr. Hills-Dunlap says.

While there are some surgeries that may not lend themselves to using existing robotic technology just yet, the number of surgeries that could benefit from robotic-assisted technology seem to outweigh the number of surgeries that can’t, especially when it comes to adolescent pediatric surgery.