E.g., 09/2017
E.g., 09/2017

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Savannah's story: Bilateral ureteral reimplantation with da Vinci surgical robot


“I’d like to send her in for some tests.” Something you never want to hear from a doctor, but a recommendation we nearly dismissed. We had enjoyed a trouble-free pregnancy, and Savannah was a perfectly healthy 6-month-old. This was just a little urinary tract infection (UTI), it happens all the time…right?

Well, we did the tests and that UTI was the start of an enduring two-year struggle – for us and our precious baby. The tests found that Savannah had a congenital defect that led to repeated severe kidney and bladder infections. She needed daily antibiotics and surgery, but she was still too small for a surgeon to be able to operate on her. It was a waiting game.

Month-by-month, the infections started resisting her medicines and we were running out of options. We were trying so hard to strike that balance – waiting for her to grow big enough to have a successful surgery, while praying the infections wouldn’t damage her kidneys permanently. My greatest fear was having to tell my daughter, “You’ll need to be on dialysis for the rest of your life because we made the wrong call.”

About two years after that first infection, we were out of options. The next fever would mean a 10-day course of IV antibiotics at the children’s hospital, then surgery as soon as she was recovered. We decided to start seriously talking about our surgical options. It was time.

Her specialist in California was confident he could fix the defect. That was great news, but then came the hard part, she’d need several days in the hospital…stents, tubes, drains and more surgical procedures to remove them as the healing progressed. Her pain and the injury to her bladder would be so substantial that she’d need narcotic and anti-spasm medications. Of course, those came with some worrisome side effects that might lead to further complications. She’d also have a long incision and scar along her waistline that we were concerned would make her self-conscious as she grew older.

In the era of modern medicine, we imagined there had to be a better way.

A year before that conversation with her specialist, I had started working for a company called Intuitive Surgical that was pioneering the use of robotic-assisted surgery. But pediatric urology is a specialized field and I had never heard of pediatric surgeons using the technology, called the da Vinci Surgical System. I asked her specialist about it, and he was somewhat dismissive. “It’s still new and unproven, and the success rates aren't as good as traditional open surgery.” That was deflating to hear, especially at one of the best children’s hospitals in the country. But, I decided to do some of my own checking anyway. A few internet searches later, I’d found over a dozen pediatric surgical groups using the system. And surgeons had done thousands of the exact procedure that Savannah needed! Didn’t sound unproven to me.

Ultimately, my research led me to Dr. Chester Koh at Texas Children’s. Some surgeons are extremely talented in the operating room and quite poor at the hospital bedside. And some have a great bedside manner, but aren’t leaders in their surgical fields. It’s rare to find someone who possesses both, and it looked like Dr. Koh might have been one.

I reached out to him and he was very responsive. We talked through what Savannah’s surgery and recovery would look like if he did a robotic-assisted procedure versus what her specialist had walked us through with a traditional open surgery. The differences were amazing. Several days to a week in the hospital for open compared with just a couple of days with the robot. The likelihood of needing narcotics or anti-spasm medication was much lower, she wouldn’t need a single stent or drain, and the big long scar on her stomach would turn into a few "key hole" incisions measured in millimeters, not inches. The scars may not even be visible by the time she goes to her first adolescent pool party! Wow. It was a no brainer for us. Dr. Koh and his team in Texas were a few thousand miles away from our home in California, but it had to be worth the trip.

image003Everyone we encountered at the hospital was amazing and the facility was perfectly suited to make children feel completely comfortable. Savannah took to the surgical team so quickly and easily that when it was time to go, she gladly hugged her anesthesiologist around the neck and went away to get prepped. She left her teary-eyed parents watching for just one glance back so we could blow her a kiss. It didn’t come, but we could still see she had a smile on her face.

The procedure went great and Savannah was walking around within hours! Pain management and recovery time? She needed one dose of Ibuprofen, and we were out of the hospital the next day! The surgery was on a Tuesday morning, we were discharged Wednesday evening and Thursday morning she was sitting cross-legged on the floor playing with her dolls like nothing had ever happened. It was truly remarkable.

Dr. Koh was confident that the surgery was a success, but the true test would come six months later, after she had healed completely.

After the long wait, back in California, we peered at the screen as the radiologist injected the dye. Every time we’d done this before, we watched it slowly travel all the way up into her kidneys, taking the same path the infections always had in the years before. We kept watching, and waiting, and for the first time in Savannah’s life, the dye stayed where it was supposed to! She was completely healed, and the procedure was a 100 percent success! We cried and hugged. What a relief. Her kidneys were growing and healthy, and all of the worry was gone.

Well, for that one moment, all of the worry was gone. Then I had this sinking feeling welling up from deep within me. BOYS. My next big challenge as a father of a daughter. Who knows, maybe in a few years we’ll have a robot that can help with that one too.

Ron Bair, father of patient