Dr. Michael Tirabassi is a magician of sorts among pediatric surgeons. He has the unique ability to remove a child’s appendix – or an ovary or a section of colon – without leaving evidence in the form of a scar.
"We’re getting much better at hiding the scars with endoscopic surgery," Tirabassi says. "It is difficult to even tell the child had surgery."
The technique is called Single Incision Pediatric Endoscopic Surgery, or SIPES for short. In a nutshell, it’s the next evolution of minimally invasive (or laparoscopic) surgery. Instead of making multiple small incisions – three for an appendectomy – through which the camera and instruments would be inserted individually, only one incision is made. It’s tucked inside or immediately adjacent to the naval.
"We hide the scar of surgery right next to the belly button or within it, which makes it nearly a scar-free surgery," Tirabassi says.
Less Anxiety, Less Scarring
The major benefit of SIPES is cosmetic, since the scar is usually either difficult, or impossible, to see.
"Often the biggest cause of anxiety for our pediatric patients, especially our teenagers, is the idea of multiple incisions and severe scarring," says Maureen Howe, child life specialist. "It is a great comfort to our patients and their families to learn there is only one small incision with very little scarring, if any."
In addition, complications are reduced. With multiple incision sites come multiple chances for complications, such as infection, hernia, or adhesions. One incision reduces the chances for those problems.
"SIPES has impacted the recovery time in patients greatly," says Kimberly Murphy, RN, Baystate Children’s Hospital Surgery Center. "Not only is it fast, but the kids have less pain, less nausea, and therefore the need for fewer narcotics."
Special Anesthesia Care for Kids
The specialized skill of Baystate’s surgeons is also enhanced by their collaboration with the pediatric anesthesiologists at Baystate Children’s Hospital.
Even when his patients are too young to articulate their fears, Dr. Donald Schwartz, director of Pediatric Anesthesiology, knows they have them. He and the rest of Baystate’s team of nine pediatric anesthesiologists provide anesthesiology services for children at Baystate Children’s Hospital 24/7 for surgeries and emergencies.
Before scheduled surgeries, they meet with each patient and their parents to assess the child’s health history and past surgical history to determine if they are at greater risk for complications from anesthesia. They also evaluate each child's state of mind.
"We take steps to relieve any anxiety they might have, perhaps with distraction therapy from our child-life specialists or medication," he says. "We also allow parents to be in the operating room until the child is asleep. That's something that we advocate very strongly. Children don't have to separate from their parents, and that alleviates this big concern and stressor."
Schwartz says there is a particular expertise involved in anesthetizing children since intubation can be more difficult, establishing an intravenous can be challenging because of small veins, and pediatric vital signs are completely different.
"Children have very different physiology," he says. "What we would accept as normal in an adult we would not accept as normal in a child. Children are also prone to certain complications that adults are not prone to."
Highly Specialized and Close to Home
Tirabassi and Dr. Kevin Moriarty, chief of Pediatric Surgery at Baystate Children’s Hospital, are the area’s only two pediatric surgeons using the SIPES technique, performing appendectomies and major colon resections, correcting rectal prolapse, removing an ovary or untwisting a twisted ovary. They say many young patients are candidates for this type of surgery.
"This is something that’s really on the forefront in the country for the surgical care of children," says Tirabassi. "We are leading the way. There are very few pediatric surgeons in the country who perform SIPES."