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New pediatric gallbladder procedure improves outcomes

May 21, 2017
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Little did Taisha Diaz expect that the pediatric surgeon who operated on her just days after her birth back in October 2001 at Baystate Children’s Hospital would once again return years later to nurse her back to health.

“Taisha was a preemie. She weighed just a little over two pounds when she was born, and needed immediate surgery for perforated necrotizing enterocolitis,” said Lucy Diaz, Taisha’s mom.

Flash forward 15 years later and in January of this year Taisha found herself in the Sadowsky Family Pediatric Emergency Department at Baystate.

“I was worried. I felt sick for a couple of days, but nothing like I felt before, so we decided to go to the emergency room,” said Taisha, who was complaining of pain in the middle of her chest.

Doctor and patient reunion

Taisha went through various tests, including an EKG to check her heart, but ultimately it was an ultrasound that helped to diagnose that a gallstone was lodged in the neck of the gallbladder and would require surgery. It was Dr. Kevin Moriarty, chief of Pediatric Surgery at Baystate Children’s Hospital – who had performed Taisha’s intestinal surgery for the perforated necrotizing enterocolitis 15 years ago – who met Taisha and her mom in the pediatric emergency department to give them the news and explain what would come next.

It was decided that Taisha could wait until February school vacation to undergo the surgery, so that she wouldn’t miss any schoolwork at Chicopee High School, where she is a freshman.

“Surgery is needed because gallstones obstruct the cystic duct that drains bile from the gallbladder, resulting in intermittent pain. We need to remove the gallbladder because even if you remove the gallstones, they will return,” said Dr. Moriarty.

Once Taisha learned that Dr. Moriarty had operated on her when she was a baby, there was a connection there, explained her mom.

“I think it made her feel a little better about the surgery,” Lucy said.

A new surgical procedure

Lucy and her husband also felt somewhat better after Dr. Moriarty explained a new surgical procedure that they wanted to use on Taisha involving a new green dye to help make the surgery safer.

“Prior to the fluorescent green dye, we would have to inject a contrast dye into the gallbladder and use x-ray to look at the anatomy. Not only did this take extra time, but it involved radiation exposure. Now we can inject a green dye into the patient 45 minutes prior to the operation. The fluorescent dye is excreted in the bile after being cleared from the bloodstream by the liver,” explained Dr. Moriarty, who noted that parents are given the option to opt out of using the green dye in favor of conventional x-rays.

“The use of the green dye in Taisha’s case would be extremely helpful to us in visualizing the biliary system during minimally invasive laparoscopic surgery, especially because of the potential scaring that might have resulted from her previous intestinal surgery,” he added.

The procedure is made possible through a connected surgical video system – Stryker’s 1588 Advanced Imaging Modalities (AIM) Platform – that with the use of numerous imaging capabilities allows surgeons with the touch of a button to visually differentiate critical anatomy across an array of minimally invasive surgeries. The imaging modality used by the pediatric surgeons at Baystate Children’s Hospital is called ENV, short for Endoscopic Near Infrared Visualization.

Benefits for the patient and surgeon

“The benefit for the surgeon is that with the infrared cameras, the green dye makes it possible for us to see the anatomy of the bile ducts and gallbladder much more clearly. There is no guesswork to what we are looking at, and as a result it is a safer procedure for the patient because it reduces the risk of common bile duct injury during laparoscopic cholecystectomies (gallbladder removal),” said Dr. Moriarty.

“I feel good now, although there are days when I get heartburn feeling, but Dr. Moriarty prescribed an over-the-counter medication to help,” said Taisha.

“Taisha is learning her boundaries and what foods she can and cannot eat to help avoid getting any heartburn feeling,” said her mom.

New technology like that used in Taisha’s surgery is constantly helping surgeons today to become more precise at the operating table, vastly improving the quality of medical care that their patients receive. Medical technology comes at a cost, however, putting stress on hospital budgets.

Thanks to the Baystate Health Foundation

It was the Baystate Health Foundation – with monies raised from the Baystate Children’s Hospital Golf Tournament, the Max Golf Classic and Children’s Miracle Network Hospital initiatives – that provided the funding for the two 1588 Advanced Imaging Modalities (AIM) Platforms along with four cameras each in the hospital’s two pediatric minimally-invasive operating rooms.

“We are very grateful too for the generosity of Baystate Health Foundation donors for their assistance in obtaining this advanced technology, which will improve patient safety for young patients who must undergo surgery involving the biliary ducts,” said Baystate pediatric surgeon Dr. Michael Tirabassi.

“Compared to the larger adult laparoscopes, using smaller laparoscopes on children requires a stronger light to be able to see well. The light sensitivity is key and that is what Stryker brings to the operating room with its unique AIM technology,” he added.

Dr. Moriarty performed their first surgery using the new video system on a young girl with gallstone pancreatitis in January, and the Pediatric Surgery Division has since completed four additional surgeries, including Taisha’s gallbladder removal.

While the AIM Platform is being used now primarily for bile duct surgery, Dr. Tirabassi said the technology will offer other applications in the future, such as intestinal surgery, for pediatric surgeons at Baystate Children’s Hospital.

For more information

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