pedsurg

We are constantly hearing about the wonders of 3D printing. A lot of it involves very difficult tissue engineering.. which is great, but there are other uses for it too!

Surgeons at Kosair Children’s Hospital (Louisville Kentucky) used the 3D printer to create a 3D rendering of a child’s heart. Instead of trying to figure out a defect in a heart using the traditional CT scanner, this allows for a better understanding of the nature of the defect and also gives the surgeon an opportunity to create a better plan for the surgery. 

The best part of this is that it only cost ~$600 (excluding the price of the printer)! Can anyone buy me a printer?!?

Ectopia Cordis Herniating Heart.

When Nazeem was born his heart was on his chest, on the outside, pumping normally. The aorta went from his heart straight into his chest. Doctors wrapped his heart in Gore-Tex, plus a layer of his own skin, and gradually moved it inside his body.

Naseem was born with Ectopia Cordis - the heart develops outside the body and the baby does not have a sternum. The sternum protects us from impacts, hence he should never play impact sports. When he is a bit older, about six months, pieces of his ribs will be grafted across his chest to create a makeshift sternum. About 1 in every 180,000 to 126,000 babies are born with Ectopia Cordis.

Doctors knew about his condition about a month before he was born after an ultrasound scan. In September his mother had noticed he seemed to be having hiccups all the time (probably the beating heart).

Hernia’s are a pretty common thing. We usually see ventral hernias or inguinal hernias. But something like this, I would be terrified as a parent, but amazed as a physician.. 

Dr. Ben Carson

Dr. Ben Carson, Director of Pediatric Neurosurgery at Johns Hopkins, along with being awarded the Presidential Medal of Freedom, is one of my heroes.  His autobiography Gifted Hands is one of my favorite books ever.  It talks about his journey to where he his today, and all the difficulties he had faced along the way.  His passion for innovation and his drive to become a surgeon is something I respect dearly in my own studies.

Gastroschisis

Gastroschisis, a condition very similar to omphalocele, is a a birth defect in which an infant’s intestines stick out of the body through a defect on one side of the umbilical cord.

Unlike omphalocele, there is no membrane covering the intestine, therefore being fatal as soon as the baby is born. It is treated almost instantly, and is done in a way very similar to an omphalocele repair. The affected organs are covered in a thin man made membrane and put back into the abdomen area. 

Gastroschisis seems more fatal, and needs immediate care, however the survival rates for gastroschisis lies in the 85-90% while omphalocele lies in the 60%. This is because omphalocele is related with many other genetic disorders and organ anomalies.  

Nephrectomy

I have recently gotten the chance to start shadowing a pediatric surgeon in my area. And I have to say its like a dream come true!

Nephrectomy, or a kidney removal was the first surgery that I had an opportunity to observe, so here were some notes that I took from it.

The picture is actually a tumor which had grown into a tremendous size. The kidney was destroyed, and the tumor had replaced the whole kidney.

It was my first surgical experience, so I learned about the basic preparations needed for a surgery. The anesthesiologist, surgeons, and nurses took all pre-cautions needed for the surgery. They had the extra blood ready, they had iv’s going in the babies’ arms and legs’ arteries just in case they needed to pump the blood in. 

The surgery was fairly simple, after the incision they begin removing all the connective membrane and tissue between the kidney and the body. The key part of this surgery seemed to be the cutting of the artery and vein that connected the kidney to the other parts of the body. It was crucial to cut the artery first in order to cut off and excess blood going into the kidney, lessening loss of unnecessary blood, and then the vein was cut to loosen the kidney. 

All I could say after this procedure was wow. It was an eye opening experience for me. It made me more motivated than ever to want to be in the surgeons’ place one day. 

…must study hard and work hard… 

Inguinal Hernia Repair

An inguinal hernia is a protrusion of abdominal cavity contents through the inguinal canal. 

It can be categorized into two different categories.

The surgical repair for this in infants (pediatric surgery) was fairly simple. First a quick exploratory laparoscopy is done through the belly button, to check for both sides.

The testicles drop last 4-6 weeks of pregnancy, so when the baby is premature or the abdominal wall fails to develop fully to push the testicle down, the hernia forms. So this means that it would often form on both sides. 

Then an incision is made where the hernia would be, and the hernia is simply cut out. The main thing to notice during this is the testicular vessels and spermatic cord that goes through. All of these need to be preserved correctly so that the baby will be able to reproduce and have full function of his reproductive organs. 

I’m beginning to actually recognize different body parts, and see different vessels and such when the surgeon is operating, it’s very exciting.

Omphalocele

Omphalocele is a birth defect in which the baby’s intestine or other abdominal organs are protruding from the belly button. An omphalocele is a type of hernia, the intestines and organs are covered in a thin layer of membrane. An omphalocele is easy to diagnose because of the clearly apparent visual symptoms. 

Size can vary small 1cm bubbles to up to 10cm.  This is very important to see how they are going to be treating the matter. Approximately 25 - 40% of infants with an omphalocele have other birth defects. They may include genetic problems (chromosomal abnormalities), congenital diaphragmatic hernia and heart defects. Because of these possibilities, the surgery for omphalocele is postponed until the other anomalies are fixed. 

Omphalocele repair results in literally cutting the stomach, putting back the organs inside the body and sewing it up. This is also a treatment for omphalocele’s brother disease gastroschisis (which I will be talking about later).