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Reprinted with permission,
Courtesy, Asbury Park Press, a Gannett Co. newspaper.
By CAROL
GORGA WILLIAMS
For a while, it looked like Leo DiGuilio, shortstop extraordinaire,
would spend this season on the bench, if he could even leave
his Bradley Beach home at all.
Leo, 12, was born with a urologic problem that had grown worse
and more painful over time. Surgery was just about his only option
but a traditional operation would keep him in a hospital for
a week, jacked up on painkillers, and would subject him to a
long rehabilitation, mostly from the massive incision surgeons
would make to get to his internal organs.
So Leo put down his baseball cap and opted to become an explorer.
He became the first-ever pediatric surgery patient at Monmouth
Medical Center to under go his procedure robotically.
Instead of a long incision, he instead received four tiny incisions,
each one only a few millimeters in length.
Rather than being stuck in the hospital for a week, Leo had
his surgery last Monday, and was home Tuesday evening.
By Wednesday, he was walking around the block with his mom,
Mary. By Friday, there was no more pain and no more need for
pain medications. And Leo will will be pacing between second
and third bases in the next few weeks, months before he enters
the seventh grade at Bradley Beach Elementary School this fall.
Mary DiGuilio admits that Leo's parents did not share many details
of the surgery with Leo beforehand.
"I did not want to make him too nervous and upset," she said. "After
he found out, he absolutely did think it was cool, like video-game
technology."
Obstruction removed
Leo's surgery was performed by urologists and robotic surgeons
Drs. Michael P. Esposito and Mutahar Ahmed, assisted by pediatric
urologist Dr. Thomas S. Vates III. Esposito has done many robotic
surgeries at the Long Branch hospital, which is the only medical
center in the region to offer the technology.
The da Vinci S surgical robot was used on Leo when surgeons
performed a robotic pediatric pyeloplasty to correct what medical
authorities describe as a common congenital malformation of the
junction between the ureter and the kidney, called uretero-pelvic
junction obstruction.
If left untreated, Leo could have experienced permanent kidney
damage. Instead, Dr. Esposito removed the obstruction and reattached
the healthy part of Leo's kidney to the healthy part of the ureter — the
narrow tubes that carry urine from the kidneys to the bladder.
"This saves the kid a big 12-to-15-inch incision," Esposito
said after the surgery. "They will be replaced with four holes,
each less than 8 millimeters in length. He will have no pain
from the incision, and the inside result is 98 percent success
rate."
The procedure took about an hour and 15 minutes with Esposito — operating
the robot from a control console in the operating room — manipulated
robotic instruments and a camera that were placed into the incisions
to do the cutting and suturing.
Safer surgery
Mary DiGuilio said she was quite pleased with the mini-incision,
and all that goes with it: less pain, shorter healing, less blood
loss and chance of infection.
"He's only 12," she said of her only child. "You don't want
to have scars all over your body."
Because the surgeon is more comfortable and surgeries are done
more quickly, with less exertion by the surgeon — many
surgeries are physically demanding — there is less chance
that the surgeon will experience a hand tremor or be injured.
This allows for increased control, precision and dexterity, medical
authorities have said.
"He would have been in the hospital for three or four days,
on morphine, and it easily would have been a three- to six-month
recovery," Esposito said. "This kid is an avid baseball player.
. . . He will be back playing baseball next week as opposed to
next year. It is a huge difference."
Vates said he referred Leo and his family to Esposito, who does
adult urologic surgeries, while Vates gets more experience on
the robot.
"It can be done in any patient population," said Vates, noting
data are showing particularly good benefits for adolescents,
in terms of less need for pain management and fewer days in the
hospital.
"Other studies have shown improvement (as opposed to an open
incision) but you can't say we've seen any decrease in pain medication
or length of stay issues" in other age groups, based on a lack
of data.
"For people who are comfortable using it, it is probably the
preferred method," Vates said of the robot, approved by the government
for use in surgeries in 2000. ". . . Since we are in the area
near New York and Philadelphia where there is a lot of interest
in medical innovation, New Jersey benefits from that."
The DiGuilios did not want their son to lose his summer, full
of baseball and time at the beach.
"The fact that what would be months of recovery now becomes
weeks is wonderful," Mary DiGuilio said. "And he came through
it with flying colors. I'm really proud of him."
Additional Facts
For more information on Monmouth Medical Center's robotic surgery
program, go to www.saintbarnabas.com/hospitals/monmouthmedical/ or
call
888-724-7123. For more information on the robotic system
in place there, visit www.davincisurgery.com.
Date: June 21, 2009
CONTACT: Kristine A. Brown
Director of Public Relations
732-557-3902
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