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Small Wonder - Minimally Invasive Surgery Videos

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Team, Tools, Technique

How CHOP put together its MIS program and team; how the team works together; how CHOP innovates by working with industry to develop new and better instruments for pediatric patients

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Transcript: Team, Tools, Technique


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Thane Blinman, MD: When we first started minimally invasive surgery at CHOP, we could pretty much do appendectomies, pyloromyotomies for pyloric stenosis, and maybe a few other minor things.

N. Scott Adzick, MD: We now do everything that can be done in a proper manner with a minimally invasive approach.

Thane Blinman, MD: We can take out defective lobes of the lung. We can repair the esophagus. We can remove duplication cysts. We can fix reflux disease. In fact, CHOP offers over 100 different procedure codes for minimally invasive procedures alone.

Alan Flake, MD: In the old days we would think about doing a procedure open. Now we always think about, "Can we do this minimally invasively?"

Thane Blinman, MD: Having a team is critical to making this work the right way.

Susan Scully, RN: Teamwork is the most important thing that we do here.

Thane Blinman, MD: The reason that we can do all those different procedures in the daytime and the nighttime, on the weekday or on a weekend is that all the nurses are very, very well trained in these techniques.

Susan Scully, RN: Without the instruments and without the things that we put in place, they couldn't do their surgery. So basically, as the specialty nurse, I have to make sure that the instruments we have are functional, and that we have the instruments that each different doctor needs for each different surgery that he does.

Thane Blinman, MD: She had to learn how every single one of those things worked and then teach that to all the other nurses in the operating rooms.

N. Scott Adzick, MD: So that we can have that sort of quality 24 hours a day, 7 days a week.

Alan Flake, MD: Minimally invasive surgery is a very technical endeavor. You're dependent on high technology to do the procedures.

N. Scott Adzick, MD: You need an industry partner here on site to help you solve these problems in real time.

Thane Blinman, MD: And that's where Lem comes in. Lem is like a secret weapon. Lem is like our ace up the sleeve.

Lemuel White, On-site Endoscopic Specialist: Where the nurse is concerned with the patient, my job is to be concerned with that room. It's a unique position. There's not too many on-site technicians in the country.

Alan Flake, MD: Like any complex electronically driven system, you can have breakdowns in that system. You can have glitches that occur, and they can during surgery or before or after surgery.

Lemuel White: Once the rooms are up and running, we then move on to the instruments.

Thane Blinman, MD: Our instruments have tiny little moving pieces. Very, very fine action at the tips, and they're -- they're just delicate. They don't last nearly as long as the open kind of tools do. And, as a consequence, we've got to really pay attention to make sure that the tools that we're using are still in good working order.

Lemuel White: You're constantly cleaning, oiling, maintaining, adjusting, tightening all these instruments, and making sure this equipment, every case, is just like new.

Thane Blinman, MD: Porsche perfect for every procedure, for every baby, every single time. Very often we find that the tools we use don't work exactly the way we want it to. Some of the things were designed perfectly for the babies, but most of the things weren't designed for children. And we've adapted their use, but even those will have problems.

N. Scott Adzick, MD: You have to get industry to play along because they have the horsepower to make the things that you need. So we generate the ideas. They generate the instruments.

Thane Blinman, MD: And we can give them very specific recommendations. Your tool would help us if it did this.

Lemuel White: Having that innovation done here translates out into the field in all the other hospitals.

Susan Scully, RN: Kids wouldn't survive as well, or do as well, if we didn't have the teams that we have and if we didn't communicate the way we do.

Thane Blinman, MD: There are nine general surgeons on the staff here and all of them use minimally invasive techniques in their practices. Moreover, some of the urologists are now using these methods, including the robot. Some of the neurosurgeons use some of these techniques, even using minimally invasive surgery in the head. The ear, nose and throat doctors have always used different scopes, but now they have different tools that they use. And, of course, the orthopedic doctors are using arthroscopy, or looking into the joint, that way. So, essentially, this has become a very normal part of what we do at CHOP.
 

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