The FDA has approved a surgical robot, part of the da Vinci Surgical System, for use in thoracic surgery, general laparoscopic surgery, and for surgical assistance. The robot has 3 arms that can be moved with pinpoint accuracy. Its space age technology magnifies the skills of experienced surgeons.

Sitting across the room, the surgeon manipulates the robot’s controls. This translates into precise movements that allow for complex and delicate surgery through smaller incisions than ever before.

When it comes to operating on children, tiny incisions and extreme precision are welcome indeed! I expect that in the next few years, robotic support will enhance the expertise of pediatric surgeons and open the door for exciting advances in pediatric surgery.

A capillary hemangioma is a bright red birthmark that can sometimes be the most noticeable feature of a little baby. Hemangiomas often don’t appear until a baby is a month old, and can continue to grow throughout infancy.

Some are cute; some are large and unsightly. Thankfully, most will disappear on their own within about 2 years. Because of this, and because treatments often resulted in complications and scarring, previously, most hemangiomas were left untreated.

Recently, however, treatments have been improving. Removing them is now an option well worth considering.

The May 2000 issue of the Journal of the American Academy of Dermatology highlights a new type of treatment: mild cryosurgery. Using a probe that is only half as cold as standard liquid nitrogen probes, the hemangiomas are gently frozen.

This simple technique has impressive results, without the complications sometimes seen with traditional cryosurgery.

Whether hemangiomas are treated or not, babies deserve to have parents and others look at them with wonder and delight.

The Cleveland Clinic was the scene of a truly amazing feat. When women want permanent birth control, they sometimes have a simple operation called a tubal ligation, where the fragile Fallopian tubes are each tightly tied in two places, and then cut in between. Reversing a tubal ligation requires exacting microsurgery in an attempt to reconnect the delicate tubes without scarring.

At the Cleveland Clinic, surgeons reconnected Fallopian tubes in 9 of 10 women – without touching them. Instead they used computer operated robotic arms, controlled voice recognition and two ‘mouses’ shaped like surgical instruments. The computer was able to magnify the surgical field and subtract the normal fine tremor of the human hand.

Soon world-class surgeons will be able to use the internet to guide operations on the other side of the world, or even in space.

Dr. Greene’s Answer:

From the 1930′s through the 1960′s, tonsillectomies and adenoidectomies were considered routine surgeries. At that time, the tonsils and adenoids were thought to be useless organs, because their function was not understood, and because they often melt away after childhood. In the late ’60′s we discovered that the tonsils and adenoids play an important role in the immune system. Once this was understood, the practice of routine tonsillectomy and adenoidectomy declined.

In 1990, a very well-designed study by Jack Paradise, M.D. (and colleagues), published in the Journal of the American Medical Association, did show a clear but modest reduction of ear infections following adenoidectomies. In 1999, the same author published another study which showed a “limited and short term” effect. Now we are faced with a decision — is the short-term benefit of removing the adenoids worth the cost?

The adenoids (also called the nasopharyngeal tonsils) are positioned at the back of the throat as defenders against bacteria and toxic substances that come into the body through the nose and mouth. When they are active — fighting infections and producing antibodies — they can become quite enlarged. In this state they can block the eustachian tube and clog the drain from the middle ear. Typically this obstruction is not complete and will still allow some of the normal secretions from the middle ear to drain.

Because the risk of adenoid surgery is greater than that of tube placement, the American Academy of Pediatrics recommends tube placement before adenoid surgery for the initial surgical treatment of most children with persistent middle ear fluid (Pediatrics 2004). However in children over 4 years old who mouth breathe chronically, snore heavily, and/or have chronic nasal congestion, the likelihood of benefit from adenoid surgery is increased. Thus, some doctors may consider adenoid surgery with tube placement or with myringotomy (hole made in the eardrum) for children over 4 years old who have the above symptoms of problematic adenoids.

Tonsillectomies are another story.

In 1983, the British Medical Journal reported a controlled study performed by A.R. Maw. The authors compared those who had their adenoids taken out with those who had their adenoids and tonsils removed. They found that adenoidectomy did result in improvement in middle ear disease. However, there was no additional benefit from having the tonsils removed. At present, there is no evidence that tonsillectomy alone is of any benefit in the treatment or prevention of otitis media. If a child were suffering from some other concurrent condition, such as obstruction of the airway or sleep apnea, however, I would consider tonsillectomy in addition to adenoidectomy as a possible solution.

For your son, Pauline, it’s not really a question of antibiotics versus surgery (the long courses of antibiotics may not be necessary — they may not be speeding up the disappearance of the fluid). The question is fluid in the ear versus surgery. Surgery may well be the better option for your son. His 2 or 3 infections per year — each with 1 or 2 months of fluid — mean that his hearing may be decreased for up to 6 months each year. A formal hearing test and thoughtful assessment of his school performance may help you to reach a decision. The information here can be used as a starting point for discussion with your doctors about the best course of treatment for your son.