BAMC Docs Perform Robot-Assisted Pediatric Surgery

By Elaine Sanchez

Brooke Army Medical Center

JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas, July 14, 2015 – A 2-year-old boy has a shot at a better quality of life, thanks to a robot and a few skilled surgeons here.

Doctors here performed surgery on Jose Collado Jr., son of Army Maj. Jose and Alma Collado, last month to remove a large cyst from behind his bladder. The procedure marks Brooke Army Medical Center’s first robot-assisted pediatric surgery.

“The surgery was very successful,” said Army Lt. Col. (Dr.) Thomas Novak, BAMC’s chief of pediatric urology. “We were incredibly pleased at the outcome and at the impact we made on Jose’s future quality of life.”

The Collados first brought their infant son to Brooke two years ago, hoping to pave a better future for Jose.

Jose had been diagnosed shortly after birth with polymicrogyria, a rare brain malformation that can cause problems with eyesight, seizures and developmental and motor delays. Along with these issues, which include legal blindness, Jose also had a cyst behind his bladder.

As a number of specialists addressed Jose’s eyesight, seizures and development, Novak focused on his cyst. Due to the size, the mass was likely to cause bladder and bowel problems later in life, he explained. However, he was hesitant to perform surgery while Jose was still an infant, particularly in the absence of symptoms. The doctor advised the concerned parents to hold off on surgery until their baby had an opportunity to grow.

Robotic Technology

From the beginning, the doctor said, he thought a robotic approach would be ideal.

Robotic technology has been a surgery staple at BAMC for several years, but until now, was reserved solely for adults. Novak had long since noted the success of robot-aided pediatric surgery in other parts of the country, particularly for urologic cases, and felt it could have a place at BAMC.

“It’s definitely not mainstream,” he said. “But there are a handful of people who have practices focused on pediatric robotic urology.”

Robotic technology, he explained, offers numerous benefits: it’s minimally invasive, more agile in small spaces, offers 3D high resolution magnification for better views of the surgical site, and typically involves a quicker recovery time.

“The robot has movements analogous to a hand,” he said. “You can move with complete free range of motion and obtain a much better visual as you go deeper and into tighter spaces.”

Open Incision Would Be Difficult

In Jose’s case, Novak saw the potential to move toward the deep-seated mass with better visibility. “The mass was in an area where open surgical incision would be difficult,” he explained, “and risky with vital structures in the way.”

Novak patiently followed Jose closely for two years. However, with a potential military move for the family looming, the Collados asked Novak to perform the surgery before they left. Confident that Jose was ready, the doctor quickly enlisted the help of Army Maj. (Dr.) George Kallingal, a urologic oncologist and robot-assisted surgery expert, and Air Force Maj. (Dr.) Michelle Marino, a pediatric anesthesiologist. “We took a team approach to gain experience and comfort for everyone involved,” Novak said.

Because robot-assisted pediatric surgery had never been performed here, Novak garnered support at the highest echelons of his command. “Everyone was very supportive,” he said. “I felt strongly Jose was the right candidate who could greatly benefit from the surgery.”

Novak and his team performed the surgery June 30. “It was highly successful,” he said. “We removed the cyst without any complications.”

Quick Recovery

Jose’s father noted his son’s quick recovery. “We were home after two nights at the hospital, and Jose was fine,” Collado said. “He’s up and about like nothing ever happened.

“We are ridiculously happy with the doctors here,” he added, noting special gratitude for Jose’s neurologist, Army Lt. Col. (Dr.) Richard Hussey, and for Novak. “It’s one of the reasons we wanted to come here; the pediatric care was very well known.”

Collado was so pleased with the care that he volunteered for an assignment in Korea rather than move his family away. “I wasn’t comfortable with a break in care,” he said. “Jose’s progress here has been unbelievable.”

Novak said he couldn’t be more pleased with the outcome.

“Everything came together: the right patient, right family, right problem, right team,” he said. “We hope to do more surgeries of this type in the future, but in the meantime, it’s just very rewarding to have made a difference in Jose’s life.”