Tiniest incisions help tiniest patients

Tiniest incisions help tiniest patients

Ashwin Pimpalwar, M.D. Operating through one-eighth inch incisions and using specially designed endoscopic equipment, a University of Missouri Children’s Hospital surgeon is able to offer some small patients big benefits.

Ashwin Pimpalwar, M.D., an assistant professor of pediatric general surgery at University of Missouri Health Care, is using minimally invasive techniques to repair a number of gastrointestinal and respiratory conditions in pediatric patients.

“During the last few years, we have gotten the instrumentation down to the tiniest sizes,” said Pimpalwar. “For pediatric patients, especially babies, this is the key to being able to offer a surgical approach that will reduce postoperative pain and scarring while speeding up recovery.”

More traditional open surgeries usually require a much longer incision to gain access to the surgical area. Recovery also takes longer — up to four or five days, so that the physician can monitor the patient and treat postoperative pain issues.

“With less injury to skin, muscle, and nerves, there are fewer wound complications, postoperative pain management is easier, and the return to normal functioning is quicker,” said Pimpalwar. “For children, this can mean less time missed at school. For parents, it often means less time away from work caring for their child.”

Pimpalwar’s approach to minimally invasive surgery is to use a small telescopic camera and instruments inserted through tiny openings in the abdominal or chest wall. The incisions are three millimeters, or about one-eighth inch long. The area is then inflated with gas to allow access, and Pimpalwar is guided by a monitor that shows the internal view projected by the telescopic camera.

The incisions are so small that stitches are often not even used. Instead, post-operative closure of the openings is achieved by using special glue that holds the edges of the tissue together.

Although a minimally invasive approach is appropriate for many pediatric patients, there are some instances when a more traditional, open procedure is necessary.

“The goal in any procedure is to achieve the best possible outcome,” said Pimpalwar. “Being able to accomplish this objective with fewer complications, less pain, faster recovery and less scarring is a gratifying experience for me. I am very pleased to be able to offer this service to mid-Missourians.”

Children’s Hospital is the largest and most comprehensive pediatric health-care center in mid-Missouri. Housed at University Hospital and Clinics and Columbia Regional Hospital, the 115-bed hospital is the only facility in mid-Missouri offering comprehensive, specialized children’s services such as trauma care, neonatal transport, child life therapy and a hospital school.

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