Centre for Complex Paediatric Surgery - Robotic and Minimally Invasive Surgery

The Nanavati Max Centre for Complex Paediatric Surgery is one of India's leading clinical facilities, offering advanced Robotic and Minimally Invasive Surgical solutions designed specifically for children. The state-of-the-art Da Vinci Xi system allows surgeons to perform complex surgeries on infants and children using 8-millimetre keyholes to ensure minimal tissue involvement, less pain, and faster recovery.

Specialising in complex procedures such as Duhamel's pull-through for Hirschsprung's disease, Ladd's procedure for malrotation, and pyeloplasty for hydronephrosis, our team of expert paediatricians, neonatologists, paediatric surgeons, anaesthesiologists, critical care specialists and trained support staff, deliver successful clinical surgical outcomes. We offer specialised paediatric care across different clinical specialities such as urology, nephrology, hepatobiliary surgery, gastroenterology and oncology.

Robotic surgery is specifically beneficial for children due to its higher precision while operating on delicate and minute structures of the intestine, kidneys, and lungs. We have performed successful robotic paediatric surgeries on children aged 6 months to 18 years with shorter and seamless post-operative recovery. With a focus on holistic care, our centre also provides specialised services in urology, nephrology, hepatobiliary surgery, and more.

We at Nanavati Max Hospital, ensure that each child receives world-class care and join the society to lead a healthy, active life.

Our Facilities & Services

Dedicated Infrastructure

• Separate Paediatric Ward
• Separated paediatric ICUs

Trained Healthcare Staff

• Paediatricians
• Neonatologists
• Paediatric Surgeons
• Paediatric Anaesthesiologists
• Paediatric Intensive Care Specialists
• Neonatal Intensive Care Specialists
• Paediatric Nurses

Advanced Equipment

• DaVinci Xi Robotic System
• 3D and 4K Laparoscopy system
• Micro-surgical instruments.

Intensive Care Units for Children

Our specialised intensive care units for children include:

a) Neonatal Intensive Care Unit

1. 24x7 trained doctors and nurses
2. Admission of babies as small as 24 weeks of gestation (roughly six months of pregnancy) and as small as 400 grams in weight.
3. Specialised Incubators for extreme preterm and surgical infants.
4. State-of-the-art neonatal ventilators, phototherapy, and monitoring systems.

b) Paediatric Intensive Care Unit

1. Separate and specialised unit
2. 24x7 trained doctors and nurses
3. State-of-the-art ventilators
4. Can admit children with trauma
5. Can admit children who need dialysis
6. Can admit children who need ventilators
7. Multidisciplinary support from all varieties of paediatric specialists
8. Facilities for Bronchoscopy in the ICU.

Why Choose Nanavati Hospital for Paediatric Surgery?

At Nanavati Max's Centre for Paediatric Surgery, patients can expect:

• Highly skilled surgeons and medical staff: Our Paediatric General surgeons have decades of international and national experience. Specialists for Paediatric Urology, Paediatric ENT and Airway surgery, Paediatric Orthopaedic surgery, Paediatric Neurosurgery, Paediatric Thoracic surgery, Paediatric Liver Surgery, and Paediatric Oncosurgery (cancer surgery) are available.
• Advanced technology and equipment: Our facility is equipped with the DaVinci Robotic system, one of the most advanced robotic surgical systems to date. We are one of the few centres in India offering paediatric robotic surgery.
• Multidisciplinary team: Super-specialists in all medical specialities, such as paediatric nephrology, paediatric gastroenterology, paediatric endocrine, paediatric neurology, paediatric asthma and pulmonary medicine, paediatric hepatology, paediatric general medicine, paediatric intensive care, paediatric rheumatology, and paediatric infectious diseases, are available to provide personalised care.
• Comprehensive care approach: Our department adopts a comprehensive approach to treatment, ensuring that every aspect of a child's care is addressed with precision and expertise.

Our Paediatric Surgical Specialities

• Neonatal surgery
• Paediatric Urological surgery
• Paediatric Oncological surgery
• Paediatric Thoracic surgery & Pulmonology
• Paediatric Hepatobiliary surgery
• Paediatric Orthopaedic surgery
• Paediatric Neurosurgery
• Paediatric Oesophageal surgery
• Paediatric Lung surgery
• Paediatric Lung surgery
• Paediatric ENT & Airway diseases
• Antenatal counselling for foetal congenital anomalies

Conditions Treated Under Paediatric Surgery

Common paediatric surgical conditions treated by the department include:

Diaphragmatic Hernias

A diaphragmatic hernia occurs when one or more of the baby's abdominal organs move upwards into the chest through a defect or opening in the diaphragm, hindering the development of lungs on both sides.

Entering the child's chest through keyholes, these contents can be pushed back, and the defect is closed by suturing (stitching) the defect, sometimes using a specially made 'bio-patch'.

Hirschsprung's Disease

In Hirschsprung's Disease, the lowermost part of the intestine i.e. the rectum and colon do not 'open' to pass stools; hence, the child develops distension and vomiting. Usually, a stoma is made for such babies. We are one of the few centres that do single-stage pull-through surgery using modern technology such as robotics and 3D laparoscopy.

The surgery is called Duhamel's pull-through procedure, where a part of the original rectum is maintained and a new, well-functioning intestine is pulled through behind it and joined with it.

Malrotation

This is a common cause of bile vomits in newborn babies and older children. Due to an abnormally placed intestine, it twists, causing volvulus, which may be dangerous. Such children need immediate surgery called Ladd's procedure, which is best done by robotic or laparoscopic surgery.

Intestinal Obstruction: Blockage of the intestines is common in children, and it may be due to a congenital cause such as atresia or web or a defect in its placement. It may also happen in the later stage of life due to inflammation or adhesions due to prior surgery. A sudden blockage (acute) usually means that the cause needs to be repaired immediately, which is best done by robotic or laparoscopic surgery. Using image-guided surgery with fluorescent ICG dye, we can identify the segments of the intestine which are at fault and minimise the surgery needed, reducing long-term complications.

Choledochal Cyst

When there is a blockage to the flow of bile from the liver due to a cyst formation, it is called Choledochal Cyst. This is a serious condition which may cause life-threatening infections or damage to the pancreas. It needs urgent surgery to remove the choledochal cyst and reconstruct the drainage of bile using a Y-shaped piece of the small intestine. This complex surgery is best done using robotics or laparoscopy with the lowest risk of complications.

Pelvic-ureteric junction obstruction: A blockage of the urine flow in a child just below the kidney is called pelvic-ureteric junction obstruction. When it reaches a critical point, the kidney is at risk for damage, so a pyeloplasty is recommended. This very fine repair within millimetres of tissue is best done by robotic surgery or laparoscopy. This surgery is best done by a Robotic or Laparoscopic approach where a very fine repair within millimetres of tissue is required.

Vesico-ureteric reflux

The reverse flow of urine towards the kidneys is the most common cause of urinary infections in children. When the grade of reflux is high and it is causing damage to the kidneys, reimplantation is done to stop this reverse flow of urine. Using modern technology, we can create keyholes in the child's bladder and perform this operation by robotic or laparoscopic surgery. This surgery has a more than 95% chance of solving the problem. In lower-grade surgery with recurrent urinary infections, an injection can also be made into the opening of the ureter to reduce/eliminate the reflux, which is called an STING procedure.

Oesophageal Stricture

Narrowing of the food pipe (oesophagus) in children can be caused by birth after previous surgery, ingestion of caustic liquids or, rarely, a button battery or reflux disease. This is a serious condition that needs multimodal treatment in the form of nutrition support and endoscopic management of stricture. However, when all measures fail, the stricture may have to be resected and replaced by the oesophagus or the stomach as required. This complex surgery is best done by robotic assistance or thoracoscopy and laparoscopy. The surgery to treat this condition is termed Gastric pull-up surgery.

Frequently Asked Questions

1. Which Procedures Can Be Performed Robotically or Laparoscopically Procedures in Children?

The following procedures can be performed with a robotic or laparoscopic approach in children below 18 years of age:

• Duhamel's Pull-Through Procedure for Hirschsprung's Disease
• Resection & Anastomosis for Intestinal Obstruction
• Ladd's Procedure for Malrotation
• Pyeloplasty for hydronephrosis due to Pelvic-Ureteric Junction Obstruction (PUJO)
• Vesicoscopic Reimplantation for Hydronephrosis due to Vesico-Ureteric Reflux (VUR)
• Excision and Roux-en-Y Anastomosis for Choledochal Cyst of Bile Ducts
• Gastric Pull-Up for Oesophageal Stricture
• Lobectomy for Lung Cyst
• Repair of Diaphragmatic Hernia for Congenital Diaphragmatic Hernia (CDH)
• Bladder Augmentation for Urinary Incontinence
• Excision of Tumour for Small Tumours and Cancers
• Excision of Splenic Cyst for Splenic Cyst
• Puestow's Procedure for Recurrent Pancreatitis with Ductal Block

2. Can You Guide Parents on Child Safety Measures and Injury Prevention?

The most effective practice to prevent injuries and ensure children's safety is to childproof homes. Secure the edges of your furniture, use window grills and safety doors and keep sharp objects or hazardous substances out of their reach. Supervising their playtime and creating awareness about road safety or protective gear like helmets from an early age is ideal. Strictly follow the vaccination program launched by the Indian government to avoid common infections and diseases. Consult with a paediatrician in case of medical emergencies rather than trying home remedies.

3. How Do You Ensure The Safety and Comfort of Paediatric Patients During Surgery?

Nanavati Max Center for Pediatric Surgery is one of Mumbai's oldest medical facilities for the paediatric age group. We have created a separate Paediatric Ward to offer the highest standards of safety and comfort to our young patients. Our dedicated team of paediatricians, neonatologists, paediatric surgeons, intensivists, anaesthetists and trained support staff specialise in the management of all paediatric emergencies and conditions.

Sophisticated technology, such as the Da Vinci Xi robotic surgical system and 3D/4K laparoscopy systems, helps us offer precise minimal-access surgery. Our advanced Paediatric Intensive Care Unit (PICU) and neonatal Intensive Care Unit (NICU) are supervised 24/7 by paediatric intensivists and support staff to ensure the safety of our recuperating young patients.

4. Do You Offer Minimally Invasive Surgical Options for Children?

Yes, we offer a range of minimally invasive surgical options for paediatric patients. These include laparoscopic and robotic-assisted surgeries that involve smaller incisions, leading to less pain, faster recovery times, and minimal scarring. One of the most advanced surgical technologies, the Da Vinci Xi robotic system, allows our surgeons to perform highly precise and effective procedures. Minimally invasive techniques are part of our commitment to providing the best possible outcomes for our patients while minimising their discomfort.

5. Do You Offer Telemedicine or Virtual Consultations for Paediatric Patients?

Yes, we offer telemedicine and virtual consultations for paediatric patients living in different parts of India and abroad. The service is widely used for initial consultations, follow-up visits, and ongoing care management without the need for travel. Our paediatricians conduct these sessions with the same level of care and attention as in-person visits to offer the best possible medical advice and support.

6. What Age Range Do You Treat Children in Your Paediatric Department?

Our paediatric department provides care for children from birth through adolescence, including neonates, infants, toddlers, school-aged children, and teenagers. We are equipped to handle a wide range of paediatric surgical and medical conditions and offer specialised care tailored to each age group's unique needs.

7. How Do You Handle Medical Emergencies Involving Children?

Our dedicated and trained emergency team is available 24/7 to handle children's medical emergencies. Our paediatric ICU and neonatal ICU are equipped with state-of-the-art technology and staffed by experienced paediatricians, surgeons, and critical care specialists. We ensure prompt and efficient care in an emergency, coordinating with various paediatric subspecialists to provide comprehensive treatment. Our protocols are designed to stabilise and treat young patients quickly, ensuring the best possible outcomes.

8. Do You Provide Child Check-Ups and Routine Vaccinations?

We offer child check-ups and routine vaccinations as part of our comprehensive paediatric care services. Regular check-ups are essential for monitoring your child's growth and development, preventing illnesses, and addressing health concerns early. Our vaccination program follows the latest guidelines by the governments of India & Maharashtra to protect children from various infectious diseases.

9. What Support Services Do You Provide for Families During The Surgical Process?

We understand that surgery can be a stressful experience for families. To support you during this time, we offer pre-operative counselling, family-centred care plans, and post-operative support. Our child life specialists help prepare children and families for surgery through education and emotional support. We also provide comfortable waiting areas, regular updates on the child's progress, and access to psychological support services to help families cope with the surgical process.

10. How Can I Access Medical Records or Schedule Appointments for My Child?

Accessing medical records and scheduling appointments for your child is easy and convenient. You can request medical records through our hospital's patient portal or by contacting our medical records department. To schedule an appointment, you can call on 022 6826 0000. Our administrative staff is available to assist you with your questions or concerns.

11. Do You Offer Second Opinions for Paediatric Surgical Cases?

Yes, we offer second opinions for paediatric surgical cases. If you have concerns about a diagnosis or treatment plan, our experienced paediatric surgeons can review your child's medical records and provide a comprehensive second opinion.