Since 1870, Children's Hospital has been a pioneer not just in treating children from all walks of life, but in developing new surgical techniques. The Hospital added one more breakthrough to its long list last summer. My associate, Alexandra B. Stoddard, has the story of a Montgomery County teen-ager whose gall bladder surgery proved surprisingly smooth. Winston Harding is a 15-year-old from Wheaton who loves to play basketball, eat pizza and make people laugh. In August, he made something else: history.
When he was 11, Winston began suffering abdominal pain. The attacks were sometimes so severe that he awoke in the middle of the night. Last March, doctors at Children's Hospital diagnosed Winston as having gallstones, which form when bile crystallizes in the gall bladder.
After a low-fat diet reduced Winston's pain, a sonogram was taken. It indicated that stones were still present. So Winston's doctors recommended that he have his gall bladder removed.
This surgery is relatively common and relatively safe. However, it involves an incision between six and nine inches long that cuts through muscle and causes a dull ache for weeks afterward. The classic technique also requires a hospital stay of between 5 and 10 days and between four and six weeks of recovery at home.
Luckily for Winston, however, he did not have traditional gall bladder surgery. Instead, Winston became the first child in the United States reported to undergo laparascopic gall bladder surgery.
Laparascopic surgery, which has mostly been used for gynecological procedures, offers a shorter hospital stay, much shorter recovery time, smaller cost and less scarring.
Kurt Newman, an attending surgeon at Children's, performed the surgery on Aug. 24. Since there had never before been a reported case of a child undergoing this specific kind of surgery, Dr. Newman consulted his best friend, Steve Evans, a general surgeon who had trained with him in Boston and who had performed laparascopic surgery often on adults.
"He helped me figure out how to do it in children," said Dr. Newman, "It was a lot of fun because he came and helped with the procedure."
The surgery lasted more than four hours. It involved the insertion of several instruments and a TV camera into Winston's abdomen through four incisions, each the circumference of a dime.
First, carbon dioxide was infused into Winston's abdominal cavity to expand it, making room for Dr. Newman to operate. Because the holes in Winston's abdomen were too small to see through, Dr. Newman conducted the entire procedure by watching it on a TV screen.
"One of the residents referred to the surgery as Nintendo surgery. It's not the kind of surgery you're used to even thinking about," said Dr. Newman. "It's really strange. There's no blood and no incision."
Once the gall bladder had been cut out, the camera was removed through the main incision and reimplanted through another. Reaching through the main incision with forceps, surgeons pulled the gall bladder to the edge of the hole.
However, because the gall bladder was full of bile and stones, it was still the size of a clenched fist and wouldn't fit through the incision. So a suction instrument was used to remove the stones and the remaining bile. This caused the gall bladder to shrink to the point where it could be removed.
Winston's operation was on a Friday. He went home that Sunday. Recovery at home took a week and a half. Winston's surgery left him with only three tiny scars. The stitches, which were sewn on the inside of his abdomen, dissolved on their own.
Winston's mother said she was scared while her son was in surgery. But the staff at Children's was very nice and continued to report to her on Winston's progress, she said.
"Everybody was nice," said Patricia Bartley. "It must take a special type of person to deal with sick children."
Winston, who said that lunch is one of his favorite subjects at school, ordered a large pizza right after surgery with everything on it. He said the surgery was so smooth that he would do it again. "I had a good time; I'd go back," he said.
Winston was burning up the basketball court within two weeks of his surgery, and he says he is enjoying the ninth grade at Montgomery Blair High School (he calls it "the best high school in the world"). Meanwhile, doctors at Children's have performed gall bladder surgery several times since Winston was the patient, in similar fashion.
Winston knows he was lucky, not only to have had this revolutionary surgery, but to have drawn a pioneer like Dr. Newman to perform it. But the admiration goes in both directions.
"Winston is a real star," Dr. Newman said. "It was just a pleasure taking care of him."
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