Marcus Jarboe, M.D., says that interdisciplinary collaboration is what makes pediatric MIS widely available at Mott.

The Kindest Cut

Minimally invasive surgery is the first choice at Mott

issue 18 | spring/summer 2013

Minimally invasive surgery (MIS) is increasingly becoming the norm for children of all ages at C.S. Mott Children's Hospital. It is now used on even the smallest patients, including premature infants and in utero. It is also becoming routine for complex procedures that previously required open surgeries. Advancing technology that continues to shrink the size of MIS equipment is one reason for this change. But the key to offering this level of specialized expertise nearly across the board at U-M is the commitment to the MIS approach among all the physicians.

"All the surgeons in our group have extensive experience in MIS, and are very comfortable with advanced laparoscopy," says Marcus Jarboe, M.D., pediatric surgeon at Mott. "This creates an environment where we constantly challenge ourselves to find creative approaches to difficult cases."

One way to achieve these goals is to leverage different disciplines where possible. For example, Jarboe is fellowship-trained as both a pediatric surgeon and an interventional radiologist. "When we are trying to solve a difficult problem, it's very helpful to have a thorough understanding of all the different techniques available," he explains. "Everyone brings his or her own expertise to the table, which helps us devise unique solutions."

Another critical element for successful MIS is anesthesia. "Without the right anesthesiologists, using MIS on sick infants and children is not possible," Jarboe emphasizes. "We have excellent anesthesiologists who are committed to making these MIS procedures possible, even on very tiny infants and patients with complications, such as heart defects."

Another example of leading-edge surgery at Mott is fetoscopic surgery, which has expanded the possibilities for in utero treatments. The small tools and minimally invasive approaches are well suited to treat fetal disorders such as twin-twin transfusion syndrome.

In addition to physical benefits of MIS, such as less pain and faster recovery, there are also emotional benefits for children later in life. "A 2-centimeter incision in an infant can turn into a sunken 8-inch scar by the time the teenage years roll around. So, we plan for tiny incisions that make for tiny scars," says Jarboe. "It's not a vanity issue with the kids; it's a confidence issue. So, it's rewarding to be able to offer surgical solutions that have so many advantages."