A risky operation made safer by MRI-guided navigation means children suffering from a serious birth defect have a better chance at becoming continent later in life.
Johns Hopkins pediatric urologists are using technology similar to GPS software to improve the outcome of bladder exstrophy surgery. The complex operation involves reconstructing bladders of children born with the organ outside of their bodies.
“We didn’t know if the technology would be accurate because it’s never been used with soft tissue in the pelvic floor,” says pediatric urologist Heather Di Carlo. To date, the team has used the system in 37 such operations with no complications.
During the operation, surgeons reposition the bladder inside the body. This requires doctors to carefully cut away the tissue holding the bladder outside the abdominal wall, a difficult procedure due to the proximity of major blood vessels and other organs.
It’s critical that surgeons cut the right tissue; if they don’t, the bladder can reherniate, and additional corrective surgery dramatically increases the likelihood of permanent incontinence. Thanks to the navigation system, the surgeons can better assess which tissue to cut.
To use the navigation system, MRI scans of the patient’s pelvis are taken prior to the operation. Those images are uploaded into software that aligns the images with precise landmarks on the child’s body, like hip and pubic bones. Using a special pointer, the surgeons can then indicate a specific area on the child’s body and see that corresponding visual on an MRI monitor.
Pediatric urologist John Gearhart got the idea after seeing the navigation system used in neurosurgery. The team received FDA approval to study the technology and hopes to publish its work in The Journal of Urology.
The researchers also want to use the technology while telementoring surgeons around the world in bladder exstrophy surgery.