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University of Chicago Physician Spares Children Post-Surgical Pain and Complications with Robotic Approach to Common Problem

Kyle Loess and family with Mohan Gundeti

When Kyle Loess was born in April, 2003 with swelling in the urine-collecting structures of his kidneys, known as hydronephrosis, physicians at the University of Chicago promptly diagnosed him with vesicoureteral reflux and ureterocele, a bulbous dilation of the lower end of the ureter. The condition results from a defect in the valve that normally prevents urine from flowing backward from the bladder into the ureters.

Kyle's mother, Tonya Bouquet, learned that despite being relatively common -- affecting about one in 300 male and female children -- vesicoureteral reflux can cause serious complications such as chronic urinary tract infections which, if left untreated, can result in kidney damage.

"Sometimes, as children with this condition grow and their ureters lengthen, valve function may improve and the reflux will resolve itself," said Mohan Gundeti, MD, director of Pediatric Urology and associate professor of surgery, pediatrics and obstetrics/gynecology.

But at age five, when Kyle's condition had only corrected itself on his right side, Gundeti recommended surgery. Ordinarily, the severity of Kyle's condition would have necessitated a standard, open approach to surgical repair, which can result in a great deal of bladder pain and spasms during recovery because of disruption to the bladder lining. But Gundeti's skill and experience using robotic and minimally invasive techniques allowed him to perform corrective surgery laparoscopically.

He performed a robot-assisted laparoscopic ureteral reimplantation, replicating each step of the traditional open surgical process using the da Vinci® robot. Through a small, half-inch incision in the lower abdomen, using the three-dimensional robot instrument, Gundeti repositioned the ureters, tunneling them through the bladder wall without opening the bladder. This effectively created a one-way valve mechanism to prevent bidirectional urine flow.

The University of Chicago Medicine Comer Children's Hospital is one of only a few health centers in the United States and the only one in the Chicago area offering robot-assisted laparoscopic surgery for complicated cases of vesicoureteral reflux.

"Our main objective is for children to feel better quickly, with as little pain as possible," Gundeti said.

July 2009


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