Pediatric surgery

Pediatric surgery is an autonomous discipline of surgery and covers the period from newborn to teenager. Pediatric surgeons therefore have to be familiar with the particular characteristics and growth phases of their patients in relation to the age of each individual. Nowadays, minimally-invasive techniques are naturally enough common practice in this area of medicine.

All areas of abdominal, thoracic and tumor surgery through to pediatric urology and orthopedics are covered. One focus in pediatric surgery relates to malformations. These diseases are generally not restricted to a single organ system and this is why pediatric surgeons rarely specialize in a single organ, as is the case in adult surgery. Pediatric surgeons base their operating techniques on adult surgery, although specific characteristics relating to the young age of their patients generally makes it necessary to adopt a special procedure.

This means that particular specifications have to be observed for operating techniques and in the technical development of instrument sets in order to take account of the requirements of young patients. Pediatric surgeons therefore often adopt independent approaches.

Richard Wolf has also taken up this challenge and works together with experienced pediatric surgeons to develop special individual endoscopy systems and instruments tailored to this specialist area.

The new technique in pediatric surgery

Single-port Laparo-Endoscopic Varicocele Dissection (LEVD)
Testicular varicose veins (varicocele testis) occur in approximately 5 - 10% of all young boys during the growth phase. The presentation in most patients is on the left-hand side. The cause is increased hydrostatic pressure in the testicular veins where they join the left renal vein. Clinically the patient presents with thickened convolutes (adhesions) in the spermatic cord. There may also be a dragging ache in the relevant groin region.

Single-port Laparo-Endoscopic Varicocele Dissection (LEVD) is a new surgical procedure in pediatric surgery. The "scarless" intervention is associated with the reduction of surgical trauma and is carried out as an outpatient procedure.

By contrast with previous standard laparoscopic procedures using 3-trocar technology, the surgeon only uses one port in LEVD through which the operating laparoscope and in turn the instrument set can be inserted. The mini-operating laparoscope with integrated 3.5 mm working channel is a key element for the new surgical technique. The perfectly harmonized operating set is completed by a 3.5 mm instrument set in monopolar and bipolar versions.

The compact instrument set was created for this innovative method in the course of cooperation with PD Dr. med. Ulf Bühligen, Senior Surgeon at the Clinic and Polyclinic for Pediatric Surgery at Leipzig University Hospital.

Children with infantile hypertrophic pyloric stenosis (IHPS) are born with an enlargement and thickening of the circular pyloric muscle (muscle controlling the exit of food from the stomach). This means that the passage leading out of the stomach is constricted by the enlarged muscle and food is unable to pass out of the stomach. Infants therefore regularly regurgitate their meals and this leads to a dangerous imbalance in metabolism and dehydration. A pyloromyotomy is therefore carried out to expand the pylorus using a minimally invasive surgical technique. Initially, a longitudinal incision is made in the pylorus and the muscle is dilated in the second stage.

Richard Wolf joined forces with Professor Amulya Kumar Saxena, Chelsea and Westminster Hospital NHS Foundation Trust and Imperial College London, to develop the SAXENA Pyloric Spreader for this special procedure.