Little Miracles: A Baby’s Experience with Minimally Invasive Surgery
Posted Sep 27 2012 6:00am
After spending nearly two unexpected weeks in the Neonatal Intensive Care Unit (NICU), the Van Ettens’ infant son is now happily resting at home.
Monica and Jim Van Etten had watched reality shows about complicated pregnancies and births, but they never imagined they would experience something similar.
Nothing seemed out of the ordinary when Monica went to her local hospital to deliver her baby boy on September 4. She had a c-section, but her full-term baby was a healthy size: 8 pounds 3 ounces and 21 inches long. When he came into the world, little Hunter needed an oxygen mask, but everyone thought it was because he had fluid in his lungs that hadn’t come out like it would have during a vaginal delivery.
That night, the Van Ettens’ son kept making gurgling noises, and the nurses had to keep suctioning out fluid. A neonatologist wondered if something might be wrong, so he asked a nurse to put a tube down the infant’s throat. When neither she nor he could get the tube down, his suspicions were confirmed.
In fact, little Hunter was born with a couple congenital conditions relating to his trachea (windpipe) and esophagus. The first, esophageal atresia (EA), meant that the tube going from his mouth to his stomach was in two, unconnected pieces. The second was tracheoesophageal fistula (TEF), which meant that Hunter’s windpipe and esophagus were attached to each other. These two conditions commonly go hand-in-hand but are actually quite rare – found in about 1 out of every 4,000 live births.
Hunter was transferred to Sinai Hospital the next day, where the Van Ettens met with Holly Williams, M.D. , a pediatric surgeon.
“We read about Dr. Williams’ credentials online and knew we were in the best of hands,” says Jim Van Etten. In 2008, Dr. Williams was the first surgeon in Maryland to correct TEF/EA with minimally invasive surgery (MIS), and currently she has done more of this type of procedure than any other surgeon in the state. She was able to perform MIS in terms of a laparoscopic procedure requiring three small, keyhole incisions – instead of a large incision under the ribcage – to correct Hunter’s esophageal and tracheal abnormalities.
Dr. Williams explains that the surgery was a two part process. First, she had to disconnect the abnormal connection between Hunter’s trachea and esophagus and close the resulting hole in the trachea.
“This needs to be done relatively quickly,” says Dr. Williams. Otherwise air will go into a baby’s stomach, which would cause major problems, she says.
Second, the two ends of Hunter’s esophagus had to be sewn together. While this presents special challenges if a baby is premature (and therefore has fragile tissue) or if the ends of the esophagus are very far apart (called a “long gap”), Hunter had neither of these extra obstacles.
During and after Hunter’s surgery, members of five different churches – including ones in Canada, Michigan and Iowa – were praying for him, thanks in part to Facebook to help spread the word. His surgery took three to four hours, and while he was a little swollen afterwards, he had a good color.
Because surgery could be performed in this minimally invasive fashion, Hunter’s recovery time was shortened. Dr. Williams explains that MIS also makes patients experience less discomfort after surgery, which means they need less pain medication.
However the biggest benefit of minimally invasive thoracic surgery on infants is the long term one.
“You don’t have to worry about the potential for chest wall deformity,” says Dr. Williams, who explains that a large incision between the ribs in a traditional thoracotomy might cause rib or muscle problems down the road – the two sides of the body may not grow the same or a child may later experience shoulder problems on the side where the incision was made.
In all, Dr. Williams said Hunter recovered the best that anyone could expect.
“He’s as cute as a button and fantastically handsome,” she remarks. “He healed in the fastest amount of time, started feeds in five days [after surgery] and had no leakage from his esophagus.”
Hunter was fortunate to not have experienced any postsurgical complications. Dr. Williams says that some babies develop reflux after this type of procedure that – if severe enough – may require a second surgery.
“I never thought I’d be able to handle something like this,” says Monica. “It’s such a blessing to have healthy kids, but it’s not a given.”
“You get the peace and the strength to make it through,” adds her husband. “All the staff here at Sinai have been wonderful, and have been willing to answer our questions in detail.”
The couple was impressed that Sinai’s nurses in the Neonatal Intensive Care Unit (NICU) treated their babies as if they were their own; Hunter received plenty of rocking and handling when the Van Etten’s were away from the hospital. Jim said one time they arrived to find him missing from his bassinet – because a nurse was rocking him just a few feet away.
Monica was also moved by the compassion of one of the doctors who gave Hunter his ultrasound; the physician even cried along with Monica during the diagnosis.
“People really care here,” she says.
Now that Hunter has healed, there will only be tears of joy. That’s because – nearly two weeks after being born – he finally got to finally go home.
The Van Ettens’ favorite photo of their son while he was in the Jennifer Gandel Kachura Neonatal Intensive Care Unit (NICU) at Sinai Hospital