Children Surgical Specialist

The Children's Minimally Invasive Surgery Center ®

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Procedures

☼ Preemptive Analgesia

☼ Minimally Invasive Pectus Excavatum Repair

☼ Laparoscopic Nissen Fundoplication

☼ Laparoscopic Splenectomy

☼ Minimally Invasive Colon Surgery

☼ Thoracoscopy

☼ Laparoscopic Appendectomy

☼ Laparoscopic Cholecystectomy

☼ Laparoscopy

☼ Surgery for Teenage Morbid Obesity

Please also see the following documents

Pediatric Hernias and Hydroceles
What is a Pediatric Surgeon?
Post-Op Orders

Preemptive Analgesia

After the patient is safely asleep under general anesthesia, Dr. Geissler injects a local anesthetic agent, Marcaine, into the surgical area before skin incisions are made. This technique of preemptive analgesia blocks the transmission of pain before the nerves are stimulated. This technique improves postoperative comfort and decrease the postoperative need for narcotic pain medicine which, in turn, speeds recovery and shortens a patients length of stay.

Minimally Invasive Pectus Excavatum Repair

In 1998, a new, less invasive technique was introduced by Dr. Nuss to correct pectus excavatum chest wall deformities by making small incisions (2-3 inches) on the lateral chest walls and placing a corrective bar behind the sternum, thus eliminating long vertical or horizontal incisions across the front of the chest and eliminating the need to remove the actual cartilage segments. This bar remains in place over a recommended two year period, maintaining the immediately corrected chest wall shape as the child grows and cartilage segments stabilize. The problem with Dr. Nuss' original technique was that he could not visualize the structures underneath the chest wall as the bar was passed, and he had one child suffer a nonfatal perforation of the heart. Rather than abandon this concept like many other surgeons, Dr. Geissler applied thoracoscopic visualization techniques to watch internally as the bar was passed to avoid damage to internal structures. He performed the first "Nuss" procedure at Children's Memorial Hospital in 1998 with Dr. Nuss himself and later that year did the first thoracoscopic Nuss procedure as well. He traveled to Norfolk, Virginia to take Dr. Nuss' advanced course in April 2003 and has a certificate of training from the course. He has performed all of the thoracoscopic Nuss procedures at Children’s Memorial Hospital since 1998 and has the largest experience in the Chicagoland area. He has had no bleeding, infection, or cardiac complications over a five year period.

Dr. Geissler offers this safe, less invasive technique to all appropriate patients. Patients have less pain and easier recovery periods when their deformity is corrected at a younger age when the chest wall is more malleable and the deformity is not as severe.

Families have been thrilled with their results and with their ability to make an informed choice of surgical options for the correction of their children's chest wall deformities. They volunteer to form a phone tree to accept calls from parents of prospective patients to provide support and verify information and expectations. A team approach is utilized which includes a pulmonologist, physical therapist, radiologic evaluation, and pain service consultation for postoperative management. Preoperative pulmonary function testing may reveal significant chest wall restriction of respiratory function. Data sheets are maintained which will form the basis for clinical research and results based performance review. Letters are sent to insurance companies to assist in the precertification process. An informative video is available for patients, their families, and their referring physician.

Laparoscopic Nissen Fundoplication

Control of severe pathologic gastroesophageal reflux which fails medical therapy is usually accomplished with a Nissen fundoplication. Using a five-port laparoscopic technique, a portion of the upper stomach (the fundus) is wrapped around the esophagus and sutured to itself. Instruments are manipulated through 5 mm puncture holes (port sites) and the traditional large abdominal incision is avoided. Dr. Geissler has received special training from a renowned national expert in this technique in 2002. Postoperative pain is minimized and return of bowel function and feeding is more rapid.

Laparoscopic Splenectomy

Laparoscopic techniques are applied to the elective removal of the spleen for certain hematologic conditions such as thalassemia, spherocytosis, idiopathic thrombocytopenic purpura (ITP), and sickle cell anemia. A four-port technique is used. Dr. Geissler performed the first laparoscopic splenectomy at Children's Memorial Hospital in 1996, and performs all of his splenectomies with this technique. He has one of the largest experiences with pediatric laparoscopic splenectomy in the nation, with over 120 consecutive splenectomies performed over a seven year period with only one case requiring conversion to an open technique (0.83%). There has been no postoperative bleeding, major

complications, or need for second operations. Dr. Geissler has performed ALL of the laparoscopic splenectomies at Children's Memorial Hospital since 1996. He has two certificates of training in this technique and "Advanced Solid Organ Laparoscopy" from the Ethicon Institute in Cincinnati and from St. Jude's Hospital in Memphis.

The need for postoperative support and pain medicine in these patients is so minimal that 94% of patients are discharged on the morning following surgery, after a full breakfast and on oral pain medications alone.

Minimally Invasive Colon Surgery

Patients may require a segment of their colon and/or rectum to be removed for Hirschsprung's disease. A laparoscopic four-port technique is used to free the involved colorectal segment from its intra-abdominal attachments and blood vessels. The diseased segment is then prolapsed transanally and removed, thus avoiding a standard abdominal incision.

Dr. Geissler performs the laparoscopic "Soave" technique for standard Hirschsprung's disease. He also performs the transanal soave pull-through procedure for short segment Hirschsprung's Disease. He performed the first "complete" transanal pull-through procedure at Children's Memorial Hospital in 2001 for short segment Hirschsprung's disease. This procedure involves an exclusive transanal dissection and does not require laparoscopy, therefore there are no external visible scars on the abdominal wall.

Thoracoscopy

Many intrathoracic conditions can be visualized thoracoscopically and treated with minimally invasive techniques. Dr. Geissler performed the first thoracoscopic resection of a bronchogenic cyst at Children's Memorial Hospital in 1999, avoiding a painful thoracotomy incision. He also has removed paraspinal neuroblastomas, ganglioneuromas and intrathoracic hemangiomas with this technique. He performs diagnostic lung biopsies, spinal exposures for scoliosis surgery, decortication, and Heller myotomies for esophageal achalasia.

Laparoscopic Appendectomy

The appendix can be emergently removed through a laparoscopic or a more traditional right lower quadrant incision technique. The laparoscopic technique involves the placement of three working "ports" and has its greatest advantage in teenage and larger patients. It is also desirable for diagnostic dilemmas, for when other organ systems need to be evaluated (diagnostic laparoscopy), and to provide optimal cosmesis. It may not be advantageous for very small patients, and is not desirable when patients are unstable or have complicated presentations.

Laparoscopic Cholecystectomy

Certain illnesses and hemolytic conditions can predispose children to developing gallstones at any age, resulting in abdominal pain and possible future complications including pancreatitis, infection, and jaundice. Laparoscopic removal of the gallbladder is achieved with a four-port technique, and most patients are discharged on the morning following surgery.

Laparoscopy

Additional applications of laparoscopic surgery include the diagnostic evaluation of chronic abdominal pain, the treatment of ovarian cysts, lysis of adhesions, tumor staging and biopsies, pyloromyotomy, removal of retained VP shunt catheters, and treatment of Meckel's diverticulum. Undescended testes can be located and mobilized with this technique as well. Dr. Geissler performs all of his pyloromyotomies for pyloric stenosis through the umbilicus for a "scarless" appearance.

Surgery for Teenage Morbid Obesity

Dr Geissler attended the bariatric surgery planning meeting at the national American Pediatric Surgery Association meeting and will learn more about gastric banding and bypass procedures for teenagers suffering with morbid obesity.