The importance of high-quality pediatric services

Children patients are not just younger adult patients, some smaller sized patients with pretty much the same kind of illnesses, as Professor Burak Tander - a doctor with a huge pediatric surgery experience – often says. They have very different diseases; they need to be treated with different surgical approach and treatment methods. The role of a medical team with large experience in treating children is crucial for the success of the therapy. As one of the most experienced pediatric surgeons and a doctor who coordinates such a pediatric department at Atakent ACIBADEM Hospital, Professor Tander talks about the importance of high-quality pediatric services, which basically means having an intensively trained medical team in children problems, available for all specialties under one hospital roof.

The difficulty of establishing the diagnosis

It’s not easy to diagnose a child – she cannot describe very well symptoms, maybe she exaggerates, so do her parents, or, on the contrary, they oversee important signs thinking it’s actually nothing serious. For Professor Burak Tander, the key to an impecable diagnosis is the perfect collaboration in a good pediatric surgery center, the fact that a doctor can rely fully on an experienced imaging department and on a very good laboratory. You need to make a good physical examination and you need to think of every possible problem this child could have. Also, you rely a lot on laboratory investigations and especially imaging investigations, these are very helpful, but the problem is which imaging investigation, which laboratory investigation one can rely upon. The pediatric surgeon should know every possible imaging sand laboratory investigation in every possible situation, and she should choose the correct one to order. In a good pediatric surgery center, a broad spectrum of imaging methods and laboratory methods should be available. You cannot do good surgery without relying on your colleagues, very experienced in diagnosis. And this is true especially in tumor cases, in cancer patients. In cancer, an imaging study is very important, especially MR studies and CT studies.

The large experience in minimally invasive pediatric surgery

For scared parents the simple words minimal invasive surgery brings hope and they tend to rely more on these techniques when it comes to their children’s health. But families should choose very wisely the medical center and the doctor who performs the minimally invasive surgery, since her experience is the most important aspect in the decision. It sounds simple, but things can go wrong very easy in this kind of procedure, easier than in a classical surgery. Professor Burak Tander – who often sees patients with badly performed surgeries and needs to reoperate - explains why: The main problem is the difficulty of the endoscopic minimal invasive operations because the space in children’s bodies, the space in which we should operate, is sometimes too small to make the surgery and therefore we have special instruments, very small size instruments and also special, different methods. The surgery complications management is much more challenging in minimal invasive methods. I can give you an example. If you operate a child by laparoscopy and a sudden bleeding happens, you cannot manage this bleeding easily when compared to open surgery. In open surgery, you put a finger and press the bleeding point and the bleeding stops. But in minimal invasive surgery it is impossible. Therefore, you need some experience. First, an experienced minimal invasive pediatric surgeon does not cause easily bleeding problems, and, secondly, if there is a bleeding, an experienced surgeon can manage it. And therefore, we always say that experience is the most important thing in minimal invasive pediatric surgery. Fortunately, we have quite a good experience in minimal invasive surgery and almost all operations which can be managed by minimal invasive methods are operated by our team, here, in ACIBADEM Atakent Hospital.

A key team member – the pediatric anesthetist

Every medical team member should have a lot of experience in childcare, but we have to emphasize the role of the anesthetist. Some surgeries – like laparoscopic interventions – require special anesthetic management. Professor Burak Tander describes the important part played by the anesthetist. In laparoscopic surgery you put some carbon dioxide gas within the abdomen. It means that there is some pressure on diaphragm. If the child has serious lung problems, this pressure might be harmful for him. But this is mostly not the case, because only a small percent of children is suffering from serious heart and lung problems. Therefore, we can say that more than 99% of children are suitable for the anesthetic management of laparoscopic surgery. But there are still some children with this problem, and we need to diagnose this problem earlier and what should we do? We always let the anesthetist know that we will have a challenging surgery, laparoscopic surgery, in the forthcoming days before operation and the anesthetists are always coming and examining the patient and make sure the patient has no serious heart and lung problems, so this patient is a good candidate for laparoscopic or thoracoscopic surgery. In thoracoscopy, it’s the same situation, you put some gas pressure within the thorax, within the chest, so this may have some pressure in lungs or heart. There is a sub-specialty of anesthesia called pediatric anesthesia. In a good pediatric surgical center, the anesthetist should be very, very good, well experienced in children cases. And in neo-nates, too. Because anesthesia in children and infants is very different than the other ordinary, regular, cases. In ordinary cases, anesthesia is not difficult, it’s quite easy, simple, but in tumor cases, for example, in advanced minimally invasive surgical cases, there should be a special anesthetic gear.

“An experienced cancer surgeon can save lives”

Pediatric oncology cases are the most challenging, in Prof. Dr. Burak Tander’s opinion. Why? Because the tumors have more invasions on the tissues. What does it mean? It means that removing the tumor from the body will provoke much more bleeding. Therefore, the tumor removal management is very important. And, here, the experience is the most important point for the tumor removals. So, we can suggest that cancer cases are very, very dangerous, tumor surgery cancer patients may be very, very dangerous sometimes. But if it is well performed, that surgery can save the child's life. An experienced cancer surgeon can save lives. And, unfortunately, in some cancers only surgery is beneficial. Some cancers are resistant to chemotherapy and radiation therapy or to other therapies and some tumors are curable only by surgical management. Also, some cancers are not resistant to chemotherapy, but in those patients, surgery is the most reliable and most beneficial way to treat. For example, kidney tumors in children. They could be managed by chemotherapy, but chemotherapy is not enough, so surgery becomes viable. If you remove the tumor, the patient heals.

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