New pediatric general surgery program at Cedars-Sinai makes minimally invasive surgical procedures available to children

November 26, 2000

When Susan Amiryar and Omar Fazli took their son, Yama Fazli, to Cedars- Sinai Medical Center's Emergency Room in the middle of the night last September, they were facing one of the greatest fears of many parents - a sick child who was in pain and might need surgery. According to an ultrasound evaluation, Yama's appendix was three times its normal size and ready to burst.

There was no question that Yama needed surgery to remove his inflamed appendix, but the 8-year-old who was born at Cedars-Sinai and has a near-genius IQ, needed convincing. Enter Steve C. Chen, M.D., Associate Director of the new Pediatric General Surgery program at Cedars-Sinai Medical Center. He sat down with Yama and his family and explained that he planned to take what has been a routine laparoscopic procedure for adults and adapt it for his pediatric patient. The procedure would take approximately 30 minutes, and Yama would be able to go home from the hospital the next day.

"I think it's important as a physician to ask yourself, 'How would I feel if I were in the patient's and the parents' situation?' Yama was very curious about the procedure that I had planned for him, and because the process is simple, it was not difficult to explain," says Dr. Chen.

Using a laparoscope - a long, thin, viewing scope with a light on one end-- to operate in a situation like Yama's proves to have several advantages says Dr. Chen. "First, appendicitis is relatively common, but it can be difficult to diagnose. With the camera used in laparoscopic procedures, I can evaluate the appendix by actually seeing it. If the appendix is not the problem, I can look for other pathology. Second, recovery time is shortened and pain is minimized because the incisions are smaller. And, third, there's a cosmetic advantage as the scars are small and heal relatively quick."

Only three tiny incisions were made in Yama's abdomen. One incision , approximately three millimeters long, was made near the bellybutton for the camera to be inserted. Two additional incisions - one about three millimeters and another approximately 12 millimeters--were made elsewhere in the abdomen, allowing Dr. Chen to work with instruments with both hands. According to Susan, Yama's mother, both of her son's smaller incisions were completely gone less than two months after his operation.

"We were amazed at how caring he (Dr. Chen) was," says Susan. "He took the time to make sure we - and especially Yama - understood how everything was going to happen. He took all that time to spend with us for something really easy - although at the time it wasn't so easy for us," she added.

As for Dr. Chen, his goal is to provide more minimally invasive procedures available to children who need surgery. "I have seen kids respond so well to minimally invasive surgery that it's my goal to use more laparoscopy and thoracoscopy in routine surgeries," he says, noting that Cedars-Sinai has "a terrific team of pediatric nurses, pediatric specialists, and state-of-the-art facilities including a brand new neonatal intensive care unit, capable of handling a variety of different cases."

"In this field where I work with kids," he says, "I have the best job in the world. Kids have done nothing to be in their situations - and I believe they deserve the best care. My work can be so rewarding - to see them get well and go on to live productive lives. I want my patients and especially their parents to walk away feeling that we brought about the best possible outcomes for their children."

Susan Amiryar clearly feels that way. "If anything happens to us, the only place we want to go to is Cedars-Sinai," she says.
Note: Appendicitis occurs when the appendix, a blind tube just after the junction between the small and large intestine becomes blocked. Though it has no known function in humans, the appendix contains tissue that is similar to lymph nodes. When blocked, this tissue secretes fluid, causing the appendix to swell and promoting bacterial growth. As the volume of fluid increases, the appendix swells, much like a balloon being filled with water. Left untreated, an inflamed appendix can eventually burst with the fluid spreading through the abdominal cavity, resulting in a potentially life-threatening infection.

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Cedars-Sinai Medical Center

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