Logo for LaproSurge


3rd August 2019

Boy, five, becomes the first child in Britain to be saved from kidney failure by a surgeon using a 'Robocop' arm

Mail On Sunday - 3rd August 2019

Alexander Pasek pictured with mother Estera

Alexander Pasek, five, (pictured with mother Estera) became the first child in Britain to benefit from 'Robocop' keyhole surgery on the NHS

• Alexander Pasek had eight-hour operation at Evelina London Children's Hospital

• High-tech mechanical handpiece was used to remove a blockage in his kidney

• Gadget, called FlexDex, gives surgeon increased control, dexterity and accuracy

• Only seven specialist centres in the UK robots, but they will soon be available to 52 British surgeons and 16 NHS hospitals

A five-year-old boy has become the first child in Britain to benefit from 'Robocop' keyhole surgery on the NHS – after a high-tech new mechanical handpiece was used to remove a blockage in his kidney, saving him from potential organ failure.

The device, used for making small incisions and stitching in the body, comprises a strap that locks around the surgeon's wrist and then attaches to a lightweight frame surrounding his or her hand.

In the centre of the frame is a controller similar to a gaming joystick. This can be gripped and manipulated to move an arm – a tube about 2ft long and slimmer than a pencil – that extends from the front of the frame.

At the end is a surgical 'grabber' which the doctor uses to perform intricate manoeuvres within the body via tiny incisions.

Keyhole Surgery

Traditional keyhole surgery instruments require whole-arm movements by the surgeon in order to move them around inside the body. In contrast, the new gadget, known as FlexDex, merely requires gentle wrist movements, giving surgeons the same control, dexterity and pinpoint accuracy as state-of-the-art surgical robots.

The innovation throws open the possibility that thousands more NHS patients could benefit from the advantages of minimally invasive keyhole surgery, which include faster recovery, less pain during recovery and smaller scars.

At about £400, FlexDex is far cheaper than the £1.5 million Da Vinci surgical robot machines, which only a handful of UK hospitals have been able to afford. It can be used in any operating theatre, yet doctors testing it claim it gives them similar outcomes.

Last December, schoolboy Alexander Pasek underwent an eight-hour operation at the Evelina London Children's Hospital. During the procedure, the FlexDex was used to remove a blockage in his kidney that could have caused it to fail – potentially saving him from needing a transplant. 'He was out of hospital three days after the operation – the recovery was fantastic,' says his mother Estera, 35.

The device was called a 'game-changer' by Alexander's surgeon, Massimo Garriboli, who said it could also be used for a host of common keyhole operations, including hernia repairs and hysterectomies.

Alexander was diagnosed last year with a condition called hydronephrosis, during which a problem with the urinary tract leads to a build-up of urine in the kidneys. The kidneys become stretched and swollen, leading to persistent pain and, if left untreated, kidney failure.

Children with hydronephrosis are generally born with it. With Alexander under general anaesthetic, Mr Garriboli made a keyhole incision in his abdomen.

Using small, precise cuts, he detached the ureter – the tube that carries urine from the kidney to the bladder – from the blocked kidney.

He then had to remove the smallest, narrowest part of Alexander's ureter and join the two parts back together, allowing the urine to flow properly. Then, armed with the FlexDex device, Mr Garriboli stitched the ureter and kidney back together.

Evelina Hospital

Alexander had the life-saving surgery at Evelina London Children's Hospital last December

While only seven specialist centres in the UK have Da Vinci robots, the FlexDex device will soon be available to 52 British surgeons and 16 NHS hospitals. Mr Garriboli says: 'The surgery itself has not changed – I've done exactly the same thing without the FlexDex. But the FlexDex has helped me do it in a way which is more delicate, more gentle on the tissue, and therefore provides better-quality results.

'It basically works like a mechanical extension of my own arm, and it's so sensitive I can almost feel the pressure I'm using inside the body when the grabber on the end grips things. It's all the advantages of robotic surgery, but without the cost.'

Alexander was diagnosed with the kidney condition while visiting relatives in Poland in July last year. He was rushed to hospital after having an allergic reaction to eating peanuts and sent for a precautionary ultrasound. While he was back to his usual self the next day, the scan revealed swelling in one of his kidneys.

Until this point, there had been no signs that he had hydronephrosis. 'He never had any symptoms, he was going to the toilet normally and he wasn't complaining about any pain, so it was a massive shock,' Estera said.

The diagnosis was confirmed upon the family's return to the UK and it was decided that Alexander required surgery.

When Mr Garriboli explained that he would be using the new FlexDex during the procedure – and that Alexander would be the first child in the UK to benefit – Estera admits she was a little nervous.

But she adds: 'They told us that it had been used on children in other places in the world and we trusted Mr Garriboli.'

Alexander enjoyed a speedy recovery following his operation. He was discharged within three days of the procedure and was back at school within eight. Luckily, it appears he is now clear of the potentially dangerous condition.

His mother says: 'Alexander recovered really quickly and was playing normally within a week.

'We just need to have a routine check-up in September to make sure everything is still working properly, but he seems absolutely fine.'

Click for article