More than 12,000 high-complexity operations in five years at the SJD Barcelona Children's Hospital

Almost half of the 25,000 operations undertaken in the last five years in the Central Surgical Wing (CSW) of the SJD Barcelona Children's Hospital are high-complexity, meaning they take longer than three hours, require highly specialised staff and very advanced technology, and also involve intensive post-operative monitoring and maintenance.

The Central Surgical Wing is where the most complex surgical operations at the SJD Barcelona Children's Hospital are carried out. In particular, of the 5,236 operations performed in 2023, 52.7% (2,759) of them were medium-complexity and 47.3% (2,477) were high-complexity.

Thanks to the new CSW facilities, that were opened in 2019, staff now have larger and better equipped surgical theatres with advanced technology, such as intraoperative hybrid arch, magnetic resonance or CT scan. ‘These facilities are a global reference point. Staff from all over the world come here to see how we work’, explains Juanjo Lázaro, Head of the SJD Oncology Department.

The cutting-edge technology used in the new theatres has made it necessary to welcome new staff members to surgical teams, and it has completely changed how professionals work. ‘We’ve welcomed neurophysiologists and engineers, and thanks to the new technology and simulation facilities we have, we can now carry out extremely complex surgical procedures more accurately and in less time’, highlights Lázaro. ‘All without losing that human quality that defines the SJD Barcelona Children's Hospital’, adds María José Tojo, Head Nurse at the SJD Barcelona Children's Hospital. ‘Patients are especially vulnerable during surgery, and staff are able to retain a level of compassion for both the patient and their families despite all this new technology.’

Unique procedures

One of the most unique procedures that has taken place in the new surgical theatres was one year ago: the separation of conjoined twins from Mauritania who were joined at the abdomen. In this case, simulation played a decisive role, as it allowed professionals to anticipate and resolve issues that could arise before the real procedure.

One week before the operation, all of the staff involved in the procedure carried out a simulation of the operation using a 3D recreation of the girls. This trial run allowed them to determine—among other things—the best way to position the girls on the operating table, intubate them and conduct the surgery. It also allowed for optimal organisation of the space, for example, they could plan where to place surgical instruments so they would not get in the way during the procedure. This was relevant because, once separated, the operation would have to continue on both patients simultaneously.

The Central Surgical Wing also administered Luxturna gene therapy for the first time ever in Spain to a 12-year-old girl with hereditary retinal dystrophy that was rendering her blind. The difficult part of this procedure was the preparation, as it required several very extreme precautions to be taken: using a biohazardous material, transferring it to the operating theatre and administering it to the patient in a time frame of four hours.

On top of the average 5,000 operations done in the Central Surgical Wing each year, around 6,000 more are done on an outpatient’s basis in the Surgery Outpatient's Department at the SJD Barcelona Children’s Hospital. There are also another 1,500 low-complexity procedures performed in theatre at the SJD Pediatric Cancer Center. Moreover, in the field of gynecology and obstetrics, 1,400 gynecological procedures and 22 fetal operations are performed each year. In total, almost 14,000 operations are done every year across each of the different operating theatres at the SJD Barcelona Children's Hospital.

Other figures from the SJD Central Surgical Wing

• January 2020: Use of indicyanine green and 3D laparoscopy - Surgery Department.
• February 2020: First brain tumour operation with MRI and Brainlab navigation - Neurosurgery Department.
• February 2020: First limb tumour operation with portable CT machine - Orthopedic Surgery & Traumatology.
• March 2020: First surgical operation with laser ablation, a stereotactic robot and MRI scanning - Neurosurgery Department.
• May 2020: First idiopathic scoliosis operation using Azurion arch - Spinal Unit.
• June 2020: First scoliosis operation using Azurion arch and Brainlab navigation - Spine Unit.
• October 2020: First head and neck operation using Azurion arch - Maxillofacial Surgery, ENT and Neurosurgery Departments.
• July 2021: Integration of a videocall system between the Central Surgical Wing and the Anatomical Pathology Department.
• July 2021: First surgical procedure using ‘mapping’ technique in the Neuromodulation Unit - Neurosurgery Department.
• September 2021: Incorporation of Clarifye as a guidance tool in scoliosis operations - Orthopedic Surgery & Traumatology Department and Spine Unit.
• December 2021: Application of Clarifye in a case of osteoid osteoma - Orthopedic Surgery & Traumatology and Oncology Departments.
• March 2022: Increasing fibre number in TPO procedures (from two to five) with initial study on cadavers and later study on patients - Neurosurgery Department.
• June 2022: Opening the new surgical wing of the SJD Pediatric Cancer Center Barcelona.
• June 2022: Implementation of augmented reality goggles as a preoperative tool.
• October 2022: First arteriovenous malformation operation planned and navigated using Brainlab.
• December 2020: Brainlab-navigated maxillofacial surgery - Maxillofacial Surgery Department.
• September 2023: Bladder exstrophy and hip surgery - Surgery Department and Orthopedic Surgery and Traumatology Department.
• July 2024: Tetralogy of Fallot correction surgery and tracheal reconstruction - Heart Unit and ENT Department.
• October 2024: Fetal spina bifida surgery - Neurosurgery Department and Fetal Surgery Unit.