Cottage Children's Medical Center Pediatric Surgeon Develops Laparoscopic Techniques
A big, burly Russian pediatrician accused Dr. Robert Kanard of witchcraft.
He could think of no other explanation for how the pediatric surgeon performed an appendectomy on one of his patients.
Dr. Robert Kanard explained he makes small incisions in laparoscopic surgeries to avoid scarring.
"He said, 'I saw my patient. There was no scar. I think maybe you're a liar. Then I called pathology, and they have the appendix. So now I think you are a witch.' So now I'm thinking this is going from bad to worse!" Dr. Kanard, 49, told the News-Press, laughing in a conference room at Santa Barbara Cottage Hospital.
No, surgery with minimal or no scarring isn't black magic. Instead, it's the result of work by Dr. Kanard, who developed new laparoscopic techniques for appendectomies and hernias.
"I think the pediatrician liked it. He kept sending me patients," Dr. Kanard said, smiling.
The technique can be used in most surgeries, including gallbladder and lung operations for youths and adults, said the award-winning physician, who joined Cottage Children's Medical Center in November as its chief of pediatric surgery. Since then, he has used his techniques successfully in one gallbladder operation, two appendectomies and surgery on a hernia at the children's hospital, which is part of the Cottage Hospital campus at 400 Pueblo St.
Dr. Robert Kanard, chief of pediatric surgery at Cottage Children's Medical Center, performs an appendectomy using a laparoscopic technique that he developed. He makes a small incision through the belly button.
He said he would be glad to teach his techniques to other surgeons.
The Wyoming native moved to Santa Barbara in August after working in pediatric surgery from 2015 to 2017 at the University of Illinois College of Medicine at Peoria and from 2009 to 2015 at the university's Chicago campus.
Dr. Kanard strives to do his operations through a single incision.
He puts plastic and metal tubes, which carry tiny scissors, staplers and a camera, through a small cut. He often hides the incision in the belly button, which he said heals well. He also has concealed small cuts in the natural creases of the stomach.
He explained he operates controls for the instruments outside the body and watches what's happening inside on a high-definition monitor.
"It's the combination of the technique and the awareness of where the scar is going to be," Dr. Kanard said.
Dr. Kanard made a single incision in a belly button when he operated on this 9-year-old girl during a gallbladder operation. This photo was taken immediately after surgery.
Traditional surgery relies on large cuts and produces big scars, Dr. Kanard said, but noted laparoscopic surgery requires fewer and smaller cuts.
"I was trained pretty traditionally with everything opened," said Dr. Kanard, who earned his medical degree in 2000 at St. Louis University Health Sciences Center and completed his surgical residency in 2006 at the University of Louisville.
As the father of five children, ages 4 through 14, Dr. Kanard said he felt motivated to make surgery easier for kids and found the answer when he learned more about laparoscopic procedures during his pediatric surgery fellowship in 2006 to 2008 at the Children's National Medical Center in Washington, D.C.
Laparoscopic surgery has been around since the 1990s, but the possibilities with it are expanding, Dr. Kanard said.
"It's a way to push the boundaries of surgery. You can take a gallbladder out through a scope, which everyone does. But can you do it in one incision?" Dr. Kanard said.
The answer was yes, as Dr. Kanard found when he made one cut through the belly button of a 9-year-old girl in 2008 at Central DuPage Hospital in Winfield, Ill.
"The next morning, I went to see her on my rounds. Her bags were packed, and she was ready to go," Dr. Kanard said. "I said, 'Are you sure? There's no pain?'"
The girl went home, and the mother told Dr. Kanard the following day that she still had no pain.
"I saw her in the clinic two weeks later, and she had no scar," Dr. Kanard said.
He recalled what happened when he performed stomach surgery at St. Alexius Medical Center in Chicago. "The nurse came running out and said, 'You're not going to believe this! This child has no scar!'
"I knew I had done three incisions. I went in there and saw the child," Dr. Kanard said. "The small incisions were disappearing in the skin creases, and in the belly button, you didn't see it at all."
The laparoscopic operations mean a faster and less painful recovery for patients, including babies who are naturally sensitive to the stresses of operations and healing, Dr. Kanard said.
For older kids, there's not the stigma of a large scar.
"Self-esteem is a huge thing," Dr. Kanard said.
Dr. Kanard said he developed a laparoscopic procedure for appendectomies in 2007. His surgery leaves a single bandage on the belly button.
Laparoscopic techniques already existed for hernias, but Dr. Kanard found they had a high recurrence rate.
"I came up with a new procedure for doing hernias, and there have been no recurrences for the operations I have had," he said.
In a hernia, part of an organ is displaced and protrudes through the wall of a cavity. The traditional surgical method is to sew up the hole.
"What I do is I remove the hole, so there's no stitches to put in," said Dr. Kanard, who has used this procedure since 2010. "As I explain to parents, if you have a mountain and a tunnel going through the mountain, that's a hernia. If you take the tunnel out and take the road out, there's no hole."
"By removing the tunnel, you don't need stitches, and the hernia doesn't come back," he said.
Dr. Kanard said he's glad to go the extra step to make operations less traumatic.
"If my kids needed surgery, I would hope someone would go beyond, 'Sick appendix. Take the appendix out.'"
For more information about pediatric services at Cottage Health, call 1-877-247-3260 or go to www.cottagehealth.org/childrens.
Published in the Santa Barbara News-Press on January 16, 2018, and reprinted with permission.