Advanced Surgical Skills, Technology Yield Strong Outcomes

Pediatric surgeons at Cincinnati Children’s rely on a suite of advanced, minimally invasive technologies to treat children requiring complex tumor resections. From fluorescence-guided surgery to 3-D tumor modeling, these tools improve precision, safety and recovery for even the most challenging cases.

“These technologies are often available in the adult-care setting, but it’s unusual to have so many in a pediatric institution, particularly for cancer care,” says Roshni Dasgupta, MD, pediatric surgeon and director of surgical oncology at Cincinnati Children’s. “We do a very high volume of minimally invasive surgeries here, allowing our surgical team to develop deep expertise in cutting-edge techniques. The goal is to give patients the best surgical oncology outcome possible and the potential for a cure.”

Robotic Surgery: Greater Precision, Faster Recovery

One example of the team’s advanced capabilities is robotic surgery, a minimally invasive option that can dramatically reduce recovery time and pain.

“Robotic surgery gives us an additional degree of freedom compared to the human hand, providing access to angles and planes we couldn’t safely reach with laparoscopy,” says pediatric surgeon Juan Gurria, MD, director of robotic surgery at Cincinnati Children’s. “It also offers 10x magnification of the surgical field compared with laparoscopic visualization.”

Candidates for robotic procedures typically have tumors less than six centimeters in diameter that are not invading major vessels or adjacent organs. For these patients, the benefits are significant: smaller incisions, minimal scarring, shorter hospital stays and less opioid use. Just as importantly, patients recover quickly enough to resume or begin chemotherapy within days rather than weeks, minimizing treatment disruption.

One recent case illustrates the impact of robotic surgery. A young patient from West Virginia underwent robotic tumor resection for ganglioneuroblastoma and was discharged within days, needing only acetaminophen for at-home pain relief. “The operation took half the time of an open procedure, and the oncologic outcome was perfect,” Gurria says. “That’s what this technology can deliver.”

Lighting Up Tumors with Fluorescence-Guided Surgery

Cincinnati Children’s is also pioneering fluorescence-guided surgery to identify tumors that are not palpable or are undetected on advanced imaging. The team has published studies on its use in lung metastases from hepatoblastoma and sarcoma.

“We can use fluorescent dyes during laparoscopic and open procedures to make cancer cells literally glow under near-infrared light,” explains Dasgupta. “This allows surgeons to identify tumors in the thoracic and abdominal cavities that we’d otherwise miss, opening up the possibility of a cure. The technique is also helpful for lymph node mapping. As a result, we often can remove only the lymph nodes that are involved in metastatic disease.”

3D Modeling Improves Surgical Planning, Family Education

The team also uses three-dimensional tumor modeling to create virtual and physical replicas of the tumor. The tumor models are based on patient-specific radiological images.

“We can use special 3D glasses to see a holographic image of the tumor inside the patient’s body and visualize the complex relationships between the tumor, nerves, organs and other structures,” Dasgupta says. “That improves presurgical planning and helps you get the right people in the OR. For example, if we can see that the tumor transects a nerve, we’ll ask a plastic surgeon to help with reconstruction.”

Dasgupta also uses a 3D printout of the tumor to educate families before surgery and gives them the model as a memento afterward.

A 15-Year Track Record with HIPEC

Pediatric surgical teams at Cincinnati Children’s also have advanced expertise with heated intraperitoneal chemotherapy (HIPEC). The technique involves surgically removing visible tumors, then circulating heated chemotherapy within the abdomen to destroy microscopic disease. Surgeons typically use it to treat peritoneal malignancies, such as sarcomas or desmoplastic round cell tumors.

Over 100 patients have received HIPEC at Cincinnati Children’s since 2010, more than at any other pediatric institution.

“We’ve refined every aspect of HIPEC care,” says Dasgupta. “Our anesthesia, intensive care and nursing teams are all experienced in managing the physiologic challenges of this procedure. That coordinated expertise makes the difference.”

Because the chemotherapy is heated to 42°C, it enhances chemotherapy delivery to residual cancer cells. The team has developed specialized protocols to prevent kidney and bowel injury. Dasgupta notes that they haven’t had a single case of long-term kidney damage because of how carefully they manage these patients.

Collaboration and Research Drive Excellence

With so many advanced technologies at their disposal, pediatric oncologists can develop highly customized treatment plans in collaboration with other specialists at Cincinnati Children’s.

“There’s no single recipe for these cases. It depends on the tumor’s behavior, the therapies already tried, and how the patient has responded,” Dasgupta says. “Our role is to determine which surgical techniques can give each child the best possible chance, often when options are limited. But surgery is just one piece of the plan. It takes coordinated care—oncology, radiation, anesthesia, critical care—all working together. That collaboration is what truly defines the way we care for our patients.”

For more information or to discuss a patient, contact roshni.dasgupta@cincinnatichildrens.org.

(Published February 2026)

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