The Pinedas were worried about their baby’s future. Often, if left untreated, cleft lip and palate can lead to speech and socioemotional developmental delays. Some babies also face feeding issues.

However, even before the parents reached their home, Victor Chien, MD, a pediatric plastic surgeon and director of Pediatric Cleft and Craniofacial Surgery at Cedars-Sinai Guerin Children's, called the Pinedas to reassure them and offer a novel solution: robot-assisted surgery.

“We left the ultrasound feeling really sad with the news,” Marisol Pineda said. “But Dr. Chien reassured us that everything was going to be okay. He explained that although Luka has a cleft lip and palate, he would be able to fix it.”

July marks National Cleft and Craniofacial Awareness and Prevention Month. A cleft lip typically occurs when the tissues that make up the upper lip don’t join properly before birth. Children born with a cleft lip can also have a cleft palate—a condition in which the roof of the mouth doesn’t fuse properly. About 1 in every 1,031 babies in the United States is born with cleft lip with or without cleft palate, according to the Centers for Disease Control and Prevention.

Luka was born prematurely at 33 weeks of gestation and was immediately admitted to the Neonatal Intensive Care Unit (NICU) at Cedars-Sinai Guerin Children’s. In addition to being a preterm baby, Luka experienced breathing difficulties due to his cleft lip, which made it hard for him to close his mouth. He also gained weight more slowly because he struggled to latch onto the bottle, so he required a temporary feeding tube.

At first, Luka’s parents were apprehensive about a robot assisting with the surgery. But Chien reassured them by explaining the procedure. However, he recommended waiting until Luka weighed at least around 10 pounds or was 3 months old.

Robot-assisted cleft lip repairs are still under Food and Drug Administration review and have been used only in a handful of cases. Surgeons control the robot remotely, facing a screen away from the patient, performing the surgery using chopstick-like instruments, which allows for finer movements in small spaces like an infant’s mouth.

“The robot-assisted approach takes about the same time as the traditional approach, but it offers surgeons enhanced precision, especially when carefully separating delicate tissue and suturing. We’re using the robot for key fine sutures in three critical layers of the lip repair and now superfine dissection,” Chien said. “The main thing we are trying to reduce with all the finer techniques a robot offers is the amount of trauma and scarring on the smallest, delicate tissues.”

Furthermore, robotic assistance reduces awkward operating positions for surgeons working on the smallest patients. Chien noted that the robot’s precision eliminates hand tremors, making the procedure “gentler on the tissues.”

The family put their trust in Chien—and the results amazed them.

Following his robotic cleft lip repair, Luka was smiling, thriving and finally able to gain weight as feeding became easier.

“Physically, the surgery made a big difference. My son’s lips looked really good. The scarring was barely noticeable,” Pineda said. “He’s such a happy baby. He smiles a lot.”

Earlier this year, Luka underwent his second surgery to repair his cleft palate, an opening in the roof of the mouth that made eating solid foods and swallowing difficult. While the robot was not used for that procedure, the operation was successful, marking another important milestone in his care.

Today, at 18 months, Luka is active and playful just like any other toddler and is meeting developmental milestones. Pineda said she is relieved his early feeding struggles are behind him.

“The thing about a cleft lip and palate is there are so many emotions and worries that come with it, but we’re grateful for the advancements in technology and the care Luka received,” Pineda said. “He loves to eat; he’s such a happy eater. You would never know everything he’s been through.”

Chien is optimistic about what robotic surgery can offer and is eager to train future surgeons to adopt the technology.

“This technology could transform the way we perform delicate pediatric procedures,” he said. “It’s a new frontier for plastic surgery.”

Read more from Cedars-Sinai Stories and Insights: Cleft Lip and Cleft Palate FAQ