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

Microsurgery is a highly specialized technique used to connect tiny blood vessels. With the remote-controlled Symani Surgical System, surgeons sit in a unique chair and use hand controllers, which reduce natural hand tremors, to perform the delicate technique while a 3D screen magnifies the operating area.

Chien, who performed the surgery, told KTLA 5 “Rich on Tech” reporter Rich DeMuro the system allows for remarkable precision when connecting vessels thinner than a human hair.

“This robot and the three-dimensional aspect of the visualization allows us to add efficiency and precision to these very difficult cases,” Chien said.

Cetrulo, director of the Division of Plastic Surgery and the General William and Willa Dean Lyon Family Chair in Reconstructive and Plastic Surgery in honor of Randolph Sherman, MD, added, “What we’re watching on the screen, it could look normal to us, but in reality, it’s absolutely tiny.”

Cetrulo told DeMuro the surgery performed at Cedars-Sinai was a “100 percent success” and it could “open up a whole-new avenue of treatments for patients for diseases we never even considered treating.”

The surgeons noted robot-assisted microsurgery could one day be used for brain, abdomen and chest surgeries.

“These tools allow us to use our mastery in a level of precision and a level of dedication that was not previously possible,” Chien told DeMuro. 

Click here to watch the complete segment on KTLA 5.

Cedars-Sinai has successfully performed the first robot-assisted microsurgical head and neck cancer reconstructive surgery in the United States after the robot device received Food and Drug Administration approval for the procedure, marking a significant milestone in surgical advancements.

This procedure underscores Cedars-Sinai's commitment to staying at the forefront of medical innovation and adopting leading-edge surgical techniques that positively enhance patient care and improve outcomes.

The surgery was performed by Victor Chien, MD, who utilized the Symani Surgical System. Chien said the robot enabled him and his team to perform a complex microsurgical procedure with a higher level of precision and control than conventional methods to operate on micro blood vessels thinner than a human hair.

“The surgery demonstrates the microsurgical platform’s remarkable ability in lending greater precision and care when handling tissue in small and diseased vessels,” said Chien, a plastic surgeon in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai. “By removing the limitations that come with natural tremor in a human hand, the robot helped us execute this procedure in an efficient manner.”

Microsurgery is a highly specialized technique that involves connecting tiny vessels to restore blood flow or redirect fluid during surgical procedures. The microsurgery robot is designed to augment a microsurgeon’s capability to carry out surgery at the micro level by adding precision and control for extremely delicate procedures where surgical options may otherwise be limited. Additionally, Chien noted that robotic assistance greatly enhances 3D visualization and dexterity, enabling skilled microsurgeons to navigate complex areas more easily.

“Enlisting the technology potentially minimizes scarring and tissue damage, and I expect the added precision will ultimately increase operative efficiency,” Chien said.

Besides head and neck reconstruction surgery, the robot can be utilized for other complex procedures, such as breast reconstruction following cancer treatment; lower extremity microsurgical reconstruction, which involves microsurgery to repair tissues in the lower limbs following injury, disease or congenital defects; and lymphovenous bypass procedure for lymphedema, a procedure involving rerouting blocked lymphatic vessels to reduce fluid buildup caused by complications from radiation therapy.

“We are the first program in the Western U.S. to have microsurgical robotic capabilities and to perform a wide variety of successful cases using the device,” said Curtis L. Cetrulo Jr., MD, vice chair of Research in the Jim and Eleanor Randall Department of Surgery and director of the Division of Plastic Surgery at Cedars-Sinai. “We are building a robust corps of highly skilled surgeons and fellows trained in robot-assisted microsurgical technique, and we are excited to provide these innovative treatment options to our patients.”

Read more from the Cedars-Sinai Blog: Pioneering Advances in Surgery