Robotic surgery gives Connecticut toddler born with kidney defect a fresh start

Payton Grassia and her mom, Jessica

Payton Grassia is all things preschooler. She loves finger painting and outdoor play, has a “big personality,” her mom says, and recently added big sister to her list of credentials.

But beyond her sweet smile and playful charm, this spunky three-and-a-half-year-old is also a fighter.

And her fight began before she was even born.

Prenatal testing

While pregnant, Payton’s mom, Jessica Grassia, had an amniocentesis, a test used to identify potential congenital defects in babies.

The test revealed that her unborn baby, at 28 weeks in utero, had a duplex collecting system—a normal finding where a kidney has two ureters (tubes that carry urine from the kidney to the bladder) rather than one. This condition may affect the drainage of urine from the urinary system.

“When we found out that there was something wrong with my baby’s left kidney, it was very emotional,” says Jessica.

Upon receiving the news, she and her husband, Richard, called upon a local, Connecticut-based pediatric urologist who recommended waiting until the baby was born for further evaluation and treatment.

Baby Payton’s arrival

Payton was born on June 17, 2011. Along with tiny booties, frequent feedings and gentle snuggles, Payton’s first few months also included frequent trips to her urologist.IMG_0090 2

At one month old, Payton underwent MRI (magnetic resonance imaging) and VCUG (voiding cystourethrogram) testing. Here, doctors also determined that she had a ureter blockage in her upper kidney, which was causing hydronephrosis—a condition where urine overfills, or backs up, into the kidney, prompting the kidney to swell.

Doctors quickly prescribed antibiotics for Payton in an effort to prevent urinary tract infections—a common result of hydronephrosis, and opted to wait until the she was a bit older and stronger for surgery.

Surgery and hydronephrosis

IMG_0274 3At 11 months old, Payton underwent open surgery (a procedure that requires a large incision) to remove the blockage in her kidney.

The surgery was successful but Payton’s hydronephrosis was still present months later and was worsening.

“Six months after surgery, we were informed that her hydronephrosis was still moderate-to-severe when it should have improved by that point,” Jessica says.

Seeking a second opinion

The Grassias opted for a second opinion and decided to travel to Boston Children’s, which was ranked #1 in pediatric urology  in U.S. News & World Report 2014-15.

Alan B. Retik, MD,who was urologist-in-chief at the time, ordered repeat MRI and VCUG testing and identified a second blockage on Payton’s upper left kidney in addition to the single blockage previously detected.

Based on these findings, Retik consulted with a team of specialists and scheduled another surgery to resolve Payton’s hydronephrosis.

Next steps for Payton

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Payton and Dr. Yu at a recent follow-up appointment

Due to the location of the newly detected blockage, the team, which included Richard N. Yu, MD, PhD, director of Boston Children’s Pediatric Robotic Surgery Program, recommended minimally invasive robotic surgery to repair Payton’s upper kidney and remove the blockage. This procedure, which is conducted through very small incisions, ultimately reduces pain, recovery time and scarring compared to traditional open procedures.

With Yu leading the surgical charge, the team saved the upper portion of Payton’s kidney by correctly removing and repairing the blockage. “Minimally invasive robotic surgery was useful from a technical standpoint because we were able to approach the kidney from an area that was undisturbed from Payton’s prior surgery,” says Yu.

Watch this video to learn more about minimally invasive robotic surgery.

After her surgery, Payton “bounced back quickly,” her mom says, even walking to the hospital playroom 24 hours after the procedure.

“I would highly recommend robotic surgery,” Jessica says. “Payton’s healing time was remarkably quick and there is very minimal scarring on her body.”

Life after minimally invasive surgery

With the surgery behind her, Payton is as active as ever, living without restrictions and continuing to thrive.

“Payton is full of life with a big personality,” her mom says. “She loves school, being a big sister and is counting down the days till summer so that she can go swimming.”

Learn more about Boston Children’s Department of Urology and minimally invasive surgery.