Doctors at Sir Ganga Ram Hospital have used robotic surgery to successfully remove a tumour from the left adrenal gland of a child. They also cured him of blood pressure.
“Robotic surgery is rarely used in children because of the small size of the abdomen, especially for adrenal tumours, which are deep-seated and adjacent to big blood vessels,” said a release issued by the hospital on Tuesday.
First such case
This is the first such reported case of robotic pheochromocytoma (large tumour) excision in paediatric age group in India, the hospital stated.
The doctors said that a 14-year-old was admitted to the hospital with sweating, palpitations, breathlessness and high blood pressure.
The patient had an eight cm tumour in left adrenal gland, along with high catecholamine (hormone) levels, suggestive of pheochromocytoma.
Prof. Satish Aggarwal, Department of Paediatric Surgery, Sir Ganga Ram Hospital, said, “This is a very challenging case to manage because of the wide variations in blood pressure, precarious location of tumour and low reserve in children.”
The child was planned for excision of tumour by robotic surgery, rather than open surgery, in consultation with Vivek Bindal, robotic surgeon, Sir Ganga Ram Hospital.
“The location and size of tumour, its proximity to vital organs like pancreas and major blood vessels, coupled with small abdominal cavity in a child made it a very challenging and robotic platform was chosen to overcome these problems. The additional benefits of small incisions, minimal blood loss and faster recovery in a child made us proceed with robotics,” he said.
Another challenge was to maintain blood pressure before, during and after the surgery.
Even minimal manipulation of adrenal tumour during surgery can shoot the blood pressure to alarming levels, while it falls precipitously immediately after its removal.
Jayashree Sood, chairperson, Department of Anaesthesia, said, “This rare tumour required meticulous preoperative preparation. Intra-operatively beat to beat monitoring was done and appropriate drugs were administered as required . After the surgery the child was managed in the surgical ICU since inotropes needed to be continued to maintain his blood pressure. ”
The child underwent a successful removal of left adrenal tumour, which stuck to kidney, pancreas, spleen and large intestine.
Keyhole robotic surgery was performed and the structures were dissected one by one safely.
Dr. Bindal said, “The tumour was very vascular, and had multiple blood vessels supplying it, arising from renal vessels and aorta. They were isolated and divided in between clips. It was removed in totality without any significant blood loss.”
The procedure lasted for two hours.
The patient was kept in hospital for four days and discharged thereafter, without any blood pressure medication.
Before the surgery, he was taking three different tablets for blood pressure in high doses.
Prof. Aggarwal said that the child was doing well at three week follow up. He would keep the child under his able watch.
