by The Welthi Bureau | 20 DEC 2017
A complicated Robotic surgery, spanning over four hours to remove a rare tumour called Aortocaval Paraganglionoma causing serious life threatening complications to a 30 year old young man was carried out at Apollo Cancer Institute by Senior Surgical Oncologists, Dr Hemanth Vudayaraju and Dr Chinnababu Sunkavalli.
Aortocaval Paraganglionoma is a rare tumour that develops from cells outside the adrenal glands between the two main blood vessels of Vena Cava and Aorta, in close proximity of the critical nerves in the abdominal area. This tumour, which can be malignant in 40% cases, can occur in any age group, but is usually seen in young adults. These tumours have very short history due to dangerously high Blood Pressure and often present early. They require good clinical expertise to diagnose early. In the long run they can cause irreversible heart and kidney damage and lead to brain stroke.
The patient Mr B. Raju Naik, a Sales Officer by profession from Warangal, was in extreme distress, when he visited Apollo Cancer Institute. The tumour led to release of excessive hormones causing uncontrolled hypertension and consequently severe headache, convulsions, loss of vision, heart and kidney damage, within a short period of one month since the initial symptoms. He visited three different hospitals, which stabilised his unusually high BP with four medicines, diagnosed the ailment and referred to us for further treatment. However during this interim period he had episodes of siezure, unconsciousness, dizziness, visual disturbance.
The permanent cure for this problem is by Surgery, which was attempted after initial control of BP by many medicines. The surgery itself is very tricky and risky. The moment we touch the tumour, it will release hormones which impacts the BP of the patient. While administering anaesthesia and performing surgery, the BP can rapidly shoot up to dangerously high levels and abruptly fall to very low levels. Therefore an expert team of anaesthetists led by Dr G Shekhar Reddy, constantly monitored and deftly handled the situation during the course of the surgery. The case was also complicated because of the unusual location of the tumour in an area which is inaccessible and risky.
In this patient the tumour was embedded deep in the abdomen and densely struck on two major blood vessels of the body (IVC & Aorta), making it difficult for us to identify a safe approach to it. This prompted us to utilise the deft manoeuvrability offered by Robot to remove the tumour and we foresaw a better outcome with robotics than Laparoscopy or Open Laparotomy, says Dr Hemanth Vudayaraju.
The tumour was eventually removed by a robotic surgery approach in which 5 small incisions (1cm or less) were made and long instruments placed in the abdomen. The surgery was performed with the surgical Robot controlled by the surgeon instead of the usual Open Laparotomy approach which requires a 15 - 20 cm incision. The procedure lasted 4 hours. The patient has since recovered well from the procedure and was fit for discharge on the 3rd day, instead of the 10 days. Now, a week after the surgery he is totally off the hypertension medicines.
Robotic Surgery presents innumerable advantages to the surgeon and the patient, including magnified 3D vision, high instrument dexterity, high precision, small or no scars, less pain, rapid recovery, no wound related compilations, minimal blood loss, therefore no need for blood transfusions. Hospital and ICU stay for the patient is reduced, early recovery means rapid return to normalcy and work,says Dr Chinnababu Sunkavalli.
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