Robotic surgery is rarely used in children because of small size of abdomen. (File photo)
Doctors at a Delhi hospital have successfully removed a "tennis ball-sized tumour" from the abdomen of a 14-year-old boy using a keyhole robotic surgery, which they claimed was the first such operation for pediatric patients reported in the country.
The patient, who was admitted at the Sir Ganga Ram Hospital here late last month, received a fresh lease of life after the "rare tumour" was surgically removed in the first week of May by a team of doctors, hospital officials said.
"The boy underwent a successful removal of left adrenal tumour, which turned out to be 8 cm in size, and was stuck to kidney, pancreas, spleen and large intestine. A keyhole robotic surgery was performed and the structures were dissected one by one, safely," the hospital said in a statement today.
Adrenal glands are deep-seated gland in the abdominal cavity above kidney, adjacent to the biggest blood vessels and important organs of the body. They are endocrine glands that produce a variety of hormones, including adrenaline.
The teenaged patient had a "tennis ball-sized tumour (pheochromocytoma), a rare functional tumour of adrenal gland" which leads to very high blood pressure and other medical problems. It is usually removed by open surgery, which entails a big cut and long recovery, the officials said.
"The procedure lasted for two hours. The patient was kept in the 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," the statement said.
Robotic surgery is rarely used in children because of small size of abdomen, especially for adrenal tumours, which are deep-seated and adjacent to big blood vessels, it said.
"To the best of our knowledge, it is the first such reported case of robotic pheochromocytoma (large tumour) excision in pediatric age group in India," the hospital statement claimed.
The child was planned for excision of tumour by robotic surgery, rather than open surgery, in consultation with Dr Vivek Bindal, a robotic surgeon at the SGRH.
"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. The tumour was removed in totality without any significant blood loss," Mr Bindal said.
The doctors said the surgery was a major challenge but the procedure has its own benefits such as minimal blood loss, faster recovery, precise movement of instruments and its three-dimensional view.
Another challenge was to maintain blood pressure before, during and after the surgery. Even minimal manipulation of adrenal tumour during a surgery can shoot the blood pressure to alarming levels, while it falls precipitously immediately after removal of tumour, doctors 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," Chairperson of the Department of Anesthesia, Dr Jayashree Sood, said.