Mohali, 1 june, 2024: A team of doctors at Fortis Hospital, led by Dr. Dharmender Aggarwal, saved a 56-year-old man from a complicated cancer on his transplanted kidney, by performing a complex robotic-assisted surgery. The surgery was performed by using the da Vinci robotic-assisted surgical system to remove the tumour from the upper pole of his transplanted kidney and preserve the renal function of the same.
The patient had lost both kidneys due to renal failure caused by chronic conditions like diabetes and hypertension, and had underwent a kidney transplant in 2018. His sister donated the kidney, and he had regularly visited the hospital for check-ups after that. However, the COVID-19 pandemic posed challenges to visiting the hospital for regular follow-ups. On evaluation at Fortis Hospital, three years later, it was found that he had developed a tumour on his transplanted kidney.
Commenting on the complexity of the case, Dr. Dharmender Aggarwal, Consultant Uro-oncology and Robotic Surgeon at Fortis Mohali, stated, “After reviewing the MRI scan and ultrasound, our team concluded that the tumour was likely to be malignant. While we discussed the possibilities of doing a kidney biopsy, it was not a feasible option due to the complex position of the tumour. Patients who have undergone kidney transplants are at a higher risk of developing malignant tumours due to the immunosuppressant required to maintain kidney function. These immunosuppressive weaken the patient’s immune system, increasing their susceptibility to malignancies. Removing this kidney would have left the patient in a challenging situation, as finding another donor would be difficult, and he would have to return to dialysis. Therefore, it was crucial to remove the tumour before the malignancy spread to other parts and save the only functioning kidney that was donated by his sister”.
Dr. Aggarwal further elaborated on the challenges of proceeding with any surgical procedure, “The transplanted kidney’s position differed from that of a native kidney, being closer to the internal iliac artery. Traditional surgeries would have posed significant difficulties in dissecting the blood vessels, accurately locating and removing the tumour. Therefore, we opted for a robotic-assisted partial nephrectomy. The standard warm ischemia time (the time an organ remains at body temperature after its blood supply has been reduced or cut off) for procedures like partial nephrectomy is below 25 minutes, as clamping the blood vessels for longer can cause severe ischemic damage to the kidney”.
The three dimensional vision, enhanced precision and dexterity offered by the advanced robotic technology, the da Vinci enabled the doctors to dissect and resect the tumour within a short warm ischemia time of just 10 minutes with a minimal blood loss of only 100 ml. Over 95 percent of the kidney was preserved, while ensuring complete removal of the tumour. As a result, the patient has swiftly recovered and his kidney is functioning well now without any complications.
Commenting on his fast recovery, the 56-year old patient said, “Losing both kidneys was already distressing enough. My sister who served as a donor in 2018 helped me undergo a kidney transplant and live a healthy life. After what I went through, losing the only functioning transplanted kidney to this tumour was unimaginable. I express my immense gratitude to the team of doctors at Fortis hospital who helped me survive this situation. Going back to dialysis would have been extremely difficult. Thanks to the technology and expertise and skills of the doctors, I was able to retain my renal function and recover well.
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