In a first-of-its-kind operation in Telangana and Andhra Pradesh, doctors at AIG Hospital, Hyderabad, have successfully performed a robotic retroperitoneal partial nephrectomy recently on a patient with chronic liver disease. Instead of going through the abdomen, the conventional but risky route, they went the side way to reach the kidney, allowing them to safely excise the cancerous growth without impairing the kidney's functioning.
Why the Side Route Was the Safer Choice
The patient was a 45-year-old woman with chronic liver disease (CLD) and ascites (buildup of fluid in the abdominal cavity). She was admitted to the hospital complaining of right flank pain, severe fatigue, and general weakness.
Scanning revealed a 4 cm tumor on her right kidney and an enlarged liver of 5 cm. That her liver was so weakened and she had fluid retention made the classical abdominal approach a risky venture with potential organ damage and post-operative complications.
Instead, the group employed a retroperitoneal technique, accessing from the body side. This did not damage the liver and intestines and reduced the likelihood of acquiring complications such as peritonitis and fluid leakage.
Precision Technology for High-Risk Patients
Using state-of-the-art robotic technology, the surgical team carefully navigated through the narrow retroperitoneal space. During the procedure, a robotically assisted ultrasound probe was used to clearly define the tumor and resect only the infected part of the kidney.
The conventional transperitoneal (abdominal) laparoscopic or robotic route was ruled out due to ascitic fluid, fragile liver architecture, and risk to surrounding intestinal structures. We decided to use the retroperitoneal approach, a far more intricate but targeted route that avoids entry into the abdominal cavity altogether. This approach represents a significant advancement for patients who were previously considered high-risk or inoperable.Dr. Bipin Chandra Pal, Director and HOD of Urology and Renal Transplantation at AIG Hospitals
A team effort in the specialty
The operation was a multidisciplinary collaboration involving urologists, hepatologists, radiologists, and anesthetists. Dr. Mithun Sharma, Head of Hepatology, illustrated the unique difficulties of operating on a patient with cirrhosis:
“The patient is suffering from liver cirrhosis, a serious condition where the liver is permanently damaged. People with cirrhosis face much higher risks during surgery, including complications, infections, and slower recovery,” he added.
Chairman Dr. D. Nageshwar Reddy called it a perfect example of "multidisciplinary, high-precision care". He further said that thanks to this new technique, the patient not only avoided a major surgical trauma but was also discharged within 48 hours.
“A patient with chronic liver disease and a complex renal tumour would traditionally face prolonged hospitalization and elevated surgical risk. But with advanced planning and integration between hepatologists, urologists, radiologists, and anesthetists, we were able to achieve an organ-preserving, minimally invasive outcome that dramatically shortened recovery time,” he added.
Rapid recovery, normal kidney function
The patient recovered very quickly after the surgery and experienced no pain or complications. His kidney function was not affected at all, and follow-up pathology revealed complete removal of the tumor.
(Input from various sources)
(Rehash/Muhammad Faisal Arshad/MSM)