Category Archives: Landmark surgeries.

3 May, 2012 14:23


From DNA, 10 months ago …..
And last month Asian Hospitals completed 50 Robotic Surgeries.

Medical revolution: At Mumbai’s Asian Heart Hospital, robots to help with surgeries

Published: Thursday, Jul 7, 2011, 8:00 IST By DNA Correspondent | Place: Mumbai | Agency: DNA

Mumbai’s first robotic facility for surgery was inaugurated at Asian Heart Institute in Bandra-Kurla Complex on Wednesday. On the occasion the hospital authorities launched a separate centre on the hospital premises dedicated to robot-assisted surgeries which will be called Asian Vattikuti centre for robotic surgeries.

This robotic facility will be used in both cardiac and non-cardiac surgeries. Officials from the hospital said that the robot will be used in valve replacement and bypass procedures. The hospital will also use the robot surgery facility in urology, gastrointestinal and gynaecology surgeries. The latest in robotic surgery – the da Vinci robotic surgical system with simulator capabilities robot costs around Rs15 crore.

“On Wednesday, Dr Ramakanta Panda, the prime minister’s surgeon, demonstrated the country’s most advanced robot for minimally invasive surgery. We have a tie-up with Vattikuti Foundation, which is a philanthropic organisation based in Michigan, US. We also trained robotic surgeons for cardiac and non-cardiac surgeries. Dr Panda will be involved with cardiac robotic surgeries,” said Dr Vijay D’Silva, medical director, Asian Heart Institute.

“The actual robotic assisted surgery will start after July 15. The Vattikuti Urology Institute is considered a pioneering institute in what has been called a “medical revolution.”

On the benefits of minimally invasive robotic surgery, D’Silva said, “Over 5,000 robot-assisted surgeries later, it has been proven that there is lesser trauma and pain, shorter hospital stays, and minor scarring for the patient.”

According to experts, there are only eight or nine trained robotic surgeons in the country and in Mumbai, Dr Jaydeep Palep, an Italy-trained surgeon, is only familiar with the technique. Dr Palep, who has done robotic surgeries in Hyderabad and Pune, has joined the Asian Heart Institute for non-cardiac surgeries.

The AHI had sent Dr Pranav Kandachar, Dr PradyothKumar Rath, Dr Panda and Dr Manoranjan Mishra for a week’s training in France. “Our next batch of doctors will soon go to France soon for training,” said Dr Panda.

Senior laparoscopic surgeon Dr MM Begani of Bombay hospital, said, “Robotic surgery will be more beneficial in complex surgeries that cannot be done using traditional procedures like laparoscopic. Robotic surgery will be useful for removal of prostate, cardio-thoracic surgery and in gynaecology for minimal invasive surgery.”

Corrective surgery for ALCAPA in a 35 year old man: a life re-energised!


Vikram Bhangale, 35, of Mumbai, was referred by Dr Rajiv Karnik for corrective surgery for ALCAPA on August 12, 2011.

Case history given by Doctor:

Patient is a known case of anomalous location of coronary artery arising from Pulmonary Artery since birth, with mild hypertension and a history of gout with associated pain occasionally in ankles. He had a history of femur bone fracture and was operated in January 2006 and a rod was put in the right leg in Feb’10. He was admitted to AHI for corrective surgery for left coronary artery arising from main coronary artery.

He also had a Low Ejection Fraction.

 

Case history given by patient:

As a child the patient was asked to take medication and avoid rigorous activity. He was advised to visit the doctor if he felt uneasy. In spite of the medical condition, the patient had normal, fun childhood and participated in all activities. For the past two years he was experiencing heavy breathing and decided to get it checked and underwent an ECG which came out to be abnormal. He underwent Angiography before going to the US, where he underwent 2D echo tests and sent the reports to his doctor in India, Dr Rajiv Karnik. Dr. Rajiv Karnik referred him to AHI and provided all his history. The meeting with Dr Ramakanta Panda was excellent and the patient and his family felt very confident and comfortable after being briefed about the procedure. The meeting was smooth-sailing since Dr Panda already had the history of the patient and all the corresponding reports with him.

What makes this case interesting. 

Anomalous origin of the left coronary artery arising from the pulmonary artery (ALCAPA) is a rare but serious congenital anomaly.

The ALCAPA occurs when the baby’s heart is developing, early in the pregnancy. The developing blood vessels in the heart do not connect correctly. In normal individuals the left and right coronary arteries arise from the aorta at the point where the aorta meets the left ventricle & these supply oxygen rich blood to the heart. However in the case of this patient the left coronary artery was arising from the pulmonary artery which carries deoxygenated blood. As a result the left coronary artery carried deoxygenated blood to the heart as well. This is when the heart does not get enough oxygen and it begins to die which causes a condition leading to a heart attack in the baby.

If left untreated, the condition results in a mortality rate of up to 90% within thefirst year of life.

The survival of the individual depends on two factors  – dominance and collaterals. In layman’s terms, Dominance determines which coronary artery supplies more blood to the heart. Collateral blood supply is the flow of blood from a coronary artery to an adjacent artery. This collateral circulation provides alternate routes of blood flow to the heart in cases when the heart isn’t getting the blood supply it needs.

Therefore, in the case of Patient Bhangale, his right coronary artery was dominant and the collateral blood supply from the right coronary artery to the left coronary artery was sufficient. Hence the patient could pass through childhood with relatively minor symptoms.

The procedure he underwent is called a Takeuchi repair. Due to the difficult location of the left coronary artery, an intrapulmonary artery tunnel was required to redirect oxygenated blood into the vessel from the aorta through an aortopulmonary window.

 

For more information on diet, health and nutrition, please email Harpinder Gill at harpinder.gill@ahirc.com. You are welcome to email us with any question on any health topic. Please allow 24 hours for an answer, and if your query seems requiring an urgent response, expect to hear from us before that time.

Another watershed surgery at AHI.


65 year old Khurrum Khan Choudhary, Bangladeshi, hale and hearty after Bypass Surgery & Abdominal Aortic Aneurysm Stenting

Case history given by Doctor:

Patient complained of chest heaviness and breathlessness on exertion and irregular heartbeat since 1993. This condition increased in 2006. Patient suffers from back pain and ankle edema. He has undergone a angiography and a triple vessel coronary artery disease in 1993.

He had an abdominal aortic aneurysm since 2003. He has a history of Myocardial infarction in 1993 & 2001 and is a known case of diabetes since 2004 & hypertension since 1998.

He was a habitual smoker and stopped in 1993. He underwent abdominal aortic angiography in July 2011 and an infrarenal abdominal aneurysm of 5.1 cm in diameter was detected.

Case history given by patient:

In 1993, the patient suffered from a myocardial infarction.  His physician advised visiting a hospital in Dhaka, a good 150 miles away from his village. Not realizing the gravity of his condition, the patient drove to Dhaka and thence to a cardiologist in Kolkata where he underwent an angiography which revealed 3 blockages. He was advised to take medication, exercise regularly and control his diet.

Ten years later, an abdominal aortic aneurysm was detected. Two years after that he visited his daughter in Australia and underwent a CT Angiography. He was advised to undergo bypass surgery and then abdominal  stenting after a gap of 3 months.

In the mean time, his children found out about AHI through the internet and communicated with Dr. Panda. Choudhary also interacted with Dr Panda, and says he gained immense confidence from his conversations with Dr Panda. He remembers his first meeting with Dr Panda as  good, comforting and reliable. The family appreciated that Dr Panda assured them that he would treat the patient like his own brother. They preferred coming to AHI even though they had access to hospitals in Singapore and Australia, and were particularly comforted with the fact that Bangladesh and India share a similar culture.

What makes this case interesting.

The patient needed bypass surgery as well as a surgical solution to his abdominal aortic aneurysm. This entailed a dual procedure, making it a challenging case.

The bypass was completed first, followed by the stenting of the aneurysm. (At the time of surgery, the aneurysm was 5.1 X 5.7 X 6.8 cms.)

Just a few years ago, this kind of situation was not easily responded to and would in all likelihood proved to have been fatal.
Bypass Surgery on 8th Aug’11
Abdominal Aortic Aneurysm  Stenting on 12th Aug ’11.

 

For more information on diet, health and nutrition, please email Harpinder Gill at harpinder.gill@ahirc.com. You are welcome to email us with any question on any health topic. Please allow 24 hours for an answer, and if your query seems requiring an urgent response, expect to hear from us before that time.

Defusing an aneurysm, and making a little history in Mumbai..


BACKGROUND: What is an aneurysm?

An aneurysm is an area of a localized widening (dilation) of a blood vessel. An aortic aneurysm is a general term for any swelling (dilation or aneurysm) of the aorta, usually representing an underlying weakness in the wall of the aorta at that location. Once an aneurysm reaches 5 cm. in diameter, treatment is usually considered necessary so as to prevent rupture. Below 5 cm., the risk of the aneurysm rupturing is lower than the risk of conventional surgery in patients with normal surgical risks. The goal of therapy for aneurysms is to prevent them from rupturing. Once an abdominal aortic aneurysm has ruptured, the chances of survival are low, with 80 to 90 percent of all ruptured aneurysms resulting in death.

CASE:

Last week, a 60 year old patient underwent Abdominal Aortic Aneurysm Stenting (Debranching and thoracic abdominal aneurysm stenting) at AHI, in a surgery that was complicated, challenging, SUCCESSFUL.

Case history given by Doctor:

“Patient complained of intermittent abdominal pain and giddiness since 2004, which increased in past few days. The patient is a known case of abdominal aortic aneurysm since 2004.Thoracic and abdominal aortic angiography was done on July 7, 2011, revealing large saccular aneurysm of distal descending thoracic aorta and proximal abdominal aorta stenting at D8 level and extending up to the origin of coeliac artery. The Patient was advised for aortoplasty. Patient is a non-smoker and non alcoholic. He has hypertension since 5 yrs.

The challenge:

The patient suffered from 2 aneurysms, one in the chest and the other in the abdomen. All vital organs in the abdomen such as intestine, kidney, liver were getting the blood supply via the abdominal aneurysm. Hence, stenting it would mean restricting the blood supply to these organs thus proving fatal. Hence, first a new channel was created to supply blood to these organs and then the aneurysm stenting was done. Such a case is very rare and in all likelihood, this surgery WAS THE VERY FIRST OF ITS KIND IN MUMBAI.

 

For more information on diet, health and nutrition, please email Harpinder Gill at harpinder.gill@ahirc.com. You are welcome to email us with any question on any health topic. Please allow 24 hours for an answer, and if your query seems requiring an urgent response, expect to hear from us before that time.

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