Malabar Institute of Medical Sciences (MIMS), Calicut conducted the world’s first 3D
Laparoscopic approach for giant renal vein aneurysm of right kidney and
successful auto transplantation to Mr. Abdul Khader, a 44 year old male from
Kadavalloor, Thissur, Kerala.
3D Laparoscopic Urologist Dr. Krishna Mohan and the team could
bring the man back to normal life through this extreme life threatening
surgery. Mr. Abdul khader came to MIMS after detecting to have a life threatening venous aneurysm (around
10 cm sizes) of right kidney. Nephrectomy ie; Kidney removal surgery was
suggested from other centres.
“We are happy to inform you all that we are the first hospital to
do keyhole surgery kerala for giant renal vein aneurysm in the world and we could
successfully give back the kidney to the patient” Dr. Krishna Mohan, 3DLaparoscopic Urologist at MIMS said.
Renal vein aneurysm is due to venous malformation due to defective
development during later stage of embryogenesis while venous trunks are formed.
Weakness of venous wall due to lack of development of media. The venous
aneurysm can be detected incidentally or can present as abdomen pain,
hypertension or due to complications like spontaneous rupture or rupture and
bleeding in trivial accidents and can cause death. Thrombosis and pulmonary embolism and pressure
effects on adjacent organs can occur. This situation can be assessed as a bomb
in abdomen which can explode at any moment resulting in fatal bleeding and
death. If it bleeds even there won’t be time to shift to hospital as hemorrhage
will be fatal.
The treatment is surgery and priority is to save the life first by
nephrectomy and to save the kidney if possible. Other option is to embolisation
of renal artery and to block the renal artery which may result in
non-functioning of the kidney or to do nephrectomy by an open surgery or
laparoscopy Surgery.
Since the right kidney was functioning better than the left
kidney, saving the kidney was another priority for us. We did renal angiogram
which gave the clear cut picture of complex vascular anatomy. The embolisation
of renal artery was deffered as high risk of pulmonary embolism and sudden
death. We decided to take him for surgery after explaining the complications
and necessity of complex surgery. The surgery was highly complex due to the
risk of aneurysm rupture and massive bleeding, embolism, including a major
threat to life. This was a surgery on major blood vessels aorta and inferior
venava which associated with heart. Aorta arises from heart carries oxygenated
blood. Inferior venacava takes blood to heart. Dr. Krishna Mohan added.
“We explained about the high risk and gave confidence to the
desperate patient and to his family. Our plan was to do a 3D laparoscopic
nephrectomy and to repair the kidney after renal cooling in bench surgery (out
side) and finally auto transplantation” he added
3D laparoscopy was chosen since it is 36 times magnified vision
and vessel anatomy will be much clear compared to non 3D Laparoscopy and open
surgery. Since any small pressure on aneurysm may result in rupture and sudden
death, 3D Laparoscopy was the best choice. MIMS is the second urology and transplant unit in India with this
facility.
Mr. Abdul Khader underwent surgery on 4/8/2014. This complex
unusual surgery took 8 hrs and no blood transfusion required. He stayed in ICU for 2 days discharged after 2
weeks’ hospital stay on 18/8/2014. It was second life to him.
The Surgery team included Dr. Krishna Mohan laparoscopic urologist
and transplant surgeon, Dr. Harigovind, Senior Consultant Urologist &
transplant surgeon and Head of the department, Dr. Ashish Jindal, Consultant
Urologist and transplant surgeon, Dr. Rekha S, Consultant Anaesthesiologist.
The Radiology support was by Dr. K.G. Ramakrishnan, Senior Consultant
Radiologist and Dr. Shailage, Consultant Radiologist at MIMS
Participants in Press Conference
Dr. Hamza P., Chief of Medical Services, MIMS
Dr. Abdulla Cheryakkat, Managing Director, MIMS
Dr. Krishna Mohan, 3D Laparoscopic Urologist, MIMS
Dr. Harigovind, Senior Consultant Urologist, MIMS
Dr. Ashish Jindal, Consultant Urologist, MIMS
Dr. Rekha S, Consultant Anaesthesiologist. MIMS
Mr. Abdul Khader, the Patient
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Mr. Abdul Khader who underwent the world’s first 3D Laparoscopic approach for giant renal vein aneurysm of right kidney and successful auto transplantation thanking MIMS doctors, who include (from right) Dr. Hamza P., Chief of Medical Services, Dr. Ashish Jindal, Consultant Urologist, Dr. Harigovind, Senior Consultant Urologist, Dr. Krishna Mohan, 3D Laparoscopic Urologist, Dr. Rekha S, Consultant Anaesthesiologist and Dr. Abdulla Cheryakkat, Managing Director.
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Dr. Krishna Mohan, 3D Laparoscopic Urologist & Transplant surgeon conducting the world’s first 3D Laparoscopic Surgery for giant renal vein aneurysm of right kidney and successful auto transplantation.
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C.T image of giant renal vein aneurysm of right kidney of Mr. Abdul Khader.
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