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    Medical breakthrough in surgery in India

    There have been numerous cases in India, where some rare surgeries have left the world at awe with a happy and grateful patient who gets a new lease of life. SurgeryPlanet summarizes a few of these cases that have happened recently in India.


    Domino Liver Surgery in New Delhi, India


    Mitral valvuloplasty, a breakthrough in the annals of heart surgery, has proved to be quite successful in the Indian scenario with over 100 such surgeries performed in Bangalore City's Manipal Hospital.

    In February this year, at NewDelhi’s Sir Ganga Ram Hospital, there was a Domino Liver transplant done which lasted for about 16hours with 20 doctors working on this.

    This has been branded as a “breakthrough surgery” as this team of 20 doctors performed the country’s first and the world’s youngest domino Liver Transplant.

    In this procedure, one patient is cured with the transplant afterwhich his organ is used for a life saving transplant for someone else.

    22-month old Shourya was cured of Maple Syrup Urine Disease(MSUD), which is a rare inherited metabolic disorder that causes mental retardation and death, underwent this transplant, where 20% of his aunt’s liver was used. His own liver was then transplanted to 3-year old Siya, who was battling end stage liver failure due to another rare condition called Langerhans Cell Histiocytosis (LCH).

    Another drawback with Shourya was that he lacked a vital enzyme called BCKAD because of which he had to be on a protein-free diet, lest it cause brain damage. He was to be fed a special amino acid free formula milk bought from the UK, that was very expensive for his family. Since it was observed that 12% of this enzyme is present in the liver, the doctors decided to undertake a transplant. Since his parents carry a defective gene for MSUD, it was planned that 20% of his aunt’s Liver would be used for the transplant.

    The surgeries were conducted on Jan 31st this year.

    The domino transplant was possible because both the children had the same blood group (B positive) and it was also advantageous that they both weighed almost the same.
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    Recently, it was discovered that a liver transplant could help cure MSUD. The biggest risk, though was to have the patient’s body accept the new Liver. During the surgery on Shourya, the amino acids, glucose and sodium levels in blood were on tight control with close monitoring to ensure that the slightest stress was avoided which could lead to multiple complications

    A strict protocol was followed during the surgery and later until the new liver started functioning normally.

    The second child, Siya was diagnosed with LCH in Nov 2007 and since then has been put onto chemotherapy. LCH behaves like a cancer and causes the body’s immune cells to attack the body rather than fight off infections. After a year into Chemotherapy, she was cured off LCH, but unfortunately had an end-stage Renal Failure.

    For the surgery, the team was divided into three units who prepared the donor liver, Shourya's own liver and Siya's diseased liver for removal in three separate operating theatres.

    First the donor liver and then Shourya's own liver were removed and prepared for transplantation by re-constructing the vital blood vessels with complex vein grafts. Shourya was transplanted first, and then his liver was transplanted into Siya.

    Domino transplants are rare because there are very few conditions in which you can cure the patient with a transplant and then transplant his or her organ into someone else without passing on the disease. MSUD is one such disease.

    This surgery roughly costed around US$ 30000. Shourya post-operatively will now be able to tolerate normal protein diet. In the case of Siya, she will be on low dose chemotherapy for another six months to ensure that LCH does not recur in the new liver.

    MINIMALLY INVASIVE BRAIN TUMOR SURGERY

    Patients who suffer from brain tumor usually need surgery as part of overall management. Conventional approach to brain tumors has been through a craniotomy (making a window on the skull).This form allows the neurosurgeon to adequately visualize the tumor and manipulate the surrounding structures ensuring safe removal. With the advent of minimal access surgery in other parts of the body, there is an increasing tendency to minimize the size of the skull opening or incision.

    In general, endoscopic surgery forms the basis of minimal access surgery for all other parts of the body. Recently, due to technological improvements and a drive towards less invasive surgical procedures, the use of endoscopy has expanded in neurosurgery. The introduction of the endoscope in neurosurgery is the result of technological advancements in the camera's design, including reduced size, improved resolution and brighter illumination.

    Endoscpoic neurosurgery involves the insertion of an endoscope, or tiny video camera, through a small incision to treat a range of neurological conditions. The result is


    * Faster and simpler procedur
    * Reduced post -operative complications
    * Faster recovery
    * Less pain and scarring

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    The endoscopic trans -nasal approach is performed through the nostrils. A natural passage way exists at the back end of the nose leading into the sphenoid sinus (an air filled cavity in the depth of the skull), which can be enlarged so that the endoscope and instruments can pass into this air filled cavity. From this region the sella turcica is easily accessed, which is the location of pituitary gland. Neurosurgeons use this route normally to remove the tumor from pituitary (the master glad).

    BREAK THROUGH IN BRAIN TUMOR SURGERY- FIRST TIME IN INDIA (REMOVAL OF BRAIN TUMOR THROUH NOSE)


    A 40 year old lady had problems with here vision, especially her right eye. It was found that there was a 2-cm long tumor in her brain that was affecting the right Optic Nerve hence obstructing her vision. Several tests including the MRI were performed. After discussing various options with the family, the Neurosurgeon and his team decided to do the minimal invasive surgery and remove the tumor through the nose.

    This was a pioneering technique of removing a meningioma (a type of benign brain tumor) using an endoscope through the nose. The successful removals of this kind of tumor through the nose require exceptional skills. This technique has created ripples in the health care community. Generally it is hazardous to perform this surgery without perquisite skill and specialized equipment.