Fifteen-year-old Deepali did not know two years ago that she was living on one kidney. She had lingering dull pains in her left side, which grew from time to time. But only in the last two years she felt a nagging pain that lasted 10 minutes. Only when the frequency of these episodes increased did she see a doctor. It was then that she discovered that she was born with developmental anomalies that caused both of her kidneys to fuse together on her left side. This means that technically she had one kidney and no right kidney. Not only that, she had a tennis ball-sized cyst, which doctors at the BLK-Max Specialty Hospital removed using robotic surgery, preserving her unique kidney, avoiding a transplant, and giving her a new life.
“This was one of the most challenging cases in my entire 30-year career as a surgeon,” said Dr. Surender Dabas, Senior Director, Department of Surgical Oncology and Robotic Surgery, BLK-Max Super Specialty Hospital. “Deepali was born with a fused kidney on the left side of her body and had virtually no right kidney. She had a large cyst (10×10 cm) in her fused kidney, which required immediate surgical intervention. To make matters worse, the location of the cyst was very difficult as it was located in an overlapping area of the ureter, renal arteries and veins. Not only that, the renal vessels and ureters were abnormally intertwined with the cyst, and damage to any of these structures would have been catastrophic for the patient. A slight tilt here and there and a single kidney will be destroyed. Then we’d have to remove it, get a transplant, and confine it to a lifelong immunosuppressant protocol. Our task was to open the kidney, completely remove the tumor to prevent recurrence, and sew it back up without damage. Given the delicacy of the operation, we had to stop the renal artery for a while, we had a window of 12 to 20 minutes. That’s why I chose high-precision robotic surgery. Not only were we able to perform the operation accurately, but we also saved the kidney,” says Dr. Dabas, who has 20 years of experience. crayfish surgery and ten years of robotic surgery. And in all these years, he has never faced such a difficult case as Deepali’s.
“She successfully underwent robotic removal of the cystic mass. Using robotic techniques, carefully dissecting the surrounding structures, blood vessels and ureters, the team was successfully able to dissect the cystic mass with minimal blood loss and preserve the surrounding structures,” explains Dr. Dabas.
The case was also challenging given the child’s small stature and smaller abdomen, but thanks to robotic surgery, she recovered quickly without any postoperative complications and was discharged on the fourth day after surgery. “Now she has minimal scarring and the follow-up is good,” says Dr. Dabas.
Parapelvic renal cysts are usually located in the hilum of the kidney and, over time, can lead to compression of the renal pelvis, blood vessels, other organs, and lymphatic vessels. This can further provoke uronephrosis, renal vascular hypertension and, ultimately, renal failure. Since Dipali had a fused kidney, she could have developed serious complications if treatment had been delayed.
Speaking about how robotic surgery could save a life, Dr. Dabas said that Dipali wouldn’t have many options in traditional laparoscopic surgery. “Firefly’s technology allows us to send dye to the target part of the body, and so we get a very clear view of the cyst. The robotic arm is more agile than a human arm and can make cuts with high precision.”
Advocating for greater use of robotic surgery in public hospitals and in training surgeons, Dr. Dabas says, “The cost of robotic surgery is gradually coming down and is now covered by health insurance. In addition, technology changes every two to three years to become even more precise, simpler and more controllable. If we do not accept or encourage the widespread use of technology, we will lose out on revolutionary operations like this one, where we could give a young girl a second chance at life. It is encouraging that many public hospitals in South India are using robotic technology.”