The Son of an 85 year old woman with tumor visits us with hope and what happened next is something special.
It was an anxious Mr. Barbosa who walked into my cabin on a rainy gloomy August day. His 85 year old mother Agnes had been diagnosed with a tumor in the last part if the duodenum. The duodenum is an area where the stomach ends and the small intestine begins. It’s also an area where most of the important blood vessels supplying the vital organs like the intestine and liver pass. It’s like a Dadar junction of the local Mumbai railway. !
His concern was obvious. He wanted his mother to get treated but without pain and with minimum risk. Her age and a slightly obese built presented another challenge. The thought of giving up had also crossed his mind but when we counseled him regarding the perils of wait n watch, the thought of letting go never crossed his mind again.
Agnes was actually much more positive. Her only question was “will it hurt a lot? “. At that age it’s about daily inconvenience and getting back to normal not just the desire to live longer!
After careful deliberations with our team of physicians, cardiologists anesthesiologist s and surgeons, I took a decision of going ahead with a laparoscopic excision of the mass. Minimal Access surgery would mean a small incision less pain and early recovery which was what Agnes wanted!
Laparoscopic Surgery – A Marvel of Modern Science
Also known as minimal invasive surgery or keyhole surgery, laparoscopic surgery is a revelation of modern day surgical intervention. The surgery is performed by making a small hole very far from the location of the tumor. In that way the pain and the risk to the patient remains minimal. The chances of hemorrhage are also less and also the recovery time is much shorter when compared to normal surgeries. The diameter of the insertion is between 0.5 and 1.5 cm, depending on the requirement.
The Precision of Craftmanship
On the day of surgery Agnes was relaxed which was a good sign. A relaxed patient actually makes the doctor very confident. After a smooth induction of general anesthesia by our expert anesthesiologist, the surgery started. Minimal Access surgery is done by inserting small tubes called ports. A hi-definition camera is inserted through one of the ports and we do the surgery using a lot of hi tech gadgets.
Her obesity did present a challenge but since we are used to operating obese patients we overcame this difficulty easily. The next challenge was separating the superior mesenteric artery (supplying the small intestines) and inferior mesenteric vein (supplying large intestine). There are important organs around the pancreas, splenic vein and renal (kidney) vessels. All these were carefully separated and ultimately the tumor with part of the duodenum was excised.
The next challenge was rejoining the bowels so as to reestablish continuity. This was done by joining the intestine to the stomach using staplers. And voila, a tumor which previously required an incision spanning the entire tummy was removed by a small 1″incision around the umbilicus.
The post-operative course was smooth thanks to the ever cooperative and positive Mrs. Agnes and our dedicated resident physicians and nurses! In a matter of 6 days Agnes was home blessing us and of course the last thing she complained of was PAIN!
About the Author – Dr. Anil Heroor
As the head of the Surgical Oncology department of Fortis Hospitals Mulund, Dr Heroor specializes in Breast Cancer, Gastrointestinal cancer and Minimal access surgery (MAS) for gynaecology. Being awarded as the Wockhardt medal for being 1st in LTMMC in MS(Gen Surgery), he received extensive training at the TATA Memorial Hospital training for cancer surgery after which he went to Memorial Sloan Kettering Hosp, NY, USA and KURUME university hospital, Japan for further training.