Shimla,23.05.18-A pride of Himachal Dr. Vivek Bindal, consultant and Coordinator (Robotic Surgory), Institute of Minimal Access, Metabolic and Bariatric, at Sir Ganga Ram hospital performed robotic surgery on a 14-year-old child and removed a large tumor from his left adrenal gland thus saving his life. During this uphill task Prof. Satish Aggarwal was also in this team. Experts claim that the surgery is first of its kind in India. Robotic surgery is rarely used on children because of small size of abdomen, especially for adrenal tumors, which re deep seated and adjacent to big blood vessels.

Adrenal gland is a deep seated gland in human abdominal cavity above kidney, adjacent to biggest blood vessels and important organs of our body. According to doctors the procedure lasted for two hours and the child was kept in hospital for four days and discharged thereafter, without any blood pressure medication. Before surgery, he was taking three different tablets for blood pressure in high doses.

"Pheochromocytoma" is a rare functional tumor of adrenal gland which leads to very high blood pressure and other medical problems. It is usually removed by open surgery, which entails a big cut and long recovery, told doctors.

"The child had symptoms like sweating, palpitations, breathlessness and high blood pressure. On investigations, he was found to have a large 8 cm tumor in left adrenal gland, along with high catecholamine (hormone) levels, suggestive of pheochrmocytoma," said Prof. Satish Aggarwal, department of pediatric surgery, Sir Ganga Ram Hospital. The child was planned for excision of tumor by robotic surgery, rather than open surgery.

"The location and size of tumor, its proximity to vital organs like pancreas and major blood vessels, coupled with small abdominal cavity in a child made it a very challenging and robotic platform was chosen to overcome these problems. The additional benefits of small incisions, minimal blood loss and faster recovery in a child made us proceed with robotics," said Dr. Vivek Bindal, Robotic surgeon at Sir Ganga Ram Hospital.

Experts said the challenge was to maintain blood pressure before, during and after the surgery. According to doctors even minimal manipulation of adrenal tumor during surgery can shoot the blood pressure to alarming levels, while it falls precipitously immediately after removal of tumor.

The child underwent a successful removal of left adrenal tumor, which turned out to be 8 cm tumor, stuck to kidney, pancreas, spleen and large intestine, Keyhole robotic surgery was performed and the structures were dissected one by one safely.

"The tumor was very vascular, and had multiple bold vessels supplying it, arising from renal vessels and aorta. They were isolated and divided in between clips. The tumor was removed in totality without any significant blood loss," said Dr. Bindal. Dr. Vivek Bindal hails from Solan and is Son of Dr. Rajeev Bindal, Speaker of H.P. Legislative Assembly.