Ahmedabad: Dr Apurva Vyas, head, department of minimal access and gastro intestinal surgery at Sterling Hospital, Ahmedabad, claims to have successfully performed a unique robotic surgical procedure on a 37-year old patient to relieve him of acute pain caused by a rare condition of Median Arcuate Ligament Syndrome (MALS).
The patient’s weight was 60 kilograms, much below the normal weight of a person his height of 185 cm.
According to Dr Vyas, this is the first such procedure to be conducted in India using the da Vinci surgical robot. It is reported to be the third in the world.
The medical condition, found in one among 100,000 humans, is referred to as Celiac Artery Compression Syndrome and is characterised by abdominal pain from compression of the celiac artery.
Celiac artery compression can be loosely compared to a heart attack-like situation of the digestive system. The patient suffers severe pain as soon as he starts eating and is never able to eat enough for the body’s needs. Because the condition is so rare it is near impossible to diagnose quickly.
The celiac artery supplies oxygenated blood to the digestive system — the stomach, liver, spleen and the part of the oesophagus that reaches into the abdomen. In addition, it supplies blood to half of the duodenum and the pancreas. Compression of the celiac artery leads to inadequate blood supply to the digestive system, especially after food intake when the oxygen requirements go up significantly.
Doctors have to rule out conditions such as hernia, peptic ulcer and other gastric pathology before finally getting a CT angiography to determine if an artery is being compressed. Surgery is currently the only treatment option and involves releasing the ligament that causes the compression.
However, reaching the celiac artery through conventional surgery is not that easy because it is deeply located under the crus of the diaphragm.
“Using a four-armed surgical robot, I was able to reach the root of the celiac artery where human fingers could not. The three-dimensional high definition view magnified the artery multi-fold to help me achieve precision that prevented collateral damage to healthy tissue, arteries and nerves,” said Dr Apurva Vyas who started using robotic surgery in Ahmedabad in 2016.
“I was happy to see the patient recover quickly. He was back home on the third day post surgery. The patient was able to get to productive work much earlier,” added Dr Vyas who has done nearly 900 gastric bariatric surgeries since he earned his Masters in Surgery (MS) in 1996. He now heads obesity surgery practice at the 250-bed Sterling Hospitals in Ahmedabad.
A host of reasons, mainly lifestyle related, have led to the growing incidence of weight gain. According to a study, obesity is one of the primary reasons for the rise in cancer cases and while it affects both sexes, women are more likely to be affected by the obesity-related forms of cancer.
“Even though the patient agreed to go in for robotic surgery, his family needed convincing as they had many apprehensions,” said Dr Vyas.
“When I told them I would be on the console with full control of my instruments and a 10x magnified view of inside the body with a computer assisting me in doing a precise surgery they agreed. On a follow-up visit, the patient’s wife came along to thank me for relieving her husband of the pain and helping him eat to his heart’s content without complaining of pain,” added Dr Vyas.
Dr Vyas, who was invited to present this case at Vattikuti Foundation’s bi-annual Robotic Surgeons Council meet in Chennai attended by over 150 robotic surgeons in early April 2017, said that he has observed his patient over the past three follow-up visits and the patient is doing well and is back to his regular diet intake without any recurrence of symptoms.