: Fortis Hospitals, Cunningham Road has consistently begun to use an advanced surgical technique in the field of laparoscopic surgery called ‘Single Incision Laparoscopic Surgery’ (SILS). The team led has performed many Single Incision Laparoscopic Surgeries which include Cholecystectomies (removal of the gallbladder) and Appendicectomies (removal of the appendix) with remarkable success and getting patients back to their normal life faster.

Globally, Single Incision Laparoscopic Surgery has only gained popularity over the last one to two years and this surgical technique is mainly offered at major laparoscopic centers. In India, the procedure is relatively new as most hospitals lack the expertise and equipment required for the procedure.

SILS is an advanced minimally invasive surgical procedure in which the surgery is done through a single entry point i.e. the navel. A 20mm incision at the umbilicus is all that is required for the surgery. A scope is inserted that can be moved around in the body and return images form various angles giving the surgeons a larger field of vision for the surgery and the instruments used to perform the surgery are flexible thereby enabling extra reach and maneuverability.

SILS involves the use of flexible instruments and a higher level of laparoscopic expertise. Currently Fortis Hospitals has been using this technique for uncomplicated Gallstone Disease and Appendicitis. All of the  patients have been discharged in 24 hours after surgery and have been ambulant within 3 to 6 hours of the surgery. In fact, in one of the patients’ both the gallbladder and appendix were removed using SILS and she was discharged within 24 hours and was back to routine activity in three days post surgery, thus highlighting the advantages of SILS.

Earlier, patients had limited choices when it came to surgery i.e. conventional open surgery or laparoscopic with multiple incisions, laparoscopic surgery being the preferred choice. However now with the introduction of Single Incision Laparoscopic Surgery, patients can undergo surgical procedures with just a single incision (approx half an inch) in the belly button and that too with a number of benefits over conventional procedures such as less pain, quicker recovery, less blood loss, less complications and minimal scarring and helping patients getting back to work faster.

SILS is the next big step in laparoscopic surgery worldwide. It offers a huge cosmetic advantage and also enables much quicker recovery for the patient compared to conventional lap surgery. For the patient it is extremely appealing to be offered surgery through a single small cut, than through multiple incisions.

SILS is an excellent option for all patients who need laparoscopic surgery more so for uncomplicated Gallstones, Appendicitis and Hernia operations. At Fortis Hospital, Cunningham Road and Bannerghatta Road, as a routine, SILS is being offered to all suitable patients.

To know how SILS can benefit you and the procedures for SILS , pls visit our SILS page at our website fortishospitals.in

By Dr Avishek Mukherjee Consultant Uro surgeon, Fortis Hospital & Kidney Institute,Kolkata

Kidney cancer is one of the most common cancers affecting males in the middle age group, especially those who sm ke. Smoking is one of the most important causative factors. These cancers are best treated with surgery wherein the cancer bearing organ is removed along with the cancer and the surrounding layers so that cancer recurrence can be reduced maximally. However this also means that the unaffected portion of the kidney also has to be sacrificed with the cancer. Nephron sparing surgery allows the surgeon to remove the cancer bearing area of the kidney while at the same time preserving the rest of the unaffected parts of the kidney thereby preserving as many functioning nephron units as possible.

This surgery can be performed by laparoscopic approach which the additional advantage of rapid recovery and rapid return to work. At the Fortis Kidney Hospital we have performed many such procedures to remove the cancer bearing tissue and at the same time preserve the rest of the kidney.

This surgery can however be only offered to those who present in the earlier stage of the cancer, and the tumor has as yet not affected the main blood supply of the kidney. These cancers can easily be detected in early stage by a simple abdominal ultrasound evaluation and can routinely be done in individuals above the age of 50 years. After the tumor is suspected then the surgeon will usually advise for CT angiography to assess the relationship of the blood vessels of the kidney with the tumor. Once it is detected that the cancer is in the early stage and has not yet attacked the main central vessels then the uro-surgeon can decide in favor of removal of the main tumor while at the same time preserve the rest of the nephrons.

This surgery performed by minimal invasive technique at Fortis Kidney hospitals. The patient needs to be admitted for five to six days and can return to work after two weeks of rest.

This treatment can be offered to most patients if the cancer is detected in the early stage of the disease and therefore the importance of regular kidney check up and ultrasound examination after age pf 50 years.

Adding another feat to the history of cardiothoracic surgery at Fortis Hospitals Bangalore, the team of experts led by noted cardiac surgeon Dr. Vivek Jawali and Dr. Ramcharan Thiagarajan, Consultant Surgical GI & Hepato-Pancreatic Biliary Surgoen has performed a combined cardiac bypass and liver tumor surgery on a 63 year old Nigerian.

This is one the most rare and complicated case where a patient underwent a cardiac bypass and a liver surgery at the same time. Mr. Saidu Abubarkar, retired Executive Director of Nigerian Television Authority had visited Fortis Hospitals Bangalore couple of months ago for a cardiac consultation.

Mr. Saidu was witnessing breathing problem and weakness while walking for quite some time. Upon consulting doctors at his native, he was advised to go for a second opinion with a cardiac expert as he was diagnosed of heart trouble.  Knowing about the cardiac expertise at Fortis Hospitals Bangalore he decided to come down to India for his treatment. He was diagnosed to have coronary artery disease with severe left ventricular dysfunction and had 6 blockages and was recommended for a bypass surgery. During his preoperative evaluation he was diagnosed to have compensated liver disease with a malignant tumor in the right lobe of the liver. He was known to be positive for Hepatitis B virus for which he was advised to take antiviral medication. The elevated liver marker was suggestive of Liver cancer and was advised for a liver resection.

“This is a very risky and complicated situation where the patient’s heart was weakened with 6 blockages, he was hypertensive, diabetic, cirrhotic liver and had liver tumor. We had to carefully understand and evaluate Mr. Saidu’s case to ensure that he receives the appropriate treatment and both his liver and cardiac problem was taken care of” said Dr. Vivek Jawali, Chief Cardiothoracic Surgeon, Fortis Hospitals Bangalore. After discussion between the cardiac and the liver teams the surgeons finally decided to go ahead with the combined surgery where the cardiac bypass was to be done first and then immediately followed by the liver surgery.

“We have done many combined cardiac surgeries in the past, but a cardiac bypass and a liver surgery of his nature is to my knowledge is one of its kind which has not been recorded in the medical history. Both the surgeries were high risk surgery and to perform both in the same sitting was a challenge which our team took and successfully accomplished” added Dr. Vivek Jawali.

“The tumor was resting deep inside and back of the liver and due to its location he was not a candidate for other palliative options and surgery was the best option. The liver had cirrhosis on visual examination. About 20 – 25% of his liver was resected along with the tumour completely with adequate surgical margin.  However since his liver is already affected by Hepatitis B and has cirrhosis, he has to ultimately get a liver transplant at a later stage” said Dr. Ramcharan Thiagarajan.

“The advantages of the combined surgery are that the patient need not have to wait to recover from his heart surgery and then go through rigmorale of major liver surgery and recover again, faster recovery, financial benefit of one surgery rather two and he need not have to worry about the spread of Liver cancer during the waiting time. However there is a synergistic risk of bleeding especially after combined cardiac and liver surgery, but with the clinical expertise and facilities available at our institution, we were successful in handling the criticality of the situation and perform both the surgeries without much blood loss and help the patient recover at the earliest” added Dr. Ramcharan. The purpose of performing high risk surgery is to benefit the patient population.

Mr. Saidu has recovered phenomenally fast, has been discharged from the hospital and is ready to go back to his native in few days time.

“When my doctors in my hometown said I had heart problem I was not ready to believe them. I have been quite active all my life into tennis, football etc. I have 10 children and 12 grandchildren and love to spend my time with my grandchildren. But when my heart problem was confirmed I decided to get the treatment without much delay. On recommendation of my friend I searched on the internet about Fortis Hospitals and came to know about their expertise and decided to come here for my treatment. Today I am grateful to the hospital and doctors to have given a new life to my. I am eagerly waiting to fly back home to see my children and spend time with them” said Mr. Saidu.

Fortis Hospitals Puts 27 Year Old Nigerian Back on her Feet After Multiple Joint Replacement Surgery

Fortis Hospitals Mulund, Mumbai, performed a multiple joint replacement surgery on a 27 year old young Nigerian patient. Rebacca underwent a hip and a shoulder replacement surgery by Dr. Sachin Bhonsle,Consultant Orthopedic Surgeon, after years of suffering in pain and immobility.

Rebecca was suffering from a sickle cell disease since birth; an inherited (genetic) disorder where the RBC (red blood corpuscles) assumes an abnormal shape of a sickle under certain conditions. Any stress, injury, or operation can lead to change in shape of the RBCs. But they are extremely sensitive to drop in oxygen saturation of blood. This causes immediate ‘sickling’.

Sickle cells contain abnormal haemoglobin, known as ‘haemoglobin S’, which causes the cells to have a sickle shape. Sickle-shaped cells don’t move easily through blood vessels. The clumps of sickle cells block blood flow in the blood vessels that lead to the limbs and organs. Blocked blood vessels can cause pain, serious infections, and organ damage. It can be at times life threatening.

Commonest problems encountered are:

1. Sickle crises – painful abdominal emergencies because of blockage of blood vessels to abdominal viscera.

2. Anaemia – red blood cells are easily destroyed and their life span is reduced causing anaemia.

3. Avascular necrosis (AVN) of bones – certain bones with peculiar blood supply undergo AVN because of blockage of the artery. Once the blood circulation is lost the bone crumbles and the adjoining joints undergo arthritis. Commonest are hip and shoulder joints. Remodelling of entire skeleton is affected sometimes.

In Rebecca’s case the disease was severe to the degree that 93% of her haemoglobin was abnormal. This resulted in extreme abdomen pain and loss of blood supply to bones. Due to the lack of blood flow in her bones she developed avascular necrosis in her hip joint and right shoulder. “She came to us in a complete immobile state with a painful right hip and shoulder which were completely damaged. The sickle disease had affected her knees as well” said her surgeon Dr. Sachin Bhonsle, Consultant Orthopedic Surgeon.

“We had three major challenges before we decided to go ahead with the surgery. Firstly, control of her Sickle cell disease – Rebecca had 93% ‘haemoglobin S’ (HbS). Subjecting her to trauma of a major surgery like joint replacement, associated blood loss and stress would have precipitated a life threatening sickle crisis. To reduce her HbS to about 30% we had to perform an exchange transfusion. Exchange transfusions involved removing blood with HbS and replacing it with fresh blood of compatible donors. It took about five days to restore the HbS to a safe level, after which she was ready for surgery.”

Secondly, there was the challenge of doing a shoulder and hip replacement at same time. Thirdly, when doing a joint replacement on very young patient it is important to perform a joint replacement surgery which would give her a long lasting and better quality of life.”

After proper examination we decided to go ahead with the replacement of right hip and shoulder. A decision was taken to use an ‘uncemented hip replacement’ of a robust construction, which has a potential to last a lifetime. A ceramic bearing was chosen for this hip which again will never wear out.

Dr. Bhonsle used a minimally invasive approach to replace Rebecca’s right hip whereby the hip joint was reached by minimal disruption with just a 4 inch cut. Because of avascular necrosis the bone quality was very hard and difficult to prepare, but it was achieved using careful and specialized instrumentation. Uncemented prosthesis was securely implanted and a ceramic bearing was fitted. Rebecca’s hip was ready to use. Similar minimal invasive approach was taken to the shoulder joint. Cemented shoulder prosthesis was selected and secured.

Rebacca was able to walk on the 2^nd day of her surgery.  Following the surgery her pain has gone completely. She had a speedy recovery and was able to get back to her normal course of life within few weeks of the surgery.

A team of Neurosurgeons led by Dr. Sunil Kutty, Consultant Neuro & Spine Surgeon operated the dorsal spinal tumour on a 33 year old Mr Ravindra Ghatse, who was experiencing difficulty in walking, numbness & weakness in his legs.

Mr Ghatse was suffering from Neurofibromatosis type 2 (NF2), a genetic abnormality, which he inherited from his mother. Neurofibromatosis is a neurocutaneous syndrome, which gets passed down through the parents’ genes, affects the brain, spinal cord, nerves, skin, and other vital systems in the body. Of the two types of neurofibromatosis – NF1 and NF2, NF1 is more common. NF2 is characterized by the presence of bilateral acoustic neurofibroma (a type of brain tumor) and is rarer, seen in 1 in 45,000 births in India. People with NF2 usually develop benign tumors on the nerves responsible for hearing and balancing in their ears, causing hearing loss, eventual deafness, and problems with balance.

The disease was affecting Mr Ghatse’s, ability to walk and body balance. 3 months ago he had a fall while walking and was not able to get up. He visited Dr. Sunil Kutty at Fortis Hospital Kalyan and was detected to have multiple tumors i.e. a Dorsal cord neurofibroma causing spinal cord compression, a small Cervical neurofibroma, a small asymptomatic acoustic neurofibroma (Brain tumor), Peripheral neurofibroma (in right upper hand) and a tumour on the abdominal wall. This patient thus had five tumors and it seemed that there could be a few more tumors which were undetected or could generate later.

As per Dr. Sunil Kutty, Neurosurgeon at Fortis Hospital, Kalyan, “All the tumors seemed benign and most were not causing symptoms or affecting patients day to day activity hence there was no need to remove them, but the dorsal spinal cord tumor was gradually increasing and had become symptomatic causing him trouble in performing his regular physical activity. Hence we took a decision of removing the dorsal spinal tumour.”

The neurosurgeon talked at length with Mr Ghatse about the need for removal of the dorsal spinal tumor to relieve the compression on the spinal cord, the likelihood of tumor recurrence and the possible need for more surgeries to remove tumors in the future was also discussed with the patient. Patient agreed and was operated at Fortis Hospitals Kalyan with complete removal of the dorsal cord tumor. He was discharged 2 days after the surgery and his physical healing is in progress, he returned to work within a few days.

“The tumour became absolutely unbearable after a certain period of time. I was under tremendous pressure, pain and often used to worry the final outcome and its effect on my job. The surgery has been successful and has renewed my confidence,” said Mr Ravindra Ghatse.

About Fortis Hospitals Kalyan:-

In keeping with the international model of health systems, Fortis Hospitals Kalyan conceived the concept of hospitals situated at convenient locations across the city, bringing high level care within the reach of the neighbourhood.

The hospital is designed to deliver high standards of healthcare services supported by sophisticated technology and experienced medical professionals. The state-of-the-art, 80 bedded, multispecialty hospital has been established to create a centre of excellence with thrust upon Non-invasive Cardiology, Neurology, Neurosurgery, Orthopaedics, Minimal Access Surgery along with other specialties like Urology, Medical and Surgical Oncology, Endocrinology, Gynecology, Critical care, Emergency and Preventive Healthcare.

Fortis Hospitals Kalyan has an expert and experienced team of specialist consultants, technicians, nursing staff and administrators to deliver patient centric services round-the clock. Fortis Hospitals Kalyan is fully equipped with state-of-the-art 2 operations theaters, have dedicated endoscopy suite, 11 bedded patient centered ICU, 4 bedded emergency / casualty department, 24 hrs diagnostic facility and dedicated 24hrs emergency services.

Fortis Hospitals Kalyan has a corporate support cell to cater the growing demand of an organizational healthcare system for corporate. This cell, apart from helping the hospital empanelment for medical services, also provides information and assists corporate on various corporate health plans of Fortis, thereby enabling access to employees to quality medical care.