New Delhi: Siblings from Almora (Uttarakhand) were mounted on escalating high blood pressure, the reason being tumors in the adrenal glands of both of them. Removing them without damaging very essential glands presented a very risky proposition. But robot came in handy and Dr Ashwin Mallya very meticulously pulled off the rare surgery.

Sir Ganga Ram Hospital, Department of Urology recently received siblings from Almora, Uttarakhand. Both presented with very high blood pressure to the tune of 200/120 mm Hg and were suffering from various complications including seizures.

Both were evaluated. Brother Manan Joshi who is 8 years old was found to have a large tumor of the size of 4.5 cm in the left Adrenal Gland. Surprisingly his sister Disha 15years old was found to have two tumors, one in each adrenal gland, the larger one in right Adrenal Gland measuring 5.5 cms and another in left adrenal gland measuring 2.5 cms.

Dr. Ashwin Mallya, Urologist and Robotic Surgeon, Sir Ganga Ram Hospital who operated on both the patients said, “The initial challenge for us was to stabilize the Blood Pressure of the siblings before planning this complex surgery. We planned to remove the tumors and preserve the normal part of Adrenal Gland because Adrenal Glands are very vital organs of the body as they produce steroids and maintain blood pressure. We accomplished this by using minimally invasive surgery through Key Hole Incisions.”

According to Dr. Ajay Sharma, Chairperson, Urologist and Robotic Surgeon, Sir Ganga Ram Hospital, “The tumors of Adrenal Gland are very challenging to operate because of their location in the body. These glands are small, triangular shaped glands located on top of both kidneys. They are very close to the major blood vessels and during operation there are chances of life-threatening fluctuation in blood pressure and heart rate.”

First, Manan was taken for laparoscopic surgery, for left adrenal tumor removal. His tumor was removed and the surgery took 2 hours with 50 ml blood loss.

After that Disha was operated using Robotic Technology. Her right adrenal gland along with 5.5 cms tumor was removed completely. The tumor in the left adrenal gland measuring 2.5 cms was removed sparing as much of normal Adrenal as possible. Her surgery took 3.5 hours.

Biopsy reports of the tumors revealed pheochromocytoma (rare adrenal tumor).

Genetic studies of the siblings have revealed a rare familial tumor syndrome called VHL syndrome. This syndrome causes tumors all over the body.

Dr. Sachin Kathuria, Consultant Urologist added, “These rare and complex cases could be performed smoothly due to the team approach consisting of Urologists, Anesthetists, Pediatric Cardiology, Neurology and Endocrinology.”

Both siblings have recovered and have resumed schooling within 2 weeks of surgery.