Indias first 3 D Laparoscopic Appendix substitution of ureter Performed at VPS Lakeshore Hospital, Cochin
Forty two year old male patient who had been suffering from right lower abdominal pain was undergoing treatment at various hospitals for 3months with no relief. He was then admitted to the urology department at VPS Lakeshore hospital. An MRI scan revealed a 34cm sized tumour in the right ureter (the tube which connects the kidney to the urinary bladder), which was also causing an obstruction in the right kidney. The patient had two options of either removing the whole right kidney along with the tube till the bladder or saving the Right kidney by cutting around 4 cm of the ureter which held the tumour which also meant that there would be a huge gap in right ureter after the removal of the tumour.
With the help of 3 D laparoscopy, the tumour 4cm was identified in the mid ureter and about 5 cm of the right tube (ureter) was excised in the middle along with the tumour. The upper and lower part of the ureter could not be joined together due the large gap. A new tube reconstruction using the bladder tissue was not possible as all the abdominal contents were stuck together. The doctors decided to bridge the gap using the Appendix, which is a thin tubular structure which sits at the junction of the large intestine and small intestine. The appendix is almost the same size as of the ureter. The appendix was separated from the intestine along with its blood supply and connected to the ureter laparoscopically bridging the gap and establishing continuous urine flow from the right kidney. The patient recovered well following the procedure and was discharged on the 4 th day.
This rare surgery has been accomplished by the team including Chief urology surgeon Dr. George P Abraham ,Dr. Datson George P. ,Dr Vijay and anesthesia chief Dr mohan Mathew. This is the first time in India that the appendix has been connected laparoscopically to the ureter. Only 4 laparoscopic cases have been reported worldwide. The Appendix, which usually serves no function to the human body, can be used for such substitutions thus salvaging the kidney.