THE lives of three Guyanese were recently saved, thanks to groundbreaking surgeries, including Guyana’s first-ever locally performed laparoscopic adrenalectomy.
The three surgeries were performed on Thursday at the Georgetown Public Hospital (GPHC) by a team of remarkable surgeons. Each of the surgeries lasted for approximately three hours.
The laparoscopic adrenalectomy was performed on a 54-year-old female, who was diagnosed with a pheochromocytoma after suffering with uncontrolled high blood pressure, while a “gallbladder cancer cholecystectomy, and hepatectomy” was performed on a 50-year-old female with a history of ovarian cancer. A ”ruptured Abdominal Aortic Aneurysm (AAA) and emergency graft repair” was performed on a 36-year-old male patient.
Though adrenalectomy, which involves the removal of the adrenal gland, would have been done in Guyana before, Thursday’s surgery marked the first time one was performed laparoscopically.
The laparoscopic adrenalectomy was performed by a team of surgeons led by General and Advanced Laparoscopic Surgeon, Dr. Heimraj Ramcharran, who hailed the occasion a momentous one.
“It’s pretty exciting for me as a surgeon that we can now do more of these, and bring up our patient care to that of the developed world. I’m grateful that we were able to complete it, and that we had the equipment provided by the hospital CEO, Robbie Rambarran and Dr Navin Rambaran, Head of Department of Surgery,” Dr. Ramcharran commented.
Dr. Ramcharran would have been trained in laparoscopic surgery during a fellowship in Canada, and now looks forward to training other Guyanese doctors in this area.
As opposed to “open surgery”, where a surgeon makes incisions 6 – 12 inches long in order to access organs, laparoscopic surgery is a minimally invasive surgery, whereby notably smaller cuts are made, and the doctor conducts the surgery via inserted cameras.
Thursday’s adrenalectomy would also mark the first time laparoscopic surgery of such an extensive nature was performed here in Guyana.
“It was a success, and represents now that we can do major surgeries laparoscopically. We don’t have to do open surgeries as before, and this is how it is happening in the developed world, widespread. Majority of patients do laparoscopic surgeries, and don’t do open surgeries as much,” Dr. Ramcharran said.
He added: “We did four small holes in the abdomen; we put in some cameras and equipment, and we did the entire surgery through the four small holes. This allows the patient to be up and about in about six hours after the surgery. In our case, our patient was walking the next morning with minimal pain, eating and tolerating a regular diet.”
Dr. Ramcharran shared that he is grateful for the backing of his team during surgery, which included a number of surgeons, anaesthetists and an endocrinologist.
On the surgical team, Dr. Ramcharran was assisted by Dr. Tamesh Algu, Dr. Leon Placeras, Dr. Delon Ramnarine, Dr. Drohinauth Singh, and Dr. Kevon Tracy, while on the anaesthesiology team were Dr. Arturo Marrero, Dr. Yvette Martin, Dr. Rhina Acousta and Dr. Fernando.
Dr. Ramcharran particularly praised the work of Dr. Yaquelin Gonzalez-Ricardo, who played a vital role in stabilising the patient’s blood pressure to a level necessary for surgery. The patient’s blood pressure was excessively high, due to the tumor in her adrenal gland.
Dr. Ramcharran was also on the team for the cholecystectomy, which involved the removal of the gall bladder, and the hepatectomy, which involved the removal of part of the liver. This surgery was led by Dr. Duan Yunfei, who is part of a medical team here in Guyana from China.
Dr. Ramcharran explained that without Dr. Yunfei’s role in the hepatectomy, the patient would not have had that much longer to live.
“Dr Yunfei is a hepatic (liver) surgeon who came to Guyana just a month ago, and it’s a good thing that he was there. If he wasn’t here, we wouldn’t have been able to resect the liver, and then the patient would’ve lived for about six months more; that’s how aggressive this cancer was. But with the hepatectomy, now the patient can live a longer space of time,” Dr. Ramcharran said.
“That surgery was a bit challenging, because of the blood loss that can occur, but Dr. Yunfei was very skillful, and able to go through the surgery with minimal blood loss,” he added.
Meanwhile, the ruptured AAA and emergency graft repair was performed by Dr. Kishore Persaud and Dr. Carlos Martin.
Speaking with the Guyana Chronicle, Dr. Persaud explained that while AAA surgeries would’ve been performed in Guyana in the past, this would have been the first time that one would have ruptured. He added that this is the first case he can recall of a patient surviving after a ruptured AAA.
It was while the patient was being transported to surgery on Thursday afternoon that the aneurysm ruptured, and he went into hypovolemic shock. An aneurysm is a ballooning at a weak spot in an artery wall.
“We would’ve done aortic aneurysms before in the past, but this is the first case we would’ve done of a ruptured aortic aneurysm at GPHC, and the first case to survive off the operating table. The patient is in a stable condition, awake and sitting up in bed,” Dr. Persaud noted.
He explained that the surgery was particularly possible, due to the availability of the grafting materials, more of which is needed.
“It’s the graft that allowed us to perform such a lifesaving surgery. We have the resources, in terms of the technical capabilities and human resources, but we are lacking the grafts to do other such surgeries. If we do not have more vascular grafts available, we would not be able perform more such surgeries,” he explained.