A Critical Diagnosis at Birth
A 45-day-old baby boy from Nashik, born with severe respiratory and cardiac issues, was also diagnosed with pelviureteric junction obstruction. This condition, which blocks urine flow from the kidney to the ureter, put him at high risk of kidney failure if left untreated.
Urgent Need for Surgery
Doctors at Saifee Hospital in Mumbai determined that immediate surgery was necessary. While most doctors prefer to operate at three to four months of age, Dr. Hussain Kotawal and his team decided to proceed earlier to prevent irreversible damage. “If you don’t operate on time, the kidney will fail,” Dr. Kotawal told Mumbai Mirror.
A Delayed Diagnosis
The baby, the first child of a Nashik couple, was born in Aurangabad along with his twin sister. Due to his critical condition, doctors hospitalized him for 15 days after birth. His parents, unaware of the severity, only realized the urgency after doctors explained the risks.
Doctors can often detect pelviureteric junction obstruction during pregnancy through anomaly scans at five months. However, they did not conduct such an investigation in this case, leading to a delayed diagnosis. Without timely treatment, the blockage could have resulted in complete kidney failure.
Overcoming Surgical Challenges
Performing surgery on such a small baby presented significant challenges. The baby, weighing only 2.94 kg, had limited abdominal space for surgical instruments. Even laparoscopic surgery, a minimally invasive approach, required sufficient space to operate effectively.
Surgeons used carbon dioxide (CO2) at extremely low pressure to create a small working area inside the abdomen. With a 3-4 mm space to maneuver, robotic surgery provided the precision, depth, and ease needed to perform the procedure successfully.
A Successful Procedure and Recovery
As reported by timesofindia, the three-hour surgery corrected the malrotated kidney, which was abnormally positioned near the spine, and cleared the urine blockage. To aid recovery, doctors inserted a stent to drain urine from the affected area and keep the surgical site dry for proper healing. Doctors will remove the stent within six weeks.
Remarkably, doctors discharged the baby just 36 hours after the surgery, marking a milestone in neonatal robotic surgery and offering hope for similar cases in the future.