Surgeons Perform First-In-SA Robotic Adrenalectomy Surgery
Posted on 18 December 2018
Earlier this year, Dr Frikkie Rademan and Dr Reniel de Beer performed the first adrenalectomy using the da Vinci Robotic Surgical System at Mediclinic Durbanville.
“It felt like a cold,” says Jade Picoto, from Durbanville, Cape Town. “I had some congestion, a blocked nose. I thought I should get some medication for the symptoms, so I went to see my doctor.”
The reality was far more serious. Just 24 hours later, Jade felt weak and breathless, coughing up fluid from her lungs. She was rushed to the Emergency Centre at Mediclinic Durbanville, where she was diagnosed with severe heart failure.
Another symptom: Jade had bloating in her stomach. She had an ultrasound done on her abdominal region, to determine the cause of the bloating, and this is how doctors picked up the true cause of her symptoms.
“They found I had a tumour, or a big mass, in my adrenal gland.”
This kind of tumour is known as a pheochromocytoma, says Dr Reniel de Beer, a specialist surgeon at Mediclinic Louis Leipoldt. “It is very rare – a surgeon might only see a case like this every second or third year.”
A pheochromocytoma typically results in the adrenal glands releasing higher-than-usual epinephrine and norepinephrine – the hormones that control heart rate, metabolism and blood pressure. This can lead to life-threatening hypertension if left undiagnosed or untreated. In Jade’s case, Dr De Beer says the tumour affected the health of her heart. “She developed cardiomyopathy, because of the high levels of adrenaline that her body was subjected to.”
Surgical removal of the tumour is generally effective at curing the underlying condition and its symptoms. But the surgery is anything straightforward, says Dr De Beer. “We first had to treat her heart disorder before we could operate,” he says. “We needed her heart condition to be stabilised before she went under.”
Why? Dr Frikkie Rademan, a general surgeon at Mediclinic Durbanville, who assisted Dr De Beer in performing this surgery, says the tumour causes high blood pressure, which can be dangerous and even lethal during surgery.
This added an extra layer of complexity to the procedure. “With pheochromocytomas, we have to try to avoid touching the tumour as much as possible,” says Dr Rademan. “Every time we touch it, even lightly, it secretes adrenaline, and this causes the blood pressure to go through the roof.”
This is where the da Vinci Robotic Surgical System comes in.
The robotic surgical system helps surgeons perform extremely complex procedures with incredible precision. Both Dr Rademan and Dr De Beer have undergone rigorous training overseas to become certified to use the system.
Doctors at Mediclinic Durbanville have been using the da Vinci robot to perform prostate cancer surgery since 2013, and other surgeons have since become trained in using the system to perform a range of other complex procedures.
The innovative surgical system offers doctors much-improved precision, increased range of motion, greater visualisation and improved access within a confined space. Patients also benefit, by experiencing less pain, a lower risk of postoperative complications, a shorter stay in hospital and much quicker return to daily life.
In this groundbreaking adrenal gland surgery, doctors needed to remove a tumour without touching it – much like unwrapping a chocolate without crushing or puncturing it. Dr Rademan and Dr De Beer successfully removed the tumour from Jade’s adrenal gland, using the robot to minimise manipulating the mass itself while doing so.
When Jade was admitted to the Emergency Centre at Mediclinic Durbanville, she was told she had 7% heart function. Just a few weeks after surgery, however, she feels no ill-effects. “I feel fit, healthy and ready to take on life again.”