A 36-year-old Bihar woman underwent life-saving surgery at the Minimal Access Smart Surgery Hospital (MASSH) in Chirag Enclave, marking a noteworthy medical accomplishment. The patient was diagnosed with a rare and complicated combination of conditions after initially seeking treatment for the removal of a gallbladder stone. The patient had portal cavernoma (PC), a disorder in which the blood vessels surrounding the gallbladder enlarge, in addition to gallbladder stones. This uncommon combination made the surgery especially difficult, necessitating quick action and cutting-edge equipment. Utilizing 3D Rubina 4K Laparoscopic technology, the procedure took 49 minutes to complete, which is a fraction of the time usually needed for cases this complex.
The patient had come to MASSH with a large, 18mm stone lodged in the neck of her gallbladder, a location that posed a high risk of rupture. In such cases, if the stone is not removed in time, the gallbladder can burst, spilling bile and causing sepsis—an infection that can lead to severe complications, including kidney failure and coma. This situation made surgery an urgent necessity.
However, the patient’s condition was complicated by Portal Cavernoma, which was discovered through ultrasound. This rare disorder causes engorgement of veins around the gallbladder, significantly increasing the risk of life-threatening bleeding during surgery. Unlike typical gallbladder surgeries, where only one vein is involved, in this case, 8 to 10 veins were pushing blood to the gallbladder, creating a complex surgical challenge.
Dr. Sachin Ambekar, Director of the Minimal Access Surgery Department at MASSH Hospital, explained, “This was an urgent situation where the gallbladder could not be left untreated, as it would burst. The combination of gallstones and Portal Cavernoma, especially without the ability to perform preliminary interventions like a shunt or embolization, made it a rare and dangerous case,” said Dr. Ambekar.
With the patient showing no signs of chronic liver disease or other typical causes of Portal Cavernoma, Dr. Ambekar identified this condition as a genetic malformation. This distinction made the surgery even more critical as it had to be completed within 24 hours to avoid further complications.
In most reported cases of Portal Cavernoma, surgeons would first perform a shunt or embolization to reduce blood flow in the engorged veins, making surgery safer. However, in this case, the gallbladder condition was so severe that it had to be addressed immediately. The surgery had to be carried out without the usual preoperative measures for the Portal Cavernoma, making it an unprecedented challenge.
The 3D laparoscopic technology used at MASSH was crucial to the success of the surgery. Conventional two-dimensional laparoscopic techniques were not an option due to the complexity of the anatomy and the risk of bleeding. Dr. Ambekar’s team used the 3D system, which provided enhanced precision, reducing the risk of complications and significantly shortening the surgery time. “Typically, such surgeries take between 170 and 250 minutes. However, we completed it in just 49 minutes, thanks to the advanced 3D laparoscopic technology,” Dr. Ambekar noted.
The patient, who had not been previously aware of her Portal Cavernoma, was informed about the potential risks of bleeding and the need for blood transfusions during the procedure. Despite these concerns, the surgery was completed without any complications. The patient was discharged the very next day, showcasing the effectiveness of the minimally invasive procedure.
Hanish Bansal, Executive Director of MASSH Hospitals, praised the team’s performance and reaffirmed the hospital’s commitment to utilizing cutting-edge technology for complex medical conditions. “MASSH continues to set new standards in the medical field by using the latest technology and expert care for rare and difficult cases. This surgery is a perfect example of how advanced technology, combined with expert skill, can produce remarkable results,” said Mr. Bansal.
