Chennai : In a groundbreaking achievement, doctors at Dr. Mehta’s Hospitals have pioneered a technically challenging thoracoscopic surgery, successfully removing a 600-gram lesion from the thoracic cavity of a 5-year-old girl. This unprecedented medical feat, conducted in November 2023 at the Chetpet campus, marks the first instance in India where a sophosticated thoracoscopic technique on a child of this age. It is also crucial to note that this case remains elusive only four other cases found in the world according to medical literature.
The patient, a 5-year-old girl from Rajasthan, was diagnosed with Giant Thymolipoma—a rare and formidable condition involving the formation of a huge lesions within the chest cavity. The condition came to light incidentally during her admission for dengue fever at a private hospital, where she had reported a year-long history of fatigue, especially after mild to moderate physical activity.
Upon arriving at Dr. Mehta’s Hospital, the expert team led by Dr. Sekar S (Senior Paediatrician) and Dr. Raghul M (Advanced Paediatric Laparoscopic and Thoracoscopic Surgeon) meticulously examined the patient. Despite the absence of typical symptoms like fever, loose stools, and urinary disturbances, respiratory examination indicated reduced air entry on the left side A chest X-ray revealed complete opacity with minimal sparing of the left apex, prompting a comprehensive investigation via CT scan that exposed a well-defined lesion with soft tissue density and streaks of fat in the anterior mediastinum, measuring 7.5x16x11 cm (APxTRxCC).. The scan unveiled a bilateral mediastinal heterogeneous mass, sparking suspicions of Giant Thymolipoma or liposarcoma. The surgical repair was planned through a minimally invasive video-assisted thoracoscopic surgery (VATS).
During the procedure, Dr. Raghul M operated through 5 mm ports at the 3rd and 5th intercostal spaces over the anterior axillary line, with able single luminal ventilation by Dr. Karthikeyan ( Paediatric Anesthetist ) ,a massive Thymolipoma was discovered, occupying the entire left hemithorax. Through the left thoracoscopic window, the mass lesion was identified and delineated. The mass on the right side was also approached through the left window, cauterizing and dividing the major blood vessels supplying the lesion, successfully removing the entire 600-gram mass, leaving no residues.
According to Dr. Sekar S from Dr. Mehta’s Hospital, “The diagnosis of thymolipoma needs a high index of suspicion, the primary treatment for which needs surgical excision, with video-assisted thoracoscopic surgery (VATS), the latter being the most advanced method of choice. This is the first reported case in India where a Giant thymolipoma in which both sides of the lesions were operated and removed from a single side through the technically demanding VATS approach”. This unprecedented success not only underscores the complexity and risk associated with such procedures but also opens new avenues for employing thoracoscopic techniques in the management of similar conditions, offering hope to patients and families facing challenging medical diagnoses.
Postoperative X-rays revealed no mediastinal mass, confirming the thoracic procedure’s success in treating the giant thymolipoma. The child, showing remarkable progress and recovery in post operative care, was discharged four days post-operation. This groundbreaking achievement at Dr. Mehta’s Hospitals not only emphasizes the highly risky and complex nature of the procedure but also highlights its unparalleled success, showcasing the hospital’s commitment to pushing the boundaries of pediatric surgical excellence.
