Sir Ganga Ram Hospital on May 22 said it had carried out the country's first successful robotic surgery on a child to remove a tumour of from an adrenal gland that was causing very high blood pressure and other medical problems.

"To the best of our knowledge, it is the first such reported case of robotic pheochromocytoma (large tumour) excision in pediatric age group in India," said the hospital in a statement after the 14-year-old-child was doing well after three-week's of follow up. The child, who had reported of sweating, palpitations, breathlessness and high blood pressure, was found to have a large eight centimetre tumour in left adrenal gland, along with high hormone levels, suggestive of pheochromocytoma.

The adrenal gland is a deep-seated gland in the abdominal cavity above kidney, adjacent to biggest blood vessels and important organs of the body. It is usually removed by open surgery, which entails a big cut and long recovery. "The location and size of tumour, its proximity to vital organs like pancreas and major blood vessels, coupled with small abdominal cavity in a child made it very challenging and robotic platform was chosen to overcome these problems," said Robotic Surgeon Vivek Bindal.

The child underwent the robotic surgery for two hours that removed tennis ball sized tumour stuck to kidney, pancreas, spleen and large intestine. Keyhole robotic surgery was performed and structures were dissected one by one as the tumour was very vascular with multiple blood vessels. Another challenge was to maintain blood pressure before, during and after surgery.

"This rare tumour required meticulous preoperative preparation," said Jayashree Sood, Chairperson, Department of Anesthesia. Even minimal manipulation of adrenal tumour during surgery can shoot the blood pressure to alarming levels, while it falls precipitiously immediately after removal of tumour, she said. The tumour was removed in totality (otherwise it could have turned out to be cancerous) without any significant blood loss. The child was kept in hospital for four days and thereafter was discharged without any blood pressure medication. Satish Aggarwal from Department of Pediatric Surgery said: "This was a very challenging case to manage because of wide variations in blood pressure, precarious location of tumour and low reserve in children."