A seven-year-old girl from Bangalore experienced severe swelling in her neck, which had persisted for more than a year. Adding to the woes, there was no clear diagnosis of her condition.
Dr Sandeep Nayak, senior director of surgical oncology, robotic and laparoscopic surgery, Fortis Hospitals, Bangalore, who treated her, recalls that the girl indeed had cancer developing in the thyroid glands. The girl has now got a new lease of life, thanks to robot assisted surgical intervention which was developed by Dr Nayak in 2018.
Speaking to Happiest Health, Dr Nayak recalled that the girl’s family had travelled to many cities and visited several hospitals in the process but were struggling with the diagnosis. “Once she was brought in, she had to undergo an ultrasound-guided test and biopsy testing after which she was officially diagnosed with Papillary Carcinoma, a form of thyroid cancer,”
It was diagnosed that she had swollen lymph nodes in the neck due to the thyroid cancer. Once the diagnosis was confirmed, the doctors realized that it would be the first such case of pediatric thyroid surgery in India that they would have to perform. “We had to make a detailed treatment plan,” said Dr Nayak.
A team of doctors, led by Dr Nayak successfully treated her using the Robotic-assisted Breast-axillo Insufflation Thyroidectomy (RABIT) and Bilateral Neck Dissection procedure done in October 2023. The procedure uses robotic technology for thyroid removal through minor incisions and robotic infraclavicaular approach for Minimally Invasive Neck Dissection (RIA MIND).
Dr Nayak, who pioneered the use of new technology calls this case unique because it is one of the rare cases of a robotic thyroid surgery combined with neck dissection being performed for such a young child with thyroid cancer.
“This type of surgery, conventionally, requires a large incision-a 15 to 20 cm U-shaped wound in the front of the neck, and we must do open surgery. Children going through such a major incision during surgery will have a big scar in the front of the neck for a lifetime. Considering all that, it is a unique case,” he says.
Dr Nayak adds that in the RABIT procedure, the scar is only ‘marginally noticeable’, measuring between 0.8 – 2 centimeters-long.
“Whereas the conventional open thyroidectomy with neck dissection procedure leaves behind an unsightly U-shaped 15-centimeter-long scar in the neck region, which usually affects the patient’s confidence and causes a lot of distress,” he says.
Dr Nayak says that although the procedure itself was not much different than an adult thyroid surgery, since the child’s structures were smaller compared to that of an adult, they had to be extra careful.
“One pro when it comes to robotic surgeries is that it gives a lot of magnification unlike conventional open surgery where we must be extra careful. Here, every structure is magnified. Then we decided that we should go ahead with robotic surgery,” he says.
Pioneering the Robotic-Assisted Breast-axillo Insufflation Thyroidectomy (RABIT) technique
Speaking about his innovative work on robotic technology for thyroid removal using minor incisions, he says that the quality of surgery, recovery of persons is better and the surgery also has better outcomes, when compared to the conventional open thyroidectomy surgery.
Further explaining the technique he pioneered, Dr Nayak says “The traditional techniques which many used to follow, would leave a large wound behind the neck. Initially, I was not convinced about performing neck surgeries with such a big wound. Then I got to thinking about it. I used to do a lot of laparoscopic thyroid surgeries also back then. I just modified it and started using it for robotic surgeries- that’s how the entire technique came about.”
“Overall, I felt that the outcomes were better, compared to the open surgeries we were doing. This is how the surgical process began shifting,” Dr Nayak says, adding “Today, most of my thyroid work is robotic.”
Good prognosis for thyroid cancers in the long run
Dr Nayak says that within two days, the girl was shifted out of the pediatric Intensive Care Unit (ICU) and discharged soon from the hospital.
He adds that post the surgery, they sought the pediatric department’s help extensively.
“We’re not pediatricians or pediatric surgeons so we had to involve the relevant departments for help, for maintenance of fluids etc.”
Girl, back to school
Currently, the girl is back to living her life as usual, going to school while undergoing routine radioactive therapy, an integral part of thyroid cancer treatment.
“She is now living life as any other child of her age would,” says Dr Nayak adding “In the long run, thyroid cancers do have a good prognosis – she had a lot of swelling in the neck but in the long run, she is expected to do well.”
