Bengaluru sees first ‘Taj Mahal’ surgery

Bengaluru: IT city’s medical history has probably got another unheard word and surgery added to its list, ‘Taj Mahal resection’! Taj Mahal recreated, but, this time in the medical world and also not in the form as one would imagine. This rare operation which has been performed mostly by Japanese liver surgeons who happened to coin the term ‘Taj Mahal resection’ for this procedure has been performed by city doctors in a bid to save a 72-year-old man suffering from cancer of the bile duct (Klatskin tumour).

“It is a term given for a surgery done for liver cancer, a very difficult treatment option requiring high expertise from the surgeon. It is one form of liver resection or removal of a part of liver or the central part of the liver which is in the shape of a dome,” explains Dr Nagaraj Palankar, Consultant Surgical Gastroenterologist, Manipal Hospital who says that he himself has performed the surgery for the first time since his practice began.

Seventy-two-year-old Ramesh, a retired school teacher found that his urine was dark yellow in colour and his eyes were also yellow. He consulted a physician in his hometown who determined that the medical condition was jaundice. He underwent blood tests and ultra sonography which revealed the cause of jaundice to be due to cancer of the bile duct (Klatskin tumour). He was counselled regarding the serious nature of the disease and was advised to consult a gastrointestinal surgeon at a tertiary referral center for further treatment.

He underwent an MRI scan which showed that he was suffering from Type III hilar holangiocarcinoma. Traditionally, these tumours are difficult to treat and require draining the bile duct by placing a tube called portal vein embolisation (radiological procedure to enlarge the size of the liver so that a larger portion of the liver can be removed during operation) followed by the removal of a large portion of the liver.

Ramesh underwent an alternative surgical procedure, ‘Taj Mahal resection’ which involved removal of a dome shaped portion of the liver in the central part of the liver along with the bile duct. “The operation lasted 12 hours and was associated with minimal blood loss. He was kept in the ICU for overnight monitoring and was discharged from the hospital on the 6th post operative day,” says Dr Nagaraj who adds that despite a lengthy procedure performed probably for the first time in the city it is better than other surgeries in which 60%-70% liver can be removed from 6 to 7 hours.

This procedure involves removing a smaller portion of the liver (20-25%) and it can be safely done without any pre operative procedures like Percutaneous transhepatic biliary drainage (PTBD) and portal vein embolisation. This is considered to be technically the most challenging operation in liver surgery with very few such operations being performed world-wide.