By Lindsey Turnbull
A team of doctors at CTMH The Doctors Hospital recently removed a giant tumour from the uterus of a patient, one of the largest tumour the doctors had ever removed, weighing in at 21lbs 2oz. This was very likely the largest tumour ever seen by surgeons in the Cayman Islands and one of the largest ever seen in the world with a successful outcome. The team of medical professionals who successfully removed the tumour was led by Senior Specialist/Consultant Obstetrician and Gynecologist Dr Sarath De Alwis, who was assisted by surgeons Dr Steve Tomlinson and Dr Chris Bromley.
“The patient presented with an abdominal mass extending to the chest, with a lot of pain and discomfort, particularly in the back, having undergone surgery previously in London,” Dr De Alwis advised. “She needed the mass to come out.”
The surgery, which took three hours, presented challenges, given the size of the mass, so Dr De Alwis enlisted the assistance of Dr Tomlinson and Dr Bromley, along with a team of experienced nurses who were well-versed in working together as a surgical team. The approach was to ensure every measure was taken to keep the patient safe, the doctor advised.
“We anticipated that it would be a difficult surgery and that it would bleed a lot,” Dr De Alwis said. “The anesthetist, Dr Stephen Gay, put in an arterial line rather than a venous line to help control the bleeding as many patients have died under similar circumstances. The mass was under the diaphragm and pressing the liver and kidneys and it had gone into the pelvis so that the pelvic structures could not be seen from below. The abdominal wall was so enlarged vertically as well as transversally so it looked like triplets.”
The size of the mass was the largest difficulty, because it had attached itself to various parts of the patient’s internal organs, including the bowel, rectum, bladder and pelvic wall, hence increasing the risk of bleeding. She was bleeding profusely from all sides of the tumour, especially from behind the mass, the doctor advised.
“We had to stick to basic principles of surgery, we couldn’t do any fancy stuff,” Dr De Alwis advised. “So, the basic principles are: a) you have to stop the bleeding and b) approach it in such a way that she won’t bleed. Those are the two cardinal things,” he said.
The doctors then had to move quickly to remove the mass, trying to remove it in one piece so it could be examined histologically as a whole, to look for malignancies. The doctors kept the tumour in a bucket before it was flown to the US to be examined. They managed to save one ovary and the patient went home two days later in good health. It was considered one of the biggest tumour in the world, most likely the ever in the Cayman Islands, Dr De Alwis said.
Assisting surgeon Dr Bromley said that he had looked at the size of the patient’s stomach with some concern before they began to operate.
“I could see it was going to be a substantial operation,” he confirmed.
Dr Bromley said that the operation began smoothly and continued so with Dr De Alwis performing the surgery “extremely expertly”, however when they uncovered the tumour he said he was “truly over-awed” at its size.
“It went way beyond my experience, probably the largest I had ever seen,” he said.
“It was the largest uterine fibroid that I had ever seen,” assisting surgeon Dr Tomlinson confirmed. “The surgery went like clockwork and did not take that long considering the amount of work that had to be done, especially when you consider that a normal hysterectomy takes about an hour. We had a great team – it’s really nice when a team is used to working together and can anticipate whatever the surgeon needs. Everything went very well.”
Dr De Alwis confirmed this: “You need a very experienced team who are on the ball because we needed 27 needles and sutures, which need to be constantly given to the surgeons. It’s a synchronised exercise where everybody knows what they are doing. It was a great experience for the team.”
The good team that participated consisted of CTMH staff: Beverly Edwards, Ms. Loraine Kate Tenorio, Sinto Jose and Andrea Radacher. The anesthetic assistant was Gino Brown. Much credit must also go to the office staff: Marianna Turner, Myria Balicao and Shanika Jayamanna.
Dr Tomlinson said the patient had told him she had lost 32 lbs overall and was doing well now.
The patient has already been to see Dr De Alwis for a check-up and he also confirmed she was doing well and had a very positive and cheerful outlook on her situation.