Fortis Hospital Anandapur Successfully Conducts its First Parathyroidectomy Surgery Without General Anesthesia 

Fortis Hospital Anandapur Successfully Conducts its First Parathyroidectomy Surgery Without General Anesthesia 

 Cervical Plexus Block technique customized for high-risk case, patient was awake during surgery and did not require ICU stay  

 Kolkata, July 2024: Fortis Hospital Anandapur successfully conducted its first parathyroidectomy surgery (surgical removal of the parathyroid glands near the thyroid gland) using a unique technique, which is different from the traditional approach of using general anesthesia. This intervention technique, ‘Ultrasound-guided superficial and intermediate cervical plexus block’ uses a different kind of anesthesia that numbs the nerves in the neck, blocking pain in the area. The procedure was successfully conducted on a 60-year-old patient under the guidance of Dr. Dhritiman Maitra, Consultant, General Surgery, Fortis Hospital Anandapur, along with Dr. Shilpa Kanakam, Consultant, Anesthesiology, Fortis Hospital Anandapur. The patient has recovered well and was discharged within 4-5 days, post satisfactory monitoring of his calcium levels. 

 Initially, when the patient consulted Doctors at Fortis Anandapur, he had a severe cough. Post Dr. Sushmita Roy Chowdhary’s evaluation, the patient underwent a chest X-ray and CT scan which revealed two rib fractures and blood accumulation in his left lung space (hemothorax). The patient was also suffering from multiple co-morbidities including severe obesity, chronic lung disease and triple vessel heart disease (blockages in three heart vessels). The doctors, therefore, opted for cervical plexus block. Choosing general anesthesia could have resulted in further complications such as difficulty in maintaining optimum oxygen and ventilation in the body, increased risk of airway obstruction, pneumonia and cardiovascular instability. 

 Dr. Roy Chowdhury, Director, Pulmonology, Fortis Hospital Anandapur, said, “The patient presented with accumulation of blood in the space around the left lung (hemothorax). This was caused by a rib breaking/fracture spontaneously due to severe coughing. While such cases are uncommon, we have encountered a few and successfully treated them before. Given the unusual nature of the rib fracture, further tests such as ultrasound of the neck along with an imaging test to examine the function of the parathyroid glands were done. The results confirmed that the patient has primary hyperparathyroidism, a condition where too much parathyroid hormone is produced, making the bones weak. This weakness in the bones caused the rib to break, which then led to the hemothorax.” 

 Talking about the procedure, Dr. Dhritiman Maitra, Consultant, General Surgery, Fortis Hospital Anandapur explained, "This case presented a unique set of challenges due to the patient’s complex medical history. Traditional surgical approaches were considered high-risk as he had various health issues. We chose a superficial and intermediate cervical plexus block along with sedation and the left inferior parathyroid gland was removed. Immediately after the surgery, monitoring of intraoperative parathyroid hormone was conducted on the operating table, and the results showed that the parathormone levels had come down to normal. His calcium level had also come down which confirmed that it was indeed the parathyroid gland that was causing trouble. This procedure not only prevented the risks associated with general anesthesia, but also allowed for a smoother postoperative recovery given the patient’s pre-existing heart condition. The patient was discharged after 4-5 days; he could have been discharged on the day of the surgery, but his calcium levels needed to be monitored.” 

 Explaining this unique approach, Dr. Shilpa Kanakam, Consultant, Anesthesiology, Fortis Hospital Anandapur said, "This is the first time we have performed this surgery under a cervical plexus block. We tailored this approach specifically for this patient due to his compromised heart and lung condition, avoiding general anesthesia. While the removal of a parathyroid adenoma is a common procedure, his high-risk condition made this case unique. It is also rare to conduct this surgery without general anesthesia. Throughout the surgery, he was awake and communicating with us. Remarkably, he could walk, eat, and drink immediately post-operation, and did not require an ICU stay. This was in stark contrast to the typical fasting and ICU requirements following general anesthesia."