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00:00So, he is a child, he came to us last year, when he came to us, he is 6 years old, when
00:07he came to us, in Uzbekistan, he was told that he has a brain tumour in both his kidneys
00:15and he was given a cycle of chemotherapy earlier.
00:19So, when he came to us, he is his mother, he came with the intent that because he was
00:26told that he has cancer in both his kidneys, so both his kidneys will be removed and after
00:33this, he will be transplanted and his mother will be the donor.
00:36He is his fourth child and after that, his mother also had a uterus operation.
00:41So, when he came to us, we thoroughly evaluated him.
00:46We did a PET-CT scan on him and in the PET-CT scan, it was found that the right side kidney
00:53had a good effect of chemotherapy, the tumour shrank to about 4 cm.
00:59On the left side, the tumour was involving two poles of the kidney, as you can see, upper,
01:05middle and lower.
01:06So, the tumour was involving almost the middle and the lower pole and it was around 6 cm
01:12in a small child.
01:14A big lymph node, which is the first station from where the tumour comes out, is called
01:20a lymph node.
01:21So, a big lymph node of the child, which is the main artery of the body, is called a
01:26aorta.
01:27So, it was sitting on the aorta from where the artery of the kidney comes out.
01:31So, after seeing all these PET-CT scan findings, we decided that we will operate the tumour
01:37of the right side of the child first.
01:40When such cases come worldwide, in most of the cases, nephron sparing surgery, that is,
01:46the less involved site, the kidney of that site is partially removed and the more involved
01:54site is completely removed.
01:56After this, the child is again given chemotherapy depending upon the biopsy.
02:00But when we saw him, we did laparoscopic surgery in his first stage, in which we separated
02:08the tumour of his right side from the kidney.
02:11After removing the tumour, all the lymph nodes of the right side, the IVC, which is the
02:16main vein on the right side, we removed all the lymph nodes there.
02:21We removed the big lymph node on the left side of the child and re-biopsied the kidney
02:28on the left side to see its histology.
02:31So, we did his sub-surgery last year, in August.
02:36And after this, in his biopsy, his kidney tumour came out with good margins, that is,
02:43there was no residual tumour in the kidney.
02:46All the lymph nodes on the right side were free of tumour.
02:50The lymph node on the left side, which was expected, came out as Williams tumour.
02:55And in the kidney biopsy on the left side, there was also a Williams tumour with favourable
02:59histology.
03:00After this, he was prescribed a chemotherapy course, in which we gave him the first cycle
03:07here and after that we sent him to Uzbekistan.
03:12He completed the entire cycle there.
03:15He then came back to us in November.
03:19When he came back in November, he came for management of the left side.
03:24So, we repeated his PET-CT again to evaluate how was the treatment response to chemotherapy.
03:30So, on PET-CT, we found that the right side was entirely free of tumour.
03:35On the left side, the lymph node which was removed, that area was free of tumour.
03:40And in the left kidney, the tumour of partial response had shrunk a little.
03:45So, we told him, let's try to save this kidney of the kid as well.
03:50Because there is a possibility that there is recurrence in such kids who have bilateral tumour.
03:56So, we have to shave off the tumour.
03:58Secondly, the chemotherapy that these kids usually get is also a very toxic chemotherapy
04:03because it affects the kidneys.
04:05To bear that, the kid needs a good kidney function.
04:10So, that's why we took him for the left side.
04:15So, intraoperatively, when we put the laparoscope and did the dissection,
04:19because his surgery was already done, we removed the lymph node from there,
04:22took the biopsy, the kid got two chemotherapies.
04:25So, the kidney was very stuck.
04:27So, during that time, we felt that maybe we could not save him, but we tried.
04:33So, we decided that once we will remove the kidney and see.
04:37And with the same intent, we tried to remove the laparoscopic kidney
04:42and removed it from that incision so that the kid can be transplanted from that incision.
04:46So, when we removed it, we gradually removed it and perfused the kidney,
04:51kept it in the eye sludge so that it can be reused and can be transplanted.
04:56So, in that, we were able to separate the entire tumour from the kidney.
05:02And in that, the veins of the kidney, like we felt that it is going inside a vein,
05:07we also separated it and reconstructed the vein.
05:09We also reconstructed the urinary collecting system,
05:12because if you separate the kidney, it gets cut.
05:16We repaired it.
05:17After repairing the entire kidney, we saw that probably we were saving around 50% of the kidney.
05:23Generally, the dictum is that if it is more than 30%, then the kidney becomes viable.
05:27Then we reconstructed it and with the same incision, which was done on the left side,
05:32we transplanted the kidney again.
05:35And after doing that, it started pouring urine.
05:39Now, the kid is in front of you.
05:41Both his surgeries have been done.
05:43After this, we did one more PET CT of him.
05:46So, in that PET CT, he is disease-free.
05:48There is no cancer.
05:49He is healthy.
05:51And now, he is cancer-free.