* Windpipe Almost Completely Blocked Due to Thyroid Cancer; Securing the Airway and Maintaining Oxygen Supply During Surgery Was a Major Challenge
* A Multidisciplinary Team of Cardiac Surgery, Anaesthesia and Surgical Oncology Specialists Made the Complex Procedure Possible with the Support of a Heart-Lung Machine
TIL Desk Lucknow:ЁЯСЙA rare and highly complex thyroid cancer surgery was successfully performed at ApolloMedics Super Speciality Hospital, Lucknow, through the coordinated efforts of multiple medical specialties and advanced medical facilities. A 70-year-old male patient had a cancerous mass in his neck that was severely compressing his windpipe, making it extremely difficult to safely administer anaesthesia and perform the surgery through conventional methods. In view of the critical airway situation, the cardiac surgery, anaesthesia and surgical oncology teams worked together and used cardiopulmonary bypass (CPB), commonly known as a heart-lung machine, to maintain the patient’s blood circulation and oxygen supply while securing the airway, following which the thyroid cancer surgery was successfully completed.
The complex procedure involved Dr. Tarun Batra, Director, Surgical Oncology; Dr. Bharat Dubey, Director, Cardiac Surgery; Dr. Manish, Director, Anaesthesia; Dr. Shishir Agrawal, Associate Director; and Dr. Hiteshi Agrawal, Cardiac Anaesthesia Specialist, along with the supporting medical team.
The patient had a large mass extending across the front and both sides of the neck, putting severe pressure on the windpipe. Due to the extent of the obstruction, conventional intubation was not possible. Attempts to secure the airway using bronchoscopy and other available techniques were also unsuccessful. The medical team subsequently postponed the surgery and discussed the situation with the patient’s family before developing an alternative strategy. Since the cancer had not spread to other parts of the body and was confined to the neck region, surgery was considered an essential treatment option.
The patient was placed on peripheral cardiopulmonary bypass through the femoral artery and femoral vein. Spinal anaesthesia was used to numb the lower part of the body, while the heart-lung machine maintained blood circulation and oxygen supply. When it was still not possible to secure the airway through conventional methods, the surgical oncology team performed a subglottic tracheostomy under bypass support. This procedure created an alternative airway below the tumour, through which a tube was inserted.
Once the airway was secured, the patient was gradually weaned off the heart-lung machine and normal blood circulation was restored. The thyroid surgery was then completed. The surgery lasted approximately four and a half to five hours, with no significant excessive blood loss during the procedure. Following surgery, the patient was shifted to the ICU for monitoring and was recovering well.
In this case, a thyroidectomy was performed with cardiopulmonary bypass support, a procedure referred to as thyroidectomy with CPB support. According to the doctors, such cases are extremely uncommon, and successful management requires close coordination among multiple medical specialties.
Dr. Tarun Batra, Director, Surgical Oncology, ApolloMedics Super Speciality Hospital, Lucknow, said, “In this case, a conventional tracheostomy was not possible because of the tumour. Therefore, we had to create an alternative airway below the tumour. Close coordination with the cardiac surgery and anaesthesia teams played a critical role in completing the procedure safely. In such cases, timely decision-making and coordinated teamwork among all specialists are extremely important.”
Dr. Bharat Dubey, Director, Cardiac Surgery, ApolloMedics Super Speciality Hospital, Lucknow, said, “The biggest challenge in this patient’s case was securing the airway. Due to the pressure exerted by the tumour, conventional intubation was not possible. In such a situation, maintaining the patient’s blood circulation and oxygen supply with the support of cardiopulmonary bypass was essential. With the collective efforts of all the teams, we were able to secure the airway and proceed with the surgery.”
Dr. Mayank Somani, MD & CEO, ApolloMedics Super Speciality Hospital, Lucknow, said, “Coordination among different medical specialties played a crucial role in this case. The cardiac surgery, anaesthesia and surgical oncology teams worked together to develop a safe treatment plan for the patient. The availability of multiple specialties and the necessary medical facilities under one roof at ApolloMedics helped us manage and complete this complex procedure within the same hospital.”
At ApolloMedics Super Speciality Hospital, Lucknow, expertise from multiple medical departments and the necessary advanced medical resources are available under one roof to facilitate the management of complex and high-risk cases through coordinated multidisciplinary care.
