10 a.m Monday, July 24. A busy day like any day for the Anuradhapura Teaching Hospital. A few of the staffers at the Hospital carrying out their routine work, were aware that at precisely this time, a team of six doctors, were poised to make medical history, not just at this provincial hospital, but in the entire country .
For the next ten hours, until 8 p.m when they were finally able to down their gloves and surgical tools, the six doctors, including, four Consultant doctors and two medical officers, as well as a dedicated team of support staff, would work heedless of their own personal needs, with one mission in mind: To give a young leg amputee back his life and hope for the future, with a gift of a brand new leg.
“A 52 year old man who lay brain dead due to an intra cerebral haemorrhage presented himself as the likely donor for the 32 year old male who had lost his leg when it was amputated just above the knee, a year ago, after an accident”, Anuradhapura Teaching Hospital’s Vascular and Transplant Surgeon, Dr Joel Arudchelvam, who headed the team of surgeons and supporting staff , told the Sunday Observer, in an exclusive telephone interview Thursday from the Anuradhapura Teaching Hospital. The patient expressed his desire for a new leg around three months ago, and since then, we have been looking for the ideal candidate . When the brain dead 52 year old’s relatives gave their consent, we decided to perform the operation without delay”. “The patient is now recovering at the ICU at the hospital, and we are hopeful the nerves attached to the bones will soon begin to function”, he said.
Describing it as a, “rare operation and very challenging, as we were virtually walking into unchartered territory”, he said, “only five (including the latest one in Sri Lanka) such operations have been performed worldwide. The first, in 2005, was in Canada on conjoined twins, and in 2011 in Spain which was very similar to this operation , and again two more in Turkey in 2012 “.
Procedure
Avoiding discussing too many ‘technical details ‘ he said, standard procedure had been followed when attaching the leg. “ It is the same procedure followed in any transplant operation, such as, a kidney transplant . We have to first match the blood group and external and internal specifications, such as, the colour, length, size, etc. For example, we have to consider whether the colour of the leg we are using matches the colour of the other leg the amputee already possesses.”
Once everything is matched what is the role of the surgeons?
“ We first attach the bone by plating, where we put plates and screws to keep the bones together. This again is standard procedure and has no adverse effects on the internal organs”, he assured. Next, the blood vessels are joined. Then, the nerves and the muscles are joined and the skin is finally closed up with metal clips and sutures.”
Critical
Then comes the most critical moment in the operation. “ We have to immediately watch whether the blood vessels are functioning well and thankfully, they are functioning well in the patient right now.”
So, how will the patient know when the nerves are functioning?
“Nerve function first starts from the upper part of the limb and then gradually spreads to the lower part. But, it won’t happen overnight. It will take time”, Dr Joel said.
Gaps
I asked him if there were any gaps or shortcomings by way of equipment, doctors, theatres, etc.
“We have everything we need except staff. As in most provincial hospitals we too lack in our cadre, doctors, anaesthetists, medical officers and nurses, the reason being that most doctors live in Colombo, as I do, or in the suburbs and have to commute to the hospital for any such surgery.”
Was he and his staff happy about the outcome of their history making surgery, that helped put our tiny island on the world’s medical map?
“ Most certainly. All our efforts in our long gruelling surgery were amply rewarded when we saw that the recipient’s vessels were already showing signs of good function”.
Urging the public to respond to calls for voluntary donations of organs to be used in similar transplant operations, hospital sources said, the 52 year old’s kidneys too had been donated to the Kandy General Hospital, to be used to give another patient a new lease of life..
The operating team headed by Dr Joel Arudchelvam comprised plastic surgeon Dr Amila Ratnayaka, Orthopaedic surgeon, Dr Nuwan Wijesinghe , Anaesthetist, Dr Levan Kariyawasam, a nursing team and support staff of the Anuradhapura Teaching Hospital.