The operation was particularly challenging because liver surgery in infants requires advanced technology to prevent excessive bleeding, which can lead to death during the procedure.
Liver surgery is inherently complex due to the medications involved and the significant risk of blood loss, especially critical in a six-kilogram infant with a limited blood supply.
The child was initially taken to a private hospital where doctors discovered an abdominal mass. The mother was advised to transfer the child to CHUK, which had better equipment and more specialised doctors. At the time, the baby was only two months old.
Upon admission to CHUK and after a thorough examination, the child was diagnosed with liver cancer. The tumour had completely infiltrated the liver.
Since such tumours can sometimes respond to medication, the child was put on treatment, which helped shrink the tumour, leaving it confined to the right lobe of the liver.
After extensive analysis of medical images, the team of doctors determined that although most of the liver was affected, approximately 30% of healthy liver tissue remained.
Dr. Alain Jules Ndibanje, a paediatric surgery specialist at CHUK and the lead surgeon in the operation, told IGIHE that this 30% was sufficient for the liver to continue performing its vital functions.
The liver plays a crucial role in detoxifying blood, storing and releasing glucose, aiding digestion, and more.
'After detailed analysis, we decided to operate and remove the part severely affected by cancer. The surgery was successful, and we left 30% of the liver that was still healthy," Dr. Ndibanje said.
The complex procedure involved a team of around 20 medical professionals, including paediatric surgeons, paediatric oncologists, imaging experts, anaesthesiologists (who faced the delicate process of administering anaesthesia to a baby with compromised liver function), and a collaborative team from the University of Michigan working with Rwandan doctors.
To prevent excessive blood loss, advanced surgical technology was employed. The surgeons carefully tracked every blood vessel connected to the liver, mapping them out before and during surgery.
'We used specialised tools to isolate each blood vessel to avoid bleeding. We progressed very slowly. The operation lasted about nine hours. The baby is now awake, feeding again, and we're hopeful for continued recovery," Dr. Ndibanje explained.
The paediatric surgeon described the case as the most serious liver condition they've encountered in children, noting that they usually deal with more manageable issues.
Despite the complexity and high cost of the surgery, all expenses were covered by the national health insurance scheme, Mutuelle de Santé. Dr. Ndibanje also acknowledged the invaluable support from the University of Michigan team.
The surgery comes on the heels of other major medical milestones at CHUK, including the recent non-invasive removal of a coin from the stomach of an 18-month-old and a pioneering procedure where a foetus received a blood transfusion while still in the womb â€" a first for Rwanda.
IGIHE
