Dubai: Expat undergoes 2-hour surgery while conscious to remove coconut-sized tumour

A 38-year-old Gambian expat underwent a successful surgery of a coconut-sized enlarged thyroid gland, which was obstructing his breathing.

This is the country's first hemithyroidectomy under regional anaesthesia. The patient, Gibril Ceesay, was conscious throughout the two-hour surgery.

An F&B supervisor who has been living in the UAE for eight years, Ceesay, began experiencing neck pain when he went back home on vacation.

After returning to the UAE, his condition worsened. Ceesay would wake up at odd hours finding it difficult to breathe and coughing continuously.

He consulted Dr Kishore Chandra Prasad, specialist in otolaryngology, Head & Neck Surgery, Medeor Hospital.

“Invest­­igations revealed that the patient had an enlarged thyroid gland that was not only compressing his trachea and larynx but also going into the retro-sternal space (behind the sternum),” said Dr Kishore.

Regional Anaesthesia

The doctor then held detailed discussions with the anaesthesiology team headed by Dr Abdul Aneez, specialist anaesthesiologist. The team did an MRI scan and studied each aspect before deciding the best course of action.

Dr Aneez said that general anaesthesia can compromise the breathing of the patient, and they get only 2-2.5cm of space to intubate.

“However, in this case, pre-operatively, there was only 4 mm space, which is very narrow. In such a situation, if we opt for general anaesthesia and at any point if there was a compromise in breathing, it would become life-threatening. If he loses his airway, we would not be able to reach the windpipe to give oxygen,” said Dr Aneez, adding that maintaining his airway was critical.

In this case, the medical team decided that regional anaesthesia (where only a specific area is numb) would be the best option as it would allow him to breathe independently. For it to be successful, the patient’s cooperation was paramount, as he would need to lie down for two hours during the surgery.

Dr Kishore explained the process in detail to Ceesay, who agreed to undergo the procedure under regional anaesthesia.

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He administered a cervical plexus block to numb the neck. Ceesay was sedated well enough to maintain his airway and lie down calmly for two hours without any movement.

Ceesay was conscious throughout the procedure, during which Dr Kishore removed the enlarged side of the thyroid.

Apart from keeping the patient calm during the surgery, there were other challenges as well.

“First, the tumour was big, approximately 8-10 cm. It was the size of a small coconut. Secondly, the neck is an area with important structures. We had to get the right access and maintain the correct position, all the while ensuring that the patient is comfortable and breathing properly,” said Dr Kishore.

Dr Aneez maintains that regional anaesthesia is not a replacement for general anaesthesia. “Usually, general anaesthesia is preferred for the comfort of everyone involved. But in this specific case, we had to think of another solution as it was riskier to administer general anaesthesia. We used local anaesthesia to avoid complications,” said Dr Aneez.

After the surgery, Ceesay is recovering well. Doctors were able to save the other half of his thyroid gland, he does not need to continue with thyroid medicine for the rest of his life.

“As this is my very first surgery, I was nervous. But the doctors here gave me a lot of confidence. I was conscious during the surgery, but I did not have any difficulties. This was a phenomenal team. I am indebted to them and appreciate what they did for me,” said Ceesay.

• Dubai