Abu Dhabi: An Emirati in Al Ain has successfully undergone a complex 11-hour procedure that saw his kidney removed, cleared of a tumour inside it and transplanted back into his own body.
Ali Shamsi had been born with only one kidney and a tumour was growing inside it. Diagnosed with cancer in his early 60s, a part of his kidney had already been removed earlier. Later, doctors came to the conclusion that the best way to treat it would be through a procedure known as a renal bench reconstruction.
Shamsi visited Cleveland Clinic Abu Dhabi for an assessment after he started suffering from chest pain. The hospital is Abu Dhabi’s only multi-organ transplant centre and it has successfully carried out kidney, heart, lung and liver transplants since 2017. After enrolling in the hospital’s smoking cessation programme, Shamsi underwent a range of tests that revealed that the cancer had resurfaced in the kidney.
“I was in shock. I had been to the hospital to quit smoking and suddenly I was diagnosed with cancer again in my only kidney. I didn’t know what to do. I thought about travelling abroad, but I decided to put my faith in God and my doctors and stay in my country, to be treated near my family and friends,” Shamsi said.
Following the diagnosis, Shamsi underwent detailed testing to determine whether the cancer had spread. Doctors were happy to find that the tumour had not yet spread, but its precise location was worrying, because it was located deep inside his kidney. A procedure to remove the tumour while it was still in place was deemed impossible.
Best course of treatment
“With Shamsi having one kidney only and the tumour deep in the renal vein, we were limited in our treatment options. If we simply removed his kidney, he would need years of regular dialysis before an eventual donor transplant, all of which would carry its own set of risks. We determined that the best course of action for Shamsi was a complex surgery to remove his kidney, dissect the tumour, reconstruct the kidney and transplant it back,” said Dr Waleed Hassen, department chair for Urology and surgical oncologist at the hospital.
Dr Hassen performed the surgery on Shamsi, along with other skilled surgeons in transplant, microsurgery and surgical oncology. Since the tumour was located deep inside the kidney, a transplant surgeon first removed Shamsi’s kidney, similar to the removal required during a kidney transplant. Once taken out of the body, the kidney was placed in a slush solution to keep it cool while a surgical oncologist and microsurgeon worked together to carefully dissect it, in order to reach the tumour.
“Having the kidney outside the body meant we had a much better access. Leaving it in the body would not only mean operating on it in a tight space, but also running a high risk of causing substantial bleeding. Once outside and in a slush solution, we had an optimal approach to reach the tumour, causing as little damage to the healthy tissue as possible before putting it back together,” said Dr Kashif Siddiqi, a urologist specialised in microsurgery who also worked on Shamsi’s kidney.
After accessing the tumour and removing it under strong magnification, the surgeons repaired Shamsi’s kidney and began the delicate work of transplanting it back into his body.
“This was a very complex operation that really required a high level of skill and coordination across our team with extensive experience in both transplant and surgical oncology. There are not many places in the world that can perform this surgery. From Shamsi’s perspective, this approach meant that we are able to save his kidney, which is a huge benefit. He will not need dialysis, a transplant or immunosuppressants and can live his life normally, free of cancer,” said Dr Bashir Sankari, chair of the Surgical Subspecialties Institute at Cleveland Clinic Abu Dhabi, and the transplant surgeon who participated in the procedure.
Following his successful surgery, Shamsi spent almost three weeks recovering in hospital before returning home to Al Ain. He then began dialysis at Cleveland Clinic Abu Dhabi — Al Ain, while his kidney continued to recover.
“Before the procedure, I was very scared, I cried on my way to the operating room. I had never heard of such an operation where they take out your kidney and then put it back. Dr Hassen and the team truly saved my life and I owe them the world for that. When doctors told me my kidney had recovered enough and I could stop dialysis, I [felt like I] was flying. It was the best news I had ever heard. I feel amazing now, I was even able to fast this Ramadan because I felt so strong. Through this journey, I really feel that Dr Hassen has become like a brother to me. The UAE has the best health-care facility in the world,” Shamsi said.