August 4, 2022

Multidisciplinary management leads to a first in surgery

Our values, ‘safe, kind, together’ drive our approach to patient care, and our vision of a healthier community.

This is amply illustrated in our story today, of two life-threatening cases that were successfully treated here at Northern Health. This was achieved thanks to cutting-edge technology and multidisciplinary management – the latter underlining the importance of ‘together’.

Dr Bibhusal Thapa, Northern Health Thoracic Surgeon, said, “Significant development of capabilities in Interventional Radiology (IR), Respiratory Medicine and Thoracic Surgery at Northern Health, has allowed us to effectively treat patients with hemoptysis of varied rare etiologies – or causes – in a collaborative manner.”

Hemoptysis (coughing of blood) is a common presentation of a range of pulmonary problems. Large volume hemoptysis is a complex problem to treat and can easily be life-threatening.

The first case was that of a 28-year-old man with a vascular anomaly of the lung, called pulmonary sequestration.

As Bibhusal explained, “Pulmonary sequestration is a rare congenital malformation of the lung. They can cause significant medical problems including repeated pneumonia and even life-threatening bleeding from the lungs. They are mostly diagnosed in children, with adult presentations even rarer.”

He further elaborated, “Operation for this condition can often be complicated by massive bleeding, making it risky. We successfully tackled this difficult problem with the assistance of our IR colleagues at Northern Health, using state of the art treatment techniques.”

Dr Terry Kok, Director of Interventional Radiology at Northern Health, added, “We were able to carefully map and block, specific blood vessels to this area of abnormal lung, with a high level of precision to reduce the risk of bleeding and ensure the surgery was successful.”

The second case, a patient in his 70s, diagnosed with cancer in his left lung, was coughing blood, which seemed to be coming from the opposite lung.  Angiography identified a rare arterial anomaly.

“This was a rare situation where the patient had two life-threatening conditions; one on each lung. He had cancer on the left lung and a highly unusual fistula – an abnormal passageway – on the right lung, causing repeated life-threatening bleeding in the lungs,” explained Bibhusal.

Although the cancer in the left lung was in its early stages and could be removed by surgery, the bleeding from the right made this difficult and potentially dangerous.

“Successful blockage of the abnormal vessels in the right lung by very precise embolisation allowed us to safely operate upon the cancer on the left side,” Bibhusal explained.

“The combined approach which rendered the surgery safe is certainly a first for Northern Health. I would like to thank my colleagues Dr Terry Kok, Dr David Burrows, Dr Krishna Bhagwat and the Respiratory Medicine team for managing these difficult situations safely and effectively.”

From left to right: Dr Bibhusal Thapa, Dr Terry Kok and Dr Krishna Bhagwat

The Department of Thoracic Surgery have written a paper on this, which has been presented for publication in the ANZ Journal of Surgery.

Dr Katharine See, Director, Respiratory Medicine said, “It was fabulous working with such a collaborative team to achieve these exceptional outcomes for complex patients.”

The Thoracic Surgical service at Northern Health has been providing care to the community in the northern suburbs of Melbourne for many years. With recent strengthening of the Thoracic Surgical team, this service has now grown to be able to provide all manner of Thoracic Surgical services to our community.

With the establishment and successful running of the lung cancer management stream, Northern Health now has the capacity to provide ‘one stop care’ for complete investigation and treatment of different types of thoracic cancers. In partnership with the Pleural Medicine team, the Thoracic Surgical service offers a complete and holistic approach to investigation and treatment of both malignant and non-malignant pleural diseases.​

Featured image shows Dr Bibhusal Thapa, Dr Terry Kok and Dr Katharine See.