Tomoaki Kato, MD, explains how a tennis-ball sized malignant tumor and six organs were removed from 7-year-old Heather McNamara of Long Island, N.Y. Three organs were reimplanted after being cooled during the operation, but the rest could not be saved. The surgery lasted 23 hours.

Surgeon tells how his team removed 6 organs during cancer operation

A 7-year-old New York girl is the first child to undergo the unique procedure that reimplanted some of her organs after a malignant tumor was removed.

By Brian Hedger — Posted March 30, 2009

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He had performed marathon surgeries before, but this was different.

This one required an intense focus that left Tomoaki Kato, MD, physically exhausted when it ended, 23 hours after it began.


On the mend after successful surgery, Heather McNamara, 7, is joined by her doctor, Tomoaki Kato, MD, (center) and her father, Joseph McNamara.

On Feb. 6, Dr. Kato and seven other surgeons removed six organs from Heather McNamara, 7, and cooled the organs in the operating room at NewYork-Presbyterian Morgan Stanley Children's Hospital with preservation fluid used in transplantations.

With the organs removed, the surgeons gained access to what had been considered by other doctors as an inoperable cancerous tumor the size of a tennis ball. The tumor was tangled among organs and blood vessels.

After the lesion was removed, the girl's large and small intestines and liver were reimplanted. Her stomach, spleen and pancreas had been severely damaged by the cancer and could not be saved. Dr. Kato said he connected her esophagus to her small bowel to act as a stomach.

The procedure was believed to be just the second of its kind, and the first on a child.

It was extremely challenging, mentally and physically. Dr. Kato remembers briefly talking to the girl's parents after the operation, then stumbling to a nearby couch to sleep.

"I am used to long surgeries, but not this type," said Dr. Kato, surgical director of liver and intestinal transplantation at NewYork-Presbyterian Hospital/Columbia University Medical Center. "I usually don't get exhausted at the end. Sometimes I'll get tired, but not to the point where you have trouble keeping yourself up. This surgery got me to that level. It was an intense 23 hours."

Marathon in the OR

The surgeons spent the first seven or eight hours diligently working with the girl's organs and blood vessels outside her body. It was the most mentally taxing part.

"What really took the longest was immobilizing everything after taking the organs out," Dr. Kato said. "The best approach is to take everything at the same time, then cut the tumor and separate the organs outside of the body."

He did a similar procedure in 2008 on a 62-year-old woman in Miami. Heather's tumor, he said, was in a slightly different location, but both surgeries were successful.

He hopes other surgeons will learn and adopt the technique. "Any program that can do [multiple-organ] transplants could do this procedure."

The Long Island, N.Y., girl was released from the hospital in March, four weeks after the surgery. She is doing well, according to her father, Joseph McNamara, who was prepped to be a donor if his daughter's liver had been damaged.

With her reconstructed stomach, "I've been telling everybody that she won't be able to compete in any hot dog-eating contests, but she will be able to eat fairly regularly," Dr. Kato said. "It will be similar to the way a gastric-bypass patient eats, in small portions."

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