Robo doc

Surgical robots, a highly advanced technology, are slowly making their way into Indian hospitals

A few years ago, who would have imagined that robots would be able to perform complex surgeries? Robots are slowly making their way into our hospitals. Surgical robots, a highly advanced technology that has been operational in developed countries like the US for more than a decade is now in India.

The first robotic surgery in India was conducted at the All India Institute of Medical Sciences (AIIMS) in 2008. The operation was carried out by Dr PN Dogra, from the urology department on a 50-year-old woman suffering from cancer of urethra and urinary bladder. Today, with improved technology, every department of the institute is adapting itself to robotic surgery.

Da Vinci Robot, touted to be the best surgical robot, was brought to six private hospitals in India by Vattikutti Foundation last month. Robotic surgery is advanced from laparscopic surgery. Da Vinci robot does not have “a mind of its own” and needs direction from doctors. The world over, doctors who use Da Vinci robots have been trained to handle them. Doctors sitting in a corner of the operation theatre give instructions to the robot to carry on with the surgery. The robot offers surgeons high definition and three-dimensional viewspace. Surgeons sit in a console, a few feet from the patient. The console comes with joysticks that they move to control the robotic arm based on what they see through a high-resolution camera.

One arm of the robot controls the camera and the other three hands manipulate the surgical instruments. The robotic arm is designed in such a way that it can reach the interiors of the organ curvature, which is not possible in traditional or microscopic surgery without damage to normal tissues.

The robotic arm moves in-sync with the movements of the surgeon's hands and performs the surgery. After the surgery is complete, doctors close the keyhole incisions. “The operating surgeon in his console has full control over the robotic arms; he has sharp 3D high definition vision of the operation site and superior magnification through incisions as tiny as one to two centimetre,” said Dr Mani Menon, the first surgeon to do robotic prostatectomy in 2001 at the Henry Ford Hospital in Detroit, USA, and is also regarded as founding father of robotic surgery. “The robotic wrist instruments offer a far greater range of motion than the human hand, and the natural tremors of the doctor’s hand are also reduced,” he added.

Apart from All India Institute of Medical Sciences (AIIMS), Da Vinci robots are now available at six private hospitals in India. Vattikutti Foundation is chalking out plans for expansion of robotic surgery. The Foundation is already in talks with hospitals to bring in more robots. “We are looking at having about 500 Da Vinci Robots in five years in India,” said Raj Vattakutti.

A lot of patients may be apprehensive about getting operated by a robot but Dr Menon explains that there is nothing to fear as the robot only takes directions from the doctors in-charge. “Technology is only as good as the hand that wields it,” said Dr Prathap C Reddy, chairman of Apollo Hospitals. Apollo Chennai and Apollo Kolkata are among the six hospitals in the country that have Da Vinci robots. The other hospitals are Medanta in Gurgaon, KIMS in Hyderabad, Manipal in Bangalore and Asian Institute in Mumbai. Robotic surgeries will be an option for a range of treatments such as heart, uterine, ovarian, prostrate, kidney and weight-loss procedures.

Patients going for surgeries can choose the robotic methods, but may have to pay up to 75 per cent more. Robot co­sts around Rs 10 crore. At present, this form of trea­tment can be offered to tho­se patients who can aff­ord such an added ex­pe­nse. Acc­or­ding to Vatt­ikutti, however, the cost of robotic surgery would come do­wn once rob­ots become popular. “Volume — both in terms of number of surgeries performed with Da Vinci and the number of hospitals acquiring Da Vinci — will bring down the cost,” said Vattikutti. This new-age minimal invasive technology is bloodless alternative to long and tedious operations.

Using robots makes the surgeon's job easier and eventually increases the success rate.

“It's one of the best tools with which a surgeon can operate. There is no peering over the patient, no fear of trembling of hands, or worries over accuracy,” said Menon. The outcome, particularly for removal of prostrates, has been better than open surgery, according to Dr Menon. “Some years ago, I tried to specialise in laproscopic prostatectomy. The results were awful because the procedure is difficult. But with just four robotic surgeries we could tell the difference. The robotic arms are as good as those of experienced surgeons,” he said. Until a few years ago, prostate surgery used to be quite painful and required several blood transfusions but, apparently, with robotic surgery it is much safer and less painful. “Robotic surgery is the future. In this robotic operation, we only need three incursions — of one centimetre each — which prevents heavy bleeding and reduces the rehabilitation period by seven times,” said Dr Arvind Kumar, professor of surgery at AIIMS.

“Efforts have been quite successful and over a period of time more hospitals will warm up to the idea and we will be able to enhance the use of robotics. Recovery period is much shorter. One can give a better and quicker procedure,” said Dr Naresh Trehan, chairman of Medanta Medicity.

In case of failure or a defect in the robot mid-operation, doctors presiding over the operation can take over and perform the surgery manually. Globally, over 10,000 surgeries have been conducted with the use of the robot. zz


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