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    Posted on 06 March 2012
    Mahendra Bhandari

    The remarkable world of robotic surgery

    Dr Mahendra Bhandari

    Photo: Shailendra Pandey

    MENTION surgery, and most patients cringe. Yet, it was the an ancient Indian surgeon, Sushruta (around 600BC), who saved lives and limbs of many. Nevertheless, surgery is still treated as a last-resort — except for ailments like prostate cancer. With the possibility of death staring them in the face, many prefer to make surgery their first option. Prostatectomy — surgical removal of the prostate — cures cancer if diagnosed in early stages.

    Conventional surgery entails 30 per cent chances of complications. Robotic surgery ensures less than 5 per cent complications, going by US statistics. Surgeons, with the help of computer-controlled robotic arms, remotely operate on the human body with very fine instruments. With the patient under general anaesthesia, big surgeries can be done with the robotic arms through buttonholes in the abdomen. Also, the surgeon works under immersive 3D, magnified, real-time vision of the operative field.

    Coincidentally, the pioneer of robotic surgery techniques in prostate cancer is a man of Indian origin — 63-year-old Dr Mani Menon. Born in Thrissur, India, and now a naturalised American citizen, Menon is the director of the Vattikuti Urology Institute at the Henry Ford Hospital in Detroit. His tryst with destiny began in 1997, when he was recruited by hospital as chair of urology and tasked with reviving the prostate cancer programme.

    Things began moving when the hospital’s urology department received a $20-million grant from the Vattikuti Foundation — an entity with the mission to make robotic surgery and other technologically-advanced medical procedures cost-effective and available to the needy.

    The donation led to the birth of the Vattikuti Urology Institute, letting Menon and his team to explore minimally invasive treatments of prostate and other cancers. With more than 4,000 robotic prostatectomies, Menon is a global authority on the use of robotic surgery.

    One also needs to recognise the robot performing such surgeries. The leading manufacturer of surgical robots today is the California-based Intuitive Surgical Inc. Hundreds of major medical centres worldwide use their da Vinci Surgical System. In the US alone, more than thousand hospitals and clinics use this robot.

    Robotic surgery is more precise, convenient and minimally invasive than laparoscopy, even for complex procedures. But it has a very steep learning curve and few experts are available for it.

    Robotic surgery is overall cheap, less invasive, less painful and a growing trend

    The robot’s arms eliminate even the faintest of tremors. For every two inches a human hand has to move for an incision, the robot’s arms move barely an inch. Robotic instruments can also access hard-to-reach areas of the body more easily. Best of all, because of the endoscope, the surgeon can more easily view the area being operated upon. In some cases, patients admitted in the morning can walk out in the evening, while others may go home within 24 hours.

    Robotic surgeries are also more precise, with less pain and trauma. For example, in a conventional bypass surgery, a patient’s chest is ‘cracked’ open by making a one-foot-long incision. With the da Vinci system, the heart is operated upon by making just a few small incisions in the chest, each only about a centimetre long.

    This being early days for robotic surgery in India and globally, surgery costs a lot. But other costs are lower. For example, due to same-day or 24-hour discharge, minimal expenses are incurred on hospital stays. The chances of infections, likely in extended stays, are negligible. Patients don’t lose weeks or months in recovery. Bleeding and post-operative pain is minimal. Incision scars are limited.

    As people learn about robotic surgery, more patients are choosing it over conventional or laparoscopic surgery. Some of India’s best hospitals now offer it. In 2010, the Vattikuti Foundation opened its first Indian centre in Gurgaon. Recently, it opened centres in three more cities: Hyderabad, Bengaluru and Mumbai. Two other affiliated hospitals are in Chennai and Kolkata. Moving forward, more specialties — such as head and neck and bariatric — will be added. As its popularity spreads, the word ‘surgery’ may no longer be dreaded by patients and their families.

    The author is the director, robotic surgery research, Henry Ford Hospital, Detroit, Michigan

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    Posted on 06 March 2012



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