Robotic way to hassle-free surgeries

Four finger-tip sized incisions, four robotic arms, including a camera eye snaking inside, the magnified image of the visceral organs being watched on a screen outside as the surgical instrument arm moves deftly to remove the tumour or blockage. Minimal blood loss, no long hospital stay—welcome to the revolutionary world of robotic surgery that is gaining in popularity in India. Some of the major hospitals in the capital, including the All India Institute of Medical Sciences (AIIMS), are performing complex surgeries the robotic way. Major procedures such as removal of tumours, heart surgery and gynaecological surgery that would traditionally require the scalpel to make large and deep cuts in the body and consequent blood loss are now being done with robotic arms. “Robotic surgery allows us to do many complex operations that would require large incisions,” Sudhir Srivastava, chairman, CEO and managing director, Fortis Healthcare and International Centre for Robotic Surgery in New Delhi, told IANS. Srivastava said conventional cardiac surgery requires splitting of the sternum, but in robotic surgery, using a robotic surgical system called Da Vinc, just four-five finger-tip sized incisions are all it requires. “The tips of the robotic arms behave like human wrists and allows us to do complex surgeries through tiny holes,” he said. The camera arm of the robot allows surgeons to see inside the body in 3D. The image of the internal organs—magnified up to 10 times in high definition—shows up on a screen at the surgeon’s console. Using hand and foot controls, the surgeon directs the robotic arms with the surgical tools to perform the required procedure. “The camera acts as the eyes, while the instruments act as the arms of the surgeon,” said Srivastava, adding that the surgery is “very precise, the incisions are tiny, there is little trauma and the patient can return home in a day or two. There are less complications, less blood transfusion and it is cosmetically preferable”. What about the cost? The cost varies between Rs.60,000 and Rs.1.5 lakh (approx $1,000-$2,700), depending on the procedure, he says. “It works out more expensive than the conventional surgery, but the benefits are huge because of all the advantages,” Srivastava said. He says the cost is due to the technology, as each machine costs about Rs.8-10 crore (approx $1.4-1.8 million), depending on the model. He says that robotic surgeries abroad are “10 times more expensive”. Fortis has two robotic systems and the hospital performs cardiac, thoracic, urology, gynaecology, general, head and neck and orthopaedics procedures. At AIIMS, robotic surgery is done in the field of urology, ENT cardiac, thoracic and in general surgery, says P.N. Dogra, professor and head of the Department of Urology, adding that the urology section gets around 130-140 patients every month. But AIIMS does not charge anything from general patients. “During the hospital stay, even the meal charge is not taken from some patients,” Dogra said. One major advantage of the robotic system, he says, is the “tremor filtration” in which the “unintentional movement of the doctor is not carried over to the patients during the operation as the doctors are behind the operation table monitoring the robot”. Arvind Kumar, a former professor of surgery at AIIMS, who is now heading the Institute of Robotic Surgery at Sir Gangaram Hospital, says the hospital performed “Asia’ first vascular surgery” using the robotic system. Explaining the high costs, Kumar says the robotic technology is in evolution. “As its uses become more, the prices will crash, like in the case of mobiles,” Kumar told IANS.