By Daphne Clarance: Dr Birbala Rai was quite excited after performing her first robotic surgery last month at PSRI Hospital, New Delhi.
A highly complicated procedure was done with ease as she sat behind a console, having a 3D vision of the surgical area, while robotic arms precisely performed the surgery. "A woman was in her third surgery and after two days of the surgery, she was discharged from the hospital," says Dr Rai, Hon. Senior Consultant, Gynaecology.
Still not so popular in India, robotic surgery is a new concept that helps surgeons to successfully go ahead with a complicated case. "Complication rates are low. A person can be out of the hospital faster and in less amount of time," says Dr Rai, Hon. Senior Consultant, Gynaecology.
This procedure typically involves a doctor sitting on a chair and using a console and directing a robot to perform the surgery while having a 3D vision of which the area will be operated on. Robotic arm extensions are directed by the surgeon to perform a highly complicated surgery even in areas where human hands can feel restricted.
According to Dr Anil Mandhani, Executive Director of urology and kidney transplant, Fortis Memorial Research Institute, Gurugram, robotic surgery has been "misunderstood" by people who think that robots do the surgery.
"This is not the case. Most people are aware of laparoscopy, where keyholes are created with different instruments like scissors and other tools to hold the tissue. These instruments are hard and have limited movement. But with robotic instruments, we put the same hole but have more freedom, almost like human hands. So it looks like you are sitting inside the abdomen and doing the surgery," says Dr Mandhani.
Dr Rai added that the "visualisation of structures" becomes vivid as a camera is mounted at a 360-degree rotation. "You can reach the nooks and corners of the surgical area. You can pick the problem areas without any disturbance," she says.
Besides scoring above the cut-open type of procedure, robotic surgery gives surgeons the freedom of "intuitive movement."
"It gives magnification unlike laparoscopy with intuitive movements. This means that if my hand is moving towards the right, in laparoscopy, the instrument will move to the left. So one has to develop a certain kind of skill to do a laparoscopy. With robotic surgery, if you want to move your hand to the right side, then the instrument will also move to the right. This is called an intuitive movement," says Dr Mandhani.
Difficult procedures are easily achieved, such as implant/ leg alignment and correction of the deformity, adds Dr Sanjay B Londhe, Arthroscope, Joint Replacement/Robotic Joint Replacement, CritiCare Asia Multispeciality Hospital & Research Center, Mumbai.
According to Dr Londhe, due to artificial intelligence utilisation, robotic surgery eliminates the possibility of human error. "It is a boon for patients and doctors and gives better cosmetic results and faster postoperative patient recovery," he says.
In some cardiac surgeries, the robotic approach is "safer for patients as there is no violation of the bone medullary canal," adds Dr Londhe.
In small kidney tumours, initially, doctors would remove the whole kidney through laparoscopy. But with the robotic approach, Dr Madhani says that surgeons can save a significant amount of the kidney and just remove the tumour without compromising the cancer principles.
But according to Dr Udgeath Dhir, Director and Head Cardio Thoracic Vascular Surgery, Fortis Memorial Research Institute, Gurugram, robotic surgery isn't about people opting for it if they like it, it's about case selection.
"It's not like a blanket cover that applies to all. You have to carefully select this robotic procedure. It's about the complexity of the surgery, and the overall safety, which account for the utmost priority. We have to assess the risk-benefit ratio and the safety of the patient and not the procedure itself -- especially keeping in mind how long you can benefit from it, assessing whether you have to do a conventional surgery or a minimal invasive one," Dr Dhir.
Unlike many of his peers, Dr Dhir feels that robotic surgery, too, has disadvantages compared to its counterpart, laparoscopy.
He says, "In cardiac surgery, very few centres are doing it in India. It takes a lot of time and costs are involved. In India, unfortunately, we haven't invested much in the health sector. This kind of technology involves heavy costs. However, we need to adapt to new technologies, and for it, we have to pay a price."
In fact, the training programs for surgeons have a learning curve. "It takes years to reach that level and then deliver. So it's not so popular as of now for multiple reasons. But gradually, it should become a popular technique," adds Dr Dhir.
But for complicated procedures, he agrees, robotic surgery is far superior. As a cardiac surgeon, Dr Dhir explains a complicated case.
"There was a patient who had a malignancy which was invading the left side of the heart and going in between the structures. If I had to do a conventional approach, there would've been an incision somewhere around 14-16 inches and accessing that place would've been tough. However, we were able to do that in a very appreciable time with less tissue dissection. The patient was discharged on Day 5," he shares.
The first robotic surgery was done on prostate cancer. "The robotic radical proctectomy was done because this organ is deeply situated in the pelvis and with laparoscopy, it would become very difficult. Therefore, this surgery started with prostrate cancer but gradually, because of its advantages, the procedure was applied to many other surgeries, with gastrosurgeons, cardio theranostic surgeons, ENT surgeons, neck surgeons and neurologists taking this approach," says Dr Mandhani.