Robotic Surgeons are the New Face of Surgery Worldwide!

His first patient had obviously overdosed on science fiction. When Dr Arvind Kumar, now professor of surgery, general, laparoscopic, thoracic, thoracoscopic and robotic surgeon at AIIMS (All India Institute of Medical Sciences), New Delhi, explained to the nervous person that his surgery would be done by robots, he was thrown "a very pertinent question": what if the robot goes haywire and starts doing its own silly movements during the procedure?

Though it was definitely a ‘theoretical' possibility, Dr Kumar had to do a lot of explaining to the patient about of the security systems in the robot. "Most patients still feel that the robotic surgical system is actually a human-like machine which walks up to the operating table and carries out the surgery with the surgeon looking at the robot, which is actually not the case," he laughs.

According to Dr Yugal K Mishra, director, department of cardiovascular surgery, Fortis Escorts Heart Institute and Research Centre, New Delhi, "the medical robot available today is from Intuitive Surgical, USA, a company manufacturing robots. It has created the well known ‘da Vinci' surgical system. The latest version, Da Vinci SI, allows superior 3D high definition vision with the instruments allowing for enhanced dexterity, precision and control. The end result: a breakthrough in surgical capabilities."

The system consists of three components: a robotic patient cart; a master console and a light source and data processing unit. The patient robotic cart comprises a central tower with three to four arms which move up and down on the tower and have numerous joints simulating the movement of the joints in the human arm - the shoulder, elbow, wrist and the fingers. These multiple joints allow a wide range of movements in the robotic arm. The last part of the arm has a robotic instrument which goes inside the patient's body though special 8 mm tubes. The central arm has a telescope with video camera inserted into the patient's body through a 12 mm tube, which transmit images to the video screen in the master console unit.

These are high definition images and give a 3D vision to the surgeon sitting at the console. He then manipulates a pair of joysticks on the console, and the movements of his hands and fingers are replicated by the robotic instrument inside the body. This is made possible by the master computer in the console which converts the movements of the joysticks into electrical impulses which pass through the robotic cart and result in movement of various parts of the robotic arm and the instruments. The light source and the data processing unit allow the vision from inside the patient's body to be transmitted to the master console and the joysticks' movement to be transmitted to the patient cart.

"Robotic surgery is being applied in a wide range of specialities ranging from general surgery, cardiac surgery, thoracic surgery, vascular surgery, urology, gynaecology to ENT surgery. It is mandatory for a surgeon to be well versed with every step of the procedure and take care of the nuisance of handling a robot," says Dr Kumar.

The desire to be at the "cutting edge" of keyhole (minimally invasive or robotic) surgery of the chest, had this MS from AIIMS training in robotic chest surgery in Italy and Switzerland. "I started the same at AIIMS in June 2008 and today it's the only centre in the country which offers robotic chest surgery to its patients free of cost," he says. Credit goes to Dr Mishra for performing the first cardiac robotic surgery using the da Vinci system in Asia in 2002 at the then Escorts Heart Institute and Research Centre. Since then, he has handled 400 cases, one of the biggest experiences in Asia.

For India it is just the beginning, says Dr Rajiv Yadav, consultant, urologic oncology and robotic surgery, Medanta, The Medicity Hospital in Gurgaon. "We do need well trained and qualified robotic surgeons catering to various surgical subspecialities. There is no fellowship training programme in India for advanced training in robotic surgery. In fact, I am the first fellowship trained robotic surgeon practicing in India. We are in the process of setting up centre of excellence with the aim of providing training in advanced robotic surgery to surgeons in the country," he adds.

The reason Yadav chose this career was because he had the passion for research and desire to keep himself on the forefront of technological advancement in cancer surgery.

"I am sure India will soon serve as a preferred destination for advanced robotic surgery," says Yadav.

Author: Ayesha Banerjee (HT Horizons)

Date: 6th January, 2011

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