Tuesday, December 20, 2011

Orthopods cleverer than anaesthetists: it is now official!

http://www.bmj.com/content/343/bmj.d7506
Orthos and anesthetists: a prospective trial!



Kudos to the BMJ group for publishing this landmark paper. It IS actually quite well written and is hilarious.


What made me laugh was the irony of it - the fact that the ortho chaps had to prove that they were more clever on abbreviated IQ testing compared to anaesthetists. Thankfully, general surgeons and urologists do not suffer from this ignominy!

Sunday, November 27, 2011

My first robotic radical prostatectomy in India

 25th November 2011.

This will be a memorable day for me! This was the day I performed my first robotic radical prostatectomy (removal of the whole prostate - for prostate cancer) in India. I was ably assisted by my friend & senior colleague Dr T Ganesan. Thank you TG! The procedure was undertaken in Manipal Hospital, Bangalore. The patient had an inguinal hernia as well, which was repaired at the same time. He was mobile the following morning and resumed normal diet after 24 hours.

I would take this opportunity to thank the entire team at Manipal Hospital, especially Dr Deepak Dubey, HOD & Consultant, Department of Urology, for facilitating this.


And, it would be remiss on my part if I did not mention my gratitude to my guru / mentor Prof Prokar Dasgupta (http://www.prokar.co.uk/), who was instrumental in converting a sceptic to an ardent devotee of robotic surgery. More, in providing me the requisite training opportunity. Thanks Prokar!

ROBOTIC SURGERY

I am sure most of you reading this already have a pretty good idea about what robotic surgery is all about. But for those not familiar with the concept, here's what is involved...

When people hear about robotic surgery, the immediate mental imagery is one of a robot performing the surgery directly without human involvement - I say this because, this is what I get asked quite frequently. Robotic surgery is basically laparoscopic surgery with a few bells and whistles added...

Fulcrum effect
In laparoscopic surgery, the points at which the ports (the tubes that are inserted via small keyhole incisions into the body) enter the body become the fulcrum of action. 

Single port (LESS surgery) nephrectomy
This is counterintuitive but with experience the surgeon gets 'accommodated' to this effect. Also, in laparoscopic surgery a procedure is performed on a 3-D structure whilst looking at a 2-D image of the same.

In robotic surgery, the robot is basically an interface - it acts as a slave to the surgeon controlling it. A master-slave system. The robot 'suffers' the fulcrum effect, thereby allowing the surgeon to perform the surgery au naturel (although via the console). The software does the magic! That's already one huge burden off! 

KS inserting ports prior to robot being docked to the patient
Plus, the surgeon sees everything in 3-D HD on the console making it an immersive experience. Also, there is no standing or clashing with your assistant who has to hold the camera, etc. The operating surgeon sits on the console - as one of my friend jokes about this: This is one kind of operation where the surgeon actually de-scrubs before he starts operating! - so there is no fatigue involved and it is ergonomically great.
The robotic cart being aligned prior to docking


The robot docked to the patient

On the console
 Also, unlike in laparoscopic surgery, where the tip of the instrument can move only in a linear fashion in 3 planes, the tips of the robotic instruments have 7 degrees of freedom and it's actions mimic the human wrist (EndoWrist).


Plus, the Da Vinci robot allows motion scaling (if you move your hand 10 cms on the console, the machine can be set to move the instrument inside the patient just 1cm) and total elimination of your tremors. These precisely are the features that make laparoscopic surgery technically very demanding and entails a huge learning curve for complex procedures.


















Dr Thirumalai Ganesan - in the centre

There is at present concerns about cost. Similar concerns were raised when laparoscopic surgery arrived on the scene. Today it's cost comparable to open surgery and comes with huge benefits for the patient - early recovery, lesser morbidity, more cost effective from a healthcare perspective. 

Robotic surgery takes this to the next level; not only does it provide all the benefits of laparoscopic surgery for the patient, it provides benefits to the surgeon as well - better ergonomy, lesser fatigue effect, increased accuracy with fine motor tasks - which in turn translates to better patient care. It is my firm belief that with increasing use of the robot in multiple surgical specialities, the cost will become comparable to laparoscopic surgery. The next few years I am sure will prove to be exciting times for robotic surgery in India.



Friday, September 16, 2011

Urology practice in Besant Nagar

It's now a year since I have been practising urology in Chennai, India. I have been an independent practitioner since May of this year. Although I wanted to start my practice outside my affiliated hospital (Global Hospital) even in April-May, there were several things that came in the way of this happening. I am glad to announce now that I will be able to offer my consultation services in two clinics in Besant Nagar.

I am part of Sukra Diabetes Care & Research Centre (Opp Woodpecker Furniture Shop), where I will be in clinic on Mon, Wed and Fri 5-7 pm. On Tue and Thu 5-7 pm, I will be available in Precision Diagnostics on 7th Avenue.

I am just starting out on this, a completely new adventure and am hoping to offer the full set of urology diagnostics/evaluation within the next few weeks. I look forward to support from all my friends, family and well-wishers in this endeavour.

Sunday, September 11, 2011

NRI to RI


It's now exactly a year since I returned back to India from London. It's been a tough year both on the personal as well as professional front. Having spent nearly 20 years abroad, the re-adjustment to India has been quite demanding. 

The most frequent question I get asked in conversations is: "Why did you come back?" I must admit, it's been tough answering that question. Yep, why did I come back? The real answer is actually quite simple - one, I wanted to look after my ageing parents and two, after our pension had been virtually wiped out and given the downward spiral that UK was into, I thought it made economic sense to come back to India. Trust me when I say that I have been planning my return over the past 5 years, but despite the mental preparation the reality of actually living here has been devastating. 

Whilst I see that we have leap-frogged in terms of availability of a lot of things that were considered unaffordable to the common man, say, a decade ago (read: mainly technology / devices), there is still so much of poverty. That at least can be explained away by the sheer numbers of people in this country. But, how can one explain continuing lack of water, electricity, basic sanitation, infrastructure, education, and persisting child labour, corruption (this has become so integral to our society that nobody thinks twice about 'paying' something extra to get a job done; worse, it persists at every layer and step of any organisation, be it public or private), nepotism and sycophancy. Nothing seems to have changed in the 20 years that we have been away. It's just that all of this can be communicated better today with the availability of broadband internet, mobile telephony and social networking sites. Yes, we did visit the country several times during this period, but despite psyching oneself for the 'reality' of coming back and living, the actual reality has been quite bitter. 

What is the basic problem? To me, it seems avarice in our compatriots appears to play the largest part in this tragedy of a country. Add to this the lovely concoction of lack of basic decency, courtesy and sanitation, we have a potent mixture of the uncouth, totally indecent and rude Indian that is stereotyped in the west. Taking this a level further down, the avarice of the commoner stems from the systematic rape of this nation by the politicians - the poor have been kept poor for only one reason - it breeds ignorance, which in turn is exploited by the politicians for keeping their vote banks, not to mention their electoral coffers, rich.

Do I see any redeeming qualities at all in this country to make me stay? Yes, I do. The common man's struggle to just survive. The integrity that I see in a lot of people - my driver, housemaid, the shop keeper in the street corner, the boy working in the local pharmacy - reiterates the basic goodness in people around us. More than that, the hope that they all cherish - a better tomorrow, is something that will keep me going for the foreseeable future.

More than that, I see a huge amount of ignorance on the health front. An area where I can make some in-roads. Improve awareness in the micro-community that I serve. Also, there is a persisting lack of quality in all that is done here - mere reflection of cutting corners, in everything. Provision of the highest quality care is something that I hope we will be able to provide soon. Providers of such high quality care today are mostly individuals who remain tiny islands in this sea of misrepresentation and cheating.

My colleague was just reassuring me yesterday that the first year after returning from abroad is the worst year. "In the second year, you will start adjusting yourself to the reality here. In the third year, you will become 'native'. This is why the government gives you three years to naturalise!", he said. Only time will tell.