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.
