Surgery has been an integral part of medical practice over the years and the most known one is the open surgery where they make cut on the patient’s body and the surgeons would do what he had to do but the focus of the times when open surgery was only the option was to try and reduce the mortality rate. When we talk about mortality, it means having the patient’s life and that’s what the focus was for the doctors at the time. But now, what eventually transpired for the surgeons is this big question – Have they made that patient’s life better? This is what many want to talk about when they deal with this subject, (I.e.) can the patient jog after having had that surgery? Can he do the job that he normally does after the surgery? This is what’s called ‘Quality of Life’. This quality of life or reducing the mobility of the patients becomes the focus because not only surgery but every field of medicine needs to go through a process of evolution to improve itself for the betterment of mankind. When the dawn of laparoscopy came in, it was treated with scorn, people started thinking ‘i hear this technology is never going to fly, it’s just another gimmick, it’s not something important, open surgery is way forward’ – but here we are in 2020, you cannot think of surgery which is not laparoscopic.
“Human being is resistance to change but if the change is for better it brings about a lot of good to the mankind and in the endeavor of making surgical practices better, gave rise to the birth of robotic surgery”
Every now and then, an industry goes through technology disruption. With surgery, that’s come with the introduction of robotics. It pushes technology to make surgery better. As humans, we use all of our senses, right? We use a sense of sight, the sense of smell, the sense of touch. Surgery has sometimes hampered the full sense of engagement and interaction. As you’ve gone through the continuum of surgery, in an open procedure, the surgeon has the ability to use full dexterity of their writs. They can see the surgical site in 3D. Now, they have to make a large incision so they can access the appropriate anatomy and these large incisions can be a challenge for recovery time for the patient. In Laparoscopic surgery, the minimally invasive approach that followed makes you move your hand up to move the tip of the instrument down. Left is right, down is up. And so, the surgeons have to have this mental remapping as they are looking at a 2D screen, and the dexterity was completely lost. And that’s when they believed a robotic-assisted approach will be much better. Over the 24 years, Day Vinci systems have been used in more than several million procedures, and have more than 5000 systems installed worldwide. The whole point of the robot is to minimize the invasiveness of the surgery. When we hear the work robotic surgery we often have this misconception and a question of ‘ if the robotic is going to operate me then what is the doctors doing?’ – And this is so not true because the Robots are only autonomous; it’s only controlled 100% by the surgeon himself.
The important point is that the wrist of the instrument move which wasn’t possible with conventional laparoscopic surgery. So the areas which are initially thought to be quite difficult are now accessible easily through robotic surgery. The whole idea of doing surgery is to take the problem out with the least possible collateral damage and if the rest of the technology is allowing you to do that, then that technology ought to be embraced. It’s not a surprise that currently there are 3,500 robots that are operational in the US. And Indians very much warmed up to the idea of doing robotic surgery. Experts say that if they combine modern technology with good skills and good teamwork then there is a very good chance of achieving patient outcomes. And that’s what we all should be striving for. Looking at the way how robotic surgery comes in as there are many hospitals in India that do robotic surgery, a few cuts are needed for the instrument to be allowed to get in. Just recently there is a new invention called single quad-robotic surgery which is operatable in just one cut. It’s astonishing to how even three cuts are not needed, and just in one cut, the entire surgery is done. That’s how surgical practices are progressing and we should progress the future for the betterment of the patients, and that’s exactly the world is going in.
Surgeons insist that it is incredibly important to follow the guidelines as the guidelines are there for a reason. The reason to why guidelines exist is so that the error that may happen are minimized, so when a new robotic surgery was put in place, a new set of guideline like there should be a trained robotic surgical nurse, there should be a dedicated technician available at the time of surgery, should there be any issues or any problems with the robot, the robotic anesthetist needs to be a specific anesthetist who understands the importance of how anesthesia needs to be given at the time and so one and so forth. There were also teething problems, but what they do when that happens is the information or the feedback is passed to the relevant department that does robotic surgery. Through the feedbacks, they tend to improve and come with innovative ideas to let surgeons believe that they can master the ability to control all these problems. That’s so great in bringing all of this knowledge and expertise and coming down to surgery is real evolution. There are a few renowned hospitals in India that do multi-specialty robotic surgery. Robotic surgery is spearheaded by a group of consultant surgeons who are neurologists because prostate cancer is cancer that is best dealt with robotic surgery. In any literature, it is considered as a gold standard to do prostate cancer survey operations that have to be done robotically. Hence neurologist spearhead is at the robotic surgical program. The majority of units across India that we normally tend to are neurologically driven but there are very few hospitals that take prove in providing multiple specialties that get involved in this robotic surgery endeavor.
The surgeon has adopted modern technology to try and do a more precise job. A more precise job is because we have a ten times magnified high definition visions that can see of any organ you’re looking through robotic surgery. Surgery is a good thing, it cures a lot of people but there’s a way to go before you can say that it’s perfect. Why is it? What is it for? We are still in the early stages of robotic-assisted surgery. We continue to envision what the future might be by improving outcomes, by helping surgeons treat the patients more quickly, more comfortable, with better precision, with more information. There’s just something electrifying about that because when you realize that if you can contribute to that, then you’re actually changing the world. And robotic surgeries are creating a future of medical revolution!