‘The robotic system offers certain distinct advantages over conventional laparoscopic surgery’

In times when the world argues on how much robotics can replace human touch, Dr Gagan Gautam, Head – Urologic Oncology and Robotic Surgery, Max Institute of Cancer Care, Max Super Speciality Hospital, Saket, is successfully conducting robotic-backed surgeries. He believes that this field has immense scope and in times to come will play an important role in changing healthcare delivery. Raelene Kambli interacts with Dr Gautam and Dr Harit Chaturvedi, Chairman – Max Institute of Oncology, Max Super Specialty Hospital, Saket, to understand how this robotic system has benefitted the hospital and its profitability

Tell us about the characteristics and functionality of the da Vinci Surgical System?

Dr Gautam: At Saket, we are equipped with the da Vinci Xi robot, which is the latest generation robotic surgical system developed by US-based Intuitive Surgical. It consists of a patient-side robotic ‘cart’ – a machine with four ‘arms,’ which hold the telescopic camera and surgical instruments. These are inserted into the patient’s body through very small cuts (miniature incisions). These instruments are controlled by ‘masters’ (which can be equated to mini joysticks) located at the surgeon console. A console is like a flight simulator situated in the same operating room as the patient is undergoing surgery. The surgeon controls the movement of the robotic arms by making precise movements with his/ her hands while holding the master controls. It is important to note that a robotic surgical system is not a ‘robot’ in the real sense of the word. It is not capable of any independent actions or movements. It just translates the movements of the surgeon’s hands into those of the surgical instruments.

The robotic system offers certain distinct advantages over conventional laparoscopic (keyhole) surgery. The tips of robotic instruments can be moved in all possible directions due to the presence of a wrist joint near the tip (an ‘endowrist’). This along with the scaling of movements (the instrument moves one inch for every three inch movement by the surgeon) affords a very high degree of accuracy, which is unprecedented in the history of surgical science. The telescopic 3D camera which magnifies the view of the surgical field up to 10 times also plays a major role in providing millimetric precision to robotic surgery, something which greatly helps the surgeon to remove cancerous parts/ organs while avoiding damage and complications to other normal parts of the body.

How is this system enhancing cancer surgeries at your hospitals?

Dr Gautam: Since September 2015, when this system was installed at our Saket facility, we have operated almost 200 cancer patients with this technology. It has been used most commonly for cancers involving prostate, kidney, urinary bladder, large intestine, rectum and uterus. However, the applications of this system are many. It can even be used to operate tumours in the chest and throat. With multiple cancer specialists picking up robotic surgery, this field is bound to expand rapidly and many more patients will hopefully be benefited by this latest surgical advancement.

What is the cost effectiveness of this system in the long run?

Dr Chaturvedi: Though it has cost us a fortune to install the daVinci Xi system at our facility, I strongly believe, that there should be no reason to compromise on the health services we have to offer to our patients. If there is any recent technology established to be of proven benefit to the patients, then we must have it. After all, if we have the best men and we focus so much on processes, quality control, we must have the best technology. This trio in an academic environment contribute to delivery of latest therapeutic options to our patients.

What is the cost difference of robotics-led surgeries in comparison to the surgeries conducted by the team of doctors at your hospital?

Dr Chaturvedi: The improvements in patient parameters, such as reduced need for blood replacement, lesser need for post-operative pain killers, shorter duration of hospital stay, and earlier return to work significantly bring down any cost differences for robot-led surgeries in comparison to the conventional open surgeries along with the benefits of faster recovery. The related complications both in short term like wound infections, paralytic ileus, sub-acute obstructions and long term, for example, incisional hernias have actually proven that this technology brings down the cost. There are studies where, in the group of patients who had robotic surgery the cost was lesser compared to laparoscopy or open surgery

When do you think, you will break even on the investments you have made in installing this system?

Dr Chaturvedi: I don’t think it is fair to compare a long-term goal to a short-term one. The quality of healthcare we intend to offer would change the outlook of cancer treatments available in India. We want to provide ‘cutting-edge’ technology in cancer care and eventually bring it to within the reach of everyone. We have made break even, the day we acquired this. If we do not adopt the relevant modern tools, we actually get left behind in this fast moving world. Getting the modern tools also help in getting top professionals and in creating the right environment for good professionals to thrive. Having said this as we have said, this technology is cost effective for all the stake holders.

Exactly how do you see this technology shifting the landscape of jobs within the healthcare space?

Dr Chaturvedi: It won’t. A robotic surgery is not an automated surgery being performed by a robot independently. Instead it is a surgery where the robot gives more control to the surgeon. It gives a magnified, 3D view to the surgeon and improves precision. Like most of the modern technology, robot has not laid off people. The skill set requires further training in certain areas. We have to focus on improving the care and clinical outcomes for our patients and society at large. The healthcare sector as a whole is short on manpower by about 25 per cent. There is no question of limiting opportunities, in fact this will lead to better opportunities for better trained workers.

Some experts are of the opinion that increased adoption of robotics in healthcare practice can cause decoupling of productivity and employment. What is your opinion on the same? What precautions should be taken to prevent this?

Dr Chaturvedi: When laparoscopic surgery came to India about three decades ago, it was not immediately adopted by everyone. But now, we understand its benefits, and the technology has percolated up to the grass root levels across the country. Basic laparoscopic surgeries are being conducted even in the remotest peripheries, without causing any such decoupling. The benefits of technology will eventually seep through. As in laparoscopic surgery, the need for staff in the operation theatre has not gone down. The productivity goes up along with the employment. The staff is less fatigued and more productive. It’s an interesting era where the nature of jobs is continuously evolving, all this for the larger good.

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