The image of an operation theatre that comes to one?s mind is that of a crowded place with two to three surgeons, an anaesthesiologist and several paramedics surrounding the patient, all needed for even the simplest of surgeries. Thanks to robotic technology, several Indian hospitals may require only one surgeon, an anaesthesiologist and one or two paramedics in the operation theatre. In this nearly empty operation theatre, the doctor sits at a computer console, either in or outside the operating room, using advanced robotic surgery systems to accomplish what once took a dozen people to perform.
In recent times, Apollo Hospitals, All India Institute of Medical Sciences (AIIMS), Fortis Hospitals, Hinduja Hospital, HealthCare Global, Care Hospitals, Yashoda Cancer Institute and many more healthcare organisations are increasingly relying on advanced robotic systems like CyberKnife Robotic Radio Surgery and Da Vinci Robotic System. While the former is being utilised for giving radiation to the patients to treat various forms of tumours in the body, the latter is a robotic surgery apparatus. ?Therapeutic applications of such systems are found in cardiology, neurology, urology and cancer surgeries,? says Chilukuri Srinivas, consultant clinical oncologist at Yashoda Cancer Institute, Hyderabad.
Robotic systems like CyberKnife use real-time image guidance technology and computer-controlled robotics to deliver extremely precise dose of radiation to targets, avoiding the surrounding healthy tissue. Surgeons operate through several small incisions and remove only the cancerous tissue from the body, all using robotic arms guided by video taken by a camera controlled by a separate robotic arm. As a result, robotic systems are also able to decrease the fatigue that doctors experience during surgeries that can last several hours.
?Robotic systems are of great value and provide us with three major advances which include remote surgery, minimal invasive surgery and unmanned surgery,? says Rajendra Kumar, chief of business development at Care Hospitals in Hyderabad. ?Other major advantages are precision, miniaturisation, small incisions, decreased blood loss, less pain and quicker healing time. Virtual surgeries are also made possible and can be used to train new hands and operating surgeons can practice procedures on virtual images, before actually touching the patient,? he adds. The Da Vinci Robotic System is being used at Care Hospitals for cardiac and urology procedures.
Let us take for instance lung cancer, which could not be treated with traditional radiation techniques. This is due to the high risk of radiation damage to the surrounding healthy tissue as tumours in the lungs move as the patient breathes. However, a robotic surgery system follows the lung tumour accurately while the patient is breathing. The system uses continual image guidance technology to track patient?s breathing cycle, detect the location of the tumour and corrects the direction/angles accordingly, therefore minimising any damage to surrounding critical structures.
Similarly, tumours in the spine are challenging to treat with surgery because of the proximity to the spinal cord. However, robotic systems can track tumour and the patient?s spine movement during the treatment, hence minimising the risk of damage to surrounding tissues. Also, robotic systems have shown promising results in treating prostate cancer.
By using such systems, the treatment allows delivery of high dose radiation directly to the treatment site. Pediatric cancer patients too can undergo treatment without the painful restraint of being locked up into the large metal head frame or the physical trauma associated with other traditional cancer treatments.
All in all, cancer treatment which is usually a long drawn and painful experience is fast becoming more precise, faster and far more comfortable for the patients due to robotic radio surgery systems. Such systems can treat any brain tumour in less than 16 minutes and a body tumour of prostate, spine, liver, pancreas and kidney within 30 minutes with three to five sessions. Anesthesia too is not required, as the procedure is painless and non-invasive.
?In our endeavour to fight cancer, we have brought CyberKnife robotic radio surgery system in Asia Pacific. It is the world?s first and only robotic radio surgery system designed to fight tumours anywhere in the body with sub-millimeter accuracy,? says Prathap C Reddy, executive chairman, Apollo Hospitals. While the private sector has increasingly taken forward strides in embracing robotic surgery, the same pace is yet to be seen in public hospitals. An exception is that of AIIMS which is using robotic technology for urology and cardiac surgeries.
While robotic surgery is expected to become more popular in India, certain apprehensions remain, which largely revolve around cost considerations. However, as technology becomes more prevalent and economies of scale set in, the benefits will far outweigh cost factors, informs Kumar of Care Hospitals.