Robotic-Assisted Surgery (RAS) is a surgical procedure that involves robotic instruments to treat patients with diseases such as colorectal cancer. As opposed to the traditional surgical methods, robotic surgeries are deemed less "painful" with "fewer complications" according to Intuitive India, one of the companies that has been working in this space since 1995. This surgical method is also said to result in less blood loss as well as have a faster recovery rate. Although robotic surgery has been a part of medical science for over 25 years, its demand appears to be increasing owing to the coronavirus pandemic. This is mainly because RAS, unlike traditional surgeries, physically require less doctors or surgeons in the operation theatre. The technology to carry out robotic surgery is also improving with the entry of new players and the introduction of 5G/ 6G networks.
With better connectivity options, experts claim the RAS can transform into telesurgery (or remote surgery) that will further allow the treatment of patients without having the surgeon physically present in the same state or even country.
The demand for robotic-assisted surgery in India is also high, and the country over the years has installed more than 70 robotic instruments across locations such as Delhi, Mumbai, Bengaluru, Chennai, and Kolkata. Most of these consoles are provided by the Silicon Valley-based company, Intuitive which pioneered the da Vinci surgical system. Notably, there are 70 da Vinci systems installed in India, according to the company.
In November 2019, the Government also introduced its first public RAS facility at Safdarjung hospital in Delhi. With this development, the Government aims to bring robotic surgery technology at public hospitals to treat patients for free. Similarly, RAS, by its nature is capital intensive, and the cost associated with this procedure is also high. Further, the RAS may likely be useful amid the pandemic; however, the robotic surgical procedure demands highly skilled surgeons.
To learn more about RAS and its growth in India, Gadgets 360 spoke with Dr Venkatesh Munikrishnan, who is a Consultant Colorectal Surgeon and Clinical Lead at The Institute of Colorectal Surgery, Apollo Hospitals Chennai. Dr Munikrishnan has been performing robotic-assisted surgeries for over four years and comes with 23 years of experience. These are the edited excerpts from the conversation.
What happens during robotic surgery, and why is it considered advantageous?
During the RAS procedure, there's a console where the surgeon sits, and there are joysticks through which he operates. Next to the patient, the robot with arms carries instruments that go into the patient. These instruments are miniaturised that mimic a surgeon's movements so that it is precise. The robot also gives a ten-times magnification and 3D view.
Those are the advantages of RAS compared to open surgery or laparoscopy.
Why are robotic surgeries important amid the coronavirus pandemic?
The main difference here is being socially distanced. We don't need that many people around the robot as it has arms that will help in surgery. So, you will need only one [surgeon] instead of three, and the surgeon is also not next to the patient as he is sitting with the console away. This console can be as far as possible from the patient.
In the context of the COVID-19 situation, there were concerns regarding the aerosolisation of the virus as you need to inflate the abdomen with gas to create the space to operate. Now, that concern has been addressed.
Secondly, infection rates or wound infection rates are fewer compared to laparoscopy or open surgeries. The more contact you have, there are more risks of transmitting virus as well as bacterial infections. You are also moving the team including doctors and support staff away using this technology to do most of the technical work during the surgery.
Is RAS popular in India and what kind of surgeries can this technology perform? Also, how is this going to evolve in the future?
Currently, there are around 80 RAS instruments across India, and Apollo ecosystem probably has the maximum number of robots. Most of it is in the the Urology and Gastrointestinal space, but it is also getting popular in general surgeries. Some gynaecology and head and neck surgery usage are there as well.
If this technology were to evolve post-COVID, and we know that the ratio of doctors-to-patients in India is less - that too expertise in areas such as colorectal cancer surgery is not easily available. So, we can place a robot next to the patient and send a support team to perform such types of complex surgeries. The specialised surgeon can be miles away or in a neighbouring city, but still be connected with the robot via the internet/5G.
Who are the key providers of RAS technology?
We [Apollo Chennai] are using an Intuitive surgical robot, and the latest is the fourth-generation da Vinci Xi model. This is probably the most widely used robot around the world. There are newer ones, such as CMR (Cambridge Medical Robotics) that have entered the market. Johnson & Johnson and Medtronic also have robots in development. There are several robots in development too, but I think Intuitive is a front runner because they've been in the market for a long time.
What are the challenges associated with robot surgery in India? Are doctors apprehensive about RAS?
One is access to technology as they are expensive. But with more companies coming into the foray, the cost may go down. Also, more insurance is coming to play, insurance companies will cover the cost [associated with this procedure].
But to address cost, you also need to be efficient. It doesn't matter whether its a private hospital or a government hospital because someone is paying for it. If we become efficient to carry out this procedure, the cost will go down [as more patients are being treated in less amount of time].
We also have a reluctance to anything new, right? And in this profession, you always keep learning. So surgeons have to adapt, adopt, and get trained.
How is telesurgery going to help and where is it leading at the moment?
As I said that the expertise level is limited, so the technology has to evolve. You will plug this [RAS console] to 5G/6G network and bring this expertise across the country. The only thing we need to figure out is to how to make this [telesurgery] cheaper so that every patient can benefit from it.
Also, the next thing with this technology is that you can get augmented reality to come and assist you. It's just a matter of time.