Revolution of Robotic Surgery in health sector

Dr. Rooma Sinha

Revolution of Robotic Surgery in health sector

Why are women afraid of surgeries?

- Women are mothers, wife, they take care of the family. Their first reluctance in coming to hospital for surgery is that they have to be away from their family and of course, the regular fear of pain what will happen after the surgery and all these factors. But the main factor that prevents them to take a decision for surgery is that they have to be away from their family. So when they tell the woman that you need a surgery, the first thing she asks, how long do I have to be in hospital? How long do I need bed rest? And when can I go back to taking care of my family or go back to work? At that is the reason why we try to do surgeries in a manner today that the patients need to visit the hospital minimum and stay in the hospital as minimum as possible, recover very fast without much pain, and so that they're able to take care of their families.

2.What is the women's health ratio from past 25 years, or they, are taken care or neglecting the health?

- Women, by and large, don't take care of their health as the foremost issue in their life, they always bring the good, good health or well-being of their children, of their husband, of their family before their own problem. So I find that women reach to us only when the problem is beyond was their able to handle. So this is one problem, I think, especially in Indian women, that they don't really come forward with their health problems very fast. One example I will give you of elderly women, especially the grandmothers. A common problem in women is post menopausal bleeding. But many of these women will keep quiet. They'll think, oh, it will go back. Let me not disturb my son or my daughter in law or my other family members for this little problem. But they must understand that this sign of bleeding in the post menopausal age group can be a sign of uterine cancer. And if detected early, we can treat them completely. But many times we find that they come late. They have had been having bleeding for maybe six months, one year. By the time they come to us, they already have developed cancer. So this is small things which women neglect, but they should come forward as soon as they form a problem because the earlier they come better outcome we can give.

3.What is the main cause of several health issues in youngsters?

- Yes, to the young girls, I really want to talk about them all the time, and this is one of the social initiatives that I take that I actually take a lot of public related health talks to talk about it. The commonest problem that young girls walk into my office is some kind of period problem, and that is usually delayed periods, weight gain and commonest diagnosis. They come with already diagnosed or they come with what we call as a PCOS with a polycystic ovary syndrome. What these young girls need to understand is polycystic ovary syndrome. And that is why we call it syndrome, not a condition, because it's a syndrome of things which remained with the girls all their life. It is not that I can do magic when they give them one course of medication and they will become better. It is a lifestyle disease. It is something that is happening to our young girls because there is lack of exercise. There is a lot of pre processed junk food in their diet and they are obese. So these three factors, if they look into most of them, can actually improve their health themselves. So young girls must ensure that their weight is normal, which is in the normal BMI or something about 18 to 22. They eat right. And they exercise every day. Today, in this era of everything online, everybody is sitting much more than what they were doing earlier. So we have to make an effort to exercise or to move around or to use our body. The weight is meant to be. So this is something which young girls need to be aware of because PCOD they may come to us today with just period problem, but it has a long term implication that means it is associated with long term development of diabetes, long term development of other metabolic conditions. They may have a ovulatory function problems so that they have difficulty in getting pregnant. So it has implications for many stages in their life. So if they take right now, they can maintain better health.

4.Many ladies are suffering with either obesity or emaciation (low weight) what is the cause?

- Obesity is what slowly gets into us, and we don't realize by the time we realize that we have already become obese and then it becomes very difficult to lose. So maintaining a good weight is probably one of the most important thing. As a person, you can intervene weak women more often are because of development of anaemia or other deficiencies, because the diet is not sufficient. They are probably bleeding heavily during the periods, but ignoring that fact. And many times these women who have heavy bleeding leading to anaemia and weakness can be treated with simple medication. All they need is to seek help at the right time. The other factor, the other classic class of women today are also the Google hunters for a simple problem. They will think that the worst has happened because they will look into so many symptoms and the Google baba will give them an answer, which probably is not true. So I would suggest that if you think anything is happening, which is out of the ordinary, it is better to seek medical help rather than take it with the fact that it may go away or there is something very serious to me either.

5.What is Role of Robotic Surgery in Modern Surgical procedure?

- When we talk about robotic surgery, we have to understand the background of surgery. If you look at centuries of surgery was performed right from the day of 6th century B.C. where surgery was performed on the banks of the River Ganges by Shushruth. And then came development of anaesthesia, pain medicine, antisepsis. And so surgery came to the operation. Theatres and big surgeries were performed at that point of time. The bigger the incision one surgeon would make, the bigger the surgeon would be. But that was not going really good to the quality of life of the women or men who were undergoing surgery. And that is why three or four decades back, the technology of doing keyhole surgery came. At that time that was also brushed aside thinking into something new and probably will not be help. But today, that technology, as we know, as laparoscopy, is here to stay. Everybody knows about laparoscopy. All patients want their surgery. And why not? Especially in gynaecological surgery. There is no surgery that we cannot do by minimal access or keyhole surgery. But the problem is that these are difficult surgeries to gain skilful. It takes a long time for a surgeon to gain the skill to be able to perform these surgeries for these women perfectly and in all situations. And that is the reason robotic surgery today is a logical step in improving these minimal access or keyhole surgery to be able to do more and more surgeries for women. Now, why are we moving into more technology? It's true for every field of life. And if you take just a simple form of communication now, about 10 years back, almost everybody had a Small phone with where you could punch in some numbers, make a call, receive an SMS. But today, nobody wants to have anything less than a Smartphone for simple reason for communication was given that phone as well as your Smartphone. So I jokingly tell my patients that a robotic platform for me to operate is like a Smartphone. I get better technology in terms of I can see better because I'm working at a 3D vision with ten times magnification as compared to what I was doing in laparoscope, which was a 2D vision with three or four times magnification. The laparoscope give me long instruments which were difficult to manipulate. While robotic instruments are intuitive, they move like my hand is as if I'm doing an open surgery, but with minimal access to me. Because of magnification of robotic surgery, I can do more precise surgery, less blood loss so there is no need for blood. Pain is less. There is less tissue damage. We are able to send women home the same day, a maximum next morning. So that is the advantage for the patient to embrace technology when they want to get this surgery done. So this is the advantage of robotic surgery in contemporary times.

6.What is the difference between robotic surgery and general surgery and laparoscopy?

- So there are basically, if you ask today, there are basically two forms of surgery. One is an open surgery and the other is a minimal access or keyhole surgery. The open surgery is still valid for some conditions. And if you ask me, in gynaecology other than carcinoma of the ovary, the rest, all gynaecological surgeries can be done by keyhole surgery in the keyhole surgery. The technology that is available now everywhere is laparoscope. But not many surgeons are able to do all surgery laparoscopically across all spectrum of disease. So the newer technology that has now added onto the laparoscopy is the robotic platform. It's a logical advancement of laparoscopic surgery. Differences feel. One is the way we see, and that is very important because what we see, we operate in a laparoscopic surgery. We have a 2D vision in robotic surgery. We have a 3D vision just like we are seeing right now. But in a 2D vision, I have to my mind, does work more to understand a 3-D pathology and 2D screen to be able to operate. We understand. We learn, we do. But it's difficult. The second is the use of instruments now instruments and laparoscopic surgery, as we call it in our language spestick That means it is just a stick with which I will try to manipulate and do the surgery. However, in robotic surgery, it is like my wrist so I can move my hand, the instrument, just like my hand inside the patient and perform the surgery better. There are various other advantages that you can see, the amount of blood loss, the pain, quick recovery, all those things that are much more with robotic surgery as compared to laparoscopic or even open surgery for that matter.

7.Which type of robotic surgery is special in gynaecology?

- Before we understand what surgeries we can do in gynaecology, I must also clear some myth, robotic surgery by name means. There is some robot, but there is no robot. It is a computer assisted surgery, so the surgery is as good as the surgeon. So the surgeon's technical knowledge gets extrapolated by this computer enhanced technology to be able to do this. So there is no robot, there is nothing automatic going on. It is a surgeon who is performing. So that myth, I suppose, should be not entertained in anybody's mind. For women in gynaecology, the commonest surgery we do is basically for fibroid uteruses, where we remove the fibroid and save the uterus for young women who are wanting to get pregnant. We do surgeries for patients who have problem of endometriosis, which is a chronic inflammatory problem which affects your ovaries, uterus, pelvis, giving you chronic pain, infertility. We also do complex hysterectomy, which are difficult to perform. Otherwise we do cancer surgeries for cancer of the uterus, cancer of the mouth of the uterus and so and so forth. We do surgeries for patients who have urinary leakage and that is the kind of surgery for fistulas and things like that. We do we can also do for some of the prolapsed kind of problems that the women have. So there is various problems in women on gynaecological issues that they have can be performed by robotics today.

8.Can we do any kind of surgeries of robotic surgery?

- Any surgery that a woman needs today can be done robotically and it is the women's prerogative to be able to get access to be able to have their surgery by keyhole surgeries. There is no need or there is really no requirement for any woman to be undergoing operative surgery, which is open in nature today. We have technology, we have skills, and especially at Apollo hospitals across the country. We have enough technology and skills to be able to help women to have minimal access surgery. And that's what we have today. I'll also be talking of Fast-Track surgery now today with the Covid time, we have also understood the importance of telemedicine. So what we are offering to women today is a kind of Fast-Track surgery where we do most of the counselling and talking to the patient on a telemedicine platform. So video consultation to understand the patient's problem, look into her reports, make a decision whether she needs the surgery or she doesn't need a surgery. And then the patient is actually asked to come for a physical consult where the patient is examined. A final decision is made. The patient is examined by the surgeon by the anaesthetist. All the paperwork is done and the patient is sent to home. The patient that finally comes on the day of surgery, gets the surgery done, most often goes home the same evening on maximum the next morning. So that is we are addressing to the fear of women, of not being aware of being away from their family when their advice to surgery. So today we are able to with our telemedicine platform, with our platform of doing all this high technology service with Apollo Homecare, which can actually also give them a home care assistance if they need. Later on, we are able to manage patients at their home front with the cutting edge technology.

9.Does any age restriction in robotic surgery?

- There is no age restriction, so even for elderly women, for obese women, these are some of the women's where we would electively advise this type of surgery, mainly because they have very quick recovery they do need to be lying on the bed for too long. And that's the advantage.

10.What kind of awareness is needed for robotic surgery, especially among women?

- Awareness regarding I say I would I would take an example of a very simple problem, dysmenorrhoea, and that is painful periods now, painful periods can effect women who are under 16 and 17 years old to 50 years old. But when they are young, most often it is brushed aside and saying it is part of growing up. It will go away after some time. But one must remember at dysmenorrhoea, which is incapacitating, can be a clue to an underlying disease, and that is a disease is what we call as endometriosis. It is seen on an average that one in 10 women suffer from endometriosis, that about 25 million women in this world who suffer from endometriosis. This is such a common problem that women take about six physician visits to be able to come to the right place, that a diagnosis is made often about five to six years of their life or the disease process is wasted before their diagnosis of endometriosis has made. So awareness about the disease is much more important to be given in the society. And then when they understand that the disease requires medical help and if that medical help is in the form of surgery, we would like to address this to the women of this country that all gynaecological surgeries today can be addressed by minimal access surgery, maybe laparoscopy, maybe robotics, depending upon your disease process, depending up on the severity of disease process, very rarely you would need an open surgery. So that is something the women of this country need to understand and look for when they need a treatment, especially surgically.

11.Is robotic surgery used for small surgeries or a very typical kind of surgeries?

- At the moment, robotic surgery is offered for that are complex and critical surgeries because we also have technology and skill to do laparoscopic surgeries. So many surgeries today, both laparoscopic and robotic, to complement each other. They don't substitute each other. So it's a complementary product here which actually complements the severity of the problem. So if there is a very complex problem, which is maybe difficult to handle by laparoscopy, we offer them robotic surgery. So robotic surgery is gaining acceptance because complex problems are the ones we handle here at Apollo hospitals very often.

12.What kind of the Advanced surgical technologies are available in Apollo hospital?

- We have for the state of art Da Vanci robotic platform to do robotic surgery at Apollo hospital. We were one of the first hospitals in Hyderabad to adopt this technology. And we have been doing robotic surgery for the last eight years since 2012. It's a multidisciplinary department. So many departments use this other than gynaecology. However, in gynaecology, we have taken the lead in this country to offer robotic surgery for complex gynaecological problems to women. So today, Apollo Hospital gynaecology department here, along with me as one of the lead faculty, provides one of the largest numbers of robotic surgery for the whole country.

13.How are the results in robotic surgery? What kind of response is there from patients?

- Robotic surgery for patients is a very comfortable surgery because, as I mentioned, they come on the morning of surgery and either go the same evening or the next morning, the pain is minimal. They very rarely required any kind of blood transfusion. When the patients have this kind of surgery, they are put back on their oral feed within three to six hours. They are back on their feet the same evening. They are able to walk up to the washroom. They can go, they can eat, they sleep well. So they most of the patients up to two or three days tell me they don't even feel they had a surgery, which is the biggest advantage and accomplishment that that we get after doing robotic surgery for patients.

14.Post operative checkups are needed in normal surgeries, what about in robotic surgeries?

- These kind of minimal access surgery, the multiple times patients did not come back to us and the technology that we are using today, we are actually often talking to patients online or on video consult within a week of the surgery and understanding what the problems are. Very rarely a patient actually needs to come back to us in the hospital for anything because there is really nothing we need to do for the patient, although there are hardly any stitches that are mostly just to be removed. There is no pain. Patient is taking oral medications, oral feed, so there is no need for patient to be coming to the hospital again and again. So we manage the patient with minimal visits to the hospital.

15.Can we do big surgeries in robotic way?

- We do big surgeries only on robotic surgery, the complex patients who take high skilled kind of surgical expertise are being offered robotic surgery, and we are able to do give good outcome with minimal discomfort to the patient in quick recovery.

16.What awareness you are going to bring in public about robotic surgery?

- For public to understand is, first of all, to understand that there is no myth. The second thing, that public has a concept that robotic surgery will take very long, which is not true, that those were the days when anything is new. It takes longer time, but it takes people to settle down. But here at Apollo Hospital, we have been doing for eight years today our robotic surgery timing is probably at par or even less than what we were doing in the surgery. The third thing that the public understands is robotic surgery is expensive. Yes. If you look at the end of the date, you may feel that robotic surgery is expensive, but you have to look at the overall picture. Now, the overall picture talks about not just that the amount you spend just for the surgery, but it's the it's the workforce or it's the amount of the productive base that you gain by quickly recovering is what compensates for what you do. Many of us may feel do not feel anything in spending money for an expensive holiday or an expensive anything else. But we always feel the pinch when there is an expensive form of treatment, but we have to understand that technology is improving the life in every field. Way Medicine should be left behind by surgical specialties, should be left behind and not use technology to give the best to you. And that's what we are trying to do by using robotic technology in day to do surgical armamentarium.

17.Being a gynecologist what message you're giving to the women?

- To my women in the society, I would say you are the best you are the most hardworking force here. I also understand that women work double or triple times anybody around them. They are always on their toes trying to make something or the other better, either in their professional front of their home front. What you need to understand? I have to give you the example of the Airline. Now, when there is a low pressure in the airline, what do they say? Put your mask first and then attend to the next. That same holds to your health. Take care of your health first and then take care of everybody else, because if you remain healthy, you are the leaders of your family and the society. You are healthy. Everybody is around you, is healthy, you are happy, everybody is around happy. So that is one message which I have learned the hard way and I would like to impart to all the women there.