New Delhi: Kathija, looked peaceful as she lay on the operation table at Sparsh Hospital in Bengaluru, and Mako, a surgical robot, went into action. She had stage-4 arthritis in both knees, and had been confined to her home for many months. She finally decided to undergo a knee replacement surgery, hoping to relieve pain and reclaim her social life.
With its long, slender fingers and superb surgical skills, Mako stole the show at the operation theatre. Be it creating a 3D model of Kathij a’s joints based on CT scan reports, creating boundaries, removing bits of the patient’s knee or making precise bone cuts, Mako leaves one wondering about the blurring lines between robots and humans.
Once the surgery was done, the jubilant team of surgeons at Sparsh collectively said, “Thank you Mako!” I looked up to see whether Mako smiled or bowed its head. Dr Sharan Shivraj Patil, chairman and chief orthopaedic surgeon at the hospital, told me that Mako cannot smile back. Not yet! But it can put a smile on the patient’s face. “The pain is less and the recovery is faster. Even infection rates are less,” says Dr Patil.
At Sparsh, around 75per cent of the knee replacement patients opt for robotic surgery. Mako comes in handy in hip replacements as well. “How much of bone should be cut is decided by the robot, based on our capture of anatomy and CT scan reports. This helps surgeons plan the surgery better and calculate the size of the implant accurately. We have never had to change the implant size,” says Dr Patil.
Surgical robots have been game changers. They are now being used in brain, spine, lung and heart surgeries. “Now we have robots not just for doing regular surgeries like knee and hip replacements, but also for abdominal surgeries that includes gynaecology, urology, colorectal and prostate surgeries,” says Dr Rooma Sinha, senior consultant gynaecologist, laparoscopic and robotic surgeon at Apollo Hospitals, Hyderabad. The robots, she says, are becoming more user-friendly, and more acceptable to patients.
Rohini Lal (name changed) from Ahmedabad would vouch for surgical robots. The 46-year-old had abnormal bleeding, was diagnosed with uterine cancer and underwent a robotic surgery at HCG Cancer Centre, Ahmedabad. “Her uterine cancer was thoroughly excised, with minimal impact on surrounding healthy tissues,” says Dr Kalpana Kothari, a gynaecologic oncologist and robotic surgery expert at the centre. Rohini’s husband, Lal, says his wife’s post-operative pain was much less, and recovery faster because of the robotic surgery.
Better than humans
Robots are better surgeons than humans in many ways. Robotic wrists rotate 360 degrees. Using the joystick, the surgeon can curve the scissor upside down. It enhances precision and causes less bleeding and damage to surrounding tissues. It also gives the surgeon more control. The camera that goes in gives a 3D view, allowing the surgeon to see the internal organs clearly. The camera also gives a magnified view of the area to be operated on.
At an operation theatre in Manipal Hospital, Bengaluru, Jatin Prakash (name changed), a 46-yearold patient is about to be operated on. Prakash was diagnosed with a kidney tumour following a health check up.
Dr Deepak Dubey draws our attention to a 3D monitor that shows a small blood vessel that’s going into the patient’s kidney. Dr Dubey, HOD and consultant in urology, robotic surgery and renal transplantation, takes special care to preserve the vessel. “Since there is no bleeding, people recover faster, and they experience less pain. Within a week or ten days, they are back to work. Traditional methods would require the patient to take rest for a month,” he says.
Dr Dubey and his team currently use the fifth-generation Da-Vinci robotic system. Da Vinci is a great tool for surgeons for operations on the heart, lungs, food pipe, chest and other organs deep inside the body.
Can robots use their discretion and perform surgeries on their own? Currently, robots are operated and controlled by surgeons. In the future, we may have robots that are more self-reliant and autonomous. Every time a robotic surgery is performed, the data is stored in the cloud. Once enough data is available, experts say artificial intelligence (AI) could be applied on it for robots to act autonomously.
Dr Patil finds it exciting that even a young surgeon can now produce results as good as those of senior surgeons with the help of surgical robots. Senior surgeons also have reasons to rejoice. “As you age, your diagnostic skills and ability to resolve a problem get better. A surgeon is at his or her peak around 55, as far as motor skills are concerned,” says Dr Patil. But then the journey downhill starts. “With robots, you can go on for much longer, because they take away the need for great motor skills,” he says.
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