Dr Sudhir Kumar Rawal, Director – Surgical Oncology, Rajiv Gandhi Cancer Institute, sheds light on how robotic-assisted surgeries are not only promising us better clinical outcomes, but also making complex surgeries simpler
The role of robotics in healthcare dates to the 1980s when a robotic arm assisted in a surgery for the first time globally. The operation, a neurosurgical biopsy in the US, was a success. Decades later, in 2002, the first robotic-assisted surgery in India was carried out at Escorts Heart Hospital in Delhi using the da Vinci Surgical system manufactured by Intuitive, making the robotic arm look primitive in comparison.
Today, we are in times when advances in sensor and motion control technologies have made robots more precise, and offer more capability to surgeons than ever before. Robotic-assisted surgeries are not only promising us better clinical outcomes but also making complex surgeries simpler.
In my three-decade-long clinical practice, I have performed more than 4,000 successful robotic-assisted surgeries using systems like da Vinci. The system has enabled me to perform complex surgeries with smaller incisions, in some cases leading to less blood loss, less complications, shorter hospitals stay and fewer readmissions and faster return to work for my patients.
Robotic tools, technologies and techniques can now enable a surgical operation to be performed with better visualisation of the anatomy than was possible in laparoscopic surgery. This improved visualisation helps in the preservation of nerves and other critical structures. This is particularly important for complex gynaecologic, rectal and prostate cancer surgeries.
For me, as a surgeon, robotic-assisted systems like da Vinci have not only enhanced precision, but also flexibility and control. In fact, there are more than 21,000 independent, peer-reviewed articles that examine robotic-assisted surgery using the da Vinci surgical system and that demonstrate the safety, effectiveness and benefits of robotic-assisted surgery.
For years, laparoscopic surgery was considered as a safe and feasible option for certain cancers, including colon, cervical, endometrial and oesophageal. However, it came with its limitations—a two-dimensional image, dependence on a trained assistant to hold the camera and instruments with a limited range of motion.
With a system like da Vinci, I can operate sitting at the console unit in the OR, using my hand and foot controls, with 3-D high-definition visualisation of the anatomy, providing a clear point of view without the physical trauma of large incisions needed for an open surgical procedure. machine’s four, thin robotic arms, which hold a camera and surgical instruments, are inserted into very small incisions that are one-to-two centimetres long. The system translates the hand, wrists and finger movements of the surgeon into precise, real-time and tremor-filtrated movement of the surgical instruments positioned inside the patient’s body, which can bend and rotate far greater than either traditional laparoscopic instruments or the human wrist.
Looking at the bigger picture
Even though, currently, India has over 70 robotic installations, the number of surgeries performed and access to the technology has room to expand and make a positive impact on the country’s patients and healthcare system. According to a report, non-communicable diseases may cost the Indian economy $6.2 trillion during the 2012-2030 period. Hence, to manage the disease burden, it is imperative for the Indian healthcare industry to gear up to take major technology leaps and consider techniques like robotic-assisted surgery that offer minimally invasive surgical options to patients who may benefit.
I am optimistic – so far, I have trained hundreds of surgeons to utilise robotic-assisted surgical systems and have been impressed by how quickly younger surgeons adapt to RAS. As Indian surgeons increasingly adopt the practice, educate patients across the country and share their personal experiences with colleagues, we will likely see access to, and the impact of, RAS increase in the future.