Laparoscopic treatment for solid cancers - cancers that affect solid tissues - is all set to be revolutionised as minimally invasive robots have made their way into operation theatres. However, prices are steep: patients will have to shell out at least `2-3 lakh more in operation costs.
Dr Sandeep Nayak, assistant professor at the department of surgical oncology at Kidwai Memorial Institute of Oncology, has used these robots to perform laparoscopic procedures in Pune and Hyderabad. Nayak was speaking at the International Conference on Innovations in Biotech and Medicine 2013 at Bangalore Medical College and Research Institute (BMCRI) on Monday. He notes while robots would benefit surgeons who are used to open surgeries, their conventional use would not suit Indian patients who may not be able to afford it. “Minimal access cancer surgery (MACS) is primarily an approach that helps surgeons overcome difficulties.
Currently, surgeons rely on high-definition screens to monitor precise incisions through pre-bent instruments. Robots, however, give surgeons a great deal of flexibility. A surgeon sits at a digital kiosk that is connected to a large robot with incision arms, which he controls using joysticks,” Dr Nayak explained during his presentation.
As there are no large incisions into the body compared to conventional open surgeries, MAC procedures leave smaller wounds and cause less pain and blood loss. “In fact, MAC surgeries require 40-50 per cent less analgesics. It avoids the problem of making an incision and then declaring the cancerous tumour as inoperable,” Nayak says. Patients also enjoy faster recovery and shorter hospital stays, he adds.
Dr Nayak said these robots are very expensive and also have high maintenance costs. For surgeons, MACS has a long learning curve. The robot virtually occupies the entire operation theatre, leaving little room for an assistant to move around. Moreover, it takes a long time to dock a robot over the patient’s body, Dr Nayak says. “The question that surgeons need to answer is- at whose expense will this innovation work? Ultimately, the patient will bear these costs,” he noted.
Human Skill Still Paramount
Only da Vinci robots, manufactured by an American company, are approved for medical use. All India Institute of Medical Sciences, New Delhi, was the first to have this robot. In Bangalore, only Manipal Hospital has this system, Nayak says. Robotics in MACS is the future, Nayak argues, as it will help surgeons while performing open surgeries and not laparoscopy. These robots do away with possible sources of error such as hand tremors. “But robots are only assistants to a surgeon and not his replacement. The technique of the procedure more than the approach determines the outcome,” he adds.