Hysterectomy is a painful surgical procedure. Post-op, the patient experiences acute discomfort and pain and takes up to a month to recover. If the uterus has been removed by cutting open the abdomen, it leaves a five to seven-inchlong scar. While a laparoscopic removal does away with the scarring, the patient still takes at least three weeks to recover fully. But Deepa Vaid, 44, was back at work within seven days of a hysterectomy. This is because a robot had performed her procedure at Delhi's Fortis hospital. The surgeon, sitting at a console, controlled the movements of the robot while looking at a monitor which provided a 3-D high-definition view of what's was going on inside her body.

"I have two teenaged children and an ageing mother-in-law to look after. I also help out my husband with his business, so I could not afford a long recovery period and therefore opted for the robotic surgery, " says Vaid. "There was minimum blood loss and hardly any scarring, I didn't even have to change the dressing. "

Robotic surgery, though very limited in its reach currently, is being heralded as the next surgical breakthrough in India. Going under the knife is usually fraught with risks of infection and a long recovery. Then in the 1980s laparoscopic procedures revolutionised the surgical experience by removing the scalpel from the picture. It involved making a few small incisions through which a camera and tiny instruments were inserted in the body to perform the necessary snips and tucks while the surgeon viewed the proceedings on a screen. Now, with a surgeoncontrolled robot, four to five, 10-12 mm long incisions are made through which the surgery is conducted. This has drastically cut down blood loss, pain, scars and recovery time. This is possible even in complex procedures like coronary bypass, cancer removals and kidney transplants.

Dharampal Singh, an affable 72-year old from Bela Gaon in Palwal, Haryana, vouches for the virtues of robotic surgery. He spends his days attending weddings, catching up on village gossip and resolving petty disputes. It is hard to imagine that the man has just undergone a coronary bypass. He was diagnosed with two blockages in his heart in January and was advised immediate surgery. "An open heart would have meant almost a month of bed rest. My father at that time weighed more than 100 kg and helping him sit up or down or get up from the bed would have been difficult for us, " says Prahlad, Singh's son who works as a constable in BSF. So, after discussions with BSF doctors, Prahlad decided to opt for a robotic bypass. "My father got admitted on January 15 and he was discharged on the 21st. It cost me Rs 3. 72 lakh but it was worth it, " says Prahlad.

A conventional bypass involves making a foot-long cut on the chest and sawing of the sternum or the chest bone. It takes four to six weeks for the bone to heal and the chances of infection are very high. In open heart surgeries almost half the patients need blood transfusion but in robotic bypass the figure is just 17 per cent. "Patients can drive or take up physical activities like playing golf in a matter of a week or two, " says Dr Sudhir P Srivastava who has performed 1, 250 robotic cardiothoracic surgeries in the US in the past decade. Last year, he set up the International Centre for Robotic Surgery in Delhi where he conducts such procedures and also trains surgeons.

Robots hold great promise for the surgeons as well. They overcome the handicaps of open and laparoscopic procedures. For instance, the human wrist can turn only 180 degrees or a bit more and a laparoscopic probe 100 degrees. This limits movement and usage of surgical tools. But the robotic arm has a 360-degree motion. The machine also makes the surgeon 'ambidextrous'. Sitting at the console, he can command the machine placed next to the operating table with both his hands and the robotic arms will execute the motion. The degree of precision is much higher. If the surgeon wants to make a cut at 37. 5 degree, then the robot will make just that overcoming chances of human error and unintentional injury to the patient. And of course, the surgeon's energy level stays high as he sits at the console rather than standing for hours at the table.

However, every technology has a downside. For robodocs the biggest drawback is their price. Any robotic surgery will cost Rs 1-1. 5 lakh more than the conventional route. At present the cost of buying one robot is approximately Rs 8 crore. "The annual maintenance bill of these machines is Rs 37 lakh. And their computer software is programmed to seal after ten usages. Such factors make this procedure very expensive, " says Dr Kapil Kochhar, minimally invasive surgeon at Artemis hospital in Gurgaon.
Another disadvantage is the huge size of the robots. It takes 45 to 60 minutes to get the machine working. This leads to wastage of time especially when there's a long queue for the OT. Robots are not ideal for certain surgeries like knee replacement and for conditions like congenital anomalies. They are also not advised in case someone's just had a heartattack and needs immediate surgery.

However, surgeons are hopeful that with the entry of more manufacturers of these robots, the cost will crash. (At present Intuitive Surgical based in California has monopolised the market with its robot called the da Vinci Arm. ) Till then more surgeons will also get trained to operate these machines. As renowned cardiologist Dr Ramakant Panda says, "Robotics will replace laparoscopy in 10-14 years. They are the future. "

BOT'S ANATOMY

14

is the number of robot surgeons India has. They operate in hospitals like Medanta, AIIMS, Escorts, Chettinad Health City, Rajiv Gandhi Cancer Institute & Research Centre and Asian Heart Institute

8

crore is the cost of the Da Vinci robot

1-1. 5

lakh is the additional amount you spend if undergoing a robotic surgery

40

times magnified highdefinition 3-D view aids the surgeon Robotic surgery is covered under health insurance

45-60

minutes are required to start up the robot The surgeon places his fingers on 5 rings hanging at the console and controls the robot by pulling the rings, just like a puppet