New Delhi: He looks like an airplane pilot in his cockpit. Except that he is a surgeon and he isn`t in a cockpit. This pilot in question is Prem Nath Dogra, a doctor, and he mans a surgical console. He is monitoring a robot fitted with four arms that he deftly manipulates to conduct a complex operation.
It`s a scene from India`s first robot-assisted surgery last month conducted by Dogra, head and professor in the Department of Urology at the All India Institute of Medical Sciences (AIIMS).
Along with a five-member team, he performed a `robotic anterior exenteration`, in simple words, the removal of organs towards the front of the pelvic cavity, on a 50-year-old woman with cancer of the urethra and bladder.
One arm of the robot controlled the camera and the other three manipulated the instruments. The entire process was observed via a high-definition 3D vision system.
"Unlike in an open surgery, there is no sensation of touch and the surgeon has to rely solely on visual cues. The robotic anterior exenteration was a challenging surgery, with the risk of intraoperative injury to major blood vessels, massive bleeding and also injury to the bowel and other structures," Dogra said.
"However, with the help of the robot, the surgery could be conducted quickly and safely with negligible blood loss. There were no post-operative complications and the patient was discharged within a week of the surgery."
`Articulating` surgical instruments are mounted on the robotic arms and introduced into the patient`s body through slender tubes called cannulae. The surgeon`s hand movements at the console are then translated into corresponding micromovements of the instruments. Throughout the process, the camera transmits live 3D images to the surgeon`s console.
Was he nervous or tense before the unique surgery? "When you are heading the team, you can`t be nervous or tense. Yes, I had to be careful and meticulous during the surgery, as this was a radical one where the uterus, the fallopian tubes, ovaries, bladder, urethra, anterior and lateral vaginal walls and the pelvic lymph nodes were removed."
"The urinary system is then diverted extracorporeally by joining both the ureters to a short segment of the small bowel which is then brought out through an opening (a stoma) in the abdominal wall. The urine is collected in a bag that is fitted over the stoma on the abdominal wall."
What made the four-and-a-half-hour surgery tough was the preparation for D-Day. "It was only after attaining sufficient proficiency in robotic surgical methods that such a procedure was planned. Besides the console surgeon, a dedicated team of assistants, nurses and paramedical OT staff had to be trained," Dogra said.
The robotic system that made it all possible is the da Vinci surgical robotic system, manufactured by the California-based Intuitive Surgical. No Indian company at present makes it, Dogra said.
"The robotic system costs $1 million. However, we hope that with the introduction of indigenously manufactured systems, the cost will come down. The surgery itself, however, did not cost the patient any additional money," he added.
For Dogra, achieving such a feat took a lot of personal commitment. "I underwent a training course in robotic surgery at UCI Irvine in California and have also participated in many international robotic surgery workshops while interacting with leading surgeons in this field," he said.
"Regular robotic surgeries and exchange programmes with international faculty are now being held at AIIMS," he said.
At present most robotic surgeries are carried out in the United States, he said. However, Asian countries are catching up. "There are about 50-60 robotic systems in Southeast Asia. Robotic surgeries are also regularly carried out in Malaysia, Singapore, Japan and (South) Korea," Dogra said.
"At the urology department in AIIMS, our next step would be to do advanced robotic surgery after attaining sufficient expertise in conventional robotic procedures," he said.