Surgeries by robots, assisted and unmanned are not new. From performing robot-assisted bladder reconstructions in 2008, to unmanned heart surgeries in the present day, this technology has come a long way with benefits like reduced bleeding, faster recovery and rarer hitches.
The recovery period in an open surgery for prostate cancer is 15 days, while in a robot-assisted prostate cancer surgery, it is only one day – reduced by more than 90 percent. It comes as no surprise that one of the leading healthcare giants, Apollo Hospitals has been leveraging this technology for almost five years now.
John T Chandy, VP-Proton Therapy and Oncology Business Unit, at Apollo Hospitals, explains how the hospital took six to seven months to deploy the technology successfully. "We sent our surgeons to the US to train them and today, we ourselves run a training center for robot assisted surgeries in Chennai with over 1,500 successfully completed cases," he says. Chandy added that only surgeons who have prior experience in laparoscopy can qualify for this.
According to Chandy, the hospital currently has four robotic units in its oncology department at the centers in Kolkata, New Delhi, Chennai and Hyderabad and is planning to implement four more by 2017. Apollo uses robots in surgeries related to urology – prostrate and bladder to kidney tumors and rectal cancer.
Initially, the project was within the allocated budget, but with time and degrees of implementation, the project cost exceeded. While the centers in Hyderabad and Kolkata took longer to set up, the Delhi and Chennai centers fared better.
Chandy explains that cancer surgery was originally an open and long procedure, in which the chances of infection are also higher, recovery is longer, with higher blood loss. “We then moved to laparoscopic surgery which is used widely around the world,” he says. However, even with better tools, there are certain limitations in laparoscopy in terms of visibility.
“Sometimes the tumor is not in a region where a human hand can reach without risking the patient, which is where the implementation of robotics comes into picture,” says Chandy. With the implementation of robotics, the surgeries have been enhanced by more visibility, higher flexibility, better accessibility and lesser time offered by this technology.
How does it work? The arm of a robot is equivalent to a surgeon's arm, with attached instruments that have the ability to rotate 360 degrees. These robotic arms are controlled by trained surgeons, pretty much like a pilot operating an aircraft.
As a result, a surgeon can perform a higher number of surgeries as each open surgery takes up to six hours where a robot assisted surgery takes only half the time. “This way, the doctors are less exhausted as well,” says Chandy. He adds that other benefits are lesser cost for the patients as billing is based on hours spent in the hospital.
Additionally, each surgery is recorded and shared for educational purposes, reviewing the technique, accommodating criticism and if needed, even the medico-legal details.
What are the challenges in deploying robotics? According to Chandy, a hefty initial investment and skilful doctors in the manpower is a must. He added that the resistance to automation without understanding the technology is a big factor as well. “It is important to understand that it is a robot assisted surgery and the robot is not replacing the human surgeon,” he says.
So, will it ever be robot only? By 2018, 45 percent of the fastest-growing companies will have fewer employees than instances of smart machines. Are we really headed for an automated workforce?
Chandy does not think so. “Unmanned robot surgery will not be in the picture at least for a decade,” he says.