Robotic Surgery

Background

Imagine going in for radical or extensive surgery, being out of the hospital in 4 days and resume work again in another 4 – 7 days. All with, little to no scar, minimal pain and minimal blood loss. Introducing the da Vinci robotic surgery system that was developed to overcome the limitations of minimally-invasive surgery and to enhance the skills of surgeons performing open surgery. The Robotically-assisted surgery requires four to five small incisions, each less than two centimeters, except one of 5 & 6 centimeters. These small incisions heal significantly earlier than the large incision needed for traditional surgery.

The precise inbuilt movements of the robotic arms allow a more targeted approach for cleaner removal of malignant tissue with minimal damage to healthy surrounding tissue during robotic surgery. This technique seeks to improve open surgeries that have not yet benefited from other minimally-invasive techniques. Using the most advanced technology available today, the Da Vinci Surgical System enables surgeons to perform delicate and complex operations through few small incisions with magnified and 3D vision, precision, dexterity and control.

As of May 2015, 26 Da Vinci Robotic Systems are installed in various hospitals all over India..

Surgery Team

The entire Robotic Surgery team including the Surgeons, nurses and technicians, undergo thorough and structured training on the foundational understanding of the Surgical System. This includes driving the System to enhance understanding its capabilities, observing live procedures to learn clinical applications and techniques. Surgical teams also attend hands-on training sessions. Specialized training is given for cleaning and sterilization protocol of the robotic arms as well as instruments used in surgery.

Each surgeon undergoes extensive training under an experienced proctoring surgeon during their initial procedures. The combined team of Dr. Jagdeesh N. Kulkarni and Dr. V. Srinivas have performed the maximum number of Radical Prostatectomies (i.e. over 400 cases) in the country in the short span of three years. Additionally they have also performed other Uro oncological and Gynecological oncology surgeries.

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Trained Robotic Surgeons in other specialty

Thorasic Surgery: Dr. Ramakant Deshpande, Dr. Sanjay Sharma,Dr. Prriya Eashpuniyani

GI Surgery : Dr. Ulhas Kulkarni, Dr. Vinayak Jog, Dr. Rajesh Shingh

Head & Neck Surgery : Dr. Deepak Parikh, Dr. Dhairyasheel Savant, Dr. Shravan Shetty

GYN Surgery : Dr.Vrunda Karanjgaokar

Surgeon Console

The Surgeon Console is where the surgeon sits and manipulates the robotic surgical instruments. The console is positioned a few feet away from the patient. During the procedure the surgeon operates (seated comfortably at the console) using binocular, high definition, 3D image inside the patient’s body. Further the surgeon’s fingers grasp the master controls, colloquially called joysticks, beneath the head of the console with hands and wrists naturally positioned relative to his or her eyes. As the surgeon moves his hands, wrists and fingers, the instruments are duplicating the same movements inside the patient’s body. The Da Vinci Robotic System is able to scale the doctor’s motions and translate them to the operating arms during robotic prostate surgery. In fact these instruments behave like extended arms. This is the best example of Hand-Eye co-ordination. However there is a myth that the robots or machines operate and not the surgeon. Truly speaking, the robot operates on the surgeons command.

Patient-side Cart

The patient-side cart is positioned near the patient during surgery. It includes either three or four robotic arms that carry out the surgeon’s commands. The robotic arms move around fixed pivot points which reduces trauma to the patient, improves the cosmetic outcome, and increases overall precision. The arms use a technology called Endo Wrist–flexible wrists that surgeons can bend and twist like human wrists. The surgeon uses hand movements and foot pedals to control the camera, adjust focus, and reposition the robotic arms. The Da Vinci has a three-dimensional lens system, which magnifies the surgical field up to 15 times.

Vision Cart

The vision system is equipped with a high-definition, 3D endoscope (flexible tube with a camera and light at the tip) and image processing equipment that provides true-to-life images of the patient’s anatomy. A view of the operating field is available to the entire OR team on a large viewing monitor (vision cart). This widescreen view provides the surgical assistant at the patient’s side with a broader perspective and visualization of the procedure. This high-resolution real-time magnification showing the inside of the patient allows the surgeon to have a considerable advantage over conventional open surgery.

Why Robotic

Due to robotic use, the surgery is done with precision and smaller incisions, resulting in decreased blood loss, with less pain and quicker healing time. There is a marked reduction in the need for the blood transfusions, use of pain medication and duration of hospital stay. Additionally it over comes the problem of limited access to some areas during conventional open surgery, long recovery time, long hours of operation, blood loss, surgical scars and marks.

Advantages of this technique are:

• The incisions heal with little or no visible scarring and patient recovery period is short.
• Because patient recovery after robot-assisted surgery is quicker, the hospital stay is shorter.
• On an average patient leaves the hospital two to five days earlier than patients who undergoes traditional surgery and returns to work and normal activity 50% more quickly.
• Robot-assisted surgery gives the surgeon better control over the surgical instruments and a better 3D view of the surgical site.
• Surgeons no longer have to stand throughout the surgery and do not tire as quickly. At the end of surgery, the surgeon is less tired and appears fresh.
• The surgical robot can continuously be used by rotating surgery teams.
• The Surgical System integrates 3D HD endoscopy and state-of-the-art robotic technology to virtually extend the surgeon’s eyes and hands into the surgical field.
• Slim, telescoping instrument arms provide better patient access and optimal port placement.
• Together, these technological advancements provide Da Vinci surgeons with unparalleled precision, dexterity and control that enable a minimally invasive approach to many complex surgical procedures.

Safe Mechanisms

To start the procedure, the surgeon’s head must be placed in the console. Otherwise, the system will lock and remain motionless until it detects the presence of the surgeon’s head once again. In case of power outage, included in the power source is a backup battery that allows the system to run for twenty minutes, giving the hospital enough time to re-establish power. Alert mechanism in case of gas leak.

Robotic Surgeries

General surgery, Colorectal surgery, Gastrointestinal surgery, Bariatric surgery, Head & Neck surgery, Breast and Thoracic surgery, Hepato-Billiary -Pancreatic surgery.

Urology Pyeloplasty, Radical Prostatectomy, Uretero vaginal fistulae, Radical Cystectomy with continent pouch, Diverticulectomy, Vesico vaginal fistulae, Millins Prostatectomy, Radical Cystectomy with ileal conduit, Ureteral stricture repair, Cystolithotrity large / multiple, Bilateral Varicocoelectomy, Bilateral orchidectomy, Adrenalectomy, Pyelo and Nephrolothotomy, Pyleolithotomy, Radical cystectomy, Ileal conduit, Extended pyelolithotomy, Renal cyst excision, Radical Nephrectomy, Varicocele ligation, Ureteral reimplantation, Ureterolithotomy, Nephrectomy, Decortication of renal cyst, Augmentation Cystoplasty, Upper pole heminephrectomy, Bilateral Ureteric Reimplantation, RPLND, Complex reconstructive urology services, Transvesical prostatectomy with removal of bladder stones.

Gynaecology Hysterectomy for benign conditions, Myomectomy, Oopherectomy, Colpo suspension, Radical hysterectomy & oncologic clearance, Surgery for Endometeriosis.

Relative Desk

Nasser Mohammed Al-Khanjry, May 2015 “I am writing to thank you for your big support and service during my visit to Somaiya Ayurvihar – Asian Cancer Institute ( formerly known as Asian Institute of Oncology ) in May 2015. I underwent a surgery to remove my prostate and thankfully the operation was smooth. I felt the hospital really took care of me. I appreciated the level of concern throughout my trip. It helps when you’re undergoing treatment to be informed of the process and options as well as to receive good service from the staff reporting to you. Its my hope to return to India for a check up and I’m currently waiting for my local doctor to approve my trip. Up until now my health has been improving and I feel I’m doing well during the recovery period. If you have any recommendation concerning my diet, I would welcome your advice. Keep up the wonderful work and I wish you and your family good health.”

Chandrakant Pawar, June 2015 “I am very happy that all medicine requirements of the patients are procured by the hospital from its Pharmacy and also returns are adjusted from the final bill promptly. This saves lot of hassle for the patient’s relatives. I am fully satisfied the way the bill and other documents are prepared and that Insurance Companies may not call for further details. This is really an excellent job and I understand that time is required for inputs from all departments. The dietician and Physiotherapist take regular rounds and explain in detail the need for exercise. All nurses are generally courteous, cooperative and polite and look after the patient well.”