Indian robotic surgery

Many of India's billion-plus people struggle with a public healthcare system that is overburdened in cities and virtually nonexistent in villages.

Be it life expectancy, or infant mortality, Indian healthcare ranks way below many other countries, such as China, Brazil, Sri Lanka and even Bangladesh.

Many people are unable to access - or cannot afford - modern healthcare services.

So it's perhaps ironic that at the other end of the spectrum robotic surgery is gaining popularity in India, and has even broken new ground.

One or two small holes

Early one morning, at the Institute of Robotic Surgery in New Delhi, we meet 19-year-old Shivani Kumari, as she is wheeled into the operation theatre for the removal of her thymus gland.

Because of its central location in the upper body - and its proximity to the heart - the thymus presents specific challenges for surgery.

But Shivani Kumari looks happy and knows what's in store.

"I feel ok and not at all nervous," Kumari says. "I have heard about this technique and it [leaves no scar]. I will be going through only one or two small incisions, and that too during anesthetic period, and it will be painless. Nobody wants to make a big scar on his or her body."

Dr Arvind Kumar, director of the Institute of Robotic Surgery sits at a special console, which provides a high resolution three-dimensional image of Shivani's thymus gland.

He begins the operation after Shivani is administered anesthesia.

He controls the robot by maneuvering levers, pedals and buttons on the console with his arms, feet, fingers and wrists.

Kumar is the first surgeon to do robotic chest surgery in India. His center handles over 400 major chest cases every year.

Infant technology

"A robot with the ability to have vision on the other side because of the angulations it provides, allows us to go to the other side with equal accuracy. It's a magnificent development as far as achieving complete radical removal of the gland by just three small holes on one side. I think it is almost a revolution," says Dr Kumar.

Although robotic surgery is considered to be in its infancy in India, with over 30 multi-purpose hospitals offering robotic surgical procedures it is gaining ground.

Dr Belal Bin Asaf, a thoracic surgeon in the capital's Ganga Ram Hospital vouches for the method's increasing recognition.

"Yes, this will definitely expand," Dr Asaf says. "Currently in India we have a lot of corporate and multi-speciality hospitals coming up. When more and more people realize the potential of this beautiful machine, I guess more and more people will buy it. The current limiting factor is the initial costs involved, which in due course and with increased usage, will come down in time."

The surgical robotic system is offered in the areas of urology, gynecology, cardiology, gastrointestinal surgery, obesity, and is even used to treat some sleep disorders.

Dr Kumar says India has made great strides in the last couple of years.

"We are the only center in Asia Pacific and one of the very few centers in the world doing a procedure called complete robotic aortobifemoral bypass. In layman's terms, the heart blood vessels get choked in a disease called atherosclerosis. The same way the main blood vessel that takes the blood to the two limbs also gets blocked. And as the disease advances, you may have a danger to the limb and it may even become gangrenous," says Dr Kumar.

A major reason why robotic surgery in India has not progressed at a faster rate is its cost.

The system sells for over million euros. The added costs of annual maintenance and the disposable supplies that are needed push the system beyond the reach of many institutions and health care institutions.

Homegrown alternative

Dr Kumar says work is underway on a cost effective, efficient, and homegrown alternative. Indian innovation is a growth industry.

"There is nothing complex about these instruments," says Dr Kumar. "They are very simple instruments. It is just that as of today they are patented, but at some time the patents will expire. And after that we should make this technology available to our patients at a much cheaper price and provide a wider range of instruments than what we have today."

Robots have already had an impact on the delivery of healthcare in a way that few technologies have in the history of surgery. For instance, in the United States, over 500 robots are in use in surgery, and it's an upward trend.

As for India, Dr Kumar says robotics will help Indian's healthcare system touch parts of the country that are currently out of reach.

"We are a huge country and it would be impossible for any system to be able to provide super specialists at all places across the country," says Dr Kumar. "I look forward to a situation where super specialists will be located at certain centers and there will be satellite centers… that is what will offer the true value of this revolutionary technology and that is what is going to allow every citizen to have access to state of the art technology."