Robotic Surgery in Bellandur, Bangalore | Dr. Girish Nelivigi | Urologist in Bangalore
What is robotic surgery?
It is a new technique of doing surgery wherein the surgeon operates through a robot. It is more accurately called robot-assisted surgery as the robot assists the human surgeon.
Does the robot do the surgery?
No. It is the human surgeon who does the surgery. To understand the concept, we will discuss the three main ways in which surgeries are done.
The oldest and still widely practiced method is open surgery where the surgeon makes a cut on the skin, exposes the organ to be operated upon, and does the surgery. This results in a large skin cut with a longer hospitalization and recovery with a longer scar.
The next stage in the evolution of surgery is laparoscopic surgery or Minimally Invasive Surgery or Key Hole Surgery. Here 3-4 cuts are made on the skin each measuring 1 cm or less. Long, thin instruments are inserted through these holes, and surgery is carried out. A telescope with an external camera helps in viewing the inside of the body. The advantages of this surgery are faster recovery time, shorter hospitalization, less pain after surgery, and better cosmesis. In the last few years, this method of surgery has become very popular all over the world.
Robotic surgery is an extension of laparoscopic surgery. The skin cuts and the instruments are almost the same but the instruments are attached to the arms of a robot. So instead of the surgeon manipulating the instruments directly, he does it through joysticks which transmit the surgeon’s finger movements to robotic arms and consequently to the instruments inside the patient. The surgeon need not stand by the patient’s side while operating. He can be seated at a robotic console which can be in the same room or in the next room. Therefore, in robotic surgery, it is the surgeon who carries out the surgery with the robot as an intermediary.
So to put these three kinds of surgery in perspective, open surgery is akin to eating food with bare hands. Laparoscopic surgery is akin to eating food with chopsticks. Robotic surgery is like eating food with the help of mechanized and hinged chopsticks! As you can imagine, eating noodles using such chopsticks is much easier!
The advantages of robotic surgery as compared to laparoscopic surgery are many. They are:
As the surgeon is seated during surgery his fatigue and pain levels are much lower. This is an advantage in major and prolonged surgeries.
Better vision: A robotic system offers a much better magnification and binocular vision as compared to laparoscopic surgery. This gives more confidence to the surgeon when he has to deal with delicate structures and helps him in identifying the tissues and planes better.
Articulated instruments: In laparoscopic surgery, the instruments are straight without hinges. This makes operating in narrow and deep spaces cumbersome. It is especially so when suturing has to be done in narrow spaces. Imagine how difficult it is tying a knot using toothpicks! On the other hand, robotic instruments are hinged which means they resemble a human hand with its joints. This makes delicate tying and manipulation much easier.
Disadvantages of robotic surgery:
The biggest problem with robotic surgery is the cost. The cost of each robotic system ranges from Rs. 8 crores to 14 crores depending upon the model and whether it is a new one or a refurbished one. The Annual Comprehensive Maintenance Contract is about 10% of the capital cost. Apart from this upfront and maintenance cost, the recurring expenditure for each surgery is about Rs. 25000/- Compared to this, a laparoscopy system costs anywhere between Rupees 8 lakhs to 30 lakhs. The recurring expenditure is also low. So an average robotic surgery costs more than 3 lakhs to the patient whereas a laparoscopic surgery costs about a lakh. At present, robotic surgery in India is not covered by insurance.
Another drawback of the robotic system is that it occupies a very big space in the operating room. This is not a major problem in big hospitals but is a problem in smaller hospitals.
Setup time: It takes about 30- 60 minutes to set up the robot before starting the surgery. It is called docking time. This requires dedicated and experienced OT staff.
Where does robotic surgery stand today?
Robotic surgery has definite advantages in certain urological surgeries. These are radical prostatectomy, radical cystectomy with reconstruction, and partial nephrectomy. However other urological surgeries can be done with almost equal ease by robotic or laparoscopic methods and robotic surgery offers no advantages. But once an investment in the robot is done, the only way to recoup the investment is to use it for all surgeries even though they are more expensive. To recoup the investment, you need to do at least 20 robotic surgeries per month, but in India, many centers are not able to reach those numbers. Therefore most hospitals and robotic surgeons offer robotic surgeries to all patients even though they are not advantageous. Therefore there is a clash between ethical interest and commercial interest which is impossible to avoid.
Robotic surgery has advantages in certain surgeries but the cost escalation is very high. So before you decide on which surgery to undergo, a detailed discussion with the doctor about the cost versus benefit has to be done.