Latest / Health Wealth / Does the Robot Actually Perform Your Surgery? The Truth About Robotic Heart Surgery | Doctor vs Internet

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Does the Robot Actually Perform Your Surgery? The Truth About Robotic Heart Surgery | Doctor vs Internet · Health Wealth

0:00
Speaker 1: This is india today podcasts.
0:04
Speaker 2: Traditionally when we do an open surgery so we have
0:07
to open the chest then we split it up and
0:10
go inside the heart and then perform the surgery it
0:13
alters your physiology if i do the same thing uh
0:16
without opening the chest, patient have no pain, no trauma,
0:28
no blood loss. Now, robot has gone to that level.
0:31
I can do the surgery in the morning and patient
0:33
can be having coffee in the evening. What do you think? Yes.
0:37
When we do an open surgery, the cut is around
0:39
10 to 15 centimeter in front of the chest. There
0:41
should not have a cut in the chest, according to me.
0:44
That's an injustice. You may feel normal. You may look normal.
0:48
But that stigma is always there. You see the amount
0:51
of loss you have got from the whole family. So
0:53
much of blood loss. So much of trauma. And on
0:56
top of that whole thing, the patient who is going
0:58
through it, you know, he has a big psychological impact
1:01
on his life. He thinks that my chest is open.
1:04
I am no more, you know, useful for anyone. That
1:07
has to change now. And mark my word, after five years,
1:10
most of the leprosy will be gone by. I want
1:12
to do robotic surgery. Anything will happen. They... Have a
1:15
feeling in your mind that everything can be done robotically.
1:19
Answer is no.
1:21
Speaker 1: For what diseases or what operations will you say we
1:24
must use a robotic arm? Robotic surgery doesn't mean that
1:27
only robots are doing surgery.
1:29
Speaker 2: You are the captain of that ship or that aircraft.
1:33
They have to listen to you. You run like an
1:35
Airbus A380.
1:37
Speaker 1: Can I ask you a very silly question?
1:40
Speaker 2: Yes.
1:40
Speaker 1: But I'm sure this is a question on everybody's mind.
1:42
If you are doing robotic surgery... If the light goes off,
1:47
what will happen? Tell me exactly what the robot looks like.
1:52
How are you running it? You gave an example of
1:55
an Airbus. I'm thinking of something like a Transformers. Hello
2:01
and welcome to Doctor vs Internet. I'm Sonal Mehrotra Kapoor.
2:04
Today we are going to talk about a subject that
2:06
is of huge fascination. One topic on which a lot
2:10
of innovation is happening in the country. I'm talking about
2:13
robotic surgery and robotic surgery specifically in the area of heart. Now,
2:19
you must have seen these ads all around, doctors are
2:21
talking about it, but patients are little apprehensive. How to
2:27
decide if you want to go for a robotic surgery?
2:31
zyada precise hota hai? Kya iska recovery time zyada ya
2:35
kam hota hai? Kya doctor actually mein surgery karte hai
2:38
ki robot surgery karta hai? And what happens if the
2:40
light suddenly goes away? What exactly is the truth? Ye
2:43
saari baate karne ke liye hamare saath hai Dr. Rithvik Rajbhujan.
2:48
Thank you so much for joining us, sir. He's a
2:50
senior director of Cardiothoracic and Vascular Surgery and also the
2:53
lead of Robotic Cardiosurgery at Fortis & Scott. Thank you
2:57
so much for joining us, sir. You have loads of
2:59
experience in understanding and playing around with robots. So this
3:04
is going to be a fascinating where I am looking
3:06
forward to learn a lot more. And my real hope
3:09
with this podcast is that those who are watching this,
3:12
those who face this question, whether you want to take
3:14
robotic surgery or not, So, are you ready?
3:21
Speaker 2: Yes.
3:22
Speaker 1: So, first, why don't you start by telling us a
3:24
little bit about what exactly is a robotic heart surgery?
3:29
And robotic surgery doesn't mean that only robots are doing surgery.
3:34
Speaker 2: Thank you, Sunil. I think you asked a lot of
3:36
questions at once. So, let us answer one by one. So, Sunil,
3:42
before you understand how a robot performs a surgery, we
3:45
should know... For people's knowledge, for normal information, we should
3:50
know what a heart surgery means. And you'll be surprised
3:55
to know that heart surgery is not a very old specialty.
3:59
It's very recent. Because our surgery started only in 1960s.
4:02
Till 1960s, all of us died of heart surgery. All
4:09
of them used to die. Why? You ask me? Because
4:12
at that time, there is no... material, no process to
4:17
stop the heart. That's the biggest contribution to the mankind
4:23
that we have the heart-lung machine in 1958. That means
4:26
we can stop the heart safely and perform the heart surgery.
4:29
Suppose there is a hole in your heart, in someone's heart.
4:33
How will we close it? How to close this heart?
4:35
For that, I have to stop the heart. So that
4:37
technology only came in 1958, 1960. From there on, we
4:42
have progressed very rapidly. There is no doubt about it.
4:44
bypass surgeries came, valve surgeries came, people have become celebrities.
4:48
So many celebrities have come up like a big bypass.
4:50
Then heart transplant came. We can even change people's heart,
4:53
you know. That also came in 1967. So these are
4:56
very important. In between what was happening that we have
5:00
observed one very small and very important observation that when
5:04
you open the chest, suppose when you open the chest
5:06
for open heart surgery, when you cut your breast bone
5:08
in front of the chest, it alters your physiology. Your
5:13
mechanism is breathing, your movement, getting up and sitting, all
5:18
these things change. So that was the time when scientists
5:21
have started thinking something else. Can we do it separately?
5:24
Can we do it differently? Can we do it without
5:26
opening the chest? Then around 1990s, mid-1990s, we have started
5:32
something called minimally invasive cardiac surgery where we have started
5:36
doing surgeries without opening the chest. The same bypass operation,
5:39
same valve replacement, same different types of hearts, hole in
5:43
the heart, tumors of the heart, all these surgeries have
5:45
people have started doing from the side without opening the chest.
5:48
That is the beginning.
5:49
Speaker 1: Explain that.
5:50
Speaker 2: Yeah.
5:50
Speaker 1: Without opening the chest means?
5:51
Speaker 2: Yeah. So, traditionally when we do an open surgery, so
5:55
we have to open the chest. There's a bone in front.
5:57
If you touch your, in between breast, you'll find a bone.
6:00
Speaker 1: Yeah.
6:00
Speaker 2: This tough structure is called sternum. This bone is called sternum.
6:04
We cut it from the inside. Then we split it
6:07
up and go inside the heart and then perform the
6:09
surgery like a bypass surgery. valve separation, heart defects, or
6:14
so on and so forth. So, when you open this up,
6:19
your whole mechanism of breathing and all these things becomes altered.
6:24
I am not saying that … And altered for life.
6:27
Altered for life, yeah. So, some of the people are
6:30
not fit for this. For example, badly diabetics, very frail,
6:34
quick cancer spirit, early cancer. We have found that when
6:45
we cut them, we make them more diseased, then become better.
6:49
So during that time, the surgeons, the scientists have started
6:52
thinking the alternatives. And one of the alternatives was without
6:55
opening the chest, the non-sternotomy or non-open-heart surgeries. Then we
7:01
started evolving on that area slowly and slowly. And I
7:05
think robot is an extension of that. So first we
7:09
did this, opened it. We did open surgeries. Then when
7:13
we were fully trained, we were very confident that we
7:17
can do openly anything. Then we have moved to this
7:19
side without opening the chest. The same bypass, same valves,
7:22
we have started from the side. Now when we become
7:25
expert on that also, now you thought why to open
7:27
from the side also. Don't do anything. Make some small
7:30
three ports and do the surgery. Then the robotic came
7:33
because As you will see, what robot does basically, it
7:38
reduces the human efficiency and it increases the precision, it
7:44
increases the magnification, it increases the visualization, it increases the accuracy. Nowadays,
7:51
with AI and other advanced imaging technique, I can also
7:55
plan the surgery well in advance. Entire route can be chosen.
7:58
Entire route, entire route. So, I am sure what I
8:06
will see exactly. So those things are very important. So
8:08
that's why now robot has gone to that level that
8:12
I can do the surgery in the morning and patient
8:15
can be having coffee in the evening.
8:17
Speaker 1: What are you saying?
8:18
Speaker 2: Yes, that's what I'm saying. Exactly that's what I'm saying.
8:21
That's what the patient needs now. I'm telling you again, see,
8:25
once in a time, you know, I still remember when
8:27
I used to do my bypass surgery of my uncle.
8:31
in a place in South India, because I was in
8:34
that time, because I was born, and I'm basically from Assam,
8:36
so at that time there was no surgery in North East,
8:39
heart surgery, so I think we have booked about 40 tickets.
8:44
In Chennai Express, I would say. And all of us
8:48
have gone in different roles. Somebody to give only blood.
8:52
Somebody to give only donate blood. You know, five people.
8:58
Same group. Then somebody has given only to cook Asamese food.
9:03
Somebody has given rice, lentils, all these things. So I
9:06
think that was like a Kumbh Mela for us. Going
9:09
to doing a bypass surgery. So I think, Sonal, that
9:13
has to change now. Still it is happening in our country.
9:16
You see the amount of loss you have got from
9:18
the whole family. You have involved so many people. So
9:22
much of blood loss, so much of trauma. And on
9:25
top of that whole thing, the patient who is going
9:27
through it, he has a big psychological impact on his life.
9:31
Because he thinks that my chest is open. I am
9:33
no more useful for anyone. That I can tell you
9:37
later on.
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Speaker 1: They think it's second life.
9:39
Speaker 2: Yes, yes. So I think if I do the same
9:44
thing without opening the chest, without doing anything and patient
9:49
have no pain, no trauma, no blood loss and he
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recovers in like six or seven days time and can
9:56
join back his work.
9:57
Speaker 1: But how are you saying no pain, no trauma? I mean,
10:00
there are still insurgents, right?
10:02
Speaker 2: Yes.
10:03
Speaker 1: And before that, just explain to me the difference between
10:06
laparoscopy and robotics. Because in laparoscopy, you do three holes.
10:11
One goes to the camera, the other goes to the other,
10:14
and you're able to do it. And what would have
10:16
been an open surgery is just done by three little holes,
10:18
which is just a stitch. Yeah. How is that different
10:20
from robotics?
10:21
Speaker 2: So basic difference between laparoscopy and robotics is the visualization.
10:25
So in laparoscopy, we see it in two-dimensional. Like we
10:30
don't see exactly how the structure is. We see it,
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but it is two-dimensional interface. But in robotics, for scientific term,
10:37
it is three-dimensional. I will see exactly what I can
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see in open. And my control of the instruments are
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much better in robotics because robotics, the instrumentation is totally different.
10:48
They rotate in 360 degrees. My hand also doesn't move
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in 360 degrees in certain areas. Suppose you have to
10:54
work in depth. Gynecological surgeries, pelvic surgeries, then the prosthetic
11:01
surgeries we do, the prosthetics are in a lot of depth. So,
11:04
the hands don't go there. The robotic arms go there.
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And then they can do the surgeries with precision when
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they open. They can't even do the hands in the surgery. So,
11:13
that's why our precision is much better in robotics. So
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that's why robotics is gaining the popularity day by day.
11:19
That's why in some of the specialties, slowly and slowly
11:22
you will see, and mark my word, after five years,
11:26
most of the leprosy will have gone by. It will
11:28
be all by, because robotics can enable other things also.
11:32
Not only the surgery, the planning, the visualization, the imaging,
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all these things can be, you know, stationed in one platform.
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Speaker 1: Interesting. You're saying that laparoscopy would be gone in five
11:45
years and robotics will take over.
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Speaker 2: I will not say gone because still there are some
11:50
conditions where laparoscopy is okay. But I think by far,
11:54
most of the centers where robotics is pre-run, they are
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slowly sighing you from laparoscopy.
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Speaker 1: Help me understand this a little bit. When you say
12:02
that in a robotic surgery, the number of cuts you make,
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the number of insurgents you do, they are less. Can
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you explain to me compared to, say, a lap row
12:12
or an open heart, how small are they? So, if
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you're not cutting open, where exactly are you making the
12:17
cut and how big is it?
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Speaker 2: Okay. So, when we do an open surgery, the cut
12:23
is around 10 to 15 centimeters in front of the chest, right? So,
12:27
if I do, for example, a hole in the heart,
12:30
atrial septal defect, which I'm going to do today as well,
12:34
so what happens in that is, there are three ports, actually.
12:37
This is less than, I would say, It's about 4
12:41
to 5 mm maximum because the port size is only
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8 mm.
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Speaker 1: By port, you mean the hands of the robot?
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Speaker 2: Yeah, yeah. It's like your pain, the size of this pain.
12:51
It will go inside. And to take it inside, the
12:55
cut is very small, minuscule. You will not even see
12:58
it after four months. That is so small.
13:01
Speaker 1: Seriously?
13:02
Speaker 2: Yeah. And there is one incision which I have to make.
13:05
It's called a walking port, where we put our other stuff.
13:08
That's about around two centimeters, this much.
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Speaker 1: That's it?
13:13
Speaker 2: Just remember these fingers. This is the one. That is
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the size of the whole cut. There will be no
13:18
bone cutting. There is nothing. So bone cutting, bone splitting,
13:21
muscle splitting, nothing will happen. It will just be this
13:23
much cut and then the whole entire surgery will be done.
13:26
So that's why I am saying it's a very big
13:27
boon for patients where they can say that, no, I
13:32
don't want any cuts on my body. It's very, very
13:34
effective for them, cosmetically, ergonomically. from pain-wise, recovery-wise, very good.
13:40
In fact, some of my doctor friends, which I have
13:43
performed robotic surgeries, they proudly go and, you know, start
13:46
to swim at the end of just three weeks and
13:49
swimming after doing a bypass and then sending videos back
13:53
to me. See, I am just swimming around. So, those
13:57
are things which you can, that's why I am saying, Sunal,
14:00
we must change this. We must change this concept that, brother,
14:04
open surgery is done, I will not be able to
14:05
do anything, I will die, I am finished. This has
14:08
to stop. We have to now think, no, this is
14:12
a surgery, normal surgery. It's like any other surgery. It's
14:15
like a gallbladder surgery, appendix surgery. You come, get it done,
14:18
and go home. Yeah, of course, again, I'm telling you,
14:20
there's a disclaimer. 70% of the cases, 30% still will
14:23
need an open surgery, probably, in today's date. It's possible
14:26
that after 10 years or after 5 years, when I
14:28
meet you again, I can tell them 90% will be
14:30
done by robotics. At this stage, I will say, yes,
14:34
70% can be safely done and very safely, effectively done
14:37
by a robot. Another question people ask me is a
14:39
very important aspect, which I want to highlight. They ask, sir,
14:43
how effective is it? Because cardiac surgery is measured in
14:47
terms of effectiveness. Suppose someone has chest pain, heart attack.
14:51
Will it save me from a heart attack? Will it
14:54
cause my symptoms to go away? Similarly, like an open heart.
14:57
Answer is exactly yes. Because the things or the surgical process,
15:01
what we do, doesn't change at all.
15:03
Speaker 1: It's just the process of doing it.
15:04
Speaker 2: Process and the approach. I'm not cutting the chest. I'm
15:07
not open. splitting the bone open, I'm doing exactly the
15:10
same thing which was supposed to be done in the
15:12
open surgery. So technology, the grafts, the valves, the whole
15:19
ecosystem and the things which we put in the open,
15:21
exactly will be done the same way. So our long-term,
15:24
so if I think I cannot give the same long-term
15:26
result like an open surgery, I would not probably do
15:29
a robotic surgery.
15:30
Speaker 1: Okay, let's talk about in what kind of operations do
15:34
you prefer a robotic surgery? If a patient comes to you,
15:37
for which diseases or for which operations will you say
15:40
we must use a robotic arm?
15:42
Speaker 2: Yeah. So, first I will tell you, before the disease,
15:49
who are my clients for robotic surgery? So, I divide
15:53
this into a very specific two groups. One group is
15:57
that All internet, Google, AI, and chat GPT. So they
16:04
come to me asking for a robotic surgery. That's actually
16:07
a bigger group, I would say.
16:09
Speaker 1: And I'm assuming younger people also.
16:11
Speaker 2: Yes, yes. Older people are still a little. Yeah, tech savvy.
16:15
And they're very enthusiastic to go home soon. So these
16:22
are the people. And the one who I think they're
16:25
really in robotic surgery. So let me first tell about
16:27
the one. who needs robotic surgery. Number one, young females.
16:32
All young females, they should not have a cut in
16:34
the chest, according to me. That's an injustice. So any
16:38
female coming to me, who is unmarried, even married also.
16:42
So if I make a cut here, so whoever, you
16:44
cannot wear any, you know, low cut.
16:46
Speaker 1: To live with a scar for their life.
16:48
Speaker 2: The scar is always there. You may feel normal, you
16:52
may look normal, but that stigma is always there. So
16:55
I would like to prefer non-open-heart surgery for young females.
16:58
There's number one client. Number two, very old. Very old
17:02
means they are frail, like more than 65 years, 70 years,
17:06
but they still have a good life to go. Suppose
17:10
he's otherwise normal, he's very badly diabetic, but he's 65 years,
17:14
he needs a bypass operation. I would not like to
17:16
open him. I would like to prefer him for a
17:19
robotic surgery. Why? Because in diabetics, the chances of infection
17:24
in the chest when we open is very high. His heart,
17:27
his sugar will go up. He will have lots of
17:30
hospital visits unnecessarily for infections. And the pain will persist.
17:34
Numbness will persist. Swelling will persist. Everything will persist. A
17:37
lot of clinicians I have seen saying that it's just
17:40
a fracture. It's not a fracture. It's not a fracture.
17:43
It's different from fracture. It's a cut on the chest
17:45
which may not heal.
17:47
Speaker 1: Right?
17:47
Speaker 2: So that's why those are my top priority clients. Then thirdly,
17:52
very important group, obese. Those who are obese. It is
17:56
very difficult for them to do open surgery. I think
17:59
they should avoid. Yesterday, I did a patient robotically. He
18:04
is very obese. He had a stroke earlier. One side
18:07
is not working. So, if I do an open surgery,
18:09
his life will be hell. He will not be able
18:12
to walk properly. Already, he is not walking. On the
18:16
top of that, if I do a big cut here,
18:18
I think he will be totally limited to bed. Then,
18:24
The patients with a lot of other comorbidities, like dialysis-dependent patients,
18:28
whose bones are very weak, frail, normally have fractures.
18:32
Speaker 1: Anyone who is immunocompromised also.
18:34
Speaker 2: Yes, yes. Immunocompromised are important as well. They are frail.
18:38
The frailty index is very high.
18:39
Speaker 1: They won't be able to take the surgery.
18:40
Speaker 2: Yes, yes, yes. But still, they'll want to live for
18:43
a couple of years.
18:43
Speaker 1: So you're saying all those people who would have otherwise
18:47
not qualified for in-heart surgery, because of robotics, have a
18:51
chance now. Yes.
18:52
Speaker 2: They still have an open, they can still have an
18:54
open heart surgery. But I would say that if I
18:57
put an open surgery for them, their life, quality of
19:01
life will be impaired very, very severely. So in those cases,
19:05
a robot can definitely help. And now the other group.
19:10
Speaker 1: Yes.
19:11
Speaker 2: More important. The other group comes to me saying, Sir,
19:13
I want to do robotic surgery, whatever happens. So I
19:17
don't want to do anything. So they have a feeling
19:20
in their mind that, Everything can be done robotically. Answer
19:24
is no. Heart surgery is a very sophisticated operation. You
19:28
must understand that. So all conditions, suppose a patient comes
19:32
with crash. So we are doing CPR and all. So
19:35
he is already dying. I cannot do robotic surgery in that.
19:37
It is an emergency procedure. I have to open this
19:40
patient to save his life. Some of the conditions are
19:44
the heart condition is very poor. His vessels are very
19:48
very small so there are some severe complications where I
19:51
think we should avoid robot so if you ask me
19:55
medically at least 70% of the heart conditions in today's
19:58
date we can do it robotically for a bypass operation
20:03
valve replacement valve repairs heart valve repairs then closure of
20:06
your atrial septal so congenital heart defects say which are
20:10
made from birth, we can close them robotically easily. That
20:13
is the easiest operation to do.
20:15
Speaker 1: Hole in the heart.
20:16
Speaker 2: Yes, hole in the heart. And cardiac tumors. Cardiac tumors
20:19
are also rare condition, but when it comes, you have
20:22
to do an open surgery. In those days also, you
20:24
can do robotically.
20:26
Speaker 1: Interesting.
20:26
Speaker 2: Yeah.
20:28
Speaker 1: So I like what you're saying that it throws open
20:31
two kind of categories of patients for you. One, who
20:34
otherwise would have not have been a candidate for Second,
20:38
those who would have lived with the outcome of open-heart
20:42
surgery for the longest time, their quality of life is
20:46
not impacted as much as would have been the case.
20:50
But you're saying there are also cases where you don't
20:52
need one. I see, I was speaking to an oncologist
20:55
yesterday and he was talking very highly of robotic surgery.
20:58
Speaker 2: Yeah, definitely. Oncology is a big branch now. Initially, there
21:01
was a lot of apprehensions regarding whether they can fill
21:05
the tumor or not, all this. But now with the
21:08
recent machines, the advanced machines, they are very safe. Oncological
21:12
robotic surgery is very safe nowadays. The other thing, Sonal,
21:15
I want to emphasize is that that feeling of having
21:20
an open surgery is different than the feeling of having
21:23
a robotic surgery.
21:24
Speaker 1: Explain that.
21:25
Speaker 2: So, I am saying that when you open the chest,
21:31
they always have the psychological stigma that I have opened
21:34
the chest. Maybe I will not be able to get thicker.
21:37
But when we do robotic surgery, I think from the
21:39
day of zero, he or she feels, no, those things
21:41
will never be there. I'll be just like what I
21:43
was yesterday. I'll not be person will be transformed tomorrow
22:07
from an open surgery. So that psychological feeling is very important.
22:10
It is above anything else, you know. That human factor
22:14
of not having your chest open is a different feeling altogether.
22:18
You can understand only when you feel somebody within a
22:21
robotic and non-robotic surgery or open surgery. At this time,
22:25
I would also like to say that open surgeries have
22:28
a lot of importance. Because I have an open surgery.
22:33
I was an open surgeon and I have transformed myself
22:36
to give the society and technology which is upcoming and
22:44
which can be done safely where the results are totally different,
22:48
where the immediate outcomes are different, where the patient can
22:52
go back to their job, go back to their profession
22:54
at the earliest and can resume all their previous activities,
22:59
hobbies and everything as he was or she was doing before.
23:02
So why not?
23:03
Speaker 1: So you're saying that in heart surgeries, a lot of
23:06
time grafts have been, you know, have to be put
23:09
and they're taken out in other parts of your body.
23:10
Is that process robotic? And then basically the question is,
23:15
do you have less scars?
23:17
Speaker 2: Very important. I think it's a very important question for
23:21
all of us to know. So basically when you do
23:24
a bypass surgery, this is most commonly done surgery for heart.
23:27
If you know that the commonest surgery in the heart
23:31
section is bypass surgery. So, robot has a very important
23:36
role in taking these veins, taking these grafts. So, the
23:42
arteries in the chest wall, if you are like a
23:46
very young patient, we don't want to use veins in that.
23:50
Feet and hands too. We want to take out everything
23:53
from inside. That is called total arterial bypass. For which,
23:55
if we do it open, it has a lot of complications.
23:59
So if I want to do a total arterial bypass,
24:02
it is called total arterial bypass because both the arteries
24:04
are removed and the robot can safely take out both
24:07
the arteries. Especially for young patients whose life is very long.
24:11
Suppose nowadays in India there are so many heart attacks
24:13
in young patients. We used to sometimes do bypass at
24:16
the age of 35, 38, 25. For those people, total
24:21
arterial graft is very important. For these people, robotic surgery
24:24
is very important because we can take out both the
24:26
arteries without opening the chest. effectively and put them into
24:30
total arterial surgery so that their long-term results are very good. Now,
24:35
if I don't use total arteries, suppose I want to
24:37
use veins or arteries from the other part of the body,
24:39
that can be also done, not robotically now, but endoscopically.
24:43
There will be no cuts anywhere in the body. There
24:47
will be small, small scars, one on the knee and
24:50
one on the thigh. From there, we can take out
24:52
the entire vein. That is also without cuts. So, if
24:56
you do a small cut here, There will be small
24:58
cut in the leg also. But there will be no
25:00
seera pari. Nothing like that will happen. So, especially for ladies,
25:03
it's very important. A lot of people come and say, sir,
25:05
you have made such a big cut. I am not
25:07
able to wear a mini skirt. So, to have a
25:10
mini skirt, definitely you should have endoscopic and robotic surgery.
25:14
Speaker 1: But you need a lot of training. Yes. Because I
25:16
am sure even to run those machines, you require a
25:20
very different kind of skill, right?
25:22
Speaker 2: Yes. So, in this, First of all, your system should
25:28
be credible. Wherever you are working, you cannot just start
25:31
robotic surgery in a XYZ hospital. So your ecosystem has
25:35
to be very, very strong. Ecosystem means, apart from being
25:40
a doctor, I always like to be a pilot, always
25:42
in my life. I never became a pilot because of
25:44
so many reasons, XYZ reasons, but I wanted to be
25:46
a pilot. So in robotic surgery, especially, you run like
25:50
an Airbus A380. It's like that. Because there are so
25:54
many machines, So many controls, so many people under your arm.
25:58
So you feel like a real pilot, you know, when
26:00
you do a robotic surgery. I really like that feeling.
26:04
You are the captain of that ship or that aircraft.
26:08
They have to listen to you. The whole operating theater
26:11
ecosystem ups and downs on my command, including the robot, right?
26:15
So that is a very different feeling. I'm not saying
26:17
that I'm doing surgery for that. But all I am saying.
26:19
Speaker 1: So humans don't listen?
26:22
Speaker 2: No, everyone listens. Everyone listens. Everyone listens. But robots listen
26:26
the most at that time. Because it really, really moves
26:29
with both my hands and both my feet together.
26:32
Speaker 1: Your feet also?
26:33
Speaker 2: Yes, yes. So I'll tell you, explain. So if you
26:35
see the robot, it has got controls on the hands.
26:38
And there are some controls on the feet. So your legs,
26:41
both the legs and both the hands are moving equally
26:44
all the time. So you have to have a complete...
26:48
balance on your mind you know so you must be
26:50
seeing no when you see especially that is in not
26:54
in the boeings in the airbus they always write in
26:56
the on the on the on the door of the
26:58
pilot leave everything behind before this door you go inside
27:02
and just you know uh you know fly the aircraft
27:06
so similarly when we come and sit in the robotic
27:08
it's called surgical console where you sit inside the robot
27:11
so you have to leave everything alone.
27:13
Speaker 1: Okay, take a step back. Tell me exactly what the
27:16
robot looks like. How are you running it? You gave
27:20
an example of an Airbus. I am thinking of Transformers.
27:22
You must be sitting there.
27:25
Speaker 2: So, basically, there are... Thank you, Sonal, for asking this question. So, basically,
27:29
there are... So, as I operate with my hand, there
27:33
are two hands. There are ten fingers. Similarly, when I
27:37
operate a robot, I will have more than two hands.
27:41
Because the transmission in the robot is through the arms.
27:45
There are three arms or four arms sometimes, which I
27:48
replicate my movement of my hand. Suppose I hold a
27:51
structure with my left hand. If I hold it with
27:53
the robot, it will hold the arm there. The arm
27:56
will grab. And I will cut it a little. So,
27:59
these all robotic movements I will do inside. That will
28:02
exactly get transmitted to the body of the patient's human body.
28:05
Speaker 1: You are Durgama. You have so many arms.
28:10
Speaker 2: Yes, yes. I would say we have control on a
28:16
lot of arms and my activities inside the body is multifaceted. Secondly,
28:22
there are three parts of robot. One is the robotic
28:38
surgical console, where I sit. Then secondly, is the patient cart,
28:44
where the patient is attached. They are all inside the OT,
28:47
inside the operating room. And thirdly, there is a vision cart,
28:49
where all the people in the operating room can see
28:51
what is going on.
28:52
Speaker 1: You are not in the OT.
28:54
Speaker 2: I am in the OT. I am inside the OT.
28:55
Speaker 1: But you are in your, on the console.
28:58
Speaker 2: There is a console, where I am working as a robot.
29:01
And the patient's table is with me. And there are
29:05
all the robot arms attached to it. On the, there
29:07
is a third system called a vision card. Because the assistant,
29:13
because they are one surgeon, because for safety, there is
29:17
one surgeon always sits with the patient. It's called a
29:20
table side surgeon. It's called a table surgeon. It's like
29:23
a second engine of an aircraft. The first engine fails,
29:25
the second engine takes over, right? So similarly, it is
29:29
same actually. And most importantly, in this ecosystem, commands are
29:42
very important. The whole team should know now what is
29:46
going to happen. Which step is coming. Suppose I have
29:49
to exchange an instrument. Then the instrument is not supposed
29:51
to be ready beforehand. Because we change instruments sometimes. We
29:54
take out this arm, take out the other arm, take
29:57
out the blade, take out the blade, take out the forceps, So, yes,
30:00
robotics arms, they are very important to exchange in time. So,
30:03
these are very intricate movements between the robotic surgeon, the console,
30:07
the nurse, the technician. So, this ecosystem is very important. So,
30:12
that's answering a question that how to choose a good
30:17
robotic center is number one. What is the experience of
30:20
that center to run that robot? For example, we have
30:22
been running the longest legacy of robotic cardiac surgery at
30:26
Fortis Ascot. So, This is a center where we have
30:29
built the system, built the technology, built the techniques how
30:35
to refine robotic surgery. So these are the very advanced
30:38
centers because we train people, we train other surgeons also.
30:41
So these are advanced. Apart from that, if someone wants
30:43
to go for robotic technology, definitely they have to see
30:46
the ecosystem first. That what is the ecosystem of these hospitals,
30:51
whether they are really doing robotic surgery or.
30:52
Speaker 1: Just, And like the pilot, they have number of hours
30:57
of flying.
30:58
Speaker 2: Yes, very important.
30:59
Speaker 1: Similarly, number of hours of operating on robotics for any surgeon.
31:02
Speaker 2: Very important. They must see the credential very nicely. So
31:06
we have now gone, because the other thing which is
31:11
important in robotics is that I don't have to do anything.
31:14
It is in the cloud. So for the example, we
31:16
have got Da Vinci system. Da Vinci is a cloud.
31:19
Speaker 1: You have, one second, you have Da Vinci system?
31:22
Speaker 2: Yeah, it's called, yeah.
31:24
Speaker 1: That's very artistic. I'm really liking where this podcast is going.
31:28
Speaker 2: So it's the oldest robot in the world. And it
31:33
has gone through a lot of different generations. Now we
31:37
have the XI system. It's called XI, that means XI.
31:40
It's an US machine and made by Intuitive. So what
31:44
I'm saying, I can analyze my surgery at the end
31:48
of the surgery. Everything will come into my phone. I
31:52
can see my movements, where I have done mistake, where
31:55
I have delayed, which step I have taken maximum time,
31:58
which step I have taken minimum time. So I can
32:00
analyze my entire, you know, surgical steps. I can refine
32:03
next surgery. It's like, you know, seeing, for example, I'm
32:06
not Sushant Tendulkar, but he sees everything after the batting,
32:09
you know, where he has made mistakes. So similarly, now,
32:13
and secondly, if somebody wants to see my credential, he
32:16
can ask Da Vinci people that how many exactly surgeries
32:19
have been done by this fellow. This doctor. Because my
32:21
every number, every hour.
32:23
Speaker 1: That's very important.
32:24
Speaker 2: My every number, every hour, my complications, everything is noted
32:27
by Da Vinci. I cannot hide anything.
32:29
Speaker 1: So, your report card is in public.
32:32
Speaker 2: It is not in public.
32:33
Speaker 1: It is not in public.
32:34
Speaker 2: It is in the system. So, that's why after doing
32:37
a certain number of cases, the company itself certifies me
32:41
as their proctor, as their teacher, as their Da Vinci
32:46
proctor or Da Vinci surgeon like that. So we have
32:48
an intuitive certificate that I'm an intuitive certified robotic surgeon, right?
32:52
So that's very difficult to get because there are a
32:54
lot of levels to cross.
32:56
Speaker 1: How many doctors are there who are Da Vinci certified
32:58
in India?
32:58
Speaker 2: In cardiac surgery, I think it's very less. Only a
33:01
handful of, I think, around 20 surgeons in the country.
33:04
So we are a rare breed now. Robotic surgery, there
33:08
are a lot of cardiac surgeons, but robotic cardiac surgery
33:10
is a new specialty and a lot of people are
33:12
not doing it. So it is difficult. It needs a
33:16
lot of training. It needs a lot of patience. And
33:18
also you have a lot of patience to do robotics.
33:21
Speaker 1: Yeah.
33:21
Speaker 2: All of us together.
33:22
Speaker 1: But like pilots, to use your analogy, sit in a
33:25
simulator in practice, you also have to sit in practice
33:28
for hours to actually do this.
33:30
Speaker 2: So we have got two types, three types of simulation.
33:33
First theoretical, you analyze the machine, you see how the
33:36
parts move. Then you do the online simulation. Da Vinci
33:39
has their own online simulation. So all these things. And
33:46
then you have to practice on animal models. So they
33:49
have got their different animal laboratory in the country where
33:52
you go and practice on animals first. And then when
33:55
they are certified and when satisfied that your movements are
33:57
safe to handle the robot, then they will certify you
34:01
to do the surgery. So this certification is very important.
34:04
So without that, you can't perform surgery. So that's why
34:07
it's not done by everyone.
34:10
Speaker 1: Can I ask you a very silly question?
34:12
Speaker 2: Yes.
34:13
Speaker 1: But I'm sure this is a question on everybody's mind.
34:16
If you are doing robotic surgery, if the internet goes
34:19
off or the light goes off, what will happen?
34:24
Speaker 2: Okay. So, this is not a silly question. It's a
34:26
very important safety question. So, all the da Vinci and
34:32
all the robots have almost 30 to 40 minutes of backup. So,
34:38
the arms will keep on moving. Robotic work will never stop.
34:42
I can safely perform the surgery.
34:45
Speaker 1: They are not dependent on internet?
34:47
Speaker 2: No, they are not dependent. I am coming to the
34:50
next question. Next, I will tell you about internet. But normally,
34:53
in your surgery, you don't need internet.
34:55
Speaker 1: You just need electricity.
34:56
Speaker 2: Oh, you need electricity. Internet. I am telling you what
34:59
you need internet for. This is the next thing actually,
35:01
next level of thing. So, that is called robotic telesurgery. So,
35:05
telesurgery is a surgery where I operate in Delhi and
35:10
I sit in the robot I start the procedure. And
35:14
the same thing will be replicated in Puttaparthi, in Karnataka.
35:18
Speaker 1: Wow.
35:19
Speaker 2: Yeah. So this is robotic telesurgery. So what will happen,
35:22
there will be two robots. One robot is here. One
35:24
robot is in Puttaparthi. So the surgeon who is sitting
35:27
in the console will not do anything. He will just
35:28
put his arms. And then.
35:31
Speaker 1: He is a table surgeon.
35:31
Speaker 2: He is a table surgeon. And I will do the
35:33
whole robot surgery from here. So that is the future now.
35:36
A lot of surgeries have been done in India. And
35:39
I have also.
35:39
Speaker 1: Do you think this will be possible in India?
35:41
Speaker 2: In India, I think there's a big future. But only
35:45
thing is that at least the cost is very.
35:47
Speaker 1: I mean, it sounds really exciting and fascinating. In my mind,
35:50
I think there are so many people who wait that
35:53
in Ames, in Scots, in some other big hospital, they
35:56
will get time, they will get to, you know, get
35:59
treated there. If robotics can be used and somebody doesn't
36:03
have to uproot themselves and their entire life and come
36:07
all the way, this could be huge. But then, there
36:09
are questions of infrastructure availability, internet access, you know, unlimited electricity,
36:15
all of that comes to mind. So I think, I
36:17
don't know, India may have possibility.
36:18
Speaker 2: Yeah, you're right. So at this station, we are using
36:21
telesurgery for only one purpose, which is very important. Again,
36:25
in the robotic surgery in general, is for teleproctoring. Means
36:30
I can teach somebody robotically sitting here. I don't have
36:34
to travel. So that is very important. Suppose I, for example,
36:38
Last week, I had a teleproctoring from US. Dr. Douglas
36:42
Murphy is a very big name robotic surgeon in the US.
36:45
But I cannot, I can travel. But if I travel
36:48
to Pennsylvania, it will take so much of time and,
36:50
you know, effort and come back again. So what I did,
36:53
I requested him to, you know, do the things from
36:58
a distance so that we can observe him. So that
37:00
is very important that I can learn from my mentors,
37:03
which are specifically designed to do certain surgeries, right? So
37:07
that is very important. Teleproctoring is very important. Telesurgery, yes,
37:10
as you said, it takes time. It will take some time.
37:12
But as the robots are coming up cheaper and cheaper,
37:16
I think the day will come that we can do
37:17
certain surgeries in tier B and tier C cities from
37:21
metro cities in some of the hospitals.
37:24
Speaker 1: Okay. You spoke about cost, so let's get to that.
37:29
Healthcare in India is affordable compared to international standards, but
37:33
still not really accessible for majority of our population. You
37:37
are saying that robotics is more accessible in a way
37:41
and it will take less time in recovery. Your quality
37:46
of life is better. You are back on your feet very,
37:48
very quickly. All of that is there. But does it
37:50
cost more?
37:52
Speaker 2: Yes. So there is some charge that we charge extra
37:56
to the patient. But I think if you say the benefits,
38:00
it really overweighs that cost.
38:03
Speaker 1: Does it cost more than lab pro or does it
38:05
cost more than open heart surgery?
38:06
Speaker 2: So, with open-heart surgery, I charge almost 20% extra to
38:11
30% extra. But I think if I can discharge the
38:15
patient in three or four days' time, the resources, yeah,
38:18
it actually weighs out.
38:19
Speaker 1: That negates, yeah.
38:21
Speaker 2: It really weighs out and negates. So, cost is not
38:24
at all a factor, I think. So, it's not very
38:26
costly at this stage because if I see the benefits,
38:29
this cost is very negligible. It's too much because …
38:34
If I don't do open surgery, I think it just
38:37
makes so many things less. The cost is the minimum
38:40
part actually in that. Okay.
38:42
Speaker 1: There are some regular FAQ questions that come to us.
38:46
I want to ask you that. And this is a
38:49
take it or trash it segment. So I'll throw a question.
38:52
If you think it's true, you say you take it.
38:54
If you think it's trashed, say trash it. Okay. Some
38:59
frequently asked questions on robotic cardiac surgery.
39:02
Speaker 2: Okay.
39:03
Speaker 1: Take it or trash it, robotics edition. Okay. Robotic surgery
39:07
means that the robot does the surgery.
39:10
Speaker 2: Trash.
39:12
Speaker 1: It's actually the doctor who's performing.
39:13
Speaker 2: Yes, always, always.
39:15
Speaker 1: If the robot fails, the patient is in danger.
39:19
Speaker 2: Robot cannot fail. It's a trash because as I told you,
39:22
septic mechanism is very, very strict and septic is very,
39:26
very well streamlined. Robot cannot fail. Robot cannot fail. fail
39:30
because I have not encountered anything where robotic arms gone
39:35
without my you.
39:36
Speaker 1: Know but it's a machine it could have a glitch.
39:39
Speaker 2: Well see system yeah you can you are right but
39:43
at the same time those glitches cannot harm patients because
39:46
there is a point beyond which the robotic arms cannot
39:49
go also For example, there is a big vessel. The
39:52
robot will stop itself even if I don't do anything.
39:55
Speaker 1: What do you mean?
39:55
Speaker 2: Suppose I get a very big artery or vein from
39:57
where bleeding can happen, hemorrhage can happen, complications of the
40:01
patient can happen. So robotic arms will tell me 100 times.
40:06
Speaker 1: How will it tell you?
40:08
Speaker 2: It freezes my hand. My hand will stop. So that's
40:12
very important. Those features are very, very important. So that's
40:15
why a lot of things are made in such a
40:17
way that even if you want to … So.
40:19
Speaker 1: You've designed these 10 steps that you will perform in
40:22
the surgery.
40:22
Speaker 2: Yeah.
40:23
Speaker 1: When you actually go inside the body, you encounter something new.
40:27
The robot will spot it and stop before.
40:29
Speaker 2: You can proceed. It will not stop. It will allow
40:32
me to be safe. It will go in such a
40:35
way that I cannot hurry my speed or something like that.
40:39
It will … Because robot cannot, robot is not a human.
40:42
It will see exactly what I am seeing. So, but
40:45
it will not go to a structure where it can
40:48
harm or cause any damage to the patient's body. So,
40:51
that's why the deco system is very important. Suppose you
40:54
blink your eyes, robot will stop. It will not work.
40:56
The instrument freeze. They do not move. Even if I want.
41:01
My hands are with the instrument, but I blink my eyes,
41:04
robot will stop there.
41:05
Speaker 1: Even if you shake your head, you want to shrug
41:07
a little bit.
41:07
Speaker 2: No, no, no, it will stop. It will stop. It
41:10
will not allow anything which he or she, the robot,
41:14
thinks that is unsafe. There is no sex of robot,
41:18
but I am just saying.
41:20
Speaker 1: Must be a she.
41:20
Speaker 2: If it's that efficient, it has to be a she. Okay.
41:24
Speaker 1: Taking a trashy robotic surgery is still experimental.
41:28
Speaker 2: No, totally trash. A lot of papers have been published
41:31
on robotic cardiac surgery that results are effective, results are
41:35
equally safe like an open surgery. So, it's not an
41:37
experimental at all. No, surgery is experimental at this stage. Okay.
41:41
Speaker 1: Anyone with a heart problem can opt for a robotic surgery?
41:45
Speaker 2: Yes. I think it is a valid point. Up to
41:49
60 to 70% of the heart elements can be treated robotically. Okay.
41:53
Speaker 1: But check with your doctor if you really qualify. Older
41:56
patients can't have robotic surgery?
41:58
Speaker 2: No, totally dress. I think they are the people who
42:01
need really robotic surgery.
42:03
Speaker 1: Okay. Every hospital with a robot is equally good? Yes.
42:08
Speaker 2: Yeah, this is a very hypothetical question. All robots are
42:12
now made by very prominent robotic companies. So all robots
42:18
are good, but all robots cannot be used for every organ.
42:21
For example, intuitive da Vinci system can be used for
42:24
a lot of things, but it cannot be used for orthopedics,
42:26
for example. So orthopedic system is a different robot. So
42:29
organ-specific robots have come now for heart disease, liver disease,
42:33
gallbladder disease, like that, you know.
42:35
Speaker 1: Okay. Your surgeon's experience matters more than the machine.
42:40
Speaker 2: Yes. It's very important. You have to have experience in robotics, right? Okay.
42:46
Speaker 1: Smaller cuts means safer surgery.
42:50
Speaker 2: See, safety of the surgery doesn't depend on the size
42:53
of the cut. A bypass surgery can be done very
42:57
safely with a small cut. But that doesn't mean that
43:01
robotic surgery cannot have complications. Its complication rates depends on
43:05
the condition of the heart. It doesn't depend on the
43:07
robot or open. In open also, we have 1% complication
43:11
in heart surgery. In robot also, we have got 1%
43:13
chance in heart surgery. Going into different complications. So, that
43:17
is already there.
43:17
Speaker 1: So, complication rate is the same?
43:18
Speaker 2: Same.
43:19
Speaker 1: Same.
43:19
Speaker 2: It cannot come down by the use of the robot
43:21
or something like that. Yes. Your immediate recovery is much faster.
43:26
Speaker 1: Yes.
43:26
Speaker 2: Okay.
43:26
Speaker 1: Which brings me to the next question. Robotic surgery means
43:28
less pain.
43:29
Speaker 2: Okay. Absolutely. There is no less pain. There is no pain.
43:34
There is no less pain. There is no pain at all. Yeah.
43:37
Speaker 1: Okay. You'll be back on your feet in days, not weeks.
43:40
Speaker 2: I would go one step ahead. I would say in
43:42
hours now. Yeah.
43:45
Speaker 1: Wow. Robotic surgery is only for the rich.
43:49
Speaker 2: No, not at all. Because it's the same cost. I
43:52
would again emphasize that cost is not an important factor
43:55
in robotics because cost is slightly minimal. The amount of advantage,
43:59
it really negates the cost. This is a very important
44:02
message to everyone. It's not costly surgery. Please do not
44:05
tell that it's a costly operation. Even sometimes open surgery
44:08
costs more than robotic surgery.
44:10
Speaker 1: Oh, is it?
44:10
Speaker 2: Yes, yes. Okay.
44:11
Speaker 1: Yeah. Okay, and this is interesting. Robots will replace heart
44:16
surgeons one day.
44:18
Speaker 2: Well, it can replace anyone, theoretically, but at this stage,
44:21
it's a trash because, you know what, Sunal, you must
44:24
have read one article about a year back. A heart
44:28
transplant is done robotically.
44:29
Speaker 1: Yeah.
44:30
Speaker 2: You must have read that now, yeah. So, future is that, actually.
44:35
People are trying to do surgeries, most of the complex surgeries,
44:40
heart surgeries, robotically. What it will replace is our precision.
44:46
What it will replace is our interventions. What it will
44:50
replace is our planning. So, for example, I was telling
44:55
you before also, I am emphasizing the same thing with
44:58
the AI and our imaging techniques in AI and imaging. So,
45:03
I can read a CT scan first. I can exactly
45:05
make a three-dimensional model of the heart. And I can
45:09
put it inside a 3D model in the AI and
45:13
exactly can find out which space I have to go inside,
45:16
which space I have to go inside the heart, how
45:19
much centimeter I will go inside, how much centimeter I
45:21
keep my port outside. So all these things will reduce pain, trauma, bleeding, everything. Also,
45:27
it makes our surgery more precise. So AI plus AI-enabled
45:33
technology Imaging plus the robot together can do a lot
45:38
of changes. And things are coming. I cannot reveal a
45:41
lot of technical things here, but experiments and things are
45:45
going into robotic technology to feel the tactile feedback also.
45:47
I can feel it also, how much stretch in the tissue.
45:50
It's coming now, but it will take some few more years.
45:54
And at one point of time, I think you can
45:55
have robot where you make half pass the needle, rest
45:59
the robot will pass. It is not the robot will
46:02
do the surgery, but our human effort will become less even.
46:05
Even lesser and lesser. But they can replace but for sure. Okay.
46:09
Speaker 1: So, is it right to say that if you are
46:10
doing a heart surgery, then there are 5-6 doctors in
46:16
an OT, if not more. In a robotic surgery, it's
46:19
just the different arms and one doctor.
46:23
Speaker 2: At this stage.
46:23
Speaker 1: The one who is running the console and then there
46:25
is a table surgeon.
46:26
Speaker 2: Like you said. Yes, yes, yes. So, I think that
46:30
has not been so technologically advanced that we have to
46:36
The manpower is still the same. But the efficiency is
46:40
much more. So, initially when we started this program, we
46:44
used to take long time for robotic surgery. Eight, nine
46:47
hours and all these things. Now, it has come down
46:49
to two hours. Now, in a day, we are doing
46:52
three robotic surgeries. Robotic heart surgeries in a day. Morning one, afternoon,
46:56
evening one. That means our efficiency has gone beyond to
46:58
the level that we have used the robot to its
47:01
maximum capacity in a day. In 24 hours, we have
47:04
used it So, that robot is really exhausted towards the end. So,
47:09
that means we have used the robot to the fullest
47:11
of the capacity. So, things have changed. So, it's like laparoscopy.
47:14
Sometimes in a day, it will come that in a week,
47:17
we have probably done 20 robotic cardiac surgery. And they're
47:20
all going home in the same time. Like, it's like that,
47:25
you know. Yeah.
47:26
Speaker 1: So, what are the downsides of robotic surgery? Are there
47:30
any things that... which are a bit of a blind
47:34
eye for us, blind corners for us?
47:38
Speaker 2: Not really. Yeah, definitely you cannot do certain surgeries robotically. Still,
47:43
we are lacking in that. Like with laparoscopy, we can
47:46
do almost all the surgeries in general surgery. Robot, especially
47:51
in the heart, we are not in a stage to
47:54
do everything. Otherwise, apart from that, I don't think that
47:58
robot has got some specific disadvantage. It has got all plus, plus, plus, plus, plus.
48:04
Nothing negative or nothing, you know, which I can tell
48:08
that it's not good for the patient. Nothing like that.
48:11
There's no adverse factors from the robot per se. There's
48:14
nothing like that at this stage.
48:18
Speaker 1: So, help me understand this. I have a disease diagnosed.
48:24
It's obviously a very... like troubling time for the patient,
48:28
for the family, all of that. And a suggestion comes
48:30
on board by the surgeon that maybe we can try
48:33
robotics in this one. So what all should I consider?
48:39
What all questions should I ask my doctor before deciding
48:44
to go for a robotic surgery?
48:45
Speaker 2: So yeah, definitely about the safety of the operation. Why safety?
48:48
I'm saying that they have to ask one question, whether
48:51
it is as safe as an open surgery or not.
48:53
Because in some of the operations, it is... It is
48:56
not safe for a robot to go in, like a
48:58
very emergency situation. The patient's heart condition is very serious, complicated. Definitely,
49:04
we should not go for robotics. So that's the point
49:06
they should always ask the surgeon. They should not pressurize
49:09
the surgeon to do it robotically. I think that is
49:11
the best thing to be left to the surgeon, what
49:13
do they decide? Do I have to do it robotically
49:16
or non-robotically? Secondly, they should also ask about the surgeon's experience.
49:23
How much robotic surgery you have done? How the program
49:26
has started? That's a very important point. Specifically, I am
49:29
saying for robotic cardiac surgery. Whether he is credentialed or not.
49:32
What machine is credentialed? In which machine? In which platform
49:36
are you doing it? All these things are important. You
49:38
must know all these things in details. From a patient's perspective.
49:42
Speaker 1: But how will the patient understand which surgery to do?
49:45
I will tell you.
49:46
Speaker 2: I will have to do chat GPT. I will tell you.
49:49
So you can see in the system, in the internet
49:53
that which hospitals come in which year. Their robotic surgical experience.
49:57
For example, Portuguese escorts have the first robot in the
50:00
country in 2001. That means by experience, we are by
50:03
far the largest experience in the country. Similarly, you can
50:06
see there are so many hospitals have come up in 2019-20. So,
50:09
they are also well experienced. So, experience of the surgeon
50:12
and the team is very important. So, that must be asked.
50:16
Speaker 1: So, safety meaning do you qualify for robotic surgery? Ask
50:22
the surgeon. Then ask for the number of experience the
50:24
surgeon has. And thirdly, ask the machine that they are using.
50:27
Third question. Fourth question.
50:28
Speaker 2: Fourth question is that whether that surgery is going to
50:31
be effective or not. If I do it robotically. Is
50:35
there any compromise on the effectiveness, long-term outcome of the surgery?
50:38
For example, suppose we have to remove three blockages in
50:42
a bypass surgery. We have to ask the surgeon, sir,
50:45
can you replace all the three blockages by robotic? If
50:48
the answer is yes, you are very safe to go.
50:51
If he says no, no, no, you may not be
50:53
able to do it. So in that case, I think
50:55
we should go for an open surgery. That's very important.
50:58
Speaker 1: So you don't want to do another operation.
50:59
Speaker 2: Yes, another operation or unnecessarily put the patient into some
51:02
complicated future. Thirdly, next we have to ask about the
51:11
quality of life. Is it really worth doing this surgery
51:16
or there is no difference in the quality of life?
51:17
That is a very important question. Everybody must ask. Everybody
51:21
should ask this question. I think that's the most important
51:23
aspect of my surgery, robotic cardiac surgery. The quality of
51:31
life is totally different in robotic surgery, apart from.
51:35
Speaker 1: All right, Dr. Rithvik. This episode has been an eye-opener.
51:38
I have learned so much.
51:39
Speaker 2: Thank you.
51:40
Speaker 1: And I really hope our viewers also take back all
51:43
this information and are able to make more informed decisions.
51:46
Thank you so much for your time.
51:47
Speaker 2: Thank you, Sanal. Thank you very much.