By Prashansa Srivastava
Over the centuries, innovative medical developments and techniques have changed the face of healthcare. Incorporation of such technologies helps developing nations in particular to combat problems such as inadequate medical infrastructure, unaffordable health care and a shortage of qualified medical professionals. Robotic technology is helping to trigger a similar evolution of healthcare services in India, with the arrival of robot-assisted surgery ushering in a new era in minimally invasive operations.
Safdarjung Hospital, one of the largest central government hospitals, is in the process of procuring robots to perform high-tech 3D laparoscopies to treat advanced urology cancer, complex reconstructive surgeries and for kidney transplants. The state-of-the-art technology is estimated to cost about INR 18 crores. The poor will be provided with this facility for free whereas those admitted in private wards will be required to pay a subsidised amount.
One foot into the future
Robotic surgery is performed by making three holes. Through one hole, a camera is inserted allowing 3D vision. The other two holes are for surgical instruments mounted on robotic arms manoeuvered by the surgeon. Robotic surgery has initiated a paradigm shift in the fundamental foundations of surgery worldwide due to its inherent advantages of enhanced magnification and control of operating instruments. The robotic arms can get into hard-to-reach places, reduce the chances of damage to important nerves and promise quicker recuperation. In status quo, more than 100 patients with urological cancer are waiting for treatment with the waiting time being more than a year.
The Indian context
In India, robotic surgery is still in its infancy. There are only eight such units installed in India, of which five are in New Delhi, one in Chennai, one in Nadiad and another in Pune. Financial factors have hindered the progress of robotic surgery in India. The da Vinci Surgical System made by the American company Intuitive Surgical enjoys monopoly power in the market and has hefty acquisition costs making it beyond the reach of many health care systems and medical institutions without the financial assistance of the government. The attachments on the robotic arms are disposable, further driving up maintenance costs.
A way to decrease costs and ensure domestic growth of robotics in medicine is to encourage development of indigenous surgical robots. Achieving the sophistication of the da Vinci system is a Herculean task as robotic technology has not entered the mainstream health care system due to accessibility issues and a deficit in educational opportunities. The government can invest in robotics fellowships and training to promote future growth and provide accessible world-class medical expertise with robust infrastructure to improve the quality of healthcare in India. Continued government support is of paramount importance to help in dissemination of robotic technology so that more hospitals are encouraged to invest in it making it accessible and affordable to a greater number of people.
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