Need a course to fix the lacuna of robot-assisted surgeries

According to a recent Lancet Oncology study, nearly 70% of cancer patients in India were unable to undergo surgeries between 2019-20 during the pandemic lockdown. The delayed or missed cancer treatment added a subsequent backlog, which impacted cancer mortality and increased complications in the next 5 years.

The ill-equipped medical infrastructure needs a push to promote specialisation in robotic surgery. Apart from being able to clear the backlog, these tech-savvy surgeries are also covered under the Indian health insurance policy, meaning more demand for robotic surgeons. Despite the increasing demand, the medical curriculum is yet to give the deserved prominence.


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Strong comeback

Talking to Education Times, Alejandro Coca, CEO, told that robotic surgery has been operational since 2006, but has never been at the forefront. The fear of the Covid infection has caused an increased demand for robotic surgery, which involves the minimal invasive procedures by a surgeon operating with a console and 3D camera system.

“Many leading hospitals are utilizing robot-assisted surgery to safely clear the backlog and continue to deliver urgent patient care. For the same, in the last decade, the number of robotic installations in India has increased significantly.”

In 2006, India’s first urologic robotic installation was done at the All India Institute of Medical Sciences (AIIMS), New Delhi. As on July 2019, nearly 66 robotic centers and 71 installations with more than 500 trained robotic surgeons are available here.

Dr Rahul Pandey, Laparoscopic surgeon, course supervisor at World Laparoscopy Hospital, Gurugram says, “The pandemic brought awareness and acceptance for robotic healthcare technology. A large number of urological cancer patients are choosing robotic surgery owing to its accurate and effective result. Same recovery rate is seen for robot-assisted surgery done for gynaecological malignancies than the normal laparoscopy.”

“In the coming years, the number of laparoscopy surgeries can go down and more bot-facilitated surgeries will be done. We need to introduce more training and course module correction to popularise this.”

Technological luxury tag

The slow acceptance of bot-assisted surgeries is because it is perceived as luxury healthcare. To an extent the perception stands true to its high surgery cost.

Explaining the training pitfall, Dr Yugal Kishore Mishra, Head of Cardiac Sciences and Chief Cardio Vascular Surgeon at Manipal Hospital, New Delhi, says, “Training options are limited because of the lack of expensive equipment in hospitals. PG students rarely get any training on a robot/a simulator during their residency period. The most important step is to increase the training opportunities.” By managing the equipment scarcity, we can have more trained surgeons, which may reduce the cost of robot-facilitated surgeries.

Dr Pandey said that the robotic surgery cost an additional Rs 1-1.5 lakh as hospitals use the expensive Da Vinci robots and its multidisciplinary application is not practised.

Course correction

“After curtailing the additional surgery cost, having a trained manpower who have demonstrated their proficiency for robotic surgical skills and procedural tasks, is the area to focus,” says Dr Pandey. Lack of proper training in India forces several aspiring doctors to work with robotic product manufacturing MNCs or enrol in foreign universities for a short-term course that requires an exorbitant fee.

“Most freshers get little exposure to robotic surgery as this is not a part of their clinical aspect of surgery at PG level. This skill lacuna needs to be rectified by the Indian medical colleges. MRI scanning machines are given their due importance for installation at medical colleges, same should be for robotic surgical system, instruments, to train the students.” adds Dr Pandey.

Dr Sanjay Gogoi, HOD urology, HCMCT Manipal Hospitals, Delhi says, “Robotic surgery is not the standalone artificial intelligence-driven machine surgery. Rather it is another form of specialisation, which is not accessible to many medical students while pursuing the MD/MS. Most medical colleges as of now are not providing robotic surgical training to students.” He added that this technology is set to boom and more trained professionals will be required. This demands urgent attention for course module updation to fix the training vacuum among medicos is important.

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