Dr. Srivastava’s brief introduction
Dr. Sudhir P. Srivastava has performed over 1300 robotic cardiothoracic procedures — the largest volume in the world. He is the only doctor in the world to have performed a Quadruple Vessel Beating Heart TECAB (Totally Endoscopic Coronary Artery Bypass) Surgery while at the University of Chicago in 2007. He has also carried out several ‘first ever’ complex cardiac procedures in India since November 2011. These first time operations in India were: Robotic Single Vessel Beating Heart TECAB, Robotic Double Vessel beating Heart TECAB, Robotic Myxoma Excision and several other hybrid cases. Today he is the only cardiothoracic surgeon in India who performs Totally Endoscopic Coronary Artery Bypass on a beating heart.
The name ‘Robotic Surgery’ seems to suggest that the procedure is being performed by a robot…
The name has stuck, but it’s actually a misnomer. To call it ‘Robot-Assisted Surgery’ would be more appropriate. The robotic surgical system serves as an instrument for surgeons, enabling them to be more precise, advancing their technique and enhancing their capability in performing complex minimally invasive surgery. The da Vinci System replicates the surgeon’s movements in real time. It cannot perform any type of surgical manoeuvre without the surgeon’s control.
How is robotic surgery more beneficial for patients?
As opposed to traditional methods of performing surgery, robot-assisted surgery is minimally invasive which means smaller incisions of 1-2 cm only as compared to conventional surgery where the body is opened to access the operative field with a 10-12 cm cut. Minimally invasive surgery results in lesser pain & trauma, lesser blood loss, faster recovery time & minimal scarring. In fact we send the patient home in 3-5 days. The procedure becomes less daunting for old and young alike. Taking into account all these factors, robotic surgery has seen tremendous growth and acceptance in the Western World giving rise to numerous benefits for the patient.
In laparoscopic surgery also smaller cuts are made instead of big cuts. Then how is Robotic Surgery different from laparoscopic and endoscopic procedures?
Robotic Surgery allows surgeons to perform complex surgical procedures that may not be feasible through laparoscopic/endoscopic options. In Robotic Surgery, a surgeon gets a 3D vision of the area that has to be operated upon, and that too magnified up to 10 times more. The instruments we use can be moved the way we move our wrist and there is no tremor while performing the operation. Laparoscopic procedures, on the other hand, offer surgeons only 2D vision; long instruments with no wrist-like motion and no tremor filtration.
Which medical procedures can be performed using robotic assistance?
Robotic Surgery can be performed for the following specialities: cardiac, thoracic, urology, gynaecology, general, head & neck, orthopaedics and ENT.
What could be the difference in cost between a surgery performed in traditional method and one using a robot and will my health insurance pay for it?
The cost of Robotic Surgery is 30-40% higher than traditional surgery. However, with the benefits offered by Robotic Surgery including minimal rehabilitation, less personal trauma/ side effects & early return to work, in the end it is overall less expensive. The patients who have already opted for this surgical option counter that robotic surgery actually proves to be cheaper overall – from the point of view of the reduced hospital bill and speedy return to an active, productive life. Also, Robotic surgery is billed as Minimally Invasive Surgery & therefore, is covered by health insurance.
What are the factors preventing Robotic Surgery from being integrated into medical procedures at a faster pace?
High initial capital costs and high costs of robotic consumables add to the cost of each case. There is a steep learning curve for surgeons and operating room teams. The ideal requirement at this time includes surgeons with 8-10 years of operative experience and commitment on part of operating room teams. Many surgeons don’t want to go through the learning curve, longer operative time and possible different outcomes in the middle of their surgical careers. Like any new technique and procedure, initially there is lack of awareness amongst physicians and patient community that leads to slower adoption. However, when institutions and surgeons have committed themselves to robotic technology, the adoption has been much faster as witnessed by the global growth of robotic surgery procedures. The number of robotic systems in India has increased from 14 to 22 in a year which means that people are becoming aware and there is an increase in demand for robotic surgery. However, the problem in India remains lack of talent in robotic surgery, and surgeons being capable of using such technology and delivering the required results. There has been no stress by the major medical service providers to bridge this gap. We at ICRS intend to change this approach and make robotic surgery an attainable reality for any physician willing to commit the time to learn these techniques.
You are the Chairman-MD of ICRS (International Centre for Robotic Surgery). What is ICRS all about?
To give you a background, I have been based in the US since the 70s, and was practising there. I have launched robotic surgical programmes in several countries like Australia, Korea, China, Thailand and Japan. But it has always been a dream for me to offer my service through medicine to India. Throughout my evolution as a surgeon, I was constantly teaching fellow colleagues in India, and in 2002, I performed the first robotic surgery in the subcontinent. Since then, I have hosted many Indian surgeons back in the US who have been enthusiastic about training. But in order for the programmes to flourish in India, and to utilise the full talents of many gifted Indian surgeons, there had to be someone on the ground to further mature their training. In 2010, I set up ICRS in India to provide the most advanced surgical practices to patients in the Indian subcontinent, and to also teach and train surgeons. ICRS is the only centre in India providing a comprehensive robotic surgery program. The ICRS consulting team consists of 20 world leaders in the fields of minimally invasive and robotic surgery specialising in Cardiac, Thoracic, Urology, Gynaecology, General Surgery, Head and Neck and Orthopaedics. The combined robotic surgery experience of these surgeons is over 15,000 cases — the largest collective volume in the world.
ICRS has collaborated with Fortis Healthcare to provide onsite surgical expertise to the Fortis network of hospitals. On November 2nd 2012, the first robotic surgery centre was launched at Fortis Escorts Heart Institute, New Delhi. Fortis ICRS centres will be set up across Fortis hospitals in Mumbai, Gurgaon, Bangalore, Chennai, Kolkata as well as some tier II cities including Mohali and Jaipur. Fortis ICRS is a big step forward towards commitment to providing the latest in healthcare in terms of cutting-edge technology and best-in-class medical expertise. The centres will certainly set new paradigm in robotic surgery in India.
ICRS has also collaborated with Asian Heart Institute ‘India’s Highest Accredited Hospital’ and ‘The Best Private Cardiac Hospital'( as per a CNBC and The Week survey done in 2011) to offer expertise and service in robotic cardiovascular surgery in Mumbai and Western India .
My vision is to establish comprehensive robotic surgery program here in India, developing and nurturing talent to make this a longer term reality, and conducting educational forums and seminars to educate the mass on the benefits and results of such a program.
What can developments in this field mean to the country?
Today, robotic surgery is not considered experimental as very mature programs are now available world-wide. Robotic surgery has been practiced for the last 12 years worldwide. Last year approximately 350,000 robotic procedures were performed globally. Development in this field would mean many more patients can benefit in India utilising this approach. This will further be a boon to the medical tourism industry in India.
India was one of the first countries to recognize the potential of medical tourism and today is the leading destination for global medical tourists. Already in 2004, India has received 150,000 medical tourists and this number has grown by an impressive 33% by 2008 to 200,000 inbound medical tourists. It is estimated that by the year 2015, India will receive over half a million annual medical tourists annually.
Patients have realized that they have better options other than receiving local medical treatment and it is their right to check elsewhere and take advantage of the fact that the improvement of the means of transportation along with the internet is turning our world into a “global village”.
Two major reasons for travelling to another country for medical treatment is availability of more advanced medical technology with ongoing research in the specific field of surgery and lower medical costs as many patients do not have proper medical insurance (or any at all) and when in need of surgery, they cannot afford to pay for it in their home countries.
India’s private medical sector offers the most advance medical treatments and technology available in the world today. There are 22 robotic systems in different centres across India and a talented pool of surgeons performing robotic surgery in various specialities. Further, in countries like USA and Australia, Robotic Surgery procedures cost anywhere between $ 40, 000 – $ 75, 000 which is approximately four times more than the cost prevailing in India.
The most advanced healthcare service is now available here at a fraction of cost compared to other countries. And after receiving medical treatment and recovering, patients are free to keep travelling and enjoy a vacation in India and the countries surrounding it as India is located in the heart of East Asia.
I strongly believe that Robotic Surgery will provide a boost to the already existing medical tourism industry in India and will bring revenue and prestige to the country. We expect many medical value trips / tourism facilitators to partner with programs like ours to further grow awareness internationally and further enhance our reach in medical service and science.
What’s the best way to schedule an appointment with you or to obtain more information about International Centre for Robotic Surgery?
You can reach us via the following mediums:
Call: 9PM IST – 6PM IST: 011 – 47134472
6PM IST – 9AM IST: 9810822348
Saroj Srivastava, 65, a former diplomat, on whom India’s first ever robotic double vessel bypass procedure was performed, says, “I was petrified about undergoing a bypass, as it involves opening the chest and cutting the breastbone to access the heart. But then I was told that a robotic bypass involves making just four fingertip-sized incisions in the body and that, it results in less blood loss, less pain and much faster recovery.” Srivastava decided to go for it and was enjoying breakfast with her family the very next day of the surgery. Discharged just 3 days later, she says smiling, “I was up and about within a week’s time. I am glad I opted for it.
The benefits of robotic surgery are not just restricted to the heart. Robotic surgery can be applied in other specialities as well. Take for example, the case of Deepa Vaid,44, who had been suffering from excessive bleeding due to uterine fibroids and was advised to undergo a hysterectomy. Says Vaid, “I was so stressed out.” My husband was suffering from severe back pain, so I was taking care of my two kids, my 85 year old mother-in-law and a business all on my own. I had seen my niece undergo laparoscopic hysterectomy. She had so much trouble just changing side and was bed-ridden for over a month. I couldn’t afford such a long recovery time!” So, when her gynaecologist informed her that with robotic surgery, she won’t have to go through that ordeal, she was relieved. “It was nothing less than miraculous!”, she says. ” I was discharged in just two days and was back at work in a week! There was hardly any blood loss, minimal pain and negligible scarring – and no need to even change the dressing.”
Significantly, robotic surgery is also endorsed by people in rural India, like 72 year old farmer Dharampal Singh from Bela village, Haryana. Singh’s son Prahlad who’s a BSF constable recounts, “An open heart procedure would have meant a month or more of bed rest. My father weighed about 115kgs and helping him sit or get up from the bed would have been tough.” So, after consulting with BSF doctors, they decided to opt for a robotic bypass. “My father was home in just six days and on his feet soon after. That too without having his chest split wide open!” Singh, who has become the village celebrity, had a very practical reason to go robot. “Is umar me maut se kisko darr lagta hai? Par kaun maheeno bistar pakadkar rehna chahta hai? (Who is afraid of death at this age? But who would want to be bed-ridden for months?), he says.
Be it a septuagenarian or small children, this new procedure is giving hope to many in India. Take the case of one year old Aditya Khandelwal from Kota, Rajasthan, who was suffering from Vesico Ureteral Reflux (VUR) – a condition in which the valve between the ureters (the tubes that carry urine away from the kidneys) and the bladder does not function properly. Says father Dr. Anish Kandelwal, a general practitioner, ” For 8 months, he had recurrent infection, high fever and was losing weight. We brought him to Delhi and go for robotic ureteric re-implantation. If we had opted for the open procedure, it would have been very painful for my little boy – especially the 48 hours after the anaesthesia wears off. It would have taken him at least a couple of months to recover. Also, post operative care would have been very tough, as restraining a one year old from playing and making sudden jerky movements is difficult. Adds Aditya’s mother, “At no point did I feel that my son was undergoing a major surgery. He was playing in his room just two days after the operation.” So what made this possible? Robotic Urologist Dr, Anant Kumar, who performed the operation on Aditya explained, “Easy access to small baby structures made the surgery precise and easier, which would not have been possible with rigid laparoscopic instruments.