In robotic surgery, the robot does not operate on the patient itself; instead, the surgeon's hand movements are replicated very precisely inside the patient's body through a computer system.
What you should know
Dr. Pratikman Singh Gurung, dressed in a white coat, does not directly touch the patient's body when he enters the operating theater. But the surgeon's movements, which he performs while sitting at a computer console, begin to move inside the patient's body within seconds through robotic arms. Without touching the patient, doctors make the operation successful through technology.
This cutting-edge technology is called robotic surgery. Dr. Gurung is one of the doctors working to institutionalize this technology in Nepal. He is a urologist and robotic surgeon.
Having earned his MBBS and PhD degrees from University College London, he has completed a robotic surgery fellowship recognized by the American Urology Association and the Endourology Society. He is changing the traditional perception of surgery by applying the knowledge and experience he learned abroad in Nepal. He is working as the director of the robotic surgery program at Chitwan Medical College. This service has been started from Chitwan Medical College since last October. During this time, 20 operations have been successfully performed using robots.
Robotic surgery began in the US in 2000. Initially tested on animals, this technology gradually spread around the world after it was approved for use in humans. This technology, which has been established in Europe through the US, has been widely used in recent years in countries such as India, China, Thailand and Singapore. GI surgeons, uro surgeons, gynecologists, ENT surgeons, anesthesiologists, general surgeons, etc. can perform robotic surgery.
How is surgery done?
The surgical robot of the American company Da Vinci is famous. It has four robotic arms, which are called 'robotic arms'. One arm has a camera, while the other arms are equipped with various surgical instruments. The robotic arms are inserted into the patient's body through small holes.
The surgeon sits at a separate console in the operation theater and operates the robotic system using switches and controls.
Every movement the surgeon makes outside is carried out exactly in the same way inside the patient's body through a computerized system. Since only small incisions are made in robotic surgery, the surgical scar on the body is very small. Patients recover faster and hospital stays are also reduced.
The surgeon's activities are quick and easy due to the state-of-the-art computer system, which Gurung argues will give good results even in major operations. According to him, robotic surgery is not a process where the robot performs the surgery itself. It is a technology that replicates the surgeon's hand movements very accurately inside the patient's body through a computer system.
Dr. Gurung says, 'The camera shows more than what we see with our eyes. The camera reaches where the head cannot reach. A clear view is seen even in dark and narrow places.' According to him, the camera in one of the robotic arms shows a 3D view, which is very effective, making it easier to decide what to keep and what to remove.
Dr. Gurung said that robotic surgery is very useful in complex operations such as prostate cancer. Previously, problems such as urine leakage and infection were common after prostate surgery performed through incisions. But since robotic surgery is performed through small incisions, there is less damage to the body and complications are also minimal.
He says that this technology is widely used in the treatment of prostate cancer in the United States. Robotic surgery is also considered effective in kidney cancer.
In this technology, the kidney does not have to be removed, only the damaged part can be removed and the remaining kidney can be preserved. Although many problems are seen in such operations performed through laparoscopy, robotic surgery has made it easier for the patient.
Robotic surgery can be used for everything from simple to complex operations. This technology is useful in gallbladder removal, hernia, intestinal surgery, hysterectomy, removal of only the lump of meat that has grown in the uterus, endometriosis, prostate, kidney and bladder surgeries. Heart valve repair, coronary artery bypass, esophageal cancer, and intestinal problems can also be treated through robotic systems.
Robotic surgery begins in Nepal
B&B Hospital has introduced robotic surgery technology for the first time, bringing a historic turn to Nepal's health system. In Asad 2081, the hospital started using the robotic system of an Indian company.
This technology was formally introduced to Nepal by successfully operating on three women on the same day. This day has been specially recorded in Nepali medical history as it was the first time a robot-assisted surgery was performed in the country.
Senior obstetrician and gynecologist Dr. Nutan Sharma successfully performed complex surgeries on three women using robots. Dr. Sharma removed the uterus of a 52-year-old woman, an ovarian cyst of a 31-year-old woman, and a uterine tumor of a 34-year-old woman using robotic technology.
She said that all the surgeries were successful and the patients returned to normal soon. She said, ‘This is the most important moment of my life. The patients said that I should have given them a ‘certificate’.’
She said that it is a matter of pride to have the record of the success of the first robotic surgery in the country. According to Dr. Sharma, robotic surgery is an advanced technology than traditional laparoscopy.
Recounting her experience of performing robotic surgery, she says, ‘It provides a 3-D view and my hand can rotate in many angles. Everything is under control, how deep to go, what angle to adjust. This makes the surgery much easier and safer.’ Robotic surgery is more expensive than laparoscopy. She said that patients can decide which type of surgery to undergo according to their financial situation. She says that robotic surgery is not the choice of everyone due to financial reasons.
Robotic service at Chitwan Medical College
Robotic surgery service has also expanded outside the valley
The gynecologist and gynecologist involved in this surgery, Birendra Bhagat, works at Medanta Hospital in India. He comes to Chitwan specifically for robotic operations. He says, ‘Initially, it took time to explain the system in Chitwan to the patients and staff,’ says Dr. Bhagat, ‘but gradually everything is becoming easier.’
According to Dr. Bhagat, it is easier to explain robotic surgery to patients who have relatives abroad. Relatives living abroad have started suggesting robotic surgery in Nepal. Recounting an experience, he said, ‘The son of a patient who returned after undergoing robotic surgery was in Australia. He had undergone robotic surgery in Nepal on his own initiative.’
He believes that this surgery will gradually be understood and will be easier in Nepal. He believes that many patients who used to go to India for this type of treatment will now receive treatment in Nepal. Dr. Bhagat is optimistic about the future of robotic surgery. ‘Earlier, when kidney transplants were not available, patients used to go abroad,’ he says. ‘After this service was started in Nepal, patients started getting treatment here. Robotic surgery will also follow the same path.’
Robots are also used in neurosurgery
Robotic systems are also being used in complex surgeries related to the brain and nervous system at Annapurna Neuro Hospital. The hospital has stated that a robot called ‘Remibot’ is being used in brain surgery. According to Consultant Neurosurgeon and Medical Director Dr. Sudan Dhakal, in this procedure, the surgeon performs the operation, the robot only assists in the treatment. He says that the robot will be of great help as it is difficult to reach the inner part of the brain.
According to Dr. Dhakal, the robot has been very useful in the stereotactic EEG (SEEG) procedure. He said, ‘In the process of placing many needles inside the brain and measuring the wave, it used to take about two hours to place one needle without the robot, but after the robot came, the same work has been possible in 20 minutes.’ He said that since five or six needles have to be placed at a time, both time and risk have been reduced.
Dr. Dhakal says that robots can also be used in spinal surgery. This will reduce the need for multiple X-rays and reduce radiation exposure for doctors, he said. He claims that using robotic surgery will not cost the patient unnecessarily. He said, ‘This robotic surgery will not be expensive for the patient, it is just a tool that makes the work easier for the surgeons.’
The government is also introducing robots
Although robotic surgery is conducted by private hospitals, it is not yet available in government hospitals. Robotic surgery is considered positive because new technology has been introduced in Nepal, said Dr. Prakash Budhathoki, spokesperson for the Ministry of Health. He said that the government is also preparing to introduce this technology as it is considered to be fast and efficient in treatment.
He said that the government has allocated a budget of 880 million rupees to introduce two, one in Kathmandu and one outside Kathmandu. He said, ‘A guideline will be prepared to regulate this treatment method and the government is also preparing to introduce it.’ According to him, the government will decide to go ahead with the procurement process after understanding its further effectiveness.
