The patient’s heart is still beating, his chest is closed, and there is no surgeon hunched over the operating table. Yet, as the monitors outside the sterile operating theatre—watched by a gaggle of excited visiting and local doctors—confirm, there is a coronary bypass surgery underway at the Escorts Heart Institute here. On the colour screen, scalpels and pincers are indeed pulling and slicing their way through the pink flesh enveloping the troublesome artery. The confusion is greater when you spot Naresh Trehan three feet from the foot of the operating table, hunched over something that looks like suspiciously like a video-games console. It all becomes clear when you realize the surgical tools inside the patient actually belong to the able, metallic hands of da Vinci, a Rs 5 crore machine. It’s being guided by Trehan as he perfoms India’s first robotically assisted heart surgery. ‘‘The kids who do video games will excel in this,’’ jokes Trehan, looking up from his workstation. He’s using a pair of joysticks to control da Vinci’s two robotic arms, each as flexible—and hugely more accurate and forgiving—than a surgeon’s wrist. What he’s been peering at is a three-dimensional view from inside his patient’s chest, coming from a tiny camera inserted into the chest along with the robotic arms. Inaugurated by President A P J Abdul Kalam this morning, the robot heralds the arrival of surgery’s new frontier to India. Once it is fully mastered, the robot should slash hospitalization time by more than 75 per cent, reduce trauma, surgical damage and the risk of infection. Born from a US Defence Department project that would allow doctors far away to remotely operate in battlefield hospitals, there are less than 100 Da Vinci’s scattered across premier institutions in Europe and the United States. Since Escorts regards the robot as an investment for the future, the cost of a beating-heart surgery won’t change from the hospital’s standard of Rs 1.5 to Rs 1.75 lakh. Minimally invasive surgery has been around for some time, but the present avatar, which is now commonly used for a variety of non-cardiac procedures, involves no robots and a two dimensional image. Most importantly, the movement of instruments is counter-intuitive, similar to doing surgery while looking at a mirror. That often makes it an incredibly tough affair. Da Vinci is intuitive: the 3-D image and motion scaling—if the surgeon moves his hand an inch, the robot will move as little as 1 mm—allows for easy, precise surgery. Still, it demands a very skilled surgeon, one who excels at surgery and has mastered the robot. Not only can the robot reach difficult nooks and corners, it compensates if a surgeon’s hand is shaky, which also means less damage to surrounding tissues. Open-heart surgery is traumatic essentially because it requires a large incision in the chest, sawing through the breast bone and then cracking open the ribcage. All that da Vinci and its camera needs to wriggle inside is three holes—about the diameter of a pencil—on the side of the chest. This simple entry and exit reduces recovery time. It’s already down from the standard six to eight weeks to two. Trehan predicts a time when his patients will walk out the next day. Using a robot not only saves hospitalization time and costs and trauma, it also dispenses with the heart-lung machine, which takes over the heart’s functions when the heart is stopped—an inherently risky procedure—in conventional surgery. All this means there is no need for blood transfusions and the risk of diseases like Aids and Hepatitis. Right now, Escorts still opens the chest to some degree but doctors soon hope to do a coronary bypass only endoscopically, through the three small incisions. The institute is starting with single bypass surgeries and will later move to double and triple bypass. Outside the operation theatre, Trehan basks in the power of da Vinci and takes a quick potshot at his rivals. He refers to a 1977 statement he made, after a rival said robots in hospitals would only be good for pushing carts. With a smirk, he repeats now what he said 15 years ago: ‘‘Surgeons who don’t learn this will be pushing carts.’’
