1. Advances In Medical Technology
2. Robotic Surgery Opens New Doors
Advances in Medical Technology
Dr. A K. Dewan,
MS, MCh (Surgical Oncology)
Consultant Surgical Oncologist
Rajiv Gandhi Cancer Institute, Delhi
Ganga Prem Hospice
Dr A K Dewan at RGCI
means the procedures, equipments and processes
by which medical care is delivered. Examples of
advanced medical technology in oncology include
Minimally invasive surgery, Robotics, HIFU (High
Intensity Focused Ultrasound), Tomotherapy, IGRT,
Targeted therapies, PET scan and Telemedicine
Some innovations such as new drug molecules may
cost more immediately but save more lives and
have effect on survival. Any innovation saving
meaningful human life is a worthy innovation.
A few other examples are newer anaesthetic agents
and newer machines and monitoring devices. These
have reduced patient recovery time, shortened
hospital stay and lead to fewer medical errors.
These changes have reduced the overall costs although
the technology may have been expensive. At the
same time, these innovations have made it possible
to perform surgeries on high-risk patients. Newer
technology in radiotherapy is precision based
aiming to reduce the morbidity associated with
radiation. In the history of surgery, laparoscopic
cholecystectomy remained unchallenged from the
time it was introduced and soon became the gold
standard. Cost of laparoscopic cholecystectomy
has reduced dramatically with good innovative
instrumentation and increasing expertise.
Robotic surgery, single port minimally invasive
surgeries have become popular in the last decade.
HIFU is being used for fibroid uterus and prostate
cancer. Newer techniques are quite expensive but
if a patient of localized prostate cancer has
a hospital stay of 7 days for open surgery vs.
3 days for Robotic surgery vs. one day for HIFU.
There is cost saving in terms of hospital stay,
faster recovery and minimal morbidity. Who knows
HIFU may replace Robotic surgery in prostate cancer
in the near future. Another mind-blowing question
is what influences the growth of these innovations?
Is it industry or doctor or consumer? The answer
is consumer demand for better health. As people
become wealthier, they provide a fertile market
of new medical innovations. Advances in medical
technology are perceived as a way to promote the
goal of achieving and maintaining good health.
Consumer demand is also affected by increasing
public awareness of medical technology through
the media, the Internet and advertisement from
industry. Professionals also try to find better
ways to treat their patients with the latest
and best. They may also be motivated
by professional goals like peer recognition, prestige
and improvement in practice. Industry driven innovations
may find consumer interest and major financial
My humble appeal is to the clinicians, oncologists,
researchers and industrialists. India has a huge
medical market potential. Let us invest in basic
science that is not motivated by an interest in
creating new products but by the desire to increase
human understanding. Clinicians should join hands
with researchers and spend some time of their
life in bringing technology from the lab to the
bedside of the patients. Secondly, as a clinician
we are becoming high tech but low touch. No young
doctor wants to touch the patient. Doctors dont
clinically examine the patient. They only see
and treat latest X-rays and scans. Remember X-rays
and scans are only as good as doctors who request
them and the radiologist who reports them.
High-end technology can never replace clinical
skill. Let us be high tech and high touch.
Surgery Opens New Doors
Technology and scientific
innovation are making cancer treatment better
and safer for patients.
such innovation is robotic surgery, where
a multi-armed robot, controlled and manipulated
by a surgeon, performs surgical procedures
on a patient. Robotic surgery is particularly
useful in prostate cancer surgeries. What
a robot does is make the surgery happen with
much reduced blood loss, pain, and recovery
time. The robotic assisted prostate cancer
surgery is also sometimes called bloodless
prostate surgery for this reason.
|Surgeons at the
console of the robotic surgery apparatus
at Rajiv Gandhi Cancer Institute, Delhi.
A four-armed robot assists
the surgery by entering some very tiny and precise
surgical instruments into the patient. The robots
four arms are controlled by the surgeon. One arm
of the robot controls the camera and the other
three arms have surgical instruments mounted on
them. The surgeon has a 3D vision console at his
disposal with an instrument like a joystick through
which the surgeon controls the robot. The device
not only senses and obeys the surgeon's hand movements,
it also detects any tremors in the surgeon's hands
so that the tremors are not duplicated. The patient
has smaller surgical scars to remind him of the
surgery, recovers faster and returns home sooner.
The robot enables surgeons to perform even the
most complex and delicate procedures through very
small incisions with unmatched precision.
Robotic surgery has enabled
patients to benefit from surgeons' expertise even
in remote locations. "Surgeries have been
performed cross-Atlantic with the help of the
robot, with the console and control being in the
surgeons hand, and the robot with the patient
in another location. The surgeon is still indispensable
but the precision and convenience is much higher,"
says Dr Dewan, surgical oncologist and medical
director, Ganga Prem Hospice,
As a first in India, robotic
surgery has been introduced in the Rajiv Gandhi
Cancer Institute & Research Centre, Delhi,
which becomes the first exclusive cancer institute
to have the da Vinci Surgical system facility.