The first in India to do post-doctoral Fellowship in Minimal Access Surgery, Dr Vikas Kapur, Senior Consultant & Director, MS (Surgery), FNB (Minimal Access Surgery), Narayana super-speciality hospital, Gurugram, Haryana, has extensive experience of working in some premier hospitals of India. Having garnered exceptional expertise in robotic surgery, he is transforming lives and the healthcare landscape like never before.
Dr. Vikas Kapur, MS (Surgery), Fellow National Board - Minimal Access & Bariatric Surgery Director & Senior Consultant - Department of Minimal Access GI and Bariatric Surgery
1. What are the myths surrounding robot assisted surgery?
When patients and their families come to us the questions are invariably whether Robotic Assisted Surgery (RAS) is safer than the traditional surgery and if the procedure is simple or why is it better than laparoscopy surgeries and why is it more expensive etc. We counsel and familiarise the patients about the robot cart, which has a camera, a left hand and two right hands giving it an edge over other methodologies of surgeries. We assure them that the entire control is in the hands of the surgeon, who has expertise, because in RAS the robotic arms are manoeuvred sitting at the console. With awareness and word of mouth publicity by patients who have recovered leading a better quality of life, one does get to see a gradual change in people’s mind set. Now patients have started opting Robotic Assisted Surgeries, so Narayana Healthcare, Gurugram, recently acquired a Da Vinci robot to meet the increasing demand.
2. What are the advantages of RAS, both for the surgeon and the patients?
Surgeries are done on surgical planes as every organ is multi-layered. In RAS, the advantage is that the vision is magnified multi-fold by 14 times so the chances of trauma to adjacent cells are negligible. In cutting, inserting a device, placing a mesh or suturing, less time taken for dissection, in every case, robots are much superior. Most importantly, tissues are better identified because of the 3D vision, which is far superior to laparoscopic surgeries making the dissection more precise. Chances of relapse, bleeding, and infections are therefore ruled out. Also, through team practice, where every member brings in their experience and expertise, both global and the Indian perspectives, we can take quick decisions enabling us to operate a larger number of patients, saving on time. For patients, the recovery is faster, hospitalization is minimised and post-operative complications are rarely reported, thereby, reducing overall financial costs or burden.
3. In a cost sensitive market like India, how does minimal access surgeries pass on the benefit to the needy patient?
An RAS costs 1 lakh rupees more than conventional laparoscopic surgeries, but I advise patients to go for it as the outcome is markedly different and better. Now insurance companies have included RAS under its cover, and even the IRTA has come out with the guidelines that robotic surgery is important and an integral part of patient care. Empanelled patients as in the CGHS are paid a lakh extra for cancer surgery. I think as scalability increases, as robotic surgeries become more popular and efficiency improves, the costs are bound to come down making RAS more accessible even for the lower income group patients.
4. How important is it to be proficient in conventional surgeries and the reason to shift to RAS?
Surgical training begins with open surgeries, then upgrades to laparoscopy and then advances to robotic surgeries. As the RAS skills of the surgeon advances so does the respect for tissues and the fact is that it improves your skills in open surgeries. Because there are certain advantages that is why patients as well as doctors are switching over to RAS. Most importantly, RAS reduces tremors, which is not passed on to the patients undergoing operation, it improves concentration, and a surgeon can take a break and then go back if the going is tough in a complicated surgery of long duration. The only disadvantage is that there is no tactile sensation, one can’t feel the tissue, but this can be overcome with practise. Today, cardiac, spine, orthopaedic and pulmonary (lung surgeries) are being done robotically.
5. In the coming decade, what would be the scope and role of minimum access and bariatric surgeries?
A decade from now every surgery will be done by robots. Most of the surgeons will switch over to doing robotic surgery. And as technology and digital connectivity improves, tele- surgery will become a reality.
When we talk of bariatric it is basically a metabolic syndrome, besides lifestyle, obesity and family history. With people becoming more health conscious, bariatric will have a role as a specialty. I send such patients first to an endocrinologist to manage the condition with modern drugs which are very effective. If it does not work for them, then the patient is operated.
Only if we are able to change the culture such cases will come down. We conduct regular awareness campaigns, health camps, health check-ups, patients are being screened and advised.
