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Prof. Somashekhar, Chairman, Manipal Comprehensive Cancer Centre, Health News, ET HealthWorld

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Shahid Akhter, editor, ETHealthworld spoke to Professor Somashekhar, Chairman of Manipal Comprehensive Cancer Centre and the Intuitive Manipal Robotic Institution at Bangalore to know extra in regards to the surge in robotic surgical procedures throughout the pandemic.

What potential does robotic-assisted surgical procedure maintain to change into the brand new regular method of conducting surgical procedures throughout Covid and past?
These are powerful occasions which the world is going through. India bought affected someplace round March with this pandemic, which is now very rampant worldwide. But, we must always look past simply mourning about it. What is most essential is to know that we have to dwell with this and make modifications and perceive the brand new regular.

If you look again, what has occurred since February is that many of the international locations, together with India went in lockdown. Remember the mortality of Covid is 0.5% solely. But the mortality of untreated different issues like colon, rectal cancers is 30%. So, we must always not ignore the curable, probably treatable situations. Which if ignored, will result in greater charge of mortality. During this pandemic time, we didn’t need to do main open surgical procedures, primarily as a result of sufferers keep within the hospital for weeks collectively, surgeons, assistants, sisters- all collectively. In an open surgical procedure, there are quite a lot of devices that should be used, lot of vaporization is required, potential issues, ache, ICU stay- all inflicting threat to sufferers, their attendants, medical doctors and healthcare employees.

So, the brand new regular that each one of us have embraced and adopted is minimal entry surgical procedure, particularly robotic surgical procedure. Because in robotic surgical procedure, we use 2 or Three devices solely and surgeon sits within the console and 1 bedside assistant with sister. It requires solely minimal interplay and supplies most profit with minimal invasive nature. So, sufferers go residence the identical day or subsequent day, no want for ICU, much less issues, much less readmissions, much less an infection, and high quality of surgical procedure can also be excellent. So, it’s a boon for sufferers, who’re truly kindred for robotic surgical procedure. So, the brand new regular is minimal entry surgical procedure with keyhole robotic-assisted surgical procedure. Patient comes surgical procedure, goes residence sooner after restoration, much less to no issues, no blood transfusions, no ICU keep and decrease issues.

Worldwide now there’s a fast push to robotic-assisted surgical procedures throughout this pandemic as it’s the popular possibility. In this situation, the place sufferers can go residence early with much less issues and fewer publicity to- different sufferers, attendants, healthcare employees, and hospital employees. It will not be compromising the end result and medical situation of the affected person.

How RAS, being a minimally invasive process can scale back the transmission of an infection?
During this pandemic, the three essential issues we have to take into account are, – bodily social distancing, which suggests the nearer you’re and the extra you’re interacting, the probabilities of contracting the virus is excessive.

In an open surgical procedure, other than the surgeon and affected person, there will likely be one other surgeon, one assistant, and a nurse within the OT. They additionally are available in contact with the physique fluids in an open surgical procedure. Because of the reduce, the affected person takes very long time to get well. They are required to remain within the ICU, ward, go to OPD and they’re going to additionally want dressing.

On the opposite hand, for minimally invasive robotic-assisted surgical procedure, when you dock the robotic and all the things is sealed, you don’t have direct contact. Naturally bodily distancing is maintained. Because it’s minimally invasive, the affected person can eat the identical day, stroll identical day, cross urine and movement the identical day, and go residence the following day. So, there are not any wound issues and infections. Features supporting bodily distancing, and minimal interactions, is definitely inbuilt within the robotic know-how. That is why robotic-assisted surgical procedure is the best method of performing surgical procedure throughout the pandemic.

How RAS is proving to be a socially distant surgical procedure throughout Covid?
This is a vital facet. In minimal invasive, much less human interactive robotic-assisted surgical procedure, surgeons sit on a console not touching the affected person and carry out the surgical procedure. All keyhole robotic ports are docked earlier than the surgical procedure. Post-surgery, sufferers are in a position to get well sooner and in a position to stroll round with out issue. It fulfils all the standards of pure bodily distancing.

What are the assorted protocols and pointers in place for surgeons and sufferers present process robotic assisted surgical procedure?
We had been unclear on the efficacy and security of minimal entry surgical procedure within the preliminary pointers of SAGES. Immediately, the International Society of Robotic Surgery, the SAGES, the International Society of Gyne-Onco, the International Society of Colorectal and Indian Society of Surgical Oncology and AMASO, (Academy of minimal Access Surgery Onco) bought collectively. I wrote a white paper draft for security, adaption and the precautions that needs to be taken to do secure robotic-assisted surgical procedure throughout pandemic. All these pointers, helped in bringing collectively a protocol.

The foremost protocol- the affected person must be screened for RT-PCR, HRCT, in order that the affected person is secure. The surgical OT modification is known as Rule quantity 20. 20 air cycle per hour, and 20 minutes distinction between 2 circumstances, intubation and extubation- 20 minutes to intubate earlier than we enter the OT, and temperature is ready at 20. All the pneumo and the smoke that comes out by the robotic ports is vented out by a selected smoke evacuator handed by sodium hypochlorite. So, these are the three modifications which we did and carried out robotic-assisted surgical procedures safely. We have completed over 100s of them and never 1 affected person turned optimistic, no threat to the affected person or any threat to the well being employee. Currently, the utmost variety of surgical procedures I carry out are robotic-assisted for the good thing about the affected person.

What are the assorted precautionary measures taken by the surgeon within the OR for a robotic assisted surgical procedure to happen?
For any surgical procedure throughout the pandemic, we have to put on PPE (private safety tools). You should additionally put on the N95 masks, the visor, P100 respirator, and canopy the entire physique. The fantastic thing about robotic-assisted surgical procedure is that we don’t have to totally immerse ourself. So, surgeons invariably put on private safety tools throughout surgical procedure. The surgeon console and the entire system is recurrently cleaned with sodium hypochlorite. Whenever surgeons are shifting from console, we clear the tools once more. These are the precautions that we take.

Why is Robotic assisted surgical procedures higher than laparoscopy and open surgical procedure throughout Covid?
Primarily robotic-assisted surgical procedure is painless, minimal invasive, supplies quick restoration, lesser time required to cross first flatus and sooner bowel, early mobilization, lesser complication and early discharge, with out compromising the end result.

How many Robotic surgical procedures have you ever carried out because the Lockdown ?
During the preliminary days of lockdown in April, elective surgical procedures had been stopped as per the Government of India pointers. But, we had been in a position to carry out all most cancers and different emergency surgical procedures. Ever because the final week of April, we now have not stopped any surgical procedure. Every week we carry out robotic-assisted surgical procedure. All over India, round 100s of robotic-assisted surgical procedures are completed each month by surgeons. We can do 2-Three robotic-assisted surgical procedures on the identical day and sufferers can go residence straightforward and comfortably with out issues. The new regular is minimal entry surgical procedure with robotics. During this pandemic time folks have embraced robotic-assisted surgical procedure much more than earlier than.

Do all sufferers present process surgical procedure at your hospital should be examined for Covid, how do you perform your complete process?
Such elements are ruled by the rules beneath the rule of the legislation. Every nation has totally different set of pointers. In India, it’s ruled by the Ministry of Health and ICMR. ICMR introduced the rules in March. They stated that solely the most cancers surgical procedure and immuno-compromised sufferers needs to be seemed into. Soon, in April- May, the rules modified. In our hospital, all of the sufferers present process surgical procedure have RTPCR swab testing completed. So, we will segregate the patients- affected person who’re in danger, who aren’t in danger. We have totally different OT for optimistic and adverse sufferers with particular safety. So, we’re conscious of the end result in a optimistic affected person. Post-op care, lung administration necessities, anaesthesia, are all totally different in optimistic and adverse sufferers, so we segregate them.

What are the areas of therapies that you’ve got lined beneath RAS throughout Covid?
With robotics, we carry out gynae cancers, endometrial, uterine most cancers, cervical most cancers, sentinel lymph node, colorectal surgical procedures, sphincter preserving LIR. I’ve completed robotic lungs, robotic esophagectomy, meals pipe most cancers, robotic colon surgical procedures, robotic thyroidectomy, robotic gastrectomy. My colleague urologists are performing -robotic prostate surgical procedure, kidney surgical procedure. Surgeries are taking place with robots, safely like earlier than.

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