Dr Sailesh Puntambekar
Managing Director, Galaxy Care Hospital, Pune

Dr Sailesh Puntambekar, Managing Director, Galaxy Care Hospital, Pune shares his excitement about the new age technology tools available at the hands of a surgeon at Maharashtra Healthcare Leadership Summit 2014, Pune

Technology is in-built in healthcare, thus it makes an exciting subject for medical practitioners across various fields in medicine. This when taken into perspective of the role of technology to us, as a surgeon “ there is a rapid pace of technology revolution in treatment modalities. The biggest revolution that is taking place through technology is that a lot of surgeries today are done only through a key-hole. If you ask one doctor today what is his ultimate aim when performing surgeries, the chances are high to hear that he wants to perform a scar-less surgery. This has gained significance in many specialties.

Key-hole Surgery
When it comes to scar-less surgery, it is usually accepted that except for the delivery of a new born baby that can be taken out of the uterus only and needs a wide slit, there is no organ that cannot be taken out by a key-hole technology. So much so, that we are now advanced to the technology that is called Robotic Technology. These are disruptive technologies that breaking the age old myth of big surgeons takes big incisions in surgery. The pace of technology has accelerated to such an extent that today the usual trend is that big surgeon takes no incisions. The biggest surgeons in the world do not take incisions; they approach the organs through various orifices and off course through key-hole incisions. The transformation that has come at the hands of the surgeon is in the form a magnification technology. Initially, surgeons used to see and cut incisions based on their assessment and experience. However, with the advent of advanced technology today, any surgeon sitting on the console, actually sees 40 times magnified image; as a result of which they are empowered with high precision and can cut better as they see better. The improvement in visualization directly results in better surgery and subsequently faster recovery of the patient.

Robotic Surgery
The most important thing that technological innovations have brought in is Robotic Surgery. Robotic Surgery is that which leads to a huge number of computer-aided surgeries. Patients tend to view surgeons is different light as compared to other decisions in healthcare. Surgeons broadly can be divided as good, excellent and average. Firstly, the extremely intelligent surgeons but lazy, second comes the ones who are extremely intelligent and hard-working ones, who are the best of the above two category. Thirdly, there are surgeons who are extremely docile and lazy, with no harm to the society. Fourth category consists of the surgeons who are extremely enthusiastic but with do feel motivated to keep with the times and promote archaic practices amongst patients. They are harm to the society. There is hardly any possibility for the patient to know that he will receive the best of the healthcare, as he has blind faith to his surgeon. So, there is a need to have a kind of machine that is intelligent and can be easily operated that will bridge the gap between of having the skills or absence of them. This is where the robot technology in medicine becomes relevant, as the technology helps us to have a better surgery done irrespective of which category of surgeon one is and his skill-sets and the type of surgery. This is a kind of total integration of the surgical care and this is in existence in Pune city besides being utilised world-wide. The surgeon is only human and has limitations on the number of surgeries it can perform to perfection. Robotic surgery brings on-board robot machines that are precise to provide a 40 times magnified picture, thus ensuring of maximum accuracy and utmost smoothness, during surgeries. So when we can define, magnify and see clearly the organ, there remains hardly or minimum chances of damage. So, as suggestive technique and assistive tool a technological innovations or machinery that may replace an individual surgeon with optimum accuracy is more far-sighted.

We have reached the era, where the surgeon becomes face-less; surgeries are very safe, guaranteed and fruitful.

Minimally Invasive Surgery
To become good doctors, it is mandatory to do precise and excellent surgeries without any emotional attachment, irrespective of time. This is with reference to Minimal Invasive Surgery. There are several types of surgeries that we can do. One must be wondering is it possible to bring out the organs in the chest or the abdominal cavity, because there are cavities which are present here. But, technologies are advanced to such an extent that we can take out organs like thyroids, sub-mandibular glands, varicose veins, and organs in the legs or operate through the vagina to reach the gall-bladder. As a matter of fact, today through a small umbilicus or the naval we may insert multiple instruments to get clear magnified picture and even complete a surgery. Ten years down the line, this scenario was something unimaginable. Today its a fact that the only limitation in doing this kind of surgery, does not lie in the instrumentation but lies in the surgeons mindset. If the surgeon has a positive mindset and believes that he can successfully operate then it is possible to get the best of the results.

Orifice Assisted Single Incision Surgery
In Orifice Assisted Single Incision Surgery (OASIS), there is a huge difference between the demand and supply scenario in this sector. There are excellently skilled surgeons but the gap remains not because one does not want to do it but because one cant do it. So there is a huge mis-match between having skilled surgeons and not having skilled surgeons. Unfortunately, the demand has gone extremely high. In addition to that there is an integrated Robotic Surgery, which actually guides you to exact organ and informs you if there is an artery or vein or the critical condition of any organ. As a matter of fact a surgeon may instruct his assistant to complete the process by marking the area to be operated. However, when this technology was first introduced in Pune it was not widely accepted, highlighting of the risk factor associated in the doctor being closely associated with patient during the surgery, which may cause harm to the patient while the doctor is somewhere outside. This is completely fallacious and we are doing the surgery with extreme magnifications. Thus, these Robotic surgeries can be done much easily with the robots available for the purpose. Actually, the robot and the surgeons are in a synergistic relationship to ensure the patient gets the best benefit. The robotic technology in medicine was first embraced in the country in 2009 and we had the fifth robot in the country. After a continuous five years perusal, we only have a number of 26 robos in the entire country.

Futuristic Technologies
It is very important to have this advanced machinery so much so as surgeon can operate a patient at their convenience and at the convenience of the patients.. Some of the key features of robotic surgeries are the doctor needs not to be in close association with the patient during the surgery and can be done both being located else-where. The doctor may tele-monitor the patient and the first of the kind of similar surgery was done Trans-Atlantic and was named after the pilot who flew the aircraft for the doctor and is called Lumbars Operation. As a matter of fact, the future of surgery is man-less surgeries, wherein 180 of them had been done without the doctor present on the spot of operation. We have reached the era, where the surgeon becomes face-less, surgeries are much safe, guaranteed and fruitful.

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