Robotic surgery at AIIMS for rare neuro disorder

On Saturday, for the first time ever, the All India Institute of Medical Sciences (AIIMS) performed robotic thoracoscopic thymectomy on patients with myasthenia gravis, a rare autoimmune disorder. AIIMS has been performing video assisted thoracoscopic (VAT) thymectomy, or removal of thymus gland, for the past eight years involving more than 200 cases so far. But this is the first time that doctors used a robot for the purpose, making the procedure more precise. “Robotic surgery is more precise and accurate. It is the future of all surgeries. The robots are so designed that they can reach inaccessible areas in the body and bend and curve as per the shape of the organ. If it works well, then AIIMS would be the only government hospital in India to offer robotic thymectomy,” said a senior doctor. Myasthenia gravis is a neuromuscular disease that leads to muscle weakness and fatigue. Though no definite cause is known, removal of the thymus gland often helps cure the problem completely. “The thymus gland plays an important role in the development of the immune system in early life. In infants, the size of the gland is really big and covers almost the entire chest, but with age the size reduces and has no role to play in the body. It is full of fat. In nearly 75% of myasthenia gravis patients, the size of the thymus gland is considerably big and the functioning is abnormal,” said Dr Arvind Kumar, professor, surgery with specialisation in thoracoscopic thymectomy, AIIMS. According to sources, nearly 12-16 thymectomies had been planned till Monday evening, but only six could be uted. Dr Arvind Kumar performed all the surgeries and was assisted by two experts from Germany, who had flown down especially for the three-day session. Thymectomy can be either performed through an open method or VAT. The former is similar to open-heart surgery in which the chest bone is cut open and the thymus gland, which is anterior to the heart, is taken out. In VAT thymectomy, three tiny incisions are made in the left chest through which the surgical instruments along with a small scope is introduced into the body and the surgery is carried out with the help of a visual monitor. The robotic surgery is similar to VAT, but the only difference is that the surgeon uses a specialized console with monitor to perform the surgery. The plus point of VAT thymectomy is that it leaves minimal scars. In myasthenia gravis, the body produces certain antibodies which attacks its own immune system and blocks or destroys the communication between nerves and muscles, thereby preventing muscle contraction. Incidentally, thymectomy is also done on patients with thymic carcinoma (a rare type of thymus gland cancer) and non-metastic thymoma.

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