Interview

Curing Cancer, Avoiding Infection

Dr Jagdishwar Gajagowni

As the Head of Surgical Oncology and Clinical Director of Oncosurgery at KIMS hospital, Dr Jagdishwar Gajagowni leads a hi-tech set up to fight cancer. But while attending to cancer cases, the risk of Hospital Acquired Infections (HAIs) presents a clear and present danger, he tells ENNs Rajesh K Sharma. Thankfully, STERRAD is an able deterrent for HAIs…

Dr Jagdishwar Gajagowni

Dr Jagdishwar Gajagowni
Head of Surgical
Oncology and Clinical
Director of Oncosurgery at
KIMS hospital,

Dr Jagdishwar Goud Gajagowni is Head Of Surgical On- cology and Clinical Director, Robotic Oncosurgery at Krishna Institute of Medical Sciences (KIMS), a 1800 bed super-specialty hospital situated in Hyderabad. KIMS is the largest corporate healthcare group in Telengana and Andhra Pradesh states, operating six successful, fully- independent hospitals and treating more than three lakh people annually. The KIMS Institute of Oncological Sciences treats patients suffering from more than 200 types of cancers. The department collaborates with other departments and divisions at KIMS to provide patients with comprehensive cancer care.

As the Clinical Director of the Oncology Robotic centre at KIMS, Dr Gajagowni over sees a high-tech set up involving the latest robotic equipment for treating cancer cases. Treatment of cancer is now a multi- disciplinary science, and the radiation oncologists, medical oncologists and surgeons at the Oncology Robotic Center at KIMS work closely with nurses, pathologists, radiologists and pain management specialists to maximize the effectiveness of the treatment.

Explaining the advantages of robotic surgery over Laparoscopic surgery, Dr Gajagowmi says the stable 3-D imaging makes the appreciation of the patients anatomy better. The stability offered by robotic surgery also makes the reaching and grasping of the various blood vessels easier and simpler. It is easier to hold the nerves with the help of robotic arms, he says. The resultant stability is a big advantage when dealing with soft tissues and small nerves, he says.

Robotic surgery also makes the movement of instrument more intuitive, thereby reducing the learning curve for dissection and suturing. Negotiation over and under structures like ligating vessels, dissection on opposite side like in Esophagus is better, he says. The 180 degree rotation of the robotic arms needle holder also makes the suturing of narrow spaces like prostatic neck, mid Esophagus etc easier and better, he points out. Since the surgeon controls the camera and the cautery, it saves his time as he doesnt have to depend on a third person for all data. As a result, the surgeon can synchronize his dissections better, Dr Gajagowni points out.

A surgery in any discipline carries with it a risk of Hospital Acquired Infections (HAI). Though hospitals and doctors take precau- tions against spreading an unwanted infection, the risk remains high. According to estimates, the rate of HAI is as high as five percent in India.

In Oncology, the risk of infection is high, as it involves contact with sensitive tissues and very small veins and vessels. The surgeons and the nursing staff are by the patients side all the time, Dr Gajagowni clarifies. Also, the instruments, by virtue of being small, are difficult to sterilize by normal procedures, often requiring specialized instruments, like STERRAD.

KIMS takes infection control very seriously at its premises. It has an infection control board that take note of any reports of infection that it comes across and analyzes them. It then suggests measures to control the infections effectively. In addition, KIMS uses STERRAD to sterilize its equipments used in Laparoscopic and robotic surgeries. KIMS also carries out regular fumigation on its premises to guard against the spread of vector diseases.

STERRAD, Dr Gajagowni says, has been beneficial to KIMS. He points out that the instruments are sterilized faster using STERRAD, thus saving on time. Robotic instruments are expensive, he says, and ensuring their cleanliness is of paramount importance. Sterilization time in STERRAD is less than an hour versus 12 hours in EO. This helps us do more cases with limited set of instruments. This technology helped us to upgrade from disinfection to terminal sterilization and avoid use of liquid chemicals. This helps to reduce post-operative infections, he says.

Further expounding on the advantages of STERRAD, Dr Gajagowni says it is safe for the environment and the healthcare workers as it does not leave any toxic residues like other low temperature sterilizers. Its fast cycle time of less than an hour means that it is ready for use immediately without any aeration. This allows the instruments to be used for more surgeries. The STERRAD is also very useful for sterilizing the minimal invasive and robotic instruments that are otherwise delicate to handle by human hands. STERRAD is compatible with most of the delicate devices used for Robotics procedures. As the Robotics Center at KIMS continues to treat cancer cases under Dr Gajagownis guidance, he is positive about the advances happening in Indian healthcare scenario. He says advances are happening in both, Laparoscopy and Robotics. The future is even more optimistic, with advances happening in the malleability of instruments. The optics will further improve when better 3-D becomes available, he says. Advances in Staplers and Cautery mean that in time, they will have less lateral spread and their sealing effect will also improve.

For more information about STERRAD, contact Mr Kamakannan Thiru at tkamala@its.jnj.com

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