December 2018, a Gujarat cardiac surgeon, Dr Tejas Patel creates history by performing world’s first tele-robotic heart surgery on patient who is 30-km away. The last three decades has seen paradigm shift in the advancements in the medical field. Surgery and pharmacy is heavily impacted from manifold technological disruptions.
Medical innovations have brought down morbidity and mortality rates. We spoke to eminent doctors who told us how we are transitioning, thanks to the the use of mobile technology, wearable technology, tele-medicines and graduating into an advanced systems of healthcare activities and services.
Cutting-edge technological disruptions with robotics, artificial intelligence, genomics, regenerative medicines, et al is pacing up. Surgeries performed in India today are using minimally invasive and guaranteed gold standards that are available in any part of the world. Doctors have a whole new way of accessing the remotest parts of a patient’s body with astute precision by not just the skilled hands of a surgeon but with rightfully-guided robotic hands. Tech-enabled new machinery is creating the best way forward for our highly skilled technicians, surgeons and researchers. Breakthrough in surgical technologies has reduced the duration for surgeries. It has commendably enhanced doctor’s skill sets and accoutrements and improved patients conditions.
In terms of Robotic Surgery, Robotic surgical suite has been added in the armamentarium of surgical facilities. The Da Vinci system is being extensively used as it is a very good alternative to traditional or open surgeries and laparoscopic surgeries. The Da Vinci Surgical System allows surgeons to operate on minimally invasive options for complex procedures as well.
Dr Sudhir Rawal, Medical Director and Chief of GenitoUro Oncology Services at Rajiv Gandhi Cancer Institute and Research Centre says, “Treatment of uro-oncological conditions have improved dramatically in the last decade. In lieu of the advances made cancers are now diagnosed at early stages and in the event of surgeries, one can make use of the latest, the Da Vinci Surgical system which is part of the Robotic suite as well as the CyberKnife.”
CyberKnife is the world’s first non-invasive whole body radiosurgery system. “It is a ray of hope extended to patients who need to undergo treatment of tumours and lesions, even if they were previously diagnosed as inoperable or untreatable. CyberKnife uses state-of-the-art, real time image guidance similar to the cruise missile technology. They have the ability to precisely pinpoint the targeted tumour. It delivers intense doses of radiation only onto the required cancer cells.” This technology was first launched at Apollo Speciality Cancer Hospital in Chennai.
Also, uro-oncology uses the applications in detection of pathologies on radiological imaging, for distinguishing a single tumour cell in several histological samples or making diagnosis of melanoma with smartphones. “The state-of-the-art ultrasound technology allows the acquisition of higher resolution images. The recent introduction of elastography and ultrasound contrast agents have further enhanced our capability in many clinical situations, especially in oncology. These include differentiation of solid renal masses from cysts, detection of solid nodules within echogenic/hemorrhagic cysts, and identification of suspicious targets during prostate biopsies. These techniques are still evolving.” he says.
Dr Sudhir Rawal says, “Multiparametric MRI has truly proved to be a game-changer for uro-oncology. It has further improved the characterisation of cysts over traditional
CT-based Bosniak grading and has increased confidence in evaluating small renal masses.”
AI has been instrumental in increasing the rate at which plastic surgeons and cosmetologists deliver successful, aesthetic and reconstructive surgeries. The algorithmic approach enabled by computerised ‘big data crunching’ gives them better understanding of outcomes and thereby beautifully impact reconstructions in terms of counting the number of wrinkles and lines on the face that need treatment, identifying face shape based on image processing technique, applying virtual makeup, analysing fractures and producing 3D implants individualised to the person’s facial profile.
Dr Debraj Shome, Co-Founder and head of the Institute of Aesthetic Surgery, The Esthetic Clinics, Mumbai says, “Burns are the most common injuries that require the help of a plastic surgeons. They need to be treated very carefully to avoid infections and to ensure that there are fewer visible marks of injury. With the use of AI in burn treatments, it is easier to assess the total surface area of the burn and its degree. It tells you how to plan and what will go into precise execution of surgical treatments.”
Dr Shome adds, “there is the Elective cosmetic surgery, a pre-planned surgery where AI uses a wide range of facial image database to assess skin types and problems areas so as to decide concrete outcomes for the cosmetic surgery. It saves patients of unrealistic expectations and enables their decision-taking.”
Besides this, Dr Shome says there are successful surgeries performed for those requiring hand transplants and peripheral nerve surgery. He says, “AI has emerged as the prefect tool for making sure that the interaction of joints and muscles is replicated and modelled well. There are two options in hand surgery namely hand transplant and a prosthetic limb. With the use of AI in such cases, the surgeons can collect precise data on how to restore the hand grasp and wrist control. AI is used to design automated controllers for a variety of neuroprotheseses. This helps greatly in improving the patient’s quality of life after surgery.”
Heart of the matter
In the arena of heart diseases too, significant innovations are taking place. Rheumatic heart disease (RHD) a problem comprising damage to one or more of the heart valve even after an episode of acute rheumatic fever (ARF) is resolved is a condition that needs proper care as the heart and its muscles could be inflamed.
Dr Bipeenchandra Bhamre, cardiac surgeon from Sir Harkisandas Narrottumdas Hospital, Mumbai says, “ Human heart with four valves may weaken due to RHD or become stenotic (area of passage of blood shrinks causing obstruction to blood flow). Valves may become regurgitant (blood flow becomes two directional) or there could be lesions that affect heart functioning. This condition calls for medical interventions.”
India has about 1.5 lakh heart valve patients that need valve replacement. Considerable advancements are being marked in the arena of cardiac surgeries. About 50,000 operations are performed every year. “About 30 to 40 per cent of the patients diagnosed with rheumatic heart disease will eventually require heart valve repair or replacement.Echocardiography tells you which valve is affected and the severity of the heart valve dysfunction. Surgical options are available for critical valve stenosis, severe valvular regurgitations and for aortic valve replacement too. Tissue valve or Mechanical valve are options one can choose from.”
In order to distinguish when both kind of valves are said to be good, Dr Bhamre says, “One can go with mechanical valves as they are made of a special type of carbon or titanium and other sturdy materials. These are durable and last for decades. However, it is more suited to younger people. And these valves could use anti-clotting drugs for life. Tissue valves are considered an apt choice for elderly people.”
Recent developments in transcatheter valve has made heart valve implantation from a small vessel in patient’s leg easy. “Transcatheter aortic valve implantation (TAVI) is a procedure that allows an aortic valve to be implanted using a catheter that is inserted into a large blood vessel in the groin or through a small incision in chest. Even though TAVR is restricted to selected patients, the elderly can take it up,” says Dr Bhamre.
Make no bones about it
Orthopaedia has registered many innovations since being intervened by technology. Renowned Orthopaedic and Joint Replacement Surgeon, Dr Raju Vaishya, at Indraprastha Apollo Hospital, New Delhi, says, “Diagnostics and treatments are the two areas that have seen advancements in bone and joint diseases. Radiology has come in a big way moving away from conventional video graphs to digital radio graphs that give high quality pictures. There are one-minute full body CT scans and Magnetic Resonance Imaging revolutionising treatments of spine-related problems.”
Technology is going great guns making it easy for the doctors to decipher the exact crack or fissure/s bone has undergone. “We are robust on the use of Positive Emission Tomography or (PET) scan for treating patients suffering from cancer of the bone marrow, metastases, or problems that mimic cancer. Additionally, DXA scan in radiology is used to diagnose bone mineral density and hence the encumbrance of osteoporosis, a silent disease.”
“Operative treatments requiring minimal invasion are using injections such as viscous gel or hyaluronic acid, platelet rich plasma or (PRP) and stem cells that are used to cure diseases of bones and joints. Besides this, arthroscopic surgery, an endoscopic surgery is revolutionary in its uptake of sports injuries.”
What the doctor’s community in the country is also doing is to make home-grown implants that cost the wearer less and making precise replicas or artificial fittings. “In the Indian market, joint replacement surgeries with artificial implants such as the golden knee is doing good. The durable golden knee can be used by the elderly for about 30-35 years. Computer navigation aids making the best customised implants for patients,” says Dr Vaishya.
Turning a new leaf in this area is regenerative methods. “It is now possible to have laboratory-grown cartilage and bone marrow for transplantations in joint tissues and bones,” adds Dr Vaishya.
Pharmacy is seeing breakthroughs in the form of new anti-microbial therapies, new painkillers overtaking non-steroidal anti-inflammatory drugs that have descended the market for good. “Emphasis is on nutraceuticals or natural products derived from herbs that relieve pain and inflammation in case of osteoarthritis,” says Dr Vaishya.
Advancements in the field of assisted child-birth is setting good examples in the country. They are helping both mother and child to be in better health. Dr Manisha Singh, Consultant Gynaecology, Reproductive Medicine and Robotic Surgery, Fortis Hospital, Bengaluru, says, “Artificial Intelligence in health care is happening at the levels of virtual and physical. Software-aided computer technology mixed with extensive medical research and clinical data has improved preventive and therapeutic options.”
“Doing first-trimester screening or double or quadruple marked test at 16 weeks of pregnancy to evaluate risk of Down’s syndrome in foetus using computerised algorithms is helping us arrive at better diagnosis.”
For complex gynaecological surgeries robotics is very much in use says the doctor. “For surgeries such as hysterectomies for cancer, endometriosis excision surgery, and myomectomies for fibroid removal the medical community relies on Da Vinci Robotics. It has led to improved finesse and dexterity during operations.” Dr Manisha Singh adds, “Nanotechnology is being used to make nanorobots used for drug delivery into cancerous cells.”
Technology is assisting the road to drug development. Genomics is bringing about far-reaching and impactful changes in both the manner in which diagnosis happens and in the treatment of infectious diseases. These include DNA sequencers, involving a wide variety of new tools for gathering, analysing, and disseminating genetic and genomic information. Genomics and its related lab-technologies have numerous opportunities in fields of medicine, industry and much more. Cancer, congenital diseases and acute infections are areas where genome based research is continuing.
Availability of intricate tools fired with technology are ensuring precise results. Unlike earlier times when patients would rely on the closest possible approximation being arrived at by a doctor, now it is available on the fingertips of technology. Tech-infused palliatives and tech-driven procedures are here to make for healthy, happy lives.
The biggest takeaway from technological advancements is that they are cost-effective in the long run. With technological accessibility, its costs go down. We are hooked to the never-before-ways of improving quality of life, answering medical problems and saving countless lives.