Cancer treatment
1. Advances in medical technology
2. Robotic surgery opens new doors

Advances in medical technology

Dr. A K. Dewan, MS, MCh (Surgical Oncology) Consultant Surgical Oncologist Rajiv Gandhi Cancer Institute, Delhi Medical Director Ganga Prem Hospice

Dr A K Dewan at RGCI

‘Medical Technology’ means the procedures, equipments and processes by which medical care is delivered. Examples of advanced medical technology in oncology include Minimally invasive surgery, Robotics, HIFU (High Intensity Focused Ultrasound), Tomotherapy, IGRT, Targeted therapies, PET scan and Telemedicine etc.

Some innovations such as new drug molecules may cost more immediately but save more lives and have effect on survival. Any innovation saving meaningful human life is a worthy innovation. A few other examples are newer anaesthetic agents and newer machines and monitoring devices. These have reduced patient recovery time, shortened hospital stay and lead to fewer medical errors. These changes have reduced the overall costs although the technology may have been expensive. At the same time, these innovations have made it possible to perform surgeries on high-risk patients. Newer technology in radiotherapy is precision based aiming to reduce the morbidity associated with radiation. In the history of surgery, laparoscopic cholecystectomy remained unchallenged from the time it was introduced and soon became the gold standard. Cost of laparoscopic cholecystectomy has reduced dramatically with good innovative instrumentation and increasing expertise.

Robotic surgery, single port minimally invasive surgeries have become popular in the last decade. HIFU is being used for fibroid uterus and prostate cancer. Newer techniques are quite expensive but if a patient of localized prostate cancer has a hospital stay of 7 days for open surgery vs. 3 days for Robotic surgery vs. one day for HIFU. There is cost saving in terms of hospital stay, faster recovery and minimal morbidity. Who knows HIFU may replace Robotic surgery in prostate cancer in the near future. Another mind-blowing question is what influences the growth of these innovations? Is it industry or doctor or consumer? The answer is consumer demand for better health. As people become wealthier, they provide a fertile market of new medical innovations. Advances in medical technology are perceived as a way to promote the goal of achieving and maintaining good health. Consumer demand is also affected by increasing public awareness of medical technology through the media, the Internet and advertisement from industry. Professionals also try to find better ways to treat their patients with the ‘’latest and best’’. They may also be motivated by professional goals like peer recognition, prestige and improvement in practice. Industry driven innovations may find consumer interest and major financial reimbursements.

My humble appeal is to the clinicians, oncologists, researchers and industrialists. India has a huge medical market potential. Let us invest in basic science that is not motivated by an interest in creating new products but by the desire to increase human understanding. Clinicians should join hands with researchers and spend some time of their life in bringing technology from the lab to the bedside of the patients. Secondly, as a clinician we are becoming high tech but low touch. No young doctor wants to touch the patient. Doctors don’t clinically examine the patient. They only see and treat latest X-rays and scans. Remember ‘X-rays and scans are only as good as doctors who request them and the radiologist who reports them’. High-end technology can never replace clinical skill. Let us be high tech and high touch.

Robotic surgery opens new doors
Technology and scientific innovation are making cancer treatment better and safer for patients.

One such innovation is robotic surgery, where a multi-armed robot, controlled and manipulated by a surgeon, performs surgical procedures on a patient. Robotic surgery is particularly useful in prostate cancer surgeries. What a robot does is make the surgery happen with much reduced blood loss, pain, and recovery time. The robotic assisted prostate cancer surgery is also sometimes called bloodless prostate surgery for this reason.

Surgeons at the console of the robotic surgery apparatus at Rajiv Gandhi Cancer Institute, Delhi.

A four-armed robot assists the surgery by entering some very tiny and precise surgical instruments into the patient. The robot’s four arms are controlled by the surgeon. One arm of the robot controls the camera and the other three arms have surgical instruments mounted on them. The surgeon has a 3D vision console at his disposal with an instrument like a joystick through which the surgeon controls the robot. The device not only senses and obeys the surgeon's hand movements, it also detects any tremors in the surgeon's hands so that the tremors are not duplicated. The patient has smaller surgical scars to remind him of the surgery, recovers faster and returns home sooner. The robot enables surgeons to perform even the most complex and delicate procedures through very small incisions with unmatched precision.

Robotic surgery has enabled patients to benefit from surgeons' expertise even in remote locations. "Surgeries have been performed cross-Atlantic with the help of the robot, with the console and control being in the surgeon’s hand, and the robot with the patient in another location. The surgeon is still indispensable but the precision and convenience is much higher," says Dr Dewan, surgical oncologist and medical director, Ganga Prem Hospice,

As a first in India, robotic surgery has been introduced in the Rajiv Gandhi Cancer Institute & Research Centre, Delhi, which becomes the first exclusive cancer institute to have the da Vinci Surgical system facility.