AT YOUR SERVICE DOC: Aesop assisting Dr Naresh Trehan in the landmark surgeryAt 21, Mehrunisa is too old to get excited about Aesop's Fables. But a namesake of the Greek legend is changing this Bangladeshi woman's life forever.A robot called Aesop 3000 got together with surgeons at the Escorts Heart Institute and Research Centre (EHIRC) in Delhi to fix a hole in Mehrunisa's heart. No fable this: it was Asia's first robot-assisted surgery.If the very idea of robots turning surgeons is unnerving, think again. The machine is outperforming humans: cutting down the risk of tremors in a surgeon's hands, creating the tireless doctor available round the clock. For the modern surgeon, reducing risk to the patient's life by using a thinking robot is a big leap ahead. It seems like yesterday that scalpels and knives squeezed in through holes the size of a rupee coin made history. Now, it is the robots. Mehrunisa's surgery is at medicine's cutting edge with Aesop's nonhuman intervention allowing surgeons to make the minimally invasive surgery more accurate than ever before. In Europe and the US, Aesop and other robots have been actively used for surgery for about three years now. They are specially designed to think intelligently and carry out a complete surgical procedure. Aesop is the world's first robot cleared by the US Food and Drug Administration. Inside the operation theatre, where Mehrunisa lies in deep anaesthesia, there is excitement in the air. .preferred-source-banner{ margin-top: 10px; margin-bottom:10px;}"Wake up, Aesop," says Dr Naresh Trehan, chief of EHIRC. Thanks to a computer memory card that the surgeon had inserted in the robot just before the operation, it recognises the voice. Ten other surgeons have their voices taped on to such cards for Aesop to use. But once Trehan's card is in, the robot turns a deaf ear to all other sounds and voices. Another thing: if anybody expects a man-machine to whirr into action and clank towards Mehrunisa, think again - that is the stuff of early Asimovs.Click here to EnlargeAesop is a sleek, small machine with a camera at the tip of its metallic arm. A two-inch incision is made under the young woman's right breast to insert a tiny five-mm telescope between her ribs. This image, caught by the robotic camera, is beamed on to a video screen.Meanwhile, Aesop listens to Trehan saying "move left" and obeys immediately, shifting the frame of vision to wherever Trehan wants it. To Trehan, a human surgical machine with around 19,000 operations under his belt, the second highest in the world, Aesop was exhilarating. "If you can perform with minimum mutilation of the patient, that is really the best thing," he says. A day after the surgery, Mehrunisa was doing fine, according to the hospital. One wonders if her recovery will testify what Trehan believes: "Robot-assisted surgery is more than what the doctor thinks he can do best." He is all the more excited about the future when they will work with two and three-arm versions of the robot, when the second arm will dissect and the third will stitch. The team at EHIRC is busy developing prototypes for these. That would be the day. Mehrunisa's experience has been with the first stage of robotic surgery, which is relatively simple assistance with a surgeon's vision. The West of course is way ahead. In a few centres in Europe and the US, the real robo-surgeons have arrived. No human beings near the patient in the operation theatre. The surgeon simply sits at a three-dimensional video console operating a set of controls instead of surgical instruments. The instruments are with the robot, which carries out the whole surgery.For Dr Hami Shennib, cardiac surgeon at the Montreal General Hospital in Canada and key player in the revolution of minimally invasive surgery, the important thing is how to make cardiac surgery as patient friendly as possible. "This event at EHIRC was a landmark in the whole of Asia," says Shennib.The Milestones 1. Coronary Artery BypassChanged human life. Blocked arteries bypassed by grafting fresh blood vessels to normalise flow.2. Heart TransplantReplacing a person's damaged heart with a healthy one taken from a brain-dead donor.3. Minimally Invasive SurgerySurgery through coin-sized holes instead of deep incisions.4. RobotsState-of-the-art robots are actually performing surgeries.5. Smart DrugsThe future. Injecting drugs into the body and using gene therapy to keep the heart healthy.There are others who hold a contrary view. Dr Ganesh Mani, senior cardiac surgeon at Delhi's Apollo Hospitals, regards robotic surgery as a novelty that India can ill-afford. "India has a glut of trained cardiac surgeons, what will happen to them if robots replace them?" he worries. Mani believes that robots should be doing what they were originally made for - jobs like pushing trolleys around. Not cardiac surgery, which is a fine art. Trehan feels the surgeon can never be replaced. "The surgeon will always be there as this is only robot-assisted surgery," he says. Also worrying is the large number of small children across the country who suffer from rheumatic heart disease and never see the door of a hospital. Little wonder that Mani thinks the cost of a robot should be channelled to India's real health priorities.That is a thought considering the robot that helped fix Mehrunisa's heart cost EHIRC US$ 67,000 (Rs 28.5 lakh). That's probably enough to finance an entire village hospital. Moreover, the surgery itself has cost the patient's family a little below Rs 1.5 lakh. Of course, there are indirect cost-cuts: as advocates of minimally invasive surgery point out, there is a reduction in the time a patient spends in hospital, as much as 80 per cent in some cases. Trehan hopes the patient will be discharged in a few days. He also believes she will benefit from the advantages of using a robot: precision, no shaky hands, no infections and a machine that never tires, never goes on strike. But as Dr I.S. Virdi, cardiac surgeon at Apollo, says, "Robot-assisted surgery has such intricacies, it almost tends to complicate things." So the robo-surgeons might need to become simpler. Yet they are pushing medical frontiers. But arriving at milestones is only an indication of the road ahead. And that's what the robo-surgeons are: just one more milestone in the long road to surgical perfection: from the classic coronary artery bypass in 1969-70 to heart transplants to minimally invasive techniques and now robots. Coming soon: heart surgery as a day procedure; gizmos that you can inject to make the heart grow vessels afresh; gene therapy to make the heart grow stronger. It is indeed an endless road of discovery. Meanwhile, rest at the milestone and celebrate the robodocs.Published By: AtMigration Published On: Nov 9, 1998--- ENDS ---
