Does the Robot Actually Perform Your Surgery? The Truth About Robotic Heart Surgery | Doctor vs Internet의 전체 녹취록

very recent. Because our surgery started only in 1960s. 73 00:04:02.270 --> 00:04:09.159 Till 1960s, all of us died of heart surgery. All 74 00:04:09.180 --> 00:04:12.520 of them used to die. Why? You ask me? Because 75 00:04:12.719 --> 00:04:17.709 at that time, there is no... material, no process to 76 00:04:17.750 --> 00:04:22.970 stop the heart. That's the biggest contribution to the mankind 77 00:04:23.310 --> 00:04:26.689 that we have the heart-lung machine in 1958. That means 78 00:04:26.769 --> 00:04:29.329 we can stop the heart safely and perform the heart surgery. 79 00:04:29.360 --> 00:04:33.079 Suppose there is a hole in your heart, in someone's heart. 80 00:04:33.120 --> 00:04:35.160 How will we close it? How to close this heart? 81 00:04:35.600 --> 00:04:37.899 For that, I have to stop the heart. So that 82 00:04:37.980 --> 00:04:42.040 technology only came in 1958, 1960. From there on, we 83 00:04:42.060 --> 00:04:44.120 have progressed very rapidly. There is no doubt about it. 84 00:04:44.720 --> 00:04:47.860 bypass surgeries came, valve surgeries came, people have become celebrities. 85 00:04:48.500 --> 00:04:50.600 So many celebrities have come up like a big bypass. 86 00:04:50.620 --> 00:04:53.620 Then heart transplant came. We can even change people's heart, 87 00:04:53.699 --> 00:04:56.930 you know. That also came in 1967. So these are 88 00:04:56.939 --> 00:05:00.370 very important. In between what was happening that we have 89 00:05:00.470 --> 00:05:04.230 observed one very small and very important observation that when 90 00:05:04.250 --> 00:05:06.670 you open the chest, suppose when you open the chest 91 00:05:06.689 --> 00:05:08.889 for open heart surgery, when you cut your breast bone 92 00:05:08.910 --> 00:05:12.730 in front of the chest, it alters your physiology. Your 93 00:05:13.069 --> 00:05:18.779 mechanism is breathing, your movement, getting up and sitting, all 94 00:05:18.800 --> 00:05:21.959 these things change. So that was the time when scientists 95 00:05:21.980 --> 00:05:24.920 have started thinking something else. Can we do it separately? 96 00:05:24.959 --> 00:05:26.759 Can we do it differently? Can we do it without 97 00:05:26.800 --> 00:05:32.870 opening the chest? Then around 1990s, mid-1990s, we have started 98 00:05:32.930 --> 00:05:36.029 something called minimally invasive cardiac surgery where we have started 99 00:05:36.069 --> 00:05:39.709 doing surgeries without opening the chest. The same bypass operation, 100 00:05:39.750 --> 00:05:43.149 same valve replacement, same different types of hearts, hole in 101 00:05:43.170 --> 00:05:45.670 the heart, tumors of the heart, all these surgeries have 102 00:05:45.730 --> 00:05:48.189 people have started doing from the side without opening the chest. 103 00:05:48.509 --> 00:05:49.230 That is the beginning. 104 00:05:49.350 --> 00:05:50.029 Explain that. 105 00:05:50.370 --> 00:05:50.550 Yeah. 106 00:05:50.569 --> 00:05:51.790 Without opening the chest means? 107 00:05:51.829 --> 00:05:55.170 Yeah. So, traditionally when we do an open surgery, so 108 00:05:55.230 --> 00:05:57.870 we have to open the chest. There's a bone in front. 109 00:05:57.889 --> 00:06:00.230 If you touch your, in between breast, you'll find a bone. 110 00:06:00.290 --> 00:06:00.490 Yeah. 111 00:06:00.529 --> 00:06:04.379 This tough structure is called sternum. This bone is called sternum. 112 00:06:04.399 --> 00:06:07.160 We cut it from the inside. Then we split it 113 00:06:07.220 --> 00:06:09.620 up and go inside the heart and then perform the 114 00:06:09.639 --> 00:06:14.279 surgery like a bypass surgery. valve separation, heart defects, or 115 00:06:14.300 --> 00:06:18.920 so on and so forth. So, when you open this up, 116 00:06:19.199 --> 00:06:24.110 your whole mechanism of breathing and all these things becomes altered. 117 00:06:24.910 --> 00:06:26.970 I am not saying that … And altered for life. 118 00:06:27.189 --> 00:06:30.250 Altered for life, yeah. So, some of the people are 119 00:06:30.310 --> 00:06:34.079 not fit for this. For example, badly diabetics, very frail, 120 00:06:34.180 --> 00:06:45.050 quick cancer spirit, early cancer. We have found that when 121 00:06:45.089 --> 00:06:48.430 we cut them, we make them more diseased, then become better. 122 00:06:49.689 --> 00:06:52.860 So during that time, the surgeons, the scientists have started 123 00:06:52.920 --> 00:06:55.920 thinking the alternatives. And one of the alternatives was without 124 00:06:55.959 --> 00:07:01.040 opening the chest, the non-sternotomy or non-open-heart surgeries. Then we 125 00:07:01.079 --> 00:07:05.170 started evolving on that area slowly and slowly. And I 126 00:07:05.209 --> 00:07:09.089 think robot is an extension of that. So first we 127 00:07:09.110 --> 00:07:13.300 did this, opened it. We did open surgeries. Then when 128 00:07:13.560 --> 00:07:17.100 we were fully trained, we were very confident that we 129 00:07:17.120 --> 00:07:19.319 can do openly anything. Then we have moved to this 130 00:07:19.339 --> 00:07:22.779 side without opening the chest. The same bypass, same valves, 131 00:07:22.819 --> 00:07:25.129 we have started from the side. Now when we become 132 00:07:25.490 --> 00:07:27.850 expert on that also, now you thought why to open 133 00:07:27.910 --> 00:07:30.670 from the side also. Don't do anything. Make some small 134 00:07:30.709 --> 00:07:33.329 three ports and do the surgery. Then the robotic came 135 00:07:33.430 --> 00:07:38.689 because As you will see, what robot does basically, it 136 00:07:38.709 --> 00:07:44.779 reduces the human efficiency and it increases the precision, it 137 00:07:44.839 --> 00:07:51.060 increases the magnification, it increases the visualization, it increases the accuracy. Nowadays, 138 00:07:51.100 --> 00:07:55.000 with AI and other advanced imaging technique, I can also 139 00:07:55.060 --> 00:07:58.149 plan the surgery well in advance. Entire route can be chosen. 140

00:07:58.189 --> 00:08:05.680 Entire route, entire route. So, I am sure what I 141 00:08:06.339 --> 00:08:08.939 will see exactly. So those things are very important. So 142 00:08:08.980 --> 00:08:12.160 that's why now robot has gone to that level that 143 00:08:12.920 --> 00:08:15.579 I can do the surgery in the morning and patient 144 00:08:15.600 --> 00:08:17.120 can be having coffee in the evening. 145 00:08:17.759 --> 00:08:18.519 What are you saying? 146 00:08:18.680 --> 00:08:21.519 Yes, that's what I'm saying. Exactly that's what I'm saying. 147 00:08:21.959 --> 00:08:25.050 That's what the patient needs now. I'm telling you again, see, 148 00:08:25.290 --> 00:08:27.550 once in a time, you know, I still remember when 149 00:08:27.610 --> 00:08:30.449 I used to do my bypass surgery of my uncle. 150 00:08:31.009 --> 00:08:33.820 in a place in South India, because I was in 151 00:08:34.080 --> 00:08:36.240 that time, because I was born, and I'm basically from Assam, 152 00:08:36.259 --> 00:08:38.860 so at that time there was no surgery in North East, 153 00:08:39.440 --> 00:08:43.639 heart surgery, so I think we have booked about 40 tickets. 154 00:08:44.600 --> 00:08:48.419 In Chennai Express, I would say. And all of us 155 00:08:48.440 --> 00:08:51.559 have gone in different roles. Somebody to give only blood. 156 00:08:52.059 --> 00:08:58.200 Somebody to give only donate blood. You know, five people. 157 00:08:58.559 --> 00:09:03.279 Same group. Then somebody has given only to cook Asamese food. 158 00:09:03.799 --> 00:09:06.460 Somebody has given rice, lentils, all these things. So I 159 00:09:06.500 --> 00:09:09.039 think that was like a Kumbh Mela for us. Going 160 00:09:09.080 --> 00:09:13.100 to doing a bypass surgery. So I think, Sonal, that 161 00:09:13.120 --> 00:09:15.899 has to change now. Still it is happening in our country. 162 00:09:16.779 --> 00:09:18.860 You see the amount of loss you have got from 163 00:09:18.879 --> 00:09:21.990 the whole family. You have involved so many people. So 164 00:09:22.590 --> 00:09:25.029 much of blood loss, so much of trauma. And on 165 00:09:25.090 --> 00:09:27.769 top of that whole thing, the patient who is going 166 00:09:27.789 --> 00:09:30.769 through it, he has a big psychological impact on his life. 167 00:09:31.110 --> 00:09:33.470 Because he thinks that my chest is open. I am 168 00:09:33.529 --> 00:09:37.490 no more useful for anyone. That I can tell you 169 00:09:37.509 --> 00:09:37.850 later on. 170 00:09:38.470 --> 00:09:39.549 They think it's second life. 171 00:09:39.690 --> 00:09:43.960 Yes, yes. So I think if I do the same 172 00:09:44.009 --> 00:09:49.500 thing without opening the chest, without doing anything and patient 173 00:09:49.559 --> 00:09:53.450 have no pain, no trauma, no blood loss and he 174 00:09:53.659 --> 00:09:56.129 recovers in like six or seven days time and can 175 00:09:56.169 --> 00:09:57.009 join back his work. 176 00:09:57.350 --> 00:10:00.059 But how are you saying no pain, no trauma? I mean, 177 00:10:00.080 --> 00:10:02.279 there are still insurgents, right? 178 00:10:02.409 --> 00:10:03.389 Yes. 179 00:10:03.909 --> 00:10:06.549 And before that, just explain to me the difference between 180 00:10:06.830 --> 00:10:11.049 laparoscopy and robotics. Because in laparoscopy, you do three holes. 181 00:10:11.149 --> 00:10:14.210 One goes to the camera, the other goes to the other, 182 00:10:14.230 --> 00:10:15.990 and you're able to do it. And what would have 183 00:10:16.009 --> 00:10:18.409 been an open surgery is just done by three little holes, 184 00:10:18.429 --> 00:10:20.720 which is just a stitch. Yeah. How is that different 185 00:10:20.740 --> 00:10:21.440 from robotics? 186 00:10:21.620 --> 00:10:24.990 So basic difference between laparoscopy and robotics is the visualization. 187 00:10:25.570 --> 00:10:30.370 So in laparoscopy, we see it in two-dimensional. Like we 188 00:10:30.389 --> 00:10:33.450 don't see exactly how the structure is. We see it, 189 00:10:33.490 --> 00:10:37.340 but it is two-dimensional interface. But in robotics, for scientific term, 190 00:10:37.379 --> 00:10:39.820 it is three-dimensional. I will see exactly what I can 191 00:10:39.860 --> 00:10:43.539 see in open. And my control of the instruments are 192 00:10:43.580 --> 00:10:47.500 much better in robotics because robotics, the instrumentation is totally different. 193 00:10:48.029 --> 00:10:51.629 They rotate in 360 degrees. My hand also doesn't move 194 00:10:51.870 --> 00:10:54.529 in 360 degrees in certain areas. Suppose you have to 195 00:10:54.549 --> 00:11:01.580 work in depth. Gynecological surgeries, pelvic surgeries, then the prosthetic 196 00:11:01.600 --> 00:11:04.159 surgeries we do, the prosthetics are in a lot of depth. So, 197 00:11:04.179 --> 00:11:06.840 the hands don't go there. The robotic arms go there. 198 00:11:07.539 --> 00:11:10.360 And then they can do the surgeries with precision when 199 00:11:10.379 --> 00:11:13.120 they open. They can't even do the hands in the surgery. So, 200 00:11:13.139 --> 00:11:16.379 that's why our precision is much better in robotics. So 201 00:11:16.409 --> 00:11:19.620 that's why robotics is gaining the popularity day by day. 202 00:11:19.940 --> 00:11:22.679 That's why in some of the specialties, slowly and slowly 203 00:11:22.720 --> 00:11:26.320 you will see, and mark my word, after five years, 204 00:11:26.779 --> 00:11:28.840 most of the leprosy will have gone by. It will 205 00:11:28.860 --> 00:11:32.519 be all by, because robotics can enable other things also. 206 00:11:32.940 --> 00:11:37.710 Not only the surgery, the planning, the visualization, the imaging, 207 00:11:38.070 --> 00:11:41.370 all these things can be, you know, stationed in one platform. 208 00:11:41.929 --> 00:11:45.210 Interesting. You're saying that laparoscopy would be gone in five 209 00:11:45.250 --> 00:11:46.750 years and robotics will take over. 210 00:11:46.769 -->

00:11:50.519 I will not say gone because still there are some 211 00:11:50.580 --> 00:11:54.159 conditions where laparoscopy is okay. But I think by far, 212 00:11:54.419 --> 00:11:56.899 most of the centers where robotics is pre-run, they are 213 00:11:56.940 --> 00:11:59.840 slowly sighing you from laparoscopy. 214 00:11:59.879 --> 00:12:02.139 Help me understand this a little bit. When you say 215 00:12:02.299 --> 00:12:07.490 that in a robotic surgery, the number of cuts you make, 216 00:12:07.529 --> 00:12:09.750 the number of insurgents you do, they are less. Can 217 00:12:09.769 --> 00:12:12.500 you explain to me compared to, say, a lap row 218 00:12:12.600 --> 00:12:14.470 or an open heart, how small are they? So, if 219 00:12:14.490 --> 00:12:17.929 you're not cutting open, where exactly are you making the 220 00:12:17.970 --> 00:12:19.080 cut and how big is it? 221 00:12:19.429 --> 00:12:23.210 Okay. So, when we do an open surgery, the cut 222 00:12:23.230 --> 00:12:26.879 is around 10 to 15 centimeters in front of the chest, right? So, 223 00:12:27.029 --> 00:12:30.320 if I do, for example, a hole in the heart, 224 00:12:30.519 --> 00:12:34.679 atrial septal defect, which I'm going to do today as well, 225 00:12:34.700 --> 00:12:37.659 so what happens in that is, there are three ports, actually. 226 00:12:37.679 --> 00:12:41.889 This is less than, I would say, It's about 4 227 00:12:41.889 --> 00:12:45.340 to 5 mm maximum because the port size is only 228 00:12:45.340 --> 00:12:46.399 8 mm. 229 00:12:46.480 --> 00:12:48.179 By port, you mean the hands of the robot? 230 00:12:48.200 --> 00:12:50.740 Yeah, yeah. It's like your pain, the size of this pain. 231 00:12:51.039 --> 00:12:55.259 It will go inside. And to take it inside, the 232 00:12:55.299 --> 00:12:58.019 cut is very small, minuscule. You will not even see 233 00:12:58.100 --> 00:13:01.000 it after four months. That is so small. 234 00:13:01.360 --> 00:13:01.940 Seriously? 235 00:13:02.000 --> 00:13:05.110 Yeah. And there is one incision which I have to make. 236 00:13:05.149 --> 00:13:07.570 It's called a walking port, where we put our other stuff. 237 00:13:08.980 --> 00:13:11.419 That's about around two centimeters, this much. 238 00:13:12.159 --> 00:13:12.879 That's it? 239 00:13:13.059 --> 00:13:16.110 Just remember these fingers. This is the one. That is 240 00:13:16.120 --> 00:13:18.149 the size of the whole cut. There will be no 241 00:13:18.250 --> 00:13:21.730 bone cutting. There is nothing. So bone cutting, bone splitting, 242 00:13:21.830 --> 00:13:23.629 muscle splitting, nothing will happen. It will just be this 243 00:13:23.649 --> 00:13:25.750 much cut and then the whole entire surgery will be done. 244 00:13:26.429 --> 00:13:27.730 So that's why I am saying it's a very big 245 00:13:27.769 --> 00:13:32.059 boon for patients where they can say that, no, I 246 00:13:32.080 --> 00:13:34.600 don't want any cuts on my body. It's very, very 247 00:13:34.639 --> 00:13:39.919 effective for them, cosmetically, ergonomically. from pain-wise, recovery-wise, very good. 248 00:13:40.399 --> 00:13:42.899 In fact, some of my doctor friends, which I have 249 00:13:43.139 --> 00:13:46.720 performed robotic surgeries, they proudly go and, you know, start 250 00:13:46.759 --> 00:13:49.740 to swim at the end of just three weeks and 251 00:13:49.820 --> 00:13:53.720 swimming after doing a bypass and then sending videos back 252 00:13:53.759 --> 00:13:57.240 to me. See, I am just swimming around. So, those 253 00:13:57.299 --> 00:14:00.019 are things which you can, that's why I am saying, Sunal, 254 00:14:00.139 --> 00:14:03.750 we must change this. We must change this concept that, brother, 255 00:14:04.250 --> 00:14:05.549 open surgery is done, I will not be able to 256 00:14:05.590 --> 00:14:08.769 do anything, I will die, I am finished. This has 257 00:14:08.809 --> 00:14:11.710 to stop. We have to now think, no, this is 258 00:14:12.049 --> 00:14:15.250 a surgery, normal surgery. It's like any other surgery. It's 259 00:14:15.269 --> 00:14:17.940 like a gallbladder surgery, appendix surgery. You come, get it done, 260 00:14:18.340 --> 00:14:20.360 and go home. Yeah, of course, again, I'm telling you, 261 00:14:20.399 --> 00:14:23.559 there's a disclaimer. 70% of the cases, 30% still will 262 00:14:23.600 --> 00:14:26.220 need an open surgery, probably, in today's date. It's possible 263 00:14:26.240 --> 00:14:28.389 that after 10 years or after 5 years, when I 264 00:14:28.429 --> 00:14:30.509 meet you again, I can tell them 90% will be 265 00:14:30.529 --> 00:14:34.070 done by robotics. At this stage, I will say, yes, 266 00:14:34.070 --> 00:14:37.110 70% can be safely done and very safely, effectively done 267 00:14:37.129 --> 00:14:39.549 by a robot. Another question people ask me is a 268 00:14:39.570 --> 00:14:43.450 very important aspect, which I want to highlight. They ask, sir, 269 00:14:43.490 --> 00:14:47.480 how effective is it? Because cardiac surgery is measured in 270 00:14:47.500 --> 00:14:50.879 terms of effectiveness. Suppose someone has chest pain, heart attack. 271 00:14:51.379 --> 00:14:54.460 Will it save me from a heart attack? Will it 272 00:14:54.860 --> 00:14:57.559 cause my symptoms to go away? Similarly, like an open heart. 273 00:14:57.679 --> 00:15:01.440 Answer is exactly yes. Because the things or the surgical process, 274 00:15:01.460 --> 00:15:03.019 what we do, doesn't change at all. 275 00:15:03.159 --> 00:15:04.490 It's just the process of doing it. 276 00:15:04.500 --> 00:15:07.159 Process and the approach. I'm not cutting the chest. I'm 277 00:15:07.210 --> 00:15:10.250 not open. splitting the bone open, I'm doing exactly the 278 00:15:10.289 --> 00:15:12.669 same thing which was supposed to be done in the 279 00:15:12.690 --> 00:15:18.990 open surgery. So technology, the grafts, the valves, the whole 280 00:15:19.009 --> 00:15:21.049 ecosystem and the things which we put in

the open, 281 00:15:21.210 --> 00:15:23.960 exactly will be done the same way. So our long-term, 282 00:15:24.320 --> 00:15:26.440 so if I think I cannot give the same long-term 283 00:15:26.480 --> 00:15:29.379 result like an open surgery, I would not probably do 284 00:15:29.440 --> 00:15:30.519 a robotic surgery. 285 00:15:30.600 --> 00:15:34.580 Okay, let's talk about in what kind of operations do 286 00:15:34.620 --> 00:15:37.500 you prefer a robotic surgery? If a patient comes to you, 287 00:15:37.879 --> 00:15:40.919 for which diseases or for which operations will you say 288 00:15:40.960 --> 00:15:42.159 we must use a robotic arm? 289 00:15:42.379 --> 00:15:48.769 Yeah. So, first I will tell you, before the disease, 290 00:15:49.730 --> 00:15:53.210 who are my clients for robotic surgery? So, I divide 291 00:15:53.809 --> 00:15:57.509 this into a very specific two groups. One group is 292 00:15:57.529 --> 00:16:04.500 that All internet, Google, AI, and chat GPT. So they 293 00:16:04.559 --> 00:16:07.620 come to me asking for a robotic surgery. That's actually 294 00:16:07.639 --> 00:16:09.299 a bigger group, I would say. 295 00:16:09.460 --> 00:16:11.039 And I'm assuming younger people also. 296 00:16:11.279 --> 00:16:15.159 Yes, yes. Older people are still a little. Yeah, tech savvy. 297 00:16:15.379 --> 00:16:22.009 And they're very enthusiastic to go home soon. So these 298 00:16:22.049 --> 00:16:25.029 are the people. And the one who I think they're 299 00:16:25.049 --> 00:16:27.330 really in robotic surgery. So let me first tell about 300 00:16:27.389 --> 00:16:32.059 the one. who needs robotic surgery. Number one, young females. 301 00:16:32.779 --> 00:16:34.759 All young females, they should not have a cut in 302 00:16:34.779 --> 00:16:38.379 the chest, according to me. That's an injustice. So any 303 00:16:38.419 --> 00:16:41.559 female coming to me, who is unmarried, even married also. 304 00:16:42.139 --> 00:16:44.340 So if I make a cut here, so whoever, you 305 00:16:44.360 --> 00:16:46.769 cannot wear any, you know, low cut. 306 00:16:46.779 --> 00:16:48.649 To live with a scar for their life. 307 00:16:48.669 --> 00:16:52.289 The scar is always there. You may feel normal, you 308 00:16:52.350 --> 00:16:55.370 may look normal, but that stigma is always there. So 309 00:16:55.490 --> 00:16:58.470 I would like to prefer non-open-heart surgery for young females. 310 00:16:58.509 --> 00:17:02.559 There's number one client. Number two, very old. Very old 311 00:17:02.600 --> 00:17:06.299 means they are frail, like more than 65 years, 70 years, 312 00:17:06.500 --> 00:17:09.099 but they still have a good life to go. Suppose 313 00:17:10.099 --> 00:17:14.089 he's otherwise normal, he's very badly diabetic, but he's 65 years, 314 00:17:14.369 --> 00:17:16.670 he needs a bypass operation. I would not like to 315 00:17:16.730 --> 00:17:19.170 open him. I would like to prefer him for a 316 00:17:19.190 --> 00:17:24.490 robotic surgery. Why? Because in diabetics, the chances of infection 317 00:17:24.509 --> 00:17:27.630 in the chest when we open is very high. His heart, 318 00:17:27.730 --> 00:17:30.119 his sugar will go up. He will have lots of 319 00:17:30.200 --> 00:17:34.079 hospital visits unnecessarily for infections. And the pain will persist. 320 00:17:34.180 --> 00:17:37.299 Numbness will persist. Swelling will persist. Everything will persist. A 321 00:17:37.660 --> 00:17:40.490 lot of clinicians I have seen saying that it's just 322 00:17:40.569 --> 00:17:43.470 a fracture. It's not a fracture. It's not a fracture. 323 00:17:43.509 --> 00:17:45.470 It's different from fracture. It's a cut on the chest 324 00:17:45.910 --> 00:17:46.609 which may not heal. 325 00:17:47.109 --> 00:17:47.289 Right? 326 00:17:47.950 --> 00:17:51.930 So that's why those are my top priority clients. Then thirdly, 327 00:17:52.079 --> 00:17:56.500 very important group, obese. Those who are obese. It is 328 00:17:56.519 --> 00:17:59.240 very difficult for them to do open surgery. I think 329 00:17:59.339 --> 00:18:04.099 they should avoid. Yesterday, I did a patient robotically. He 330 00:18:04.119 --> 00:18:07.019 is very obese. He had a stroke earlier. One side 331 00:18:07.059 --> 00:18:09.460 is not working. So, if I do an open surgery, 332 00:18:09.500 --> 00:18:12.400 his life will be hell. He will not be able 333 00:18:12.460 --> 00:18:16.769 to walk properly. Already, he is not walking. On the 334 00:18:16.789 --> 00:18:18.529 top of that, if I do a big cut here, 335 00:18:18.809 --> 00:18:22.150 I think he will be totally limited to bed. Then, 336 00:18:24.019 --> 00:18:27.880 The patients with a lot of other comorbidities, like dialysis-dependent patients, 337 00:18:28.319 --> 00:18:32.680 whose bones are very weak, frail, normally have fractures. 338 00:18:32.900 --> 00:18:34.619 Anyone who is immunocompromised also. 339 00:18:34.839 --> 00:18:38.000 Yes, yes. Immunocompromised are important as well. They are frail. 340 00:18:38.359 --> 00:18:39.599 The frailty index is very high. 341 00:18:39.619 --> 00:18:40.660 They won't be able to take the surgery. 342 00:18:40.680 --> 00:18:43.119 Yes, yes, yes. But still, they'll want to live for 343 00:18:43.140 --> 00:18:43.720 a couple of years. 344 00:18:43.960 --> 00:18:47.079 So you're saying all those people who would have otherwise 345 00:18:47.180 --> 00:18:51.170 not qualified for in-heart surgery, because of robotics, have a 346 00:18:51.210 --> 00:18:52.130 chance now. Yes. 347 00:18:52.890 --> 00:18:54.670 They still have an open, they can still have an 348 00:18:54.710 --> 00:18:57.240 open heart surgery. But I would say that if I 349 00:18:57.299 --> 00:19:01.220 put an open surgery for them, their life, quality of 350 00:19:01.259 --> 00:19:05.240 life will be impaired very, very severely. So in those cases, 351 00:19:05.299 --> 00:19:10.549 a robot can definitely help. And now the other group. 352 00:19:10.869 -->

00:19:11.150 Yes. 353 00:19:11.250 --> 00:19:13.690 More important. The other group comes to me saying, Sir, 354 00:19:13.710 --> 00:19:17.089 I want to do robotic surgery, whatever happens. So I 355 00:19:17.109 --> 00:19:20.009 don't want to do anything. So they have a feeling 356 00:19:20.049 --> 00:19:24.799 in their mind that, Everything can be done robotically. Answer 357 00:19:24.839 --> 00:19:28.539 is no. Heart surgery is a very sophisticated operation. You 358 00:19:28.599 --> 00:19:32.420 must understand that. So all conditions, suppose a patient comes 359 00:19:32.440 --> 00:19:35.559 with crash. So we are doing CPR and all. So 360 00:19:35.599 --> 00:19:37.940 he is already dying. I cannot do robotic surgery in that. 361 00:19:37.960 --> 00:19:40.009 It is an emergency procedure. I have to open this 362 00:19:40.009 --> 00:19:44.039 patient to save his life. Some of the conditions are 363 00:19:44.039 --> 00:19:48.269 the heart condition is very poor. His vessels are very 364 00:19:48.269 --> 00:19:51.450 very small so there are some severe complications where I 365 00:19:51.490 --> 00:19:55.039 think we should avoid robot so if you ask me 366 00:19:55.079 --> 00:19:58.700 medically at least 70% of the heart conditions in today's 367 00:19:58.720 --> 00:20:02.859 date we can do it robotically for a bypass operation 368 00:20:03.380 --> 00:20:06.960 valve replacement valve repairs heart valve repairs then closure of 369 00:20:06.980 --> 00:20:10.680 your atrial septal so congenital heart defects say which are 370 00:20:10.700 --> 00:20:13.849 made from birth, we can close them robotically easily. That 371 00:20:13.910 --> 00:20:15.009 is the easiest operation to do. 372 00:20:15.250 --> 00:20:15.970 Hole in the heart. 373 00:20:16.069 --> 00:20:19.670 Yes, hole in the heart. And cardiac tumors. Cardiac tumors 374 00:20:19.710 --> 00:20:22.069 are also rare condition, but when it comes, you have 375 00:20:22.089 --> 00:20:24.369 to do an open surgery. In those days also, you 376 00:20:24.410 --> 00:20:25.329 can do robotically. 377 00:20:26.329 --> 00:20:26.829 Interesting. 378 00:20:26.930 --> 00:20:27.470 Yeah. 379 00:20:28.279 --> 00:20:31.500 So I like what you're saying that it throws open 380 00:20:31.559 --> 00:20:34.579 two kind of categories of patients for you. One, who 381 00:20:34.740 --> 00:20:38.349 otherwise would have not have been a candidate for Second, 382 00:20:38.380 --> 00:20:42.690 those who would have lived with the outcome of open-heart 383 00:20:42.710 --> 00:20:46.690 surgery for the longest time, their quality of life is 384 00:20:46.730 --> 00:20:50.069 not impacted as much as would have been the case. 385 00:20:50.130 --> 00:20:52.089 But you're saying there are also cases where you don't 386 00:20:52.109 --> 00:20:55.369 need one. I see, I was speaking to an oncologist 387 00:20:55.410 --> 00:20:58.410 yesterday and he was talking very highly of robotic surgery. 388 00:20:58.430 --> 00:21:01.769 Yeah, definitely. Oncology is a big branch now. Initially, there 389 00:21:01.789 --> 00:21:05.259 was a lot of apprehensions regarding whether they can fill 390 00:21:05.279 --> 00:21:08.079 the tumor or not, all this. But now with the 391 00:21:08.559 --> 00:21:12.440 recent machines, the advanced machines, they are very safe. Oncological 392 00:21:12.480 --> 00:21:15.599 robotic surgery is very safe nowadays. The other thing, Sonal, 393 00:21:15.660 --> 00:21:20.559 I want to emphasize is that that feeling of having 394 00:21:20.599 --> 00:21:23.619 an open surgery is different than the feeling of having 395 00:21:23.640 --> 00:21:24.400 a robotic surgery. 396 00:21:24.549 --> 00:21:25.119 Explain that. 397 00:21:25.740 --> 00:21:31.170 So, I am saying that when you open the chest, 398 00:21:31.309 --> 00:21:34.349 they always have the psychological stigma that I have opened 399 00:21:34.369 --> 00:21:36.009 the chest. Maybe I will not be able to get thicker. 400 00:21:37.380 --> 00:21:39.400 But when we do robotic surgery, I think from the 401 00:21:39.440 --> 00:21:41.579 day of zero, he or she feels, no, those things 402 00:21:41.700 --> 00:21:43.259 will never be there. I'll be just like what I 403 00:21:43.259 --> 00:22:06.940 was yesterday. I'll not be person will be transformed tomorrow 404 00:22:07.019 --> 00:22:10.220 from an open surgery. So that psychological feeling is very important. 405 00:22:10.779 --> 00:22:14.059 It is above anything else, you know. That human factor 406 00:22:14.559 --> 00:22:17.740 of not having your chest open is a different feeling altogether. 407 00:22:18.240 --> 00:22:21.819 You can understand only when you feel somebody within a 408 00:22:21.839 --> 00:22:25.150 robotic and non-robotic surgery or open surgery. At this time, 409 00:22:25.230 --> 00:22:28.009 I would also like to say that open surgeries have 410 00:22:28.029 --> 00:22:30.970 a lot of importance. Because I have an open surgery. 411 00:22:33.900 --> 00:22:36.180 I was an open surgeon and I have transformed myself 412 00:22:36.640 --> 00:22:44.009 to give the society and technology which is upcoming and 413 00:22:44.109 --> 00:22:47.990 which can be done safely where the results are totally different, 414 00:22:48.430 --> 00:22:51.460 where the immediate outcomes are different, where the patient can 415 00:22:52.180 --> 00:22:54.759 go back to their job, go back to their profession 416 00:22:54.859 --> 00:22:59.420 at the earliest and can resume all their previous activities, 417 00:22:59.460 --> 00:23:02.180 hobbies and everything as he was or she was doing before. 418 00:23:02.619 --> 00:23:03.140 So why not? 419 00:23:03.809 --> 00:23:06.829 So you're saying that in heart surgeries, a lot of 420 00:23:06.890 --> 00:23:08.910 time grafts have been, you know, have to be put 421 00:23:09.069 --> 00:23:10.670 and they're taken out in other parts of your body. 422 00:23:10.690 --> 00:23:15.109 Is that process robotic? And then basically the question

is, 423 00:23:15.109 --> 00:23:16.789 do you have less scars? 424 00:23:17.789 --> 00:23:20.950 Very important. I think it's a very important question for 425 00:23:21.029 --> 00:23:24.579 all of us to know. So basically when you do 426 00:23:24.599 --> 00:23:27.160 a bypass surgery, this is most commonly done surgery for heart. 427 00:23:27.640 --> 00:23:30.859 If you know that the commonest surgery in the heart 428 00:23:31.579 --> 00:23:36.240 section is bypass surgery. So, robot has a very important 429 00:23:36.700 --> 00:23:41.730 role in taking these veins, taking these grafts. So, the 430 00:23:42.049 --> 00:23:45.250 arteries in the chest wall, if you are like a 431 00:23:46.309 --> 00:23:50.089 very young patient, we don't want to use veins in that. 432 00:23:50.390 --> 00:23:53.289 Feet and hands too. We want to take out everything 433 00:23:53.309 --> 00:23:55.849 from inside. That is called total arterial bypass. For which, 434 00:23:55.890 --> 00:23:58.410 if we do it open, it has a lot of complications. 435 00:23:59.910 --> 00:24:02.190 So if I want to do a total arterial bypass, 436 00:24:02.210 --> 00:24:04.690 it is called total arterial bypass because both the arteries 437 00:24:04.809 --> 00:24:07.470 are removed and the robot can safely take out both 438 00:24:07.490 --> 00:24:11.019 the arteries. Especially for young patients whose life is very long. 439 00:24:11.039 --> 00:24:13.599 Suppose nowadays in India there are so many heart attacks 440 00:24:13.660 --> 00:24:16.440 in young patients. We used to sometimes do bypass at 441 00:24:16.460 --> 00:24:21.369 the age of 35, 38, 25. For those people, total 442 00:24:21.410 --> 00:24:24.890 arterial graft is very important. For these people, robotic surgery 443 00:24:24.930 --> 00:24:26.910 is very important because we can take out both the 444 00:24:26.950 --> 00:24:30.349 arteries without opening the chest. effectively and put them into 445 00:24:30.390 --> 00:24:34.829 total arterial surgery so that their long-term results are very good. Now, 446 00:24:35.269 --> 00:24:37.069 if I don't use total arteries, suppose I want to 447 00:24:37.130 --> 00:24:39.089 use veins or arteries from the other part of the body, 448 00:24:39.509 --> 00:24:42.589 that can be also done, not robotically now, but endoscopically. 449 00:24:43.190 --> 00:24:47.329 There will be no cuts anywhere in the body. There 450 00:24:47.349 --> 00:24:50.210 will be small, small scars, one on the knee and 451 00:24:50.250 --> 00:24:52.650 one on the thigh. From there, we can take out 452 00:24:52.670 --> 00:24:56.119 the entire vein. That is also without cuts. So, if 453 00:24:56.160 --> 00:24:58.269 you do a small cut here, There will be small 454 00:24:58.289 --> 00:25:00.130 cut in the leg also. But there will be no 455 00:25:00.190 --> 00:25:03.150 seera pari. Nothing like that will happen. So, especially for ladies, 456 00:25:03.170 --> 00:25:05.299 it's very important. A lot of people come and say, sir,

457 00:25:05.319 --> 00:25:07.740 you have made such a big cut. I am not 458 00:25:07.759 --> 00:25:10.619 able to wear a mini skirt. So, to have a 459 00:25:10.619 --> 00:25:13.200 mini skirt, definitely you should have endoscopic and robotic surgery. 460 00:25:14.559 --> 00:25:16.809 But you need a lot of training. Yes. Because I 461 00:25:16.829 --> 00:25:20.809 am sure even to run those machines, you require a 462 00:25:20.829 --> 00:25:22.470 very different kind of skill, right? 463 00:25:22.490 --> 00:25:28.119 Yes. So, in this, First of all, your system should 464 00:25:28.160 --> 00:25:31.680 be credible. Wherever you are working, you cannot just start 465 00:25:31.700 --> 00:25:35.680 robotic surgery in a XYZ hospital. So your ecosystem has 466 00:25:35.720 --> 00:25:40.109 to be very, very strong. Ecosystem means, apart from being 467 00:25:40.130 --> 00:25:42.250 a doctor, I always like to be a pilot, always 468 00:25:42.269 --> 00:25:44.250 in my life. I never became a pilot because of 469 00:25:44.430 --> 00:25:46.690 so many reasons, XYZ reasons, but I wanted to be 470 00:25:46.750 --> 00:25:50.589 a pilot. So in robotic surgery, especially, you run like 471 00:25:50.630 --> 00:25:54.029 an Airbus A380. It's like that. Because there are so 472 00:25:54.049 --> 00:25:57.890 many machines, So many controls, so many people under your arm. 473 00:25:58.289 --> 00:26:00.109 So you feel like a real pilot, you know, when 474 00:26:00.170 --> 00:26:03.660 you do a robotic surgery. I really like that feeling. 475 00:26:04.039 --> 00:26:06.819 You are the captain of that ship or that aircraft. 476 00:26:08.099 --> 00:26:11.000 They have to listen to you. The whole operating theater 477 00:26:11.059 --> 00:26:14.690 ecosystem ups and downs on my command, including the robot, right? 478 00:26:15.069 --> 00:26:17.250 So that is a very different feeling. I'm not saying 479 00:26:17.269 --> 00:26:19.930 that I'm doing surgery for that. But all I am saying. 480 00:26:19.950 --> 00:26:22.279 So humans don't listen? 481 00:26:22.299 --> 00:26:26.339 No, everyone listens. Everyone listens. Everyone listens. But robots listen 482 00:26:26.359 --> 00:26:29.380 the most at that time. Because it really, really moves 483 00:26:29.420 --> 00:26:32.319 with both my hands and both my feet together. 484 00:26:32.460 --> 00:26:33.240 Your feet also? 485 00:26:33.279 --> 00:26:35.799 Yes, yes. So I'll tell you, explain. So if you 486 00:26:35.819 --> 00:26:38.279 see the robot, it has got controls on the hands. 487 00:26:38.700 --> 00:26:41.259 And there are some controls on the feet. So your legs, 488 00:26:41.619 --> 00:26:44.019 both the legs and both the hands are moving equally 489 00:26:44.480 --> 00:26:48.220 all the time. So you have to have a complete... 490 00:26:48.240 --> 00:26:50.720 balance on your mind you know so you must be 491 00:26:50.759 --> 00:26:54.019 seeing no when you see especially that is in not 492 00:26:54.059 --> 00:26:56.529 in the

boeings in the airbus they always write in 493 00:26:56.569 --> 00:26:58.630 the on the on the on the door of the 494 00:26:58.690 --> 00:27:02.569 pilot leave everything behind before this door you go inside 495 00:27:02.609 --> 00:27:05.690 and just you know uh you know fly the aircraft 496 00:27:06.059 --> 00:27:08.220 so similarly when we come and sit in the robotic 497 00:27:08.259 --> 00:27:10.740 it's called surgical console where you sit inside the robot 498 00:27:11.339 --> 00:27:13.220 so you have to leave everything alone. 499 00:27:13.440 --> 00:27:16.740 Okay, take a step back. Tell me exactly what the 500 00:27:16.789 --> 00:27:19.970 robot looks like. How are you running it? You gave 501 00:27:20.029 --> 00:27:22.170 an example of an Airbus. I am thinking of Transformers. 502 00:27:22.269 --> 00:27:25.029 You must be sitting there. 503 00:27:25.049 --> 00:27:29.470 So, basically, there are... Thank you, Sonal, for asking this question. So, basically, 504 00:27:29.529 --> 00:27:33.170 there are... So, as I operate with my hand, there 505 00:27:33.230 --> 00:27:37.349 are two hands. There are ten fingers. Similarly, when I 506 00:27:37.430 --> 00:27:40.710 operate a robot, I will have more than two hands. 507 00:27:41.359 --> 00:27:44.660 Because the transmission in the robot is through the arms. 508 00:27:45.240 --> 00:27:48.650 There are three arms or four arms sometimes, which I 509 00:27:48.670 --> 00:27:51.349 replicate my movement of my hand. Suppose I hold a 510 00:27:51.369 --> 00:27:53.569 structure with my left hand. If I hold it with 511 00:27:53.589 --> 00:27:56.130 the robot, it will hold the arm there. The arm 512 00:27:56.150 --> 00:27:59.930 will grab. And I will cut it a little. So, 513 00:27:59.990 --> 00:28:02.240 these all robotic movements I will do inside. That will 514 00:28:02.279 --> 00:28:05.140 exactly get transmitted to the body of the patient's human body. 515 00:28:05.640 --> 00:28:10.460 You are Durgama. You have so many arms. 516 00:28:10.599 --> 00:28:16.099 Yes, yes. I would say we have control on a 517 00:28:16.119 --> 00:28:22.779 lot of arms and my activities inside the body is multifaceted. Secondly, 518 00:28:22.819 --> 00:28:25.440 there are three parts of robot. One is the robotic 519 00:28:38.930 --> 00:28:43.660 surgical console, where I sit. Then secondly, is the patient cart, 520 00:28:44.140 --> 00:28:46.759 where the patient is attached. They are all inside the OT, 521 00:28:47.180 --> 00:28:49.599 inside the operating room. And thirdly, there is a vision cart, 522 00:28:49.640 --> 00:28:51.599 where all the people in the operating room can see 523 00:28:51.660 --> 00:28:52.480 what is going on. 524 00:28:52.920 --> 00:28:53.880 You are not in the OT. 525 00:28:54.200 --> 00:28:55.940 I am in the OT. I am inside the OT. 526 00:28:55.940 --> 00:28:58.470 But you are in your, on the console. 527 00:28:58.490 --> 00:29:01.890 There is a console, where I am working as a robot. 528 00:29:01.910 --> 00:29:05.490 And the patient's table is with me. And there are 529 00:29:05.549 --> 00:29:07.740 all the robot arms attached to it. On the, there 530 00:29:07.759 --> 00:29:12.609 is a third system called a vision card. Because the assistant, 531 00:29:13.269 --> 00:29:17.069 because they are one surgeon, because for safety, there is 532 00:29:17.150 --> 00:29:20.329 one surgeon always sits with the patient. It's called a 533 00:29:20.529 --> 00:29:23.170 table side surgeon. It's called a table surgeon. It's like 534 00:29:23.190 --> 00:29:25.059 a second engine of an aircraft. The first engine fails, 535 00:29:25.079 --> 00:29:29.279 the second engine takes over, right? So similarly, it is 536 00:29:29.319 --> 00:29:42.640 same actually. And most importantly, in this ecosystem, commands are 537 00:29:42.680 --> 00:29:46.759 very important. The whole team should know now what is 538 00:29:46.779 --> 00:29:49.420 going to happen. Which step is coming. Suppose I have 539 00:29:49.440 --> 00:29:51.799 to exchange an instrument. Then the instrument is not supposed 540 00:29:51.819 --> 00:29:54.920 to be ready beforehand. Because we change instruments sometimes. We 541 00:29:54.940 --> 00:29:57.190 take out this arm, take out the other arm, take 542 00:29:57.250 --> 00:30:00.319 out the blade, take out the blade, take out the forceps, So, yes, 543 00:30:00.359 --> 00:30:03.660 robotics arms, they are very important to exchange in time. So, 544 00:30:03.680 --> 00:30:07.799 these are very intricate movements between the robotic surgeon, the console, 545 00:30:07.839 --> 00:30:11.900 the nurse, the technician. So, this ecosystem is very important. So, 546 00:30:12.099 --> 00:30:17.140 that's answering a question that how to choose a good 547 00:30:17.180 --> 00:30:19.980 robotic center is number one. What is the experience of 548 00:30:20.009 --> 00:30:22.890 that center to run that robot? For example, we have 549 00:30:22.930 --> 00:30:26.309 been running the longest legacy of robotic cardiac surgery at 550 00:30:26.349 --> 00:30:29.509 Fortis Ascot. So, This is a center where we have 551 00:30:29.990 --> 00:30:35.349 built the system, built the technology, built the techniques how 552 00:30:35.369 --> 00:30:38.349 to refine robotic surgery. So these are the very advanced 553 00:30:38.369 --> 00:30:41.289 centers because we train people, we train other surgeons also. 554 00:30:41.670 --> 00:30:43.730 So these are advanced. Apart from that, if someone wants 555 00:30:43.750 --> 00:30:46.970 to go for robotic technology, definitely they have to see 556 00:30:46.990 --> 00:30:50.759 the ecosystem first. That what is the ecosystem of these hospitals, 557 00:30:51.079 --> 00:30:52.920 whether they are really doing robotic surgery or. 558 00:30:52.859 --> 00:30:57.920 Just, And like the pilot, they have number of hours 559 00:30:57.980 --> 00:30:58.539 of flying. 560 00:30:58.559 --> 00:30:59.180 Yes, very important. 561 00:30:59.200 -->

00:31:02.859 Similarly, number of hours of operating on robotics for any surgeon. 562 00:31:02.880 --> 00:31:06.099 Very important. They must see the credential very nicely. So 563 00:31:06.559 --> 00:31:11.200 we have now gone, because the other thing which is 564 00:31:11.259 --> 00:31:13.740 important in robotics is that I don't have to do anything. 565 00:31:14.339 --> 00:31:16.900 It is in the cloud. So for the example, we 566 00:31:16.940 --> 00:31:18.809 have got Da Vinci system. Da Vinci is a cloud. 567 00:31:19.329 --> 00:31:22.390 You have, one second, you have Da Vinci system? 568 00:31:22.619 --> 00:31:23.789 Yeah, it's called, yeah. 569 00:31:24.009 --> 00:31:27.789 That's very artistic. I'm really liking where this podcast is going. 570 00:31:28.230 --> 00:31:33.690 So it's the oldest robot in the world. And it 571 00:31:33.730 --> 00:31:37.130 has gone through a lot of different generations. Now we 572 00:31:37.170 --> 00:31:39.839 have the XI system. It's called XI, that means XI. 573 00:31:40.880 --> 00:31:44.480 It's an US machine and made by Intuitive. So what 574 00:31:44.500 --> 00:31:48.480 I'm saying, I can analyze my surgery at the end 575 00:31:48.500 --> 00:31:52.160 of the surgery. Everything will come into my phone. I 576 00:31:52.200 --> 00:31:55.069 can see my movements, where I have done mistake, where 577 00:31:55.089 --> 00:31:57.809 I have delayed, which step I have taken maximum time, 578 00:31:58.069 --> 00:31:59.990 which step I have taken minimum time. So I can 579 00:32:00.049 --> 00:32:03.170 analyze my entire, you know, surgical steps. I can refine 580 00:32:03.210 --> 00:32:06.349 next surgery. It's like, you know, seeing, for example, I'm 581 00:32:06.390 --> 00:32:09.470 not Sushant Tendulkar, but he sees everything after the batting, 582 00:32:09.490 --> 00:32:12.369 you know, where he has made mistakes. So similarly, now, 583 00:32:13.049 --> 00:32:16.819 and secondly, if somebody wants to see my credential, he 584 00:32:16.839 --> 00:32:19.039 can ask Da Vinci people that how many exactly surgeries 585 00:32:19.059 --> 00:32:21.779 have been done by this fellow. This doctor. Because my 586 00:32:21.900 --> 00:32:23.039 every number, every hour. 587 00:32:23.059 --> 00:32:24.079 That's very important. 588 00:32:24.440 --> 00:32:27.680 My every number, every hour, my complications, everything is noted 589 00:32:27.700 --> 00:32:29.769 by Da Vinci. I cannot hide anything. 590 00:32:29.960 --> 00:32:32.150 So, your report card is in public. 591 00:32:32.210 --> 00:32:32.990 It is not in public. 592 00:32:33.049 --> 00:32:34.269 It is not in public. 593 00:32:34.309 --> 00:32:37.349 It is in the system. So, that's why after doing 594 00:32:37.369 --> 00:32:41.150 a certain number of cases, the company itself certifies me 595 00:32:41.599 --> 00:32:46.119 as their proctor, as their teacher, as their Da Vinci 596 00:32:46.140 --> 00:32:48.710 proctor or Da Vinci surgeon like that. So we have 597 00:32:48.730 --> 00:32:52.470 an intuitive certificate that I'm an intuitive certified robotic surgeon, right? 598 00:32:52.809 --> 00:32:54.589 So that's very difficult to get because there are a 599 00:32:54.589 --> 00:32:55.789 lot of levels to cross. 600 00:32:56.029 --> 00:32:58.349 How many doctors are there who are Da Vinci certified 601 00:32:58.369 --> 00:32:58.609 in India? 602 00:32:58.710 --> 00:33:01.430 In cardiac surgery, I think it's very less. Only a 603 00:33:01.430 --> 00:33:04.140 handful of, I think, around 20 surgeons in the country. 604 00:33:04.880 --> 00:33:07.839 So we are a rare breed now. Robotic surgery, there 605 00:33:08.019 --> 00:33:10.200 are a lot of cardiac surgeons, but robotic cardiac surgery 606 00:33:10.720 --> 00:33:12.779 is a new specialty and a lot of people are 607 00:33:12.819 --> 00:33:16.000 not doing it. So it is difficult. It needs a 608 00:33:16.000 --> 00:33:18.410 lot of training. It needs a lot of patience. And 609 00:33:18.470 --> 00:33:20.410 also you have a lot of patience to do robotics. 610 00:33:21.029 --> 00:33:21.269 Yeah. 611 00:33:21.390 --> 00:33:22.009 All of us together. 612 00:33:22.069 --> 00:33:25.789 But like pilots, to use your analogy, sit in a 613 00:33:25.829 --> 00:33:28.549 simulator in practice, you also have to sit in practice 614 00:33:28.569 --> 00:33:30.450 for hours to actually do this. 615 00:33:30.589 --> 00:33:32.769 So we have got two types, three types of simulation. 616 00:33:33.009 --> 00:33:35.990 First theoretical, you analyze the machine, you see how the 617 00:33:36.029 --> 00:33:39.140 parts move. Then you do the online simulation. Da Vinci 618 00:33:39.160 --> 00:33:46.180 has their own online simulation. So all these things. And 619 00:33:46.220 --> 00:33:49.250 then you have to practice on animal models. So they 620 00:33:49.269 --> 00:33:52.490 have got their different animal laboratory in the country where 621 00:33:52.509 --> 00:33:55.049 you go and practice on animals first. And then when 622 00:33:55.069 --> 00:33:57.849 they are certified and when satisfied that your movements are 623 00:33:57.910 --> 00:34:00.690 safe to handle the robot, then they will certify you 624 00:34:01.109 --> 00:34:04.029 to do the surgery. So this certification is very important. 625 00:34:04.650 --> 00:34:07.789 So without that, you can't perform surgery. So that's why 626 00:34:07.910 --> 00:34:09.050 it's not done by everyone. 627 00:34:10.409 --> 00:34:12.489 Can I ask you a very silly question? 628 00:34:12.510 --> 00:34:12.679 Yes. 629 00:34:13.590 --> 00:34:15.480 But I'm sure this is a question on everybody's mind. 630 00:34:16.130 --> 00:34:19.780 If you are doing robotic surgery, if the internet goes 631 00:34:19.820 --> 00:34:23.480 off or the light goes off, what will happen? 632 00:34:24.480 --> 00:34:26.719 Okay. So, this is not a silly question. It's a 633 00:34:26.719 --> 00:34:32.300 very important safety question. So, all the da Vinci and 634

00:34:32.320 --> 00:34:38.170 all the robots have almost 30 to 40 minutes of backup. So, 635 00:34:38.230 --> 00:34:42.349 the arms will keep on moving. Robotic work will never stop. 636 00:34:42.900 --> 00:34:45.280 I can safely perform the surgery. 637 00:34:45.300 --> 00:34:47.360 They are not dependent on internet? 638 00:34:47.659 --> 00:34:50.000 No, they are not dependent. I am coming to the 639 00:34:50.059 --> 00:34:53.650 next question. Next, I will tell you about internet. But normally, 640 00:34:53.670 --> 00:34:55.289 in your surgery, you don't need internet. 641 00:34:55.329 --> 00:34:56.570 You just need electricity. 642 00:34:56.610 --> 00:34:59.610 Oh, you need electricity. Internet. I am telling you what 643 00:34:59.630 --> 00:35:01.550 you need internet for. This is the next thing actually, 644 00:35:01.570 --> 00:35:05.829 next level of thing. So, that is called robotic telesurgery. So, 645 00:35:05.849 --> 00:35:10.429 telesurgery is a surgery where I operate in Delhi and 646 00:35:10.719 --> 00:35:14.050 I sit in the robot I start the procedure. And 647 00:35:14.210 --> 00:35:18.309 the same thing will be replicated in Puttaparthi, in Karnataka. 648 00:35:18.769 --> 00:35:19.110 Wow. 649 00:35:19.210 --> 00:35:22.239 Yeah. So this is robotic telesurgery. So what will happen, 650 00:35:22.260 --> 00:35:24.440 there will be two robots. One robot is here. One 651 00:35:24.860 --> 00:35:27.280 robot is in Puttaparthi. So the surgeon who is sitting 652 00:35:27.300 --> 00:35:28.780 in the console will not do anything. He will just 653 00:35:28.800 --> 00:35:30.820 put his arms. And then. 654 00:35:31.000 --> 00:35:31.739 He is a table surgeon. 655 00:35:31.760 --> 00:35:33.300 He is a table surgeon. And I will do the 656 00:35:33.320 --> 00:35:36.690 whole robot surgery from here. So that is the future now. 657 00:35:36.710 --> 00:35:39.070 A lot of surgeries have been done in India. And 658 00:35:39.190 --> 00:35:39.469 I have also. 659 00:35:39.489 --> 00:35:40.809 Do you think this will be possible in India? 660 00:35:41.550 --> 00:35:45.550 In India, I think there's a big future. But only 661 00:35:45.570 --> 00:35:47.969 thing is that at least the cost is very. 662 00:35:47.989 --> 00:35:50.889 I mean, it sounds really exciting and fascinating. In my mind, 663 00:35:50.909 --> 00:35:53.750 I think there are so many people who wait that 664 00:35:53.769 --> 00:35:56.710 in Ames, in Scots, in some other big hospital, they 665 00:35:56.769 --> 00:35:59.519 will get time, they will get to, you know, get 666 00:35:59.559 --> 00:36:03.739 treated there. If robotics can be used and somebody doesn't 667 00:36:03.780 --> 00:36:07.360 have to uproot themselves and their entire life and come 668 00:36:07.400 --> 00:36:09.539 all the way, this could be huge. But then, there 669 00:36:09.559 --> 00:36:15.449 are questions of infrastructure availability, internet access, you know, unlimited electricity, 670 00:36:15.710 --> 00:36:17.150

all of that comes to mind. So I think, I 671 00:36:17.190 --> 00:36:18.690 don't know, India may have possibility. 672 00:36:18.829 --> 00:36:21.690 Yeah, you're right. So at this station, we are using 673 00:36:21.949 --> 00:36:25.849 telesurgery for only one purpose, which is very important. Again, 674 00:36:25.969 --> 00:36:30.519 in the robotic surgery in general, is for teleproctoring. Means 675 00:36:30.940 --> 00:36:34.579 I can teach somebody robotically sitting here. I don't have 676 00:36:34.599 --> 00:36:38.360 to travel. So that is very important. Suppose I, for example, 677 00:36:38.920 --> 00:36:42.400 Last week, I had a teleproctoring from US. Dr. Douglas 678 00:36:42.440 --> 00:36:45.300 Murphy is a very big name robotic surgeon in the US. 679 00:36:45.679 --> 00:36:48.099 But I cannot, I can travel. But if I travel 680 00:36:48.119 --> 00:36:50.559 to Pennsylvania, it will take so much of time and, 681 00:36:50.800 --> 00:36:53.579 you know, effort and come back again. So what I did, 682 00:36:53.860 --> 00:36:58.099 I requested him to, you know, do the things from 683 00:36:58.139 --> 00:37:00.519 a distance so that we can observe him. So that 684 00:37:00.579 --> 00:37:03.659 is very important that I can learn from my mentors, 685 00:37:03.679 --> 00:37:07.559 which are specifically designed to do certain surgeries, right? So 686 00:37:07.599 --> 00:37:10.260 that is very important. Teleproctoring is very important. Telesurgery, yes, 687 00:37:10.320 --> 00:37:12.900 as you said, it takes time. It will take some time. 688 00:37:12.940 --> 00:37:15.780 But as the robots are coming up cheaper and cheaper, 689 00:37:16.239 --> 00:37:17.900 I think the day will come that we can do 690 00:37:17.940 --> 00:37:21.510 certain surgeries in tier B and tier C cities from 691 00:37:21.969 --> 00:37:23.889 metro cities in some of the hospitals. 692 00:37:24.429 --> 00:37:27.449 Okay. You spoke about cost, so let's get to that. 693 00:37:29.190 --> 00:37:33.130 Healthcare in India is affordable compared to international standards, but 694 00:37:33.210 --> 00:37:37.599 still not really accessible for majority of our population. You 695 00:37:37.679 --> 00:37:41.010 are saying that robotics is more accessible in a way 696 00:37:41.030 --> 00:37:46.449 and it will take less time in recovery. Your quality 697 00:37:46.469 --> 00:37:48.610 of life is better. You are back on your feet very, 698 00:37:48.650 --> 00:37:50.670 very quickly. All of that is there. But does it 699 00:37:50.750 --> 00:37:51.929 cost more? 700 00:37:52.329 --> 00:37:56.829 Yes. So there is some charge that we charge extra 701 00:37:56.869 --> 00:38:00.489 to the patient. But I think if you say the benefits, 702 00:38:00.760 --> 00:38:02.099 it really overweighs that cost. 703 00:38:03.460 --> 00:38:05.139 Does it cost more than lab pro or does it 704 00:38:05.179 --> 00:38:06.400 cost more than open heart surgery? 705 00:38:06.789 --> 00:38:11.190 So, with open-heart surgery, I charge almost 20% extra to 706 00:38:11.190 --> 00:38:15.289 30% extra. But I think if I can discharge the 707 00:38:15.309 --> 00:38:18.929 patient in three or four days' time, the resources, yeah, 708 00:38:18.969 --> 00:38:19.880 it actually weighs out. 709 00:38:19.889 --> 00:38:21.349 That negates, yeah. 710 00:38:21.369 --> 00:38:24.230 It really weighs out and negates. So, cost is not 711 00:38:24.269 --> 00:38:26.650 at all a factor, I think. So, it's not very 712 00:38:26.690 --> 00:38:29.250 costly at this stage because if I see the benefits, 713 00:38:29.929 --> 00:38:32.889 this cost is very negligible. It's too much because … 714 00:38:34.070 --> 00:38:37.050 If I don't do open surgery, I think it just 715 00:38:37.239 --> 00:38:40.139 makes so many things less. The cost is the minimum 716 00:38:40.179 --> 00:38:42.260 part actually in that. Okay. 717 00:38:42.420 --> 00:38:46.679 There are some regular FAQ questions that come to us. 718 00:38:46.760 --> 00:38:49.539 I want to ask you that. And this is a 719 00:38:49.559 --> 00:38:52.360 take it or trash it segment. So I'll throw a question. 720 00:38:52.480 --> 00:38:54.579 If you think it's true, you say you take it. 721 00:38:54.719 --> 00:38:58.929 If you think it's trashed, say trash it. Okay. Some 722 00:38:59.119 --> 00:39:02.250 frequently asked questions on robotic cardiac surgery. 723 00:39:02.409 --> 00:39:02.590 Okay. 724 00:39:03.840 --> 00:39:07.820 Take it or trash it, robotics edition. Okay. Robotic surgery 725 00:39:07.840 --> 00:39:09.860 means that the robot does the surgery. 726 00:39:10.739 --> 00:39:11.039 Trash. 727 00:39:12.219 --> 00:39:13.659 It's actually the doctor who's performing. 728 00:39:13.780 --> 00:39:14.840 Yes, always, always. 729 00:39:15.559 --> 00:39:18.019 If the robot fails, the patient is in danger. 730 00:39:19.119 --> 00:39:22.610 Robot cannot fail. It's a trash because as I told you, 731 00:39:22.650 --> 00:39:26.530 septic mechanism is very, very strict and septic is very, 732 00:39:26.550 --> 00:39:30.289 very well streamlined. Robot cannot fail. Robot cannot fail. fail 733 00:39:30.309 --> 00:39:34.969 because I have not encountered anything where robotic arms gone 734 00:39:35.179 --> 00:39:36.849 without my you. 735 00:39:36.659 --> 00:39:38.960 Know but it's a machine it could have a glitch. 736 00:39:39.920 --> 00:39:43.079 Well see system yeah you can you are right but 737 00:39:43.500 --> 00:39:46.780 at the same time those glitches cannot harm patients because 738 00:39:46.840 --> 00:39:49.019 there is a point beyond which the robotic arms cannot 739 00:39:49.059 --> 00:39:52.139 go also For example, there is a big vessel. The 740 00:39:52.159 --> 00:39:54.570 robot will stop itself even if I don't do anything. 741 00:39:55.090 --> 00:39:55.510 What do you mean? 742 00:39:55.949 --> 00:39:57.809 Suppose I get a very big artery or vein from 743 00:39:57.929 --> 00:40:01.550 where bleeding can happen, hemorrhage can

happen, complications of the 744 00:40:01.730 --> 00:40:04.909 patient can happen. So robotic arms will tell me 100 times. 745 00:40:06.789 --> 00:40:07.929 How will it tell you? 746 00:40:08.269 --> 00:40:12.099 It freezes my hand. My hand will stop. So that's 747 00:40:12.119 --> 00:40:15.099 very important. Those features are very, very important. So that's 748 00:40:15.139 --> 00:40:17.659 why a lot of things are made in such a 749 00:40:17.699 --> 00:40:19.400 way that even if you want to … So. 750 00:40:19.280 --> 00:40:22.250 You've designed these 10 steps that you will perform in 751 00:40:22.269 --> 00:40:22.869 the surgery. 752 00:40:22.989 --> 00:40:23.170 Yeah. 753 00:40:23.389 --> 00:40:27.150 When you actually go inside the body, you encounter something new. 754 00:40:27.289 --> 00:40:30.329 The robot will spot it and stop before. 755 00:40:29.829 --> 00:40:32.469 You can proceed. It will not stop. It will allow 756 00:40:32.510 --> 00:40:35.860 me to be safe. It will go in such a 757 00:40:35.880 --> 00:40:38.860 way that I cannot hurry my speed or something like that. 758 00:40:39.500 --> 00:40:42.610 It will … Because robot cannot, robot is not a human. 759 00:40:42.849 --> 00:40:45.909 It will see exactly what I am seeing. So, but 760 00:40:45.929 --> 00:40:48.670 it will not go to a structure where it can 761 00:40:48.710 --> 00:40:51.519 harm or cause any damage to the patient's body. So, 762 00:40:51.539 --> 00:40:54.019 that's why the deco system is very important. Suppose you 763 00:40:54.039 --> 00:40:56.199 blink your eyes, robot will stop. It will not work. 764 00:40:56.800 --> 00:41:00.699 The instrument freeze. They do not move. Even if I want. 765 00:41:01.179 --> 00:41:03.590 My hands are with the instrument, but I blink my eyes, 766 00:41:04.090 --> 00:41:05.010 robot will stop there. 767 00:41:05.610 --> 00:41:07.349 Even if you shake your head, you want to shrug 768 00:41:07.449 --> 00:41:07.730 a little bit. 769 00:41:07.789 --> 00:41:10.219 No, no, no, it will stop. It will stop. It 770 00:41:10.739 --> 00:41:14.360 will not allow anything which he or she, the robot, 771 00:41:14.380 --> 00:41:18.179 thinks that is unsafe. There is no sex of robot, 772 00:41:18.219 --> 00:41:18.920 but I am just saying. 773 00:41:20.059 --> 00:41:20.659 Must be a she. 774 00:41:20.679 --> 00:41:23.960 If it's that efficient, it has to be a she. Okay. 775 00:41:24.519 --> 00:41:27.320 Taking a trashy robotic surgery is still experimental. 776 00:41:28.039 --> 00:41:31.519 No, totally trash. A lot of papers have been published 777 00:41:31.619 --> 00:41:35.079 on robotic cardiac surgery that results are effective, results are 778 00:41:35.099 --> 00:41:37.820 equally safe like an open surgery. So, it's not an 779 00:41:37.880 --> 00:41:41.400 experimental at all. No, surgery is experimental at this stage. Okay. 780 00:41:41.960 --> 00:41:44.880 Anyone with a heart problem can opt for a robotic surgery? 781 00:41:45.420 --> 00:41:49.789 Yes. I think it is a valid point. Up to 782 00:41:49.789 --> 00:41:53.469 60 to 70% of the heart elements can be treated robotically. Okay. 783 00:41:53.610 --> 00:41:56.929 But check with your doctor if you really qualify. Older 784 00:41:56.949 --> 00:41:58.789 patients can't have robotic surgery? 785 00:41:58.909 --> 00:42:01.670 No, totally dress. I think they are the people who 786 00:42:01.730 --> 00:42:03.050 need really robotic surgery. 787 00:42:03.739 --> 00:42:06.820 Okay. Every hospital with a robot is equally good? Yes. 788 00:42:08.079 --> 00:42:12.619 Yeah, this is a very hypothetical question. All robots are 789 00:42:12.699 --> 00:42:18.260 now made by very prominent robotic companies. So all robots 790 00:42:18.280 --> 00:42:20.940 are good, but all robots cannot be used for every organ. 791 00:42:21.440 --> 00:42:24.199 For example, intuitive da Vinci system can be used for 792 00:42:24.219 --> 00:42:26.280 a lot of things, but it cannot be used for orthopedics, 793 00:42:26.320 --> 00:42:29.550 for example. So orthopedic system is a different robot. So 794 00:42:29.719 --> 00:42:33.349 organ-specific robots have come now for heart disease, liver disease, 795 00:42:33.630 --> 00:42:34.909 gallbladder disease, like that, you know. 796 00:42:35.730 --> 00:42:40.610 Okay. Your surgeon's experience matters more than the machine. 797 00:42:40.869 --> 00:42:45.389 Yes. It's very important. You have to have experience in robotics, right? Okay. 798 00:42:46.050 --> 00:42:48.360 Smaller cuts means safer surgery. 799 00:42:50.010 --> 00:42:53.719 See, safety of the surgery doesn't depend on the size 800 00:42:53.760 --> 00:42:57.599 of the cut. A bypass surgery can be done very 801 00:42:57.739 --> 00:43:01.820 safely with a small cut. But that doesn't mean that 802 00:43:01.900 --> 00:43:05.820 robotic surgery cannot have complications. Its complication rates depends on 803 00:43:05.840 --> 00:43:07.860 the condition of the heart. It doesn't depend on the 804 00:43:07.889 --> 00:43:11.190 robot or open. In open also, we have 1% complication 805 00:43:11.230 --> 00:43:13.590 in heart surgery. In robot also, we have got 1% 806 00:43:13.590 --> 00:43:17.130 chance in heart surgery. Going into different complications. So, that 807 00:43:17.150 --> 00:43:17.489 is already there. 808 00:43:17.510 --> 00:43:18.510 So, complication rate is the same? 809 00:43:18.550 --> 00:43:18.769 Same. 810 00:43:19.050 --> 00:43:19.250 Same. 811 00:43:19.349 --> 00:43:21.429 It cannot come down by the use of the robot 812 00:43:21.489 --> 00:43:25.570 or something like that. Yes. Your immediate recovery is much faster. 813 00:43:26.130 --> 00:43:26.230 Yes. 814 00:43:26.309 --> 00:43:26.530 Okay. 815 00:43:26.550 --> 00:43:28.610 Which brings me to the next question. Robotic surgery means 816 00:43:28.710 --> 00:43:29.309 less pain. 817 00:43:29.889 --> 00:43:32.869 Okay. Absolutely. There is no less pain. There is no pain. 818 00:43:34.050 -->

00:43:36.690 There is no less pain. There is no pain at all. Yeah. 819 00:43:37.690 --> 00:43:40.130 Okay. You'll be back on your feet in days, not weeks. 820 00:43:40.929 --> 00:43:42.719 I would go one step ahead. I would say in 821 00:43:42.840 --> 00:43:44.380 hours now. Yeah. 822 00:43:45.239 --> 00:43:48.659 Wow. Robotic surgery is only for the rich. 823 00:43:49.440 --> 00:43:52.360 No, not at all. Because it's the same cost. I 824 00:43:52.400 --> 00:43:55.679 would again emphasize that cost is not an important factor 825 00:43:55.699 --> 00:43:59.949 in robotics because cost is slightly minimal. The amount of advantage, 826 00:43:59.989 --> 00:44:02.849 it really negates the cost. This is a very important 827 00:44:02.869 --> 00:44:05.690 message to everyone. It's not costly surgery. Please do not 828 00:44:05.730 --> 00:44:08.719 tell that it's a costly operation. Even sometimes open surgery 829 00:44:08.739 --> 00:44:10.050 costs more than robotic surgery. 830 00:44:10.369 --> 00:44:10.690 Oh, is it? 831 00:44:10.690 --> 00:44:11.889 Yes, yes. Okay. 832 00:44:11.909 --> 00:44:16.050 Yeah. Okay, and this is interesting. Robots will replace heart 833 00:44:16.090 --> 00:44:16.849 surgeons one day. 834 00:44:18.269 --> 00:44:21.469 Well, it can replace anyone, theoretically, but at this stage, 835 00:44:21.489 --> 00:44:24.289 it's a trash because, you know what, Sunal, you must 836 00:44:24.309 --> 00:44:28.199 have read one article about a year back. A heart 837 00:44:28.239 --> 00:44:29.420 transplant is done robotically. 838 00:44:29.739 --> 00:44:30.039 Yeah. 839 00:44:30.119 --> 00:44:34.440 You must have read that now, yeah. So, future is that, actually. 840 00:44:35.119 --> 00:44:39.929 People are trying to do surgeries, most of the complex surgeries, 841 00:44:40.889 --> 00:44:45.909 heart surgeries, robotically. What it will replace is our precision. 842 00:44:46.590 --> 00:44:50.030 What it will replace is our interventions. What it will 843 00:44:50.050 --> 00:44:55.239 replace is our planning. So, for example, I was telling 844 00:44:55.260 --> 00:44:58.079 you before also, I am emphasizing the same thing with 845 00:44:58.099 --> 00:45:03.019 the AI and our imaging techniques in AI and imaging. So, 846 00:45:03.099 --> 00:45:05.869 I can read a CT scan first. I can exactly 847 00:45:05.949 --> 00:45:09.929 make a three-dimensional model of the heart. And I can 848 00:45:09.949 --> 00:45:13.889 put it inside a 3D model in the AI and 849 00:45:13.949 --> 00:45:16.230 exactly can find out which space I have to go inside, 850 00:45:16.889 --> 00:45:19.010 which space I have to go inside the heart, how 851 00:45:19.050 --> 00:45:21.409 much centimeter I will go inside, how much centimeter I 852 00:45:21.449 --> 00:45:27.210 keep my port outside. So all these things will reduce pain, trauma, bleeding, everything. Also, 853 00:45:27.650 --> 00:45:33.110 it makes our surgery more precise. So AI plus AI-enabled 854 00:45:33.710 --> 00:45:38.389 technology Imaging plus the robot together can do a lot 855 00:45:38.429 --> 00:45:41.230 of changes. And things are coming. I cannot reveal a 856 00:45:41.230 --> 00:45:45.389 lot of technical things here, but experiments and things are 857 00:45:45.409 --> 00:45:47.889 going into robotic technology to feel the tactile feedback also. 858 00:45:47.989 --> 00:45:50.269 I can feel it also, how much stretch in the tissue. 859 00:45:50.690 --> 00:45:53.550 It's coming now, but it will take some few more years. 860 00:45:54.190 --> 00:45:55.929 And at one point of time, I think you can 861 00:45:55.969 --> 00:45:59.090 have robot where you make half pass the needle, rest 862 00:45:59.110 --> 00:46:02.090 the robot will pass. It is not the robot will 863 00:46:02.110 --> 00:46:04.699 do the surgery, but our human effort will become less even. 864 00:46:05.440 --> 00:46:09.119 Even lesser and lesser. But they can replace but for sure. Okay. 865 00:46:09.139 --> 00:46:10.880 So, is it right to say that if you are 866 00:46:10.920 --> 00:46:16.090 doing a heart surgery, then there are 5-6 doctors in 867 00:46:16.110 --> 00:46:19.110 an OT, if not more. In a robotic surgery, it's 868 00:46:19.150 --> 00:46:22.250 just the different arms and one doctor. 869 00:46:23.469 --> 00:46:23.929 At this stage. 870 00:46:23.949 --> 00:46:25.570 The one who is running the console and then there 871 00:46:25.610 --> 00:46:26.570 is a table surgeon. 872 00:46:26.329 --> 00:46:29.409 Like you said. Yes, yes, yes. So, I think that 873 00:46:30.530 --> 00:46:33.699 has not been so technologically advanced that we have to 874 00:46:36.409 --> 00:46:40.739 The manpower is still the same. But the efficiency is 875 00:46:40.820 --> 00:46:44.159 much more. So, initially when we started this program, we 876 00:46:44.199 --> 00:46:47.280 used to take long time for robotic surgery. Eight, nine 877 00:46:47.320 --> 00:46:49.719 hours and all these things. Now, it has come down 878 00:46:49.739 --> 00:46:51.960 to two hours. Now, in a day, we are doing 879 00:46:52.000 --> 00:46:56.159 three robotic surgeries. Robotic heart surgeries in a day. Morning one, afternoon, 880 00:46:56.219 --> 00:46:58.539 evening one. That means our efficiency has gone beyond to 881 00:46:58.579 --> 00:47:01.219 the level that we have used the robot to its 882 00:47:01.300 --> 00:47:04.389 maximum capacity in a day. In 24 hours, we have 883 00:47:04.409 --> 00:47:08.909 used it So, that robot is really exhausted towards the end. So, 884 00:47:09.010 --> 00:47:11.309 that means we have used the robot to the fullest 885 00:47:11.349 --> 00:47:14.510 of the capacity. So, things have changed. So, it's like laparoscopy. 886 00:47:14.530 --> 00:47:16.989 Sometimes in a day, it will come that in a week, 887 00:47:17.420 --> 00:47:20.340 we have probably done 20 robotic cardiac surgery. And they're 888 00:47:20.420 --> 00:47:25.260 all going home in the same time. Like, it's like that, 889

00:47:25.300 --> 00:47:25.860 you know. Yeah. 890 00:47:26.039 --> 00:47:30.349 So, what are the downsides of robotic surgery? Are there 891 00:47:30.409 --> 00:47:34.159 any things that... which are a bit of a blind 892 00:47:34.300 --> 00:47:36.159 eye for us, blind corners for us? 893 00:47:38.760 --> 00:47:42.989 Not really. Yeah, definitely you cannot do certain surgeries robotically. Still, 894 00:47:43.010 --> 00:47:46.909 we are lacking in that. Like with laparoscopy, we can 895 00:47:46.929 --> 00:47:51.429 do almost all the surgeries in general surgery. Robot, especially 896 00:47:51.449 --> 00:47:54.250 in the heart, we are not in a stage to 897 00:47:54.289 --> 00:47:58.210 do everything. Otherwise, apart from that, I don't think that 898 00:47:58.309 --> 00:48:04.050 robot has got some specific disadvantage. It has got all plus, plus, plus, plus, plus. 899 00:48:04.150 --> 00:48:08.409 Nothing negative or nothing, you know, which I can tell 900 00:48:08.429 --> 00:48:11.230 that it's not good for the patient. Nothing like that. 901 00:48:11.269 --> 00:48:14.849 There's no adverse factors from the robot per se. There's 902 00:48:14.869 --> 00:48:16.510 nothing like that at this stage. 903 00:48:18.420 --> 00:48:23.300 So, help me understand this. I have a disease diagnosed. 904 00:48:24.179 --> 00:48:28.050 It's obviously a very... like troubling time for the patient, 905 00:48:28.090 --> 00:48:30.840 for the family, all of that. And a suggestion comes 906 00:48:30.940 --> 00:48:33.340 on board by the surgeon that maybe we can try 907 00:48:33.380 --> 00:48:38.800 robotics in this one. So what all should I consider? 908 00:48:39.340 --> 00:48:43.800 What all questions should I ask my doctor before deciding 909 00:48:44.010 --> 00:48:45.309 to go for a robotic surgery? 910 00:48:45.550 --> 00:48:48.929 So yeah, definitely about the safety of the operation. Why safety? 911 00:48:48.949 --> 00:48:51.329 I'm saying that they have to ask one question, whether 912 00:48:51.349 --> 00:48:53.090 it is as safe as an open surgery or not. 913 00:48:53.630 --> 00:48:56.119 Because in some of the operations, it is... It is 914 00:48:56.219 --> 00:48:58.119 not safe for a robot to go in, like a 915 00:48:58.519 --> 00:49:03.840 very emergency situation. The patient's heart condition is very serious, complicated. Definitely, 916 00:49:04.420 --> 00:49:06.500 we should not go for robotics. So that's the point 917 00:49:06.599 --> 00:49:09.300 they should always ask the surgeon. They should not pressurize 918 00:49:09.320 --> 00:49:11.530 the surgeon to do it robotically. I think that is 919 00:49:11.530 --> 00:49:13.940 the best thing to be left to the surgeon, what 920 00:49:13.940 --> 00:49:16.179 do they decide? Do I have to do it robotically 921 00:49:16.280 --> 00:49:22.760 or non-robotically? Secondly, they should also ask about the surgeon's experience. 922 00:49:23.500 --> 00:49:26.059 How much robotic surgery you have done? How the program 923 00:49:26.260 --> 00:49:29.219 has started? That's a very important point. Specifically, I am 924 00:49:29.280 --> 00:49:32.869 saying for robotic cardiac surgery. Whether he is credentialed or not. 925 00:49:32.880 --> 00:49:36.179 What machine is credentialed? In which machine? In which platform 926 00:49:36.199 --> 00:49:38.650 are you doing it? All these things are important. You 927 00:49:38.710 --> 00:49:42.659 must know all these things in details. From a patient's perspective. 928 00:49:42.679 --> 00:49:45.900 But how will the patient understand which surgery to do? 929 00:49:45.940 --> 00:49:46.340 I will tell you. 930 00:49:46.420 --> 00:49:49.000 I will have to do chat GPT. I will tell you. 931 00:49:49.019 --> 00:49:53.239 So you can see in the system, in the internet 932 00:49:53.280 --> 00:49:57.699 that which hospitals come in which year. Their robotic surgical experience. 933 00:49:57.719 --> 00:50:00.219 For example, Portuguese escorts have the first robot in the 934 00:50:00.239 --> 00:50:03.559 country in 2001. That means by experience, we are by 935 00:50:03.579 --> 00:50:06.889 far the largest experience in the country. Similarly, you can 936 00:50:06.929 --> 00:50:09.869 see there are so many hospitals have come up in 2019-20. So, 937 00:50:09.889 --> 00:50:12.570 they are also well experienced. So, experience of the surgeon 938 00:50:12.590 --> 00:50:15.860 and the team is very important. So, that must be asked. 939 00:50:16.260 --> 00:50:22.099 So, safety meaning do you qualify for robotic surgery? Ask 940 00:50:22.119 --> 00:50:24.739 the surgeon. Then ask for the number of experience the 941 00:50:24.780 --> 00:50:27.530 surgeon has. And thirdly, ask the machine that they are using. 942 00:50:27.670 --> 00:50:28.710 Third question. Fourth question. 943 00:50:28.750 --> 00:50:31.349 Fourth question is that whether that surgery is going to 944 00:50:31.389 --> 00:50:35.239 be effective or not. If I do it robotically. Is 945 00:50:35.260 --> 00:50:38.539 there any compromise on the effectiveness, long-term outcome of the surgery? 946 00:50:38.840 --> 00:50:42.320 For example, suppose we have to remove three blockages in 947 00:50:42.340 --> 00:50:45.449 a bypass surgery. We have to ask the surgeon, sir, 948 00:50:45.690 --> 00:50:48.789 can you replace all the three blockages by robotic? If 949 00:50:48.809 --> 00:50:50.730 the answer is yes, you are very safe to go. 950 00:50:51.070 --> 00:50:52.949 If he says no, no, no, you may not be 951 00:50:53.070 --> 00:50:55.570 able to do it. So in that case, I think 952 00:50:55.590 --> 00:50:58.150 we should go for an open surgery. That's very important. 953 00:50:58.329 --> 00:50:59.929 So you don't want to do another operation. 954 00:50:59.969 --> 00:51:02.829 Yes, another operation or unnecessarily put the patient into some 955 00:51:02.869 --> 00:51:10.369 complicated future. Thirdly, next we have to ask about the 956 00:51:11.409 --> 00:51:16.050 quality of life. Is it really worth doing this surgery 957 00:51:16.219 --> 00:51:17.880 or there is no difference in the quality of life? 958 00:51:17.920 --> 00:51:21.099 That is a very important question. Everybody must ask. Everybody 959 00:51:21.119 --> 00:51:23.500 should ask this question. I think that's the most important 960 00:51:23.559 --> 00:51:30.989 aspect of my surgery, robotic cardiac surgery. The quality of 961 00:51:31.010 --> 00:51:34.820 life is totally different in robotic surgery, apart from. 962 00:51:35.519 --> 00:51:38.559 All right, Dr. Rithvik. This episode has been an eye-opener. 963 00:51:38.699 --> 00:51:39.840 I have learned so much. 964 00:51:39.860 --> 00:51:40.360 Thank you. 965 00:51:40.440 --> 00:51:43.369 And I really hope our viewers also take back all 966 00:51:43.409 --> 00:51:46.250 this information and are able to make more informed decisions. 967 00:51:46.269 --> 00:51:47.170 Thank you so much for your time. 968 00:51:47.190 --> 00:51:48.329 Thank you, Sanal. Thank you very much.