Luckily for her, robotic surgery came to her rescue. Using the latest generation da Vinci Si robot, doctors at the Apollo Hospitals, Hyderabad removed the right half of her thyroid gland through a small incision in her axilla (arm-pit); in the process avoiding any kind of incision or scarring in the neck. An intra-operative frozen section of the nodule also ruled out the presence of any cancer in the nodule. Due to the robotic technique, Priya recovered fast and was discharged from the hospital within two days following her surgery. She also had minimal discomfort in her neck following the operation and was able to eat and speak the very next day. Priya now has no hesitation in recommending the robotic technique to anyone else who may require a thyroidectomy.

 Robotic Thyroidectomy

 The technique of trans-axillary robotic thyroidectomy was first described by Prof Woong Youn Chung, a surgical endocrinologist at the Yonsei University in Seoul, Korea in 2005. The impetus for developing the technique was dictated by the high incidence of thyroid cancers in South Korea. A large number of these patients were young and were reluctant to have a scar on their neck, which a conventional thyroidectomy would result in. Prof. Chung had experimented with the endoscopic technique of removing the thyroid gland from the axilla, but was not happy with it. The procedure was cumbersome and did not offer satisfactory visualization of the thyroid gland. During that time, surgeons were already removing the prostate gland regularly for cancer using the robotic technique with excellent results. Prof Chung devised a special retractor (Chung retractor) to aid in keeping the subcutaneous tunnel created between the axilla and the neck lifted up during the robotic procedure. Between 2005 and 2012, Dr Chung and his team performed over 3,200 trans-axillary robotic thyroidectomies on patients from across all over the world, majority (over 80%) of them for cancer of the thyroid gland.  Other than the excellent cosmetic results achieved, Dr Chung also demonstrated the superiority of this technique over both conventional neck and endoscopic techniques in terms of faster recovery and fewer complications. 

 In the first week of February this year, for the first time in the country, surgeons at the Apollo Hospitals in Chennai and Hyderabad successfully performed a series of ten robotic thyroidectomies through the trans-axillary route for both benign and malignant nodules of the thyroid gland under the supervision and guidance of Prof. Chung. With further experience and awareness, it is expected that this revolutionary technique may be a boon for young patients in India suffering from benign and malignant diseases of the thyroid gland who may wish to have surgery performed without scarring of the neck.

Traditionally, surgery of the thyroid is done through a cut in the lower part of the neck. In most cases the cut heals well leaving behind a fine scar; but some people have a tendency to form thick and unsightly scars. Additionally, a neck scar may be psychologically upsetting to young patients. Thanks to the advent of the Robotic surgical systems, it is now possible to do thyroid surgery without opening the neck and without leaving a visible scar!

So, what is a robotic surgical system?

The Robotic system is a revolutionary innovation which uses specially designed robotic arms to perform surgical procedures in areas which are otherwise difficult or impossible to reach.  The robotic arms are controlled by a computer console which the surgeon operates using hand and foot controls – somewhat like a video-game, but a thousand times more precise and sophisticated. The endo-wrist attached to these arms can move in different directions and at multiple angles (270 degrees) – something that the human wrist cannot. This helps it to dissect, suture and divide tissues with a precision that even the most dexterous surgeon cannot. An endoscopic camera provides a 3-D magnified view of the surgical field (area being operated) when viewed through the console; making structures like nerves, blood vessels etc. much larger and therefore more easily visible enabling faster surgery with more precision. Using small and hidden cuts surgeons can remove complex tumours with minimal tissue damage, hastening recovery and reducing hospitalization. Wondering how the robot performs surgery? Well, it doesn’t. Though the robot facilitates the surgery, it is the operating surgeon’s hand movements that are transmitted to the robotic arms and the surgeon continues to direct the operation. The newer generation robotic systems (da Vinci Si) have motion scaling with tremor filtration. This eliminates tiny, uncontrolled movements in the surgeon’s arms making surgery much more precise. The main application of this system has been in cancer, cardiac and urologic surgery.

Robotic surgery for thyroid cancer

Robotic thyroid surgery for benign and cancerous nodules of the thyroid gland is done through a cut in the arm-pit (axilla). This avoids a visible scar in the neck. Specially designed retractors allow the robotic arms to reach the neck region and remove the thyroid without cutting open the neck!

Other applications of the robot in cancer surgery include;

• Trans-oral robotic surgery (TORS) – surgery for cancer of the throat via the mouth.
• Robotic gastro-intestinal and colorectal surgeries through tiny ports on stomach avoiding large cuts and extensive mobilization of organs in the abdomen, thus hastening recovery and minimizing complications from these surgeries
• Gynaecological procedures including hysterectomy (removal of uterus), myomectomy (removal of fibroids) and other pelvic surgeries.
• Robotic radical prostatectomy for early and localized cancer of the prostate.

As the superiority of this technique over open and laparoscopic surgery is being established, many other indications are still evolving. With time, robotic surgery is expected to replace other conventional methods of surgery.

Also read Robotic surgeries – the future of complicated procedures?

Resident of Ghaziabad, Himanshu was an IT professional. In Dec 2009, he complained of severe abdominal pain and was rushed to a local hospital. ‘He was diagnosed with thrombosis of the main vein of the intestine which resulted in loss of blood supply to most of his intestine,’ A.S. Soin, chairman, Institute of Liver Transplantation at Medanta, said.

Himanshu was dependent on intravenous nutrition for three years. The donor was a deceased 20-year-old man, Soin said. Here’s how an intestinal transplant works.

How it works:

Intestinal transplants are offered to people with intestinal failure who can’t eat normal food because their digestive system doesn’t work. It’s also the last-resort treatment option for patients with intestinal failure who develop life-threatening complications from total parenteral nutrition.

Intestinal transplantation has evolved in the past decade from being considered an ‘experimental’ procedure to what is considered as a last-resort treatment option for patients with intestinal failure who develop life-threatening complications from total parenteral nutrition (TPN). Long-term TPN can result in complications including bone disorders, catheter-related infections and liver failure. Over an extended period of time, TPN also can damage veins used to administer the nutrition via the catheter. The procedure has shown advancement in number of surgeries performed without complications due to the advancement of techniques relating to organ preservation, surgical technique, immunosuppression, and postoperative management.

 In the procedure, either the small bowel or intestine is transplanted in isolation, or can be transplanted with the liver and/or other gastrointestinal organs. The blood vessels of the patient and donor are connected to establish blood supply to the transplanted intestine and the donor organs are then connected to the patient’s intestine.  

Usually an ileostomy is then performed. It is a surgically created opening through which the ileum (a section of the patient’s small intestine), is brought up through the abdominal wall. This opening allows the waste from the body to directly pass out of the body. This procedure is important for transplant patients because it allows doctors to keep a close eye on the patient’s progress. In time, the ileostomy is closed. A feeding tube is also placed into the stomach to help the patient transition to an oral diet.

Post-Transplant Complications:

The commonest complications from a transplant are infections due to the high doses of immunosuppressive medication, rejection of the transplant and/or intestinal ischemia and leaks from the anastomoses due to surgical technical difficulty in reconnection of the intestine and the vessels. The first patient who received the intestinal transplant passed away within 42 days because the immunosuppressant drugs given to keep the body from rejecting the organ is too strong and can completely subjugate the immune system. 

Click here to read more about the procedure

With inputs from IANS

So what is an intestinal transplant? Why does she need it? Will it work? Here are some things you need to know about intestinal transplants.

Intestinal transplantation has evolved in the past decade from being considered an ‘experimental’ procedure to what is considered as a last-resort treatment option for patients with intestinal failure who develop life-threatening complications from total parenteral nutrition (TPN). Long-term TPN can result in complications including bone disorders, catheter-related infections and liver failure. Over an extended period of time, TPN also can damage veins used to administer the nutrition via the catheter. The procedure has shown an advancement in number of surgeries performed without complications due to the advancement of techniques relating to organ preservation, surgical technique, immunosuppression, and postoperative management.

 Why is it needed?

Transplantation is the only treatment available for patients diagnosed with irreversible intestinal failure in the short gut syndrome (a mal-absorption disorder, in which removal of the small intestine is necessary), defective intestinal motility ( when the intestines are not able to move food through the gastrointestinal tract) or in cases where the intestines need to be removed in part or totally due to cancer or trauma.

Without a transplant, patients with intestinal and liver failure have an expected median survival of 6 – 12 months while continued on TPN. 

Procedure:

An Intestinal transplant is a complex surgery, which requires a highly skilled multidisciplinary transplant team. A transplant surgery usually takes about 3-4 hours, where as if the patient requires multi organ transplant the procedure might take upto 12 hours. Either the small bowel or intestine is transplanted in isolation, or can be  transplanted with the liver and/or other gastrointestinal organs.

Intestinal Transplant Procedure

In this procedure the intestine and other diseased organs are replaced with healthy donor organs. The blood vessels of the patient and donor are connected to establish blood supply to the transplanted intestine. The donor organs are then connected to the patient’s intestine.

Usually an ileostomy is then performed. It is a surgically created opening through which the ileum (a section of the patient’s small intestine), is brought up through the abdominal wall. This opening allows the waste from the body to directly pass out of the body. This procedure is important for transplant patients because it allows doctors to keep a close eye on the patient’s progress. In time, the ileostomy is closed. A feeding tube is also placed into the stomach to help the patient transition to an oral diet.

Post Transplant Complications:

The commonest complications from a transplant are infections due to the high doses of immunosuppressive medication, rejection of the transplant and/or intestinal ischemia and leaks from the anastomoses due to surgical technical difficulty in reconnection of the intestine and the vessels.

Recovery:

Care after an intestinal transplant differs slightly for each patient, depending on their medical history, type of transplant and medical condition at the time of their transplant. The length of stay in the hospital varies for each patient, but can last for several weeks or as long as several months.

Immediately after a transplant the patient is shifted to the ICU and is closely monitored. After he/she has stabilised and shifted out, close monitoring is required to prevent bacterial, fungal and viral infections. Some patients also may require blood pressure, diabetes or anti-ulcer medications. It is important to remember that an intestinal transplant is not a surgical cure, but rather a last-resort therapy that requires meticulous administration of medication and close monitoring to be successful. We hope this helps our Delhi rape victim to lead a healthy life!

Also read: Sepsis and low platelet count: Will the Delhi rape victim recover soon?

“Robotic surgery allows us to do many complex operations that would require large incisions,” Sudhir Srivastava, chairman, CEO and managing director, Fortis Healthcare International Centre for Robotic Surgery in New Delhi, told IANS. Srivastava said conventional cardiac surgery requires splitting of the sternum, but in robotic surgery, using a robotic surgical system called Da Vinci, just four-five finger-tip sized incisions are all it requires. ”The tips of the robotic arms behave like human wrists and allows us to do complex surgeries through tiny holes,” he said. The camera arm of the robot allows surgeons to see inside the body in 3D. The image of the internal organs — magnified up to 10 times in high definition — shows up on a screen at the surgeon’s console. Using hand and foot controls, the surgeon directs the robotic arms with the surgical tools to perform the required procedure.

“The camera acts as the eyes, while the instruments act as the arms of the surgeon,” said Srivastava, adding that the surgery is “very precise, the incisions are tiny, there is little trauma and the patient can return home in a day or two. There are less complications, less blood transfusion and it is cosmetically preferable”.

What about the cost?

The cost varies between Rs.60,000 and Rs.1.5 lakh (approx $1,000-$2,700), depending on the procedure, he says. ”It works out more expensive than the conventional surgery, but the benefits are huge because of all the advantages,” Srivastava said. He says the cost is due to the technology, as each machine costs about Rs.8-10 crore (approx $1.4-1.8 million), depending on the model.

He says that robotic surgeries abroad are “10 times more expensive”. Fortis has two robotic systems and the hospital performs cardiac, thoracic, urology, gynaecology, general, head and neck and orthopaedics procedures.

At AIIMS, robotic surgery is done in the field of urology, ENT cardiac, thoracic and in general surgery, says P.N. Dogra, professor and head of the Department of Urology, adding that the urology section gets around 130-140 patients every month. But AIIMS does not charge anything from general patients. “During the hospital stay, even the meal charge is not taken from some patients,” Dogra said. One major advantage of the robotic system, he says, is the “tremor filtration” in which the “unintentional movement of the doctor is not carried over to the patients during the operation as the doctors are behind the operation table monitoring the robot”.

Arvind Kumar, a former professor of surgery at AIIMS, who is now heading the Institute of Robotic Surgery at Sir Gangaram Hospital, says the hospital performed “Asia’ first vascular surgery” using the robotic system. Explaining the high costs, Kumar says the robotic technology is in evolution. “As its uses become more, the prices will crash, like in the case of mobiles,” Kumar told IANS.

Source: IANS

He was discharged at 9.30 p.m. and was accompanied home by his wife Jaya Bachchan.

The 69-year-old actor, who was admitted to the hospital Feb 11, was kept under observation following complaints of pain post the surgeries.

He was feeling restricted in his movements but kept his fans updated about his activities and progress through social networking mediums.

On Wednesday night, the veteran star shared his excitement over his freedom from tubes and needles.

He wants to spend his recovery time at home “in constructive learning and to acquire knowledge of matters still a mystery for me”, Big B posted on his blog bigb.bigadda.com

Source: IANS

The stone removed from the blader of Amlesh Kumar, a resident of south Delhi’s Sangam Vihar neighbourhood, weighs nearly 450 grams. ”Amlesh Kumar had been experiencing pain in his lower abdomen since the past 20 years. He initially ignored this occasional pain and took ayurvedic medicines without proper consultation,” said his doctor Manish Singla, senior consultant urologist at Delhi’s RG Stone Urology and Laparoscopy Hospital.

While consulting quacks and witch doctors, Amlesh Kumar, a plumber, used to take medicines which brought down pain.

“One morning, when the pain became excruciating and he found difficulty in passing urine, he rushed to a local hospital and then to the RG stone hospital,” the doctor said. 

Tests at the hospital showed he was suffering with a large stone in urinary bladder. 

“Given the size of the stone we opted to perform cystolithotomy instead of the usual minimally invasive procedures. The surgery lasted an hour and the patient is doing very well now,” the doctor said. 

Cystolithotomy is the surgical removal of bladder stones via a lower abdominal incision. 

Doctors from the hospital said that superstition and blind faith in witch doctors and quacks made cases of many other stone patients worse. 

“This is very unfortunate that in a city like Delhi, where there are ample of facilities available, people still overlook such problems until it escalates into something serious. Like in this case, the patient had been ignoring the ailment for 20 years and was relying on traditional medicines which were of no help,” said Baldev Raj, country head of the hospital.

“All this happens due to lack of awareness. Considering this, we have started a unique programme,” he said. 

Amlesh Kumar said he was misled into consulting the witch doctors. 

“I’m glad that I finally approached the hospital…I had lost all hopes of surviving when I came to know that the stone had become so large,” he said.

“I was continuously visiting tantriks because many people told me that it was a case of black magic,” he said. 

Raj added that the hospital was now planning to run an awareness campaign.

“We will run a medical van across villages of India to educate people about various urological disorders, give them free medical consultation and distribute awareness literature,” Raj said.

“This initiative will also help patients who cannot travel to the city to get their check-ups done. As part of corporate social responsibility, RG stone will provide free treatment to poor patients,” he said. 

Source: IANS

“There were some medical procedures today as well for — and this is being disclosed to the Ef (extended family) at this point of time — a surgery that I shall be undergoing on the 11th morning. I do not wish to talk much on my medical condition, but trust and faith in my FmXt (extended family) allows me to do so,” Amitabh wrote on his blog bigb.bigadda.com.

“The surgery they say is not too complicated, but then all doctors say the same as you end up on the operating table, and before long the details and the subsequent anxieties begin to rise. 

“There has been a dosage of injections intravenous that began today and shall continue for a few days… a pain in the abdomen has to be investigated tomorrow under a CT Scan and then and only then shall the ok for the surgery be given… so the next few weeks shall be full of nothing else but the hospital and medical bulletins… boring it may be but it shall be as informative as possible,” Amitabh posted.

The 69-year-old has been battling with health issues for long and wishes to have an ailment-free life, but says he is grateful that he is still going strong.

“My stomach which has already been the bed of many complicated battles in the past, shall have to entertain this as well. It’s a war zone, my body, and one which has been through a great deal and still does,” he wrote.

“I sometimes lament the fact that I do not have the benefit of a complete and ailment free body structure, and I wonder how wonderful it would be to be normal again. But this was my fate and I shall accept it with a smile. 

“I just feel blessed that despite all the encumbrances the Almighty gave me the courage to keep going has been undiluted. That courage, wrapped as it were, in the love and prayers of well wishers has pulled me through on several occasions and on this one too I solicit similar,” he added.

Source: IANS