Centre for Robotic Surgery – A dedicated Urology Centre in India

Posted on May 1, 2017 by admin

Centre for Robotic Surgery (CRS) is a dedicated urology centre in India that provides state-of-the-art medical facilities and surgical care in all aspects of urology. It’s a super specialty initiative set at Nadiad, Gujarat in India to serve patients with advanced technology. Urology is one of the most competitive areas for surgeons and India has made a significant mark in the eradication of urologic diseases. CRS stands in the second position amongst all urology hospitals in India that is completely devoted for providing treatment to patients suffering from any urological ailments.

Department of urology at CRS has a complete range of comprehensive facilities while managing the complex urological conditions of patients. The goal of CRS is to provide highest level of consistent patient care by using minimally invasive surgical techniques such as Da Vinci Si Robot. With this technique the surgical process is carried out with much precision, which was virtually unthinkable few years ago. Additionally there is screening, staging, and other up to date facilities that is able to locate any urologic disorder at kidney, bladder, and prostate and operate on it accordingly.

The advanced minimally invasive surgery at CRS has proved very advantageous for doctors and patients alike. It has been highly beneficial because there is less surgical complication as very small incision is done and the disease can be easily controlled. Besides the pain & scaring is relatively less, blood loss is very low, and the chances of infection are negligible, thus resulting in faster recovery for patients at comparatively less expense. The entire recuperation process post surgery has become less stressful.

CRS aims to bring world-class medical care within the reach of a common man with the help of technology. Over the years, it has been instrumental in providing clinical services for Urology & Nephrology. Further, the doctors at CRS have a rich global exposure and experience of taking care of patients of various backgrounds. The hospital has extraordinary outpatient services, including proper consultation for all treatment process. Be it nurse, paramedics, and managerial staff – everyone is adequately involved in patient care. We can say the CRS is pioneering its steps extensively to heal urological diseases.

How Robotic Surgery is Done

Posted on May 1, 2017 by admin

Robotic Surgeries are advanced version of laparoscopic Surgeries. In compared to open surgeries, laparoscopic surgeries are advanced and less invasive. But laparoscopic surgery has its own limitations. It is very effective for normal routine procedures but when there are more complex surgeries involved; option of laparoscopic surgery is not feasible. In such surgeries, greater precision is required and it is only possible by the most advanced robotic surgeries.

In cases such as radical prostatectomy, the target (prostate) is delicate and tightly surrounded with the nerves affecting urinary control and sexual functions. Using the robots your surgeon has a better tool to spare surrounding nerves, which may enhance in recovery experience and clinical outcomes.

Robotic Surgery has added advantage such as:

Less Pain
Less Scarring
Less Blood Loss
Faster recovery to normal activities

At Centre for Robotic Surgery a super specialty initiative of Muljibhai Patel Urology Hospital, we use da Vinci Si® surgical system instruments for surgeries related to Nephro-Urology. We generally receive the comments that how will the surgery be made? Will there be a doctor available or only robots will perform the surgeries? Well, this article is written to clear those confusions. Let’s observe the picture given in fig (A).

Figure A: da Vinci Si® surgical instrument

In laparoscopic surgeries, several incisions are made and small camera and other instruments are inserted through them. This camera is connected with the visual output unit where surgeons can see inside view of the patients’ body.

In robotic surgery, the surgical instruments are hooked up to the machine, and surgeon sits at one console to operate them. Here high definition 3-D camera is inserted in patient’s body and the 3D display is shown on the screen. We call this entire setup as Robot. Here actual surgery is performed by doctors, but through mechanical arms. In the above image, you can see

Surgeon’s Console – Surgeon sits here and operates robots. This console also has the video output from where surgeon can view the inner part of patient’s body.
Image Processing Equipment – It’s a video output to see the ongoing surgery to anesthesiologist, other doctors and nurse.
Endowrist Instruments – They are the human wrist like instruments to provide superior motion control, precision and fluid ambidexterity.
Surgical Arm Cart – They are robotic hands acts like human arms
Hi-Resolution 3-D Endoscope – It has high definition 3-D camera at its end which is inserted in to patient’s body through separate incision.

Now it’s an obvious question that what are the advantages of doing so?

Figure – B High Definition 3D Vision with Zooming

Above is the video snippet from Dr. Mahesh Desai who is current president of Endourology Society and Medical Director at Muljibhai Patel Urology Hospital, Nadiad. He describes the advantages in his video. To view click here.

Advantages of robotic surgeries are:

High Definition 3-D Vision: You are able to see target organ with much more clarity. The Zoom option shows the picture bigger and 3-D vision shows the depth.
Greater Precision: In laparoscopy, after long time the surgeon usually gets tired. This effect in tremors in his / her hands. Robotic arms solve this issue. It enables 360 degree moment which is not possible by human hand.
Quick Recovery: It requires very small incisions to operate through robots. Which is not the case with open surgery? This helps in fewer traumas, less pain and less loss of blood. Ultimately it results in to faster recovery.

A new era of tele-surgery:

Robotic surgery has opened new era of surgery. While human doctors will still perform common types of surgeries, robots will perform complex surgeries that are seemingly impossible even if attempted. The console is not attached with surgical arm-cart. That means surgeon can operate on patient. by sitting at distant place. In future, it will be possible for surgeon to sit in one country and operate a patient located at remote place.

The only point of consideration would be latency – that means there will a time delay in transmission of signals from one end to other end and vice versa. This will lead to delay in moment in surgeon’s hands and robotic hands. But it will be sorted out sooner with the use of technology. This will give birth to the concept of tele-surgery. It will also lead to modify international laws on surgery.

Technology is a boon to medicines. Robotic surgery is increasingly becoming popular. It takes a huge cost of investment and in training and development. Since the purchasing, installment and maintenance costs are very high, the surgery is comparatively costly. Day by day this surgery is becoming popular and sooner the cost associated will be lowered. It requires spreading awareness among people and erasing the myths for traditional thinking of “Robots”.

Source: How Stuff works

Advantages of Robotic Surgery

Posted on May 1, 2017 by admin

Benefits of Robotic Surgery for Prostate (Prostatectomy) Cancer

Posted on May 1, 2017 by admin

“Robotic Surgery“ has revolutionized the medical field by storm. This surgery is gaining immense popularity for prostatectomy, hysterectomy, and heart related diseases. It is a minimally invasive surgery performed by a robot, wherein the systems are controlled by the surgeon and his/her movement’s are translated in the computer and further carried out by the robot on patients. Here, the robotic arms are attached to long instruments and are placed through small keyhole openings in the patient’s abdomen instead of the surgeon’s hands.

Though, the robot performs the operation but the entire process is actually controlled by the surgeon, which includes handling the forceps with the help of ‘master control’. The surgeon monitors the robot’s work and every movement step by step. Da Vinci Surgical System – state-of-the-art technology is used for this surgery.

Why is Robotic Surgery gaining popularity to cure prostate cancer?

Basically, prostate cancer is a malignant tumor forming in the small outer part of the masculine gland. It usually happens when the prostate cells grow without any control and invades nearby tissues to spread rapidly throughout the body. Usually if the disease is detected at an early stage it’s curable but if it’s not detected and treated on time then it can prove futile.

The reason why “robotic surgery for prostate cancer“ is gaining popularity is due to its high level of precision during operation compared to traditional surgeries. Robotic Prostatectomy removes the entire prostate, which involves taking out all the prostatic tissue and lymph nodes. After completion of the surgery the patient can go through Prostate-specific antigen (PSA), where the results for any disease will show negative as the cancer gets eliminated completely due to this low-dose radiation.

Besides there are numerous other potential benefits of Robotic Prostatectomy over traditional (open) prostate surgery, this includes:

Small incisions
Very low amount of blood loss
Faster recovery
Less expensive and shorter period of stay in hospital
Minimal pain
Less risk of infection & scarring
Better erectile function

Moreover, the best part of this surgery is that the patient’s life won’t change very drastically due to it and they will be able to return back to their normal life as soon as possible. It’s indeed amazing that how this technology has expanded with leaps & bounds to completely eradicate certain urological diseases like prostate cancer.

Treatments Related to Various Stages of Prostate Cancer

Posted on May 1, 2017May 1, 2017 by admin

Prostate cancer is a form of cancer that grows in the prostate, a gland in the male reproductive system. Prostate cancer is most common in the developed world with cumulative rates in the developing world and it is the sixth leading cause of cancer among men globally.

Based on the three factors such as TNM stage, PSA and Gleason score, the patients are classified into high, intermediate and low risk groups. The low risk patients are usually treated with radical prostatectomy or radiotherapy alone.

Patients who are classified in intermediate risk disease are usually treated with radiotherapy and a short duration (less than 6 months) of hormonal therapy. It depends upon surgeon’s decision to prefer for robotic radical prostatectomy or not. Although the role of surgery in these patients remain uncertain, and the patient with high risk disease are usually treated with radiotherapy and a long duration of hormonal ablation. Many high risk patients are not cured by this treatment.

Stages of Prostate Cancer Using TNM System:

Prostate cancer is staged using the TNM system. This is used all over the world. It separately assesses the tumor (T), lymph nodes (N) and secondary cancer (metastases – M).

T – For tumor — describes the size of the main area of prostate cancer.
N – For nodes — describes whether cancer has spread to any lymph nodes and to what extent.
M – For metastasis — means distant spread of prostate, for example, to the bones or liver.

Different Stages of Prostate Cancer:

There are four Stages of Prostate Cancer that we have discussed it below. Following are the different Stages along with their treatments.

Stage I

In stage I, cancer is found in the prostate only. The cancer is found by needle biopsy or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 10 and the Gleason score is 6 or lower. It is found in one-half or less of one lobe of the prostate. It cannot be felt during a digital rectal exam and is not visible by imaging. They usually grows very slowly and do not show any symptoms at the early stage. The cancer is very small and completely inside the prostate gland, which feels normal during a rectal examination.

Treatment:

Surgery to remove the prostate gland (called radical prostatectomy). Since it is too small, surgery is not preferred at this stage.
Watchful Waiting or Active Surveillance. In this therapy, the doctors closely watch the tumor to see if it causes any symptoms or it appears to be growing. Common test such as PSA is usually done in this method.
Radiation Therapy: It uses high frequency x-ray beam to kill prostate cancer cells or to refrain them from being divided and grow rapidly.

Stage II

In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. If it is not treated then it is likely to spread outside of prostate. If the patient is so elder or having more complex diseases or after watchful waiting there are no any significant increase in growth of cancer tumor, then in such cases

Radical Prostatectomy and Radiation Therapy are the preferred options. Stage II is divided into stage IIA and stage IIB.

In stage IIA, cancer:

The PSA level is lower than 20 but higher than 10 and the Gleason score is 6-7. It is found by needle biopsy or in a small amount of tissue during surgery for other reasons.

In stage IIB, cancer:

Such cancer is found in opposite sides of the prostate. The PSA can be any level and the Gleason score can range from 2 to 10. In some cases, the tumor has not spread outside the prostate and such tumors cannot be felt during a digital rectal exam and not visible by imaging. In such cases, the PSA level is 20 or higher and the Gleason score can range from 2 to 10.

Treatment:

Radiation therapy with ADT
Hormone Therapy: It is used to stop the production of testosterone and all androgens either temporarily or permanently. Prostate cancer grows when it is exposed in presence of testosterone, so this therapy is used to stop its production.
Radical prostatectomy and sometimes proceeded by hormonal therapy. In some cases the lymph nodes are removed.
Brachytherapy and external beam radiation combine. The radiation theraphy also includes follow up of hormone therapy.

Stage III

In this stage, the cancerous cell has significant growth. Cancer tumor has spread beyond the prostate gland but not has reached to bladder, lymph nodes, rectum or any other organs. Some times for elders doctors prefer to go for watchful waiting stage. This is preferred only if patient is having many sever complications or other illness.

The PSA can be any level and the Gleason score can range from 2 to 10.

Treatment:

External beam radiation plus hormone therapy
Radical prostatectomy in selected cases. Many times pelvic lymph nodes are also removed. Radiation therapy may be followed after this surgery.
In some cased only hormone therapy is preferred.

Stage IV

This is the final stage of the cancer and usually it is not curable. It has grown into the bladder or rectum, or has spread to the lymph nodes or another part of the body. It may spread to the bones, liver or lungs type of distant places. In this case, removing any part of the body will not solve the problem. It is preferred to wait and watch for the elder person.

Treatment:

Hormone therapy
Chemotherapy
External beam radiation plus hormone therapy (in selected cases)
Surgery such as TURP which helps in reducing symptoms such as bleeding
Some reliving treatments are also done to reduce symptoms such as bone pain.

We have discussed here different stages of prostate cancer along with their Prostate Cancer Treatment.

For more information you can visit our website: http://www.mpuh.org/centreforroboticsurgery/

Why You Should Opt For Robotic Radical Prostatectomy

Posted on May 1, 2017 by admin

Radical Prostatectomy is the operation done to remove the prostate gland and nearby tissue in order to remove prostate cancer. Earlier, the prostatectomies were done using open surgeries, but with the modern advances in the field of surgery, laparoscopic surgeries (also known as minimally invasive surgeries or keyhole surgeries) have become the more preferred and common type. And even though there always are certain risks involved when it comes to surgery, for prostate cancer surgery turns out to be the most effective type of treatment as it removes malignant tumors without producing the painful side effects of radiation therapy or chemotherapy.

During the last decade, robot-assisted prostatectomy procedures have vastly outnumbered the open radical prostatectomy surgeries. In fact,according to a study conducted in 2013, robot-assisted prostatectomies accounted for around 85% of all radical prostatectomies (compared to just 22% in 2003).

Here are some of the main reasons why both surgeons and patients prefer robotic surgery for prostate cancer over the open surgeries.

Benefits of Robot Assisted Radical Prostatectomy

Some of the most notable advantages of robotic prostate cancer surgery include:

Better Results

Robotic surgical systems like the da Vinci system (also used at Centre for Robotic Surgery), are known to provide better clinical results for prostate cancer surgery as compared to other traditional procedures. This is since such a robotic surgical system offers the surgeon with more degrees of freedom than a human hand and magnified 3-D image of the ongoing procedure, as well as enables the surgeon to make much more precise movements inside the incision than they ever could on their own.

As a result, the efficiency and ease of robotic radical prostatectomy is far higher compared to non-robotic surgeries, and it also reduces damage to the healthy tissue and scar tissue build up. Therefore, the overall clinical results are far superior in a robotic prostatectomy.

Lesser Complications

While any prostatectomy is not completely safe, the risk of complications is much less in a robot-assisted radical prostatectomy than in other types. The development of infection at the incision site, which is a primary cause of delayed recovery, is more common with open surgeries compared to robotic.

The surgical systems such as the da Vinci surgical system requires only four to five incision which are smaller than two inches; while other traditional open surgeries require bigger, six-to-eight inch incisions instead. As a result, the chances of post-operative infections are much higher in non-robotic surgeries.

Quicker Recovery

The use of robotic surgical systems has many benefits, chief of those being smaller incisions, less number of sutures, more effective removal of cancerous tissue, less damage to the healthy tissue, minimal bleeding, and reduced contact between the incision walls and the surgical instruments. All these benefits translate directly into a speedier and more hassle-free post prostatectomy recovery of the patient.

Minimum Scarring

Apart from the obvious aesthetic benefit, minimum scarring caused by robotic surgeries also ensures better healing. This is because in certain rare cases, open surgeries can lead to excess scar-tissue build up, which can affect the normal functioning of the prostate.

And therefore, among the various prostate cancer treatment options, robotic radical prostatectomy has fast become a top choice for both doctors and patients. To learn more about prostate cancer, outcomes of robotic prostatectomy, post-operative care, etc., click here.

Robotic Surgery is the Best Option for Kidney Treatment

Posted on May 1, 2017 by admin

21st century has seen a boom in the medical industry with several new technologies being invented to treat complicated diseases. Da Vinci robot assisted surgery being one of them. This type of surgery has proved advantageous for both surgeons and patients for the treatment of numerous complicated diseases, including kidney related surgeries.

Kidneys play an important role in the functioning of human body system. We all know that they are two small bean-shaped organs located behind the abdomen and above the waist. Its main role is in processing blood, regulating blood pressure, maintaining calcium levels, and removing wastes, toxic substances, and excess fluids from the body. Kidney related disorders include:

• Bladder Problems
• Ureter Blockage
• Kidney Cancer and
• Kidney stones

In case when both the kidneys get damaged, “kidney transplantation” takes place.

With the help of robotic surgery the doctors are able to conduct operation with much precision that was never before possible earlier. The Da Vinci Surgical System is the state-of-the-art technology helping doctors to provide several benefits concerning kidney surgery, including less complication during operation, controlling of kidney cancer, less pain & scarring, relatively low blood loss, low risk of infection, faster recovery, and comparatively less expense because stay in hospital is much shorter.

The pencil-thin four arms of robot holing camera in one hand and surgical instruments in other three are able to operate through a patient’s body in such a precise manner compared to traditional open surgery that it is helping surgeons to gain expertise in kidney or kind of urological surgeries like never before. Though the robot is performing the operation but actually it’s the surgeon who is in total control of the machine. Sitting behind the console, the surgeon provides instruction to the robot to move its arms for conducting the operation and its every move is monitored thoroughly. A well trained person is required to provide instructions to the robot but overall the Da Vinci assisted Robotic Surgery has made the operation of complicated diseases much easier.

So it’s advisable that if a patient is suffering from a complex kidney ailment then he/she should opt for Robotic Surgery, as this will help them to return back to the day-to-day activities of their life in a faster manner.

Symptoms of Kidney Failure

Posted on May 1, 2017 by admin

People suffering from Chronic Kidney Diseases suffer from a very subtle symptoms which often go unnoticed. The time period between Chronic Kidney Disease (CKD) and Kidney failure is undetermined. It may take years and also may happen soon, depending on case-to-case basis. Kidney failures can be determined with early stage symptoms which are necessary to be identified. Let us discuss the symptoms of kidney failures:

• The beginning is often asymptomatic which means there would be a very less amount of visible symptoms but as the disease advances the kidneys would be unable to regulate water, balance the electrolytes, remove the waste from the body, and produce red blood cells. Such a person would often undergo Lethargic behavior, uneasiness, weakness, short of breath, and general swelling.

• The body would be unable to manufacture bicarbonate due to which the body acidity increases. It is known as metabolic acidosis. Such body dysfunction would alter the enzyme and oxygen metabolism which would end with an organ failure.

• Kidney would not be able to excrete the potassium from the body thereby increasing its level in the serum and it causes fatal heart rhythm disturbance.

• Urea level rises in the blood and it affects various body organs like brain, heart, muscles and would also be responsible for low calcium levels in the body.

• Weakness may be due to anemia but in certain cases the red blood cell counts starts decreasing due to the lower level of erythropoietin which is caused due to the kidney failure. It reduces the oxygen carrying capacity of the blood and hence the body gets tired very soon.

• Loss of appetite and fatigue becomes regular and if it continues, it may affect the mental balance which may end up in comma.
• Rising blood pressure due to excess of fluid present in the body is another symptom for kidney failure and the fluid may start to deposit on lungs which ends with heart failure.

The symptoms of kidney failure would vary a lot depending on patient to patient and also it depends on what kind of treatment you undergo.

Test required to diagnose the Kidney Failure

• Kidney failures can be diagnosed with blood test. The buildup of waste product would determine the kidney failures. BUN, GFR, and Creatinine are essential factors to determine the condition of kidneys. When the BUN and Creatinine level rises up in the blood and the GFR level decreases, the kidney failure is confirmed. The above mentioned three factors determines the rate with which the blood is filtered through the kidneys. The rate would always differ depending on the age, gender, and race of the person.

• Urine can be used to determine the Kidney failure. With a urine test, the doctor would measure the amount of protein and the presence of abnormal cells in it. If protein is found in the urine, it points towards something abnormal in the body. Abnormally aggregated red and white blood cells in the kidney denotes the presence of Kidney Disease.

• Abdominal Ultrasound test can determine the size of the kidney. If any obstruction is seen in he reports, it denotes presence of Kidney Disease.

Robotic Nephrectomy – Advancement in Laparoscopic Surgery

Posted on May 1, 2017May 1, 2017 by admin

Kidneys are the essential part of human body which helps to purify the blood. It extracts the wastes from the blood and acts as a natural filter, the wastes are diverted to the urinary bladder and the purified blood is diverted towards heart. Bean shaped kidneys are located on each side of lower back of human body. The left kidney is slightly larger than the right one.

Kidney cancer is somewhat more common in men and is usually diagnosed between the ages of 50 and 70 years. The reason of kidney cancer is unidentified, although it may be connected to numerous risk factors such as smoking, obesity, workplace exposure to chemicals, high blood pressure. Every year, kidney cancer is analyzed about 190,000 people worldwide.

It is important to realize that with early diagnosis and treatment, kidney cancer can be cured. In fact, the survival rate ranges from 79 to 100 percent. Treatment of maximum kidney cancers starts with exclusion of the primary tumor in an operation called a nephrectomy. The main reason of surgery is to remove the primary tumor and complex tissue in the kidney. Even if cancer has already circulate, a nephrectomy might still be helpful because the body then have fewer cancerous cells to fight through treatments that doctors prescribed after surgery.

Kidney Cancer does not have an early symptom but now before consulting the doctor one can observe the symptoms of cancer by his own.

Followings are possible symptoms:
• Blood in urine
• Lump in your abdomen or side
• Unexplained weight loss
• Pain in your side that doesn’t go away
• Loss of appetite
• Extreme fatigue
• Anemia

Kidney cancer that propagates to other parts of our body may create other symptoms, like:
• Shortness of breath
• Coughing up blood
• Bone pain

Some of the Causes & Risk Factors for Kidney Cancer are as follows.

Investigators have found numerous risk factors that make you more likely to grow kidney cancer. The following are some of the risk factors for developing kidney cancer:
• Smoking
• Hypertension
• Having certain hereditary conditions, such as von Hippel-Lindau (VHL) disease or inherited papillary renal cell carcinoma.
• Obesity
• Family history of kidney cancer
• Chronic kidney dialysis and/or failure
• Tuberous sclerosis (common genetic condition that produces growths in the body from birth throughout adulthood)
• Using certain pain medications for a long time.

Some of the basic Treatments for the Kidney Cancer are as follows:
• The primary treatment option for kidney cancer is to remove all or part of the kidney and the tumor.
• In many cases, there is a possibility that only some part of the kidney is affected, hence removal of cancerous part serves the purpose. Such type of surgery is called Partial Nephrectomy.
• Kidney cancer that persists and propagate to other parts of the body might not be treatable, but may be controlled with treatment
• Kidney cancer does not respond well to radiation and chemotherapy treatments.

It is advisable for patients to consult a doctor first and then decide the treatment, since treatment is dependent upon patient’s characteristics. Information provided over here is for the reference purpose only.

Why to choose Robotic Surgery:
Kidney treatment is possible by Open Surgery or Laparoscopic surgery. In open surgery, the doctors make a big scar and then perform the operation. This result in heavy blood loss and more complications.

The preferable way to open surgery is laparoscopic surgery, where tiny cuts are made by the surgeons. This surgery provides faster recovery and comparatively less complications.

The advancement to laparoscopic surgery is Robotic Kidney Surgery, where similar number of cuts is made. But in this surgery, the surgeon sits at one end and operates the robots. The robotic hands can move 360 degree and the High Definition camera provides 3D view. This helps surgeon to analyze the depth and helps him to make surgery easier.

The benefits of Robotic Kidney Surgery are:
• Excellent clinical outcomes and cancer control
• Quicker return to normal activity
• Shorter hospitalization – most go home the next day
• Less scarring than traditional open surgery
• Less blood loss
• Reduced pain – most patients don’t even need narcotics after surgery
• Fewer complications and less risk of infection
• Excellent chance of preserving the kidney, in certain operations

For more information you can visit: About Robotic Kidney Surgery

Da Vinci Robotic Surgery in India (An experience)

Posted on April 30, 2017 by admin

Advanced science and technology is a boon in the medical field. Major changes and inventions in medicines and surgical instruments have really ensured that people don’t succumb to deadly diseases any more.

One of the latest feats in the healthcare sector is Robotic Surgery, which is slowly gaining its popularity worldwide. Whether its cardiac related problems, kidney or urological diseases – Da Vinci Robot assisted Surgery has become an answer to all complicated surgeries in present time. Continue reading “Da Vinci Robotic Surgery in India (An experience)” →