First robotic assisted surgery aboard a hospital ship : A moment of triumph, all round | Sunday Observer

First robotic assisted surgery aboard a hospital ship : A moment of triumph, all round

20 May, 2018

Achieving another significant milestone in emergency preparedness and healthcare, USNS Mercy while docked in Trincomalee on its Pacific Partnership mission recorded the first robotic assisted surgery aboard a hospital ship, performing a cholecystectomy or gall bladder removal on a Sri Lankan patient.

A moment of many feelings. Elation, anticipation mixed with anxiety. It certainly was “a fantastic experience. Something my team and I will never forget,” says Dr. Vyramuthu Varanitharan, General Surgeon of Base Hospital, Muttur, happy to be part of a historic moment. For Varanitharan, it was a moment when his two year training in UK and robotic surgery training in France came to realization. A time for which he and Cmdr. Tamara Worlton, a surgeon from the Pacific Partnership mission had been training for, since USNS Mercy docked in Trincomalee. It was the first ever robot-assisted surgery on a live patient aboard a hospital ship.

U.S. Ambassador to Sri Lanka and the Maldives Atul Keshap opined that the “landmark surgery advances the boundaries of what is possible through collaboration, skill, and technology. We are proud to partner with Sri Lankan medical professionals on this ground-breaking achievement for the international medical field,” in a press release issued by the US Embassy, Colombo, on the occasion.

Intensive planning and preparation had been the precursor to the success of the surgery. In preparation for the actual surgery the two surgeons had had simulation exercises on a mock patient using the Da Vinci XI Surgical System aboard USNS Mercy. As a team, they had finalized surgical plans, supported by Lt. Cmdr. Kyle Gadbois, Director of Surgical Services of the mission. Smooth and routine surgery was the result of their effort, enabling the patient to be “discharged from the ship in excellent condition for routine post-operative follow up care by Dr. Varanitharan,” according to the press release.

The experience was “wonderful and unforgettable,” Varanitharan recalled during an exclusive interview with the Sunday Observer. While he was to perform the actual surgery, a team of four, consisting of the hospital Director, Senior House Officer and two nurses from Muttur Base Hospital accompanied him.

The surgery was assisted by a multinational team of medical professional.

The surgery was a one of a kind experience for this surgeon posted in one of the peripheral base hospitals, 275 kilometers away from Colombo.

Comparative to his current operating theatre, at the Base Hospital Muttur, “though some of the equipment and facilities were almost the same, the operating theatre at the hospital ship Mercy was high-tech, state-of-the-art, much like or even more advanced to those I was used to during my training in UK,” opined Varanitharan. Muttur being a Type B Base Hospital, takes 6th position in the hospital hierarchy of the country.

Though medical surgery had seen progress in leaps and bounds since the open surgery days of yesteryear, robotic or robot assisted surgery takes it to a much higher level, Varanitharan explained. “Once the patient was anaesthetized and the initial cut made, I moved away to the robotic work station. It was an enclosed area, which enabled focusing complete attention on the task at hand. It provided a three dimensional view inside the patient’s body. The Da Vinci XI robot had four robotic arms or ports. While one was operating the camera, the other three arms were dispensed for the surgeon’s use.

It was more of a virtual experience, where the surgeon would place his hands in the manoeuverable parts or rings of the work station and take command of the robotic arms to do his will.”

The beauty of this kind of surgery is the proximity of the camera and the clarity of pictures with improved details of the structure, paving the way to “fine and advanced surgery, minimizing accidental damage to other structures, bleeding and morbidity,” opined Varanitharan.

The patient, who underwent surgery had been one in the waiting list for gall bladder removal. Initially, many patients were reluctant to be operated by a foreign doctor, said Varanitharan. “They have had previous experience of being assisted by doctors from other countries.

However, as this was surgery, they were not very much willing to go ahead. Some of their questions depended on the sustainability of the treatment.

Who do they consult if something goes wrong, was one of the questions they had,” he explained. The patient had been one with a number of gall-stones and needed gall bladder removal. By agreeing to do the surgery at the hospital ship, “the patient advanced the surgery date by about two months,” commented Varanitharan, who is the only surgeon stationed at Muttur. “Here, my waiting list runs over 2 months.”

Pacific Partnership is the largest annual multinational disaster response preparedness mission conducted in the Indo-Pacific.

This year’s mission includes military and civilian personnel from the United States, Canada, United Kingdom, Australia, France, Peru, and Japan.

The mission during its stay in Sri Lanka carried out mobile medical clinics, building projects and various other community enhancement projects in the Trincomalee district. Year 2018 was the second consecutive year of the mission in Sri Lanka. 

Easy and less risky...

Information technology has helped many advances in medical surgery, and depicts a completely different scenario, from that of 50 years before. Abdominal surgery such as, cholecystectomy, or gall bladder removal has been made much easier, and less risky with these advancements.

Open Surgery

Open surgery was the order of the day many years ago. Whether a surgery was simple or major, the surgeon had to make a cut of about 6 to 12 inches. This gave the surgeon enough room to see what they were doing and enough access for the instruments etc. This was neither easy on the patient, nor on the surgeon. The risk of accidental damage was high.

Laparoscopic Surgery or Keyhole Surgery

Laparoscopic surgery brought open surgery to a higher plane, when surgery was assisted by a tiny video camera called a laparoscope. Instead of making long cuts on a patient’s body, this enabled surgeons to work with a few smaller cuts. One cut to insert the laparoscope or the camera and one or two others for the instruments that the surgeon used. There were many benefits in this kind of surgery as against open surgery.

· Smaller cuts were made in the body causing:

* Less pain for the patient

* Less risk of infection

* Less time spent in the hospital

* Less time for total healing

* Greater visibility of the area of surgery using the laparoscope assists precision

However, though it was easy on the patient, it wasn’t so on the surgeon. The camera as well as the surgeon needed to move constantly as the surgery progressed. Furthermore, the instruments were not made to enable much manoeuverability, therefore, surgeons needed to be extremely careful on accidental damage.

Robotic or Robot Assisted Surgery

This is a form of laparoscopic surgery. It is an advanced form, where human hands of the surgeon are replaced by robotic arms. This could even be less invasive, necessitating less cuts in the body. The robotic arms (usually four), are directed by a surgeon in the actual operation. While one arm operates the camera, two replace the surgeon’s hands and the other is used to gently move obstacles in the way of the surgery. As there is greater manoeuverability in robotic arms the process is less invasive and more accurate, minimizing accidental damage.

In addition to the benefits of laparoscopic surgery, robot assisted surgery benefits both the patient and the surgeon by:

* Increased precision of the surgery

* Reduced blood loss and transfusions

* Minimal scarring

* Less trauma on the patient’s body

* Reduced fatigue for the surgeon

=More manoeuverability for the surgeon