“Technology is definitely the way forward” – Dr. Ramakant Panda
Dr. Ramakant Panda
Good afternoon. I think it’s better to discuss things that are changing the face of medicine and heart disease and therefore I chose this as the topic of my talk today.
In our college days, when I saw Captain Kirk holding a mobile phone, it seemed like science fiction. Within 10 years, in 1994, mobile phones became a reality.
The same thought applies to medicine, considering the way it’s changing. What we consider science fiction today will be a reality 20 years down the line.Recently, I was reading an article that shocked me. It said that the future of medicine and surgery does not lie in the guts of the surgeon, how brave the surgeon is, how intelligent the surgeon is or how innovative the surgeon is.The future of medicine is dependent on the way technology is changing our lives, which in turn is going to change the way we practise medicine.
Unfortunately, the penetration as well as the application of information technology — though it is changing our life — is minimal in the sphere of health care. I think health care is the next frontier where information technology is going to make a significant difference and change the way we are practising medicine and the way we are treating people. I feel that this development is definitely going to be for the better.
I clearly remember, in my medical school days, the Dean of my medical college — who happened to be the father of a close friend — wanted to get an angiography. In those days, there were only two places in India which would do an angiography, All India Institute, Vellore and maybe K. M. Hospital. This was in 1977. So, he flew to Chicago to get an angiogram done. Today, an angiogram is performed at every street corner. People get an angiogram done and go home within two hours, and it is 99.99 per cent safe. That’s the kind of change that has taken place in the last 20 years.
Similarly, in cardiac surgery, we used to take everything from the leg to do a bypass. We soon realised that within 10 years, this leads to blockages. Shortly, new technology came along, called total arterial grafting, where the inside arteries and hand arteries are used to do the bypass. The arterial graft works for longer than the one where you draw from the leg. Today 99 per cent doctors use an arterial graft.
The next innovation that has taken place in the last 10–15 years is to do surgery with a keyhole, which is a very tiny hole made with a small incision. Earlier, a cut that was 8–10 inches had to be made; with the new technology,The next innovation I am going to talk about is the robot.There’s a common misconception that we’re the first one in the country to bring the most advanced robot. We brought a robot to the Asian Heart Institute around two years ago. The advantage of robotic surgery,is that you do the entire surgery through a keyhole incision. People feel when the robot is operating, what happens if the robot makes a mistake, takes control or doesn’t listen to the surgeon? It doesn’t work that way. Currently, robots are under the control of surgeons.The moment the surgeon stops, the robot stops. He’s basically an extension of the arm of the surgeon, nothing more.
Robotic surgery came up as an off-shoot of the space programme. It was a result of the thought: What would happen in case an astronaut needs surgery in space? Who is going to operate?
You can now operate on astronauts from earth. Here, the surgeon sits 20 feet away from the patient in a console. The surgical instruments are moved around inside the patient’s body, through the console. The big advantage is that the patient doesn’t need blood transfusion, as there are only onecentimetre keyholes. The patient can go home in 2–3 days and go back to work in 5–6 days.
Today, there is extensive robotic application in kidney surgery, urology, prostate surgery. Almost 80 per cent of the surgery in USA today is done robotically. Trainees in most medical programmes want a robot to practise on. This is the way things are changing and I think in the next 10–20 years, a majority of surgery will be done through robots.
The other important thing coming up is merging specialities. So far, cardiac surgeons and cardiologists have been working separately. Surgeons cut open and perform surgery and the cardiologists put in the catheter. If you combine both, one can provide much better treatment to the patient. As a result, hybrid surgery is coming in, where you combine angioplasty surgery and do a stent or valve replacement. Currently,cath labs are changing into a hybrid switch, which is a combination of an operation theatre and a cath lab. For valve replacement, you have to make a 4- or 8-inch incision. Technology has already come into place where you can do it through the groin. You just make a small cut in the groin and put a valve through it. Already 60,000 of these valves have been replaced worldwide.Unfortunately, in India, because of the policy paralysis in the last few years, the government has taken the decision to not allow it in India. However, for selected cases, we are performing it with prior permission from the government. I am hoping that in the next six months to a year, this will be a common procedure for valve replacement. Especially for the aortic valve, you don’t need to go through major surgery; you can just go and get it done through the groin and be home in two or three days.
These are some of the innovations taking place. The other one is the artificial heart. Again, the heart is conceptually one of the easiest organs to replace artificially. It’s less complex than the kidney or liver, but unfortunately, the major problem to charge it for power; you need to be connected to a power source. Therefore, there is a cable running from the patient to the power source. You can keep the patient alive for 2–3 years, and during that time if the heart recovers, you can take the artificial one out or you can do a heart transplant.
The next innovation is called the total artificial heart, where the batteries can be charged transcutaneously. You don’t need to connect to a power source to charge. The patient can go to a room that is fully magnetised, through which the power can be transferred to the battery and the patient can lead a normal life. It is similar to when pacemakers were introduced. Twenty-thirty years ago, the pacemaker was a big thing.Today you can get a pacemaker with local anaesthesia and be back home within 2–3 days. The total artificial heart is also going to be a similar innovation in the next 5–10 years. In the next 3–4 years, a totally implantable artificial heart will be available, where the person can go in with a very bad heart, get a replacement and subsequently charge it as and when required.
The other technology that is coming up is the combination of an MRI, angiogram as well as CT Scan. Three-dimensional images are combined and we have a virtual image where the surgeon can practise. The current robot we have at Asian Heart, has got a simulator, where trainers and trainees can practice just like airline pilots practice on auto pilot, so that when the doctor goes and operates on the patients, the chances of complications are fewer.
Nanorobotics helps you identify a tissue or heart with a block and helps clean it up with minimal invasion. Another advancement of robotic surgery is where the surgeon can operate from anywhere in the world, through telesurgery, similar to robotic surgery. The technology is still being developed. It will take another 5–10 years to be able to use this, primarily due to slow internet speeds. However, once the technology is developed, a surgeon in Mumbai will be able to operate on a patient in Delhi.The advantage of expertise will be available to all. Also, people in remote areas will have access to superior quality of health care, despite their geographic location.
The other change taking place is a complete change of the operation theatre, where a lot of electronics and robotics are coming into play. Nurses and assistants can be replaced within 5–10 years by these machines as the prototypes are currently under testing.
Another development at Asian Heart is that patients can use iPhones and other smart-phones to transmit information to doctors.This, along with other health care mobile applications, will transform the sector in a positive manner. Also in the pipeline, is a small device in the patient’s house, which when placed on his/ her heart in case of chest pain, will transmit the required data to Asian Heart, where the doctors can monitor the patient round the clock and prescribe treatment.
Stem cell research has been going on for many years but there is no clarity on how they can be used for treatment of a specific body part, say the heart, spine or brain. These knots are expected to ease out in the next 5–10 years and this method will revolutionise medical care to a great extent. A lot of progress can be made as the pumping of the heart can be significantly improved with a stem cell injection, thus preventing heart attacks.
Similarly, there is extensive research being carried out to improve the application of tissue, proteins and genes to treat patients.
Genome mapping has already been done to see all the areas that house genes esponsible for heart attacks. Also, it helps identify in a child the health risks that he or she may face later on in life at the age of 30 or 40 as far as heart problems are concerned. This prediction of health risks through gene mapping is excellent as the patient can then be advised regarding the preventive measures he or she needs to take to minimise risk.
Asian Heart is extremely involved with social causes and helping the less privileged. We would love to collaborate with the Rotary Club of Bombay and offer our services, if such a need ever arises.