First Remote Robotic Telesurgery on Human in India: A Milestone at World Laparoscopy Hospital

Aaradhya Sharma

https://www.laparoscopyhospital.com/SERV01.HTM  In the rapidly evolving field of medical technology, few achievements are as groundbreaking as the first remote telesurgery performed on a human in India by Mantra Robot. This historic event took place at the World Laparoscopy Hospital (WLH), marking a significant milestone in the realm of minimally invasive surgery and setting a new benchmark for the future of surgical care. For conducting this surgery permission was obtain by Clinical trial registry of India.  The Evolution of Telesurgery  Telesurgery, the ability to perform surgical procedures on a patient from a remote location, leverages advanced telecommunications technology and robotic systems. This innovative approach bridges the gap between patients and highly specialized surgical expertise, offering numerous benefits, especially in regions with limited access to advanced medical care.  The concept of telesurgery has been in development for decades, with significant progress made in the early 21st century. The introduction of robotic-assisted surgery, particularly the da Vinci Surgical System, revolutionized the field by providing surgeons with enhanced precision, flexibility, and control.  World Laparoscopy Hospital: A Pioneer in Minimally Invasive Surgery World Laparoscopy Hospital, located in Gurugram, India, has been at the forefront of laparoscopic and robotic surgery education and practice. Under the visionary leadership of Dr. R.K. Mishra, the hospital has established itself as a global center of excellence. It has trained thousands of surgeons from around the world in advanced minimally invasive techniques.  WLH's commitment to innovation and excellence made it the ideal setting for India's first remote telesurgery. The hospital's state-of-the-art facilities and experienced surgical team provided the necessary infrastructure and expertise to undertake this groundbreaking procedure.  The Historic Robotic Remote Telesurgery  The first remote telesurgery performed in India at WLH involved a highly complex procedure. Utilizing the Mantra Surgical System, the surgery was conducted by Dr. R.K. Mishra from a remote location, while the patient was situated in the operating room at WLH. The seamless integration of advanced robotic technology and high-speed internet connectivity ensured that the procedure was executed with utmost precision and efficiency.  The surgery was a success, demonstrating the immense potential of telesurgery in expanding access to high-quality surgical care. It also highlighted the capability of WLH to serve as a hub for cutting-edge surgical innovations.

Transcript

00:00Hello friends, this is a video of telesurgery and we are performing the robotic cholecystectomy.

00:11This surgery is performed remotely and this is the first telesurgery on the human

00:19in India. So we have taken the permission from the Indian clinical trial registry.

00:26Previously we have done it on the animal successfully and now we are doing telesurgery

00:35on human and here the main robot is in World Laparoscopic Hospital and we are performing

00:44it from Udyog Bihar and the robot is in Cyber City Gurgaon and our surgeon console is in Udyog

00:53Bihar that is the main office of the mantra robot. So this is the first surgery on the human which

01:00was performed in India and this is very successful and there was no latency at all

01:07and surgeries were performed nicely. So we can see this is cystic pedicle dissection.

01:13Left hand we have the robotic grasper and right hand has the bipolar Maryland.

01:19Mantra robot has a beautiful console and it's an open console so you have to wear the 3D glasses

01:28and the controller is also completely free so you can just take it in your hand

01:35and without any problem without any closed console you can perform it nicely.

01:39So we can see this is the posterior peritoneum which is separating and we are using the bipolar

01:48to make the dissection of the cystic duct and cystic artery.

01:53We can see in the left lower corner all the surgeons which is at World Laparoscopic Hospital

01:59they are just watching the surgery because it is performed remotely.

02:03So this is the first tele surgery on the human in India and we are very excited to see the result of

02:13this procedure. So we can see the cystic duct and cystic artery is nicely excretinized

02:20and then this is the interior window and this is the posterior window.

02:24U.S. Maryland has dissected both the window so Calot's critical view of the safety was identified

02:32and then we are applying the clip over the cystic duct.

02:36Because it is a mucosil of the gallbeder so initially we have aspirated

02:40so that's why you are seeing some mucus in the Calot's fossa

02:45and because it was fully distended and there is a large stone on the horseman's couch.

02:49The same teacher 35 year old man with the repeated history of the college cystitis.

02:56So we have applied the clip over the cystic duct and now this is the clip over the cystic artery.

03:04Again we have little bit applied bipolar also on the artery

03:09so that we will have 100% sure that there should not be any bleeding

03:13and the artery is coagulated. Here we have not applied the clip towards the gallbeder because it's

03:20already a mucosil of the gallbeder and there was no bile in the gallbeder only mucus.

03:27Now we are separating the cystic duct and cystic artery with the seizures.

03:32So this was very good and you know the surgery become uneventful without any problem. We can see

03:45in the world laparoscopy hospital all the surgeons are watching this surgery live and robotic arms are

03:53moving but we are not surgeon is not in the world laparoscopy hospital we did it surgery remotely to the

04:00internet connection. We can see this is in the left lower corner this is the Mantra office and by the side

04:08of me we have Dr. Sudhir Srivastava who is the CEO of Mantra robot. So in the world laparoscopy hospital here

04:19Dr. Bhalla is there who is already nicely scrubbed so that in case of any problems we will immediately

04:27take care and the patient should not have any complications. So I am at Mantra office and the

04:36patient is at world laparoscopy hospital. So we can see now almost cystic duct dissection is over

04:44now gallbeder is separating from the liver. This patient has grade 2 fatty liver. The liver was very bulky

04:53and heavy and heavy and little bit enlarged but it's a good plate and now it is almost separating because

05:00it was acute cholecystitis. So you have adimetous gallbeder but it is almost separated. So surgery has

05:08hardly taken 20 minutes time. Of course docking time has its own time and we did successfully this surgery.

05:17So this is the last part of the fundus part of the gallbeder. We are using monopolar seizures here

05:24and it is done. So this is very good and our experience was fantastic performing this daily surgery.

05:34So maybe in the future it will perform more remotely and will start performing from one state to another

05:41state. Hardly 5 ml blood was lost and now to extract the gallbeder. The local surgeon will put a claw

05:50forcep and it will be taken out because unfortunately robot cannot extract the specimen. So this is the

05:59long jaw agham forcep which is coming. Little bit stretching of the port is required

06:06and then gallbeder is out. This is a left hypochondric port through which gallbeder is taken out.

06:14And after that of course we will do the port closure and port closure also robot will not do. So local

06:21surgeon has to perform port closure. You can see it is dry there is no bleeding and we are using here

06:29cobblers needle to do port closure. So thank you very much for watching this video and it was the first

06:37daily surgery on human in India. So I hope in the future more and more surgery you will perform

06:45and it will change the scenario of tele-surgery. Thank you for watching.

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