Robots cannot take over surgeries completely: Dr Ravi Shankar Shetty

By Rithu Dravid | NT

Bengaluru: Dr Ravi Shankar Shetty is the country’s leading cardiothoracic surgeon. He has performed more than 5,000 surgeries in the last 14 years. He currently heads the cardiac surgery unit at the M.S. Ramaiah Medical College & Hospital in Bengaluru. Dr Shetty specialises in minimally invasive cardiac surgery, aortic surgeries, valve repairs, congenital heart disease corrections, off-pump and CABGs (Coronary Artery Bypass Graft), ECLS (Extracorporeal Life Support), cardiac and renal transplant.

In this interview with News Trail, he delves into the different aspects of cardiac surgeries and how technology is changing it.

Edited excerpts from an interview.

NT: You have performed the first paediatric cardiac transplant in Karnataka. Can you elaborate on this?
Dr Shetty: The transplant was perfor med three years ago on 11-year-old Abhiman from Andhra Pradesh. He had a condition called dilated cardiomyopathy, where the heart is unable to pump blood. It is a genetic condition. His younger sister, aged 10, also has the same condition and has been waiting for a paediatric heart transplant for more than a year-and-a-half, as there are no donors. In a paediatric heart transplant it is difficult to get heart donors. We cannot place an adult heart in a child even if the blood group is the same. The chest cavity is smaller in children and too big a heart will cause post-operative issues. There could be bleeding in the brain too.

How can these surgeries be made affordable to the common man?
With the innovative healthcare delivery models that lower costs, improve quality, and increase access to services are helping the patients. Innovative schemes, such as micro-insurance, telemedicine and schemes for below poverty line patients, have benefited the poor patients too. These card holders can avail it free of cost irrespective of all forms of surgeries. We have performed more than 15 heart transplants in these BPL patients.

What is minimally invasive cardiac surgery? What are the risks? Does it improve the quality-of-life?
This type of cardiac surgery has been in existence for the last 10 years world over, but not all cardiac surgeries are performed using the minimally invasive method. Although the heart surgery part will be the same, the main difference lies in the opening in the chest wall or the access to the heart. Normally the bone called the sternum in the middle of the chest is cut open and accessed to the heart. But the minimally invasive method can have access to the heart through the left or the right side of the heart depending on the surgery. This minimally invasive cardiac surgery should be restricted and tailored to very few patients as there could be an increased risk. It may not be as optimal as the open heart surgeries, which have been there for over 60 years and the outcomes have been very good. The minimally invasive cardiac surgery is new and it is evolving.

How can technology be used as a vehicle to deliver healthcare?
Robotic systems enhance precision, flexibility and control during the surgery and allow doctors to see the site better, compared with traditional techniques. Thanks to the advancement in technology, we see fewer complications, such as surgical site infections, and blood loss. What do you think of the future of cardiac surgery? Will robotic surgeries replace doctors? Robotic surgery is a method to perform surgery using very small tools attached to a robotic arm. The surgeon controls the robotic arm with a computer. Robots cannot take over surgeries completely. It is just a robot-assisted surgery. Robotic surgeries are still in the early stages in India. The cost of these surgeries is Rs 15 lakhs as compared to a bypass surgery that would cost Rs 3 lakhs. More non invasive techniques , such as valve replacements have replaced old operative procedures.

How many surgeries are performed on an average in a month at the MS Ramaiah Narayana Heart Center?
At the M S Ramaiah Narayana Heart Center, we have performed the highest number of heart transplants in Karnataka in the last six to seven years. We have done 43 heart transplants in the last six years besides conducting the first pediatric heart transplant in the State. The team also did the highest number of temporary heart circulated support device surgery or the ventricular support device surgery. In case of a sudden heart attack, the normal treatment cannot involve a surgery or a placement of a stent as it will cause damage to the heart and then the heart needs to be supported for some time with a machine that acts like an artificial heart. We have all the latest machines in place at our cardiac unit. Surgical deaths are very few unless the patient has comorbidities.