On 5th December, Dr Tejas M. Patel, Chairman and Chief Interventional Cardiologist at Ahmedabad’s Apex Heart Institute, achieved rare feat in the field of cardiovascular treatment. Sitting behind a console at the complex of the Akshardham temple in Gandhinagar, Dr Tejas successfully performed angioplasty on five patients who were some 32 kms away from him using the first-in-human telerobotic intervention. Edited excerpts from his interview with Neha Wagle:
As per our knowledge, you have performed about 300 robotic surgeries so far. How much time did it take to prepare for a full-fledged in-human telerobotic operation?
Animal study and stimulation was a totally different thing. On humans, we have performed 300 surgeries based out of robotic equipment and consoles which have been installed in our institutions. But recently, in Gandhinagar, we performed the first-in-human distant wireless telerobotic coronary intervention. Sitting 32kms away from my cath lab, patient and robot, with the help of console and Internet, we were able to give command to the robot to travel the wire, balloon, stands etc.
How different is the process from the robotic PCI?
There is a difference between robotic Percutaneous Coronary Intervention (PCI) and distant robotic PCI. In robotic PCI, we work sitting away from the patient at the cath lab in a hospital’s operation theatre. Sitting in front of the console, we give command to the robot and perform the operation. But, in case of this distant robotic PCI, we were 32 kms away from the robot, the cath lab and the patient. The coronary intervention was carried out giving command to the robot to perform operation using an Internet-enabled robotic arm at the cath lab in the operation theatre. We are proud to say that this is the first-in-human telerobotic intervention.
Can you elaborate us on the procedure of this operation?
Talking about the procedure, in the beginning, the cardiologist got the case details and planned a surgery based on the case’s complications and requirement. On the other hand, cath lab was equipped with a robotic arm connected to the online system as the patient was taken to the operation theatre. Later the cardiologist took position at the console with control of the robotic arm and screens displaying the heart up close. Another monitor displayed real-time vital stats of the patient. In the final stage, the cardiologist performed the surgery through robotic arm using controls on the console while doctors in the operation theatre kept the cardiologist updated.
Five patients located at the Apex Heart Institute in Ahmedabad had to undergo an elective PCI procedure from a distance of around 32 kms away. Each procedure was remotely performed from inside the Swaminarayan Akshardham temple located in Gandhinagar. All the five patients were with critical blocks and the procedures for all the patients were done in less than 10 minutes time. Overall, the experience was amazing!
With the successful execution of the first-in-human telerobotic intervention, we are now opening new avenues and this is going to change the global scenario of telerobotic interventions. A time will come when a patient in the most remote area will be treated using an Internet-enabled robotic arm at the cath lab in the operation theatre. Not only it is going to help the people with heart blocks, but will also impact on strokes which leads to major paralysis.
How robotic PCI is more beneficial in treating cardiology?
It will practically eliminate the distance between patient and the doctor. Imagine, after two to three years there is going to be a briefcase technology – a cardiologist will move around with the briefcase which will consist of a mini console and the cath lab which is equipped with a robot and Internet connectivity at both the ends to help doctors perform. This is exactly a transformation like telecom technology – from a telephone to a mobile device.
In recent years, what are the various trends you have observed while performing cardiac surgeries?
This operation was a ground-breaking research. The first coronary angiography was done by Dr Mason Sones in 1958 till then nobody knew how coronary can be cumulated. In 1977, Andreas Gruentzig, a cardiologist did first balloon angioplasty. Nobody ever thought that blocks in the coronary can be dealt without bypass surgery or without any cut inserting a balloon and carrying the operation successfully. When Dr Ulrich Sigwart did stenting in 1986 at Switzerland, nobody ever thought that this can be done. 1986 the first stenting was performed and that was the last innovation on the intervention front and following that after 30 years this is a telerobotic standing remaining from a distance the cardiologist has fixed a block. This is going to be written in the history. I am really very happy and proud that we are being instrumental to bring India’s name to be written in the history.