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Thursday, 21 December, 2023
When James (name changed), a 47-year-old man from Bengaluru arrived at the Emergency Room of Kauvery Hospitals, Electronic City, Bengaluru, he was struggling with breathlessness and mild chest discomfort for about two months. While these attacks were more pronounced during exerting physical activities, initially they weren’t severe. Also, there wasn’t any earlier trauma or surgery in his case.
Upon examination, he was found to have an organo-axial volvulus of the stomach which occurs when the stomach rotates about its longitudinal axis. Also, his small intestines and transverse colon had gone up in the left side of his chest. Further imaging revealed diaphragmatic eventration, a condition where the left hemidiaphragm - half of the diaphragm, the muscle separating the chest cavity from the abdomen and serving as the main muscle of respiration, was abnormally elevated. This ailment is very rare, affecting less than 0.05% of the population, and can lead to severe respiratory distress if left untreated.
James underwent a unique robotic procedure - Diaphragmatic Eventration – Robotic Plication with Gastropexy, under the expertise of Dr. Sreedhara. This surgery involved the removal of the affected portion of the diaphragm and suturing to make it taut. Additionally, gastropexy, which involves suturing the stomach to the abdominal wall, was performed. This innovative approach facilitated a smoother recovery, and James, after an uneventful postoperative period, returned to his daily routine within 10 days.
Speaking about the complex condition, Dr. Sreedhara, said: “Diaphragmatic eventration, whether congenital or acquired, can be debilitating, but our tailored robotic surgery offers an effective solution, enhancing the quality of life for patients like James.”
Not just James, Basudha (name changed), 58, from Bhubaneswar, and Raj (name changed), a 27-year-old IT professional from Tamil Nadu also experienced the wonders of robotic surgery and the skill-driven magic of Dr. Sreedhara to get back to a healthier life.
Imagine living with a protruding mass during passing stools for over 30 years. This was the reality for Basudha, who complained about bleeding from rectum, frequent bowel movements, and tenesmus, the feeling that one needs to pass stools, even though their bowels are already empty, involving straining, pain, and cramping.
Upon examination, Basudha was diagnosed with a complete prolapsed rectum, extending 12 cm. This happens when part of the large intestine's lowest section, the rectum, slips outside the anus.
“Traditional treatments often come with complications and high recurrence rates, making surgical intervention essential. Our patient underwent a robotic posterior mesh rectopexy, a procedure that involves the use of advanced technology to address the issue. The postoperative period was smooth, and the patient was discharged after 48 hours. Rectal prolapse, though not always an emergency, significantly impacts one's life. Our robotic approach provides a precise and effective solution, minimising postoperative complications and improving patient outcomes,” added Dr. Sreedhara.
Raj, on the other hand, was struggling with severe reflux esophagitis - a condition in which the stomach contents reflux into the oesophagus or beyond - oral cavity, larynx, or the lungs, despite being on high-dose PPI (Proton Pump Inhibitor) Drugs for over three years. His condition not only affected his physical health but also took a toll on his emotional well-being and social life.
After thorough evaluation, including gastroduodenoscopy and 24-hour pH monitoring, Raj underwent Robotic Toupet’s Fundoplication with the closure of the hiatal hernia defect. Remarkably, he started a liquid diet on the same day as the surgery and was discharged after just 24 hours.
Highlighting the efficacy of robotic surgeries in treating GERD, Dr. Sreedhara said: “Gastroesophageal Reflux Disease (GERD) is a common ailment, but when standard treatments fail, our robotic surgery, with its precision and reduced postoperative time, proves to be a transformative solution. It not only alleviates symptoms but also restores a patient's overall well-being.”
The aforementioned three procedures were a part of 100 successful robotic gastrointestinal (GI) surgeries that Dr. Sreedhara, a seasoned laparoscopic surgeon with over 20 years of experience, has successfully completed in just 95 days. With this groundbreaking achievement, Dr. Sreedhara became the first doctor in the country and the second doctor in Asia to complete an astounding 100 robotic surgeries in an impressive 95 days. He achieved this milestone as the Head of the Department of Surgical Gastroenterology & General Surgery at Kauvery Hospital, Electronic City, Bengaluru. Also, he has been recognised as a Proctor in General Surgery for Intuitive, showcasing expertise in robotic surgery. He holds the privilege of training and certifying fellow surgeons, contributing to the expansion of robotic surgical skills.
This extraordinary feat not only showcases his exceptional skills but also highlights the rapid advancements in robotic surgery technology in India.
Bringing A Vision to Life
Dr. Sreedhara's foray into robotic surgery was not merely a professional decision but a pursuit of excellence in patient care. With two decades of laparoscopic surgery expertise, he recognised the potential of robotic technology to revolutionise the field, offering patients a more precise, minimally invasive, and efficient surgical experience.
Overcoming Hurdles and Riding Through Difficulties
Transitioning to robotic surgery was not without its challenges. Dr. Sreedhara faced resistance and scepticism within the medical community and among patients. “The key challenge was to overcome the prevailing mindset that laparoscopy, a well-established technique, was sufficient. To address this, I actively engaged in educating and creating awareness among colleagues, hospital staff, and patients about the benefits of robotic surgery,” said Dr. Sreedhara.
To overcome resistance, Dr. Sreedhara adopted a multifaceted approach. He organised hands-on sessions, allowing hospital staff to experience the robotic system directly. He also reached out to referral doctors, explaining the additional value and benefits of robotic surgery. Over time, this concerted effort started yielding results, gradually transforming perception and paving the way for wider acceptance.
The Role of Robotic Surgery in GI Procedures
Robotic surgery offers unparalleled advantages over traditional laparoscopy in GI procedures. Dr. Sreedhara highlighted the enhanced precision, three-dimensional visualisation, and improved depth perception provided by robotic instruments. “This technological evolution significantly reduces surgery duration, anaesthesia requirements, and postoperative recovery time, resulting in a more effective and patient-friendly approach,” he added.
Becoming a Center of Excellence
In recognition of Dr. Sreedhara's commitment to excellence, Kauvery Hospitals has been designated as a Centre of Excellence for Robotic General and GI surgery - one of the very few existing ones in the country. This accolade positions the institution as a training hub for surgeons across the country. Dr. Sreedhara envisions a future where his hospital becomes an international destination for training in robotic surgery, marking a significant milestone in the evolution of medical education and technology in India.
The Future: Advancements and Expansion
As technology continues to evolve, Dr. Sreedhara envisions further advancements in robotic surgery, with the imminent arrival of a fourth-generation robot and the development of single-port procedures. “My goal is not just personal success but contributing to the growth of robotic surgery in India and beyond. I am determined to nurture a legacy of excellence, training future generations of surgeons and fostering international collaborations in the realm of robotic surgery,” Dr. Sreedhara shared his views.
Dr. Sreedhara's remarkable journey from laparoscopy to pioneering robotic GI surgeries exemplifies a commitment to innovation and patient-centric care. His accomplishments serve as a hope for the medical community, encouraging a shift toward embracing cutting-edge technologies that enhance surgical precision, reduce recovery times, and ultimately improve patient outcomes.
