Thanks to the minimally invasive approach of doing surgeries, Scalpels, scissors and forceps are no longer the mainstay of an operation theatre.

The scene inside one of the operation theatres of Escorts Heart Institute and Research Centre in Delhi, where a bypass surgery was being conducted was relaxed. Part of the ease was probably because this was a "robotic surgery", perhaps the ultimate in high precision, minimally invasive procedures. Still, the man in the hot seat, in this case the "console", from where he conducted the operation, Dr. Yugal Kumar Mishra, managed to keep a running commentary going.

But isn't a beating-heart bypass surgery a very complicated procedure that requires extreme concentration? "This is simple," Mishra laughs, rubbing his hands in excitement. He could talk. After all, this was perhaps the 351st - or was it the 352nd - robotic surgery presided over by the man who took over as the director of cardiovascular surgery after Dr. Naresh Trehan . The patient, he explains, will be up and about in around 10 days, compared to the 30-45 days in an ordinary surgery, where the chest has to be completely opened.

That is the beauty of the "minimally invasive" procedures, where instead of incisions of five inches and more, all the work is done by instruments inserted into the body through three or four half-inch cuts. Result: The trauma is reduced to a fraction, the recovery is faster and even the pain is much less.

The essential instrument in minimally invasive surgery is the scope, explains Dr. Arun Prasad , Senior Consultant of Apollo Surgical Centre’s Minimal Access Surgery. Also known as endoscope, this is a thin rod-like instrument, mounted with a tiny video camera and a powerful light, which functions like a telescope, projecting the magnified interior view of the body onto monitors.

The rest of the instruments include the usual scissors, forceps and the rest, about 2 to 3 mm in size, also mounted on thin rods, which are inserted into body through hollow rods called canulae, which hold the half-inch incisions open.

Laparoscopic cholescystectomy , or removal of the gall bladder through laparoscopy (translated from Greek, laparoscopy means examination of the abdomen through a scope) became popular only in the 1980s. And in the 1990s, in view of its advantages, surgeons started using the minimal invasive procedure for the spine and other parts of the body. In India, Tempton Udwalia of Mumbai’s Hinduja Hospital is accepted a pioneer by most.

Currently, this process is applied for diagnostic and therapeutic processes in the brain, heart, organs in the chest and abdominal cavity, reproductive and genito-urinary organs and even some orthopaedic problems. "It can be used for removal of fluids, tumours and cysts, glands like prostrate and thyroid, organs like gall bladder, appendix, spleen, kidneys, uterus and even spinal discs," says Prasad.

"When applied to the brain and spinal cord though," points out Dr D V Rajkumar, Consultant Neurosurgeon, Wockhardt hospitals , Bangalore, "the word we use is not minimally invasive. It is minimal access."

In fact, so small can be in the incision and so reduced the trauma, some operations can be done under local anesthesia, says Dr Vikas Gupte, Consultant Neurosurgeon, Wockhardt Mumbai , who is one of the few doctors in India to have conducted "slipped disc surgery in the awake state". In some cases, such incisions can be closed by a single stitch, says Dr Gupte, a specialist in Percutaneous Endoscopic Cervical/Lumbar Discectomy. Similar is the case of the brain.

The process, which has been in use in India and abroad since the mid-90s, has perhaps given rise to other ideas.

"The more sophisticated version of the surgery that has been developed lately is the Natural Orifice Transluminal Endoscopic Surgery, also known as NOTES," says Dr Arun Prasad.

For Paediatric gastroenterologist Dr Anupam Sibal of Apollo hospitals , minimal invasive surgery means a whole new realm of relief.

Minimal invasive surgery for kids ensure that in most cases, the hospital stay for children can be minimised to even a day. And the post-op period can be significantly shorter.

For Dr Arun Prasad, not only does it mean more collaborations, but smaller incisions too as the surgical instruments become smaller. "Currently we have instruments of a diameter of 10 millimeter. But already instruments of 3 millimeter diameter are available and used. Though, because they are delicate, they cannot be used for too many procedures," he says.

Dr Rajkumar agrees. "Earlier we used to say 'big surgeons use big incisions'. Now it is 'big surgeons use small incisions'. Incisions used to be measured in inches. Now it is in centimeters and millimeters. I believe we are looking at a time where there would be no incisions at all. The various non-invasive techniques using gamma rays and X-Rays that are already used to arrest and shrink the smaller brain tumours, will be modified to eliminate surgery largely."

More at: http://www.indianexpress.com/sunday/story/237760._.html