Indian Medical Wonders - Story 5

Surgeries with a robot's assisstance in Bangalore


The Robotic Assisted Surgery (RAS), a boon in these times when going under a surgeon’s scalpel is routine, can now be accessed in the city. Besides oncological treatment, RAS can be performed in urology, gynaecology, ENT and select cardiac procedures.

Over the past five days, Manipal Hospital has undertaken about 16 successful surgeries with assistance from a robot, the da Vinci surgical system.



On Monday, the Manipal Health Enterprise (MHE) launched the Manipal Vattikuti Institute of Robotic Surgery in their flagship hospital in the city.

Speaking on the occasion, Dr Sudarshan Ballal, medical director, MHE, said, “RAS can be used for many types of surgeries, from oncology to urology. The major advantage of RAS is that the incisions made during surgery are tiny. Thus, the recovery is quick.”

On an average, a patient undergoing RAS would leave the hospital two to five days earlier than those who have undergone traditional surgery and return to work with normal activity 50% faster. An additional benefit of RAS is that it can reach where surgeon’s hands cannot and allows 3600 rotation, which is humanly not possible. Thus, robots take surgery beyond the limits and reach of the human hand.

Launching Manipal Vattikuti Institute of Robotic Surgery, Padmabhushan Dr Ramdas Pai, chairman, Manipal Education and Medical Group, said: “RAS would take surgery to the next level of medical excellence. It will open a new chapter in delivering quality healthcare and enhance clinical outcome for the community at large.”

P Balaram, director, Indian Institute of Science, said, “It is about time that we focus on the fusion of research, medicine and engineering. Today, India has no dearth of good physicians and surgeons. But now we should think of how to move to a stage where technology can improve patient care in hospitals.”

Indian Medical Wonders - Story 4

New Surgery to Reverse Blindness

Doctors in a city hospital used a less than half-millimetre stainless steel device – as small as grain of rice – to restore vision in a 67-year-old woman who was suffering from glaucoma. The surgery, which is done in less than 15 minutes, may soon replace traditional open surgeries as it reduces infection rates and help patients recover quickly, say doctors.


K Leelavathi, came to the Vasan Eye Care hospital in the city with complaints of deteriorating vision in her left eye recently. The chief medical officer Dr Arvind Venkatraraman, who had operated her right eye in 2009 for the same problem – open angle glaucoma - said surgery was unavoidable.

Glaucoma refers eye conditions that lead to damage to the optic nerve, which carries visual information from the eye to the brain. In many cases, damage to the optic nerve is due to increased pressure in the eye. Glaucoma is one of the most common causes of blindness worldwide affecting nearly 10% of the population in India. Doctors find two types of glaucoma common – primary open angle and primary angle closure. In an angle closure glaucoma, the pressure inside the eye rises rapidly and patients often complain of severe pain in the eye. Eye turns red and the vision becomes blurred.

Leelavathi did not have any of these warning signs be cause she had the open angle glaucoma, where the pressure builds up is slow and hence the vision loss is also gradual. "I came to the hospital because I suspected this could be the problem. I was treated with glaucoma surgery two years ago," she said.

Doctors noticed that pressure in Leelavathi's eye, shot up to 28mm Hg (normal is 18-20mmHG) despite medications. Patients with glaucoma are normally managed with eye drops that keep the eye pressure low. In some people, the pressure build up despite eye drops. For Leelavathi too the two expensive and efficient eye drops, which cost Rs 1,000 a month each, were useless. She was advised surgery.

In 2009, doctors made a cut in the upper part of the eye between the sclera and the iris to create a small flap to allow the fluid to drain out freely. This reduces the eye pressure. Leelavathi is off eye drops and her eye pressure on the right eye is 17mm Hg. But Dr Arvind says that the risks associated with the trabeculotomy were high. "The surgeon is always in a dilemma on whether he has made a good cut. If the cut is too small, the fluid might not drain well and the pressure would be high. If it is too large, the eyes may be dried out in no time. In both cases, the treatment is a failure," he said. The open surgery also has risk of anesthesia and infection.
Discover the POWER of BLACK for a Pure White Skin


So this time, doctors decided to try out a new age device – mini-glaucoma shunt - which was introduced to select ophthalmologists in India two weeks ago. During the surgery, doctors used anesthetic gel to numb the eyes and then cut out a thin flap in the front of the eye. The shunt is mounted on the hollow needle is inserted through the eye, into the anterior chamber. Once the shunt is in place, needle is pulled out and the flap is with tiny sutures. "We saw the fluid flow out of the eye freely and eye pressure dropped," said Dr Arvind. In the next 24 hours, Leelavathi's vision improved. "I recovered faster this time," she said.

The cost of the surgery is at present a little higher than that of the conventional surgery as the shunt itself cost Rs 29,000. The total surgery cost is Rs 40,000 when compared to Rs 25,000 for the conventional surgery. Dr Arvind feels that if shunt, which has been approved by the Indian government and the US FDA, continues to show good results, this might even replace most routine surgeries and the cost might come down. "We may not be able to use them in patients who have inflammation. But for the rest, it seems like a better deal than the conventional surgery," he said.

Affordable yet Quality Rhinoplasty

Rhinoplasty or nose surgery is a procedure where the skills of the surgeon are quite important. Even a slight mistake can kill the purpose of the surgery which is to get the distorted nose right. Efficiently done, rhinoplasty can reshape the nose in the way you want. The surgery can reduce or increase the size of the nose, change the shape, narrow the span of the nostrils. It could also be done to correct a birth defect or injury.



Surgeons can perform Rhinoplasty surgery in three ways – Open technique, Closed technique and Delivery technique. In the open technique, the skin over the Cartilage framework of the nose is lifted. Thereafter, the surgeon can make surgical changes to create a nose which looks aesthetically more pleasing. In the closed technique, the incisions are made inside the nose. Cartilage is then pulled out from the nose which is then shaped the right way. In the delivery technique the cartilages are dissected out without interfering with the columella. These are sculpted by the surgeon under direct vision to get them in proper shape. They are thereafter put back at their natural place in the nose.

Thousands of westerners arrive India each year to get their rhinoplasty surgery done. Most people get cosmetic surgery in India done to get their looks right. However, it is also performed to correct structural deformities of the nose that can cause breathing problems. The surgery works well for the people who are looking for improvement, not perfection, in the way they look. People who are realistic in expectations can achieve positive results from the surgery.

Indian Medical Wonders - Story 3

A 32-year-old woman in Mumbai has been living with a disorder that strikes only one in a million. Suffering from partial situs inversus, Janhavi Raul weighed 112 kg when she recently sought help for obesity consultation.
Dr Sanjay Borude, bariatric surgeon said, “She had a stomach which was double the size of a normal person’s. We have decided to perform a vertical sleeve gastrectomy and cut out 80% of the stomach to reduce her urge to eat. The operation was a challenge because of the disorder.”
Raul who is married with a child and works as a commercial artist, was aware of the disorder.
“She came to us a week ago. When she told us her stomach was located in the right side of the body instead of left, we did a thorough checkup before going ahead with the surgery. Apart from her heart, which was located in left, the stomach, intestine, liver, appendix were located in the reverse direction,” said Dr Borude.
This surgery is the first of its kind in India. Situs inversus (also called situs transversus or oppositus) is a congenital condition in which the major visceral organs are reversed from their normal positions. The normal arrangement is known as situs solitus. While complete situs inversus disorder is found in one among 22,000 people, partial situs inversus is very rare and found in only one among a million people.
“I wanted to lose weight as it was creating lot of health problems. I already knew about my condition as I was told my stomach was located in the reverse direction during my pregnancy,” said Raul.
Post-operation, doctors are monitoring Raul’s condition. “In normal cases, a sleeve gastrectomy patient is discharged in two-three days. But we may keep her for a longer time and see how her body is reacting,” said Dr Borude.

Best Dental Treatment and Affordable too !!

The primary draw for dental tourism is the savings afforded for dental patients. Patients from developed nations like USA and UK travel to India where the cost of healthcare is low despite the fact that dentists are expertly-trained and on-site equipment is state-of-the-art. Dental clinics in India have most sophisticated dental chairs, most advanced diode lasers, most advanced CAD CAM devices. Savings in India are attributed to the low cost of administration and labor.

Dental patients also relish the experience to tour exotic Indian destinations and maintain the spending power to pamper themselves during their stay. Those receiving inpatient procedures can afford lavish facilities at significant savings compared to dental work at a standard clinic in their home country.



Dental tourists seek procedures ranging from root canals to dental implants. Of course, relatively inexpensive procedures like simple cleanings or cavity fillings don’t usually attract dental patients to India.

Many insurance packages offered through employers don’t offer sufficient coverage for dental work, meaning patients have to pay the bulk (if not all) of their expenses themselves. These costs are often prohibitively expensive.

Given exorbitant prices for dental operations in the United States and the United Kingdom, patients from these countries are increasingly seeking dental care away from home. In some cases, unrealistic waiting lists also drive patients across national boundaries.

Recovery time is usually short for dental work, even when the procedure is relatively invasive. For this reason, outpatients can travel to a vacation destination, receive dental work and then spend the remainder of their time enjoying a vacation—all for less than the price of receiving dental work at home.

Heal & Wheel understands the choices of dental patients travelling from various nationalities and understands the needs of a dental patient. Heal & Wheel has collaborated with the best Indian dental clinics. There has been a constant surge of dental patients coming to India through Heal & Wheel.

NDM Virus was a mistake by Lancet - Lancet Apologises

Naming the drug resistant superbug New Delhi Metallo Beta Lactamase-I (NDM-1) after India's capital city was a "big mistake", Dr Richard Horton, editor of the prestigious British medical journal `The Lancet'.

Dr Horton told TOI that "it was an error of judgement" on their part to allow the article get published with the name NDM-1 as "we didn't think of its implications for which I sincerely apologise."

According to Dr Horton, naming the bug after New Delhi "unnecessarily stigmatised a single country and city".

Dr Horton, however, strongly felt that the science "was strong, sound and correct" but in the mistake of naming the bug, "it distracted people from the important science".

The journal, he said on Tuesday, has now learnt to be more careful with new inventions, discoveries or conditions named after a particular country or city. "I would welcome if researchers changed the name of the superbug but it is in the hands of those who named it in the first place," Dr Horton who is in India said.



Reacting to Dr Horton's comments, director-general of the Indian Council of medical Research Dr V M Katoch said, "It was unfair to name a superbug -- organisms that grow in nature in every country -- after India without any evidence that it originated here."

In August 2010, `Lancet' had published a multi-centre study, warning how a new superbug had emerged from India and had spread across the world which made bacteria highly resistant to almost all antibiotics, including the most powerful class called carbapenems.

India's scientific fraternity, including the Union health ministry, had strongly lodged a complaint against naming it after New Delhi saying it was a ploy to put a stop to and "defame India's growing medical tourism industry". The ministry went on an overdrive to convince people that Indian hospitals were safe for foreign patients and described the study "malicious propaganda".

The `Lancet' study had said NDM-1 was common in India, Pakistan and Bangladesh in particular and had spread to over 15 countries including United Kingdom, US, Canada, Australia, Netherlands and Japan.

Most experts blamed the emergence of this gene on the widespread misuse of antibiotics stating that Indian doctors had not yet taken the issue of antibiotic resistance seriously and that India needed both an improved policy to control the use of antibiotics and a central registry of antibiotic-resistant infections.

Dr Samlee Plianbangchang, WHO's regional director for south-east Asia, had said that the drug resistance was caused "largely due to the incorrect use of medicines, including use for too short a time, too low a dose, inadequate potency or for a wrong disease."

Abdul Ghafur, one of the authors of the superbug story from Chennai, recently said the alliance between the enzyme and New Delhi was only hypothetical and not proven. He said he strongly believed that the name of NDM-1 must be changed to remove the words "New Delhi".

Read more: Lancet says sorry for 'Delhi bug' - The Times of India http://timesofindia.indiatimes.com/india/Lancet-says-sorry-for-Delhi-bug-/articleshow/7261135.cms#ixzz1AtGHzJ9e

Europe in Grip of Super Bug - Not India !!

Europe is now in the grip of an old superbug that seems to have become more potent. The deadly drug-resistant superbug Clostridium difficile (C-diff) is causing an increasing number of infections across Europe.

In an Europe-wide study, scientists have found infections due to C-diff being widespread. Incidence in hospitals has risen to 4.1 per 10,000 patient days in 2008 from 2.45 per 10,000 patient days in 2005.

What's worse, when the team of scientists followed the patients up with infection after three months, they found that 22% had died, and C-diff infection had played a part in 40% of those deaths.

The study has been published in the British medical journal, The Lancet, on Tuesday.

C-diff is a spore-forming bacterium, which was discovered in 1978 and found to be the cause of antibiotic-associated diarrhoea and colitis.

The recent study revealed that C-diff infection rates were high in Finland, Poland and Britain, which had rates of 19.1, 12.5 and 10.4 per 10,000 patient days, respectively. It is lower in France and Hungary, which had incidences of 2.1 and 2.0 per 10,000 patient days, respectively.

When the normal bacteria that live in the colon are disturbed -- usually due to antibiotic treatment -- and a patient ingests C-diff spores, the bacteria can multiply and release the toxins.

Some experts claim it now rivals the superbug MRSA as one of the leading threats to humans. Since its discovery, C-diff has grown increasingly resistant to antibiotics.


Ed Kuijper of Leiden University Medical Center in The Netherlands, who led the study with his colleague Martijn Bauer, said, "It is clearly on the rise. There is also a huge variation of incidence in different European countries. Overuse and misuse of antibiotics in recent decades have fueled a rise in drug-resistant superbugs like C-diff."

Earlier this year, scientists warned that a new so-called superbug from India -- New Delhi metallo-beta-lactamase (NDM-1) -- could spread around the world.

"Antibiotic resistance remains a serious threat to patient safety, reducing options for treatment and increasing lengths of hospital stay, as well as patient morbidity and mortality," said Marc Sprenger, director of European Center for Disease Prevention and Control (ECDC).

The study was collaboration among 106 laboratories in 34 European countries. Each hospital tested stool samples of patients with suspected C-diff infection that developed three or more days after being admitted to hospital.

A case was defined when, subsequently, toxins were identified in stool samples. Detailed clinical data and stool isolates were collected for the first 10 cases in each hospital. After three months, the clinical data was followed up.

"Decreasing antibiotic use in hospitals has shown decreasing incidence of infections," said Dr Dominique Monnet of ECDC.

Symptoms of C-diff include profuse diarrhoea and abdominal pain and distention of the abdomen. An infection is also frequently accompanied by fever, nausea and dehydration. In some rare cases, blood may be present in the stool. The infection is spread by spores that contaminate the hospital environment and hands of health care workers who can transmit the spores to patients.

Read more: Europe in grip of new superbug, not Indian - The Times of India http://timesofindia.indiatimes.com/india/Europe-in-grip-of-new-superbug-not-Indian/articleshow/6942828.cms#ixzz15lMfmwHi