Robotic surgery for urinary bladder cancer – a personal experience


My father recently went through a radical cystoprostatectomy with extended pelvic lymph node dissection and urinary diversion at the MAX Hospital in Delhi. For those of us like me whose knowledge of such procedure was as robust as a commoner’s in the remote part of India understanding the French and Greek delicacies – it was time to hit Dr. Google and Dr. Wikipedia for that piece of instant knowledge. After going through 48 hours of instant crash course I couldn’t have been more depressed. Anyways it was time for me to pack my bags and take a long flight from Atlanta to New Delhi.
As I was touching down Delhi, little did I realize that the coming few weeks will not only change my outlook towards doctors in general but also hospitals.

Next morning, we met Dr. Gagan Gautam – The Little Master.

We got Dr. Gagan’s reference all the way from United States from another Master in the same field and a family friend, who felt that there’s no one better than him in this field in India. With that reference when we walked into his office in MAX Saket Hospital expecting to meet a self obsessed, boisterous handsome young man. Handsome he was, as my Dad told everyone, but he was anything else like what we assumed.

To describe Dr. Gagan would be like describing Pele, Lionel Messi, Sachin Tendulkar, Napoleon, Lata Mangeshkar and Mother Teresa all rolled into one. Calm Confidence, Care and Compassion comes close to describing someone who sure has deep mastery over what he does.
From the moment I met him first time for consultation and three weeks later, after multiple tests, when he performed that complicated surgery with utmost compétence, there wasn’t a moment where I had any doubts in his abilites.

Though, apprehensive we were.

Coming back to the procedure itself – it’s a complex 8 hours surgery, where the bladder and prostate are removed and with urinary diversion. Radical cystectomy entails removal of the bladder, adjacent organs, and regional lymph nodes. In males, radical cystectomy generally includes removal of the prostate as well as the urinary bladder. Urinary diversion entails removal of bladder and requires the urinary flow be redirected in several forms.

These surgery can be performed by open procedure or using Robotics. With my faith in Digital Technologies and its potential benefits to mankind, I personally had an inclination towards Robotics. This was supposed to be a very complex surgery with an average total time of 7-8 hours.

After an elaborate discussion with Dr. Gagan Gautam, we were more than convinced that Robots were the way. Now the question was on The Man Behind the Machine – Though as mentioned before I or the patient, My Dad, never had an iota of doubt in our mind about him. But rest of the family had to be satisfied. So we went on a CIA mission for a day, starting from experts at TMH, Mumbai to Senior Doctors in Bangalore and finally ending back in Delhi. And at every instance there was only one message that came back – Dr. Gagan is the Best Man that can be Behind the Machine for this kind of procedure. Finally in the evening my Uncle who’s been a famous Senior Orthopedic Surgeon himself in his days gathered the entire family and expressed his golden opinion. He asked everyone if we were aware of Napoleon’s Battle of Lutzen. He explained that in that war when Napoleon was losing the battle inspite of having the best generals on his side, he called his team to review the battle plan. All his best generals walked him through their own version – finally, a little frustrated, he told them – “Today as I stand in the battle ground, I don’t want my Best General to fight for me but I want my LUCKIEST General to fight for me.” He went on to explain the nuance of a successful surgery – “It’s when The DOCTOR’s Skills, PATIENT’s Perseverance and the ALMIGHTY comes in single line – Miracles Happen”. And we don’t have doubts over the first two, we will have to wait watch for the third one, so let’s go and get it done.

While we never had any doubts on Dr. Gagan’s ability as a Senior Robotics Surgeon, what struck all of us was his humane approach towards this whole thing. That started from the team he had, which included a few that we met and interacted almost on a daily basis – Dr. Puneet Ahluwalia, Mr. Majo and Mr. Abhishek his coordinator. We never met a more compassionate team of people in any profession leave alone in medical profession. We reached out to them over weekends, late nights, holidays and the response time was always less than thirty minutes from the moment they received it. They put to shame some of the IT folks and Client service organizations responsible for system maintenance and customer service in terms of response time and that too with utmost empathy. But then a Team is as good as the Captain and Captain is as good his Team. Dr. Puneet himself was always available and was a true reflection of Dr.Gagan. I am a Digital Practioner myself and I was so glad to see the new generation of Doctors adopting to Digital Technologies so easily for a seamless patient experience.

Ca bladder blog

Some observations on the MAX Hospital in Saket, Delhi. In the past I have had very poor experience in Hospitals in India. We realized that most of the hospitals in India after being taken over by large Corporation have become a money making machines and have little care for patients. When we walked into Max, every place I saw one message – “MAX, Where Patients come first”. Being in the field of consulting, I thought it to be another Marketing Tag Line. And I am so glad that I was so wrong. Every hospital staff that we encountered was an epitome of Dr. Gagan and his team – very down to earth, approachable, caring and compasivo. Their whole attitude is to get the patient well and get them out of hospital healthy and hearty as soon as possible. If there’s ever a word called personal care in a Corporate Hospitals in India, we found it at Max. Also, my father found the pain management process at MAX outstanding.

After I started interacting with Dr. Gagan for a while, I got a little worried of my own job smile emoticon:-). Dr. Gagan could very well have been a successful Consultant, a CEO, a rising Entrepreneur in the Silicon Valley, a Preacher and later I realized he could as well have gotten us that missing Gold Medal at Rio in the long distance running. The kind of expertise that he brings to the table along with his serene calm personage, when he meets his patient is just exceptionnel. I can relate one incident to highlight the same – When we realized the seriousness of my dad’s disease and the complex and long nature of the procedure, we were hesitant to tell him so. But Dr. Gagan was pretty clear that he needs to share the same with my Dad. He had an hour long conversation with various audiences – my family including my Dad, my Dad alone and my family alone. He took a lot of time to explain the details of the disease, the sickness and the realization of the reality of the situation and the way he did oozed utmost confidence of a Master who was in total control. His calm comportement, the confidence that he executed was like watching Messi having the ball in the box while playing for Barca or when Sachin walking out to bat against the fierce Australian team. Also, the patience and time he gives to his patients and his family to go over the details is just exemplary. I am also in a Client Services Business and always try to avoid prying customers who want every details of execution and risks associated with it – Dr. Gagan taught me otherwise.

For me Dr. Gagan Gautam is almost a paradox as an expert Robotics Surgeon along with rest of his personal traits. How can a person who deals with Robots day in and day out as a profession, be so humane and compassionate towards his patients. But then we have never seen a more human character than Optimus Prime or a Superman.

My two young boys, my wife and my entire family have been following Dr. Gagan like a shadow on his social network and have become a big fan of him – My boys described him best in one word, well – one word on twitter – 

“SUPER ROBO DOC” – The Human Behind the Robots
Dr. Gagan Gautam – YOU ARE THE BEST.

Feedback by Bibhakar Pandey. He is Venture Leader and Digital Practioner, lives in Atlanta, Georgia with his wife Rashmi and two boys. His Father Bibhuti Pandey, who is a patient of Dr. Gagan Gautam is a Senior Lawyer practicing Law in Supreme Court and High Courts in Patna and Ranchi. He lives with his wife Sudha in Patna, Bihar. His Daughter Shweta works in a Multinational Medical Firm and lives with her husband Balaji in Bangalore, Karnataka.
For any query on the patient experience during the surgery or this article please contact Bibhakar Pandey on email –