Advanced kidney cancer now amenable to robotic surgery

Advanced kidney cancer has a potential to spread to other parts of the body like lungs, liver or bones; however in certain rare circumstances, the tumour grows within the veins of the kidney and blocks the main vein of the body (inferior vena cava) going towards the heart. This blocks the flow of blood to the heart and may lead to severe complications. A piece of the tumour can also get detached and get lodged in the heart or lungs causing sudden death. Fortunately, even in this advanced stage, removal of the kidney and the tumour thrombus (clot) from the vein can potentially cure the patient. This is usually done via conventional open surgery due to the complexity involved in blocking multiple sources of blood supply to the vein, opening the vein, removing the tumour from it and reconstructing it in a way that there is no leakage of blood from it. This involves a large cut (incision) on the body and results in significant blood loss, high complication rates and delayed recovery. Robotic surgery can now be offered in this rare condition to enable the patient to recover faster with less pain, discomfort and blood loss.

This procedure, technically known as robotic radical nephrectomy with IVC thrombectomy, was recently performed by Dr Gagan Gautam – Head of Urologic Oncology and Robotic Surgery at Max Institute of Cancer Care, Saket, New Delhi on Sanjay Doolabh, a 46 year old businessman from Zimbabwe, who was discharged 3 days after surgery and flew back to his country in a week.
“This represents a significant advance in Indian robotics as we can now offer potentially curative treatment to this rare group of advanced kidney cancer patients, with a minimally invasive robotic approach which may decrease chances of complications and hasten recovery”, Dr Gautam stated in reply to a question. “Till date, this operation is being performed in only a handful of institutions in the world and the worldwide experience is likely to be less than 50 cases.”
Dr. Gautam has been trained in robotic surgery at the University of Chicago and currently leads a team of urologic cancer surgeons who perform robotic surgery for prostate, kidney and urinary bladder cancer at Max Institute of Cancer Care, Max hospital, Saket, New Delhi.

Heading home – the patient’s side of the story..

Dr Gagan Gautam is the Head of Urologic Oncology and Robotic Surgery at Max Institute of Cancer Care, New Delhi, India. He has played a key leadership role in establishing robotic surgery programs in India and has trained and proctored many surgeons in robotic surgery for kidney, prostate and urinary bladder cancer.


Robotic surgery in India – Challenges and opportunities

There is little doubt that over the past decade, robotic technology has created a mini revolution in surgery. After taking the western world by storm, it is now headed our way, to India. The big question is … are we ready for it?

The scope of robotic surgery in the Indian healthcare scenario seems to be expanding rapidly. Only a few years ago the number of robotic systems in India could be counted off on the fingers of a single hand. However, the number is currently around 25 and is all set to explode in the years to come. It is estimated that over 2500 robotic procedures were performed in India in 2013. However, this is just a small fraction of the number of patients who can benefit from this technology. With rising levels of education and awareness, implementation of cancer screening programs, increasing economic strength, and the availability of modern technology, these numbers are likely to multiply many times over in the coming years.

This technology affords a number of advantages to the surgeon as well as the patient. It is now possible, with robotic technology, to see tissue details in magnified 3-D vision, that were never visualized earlier. Highly miniaturized and dexterous robotic instruments enable the surgeon to perform precise and accurate surgery resulting in excellent outcomes with decreased chances of complications.

However, an under appreciated caveat of this technology is the centralization of major surgical procedures in high volume centers. This is not necessarily a bad thing. Research studies have consistently shown that complex surgical procedures are best performed at tertiary institutions by experienced surgeons dedicated to that particular sub speciality. Not only does this result in optimal surgical outcomes, but also provides opportunities for dedicated follow-up, additional treatments and further research. Robotic technology permits more and more patients to be operated in fewer institutions by a dedicated group of surgeons specialized in the care of these patients. At the same time, robotics has greatly reduced the learning curve of complex surgical procedures, thereby enabling rapid dissemination and assimilation of highly advanced surgical skills by surgeons who are interested in performing robotic surgery.

Every challenge is an opportunity and vice versa. In India, there are certain unique challenges that have to be overcome before robotic surgery becomes widely acceptable. Even if we move beyond the oft cited constraints of cost and prioties in healthcare, availability of trained manpower remains a major issue. Currently, in India, there is a severe deficiency of adequate training facilities for robotic surgery. The establishment of fellowship programs and structured training for entire surgical teams is the need of the hour. Leading robotic programs in India need to take the lead in establishing these training centers. Proctors and preceptors from these Indian institutions need to play a role in helping other surgeons and establishments overcome their learning curve safely and efficiently.

The Da Vinci surgical robot in action

Next generation surgery – The Da Vinci surgical robot in action.

Hopitals and insurance companies need to work together to work out issues regarding financial compensation for robotic surgery. We need to demonstrate definite improvement in patient outcomes, decreased hospitalization and a reduced readmission rate after robotic surgery to encourage insurance companies and government agencies to cover the additional cost of robotic surgery. This can only be achieved by maintaining a robust database for every major procedure done, using the robot.

There is little doubt that India is now ready for a rapid expansion and development of robotic surgery. In fact, due to the combination of a large case mix of complex medical conditions and his/her inherent ability to get comfortable with modern technology, in the times to come, the Indian surgeon may be in a unique position to provide international leadership in certain disciplines of robotic surgery.

[Dr. Gagan Gautam is the Head of Robotic Surgery and Uro Oncology at Max Institute of Cancer Care, New Delhi, India. Though his prime focus is the surgical care of patients with prostate, kidney and urinary bladder cancer, he is also involved in robotic surgery training and counselling and has been pioneering the safe and widespread adoption of robotic surgery in India. He has been invited to a number of national and international workshops and meetings where he has taken lectures and conducted live surgical demonstrations of robotic surgery]

View Dr. Gagan Gautam’s profile or visit his website

Contact Dr. Gagan Gautam or connect with him on twitter or facebook

Kidney cancer treatment in India – Patient feedback

A diagnosis of kidney cancer does not mean that your are at the end of the road. There are innumerable stories of courage, innovation and determination that can inspire us. Fortunately, with modern technology and treatment techniques, there is hope for the vast majority of people who would not have been treated effectively till just a few years back.

One such story, is that of a surgical colleague of mine, a plastic surgeon in Iraq, who had came over with his father to me a few months ago. What follows is an extract from his post on You can read his post through a link at the end of this blog.


There is always light at the end of the tunnel….recovering well after surgery…..

“Everyone may face a hard time, and during that, you have to know who will be there with you to pass it.
My father Safaa Alhassany is 67 year old with past medical history of angina, hypertension, gout and DM. We discovered accidentally that he had a big tumour in the middle lobe of his left kidney and to make it complicated, the right one was shrinkage and with only 12% function!! Which meant a real ((disaster))!!
After a lot of consultations there in my country and here in India, there was no doubt that we are going to the dark side of our life..
There was no choice other than nephrectomy due to the size and site of the tumour.
Thanks Godness, following someone’s recommendation, I met Dr. Gagan Gautam and he was the only one offers a partial nephrectomy to save the kidney and get rid of the mass. Within a week time, he bravely took the plunge and operated on my dad and thankfully did it, saving about a half of the kidney after a super-major, long and difficult operation lasted more than 5 hours.After a month of this nightmare, I write my story just to say thank you to the one who saved our family Dr. Gagan Gautam and to let the others know that the hope is usually there but you have look for it carefully.
A big thank you to Dr. Gagan Gautam and his team.”

Dr. Hussein safaa

Dr. Gagan Gautam is the Head of Urologic Oncology & Robotic Surgery at Max Institute of Cancer Care, New Delhi, India. He is India’s leading expert in robotic surgery for prostate, kidney and urinary bladder cancer treatment. To know more about him, click here, or visit his website

To read Dr. Gautam’s blog on robotic surgery for kidney cancer, please click here.