Health – Mumbai-born doc set to revolutionise bypass surgery
MUMBAI: When Dr Ranjit Deshpande gets ready to perform a cardiac bypass surgery in London’s King’s College, there is no role for the saw that has
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traditionally been used to cut open the breast bone in order to expose the heart. The Bandra boy instead uses an endoscopic camera and a huge LCD TV to get a ‘close’ look at the beating heart.
His patients go home within 48 hours without the tell-tale eight-inch scar on their chest.
“They only have a 3- to 5-cm scar on the left side of their chest,” says the former Nair Hospital-trained surgeon, who evolved the ‘coronary bypass surgery via a keyhole’ technique a few months ago.
The technique that could, in the near future, revolutionise the way heart surgeries are performed has so far been used on 14 patients in London. “Each of the patients is doing well,” said the doctor, who was on a fortnight-long visit to his general practitioner father P R Deshpande’s MIG Colony home in Bandra East.
The doctor says he owes his innovation to medical practices in India. “I worked with Dr Nitu Mandke at Hinduja Hospital when beating heart surgery was still new. Before that, I worked at Tata Memorial Hospital where video-assisted thoracic surgery was common,” he says.
It is this experience on the video-assisted surgery (now an LCD TV monitor) that Deshpande now draws to perform his minimally invasive cardiac surgery. It is the workmanship he picked up as Mandke’s team member that helps him in drawing out the internal mammary artery through a 3mm-hole.
There is another India angle that Deshpande is proud of. “When most centres across the world are investing in buying expensive infrastructure used for robotic surgeries, my method is relatively cheaper.” The commonplace video—as against the exotic Da Vinci robotic arm—is suited for Indian budgets, he says.
“In fact, the procedure’s USP is that it doesn’t require costly equipment like a surgical robot (Da Vinci robot). In the UK, the cost of this robot is 1.5 million pounds. But my technique only requires an initial set-up cost of 50,000 pounds,” he adds.
At present, Deshpande uses the technique only for persons with single-vessel or double-vessel problems. “When I get back to London, I plan to use it on a patient with triple-vessel blockages.”
Will his technique find wide acceptance? Deshpande is confident: “The world of medicine and surgery is rapidly changing and so are patients. Many young people hate big scars and can’t afford to stay out of work to recover from heart surgery.”
Dr S Bhattacharya, one of the country’s leading heart surgeons, points out that many new techniques using minimally invasive ways are coming up. “But they are still in their infancy. Maybe, at a later date, they will have matured enough to handle the complex nature of heart problems among Indians, but not now,” he says. “I am not satisfied if I don’t physically touch the mammary artery and tighten it adequately,” he adds.
Deshpande’s technique evolved from his training in a Belgium centre known for its minimally invasive heart surgeries for heart valves. “To keep pace with the rapid advances, I went to the Belgium centre that has performed over 2,000 minimally invasive cardiac surgery procedures for valves,” he says. Back in London, he used the same methodology for performing minimally invasive beating heart surgery. “What other surgeons were doing with robotic arm, we did using endoscope that is available at every hospital these days,” he says.
Traditionally, coronary artery bypass surgery involves bypassing blocked arteries, which supply blood to the heart with a new blood vessel (graft) which is attached beyond the blockage in the coronary artery. Also, surgeons have had to make large incisions over the breast bone to access the heart and the blocked vessel.
Using the King’s method, the surgeon inserts a special surgical camera (endoscope) through a 3-mm incision so that he can see pictures of the heart. “I pass three probes through the second, fourth and sixth space between the ribs on the left. Using the camera and the probes, I dissect the internal mammary artery and bring it down to the artery that needs the bypass,” he says. Then the lowermost incision is widened to 3 to 5 cm to use the new surgery wonder tool—called a harmonic scalpel—to clear the blockage before joining the newly dissected internal mammary artery with the problem artery.
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