It was like a scene straight out of Star Wars or Star Trek: In the Cancer surgery unit of a private hospital in Mysuru in Karnataka, Dr Vijaykumar and his team performed surgery as Dr Vishal Rao — who was in Bengaluru — guided them through the process.
He was even able to mark the exact spot on the patient where the surgery had to commence!
Thanks to the Metaverse, the operation took place as if the two surgeons were in the same room.
Not only could Rao see the patient in front of him, but he could also read information projected onto the inside lens of his goggles, and mark the exact location where the patient needed to be operated on.
In another scenario, the parents of a nine-year-old boy from North India were shattered when they found that he had a hole in the heart, and leaving it untreated meant there was a risk of irreversible damage to his lungs and heart.
The parents, after a thorough search, found that Apollo Hospitals in Bengaluru was ready to perform a robot-assisted cardiac surgery — a first of its kind in the country — in the given paediatric age group.
Dr Sathyaki Nambala, the chief surgeon of robotic and minimally-invasive cardiac surgery, was thrilled to complete the surgery in 60 minutes.
Artificial Intelligence (AI), robotics, and the Metaverse are the recent buzzwords leading to medical tourism taking flight in the states of South India.
With the waning of the pandemic, several South Indian states —especially Karnataka, Tamil Nadu, and Telangana — have gained great traction not just amongst international travellers but even people from the northern states for elective surgeries and other treatments.
South First took a deep dive into this area to find out why people are increasingly opting to come to South India for healthcare.
“The lack of access to healthcare — especially surgery — is a huge problem across the globe, and even in India. Patients have to travel for hours to get the specialist surgeon they need. But in South India, we not only have advanced technology but also several qualified surgeons and niche doctors. This is just the beginning. Southern states are going to be very promising in boosting medical tourism,” Rao, who was the first Karnataka to operate on a tumour using the Metaverse, told South First.
Robotics, AI are game changers
Dr Sharan Shivaraj Patil, chairman of SPARSH Hospital, explained to South First that allopathic medical science has really changed the landscape of healthcare in terms of alleviating pain, taking care of diseases, and surgical interventions that have dramatically changed the quality of life.
He said that it has “given us a greater understanding of the human body, and we are now able to do a lot more things that were not possible earlier”.
“If there’s one area where health science has fallen short, it is that we are not as precise as some other sciences are. This is where technologies such as robotics can make a great deal of difference. Robotics has made surgical science more precise,” he explained.
Robots are used extensively today in surgical fields in the Western world. It is being used equally well in India now.
Patil said South India was fortunate to have a lot of medical procedures done locally.
“Medical tourism is all about better science, and is a big motivator to invest in this kind of technology. We need to maintain this tech-based science to attract more people, and this, in turn, will help us build more and adopt more advanced technologies,” he explained.
Patil also said this would benefit the locals as well.
Meanwhile, Dr Vishal Rao, the dean of head and neck oncology at HCG Cancer Care Hospital, has even started a centre for XR (Extended Reality) in Oncology — a joint initiative in collaboration with Microsoft.
He said, “Under this, we will build use cases for various verticals and departments to build pilots for meta tumour boards, paediatric assistance, robotic and remote-assist surgeries, 3D virtual organ visualisation and planning, the entire HCG hospital tour, patient teleport experience in wards, and meta counselling.”
He explained that recently the team used the HoloLens (XR lab) for surgical planning in a residual Oropharyngeal Carcinoma.
“The 3D visualisation in the virtual space helped us understand the tumour extension better and improved our surgical outcome,” he said.
Shorter hospital stays, cheaper cost
The doctors said southern states are preferred for surgeries as the cost of living in these places is lower compared to the rest of India, and also the options of hospitals offering precision surgeries are quite huge.
The ward rates, the cost of hotel rates for patients’ relatives, and even the number of hospital days are reduced due to precision-based surgeries.
While international travellers definitely benefit from this, people from other parts of the country also come to hospitals in places like Bengaluru, Chennai, and Hyderabad for the same reason, explained the doctors.
Riyaz Khan, the CEO of Continental Hospital, told South First that even during the pandemic the hospital got patients from other states and countries as the cost of surgeries and other treatment, compared to states like Maharashtra and Delhi, was 30 percent lower in Hyderabad.
He says, “Patients come for speciality treatments in oncology, orthopaedics, cardiology, spine surgery, gynaecology, etc, from countries including those from West Africa and the Middle East, like Yemen and Oman. Patients come from Saudi Arabia and Bangladesh, too. We also get many patients from West Bengal, Delhi, and even Maharashtra.”
Hyderabad and Bengaluru preferred cities
With Hyderabad being known as the medical hub of India and Bengaluru being known as the city developing the highest number of healthcare apps, doctors say precision surgeries have been appreciated and affordable here.
These two cities are most preferred among southern cities for precision surgeries.
Patil said, “For example, when we do an orthopaedic surgery using a robot, the surgery is far more precise, far better calculated, the tissue damage is much less, and the size of the incision becomes smaller.”
He added: “It does not do any collateral damage, pain levels become much lower because there are no cuts or damaged tissue that are not meant to be treated, and the recovery is much faster.”
Dr Rooma Sinha, a laparoscopic and robotic surgeon with the Apollo Health City in Hyderabad, concurred.
A gynaecologist who perform the first-ever gynaecological robotic surgery for uterine tumours in India, Sinha told South First, “I have performed over 500 robotic surgeries. Several patients would initially not understand how this surgery works. But now, the number of people seeking robotic surgeries for gynaecological surgeries has gone up. There are patients from various states and countries coming to me.”
Boost for medical tourism
A study by PwC India says the highest increase in the use of AI has been witnessed in India during the pandemic.
As per the study, AI adoption was 73 percent in India among healthcare and pharma companies.
“We call the use of these technologies medical miracles. Everything, from 3D-printed bone implants that use stem cells, robotic microsurgery platforms, to digital apps that detect mental health disorders, is now possible in labs,” said Rao.
“Several startups and corporations are working on this at a breakneck pace. The Metaverse is being explored across several streams of medicine. Southern states have been pioneers in making the highest use of all these,” he added.
Unquestionably, robots can be programmed to do exactly what the surgeon wants them to do.
A robot can be very effective in executing the plan made by the doctor.
Planning can be done by the doctor, but the execution can be done by the robot.
It never gets tired and it will do the same procedure with precision consistently, Rao explained.
If one looks at any surgical procedure, like cancer surgeries, urology surgeries, and obstetrics surgeries, whenever the doctors have to go into the abdomen and do some surgeries, normally there is a need to make a larger cut as the doctors’ hands have to go into the body.
Patil explained: “The dexterity of our hands can never be compared to the dexterity of the robot’s because a robot’s hand can turn 360 degrees. It can dissect, it can cut, it can do the least damage to the surrounding tissue, and it can do this with a much smaller hole.”
He added: “When we use robotics for surgery, in most cases we send the patient home the same day. There is less pain, faster recovery, and a better patient experience. This helps patients spend fewer days in the city. Works out economically, too.”
AI-powered diagnostic labs
AI-powered Cath labs across Bengaluru, Hyderabad, Chennai, and Kochi have helped healthcare providers in many ways, like in cardiovascular, oncology, and neuro-intervention procedures.
“There are people from other states who prefer to even get their scans and other checks done from southern cities. The image clarity obtained through several innovative image automations can enable physicians to deliver proactive, pre-emptive, and preventive care for at-risk individuals, improving lives increase clinical confidence,” said the doctors.
For instance, Kumaran Hospitals in Chennai recently added an AI-enabled Cath lab that aids in immediate and highly efficient results.
Union ministry’s encouragement
The Union Health Ministry’s new Heal in India and Heal by India initiative is expected to boost medical tourism even more in the southern states.
A portal being developed under the Ayushman Bharat Digital Mission, expected to be launched on 15 August, is said to have a repository of healthcare professionals and hospital services that can be accessed by not only Indians but also by overseas patients seeking medical help in India.
Interestingly, sources say that the ministry has drawn up plans to augument the infrastructure at 37 hospitals across 17 cities in 12 states, including Karnataka, Kerala, Tamil Nadu, Telangana, and Andhra Pradesh.
The government is said to working on easing medical visa norms for patients and their relatives from some of the identified countries.
Southern states have been known for not just health tourism but as wellness hubs, too.
The Medical Tourism Index 2020-21 puts India at the 10th position out of the 46 countries and 12th in the world’s top 20 wellness-tourism markets.
The report says the cost for medical procedures in India is 65-90 percent less than treatment in the US.
Concerns raised by doctors
One of the concerns doctors raised was that the insurance sector has not yet embraced robotic surgeries.
Patil explained, “We’ll need a big push from the medical fraternity to get them onboard to accept it as a smart intervention. With robotics, the complications are fewer and it will be a gain for the insurance sector.”
He added: “If they are not on board, it slows down the progress because though a lot of people are insured, they will not be able to pay for it from their pocket if the insurance does not cover robotic surgeries, because it will obviously cost them 10-15 percent more than what a conventional surgery would cost.”
The doctors added that at the moment, some of the precision surgeries are expensive, but over time the cost will come down and the skill sets will get better.