The Role of Physics and Engineering in Surgery

INTRODUCTION

The Lancet commission on global surgery estimates that about one third of global disease burden is surgical. Many innovations like discovery of anesthesia, antisepsis helped surgeries take a giant leap in offering dramatic increase in number and usefulness of the procedures in curing surgical conditions. The most recent such innovation is the minimally invasive surgeries. It is now left to Physics and Engineering to open up new Horizons.

THE PAIN

Unlike the earlier innovations the market penetration of the minimally invasive surgeries was not very significant. The poor one third of the World receives less than 6% of the total number of surgeries that are carried out. With surgical procedures we are able to deal only with the macroscopic disease and that too we know only about the anatomy and very little about the physiological problems associated with surgical disease. In other words at surgery we do not know about the functioning or nonfunctioning areas of the organs just by looking at it. It is difficult to macroscopically know the extent of the microscopic disease especially the cancers.

THE TRENDS

The current trend everywhere is towards minimally invasive procedures and remote controlled procedures. With the former the recovery is rapid and pain is less so that patients can get back to productive work soon. With the remote controls the problem of lack of surgical workforce in rural and remote areas could be solved.

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THE ROLE OF PHYSICS AND ENGINEERING

The following are some of the dramatic examples that made significant contributions:

  1. X rays made bones visible and helped with many innovative minimally invasive procedure like percutaneous removal of stones and all the minimally invasive orthopedic procedures.
  2. Telescopes made looking inside in a minimally invasive manner and lead to many innovative surgical procedures possible. The laparoscopic and endoscopic surgeries are extensions of these.
  3. Robotics and remote controlled arms helped with 3 -D visualizations and remote controlled surgical procedures. These can make up for lack of availability of expert surgical workforce in remote and rural areas.
  4. Florescence guided surgeries helped with identification of disease that are not visible to naked eye or the ordinary camera.
  5. Ablation surgeries. These surgical procedures helped in destroying tissue with heat or microwave etc without the traditional means of cutting and removing the diseased portion giving minimally invasive methods. Lasers can help with breaking of stones, etc.

THE WAY FORWARD

  1. Near infrared fluorescence. This has been used effectively with fluorescent dyes for cancer surgeries.
  2. Endoscopic nano-robotic surgeries. These could make surgeries really minimally invasive.
  3. Transmission through internet could take lots of medical treatment to remote and rural areas. Sensors can transmit the signals and blood tests and other test are possible from a central large facility. Surgeries could be performed from central locations in remote areas.
  4. Treatment cost could be lowered for instance by gas less laparoscopic surgeries, doing away with telescopes for laparoscopic surgeries.
  5. 3-D printing technology has great potential for surgeries and implants.
Gnanaraj-64 Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. During the past year, he has been training surgeons in innovative gas less single incision laparoscopic surgeries.

Image: A laparoscopic robotic surgery machine. Patient-side cart of the da Vinci surgical system. Author: Nimur. Date: 3 June 2006. Access the original Image information here: https://commons.wikimedia.org/wiki/File:Laproscopic_Surgery_Robot.jpg

References (click to show/hide)

  1. http://www.lancetglobalsurgery.org/
  2. https://en.wikipedia.org/wiki/Percutaneous_nephrolithotomy
  3. http://www.davincisurgery.com/
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245053/
  5. http://journals.sagepub.com/doi/full/10.1258/td.2008.060115

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