Computer Assisted Surgery in India

What is the Cost of Computer Assisted Surgery in India?

The average cost of Computer Assisted Surgery in India ranges around Rs. 4,00,000 ($5,000) to 9,20,000 ($12,000). The cost of surgery depends upon the patient's current situation, the types of surgery requires, specialized surgeons at top hospitals, etc.

Computer Assisted Surgery in India is quite economical as compared to other countries of the world. India provides quality of the medical healthcare facilities at low price which makes India one of the best destinations for low cost computer assisted surgery. One can have a fair idea of having the low cost medical treatments done in India and US.

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	MORE THAN 3,000 INTERNATIONAL PATIENTS OPERATED IN LAST 18 YEARS FOR VARIOUS SPINE AND NEUROSURGERY PROCEDURES
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Overview

Computer Assisted Surgery, abbreviated CAS, uses special probes attached to the body to help your surgeon ensure proper positioning of the joint replacement implants. The probes are detected by an infrared camera that is connected to a computer terminal. The computer terminal constructs an electronic model of the knee or hip based on the information gathered by sensing the position of these probes. The computer can then help guide your surgeon's placement of the knee or hip replacement implants to ensure proper positioning of the joint replacement. Computer-assisted surgery is just developing, and there is certainly not enough known about Computer Assisted Surgery to say that it will lead to better results than standard surgical procedures.

What is Computer Assisted Surgery?

Computer assisted surgery (CAS) represents a surgical concept and set of methods, that use computer technology for pre surgical planning, and for guiding or performing surgical interventions. CAS is also known as computer aided surgery, computer assisted intervention, image guided surgery and surgical navigation, but these terms that are more or less synonyms with CAS. CAS has been a lead in factor for the development of robotic surgery. CAS has been shown to make it less likely that limb alignment problems will occur after knee replacement surgery, but the computer models do not eliminate the chance of these errors being made.

Why do Computer Assisted Surgery?

Factors affecting prosthetic lifespan vary. Ones of the most important factors are the accuracy of prosthesis placement and the restoration of surrounding muscle and ligament balance. This relies mostly on the orthopedic surgeon’s skill and judgment. However, research has shown that incorrect placement still occur even with the most skilled and experienced surgeons. The chance for incorrect prosthetic placement will be greater in a less skilled or inexperienced surgeon. Therefore, computer technology has been introduced to assist in more accurate positioning of prosthetic components, allowing the surgeons to make informed decisions intra-operatively for precise prosthetic placement. With Computer Guided Surgery the surgeon has a greater “vision” during surgery. This supports decision-making and enhances the surgeon’s flexibility to accommodate individual variation in knees of different people. During the surgery, the surgeon has only one chance to make a correct cut. The Computer Guided Surgery System allows the surgeon to precisely judge the accuracy before making a cut. This is of immense value.

What are the Principles of Computer Assisted Surgery?

The principle of Computer assisted surgery is straightforward. A similarity can be drawn between CAS to assist in surgery and GPS to assist with navigating and route planning. Both provide a means for getting to the next stage, i.e. in providing accurate positional information that allows better decision-making Computer assisted surgery is incorporated with software to process images real time. A digital model is produced that serves as a map for each particular procedure. The image is then made available to surgeons to guide them through the operation. Surgical instruments can be incorporated into the map so that instrument position, attitude, and progress can be monitored and controlled to within fractions of millimeters. Surgeons can use this real-time data to correct the procedure intra-operatively. This is much different from non-CAS surgery as the prosthetic evaluation by X-ray is done post-operatively. Should there is any incorrect prosthetic alignment; there is a greater likelihood of requiring a subsequent revision. There is a greater risk for post-operative complication as well as increased costs. In this case of incorrect prosthetic alignment from non-CAS surgery, the patient and physician must accept the surgical outcome, including the likelihood of shortened total knee arthroplasty life span.

How Computer Assisted Surgery Works?

A sensing device is attached to the patient’s for patient data registry and an infrared camera will help receive the data for processing and create each patient’s digital model. The software contains data for various types and sizes of prostheses. The computer will then assist the surgeon with enough information to prepare the best bone bed surface for each particular type of prosthesis, as well as assisting the surgeon in choosing the optimal prosthetic size for the patient. The surgeon will then apply the data from the CAS system to shape a fitted bone bed. CAS also helps in monitoring the accuracy of the bone bed shape preparation. If there is a mal-alignment, timely correction can be performed right away. The latest version of the software enables the surgeon to determine the balance of the surrounding ligament and muscle. The ultimate goal is for optimum functionality and durability over time.

What are the Types of Computer Assisted Surgery?

Computer Assisted surgery is the beginning of a revolution in surgery. It already makes a great difference in high precision surgical domains, but it is also used in standard surgical procedures.

Computer Assisted Neurosurgery : Telemanipulators have been used for the first time in neurosurgery, in the 1980’s. This allowed a greater development in brain microsurgery (compensating surgeon’s physiological tremor by 10-fold), increased accuracy and precision of the intervention. It also opened a new gate to minimally invasive brain surgery, furthermore reducing the risk of post-surgical morbidity by accidentally damaging adjacent centers.

Computer Assisted Oral and Maxillofacial Surgery : Bone segment navigation is the modern surgical approach in Orthognathic surgery (correction of the anomalies of the jaws and skull), in temporal-mandibular joint (TMJ) surgery, or in the reconstruction of the mid-face and orbit.

Computer Assisted ENT Surgery : Robotic surgery fits most of the surgeon’s needs in areas with limited surgical access and requiring high-precision actions, such as middle-ear surgery.

Computer Assisted Orthopedic Surgery (CAOS): The application of robotic surgery is widespread in orthopedics, especially in routine interventions, like total hip replacement. It is also useful in pre-planning and guiding the correct anatomical position of displaced bone fragments in fractures, allowing a good fixation by osteosynthesis. Early CAOS systems include the HipNav, OrthoPilot, and CI systems.

Computer Assisted Visceral Surgery : With the advent of Computer assisted surgery, great progresses have been made in general surgery towards minimal invasive approaches. Laparoscopy in abdominal and gynecologic surgery is one of the beneficiaries, allowing surgical robots to perform routine operations, like cholecystectomies, or even hysterectomies. In cardiac surgery, shared control systems can perform mitral valve replacement or ventricular pacing by small thoracotomy. In urology, surgical robots contributed in laparoscopic approaches for Pyeloplasty or Nephrectomy or prostatic interventions.

C omputer Assisted Radiosurgery: Radiosurgery is also incorporating advanced robotic systems. Cyber Knife is such a system that has a lightweight linear accelerator mounted on the robotic arm. It is guided towards tumor processes, using the skeletal structures as a reference system (Stereotactic Radiosurgery System). During the procedure, real time X-ray is used to accurately position the device before delivering radiation beam.

What are the Common Procedures of Computer Assisted Surgery?

Computer Assisted Knee Replacement: Perfection with consistency is difficult in knee replacement surgery without computer image guided surgery. This is proven beyond doubt and in all corners of the world. The knee joint is a connecting link between the hip joint and the ankle joint. The angle between the thigh bone and the leg bone has to be so accurately aligned that the hip, the knee and the ankle fall exactly in a straight line. These angles are dependant on the way the worn surfaces are reshaped by the surgeon. Even a millimeter of deviation can lead to significant alignment changes and early failure. In this procedure, a computer is installed with medical surgery software and is connected to a surgical infra-red camera and specialized surgical instruments. This knee surgery computer system is used by the surgeon to perform the knee replacement. This allows for more precision and accuracy during the surgery. The system acts as a GPS for the human body helping the surgeon by providing real-time navigation information and enhanced 3-D visualization. The International Society for Computer Assisted Orthopaedic Surgery is a non-profit organization working towards the growth of this field.

Computer Assisted Hip Resurfacing: In hip resurfacing it is important that both femoral head and acetabular side implants have been put with proper size, orientation and position. In conventional hip resurfacing these have been put with help of non – CAS instruments which may not be accurate and precise. This inaccuracy and imperfection would lead to early failure and complications like fracture of neck femur. With the help of CAS both components can be placed with precision and accuracy. This improves the result and longevity of the procedure. In hip resurfacing it is important that both femoral head and acetabular side implants have been put with proper size, orientation and position. In conventional hip resurfacing these have been put with help of non - CAS instruments which may not be accurate and precise. This inaccuracy and imperfection would lead to early failure and complications like fracture of neck femur. Computer-assisted Hip Joint Surgery enables surgeons to operate with smaller incisions and greater precision. The Computer-assisted hip resurfacing helps surgeons align the patient's bones and replacement implants with a degree of accuracy not possible with the naked eye, which happens to be the important benefits of this procedure.

Computer Assisted Neurosurgery: Now days many of the procedures pertaining to neurosurgery are being taken up with techniques using Computer Assisted Surgeries. Computer-assisted navigational techniques enable physicians to perform neurosurgical procedures with incredible accuracy leading to better outcomes for patients. Computer-assisted techniques are used to treat patients with many neurological disorders, including tumors, chronic pain, epilepsy and movement disorders. Interactive image-guided neurosurgery is the process whereby normal images such as x-rays, computed tomographic scans, and magnetic resonance imaging of the brain and spine can be coupled with directional devices to allow the surgeon to find a precise spot in the brain or spine, and utilize the most efficient route to that spot. Few of the benefits of having neurological procedures performed using Computer Assisted include; the patient no longer needs to wear a metal device around the head during surgery. This advanced technology provides “near-real-time” images of the brain or spine during surgery, allows the neurosurgeon to be more precise and make smaller incisions and continue to deliver the most effective care at the site of the surgery.

Computer Assisted Spine Surgery: Computer navigation uses intra-operative fluoroscopic imaging to reconstruct spinal anatomy in reference to fixed sensor arrays. After the initial imaging sequence, the infra red sensor arrays help to guide the surgeon regarding 3 dimensional anatomies through which screw trajectories can be planned without damage to vital structures. This system is scientifically proven to improve accuracy rates of screw placement and allows placement of screws in challenging situations like the cervical spine pedicles and in scoliosis. Another advantage of this system is that it reduces the exposure time to rays from the fluoroscopy unit. CAS starts with the premise of a much better visualization of the operative field, thus allowing a more accurate preoperative diagnostic and a well defined surgical planning, by using surgical planning in a preoperative virtual environment. This way, the surgeon can easily assess most of the surgical difficulties and risks and have a clear idea about how to optimize the surgical approach and decrease surgical morbidity. During the operation, the computer guidance improves the geometrical accuracy of the surgical gestures and also reduces the redundancy of the surgeon’s acts. This significantly improves ergonomic in the operating theatre, decreases the risk of surgical errors and reduces the operating time.

What are the Benefits of Computer Assisted Surgery?

The main benefit of Computer Assisted Surgery is improved accuracy and higher precision in diagnosing, planning, and execution of surgeries. Its ability to provide simulations means that the surgeon can rehearse on the model before operating on the patient. For this reason, it can also be used in training other physicians on complex and difficult surgical procedures. There are disadvantages as well, however. Obtaining the system and training surgeons in its use entails costs, and installing and updating the software takes time. Thus the benefits of having a Computer Assisted Surgery are as under:

• Cutting bone and positioning the components with an accuracy up to 0.5 degrees and 0.5 mm
• Constant guidance, monitoring and confirmation during surgery -ability to judge the bony cuts before actually making the cuts
• Ability to verify the cut to very precise accuracy
• Increased implant longevity.
• Three Dimensional planning
• No radiation during surgery.
• Range of motion analysis to achieve maximum function
• Correct implant selection and placement.
• Decreased incidence of pulmonary embolism in knee surgery

Why prefer India for Computer Assisted Surgery?

Computer Assisted Surgery in India is attracting a large number of international medical tourists to Indian hospitals and medical centres. These hospitals are competent to handle various computer assisted intervention, image guided surgery and surgical navigation. Computer assisted surgery in India is properly planned and performed by expert surgeons.

This rush to India is due to the fact that India gives the same services with the same quality as delivered in the premier hospitals in USA, Canada and UK with the same latest medical procedure. The associated price & cost of these surgeries in India is pretty less than what the patients incur in these developed nations.

In India, many surgeons have this expertise and experience. Most of them have massive experience in handling cases from simple to complex, both in India and abroad. Most of the surgeons and doctors are qualified abroad and known for the best results in the medical arena. In India, the various computer assisted surgeries are available at hospitals in the following cities with latest amenities and state-of-art-facilities.

Some of the common countries from which patients travel to India for surgery are:

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