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Remember the quintessential Bollywood operation theatre? Masked figures surround the patient (mostly off camera) amid a spooky glow and tense music, with the surgeon intoning words like ‘‘scissors’’ and ‘‘forceps’’. Recalling one of those solemn moments, actor Ashok Kumar, in an interview, had once clarified that the ‘‘patient’’ was a pillow.

The scene inside one of the operation theatres of Escorts Heart Institute and Research Centre in Delhi, where a bypass surgery was being conducted last Wednesday, could not have been more different.

Sure, the doctors were alert, but they were also very relaxed. Most stood around, looking at the monitor, where the insides of the patient’s heart could be seen magnified several hundredfold. Others lounged about, talking, joking and even attending to the occasional phone call. Some even laughingly offered to take off their masks for the benefit of our photographer.

Part of the ease was probably because this was a ‘‘robotic surgery’’, perhaps the ultimate in high precision, minimally invasive procedures. Still, the man in the hot seat, in this case the ‘‘console’’, from where he conducted the operation, Dr Yugal Kumar Mishra, managed to keep a running commentary going for our benefit.

But isn’t a beating-heart bypass surgery a very complicated procedure that requires extreme concentration? ‘‘This is simple,’’ Mishra laughs, rubbing his hands in excitement. He could talk. After all, this was perhaps the 351st — or was it the 352nd — robotic surgery presided over by the man who took over as the director of cardiovascular surgery after Dr Naresh Trehan. The patient, he explains, will be up and about in around 10 days, compared to the 30-45 days in an ordinary surgery, where the chest has to be completely opened.

That is the beauty of the ‘‘minimally invasive’’ procedures, where instead of incisions of five inches and more, all the work is done by instruments inserted into the body through three or four half-inch cuts. Result: The trauma is reduced to a fraction, the recovery is faster and even the pain is much less.

‘‘Only three places in India have the facility of robotic surgery,’’ one of his teammates proudly says, ‘‘including the All India Institute of Medical Sciences’’. Part of the reason is that the medical community is divided over the necessity of the

Rs 12-crore instrument. Most agree that a robotic surgery is only essential for really complicated and time consuming processes, like removal of a cancerous prostrate gland, in which a 10-hour procedure can be reduced to two hours.

The essential instrument in minimally invasive surgery is the scope, explains Dr Arun Prasad, Senior Consultant of Apollo Surgical Centre’s Minimal Access Surgery. Also known as endoscope, this is a thin rod-like instrument, mounted with a tiny video camera and a powerful light, which functions like a telescope, projecting the magnified interior view of the body onto monitors.

The rest of the instruments include the usual scissors, forceps and the rest, about 2 to 3 mm in size, also mounted on thin rods, which are inserted into body through hollow rods called canulae, which hold the half-inch incisions open.

The technique is not new. Dr Jacobeus performed the first visual examination of abdominal organs in 1910. But in 1987, Phillip Mouret performed the first such operation in France.

Laparoscopic cholescystectomy, or removal of the gall bladder through laparoscopy (translated from Greek, laparoscopy means examination of the abdomen through a scope) became popular only in the 1980s. And in the 1990s, in view of its advantages, surgeons started using the minimal invasive procedure for the spine and other parts of the body. In India, Tempton Udwalia of Mumbai’s Hinduja Hospital is accepted a pioneer by most.

Currently, this process is applied for diagnostic and therapeutic processes in the brain, heart, organs in the chest and abdominal cavity, reproductive and genito-urinary organs and even some orthopaedic problems. ‘‘It can be used for removal of fluids, tumours and cysts, glands like prostrate and thyroid, organs like gall bladder, appendix, spleen, kidneys, uterus and even spinal discs,’’ says Prasad.

‘‘When applied to the brain and spinal cord though,’’ points out Dr D V Rajkumar, Consultant Neurosurgeon, Wockhardt hospitals, Bangalore, ‘‘the word we use is not minimally invasive. It is minimal access.’’

The reason being that the idea is not only to invade in minimum, but access only the portion required. In conventional open surgeries of the spine, where, for example, a damaged disc has to be removed, not only a 6 to 7 inch incision is required, it is also necessary to dislodge the muscle mass that holds the spine in place and strengthens it. ‘‘Thereafter, even though the wounds heal, the area remains weakened and may in future give rise to further complications,’’ he says.

In fact, so small can be in the incision and so reduced the trauma, some operations can be done under local anesthesia, says Dr Vikas Gupte, Consultant Neurosurgeon, Wockhardt Mumbai, who is one of the few doctors in India to have conducted ‘‘slipped disc surgery in the awake state’’. In some cases, such incisions can be closed by a single stitch, says Dr Gupte, a specialist in Percutaneous Endoscopic Cervical/Lumbar Discectomy. Similar is the case of the brain.

‘‘Years ago, a tumour removal involved opening up a considerable portion of the skull,’’ says Dr Rajendra Prasad, Senior Consultant, Neurosurgery and Spinal Surgery, Apollo, whose father too, had been a neurosurgeon. ‘‘Today, we can zero-in on the exact area and operate using the smallest possible incision, using only local anesthesia in some cases.’’

The process is hugely aided by ‘‘neuronavigation’’, where a CT scan is reformatted into a three-dimensional image to give the exact location of the affected area. ‘‘This is so specific that we could extract a bullet from the head of a man and in another case, accommodated the wishes of a 10-yr-old girl, who insisted on not shaving her head fully,’’ adds Prasad.

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